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: zyvox / vancomycin hcl attending: chief complaint: hip infection major surgical or invasive procedure: right ij left picc line placement by interventional radiology ng tube placement history of present illness: mr. is a 63 yo m w/ h/o cad s/p thr for oa. he had persistent drainage post-op. he was taken back to or 7 days post op for irrigation and wound cxs then were negative. he was given about 4 days of iv kefzol and he was d/c??????ed on diclox for 10 days. he developed fever and purulent wound discharge at home and represented to osh. he had the hardware removed around and dr. put in a tobramycin/gentamicin/vanco spacer. id was consulted and he was given iv vanco when wound cx??????s grew mrsa. esr at that time about 100 and crp of 9.6. post op, he had a vac dressing for about 6 days and then he went back to the or for wound closure. he was d??????ced tp home with picc line for outpt iv vanco. six days ago, vna called and said pt was febrile at home to 102 with n/v sweats, chills. he was brought back to the hospital where he had a nl wbc but had 10% eosinophils. his wound apparently looked okay. he was taken off iv vanco and placed on iv linezolid. he had been on the vanco for ~2wks. his esr was up to 110 but his crp was 2.4. patient states that ~6 hours after beginning linezolid, he developed a whole body rash. it began on his legs and back and spread to his face, trunk, and arms. it was accompanied by face and neck swelling and was pruritic. it was then thought that he was reacting to the linezolid and he was switched back to vancomycin. he contined spiking temps so he was taken back to or this past and the abx spacer was removed. there was small amt of purulent drainage in wound. he did some additional debridement. pt got some blood before going to or cause he was anemic. wound was left open with vac dressing on. prior to transfer, he was said to be in delirium. he??????d been on coumadin since his operation and his last inr on was 5.8 at which time he was taken off all anticoagulation. it is unclear whether blood cultures were drawn at outside hospital. on admission to the floor, mr. is alert and oriented x 3, hemodynamically stable. he is complaining of some pain at his r hip surgical site but is otherwise w/o complaint. ros: he denies any chest pain, sob, ha, vision changes, lightheadedness, change in his bms. no diarrhea. no constipation. no brbpr, hematochezia, melena. no dysuria. no changes in urination. no abdominal pain. no numbness, tingling, or weakness. past medical history: cad- stents x 2- , . cath - mild inf. hypokinesis; ef~66% osteoarthritis hypertension hypercholesterolemia mrsa wound infection h/o skin cancer s/p tkr x 2 (most recently in ) s/p cervical spine spur removal (no hardware) s/p appendectomy s/p cholecystectomy s/p lower lumbar surgery x 2 w/ hardware (plates and wires) social history: lives w/ wife. frisee. has electric chair lift. walks w/ walker. distant smoking hx. 2-4 beers/night prior to surgery. no ivdu. family history: father- throat cancer mother- vaginal cancer brothers and sisters- alive and well. physical exam: pe: t:95.2 bp: 134/70 hr: 72 rr: 18 o2 99% ra gen: pleasant, well appearing male in nad heent: no conjunctival pallor. no icterus. perrl. mmm. mucosal ulcers on upper lip. neck: supple, no lad, no jvd. no thyromegaly. cv: rrr. distant heart sounds. no murmurs, rubs or lungs: ctab, good bs bl abd: obese. soft, nt, nd. nl bs. no hsm ext: wwp, no cce. 2+ dp pulses bl. picc c/d/i in r ue. r hip wound c/d/i w/ wound vac in place. skin: diffuse maculo-papular rash, non blanching over legs, trunk, arms, face. neuro: a&ox3. appropriate. listens and responds to questions appropriately, pleasant pertinent results: admission labs: . 08:25pm blood wbc-16.8* rbc-3.43* hgb-10.1* hct-29.4* mcv-86 mch-29.6 mchc-34.5 rdw-14.8 plt ct-178 08:25pm blood pt-35.3* ptt-42.4* inr(pt)-3.9* 08:25pm blood glucose-75 urean-22* creat-1.1 na-139 k-3.4 cl-103 hco3-26 angap-13 08:25pm blood alt-607* ast-356* ck(cpk)-598* alkphos-663* totbili-1.3 08:25pm blood calcium-7.8* phos-3.0 mg-1.6 06:53pm urine color-yellow appear-clear sp -1.010 06:53pm urine blood-tr nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-1 ph-5.0 leuks-neg 06:53pm urine rbc-7* wbc-0 bacteri-many yeast-none epi-0 . other labs: . 04:45am blood caltibc-160* hapto-97 ferritn-1417* trf-123* 11:00am blood hbsag-negative hbsab-positive hbcab-negative hav ab-negative igm hbc-negative igm hav-negative 03:13pm blood smooth-positive 03:13pm blood -negative 04:45am blood afp-1.6 08:57am blood crp-79.4* 04:45am blood pep-no specifi igg-1288 iga-31* 11:00am blood hcv ab-negative . microbiology: blood cx (1/4 bottles) : grew pan-sensitive e.coli sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s imipenem-------------- <=1 s levofloxacin----------<=0.25 s meropenem-------------<=0.25 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s would cx grew pan-sensitive e. coli all other blood cxs were no growth to date urine culture sent on and urine analysis negative on acinetobacter baumannii. 10,000-100,000 organisms/ml.. "note, for amp/sulbactam, higher-than-standard dosing needs to be used, since therapeutic efficacy relies on intrinsic activity of the sulbactam component". 2nd isolate. <10,000 organisms/ml. sensitivities: mic expressed in mcg/ml _________________________________________________________ acinetobacter baumannii | ampicillin/sulbactam-- 4 s cefepime-------------- 32 r ceftazidime----------- =>64 r ciprofloxacin--------- =>4 r gentamicin------------ =>16 r imipenem-------------- 8 i levofloxacin---------- =>8 r tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r . ruq u/s (): no biliary ductal dilatation. status post cholecystectomy. atrophic left lobe of the liver. . pelvis and right hip, three views(): explanted right hip prosthesis. irregular lucencies and new bone formation in the residual aspect of the proximal right femur could nonspecific but could reflect residual osteomyelitis. . ct abdomen and pelvis (): 1. no intra-abdominal fluid collections identified. 2. patent hepatic vasculature. 3. small nonobstructing left renal calculus. 4. air within the bladder. this is presumably secondary to recent foley catheterization. if not, this could be secondary to an infectious etiology. 5. fluid and calcific densities at the right femoral prosthesis removal site. foci of air along the right femoral diaphysis may be secondary to packing material. if there was no packing material placed at this location, this could represent an infectious process. evaluation for osteomyelitis is difficult given the extensive postoperative changes. . echo (): 1. the left atrium is mildly dilated. 2. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. 3. the aortic valve leaflets (3) are mildly thickened. 4. the mitral valve leaflets are mildly thickened. . ct head non-contrast () and : low attenuation involving the right frontal subcortical white matter, which probably represents microvascular ischemic disease. the presence of a small subacute infarct cannot be totally excluded. if the patient has any neurologic deficit, correlation with diffusion-weighted mri would be helpful. . eeg (): this is a mildly abnormal eeg in the primarly drowsy state due to the presence of generalized bursts of polymorphic delta. this abnormality suggests subcortical deep midline irritability, which, given the patient's age, would most likely be related to vascular disease. . mri/mra of brain (): impression: no evidence of acute infarction. probable chronic microvascular angiopathy. faint flow signal demonstrated within the distal right vertebral artery, which appears to have increased in caliber at the vertebrobasilar junction. these findings may be secondary to stenosis of the distal right vertebral artery versus a developmentally hypoplastic vertebral artery. if clinically indicated, further evaluation of the vertebral artery can be performed with a ct angiogram or mr angiogram of the neck. otherwise, normal mra of the circle of . . disharge labs: 06:03am blood wbc-11 rbc-2.82* hgb-8.3* hct-24.9* mcv-88 mch-29.4 mchc-33.3 rdw-15.9 plt ct-332 06:03am blood pt-13.6* ptt-29.2 inr(pt)-1.2* 06:03am blood glucose-91 urean-8 creat-0.7 na-131* k-4.4 cl-101 hco3-27* angap 7* 06:03am blood alt-43* ast-38 ldh 206 alkphos-163* totbili-0.5 06:03am blood calcium-7.8* phos-3.6 mg-1.9 12:28pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 12:28pm urine color-yellow appear-clear sp -1.011 brief hospital course: this is a 63 y.o. man with a history of cad s/p pci/stentx2 s/p elective r thr in complicated by wound infection s/p hardware removal in admitted with persistent wound infection with subsequent allergic drug rash, recent gnr bacteremia and with lab data concerning for dic. . 1 infected hip. s/p hardware removal and multiple debridements, most recently on . patient with persistent pain. past cultures grew mrsa. on this admission with swab cultures growing pan-sensitive e. coli. transient gnr bacteremia (1/4 bottles on grew e.coli) possibly from this source. surviellance cxs after showed no growth to date. we continued vac dressing in place and changed every 3 days by orthopedics, pain control with oxycodone, hydromorphone prn, abx coverage for infected hip with daptomycin 600mg iv q24h for past mrsa, which was discontinued after a total of 6 weeks course, and ciprofloxacin 400mg iv q12h switched to cipro 500mg po q12 hr on per id rec for e.coli bacterimia, and will be continued for a total of 6 weeks. we went back to the or on for i&d of the right hip and primary closure by orthopedics, and continued to be hemodynamically stable and afebrile after the procedure. . 2 coagulopathy/dic. low fibrinogen (dropped to 70s on ), low haptoglobin (<20), elevated d-dimer (elevated to 3800s on ), elevated t bili (peaked to 3.0 on ), elevated inr (peaked to 2.3 on while not on any anticoagulation) all consistent with dic. although pt's platelets remained >100,000s, some schistocytes seen on peripheral smear. hem/onc was consulted and recommended checking heiz body (negative) and g6pd level 6.5 (wnl), cryoprecipitate prn (he received a two units total) to keep fibrinogen>100, ffp prn for bleeding (pt didn't require any), vitamin k for elevated inr, and continued to monitor coags and dic labs which improved. . 3 e. coli bacteremia. initially presented with fever, but negative cxs; however blood cx 1/4 bottles on grew e. coli pan-sensitive, like from hip wound source (same organism). patient was started on ciprofloxacin 400mg iv q12h switched to cipro 500mg po q12 hr on per id rec for a total of 6 weeks (day1 ). surveillance cultures since then showed no grwoth to date. . 4 delirium - initially thought to be related to recent fevers, eosinophilic drug rash, but pt reported having some increased confusion and hallucination which was getting worse on and . head ct w/o contrast showed low attenuation involving the right frontal subcortical white matter, which probably represents microvascular ischemic disease, eeg which r/o seizures. neuro was consulted and recommended checking folate, vit b12, ammonia which are wnl; rpr nr; started thiamine 100mg/day prophylaxis given ho of etoh use, but unlikely, mri/mra brain with gadolinium showed no acute changes. his delirium improved since with improved po intake and correction of his hyponatremia (see below). . 5 lft abnormalities. pt's lft's were elevated without clear eitiology earlier on this admission. they were improving initially, and subsequently trending up again on in the setting of decreasing fibronogen, haptoglobin, increasing d-dimers and inr. liver disease may also explain low fibrinogen, low haptoglobin and elevated t. bili. unlikely concern for infarct. hep serologies negative, anti-smooth muscle ab positive (1:40). ?autoimmune hepatitis? negative, u/s () without signs of obstruction. we continued to monitor lfts, which continued to trend down with resolution of dic/coagulapathy . 6 rash with eosinophilia. rash developed with eosinophilia elevated as high as 40% around , most likely drug rash. dermatology was consulted who agreed with diagnosis of likely drug rash. he was treated symptomatically with benadryl, triamcinolone cream, and sarna lotion. avoided beta lactams and vanc and linezolid, all possible sources of prior eosinophilic reaction. his rash continued to improve and resolved during his hospital stay. . 7 ? uti (likely contamination from foley). urine cx on the grew actinobacter <100,000 organisms, resistent to cipro, and cefepime, sensitive to unasyn and augmentin, however ua on the same day was negative and patient had a foley in at the time; a repeat ua done on was obtained after foley was d/c'ed was negative; this is most likley contanmination from the foley; after discussion with id team, abx treatment was not necessary. patient will have a follow up ua and urine cx in a week at the rehab as a follow up; . 8 anemia. potentially related to dic or hemolysis. direct coombs negative x2, inconsistent with autoimmune hemolysis; g6pd wnl and body negative we ontinued to monitor his hct, which remained stable. . 9 iga deficiency. this was initially a concern for blood product reaction/hemolysis. significance unclear. pt is deficient, though iga is present. . 10 cad. stable. no acute issues. continued metoprolol 50mg po bid, which was increased to 75mg po bid on , increaed to 100mg po bid on , isosorbide mononitrate 60mg po qd with holding parameters; continued ramipril 5 mg po qday, which was increased to 10mg po qday for better bp control; we held aspirin 81mg po qd initially, after likely dic/coagulapathy, which was restarted on after resolution of his coagulapathy/dic; held home furosemide 20mg po qd given apparent volume depletion and poor po intake, and monitored his i/o very closely. . 11 hyponatremia - started on with na nadired to 128; urine lytes: creat:60; na:73; osmolal:539; urine na 73; differential diagnosis included appropriate vs inappropriate increase in adh vs hypothyroidism vs adrenal insufficiency; given patient has poor po intakes in the past three weeks, most likely increased adh (appropriately response to hypovolemia); we started him on some iv fluids, and his hyponatremia resolved. . 12 nutrition/fen - nutrition was consulted; patient reported having decreasing po intake despite encouragement from staff and family memebers, was initially started with ppn on x 3 days, after discussion with family, tube feeding was started on , but patient self-extubated the ng tube x 2. after discussion with family and nutritionist, carolie count was started on for three days, and showed improved po intake and nutrition intake. with patient's delirium resolving around , he was more willing to take po and boost supplements with much encouragement by staff and family. . 13 prophylaxis - enoxaparin 40mg sc q24h. - dolasetron 12.5mg iv q8h: prn - docusate 100mg po bid, senna 1 tab po bid - bisacodyl 10mg po/pr prn . 14 code status - dnr/dni, confirmed with patient and wife; medications on admission: diphenhydramine hcl 25-50 mg po q6h:prn celebrex 200 mg daily granisetron 1 mg iv q8-12hrs prn metoclopramide 10 mg iv q4-6 hrs prn nausea promethazine 12.5-25 mg po q6-8hrs prn nausea propoxyphene 100-200 mg po q4-6hrs prn morphine pca 2-4 mg q 6 min. 30 mg/4hr limit ramipril 5 mg po daily pantoprazole 40 mg po q24h metoprolol 50 mg po bid isosorbide mononitrate (extended release) 60 mg po daily furosemide 20 mg po daily atorvastatin 40 mg po daily discharge medications: 1. isosorbide mononitrate 60 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. lovenox 40 mg/0.4 ml syringe sig: one (1) injection subcutaneous once a day: continue until instructed to stop by your orthopedist. disp:*30 syringes* refills:*0* 5. percocet 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*80 tablet(s)* refills:*0* 6. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 4 weeks. disp:*56 tablet(s)* refills:*0* 7. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. ramipril 5 mg capsule sig: two (2) capsule po daily (daily). 9. metoprolol tartrate 50 mg tablet sig: two (2) tablet po bid (2 times a day). 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. oxycodone 10 mg tablet sustained release 12hr sig: three (3) tablet sustained release 12hr po q12h (every 12 hours). 13. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. discharge disposition: extended care facility: of - , nh discharge diagnosis: primary: 1. mrsa wound infection 2. type 4 hypersensitivity to vancomycin 3. e. coli bacteremia 4. delirium 5. right hip infection 6. questionable dic (with transaminitis, decreased fibronogen, and decreased haptoglobin, although platelets remained >50,000) 7. eosionophilia and drug rash . secondary: 1. cad 2. hypertension 3. hypercholesterolemia 4. osteoarthritis discharge condition: hemodynamically stable, afebrile, tolerating pos discharge instructions: please call your doctor or return to the hospital with increased pain, swelling, wound drainage, chest pain, shortness of breath, lightheadedness, fevers, chills, nausea, vomiting, abdominal pain, changes in your stools or urination, or any other concerns. . you were admitted for hip wound infection and subsequent e. coli bacteremia, you completed a 6 week course of iv daptomycin for your mrsa wound infection, you need to continue ciproflaxin 500mg by mouth twice a day for a total of 6 weeks (you were started on ). . you right hip infection was treated and healed nicely with vac dressing changes, you had an incision and drainage and primary closure of your right hip on . surgical staples can be removed on post op day 10 by the rehab doctors, and if you experience any fever, erythema, drainage, signs of infection around the right hip, dihiscience of the closure, please go the nearest er or call orthopedic clinic at . in addition, please follow up with dr. in the orthopedic clinic in 2 weeks for follow up your hip closure done on , and dr. in months after for discusion of future hip replacement at . . please take your medications as prescribed. . please follow up with your appointments see below. followup instructions: please follow up with your pcp . , on , at 9:30am . please follow up with dr. in the orthopedic clinic in 2 weeks by calling for primary hip closure follow up. . please follow up with dr. in months after for discusion of future hip replacement at . please follow up dr , md in the clinic phone: date/time: 9:00 procedure: venous catheterization, not elsewhere classified excisional debridement of wound, infection, or burn transfusion of packed cells local excision of lesion or tissue of bone, femur diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery other postoperative infection hyposmolality and/or hyponatremia defibrination syndrome bacteremia other specified disorders of biliary tract dermatitis due to drugs and medicines taken internally other specified antibiotics causing adverse effects in therapeutic use delirium due to conditions classified elsewhere hip joint replacement eosinophilia selective iga immunodeficiency 

Answer: The patient is high likely exposed to