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 attending: chief complaint: s. aureus bacteremia, presumed endocarditis major surgical or invasive procedure: -hemodialysis -femoral central line placement -external jugular central line placement - done in interventional radiology -dobhoff feeding tube placement history of present illness: 30 yo f with h/o sle, esrd on hd (t, th, sat), htn, anemia, sickle trait, with multiple admissions and recent mssa endocarditis (tx w/ vanco until ) and osteomyelitis with bka. pt readmitted to yesterday with generalized weakness, shaking chills, desaturation. the patient reports that on sunday (4 days prior) she began to feel weak, shaking chills and total body aches. she reports that the symptoms progressively got worse. she was scheduled for her normal dialysis on tuesday, but the ambulance taking her to the dialysis center felt she was too sick and took her to hospital. once at the hospital she received hd, was given a dose of vancomycin, and blood cultures were sent. the patient had spiking fevers (tmax: 104.8) while in the hospital. the blood cultures showed s. aureus from 6/24 per micro-lab. they also performed a tte that showed vegetations on the mitral valve. the patient was then transferred here to . . upon arrival to she started reporting having has, she then had an acute decline in mental status and was found to have ichs on ct of head, likely from septic embolic and complicated by her uremic coagulopathy and itp. 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 social history: no smoking, occasional alcohol, no drug use. originally from , now lives in . used to work at . family history: noncontributory physical exam: pe: t:101.0 bp:100/50 hr: 100 rr: 18 o2 91% ra --> 96% 2l gen: nad, appears malaised and eyes closed heent: no conjunctival pallor. no icterus. mmm. op clear. neck: supple, ej placed, no lad, no jvd. cv: tachy. nl s1, s2. + murmurs at apex, no rubs or lungs: ctab, good bs bl, no w/r/c abd: soft, nt, nd. nl bs. ext: pt s/p l bka, no cce, hd access on right leg (no erythema, tenderness to palpation, swelling) skin: no rashes/lesions. neuro: a&ox3. appropriate. cn 2-12 grossly intact. psych: listens and responds to questions appropriately pertinent results: 07:20pm blood wbc-4.6 rbc-5.20 hgb-13.4 hct-43.2 mcv-83 mch-25.9* mchc-31.1 rdw-19.3* plt ct-68* 07:20pm blood neuts-65 bands-3 lymphs-24 monos-8 eos-0 baso-0 atyps-0 metas-0 myelos-0 07:20pm blood pt-13.7* ptt-38.0* inr(pt)-1.2* 07:20pm blood glucose-108* urean-26* creat-7.0*# na-135 k-3.8 cl-96 hco3-26 angap-17 01:10pm blood alt-30 ast-44* ld(ldh)-206 alkphos-124* amylase-94 totbili-0.4 01:10pm blood albumin-3.3* calcium-9.1 phos-3.4 mg-2.6 01:10pm blood vanco-31.0* . labs upon discharge: . 06:00am blood wbc-5.5 rbc-4.19* hgb-10.9* hct-36.0 mcv-86 mch-26.1* mchc-30.3* rdw-20.9* plt ct-126* 05:13am blood wbc-6.3 rbc-3.34* hgb-9.0* hct-28.4* mcv-85 mch-27.1 mchc-31.8 rdw-22.5* plt ct-109* 03:23am blood wbc-6.1 rbc-3.12* hgb-8.3* hct-26.5* mcv-85 mch-26.5* mchc-31.2 rdw-21.3* plt ct-98* 03:52am blood wbc-7.8 rbc-2.98* hgb-8.2* hct-25.5* mcv-86 mch-27.5 mchc-32.2 rdw-22.3* plt ct-94* 05:13am blood glucose-95 urean-25* creat-5.3*# na-142 k-4.0 cl-107 hco3-24 angap-15 03:23am blood glucose-98 urean-34* creat-6.7*# na-139 k-4.1 cl-106 hco3-23 angap-14 03:52am blood glucose-107* urean-51* creat-8.1*# na-139 k-5.3* cl-104 hco3-22 angap-18 06:00am blood alt-2 ast-37 alkphos-251* totbili-0.2 03:52am blood calcium-9.3 phos-5.4* mg-2.7* . 05:38am blood wbc-5.8 rbc-3.15* hgb-8.4* hct-27.0* mcv-86 mch-26.5* mchc-30.9* rdw-21.0* plt ct-100* 05:38am blood glucose-94 urean-43* creat-7.1*# na-137 k-4.1 cl-99 hco3-25 angap-17 06:00am blood alt-2 ast-37 alkphos-251* totbili-0.2 05:38am blood calcium-9.1 phos-4.5 mg-2.5 05:14am blood hapto-64 12:05am blood ammonia-18 12:05am blood tsh-0.43 05:52am blood hcg-<5 . : tte the left atrium is elongated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). with depressed free wall contractility. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is a moderate-sized (1.0 x 0.6 cm) vegetation on the mitral valve. mild to moderate (+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. impression: moderate-sized vegetation on the posterior mitral leaflet. mild-moderate mitral regurgitation. left ventricular hypertrophy with preserved global and regional biventricular systolic function. ct-head impression: 1. large bilateral parenchymal hemorrhages in bilateral frontal lobes and left occipital lobe with surrounding edema and fluid/fluid levels. there are subarachnoid hemorrhages bilaterally, but worse on the left. tiny hemorrhage of the left thalamus and possible tiny hemorrhage of the left cerebellum. 2. accentuated /white matter differentiation and effacement of some sulci suggestive of diffuse edema. . echo - there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. there is a 2.5cm highly mobile linear echodensity attached to the mitral leaflet c/w a vegetation. there is mild mitral regurgitation. the end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the vegetation appears similar in length and mobility, but of much smaller diameter. the severity of mitral regurgitation has decreased. . ct abdomen - limited evaluation of the lung bases demonstrate bibasilar opacities, consistent with airspace disease. these appear improved when compared with the prior examination of . again seen is hepatomegaly. there are no focal liver lesions. within the spleen, again identified is a small hypoattenuating lesion, not significantly changed. this is nonspecific, but differential considerations could include small cyst or hemangioma. in the region of the splenic hilum, again seen are several densities, which represent splenules or varices. these are also unchanged in appearance. pancreas is unremarkable. there is gallbladder distention presumably due to npo status. there is no evidence of cholecystitis. the adrenal glands are unchanged, again noting a slightly lobular contour of the right adrenal gland. there has been bilateral nephrectomy. there is a small amount of free fluid inferior to the liver. this is not drainable. intra-abdominal bowel loops are normal in caliber. pelvis: the bladder is collapsed. intra-pelvic bowel loops demonstrate normal caliber. as before, there are several prominent lymph nodes within the pelvis, such as a right iliac chain node measuring approximately 10 mm in short axis diameter. bilateral inguinal lymphadenopathy is also identified. there is a left femoral venous catheter. bone windows: no osteolytic or osteoblastic lesions. conclusion: 1. no intra-abdominal abscess. 2. gallbladder distention, presumably due to npo status. no evidence of cholecystitis. 3. bibasilar airspace disease, improved in extent and appearance from . . liver and gallbladder us - findings: limited views of the gallbladder demonstrate small amount of sludge. the gallbladder wall measures 3 mm. a small amount of free fluid is identified. the common bile duct measures approximately 6 mm. there is no evidence of cholelithiasis. within the gallbladder neck, there is a small curvilinear hyperechoic structure without shadowing which may represent a fold or a tiny polyp. a son sign was not present. impression: no evidence of cholelithiasis. small amount of gallbladder sludge. dilated common bile duct up to 6 mm. . ct of head findings: there has been interval evolution of multiple large bilateral parenchymal hematomas, without change in size, surrounding edema, or mass effect, consistent with evolution of hemorrhages. no new foci of hemorrhage are identified. there continues to be present sulcal effacement and s-shaped midline shift. imaged paranasal sinuses and mastoid air cells are clear. osseous structures are unremarkable. impression: interval evolution of bilateral parenchymal hemorrhage, without change in size or associated mass effect. no new intracranial hemorrhage. . cxr - findings: in comparison with the study of , there has been placement of a right central catheter that extends to the lower portion of the svc. diffuse bilateral pulmonary opacifications persist, along with the strikingly prominent dilatation of the main pulmonary artery trunk indicating chronic pulmonary hypertension. impression: little change except for placement of new central catheter. brief hospital course: a/p: this is a 30 yo f with h/o sle, esrd on hd (t, th, sat), htn, anemia, sickle trait, with multiple admissions and recent mssa endocarditis (tx w/ vanco until ) and osteomyelitis with bka admitted for s. aureus bacteremia. had ich likely secondary to septic embolic and underlying coagulopathy. continues to have improving mental status, being treated for endocarditis with cefazolin, and is otherwise stable. see below for discussion of each problem... . # acute intracranial hemorrhage: pt c/o of new onset left frontal headache at ~10am on . the patient did not have any focal neurological findings. the patient continued to c/o headache after dialysis and it did not improve with tylenol or dilaudid. the patient had increased blood pressure during the night refractory to treatment. the patient also began to have a nose bleed and a stat head ct was performed that showed large bilateral parenchymal hemorrhages in bilateral frontal lobes and left occipital lobe with surrounding edema. there were also subarachnoid hemorrhages bilaterally. the patient was transfered to the sicu and intubated. the ichs were likely due to septic embolic from endocarditis and underlying thrombocytompenia and uremic coagulopathy. neurosurg was unable to operate. she had two siezures and was treated with dilantin that was eventually switched to po keppra. neuro consult was appreciated. they advise that her prognosis is difficult to say with her ichs. she continues to improve and is currently conversational, although not always appropriately answering questions. . # s. aureus bacteremia: pt was transferred from hospital (). pt had blood cultures drawn at that showed mssa bacteremia as well as a tte that showed vegatation on the mitral leaflet. the patient had already received vancomycin 1gm during dialysis on and . after the transfer to repeat blood cultures were drawn. the cultures drawn from and were positive for s. aureus. id was consulted and continued vancomycin 1gm at dialysis pending sensitivity results. a tte was performed and confirmed the moderate vegatation on the mitral leaflet. daily ekgs were performed on the patient that did not reveal prolongation of the pr interval. the patient then became febrile again for unknown reasons. no cultures were positive. were broadened to vanco/cefepime/flagyl. pt then stopped spiking fevers. because no source of infection was found in cultures or ct scans, was switched again to ceftriaxone to cover mssa on . pt has remained afebrile and we will complete week course of hemodialysis dosed ceftriaxone for endocarditis. of note, second echocardiogram during hospitalization showed interval decreased size of her vegetation. she will complete her cefazolin course and get dosed at dialysis, 2 gm m and w, 3 gm on friday. end date is , she has follow up with id. . # esrd on hd: the patient had received dialysis on the day of transfer. the nephrology service was consulted at this time. dialysis was continued throughout her stay through her temporary femoral cath until her last dialysis in which her ej dialysis cath was used. dialysis was given with isotonic fluids for her increased icp from the hemorrhages. she did have some episodes of mild hyperkalemia that was resolved at dialysis. were using kayexcelate prn, but did not need to use it. . # itp: the patient had a platelet level was 68 on admission. the patient had no signs of avtive bleeding or bruising. the patient was typed and crossed and continued on her home prednisone. on the patient had a acute intracranial hemmorhage. she then was treated with ivigx2 and iv methylpred for itp. was also thought to have uremic plts and was given ddavp x 1 and cryoppt. dic labs were checked. pt was not thought to have dic. platelets remained low throughout the stay, set an arbitrary goal of >75,000 or active rebleeding before transfusion. did not transfuse during hospitalization. pt also has history of hit so did not used heparin at all. . # hypotension and tachycardia - has several episodes while in the micu and one while on the floor. all were resolved with small boluses of 500 cc ns. has had stable blood pressures the past week and a half before discharge. . # nutrition - patient had ng tube placed after ich and was being fed on tube feeds. when her mental status started to improved, our speech and swallow team cleared her for pureed food and thin liquids. she did pull our her ng tube once, but was replaced while she was under anesthesia for her ej catheter. she is currently being fed and having tube feeds to meet appropriate calorie demands. if at rehab, she is able to keep up with calories on her own, the ng tube can be pulled. we discussed the option of placing a peg tube, but since her mental status improved, we decided against it. . # pain control - pain control has been an issue for the patient since her mental status improved. most of her complaints revolve around her sacral wound. she also did complain about wrist and elbow pain one day. rheumatology was consulted to answer the question if she was possibly in a lupus flair. they thought she was not in a flair. the pain resolved and she no longer has limb pain. she also complains of back pain of unknown etiology. our concern is that there may be a central component to her pain due to the hemorrhages in her frontal load. we have continuously increased her dilaudid dose. she is currently getting 4-6 mg po q 3 hrs with some relief. she also has a 125 mg fentanyl patch. pain service was asked, and they recommended restarting her amitryptline, as well as adding gabapentin for neuropathic pain. we feel comfortable increasing her dilaudid as needed as long as she remains unsedated. . # sacral stage ii ulcer - remains stable, not infected. wound care consult was called and recommended routine management of ulcer. . # hypotension - had transitory hypotension while in the micu which was responsive to fluid boluses. has remained stable while on the floor, and is currently not an issue. . # abdominal pain - had several days of abdominal pain and had a ct scan and ultrasound that was negative. pain has since resolved. belly labs have been normal except for consistently elevated alk phos. the elevated alk phos is likely from her bone rather than her liver due to her very severe osteodystrophy secondary to her renal failure. . # anemia - chronic enema likely from renal failure and other multiple medical problems. after her ej placement had an acute hct drop to high 20s that has been stable since the procedure. guiac negative stool. not hemolyzing based on labwork. she is not actively bleeding at this time, and recommend continuing to follow cbc. she was not transfused during this admission. . # in general, her major issues at the time of discharge were pain control. she will need to have her main meds continually titrated for relief. she will also start needing pt/ot for strength and mobility. she is afebrile and her vital signs have been stable for about 1-2 weeks now and her mental status has been continuously improving. . medications on admission: tylenol 650mg q6prn amitriptyline 100mg qhs asa 81mg daily nexium 20mg daily fentanyl 100mcg/hr patch q3d folic acid 1mg heparin 5000u sq q12 dilaudid 1mg q3 multivit prednisone 5mg daily senna 8.6mg sevelamer 1600mg at breakfast & dinner tizanidine 2mg tid discharge medications: 1. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 2. b complex-vitamin c-folic acid 1 mg capsule : one (1) cap po daily (daily). 3. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 4. lactulose 10 gram/15 ml syrup : thirty (30) ml po bid (2 times a day). 5. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 6. fentanyl 100 mcg/hr patch 72 hr : one (1) patch 72 hr transdermal q72h (every 72 hours): we also had a 25mg patch for a total of 125 mg q72 hrs. 7. prednisone 5 mg tablet : 0.5 tablet po daily (daily). 8. levetiracetam 250 mg tablet : two (2) tablet po bid (2 times a day). 9. acetaminophen 500 mg tablet : two (2) tablet po tid (3 times a day). 10. cefazolin in dextrose (iso-os) 1 gram/50 ml piggyback : two (2) piggyback intravenous hd protocol (hd protochol): please give at hemodialysis. please give 2gm on mon, 2gm on wed, 3gm of friday of cefazolin. 11. fentanyl 25 mcg/hr patch 72 hr : one (1) patch transdermal q72h (every 72 hours): we use this in combination with a 100 mg patch for a total of 125 mg q 72 hr. 12. hydromorphone 4 mg tablet : 1 to 1.5 tablet po q3h (every 3 hours) as needed. 13. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical every twelve (12) hours as needed for back spasm. 14. amitriptyline 50 mg tablet : two (2) tablet po hs (at bedtime). 15. lorazepam 1 mg tablet : one (1) tablet po bid (2 times a day). 16. gabapentin 300 mg capsule : one (1) capsule po bid (2 times a day). discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: 1. acute intracranial hemmorhage 2. mssa endocarditis 3. itp 4. esrd . secondary: 1. hypertension 2. sickle cell trait 3. gerd 4. sle discharge condition: stable vital signs, sbps in 100s-120s, dobhoff in place, sacral decub ulcer, macular rash, can answer yes/no questions, but is not always answering questions appropriately, cannot ambulate - still in bed. discharge instructions: you were admitted to because of staph. aureus bacteria infection found in your blood. we performed a echo of your heart and found a vegatation on your heart valve. this is conistent with endocarditis, an infection of your heart valve. you were treated with vancomycin at dialysis for this infection, and then when you kept having fevers, we broadened your coverage. no other bacteria grew. you then stopped having fevers and the infectious disease team decided to just keep you on cefazolin as an antibiotic. . you also had a bleed in your head that was diagnosed on ct-scan. it affected your ability to communicate with us, but as time went on, you got better and were able to talk. you are still sometimes confused. the neurology team is still not able to tell how much better you will get. . you are continuing to have pain from your bed sore and your l wrist. we are trying to control your pain with dilaudid and fentanyl patch. we need to be careful with your pain medicines so we don't sedate you too much, and because your kidney does not metabolize the medicines well. . you were kept on dialysis throughout your hospital stay for kidney failure from your lupus. you will need to continue that as well. we put in an external jugular catheter for dialysis access. . you will be going to a rehab facility where they can work on your strength, ability to eat and monitor your health. . pleae return to the hospital for changes in mental status, seizures, increasing pain, chest pain, shortness of breath, or any other concerns. followup instructions: pt going to acute rehab facility - will have doctor at next facility who will continue management of care. . please follow up with your pcp . phone number after discharge from rehabilitation. . please see dr. in infectious disease at on at 2pm. the phone number is . we will be faxing your blood work to him weekly. . pt needs to continue dialysis on mwf schedule. labs can be drawn at dialysis. dialysis will also dose and give her cefazolin (2gm given after hd m and w, 3gm on f), which she will need to continue for a total of weeks. the start date of her cefazolin was . end date is . md procedure: enteral infusion of concentrated nutritional substances hemodialysis injection or infusion of thrombolytic agent venous catheterization for renal dialysis venous catheterization for renal dialysis venous catheterization for renal dialysis arteriography of cerebral arteries incision with removal of foreign body or device from skin and subcutaneous tissue magnetic resonance imaging of brain and brain stem diagnoses: chronic glomerulonephritis in diseases classified elsewhere systemic lupus erythematosus hyperpotassemia thrombocytopenia, unspecified anemia in chronic kidney disease end stage renal disease other chronic pain abdominal pain, unspecified site esophageal reflux unspecified protein-calorie malnutrition infection with microorganisms resistant to penicillins other convulsions subarachnoid hemorrhage hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease anxiety state, unspecified hypotension, unspecified methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site acute and subacute bacterial endocarditis other diseases of lung, not elsewhere classified infection and inflammatory reaction due to other vascular device, implant, and graft kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure encephalopathy, unspecified hyperosmolality and/or hypernatremia other and unspecified coagulation defects aphasia below knee amputation status immune thrombocytopenic purpura autoimmune hemolytic anemias kidney replaced by transplant chronic ulcer of other specified sites flaccid hemiplegia and hemiparesis affecting unspecified side septic pulmonary embolism renal osteodystrophy 

Answer: The patient is high likely exposed to