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: patient recorded as having no known allergies to drugs attending: chief complaint: basal cell carcinoma of the anterior chest wall with erosion and chest wall bleeding with cough. major surgical or invasive procedure: : radical sternectomy and placement of a vac dressing. : chest wall reconstruction and omental flap. : 1. major reconstruction of chest wall, post-traumatic. 2. right latissimus muscle flap. 3. bilateral pectoralis muscle flap. 4. local advancement flap 30 cm2. 5. split-thickness skin graft to trunk 625 cm2. 6. placement of negative pressure wound therapy. history of present illness: the patient is a 53-year-old gentleman who has had a basal cell carcinoma of the anterior chest wall for approximately 10 years without treatment. on presentation in the emergency room he was exsanguinating from this tumor and had lost approximately 500 to 1000 ml of blood acutely and had dropped his hematocrit to 28. the tumor was a fungating mass which smelled infected and had eroded clearly on exam. this was also seen on ct scanning through the majority of the sternal body and manubrium. it did not appear to be invading the heart or great vessels. thoracic surgery was consulted for evaluation and treatment. past medical history: hiv basal cell carcinoma social history: divorced, with 2 children. lives alone. (brother is contact) works out of home as a masseuse. quit smoking in . occasional etoh. no ivdu. family history: noncontributory physical exam: vs: t: 97.3 hr: 87 sr bp: 122/78 sats: 98% ra general: pleasant in no apparent distress neuro: alert and oriented x 4 without focal deficits. perrla, moves all extremities to command. heent: normocephalic, mucus membranes moist resp: clear breathsounds t/o cv: rrr normal s1,s2 at apex, no mrg or jvd chest: sternal bed healing without redness, drainage, covered with xeroform, gauze and abd pads. abd:soft, nt, nd ext: warm bue, ble, without edema. left thigh graft healing with xeroform dressing adhered. right picc line intact without redness, swelling or drainage at the site. pertinent results: 04:42pm blood wbc-6.6 rbc-3.10* hgb-8.7* hct-26.7* mcv-86 mch-28.1 mchc-32.7 rdw-17.8* plt ct-746* 05:51am blood wbc-7.5 rbc-3.21* hgb-9.1* hct-27.2* mcv-85 mch-28.3 mchc-33.4 rdw-17.1* plt ct-796* 04:42pm blood pt-14.6* ptt-26.3 inr(pt)-1.3* 07:16am blood wbc-9.4 lymph-27 abs -2538 cd3%-67 abs cd3-1712 cd4%-15 abs cd4-375 cd8%-51 abs cd8-1295* cd4/cd8-0.3* 04:42pm blood glucose-112* urean-10 creat-0.6 na-136 k-3.5 cl-101 hco3-29 angap-10 04:51am blood glucose-104* urean-10 creat-0.5 na-135 k-3.3 cl-103 hco3-27 angap-8 07:16am blood glucose-113* urean-4* creat-0.9 na-124* k-4.1 cl-89* hco3-27 angap-12 05:23pm blood alt-13 ast-26 alkphos-53 totbili-0.7 02:04am blood alt-12 ast-15 ld(ldh)-157 alkphos-49 amylase-77 totbili-0.3 04:42pm blood mg-1.8 04:51am blood calcium-7.3* phos-3.2 mg-1.8 09:02pm blood calcium-8.7 phos-4.2 mg-1.5* 01:52pm blood type-art o2 flow-3 po2-97 pco2-33* ph-7.55* caltco2-30 base xs-6 intubat-not intuba vent-controlled chest xray on : portable ap chest radiograph was compared to prior study from . left apical pneumothorax has slightly increased in the interim, moderate. the right chest tube is in unchanged position. there is also small right apical pneumothorax, grossly unchanged as compared to . the position of the fixators of the anterior chest wall is unchanged as well as there is no change in the cardiomediastinal silhouette. the amount of pneumothorax on the left is minimal. right pleural effusion is unchanged. micro: 6:42 pm tissue site: sternum sternal tumor mass. **final report ** gram stain (final ): reported by phone to @ 1115pm . 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. 4+ (>10 per 1000x field): gram positive cocci. in pairs and chains. tissue (final ): reported by phone to dr , 1145am. due to mixed bacterial types (>=3) an abbreviated workup is performed; p.aeruginosa, s.aureus and beta strep. are reported if present. susceptibility will be performed on p.aeruginosa and s.aureus if sparse growth or greater.. beta streptococcus group a. moderate growth. proteus mirabilis. rare growth. further workup requested by dr. (). pseudomonas aeruginosa. sparse growth. staph aureus coag +. sparse 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 _________________________________________________________ proteus mirabilis | pseudomonas aeruginosa | | staph aureus coag + | | | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s 2 s ceftazidime----------- <=1 s 4 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s <=0.25 s clindamycin----------- r erythromycin---------- r gentamicin------------ <=1 s 2 s <=0.5 s levofloxacin---------- 0.25 s meropenem-------------<=0.25 s 1 s oxacillin------------- 0.5 s piperacillin/tazo----- <=4 s 8 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=0.5 s anaerobic culture (final ): bacteroides fragilis group. sparse growth. beta lactamase positive. mrsa screen (final ): no mrsa isolated. urine culture (final ): no growth. pathology: diagnosis: 1. left rib cartilage (a): cartilage, no malignancy identified. 2. skin, subcutaneous tissue, and chest wall tissue including portion of ribs, sternal tumor, resection (b-h): baso-squamous carcinoma, deeply invasive into chest wall, ulcerated, approximately 17 mm. thick. margin clearance: - superior margin: 5 mm. - right superior: 1 mm. - left superior: 2 mm. - deep margin: positive, focally, center of tumor. four lymph nodes, no carcinoma seen. note: sections of bone are being decalcified, the findings of which will be reported in the addendum. brief hospital course: mr. came to the emergency room on for a large fungating, foul smelling anterior sternal basal cell carcinoma which was bleeding. initial bedside hemostasis was obtained with cautery, sutures and surgicell in the emergency room. a ct chest revealed complete erosion of anterior chest wall soft tissues and the mid sternal body, without invasion into the heart or great vessels. thoracic and plastic surgery was consulted. the patient was then taken to the operating room on where he underwent radical sternectomy with wound vac placement. he was transferred to the icu intubated given the extensive change to the thoracic cavity for further management. while in the sicu he required fluid challenges and neosynephrine for hypovolemia with good response. he remained intubated and was taken back to the operating room on with plastic and thoracic surgery for major reconstruction of chest wall, with right latissimus muscle flap, bilateral pectoralis muscle flap, local advancement flap 30 cm2, split-thickness skin graft to trunk 625 cm2 and placement of negative pressure wound therapy. he transferred back to the sicu intubated for increased narcotics requirement for adequate pain control. the pain service was consulted and once his pain was well controlled he extubated on . he transferred to the floor on hemodynamically stable. drains & chest tubes: right and left chest tubes were removed , with stable postpull films. jp drains x 4 at anastomosis site remained with serousanguious drainage. the jp #4 was discontinued on date of discharge. plastic surgery will followup in a week from discharge for further management, including drains. nutrition: the patient was given tube feedings via dobhoff while intubated. he was seen by speech and swallow on , who cleared him for a regular diet with thin liquids which he tolerated. cv: the patient while on the floor was hemodynamically stable in normal sinus rhythm. renal: a foley catheter which was placed initially on and discontinued on . the patient voided well after removal. two urine cultures done inhouse were negative. sternal wound: vac dressing managed by the plastic team. on the vac dressing was removed, with instruction for further dressing changes with xeroform and light gauze fluff and abd pads to cover, changing daily. id: infectious disease was consulted . initially he was started on vancomycin and once the sternal wound cultures grew beta-strep a he was switched to unasyn and clindamycin. once the final intraoperative tissue specimen consisting of sternum and tumor revealed a polymicrobial infection including mssa, pseudomonas, proteus and b. fragilis on he was transitioned to a 6 week course of imipenem for monotherapy of the above polymicrobial sternal osteomyelitis. hiv: his haart regime was restarted immediately postoperatively. he was followed by his medicine team while inhouse. picc: placed 54 cm r basilic: cxr revealed the right pic catheter ends in the svc. neuro: pain control requiring ketamine drip with episodes of hullcinations and confusion. once the ketamine drip was stopped his mental status improved. his pain was well controlled oxycodone and tylenol on discharge. during his confusion in the icu head ct was done and negative for any acute abnormality. heme: required 7 units of prbc, 4 ffp, 1 plts in or . his inr elevated to 3.3 on which he was given vitamin k for. the patient was seen by physical therapy and deemed a candidate for rehab. the patient was screened and accepted at rehab. he was deemed stable for discharge to rehab on , with close outpatient followup with infectious disease, plastic surgery and thoracic surgery. he will also have weekly labs. medications on admission: 1. tenofovir disoproxil fumarate 300 mg tablet sig: one (1) tablet po daily (daily). 2. lopinavir-ritonavir 200-50 mg tablet sig: two (2) tablet po bid (2 times a day). 3. lamivudine 300 mg tablet sig: one (1) tablet po once a day. discharge medications: 1. tenofovir disoproxil fumarate 300 mg tablet sig: one (1) tablet po daily (daily). 2. lopinavir-ritonavir 200-50 mg tablet sig: two (2) tablet po bid (2 times a day). 3. lamivudine 300 mg tablet sig: one (1) tablet po once a day. 4. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 5. acetaminophen 500 mg tablet sig: two (2) tablet po every eight (8) hours as needed for pain. 6. imipenem-cilastatin 500 mg iv q6h 7. 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. 8. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 9. white petrolatum-mineral oil 56.8-42.5 % ointment sig: one (1) appl ophthalmic prn (as needed) as needed for dry eyes. discharge disposition: extended care facility: discharge diagnosis: basal cell carcinoma of the anterior chest wall. hiv. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: the patient is transferring to in with the following discharge instructions: strict sternal precautions: no lifting, pushing or pulling greater than 10 pounds for 2 months at least and until cleared by physician. chest pt. no lying on stomach. call dr. (plastic surgeon) at if wound bed becomes red, drains, opens, or if any wound concerns. they are also managing jp drains: drain care: 3 bulbs to suction. cleanse insertion site with mild soap and water or sterile saline, pat dry, and place a drain sponge daily and as needed. apply a drain sponge if needed. monitor and record quality and quantity of output. empty bulb frequently. ensure that the drain and bulb are secured to the patient. monitor for signs of infection or dislocation. sternal dressing: cover with xeroform and light gauze fluffs with abd pad, changing daily. left leg xeroform dressing to stay on until it sloughs off. call plastic surgery at above number if any concerns regarding this wound. call dr. office immediately at if fevers greater than 101.5, coughing, shortness of breath, or any sternal instability or chest pain. right picc line per protocol. antibiotics: imipenem-cilistatin 500mg iv q6hrs, duration to be determined by infectious disease. do not discontinue until approved by infecious disease department. labs: check weekly cbc with differential, bun/creatinine, lft's, esr, crp and fax all laboratory results to infectious disease r.ns. at ( all questions regarding outpatient antibiotics should be directed to the infectious disease r.ns. at ( or to on md in when clinic is closed. while on narcotics take stool softeners to prevent constipation. work with physical therapy, walking three times per day to improve function. followup instructions: **follow-up with dr. (plastic surgery) on at 1115am in on . 5a **follow-up with , md phone: date/time: 3:30 . get a chest xray 30 minutes prior to this appointment on the radiology. **provider: , md phone: date/time: 9:50 infectious disease ground floor **provider: , md phone: date/time: 9:30 infectious disease ground floor procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube arterial catheterization other repair of chest wall other skin graft to other sites local excision of lesion or tissue of bone, scapula, clavicle, and thorax [ribs and sternum] graft of muscle or fascia attachment of pedicle or flap graft to other sites other repair of omentum division or crushing of other cranial and peripheral nerves regional lymph node excision reconstruction of eyelid with tarsoconjunctival flap radical excision of skin lesion application of pressure dressing diagnoses: other iatrogenic hypotension hyposmolality and/or hyponatremia secondary malignant neoplasm of pleura iatrogenic pneumothorax methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation nontraumatic hematoma of soft tissue acute osteomyelitis, other specified sites accidents occurring in residential institution secondary malignant neoplasm of bone and bone marrow asymptomatic human immunodeficiency virus [hiv] infection status pseudomonas infection in conditions classified elsewhere and of unspecified site bacteroides fragilis streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group a 

Answer: The patient is high likely exposed to