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: penicillin g / azithromycin attending: chief complaint: transfer from osh for multiple issues major surgical or invasive procedure: c1-2 posterior decompression, evacuation abcess ventriculostomy placement history of present illness: 65 yo m with pmhx of asthma who presented to osh for confusion and bizzare behavior, found to have fevers, neck stiffness, abnormal lp, mssa bacteremia with hospital course c/b aspiration event and intubation and acute hemiparesis episode concerning for cva now transferred for ongoing management for medical issues. . patient was admitted to on after friends found him confused in his home after not showing up to work for 2 days. friends report he was confused with slurred speech, unsteady on feet, and letting something burn on his oven. per report of brother, pt had visited pcp twice in prior 10 days for neck pain and apparently co-workers and reported he was feeling less well, complaining of neck pain, and perhaps acting more confused or unusual than normal. pcp is reported to have treated neck pain with flexeril, benzos, and vicodin. when arrived at on , temp was 101.2 and pt was confused. zosyn was started emperically but on hd #2 pt appeared worse and lp was done showing high protein, low glucose, with elevated wbc of pmn predominance but gram-stain showed no organisms and csf cx was still negative at time of transfer. gram-stain from bcx on admission grew gpcs and vancomycin started -> cultures ultimately grew 4/4 bottles mssa on and id saw pt in consult and started cefazolin to which the mssa was sensative. later on hd #3 (), he had an aspiration event that required intubation and transfer to micu although hemodynamically stable at time. pt was placed back on vancomycin and started on cefepime (unclear but zosyn possibly stopped somewhere in this interval). highest temp of hospitalization was also on this day to 104.0 in am . on intubation and icu transfer, pt given propofol with resulting bp drop and was started on dopaminem with rij cvl placed. he underwent tte which showed small hyperechoic 3mm lesion in rv trabeculations and 1.5 cm isoechoic rv apical septum lesion. neither were thought suggestive of a vegetation/endocarditis and no left-sided valvular lesions were noted. he was also noted to have infiltrate on cxrs during admission and sputum cx from grew mssa. he was maintained on but failed extubation on with immediate reintubation. changed to vanc/meropenem on but continued to spike fevers. on early tues () he developed right arm weakness and a ct head was noted to have new right cerebellar infarcts (one hypodense lesion in pons and one large non-hemorrhagic r cerebellar infacrtion with partial effacement of 4th ventricle). no hemorrhage or midline shift. hard to oxygenate since requiring fi02 of 100% and peep of 12 to maintain sats in the 80s. receiving sqh only for dvt ppx. . brother speaks to pt every few weeks. confirms that pt is somewhat of a recluse but reports that he volunteers some at a senior center. confirms that sent co-workers of pt to find him on due to pt seeming confused via phone and due to reports that pt was confused at the senior center where he volunteered. for neck pain but brother did not recognize torticollus. brother mentioned that two weeks prior pt had reported a rash on his body but did not give further discription. pt also says that he did not recognize the name torticollus in reference to his brother's neck problem. . in the icu, pt minimally responsive to some questions and commands but unable to speak due to endotracheal tube so further information could not be elicited. . review of sytems (unable to obtain due to intubated state): past medical history: (per osh records and brother) -asthma/allergic rhinitis -depression -dyslipidemia -question of intermittent torticollus since a teenager social history: (some per osh records, some per brother): works as a technician at . apparently also volunteers at a elder center. single. reported to be somewhat reclusive and lives alone. no reported history of smoking, alcohol, or drug use per brother. family history: (per osh records) one sister died of lung ca. brother with asthma and some mental health issues as well. mother died at 87 and father died at 52 (either liver or kidney ca) physical exam: admission physical exam vitals: t: 100.5 / bp: 123/57 / p: 79 / r: 19 / o2: 99% on vent general: opening eyes and responsive to some simple comands, intermittently losing concentration on surroundings heent: sclera anicteric, no evidence of conjunctival hemorrhage, mmm, et in place, tongue questionably deviated to the l neck: supple, r ij in place but kinked lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: soft heart sounds difficult to hear above ventilatory, rrr, soft s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly skin: no rashes or areas of skin break noted gu: no foley ext: very arm, well perfused, 2+ pulses bounding pulses at dp and radial, no clubbing, cyanosis or edema, no evidence of lesions or osler's nodes on exam. neuro: 4+/5 strength to grip in l hand, 3/5 strength to grip in l hand, able to squeeze hands on command (l>r) and able to move l toes but not r toes to command, difficulty with eye tracking but unsure if due to cn deficits or concetration issue, pupils equal and reactive, tounge questionably deviated to the left pertinent results: 11:40pm urine color-yellow appear-clear sp -1.035 11:40pm urine blood-tr nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-neg 11:40pm urine rbc-7* wbc-3 bacteria-none yeast-none epi-1 11:40pm urine granular-4* hyaline-1* 11:40pm urine mucous-rare 10:36pm glucose-115* urea n-21* creat-0.7 sodium-149* potassium-4.1 chloride-117* total co2-28 anion gap-8 10:36pm estgfr-using this 10:36pm alt(sgpt)-54* ast(sgot)-67* ld(ldh)-287* alk phos-101 tot bili-0.8 10:36pm calcium-7.6* phosphate-3.5 magnesium-2.5 iron-19* cholest-65 10:36pm caltibc-140* ferritin-720* trf-108* 10:36pm triglycer-156* hdl chol-11 chol/hdl-5.9 ldl(calc)-23 ldl()-<50 10:36pm wbc-15.3* rbc-2.88* hgb-9.0* hct-27.1* mcv-94 mch-31.2 mchc-33.1 rdw-14.0 10:36pm neuts-89.3* lymphs-6.7* monos-2.7 eos-0.9 basos-0.3 10:36pm plt count-321 10:36pm pt-14.9* ptt-32.7 inr(pt)-1.3* 10:30pm type-art po2-285* pco2-41 ph-7.43 total co2-28 base xs-3 brief hospital course: 65 year-old m with high grade mssa bactermia, mssa positive sputume with cxr concerning for infiltrate, lp concerning for bacterial meningitis, and new posterior circulation cerebellar infarcts with background story and diagnostics unclear as to where is initial location of infection. . # respiratory failure: seems to have been triggered by aspiration event on per osh records. cxr showing bilateral lung field opacifications most pronounced at bases concerning for consolidation plus pleural effusions. in setting of mssa in sputum, likely has staph aureus pna as this is rarely a contaminant/colinizer although likely that this bug seeded from another source or from bacteremia. had reported difficulties ventilating at osh, but gas on arrival to on 100% fio2 and peep 12 was ph 7.43 pco2 41 po2 285 hco3 28 and pt tolerated initial wean to peep 10 and fio2 50% with sats in high 90s. pt has history of significant asthma which may contribute to difficulty weaning off vent down the road. infectious disease was consulted and recommended..... . # fevers with mssa bacteremia: known mssa 4/4 bottles from osh bcx on although only reported in transfer summary and no attached micro cultures. tte questionably negative for endocarditis at osh. supposedly surveliance cultures negative since although no lab reports. pt has been on vanco since , , or and received doses of zosyn before then. has also received cefepime or meropenem over last few days but still febrile. unclear if cns infection primary with later bacteremia and possible heart valve seeding or if primary endocarditis with septic embolic causing cns seeding and positive lp. despite fact that all inital symptoms cns in nature, more likely that primary endocarditis with cns seeding as could have sub-clinical symptoms for endocarditis and mssa endocarditis much more common than mssa meninigitis. depending on location of heart involvement could also better explain lung seeding. other possiblity is that mssa bactermia was primary even (although no obvious portals of entry on history/exam) and heart, lung, and cns are all areas of seeding. id contact overnight for initial recs - will continue vanco/meropenem (at increased vanco dose) due to concern for nafcillin cns penetration if meningitis were primary insult. is suboptimal of mssa endocarditis but will still cover organism and reasonable to continue in short term while cns issues clarified (vanco 1g iv q12 and meropenem 1000mg iv q8). lactate 0.9 - id consult team will see in am - tte since none here and desire to eval r heart which tee won't - plan for tee tomorrow if possible by cards (id strongly recommends) - npo for possible tee in am - survelliance bcx and initial ucx and sputum cx - holding tylenol initially to eval fever curve - card tee c/s in am . # lp suggestive of meningitis with new head ct findings: as mentioned above, unclear if meningitis primary event or seeding although think seeding more likely. lp very suggestive of bacterial process with high wbc with pmn predominance, low glucose, and high protein. very unlikely viral process and less likely that had full-blown meningitis in days of symptoms concern that new ct findings at osh from am along with r sided weakness caused by new stroke or mycotic aneurysm. however, cns findings of r sided weakness do not correlate with r sided cerebellar findings on head ct so picture repains unclear. images sent with patient on transfer do not include most recent head ct. - mri/mra of brain to eval reported acute head ct findings at osh - per neuro, if will take any time to get mri/mra, would get head ct here since we do not have image and picture per report unclear - checking flp and with next labs per neuro recs - neuro c/s in am - id c/s and infectious management as above . # anemia: hgb on admission at 9.0. no prior records to compare for baseline. no evidence of bleeding on exam and no suggestive reports on history. lactate 0.9 indicating that anemia likely not causing significant hypoperfusion. ldh slightly up which could be indicative of mild hemolysis especially if invoking endocarditis. however, may have underlying issues that explain anemia more than acute illness. - iron studies - check hapaglobin and retic count with am labs - trend hct and maintain active t&s . # hypernatremia: sodium on admission is 149. was trending up at osh from 134 on likely because pt npo and not receiving fluid. free water defecit 2.5-3.0l based on todays labs/weights. - start d5w at 125ml/hr for 1.5l and recheck am labs - plan to correct total deficit over 24hrs . # anxiety/depression: long history of anxiety and depression that apparently also runs in family. pt is somewhat of per reports and may be component of personality disorder although no way to evaluate this at this time. on significant home regimen of anti-anxiety and anti-depressant medications and would be at risk for withdrawal if all stopped suddently. - cont buproprion 200mg (home dose) -> low threshold to stop if any concerning seizure activity in light of new cns findings - cont buspar at 15mg daily - hold home celexa, aderal, and xanax . fen: no ivf, replete electrolytes, regular diet prophylaxis: subcutaneous heparin access: ij from osh code: full presumed communication: next of - brother cell: / work: pcp: , .d. phone: disposition: icu pending clinical improvement . micu green course : 1. hemoptysis: patient had bronch on admission which demonstrated no active bleeding in lungs but significant secretions lmsb with all subsegments plugged. suctioned for many thick plugs until subsegments distally were patent. source felt to be nasopharyngeal given reports of ngt attempts and bleeding from trach just after cuff dropped. - recommend frequent suctioning due to mucous plugging and coughalator - nac prn for secretions . 2. pneumonia: cultures have repeatedly grown out enterobacter aerogenes, pan-sensitive. - continued cefepime for total 2 weeks of therapy . 3. c2-c3 abscess: per id discontinued nafcillin and started vancomycin (due to lowering the seizure threshold with 2 b-lactam agents) . 3. shoulder pain: mild pain with passive range of motion bilaterally. no localized tenderness or overlying erythma. - if worsens consider imaging for ? effusion and tap due to mssa infection . 4. nutrition: recommend s&s consult and consideration of peg if appropriate. . otherwise prior care continued and patient transferred back to neurology team. medications on admission: home medications: -simvastatin 40mg -advair 250/50 -zolaire q month (anti-ige) -singular 10 -flonase -celexa 20mg qd -bupropion 200mg -xanax 0.5mg qd -aderal xr 15mg qd -buspar 15mg qd -albuterol prn . transfer meds: 1. d5 1/2ns with 20kcl at 125ml/hr 2. 500mg q6 3. vanco 750mg q12 4. aderal 10mg in am and 5mg in pm 5. buspar 15mg 6. singular 10mg 7. bupropion 200mg 8. simva 40mg qd 9. protonix 40mg iv bid 10. sqh 5000 units q8 11. propofol gtt 12. ativan 1-2mg prn 13. advair 250/50 14. morphine 1-2mg prn discharge medications: 1. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 2. buspirone 5 mg tablet sig: three (3) tablet po daily (daily). 3. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation q6h (every 6 hours). 4. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation qid (4 times a day). 5. acetaminophen 650 mg/20.3 ml solution sig: one (1) po q6h (every 6 hours) as needed for pain. 6. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 7. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 8. senna 8.8 mg/5 ml syrup sig: one (1) tablet po bid (2 times a day). 9. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 10. bupropion hcl 100 mg tablet sig: two (2) tablet po bid (2 times a day). 11. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for skin lesion. 12. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 13. oxycodone 5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for pain. 14. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 15. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 16. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 17. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for thrush. 18. diphenhydramine hcl 25 mg capsule sig: one (1) capsule po hs (at bedtime). 19. 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. 20. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 21. vancomycin 1000 mg iv q 12h 22. cefepime 2 g iv q8h 23. 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. 24. morphine sulfate 2-4 mg iv q4h:prn pain 25. 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. 26. hydromorphone (dilaudid) 0.5 mg iv q6h:prn pain 27. 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. 28. outpatient lab work chem 7, esr, crp, lfts weekly please fax results to dr. fax 29. outpatient lab work vancomycin trough on please fax results to dr. 30. nafcillin 2 gram recon soln sig: one (1) intravenous every four (4) hours: ****this medication is to begin on of vancomycin and cefepime. 31. mri c spine with and without contrast re epidural abscess. this should be done in 4 weeks. ordered as an outpatient in the system. discharge disposition: extended care facility: hospital for continuing medical care - ( center) discharge diagnosis: epidural abscess discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to the an episode of confusion and bizarre behavior. your pcp said that you had been experirncing neck pain for approximately 10 days. you had a a lumbar puncture that was suggestive of a bacterial meningitis and you were started on broad spectrum antibiotics. on examination you were found to have r>l sided weakness and ataxia. an mri revealed a cerebellar infarct in addition to an epidural abscess. neurosurgery evacuated your abscess posteriorly but could not access the anterior portion. infectious disease was involved and kept you on antibiotics for treatment. a follow-up mri showed possible worsening of the abscess, however it was felt by neurosurgery to be related to granulation tissue and they wished for you to receive a longer course of antibiotics and follow-up as an outpatient. followup instructions: please follow up with dr. on at 11:15am in spine center on , 2. if you need to change this appt, please call . you will also need a repeat cervical mri with and without gadolinium when you finish your course of antibiotics, this can be arranged by calling dr office. provider: , md phone: date/time: 11:00 provider: , md phone: date/time: 11:15 provider: flash, md phone: date/time: 11:00 md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] other exploration and decompression of spinal canal temporary tracheostomy closed [endoscopic] biopsy of bronchus bronchoscopy through artificial stoma ventricular shunt to extracranial site nec diagnoses: anemia, unspecified obstructive hydrocephalus severe sepsis methicillin susceptible staphylococcus aureus septicemia hypopotassemia dysthymic disorder other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure pneumonitis due to inhalation of food or vomitus cerebral edema methicillin susceptible pneumonia due to staphylococcus aureus acute and subacute bacterial endocarditis hyperosmolality and/or hypernatremia intraspinal abscess acute osteomyelitis, other specified sites ventilator associated pneumonia cerebral artery occlusion, unspecified with cerebral infarction quadriplegia, unspecified other diseases of trachea and bronchus other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms phlebitis and thrombophlebitis of intracranial venous sinuses acute mastoiditis without complications other myelopathy extrinsic asthma, unspecified staphylococcal meningitis 

Answer: The patient is high likely exposed to