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: demerol / unasyn / cephalosporins / levaquin / moexipril / morphine / cyclosporine attending: chief complaint: ?infected hardware major surgical or invasive procedure: left obturator artery pseudoaneurysm embolization history of present illness: ms. is a 29 year old woman with esrd on hd s/p failed renal transplant (rejection ) and s/p bilateral nephrectomy, now s/p right tibial imn on who returns from rehab with worsening leg wound and possible infection. she also notes worsening right knee swelling and pain. . her recent admission was complicated by possible cellulitis, which was treated with vancomycin/zosyn to complete a 2 week course. she was discharged from on and was found hypotensive on (blood cultures growing coag negative staph sensitive to vancomycin). she received one dose of gentamicin at that time. she responded well to ivf. the right knee was aspirated on and showed gram positive cocci in pairs and clusters but nothing grew in cultures. she had a picc line catheter tip culture on which grew coag negative staph sensitive to vancomycin. she had another catheter tip sent for culture on (unclear what line) which did not grow anything. she also underwent a debridement of the right lower extremity wound by vascular surgery. coumadin and heparin were discontinued (started for dvt prophylaxis after tib/fib surgery) and she was anticoagulated with lovenox. . she was transferred back to for concern for hardware infection, and non-healing wound. the septic knee reportedly has improved significantly with surgery and antibiotics. . in the ed, vital signs were t99.1, hr 100, bp 99/50, rr 16, sat 95% on room air. she received dilaudid iv for pain, in addition to vancomycin iv x 1 (preceded by benadryl) and clindamycin iv x 1. she was given 2 l ns for rehydration. . review of systems: she notes constipation, right lower extremity pain (both at the site of the wound and at the knee), and low grade temperature. she denies abdominal pain, nausea, vomiting, shortness of , dizziness, and vomiting. she has mild numbness of the right lower extremity below the knee. past medical history: past medical history: - sle diagnosed complicated by lupus nephritis, anemia, serositis and ascites - end stage renal disease secondary to lupus, hd t/th/sat - history of vsd s/p corrective surgery, age 13 - hypertension - itp - mssa endocarditis - sickle cell trait - s/p left oophorectomy related to iud associated infection - restrictive lung disease noted on pfts . in , chest ct with diffuse ground glass opacities. - gerd - s/p cadaveric renal transplant on complicated by rejection and capsule rupture 11/. - right pelvic abscess s/p tah/rso - b/l renal solid masses s/p resection pathology was negative for carcinoma - r tib/fib fx with orif social history: no smoking, occasional alcohol, no drug use. originally from , now lives in . used to work at . family history: non-contributory physical exam: vitals: t 97.0, bp 92/70, hr 86, rr 18, sat 100%2l gen: chronically ill appearing, no acute distress heent: eomi, op clear neck: no lymphadenopathy cardiac: rrr, normal s1/s2, 1/6 systolic murmur at apex lungs: cta bilaterally. no wheezes, rales, or rhonchi. abd: soft, but distended, mildly diffusely tender, normal active bowel sounds. no hepatosplenomegaly. midline and bilateral oblique scars from previous abdominal surgeries. ext: no clubbing, cyanosis, or edema. + dp pulses bilaterally. right knee: swollen and tender to palpation, no erythema, no warmth right leg: open wound with no purulence on anterior surface, approximately six inches long and 4 inches wide, 2cm deep, no swelling, no erythema. skin: no rashes neuro: a&o x 3 pertinent results: . ct lle with contrast: 1. fluid collection due to an apparent skin defect in the anterolateral distal calf. it may represent seroma. abscess less likely. 2. distal calf intermuscular hypoattenuation which should be followed on further series but is likely to represent muscle edema. 3. recent tibia and fibular fractures. 4. subcutaneous edema in distal calf and foot. . 8/16 l tib/fib plain film: no definite radiographic evidence for osteomyelitis. internally fixated tibial fracture and impacted nondisplaced nonangulated fibular fracture as previously described. significant soft tissue ulceration at the level of the fracture site. . r knee plain film: no definite radiographic evidence for osteomyelitis. internally fixated tibial fracture and impacted nondisplaced nonangulated fibular fracture as previously described. significant soft tissue ulceration at the level of the fracture site. . shoulder plain film 1. demineralization of the bones associated with a reticular appearance, this may be seen in the setting of renal failure. 2. no erosions identified. 3. no fractures are seen. 4. diffuse opacities within the visualized lungs, cannot exclude underlying pneumonia. . r le u/s no evidence of dvt. . bilateral arterial doppler u/s impression: on the right normal arterial doppler study _____ lower extremity at rest. on the left there appears to be mild tibial artery occlusive disease. . cxr 1. stable bibasilar opacities may reflect underlying pneumonia with possible associated atelectasis. 2. findings consistent with pulmonary artery hypertension. 3. interval removal of left-sided picc line. . cta chest with and without contrast 1. slightly limited study due to patient motion and insufficient contrast -bolus, but no evidence of pulmonary emboli. 2. stable extensive airspace opacities in both lungs with ground glass opacities with interlobular thickening. findings are likely related to a combination of left ventricular heart failure superimposed on an underlying chronic process such as cop or lupus pneumonitis. 3. stable mediastinal and hilar lymphadenopathy. 4. enlarged pulmonary artery consistent with underlying pulmonary arterial hypertension. . echocardiogram with bubble study. impression: no asd/pfo seen. no evidence of endocarditis. possible shunting through the pulmonary vasculature. symmetric lvh with preserved global and regional systolic function. mildly dilated right ventricle with preserved systolic function. moderate tricuspid regurgitation. mild pulmonary hypertension. . compared with the prior study (images unavailable for review) of , right ventricular systolic function may have slightly improved. severity of mitral regurgitation appears less. discrete mitral valve echodensity is not appreciated on the current study. the other findings are similar. . ct abd/ pelvis: impression: 1. interval decrease in size of bilateral renal fossa fluid collections. 2. interval development of the presumed hematoma in the left obturator internus muscle. 3. there is significant interval change in bibasilar ground-glass opacities, with redemonstration of a right middle lobe pulmonary nodule now measuring 5 mm in size. 4. stable pelvic lymphadenopathy. . ct abd/ pelvis: impression: 1. slightly worsened left lower lobe peribronchial opacity and airspace consolidation. this nonstanding. 2. interval expansion of the obturator internus presumed hematoma. there is also an avidly enhancing focus here. the findings are highly concerning for pseudoaneurysm. 3. stable nephrectomy bed postoperative collections. . ir embolization: impression: angiographically successful embolization of left obturator artery pseudoaneurysm with microcoils and thrombin. . 04:25pm blood wbc-8.6 rbc-2.82* hgb-8.5* hct-26.5* mcv-94 mch-30.2 mchc-32.1 rdw-20.5* plt ct-114*# 04:32am blood wbc-6.6 rbc-2.62* hgb-8.0* hct-25.0* mcv-95 mch-30.5 mchc-31.9 rdw-19.8* plt ct-147* 12:38pm blood wbc-7.5 rbc-2.81* hgb-8.4* hct-26.2* mcv-93 mch-29.9 mchc-32.0 rdw-19.5* plt ct-100* 08:00am blood wbc-7.0 rbc-3.15* hgb-9.3* hct-28.8* mcv-91 mch-29.6 mchc-32.4 rdw-19.5* plt ct-147* 04:25pm blood pt-12.8 ptt-31.3 inr(pt)-1.1 05:00am blood pt-12.9 ptt-32.3 inr(pt)-1.1 04:25pm blood esr-115* 04:42am blood ret aut-4.3* 04:25pm blood glucose-98 urean-23* creat-7.0*# na-136 k-4.8 cl-101 hco3-24 angap-16 08:00am blood glucose-83 urean-24* creat-7.4* na-137 k-4.5 cl-101 hco3-27 angap-14 04:42am blood alt-12 ast-19 ld(ldh)-204 alkphos-193* totbili-0.2 dirbili-0.1 indbili-0.1 04:42am blood albumin-2.5* calcium-8.8 phos-3.1 mg-2.3 iron-59 12:38pm blood albumin-2.8* calcium-9.1 phos-2.6* mg-2.7* 04:42am blood caltibc-130* hapto-77 ferritn-1223* trf-100* 05:20am blood pth-144* 08:06am blood pth-80* 08:30am blood pth-153* 04:42am blood crp-33.6* 05:20am blood pep-polyclonal igg-3236* iga-289 igm-155 ife-no monoclo 05:20am blood vanco-40.4* 05:59am blood vanco-27.6* 04:56am blood vanco-26.4* 04:32am blood vanco-25.3* . blood cx (venipuncture): enterococcus faecium | ampicillin------------ =>32 r linezolid------------- 2 s penicillin------------ =>64 r vancomycin------------ =>32 r all subsequent blood cultures are thus far negative. . swab wound cultures: no growth (final) brief hospital course: a/p: ms. is a 29yo female s/p failed renal transplant (rejection ) and s/p bilateral nephrectomy, now s/p right tibial imn on who was transferred from rehab with bacteremia, worsening rle, and concern for hardware infection. . #) bacteremia: the patient was transferred from rehab with positive bcx growing coag negative staph sensitive to vancomycin on , and grew vre sensitive to linezolid in bcx on . there was no clear source for the bacteremia ?????? cxr and ct of the chest was not suggestive of pna. surgery and orthopedics were not concerned for wound infection or hardware infection as a possible septic source. ct of the abdomen/ pelvis was without evidence of abscess or any other infectious source. surgery was not concerned for the l obturator hematoma (see below) as potential source for sepsis. the id service was consulted, and the patient was treated with linezolid for vre bacteremia and vancomycin for coag. negative staph. vancomycin will be dosed at dialysis. it will be continued for an unspecified course, to be determined during outpatient follow-up with dr. . surveillance cultures remained negative for the remainder of the patient??????s hospital course and the patient was clinically well (afebrile, without leukocytosis, negative blood cultures) upon discharge. . #) hypotension: on while on the floor, the patient was found to be lethargic with desaturation to 85% and sbps~70's. she had received dilaudid >10mg iv over the course of the day and had a rapid yet brief improvement in her mental status and bp in response to narcan. bp was unresponsive to ivf boluses and she was transferred to the micu for closer management, where she briefly required pressors in addition to multiple fluid boluses. she was started on linezolid, aztreonam, and flagyl for presumed sepsis, with sources likely either hardware or abdomen. she was started on stress dose steroids, which was quickly tapered. hypotension stabilized while in the micu and the patient was transferred to the floor in stable condition. as above, subsequent cultures have been negative to date. . #) rle ulcer: upon presentation there was no clear purulent drainage but the wound was exquisitely painful to touch. there was no fever or leukocytosis, and no clear osteomyelitis on right leg films. ct, however, demonstrated small abscess in the anterior subcutaneous tissues near the fixation but no deep abscess. she was started on clindamycin and vancomycin, and plastic surgery and orthopedics were consulted for wound care. she was continued on dry sterile dressing changes during her hospital course. both services monitored the wound regularly and felt that the wound was healing well by discharge. the patient will see orthopedics as an outpatient to follow-up re: imr placement and plastic surgery to follow-up progression of wound healing. . #) abdominal pain: the patient has complained of significant diffuse abdominal pain during admission, up to . ct scan of abdomen/pelvis was unremarkable except for an incidental finding of a l obturator hematoma (spontaneous in nature - no history of manipulation or trauma). general surgery did not suspect any acute process that could account for her symptoms. pain subsequently resolved; however, the patient began experiencing significant luq pain different than prior on . a repeat ct of the abd/ pelvis showed slight interval expansion of the hematoma, and there was a concern for a pseudoaneurysm. the patient was taken for angiography with placement of 13 coils and thrombin into the pseudoaneurysm with a rapid improvement in pain. luq pain was thought by gi and general surgery services to be referred pain from this pseudoaneurysm. the patient was able to tolerate po well subsequently and had much improved pain managed by a fentanyl patch (uptitrated to 200mcg) and oral dilaudid by discharge. . #) s/p nephrectomy: the patient was continued on a tues, thurs, sat schedule for dialysis without any complication. she is to continue as an outpatient on this schedule. . the patient was discharged in stable condition to home. she was afebrile, vss, tolerating po well, and ambulating with crutches (secondary to rle wound). she was discharged to home with pt follow-up and vna for dressing changes. medications on admission: vitamin c 500mg aspirin 81mg daily amitryptyline 100mg qhs calcium acetate 1334mg tid with meals senna prn dulcolax 10mg daily lovenox 30mg qpm-->contraindicated in hd patients? gabapentin 200mg po qhs prednisone 5mg daily colace 100mg lactulose 30mg q8h acetaminophen 650mg po q6h sevelamer 1600mg tid silver sulfadiazine 1% cream applied . allergies: demerol / unasyn / cephalosporins / levaquin / moexipril discharge medications: 1. home oxygen patient needs oxygen at home 2-3l nc as she has ambulatory desaturations to 88% 2. comode please give patient high comode 3. shower chair please give patient shower chair 4. amitriptyline 50 mg tablet : two (2) tablet po hs (at bedtime). disp:*60 tablet(s)* refills:*2* 5. ascorbic acid 500 mg tablet : one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 6. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 7. calcium acetate 667 mg capsule : two (2) capsule po tid w/meals (3 times a day with meals). disp:*180 capsule(s)* refills:*2* 8. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 9. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*1* 10. sevelamer 800 mg tablet : one (1) tablet po tid w/meals (3 times a day with meals). disp:*90 tablet(s)* refills:*2* 11. pantoprazole 40 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 12. linezolid 600 mg tablet : one (1) tablet po q12h (every 12 hours) for 10 days. disp:*20 tablet(s)* refills:*0* 13. prednisone 5 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 14. gabapentin 100 mg capsule : two (2) capsule po hs (at bedtime). disp:*60 capsule(s)* refills:*2* 15. silver sulfadiazine 1 % cream : one (1) appl topical (2 times a day). disp:*1 tube* refills:*2* 16. hydromorphone 2 mg tablet : 1-3 tablets po q4h (every 4 hours) as needed for pain. disp:*90 tablet(s)* refills:*0* 17. lactulose 10 g/15 ml syrup : thirty (30) ml po daily (daily) as needed for constipation. disp:*30 units* refills:*1* 18. medication during dialysis vancomycin iv (to be given at hemodialysis per hd protocol) 19. outpatient lab work please draw 2 sets of blood cultures after patient finishes linezolid on discharge disposition: home with service facility: homecare discharge diagnosis: primary: right lower extremity cellulitis/wound infection right tibia/fibula fracture septic right knee bacteremia hypoxia . secondary: end-stage renal disease on hemodialysis discharge condition: good, pain well-controlled, bp stable 100-130s discharge instructions: you were admitted for an infection of your right leg and bloodstream. this was treated with antibiotics, and with evaluation by orthopedics, plastic surgery, and vascular surgery, who felt that the wound had good blood flow and would heal over time. because of the type of organism and the fact that you have orthopedic hardware in your leg, you need to take 2 antibiotics: the first, linezolid, is an oral medication you should take for 10 more days; the second, vancomycin is an intravenous antibiotic which you should get during dialysis. you will need this for several months. we have arranged followup with dr. of infectious disease, please see below for details. you were seen by the pulmonary doctors because have needed extra oxygen to avoid feeling short of . you should follow-up with them as an outpatient (details below - dr. office will call you with an appointment, but you should have a repeat ct scan of the chest before that. you should also have pulmonary function tests before or on the day of that appointment, dr. office can arrange this). you have been started on several new medications: linezolid, vancomycin, and lactulose. please return to the emergency room if you experience worsening knee pain, fevers, shortness of , chest pain, or any other new or concerning symptoms. followup instructions: provider: (infectious disease specialist), md phone: date/time: 11:30 . 10:15am follow-up ct scan of the chest. please do not eat anything from 3 hours before study in clinical center on . provider: scan phone: date/time: 10:15. . dr. of pulmonology and would like to see you as an outpatient in months. her office will call you with an appointment. if you do not hear from them in a few weeks, call ( to make an appointment. . orthopedic followup: provider: xray (scc 2) phone: date/time: 10:10 provider: , md phone: date/time: 10:30 . followup with the at 1pm with , np in central suite. (she is a nurse practitioner who works with dr. followup with dr. on at 10:40am. if she wants to see you sooner, someone from her office will call you. procedure: hemodialysis arteriography of femoral and other lower extremity arteries other surgical occlusion of vessels, lower limb arteries transfusion of packed cells diagnoses: systemic lupus erythematosus thrombocytopenia, unspecified end stage renal disease hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hemorrhage complicating a procedure hypotension, unspecified cellulitis and abscess of leg, except foot bacteremia peripheral vascular complications, not elsewhere classified postinflammatory pulmonary fibrosis other constipation complications of transplanted kidney chronic pulmonary heart disease, unspecified aneurysm of artery of lower extremity infection and inflammatory reaction due to other internal orthopedic device, implant, and graft sickle-cell trait 

Answer: The patient is high likely exposed to