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: macrolide antibiotics / ambien attending: chief complaint: lower extremity weakness, paralysis, back pain major surgical or invasive procedure: c7-t10 laminectomy with washout intubation left trauma ij central line right subclavian central line right arm arterial line history of present illness: pt intubated and sedated on arrival to micu, history obtained from ed record and girlfriend. 61 yo male diabetic x 15 years who presents to ed with bilateral lower extremity weakness and back pain for the past 2 days. according to his girlfriend, pt had been in his usual state of health except for a flare of his neuropathy and gout on day weekend, who developed right sided back pain about two days ago after heavy lifting. yesterday the patient was unable to lie down and had to sit at the side of his bed for about 24 hours. he was able to ambulate to the bathroom at 9 am, but complained of "pain all over". he had been prescribed percocets following removal of a r callus by podiatry, and took four of the percocet yesterday for pain relief. this morning he was unable to get out of bed secondary to loss of sensation in his feet, legs, and buttock region. typically ambulates limited distance with cane. his girlfriend called 911 and he was taken to and transferred to ed for further evaluation. . in the , pt found to have a leukocytosis, febrile to 100.3 max. concern for epidural abscess was raised given history of diabetes. neurosurgery and neurology were consulted, patient found to have flaccid paraplegia, poor rectal tone, absent reflexes in the legs, t4-t6 sensation level, and weak cough; rec stat imaging at as pt body habitus too large to fit into ct/mri scanner here. pt was electively intubated for ct, sent to , however, because of his obesity, this was unable to be done as he could not fit on the fluoro table, and a regular ct was done instead. the patient was started on vanc/ zosyn along with 2 liters of ivf and transferred to the micu with plans to undergo an open mri at shields mri in . past medical history: diabetes- insulin dependent x 15 years mi 5 yrs ago cabg x 4 5 years ago chronic back pain neuropathy- unable to feel the bottom of his feet gout social history: quit etoh after cabg, 2 ppd smoker x 5 years, retired rep, has two sons but limited contact. widowed 15 years ago, now lives with his girlfriend. family history: brother died of cancer, unknown cause physical exam: vitals: 179 kg/temp 99.4/bp 109/51/ hr 76/ 100% vent settings: ac/ 100% fio2/ 14/ 650-698/ peep 15 gen: sedated, will respond to some questions, intubated, obese heent: atraumatic, anicteric, pupils constricted but equal and reactive neck: unable to appreciate jvp, no lad cv: soft precordium, rrr, no murmurs. cabg scar on chest lungs: cta b/l, distant bs abd: soft, nt, nabs, no organomegaly appreciated ext: warm, dry. dp pulses dopplerable. lower extremities with chronic venous stasis changes, dry, cracked skin. hyperpigmentation. right callous on great toe, appears clean, no frank pus neuro: arousable, responsive to some commands, no myoclonus, toes mute bilaterally, unable to move extremities pertinent results: 09:55pm type-art temp-37.4 rates-14/22 peep-15 o2-80 po2-90 pco2-51* ph-7.34* total co2-29 base xs-0 aado2-433 req o2-74 intubated-intubated vent-controlled 09:10pm glucose-167* urea n-34* creat-2.0* sodium-137 potassium-5.5* chloride-99 total co2-26 anion gap-18 09:10pm alt(sgpt)-24 ast(sgot)-49* ld(ldh)-239 ck(cpk)-3981* alk phos-97 amylase-27 tot bili-0.4 09:10pm lipase-27 09:10pm ck-mb-27* mb indx-0.7 ctropnt-0.02* 05:17am lactate-1.6 04:15am glucose-167* urea n-28* creat-1.5* sodium-136 potassium-5.3* chloride-102 total co2-24 anion gap-15 04:15am probnp-950* 04:15am wbc-27.7* rbc-4.84 hgb-13.5* hct-40.7 mcv-84 mch-27.9 mchc-33.2 rdw-17.5* 04:15am plt count-385 09:10pm wbc-26.0* rbc-4.52* hgb-12.7* hct-38.0* mcv-84 mch-28.0 mchc-33.3 rdw-17.5* 04:39am blood wbc-16.9* rbc-3.30* hgb-9.6* hct-27.8* mcv-84 mch-29.1 mchc-34.4 rdw-17.3* plt ct-374 03:44am blood neuts-87.4* lymphs-7.3* monos-2.8 eos-1.9 baso-0.6 04:39am blood plt ct-374 11:28am blood fibrino-732* 04:39am blood urean-23* creat-1.1 k-3.6 12:01am blood ck(cpk)-157 09:10pm blood alt-24 ast-49* ld(ldh)-239 ck(cpk)-3981* alkphos-97 amylase-27 totbili-0.4 04:19pm blood ck-mb-4 03:34am blood ctropnt-0.11* 01:52pm blood ck-mb-3 ctropnt-0.30* 05:30am blood ck-mb-3 ctropnt-0.33* 05:09am blood caltibc-209* hapto-417* ferritn-293 trf-161* 10:40am blood cortsol-49.6* 04:01am blood type-art temp-36.6 o2 flow-4 po2-60* pco2-39 ph-7.42 caltco2-26 base xs-0 intubat-not intuba vent-spontaneou 12:22pm blood freeca-1.10* . picc line placment sch 2:34 pm impression: uncomplicated ultrasound-guided dual-lumen picc line placement via the right basilic venous approach. final internal length is 45 cm, with the tip positioned in the svc seen on portable chest radiograph. the line is ready to use. . cardiology report ecg study date of 1:11:52 pm . sinus rhythm. frequent ventricular premature beats. left atrial abnormality. left axis deviation with left anterior fascicular block. right bundle-branch block. low qrs voltage in the precordial leads. compared to the previous tracing of frequent ventricular premature beats are more prominent. . chest (portable ap) 7:36 am . patient is markedly rotated. endotracheal tube, left internal jugular vein line, right subclavian line, and nasogastric tube are probably unchanged; tip of nasogastric tube is not visualized on this study. vertical staple line, probably down pt's back. changes of cabg, with multiple broken cerclage wires. both extreme costophrenic angles are excluded from the study, however, appearance of cardiomegaly and pulmonary vascular congestion is similar to the previous study. no definite pneumothorax. probable small layering left pleural effusion. . echo study date of : . conclusions: due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). extremely limited study. . impression: unable to exclude endocarditis given extremely limited views. if clinically indicated, a transesophageal study could be done. . brief hospital course: a/p: 61 yo male with lower extremity paralysis and back pain with c7-t8 epidural abscess s/p washout, laminectomy t2-t10 on . . # epidural abscess. the patient underwent a t2-t10 washout, laminectomy on by our neurosurgery service. he will follow up with dr. in 4 weeks. he will need an outpatient ct of his spine to assess interval improvement before his follow up appointment with dr. . - surveillance blood cultures have been negative since and kast grew mssa growth on . on discharge, the patient was on nafcillin day 9 of antibiotics on . total 6 weeks of antibiotics. - the patient remains afebrile, however, wbc still elevated but stable at 16 on discharge. . # respiratory failure: - the patient was intubated electively for transport to his mri at shields. he remained on the ventilator with a large peep requirement whichw as felt to be secondary to his body habitus. - he remained intubated for the or on . subsequently, he was quickly extubated without further events. - he has intermittent shortness of breath at baseline which was felt to be secondary to atelectasis. he has a known diagnosis of obstructive sleep apnea but did not use his bipap at home. he may benefit from intermittent bipap at night at the rehab. - on discharge, the patient was sat'ing 93% on 2 liters o2 with a productive cough with no signs of chf or infiltrate on chest xray. . # hypotension, unresponsive episode while intubated - the patient had an episode of hypotension on while intubated from sbp 130 to 80s that required iv bolus of fluid and short run of neosynephrine to maintain his pressures. the patient was intubated and sedated during this time. his fentanyl and versed were immediately discontinued and narcan was administered with good effect. it was felt that this episode was secondary to oversedation with depots of sedatives in subcutaneous fat that contributed to a cumulative overdose despite the fact that the patient had not received additional sedation during this time. ekg was unremarkable but the patient did have a bump in his cardiac enzymes to 0.33 which remained flat. he was not treated for acs as this was felt to be secondary to demand in the setting of hypotension that an acute plaque burden. . # leukocytosis- felt to be secondary to his epidural abscess. wbc 16-17 on discharge. . # diabetes- insulin dependent x 15 years. initially was on lantus and hssi which was later switched to insulin gtt while in the icu for tight blood sugar control. - bs mid 100s on insulin gtt. maintain peri-operatively for now. - he was continued on a sliding scale insulin and his lantus was increased to 50 units glargine on with stable blood sugars on discharge. . # cardiac 1. vessels- history of mi/ cabg x4. in the setting of a hypotensive, unresponsive episode related to oversedation, the patient was found to have an elevated troponin with no ekg changes and flat at 0.33, 0.3. he had an episode of atypical bilateral chest pain on with no associated symptoms that was reproducible with palpation and worse with movement. - restart asa 325 mg on 60-23-07 per neurosurgery. - . 2. pump- ef >55%. - the patient was diuresed towards the end of his stay with 20 mg iv lasix per day with -500 to 1 liter negative. - lasix 40 mg po qd was restarted on upon discharge. . # fen- diabetic, cardiac, monitor lytes. . # proph- hep sq tid, h2 blocker . # access- a line- d/c'd, right subclavian central line dc'd, left ij double lumen placed - dc'd on . picc placed by ir on . . # code- full, however, the patient expressed the desire with present to not experience a prolonged intubation . # brother and girlfriend (hcp) medications on admission: percocet, asa, zantac, avapro. atenolol 25mg daily avapro 300mg qday lasix 80mg daily glucophage 100mg lantus 90 units daily lipitor 40mg daily asa percocet 5mg daily/prn talwin i tab daily discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 2. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 3. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed. 4. nicotine 21 mg/24 hr patch 24 hr sig: patch 24 hrs transdermal daily (daily). 5. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 6. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day). 7. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 8. losartan 25 mg tablet sig: two (2) tablet po daily (daily). 9. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed). 10. morphine 30 mg tablet sustained release sig: two (2) tablet sustained release po q12h (every 12 hours). 11. morphine 15 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 12. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 13. heparin flush cvl (100 units/ml) 1 ml iv daily:prn 10ml ns followed by 1ml of 100 units/ml heparin (100 units heparin) each lumen qd and prn. inspect site every shift 14. nafcillin 2 gm iv q4h day 1 15. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 16. heparin (porcine) 10,000 unit/ml solution sig: one (1) injection tid (3 times a day). 17. metoprolol tartrate 50 mg tablet sig: one (1) tablet po tid (3 times a day). 18. zolpidem 5 mg tablet sig: two (2) tablet po hs (at bedtime) as needed. 19. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 20. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) inhalation q4h (every 4 hours). 21. ipratropium bromide 0.02 % solution sig: inhalation q4-6h (every 4 to 6 hours). 22. insulin sliding scale and lantus 50 qhs discharge disposition: extended care facility: discharge diagnosis: c7-t8 epidural abscess paraplegia discharge condition: stable. on 2 liters o2 with sats of 93-97% discharge instructions: resume aspirin 325 mg 7-14 days post-operative . will continue iv nafcillin for at least a total of 6 weeks. follow up with dr. in 4 weeks. followup instructions: the patient should have his staples removed on . he should follow up with dr. in 4 weeks. please call to schedule this appointment. the patient should have a ct of his spine prior to seeing dr. . procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances non-invasive mechanical ventilation other intubation of respiratory tract other intubation of respiratory tract other exploration and decompression of spinal canal closed [endoscopic] biopsy of bronchus infusion of vasopressor agent diagnoses: acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified severe sepsis gout, unspecified aortocoronary bypass status other opiates and related narcotics causing adverse effects in therapeutic use methicillin susceptible staphylococcus aureus septicemia chronic kidney disease, unspecified acute respiratory failure septic shock old myocardial infarction morbid obesity methicillin susceptible pneumonia due to staphylococcus aureus altered mental status intraspinal abscess unspecified hereditary and idiopathic peripheral neuropathy diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled paraplegia foreign body in larynx inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation 

Answer: The patient is high likely exposed to