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: patient recorded as having no known allergies to drugs attending: chief complaint: fevers major surgical or invasive procedure: left shoulder wash out and debridement- and right sternoclavicular joint excision- and vac placement to sternal wound- bronchoscopy- tee- chest tube for pneumothorax- - lumbar puncture- intubation for airway protection- femoral central line for intravenous access picc line placement for long term antibiotic therapy- history of present illness: 61 yo with hx of htn, etoh abuse presents with 2 months of fevers to 104, weight loss and left shoulder pain. has had 1-2 weeks of drenching night sweats. had 30# wt loss over last year- thinks most wt loss came after he quit drinking . no ha/visual changes/gu-gi sx/cough/voice changes/dysphagia/odynophagia. no travel/stds/rash. tagged wbc scan showed increased uptake in left shoulder, right sternoclavicular joint and thoracic vert. the scan was obtained as outpt as part of workup of patient's fevers (up to 104 at home) nightsweats and 30# weight loss over past 2 months. previously all studies obtained, including tte were negative except for esr noted to be 130. in ed rec'd unasyn 3gm, 1 gm tylenol and shoulder was tapped. past medical history: pmh: htn etoh abuse quit hypercholesterolemia pancreatitis depression epistaxis with recent cauterization social history: sh: employed, no smoking, etoh abuse-quit one mo ago, no hx of dts, no ivdu, married 11 years, monogamous, denies hiv risk factors, 28 yo son family history: fh: mother died 92 from emphysema; father died of "old age" 82 physical exam: pe on admission: vs 99.7 107-125 133/86 24 95% ra nl wt 172 now 145 gen a&ox 3, pleasant nad perrla, eomi, o/p clear, + temporal wasting neck supple from right sternal mass no tracheal deviation cv tachy rr without mrg lungs ctab abd scaphoid no splenomegaly no occipital,axillary, auricular, epitrochlear lad shoulder erythema, hot, indurated, pain with active/passive mvmt, decreased rom ext atrophic, fine resting tremor no c/c/e pertinent results: 07:00pm ret aut-2.8 07:00pm sed rate-130* 07:00pm pt-13.4 ptt-29.5 inr(pt)-1.1 07:00pm plt count-360# 07:00pm neuts-76.1* lymphs-17.6* monos-5.6 eos-0.5 basos-0.3 07:00pm wbc-8.8# rbc-3.51* hgb-10.5* hct-32.3* mcv-92# mch-29.9# mchc-32.4 rdw-17.0* 07:00pm crp-12.56* 07:00pm tsh-3.0 07:00pm caltibc-259* vit b12-410 folate-16.2 ferritin-179 trf-199* 07:00pm albumin-2.9* uric acid-2.9* iron-18* 07:00pm alt(sgpt)-36 ast(sgot)-70* ld(ldh)-219 alk phos-148* amylase-15 tot bili-0.6 07:00pm glucose-95 urea n-15 creat-0.6 sodium-133 potassium-4.2 chloride-97 total co2-27 anion gap-13 07:06pm lactate-1.1 10:22pm joint fluid wbc-* rbc-* polys-97* lymphs-0 monos-0 macrophag-3 03:13pm blood esr-115* 04:00am blood hapto-298* 03:45am blood crp-6.50* lt shoulder joint tap: wbc 130,500 97% polys mri chest/mediastinum w/o & w/contrast 8:29 am impression: in the absence of a clinical history, these findings could be seen in the setting of rheumatoid inflammatory polyarthropathy. given the laboratory results from recent left shoulder aspiration, the findings are consistent with an infectious process. changes involving the right sternoclavicular joint are accute and represent an active inflammatory arthropathy. considerations again include rhematoid and infection. the changes anterior to the right sternoclavicular joint appear chronic given the presence of a tiny calcification within the subcutaneous tissue (seen on ct) and these may be due to an old trauma or chronic infection. the study and the report were reviewed by the staff radiologist. abd ct 150cc nonionic contrast 5:51 pm impression: 1) postoperative changes... 2) fluid identified external to the left glenohumeral joint. 3) small-to-moderate bilateral pleural effusions, right greater than left, with associated atelectatic changes. 4) tiny right basilar pneumothorax. 5) no evidence of disseminated infection. the study and the report were reviewed by the staff radiologist. mra brain w/o contrast 5:37 am impression: normal mr angiography of the circle of . the study addresses major vessels in that medium and small vessels where you expect vasculitis to be found. the study and the report were reviewed by the staff radiologist. tee : conclusions: the left atrium is normal in size. no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque. there aortic valve leaflets (3) are thin/mobile. no masses or vegetations are seen on the aortic valve. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mass or vegetation is seen on the mitral valve. no mitral regurgitation is seen. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. impression: trace aortic regurgitation with normal valve morphology. no 2d echo evidence of endocarditis mri spine 1.degenerative disc disease of the cervical, thoracic and lumbar spine, as described, most notably at l4-5, where there is fairly severe canal stenosis. 2. abnormality at t7-8 attributable to discitis and osteomyelitis with epidural involvement. no clear evidence of an epidural abscess. note is made of bilateral pleural effusions and multiple renal lesions, most likely representing cysts. cxr : impression: small residual right apical pneumothorax post-chest tube removal. otherwise, unchanged appearance of right-greater-than-left effusion and lower lobe atelectasis. brief hospital course: assessment: 61 yo male with pmh etoh, pancreatitis, hypercholesterolemia who presented with fevers/ns/weight loss and left shoulder pain/sternal mass and found to have a left septic shoulder, manubrium/rt sternoclavicular joint osteomyelitis, t7-8 thoracic spine diskitis/osteo. of note, patient has had multiple negative blood cultures, negative tee, & negative lp. hospital course: patient was admitted to medicine. shoulder joint aspiration revealed > 100,000 wbc/97% polys, no microorganisms. he was initially started on unasyn and taken to or for debridement by orthopeadics (dr. . thoracics (dr. became involved when pre-op mri demonstrated infectious collection around r sternoclavicular joint. manubrium and right 1st rib were removed and vac device was placed. post- op complicated by a right pneumothorax requiring chest tube placement which was removed on . he also had a persistent right pleural effusion s/p surgery which remained stable. post-op course was also complicated by significant delirium accompanied by hallucinations, elevated bps, and agitation. in light of his etoh abuse, he was diagnosed with delirium tremens and transferred to the micu for 2 days and started on benzos. he was electively intubation for airway protection. he returned to or on for repeat debridement of both shoulder and sternum for continued fevers. his sternal debridement from grew coag neg staph and group b strep and he was started on vanco, gent and ampicillin for presumed endocarditis. his left shoulder culture was initially negative. gent was d/ced on and ampicillin was changed to pcn (-cidal) on . from then, he was continue on vanco (for coag neg staph) and iv penicillin (for gbs). the sensitivities from the sternal debridment revealed the coag neg staph was resistant to erythromycin & pcn and sensitive to oxacillin, levo and gent. the gbs was sensitive to both pcn and erythromycin. he also had a coag negative staph species seen from culture of left shoulder which was ox/pcn resistant and sensitive to vanco. this however was thought to be a contaminent and not the causative organism. id following looked for endocarditis as source- tte and tee done here both negative for vegetations. also looked for other areas of infection due to fevers: mra-brain negative, lp negative, bronchoscopy negative, abdominal ct scan also done, no other abcesses, lesions in kidneys thought to be cysts. mri spine demonstrated diskitis and osteomyelitis in thoracic spine (t7/t8)- orthospine consulted and recommended prolonged antibiotic treamtent. no epidural abscess was seen. patient improved on iv antibiotics. esr and crp greatly diminished prior to discharge. (esr from 125 peak on , down to 42 on and crp peak on , down to 1.8 on ). he did have a fever on , but blood and urine cultures were negative. stage 1 decub ulcer stable. urine/serum eos negative (r/o drug fever). he was clinically improved and afebrile x 48 hours by time of discharge. of note, day 1 of antibiotic treatment = pod 1 = . he was changed to iv oxacillin 2 gm q4 hours (from iv vanco/iv pcn) on day of discharge. baseline lfts were alt 26, ast 50, alk phos 117, tuberculosis 0.2. weekly lfts, cbc, bun/cr should be faxed to dr. (fax ; phone ). he will follow up with all surgeons/consults (ortho- dr. , thoracics- dr. , and spine ortho- dr. and follow up in clinic with dr. on . he should continue iv antibiotics for at least 6 weeks (6 weeks= ) and id will decide if a longer course is required. he will need repeat mri of the spine in about 2 months (first week of ) and will see dr. for follow up appointment. the source of his multiple infections was not found, but hematogenous spread is clearly the case. his tee was negative and interestingly multiple blood cultures were negative as well. 2. delerium/dts- initally, he was placed on ciwa scale with prn ativan. as noted above, post-op patient much more confused, visual hallucinations, concerning for dts and was transferred to micu for intubation/sedation in order to obtain mri brain/spine and lp. to recap, the brain mri was negative, spine with osteo as above, lp without meningitis. he was still delerious until and were holding benzos and narcotics due to mental status; neuro consulted by micu team for further evaluation, however, mental status markedly clear on , and was likely thought to be to benzos/sedating meds in micu. 3. ptx.- apical right sided s/p chest tube placement. also had rij injury intraop. rue performed and negative for damage to vascular structures. ct removed . pulmonary function stable. 5. htn- no meds as outpatient or currently. hypertension on floor was c/w likely dts. 6. hyperlipidemia- holding pravachol 7. anemia- consistent with anemia of chronic disease (fe 18, tibc 259, ferritin 179, b12 410 and folate 16). had recent colonscopy in which was essentially negative. guiac negative. 8. renal- cr did increase to 1.2 on day of discharge from 0.4-0.5 on admission. his baseline is closer to (0.7-0.9). fena was < 1% and he was hydrated with 1 liter ivf. he was taking good pos by day of discharge. urine eos negative. sediment bland. renal function will need to followed at rehab. 9. depression- celexa was held during stay. would recommended restarting it on discharge at 1/2 dose- 20 mg qd and increasing to 40 mg qd in one week. 10. code- full 11. communication- with wife 12. access- he currently has picc line in right anticub which is day 7 today. 13. dispo- he was discharged to on . phone: . medications on admission: pravachol 20 qd humabid prn celexa 40 qd mvi cipro 250 mg discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 3. multivitamin capsule sig: one (1) cap po daily (daily). 4. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day) as needed. 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 8. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 9. oxacillin sodium 2 g recon soln sig: one (1) injection intravenous every four (4) hours. 10. celexa 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: left septic shoulder osteomyelitis of right sternoclavicular joint and manubrium thoracic osteomyelitis/diskitis- t7/t8 right pleural effusion (post-op) right apical pneumothorax s/p chest tube etoh withdrawal/delerium tremens anemia of chronic disease hyperlipidemia discharge condition: fair. he is medically stable for discharge to rehab facility. discharge instructions: 1. please remove sutures in left shoulder on . 2. please check weekly esr/crp, cbc with differential, bun/cr, lfts starting . these tests can also be done more frequently if clinically indicated. please fax results to dr. (fax ; phone ). 3. if patient spikes, please obtain blood cultures x2, urine culture, and repeat cxr. 4. vac dressing needs to be changed on mondays and thursdays. 5. please continue oxacillin for at least 6 weeks. infectious disease physician will determine if longer treatment is necessary. followup instructions: provider: , md where: orthopedics phone: date/time: 2:00 provider: , multispecialty multi-specialty thoracic unit-cc9 where: clinical ctr. - 9th fl. multi date/time: 10:30 provider: , md where: lm disease phone: date/time: 9:30 dr. , your primary care physician, contact you to arrange a follow up visit. dr. - - at 11 am at . will need repeat mri of the spine the first week of (2 month follow up). procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified spinal tap incision of lung diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus suture of vein other excision of joint, other specified sites transfusion of packed cells other irrigation of wound other immobilization, pressure, and attention to wound other immobilization, pressure, and attention to wound arthroscopy, shoulder other local excision or destruction of lesion of joint, shoulder other local excision or destruction of lesion of joint, other specified sites diagnoses: anemia of other chronic disease unspecified pleural effusion unspecified osteomyelitis, other specified sites accidental puncture or laceration during a procedure, not elsewhere classified other and unspecified hyperlipidemia iatrogenic pneumothorax drug-induced delirium other and unspecified disc disorder, thoracic region alcohol withdrawal delirium pyogenic arthritis, shoulder region complete rupture of rotator cuff 

Answer: The patient is high likely exposed to