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: mr. is an 86-year-old gentleman with a history of coronary artery disease status post coronary artery bypass graft, congestive heart failure with an ejection fraction in the 30% range, atrial fibrillation on coumadin, chronic renal insufficiency, hepatitis c, liver cirrhosis, who presented to the medical intensive care unit with fever and hypotension on . the patient was transfused at the approximately two days prior to admission for chronic anemia of uncertain etiology, according to the patient's family. the day following transfusion, the patient was in his usual state of health. the morning of admission, at 1 a.m., the patient began to have rigors and a fever at home. the patient's family describes a fever to 38.5 degrees celsius in the early morning hours. the patient denied chest pain, shortness of breath, cough, dysuria, nausea, vomiting, diarrhea. he has chronic abdominal pain. it was unclear whether there were any changes in this abdominal pain. additionally, the patient did not complain of headache or neck stiffness. in the emergency room, the patient was afebrile and initially had a blood pressure in the 110 range, but became progressively hypotensive with a systolic blood pressure in the 80s, as well as a temperature spike to 102 degrees farenheit, and oxygen saturation in the 90s. on physical examination in the emergency room, there was noted to be right upper quadrant as well as left lower quadrant tenderness without rebound or guarding. it was unclear in discussion with the patient's family whether this was actually a change for him. the patient was noted to have a white count of 17.8, with a left shift and 1 band form. the chest x-ray, urinalysis and blood cultures were performed. chest x-ray failed to demonstrate infiltrates. urinalysis demonstrated evidence of urinary tract infection. the patient was given ampicillin, levofloxacin and flagyl. the patient's daughter, acting as his health care proxy, refused further workup including ct scan and lumbar puncture in the emergency room. additionally, the patient's family refused central venous access. therefore, in the emergency room, the patient was begun on dopamine via peripheral intravenous lines and was transferred to the intensive care unit. past medical history: coronary artery disease status post coronary artery bypass graft in , ejection fraction depressed in the 30 to 35% range, polymorphic ventricular tachycardia status post icd, left ventricular aneurysm, history of hyperparathyroidism status post parathyroid resection, chronic renal insufficiency with a creatinine baseline 1.8 to 1.9 range, anemia for which the patient is followed at the , hepatitis c with stable liver mass, hypertension, urinary tract infections, paroxysmal atrial fibrillation, hard of hearing. allergies: no known drug allergies. medications on admission: according to the patient's wife and daughter, 12.5 mg by mouth twice a day, lasix 20 mg by mouth three times a week, zestril 2.5 mg by mouth once daily, coumadin 3 mg by mouth once daily, multivitamin one pill once daily, calcium 250 mg by mouth twice a day, trental 400 mg by mouth twice a day, nexium 20 mg by mouth once daily, vitamin d. social history: retired schoolteacher from , positive 60 pack year tobacco history, quitting two years ago, denies alcohol use. physical examination: at the time of admission, temperature was 92.0, heart rate 72, blood pressure 107/42 on 5 mcg of dopamine, respiratory rate 22, oxygen saturation 92 to 93% on room air. in general, an elderly male in distress. the oropharynx was noted to be dry. the lungs were clear. the left radial pulse was decreased. the right radial pulse was regular. the cardiac examination revealed a distant cardiac examination with a normal s1 and s2, a ii/vi holosystolic murmur at the apex. present bowel sounds and an abdominal examination notable for wincing and grimacing with palpation in the right upper quadrant but otherwise non-rigid abdomen, nondistended abdomen. there was no peripheral edema. the neck was noted to be supple. the patient was following commands of his daughter. was alert, moving all four extremities equally. he was noted to have bibasilar crackles, approximately one-quarter of the way up, otherwise clear to auscultation bilaterally. please note that the patient's blood pressure on the initial examination by medicine in the emergency room had a blood pressure in the 80s/40s. data: white blood count at the time of admission was 17.8, hematocrit 29.8, with a differential on the initial white count of 94% neutrophils, 1% bands, 2% lymphocytes, 2% monocytes, 1% atypical cells. a repeat differential on at 3:40 a.m. demonstrated 80% neutrophils, 15% bands, 1% lymphocytes, 3% monocytes, as well as 1% metas. a platelet count at admission was 185, with a pt of 20.3 and an inr of 2.9, a ptt of 41.8. urine at the time of admission was negative for urinary tract infection. a chem 7 at the time of admission revealed a sodium of 137, potassium 4.6, chloride 103, bicarbonate 19, bun 57, creatinine 2.2, glucose 84. alt was 48, ast 59, ldh 271, ck 27 and flat for this admission. alkaline phosphatase was 274, amylase 131, total bilirubin 1.1, lipase 24, troponin less than 0.3 on multiple measures. calcium was 8.2, phos 2.5, magnesium 1.6. albumin was 3.0. a free calcium 67 was 1.12. blood cultures from demonstrate no growth to date. blood cultures from demonstrate staphylococcus aureus coag-positive, sensitive to oxacillin in four out of four bottles. a sputum from was felt to be contaminated. urine culture demonstrated less than 10,000 organisms. radiologic data: chest x-ray from demonstrated no defined consolidation. a pa and lateral from the same date demonstrated interval increase in size of bilateral pleural effusions, incidental note made of degenerative change in the right shoulder. a repeat chest x-ray of demonstrated findings consistent with asymmetric pulmonary edema. a ct scan performed on of the abdomen and pelvis demonstrated the following: bilateral pleural effusions, right greater than left, with a small right subpulmonic component, bibasilar partial collapse, consolidation, right greater than left, low attenuation of focus in the superior aspect of the right lobe of the liver. evaluation is limited by lack of intravenous contrast, small amounts of free fluid within the pelvis. there is fluid and stranding within the right pericolic gutter. no abdominal pathology is identified. a right upper quadrant ultrasound performed demonstrates cholelithiasis without evidence for acute cholecystitis, as well as question of liver echotexture and solitary well-defined mass within the right hepatic lobe, consistent with the patient's history of cirrhosis and known hepatic mass. electrocardiogram from was read as follows: atrial fibrillation, intraventricular conduction defect, inferior infarct age undetermined. cardiology data: echocardiogram performed on demonstrated the following: the left atrium is mildly dilated. left ventricular cavity is mildly dilated. overall left ventricular systolic function difficult to assess, but probably moderately depressed. posterolateral and apical hypokinesis was present. the aortic valve leaflets are mildly thickened. mitral valve leaflets are mildly thickened. moderate 2+ mitral regurgitation is seen. due to shadowing, the severity of mitral regurgitation might be significantly underestimated. moderate 2+ tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. (vegetations were not commented on.) hospital course by system: 1. infectious disease: the patient, as stated above, was admitted with hypotension and fever, felt to be consistent with sepsis. the patient was originally covered broadly with ampicillin and gentamicin in the emergency room. to this regimen, levofloxacin was added. ultimately the patient's blood cultures revealed gram-positive cocci, later identified as staphylococcus aureus coag-positive, and the patient was begun on vancomycin for the possibility of resistant organisms, however, this was changed to oxacillin rapidly as sensitivities became available. to date, the patient has one set of blood cultures which has demonstrated no growth to date. the patient's transthoracic echocardiogram was done to rule out the possibility of endocarditis, given the patient's history of abnormal valvular morphology as well as recent staphylococcal bacteremia. the patient's family, though they appeared to understand the risks and benefits which were described to them of transesophageal echocardiogram, repeatedly refused to undergo this procedure. the patient's family refused lumbar puncture in the emergency room, which was requested by a physician from the emergency room given the patient's question of mental status and fever. ultimately, secondary to concerns surrounding the patient's obvious right upper quadrant tenderness, it was suggested that the patient go for a ct scan of the abdomen and pelvis. the patient's family rejected this suggestion in the emergency room, but later were more willing to consider the possibility of abdominal ct, which the patient underwent on . this study was performed to rule out intra-abdominal source of sepsis. with the patient's initial picture of fever and hypotension, he was assumed to have sepsis secondary to staphylococcus aureus of unknown etiology. the patient rapidly defervesced, and maintained a blood pressure within the normal range on antibiosis, principally vancomycin and then oxacillin, other antibiotics having been discontinued when culture data returned. given the fact that the patient's family refused transesophageal echocardiography, and given the fact that discussions with cardiology led to a suggestion for transesophageal echocardiography to further assess for presence of endocarditis, a decision was made to treat the patient as if he did indeed have staphylococcal endocarditis, as the patient's family repeated refused measures, including transesophageal echocardiogram, to assess for the presence of said infection. the current plan is to treat the patient with oxacillin intravenously for the continuance of a six week course. 2. cardiovascular: the patient was known to have a history of tricuspid as well as mitral regurgitation by an echocardiogram in . the patient was again sent for echocardiography, with a fairly limited study which did not mention in the official report the presence or absence of valvular vegetations. in discussing this study with the cardiology fellow decided that the safest course of action was to pursue transesophageal echocardiogram to rule out the possibility of endocarditis in this gentleman. the patient's family refused transesophageal echocardiogram, although the risks and benefits of this procedure were described to them. the patient was ruled out for myocardial infarction. the patient was initially maintained on peripheral dopamine for pressor support, as the patient's family refused central access, although the risk of peripheral necrosis or other risks of peripheral administration of dopamine or other pressors were repeatedly explained to them. the patient's family nonetheless refused to allow the patient to have central access established. echocardiography was repeated during the course of this admission, with a transthoracic echocardiogram with the above-noted results. his antihypertensive medications were initially held at admission, and then restarted prior to the time of his impending discharge. the patient has a history of congestive heart failure with a further history of a low ejection fraction. lasix was initially withheld from the patient as he was admitted in a state of hypotension. by the time of discharge, however, the patient had been restarted on his outpatient dose of lasix. examination of the patient's lung fields was often difficult given the patient's refusal to breathe quietly, even through translation, preferring rather to speak loudly with his wife during the course of pulmonary examination. however, the patient was noted to have stable pulse oxygenation throughout the course of this admission, with no episodes of flash pulmonary edema or other concerning pulmonary events to the current date. 3. renal: the patient's creatinine was noted to be approximately at his baseline. attempts were made to renally dose medications. 4. hematology: the patient does admit to chronic anemia of unknown etiology, for which it is believed he has been following at the , but has evidently refused any invasive workup at that institution, including bone marrow biopsy. 5. gastrointestinal: the patient has a history of hepatitis c, with evidence for cirrhosis on imaging, as well as a stable hepatic mass. 6. access: the patient's family repeated refused central access, although at one point they did consent to central line placement. the patient's family later rescinded this decision. the patient was maintained on peripheral intravenous lines through the course of his stay, with recognition by the medical care team that this represents a suboptimal situation, especially initially in a patient who was septic with low blood pressures on pressor support. the risks of continuing without central access were repeatedly described to the patient's family, who appeared to understand these risks, but refused central access. at the current time, the plan is for placement of picc access for long-term antibiosis at the time of impending discharge from the hospital. today, , the patient's wife has for a second time refused picc placement, notwithstanding the repeated discussion with the medical team regarding the patient's need for long-term antibiosis. code status: the patient's family, while stating that they did not want the patient to undergo transesophageal echocardiography, central venous access for pressor support during the period of hypotension and sepsis, or other testing including initially ct scan, did state that they would like all possible measures to be taken to revive the patient should he stop breathing or cease to have a pulse. communication: the medical care team experience some difficulty in communication with the patient, who speaks a very limited amount of english. the patient's family, including the patient's daughter and wife, speak and were often noted to refuse certain aspects of the care of the patient for reasons that were often unclear; for instance, the patient's wife has refused picc placement today because, in her words, the patient has "a fever," although his temperature has repeatedly been measured at 98.5 by nursing staff today. medications at the time of this discharge summary: oxacillin 2 grams intravenously every four hours to be continued for the remainder of a five week course to complete a total of six weeks of antibiosis (given the patient's and the patient's family's insistence of avoidance of transesophageal echocardiogram), protonix 40 mg by mouth once daily, colace 100 mg by mouth twice a day, zestril 2.5 mg by mouth once daily, tums, vitamin d, coumadin 3 mg by mouth daily at bedtime, lopressor 12.5 mg by mouth twice a day (this is the dose which the patient's family insists upon, as it was evidently his outpatient dose). discharge plan: at the current time, the discharge plan is still currently in some state of flux, however, it is planned that the patient will be treated with intravenous antibiotics for a total of a six week course, given his and his family's refusal to fully evaluate the patient for the possibility of staphylococcal endocarditis. condition at the time of this discharge summary: stable. diagnoses to the date of this discharge summary: 1. staphylococcus aureus sepsis of unclear etiology 2. cholelithiasis without evidence of cholecystitis 3. anemia of uncertain etiology, followed at the 4. hypomagnesemia, repleted as needed please note that this is an interval dictation. further information may be found on the patient's page one or as addended in further discharge summary dictations. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart angiocardiography of venae cavae diagnoses: anemia, unspecified mitral valve disorders congestive heart failure, unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft methicillin susceptible staphylococcus aureus septicemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease diseases of tricuspid valve 

Answer: The patient is high likely exposed to