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 / erythromycin base / demerol attending: chief complaint: abdominal pain, nausea/vomiting major surgical or invasive procedure: : removal of tunneled catheter and placement of hickman catheter history of present illness: 67f with multiple medical problems, including fibromyalgia, mrsa osteomyelitis of l2-3, and a history of recurrent sbos. she reports increasing abdominal pain since the day prior to admission, with waves of cramping. she has had po intolerance and emesis and dry heaves on day of admission as well. she reports no flatus, but diarrhea for the past few days. all these symptoms are typical of her prior episodes of sbo -- her husband reports that this will be her 89th episode, typically averaging hospitalizations per year. this attack to them, seem less severe than her prior episodes. she denies chest pain, fevers/chills, or sick contacts. past medical history: l2-l3 osteomyelitis and discitis psoas abscess left upper extremity thrombosis spinal stenosis multiple admissions for partial small bowel obstruction h/o ovarian ca diagnosed 23 years ago, s/p abdominal xrt chronic abdominal pain low back pain fibromyalgia hypothyroidism gerd hypercholesterolemia depression radiation enteritis elevated creatinine cardiomyopathy ef 50%, + mr () fe deficiency anemia past surgical history: tah/bso exploratory laparotomy with lysis of adhesions appendectomy laminectomy and spinal fusion l4-l5 social history: married. denies tobacco or alcohol use. previously worked as a registered nurse in an outpatient medical practice. family history: cancer, heart disease in several family members physical exam: tc 98.5, hr 84, bp 188/97, rr 20, o2sat 100% genl: nad cv: rrr resp: cta-b abd: soft, tender to llq, rlq, no tap tenderness, no reboud, no guarding, non-distended extr: no c/c/e pertinent results: 05:45pm glucose-87 urea n-13 creat-1.1 sodium-139 potassium-3.5 chloride-104 total co2-23 anion gap-16 05:45pm estgfr-using this 05:45pm alt(sgpt)-7 alk phos-68 tot bili-0.2 05:45pm lipase-30 05:45pm albumin-3.6 calcium-8.9 05:45pm wbc-10.7 rbc-3.25* hgb-8.8* hct-28.0* mcv-86 mch-27.1 mchc-31.5 rdw-16.5* 05:45pm neuts-65.6 lymphs-27.5 monos-5.7 eos-0.8 basos-0.5 05:45pm plt count-579* 05:23am blood wbc-6.2# rbc-2.60* hgb-7.2* hct-22.1* mcv-85 mch-27.8 mchc-32.7 rdw-16.1* plt ct-477* 07:00am blood wbc-7.6 rbc-2.73* hgb-7.5* hct-23.2* mcv-85 mch-27.5 mchc-32.3 rdw-16.3* plt ct-485* 04:39am blood wbc-8.9 rbc-2.77* hgb-7.7* hct-23.6* mcv-85 mch-27.6 mchc-32.4 rdw-16.2* plt ct-536* 04:17am blood wbc-12.3* rbc-2.44* hgb-7.0* hct-21.1* mcv-86 mch-28.8 mchc-33.3 rdw-16.1* plt ct-446* 09:24pm blood wbc-12.1* rbc-3.63*# hgb-10.4*# hct-31.2*# mcv-86 mch-28.6 mchc-33.2 rdw-16.3* plt ct-398 05:06am blood wbc-15.8* rbc-3.62* hgb-10.6* hct-30.9* mcv-85 mch-29.4 mchc-34.4 rdw-16.5* plt ct-418 05:57pm blood wbc-11.8* rbc-3.12* hgb-9.0* hct-27.2* mcv-87 mch-28.7 mchc-32.9 rdw-16.3* plt ct-492* 05:04am blood wbc-10.8 rbc-3.18* hgb-8.9* hct-26.9* mcv-85 mch-28.1 mchc-33.2 rdw-16.1* plt ct-509* 04:05am blood wbc-8.4 rbc-3.03* hgb-8.6* hct-26.2* mcv-87 mch-28.3 mchc-32.6 rdw-16.2* plt ct-520* 04:48am blood pt-13.7* ptt-44.7* inr(pt)-1.2* 05:06am blood esr-15 04:50pm blood esr-60* 05:45pm blood glucose-87 urean-13 creat-1.1 na-139 k-3.5 cl-104 hco3-23 angap-16 05:20am blood glucose-99 urean-10 creat-1.0 na-140 k-3.6 cl-107 hco3-21* angap-16 06:06pm blood k-4.8 05:23am blood glucose-102 urean-5* creat-1.2* na-136 k-3.3 cl-105 hco3-22 angap-12 07:00am blood glucose-105 urean-4* na-135 k-3.1* cl-105 hco3-20* angap-13 04:39am blood urean-4* creat-1.2* na-137 k-3.7 cl-106 hco3-20* angap-15 04:26am blood glucose-105 urean-11 creat-1.3* na-130* k-4.2 cl-100 hco3-21* angap-13 04:06am blood glucose-109* urean-11 creat-1.4* na-129* k-4.5 cl-98 hco3-21* angap-15 11:18am blood glucose-86 urean-14 creat-1.5* na-131* k-5.2* cl-103 hco3-18* angap-15 11:42pm blood glucose-90 urean-12 creat-1.5* na-130* k-4.6 cl-100 hco3-19* angap-16 05:30am blood glucose-79 urean-13 creat-1.6* na-130* k-4.5 cl-99 hco3-20* angap-16 05:12am blood glucose-54* urean-17 creat-1.5* na-129* k-4.4 cl-100 hco3-15* angap-18 05:57pm blood glucose-103 urean-24* creat-2.0* na-129* k-4.2 cl-100 hco3-16* angap-17 05:04am blood glucose-101 urean-24* creat-2.0* na-128* k-4.0 cl-100 hco3-16* angap-16 05:26am blood glucose-82 urean-19 creat-2.0* na-129* k-4.0 cl-102 hco3-17* angap-14 07:59am blood glucose-98 urean-18 creat-1.8* na-135 k-3.6 cl-105 hco3-18* angap-16 04:05am blood glucose-92 urean-17 creat-1.6* na-135 k-4.1 cl-108 hco3-19* angap-12 04:05am blood calcium-9.0 phos-3.0 mg-1.8 02:25am blood tsh-28* 06:45pm blood prolact-58* 07:00am blood free t4-1.5 05:06am blood crp-1.3 04:50pm blood crp-2.6 07:00am blood vanco-21.1* 08:09pm blood vanco-20.1* 01:08pm blood ttg-iga-3 02:50am blood type-art po2-92 pco2-27* ph-7.46* caltco2-20* base xs--2 07:09pm blood type-art po2-104 pco2-30* ph-7.42 caltco2-20* base xs--3 02:36am blood lactate-1.1 02:50am blood lactate-0.9 02:50am blood freeca-1.13 brief hospital course: # gastrointestinal the patient was admitted to the hospital for partial small bowel obstruction. patient initially refused a ngt and foley catheter. she was maintained npo and started on maintenance fluid. she underwent serial examinations with improvement in her abdominal pain. in the emergency department, she had a kub performed: history: 67-year-old female with history of small bowel obstructions, now with similar symptoms. evaluate for obstruction. comparison: ct . abdomen, supine and left lateral decubitus: spinal fusion hardware is noted at l4-l5. there are gas-filled loops of small bowel, with several bowel loops borderline in size, similar to the prior study. though there is a relative paucity of bowel gas in the colon, air is evident in the rectum. no free air or pneumatosis is identified. impression: borderline dilated small bowel loops, which can be seen with an ileus, though an early and/or partial small bowel obstruction cannot be excluded. patient was started on pain control with dilaudid. patient had persistent diarrhea during her hospitalization and had at least 8 c. difficile samples sent to the laboratory, all of which have returned negative. the gi service was consulted for persistent diarrhea. they initially recommended stool cultures (negative), a clear liquid diet, and observation for clinical improvement. the patient was later ordered for an mr enterography, however, her diarrhea improved prior to obtaining the study. an anti-transglutaminase was sent to evaluate for celiac disease and was in the normal range. disease the patient # infectiouswas maintained on her home dose of vancomycin for her previous mrsa bacteremia and mrsa l2-l3 osteomyelitis. the infectious disease service was consulted on and followed her for several weeks. patient had been on vancomycin since . id recommended continuing vancomycin. on , the patient was found to have a urinary tract infection. she was started on ciprofloxacin, though this was changed to bactrim as cipro can lower the seizure threshold. the sensitivities returned on the urine culture, and was resistant to bactrim. ultimately, she completed her treatment for uti with macrobid. there was no further dysuria, frequency, or urgency. on hd # 20, her vancomycin was discontinued and she was started on bactrim ds for her discitis this was discontinued after 3 days due to worsening renal function. infectious disease did not feel as though additional antibiotics were necessary for the discitis. on hd # 11, blood cultures were sent and returned with parapsilosis. unfortunately, the sensitivities showed that the was resistant to fluconazole and oral therapy was not available. the patient was started on micafungin 100mg iv daily on . id recommended last dose of micafungin on . micafungin was discontinued prior to discharge. on , the patient was brought to the operating room to have her existing tunnelled catheter removed due to the fungemia and a new hickman catheter was placed without incident. due to the fungemia, the patient had an ophthalmology consult and was evaluated. they found no evidence of fungal endophthalmitis. . she also had a tte performed: the left atrium and right atrium are normal in cavity size. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 50%). the estimated cardiac index is normal (>=2.5l/min/m2). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is high normal. there is no pericardial effusion. compared with the prior study (images reviewed) of , left ventricular systolic function is less dynamic and increased pcwp is now suggested. # renal on the patient was noted to have hyponatremia with a sodium of 130. she had a nadir of 129. she further was noted to have worsening of her creatinine (baseline 1.0-1.2). as the creatinine continued to elevate, nephrology was consulted. nephrology recommended discontinuation of the bactrim as this was likely contributing to her worsening creatinine level. further, the hyponatremia was attributed to siadh likely secondary to the patient's opiate use. her opiate use was curtailed and her free fluid was limited and her hyponatremia resolved. renal service also made recommendations regarding the patient's labile blood pressures. she had intermittent periods where her systolic blood pressure was 220s with diastolics in the 110s. she was being treated with iv lopressor and ultimately with iv hydralazine. she was started on metoprolol by mouth and this was titrated to effect. renal recommended the discontinuation of all iv blood pressure medications as they were likely causing relative hypotension and hypoperfusion of her kidneys. she was maintained on coreg and started on amlodipine 2.5 mg po daily. if her blood pressure is not well controlled, we would recommend increasing her amlodipine to 5 mg po daily. the patient's urine output was low on occasion and she did require small boluses of ivf. the ivf likely worsened her hyponatremia, however. in her extended care facility, she should be encouraged to drink fluids. if she does require a fluid bolus, would recommend a 500ml bolus given over 5 hours. her creatinine peaked at 2.0 and has continued to trend down. her most recent creatinine was 1.6 on . her sodium and creatinine should be monitored in her extended care facility. # hematology the patient was maintained on lovenox 60mg sc bid for her recent lue dvt (~). during the admission, she complained of rue numbness and tingling and had a negative duplex ultrasound performed. after her hickman line placement on , she was noted to have oozing around the insertion site. shortly thereafter, her lovenox was discontinued for several days. after the oozing resolved, she was restarted on lovenox, but at a prophylactic dose only. on , the patient was noted to have a hematocrit of 21.1 due to blood loss on top of anemia of chronic disease and she was transfused 2units of prbcs with appropriate increase in hematocrit. # neurologic on hd # 10, a trigger was called as the patient was exhibiting seizure like behavior. nursing staff and the patient's husband report but rhythmic contractions and relaxations of her upper extremities. this reportedly lasted for two minutes at which point she appeared to have a blank stare and was non-verbal. two minutes later her confusion cleared. she showed no evidence of tongue laceration or incontinence. at that time she obtained a head ct: history: 67-year-old female with small-bowel obstruction, now with tonic- clonic seizure. here to assess for intracranial process. comparison: ct head, most recently of . technique: mdct axial imaging was performed through the brain before and after administration of 90 ml of iv optiray 350. ct head before and after iv contrast: no evidence of acute intracranial hemorrhage, edema, mass effect, hydrocephalus, or large vascular territory infarction is seen. periventricular white matter hypodensities are mild, likely due to chronic microangiopathic ischemic change. after administration of gadolinium, no abnormally enhancing mass is seen. vascular calcifications are noted along the dominant right vertebral artery, as well as the carotid siphons. while the current study is not tailored towards the study of such, there is apparent normal enhancement of the vessels of the circle of . there is also normal enhancement of the venous sinuses. the soft tissues, orbits, and skull appear unremarkable. the mastoid air cells and middle ear cavities are normally aerated. minimal layering fluid or mucosal thickening is noted along the sphenoid sinus, which was not present on . impression: no evidence of acute intracranial process nor abnormal enhancing mass seen. if there remains concern for subtle process, mri would be recommended for more sensitive evaluation while down at ct, the patient reportedly exhibited further seizure activity and she received ativan. she was transferred to the trauma-surgery icu where she had a neurology evaluation. neurology commented on how the postictal period was remarkably short and atypical for a tonic-clonic seizure. they recommended a 24 hour eeg with video as well as a lumbar puncture. the patient continues to refuse lumbar puncture. eeg on : findings: routine sampling: showed a 9 hz predominant biposterior rhythm in the most awake parts of this recording. there were no areas of prominent focal slowing or epileptiform features seen. sleep: the patient progressed from wakefulness to sleep with no additional findings. cardiac monitor: showed a generally regular rhythm. spike detection programs: showed no clear epileptiform features. seizure detection programs: there were eight entries in this file for muscle and movement artifacts, rhythmic alpha activity but no ongoing seizure activity. pushbutton activations: there were none. impression: this telemetry captured no pushbutton activations and no interictal epileptiform activity. the background activity was normal. eeg : findings: routine sampling: showed a 9 hz predominant biposterior rhythm in wakefulness. there were no areas of prominent focal slowing or epileptiform features seen. sleep: the patient progressed from wakefulness to sleep with no additional findings. cardiac monitor: showed a generally regular rhythm. spike detection programs: there were no entries in this file. seizure detection programs: there were three entries in this file for movement and muscle artifacts. there was no ongoing seizure activity seen. pushbutton activations: there were none. impression: this telemetry captured no pushbutton activations and no ictal or interictal epileptiform activity. the background activity was normal. an mri/mra of the brain was ordered, however, the patient was not able to comply with the study for several days. the study was obtained on : history: 67-year-old female patient with osteomyelitis and discitis. patient with mental status changes and new onset seizures. technique: mri of the head was performed with and without iv contrast and mra of the brain was also performed. comparison: ct scan dated . no previous mri. findings: mri brain: there are nonspecific non-enhancing t2/flair hyperintense foci within the bilateral centra semiovale and periventricular regions likely representing chronic small vessel ischemic changes in a patient of this age. there is an ill-defined focus of flair-hyperintensity, with no enhancement, within the medial inferior right cerebellar hemisphere/lateral vermis, with no evidence for restricted diffusion likely representing chronic infarction. there is moderate diffuse parenchymal volume loss with associated proportionate prominence of the ventricles and sulci, likely reflecting age-related volume loss. there is no evidence of acute infarction, hemorrhage, abnormal enhancement, or hydrocephalus. no mesial temporal sclerosis, cortical dysplasia or heterotopia is seen. the visualized major vascular flow voids are normal. orbital structures are unremarkable. there is mucosal thickening of the bilateral ethmoid air cells and a mucus-retention cyst in the right sphenoid sinus. otherwise, the remainder of the paranasal sinuses as well as mastoid air cells are clear. mra brain: anterior circulation: the bilateral mcas and acas are unremarkable without evidence for aneurysm (greater than 3 mm), avm, or stenosis. incidental note is made of fenestration at the aca-acom complex, a normal variant. posterior circulation: bilateral pcas and basilar artery are unremarkable. the right vertebral artery is dominant. the left vertebral artery is non-dominant and becomes more diminutive, just distal to the takeoff of the left pica, also a normal variant. there is no evidence for aneurysm (greater than 3 mm), avm, or stenosis. impression: 1. no acute infarction or hemorrhage, and no pathologic focus of enhancement. 2. right inferior cerebellar/lateral vermian chronic infarction, and likely mild chronic small vessel infarction in a patient of this age. 3. fenestration of the acom complex, a normal variant. no significant neurovascular abnormality identified. after this extensive workup, it was ddecided that the patient had pseudoseizures rather than a true seizure disorder and that anticonvulsants were not required. during the hospitalization, the patient had waxing and mentals status. she reportedly was seen talking to her finger and calling out for her mother (who is deceased) on multiple occasions. psychiatry was consulted for her abnormal behavior. psychiatry recommended antidepressant -- sertraline begin at 50 mg qd, after 4 days increase to 100 mg daily. further, they recommended that the patient would benefit from outpt psychiatry or therapy. # musculoskeletal the patient was evaluated by orthopaedics/spine due to her recent l2-l3 osteomyelitis. a l spine mri was obtained: lumbar spine mri. history: 67-year-old female presents with history of lumbar osteomyelitis. comparison: prior lumbar spine mris, through . findings: the patient was unable to tolerate the examination, only a sagittal t2 sequence was acquired. the configuration of the lumbar spine appears similar, with marked abnormality of the disc space at l2-l3 with an associated fluid cleft. fusion is noted just inferior to this. there is likely at least moderate narrowing of the spinal canal at the l3 level. there is slightly increased prevertebral soft tissue, displacing the aorta anteriorly. this may relate to progressive inflammatory change, though is incompletely evaluated. again noted is a kyphotic deformity at t10 associated with the disc protrusion and associated osteophytes. impression: incomplete examination demonstrates grossly similar appearance to the previous mri from on limited sagittal t2 seqeunce. complete study to be performed when pt. is co-operative for complete assessment. severe central canal stenosis with possible compression on the cauda at l2-3 and l3-4 levels, incompletely assessed. a repeat lumbar spine mri is recommended as an outpatient if clinically indicated. medications on admission: 1. carvedilol 3.125 mg po bid 2. lisinopril 10 mg po daily 3. omeprazole 40 mg po daily 4. simvastatin 40 mg tablet sig: one (1) tablet po daily 5. cholecalciferol 1000u po daily 6. sertraline 100 mg po daily 7. alendronate 70 mg po qsun 8. lorazepam 0.5 mg po q6h as needed for anxiety. 9. senna 8.6 mg 10. fentanyl 100 mcg/hr patch q72h 11. calcium carbonate 500 mg po qid 12. levothyroxine 150 mcg po daily 13. zoloft 100mg po daily 14. vicodin 5/500mg 1-2 tabs qid prn pain 15. lovenox 1mg/kg 16. vancomycin 500mg iv daily discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever or pain. 2. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed for constipation. 3. carvedilol 3.125 mg tablet sig: one (1) tablet po bid (2 times a day). 4. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. levothyroxine 75 mcg tablet sig: two (2) tablet po daily (daily). 7. sertraline 50 mg tablet sig: two (2) tablet po daily (daily). 8. amlodipine 2.5 mg tablet sig: one (1) tablet po daily (daily). 9. hydromorphone 2 mg tablet sig: 1-2 tablets po every 6-8 hours as needed for pain for 10 days. 10. simvastatin 40 mg po daily 11. heparin flush (10 units/ml) 2 ml iv prn line flush tunneled access line (e.g. hickman), heparin dependent: flush with 10 ml normal saline followed by heparin as above daily and prn per lumen. discharge disposition: extended care facility: - heathwood discharge diagnosis: partial small bowel obstruction hyponatremia acute renal failure fungemia pseudoseizures depression discharge condition: stable, afebrile discharge instructions: you were evaluated and treated for a partial small bowel obstructions. you had a lengthy hospitalization with multiple other treatments. please adhere to a renal diet. you are encouraged to drink fluids. please call your primary care physician or return to the emergency department for any of the following: * fever greater than 101 * severe abdominal pain * persistent nausea/vomiting * confusion * seizure activity * any new or concerning symptom followup instructions: please make an appointment to see dr. in 2 weeks. his office number is (. you should also schedule an appointment to see your regular physician. you should also follow up with the infectious disease clinic in weeks. their telephone number is . procedure: venous catheterization, not elsewhere classified diagnoses: other primary cardiomyopathies anemia of other chronic disease esophageal reflux unspecified essential hypertension acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) unspecified acquired hypothyroidism candidiasis of other urogenital sites other convulsions depressive disorder, not elsewhere classified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure personal history of venous thrombosis and embolism other and unspecified infection due to central venous catheter other disorders of neurohypophysis myalgia and myositis, unspecified delirium due to conditions classified elsewhere unspecified intestinal obstruction personal history of irradiation, presenting hazards to health late effect of radiation radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other and unspecified mycoses arthrodesis status spinal stenosis, lumbar region, without neurogenic claudication personal history of methicillin resistant staphylococcus aureus personal history of malignant neoplasm of ovary gastroenteritis and colitis due to radiation 

Answer: The patient is high likely exposed to