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: history of present illness: the patient is a 26-year-old woman with a history of iv drug abuse, who initially presented to an outside hospital on from a drug and detoxification facility with a chief complaint of headache, abdominal pain, and fever. at the outside hospital, the patient was found to be febrile to 104.6 degrees f, and she subsequently developed hypotension with a systolic blood pressure in the 80s. during this initial evaluation, the patient was confused and only intermittently answering questions. there was concern for possible headache, neck stiffness, and photophobia, so given the concern for meningitis, a spinal tap was done. this study demonstrated 50 white blood cells (84% neutrophils), 10 red blood cells, protein of 23, glucose of 86, and 0-5 yeast per high power field. given these findings and concern for meningitis, the patient received vancomycin, ceftriaxone, metronidazole, and gentamicin at the outside hospital. given the lack of intensive care unit beds at the outside hospital, the patient was therefore transferred to the for further evaluation. on arrival to the emergency department at the , the patient was found to have icteric sclerae, a 2/6 systolic ejection murmur, abdominal guarding, and right upper quadrant tenderness. given the concern for an abdominal process, the patient was given levofloxacin and metronidazole; she was also given ambisome given the finding of yeast in her csf at the outside hospital. in the emergency department, she had an abdominal ultrasound that was negative for the presence of gallbladder or ductal dilatation. also at this time, the patient began to deny the report that she was hiv positive; this report has been obtained only by report and not by documented laboratory testing from the outside hospital. past medical history: 1. intravenous drug abuse. 2. cholelithiasis. 3. cholecystectomy. 4. spontaneous abortion x2. 5. therapeutic abortion x1. allergies: no known drug allergies. medications on admission: none. social history: the patient is a single mother of three children ages 9, 8, and 2 years old. she is unemployed. she last used heroin 3-4 days prior to admission; she began using heroin one year prior to admission. the patient smokes a third of a pack of cigarettes a day and denies any history of alcohol abuse. she denies any history of providing sexual favors for drugs or money. she says her only lifetime partner is her husband. initial physical examination: temperature 97.6, heart rate 95, blood pressure 113/71, respiratory rate 20, and oxygen saturation 100% on room air. during this initial evaluation, the patient was not reliable as a historian. she appeared to be a well dressed well-nourished female in moderate distress from "not feeling well", lying in bed, and subsequently having emesis x1. heent exam: extraocular movements are intact. there was mild scleral icterus. mild conjunctival edema. pupils are equal, round, and reactive to light. there were small conjunctival hemorrhages on the right greater than on the left. her face was symmetric. her neck was stiff with pain with flexion half-way down towards the chest. the right ij central venous catheter was in place. a small posterior cervical lymph node is palpable. her oropharyngeal examination was remarkable for upper dentures with eroded mucosa and white plaques consistent with thrush underneath. her tongue was coated with a whitish film, and she had a few petechiae on her upper palate. her heart was regular, rate, and rhythm, and there was a holosystolic murmur throughout the precordium that radiated to the axilla. her lungs were clear to auscultation bilaterally. her abdomen was soft, there were normoactive bowel sounds, she had bilateral upper quadrant guarding, and mild abdominal distention. the patient notes that her abdominal discomfort has been present for the past five months. she had bilateral upper extremity tract marks in her right forearm and in her bilateral antecubital fossa that were clean. scattered dark macules were seen on her palms bilaterally. she had mild, but not true cmt on pelvic examination. she was moving all extremities freely and equally and had full strength on neurologic examination. her laboratories from the outside hospital included the following: urinalysis was essentially negative. one out of two blood culture bottles were growing gram-positive cocci in clusters initially. her csf demonstrated 0-4 neutrophils and 0-5 yeasts per high power field, 10 red blood cells, 50 white cells (80% neutrophils, 3% lymphocytes, 13% monocytes), 23 protein, and 86 glucose. her complete blood count showed a white count of 13.3, hematocrit 35.5, and platelets 110,000. differential for white count demonstrated 77 neutrophils, 14% bands, 2% lymphocytes, and 6% monocytes. her inr was 1.28 and her ptt was 49. serum chemistries demonstrated a sodium of 133, bicarbonate 21, bun 34, creatinine 2.0. of note, her creatinine was 0.5 in . her total bilirubin is 3, direct bilirubin 2.3, alt 967, ast 396, ggt 125, alkaline phosphatase 156; her lfts had been normal at baseline one month prior. her electrocardiogram at the outside hospital demonstrated sinus tachycardia at 112 beats per minute, normal axis, and normal intervals. her head ct scan from the outside hospital demonstrated motion artifact and normal volumes to the ventricles. an abdominal ultrasound demonstrated increased echotexture to the bilateral kidneys, and no evidence of hydronephrosis. at the , her laboratories demonstrated sodium 140, potassium 3.8, chloride 113, bicarbonate 16, bun 26, creatinine 1.5, and glucose of 204. her calcium was 5.8, magnesium 1.2, and phosphate 3. her white count was 12.2, hematocrit 29.7, and platelets of 60,000. differential of her white count demonstrated 68% neutrophils, 19% bands, 9% lymphocytes, and 4% monocytes. her fibrinogen was 477, fdp 10-40, and d dimer was pending. her alt was 529, ast 150, alkaline phosphatase 97, amylase 46, lipase 23, and albumin 2.3. her urinalysis had greater than 50 red blood cells, white blood cells, and leukocyte esterase and nitrate were negative. her ptt was 36.7 and her inr of 1.6. her abdominal ultrasound demonstrated minimal new intrahepatic ductal dilatation and small pneumobilia. a hiv test was done on admission to the and was pending. hospital course by systems: 1. infectious diseases: while the patient was reported to be hiv positive upon her arrival to the emergency department at the , her hiv test subsequently returned negative. she also informed her caretakers that she had multiple hiv tests in the past, all of which had been negative. the report of "yeast" found in her csf at the osh was also found to be false-positive. no yeast or fungal organisms grew out the culture of her csf, and a csf gram stain was repeated twice at the outside hospital and found to be negative both times. the patient received several doses of ambisome at the , but once it had been confirmed that the finding of yeast was a false-positive, her ambisome was discontinued. by hospital day three, the gram-positive cocci in clusters that ultimately grew out from blood culture bottles at the outside hospital had been speciated as methicillin-sensitive staphylococcus aureus (mssa). once this definitive speciation was made, the patient's antibiotic regimen was tailored to include oxacillin and gentamicin; the gentamicin was used for only four days in order to aid in the clearance of her bacteremia. given the finding of this bacteremia and her alarming concert of symptoms on admission, a transthoracic echocardiogram was performed on hospital day two. this study demonstrated a thickened posterior mitral leaflet with a question of prolapse and at least mild-to-moderate mitral regurgitation consistent with possible endocarditis. biventricular systolic function was preserved. pulmonary artery systolic hypertension was seen. given these findings, a transesophageal echocardiogram was performed on hospital day three. this study demonstrated a moderate sized mitral valve vegetation consistent with a diagnosis of bacterial endocarditis. given this finding, it was felt that all of the patient's initial signs and symptoms were consistent with bacterial endocarditis. given that the finding of yeast in the csf was found to be a false-positive, and given that all subsequent gram stain and culture data from the csf remained negative, the patient was not felt to have had bacterial meningitis at any point (of note, two colonies of gram-positive cocci in clusters were isolated from the patient's csf culture; however, these colonies were subsequently speciated as coag-negative staph, and were therefore thought to be a contaminate. given the patient's lfts abnormalities on admission, an abdominal ct scan was done on hospital day two. this study demonstrated a focal area of low attenuation in the contrast enhanced right kidney, that was ultimately attributed to a septic embolus to the right kidney. also seen were large bilateral pleural effusions with compressive atelectasis, ascites, and free abdominal fluid, and a large amount of pelvic fluid. these fluid collections were all thought to be secondary to a systemic inflammatory response syndrome secondary to the patient's underlying bacterial endocarditis. in order to rule out the possibility of an epidural abscess, a spinal mri was done on hospital day four. this study demonstrated no evidence of epidural abscess. also of note, a mri of the head had been done on hospital day two in order to further evaluate for the possibility of meningeal inflammation. this study did not demonstrate any definite evidence of a focal lesion in the third ventricle or a focal mass within the brain. following the initiation of the appropriate antibiotic therapy as noted above, the patient slowly began to improve clinically. she initially continued to spike high fevers, but she gradually defervesced. her white count also initially remained elevated, but this too gradually began to trend down while on appropriate antibiotics. she did develop reactive arthridities in both her left ankle and her left hand. the department of rheumatology was consulted given these reactive arthridities and recommended supportive care to the area. the patient's lfts abnormalities present on admission gradually normalized. of note, however, the patient did develop mild elevations in her alkaline phosphatase, amylase, and lipase following the initiation of oxacillin therapy. it was thought that these elevations may have been secondary to oxacillin, but the elevations did not persist and had begun to trend towards normal at the time of discharge. given these normalizations, and given that the patient's hematocrit had been remaining stable (thus indicating that there was no significant myelosuppression as a result of oxacillin therapy), the patient was discharged with a plan for six weeks of continued oxacillin therapy. in order to rule out the possibility of mycotic aneurysm in the brain, a mri of the head was obtained on hospital day seven. this study demonstrated no evidence of acute infarct from septic emboli, and a subtle increased signal in the right temporal region that could be within the sulcus. a similar, but less apparent abnormality was also seen along the sulcus of the left occipital region. these abnormalities were nonspecific in nature, but were thought to possibly have been due to a high protein content of the csf. given the patient's overall clinical stability, however, the decision was made to clinically follow the patient as an outpatient following her discharge from the hospital. also of note, the patient had a cervical chlamydia probe return positive during this hospitalization. she received azithromycin 1,000 mg once during her hospitalization for treatment of this chlamydia. 2. cardiovascular: given that the patient had significant endocarditis, a cardiology consult was obtained early in the patient's hospitalization for evaluation of whether or not the patient was a surgical candidate for her endocarditis. given that the patient did not have clinically significant congestive heart failure or valvular dysfunction with persistent infection after 7-10 days of appropriate antibiotics, the patient was deemed not to be a surgical candidate. she subsequently developed no significant congestive heart failure, and she had no further embolic phenomena following the septic embolus sheath to her right kidney. given her bilateral pleural effusions and mitral regurgitation, the patient was transiently on furosemide during this hospitalization, but had no signs or symptoms of congestive heart failure at the time of her discharge from the hospital. 3. rheumatology: as noted above, the patient initially developed a left ankle reactive arthritis on hospital day six. given the asymmetric edema in her left ankle, a rheumatology consult was obtained. the rheumatology service agreed that the swelling in her left ankle was reactive arthritis. the patient subsequently developed left hand swelling later in her hospitalization, at which point the rheumatology service was reconsulted. they again felt that the swelling in the patient's left hand was due to a reactive arthritis that would be best managed with supportive care. she was started on a 14 day course of naproxen for treatment of the inflammation and swelling in her hand. by the time of discharge, the patient's swelling in both her left hand and her left ankle had improved dramatically, and were nearly at their baseline. 4. hematology: soonafter admission, the patient manifested a significant anemia with a hematocrit in the low 20s. the etiology of this anemia was ultimately thought to be multifactorial due to a combination of anemia of chronic disease, recurrent phlebotomy, menstruation, and oxacillin induced myelosuppression. there was no evidence of hemolysis either by laboratory evaluation or by direct evaluation of the peripheral smear. given that the patient's hematocrit was low, she was started on iron supplementation during this hospitalization. at the time of discharge, however, the patient's hematocrit had been consistently stable for over one week, and the decision was made to continue her on oxacillin for the time being with twice weekly hematocrits following her discharge from the hospital. 5. psychiatry: by hospital day eight, the patient began threatening to leave the hospital against medical advice due to inadequate pain control. given the concern for the patient possibly leaving the hospital against medical advice without plans for continued intravenous antibiotics, a psychiatry consult was requested. the psychiatry service felt that the patient had poor coping mechanisms given the severity of her illness, and recommended initiation of an atypical antipsychotic. in addition, they recommended analgesia as necessary, including with narcotic medications if necessary, in order to adequately control the patient's pain. the patient was subsequently started on an atypical antipsychotic, and her narcotic medication dosing regimen was increased, with excellent therapeutic affect. discharge condition: good. discharge placement: hospital. discharge diagnoses: 1. methicillin-sensitive staphylococcus aureus endocarditis complicated by right renal septic embolus. 2. chlamydia. 3. systemic inflammatory response syndrome. 4. multifactorial anemia. 5. reactive arthritis. 6. intravenous drug abuse. discharge medications: 1. oxacillin 2 grams iv q4h through . 2. naproxen 500 mg po bid through . 3. pantoprazole 40 mg po q day. 4. ferrous sulfate 325 mg po q day. 5. quetiapine 25 mg po tid. 6. hydromorphone 1 mg iv q4h prn pain. followup: 1. the patient should have her hematocrit, alkaline phosphatase, amylase, and lipase all checked twice a week while at . the results of these blood tests should be faxed to dr. at fax # in the department of infectious diseases at . 2. the patient should arrange for a follow-up appointment with dr. by calling . she should arrange for this appointment during the week after she leaves . 3. the patient should call to arrange for a follow-up appointment with dr. during the week following her release from . 4. note that the patient should receive the hepatitis a and hepatitis b virus vaccines as an outpatient. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart diagnoses: methicillin susceptible staphylococcus aureus septicemia sepsis opioid type dependence, unspecified candidiasis of mouth pleurisy with effusion, with mention of a bacterial cause other than tuberculosis pyogenic arthritis, ankle and foot pyogenic arthritis, hand acute and subacute bacterial endocarditis 

Answer: The patient is high likely exposed to