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: lisinopril / kefzol / sulfa (sulfonamide antibiotics) / shellfish derived attending: chief complaint: lethargy, diffuse body pain, inability to ambulate major surgical or invasive procedure: intubation arthrocentesis of right wrist, left wrist, and right hallux central line placement cvvh, dialysis catheter placement arterial line placement (axillary) egd times 2 attempted ct-guided emoblization history of present illness: 66f with known rv and lv diastolic dysfunction, ckd with baseline cr 1.5, af not on coumadin who presents with lethargy and pain throughout her body, limiting her ability to walk, which started approx. 4 days prior to admission. history is limited as patient is poor historian and somnolent at times. she denies any recent travel, new medications except prednisone which was started approx. 5 days ago for r great toe pain. in the ed, initial vs: 97.9 102 83/59 18 99% ra. exam notable for bruising over extremities and flank, non focal neuro exam, dre with guaiac positive brown stool. cxr showed no evidence of pna. ua showed trace leuks, 2 wbc, no bacteria or nitrites. she was given 3l ns with no change in bp but lactate improved from 2.2 to 1.2. sbp was in the 40s at one point and a r ij cvl was placed under sterile conditions. she was started on norepinephrine with minimal improvement in bp despite maxing out. dopamine was added and she was extremely responsive to dopamine, with improvement in maps immediately. she was given hydrocortisone 100mg iv x1 for stress dose steroids. she was also given zosyn and vancomycin iv empirically given bandemia and overall instability. ct abdomen/pelvis without po or iv contrast showed no clear cause for leukocytosis. on arrival to the micu, she complains of pain throughout her body. review of systems: (+) per hpi, otherwise negative. past medical history: -dyslipidemia -hypertension -severe diastolic dysfunction of left ventricle -severe pulmonary hypertension -right ventricular contractile dysfunction and dilatation with recurrent right heart failure, requiring ultrafiltration in past -severe tricuspid regurgitation -atrial fibrillation not on coumadin gi bleed -patent foramen ovale (closed ) -ulcerative colitis -angioectasia of entire colon (last colonoscopy ) -chronic renal insufficiency (baseline 1.5) -history of etoh abuse with current etoh use -chronic massive leg edema with recurrent leg cellulitis -ventral hernia status post repair -gout -appendicitis, medically managed social history: - four children - tobacco history: denies - etoh: 1 drinks per week, denies history of withdrawal symptoms. prior heavy etoh use. - illicit drugs: denies family history: -father with mi at age 68 -mother breast cancer at age 52 physical exam: admission physical exam: general: alert, oriented to person, place, time, anxious at times heent: sclera anicteric, mm dry, oropharynx clear, eomi, perrl neck: supple, jvp elevated to earlobe, 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-distended, bowel sounds present, no organomegaly, diffusely tender gu: foley with clear yellow urine ext: slightly cool, 1+ pulses, no clubbing, cyanosis or edema skin: ecchymoses noted over bue, l posterior and r lateral flank neuro: moving all extremities, non-focal discharge physical exam: expired pertinent results: admission labs: 08:35pm blood wbc-33.1*# rbc-4.10* hgb-12.3 hct-38.6 mcv-94 mch-30.1 mchc-32.0 rdw-16.5* plt ct-125* 08:35pm blood neuts-89* bands-4 lymphs-0 monos-6 eos-0 baso-0 atyps-1* metas-0 myelos-0 08:35pm blood hypochr-normal anisocy-occasional poiklo-2+ macrocy-occasional microcy-normal polychr-occasional burr-2+ 08:35pm blood pt-13.5* ptt-26.7 inr(pt)-1.3* 08:35pm blood glucose-123* urean-133* creat-4.3*# na-128* k-4.4 cl-93* hco3-21* angap-18 08:35pm blood alt-11 ast-36 alkphos-196* totbili-0.8 08:35pm blood lipase-11 08:35pm blood ctropnt-<0.01 08:35pm blood albumin-3.3* calcium-9.6 phos-3.3 mg-1.9 08:35pm blood tsh-4.1 08:38pm blood lactate-2.2* imaging: ct abdomen without intravenous contrast: there is a persistent rounded right lower lobe opacity with an unchanged moderate right pleural effusion. minimal left dependent atelectasis is identified, and there is also a trace left pleural effusion. there is unchanged cardiomegaly and a pfo occlusion device partially visualized. complete evaluation of the abdominal and pelvic viscera is limited secondary to the non-contrast technique. the liver appears homogeneous without focal lesion. no intra- or extra-hepatic biliary ductal dilatation is identified. redemonstrated is are multiple large gallstones measuring up to 1.9 cm. the spleen, pancreas, and adrenal glands appear normal. kidneys are small though symmetric and without focal lesion or hydronephrosis. there is diffuse mesenteric edema with a small amount of perihepatic ascites. edema within the subcutaneous tissues is also extensive. findings are likely secondary to aggressive fluid resuscitation given clinical history of hypotension requiring pressors. the bowel overall appears within normal limits without evidence of obstruction. no focal loop of bowel demonstrates surrounding inflammation or wall thickening. the appendix is retrocecal and remains dilated measuring up to 9 mm, similar to prior (2:35). there is a proximal appendicolith. no periappendiceal fluid collection is identified to suggest developing abscess. there is no extraluminal air. the colon appears normal without signs of inflammation or obstruction. the abdominal aorta remains moderately calcified though non-aneurysmal. ct pelvis without intravenous contrast: a foley catheter and a small amount of air are visualized within the bladder, which is otherwise unremarkable. the uterus and adnexa appear unremarkable. there is trace pelvic free fluid. osseous structures: no bone destructive lesion or acute fracture is identified. loss of vertebral body height at multiple lumbar levels appears unchanged from prior examination. impression: 1. diffuse mesenteric edema, trace ascites, bilateral pleural effusions and diffuse subcutaneous edema, findings consistent with third spacing secondary to recent volume resuscitation. 2. persistently dilated fluid-filled appendix with surrounding fat stranding suggestive of chronic appendicitis in this patient who was treated medically for appendicitis in . appendiceal mucocele remains a possibility given the duration of ct abnormalities. 3. cholelithiasis. if there is concern for cholecystitis, this would be better evaluated by ultrasound. 4. unchanged moderate-sized right pleural effusion with overlying rounded right lower lobe consolidation/rounded atelectasis. bilateral lower extremity doppler ultrasound: examination was limited secondary to patient's body habitus and inability to cooperate. the left calf veins could not be seen. scale and doppler son of the bilateral common femoral, superficial femoral, and popliteal veins were obtained. the right posterior tibial and peroneal veins were also examined. there is normal flow and compressibility. edema is seen within the subcutaneous tissues of the bilateral calves. impression: no evidence of dvt in the lower extremities. left calf veins not visualized. wrist imaging: there are again seen severe degenerative changes of the first cmc joint with subluxation. this is similar to the prior study. no acute fractures are identified. there is generalized demineralization. there are also degenerative changes with joint space narrowing in the radiocarpal joint. there is prominent soft tissue swelling seen about the wrist, particularly along the dorsum of the hand. impresssion: no fracture. if there is concern for joint fluid or intra-articular abnormalities, mri could be performed. ruq u/s findings: redemonstrated are large only rim calcified non-shadowing gallstones in the gallbladder without evidence of gallbladder distention. the wall measures 4 mm. the appearance of the gallbladder is unchanged from . there is no pericholecystic fluid and sign is negative. there is no intra- or extra-hepatic biliary dilation with the common bile duct measuring 5 mm. there are no focal hepatic lesions. the portal vein is patent with normal hepatopetal flow. there is no ascites. the partially visualized pancreas is normal. impression: rim-calcified non-shadowing gallstones in the gallbladder, but no evidence of pericholecystic fluid or gallbladder distention. the appearance of the gallbladder is unchanged from . negative sign. tte the left atrium is mildly dilated. no left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). a septal occluder device is seen across the interatrial septum. there is a bidirectional color flow doppler shunt across the interatrial septum at rest.. the estimated right atrial pressure is 5-10 mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: right ventricular cavity enlargement with free wall hypokinesis. well seated atrial septal occluder with small bidirectional shunt. pulmonary artery hypertension. mild mitral regurgitation. compared with the prior study (images reviewed) of , the severity of mitral regurgitation is reduced and a small bidirectional atrial septal shunt is now suggested. the estimated pa systolic pressure is now higher (may be related to better image quality during the current study rather than a true change). microbiology: 8:35 pm blood culture **final report ** blood culture, routine (final ): staph aureus coag +. final sensitivities. 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. consultations with id are recommended for all blood cultures positive for staphylococcus aureus, yeast or other fungi. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s aerobic bottle gram stain (final ): gram positive cocci in clusters. reported to and read back by , rn at 10:45am. anaerobic bottle gram stain (final ): gram positive cocci in clusters. 9:35 pm urine **final report ** urine culture (final ): <10,000 organisms/ml. respiratory viral culture (final ): no respiratory viruses isolated. culture screened for adenovirus, influenza a & b, parainfluenza type 1,2 & 3, and respiratory syncytial virus.. detection of viruses other than those listed above will only be performed on specific request. please call virology at within 1 week if additional testing is needed. respiratory viral antigen screen (final ): negative for respiratory viral antigen. specimen screened for: adeno, parainfluenza 1, 2, 3, influenza a, b, and rsv by immunofluorescence. refer to respiratory viral culture for further information. 7:48 am joint fluid source: right toe, left wrist, right wrist **final report ** gram stain (final ): reported to and read back by @ 0955, . 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram positive cocci. in pairs and singly. fluid culture (final ): staph aureus coag +. heavy growth. 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. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s 2:48 pm blood culture source: line-rij. **final report ** blood culture, routine (final ): staph aureus coag +. sensitivities performed on culture # 350-1007f . consultations with id are recommended for all blood cultures positive for staphylococcus aureus, yeast or other fungi. anaerobic bottle gram stain (final ): gram positive cocci in clusters. 2:16 pm sputum source: endotracheal. **final report ** gram stain (final ): pmns and <10 epithelial cells/100x field. 1+ (<1 per 1000x field): budding yeast with pseudohyphae. respiratory culture (final ): commensal respiratory flora absent. yeast. sparse growth. staph aureus coag +. rare growth. 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. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s 3:47 am blood culture source: line-aline. **final report ** blood culture, routine (final ): no growth. brief hospital course: 66 year old feamle with severe diastolic lv dysfunction and rv dysfunction, ckd, severe tr who presented with worsening lethargy and diffuse body pain, found to be hypotensive, with bandemia and worsening renal function with erythematous and edematous wrists (bilaterally) and right hallux, found to have polyarticular septic joints with staphylococcus aureus causing overwhelming sepsis. the patient arrived to the micu on pressors. on morning of admission, the patient's blood cultures returned positive with gram positive with gpcs. the patient was started broadly on antibiotics with vancomycin and zosyn upon admission. rheumatology was consulted on the morning of admission and tapped the patient's left wrist. gram stain returned showing large amount of gram positive cocci. plastic surgery became involved and tapped the patient's right wrist and right hallux which also showed evidence of septic joint with large amount of gram positive cocci. id was consulted in light of the patient's high-grade bacteremia. tte that was done did not show evidence of vegetations. in light of her polyarticular septic joints, the patient was planned to be taken to the or for joint wash-outs. however, as the patient was being wheeled for her procedures, she developed large-volume hematemesis and was subsequently intbuated for airway protection and concern for aspiration. hepatology performed a bedside egd and found bleeding, within the esophagus, stomach. the patient received 4 units of blood and 1 unit of ffp in the setting of her acute gi bleed. interventional radiology attempted embolization in light of the acute gi bleed, but the procedure was aborted secondary to dissection. the patient acutely stabilized. a repeat egd on showed evidence of ischemic gastritis with large ulcerations present in the esophagus, stomach, and duodenal bulb. the patient had epinephrine injections and one clip placed where a vessel was visible. of note, because of the , the patient was started on cvvh as well. because of the patient's clinical instability and three-pressor requirement, plastic surgery performed serial bedside taps of the involved joints at the bedside. joint aspiration fluid and blood cultures returned with staph aureus, and antibiotics were narrowed to vancomcyin from vancomycin and zosyn. through the patient's admission, the patient's family was updated regarding her clinical status. in light of her clinical course, a family meeting was held during which the decision was made to transition the patient to comfort measures only on , . cvvh and pressors were discontinued. the patient was not extubated, but ventilator settings were modified in a way to mimic atmospheric conditions. the patient expired peacefully with her family surrounding her at the bedside on . medications on admission: per omr, patient unable to confirm all albuterol sulfate - 90 mcg hfa aerosol inhaler - 2 inhalations(s) po four times a day as needed clonazepam - (prescribed by other provider) - 0.5 mg tablet - 1 tablet(s) by mouth at bedtime epinephrine - 0.3 mg/0.3 ml (1:1,000) pen injector - inject once for allergic emergencies fluocinonide-emollient - 0.05 % cream - apply twice a day folic acid - 1 mg tablet - 1 tablet(s) by mouth daily gabapentin - 300 mg capsule - 1 capsule(s) by mouth once a day hs gummie - - vitamin for adults daily hydroxyzine hcl - 10 mg tablet - 1 tablet(s) by mouth four times a day as needed for itching levothyroxine - 125 mcg tablet - 1 tablet(s) by mouth daily mesalamine - 0.375 gram capsule, ext release 24 hr - 2 capsule(s) by mouth once a day on hold metoprolol tartrate - 25 mg tablet - 1 tablet(s) by mouth twice a day omeprazole - 20 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth once a day before breakfast oxycodone - 5 mg tablet - 1 tablet(s) by mouth four times a day as needed for pain potassium chloride - 20 meq tablet, er particles/crystals - 1 tablet(s) by mouth daily prednisone - 20 mg tablet - 2 tablet(s) by mouth once a day spironolactone - (prescribed by other provider) - 25 mg tablet - 1 tablet(s) by mouth once a day torsemide - 20 mg tablet - two tablet(s) by mouth twice a day acetaminophen - (prescribed by other provider) - 500 mg tablet - 2 tablet(s) by mouth three times a day aspirin - (discharge med) - 81 mg tablet, chewable - 1 tablet(s) by mouth daily (daily) cyanocobalamin (vitamin b-12) - 1,000 mcg tablet - 1 tablet(s) by mouth once a day ferrous sulfate - 325 mg (65 mg iron) tablet - 1 tablet(s) by mouth twice a day loperamide - (prescribed by other provider) - 2 mg tablet - 1 tablet(s) by mouth three times a day as needed for diarrhea magnesium - (prescribed by other provider) - 200 mg tablet - 2 tablet(s) by mouth twice a day discharge medications: expired discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine insertion of endotracheal tube hemodialysis venous catheterization for renal dialysis arterial catheterization endoscopic control of gastric or duodenal bleeding arteriography of other intra-abdominal arteries arthrocentesis arthrocentesis arthrocentesis diagnoses: thrombocytopenia, unspecified hypocalcemia coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified acute posthemorrhagic anemia hyposmolality and/or hyponatremia severe sepsis unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation other chronic pulmonary heart diseases depressive disorder, not elsewhere classified alcohol abuse, unspecified hypopotassemia chronic kidney disease, unspecified other and unspecified hyperlipidemia acute respiratory failure cardiogenic shock septic shock chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction do not resuscitate status ulcerative colitis, unspecified diseases of tricuspid valve leukocytosis, unspecified chronic diastolic heart failure unspecified disorder of liver ulcer of esophagus without bleeding critical illness myopathy methicillin resistant staphylococcus aureus septicemia mixed acid-base balance disorder arterial embolism and thrombosis of upper extremity personal history of surgery to heart and great vessels, presenting hazards to health other appendicitis septic arterial embolism other specified gastritis, with hemorrhage duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation, without mention of obstruction pyogenic arthritis, multiple sites 

Answer: The patient is high likely exposed to