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: darvon attending: chief complaint: back pain and hip pain major surgical or invasive procedure: left knee washout laminectomy history of present illness: this is a 62 year old female with a history of multiple psychiatric disorders, alcohol abuse, multiple falls, s/p vp shunt placement in for subdural hematoma and left hip replacement in who presents from house s/p fall on with worsening left hip pain. she was taken to nebh for evaluation after her fall on . at that time she was complaining of left hip pain and was noted to have bruising over her surgical incision site. per notes she had a ct scan of her left hip which was negative and was diagnosed with trochenteric bursitis and was sent home with vicodin and physical therapy. per notes when she returned from this hospital stay she was confronted about her alcohol use and instructed to throw away any alcohol in her room. since that time she has been complaining of worsening left hip pain despite treatment with vicodin. she has also been noted to be more lethargic by staff. she was sent here out of concern that she could be withdrawing from alcohol. on my interview she reports that since her fall she has been having worsening left hip pain as well as back pain. this has been preventing her from walking. the back pain is diffuse and not well localized. she does endorse mild pain with movement of her neck but no photophobia or headaches. she also endorses pain with deep inspiration. she denies fevers but endorses chills. she denies cough or congestion. she has chest pain only with deep inspiration and no frank shortness of breath. no nausea, vomiting, diarrhea. she does have chronic constipation. she has mild diffuse abdominal pain. she denies dysuria or hematuria. she endorses mild decreased urine output. no bowel or bladder incontinence. she has chronic left leg weakness which she does not think is worse than her baseline. she has mild numbness in her left foot which is also unchanged. . in the ed, initial vs were: t: 96.8 p: 77 bp: 82/45 r 18 o2 sat 95% on ra. she received two liters of normal saline with improvement in her blood pressure as well as morphine for pain. ekg showed normal sinys rhythm, normal axis, normal intervals, diffuse tw flattening, no priors for comparison. she had a cxr which showed no focal infiltrates. ct head showed stable hydrocephalus. her labs were notable for a leukocytosis with left shift and bandemia, acute renal failure, hyponatremia, hypokalemia, thrombocytopenia and anemia. toxicology screen was positive only for opiates. she was admitted to the floor for further management. . on the floor she continues to complain of left hip pain and diffuse back pain and pleuritic chest pain. she is very difficult to engage and cries throughout the interview and asks for pain medications. past medical history: past medical history: depression anxiety obsessive compusive disorder with hoarding tendencies anxiety alcohol abuse history of bulemia hepatitis c contracted from a blood transfusion hypertension hip fracture s/p orif at left knee meniscus repair in at vp shunt placed for hydrocephalus that developed after a fall in with subdural hematoma h/o hemolytic uremic syndrome h/o seizure (at time of hus), none since chronic numbness l leg and mild weakness l leg and l arm since her fall in chronic constipation left hip replacement at social history: social history: patient currently lives at house. she has two sons but she has no contact with them. she has a limited relationship with her husband who sends alimony support. she denies ever using illicit drug use. she previously worked as a bank teller. she denies a history of smoking. she has a history of heavy alcohol use per notes although she denies this on my interview. drink of choice is wine. family history: father has hypertension and stroke. mother has rheumatoid arthritis. sibling is healthy. physical exam: physical exam: (at 7:30 am on ) vitals: 97.0 bp 106/67 p 98 rr 18 o2 sat 95% ra general: aox3, tearful throughout exam but easily calmable and redirectable. somewhat lethargic but appropriate, interactive heent: sclera anicteric, mmm, dentures removed with no remaining teeth, no clear mouth lesions neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, iii/vi sem at lusb, no rubs or gallops abdomen: soft, mildly tender in ruq, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley draining clear yellow urine ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. l trochanteric bursa notable for ttp, light pink area of blanching erythema and edema extending from trochanteric bursa extending towards l glutteal muscle. r hip w/ no erythema or fullness. nails are dirty. she has no lesions or osler nodes. back: tenderness to palptation over entire spine and paraspinal muscles. most prominent along spinous processes, but very tender throughout. does have mild tenderness when moving neck but is able to move in all directions with full range of motion neurologic: cn ii-xii tested and intact, strength 5/5 in upper extremities, in right lower extremity, in left lower extremity but limited due to pain. l upper extremity with limited range of motion due to pain, unable to lift shoulder above 90 degrees on active motion, and passive motion limited due to pain. sensation intact to light touch throughout. reflexes 2+ and symmetric.gait not tested. no saddle anesthesia. pertinent results: on admission: 04:18pm blood wbc-13.1*# rbc-2.90* hgb-9.2* hct-27.2* mcv-94 mch-31.6 mchc-33.6 rdw-14.9 plt ct-124* 04:18pm blood neuts-82* bands-8* lymphs-2* monos-6 eos-0 baso-0 atyps-0 metas-2* myelos-0 04:18pm blood plt smr-low plt ct-124* 06:33pm blood pt-13.9* ptt-26.5 inr(pt)-1.2* 06:33pm blood fibrino-665* 05:45am blood esr-60* 04:18pm blood glucose-133* urean-40* creat-1.5* na-121* k-3.0* cl-88* hco3-22 angap-14 04:18pm blood alt-26 ast-36 ld(ldh)-189 ck(cpk)-14* alkphos-64 totbili-0.9 04:18pm blood albumin-2.9* calcium-8.7 phos-1.7* mg-1.9 iron-8* 05:45am blood crp-218.7* brief hospital course: 1. mssa bacteremia: was complicated by abscesses at t1-t2, l3-l4, septic left hip and septic left knee. underwent the following procedures given multiple abscesses on the following dates: a. washout, left knee, with anterior synovectomy. b. revision, left knee, one component. c. bilateral laminectomies, c7, t1, and upper t2. d. bilateral laminectomies, l3, l4, l5, and s1. e. washout, left hip, with revision of acetabular component. . she was also started on iv nafcillin, however she developed persistent fevers, rash across her sternum and renal failure which raised concern for ain. she had received about 3 weeks of nafcillin before it was changed to iv vancomycin given the above concerns. she should continue iv vancomycin until to complete the six week course of antibiotics. surveillance cultures were drawn following initiation of antibiotics and these were negative; she was also afebrile after the above procedures were complete. she will need weekly safety labs (cbc, chem 7) faxed to the infectious disease department (see discharge instructions). she has follow up appointments set up with id, orthopedics, and neurosurgery given the above procedures. . 2. acute renal failure: likely secondary to ain following initation of nafcillin. creatinine rose from baseline near 1 to 1.9 with development of fever and rash across sternum 10 days after initiation of nafcillin. differential includes atn secondary to hypotension perioperatively. have attained new baseline of 1.7 or could be slowly resolving. received fluids perioperatively and has led to volume overload grossly (especially noted in upper extremities, lower extremities, abdomen). diuresis has been cautious given renal function, although in general she auto-diureses. despite these attempts, she continues to be overloaded and attempts at further diuresis with monitoring of renal function are encouraged when she is at rehab. she did not have any difficulty with pulmonary edema during the hospitalization and saturated well on room air. chest x-ray did not show any evidence of volume overload. continued monitoring of renal function is encouraged. . 3. anemia: hct has been relatively stable but occasionally dropped and was thought to be secondary to hematoma along left hip s/p left hip washout. she remained guiaic negative. other contributing factors included blood loss perioperatively, bome marrow suppression in setting of sepsis, and anemia of chronic disease. around time of discharge, her hematoma appeared to be stable and she was hemodynamically stable. hct at time of discharge was stable at 24. orthopedics were called to evaluate and they did not feel it was expanding. orthopedics will follow up this area after 1 month. we set a transfusion goal at 21. rapid hct drops should be evaluated and would require repeat imaging. . 4. alcohol abuse: she had no s/sxs of alcohol withdrawal. she was continued on her home thiamine, folate, multivitamins. sw was consulted. they felt that she occasionally felt depressed secondary to her prolonged hospitalization and that her drinking was likely related to masking underlying symptoms of depression. following their assessment, they found that ms found talking to a chaplain regularly quite useful and they recommended regular chaplain visits following discharge to rehab facility. . 5. depression/anxiety/ocd: she was continued on her fluoxetine and mirtazapine. megace was initiated for poor po intake; following initiation of megace, her appetite improved. psychiatry was consulted just prior to discharge for obra form and during assessment they felt that she was not depressed and had likely underlying alcohol abuse as well as an element of cognitive impairment secondary to frontal disinhibition leading to her tearfulness and emotional lability. they encouraged further continuation of fluoxetine, mirtazapine, and megace. we also discontinued her trazadone and would encourage eventual discontinuation of her benzodiazepines as this can worsen her cognitive impairment. . 6. chronic constipation: frequently constipated; she was given an aggressive bowel regimen including psyllium, senna, colace, and enemas prn. . 7. hypertension: her antihypertensives were intially held while she was septic and she remained normotensive during her hospitalization. for these reasons her home antihypertensives were not restarted. . 8. hyponatremia: chronic going back to at least 2 years. likely secondary to underlying liver disease from history of hepatitis c and alcohol abuse. she will be following up with liver in ; this appointment has been scheduled. medications on admission: alendronate 70 mg qweek on saturday colace thiamine 100 mg daily multivitamin amlodipine 5 mg daily folic acid 1 mg daily fluoxetine 30 mg daily calcium + d aspirin 325 mg daily labetalol 200 mg ibuprofen 600 mg po bid lorazpam 1 mg po tid metamucil 15 ml tid senna 2 tablets qhs mirtazapine 30 mg qhs lorazepam 1 mg q6h:prn anxiety tums 2 tabs po tid tylenol prn vicodin 1 tab po qhs and discharge medications: 1. mirtazapine 15 mg tablet sig: two (2) tablet po hs (at bedtime). 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 3. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for fever, pain. 4. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 5. fluoxetine 10 mg capsule sig: three (3) capsule po daily (daily). 6. multivitamin tablet sig: one (1) tablet po daily (daily). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. senna 8.6 mg capsule sig: one (1) tablet po hs (at bedtime). 9. lorazepam 1 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for anxiety. 10. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 11. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for gas pain. 12. megestrol 400 mg/10 ml (40 mg/ml) suspension sig: one (1) po daily (daily) as needed for appetite. 13. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 14. calcium carbonate 500 mg (1,250 mg) tablet sig: one (1) tablet po tid (3 times a day). 15. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous q 24h (every 24 hours). 16. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) injection q8h (every 8 hours) as needed for nausea. 17. alendronate 70 mg tablet sig: one (1) tablet po once a week. 18. metamucil powder oral discharge disposition: extended care facility: twins oaks care and rehabilitation ctr discharge diagnosis: 1. mssa bacteremia 2. thoracic and lumbar osteomyelitis 3. septic left knee and septic left hip 4. acute renal failure secondary to atn vs ain from nafcillin 5. left flank hematoma s/p left hip washout, stable 6. anasarca 7. depression 8. chronic constipation 9. hyponatremia discharge condition: stable for rehab, saturating well at room air. discharge instructions: you presented to the on with a complaint of lethargy, hip pain, and back pain. while you were here, we found that you had a serious infection caused by a bacteria called staph aureus. this bacteria infected several places in your body including parts of your spine (your thoracic/lumbar spine), your left hip, and your left knee. for these reasons, we started you on antibiotics and surgically cleaned out your spine, hip and knee. following these measures, your kidneys were slightly injured which we thought could be because of your antibiotics. as a result, we changed your antibiotics from nafcillin to vancomycin. you will need to be on these antiobitics for a long duration (6 weeks). you started your antibiotics on , so you should continue to take them until . you have a special line placed (a picc line) for the antibiotic to be given. . while you were here, you also developed a lot of swelling because you had a lot of fluid given to you around the time of your surgeries. while in rehab, they will continue to give you water pills to help this swelling come down. . as a result of one of your left hip surgery, you developed a large area of bleeding around your left hip that we call a hematoma. initially, this area continued to bleed but over time the bleeding stopped. you did initially require blood transfusions for this, however over the past week you have not required any. . the medication changes that we made during this hospitalization are summarized below: we started the following meds that you should continue: (1) zofran - you can take this as necessary for nausea. (2) vancomycin - you should continue to take 1 gm iv once a day until . (3) calcium carbonate - increased the dose to 1250 mg three times a day (4) megace - you can take this to help your poor appetite at 400 mg daily. (5) simethicone - you can take this as needed for the pain that you have from gas. (6) ranitidine - take this daily to help protect your stomach from acid. (7) you can take bisacodyl as necessary for constipation, as this was a frequent problem during your hospitalization. (8) vitamin d - you should take this daily. (9) aspirin - you should take 81 mg instead of 325 mg because of your history of bleeding - high dose aspirin can make it worse. . we stopped the following medications and they should be held until your outpatient doctors feel that they can safely restart them: (1) we stopped your amlodipine and labetalol since they were dropping your blood pressures too low. if your blood pressures continue to be high, these can be restarted by your rehab doctors. (2) aspirin 325 mg: we changed this to 81 mg daily because we wanted to lower your bleeding risk since you had a hematoma. (3) we stopped your ibuprofen because your kidneys have been slightly injured during your hospital stay: you should not continue this medicine while your kidneys recover. . you will need to follow up with both orthopedics and infectious disease. the appointment dates are listed below. . if you experience worsening fevers, chills, bleeding, dizziness, ligtheadedness, joint pains, or any other concerning symptoms, please let your primary care doctor know or return to the emergency department. followup instructions: 1. please follow up with dr , infectious disease doctor on at 2:10 pm. if you want to reschedule, please call . . 2. please follow up with dr on at 11 am at the . . 3. you have been scheduled for re-imaging of your back on . this has been set up for 1 pm. if you want to reschedule, please call and press option 1, then option 1 again to reschedule. . 4. you also have a follow up appointment with neurosurgery to follow up your back surgeries on at 10:00 am. to reschedule, you can call at 10 am at . . 5. please follow up with dr on at 1120 am, who is an orthopedic doctor, regarding your left hip. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances arterial catheterization other exploration and decompression of spinal canal synovectomy, knee revision of hip replacement, acetabular component revision of knee replacement, tibial component diagnoses: other iatrogenic hypotension anemia of other chronic disease hypocalcemia acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified acute posthemorrhagic anemia unspecified protein-calorie malnutrition severe sepsis unspecified viral hepatitis c without hepatic coma hematoma complicating a procedure methicillin susceptible staphylococcus aureus septicemia hypopotassemia dysthymic disorder acute respiratory failure septic shock other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation paralytic ileus other constipation acute glomerulonephritis with other specified pathological lesion in kidney dermatitis due to drugs and medicines taken internally other antihypertensive agents causing adverse effects in therapeutic use surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation intraspinal abscess acute osteomyelitis, other specified sites other disorders of neurohypophysis hip joint replacement presence of cerebrospinal fluid drainage device obsessive-compulsive disorders pyogenic arthritis, pelvic region and thigh history of fall pyogenic arthritis, lower leg penicillins causing adverse effects in therapeutic use infection and inflammatory reaction due to internal joint prosthesis other and unspecified alcohol dependence, episodic long-term (current) use of antibiotics 

Answer: The patient is high likely exposed to