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: neck pain major surgical or invasive procedure: : c5 partial corpectomy, c5-6 arthrodesis, c5-6 application interbody cage, c5-6 anterior cervical instrumentation, biopsy c5-6 disk and bone ng tube placement history of present illness: 69 yo male with history of esophagectomy for barrett's esophagus, hld, htn, cad, afib, dm t2, copd, dvts/ transfered from for c5-c6 epidural abscess and mssa bacteremia. the patient was transfered given his primary surgeons, dr. , are here at . he was initially seen on at hospital for leukocytosis, had evidence of uti. subsequently blood and urine cultures grew mssa and he was treated as an outpatient with bactrim. he then had acute on chronic neck pain on and presented to regional hospital. there, he was found to have herpes zoster in his anus, started on acyclovir and treated with keflex for known mssa uti/bacteremia. cervical mri was obtained for neck pain which showed cervical discitis and epidural phlegmon at c5-c6. then, he was transitioned to nafcillin. his last blood cultures were positive on . reports increasing incontinence of urine and stool. has been treated with large pain regimen of gabapentin, morphine pca. . the patient was transferred and appeared well and not in acute distress. he was complaining of neck pain, as well as pain in the right shoulder. no fevers. no urinary complaints. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: 1. extensive h/o dvt/pe in past 2. chronic diastolic chf 3. paroxysmal afib 4. cad: no history of mi per pt. 5. htn 6. hld 7. barretts esophagus s/p esophagectomy (by ) in . his last check up was in in . no recurrence at that time. 8. copd 9. dm2 10. obesity 11. osa, intolerant of cpap 12. recurrent falls of unclear etiology 13. aortic stenosis social history: the patient lives in with his wife. is retired. he quit smoking in . he has a couple of alcoholic drinks every other day. family history: noncontributory physical exam: admission exam: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, systolic murmur which patient states is old abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly, patient has right gluteal erythema with small vesicles in the s3-s4 distribution gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema discharge exam: physical exam 96.3, 71, 135/83, 71, 16 96 3 l in/ out: /1700 general: alert, oriented male, no acute distress heent: sclera anicteric, dry mm, oropharynx clear neck: supple, jvp elevated to clavicle, no lad lungs: bibasilar insp. crackles with decreased lung sounds toward the bases, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, harsh systolic murmur in the 2nd intercostal space radiating to the left 2nd intercostal space and systolic murmur in the left 4th intercostal space radiating to the right axilla. abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly, patient has bilateral gluteal erythmea with no vesicles visulaized. gu:no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. nonpitting edema to the ankles bilaterally pertinent results: admission labs: 10:17pm blood wbc-6.6 rbc-2.82* hgb-8.4* hct-25.1* mcv-89 mch-29.8 mchc-33.4 rdw-17.9* plt ct-330 10:17pm blood pt-15.2* ptt-27.1 inr(pt)-1.3* 10:17pm blood glucose-115* urean-10 creat-0.8 na-139 k-4.0 cl-102 hco3-26 angap-15 10:17pm blood calcium-8.8 phos-3.8 mg-1.9 blood culture: no growth urine culture: no growth c. diff - negative tissue culture - mssa hsv viral culture - negative vzv viral culture - negative mri c-spine, l-spine, t-spine: impression: 1. increased signal intensity in the c5-c6 disc and c5 and c6 vertebral bodies along with an epidural component of soft tissue enhancement with moderate canal stenosis and compression on the cervical cord as seen on the prior study. findings were discussed with dr. by dr. on . ct c-spine: 1. diffuse demineralization, without fracture or traumatic malalignment. 2. disc space narrowing and anterior/posterior osteophytes, resulting is moderate-to-severe canal narrowing at this level. this, as well as findings concerning for discitis/osteomyelitis, were better assessed on the mri performed earlier the same day. please see that report for further details. tee: there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. no masses or vegetations are seen on the aortic valve. no aortic valve abscess is seen. significant aortic stenosis is present (not quantified). trace aortic regurgitation is seen. the mitral valve leaflets are not well seen. no vegetation/mass is seen on the pulmonic valve. impression: limited study. mildly thickened aortic valve leaflets without discrete vegetation. likely aortic stenosis (not quantified). mitral valve not well seen due to anatomic abnormality of prior esophagectomy/hiatal hernia. ekg: atrial fibrillation with rapid ventricular response. intraventricular conduction delay of right bundle-branch block type. st-t wave abnormalities. since the previous tracing of limb lead voltage is now less prominent at a faster rate. . discharge labs 07:45am blood wbc-5.9 rbc-3.92* hgb-11.6* hct-35.5* mcv-90 mch-29.6 mchc-32.7 rdw-17.1* plt ct-247 03:30am blood wbc-6.7 rbc-3.66* hgb-11.2* hct-32.6* mcv-89 mch-30.7 mchc-34.4 rdw-17.1* plt ct-253 04:06am blood wbc-6.9 rbc-3.50* hgb-10.5* hct-30.7* mcv-88 mch-30.1 mchc-34.3 rdw-17.0* plt ct-210 07:45am blood plt ct-247 07:45am blood pt-15.9* ptt-26.3 inr(pt)-1.4* 03:30am blood pt-15.4* ptt-27.8 inr(pt)-1.3* 04:06am blood plt ct-210 04:06am blood pt-15.0* ptt-27.1 inr(pt)-1.3* 05:40pm blood pt-15.3* ptt-27.5 inr(pt)-1.3* 05:28am blood plt ct-339 10:17pm blood pt-15.2* ptt-27.1 inr(pt)-1.3* 05:40pm blood fibrino-580*# 04:25pm blood esr-140* 07:45am blood glucose-136* urean-12 creat-0.5 na-139 k-3.2* cl-99 hco3-31 angap-12 03:30am blood glucose-132* urean-12 creat-0.6 na-138 k-3.8 cl-101 hco3-28 angap-13 10:30pm blood glucose-109* urean-10 creat-0.6 na-138 k-3.1* cl-101 hco3-28 angap-12 04:06am blood glucose-117* urean-8 creat-0.5 na-139 k-3.4 cl-104 hco3-27 angap-11 05:30am blood na-137 k-3.7 cl-104 07:45am blood calcium-9.1 phos-2.7 mg-2.1 03:30am blood calcium-8.8 phos-3.8 mg-2.0 10:30pm blood calcium-8.7 phos-2.6* mg-2.1 04:06am blood calcium-8.6 phos-3.0 mg-2.1 05:28am blood caltibc-296 ferritn-129 trf-228 04:25pm blood crp-50.6* 04:36am blood type-art temp-38.1 po2-139* pco2-42 ph-7.43 caltco2-29 base xs-3 intubat-intubated 10:13am blood type-art temp-37.0 rates-/15 peep-15 fio2-40 po2-121* pco2-41 ph-7.45 caltco2-29 base xs-4 intubat-intubated 04:36am blood freeca-1.15 10:13am blood freeca-1.20 10:57pm urine color-yellow appear-clear sp -1.023 10:57pm urine blood-mod nitrite-neg protein-neg glucose-neg ketone-40 bilirub-neg urobiln-neg ph-6.5 leuks-tr 10:57pm urine rbc-28* wbc-17* bacteri-none yeast-none epi-0 . echo there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. no masses or vegetations are seen on the aortic valve. no aortic valve abscess is seen. significant aortic stenosis is present (not quantified). trace aortic regurgitation is seen. the mitral valve leaflets are not well seen. no vegetation/mass is seen on the pulmonic valve. impression: limited study. mildly thickened aortic valve leaflets without discrete vegetation. likely aortic stenosis (not quantified). mitral valve not well seen due to anatomic abnormality of prior esophagectomy/hiatal hernia. . cxr the et tube tip is 5 cm above the carina. the location of the ng tube tip is unchanged. cardiomediastinal silhouette is unchanged. mild interstitial edema and bilateral pleural effusions appear to be slightly more pronounced on the current study. . dvt study non-occlusive thrombus of the mid and distal right superficial femoral vein. brief hospital course: 69 ym h/o dvt/pe, chronic neck pain recently admitted to osh found to be bacteremic and discharged with po abx, readmitted to another osh and found to have c5-6 diskitis w/ phelgmon and continued bacteremia, transferred for further care. #. bacteremia: patient had blood cultures at hospital that grew mssa as well as 1 set of blood cultures from hospital grew out mssa. last positive on . etiology of mssa likley cervical injections by an anesthesiologist in nh. patient had transthoracic echo at osh that did not show endocarditis, but could not have tee done because of difficult anatomy. patient also had mssa growing from urine. likely that initial source of infection was cervical injections leading to diskitis and phlegmon, leading to bacteremia and hematogenous spread to urine. following transfer to , continued naficillin. patient had blood cultures drawn, which did not grow mssa. orthospine consulted and patient underwent surgery to treat c5-6 phlegmon . patient underwent tee and mitral valve was not well visualized but no vegetations were seen. infectious disease consulted and recommended 6 week antibiotic course from date of washout on and id follow-up within two weeks of discharge. #. cervical diskitis w/ c5-6 phelgmon: patient has chronic neck pain that was acutely worsening. mri done at osh did show c5-6 diskitis phelgmon. this could likely be the source of the bacteremia, or conversely the bacteremia could have seed the phelgmon. patient had repeat mri at showing persistent epidural abnormailty with enhancement at c5/6 and moderate canal stenosis with deformity on the cord. minimal prevertebral soft tissue swelling. ct scan of c-spine showed diffuse demineralization, without fracture or traumatic malalignment, disc space narrowing and anterior/posterior osteophytes resulting is moderate-to-severe canal narrowing at this level. patient went to or for debridement/laminectomy of diskitis they took out disk which was already necrosed. patient did well post surgery. he was kept intubated following surgery to allow swelling in neck to decrease.he was extubated without complications. on the general floor the patient was stable on 2 l nc without any complaints of dyspnea. naficillin was continued. his ng tube was placed in because of poor oral intake though he was tolerating pre thickened diet well. speech and swallow determined in the next couple of days the patient's post op swelling should decrease which would allow advanced diet and adequate caloric intake. the patient will be followed by speech and swallow at rehab. . #. anticoagulation: patient is on coumadin for a.fib as well as extensive history of pes/dvts in the past and has current dvt. presented to with inr of 13. he was not actively reversed. he had his coumadin held and was subtherapeutic on arrival to . patient was initially started on heparin gtt, which was stopped for spinal surgery. on , patient was restarted on coumadin and sqh. patient had b/l lower extremity ultrasound as he had low grade fevers showing non-occlusive clot in right superficial femoral vein, however it is unclear if the clot is acute or chronic. patient was not started on heparin gtt given risk of bleeding. he does have a patent ivc filter in place. goal inr is between and inr as of was 1.4 on 5mg coumadin daily and slowly trending up. his inr was 1.5 on and his coumadin was increased to 7.5mg daily from 5mg daily on . . #diarrhea- the patient has been experiencing 7 days of diarrhea in the abscence of any fevers/chills. not experiencing any abdominal pain. he has been negative 3 times for c.diff stool antigen test.could be antibiotic induced/ tube feed induced. prescribed loperamide to slow his diarrhea on . his potassium has been repleted for the last 2 days. . #. lower back rash: patient went to hospital complaining of total body pain including pain around his anus. was found to be guaiac positive with vesicles around the anus and right gluteal area. on transfer patient was taking valtrex. infectious disease team did not think patient's ulcer was consistent with zoster. wound culture was negative for zoster and valtrex was discontinued. likely pressure in etiology though no skin breakdown seen. . # pain: patient with uncontrolled pain from neck . prior to surgery patient was intubated and pain was controlled with fentanyl. following extubation patient was started on dilaudid pca. patient's home dose of gabapentin was uptitrated for neuropathic leg pain. he was transitioned from pca pump to iv bolus's of dilaudid on . . #. uti: the patient had dysuria as an original complaint. he also had positive urine culture from hospital with mssa. patient was continued on naficillin as above. patient's urine cultures at had no growth. . #. h/o a.fib: on admission patient was in sinus rhythm. he was continued on metoprolol. patient's coumadin was initially held as above. following surgery patient had atrial fibrillation with rvr. patient's metoprolol dose was uptitrated and he received ivf.coumadin has been restarted per above. . #. dm2: treated patient with humalog insulin sliding scale. ----------------- outpatient follow up -continue nafcillin 8 weeks from - coumadin with goal inr of between -have speech and swallow follow the patient and assess when ng tube can be removed. patient was tolerating prethickened diet well on discharge. medications on admission: medications on transfer: vitamin d 4000units daily celexa 20mg daily neurontin 600mg tid lopressor 25mg lasix 80mg mon thurs finasteride 5mg dialy protonix 40mg daily folic acid 1mg daily nafcillin 2gm q4h - started novolog sliding scale valacyclovir 1000mg tid morphine pca tylenol prn ativan 0.5mg q6h prn ambien 5mg qhs prn tums 1000mg q4h prn maalox prn duoneb prn percocet prn ultram prn zofran prn compazine prn . home medications: opana 10mg q6h for 10 days lopressor 25mg lasix 80mg mon and thurs zetia 10mg daily proscar 5mg daily protonix 40mg daily folic acid 1mg compazine 10mg vitamin 2000mg daily potassium 10meq daily neurontin 600mg tid coumadin 5mg daily discharge medications: 1. cholecalciferol (vitamin d3) 400 unit tablet : two (2) tablet po daily (daily). 2. citalopram 20 mg tablet : one (1) tablet po daily (daily). 3. finasteride 5 mg tablet : one (1) tablet po daily (daily). 4. folic acid 1 mg tablet : one (1) tablet po daily (daily). 5. nafcillin 2 g iv q4h 6. nystatin 100,000 unit/g cream : one (1) appl topical (2 times a day). 7. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension : 15-30 mls po qid (4 times a day) as needed for abd pain . 8. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler : two (2) puff inhalation q6h (every 6 hours) as needed for wheezing. 9. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler : two (2) puff inhalation q6h (every 6 hours) as needed for wheezing. 10. metoprolol tartrate 25 mg tablet : one (1) tablet po tid (3 times a day). 11. acetaminophen 325 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for pain. 12. lorazepam 0.5 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for anxiety. 13. zolpidem 5 mg tablet : one (1) tablet po hs (at bedtime) as needed for insomnia. 14. gabapentin 400 mg capsule : two (2) capsule po q8h (every 8 hours). 15. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day) as needed for constipation. 16. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 17. senna 8.8 mg/5 ml syrup : one (1) tablet po bid (2 times a day) as needed for constipation. 18. zinc sulfate 220 mg capsule : one (1) capsule po daily (daily). 19. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 20. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day): continue until inr therapeutic . 21. hydromorphone 2 mg/ml syringe : one (1) injection q3h (every 3 hours) as needed for pain . 22. loperamide 2 mg capsule : one (1) capsule po qid (4 times a day) as needed for diarrhea . 23. warfarin 2.5 mg tablet : three (3) tablet po once daily at 4 pm. discharge disposition: extended care facility: - discharge diagnosis: mssa bacteremia cervical discitis 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: it was a pleasure to care for you as your doctor. . you were brought to the hospital becasue of bacteria found to be growing in your blood. you were found to have a spine infection in your neck and underwent surgical debridement of it. . you will need to take an antibiotic nafcillin for 8 weeks from . . you were started on dilaudid as needed for pain. . followup instructions: department: surgery when: tuesday at 10:00 am with: lmob (nhb) building: lm bldg () campus: west best parking: garage department: surgery when: tuesday at 11:00 am with: , md building: lm campus: west best parking: garage department: surgery when: tuesday at 11:00 am with: lmob (nhb) building: lm bldg () campus: west best parking: garage procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus other excision of joint, other specified sites other cervical fusion of the anterior column, anterior technique biopsy of bone, other bones insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae diagnoses: obstructive sleep apnea (adult)(pediatric) abnormal coagulation profile coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified atrial fibrillation aortic valve disorders other and unspecified hyperlipidemia bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site long-term (current) use of anticoagulants personal history of venous thrombosis and embolism diarrhea intraspinal abscess chronic diastolic heart failure spinal stenosis in cervical region other and unspecified disc disorder, cervical region herpes zoster without mention of complication 

Answer: The patient is high likely exposed to