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: tegretol attending: chief complaint: "fluid leaking from legs" major surgical or invasive procedure: none history of present illness: on the morning of (2 days pta), ms. mother discovered that sheets were drenched with fluid from her legs and feet. she noted that her socks were so sodden that "you could wring them out" and that there was some skin breakdown along her calves. she emergently scheduled an appt with the pcp (dr. ) and the vascular doctor (dr. for the following day. upon presentation to the doctor, she was sent to the ed. her mother had noted increasing le and full-body edema for the past 2-3 months, so much so that she had to buy her new pants in a larger size. she has a history of le brawny edema(l>r)and blanching erythema over the past 10 yrs, but never as severe or with leakage of fluid. she presented to on for this increasing edema, and her regular dose of furosemide was increased from 150 mg to 240 mg . however, the swelling worsened. her mother also noted that she began to develop a "pimply rash" along her left calf and that it seemed to be itchy. she has been treating it with a topical antiseptic. per her mother, she has not had any sob, cp, or increased doe. pt denies pnd or orthopnea, but wears a bipap machine at night for past 20 yrs. other symptoms include a dry cough that occasionally leads to post-tussive emesis, and some loose stools. her blood pressure is usually 120/80, but over the wknd it was 140/84. she has been afebrile. . she has had utis in the past, but only every yrs. . in the ed, urinalysis showed 21-25 wbcs, 21-25 rbcs. dipstick showed prot 500. cxr showed possible atelectasis vs infiltrate. she was given cipro 500 mg and ceftriaxone 1 gm. . ros: no nausea, diarrhea, headaches, dizziness, positive for pain in r knee when walking. past medical history: 1. osteoarthritis. 2. rheumatoid arthritis. 3. osteoporosis with vertebral compression fractures - normal bmd at the femoral neck, osteopenia at the trochanter, and osteoporosis at the total hip () 4. developmental delay. 6. sleep apnea; since on nocturnal ventilation with bipap at 18/12 cm h20 plus 4 liters of nasal cannular oxygen titrated in, else will desaturate to 45% 7. obesity. 8. history of leg ulcers. 9. leg swelling - since , followed by podiatry and vascular surgery (dr. 10. pilonidal cyst removal - , complicated by wound dehiscence 11. r knee replacement - 12. sle - dx , diagnosis not documented well social history: developmentally delayed, lives with mother and sister family history: na physical exam: t:96.8 bp: 126/68 p: 80 rr: 16 o2 sats: gen: pleasant woman, nad heent: malar rash eomi, perl, mmm, no tonsilar exudates cv: rrr, nl s1, s2, no m/r/g resp: slight crackles bilaterally abd: soft, slightly tense, tender to deep palpation in r and l uq ext: 4+ edema in both le, red, erthymatous, non-indurated area covering l calf, some skin breakdown, oozing fluid. scaly in areas, with scattered pustules. 3+ edema in l arm (normal r). swanneck deformity in fingers, nodule on l forefinger neuro: cn ii-xii intact, no focal deficits pertinent results: 03:30pm wbc-5.3 rbc-3.89* hgb-11.4* hct-34.7* mcv-89 mch-29.2 mchc-32.8 rdw-16.8* 03:30pm calcium-7.7* phosphate-4.6*# magnesium-2.5 03:30pm alt(sgpt)-24 ast(sgot)-43* alk phos-81 amylase-42 tot bili-0.1 03:30pm lipase-32 03:30pm glucose-86 urea n-30* creat-0.6 sodium-139 potassium-6.7* chloride-109* total co2-25 anion gap-12 04:00pm urine rbc-21-50* wbc-21-50* bacteria-mod yeast-none epi-0-2 04:00pm urine blood-lg nitrite-neg protein-500 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-sm 02:31pm blood wbc-5.4 rbc-2.70* hgb-7.9* hct-24.3* mcv-90 mch-29.2 mchc-32.5 rdw-17.4* plt ct-226 04:00pm urine 24creat-651 24prot- 05:54pm urine 24creat-510 24prot-6780 05:54pm urine u-pep-multiple p osmolal-317 11:08pm urine hours-random urean-394 creat-59 na-22 totprot-1850 prot/cr-31.4* 02:21pm urine blood-lg nitrite-neg protein-500 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-sm . ct chest : impression: 1. limited study. poorly defined nodules are likely secondary to bronchopneumonia. however, along with several more well-defined nodules, the differential diagnosis includes fungal and nocardia infection as well as metastatic disease. short-term followup ct after treatment for infection is recommended. 2. peripheral and basilar honeycombing is consistent with interstitial fibrosis. it demonstrates mild progression since the prior examinations six years earlier. such slow progression favors a fibrotic subtype of nsip over uip. 3. mild hydrostatic pulmonary edema. . : films of hand: 3 views right hand: there is moderate to severe degenerative disease of the right hand. juxta-articular osteopenia and moderate to severe joint space narrowing are seen within the proximal and distal interphalangeal joints. mild erosive changes are most prominent at the second proximal phalangeal joint. there is narrowing of the first cmc joint. narrowing and partial ankylosis is seen within the carpal bones. there is mild subluxation at the second and fifth mcp joint. hyperextension of the third and fifth proximal phalangeal joints with associated flexion of the distal phalangeal joints is consistent with "swan neck deformity." there is mild erosion of the ulnar styloid process. 3 views left hand: there is moderate to severe degenerative disease of the left hand. juxta-articular osteopenia and moderate to severe joint space narrowing is seen within the proximal and distal interphalangeal joints. mild erosive changes are most prominent at the second, third, and fourth proximal interphalangeal joints. there is narrowing of the first cmc joint. narrowing and partial ankylosis is seen within the carpal bones. there is mild subluxation at the fifth mcp joint. hyperextension of the proximal phalangeal joints with associated flexion of the distal phalangeal joints is consistent with "swan neck deformity." there is mild erosion of the ulnar styloid process. impression: 1. findings consistent with rheumatoid arthritis. . ruq u/s 1. normal hepatic echotexture without focal lesion. 2. cholelithiasis without cholecystitis. . renal u/s renal ultrasound: study is limited due to patient's body habitus and difficulty complying with instructions. the right kidney measures 12.4 cm, and the left kidney measures 11.4 cm. both kidneys are echogenic. at least three nonobstructing calculi measuring up to 8 mm are present within the lower pole of the left kidney. there is no hydronephrosis or solid renal masses. a foley catheter is seen within a collapsed bladder. impression: 1. limited examination. three nonobstructing calculi within the lower pole of the left kidney. 2. echogenic kidneys, suggestive of underlying renal parenchymal disease. . echo: conclusions: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef 70%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflet(3)appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is a small pericardial effusion. the effusion appears circumferential. there are no echocardiographic signs of tamponade. compared with the findings of the prior report (images unavailable for review)of , a small pericardial effusion is now present. . bilateral lower ext u/s: impression: no evidence of deep venous thrombosis in either lower extremity . ekg : sinus rhythm. non-specific lateral st-t wave abnormalities. low precordial lead voltage. compared to the previous tracing of the rate is increased. otherwise, no diagnostic interim change . ct c/a/p: 1. bilateral small pleural effusions and diffuse pulmonary interstitial prominence likely indicating cardiac failure. 2. left pericolic gutter fluid collection, likely due to recent extensive spinal surgery, however, superinfection of this collection cannot be excluded. 3. slightly enlarged right abdominal rectus sheath hematoma. 4. small right perinephric fluid collection in association with a right renal low density lesion; most likely common this represents a ruptured cyst, however, correlation with ultrasound is recommended for further evaluation. solid mass, such as neoplasm, not excluded. 5. small left-sided abdominal wall high density fluid collection likely representing hemorrhage within a seroma. 6. radiopaque gallstones without ct evidence of cholecystitis. 7. right adrenal lesion concerning for metastatic deposit. 8. interval spinal fusion from t10 to l4. . renal u/s: extremely limited study demonstrating a nonobstructed right kidney. small right perinephric fluid collection is noted as seen on the ct study of one day prior. . mri t-,l-spine: (pt. unable to tolerate contrast phase to back pain) 1. fluid in the laminectomy bed at l1/2, which is expected at three weeks following surgery. superimposed infection cannot be excluded by imaging. 2. while there is persistent angulation at l1/2 with focal obliteration of the cerebrospinal fluid around the conus, the fluid collection in the laminectomy site may not necessarily exert pressure on the conus. abnormal signal within the conus may be related either to persistent compression, or to myelopathy resulting from presurgical compression. 3. left retroperitoneal fluid collection, better defined on the torso ct. 4. contrast-enhanced images may be performed for assessment for intradural infection, if clinically indicated. . tee: no echo evidence of endocarditis. o/w study unchaned when compared with above tte. brief hospital course: 49 yo f with h/o developmental delay and rheumatoid arthritis admitted for anasarca, found to have nephrotic syndrome and has had a prolonged hospital course complicated by new le weakness/numbness. now s/p t8-l3 fusion and prolonged intubation transferred out of the sicu on to the general medical service. . # nephrotic syndrome: secondary to biopsy proven focal segmental glomerulosclerosis. the biopsy showed significant nephron hypertrophy, a finding associated with obesity. however, per pathology, such glomerular findings, when secondary to obesity, typically do not produce the profound edema and proteinuria seen in this patient. electron microscopy showed global foot process effacement which further supports a primary process. she was diuresed with lasix. her urine pr:cr improved to 1.1 on from 2.8 on and 1.8 on . acei has been held given pr:cr <3. cyclosporin was not restarted given her infections. her cholesterol was found to be elevated while her triglycerides were normal and she was started on a statin. weekly urine pr:cr levels and serum albumin should be checked (next ) and results faxed to nephrology. she will be discharged on 20mg po lasix once daily (currently in conjunction with diamox, but please see below re: discontinuation of this). she should follow up with nephrology as scheduled and results of her weekly urine protein:creatinine and serum albumin should be faxed to dr. office. . # leukocytosis: total wbc normalized, but did have a bandemia that maxed at 13% prior to her 2nd surgery and then resolved following debridement of her surgical wound. etiology of her early leukocytosis was explored in the setting of abdominal discomfort. although positive for cholelithiasis, ruq u/s was negative for cholecystitis. there was also some concern for abscess given recent surgery with abdominal approach and ct abdomen/pelvis showed no definitive abscess or evidence of such. despite no clear intraabdominal process causing leukocytosis, blood and urine cultures were positive for vre on as discussed below. her white blood cell count and differential should be monitored at rehab given her multiple sources of infection and treatment with linezolid. . # vre bacteremia: blood and urine cultures from were positive for vre. her picc line was pulled and her foley changed and subsequent cultures have been negative. although her total wbc count normalized, she developed a bandemia of 13% which resolved after being taken to the or for surgical wound debridement; surgical wound also grew vre and mrsa. she has remained afebrile on linezolid. given her recent orthospine surgery and hardware, infectious disease was consulted. crp and esr were both found to be grossly elevated. tte and tee both negative for vegetation. given there was no involvement of hardware on 2nd trip to the or, id has reccommended a 2 week course of linezolid to be completed on . daily cbcs must be monitored while she is on linezolid and it should be discontinued on with close monitoring following its discontinuation. . # lower extremity weakness/numbness: most likely secondary to l1-l2 vertebral compression fracture. orthospine was consulted and she is now s/p t8-l3 fusion. although she states that sensation is improved, she remains unable to move her lower extremities actively. ortho spine feels that these deficits may not improve significantly given similar pre-and post-op function. physical therapy was consulted and they worked with her with passive range of motion. she will need to follow up with dr. of orthospine within 2-3 weeks of discharge. . # surgical wound infection: following her surgery, her back wound was noted to have increased drainage and was malodorous. ortho spine took her back to the or for surgical wound debridement. although infected wound, there was apparently no involvement of hardware. cultures were sent which revealed vre and mrsa. she is already on linezolid for duration as outlined above. . # coccygeal ulcer: plastics was consulted and ulcer was thought to coccygeal bone spur. they have reccommended wet to dry dressing changes which should be continued at rehab. when other medical issues improved, an oupatient f/u appointment can be scheduled with plastic surgery at ( to remove the bone spur which likely precipitated ulcer formation. this appointment has not yet been scheduled and can be done as an outpatient. . # hypoalbunemia: albumin ranged from 1.4-2.0 secondary to proteinuria in the setting of nephrotic syndrome and poor nutritional intake. she was getting tube feeds while intubated in the micu following her first surgery, but it was removed on transfer to the floor. although her po intake did improve slightly, it did not increase significantly. she was started on reglan for motility and megace for appetite stimulation. additionally, her meals were supplemented with ensure. . # elevated inr: inr became elevated to 1.4. this was thought most likely to poor nutrition and vitamin k deficiency given its normalization with po vitamin k. . # hypoxia: directly following her first surgery, she remained intubated. this was thought secondary to volume overload and ct chest demonstrated diffuse interstitial disease that could be heart failure, but tte revealed normal function. . # elevated bicarb: elevation occurred in the setting of diuresis with iv lasix so thought to represent a contraction alkalosis. diamox was added to the lasix with improvement in the bicarb level. per renal, diamox should be discontinued at rehab when bicarb is 26-27. on day of discharge, hco3 was 29. daily chem 10 should, thus, be monitored daily while at rehab. . # osa: uses bi-pap and 4l o2 by nc at home. settings 18/12. has not required it while in-house. home cpap should be reinitiated while at rehab. . # mrsa cellulitis: she had a recent history of mrsa cellulitis and given her known vre as above, was continued on linezolid. left lower extremity swelling and erythema persists, but is improved. course of linezolid as above (to finish ). . # osteoporosis: most likely related to vitamin d deficiency with low vitamin 25 hydroxy d. she has a history of several vertebral compression fractures, present since . endocrine was consulted and she was started on vitamin d supplementation, calcium and calcitonin. per pt's sister, was started approximately 2 years ago in the outpatient setting, prescribed by dr. . it has been held, however, given concern for possible contribution to fsgs/nephrotic syndrome. she will need to follow up with endocrine as an outpatient at her convenience for continued management of her osteoporosis and multiple medications for this problem. . # rheumatoid arthritis: per prior discussion with dr. , the patient has long standing interstitial lung disease and her joint disease is likely jra. films were consistent with dx of ra. additionally, spinal arthritis was seen on kub during this hospital stay. her pain remained well controlled with tylenol and dilaudid (used post operatively). . # anemia: previous baseline hct appears to be in the low to mid 30s, more recently 24s-25s. she did develop a hematoma s/p renal biopsy that subsequently remained stable. throughout this hospitalization, with surgery x2, and hematoma, she received a total of 23 units of prbcs. b12 was found to be slightly low and she will need to be continued on qmonthly b12 injections upon discharge (first dose given ). additionally, erythropoeitin was initiated per renal which should be delivered qmwf. . # f/e/n: speech & swallow evaluated her and cleared her for thin liquids and soft solids. meals were supplemented with ensure pudding. . # prophylaxis: sq heparin was discontinued given the risk of worsening osteoporosis and she was continued on fondaparinux for prophylaxis. medications on admission: alendronate sodium 70mg--one tablet once a week-drink with at least 8 ounces of water and remain upright for 30 minutes afterwards not eating or drinking anything colase 100mg-- 3 tablets qday furosemide 80 mg--3 tab klaron 10%--apply twice a day to cheeks and nose klor-con 10 10meq--3 by mouth tid nizoral 2 %--apply to affected area twice a day nizoral shampoo --as directed every other day nystatin u/g--apply beneath each breast up to twice a day for rash tylenol extra strength 500mg--1 pill by mouth tid prn. discharge medications: 1. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 2. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 3. acetaminophen 325 mg tablet sig: two (2) tablet po q4-6h (every 4 to 6 hours) as needed for fever, pain. 4. epoetin alfa 3,000 unit/ml solution sig: 6000 (6000) units injection mwf (-wednesday-friday). 5. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po 1x/week (once per week) for please see below for duration weeks: to be delivered every sunday and complete , . 6. megestrol 40 mg/ml suspension sig: four hundred (400) mg po daily (daily). 7. fondaparinux 2.5 mg/0.5 ml syringe sig: 2.5 mg subcutaneous daily (daily). 8. lasix 40 mg tablet sig: one (1) tablet po twice a day. ***see addendum for correct dose 9. diamox sequels 500 mg capsule, sustained release sig: one (1) capsule, sustained release po once a day: to be given only until bicarb (hco3) is 26-27. it should be stopped at that time. 10. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 9 days: to be completed on . 11. dilaudid 2 mg tablet sig: 1-3 tablets po every four (4) hours as needed for pain. 12. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid w/meals (3 times a day with meals). 13. reglan 10 mg tablet sig: one (1) tablet po every six (6) hours: to aid in gi motility. 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day): to be used while patient requiring narcotics for pain control. 15. colace 100 mg capsule sig: one (1) capsule po twice a day: to be used while patient is requiring narcotics for pain control. 16. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed: to be used while patient is requiring narcotics for pain control. 17. calcitriol 0.25 mcg capsule sig: one (1) capsule po once a day. 18. calcitonin (salmon) 200 unit/ml solution sig: one (1) spray intranasal injection daily (daily): please alternate nostrils. 19. nizoral 2 % cream sig: one (1) topical once a day: apply to affected areas on face. 20. nizoral a-d 1 % shampoo sig: one (1) topical once a day. 21. cyanocobalamin 1,000 mcg/ml solution sig: 1000 (1000) mcg injection once a month. discharge disposition: extended care facility: - discharge diagnosis: primary: nephrotic syndrome osteoporosis compression fracture now s/p t8-l3 posterior fusion lower extremity weakness secondary to compression fracture vancomycin resistent enterococcal uti, bacteremia mrsa cellulitis rheumatoid arthritis anemia discharge condition: stable, afebrile. discharge instructions: please call your doctor or return to the emergency room if you develop fevers/chills, drainage from your back wound, worsening back pain, worsening lower extremity sensory deficits, open wounds on your legs, nausea/vomiting/diarrhea or any other symptoms that concern you. . please follow up with your appointments as below. . please take your medications as prescribed. in particular, please complete the course of linezolid (to finish on ). followup instructions: please follow up with dr. at on tuesday, at 2:20pm. . please follow up with dr. at renal clinic in the building on , on tuesday, at 11:30am. labs will be drawn while at rehab that should be faxed to dr. office at . . please follow up with dr. in the clinic ( on at 9am. his office is located in the building on the (). . because of your severe osteoporosis, you should follow up in endocrine clinic at with dr. on , at 2pm (. . please follow up in dr. clinic for evaluation of the peri-rectal lesion near the site of your old surgical scar. call his office at for an appointment. . appointment scheduled prior to this hospitalization: provider: phone: date/time: 3:00 md 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 non-invasive mechanical ventilation closed [percutaneous] [needle] biopsy of kidney transfusion of packed cells dorsal and dorsolumbar fusion of the posterior column, posterior technique excision of lesion of other soft tissue repair of vertebral fracture lumbar and lumbosacral fusion of the anterior column, anterior technique transfusion of other serum transfusion of platelets other repair and plastic operations on spinal cord structures insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae fusion or refusion of 4-8 vertebrae insertion of recombinant bone morphogenetic protein diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) acute kidney failure with lesion of tubular necrosis other postoperative infection cellulitis and abscess of trunk urinary tract infection, site not specified congestive heart failure, unspecified acute posthemorrhagic anemia hematoma complicating a procedure cellulitis and abscess of leg, except foot bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site osteoporosis, unspecified morbid obesity pressure ulcer, lower back rheumatoid arthritis streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] other and unspecified coagulation defects paraplegia pathologic fracture of vertebrae kyphosis associated with other conditions mild intellectual disabilities major osseous defects infection with microorganisms with resistance to multiple drugs nephrotic syndrome with lesion of membranous glomerulonephritis 

Answer: The patient is high likely exposed to