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: cellulitis/osteomyelitis/septic right knee joint and uti major surgical or invasive procedure: i&d, washout, and liner exchange of the right knee history of present illness: ms. is an 84 year-old woman with dm, htn, hld, ckd who had a chair break from under her one week ago now presenting with rle swelling and erythmea. patient reports that she landed on her bottom and felt well initially however in the days that followed she had stiffer back and neck and sore right leg, athough she was able to walk. she then noticed rle swelling two day prior to presentation with redness of her rle prompting presentation to the ed. initial vitals in the ed were 98.7 106 148/74 18 97% ra. on evaluation in the ed her ble was noted to be swollen with pronounced erythema consistent with cellulitis on the right leg from ankle to thigh on the posterior side. labs in the ed were notable for lactate of 2.8, wbc 22.4 with 92.4% pmns and ua c/w uti. she was given 1g vancomycin iv and 500mg levofloxacin iv and was planned to be admitted to the medicine service. subsequently she was noted to have an episode of svt with hr to the 160s for which she received 20mg iv and 30mg of po diltiazem and the decision was made to admit her to the micu for further care. vitals on transfer were 110 153/43 22 99% ra. on the floor she appears comfortable and denies numbness, tingling, weakness, or incontinence. past medical history: type ii diabetes, hypertension, high cholesterol, obesity, mild renal insufficiency, and a previous history of asthma. problems with balance and has swelling of her foot. right knee replacement surgery and left knee replacement in . colonoscopy and had a small polyp removed in that was an adenoma no repeat given age and weight have offered repeat colonoscopy. bone density study wnl. social history: normally walks with a cane, lives in senior apartment. pt lives alone and son "checks in on her" once daily but does not assist with adl's such as bathing. family history: her father had a ruptured gallbladder and cardiovascular disease. her mother died at the age ninety-five. physical exam: admission exam (per ortho): general: morbidly obese, alert, oriented x 3, no acute distress heent: sclera anicteric, mmm, oropharynx clear, pupils 4mm-2mm bl neck: plethoric neck, supple, no lad lungs: distant lung sounds bl, summetric breath shounds, no wheezes, rales, rhonchi cv: regular rate and rhythm, no murmurs, rubs, gallops abdomen: obese abodmen, soft, non-tender, nomal bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: bl le edema with lichenification and venous stasis changes. erythema of rle from ankle to thigh. skin breakdown on the back of the right calf with minimal drainage noted. on transfer to medicine: vs: t: 97.8; bp: 106/53 (83-120/38-65); hr: 83 (83-95) ; rr: 16 99% 2l los: + 4256cc ga: obese women, lying flat, very pleasant, a&ox3 heent: eomi, mmm. no lymphadenopathy. neck supple. jvd difficult to assess cards: rrr s1/s2 heard. no murmurs rubs or gallops pulm: patient was unable to turn pain of right knee so difficult to assess, but lung sounds present with no audible rales abd: soft, nt nd, +bs. organomegaly difficult to assess extremities: rle wrapped with jp drain in place. lle with chronic skin changes, minimal pitting edema skin: warm and moist neuro/psych: cns ii-xii intact. discharge exam: vs: 98.2, 122/58, 84, 16, 94%ra fs 100s-200s in: 360/8hr, out 1000 (foley) ga: obese women, lying flat, sleeping, comfortable, pleasant, a&ox3 heent: mmm. no lymphadenopathy. jvd difficult to assess cards: distant, rrr s1/s2 heard. no murmurs rubs or gallops pulm: ctab. no wheezes, rales or rhonchi, good inspiratory effort. abd: obese, soft, nt nd, +bs. organomegaly difficult to assess. extremities: rle wrapped, knee with stapled incision looking clean intact and healing well. right foot with 2+ edema. lle with chronic skin changes, minimal pitting edema, right hand with mild erythema around the base of the thumb stable from yesterday. skin: warm and moist neuro/psych: less confused this morning, a&ox3. cns ii-xii intact. moving all extremities. pertinent results: admission labs: 11:30am blood wbc-22.4*# rbc-4.12* hgb-13.3 hct-41.5 mcv-101* mch-32.2* mchc-31.9 rdw-13.0 plt ct-291 11:30am blood neuts-92.6* lymphs-4.4* monos-2.3 eos-0.4 baso-0.2 12:33pm blood pt-13.7* ptt-29.7 inr(pt)-1.3* 11:30am blood glucose-274* urean-38* creat-1.4* na-133 k-4.6 cl-97 hco3-20* angap-21* 11:37am blood lactate-2.8* . joint fluid analysis wbc rbc polys lymphs monos 10:50 * * 100* 0 0 . inflammatory markers: 07:00am blood esr-127* 07:00am blood crp-142.8* discharge labs: 07:35am blood wbc-8.9 rbc-3.25* hgb-10.3* hct-31.7* mcv-98 mch-31.7 mchc-32.5 rdw-13.1 plt ct-620* 07:35am blood calcium-9.0 phos-4.0 mg-2.0 07:35am blood glucose-104* urean-24* creat-1.1 na-136 k-4.4 cl-103 hco3-26 angap-11 urine analysis: 11:40am urine color-amber appear-cloudy sp -1.018 11:40am urine blood-mod nitrite-neg protein-30 glucose-150 ketone-10 bilirub-neg urobiln-2* ph-5.0 leuks-lg 11:40am urine rbc-44* wbc->182* bacteri-many yeast-none epi-0 repeat after antibiotics: 01:03pm urine color-yellow appear-cloudy sp -1.018 01:03pm urine blood-sm nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-2* ph-5.0 leuks-sm 01:03pm urine rbc-4* wbc-6* bacteri-none yeast-none epi-0 microbiology: blood culture: beta streptococcus group g. (second bottle), , , blood culture ngtd , urine culture negative mrsa screen negative jount fluid:gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. 3+ (5-10 per 1000x field): gram positive cocci. in pairs and chains. reported to and read back by to @1345 . fluid culture (final ): beta streptococcus group g. moderate growth. sensitivities per dr # . sensitivity testing performed by sensititre. sensitive to clindamycin mic <=0.12 mcg/ml. sensitivities: mic expressed in mcg/ml _________________________________________________________ beta streptococcus group g | clindamycin----------- s erythromycin----------<=0.25 s penicillin g----------<=0.06 s vancomycin------------ <=1 s tissue: tissue bone right knee. gram stain (final ): reported to and read back by @ 2211 on - cc7d. 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 3+ (5-10 per 1000x field): gram positive cocci. pairs and short chain. tissue (final ): beta streptococcus group g. moderate growth. anaerobic culture (preliminary): no anaerobes isolated. imaging: ecg: rate 100, sinus tachycardia. atrial ectopy. left bundle-branch block. //11 ecg: rate 169, lead v1 is missing. regular wide complex tachycardia which is most likely a supraventericular tachycardia with inverted p waves noted in the inferior leads. compared to the previous tracing of the same date supraventricular tachycardia is new. lenis: no evidence of deep vein thrombosis in the right lower extremity. ct c-spine: 1. no acute fractures. severe multilevel degenerative changes. 2. chronic bilateral maxillary sinus disease. : cxr: no pneumonia right wrist: no acute fracture or dislocation. moderate-to-severe osteoarthritis of the first cmc and triscaphe joints. right hip: no fracture or dislocation. lumbosacral spine xray: no definite fracture or subluxation. ecg: rate 97, artifact is present. probable sinus rhythmn with atrial eactopy. the p-r interval is 180 milliseconds. left bundle-branch block. compared to the previous tracing of supraventricular tachycardia is no longer present. right knee xray: limited examination due to body habitus. probable joint effusion. however this is difficult to evaluate. prior total knee arthroplasty. the hardware appears intact. no definite peri-hardware lucency. no definite fracture identified, however no true ap and lateral views were provided. no definite dislocation. impression: limited examination as above. no definite acute abnormality. right wrist xray: as compared to the prior study, there is no substantial change with diffuse demineralization of the osseous structures that were imaged. there is no evidence of fracture or dislocation seen. severe degenerative changes of the first carpometacarpal joint and triscaphe joint are noted with joint space narrowing, subchondral sclerosis, and osteophyte formation, unchanged since the prior study. no interval development of soft tissue swelling, or subcutaneous or periarticular" gas is noted. echo: the left atrium is mildly dilated. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 50-55%). the aortic valve leaflets (?#) appear grossly normal with good leaflet excursion. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears grossly structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: very suboptimal image quality. no definite vallvular pathology or pathologic valvular flow identified. normal left ventricular cavity size with low normal global systolic function. compared with the report of the prior study (images unavailable for review) of , the severity of mtiral regurgitation is now reduced. tee: overall left ventricular systolic function is normal (lvef>55%). there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. there are three aortic valve leaflets. no masses or vegetations are seen on the aortic valve. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. there is no pericardial effusion. impression: no evidence of endocarditis. brief hospital course: 84 year-old woman with dmii, htn, hld, obesity and ckd presented one week after a mechanical fall with right knee group g strep cellulitis, septic joint, and evidence of osteomyelitis of the surrounding bones, as well as a uti. . # septic joint/osteomyelitis: joint tap of the right knee showed impressive septic joint, growing group g strep. patient was admitted to the unit after a run of svt. orthopedic surgery took the patient to the or and performed a right knee washout with replacement of the plastic liner on . a jp drain was placed for several day which drained serosanginous fluid. tissue and bone samples also growing group g strep, pansensitive. patient was inititially started on vancomycin and levofloxacin in the ed, but was broadened to vanc/zosyn in the unit, and then switched to ceftriaxone once the cultures returned on . esr (127), crp (142.8), suggestive of osteomyelitis as well. bone sample also growing group g strep. midline catheter was placed (there was difficulty advancing the picc further). infectious disease was consulted and recommended at least 6 weeks of ceftriaxone and weekly blood monitoring. patient will have opat monitoring in the outpatient setting (). tte study was suboptimal but did not show vegetations on the valves. tee did not show any valvular vegetations. jp drain was removed 2 days prior to discharge to rehab. joint was bandaged with dry sterile dressings during admission. pain was managed initially with dilaudid and transitioned to oxycodone. . #. point tenderness and erythema over right wrist: erythema and tenderness is surrounding a previous iv site, which suggests previous infilration by the iv. xray more consistent with osteoarthritis. appearance is somewhat suggestive of a cellulitis, however it has been improving since administration of ceftriazone. it has also been treated with warm compresses. . #. uti: patient had a grossly positive ua with wbc greater than assay and many bacteria. initial urine culture was mixed flora and second culture, after antibiotic administration, was negative. patient remained asymptomatic. continued ceftriaxone should adequately treat the infection. . #. hypoxemia: upon transfer from the micu, patient was 5l above her normal weight with an oxygen requirement. she was lying flat and breathing comfortably on 2l nasal cannula. patient was given lasix 20mg iv and put out 4l of urine. soon after, patient was weaned off supplemental oxygen and breathing comfortably on room air. echo shows ef>55%. . #. svt: patient had a single observed run of svt to 160s in the ed likely secondary to infection. no repeat episode has been observed. patient was monitored in the micu and transferred to the floor, shortly after without any further events. during her hospitalization, she remained on diltiazem. it was discontinued several days prior to discharge without any further events. . #. dmii: held oral diabetic medications while inpatient. continued home lantus therapy and covered with an iss. finger sticks remained in the mid 100s - mid 200s. . #. htn: initially held lisinopril for concern of low blood pressure and recurrence of svt, but we were able to restart it without any issues. patient was also in diltiazem initially on admission. just prior to discharge, lisinopril with discontinued for a rising creatinine (1.2) and k+ (5.2). blood pressures were monitored and systolics were below 140. . #. hld: continued statin therapy. . #. ckd: initially held lisinopril for low blood pressure. it was restarted prior to discharge, but again discontinued for rising k+ and creatinine. urine lytes were unrevealing and her creatinine improved on . . transitional issues: - foley pulled at 7:30am, if does not urinate will need foley replacement and another trial of voiding in days. patient will go to rehab to build up her strength. additionally, she will have follow up with infectious disease at clinic and weekly lab draws. she will also need to schedule an appointment with her original orthopedic surgeon to decide whether she will require further treatment of her knee or replacement of the hardware present. medications on admission: glimepiride 4mg metformin 250 mg lisiniprol 20 mg simvastatin 40 aspirin 81 mg januvia 100 mg levemir insulin 55 units daily discharge medications: 1. glimepiride 4 mg tablet sig: one (1) tablet po twice a day. 2. metformin 500 mg tablet sig: 0.5 tablet po twice a day. 3. simvastatin 40 mg tablet sig: one (1) tablet po once a day. 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. januvia 100 mg tablet sig: one (1) tablet po once a day. 6. levemir 100 unit/ml solution sig: fifty five (55) units subcutaneous once a day. 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 8. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po daily (daily). disp:*30 packet* refills:*2* 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 10. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain: do not exceed 4gm a day. disp:*100 tablet(s)* refills:*0* 11. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*80 tablet(s)* refills:*0* 12. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: two (2) grams intravenous q24h (every 24 hours): continue until the infectious disease specialists tell you to stop. disp:*84 grams* refills:*0* 13. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. disp:*20 syringes* refills:*1* 14. enoxaparin 30 mg/0.3 ml syringe sig: thirty (30) mg subcutaneous q12h (every 12 hours) for 2 weeks. disp:*28 syringes* refills:*0* 15. outpatient lab work weekly labs while on ceftriaxone: please draw cbc with differential, basic metabolic panel, liver function tests, esr, crp and fax results to infectious disease at #. 16. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: discharge diagnosis: primary diagnosis: septic knee secondary diagnosis: type ii diabetes, hypertension, high cholesterol, obesity, mild renal insufficiency, and a previous history of asthma. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms. , it was a pleasure taking care of you at . you were admitted for an infection in your knee which required a surgical procedure to remove the infected material. the plastic liner in your knee was replaced during the procedure. you were treated with antibiotics and are doing better, although you will need to continue intravenous antibiotics as an outpatient to fully treat the infection and you will need to go to a rehabilitation facility to get your mobility back. you should follow up with the infectious disease specialists (see appointment below) and with your original orthopedic surgeon at . the following medications were added: continue ceftriaxone 2gm intravenously one time daily - course will be decided by infectious disease physicians. take tylenol 650mg every 4 hours as needed for pain. do not exceed 4gms per day. take oxycodone 5mg by mouth every 6hours as needed for pain. continue lovenox 30mg 1 syringe twice daily, continue for 2 weeks take lisinopril 10mg (you used to take 20mg) by mouth daily. while on all these pain medications you are at risk risk for constipation. please take the following medications regularly to keep your bowel movements soft. take senna 1 tablet by mouth twice daily. take docusate sodium 1 tablet twice a day by mouth. take miralax 1 packet by mouth daily. please continue your other medications as prescribed. no other changes have been made. followup instructions: please schedule an appointment with your primary care doctor after your leave rehab. dr office number is: #. please schedule a follow up appointment with the original orthopedic surgeon that first operated on your knee. you should schedule this appointment for as soon as possible. department: infectious disease when: friday at 9:00 am with: , md building: lm campus: west best parking: garage department: infectious disease when: tuesday at 10:00 am with: , md building: lm bldg () campus: west best parking: garage you will additionally need weekly blood draws for monitoring while you are on the intravenous antibiotics. md procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart arthrocentesis synovectomy, knee insertion or replacement of (cement) spacer central venous catheter placement with guidance diagnoses: urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified sepsis chronic kidney disease, unspecified other specified cardiac dysrhythmias morbid obesity hypoxemia surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation streptococcal septicemia knee joint replacement cellulitis and abscess of hand, except fingers and thumb pyogenic arthritis, lower leg infection and inflammatory reaction due to internal joint prosthesis unspecified osteomyelitis, lower leg osteoarthrosis, generalized, site unspecified other synovitis and tenosynovitis 

Answer: The patient is high likely exposed to