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: meperidine / morphine attending: chief complaint: neck pain major surgical or invasive procedure: 1) c5-6 corpectomy / cage / acdf for abscess (white/) 2) c6-t1 lami / c4-t2 psf (white) history of present illness: 52f with pmh of hypothyroidism and depression who presents with 6 days of progressive neck pain and spasms. neck pain started on and is described as spasms l>r. she initially attributed pain to sleeping position and took flexeril with minimal relief. pain persisted and was associated with increased fatigue, decreased appetite and po intake. she called pcp and was prescribed tylenol #3 with also minimal relief. 2 days pta, she noted progressive lightheadedness, dizziness and fatigue as well as subjective fevers and night sweats. on day of transfer, she felt so weak she was unabel to stand, was concerned she was going to pass out and had weakness in her hands bilaterally. denies headache, photophobia, dysuria, sick contacts, cough, sore throat, abdominal pain, sinus pain or congestion, or recent travel. . she was initially seen at osh ed where she had ct head, c spine and chest which were all unremarkable. she had lp with 4 wbc, 0 rbc, 300 protein, 40 glucose. prior to lp, she received vanco, ctx, and decadron. she looked well but had asympomtatic hypotension with sbp in 60s-80s so received 6l at osh and was transferred to ed. . in our ed, initial vs 99.9 87/60 80 18 98%ra. she was evaluated by neuro who recommended cta. mri also performed which was limited but revealed prevertebral edema c2-c6. patient was evaluated by spine who felt this required medical management with antibiotics and was nonoperative. neuro exam normal except for mild weakness triceps b/l. she received an additional 2l ns with improvement in sbp to 90s-100s. she did not receive further antibiotics. she was also noted to desaturate with sleeping. vs prior to transfer 71 112/60 17 98-99%2l . on arrival to icu, she reports thirst and denies lh, dizziness. neck pain currently 0/10. past medical history: past medical history: hypothroidism depression gerd hyperlipidemia . past surgical history s/p appendectomy, hysterectomy, breast augmentation social history: nurse . drinks wine with dinner, smokes ~ ppd x >30 years. denies any other drug use. lives with husband. has 2 sons in college. has 2 cats, no other pets. no recent travel. denies recent dental work. family history: brother with dm2. father with als. mother healthy. fh neurological disease, recurrent infections, malignancy. physical exam: gen: pleasant, comfortable, nad, sitting up in bed heent: perrl, eomi, anicteric, mm dry, op without lesions, no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits resp: bibasilar crackles. otherwise cta b/l cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e skin: no rashes/no jaundice/no splinters hemorrhages or stigmata of endocarditis. incisions c/d/i neuro: aaox3. cn ii-xii intact. 5/5 strength throughout ues and les except at triceps where l , r . interossei stregth intact. biceps, brachioradialis and patellar dtrs 2+. focal neck ttp. pertinent results: 06:00am blood wbc-8.0 rbc-3.26* hgb-10.1* hct-28.8* mcv-88 mch-30.9 mchc-35.0 rdw-13.8 plt ct-378 06:00am blood neuts-73* bands-2 lymphs-16* monos-3 eos-2 baso-1 atyps-2* metas-1* myelos-0 06:00am blood glucose-101* urean-2* creat-0.4 na-140 k-3.0* cl-99 hco3-32 angap-12 06:49am blood alt-58* ast-66* ld(ldh)-256* alkphos-66 totbili-0.2 06:00am blood calcium-7.8* phos-3.2 mg-2.2 06:49am blood caltibc-165 vitb12-1462* folate-15.5 hapto-502* ferritn-1806* trf-127* microbiology time taken not noted log-in date/time: 6:08 pm tissue disc c5. gram stain (final ): reported by phone to @ 9pm . 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. tissue (preliminary): staph aureus coag +. moderate growth. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. this isolate is presumed to be resistant to clindamycin based on the detection of inducible resistance . sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s anaerobic culture (preliminary): fungal culture (preliminary): no fungus isolated. imaging radiology report mr w& w/o contrast study date of 1:00 am , eu 1:00 am mr w& w/o contrast clip # reason: ? abscess contrast: magnevist amt: 15 medical condition: 52 year old woman with fever, four days of neck pain, seen at osh with negative lp, ct head/neck, cxr, ua. persistently low bp's after fluid resuscitation. reason for this examination: ? abscess contraindications for iv contrast: none. wet read: ipf tue 2:58 am very limited scan due to motion; patient unable to cooperate. prevertebral edema c2-c6. increased signal in c5-c6 disk concerning for inflammation. high signal in c5- and c6 vertebral bodies. although some of changes might be degenerative cannot exclude c5-c6 discitis osteomyelitis complex at level c5-c6; however very subotimal scan due to motion and most of post-contrast sequences are non-diagnostic. signal in the cord is preserved. scan should be repeated when patient able to cooperate. final report cervical spine mri with and without contrast, indication: 52-year-old woman with fever and neck pain for four days. seen at an outside hospital with a negative lumbar puncture and negative cts of the head and cervical spine. persistently low blood pressure after fluid resuscitation. evaluate for an abscess. comparison: cervical spine ct obtained at on is available for correlation. technique: sagittal t1-weighted, t2-weighted, and stir images of the cervical spine were obtained, with axial gradient echo and t2-weighted images. following intravenous gadolinium administration, sagittal and axial t1-weighted images of the cervical spine were obtained. findings: the study is limited by motion artifacts, despite repetition of multiple sequences. stir images demonstrate abnormal high signal in the c5-6 intervertebral disc, and in the marrow of the c5 and c6 vertebral bodies. there is a large prevertebral collection from c2 through c6, with prevertebral edema extending inferiorly to t1. this collection demonstrates high signal on t2-weighted images and intermediate signal on pre- and postcontrast t1-weighted images, more consistent with a phlegmon than an abscess. there is an anterior epidural collection from c4 through c6, which enhances on post-contrast images, consistent with a phlegmon. this collection moderately narrows the spinal canal and deforms the spinal cord. there is also a small left posterior epidural rim-enhancing fluid collection at c7-t1 (series 13, image 6, and series 14, image 27) consistent with an abscess, which also moderately narrows the spinal canal and deforms the left posterolateral spinal cord. evaluation of spinal cord signal is limited due to motion artifacts. there is edema in the interspinous ligaments from c3-4 through c6-7, as well as edema in the posterior subcutaneous soft tissues. multilevel degenerative changes are present, but are suboptimally assessed due to motion artifacts. impression: 1. findings consistent with discitis and osteomyelitis at c5-6. 2. anterior epidural phlegmon from c4 through c6, moderately narrowing the spinal canal and deforming the spinal cord. small left posterior epidural abscess at c7-t1, moderately narrowing the spinal canal and deforming the spinal cord. evaluation of cord signal is limited by extensive motion artifacts. 3. large prevertebral collection from c2 through c6, more consistent with a phlegmon than an abscess. radiology report mr w& w/o contrast study date of 1:14 pm white, tsicu 1:14 pm mr w& w/o contrast; mr w &w/o contrast; mr w & w/o contrast clip # reason: epidural abscess contrast: magnevist amt: 16 medical condition: 52 year old woman with epidural abscess reason for this examination: epidural abscess contraindications for iv contrast: none. wet read: natg wed 5:11 pm 1. interval c5-6 corpectomy and c4-7 anterior reconstruction with debridement of discitis/osteomyelitis. a residual fluid collection anterior to the spine at the c5-6 level most likely represents a postoperative seroma, recommend attention on followup. 2. moderate-sized intracanalicular, epidural collection, which is intermediate in signal intensity on t1- and t2-weighted imaging, and shows peripheral enhancement with central low signal on t1-weighted post-contrast images, results in moderate canal narrowing and in this setting is concerning for infectious phlegmon/early abscess. 3. heterogeneous marrow with numerous foci of t1/t2 hyperintensity without abnormally high signal on stir or post-contrast images most likely represent hemangiomas as well as reconversion of red marrow in the setting of patient's known anemia. final report clinical information: 52-year-old female who presented with an epidural abscess and is status post c5-6 corpectomy and anterior reconstruction. comparison: mr performed . technique: multisequence multiplanar mr images were acquired of the entire spine, before and after the administration of contrast. findings: cervical spine: the patient is intubated, status post c5-6 corpectomy with placement of interbody spacer device. the overall aligment appears preserved. a residual fluid collection is seen anterior to the spine extending from the midline rightward and measuring 3.0 x 2.2 x 0.9 cm. more widespread edema and induration in this area is likely post-operative. posterior to the thecal sac is a dorsal epidural space collection which is intermediate in t2 signal and low in t1 signal which extends from the c3-4 disc space to the upper t2 vertebral body level, measuring 10 cm (cc) and producing moderate narrowing of the central canal (3;8, 6;20). this collection does enhance peripherally with a residual low-t1-signal center following contrast administration (13; 8). otherwise, no significant abnormal enhancement is noted. the cervical spinal cord and the cranio-cervical junction are unremarkable in appearance. thoracolumbar spine: the visualized spinal cord and conus medullaris are normal in appearance and terminate normally at the l1 vertebral body level. the cauda equina nerve roots are unremarkable. there is no significant disc degenerative disease or neural foraminal narrowing. vertebral body disc height and alignment is preserved. edema seen in the posterior lumbar soft tissues is likely related to the patient's recent debilitated state. the bone marrow is diffusely heterogeneous with scattered t1-/t2-hyperintense foci, likely representing hemangiomas (or "fatty rests"), the largest of which within the t5 vertebral body, abutting the superior endplate, measures approximately 1 cm. throughout the spine, these foci demonstrate no increased and predominantly decreased stir-signal and no abnormal enhancement, consistent with their non-aggressive nature. impression: 1. interval c5-6 corpectomy and c4-7 anterior reconstruction with debridement of discitis/osteomyelitis. moderate-sized dorsal epidural collection, which shows peripheral enhancement with central low-signal on t1-weighted post-contrast images, results in moderate canal narrowing; in this setting, this finding likely represents persistent infectious phlegmon/abscess. apparently, the patient is already scheduled for posterior decompression and debridement. 2. residual fluid collection anterior to the spine at the c5-6 level most likely represents post-operative seroma; attention should be paid to this region on any follow-up study. 3. heterogeneously hypointense bone marrow signal likely represents reconversion of red marrow in response to the patient's known anemia, with several scattered hemangiomas. brief hospital course: the patient was admitted to the with neck pain and fever. mri was concerning for cervical epidural abscess and the patient was taken to the or for anterior c5-6 corpectomy / cage / fusion on and c6-t1 lami / c4-t2 psf with icbg on without complication. for details please refer to the dictated operative note. postoperatively the patient was taken to the icu intubated. she was extubated on pod#1 and transferred to the floor that same day. teds / pnemoboots were used for postoperative dvt prophylaxis. intravenous antibiotics were administered in the form of nafcillin + vancomycin followed by nafcillin alone once cultures returned mssa. an echo performed revealed no evidence of vegetation. a picc line was placed for long term antibiotics. the patient's pain was controlled with iv pain medications followed by oral analgesics once tolerating pos. the patient's diet was advanced as tolerated. the foley was removed on pod#3 following the second procedure. physical therapy was consulted for mobilization. the hospital course was otherwise unremarkable. on the day of discharge the patient was afebrile with stable vital signs, comfortable on oral pain control and tolerating a regular diet. the patient was discharged with instructions to follow up in clinic as directed. she is to continue taking nafcillin via picc as recommended by the infectious disease consult service. medications on admission: levothyroxine 175mcg daily celexa 20mg po daily omeprazole 20mg po daily simvastatin 20mg po daily flexeril x 1 dose discharge medications: 1. levothyroxine 175 mcg tablet sig: one (1) tablet po daily (daily). 2. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 3. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 4. oxycodone 5 mg tablet sig: 1-3 tablets po q3h (every 3 hours) as needed for pain. disp:*100 tablet(s)* refills:*0* 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain, headache, fever. 7. nafcillin in d2.4w 2 gram/100 ml piggyback sig: two (2) gram intravenous q4h (every 4 hours). disp:* cc* refills:*3* 8. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 9. outpatient lab work please check esr, crp, wbc chem7, lfts weekly while on nafcillin and fax to . thanks. 10. picc dressing kit sig: one (1) picc dressing kit once a week for 6 weeks. disp:*6 week supply* refills:*0* 11. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush for 6 weeks. disp:*6 week supply* refills:*0* 12. saline flush 0.9 % syringe sig: two (2) ml injection three times a day for 6 weeks. disp:*6 week supply* refills:*0* 13. diazepam 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for spasm. disp:*80 tablet(s)* refills:*0* discharge disposition: extended care facility: hospital - discharge diagnosis: cervical epidural abscess discharge condition: stable a&o x3 ambulatory - independent discharge instructions: immediately after the operation: - activity: you should not lift anything greater than 10 lbs for 2 weeks. you will be more comfortable if you do not sit in a car or chair for more than ~45 minutes without getting up and walking around. - rehabilitation/ physical therapy: o 2-3 times a day you should go for a walk for 15-30 minutes as part of your recovery. you can walk as much as you can tolerate. o isometric extension exercise in the collar: 2x/day x 10 times perform extension exercises as instructed. - swallowing: difficulty swallowing is not uncommon after this type of surgery. this should resolve over time. please take small bites and eat slowly. removing the collar while eating can be helpful ?????? however, please limit your movement of your neck if you remove your collar while eating. - cervical collar / neck brace: you need to wear the brace at all times. you may remove the collar to take a shower. limit your motion of your neck while the collar is off. place the collar back on your neck immediately after the shower. - wound care: remove the dressing in 2 days. if the incision is draining cover it with a new sterile dressing. if it is dry then you can leave the incision open to the air. once the incision is completely dry (usually 2-3 days after the operation) you may take a shower. do not soak the incision in a bath or pool. if the incision starts draining at anytime after surgery, do not get the incision wet. call the office at that time. if you have an incision on your hip please follow the same instructions in terms of wound care. - you should resume taking your normal home medications. - you have also been given additional medications to control your pain. please allow 72 hours for refill of narcotic prescriptions, so plan ahead. you can either have them mailed to your home or pick them up at the clinic located on 2. we are not allowed to call in narcotic (oxycontin, oxycodone, percocet) prescriptions to the pharmacy. in addition, we are only allowed to write for pain medications for 90 days from the date of surgery. - follow up: o please call the office and make an appointment for 2 weeks after the day of your operation if this has not been done already. o at the 2-week visit we will check your incision, take baseline x rays and answer any questions. o we will then see you at 6 weeks from the day of the operation. at that time we will most likely obtain flexion/extension x-rays and often able to place you in a soft collar which you will wean out of over 1 week. please call the office if you have a fever>101.5 degrees fahrenheit, drainage from your wound, or have any questions. physical therapy: weight bearing as tolerated cervical collar at all times treatments frequency: iv antibiotics wound checks physical therapy dressing changes followup instructions: call to schedule follow up appt with dr in days. please also call to schedule follow up appt with infectious disease in 6 weeks. procedure: imageless computer assisted surgery excision or destruction of lesion of spinal cord or spinal meninges diagnostic ultrasound of heart other excision of joint, other specified sites other cervical fusion of the anterior column, anterior technique excision of intervertebral disc excision of bone for graft, other bones open biopsy of soft tissue open biopsy of soft tissue biopsy of bone, other bones biopsy of bone, other bones other cervical fusion of the posterior column, posterior technique insertion of interbody spinal fusion device fusion or refusion of 4-8 vertebrae fusion or refusion of 4-8 vertebrae central venous catheter placement with guidance diagnoses: esophageal reflux tobacco use disorder acute posthemorrhagic anemia unspecified acquired hypothyroidism depressive disorder, not elsewhere classified candidiasis of mouth other and unspecified hyperlipidemia bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site hypovolemia intraspinal abscess acute osteomyelitis, other specified sites other and unspecified disc disorder, cervical region vascular myelopathies unspecified disease of spinal cord acute venous embolism and thrombosis of superficial veins of upper extremity 

Answer: The patient is high likely exposed to