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: recent fall, possible shortness of breath major surgical or invasive procedure: none history of present illness: difficult to obtain history due to language barrier. . this is an 82 yo cantonese speaking female with a hx of chf, dm2, and afib who presents from rehab after an unwitnessed fall 4 days ago. noted to right neck echymosis today, extending onto the left side. there may have also been some dyspnea per report. however, per her son in the , she had no complaints but seemed more confused on the day of admission. . on presentation to the ed, initial vitals were 97.9 84 156/123 24 85% on ra. however, pleth on her o2 sat was very difficult to obtain throughout her stay and likely unreliable. ct head was negative and ct c-spine showed spinous process fractures. cxr showed old cardiomegaly and questionable lll infiltrate. u/a showed a uti. she received ceftriaxone, azithromycin, and vancomycin to treat uti and ? pna. she was maintained on a nrb and per report desatted when taken off nrb. however, her pleth remained very irregular. due to hypoxia requiring a nrb, she was admitted to the icu for further care. . review of systems is not able to further be obtained due to language. past medical history: diastolic chf with severe tr afib on coumadin ckd baseline cr approx 2.4 type 2 dm chronic hep b gout glaucoma monoclonal gammopathy, suspected multiple myeloma. pt/family have declined workup. seen by heme/onc at social history: any history of smoking, etoh, or other drug use was born in and has been living in the united states for the past 30 years. she is married; her husband is 88, lives with her, and is in good health. she has three sons. family history: significant for dm and htn. physical exam: general: pleasant, chronically ill appearing female in nad heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. mmm. op clear. neck with diffuse ecchymosis. cardiac: irregular rhythm, normal rate. normal s1, s2. no murmurs, rubs or gallops. lungs: coarse breath sounds diffusely but no wheezes abdomen: nabs. soft, nt, distended, tympanitic extremities: + le edema, 2+ dorsalis pedis/ posterior tibial pulses. skin: no rashes/lesions; ecchymoses on neck as above neuro: alert, interactive, no focal abnormalities pertinent results: 07:15pm glucose-83 urea n-75* creat-2.8* sodium-133 potassium-5.2* chloride-96 total co2-28 anion gap-14 07:15pm ck(cpk)-60 07:15pm ctropnt-0.07* 07:15pm ck-mb-notdone 07:15pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 07:15pm wbc-4.1 rbc-2.66* hgb-8.7* hct-27.3* mcv-103* mch-32.6* mchc-31.7 rdw-21.9* 07:15pm neuts-62.5 lymphs-22.7 monos-9.5 eos-4.5* basos-0.8 07:15pm plt count-108* 07:15pm pt-22.4* ptt-46.8* inr(pt)-2.1* ct head : 1. no acute intracranial abnormality. 2. chronic small vessel ischemic disease. 3. sinus disease, likely inflammatory in etiology. ct c-spine : 1. transverse fractures through the spinous processes of c2 through c6. right posterior neck hematoma, incompletely assessed. 2. severe multilevel degenerative disease with moderate central canal stenosis, which predisposes this patient to spinal cord injury with minor trauma. in the appropriate clinical context, consider mr for further characterization. 3. large multinodular goiter. mri c-spine : 1. large linear fluid collection within the epidural space, beginning at approximately c3-c4 extending into the visualized upper thoracic spine is most suggestive of epidural hematoma. 2. multilevel cervical spondylosis as described above. there is moderate-to-severe canal narrowing at the c6-c7 interspace related to a combination of disc osteophyte complex and more focal component of epidural hematoma at this level. no definite cord edema is identified, although the exam is somewhat limited on the fluid-sensitive sequences. 3. slightly increased signal within the c7 and t1 vertebral bodies in conjunction with mild anterior soft tissue swelling at this level is concerning for traumatic vertebral body fractures. no significant loss of vertebral body height or retropulsion of bony fragments is noted at the levels. 4. diffuse edema within the posterior spinal tissues related to known spinous process fractures. limited ability to assess the anterior and posterior longitudinal ligaments related to motion artifact on current study, however, no definite discontinuity is identified. 5. moderate canal stenosis at the c4-c5 interspace, predominantly related to disc osteophyte complex and focal ossification of the posterior longitudinal ligament at this level. cxr impression: 1. marked cardiac enlargement, unchanged, likely reflecting a combination of cardiomegaly and pericardial effusion, as seen on prior ct from . no evidence of pulmonary edema. 2. retrocardiac opacity, which may reflect atelectasis. an infectious etiotoly is not excluded and clinical correlation is recommended. 3. no displaced fractures identified. tte the left atrium is moderately dilated. the right atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the right ventricular cavity is markedly dilated with mild global free wall hypokinesis. there is abnormal diastolic septal motion/position consistent with right ventricular volume overload. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened. there is a minimally increased gradient consistent with minimal aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. severe tricuspid regurgitation is seen. there are torn tricuspid valve chordal structures seen prolapsing across the valve and into the right atrium. the pulmonary artery systolic pressure could not be determined due to the severity of tricuspid regurgitation. there is a small pericardial effusion. impression: severe tricuspid regurgitation with evidence of right ventricular volume overload. markedly dilated right ventricle with mild global hypokinesis. preserved left ventricular systolic function. small circumferential pericardial effusion. compared with the prior study (images reviewed) of , the findings are similar. brief hospital course: ap: 82f with chronic dchf, severe tr, dm2, and ckd who presents from rehab s/p fall with confusion, hypoxia, c-spine fractures, pyuria .# cervical spine fractures: per trauma, no acute management needed. mri also shows cervical spine epidural hematoma but neurologically remains intact. per dr. , it is okay for pt to be on coumadin as long as she is not supratherapeutic. plan is for soft collar x 4 weeks. she has follow-up in spine clinic next week with plain films ordered. # confusion: initially presented with confusion s/p fall and ?hypoxia vs. uti. the true etiology is unclear at this point as pt got broad spectrum abx in icu initially. currently pt knows she is in a hospital and thinks it is , she recalls recent events accurately and does not appear confused/delirious. she likely has underlying dementia. per family, pt is much clearer than when she first presented to hospital #. ? hx of hypoxia: unclear if hypoxia was true or a measurement artifact. abgs in the icu support good oxygenation. sometimes difficult to get accurate o2 on finger; much more reliable with a forehead monitor. no evidence of infection. stable on ra now. no clinical signs of pna . .#. acute on chronic renal failure: exact etiology of exacerbation? thought possibly due to bactrim (given for pyuria) or low-flow state with sbp low 100s. she has known underlying ckd stage 4, due to combination of dm and suspected multiple myeloma. has known monoclonal gammopathy which has been documented at . no hydronephrosis on ct scan, urine eos neg, renal u/s no acute hydronephrosis. she was followed closely by renal and her cr is now improving. cr peaked at 4.1, now 3.2 appears her baseline is cr 2.4 range. she will need weekly cr check until her cr normalizes to her baseline. she should follow-up with her renal physician sometime within the next 2-3 weeks. # anemia - labs show no sign of fe deficiency. likely from ckd and anema chronic disease. renal recommended increasing epo to 8000 units three times week. .#. afib: currently rate controlled. coumadin held for several days due to supratherap levels. she is now resumed on coumadin. will need close monitoring of inr. should not allow further supratherap levels due to cervical hematoma. inr on day of discharge was 2.2 continue digoxin #. type 2 dm uncontrolled with complications: had a hypoglycemic episode early in hospitalization, may have been due to reduced cr clearance of insulin. with consult services' assistance, her insulin regimen has been changed to nph and iss. . #. chronic diastolic heart failure: she has known severe tricuspid regurgitation, rv overload, on echo as well as echo here. records from shows that she has been admitted there for chf exacerbation several times requiring diuresis. her family reports she is chronically edematous. she has signs of anasarca here but breathing was stable. her lopressor dose was decreased this admission and imdur held to increase overall blood pressure and improve forward flow to her renal perfusion. . #. possible uti vs contaminated specimen - dirty u/a in ed. has hx of proteus sensitive to all except cipro. -she was initially tx with bactrim, urine culture grew e. coli esbl but then final result returned and showed signs of contamination. second ucx showed flora. third ucx showed 10,000-100,000 vre but clinically pt not exhibiting signs of a uti, is afebrile, nl wbc, no change in ms dysuria, other urinary sx. a final ua from shows 2 wbcs, neg leuk, neg nit, no bacteria or yeast. bactrim discontinued as given concerns over renal failure and monitor. # hx of gout: cont colchicine and allopurinol . #. glaucoma: cont xalatan eye drops. . fen: low salt cardiac dysphagia diet w thin liquids .ppx: -dvt ppx with coumadin -bowel regimen -pureed diet w thin liquids . code status: dnr/dni confirmed . emergency contact: (son), . . medications on admission: acetaminophen coumadin 0.5mg t/th/sat/sun 1mg mwf digoxin 0.125mg qod colchicine 0.6mg qod metoprolol 75mg po qam 50mg at 2pm and 10pm insulin: -- novolin ss modified -- novolog 70/30 34 units with breakfast, 10 units with dinner procrit 10k units qwk imdur 30mg po daily atrovent 2 puffs inh torsemide 40mg xalatan eye gtt 1 gtt ou qhs ranitidine 150mg qhs prevacid 30mg po daily allopurinol 100mg po daily neurontin 300mg po daily phoslo 2 tabs po tid fesulfate 325mg po daily kcl 40 meq daily senna colace fleets enema prn mom prn dulcolax prn discharge medications: 1. digoxin 125 mcg tablet : one (1) tablet po every other day (every other day). 2. colchicine 0.6 mg tablet : 1-2 tablets po every other day (every other day). 3. insulin nph human recomb 100 unit/ml suspension : eighteen (18) units subcutaneous qam. 4. novolin r 100 unit/ml solution : per sliding scale injection four times a day. 5. atrovent hfa 17 mcg/actuation aerosol : two (2) puffs inhalation every six (6) hours as needed for shortness of breath or wheezing. 6. latanoprost 0.005 % drops : one (1) drop ophthalmic hs (at bedtime). 7. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 8. allopurinol 100 mg tablet : one (1) tablet po every other day (every other day). 9. gabapentin 300 mg capsule : one (1) capsule po q48h (every 48 hours). 10. calcium acetate 667 mg capsule : two (2) capsule po tid w/meals (3 times a day with meals). 11. ferrous sulfate 325 mg (65 mg iron) tablet : one (1) tablet po daily (daily). 12. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. 13. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). 14. torsemide 20 mg tablet : two (2) tablet po bid (2 times a day). 15. acetaminophen 500 mg tablet : two (2) tablet po q6h (every 6 hours) as needed. 16. magnesium hydroxide 400 mg/5 ml suspension : thirty (30) ml po q6h (every 6 hours) as needed. 17. metoprolol tartrate 25 mg tablet : one and a half tablet po three times a day: hold for sbp <110, hr <60. 18. epoetin alfa 4,000 unit/ml solution : 8000 (8000) units injection qmowefr (monday -wednesday-friday). 19. oxycodone-acetaminophen 5-325 mg tablet : 1-2 tablets po q4h (every 4 hours) as needed: total tylenol not to exceed 4 g/day. 20. senna 8.6 mg tablet : 1-2 tablets po bid (2 times a day). 21. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day). 22. atrovent hfa 17 mcg/actuation aerosol : two (2) puffs inhalation twice a day. 23. coumadin 1 mg tablet : half tablet po tues/thurs/sat/sun. 24. coumadin 1 mg tablet : one (1) tablet po mon/wed/fri. 25. outpatient work pt will need her inr checked 2-3 times this week to ensure it does not become supratherapuetic. please check cr, electrolytes twice this coming week to monitor renal function and ensure it continues to improve discharge disposition: extended care facility: - discharge diagnosis: primary: acute renal failure cervical spinal fracture hypoglycemia resolved chronic kidney disease atrial fibrillation chronic diastolic heart failure anemia discharge condition: stable discharge instructions: if you have fevers, chills, worsening neck pain, focal weakness, numbness or tingling of your extremities, please seek medical attention followup instructions: please follow with orthopedic spine at as below: provider: xray (scc 2) phone: date/time: 12:40 provider: . phone: date/time: 1:00 follow up with your primary care physician weeks. call dr. office at for an appointment. follow up with your kidney doctor dr. . s. balakrishnan at medical center in the next 2-3 weeks. md procedure: venous catheterization, not elsewhere classified diagnoses: anemia in chronic kidney disease urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation other chronic pulmonary heart diseases polyneuropathy in diabetes unspecified glaucoma other persistent mental disorders due to conditions classified elsewhere unspecified disease of pericardium long-term (current) use of insulin insulins and antidiabetic agents causing adverse effects in therapeutic use long-term (current) use of anticoagulants multiple myeloma, without mention of having achieved remission hypoxemia streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta diabetes with other specified manifestations, type ii or unspecified type, uncontrolled diseases of tricuspid valve delirium due to conditions classified elsewhere chronic diastolic heart failure sulfonamides causing adverse effects in therapeutic use diabetes with neurological manifestations, type ii or unspecified type, uncontrolled other fall closed fracture of multiple cervical vertebrae diabetes with renal manifestations, type ii or unspecified type, uncontrolled monoclonal paraproteinemia 

Answer: The patient is high likely exposed to