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: history of present illness: the patient presented on at with 24 hours of worsening mental status changes and bilateral upper extremity swelling. patient has a past medical history of being a nursing home resident, dementia with behavioral disturbance/depressed features, recent admission to hospital with urosepsis of unknown etiology requiring intubation, and discharged on , diabetes mellitus, coronary artery disease status post mi, chf, copd, status post pacemaker placement, which required replacement for low battery in of this year. at the outside hospital, a chest ct with contrast was performed, which showed obstruction of the superior vena cava at the level of the origin of the svc. a head ct was also done which was negative with no acute hemorrhage, an old left frontal infarct, and thalamic calcifications and cortical atrophy. it was uncertain what the etiology of obstruction was and ultimately the patient was started on heparin drip and transferred to for further evaluation and possible intervention. at the time of the arrival of the patient to the emergency room, the patient was slightly febrile at 101.4. had a blood pressure of 124/84. pulse of 105. breathing at 30 and sating 94% on room air. vascular surgery evaluated the patient and recommended a venogram and a possible svc stent at that time. patient was admitted for further workup. past medical history: 1. nursing home resident at in . 2. dementia with behavioral disturbance and depressed features, although baseline is alert, conversant, and fairly self sufficient with activities of daily living, although requires wheelchair. 3. recent admission at hospital with urosepsis of unknown etiology requiring intubation, but discharged on and admission on . 4. diabetes mellitus. 5. coronary artery disease status post mi. 6. chf with recent admission with 24 hour intubation. 7. copd. 8. status post pacemaker placement replaced on for low battery leads and without lead transition at that time. 9. status post traumatic brain injury. 10. gerd. 11. hypertension. 12. status post left knee surgery. 13. status post appendectomy. medications on arrival: 1. nitro patch 0.2 mg q.a.m. 2. annulose 10 mg in 30 cc q.a.m. 3. zyprexa 5 mg p.o. q.h.s. 4. protonix 40 mg p.o. q.d. 5. metoprolol 50 mg p.o. q.d. 6. magnesium oxide 40 mg p.o. t.i.d. 7. calcium carbonate 1.2 grams t.i.d. with food. 8. dulcolax p.o. q.a.m. 9. procardia xl 60 mg q.d. 10. cardura. 11. multivitamin. 12. artificial tears. 13. aspirin 325 mg p.o. q.d. 14. trazodone 50 mg p.o. q.d. 15. albuterol. 16. insulin. allergies: the patient reportedly had an allergy to shellfish and ivp dye, however, at the outside hospital the patient received contrast with a ct scan without any problems as well as an inpatient. although of note, the iv dye used was nonionic ............ family history: unknown. social history: the patient is a former smoker, unknown alcohol use, and his surviving relatives is an elderly sister, who knows him poorly. physical exam at time of admission: generally, patient in some distress, was intermittently screaming at baseline. patient's vital signs were a temperature of 99.7, pulse of 105, blood pressure 130/86, respiratory rate 24, and saturation 97% on 2 liters. pertinent physical findings: the patient had great significant periorbital edema or facial swelling. the patient did have 3+ bilateral pitting upper extremity edema without lower extremity edema and had 2+ dp and pt pulses. the patient's heart rate was tachycardic, but regular with a normal s1, s2 with no murmurs. lungs: patient was making poor effort with bibasilar crackles. chest had numerous dilated and tortuous superficial veins that were apparent. the abdomen was benign. laboratory studies before the patient was admitted: at the outside hospital, the patient had a cbc which had a white count of 3.7, hematocrit 32.6, and platelets of 214. coagulation showed a pt of 13.8, ptt of 33.4, and an inr of 1.2 previous to starting heparin. chem-7 was significant for a potassium of 3.5, creatinine of 0.9, and bicarb of 33. lfts were significant for an alt of 31, ast of 27, alkaline phosphatase of 606, and total bilirubin of 1.64, direct bilirubin of 1.1, and an albumin of 2.8. patient's ck and troponin-i were both negative. additional laboratory studies on arrival in the emergency room showed a lactate of 1.8. a differential on his white count with 83% polys. a urinalysis showed a large amount of blood with trace leukocyte esterase, 150 ketones, but was otherwise negative. electrocardiogram showed sinus tachycardia at 107 with left axis deviation and new poor r-wave progression in leads v2 through v5 with t waves consistent with normal ekg. the calcium, magnesium, and phosphorus were 9.7, 2.0, and 3.3 respectively. uric acid and iron studies were normal. cholesterol study was normal. tsh was 1.5. a lp was performed due to the patient's mental status change which had 175 reds, 1 white cell with a differential of 73% polys, 27% lymphocytes, total protein was 22, and glucose was 125, gram stain was negative, and subsequent lp culture never grew out any organisms. chest x-ray at the time of admission showed no effusion or infiltrate, but did have a tortuous aorta. hospital course by systems: this is up to date to the evening of . future dictation is to be addended. 1. svc syndrome: patient had notable svc syndrome on chest ct at outside hospital and the chest ct was repeated while the patient was in-house on , which was performed with contrast and showed occlusion of the svc without obvious evidence of clot or external compression, and also of note, on the chest, the lungs were clear and the abdomen had no significant pathology. on the evening of , the patient was taken for a svc graft and attempted wire transversal of the occlusion with theoretical stent placement. however, the svc was found to be totally occluded above the level of the azygos and subsequently wires cannot be passed either above or below. the occlusion cannot be opened. at that time, the recommendation was made for sharp recanalization potentially some time in the future. however, at that time the patient's guardianship status arrived, and it was not until the patient's guardian was appointed and a discussion was arranged between patient's guardian and dr. of interventional radiology. we were able to reconsider the sharp recanalization. on , dr. visited the patient and found the patient to be somewhat hesitant to have the procedure done, although his mental status was not completely clear. consequently, we arranged for a family meeting on with the guardian and dr. . at this time, it was decided with the patient's seeming approval, the procedure should go ahead on with sharp recanalization. however, over the following several days the patient became increasingly clear of mental function and on about , patient's expressed to the attending, dr. that he did not want to have the procedure done. consequently, on the 15th, dr. and legal guardian were , and it was felt that the procedure should not be performed. specifically, dr. talked with the guardian, and decided that procedure would be of no significant benefit to the patient at this time, and could be deferred until future. specific argument was that a cerebral blood flow study was performed which showed no significant venous stasis, and thus, it was unclear whether or not the patient's mental function would improve after the procedure, and the patient also did not seem to be significantly bothered by his upper extremity swelling. at that time, svc was electively not to be treated and the upper extremity swelling was noted on daily examinations, but was otherwise not treated. 2. mental status change: by report, the patient at the outside nursing home was fairly functional with his activities of daily living, is able to carry on conversations with his problems. however, in the emergency room, the patient's mental status had declined to the point of intermittent screaming without provocation. consequently, the patient was started on haldol prn, and was maintained on this throughout his course up until the point at the time of this dictation on . the patient's mental status gradually cleared, although there was some waxing and component. it was unclear exactly what the cause of the decline in mental status was. multiple urinalyses showed fungus in the urine, however, it was not felt that this was significant. a cerebral blood flow study was obtained on which showed no significant venous stasis nor retrograde flow into the jugular veins indicating no extension of the clot superior. consequently, it was felt that the mental status was not necessarily subsequent secondary to occlusion of the jugular veins due to obstruction secondary to the svc occlusion. also as the patient developed mrsa bacteremia in his hospital course, the patient's mental status remained improved from the time of his admission, and the patient was able to carry on intermittent conversations. 3. left thigh hematoma: early on the morning of , the patient lost iv access. consequently, a femoral line was placed in the left. patient, at this time, was continuing to be maintained on heparin and there was difficulty in regulating the patient's heparin level, and there were several periods of time in which the patient's ptt was elevated greater than 150. the maximum level in which at which the test could be measured. on the morning of , the patient was noted to have a hematocrit which had dropped down to 18.9 from 25.3 the previous day, and the previous day it has actually fallen as well from 32.3. consequently, a ct of the abdomen was obtained and this showed a bleed to the left thigh around the site of the left femoral line. the patient subsequently developed some hypotension as well as respiratory failure with worsening mental status. consequently, was transferred to the medical icu. in the medical icu, the patient's hematocrit reached a low of 17.7 on the morning of , and consequently, the patient was transfused with 6 units of packed red blood cells and 2 units of fresh-frozen plasma, and the heparin was obviously stopped. the patient required intubation for 24 hours due to worsening respiratory functioning in the setting of mental status decline, but was extubated uneventfully on , and was transferred back to the floor on . the patient's hematocrits were serially drawn every 12 hours and later every 24 hours. after transfer out of the medical icu, the patient's remained stable in the mid 30s for the remainder of his stay up until this dictation, . 4. fungus in urine: the patient had numerous urinalyses performed during his hospitalization, which showed blood and urine cultures repeatedly grew out fungus, which was identified as presumptively not albicans. patient was generally afebrile and consequently, it was felt that this was probably a spurious result. however, to be safe, the patient was transferred over to a condom catheter. the patient's fungal urine cultures were drawn after this time and found to have fungus, but presumptively not c. albicans, but again this was probably thought to be a spurious result, although it was requested that the speciation be performed and this was being completed at the time of this dictation on . 5. mrsa bacteremia: the patient's femoral line was maintained after the time of this hematoma. because it was his only access for blood draws and delivery of medications. however, the patient began having mild fevers over the weekend, and 14th, and consequently, it was decided that the femoral line should be changed over wire. this was done without event maintaining sterile procedure throughout. however, the following day, the patient's blood cultures began to grow out coag positive staph, which subsequently grew out methicillin-resistant staphylococcus aureus. the two femoral line tips were cultured and this also grew out mrsa, and in addition to pseudomonas which was pansensitive except for ciprofloxacin. in addition, there is also a single culture which grew out coag negative staph, which was resistant to oxacillin, but sensitive to vancomycin. patient was started on vancomycin on after the blood cultures began to return positive and the patient was significantly afebrile, but this is complicated by the lack of access issue, which will be discussed in the next problem. consequently only two doses of vancomycin over the 16th and 17th were given and one dose of gentamicin 1 mg/kg dosing. on the evening of , no access was available and consequently the patient was given p.o. linezolid. further events regarding his mrsa bacteria will be dictated in the near future. 6. access: after the left femoral line was pulled, the patient's access became very difficult. a brief iv was placed in one of the varices in the patient's left chest, but this fell out after a single dose of iv vancomycin was given. a subsequent iv was placed in the patient's left ankle, but this fell out after another dose of vancomycin was given. the following day on , repeated ivs were attempted, but unable to be performed. consequently, it was decided that should attempts to replace a right ij central line. the patient was taken to the interventional pulmonology procedure unit, where there were three attempts made to place the line without success. after this, the patient was taken to the interventional radiology for an angiographically placed line, but this was declined on the 18th with possible repeat attempt on the 19th, and future events and this problem will be dictated in subsequent addendum. 7. diet: the patient was initially made npo due to his decline in mental status. on the patient's discharge for the medical icu on , the patient had a swallow study done, which showed the patient was able to tolerate nectar thickened liquid diets and full sized medications. consequently, this patient was started on this diet, and maintained throughout the rest of his hospital stay up until , the time of this dictation. nutrition was also consulted, and found the patient to be serially lacking in calorie intake and protein intake, however, it was decided that the patient would not tolerate placement of a nasogastric tube for tube feeding and that the patient's dietary intake would probably increase once he was discharged. 8. hypertension: patient was maintained on his baseline metoprolol 12.5 p.o. b.i.d. once he was known to be able to tolerate p.o. 9. code status and guardianship: on the arrival, the patient was known to have only one surviving relative, whose name is . this person was . it was found that she did not really know the patient and was unable to assess what his wants would be in terms of aggressiveness of care. at the previous hospital stay, she had been his healthcare determining person, but it was decided that she was probably inadequate for the task and consequently, legal guardianship was requested and obtained on the evening of . the new guardian was , phone number , who wanted to reverse the patient's dnr/dni status to full code. in addition, this person subsequently spoke with drs. and regarding sharp recanalization procedure and maintained her guardianship status throughout the remainder of the hospital stay. of note, the patient's legal guardian found her job difficult as she did not know the patient previously and was forced to decide what the patient's wants would be in terms through discussions with the staff and other residents at the nursing home. disposition at the time of this dictation, is pending treatment of the patient's infection and will be further decided upon on further dictation. as well as condition on discharge, discharge status, discharge diagnosis, discharge medications, and followup plans will all be dictated in future addendum. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified spinal tap incision of lung insertion of endotracheal tube diagnoses: congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified acute respiratory failure bacteremia compression of vein other complications due to other vascular device, implant, and graft infection and inflammatory reaction due to other vascular device, implant, and graft 

Answer: The patient is high likely exposed to