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: zocor attending: chief complaint: fever major surgical or invasive procedure: permenant tunneled line placement picc placement temporary dialysis line placement egd x 2 history of present illness: 39 yo f with pmh significant for esrd on hd diabetic nephropathy, type i dm, htn, hypercholesterolemia who presents today with fever at dialysis. the pt states she was in usoh when she went to dialysis today at . she reports she was "just hooked up to the machine" when she had a fever to 103 f associated with rigors and myalgias. given vancomycin 1 gm x 1 at hd and transferred to ed for further evaluation. the pt denies pain, redness, swelling, discharge from r scv hd line which she has had for 7 months after her avf "stopped working". denies recent sick contacts, travel, headache, nausea, vomiting, diarrhea, abominal pain, chest pain, shortness of breath. . in the ed, t 104.2, bp 172/68, hr 112, rr 20, o2 sat 98% on ra. given 2l ivf, 1 gm tylenol and motrin 600 mg x 1 with defervescence, ciprofloxacin 400 mg iv x 1, and gentamicin 30 mg iv x 1. seen by renal and transplant surgery. admitted to medicine for likely line infection and treatment with iv abx. past medical history: 1. type 1 dm 2. hypercholesterolemia 3. htn 4. esrd dm - pre-op for renal transplant 5. blindness in right eye 6. left leg weakness 7. goiter social history: lives at home with her mother, stepfather and sister. she denies tobacco, alcohol, and ivdu. family history: multiple family members on father's side with dm ii. denies family h/o cad, ca. physical exam: pe: tm 104.2 tc 98.9 bp 125/62 hr 95 rr 18 100% on room air fs 417 gen: thin female, laying comfortably in bed. no acute distress. alert and oriented to person, place, and date. heent: yellow dentition. left pupil reactive to light. sclerae anicteric. right eye blind. mmm, op clear, neck supple, no lad, r scv permacath with dressing c/d/i, no overlying warmth, erythema, non-tender to palpation, no drainage. cv: rrr. normal s1 and s2. ii/vi systolic murmur heard over lsb (not documented on prior d/c summary) chest: cta bilaterally. no w/r/r. abd: soft, nt, nd, normoactive bs ext: no le edema, + 2 dp pulses b/l, no palpable thrill over site of l arm avf, no bruit appreciated. pertinent results: initial labs: 01:20pm wbc-10.3# rbc-4.45 hgb-12.1 hct-34.8*# mcv-78* mch-27.1 mchc-34.7 rdw-16.1* 01:20pm neuts-93.0* bands-0 lymphs-4.8* monos-1.7* eos-0.4 basos-0 01:20pm plt smr-normal plt count-257 01:20pm pt-13.4* ptt-47.9* inr(pt)-1.2* 01:20pm calcium-7.9* phosphate-1.8*# magnesium-1.6 01:20pm glucose-245* urea n-19 creat-3.2*# sodium-137 potassium-3.2* chloride-94* total co2-29 anion gap-17 01:39pm glucose-241* lactate-1.5 na+-137 k+-5.6* cl--99* 09:21pm potassium-3.5 . ekg: nsr @ 86 bpm, nl axis, nl intervals, lvh, twi i, avl, v2-v6, no peaked t waves. (new twi v4-v6 compared to prior ekg ) . imaging: cxr - there has been interval placement of a large bore dual lumen catheter from right internal jugular approach. the distal tip is near the cavoatrial junction. the lungs are clear. the mediastinum is otherwise unremarkable. no pleural effusion or pneumothorax is seen. the visualized osseous structures are unremarkable. tte: the left atrium is normal in size. left ventricular wall thickness, cavity size, and systolic function are normal (lvef 60%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. there is moderate pulmonary artery systolic hypertension. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. tee 1. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). regional left ventricular wall motion is normal. 2. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. there are multiple, mobile, very thin, fibrinous strands on the mitral annulus and valve, which probably do not represent infective endocarditis. 3. compared with the prior study (images reviewed) of , there is no significant change. cxr: 1. no free air. 2. new small left lower lobe opacity, most likely atelectasis, although pneumonia cannot be excluded. 3. appearance suggesting a small new left loculated pleural effusion. findings discussed with drs. and . ruq us 1. cholelithiasis without cholecystitis 2. large right pleural effusion. 3. echogenic and small right kidney consistent with the given history of renal failure. cxr 1. new patchy left lower lobe opacity, concerning for infectious process such as pneumonia. 2. right-sided picc line croses midline into the left brachiocephalic vein. . micro: blood culture drawn off hd line at hd center - 4/4 bottles staph aureus sensitive to naficillin blood culture on admission - 1/4 bottles mssa blood cultures 11/23, negative blood culture : capnocytophaga species}; anaerobic bottle-final {lactobacillus species, veillonella species, prevotella species} blood cultures: , , : negative discharge labs: wbc 11.6 hgb 10.5 hct 30 plt 225 141 101 15 -----------< 106 4 29 3.5 brief hospital course: 39 yo f c esrd on hd with r scv permacath hd line x 7 months, dm type i, htn presents with fevers to 104.2 at dialysis, here with line infection and mssa bacteremia. . 1) fever - pt with elevated temperature, tachycardia, and relative hypotension on admission concerning for peri-septic picture. was placed on iv vancomycin, dosed by level, iv cipro, and iv gentamicin dosed at hd for broad-spectrum coverage. bp meds were held on admission. seen by both transplant surgery and renal consult in ed who recommended that hd line be kept in the interim until blood cultures positive off line. pt's hd center who confirmed that blood cultures drawn at hd center off hd line significant for 4/4 bottles of staph aureus sensitive to oxacillin, 1/2 blood cultures also positive here for staph aureus sensitive to oxacillin. as bps stable, af, and wbc stable, line was kept and pt dialyzed through line on the third hospital day to maintain her usual hd schedule. at hd, spiked temperature to 101.5 and became tachycardic and bps elevated. given dose of iv vancomycin. the following day, blood cultures on admission with mssa and vancomycin switched to iv nafcillin. on surveillance cx were positive for prevotella, lactobacillus, capnocytophagia and speciations were not done. patient was already on zosyn which was continued for total of 14 days. meropenem was briefly added for 1-2 doses when pts blood pressure dropped, but zosyn was resumed. multiple surveillance cx were negative thereafter. patient had a new permenant dialysis catheter placed. . 2) esrd on hd - seen by renal and transplant consult. pt usually on m/w/f hd schedule. was dialyzed on third hospital day as above with spike in temperature. given blood cultures off line at hd center and blood cultures on admission here positive for mssa, r scv tunneled line d/c'd. patient had temporary line placed and then a permenant tunneled line. pt with l avf and per op note , thrombectomy of thrombosed avf performed; however pt has had tunneled hd cath since and reports her hd center being unable to access graft. . 3) dm type i - hba1c 7.9 . reports taking lantus 8 u qam at home with hiss. initially had a very elevated fs in 400s on admisison without anion-gap metabolic acidosis which resolved with 14 u humalog. placed on 10 u lantus qam for increased glycemic control in setting of infection, fs qid, and hiss. as infection cleared, patient had low blood sugars on this regimen and lantus was decreased to 5 units. . 4) htn - pt with relative hypotension on admission and bp meds held. during hospital course, bps increased and bp meds were restarted, including metoprolol 100 mg , lisinopril 40 mg qd, and nifedipine 60 mg qd. asa continued. after tee, pt had esophagitis and upper gi bleed which caused hypotension. all bp meds were again stopped. after bleeding was under control, metoprolol, nifedipine, lisinopril and diovan were restarted. . 5) hypercholesterolemia - pt refused lipitor stating that lipitor was "killing her liver" and her md told her to d/c it. deferred to outpt management and d/c lipitor. . 6) anemia - baseline hct mid 30s. hct currently at baseline. iron studies suggest anemia of chronic disease. on epo at hd. . 7.) ugib- this occurred in setting of elevated coags (dic labs negative) and tee trauma. patient was hypotensive and had several episodes of hemoptysis. transferred to unit. given ffp, prbcs, ddavp, and protamine. patient had egd which showed erosive esophagitis and clot, but no active bleeding. protonix started. follow-up egd showed no active bleeding. patient should have egd in one month. hematocrit stable after 2nd egd. medications on admission: sevelamer 800 mg tid calcium acetate 667 mg tid pravastatin 40 mg qd ursodiol 500 mg nifedical 60 mg qd metoprolol 100 mg lisinopril 40 mg qd losartan 25 mg qd aspirin 325 mg qd folic acid 1 mg qd docusate sodium 100 mg multivitamin,tx-minerals 1 tab qd pantoprazole 40 mg qd lantus 8 u qam epogen 3700 qhd hectoral 5 mg qhd discharge medications: 1. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 4. epoetin alfa 10,000 unit/ml solution sig: as directed injection asdir (as directed). disp:*qs qs* refills:*2* 5. sevelamer 800 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 6. metoprolol tartrate 50 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 7. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours) for 1 months. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 9. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). disp:*180 capsule(s)* refills:*2* 10. losartan 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. insulin glargine 100 unit/ml solution sig: five (5) units subcutaneous once a day: take in am. disp:*qs qs* refills:*2* 12. humalog 100 unit/ml solution sig: as directed subcutaneous four times a day: see sliding scale. disp:*qs qs* refills:*2* 13. nifedipine 90 mg tablet sustained release sig: one (1) tablet sustained release po once a day. disp:*30 tablet sustained release(s)* refills:*2* discharge disposition: home discharge diagnosis: primary 1. line sepsis 2. ugib esophagitis 3. htn 4. dm 5. esrd discharge condition: hd stable and afebrile. discharge instructions: you were admitted with fever and elevated white count and found to have an infection of your dialysis line. you were treated for 14 days with antibiotics iv. while in the hospital, you had a gi bleed from your esophagus requiring protonix therapy twice daily and a follow-up egd in 1 month. your blood counts have been stable. in addition, you have a small infiltrate on chest xray which may suggest pneumonia. you were already on antibiotics and dr. wants to follow you closely and not add additional antibiotics at this time. please take all medications as directed. please follow-up with all outpatient appointments. please return to the ed or call dr. if you experience fevers, chills, shortness of breath, cough, chest pain, worsening diarrhea or any other concerning symptoms. please be sure to take the protonix twice a day and avoid spicy foods for the next few weeks. please take to dr about scheduling a bilateral upper extremity venogram to assess your veins for dialysis access. followup instructions: dr would like to see you in her office tomorrow, friday at 1:45. please see dr. on monday at 1:30. her phone number is . . you also need a follow-up egd in one month. please go to your appointment on and arrive at 7am on the of the building with dr. . . please go to dialysis tomorrow. ( please call her unit and tell them she will be back tomorrow). procedure: other endoscopy of small intestine other endoscopy of small intestine diagnostic ultrasound of heart hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis transfusion of packed cells transfusion of other serum diagnoses: other iatrogenic hypotension anemia of other chronic disease end stage renal disease pure hypercholesterolemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site infection and inflammatory reaction due to other vascular device, implant, and graft diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled esophageal hemorrhage acute esophagitis goiter, unspecified 

Answer: The patient is high likely exposed to