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: thoracic spine ulcer major surgical or invasive procedure: picc ir-guided drainage of superficial paravertebral abscess picc intubation with subsequent extubation history of present illness: 83f with h/o chondrosarcoma s/p thoracic fusion/resection and xrt who presented to osh with complaint of non-healing thoracic ulcer for one year with recent increase in drainage/purulence. her neurosurgeon is at mwh - dr. . she was supposed to be taken straight to per her neurosurgeon at mwh but somehow went there first. in the mwh ed she was documented as having a normal neurologic exam, a ua done for workup of fever which was negative, she was reportedly given ctx and was transferred here for evaluation of her ulcer. in the ed at her initial vs were: 98.5 80 112/58 16 96. exam significant for low rectal tone, guaiac negative. strength lower extremities bilaterally. decreased sensation in lower extremities. cn intact. upper extremities intact. received ns and vanc. patient had been walking prior to this per ed staff. however, lower extremity weakness, bowel incontinence, bladder incontinence is old per neurosurgery. neurosurgery felt that the weakness and low rectal tone in the lower extremities was chronic and thus did not feel it was a neurosurgical emergency. in all of the documentation sent from hospital the neurologic exams are recorded as normal, however, in a report from the nh it notes that she has a paraplegia from the t10 level down and the patient reports that she has not been able to walk since the wintertime and has had weakness for at least a year. mr t spine was performed, which showed paraspinal abscess with probable mass effect causing cord compression, as well as likely osteomyelitis/diskitis. . vs prior to transfer to the floor: 99 96 131/70 18 96% 2l . on presentation to the floor patient was hoh but denied pain. denied new weakness. reported bowel and bladder incontinence was old - has had since at least last winter. denied fevers, chills, nightsweats, back pain, dysuria, rash. past medical history: - cad s/p cabg x4 - chondrosarcoma originally dx , s/p resection, with recurrence in 06, s/p t5-t8 posterior fixation in 07 and resection with indwelling hardware in her spine and also s/p radiation treatment - chronic thoracic ulcer, non-healing, approx. 1 yr - htn - hyperlipidemia - severe kyphoscoliosis - mild rhabdomyolysis - dementia - ?paraplegia from t10 level hardware malalignment (per nh notes) social history: lives at nursing home. per discussion with hcp, patient has complicated family life in which ?niece in the past refused treatment and only wanted supportive measures obo the patient, but that the patient really wanted to be full code, full care. hcp was recently set as a neigbor of the , . home phone: , cell: . liaison at nh is , . pcp: . family history: not able to obtain given poor historian. physical exam: vitals: t 99 hr 90 bp121/66 rr 22 o2 97% 2l gen: slim elderly f in nad heent: nc/at anicteric sclera dry mm neck: supple. no lad lungs: ctab heart: rrr no m/r/g abd: soft. nt/nd, +bs. foley in place rectal: brown stool with low rectal tone back: 2x2 cm purulent draining ulcer at about level of t4 with hardware showing through ulcer and surrounding erythema. severe kyphoscoliosis extrem: no edema neuro: a+ox3. cn 2-12 in tact. unable to passively move legs or toes. no sensation in lower extremities bilaterally below approx. t10 level. reflexes 3+ bilateral lower extremity (patellar) and 1 bilateral upper extrem (brachioradialis). sensation and strength intact in bilateral upper extremities. pertinent results: 08:20pm wbc-19.6* rbc-4.08* hgb-11.4* hct-34.3* mcv-84 mch-28.0 mchc-33.3 plt ct-562* 08:20pm neuts-85* bands-1 lymphs-4* monos-10 eos-0 baso-0 atyps-0 metas-0 myelos-0 08:20pm pt-14.0* ptt-30.8 inr(pt)-1.2* 06:45am esr-120* 06:45am crp-greater than 300 08:32pm lactate-1.5 06:45am calcium-8.5 phos-3.5 mg-1.9 06:45am alt-33 ast-30 alkphos-105 totbili-0.5 . bcx , : staph aureus coag + | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s aspiration of superficial paravertebral collection : staph aureus coag + | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s . pleural analysis () wbc 174, rbc 139, polys 23, lymphs 38, monos 20, macro 18 other 1 . pleural chemistry () totprot 3.4, glucose 177, ld(ldh) 113 . ekg (): sinus rhythm. consider left ventricular hypertrophy by voltage. modest inferolateral st-t wave changes are non-specific. no previous tracing available for comparison. . t-spine xr (): nondiagnostic thoracic spine radiographs. . cxr (): severely limited study due to severe kyphoscoliosis. there is a left pleural effusion. a left lower lobe consolidation cannot be excluded. . mr (): 1. interval development of osteomyelitis and discitis extending from the t6- t9 vertebral bodies with prevertebral, paravertebral, and epidural extension resulting in stenosis of the spinal canal at t7/8. recommend continued interval follow-up to exclude recurrent neoplasm. 2. interval increase in bilateral pleural effusions, left greater than right. . ct t-spine (): 1. osteomyelitis and discitis, with fragmentation of vertebral bodies t6-t8, but better appreciated on mri scan from one day prior. 2. soft tissue defect posteriorly at level of t7, with left paraspinal abscess at this level. 3. right anterior paraspinal soft tissue enhancing lesion with loculated fluid and gas, most likely to represent abscess and adjacent phlegmon with inflammatory change. however, underlying soft tissue neoplasm at this site is difficult to exclude given iv contrast enhancement, and recommendation was already made for surveillance. 4. bilateral pleural effusions, large on the left causing near-collapse of the left lower lobe. note added at attending review: i agree with the above findings. note particularly the fragmentation of the t8 vertebral body anteriorly and dramatic lucency within the body posterolaterally. there is lucency surrounding the t8 pedicle screws, suggesting loosening and premably infection. these findings also suggest advanced osteomyelitis. . abscess aspirate (): successful ultrasound-guided aspiration of superficial paravertebral collection. . tte (): no vegetations seen. mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. absence of vegetations on transthoracic echocardiogram does not exclude endocarditis. . picc (): uncomplicated ultrasound and fluoroscopic-guided single-lumen picc line placement via the right brachial venous approach. final internal length is 33 cm, with the tip positioned in svc. the line is ready to use. note is made of arterial puncture of the left brachial artery with pressure held for five minutes with no immediate post-procedure complications without developing hematoma or loss of distal pulses noted. . video swallow (): barium passed freely through the oropharynx and esophagus without evidence of obstruction. there was no gross aspiration or penetration . chest (portable ap) study date of 3:58 pm compared to prior radiographs from ealier today, there has been marked reduction in size of the left pleural effusion, now small, consistent with history of thoracentesis. there is no pneumothorax. a small- to-moderate left pleural effusion persists. minimal right perihilar opacity is not significantly changed. a right picc line is unchanged in position. patient is status post median sternotomy with thoracic fixation hardware again noted. healed posterior rib fractures are seen on the left. impression: no pneumothorax status post left thoracentesis. brief hospital course: #hypercarbic respiratory distress - on the evening of , the patient became acutely dyspnic and confused while receiving two units of prbc. abg showed hypercarbia with pco2 in 105, shortly thereafter patient became less reponsive and code blue was called for respiratory failure. she was intubated without complication and transferred to the icu. most likely cause is volume overload secondary to prbc transfusion in patient with poor baseline pulmonary reserve given previous kyphoscoliosis, bilateral effusion and inablility to fully expand lungs as previously noted in pulmonary consultation. effusion appeared acutely worse on cxr. concern for possible aspiration however bedside bronch did not reveal any obstruction/consolidation. she was started on cefepime and vancomycin for presumed hap, but cultures were all negative and patient remained afebrile with no white count. upon transfer from the micu, she was on only ancef (for paraspinal abscess and osteomyelitis). she was extubated without complication, and remained stable from a respiratory standpoint and was saturating 97% on 2lnc upon transfer from the micu. her improvement was attributed to diuresis with lasix with a goal of 2l negative a day. she does have a right sided effusion, which does not require thoracentesis at this time in light of respiratory improvement. she had an effusion tapped by interventional pulmonology, which appeared transudative. following this procedure, she had stable respiratory status on 2l nc. - cytology on effusion is pending # paraspinal abscess/osteomyelitis/bacteremia - mr imaging strongly suggestive of t6-t8 osteomyelitis, diskitis, hardware infection, and prevertebral, paravertebral, and epidural extension resulting in stenosis of the spinal canal at t7/8. examination of wound showed clearly exposed hardware with no overlying barrier. picc was placed. ir-guided drainage of abscess performed, initially the patient was placed on vanc + ceftazidime (hd ). pt was then switched to nafcillin monotherapy (hd ) when bcx and abscess cx grew out mssa. pt was then switched to cefazolin (hd 8-discharge) when nafcillin potentially caused ain (see below). tte was performed and showed no vegetations; bcx negative as of hd 3. patient was initially scheduled for removal of implanted thoracic spine hardware by neurosurgery and surgery, but was delayed once for arf, and a second time by gi bleeding. patient was subsequently seen by pulmonology to assess chances of her coming off of the ventilator should the surgery occur. due to severe kyphosis, low respiratory reserve, and generalized weakness, patient would likely require a prolonged course on the ventilator, likely needing a tracheostomy. patient is stable, afebrile, and pain free on medical treatment of infected hardware, for the time being will be continued on antibiotics. hcp with the more conservative medical management, saying that pt would not have wished to been on the ventilator. patient was also in agreement with deferring surgery indefinitely. infectious disease made antibiotic recommendations in light of her hardware remaining, which are cefazolin for 6 weeks starting from , to be followed by cefalexin po for chronic suppression. . # arf - creatinine rose to 1.3 (from 0.5), diminished urinary output, elevated wbc noted on hd7. ua positive for eosinophils. pt had suffered diarrhea on hd6. arf attributed to volume depletion and possible ain. pt was volume resuscitated, nafcillin was discontinued and replaced with cefazolin. the patient's creatinine initially remained stable but after 72-96 hrs began to improve. this is clinically consistent with ain from nafcillin exposure. creatinine trended down to 0.9 over course of admission and was stable during diuresis in the micu as well as on readmission to the medical floor. . # gi bleed - pt was found to have a few episodes of melenotic stool and was observed ot have a hematocrit drop of 5. patient was transfused 2 units of prbc twice to maintain a goal hematocrit of >30 given her history of cad. patient was started on pantoprazole iv bid, and asa and heparin was discontinued in light of gi bleed. gastric lavage was performed which returned heme negative aspirate. gi was consulted and did not do an egd. . # inr - unclear why patient had elevated inr of 4.6, thought to be likely due to poor nutrition, as patient has been eating poorly as well as receiving antibiotics. pt was given vit k 5 mg and 4 units of ffp with inr correcting to 1.4. inr on discharge was 1.0. . # nutrition/swallow - pt was noted to have poor swallowing during meals. soft meals with thickened liquids with 1:1 observation during meals per nutrition recs. no aspiration seen on video swallow study. . # diarrhea - pt with numerous bm starting on hd6. concern for c. diff given antibiotic therapy. c. diff eia toxin a+b neg x 3. . # cad s/p cabg - patient had no complaints of chest pain. was initially continued on home doses of metoprolol and aspirin. metoprolol was increased to 25mg for better bp control. . # dementia - patient was continued on home dosage of aricept. medications on admission: metoprolol 12.5mg thiamine 100mg daily mvi folic acid 1 mg daily asa 81mg daily hctz 12.5mg daily natural tears 1gtt colace 100mg aricept 5mg daily discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever. 2. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) treatment inhalation q4h (every 4 hours) as needed for wheeze. 4. ipratropium bromide 0.02 % solution sig: one (1) treatment inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 7. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 8. multivitamins tablet, chewable sig: one (1) tablet po daily (daily). 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. guaifenesin 100 mg/5 ml syrup sig: five (5) ml po q6h (every 6 hours) as needed for cough. 11. donepezil 5 mg tablet sig: one (1) tablet po hs (at bedtime). 12. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 13. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 14. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 15. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 16. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 17. cefazolin 1 gram recon soln sig: one (1) gram intravenous every twelve (12) hours for 23 days: please continue iv cefazolin until . then start on po keflex as prescribed. 18. keflex 500 mg capsule sig: one (1) capsule po every eight (8) hours: please start on after iv antibiotic course if completed. 19. outpatient lab work please draw weekly cbc, ast, alt, electrolytes, bun, creatinine and fax results to dr. (infectious diseases) at ( 20. wound care thoracic spine ulcer: pack loosely with damp amd gauze 1" cover with 4 x 4s, abd secure with medipore tape change dressing 2 - 3 x a day 21. pressure ulcer precautions pressure ulcer care per guidelines: turn and reposition off back q 2 hours and prn limit sit time to 1 hour at a time using a pressure redistribution cushion discharge disposition: extended care facility: riverbend of discharge diagnosis: primary diagnoses: osteomyelitis paraspinal abscess with cord compression bacteremia arf likely due to ain secondary diagnoses: cad s/p cabg x4 h/o chondrosarcoma s/p t5-t8 posterior fixation in and resection with indwelling hardware in her spine and also s/p radiation treatment hypertension hyperlipidemia kyphoscoliosis mild rhabdomyolysis dementia discharge condition: awake, alert, comfortable, saturating well on 2l nasal canula discharge instructions: you were admitted for an infection in your back. you were given antibiotics for the infection. during your hospitalization, your kidneys suddenly worsened in function. after some additional laboratory work, we believe that this was due to an uncommon reaction to the antibiotics you were being given for your infection. this antibiotic was immediately stopped and replaced with another antibiotic that would also be effective for your infection. your kidney function gradually improved after the medication change. you also had in your stool, which resolved on its own. you were transferred to the icu briefly and intubated for difficulty breathing. you had some fluid surrounding your lungs removed which helped with the breathing. it was decided that the risks outweighed the benefits for the hardware in your spine to be removed. you will be kept on iv antibiotics until and then switched to oral antibiotics. there were changes made to your medications, please take them as prescribed. if you notice pain, fever, chills, loss of your ability to move your arms, or any symptom that concerns you, please return to the emergency department immediately. followup instructions: provider: , md phone: date/time: 11:30 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified insertion of endotracheal tube thoracentesis other bronchoscopy other exploration and decompression of spinal canal transfusion of packed cells continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified insertion of endotracheal tube thoracentesis other bronchoscopy other exploration and decompression of spinal canal transfusion of packed cells diagnoses: anemia of other chronic disease acute kidney failure with lesion of tubular necrosis unspecified pleural effusion acquired coagulation factor deficiency hyposmolality and/or hyponatremia aortocoronary bypass status unspecified osteomyelitis, other specified sites other persistent mental disorders due to conditions classified elsewhere other and unspecified hyperlipidemia acute respiratory failure bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site blood in stool 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 scoliosis [and kyphoscoliosis], idiopathic rhabdomyolysis personal history of irradiation, presenting hazards to health paraplegia pressure ulcer, stage iv disruption of external operation (surgical) wound intervertebral disc disorder with myelopathy, thoracic region infection and inflammatory reaction due to other internal orthopedic device, implant, and graft penicillins causing adverse effects in therapeutic use pressure ulcer, upper back 

Answer: The patient is high likely exposed to