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: this is a 63 year old primarily spanish speaking male with a history of end-stage renal disease secondary to diabetes mellitus on dialysis. the patient also has a history of coronary artery disease, chronic obstructive pulmonary disease, recurrent methicillin resistant staphylococcus aureus/vre dialysis catheter infection and status post methicillin resistant staphylococcus aureus epidural abscess of l2 to 3, status post incision and drainage in . the patient is now here from his outpatient hemodialysis center with a fever up to 103.3 f., lethargy and back pain. per the hemodialysis center notes the patient had a temperature the previous night at home, however, he was afebrile at the beginning of his hemodialysis session. the patient was given tylenol for his back pain which did not help. the patient also complained of increased back pain. his pain was mostly between the shoulders. temperature came down to 101.8 f. blood cultures were drawn times two. the patient was given one gram of kefzol and 80 mg of intravenous gentamicin and sent to the emergency department. at , the patient was given 1 gram of vancomycin and 2 grams of ceftriaxone. a lumbar puncture was performed. a head ct scan was performed and was negative. the patient received about a liter of intravenous fluids. initially, the patient was only minimally responsive and could only open his eyes, however, he quickly perked up and after the antibiotics, he was alert and oriented times three. he complained of mild headache, mostly bifrontal and mild neck pain as well as the thoracic back pain. the patient denied any chest pain or shortness of breath. past medical history: 1. end-stage renal disease on hemodialysis. 2. diabetes mellitus, non-insulin dependent. 3. chronic obstructive pulmonary disease. 4. one vessel coronary artery disease, status post catheterization in ; status post left circumflex percutaneous transluminal coronary angioplasty and stent. 5. congestive heart failure. 6. history of methicillin resistant staphylococcus aureus l2 to 3 epidural abscess with incision and drainage in . 7. recurrent line infections with methicillin resistant staphylococcus aureus, vre and klebsiella. 8. thrombosis in right internal jugular, right subclavian and right brachiocephalic veins in 10/. 9. peptic ulcer disease. 10. hypertension. 11. history of medication noncompliance. medications on admission: 1. epogen. 2. coumadin 4 mg p.o. q. day. 3. ambien 5 mg q. h.s. 4. amitriptyline 25 mg p.o. q. day. 5. protonix 40 mg p.o. q. day. 6. aspirin 325 mg p.o. q. day. 7. plavix 75 mg p.o. q. day. 8. norvasc 10 mg p.o. q. day. 9. enalapril 20 mg p.o. q. day. 10. metoprolol 25 mg p.o. three times a day. 11. tylenol p.r.n. 12. senna p.r.n. 13. colace p.r.n. 14. tums with meals. 15. regular insulin sliding scale. social history: the patient is married and is a nonsmoker and nondrinker. family history: noncontributory. physical examination: temperature 103.2 f.; blood pressure 128/44; pulse 88; respiratory rate 14; o2 saturation 100% on two liters. in general, the patient is alert and oriented times three in no apparent distress. heent: oropharynx clear; anicteric. pupils equally round and reactive to light and accommodation. extraocular movements are intact. neck supple; no lymphadenopathy. generalized plethora and edema of neck. cardiovascular: regular rate and rhythm, no murmurs, gallops or rubs. lungs are clear to auscultation bilaterally. chest: left sided quinton dialysis catheter without any surrounding erythema or exudate, nontender. back with no costovertebral angle tenderness. minimal paraspinal thoracic tenderness to palpation. extremities: cachectic; no cyanosis, clubbing or edema. left sided av fistula with positive thrill. abdomen soft, nontender, nondistended. normoactive bowel sounds. no hepatosplenomegaly, masses or bruits. neurologic: alert and oriented times three. no focal signs. laboratory: white blood cell count 14.7 with a differential of 92% neutrophils, 11% lymphocytes, hematocrit 34.3, platelets 127, sodium 141, potassium 3.5, chloride 99, bicarbonate 27, bun 25, creatinine 3.5, glucose 224. ck 22, pt 16.4, ptt 42.7, inr 1.8. lumbar puncture tube #1, 9 white blood cells with 6% polys, 48% lymphocytes, 46% monocytes, 18 red blood cells. glucose 173. tube #2, white blood cells 9 with a differential of 2% polys, 51% lymphocytes, 47% monocytes, 3 red blood cells and a protein of 37. chest x-ray with poor inspiration, diffuse haziness but no focal infiltrates. head ct scan with no evidence of bleeding or masses. ekg with normal sinus rhythm at 99 beats per minute. t wave inversions in i and avl, depressions with t wave inversions in v4 through v6. biphasic t waves in v2 to v3. no old electrocardiograms accessible for comparison. hospital course: in short, this is a 63 year old spanish speaking male with a history of end-stage renal disease on hemodialysis, diabetes mellitus, coronary artery disease status post left circumflex stent, chronic obstructive pulmonary disease, history of recurrent dialysis catheter infections with methicillin resistant staphylococcus aureus and vre, and history of methicillin resistant staphylococcus aureus epidural abscess, who now presents with fever, lethargy, back pain and headache. 1. infectious disease: the patient did not have any further high spikes after being admitted. he had only low spikes for a couple of days and then was afebrile afterwards. the patient had blood cultures drawn in the emergency department. these were negative without any growth. the patient's fever was presumed to be secondary to his left sided quinton catheter, even though it did not show any obvious signs of infection. the patient was kept on a regimen of vancomycin and gentamicin for broad coverage. of note, the patient's blood cultures from his dialysis center were found to be positive, growing four out of four tubes of methicillin sensitive staphylococcus aureus. this was found to be overall pan sensitive, only resistant to penicillin, ampicillin and tetracycline. however, the mic was only low for oxacillin at a level of 0.25. for this reason, the patient was switched from vancomycin and gentamicin to intravenous oxacillin at a dose of 1 gram q. four hours. his quinton dialysis line was pulled after dialysis was started with his left av fistula. the quinton tip also grew methicillin sensitive staphylococcus aureus. the patient was unable to have a right sided picc line placed because of the extensive network of clots in his right internal jugular, subclavian and brachiocephalic veins. however, a midline catheter was successfully placed on . the patient was continued on intravenous oxacillin. because the patient was also having back pain, and given his history of an epidural abscess, there was a concern that he might have seeded his vertebrae, thus causing osteomyelitis. the patient received an mri of the spine. this was negative for an epidural abscess, but did show increased signal and paravertebral swelling anterior to c3 through 5, suspicious for osteomyelitis. even though this is not the area where the patient was having pain, it was decided that the patient should be treated for presumed osteomyelitis for a total of six weeks on antibiotics. given that the patient was bacteremic with methicillin sensitive staphylococcus aureus, there was also concern that he may have seeded his heart valves. the patient had a transthoracic echocardiogram a couple of days after admission. this showed low normal left ventricular ejection fraction, small asd, but only mild mitral regurgitation and no change in his valves. a transesophageal echocardiogram was planned for , but during the procedure, the patient was unable to tolerate the tube and therefore it was aborted. 2. access: as already noted, the patient came in with a left sided quinton catheter. he also had an av fistula with a positive thrill that had been placed in , but had not been used yet. the quinton catheter was taken out after the av fistula was tested and found to be usable. a midline catheter was placed in the right side for intravenous antibiotics. unfortunately, after a couple of sessions of dialysis, it was realized that there was not good blood flow going through the left sided av fistula. the patient initially had an av fistula ultrasound and then an av fistulogram. this revealed the stenosis between the arterial and venous components. the patient had an angioplasty to open up the av fistula. this was performed by transplant surgery. as a temporary measure, the patient received a central line for dialysis through his left sided ej. transplant surgery's recommendation was to leave the av fistula alone for one to two weeks following the angioplasty and then to retest it. 3. cardiovascular: the patient's initial presentation had some concerning t wave and st changes on his ekg even though an old ekg was not accessible. the patient was ruled out by serial cardiac enzymes. he had no episodes of chest pain or shortness of breath. the patient was kept on his regimen of aspirin, plavix, lopressor, and enalapril for cardiac health. the patient also received a nitroglycerin patch. 4. hematologic: the patient has a history of right sided clots in his internal jugular, subclavian, brachiocephalic veins; for this reason, he is on anticoagulation. because of all the interventional procedures performed, the patient was mostly off of coumadin, but was kept on a heparin drip towards the end of his stay. we were just waiting for his coumadin to become therapeutic. he was placed on 7.5 mg of coumadin. his inr on , was 1.6. it was expected to become therapeutic by , with a goal range of probably between 2.0 to 3.0. 5. renal: the patient is followed closely by the renal team. he received hemodialysis every monday, wednesday and friday. there were no further complications during hemodialysis including fever, hypotension, or volume overload. condition at discharge: good. discharge medications: 1. coumadin 7.5 mg p.o. q. day. 2. calcium carbonate 1000 mg p.o. three times a day, taken with meals. 3. oxacillin 1 gram intravenous q. four hours, to be taken until . 4. sarna lotion, one application topically twice a day p.r.n. 5. nitroglycerin ointment 2%, 0.5 inches topically q. six hours. 6. ambien 5 mg p.o. q. h.s. p.r.n. 7. percocet one tablet p.o. q. four to six hours p.r.n. back pain. 8. nitroglycerin 0.3 mg sublingually p.r.n. chest pain. 9. milk of magnesia 15 to 30 ml p.o. four times a day p.r.n. 10. bisacodyl 10 mg p.o./p.r. q. day p.r.n. 11. lopressor 100 mg p.o. three times a day; hold for systolic blood pressure less than 100, pulse less than 60. 12. norvasc 10 mg p.o. q. day. 13. enalapril 20 mg p.o. q. day. 14. plavix 75 mg p.o. q. day. 15. enteric coated aspirin 325 mg p.o. q. day. 16. protonix 40 mg p.o. q. 24 hours. 17. amitriptyline 25 mg p.o. q. h.s. 18. colace 100 mg p.o. twice a day. 19. senna two tablets p.o. q. day. 20. tylenol 325 to 650 mg p.o. q. four to six hours p.r.n. 21. lantus 15 units subcutaneously q. a.m. 22. regular insulin sliding scale. discharge instructions: 1. the patient is to be discharged to east point rehabilitation once his inr is within therapeutic range. 2. the patient will follow-up with his renal doctors. 3. the patient will continue to receive hemodialysis every monday, wednesday and friday. 4. the patient will also need to be seen for removal of his temporary external jugular dialysis catheter once his av fistula is retested and working again. discharge diagnoses: 1. methicillin sensitive staphylococcus aureus bacteremia, now resolved. 2. osteomyelitis. 3. end-stage renal disease on hemodialysis. 4. diabetes mellitus. 5. coronary artery disease, status post left circumflex stent. , m.d. dictated by: medquist36 procedure: spinal tap incision of lung hemodialysis angioplasty of other non-coronary vessel(s) venous catheterization for renal dialysis diagnoses: congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified unspecified osteomyelitis, other specified sites percutaneous transluminal coronary angioplasty status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease bacteremia infection and inflammatory reaction due to other vascular device, implant, and graft diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to