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: patient recorded as having no known allergies to drugs attending: chief complaint: altered mental status major surgical or invasive procedure: temporary hd catheter line placement tunnelled hd catheter line placement hemodialysis history of present illness: mr. is a 67 year old gentleman with a past medical history notable for hypertension, esrd on dialysis, chf, atrial fibrillation on coumadin, recent mrsa bacteremia on vancomycin, cad s/p cabg and lad stenting, and past cva who presented to the on from his renal dialysis facility because of change in mental status. mr. has been admitted approximately once per month since for , chf, sepsis, and line infections. his most recent hospital admission to the was from to for chf in the setting of poorly controlled hypertension. the patient was discharged on to his nursing home facility where, per report from at the home, the patient returned to his baseline state of health. mr. did well until the evening prior to admission, when the staff found him to be shouting more than normal. at baseline, the patient shouts infrequently in his native creole language, but the staff noted that he was shouting more frequently last night; they also note that he seemed more confused than normal. in addition, mr. did not sleep much on the evening prior to admission. he denied any pain symptoms when questioned by the staff. on the morning of admission, the patient was taken to dialysis at dialysis where he screamed continuously and held his groin area (the site of a femoral line). due to concern about the patient's change in mental status and possible pain at the femoral line site, he did not undergo his dialysis treatment and was taken to the emergency department for evaluation. . in the ed, the patient's vital signs were: t 95.5, hr 90, bp 158/98, rr 16, o2sat 99/ra. the patient underwent a ct of the head and chest x-ray. the cxr showed chronic lll consolidation, rll consolidation that had been noted on the previous admission and has not yet resolved, as well as small bilateral pleural effusions. the ct of the head showed no acute intracranial pathology. the patient was given 1 gram of ceftazidime, 1 gram of vancomycin, epoetin, 5 mcg of paricalcitol, 62.5 mg of ferric gluconate. mr. was found to be hyperkalemic and to have an inr of 1.3. given the persistence of the rll consolidation, the patient was admitted to the general medical service for work-up of his mental status change and treatment of pneumonia. . review of systems: per report from at the nursing home, the patient has not had any recent cough, fever, nausea, vomiting, or diarrhea. she says that his blood pressure, heart rate, and oxygen saturation have all been normal over the last several days. . micu txfer: reason for transfer: bradyacardia and ams . during his hospitalization, his mental status improved on antibiotics. he was initially treated with levo/flagyl, changed to cefepime and tobramycin and flagyl when his cultures grew out enterobacteriae; subsequently this was changed to meropenem as it was felt that he may have an esbl organism. . on , patient was alert and conversing with team. on , patient was found to be unresponsive/lethargic and bradycardic to the 40s. he was in afib and did not have any changes on his ekg. his pressure was in the 90s at this heart rate. his finger sticks were normal. he was afebrile. his last nodal agents was 9pm on (he is on metoprolol 25mg ) and his last sedatives were olanzapine at 10am on and trazodone at 9pm on . on the floor, he was given atropine x 2 and his heart rate increased to 60s after 1st atropine and his bp increased to the 110s. however, his mentation did not improve. ct of head showed ?stroke, but neuro consulted and felt not c/w pt presentation. . on transfer to floor from micu: summary of micu course--the episode of ams that brought him to the micu was accompanied by bradycardia and hypotension. he was started on dopamine; as his hr and bp picked up so did his mentation. neuro was consulted about a finding of possible stroke on ct which they felt was not clinically consistent with his physical exam. . his vitals signs were stable and mental status improved and he was called out to floor. past medical history: 1) left occipital lobe cva p/w change in ms , chronic cvas now on coumadin for likely embolic nature 2) paroxysmal afib, rate controlled with tachy/brady, occas 2 sec pauses, best managed with metoprolol 75 tid per cards 3) chronic eosinophilia unknown etiology, strongyloides sent in for w/u as well as spep/upep 4) h/o gi bleed in while on asa, plavix, iib/iiia post-cath--no egd or c-scope performed in f/u yet 5) esrd secondary to htn, dialysis mwf- followed by dr. 6) h/o bacteremia w/ mrsa (most recently diagnosed on admission from to ) on vancomycin until . 7) h/o pulling out groin lines 8) htn, controlled 9) cad s/p nstemis, 2 lad stents, cabg : last echo , ef >55% 10) hyperlipidemia 11) diverticulosis 12) severe hyperparathyroidism, presumed adenoma, not on vitamin d for this concern 13) chronic anemia 14) chronic transudative pleural effusions 15) h/o neurocysticercosis calcified social history: lives in nursing home. no tobacco, etoh, illicit drug use. transfer paper work from nursing home lists as the relative or guardian (. family history: mother with hypertension. no history of no strokes, seizures, or heart disease physical exam: vs: t: 98.4 (rectal) hr: 54 bp: 124/65 rr: 18 sat: 100/ra fs: 133 gen: patient is laying in bed comfortable. wasting apparent in temporal region and upper and lower extremities. he moans every few minutes. patient only understands a few words of english so very difficult to communicate with him. in the presence of a translator, the patient did not provide meaningful answers to questions other than his name. heent: oropharyngeal mucosa without exudates. pupils minimally reactive bilaterally. neck supple without lad. no jvd. cv: irregularly irregular. normal s1, s2. s3 appreciated. 1+ carotid, radial pulses. 2+ brachial pulse. unable to palpate dp, posterior tibial, and popliteal pulses. pul: difficult exam because of poor cooperation. appreciated decreased breath sounds at bases with crackles bilaterally. abd: soft, non-tender, positive bowel sounds, no hsm. ext: trace edema in le. atrophy in upper and lower extremities. pertinent results: admission labs: 11:08am glucose-137* urea n-31* creat-6.2*# sodium-134 potassium-6.5* chloride-93* total co2-28 anion gap-20 k+-6.0* . wbc-5.1 rbc-4.69 hgb-11.9* hct-36.6* mcv-78* mch-25.4* mchc-32.5 rdw-21.6* neuts-48.3* lymphs-37.5 monos-5.4 eos-8.4* basos-0.4 . pt-14.2* ptt-30.7 inr(pt)-1.3* caltibc-195* vitb12-1530* ferritn-637* trf-150* tsh-2.4 . 12:30 pm blood culture; enterobacter cloacae. (sensitivities: cefepime s; ceftazidime r; ceftriaxone r; ciprofloxacin r; gentamicin s; imipenem s; levofloxacin i; meropenem s; piperacillin r; tobramycin s) . aerobic bottle (final ): enterobacter cloacae. identification and sensitivities performed on culture # . . final bld cultures on and are negative. . brief hospital course: mr. is a 67 yo w pmhx of htn, esrd on dialysis, chf, atrial fibrillation on coumadin, recently completedcourse of vancomycin for mrsa bacteremia, cad s/p cabg and lad stenting, and past cva who was admitted and treated for mental status changes secondary to enterobacter bacteremia who's hospitalization was complicated by micu stay for acute change in mental status and bradycardia which had resolved by discharge. . # mental status change: felt to have resolved per family. patient was initially admitted with change in ms on . he had an acute decompensation on for which he was transfered to the micu. the episode of ams that brought him to the micu was accompanied by bradycardia and hypotension. he was started on dopamine; as his hr and bp picked up so did his mentation. neuro was consulted about a finding of possible stroke on ct which they felt was not clinically consistent with his physical exam. we discontinued his trazadone. baseline he is oriented to self and to hospital but not which one or year. . # bacteremia-mrsa and enterobacter: positive cultures on and with enterobacter cloacae sensitive to meropenum. initially was treated with levo/flagyl, then cefepime and tobramycin, changed to meropenum on . he had a new left tunneled hemodialysis line put in on . he completed a 14day course of meropenum on . vanco course is complete as on per last d/c summary. . # cxr with bilateral consolidations/pleural effusions: cxr shows worsening pleural effusions and he has a persistant oxygen requirement. likely secondary to chronic chf. patient will go to nh with 1-2l oxygen. . # diarrhea: now resolved. started while in micu, c.diff negative x1. . # end stage renal disease: this patient has esrd and is on dialysis (mwf schedule). continue with nephrocaps and sevelamer. he had ir guided permanent hd catheter placement . his inr was reversed with 10 vit k for this procedure. . # bradycardia: resolved. unclear etiology: possibly med effect-received metoprolol on night before micu admission, ruled out cardiac event with negative cardiac enzymes. initially some response to atropine, but not sustained. improved with dopamine and was slowly weaned off. he was monitored on telemetry. his metoprolol was discontinued. . # hyperparathyroidism: this patient has baseline secondary hyperparathyroidism. continue with cinacalcet. . # hypertension: patient has baseline hypertension normally treated with multiple drugs. patient had episode of hypotension prompting unit transfer. which resolved and antihypertensives were slowly added back. at discharge patient was on admission doses of clonidine, amlodipine and lisinopril, but his metoprolol was discontinued. . # coronary artery disease: he was managed with medical management by continuing atorvastatin 80mg and asa 81mg. metoprolol was discontinued. . # atrial fibrillation: goal inr = 2.0 to 3.0. he was reversed for tunneled line placement. patient was restarted on coumadin at home dose of 1mg qhs. he should have twice weekly coumadin checks until he stabilizes. . # mass in r atrium: we spoke with echo room who read it as a ra "lump". he felt that it was not a myxoma, thrombus, or cancer, but rather more likely hypertrophy. he said that it would not likely increase risk of endocarditis over normal anatomy. he recommended mri of the heart to better characterize if we felt it should be persued, and that tee would have limited utility. . # anemia: patient with baseline anemia, but slowly worsening over hospital course. laboratory studies consistent with anemia of chronic disease. retic count of 2.9 (ri = 2.9*(27.2/45)/2.0 = 0.88 or less than 2% and thus hypoproliferation). patient received epo and transfusions. discontinued iron supplementation. . medications on admission: docusate sodium 100 mg capsule one capsule po bid (2 times a day) b complex-vitamin c-folic acid 1 mg capsule one cap po daily sevelamer 800 mg tablet one tablet po tid (3 times a day). lactulose 10 g/15 ml syrup thirty ml po daily prn constipation. trazodone 25 mg po hs (at bedtime) prn insomnia cinacalcet 30 mg tablet one tablet po daily aspirin 81 mg tablet, chewable one tablet po daily clonidine 0.2 mg tablet one tablet po tid (3 times a day) amlodipine 5 mg tablet one tablet po daily atorvastatin 80 mg tablet one tablet po daily ferrous sulfate 325 (65) mg tablet one tablet po daily pantoprazole 40 mg tablet, delayed release (e.c.) one tablet, delayed release po q24h (every 24 hours) metoprolol tartrate 25 mg tablet one tablet po bid (2 times a day) lisinopril 10 mg tablet one tablet po daily (discharge summary says 20 mg per day, med sheet says 10 mg per day) vancomycin hcl 1000 mg iv to be dosed at hemodialysis (through ) coumadin 1 mg tablet one tablet po qpm (discharge summary said to take every other day, med sheet from nursing home says he is getting it every evening) discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 2. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). 3. meropenem 500 mg recon soln sig: one (1) recon soln intravenous qhd: please have his hemodialysis unit dose the meropenum after hd until . 4. atorvastatin 80 mg tablet sig: one (1) tablet po at bedtime. 5. clonidine 0.2 mg tablet sig: one (1) tablet po tid (3 times a day): please hold for sbp < 100. . 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): titrate to 1bm each day. 8. lactulose 10 g/15 ml syrup sig: thirty (30) ml po daily; prn () as needed for constipation. 9. sevelamer 800 mg tablet sig: one (1) tablet po three times a day: please monitor phosphate. . 10. coumadin 1 mg tablet sig: one (1) tablet po at bedtime: please monitor with inrs. 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 12. lisinopril 20 mg tablet sig: one (1) tablet po once a day. 13. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 14. sevelamer 800 mg tablet sig: one (1) tablet po tid (3 times a day). 15. warfarin 1 mg tablet sig: one (1) tablet po hs (at bedtime). 16. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 17. docusate sodium 150 mg/15 ml liquid sig: 10ml po bid (2 times a day). discharge disposition: extended care facility: roscommon discharge diagnosis: primary bacteremia-enterobacter esrd on hd cad s/p cabg a fib h/o mrsa bacteremia bradycardia secondary anemia discharge condition: stable discharge instructions: please take your medications as prescribed. we have discontinued your metoprolol secondary to your bradycardia, the trazadone secondary to change in mental status, and iron discontinued. . please seek medical attention for chest pain, palpitations, shortness of breath, fever, chills, or if other caregivers a change in mental status and for any other symptoms concerning to you. followup instructions: please follow-up with the physician at the facility and your pcp in the next 1-2 weeks. procedure: hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis transfusion of packed cells diagnoses: anemia of other chronic disease end stage renal disease abnormal coagulation profile anemia, unspecified unspecified pleural effusion congestive heart failure, unspecified toxic encephalopathy atrial fibrillation infection with microorganisms resistant to penicillins coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site secondary hyperparathyroidism (of renal origin) diarrhea cerebral artery occlusion, unspecified with cerebral infarction adult failure to thrive eosinophilia 

Answer: The patient is high likely exposed to