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: penicillins / keflex / gentamicin / cipro cystitis attending: chief complaint: leg pain. major surgical or invasive procedure: arthrocentesis (hip joint tap). left hip girdlestone procedure with dr. . history of present illness: 71 y/o w/ metastatic melanoma with progressive left proximal lower extremity pain, now unable to bear weight. pain started , and progressed rather quickly. visited ed received femur x-ray which showed lytic lesions but no pathologic fracture, also leni negative for dvt, remains on coumadin now supratherapeutic. he was recently started on morphine 15 mg er of which he took 3 doses over 4 days and morphine ir which also makes him "loopy" per his wife. . initial vitals 98.8 106 136/84 20 99% no fever. no n/v, cp, sob, abd pain. has had recent urinary retention while using morphine and has required foley catheter placement on by urology. poor po intake. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight gain. denies blurry vision, diplopia, loss of vision, photophobia. denies headache, sinus tenderness. denies chest pain or tightness, palpitations. denies cough, shortness of breath, or wheezes. denies nausea, vomiting, diarrhea, constipation, abdominal pain. denies dysuria, stool or urine incontinence. denies rashes or skin breakdown. no numbness/tingling in extremities. all other systems negative. past medical history: -prior treatment: mr. wide local excision of a 1.5-mm thick superficial spreading melanoma from his inner aspect of his left thigh in . a sentinel lymph node biopsy was performed at that time. this report was remarkable for bilateral calf dvt into the femoral and popliteal veins with probable pulmonary embolism on ct scan. he has remained on coumadin since that time. he developed biopsy-proven recurrence in left inguinal area, which on review, was felt to be within the lymph nodes with evidence of extracapsular extension into the resection margin. he left inguinal node dissection on with pathology revealing metastatic melanoma with a soft tissue, not extending to the margins. he received adjuvant radiation therapy to the inguinal area. he began his adjuvant interferon therapy on . mr. course was complicated by urinary tract infection and thus being off of the interferon from through being on antibiotics. his urine culture was clear as of and he resumed therapy that day. mr. interferon was discontinued on due to prostatitis flare. he was diagnosed with prostate cancer with biopsy-positive prostate cancer 3+3. he was followed from until when screening showed a rul nodule. -- ct torso which showed a 25 x 23 mm right upper lobe nodule and a 3mm r. apical nodule with no other disease in the chest, abdomen of pelvis. -- pet-ct: fdg avid lesion in the right upper lung 2. fdg avid bilateral hilar nodes 3. fdg avid lesion in the inferior left abdominal wall 4. fdg avid mass in the left scapula and multiple fdg avid skeletal sites. -- mri brain: no evidence of intracranial metastases. -- scapular bx: malignant epithelioid malignancy, s-100 positive, and negative for keratin cocktail, mart-1, and hmb-45. similar to primary melanoma. braf v600e mutant -- consented for df-hcc 09-406 (ro5185426 or dacarbazine). deemed ineligible due to prostate cancer. -- c1d1 dacarbazine 1000mg/m2 -- ct torso with no new lesions, slight decrease in groin met, stable bony disease -- mri brain without cns disease -- c11d1 dacarbazine 1000mg/m2 . other pmhx: -dvt following melanoma excision - left groin ln disection with resultant left edema social history: he once owned his own courier company. he sold it in and now works for another person. lives with his wife. is a physical therapist and helping out a lot. no t/a/d. family history: non-contributory. physical exam: admission exam: vs: 100.5 152/96 100 18 94% ra gen: elderly man in nad, awake, alert, but slow to respond heent: eomi, sclera anicteric, conjunctivae clear, op moist and without lesion neck: supple, no jvd cv: reg rate, normal s1, s2. no m/r/g. chest: resp unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, nt, nd, no hsm, bowel sounds present ext: no c/c/e, left leg slighly larger than right (chronic from surgeries), 2+ dp/pt bilaterally, left groin with erythema and lymphadenopathy. skin: right scapular lesion with skin tear/burst blister, warm skin neuro: oriented x 3, normal attention, cn ii-xii intact, strength in upper extremities, limited by pain in lower extremites, intact sensation to light touch pertinent results: admission labs: 11:25am plt count-207# 11:25am neuts-85.8* lymphs-9.1* monos-5.0 eos-0 basos-0.1 11:25am wbc-7.4# rbc-3.45* hgb-12.5* hct-36.0* mcv-104* mch-36.1* mchc-34.6 rdw-13.7 11:25am glucose-187* urea n-18 creat-0.7 sodium-133 potassium-3.8 chloride-98 total co2-24 anion gap-15 02:59pm pt-39.2* ptt-37.9* inr(pt)-4.0* 03:20pm urine mucous-many 03:20pm urine rbc-10* wbc-10* bacteria-none yeast-none epi-0 03:20pm urine blood-mod nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-2* ph-6.0 leuk-tr 03:20pm urine color-yellow appear-clear sp -1.025 . cxr: findings: as compared to the previous radiograph, there is no relevant change. minimal plate-like areas of atelectasis at the left lung base. no focal parenchymal opacity suggesting pneumonia. no pleural effusions. pulmonary edema. unchanged normal size of the cardiac silhouette. minimal tortuosity of the thoracic aorta. unchanged right-sided picc line. . le doppler u/s: negative. . cxr: impression: mild bibasilar atelectasis. no evidence of acute cardiopulmonary disease. . cxr: in comparison with study of , there is blunting of the left costophrenic angle, suggestive of pleural effusion. however, no evidence of acute focal pneumonia or vascular congestion. . mri hip: impression: 1. contrast not administered. 2. interval girdlestone procedure with removal of left femoral head. fluid in left actebulum and surrounding greater trochanter may be post surgical. 3. persistent high signal in left iliacus muscle on stir imaging in keeping with intramuscular edema but muscle expansion has decreased with further decreases in size of intramuscular fluid locules. 4. stable bone mets in right upper femur and right inferior pubic ramus. . ct head: impression: no intracranial hemorrhage, edema, or mass effect. no evidence of metastatic disease. mri with and without contrast would be more sensitive if there is high clinical concern. . echo: the left ventricular cavity is small. left ventricular systolic function is hyperdynamic (ef 80%). right ventricular chamber size and free wall motion are normal. the mitral valve leaflets are not well seen (mitral valve prolapse is probably present). trivial mitral regurgitation is seen. there is no pericardial effusion. impression: suboptimal image quality. small, hyperdynamic left ventricle. . cxr: impression: no acute intrathoracic process. unchanged sclerotic metastasis in the upper thoracic spine. . mri pelvis/thigh: impression: 1. asymmetric enhancement and edema extending from the medial inferior left psoas muscle, majority of left iliacus muscle with extension into the proximal left thigh to involve the left iliopsoas, left obturator externus, pectineus, adductor muscle group, quadratus femoris and gluteus minimus musculature with mild enhancement and edematous changes. in addition, there are small locules of rounded fluid in the left iliacus muscle posteriorly, which demonstrate non-enhancement centrally with the largest pocket with layering debris measuring approximately 1.3 x 2.3 cm. this constellation of findings is concerning for an infectious or inflammatory process in the correct clinical setting. inflammatory neoplastic process is also a possible consideration. 2. left femoral neck likely osseous metastatic lesion is stable in size in comparison to prior comparisons. no pathologic fracture. 3. small left hip joint effusion with likely reactive edema in the medial and posterior left acetabulum. an infectious etiology is not entirely excluded given adjacent edematous marrow and soft tissues. . ct left prox leg: sclerotic foci in the right l5 vertebral body (2:7) measuring 10 mm (previously measuring 9 mm), left ilium (2:7) measuring 13 mm (previously measuring 14 mm), left greater trochanter mixed lytic and sclerotic (2:57) measuring 5 mm (prior measuring 5 mm) and left proximal femur mixed lytic/sclerotic (2:67) measuring 13 mm (prior measuring 11 mm) are essentially unchanged in size to slightly increased in appearance compared to the prior examination. no acute fracture is seen. impression: multiple osseous lesions, as above, consistent with known history of metastasis, stable to slightly increased. no acute fracture. . left femur/hip x-ray: impression: metastatic lesions in the proximal femora bilaterally without left femoral fracture. . lle doppler u/s: impression: no left lower extremity dvt. . discharge labs: wbc 7.4, hb 9.8, hct 28.4, mcv 97, plt 300. pt 13.1, inr 1.1, ptt 27.3 esr 130 esr 126 retic 1.1 glucose 124, bun 36, creat 2.1, na 139, k 4.6, cl 105, co2 26. alt 17, ast 22, ldh 272, alp 57, t bili 0.4 ck 56 albumin 2.5, ca 8.9, phos 3.6, mg 2.6 b12 414, folate 9.7 hba1c 6.5% crp 165 crp 131.1 psa 19.2 brief hospital course: 72yo man with metastatic melanoma, hx of dvt on warfarin, and prostate ca (not treated) admitted for left proximal leg pain with weight bearing x1-2wks, fever. also foley catheter placed prior to admission for urinary retention while on morphine. mri demonstrated inflammation of his left iliopsoas muscle and a left hip effusion. ortho was and upon discussion, it was initially decided that no operative intervention was necessary. infectious disease was and interventional radiology aspirated the left hip, which showed a wbc > 20,000 and gpcs (eventually speciated to mssa). he was taken urgently to the or for wash out. during surgery, the severity of the infection led to a left femoral head resection. he tolerated the procedure without intra-operative complication, and was transferred to the floor per routine. pain was intially controlled with parenteral narcotics with assistance from the palliative care service. eventually, he was transitioned to a po pain regimen to good effect. once mssa was speciated, vancomycin was changed to nafcillin after a successful nafcillin desensitization in the icu without hives, edema, or anaphylaxis. repeat mri did not show any remaining joint effusion. . on pod#3, mr. creatinine rose to 1.2 from baseline 0.7, and subsequently to 2.2 on pod#4. the renal service was and his antibiotics were changed from nafcillin to daptomycin. he was transferred back to the hospitalist oncology service on pod#6 for continued management of his kidney issues, which subsequently stabilized. he was restarted on warfarin with an enoxaparin bridge for dvt treatment considering his past histories of dvts and pe. fevers persisted for about one week post-op, but repeat cultures and cxr remained negative. he also required rbc transfusions for anemia of inflammation. he was transferred to rehab once afebrile with the plan to continue daptomycin for six weeks total, then follow-up with orthopedics for a hip replacement. . # mssa septic hip and infective myositis: hip wash out and femoral head resection . nafcillin changed to daptomycin due to . id and ortho . repeat mri without evidence of fluid re-accumulation. plan to continue daptomycin x6wks total while checking ck qwk, next . physical therapy: no weight bearing to left hip changed to weight bearing as tolerated. ortho and reconstructive surgery f/u in weeks with repeat mri +/- arthrocentesis prior to hip replacement. . # fever: due to septic joint and infective myositis. repeat cxr negative x2. c. diff negative x1. echo negative. le doppler u/s negative. repeat esr and crp still elevated. repeat cultures no growth to date. . # nafcillin desensitization: in the , mr. nafcillin densensitization and received a total of 3 doses of nafcillin while in the without hives, edema, or anaphylaxis. he was also hemodynamically stable without periods of hypotension throughout the desensitization. . # acute renal failure: stable. due to ain from nafcillin vs. atn due to sepsis/pre-renal vs. obstruction (urinary retention). renal service . nafcillin switched to daptomycin . . # hyponatremia: resolved with iv fluids. . # metastatic melanoma: dr. is planning to enroll mr. into a clinical trial after resolution of current infection. asymptomatic from cancer disease. . # prostate ca: psa 19.2, increased from 10.5 on 12/. follow-up as outpatient. continued calcium and vitamin d. . # uti: mssa and coag-negative staph, 10,000-100,000 organisms/ml. foley catheter removed. changed nitrofurantoin to vancomycin for mssa uti and septic arthritis, then to nafcillin with sensitivities, then to daptomycin due to . repeat u/a negative. . # hyperglycemia: mild. hba1c 6.5. insulin sliding scale stopped. . # urinary retention: developed in setting of narcotic analgesia. foley catheter placed prior to admission. resolved with tamsulosin. foley removed. . # dvt: warfarin increased to 6mg daily and bridged with enoxaparin while subtherapeutic. inr goal 2.5-3.0 per ortho. . # macrocytic anemia: transfused 1u prbc and 1u . adequate b12 and folate. low retic suggested decreased production, likely anemia of inflammation. . # pain (lle): oxycontin 10mg with prn oxycodone. . # fen: regular diet. . # dvt ppx: on chronic antociagulation for h/o dvt/pe. . # gi ppx: ppi and bowel regimen. . # precautions: fall. . # lines: picc line. . # code: full. medications on admission: alprazolam - 0.25 mg tablet - tablet(s) po once before your mri morphine - 15 mg tablet po q4-6 as needed for severe pain morphine - 15 mg tablet extended release po twice a day ondansetron hcl - 8 mg po q8 prn nausea oxycodone-acetaminophen 5 mg-325 mg tablet po q6 hrs as needed for pain polyethylene glycol 3350 - 17 gram powder 1 packet po daily hold for loose stool prochlorperazine maleate - 5 mg tablet po q4-6 as needed for nausea warfarin - 2 mg tablet - 3 tablet(s) po once a day or as directed calcium carbonate - 500 mg (1,250 mg) 2 tablet(s) po once a day cholecalciferol (vitamin d3) 2,000 unit po once a day psyllium sennosides - 8.6 mg tablet - 1 tablet(s) by mouth hold for loose stool allergies: pcn, gentamicin, keflex, ciprofloxacin discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 2. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 3. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 4. oxycodone 10 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po q12h (every 12 hours) for 1 months. disp:*60 tablet extended release 12 hr(s)* refills:*0* 5. oxycodone 5 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. disp:*100 tablet(s)* refills:*0* 6. acetaminophen 500 mg tablet sig: two (2) tablet po q8h (every 8 hours) as needed for pain. 7. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush for 6 weeks. disp:*qs ml(s)* refills:*0* 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 10. polyethylene glycol 3350 17 gram/dose powder sig: one (1) dose po daily (daily) as needed for constipation. 11. ondansetron hcl 4 mg tablet sig: 1-2 tablets po every eight (8) hours as needed for nausea. 12. prochlorperazine maleate 5 mg tablet sig: 1-2 tablets po every eight (8) hours as needed for nausea. 13. warfarin 2 mg tablet sig: three (3) tablet po once daily at 4 pm: goal inr 2.5-3.0. 14. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid w/meals (3 times a day with meals). 15. gabapentin 300 mg capsule sig: one (1) capsule po q8h (every 8 hours). 16. enoxaparin 80 mg/0.8 ml syringe sig: seventy (70) mg subcutaneous q12h (every 12 hours): until inr >2. 17. alprazolam 0.25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)) as needed for insomnia. 18. daptomycin 500 mg recon soln sig: four y (440) mg intravenous q24h (every 24 hours): six weeks total, finishing . 19. outpatient lab work dx: septic arthritis, metastatic melanoma, prostate cancer. labs: cbc, chem7, ck. draw weekly until . please fax to (dr. ). discharge disposition: extended care facility: hospital for continuing medical care- discharge diagnosis: left hip septic arthritis (hip infection). left psoas infective myositis (muscle infection). fever. metastatic melanoma. prostate cancer. acute kidney failure. urinary tract infection. anemia. 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 for left hip pain thought to be due to either metastatic melanoma or prostate cancer. however, mri revealed a severe infection of the hip joint (septic arthritis) and surrounding muscles (myositis). you were started on iv antibiotics and infectious disease specialists and orthopedic surgeons were . you arthrocentesis where fluid was removed from the hip. this fluid was grossly infected with staphylococcus aureus bacteria. the orthopedic surgeons took you to the operating room to wash out the infection, but found the region to be so infected that they needed to remove the head of the femur (leg bone). your kidney function also worsened, so the kidney doctors . they thought it may have been due to your antibiotic (nafcillin), so this was changed to daptomycin. you will need to remain on daptomycin for six weeks total finishing . after this, mri of the hip will need to be done and possibly another needle aspiration to prove the infection has cleared. once the infection is fully gone, the orthopedic surgeons can perform a hip replacement. meanwhile, you will receive physical therapy and iv antibiotics at a rehab facility. you did require red blood cell transfusions for anemia and you may require additional blood transfusions in the future. therefore, your blood counts will need to be monitored regularly. . you have been prescribed a narcotic pain medication. please take only as directed and do not drive or operate any machinery while taking this medication. there is a 72 hour (monday through friday, 9am to 4pm) response time for prescription refill requests. there will be no prescription refills on saturdays, sundays, or holidays. please plan accordingly. . wound care: - keep incision clean and dry. - do not soak the incision in a bath or pool. activity: - continue to weight-bear as tolerated. - external shoe lift to his affected leg. . other instructions: - resume your regular diet. - avoid nicotine products to optimize healing. - take all medications as instructed. - continue taking blood thinners as directed. - if you have any increased redness, drainage, swelling, numbness, or if you have a temperature greater than 101.5, please call the office or come to the emergency department. . medication changes: 1. daptomycin x6 weeks total (last day ). 2. enoxaparin (lovenox) 70mg subcutaneous injection 2x a day until warfarin (coumadin) is therapeutic (inr 2.5-3.0). 3. oxycontin 10mg 2x a day. 4. oxycodone 5-10mg as needed for breakthrough pain. 5. 3. tamsulosin (flomax) daily to prevent urinary retention. followup instructions: please have weekly labs including cbc, chem7, lfts, and ck faxed to dr. at . . please call the infectious disease office to schedule a follow-up appointment in 4 weeks at . . please call the nephrologist (kidney doctor) dr. and dr. in 2 weeks at . . please call you oncologist dr. to schedule a follow-up appointment in 4 weeks at . . department: healthcare of when: wednesday at 2:10 pm with: . , md building: (, ma) ground campus: off campus best parking: parking on site . department: orthopedics when: friday at 11:40 am with: , md building: campus: east best parking: garage . department: surgical specialties: urology when: thursday at 2:15 pm with: , md building: campus: east best parking: garage procedure: venous catheterization, not elsewhere classified arthrocentesis other partial ostectomy, femur diagnoses: urinary tract infection, site not specified acute kidney failure, unspecified hyposmolality and/or hyponatremia need for desensitization to allergens methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site malignant neoplasm of prostate long-term (current) use of anticoagulants personal history of venous thrombosis and embolism diarrhea encounter for palliative care other and unspecified coagulation defects secondary malignant neoplasm of bone and bone marrow other abnormal glucose anemia in neoplastic disease other specified retention of urine pyogenic arthritis, pelvic region and thigh penicillins causing adverse effects in therapeutic use infective myositis acute glomerulonephritis with unspecified pathological lesion in kidney personal history of malignant neoplasm of bone 

Answer: The patient is high likely exposed to