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: gi bleed. mrsa bacteremia. major surgical or invasive procedure: -esophagogastroduodenoscopy (egd), -picc line, history of present illness: mrs. is a 74 year old woman with past medical history significant for rheumatoid arthritis (on chronic prednisone), asthma, hypertension, hyperthyroidism, presenting from rehab facilty after being found to have altered mental status and bright red blood per rectum. per transfer notes, patient was intially taken to hospital where she was evaluated for abdominal pain. vitals on arrival 94/52, 83, 14, 98 f. given her altered mental status, ct head was performed with preliminary read raising the question of a basal ganglia hemorrhage. labs there revealed ast 103 / alt 112, ap 451, t bili 3.0 and d bili 2.1. patient was transferred for further management of suspected intracraneal hemorrhage. in our ed, 98.2, 110/63, 85, 22 100% 4l nc. patient underwent repeat head ct which did not reveal any acute intracraneal process. patient was also noted to have two bowel movements with bright red blood. labs repeated and given osh elevation in liver enzymes and congestive pattern, ct abdomen was performed. surgery, gi and ercp services were , and decision was made to admit patient to icu for further management. at this time, patient denies any pain or discomfort. she is not accompanied by family and she reports feeling slightly confused. she is unable to relate why she was brought to the hospital and believes she was home earlier today. denies any chest pain, but reports some difficulty breathing. also reports single episode of vomiting earlier in the week with gastric contents and clear liquid. she denied any light headedness or palipiations. past medical history: -asthma -rheumatoid arthritis, on prednisone since per patient -hypertension -hyperthyroidism, on methimazole -anxiety -transient ischemic attack (9 years ago) -glaucoma -status-post bilateral knee replacements -status-post bilateral hip replacements social history: does not smoke, drink alcohol or take other drugs. lives with husband and has visiting home health aid. last walked two weeks ago, however prior to that did require a walker and assistance. family history: sister with pancreatic cancer. physical exam: on admission: tmax: 37.4 ??????c (99.4 ??????f) tcurrent: 37.4 ??????c (99.4 ??????f) hr: 90 (86 - 90) bpm bp: 128/65(65) {84/45(55) - 128/65(65)} mmhg rr: 24 (24 - 29) insp/min spo2: 100% heart rhythm: sr (sinus rhythm) general appearance: no acute distress eyes / conjunctiva: perrl, conjunctiva pale head, ears, nose, throat: normocephalic, poor dentition lymphatic: cervical wnl, supraclavicular wnl cardiovascular: (pmi normal), (s1: normal), (s2: normal), (murmur: systolic), ii/vi at left base peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (breath sounds: diminished: , rhonchorous: ) abdominal: soft, bowel sounds present, tender: right upper and lower quadrants, obese gu: anus with tender external hemorrhoid and small fissure at the 6 o??????clock position, extremities: right: trace, left: trace, (+) ecchymoses musculoskeletal: muscle wasting skin: warm neurologic: attentive, follows simple commands, responds to: not assessed, oriented (to): self, place, movement: not assessed, tone: not assessed on discharge: vitals: t 98.0, bp 120/66, hr 76, rr 24, o2 sat 93% on room air. tm 100.1, 120-131/59-81, 70-101, 22-24, 91-93% on room air i/o , 0/450 since midnight. general appearance: no acute distress eyes / conjunctiva: perrl, conjunctiva pale head, ears, nose, throat: normocephalic, poor dentition, evidence of thrush lymphatic: cervical wnl, supraclavicular wnl cardiovascular: normal s1/s2, +systolic murmur peripheral vascular: normal radial and pedal pulses respiratory/chest: good air movement with upper airway coarse breath sounds present on anterior exam, no crackles noted on posterior exam abdominal: soft, bowel sounds present, diffuse tenderness, no guarding extremities: severe joint disruption due to ra, s/p bilateral hip and knee replacements, large amount of anasarca noted with 3+ edema in right lower extremity, 2+ in left lower, 1+ in left upper, and significant improvement in right upper back to baseline; overall improving slowly skin: warm, + multiple ecchymoses neurologic: attentive, follows commands, alert and oriented. pertinent results: labs on admission: 09:41am blood wbc-16.7* rbc-3.04* hgb-9.0* hct-27.7* mcv-91 mch-29.5 mchc-32.4 rdw-17.0* plt ct-326 05:10pm blood wbc-18.2* rbc-3.67* hgb-10.8* hct-33.3* mcv-91 mch-29.3 mchc-32.3 rdw-17.9* plt ct-318 10:02pm blood neuts-96.3* lymphs-2.6* monos-1.1* eos-0 baso-0 05:10pm blood pt-11.7 ptt-23.5 inr(pt)-1.0 10:02pm blood pt-14.0* ptt-23.9 inr(pt)-1.2* 05:10pm blood glucose-163* urean-44* creat-1.0 na-131* k-5.3* cl-89* hco3-29 angap-18 09:41am blood glucose-150* urean-30* creat-0.8 na-133 k-4.5 cl-98 hco3-27 angap-13 05:10pm blood alt-82* ast-60* ck(cpk)-107 alkphos-463* totbili-4.7* dirbili-3.5* indbili-1.2 03:06am blood alt-65* ast-48* alkphos-392* totbili-4.3* 05:10pm blood ctropnt-0.02* 09:41am blood calcium-7.4* phos-1.7* mg-2.4 05:10pm blood albumin-2.8* calcium-8.3* phos-3.2 mg-2.8* 05:28pm blood lactate-1.6 labs on discharge: 05:33am blood wbc-11.9* rbc-2.52* hgb-7.3* hct-23.3* mcv-93 mch-29.0 mchc-31.3 rdw-19.5* plt ct-353 05:23am blood neuts-87.6* lymphs-8.6* monos-2.4 eos-1.1 baso-0.3 05:23am blood pt-13.7* ptt-32.1 inr(pt)-1.2* 05:33am blood glucose-111* urean-14 creat-0.8 na-133 k-4.6 cl-99 hco3-30 angap-9 05:58am blood alt-36 ast-43* ld(ldh)-304* alkphos-487* totbili-1.9* 05:33am blood calcium-8.0* phos-3.5 mg-1.9 additional labs: 06:40am blood hbsag-negative hbsab-borderline hbcab-negative 06:40am blood ama-negative smooth-negative 06:40am blood -negative dsdna-negative 06:18am blood pep-hypogammag igg-545* iga-204 igm-465* ife-no monoclo : egd: esophageal candidiasis : ct abd/pelv: 1. small amount of new perihepatic free fluid. 2. no evidence of obstruction. 3. small bilateral pleural effusions with associated atelectasis and/or consolidation of the adjacent lung. 4. calcified rounded lesion within the uterus, c/w calcified fibroid. 5. bilateral renal hypodensities, too small to characterize, may reflect renal cysts. : echo: the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). diastolic function could not be assessed. there is an abnormal systolic flow contour at rest, but no left ventricular outflow obstruction. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: hyperdynamic lv systolic dysfunction with an abnormal systolic flow contour without lvot gradient. mild mitral regurgitation. mild pulmonary artery systolic hypertension. picc line placement : uncomplicated ultrasound and fluoroscopically guided single-lumen picc line placement via the right basilic venous approach. final internal length is 36 cm with the tip positioned in the svc. the line is ready to use. brief hospital course: mrs is a 74 year old woman with rheumatoid arthritis, asthma, hypertension, presenting from with question of basal gangia ich, found not to have any intracraneal process but having abdominal pain, leukocytosis, bright red blood per rectum. # mrsa sepsis - patient was initially admitted to the icu with gi bleed and was quickly transitioned to the floor once her hct was stable. on the floor, gi planned for a colonoscopy, but during the prep, she triggered for hypotension, tachypnia with anxiety and altered mental status. she was transfered to the icu, started on levaphed and her vitals were t: 100.8 bp: 116/50 on 0.3 of levo p: 90 r: 18 o2: 100% on 3l nc. a left ij was placed and her right ij, which was placed in the ed for access due to gib, was pulled. she was given 6 liters of iv fluid and was off of pressors by the next morning. she was started on vanc/zosyn. blood cultures grew out 4/4 bottles of mrsa (presumed from initial cvl) with gnr in bottles. a tte showed mildly thickened mitral valve, but no evidence of valvular vegitation. she defervesed and was tranfered from the icu on vanc/zosyn. zosyn was discontinued and the patient was continued on vancomycin for a planned six week total course for line infection. her surveillance blood cultures remained negative at the time of discharge. the decision was made to treat for six weeks (a full course for endocarditis) as the patient did not want to undergo further invasive procedures including tee. the patient will follow up with infectious disease clinic after her course of vancomycin to monitor for recurrence of infection. in addition to endocarditis, there remains a concern for potential seeding of her artifical joints (knees and hips). her white count was trending down throught the day of discharge. # new atrial fibrillation with rvr: during fluid resuscitation in the icu, the patient developed a-fib with rvr in the setting of pressors. amiodarone bolus and drip were started and on day 2, metoprolol was started. this was titrated up to 25 mg tid and the patient converted back into sinus rhythm briefly. over the course of her 3rd night in the icu, her rhythm continued to flip back and forth between sinus and a-fib, but primarily in sinus with rates of 80s. she was discharged with heart rate in the 70's on 12.5mg twice daily of metoprolol, which may titrated up if needed. # gi bleeding: she was initially sent to the icu for a questionable history of melena, she had no melena during a period of observation and no significant hct drop to suggest an upper gi bleed. she did have bright red blood per rectum and on exam a rectal fissure and hemorrhoids. in the icu she underwent an egd which revealed esophageal candidiasis. she was then transferred to the floor where she underwent a prep for a colonoscopy, but decompensated as above. she had possible proctitis on ct scan and treated with cipro flagyl. gi followed and did not want to do colonoscopy in setting of sepsis. she expressed a desire to limit invasive testing and due to the fact that she had a recent (2 years ago) colonoscopy which did not show any masses, it was felt that colonoscopy could be deferred at this time. her hct remained stable throughout the remainder of the admission. on she received one unit of prbc's for a hct of 22.7 for symptommatic relief. there was no evidence of continued bleeding at the time of discharge. it recommended for her to have weekly cbc checked for hct monitoring. # hyperbilirubinemia / elevated transaminases: the patient is status-post cholecystectomy, however this does not exclude intrabiliary obstruction. gastroenterology was consulted and lfts were trended. at discharge, her lfts were slowly improving. she is negative ab for autoimmune hepatitis, psc, and viral hepatitis. the differential includes drug induced liver disease (methimazole and azt ?????? recently discontinued, chronic prednisone ?????? recently lowered) or possibly congestive hepatitis. her methimazole was held on this admission. if her tsh, t3 and t4 remain within normal limits, this will not be restarted. # esophagitis: seen on intial egd - likely due to chronic prednisone. she was treated with fluconazole, and completed a 10 day course starting from . # arthritis, rheumatoid (ra): on prednisone 10mg daily at baseline. initially she presented on 40mg po prednisone for question of copd flare, and this was tapered in the setting of gi bleed. her steriods were transiently increased to stress doses in the icu for possible adrenal insufficiency in the face of long standing steriod use, but once septic picture presented itself, prednisone was restarted at 5mg . # hypertension: initially on telemetry the patient had short bursts of a long pr narrow complex tachycardia, likely causes are atrial tachycardia, avrt or uncommon avnrt. lisinopril was held, and initially metoprolol was held as well during hypotension, but restarted in the face of a-fib with rvr. metoprolol was titrated up to acheive rate control and at discharge was titrated back down to 12.5mg . this may be titrated as needed. # anasarca: the patient received +7l while in icu. she is clearly edematous and has been diruesed approximately 3l since arriving to floor. the plan is to continue gentle diruesis as this is helping with her anasarca and her assoiciated pain. it should be noted that she is incontinent, making monitoring of urine output difficult. she should be regularly bladder scanned and straight cath performed if needed. please avoid foley as this would be an additional source of potential infection. # leg pain: likely due to anasarca and patient states it is new pain and not in ankle (ie- not due to ra). she is asking for pain control and clearly bothered by the pain. low dose opiate has been started though she is worried about somnolence with these medications. please use low doses as needed. medications on admission: xanax 0.5mg qhs, .375 daily albuterol atrovent nystatin alphagan ferrous sulfate calcitriol gabapentin 300mg qhs, 100mg am naproxen docusate alendronate 70mg azathioprine 75mg protonix 40mg daily lisinopril 20mg methimazole 10mg daily xalatal metoprolol 50mg vitamin d tums aspirin amlodipine prednisone 40mg daily singulair discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 2. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q4h (every 4 hours) as needed for sob. 4. brimonidine 0.15 % drops sig: one (1) drop ophthalmic (2 times a day). 5. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 6. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 7. gabapentin 300 mg capsule sig: one (1) capsule po hs (at bedtime). 8. gabapentin 100 mg capsule sig: one (1) capsule po q8am. 9. gabapentin 100 mg capsule sig: one (1) capsule po q2pm (). 10. prednisone 5 mg tablet sig: one (1) tablet po bid (2 times a day). 11. alprazolam 0.25 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 12. calcium carbonate 500 mg tablet, chewable sig: two (2) tablet, chewable po bid (2 times a day). 13. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 14. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 15. lidocaine hcl 2 % solution sig: twenty (20) ml mucous membrane daily (daily) as needed for mouth pain. 16. insulin lispro 100 unit/ml solution sig: sliding scale. subcutaneous asdir (as directed). 17. oxycodone-acetaminophen 5-325 mg tablet sig: 0.5-1 tablet po q4h (every 4 hours) as needed for pain: hold for oversedation or rr<12. 18. oxycodone-acetaminophen 5-325 mg tablet sig: 0.5 tablet po bid (2 times a day) as needed for pain: hold for oversedation or rr<12. 19. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 20. clotrimazole 10 mg troche sig: one (1) troche mucous membrane qid (4 times a day). 21. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. 22. vancomycin 500 mg iv q 24h discharge disposition: extended care facility: rehab discharge diagnosis: primary: -gastrointestinal (gi) bleed -mrsa bacteremia -septic shock secondary: -rheumatoid arthritis discharge condition: stable, afebrile. discharge instructions: you were admitted for gastrointestinal (gi) bleed. while you were here, you developed a blood infection with mrsa bacteria. you were treated briefly in the icu for this and received fluids and antibiotics. you had a picc line placed which you will use to complete a six week course of vancomycin which will be completed on . your lisinopril and your methimazole were discontinued. your metoprolol was reduced to 12.5mg twice a day. your prednisone was resumed at your long-term dose of 5mg twice a day. you are to continue vancomycin through . your azathioprine was also held and this may be resumed at follow up with your pcp. you are being given low dose percocet to help manage your pain. please be careful when taking these medications as they can make you drowsy and increase your risk for falls. you should not attempt to operate any kind of machinery (incuding driving) while on this medication. please return to the hospital or call your doctor if you have temperature greater than 101, shortness of breath, worsening difficulty with swallowing, chest pain, abdominal pain, diarrhea, or any other symptoms that you are concerned about. followup instructions: you have a follow up appoitment with dr. on at 1:45pm. the office can be reached . please discuss resumption of azathioprine, methimazole and lisinopril at this visit. you also have a follow up appointment with infectious disease clinic to monitor your progress in treating your infeciton: -provider: care id phone: date/time: 1:30 md, procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine diagnoses: unspecified essential hypertension long-term (current) use of steroids severe sepsis atrial fibrillation asthma, unspecified type, unspecified thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm anxiety state, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure septic shock other specified disorders of biliary tract rheumatoid arthritis other and unspecified infection due to central venous catheter methicillin resistant staphylococcus aureus septicemia hemorrhage of rectum and anus jaundice, unspecified, not of newborn candidal esophagitis other specified disorders of liver anal fissure edema unspecified hemorrhoids without mention of complication 

Answer: The patient is high likely exposed to