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: transferred from osh for consideration of cabg major surgical or invasive procedure: cabg x5 (lima>lad, svg>diag, svg>ramus>ygraft>om, svg>pda) history of present illness: 53 y/o m w/ hx cad with known unvascularized 3vd, chronic systolic hf with ef 20%, dm, hyperlipidemia, hx of cva, asthma/copd, with recent prolonged hospitalization at for inferior mi, cardiogenic shock, respiratory failure, vap and arf who is being transferred from osh for consideration of cabg. the pt was admitted to on for imi and resp failure. during this hospitalization, he required intermittent dopamine for cardiogenic shock and was unable to be weaned from vent. he had a cardiac cath on demonstrating severe 3vd and global ventricular dysfunction and an ef 20% and no mr. because of his other complicating medical issues, he was determined to not be a candidate for stenting or cabg. he was discharged to rehab and 2 days later he pt represented to another hospital with 9/10 cp. his ekgs were reportedly unchanged from prior, had flat cardiac enzymes and was medically managed with acei, lipitor, but no bb. pt was not able to be weaned from vent so was transferred back to rehab after having a trach and peg placed. he was either then discharged or signed out ama from rehab. . he then presented to ed early this am with severe respiratory distress and chest pain, failed bipap, and required intubation. prior to intubation, the pt had an episode of black coffee ground emesis. a ngl lavage was performed with aspiration of dark material that was guaiac positive. his hct dropped from 36.9 --> 30.5. he had diffuse pulm infiltrates that improved with 1.5 l diuresis but briefly dropped his pressures to the 80s. . on review of symptoms, he denies any prior history of deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. . cardiac review of systems is notable for absence of paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: # cad with known 3vd - was not revacularized complicating medical issues including not being able to quit smoking # dm # hyperlipidemia # hx o cva # asthma/copd # disabled dm and cva social history: social history is significant for the prescence of current tobacco use. pt does use unknown amount of alcohol. family history: nc physical exam: vs: t 98.9, bp 114/59, hr 71, rr 24, o2 100% on on ac fio2 0.50 rr 16 tv 500 peep 5 gen: wdwn middle aged male, intubated, sedated but able to respond appropriately to commands. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp of 10 cm. cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. no s4, no s3. no m/r/g appreciated chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. no crackles, wheeze, rhonchi. decreased bs b/l at bases abd: obese, soft, ntnd, no hsm or tenderness. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ without bruit; femoral 2+ without bruit; 1+ dp left: carotid 2+ without bruit; femoral 2+ without bruit; 1+ dp pertinent results: ekg demonstrated sinus tachycardia @ 105 bpm, nl axis, nl intervals, elevation iii, 0. depressions i, avl, twi i, avl, v5-6, lbbb with no significant change compared with prior dated at 4 am. . cardiac cath brief history: the patient is a 53 yo male transferred from an outside hospital with an nstemi, congestive heart failure now intubated with known severe three vessel disease and transferred for cabg. the patient is now s/p pea arrest on . . indications for catheterization: coronary artery disease, canadian heart class iv, unstable. prior mi. . procedure: right heart catheterization: was performed by percutaneous entry of the left femoral vein, using a 7 french pulmonary wedge pressure catheter, advanced to the pcw position through an 8 french introducing sheath. cardiac output was measured by the fick method. coronary angiography: was performed in multiple projections using a 5 french jl4 and a 5 french jr4 catheter, with manual contrast injections. intra-aortic balloon counterpulsation: was initiated with an introducer sheath using a cardiac assist 9 french 30cc wire guided catheter, inserted via the left femoral artery. peripheral imaging was performed. conscious sedation: was provided with appropriate monitoring performed by a member of the nursing staff. . hemodynamics results body surface area: 1.86 m2 hemoglobin: 9.1 gms % fick **pressures right ventricle {s/ed} 52/14 pulmonary artery {s/d/m} 56/32/43 pulmonary wedge {a/v/m} 30/31/28 aorta {s/d/m} 103/73/85 **cardiac output heart rate {beats/min} 103 rhythm sinus o2 cons. ind {ml/min/m2} 125 a-v o2 difference {ml/ltr} 37 card. op/ind fick {l/mn/m2} 6.3/3.4 **resistances pulmonary vasc. resistance 191 . **arteriography results morphology % stenosis collat. from **right coronary 1) proximal rca normal 2) mid rca discrete 70 2a) acute marginal normal 3) distal rca discrete 100 4) r-pda discrete 80 . **arteriography results morphology % stenosis collat. from **left coronary 5) left main normal 6) proximal lad discrete 70 6a) septal-1 normal 7) mid-lad normal 8) distal lad discrete 80 9) diagonal-1 discrete 80 11) intermedius discrete 12) proximal cx discrete 100 13) mid cx discrete 100 13a) distal cx discrete 100 . technical factors: total time (lidocaine to test complete) = 0 hour50 minutes. arterial time = 0 hour46 minutes. fluoro time = 7.6 minutes. contrast injected: non-ionic low osmolar (isovue, optiray...), vol 70 ml, indications - renal anesthesia: 1% lidocaine subq. anticoagulation: heparin 0 units iv cardiac cath supplies used: 4f cordis, multipack 8f arrow, iabp ultra fiberoptix catheter 40cc - allegiance, custom sterile pack . comments: 1. coronary angiography of this right dominant system revealed a normal lmca, 70% proximal stenosis in the lad, 80% distal lad stenosis and 80% stenosis in d1. the lcx was totally occluded. the rca had a 70% mid stenosis, 80% stenosis of the right pda and total occlusion after the pda. . 2. peripheral arteriography revealed a right iliac artery that was patent and a left iliac artery with a 60% stenosis without a gradient of flow. . 3. hemodynamics revealed low-normal systemic arterial pressures with an sbp of 103 mm hg. the rvedp was elevated at 14 and the pasp was 56. the pcwp was 28 mm hg for which 40 mg iv lasix was given. . 4. an iabp was placed without complication in the left groin. . final diagnosis: 1. three vessel coronary artery disease. 2 . acute infero-posterior myocardial infarction, managed by iabp. echo the left atrium is normal in size. the left ventricular cavity size is normal. there is moderate regional left ventricular systolic dysfunction with inferior and lateral akinesis (estimated ejection fraction ?30-35%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is no pericardial effusion. no vegetation seen (cannot exclude; views are technically suboptimal) compared with the prior study (images reviewed) of , there is no definite change. pre cpb normal right ventricular systolic function. significant left ventricular enlargement. left ventricle with moderate global dysfunction and severe hypokinesis of all but the basal septal, anterior, and inferior walls. the apex is essentially akinetic. no thrombus is seen in the left ventricular apex. the left ventricular ejection fraction is about 15-20% at best. there is spontaneous echo contrast seen in the left atrium and left atrial appendage. no thrombus is seen in either of these locations. the mitral leaflets are mildly thickened and there is trace mitral regurgitation. there is no aortic regurgitation. a fibrinous echodensity is seen extending from the wall of the proximal ascending aorta to the left or non-coronary cusp of the aortic valve consistent with a fibroelastoma. there is mild tricuspid regurgitation. there is mild atheromatous disease seen in the descending thoracic aorta and aortic arch. ct abdomen w/contrast 1:44 pm abdomen: incompletely imaged small to moderate bilateral pleural effusions, (left greater than right) are associated with atelectasis. the liver, spleen, pancreas, and adrenal glands appear unremarkable. the gallbladder is present. mild right perinephric and fat stranding is a nonspecific finding, as the kidneys enhance symmetrically, without hydronephrosis. . a gastrostomy tube balloon lies in the left upper quadrant musculature, and a moderate amount of air tracks along the musculature inferiorly. no discrete fluid collection is seen. the stomach is partially filled with contrast and there is no evidence of oral contrast extravasation into the peritoneum or into the subcutaneous tissues. . there is no free intraperitoneal air, bowel dilatation or ascites within the abdomen or pelvis. atheromatous calcification of the distal aorta and iliac arteries is moderate, without aneurysm. . pelvis: a foley catheter and air is seen in the bladder. the prostate gland is unremarkable. the rectum and sigmoid colon are within normal limits. . osseous structures: there are no suspicious lytic or blastic lesions. a sclerotic focus in the right femoral head has a nonaggressive appearance. . impression: 1. gastrostomy tube balloon in the left upper quadrant soft tissues with associated soft tissue air moderate air but no evidence of oral contrast extravasation or abscess. 2. bilateral pleural effusions. . pathology . soft tissue, posterior rectus sheath, "abdominal wall abscess" (a,b): fibroadipose tissue and skeletal muscle with intense acute inflammation and necrosis. . stains for micro-organisms will be performed and the results issued in a separate addendum. . clinical: 53 year old man with abdominal wall abscess, rule out necrotizing fascitis, specimen submitted, posterior rectus sheath. . gross: the specimen is received fresh labeled with " " the medical record number and "posterior rectus sheath". it consists of multiple fragments of tan soft red tissue measuring 3 x 2.5 x 1 cm in aggregate. a portion of the tissue appears necrotic with areas of cautery. the specimen is entirely submitted in a-b. . microbiology . 1:00 pm tissue site: abdomen abdominal wall tissue. . **final report ** . gram stain (final ): reported by phone to @ 2225 on - fa6b. 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram positive rod(s). 3+ (5-10 per 1000x field): gram positive cocci. in pairs and clusters. 1+ (<1 per 1000x field): yeast(s). tissue (final ): due to mixed bacterial types ( >= 3 colony types) an abbreviated workup is performed appropriate to the isolates recovered from the site (including a screen for pseudomonas aeruginosa, staphylococcus aureus and beta streptococcus). enterococcus sp.. moderate growth. albicans, presumptive identification. moderate growth. lactobacillus species. moderate growth. gamma(i.e. non-hemolytic) streptococcus. sparse growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ <=2 s penicillin------------ 8 s vancomycin------------ <=1 s urine cx yeast >100,000 brief hospital course: pt was admitted to the ccu at for further work-up and treatment of his medical condition. he ruled in for an nstemi with severe lv dysfunction per tte. on he experienced acute dyspnea and hypotension suffering pea arrest. he was intubated and resuscitated with multiple rounds of epi/atropine. dopamine was started for hypotension. his arrest was thought due to global cardiac ischemia/cardiogenic shock. he was put on broad spectrum antibiotics given leukocytosis and potential sepsis and ? aspiration. he was also thought to have an ugib given his melena, though gi did not think his bleed was acute. he underwent cardiac cath on showing severe 3vd and elevated filling pressures. iabp and swan were placed. he required prbcs given his anemia. pressors were eventually weaned. balloon pump was kept in for a week. pt kept on asa, heparin, plavix, metoprolol, statin, and isordil tid as pressures would tolerate. pt had several episodes of tachycardia, tachypnea, and hypertension that would induce st depressions on ant leads of ecg. these changes would dissipate with control of bp and hr. fever, leukocytosis, question of impaired anoxic encephalopathy s/p pea arrest, and question of gi bleed initially prevented cabg. fever spiked vanco/zosyn . peg from osh, became tender and tube feeds were causing patient pain. pt was taken to or for exploration of peg site and removal of rectus sheath abscess. vac was placed. fever resolved. mild leukocytosis of 11.5 remained day of surgery. pt was extubated on for several day period and showed no signs of anoxic brain injury. he was reintubated on for flash pulmonary edema and respiratory distress. kept intubated up until cabg. on admit there was question of gi bleed, but patient was on heparin for greater than a week with out significant hct drop. pt noted to have free air on cxr , but benign abd exam. prn blood transfusions were given. plavix was discontinued several days before surgery. on he underwent cabg x 5. he was transferred to the icu on levophed, milrinone, insulin and propofol. on he was extubated and reintubated for agitation. seen by id and pan-scanned. thoracentesis for 700 cc performed on . extubated again on . he was transferred to the floor on . picc placed on . he was ready for discharge to rehab on pod #12. medications on admission: asa 325mg daily lipitor 40mg daily iss, no standing prednisone 20 mg daily bumex 1mg metoprolol ?mg daily flomax 0.4 mg daily prevacid 30mg daily coumadin 9mg daily flonase nasal spray fish oil discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po daily (daily). 2. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). 3. atorvastatin 80 mg tablet : one (1) tablet po hs (at bedtime). 4. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 5. nicotine 14 mg/24 hr patch 24 hr : one (1) patch 24 hr transdermal daily (daily). 6. zosyn 4.5 gram recon soln : one (1) intravenous every six (6) hours for 4 weeks: started - through . 7. vancomycin in dextrose 1 gram/200 ml piggyback : one (1) intravenous q 24h (every 24 hours) for 4 weeks: started - through . 8. fluconazole 200 mg tablet : two (2) tablet po q24h (every 24 hours) for 4 weeks: started - through . 9. carvedilol 3.125 mg tablet : two (2) tablet po bid (2 times a day). 10. prednisone 20 mg tablet : one (1) tablet po daily (daily). 11. insulin glargine 100 unit/ml solution : fifteen (15) units subcutaneous at bedtime. 12. insulin lispro 100 unit/ml solution : per sliding scale subcutaneous four times a day. 13. fluticasone 110 mcg/actuation aerosol : two (2) puff inhalation (2 times a day). 14. lasix 20 mg tablet : one (1) tablet po twice a day for 1 weeks: then reassess need for diuresis. 15. potassium chloride 20 meq tab sust.rel. particle/crystal : one (1) tab sust.rel. particle/crystal po bid (2 times a day) for 1 weeks: while on lasix. 16. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day): sq. 17. ipratropium bromide 17 mcg/actuation aerosol : six (6) puff inhalation q4h (every 4 hours). 18. albuterol sulfate 0.083 % (0.83 mg/ml) solution : one (1) inhalation q4h (every 4 hours) as needed. discharge disposition: extended care facility: discharge diagnosis: cad now s/p cabg pmh: dm, htn, cad, copd, lipids, cva, smoker, etoh, vre by rectal swab discharge condition: good. discharge instructions: call with fever, redness or drainage from incision or weight gain more than 2 pounds in one day or five in one week. shower, no baths, no lotions, creams or powders to incisions. no lifting more than 10 pounds or driving until follow up with surgeon. followup instructions: dr. (trauma surgeon) in weeks for wound check dr. 2 weeks dr. 4 weeks dr. after discharge from rehab md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters insertion of endotracheal tube enteral infusion of concentrated nutritional substances (aorto)coronary bypass of four or more coronary arteries thoracentesis implant of pulsation balloon excision or destruction of lesion or tissue of abdominal wall or umbilicus closure of gastrostomy diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery other postoperative infection congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified chronic systolic heart failure chronic obstructive asthma, unspecified acute myocardial infarction of inferoposterior wall, initial episode of care other disorders of muscle, ligament, and fascia mechanical complication of gastrostomy 

Answer: The patient is high likely exposed to