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: tetracycline / nafcillin attending: chief complaint: nausea, vomiting, diarrhea major surgical or invasive procedure: transesophageal echocardiogram - negative for any vegetation history of present illness: 48 year old male with type 1 diabetes, pvd s/p right bka, cad, benign hypertension and ckd stage ii who presents with nausea, vomiting, diarrhea. the patient reports that he has felt unwell for 6 days. initially he describes a cough with clear sputum production approximately 6 days prior to admission. his symptoms progressed within 24-48 hours to include nausea and non-bloody emesis. he reports inability to keep any food down for the 4-5 days prior to admission with the exception of a small amount of water days prior to admission. he also noted non-bloody diarrhea, described as loose stool occurring approximately 2 times per day. he denies any known sick contact though notes that his symptoms started sometime after working with children at a day care facility. he denies clear fevers at home and denies chills or nightsweats. he does endorse a headache for 24 hours approximately 3-4 days prior to admission, however this self resolved. he notes some blurry vision on admission. there was some concern for neck stiffness in the ed, however he does thinks the neck tenderness that occurred while in the ed was similar to his prior pain with slipped discs in the neck. he was initially admitted to the , and was febrile with a leukocytosis and tachycardia concerning for sirs, also with acute renal failure. he was started on vancomycin and ceftriaxone. while in the , the patient had several blood cultures which were positive for staph aureus sensitive to oxacillin (mssa). ct chest, ct sinus, and tte were negative for source of bacteremia. podiatry was consulted for a foot ulcer as well and felt this not to the source of the septicemia/bactremia. after being discharged to the floor, the patient noted that he had a rash on his chest/abdomen after going to the gym frequently prior to admission, but no pustules. denies leg pain, stump pain. past medical history: - coronary artery disease s/p mi , angioplasty c stent lad ', radiation brachytherapy lad ' - type i dm since age 18 - diabetic retinopathy - diabetic nephropathy (baseline creatine 1-1.5) - htn - hypercholesterolemia - hypothyroidism - cervical disc - peripheral disease s/p l akpop--> dorsalis pedis with non-reversed saphenous vein graft ' - s/p right ak to dp bypass with reversed greater saphenous vein - right bka - left trans metatarsal amputation ' - appendectomy social history: disabled prior employee of . denies etoh, tobacco or drug use. sexually active with 1 partner in the past year and 'always' uses protection against std's. hiv tested many years ago and was negative. family history: father with 3 cabg in his 70's, deceased at 86; also had dm type 2, cad, mi, pvd. otherwise non-contributory. physical exam: ros: gen: - fevers, - chills, - weight loss eyes: - photophobia, - visual changes heent: - oral/gum bleeding cardiac: - chest pain, - palpitations, - edema gi: - nausea, - vomitting, - diarhea, - abdominal pain, - constipation, - hematochezia pulm: - dyspnea, - cough, - hemoptysis heme: - bleeding, - lymphadenopathy gu: - dysuria, - hematuria, - incontinence skin: - rash endo: - heat/cold intolerance msk: - myalgia, - arthralgia, - back pain neuro: - numbness, - weakness, - vertigo, - headache physical exam: vs: stable and afebrile gen: nad pain: 0/0 heent: eomi, mmm, - op lesions pul: cta b/l cor: rrr, s1/s2, - mrg abd: nt/nd, +bs, - cvat ext: - cce, r bka neuro: caox3, non-focal derm: few scattered healing ulcers pertinent results: 11:10 pm blood culture **final report ** blood culture, routine (final ): staph aureus coag +. final sensitivities. penicillin sensitivity available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- 4 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s aerobic bottle gram stain (final ): reported by phone to 10:30am. gram positive cocci in pairs and clusters. anaerobic bottle gram stain (final ): gram positive cocci in clusters. tee : conclusions no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. the pulmonic and tricuspid valves appear normal. there is no pericardial effusion. impression: no evidence of endocarditis or abscess on tee. mild mitral and aortic regurgitation. abdomen u.s. (complete study) study date of 8:44 am impression: 1. sludge in otherwise unremarkable gallbladder. 2. mildly echogenic kidneys, suggestive of chronic medical renal disease. 3. no significant fluid collection or abscess seen. foot ap,lat & obl left study date of 4:15 pm final report history: ulcer. osteomyelitis. three radiographs of the left foot again demonstrate the patient to be status post transmetatarsal amputation. there is osseous remodeling about the surgical resection margins of the first through fourth metatarsals when compared with . assessment for the presence and/or absence of subcutaneous air in the regional soft tissues is markedly limited by overlying dressing material. there is diffuse demineralization attributable to disuse. surgical staples are again noted in the soft tissues overlying the distal and medial leg. atherosclerotic calcifications are noted. there is either interval debridement or osseous resorption of the fifth metatarsal base when compared with . clinical correlation is requested. mr w& w/o contrast study date of 12:34 pm impression: 1. no evidence of epidural abscess or unusual fluid collection. 2. no abnormal signal throughout the cord. 3. no change in moderate degenerative change of the cervical spine, with posterior bulging of c5-c6 disc causing mild indentation on the thecal sac. ct chest w/o contrast clip # impression: 1. the left perihilar lung nodule on the chest radiograph is a focal dilatation of a small pulmonary artery, not requiring followup, unless the patient has clinical manifestions of vasculitis. 2. solitary 3.5 mm right middle lobe nodule. if the patient does not have any history of any risk factors for malignancy, then the nodule does not require any further followup. if, however, the patient has underlying risk factors for malignancy including smoking, then the nodule needs to be followed with a chest ct in one year (with contrast administered to evaluate the status of the left pulmonary artery on the same examination). 3. atherosclerotic coronary and abdominal artery calcifications. 4. trace pericardial and pleural effusions. ct sinus/mandible/maxillofacial w/o contrast study date of 3:32 pm impression: there is no evidence of air-fluid levels in the paranasal sinuses, minimal mucosal thickening is noted on the floor of the left maxillary sinus as described above. bilateral atherosclerotic calcifications noted in the carotid siphons. deformity of the left eye globe possibly related with history of retinal detachment and post-surgical changes. tte : conclusions the left atrium is elongated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed (lvef= 40-50 %) secondary to hypokinesis of the anterior septum and anterior free wall, and akinesis of the apex. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. compared with the findings of the prior report (images unavailable for review) of , mild aortic regurgitation is now evident. impression: no obvious vegetations seen chest (pa & lat) study date of 11:45 pm impression: 1. probable 14 mm left-sided pulmonary nodule as described. a ct is recommended for further evaluation. 2. no acute cardiopulmonary process. brief hospital course: 1. septicemia due to staphylococcus aureus, bacteremia - source remains unclear despite extensive evaluation including tte, tee, chest ct, ct sinus, neck mri - once blood cultures became positive and sensitivities known, he was transitioned to nafcillin. in the 2 days post nafcillin, he developed acute renal failure, felt to be due to atn or ain from nafcillin. - id consultation was obtained - his antibiotics were changed to cefazolin with id consultation - once the tee was negative, he was changed to a simple 2 week course of cefazolin with monitoring labs to go to clinic, and follow up at that time. he will continue cefazolin at home. - picc was placed once surveillance cultures were negative - no source was ever identified. there was some concern that his remaining foot was the source, but podiatry felt this not to be the case. he will have a follow up foot film next week with additioanl f/u in clinic in 2 weeks 2. acute renal failure, acute tubular necrosis - felt to be due to nafcillin - c3/c4 levels drawn as initially post-infectious glomerulonephritis was considered, but given rapid resolution with cessation of nafcillin and normal c3/c4, this diagnosis is highly , patient stays on cefazolin - renal consultation was obtained - initially cefazolin was 1gram q8h, but ultimately when createnine returned to baseline he was returned to 2grams q8h dosing 3. type 1 diabetes uncontrolled with complications - insulin maintained as prior regimen 4. benign hypertension - metoprolol 5. cad native , hyperlipidemia - aspirin, metoprolol, simvastatin 6. hypothyroidism - synthoroid 7. left plantar foot ulcer - seen by wound care; not felt to be actively infected at this time; f/u in podiatry and also clinic 8. pulmonary nodule - admission cxr with report of left 14 mm pulmonary nodule, on further evaluation with noncontrast chest ct this was found to be a focal dilatation of a small pulmonary artery, not requiring followup, unless the patient has clinical manifestions of vasculitis. however, ct did also note a rml nodule which will need f/u imaging if he has hx smoking (pcp believes he does have hx remote smoking). this information has been conveyed directly to pcp by myself over the phone. medications on admission: medications (patient does not know any of his home meds, list from d/c summ , also confirmed with pharmacy: cvs in on . ): metoprolol 50mg daily levothyroxine sodium 100 mcg po daily simvastatin 20mg daily aspirin 325 mg po daily -> not recorded at the pharmacy lisinopril -> patient believes he takes this medication though pharmacy has no record of this. insulin fixed dose: nph 28u qam, 0-10u qpm per sliding scale humalog sliding scale discharge medications: 1. cefazolin 10 gram recon soln sig: two (2) grams recon soln injection q8h (every 8 hours) for 12 days. disp:*qs grams recon soln(s)* refills:*0* 2. heparin flush 10 unit/ml kit sig: one (1) flush intravenous three times a day as needed for picc use for 12 days: sash. disp:*qs flushes* refills:*0* 3. saline flush 0.9 % syringe sig: one (1) flush injection three times a day as needed for picc use for 12 days: sash. disp:*qs flushes* refills:*0* 4. picc care picc line care and dressing changes per protocol 5. outpatient lab work cbc, chem 10 fax results to: md 6. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 7. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 8. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 9. insulin nph human recomb 100 unit/ml cartridge sig: twenty eight (28) units subcutaneous qam: please resume your prior home dose of nph including your morning scheduled nph and prior evening dose/sliding scale. we have not made any deliberate changes to your insulin regimen. 10. humalog 100 unit/ml cartridge sig: sliding scale subcutaneous per sliding scale: please resume your prior humalog insulin sliding scale regimen. we have not made any deliberate changes to your regimen. 11. toprol xl 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day: this medicine is also known as metoprolol in generic form. please resume whatever dose you were taking at home if it does not match this order. discharge disposition: home with service facility: critical care systems discharge diagnosis: staph aureus septicemia staph aureus bacteremia secondary: acute renal failure, possibly secondary to nafcillin, resolving coronary artery disease, native peripheral disease type 1 diabetes, poorly controlled with complications hypertension, benign hyperlipidemia hypothyroidism foot ulcer discharge condition: stable discharge instructions: please seek medical attention if you develop a recurrent fever >101 or develop nausea, vomiting, shaking chills, worsening joint pain please keep the follow-up appointments below with the infectious disease clinic, as well as your appointment with your surgeon dr. . we have made a podiatry appointment for you for tomorrow . if you are unable to make this time, please call to reschedule. you will need to get a repeat x ray for your left foot on . you can walk-in anytime that day to radiology, . the xray order is already in the computer. if you have any questions . please follow-up with your primary care physician in the next 1-2 weeks. , j. phone: aside from the new antibiotic that you are on, we have not deliberately changed any medications. please resume the medications you were prior to this admission. followup instructions: provider: care id phone: date/time: 1:30 . suite g provider: lab phone: date/time: 1:30 provider: , md phone: date/time: 2:15 provider: , dpm podiatry; building on , phone: date/time: 3:00 md procedure: venous catheterization, not elsewhere classified diagnoses: acidosis anemia in chronic kidney disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere coronary atherosclerosis of native coronary artery pure hypercholesterolemia acute kidney failure with lesion of tubular necrosis unspecified acquired hypothyroidism percutaneous transluminal coronary angioplasty status methicillin susceptible staphylococcus aureus septicemia sepsis chronic kidney disease, unspecified alkalosis old myocardial infarction other diseases of lung, not elsewhere classified below knee amputation status diabetes with renal manifestations, type i [juvenile type], uncontrolled diabetes with ophthalmic manifestations, type i [juvenile type], uncontrolled background diabetic retinopathy atherosclerosis of native arteries of the extremities with ulceration ulcer of heel and midfoot hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified chronic total occlusion of artery of the extremities penicillins causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to