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: no known allergies / adverse drug reactions attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization peritoneal dialysis history of present illness: 77-year-old male with a history of known 3 vessel disease, diabetes, atrial fibrillation, morbid obesity and end stage renal disease on peritoneal dialysis with bilateral above the knee amputations who was transferred to for eval for cabg but now not felt to be surgical candidate and now being treated medically. for complete admission history, please see admission note and icu transfer note. briefly, "lhc on showed completely occluded vessels except for lad, with 70% stenosis, so underwent no pci. pre-lhc sbps were 120s-140s. post-lhc, carvedilol 6.25 mg was increased to 12.5 mg , and the patient had an extra liter taken off during pd. recent antibiotic changes included ceftriaxone converted to ciprofloxacin and vancomycin for treatment of morangella and mssa growing from the right stump. overnight, sbp were noted to be in the 70s, and the patient was somnolent. he was given 1 liter of ns- sbp improved to 90s and mental status improved. sbp then dropped in 70s again, and he received another 1.5 liters of ns. lactate 2.4. stable hematocrit post lhc. no pulsus paradoxus on exam. picc and 22 gauge in hand. patient was then transferred from to the micu for hypotension. he originally presented to osh in with nstemi and was treated medically at that time as he was being treated for a mrsa bacteremia from his right aka stump infection. since then he has had multiple episodes of anginal cp occuring at rest, relived by nitro. states his last occurence of cp was 4 days ago. currently, denies cp/sob/n/v, lightheadeness, palpitations. states he feels at his baseline. on arrival to the micu, he had a temp of 96.1, hr 71, bp 115/63, rr 18 and o2 sats of 95% on 3l nc. he was well oriented and mentating well. his bp is intermittently in the 80s, and is very difficult to get an accurate pressure given his habitus and prior ue av fistulas." patient was on norepinephrine from to and weaned off without any incident. patient was thought to have peritonitis although no cultures positive (and not enough wbc in peritoneal fluid) but question possible yeast infection. patient is currently on fluconazole/meropenem/vancomycin; vanc now held due to high level. on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. past medical history: 1. cardiac risk factors: diabetes, dyslipidemia, hypertension 2. cardiac history: nstemi (medical management) -cabg: none -percutaneous coronary interventions: none -pacing/icd: none 3. other past medical history: 1. cad s/p cath at osh, nstemi -treated medically 2. chronic atrial fibrillation on coumadin 3. hypertension 4. hyperlipidemia 5. type ii dm-insulin dependent 6. hypothyroidism 7. peripheral arterial disease s/p b/l aka 8. right aka stump wound infection 9. esrd-peritoneal dialysis 10.gout 11. morbid obesity social history: currently has a girlfriend. worked many jobs, including starting a computer business in the 70s and doing a well business. originally from and enjoys country and western music. lives with daughter, has been a for past wks -tobacco history: denies -etoh: denies -illicit drugs: denies family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; mother died in her 60s of cva. physical exam: admission exam: vs: t 97.8 bp 107/63 hr 80 rr 16 o2 sat 96% ra general: obese, ashen appearing man in nad heent: ncat. sclera anicteric. eomi. mmm, dentures. neck: plethoric, unable to asses jvp 2/2 habitus. cardiac: distant heart sounds, rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. pmi not palpable. lungs: cta anteriorly. no increased wob. no wheezes, rales, rhonchi. abdomen: obese, ntnd. pd catheter is c/d/i. nabs. extremities: lue with hd fistula, + thrill, + bruit. aka of the bles. rle with healing surgical scar with surrounding erythema and scant pus. scar is ttp. lle with well healed surgical scar, no erythema or pus. right: carotid 2+ left: carotid 2+ neuro: a/ox3, cn ii-xii grossly intact. non focal. discharge: general: alert, oriented x 3 heent: dry mouth neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, distended/ obese, bowel sounds present, no organomegaly. ext: warm, well perfused, 2+ pulses, b/l av fistulas, no clubbing, cyanosis or edema pertinent results: admission labs: 07:30pm blood wbc-15.8* rbc-3.48* hgb-10.7* hct-33.5* mcv-96 mch-30.8 mchc-32.0 rdw-19.2* plt ct-379 11:41am blood esr-118* 07:30pm blood pt-14.8* ptt-30.9 inr(pt)-1.3* 07:30pm blood glucose-147* urean-68* creat-6.4* na-132* k-4.6 cl-92* hco3-29 angap-16 07:30pm blood alt-42* ast-32 ld(ldh)-224 alkphos-242* amylase-56 totbili-0.2 10:22pm blood ck-mb-5 ctropnt-0.74* 04:15am blood ck-mb-6 11:41am blood calcium-8.8 phos-5.9* mg-2.3 07:30pm blood %hba1c-6.0* eag-126* 11:41am blood crp-101.8* 04:15am blood tsh-14* discharge: 03:38am blood wbc-16.7* rbc-2.83* hgb-8.7* hct-27.4* mcv-97 mch-30.8 mchc-31.9 rdw-19.0* plt ct-296 05:53am blood neuts-74.4* lymphs-9.7* monos-9.8 eos-5.6* baso-0.5 10:33am blood pt-34.6* ptt-45.4* inr(pt)-3.5* 03:38am blood glucose-61* urean-48* creat-5.6* na-129* k-4.1 cl-92* hco3-28 angap-13 05:02am blood alt-32 ast-44* alkphos-165* totbili-0.1 03:38am blood calcium-8.7 phos-6.0* mg-2.3 03:04am ascites wbc-139* rbc-0 polys-32* lymphs-4* monos-61* eos-1* mesothe-2* 04:02am other body fluid wbc-64* rbc-4* polys-20* lymphs-17* monos-60* mesothe-3* cultures: . 2:48 pm swab source: r aka wound site. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. wound culture (final ): staphylococcus, coagulase negative. rare growth. . 5:58 pm fluid,other peritoneal dialysate. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (final ): no growth. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (preliminary): anaerobic culture (final ): no growth. . 1:08 pm dialysis fluid peritoneal dialysate fluid. **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. . 4:46 pm catheter tip-iv source: a line. **final report ** wound culture (final ): no significant growth. . 4:02 am peritoneal fluid gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (preliminary): no growth. anaerobic culture (preliminary): no growth. . blood cultures: no growth x5 and pending x2 on . right stump mri history: mrsa wound infection of the right aka stump. technique: mr of the right thigh without iv contrast per protocol. comparison: no prior. findings: due to low gfr of 9, the study was protocoled as non-contrast infection protocol. patient is status post above-knee amputation. there is relatively normal t1 signal in the remaining femur thus excluding osteomyelitis. there is only trace edema at the distal tip of the femoral bony stump. there is muscle fatty atrophy. there is moderate edema in the surrounding muscles and subcutaneous tissues which can be consistent with myositis and cellulitis. given lack of contrast, assessment for rim-enhancing collection is suboptimal; however, no large collection is seen. impression: 1. no mr evidence of osteomyelitis. 2. moderate edema in the muscls and soft tissues concerning for myositis and cellulitis in the appropriate clinical setting. given the lack of iv contrast, assessment for rim-enhancing collection is suboptimal; however, no large collection is seen. 3. fatty muscle atrophy. . cardiac catheterization: comments: 1. difficult access due to severe tortuosity and calcification in aorto-iliac system. upsized to 7 fr long sheath, and used xb guide for left coronary artery and 0.75 for rca pictures. 2. severe occlusive 3 vessel coronary artery disease. occlusive rca and lcx/om1 disease with heavily calcified lesions. focal eccentric tandem lad lesions > 80%. timi 2 flow throughout. 3. not attractive for percutaneous coronary intervention, but lad lesions could be revascularized using rotational atherectomy and stenting if fails aggressive medical therapy. final diagnosis: 1. three vessel diffuse, occlusive, calcified coronary artery disease. 2. focal eccentric tandem lad lesions could be treated by rotational atherectomy and stenting if aggressive medical management fails. 3. continue beta-blocker therapy. increase imdur to 30 mgs daily. 4. central blood pressure is 20 mm hg higher than the patient's non-invasive cuff pressure. . ct pelvis with contrast: history: 77-year-old man presenting with sepsis. please evaluate for a right hip/pelvis superficial abscess. comparison: no prior cross-sectional imaging is available. technique: continuous axial images from the pelvic brim to the mid thighs were obtained after the hand injection of approximately 85 cc of iv optiray contrast. coronal and sagittal reformatted images were also available for review. findings: evaluation is limited by poor contrast opacification. the aorta, common iliac arteries, and their branches are heavily calcified. the prostate is normal in size. the bladder is nearly collapsed. the seminal vesicles are symmetric and unremarkable. there is scrotal edema. there is a small amount of simple fluid in the pelvis with a peritoneal dialysis catheter in place. the visualized gastrointestinal tract is unremarkable. no abscess is identified in the soft tissues of either thigh. there is marked muscle atrophy of the lower extremities and pelvis and soft tissue edema. degenerative disease of the lower lumbar spine is noted. no lytic or blastic lesions are seen. impression: 1. no right soft tissue abscess is identified in the hip/pelvis region. 2. marked arterial calcification involving all visualized large and small arteries in the pelvis. . liver/ gallbladder ultrasound: indication: 77-year-old male with diabetes, end-stage renal disease, on peritoneal dialysis, now presents with hypotension and leukocytosis concerning for sepsis. question cholecystitis. comparison: ct pelvis dated . findings: the liver is coarsened and nodular, compatible with cirrhosis. no discrete lesion is identified. a moderate sized abdominal ascites is present. the gallbladder demonstrates diffuse mural edema, without tense distention, likely related to systemic disease. the main portal vein demonstrates normal hepatopetal flow. there is no biliary dilatation. the common duct is 4 mm. the spleen also appears coarsened and measures 12 cm, containing multiple gamna-gandy bodies. the right kidney appears grossly abnormal and echogenic, consistent with end-stage renal disease. the left kidney is not well visualized. impression: 1. cirrhosis without discernible focal lesion. 2. abdominal ascites and mild splenomegaly, consistent with portal hypertension. 3. diffuse gallbladder wall edema without distention, likely related to third spacing in the setting of background liver disease. brief hospital course: 77-year-old male with a history of known 3 vessel disease, diabetes, atrial fibrillation, morbid obesity and end stage renal disease on peritoneal dialysis with bilateral above the knee amputations who was transferred to for eval for cabg but now not felt to be surgical candidate. after discussion with the patient and his family, he was transitioned to hospice care. # coronary artery disease: the patient's was transferred from osh for cabg evaluation. the patient was admitted to cardiac surgery, but was deemed to not be a surgical candidate. he was then transferred to cardiology for pci and ongoing management of his cad and angina. he was placed on a heparin gtt and his coumadin was held in preparation for cardiac cath. on he underwent cath, which showed diffuse coronary disease detailed above including 70% occluded lad. no inervention was undertaken and no stents were placed due to conern that any compliactions would be catastrophic. his carvedilol was uptitrated and he was started on low dose lisinopril for medical optimization of his severe cad. the day after cath, the patient became hypotensive, was noted to be mentating poorly and was transferred to the micu where he was on norepinephrine for 3 days to maintain his pressures. the etiology of the low blood pressure was not entirely clear. our intial differential included hypovolemia secondary to dialysis, cardiogenic shock in the setting of known severe cad, and sepsis. an arterial line was placed for continuous blood pressure monitoring. patient required iv pressor support for continued hypotension. a tte was performed and did not show any evidence of new wall motion abnormalities, changes in ef, or new valvular disease. the patient did receive multiple liters of crystalloid for blood pressure support. peritoneal dialysis was held for low blood pressures. the only potential source for sepsis was suspected bacterial pertonitis secondary to his dialysis. the cell count was consistent with bacterial peritonitis but the culture was negative, most likely because of pre-antibiotic treatment. skin sources were considered and he was treated with vancomycin. the coverage was initially expanded to include cefepime and fluconazole to cover for bacterial peritonitis but was transitioned to meropenem and vanc. the patient's blood pressure improved and on his last icu day the pressor support was discontinued. on the floor patient was initially continued on iv antibiotics and peritoneal dialysis, with holding of his carvedilol and ace inhibitor due to continued pressures in the 100 systolic range. however, after prolonged discussion with the patient, his family, and the paliative care team, the patient was transitioned to hospice care per his wishes. all medications except for pain meds were discontinued, and patient opted to stop dialysis as well. # aka stump infection, complicated by sepsis: pt was started on vanc/ceftriaxone for presumed mrsa stump infection given osh history of mrsa bacteremia. id was consulted and recommended mri to evaluate for osteo given his elevated crp/esr. mri showed no e/o osteomyelitis, but was concerning for myositis or soft tissue infection of the r stump. his ceftriaxone was d/c'ed and he was chagned to cipro based on culture and sensitivity data from osh. all antibiotics were eventually discontinued when patient was transitioned to hospice care. . # atrial fibrillation, with chads ii of 4. on warfarin with goal inr : rate well controlled. we discontinued his medications when goals of care shifted to comfort. # esrd: patient was continued on peritoneal dialysis with the help of the renal team. at the end of the hospital stay, patient stopped peritoneal dialysis per his wishes. # goals of care: on , a discussion was had with the patient regarding his code status when he began to have more episodes of ventricular bigeminy. patient stated that given his serious coronary artery disease and his continued pain and the fact that he looked forward to only being pain free during the days, the he wished to focus on comfort measures and attempt to go to a hospice at home. all antibiotics were discontinued, as was peritoneal dialysis and patient transitioned to morphine elixir 5 mg q4hr with prn 5-10mg q2hr. this was changed to dilaudid on day of discharge given concern the morphine metabolites were accumulating due to patient's renal failure and contributing to excessive sedation with little effect on pain. patient was also started on a fentanyl patch. family was briefed and in agreement with the plan to attempt home hospice. medications on admission: ceftazidime 1 g iv q24h vancomycin 1000 mg iv q 12h 1. lidocaine 5% patch 1 ptch td daily back pain 2. aspirin ec 81 mg po daily 3. mirtazapine 15 mg po/ng hs 4. acetaminophen 325-650 mg po/ng q6h: 5. miconazole powder 2% 1 appl tp tid groin 6. ascorbic acid 250 mg po/ng daily 7. magnesium oxide 400 mg po/ng 8. aluminum-magnesium hydrox.-simethicone 15-30 ml po/ng 9. metoclopramide 10 mg iv q6h:prn nausea 10. carvedilol 3.125 mg po/ng 11. mupirocin nasal ointment 2% 1 appl nu duration: 5 days 12 oxacalcitriol 60 mg po hs 13. nitroglycerin sl 0.4 mg sl prn chest pain 15. nephrocaps 1 cap po hs 16. oxetanone 5 mg po/ng q6h:prn pain 17. docusate sodium 100 mg po bid 18. oxycodone sr (oxycontin) 20 mg po q12h 19. pantoprazole 40 mg po q24h 20. simvastatin 10 mg po/ng daily 21. insulin sc sliding scale 22. vancomycin 1000 mg iv q 12h @ 1819 23. sevelamer carbonate 2400 mg po tid w/meals 24. levothyroxine sodium 224 mcg po/ng daily 25. lantus 15u qhs 26. warfarin 1.5mg po qday discharge medications: 1. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*0* 2. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. disp:*30 tablet, sublingual(s)* refills:*0* 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*30 capsule(s)* refills:*0* 4. fentanyl 25 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). disp:*10 patch 72 hr(s)* refills:*0* 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*0* 6. dilaudid 2 mg tablet sig: 1-3 tablets po q2hr as needed for pain. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: hospice discharge diagnosis: primary: coronary artery disease, atrial fibrillation, end stage renal disease secondary: hypothyroidism, morbid obesity discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: bedbound. discharge instructions: dear mr. , it was our pleasure to care for you at . you were admitted for chest pain and evaluation of a possible cardiac surgery. it was determined that given your concurrent infections and renal failure that you were not a good surgical candidate. likewise, on cardiac catheterization, it was clear that you had serious disease in your coronary arteries that was not amenable to intervention. we attempted to optimize your medications to provide you the best benefit possible, although your blood pressure was low and we could not start some of the medications. it also became clear that you were in continued pain, specifically in your back, and when we talked with you it was clear that your goals were to be made comfortable. we then shifted our focus away from giving you antibiotics and dialysis, to controlling your pain and making you as comfortable as possible. we made the following changes to your medications: 1. place fentanyl patch 25mg to be changed every 72 hours 2. please take dilaudid 2-6mg every two hours as needed for pain. please hold for excessive sedation 3. take senna 1 tablet twice a day 4. take colace 1 tablet twice a day 5. take mirtazapine 15mg at bedtime as needed for sleep. followup instructions: the home hospice team will be managing your pain. please address further concerns with the hospice physician. procedure: coronary arteriography using two catheters left heart cardiac catheterization arterial catheterization peritoneal dialysis central venous catheter placement with guidance diagnoses: anemia in chronic kidney disease end stage renal disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere renal dialysis status subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified cirrhosis of liver without mention of alcohol unspecified septicemia hyposmolality and/or hyponatremia severe sepsis unspecified acquired hypothyroidism gout, unspecified atrial fibrillation peripheral vascular disease, unspecified systolic heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia long-term (current) use of insulin septic shock morbid obesity long-term (current) use of anticoagulants methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site encounter for palliative care diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled infection (chronic) of amputation stump myoclonus candidiasis of skin and nails pressure ulcer, stage ii spontaneous bacterial peritonitis amputation of limb(s) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation pressure ulcer, hip 

Answer: The patient is high likely exposed to