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: benzodiazepines / oxycodone attending: chief complaint: bacteremia major surgical or invasive procedure: transesophageal echocardiogram picc line placement history of present illness: mr. is a 78 year old gentleman with dm, cri, htn s/p avr (porcine) and 2 vessel cabg (lima--> lad, svg-->om1) in transfered from osh with ? prosthetic aortic valve mrsa endocarditis. pt initially presented to osh on with low grade fevers, n/v, diarrhea. had recent admission for pna at same hospital. pt had persistent fevers and blood cxs grew high grade gpc found to be mrsa. at this time pt also had plt drop (222-->86), creat 1.9->2.9 and hct drop. felt pt had dic although per osh records no schistocytes on smear. however, counts recovered prior to transfer. pt underwent tee at osh which showed veg on prosthetic valve, no abscess. pt transfered to ct for further management. during this time pt initially treated with vanc/ ctx, changed to vanc/gent after tee on . of note, pt reports multiple tooth extractions prior to admission. he underwent tee which showed prosthetic valve thickening but no vegetation. he is followed by infectious diseases. bl cx drawn on admission to are pending. he was transferred to medicine service to undergo w/u of source of bacteremia as cardiac surgery did not feel valve replacment indicated given the negative tee. past medical history: cad s/p ptca lad ' and cabgx2 (lima->lad, svg->om2) aortic stenosis s/p avr (tissue) htn dm hypercholesterolemia cri (baseline 2.3-2.5) prostate ca s/p prostectomy c artificial urinary sphincter placement copd, dm, gout, h/o mrsa uti h/o gi bleed s/p b hip replacementwith revision 8 years ago s/p ccy social history: pt denies etoh, quit tob 40 yrs ago, retired owner of a cleaning business, veteran. family history: mother with dm, sister with dm physical exam: vs: t 98.6 tm 101.0 bp 128/47 rr 18 94% ra gen: comfortable appearing, heard of hearing, but nad heent: op clear w/o exudate, no obvious infection of of teeth. tenderness to palpation of left mandible and temporal bone cv: rrr s1s2, late systolic murmur best at lusb resp: decr bs b/l and with course crackles at bases abd: +bs, soft, nd/nt ext: 1+ le edema b/l, 2+ pp b/l neuro: aao x 3 pertinent results: 03:59pm pt-14.7* ptt-33.4 inr(pt)-1.3* 03:59pm plt count-138* 03:59pm wbc-10.2# rbc-3.08* hgb-9.3* hct-27.8* mcv-90 mch-30.3 mchc-33.6 rdw-17.2* 03:59pm genta-<0.3* vanco-10.6 03:59pm calcium-8.4 phosphate-3.4 magnesium-1.9 03:59pm ck-mb-notdone ctropnt-0.05* 03:59pm alt(sgpt)-48* ast(sgot)-38 ld(ldh)-485* ck(cpk)-44 alk phos-96 tot bili-0.6 03:59pm glucose-188* urea n-46* creat-2.3* sodium-131* potassium-4.4 chloride-105 total co2-16* anion gap-14 04:43pm urine blood-mod nitrite-neg protein-100 glucose-tr ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 04:43pm urine color-straw appear-clear sp -1.013 04:43pm urine rbc-0-2 wbc- bacteria-few yeast-none epi-0-2 04:43pm urine granular-0-2 . pcxr : a single ap view of the chest is obtained and is compared with the prior study of . the heart is not enlarged. there is evidence of prior cardiac surgery. there appear to be bilateral pleural effusions. there is haziness of the pulmonary vasculature and especially in the perihilar areas and the findings likely represent failure . transesophageal echocardiogram : the left atrium is dilated. no mass/thrombus is seen in the left or right atrium/atrial appendage. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the aortic arch and descending thoracic aorta. a bioprosthetic aortic valve prosthesis is present. the right coronary cusp of the prosthetic aortic valve appears thickened without a definite vegetation. a small paravalvular aortic valve leak is present near the junction of the right and left coronary cusps. no aortic valve abscess is seen. trace (physiologic) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. moderate (2+) mitral regurgitation is seen. no vegetation/mass is seen on the mitral, tricuspid or pulmonic valves. there is no pericardial effusion. . tee : impression: small vegetation on right coronary leaflet of bioprosthetic aortic valve. mild-to-moderate mitral regurgitation. preserved biventricular systolic function. . cxr: ap upright portable chest x-ray: the patient is status post median sternotomy and coronary artery bypass graft. the cardiac silhouette, mediastinal and hilar contours are normal and stable. there are dense intramural aortic calcifications. the pulmonary vasculature is normal and there is no pneumothorax. small, stable pleural effusions are again noted, with bibasilar linear and patchy atelectasis. the surrounding soft tissue and osseous structures are unchanged. impression: no significant interval change in small bilateral pleural effusions with bibasilar atelectasis brief hospital course: mr. is a 78 y/o m with h/o dm, cri, htn s/p avr (tissue) and 2 vessel cabg (lima--> lad, svg-->om1) in who presented to osh with fevers, n/v/d. he was transfered to with a question of prosthetic aortic valve mrsa endocarditis after having had several tooth extractions prior to admission. he had had a recent admission at this osh for pna. since then, he had persistent fevers, and blood cultures revealed mrsa. at that time pt also had plt drop (222-->86), creat 1.9->2.9 and hct drop and there was concern for dic however blood counts recovered before transfer. tee at osh showed vegetations on the prosthetic valve and he was treated with vancomycin and ceftriaxone, then vanc/gent which was started on . pt transfered to ct service and repeat tee performed which was negative for vegatiation. pt was transfered to the medicine service for further management. . on the medicine service, he had an mi, diagnosed when he had cp, sob, and diaphoresis on the morning of . ekg showed dynamic st/twi in ii, iii, avl, v3-v6 and he had positive ces. he had a cath which showed rca patent, occluded lm, lad, lcx. om1 occluded and om2 perfused via svg. he had a bare metal stent placed to the lcx. . the following morning he became acutely confused after receiving 2.5mg of seroquel and 0.25 mg ativan x2. a stat head ct was negative. he was transferred to the ccu for close monitoring and further care. in the ccu, ortho was consulted, who felt his hip was highly unlikely to be the source of his infection. id continued to follow the patient throughout his admission. he had an episode of tachypnea, for which he received lasix. . the tee was repeated on given persistent positive blood cultures and revealed aortic valvular vegetation. vancomycin was continued. ct surgical consultation obtained regarding valve replacement and significant discussion with family re. risks and benefits of the operation. dr. with ct surgery re-evaluated the patient and decided long term iv antibiotics would be the best approach for positive outcome at this time. . # pt with multiple blood cultures with mrsa at , which meets criteria for endocarditis (1 major, 3 minor) but did not have clear vegetation on tee in this hospital initially. started on vanco/gent (renally dosed). pt also has chronic diarrhea s/p radiation for his prostate ca, he was negative for c. diff toxin on multiple stool exams, o&p exam negative. pt had recent dental procedure, along with significant tenderness of his facial and mandibular bones on exam. repeat panorex and dental consult did not indicated any need for surgical extraction. he should continue on iv vancomycin for full 8 weeks starting from dosed 1gram every other day. . # renal- the patient developed acute renal failure in setting of gentamicin and vancomycin despite renal dosing. gentamicin was discontinued. the renal service was consulted. kidney function steadily improved, (baseline cr 2.1-2.5) his discharge cr 2.8. vancomycin levels should be drawn weekly to ensure optimum concentration and limit potential renal toxicity. levels should be drawn just prior to next dose for a trough. . # anemia- the patient has h/o of anemia of chronic disease. his hct has remained stable since admission. his stools were guaiac negative. hemolysis labs revealed evidence hemolysis in the setting of aortic valve disease. he was re-started on epogen during this admission. . # cv-ischemia- patient had an mi on admission to the medicine service. mi, diagnosed when he had cp, sob, and diaphoresis on the morning of . ekg showed dynamic st/twi in ii, iii, avl, v3-v6 and he had positive ces. he had a cath which showed rca patent, occluded lm, lad, lcx. om1 occluded and om2 perfused via svg. he had a bare metal stent placed to the lcx. he did not have further cp throughout the admission. . # prostate ca, s/p artificial urinary sphincter. initially urinary hesitancy relieved by voiding upon standing. foley was placed by urology to aide in voiding symptoms. if patient has further need for foley catheter it should only be placed by urology. . # dm- blood glucose well controlled. nph at home, which was held today, likely tee. will re-start soon. in meantime, cover with hiss . # htn- continued toprol xl. started low dose captopril. monitor creat weekly, d/c captopril if creat continues to rise. . # gout- we stopped allopurinol in the setting of his renal insufficiency. he did not develop any symptoms of gouty arthritis during this admission. medications on admission: humulin 70/30 25u qam humulin n 100 20u qpm allopurinol 150 casodex 150 felodipine 5 topro xl 25 epo 4000 mwf simvastatin 40 zoloft 50mg qdaily discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain/headache. 2. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 3. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. epoetin alfa 4,000 unit/ml solution sig: one (1) injection injection qmowefr (monday -wednesday-friday). 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 7. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. 8. cepacol 2 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed) as needed for pain. 9. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain: on tab q5min x3. md. 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 11. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 12. alprazolam 0.25 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 13. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed. 14. hydroxyzine hcl 25 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for itching. 15. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 16. insulin nph human recomb 100 unit/ml suspension sig: twenty (20) units subcutaneous at bedtime. 17. insulin pump cartridge cartridge sig: one (1) sq injection subcutaneous four times a day: as per sliding scale. 18. insulin nph-regular human rec 100 unit/ml (70-30) suspension sig: twenty six (26) units subcutaneous qam. 19. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation every six (6) hours. 20. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) gram intravenous q48h (every 48 hours): until . 21. captopril 12.5 mg tablet sig: one (1) tablet po tid (3 times a day). discharge disposition: extended care facility: medical center - discharge diagnosis: endocarditis myocardial infarction congestive heart failure discharge condition: stable discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: followup instructions: infectious disease clinic follow up- provider: , md phone: date/time: 11:30 . repeat tee . pt will need transport to on the to the cardiac cath holding area by 8am. the procedure will take 3 hours. . please follow-up with dr. on tuesday, at 1:15pm, in on . office phone: ( md procedure: venous catheterization, not elsewhere classified insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters left heart cardiac catheterization diagnostic ultrasound of heart diagnostic ultrasound of heart other and unspecified coronary arteriography transfusion of packed cells cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified personal history of malignant neoplasm of prostate infection with microorganisms resistant to penicillins bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site long-term (current) use of insulin dermatitis due to drugs and medicines taken internally acute and subacute bacterial endocarditis acquired hemolytic anemia, unspecified diarrhea personal history of irradiation, presenting hazards to health urinary incontinence, unspecified hip joint replacement infection and inflammatory reaction due to cardiac device, implant, and graft unspecified drug or medicinal substance causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to