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: no known allergies / adverse drug reactions attending: chief complaint: shortness of breath, admitted from cardiology clinic for chf exacerbation major surgical or invasive procedure: right heart catheterization picc placement history of present illness: mr. is a 54y/o gentleman with htn, hld, dm2, ckd (baseline cr 2.0-2.2), cad s/p cabg (lima-lad, svg-pda, and radial-om1-om2) with systolic and diastolic heart failure (ef has been as low as 20% in the past) who is admitted from clinic due to concern for chf exacerbation. in he had a b&wh admission for heart failure in the setting of a 30 lb weight gain. there he reportedly had an ef of 20% on admission (in acute decompensated chf), improved to 40% on discharge. he was diuresed down to 220 lbs. after his hospitalization, he was compliant with medications and feels that he has been good about adhering to a low-salt diet. he has been on lasix 80mg since then. due to recent dietary changes, he may have a lower baseline dry weight (or, alternatively decreased muscle mass at baseline). he came to cardiology clinic today because of 2 weeks of progressive shortness of breath on exertion. ~1 month ago, he could walk 4 blocks before getting very tired but over the past 2 weeks he has progressed to the point that he is short of breath after taking a few steps. he has orthopnea and has not been able to sleep comfortably; he gets a few hours of rest when seated in a chair. he feels exhausted. denies chest pain or palpitations. prior to cabg, his anginal pain was exertional back pain, but he has had none of this recently. he feels that he has been urinating less after taking his usual dose of lasix. no missed doses of lasix. has been adhering to his low salt diet. his weight is up 5 lbs over the past week and is now 228.17 lbs. pedal edema is mildly worse than usual. he notes that he has worsening painless ulcers on his anterior calves. cardiac review of systems is notable for absence of chest pain, palpitations, syncope or presyncope. past medical history: past medical history: hypertension dyslipidemia diabetes mellitus -retinopathy s/p laser surgery -peripheral neuropathy with ulcers chronic kidney disease (baseline cr 2.0-2.2) coronary artery disease -s/p cabg in (lima-lad, svg-pda, and radial-om1-om2) congestive heart failure -: b&wh admission with ef of 20% in chf, improved to 40% on discharge deep vein thrombosis x1 (s/p warfarin in the past) s/p right knee arthroscopy iron deficiency anemia gout social history: -home: lives in with his wife. married 20 years. -occupation: works as a financial planner, lawyer, runs a property company. -tobacco: used to smoke one cigar daily since high school until stopping after cabg. no cigaretters. -etoh: none -illicits: none family history: mom had cabg in 60s. 3 brothers all without heart disease or diabetes. father with ?lymph cancer. physical exam: admission exam: t=98.6 hr=104 bp=144/82 rr=26 o2sat=90%4l nc, 86%ra weight: 103.5 kgs (228.17 lbs) general: alert, oriented x3. cannot complete long sentences without pausing to catch breath. not in acute distress, however. heent: ncat. sclera anicteric. eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthelasma. neck: supple with elevated jvp to earlobe at 45 degrees. cardiac: pmi closer to midline w/ rv lift. rr, s1, s2 w/ paradoxical splitting, s3. no murmur or rub. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. crackles -basilar lung fields, worse on the right. abdomen: softly distended. abd aorta not enlarged by palpation. no abdominal bruits. bs present. extremities/skin: cooler. severe stasis dermatitis with anterior weeping ulcers on lower extremities. also with healing ulcer on r side of thigh. + edema to thighs bilaterally. pulses: dopplerable throughout, left dp is 1+. discharge exam: t=97.4, bp 129/74 (123/155/63-81), hr 71 (67-80), rr 18, pox 99%ra weight: 96kg (211 lbs) general: alert, oriented x3. very comfortable. ambulating around room with no complaints. heent: mmm neck: supple with jvp 6-7cm cardiac: pmi closer to midline w/ rv lift. rr, s1, s2 w/ paradoxical splitting, s3. no murmur or rub. lungs: clear to auscultation bilaterally abdomen: softly distended. abd aorta not enlarged by palpation. no abdominal bruits. bs present. extremities/skin: cooler. severe stasis dermatitis with anterior weeping ulcers on lower extremities. also with healing ulcer on r side of thigh. trace le edema. pertinent results: ================================================== admission labs 01:30pm glucose-87 urea n-61* creat-2.5* sodium-136 potassium-3.9 chloride-100 total co2-24 anion gap-16 01:30pm ck-mb-6 ctropnt-0.05* probnp-4874* 01:30pm wbc-7.8 rbc-4.13* hgb-9.9* hct-32.9* mcv-80* mch-23.9*# mchc-30.0*# rdw-18.9* 01:30pm plt count-318# discharge labs 07:10am blood wbc-4.9 rbc-3.88* hgb-8.9* hct-30.6* mcv-79* mch-23.0* mchc-29.1* rdw-18.4* plt ct-222 06:57am blood glucose-220* urean-89* creat-3.4* na-137 k-3.8 cl-91* hco3-35* angap-15 06:57am blood calcium-8.6 phos-5.0* mg-2.9* ================================================== creatinine trend creat-2.5 creat-3.0 creat-3.1 creat-3.1 creat-3.0 creat-3.2 creat-3.4 wbc trend wbc-7.8 wbc-13.3 wbc-4.9 other pertinent labs 01:30pm blood ck-mb-6 ctropnt-0.05* probnp-4874* 07:43am blood ctropnt-0.04* ================================================== microbiology data 7:56 pm blood culture source: venipuncture. **final report ** blood culture, routine (final ): staph aureus coag +. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- r erythromycin---------- r gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s oxacillin-------------<=0.25 s trimethoprim/sulfa---- <=0.5 s aerobic bottle gram stain (final ): gram positive cocci in clusters. anaerobic bottle gram stain (final ): gram positive cocci in clusters. blood culture blood culture, routine-pending blood culture blood culture, routine-pending blood culture blood culture, routine-pending urine urine culture-final blood culture blood culture, routine-final {staph aureus coag +}; aerobic bottle gram stain-final; anaerobic bottle gram stain-final 7:56 pm blood culture source: venipuncture. **final report ** blood culture, routine (final ): staph aureus coag +. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- r erythromycin---------- r gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s oxacillin-------------<=0.25 s trimethoprim/sulfa---- <=0.5 s ================================================== 2d-echocardiogram : this study was performed with optison echocardiographic contrast for endocardial border detection. the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is mildly dilated. overall lv systolic function appears moderately-to-severely depressed (ejection fraction 30 percent), with regional variation. the inferior septum, inferior free wall, and posterior wall appear severely hypokinetic, whereas the rest of the left ventricular walls appear mildy-to-moderately hypokinetic. in addition, significant mechanical dyssynchrony with a typical left bundle branch block activation sequence is present. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests a marked restrictive filling abnormality, with elevated left atrial pressure. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. . the right ventricle was poorly visualized. the right ventricular free wall was seen only in limited subcostal window imaging. on the basis of this single imaging window, the right ventricle appears hypokinetic, possibly severely so. the tricuspid annular dimension of 4.2 cm in the apical four chamber window suggests that the right ventricle is dilated, but the actual right ventricular cavity dimension could not be determined with certainty due to the technically suboptimal nature of this study. . the right ventricular outflow tract pulsed doppler velocity spectrum is bifid, which suggests that pulmonary arterial hypertension due to precapillary (pulmonary arteriolar) constriction is present. . compared with the findings of the prior study (images reviewed) of , significant left ventricular and right ventricular contractile dysfunction is now present. mechanical dyssynchrony is now present, with a markedly restrictive filling pattern. suboptimal study, performed with contrast . ================================================== 2d-echocardiogram 11:22:25 am compared with the prior study (images reviewed) of , regional variation in left ventricular function is more difficult to determine due to absence of intravenous contrast administration. there is no obvious evidence of endocarditis. estimated pulmonary artery pressure is lower. ================================================== ecg 11:32:30 am sinus rhythm. complete left bundle branch block. compared to the previous tracing of complete left bundle-branch block is now present. ecg 7:45:50 pm sinus tachycardia. left bundle-branch block. compared to the previous tracing of the heart rate has increased. non-conducted premature atrial contractions are no longer seen. ================================================== right heart catheterization 1. resting hemodynamics revealed elevated right- and left-sided filling pressures, with a rvedp of 20 mmhg and pcwp of 35 mmhg. there was severe pulmonary arterial hypertension, with pasp of 83 mmhg. the cardiac output was reduced, with a cardiac index of 2.1 l/min/m2 (using an assumed oxygen consumption). final diagnosis: 1. elevated right- and left-sided filling pressures. 2. severe pulmonary arterial hypertension. 3. reduced cardiac output. ================================================== bilat lower ext ultrasound 9:01 am no evidence of deep vein thrombosis in either leg. no superficial thrombophlebitis or edema identified. ================================================== chest port. line placement 1:27 pm satisfactory placement of right picc line with tip in the low svc. ================================================== brief hospital course: mr. is a 54 year old gentleman with htn, dm2, ckd (baseline cr 2.0-2.2), cad s/p cabg , as well as systolic and diastolic heart failure (ef had been as low as 20% but last known to be 40%), who was admitted to the cardiology service from clinic on for worsening dyspnea over 2 weeks. chf exacerbation was in the setting of new inferior hk and he was diuresed with hopes of pursuing rhc/lhc. due to with cr >3.0, only rhc was done, and showed very elevated filling pressures so he was transferred to the ccu for milrinone to assist with lasix gtt. his course has been complicated by piv-associated mssa bacteremia for which he is on 4 weeks of nafcillin. he continued to be diuresed and was transferred back on the cardiology floor. he was discharged home on oral diuretics with pcp, , and id follow-up. active issues #. chf exacerbation: volume status much improved, weight 103.5 --> 96kg. improved jvp, improved pedal edema, no crackles on lung exam. off supplemental oxygen, ambulating with no complaints. he will follow up at cardiology heart failure clinic with np two days after discharge, and then will see his primary cardiologist dr. in 1 month. (a) diuresis he was treated with a lasix gtt (mostly @30/hr). in the ccu was on milrinone for a few hours. did receive 2 doses of metolazone. diuresed well and was discharged on torsemide instead of furosemide. given his cr elevation, he will hold torsemide on day of discharge and the subsequent day, but will restart torsemide 60mg on . (b) preload/afterload reduction given his he could not be started on an acei but he was started on isosorbide and hydralazine, which were uptitrated. in addition, his metoprolol was changed to carvedilol for better afterload control. hopefully in the future he can be put on an acei if his renal function allows. (c) improve contractile function he is s/p milrinone in the ccu for a few hours. also, in case his pump dysfunction is due to ischemic heart disease, he should undergo left heart catheterization when stable from a volume and standpoint, in order to see if there are any grafts/native vessels that would benefit from revascularization. finally, he had significant dyssynchrony and he is a candidate for crt and should get biv-icd once his infection is treated (can happen as outpatient within ~6weeks). (d) prevent remodeling he is on a beta blocker (metoprolol changed to carvedilol this admission). acei was not started because of . #. peripheral iv-associated mssa bacteremia: on nafcillin x4 weeks. he rigored and spiked to 102.7 on arrival to the ccu from the rhc. had hr up to 120 and rr 25. never dropped bp however. wbc 8-->13, 91.5% pmns. received vanc/zosyn initially. source was initially unclear. infectious disease was consulted; the likely source is a right forearm piv site which was infiltrated and erythematous. grew mssa from blood cultures 9/10 but subsequently cleared. changed from vanc to nafcillin because it speciated as mssa. antibiotics were switched to nafcillin. he declined tee but underwent tte on that showed no obvious vegetation. since cannot rule out endocarditis, will treat for 4 week course with nafcillin via picc ]. wbc trended down and he remained afebrile since . he will follow up with infectious disease clinic after discharge, with weekly surveillance labs sent to clinic. #. hypertension: bp now better controlled. he had sbp 140-160 so his medications were uptitrated. he was started on isosorbide and hydralazine, which were uptitrated. in addition, his metoprolol was changed to carvedilol for better afterload control. he should follow up with his pcp and cardiologist to ensure adequate bp control. #. on ckd: baseline cr 2.1, presented at 2.5, now ~3.4. elevated cr likely secondary to decreased cardiac output and less perfusion than usual recently. his allopurinol has been stopped. medications were renally dosed. avoided left heart cath due to risk of receiving dye. creatinine initially improved somewhat with diuresis but then increased again toward the end of this admission. cr on discharge is 3.4 - his torsemide was held on day of discharge and the next day, but will be restarted on . he should have cr recheck at his upcoming cardiology visit. could benefit from lisinopril in the future if renal function improves. he should establish care with a nephrologist if he does not already have one. #. cad s/p cabg last cath in noted severe native 3vd with patent lima-lad, svg-pda, and radial-om1-om2. admission tte showed new inferior hk. he was continued on asa, pravastatin, and beta blocker (metoprolol changed to carvedilol). when he is stable from a volume and standpoint, he would benefit from left heart catheterization in order to assess grafts/native vessels. he will follow up with his cardiologist. #. neuropathic & venous statis ulcers. weeping but not infected. pulses palpable. he was seen by wound care. if wounds do not heal with next several weeks, he should be referred for abis or a vascular surgery consult to rule out an arterial component. he should get prescription compression stockings after his ulcers have healed and arterial insufficiency has been ruled out. inactive issues #. diabetes mellitus: not optimally controlled. hba1c has been >12% in the past but most recently was 7.1% in 5/. in house, he was on lantus with ssi humalog coverage, and am glucose was 150-200. he is being discharged on his home lantus and mealtime aspart, and should follow up with his pcp for ongoing diabetes management. #. dyslipidemia: stable. cholesterol panel in : tchol 132, tg 99, hdl 42, ldl 77. he continues on pravastatin. #. h/o deep vein thrombosis: lenis negative here. he received heparin dc tid for dvt prophylaxis. # iron deficiency anemia: hct stable at 30-33 this admission. he continues on his home iron supplements. transitional issues -code status: full code -emergency contact: (wife) -labs/studies pending at discharge: none -cardiology follow-up: at clinic with days, and then with primary cardiologist dr. in 1 month -dry weight: 96kg -diuretics: given his cr elevation, he will hold torsemide on day of discharge and the subsequent day, but will restart torsemide 60mg on . -acei: consider lisinopril once renal function improves. -crt: should get biv-icd once his infection is treated. -cardiac cath: he should undergo lhc once stable from a volume and standpoint. -***picc should be removed after completion of iv antibiotics.*** -should be referred for abis or a vascular surgery consult -should get prescription compression stockings after his ulcers have healed and arterial insufficiency has been ruled out -neprology: he should establish care with a nephrologist if he does not already have one. -outpatient labs: he should have cr/electrolyte recheck at his upcoming cardiology visit. also, will have weekly opat labs. medications on admission: preadmission medications listed are correct and complete. information was obtained from patientpharmacy. 1. furosemide 80 mg po bid 2. glargine 44 units bedtime aspart 22 units breakfast aspart 22 units lunch aspart 22 units dinner 3. metoprolol succinate xl 25 mg po daily 4. pravastatin 80 mg po daily 5. aspirin 81 mg po daily 6. allopurinol 100 mg po daily discharge medications: 1. nafcillin 2 g iv q4h ] rx *nafcillin in d2.4w 2 gram/100 ml 2 grams iv every 4 hours disp #*288 gram refills:*0 2. aspirin 81 mg po daily 3. glargine 44 units bedtime aspart 22 units breakfast aspart 22 units lunch aspart 22 units dinner 4. pravastatin 80 mg po daily 5. carvedilol 25 mg po bid rx *carvedilol 25 mg 1 tablet(s) by mouth twice a day disp #*60 tablet refills:*0 6. hydralazine 50 mg po q8h rx *hydralazine 50 mg 1 tablet(s) by mouth three times a day disp #*90 tablet refills:*0 7. isosorbide mononitrate (extended release) 120 mg po daily rx *isosorbide mononitrate 120 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 8. outpatient lab work tuesday : please check chem10. to be followed up by , ( and also dr. (. 9. torsemide 60 mg po bid hold your torsemide today and tomorrow, and restart on tuesday rx *torsemide 20 mg 3 tablet(s) by mouth twice a day disp #*180 tablet refills:*0 discharge disposition: home with service facility: home solutions discharge diagnosis: primary: congestive heart failure (acute on chronic) mssa bacteremia secondary: coronary artery disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you at ! you were admitted here because you were having worsening shortness of breath. you were found to have an exacerbation of your congestive heart failure. you underwent right heart catheterization which found that the filling pressures in your heart were very high so you went to the cardiac icu for more aggressive fluid removal. then you were transferred back to the floor and were changed back to oral diuretics. you have lost many pounds of fluid weight and are much more comfortable. today's weight is 96kg (211 lbs). please weigh yourself every morning, and call your doctor if weight goes up more than 3 lbs. due to poor blood flow to the kidneys, your creatinine is elevated. on the day of discharge, your creatinine is 3.4. please hold your torsemide today and tomorrow, and restart on tuesday . you shuld have labs checked at your upcoming appointment (lab slip has been included). when your infection has been treated and kidney function is better, you will likely be referred for left heart catheterization to make sure there are no new blockages in your bypass grafts or heart arteries. in addition, you will be evaluated for a possible pacemaker/defibrillator that can help improve the pump function of your heart. your hospital stay was comlpicated by a peripheral line-associated staph bloodstream infection. you declined transesophageal echo to make sure there was no heart valve infection, so you will receive a full 4 weeks. you will follow up with the infectious disease team in outpatient antibiotic therapy (opat) clinic. we made the following changes to your home medication list: -stop metoprolol -stop furosemide (lasix) -stop allopurinol (because your kidney function is worsened; ask your primary care doctor when you can restart this) -start carvedilol -start torsemide (hold your torsemide today and tomorrow, and restart on tuesday ) -start isosorbide mononitrite -start hydralazine -start nafcillin (four week course .) followup instructions: cardiology - heart failure clinic when: tuesday at 1:30 pm with: , np building: sc clinical ctr campus: east best parking: garage **please have labs checked at this visit. a lab slip had been included.** primary care department: primary care - dr. office , np tue. ; 4:00 pm physicians 100 way , phone: cardiology department: cardiac services when: wednesday at 10:40 am with: , m.d. building: campus: east best parking: garage infectious disease - clinic you will be contact at home with an appointment. if you do not hear back within business days, please call ( to schedule a follow-up visit. procedure: venous catheterization, not elsewhere classified pulmonary artery wedge monitoring right heart cardiac catheterization diagnoses: acidosis congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status other chronic pulmonary heart diseases diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site long-term (current) use of insulin iron deficiency anemia, unspecified personal history of venous thrombosis and embolism diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy ulcer of other part of lower limb venous (peripheral) insufficiency, unspecified acute on chronic combined systolic and diastolic heart failure infection following other infusion, injection, transfusion, or vaccination 

Answer: The patient is high likely exposed to