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: nitrofurantoin / alpha-2 receptor antagonst antidepresnts attending: chief complaint: fever, confusion major surgical or invasive procedure: s/p l3/4 discectomy and fusion picc line placement history of present illness: 79 year old man pmh significant for mrsa osteomyelitis and bacteremia, djd/back pain, diet controlled dm, anxiety disorder, and bph. he underwent turp in c/b ~ 6 months of recurrent mrsa uti??????s, cachexia, low grade fevers, anorexia. was rx with intermittent courses of abx (duration not known), but continued to be ill. . was readmitted to medical center with intractable back pain, found to have mrsa and pseudomonal bacteremia. mri with l3-l4 osteo/discitis/paraspinal mass. no surgery or biopsy, tte negative, tee done , showed no evidence of endocarditis, ef 45%. he was treated for 6 weeks with vanco (changed to linezolid) and cipro for pseudomonas, sent to rehab and was doing better; starting to walk, had peg for weight-loss. . admitted to hospital with weakness, fever, confusion, pain, started on levaquin, then changed vancomycin and bactrim for when multiple blood cultures grew mrsa, urine culture with klebsiella pneumoniae. repeat mri shows partial resolution of paraspinal mass, improved discitis, but ? small epidural abscess (question minor nerve root impingement). md neuro exam is significant for ??????generalized weakness,?????? but non-focal. . yesterday afternoon had a 15 minute bout of chills, hypotension and sob - sbp 70/ hr 70. transferred to icu, cxr normal, abg normal, buffed up to 120/ with ivf. comfortable on 2l o2, but still with severe back pain. wbc 10, plts 500, hct 35, na 133, bun/ cr 20/1.1, alb: 2.6. should be ok for floor as he is in icu because it is a small hospital. . on arrival to the floor, he was awake, alert, very conversant. does not remember much of the details of his most recent hospitalization he states to paim medications he is on. his pain is well controlled, no dysuria. denies chest pain. he has not ambulated since arrival. no changes in sensation in hands or feet. . on review of systems, the patient denies any chest pain, shortness of breath, night sweats, fevers, chills, night sweats, fatigue, headaches, dizziness, blurred vision, sore throat, nausea, vomiting, abdominal pain, any new rashes, denies dysuria, hematuria, increased urgency, diarrhea, constipation, hematochezia, melena, epistaxis. all other systems reviewed in detail and negative except for what has been mentioned above. past medical history: - l3-l4 osteomyelitis/discitis/paraspinal mass likely mrsa - djd/back pain - dm ii, diet controlled - cad s/p ptca , stent to rca and left circ. nstemi in with ptca of rca. - bph, s/p turp - recurrent mrsa utis - s/p peg tube placement - anxiety disorder social history: married, lives with wife at home. retired from making plastic windows at company in . previously healthy prior to turp in . previously active, now with difficuty walking from pain. denies alcohol, remote history of tobacco. family history: nc physical exam: vs: t:98.2 hr:92 bp:120/70 rr:16 sat:97 on ra gen: appears well dressed, well nourished, in no acute distress heent: ncat, perrl, sclera anicteric, no ulcers, oropharynx otherwise clear, throat with no erythema or exudates, no thrush, no cervical lymphadenopathy, jvp is flat cv: normal s1/s2, rrr, systolic flow murmur, no r/g, no tenderness to palpation of precordium, pmi non-displaced lungs: clear to auscultation bilaterally, no w/r/rh abdomen: soft, nontender, nondistended, normoactive bowel sounds, no hepatosplenomegaly, no ascites ext: no peripheral edema, no clubbing, cyanosis, no calf pain, dp pulses are 2+ bilaterally neuro: a + o x 3, cn ii-xii grossly intact, motor both upper and lower extremities, sensation grossly intact to light touch, dtr 2+ throughout, toes downgoing skin: pink, warm, no rashes pertinent results: 05:15am blood wbc-9.1 rbc-3.78* hgb-11.7* hct-35.3* mcv-94 mch-30.9 mchc-33.1 rdw-14.9 plt ct-481* 05:04pm blood wbc-14.5* rbc-3.28* hgb-10.2* hct-29.7* mcv-91 mch-31.0 mchc-34.1 rdw-16.1* plt ct-536* 06:56am blood wbc-8.5 rbc-3.25* hgb-10.4* hct-29.0* mcv-89 mch-31.9 mchc-35.7* rdw-15.6* plt ct-226 05:07am blood neuts-75.4* lymphs-15.7* monos-5.0 eos-3.7 baso-0.2 06:47am blood pt-13.7* ptt-35.7* inr(pt)-1.2* 06:56am blood pt-13.3* ptt-33.3 inr(pt)-1.2* 05:44am blood esr-110* 05:36am blood ret aut-1.4 06:34am blood glucose-169* urean-15 creat-0.8 na-130* k-4.7 cl-95* hco3-30 angap-10 06:56am blood glucose-174* urean-10 creat-0.5 na-132* k-3.7 cl-96 hco3-26 angap-14 05:15am blood alt-28 ast-26 ld(ldh)-152 alkphos-113 totbili-0.2 02:08am blood alt-32 ast-52* alkphos-141* totbili-0.5 05:15am blood albumin-3.2* calcium-9.0 phos-3.6 mg-2.2 06:34am blood calcium-8.3* phos-2.9 mg-1.7 06:56am blood calcium-8.0* phos-1.6* mg-1.7 05:36am blood caltibc-233* ferritn-480* trf-179* 02:08am blood triglyc-91 05:15am blood crp-39.8* 05:44am blood vanco-22.9* 06:56am blood vanco-8.1* 02:59pm blood type-art po2-182* pco2-45 ph-7.42 caltco2-30 base xs-4 04:57pm blood type-art po2-281* pco2-34* ph-7.49* caltco2-27 base xs-3 intubat-intubated 02:59pm blood glucose-130* lactate-1.3 na-131* k-4.3 cl-97* calhco3-29 04:57pm blood hgb-11.5* calchct-35 o2 sat-99 04:57pm blood freeca-1.05* . : transesophageal echo conclusions: no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild to moderate regional left ventricular systolic dysfunction with anterior hypokinesis (segmental wall motion was not fully assessed). there are simple atheroma in the aortic arch and 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 regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. trace mitral regurgitation is seen. . : mri of c/t/l spine impression: 1. discitis-osteomyelitis at l3-4 with pre- paravertebral inflammatory change with no evidence of epidural abscess at this location. clumping of the cauda equina nerve roots suggests arachnoiditis. 2. stir signal hyperintensity and enhancement at the t10-11 intervertebral disc and superior endplate of t11, also suspicious for discitis-osteomyelitis, also with no evidence of epidural abscess at this location. . echo study date of no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild to moderate regional left ventricular systolic dysfunction with anterior hypokinesis (segmental wall motion was not fully assessed). there are simple atheroma in the aortic arch and 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 regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. trace mitral regurgitation is seen. no vegetation or abscess seen. . prostate u.s. 1:44 pm mild bph. no son evidence of mass or abscess. . persantine mibi no definite reversible perfusion defects identified. 2. slight apical hypokinesis with low-normal calculated lvef of 49%. . stress study date of no anginal type symptoms or ischemic ekg changes. nuclear report sent separately. . l-spine (ap & lat) in o.r. 2:30 pm a series of four intraoperative radiographs of the lumbar spine were obtained. these demonstrate an anterior interbody fusion device placed in the lumbar spine at l3-l4. severe multilevel degenerative changes in lumbar spine are seen. evaluation of osseous structures is obscured by overlying bowel contents. retractors are seen anteriorly. please refer to operative report for full details. . l-spine (ap & lat) 3:00 pm post-surgical changes as described. limited study. brief hospital course: 79 y/o man with pmh significant for mrsa osteomyelitis and bacteremia, djd/back pain, diet controlled dm, anxiety disorder, and bph, p/w with persistent mrsa bacteremia and disc osteomyelitis, s/p discectomy with fusion. . # mrsa bacteremia/osteomyelitis/epidural abscess: bacteremia most likely from chronic osteomyelitis/disc abscess. blood cultures growing mrsa, last positive blood culture was on . patient does not have any focal neurologic findings. repeat mri on showed l3/l4 and t11 discitis without any evidence of epidural abscess (based on prior mri from osh). tee on negative for vegetations/abscess. rectal ultrasound to r/o prostatic abscess/fluid collection was negative. leukocytosis, likely from intermittent bacteremia. crp 40, esr 110. orthopedic spine surgeons were consulted and pt had resection of infected disc abscess with subsequent rod fixation on . bone tissue culture from grew coag+ staph, sensitivities pending. pt remains afebrile, hemodynamically stable, without leukocytosis. surveillance blood cultures negative, last positive blood culture on . vancomycin 1g qday (started ) via picc line, to continue for 8 week course. pt will need weekly vancomycin level troughs. vancomycin level therapeutic on , then sub-therapeutic on and vancomycin dose was increased to 1g q12h as gfr had improved. . # klebsiella uti: pan-sensitive, on bactrim ds. treated with 10 day course, completed on . . # cad: no evidence of chest pain. pmibi and stress test normal, done prior to surgery for risk stratification. continue aspirin. . # anemia: pt with hct of 24 on transfer back to medicine service. transfused 1u prbc with appropriate increase in hct, however, hct decreased again on . orthopedics notified, not concerned about this post-op hct drop and no need to do imaging studies. transfused again with 1u prbc with appropriate increase in hct. hemolysis labs normal. iron panel . # back pain: secondary to osteomyelitis. - continue oxycodone and morphine prn, tylenol q6h - titrate up pain medications as needed . # epistaxis: secondary to trauma s/p cautery by ent. continue afrin, allow nasal packing to dissolve. avoid o2 nc, use humidified shovel mask if needed. bacitracin to nose qdaily. saline nasal spray as needed. . # dm ii: diet controlled. covered with riss while inpatient. . # anxiety/depression: continue remeron, ativan prn. . # fen: pt with hyponatremia and low phos on . low sodium from appears to be from dehydration as looked dry on exam, will replete with ns ivf. check urine na if level not improving. continue po diabetic/cardiac diet. replete lytes prn. . # prophylaxis: heparin sq, bowel regimen . # access: 1 piv, picc line - manage per protocol care . # code: full, no "heroic" measures . # communication: with patient . # dispo: dc to rehab in , . he will followup with orthopedic spine clinic and id both at outpatient. send weekly safety labs (cbc, chem 7, lfts, vancomycin level) to clinic. medications on admission: medications at home: asa 81 mg daily klonopin 0.5mg po daily colace 100mg po bid senna 2 po bid omeprazole 20mg po daily remeron 15mg po qhs vicodin po q4h prn fentanyl patch 25mg q72h tube feeds . medications on transfer: vancomycin 1000mg (started ) vitamin c 500mg zinc sulfate 220mg daily multivitamin tylenol q6h protonix 80mg daily aspirin 81mg daily colace 100mg daily bactrim ds 1 po bid (started ) remeron 15mg lortab 10/650mg prn roxanol 5mg prn pain mom 30ml prn constipation maalox 30ml q6h prn ambien 5mg po qhs discharge medications: 1. ascorbic acid 500 mg tablet : one (1) tablet po bid (2 times a day). 2. zinc sulfate 220 (50) mg capsule : one (1) capsule po daily (daily). 3. hexavitamin tablet : one (1) cap po daily (daily). 4. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 5. mirtazapine 15 mg tablet : one (1) tablet po hs (at bedtime). 6. magnesium hydroxide 400 mg/5 ml suspension : thirty (30) ml po q6h (every 6 hours) as needed. 7. aluminum-magnesium hydroxide 225-200 mg/5 ml suspension : 15-30 mls po qid (4 times a day) as needed. 8. zolpidem 5 mg tablet : one (1) tablet po hs (at bedtime). 9. sodium chloride 0.65 % aerosol, spray : two (2) spray nasal qid (4 times a day) as needed. 10. bacitracin zinc 500 unit/g ointment : one (1) appl topical qhs (once a day (at bedtime)). 11. docusate sodium 50 mg/5 ml liquid : one (1) po tid (3 times a day). 12. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 13. lactulose 10 g/15 ml syrup : thirty (30) ml po q4h (every 4 hours). 14. senna 8.6 mg tablet : one (1) tablet po daily (daily). 15. metoprolol tartrate 25 mg tablet : one (1) tablet po bid (2 times a day). 16. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 17. oxycodone-acetaminophen 5-325 mg/5 ml solution : 5-10 mls po q4-6h (every 4 to 6 hours) as needed for pain. 18. miconazole nitrate 2 % powder : one (1) appl topical tid (3 times a day) as needed. 19. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 20. lorazepam 0.5-1 mg iv q4h:prn 21. insulin lispro (human) 100 unit/ml solution : sliding scale subcutaneous asdir (as directed). 22. vancomycin hcl 1000 mg iv q 12h duration: 7 weeks start: in am 23. acetaminophen 325 mg tablet : one (1) tablet po q4-6h (every 4 to 6 hours) as needed for fever, pain. discharge disposition: extended care facility: - , me discharge diagnosis: primary diagnoses: 1. s/p l3/4 discectomy and fusion 2. l3-l4 osteomyelitis/discitis/paraspinal mass likely mrsa 3. djd/back pain 4. dm ii, diet controlled 5. bph . secondary diagnoses: 1. cad s/p ptca , stent to rca and left circ. nstemi in with ptca of rca. 2. recurrent mrsa utis 3. s/p peg tube placement 4. anxiety disorder discharge condition: stable. discharge instructions: you were admitted for bacterial infection in your blood and spine. you were treated with antibiotics. you had orthopedic spine surgery to remove the source of infection and had the lower part of your spinal cord fused. you did not suffer any complications. . you will be discharged on 7 more weeks of vancomycin. please call your pcp or return to the ed if you experience fevers, chills, back pain, nausea/vomiting, shortness of breath, chest pain. . please take all medications as prescribed. followup instructions: provider: . @ clinic phone: date/time: 10:30 . you should followup with your pcp 1 week of discharge for further medical management. call number below to make an appointment. pcp: , . dr. @ orthopedics time: 2:30pm on . please have weekly labs (cbc, chem 7, liver function tests, vancomycin level) faxed to clinic c/o dr. : fax number md procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances lumbar and lumbosacral fusion of the anterior column, posterior technique excision of intervertebral disc lumbar and lumbosacral fusion of the anterior column, anterior technique insertion of catheter into spinal canal for infusion of therapeutic or palliative substances systemic to pulmonary artery shunt other partial ostectomy, other bones insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae fusion or refusion of 2-3 vertebrae insertion of recombinant bone morphogenetic protein diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia infection with microorganisms resistant to penicillins unspecified osteomyelitis, other specified sites percutaneous transluminal coronary angioplasty status methicillin susceptible staphylococcus aureus septicemia other and unspecified disc disorder, lumbar region 

Answer: The patient is high likely exposed to