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: morphine / codeine / chocolate flavor attending: chief complaint: fever, hypotension major surgical or invasive procedure: 1. debridement of the left foot 2. hemodialysis 3. central venous catheter history of present illness: this is a 78 yo m with a past medical history significant for esrd, dm2, pvd, cad s/p cabg who presents to the ed after having fevers to 105, 1 episode of nonbloody/nonbilious emesis, and tachycardia upon arriving to hd today but was able to complete dialysis for a total of -3.8l. he was given a dose of vanco there. when ems arrived, he was found also to be hypotensive to the 70's, but he was still mentating clearly. . in the ed, he was volume resuscitated with 3+l, had a right subclavian cvl placed, and after blood cx were drawn, received doses of levo/flagyl. a ua was sent which was unremarkable. a cxr was unremarkable for infiltrate, except for known left sided pleural effusion, which, if anything, looked improved, and some right sided basal atelectasis. because he did not really respond to ivf resuscitation, he was started on levophed. labs were notable for for a lactate of 1.9, a vbg of 7.43/50/59 and a leukocytosis to 17,000 with a left shift. after going for abdominal ct, he will be sent to the for further management of sepsis. . on arrival to the , the patient admitted that he has been feeling unwell for the past several weeks. he describes having vague abdominal discomfort as if "he was going to come down with something" but it never blossoms into anything. he notes that he has become more constipated in the last 2-3 weeks and his stool has become darker. he has also had a productive cough on a daily basis bringing up grey/yellow/white sputum. he denies fevers, nausea/vomiting until today. he denies sore throat, headache, ear pain, or dysuria. he also denies sick contacts or recent travel. he has a new ulcer on his right foot, and is s/p left 3rd toe amputation secondary to gangrene but was just at the podiatric surgeon the day pta and had both areas debrided. he has not noted any change in the area of his avf. past medical history: esrd type 2 diabetes mellitus (') pvd, s/p r -dp bpg neuropathy htn hypercholesterolemia chronic anemia hiatal hernia cad, s/p cabg lima-lad, svg rca, om lower back pain s/p surgery for ?disk herniation - admission for herpes encephalitis and zoster s/p av graft thrombectomy recent l 3rd toe amputation social history: the patient lives at manor. his wife is his primary caregiver and hcp. is an ex-smoker (approx 40yrs), quit 22 years ago. used to drink socially, no longer drinks. family history: the patient's mother died of mi at 89, father had dm, ?heart dz died at 79, paternal gm had dm. he reports other family members with heart disease. physical exam: vitals: t 100.1 p 92 bp 133/69 r 17 sat 100% nc 3l general: pale 78 yo m, appears fatigued, but nad heent: at/nc, eomi, perrl (reduced visual acuity in right eye), anicteric sclerae. mm dry, op clear. fair dentition. neck: no cervical, supraclavicular lad. supple. jvp at 7cm chest: rrr harsh iii/vi sem heard best at the lusb radiating to the neck as well as across the precordium. no rubs. lungs: decrease bs at the left base, minimal dry rales at the right base. otherwise, no rhonchi/wheezes. abd: soft, nt/nd +bs, no hsm ext: feet are wrapped in dressings s/p debridement yesterday, legs are warm until distal leg/proximal ankle, then slightly cooler. venous stasis changes present to mid-calf. trace to 1+ radial pulses. neuro: a&ox3. reduced visual acuity in r eye. reduced sensation to lt at ankles. cn iii-xii in tact. skin: warm, no jaundice, no unusual lesions or rashes. access: rsc, slightly tender to palpation. pertinent results: admission labs: 12:33pm wbc-17.3*# rbc-4.56* hgb-14.9 hct-45.4 mcv-100* mch-32.7* mchc-32.8 rdw-16.2* 12:33pm neuts-84* bands-0 lymphs-10* monos-6 eos-0 basos-0 atyps-0 metas-0 myelos-0 12:33pm glucose-128* urea n-17 creat-2.6*# sodium-137 potassium-4.9 chloride-91* total co2-34* anion gap-17 12:33pm calcium-9.7 phosphate-2.9# magnesium-2.1 03:10pm alt(sgpt)-9 ast(sgot)-17 ck(cpk)-20* alk phos-79 tot bili-0.4 03:10pm lipase-55 03:10pm pt-13.3* ptt-32.6 inr(pt)-1.2* 12:48pm lactate-1.9 03:10pm ck-mb-2 ctropnt-0.30* . imaging: ct abdomen w/contrast 3:31 pm 1. small simple (by hounsfield units) left pleural effusion with enhancing pleural rim is suggestive of empyema. would suggest diagnostic thoracentesis for evaluation. adjacent area of consolidation is most reflective of atelectasis, however there is not vivid enhancement, so early underlying pneumonia cannot be completely excluded. 2. cholelithiasis with a slightly distended gallbladder lumen measuring up to 4 cm. no inflammatory changes to suggest acute cholecystitis. please correlate with clinical exam. if indicated, further evaluation with hida scan recommended. 3. hypoattenuating splenic lesion, too small to definitively characterize but likely benign. 4. extensive atherosclerotic disease. 5. diverticulosis without evidence of acute diverticulitis. . chest (portable ap) 12:39 pm cardiac silhouette, mediastinal and hilar contours are unchanged. the patient is status post cabg. interval placement of a right-sided subclavian approach central venous line with its tip projecting at the mid svc. linear opacity in the right lung base likely represent disc-like atelectasis. mild interval improvement in the left pleural effusion. no pneumothorax. . ecg study date of 12:26:36 pm sinus tachycardia. left axis deviation with left anterior fascicular block. poor r wave progression - probably old anteroseptal myocardial infarction. compared to tracing of there is no significant diagnostic change. . echo study date of the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 5-10 mmhg. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is top normal/borderline dilated. regional left ventricular wall motion is normal. overall left ventricular systolic function is low normal (lvef 50-55%). there is no ventricular septal defect. the right ventricular cavity is mildly dilated. right ventricular systolic function is borderline normal. the aortic root is mildly dilated at the sinus level. the aortic arch is mildly dilated. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. no masses or vegetations are seen on the aortic valve. there is mild aortic valve stenosis (area 1.2-1.9cm2). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. compared with the report of the prior study (images unavailable for review) of , mild as is now detected and the severity of mitral and tricuspid regurgitation has slightly increased. if clinically indicated a tee may better excluded a small valvular vegetation. . foot ap,lat & obl bilat port 9:01 pm prelim 1. focal area of lucency along the lateral aspect of the fifth proximal phalanx of the left foot, new compared with _____ previous study. in the correct clinical context, the possibility of osteomyelitis must be considered. 2. post-operative changes status post amputation of the left third digit. 3. chronic post-operative changes of the right foot. 4. neuropathic changes of the feet bilaterally. brief hospital course: a/p: 78 yo m with esrd, dm2, cad admittied from hd with fevers, leukocytosis, and hypotension 1. septic shock, resolved: with fevers, leukocytosis, hypotension and tachycardia and and the most likely source of infection being possible introduction of bacteria by recent debridement of foot ulcers and surgical site (pt has h/o mrsa and enterococcus from wound) v. parapneumonic effusion/empyema on ct, the patient had met criteria for septic. peak lactate was 1.9, now 0.6. he was given total of 4l ns (3.8 taken off at hd) and required levophed only overnight from day of admission. he now is maintaining sbps in 120s. blood cxs from grew coag + staph sensitive to vanc. pt is on vanc per hd protocol, day 4. podiatry evaluated the patient, took wound cultures of his feet bilaterally. x-rays of bilateral feet were taken; prelimin read suggests possible osteomyelitis along the lateral aspect of the fifth proximal phalanx of the left foot. podiatry (attending dr. is following. pt also had a thoracentesis that removed 60 cc of serosanguinous fluid. this has been a chronic effusion, seen on prior cxrs for months. pleural fluid analysis reveals exudative process with predominance of lymphs. this is currently not thought to be the source of infection given chronicity and initial fluid analysis. abdominal ct revealed no source of infection. he was subsequently transferred to the floor without further incidents. 2. mrsa bacteremia. an extensive evaluation by infectious diseases concluded that the most likely source of mrsa bacteremia was from the foot. it was recommended to continue the patient on vancomycin for a total of 6 weeks. 3. osteomyelitis. inconclusive evidence on plain film, and unable to obtain a mri given dialysis. supportive test of esr of 121 consistent with osteomyelitis. as in #2, id recommended 6 weeks of antibiotic therapy. 4. complex pleural effusion. pulmonary was consulted and this was thought to be from septic embolus. a ct scan was recommended in 3 months time to assess for resolution. 5. esrd: patient is being followed by renal and his usual dialysis days are tues, thurs, sat. his medications were dosed for his level of kidney function and he was maintained on vancomycin regimen with dialysis. 6. cardiac: the patient has a history of 3vd cad s/p cabg. he was maintained on his aspirin, metoprolol, and statin therapy. 7. type 2 diabetes mellitus. the patient was maintained on sliding scale insulin during hospitalization. on discharge, his glipizide was resumed. 8. hypercholesterolemia. due to the risks of combination therapy for dialysis patients, his gemfibrozil and niacin were held. he was maintained on his simvastatin and ezetimibe. a follow up fasting lipid panel is recommended in weeks. 9. peripheral artery disease / diabetic foot ulcer. podiatry and vascular surgery consults monitored the foot wounds and recommended close outpatient follow up on discharge. deep tissue cultures demonstrated pseudomonas and staph colonization vs. osteomyelitis.patient transfered to dr. service for left tma done on . pod#1 no overnight events. continued on vancomycin but cipro and flagyl discontinued. deit advanced. physical thearphy consulted for nonweight bearing left foot for toatal of four weeks.vanco will be continued for a total of 6 weeks which will becompleted on . cbc,elec and renal function should be monitered while recieving antibitocs. he will followup with dr. in clinic@ that time. (see appointments). /07 pod# continued to progress. d/c to home with services. medications on admission: 1.ezetimibe 10 mg qd, 2.glipizide 1.25 mg 3.gemfibrozil 600 mg 4.pantoprazole 40 mg qd, 5.simvastatin 40 mg qd 6.hep sc 5000mg 7.renagel 1600mg tid prior to meals, 8.colace 100mg qd, 9.flonase 0.05 each nose qd 10. niacin 500mg qd discharge medications: 1. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) intravenous hd protocol (hd protochol). disp:*qs * refills:*2* 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. fluticasone 50 mcg/actuation aerosol, spray sig: two (2) spray nasal daily (daily). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 8. collagenase 250 unit/g ointment sig: one (1) appl topical (2 times a day). disp:*1 tube* refills:*2* 9. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day). 10. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 11. sorbitol 70 % solution sig: 30-150 mls miscellaneous (2 times a day) as needed for constipation. 12. sevelamer 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 13. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po bid (2 times a day). 14. vancomycin 1000 mg iv during dialysis on to be dosed during dialysis on 15. outpatient lab work cbc, bun/cr, electrolytes,weekly @ hd 16. outpatient lab work random vanco level 2x/week 17. insulin glargine 100 unit/ml solution sig: seven (7) units subcutaneous at bedtime. 18. humalog 100 unit/ml solution sig: as directed subcutaneous three times a day. discharge disposition: home with service facility: vna discharge diagnosis: 1. septic shock, resolved 2. mrsa bacteremia 3. osteomyelitis of the foot 4. esrd on hemodialysis 5. type 2 diabetes mellitus with complications 6. peripheral arterial disease history of right bypass 7. coronary artery disease history of cabg 8. hiatal hernia 9. hyperlipidemia discharge condition: improving, without fever or hypotension discharge instructions: 1. continue with hemodialysis as scheduled. you will receive a total of 6 weeks of vancomycin given during hemodialysis. 2. continue with wound care of your feet through home nursing visits. have cbc w diff and electrolytes and bun creatinine weekly while on antibiotics call resultts to clinic att:dr. followup instructions: 1. make an appointment with podiatry within 1 week 2. make an appointment with vascular surgery within 1 week 3. you have an appointment scheduled with infectious diseases, dr. , on 9:00a. procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart hemodialysis thoracentesis amputation through foot excisional debridement of wound, infection, or burn diagnoses: anemia in chronic kidney disease end stage renal disease pure hypercholesterolemia unspecified pleural effusion unspecified septicemia severe sepsis aortocoronary bypass status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease ulcer of other part of foot alkalosis diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled septic shock pressure ulcer, heel dehydration disruption of external operation (surgical) wound acute osteomyelitis, ankle and foot other bone involvement in diseases classified elsewhere 

Answer: The patient is high likely exposed to