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: no known allergies / adverse drug reactions attending: chief complaint: left lateral thigh wound major surgical or invasive procedure: 1. drainage deep abscess hematoma left hip. 2. open biopsy, deep, left femur. 3. application of vacuum-assisted closure sponge greater than 30 cm. . 1. left lower extremity reconstruction with latissimus muscle free flap from left back. 2. local advancement flap closure of left thigh wound, 40 cm2. 3. debridement of skin, subcutaneous tissue and muscle lower extremity thigh wound 60 cm2. 4. saphenous vein graft to venous anastomosis. history of present illness: 68f with a history of high grade spindle cell sarcoma of the left thigh, subsequent pre-operative chemotherapy/radiation and resection in , underwent pre-operative chemo/xrt. her post-operative course was complicated by "radiation induced" femur fracture initially treated with orif, plating, bone graft in and a left total knee arthroplasty. due to recurrent pain from non- the plates were removed and she was coverted to an intramedullary rod. in she developed a complex abscess of the left lateral thigh wound, which was washed out and a vac placed. id was consulted at the time; she completed a prolonged course of iv vancomycin for mrsa abscess, followed by doxycycline and rifampin. during this evaluation, she is on ancef monotherapy. yesterday she underwent repeat washout in or with vac placement. we are consulted to assist in wound management. past medical history: 1. high-grade soft tissue sarcoma s/p resection 2. pathologic fx l femur s/p orif and bone graft 3. excision of benign pulmonary nodules on . 4. hypercholesterolemia social history: former bookkeeper, married to her 2nd husband, has children from a previous marriage. lives in , ma which is about a 2-hour drive away. non-smoker, non-drinker. prior to admission, ambulatory with a crutch (under right arm). former bookkeeper, retired. family history: mother is in her 90's with alzheimer's and h/o colon cancer in her 70's. daughter has clotting disorder, no bleeding diathesis physical exam: on presentation, vs: 98.9 (t max 99.9) 112/50 hr 82 rr 18 96% ra jp output since , serosanguinous : 600 cc, 600 cc, 320 cc, 300 cc, 260 cc, 150 cc gen: resting comfortably in chair, nad heent: eomi, perrl, mmm, op clear. pale conjuntiva. anicteric sclera. neck: no jvd, no lad back: two jp drains in place near latissimus dorsi flap resection. small, mildly tender mass, without overlying ecchymosis, at inferior portion of flap. cv: regular rate and rhythm, no murmurs. normal s1, s2. resp: ctab, no wheezes or crackles gi: soft ntnd no hsm, +bs ext: no c/c/e. left thigh with small degree of ecchymoses at border of flap, two jp drains in place without drainage neuro: cnii- cnxii intact, strength and sensation intact throughout psych: a&ox3, slightly blunted affect pertinent results: 06:35am wbc-5.5 rbc-4.49 hgb-12.4 hct-36.2 mcv-81* mch-27.6 mchc-34.2 rdw-16.6* plt ct-366 04:00am wbc-3.9* rbc-3.79* hgb-10.3* hct-30.5* mcv-80* mch-27.1 mchc-33.8 rdw-16.4* plt ct-279 05:00am wbc-5.3 rbc-2.22* hgb-6.4* hct-18.6* mcv-84 mch-28.8 mchc-34.4 rdw-17.1* plt ct-210 06:02am wbc-4.3 rbc-2.84* hgb-8.2* hct-24.0* mcv-84 mch-28.7 mchc-34.0 rdw-17.4* plt ct-326 06:35am pt-12.4 ptt-26.5 inr(pt)-1.0 04:00am pt-12.8 ptt-24.6 inr(pt)-1.1 04:08am ret aut-4.6* 06:35am glucose-103* urean-15 creat-0.9 na-138 k-4.2 cl-103 hco3-24 angap-15 04:00am glucose-127* urean-8 creat-1.1 na-141 k-4.3 cl-105 hco3-29 angap-11 06:35am calcium-9.1 phos-3.8 mg-2.1 06:35am calcium-8.3* phos-3.2 mg-2.0 06:23pm caltibc-222* hapto-245* ferritn-51 trf-171* 08:27pm vanco-16.4 brief hospital course: the patient was admitted to the plastic surgery service on for repair of her left lateral thigh defect, status-post washout of her an abscess of her left femur and vacuum placement of the defect by the orthopedics service. neuro: post-operatively, the patient received dilaudid iv/pca with good effect and adequate pain control. when tolerating oral intake, the patient was transitioned to oral pain medications. she did not require additional pain medication by prescription upon discharge. cv: the patient received one unit of prbc peri-operatively given the length and complexity of the procedure, and was transfused again with 2 units pod#2 for a hematocrit of 18.6; the patient responded appropriately and has since maintained hematocrit levels consistently in the 24-26 range. however, medicine was consulted given her anemia and baseline hematocrit of 36. please refer to hematology below. otherwise, the patient remained hemodynamically stable and asymptomatic; vital signs were routinely monitored. pulmonary: the patient was stable from a pulmonary standpoint; vital signs were routinely monitored. she was successfully weaned off of oxygen via nasal cannula and maintained oxygen saturations in the high 90s prior to discharge. gi/gu: post-operatively, the patient was given iv fluids until tolerating oral intake. her diet was advanced when appropriate, which was tolerated well. intake and output were closely monitored. on pod #9, however, she was found to have an elevated creatinine of 1.6, with a baseline of 0.9-1.0; at this point it is unclear whether it is pre-renal or renal secondary to possible nephrotoxicity to ciprofloxacin, which was recently discontinued. urine osmolality, creatinine, eosinophil smear, urine analysis and urine culture, were ordered, as well as serum osmolality, electrolytes, random vancomycin level and c. diff toxin. given the patient's expressed desires to go home today with vna, and vna arrangements to draw and send these respective labs with follow-up by the patient's pcp (dr. and office for weekend coverage). id: peri-operatively, the patient received vancomycin and ciprofloxacin for broad coverage based on her history of coagulase-negative staph by previous bone biopsy. her wound cultures were found negative for organisms, as were her cultures. id recommended sending a 16s rna pcr, which returned on as positive for staph epidermidis. the recommendations at this time are to continue vancomycin at her current dose of 500mg iv q12hours and discontinuing her ciprofloxacin to tailor her coverage. heme: as discussed earlier, medicine was consulted for the patient's anemia; iron studies were consistent with iron deficiency anemia, and the patient was placed on daily iron supplements. she does have a history of guiac positive stools with recent colonoscopy in the last year with unremarkable findings. recommendations at this time are to start ppi therapy daily, and follow-up with her pcp, . for elective egd to investigate an upper gi source for her guiac positive stools. the patient was advised to stay on her aspirin therapy as well as 1 month of subcutaneous lovenox for dvt prophylaxis. prophylaxis: the patient received subcutaneous heparin during this stay and will be discharged home on 30mg daily for 1 month. msk/vascular: the patient had consistent vioptix saturations in the mid 60s-70s for her graft. the graft appeared healthy with clean incision lines and dopperable signals on discharge. at the time of discharge on pod#9, the patient was doing well, afebrile with stable vital signs, tolerating a regular diet, ambulating with crutches, voiding without assistance, and pain was well controlled. medications on admission: simvastatin 20mg qd aspirin 81mg qd acetaminophen 650mg q6h prn fever/pain mvi 1 tablet qd vitamin d 800 units qd calcium carbonate 500mg po q8h docusate 100mg 1 tablet discharge medications: 1. vancomycin 500 mg recon soln sig: five hundred (500) mg intravenous q 12h (every 12 hours). disp:*28 iv bags* refills:*2* 2. aspirin 81 mg tablet, chewable sig: 1.5 tablet, chewables po daily (daily) for 30 days. disp:*45 tablet, chewable(s)* refills:*0* 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever, pain: max 12/day. do not exceed 4gms/4000mg of tylenol per day. 4. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 5. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed for loose stool: over the counter medication for loose stool. 6. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* 8. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day) as needed for indigestion/heartburn. take tums/over the counter replacement 9. lovenox 30 mg/0.3 ml syringe sig: one (1) subcutaneous once a day for 30 days. disp:*30 * refills:*0* discharge disposition: home with service facility: community nurse care,inc discharge diagnosis: chronic left lateral thigh wound 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: personal care: 1. you may keep your incisions open to air 2. clean around the drain site(s), where the tubing exits the skin, with soap and water. 3. strip drain tubing, empty bulb(s), and record output(s) times per day. 4. a written record of the daily output from each drain should be brought to every follow-up appointment. your drains will be removed as soon as possible when the daily output tapers off to an acceptable amount. 5. be careful that your bra does not disrupt or put pressure on your left posterior incision site. you may consider wearing a camisole until your follow up visit with dr. . 6. you may shower daily with assistance as needed. be sure to secure your upper body drains to a laniard that hangs down from your neck so they don't hang down and pull out. you may secure your leg drains to your waist by tying a pair of old stockings around your waist and attaching the drains to the panel of the stockings. 7. no pressure on your left thigh flap site. 8. okay to shower, but no baths until after directed by your doctor. 9. you may dangle left lower extremity 15-20 minutes tid. you should not be bearing any weight on her left lower extremity, touch down weight bear only (but patient unable to walk with walker and not partial wt bear on her lle). patient should elevate her left lower extremity when not dangling. . activity: 1. you may resume your regular diet. 2. do not lift anything heavier than 5 pounds or engage in strenuous activity for 6 weeks following surgery. . medications: 1. resume your regular medications unless instructed otherwise and take any new meds as ordered. 2. you may take your prescribed pain medication for moderate to severe pain. you may switch to tylenol or extra strength tylenol for mild pain as directed on the packaging. please note that percocet and vicodin have tylenol as an active ingredient so do not take these meds with additional tylenol. 3. take prescription pain medications for pain not relieved by tylenol. 4. take colace, 100 mg by mouth 2 times per day, while taking the prescription pain medication. you may use a different over-the-counter stool softener if you wish. 5. do not drive or operate heavy machinery while taking any narcotic pain medication. you may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. . call the office immediately if you have any of the following: 1. signs of infection: fever with chills, increased redness, swelling, warmth or tenderness at the surgical site, or unusual drainage from the incision(s). 2. a large amount of bleeding from the incision(s) or drain(s). 3. fever greater than 101.5 of 4. severe pain not relieved by your medication. . return to the er if: * if you are vomiting and cannot keep in fluids or your medications. * if you have shaking chills, fever greater than 101.5 (f) degrees or 38 (c) degrees, increased redness,swelling or discharge from incision, chest pain, shortness of breath, or anything else that is troubling you. * any serious change in your symptoms, or any new symptoms that concern you. . drain discharge instructions you are being discharged with drains in place. drain care is a clean procedure. wash your hands thoroughly with soap and warm water before performing drain care. perform drainage care twice a day. try to empty the drain at the same time each day. pull the stopper out of the drainage bottle and empty the drainage fluid into the measuring cup. record the amount of drainage fluid on the record sheet. reestablish drain suction. followup instructions: infectious disease: provider: , md date/time: 09:30 located on the , , basement level. . plastic/reconstructive surgery dr. , at 09:00 located on the , , , procedure: graft of muscle or fascia attachment of pedicle or flap graft to other sites open biopsy of soft tissue excision of muscle or fascia for graft biopsy of bone, femur diagnoses: anemia of other chronic disease pure hypercholesterolemia other postoperative infection acute posthemorrhagic anemia cellulitis and abscess of leg, except foot surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation obesity, unspecified nonspecific abnormal findings in stool contents staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus knee joint replacement other abnormal blood chemistry 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 specified disorders of skin non-healing surgical wound personal history of malignant neoplasm of other sites personal history of pathologic fracture other disorders of soft tissue 

Answer: The patient is high likely exposed to