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: no known allergies / adverse drug reactions attending: chief complaint: mitral valve methicillin resistent staph aureus endocarditis major surgical or invasive procedure: mini thoracotomy, tricuspid valve replacement (31 st. tissue), patent foramen ovale closure history of present illness: ms. is a 30 year old woman who is a current intravenous drug user, with a history of hepatitis b and c, who was transferred from on for persistent fevers and tachycardia while being treated for methicillin resistent staph aureus tricuspid endocarditis, pulmonary emboli, and cardiogenic shock. she originally presented to another outside hospital with two weeks of fevers, malaise, and nausea and vomitting. she was treated with a z-pack prior to that presentation due to a cough. she was septic with temperature of 94.5, sbp in 90s and hr in 120s, was given 1g vancomycin and 2g ceftriaxone and 750mg levofloxacin, and transferred to on . at , a chest ct was positive for pulmonary embolism and multiple bilateral cavitary pulmonary nodules, most likely septic emboli. an echocardiogram showed an ejection fraction of 70%, tricuspid valve with possible anterior flail leaflet with large highly mobile vegetation, severe tricuspid regurgitation. during her hospital stay, she developed a pulmonary embolism and cardiogenic shock. on the medicine floor, she continued to be febrile in the 100 to 101 range despite vancomycin. a heparin infusion for pulmonary emboli was discontinued when she developed anemia and there was concern for bleeding. multiple picc lines were placed and pulled as they could be possible sources of infection. she was febrile during her entire hosp stay to 100-101 degrees. she remained tachycardic with a heart rate in the 110's at rest up to 150's with activity during the entire hospitalization. most recent cultures were negative. she was kept on intravenous ativan and valium. she had a right psoas abscess, with a pigtail drain placed by interventional radiology. on presentation to , she denied any pain but did say she could not move her right leg but said this had been the case for the past month. she denied any fevers, chills, chest pain, shortness of breath or nausea or vomitting. her last menstrual period was in (mirena iud). past medical history: -adhd -hepatitis c -hepatitis b -intravenous drug use social history: ms. is married and has two children. she lives at home and is currently unemployed. her family is unaware of her intravenous drug use and she does not want it mentioned in their presence. she was a smoker as a teenager, and denies alcohol use. she has a history of intravenous heroine use as a teenager and then subsequent sobriety for many years. about six months ago she began crushing suboxone in tap water and injecting it. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission physical examination: vs: t=96.5 bp=107/71 hr=100s rr=18...o2 sat=96-98%ra general: somnolent female in nad. aao*3. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with no significant jvp. cardiac: pmi located in 5th intercostal space, midclavicular line. tachycardic loud s2. without m/r/g. no thrills, lifts appreciated. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. poor inspiratory effort. bibasilar crackles appreciated. no wheezes or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. no abdominal bruits. back: drain in lower right hip draining minimal serosanguinous fluid. extremities: 1+ non pitting edema on right leg. no femoral bruits. r knee somewhat warmer than l to touch, slightly swollen. skin: small erythematous macules on buttocks. several possible pustules noted under clear drain dressing. no stasis dermatitis, ulcers, scars, or xanthomas. no splinter hemorrhages, no lesions or osler nodes. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ neuro: aaox3, cn2-12 grossly intact, motor strength and sensation grossly intact b/l, except r hip flexor not assessed as pt said had difficult moving leg pertinent results: microbiology: -hep b viral load : hbv dna not detected. -hep c viral load : hcv-rna not detected. - mri head: findings: within the right posterior temporal region is a subcentimeter curvilinear area of elevated t2 signal that appears to exhibit corresponding contrast enhancement. the etiology for this finding is uncertain, but in light of the known systemic infection, an inflammatory process (meningeal based) could be considered, as opposed to a small vascular malformation. a ct or mr angiogram may be of some diagnostic benefit, in this regard. there is no baseline t1 hyperintensity to suggest locally thrombosed vessel or hemorrhage, although in the acute phase, t1 hyperintensity may not be present in the setting of either hemorrhage or thrombosis (as in the setting of a mycotic aneurysm). there is a punctate area of elevated t2 signal, without enhancement in the left corona radiata. there is no restricted diffusion or abnormal susceptibility, hydrocephalus, or shift of normally midline structures. the principal vascular flow patterns are identified. there is a subcentimeter, likely retention cyst arising from the floor of the left maxillary sinus. conclusion: focal areas of abnormal signal and isolated area of pathological enhancement, as noted above. please see the above report for details and recommended potential followup studies, in order to exclude a mycotic aneurysm. . - cta head: impression: 1. no evidence of acute infarct or intracranial hemorrhage. 2. no evidence of focal flow-limiting stenosis, occlusion or aneurysm greater than 3 mm in the arteries of anterior and posterior circulation of head. 3. the small enhancing focus noted in the right temporal lobe on the previous mri is not seen on the present study. however, cta can be less sensitive in the detection of very tiny aneurysms or mycotic aneurysms. as the lesion was seen on mr study, consider close folow up with mr without and with contrast to assess stability / progression and if necessary inr consult. . - mri head: impression: interval appearance of at least one, though probably several foci of slow diffusion with associated enhancement, most compatible with foci of septic emboli within the left frontal lobe. interval of previously noted abnormality within the right temporal lobe may also support septic embolization as the etiology. . tee: no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. a patent foramen ovale is present with leftward bowing of the interatrial septum and right-to-left shunt at rest. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to 32 cm from the incisors. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. no aortic valve abscess is seen. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve. the tricuspid valve has a large vegetation and associated partial flail leaflet. severe tricuspid regurgitation is seen directed towards the interatrial septum. no vegetation/mass is seen on the pulmonic valve. there is a trivial/physiologic pericardial effusion. impression: large vegetation and associated partial flail tricuspid leaflet. severe tricuspid regurgitation with flow directed towards a patent foramen ovale and a likely substantial right to left shunt at rest. . intra-op tee conclusions pre-bypass: the left atrium is normal in size. no spontaneous echo contrast or thrombus is seen in the body of the left atrium or left atrial appendage. the right atrium is moderately dilated. a left-to-right shunt across the interatrial septum is seen at rest. a small secundum atrial septal defect is present. left ventricular wall thicknesses and cavity size are normal. the right ventricular free wall thickness is normal. the right ventricular cavity is moderately dilated with borderline normal free wall function. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to xx cm from the incisors. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are moderately thickened. there is partial flail of a tricuspid valve leaflet. there is a probable vegetation on the tricuspid valve. there is a large vegetation on the tricuspid valve. there is no abscess of the tricuspid valve. severe tricuspid regurgitation is seen. there is a trivial/physiologic pericardial effusion. . 05:45am blood wbc-4.5 rbc-3.15* hgb-8.5* hct-26.3* mcv-84 mch-27.0 mchc-32.3 rdw-15.5 plt ct-221 07:51am blood wbc-4.8 rbc-3.46* hgb-8.8* hct-28.2* mcv-82 mch-25.6* mchc-31.4 rdw-15.2 plt ct-201 05:45am blood glucose-91 urean-14 creat-0.7 na-139 k-4.3 cl-104 hco3-28 angap-11 07:51am blood glucose-114* urean-13 creat-0.6 na-138 k-4.1 cl-101 hco3-28 angap-13 05:45am blood calcium-8.7 phos-4.8* mg-1.9 07:51am blood calcium-8.8 phos-4.2 mg-1.8 brief hospital course: ms. is a 30 y.o. woman with a h/o ivdu, hep b and c, transferred from on for cardiac surgery evaluation due to persistent fevers and tachycardia while on vancomycin for mrsa tricuspid endocarditis. osh stay was c/b septic emboli to lungs, r psoas abscess, and cardiogenic shock. in brief, at she remained afebrile on vancomycin, but head imaging was concerning for septic emboli suggestive of left-sided disease. tee demonstrated a large vegetation and associated partial flail tricuspid leaflet, along with severe tricuspid regurgitation with flow directed towards a patent foramen ovale and a likely substantial right to left shunt at rest. she was taken for valve repair surgery on . . active issues: . # infectious endocarditis with mrsa: osh echo showed a large vegetation on tricuspid valve and blood cx's were positive for mrsa. tte from on redemonstrated the tricuspid vegetation. osh course was c/b persistent fevers despite >1 mo vancomycin iv therapy. pt has been afebrile since and ct surgery evaluated the patient on and recommended proceeding with operation after 6 weeks of vancomycin after the first negative blood culture (on at osh), unless new sequelae developed or she became unstable. we continued her iv vancomycin at 1250mg iv q12h with a trough goal of ~20 per recommendation by id. hiv ab test, hep b/c viral loads were all negative. head imaging (mri head and cta head) initially could not r/o a small mycotic aneurysm. repeat mri head one week later on was concerning for septic emboli suggestive of left-sided disease. tee demonstrated a large vegetation and associated partial flail tricuspid leaflet, along with severe tricuspid regurgitation with flow directed towards a patent foramen ovale and a likely substantial right to left shunt at rest. she was taken for valve repair surgery on - see post-operative course below . # pe: dx with pe at osh likely secondary to septic emboli on . last cta at osh on showed intraluminal emboli with signs of pulmonary infarct. we continued to hold heparin due to recent history of septic emboli. at , ct torso showed pleural effusions, and ip placed a chest tube on which was removed several days later. pleural fluid analysis showed 1675 wbcs and 5600 rbcs; prot 4.5, ldh 184, cholest 73, c/w exudative process. the pt maintained good o2 sats on ra throughout admission. . # r psoas abscess: reported psoas abscess was likely secondary to her bacteremia. ortho tapped the hip joint at the osh and joint aspirate was not concerning for septic arthritis. she had a drain in her right hip that was placed by ir at the osh for possible absess, and was removed by surgery on given minimal output and lack of communication with the abscess on ct. she continued to remain afebrile throughout admission on the cardiology floor at . . # r leg weakness and pain: the pt had difficulty moving her right leg upon admission to , due to pain primarily in the knee. lumbar mri, knee plain films, and r leg ct were all negative for acute process. neurology was consulted, and their examination showed "significant weakness of right hip flexion and knee extension with possible weakness of right hip flexion although this could be related to right knee pain. her sensory exam shows decreased sensation to pin as well as allodynia in the distribution of the right femoral nerve. additionally she has an absent reflex in the right knee which points to a lower motor neuron dysfunction, and the pattern of weakness and sensory loss most likely suggest femoral nerve dysfunction. this is most likely due to inflammatory changes induced by the psoas abscess which could also cause femoral nerve dysfunction by local compression. given that this is a peripheral nerve dysfunction, with time, this will improve as the nerve regenerates and she has experienced this already. the characteristic of the pain is also consistent with neuropathic pain." gabapentin was started (300 mg at night and escalated by 300 mg every 3-5 days as tolerated, with a target daily dose of mg daily). lidocaine patches were occasionally applied to the knee as needed. physical therapy was initiated, and the pt demonstrated improvement in strength and pain control with the gabapentin and increased activity. . # somnolence: on pt was noted to have increased somnolence and some waxing and of alertness and consciousness but was always arousable. psychiatry saw patient on and attributed this somnolence to hypoactive delirium rather than depression and recommended a switch from diazepam to lorazepam. the pt's mental status improved on and continued to improve throughout her hospitilization; the pt remained aaox3, alert, and interactive throughout the remainder of admission. . # ivdu: at osh she was treated for suboxone withdrawal with fentanyl iv and then later a transdermal fentanyl patch; per osh report was using suboxone daily for 6 months pta. after admission, her pain regimen was decreased to the following: fentanyl patch was decreased to 12.5, prn oxycodone was decreased to 5-10mg q6hrs, and prn lorazepam was discontinued. she showed no si/sx of opioid withdrawal. . # anemia: hct 30.9 this am which is stable from which was 31.8 on (admission 34.0). fe studies were consistent with anemia of chronic disease. hct remained stable in low 30's throughout admission. . transitional issues: . - abx treatment course for mrsa endocarditis: pt is currently on vancomycin 1000mg iv q12hrs. first negative blood cx at osh was , so last day of six weeks of treatment will be . . - psoas abscess: r psoas abscess drain was pulled on ; pt has had no fevers thereafter. if pt's r leg function deteriorates or fever returns, re-imaging for psoas abscess can be considered. on mrs. was taken to the operating room and underwent a minimally invasive tricuspid valve replacement with size 31 st. tissue valve and patent foramen ovale closure with dr. . please see operative report for further details. she tolerated the procedure well and was transferred to the cvicu intubated and sedated. she awoke neurologically intact and was weaned to extubate without incident. id continued to follow her postoperatively for antibiotic recommendations. daily surveillance cultures were monitored which had no growth postoperatively. a picc line was placed for likely 6 weeks from op date of vancomycin, along with weekly surveillance labs per id. on pod#1 she was transferred to the step down unit for further monitoring. she was started on aspirin and diuresis. she was in an accelerated junctional rhythm and betablockers were not intiated. her rate was stable and she was trialed on a low dose betablocker (lopressor 12.5 ) and developed complete heart block. betablockers were d/c'd and the ep service was consulted: "she has stable narrow complex junctional escape rhythm and does not need pacemaker at this point. however, we nned to carefully monitor her recovery and re-assess the need for a pacemaker over the next week." the patient will be discharged to rehab on telemetry and follow-up with ep 2 weeks following discharge. beta blockers/nodal agents will not be given due to her complete heart block. physical therapy was consulted for evaluation of strength and mobility and rehab was recommended. on pod 7 she was cleared for discharge to , . all follow up appointments were advised. medications on admission: home meds (as per admit note ) adderall prn mirena iud. discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. medications no av nodal blocking agents due to av dissociation 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 5. oxycodone 5 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 6. gabapentin 300 mg capsule sig: two (2) capsule po hs (at bedtime). 7. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): please apply for 12 hours and then remove for 12 hours . 8. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po hs (at bedtime) as needed for constipation. 9. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. 10. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 11. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 13. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 14. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily). 15. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 16. oxycodone 10 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po q12h (every 12 hours). disp:*60 tablet extended release 12 hr(s)* refills:*0* 17. fentanyl 25 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). disp:*10 patch 72 hr(s)* refills:*0* 18. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 19. outpatient lab work weekly cbc with diff, bun/cr, vanc trough fax to clinic: 20. vancomycin 1,000 mg recon soln sig: one (1) intravenous every twelve (12) hours for 5 weeks: through . discharge disposition: extended care facility: - discharge diagnosis: mrsa tricuspid endocarditis hepatitis b and c discharge condition: alert and oriented x3 nonfocal deconditioned incisional pain managed with oral and transdermal analgesia incisions: right anterior chest wall incision - healing well, no erythema or drainage no edema discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 5 pounds for 2 weeks please call with any questions or concerns **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** **for any issues related to cardiac rhythm, please contact cardiology/ep: dr. office - if off hours will be placed in contact with cardiology fellow** followup instructions: you are scheduled for the following appointments: surgeon: , md phone: date/time: at 1:15pm in the medical office building , md phone: date/time: 3:00 id: , md phone: date/time: 9:00 id: dr. , , 10:30am cardiologist:please have your pcp refer local cardiologist to you for follow up please call to schedule appointments with your: primary care dr. in weeks **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** provider: , md phone: date/time: 9:00 md procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart open and other replacement of tricuspid valve with tissue graft repair of atrial septal defect with tissue graft diagnoses: anemia, unspecified unspecified viral hepatitis c without hepatic coma ostium secundum type atrial septal defect acute and subacute bacterial endocarditis personal history of venous thrombosis and embolism methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site attention deficit disorder with hyperactivity diseases of tricuspid valve psoas muscle abscess opioid abuse, episodic 

Answer: The patient is high likely exposed to