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: nafcillin sodium attending: chief complaint: fever, chills, neck stiffness, and right-sided paraesthesias major surgical or invasive procedure: tee intubation angiogram () history of present illness: 52 y.o. m with history of recurrent mssa epidural abscesses, mitral valve endocarditis s/p valvular repair, and osteomyelitis who presented on with fever, chills, neck stiffness and right-sided parethesias after a mechanical fall. . the patient was previously admitted from with an epidural abscess. during that admission he was treated for mssa bactermia, complicated by epidural abcesses of the cervical, lumbar and thoracic spine, along with septic arthritis of right elbow and osteo of foot (foot osteo also + for pseudomonas)thought to be intial portal of mssa entry. during that hospitalization, he required multiple operative interventions by the orthopedic and podiatry services and was treated with cefepime. that hospitalization was also complicated by flail mitral cusp and worsening mitral regurgitation resulting in a mv annuloplasty. also with acute renal failure requiring cvvh through . . readmitted from with new afib and syncope; he was started on coumadin at this time though both have since been stopped. again admitted with mssa bacteremia/paraspinal abscess. he underwent debridement of the lumbosacral spine, excision and debridement of the abscess of the deep lumbar l4-l5, l5-s1 and was treated with cefazolin. antibiotics were completed on . . the patient reports that, since , he has been working with pt and has increased strength. he has continued to have lbp and, last month, was started on a fentanyl patch by his pcp. did not tolerate this (nausea, "fogginess") and stopped taking it the week prior to this presentation. . approximately 10 days prior to discharge he was walking up 3 stairs and fell onto his buttocks. since that time, he has had significantly worsened back pain. . two days prior to arrival he began to have chills and shakes (?rigors as well) with a temperature up to 101. also with decreased appetite. one day prior to admission, he began to have neck pain and stiffness (worse than baseline) and had trouble sleeping. he took three oxycodone. he continued to have chills and called his pcp on the day of admission. was seen in the office and referred to the ed. . in the ed, t 98.3 (up to 101.3), bp 102/57, hr 82, rr 18 and 99% on room air. he was given ceftriaxone 2g, vancomycin 1g, morphine and zofran. an mri of the c/t/l spine was done which showed multilevel abscesses, discitis with osteomyelitis, and cervical disc protrusion. an lp was not attempted given the extensiveness of findings on mr. . the patient was admitted to medicine for further management of his pain and the above findings on mri. past medical history: mitral valve endocarditis with mitral regurgitation - s/p mv annuloplasty sepsis/mssa bactermia, mv endocarditis urinary tract infection epidural abscess - s/p drainage right foot abscess with osteomylelitis - s/p drainage & debridement right elbow infection - s/p drainage acute renal insufficiency requiring hemodialysis, resolved type ii diabetes in the setting of acute illness gerd cervical spondylosis with chronic neck pain prior rotator cuff surgery prior right great toe surgery hypertension atrial fibrillation, resolved social history: born and raised in , ny. went to swarthmore college. married, has 2 children. lives in , ma. is a marketing director. drinks etoh occasionally, no smoking/illicit drug use. family history: mother with and gout. no family history of premature cad. physical exam: vitals: t=96.5 (tmax 100.3), bp=102/62, hr=92, rr=22 w/ 93%ra general: looks well/mildly uncomfortable and clearly minimizing head movements. no apparent respiratory distress. heent: pupils minimally reactive (2mm at baseline). no oral lesions or erythema. mildly dry mm. neck: limited rom with only degrees left and right turning; can almost put chin to chest and has difficulty tilting back w/ pain throughout motion. no jvd. cardiac: regular rate and rhythm. +s4 appreciated at the llsb. no murmurs or rubs. lung: ctab. no c/r/w abdomen: soft, nontender, nondistended. normoactive bowel sounds. ext: wwp. no edema. multiple bony nodules on feet. no oslers or lesions noted. no splinter hemmorhages seen. nontender erythema on r elbow surrounding previous surgical scar. neuro: cnii-xii intact. strength 5/5 in all four extremities. sensation intact though feels "different" on right arm/leg and torso w/ pt describing increased "irritation" w/ light touch extending from the r trapezius to the r foot and stopping at the midline. normal rectal tone found at nightfloat admission. patellar and brachial reflexes 1+ and equal. brudzinski and kernig were negative. back: multiple well healed surgical scars noted along spine. no spinal/perispinal tenderness to palpation or percussion. derm: echymosis just above sacrum. pertinent results: 11:55am sed rate-121* pt-14.2* ptt-28.9 inr(pt)-1.2* plt count-152 neuts-91.9* lymphs-5.7* monos-1.7* eos-0.6 basos-0.1 wbc-7.7 rbc-3.59* hgb-9.5* hct-27.8* mcv-77* mch-26.4*# mchc-34.2 rdw-15.6* crp-235.7* glucose-164* urea n-19 creat-1.3* sodium-133 potassium-3.9 chloride-99 total co2-23 anion gap-15 04:26pm urine granular-0-2 rbc-0-2 wbc-0-2 bacteria-many yeast-none epi-0-2 blood-mod nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-1 ph-5.0 leuk-neg color-yellow appear-clear sp -1.016 chest (pa & lat) study date of 12:53 pm findings: the lungs are clear bilaterally with no evidence of pneumonia or pulmonary edema. there are no pleural effusions or pneumothorax. the cardiomediastinal silhouette is within normal limits, stable. midline sternotomy wires appear intact. the osseous structures are intact. impression: no acute intrathoracic process. mr c/t/l-spine w & w/o contrast study date of 4:15 pm cervical: the cord demonstrates normal signal intensity. alignment is normal. the bone marrow signal intensity is unremarkable. c2/c3: there is a mild posterior disc bulge with thickening of the posterior longitudinal ligament causing deformity of the ventral thecal sac and mild central canal narrowing as well as minimal flattening of the ventral aspect of the cord. there is no significant neural foraminal narrowing. c3/c4: there is a large left paracentral disc protrusion with components migrating predominantly superior as well as a smaller component migrating inferiorly causing moderate-to-severe central canal narrowing at this level and flattening of the anterior left lateral aspect of the cord and displacement to the right. this associated with bilateral, left greater than right uncovertebral joint degenerative changes causes severe left neural foraminal and severe left subarticular narrowing and no right subarticular narrowing or neural foraminal stenosis. there is likely encroachment on the exiting c3 nerve root. no definite cord edema is observed at this level. c4/c5: disc osteophyte complex is noted with bilateral right greater than left foraminal components causing moderate-to-severe right and mild-to- moderate left neural foraminal narrowing. there is mild central canal narrowing at this level with associated flattening of the right anterolateral aspect of the cord. c5/c6: there is a minimal disc bulge and associated uncovertebral joint degenerative changes, more on the left than on the right causing moderate-to- severe left and mild-to-moderate right neural foraminal narrowing. c6-c7: unremarkable. there is no evidence for posterior disc bulge, central canal or neural foraminal narrowing. c7-t1: unremarkable. there is no evidence for posterior disc bulge, central canal or neural foraminal narrowing. the cervical changes are stable when compared to the prior examination. there is no evidence for abnormal enhancement within the cervical spinal, paraspinal region to suggest abscess. thoracic: alignment is normal. bone marrow demonstrates normal signal intensity. the cord demonstrates normal signal intensity. t1/t2 through t3/t4: unremarkable. there is no evidence for posterior disc bulge, central canal or neural foraminal narrowing. t4/t5: there is a left paracentral disc protrusion with a possible annular tear causing minimal indentation of the left anterolateral aspect of the cord. csf fluid remains surrounding the entire cord. there is mild-to-moderate subarticular narrowing at this level. there is no evidence for neural foraminal stenosis. t5/t6 through t8/t9: unremarkable. there is no evidence for posterior disc bulge, central canal or neural foraminal narrowing. t9/t10: there is asymmetric ligamentum flavum thickening, more on the right than on the left causing minimal deformity of the posterior thecal sac and no evidence for central canal or neural foraminal narrowing. t10/t11: there is a large asymmetric ligamentum flavum thickening much greater on the right than on the left causing deformity of the posterior thecal sac bilaterally and causing moderate central canal narrowing. this displaces the cord anteriorly but does not appear to cause any significant signal abnormality. this also causes mild-to-moderate right and left neural foraminal narrowing. there is no evidence for disc bulge. t11/t12, t12/l1: unremarkable. there is no evidence for posterior disc bulge, central canal or neural foraminal narrowing. there is a hemangioma vs. focal fat in the left aspect of the vertebral body. the paraspinal musculature and soft tissue surrounding are otherwise unremarkable. lumbar spine: alignment is unremarkable. there is t2/stir hyperintensity within the intervertebral disc space at the level of l5/s1 with hyperintensity within the adjacent l5 and s1 vertebral bodies. there is extension into the epidural space at the level of l5 and s1 more on the left than on the right. there is enhancement surrounding the left exiting s1 nerve root and left lateral aspect of the anterior and left lateral epidural space. there is enhancement within the superior endplate of s1 and posterior aspect of the l5/s1 intervertebral disc space. at the t12/l1 interspinous region midline there is a t2 hyperintense oval fluid collection which demonstrates rim enhancement on post-contrast images likely representing a small 9 mm interspinous fluid collection/abscess. this is new from the prior exam. at the right l2/l3 facet joint, there is a t2 hyperintense 7.9 mm fluid collection which demonstrates rim enhancement and extends anteriorly into the epidural space likely representing right l2/l3 septic facet joint with extension into the epidural space. there is enhancement within the posterior and right lateral epidural space at this region causing moderate central canal narrowing. at the level of l3/l4 right facet joint, there are multiple t2 hyperintense fluid collections which demonstrate faint rim enhancement suggesting right septic facet joint arthropathy with right posterior facet joint abscess. at the l3/l4 right paravertebral space, there is a 1.8 cm t2 hyperintense rim- enhancing fluid collection most consistent with abscess (se#17 image 10). this slightly decreased in size when compared to the prior examination. there is t2 hyperintensity at the right facet joint and posteriorly in the left facet joint of l4/l5 with subtle rim enhancement likely representing bilateral posterior l4/l5 paraspinal abscesses. t12/l1, l1/l2: there is no evidence for posterior disc bulge, central canal or neural foraminal narrowing. l2/l3: there is a posterior disc bulge with associated described findings of bilateral facet degenerative changes and right facet septic joint with extension into the epidural space causing moderate central canal narrowing and subarticular recess narrowing. there appears to be close abutment secondary to the subarticular recess narrowing of the descending l4 nerve roots more on the left than on the right. l3/l4: there is a posterior disc bulge with a midline protrusion and annular tear with associated ligamentum flavum thickening and facet joint findings as detailed above causing mild central canal narrowing and close abutment of the descending l5 nerve roots bilaterally. l4/l5: posterior disc bulge with central protrusion is seen as well as ligamentum flavum thickening and findings as detailed above causing mild central canal narrowing. no neural foraminal stenosis is identified. l5/s1: posterior disc bulge is seen with associated heterogeneous signal intensity and irregularity of the bilateral facet joints causing mild central canal narrowing at this level. there is also a large amount of enhancement in the bilateral left greater than right enhancement within the facet joints likely representing septic joint arthropathy. impression: 1. new t12/l1 t2 hyperintensity rim-enhancing focus concerning for new abscess at the t12-l1 interspinous region. otherwise, multilevel abscess and facet joint septic arthropathy as detailed above, with minimal decrease in size. 2. findings most consistent with l5-s1 discitis/osteomyelitis complex at the level of l5/s1 with extension into the epidural space as detailed above, new when compared to the prior exam. 4. stable thoracic and cervical degenerative changes as detailed above. ct c/a/p findings: ct chest: there are patchy opacifications in the right lung involving all three lobes, which might suggest pneumonia or asymmetric pulmonary edema. the left lung appears clear. the evaluation of the lung parenchyma is somewhat limited due to motion. there is no pleural effusion. the lymph nodes in the mediastinum are not significantly enlarged. there are no pathologically enlarged lymph nodes in the hila or axilla. ct abdomen: the liver, pancreas, large and small bowel, and adrenal glands are within normal limits. kidneys and ureters are within normal alignment. in the spleen, there is a new large hypodense area, somewhat wedge shaped, measuring 7 cm in the longest diameter, and concerning for a new splenic infarct. the old hypodense area in the spleen now appears smaller. spleen is enlarged, measuring 16 cm in longest diameter. there are multiple stones in the gallbladder with no evidence of diverticulitis. there is no free fluid, no free air. there are no pathologically enlarged mesenteric or retroperitoneal lymph nodes. ct pelvis: the bladder, sigmoid colon, rectum, and small bowel are within normal limits. there are no pathologically enlarged lymph nodes in the pelvis. there is no free fluid in the pelvis. osseous structures: at the level of l5-s1, there is endplate erosion, likely consistent with discitis/osteomyelitis complex noted on mri from . there is evidence of prior surgical multilevel laminectomy in the thoracolumbar spine. impression: 1. patchy opacities in the right lung, concerning for pneumonia or asymmetric pulmonary edema. 2. new large hypodense wedge-shaped area in the spleen, 7 cm, concerning for a new splenic infarct. previous hypodensities in the spleen now appear smaller. 3. gallstones, with no evidence of cholecystitis. 4. erosion of endplates at level l5-s1, likely consistent with the mri finding of discitis/ osteomyelitis. please refer to the mri report for more details. tte the left atrium is mildly dilated. the right atrium is moderately dilated. the estimated right atrial pressure is 0-5 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve leaflets are mildly thickened. a mitral valve annuloplasty ring is present. the gradients are higher than expected for this type of prosthesis. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: no vegetation identified. if clinically suggested, the absence of a vegetation by 2d echocardiography does not exclude endocarditis. tee no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal (lvef>55%). the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is evidence of posterior mitral leaflet repair. a mitral annuloplasty ring is seen, with slightly high-than-normal gradient (mean, 7 mmhg). a moderate sized mitral valve vegetation (1.0 x 0.5 cm) is seen, likely attaching to the anterior leaflet. the bulk of the vegetation is seen best on cine loop #78, with a small, fibrillar extension of the vegetation best demonstrated on cine loop #80. trivial mitral regurgitation is seen. there is no pericardial effusion. impression: moderate-sized mitral valve vegetation without significant mitral regurgitation. no abscess seen. cxr pa and lateral : interval improvement in previously seen pulmonary opacities. no consolidation is evident on the current exam. the finding likely represented pulmonary edema. mri head w/ and w/out contrast : findings: there are several t2-hyperintense rim-enhancing lesions in the bilateral centra semiovale and right cerebellum that demonstrate restricted diffusion of varying intensity and, therefore, ages, consistent with an ongoing embolic phenomenon. decreased signal on susceptibility sequence may represent microhemorrhage- related artifact versus vascular flow-void. given the superficial nature of the lesions and equivocal evidence of susceptibility artifact, mycotic aneurysm formation at sites of emboli should also be considered. specifically, there is an 8 mm round signal-void and uniformly enhancing structure in the right sylvian fissure, which may represent a mycotic aneurysm in a sylvian branch of that mca; however, a pre- existent vascular abnormality cannot be excluded. there is no evidence of acute large hemorrhage, edema, mass effect, or major vascular territory infarction. the ventricles and sulci are normal in size and configuration. impression: multiple enhancing lesions at the -white matter junction of the bilateral centra semiovale and right cerebellum demonstrating restricted diffusion of different ages, consistent with ongoing embolic phenomenon. given the location of these lesions and equivocal appearance of susceptibility artifact versus flow void, particularly evident in the right sylvian cistern, mycotic aneurysm formation should also be considered. mra brain : findings: there is evidence of vascular flow in both internal carotids as well as the vertebrobasilar system. there is no evidence of aneurysm or vascular malformation. the anterior, middle, and posterior cerebral arteries appear patent. there is no focal flow limiting stenosis, occlusion or aneurysm more than 3mm within the resolution of mra. impression: no focal flow limiting stensis, occlusion or aneurysm more than 3 mm within the resolution of mra. please note that mra is not the ideal examination in the evaluation of mycotic aneurysms, given the lack of resolution. pl. see the prior mr without and with iv contrast. carotid/cerebral angiogram : final read not yet available. per radiology report, there was no mycotic aneurysm seen. brief hospital course: 52 year old m w/ history of cervical radiculopathy, mssa bacteremia, mv endocarditis, and multiple infected musculoskeletal sites who presented with fever, neck stiffness and right-sided paresthesias and was found to again have mssa bacteremia, mv endocarditis, and new splenic and brain emboli. . # the patient grew mssa from an aerobic and anaerobic blood cultures obtained on . mri showed fluid collections around l4/5 similar to those seen last just prior to his last admission for his abscesses. given his neck symptoms and mild headache, he was treated with meningitis dosing of ctx and vancomycin in the ed without lp due to concern for tissue contamination. he was continued on vancomycin until sensitivities returned. . on , the patient was transferred to the micu respiratory distress. he was shortly thereafter found to have a new rll infiltrate. there was also concern for volume overload (which responded well to diuresis) and possible septic emboli. he was intubated and sedated temporarily for tee which showed mv vegetation. on he was started on gentamicin and cefazolin (nafcillin allergy). on , per id suggestion, the patient underwent nafcillin desensitization protocol after which he began nafcillin 2g iv q4. he continued on gentamicin. on , the patient was transferred to the general medical floor. he was started on rifampin and, within the next 36 hours developed a significant and progressively worsening hypersensitivity rash. it was unknown whether this was rifampin or nafcillin. as a result both were stopped and the patient was continued on gent with addition of vancomycin. . shortly after arrival to the floor, the patient underwent mri of his head given his initial neurological symptoms and endocarditis. mri showed multipple septic emboli with concern for mycotic aneurysm. ct surgery was consulted due to concern that patient was throwing ongoing emboli. given patients precarious state and recent initiation of antibiotics, neuro, id, and ct surgery consensus resulted in a conventional angiogram to further characterize possible mycotic aneurysm with likely plan for ct surgery after several weeks of antibiotics. preliminary angiogram result was negative for mycotic aneurysm. as a result, the patient was discharged with close id follow up on gentamicin for at least 2 weeks as well as vancomycin for at least 6 weeks with weekly labs to be faxed to dr , the patient's outpatient id doctor. ct surgery and neurology follow up were also arranged. . aside from initial cultures, multiple sets of surveillence blood cultures collected throughout his stay remained without growth. . #. neck pain, parasthesias. the patient has chronic pain with known severe cervial disc disease. his distribution of septic emboli do not correlate well with his parasthesias suggesting his neuro symptoms are largely cervical disc disease. pain meds were titrated to maintain comfort with oxytontin 30mg q8 and additional oxycodone coverage prn. the patient was fairly comfortable with this regimen. while neck discomfort continued, the patient denied ongoing parasthesias later in his hospital course. given severity of cervical disease and potential progressive cord compression, the patient may likely need spine surgery although, given his bacteremia, the patient will need to have follow up once his overall health is improved. he was counselled on the signs and symptoms of acute cord compression which, regardless of his other health concerns, would likely be an indication for urgent decompression. he was given a short course of pain meds at discharge and was encouraged to follow up with his pcp for ongoing pain management. . #. microcytic anemia. the patient's iron level was <40 and ferritin level was >1000 suggesting both iron deficiency anemia and anemia of chronic disease/inflammation. the patient's hct remained stable throughout despite significant phlebotomy, bilirubin was normal and he was guiac negative. given the absence of signs of end organ ischemia, the patient was monitored with daily hematocrits and was started on iron. he will have weekly cbcs over the next several weeks in clinic where his labs will be closely monitored. . #. hyperglycemia. slight elevation in fsbs. required minimal sliding scale coverage. outpatient follow up recommended if persists. . #. hypertension. well controlled with toprol. . #. gerd. well controlled with ppi. on the patient was discharged to home in good condition with an outlined plan for follow up care. medications on admission: 1. toprol xl 50mg daily 2. aspirin 81mg daily 3. protonix 40mg daily 4. naproxen 500mg tid prn discharge medications: 1. gentamicin in saline (iso-osm) 80 mg/50 ml piggyback sig: eighty (80) mg intravenous q12h (every 12 hours) for 2 weeks. disp:*qs mg* refills:*0* 2. vancomycin in normal saline 1 gram/250 ml solution sig: one (1) g intravenous every twelve (12) hours for 6 weeks. disp:*qs g* refills:*0* 3. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous once a day as needed for line flush for 6 weeks. disp:*qs ml(s)* refills:*2* 4. sodium chloride 0.9 % 0.9 % syringe sig: three (3) ml injection q8h (every 8 hours) as needed for line flush for 6 weeks. disp:*qs ml(s)* refills:*1* 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for 10 doses. disp:*10 tablet(s)* refills:*0* 7. oxycontin 30 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po twice a day for 2 weeks. disp:*28 tablet sustained release 12 hr(s)* refills:*0* 8. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 9. diphenhydramine hcl 25 mg capsule sig: one (1) capsule po q6h (every 6 hours) as needed for 5 days. disp:*20 capsule(s)* refills:*0* 10. promethazine 25 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for itching for 5 days. disp:*20 tablet(s)* refills:*0* 11. toprol xl 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 12. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 13. naproxen 500 mg tablet sig: one (1) tablet po three times a day as needed for pain. discharge disposition: home with service facility: critical care systems discharge diagnosis: methicillin sensitive staph aureus mitral valve endocarditis with septic emboli cervical spine disc protrusion discharge condition: good discharge instructions: you were admitted to the hospital because of your symptoms of fevers, chilles, and right sided parasthesias. you were found to have methicillin sensitive staph aureus bacteremia, mitral valve endocarditis and septic emboli to your brain. an angiogram was done due to concern for a mycotic aneurysm. the angiogram did not show a mycotic aneurysm. you were desensitized to nafcillin in the intensive care unit. you were continued on nafcillin and gentamycin. rifampin was also added. you developed a rash around the time both nafcillin and rifampin were added so they were both stopped. you will need at least 6 weeks of vancomycin and 2 weeks of gentamycin. you will need to follow closely with dr. with weekly lab work results to be faxed to his office. you will also need to follow up with ct surgery and neurology. your mri also showed a cervical disc protrusion which may account for your intitial parasthesias. you should see a spine surgeon after discussion with dr. when it may be safe to intervene and remove the disc if that is what you would like to do. if you develop worsening neurological symptoms --- tingling, numbness, loss of sensation or coordination --- please return to the emergency room. you were also found to be anemic. your iron levels were low and you were started on iron. your inflammatory markers were also elevated due to your infection which is likely contributing to your anemia as well. please return to the ed if you experience chest pain, shortness of , neurological symptoms as listed above which could be a result of your cervical disc or further septic emboli, high or persistent fevers, chills, or any other concerning symptoms. followup instructions: , md phone: date/time: 12:00 , md phone: date/time: 4:00 , md phone: date/time: 2:00 ( building, ) dr - echocardiogram at 11am on the of the building, . appointment with dr. at 1 pm in the . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube diagnoses: esophageal reflux congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified severe sepsis methicillin susceptible staphylococcus aureus septicemia displacement of cervical intervertebral disc without myelopathy iron deficiency anemia, unspecified dermatitis due to drugs and medicines taken internally acute and subacute bacterial endocarditis hypoxemia other disorders of neurohypophysis cervical spondylosis without myelopathy other diseases of spleen personal history of surgery to heart and great vessels, presenting hazards to health penicillins causing adverse effects in therapeutic use olecranon bursitis 

Answer: The patient is high likely exposed to