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: fever, hypotension major surgical or invasive procedure: right ij central venous catheter (has since been removed) left-sided picc placement history of present illness: mr. is a 77y/o gentleman s/p l orif on (pod 7), p/w temp 104.2 yesterday at rehab with hypotension. underwent l orif of distal femur after falling from ladder. pt had an uncomplicated hospital course and was d/c'd to on . last night pt had a fever of 104.2 with chills and hypotensive sbp 80s. pt was taken to and pressure in 90s. cxr done and concerning for r sided fluid collection, given tylenol and transfered to . denies shortness of breath, chest pain or posterior leg pain. cough started today, productive of non-bloody sputum. pt admits to dizziness two days ago during rehab and standing up. pain from surgical site tolerable. also admits to foul-smelling urine and dysuria for the past 2-3 days and was told at that he has a uti. was not on antibiotics. ed course: slight crackles at lung bases. triggered for bp 82/50. 100.9 temp. started vanco/cefepime. right ij placed and started on norepi 0.12mcg/kg/min. 98/59. hr 94. 99% on 2l, rr25 past medical history: 1. osteoarthritis, bilat knees, s/p r tka at the 2. history of atrial flutter, afib with an ablation procedure. 3. moderate aortic stenosis 4. hypertension. he is tolerating his current medication. 5. hyperlipidemia. 5. chronic anxiety 6. prostate cancer s/p resection 7. skin cancer, r thigh ca 8. hospitalization for l femur fracture after falling off ladder, s/p orif social history: he is a nonsmoker. he drinks alcohol socially and occasionally, about two or three drinks a week. family history: nc physical exam: admission exam admit vitals: t 100.9. bp 98/59. hr 94. sat 99% on 2l, rr25 general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi 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 neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact discharge exam: vs: t98.4 afeb o/n 128/69, 110-120s/60s p100 80s r24 97% ra general: alert, oriented, no acute distress, pleasant, cooperative heent: sclera anicteric, mmm, eomi, perrl neck: supple, no jvd cv: regular rate and rhythm, normal s1 + s2, 3/6 systolic murmur heard best at the apex, no rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, distended, bowel sounds present, no organomegaly ext: l lateral leg with diffuse ecchymoses which extends to l lower back, staples intact, no d/c or bleeding, appropriately tender. calves symmetrical, no tenderness. l foot 1+dp pulse, 2+ dp pulse r foot neuro: cnii-xii intact, 5/5 strength upper/lower extremities on left, 3/5 strength in right ue with improved supination, strength worse with elbow extension (though improved) than elbow flexion, grossly normal sensation, gait deferred, no facial asymmetry gu: penile swelling, foley intact to gravity pertinent results: admission labs: 02:55pm blood wbc-19.9*# rbc-2.49* hgb-8.2* hct-24.9* mcv-100* mch-33.0* mchc-33.0 rdw-14.0 plt ct-256# 02:55pm blood neuts-89.0* lymphs-6.8* monos-4.0 eos-0 baso-0.2 02:55pm blood pt-12.8* ptt-28.3 inr(pt)-1.2* 02:55pm blood glucose-141* urean-25* creat-0.8 na-134 k-3.9 cl-98 hco3-27 angap-13 04:25am blood alt-200* ast-215* alkphos-256* totbili-2.4* 02:55pm blood calcium-8.5 phos-3.1 mg-2.1 03:06pm blood lactate-1.7 other pertinent labs: 03:47am blood esr-120* 03:47am blood crp-128.5* 06:10am blood vitb12-* folate-greater th 03:47am blood hbsag-negative hbsab-negative 05:03am blood vanco-17.0 discharge labs: 05:03am blood wbc-11.7* rbc-2.51* hgb-7.9* hct-25.1* mcv-100* mch-31.7 mchc-31.7 rdw-15.2 plt ct-548* 05:55am blood pt-25.6* ptt-38.9* inr(pt)-2.5* 05:03am blood glucose-120* urean-13 creat-0.9 na-136 k-4.1 cl-103 hco3-28 angap-9 05:03am blood alt-51* ast-42* alkphos-212* totbili-1.1 05:03am blood albumin-2.5* calcium-8.3* phos-3.6 mg-2.3 ======================================== urinalysis: 03:20pm urine color-yellow appear-hazy sp -1.015 03:20pm urine blood-mod nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-neg 03:20pm urine rbc-1 wbc-5 bacteri-none yeast-none epi-<1 03:20pm urine castgr-4* casthy-1* ======================================== micro data: urine culture - no growth blood culture x 2 - no growth blood culture x 2 - no growth blood culture x 1 - no growth urine culture - no growth 2:40 pm blood culture #1. **final report ** blood culture, routine (final ): staph aureus coag +. sensitivities performed on culture # from . consultations with id are recommended for all blood cultures positive for staphylococcus aureus, yeast or other fungi. aerobic bottle gram stain (final ): reported to and read back by dr. . morganstein on at 0550. gram positive cocci in clusters. anaerobic bottle gram stain (final ): gram positive cocci in clusters. 2:55 pm blood culture **final report ** blood culture, routine (final ): staph aureus coag +. consultations with id are recommended for all blood cultures positive for staphylococcus aureus, yeast or other fungi. final sensitivities. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. this isolate is presumed to be resistant to clindamycin based on the detection of inducible resistance . sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s aerobic bottle gram stain (final ): gram positive cocci in clusters. anaerobic bottle gram stain (final ): gram positive cocci in clusters. ======================================== ecg 2:15:40 pm borderline sinus tachycardia with multiple premature atrial contractions and a single ventricular premature contraction. incomplete right bundle-branch block. early anterior r wave transition. non-specific repolarization abnormalities in the inferolateral leads. compared to the previous tracing of the rate is faster and now borderline tachycardic. computed p-r interval is shorter and no longer prolonged. rsr' pattern is new in lead v1, suggesting incorrect right precordial electrode placement. early anterior r wave transition is unchanged. t wave amplitude is improved in lead ii, v3-v5. atrial and venticular ectopy are new. frontal plane axis is slightly less horizontal. ecg 8:53:20 am atrial fibrillation with rapid ventricular response. compared to the previous tracing atrial fibrillation is new. otherwise, similar findings are noted. ecg 11:27:30 am normal sinus rhythm. incomplete right bundle-branch block. isolated ventricular premature beats. non-specific st-t wave changes. compared to the previous tracing of the patient is now in sinus rhythm. ecg study date of 12:02:22 pm sinus rhythm with supraventricular premature depolarizations. compared to the previous tracing p wave morphology now appears more homogeneous. cxr : peripheral reticular opacities raise concern for underlying interstitial lung disease. no acute findings. cxr : ap supine portable chest radiograph obtained. there is interval placement of a right ij central venous catheter with tip located in the superior vena cava. there is no pneumothorax. otherwise, no change. ======================================== femur (ap & lat) left : post-orif changes of the left femur without signs of soft tissue gas. femur (ap & lat) left the patient is status post open reduction and internal fixation of a left femur fracture, which is maintained in alignment with an intramedullary rod and interlocking screws. as compared to the recent study, the radiographic appearance of the hardware, the visibility and alignment at the fracture site, and adjacent soft tissue structures all appear similar to the previous study. there is no evidence of instrument hardware failure or convincing radiographic evidence of osteomyelitis. ======================================== cta chest : 1. left lingular segmental pulmonary embolism 2. mild pulmonary edema. 3. bibasilar opacities could represent superimposed infection. 4. large right renal cyst. 5. aortic mitral annular and coronary artery calcifications. echo : the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). the ascending aorta is mildly dilated. the aortic valve leaflets are moderately thickened. no discrete vegegation is seen (cannot exclude). there is severe aortic valve stenosis (valve area 1.0cm2). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. physiologic mitral regurgitation is seen (within normal limits). there is mild-moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a prominent fat pad. impression: suboptimal image quality. severe aortic valve stenosis. mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. pulomonary artery hypertension. no discrete vegetation is seen (does not exclude endocardits if clinically suggested). compared with the prior study (images reviewed) of , the severity of aortic stenosis has progressed and pulmonary artery hypertension is now identified. valve morphology is grossly similar. ======================================== mri c/t/l-spine w/ and w/o contrast : 1. mid-cervical epidural enhancement and abnormal stir hyperintensity in the lower cervical vertebral bodies. taken together, in this patient with known recent bacteremia, fevers, leukocytosis and neck pain, these findings suggest osteomyelitis with epidural extension. there is no definite abscess as yet. 2. numerous lumbar spinal findings, likely congenital, including diastematomyelia, a tethered cord and a fatty filum terminale. mri c-spine w/ and w/o contrast 1. findings are suggestive likely of infection/septic arthritis involving the right c5-6 facet joint with adjacent soft tissue inflammatory changes and likely less than 5-mm cm fluid collection in the paraspinal region. 2. epidural phlegmon posterior to the thecal sac from c2-3 to c7 level without epidural abscess. 3. mild decrease in epidural enhancement anterior to the thecal sac in the cervical region compared to the mri of . 4. posterior soft tissue changes are unchanged compared to the prior study. no evidence of cord compression. ======================================== ct head : 1. no evidence of acute intracranial hemorrhage. 2. findings consistent with chronic ischemic disease. liver or gallbladder us 1. unremarkable appearance of the liver with no hepatic fluid collection and no biliary dilatation seen. 2. no gallstones. the gallbladder is noted to be contracted. 3. right pleural effusion. no ascites. 4. two simple right renal cysts. brief hospital course: mr. is a 77y/o gentleman with htn and prior aflutter/afib s/p ablation, who is s/p l femur orif on after sustaining fall from ladder, was discharged to rehab and was transferred here from an osh for septic shock in the setting of mrsa bacteremia and c-spine osteomyelitis. his stay was also notable for diagnosis and treatment of pulmonary embolism, rue weakness that was likely related to the spine process, and urinary retention requiring foley catheter. he was initially stabilized in the micu for 1 week, then he was then transferred to the floor and was ultimately discharged to rehab on hospital day 12. #. sepsis/mrsa bacteremia: resolved. he was transfered to the micu on levophed in presumptive septic shock considering his hypotension and fulfilment of sirs criteria with leukocytosis, fever, tachycardia, and tachypnea. he was followed by id service. he was initially treated with vancomycin and cefepime, but after 5 days his cefepime was discontinued given clinical suspicion for mrsa and the culture data revealing mrsa-positive blood cultures from admission (which subsequently cleared). tte was negative for endocarditis. the most likely explanation is that he developed a post-op hematoma, which was complicated by infection and seeding of the blood stream. subsequent blood cultures were negative and he was discharged on vancomycin via picc line for total ~6 weeks (proposed end day is ). he will follow-up at clinic for antibiotic management. #. neck pain, rue weakness: c5-c6 facet osteomyelitis. mri c-spine suggested osteo. repeat mri c-spine on was initially concerning for worsened fluid collection/?phlegmon, but per review of the imaging, ortho spine was not concerned for abscess. per neurology consult: "patient has clinical right polyradiculopathy in essentially c5/6 levels (given lmn pattern weakness in c5/6 innervated muscles, reduced tone and dropped reflexes) which may well be related to the significant findings on his mri which are concerning for an infective process involving the lower cervical region with possible septic arthritis without epidural abscess. his weakness is pretty profound however and should he not improve he may benefit from emg to better delineate this." he will be treated with vancomycin via picc line for total ~6 weeks (proposed end day is ). he will follow-up at clinic for antibiotic management. he should have a repeat mri in .5 weeks after discharge (as scheduled on d/c paperwork), which will be followed up by the infectious disease team. by the time of discharge, he still had significant rue weakness but improved grip strength and supination. he will follow up with neurology after discharge. #. segmental pe: stable, now on warfarin. he was on lovenox prophylaxis after his orif, but on arrival to , he underwent cta due to tachypnea tachycardia, elevated bnp, elevated troponin, and new right bundle branch block on ekg. he was found to have a left lingular segmental pulmonary embolism. never became very hypoxic and he is comfortable breathing room air. he was bridged to warfarin using a heparin drip. he is being discharged on warfarin with goal inr , for a proposed duration of at least 6 months (to be decided by pcp and cardiologist). inr on the day of discharge was 2.3 and next inr should be checked tomorrow (). #. urinary retention: now has foley. he failed voiding trial and required straight cath x2; subsequent attempts to replace foley were unsuccessful. on , urology was consulted and foley was placed. he should have a voiding trial on . if it is preferred, this could occur at urology in dr. office . #. s/p left orif: stable. no issues this hospitalization; orthopedic service was following along. will follow up in ortho trauma clinic in ~1 week (as scheduled in d/c paperwork). he was evaluated by pt who recommended discharge to rehab. he is wbat with walker. #. s/p svt/afib in the micu: resolved. he does have a h/o aflutter/afib s/p ablation in the past but in the micu he did have a few episodes of svt that resolved with vagal maneuvers. one ekg does suggest afib. he was started on diltiazem and this was no longer a problem. is being discharged on diltiazem er 300mg daily. he should follow up with his cardiologist, dr. . #. elevated transaminases: resolving but still present. on arrival, had transaminitis to the 200's with tbili 2.5. thought to be likely due to congestive hepatopathy either from low-flow or (resolving) shock liver. ruq u/s was reassuring without e/o abscess or acute parenchymal changes. hepatitis b and c serologies were negative. lfts trended down and by the time of discharge, transaminases were 40-50 and tbili 1.1. further workup of his mild transaminitis can be deferred to the outpatient setting. #. h/o htn: bp is stable. while he was acutely ill in the hospital, his lisinopril was held. he continues on diltiazem, which was started this admission (see above). if his bp continues to be stable upon discharge, he could certainly be restarted on lisinopril. #. hyperlipidemia: stable. he was continued on atorvastatin. #. anemia: was transfused, then hct was stable. hct>40 before surgery, but since has been in mid 20s. per records, mcv usually in low 100s. be chronic b12/folate deficiency anemia worsened by acute blood loss from recent surgery. b12 and folate were continued throughout course. he did receive 3u prbc on with subsequent hcts stable. #. anxiety/insomnia: stable. he was started on seroquel at bedtime as needed for insomnia. his lorazepam was held as it was not needed this admission. #. transitional issues -follow-up: with id/opat, ortho trauma, cardiology, neurology -keep hip staples in until ortho follow-up (scheduled) -he should have a repeat mri 1 week after discharge (as scheduled on d/c paperwork); this will be followed up by id -he is being discharged on warfarin with goal inr , for a proposed duration of at least 6 months (to be decided by pcp and cardiologist). inr on the day of discharge was 2.3 and next inr should be checked tomorrow (). -he should have a voiding trial on . if it is preferred, this could occur in clinic with dr. . -further workup of his mild transaminitis can be deferred to the outpatient setting. -emergency contact: (daughter/hcp) -code status: full code (confirmed) medications on admission: preadmission medications listed are correct and complete. information was obtained from webomr and rehab. 1. acetaminophen 1000 mg po tid 2. ascorbic acid 1000 mg po daily 3. atorvastatin 10 mg po daily 4. bisacodyl 10 mg po daily:prn constipation 5. calcium carbonate 500 mg po tid 6. cyanocobalamin 50 mcg po daily 7. docusate sodium 100 mg po bid 8. enoxaparin sodium 40 mg sc daily duration: 12 days 9. folic acid 1 mg po daily 10. lisinopril 10 mg po daily 11. lorazepam 0.5 mg po q8h 12. milk of magnesia 30 ml po q6h:prn constipation 13. multivitamins 1 tab po daily 14. oxycodone (immediate release) 5-10 mg po q4h:prn pain 15. polyethylene glycol 17 g po daily constipation 16. senna 1 tab po bid 17. thiamine 100 mg po daily 18. vitamin d 1000 unit po daily discharge medications: 1. acetaminophen 650 mg po q6h:prn fever, pain 2. atorvastatin 10 mg po daily 3. bisacodyl 10 mg po daily:prn constipation pt may refuse 4. cyanocobalamin 50 mcg po daily 5. docusate sodium 100 mg po bid 6. folic acid 1 mg po daily 7. milk of magnesia 30 ml po q6h:prn constipation 8. multivitamins 1 tab po daily 9. polyethylene glycol 17 g po daily constipation hodl for loose stool 10. senna 1 tab po bid:prn constipation 11. thiamine 100 mg po daily 12. diltiazem extended-release 300 mg po daily 13. 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. 14. warfarin 5 mg po daily16 please adjust level for goal inr 15. vancomycin 750 mg iv q 12h , to be determined by id/ clinic] 16. quetiapine fumarate 25 mg po hs:prn insomnia 17. pantoprazole 40 mg po q24h 18. aspirin 81 mg po daily 19. ascorbic acid 1000 mg po daily 20. calcium carbonate 500 mg po tid 21. vitamin d 1000 unit po daily discharge disposition: extended care facility: - ( hospital of and islands) discharge diagnosis: primary sepsis mrsa bacteremia osteomyelitis pulmonary embolus secondary hypertension s/p hip fracture discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were at rehab after your hip operation but were transferred to because you were septic from mrsa bacteria in your blood. the bacteria might have caused an infection in the spine at your neck, which is probably related to the weakness you have in your right arm. you are being treated with iv antibiotics for a prolonged duration (~6 weeks). you should follow up with various specialists (appointments listed below). in addition to the infections, you were also found to have a "pulmonary embolus," or a blood clot in your lung. for this, you have been started on a blood thinner called warfarin. we made the following changes to your medications: -start vancomycin (total ~6 weeks, proposed end day is ) -start warfarin (goal inr is ) -start seroquel as needed for insomnia -start pantoprazole -start aspirin 81mg for heart protection -start diltiazem for heart rate control -stop lorazepam -stop oxycodone -stop lovenox -hold lisinopril (you might be restarted on this as an outpatient) followup instructions: orthopedics: when: thursday at 9:50 am with: , md building: campus: east best parking: garage radiology (mri) when: thursday at 3:35 pm with: radiology mri building: sc clinical ctr campus: east best parking: garage neurology: we are working on a follow up appt in the neurology department within the next 9-15 days. you will be called at rehab with the appointment. if you have not heard within 2 business days or have questions, please call . cardiology: name: , md specialty: cardiology location: - cardiac services address: , 7, , phone: we are working on a follow up appt within the next month with dr. . you will be called at the rehab with the appt. if you have not heard within 2 business days or have questions, please call . primary care name: , md specialty: primary care address: ,ste 9a, , phone: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. md, procedure: central venous catheter placement with guidance diagnoses: unspecified essential hypertension acute posthemorrhagic anemia severe sepsis atrial fibrillation personal history of malignant neoplasm of prostate hematoma complicating a procedure aortic valve disorders unspecified osteomyelitis, other specified sites other and unspecified hyperlipidemia other specified cardiac dysrhythmias personal history of other malignant neoplasm of skin septic shock retention of urine, unspecified knee joint replacement other pulmonary embolism and infarction methicillin resistant staphylococcus aureus septicemia methicillin resistant pneumonia due to staphylococcus aureus 

Answer: The patient is high likely exposed to