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: penicillins / sulfonamides / tetracyclines attending: chief complaint: generalized weakness, anorexia major surgical or invasive procedure: left internal jugular tunneled hemodialysis catheter history of present illness: y/o y/o f w/ afib on coumadin, tachy-brady syndrome s/p ppm, ckd, and diastolic chf a/w malaise, weakness, and decreased po intake for two days and an episode of urinary incontinence the night prior to admission. per the patient's family, she felt well until 2 days ago when she noted multiple episodes of diarrhea in the setting of an increase in her laxative regimen intended to treat constipation and associated abdominal discomfort. she has not had any recent antibiotic use or health care exposures. she denies fevers, chills, dysuria, hematuria, flank pain, or changes in mental status. family does state that renal function has steadily declined over the past 6 months for which she has been followed closely by a nephrologist. . in the ed vs 96.2, 60, 110/64 19 99% 2l. ekg unchanged from prior. had transient fluid-responsive systolic hypotension to sbp 85. received levofloxacin 750 mg x1. she was transferred to the micu for close observation given hypotension in the setting of delicate volume status. past medical history: afib tachy-brady s/p ppm ckd stage iv b/l ~cr 2.2 scc leg and neck s/p radiation 4+ tr 2+ mr htn hypothyroidism htn ibs anemia b/l hct ~34% diverticulosis social history: retired. no current alcohol or tobacco use. dtrs very active in her care. lives in house in with live-in aide. family history: noncontributory physical exam: admission physical exam vs: 96.2 108/60 72 18 96% ra gen: nad, alert, oriented to location, person, but not to date heent: perrla, eomi, dry mm neck: supple, no lad, no appreciable jvd cv: reg rate (paced) nl s1s2 no m/r/g : decreased bs on r abd: soft, mildly-distended, nt bs+ extrem: warm, dry 2+ pitting edema to knees bilaterally pertinent results: heparin dependent antibodies test result ---- ------ heparin dependent antibodies negative comment: negative for heparin pf4 antibody by . 11:30am urine blood-mod nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-tr 11:30am urine rbc-* wbc-* bacteria-mod yeast-none epi-0-2 . 9:24 pm urine site: clean catch source: catheter. **final report ** urine culture (final ): identification and sensitivities requested by dr.. staph aureus coag +. ~1000/ml. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | gentamicin------------ <=0.5 s levofloxacin---------- =>8 r nitrofurantoin-------- <=16 s oxacillin------------- =>4 r penicillin g---------- =>0.5 r tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ <=1 s . chest radiograph, pa and lateral dual-lead right pectoral pacemaker with right atrial and right ventricular leads is unchanged from prior studies. cardiomegaly is again noted, although the right heart border is now obscured by right basilar opacity which also obscures the right hemidiaphragm, consistent with moderate-sized pleural effusion and related atelectasis, although underlying pneumonic consolidation cannot be excluded. there is also a small left pleural effusion with milder left retrocardiac atelectasis. the remainder of the lungs are grossly clear, without evidence of overt pulmonary edema or lung consolidation . there is no evidence of pneumothorax. calcifications are again noted along the aorta. old right lateral rib fracture is unchanged. impressions: increased right basilar opacity, with increased and now moderate-sized right pleural effusion, and related atelectasis, although underlying pneumonic consolidation cannot be excluded. small left pleural effusion with left basilar atelectasis. . tte the left atrium is mildly dilated. the right atrium is markedly dilated. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 55-60%). the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. there is abnormal diastolic septal motion/position consistent with right ventricular volume overload. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the tricuspid valve leaflets fail to fully coapt. severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. the main pulmonary artery is dilated. there is a trivial/physiologic pericardial effusion. impression: dilated right ventricle with mild global systolic dysfunction and evidence of volume overload. normal global and regional left ventricular systolic function. mild aortic regurgitation. mild mitral regurgitation. severe functional tricuspid regurgitation. compared with the prior study (images reviewed) of , findings are similar. left ventricular systolic function may have been slightly underestimated on the prior study. . vascular u/s-guided catheter placement findings: 1. patent left internal jugular vein, accessed under son guidance. 2. placement of tunneled 15.5 french x 27 cm cuff-to-tip angiodynamics hemodialysis catheter via the left internal jugular vein. 3. post-procedure chest radiograph showed the catheter tip in the right atrium with no kinks along the course of the catheter and no pneumothorax. incidental note is made of atrioventricular pacing wires in expected position placed through the right subclavian vein. impression: successful placement of left internal jugular tunneled hemodialysis catheter. the catheter is ready for immediate use. brief hospital course: #ckd stage iv - the patient presented with symptoms consistent with uremia. volume overload was refractory to diuretic therapy due to worsening renal function. left ij tunneled hd catheter was placed on with subsequent initiation of hemodialysis that day, followed by , , , and . nephrocaps were added. lasix and were discontinued. phosphate binder therapy was not added as the calcium-phosphate product was approximately 18. ppd was read as 0 mm induration on . the patient will continue to receive hd as an outpatient. . #acute on chronic diastolic chf - admission cxr showed a moderately-sized right pleural effusion with associated atelectasis and a small left pleural effusion with left basilar atelectasis. tte showed a dilated rv with mild global systolic dysfunction and evidence of volume overload, normal global and regional lv systolic function (lvef 55-60%), and severe functional tr and mild ar/mr. respiratory status remained stable with adequate room air oxygenation. volume status was managed with hd, as above. . #thrombocytopenia - the patient did not have clinical signs or symptoms of bleeding or thrombosis. attributed to an effect of cephalosporin therapy but other possible offending medications including heparin, protonix, and atorvastatin were discontinued. indwelling catheter was flushed with citrate solution rather than heparin during hd sessions. pf4 antibody was negative. the patient will have a repeat cbc two days after discharge to continue to monitor platelet count. . #anemia of chronic kidney disease - hematocrit remained stable, obviating the need for transfusion. she may continue to receieve erythropoeitin therapy as an adjunct to hemodialysis. . #uti - admission urinalysis showed wbc, moderate bacteria, and trace leukocyte esterase. she was treated with 3 days of ceftriaxone until urine culture revealed ~1000 colonies mrsa, likely a skin contaminant. she was placed on contact precautions accordingly. . #atrial fibrillation - anticoagulation was reversed with vitamin k and ffp prior to hd catheter placement. coumadin was resumed after the procedure with a goal inr 2.0-3.0. the patient will be discharged with vna services to monitor inr and adjust coumadin dosing accordingly. . #hypertension - blood pressure was low-normal during the hospitalization and metoprolol was decreased to 25 mg qhs due to concerns for hypotension, particularly in the setting of hemodialysis. . #hypothyroidism - continued levothyroxine. . #nutrition - heart-healthy diet. calcium and vitamin d were continued. medications on admission: atorvastatin 10 mg po daily epoetin alfa 40,000 units sc q2wks furosemide 20 mg po qod hydrocortisone-pramoxine cream (1 %-1%) tp to hemorrhoids tid levothyroxine 50 mcg po daily losartan 25 mg po daily metoprolol succinate - 50 mg po qam, 25 mg po qpm pantoprazole - 40 mg po daily polyethylene glycol 1 tablespoon powder po daily warfarin 2.5 mg tablet po daily restasis *nf* 0.05 % ou to each eye citalopram hydrobromide 10 mg po qhs calcium carbonate 600 mg (1,500 mg) tablet - 2 tabs po bid ergocalciferol (vitamin d2) - 400 unit tablet 1 tab po daily discharge medications: 1. cyclosporine 0.05 % dropperette sig: one (1) dropperette ophthalmic to each eye (). 2. citalopram 10 mg tablet sig: one (1) tablet po at bedtime. 3. lactaid 3,000 unit tablet sig: one (1) tablet po qac (). 4. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 5. polyethylene glycol 3350 100 % powder sig: one (1) tablespoon powder po once daily as directed. 6. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 7. warfarin 2.5 mg tablet sig: one (1) tablet po once daily at 4 pm: adjust dose as directed to maintain inr 2.0-3.0. 8. nystatin 100,000 unit/g cream sig: one (1) application topical twice a day as needed for itching. 9. outpatient lab work please check complete blood count on thursday, and fax the results to the office of dr. at . 10. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po twice a day: hold for sbp<100. 11. home equipment please provide a hospital bed for home. 12. citracal + d 315-200 mg-unit tablet sig: two (2) tablet po twice a day. 13. senna 8.6 mg tablet sig: one (1) tablet po at bedtime as needed for constipation. disp:*30 tablet(s)* refills:*0* 14. medication you may continue taking your hydrocortisone-lidocaine compound topically as needed for discomfort due to hemorrhoids. discharge disposition: home with service facility: homecare discharge diagnosis: primary 1) chronic kidney disease stage v on hemodialysis 2) acute on chronic diastolic heart failure 3) thrombocytopenia 4) urinary tract infection secondary 1) atrial fibrillation 2) anemia of chronic kidney disease 3) hypothyroidism discharge condition: clinically improved with stable vital signs. discharge instructions: you were admitted to the hospital with generalized weakness and poor appetite most attributable to worsening kidney function, or uremia. a catheter was placed and hemodialysis was initiated on . your next hemodialysis session is at on thursday, at 3:00 pm. you will continue to have dialysis on tuesdays, thursdays, and saturdays. you were also found to have a low platelet count likely due to an effect of medication. antibiotics, protonix, and lipitor, all of which can cause this problem, were discontinued. please have a complete blood count checked on thursday, and ensure that the results are faxed to the office of dr. at . the follow medications were changed: 1) vitamins called nephrocaps were started. 2) lasix and losartan were discontinued as you will continue to receive hemodialysis. 3) metoprolol was decreased to 12.5 mg twice daily due to low blood pressure. 4) calcium and vitamin d were changed to a combination pill called citracal+d, 2 tablets twice daily. 5) citalopram (celexa) was increased to 10 mg (1 full tablet) daily. please weigh yourself daily and call your physician if your weight increases by more than 3 pounds. please adhere to diet containing than 2 grams of sodium daily. please follow up with dr. on wednesday at 4:00 pm. if you need to reschedule this appointment, please call . please call your physician or return to the emergency department immediately if you experience fever, chills, sweats, dizziness, lightheadedness, passing out, falling, chest pain, palpitations, shortness of breath, cough, abdominal pain, vomiting, diarrhea, bloody or dark stools, discomfort with urination, or leg swelling or pain. followup instructions: your next hemodialysis session is at on thursday, at 3:00 pm. you will continue to have dialysis on tuesdays, thursdays, and saturdays. please follow up with dr. on wednesday at 4:00 pm. if you need to reschedule this appointment, please call . provider: clinic phone: date/time: 10:00 provider: , m.d. phone: date/time: 10:40 procedure: hemodialysis venous catheterization for renal dialysis diagnoses: thrombocytopenia, unspecified anemia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure long-term (current) use of anticoagulants cardiac pacemaker in situ 

Answer: The patient is high likely exposed to