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: transfer from outside hospital for management of ventral epidural and preverteral abscesses major surgical or invasive procedure: evacuation of prevertebral, paratracheal and paraesophageal abscess evacuation of epidural abscess removal of previous hardware for a anterior cervical diskectomy and fusion c6-c7. full corpectomy c6, full corpectomy c7, with adjacent diskectomy c5-c6 and c7-t1. hardware placement for stabilization history of present illness: 43 yo m w/ no known medical problems transferred from w/ epidural abscess found on cspine mri that was done for concern of neck pain. also has abscesses in surrounding muscles (longus coli). . the patient states that he had sudden onset of left neck and shoulder pain that occured when he was at work. was given vicodin/flexeril/naproxen with little effect. went back to orthopedist today and sent to ed because looked diaphoretic. had mri which showed "extensive prevertebral phlegmon extending down towards the mediastinum with bilateral longus coli abscesses. ventral epidural abscess at c6/c7 to c7/t1 which is narrowinf the spinal canal and flattening the ventral cord. no evidence of spondylodiskitis." he was given vanc and dilaudid. also noted to be jaundiced and reports darkened urine starting two days ago. lfts with evidence of cholestasis. . in the ed, initial vs were: 98.1 109 144/98 17 95%. patient was seen by the on-call neurosurgeon, who reviewed the images and examined the patient. her assessment was that as there are no motor defecits or clinical or radiological evidence of cord compression, intervention is not urgent. it would be a complicated resection and often these can be treated conservatively. she recommended ent consult to see if it would be possible to drain the abscess from the anterior approach and id consult. he was not given antibiotics. . on transfer, vitals were 99.5 110 159/70 98 ra. . on the floor, the patient complained of pain in his back and bilateral shoulders and was unable to find a comfortable position. he confirmed the history given in the ed. he also reports having right ear/neck pain several months ago and a "swollen uvula." he completed a course of amoxacillin and the symptoms went away bur then he thinks they may have come back once again. he also went for a dental tooth cleaning two weeks ago. prior to this monday, he does not recall any fevers/chills, sore throat, cough, or any other symptoms. also denies abdominal pain, n/v. does not report any acholic stools. no brbpr/cp/sob. . review of sytems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: migraines social history: lives with wife. works for . works on planes, loads baggage. no recent travel. no sick contacts. occasional , not more than 2/week. used to drink more when young but only socially. never told needed to cut down. no smoking. no drugs. has had one on and off partner other than wife. she does not know. they have been married 15 years. he is uncomfortable telling me. the other partner has been intermittent for years. family history: non-contributory no history of hypercoaguable states, no hx of pe or dvt physical exam: exam on admission o: 100.6 128/84 124 18 97% ra gen: no acute distress, diaphoretic, voice sounds muffled heent: ncat, perrl, mild scleral icterus, mmm, white mucous film on tongue, no appreciable lymphadenopathy, tenderness to palpation of b/l cevical neck, trapezius cv: s1, s2, rapid rate, no murmurs appreciated pulm: ctab, no wheezes or crackles abd: obese, +bs, non-tender to palpation, no rebound or guarding, negative sign ext: warm, well-perfused, no c/c/e derm: erythematous warm macular areas over anterior shins neuro: cns intact, preserved neck strength, lue is throughout except triceps , rue , lower extremities , 2+ reflexes, preserved gross sensation, normal gait exam on discharge 98.8 122/84 98 18 99% ra gen: nad, resting comfortably in chair heent: ncat, perrla, mmm, no oropharyngeal lesions, aspen collar in place cv: regular rhythm, nl s1s2, no m/r/g abd: soft, nt, nd, + bs, no hsm ext: wwp, no c/c/e. no upper extremity swelling or tenderness to palpation neuro: cn ii-xii grossly intact, strenght throughout, normal gait pertinent results: admission labs: 08:15pm blood wbc-11.2* rbc-6.26* hgb-12.1* hct-37.9* mcv-61* mch-19.4* mchc-32.0 rdw-15.4 plt ct-116* 08:15pm blood neuts-70 bands-6* lymphs-13* monos-7 eos-0 baso-0 atyps-0 metas-1* myelos-3* 08:15pm blood pt-13.8* ptt-28.1 inr(pt)-1.2* 05:00pm blood esr-28* 08:15pm blood glucose-116* urean-14 creat-0.8 na-137 k-3.7 cl-102 hco3-26 angap-13 08:15pm blood alt-119* ast-75* alkphos-229* totbili-5.1* dirbili-4.0* indbili-1.1 08:15pm blood lipase-13 06:09am blood calcium-8.2* phos-2.1* mg-1.5* 08:15pm blood hbcab-negative hav ab-negative 02:03pm blood smooth-negative anca-negative b 08:15pm blood crp-300.0* 08:15pm blood hcv ab-negative 08:16pm blood lactate-1.2 discharge labs: 05:58am blood wbc-5.5 rbc-4.42* hgb-8.9* hct-28.4* mcv-64* mch-20.1* mchc-31.2 rdw-18.7* plt ct-194 11:38am blood pt-27.0* ptt-38.5* inr(pt)-2.6* 05:58am blood glucose-111* urean-14 creat-1.0 na-141 k-4.2 cl-104 hco3-27 angap-14 06:19am blood alt-39 ast-28 ld(ldh)-194 alkphos-169* totbili-1.1 dirbili-0.6* indbili-0.5 05:58am blood calcium-9.9 phos-3.7 mg-2.0 . significant micro: blood cx: staph aureus coag + clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s oxacillin------------- 1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s . tissue cx: staph aureus coag + clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s . imaging: ruq u/s: normal right upper quadrant ultrasound . ct chest, abd, pelvis: 1. prevertebral soft tissue stranding along the anterior margin of the lower cervical/upper thoracic spine vertebral bodies, with concern of small fluid collection at the lower cervical spine in the soft tissue anterior to the vertebral body. similar findings compared to recent mr from an outside hospital, concerning for extensive prevertebral phlegmon extending towards the mediastinum. 2. multiple nonspecific ground-glass opacities in the lungs, and dependent atelectasis, nonspecific finding. 3. no extra- or intra-hepatic biliary duct dilatation. normal gallbladder. 4. splenomegaly. . ekg: sinus tachycardia. tracing is normal, except for rate. no previous tracing available for comparison . rle u/s: no evidence of dvt in the right lower extremity. calf edema. . tte: the left atrium is normal in size. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no masses or vegetations are seen on the mitral valve, athough the anterior leaflet tip is thickened, concern for vegetation. moderate (2+) mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: suboptimal image quality. cannot adequately assess for endocarditis. normal biventricular systolic function. moderate mitral regurgitation. recommend tee if clinically indicated. . video oropharyngeal swallow: minimal aspiration on thin barium which the patient was able to clear. esophogram: very limited examination as described above. in the visualized aspect of the cervical esophagus, there is no evidence of perforation or leak. marked prevertebral soft tissue swelling as noted on prior studies. . ct chest: 1. small fluid attenuation collection in the superior aspect of the left posterior mediastinum at the level of t1-t2 now appears more organized. 2. reduction in size of retropharyngealparaspinal abscess with new screw fixation of c6 and c7, better evaultaed with mri. 3. multiple right upper lobe ground-glass opacities which have increased in number and size and may represent multifocal pneumonia but the possible presence of cavitation in the lower lobes raises the possibility of septic emboli, and in light of persistent leukocytosis warrants further evaluation with echocardiography. 4. new bilateral small pleural effusions. . tte: the left atrium is normal in size. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. left ventricular wall thicknesses and cavity size are normal. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. a catheter is seen in the right atrium. no vegetation seen (cannot definitively exclude). compared with the prior study (images reviewed) of , a catheter is seen in the right atrium. findings are similar. . cxr: the left pic line now advances to the svc, clearly visible to the mid portion, but probably extending to the superior cavoatrial junction, although the tip is obscured. no pneumothorax, pleural effusion, or mediastinal widening is present. lungs are clear and the heart is normal size. a house officer on the patient's care team and i discussed the findings and their clinical significance over the telephone at the time of dictation. . mr c/t spine: post-surgical changes from level c5 through t1, with prevertebral soft tissue swelling along cervical spine, and anterior dural enhancement from c5 through t1 with no definite evidence of epidural abscess. persistent small fluid collections in the prevertebral muscles bilaterally, however, decreased in size. normal signal in the cord, with no evidence of cord compression. . ct chest: 1. interval decrease in size of mediastinal/left paraspinal collection, now measuring up to 15 x 10 mm, without a definite fluid component. no new abscess or collection in the mediastinum. 2. near complete resolution of multifocal ground-glass opacities in the lungs, without evidence of persistent or recurrent infection. . lue u/s: extensive thrombus about the picc involving the left basilic, axillary as well as the subclavian vein (deep venous thrombosis). this was discussed with at 4:30 pm on . . rue u/s: 1. no evidence of deep vein thrombosis. 2. thrombus noted within the right cephalic vein. findings were paged to dr. at the time of the examination. brief hospital course: 43 year-old m with no significant pmhx who presented to an outside hospital with posterior neck and shoulder pain, was found to have prevertebral and ventral epidural abscesses of the c-spine and transferred here for management . # prevertebral/epidural abscesses: the patient was found to have ventral epidural, prevertebral, and bilateral longus coli abscesses. neurosurgery was consulted in the ed. at first, it was believed that the patient could be treated medically with antibiotics and supportive care. he was started on intravenous broad-spectrum antibiotics that were narrowed once blood culture data returned (see below re: bacteremia). id was consulted for management recommendations. ent was consulted for possible aspiration of the collection, but were unable to based on location. however, after the patient began to spike fevers and exhibit signs of sepsis, as well as left upper extremity weakness on extension, he was taken to the or by neurosurgery for evacuation of the abscesses. there he also had c6-c7 anterior cervical diskectomy and fusion with allograft placement and plating. post-operatively the patient was continued on intravenous antibiotics and given aggressive fluid hydration. he continued to spike fevers and remained tachycardic. thoracic surgery was consulted out of concern for mediastinal involvement. additional imaging revealed continued/recurrent spinal prevertebral and epidural abscesses. he underwent a second surgical procedure by neurosurgery in which he had re-evacuation of the abscesses, removal of the prior hardware, full corpectomy of c6/c7 with adjacent diskectomy c5-c6 and c7-t1, microscopic evacuation of epidural abscess, and placement of a globus cage and anterior plating. the procedure went well without complications and he recovered nicely. he remained afebrile. additional imaging revealed no evidence of cord compression and decreased size of longus coli abscesses. he is to remain in an aspen collar at all hours of the day and will follow up with neurosurgery in 12 weeks for additional imaging. . # mssa bacteremia: the infectious disease team was very active in the management of our patient. his blood cultures from the outside hospital and on presentation to our facility grew coag + staph aureus, for which he was started on intravenous vancomycin and nafcillin. the sensitivites returned as methicillin sensitive. he underwent a number of antibiotic changes throughout his hospital course, but importantly, nafcillin was discontinued secondary to a drug rash. his surveillance cultures all returned negative. he had two ttes and one intra-operative tee to evaluate for vegetations, which were not seen. the patient was continued on intravenous vancomycin, which he will receive at home via picc for at least 6 weeks from his last surgical debridement. the absolute length of antibiotic course is still to be determined based on his clinical picture and likely re-imaging. he will follow up in the outpatient infectious disease clinic. . # left upper extremity deep venous thrombosis: the patient was found to have swelling of his distal left upper extremity and ultrasound revealed venous thromboses of the left basilic, axillary, and subclavian vein. this was provoked by the picc placed in that extremity (which had to be repositioned three times prior to ir placement). the picc was removed and the patient was started on a heparin gtt, without bolus, to treat the dvt. he was then began on coumadin, which he will continue as an outpatient (goal inr ). his inr was theraputic for 24 hours prior to discontinuation of the heparin gtt and discharge from the hospital. his course of coumadin will be at least 3 months and he will follow up at the at . . # transaminitis: the patient presented with elevated transaminases, and elevated direct hyperbilirubinemia. this was attributed to his septic picture, perhaps a response to stress (possible underlying ). he never had abdominal pain or became hypotensive. a ruq ultrasound and ct of the abdomen did not reveal any dilation of the intra/extra hepatic biliary ducts, gallbladder pathology, or abscess collections. his hepatitis and hiv serologies were negative. his enzymes trended down to normal as his clinical picture improved. . # microcytic anemia: likely chronic, stable throughout the admission. very low mcv and fe studies consistent with thalassemia. imaging studies also commented on appearance of chronic anemia. patient had no chest pain, palpitations, or dyspnea. . # dysphagia: the patient experienced dysphagia on presentation and after his surgical procedures. this was likely secondary to inflammation of the local soft tissues. he never experienced any respiratory distress. speech was consulted and the patient had a video swallowing study, which showed laryngeal penetration of thin and nectar thick liquids but no aspiration. over his hospital course his dysphagia improved and his diet was advanced to regular solids. . # voice hoarseness: following the second surgical procedure the patient had evidence of voice hoarsenss, which slowly improved. he will follow up with ent a few weeks after discharge to evaluate for vocal cord damage, should his symptoms not resolve. . # social work, occupational therapy, and physical therapy were consulted during his hospital admission. he will be discharged with home services for intravenous medication administration and continued occupational therapy to regain strength and dexterity of his upper extremities. . # code status: full medications on admission: naproxen flexeril discharge medications: 1. outpatient physical therapy for upper extremity strengthening and function 2. vancomycin 500 mg recon soln sig: 2.5 recon solns intravenous q 12h (every 12 hours) for 1 months. disp:*180 recon soln(s)* refills:*0* 3. cyclobenzaprine 10 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for pain. disp:*30 tablet(s)* refills:*0* 4. oxycodone 5 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. disp:*30 tablet(s)* refills:*0* 5. warfarin 2.5 mg tablet sig: three (3) tablet po once a day: 7.5 mg daily. disp:*90 tablet(s)* refills:*0* 6. outpatient lab work electrolyte, cbc, esr, crp to be drawn weekly and fax to (infectious disease rns) 7. outpatient lab work inr check every mon, wed, fri to determine your coumadin dose. discharge disposition: home with service facility: critical care systems discharge diagnosis: primary: methicillin-sensitive staph aureus bacteremia epidural and prevertebral cervical abscesses status-post surgical evacuation full corpectomy of c6/c7 and diskectomy of c5-c6, c7-t1 with hardware placement for stabilization discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , . you were recently transferred to for management of an abscess (collection of infection) near your spine. you were also found to have bacteria in your blood. we have treated you with intravenous antibiotics and you improved. you will need to continue these antibiotics at least until and follow up with the infectious disease specialists, who will decide whether to continue antibiotics after that. . you also underwent two separate surgical procedures by neurosurgery to remove the infectious collections near your spine. they also removed part of the bone surrounding your spine, and placed hardware to stabilize the area. **it is important that you wear the aspen collar at all times until you follow up with dr. and he tells you otherwise.** . during your hospitalization you were found to have a clot in the veins of your left upper extremity where the catheter was placed. you were placed on a blood thinner to help the clot dissolve. we then started you on another blood thinner, coumadin, which you will continue to take for 3 month to treat the blood clots. you will need to have frequent lab work to monitor your inr to adjust your coumadin dose as needed. . please do not hesistate to call you primary care physician or return to the emergency room should you develop fever, chills, or loss of strength or sensation anywhere in your body. it is important that you keep all of your follow up appointments. . the following changes were made to your home medications: - intravenous (iv) vancomycin 1250 mg was started, to be taken every 8 hours (course length to be determined by the infectious disease specialists) - coumadin was started, to be taken every day for at least 3 months. - flexaril (cyclobenzaprine) was started, to be taken as needed for muscle pain - oxycodone was started at 5-10 mg every 6 hours as needed for pain . you are being discharged home with visiting occupational therapy services to regain strength and dexterity of your upper extremities. followup instructions: please follow up with your new primary care physician as scheduled below: department: when: wednesday at 3:45 pm with: , md building: sc clinical ctr campus: east best parking: garage . you will need to call the neurosurgery office at to make an apptointment with dr. in for 1-2 weeks for a clinic appointment as well as a cervical spine ct, non-contrast. . department: infectious disease when: tuesday at 1:30 pm with: , m.d. building: lm campus: west best parking: garage . department: infectious disease when: friday at 10:00 am with: , md building: lm bldg () campus: west best parking: garage . department: otolaryngology (ent) when: tuesday at 1:45 pm with: , m.d. building: lm campus: west best parking: . garage . department: radiology when: tuesday at 1 pm with: cat scan building: cc clinical center campus: west best parking: garage . department: neurosurgery when: tuesday at 1:30 pm with: , md building: lm campus: west best parking: garage procedure: diagnostic ultrasound of heart removal of implanted devices from bone, other bones other excision of joint, other specified sites other cervical fusion of the anterior column, anterior technique other cervical fusion of the anterior column, anterior technique excision of intervertebral disc insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae fusion or refusion of 2-3 vertebrae other division of soft tissue other division of soft tissue central venous catheter placement with guidance central venous catheter placement with guidance division of joint capsule, ligament, or cartilage, other specified sites diagnoses: thrombocytopenia, unspecified unspecified septicemia unspecified osteomyelitis, other specified sites sepsis candidiasis of mouth other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other complications due to other vascular device, implant, and graft other specified disorders of biliary tract iron deficiency anemia, unspecified dermatitis due to drugs and medicines taken internally intraspinal abscess accidents occurring in residential institution other thalassemia cephalosporin group causing adverse effects in therapeutic use other specified disorders of liver other and unspecified disc disorder, cervical region abscess of mediastinum dysphagia, unspecified acute venous embolism and thrombosis of subclavian veins acute venous embolism and thrombosis of superficial veins of upper extremity acute venous embolism and thrombosis of axillary veins 

Answer: The patient is high likely exposed to