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: the patient is a 74 year-old man with a history of insulin dependent diabetes mellitus, diabetic neuropathy, hypertension who presented on to for a partial right nephrectomy of his right kidney inferior pole. subsequent pathology demonstrated it to be papillary renal cell carcinoma. during the procedure there was a reported 1 liter blood loss while the renal artery was clamped. the patient at that time received 1 unit of packed red blood cells and 6 liters of lactated ringers. the patient was transferred to the intensive care unit with an epidural. subsequently the patient was found to be hypotensive with a blood pressure of 70/30 and a heart rate of 90. the patient was bolused and subsequent enzymes were significant for a ck of 1170, mb of 79, index of 6 and a troponin of 19. electrocardiogram showed v2 and v3 segment depression. the patient was in the micu from to (). arterial blood gas at 12/12 was 7.38, 36, 56. the subsequent hospitalization was complicated by a left lower lobe consolidation and a sputum notable for mrsa and increasing o2 liter requirement. of note the patient required 10 liters at one time with nebulizer. the patient was treated with vancomycin and levofloxacin for mrsa positive staph sputum. a subsequent bedside swallow study on was noted for aspiration. neurology and psychology was also consulted for reported mental status change. mri of the head on showed no intracranial hemorrhage and no stenosis or carotid bifurcation and chronic periventricular white matter changes. past medical history: insulin dependent diabetes diagnosed seven years ago. diabetic nephropathy, hypertension, renal cell cancer papillary, status post right partial nephrectomy, depression. allergies: penicillin. medications: from last discharge from the micu the patient was on insulin sliding scale, glucotrol, maalox, neurontin, nortriptyline, trazodone, heparin and subq protonix, tylenol, zestoretic and norvasc. from transfer the patient was on insulin sliding scale, metoprolol 10 mg intravenous q day, sodium phosphate, furosemide, albumin, pantoprazole, atorvastatin, tylenol, colace, paroxetine, gabapentin, metoclopramide, albuterol and vancomycin. social history: the patient is a former lawyer. has home health from 7:00 a.m. to 7:00 p.m. he travels with a scooter. no history of alcohol or tobacco use. pertinent laboratories: on his white blood cell count was 13, hematocrit 34.5, platelets 402. electrolyte panel sodium 149, k 4.1, chloride 110, bicarb 29, bun 25, creatinine 1.3, glucose 180, calcium 7.9, phosphate 3.1, magnesium 2.4, vancomycin level was subtherapeutic. urinalysis on negative blood, red blood cells of 11. blood cultures from was notable for no growth. urine culture from was notable for no growth. electrocardiogram from showed st segment depressions in v2 and v3. echocardiogram showed an ef of greater then 50% focal wall motion abnormalities, mild la, mild left ventricular hypertrophy, mild left ventricular systolic function. pathology from showed papillary renal cell carcinoma changes consistent with diabetic glomerulosclerosis and multiloculated cystic structure. sputum from showed heavy growth, gram negative diplococci, gram positive cocci. radiology, x-ray from showed nasogastric tube, no pneumonia. x-ray from showed a left lateral pleural thickening versus loculated effusion, right picc, scattered discoid atelectasis. mri of the head on showed negative mr, intracranial, negative stenosis, carotid bifurcation negative, territorial infarct, chronic paraventricular white matter changes. video swallow study from showed penetration with silent aspiration, moderate to severe oropharyngeal dysphagia. mri kidney, abdominal imaging showed a 2 by 1 by 1.5 by 1.8 right upper pole posterior mass pancreatic cyst. no renal vein invasion. ct of the abdomen had shown a positive mass in the right kidney. no abdominal or bowel obstruction. tte from showed an left ventricular of 80%, mild left ventricular hypertrophy, borderline pulmonary hypertension. assessment: the patient is a 74 year-old man who presents to for a partial right nephrectomy on . hospital course complicate by perioperative myocardial infarction, positive oxygen requirement and variable mental status changes. hospital course: 1. cardiac: the patient's operation was complicated by a perioperative myocardial infarction with elevated ck and troponin levels. subsequent to the event the patient's heart rate, blood pressure, electrocardiogram remained stable. it was felt the patient should be catheterized as an outpatient. the patient was maintained on an aspirin, beta blocker, hctz, ace, lipitor. of note, the patient had a dobutamine stress echocardiogram performed on by . the interpretation at the time had been low probability for flow limiting coronary artery disease to the achieved work load, frequent apb with occasional beat and more frequent isolated premature ventricular contractions with increased dobutamine dose. nonsustained supraventricular tachycardia rate 160 to 170 bpm. normal intrinsic heart values. the patient was discharged on atorvastatin, metoprolol, lisinopril and aspirin. 2. renal: the patient was status post a right partial nephrectomy. the patient's creatinine remained relatively stable throughout the remainder of his hospitalization course. creatinine varied between 1.2 and 1.4. we suggest continued outpatient monitoring of the patient's ins and outs as well as his creatinine level. 3. pulmonary: the patient obtained a seven day course in house for a possible mrsa sputum positive culture. the patient, however, remained afebrile when the patient's antibiotics were discontinued on . we suggested outpatient continued monitoring of the patient's white blood cell count. of note, blood cultures were always negative. 4. endocrine: the patient has a history of insulin dependent diabetes. in house he was consulted by . the patient's sugar remained relatively well controlled with the addition of tube feeds. we suggest monitoring of his glucose levels q.i.d. finger sticks. he is maintained on glargine and other regular insulin. 5. ent: of note the patient was consulted by ent in house for possible aspiration and have normal swallow study. the patient's ent evaluation showed global function with incomplete epiglottis detection, premature spillage and silent aspiration. the ent recommendation was for peg tube and reevaluation within one to two weeks. 6. neurology: the patient in the hospital had an episode of delirium treated with haldol. mri/mra performed in house was negative. the patient was discontinued on a number of narcotic agents. we suggest continued rehab. neurology was consulted in house. it was felt that variable mental status differential included an anoxic damage versus narcotic overdose. on discharge the patient was alert and oriented to person. 7. gastrointestinal: the patient in house required peg tube for feeding. peg placement was performed on . tube feeds were initiated. we recommend outpatient monitoring of peg tube and advance his peg tube diet as tolerated. 8. psychiatric: the patient has a history of depression. psychiatry was consulted throughout. 9. hematology: the patient's hematocrit was stable following the initial blood loss during the procedure. we continued to monitor. 10. oncology: the patient has a history of renal cell carcinoma. the patient will need outpatient follow up with dr. . will obtain medicine/oncology follow up. 11. code: the patient was full code throughout hospital stay. of note, the patient's sister is his health care proxy. discharge condition: fair. discharge diagnoses: 1. renal cell cancer. 2. perioperative myocardial infarction. 3. change in mental status. 4. diabetes. 5. hypertension. 6. depression. discharge medications: insulin sliding scale lantus regimen, atorvastatin 10 mg po q day, paroxetine hcl 10 mg po q.d., gabapentin 600 mg po q.i.d., metoclopramide 10 mg q 6 hours per peg, albuterol nebulizers one h q 6, hours prn. docusate sodium 100 mg po b.i.d., acetaminophen 325 to 650 mg po q 4 to 6, metoprolol 37.5 mg po b.i.d., lisinopril 10 mg po q day, olanzapine 5 mg po h.s., aspirin ec 325 mg po q day, pantoprazole 40 mg intravenous q day, ipratropium bromide nebulizers q 6, bisacodyl 10 mg pr b.i.d. prn, milk of magnesia 30 ml po q 6 h prn. treatment: outpatient peg care, follow swallow study in one to two weeks. treatments include peg tube treatment pto as increased assistance with ambulation, assistance with activities of daily living, follow with psychiatry, diabetes care q.i.d. finger sticks and electrolytes q three days, cbc q three days to monitor creatinine and electrolyte function. renal function, the patient will follow up with dr. within two weeks. the patient will follow up with medicine and cardioloyg within one month. the patient is to be discharged to rehabilitation center. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrojejunostomy partial nephrectomy diagnoses: subendocardial infarction, initial episode of care congestive heart failure, unspecified acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) cardiac complications, not elsewhere classified malignant neoplasm of kidney, except pelvis pneumonitis due to inhalation of food or vomitus urinary complications, not elsewhere classified 

Answer: The patient is high likely exposed to