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: history of present illness: mr. is a 65-year- old male with past medical history significant for coronary artery disease status post coronary artery bypass graft, end- stage renal disease on hemodialysis, multiple episodes of methicillin-resistant staphylococcus aureus bacteremia, multiple access issues for hemodialysis with stent stenosis of the left subclavian and right ij and ivc stents, who was admitted to an outside hospital on with an episode of nausea, vomiting, and dehydration. patient was discharged but had returned to on with chest pain and shortness of breath that developed while in hemodialysis that day. the patient had noted an episode of chest pain one day prior to admission which was relieved with one sublingual nitroglycerin. in the emergency department the patient was found to have a blood pressure of 65/47, heart rate 79, temperature 96.8 f. he was emergently intubated for hypoxemia and airway protection. despite intravenous fluids the patient's blood pressure did not increase and he was initiated on neo-synephrine. one set of cardiac enzymes was negative and a ct angiogram of the chest was performed which indicated no pulmonary embolism. an ultrasound of his hemodialysis graft of his left extremity demonstrated no thrombosis or abscess. the patient was transferred to for further management. past medical history: 1. end-stage renal disease on hemodialysis secondary to diabetes mellitus. 2. diabetes mellitus insulin dependent for 35 years. 3. coronary artery disease status post four-vessel cabg. 4. 1 to 2 plus mitral regurgitation complex atheroma of the aortic arch, pso, and a normal ef on recent echocardiogram. 5. status post stroke with residual left-sided weakness. 6. atrial fibrillation. 7. hypertension. 8. av fistula. 9. history of mrsa infection. 10. esophagitis. 11. depression. medications on transfer: 1. ciprofloxacin day number two. 2. linezolid day number two. 3. renagel 2400 mg p.o. t.i.d. 4. lipitor 20 mg p.o. q.d. 5. digoxin 0.125 mg q. tuesday, thursday, and saturday. 6. calcitrol 0.25 mg p.o. q. day. 7. diflucan. 8. isordil 20 mg p.o. t.i.d. 9. zoloft 25 mg p.o. q.d. 10. actos 30 mg p.o. q.d. 11. lopressor 12.5 mg p.o. b.i.d. 12. nephrocaps. 13. sublingual nitroglycerin p.r.n. 14. humulin 70/30, 20 units p.o. b.i.d. 15. percocet p.r.n. 16. coumadin 3 mg p.o. h.s. allergies: 1. vancomycin. 2. keflex. 3. penicillin. social history: patient is married and was with his wife. has three children; two boys and one girl. no history of tobacco or alcohol use. physical examination on admission: temperature equals 98 f, heart rate 55, blood pressure 100/47, and vent settings are ac 500, rate 10, peep of 5, and an fio2 of 50 percent. in general, the patient is intubated and sedated. heent examination demonstrates conjunctival edema. cardiovascular exam is irregular irregular, s1 and s2 without murmur. respiratory examination demonstrates decreased breath sounds at the bases bilaterally, rhonchi on the right side appreciated. abdomen is obese, soft, nontender, nondistended, normoactive bowel sounds. extremities demonstrate no lower extremity edema, left av fistula with mild erythema, positive bruit. the patient's fingers and toes are cyanotic with cool fingers and toes. the patient has a right femoral hemodialysis catheter without erythema or edema. there are three peripheral ivs in place. brief summary of hospital course from through the time of this dictation, : 1. respiratory failure: mr. presented to complaining of chest pain and was emergently intubated secondary to hypoxemia and depressed mental status. a ct angiogram at the outside hospital was negative for an aortic dissection or pulmonary embolism. there were large bilateral pleural effusions noted which, upon thoracentesis, were transudative. cultures that were drawn at were negative. a component of the patient's respiratory failure was felt to be secondary to a pneumonia which was clearly demonstrated on chest x-rays. a sputum culture from was positive for e. coli, two different morphologies, multiresistant, but this organism was sensitive to meropenum, tobramycin, bactrim, cefepime, and gentamicin. the patient's sputum culture from also demonstrated mrsa. the patient's antibiotics on transfer included ciprofloxacin, linezolid. these were continued until the results of the sputum culture returned. ciprofloxacin was continued and gentamicin initiated on . patient finished a seven- day course of linezolid for the mrsa. despite treating the underlying pneumonia, the patient was difficult to wean. a repeat thoracentesis was performed on , which demonstrated a transudative fluid which, upon culture and cytology, was negative. we continued the daily treatment, and appropriate spontaneous breathing trials were performed, but the patient's mental status limited his extubation despite adequate pulmonary esthetics. hospital course was complicated by a self-extubation that occurred on and emergent reintubation. he was successfully extubated on and remains so at the time of this dictation. mr. continued to do well status post extubation until when he developed significant upper chest/neck and upper extremity edema secondary to a worsening svc syndrome. his breathing became more labored presumably secondary to decreased chest wall compliance secondary to this edema, potential aspirations, and pleural effusion, and a vvd demonstrated hypercarbia on . the patient was placed on masked ventilation for six hours and has continued to do well off of ventilatory support. a family meeting was held on with the patient's wife and brother and his three children. however, they agree not to reintubate the patient. this, because the underlying etiology of his respiratory failure would not be quickly reversible; i.e., svc syndrome secondary to failing collaterals and potential aspiration. 1. distributive shock: presented to hypotensive despite aggressive fluid resuscitation. he was initiated on vasopressors at that time. on transfer the patient had stim test to evaluate for potential adrenal insufficiency in the setting of his likely septic shock presentation. his stim test did demonstrate that he was relatively adrenal insufficient, and hydrocortisone and fludrocortisone were initiated. the patient's sepsis was treated with broad- spectrum antibiotics initially, including linezolid and ciprofloxacin. blood cultures, urine culture, portal fluid cultures were followed. the patient's sputum culture was positive for mrsa and e. coli, as above. his antibiotics were changed to linezolid, gentamicin on to complete a seven-day course of linezolid for the mrsa in the sputum. patient's blood cultures from returned positive for e. coli and he had intermittent meropenem added to gentamicin at that time. he completed a five-day course of gentamicin and continues on meropenem for a 14-day course; last dose to be administered . mr. continued to require vasopressors intermittently with levophedrine and vasopressin until and has remained hemodynamically stable throughout to the time of this dictation. the underlying etiology of his continued hypertension was unclear, although it was felt to be secondary to a combination of septic shock, adrenal insufficiency, and relative hypovolemia during sessions of cbdh and hemodialysis. his cardiac function was initially evaluated with transthoracic echocardiogram which demonstrated a left ventricular ejection fraction of 55 percent without significant abdominal aortic compromise or pericardial fluid. given his protracted hospital course requiring vasopressors, alternate sources for inferior were evaluated despite the lack of evidence of a significant leukocytosis or fever. a tee was performed on which demonstrated no vegetation. an abdominal ct scan on without contrast demonstrated a potential ________ tumors, although infection could not be ruled out. repeat ct scan of the abdomen with contrast on demonstrated no enhancement of these areas of concern. stool cultures were negative for c. difficile. 1. acute blood loss anemia secondary to gastrointestinal bleeding: mr. angiostatin had been maintained on ulcer prophylaxis with a proton pump inhibitor. despite this he developed hematochezia on with a hematocrit that decreased from 29 to 23. the ng tube was aspirated and gastroccult was negative. stools were heme positive. a gi consult was obtained and recommended conservative management at that time with close monitoring of serial hematocrits. since the patient was on heparin at the time, this was discontinued for several hours and restarted at a lower goal ptt. patient's protonix was changed to b.i.d. dosing and he was transfused five units of prbcs between and . serial hematocrits following have remained stable with the low- dose anticoagulation. the gastroenterology consults recommend an egd to be performed non-emergently prior to the discharge from the hospital. 1. peripheral vascular disease with multiple-vessel thromboses: mr. was anticoagulated during hospitalization with intravenous heparin with a goal ptt of 6100. it was difficult to maintain these values given the multiple procedures requiring discontinuation for periods of time. given his gastrointestinal bleeding the heparin was changed for a lower goal ptt. unfortunately, the patient's neck, face, upper chest, and upper extremities began to become increasingly edematous and swollen . interventional radiology was consulted and agreed to perform an ivc venogram to evaluate for any venacaval thrombus. the prior procedure involved the placement of a left subclavian triple-lumen catheter which demonstrated almost total occlusion of the svc with chronic thrombus, he had multiple collaterals from the upper extremities which drained into the ivc. the patient's ivc vena gram demonstrated that this was widely patent, and no intervention was performed. heparin was increased with a higher goal ptt and the patient was dialyzed with aggressive fluid removal goals given his worsening respiratory status secondary to the svc syndrome. on discussion with the interventional radiologist regarding other means for intervening on this svc, there was felt to be no procedure likely to provide benefit to the patient's situation. a second opinion is pending at the time of this dictation. with hemodialysis the patient's neck and upper chest edema was slightly improved on . 1. atrial fibrillation: on presentation to mr. was noted to have four- to six-second pauses on telemetry requiring atropine. an electrophysiology consult on recommended holding digoxin, beta blockers, and drawing digoxin levels. some low-dose dopamine was recommended for chronotrophy, although the patient became tachycardiac with this intervention and it was discontinued. an ep study was recommended at a later date given his acuity of illness. throughout the hospitalization patient's rate was elevated to 120s to 130s at time requiring initiation of amiodarone. the patient responded well with heart rates being in the 70s and 80s after being maintained on this medication. 1. end-stage renal disease secondary to diabetes mellitus on hemodialysis: mr. was followed by the renal service throughout his admission and was initiated on cvbh secondary to continuing total-body fluid accumulation with decreasing lung compliance while on mechanical ventilation. he continued on cvbh until his hemodynamics stabilized and tolerated hemodialysis. initially patient's left hemodialysis graft was accessed with no complications for hemodialysis. however, upon initiation of cvbh a right femoral hemodialysis catheter was utilized. given the concern for continued infection the right femoral hemodialysis catheter was changed over wire on . further hemodialysis sessions were performed from this line secondary concerns for diminished blood flow in the left upper extremity secondary to the svc syndrome. 1. adrenal insufficiency: relatively adrenal insufficient as noted above with a random cortisol level during episode of septic shock of 10.3. he was continued on fluocortolone and hydrocortisone for seven days and discontinued. he was reinitiated on hydrocortisone the following day as he once again became hypotensive. this, for a seven-day course, and he was tapered 50 percent a day per recommendations of the endocrinologists. upon taper to hydrocortisone 25 mg p.o. q.d. a repeat stim test demonstrated a basal cortisol level of 43.4 and a 60- minute post stim value of 52.6. the patient will require stress-dose steroids during any episodes of acute illness or procedures. 1. code status: the patient was initially dnr with no chest compressions or shocks but will be reintubated if necessary. based on a family meeting with his wife, brother, children, and , we agreed upon that the patient would not be reintubated if so required. 1. insulin-dependent diabetes mellitus: mr. was maintained on insulin drip protocol for the majority of his icu stay as his nutrition was not consistent given difficult intravenous and enteral access. a peg tube was placed on and tube feeds were initiated. he was changed to lantus with sliding scale on . his hospital course was complicated by one episode of diabetic ketoacidosis which was promptly recognized and treated. 1. communication: , brother-, -. patient was very involved in and was updated on a daily basis. dr , 12.684 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances hemodialysis thoracentesis percutaneous [endoscopic] gastrostomy [peg] transfusion of packed cells injection or infusion of oxazolidinone class of antibiotics diagnoses: acute posthemorrhagic anemia sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure septic shock methicillin susceptible pneumonia due to staphylococcus aureus pneumonia due to escherichia coli [e. coli] septicemia due to escherichia coli [e. coli] 

Answer: The patient is high likely exposed to