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: shoulder pain major surgical or invasive procedure: joint aspiration - right shoulder history of present illness: pt is a yo russian-speaking man with pmhx sig. for tachy-brady syndrome s/p pcm, afib on coumadin, cva in , and dementia who presents with r shoulder pain and fever. he first was seen in the ed on for right wrist pain and swelling. he had a tap that showed wbc 4250, rbc , 57%pmns, 13%l, 30%m. and was discharged home. he represented in the ed on with continued wrist pain and erythema and was admitted to medicine. no fever at that point. pt had an x-ray of the r wrist showed "no fracture or dislocation. generalized demineralization. joint space narrowing and associated osteophytes at the first cmc joint. minimal chondrocalcinosis and vascular calcifications." plastic surgery/hand servcie was consulted and did not feel that he had evidence of septic arthritis. he was treated for cellulitis and rapidly improved on vancomycin/ctx. blood cultures were negative. he was discharged on on 10 day course of vancomycin/ctx. the hospital course was also notable for severe constipation and fecal impaction. . today, pt presents from nh with complaint of shoulder pain. per his wife who visits him on a daily basis, he was fine until this morning. he was complaining of r shoulder pain. the nursing home noted that he was yelling out in pain. vs were: pulse 86-104, sat 96% on ra. . in the emergency department, initial vitals were: 97.3 84 irreg 107/74 18 98. he had a temp up to 105 rectally. x-ray showed no fracture or dislocation. us showed moderate-sized right shoulder joint effusion with debris and internal septations. ortho was consulted and attempted to tap the joint, unsuccessful. he received levofloxacin and flagyl. vitals prior to transfer were: 99.5, 98, 138/76, 22, 97% on 2l. . in the icu, pt only complains of r shoulder pain. the nursing home does not note any fevers. he denies any chest pain, dyspnea, abdominal pain, diarrhea. + constipation. no dysuria. ortho came by and tapped 20 cc of purulent drainage. past medical history: 1. tachy/brady syndrome s/p ppm placement 2. cva in with residual r eye deviation to the right and rle weakness 3. htn 4. dementia, of probable alzheimer type 5. a.fib on coumadin 6. gastritis 7. h/o chronic r heel pressure ulcer s/p skin graft, now healed. 8. h/o cholangitis social history: per record: born in . he lives in a nursing home, living very close to his wife. notes smoking 1 ppd x 20 years, quit 3 years ago (not sure this is reliable), denies etoh, drug use. family history: per record: denies significant family history (parents died in ). was an accountant. physical exam: general: pleasant, well appearing man in nad, appears young for age heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. mm dry. op clear. neck: supple, no lad. cardiac: irregular rhythm. normal rate. no murmurs. no jvd. lungs: few end expiratory wheezes on the left, coarse bibasilar crackles, good air movement biaterally. abdomen: nabs. soft, nt, nd. extremities: r shoulder more edematous than l but no warmth or increased erythema. rue is in general slighly more edematous but not erythematous or warm. pain in r shoulder with both passive and active movement. no edema or calf pain, 2+ dorsalis pedis/ posterior tibial pulses. skin: no rashes/lesions, ecchymoses. healed heel ulcer on r. neuro: a&o. appropriate. cn 2-12 grossly intact. 5/5 strength on lue and lle, in rue, in rle. psych: listens and responds to questions appropriately with one-word answers pertinent results: 10:00am wbc-14.3*# rbc-4.50*# hgb-12.8*# hct-39.1*# mcv-87 mch-28.3 mchc-32.6 rdw-14.6 brief hospital course: mr. is a year old bulgarian man with a history significant for tachy--brady syndrome, s/p pcm (recently replaced), atrial fibrillation on warfarin, cva in and dementia who presented with a spetic right shoulder. he was evaluated on with right wrist pain, a tap was performed in the ed and was interpreted as benign; it does not appear that it was cultured. he presented again on and was admitted to medicine. at that time, plastic surgery did not feel he had septic arthritis. he was treated for cellulitis and an e. coli uti. his course was complicated by fecal impaction. he was discharged on on a 10 day course of vancomycin and ceftriaxone. he returned on with right shoulder pain. he was febrile in the ed and a joint aspiration was attempted but was unsuccessful. he was observed to be mildly hypotensive, so he was admitted to the icu. he ultimately underwent joint arthrocentesis with 20 cc of purulent drainage. culture thus far is unremarkable. family wishes to pursue conservative treatment and avoid surgery/washout if possible. id consult was obtained to ensure appropriate antibiotic therapy. uric acid level was not elevated and there were no crystals reported in the joint aspirate, making crystal-arthritis less likely to be contributing. id recommended a tte which was unchanged from previous. they recommended continuing the vancomycin, increasing the ceftriaxone to 2 g iv q24 hours and continuing this until he sees dr. in the clinic at the . this plan was discussed at length with the patient's daughter who was in agreement and will accompany the patient to this appointment. a picc line was placed for him to receive ongoing antibiotics. . mr> should have weekly vanc trough levels, cbc with differential, bun/cr and lfts. please fax the results of these to dr. at . . given the inability to exonerate pacer-lead endocarditis, he may require levofloxacin suppression after initial 4 week iv course. medications on admission: 1. metoprolol succinate 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 2. multivitamin tablet sig: one (1) tablet po daily (daily). 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 4. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 5. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 6. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inh inhalation q6h (every 6 hours) as needed. 8. oxycodone 5 mg tablet sig: 0.5 tablet po every 6-8 hours as needed for pain. 9. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for fever or pain. 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): start: . 11. terazosin 1 mg capsule sig: one (1) capsule po hs (at bedtime). 12. oxybutynin chloride 5 mg tablet sig: one (1) tablet po bid (2 times a day). 13. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation four times a day. 14. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): shoulder. 15. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 16. ceftriaxone in dextrose,iso-os 1 gram/50 ml piggyback sig: one (1) gram intravenous q24h (every 24 hours) for 10 days: start: ; last day . 17. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 18. vancomycin 1,000 mg recon soln sig: one (1) intravenous once a day for 10 days: day 1: , day 10 . 20. senna 8.6 mg tablet sig: two (2) tablet po hs (at bedtime). 21. warfarin 2 mg tablet sig: as dir tablet po once daily at 4 pm: give 6 mg qday; adjust dose as needed to maintain inr = . 22. fleet enema 19-7 gram/118 ml enema sig: one (1) enema rectal once a day: give one enema daily x 5 days, thereafter give one enema if no large bm x 3 days. 23. miralax 17 gram powder in packet sig: one (1) dose po once a day: give one dose daily x 7 days, then give one dose as needed if patient goes 2 days without a bowel movement. . discharge medications: 1. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 2. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 3. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed for constipation. 4. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 7. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 8. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 9. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 11. terazosin 1 mg capsule sig: one (1) capsule po hs (at bedtime). 12. oxybutynin chloride 5 mg tablet sig: one (1) tablet po bid (2 times a day). 13. acetaminophen 500 mg tablet sig: two (2) tablet po tid (3 times a day). 14. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 15. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 16. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 17. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: two (2) g intravenous q24h (every 24 hours): please check weekly safety labs (cbc with differential, lfts, bun/cr) and fax them to dr. at . 18. outpatient lab work please check weekly safety labs (cbc with differential, lfts, bun/cr) and fax them to dr. at . 19. transportation please schedule an ambulance (bls) for mr. to attend an appointment in the infectious disease clinic at the . the appointment is on at 9:30 in the morning. the office is at , , medical office building. 20. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous q 24h (every 24 hours). 21. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm. 22. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 23. sodium chloride 0.9 % 0.9 % parenteral solution sig: three (3) ml intravenous q8h (every 8 hours) as needed for line flush. discharge disposition: extended care facility: - discharge diagnosis: ## septic arthritis, unclear etiology/organism ## s/p recent e. coli uti diagnosed , s/p ceftriaxone course ## atrial fibrillation ## chronic anticoagulation ## h/o remote cva ## hyperlipidemia ## copd ## constipation ## h/o unprovoked group b strep bacteremia x 2 in the past discharge condition: mental status:confused - sometimes level of consciousness:alert and interactive activity status:bedbound - transfers with a lift discharge instructions: mr. was admitted to the hospital and found to have an infected right shoulder joint (septic arthritis). the cause of this is not known. his family discussed the situation with orthopedics attending dr. . given the patient's overall frail health status and advanced age, it was decided to pursue conservative management and avoid surgical "washout" of the joint if possible. mr. did well on empiric antibiotics and should continue on iv ceftriaxone 2 g q24 hours and vancomycin till he follows up with dr. . followup instructions: transportation please schedule an ambulance (bls) for mr. to attend an appointment in the infectious disease clinic at the . the appointment is on at 9:30 in the morning. the office is at , , medical office building. procedure: venous catheterization, not elsewhere classified arthrocentesis diagnoses: anemia, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation constipation, unspecified other and unspecified hyperlipidemia hypotension, unspecified right bundle branch block long-term (current) use of anticoagulants late effects of cerebrovascular disease, hemiplegia affecting unspecified side cardiac pacemaker in situ hypovolemia late effects of cerebrovascular disease, aphasia unspecified gastritis and gastroduodenitis, without mention of hemorrhage pyogenic arthritis, shoulder region other late effects of cerebrovascular disease, dysphagia dysphagia, unspecified 

Answer: The patient is high likely exposed to