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: history of present illness: the patient is a 56-year-old female with a past medical history significant for right lower quadrant mass suspicious for cancer, status post percutaneous drainage of the right lower quadrant mass in . the patient had initially presented on , with abdominal pain and a pelvic mass. ct scan of her abdomen at the time showed a large 7-cm fluid collection in the subcutaneous tissues of the right lower quadrant, and inflammatory process involving the cecum and proximal ascending colon; ascending was suspected. it appeared that the inflammatory process predominately involved the cecum. ct-guided drainage of the cecal mass on , was nondiagnostic. pathology results from the right lower quadrant mass showed benign fibroblastic changes of chronic inflammation which could not rule out overlying cancer. she was to undergo surgery for the right lower quadrant mass on ; however, after long discussions with dr. and dr. , the patient decided to wait a few weeks to build up her strength before having surgery. the elective resection was planned for ; however, the patient presented on , with right upper quadrant abdominal pain and a fever to 102. past medical history: (significant for) 1. methicillin-resistant staphylococcus aureus in her sputum. 2. status post an appendectomy. 3. status post a cesarean section. 4. cecal mass. 5. history of a seizure disorder first diagnosed on her last admission in . medications on admission: dilantin, prilosec, valproic acid, iron, multivitamin, tylenol, and dulcolax. allergies: no known drug allergies. social history: the patient is a former nursing aide at . she denied tobacco or alcohol use, and lives with her son. family history: significant for mother with hypertension. there is no family history of cancer. physical examination on admission: heart rate 100, blood pressure 90/56, respiratory rate 18. in general, the patient was awake and alert. breath sounds were equal bilaterally. heart had a regular rate and rhythm. abdomen was flat, soft, right lower quadrant mass palpable and nontender. right upper quadrant tender to palpation. extremities were warm and well perfused. laboratory on admission: white blood cell count 15.6, 82 neutrophils, 1 band, 8 lymphocytes, hematocrit 28.2, platelets 913. pt 13.5, ptt 27.8, inr 1.2. chem-7 revealed sodium of 137, potassium 4.1, chloride 101, bicarbonate 22, bun 11, creatinine 0.5, glucose 86. ct scan showed a small fluid collection adjacent to the right colonic mass extending up to and around the gallbladder. there was no extravasation of contrast. there was an increase in size of the right colonic mass pushing through the abdominal wall. hospital course: the patient was admitted to general surgery. given the increase in the right colonic mass with possible reperforation, she was kept n.p.o., started on intravenous fluids and intravenous antibiotics (ceftriaxone, flagyl, and ampicillin). drainage of the new fluid collection failed. on , the patient underwent right hemicolectomy with ileotransverse colon anastomosis for presumed colon cancer. please see the dictated operative note for details. she also underwent a cystoscopy and right ureteral stent placement by urology. postoperatively, the patient was transferred to the surgical intensive care unit for postoperative management. 1. gastrointestinal: on postoperative day one, the patient was started on total parenteral nutrition. she received a right femoral line for this in the surgical intensive care unit. she was kept n.p.o. and started on intravenous zantac. she also had a nasogastric tube placed at the time of surgery. this was kept to wall suction. on postoperative day six, tube feeds were attempted; however, the patient developed diarrhea on the tube feeds, therefore they had to be discontinued. the patient was maintained on total parenteral nutrition. on postoperative day six, the patient was passing flatus and had large watery bowel movements on postoperative day seven. the stool was sent for clostridium difficile times three and was negative. on postoperative day 10, the nasogastric tube had fallen out. it was not replaced. the patient denied any nausea or vomiting. on postoperative day 11, a speech and swallow consultation was obtained for a bedside swallow evaluation. at that time the patient was not cooperating with the study; however, on postoperative day 12, she did cooperate and it was felt that she would be able to tolerate a ground diet with thin liquids. therefore, her diet was advanced at that time without complications. postoperatively, the patient had been receiving intravenous fluid hydration; however, that was hep-locked on postoperative day eight. at the time of discharge the patient was tolerating p.o. well and was not requiring any maintenance fluids. 2. infectious disease: postoperatively, given the macroperforation, the patient was started on a 10-day course of ceftriaxone, flagyl, and ampicillin which she completed. the picc line was attempted to be placed; however, it was discovered that the patient had bilateral upper extremity deep venous thromboses as well as occlusion of the superior vena cava; therefore, the picc lines had to be discontinued, and the patient received her antibiotics through peripheral ivs. the patient remained afebrile until postoperative day 15, at which time she spiked a temperature to 102.6. at this time her right groin line was pulled. it was day 15 of the right groin line. it was unable to be discontinued earlier given that the patient had no intravenous access secondary to her bilateral upper extremity deep venous thrombosis. in addition, blood cultures, urine cultures, and chest x-ray were sent, and the patient was started on vancomycin, ceftriaxone, and flagyl. her temperature maximum at this time was 104.6. infectious disease was consulted on postoperative day 17. blood cultures at the time the patient spiked grew out coag-negative staphylococcus resistant to oxacillin. in addition, a urine cultures grew out greater than 100,000 colonies of enterococcus and greater than 100,000 colonies of coag-negative staphylococcus. the ceftriaxone and flagyl were discontinued after two days given that the patient defervesced nicely, and there was a known source from the blood and the urine coag-negative staphylococcus which the vancomycin would cover. a 14-day course of the vancomycin was recommended. subsequent blood cultures and urine cultures were negative. on postoperative day 21, vancomycin day six, the patient was changed from vancomycin to linezolid per infectious disease recommendation for a total of nine more days. at the time of discharge the patient was afebrile, and there were no active infectious disease issues. 3. hematology: the patient had received 2 units of packed red blood cells prior to her surgery. in addition, she subsequently received several units of blood postoperatively. as previously, a picc line was attempted on postoperative day four. at that time, imaging revealed a left arm with central venous occlusion and venous outflow through numerous collaterals, and in the right arm central venous occlusion at the right axillary vein. the patient had had a history of right upper extremity deep venous thrombosis, and at physical examination she did have right upper extremity swelling. vascular surgery was consulted regarding the deep venous thrombosis. they recommended systemic heparin with long-term coumadin therapy. therefore, the patient was started on intravenous heparin until her coumadin was in the therapeutic range. the heparin was eventually changed to lovenox while awaiting the coumadin to become therapeutic. at the time of discharge the patient's inr was therapeutic. in addition, dr. from interventional radiology was consulted regarding possible recannulization procedure. their recommendations were that the superior vena cava and subclavian brachiocephalic veins could be recannulized; although, it would be a lengthy procedure requiring bilateral arm and right groin approach. the patient and her family members felt that they would like to hold off at this time given all of the other medical issues. the plan was if the superior vena cava syndrome symptoms persisted and/or central access was needed for central chemotherapy therapy, interventional radiology could recanalize. the patient's superior vena cava symptoms did resolve during the hospital course. therefore, there was no immediate need to recannulize at this time. this will need to be addressed as an outpatient if central chemotherapy was warranted. 4. oncology: the surgical specimen was read by pathology as poorly differentiated adenocarcinoma with 3/16 positive lymph nodes. their impression was stage iii adenocarcinoma of the ascending colon with abscess extending to abdominal wall. they believed that the patient was at high risk for recurrence and recommended adjuvant chemotherapy four to six weeks postoperatively. a discussion was held with the patient and her family members regarding 5- and leucovorin. first 5-fu, leucovorin, and cpt-11. the patient will need to follow up with dr. in his clinic (phone number ), with dr. (the hematology/oncology fellow). the patient will need to be seen at the end of at dr. . in addition, dr. was consulted from radiation/oncology. they believed that there was little call for radiation. dr. agreed to see the patient in his clinic in three weeks. therefore, the patient should have an appointment scheduled for the end of . 5. neurology: during the patient's previous hospitalization in she developed status epilepticus and was in the medical intensive care unit for an extended period of time. she had been started on dilantin; however, was not compliant with taking her medications. neurology was consulted on postoperative day seven because the patient had been refusing her dilantin, and her dilantin level was extremely low. they had a long discussion with the patient regarding the risks and benefit of her seizure medication and informed her that her risks for further seizure and possibly status epilepticus was high. she was also informed that if she developed status epilepticus there would be a change that they would be unable to stop her seizures. the patient reported that the reason she did not want to take the dilantin was because it caused burning. therefore, she was started on phosphophenytoin. on the evening of postoperative day 10, the patient developed left upper extremity weakness at approximately 8 o'clock at night. on physical examination, her cranial nerves were grossly intact, but she had decreased motor strength in her left upper extremity and decreased tone. concern was for a stroke (embolic versus hemorrhagic) versus seizure. her heparin was stopped at this time and neurology was called. a head ct was obtained which was negative for a bleed. a head mri was also obtained which was negative for stroke. toxic metabolic workup including complete blood count, urinalysis, liver function tests, and chest x-ray were all unremarkable. the chest x-ray showed bilateral pleural effusions; however, no evidence of infection. according to neurology recommendations, the patient was reloaded with her phosphophenytoin. by the following morning her left upper extremity weakness had resolved. an electroencephalogram was obtained which showed diffuse swelling with right temporal spikes consistent with a epileptogenic focus but no seizure activity. throughout the rest of the hospital course there was no evidence of seizures or stroke. the patient continued to refuse her dilantin even after several discussions regarding the importance of seizure prevention. 6. postoperative issues: the patient's pain was controlled with a morphine pca well. when she was tolerating adequate p.o. she was converted to percocet for the pain which provided adequate pain relief. the patient had retention sutures and staples of her incision. these will be discontinued by her attending after three weeks. the patient did have a foley postoperatively. this was discontinued on postoperative day 16. there were issues of low urine output immediately postoperatively, and the patient did require albumin; however, her urine output improved and was adequate throughout the rest of the hospital course. intravenous access was an issue as previously described. therefore, her right groin line was her primary intravenous central access for approximately two weeks. once the right groin line was discontinued the patient had peripheral ivs for intravenous access. intravenous access will need to be addressed if the patient does require central chemotherapy because of the bilateral upper extremity deep venous thrombosis. discharge diagnoses: 1. colon cancer. 2. status post right hemicolectomy. 3. bilateral upper extremity deep venous thrombosis and superior vena cava syndrome. 4. seizure disorder. 5. status post methicillin-resistant staphylococcus aureus, coag-negative staphylococcus bacteremia. medications on discharge: 1. coumadin 7.5 mg p.o. q.d. 2. linezolid 600 mg p.o. b.i.d. times eight days. 3. boost 1 can p.o. t.i.d. with meals. 4. dilantin 300 mg p.o. b.i.d. 5. multivitamin 1 tablet p.o. q.d. 6. tylenol 650 mg p.o. q.4-6h. p.r.n. condition at discharge: stable. follow-up appointments: follow-up appointments will need to be made for the end of with dr. in oncology, and dr. in radiation/oncology, as well as dr. for postoperative followup. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances open and other right hemicolectomy ureteral catheterization diagnoses: infection with microorganisms resistant to penicillins other convulsions cellulitis and abscess of upper arm and forearm staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes malignant neoplasm of ascending colon secondary malignant neoplasm of small intestine including duodenum other venous embolism and thrombosis of unspecified site 

Answer: The patient is high likely exposed to