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: cefazolin attending: chief complaint: desaturation and change in mental status. major surgical or invasive procedure: none. history of present illness: this is a 76-year-old man with dm ii, esrd on hd via lue av fistula, aaa, carotid disease, mssa bacteremia of unclear source, recently admitted for hypotension and complete heart block treated with a permanent pacemaker. patient now returns to with aletered mental status and hypoxemia. was at his usual hd session when o2 sat was noted to be 80% ra. was reportedly having labored breathing. complained of an odd feeling in his stomach. patient was only 1.5kg over dry weight, so only small amount of fluid removed. during hypoxemic episode, patient initially required 5l nc. became increasinly confused and changed to 100% nrb. hd session was completed and about 1l fluid was removed. by report from the family, patient was recently hospitalized at and discharged day before admission for hypotension with demand ischemia. according to family, patient has been confused intermittently for several months. in the ed, initial vs were: t98.0 hr 98 bp 122/77 rr 24 o2 100 on nrb. patient sleepy but appropriate. no jvd, but accessory muscle use. taking deep full breaths. no murmur/gallop. belly was soft but patient complained of abdominal pain. lle erythema w/o tenderness. ekg -> sinus tachycardia w/ atrial sensing and v-pacing. patient got aspirin 325 for troponin elevation, and haldol 2.5mg iv x2 for agitation. past medical history: -recent permanent pacemaker for chb -ongoing mssa bacteremia -diabetes mellitus 2 - last a1c 5.6% -chronic kidney disease stage 4 on hd mwf -ulcerative colitis: no flares x 25 years -right adrenal adenoma -gout. -history of prostate cancer, status post prostatectomy. -remote history of nephrolithiasis. -hypertension -peripheral vascular disease s/p left -dp bypass -carotid stenosis -infrarenal abdominal aortic aneurysm -deep venous thrombosis in -iron deficiency anemia -recent episode of aphasia which resolved - ? tia -prostate cancer s/p prostatectomy -?pulmonary hypertension -uses home oxygen of 2l nc, normally sats 84-86% as per family social history: quit smoking at age 73. retired as a chemical mixer from a leather tannery. no alcohol or illicit drug use. lives at home with his wife and family. family history: brother had liver cancer. father and mother had cvas. paternal grandfather had rectal cancer. physical exam: vitals: t: 97.1 bp: 136/77 p: 83 r:24 o2: 100% on 2l general: alert, oriented, no acute distress heent: sclera slightly icteric, mmm, oropharynx clear neck: supple; no jvp appreciated lungs: clear bilaterally with decreased sounds at bases cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: distended, +bs, tympanic, no organomegally appreciate (but difficult exam) ext: 1+ edema bilaterally; left second toe is bandaged (bandage is clean, dry, and intact). scar on left shin. skin: warm and dry psych: appropriate neuro: alert to person and place; tired during interview pertinent results: labs on admission: 10:00am plt smr-very low plt count-38*# 10:00am neuts-78.8* lymphs-11.1* monos-7.6 eos-2.1 basos-0.3 10:00am wbc-7.4 rbc-3.10*# hgb-9.7*# hct-31.7* mcv-102*# mch-31.1 mchc-30.5* rdw-26.5* 10:00am asa-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 10:00am haptoglob-55 ferritin-1089* 10:00am ck-mb-notdone probnp-greater th 10:00am ctropnt-2.99* 10:00am lipase-53 10:00am alt(sgpt)-3 ast(sgot)-31 ld(ldh)-367* ck(cpk)-29* alk phos-102 tot bili-1.8* 10:00am estgfr-using this 10:00am glucose-82 urea n-17 creat-4.5*# sodium-146* potassium-3.7 chloride-97 total co2-39* anion gap-14 10:32am pt-14.4* ptt-33.1 inr(pt)-1.3* 12:45pm lactate-1.5 02:20pm po2-77* pco2-52* ph-7.48* total co2-40* base xs-12 03:58pm urine hyaline-34* 03:58pm urine rbc-<1 wbc-5 bacteria-none yeast-none epi-0 03:58pm urine blood-neg nitrite-neg protein-300 glucose-100 ketone-neg bilirubin-neg urobilngn-neg ph-8.5* leuk-neg 03:58pm urine color-yellow appear-clear sp -1.008 03:58pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 03:58pm urine hours-random chloride-47 05:33pm ethanol-neg 05:33pm ck-mb-notdone ctropnt-3.06* 05:33pm ck(cpk)-26* non-contrast head ct: non-contrast head ct: please note that evaluation is significantly limited by head motion. within that limitation, there is no intracranial hemorrhage, mass effect, edema, shift of normally midline structures, or major vascular territorial infarction. the -white matter differentiation is preserved. a 6-mm hyperdense lesion at the foramen of appears stable as compared to prior exams, consistent with a colloid cyst. this appeared relatively less conspicuous on certain prior exams. prominent ventricles are essentially stable, without evidence of acute hydrocephalus. sulci are prominent, compatible with age-related involutional change. there is extensive subcortical and periventricular white matter hypoattenuation, consistent with small vessel ischemic disease, unchanged. a hypodense focus is noted in the right lentiform nucleus, consistent with lacune versus prominent perivascular space. within significant limitation by motion artifacts, paranasal sinuses and mastoid air cells appear relatively aerated. impression: 1. no evidence of acute intracranial hemorrhage. 2. stable 6 mm colloid cyst and stable appearance of prominent ventricle without evidence of hydrocephalus. 3. extensive small vessel ischemic disease and age-related involutional change. . ct : impression: 1. no evidence of central pulmonary embolism. limited evaluation of the more peripheral pulmonary vasculature due to patient respiratory motion. 2. overall stable appearance of a fusiform aaa since , continues to measure 5 cm in diameter. no evidence of current rupture. 3. extensive atherosclerotic vascular disease with two penetrating thoracic aortic ulcers, one of which is increased in size as compared to . 4. two 4-mm right middle lobe pulmonary nodular opacities are of uncertain chronicity without prior chest studies to compare. 12-month followup is recommended to document resolution or stability. right lung base linear densities are unchanged since , most consistent with chronic fibrotic changes. 5. nonspecific mediastinal and axillary lymphadenopathy. 6. perihepatic and perisplenic ascites. nodular liver contour suggests cirrhosis. gynecomastia. 7. heterogeneous-appearing thyroid with a possible subcentimeter nodule and punctate calcification on the left. findings could be further evaluated on nonemergent ultrasound. 8. nonspecific mild stable pancreatic ductal dilatation. no obstructive or mass lesion identified. 9. atrophic kidneys consistent with history of end-stage renal disease. unchanged occlusion of the left renal artery, unchanged since . . echo : the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. there is moderate global left ventricular hypokinesis (lvef = 35-40 %). the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. . right upper quadrant ultrasound : impression: 1. gallbladder wall edema, without gallbladder wall stones, sludge or sign. these findings are nonspecific and could be related to third spacing versus renal failure. however, in the appropriate clinical setting, acalculous cholecystitis is not entirely excluded. therefore, at this time, a hida scan is recommended for further evaluation, if clinical suspicion warrants. 2. trace ascites. 3. mild splenomegaly. brief hospital course: this is a 76-year-old man w/ cad, aaa, mssa bacteremia, and pulmonary hypertension who presents with confusion and hypoxemia. . #. altered mental status: patient has a history of "dementia" for several months, as per family members. patient's mental status waxed and waned throughout admission, especially during dialysis sessions. patient is alert and oriented, and consistently answers correctly when asked about "person, place, time, and events." however, his behavior is sometimes inappropriate and he is not always sure of his surroundings (at one point he thought he was in a bakery). likely mr. has some underlying dementia with superimposed delirium in the setting of frequent hospitalizations and medicalizations. also possible that there are metabolic derrangements in the setting of frequent dialysis. all offending medications were discontinued, such as ranitidine. efforts were made to orient patient and discontinue unnecessary tethers. patient will follow-up with geriatrics as an outpatient for neuro-psychiatric testing. he was given low-dose haldol (~0.5mg) as needed for agitation. of note, mr. was given 5mg of haldol in the icu and was unarousable for hours. . # hypoxia/pulmonary hypertension: mr. was initially admitted because of hypoxia (o2 sats in the 80s) during a dialysis session. however, during admission, mr. had no problems with oxygenation. he was satting 95% on room air on discharge. . #dyssynchrony on echo: as per echocardiogram performed during admission, there is dyssynchrony between native heart beat and pacemaker. electrophysiology was consulted who made some changes to pacemaker setting with moderate effect. mr. will follow-up with general cardiology in 2 weeks. . #. cad/troponin elevation: mr. had a troponin elevation on admission--however, troponin was lower than on admission the week before (at , troponin was 8.9). likely patient had a missed mi or troponin leak in setting of hypotension prior to arrival at . patient was continued on asa, plavix, metoprolol, and statin. throughout admission, patient had no ecg changes to suggest ischemia, and no new chest pain. mr. will follow-up with cardiology in 2 weeks. . #. thrombocytopenia: patient had a rapidly dropping platelet count, ever since being started on cefazolin for mssa bacteremia in early . cefazolin was held and platelet count went up. mr. was switched to nafcillin with good effect, but antibiotic was finally changed to vancomycin as this can be easily administered at dialysis. patient will continue on vancomycin (given at dialysis) through . patient had no signs or symptoms of bleeding throughout admission. patient's platelet count should be re-checked in 3 days at rehab. . # mssa bacteremia: patient with mssa bacteremia found on recent admission in . source was never identified, but thought to be from infected fistula. extensive work-up completed on previous admission. mr. did not have a fever or elevated white count during hospitalziation. patient will continue on vancomycin through . he will follow-up with id specialists. . # diabetes: patient's oral medications were held during admission, and he was started on an insulin sliding scale. his oral medications can be restarted upon discharge. . # itching: likely from uremia. patient was continued on sarna cream as needed. . # hallucinations: family states that patient has been complaining of bugs crawling on his skin and over his sheets. hallucinations have been increasing in frequency. can consider delerium vs. body dementia diagnosis as an outpatient. patient was given low-dose haldol as needed for agitation (can be changed to an anti-psychotic with fewer extrapyramidal side effects if body is suspected) and will follow-up with geriatrics as an outpatient. . # esrd on hd: patient will continue on dialysis monday, wednesdays, and fridays. patient will receive vancomycin at dialysis through or unless directed otherwise by infectious disease. medications on admission: -albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for sob. -calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). -clopidogrel 75 mg tablet sig: one (1) tablet po daily -fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). -furosemide 40 mg tablet sig: one (1) tablet po bid -ranitidine hcl 150 mg tablet sig: one (1) tablet po daily -simvastatin 10 mg tablet sig: one (1) tablet po daily -aspirin 325 mg tablet sig: one (1) tablet po daily (daily). -folic acid 1 mg tablet sig: one (1) tablet po daily (daily). -b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily -silver sulfadiazine 1 % cream sig: one (1) appl topical daily (daily) as needed for apply to foot wounds. -cefazolin 10 gram recon soln sig: two (2) grams iv injection hd protocol (hd protochol). -glipizide 2.5 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. disp:*30 tablet extended rel 24 hr(s)* refills:*2* -lisinopril 40 mg tablet sig: one (1) tablet po once a day. -metoprolol tartrate 100 mg tablet sig: one (1) tablet po daily discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours). 2. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 6. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 7. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 8. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 9. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*2* 10. vancomycin 500 mg recon soln sig: one (1) recon soln intravenous hd protocol (hd protochol). 11. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 12. glipizide 2.5 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. 13. silver sulfadiazine 1 % cream sig: one (1) topical once a day. 14. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) capsule po once a day. discharge disposition: extended care facility: rehab discharge diagnosis: primary: 1. hypoxia (resolved) 2. thrombocytopenia 3. mssa bacteremia 4. delirium . secondary: 1. esrd on hd 2. htn 3. hyperlipidemia 4. dementia discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you on this admission. you came to the hospital because of low oxygen levels at dialysis. you were initially admitted to the intensive care unit, but you were transferred to the general medical wards when your levels normalized. . you were found to have low platelets and your cefazolin was switched to vancomycin. you will continue this antibiotic through . your platelt count should be rechecked in 3 days . the electrophysiologists made some changes to your pacemaker. you should follow-up with cardiology in 2 weeks. . the following changes were made to your medications: 1. stop taking cefazolin 2. start taking vancomycin as directed by your dialysis center 3. start taking toprol xl 25mg once a day 4. stop taking metoprolol 100mg once a day 5. stop taking ranitidine (this may have been making your platelets low). . please take all of your medications as prescribed. please keep all of your follow-up . followup instructions: department: gerontology when: tuesday at 11:30 am with: , md building: lm bldg () campus: west best parking: garage department: cardiac services when: friday at 2:20 pm with: , md building: campus: east best parking: garage department: advanced vasc. care cnt when: thursday at 8:30 am with: , md building: (, ma) campus: off campus best parking: free parking on site infectious disease: 10:00a lm bldg (), basement id west (sb) md, procedure: hemodialysis artificial pacemaker rate check diagnoses: thrombocytopenia, unspecified anemia in chronic kidney disease end stage renal disease renal dialysis status diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other pulmonary insufficiency, not elsewhere classified personal history of malignant neoplasm of prostate other chronic pulmonary heart diseases other persistent mental disorders due to conditions classified elsewhere occlusion and stenosis of carotid artery without mention of cerebral infarction hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia atrioventricular block, complete bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site cardiac pacemaker in situ personal history of venous thrombosis and embolism hypoxemia abdominal aneurysm without mention of rupture ulcerative colitis, unspecified hyperosmolality and/or hypernatremia atherosclerosis of native arteries of the extremities, unspecified delirium due to conditions classified elsewhere other nonspecific findings on examination of blood benign neoplasm of adrenal gland chronic total occlusion of artery of the extremities ulcer of lower limb, unspecified other specified pruritic conditions 

Answer: The patient is high likely exposed to