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: paralysis, epidural hematoma major surgical or invasive procedure: placement of a peripherally inserted central catheter (picc line) endotracheal intubation blood transfusion arterial line history of present illness: mr. is a 53 year old man with a history of anxiety, polysubstance abuse (hepatitis b and c), peripheral vascular disease, htn, copd who presented with 3-4 days of increasing lower extremity weakness. unfortunately, he is currently intubated/sedated and cannot provide a history. per review of nursing home records and emergency department records, he noted decreased sensation in his lower extremities, starting on the left. this was accompanied by increasing weakness. these symptoms occured in the setting of his girlfriend moving a pillow for him 3-4 days ago. apparently denied trauma. he was initially seen at an osh where he had an l-spine mri that showed an acute to subacute fx at l1-l2. in the ed, initial vs were: 97.4 hr 111 100/63 rr 20 94% on 6 l. he was intubated for an mri. in the mri, he became hypotensive with sbp to 80-90s. he was started on levophed and was given vancomycin and zosyn. for sedation he was given versed 5 mg iv and vecuronium 8 mg for mri and was started on versed/fent drips. mri revealed a compression fx at t6-7 with an epidural collection likely hematoma. per radiology read, there is suggestion of mass effect on cord. per neurosurgery review of films, neurosurgery feels that there is in fact no mass effect. neurosurgery attending was contact by both the neurology and . it was felt that mr. would not benefit from an immediate surgical intervention and would best be served on the medical service. of note a rij was placed in the ed prior to transfer to the floor. . on the floor, he is intubated and sedated. he grimaces to pain but does not respond to simple commands. past medical history: - anxiety, - hep b and c - sah - pvd - htn - copd on l o2 at home - recent pneumonia social history: mr. has been at rehab hospital, recently admitted osh w/ discharge diagnosis of copd exacerbation on iv vancomycin and solumedrol. -h/o ivdu, states he has not used in years. family history: unable to obtain on admission physical exam: general: intubated, sedated heent: sclera anicteric neck: supple, no lad lungs: anterior breath sounds clear, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: cool, 1+ pulses, no clubbing, cyanosis or edema skin: multiple ecchymoses, stage 2-3 sacral decubitus ulcer neuro: strength/sensation unable to assess, patellar refelx 0/ankle jerk 0, babinski equivocal pertinent results: imaging . mri spine impression: 1. mild-to-moderate compression fractures of t5 through t7 with a heterogeneously enhancing epidural collection, concerning for ostemyelitis with evolving epidural abscess. however, the lack of extensive enhancement including the disc space is unusual for pyogenic infection and there may be a combination of chronic neurogenic spondyloarthropathy with hematoma/phlegmon and superimposed infection. tuberculosis could have this appearance and should be correlated with clinical and laboratory findings. there is resultant severe encroachment on the spinal canal anteriorly with cord deformity and abnormal cord signal. 2. findings concerning for a developing secondary infection at c5-6 without cord compression. while the endplate and disc edema could be post-traumatic, the extent of epidural enhancement would be very unusal in the setting of trauma. 3. mild compression fractures of l1 and l2 without cord or cauda equina compression. 4. additional degenerative changes as detailed. 5. pulmonary findings concerning for pleural and/or parenchymal disease for which chest ct has been recommended and please see that report for further details. . ct chest impression: 1. severe bilateral, occlusive bronchial mucoid impaction. 2. no appreciable pleural effusion, loculated or otherwise. right basal atelectasis is moderate. 3. diffuse centrilobular emphysema. 4. possible aspiration effect, right middle lobe and right lower lobes 5. diffuse debris is noted within the tracheobronchial tree. dense secretions are noted in the right lower lobe and left lower lobe bronchi. 6. vertebral body wedge compressions t5, t7 , t8, l1 with suggestion of lytic lesions in at least in t8, possible paraspinal hematoma, tumor, and/or marrow, better described on same day ct and mr.5. 7. 7 x 9 mm nodule, left upper lobe, could be malignant. . lower extremity doppler impression: no evidence of dvt in the lower extremities bilaterally. . echo the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal/small. left ventricular systolic function appears grossly preserved. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular free wall motion appears borderline preserved in suboptimal views. the ascending aorta is mildly dilated. the aortic valve is not well seen. the mitral valve leaflets are structurally normal. the estimated pulmonary artery systolic pressure is normal. there is a very small pericardial effusion. no valvular regurgitation is identified in suboptimal views. . ct spine impression: 1. multiple thoracolumbar compression fractures as described above. 2. mild multilevel degenerative disease with grade 1 retrolisthesis of l5 on s1, posterior disc bulge with mild central canal narrowing. 3. at t7 level, there is paravertebral soft tissue thickening which appears to be subpleural in location . mri spine impression: 1. continued abnormal signal in the cervical spine at c6-7 level, but significant decrease in epidural collection at this level. 2. multiple t5-7 compression fractures are again seen, with minimal decrease in epidural collection at this level, but continued abnormal cord signal thought due to mass effect. for more detailed description of degenerative changes at other levels, please refer to previous extensive report from three days prior . cxr impression: no significant change of bibasilar atelectasis. stable positions. . cxr report pending at discharge. of et tube and right central venous catheter. . microbiology blood culture blood culture, routine-negative blood culture blood culture, routine-negative blood culture blood culture, routine-negative bronchoalveolar lavage gram stain-final; respiratory culture-final {yeast}; legionella culture-pending; immunoflourescent test for pneumocystis jirovecii (carinii)-negative catheter tip-iv wound culture-negative bronchoalveolar lavage gram stain-negative; respiratory culture-final {yeast}; legionella culture-negative; immunoflourescent test for pneumocystis jirovecii (carinii)-negative blood culture blood culture, routine-negative mrsa screen mrsa screen-final {positive for methicillin resistant staph aureus} blood culture blood culture, routine-negative urine urine culture-final {yeast} blood culture blood culture- pending at discharge . laboratory results 08:00pm blood wbc-15.9* rbc-3.04* hgb-9.3* hct-28.1* mcv-92 mch-30.6 mchc-33.2 rdw-18.6* plt ct-318 03:24am blood wbc-14.5* rbc-2.62* hgb-7.9* hct-23.8* mcv-91 mch-30.1 mchc-33.1 rdw-18.7* plt ct-358 06:17am blood wbc-10.1 rbc-2.63* hgb-8.1* hct-24.1* mcv-91 mch-30.6 mchc-33.5 rdw-18.8* plt ct-371 05:45am blood wbc-8.9 rbc-2.44* hgb-7.5* hct-22.1* mcv-91 mch-31.0 mchc-34.1 rdw-18.8* plt ct-370 09:40am blood wbc-11.0 rbc-3.30*# hgb-10.0*# hct-29.4*# mcv-89 mch-30.4 mchc-34.1 rdw-18.3* plt ct-323 05:53am blood wbc-8.6 rbc-2.90* hgb-9.2* hct-26.0* mcv-90 mch-31.6 mchc-35.2* rdw-18.4* plt ct-285 05:37am blood wbc-8.7 rbc-3.15* hgb-9.5* hct-28.5* mcv-91 mch-30.2 mchc-33.4 rdw-18.0* plt ct-344 08:00pm blood glucose-74 urean-41* creat-0.9 na-133 k-4.8 cl-91* hco3-35* angap-12 03:24am blood glucose-91 urean-29* creat-0.6 na-136 k-4.2 cl-99 hco3-30 angap-11 06:16pm blood glucose-92 urean-28* creat-0.6 na-139 k-3.9 cl-98 hco3-33* angap-12 06:29am blood glucose-84 urean-30* creat-0.6 na-136 k-3.9 cl-96 hco3-34* angap-10 05:45am blood glucose-80 urean-28* creat-0.4* na-136 k-3.8 cl-98 hco3-33* angap-9 05:37am blood glucose-71 urean-25* creat-0.5 na-137 k-3.8 cl-99 hco3-33* angap-9 03:40am blood ck(cpk)-112 09:27am blood ck(cpk)-78 04:44pm blood ck(cpk)-57 03:24am blood ck(cpk)-42* 08:00pm blood lipase-27 03:40am blood ck-mb-4 ctropnt-0.12* 09:27am blood ck-mb-notdone ctropnt-0.08* 04:44pm blood ck-mb-notdone ctropnt-0.05* 03:24am blood ck-mb-notdone ctropnt-0.03* 03:40am blood calcium-8.1* phos-4.2 mg-2.0 05:37am blood calcium-8.7 phos-3.2 mg-1.9 05:45am blood caltibc-209* ferritn-1101* trf-161* 03:40am blood cortsol-7.7 03:24am blood hbsag-negative hbsab-negative hbcab-positive 08:00pm blood crp-69.1* 05:45am blood pep-no specifi 06:29am blood hiv ab-negative 08:13am blood vanco-23.1* 09:35pm blood vanco-15.5 06:17am blood vanco-20.8* 06:29am blood vanco-20.2* 05:53am blood vanco-23.8* 08:00pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 01:48am blood type-art rates-14/ tidal v-450 peep-5 po2-195* pco2-58* ph-7.35 caltco2-33* base xs-4 -assist/con intubat-intubated 02:08pm blood type-art temp-36.8 po2-63* pco2-45 ph-7.49* caltco2-35* base xs-9 08:30pm urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-tr 08:30pm urine rbc-* wbc-* bacteri-few yeast-mod epi-0-2 brief hospital course: mr. is a 53 year old man with anxiety, hepatitis c, pvd, htn, copd on home o2 who presented with paralysis secondary to a compression fracture and epidural abscess/hematoma. . # blood pressure: mr. met sirs criteria on admission with leukocytosis and tachycardia. he was initially treated with levophed and iv boluses for a goal map over 60. he was able to be weaned from pressors and his blood pressures then remained stable. his blood pressures remained stable throughout the rest of the hospitalization, but his home medications were not restarted. he was started on metoprolol for atrial tachycardia. his home lisinopril and furosemide should be restarted at rehab as his blood pressure allows. . # epidural abscess/bacteremia: mr. was seen by neurology and neurosurgery on admission. he was unable to move or have sensation in his lower extremities. he had no rectal tone. given the extent of his deficit, the timing of the injury, and his comorbidities, neurosurgery did not feel surgery would be beneficial. he was covered broadly with vancomycin/zosyn initially for bacteremia and possible epidural abscess. id was consulted. blood cultures from the osh were positive for mrsa and his antibiotic coverage was changed to vancomycin based on sensitivities. after blood cultures were negative here at a picc was placed. he will need a total of eight weeks of antibiotic therapy. he will be followed by the clinic. he will need weekly blood draws of vanc trough, chem-7, crp, esr, cbc, and lft's. he will follow up in clinic in two weeks. neurosurgery would like him to have a repeat mri in three months (). he will need a vanc trough on . . # lung nodule: mr. had a lung nodule seen on chest imaging (9mm). this will need to be followed up with a repeat ct in 3 months. . # copd/respiratory failure: mr. was initially intubated on arrival in order to have imaging studies performed. he was able to be quickly extubated on hospital day #2. the following morning he desaturated to the 70's with increased wob. he was reintubated. he remained reintubated overnight and was extubated the next day. on the floor, he was able to be weaned to 4 l (home dose 5-6 l). he was initially continued on high dose steroids for his copd flare. however, this was decreased to 40 mg of prednisone. he remained on 4 l. his goal oxygen saturation was 90-92%. he should continue to be slowly tapered on prednisone while at rehab. he should have a slow taper given his extended use of solumedrol. he should continue on bactrim while on high dose steroids. . compression fractures: mr. had compression fractures. he was started on calcium, vitamin d, and calcitonin. he was fitted for a tlso brace. he should always wear the brace when he is elevated above 30 degrees. . bowel/bladder care: mr. has no rectal tone. he is unable to sense his bladder and bowels being full. a voiding trial was attempted, but was unsuccessful. a foley was replaced. he should have a repeat voiding trial at rehab. he had not moved his bowels for several days during the hospitalization. he was given an aggressive bowel regimen. a disimpaction was attempted, but there was no stool in the rectum. he spontaneously moved his bowels on the day of discharge. his difficulty with bowel and bladder symptoms is likely related to his paralysis. his high dose of narcotics is also worsening the problem. . anemia: mr. had a slowly decreasing hematocrit. he was guiac negative. he received two units of prbc's with an appropriate increase. his anemia was consistent with anemia of chronic disease. . pain: mr. had severe pain related to his compression fractures. he was started on a pca with hydromorphone. this was transitioned to iv and then orals. he was also started on a lidocaine patch. he was continued on his home methadone dose of 120 mg, but this was spaced out in tid dosing given concerns of somnolence. . anxiety: mr. was continued on his home dose of lorazepam. . lytic lesions: mr. was noted to have lytic lesions on imaging studies. an spep was negative. this should be further evaluated as an outpatient. . wound care: mr. was admitted with an unstageable decubitus ulcer. there were no signs of infection during the hospitalization. he was followed by wound care. they recommended daily dressing changes and pressure reduction. . prophylaxis: neurosurgery felt that it was safe to start dvt prophylaxis. based on their recommendation, he was started on enoxaparin on . . code: mr. was a full code. medications on admission: - lasix 40 daily - heparin flush - lisinopril 5 daily - lorazapam 0.5 tid - methadone 120 mg - omeprazole 20 - polyethylene glycol 17 gm daily - senna daily - singulair 10 mg daily - solumedrol 40mg tid - spiriva 18 mcg - mvi - xopenex neb q6 hours - vancomycin (started on for unclear reason) - tylenol - - bisac-evac - guaifenesin - ibuprofen - lorazapam prn - zolpidem prn - morphine 2 mg q4 h as needed discharge medications: 1. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush. 2. lorazepam 0.5 mg tablet sig: one (1) tablet po tid (3 times a day). 3. methadone 40 mg tablet, soluble sig: one (1) tablet, soluble po tid (3 times a day). 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 5. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po twice a day. 6. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day). 7. singulair 10 mg tablet sig: one (1) tablet po once a day. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 10. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 11. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation not relieved by colace/senna. 12. enoxaparin 30 mg/0.3 ml syringe sig: thirty (30) mg subcutaneous q12h (every 12 hours). 13. prednisone 20 mg tablet sig: two (2) tablet po daily (daily). 14. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 15. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po mwf (monday-wednesday-friday). 16. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). 17. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for groin rash. 18. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): apply to back. 19. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for sob. 20. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for sob. 21. hydromorphone 2 mg tablet sig: 0.5-1 tablet po q3h (every 3 hours) as needed for pain. 22. vancomycin 500 mg recon soln sig: five hundred (500) recon soln intravenous q 12h (every 12 hours): please continue until . 23. calcitonin (salmon) 200 unit/actuation aerosol, spray sig: one (1) spray nasal daily (daily). discharge disposition: extended care facility: hospital - discharge diagnosis: primary diagnosis: compression fractures epidural abscess/hematoma chronic obstructive pulmonary disease bacteremia decubitis ulcer discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: thank you for allowing us to take part in your care. you were admitted to the hospital with lower extremity weakness and loss of sensation. you were found to have collections of fluid pressing against your spinal cord. you met with neurosurgeons who did not feel an operation would improve your sensation. you were discharged to a rehab facility to work on improving your mobility. we made several changes to your medications: we started vancomycin (an antibiotic). you will take this until . we stopped lisinopril and lasix. we changed your methadone to three times a day at lower doses (same total dose). we increased your bowel medications. we changed your steroids from solumedrol to prednisone. we increased your nebulizers to albuterol and ipratropium. we started calcitonin, calcium, and vitamin d for your bones. we started oral hydromorphone for breakthrough pain. we started enoxaparin (lovenox) to prevent clots from forming. followup instructions: it is very important that you have a primary care provider. have several medical issues that are important to follow up on. you will have a physician at your rehab facility. this physician is . . you have a pulmonary nodule. you need to have a repeat ct scan in 3 months to see if this lesion has changed. please discuss this with dr. . you have an appointment scheduled with dr. on at 10:50. the appointment is located at on the ground floor. this is to discuss your antibiotics. please call with any questions. department: mri (mobile) when: tuesday at 10:35 am with: mri building: de building ( complex) campus: west best parking: garage department: mri (mobile) when: tuesday at 11:15 am with: mri building: de building ( complex) campus: west best parking: garage you have an appointment with dr. the neurosurgeon on at 1 pm in the medical office building 3b. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified anemia of other chronic disease urinary tract infection, site not specified severe sepsis chronic airway obstruction, not elsewhere classified unspecified viral hepatitis c without hepatic coma peripheral vascular disease, unspecified anxiety state, unspecified acute respiratory failure septic shock retention of urine, unspecified pressure ulcer, lower back other diseases of lung, not elsewhere classified intraspinal abscess acute osteomyelitis, other specified sites paraplegia methicillin resistant staphylococcus aureus septicemia pathologic fracture of vertebrae other dependence on machines, supplemental oxygen pressure ulcer, stage iii benign essential hypertension personal history of methicillin resistant staphylococcus aureus vascular myelopathies viral hepatitis b without mention of hepatic coma, acute or unspecified, with hepatitis delta 

Answer: The patient is high likely exposed to