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: patient is a 55 year-old male with a history of rheumatic heart disease status post avr, mvr and also a history of coronary artery disease status post coronary artery bypass graft, atrial fibrillation, hepatitis c, and cirrhosis who presents with fever and change in mental status. patient was in his usual state of health until about three weeks prior to admission when he had a respiratory infection with a cough, sore throat. complained of fever and chills. this resolved in four days, however, four or five days prior to admission patient then developed chest congestion with cough productive of yellow sputum. no blood. fevers, chills to 103.8 f at home. the patient was noted by his wife to have decreased mental status. he was incoherent and non-communicative, coughing and retching. the morning of admission the patient had a temperature of 104.0 f and was weaker and incontinent of stool at home. on the way to the hospital the patient was incontinent of urine and became combative and incoherent. per the patient's wife, the patient had been complaining of a diffuse abdominal pain for the last couple of days. ed course: in the ed the patient had a temperature of 101.9 f; pulse of 90; a blood pressure 96/50; respirations at 28; saturating 93 - 95% on room air. blood cultures were sent. lumbar puncture was performed. a urinalysis and culture sent as well. the patient was given 1 gram of vancomycin and two grams of ceftriaxone and gentamicin 80 milligrams. past medical history: 1. remarkable for rheumatic heart disease, status post avr and mvr in . 2. coronary artery disease status post two vessel coronary artery bypass graft in . postoperative course was complicated by a sternal wound infection. 3. mssa bacteremia in that was treated as an endovascular infection. 4. paroxysmal atrial fibrillation. 5. seizure disorder. 6. hepatitis c, status post ribavirin and treatment, which has unfortunately advanced to cirrhosis. 7. ventral hernia and has grade i - ii esophageal varices on most recent esophagogastroduodenoscopy in . family history: noncontributory. social history: patient lives with his wife in ; formerly was a smoker and had heavy alcohol consumption; occasional marijuana use. wife denies any history of intravenous drug use. medications on admission: 1. nadolol 20 milligrams p.o. once a day. 2. dilantin 300 milligrams p.o. once a day. 3. amiloride/hydrochlorothiazide once a day. 4. advair p.r.n. 5. celexa 40 milligrams p.o. once a day. 6. coumadin. physical examination: when evaluated by the micu team patient's physical exam was as follows. patient had a temperature of 105.0 f; pulse of 89, blood pressure was 111/51, breathing at 24, pulse oximetry 99% on two liters. head, eyes, ears, nose and throat: patient had mildly icteric conjunctivae. extraocular movements are intact. his oropharynx is clear with no erythema. his neck had no lymphadenopathy and there was no noted jugular venous distention. patient's chest exam was clear to auscultation bilaterally. cardiovascular exam regular rate with mechanical s1, s2, no murmurs were appreciated. abdominal exam was remarkable for mild distention but soft and mild diffuse tenderness that did not localize. patient was noted to have hepatosplenomegaly and a ventral hernia. patient's extremities had trace peripheral edema, palpable dp pulses bilaterally. no splinter hemorrhages or lesions were noted. neurologic: the patient was oriented only to name but had no obvious focal neurologic deficits and no noted asterixis. laboratory on admission: patient had a white count of 8.5, hematocrit 41.2, platelets of 54, all of these were within baseline for the patient with the exception of his hematocrit which was evaluated from his baseline which is usually in the low 30's. chemistries were remarkable for a bun and creatinine of 31 and 1.8, the 1.8 is elevated from the patient's usual baseline creatinine of 01.0. patient's lfts were elevated with an alt of 71, and ast of 106, alkaline phosphatase 115, total bilirubin of 2.5, ldh of 493. all of these are within patient's normal baseline range. urinalysis was nitrite positive with a trace of protein, glucose and ketone negative. a small bilirubin, 11 - 20 red blood cells, no white blood cells. patient's csf first tube had 3 white blood cells, 1 red blood cell with a differential of 7 polys, 33 lymphs, 45 monos, protein was 22 and glucose was 80. gram stain was negative for pmns and no microorganisms were noted. patient's first abg on four liters nasal cannula was 7.33 with a pco2 of 49 and po2 of 150. patient's tox screen was negative and his ammonia level was 24. ekg: showed normal sinus rhythm with left axis deviation otherwise unremarkable. patient had a head ct scan which showed no acute intracranial processes. chest x-ray showed no gross infiltrate or effusions. a right upper quadrant ultrasound which showed no fluid or abscess throughout the gallbladder. in short this is a 55 year-old male with rheumatic heart disease, status post avr, mvr, coronary artery disease, status post coronary artery bypass graft, paroxysmal atrial fibrillation and hcv cirrhosis who presented with fever, mental status changes prior to admission. hospital course by issue: 1) infectious disease - because of the patient's previous history of staphylococcus aureus bacteremia and his mechanical valves, suspicion of endocarditis was quite high in this patient. patient had multiple blood cultures sent on the day of admission. four out of four bottles of which grew coag positive staphylococcus aureus was later identified as being methicillin-sensitive staphylococcus aureus. patient's urine culture was also remarkable for growing methicillin-sensitive staphylococcus aureus, however, infectious disease service felt that this was likely a flow over from the blood into the urine. patient had a tee the day after admission which showed no evidence of valvular abscess or endocarditis. patient had multiple blood cultures over the course of this hospital stay all of which remained negative after the initially positive blood culture on the 5th. patient also had a bone scan to rule out osteomyelitis. bone scan unfortunately was unremarkable. because no source was located on this patient for his bacteremia, the patient was treated with oxacillin for presumed endovascular infection. patient will complete a six week course of antibiotics for his staphylococcus aureus bacteremia. 2. gastrointestinal - patient had a history of hepatitis c cirrhosis with a history of grade i and ii varices on his previous esophagogastroduodenoscopy in . patient had an occult positive blood stool after transfer to the floor. however, he had a nasogastric lavage which was unremarkable and which returned only clear fluid. after initial drop in hematocrit from 41 to the low 30's the patient's hematocrit stabilized in the range of 30 - 31. thus it was felt that there was no need at this time for esophagogastroduodenoscopy or colonoscopy to evaluate the occult blood. patient had later stools during his hospitalization that were occult blood negative. thus it seems likely that the cause of his occult blood was nasal trauma secondary to nasogastric tube insertion. patient was evaluated by the hepatic service here in the hospital and will be scheduled for repeat egd to evaluate his varices at some point in the near future. patient received multiple fluid boluses over the course of his admission and developed notable ascites. his belly was much more distended than on arrival after fluid boluses for previous episodes of hypotension and hydration secondary to fever. because of this, patient was started on lasix and aldactone. patient had a brisk diuresis which was limited by an increase in the creatinine. patient developed abdominal pain in the setting of ascites which was localized to his right lower quadrant near mcburney's point. patient had no rebound tenderness, however, because of his profound tenderness a ct scan was obtained to rule out acute appendicitis. ct scan showed no evidence of acute appendicitis but did raise the possibility of diverticulitis thus patient was started levo and flagyl to treat a presumed diverticulitis. patient did have a therapeutic paracentesis during his stay which showed a white blood cell count of 175 and a red blood cell count of 25,000. the red blood cell count was likely due to traumatic tap. additionally patient had a gram stain of his peritoneal fluid which showed no organisms. 3. hematology - patient had a hematocrit that was stable in the range of 30 - 31 after his initial drop with hydration from 41 - 31. following his therapeutic paracentesis, the patient developed a sizable hematoma on his right flank as well as a two point drop in hematocrit. the patient was thus transfused two units of packed red blood cells and his hematocrits add up appropriately. patient's hematocrit remained stable throughout the rest of the course of his admission and his hematoma did not expand further beyond the borders initially marked. patient also had thrombocytopenia. patient's baseline platelet level is usually in the 50's. he was somewhat lower at the beginning of his admission thus heparin flushes were held and a hit antibody was sent. his hit antibody was subsequently found to be nonreactive. patient's platelets remained stabilized around 40 throughout the course of his admission. patient was on coumadin on admission, anticoagulated for his mechanical valves. during his admission, his coumadin was held and he was anticoagulated with heparin. until such time his diagnostic procedures were finished at which point and time the patient was started back on his coumadin. patient's inr was 4.0 on the day prior to discharge. 4. cardiovascular: the patient has a history of coronary artery disease. he was continued on aspirin throughout the course of his admission. the patient did develop some demand ischemia and a troponin leak secondary to rapid atrial fibrillation which he developed during his hospital course. the troponin leak resolved once his rate was returned to within normal limits. pump wise, this patient has a normal ejection fraction, however, he did have some question of failure when he developed rapid atrial fibrillation likely secondary to diastolic dysfunction. patient responded well to diuresis and had no further signs of failure or shortness of breath once his heart rate was controlled. rhythm wise, the patient had been in sinus on admission, however, during his hospital course he suddenly developed atrial fibrillation with rapid ventricular response up to the 200's. he had no initial response to lopressor thus he was started on a diltiazem drip and transferred to more intense monitoring. he was seen by cardiology who recommended not employing antiarrhythmics at this time but rather increasing his dose of nadolol and stopping the diltiazem. this was done, however, patient became hypotensive several hours after being given his beta blocker and required fluid boluses and transient dopamine for which he was transferred back to the intensive care unit overnight. patient was rapidly weaned off of dopamine although his rate remained difficult to control without beta blockers. he remained on diltiazem and diltiazem drip until he underwent dc cardioversion, prior to discharge after which he remained in normal sinus rhythm throughout the course of his stay. 5. renal - patient had a creatinine of 1.8 on admission which improved down to 1.2 with hydration. his creatinine fluctuated over the course of his hospital stay depending on his fluid status. at the time of discharge, his creatinine again, was 1.8, this was following a brisk diuresis to relieve his ascites and it was felt that the patient's creatinine would turn back towards the baseline, post diuresis. 6. pulmonary - patient had adequate o2 saturations during his admission but did have a history of using advair and several times during admission he was noted to have bilateral wheezing. whether this was due to cardiac or pulmonary causes was not clear. patient was started on atrovent nebulizer which seemed to relieve his wheezing as the diuresis. patient would likely benefit from pulmonary function tests in the near future if he has not had them already. 7. neurologically: the patient had a history of seizure disorder. he was initially somnolent with mental status changes and incontinent of urine and stool as he defervesced and was started on antibiotics. his mental status improved markedly and at one point during his hospital admission shortly after leaving the icu for the first time, this patient did have notable asterixis. he was treated with lactulose and his mental status returned to baseline. patient was maintained on dilantin throughout the course of his hospitalization. disposition: patient was discharged in good condition on home. discharge status: patient will follow up with dr. for primary care. discharge diagnoses: 1. mssa bacteremia. 2. presumed endovascular source. 3. hcv cirrhosis. 4. rheumatic heart disease, status post avr / nvr. 5. coronary artery disease, status post coronary artery bypass graft. 6. atrial fibrillation. 7. seizure disorder. medications on discharge: 1. lasix 40 milligrams p.o. q. day. 2. oxicillin 2 grams iv q. six hours times four more weeks. 3. aspirin 81 milligrams p.o. q. day. 4. aldactone 100 milligrams p.o. q. day. 5. dilantin 300 milligrams p.o. q. day. 6. protonix 40 milligrams p.o. q. day. 7. atrovent metered dose inhaler two puffs inhaled q.i.d. 8. coumadin 2.5 milligrams p.o. q. day. 9. levaquin 500 milligrams p.o. q. day times 10 days. 10. flagyl 500 milligrams p.o. t.i.d. times 10 days. 11. nadolol 20 milligrams p.o. q. day. 12. potassium chloride 20 milliequivalents p.o. q. day. 13. magnesium oxide 800 milligrams p.o. q. day. 14. lactulose 30 cc p.o. t.i.d. p.rn. 15. ambien 5 milligrams p.o. q. h.s p.r.n. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified spinal tap incision of lung diagnostic ultrasound of heart other electric countershock of heart percutaneous abdominal drainage diagnoses: thrombocytopenia, unspecified chronic hepatitis c without mention of hepatic coma atrial fibrillation aortocoronary bypass status hematoma complicating a procedure other convulsions methicillin susceptible staphylococcus aureus septicemia heart valve replaced by other means 

Answer: The patient is high likely exposed to