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: history of present illness: this patient was transferred from the cardiac care unit on . for a description of the events taken place in the cardiac care unit, please see dr. discharge note for the cardiac care unit. briefly, the patient is a 68 year old female with a history of hypertrophic cardiomyopathy diagnosed by echocardiogram in the year , who broke her left hip on , and was admitted to the orthopedic service for open reduction and internal fixation. however, prior to sickle cell, the patient experienced shortness of breath secondary to congestive heart failure and was transferred to the where she was aggressively diuresed with lasix. she experienced worsening respiratory distress. cardiology advised a blood transfusion and aggressive administration of negative inotropics (lopressor 100 four times a day and verapamil 80 three times a day currently), and close monitoring of intervascular volume (goal euvolemic) in order to minimize the patient's outflow tract gradient. she was subsequently transferred to the cardiac care unit on , where she was intubated for respiratory decompensation and underwent open reduction and internal fixation of the left hip on , which required 11 units of packed red blood cells, 7 units of fresh frozen plasma, and 2 units of plasma. during her stay in the cardiac care unit, the patient's main issues have included the following: 1) aggressive use of negative inotropics and close maintenance of euvolemic to minimize outflow tract gradient; 2) prolonged ventilation with extubation ; 3) brief oliguria secondary to atn following surgery, now resolved; 4) prolonged high-grade fevers to 103.0 f./104.0 f., thought to be secondary to zyprexa induced nms, then c. difficile infection; 5) persistent obtunded state secondary to toxic metabolic encephalopathy. past medical history: 1. hypertrophic obstructive cardiomyopathy diagnosed by echocardiogram in . 2. hypertension. 3. schizo-affective personality disorder. 4. depression. 5. anxiety disorder. 6. breast cancer. medications prior to transfer: 1. lovenox 30 mg subcutaneously twice a day. 2. protonix 40 mg intravenously q. day. 3. calcium carbonate 1000 mg four times a day. 4. miconazole. 5. nystatin swish and swallow. 6. metoprolol 100 p.o. four times a day. 7. verapamil 80 mg p.o. three times a day. 8. fentanyl patch 25 micrograms. 9. tylenol 500 to 1000 mg p.r.n. 10. bumetanide 1 gram intravenously q. day. 11. risperidone 1 mg p.o. p.r.n. 12. ativan 0.5 mg three times a day. allergies: no known drug allergies. physical examination: upon arrival, the patient was afebrile with a temperature of 97.2 f.; pulse of 88; blood pressure of 128/72; tachypneic at a rate of 36, saturation of 98% by 40% face mask. in general, this is an obtunded female laying in bed, with very shallow rapid breathing. her pupils were equal, round and reactive to light. her eyes were anicteric. oropharynx is benign. anterior lung fields were clear bilaterally. her heart was regular rate and rhythm. iii/vi harsh systolic murmur best heard at the apex. her abdomen was soft, obese, nontender, nondistended, with positive bowel sounds with no evidence of hepatosplenomegaly. extremities were cool and dry with one plus distal pulses bilaterally; no edema. foley catheter and rectal bag were in place. left inguinal incision was clean, dry and intact. she intermittently answered the questions, acknowledged the presence of visitors. she would track movements in the room but otherwise was very unresponsive. laboratory: she had a white blood cell count of 8.6, hematocrit of 28.4, platelet count of 439. coags were a pt of 13.5, ptt of 25.6 and an inr of 1.3. chem-10 included the sodium of 142, potassium 3.5, chloride 103, bicarbonate 31, bun of 21, creatinine 0.6, glucose of 127. calcium 9.1, phosphorus 3.3, magnesium 2.2. studies: echocardiogram on showed elongated left atrium, moderate symmetric left ventricular hypertrophy, severe resting left ventricular outflow tract, normal right ventricular size and wall motion, three plus mitral regurgitation (increased compared to study), ejection fraction of 70%. she was clostridium difficile positive on . chest x-ray on which showed a new left lower lobe consolidation consistent with either pneumonia or atelectasis. leni's performed on were negative for deep venous thrombosis. ct scan of the abdomen / pelvis on , which showed post-traumatic changes around the left pelvic fracture. there were no signs of abscess. overall appearance is of stranding and fluid amongst the left hip muscles, consistent with resolving hematoma. right lower lobe pneumonia versus contusion bilaterally with small pleural effusion. renal scarring. summary of hospital course: 1. cardiac: the patient continued to be managed aggressively with high dose lopressor and verapamil. there was careful attention paid to strict maintenance of intakes an outputs. she continued to receive her bumex 1 gram every morning. the overall strategy for her cardiac status was, as noted in the cardiac care unit note, to administer aggressive negative inotropics with optimization of patient's intervascular volume. again, the patient has no history of coronary artery disease. she did not have any episodes of arrhythmia during her hospital course. she did, however, continue to have a low baseline troponin leak. her troponin was always greater than 1.6 every time it was measured. it was never higher than 3.5. it was believed that this mild troponin leak was secondary to constant strain given the patient's hyperdynamic state. 2. pulmonary: the patient was initially transferred to the floor on 50% face mask. she was weaned to room air successfully on . she had required bi-pap in the cardiac care unit, but it was never required on the floor. she did, however, have one episode of tachypnea early on in her course on the floor on , with respiratory rates in the mid-40s. she continued to have o2 saturations in the high 90s during this time with normal blood pressure and slightly tachycardic. this episode self resolved. she had subtle ekg changes, specifically st abnormalities which were present on her ekg before. during this setting of tachypnea, her troponin rose from her baseline one to two range to a maximum of 3.5. chest x-ray taken at this time showed persistent mild congestive heart failure. 3. neurologic: upon arrival to the floor, the patient was initially weaned off her ativan and her fentanyl patch was discontinued. initially, the patient's neurologic status consisted of a very sparse verbal output, not really following basic commands, very limited attention span, and persistent cogwheel rigidity. it was believed on the part of neurology and psychiatry consultations, that her obtundation was secondary to toxic metabolic encephalopathy. she had an eeg performed that showed global slowing. a head ct scan did not show any focality. over the course in the floor, she did however, continue to improve in her neurological status to the point where she was able to recognize individuals walking into her room. her verbal output increased. she was able to answer in full sentences. she had a longer attention span. she was able to move her upper and lower extremities more spontaneously. over the last couple of days, she has been complaining of some depression. her psychiatric medications were stopped while she was in the cardiac care unit. those medications should be restarted at her rehabilitation center once her neurologic status stabilized. 4. gastrointestinal: the patient was initially continued on tube feeds by nasogastric tube upon transfer to the floor. she was transitioned to p.o. feeds on after passing a bedside speech and swallow evaluation. her present diet consists of clear liquids and pureed foods with boost for supplementation. she should be continued on this diet, advanced slowly, and observed for any signs of aspiration. she is also receiving colace and sennas laxatives. 5. renal: the patient had no acute renal issues while on the floor. she had good urine output with stable bun and creatinine levels. she did, however, have a continuation of a metabolic alkalosis and respiratory alkalosis after immediate transfer from the cardiac care unit but these acid based disorders resolved over the course of her stay on the floor. 6. hematologic: the patient's hematocrit was stable around 30. her goal hematocrit was 30 and above to avoid exacerbation of her cardiac hyperdynamic state. 7. infectious disease: the patient experienced high grade fevers to 103.0 f., 104.0 f., in the cardiac care unit and she spiked once to a temperature of 101.0 f., while on the floor. she was pan-cultured and the cultures were all negative. she completed a 10 day course of flagyl for her c. difficile infection. she also completed a four day course of vancomycin for a slightly purulent left inguinal wound. the wound was also debrided and is appearing clean, dry and intact currently. 8. musculoskeletal: the patient is status post open reduction and internal fixation. she has been receiving physical therapy approximately three times a week for range of motion exercises, sitting in chair and increasing her weight bearing status. her physical therapy should be continued with the rehabilitation center. she is also receiving lovenox subcutaneously twice a day and her anti-coagulation should be continued for another two and a half weeks for a total of six weeks. 9. prophylaxis: the patient was given protonix for peptic ulcer disease and pneumoboots with subcutaneous lovenox for deep venous thrombosis prophylaxis. condition at discharge: stable. discharge status: the patient is being discharged to for rehabilitation on . discharge instructions: 1. her diet currently is clear liquids with pureed foots and boost for supplementation. 2. she should continue to receive physical therapy for rehabilitation of her left hip. discharge medications: 1. enoxaparin 30 mg subcutaneously q. 12 times six weeks total (started on ). 2. pantoprazole 40 mg intravenously q. 24 hours. 3. calcium carbonate 1000 mg p.o. four times a day. 4. metoprolol 100 mg p.o. q. six hours. 5. verapamil 80 mg p.o. q. eight hours. 6. bumetanide 1 mg intravenously q. day. 7. albuterol nebulizer solution, one nebulizer inhaler q. two hours p.r.n. 8. ipratropium bromide nebulizer, one nebulizer inhaler q. six hours p.r.n. 9. aspirin 325 mg p.o. q. day. 10. colace 100 mg p.o. twice a day. 11. senna 2 tablets p.o. q. h.s. p.r.n. 12. miconazole powder 2%, one application topical four times a day p.r.n. 13. nystatin oral suspension 5 ml four times a day p.r.n. the patient should be restarted on her psychiatric medications when her neurologic status stabilizes. her psychiatric medications upon admission included: 14. celexa 20 mg q. day. 15. paxil 20 mg q. day. 16. zyprexa 5 mg twice a day plus 20 mg q. h.s. discharge diagnoses: 1. hypertrophic obstructive cardiomyopathy. 2. congestive heart failure. 3. status post left open reduction and internal fixation of hip. 4. schizo-affective personality disorder. 5. depression. 6. general anxiety disorder. 7. status post breast cancer. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube arterial catheterization pulmonary artery wedge monitoring open reduction of fracture with internal fixation, other specified bone sequestrectomy, other bones diagnoses: acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified alkalosis intestinal infection due to clostridium difficile paralytic ileus closed fracture of pubis closed fracture of acetabulum 

Answer: The patient is high likely exposed to