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 / tegretol / insulin,beef / insulin,pork / zaroxolyn attending: chief complaint: chest pain major surgical or invasive procedure: coronary catherization w/ stent placement to rca on picc line placement on for iv antibiotics left leg cast placement for tib/fib fracture intubation for respiratory failure history of present illness: 72 yo with extensive pmh, to include h/o cad s/p ptca to rca, diastolic chf (ef 70-80%), chronic afib on coumadin who presented to her pcp with leg pain and sob. at her pcps office, she was found to be cyanotic and to have agonal breathing, at which point she was sent to the er. . in the er, patient was found to be afebrile, tachycardic to 140s hypertensive then hypotensive to sbp of 62 and o2 of 92% on 4l. ekg showed ste in iii and avf and st depressions in i and avl. pt. was intubated and taken to cath lab where she was found to have no disease in her lmca, modest disease in the lad and lcx and hazy 70% occlusion of the mid rca, pa 63/33 (49), rv 58/12, pcwp of 24, ra 21(a), 26 (v). past medical history: pmh: 1. chf with diastolic dysfunction- last lvef was 65% with a normal mibi in 01/. 2. type 2 diabetes mellitus 3. atrial fibrillation 4. anemia 5. cad s/p ptca x3- pt had a stent to her rca in , lcx in , and rca in . 6. pulmonary htn 7. copd/ pt is on intermittent oxygen at home. 8. thyroid ca s/p resection- pt is now hypothyroid. 9. myoclonic tremors 10. h/o pe 11. osa on cpap 12. depression 13. anxiety 14. h/o mrsa and pt has two past icu admissions for mrsa aortic valve endocarditis and pseudomonal sepsis. she has had two intubations. 15. s/p laproscopic cholecystectomy . s/p right throcoscopy and decortication 17. s/p right lung biopsy 18. s/p right hip orif 19. s/p right ankle orif 20. s/p right aka social history: social: pt lives at senior life. divorced and has three children. she quit smoking in but has a history of 1 ppd for 15 years. no etoh or drugs. . family history: fhx: f: died at 47 of mi; m: died colon ca; b: dm physical exam: vitals: t: 100.5, hr: 110, bp: 148/75, rr: 22, o2: 99%, ac/550/23/1.0/5 general: intubated, but responsive, in nad heent: nc/at, perrla neck: supple, no jvd appreciated chest/cv: s1, s2 nl, no m/r/g appreciated, but difficult to auscultate sounds lungs: harsh bs with diffuse crackles, b/l abd: soft, nt, nd, minimal bs ext: right leg amputated below knee, 1+ pitting edema on left leg skin: warm, dry, no lesions pertinent results: 10:25pm type-art po2-86 pco2-48* ph-7.35 total co2-28 base xs-0 10:25pm glucose-222* lactate-3.0* na+-142 k+-3.0* cl--105 10:25pm freeca-1.02* 10:06pm urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 10:06pm urine rbc-* wbc-21-50* bacteria-few yeast-none epi-0 10:05pm glucose-234* urea n-26* creat-1.1 sodium-142 potassium-3.2* chloride-104 total co2-25 anion gap-16 10:05pm calcium-7.9* phosphate-3.9# magnesium-1.9 10:05pm tsh-0.28 10:05pm wbc-31.3*# rbc-4.71 hgb-12.8 hct-37.3 mcv-79* mch-27.1 mchc-34.2 rdw-15.9* 10:05pm plt smr-normal plt count-275 10:05pm pt-16.4* ptt-38.2* inr(pt)-1.5* 06:50pm glucose-470* urea n-26* creat-1.0 sodium-145 potassium-3.9 chloride-106 total co2-25 anion gap-18 06:50pm wbc-17.2* rbc-4.18* hgb-11.4* hct-34.1* mcv-82 mch-27.2 mchc-33.4 rdw-15.8* 06:50pm neuts-87* bands-4 lymphs-6* monos-3 eos-0 basos-0 atyps-0 metas-0 myelos-0 06:00pm ck(cpk)-110 06:43pm lactate-3.9* 06:00pm ck-mb-3 ctropnt-<0.01 06:00pm pt-23.4* ptt-49.7* inr(pt)-2.3* . lle xray: age indeterminate fracture involving the lateral malleolus as described above. question possible nondisplaced fracture of the distal tibia. given severity of osteoporosis, mr is recommended over ct if further imaging is required to corroborate finding. . echo: image quality is suboptimal due to body habitus, supine position, and mechanical ventilation. the left atrium is dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. the overall left ventricular ejection fraction appears relatively well-preserved (at least 50%); the inferior and posterior walls may be hypokinetic. due to suboptimal technical quality, other focal wall motion abnormalities cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , the inferior and posterior walls may now be hypokinetic. . cath: . selective coronary angiography revealed a right dominant system with lmca free of obstructive disease. the lad and lcx had modest diffuse disease. rca had a hazy mid vessel 70% lesion. 2. left ventriculography was deferred. 3. hemodynamic assessment revealed atrial fibrillation at 130 with hypotension. pcwp was elevated at 30 mm hg and rap 19 mm hg. there was moderate pulmonary hypertension. final diagnosis: 1. one vessel coronary artery disease. 2. severe systolic ventricular dysfunction and shock. 3. acute inferior myocardial infarction, managed by acute ptca. 4. ptca of vessel. . ecg study date of 9:18:20 am atrial flutter with 2:1 block. no change compared to the previous tracing of . rate pr qrs qt/qtc p qrs t 133 0 66 4 178 . chest (portable ap) 7:04 am impression: improved fluid balance with moderate-to-severe persisting interstitial and alveolar edema. the more confluent opacity in the left lung base also persists. again, this may be manifestation of confluent edema or focus of pneumonia. continued radiographic followup with progressive diuresis recommended to assess for underlying infection. . picc line placment sch 7:27 am impression: successful placement of 30-cm single-lumen 4 french picc line from right basilic vein with the tip terminating in distal svc. the line is ready for use. . chest (portable ap) 7:06 am impression: ap chest compared to through 26: . mild pulmonary edema has improved, particularly in the right lung. mild cardiomegaly is chronic. pleural effusion if any is minimal, on the left. no pneumothorax. . ankle (2 views) left 8:24 pm findings: two portable radiographs of the left ankle were reviewed. there is a distal fibular fracture with posterior angulation. there is no marked interval change from , . there is also abnormal angulation of the distal tibia suggesting buckle fracture. age is indeterminate, but unchanged from . given severe osteopenia, evaluation is limited. . impression: unchanged appearance of distal tibia and fibula with angulated fibular fracture and possible tibial fracture. severe osteopenia. brief hospital course: 72 yo with extensive pmh, to include h/o cad s/p ptca to rca, diastolic chf (ef 70-80%), chronic afib on coumadin who presented with l fibula fracture and sob, found to have ste in iii and avf, s/p pci to rca for hazy 70% occlusion. . cardiac #ischemia: cad, s/p stent of rca patient s/p inferior wall mi with 70% occlusion of rca. patient was intubated for respiratory failure secondary to pneumonia and pulmonary edema. she was placed on beta blocker and lisinopril for optimal bp control and to improve survival post mi. plavix was added for coronary stent. aspirin and statin were continued given risk factors for cad. patient remained free of chest pain after catherization. she had intermittent episoded of bradycardia but remained asymptomatic and without abnormal rhythms on telemetry. . #pump: hyperdynamic lv systolic function with ef of 70-80%, elevated rhc pressures. patient's volume status was closely monitored and she was diuresed with lasix to remove excess fluid from lungs and lower extremities, with goal of reducing afterload post mi. bp remained stable and normotensive. patient was euvolemic at discharge and lasix dose was lowered to 40mg from outpatient regimen of 80mg to prevent volume depletion. she will continue lisinopril for afterload reduction. . #rhythm: patient w/ hx of atrial fibrillation/atrial flutter. digoxin was continued and she was placed on coumadin with a therapeutic inr, temporarily bridged with heparin. . # pulm patient w/ history of pseudomonas pna and went into respiratory failure upon admission. she was intubated in the coronary care unit and extubated two days later once able to on own during trials of pressure support. daily cxr revealed resolution of pulmonary edema with diuresis. blood cultures from grew coag neg staph., g+ rods, veillonella species, suspected to be likely contaminants, vancomycin was administered and d/c'd once blood cultures remained negative. at discharge, she was on meropenem iv given h/o pseudomonas pna day 10 of 14. she has remained afebrile without elevations in wbc ct after initial leukocytosis. she had a picc line placed by ir on day of discharge to complete remaining course of meropenem. . # fibula fracture: patient suffered a left leg fracture after bumping wheelchair into wall. she has been in severe pain throughout hospital course with intractable leg pain. xrays revealed fracture of distal left tibial/fibula near ankle. orthopedics was and did not recommend immediate intervention. half-cast and splint was placed and orthopedics will follow ankle films outpatient to determine appropriate management. pain control has not been adequate with fentanyl, dilaudid, neurontin, and morphine. she was placed on pca dilaudid prior to discharge for pain relief. she will need acute rehabilitation for leg fracture. wound care was for sore at heel and dressing changes were done daily to prevent expansion into ulcer. . # anemia: patient had baseline low hematocrit with wide fluctuations. transfused 1 unit prbcs with hct stable at 28.8. she was guiaic negative. groin checks post catherization did not reveal hematoma/bruit/oozing on exam. hemolysis workup was normal and iron studies were negative for deficiency. . # hyperglycemia: mildly elevated bg, now taking po. patient was placed on sliding scale insulin with adequate fsbg control. continued glargine 16 qhs (taking 16 at ). . # neuro/psych patient emotionally labile, not content w/ overall care provided, secondary to severe leg pain from fracture. she was alert/oriented and aware of medical issues but required constant reassurance to relieve frustrations. patient may benefit from psychiatry evaluation outpatient given complexity of medical problems. . # code status: full code . # communication: - ( . # dispo: pt/ot consult done, pt cleared for acute care rehabilitation. dc to rehab medications on admission: asa 325 mg qd coumadin lopressor 25 mg lasix 80 mg simvastatin 20 mg qd glargine 16 units hs, humulin ss neurontin 600 mg qhs neurontin 300 mg klonopin 0.5 mg prn, 1mg qhs levothyroxine 175 mcg qd lidocaine patch mvi fluticasone 2 p magnesium hydroxide 30 ml prn combivent ih 2p q12 hr prn morphine 4 mg q4 buproprion 100 mg qd magnesium gluconate 500 mg oxycodone 5 mg q4 prn kcl 20 meq qd citalopram 20 mg qd quetiapine 25 mg qhs discharge medications: 1. clopidogrel 75 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. albuterol-ipratropium 103-18 mcg/actuation aerosol : puffs inhalation q6h (every 6 hours) as needed. disp:*1 * refills:*2* 3. citalopram 20 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. bupropion 100 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical qd (). disp:*30 adhesive patch, medicated(s)* refills:*2* 6. digoxin 125 mcg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). disp:*30 tablet,rapid dissolve, dr(s)* refills:*2* 8. aspirin 81 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 9. acetaminophen 650 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*120 tablet(s)* refills:*2* 10. potassium chloride 20 meq packet : one (1) po daily (daily): hold for k>5. disp:*30 * refills:*2* 11. miconazole nitrate 2 % powder : one (1) appl topical tid (3 times a day) as needed. disp:*1 2* refills:*2* 12. atorvastatin 80 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 13. gabapentin 300 mg capsule : two (2) capsule po hs (at ). disp:*60 capsule(s)* refills:*2* 14. gabapentin 300 mg capsule : one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 15. citalopram 20 mg tablet : two (2) tablet po hs (at ). disp:*60 tablet(s)* refills:*2* 16. warfarin 2 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 17. morphine 10 mg/5 ml solution : one (1) po q4-6h (every 4 to 6 hours) as needed for pain. disp:*2 2* refills:*0* 18. furosemide 40 mg tablet : one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 19. metoprolol succinate 25 mg tablet sustained release 24hr : three (3) tablet sustained release 24hr po daily (daily). disp:*90 tablet sustained release 24hr(s)* refills:*2* 20. lorazepam 0.5 mg tablet : one (1) tablet po hs (at ) as needed for anxiety. disp:*30 tablet(s)* refills:*0* 21. lisinopril 5 mg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 22. magnesium hydroxide 400 mg/5 ml suspension : thirty (30) ml po q6h (every 6 hours) as needed for constipation. disp:*1 ml(s)* refills:*0* 23. fentanyl 75 mcg/hr patch 72hr : one (1) patch 72hr transdermal q72h (every 72 hours). disp:*10 patch 72hr(s)* refills:*2* 24. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 25. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. disp:*60 tablet(s)* refills:*0* 26. hydromorphone 4 mg/ml solution : one (1) injection asdir (as directed). disp:*1 mg/ml* refills:*2* 27. meropenem 1 g recon soln : one (1) recon soln intravenous q8h (every 8 hours) for 5 days. disp:*15 recon soln(s)* refills:*0* 28. insulin glargine 100 unit/ml cartridge : one (1) 16 units subcutaneous at . disp:*1 units* refills:*2* discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnoses: s/p stemi stent to rca for 90% occlusion left tibia/fibula fracture near ankle . secondary diagnoses: chf ef 50% pvd af cad dm pulmonary htn copd hypothyroidism osa hx of pe hx of mrsa aortic valve endocarditis pseudomonal sepsis pna (multiple icu admissions; rml pna on meropenem since ) discharge condition: stable discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet. . please see your pcp or return to the ed if you experience chest pain, shortness of , increase swelling in your hands/feet. you had a heart attack and had a stent placed in the occluded coronary artery which supplies blood to the heart muscle. you also had a left leg cast placed by orthopedics for a fracture near your ankle. antibiotics were continued for presumed pseudomonas pneumonia and you will need to finish the remaining course after discharge. followup instructions: provider: xray (scc 2) phone: date/time: 3:00 . provider: , md phone: date/time: 3:20 . provider: phone: date/time: 3:20 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of non-drug-eluting coronary artery stent(s) coronary arteriography using two catheters angiocardiography of left heart structures injection or infusion of platelet inhibitor left heart cardiac catheterization insertion of endotracheal tube cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified atrial fibrillation dysthymic disorder acute respiratory failure acute myocardial infarction of other inferior wall, initial episode of care long-term (current) use of anticoagulants accidents occurring in residential institution diastolic heart failure, unspecified fracture of lateral malleolus, closed accidental fall from wheelchair 

Answer: The patient is high likely exposed to