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: demerol / unasyn / cephalosporins / levaquin / moexipril / morphine / cyclosporine / neurontin attending: chief complaint: hypotensive at dialysis with lightheadedness major surgical or invasive procedure: i&d of right upper arm ligated avg site with exteernal sutures placed to control post-i+d bleeding removal remnant avg, patch angioplasty history of present illness: pt is 31 y/o f with multiple medical problems including sle complicated by lupus nephritis and esrd requiring hemodialysis who presents from dialysis center today with fevers to 103 and hypotension with sbp in 80s. pt states that fevers just started today. she feels a little lightheaded and dizzy. the pt is also complaining of some soreness in her right arm where she had a mrsa infected av graft removed 3 months ago. the wounds had opened up a few weeks ago and had recently been draining pus. she is currently on a course of vancomycin for this. she otherwise denies cough, chest pain, shortness of breath, abd pain, nausea/vomiting, or diarrhea. past medical history: -sle diagnosed complicated by lupus nephritis, anemia, serositis and ascites - end stage renal disease secondary to lupus, hd t/th/sat - history of vsd s/p corrective surgery, age 13 - hypertension - itp - h/o mssa endocarditis - sickle cell trait - s/p left oophorectomy related to iud associated infection - restrictive lung disease noted on pfts . in , chest ct with diffuse ground glass opacities. - gerd - s/p cadaveric renal transplant on complicated by rejection and capsule rupture 11/. - right pelvic abscess s/p tah/rso - b/l renal solid masses s/p resection pathology was negative for carcinoma - r tib/fib fx with orif . complicated by wound./hardware infection requiring bka - rue avg excision - s/p cva - rue avg i&d social history: recently discharged from to home with services. lives with husband and son. smoking, occasional alcohol, no drug use. originally from . used to work at . family history: noncontributory physical exam: t 98 p 67 bp 89/57 r 18 sao2 100% gen: nad heent: an-icteric, oropharyngeal mucosa moist neck: supple lungs: clear heart: rrr abd: soft, nontender, nondistended, bs +, no guarding, non rigid extrem: right arm av graft site draining small amounts of pus at opposite ends of incision, no fluctuance, induration, or swelling, right hand neurovascularly intact, 1+ right radial pulse pertinent results: 07:00am blood wbc-6.0 rbc-2.60* hgb-7.6* hct-23.4* mcv-90 mch-29.3 mchc-32.6 rdw-19.9* plt ct-52* 07:00am blood pt-15.0* ptt-31.7 inr(pt)-1.3* 07:00am blood glucose-85 urean-44* creat-8.6*# na-140 k-4.9 cl-101 hco3-30 angap-14 06:45am blood calcium-8.8 phos-3.7 mg-2.5 brief hospital course: she presented to the ed where she was given a fluid bolus and pan-cultured. wbc was 6.1 on admission. iv vancomycin was administered. transplant surgery was consulted for her access issue and recommendations were made for a rue ultrasound which was done. this showed an ill defined 1.3 x 0.5 cm fluid collection within the superficial subcutaneous tissues of the right antecubital fossa. she was transferred to the icu for care where bp responded to small fluid bolus. dialysis was done via the l tunnelled line. nephrology was consulted and followed her throughout this hospital stay. on she required small fluid boluses x 3 for bp as low as 74/39 with response. cvvhd was performed. iv vanco was changed to dapto per id recommendations. these included serial blood cultures. repeat blood cultures were done almost on a daily basis with all negative until . blood cultures from and were negative to date. on , a tte was performed revealing mild symmetric lvh(lvef 70%). there was no ventricular septal defect. the aortic valve, mitral and tricuspid valve leaflets were mildly thickened. no masses or vegetations were seen. there was severe mitral annular calcification. significant pulmonic regurgitation was seen. there was no pericardial effusion. compared with the findings of the prior study (images reviewed)from , a vegetation on the mitral valve was no longer seen. the open areas on her right upper arm was packed with nu guaze. she was given iv dilaudid for pain management. the wound was cultured. antibiotic coverage was broadened switched backt to vanco on as there was no gn growth and the wound grew mrsa. gentamycin and aztreonam were stopped on . she was transferred out of the icu on . she continued on vanco at hd sessions on a tuesday-thursday-sat schedule. right arm dressings were continued with persistent purulence noted in wounds. endocrine was consulted for low basal cortisol levels and she was found to have secondary adrenal insufficiency based cosyntropin stim test. recommendations included increasing prednisone to 10mg qd and giving stress dose steroids if she is febrile or hypotensive. she did not require this. recs included: -prednisone 10mg po x3 days for minor illness, would not recommend starting this now as pt is clinically improving. -if the patient is undergoing surgery or has severe illness would recommend stress dose steroids -d/c prednisone and start hydrocortisone 100mg iv q 8 hours then taper. -recommend discharging pt with dexamethasone 4mg im to take prn when having emesis and unable to keep down po meds. -follow like features and once pt fully recovers from this hospitalization would slowly taper steroids as pt tolerates but also steroids may be for itp so her labs would need to be followed closely if a taper is attempted. 3. osteoporosis prevention: last bone density test was in and showed osteopenia. pt is currently a dialysis pt and on calcium and vit d. pt needs repeat dexa scan as outpatient and follow up with bone clinic. her risk for fracture is high given she has amenorrhea, is weak from recent stroke, and is on steroid treatment. prednisone was increased to 10mg qd starting on . on , she spiked a temperature to 101. repeat blood cultures were sent were negative to date. on , the avg site was i&d'd at the bedside for purulent areas. she bled extensively requiring suturing with cessation of bleeding. pain in r arm worsened after i&d. fentanyl patch was increased to 125mcg and prn dilaudid was increased to 6mg prn q 4 hours with intermittent doses of dilaudid 0.5-1mg prn q 3. a pain consult was obtained with recommendations to not increase fentanyl, resume neurontin and increase po dose of dilaudid as well as premed for dressing changes with 1mg iv dilaudid. she did not tolerate neurontin due to "twitching". this was discontinued. on , she was taken to the or the following day to remove remnant infected graft and a patch angioplasty was placed. patient was extubated and transferred to the post anesthesia care unit in stable condition. patient remained in the hospital due to poor pain control and persistent oozing of blood at incision sites. hct dropped to 20 and prbc were transfused on several days. platelets and cryo were also administered. right arm incisions continued to ooze necessitating in patient management. bleeding was partially due to a hematoma of the more distal incision. oozing decreased to one dressing change per day. vna was arrange to do dressing changes. incisions appeared without redness or purulence. pt evaluated and recommended ace wrapping of r leg to decrease edema. home pt was recommended for strength, balance and safety. homecare was arrange for right arm dressings,pt and social work. samaritan ambulance was arrange for transort. she was discharged home on . last hemodialysis was . vancomycin was to continue until for mrsa. medications on admission: dilaudid 8 mg q3hr prn gabapentin 300 mg daily fentanyl 75 mcg q72hr amitriptyline 100 mg qhs lorazepam 1 mg daily prn tizanidine 2 mg tid topiramate 50 mg qhs keppra 500 mg calcium acetate 1334 mg tid with meals nephplex 1 tablet daily calcitriol 0.25 mcg daily benadryl 25 mg q8h prn epoetin ml sc qhd lactulose 30 ml daily pantoprazole 40 mg daily prednisone 5 mg daily aspirin 81 mg daily colace senna tylenol discharge medications: 1. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) gram intravenous hd protocol (hd protochol). 2. fentanyl 100 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). disp:*10 patch 72 hr(s)* refills:*0* 3. amitriptyline 50 mg tablet sig: two (2) tablet po hs (at bedtime). disp:*50 tablet(s)* refills:*2* 4. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*50 cap(s)* refills:*2* 5. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). disp:*50 capsule(s)* refills:*2* 6. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). disp:*50 capsule(s)* refills:*2* 7. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po daily (daily). disp:*50 ml(s)* refills:*2* 8. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 10. topiramate 25 mg tablet sig: two (2) tablet po daily (daily). disp:*50 tablet(s)* refills:*2* 11. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*50 tablet, chewable(s)* refills:*2* 12. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed. disp:*50 tablet(s)* refills:*0* 13. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. disp:*50 capsule(s)* refills:*0* 14. lorazepam 1 mg tablet sig: one (1) tablet po daily (daily) as needed. disp:*50 tablet(s)* refills:*0* 15. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). disp:*50 tablet(s)* refills:*2* 16. hydromorphone 4 mg tablet sig: 1.5 tablets po q4h (every 4 hours) as needed for pain. disp:*50 tablet(s)* refills:*0* 17. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 18. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection prn (as needed) as needed for line flush. 19. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 20. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). discharge disposition: home with service facility: homecare discharge diagnosis: fever hypotension sepsis secondary adrenal insufficiency esrd on hd lupus right arm old avg site infection, mrsa h/o r bka discharge condition: fair discharge instructions: * please call dr. office if fever, chills, malfunction of dialysis catheter or right arm wound redness/bleeding/drainage or if right arm appears swollen, discolored, or feels cold/numb * please call dr. office in nine days for suture removal of the tissue ligation * care group vna arranged for dressing changes twice daily, nursing visits, physical therapy continue usual scheduled dialysis followup instructions: , rn will call you with a follow up appointment provider: , md phone: date/time: reschedule ***** provider: , m.d. date/time: 11:20 procedure: hemodialysis other incision with drainage of skin and subcutaneous tissue repair of blood vessel with tissue patch graft removal of arteriovenous shunt for renal dialysis diagnoses: chronic glomerulonephritis in diseases classified elsewhere systemic lupus erythematosus end stage renal disease renal dialysis status esophageal reflux sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other diseases of lung, not elsewhere classified personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits infection and inflammatory reaction due to other vascular device, implant, and graft glucocorticoid deficiency below knee amputation status immune thrombocytopenic purpura kidney replaced by transplant methicillin resistant staphylococcus aureus septicemia sickle-cell trait 

Answer: The patient is high likely exposed to