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 attending: chief complaint: back pain major surgical or invasive procedure: picc placement ct-guided fna biopsy of vertebral disc left knee arthrocentesis left knee arthrotomy, irrigation and debridemen with complete synovectomy and replacement of tibial liner component history of present illness: the patient is an 86 year-old man with a history of coronary artery disease, hypercholesterolemia, hypertension, elevated psa with recent prostate biopsywho was transferred from with a diagnosis of septic diskitis at t9-t10 and enterococcal bacteremia. approximately one month prior to admission to the outside hospital on , the patient had undergone a prostate biopsy for a nodule. about three weeks later, he developed a uti and was treated with a course of levofloxacin. several days later, he developed acute back pain when he attempted to rise from his bed and had difficutly standing. the pain spread across his back and radiated down his leg. he describes the pain as sharp, and was relieved by "pain pills." he notes that the pain has migrated between his back and various le joints (bilaterally) since the pain began. he has had a low grade temp and elevated esr at 150. mri revealed increased t2 signal disc t9-t10, ct guided bx revealed no evidence of malignancy or infection, and cultures were negative. initial blood cultures were negative, but on fourth day 1 bottle grew enterococcus patient had initially been treated with levofloxacin, then was changed to vancomycin when enterococcus grew from culture. the patient has had significant pain requiring narcotics. at the outside hospital the patient was also found to be in renal failure with creatinine 2.5. . evaluation at outside hospital: - abdominal ct without contrast: no aaa, extensive degenerative joint disease of the lumbar spine - bone scan : djd - mri; enhancement of the t9-10 disk, suspicious for diskitis - ck normal (concern for possible rhabdomyolysis after recent statin use) - renal u/s (limited exam)-2.6cm parapelvic cyst at upper pole of r kidney. no hydro or nephrolithiasis past medical history: - coronary artery disease with left bundle branch block suggestive of old mi - hypercholesterolemia-started on pravastatin approx. 2 months ago, discontinued after several weeks secondary to myalgias and weakness. - hypertension - elevated psa - prostate nodule with recent biopsy approx. 1 month ago - s/p r shoulder , hardware later removed - s/p bilat knee arthroplasty, revision of l knee hardware - normal colonoscopy - osteoarthritis social history: shx: married, lives with his wife who is in reasonably good health. served in ww-ii, then worked as a mechanic and supervisor until retirement. habits: 100 pack-year tobacco history, quit 21 years ago, etoh: 1 vodka nightly before dinner, no other drugs. family history: nc physical exam: gen: elderly male, appears to be in pain vs: 98.4 / 90 / 128/57 / 22 / 100% on 2l nc heent: sclera anicteric, conjunctiva pink. perrl. mm dry, op clear. neck: supple, no lad, no thyromegaly cor: tachycardic, regular rhythm, 2/6 systolic murmur best appreciated at the r sternal border, radiating to the clavicles lungs: r lung cta, l lung with focal crackles in l base, with occasional expiratory wheeze abd: soft, nt, nd, no organomegaly rectal: normal tone, no saddle anesthesia ext: wwp, 1+ pitting edema in feet and shins bilaterally. well-healed surgical scars over both knees. left knee is erythematous, warm, swollen with extensive swelling of the pre-patellar bursa. neuro: a&o x 3, cn intact. ue strength 5/5, le strength 5/5 proximally and distally. toes downgoing bilaterally. dtrs not elicited. sensation to light touch intact bilat le. pertinent results: blood cultures negative x4 urine culture negative . mri of t spine : signal within the disc space on the t2- and stir-weighted sequences at t9-10 consistent with discitis at this level. . mri of l spine : there is a focus of abnormal signal intensity in the left anterior aspect of the l4/5 disk and a small area of diskitis cannot be completely excluded, although the typical soft tissue and marrow abnormalities are absent. there is severe stenosis of the spinal canal at l5/s1 from a disk bulge, disk space and facet osteophytes and ligamentum flavum hypertrophy. there is severe stenosis of the left foramen. milder stenosis is seen at l3/4 and l4/5. . tee : conclusions: lvef>55%. no masses or vegetations see. + aortic regurgitation, 1+ mitral regurgitation. brief hospital course: mr. presented with weakness for several weeks, with subsequent development of sudden severe back pain radiating down his legs. the back pain was located in the lumbar area. also on admission he had an inflammed left knee (s/p knee replacement several years ago). mri shows enhancement of t9-10 disk space, t4-5 space, and severe stenosis at l5-s1. fna of t9-10 negative for organisms, pmns, malignant cells. l knee washed-out and liner replaced by ortho for suspected infection. enterococcus grew from 1/4 bottles on blood cx at osh, but all subsequent cultures have been negative to date. . 1. back pain and weakness: mri of t spine at had revealed abnormal enhancement of the t9-10 disk space, consistent with diskitis. however, the patient reported that mri of l spine showed severe stenosis at l5-s1, the level of the patient's back pain. also on mri, there is abnormal enhancement of t9-10 and l4-5, which possibly represents diskitis. fna of t spine lesion has not yielded any organism, although infection probably can't be excluded as patient had been treated with antibiotics for more than a week when biopsies were taken. regardless, ortho-spine felt surgery is not indicated currently for diskitis. id consulted for medical management (see below). overall, the patient's le weakness has been improving. it is likely related to stenosis as l5-s1. ortho-spine consultant recommends continued po pain medications for now, with possible epidural steroids in future once infections resolved. patient should follow-up with ortho spine in weeks. pt followed by pt with improvement in mobility. . 2. diskitis/bacteremia: at , 1 of 4 bottles from a blood culture grew enterococcus after several days. no blood cultures at grew organisims. as the patient is allergic to penecillins (unknown type of rash 50 years ago), he was started on vancomycin at the outside hospital for enterococcus bacteremia. it was unclear if the bacteremia was related to the diskitis, as only one of four bottles grew organisms, and therefore a work-up for other sources was undertaken, including tte/tee (no vegetations seen), chest x-ray, urine culture. the patient had also recently had a prostate biopsy approx. 1 month before that was complicated by a uti, so there was also concern for gram negative source of diskitis. thus, the patient was treated with a course of iv ciprofloxacin in addition to the vancomycin. an abdominal ct was also performed, which ruled-out abscess. id was consulted for recommendations for therapy. given likely need for long-term antibiotics for infected knee hardware as well as need for good enterococcus coverage, id recommended desensitization so patient could be treated with ampicillin. allergy was consulted who gave recommendations for desensitization protocol, which patient underwent in the icu overnight with no complications. the vancomycin was stopped and patient was continued on ampicillin, which he will need for 6 weeks (picc line in place). he will follow-up at the clinic for recommendations concerning possible longer-term oral antibiotic coverage given his knee hardware; this decision will be made in conjunction with either orthopedics (dr. or orthopedics (dr. ) depending on patient preference. . 3. l knee swelling: on admission, the patient's l knee was red and warm with significant swelling. there was marked swelling of the pre-patellar bursa. the patient is s/p knee replacements bilaterally, with a recent revision of his l knee hardware in . given his exam, there is concern for joint infection. ortho consulted and performed arthrocentesis, which had a leukocytosis but no organisms (though patient on antibiotics). he was taken to the or for wash-out of grossly infected knee and replacement of liner. on gram stain from the or, there were no organisms, 2+ pmns. post-operatively, the patient did well with pt on left leg). id was consulted for recommendations about antibiotics (see above). . 3. pain control: initially on morphine pca, then switched to tylenol with oxycodone as needed. . 4.renal insufficiency: cr stable around 2.0 during hospitalization. appears to be chronic from outside records from . needs outpatient work-up. no nsaids given renal function. renally dose all meds. . 5. anemia: baseline hct from was 37.6. iron studies consistent with anemia of chronic inflammation. no signs of active bleeding. . 6.cad: stable. lbbb on ekg unchanged from previous studies. asa 81mg and lopressor 12.5mg . 7. prostate hypertrophy/elevated psa: stable, to be followed as outpatient. continue tamsulosin 0.4 mg daily . 8. fen: was frequently npo for procedures (maintained on ivf). nutrition consult recommended boost tid. cardiac diet. . 9.prophylaxis: lovenox, is, protonix, bowel regimen. . 10. code: full . 11. communication: pcp is in (). wife is (). medications on admission: meds on transfer: - asa 81 - toprol xl 25 - vanco 1g qd - flomax 0.4mg qd - heparin 5000u subq tid - protonix 40 qd - flexeril 5 q 8 - pca with dilaudid - mvi qd - senekot 2 tabs po bid - tyelnol 650 q 6h prn - restaril 7.5mg qhs prn insomnia - dulcolax 10mg qd - colace 100 - mom 30cc qid - dilaudid 1-3mg sc q 2-4h prn discharge disposition: extended care facility: rehab unit at - discharge diagnosis: septic left knee diskitis t9-10 spinal stenosis l5-s1 enlarged prostate bacteremia at referring hospital (enterococcus) chronic renal insufficiency anemia of chronic disease discharge condition: good discharge instructions: take all medications as directed. call a nurse or doctor or go to the er for difficulty breathing, chest pain, fever over 101.5f, vomiting, abdominal pain, worsening pain or swelling in your knee, new weakness or tingling in your legs, bladder or bowel incontinence, numbness, or any other concerns. followup instructions: you need to have weekly lab work (cbc, bun, creatinine, lfts), and the results should be faxed to the infectious disease clinic at . your knee staples need to be removed in days; your rehabilitation center can arrange this. call dr. (orthopedics at ) for a follow-up appointment for your knee in weeks. or, if you prefer, you can follow-up with dr. at (. call dr. (orthopedics-spine) at ( for a follow-up appointment for your back in weeks. you have an appointment with dr. (infectious disease, ) on at 9:30am. md procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart arthrocentesis transfusion of packed cells revision of knee replacement, not otherwise specified biopsy of joint structure, other specified sites diagnoses: anemia of other chronic disease coronary atherosclerosis of native coronary artery pure hypercholesterolemia unspecified essential hypertension acute kidney failure, unspecified mitral valve insufficiency and aortic valve insufficiency hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) chronic kidney disease, unspecified bacteremia old myocardial infarction other and unspecified disc disorder, lumbar region knee joint replacement diseases of tricuspid valve spinal stenosis, lumbar region, without neurogenic claudication pyogenic arthritis, lower leg infection and inflammatory reaction due to internal joint prosthesis 

Answer: The patient is high likely exposed to