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: patient recorded as having no known allergies to drugs attending: chief complaint: fever, chills major surgical or invasive procedure: placement of new right tunneled catheter transfusion of 2 units of packed red blood cells in total history of present illness: 54 cantonese only speaking male with cad, htn, dm, esrd on hd was found to be febrile after he had his hemodialysis on doa. he complained of chills and fevers since friday. no n/v/diarrhea. he did have some back pain for 1-2 days. does not have any chest pain, sob, palpitations, dizziness. his fevers were most likely from infected tunnelled rij. 2 sets of blood cultures were sent and he was given vanc 1 gm, gent 60 mg. past medical history: htn dm esrd due to iga nephropathy/dm diabetic retinopathy- blindness r subclavian thrombus history of coumadin (seems to have stopped around ) anemia of chronic disease hyperlipidemia cad - cardiac catheterization from showed three-vessel disease with a 30% left main, a diffusely diseased lad with 80% mid stenosis, 90% diagonal, 60% second diagonal, and 90% om1. no suitable for pci social history: cantonese speaking with some english, immigrated to the us 10 yrs ago, currently lives with wife and 3 children, has been blind for approx 3 years, has not worked recently; no history of tobacco use, alcohol, or illicit drug use. wife injects insulin. family history: no dm, cad, stroke, htn, or renal disease physical exam: 98.6, 167/97, 79, 22, 94%/ra, fsg 198, wt 128 lbs gen: comfortable, intermittent hiccups heent: nad, neck: no jvd, tunnel catheter line nontender/ no erythema at insertion site lungs: lungs clear heart: rrr no m/r/g abd: +bs, soft, ntnd, no palpable masses, no reboud, no guarding ext: wwp, no edema neuro: aox3 . pertinent results: imaging: . cxray cardiomegaly. no evidence of chf or pneumonia. hemodialysis catheter unchanged in position . mr l spine w/o contrast 11:21 am at l2/3, there is a mild disc bulge, which is not causing canal or foraminal stenoses. at l4/5, there is a mild disc bulge eccentric to the left, which is not causing canal stenosis, but is mildly narrowing the left subarticular zone. there is no foraminal stenoses. no paraspinal soft tissue abnormalities are noted. impression: somewhat limited exam due to lack of gadolinium, but no evidence of spondylodiscitis or epidural or paraspinal abscess formation. minimal degenerative changes without canal or foraminal stenoses. . cxr impression: improvement of pulmonary congestive pattern since previous examination four days earlier. also, heart size has decreased slightly. no evidence of new discrete infectious pulmonary infiltrates. . ct chest w contrast 1. findings in the right middle lobe and right lower lobe are consistent with multifocal pneumonia. 2. mild chf. 3. small right pleural effusion and tiny on the left. 4. small right internal jugular venous thrombus. 5. no evidence of pulmonary infarction. . ct head impression: no intracranial hemorrhages or areas of abnormal enhancement. . tte echo - compared with the findings of the prior study (images reviewed) of , a possible pulmonic valve vegetation is now seen. - moderate symmetric lvh - overall left ventricular systolic function is normal (lvef 60-70%) - right ventricular pressure overload - a small pericardial effusion with no echocardiographic signs of tamponade . kub done in context of abdominal pain, n/v impression: no evidence of ileus or obstruction. . repeat ct head impression: no acute intracranial hemorrhage or mass effect. . tee impression: trace aortic regurgitation with normal valve morphology. normal pulmonic valve morphology with no evidence of vegetation or abscess. mild mitral and tricuspid regurgitation. . labs chem/cbc 06:50pm blood wbc-19.0*# rbc-4.04* hgb-12.6* hct-36.0* mcv-89 mch-31.2 mchc-35.1* rdw-16.4* plt ct-255 05:45am blood wbc-15.7* rbc-3.77* hgb-11.4* hct-34.8* mcv-92 mch-30.4 mchc-32.9 rdw-16.4* plt ct-294 12:00pm blood wbc-6.8 rbc-2.90* hgb-9.2* hct-26.8* mcv-92 mch-31.6 mchc-34.2 rdw-17.6* plt ct-244 09:25am blood wbc-5.6 rbc-3.01* hgb-9.4* hct-27.6* mcv-92 mch-31.1 mchc-33.9 rdw-17.6* plt ct-215 06:50pm blood glucose-279* urean-11 creat-3.6*# na-135 k-6.8* cl-95* hco3-30 angap-17 05:45am blood glucose-221* urean-18 creat-4.8*# na-139 k-3.8 cl-96 hco3-33* angap-14 12:00pm blood glucose-159* urean-31* creat-4.4*# na-138 k-3.8 cl-100 hco3-28 angap-14 09:25am blood glucose-190* urean-14 creat-3.2*# na-137 k-3.4 cl-95* hco3-33* angap-12 . cardiac enzymes 03:24pm blood ck-mb-notdone ctropnt-0.29* 11:00pm blood ck-mb-notdone ctropnt-0.29* 09:56am blood ck-mb-notdone ctropnt-0.36* . other labs 06:58pm blood lactate-1.0 k-5.0 02:38am blood lactate-0.9 k-3.7 03:24pm blood ld(ldh)-274* ck(cpk)-56 09:56am blood ck(cpk)-73 05:43am blood lipase-21 05:50am blood lipase-23 07:48am blood lipase-31 brief hospital course: assessment: 54 year old cantonese-speaking male with dm and esrd on hd, and cad s/p cabg, difficult to control htn, who had a 3 week hospital course for mssa septicemia from an infected hemodialysis catheter, aspiration pneumonia, unstable angina/demand ischemia with new st depressions on ekg, and co-management of other chronic medical issues. mssa septicemia from infected hd catheter - 54 year old cantonese-only speaking male with cad, htn, dm and esrd on hd presented with fever and chills . he was found to have a mssa rij hd catheter infection by cultures on and . he was given vanc/gent in the ed. the catheter was removed and he had a temporary line placed. he was treated for the infection with vancomycin, dosed with hd, per the renal attending. the patient had a tunnelled hd catheter placed on after dialysis. the patient was continued on vancomycin on the floor, day# 1= to finish a 3-week course of antibiotics the day of discharge. daily vancomycin levels were checked and he was dosed at hd (, wednesday, friday) to keep the vancomycin greater than 15. the patient was kept on vancomycin for mssa because the patient did not have good iv access until an emergent midline was placed on at which time the patient needed vancomycin coverage for aspiration/nosocomial pneumonia. so, throughout the hospital course, the patient was kept on vancomycin for mssa instead of switching to nafcillin. all surveillance blood cultures showed no growth. the new tunnelled catheter had bleeding around the site during the 24 hours that the patient was receiving heparin gtt for possible nstemi with new st depressions. since then, the catheter has had some oozing from the site when accessed by hemodialysis during his sessions but has been controlled with pressure at the site. a ct scan of the chest revealed a rij thrombus around the site of the new tunnelled catheter. per the renal team, there was no indication to change the catheter and patient will need to have a follow-up ct scan of his chest in months to assess this clot. initially, he also complained of back pain in the setting of the bacteremia and had an mri and ruq ultrasound to eval for other possible source of septicemia, which were negative. the patient also had a tte that showed a possible pulmonary valve vegetation on but a tee done 6 days later on showed no endocarditis. the patient was discharged after finishing a 3 week course of vancomycin per id team recommendations, at hemodialysis for septicemia from line infection by , his day of discharge. aspiration pneumonia - during the patient's course in the hospital, he had episodes of vomiting with likely aspiration. he had both cxr and ct chest on which showed areas in the right middle lobe and right lower lobe consistent with multifocal pneumonia. the patient was started on iv zosyn and placed on aspiration precautions. by the day of discharge, the patient completed a 7 day course of zosyn and was saturating well on room air, without cough or fever for more than 72 hours. new st depressions in lateral leads on ekg - on the am of , patient was found to have unretractable vomiting, and ekg taken showed new 2-3mm st depressions in leads v4-6. his cardiac enzymes were slightly elevated at 0.2-0.4, but his baseline troponins were also in the 0.2 range. the patient had no complaints of chest pain, although he was a difficult historian. patient was started on a heparin gtt for concern of nstemi, cardiology was consulted but no interventions were recommended as the patient was with no areas amenable for pci by his last cardiac cath, and was not a good surgical candidate. by his last cardiac cath, the patient had moderate to severe disease in almost all his coronary arteries. the patient was maintained on aspirin, plavix, and as the patient had concern of septic emboli from presumed pulmonary valve endocarditis by tte at the time, concern for cerebral hemorrhage given acute change in mental status, the patient's heparin gtt was discontinued after 24 hours on . the patient's daily 12-lead ekgs continued to have st depressions, and some new st elevations in v3 throughout his hospital stay and no events on telemetry. the patient was discharged on aspirin, plavix, beta blocker, , and statin. he was also started on long acting nitrates with good response. cardiology consult team followed him as well and recommended the above. htn/acute pulmonary edema in the setting of hypertensive urgency requiring transfer to the micu on . prior to hd, the patient received, two (hydralazine 50 mg and amlodipine 10 mg) out of his five htn medications. initial bp 154/104, but hd rn reported labored breathing and o2 sat 84-87%. soon after initiation of therapy his bp increased to 216/100. he was seen by the renal fellow and medical team and adamantly refused oxygen. his other oral bp medications were given with minimal effect. he underwent 2.5 liter ultrafiltration but remained hypertensive and hypoxic. he was given 10 mg iv hydralazine x 2 and 10 mg iv labetalol x 1 with minimal effect. o2 sat remained 85-90% ra. several discussions via cantonese interpreter and his wife were done by the medical team and the patient adamantly refused oxygen or abg. bp remained 215/106 and 1 inch nitropaste placed on patient. the patient was transferred to the micu for further management of acute pulmonary edema. 2.5 l ultrafiltrate removed during hd on date of admission, with addn 2 l removed in ccu. he was transferred back to the floor on with no oxygen requirements after removal of 4.5 liters of fluid by hd. throughout the rest of his hospital course, the patient's blood pressure regimen was optimized on discontinuing hydralazine and starting minoxidil and imdur. he was discharged on minoxidil and imdur in addition to his home regimen of maximum doses of metoprolol, amlodipine, and losartan. by discharge, his blood pressures were ranging 120-140s sbp on this regimen, with good o2 sat on ra. blood pressure control was also maintained by his m,w,f regimen of hd with fluid removal. acute on chronic anemia - the patient had anemia with hcts below his baseline of 33-34 likely due to chronic kidney disease with acute illness. given his acute coronary syndrome with the new st depressions, the patient received 2 units of prbc transfusions during his hospital stay with his hct goal to be maintained above 30. he also receives epo at hemodialysis. dm/ckd stage 5 - the patient was followed by both the renal and diabetes teams during his hospital stay. his fluid status and esrd were maintained by hemodialysis three times a week on m,w,f, and his diabetes was maintained on nph 70/30 8units qam, 6units qpm with a regular insulin sliding scale. he was discharged with follow up with his dialysis at and new appointments were made for him with cantonese and mandarin-speaking providers at for follow up on diabetes control and nutrition (both for diabetes and diastolic chf). small pericardial effusion found on echo - the patient remaied without signs of hd compromise and no signs of cardiac tamponade by echo. no jvd or hypotension. he will need follow up on this with his pcp as an outpatient. code status - initially in the icu, discussions with an interpreter found the patient to be dni but not dnr. given his many chronic medical problems and the patient's ongoing wish to go home and leave the hospital, the palliative care team was consulted to have a formal code status discussion and also goals of care discussion with the patient and wife. the result of this discussion with a cantonese interpreter was the that patient and wife decided to continue to pursue resuscitation in the event of a cardio-pulmonary arrest, and be changed to full code status. this was documented in the chart. the patient was discharged on home with close follow up. medications on admission: - metoprolol tartrate 150 tid - atorvastatin 40 mg - pantoprazole 40 mg - amlodipine 10 mg qd - calcium carbonate 500 mg tid - lisinopril 40 mg qd - sevelamer 800 mg tid - aspirin 325 mg qd - clonidine 0.3 mg/24 hr qsun - losartan 100 mg qd - clopidogrel 75 mg qd - hydralazine 50 mg qid - insulin nph 7 units qam, 7 units qhs - folic acid 1 mg qd discharge medications: 1. metoprolol tartrate 50 mg tablet sig: three (3) tablet po tid (3 times a day). 2. atorvastatin 40 mg tablet sig: one (1) tablet po once a day. 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 5. calcium carbonate 500 mg tablet sig: one (1) tablet po three times a day. 6. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 7. sevelamer 800 mg tablet sig: one (1) tablet po three times a day. 8. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 9. clonidine 0.3 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qsun (every sunday). 10. losartan 50 mg tablet sig: two (2) tablet po daily (daily). 11. clopidogrel 75 mg tablet sig: one (1) tablet po once a day. 12. erythromycin 5 mg/g ointment sig: 0.5 gm in os ophthalmic qid (4 times a day). 13. minoxidil 2.5 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 14. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 15. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*2* 16. insulin regular human 100 unit/ml solution sig: one (1) unit subcutaneous per insulin sliding scale injection qachs. 17. insulin nph & regular human 100 unit/ml (70-30) suspension sig: one (1) 8 units subcutaneous qam, once a morning before breakfast. disp:*qs * refills:*2* 18. insulin nph & regular human 100 unit/ml (70-30) suspension sig: six (6) units subcutanous subcutaneous qpm every night before dinner. disp:*qs * refills:*2* discharge disposition: home discharge diagnosis: final diagnosis septicemia secondary to infection in hemodialysis catheter . secondary diagnosis aspiration pneumonia unstable angina/ non st elevation myocardial infarction pulmonary edema acute diastolic congestive heart failure hypertensiion, malignant chronic kidney disease stage 5; on hemodialysis (, wednesday, friday) coronary artery disease, native hyperlipidemia anemia of chronic disease discharge condition: good, good o2 sat on room air, no cough, new hd tunneled catheter in place. discharge instructions: you were admitted for fever and chills at hemodialysis and was found to have a bacterial infection in your bloodstream from an infection in your dialysis catheter. to treat this, we removed your infected catheter and are treating you with antibiotics at hemodialysis treatment. while you were here, you were transferred to the intensive care unit because you had a very high blood pressure and had fluid in your lungs leading to shortness of breath. after you had sessions of hemodialysis to remove extra fluid, you improved and were transferred back to the medical floor. we also placed a new hemodialysis catheter. we made sure that you did not have other sources of the infection in your spine and abdomen by a mri of you spine and ultrasound of your abdomen. however, you were found to have an infection in your lung, so we started a second antibiotic to treat this. we were also worried about a possible infection on your heart valves and were treating you with antibiotics for this, but the accurate ultrasound of your heart showed there was no bacteria on your heart valves. . during your hospital stay, you were also found to have tracings on your heart which showed that your heart was not getting enough blood. the heart doctors were following , but because of your other medical problems and the severity of your heart disease, you are not a good candidate for surgery of placement of a stent in your heart. for this, we have been treating your heart disease with medicine and monitoring your heart tracing. you also received a total of two units of blood transfusion during your hospital stay for your low blood counts. you were also found to have a small clot at the end of your current hemodialysis catheter which you will need to follow up with a repeat ct scan of your chest in months. there is no indication to remove this catheter according to the kidney doctors. this with your primary care doctor. . on discharge from the hospital, you will be finished with a 3 week course of antibiotics for your catheter line infection, and finished with a 1 week course of antibiotics for your pneumonia. you will need to continue your hemodialysis on , wednesday, friday at . we also made the following changes to your medications: 1. we started a blood pressure medication called minoxidil, which you should take 2.5mg two times a day 2. we started a blood pressure medication called imdur 30mg daily for your blood pressure 3. we stopped your hydralazine medication for your blood pressure. do not take this medication anymore. 4. we started you on a medication called nephrocaps (b complex-vitamin c-folic acid) for your renal disease. please take one daily. 5. we adjusted your standing insulin dose to be 8 units of the nph insulin before breakfast and 6 units of the nph at night. . also, it is very important that you eat a low salt diet, less than 2 grams per day, and restrict your fluid to 1,500ml per day. you should weigh yourself daily and call your physician if your weight changes by more than 3 lbs. . please return to the hospital if you experience any fever, chills, tenderness or pain at your hemodialysis catheter site, uncontrolled nausea or vomiting, chest pain, shortness of breath, or swelling in your legs. followup instructions: you have an appointment with your primary care doctor tomorrow on at 1:30pm. provider: , . . you will need a follow up ct scan of your chest in months to follow up on the small blood clot around the tip of your hemodialysis catheter. . you have an appointment with a dietician, to work on your nutrition. she is a cantonese speaker. the appointment is on , at 3pm. please go to clinic on on the . if you have any questions, call , who is a cantonese speaker, her telephone number is . . you have an appointment at the clinic at diabetes center on , thursday afternoon at 4:30pm to follow up on your diabetes control. the physician is mandarin speaker. please go to clinic on on the . if you have any questions, call , who is a cantonese speaker, her telephone number is . . continue hemodialysis , wednesday, friday at . hd center: f (. t ( . your other appointments at are as follows: provider: , md phone: date/time: 9:20 provider: procedure phone: date/time: 10:00 provider: , .d. phone: date/time: 9:40 procedure: hemodialysis venous catheterization for renal dialysis transfusion of packed cells removal of other device from thorax diagnoses: hypertensive chronic kidney disease, malignant, with chronic kidney disease stage v or end stage renal disease chronic kidney disease, stage v anemia in chronic kidney disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery congestive heart failure, unspecified infection with microorganisms resistant to penicillins acute on chronic diastolic heart failure methicillin susceptible staphylococcus aureus septicemia sepsis other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled long-term (current) use of insulin infection and inflammatory reaction due to other vascular device, implant, and graft legal blindness, as defined in u.s.a. diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney 

Answer: The patient is high likely exposed to