Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: patient recorded as having no known allergies to drugs attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: 64yom s/p op cabgx4 on discharged to rehab on . returned to emergency prior to scheduled dialysis complaining of shortness of breath. while in the emergency room the patient was found to be anemic with a hct of 20. he was admitted to the cardiac surgery icu and transfused with several units of prbc's. additionally a gi bleed workup was initiated including a consult to the gi service. his hct increased appropriately to the packed cells and a source for his bleeding was never identified. his stools remained guiac negative throughout the hospitalization. past medical history: coronary artery disease s/p off pump cabg x4 - bms (driver) to om1 - 95% in-stent thrombosis of om1, tx with 2 des (xience) in the proximal om1 extending to the circumflex with no residual stenosis; distal l cx occluded - per cath report, left main without significant disease - lad with 30-40% plaque after large septal branch - known rca occlusion with collateral flow dyslipidemia esrd on hd m/w/f copd s/p cva l mca s/p cva r mca secondary hyperparathyroidism social history: -tobacco history: + ppd -etoh: none recently, but + history -illicit drugs: pt denies family history: no hx of cad, mi, dm per daughter. physical exam: discharge vs t 98.4 bp 109/61 hr 76sr rr 20 o2sat 93%-ra wt 102.7k gen nad neuro a&ox3, nonfocal exam cv rrr, sternum stable. incision cdi pulm diminished bilat @ bases abdm soft, nt/+bs ext warm, extensive scar tissue bilat. old wound left knee, with some necrotic and fibrinous tissue. small amount of sero-purulent drainage. pertinent results: 11:35pm plt count-281 11:35pm pt-16.1* ptt-28.2 inr(pt)-1.4* 07:50pm glucose-93 urea n-22* creat-3.2*# sodium-148* potassium-3.8 chloride-103 total co2-38* anion gap-11 07:50pm ck(cpk)-54 07:50pm ctropnt-0.12* 07:50pm wbc-9.8 rbc-2.26* hgb-6.9* hct-20.2* mcv-89 mch-30.5 mchc-34.1 rdw-17.2* 08:20am blood wbc-6.6 rbc-3.27* hgb-9.8* hct-29.8* mcv-91 mch-30.1 mchc-33.0 rdw-16.4* plt ct-257 08:20am blood plt ct-257 03:10am blood pt-16.5* ptt-29.7 inr(pt)-1.5* 08:20am blood glucose-82 urean-33* creat-7.5*# na-139 k-4.6 cl-102 hco3-29 angap-13 08:19pm blood hapto-147 10:09am blood pth-1008* 08:20am blood vanco-20.1* 8:00 pm blood culture #2/femoral. **final report ** blood culture, routine (final ): staphylococcus, coagulase negative. final sensitivities. coag neg staph does not require contact precautions, regardless of resistance. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. staphylococcus, coagulase negative. 2nd morphology final sensitivities. coag neg staph does not require contact precautions, regardless of resistance. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. please contact the microbiology laboratory () immediately if sensitivity to clindamycin is required on this patient's isolate. corynebacterium species (diphtheroids). final sensitivities. sensitivity testing performed by sensititre. erythromycin = resistant at >4 mcg/ml. gentamicin = resistant at 16 mcg/ml. penicillin = resistant at 8 mcg/ml. sensitivities: mic expressed in mcg/ml ________________________________________________________ staphylococcus, coagulase negative | staphylococcus, coagulase negative | | corynebacterium species (di | | | clindamycin----------- =>8 r erythromycin---------- =>8 r =>8 r r gentamicin------------ =>16 r 8 i r levofloxacin---------- =>8 r =>8 r oxacillin------------- =>4 r =>4 r penicillin g---------- =>0.5 r =>0.5 r r rifampin-------------- <=0.5 s <=0.5 s tetracycline---------- 2 s <=1 s vancomycin------------ 2 s 2 s <=1 s aerobic bottle gram stain (final ): reported by phone to overland @ 7pm . gram positive cocci in pairs and clusters. anaerobic bottle gram stain (final ): gram positive cocci in clusters. = = = = = = = = = = = ================================================================ , m 64 radiology report chest (pa & lat) study date of 9:34 am , csurg fa6a sched chest (pa & lat) clip # reason: eval for pleural effusions final report history: status post cabg. evaluate pleural effusions. chest, two views. a right ij central line is present, tip over mid svc. no pneumothorax is detected. the patient is status post sternotomy. there is mild prominence of the cardiomediastinal silhouette, unchanged compared with . there is a small left effusion and patchy increased retrocardiac density, essentially unchanged. there is minimal pleural thickening along the right chest wall and blunting of the right costophrenic angle. this is more apparent on today's exam, but not clearly changed. no chf. probable background hyperinflation. impression: small bilateral pleural effusions, unchanged on the left and probably unchanged on the right, though thelatter is better seen on today's examination. dr. approved: 3:53 pm echocardiography report , tte (complete) done at 3:28:57 pm final referring physician information , division of cardiothoracic , status: inpatient dob: age (years): 64 m hgt (in): 70 bp (mm hg): 88/49 wgt (lb): 190 hr (bpm): 73 bsa (m2): 2.04 m2 indication: r/o endocarditis , s/p cabg. icd-9 codes: 424.90, 424.1, 424.0, 424.2 test information date/time: at 15:28 interpret md: , md test type: tte (complete) son: doppler: full doppler and color doppler test location: west echo lab contrast: none tech quality: suboptimal tape #: 2009w004-0:57 machine: vivid echocardiographic measurements results measurements normal range left atrium - long axis dimension: 3.3 cm <= 4.0 cm left atrium - four chamber length: *5.7 cm <= 5.2 cm right atrium - four chamber length: 4.9 cm <= 5.0 cm left ventricle - septal wall thickness: 1.1 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 0.7 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: 5.5 cm <= 5.6 cm left ventricle - ejection fraction: 30% to 35% >= 55% left ventricle - stroke volume: 87 ml/beat left ventricle - cardiac output: 6.38 l/min left ventricle - cardiac index: 3.13 >= 2.0 l/min/m2 aorta - sinus level: *4.2 cm <= 3.6 cm aorta - ascending: *3.7 cm <= 3.4 cm aortic valve - peak velocity: 1.8 m/sec <= 2.0 m/sec aortic valve - lvot vti: 23 aortic valve - lvot diam: 2.2 cm mitral valve - e wave: 0.9 m/sec mitral valve - a wave: 0.9 m/sec mitral valve - e/a ratio: 1.00 mitral valve - e wave deceleration time: 206 ms 140-250 ms tr gradient (+ ra = pasp): 22 mm hg <= 25 mm hg findings this study was compared to the prior study of . left atrium: normal la and ra cavity sizes. left ventricle: normal lv wall thickness and cavity size. moderate regional lv systolic dysfunction. trabeculated lv apex. estimated cardiac index is normal (>=2.5l/min/m2). no resting lvot gradient. right ventricle: normal rv chamber size and free wall motion. aorta: moderately dilated aortic sinus. mildly dilated ascending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. mild mitral annular calcification. of the mitral chordae (normal variant). no resting lvot gradient. mild (1+) mr. tricuspid valve: normal tricuspid valve leaflets with trivial tr. normal pa systolic pressure. pericardium: no pericardial effusion. general comments: suboptimal image quality - poor echo windows. regional left ventricular wall motion: n = normal, h = hypokinetic, a = akinetic, d = dyskinetic conclusions the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. there is moderate regional left ventricular systolic dysfunction with severe hypokinesis of the distal half of the septum and anterior walls and distal inferior wall. the apex is akinetic and mildly aneurysmal. no definite thrombus is identified (cannot exclude due to suboptimal views). . the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , left ventricular systolic function is slightly improved and the estimated pulmonary artery systolic pressure is reduced. clinical implications: based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. electronically signed by , md, interpreting physician 17:54 , m 64 radiology report ct abdomen w/o contrast study date of 10:29 am , csurg csru sched ct chest w/o contrast; ct abdomen w/o contrast; ct pelvis w/o contrast clip # reason: source of bleeding**with and without contrast medical condition: 64 year old man acute anemia reason for this examination: source of bleeding**with and without contrast contraindications for iv contrast: none. final report ct torso without intravenous contrast indication: 64-year-old man with acute anemia, evaluate for source of bleeding. comparison: and . technique: mdct axial images of the torso were obtained without administration of oral or intravenous contrast. coronal and sagittal reformatted images were obtained. ct chest without intravenous contrast: bilateral large pleural effusions are present, the left is slightly increased in size, when compared with the prior study. the density values of the effusions are still low to suggest presence of a hemorrhage. there is adjacent compression atelectasis bilaterally. again note is made of aortic arch calcifications. the ascending aorta measures approximately 4.2 cm maximum dimension. there is a small amount of pericardial fluid. no significant mediastinal, hilar or axillary lymphadenopathy is noted. ct abdomen without intravenous contrast: re-demonstrated is a small diaphragmatic node, measuring now 8 mm in the short axis diameter. low attenuation splenic collection measures 8.9 x 7.1 cm, better imaged than on the prior study. there is cholelithiasis, no evidence of acute cholecystitis. the kidneys are atrophic. non-contrast evaluation of the pancreas, adrenal glands, abdominal loops of large and small bowel is unremarkable. there are dense vascular calcifications. there is no free air and no free fluid in the abdomen. ct pelvis without intravenous contrast: the prostate contains coarse central calcifications. the seminal vesicles, rectum, sigmoid colon are unremarkable. there is no free pelvic fluid, no pathologically enlarged pelvic or inguinal lymph nodes. there is no evidence of retroperitoneal hematoma. soft tissues demonstrates diffuse stranding, compatible with total body edema. bone windows: demonstrate multilevel degenerative changes, there is heterogeneous appearance of the osseous structures, compatible with renal osteodystrophy. remote fracture of the left inferior and superior pubic rami are again seen. impression: 1. 9 cm splenic collection, not entirely characterized in the absence of iv contrast, could represent a subacute hematoma, infected collection cannot be excluded. 2. low attenuation bilateral left greater than right effusions with compression atelectasis. the density values of the effusions argue against hemorrhage, however this could be confirmed with thoracentesis. 3. dilated ascending aorta, extensive vascular and coronary artery calcifications and right common iliac artery aneurysm measuring 18 mm. 4. cholelithiasis, no evidence of acute cholecystitis. the study and the report were reviewed by the staff radiologist. dr. dr. approved: mon 12:48 pm brief hospital course: mr was admitted the the cardiac surgery service and transfused with several units of packed red blood cells. he had a gasteroenterolgy and general surgery consult, they did not feel there was any indication to scope the patient at this time as he was guiac negative and his hematocrit rose predictably and remained stable. the patient also had blood cultures checked, it was positive for cornybacterium and he was started on a 2 week course of vancomycin. all lines were changed. he was also relatively hypotensive with a sbp that frequently was in the 85-95 range despite being off all antihypertensives. he was started on midodrine and his systolic blood pressure rose and remined stable in the 100-110 range. on hospital day 11 it was decided he was stable and ready for transfer to rehabilitation. medications on admission: epo plavix asa simvastatin protonix albuterol atrovent percocet cinacalet discharge medications: 1. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. sevelamer hcl 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 5. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed. 6. ipratropium bromide 0.02 % solution sig: one (1) treatment inhalation q6h (every 6 hours) as needed. 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) treatment inhalation q6h (every 6 hours) as needed. 9. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 10. midodrine 5 mg tablet sig: one (1) tablet po tid (3 times a day). 11. collagenase 250 unit/g ointment sig: one (1) appl topical (2 times a day). 12. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) gm intravenous hd protocol (hd protochol) for 5 days: thru . 13. epoetin alfa 10,000 unit/ml solution sig: 4400 (4400) units injection q hd. discharge disposition: extended care facility: life care center of discharge diagnosis: cad s/p op cabg x4(), esrd(hd), ^cholesterol, secondary hyperparathyroidism, copd, cva, s/p gi bleed discharge condition: stable discharge instructions: keep wounds clean and dry. ok to shower, no bathing or swimming. take all medications as prescribed. call for any fever, redness or drainage from wounds. followup instructions: dr in weeks dr in weeks md procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified hemodialysis transfusion of packed cells diagnoses: end stage renal disease unspecified pleural effusion congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified aortocoronary bypass status other and unspecified hyperlipidemia bacteremia chronic systolic heart failure pressure ulcer, lower back secondary hyperparathyroidism (of renal origin) personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits hemorrhage of gastrointestinal tract, unspecified staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus pressure ulcer, stage ii other diseases of spleen diphtheria, unspecified 

Answer: The patient is high likely exposed to