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: this is a 46 year old female with a history of postpartum dilated cardiomyopathy with an ejection fraction of about 15% who was recently admitted for congestive heart failure exacerbation. she presented initially to the team on , after visiting nurses association noted that her cuff blood pressure was 70/50. the patient was totally asymptomatic at the time without any chest pain or shortness of breath. on admission, the patient was noted to have a creatinine elevation from 2.0 to 5.1 with a potassium of 5.5. the patient was also noted to have decreased urine output. there was some question of whether or not she took her zestril as prescribed. the patient was noted to have a fena of 0.9% even with diuretics on board. the primary team felt that the patient was dry, possibly over-diuresed, and gave her 500 cc. of normal saline; also, her bumex was held for one to two doses. an echocardiogram was obtained and showed an unchanged ejection fraction with global left ventricular hypokinesis and akinesis. her cks remained flat. the patient went for a right heart catheterization on . this showed a right atrial pressure of 26, pa pressure of 72/46, and a pulmonary capillary wedge pressure of 39. the patient was given 2 mg of intravenous bumex in the catheterization laboratory with about 300 cc. of diuresis in result. the patient was transferred to coronary care unit on dobutamine. currently, the patient states that she is less short of breath, but is still very short of breath while in the supine position. the patient had acute respiratory distress while in the catheterization laboratory when placed in the supine position. for this reason, the swan was not left in. the patient denies any chest pain, nausea, vomiting, fevers or chills. the patient states that she does have some burning with urination. past medical history: 1. postpartum dilated cardiomyopathy with an ejection fraction of 15%. 2. cardiac catheterization from shows normal coronaries. 3. noninsulin dependent diabetes mellitus. 4. chronic renal failure with baseline creatinine of 2.0. 5. hypercholesterolemia. 6. asthma. 7. gout. 8. history of hepatitis b and c. 9. status post cholecystectomy. 10. stress test from showed mild to moderate reversible inferior wall defect. medications as outpatient: 1. bumex 2 mg p.o. twice a day. 2. digoxin 0.125 mg p.o. q. day. 3. avandia 4 mg p.o. q. day. 4. zestril 2.5 mg p.o. q. day. 5. aspirin. 6. lopresor xl 25 mg p.o. q. day. 7. lipitor 20 mg p.o. q. day. 8. albuterol. 9. serax 15 mg p.o. twice a day. allergies: lasix, penicillin, codeine, lidocaine. social history: the patient lives with her children. she has a past history of cocaine use times ten years, currently clean. the patient has a 14 year tobacco use history. the patient denies any alcohol use. family history: noncontributory. physical examination: temperature 96.2 f.; pulse 107; blood pressure 96/42; respiratory rate 23; o2 saturation 98% on two liters. in general, the patient is moderately short of breath. heent: mucous membranes were moist. pupils are equal, round, and reactive to light and accommodation. lungs clear to auscultation bilaterally. cardiovascular: regular rate and rhythm, no murmurs. soft s1 and s2. abdomen is obese, normoactive bowel sounds, soft, nondistended. slightly tender in right lower quadrant, no rebound or guarding. extremities with no cyanosis, clubbing or edema. neurological: alert and oriented times three. laboratory: ekg with sinus tachycardia, left bundle branch block which is old, no changes. white blood cell count 4.9, hematocrit 28.5, platelets 183, calcium 9.3, magnesium 2.3, phosphorus 6.0. inr 1.0. sodium 133, potassium 5.0, chloride 91, bicarbonate 26, bun 73, creatinine 5.0. glucose 111. ck 224, mb 2, troponin less than 0.3. urinalysis with leukocyte esterase moderate, white blood cells 41, squamous epithelial cells 5. urinalysis with sodium 30, urine creatinine 120, urine urea at 215. echocardiogram from , ejection fraction less than 15%, severe left ventricular systolic depression with akinetic anterior septum, hypokinesis/akinesis of anterior wall, inferior wall and apex. right ventricle is normal. three plus mitral regurgitation, two plus tricuspid regurgitation. hospital course: the patient is a 46 year old female with a history of post partum cardiomyopathy with ejection fraction of about 15% and diabetes mellitus, who presents after visiting nurses association noticed systolic blood pressure of 70. she was noted to a have acute on chronic renal failure with a bump in her creatinine from 2.0 to 5.1 in just several days. the patient was initially felt to be prerenal but noted to have pulmonary capillary wedge pressure of 39. 1. pump: with the patient's ejection fraction of 15%, and the elevated capillary wedge pressure, she was felt to be in cardiogenic shock with her decreased blood pressure. the patient's situation was not helped by the fact that about two doses of her bumex were held because she was initially felt to have been over-diuresed. the patient was placed on 2 mg intravenously of bumex twice a day. she seemed to be responding well to this dose of bumex given her urine output. the patient was also kept on dobutamine as an ianotropic given her severely depressed left ventricular function in the setting of cardiogenic shock. the patient's dobutamine was titrated to 12 micrograms per kilogram per minute. overall, the patient was making good urine. unfortunately, she was taking too much in the form of liquids as intake. once the patient's intake was stemmed, she started becoming net negative. her goal was to keep her two liters net negative per day. to further meet these goals, the patient was started on natrecor, initially at 0.01, and then titrated to 0.2 micrograms per kilogram per minute. the patient was swan-ed for hypotension on . surprisingly, her cardiac index was higher than expected at 3.28 on 12 of dobutamine and 3 of neo-synephrine. however, her svr was only 480, consistent with a septic like picture. given that the patient was already well hydrated for her treatment of sepsis, the team still felt that diuresis was the goal for this patient and to maintain at least one to two liters negative per day. of note, the patient is not a candidate for heart transplant. she has generally been noncompliant and given her social history including past cocaine use, she has been deemed to be not a candidate. in the future, she may be possibly a candidate for biventricular pacing should the need arise. 2. coronary artery disease: the patient was continued on aspirin and lipitor. beta blockers were held secondary to hypotension. it is unclear if the patient even has active cardiac disease. she does have diabetes mellitus which is a cardiac coronary artery disease equivalent. the patient's cks remained flat as already noted. there was no ischemic event to explain the patient's worsened cardiogenic shock. 3. hypotension: the patient's hypotension was initially thought to be secondary to cardiogenic shock. there was no initial cardiac index calculated when she was first given a swan in the catheterization laboratory on . the patient was kept on dobutamine and neo-synephrine. it was felt that optimally the dobutamine was more important in maintaining the blood pressure as it would increase the patient's cardiac output, whereas the patient was likely already clamped down from her cardiogenic shock and the addition of too much alpha activity would be deleterious. overall, the patient kept her mean arterial pressure between 60 and 70. on , the patient was noted to be more hypotensive, with mean arterial pressures between 50 and 55. the neo-synephrine had to be titrated up to a maximum of 5, however, this led to a decrease in urine output. of note, the patient was very pruritic that day, complaining that she had eaten some tuna fish and now she was itching all over. the patient was given benadryl and zantac for treatment of any possible systemic allergic reaction. the patient also spiked a temperature up to 101.0 f. the patient was pan cultured. because of her hypotension and fever, she was stared on empiric vancomycin, levofloxacin and flagyl. the patient also received a dose of intravenous dexamethasone both to cover any adrenal insufficiency and for any possible allergic systemic reaction. the patient's hypotension eventually resolved. she had also become quite tachycardic up to a rate of 130, in normal sinus rhythm. this, too, resolved, especially after getting tylenol. after about 24 hours, the patient started growing gram positive cocci from her blood cultures drawn peripherally and from her left sided arterial line. as already noted, she had a swan placed on . this was consistent with a septic like picture superimposed on a cardiogenic picture. because the patient's cardiac index was higher than expected, her dobutamine was able to be weaned slightly to 5 micrograms per kilogram per minute. her neo-synephrine was also titrated down as tolerated. 4. renal: the patient presented with acute on chronic renal failure. the patient's chronic renal failure is likely secondary to a combination of diabetes mellitus and her depressed left ventricular function. the patient's current acute on chronic renal failure is likely secondary to cardiogenic shock. the patient was found to be prerenal by her fena secondary to poor perfusion. the patient did receive a renal ultrasound which showed right and left kidney sizes of 9 centimeters. there was no hydronephrosis or stones identified. the renal consultation team was consulted. initially it was unclear whether or not the patient would diurese appropriately. the patient never came close to requiring any emergent dialysis for ultra-filtration. once she started diuresing with the bumex and the natrecor, her creatinine came down. by , her creatinine was close to baseline at 2.3. the patient was placed on renagel and tums. 5. infectious disease: as already noted, the patient became febrile up to 101.4 f., on . the patient grew four out of four bottles of gram positive cocci in pairs and clusters, which was identified as staphylococcus aureus. the patient's right sided ij line was discontinued. this was noted to have some pus at the end. in addition, the patient's left arterial line was taken out as blood cultures drawn from that line also grew staphylococcus aureus. a new right sided arterial line was replaced on . the patient was kept on vancomycin, renally dosed. we are checking trough levels every day. levofloxacin and flagyl were discontinued. 6. the patient was noted to be anemic with a hematocrit of 28, but stable. the patient's iron studies are consistent with iron deficiency anemia, although the patient likely also has a low epo state given her chronic renal failure. the patient was started on iron. the patient would likely benefit from an epo level as an outpatient. 7. right lower quadrant pain: this appears to be chronic; the patient states that she has had this since . the patient has had negative ct scans, the last from . the patient's pain was controlled with standing tylenol and p.r.n. oxycodone. the patient's pain overall improved. the patient was taken off the standing tylenol in order to track her fever curves. this concludes my interim stat dictation on this patient for the events from until . the remainder of the hospital course will be dictated at a future time. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified arterial catheterization pulmonary artery wedge monitoring right heart cardiac catheterization injection or infusion of nesiritide diagnoses: other primary cardiomyopathies mitral valve disorders chronic hepatitis c without mention of hepatic coma acute kidney failure, unspecified cardiogenic shock primary pulmonary hypertension acute on chronic systolic heart failure chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta 

Answer: The patient is high likely exposed to