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: compazine / sulfa (sulfonamides) / aspirin / codeine attending: chief complaint: cellulitis major surgical or invasive procedure: picc line, tee history of present illness: 62 yo f with h/o cad s/p cabg, copd, htn, chf, chronic pain, cri, s/p partial gastrectomy, with recent admission for mrsa port-a-cath infection and sacroilitis currently week 3 of 6 vancomycin course, who returns from rehab with reported yellow/green discharge from port site over the past few days. per pt tm 101 initially with associated chills. per transfer nursing notes, tm 99 overnight. pt denies feeling unwell other than a chronic non-productive cough. no cp or sob. pt expressing concerns about care she is recieving at . thinks they are not properly dressing or caring for her wound. past medical history: #hypothyroidism #htn #cad s/p cabg on plavix (asa allergy) #chf (ef 60%; nl tte ) #h/o c.diff & mrsa #hip,spine fusion age 17 -patient unsure of original diagnosis #gastrectomy ( gastric ulcers, 10 years ago) #copd #tuberculosis (dx age 14; s/p rx) # chronic lbp # recent proteus uti # osteoporosis # odynophagia # chronic anemia (b/l hct ~30) # depression/anxiety # seizure disorder (since 's; unspecified; on dilantin) # osteoporosis # chronic renal insufficiency social history: divorced, three sons, 1 of whom lives in the area. patient has resided at rehab for the past 3 years multiple chronic health complaints. tob: quit age 40. 20 pack year history. denies etoh and drugs. family history: father-committed suicide at the age of 44 mother-87 years old, currently diagnoised with gastric cancer physical exam: vs: 98.7, 122/88, 16 99% ra gen: lying in bed, nad heent: perrl, eomi, op wnl, mmm neck: supple, no lad, no jvd chest: no erythema, warmth or tenderness on palpation of former port site. no discharge. surrounding contact dermatitis at dressing site. cv: rrr. nl s1 and s2, sm lungs: ctab abd: active bowel sounds, soft, non-tender, no masses appreciated ext: no lower extremity edema, dorsalis pedal pulses palpated bilaterally (1+) skin: no rash neuro: a&ox3, cnii-xii intact, mentation intact pertinent results: 05:20pm blood wbc-4.7 rbc-3.00* hgb-9.7* hct-29.8* mcv-100* mch-32.4* mchc-32.6 rdw-16.0* plt ct-161 05:20pm blood neuts-65.4 lymphs-24.6 monos-3.6 eos-6.3* baso-0.2 05:20pm blood plt ct-161 04:31pm blood pt-13.9* ptt-27.5 inr(pt)-1.2* 05:20pm blood glucose-100 urean-25* creat-0.9 na-139 k-5.1 cl-110* hco3-22 angap-12 11:50am blood alt-20 ast-22 alkphos-206* 02:25pm blood ck(cpk)-34 02:25pm blood ck-mb-notdone ctropnt-<0.01 12:55am blood ck-mb-notdone ctropnt-<0.01 03:54am blood ck-mb-notdone ctropnt-<0.01 05:29am blood vitb12-424 folate-5.3 05:29am blood tsh-0.73 03:54am blood hiv ab-negative 02:25pm blood phenyto-12.1 03:54am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-pos tricycl-neg 05:31pm blood lactate-1.3 01:40am urine bnzodzp-pos barbitr-pos opiates-pos cocaine-neg amphetm-neg mthdone-neg . 5:35 pm blood culture pick,lft ac. aerobic bottle (final ): reported by phone to 11:30 am. enterococcus faecalis. final sensitivities. high level gentamicin screen: resistant to 500 mcg/ml of gentamicin. screen predicts no synergy with penicillins or vancomycin. consult id for treatment options. high level streptomycin screen: resistant to 1000mcg/ml of streptomycin. screen predicts no synergy with penicillins or vancomycin. consult id for treatment options. . sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus faecalis | ampicillin------------ <=2 s linezolid------------- 2 s penicillin------------ 2 s vancomycin------------ =>32 r . 3:49 pm catheter tip-iv source: picc. wound culture (final ): no significant growth. . 9:44 pm stool consistency: loose source: stool. clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. reference range: negative. . mri pelvis: slight improvement of right sacroiliitis at the inferior/posterior aspects of the joint, with unchanged appearance at the anterior/superior aspect of the joint. no drainable fluid collection. . ct c-spine: question of rotation versus rotary subluxation of c1 on c2. cervical spondylosis. other findings as noted above. . ct head: technically limited study due to patient motion. no definite signs for an intracranial hemorrhage. . ct c-spine (flex/ext): degenerative changes, particularly at c4-c5 and c5-6. no evidence of instability. . eeg: this is an abnormal eeg in the drowsy state due to the presence of diffuse background slowing as well as bursts of generalized hz slowing. these abnormalities suggest an encephalopathy, which may be seen with medications, toxic metabolic abnormalities or infections. . u/s chest: ultrasound of the right anterior chest wall in the site of the previous port- a-cath was performed. in the subcutaneous area, note is made of an area of low echogenicity which measures 0.8 x 0.8 x 1.8 cm. this represents a small pocket of fluid which may be resolving post port-a-cath removal. . mr : mild degenerative changes. no evidence of discitis or osteomyelitis in the thoracic region. no evidence of spinal cord compression or abnormal intrinsic signal within the spinal cord. . mr : signal changes within the l5-s1 disc with subtle enhancement are suspicious for early changes of discitis. no epidural mass or epidural phlegmon seen or paraspinal abscess identified. mild degenerative changes. findings suggestive of previous fusion at l4-l5 level. . video oropharyngeal swallow: mild oropharyngeal dysphagia resulting in trace aspiration of thin liquids. a small esophageal web is noted. . barium swallow: limited study. no obstruction or strictures within the esophagus. . tte: the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and systolic function are normal (lvef 70%). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. there are three aortic valve leaflets. the aortic valve leaflets are mildly thickened. no masses or vegetations are seen on the aortic valve. there is no aortic valve stenosis. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. the estimated pulmonary artery systolic pressure is normal. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , no major change is evident. the absence of a vegetation by 2d echocardiography does not exclude endocarditis if clinically suggested. . tee: 1. the left atrium is dilated. 2. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). 3. there are mobile, complex (mobile) atheroma in the aortic arch. 4. the aortic valve leaflets (3) are mildly thickened. 5. no echocardiographic evidence of endocarditis is seen. . cxr : no evidence of pneumonia or failure is present. brief hospital course: addressed by problem: . # id: the patient arrived on the floor afebrile with stable hemodynamics. she was continued on vancomycin for treatment of her recent mrsa bacteremia and port-a-cath infection with l5-s1 disciitis and right sacroiliitis. there was no evidence of cellulitis at the former port-a-cath site in the right upper chest wall. the surgical site appeared well-healed and no drainage was noted. ultrasound was performed at this site and revealed a small simple fluid collection (0.8x0.8x1.8cm) that was likely due to post-operative changes. surgery evaluated the former port-a-cath site and recommended no need for drainage. mr of the right hip, lumbar, and thoracic spine were performed and revealed resolving discitis, sacroiliitis, and no evidence of osteomyelitis or epidural abscess. the patient requested hiv test and was antibody negative. c. diff stool toxin was negative x 1. on hospital day #2, surveillance blood cultures drawn in the ed grew high-grade vancomycin-resistant enterococcus. the patient remained afebrile with stable vitals. the source of this bacteremia was unknown but thought to be most likely related to the indwelling picc line. id team was consulted and the patient was switched to iv daptomycin. her right antcubital picc line was removed on . subsequent daily blood cultures have shown no growth. a new picc line was placed in the right upper extremity by interventional on for antibiotics and blood draws as there was no other venous access available despite multiple attempts by both iv nursing and the micu team (failed left subclavian line placement, no complications). regarding the etiology of her vre bacteremia: line infection, cardiac, and gi sources were considered. although believed to be the most likely source, there was no evidence of line infection as the culture from the picc tip was negative. there was also no evidence of endocarditis or valvular vegetations on both tte and tee. abdominal sources were considered but believed unlikely given no complaints, normal exam and lfts, and therefore an abdominal ct scan was not performed. id desired to transition the patient to oral antibiotics, however the patient was taking effexor and had to be weaned off this medication given the theoretical risk for serotonin syndrome. pharmacy and psychiatry were consulted regarding effexor weaning which was successfully performed over 5 days without noted withdrawal symptoms and then discontinued completely on . daptomycin was discontinued on and the patient was started on linezolid po 600mg to complete at least a 2 week course. she remained afebrile with stable vital signs and serial neurological exams revealed no evidence of serotonin syndrome. she will need weekly cbc, bun, creatinine, and lfts to monitor for side effects while on linezolid. she will f/u with dr. from infectious disease. - cbc, bun, creatinine, lfts qweekly --> fax results to dr. @ . # loss of consciousness: on , the patient was found by staff lying on the floor of her room responding only to painful stimuli with no spontaneous movement of extremities. the event was unwitnessed. she was placed in a hard cervical collar. ct head was negative; ct c-spine revealed no fracture but there was a question of c1-c2 rotational instability. she was transferred to the micu for close observation. neurology who suggested unlikely to be cva. neurosurgery requested c-spine flexion and extension films which showed no signs of instability, however given the c1-c2 rotational instability noted in her c-spine she was continued with a hard collar. she was ruled-out for mi with serial cardiac enzymes. eeg suggested encephalopathy medications vs. toxic/metabolic vs. infection. as her symptoms resolved, she displayed evidence of a post-ictal state. her mental status gradually improved and her neurological exam resolved back to baseline. given her h/o seizure disorder, this event appeared to be most likely a seizure, however her dilantin level was therapeutic. given her positive blood cx, there was concern for septic emboli, however given the transient nature of her symptoms it was believed less likely. one possible etiology in light of the cervical ct findings was atlantoaxial subluxation. the patient stabilized in the micu and was transferred back to the floor for continued care on . daily dilantin levels were followed and were therapeutic. per neurology, she was transitioned to keppra 1000mg po bid and weaned off dilantin. she had no further loc episodes while on the floor and her neurological examination remained non-focal. she is scheduled to follow-up in with dr. in clinic. . # c1/c2 rotational instability: (see above loc for description of event) neurosurgery evaluated the patient s/p unwitness fall. c-spine flexion/extension films were stable but rotation of c1 on c2 was noted on c-spine ct. it was recommended that the patient wear a hard cervical collar (aspen) for 4 weeks given concern about rotational instability in her cervical spine. despite frequent reminders about the severity of this potential problem, the patient continued to occasionally remove and refuse to wear the cervical collar. she was counseled extensively regarding the risks including paralyzation and death. she should call to schedule a f/u appointment with dr. from neurosurgery in 3 weeks for evaluation. . # dysphagia: the patient reported difficulty swallowing large pieces of meat for at least one year. she stated that frequently she would have to vomit to remove the obstruction. denies difficulty swallowing liquids or odynophagia. also states she was told by her pcp that she had an esophageal stricture that needed to be dilated. her last egd was approximately following partial gastrectomy for peptic ulcers. gi and was consulted for evaluation, and believed the problem to likely be oropharyngeal in nature. she was noted to have a small cervical esophageal web on video swallow study; barium swallow was limited due to cervical collar but revealed no evidence of obstruction or stricture. speech and swallow evaluation was performed and negative for signs of aspiration, however it she did struggle swallowing mixed consistency liquids (e.g. cereal with milk, soup with peas) and therefore her diet was changed to eliminate these components. gi suggested outpatient evaluation including egd. she will follow-up with dr. from gi after discharge. . # htn: her bp was well-controlled throughout admission, however chagnes were made to her regimen to optimize long-term management. she was changed from metoprolol to atenolol 100mg po qd. lisinopril was started and increased 2.5mg qod to reach goal dose of 10mg qd. she was begun to be weaned off clonidine by decreasing 0.1mg qod. she tolerated these medication changes without difficulty and showed no signs of rebound hypertension during clonipine taper. she should be monitored as an outpatient by her pcp and her medications titrated for goal bp<130/80. - follow bp's as outpatient and titrate regimen . # cad: the patient is s/p cabg . cardiac cath with patent grafts. ett c myoview normal. stable c no active ischemia. she was r/o for mi with serial cardiac enzymes. ekg's were unchanged from prior studies. she was continued on beta blocker, lipitor, and imdur. plavix (patient has aspirin allergy) was briefly discontinued s/p fall and transfer to micu but reinstituted shortly after returning to the floor. of note, on tee the patient had mobile atheroma present in the aortic arch. . # chf: carries this diagnosis but ef 60-70% and requires no diuretics at home. she had both tte and tee while inpatient which were within normal limits. she remained euvolemic throughout admission. i&os and daily weights were monitored. she had no sob or signs of volume overload during admission and required no lasix. . # hypothyroidism: currently euthyroid with tsh 0.73 at admission. she was continued on her home dose of levothyroxine. . # chronic anemia: etiology is likely due to chronic disease. b12 and folate levels were within normal levels. she was guaiac negative x 1 and positive x 1. the patient reports occasional brbpr that she attributes to hemorrhoids. reports colonoscopy approximately 5 years ago at (dr. which was negative. her hematocrit remained stable throughout admission. - consider outpatient colonoscopy referral, patient has appointment for clinic . # gerd: no active issues, she was continued on proton pump inhibitor. . # chronic lbp: possibly related to disciitis, although per report and prior notes obtained from medical center this appears to be a chronic problem. she has had prior back surgery while a teenager. she was continued on her outpatient regimen while in house and required no breakthrough pain medications. . # psych: patient wih history of depression and anxiety. initially she was continued on effexor, xanax, and serax. as it was desired that she start linezolid, she was weaned off of effexor with no obvious adverse side effects noted. psychiatry was consulted regarding management of depression off effexor and benzodiazepines. she was not restarted on a new anti-depressant as she was not currently showing signs of major depression and did not desire continued treatment. regarding her benzodiazepines, zanax and serax were discontinued and she was started on klonapin 0.5mg po tid and slowly weaned to klonapin 0.5mg po qd prn prior to discharge. she was closely monitored and displayed no active signs of benzo withdrawal . # tremors: the patient complained of occasional chronic tremors involving her arms and legs that occur with activity. she was evaluated by neurology. no resting or intention tremors were noted and she had a normal neurological exam. it was though that this may be related to deconditioning and chronic illness, however other possibilities include medication side effects from her polypharmacy. she will be followed by neurlogy as an outpatient. . # osteoporosis: the patient was continued with vitamin d and calcium supplements. consideration should be given for starting alendronate after the cervical collar is removed. outpatient bone density scan may also be helpful in management. . # cough: patient complained of a dry cough on day of discharge. afebrile, no leukocytosis. cxr without pna. . # fen: diabetic/cardiac diet (no mixed consistency liquids, give pills in applesauce); electrolytes were monitored daily and repleted as needed . # ppx: pneumoboots (pt refuses sc heparin), ppi . # dispo: return to rehabilitation facility medications on admission: 1. clopidogrel 75 mg po daily 2. venlafaxine 150 mg po daily 3. isosorbide mononitrate 60 mg po daily 4. atorvastatin 20 mg po daily 5. oxazepam 10 mg po hs as needed for insomnia. 6. phenytoin sodium extended 100 mg capsule sig: three (3) capsule po monday, wednesday, friday (). 7. phenytoin sodium extended 100 mg capsule sig: six (6) capsule po sunday, tuesday, thursday, saturday (). 8. allopurinol 100 mg po daily 9. levothyroxine 175 mcg po daily 10. alprazolam 0.25 mg po qid 11. calcium carbonate 500mg po tid 12. clonidine 0.1 mg po daily 13. tizanidine 4 mg po tid 14. metoprolol tartrate 100 mg po bid 15. miconazole nitrate 2 % powder tid (3 times a day) as needed. 16. bacitracin zinc 500 unit/g ointment 17. docusate sodium 100 mg po bid 18. senna 8.6 mg po bid 19. hydromorphone 9 mg po q6h as needed. 20. gabapentin 300 mg po q8 21. oxycodone 10 mg po q4-6h prn 22. acetaminophen 500 mg tablet sig: one (1) tablet po every six (6) hours. 23. morphine 100 mg tablet sustained release po q12h 24. cholecalciferol 800 unit daily 25. pantoprazole 40 mg po q12h 26. vancomycin 1000 (1000) intravenous q 24h (every 24 hours): patient to complete 6 weeks of abx, with start date being . discharge disposition: extended care facility: - discharge diagnosis: primary: 1. high grade vre bacteremia and line sepsis 2. stable mrsa right sacroiliac osteomyelitis and l5-s1 discitis 3. seizure w/ loc and neck trauma. 4. rotary subluxation of c1 on c2. 5. oropharyngeal dysphage nos 6. esophageal web past medical history: 1. mrsa port-a-cath infection c/b sacro/vertebral osteomyelitis. 2. coronary artery disease s/p cabg . 2. hypertension. 3. chronic obstructive pulmonary disease. 4. seizure disorder nos. 5. hypothyroidism. 6. osteoporosis. 7. depression/anxiety. 9. s/p l4-l5 laminectomy and fusion. 10. peptic ulcer disease s/p gastrectomy. 11. tuberculosis treated at age 14. 12. left upper extremity dvt. discharge condition: stable discharge instructions: please take all medications as prescribed. . new medications: linezolid, lisinopril, levetiracetam, clonazepam . discontinued medications: phenytoin, metoprolol, alprazolam, oxazepam, venlafaxine . you will need weekly blood tests (cbc, bun, creatinine, and lfts) while on antibiotics (linezolid). please have the results faxed to dr. of infectious disease at (. . if you experience worsening pain, fever, nausea, vomiting, chills, headache, vision changes, weakness, numbness, tingling, seizures, shortness of breath, or other concerning symptoms please call your doctor immmediately or return to the emergency department for evaluation. followup instructions: you have the following appointments scheduled. please contact the appropriate provider with questions or in the event that you need to reschedule. . pcp: . : (. dr. is retiring and has transferred your care to dr. . you are scheduled to see dr. on thursday at 2:45pm. please call your insurance to report that you are switching pcp's. . you will need weekly blood tests (cbc, bun, creatinine, and lfts) while on antibiotics (linezolid). please fax the results to dr. of infectious disease at (. . infectious disease: dr. phone: ( date/time: 11:00 . gastroeneterology: dr. phone: date/time: 8:30 . clinic: dr. & dr. phone: date/time: 8:30 . neurosurgery: dr. phone: (. call for appointment in 3 weeks regarding cervical spine collar. . md, procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart diagnoses: anemia of other chronic disease coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified infection with microorganisms resistant to penicillins aortocoronary bypass status other convulsions depressive disorder, not elsewhere classified chronic kidney disease, unspecified anxiety state, unspecified bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site osteoporosis, unspecified old myocardial infarction personal history of venous thrombosis and embolism infection and inflammatory reaction due to other vascular device, implant, and graft streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] other and unspecified disc disorder, lumbar region sacroiliitis, not elsewhere classified other alteration of consciousness closed fracture of first cervical vertebra personal history of tuberculosis essential and other specified forms of tremor fracture, cause unspecified injury of face and neck tracheoesophageal fistula, esophageal atresia and stenosis 

Answer: The patient is high likely exposed to