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: nafcillin attending: chief complaint: sepsis and acute renal failure major surgical or invasive procedure: renal biopsy () tee x2 right sided picc line left-sided thoracentesis history of present illness: 43 year old male with no significant pmh who p/w 2 weeks of malaise, myalgias, fevers/chills. over this time period he was seen at multiple eds (, , ) for dehydration/viral illness: : seen at , found to have a clear cxr, wbc 5, hct 39 and cr 1.1. given fluids. prescribed cipro, took it qd x5 days. : seen at new , flu swab negative, again given fluids. : seen at , negative orthostatics. . as above, patient had malaise, myalgias, headaches and episodes of the 'shivers.' he noted decreased pos and fluids, as well as episodes of confusion. he notes dark urine and decreased urine output. he did endorse some diarrhea and later some lower abdominal pain. he denies cough/congestion though he endorsed this elsewhere in the chart. he denies sore throat or runny nose. he has had no recent travel outside of , no dental procedures, no unusual foods, no pets, denies ivdu. he does have a co-worker with recent bronchitis. . ed course: vs on arrival: t 97.2, hr 100, bp 134/64, rr 17, spo2 97%. patient had bun 159 and cr of 7.1; u/a showed casts, large leuk and blood, few bacteria, 100 protein. patient received 6l ivf with minimal urine output. . pt c/o sob with o2 saturation in mid 90s, found to have mild end expiratory wheeze. repeat cxr showed persistent left lower lobe atelectasis, new left mid lobe atelectasis, small left effusion and new interstitial edema. looked like fluid overload (had gotten 6l ivf for arf), received neb and lasix 20mg iv --> put out 200 cc urine and felt better. . he was seen by renal team, found to have an active urine sediment with wbc/rbc casts and bacteria. initially thought to have post-strep or post-viral glomerulernephritis, and due to this concern he received a renal biopsy. soon after this he spiked a temperature to 102.8, with tachycardia in 120's, tachypnea and rigors. blood cultures revealed 4/4 bottles with gpc. he received cipro 500mg po, vancomycin 1gm iv. bp range 106-142/50-60s. . patient was then sent to the micu for close observation before transfer to floor. past medical history: no known pmh, has not had medical care in many years. social history: lives by himself, is self employed as a heating and ac engineer. he does not smoke, occasional alcohol, and denies any ivdu. he is not currently sexually active, has not been screened for hiv/stds. family history: mother w/ breast cancer, father healthy, no siblings physical exam: on arrival to icu . vs: temp: 100.5 bp: 124/53 hr: 116 rr: 18 o2sat: 95% on 1l nc. gen: talkative, completing full sentences, in nad. heent: perrl, eomi, anicteric, mmm, op without lesions or erythema neck: jvp at jawline resp: decreased breath sounds and scattered crackles at bases cv: rrr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e, warm, good pulses, lichenified plaques on dorsum of feet b/l but no cracking. no splinter hemorrhages or osler nodes. neuro: aaox3, no focal deficits. psych: rambling, tangential thinking. pertinent results: labs: . complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:06am - - - 25.3* 04:27am 9.4 2.86* 8.0* 23.6* 83 28.1 34.1 15.0 111* 11:04pm 11.0 3.10* 8.7* 25.8* 83 28.0 33.7 14.9 123* 03:02am 8.2 3.34* 9.4* 27.0* 81* 28.0 34.6 14.7 119* 01:45am 9.5 3.85* 10.9* 31.3* 81* 28.3 34.9 15.1 136 . differential neuts bands lymphs monos eos baso 06:17am 78.2* 10.8* 5.5 4.8* 0.7 01:45am 93.7* 3.3* 2.2 0.4 0.3 . 07:30am 80* . renal & glucose glu bun cr na k cl hco3 angap 05:06am - 5 2.0 01:45am 118 159 7.2 131 3.9 99 12 24 . 05:39pm lipase: 23 . hematologic caltibc hapto ferritn trf 05:00am 236* 05:29am 430* 01:05pm 441* chems added 3:14pm 07:35am 381* 07:30am 172* - 1245* 132* 03:02am 178* 284* 633* 137* . 06:52am cortisol: 22.9 . complement c3 c4 08:00am 30* 13 . pleural pleural analysis wbc rbc polys lymphs monos eos meso macro 02:09pm 900* 9000* 54* 15* 12* 3* 7* 9* pleural chemistry totprot glucose ld(ldh) amylase albumin 02:09pm 3.4 103 148 19 1.9 . 2:09 pm pleural fluid pleural fluid. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (pending): . c. diff negative x4. . blood bank diagnosis of new big e antigen: diagnosis, assessment and recommendations: mr. has a new diagnosis of anti-e antibody. e-antigen is a member of the rhesus blood group systems. anti-e antibody is clinically significant and capable of causing hemolytic transfusion reactions. in the future, mr. should receive e-antigen negative products for all red cell transfusions. approximately 71% of abo compatible blood will be e-antigen negative. a wallet card and a letter stating the above information will be sent to the patient. . bcx : ( positive blood cx on ): 5:25 am blood culture site: arm **final report ** blood culture, routine (final ): staph aureus coag +. sensitivities performed on culture # (). aerobic bottle gram stain (final ): reported by phone to @ on /0/. gram positive cocci in pairs and clusters. anaerobic bottle gram stain (final ): reported by phone to , @ on . gram positive cocci in pairs and clusters. . all subsequent blood cultures negative ucx: negative aso : negative . ekg: nsr @ 86, twi in iii. . imaging: cxr ( @ 1am): left lung base atelectasis. no definite evidence of pneumonia or chf. . cxr ( @ 7am): persistent left lower lobe atelectasis, new left mid lobe atelectasis, small left effusion and new interstitial edema. . ct head (): normal study (no infarction, hemorrhage, mass effect, or shift of normally midline structures. normal sized ventricles. clear paranasal sinuses and mastoid air cells. unremarkable osseous structures. . renal ultrasound (): normal renal ultrasound. no hydronephrosis. . echo (): the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are three aortic valve leaflets. no masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. no aortic regurgitation is seen. no masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. . renal biopsy (): per renal team - post infectious glomerulernephritis with minimal scarring (hopeful for good prognosis). . ct chest/pelvis/abdomen no contrast: impression: 1. small subcapsular hematoma on the left kidney, post-renal biopsy. hemorrhagic material is seen within the left renal collecting system, and a large amount of blood is seen within the urinary bladder, which is not drained by the indwelling foley catheter. 2. mild simple ascites fluid in the left paracolic gutter and elsewhere within the abdomen, possibly related to generalized fluid overload and/or renal causes. fluid is seen in the subcutaneous left flank, in addition to moderate bilateral pleural effusions, a small pericardial effusion, and mild interstitial edema in the lungs. 3. consolidation at the left base raises concern for pneumonia. 4. bilateral noncalcified lung nodules, measuring up to 8 mm in diameter. three-month ct followup is recommended. 5. splenomegaly, an enlargement of the splenic vein. 6. distended gallbladder. . tee the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. no thormbus or spontaneous echo contrast is seen in the left atrium/left atrial appendage/right atrium or right atrial appendage. left ventricular systolic function is good. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to 48 cm from the incisors. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. there is a 3.1 x 1.5cm mobile heterogeneous echodensity attached to the ?anterior leaflet of the tricuspid valve and herniating through the annulus with systole and diastole c/w a vegetation on the tricuspid valve. there is no pericardial effusion. . impression: large echogenic mass on the tricuspid valve c/w vegetation. mild-moderate tricuspid regurgitation. these findings were discussed with the housestaff (dr ) and the attending on at 11:15 am. . cxr comparison is made with prior study . cardiomediastinal contours are normal. left lower lobe retrocardiac opacity may be due to atelectasis or pneumonia. bilateral pleural effusions are small. there is no pneumothorax, discoid atelectasis are also present in the lower lung zone laterally. . ct chest/abdomen/pelvis impression: 1. findings consistent with a new interval multifocal pneumonia at the lung bases compared to the ct of . 2. numerous scattered pulmonary nodules stable compared to examination one week prior. a follow-up examination following treatment of underlying condition or in 3 months is again recommended. 3. there has been some interval improvement in ascites, pleural effusions, and anasarca. a small pericardial effusion is relatively stable in size. 4. status post left renal biopsy with persistent small amount of high-density material within the collecting system and along the renal capsule, likely hematoma. 5. probable thickening of the bladder wall although given the overall decompression of the bladder, this is difficult to assess. . chest ct without contrast (). 1. bilateral lower lobe pneumonia slightly increased, more prominently on the left. 2. slight increase in bilateral pleural effusions without specific evidence of loculation. 3. bilateral pulmonary nodules and nodular patchy opacities little changed. while these are likely infectious in nature, followup imaging after resolution of symptoms is recommended to assess resolution. 4. increased pericardial effusion. 5. unchanged fullness of imaged portion of left renal collecting system. . repeat tee (): demonstrated large, mobile vegetation on the tricuspid valve (2.7 x 1.7 cm on anterior leaflet), with moderate tricuspid regurgitation. no abcess seen. there is a small pericardial effusion. "compared with the findings of the prior study (images reviewed) of there are no significant changes." . bilateral lower extremity veins: impression: 1. no evidence of dvt in either lower extremity. 2. significant bilateral calf subcutaneous edema. . v/q scan impression: lobar matched defect in the left lower lobe, correlating with cxr and ct findings is indeterminate for pulmonary embolism. . ct chest no contrast: impression: 1. interval increased size of large left and small right simple pleural effusions with left lower lobe and lingula atelectasis. no evidence for pneumonia. 2. slight interval increase in size of simple pericardial effusion without evidence of tamponade. 3. stable subcarinal mediastinal lymphadenopathy measuring 18 mm. this may be secondary to the patient's history of endocarditis. . post-thoracentesis cxr impression: little overall change. . blood crossmatch: diagnosis, assessment and recommendations: mr. has a new diagnosis of anti-e antibody. e-antigen is a member of the rhesus blood group systems. anti-e antibody is clinically significant and capable of causing hemolytic transfusion reactions. this information was communicated to the clinical team on by telephone, and they were advised to follow hemolytic markers (hapto, bili, ldh) as well as renal function in case this patient is experiencing a delayed hemolytic transfusion reaction. his current laboratory parameters as well as a negative dat argue against ongoing hemolysis. in the future, mr. should receive e-antigen negative products for all red cell transfusions. approximately 71% of abo compatible blood will be e-antigen negative. a wallet card and a letter stating the above information will be sent to the patient. brief hospital course: 43 yo man with prolonged hospital course for mssa bacteremia, tv endocarditis, pneumonia, and acute renal failure. . #)id: fever/abx hx: after transfer to the floor, the patient experienced daily fevers. his antibiotic course on the floor is as follows, as formulated in consultation with the id team, which followed along. the patient received ciprofloxacin and vancomycin in the ed on and was switched to nafcillin after transfer to the floor. he remained on nafcillin for 3 days, developed a rash, and was switched back to vancomycin. he was on vanc for 6 days, the rash disappeared, but he continued to be febrile. levaquin was added on when pneumonia was identified. he was febrile for two more days, and so he was switched to cefepime. fevers continued, so 1 day later linezolid was added, but he remained febrile for 2 days. during this time the rash never reappeared but given his original reaction to nafcillin, it was thought that he might be cross reacting to cefepime. on he was switched back to vanc and ciprofloxacin. the patient's fevers decreased, with temperatures in the 99-100.5 range, and ciprofloxacin was discontinued after a total of 7 days of gram negative coverage. the patient remained on vancomycin 1 gm q24 (dosed by trough 15-20) for the remainder of his hospital stay (completing a total of 6 weeks of abx), and his fever curve slowly improved. a picc line was placed and removed before discharge. . #) endocarditis: while in the micu, patient got a tte () which was read as negative for vegetations or regurgitation, although the image quality was "suboptimal". after having persistent fevers on the floor, on appropriate abx, without a clear source, a tee was done () which demonstrated a large echogenic mass on the tricuspid valve, 2.7x1cm, with no evidence of abscess. he continued to spike fevers through abx so a repeat tee was done on , specifically looking for abscess, and none was seen, with no change in size of vegetation. a tte performed on showed persistence of 2.1x1 cm vegetation. the patient remained on telemetry monitoring for most of his hospital stay, and was observed to have tachycardia, pvcs and occasional short runs of nsvt, but remained asymptomatic during the nsvt events, with stable vitals. the cause of these events was unclear, although his first episode occurred initially after the placement of his picc line, possibly due to stimulation by the picc line guide-wire. cardiac surgery was consulted about the patient, and they did not favor surgical intervention at the time of the consult. cardiology was consulted about his ns vt events, and they saw the patient and deemed no further workup necessary, but wanted to see him for follow-up (appointment made with dr. , and dr. . the patient's antibiotic course is as described above; after switching to vanc/cipro, the cipro was stopped (after 7 days of gram negative coverage), and the patient was maintained on vancomycin 1gm q24, with therapeutic levels verified by trough 15-20 for the remainder of his admission, and discharged on after 6 weeks of antibiotics. . #)pneumonia: a ct torso was done on in an effort to identify a source for his persistent fevers while on what was thought to be appropriate abx. at that time chest findings were limited to two noncalcified lung nodules of unclear significance. a repeat ct torso was done on after his fevers failed to resolve, and bilateral pneumonia was demonstrated, and he was immediately started on levaquin. the etiology of the pneumonia included a hospital acquired pneumonia and septic staph emboli. (the patient's antibiotic course is as described above.)multiple attempts at induced sputum sufficient for culture failed. cxr performed on showed worsening of left pleural effusion. a v/q scan was performed to rule out pulmonary embolism, given the patient's persistent tachycardia, and it was read as indeterminate for pe, but it was felt low suspicion given lack of hypoxia. pulmonology was re-consulted and they recommended thoracentesis, which was performed by the procedures team. 1.6 liters of fluid were drained. gram stain, 1+ pmns, no organisms. acid fast smear negative. no bacterial or fungal growth. acid fast culture still pending at time of discharge. cytology negative for malignant cells. pleural fluid was intermediate in composition between a transudate (by ldh criteria) and an exudate (by protein criteria). follow-up cxr showed little change in appearance of left lung. pulmonology recommended not repeating thoracentesis unless patient became symptomatic. they also did not think pulmonology follow up was necessary. patient remained asymptomatic from a pulmonary standpoint for remainder of stay and reported significant improvement in his breathing. . #) bacteremia: blood cultures on admission and the day after both grew methicillin sensitive staph aureus. antibiotic course as described above. on his presenting exam there were no focal sites of infection. all blood cultures were negative after . the patient also had negative urine cultures, and stool cultures (including 4x negative c. diff cultures done for loose stools during the admission). he was also found to be hiv and hepb negative. . #) gu: - renal failure: cr. on admission 7.9. renal consulted and assisted in formulating care. renal biopsy from admission showed post infectious glomerulonephritis, with negative aso titer. he was initially treated with bicarb supplemented fluids, but was ultimately dialyzed between after persistent uremia, acidemia and what appeared to be the development of mental status changes. after 4 dialysis sessions his renal function began to recover on its own. the patient developed hyperkalemia, with a highest k of 5.9. he was placed on a low potassium renal diet, and his beta blocker was stopped, and given a couple of doses of kayexalate. his hyperkalemia resolved, and did not return, and diet restrictions were liberalized. on discharge, the patient's cr had improved dramatically to 1.8-2.0. the renal team signed off with the recommendation that the patient have outpatient renal follow up, and an outpatient appointment has been made. . - hematuria and urinary obstruction: the initial renal biopsy led to hematuria that persisted until . throughout this time the patient had a 3way foley with continuous bladder irrigation. urology was consulted. the hematuria stopped after a large bladder clot was manually removed, suggesting the possibility that the hematuria was not due to active bleeding, but possibly clot erosion. the patient subsequently had additional clots over his stay, with no further bleeding (and negative urine culture). these subsequent clots caused temporary urinary obstruction, and straight cath was attempted to drain bladder. these clots passed spontaneously, and urology was called about future management. they recommended hand irrigation of the bladder with a 2-way catheter. the patient refused to have his bladder irrigated in this way, so it was not done, and clots did not present any further problems during the rest of his admission. . #) anemia: admission hct was 31, with mcv of 81; iron studies showed iron 17, tibc 178, haptoglobin 284, ferritin 633, transferrin 137. he continued to have a gradual hct drop even after the hematuria stopped, requiring transfusion on two occasions. the patient received 8 units of blood during his 6 week hospital course; his hct hovered in the 21-25 range, and the patient was transfused when his hct dropped below 21. during his first transfusion, the patient developed chills, which was determined not to be due to transfusion reaction by the blood bank. the patient was also started on ferrous sulfate at the recommendation of the renal team, given the possibility that an iron deficiency was obscured by an acute-phase elevation of his ferritin. he was also given one doese of epo, for the case that his renal failure was contributing to his anemia, but it was decided not to give any further epo injections. the patient was guaiac negative on admission, but was subsequently found to be guaiac positive, with no evidence of gross blood at any time in stool. the patient's stools were monitored for the duration of his stay, and it was felt that any potential source of gi bleeding could safely be worked up on an outpatient basis. after the patient's last transfusion (1 unit of prbc) on , the blood bank found that the patient had developed a big e antigen. the patients hemolysis labs were checked and his ldh, and bilirubin were found to be normal, and haptoglobin 236. additionally, his hct went from 21.8-25.3, and the patient remained afebrile, suggesting that the patient had not developed a hemolytic transfusion reaction. however, given that reactions can be delayed, the patient was told to monitor himself for fever or other symptoms after discharge (jaundice or discolored urine) and seek immediate medical attention if they developed. . #) transaminitis: the patient developed a transaminitis during his admission. he was found to be hepb and hepc negative. the transaminase levels returned to by . . #) code: full . the patient was discharged to home with id, renal, cardiology, and pcp in . in addition, he was instructed to have repeat blood cultures drawn as an outpatient. medications on admission: none, minimal amounts of acetaminophen and ibprofen for his recent illness. discharge medications: 1. outpatient lab work please draw surveillance blood cultures on . go to the lowre building at to have these done 2. hexavitamin tablet sig: one (1) cap po daily (daily). 3. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnoses: - actute bacterial endocarditis with tv vegitation - mssa bacteremia - post-infectious glomerulonephritis - pneumonia secondary diagnoses: - hypertention - hyperkalemia discharge condition: stable, ambulating independently, no oxygen requirement. discharge instructions: you were admitted for treatment for acute bacterial endocarditis with a vegitation on the tricuspid valve (bacterial infection of your heart valve), mssa bacteremia (methacillin-sensitive staph aureus bacteria in your blood), pneumonia, pleural effusions, and acute renal failure (found to be caused by post-infectious glomerulonephritis by biopsy). . please seek immediate medical attention if you develop fevers, chills, shortness of breath, chest pain, palpitations, swelling of your ankles, or any other concerning symptoms. . we have started you on iron replacement, please take this as instructed. please maintain all of your follow-up appointments that are listed below. followup instructions: the following appointments have been made for you. you must call each of these offices with your new insurance information as soon as possible (phone numbers are listed below with each appointment). you are currently listed as self-pay. you will also need to have surveillance blood cultures drawn on /8 in the at , to be followed up by dr. on your appointment. you will need a repeat echo, weeks after your last dose of vancomycin (), to be arranged by your pcp or id physician. . 1.) new primary care provider: , md phone: date/time: 8:00 . 2.) infectious disease clinic: provider: , md phone: date/time: 11:30 (located at ) . 3.) clinic: provider: , md phone: date/time: 8:30. location: building medical specialties. . 4.) cardiology clinic: provider: . and dr. () 10:00am. md procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart hemodialysis venous catheterization for renal dialysis closed [percutaneous] [needle] biopsy of kidney transfusion of packed cells insertion of indwelling urinary catheter transurethral clearance of bladder diagnoses: hyperpotassemia unspecified pleural effusion unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified severe sepsis methicillin susceptible staphylococcus aureus septicemia paroxysmal ventricular tachycardia hemorrhage complicating a procedure other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site methicillin susceptible pneumonia due to staphylococcus aureus acute and subacute bacterial endocarditis malnutrition of mild degree septic pulmonary embolism acute glomerulonephritis in diseases classified elsewhere 

Answer: The patient is high likely exposed to