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: penicillins / tetracycline / neomycin / erythromycin attending: chief complaint: syncope, fever, hypotension. major surgical or invasive procedure: none. history of present illness: this is a 52 year old female with h/o htn, dm, hypothyroidism, ra, sjogren's, vasculitis, recent lumbar surgery, presents from an osh after a fall with hypotension and fever. the patient recently underwent l3-s1 laminectomy/foraminotomy on at hospital. following surgery, she developed hypotension and renal failure and was found to have adrenal insufficiency. she was discharged on a prednisone taper which was scheduled for completion on . per report, today the patient had an unwitnessed syncopal event, however there is no documentation of this. she was brought to ed. at , the patient was febrile to 104, hypotensive. received vanco 1500mg iv, fentanyl, and ivf prior to transfer. ct head and ct chest were reportedly negative. wbc was 5.6, hct 32.8, plt 280, cr 1.1. transferred here out of concern for sepsis. in the ed, vitals t 101.6, hr 100, bp 101/53, 20, sao2 100% on 4l. was on levophed upon transfer, but this was discontinued on arrival. sbp 120-130s--> 100s. appeared pale and ashen. confused with garbled speech. pt unable to give history. tender along lower abdomen. when she was rolled over, large amount of frank pus from spinal surgical incision--mild amount of erythema with 1cm opening draining pus. labs notable for lactate 3.0, wbc 6.7 (91.4%n), cr 1.4 (from 1.1 at osh, unknown baseline). received 10mg iv dexamethasone, cefepime, flagyl, tylenol, 5l ns. ordered for ct abd/pelvis to evaluate abdominal tenderness en route to micu. admitted to micu for close monitoring and further work-up. on arrival to the floor, the patient is very somnolent and unable to answer most questions. she does admit to having some pain in her back and feeling fatigued. also feels lightheaded/dizzy. on ros, she denies ha, chest pain, sob, abdominal pain, nausea, vomiting, diarrhea, joint pain. past medical history: past medical history: -diabetes mellitus (dmii)- diet controlled, however has been on levemir and novolog sliding scale since hospital discharge given hyperglycemia on steroids -htn -oa -hypothyroidism hashimoto's thyroiditis -ra -autoimmune vasculitis -fibromyalgia -sjogren's -post-herpetic neuropathy -h/o chronic back pain s/p multiple back surgeries past surgical history: -s/p tonsillectomy -tmj surgery -wisdom teeth extraction -mediastinoscopy -thyroid lobectomy -lumbar laminectomy with fusion social history: positive for alcohol and tobacco use. married with no children. works as a computer manager. family history: non-contributory. physical exam: on admission: pe: t 97.6, bp 108/69, hr 100, rr 20, sao2 100% ra general: somnolent obese female, opens eyes to voice and attempts to answer questions but can only give few word responses and then closes her eyes again. heent: perrl, eomi, dry mm. neck: thick, difficult to assess jvp. heart: tachy, regular, no murmur appreciated. lungs: ctab, no wheezes, rales, rhonchi. abdomen: obese, soft, +bs, tender to palpation diffusely, most severe with voluntary guarding in the rlq. extrem/skin: warm and well-perfused, 2+ pedal pulses, no le edema back: 7cm lower spinal incision with staples in place, 2in patch of erythema surrounding incision for the length of the wound with approximately 1in of induration along the left edge of the incision, ~3cm area of fluctuance near the superior edge of the incision, tiny amount of thin purulent fluid could be expressed from incision neuro: a+o to name, moving all four extremities but unable to cooperate with full neuro exam on discharge: tmax 100.1 vital signs stable. a&o x 3 motor strenght intact throughout wound vac 10 inch linear dressing at midline and 4 inch dressing to the left of the midline incision. pertinent results: labs on admission: 09:07pm blood wbc-6.7 rbc-3.17* hgb-9.4* hct-28.2* mcv-89 mch-29.7 mchc-33.3 rdw-15.1 plt ct-216 09:07pm blood neuts-91.4* lymphs-3.4* monos-5.0 eos-0.1 baso-0.1 09:07pm blood pt-17.6* ptt-35.7* inr(pt)-1.6* 09:07pm blood fibrino-694* 09:07pm blood glucose-172* urean-24* creat-1.4* na-128* k-5.5* cl-98 hco3-19* angap-17 09:07pm blood alt-14 ast-17 totbili-0.5 09:07pm blood lipase-19 09:07pm blood calcium-7.8* phos-2.6* mg-1.3* 02:02am blood cortsol-43.8* 09:15pm blood glucose-151* lactate-3.0* na-127* k-5.5* cl-95* calhco3-24 ct abd/pelvis, : 1. two subcutaneous collections, the largest to the left and posterior to the surgical site measuring up to 11.4 cm. the second is more midline and to the right beginning superiorly to the surgical site and extending inferiorly and connecting to the skin. 2. no evidence of hardware failure at the l3-s1 spinal fusion. 3. no intra-abdominal abscess. 4. 5-mm nodule in the right lower lobe. followup ct at 6-12 months is suggested. ct head : no acute intracranial pathology. mri l-spine : 1. artifacts obscure details from l3 to s1 level. no abscess or abnormal enhancement seen from t12 to l2. 2. large left-sided fluid collection within the subcutaneous fat at l3 and l4 level extending to the left side of the iliac crest which by the mri appearances alone does not appear like an abscess, but clinical correlation is recommended to exclude superimposed infection. cardiac echo: the left atrium is mildly dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 70%). there is no ventricular septal defect. 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. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. the estimated pulmonary artery systolic pressure is normal. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. swab - mssa blood culture - mssa x2 blood culture , , ngtd clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). brief hospital course: this is a 52 year old female with history of htn, dm, hypothyroidism, ra, sjogren's, vasculitis, recent l3-s1 laminectomy/foraminotomy admitted from osh after fall with fever and hypotension. . ## sepsis/wound infection: initial presentation consistent with septic shock, but now off pressors, hd stable and lactate down trending. likely source is infection at spine wound seeding blood stream since both are growing coagulase positive staph. ua negative. cxr unremarkable. tte negative for vegetations and no peripheral manifestations of endocarditis, including osler nodes, spots or janeways. patient went to the or for wound washout. mri with artifact obscuring the imaging of the spinal canal at l3 to s1 level by mri. no spinal abscess or abnormal enhancement from t12 to l2. patient initially managed on vancomycin and cefepime, but later transitioned to nafcillin as this is the ideal drug for mssa bacteremia. patient will require a 8 week course of antibiotics per id recommendations. picc line was placed on and id recommended: 1. repeat stool culture for c. diff if diarrhea/loose stools persist loose stools. 2. check blood cultures x2 if fever spikes ( 101.5) 3. check cbc, lfts, chem 7 once weekly while on nafcillin. # delirium: resolved over the night following admission. was likely related to bacteremia. . # lung nodule: an incidental finding of a 5-mm nodule in the right lower lobe of the lung was noted on ct scan of the abdomen and pelvis. followup ct at 6-12 months is suggested. . # rheum: the patient has a history of ra, sjogren's, and autoimmune vasculitis per records. she is currently taking plaquenil, which was held on admission. # fibromyalgia/chronic pain: on admission, her pain meds, elavil, and neurontin were initially held for altered mental status. elavil and neurotin restarted on the medicine floor. . ## anemia: anemia: hct in mid 20s with unknown baseline. guaiac negative x1. iron studies consistent with aocd. . ## adrenal insufficiency: now off prednisone taper. random cortisol 49, so clearly no longer insufficient. . ## dm: diet controlled. continue iss while inhouse. . ## htn: holding antihypertensives in the setting of sepsis. restarted atenolol on the medicine floor. on lisinopril, atenolol and hctz at baseline. . ## prophylaxis: heparin sc 5000 tid, ppi, bowel regimen . ## code status: full code confirmed with patient . ## communication: husband medications on admission: elavil 100mg po qhs atenolol 50mg po bid lisinopril 40mg po daily klonopin 1-2mg po qhs colace 100mg po bid ferrous sulfate 325mg po tid flonase neurontin 600mg po tid hctz 25mg po daily prednisone taper (scheduled to complete on ) plaquenil 200mg po bid synthroid 125 mcg po daily protonix 40mg po bid ms contin 45mg po tid msir 15-45mg q3 prn niacin 500mg po qhs salagen 5mg po tid tylenol prn flexeril 10mg po q8 prn benadryl 50mg po qhs prn milk of magnesia prn miralax prn discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. tablet(s) 2. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 3. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 4. insulin lispro 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed). 5. amitriptyline 50 mg tablet sig: two (2) tablet po hs (at bedtime). 6. clonazepam 1 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)) as needed. 7. gabapentin 300 mg capsule sig: two (2) capsule po tid (3 times a day). 8. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 10. atenolol 50 mg tablet sig: one (1) tablet po bid (2 times a day). 11. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 12. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. 13. hydroxychloroquine 200 mg tablet sig: one (1) tablet po bid (2 times a day). 14. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 15. nafcillin in d2.4w 2 gram/100 ml piggyback sig: one (1) intravenous q4h (every 4 hours). 16. hydromorphone 2 mg tablet sig: one (1) tablet po q4h (every 4 hours). 17. heparin flush 10 unit/ml kit sig: one (1) ml intravenous prn (as needed) as needed for line flush. discharge disposition: extended care facility: healthcare, nh discharge diagnosis: lumbar wound infection discharge condition: neurologically stable discharge instructions: ?????? do not smoke. . keep your wound dry while you have a wound vac in place, you may not shower and get the area wet, but may sponge bath the area ?????? ?????? no pulling up, lifting more than 10 lbs., or excessive bending or twisting. ?????? limit your use of stairs to 2-3 times per day. ?????? have a friend or family member check your incision daily for signs of infection. ?????? take your pain medication as instructed; you may find it best if taken in the morning when you wake-up for morning stiffness, and before bed for sleeping discomfort. ?????? do not take any anti-inflammatory medications such as motrin, advil, aspirin, and ibuprofen etc. unless directed by your doctor. ?????? increase your intake of fluids and fiber, as pain medicine (narcotics) can cause constipation. we recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? clearance to drive and return to work will be addressed at your post-operative office visit. call your surgeon immediately if you experience any of the following: ?????? pain that is continually increasing or not relieved by pain medicine. ?????? any weakness, numbness, tingling in your extremities. ?????? any signs of infection at the wound site: redness, swelling, tenderness, and drainage. ?????? fever greater than or equal to 101?????? f. ?????? any change in your bowel or bladder habits (such as loss of bowl or urine control). followup instructions: follow up instructions/appointments all of your follow up care should be arranged with dr. , ask to speak to for your appointment: ext: 123 please see your primary care provider upon discharge from rehab. an appointment has been made for you on at 11:30 am with dr. . please take a copy of your discharge summary with you to this appointment. procedure: venous catheterization, not elsewhere classified removal of implanted devices from bone, other bones local excision of lesion or tissue of bone, other bones reopening of laminectomy site application of pressure dressing diagnoses: anemia of other chronic disease other postoperative infection cellulitis and abscess of trunk unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hyposmolality and/or hyponatremia severe sepsis unspecified acquired hypothyroidism methicillin susceptible staphylococcus aureus septicemia septic shock rheumatoid arthritis other diseases of lung, not elsewhere classified intraspinal abscess myalgia and myositis, unspecified disruption of external operation (surgical) wound arteritis, unspecified sicca syndrome 

Answer: The patient is high likely exposed to