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: this is a 71 year-old male with a history of coronary artery disease status post coronary artery bypass graft and mitral valve prosthetic replacement, chronic obstructive pulmonary disease, who presents with shortness of breath progressive over the past four days after undergoing a transesophageal echocardiogram several days prior to admission. he denies orthopnea, reports increased o2 requirement at home now. use to use it intermittently now 24 hours a day. he also reports a chronic cough with yellow sputum, which is mostly unchanged. he denies fevers or chills, nausea. he has not slept well in the past couple of nights, because he has been huffing and puffing. he notes that his chronic lower extremity edema is unchanged. he denies chest pain, palpitations, diaphoresis, nausea, vomiting, rhinorrhea or sore throat. he states his weight is stable. in the emergency department the patient received atrovent and albuterol nebulizers times three, solu-medrol, aspirin and lasix 40 po. past medical history: 1. coronary artery disease, myocardial infarction in , coronary artery bypass graft times four in in . 2. mitral valve replacement with a bioprosthetic valve in . 3. atrial fibrillation. 4. chronic obstructive pulmonary disease with an fev1 in of .3 on 2 liters home o2. 5. peripheral vascular disease. 6. bilateral carotid stenosis status post percutaneous transluminal coronary angioplasty and stent to the left ica. 7. history of gastrointestinal bleed with an arteriovenous malformation. 8. gastroesophageal reflux disease. 9. diverticulosis. 10. gastric ulcer. 11. history of mediastinitis secondary to coronary artery bypass graft. 12. pulmonary hypertension. 13. polypectomy. 14. chronic renal insufficiency with a baseline creatinine of 1.3 to 1.5. 15. anemia secondary to chronic disease. medications on admission: 1. aspirin 81 once a day. 2. albuterol. 3. vitamin c. 4. flovent two puffs twice a day. 5. nexium 40 twice a day. 6. simvastatin 20 once a day. 7. lasix 40 once a day. 8. colace b.i.d. 9. prednisone 10 once a day. allergies: penicillin, vancomycin, ancef, procainamide, which dropped his platelets. family history: noncontributory. social history: the patient is independent of his activities of daily living. he quit tobacco, but has a 40 pack year history. he does not drink. he is a retired firefighter. he has a positive asbestos exposure. he lives with his wife. physical examination on admission: temperature 98.6. blood pressure 122/54. heart rate 60. respiratory rate 26. oxygen saturation 99% on 2 liters. general, this si a pleasant elderly gentleman in mild respiratory distress who can speak in full sentences. heent anicteric sclera. mucous membranes are moist. neck no lad. jvp 8 to 9 cm. cardiovascular regular rate and rhythm. normal s1 and s2 with a 2 out of 6 systolic murmur at the left lower sternal border. chest decreased breath sounds on the right, diffuse wheezes, increased expiratory phase. abdomen soft, nontender with positive bowel sounds. liver edge is 2 cm below the costal margin. extremities with 2 to 3+ pitting edema left greater then right to the knees with good dorsalis pedis pulses. neurological alert and oriented times three. pupils are equal, round and reactive to light. 5 out of 5 strength throughout and downgoing toes. laboratories on admission: white blood cell count 7.4, hematocrit 33.1, platelets 100, sodium 142, potassium 5.0, which was hemolyzed, bun 25, creatinine 1.5, glucose 183. chest x-ray showed a right pleural effusion unchanged, possibly a small left pleural effusion. electrocardiogram showed sinus tachycardia with frequent premature atrial contractions, left axis deviation of the right bundle branch block and a left anterior vesicular block. t wave inversions in v1 and v2 all unchanged. hospital course on the medicine : 1. chronic obstructive pulmonary disease flare: the patient was treated with nebulizer and intravenous steroids. left ventricular pseudoaneurysm with thrombus as noted on transesophageal echocardiogram. anticoagulation was held, because of recent gastrointestinal bleed. 2. mitral valvular regurgitation with mild paravalvular leak: ct surgery was consulted and they did not advise any acute intervention. 3. coronary artery disease: the patient did not have evidence of ischemia by history or electrocardiogram, but he was ruled out for a myocardial infarction by enzymes and he was continued at this point on his aspirin and statin as beta-blocker was held, because of his chronic obstructive pulmonary disease flare. 4. carotid stenosis with left stent: the patient was continued on a baby aspirin, but was held, given the history of gastrointestinal bleed. on the patient developed the acute onset of chest pain and shortness of breath with oxygen saturations in the 70s. the patient was subsequently transferred to the medical intensive care unit for management of his respiratory failure. this portion of his hospital course is detailed in a separate discharge summary addendum. hospital course from day to : at this time the patient is back on the medicine floor and his clinical condition is improving. 1. anemia and blood loss: as noted the patient had a history of gastrointestinal bleed on anticoagulation in the past and had a slew of heme positive stools, melena and hematocrit drop, which required approximately one unit of packed red blood cells per day for several days to maintain his hematocrit above 28. his stools became heme negative and his blood count stabilized at approximately 32. he underwent esophagogastroduodenoscopy with push enteroscopy on . no clear source of his bleeding was found. he was noted to have significant chronic gastritis, but without acute bleeding. he was also noted to have a small red vessel in his jejunum that was not currently bleeding. no interventions were undertaken. gi's recommendation was that if the patient continued to have a stable hematocrit over time consideration could be given to restarting anticoagulation with the risk that he may bleed again. at the time of discharge his hematocrit was stable at 32 and he had a guaiac negative stool. 2. thrombocytopenia: stopping the linezolid correlated with improvement in the patient's platelet count up to 69 on the day of discharge. he had been restarted on his nexium several days before discharge and this did not seem to impact his platelet counts. it was felt that linezolid was the culprit. it is expected that his platelet counts will continue to rise over time. 3. atrial fibrillation: as noted the patient had recurrent atrial fibrillation with rapid ventricular rate and hypotension in the micu. he was continued on his amiodarone and digoxin. the amiodarone was decreased from 400 b.i.d. to 300 b.i.d. on . he should continue on 300 b.i.d. for a total of 14 days at which time he should be changed to 400 q.d. recommended for one month, but in fact the patient should probably see his cardiologist before stopping this dose of 400 q day. he will continue on the digoxin 0.125 q.d. his digoxin level had been stable at therapeutic range at 1.2 as of a couple of days ago. beta-blocker is being held at this time given the patient's chronic obstructive pulmonary disease though since his flare seems to have resolved one could consider restarting a beta-blocker in the near future. he is not anticoagulated at this time given his risk of gastrointestinal bleeding, though he obviously remains at risk for clot given his known left ventricular thrombus, known left superficial femoral vein deep venous thrombosis status post ivc filter and his atrial fibrillation. 4. diarrhea: appears to have resolved at this time. there was high suspicion for c-diff, but eh was negative for c-diff times three test. at this time a c-diff b toxin was pending. if he should develop diarrhea again c-diff would be a likely culprit. 5. status post mrsa pneumonia: the patient remained afebrile with a normal white blood cell count at this time. his respiratory status is gradually improving. antibiotic course completed. 6. congestive heart failure with an ef of 35% on his echocardiogram on : the patient was diuresed with lasix 40 mg intravenously b.i.d. for several days. this tended to produce a net negative 1 to 1.5 liters per day. the day prior to discharge he was switched to a more stable regimen of lasix 40 po and aldactone 25 po. we feel that he may have several more pounds of fluid to come off with a gentle diuresis over the next week and he should certainly not become fluid positive at this time. diuresis was slowed just because his bicarbonate had creeped up to 38 though his bun and creatinine had remained relatively stable at 34 and 1.1. his weights and is and os should be followed closely. 7. chronic obstructive pulmonary disease: the patient is on a prednisone taper from his chronic obstructive pulmonary disease flare. he is to receive 10 mg per day through and then he can be decreased to 5 mg per day for a three day taper and then probably can be tapered off as his respiratory status will tolerate. 8. left superficial femoral deep venous thrombosis: the patient has an ivc filter in place, but as noted above is not on anticoagulation given his risk of gastrointestinal bleeding. 9. chronic renal insufficiency: the patient's creatinine has actually improved over his baseline in the mid 1s with a creatinine of 1.1 on discharge. 10. coronary artery disease: the patient is continued on his statin and ace inhibitor. 11. diabetes mellitus type 2: the patient is controlled in the hospital on nph and a regular insulin sliding scale. 12. carotid stenosis: the patient is status post left carotid stent. ideally he wold be on , but again this is being held given his recent gastrointestinal bleeding and hematocrit drops. 13. fen: the patient has been on a cardiac and diet, however, he certainly could use nutritional consultation and supplementation given his low albumin of 2.6 recently and his mild whole body edema. 14. access: the patient is a very difficult to place an iv in and has a right double lumen picc line in place. discharge disposition: to extended care facility. discharge instructions: 1. he should contact his primary care physician or come to the emergency department with any chest pain, worsening shortness of breath, bleeding from your bottom or coughing up blood. 2. please check daily weights and adjust diuretic regimen accordingly. we feel the patient can diurese several more pounds. 3. adhere to a 2 gram sodium diet. 4. two liter fluid restriction. 5. you should have your digoxin level checked in one week. 6. you should have your hematocrit and platelets checked in three days. 7. you should have your potassium and chem 7 checked in three days as you have recently started on spironolactone. 8. if your hematocrit remained stable for a week you could consider adding back aspirin to your regimen. 9. you have an appointment with dr. cardiology on at 11:30. 10. vascular steady 2:00. 11. dr. at 3:30. discharge diagnoses: 1. chronic obstructive pulmonary disease exacerbation. 2. mrsa pneumonia. 3. chronic renal insufficiency. 4. anemia with presumed gastrointestinal bleeding source. 5. atrial fibrillation with rapid ventricular rate. 6. gastritis. 7. diverticulosis. 8. coronary artery disease. 9. history of left upper extremity deep venous thrombosis. major surgical and invasive procedures: 1. cardioversion. 2. central line placement. 3. intubation. 4. esophagogastroduodenoscopy. 5. transfusions. discharge medications: 1. atorvastatin 20 mg once a day. 2. maalox prn. 3. fluticasone two puffs twice a day. 4. artificial tears one to two drops prn. 5. albuterol nebulizer every four hours. 6. atrovent nebulizer every four hours. 7. captopril 6.25 t.i.d. 8. digoxin 0.125 q.d. 9. nexium 20 mg po b.i.d. 10. prednisone 10 mg q.d. for two days, on change to 5 mg q.d. times three days and then to 2.5 mg q.d. times two days and then stop. 11. spironolactone 25 mg q.d. 12. lasix 40 mg q.d. 13. insulin nph 20 units q.a.m. 14. insulin nph 10 units q.p.m. 15. regular insulin sliding scale. 16. bisacodyl 10 mg suppository prn. 17. amiodarone 300 mg b.i.d. until for a total of 14 days and then change to 400 mg q.d. for one month, but this dose should be continued until the patient is seen by a cardiologist. discharge condition: stable. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine insertion of endotracheal tube interruption of the vena cava atrial cardioversion transfusion of packed cells injection or infusion of oxazolidinone class of antibiotics diagnoses: thrombocytopenia, unspecified congestive heart failure, unspecified acute kidney failure, unspecified obstructive chronic bronchitis with (acute) exacerbation acute respiratory failure methicillin susceptible pneumonia due to staphylococcus aureus heart valve replaced by transplant hemorrhage of gastrointestinal tract, unspecified 

Answer: The patient is high likely exposed to