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: septic left knee major surgical or invasive procedure: - left knee washout history of present illness: mr. is a 58 year-old male with a history notable for kidney-pancreas transplant 15 years ago (on immunosuppressive therapy), diabetes (on insulin), htn, hld, ckd, pvd (status-post l bka, r tma) who presented to today for left knee pain and swelling. of note, he does have a chronic ulcer over his left stump for years that usually does not drain. on friday, he noted the onset of left knee swelling. denied trauma to the area or any open wounds around the site. over the weekend, his symptoms progressed, with intensified pain, and he developed chills and a temperature to 100.7 on the day of presentation. he did continue to wear his prosthesis over the weekend. from , he was referred to clinic. in clinic, he had his knee aspirated which returned 50cc of cloudy fluid concerning for septic arthritis. from there, he was referred to the ed for concern of septic arthritis. in the ed, initial vs were: 101.3 133 106/65 18 99% ra. labs showed wbc of 9.7, hct 34.3, cr of 2.7 (baseline 1.6-2.0), k 5.8. joint fluid analysis showed wbc of with 93% polys as well as "few rhomboid extracellular positively birefringent c/w calcium pyrophosphate" as well as crystals c/w monosodium urate crystals. gram stain was positive for 2+ gram positive cocci as well as 4+ leukocytes. blood and urine cultures were sent. lactate was 3.0. orthopedics was consulted who recommended icu admission and npo for or tomorrow. he was given vancomycin 1gm iv and meropenem 1gm iv as well as morphine 5mg iv x1. on transfer, vitals were: temperature 99.5 ??????f (37.5 ??????c). pulse 129. respiratory rate 18. blood pressure 117/89. o2 saturation 99. o2 flow ra. pain level . on arrival to the micu, patient was tachycardic but otherwise vss without acute distress. past medical history: type 1 diabetes, status post kidney and pancreas transplant with subsequent 'burnout' of the pancreatic graft, now on insulin (patient states his dm is now treated more like a type ii s/p pancreatic transplant) congestive heart failure, ef 60-65% on echo , calcified aortic and mitral valves. hypertension hyperlipidemia pvd s/p l bka, r tma, and multiple digit amputations both hands dvt in chronic kidney disease baseline cr 1.6 tertiary hyperparathyroidism s/p parathyroidectomy (three lobes). sleep apnea (patient does not use cpap) multiple admissions for osteomyelitis. social history: previously smoked 2 ppd for 10 years, but quit 20 years ago. drinks alcohol rarely on social occasions. denies use of illicit drugs. volunteers in the hospital as a patient liaison. lives with daughter and wife at home. family history: diabetes runs on both sides of his family, many generations. physical exam: admission phyiscal exam vitals: t: 101.3. hr 124. bp 131/71. rr 20 95% on ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: tachycardic, normal s1 + s2, pansystolic murmurs in the aortopulmonic region without radiation to the carotids or the axilla, no rubs or gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding gu: no foley ext: left bka. left knee edematous and warm with ttp lateral to the patella. stump with chronic keratosed wound. right lower extremity with missing phalanges. chronic ulceration on right mcp-pcp joint and well as lateral aspect of right foot. neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, gait deferred. discharge exam - unchanged from above, except as below: cv: rrr, 1/6 systolic murmur heard throughout the precordium extr: left knee still mildly tender to palpation, minimal pain with rom. no erythema or drainage from the incision site. pertinent results: admission labs: 08:20pm urine color-yellow appear-hazy sp -1.007 08:20pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.5 leuk-lg 08:20pm urine rbc-1 wbc-2 bacteria-none yeast-none epi-<1 08:20pm urine mucous-rare 07:24pm lactate-3.0* 07:10pm glucose-250* urea n-71* creat-2.7*# sodium-135 potassium-5.8* chloride-97 total co2-16* anion gap-28* 07:10pm estgfr-using this 07:10pm crp-greater th 07:10pm wbc-9.7# rbc-4.05* hgb-10.8* hct-34.3* mcv-85 mch-26.6* mchc-31.4 rdw-14.7 07:10pm neuts-90.4* lymphs-5.8* monos-3.2 eos-0.5 basos-0 07:10pm plt count-255 07:10pm pt-13.1* ptt-25.0 inr(pt)-1.2* 07:10pm sed rate-121* 05:15pm joint fluid wbc-* rbc-750* polys-93* lymphs-2 monos-0 macrophag-5 05:15pm joint fluid number-few shape-needle location-i/e birefri-neg comment-c/w monoso discharge labs: 05:09am blood wbc-3.7* rbc-3.28* hgb-8.5* hct-28.1* mcv-86 mch-26.0* mchc-30.3* rdw-15.3 plt ct-328 05:09am blood glucose-68* urean-54* creat-1.5* na-143 k-4.4 cl-104 hco3-27 angap-16 05:09am blood calcium-8.8 phos-3.3 mg-1.8 micro data: -left knee joint fluid: **final report ** gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and singly. reported to and read back by dr. and (ed) @ , . fluid culture (final ): staph aureus coag +. sparse growth. daptomycin and doxycycline requested by dr. # . daptomycin mic = 0.19 mcg/ml sensitivity testing performed by etest. sensitive to doxycycline sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin-----------<=0.25 s daptomycin------------ s erythromycin---------- r gentamicin------------ <=0.5 s levofloxacin---------- 4 r oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s -all bcx were no growth at the time of discharge imaging: -l knee plain film () impression: 1. status post below left knee amputation. 2. small-to-moderate suprapatellar joint effusion. 3. no evidence of acute fracture or dislocation. 4. osteoarthritic changes, as above. 5. extensive vascular calcifications. -tte (): the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets are moderately thickened. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: no vegetations seen. mild symmetric hypertrophy with vigorous global and regional biventricular systolic function. aortic sclerosis withotu frank stenosis. mild mitral regurgitation. mild pulmonary hypertension. -cxr (): a new right-sided picc line tip ends just in the right upper atrium. consider pulling the picc line by 2 cm to position the picc line at low svc or cavoatrial junction. there is no pneumothorax or pleural effusion. small bibasilar atelectasis is present. heart size, mediastinal and hilar contours are normal. brief hospital course: 58 year-old male with history of type i dm s/p failed pancreatic transplant and working renal transplant/stage iii ckd, dchf, and pvd s/p left bka here with septic arthritis of his left knee # left knee septic arthritis: initial presentation was concerning for septic arthritis and patient was sent from his appointment to the ed. he was seen by orthopedics and had a washout of the left knee on . he has multiple skin ulcers in the area of his amputation sites, which may have been the original source of his infection (although blood cultures this admission were negative and no evidence of bacteremia). he was initially started on vancomycin which was changed to cefazolin when the culture results from the joint fluid showed mssa. infectious disease was consulted. of note, he is allergic to nafcillin (caused leukopenia and according to records). his pain improved and he was afebrile at the time of discharge. he will continue a 5 week course of cefazoloin at home after discharge. he had a picc line placed and will have home iv infusion services to assist him with the antibiotics. he will be followed by the clinic after discharge with weekl labs drawn by his vna. blood cultures remained negative at the time of discharge. # esrd s/p renal transplant with on stage iii ckd: creatinine was initially elevated to 2.7 at admission and improved back to baseline after he was fluid resuscitated. likely etiology was pre-renal azotemia in the setting of sepsis. his lisinopril was held because of the . bp remained well controlled and he will hold lisinopril at discharge, will disucss with outpatient providers when to restart this. his cyclosporine was discontinued in the setting of a severe infection. sirolimus dose was decreased to 0.5mg daily. he will have rapamycin level checked after discharge and faxed to dr. office. # anemia: his hct remained close to his baseline of high 20s to low 30s, baseline very variable in our records. etiology likely related to his renal disease. he did not receive any blood transfusions and did not have any evidence of active bleeding. # metabolic acidosis, non-anion gap: bicarbonate reached a nadir of 13 this admission. he was initially not receiving his home dose of po bicarbonate. given that he is s/p pancreatic transplant, he is likely wastnig significant amounts of bicarbonate into his bowel. after he was restarted on his po doses of bicarbonate, his acidosis improved. # t1dm s/p failed pancreatic transplant: he was continued on his home doses of glargine and a humalog sliding scale with fair control of his blood sugar. as described above, he was restarted on his home doses of po bicarbonate. --chronic issues-- # hypertension: held lisinopril as above, can be restarted as an outpatient if cr stable and bp elevated. # hyperlipidemia: continued on home dose of atorvastatin. # peripheral vascular disease: continued on home aspirin dose. # bph: continue the patient's home tamsulosin and finasteride. #code status this admission: full #transitional issues: -will have rapamycin level checked as an outpatient, dose decreased this admission and may need to be titrated -cyclosporine discontinued this admission in the setting of infection, consider restarting as an outpatient after he has completed his course of antibiotics -will receive a total of 5 weeks of cefazolin after discharge via picc line. followed by clinic -has follow-up arranged with his transplant nephrologist and orthopedics after discharge -consider restarting lisinopril as an outpatient, held at discharge because of medications on admission: atorvastatin - 20 mg tablet - 1 tablet(s) by mouth qpm cyclosporine modified - (dose adjustment - no new rx) - 100 mg capsule - 1 capsule(s) by mouth twice daily please do not change among generics. cyclosporine modified - 25 mg capsule - 1 capsule(s) by mouth twice a day v42.0 finasteride - 5 mg tablet - 1 tablet(s) by mouth once a day insulin aspart - 100 unit/ml solution - 5 units at lunch and 10 units at suppertime as directed insulin glargine - 100 unit/ml (3 ml) insulin pen - 34 units daily at night please dispense 90 day supply= 3 boxes of 5 pens. lisinopril - 5 mg tablet - 1 tablet(s) by mouth daily omeprazole - 20 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth once a day prednisone - 5 mg tablet - one tablet(s) by mouth once daily sirolimus - 1 mg tablet - 1 tablet(s) by mouth daily tamsulosin - 0.4 mg capsule, ext release 24 hr - 1 capsule(s) by mouth at bedtime zolpidem - 5 mg tablet - one tablet(s) by mouth at bedtime as needed for sleep . medications - otc aspirin - (prescribed by other provider; otc) - 325 mg tablet - one tablet(s) by mouth once daily calcium citrate-vitamin d3 - (otc) - 315 mg-200 unit tablet - 1 tablet(s) by mouth daily insulin needles (disposable) - 29 gauge x " needle - use one daily as directed with lantus solostar insulin syringe-needle u-100 - 28 gauge x " syringe - use as directed three times a day; ml insulin syringes w/28 gauge "needles; please dispense 90 day supply mv,ca,min-iron-fa-lycopene - (otc) - 8 mg (iron)-200 mcg-600 mcg tablet - 1 tablet(s) by mouth daily sodium bicarbonate - (dose adjustment - no new rx) - 650 mg tablet - 3 tablet(s) by mouth three times a day discharge medications: 1. atorvastatin 20 mg tablet sig: one (1) tablet po hs (at bedtime). 2. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 3. insulin glargine 100 unit/ml solution sig: thirty four (34) units subcutaneous at bedtime. 4. insulin aspart 100 unit/ml solution sig: sliding scale units subcutaneous three times a day: 5 units as lunchand 10 units at dinner. sliding scale: 151-200: 4 units, 201-250: 6 units, 251-300: 8 units, 301-350: 10 units, 351-400: 12 units, over 400: md. 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 7. sirolimus 0.5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 8. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 9. zolpidem 5 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 10. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 11. multivitamin tablet sig: one (1) tablet po daily (daily). 12. acetaminophen 325 mg tablet sig: 1-2 tablets po every four (4) hours as needed for fever or pain: md if giving for fever. 13. cefazolin 1 gram recon soln sig: two (2) grams intravenous every eight (8) hours for 32 days: last dose on . disp:*32 days* refills:*0* 14. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush: for picc flush. disp:*qs 32 days* refills:*0* 15. sodium bicarbonate 650 mg tablet sig: three (3) tablet po three times a day. 16. morphine 15 mg tablet sig: one (1) tablet po every 4-6 hours as needed for pain for 7 days. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: nursing services discharge diagnosis: primary diagnoses: septic arthritis secondary diagnoses: type 1 diabetes s/p pancreas transplant end stage renal disease s/p kidney transplant peripheral vascular disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , it was a pleasure taking care of you during your admission to for joint pain and fevers. you were found to have septic arthritis, which is an infection inside your left knee. this was treated with iv antibiotics and the orthopedic surgeons washed out the joint in the operating room. your fevers and pain improved and you will be discharged to rehab to continue your course of iv antibiotics. please do not bear weight on your left knee until you are seen by the orthopedic surgeons in follow-up next week. the following changes were made to your medications: start cefazolin 2grams every 8 hours for a total of 5 weeks (last dose ) start morphine sulfate 15mg every 4-6 hours as needed for pain change sirolimus to 0.5mg daily stop lisinopril, dr. will discuss with you when to restart this stop cyclosporine, dr. will discuss with you when to restart this followup instructions: you will be contact regarding an appointment with the transplant infectious disease clinic after discharge. if you do not hear from them in the next week, please call . department: transplant center with: , md building: lm campus: west best parking: garage ***the office is working on a follow up appt for you in the next 1-2 weeks and will call you at the rehab with the appt. if you dont hear from them by tuesday, please call the office directly to book. department: orthopedics when: tuesday at 11:40 am with: , np building: campus: east best parking: garage department: podiatry when: wednesday at 9:40 am with: , dpm building: ba ( complex) campus: west best parking: garage md procedure: other local excision or destruction of lesion of joint, knee arthrocentesis synovectomy, knee diagnoses: acidosis hyperpotassemia anemia in chronic kidney disease congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) chronic kidney disease, stage iii (moderate) hypotension, unspecified methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site long-term (current) use of insulin surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation unspecified hereditary and idiopathic peripheral neuropathy examination of participant in clinical trial complications of transplanted kidney below knee amputation status chronic diastolic heart failure acute gouty arthropathy pancreas replaced by transplant chronic ulcer of other specified sites foot amputation status pyogenic arthritis, lower leg other finger(s) amputation status 

Answer: The patient is high likely exposed to