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: aspirin / tylenol plus attending: chief complaint: back pain major surgical or invasive procedure: 1. partial vertebrectomy of t12-l1 and l2. 2. fusion t12-l2. 3. spacers x2. 4. instrumentation t12-l2. 5. autograft. 1. total laminectomy of t11, t12, l1 and l2. 2. fusion t11 to l3. 3. instrumentation t11 to l3. 4. autograft. 5. epidural catheter placement. history of present illness: mr. is a pleasant 58yom with h/o recurrent mrsa infections with lumbar spine and right humerus involvement on chronic doxycycline for suppressive tx, ivdu and hcv without cirrhosis who presents after outpt ct abdomen/pelvis showed evidence of t12 discitis. pt has a complicated infectious disease history and is followed by dr. in clinic. he has h/o multiple mrsa infections since including epidural abscess, discitis, vertebral osteomyelitis, septic arthritis of r shoulder, bilateral hips, and r foot, and multiple back surgeries for drainage/debridement (of note, no hardware placed). his hospital courses have been complicated by dvt (completed 3 mos of lovenox therapy) and atrial fibrillation. his most recent hospitalization was in , when he presented with fever to 103, leukocytosis, and elevated esr/crp. no organism grew on blood cx, but given his h/o recurrent mrsa he was treated with iv vanc x8 weeks, completed in . since then he has been on chronic doxycycline suppressive therapy. . pt states his back pain has generally been at his baseline. his pain is typically r paraspinal in lumbar region but more recently has had increased pain in his middle back. the pain is worse in the am and with movement, particularly when moving from sitting to standing. has also had r leg weakness that has resulted in falls recently, states he has had this weakness for a few months. no numbness or tingling of extremities, no perineal numbness, no bowel/bladder incontinence. . he presented to clinic for f/u on , and noted occ r flank pain. he had ct abdomen/pelvis as outpatient, which had findings concerning for t12 spondylodiscitis. his id specialist dr. him and urged him to go to the ed for further evaluation, but pt did not want to go to due to transportation issues. he presented to his local osh, where he was given iv vanc 1g x1 and iv zosyn 3.375g x1. he was transferred to for further eval. . in the ed, initial vs were temp: 98 hr: 74 bp: 131/78 resp: 16 o(2)sat: 98%ra. he received iv dilaudid for pain. labs were notable for nl wbc, elevated esr 23 and crp 12. he was evaluated by spine who recommended id c/s, possible or washout. he was admitted to medicine. . upon transfer to the floor, vitals are t 97.3, bp 132/80, hr 66, rr 18, o2sat 94% on ra. he describes his pain as but similar to his chronic pain, r-sided lumbar pain that radiates to his r hip. denies recent fevers/chills (notes that with his previous infections he had fevers, chills, malaise). denies n/v. his r flank pain has resolved. . ros: per hpi, denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, brbpr, melena, hematochezia, dysuria, hematuria past medical history: -mrsa epidural abscess, discitis, vertebral osteomyelitis and r humerus intraosseous abscess s/p laminectomies/debridement and iv abx course, recurrence despite bactrim suppression (incomplete adherence suspected) and repeat iv abx course ending on indefinite doxycycline suppression. aspiration of back (?anatomy) at with bloody fluid but growth of mrsa, treated with 8 days iv vanco/pip-tazo and transitioned back to doxycycline there until he ran out . of note, no known foreign bodies or hardware. -epidural abscess ? that he recalls was treated at and . ongoing back pain. -mrsa sepsis infected shoulder -removal tip of l 1st digit. -hcv, never treated. genotype 1a, vl 3.3 million . never biopsied. no cirrhosis on ct abdomen . -afib (intermittent) -dvt per omr. off warfarin recently; managed by pcp. social history: prior lives normally in with his girlfriend. has a 32yo daughter who is a surgeon in . he grew up in on a reservation and moved to about 25 years ago. he notes that most of the people on the reservation died. he has two sisters and a brother with the same father but a different mother. states that he is a fisherman. he admits to a history of iv drug use, including intravenous cocaine and heorin. he has been sober for the last 17 years, and he notes that he had not used any iv drugs in the last 17 months until last (day prior to admission). he use heroin to help control his pain last . he smokes about ppd cigarettes for about 10-20yrs. ambulates with cane. family history: multiple siblings with osteoarthritis and joint replacements. has some family history of hyperlipidemia. no family history of diabetes or cancer known. he has one brother and two sisters. physical exam: admission pe: vs - temp 97.3f, bp 132/80, hr 66, r 18, o2-sat 94% ra general - pleasant, obese male in nad, comfortable, appropriate heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear neck - supple, no jvd lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - rrr, no mrg, nl s1-s2 abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps) skin - multiple tattoos on arms, no jaundice, no spinder angiomatas or palmar erythema lymph - no cervical, axillary, or inguinal lad neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength with r hip flexion and r foot dorsiflexion. otherwise strength throughout, sensation grossly intact throughout, dtrs 2+ in rle and 1+ in lle, toes downgoing bilaterally, no clonus, cerebellar exam intact, gait assessment deferred discharge pe: vs: 98, 100s-110s/60s, 80s, 20, 93%3l gen: comfortable, nad, multiple tattoos heent-mmm, eomi, neck supple, no lymphadenopathy, trachea midline lungs- ctabl, no wheezes, rhonic cv- rrr, s1s2, no m,r,g, no thrills abdom- soft,nd, bs+, no masses, ttp on l lateral abdomen at site of drain removal ext- no peripheral edema neuro- u/le strength 5/5 spine- dressing in place, no drainage noted, no erythema around incision site pertinent results: labs on admission: 02:00am blood wbc-6.4 rbc-4.60 hgb-14.2 hct-41.6 mcv-91 mch-30.8 mchc-34.1 rdw-13.3 plt ct-128* 02:00am blood neuts-74.2* lymphs-18.3 monos-5.7 eos-1.4 baso-0.3 02:00am blood pt-11.9 ptt-31.2 inr(pt)-1.1 07:40pm blood fibrino-534* 02:00am blood esr-23* 02:00am blood glucose-89 urean-13 creat-0.9 na-139 k-3.8 cl-107 hco3-23 angap-13 02:00am blood alt-16 ast-23 alkphos-124 totbili-0.4 01:15pm blood calcium-7.9* phos-3.5 mg-1.4* 02:00am blood crp-12.2* 07:46pm blood type-art po2-143* pco2-51* ph-7.36 caltco2-30 base xs-2 02:36am blood lactate-1.3 discharge labs: 04:35am blood wbc-7.1 rbc-2.67* hgb-8.3* hct-25.1* mcv-94 mch-31.2 mchc-33.2 rdw-13.5 plt ct-198 04:35am blood glucose-91 urean-15 creat-0.9 na-138 k-4.1 cl-99 hco3-32 angap-11 04:35pm blood alt-18 ast-32 ld(ldh)-266* alkphos-98 totbili-0.3 04:35pm blood albumin-3.1* 04:35pm blood crp-138.7* 04:35pm blood esr-116* microbiology: 2:00 am blood culture **final report ** blood culture, routine (final ): no growth. 2:00 am urine site: clean catch **final report ** urine culture (final ): <10,000 organisms/ml. 1:43 am blood culture **final report ** blood culture, routine (final ): no growth. 10:30 am tissue t12-l1 . gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. tissue (final ): no growth. anaerobic culture (final ): no growth. fungal culture (preliminary): no fungus isolated. 10:30 am swab t12-l1 disc space. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. wound culture (final ): parapsilosis. sparse growth. speciation and fluconazole sensitivity requested by #. sensitive to fluconazole , sensitivity testing performed by . this test has not been fda approved but has been verified following clinical and laboratory standards institute guidelines by clinical microbiology laboratory.. anaerobic culture (final ): no anaerobes isolated. fungal culture (preliminary): parapsilosis. id performed on corresponding routine culture. 9:23 pm urine source: cvs. **final report ** urine culture (final ): no growth. imaging: mri of the thoracic and lumbar spine without and with gad impression: findings concerning for progressive discitis at t12-l1 and possibly at l1-l2. probable abscess within the disc space at t12-l1. extensive pre- and paravertebral soft tissue abnormality at the involved levels. extensive epidural enhancement which may be related to prior surgery or infections. no large epidural abscess is noted at this time. ct of the chest with iv contrast: there is mild upper zone paraseptal emphysema (2:16). a small left pleural effusion tracks along the dependent regions and the left major fissure (301b:63). bilateral dependent atelectasis is slightly worse on the left. a left-sided picc terminates at the lower svc (2:21). the heart size is normal. there is no pericardial effusion. the great vessels are patent and normal in caliber. no large central pulmonary embolus is detected, though this examination is not optimized for evaluation of the pulmonary arteries. scattered prominent and enlarged axillary and mediastinal lymph nodes are seen, including a prevascular node measuring 10 mm along the short axis (2:18), 11mm pre-and subcarinal nodes, and a 12 mm right hilar node. ct of the abdomen with iv contrast: since the examination, the patient has undergone laminectomy and posterior fusion of t11 through l3 via two posterior rods, one left paravertebral rod, and 13 screws. there is also partial vertebrectomy of t12 through l2. interosseous disc spacers are seen at t12 through l2 (301b:46,47). the tissue immediately adjacent to the surgical hardware is difficult to evaluate due to extensive streak artifacts. there is no evidence of hardware failure. two surgical approaches are detected. the first lies along the midline dorsal to the thoracolumbar spine. there is expected post-surgical subcutaneous fat and soft tissue stranding, with a small foci of air (2:40). no fluid collections are seen. the second surgical approach is via the left flank, where there is soft tissue stranding at the entry site (2:57), and a partial left tenth rib resection (2:49). a small focus of subcutaneous and intramuscular air is seen anteriorly (2:65). thickening of the left lateroconal fascia is present, with a small focus of air at the lateral-most aspect (2:75,78). fluid tracks along the left posterior pararenal space (2:79). there is asymmetric thickening of the left psoas muscle (2:78), which appears to abut a relatively hypodense triangular-shaped prominence (2:80). this may represent a small fluid collection, thickened muscle, or phlegmon. no fluid collections are seen. a coarse calcification overlying the left psoas muscle (2:77) may represent a surgically-related loose body, as this was not visualized on the ct examination. the evaluation of the solid abdominal organs is limited due to extensive metallic streak artifacts. a small hepatic cyst is seen near the falciform ligament (2:50). there is no intra- or extra-hepatic bile duct dilation. the gallbladder, stomach, spleen, right adrenal gland, right kidney, pancreas, and intra-abdominal loops of small and large bowel are normal. the left adrenal gland is not well visualized due to metallic artifacts. a subcentimeter hypoenhancing cortical lesion within the left kidney (2:75) may represent a small cyst, but is too small to characterize. numerous prominent retroperitoneal and paraaortic lymph nodes are present (2:76,79). there is no intra-abdominal ascites. there is bony fusion of multiple lower lumbar vertebral bodies (301b:44), as seen on prior examinations. the upper thoracic spine demonstrates mild degenerative change. impression: 1. post-vertebrectomy and fusion of the thoracolumbar spine, with post-surgical changes at both the midline posterior and left flank approach. no definite fluid collections detected. inflammatory changes and soft tissue thickening along the left lateroconal fascia and posterior pararenal space may be postsurgical, but superimposed infection cannot be excluded with this technique. 2. enlarged mediastinal and retroperitoneal lymph nodes, likely reactive. 3. small left pleural effusion. mild adjacent atelectasis. 4. mild paraseptal emphysema. pathology: t12-l1 , excision: necrotic and viable , cartilage and fibrotic tissue. no active inflammation seen. clinical: osteomyelitis t12-l2. gross: the specimen is received fresh labeled with the patient's name, ", ", the medical record number and "t12-l1 ." it consists of multiple fragments of red - tan and cartilage measuring 5.0 x 4.7 x 0.8 cm in aggregate. four representative sections are submitted in cassettes a-d. brief hospital course: 58yo m with h/o recurrent mrsa infections with lumbar spine and right humerus involvement on chronic doxycycline for suppressive tx, ivdu and hcv without cirrhosis who presents with osteomyelitis of the spine. . # pt noted to have t12-l1 involvement on imaging. he underwent or debridement and fusion of the involved vertebrae. the surgery was complicated by a significant amount of blood loss requiring prbc transfusion. cultures from the or debridement grew non-albicans . infectious disease was consulted and recommended treatment with doxycycline and fluconazole for a prolonged course consisting of atleast six months. he was afebrile on this regimen and did not have a leukocytosis at time of discharge. . #pain-the acute pain service was consulted post-op for assistance with pain management. they recommended restarting methadone 10mg tid. we also added po dilaudid to this regimen for break through pain. he was given prescriptions for both dilaudid and methadone post discharge with a supply that should last until his follow up appointment with his primary care physician. . # hcv: stable, no evidence of decompensated cirrhosis during this hospitalization. #transitional: per infectious disease request an esr, crp and liver function tests were obtained prior to discharge for them to follow up considering fluconazole was started for treatment. he has follow up appointments with his primary care physician and the service as well. medications on admission: 1. doxycycline hyclate - 100 mg capsule - 1 capsule(s) by mouth twice daily 2. methadone 10mg tid discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 2. methadone 10 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*42 tablet(s)* refills:*0* 3. fluconazole 200 mg tablet sig: two (2) tablet po q24h (every 24 hours). disp:*60 tablet(s)* refills:*3* 4. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily). disp:*30 30* refills:*2* 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 6. doxycycline hyclate 100 mg capsule sig: one (1) capsule po q12h (every 12 hours). disp:*60 capsule(s)* refills:*2* 7. dilaudid 2 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. disp:*20 tablet(s)* refills:*0* discharge disposition: home with service facility: home care services discharge diagnosis: primary diagnosis: osteomyelitis of spine secondary diagnosis: hepatitis c discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , it was a pleasure taking care of you at . you were admitted to the hospital with an infection in your spine. you underwent a debridement of the infection by orthopedics and have been placed on an antifungal medication and an antibiotic medication to treat your infection. changes to your medications: start: docusate sodium 100mg twice per day for constipation fluconazole 400mg daily for your spine infection polyethylene glycol 17g pack per day for constipation senna 8.6mg twice per day for constipation dilaudid 2mg as needed for pain no other changes were made to your medications. please see below for follow up appointments that have been made on your behalf. followup instructions: department: when: monday at 11:00 am with: dr / post clinic 6th fl central suite phone: building: sc clinical ctr campus: east best parking: garage **this appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. this visit, you will see your regular primary care doctor in follow up.** department: infectious disease when: wednesday at 10:30 am with: , md building: lm bldg () campus: west best parking: garage department: when: tuesday at 3:25 pm with: , md building: sc clinical ctr campus: east best parking: garage name: , md specialty: orthopaedics location: address: , bldg. rm 239, , phone: appointment: at 1:30pm procedure: dorsal and dorsolumbar fusion of the anterior column, anterior technique other excision of joint, other specified sites excision of bone for graft, other bones excision of bone for graft, other bones dorsal and dorsolumbar fusion of the posterior column, posterior technique insertion of catheter into spinal canal for infusion of therapeutic or palliative substances systemic to pulmonary artery shunt insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae fusion or refusion of 4-8 vertebrae insertion of recombinant bone morphogenetic protein diagnoses: other iatrogenic hypotension tobacco use disorder chronic hepatitis c without mention of hepatic coma acute posthemorrhagic anemia chronic airway obstruction, not elsewhere classified atrial fibrillation opioid type dependence, unspecified hemorrhage complicating a procedure other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation paralytic ileus personal history of venous thrombosis and embolism personal history of noncompliance with medical treatment, presenting hazards to health encephalopathy, unspecified acute osteomyelitis, other specified sites accidents occurring in residential institution other and unspecified coagulation defects other candidiasis of other specified sites unspecified inflammatory spondylopathy personal history of methicillin resistant staphylococcus aureus chronic osteomyelitis, other specified sites acquired spondylolisthesis other kyphosis (acquired) dermatophytosis of nail postprocedural fever other digestive system complications acute post-thoracotomy pain 

Answer: The patient is high likely exposed to