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: s/p fall major surgical or invasive procedure: incision and drainage of r gluteus. peripherally-inserted central venous catheter. history of present illness: 87 yo male fell out of bed, now presenting with lower back pain. the patient was a book in bed when the book fell and apparently reached over to grab it. he fell out of bed and landed on his back and was found after being down for an unclear amount of time. his daughter reports "at least a few hours." on presentation he reports bilateral pain in his arms, legs, ankles, and back. the parts that hurt him the most are his right elbow, right hip, lower back, and left calf. he has a history of lower back pain but reports that this is worse than prior. he denies any current changes in his speech or vision. denies headaches, cp, sob, fever, cough, abdominal pain, n/v/d, dysuria. he reports occasional diarrhea. he notes normal uop and po intake recently at home. of note, he reports taking ibuprofen at home for his chronic low back pain. in the ed, initial vitals were: afeb 76 111/56 21 100% on ra. highlights of initial studies and interventions include: - multiple plain films and cts revealing: irregularity along l navicular, could be avulsion or enthesopathy, old rib fractures, no c-spine or hip fracture, no head bleeds - ck elevated to 10,287 iu/l - lactate of 3.9 - 3l ivf and 2l po given - given tylenol 1000mg po once for fever - given vancomycin/cefepime for coverage - ekg: sr with ste in v2, no cp, neg troponin micu admission vitals: hr 76, bp 105/45, sat 95% ra on arrival to the micu, he reports low back pain, right upper arm pain, and right sided pain. past medical history: hyperlipidemia htn bph, awaiting laser surgery s/p cataracts surgery bilaterally cad djd with lower back pain and bulging disc mod left foraminal stenosis at l2-l3 macular degeneration bcc bilateral inguinal hernia repair social history: lives with wife and son. wife with advanced alzheimer's disease, son and daughter take care of her. he eats at panera. he bathes himself and walks independently. prior pipe smoker 40 years ago, occaisional glass of white wine. he reads during the day. takes all of his medications by himself and goes to appointments. goes on the t by himself, does not drive. daughter believes that he may have hired commercial sex workers within the past year. family history: noncontributory. physical exam: admission physical examination vitals: t 102 hr 73 rr 20 bp 106/49 sao2 96% on ra general: alert, oriented, no acute distress heent: sclera anicteric, mm dry, oropharynx clear, eomi, pupils not reactive, left pupil 2mm, right pupil 6mm neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no m/r/g, no pain when palpating chest wall lungs: bibasilar crackles abdomen: +bs, soft, non-tender, distended, no organomegaly gu: +foley ext: warm, well perfused, 2+ distal pulses throughout, no clubbing, cyanosis or edema, bilateral calf tenderness l>r, bilateral + sign, dependent erythema of bilateral extermities with blisters over posterior right hip, extremities are extremely tender and swollen, with pain out of proportion to exam rectal: no tone, intact saddle sensation, no saddle anesthesia back: tenderness l3-l5 spinous processes neuro: cnii-xii intact, 5/5 strength in ue, strength limited by pain in the lower extremities, grossly normal sensation discharge physical examination: vitals: t 98.0 hr 66 rr 18 bp 139/59 sao2 96% on ra. general: elderly gentleman is awake and in nad. cardiovascular: rrr, no m/r/g. moderate tenderness to palpation over the left chest wall. pulmonary: ctab other than bibasilar crackles. skin/extremities: petechiae on calf have diminished. erythema on left calf in dependent areas. pneumoboots present. wound: clean, dry and intact. mild tenderness to palpation. neurological: alert & oriented x 3. examination limited by pain. strength and sensation exam unchanged. pertinent results: labs: 05:50pm blood wbc-4.5 rbc-4.39* hgb-14.4 hct-41.2 mcv-94 mch-32.8* mchc-34.9 rdw-13.4 plt ct-131* 06:42am blood hypochr-normal anisocy-1+ poiklo-normal macrocy-normal microcy-normal polychr-normal ovalocy-1+ 01:58am blood pt-20.2* ptt-28.7 inr(pt)-1.9* 12:11pm blood fibrino-583* 06:42am blood esr-49* 05:50pm blood urean-38* creat-1.7* 01:58am blood glucose-105* urean-38* creat-1.6* na-141 k-3.3 cl-107 hco3-22 angap-15 05:50pm blood ck(cpk)-* 01:58am blood ck(cpk)-* 06:42am blood alt-92* ast-370* ld(ldh)-540* ck(cpk)-* alkphos-24* totbili-1.4 05:50pm blood ck-mb-52* mb indx-0.5 ctropnt-<0.01 01:58am blood ck-mb-38* mb indx-0.3 ctropnt-0.03* 12:11pm blood ck-mb-27* mb indx-0.2 ctropnt-0.03* 12:11pm blood albumin-2.4* calcium-6.4* phos-3.3 mg-2.4 06:42am blood tsh-0.86 12:11pm blood pth-111* 12:11pm blood 25vitd-23* 01:58am blood crp-greater th 12:11pm blood hiv ab-negative 05:50pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 05:53pm blood glucose-128* lactate-3.9* na-139 k-3.9 cl-108 calhco3-23 08:21pm blood lactate-4.0* 02:12am blood lactate-4.1* 06:50am blood lactate-2.4* 12:28am blood lactate-1.4 ck trend on admission: peaked on hd#3: downtrended to normal by hd#14: 267. creatinine trend: on admission: 1.7 downtrended and normalized by hd#5 to 1.2 and continued to trend to 0.8-0.9 range. on discharge: 06:25am blood wbc-8.0 rbc-3.23* hgb-10.1* hct-30.8* mcv-96 mch-31.2 mchc-32.6 rdw-13.1 plt ct-732* 06:25am blood glucose-145* urean-17 creat-0.8 na-135 k-4.5 cl-98 hco3-30 angap-12 06:25am blood alt-33 ast-33 ld(ldh)-426* ck(cpk)-152 alkphos-64 totbili-0.4 06:42am blood tsh-0.86 12:11pm blood 25vitd-23* microbiology: blood culture blood culture, routine- no growth. blood culture blood culture, routine- no growth. urine chlamydia trachomatis, nucleic acid probe, with amplification-final; neisseria gonorrhoeae (gc), nucleic acid probe, with amplification-final serology/blood rapid plasma reagin test-final mrsa screen mrsa screen-final blood culture blood culture, routine-final {beta streptococcus group b}; anaerobic bottle gram stain-final; aerobic bottle gram stain-final blood culture blood culture, routine-final {beta streptococcus group b}; anaerobic bottle gram stain-final; aerobic bottle gram stain-final urine urine culture-final imaging: ct cspine: moderate cervical spondylosis. no evidence for fracture or dislocation. findings suggesting mild pulmonary vascular congestion. cxr: rib fractures, without displacement, but of uncertain acuity. no evidence of acute cardiopulmonary disease ct head: 1. no evidence of acute intracranial process. 2. small vessel ischemic disease. 3. ventricles are enlarged, slightly out of proportion of the sulcal enlargement, which may reflect central atrophy; less likely, however, normal pressure hydrocephalus could be considered in the appropriate clinical setting. ct torso: 1. findings suggesting more remote prior injury involving the right hemipelvis. 2. fluid in the right trochanteric bursa. 3. coronary artery calcifications. 4. findings suggesting mild vascular congestion. 5. small fat-containing umbilical hernia. ankle films: findings concerning for non-displaced avulsion fracture along the proximal superior navicular on the left. correlation with physical findings is suggested. if physical findings do not support the likelihood of acute injury at the site, then degenerative enthesopathy could be considered as an alternative etiology. elbow films: no evidence of recent injury. ble lenis: no dvt. mri t/l spine: 1. multilevel, multifactorial degenerative changes in the lower cervical, thoracic, and the lumbar spine as described above. degenerative changes are noted at c5 and c6 levels with moderate canal stenosis, with disc osteophyte complexes indenting the thecal sac and the cord along with ligamentum flavum changes. 2. no abnormal enhancement to suggest epidural abscess. 3. at l5-s1: increased signal intensity in the disc with minimal edema in the adjacent endplates likely degenerative. correlate clinically and with labs to exclude any associated inflammatory/infectious component. 4. small protrusions in thoracic spine. bil. small pleural effusions. ct rle: 1. nonspecific areas of low attenuation within the right gluteal muscles could represent edema from trauma, inflammation, or infection. muscle necrosis and muscle tear would be in the differential. deep and superficial fascial edema. moderate subcutaneous edema. further evaluation with mri of the pelvis may be obtained if clinically warranted. 2. focal subcutaneous cystic lesion/fluid collection overlying the right buttocks,likely representing a small inflammed subcutaneous cyst. clinically correlate to ensure resolution. 3. evaluation of the deep venous structures shows no evidence of thrombosis. tte: the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the estimated cardiac index is normal (>=2.5l/min/m2). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normal biventricular cavity sizes with preserved global and regional biventricular systolic function. moderate pulmonary artery hypertension. no valvular pathology or pathologic flow identified. mri pelvis: 1. asymmetric increase in edema predominantly in the gluteal muscles as well as in the adductor musculature and tracking along the sciatic nerve into the pelvis. this is a nonspecific finding, but could be accounted for by changes related to contusion from recent fall and to reported rhabdomyolysis. the possibility of superimposed infection cannot be excluded and could also account for or contribute to this appearance. of note, edema is seen tracking from this area through the sciatic notch into the pelvis. no large fluid collection is seen, but intravenous contrast would be required to identify smaller fluid collections. 2. right ischial bursitis. again the presence or absence of infection cannot be assessed by imaging. iv contrast would be required to distinguish fluid from thickened, hyperemic synovium. 3. no joint effusion or marrow edema detected about the hips or pelvic girdle. no gross gluteal tear, but the distalmost insertion of the gluteus maximus onto the femoral shaft is not included on these images. 4. complex fatty mass between the right gluteus medius and maximus muscles, likely a lipoma with superimposed edema, however, the differential includes a small liposarcoma. therefore, non-acute follow up examination is recommended once the patient's clinical symptoms have resolved to further assess this lesion. mri with and without contrast (7/13,) ======================================== 1. ill-defined low-signal intensity rim-enhancing collection within the gluteus medius muscle with extension to the gluteus maximus muscle, felt to represent necrotic tissue versus focal fluid collection. the presence or absence of infeciton within this area cannot be evaluated by imaging. further evaluation with ultrasound may be obtained. 2. large area of low signal intensity involving the entire gluteus maximus muscle, felt to represent developing muscle necrosis. the ddx could include fluid, but this is considered less likely. 3. focal hemorrhage anterior to the gluteus maximus muscle. 4. diffuse body wall anasarca, and large bilateral hydroroceles. le doppler u/s (): no right lower extremity dvt. r shoulder xr (): probable old healed fracture of the right proximal humerus. otherwise, no acute fracture or dislocation. if clinical suspicion for acute right humeral fracture remains high, then further assessment is recommended. ultrasound r gluteus (): a tiny fluid collection was seen on a recent mri performed two days previously. despite numerous attempts, the same tiny fluid collection could not be identified with ultrasound largely due to its location posted to the right hip joint. brief hospital course: ================================== 87 year old male with history of cad and hyperlipidemia who presents after fall found to have rhabdomyolysis and , elevated lactate, sepsis with group b beta hemolytic streptococcus and extensive right buttocks soft tissue injury. #) fall: unclear inciting event. unwitnessed. orthostatics negative. patient denied any cardiac prodrome, convulsions, incontinence, or post-ictal symptoms. focal weakness in admission was likely secondary to pain and ct head negative for ischemic changes. ekgs without arrhythmia. given later finding of sepsis, fall could have been due to delirium/confusion from bloodstream infection. #) musculoskeletal injury: s/p fall and muscle breakdown leading to rhabdomyolysis. back pain in icu in setting of initial coagulopathy concerning for epidural hematoma vs. abscess. mri thoracic and lumbar spine ruled out epidural mass, showing only degenerative changes, but could not rule out discitis. neurosurgery consulted for poor rectal tone and profound weakness on admission, but tone improved on their exam and felt l5/s1 possible discitis seen on mri more likely to represent chronic changes. pain was controlled in icu with tylenol and fentanyl boluses for turns. pain control upon transfer to the floor initially with iv dilaudid and po oxycodone. initially pain was very poorly controlled. pain service was consulted. mr. was either in significant pain or overmedicated. transitioned to po oxycodone monotherapy as pain improved. extensive imaging revealed: * large area of low signal intensity involving the entire gluteus maximus muscle, felt to represent developing muscle necrosis. (however surgery explored this region in the or and no muscle necrosis was seen. fat necrosis was seen.) * no acute c-spine injury. * no intracranial bleed. * left navicular avulsion. * old healed fracture of the right proximal humerus. * old rib fractures. * old injury to right hemipelvis. went to or on for exploration of right buttock with incision and drainage, digital debridement of fat necrosis and draining fluid thought to represent a hematoma. no muscle necrosis was seen. #) sepsis (): initially febrile to 104 f without leukocytosis in the icu. lactate peak at 4. concerned for necrotizing fasciitis, so started on vancomycin, cefepime, and clindamycin. hiv, gc/chlamydia and rpr negative after report of patient hiring sex workers. also concerned for possible infectious endocarditis; tte showed no evidence of this. blood cultures grew group b beta hemolytic streptococcus sensitive to ceftriaxone, so therapy narrowed to ceftriaxone with id consultation. picc placed for long term antibiotics. final course of antibiotics is 3 weeks from last negative blood cultures () so will complete course on . source of unclear, but evidence of skin breakdown on back on presentation. urine culture clean and no evidence of pneumonia or other infectious nidus. #) rhabdomyolysis: muscle breakdwon with extreme tenderness out of proportion to exam. cks peaked in 10,000s. treated with aggressive hydration with ivf. cks continued to rise after admission and initiation of ivf until hd#2 at 14,948 and downtrended subsequently until normalization by hd#14. initially concerned for compartment syndrome but surgery consultation and imaging deemed this was unlikely. home statin held. also initially concerned for myositis, tsh wnl, but felt that trauma and compression injury the more likely culprit, although etiology of diffuse ble petechiae anf purpura by hd#10 was unclear and raised the possibility of an evolving vasculitis. these lesions resolved over a few days. #) left navicular avulsion/enthesopahty: causing minimal pain during this admission. per ortho, needs only supportive care. no activity limitation. supportive boot only if patient desires. #) heel ulcers: secondary to being bedbound while in hospital. #) acute kidney injury: admitted with creatinine at 1.7 in setting of muscle breakdown due to rhabdomyolysis. home nsdaids and hctz held. with ivf, creatinine downtrended to 0.8-0.9 range. #) hypophosphatemia: on initial presentation. unclear etiology. vit d low, pth high. medications on admission: preadmission medications listed are correct and complete. information was obtained from patient pcp . . 1. niacin 400 mg po qid 2. aspirin 325 mg po daily 3. hydrochlorothiazide 25 mg po daily 4. ibuprofen 200 mg po bid:prn pain 5. cyanocobalamin dose is unknown po daily 6. glucosamine *nf* (glucosamine sulfate) unknown oral daily 7. fish oil (omega 3) 6 tabs po tid 8. vitamin d 1000 unit po daily 9. pyridoxine 50 mg po daily 10. folic acid 1 mg po daily 11. tamsulosin 0.4 mg po hs take 30 minutes after the same meal each day. discharge medications: 1. aspirin 325 mg po daily 2. vitamin d 1000 unit po daily 3. ceftriaxone 2 gm iv q24h 4. hydrochlorothiazide 25 mg po daily 5. cyanocobalamin 25 mcg po daily 6. folic acid 1 mg po daily 7. niacin 400 mg po qid 8. pyridoxine 50 mg po daily 9. tamsulosin 0.4 mg po hs take 30 minutes after the same meal each day. 10. acetaminophen 1000 mg po q6h:prn pain do not exceed 4g daily 11. fish oil (omega 3) 6 tabs po tid 12. glucosamine *nf* (glucosamine sulfate) 1 tab oral daily 13. ibuprofen 200 mg po bid:prn pain 14. oxycodone (immediate release) 5-10 mg po q6h:prn pain hold for oversedation, rr < 12. please alternate with standing oxycodone dosing. thank you. rx *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours disp #*120 tablet refills:*0 discharge disposition: extended care facility: healthcare center - discharge diagnosis: primary- rhabdomyolysis right gluteal injury with fat necrosis acute kidney injury sepsis with group b beta-hemolytic streptococci metabolic encephalopathy nstemi secondary- l2-l3 moderate spinal stenosis hypertension benign prostatic hypertrophy discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: patient previously able to ambulate without difficulty. out of bed with assistance to chair or wheelchair. discharge instructions: dr. . , it was a pleasure taking part in your care during your stay at . you were admitted after a fall and found to have extensive muscle damage. this released proteins into your blood (called rhabdomyolysis) and caused acute kidney injury which we treated with intravenous fluids and your kidney injury resolved. you were also found to have bacteria growing in your blood (sepsis) which we treated with antibiotics. part of the fat in your right buttock was found to be dead after your fall and needed surgical intervention. this was completed without complication. followup instructions: please follow up with your primary care physician, . at . we recommend trying to see him within 1-2 weeks following you discharge from rehab. we will send him all of the records from this hospitalization. md procedure: arterial catheterization myotomy central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery acute kidney failure, unspecified unspecified protein-calorie malnutrition severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other and unspecified hyperlipidemia cellulitis and abscess of leg, except foot septic shock macular degeneration (senile), unspecified metabolic encephalopathy accidental fall from bed streptococcal septicemia myalgia and myositis, unspecified rhabdomyolysis lumbosacral spondylosis without myelopathy ulcer of heel and midfoot unspecified vitamin d deficiency chronic kidney disease, stage ii (mild) degeneration of lumbar or lumbosacral intervertebral disc closed fracture of navicular [scaphoid], foot 

Answer: The patient is high likely exposed to