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: codeine / ciprofloxacin / morphine attending: chief complaint: :"my neck and my back" / "the spasms in my upper back" major surgical or invasive procedure: c5 c6 corpectomies c45 c56 c67 discectomies c4-7 fusion history of present illness: hpi:asked to eval this 57 year old white female with extensive pmh for ? osteo in cervical spine. note: pt has husband at bedside / both give conflicting stories of pmh and hospitalizations. pt and husband describe that pt was hospitalized at in of this yr for "perforated" vs "tear" in esophagus. hospitalization lasted approx 5.5 wks at which time she was transferred to rehab for an additional 5.5 weeks. while at she had a picc line placed for vancomycin x 4 weeks that was treating "gastric abscess and pna". she was discharged to home with picc line (but not on abx) and spent about 6 days at home. she then went back to for "fever and another esophageal tear". they removed the picc line as possible fever source. the picc cx was positive for mrsa. note during that second hospitalization she was intubated in the ed and spent "" days in the icu on ventilatory support. she did not have surgery at any time for the esophageal tears. she describes coffee ground emesis during that time and was taken off of her coumadin (which she was taking for a supraclavicular clot" that was ultimately treated by a "balloon breaking it up"). her husband recalls an admission date of because he had to miss and says she was complaining of neck pain a "few days after". she was ultimately released to home with pt. about 2 weeks after being discharged her neck pain was worse and she went to ed - had xrays and was sent home. she called her pcp and was prescribed robaxin for muscle spasm which was increased from qd to tid. the pain was continuing and she states the pt refused to perform any further treatment b/c she was getting progressively weaker without explanation. she describes that pt called pcp and osh mri was ordered. she received this imaging on and the radiologist wheeled her to the er where she was placed in a collar and seen by neurosurgery. she was sent here for further eval. images are being uploaded to the system at this time. she admits to numbness and tingling to all finger tips and palms of both hands. she also admits to pain to dorsal and ventral surfaces of arms as well as pain down anterior thighs and legs. she denies mi, cva, falls or hyperesthesias or bowel or bladder issues. past medical history: past medical history: -gastroparesis (likely narcotic induced vs idiopathic): history of tpn -childhood constipation -history eating disorder -narcotic induced ileus -history of laxative abuse and ? eating disorder -supraclavicular clot -chronic pain -history meningioma -peripheral neuropathy -gerd -c. difficile colitis -mild esophagitis -cholecystitis -hysterectomy for uterine cancer -migraine headaches -staph aureus bacteremia in setting of tpn social history: she lives with her husband. history of tobacco abuse but quit 30-40 years ago after smoking pack per day prior to that. occasional alcohol. no illicit drugs. has been on disability for years secondary to her chronic abdominal symptoms. family history: her father had diabetes and her mother died of colon cancer. physical exam: physical exam: o: t: 98.7 bp: 110/ 62 hr:108 r 18 95 o2sats gen: pale small framed female, comfortable, nad at rest heent: ncat neck: tender from occiput to upper thoracic region/ paraspinal regions bilaterally as well as to shoulders and ears. abd: soft, g-j tube noted with broth/ brown drainage noted / no coffee grounds extrem: warm and well-perfused./ no edema - note: husband feels that r hand is very swollen still "from clot" / no edema is appreciated by this examiner neuro: mental status: awake and alert, attempts to cooperate with exam. orientation: oriented to person, place, and date. motor: exam extremely limited pain all over. at best participation pt is antigravity in the distal upper extremities. resists examiners efforts to lift arms off of bed. hoffmans negative however pt describes severe pain. grips , bicep 4-/5 and breaking, triceps 4-/5 and breaking. le's actively w/d to fully flexed during pr exam however at best ip , df , pf . clonus appears to be negative however pt cries out in pain and w/d's away from examiner. sensation: intact to light touch reflexes: unable to obtain / pt very limiting to exam / on discharge: full strength in ble although in uppers with very poor effort. she does not have any focal deficits. incision, clean, dry, intact. steri strips in place. cervical collar in place. pertinent results: ct c-spine impression: chronic discitis/osteomyelitis at c5-6 with focal kyphosis and retrolisthesis at this level. recent mri showed severe canal stenosis at this level due to inflammatory epidural tissue. there is also extensive prevertebral soft tissue. ct c-spine impression: 1. note difference in levels from that given in the indication and wet read. 2. satisfactory alignment of hardware with relative alignment of spine. however, disc-osteophyte complexes at multiple levels may efface thecal sac contact cord, though cord detail is limited at all levels given ct technique and streak artifact. cxr : the left picc line tip is at the mid svc level. there is new left basal opacity that might represent atelectasis or developing infection. the right basal linear opacity is also new and also might represent atelectasis. close followup to these areas is recommended to exclude the possibility of developing infectious process. there is no pleural effusion. there is no failure. cardiomediastinal silhouette is unremarkable. cxr : the left basal atelectasis is improved. the right basal atelectasis is improved. there is no evidence of pneumonia. 02:26am blood wbc-5.8 rbc-2.89* hgb-8.5* hct-26.0* mcv-90 mch-29.4 mchc-32.6 rdw-15.9* plt ct-266 05:22am blood wbc-3.4* rbc-2.90* hgb-8.7* hct-26.3* mcv-91 mch-30.1 mchc-33.2 rdw-15.7* plt ct-306 04:38am blood wbc-3.5* rbc-2.80* hgb-8.2* hct-24.9* mcv-89 mch-29.2 mchc-32.9 rdw-15.7* plt ct-316 02:28am blood pt-13.8* ptt-33.5 inr(pt)-1.2* 02:26am blood glucose-123* urean-6 creat-0.4 na-140 k-3.7 cl-106 hco3-28 angap-10 04:38am blood glucose-105 urean-4* creat-0.4 na-144 k-3.5 cl-108 hco3-30 angap-10 05:22am blood glucose-93 urean-3* creat-0.4 na-144 k-3.3 cl-106 hco3-30 angap-11 02:26am blood alt-14 ast-19 ld(ldh)-125 alkphos-264* totbili-0.3 05:22am blood calcium-8.6 phos-3.9 mg-1.8 brief hospital course: 1) osteomyelitis: pt was transferred from the emergency department for collapse of c56. she was maintained in a cervical collar. the pt was admitted to medicine service for clearance as well as to eval the integrity of the pts esophagus given her history of esophageal perforation x 2. she was initially started on vancomycin and ceftazidine in the osh ed for empiric coverage of her osteomyelitis, however, after her initial dose her antibiotics were held per id so that adequate biopsy specimens could be obtained for culture during her surgery. the patient was carefully monitored for any signs of neurological deterioration. patient had ugi gastrograffin study that showed no evidence of esophageal perforation. the pt was medically cleared and taken to the or on for corpectomies at c5 c6 with fusion c4-7. no posterior fusion was performed. she was extubated the next morning and wound drain was removed. on she was cleared to transfer to the step down unit but due to bed availability was unable. chronic pain service recommended that the patient continue with her dilaudid pca, and patient was transferred to the step down unit. her pca was discontinued and she was transitioned to po pain medication. she tolerated tube feeds however would complain of nausea when she was aware of rate being at goal. she did not have high residuals and have regular bms. she worked with pt/ot and was oob. pt/ot recommended rehab. she did c/o sl cough on with vaigue adventitious sounds, although no elevated wbc, afebrile, no sputum. cxr was done showing some atelectasis. she had a repeat cxr on showing that the atelectasis was resolving and there was no evidence of pneumonia. on she was neurologically stable and was discharged to rehab. 2) right hand swelling: the patient has a history of r brachial vein thrombosis, and on admission was noted to have right hand swelling and warmth. she reports chronic intermittent swelling since dvt. right upper extremity ultrasound was performed that showed no evidence of clot. probable etiology for her chronic swelling is post-dvt syndrome. 3) migraine headaches: patient has a history of chronic migraine headaches and experienced them nearly constantly during this admission. her pain was well controlled with her home dose of fioricet. medications on admission: medications prior to admission: fentanyl 100mcg q 72 hrs senna two tabs po bid colace 200mg po bid scopolamine patch 1.5mg q 72 hours dicyclomine 20 mg q 6 hrs for stomach spasm ativan 1 mg q 4 hours nexium 40mg (liquid) promethazine suppository 50mg q 4 hours reglan 40 mg daily hydromorphone 2mg po q 4 hours vivonex t.e.n. packet 20 ml / hr 8pm to 8am daily coumadin 2mg (stopped last hospitalization to ) potassium chloride 20meq (powder) lactulose 15ml qd ntg fiorocet 1-2 tabs q 6 hours discharge medications: 1. metoclopramide 10 mg tablet : one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). 2. dicyclomine 10 mg capsule : two (2) capsule po qid (4 times a day) as needed for stomach spasm. 3. butalbital-acetaminophen-caff 50-325-40 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for headache. 4. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 5. multivitamin,tx-minerals tablet : one (1) tablet po daily (daily). 6. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day). 7. docusate sodium 50 mg/5 ml liquid : two (2) po bid (2 times a day). 8. trazodone 50 mg tablet : 0.5 tablet po hs (at bedtime) as needed for insomnia. 9. fentanyl 75 mcg/hr patch 72 hr : two (2) patch 72 hr transdermal q72h (every 72 hours). 10. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 11. pregabalin 25 mg capsule : four (4) capsule po bid (2 times a day). 12. ibuprofen 400 mg tablet : one (1) tablet po q8h (every 8 hours) as needed for fever. 13. lactulose 10 gram/15 ml syrup : thirty (30) ml po bid (2 times a day) as needed for constipation. 14. bisacodyl 10 mg suppository : one (1) suppository rectal daily (daily). 15. methocarbamol 500 mg tablet : two (2) tablet po qid (4 times a day) as needed for pain. 16. hydromorphone 4 mg tablet : one (1) tablet po q4h (every 4 hours) as needed for pain. 17. scopolamine base 1.5 mg patch 72 hr : one (1) patch 72 hr transdermal q72 hours (). 18. heparin, porcine (pf) 10 unit/ml syringe : one (1) ml intravenous prn (as needed) as needed for line flush. 19. lorazepam 2 mg/ml syringe : 0.5 injection q4h (every 4 hours) as needed for anxiety. 20. heparin, porcine (pf) 10 unit/ml syringe : one (1) ml intravenous prn (as needed) as needed for line flush. 21. sodium chloride 0.9 % 0.9 % syringe : one (1) injection prn (as needed) as needed for line flush. 22. promethazine 25 mg/ml solution : one (1) injection q6h (every 6 hours) as needed for nausea. 23. hydromorphone (pf) 1 mg/ml syringe : one (1) injection q4h (every 4 hours) as needed for breakthrough pain. 24. vancomycin in dextrose 1 gram/200 ml piggyback : one (1) intravenous q 12h (every 12 hours). 25. meds patient has been on all of these medications while in the hospital and has not had adverse side effects even though several of them are reported to interract with each other. 26. outpatient lab work you need weekly cbc with diff, bmp, vanco trough. you need esr and crp every other week. please fax all labs results to infectious disease nurses at . discharge disposition: extended care facility: hospital discharge diagnosis: c5 c6 cervical myelitis / 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: ?????? do not smoke. ?????? keep your wound clean and dry / no tub baths or pool swimming for two weeks from your date of surgery. ?????? you have steri-strips in place, you must keep them dry for 72 hours. do not pull them off. they will fall off on their own or be taken off in the office. you may trim the edges if they begin to curl. ?????? 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. ?????? you are required wear your cervical collar at all times for 3 months. ?????? you may shower briefly without the collar or back brace; unless you have been instructed otherwise. ?????? 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 ??????please call ( to schedule an with dr. to be seen in 4 weeks. ??????you will need ap/lat x-rays of the cervical spine prior to your . **you need to wear your cervical collar for 3 months. you will be contact by the infectious disease office for a follow-up . if there are any questions regarding antibiotics please call the infectious disease nurses at . procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances other excision of joint, other specified sites other cervical fusion of the anterior column, anterior technique fusion or refusion of 2-3 vertebrae diagnoses: anemia of other chronic disease esophageal reflux personal history of malignant neoplasm of other parts of uterus personal history of venous thrombosis and embolism methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site migraine, unspecified, without mention of intractable migraine without mention of status migrainosus gastroparesis status of other artificial opening of gastrointestinal tract personal history of methicillin resistant staphylococcus aureus chronic osteomyelitis, other specified sites major osseous defects body mass index less than 19, adult intervertebral disc disorder with myelopathy, cervical region other acute postoperative pain other pain disorders related to psychological factors 

Answer: The patient is high likely exposed to