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: -year-old male with history of coronary artery disease, congestive heart failure, acute renal failure on hemodialysis, mrsa, recently discharged after clo urosepsis and fungemia in , now admitted with left parotitis, increased white blood cell count and microangiopathic blood smear. according to referral in er notes (patient only speaks russian), patient with a left temporal firm swelling which is warm and tender. patient was afebrile at nursing home with stable blood pressure and oxygen sats. review of systems: headache but no mental status change per granddaughter, no rashes. patient denies pain, shortness of breath, chest pain, decreased po intake recently. past medical history: klebsiella urosepsis, fungemia, congestive heart failure, acute renal failure now on hemodialysis, non-insulin dependent diabetes mellitus, mrsa, history of right great toe osteo status post amputation in , coronary artery disease, status post mi times two in and , increased alkaline phosphatase, atrial fibrillation, status post pacer in for bradycardia, peptic ulcer disease, benign prostatic hypertrophy, history of acoustic neuroma status post benign brain tumor resection in with residual right facial droop. allergies: no known drug allergies. medications: aspirin, protonix, heparin subcu, regular insulin sliding scale, vitamin c, combivent, multivitamins, senna, colace, lacrilube, tums, zyprexa, dulcolax, nebs, tylenol, captopril. social history: lives at home rehab, ambulates with walker, history of tobacco and cigar use in the past, quit recently. physical examination: temperature 99.1, 85, 110/41, 16 and 91% on room air. in general, thin, russian speaking male in no acute distress. heent: right facial droop, left parotid region erythematous, swollen and firm with no fluctuants. oropharynx clear, no lymphadenopathy. chest clear to auscultation bilaterally. cardiovascular, regular rate and rhythm, no murmurs, rubs or gallops. abdomen soft, nontender, non distended, positive bowel sounds. extremities, no clubbing, cyanosis or edema. right great toe amputation with sutures intact. two scabs, clean, dry and intact. faint peripheral pulses. neuro, speaking, moving all extremities. skin, scattered areas of erythema on the legs and erythematous patches on the soles of the feet and toes, non blanching. laboratory data: on admission, white blood cell count 25.2, hematocrit 32.9, platelet count 352,000, 79% neutrophils, 7 bands, 8 lymphs, 3 monos, 1 meta and 2 myelo. chemistry, sodium 138, potassium 4.9, chloride 106, co2 23, bun 10, creatinine 1.7 and glucose 154. ct of the neck showed enlarged left parotid gland associated prominently with lymphadenopathy, airway intact. impression: -year-old male with cad, chf, status post klebsiella and sepsis in , now admitted with left parotitis. hospital course: 1. hypotension: the patient was initially treated with vancomycin for his parotitis. a urinalysis returned on the 7th indicative of infection. the patient was treated with ceftaz and levofloxacin for uti. later blood and urine cultures were found to grow out gram negative rods resistant to ceftaz and levofloxacin. the patient was then started on imipenem on the 8th which was then changed to meropenem on the 9th. subsequently on the 9th the patient was found to be hypotensive with blood pressures 60/palp. the patient's mental status was difficult to evaluate secondary to being russian speaking and hard of hearing. the icu team was called to evaluate at this time. that evening patient responded well to iv fluids and maintained adequate blood pressures at that time. the following evening the micu team was again called to evaluate for hypotension. fluid resuscitation was again attempted. after third liter of normal saline patient's blood pressure was still only in the 70's, pulse 60, respiratory rate 16 and 96% on three liters nasal cannula. it was decided to take patient to micu this evening secondary to new onset of bilateral pulmonary crackles on exam which previously had been clear to auscultation bilaterally. in the micu the patient was continued on iv fluids. the patient was believed to be in septic shock and therefore was maintained on a complete course of vancomycin times 14 days and meropenem times 14 days. the patient was started on dopamine for pressor support on . throughout the rest of the hospital stay the patient was on varying doses of dopamine which for a short period of time during micu stay was weaned to off. within 24 hours the patient required pressor support once again. the source for the hypotension was never identified initially. initially it was believed to be secondary to septic shock. after patient completed his two week course of both vancomycin and meropenem, the source became unclear. other sources of infection were ever identified. subsequent urine cultures, blood cultures, and sputum cultures were negative. right upper quadrant ultrasound and lfts were within normal limits except for an isolated, elevated alkaline phosphatase. ct was unable to be completed to look for abscess formation secondary to patient's instability. 2. renal: at time of admission the patient was requiring hemodialysis. on it was decided that patient was not hemodialysis dependent. therefore, patient's perma-cath line was discontinued as a potential source of infection. the patient's creatinine remained stable status post discontinuation of hemodialysis. issues that patient did develop were oliguria and ultimately anuria prior to expiration. the patient became very fluid overloaded and unresponsive to high dose diuresis including lasix 160 mg iv bid and q d zaroxolyn. the renal team continued to follow patient but did not feel that patient was any longer a candidate for hemodialysis given severely decompensated state. 3. pulmonary: patient with chf evident on chest x-ray. he received nebulizer treatments while in the icu and received high flow oxygen. the patient's respiratory status decreased throughout hospital stay with slowly rising pco2 and bilateral pleural effusion. a thoracentesis was done to tap patient's left sided pleural effusion which revealed a transudate consistent with congestive heart failure. the effusions then reaccumulated and exacerbated as patient's fluid overload worsened. 4. cardiovascular: patient with hypotension, unexplained by other causes. therefore, a transthoracic echo was repeated which revealed an ef of 60-70%, possibly diastolic dysfunction, rv dilation and systolic dysfunction. 5. fluids, electrolytes & nutrition: as above, patient with significant hypervolemia. the patient was started on tube feedings. 6. communication: there were extensive conversations with patient's son and granddaughter who just completed medical school. conversations consisted of end of life care, changing patient to dnr status and ultimately to dnr/dni. discussions were lengthy and patient's family was informed of patient's poor prognosis as his condition further declined. dr., 12-924 dictated by: medquist36 procedure: hemodialysis thoracentesis diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified unspecified protein-calorie malnutrition atrial fibrillation hypotension, unspecified other shock without mention of trauma other septicemia due to gram-negative organisms sialoadenitis 

Answer: The patient is high likely exposed to