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: service: medicine history of present illness: mrs. is a 62-year-old female with a complicated medical history including sarcoidosis, hepatic cirrhosis, grade ii esophageal varices, hypertension, multiple orthopaedic procedures to her left hip, right hip and right knee, who presented with left thigh recently admitted to surgery for ventral hernia repair, which had caused an ileus and ascites, which required two - drains. these drains were recently removed. the patient developed abdominal pain and diarrhea soon after. the patient also developed left thigh pain. the patient reported that the pain worsened to the point where she was unable to weight bear. she denied any nausea, vomiting, chills, feeling cold, and lightheadedness. this prompted her to present to the emergency department. in the emergency department, the patient was found to be hypotensive, with blood pressure 80/palpation, the heart rate in the 160s. her white blood cell count was noted to be 30, with 26% bandemia, and the patient was found to also be in acute renal failure with a creatinine up to 3.0. she was also hyperkalemic, acidotic, with an anion gap of 14. per the emergency department record, the patient appeared to have received 1 gram of vancomycin, 100 mg of hydrocortisone, 10 units of regular insulin, 1 amp of dextrose, and 2 mg of intravenous dilaudid. she was transferred to the medical intensive care unit on the . on arrival to the medical intensive care unit, the patient was found to be lethargic, with pinpoint pupils secondary to dilaudid. an amp of narcan was given, with improvement of mental status. on review of systems, the patient complains of exquisite pain in her left thigh, with decreased range of motion of her knee. past medical history: 1. sarcoidosis diagnosed in , with pulmonary and hepatic involvement, on chronic steroids 2. status post ventral hernia repair on 3. history of cirrhosis diagnosed by ct in with grade ii varices 4. status post right total hip replacement and right total knee replacement 5. status post open reduction and internal fixation of her left hip 6. osteoporosis 7. hypertension 8. choledocholithiasis 9. hypercholesterolemia 10. aortic stenosis with ejection fraction of 55% 11. status post total abdominal hysterectomy and bilateral salpingo-oophorectomy medications on admission: lasix 20 mg by mouth once daily, aldactone 15 mg twice a day, actigall 300 mg three times a day, protonix 40 mg by mouth once daily, prednisone 10 mg by mouth twice a day, aleve 220 mg by mouth twice a day. social history: the patient is divorced. she lives with her daughter. physical examination: on arrival to the medical intensive care unit, the patient's temperature was 99.2, blood pressure 120/84, heart rate 117, respiratory rate 12, oxygen saturation 96% on room air, and her weight was 70 kg. general examination revealed a lethargic patient, who became alert and oriented x 3 after narcan administration. she was not in any acute distress. head, eyes, ears, nose and throat examination revealed cataracts, normal mucous membranes. pupils went from 1 mm to 3 mm after narcan administration. neck examination revealed no jugular venous distention. cardiovascular examination revealed that the patient was tachycardic, with normal s1 and s2, and iii/vi systolic ejection murmur at right upper sternal border. this murmur radiates to the carotids and apex. she had no s3 and no s4. lung examination revealed lungs clear to auscultation bilaterally, with no wheezes or crackles. abdominal examination revealed a soft abdomen with decreased bowel sounds. the patient had a well-healed surgical scar with a scab in the subumbilical abdominal area. the patient was mildly tender on palpation of the middle of her abdomen. extremity examination revealed trace bilateral lower extremity edema, tenderness and warmth along her left lateral thigh. there was no induration or erythema. neurologic examination: the patient was able to move all of her toes and her ankles. she was unable to bend her left knee to full flexion secondary to pain. she was otherwise alert and oriented x 3. laboratory data: on admission, hematocrit 41.2, white count 29, and platelet count of 367. her serum chemistry revealed a sodium of 137, potassium 4.9, chloride 107, bicarbonate 16, bun 83, creatinine 2.9, glucose 78. anion gap was 14. on her initial blood work, her white count differential revealed 69% neutrophils and 26% bands. coagulation studies revealed an inr of 1.4. her esr was 87. liver studies revealed an alt of 9, ast of 30, total bilirubin of 2.9, ck of 20, calcium of 8.2, magnesium of 2.1, and phosphate of 5.6. her electrocardiogram revealed sinus tachycardia. her chest x-ray revealed no effusion, no pneumonia, and no pneumothorax. there was minimal increased interstitial opacity, questionable atelectasis, in the lower lung bases. her ultrasound of her left thigh revealed a small fluid collection in the left lateral thigh. hospital course: after being found hypotensive with hyperkalemia, the patient was treated with intravenous fluids and insulin and d-50, as well as hydrocortisone for stress dose steroids. the patient's left thigh was evaluated by ultrasound, which showed a fluid collection suspicious for an abscess. this fluid collection was aspirated by orthopaedic consultation team. the patient received a total of 12 liters of normal saline within 24 hours' time prior to producing any urine output. the patient was also started empirically on clindamycin for antibiotic coverage. surgery was consulted to evaluate the possibility of fasciitis in her left thigh. they recommended ultrasound-guided tap aspirate of the left thigh fluid collection, which on gram stain showed 4+ polymorhoneucleocytes. the patient's hypotension resolved with aggressive intravenous fluid hydration and a brief course of pressors. her acute renal failure also appeared to improve after she was aggressively hydrated. the nephrolog was consulted. her hyperkalemia began to resolved after insulin and d-50 treatments. the patient's initial tachycardia on admission resolved after intravenous fluid hydration. in terms of the patient's leukocytosis, the suspicion was that this is a reaction to the abscess in her left thigh. an mri of her left thigh was obtained on . on this mri, the patient was found to have a discrete fluid collection in the subcutaneous tissue of the anterior abdominal wall measuring 16 x 20 x 3 cm. it extends from above the umbilicus to the pubic symphysis, and is predominantly on the left side of the abdomen. the source of this fluid was not entirely clear on this mri. orthopedics thought this unlikely to involve her hip prosthesis. the patient was also found to have extensive subcutaneous edema and small fluid collections in her left thigh. she was found to not have any significant fluid within her left hip joint. at this time, the patient was on clindamycin and vancomycin as her antibiotic coverage. the patient also received a right internal jugular centrally-placed catheter on , for access. on this date, the patient had continual hypotension requiring aggressive fluid hydration, and also low-dose dopamine to be added via her central catheter. her blood culture on this date was found to have staphylococcus bacteremia. she underwent a transthoracic echocardiogram, which did not show any vegetations. on this date, the initial fluid aspirate from her left thigh also grew out coagulase positive staphylococcus aureus. the patient's hypotension was improved and was able to be weaned off dopamine on . on this date, she was also started on fluconazole for yeast in her urine. infectious diseases was consulted on . they recommended tapping of the patient's abdominal fluid collection, which was found on the mri study of her left thigh and abdomen. however, at the same time, the surgical consultants felt strongly that this fluid should not be tapped due to potential for infecting it, and a potential connection with the patient's abdominal cavity, especially in the setting of known ascites. this fluid collection therefore was not tapped on this date. the patient continued to improve. on , the patient was no longer requiring pressor support, and her creatinine had decreased to 2.0. she was no longer febrile. the patient's final cultures came back as methicillin-sensitive staphylococcus aureus in her blood obtained on . she also grew methicillin-sensitive staphylococcus aureus at the aspirate of one fluid collection in her left thigh. in the same culture, she also grew some bacillus species. on , the patient was found to have a positive urine culture growing klebsiella pneumoniae. she was started on levofloxacin by mouth for this infection. her foley catheter was removed on this date. she was also started on prednisone for her sarcoidosis. by this time, the patient's white blood cell count had decreased to 19.4. her serum creatinine had decreased to 1.9. as the patient has had stable blood pressure up until now, and has had peripheral edema due to saline resuscitation, the patient received a low-dose diuretic, and her urine output increased. on the early morning of , the patient was called out of the intensive care unit and transferred to the floor. by this time, her serum creatinine was down at 1.4. her blood pressure has been stable. she is no longer tachycardic. her methicillin-sensitive staphylococcus aureus bacteremia and left thigh abscess have been treated by continuing dosages of vancomycin, and the left thigh aspiration. her left thigh pain was much improved at this time, with no requirement of narcotics for pain control. after arrival to the floor, the patient received a picc line placement in the morning of . her right internal jugular vein central catheter was therefore removed. the patient was continued on her levofloxacin and vancomycin. the plan at this time was to further treat the patient's infections, stabilize her, diurese her, and have physiotherapist screen her, with eventual plans to discharge her to a rehabilitation center. with regards to the patient's methicillin-sensitive staphylococcus aureus bacteremia, the patient was determined to be too high risk to receive a transesophageal echocardiogram for further evaluation of her valves. this is because she has known grade ii varices in her esophagus. after much discussion with the infectious disease team and the patient's primary doctor, dr. , it was determined that the patient should be treated for a total course of eight weeks with vancomycin. this is because she is thought to be high risk for seeding her known stenosed aortic valve. the patient did very well on the floor between and 29. she was diuresed with initially 20 mg of lasix by mouth, with minimal effects. she received intravenous lasix after that, with better responses. the patient was still generally edematous, especially in her legs. she had not been able to ambulate because of her gross lower extremity edema. her renal failure was completely resolved by this time. her baseline creatinine of 0.7 was reached on . her white blood cell count was also noted to be decreasing. into the morning of , the patient was noted to be tachycardic up to 118 to 120s. this was thought to be from intravascular volume depletion due to aggressive diuresis. the patient received a trial of 250 cc of saline bolus, and her heart rate decreased from 120 to 108. this was thought to be a positive test result for her intravascular volume status. her lasix was therefore discontinued. by the next morning, the patient's tachycardia had resolved, and her heart rate ranged between 80s to 100s. however, on the same day, the patient noted new onset left thigh tenderness. this was concerning for reaccumulation of fluids or reappearance of her left thigh abscess. the patient was afebrile on this date. given the concerning symptoms, another ultrasound of her left lower extremity was obtained. on this ultrasound, the patient was again found to have hypoechoic fluid collection tracking along her left lateral thigh. this collection measures 3.2 cm in the largest ap diameter, and was thought to be more than 10 cm in length. after discussion with surgery and orthopaedics, it was determined that this fluid collection needed to be drained, with the placement of a pigtail catheter. this was done on the morning of , without complications. the patient had purulent fluids drained from her left thigh fluid collection. this fluid was sent for cell count and culture. the patient also received a chest x-ray on this date for crackles noted on physical examination. on the chest x-ray, the patient had no evidence of pneumonia. the patient was thought to have low-grade atelectasis, and was encouraged to take deeper breaths in. the patient has been using an incentive spirometer ever since admission to the intensive care unit. on the morning of , the patient experienced an episode of spontaneous drainage of most likely the subcutaneous fluid collection seen on mri in her abdomen. per patient's report, she stood up to go to the commode, and all of a sudden she felt gushing fluid coming from her abdomen. the scab in her subumbilical region apparently lifted and clear fluid drained out in copious amounts. the scab was later on covered with dry dressing. the patient did require frequent dressing change, and had persistent leakage of clear-looking fluid from this site. the surgery service was notified of this event. they recommended dry dressings frequently. they were not concerned that this fluid could be infected fluid. due to the physical characteristics of the fluid drained from the patient's left thigh fluid collection, she was started on levofloxacin by mouth for broadening antibiotic coverage until this fluid culture returns. the concern here is multiorganism infection which was not covered by vancomycin. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances incision of abdominal wall excisional debridement of wound, infection, or burn other incision with drainage of skin and subcutaneous tissue diagnoses: acidosis other postoperative infection urinary tract infection, site not specified acute kidney failure, unspecified mitral valve insufficiency and aortic valve insufficiency methicillin susceptible staphylococcus aureus septicemia pulmonary collapse cellulitis and abscess of leg, except foot seroma complicating a procedure 

Answer: The patient is high likely exposed to