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: s/p fall at the nursing home major surgical or invasive procedure: placement of right a-line placement of left internal jugular central line history of present illness: yo female, resident at rehab with h/o dementia, pe and dvt in for which she has been on coumadin (inr 4.7 on admission), chf who was found on the floor at rehab. head ct showed small right temporal intraparenchymal hemorrhage, 2x2 cm., which was unchanged on repeat head ct. inr was 4.7 and platelets of 93 at the time of presentation. c-spine was cleared by ct. in the ed, the patient was evaluated by ns and trauma and was felt not to be a candidate for intervention. she was intubated for airway protection. prior to being transferred to micu, the patient was loaded with dilantin 1 gm iv once, inr reversed with vitamin k 10 units sc, 4units of ffp, 6 pack of platelets. she was given lasix 40 iv and received 1l ns for hypernatremia. past medical history: 1. osteoporosis 2. diverticulosis and h/o lower gi bleed secondary to diverticulitis requiring subtotal colectomy 3. sss s/p ppm 4. urosepsis 5. dry eyes 6. mild ai 7. chf ef 20-30% 8. dementia 9. anxiety 10. hypercalcemia (?primary hyperparathyroidism) 11. blindness 12. anxiety social history: lives at rehab. rest of social history is unknown. son is hcp. family history: non-contributory. physical exam: afebrile hr 97 bp 116/71 rr 15 86% on vent (puls ox is not reliable) ac 400 x 16; peep 5; fio2 100% gen: thin elderly lady, intubated and sedated heent: large left fontal hematoma; eyes with clouded cornea; small pupils; no obvious reaction to light neck: supple no lad cv: tachy, irreg irreg, no m/r/g lung: crackles b/l bases abd: + bs, soft, nt, midline scar, llq hematoma ext: 2+ edema b/l ext neuro: unable to assess as patient is intubated/sedated rectal: guaiac + per ed note pertinent results: admission labs: . 11:45am pt-25.3* ptt-35.0 inr(pt)-4.7 11:45am plt smr-low plt count-93* lplt-2+ 11:45am hypochrom-3+ anisocyt-2+ poikilocy-1+ macrocyt-1+ microcyt-1+ 11:45am neuts-67.2 lymphs-26.8 monos-4.0 eos-1.6 basos-0.3 11:45am wbc-7.0 rbc-4.79 hgb-13.0 hct-43.9 mcv-92 mch-27.2 mchc-29.7* rdw-18.9* 12:13pm glucose-124* na+-157* k+-7.4* cl--114* 02:45pm calcium-11.7* phosphate-2.1* magnesium-2.3 02:45pm glucose-129* urea n-38* creat-0.8 sodium-157* potassium-4.4 chloride-121* total co2-26 anion gap-14 05:00pm pt-17.0* ptt-112.9* inr(pt)-2.0 05:00pm hypochrom-3+ anisocyt-2+ poikilocy-1+ macrocyt-2+ microcyt-1+ 05:00pm neuts-61.6 lymphs-33.5 monos-2.8 eos-1.5 basos-0.6 05:00pm wbc-5.5 rbc-3.56*# hgb-10.0* hct-33.7*# mcv-95 mch-28.2 mchc-29.8* rdw-19.3* 05:00pm calcium-11.9* phosphate-2.3* magnesium-2.3 05:00pm glucose-196* urea n-36* creat-0.9 sodium-158* potassium-4.5 chloride-116* total co2-25 anion gap-22* 05:17pm lactate-5.0* 05:17pm type- temp-36.7 rates-/18 po2-19* pco2-51* ph-7.38 total co2-31* base xs-2 intubated-intubated 07:07pm lactate-2.8* 07:07pm type-art po2-423* pco2-31* ph-7.60* total co2-32* base xs-9 intubated-intubated 10:34pm urine mucous-mod 10:34pm urine hyaline-10* 10:34pm urine rbc-115* wbc-11* bacteria-many yeast-none epi-4 10:34pm urine blood-lge nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-8.0 leuk-tr 10:34pm urine color-ltamb appear-slcldy sp -1.020 10:34pm pt-14.8* ptt-29.5 inr(pt)-1.5 10:34pm plt count-96* 10:34pm wbc-5.9 rbc-3.81* hgb-10.4* hct-34.3* mcv-90 mch-27.3 mchc-30.2* rdw-18.9* 10:34pm calcium-11.5* phosphate-1.5* magnesium-2.1 10:34pm ck-mb-3 ctropnt-0.02* 10:34pm ck(cpk)-70 10:34pm glucose-123* urea n-36* creat-0.8 sodium-158* potassium-3.3 chloride-118* total co2-31 anion gap-12 pertinent labs/studies: . 10:34pm blood ck-mb-3 ctropnt-0.02* 06:07am blood ck-mb-notdone ctropnt-0.03* . imaging: : ct head: impression: temporal intracerebral hemorrhage and subcutaneous hematoma in the left frontal region. . : ct head: impression: stable appearance of right temporal intraparenchymal hemorrhage. . : portable chest: impression: congestive heart failure with slight improvement in degree of pulmonary edema. . : portable chest: portable supine ap radiograph of the chest is reviewed, and compared with the previous study of . there is marked increase in severe pulmonary edema probably due to congestive heart failure associated with cardiomegaly and bilateral pleural effusion. there is increased atelectasis in both lower lobes. the possibility of superimposed pneumonia cannot be excluded. pacemaker leads and nasogastric tube remain in place. no pneumothorax is identified. the radiograph is suboptimal in technique. . . microbiology: blood cultures: : no growth to date : no growth to date urine: : 2 colonies, both e. coli, pan-sensitive : yeast > 100k cfu stool: : cultures negative c. diff negative x 4 . sputum: : > 25pmns, < 10epi. gram positive cocci in pairs and clusters - moderate growth of mrsa discharge labs: patient deceased . 03:46am blood wbc-6.9 rbc-2.95* hgb-8.3* hct-26.7* mcv-91 mch-28.2 mchc-31.2 rdw-20.1* plt ct-210 03:46am blood glucose-144* urean-21* creat-0.5 na-143 k-3.8 cl-102 hco3-34* angap-11 03:46am blood calcium-10.8* phos-2.0* mg-1.7 03:41am blood caltibc-194* ferritn-174* trf-149* 07:09am blood type-art po2-96 pco2-48* ph-7.37 calhco3-29 base xs-1 brief hospital course: a year-old female with a history of dementia, chf, dvt and pe (), afib, previously on anticoagulation therapy admitted s/p fall with intraparenchymal hemorrhage on admission. . #. right temporal lobe cerebral hemorrhage: the patient was transferred to s/p fall at rehab. patient was found to have a 2x2 intraparenchymal bleed on ct with noted decline in mental status while in the ed. this bleed occurred in the setting of a supertherapautic inr from coumadin. the patient had immediate reversal of her anticoagulation with 4 units of ffp and received 6 units of platelets for thrombocytopenia with platelet count of 93 and was loaded on dilantin for seizure prophylaxis and started on keppra as well. the patient was evaluated by neurosurgery who did not feel there was an indication for surgery, but did recommend reversal of anticoagulation with goal of inr < 1.3 and platelets > 1000. the patient was transferred to the icu and intubated for airway protection. the patient had a sodium of 158 on admission and was given ns for hypovolemia followed by free water repletion to a normal sodium which was discontinued after normalization and also upon recommendation from neurosurg given concern for increasing edema in setting of intracranial bleed. with regards to her bleed, the patient had two repeat head cts which demonstrated stable bleed without expansion or midline shift. given that the hematoma was stable, neurosurgery signed off recommending repeat head ct in approximately 4 weeks time. upon further discussion, they reported to the treating team that the patient's prognosis with regards to her mental status changes would be expected that she should return to her previous baseline prior to this accident. however, the treating team and geriatrics team following the patient felt that given her baseline mental status and the multiorgan damage ensuing from this accident, that it was probable the patient would not fully recover from this accident. given her stable lesion and no evidence of ongoing bleed, patient's platelet transfusion threshold lowered to 50k in attempt to decrease fluids as patient has been developing body volume overload and anasarca in setting of volume resuscitation for hypotension. the patient demonstrated very slow to no improvement in neurologic status. she demonstrated some increasing amounts of spontaneous movements and was able to open eyes to commands, but performed very few other commands. when not stimulated, despite being off all sedatives, the patient remained relatively obtunded. the patient was maintained on dilantin and keppra. after detailed discussion re: prognosis and potential for recovery with son , hcp), the code status was changed to dnr/dni/cmo, and the pt. passed away comfortably from cardiorespiratory arrest/failure shortly after. . #. hypotension: upon transfer to the micu the patient had been requiring volume support and pressors to maintain a map > 60. on admission patient was initially receiving fluid boluses and started on levophed for hypotension and decreased urine output. given the patient was developing total body fluid overload, including moderate to severe pulmonary edema, levophed was increased in an attempt to limit fluid support, with goal of fluid boluses for cvp < 14. in setting of increased levophed the patient's blood pressure did indeed respond, but she also developed rapid ventricular response to her afib. therefore, levophed was weaned and the patient was switched to neosynephrine for pressure support. the patient's cvp goals were additionally decreased with fluid boluses for cvp < 8, again given worsening fluid overload. the etiology of the patient's hypotension is unclear, but likely related to her poor cardiac function and possibly infection, although the patient never developed a leukocytosis or fever. the patient had a sputum culture with moderate growth of mrsa and a urine culture growing e. coli (see id) for which the patient has been treated. over the course of time, the patient has been weaned off neosynephrine and has been maintaining a map > 60 without any fluid or pressor support. she had been diuresed with a net negative fluid balance of 500 to 1000cc each day and was tolerating diuresis well without any associated hypotension. . #. respiratory: the patient was initially intubated for airway protection in the setting of intraparenchymal hemorrhage, with propofol sedation. the patient was initially placed on ac with blood gases revealing adequate oxygentation without hypercarbia. she was switched to pressure support 15/5, with blood gases that indicated again appropriate ventilation and oxygenation, but the patient was noted to have intermittent episodes of apnea. the patient was therefore changed to mmv setting on the vent, again noted still to trigger vent-initiated breaths for periods of apnea. on physical exam, the patient was additionally noted periodically to have periods of rapid ventilation alternating with periods of apnea, concerning for dysregulation of centrally mediated respiratory drive. throughout the hospital course this respiratory pattern seemed to resolve and the patient had a more regular pattern of breathing. of note however, the patient occasionally had periods of apnea. in attempt to help avoid respiratory suppression, the patient was started on diamox and potassium chloride to reduce metabolic alkalosis as an inhibitory respiratory signal. the patient had a rsbi of 109 with intentions to continue to attempt to wean the patient from ventilatory support. as above, the patient was noted during her hospital course to have suctioned sputum with moderate growth of mrsa. although unclear if this growth represented pure colonization, tracheobronchitis or true vent assoicated pneumonia, the patient was initiated on vancomycin therapy in attempt to correct any reversible cause constributing to ongoing respiratory distress and inability to wean from the ventilator. the patient additionally suffered from moderate to severe chf with pulmonary edema and effusions. the patient had been undergoing successful diuresis with net negative 1500cc over last 72 hours although over the course of her admission she still remains 15l positive. . #. afib - the patient had a ddd pacer that was placed for an indication of sick sinus syndrome. cardiology consult was requested as the pacer was noted to be inappropriately firing despite ventricular beats on admission. the patient's rhythm on admission and throughout her stay had been afib. indeed, interrogation of the pacer revealed that her atrial lead detected properly and revealed afib. her ventricular lead detected native ventricular beats as well. however it was found that the sensitivity of the lead was too low and was adjusted so that the ventricular lead would not inappropriately fire any longer. with inappropriate firing the patient was at risk for q on t and subsequent v-fib, but her pacing dysfunction likely was thought to have no relationship to her fall as it would not cause a bradycardia or asystole. given the patient's bleed, all anticoagulation was held. as above, her anticoagulation was reversed. the patient has known afib as well as known dvt and pe previously placing her again for increased risk of clot and embolus, but necessarily so given her bleed. the patient's metoprolol has additionally been held given her hypotension. the patient was noted to have rvr in setting of levophed drip, but since discontinuing, had ventricular reponse rate in the 80-110 range not requiring any further intervention. . #. chf ef 20-30% - on admission, patient known to have chf with reported ejection fraction of 20-30%. the patient required holding her metoprolol and lisinopril as above given her persistent hypotension and additionally required large amounts of fluid bolusing. the patient's obligate fluid load during her micu admission had resulted in moderate to severe pulmonary edema. this degree of edema may have additionally been limiting patient's ability to wean from vent. initially, effective diuresis was limited by the patient's persistent hypotension. however, since resolution of her hypotension, the patient has been diuresing well to very small doses of lasix, 10 to 20mg a day with net negative fluid balance of 500cc to 1000cc per day. . #. id: since admission, the patient was afebrile without leukocytosis. the patient had sputum cultures from with moderate growth of mrsa. although the patient had not had fever or leukocytosis or radiographic evidence of pneumonia, therapy was initiated with vancomycin in an attempt to treat any reversible causes underlying patient's ongoing clinical picture including hypotension and failure to wean form vent. urine cultures from were additionally found to be growing > 100k e. coli (pan-sensitive) as well as gpc, likely alpha strep or lactobacillus. the patient was initially started on zosyn when only gram negative rods were known, which has since been changed to bactrim given pan-sensitive e. coli. the patient completed a 7 day course for this infection. all blood cultures since admission demonstrated no growth. . #. recent pe and dvt - as above all anticoagulation was held given recent intracranial bleed. . #. hypercalcemia: patient's hypercalcemia was thought to be chronic and likely secondary to primary hyperparathyroidism as she has an elevated pth in setting of mild hypercalcemia. patient's hypercalcemia was stable throughout the hospital course, not requiring any additional treatment. . #. dementia: patient has baseline dementia, by report at baseline she was able to interact and communicate. patient's donepezil and all other non-essential medications were held during her micu course in setting of altered mental status and hypotension with need to minimize all but essential meds. . #. fen: patient was started on tube feeds for nutrition after intubation. medications on admission: tylenol mvi tobramycin/dexamethasone op 1 appl qhs to right eye coumadin artificial tears aspirin 81 mg po daily bacitracin/polymixin 1 appl to left eye calcium/vit d 500 mg po tid cyanocobolamine 259 mcg po daily cyclosporine 1 ggt to right eye donepezil 10 mg po daily furosemide 20 mg po daily lisinopril 5 mg po daily metoprolol 50 mg po bid discharge medications: not applicable. discharge disposition: expired discharge diagnosis: intracranial hemorrhage. respiratory failure. discharge condition: expired. discharge instructions: not applicable. followup instructions: not applicable. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization transfusion of other serum transfusion of platelets infusion of vasopressor agent diagnoses: thrombocytopenia, unspecified mitral valve disorders urinary tract infection, site not specified congestive heart failure, unspecified acquired coagulation factor deficiency unspecified septicemia atrial fibrillation other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness acute and chronic respiratory failure methicillin susceptible pneumonia due to staphylococcus aureus dehydration hyperosmolality and/or hypernatremia accidental fall from bed systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction fitting and adjustment of cardiac pacemaker contusion of face, scalp, and neck except eye(s) primary hyperparathyroidism 

Answer: The patient is high likely exposed to