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: back pain major surgical or invasive procedure: picc line placed on history of present illness: 80 year old female with a history of multiple sclerosis, alzheimer's disease, hypertension who presents from a nursing home with one day of back pain. per staff at her nursing home she was in her usual state of health until the day prior to presentation when she began to complain of back pain. she was unable to clarify further. her temperature was 100.4 with blood pressure 162/82. she received vicodin and tylenol without improvement. at baseline she is alert, oriented but does not ambulate. she is able to eat by herself but is incontinent of urine and stools. she was transferred to for further management. . in the ed, initial vs were: t: 98.0 p: 90 bp: 104/69 r: 16 o2 sat: 92% on ra. she became tachycardic to the 140s (sinus tachycardia) with stable blood pressures and spiked a fever to 101.5. her antibiotics were broadened to vancomycin and cefepime and she had a ct of the chest with contrast which was not timed appropriately and did not show a large pulmonary embolism but could not rule out a small pulmonary embolism. she also received 2 mg morphine, tylenol, ciprofloxacin 500 mg x 1, morphine 2 mg iv x 1 and haldol 2.5 mg iv x 1. she received 2 liters of iv with improvement in her heart rate to the high 100s. she was admitted to the icu for further management. . on the floor, she is unable to clarify further. she says that she has been having back pain for 2-3 days. the pain is in her bilateral back. it is worse with movement. it was not associated with any trauma that she recalls. she denies fevers, chills, lightheadedness, dizziness, chest pain, difficulty breathing, nausea, vomiting, abdominal pain, diarrhea, constipation, dysuria, hematuria, leg pain or swelling. past medical history: multiple sclerosis coronary artery disease hypertension hyperlipidemia osteoporosis hypothyroidism depression chronic sinusitis and allergic rhinitis. endometriosis, status post laparoscopy. dysfunctional uterine bleeding social history: currently coming from nursing home. no current smoking, alcohol or illict drug use. very remote smoking history (less than 3 pack years). used to work in a cardiology office. family history: coronary artery disease in brother. possible ms in a deceased sister. physical exam: vitals: t: 99.8 bp: 109/68 p: 89 r: 16 o2: 95% on ra general: alert, oriented to person and hospital, not , date or year, speech slurred (noted in previous neurologic exams) heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, tender in epigastric region and right upper quadrant, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley draining urine (received pyridium in er) ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema, excoriations throughout back: pain in paraspinal region bilaterally, no flank pain neurologic: cn ii-xii tested and intact, strength 5/5 throughout, sensation intact across all dermatomes, reflexes 2+ and symmetric, unable to assess gait pertinent results: 01:35pm blood wbc-12.2*# rbc-4.03* hgb-11.9* hct-37.1 mcv-92 mch-29.6 mchc-32.2 rdw-13.8 plt ct-338 01:35pm blood neuts-80.9* lymphs-12.4* monos-5.4 eos-1.0 baso-0.3 01:35pm blood glucose-118* urean-22* creat-1.0 na-140 k-3.6 cl-101 hco3-29 angap-14 04:08am blood calcium-8.0* phos-3.1 mg-1.8 01:35pm blood alt-13 ast-15 alkphos-90 totbili-0.4 04:15pm urine color-amber appear-hazy sp -1.026 04:15pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirub-neg urobiln-neg ph-6.5 leuks-tr 04:15pm urine rbc-3* wbc-21-50* bacteri-many yeast-none epi-4 . micro aerobic bottle gram stain (final ): gram positive cocci in clusters. anaerobic bottle gram stain (final ): gram positive cocci in clusters. last positive blood culture on : staph aureus coag +. sensitivities performed on culture # , . anaerobic bottle gram stain: gram positive cocci in clusters mrsa screen: no mrsa isolated sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s oxacillin-------------<=0.25 s urine culture: escherichia coli. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s urine culture on : no growth. . ecg: probable sinus tachycardia versus regular svt at 148, borderline left axis, borderline prolonged qtc at 470, no st segment elevation or depression, compared with prior dated the rate is faster. . cxr: no evidence of pneumonia. . cta chest: equivocal subsegmental pulmonary embolism in a right upper lobe branch (3:38, 402b:54) may reflect volume averaging artifact. no large pe. bibasilar atelectesis. no acute aortic pathology. abd xray on : mild distension of the stomach is once again noted in this study. dilated loops of small bowel are noted. multiple air- fluid levels are noted on left lateral decubitus. colon is noted to be filled with air throughout the colon. overall findings are consistent with ileus. impression: dilated loops of small bowel with air noted throughout colon consistent with ileus. gastric distension is once again noted in this study. abd us on : there is no focal liver lesion identified. there is no biliary dilatation and the common duct measures .6 cm. the portal vein is patent with hepatopetal flow. multiple shadowing gallstones are seen in the gallbladder which is not overly distended. there is no gallbladder wall thickening and no pericholecystic fluid is seen. the visualized portion of the pancreas is unremarkable, however, the pancreas is partially obscured by overlying bowel. the spleen is unremarkable and measures 9.3 cm. both right and left kidneys show no hydronephrosis. the right kidney measures 9.0 cm and the left kidney measures 8.8 cm. no aaa is identified on limited views of the aorta. impression: 1) cholelithiasis with no sign of cholecystitis. brief hospital course: this is a 80 yo female with history of ms, alzheimers, hypertension who presents from a nursing home with one day of back pain, fever and confusion who was found to have mssa bacterimia and developed an ileus and transaminitis. . #bacterimia/back pain: given patients history of acute onset, change in mental status, fever and elevated wbcs this was concerning for sepsis/infection paraspinal abcess, osteomyelitis. given history of osteoporosis, compression fracture was also in the differential but preliminarily no evidence on ct chest. mri t&l done on which showed no acute processes. she was given broad spectrum antibiotics including: ciprofloxacin and ceftaxine were given x1, vanco iv x 2 days until her blood culture results were available. she was foud to have mssa so she was started on nafcillin 2 gm iv q4 hrs, from ->. nafcillin was stopped due to increased in lfts, ruq abdominal pain, nausea and vomiting. she was started on cefazolin 2 gm iv q 8hrs. patient's condition had overall improved, her confusion resolved on the second day of admission although she has alzheimers at baseline. she states to always have a baseline backpain, but it was much improved from admission. pt was also found to have a uti + e.coli which she was treated for a total of 3 days, urine culture was repeated on which was negative. patient also has been followed by infectious diseases who gave antibiotic recommendations. she had a picc line placed on which she had removed after the first day, she stated that if was ictching and she pulled it out. she had another picc replaced on her right ac which was working well prior to discharge. . # nausea and vomiting: pt complained of nausea and vomited a small amount of greenish fluid on and . she also had tenderness on her right upper quad. abdominal us showed cholelithiasis without cholecystitis. since naficillin can cause some liver toxicity, the medication was discontinued. transaminitis started to trend down. however, on patient's abdomen looked distended, tympanic, and she continued to complaint of ruq abdominal pain. she had increased liquid bms for the prior 2 days which were attributed to motility agents she had received. given that she was in numerous antibiotics, stool was sent for c-diff and place her on prophylactic flagyl 500mg po. we also did a kub which showed an ileus. this was most likely related to an functional ileus, since she was on narcotics, laying in bed with decreased mobility, and no bm for a 4-5 days prior to receiving motility agents. she was made npo for 1 day. on physical exam her abdomen on the following day was soft, continued to be mildly distended, but less tender. + bs x 4 quads and she had two bms. we advanced her diet. she has been tolerating her diet well with no n/v and no complain of abdominal pain. her c-diff culture was negative and her flagyl was d/c on . #transmianitis: as noted above she had sl. increase in ast, alt and alk phos with nausea and vomiting for 2 days and ruq tenderness. this was thought to be related to the nafcillin. once nafcillin was d/c'd and labs started to trend down. she was also found to have increase in lipase of 79 and amylase of 113 on . this was believed to be caused by mild pancreatitis also related to prior treatment administration of nafcillin. she will have continue monitoring of lfts, including lipase and amylase weekly. she was doing well at discharge, tolerating her regular diet with no complains of n/v or abdominal pain. . #uti: urine culture positive for e.coli > 100,000 colonies, rresistant to cipro and ampicillin. sensitive to the cefalosporins, zozyn, tobramycin, bactrim, and nitrofurantoin. received 3 days of bactrim. d/c on . repeat ua on . urine culture on shows no growth. . #tachycardia: patient has been sinus tachycardic for most of her admission. ekg remained unchanged, she was placed on tele for the first few day of admission where she remained on sinus tachy in rates ranging from 90s to low 100s, asymptomatic. this could be due to mild hyperthyroidism, tsh low 0.08 and on levothryroxine. patient also given extra fluid bolus which she responded well, so could also be due to dehydration. patient stable at time of discharge. follow tsh and t4 as outpaint encourage po fluids. . # 2nd degree right buttock ulcer: patient with small 2x1 cm in diameter excoriation on right buttock. the wound care nurse assessed and treated the wound. the wound has overall improved, now there is only very small wound healing well less than .5cm in diameter at the time of discharge with dressing over it. . #coronary artery disease: no changes on ekg. - continue aspirin 81 mg daily . at discharge: patient is alert and oriented times place and time. she respond appropriately to questions, and conversing. very pleasant. she moves in bed with minimal assist. she is incontinent of urine and stool which is her baseline. she is stable and medically clear to go back to her extended care facility. medications on admission: cymbalta 30 mg daily folic acid 1 mg daily loratadine 10 mg daily multivitamin thiamine 100mg daily simvastatin 40 mg dialy vicodin 5-500 and q4h:prn namenda 10 mg lorazepam 0.5 mg q6h:prn prochlorperazine 10 mg q6h:prn tylenol 650 mg prn milk of magnesia 400 mg daily:prn bisacodyl 10 mg pr daily:prn fleets enema prn senna prn calcium 500 mg tid detrol 4 mg qhs aricept 10 mg qhs levothyroxine 125 mcg daily colace aspirin 325 mg daily vitamin d 50,000 q month discharge medications: 1. duloxetine 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. namenda 10 mg tablet sig: one (1) tablet po twice a day. 6. multivitamin tablet sig: one (1) tablet po daily (daily). 7. lorazepam 0.5 mg tablet sig: one (1) tablet po q 6hrs: prn as needed for anxiety. 8. donepezil 10 mg tablet sig: one (1) tablet po at bedtime. 9. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for back pain: on for 12 hrs and off for 12 hrs. 10. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 11. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 12. acetaminophen 325 mg tablet sig: two (2) tablet po q8h (every 8 hours) as needed for pain: please do not exceed 2gm per day . 13. cefazolin in normal saline 2 gram/100 ml solution sig: two (2) gram intravenous every eight (8) hours for 22 days: mssa bacterimia. please stop on . 14. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous once a day as needed for line flush: picc, heparin dependent: flush with 10ml normal saline followed by 2 ml of heparin daily and prn per lumen. 15. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush: picc, heparin dependent: flush with 10ml normal saline followed by 2 ml heparin daily and prn per lumen. 16. senna 8.6 mg tablet sig: one (1) tablet po once a day as needed for constipation: please hold for loose stool. 17. colace 50 mg capsule sig: one (1) capsule po twice a day: please hold for loose bm. 18. compazine 10 mg tablet sig: one (1) tablet po q 6hrs: prn. 19. loratadine 10 mg tablet sig: one (1) tablet po once a day. 20. calcium 500 mg tablet sig: one (1) tablet po three times a day. 21. detrol la 4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po at bedtime. 22. vitamin d 50,000 unit capsule sig: one (1) capsule po once a month. 23. milk of magnesia 400 mg/5 ml suspension sig: five (5) ml po q day prn as needed for constipation. discharge disposition: extended care facility: health care discharge diagnosis: primary: bacteremia urinary tract infection ileus secondary: alzheimers dementia multiple sclerosis htn depression discharge condition: stable, confusion and pain improved. afebrile discharge instructions: you were admitted to for severe back pain and confusion. when you came into the emergency room your temperature was 101.5 f and your heart rate was fast. we found that you have an urinary tract infection and an infection in your blood. we have been giving you antibiotics and your symptoms of back pain and confusion have improved. you had infectious diseases consult and you will need to be in iv antibiotics for a total of 4 to 6 weeks. you also had a picc line placed for the iv antibiotics. you also developed nausea, vomiting, and pain in the right side of your abdomen. you had a xray of your abdomen which showed that you had a blockage in your intestine. you didn't eat for one day and we changed some of your medications which helped you started to feel better. we have made the following medication changes: -started on cefazolin 2 gm iv every 8 hours you should have blood draws every week and you should follow the appointments as noted below. if you develop any chest pain, shortness of breath, fever (temperature greater than 101.3 f), chills, palpitations, confusion or for increase pain in your abdomen or in your back, or for any other concerns you should call your doctor or come the emergency room. followup instructions: provider: . , infectious diseases doctor, on at 9:oo am. location: at , across from emergency room. phone: blood draw: please have cbc, chem 7 (na, k, cl, hco2, bun, creat, gluc), lfts (alt,ast,t.bili, alk phos), drawn weekly while on antibiotics and have results faxed to dr. at (phone # ). procedure: venous catheterization, not elsewhere classified diagnoses: urinary tract infection, site not specified unspecified essential hypertension unspecified acquired hypothyroidism depressive disorder, not elsewhere classified methicillin susceptible staphylococcus aureus septicemia sepsis other and unspecified hyperlipidemia other specified cardiac dysrhythmias osteoporosis, unspecified paralytic ileus pressure ulcer, buttock alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance multiple sclerosis backache, unspecified acute pancreatitis pressure ulcer, stage ii 

Answer: The patient is high likely exposed to