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: sulfa (sulfonamide antibiotics) attending: chief complaint: chest pain major surgical or invasive procedure: none history of present illness: 77-y.o. male with pmh of afib, hld, dmii, peripheral neuropathy, gastroparesis, esrd on hd recently admitted to -- for cholecystitis requiring pressors. this hospitalization lasted roughly one week, and his cholecystitis was treated conservatively with unasyn and he was discharged yesterday. . today roughly 15 hours into his stay at the rehab facility he was hypotensive to the 70's with a hr of 130's in afib. in tha setting he developed chest pain. he was taken to where he was given one dose of iv lopressor and cardioverted with return of blood pressures and resolution of his chest pain. he was given a dose of unasyn, and full dose asa. . felt he was too complicated to stay there and sent him to . . in our ed initial vitals were 98.7 64 98/52 14 100% 4l nc. labs were notable for a low glucose of 66, a troponin of .44, and a lacatate of 1.4. repeat ua looked contaminated. a heparin drip was started for nstemi, cardiology saw the ekgs, which looked like demand ischemia in the setting of rapid afib. here ekg is sinus. he was seen by transplant surgery who felt his cholecystitis was not appropriate for operative intervention. . last dialyzed yesterday. . on arrival to the floor the patient is hemodynamicly stable, comfortable with no abdominal or chest pain. past medical history: pmh - plasma cell dyscrasia igm - not myeloma but ? wadenstrom's variant s/p 11 months melphalan and prednisone (last chemo ) -renal cell carcinoma s/p left nephrectomy in -dm2 -peripheral neuropathy -gastroparesis -esrd on hd m/w/f -htn -cad with mild, nonobstructive lesions seen on cath in -hyperlipidemia -bph -gout -hypothyroidism -gerd . past surgical history: -rcc s/p l nephrectomy in -s/p splenectomy for itp -hernia repair social history: the patient lived at home with his son, , up until this most recent hospitalization at the osh when he was started on hd and discharged to rehab. he has 2 sons and 1 daughter. remains independent in his adls and this is his first admission to a rehab facility. he is widowed and his wife passed away in . he is a retired clerical worker for the irs. he currently denies smoking, but does have a history of cigar smoking for approximately 40 years. he reports no etoh or illicit drug history. he mobilises independently and has an et of 20yrds. family history: his father died of lung cancer at 81 and his mother died at 90. his brother died of lung cancer. uncles with dm2, gout. physical exam: admission physical exam: t:97.8 p:63 bp:133/71 rr:18 o2sat:99% 2l general: awake, alert, nad heent: ncat, eomi, perrla, anicteric heart: distant rrr, nmrg, dialysis in place, clean lungs: ctab, normal excursion, no respiratory distress back: no vertebral tenderness, no cvat abdomen: distended, palpable gas, soft, nt, extremities: wwp, no cce, no tenderness, 2+ b radial/dp/pt skin: no rashes/lesions/ulcers pyschiatric: normal judgment/insight, normal memory, normal mood/affect pertinent results: micro pericardial fluid enterococcus raffinosus. final sensitivities. vancomycin sensitivity testing confirmed by etest. speciation and susceptibility testing of daptomycin and linezolid requested by dr. . daptomycin sensitivity testing performed by etest. sensitive to daptomycin @ 1 mcg/ml. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus raffinosus | ampicillin------------ 16 r daptomycin------------ s linezolid------------- 2 s penicillin g---------- 16 r vancomycin------------ <=0.5 s . echo the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the estimated pulmonary artery systolic pressure is normal. there is a large pericardial effusion. there are no echocardiographic signs of tamponade. . impression: large circumferential pericardial effusion without signs of tamponade. mild symmetric left ventricular hypertrophy with normal global and regional biventricular systolic function. . compared with the report of the prior study (images unavailable for review) of , pericardial effusion is probably larger. the other findings appear similar. short-term clinical and echocardiographic follow-up for stability of pericardial effusion is recommended. findings discussed with dr. at 1440 hours on the day of the study. . cardiac cath 1. successful pericardiocentesis via left sternal approach using echo guidance and micropuncture technique. 2. successful removal of 260cc of straw colored fluid sent for routine labs and cytology. final diagnosis: 1. large pericardial effusion without tamponade. 2. successful pericardiocentsis with drainage of 260cc of straw colored fluid. . gall bladder ultrasound 1. no intra- or extra-hepatic biliary duct dilatation. 2. gallbladder filled with sludge. 3. patent main portal vein. 4. small amount of perihepatic ascites and a small right pleural effusion as seen on ct. 5. fluid collection medial to the gallbladder is similar to finding seen on recent ct. . ct chest with contrast 1. interval decrease in fluid component of pericardial effusion with new gas within the pericardial effusion, likely secondary to drain. the pericardial drain lies along the inferior margin of the right ventricle and traverses the pleural space. 2. new left upper quadrant and left flank fluid collections, the upper quadrant fluid collection is high in attenuation suggesting hemorrhage and is separate from the larger right upper quadrant hemorrhagic collection which is unchanged. the left flank collection is most likely ascites. 3. slight interval worsening in appearance of acute cholecystitis. 4. bilateral moderately large pleural effusions with associated compressive atelectasis, with slight interval enlargement since . . trans esophageal echo no thrombus/mass is seen in the body of the left atrium. no atrial septal defect is seen by 2d or color doppler. left ventricular systolic function is hyperdynamic (ef>75%). there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. no masses or vegetations are seen on the aortic valve. no aortic valve abscess is seen. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. no mitral regurgitation is seen. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. . impression: no valvular vegetations or abcess seen. . admission results 11:58pm ck(cpk)-17* 11:58pm ck-mb-5 ctropnt-0.46* 04:30pm urine hours-random 04:30pm urine uhold-hold 04:30pm urine color-yellow appear-clear sp -1.029 04:30pm urine blood-lg nitrite-neg protein-500 glucose-100 ketone-50 bilirubin-neg urobilngn-neg ph-8.0 leuk-neg 04:30pm urine rbc-* wbc- bacteria-occ yeast-none epi- renal epi-0-2 03:07pm glucose-66* lactate-1.4 02:35pm glucose-66* urea n-20 creat-4.3* sodium-138 potassium-3.6 chloride-103 total co2-23 anion gap-16 02:35pm estgfr-using this 02:35pm alt(sgpt)-8 ast(sgot)-21 ck(cpk)-22* alk phos-102 tot bili-0.4 02:35pm lipase-12 02:35pm ctropnt-0.44* 02:35pm ck-mb-4 02:35pm wbc-6.7 rbc-3.63*# hgb-12.3*# hct-40.0# mcv-110* mch-33.8* mchc-30.7* rdw-23.7* 02:35pm neuts-63.8 lymphs-30.6 monos-4.5 eos-0.8 basos-0.3 02:35pm plt smr-very low plt count-75* 02:35pm pt-13.5* ptt-34.0 inr(pt)-1.2* . pending results pericardial fluid cytology pending abdominal fluid cytology pending final culture data from blood, urine, pericardial fluid and abdominal fluid not all finalized brief hospital course: hospital course this is a 77 year old gentleman with complex medical issues, including recent hospitalization for medically managed cholecystitis, presenting with chest pain, found to be in atrial fibrillation with rapid ventricular response, and admitted to medicine. patient was transferred to the ccu for monitoring after pericardiocentesis (no tamponade physiology on echo, procedure performed for diagnostic purposes), who subsequently developed fever and hypotension requiring pressure support with phenylephrine. he ultimately opted for re-focus of medical management to pain management and positioning therapy and was discharged to a rehabilitation facility. . active issues # goals of care: after significant discussion with both his family and his medical providers the patient voiced his desire for re-focus of his medical management to control of his pain, and focus on comfort. these discussions arose in the setting of initiation of permanent dialysis and prolonged and profound physical and emotional decompensation. the patient stated he understood that termination of dialysis would not be compatible with life. the patient was transferred to a rehabilitation facility for management of pain and positioning therapy. . # pericardial effusion: echo performed on admission demonstrated large circumferential pericardial effusion, no evidence of tamponade. since the patient had been having transient episodes of hypotension during hd sessions, and in order to better clarify the etiology of the pericardial fluid, a pericardiocentesis was performed. per report, 260 cc of yellow serous fluid was removed. two hours post-procedure the patient became hypotensive, initially responding to fluid boluses, then requiring neo for pressure support. he was pan-cultured and started on broad antibiotics- vancomycin, cefepime and metronidazole. it was noted that his pericardial fluid changed in nature from serous to cloudy pink thick fluid. he then became febrile, and received more volume resuscitation for likely septic shock. studies were consistent with an exudative effusion and culture grew vancomycin resistant enterococcus. broad spectrum antibiotics were discontinued and daptomycin was started. the source remained unclear, given nothing on imaging to support contiguous spread, and highly unlikely that the procedure introduced the organism. furthermore, blood and urine cultures were negative throughout his hospital stay. a tee was negative for evidence of valvular vegetations. repeat imaging showed the effusion was resolved and the pericardial drain was removed. he was treated with a 5 day course of daptomycin before antibiotics were discontinued on discharge following the wishes of the patient. . # hypotension: the patient was noted to be hypotensive on admission, thought to be secondary to hypovolemia from poor po intake. he also had a recent history of transient hypotension during hemodialysis for which he was started on midodrine. echocardiogram revealed an enlarged pericardial effusion (details above). post-pericardiocentesis the patient was treated with fluid resuscitation and broad antibiotics for presumed septic shock. his blood pressure was supported with phenylephrine. -stim test was negative for adrenal insufficiency. additionally, albumin of 1.7 so likely has poor intravascular osmotic pressure. given his history of recent medically-managed cholecystitis, and known intra-abdominal fluid collections, a ct torso was obtained to investigate potential sources of infection. his hd catheter was removed. surgery was consulted to investigate possible cholecystitis (details below), and ir performed a drainage of an intraabdominal fluid collection, a hematoma. serial blood and urine cultures were negative. his hypotension resolved, and he was weaned off phenylephrine prior to discharge. his midodrine was increased to 5 tid. medical management was discontinued as the patient declined further medical management. . # suspected cholecystitis: the patient had a recent history of medically-managed cholecystitis. on admission he was initially treated with broad spectrum antibiotics, which were then narrowed to levaquin. given our clinical concern for sepsis, a ruq ultrasound was obtained and demonstrated a sludge-filled gallbladder and a small, unchanged fluid collection. ct torso demonstrated stranding, concerning for acute cholecystitis. surgery was consulted and recommended hida scan given low suspicion on physical exam. hida scan was positive and a percutaneous drain was attempted; however, the procedure was complicated by collapse of the gallbladder (inconsistent with acute cholecystitis) and development of a small hematoma. a drain was placed in the abdominal fluid collection, which appeared to be an old hematoma. microbiology was sent and was negative for growth. the drain was removed. . # esrd on hd: the patient normally receives hd on t/th/sat. renal was consulted. hd initially was on hold given new pressor requirement and stable electrolytes. given concern for sepsis, the tunneled dialysis catheter was removed and replaced with a temporary catheter. once stable, the patient received cvvh with phenylephrine for pressure support. culture of the catheter tip revealed no growth. a permanent catheter was not placed as the patient declined further dialysis. . # atrial fibrillation with rapid ventricular response: present on admission. the patient spontaneously cardioverted and remained in sinus for the rest of his admission. the patient has s2 score of 3; however, given his history of intraabdominal hematomas, we elected to continue aspirin 325 for anticoagulation. medical management was discontinued as the patient declined further medical management. . # coronary artery disease: presented with cp in setting of af with rvr, found to have st changes and elevated troponin consistent with demand ischemia. enzymes were cycled and the patient ruled out for an acute myocardial infarction. we continued his aspirin and statin. medical management was discontinued as the patient declined further medical management. . # anemia: no evidence of acute bleeding. likely secondary to chronic inflammation. is on aranesp as outpatient. hct trended down initially on admission and was stable around 20 at the time of discharge. he required a transfusion of 1 unit of prbcs with appropriate response. . # thrombocytopenia: relatively stable. unclear etiology, reportedly has chronic itp, and is status post splenectomy. . # peripheral neuropathy: continued on gabapentin 100 qhs. medical management was discontinued as the patient declined further medical management. . # gastroparesis: continued on metoclopramide 5 mg po qidachs. medical management was discontinued as the patient declined further medical management. . transitional issues - medical management: management of pain and optimization of positional comfort. - pending studies: pericardial and abdominal fluid cytology, finalized culture data - code status: dnr/dni, do not resuscitate. medications on admission: acetaminophen 325 mg tablet po q6h prn mom prn constipation simvastatin 40 mg tablet po daily allopurinol 100 mg tablet sig:po daily pantoprazole 40 mg tablet, delayed release po q24h docusate sodium 100 mg senna 8.6 mg tablet sig: po bid tramadol 50 mg po q12h metoclopramide 10 mg tablet sig: 0.5 tablet po qidachs polyethylene glycol 3350 17 gram/dose daily (daily). midodrine 2.5 mg tablet 6a 11a 4p simethicone 80 mg tablet, qid as needed for gas. gabapentin 100 mg hs b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. levothyroxine 125 mcg daily discharge medications: 1. ativan 0.5 mg tablet sig: 1-2 tablets po every four (4) hours as needed for end of life anxiety: pt is comnfort care. disp:*100 tablet(s)* refills:*0* 2. colace 100 mg capsule sig: one (1) capsule po twice a day. disp:*30 capsule(s)* refills:*0* 3. senna 8.6 mg capsule sig: one (1) capsule po twice a day as needed for constipation. disp:*60 capsule(s)* refills:*0* 4. oxycodone 20 mg/ml concentrate sig: 2.5-5 mg po q2hrs as needed for pain: pt is comfort care. disp:*30 ml* refills:*0* 5. zyprexa zydis 5 mg tablet, rapid dissolve sig: 2.5mg-5mg tablet, rapid dissolves po every six (6) hours as needed for anxiety or agitation. disp:*80 tablet, rapid dissolve(s)* refills:*0* 6. prochlorperazine 25 mg suppository sig: one (1) tablet rectal three times a day as needed for nausea: nausea if unable to take pos. disp:*30 tabs* refills:*0* 7. acetaminophen 500 mg tablet sig: 1-2 tablets po four times a day as needed for fever or pain. 8. gabapentin 100 mg capsule sig: one (1) capsule po at bedtime. disp:*30 capsule(s)* refills:*1* 9. tramadol 50 mg tablet sig: 0.5 tablet po q4h (every 4 hours) as needed for mild pain or neuropathy. disp:*30 tablet(s)* refills:*1* discharge disposition: extended care facility: immaculate nursing/restorative center discharge diagnosis: pericardial effusion cardiac tamponade hypotension enterococcus infected pericardial fluid collection secondary: end stage renal disease peripheral neuropathy hypothyroidism discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: you were initially admitted to the hospital after experiencing several episodes of low blood pressure. during your hospitalization you were noted to have a large fluid collection around your heart which was drained and thought to be infectious. you were treated in the intensive care unit due to the large fluid collection and your low blood pressure. after a discussion with you, your providers and your family you decided you did not want any further medical treatment and wanted to transition care to management of your pain and positional discomfort. you are being discharged to a facility to help with your pain management. we have reconciled your medications to be more concurrent with your goals of care. you also refused dialysis and were able to tell us the consequence of stopping dialysis. we changed your medications as noted in the discharge summary. followup instructions: none procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart hemodialysis venous catheterization for renal dialysis pericardiocentesis percutaneous abdominal drainage arterial catheterization diagnoses: end stage renal disease renal dialysis status anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux unspecified septicemia unspecified acquired hypothyroidism gout, unspecified atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes personal history of tobacco use hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia other malignant lymphomas, unspecified site, extranodal and solid organ sites diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled infection with microorganisms without mention of resistance to multiple drugs streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] do not resuscitate status dehydration acute cholecystitis personal history of malignant neoplasm of kidney acquired absence of kidney personal history of antineoplastic chemotherapy immune thrombocytopenic purpura hemoperitoneum (nontraumatic) gastroparesis other acute and subacute forms of ischemic heart disease, other other acute pericarditis 

Answer: The patient is high likely exposed to