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: nafcillin attending: chief complaint: rle weakness, fever major surgical or invasive procedure: 1. bilateral t12 laminotomy. 2. laminectomy, l1, l2. 3. bilateral l3 laminotomy. 4. open bone biopsy, deep. -picc placement history of present illness: the patient is a 78 yom with h/o dm2, htn, ckd (cr was 2.4 on on last admission), cad s/p mi on , who presents with 3 days of lumbar back pain and f/c/rigors. the day prior to admission, the patient went to for acute on chronic lower extremity weakness without trauma (he normally uses two canes to ambulate, which is thought to be due to spinal stenosis). he was found to be febrile to 104 with progressive right leg weakness and decreased rectal tone. at , c/t/l spine mri was concerning for epidural abscess though it was a poor quality film as they did not use gadolinium given cri. he was also found to have a uti (has a urosomy bag) and was started on vanco/cipro prior to transfer for the uti, possible leg cellulitis and epidural abscess. he was transferred for surgery evaluation. on admission to , called to report he was growing gpc in blood culture bottles from . . in the ed, he also received acetaminophen x2, zosyn, atorvastatin 80 mg, carvedilol 25 mg, and isosorbide mononitrate (extended release) 30mg. . of note, on , he was admitted for c/f stemi, though ultimately did not have a cath b/c it was felt his case was atypical for stemi. he was managed medically with asa, plavix 600 mg, heparin gtt, nitro gtt. he subsequently underwent an echo with limited views which revealed hypokinesis of the distal septum, apex and distal anterior and inferior walls with an ef of 45% and no prior echo for comparison. patient requested transfer to for insurance issues and was transferred shortly thereafter. initial tnt was 0.1 and rose to 1.3 prior to transfer. ck rose to 250 with mb 18. it is unclear exactly what happened at va and he was discharged on . past medical history: # diabetes 20 years, neuropathy, nephropathy, ?charcot foot # dyslipidemia # htn # cad s/p recent mi 6 days ago - h/o silent mi, ?pci in past # ckd # pmr on prednisone # bladder ca s/p urostomy # depression # s/p appendectomy social history: lives alone in with his girlfriend. korean veteran. 90 pack year smoking history, quit 40 years ago. denies tobacco or illicit drug use. family history: doesn't know family history physical exam: vs on arrival to the ed: t 104.4, bp 214/82, hr 86, 20, 95% on ra vs on arrival to the icu: t 98.2 (post tylenol), bp 113/55, hr 63, 20, 94% on ra gen: elderly man, comfortable in bed heent: poor dentition, op clear, nml sclera neck: jvd to midneck cv: rr, no m/r/g appreciated lungs: cta b/l, no w/c abd: somewhat obese, soft, ntnd, + bs, no fluid wave; rlw ostomy bag with clean healthy-looking stump ext: 2+ le edema neuro: aaox3, cn ii-xii in tact, 2-3/5 strength on le b/l, strength on upper extremities b/l, 2+ patellar & ankle reflexes b/l symmetric, down-going babinski, normal sensation on legs throughout dre: deferrred on arrival to icu (decreased tone per ed and ortho spine) pertinent results: admission labs: . 10:36pm lactate-2.1* 10:20pm glucose-179* urea n-59* creat-2.9* sodium-137 potassium-5.2* chloride-105 total co2-24 anion gap-13 10:20pm ck(cpk)-110 10:20pm ck-mb-2 ctropnt-0.71* 10:20pm crp-78.8* 10:20pm wbc-9.9 rbc-3.58* hgb-10.8* hct-32.2* mcv-90 mch-30.3 mchc-33.7 rdw-16.3* 10:20pm neuts-84.4* lymphs-10.5* monos-3.4 eos-1.4 basos-0.3 10:20pm plt count-149* 10:20pm pt-12.8 ptt-30.5 inr(pt)-1.1 10:20pm sed rate-90* . pertinent labs/studies: . hct: 27.8 () -> 26.1 () -> 24.7 () inr: 1.2 esr: 66 crp: 125.8 cr: 3.1 () -> 4.8 () -> 3.1 () bun: 62 -> 71 k: 5.0 () -> 5.6 () . troponin: 0.70 () -> 0.32 -> 0.30 () . tibc: 172 vit b12: 509 folate: 10.1 ferritin: 582 trf: 132 . vanco trough: 25.8 (). . urine eosinophils: positive () . microbiology: 10:20 pm blood culture **final report ** blood culture, routine (final ): staph aureus coag +. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s aerobic bottle gram stain (final ): gram positive cocci in clusters. reported by phone to at 1814 on . anaerobic bottle gram stain (final ): gram positive cocci in clusters. === , no growth blood cultures === 1:00 am urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. === 12:55 pm urine culture (final ): no growth. . admission ekg: sinus @ 71. rbbb. rad. inferior qws. compared to prior, little diagnostic change. . transthoracic echocardiogram (@wxva): nl rv. moderating thickened av w/o as. trace ai. mild mac. no ms. mr. . ef 55%. moderate concentric lvh. no regional wma. grade i diastolic dysfunction. . transthoracic echocardiogram : there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with hypokinesis of the distal septum, apex and distal anterior and inferior walls. not all of the remaining segments are visualized, but most appear to contract normally (lvef = 45%). the aortic valve is not well seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is a trivial/physiologic pericardial effusion. impression: mild regional left ventricular systolic dysfunction, c/w cad. . mri c/t/l spine w/o contrast (prelim read): at l1-2, there is moderate spinal stenosis seen secondary to disc and facet degenerative changes. at l2-3, mild-to-moderate spinal stenosis with moderate right subarticular recess narrowing seen. from l3-4 to l5-s1 level, degenerative disc disease and mild bulging identified. no spinal stenosis seen. there is no discitis, osteomyelitis, or epidural abscess. no paraspinal abscess identified. impression: degenerative changes with moderate spinal stenosis at l1-2 and mild-to-moderate spinal stenosis at l2-3 level. no evidence of discitis, osteomyelitis, or epidural abscess. . 12/21 persantine stress test: no anginal symtoms or ischemic st segment changes. appropriate hemodynamic response to the persantine infusion. nuclear report sent separately. mpression: normal myocardial perfusion. moderately enlarged left ventricular cavity size with mild global hypokinesis. calculated left ventricular ejection fraction is 44%. . echo tee: 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 symmetric left ventricular hypertrophy. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. no masses or vegetations are seen on the aortic valve. there are filamentous strands on the aortic leaflets consistent with lambl's excresences (normal variant). trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. there is no pericardial effusion. impression: no 2d echocardiographic evidence of endocarditis. . ct head: 1. study limited by lack of contrast administration. within this limitation, no evidence of septic emboli. 2. there is no evidence of acute hemorrhage, edema, large mass, mass effect or infarction. 3. sequelae of chronic microvascular infarction noted. . renal ultrasound: findings: the right kidney measures 12.2 cm. the left kidney measures 11.2 cm. there is no hydronephrosis bilaterally. although son penetration is difficult, no obvious renal mass or calculi are seen bilaterally. impression: no hydronephrosis . left upper extremity ultrasound findings: grayscale and doppler evaluation of left internal jugular, subclavian, axillary, brachial, and basilic veins demonstrate normal compressibility, flow, response to augmentation wherever applicable. the right internal jugular waveforms are demonstrate normal respiratory phasicity and asymmetric. there is an intraluminal thrombus distending the left cephalic vein with lack of compressibility of the left cephalic vein consistent with left cephalic thrombosis. there is no color flow within the thrombosed vein suggesting a nearly occlusive thrombus. impression: nearly occlusive left cephalic vein thrombus. no evidence of deep venous thrombosis in the left upper extremity. . . discharge labs: . wbc: 7.9, hgb 8.2, hct 24.7, plt 292 pt 13.6, ptt 36.6, inr: 1.2 glucose: 102 na: 142 k: 5.6 cl: 112 hco3: 23 bun: 71 cr: 3.1 . vancomycin trough: 24.5 brief hospital course: 78 year old male with sig vascular risk factors, admitted with suspected spontaneous epidural abscess and cauda equina syndrome. #. cauda equina syndrome: on presentation, the patient clinically had cauda equina syndrome with decreased rectal tone and progressive rle weakness. mri on admission did not demonstrate epidural abscess, though it was concerning for epidural lipomatosis, per ortho spine. the patient underwent a laminectomy of t12-l3 on for spinal canal stenosis. after discussion with both cardiology and ortho spine, the patient's home dose of asa was restarted on pod1, given his recent mi. the patient's plavix was held until . per ortho spine, the patient could continue activity as tolerated. he was seen by pt on , who recommended discharge to a rehab facility. #. mssa bacteremia: osh bcx bottles grew gpc; aerobic bottle here grew gpc, speciated as mssa. patient was initially on vanc/zosyn on for broad spectrum coverage, and which was subsequently switched to nafcillin following speciation per id recs. tte and tee showed no evidence of endocarditis. patient was switched from nafcillin to vancomycin due to allergic intersitial nephritis with renal failure. his vancomycin was renally dosed, and troughs were checked daily. the patient should complete a 4 week course of vancomycin, per infectious disease, which will end . the patient's most recent vancomycin trough on 1000 mg vancomycin daily was supratherapeutic at 25.5. thus, we would recommend decreasing this dose to 750 mg and checking a vancomycin trough on . #. uti: cx at osh with > 100,000 e cloacae, klebsiella in urine sensitive to ciprofloxacin, has urostomy. was started on ciprofloxacin per id recs on . repeat urine culture was negative. patient had evidence of delirium, so given negative repeat urine culture ciprofloxacin was stopped after a 3 day antibiotic course and patient was monitored. . #. cad, native vessel: high risk for surgery given recent medically managed stemi . was continued on carvedilol, imdur, aspirin. atorvastatin was initiated. plavix was held pre-op and was restarted on . we continued to hold his lisinopril, given his cki, and his lasix was restarted at 20 mg po daily on . patient had tte for pre-op evaluation, and had p-mibi performed following his procedure, given the fact that he had twi laterally on ekg (no cp, vss) the night following his procedure. cardiac enzymes showed troponin leak and p-mibi showed normal myocardial perfusion. troponin leak was felt to be both demand in setting infection, due to increasing renal failure and perhaps resolving enzymes from stemi. the patient reportedly already has an appointment scheduled with his outpatient cardiologist at the va. . #. ckd stage iv: unclear baseline although on admission was in the mid-2s and trended up to mid-3's post-op. urine lytes were sent and revealed allergic interstitial nephritis due to eosinophils and fena 1.5%. naficillin was stopped and patient was transitioned to vancomyin with improvement in renal function. the patient's renal fucntion improved to 3.1 and he was restarted on lasix 20 mg daily on . . #. htn, benign: the patient had borderline low bps when started on cardiac meds including beta-blocker & imdur per cards recs pre-op. amlodipine, lasix, and lisinopril were held for surgery. he then became hypertensive to sbps of 180s on and . lasix was restarted on and amlodipine was restarted on . his lisinopril was held given his cki. . #. superficial left upper extremity clot: the patient developed swelling of his left arm on in the setting of refusing sc heparin. lue u/s demonstrated nearly occlusive left cephalic vein thrombosis but no evidence of dvt. he agreed to sc heparin and was restarted on his home dose of plavix, warm compresses, and left arm elevation. . #. altered mental status: post-operative patient developed waxing and mental status attributed to multifactorial delirium: post-operative, bacteremia, urinary tract infection, pain management with morphine post-operatively, elderly. ct head showed no acute event. no other infections identified. patient's opioids, ambien and ciprofloxacin were stopped with improvement in patient's mental status. at discharge the patient was alert and oriented x3. . #. anemia of chronic disease: hct 32 on admission. given 2 units prbcs prior to surgery. patient hct was lower post surgery at hct 24-27. slight drift downward attributed to poor nutrition with delirium and blood draws. iron and b12, folate studies revealed anemia of chronic disease. the patient's hct on discharge was 24.7. . #. pmr: has h/o pmr and is on chronic prednisone. checked with id - no need for prophylaxis as dose not high enough. continued prednisone #. dm2, poorly controlled with complications: glargine/ hiss, follow bgs . #. neuropathic pain: the patient was continued on his home dose of gabapentin 600mg qhs . #. depression: the patient was continued on his home doses of venlafaxine and citalopram #. fen/ppx: the patient was maintained on a cardiac, diabetic diet. he refused sc heparin until when told about the superficial upper extremity clot, then agreed to sc heparin. the patient was full code during this admission. #. communication: patient and medications on admission: home medications (per cards per recent d/c paperwork at wxva): prednisone 7.5mg daily amlodipine 10mg daily gabapentin 600mg qhs carvedilol 12.5 mg lasix 20mg daily insulin nph 12units qam, 12units qpm citalopram 20 mg daily plavix 75 mg daily asa 81 mg daily imdur 30 mg daily lisinopril 5 mg daily simvastatin 40 mg daily venlafaxine 75 mg qam, 150 mg qpm discharge medications: 1. prednisone 5 mg tablet sig: 1.5 tablets po daily (daily). 2. insulin lispro 100 unit/ml solution sig: sliding scale subcutaneous four times a day. 3. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 4. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 5. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 7. polyethylene glycol 3350 17 gram/dose powder sig: seventeen (17) grams po daily (daily) as needed for constipation. 8. senna 8.6 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for constipation. 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 10. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 11. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 12. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 13. gabapentin 600 mg tablet sig: one (1) tablet po at bedtime. 14. venlafaxine 75 mg tablet sig: one (1) tablet po qam. 15. venlafaxine 75 mg tablet sig: two (2) tablet po qpm. 16. coreg 25 mg tablet sig: one (1) tablet po twice a day. 17. lipitor 80 mg tablet sig: one (1) tablet po at bedtime. 18. amlodipine 10 mg tablet sig: one (1) tablet po once a day. 19. vancomycin 1g based on level discharge disposition: extended care facility: va discharge diagnosis: cauda equina syndrome, mssa bacteremia, uti, acute on chronic kidney injury secondary diagnoses: -cad s/p stemi (medically managed) -iddm -dyslipidemia -htn -cki -polymyalgia rheumatica -bladder cancer s/p urostomy -depression discharge condition: mental status:clear and coherent, sometimes confused level of consciousness:alert and interactive activity status:out of bed with assistance to chair or wheelchair discharge instructions: you were admitted to hospital for evaluation of lower back pain associated with fevers, chills, and rigors. you were diagnosed with cauda equina syndrome which occurs when there is compression of your spinal cord. in order to relieve the compression, you required an operation called a laminectomy which you tolerated well. you were also found to have an infection in your blood with a bacteria called mssa. you were treated with nafcillin, which unfortunately worsened your kidney function due to a process called allergic interstitial nephritis. luckily, your kidney function returned to its baseline when this medication was stopped and replaced with vancomycin. you will require a total of 4 weeks of treatment with vancomycin and for that reason, a more permanent iv called a picc was placed before your discharge to the va. you also developed a urinary tract infection which responded well to treatment with ciprofloxacin. the following changes have been made to your home medications: - your home carvedilol dose has been increased to 25mg twice daily - your home lisinopril dose has been held for now and may be restarted at the discretion of the va - your home simvastatin was changed to lipitor 80mg daily - you were started on senna, docusate, and miralax to help move your bowels - you will use tylenol as needed for your pain please follow-up with all of your outpatient medical appointments listed below. followup instructions: please follow-up with all of your outpatient medical appointments listed below: 1. infectious disease, provider: , md phone: date/time: 9:00 2. ortho/spine, provider: , md (orthopedics). date/time: at 1:30 pm. location: . 3. please follow-up with your previously scheduled va kidney, va cardiologist, and va primary care physician. procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart other exploration and decompression of spinal canal biopsy of bone, other bones diagnoses: hyperpotassemia coronary atherosclerosis of native coronary artery polymyalgia rheumatica urinary tract infection, site not specified congestive heart failure, unspecified long-term (current) use of steroids acute kidney failure, unspecified severe sepsis chronic kidney disease, stage iv (severe) diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes depressive disorder, not elsewhere classified lipoma of other specified sites methicillin susceptible staphylococcus aureus septicemia other and unspecified hyperlipidemia old myocardial infarction personal history of malignant neoplasm of bladder acute glomerulonephritis with other specified pathological lesion in kidney phlebitis and thrombophlebitis of superficial veins of upper extremities delirium due to conditions classified elsewhere diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled chronic diastolic heart failure diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified arthropathy associated with neurological disorders acute myocardial infarction of unspecified site, subsequent episode of care cauda equina syndrome without mention of neurogenic bladder degeneration of lumbar or lumbosacral intervertebral disc cystostomy, unspecified 

Answer: The patient is high likely exposed to