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 attending: chief complaint: osteomyelitis and neck abscess major surgical or invasive procedure: : removal of hardware at c5-c6, redo cervical diskectomy at 5-6, anterior cervical diskectomy at c6-c7, evacuation of paraspinal abscess. transcervical incision and drainage of prevertebral space abscess. : flexible esophagoscopy and i&d of left neck and supraclavicular fossa. : incision and drainage of left supraclavicular fossa abscess and placement of a 20-french ponsky peg tube. : ct guidance, an 18-gauge needle was inserted directly into the collection and approximately 6 cc of opaque light red fluid was aspirated and sent for gram stain and culture. : picc line placement. history of present illness: ms. is a 47 year-old woman with h/o c5/6 laminectomy and anterior fusion in , now transferred from for evaluation of abscess. states that she was doing fine neurologically until about one week ago, aside from rare episodes of non-urge, non-stress urinary incontinence over the past few months. approximately one week ago, she was standing when her legs suddenly became weak bilaterally, and she fell. she does not report any head trauma or other subsequent injury. since that time, she has noted multiple other symptoms including tactile fevers, shaking chills, throat pain, dysphagia, right sided rib pain, odynophagia, anterior neck pain and swelling. she presented a few days ago to . she had a cxr taken which revealed bilateral lower lobe infiltrates and ?atypical pneumonitis. she was subsequently admitted to the medical service. subsequent work up included a barium swallow study which, per report, was concerning for a ruptured esophageal diverticulum. ct neck was reportedly normal, but ct chest showed a ring enhancing area anterior to c5-c7 vertebral bodies. enhancement was noted on mri c spine as well. she was started on antibiotics while at , after she spiked a temperature. she was subsequently transferred to for neurosurgery and ent evaluation. past medical history: 1. c5/c6 laminectomy and anterior fusion 2. ?esophageal rupture, as above 3. asthma 4. status post tonsillectomy social history: has two children. ex-pharmacist. 25 pack year smoker. rare alcohol use. no drug use. family history: non-contributory physical exam: on admit: temp: 101.6 bp: 114/57 hr: 122 rr: 30 ox: 95%/2l gen: ill appearing, tachypneic. heent: mm dry. wearing collar. left anterior neck soft tissues swollen, painful to palpation. no overt crepitus in supraclavicular regions. ?swelling in posterior pharynx though no exudate, pus. voice hoarse. no stridor. neck: collar, as above. lungs: rhonchi in both lower lungs. cardiac: rrr. s1/s2. no m/r/g. abd: soft, nt, nd, +nabs. no rebound or guarding. no hsm. belly button pierced, well-healed. extrem: warm and well-perfused. no c/c/e. neuro: mental status: awake and alert, cooperative with exam but mildly inattentive. oriented to person, place, and date. speech fluent with good comprehension and repetition. naming intact. no dysarthria or paraphasic errors. no apraxia, no neglect. cranial nerves: i: not tested ii: pupils equally round and reactive to light, 5 to 3 mm bilaterally. visual fields are full to confrontation. iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation intact and symmetric. viii: hearing intact to finger rub bilaterally. ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. motor: normal bulk and tone bilaterally. strength full power throughout. +asterixis. no drift. sensation: intact to light touch, propioception, pinprick and vibration bilaterally. no sensory level anteriorly. reflexes: present, normal and symmetric. toes downgoing bilaterally. coordination: normal on finger-nose-finger, rapid alternating movements. pertinent results: wbc-18.5*# hgb-9.4 hct-32.0 plt ct-395 wbc-9.8 hgb-9.2* hct-28.0 plt ct-782* wbc-11.1 hgb-8.9* hct-27.6 plt ct-750* wbc-15.1 hgb-9.5* hct-28.6 plt ct-710* wbc-26.2 hgb-10.4*# hct-30.9 plt ct-475* wbc-9.1 hgb-10.2* hct-30.5plt ct-379 wbc-12.4 hgb-11.8* hct-36.3 plt ct-499* wbc-6.6 hgb-10.7* hct-32.0 plt ct-499* neuts-94.7* bands-0 lymphs-4.0* monos-1.1* eos-0.2 neuts-84.6* lymphs-11.7* monos-3.4 eos-0.1 baso-0.2 neuts-85.3* lymphs-9.6* monos-2.2 eos-2.7 baso-0.3 chem: glucose-113* urean-12 creat-0.7 na-134 k-3.6 cl-99 hco3-28 glucose-79 urean-5* creat-0.5 na-136 k-3.7 cl-102 hco3-28 ck(cpk)-25* alt-17 ast-18 alkphos-127* totbili-0.5 micro: swab: mssa, strep viridans, yeast tissue cx: strep viridans, strep milleri; privotella sputum cx: sparse oropharyngeal flora, yeast bld cx: neg x2 pleural fluid: neg abscess: strep milleri, lactobacillus sputum: staph aureus, resistant to pcn pleural fluid: 3+pmns, cx: enterococcus sp. h.pylori negative abcess: 4+ pmns, no orgs. no growth on cx. blood and urine cx: no growth cvl tip cx: no growth pleural fluid: 3+pmns ct chest w/contrast 1. diffuse tree-in- and dependent ground glass opacities likely representing aspiration. 2. small bilateral pleural effusions, right greater than left. 3. please see ct neck examination performed on the same day for comment on irregular fluid-filled lower cervical esophagus with paraesophageal foci of air. esophageal rupture cannot be excluded. 4. 7-mm left upper lobe nodule. this may be infectious or inflammatory in etiology, but can be followed with dedicated chest ct in three months. ct neck w/contrast (eg:parotids) impression: 1. multiple small abscesses, obliteration of the deep and superficial fascial planes, and stranding and emphysema centered at c5/6. what is presumed to be the esophagus in this region is irregular and fluid filled and esophageal perforation cannot be excluded and would best be evaluated via contrast esophagogram with fluoroscopy. heterotopic bone posterior to the esophagus at this location may indicate mechanism of injury. given obliteration of the deep and superficial fascial planes and extensive subcutaneous emphysema, a rapidly spreading infection also cannot be excluded and close clinical correlation is recommended. ct chest w/contrast 1. perforation of the posterior esophagus at the c4/c5 level with extravasation of oral contrast and connection to the neck incision. this has caused a massive infectious process with multiple small abscesses in the left supraclavicular region and pockets of air which have further increased in extent since . there is beginning extension of infectious process into the superoposterior mediastinum. 2. new development of aneurysm or pseudoaneurysm arising from the left vertebral artery. as this is in the region of the planned surgical drainage, special attention is required in order to avoid vascular injury. 3. increase in size of bilateral pleural effusions. 4. slight improvement in multifocal ground-glass opacities and tree-in- opacities. 7-mm left upper lobe nodule. this may again be infectious or inflammatory in etiology and can be followed with dedicated chest ct in three months. ct neck w/contrast (eg:parotid impression: 1. mild interval increase in size of a 1.5-cm pseudoaneurysm of the left vertebral artery at the c6-7 level compared to . 2. destructive changes of c6 and c7 vertebral bodies with posterior displacement of c6 and focal kyphosis. these findings may relate to motion after removal of hardware but osteomyelitis must be strongly considered. consider mr of the cerival spine for better evaluation, especially for the presence of epidural involvement. 3. residual 2.5 x 1.3 x 3.9 cm fluid collection with an enhancing rim within the left tissues of the supraclavicular region. this area overall appears significantly improved compared to 10//. other associated findings as described above. mr w& w/o contrast 3:22 pm findings: at c5-6 and c6-7 increased signal is identified within the partially obliterated discs with increased signal within the adjacent vertebral bodies. there is enhancement seen in this region following gadolinium administration with a focal area of low signal seen within the c6-7 intervertebral disc area. in addition, there is widening of the prevertebral soft tissues identified with small pockets of air and low signal indicating abscess. there are also soft tissue changes seen within the left supraclavicular region in the region of trapezius muscle with a focal abscess. additionally, there is enhancement seen in the region appropriate for proximal left vertebral artery which was seen as a pseudoaneurysm on the previous cta examination of . surrounding the dilated pseudoaneurysm of the left vertebral artery there is also an irregular area of fluid collection identified measuring approximately 3 cm indicating an abscess. impression: findings indicative of discitis and osteomyelitis at c5-6 and c6-7 with prevertebral abscess in the left supraclavicular region involving the trapezius muscle as well as in the left anterior aspect of the neck along the course of the left vertebral artery with an area of enhancement indicating vertebral artery pseudoaneurysm seen by the previous cta examination. epidural soft tissue enhancement indicating phlegmon is seen with mild indentation on the spinal cord without evidence of epidural abscess. mr w& w/o contrast 6:16 pm findings: comparison with the prior examination discloses high t2 signal within both the c5-6 and c6-7 disc spaces. there is also now a small area of high t2 signal within the prevertebral soft tissue spanning the c5-6 disc space. while these post-contrast scans are of poor quality due to extensive patient motion, there is likely a small amount of pathological contrast enhancement within the anterior epidural space posterior to the c6-7 interspace. given the prior findings, the findings are quite consistent with extensive infectious disease within the intervertebral disc, epidural and prevertebral spaces. left-sided posterior paraspinal abscesses, that were defined on prior imaging studies appears somewhat smaller at this time, particularly the more posteriorly situated abscess. there is no definite signal abnormality within the visualized spinal cord, although the deformed vertebral segments at the c5-c7 level resulting continued impression upon the ventral cord surface. ct c-spine w/o contrast 3:55 am findings: the appearance of the cervical spine appears unchanged with no evidence of acute fracture or dislocation. extensive degenerative sclerotic changes at c5-c6, involving the c4 vertebral body, and degeneration of the inferior endplate of c6 and superior endplate of c7 are stable as is the posterior displacement of c5 and c6 with a cranial angulation of the posterior aspect. no prevertebral soft tissue swelling is identified. visualized contents of the intrathecal sac appear unremarkable. evaluation of lung apices displays evidence of centrilobular emphysema. soft tissue mass within the lower left neck consistent with patient's known treated pseudoaneurysm is unchanged from one day prior. brief hospital course: patient was admitted to neurosurgery service on for paravertebral spinal fluid collection and an epidural spinal abscess which was most prominent at c5-6 and c6-7. on the day of admission, she went to the operating room with neurosurgery/ent and underwent: 1. removal of hardware at c5-c6; 2. redo cervical diskectomy at 5-6; 3. anterior cervical diskectomy at c6-c7; 4. evacuation of paraspinal abscess. she was extubated on pod#1 and started po diet with increased drainage from the wound. on she went back to or with thoracic and had repeat incision and drainage of left supraclavicular fossa abscess and placement of a 20-french ponsky peg tube. she also received units of blood transfusion. id: was consulted and she was started on vanc/aztreonam/flagyl. id continued following on her antibiotic treatment and dosage adjustment. fluconazole was added on for yeast from her neck wound. they continued to follow her cultures. on the stopped the aztreonam and started clindamycin awaiting sensitivities. on clindamycin was stopped. levofloxacin was started empirically for gnrs. on she spiked a temp to 101.2. the cental line was removed and she was pancultured. the pleural cultures grew vre. the vancomycin was changed to linezolid. the culture from the neck abscess had no growth. she remained afebrile, a picc line was placed on . on she was positive for c. diff. flagyl was continued. she continued to improve and was discharge to home on daptomycin, ciprofloxacin, fluconazole and flagyl through . on the swallow evaluation and chest ct revealed cervical esophageal perforation with neck and supraclavicular fossa abscesses. thoracic was consulted and she underwent a flexible esophagoscopy and i&d of left neck and supraclavicular fossa with thoracic on . she was put on strict npo postoperatively and a dobbhoff feeding tube was inserted on , which was self-removed by the patient shortly afterwards. she went back to or with thoracic and had repeat incision and drainage of left supraclavicular fossa abscess and placement of a 20-french ponsky peg tube. she also received units of blood transfusion. on psychiatry was consulted for evaluation of intermittent confusion, recommended starting haldol and ativan treatment for delirium. on repeat chest ct showed marked interval increase in size of large bilateral pleural effusions with loculated components; and persistent multifocal ground-glass opacities within the lungs; incompletely imaged left supraclavicular region, where fluid collection and subcutaneous emphysema are again seen. she underwent chest tube placement at bedside on with thoracic surgery and had 700cc drainage. on the chest-tube was removed. repeat chest ct on revealed a loculated right pleural effusion which was drained for 70cc. respiratory: intubated for acute respiratory distress. she remained stable and was extubated on . her respiratory status continued to improve and she was weaned from oxygen with saturations in the 90's. on she developed acute respirator distress and hematemesis. atraumatic intubation at the bedside was performed. she was extubated on without difficulty with saturations 98% on 2 liters nasal canula. her discharge oxygen saturation was 95% on room air. cardiac: she remained in sinus rhythm throughout her hospital course. gi: on gi was consulted for hematemesis: egd was performed and bleeding was mostly likely from the site of previous esophageal defect/perforation. she was transfused with 2 units packed-red-blood cells. she had no further bleeding and her hematocrit remained stable. nutrition: was consulted and she was started on replete with fiber goal of 70cc/hr which she tolerated. she was discharged on probalance 4 cans qid. gu: voiding without difficulty wound: neck incision was well healed on discharge. pain: pca dilaudid and roxicet with good control. on she developed radiculopathy pain down both arms. the pain service was consulted and recommended a fentanyl patch and neurontin. she had no relief and therefore she was started on methadone with roxicet for breakthrough pain with good pain control. neuro: on her wbc continued to rise. neurosurgery was consulted. a repeat ct of the chest/neck revealed a left vertebral pseudoaneurysm 1.5 5cm by 1.2 cm. the left supraclavicular abscess had decreased. it also revealed osteomyelitis of the c5-c6 vertebral bodies. cta of the neck on did not reveal a esophageal fistula. it did re-confirmed thrombosis of the left vertebral artery from the origin of c1. neurosurgery recommended an mri which was done on . it showed vertebral destruction/involvement with some compression of the cord. of note a fluid collection was noted at the neck which 6cc was aspirated and sent for cultures on . a repeat cervical mri showed no further compromise changes. the left posterior paraspinal abscess was somewhat smaller. no surgical decompression was warranted. a cta of the neck on show that the left vertebral artery remains occluded and no further imaging is required. mobility: she continue to work with physical therapy. disposition: discharged to home in stable condition on home intravenous antibiotics. she will follow-up with infectious disease as an outpatient and dr. for a barium swallow in one week. medications on admission: oxycodone fioricet combivent albuterol xanax discharge medications: 1. nicotine 21 mg/24 hr patch 24 hr : one (1) patch 24 hr transdermal daily (daily). 2. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily): give via g-tube. disp:*30 tablet,rapid dissolve, dr(s)* refills:*2* 3. metronidazole 500 mg tablet : one (1) tablet po tid (3 times a day): crush & give via g-tube. disp:*98 tablet(s)* refills:*0* 4. fluconazole 200 mg tablet : one (1) tablet po q24h (every 24 hours): crush & give via g-tube. disp:*32 tablet(s)* refills:*0* 5. acetaminophen 160 mg/5 ml solution : thirty (30) ml po tid (3 times a day). disp:*2700 ml* refills:*2* 6. oxycodone 5 mg/5 ml solution : ml po q3h (every 3 hours) as needed for pain. disp:*2400 ml* refills:*0* 7. gabapentin 400 mg capsule : one (1) capsule po q8h (every 8 hours): crush & give via g-tube. disp:*90 capsule(s)* refills:*0* 8. heparin flush cvl (100 units/ml) 1 ml iv daily:prn 10ml ns followed by 1ml of 100 units/ml heparin (100 units heparin) each lumen qd and prn. inspect site every shift 9. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 10. daptomycin 500 mg recon soln : one (1) recon soln intravenous q24h (every 24 hours). disp:*32 recon soln(s)* refills:*0* 11. levofloxacin 500 mg tablet : one (1) tablet po once a day: crush & give via g-tube. disp:*32 tablet(s)* refills:*0* 12. outpatient lab work please obtain weekly cbc, chem 7, lfts, and ck level. fax results to dr at 13. normal saline flush 0.9 % syringe : one (1) 10 ml injection every eight (8) hours: flush picc q8hrs . disp:*132 10 ml * refills:*2* 14. heparin lock flush (porcine) 100 unit/ml syringe : one (1) ml intravenous daily (daily) as needed. disp:*qs for 32 days ml(s)* refills:*2* 15. methadone 10 mg tablet : 1.5 tablets po tid (3 times a day): crush and give via g-tube. disp:*135 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: cervical esophageal perforation with neck and supraclavicular fossa abscess. epidural space abscess with extension to the prevertebral space. discharge condition: stable discharge instructions: call dr. office at if you experience chest pain, shortness of breath, fever, chills, nausea, vomiting, diarrhea, or abdominal pain. please call if you have difficulty tolerating tube feeds. if your feeding tube falls out, save the tube, call the office immediately . the tube needs to be replaced in a timely manner. do not put any medication down the tube unless they are in liquid form. flush your feeding tube with 50cc every 8 hours if not in use and before and after every feeding. vna instructions : place a clean dressing over feeding tube site. continue tube feeds and flushes as directed. administer iv antibiotics as directed. monitor neck wound sites. tubefeeding: probalance full strength with 10g beneprotein/day - administer 420cc 4 times per day. flush w/ 50 ml water q8h, before and after feedings. activity: as tolerated. walk at least 4 times per day for minutes at a time w/ rest periods as needed. medication: please followup with your primary care physician for pain medication management. take antibiotics as prescribed until or otherwise directed by infectious disease. labs: please obtain weekly cbc, chem 7, lfts, ck level. please fax results to dr at . followup instructions: , md phone: date/time: 11:00 on at 10:30am on the i, pulmonary interventional unit. barium swallow at 9:00am on the clinical center . no tube feeds after midnight monday. cxr: after barium swallow procedure: insertion of intercostal catheter for drainage insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified other endoscopy of small intestine other esophagoscopy insertion of endotracheal tube insertion of endotracheal tube thoracentesis percutaneous [endoscopic] gastrostomy [peg] arterial catheterization barium swallow removal of implanted devices from bone, other bones other incision with drainage of skin and subcutaneous tissue other incision with drainage of skin and subcutaneous tissue injection of antibiotic excision of intervertebral disc excision of intervertebral disc transfusion of packed cells other irrigation of wound other irrigation of wound injection or infusion of oxazolidinone class of antibiotics upper gi series other computerized axial tomography diagnoses: pneumonia, organism unspecified anemia, unspecified tobacco use disorder unspecified pleural effusion hyposmolality and/or hyponatremia infection with microorganisms resistant to penicillins occlusion and stenosis of vertebral artery without mention of cerebral infarction asthma, unspecified type, unspecified acute respiratory failure loss of weight methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site intestinal infection due to clostridium difficile hematemesis streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus intraspinal abscess acute osteomyelitis, other specified sites accidents occurring in residential institution fall from other slipping, tripping, or stumbling delirium due to conditions classified elsewhere other disorders of muscle, ligament, and fascia arthrodesis status perforation of esophagus open wound of nose, unspecified site, without mention of complication other and unspecified disc disorder, cervical region cellulitis and abscess of neck aneurysm of artery of neck other complications due to other internal orthopedic device, implant, and graft diverticulum of esophagus, acquired 

Answer: The patient is high likely exposed to