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: magnesium / latex / salicylate / benzocaine attending: chief complaint: fever, knee pain major surgical or invasive procedure: l knee washout intubation extubation transesophageal echocardiogram history of present illness: ms. is a 25 yo f with pmh of severe persistent asthma with multiple prior intubations, ivda, septic arthritis presenting with two days of fever and knee pain. she reports that on the evening prior to presentation she developed fever to 102 and swelling of her left knee. two days prior to that she reports falling out of a car and cutting her hand on the ground which became progressively more swollen and painful. she does also endorse injecting heroin into her right antecubital fossa one week ago but denies sharing needles. of note, details of her history change when asked at different times or by different interviewers. she also endorses history of cellulitis in her left leg two months ago at hospital for which she was treated with antibiotics. reports that the infection started in her foot and spread upward. she denies having to have her left knee tapped at that time. in the ed, initial vs were: t 101 p 146 bp 105/64 r 18 o2 sat 94% ra. she had drainage of a 2x2 cm abscess on her left hand which was packed in the ed. she was evaluated by orthopedics due to concern for septic joint and she had drainage of reportedly purulent material from her left knee. she was given 6l ns iv and had 3l urine output in ed. she was also given morphine 4mg iv, zosyn 4mg iv, tylenol 1 g po, levofloxacin 750mg iv, ativan 0.5mg iv, vancomycin 1g iv. past medical history: severe persistent asthma - multiple intubations chronic sinusitis opiod dependence s/p bilateral knee replacements for osteonecrosis long term prednisione use (r knee , left knee ) hypogammaglobulinemia hepatitis c tobacco abuse -spontaneous ptx in -s/p r vats/bleb resection and pleurectomy at hospital in osteopenia by xray social history: she endorses recent injection of heroin in the past week and reports that prior to this she had been clean for about two years. she does have history of injection drug use and cocaine use in the past. tobacco: she endorses smoking ppd currently and has been smoking for the past 10 years. family history: mother - breast cancer - asthma and hyperthyroidism physical exam: vitals: t: 98.1 bp: 92/64 p:95 r:21 o2: 97% ra general: awake, alert and oriented heent: sclera anicteric, dry mucous membranes, oropharynx clear, no roths spots neck: supple, jvp not elevated, no lad lungs: decreased air movement, scattered squeaks in the upper air fields, no crackles cv: regular, tachycardic(after nebs), normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: left knee with clean dry surgical site with staples in place. +edema, but not erythema. mild tenderness to palpation. good rom. good pulses. pertinent results: knee x ray: in comparison with the study of , there has been placement of a total knee prosthesis without evidence of hardware-related complication. there is substantial soft tissue swelling in the suprapatellar region. it is unclear whether this could merely represent postoperative change, since the date of the surgical procedure is not known. if postoperative changes should have been resolved by this time, the possibility of an acute inflammatory process must be seriously considered given the clinical history. chest x ray pa / lat: no acute intrathoracic process. hand x ray: osteopenia, for which additional workup is strongly recommended (perhaps beginning with bone mineral measurements). if this patient has no underlying obvious etiology, the differential would include osteogenesis imperfecta. transthoracic echocardiogram: suboptimal study due to patient decision not to allow for study completion. possible very small vegetation on the posterior mitral leaflet. if clinically indicated, a follow-up transthoracic study with color doppler and apical images and/or a tee is suggested to better assess the possible posterior mitral leaflet abnormality transthoracic echocardiogram: the left atrium and right atrium are normal in cavity size. the interatrial septum is aneurysmal. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen (clip ). the estimated pulmonary artery systolic pressure is high normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , the previously noted mobile echodensity on the posterior mitral leaflet is no longer seen . mild mitral regurgitation is now seen (not previously assessed).if the clinical suspicion for endocarditis is moderate or high, a tee would be better able to define the mitral valve morphology and severity of mitral regurgitation. transesophageal echocardiogram: the left atrium and right atrium are normal in cavity size. the interatrial septum is aneurysmal. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen (clip ). the estimated pulmonary artery systolic pressure is high normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , the previously noted mobile echodensity on the posterior mitral leaflet is no longer seen . mild mitral regurgitation is now seen (not previously assessed). if the clinical suspicion for endocarditis is moderate or high, a tee would be better able to define the mitral valve morphology and severity of mitral regurgitation. time taken not noted log-in date/time: 12:26 pm swab (l) thumb. **final report ** gram stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. smear reviewed; results confirmed. wound culture (final ): beta streptococcus group a. moderate growth. staphylococcus, coagulase negative. rare growth. coag neg staph does not require contact precautions, regardless of resistance. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. sensitivities: mic expressed in mcg/ml _________________________________________________________ staphylococcus, coagulase negative | erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- 4 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- =>16 r vancomycin------------ 2 s left knee joint fluid also grew group a beta hemolytic streptococcus, as did blood cultures from . brief hospital course: septic shock, septic arthritis, prosthetic joint: the patient was initially admitted with septic shock, was on pressors and weaned. she was started on broad spectrum antibiotics until cultures returned with group a strep bactermia. at that time she was transitioned to penicillin and clindamycin. clindamycin was in case she had toxic shock, this was discontinued on as she was no longer pressor dependent. her bacteremia was detected on and subsequent blood cultures had cleared (pending as of ). her l knee joint fluid and l thumb abscess also grew group a strep. had knee washout and replacement, . plastic surgery i&d to thumb. she will need 6 weeks of penicillin. she had a tee without evidence of endocarditis. needs weekly labs, id and ortho f/u. cpm 0-100 as tolerated. staples out two weeks from discharge from . polysubstance abuse: the patient was initially noted to be extremely agitated with acute illness. this cleared. she is stable on seroquel at night. prn clonapin. also needs narcotic pain meds weaned off over 6 weeks. asthma: asthma exacerbation on admission. severe persistent asthma with multiple (> 20) intubations in the past. she is not compliant with her meds and was intubated due to respiratory failure. she was extubated successfully on and her asthma had improved with bronchodilators alone, given her sepsis steroids were not added. she is stable now on her home meds, but still has wheezing on exam, but is moving air well. this is her baseline. she will need f/u with her pulmonologist at , dr. that can be set up upon her discharge from rehab or ealier if needed. prophylaxis: she was started on lovenox 40mg sc daily for ppx after her knee washout and will need this for 3 weeks post op. mrsa+: was found in her record with unclear actual source. mrsa negative in all cultures at our hospital and negative mrsa screen. consider repeating mrsa screens x 3 to remove precautions. sinus tachycardia: the patient frequently tachycardic after neb/inh treatments. hepatitis c chronic: antibody +, vl 7700. will f/u with id. hiv neg. medications on admission: medications (confirmed by local pharmacy): 1) advair 500/50 b.i.d. 2) albuterol inhaler (proair) up to 4 times daily. 3) theophylline sr 450 mg once daily. 4) spiriva 18 micrograms once daily. (not filled) 5) singulair 10 mg once daily. 6) dilaudid 4 mg p.o. q4hr (unclear if currently getting this) 7) duonebs p.r.n. (she uses this approximately once a week). 8) prilosec 20 mg once daily. 9) calcium/vitamin d. 10) seroquel 100mg qhs (not filled) 11) clonidine (not confirmed by pharmacy) 12) xopenex (not filled) discharge medications: 1. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 2. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 3. enoxaparin 40 mg/0.4 ml syringe sig: one (1) subcutaneous daily (daily): until . 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 5. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for mouth pain. 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation every four (4) hours as needed for dyspnea, wheezing. 7. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 8. quetiapine 100 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 9. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 10. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 11. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 12. hydromorphone 2 mg tablet sig: 1-3 tablets po q3h (every 3 hours) as needed for pain: should be weaned over 6 weeks. 13. penicillin g potassium 20,000,000 unit recon soln sig: four (4) million units injection q4h (every 4 hours) for 5 weeks: do not stop medication until instructed by clinic at . 14. clonazepam 0.5 mg tablet sig: one (1) tablet po twice a day as needed for anxiety. discharge disposition: extended care facility: - discharge diagnosis: septic arthritis, prosthetic joint discharge condition: good discharge instructions: patient was admitted with group a strept infection of her prosthetic knee. needs 6 weeks on antibiotics. also needs pt for right knee with cpm 0-100 degrees as tolerated. lovenox for 3 weeks post op and staple removal in 2 weeks. needs f/u with clinic and ortho clinic during 6 week course and appointments with pcp and pulmonary(dr. ) after discharge from rehab. followup instructions: id follow up - anticipate 6 weeks iv pen g from and then 6 months of oral therapy pending clinical course - we will arrange follow up in id clinc with dr. , md or dr. in weeks - check weekly cbc diff bun cr lfts while on iv antibiotics and fax all lab results to infectious disease r.ns. at ( - all questions regarding outpatient antibiotics should be directed to the infectious disease r.ns. at ( or to on md in when clinic is closed. provider , orthopedic private practice phone: date/time: 3:45 pcp() and pulm() f/u after discharge from rehab. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified diagnostic ultrasound of heart insertion of endotracheal tube arterial catheterization other incision with drainage of skin and subcutaneous tissue arthrocentesis revision of knee replacement, patellar component diagnoses: acidosis hyperpotassemia anemia, unspecified acute kidney failure, unspecified hyposmolality and/or hyponatremia severe sepsis other, mixed, or unspecified drug abuse, unspecified unspecified viral hepatitis c without hepatic coma opioid type dependence, unspecified acute respiratory failure other specified cardiac dysrhythmias septic shock streptococcal septicemia drug withdrawal unspecified procedure as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure methemoglobinemia endocarditis, valve unspecified, unspecified cause asthma, unspecified type, with (acute) exacerbation cellulitis and abscess of hand, except fingers and thumb effusion of joint, lower leg pyogenic arthritis, lower leg infection and inflammatory reaction due to internal joint prosthesis 

Answer: The patient is high likely exposed to