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: amoxicillin attending: chief complaint: endocarditis major surgical or invasive procedure: tee history of present illness: this is a 24 yof with history of ivdu who initially presented to hospital on with 2 days of right sided chest and abdominal pain, as well as difficulty breathing for 2 days. she reports haveing used about 1g of heroin/day as well as cocaine recently over the past 2.5 weeks. . given her shortness of breath and tachycardia, a ct chest was obained on admission which showed no pe, but right middle and lower lobe air space opacities suggestive of multifocal consolidation, as well as multiple nodular densities in the right upper lobe, left upper lobe, and left lower lobe with associated central cavitation concerning for septic emboli. there was also evidence of mediastinal and axillary adenopathy. due to her ivdu history and ct findings there was concern for endocarditis and was started on vanco/ceftriaxone. of note, she has had history of mrsa cellulitis in the past. echo was obtained showing 2 cm vegetation on the tricuspid valve, with potential concern for fungal vegetation. blood cultures were drawn and are now growing out gpc clusters in bottles. id consult was obtained and abx were changed to vanc/cefepime. hiv and hepatitis b and c serologies were sent given her ivdu and were pending on transfer. . of note, given her subjective history of weightloss/fevers there was concern for tuberculosis, so ppd was placed. she remained tachycardic throughout admission presumed secondary to fevers, pain, and anxiety. . given her endocarditis, she was transferred to where she could have a cardiac surgery evaluation. . on arrival to the micu, initial vs were 102.9 130 128/52 27 96% ra. she complains of significant chest pain that inhibits her taking a deep breath. she denies peripheral edema, n/v/d. she endorses night sweats and weight loss over the past several days . review of systems: (+) per hpi (-) denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: -ivdu -depression -mrsa cellulitis social history: lives at home with her dad, who was previously addicted to narcotics but sober x 15 yrs. not working or in school. no etoh, smokes cigarettes/day, + heroin and cocaine abuse. family history: lung cancer in paternal gm with brain mets mother with a h/o ivdu physical exam: admission pe vitals: 102.9 130 128/52 27 96% ra general: alert, oriented, tachypenic, moderate distress heent: sclera anicteric, perrla (3mm in diameter) mmm, oropharynx clear, eomi neck: supple, jvp not elevated, but difficult to interpret given tachypnia. no lad cv: tachy, regular, s1 + s2, difficult to appreciate murmur given tachycardia lungs: tachypenic, shallow breaths, clear to auscultation anteriorly abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. no splinters, oslers nodes, or lesions. evidence of track marks over the arms. some evidence of skin popping as well neuro: cnii-xii intact, moving all extremities. discharge pe: vs: 97.9 112/60 (110-112/68-83) 108 (104-116) 18 100ra general: alert, oriented, laying comfortably in bed heent: sclera anicteric, mmm, oropharynx clear, eomi neck: supple cv: tachy, regular, s1 + s2, soft systolic murmur at llsb lungs: clear to auscultation b/l, no wheezes/rhonchi/crackles abdomen: soft, non-tender, non-distended, +bs ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. skin: slight petechiae over feet, resolving--> new petechiae scattered along le b/l, nonblanching, nontender, ranging in size some pinpoint to 2 cm in diameter; slightly present on the lower back as well --> continuing to resolve, fading in color neuro: cn 2-12 grossly intact, normal muscle strength and sensation throughout pertinent results: admission labs: 08:20pm blood wbc-11.3* rbc-3.25* hgb-9.6* hct-29.7* mcv-91 mch-29.6 mchc-32.5 rdw-12.9 plt ct-110* 03:38am blood wbc-14.2* rbc-3.12* hgb-9.1* hct-28.7* mcv-92 mch-29.2 mchc-31.7 rdw-12.9 plt ct-111* 08:20pm blood neuts-88.0* lymphs-8.4* monos-3.0 eos-0.1 baso-0.5 03:38am blood neuts-85.4* lymphs-10.6* monos-3.6 eos-0.1 baso-0.3 08:20pm blood pt-17.7* ptt-33.1 inr(pt)-1.7* 08:20pm blood fibrino-513* 03:38am blood fdp-10-40* 12:37pm blood esr-100* 04:57am blood ret aut-0.7* 08:20pm blood glucose-101* urean-6 creat-0.4 na-140 k-3.0* cl-106 hco3-31 angap-6* 03:38am blood glucose-100 urean-6 creat-0.6 na-139 k-3.2* cl-106 hco3-25 angap-11 08:20pm blood alt-13 ast-16 ld(ldh)-220 alkphos-70 totbili-0.5 03:38am blood alt-13 ast-14 ld(ldh)-229 alkphos-64 totbili-0.5 08:20pm blood albumin-2.3* calcium-7.2* phos-1.7* mg-2.0 03:38am blood calcium-7.1* phos-2.6* mg-1.9 05:22am blood caltibc-137* hapto-352* ferritn-349* trf-105* 12:37pm blood crp-245.2* discharge labs: 05:55am blood wbc-9.3 rbc-3.53* hgb-10.1* hct-33.6* mcv-95 mch-28.7 mchc-30.1* rdw-14.4 plt ct-918* 06:06am blood wbc-9.1 rbc-3.33* hgb-9.5* hct-31.5* mcv-95 mch-28.5 mchc-30.1* rdw-14.2 plt ct-871* 06:06am blood pt-12.5 ptt-30.1 inr(pt)-1.2* 05:55am blood glucose-105* urean-17 creat-0.7 na-142 k-5.0 cl-101 hco3-32 angap-14 06:06am blood glucose-104* urean-12 creat-0.7 na-142 k-4.5 cl-102 hco3-34* angap-11 06:06am blood calcium-9.0 phos-4.8* mg-2.3 09:16am blood cryoglb-no cryoglo 08:20pm blood hbsag-negative hbsab-positive 08:20pm blood hcv ab-positive* studies: echo : impression: large tricuspid valve vegetation with mild (possibly underestimated) tricuspid regurgitation. no other valvular vegetations appreciated. preserved biventricular regional and global left ventricular systolic function. very small circumferential pericardial effusion. ct abd/pelvis: impression: 1. new basilar consolidations concerning for septic emboli. 2. increased bilateral pleural effusions since the reference study from . 3. new moderate ascites and body wall edema. tee: impression: there is a large vegatation on the tricuspid valve. moderate to severe tricuspid regurgitation. overall normal biventricular function. very small pericardial effusion. ruq u/s: impression: -> no portal vein thrombosis identified. -> trace of ascites in the pelvis. there are right and left pleural effusions noted. -> no focal collection is seen in either the spleen or liver. ct abd/pelvis: impression: 1. increasing bilateral pleural effusions and new moderate-sized pericardial effusion. cavitating pulmonary nodules c/w septic emboli. 2. no evidence of septic emboli within the abdomen. 3. moderate amount of free fluid in the dependent portion of the pelvis. ct chest impression: 1. worsening right upper and right middle lobe pneumonia with multiple bilateral septic emboli, many of which have cavitated, the most prominent of which appears to communicate with a branch of the right middle lobe bronchus and extends to the periphery, but given the lack of gas within the pleural space, bronchopleural fistula is not favored at this time. findings discussed with at 22:39 on by over the phone. 2. pleural and pericardial effusions as described above. ct chest: impression: 1. right upper lobe noncavitary consolidation has improved since the recent study, and a few nodules show new cavitation. however, dominant wedge-shaped areas of cavitary consolidation in the right middle lobe and lingula are not appreciably changed. 2. resolved left pleural effusion, decreased right pleural effusion, and persistent moderate pericardial effusion. brief hospital course: 24 yof with history of ivdu, past mrsa cellulitis, presenting to hospital with breathing difficulty and tachycardia. ct torso showed cavitary lesions suggestive of septic emboli, and echo with large tricuspid vegitation suggestive of endocarditis. # right-sided endocarditis with septic pulmonary emboli: transferred from an osh with know tricuspid valve endocarditis, cultures eventually speciated to mssa. ct scan at the osh with cavitary lung lesions, consistent with septic emboli from her known endocarditis. she was seen in consultation by the infectious disease service and the cardiac surgery service, she underwent a tee which showed a 1.7cm x 1cm tricuspid valve vegetation, no abscess formation, and no involvement of any other valves. given the tee findings the cardiac surgery service felt that no surgical intervention was needed at this time. she remained on vancomycin with a goal trough of over 20, when the cultures from the osh returned mssa it was decided to continue her on vancomycin given her history of throat closing with amoxicillin. however, the patient later developed a new le rash, which initially was thought could be related to vanc. vanc was stopped and the patient was briefly on dapto, when it was decided by id that she should undergo pcn desensitization so she could be on the appropriate nafcillin for her mssa endocarditis. . on the floor, the patient was hemodynamically stable, though she continued to be tachypneic to 30-40s and tachycardic to 120-130s. her daily ekg's did not show any evidence of conduction system disease. a picc was placed with plans for a total of 6 weeks of antibiotics based on date of first negative cultures, which was on . end date will be . . the patient was found to have an increasing white count and repeat ct chest was done on . thoracics was consulted re: potential for any operable/resectable areas that could be causing this white count. however, ct chest showed improvement compared to priors, and thoracics said no intervention was needed at this time. . # pcn desensitization: the patient was transferred to the micu for pcn desensitization, which she tolerated without any issue. she also received nafcillin without incident and was able to be called out to the floor without issue. it is very important that the patient should not miss given her recent desensitization. . # fevers/weight loss: prior to transfer given the septic emboli on her chest ct and fevers and weight loss there was concern for possible tuberculosis. a ppd placed at the osh was negative and she had three sputums negative for afb. the patient was also noted to be hiv negative at osh. . # tachycardia: cta negative for pe prior to transfer, thought to be related to pain, fever and withdrawal symptoms, she was monitored on telemetry and remained in sinus tachycardia throughout her stay. . # ivdu: pt with long history of ivdu likely precipitating her endocarditits, hiv antibody negative at the osh on . hepatitis c antibody positive here with a viral load of 173,401. hepatitis b serologies showed immunity. hepatology was curbsided and said pt could follow up in hepatology clinic at any time for hcv treatment if she desired this. however, it is not urgent so they recommended she finish endocarditis treatment first and no longer be using iv drugs. the patient was also given clonidine prn for any withdrawal symptoms. . # abdominal pain: the patient had an episode of abdominal pain, with exam notable for rebound tenderness. surgery was consulted, and kub was done. kub was negative for free air or any evidence of obstruction; lactate was normal. surgery recommended npo until abdominal pain resolves. the patient's diet was advanced slowly, and her abdominal pain resolved. given her recent diagnosis of hsp (see below), it is possible that this acute episode of abdominal pain was intussuception that had self resolved. . # diarrhea: the patient reported having some intermittent diarrhea while in patient; was found to be cdiff negative x2. . # anemia: the patient was found to be iron deficiency on studies, with no evidence of hemolysis, and she was started on ferrous sulfate. . # new ble pupura: the patient was found to have new le rash, which was initially thought to be secondary to vanc. there was some improvement after vanc was stopped. derm was consulted and punch biopsies were done. path was consistent with leukocytoclastic vasculitis, with iga deposits in vessel walls, consistent with henoch-schonlein purpura. this was thought to be most likely secondary to her underlying bacterial endocarditis. . # thrombocytosis: the patient had a persistent thrombocytosis during this admission, likely reactive in the setting of her endocarditis. upon discharge, it had started trending down. transitional issues: # new hep c: the patient should follow up as an outpatient in liver clinic once treatment for endocarditis is finished. . # bacterial endocarditis: the patient will need to complete six weeks total of antibiotics starting from 1st negative culture; end date will be . she will be discharged on nafcillin. . # le purpura s/p punch biopsy: the patient had punch biopsy done on . the patient will need to have sutures removed from biopsy site in two weeks (). the patient will also need outpatient dermatology follow up. please call to make an appointment. # infectious disease follow up: the patient will follow up in clinic on 10a with dr. and 11.30a with dr. . please send weekly cbc w/diff, bmp, lfts to . # hsp: please get urinalysis once weekly to monitor for hematuria for two months. medications on admission: none discharge medications: 1. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day). 2. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for bloating. 3. clonidine 0.1 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for withdrawals. 4. lorazepam 0.5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for anxiety. 5. hydromorphone 2 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain: please hold for rr<12, altered mental status. 6. zofran 4 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. 7. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever or pain. 8. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 9. nafcillin 2 gram recon soln sig: one (1) intravenous every four (4) hours: please stop . discharge disposition: extended care facility: tewsbury state hospital discharge diagnosis: primary: mssa bacterial tricuspid endocarditis with pulmonary septic emboli intravenous drug use hepatitis c secondary: reactive thrombocytosis henoch-schonlein purpura discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure taking care of you while you were hospitalized at . you were transferred to because you were found to have a bacterial infection in your blood, with bacteria on your heart valves and in your lungs. we started you on antibiotics to help treat this infection. because you had an allergy to penicillin, we had to send you back to the intensive care unit for desensitization; you tolerated this well. it is very important that you do not not miss any of your of the antibiotic. we made the following changes to your medications: start nafcillin 2 grams every four hours through your veins start zofran 4 mg every 8 hours by mouth as needed for nausea start sarna lotion, applied to your hands/feet, as needed for dry skin start dilaudid 2-4 mg as needed for pain every 4 hours start clonidine 0.1 mg by mouth as needed every 4 hours start lorazepam 0.5 mg by mouth as needed for anxiety every fours hours start acetaminophen 650 mg as needed for fever/pain every 6 hours (do not exceed 2 grams daily) followup instructions: please followup with your primary care physician days regarding the course of this hospitalization. please call to make an appointment to make an appointment with dermatology clinic. you will also have to follow up with the liver doctors as outpatient, given your new diagnosis of hepatitis c. department: infectious disease when: tuesday at 10:00 am with: , md building: lm campus: west best parking: garage department: infectious disease when: tuesday at 11:30 am with: , md building: lm bldg () campus: west best parking: garage md procedure: diagnostic ultrasound of heart closed biopsy of skin and subcutaneous tissue central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified abdominal pain, unspecified site tobacco use disorder unspecified pleural effusion chronic hepatitis c without mention of hepatic coma hypopotassemia need for desensitization to allergens pulmonary collapse opioid type dependence, continuous defibrination syndrome bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site iron deficiency anemia, unspecified cocaine abuse, episodic acute and subacute bacterial endocarditis other ascites diarrhea drug withdrawal splenomegaly essential thrombocythemia personal history of allergy to penicillin septic pulmonary embolism allergic purpura 

Answer: The patient is high likely exposed to