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: fever, chills, rigors and increased white blood cell count prior to elective surgery in an outside hospital. major surgical or invasive procedure: surgical drainage of cervical spine abcsess on interventional radiology drainage of lumbar para-spinal abcsess on surgical drainage of cervical fluid collection on picc line placed on picc line placed on history of present illness: mr. is a very nice 52 yo gentleman from , with dm2, ckd, ich s/p craniotomy (9 years ago), pvd, b/l sfa stent placement (~1 mo ago) who is an ivdu (heroin, last dose 08/03) and comes c/o fever, chills and increased in wbc. pt. started complaining of worsening of his claudication in both calfs and was admitted to on for elective femo- bypass placement. then, few hours later he was found to have an increased wbc of 19.4, fever of 103.4 f and chills. patient had mrsa in blood cultures, and mri of spine taht showed osteomyelitis at c3-c4 & c-4-c5 patient received ancef, flagyl and vancomycin and was trasnfered to . past medical history: hcv: treated with injections and pills (doesn't know more); followed in . insulin dependent dm cri stage 3, baseline cr 2.1 pvd s/p bilateral sfa stents intracranial hemorrhage s/p craniotomy after fall 9 years ago hypertension hyperlipidemia restrictive lung disease vitamin d deficiency hernia surgery social history: originally from . moved to us 17 yrs ago. currently unemployed, but former painter. used to smoke 1 ppd x35 years, but quit 8 months ago. occasional etoh. denies drugs. lives in with his brother. married. has a girlfriend. used to work with birds (for 3 months) and in the aggriculture in new jerssey a few months ago. family history: nc physical exam: temp 101.6 f hr 84 bp 138/80 rr 16 spo2 96% ra . general: nad, a&o x3, sitting in bed, ready to walk, wearing rigid collar heent: peerla, normal eye movements, no icteric conjuntivae, normal pharynx neck: supple, no bruits, thyroid not palpable, pulses ok heart: rrr, no m/r/g lungs: ronchi, crackles bilaterally abdomen: non-tender, non-distended, decreased bowel sounds, no signs of peritoneal irritation back: no cva tenderness; pain on palpation of l3 & l4 supraspinal apofises extremities: strenght , palpable pulses bilaterally, warm, normal rots neurologic: craneal nerves intact, a&o x3, normal rots in le, patient able to walk with normal gait, can walk on heels and on toes; normal senstaion and propiosception. pertinent results: on admission: 09:45pm wbc-17.6* rbc-4.27* hgb-12.9* hct-36.9* mcv-86 mch-30.1 mchc-34.9 rdw-13.5 09:45pm neuts-77* bands-0 lymphs-8* monos-11 eos-1 basos-0 atyps-0 metas-2* myelos-1* 09:45pm hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 09:45pm plt smr-normal plt count-272 09:45pm glucose-148* urea n-24* creat-1.4* sodium-132* potassium-3.2* chloride-87* total co2-32 anion gap-16 09:45pm alt(sgpt)-30 ast(sgot)-42* ld(ldh)-276* alk phos-131* tot bili-0.8 09:45pm albumin-2.9* calcium-8.8 phosphate-3.3 magnesium-1.7 mri of the spine on discitis, osteomyelitis from c3 through c5 with extensive prevertebral phlegmon and abscess. tiny focus of epidural abscess as well as the predominant epidural phlegmon in the cervical spine. osteomyelitis in the lumbar spine, predominantly from l1 through l3. there is abnormal enhancement in the right paraspinal musculature abutting the facet joint from l1 through l5. there is a left prevertebral/paravertebral abscess at t12-l1. there is epidural enhancement at l2-l3 on the right, which appears continous with the paraspinal musculature enhancement. no convincing evidence for epidural abscess in the lumbar spine is seen. there is also prominent epidural enhancement within the left aspect of the canal at l5-s1. cxr: no acute cardiopulmonary process. tte: the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. there is mild global left ventricular hypokinesis (lvef = 40-45 %). the estimated cardiac index is borderline low (2.1l/min/m2). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: normal biventricular cavity sizes with mild global left ventricular hypokinesis c/w diffuse process (toxin, metabolic etc. cannot exclude, but multivessel cad less likely). no valvular pathology or pathologic flow identified. mri : 1. marked prevertebral soft tissue swelling with mixed signal intensities. post-operative changes and edema can have this appearance. from an imaging standpoint, it is difficult to rule out residual infection. followup mr of the neck may be helpful to document resolution of these changes. 2. small abscess in the right paraspinal musculature, posterior to l3 and l4 as described above. there are associated inflammatory changes in the muscle, likely representing myositis. ct of neck : impression: extensive intercommunicating fluid collections with numerous suspended air bubbles at the surgical site in the neck, deep to the right sternocleidomastoid, as described. the collection overall measures roughly 6.3 cm (ap) x 2.0 cm (trv), 2:25, and extends over some 5 cm, craniocaudally. though direct comparison is somewhat difficult, this process does not appear significantly improved and may, in fact, be worse since the enhanced mr examination of . this process extends deep to the strap muscles, communicating with the retropharyngeal and prevertebral spaces, and persistent infected fluid collections cannot be excluded. there is marked left lateral displacement of the laryngeal skeleton and cervical airway, which remain patent. mri : 1. postoperative change in the cervical spine involving c3 through c5. persistent signal abnormality at c3 through c5 vertebral bodies and intervening disc is likely related to ongoing inflammation, however, from an imaging standpoint, it is difficult to differentiate between postoperative change and residual infection. no epidural collection is identified. 2. large fluid collection containing gas at the surgical site in the neck extending to the c3 through c5 anterior prevertebral space not significantly changed from the postoperative mri from , and better evaluated on ct from . laboratory values upon discharge: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 05:05am 7.2 3.22* 9.6* 28.4* 88 29.8 33.7 13.6 387 source: line-picc differential neuts bands lymphs monos eos baso atyps metas myelos 06:46am 67.2 20.9 8.6 2.9 0.5 renal & glucose glucose urean creat na k cl hco3 angap 05:05am 158* 20 1.5* 132* 4.1 94* 27 15 brief hospital course: patient was feeling better on arrival and was complaining of cervical neck pain. pt was admitted to neurology. he had an mri done which corroborated the cervical spine abcsess and showed a second one in the lumbar paraspinal muscles area (l3-l4, l4-l5). patient had vancomycin continued (1 g qd) as well as rifampin 300 mg po qd, cefazolin (1g iv q12 hrs) and flagyl (500 mg iv q8hrs). pt had vancomycin trough in am which was 5.0, had blood cultures, neurosurgery consult, tte and had pain medication. id was consulted. tte did not show any valvular or abnormal flow suggesting endocarditis. id recommended stopping ancef and flagyl on . patient had surgery on for abcsess drainage. patient went to icu until , when he also had a picc placed in right arm. he was extubated on . patient was still febrile, and started with a productive cough on . due to persistent fever a repeat mri was obtained as well as more blood cultures. repeat mri showed a small paraspinal abcess in lumbar region (l3-l4). since patient still febrile, but not growing anything on blood cultures, blood cultures were continued. neck pain kept increasing, so a ct scan of the neck was done, showing recurrence of the spinal abcsess with a big collection of fluid in the right cervical region. an mri ruled out epidural abscess, showed the same osteomyelitis seen in the priro mri. patient undergo surgical abcsess drainage on . he had a drain left in place, which was removed on . patient has been afebrile since surgery (max temp 100.4 without tylenol). patient currently is blood culture negative. pt grew gram negative non-fermenting bacteria pan-sensitive in blood taken from the picc placed in the right arm. so picc was retrieved and patient was continued with peripheral iv. zosyn was started, but when sensitivities came back, id recommended switching to ciprofloxacin po. patient to complete 14 day course. new picc was placed when patient afebrile >48 hours with negative cultures on . it can be pulled out when patient finished 6-week antibiotic course and ok with id. patient had acute renal failure, which was contrast induced after the ct scan. creatinine went from his baseline of 1.2 to 1.8 on . right now patient trending down to 1.5. wbc trending down, now 7.8 from a max of 18.2. patient was explained the risk of doing ivdu and was counseled to quit. patient was explained the severity of his disease in english and spanish and was able to repeat to us. patient is being discharge to in where he will finish his 6 week course of antibiotic therapy. patient having vancomycin trough on friday, weekly cbc, chem-7, lfts, crp, esr. id is following results. patient followed in 6 weeks by neurosurgey. patient will need to use hard collar in between. medications on admission: plavix 75 mg daily enalapril 40 mg po daily lantus 50 u sc daily robaxin 500 mg po tid vitamin d 50,000 u po twice weekly tylenol 650 mg daily ibuprofen 1 tablet po q6hr robitussin dm prn discharge medications: 1. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 2. enalapril maleate 20 mg tablet sig: two (2) tablet po once a day. 3. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 7 days. disp:*8 tablet(s)* refills:*0* 4. vancomycin 1,000 mg recon soln sig: one (1) recon soln intravenous q 24h (every 24 hours) for 25 days. disp:*25 recon soln(s)* refills:*0* 5. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical q 24h (every 24 hours) for 7 days: on for 12 hours and then off for 12 hours. disp:*7 adhesive patch, medicated(s)* refills:*0* 6. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush for 25 days. disp:*30 ml(s)* refills:*0* 7. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever. 8. sodium chloride 0.9 % 0.9 % syringe sig: one (1) injection three times a day as needed for 25 days. disp:*25 syringe* refills:*2* 9. clopidogrel 75 mg tablet sig: one (1) tablet po once a day. 10. insulin please follow your home regimen. 11. oxycodone 5 mg tablet sig: one (1) tablet po every six (6) hours as needed for breakthrough pain. disp:*30 tablet(s)* refills:*0* 12. sodium chloride 0.9 % 0.9 % syringe sig: one (1) ml injection prn (as needed) as needed for line flush. disp:*25 syringes* refills:*3* discharge disposition: extended care facility: heritage manor discharge diagnosis: primary mrsa sepsis with cervical abcsess and cervica osteomyelitis as well drained paraspinal abscess in lumbar spine gram negative sepsis (not fermenter, not pseudomonas) secondary insulin dependent diabetes mellitus chronic renal failure stage 3, baseline cr 2.1 peripheral vascular disease intravenous drug use (last ) discharge condition: stable, with picc line in left arm, breathing normally on room air, comfortable and with pain controlled. discharge instructions: you were sent here from hospital due to fever, chills and increase wbc before your elective surgery. you were admitted to the neurology service and got a ct scan of your neck and spine. 2 abscesess were found and you had the major one surgically drained. you had an mri later, which showed cervical osteomyelitis (infection of the bone). since your fever persisted, as well as positive blood cultures growing s aureus, you had another ct of the neck showing a recurrence in the cervical abscess that was srugically drained again. you had a picc line placed in your arm to give you antibiotics for the infection in the bone. you will need 6 weeks at least. this type of infections are associated with intravenous drug use, such as heroin. please stop doing drugs. we are happy to provide you with help. however, you need to be constant in your appointments and good with your treatment. intravenous drug use also has risks for multiple infections, including hiv and other hepatitis. please stop smoking, since it is very bad for your health and increases your risk for lung diseases and cancer. if your neck pain persist, you have fever, chills, rigors or anything else that concerns you please come back to the er. followup instructions: please arrange for follow up in the neurosurgery clinic with dr ; office number: . please use hard collar all the time (but to shower) until seen by dr. . please obtain an appointment with the infectious disease doctor (dr. ) within 3 weeks at: ( follow up with your primary care as needed. you will need a vancomycin trough level this friday ; then you will need weekly (every tuesday) vancomycin trough, cbc, chem-7, lfts, esr, crp. please fax results to the infectious disease clinic at . you can have your picc line retrieved after the last vancomycin dose. if you want to leave ama, then you must have the picc line removed before that. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified excision of intervertebral disc reopening of laminectomy site aspiration of other soft tissue other incision of soft tissue diagnoses: diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified infection with microorganisms resistant to penicillins peripheral vascular disease, unspecified methicillin susceptible staphylococcus aureus septicemia sepsis other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) long-term (current) use of anticoagulants intraspinal abscess acute osteomyelitis, other specified sites 

Answer: The patient is high likely exposed to