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: patient recorded as having no known allergies to drugs attending: chief complaint: cc: major surgical or invasive procedure: s/p washout septic knee washout in or s/p picc placement s/p gj placement, ir guided history of present illness: . hpi: patient is an 84 year old male who presented from nh with hypotension. per records as patient is poor historian d/t dementia. per the patients family, he was in his usoh until days ago at when he was noted to be disoriented/confused. he improved for a day but then became worse last night. last night he was found to be hypotensive x 2 at the nursing home and was tranferred to for further evaluation. he denies cough, uri symptoms, abdominal pain, sob, or chest pain. + urinary frequency without dysuria. no sick contacts. has chronic diarrhea which has not worsened. . until , the patient had been living at home with his wife. at that time he began falling (8-10x during ). he was admitted to on - 21st for workup of these falls. per report from the patients son, the patient was found to have elevated cardiac enzymes and a stress/echo that showed an old mi. the ce's were attributed to arf (thought to be prerenal). he was transferred to on and has been there since. of note, while at the patient was accidently given klonipin instead of clonidine and per family report his mental status deteriorated at that time and has not returned to baseline ( baseline ms - someone checked on 1x per day, son lays out pills, but lived alone with wife). . in the ed, the patient was found to have a temp of 100.2, hr 73, bp 88/41, rr20, o2 sats nrb. lactate was 2.2/wbc 11.4. a code sepsis was called and a right subclavian was placed. he recieved a total of 4 l ivf with response of bp to the 120's. he was treated with a dose of ceftriaxone and vancomycin. received 1 unit prbc. urology was called because of difficulty placing a foley and they were able to place a foley. a ua was grossly positive. a ct abdomen was preformed which showed a aaa as well as + perichol. fluid and gb wall enhancement. surgery was consulted and an ruq u/s was performed which did not show evidence of cholcystitis. per surgery, no active surgical issues. he was admitted the icu with a diagnosis of sepsis. . past medical history: . # right total hip replacement in # duodenal ulcer in , status post laparotomy # cataract surgery in # tonsils and adenoids in the # cri, unclear baseline # knee surgery # silent mi # pacer placed at . social history: . sh: smokes cigars, no cig, quit etoh 10 yrs ago (abuse 10 yrs ago) . family history: . fh: non-contributory . physical exam: . pe: t 97.9, bp 97/51, hr 68, o2 98% on gen: awake, nad heent: poor dentition, dry mmm cardiac: s1 s2 no m/r/g lungs: cta x 2 abd: distended, soft, neg sign ext: right knee with punctate wound draining wound with surrounding erythema, no c/c/e neuro: aox1 gu: blood at tip of penis, foley inserted . pertinent results: studies: ct abd/pelvis: 1. dilatation of the ascending aorta to 4.5 cm. 2. a 2-mm right middle lobe pulmonary nodule, which can be followed if clinically indicated in one year. 3. abdominal aortic aneurysm measuring 3.7 cm extending to the common iliac arteries. 4. polycystic kidney disease. hyperdense lesions within both kidneys likely represent hemorrhagic cysts, although these cannot be fully evaluated on this examination. 5. pericholecystic fluid and mild gallbladder wall enhancement. if there is clinical concern for cholecystitis, gallbladder ultrasound can be performed. . ct head - no hemmorhage or mass effect . cxr - a left side pacemaker is seen with leads in appropriate position. there is mild cardiomegaly. the aorta is tortuous and dilated. the lungs are clear without focal consolidation, effusion, or pneumothorax. the left costophrenic angle is incompletely evaluated. the osseous structures are unremarkable. . brief hospital course: . assessment/plan: 84 yo m with h/o cad s/p pacer placement transferred from micu after sepsis and hypotension found to have mssa bacteremia left knee infection s/p washout in or. . # sepsis/infected knee joint - the patient was admitted to the micu with hypotension and sepsis without elevated wbc or fevers. he was initially started on vanc/gent for broad coverage until a source could be isolated. blood cultures on admission grew coag positive staph aureus (mssa) in bottles. he was found to have a draining knee abscess with fistula tract to the skin which was thought to be the source of his sepsis. he went to the or with orthopedics who performed a knee washout. cultures from the knee were found to be coag positive staph aureus (mssa). the patient was put on a 6 week course of nafcillin. he was found to have an appropriate response to stim test. an intra-op tee demonstrated no significant valvular regurgitation, but a possible small echodensity at tip of anterior mitral leaflet. additionally, hip films from site of prior total hip replacement were unremarkable making infected hardware less likely. surveillance cultures were monitored and showed no evidence of further mssa bacteremia. an id consult was obtained and they recommended reviewing the tee with cardiology to ensure there was no evidence of vegetations. the patient has a pacemaker with wires but it did not appear that these were seeded given that his bacteremia cleared quickly and his surveillance cultures were negative. during his hospital course, he was found to have some serosanguinous drainage from his knee wound and he was followed closely by ortho. the drainage tapered off and there was no need for further washouts. . # atrial fibrillation: patient found to be intermittently in atrial fibrillation during his micu course. patient was not previously anticoagulated per osh records as well as from history from son and daughter, but osh records indicate history of atrial fibrillation. was on heparin gtt in the micu for a-fib. he was seen by cardiology during his micu course who recommended long term anticoagulation. after receiving 2 doses of coumadin, the patient's inr climbed rapidly to 11.4 likely due to his very poor nutritional status. the patient required two units of ffp to reverse this inr. he was restarted on coumadin at a much lower dose, 1mg po qod. his inr.. he was maintained on low dose beta blocker for rate control. . # agitation/mental status: the patient has dementia at baseline and per his family, this has been worsening over the last year. the patient was intermittently agitated initially from his acute sepsis and bacteremia, as well as from sundowning in setting of acute illness. he was given prn haldol for agitation and a 1:1 sitter as necessary. his aricept for dementia was held initally given his aspiration with plans to restart after obtaining a gj tube. . # gallbladder wall thickening - ruq u/s without evidence of cholecystitis. per surgery, there was no need for acute surgical intervention. the patient had no evidence of ductal dilation and only mildly elevated ast and alk phos but normal bili. there was no current concern for an obstructive pattern. . # arf - patient's creatinine was 3.2 upon admission which improved to 1.5 upon ivf volume resuscitation. prior creatinine 1.0 in 11/. an feurea was 58%. renal u/s demonstrating polycystic kidneys, but no frank hydronephrosis. his medications were renally dosed. his acei was held upon admission. his polycystic kidneys can be further evaluated as an outpatient. . # aspiration: the patient was evaluated by speech and swallow while in the micu and was found to be aspirating. an ngt was attempted in the micu but was unsuccessful. the patient was sent to fluoro for ngt placement but fluoro was also unsuccessful in placing the ngt. an ir guided gj tube was also attempted but was unsuccessful given the patient's unusual anatomy after bowel resection for duodenal ulcer in the past. surgery placed a j-tube in the or and the procedure was well tolerated. tube feeds were initiated as per a nutrition consult. after approximately 14 hours of tube feeds, the patient was found to have bilious emesis with respiratory distress concerning for aspiration. the patient was found to be 85% on ra with abg showing ph 7.3, co2 33, o2 37, and hco3 17. his o2 sat improved with 50% face mask. a chest xray obtained revealed a new left upper lobe consolidation concerning for aspiration. additionally on cxr, free air was seen in the peritoneum but given the patient's j-tube placement, the free air was thought to be consistent with recent surgical procedure. the patient showed no signs of an acute abdomen. flagyl was added to the patient's regimen for concern of aspiration. . # polycystic kidneys: not known to be on patient's problem list prior to this hospitalization but patient is usually followed at va. he had an elevated cr to 3.4 upon admission but currently 1.6 after ivf hydration and resolution of sepsis. baseline creatinine unclear. will need to have this followed as an outpatient. . # cad s/p pacer placement: not clear why patient has pacemaker but thought to be from sss (placed at in ). the patient was found to have mildly elevated troponin (.12) in setting of flat cks. his troponin trended down. his elevated troponin was thought to be related to his arf but could also be consistent with demand ischemia in the setting of sepsis. he ruled out for mi by three sets of cardiac enzymes. as an outpatient, he was on simvastatin, felodipine, atenolol, and fosinopril as an outpatient. these were held initially in the setting of aspiration but were restarted after his j-tube was placed. . # anemia: his anemia was found to be consistent with anemia of chronic disease. he got 1 unit prbcs for drifting hct in micu on . his hematocrit remained stable after receiving 1 unit prbcs. . # aaa: 4.5 cm, no concern for rupture or leakage on ct without contrast. there is no prior imaging of the patient's aaa at . this will continued to be followed by his outpatient doctor. . # hypercholesterolemia: continue simvastatin when peg placed . # fenl ivf as above. not tolerating po intake aspiration. ng tube could not be placed by fluoro. gj tube was obtained for tube feeds and meds. . # ppx - sq heparin . # access - picc line for 6 weeks of nafcillin for septic knee . # code - full . # dispo - on the morning of , the patient was seen to have large volume bilious green emesis after tube feeds were started overnight with desaturation to 85% on 3l nc (which improved with non-rebreather). there was concern for aspiration. a chest xray was obtained which revealed a new lul consolidation concerning for aspiration. free air in the peritoneum was also seen on cxr but this was consistent with recent peg tube placement. additionally, a kub showed no evidence of sbo. later in the day, the patient was found to desaturate to the 70s on 50% face mask. an abg was obtained which showed: ph 7.14, po2 52, pco2 44, bicarb 16, lactate 4.4. given the patient's respiratory distress and abg, he was transferred to the micu. he was intubated with repeat abg showing ph 7.08, po2 62, pco2 56, bicarb 18, lactate 6.0. a repeat cxr showed worsening bilateral opacities. the family was contact and given a decision was made to make the patient cmo. he passed away shortly after. . medications on admission: meds: simvastatin 20mg qd felodipine 5mg qd atenolol 50mg qd fosinopril 40mg qd zoloft 50mg qd omeprazole 20mg qd calium 500mg aricept 10mg qd loperamide prn no asa ibuprofen prn . all: nkda discharge disposition: expired discharge diagnosis: primary: respiratory failure from aspiration pneumonia septic shock mssa bacteremia from knee abscess open g-tube placement . secondary: s/p total hip replacement h/o duodenal ulcer atrial fibrillation cad arf on cri dementia . discharge condition: expired discharge instructions: not applicable followup instructions: not applicable procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances transfusion of packed cells percutaneous (endoscopic) jejunostomy [pej] transfusion of other serum synovectomy, knee diagnoses: anemia of other chronic disease acute kidney failure with lesion of tubular necrosis intestinal bypass or anastomosis status severe sepsis atrial fibrillation methicillin susceptible staphylococcus aureus septicemia chronic kidney disease, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus cellulitis and abscess of leg, except foot septic shock cardiac pacemaker in situ delirium due to conditions classified elsewhere hip joint replacement ulcer of other part of lower limb polycystic kidney, unspecified type pyogenic arthritis, lower leg other specified disorders of joint, lower leg unspecified derangement of joint, pelvic region and thigh contracture of joint, lower leg 

Answer: The patient is high likely exposed to