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: codeine / enalapril attending: chief complaint: cc: fever,hypotension major surgical or invasive procedure: none history of present illness: hpi: 48 yo m w/ h/o esrd s/p failed transplant, h/o hep b/c/?d, h/o paf on coumadin, h/o sarcoid, h/o pulmonary aspergillosis, and h/o mrsa line sepsis and presumed recurrence , who presented to the ed from dialysis with hypotension noted after hd. pt was recently admitted to vascular surgery service for l tma and d/c'd on vanc (at hd) . pt was at rehab until the day of admission when he went to hd and became hypotensive and was transferred to the ed. . in the , pt had r femoral triple lumen placed and received 1l ns, vanc, levo, and flagyl and due to persistent sbp in the 70s he was admitted to the micu. in the micu his antibiotics were continued and he was given an additional 1l ns. he has been hemodynamically stable and is now being transferred to the floor. past medical history: pmh: past medical history: 1. esrd s/p failed transplant now collapsing glomerulonephritis, hd qmwf at 2. amyloidosis 3. sarcoidosis 4. hx of pulmonary aspergillosis - on itraconazole, followed by pulm 5. hx of hyperkalemia 6. hep b, c, ? d 7. htn 8. hx of iv drug use 9. h/o sinusitis requiring drainage 10. recent epistaxis requiring intubation 11. spep/upep positive 12. paroxysmal atrial fibrillation - off bb, on coumadin 13. h/o c diff 14. mrsa line sepsis (), new tunneled fem line , tte neg for veg, line sepsis (), new tunneled fem line 15. h/o purulent ascites while on pd 16. gynecomastia 17. iron deficiency anemia 18. renal osteodystrophy 19. adrenal insufficiency - on prednisone 5 mg po qd 20. h/o b/l ue dvt : pt should not have ij or scl lines 21. h/o pancreatitis ** echo : ef > 55%, 1+ mr social history: soc hx: lives with girlfriend, on disability; 1 packper day x30 years of tobacco use, still currently smoking. no alcohol, but previous history of abuse. family history: diabetes physical exam: pe: vs 98.4 hr 100 bp 120/64 r 12 o2 100% on 2l nc gen: lethargic but arousable to voice. heent: eomi, perrl, op clear, anicteric neck: supple, no appreciable lad. chest: crackles at the bases bilaterally cv: rrr nl s1 s2 no mrg appreciated abd: soft, nt, nd +bs no guarding or rebound ext: r bka, l tma (dark skin around sutures, otherwise clean, dry), right femoral triple lumen, left tunneled hd catheter. neuro: moves all 4, oriented to person, year, not to place, answers questions, follows commands. pertinent results: studies: cxr: impression: no interval change from , with persisting calcified mediastinal and hilar lymphadenopathy, biapical pleural scarring, and scarring/bronchiectasis in the upper lobes and right lower lobe. no new consolidation to suggest acute pneumonia. . head ct: 1. no evidence of intracranial hemorrhage. 2. bilateral internal capsule hypodensities as well as hypodensity adjacent to the frontal of the left lateral ventricle which are new compared to the prior study of , . these may represent chronic microvascular infarction or virchow- spaces. given the patient's age, however, a demyelinating process cannot be excluded. mri with dwi is more sensitive in the detection of acute infarction. 03:55pm plt smr-very high plt count-629*# 03:55pm hypochrom-2+ anisocyt-1+ poikilocy-1+ macrocyt-normal microcyt-normal polychrom-occasional ovalocyt-1+ target-occasional 03:55pm neuts-73.7* bands-0 lymphs-11.4* monos-10.7 eos-3.5 basos-0.7 03:55pm wbc-13.5* rbc-4.12* hgb-10.6* hct-34.0* mcv-83# mch-25.7* mchc-31.2 rdw-19.1* 03:55pm calcium-9.6 phosphate-2.7# magnesium-2.0 03:55pm ggt-206* 03:55pm alt(sgpt)-11 ast(sgot)-25 alk phos-238* amylase-48 tot bili-0.1 03:55pm glucose-239* urea n-20 creat-5.0*# sodium-137 potassium-4.0 chloride-101 total co2-25 anion gap-15 04:11pm lactate-2.4* 04:35pm urine rbc-0-2 wbc-* bacteria-few yeast-none epi-0 trans epi-0-2 renal epi-0-2 04:35pm urine blood-neg nitrite-neg protein-500 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-8.0 leuk-neg 04:35pm urine color-straw appear-clear sp -1.014 05:09pm pt-26.2* ptt-36.6* inr(pt)-2.7* 07:20pm o2 sat-73 07:27pm type- po2-26* pco2-59* ph-7.30* total co2-30 base xs-0 08:41pm fk506-2.0* brief hospital course: this is a 48 y/o male with esrd on hd with hx mult line infections with recent l tma (trans-metatarsal amp), who presented to ed initially with hypotension, fever, requiring monitoring in the micu overnight, who remained hemodynamically stable and was transferred to the medical floor for further management. 1. hypotension/sepsis - pt was hemodynamically stable after fluid resuscitation. given his history of line infection, his most likely source of possible sepsis was another line infection from his hd line. his cxr, urine were all clear. he was evaluated by vascular, who did not feel his l tma was the source of the infection, but that the patient would need an eventual left bka. his blood cultures from and onwards have been no growth to date. he was started on vancomycin/levofloxacin/flagyl and then changed to just vancomycin once patient was stable and it was felt that his infection was from his hd line. he needs to continue vancomycin empirically for 2 weeks, to be dosed at hd. as the patient has a history of extremely poor and difficult access, his hd line cannot be removed. the patient remains on daily low-dose prednisone given his history of adrenal insuffieciency in the past. the patient's ms was also lethargic initially, which has improved to his baseline after starting appropriate treatment with antibiotics. . 2. esrd - on hd tues/thurs/sat. on sevelemer, cinecalcet, and tacrolimus. needs to be dosed vanco at hd until . . 3. hx adrenal insufficiency - was on stress dose steroids briefly, changed over to low-dose po prednisone as pt is hemodynamically stable . 4. dm - continue insulin ss as directed . 5. pain - continue lidocaine patches and oxycodone prn . 6. afib - hold metoprolol as patient was initially hypotensive and now normotensive. on coumadin 1 mg qod, which was increased to 2 mg qod upon discharge as his inr was 1.5. his goal inr is . he should have repeat pt/ptt/inr in days as dose adjustment may be necessary. . 7. psych - on welbutrin and remeron. d/c'd zyprexa due to the lethargy. . # fen - reg diet, monitor lytes. ivf prn hypotension. # code: full. confirmed with hcp # ppx - heparin sq, protonix for gi. bowel regimen. # access: l femoral tunneled hd cath, right femoral line was d/c'd on with good hemostasis # comm: hcp (girlfriend) medications on admission: meds on admission: docusate sodium 100 mg po bid famotidine 20 mg po q24h itraconazole 100 mg po bid oxycodone-acetaminophen 5-325 mg po q4-6h prn tacrolimus 0.5 mg po daily lidocaine 5 % adhesive patch, 12 h on 12 h off senna 8.6 mg po bid prn folic acid 1 mg po daily metoprolol tartrate 12.5 mg po bid sevelamer 800 mg po tid prednisone 5 mg po daily cinacalcet 30 mg po daily coumadin 1mg po qod epo 20k t, th, sat hd t, th, sat tylenol prn xenaderm zyprexa 5 po qd mirtazapine 15 mg po qhs wellbutrin 100 sr qd atarax 10 mg po tid prn discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 3. itraconazole 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. sevelamer 800 mg tablet sig: one (1) tablet po tid (3 times a day). 7. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical qd (). 8. oxycodone 5 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 9. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). 10. bupropion 100 mg tablet sustained release sig: one (1) tablet sustained release po qam (once a day (in the morning)). 11. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 12. warfarin 1 mg tablet sig: two (2) tablet po qod (). 13. heparin lock flush (porcine) 100 unit/ml syringe sig: one (1) ml intravenous daily (daily) as needed: for right femoral line. 14. tacrolimus 0.5 mg capsule sig: one (1) capsule po qd (). 15. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 16. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) gram intravenous qhd (each hemodialysis) for 10 days: to be dosed on dialysis days during hemodialysis, last dose on to finish a 14 day course. 17. epoetin alfa 10,000 unit/ml solution sig: 15,000 injection asdir (as directed): to be given during hemodialysis on hd days. 18. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 19. insulin insulin sliding scale as directed on attached sheet discharge disposition: extended care facility: rehabilitation & nursing center - discharge diagnosis: primary - line infection secondary - esrd, amyloidosis, sarcoidosis, htn, paf, mrsa line sepsis discharge condition: stable, afebrile with vss discharge instructions: -continue with all medications as prescribed -continue vancomycin to finish a 2-week course (last dose on ) - this should be dosed at hemodialysis -continue coumadin every other day for goal inr - recheck pt/ptt/inr in days for dose adjustment -continue with hemodialysis as scheduled on tues, thurs, and sat -if symptoms of dizziness/lightheadedness, fevers, shortness of breath, confusion, or any other concerning symptoms occur please come to the ed or seek medical attention immediately -vancomycin needs to be continued for 2 weeks and dosed at each hemodialysis followup instructions: 1) dr. , at 9:25 am 2) provider: , md phone: date/time: 9:50 procedure: hemodialysis diagnoses: chronic kidney disease, stage v mitral valve disorders long-term (current) use of steroids diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia unspecified viral hepatitis c without hepatic coma atrial fibrillation sarcoidosis sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease long-term (current) use of anticoagulants infection and inflammatory reaction due to other vascular device, implant, and graft below knee amputation status viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta aspergillosis above knee amputation status 

Answer: The patient is high likely exposed to