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: adhesive tape attending: chief complaint: hypotension major surgical or invasive procedure: rij placement history of present illness: ms. is a 71yo paraplegic female with pmh significant for htn, hld, and chronic uti's who is being transferred to the micu for management of hypotension. per her son, the patient's home nurse noted that she had a slight temperature this morning. her son noted that her appetite was poor and was also incoherent. he also noted that her catheter contained urine that was dark and concentrated. he immediately called 911. she was then brought to ed for further work-up. there is no report of sob, chest pain, abdominal pain, diarrhea, or constipation. the son was also concerned that her catheter was not working well and needed to be changed. in the ed, initial vitals were t 102.2 bp 115/33 ar 105 rr 18 o2 sat 94% on 3l nc. she received vancomycin 1gm iv, zosyn 4.5gm iv, and tylenol 1gm. her blood pressure dropped to 95/43 and given lack of improvement after receiving 3l ns, she is being transferred to the micu for closer monitoring. past medical history: 1)paraplegia anterior spinal infarct 2)thoracic aneurysm repair () 3)hx of lll collapse/pna s/p mucous plug removal via bronchoscopy 4)htn 5)hyperlipidemia 6)gerd 7)suprapubic catheter placement / utis on ppx bactrim 8)fecal incontinence 9)depression social history: 58 year tobacco history, now smoking 3 cigarettes per day, denies ethoh, denies drug abuse. widowed. has 3 sons. she lives alone in . family history: son has dm physical exam: vitals t 95.8 bp 117/50 ar 65 rr 23 o2 sat 95% on 3l nc gen: patient awake, responsive to commands heent: mmm, perrla heart: rrr, no audible m,r,g lungs: ctab, scattered crackles at posterior bases abdomen: markedly distended but soft, nt, +bs extremities: 1+ bilateral edema, 2+ dp/pt pulses bilaterally; large ulcer approximately 6cm in diameter over l ischium that appears to probe down to bone. she also has wound vac dressing in place on left lower extremity. pertinent results: 07:55pm lactate-1.1 07:57pm wbc-14.0*# rbc-4.76 hgb-12.6 hct-38.8 mcv-82 mch-26.4* mchc-32.4 rdw-15.9* 07:57pm calcium-8.3* phosphate-3.1 magnesium-2.3 07:57pm glucose-120* urea n-12 creat-0.5 sodium-138 potassium-4.6 chloride-102 total co2-24 anion gap-17 08:00pm urine rbc-0 wbc-0-2 bacteria-many yeast-none epi-0 08:00pm urine blood-neg nitrite-pos protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-9.0* leuk-mod 05:52am blood wbc-8.9 rbc-4.31 hgb-11.3* hct-36.0 mcv-84 mch-26.1* mchc-31.3 rdw-15.7* plt ct-427 06:30am blood esr-105* 06:55am blood esr-80* 05:52am blood esr-90* 05:52am blood glucose-114* urean-9 creat-0.4 na-143 k-4.1 cl-104 hco3-29 angap-14 05:52am blood albumin-3.2* calcium-8.5 phos-2.8 mg-2.5 07:05am blood crp-123.6* 05:52am blood crp-101.0* ecg: sinus tachycardia. left axis deviation. left anterior fascicular block. diffuse non-diagnostic repolarization abnormalities. compared to the previous tracing of heart rate has increased. otherwise, no major change. : kub single ap abdominal radiograph obtained, however, limited as only the superior portion of the abdomen imaged. the imaged portion is obscured by overlying pannus, however, the underlying bowel loops show a nonspecific bowel gas pattern with mildly air-filled distended loops of colon. no intra-abdominal free air. multiple left-sided rib deformities are noted. : single ap chest radiograph compared to show slightly increased interstitial lung markings, which may represent mild edema with areas of new patchy opacity in the right lung base and left mid lung, which may represent atelectasis although aspiration/pneumonia would be difficult to exclude. there is no pneumothorax or pleural effusion. the cardiomediastinal contour is unchanged. again seen are multiple left-sided rib deformities. ct head: impression: 1. no acute intracranial hemorrhage. 2. moderate opacification from fluid versus mucosal thickening in the maxillary sinuses, not , reflect sinusitis, and clinical correlation is recommended. cta chest impression: 1. no evidence of pulmonary embolism or aortic dissection. 2. mild cardiac decompensation with pulmonary vascular congestion but no alveolar edema. small right pleural effusion. 3. possible small airways infection in the right middle lobe. 4. aneurysmal descending aorta, 4 cm. descending aortic graft in place without complication. 5. enlargement of the pulmonary arteries suggesting underlying pulmonary artery hypertension. mri hip findings: please note that due to hardware failure, the complete sequences could not be obtained. there is a comminuted left proximal femur intertrochanteric fracture, with coxa varus orientation. there is a large amount of marrow edema within the proximal femur. marrow edema and a small fracture line also extends into the femoral neck. however, the marrow signal in the femoral head appears normal. there is a small left hip joint effusion. the adjacent left acetabulum appears normal. there is a large amount of surrounding muscular edema. also noted is abnormal marrow signal in bilateral ischial tuberosities, left greater than right. these areas of abnormal marrow signal are just deep to the bilateral decubitus ulcers. in the appropriate clinical setting, these are consistent with osteomyelitis. the right hip appears normal. there is no evidence of right hip fracture. a suprapubic catheter is present. there is a large amount of pelvic musculature atrophy, consistent with patient's history of quadriplegia. there are spinal cysts which are partially visualized on the t1 images in the sacral spine. due to lack of t2-weighted images, these cannot be further evaluated. differential consideration includes tarlov cyst. 8/3 l hip xr: impression: 1. comminuted intertrochanteric fracture of the proximal left femur. 2. sclerosis and osseous irregularity of the left ischial tuberosity in the region of a vacuum drain is concerning for osteomyelitis. correlation with the recently performed mri is advised. r hip xr: markedly limited study without definite evidence for acute bony injury or marked infection. if there is high clinical concern, cross-sectional imaging is recommended. due to the patient's large size mri may not be possible and ct scan may be the best alternative. (per discussion with radiologist after fracture seen on mr, fracture was previously visible on this film as well, but was poor study) brief hospital course: ms. is a 71yo paraplegic female with pmh as listed above who presents with transient hypotension and leukocytosis. 1)hypotension: patient initially found to be hypotensive with sbp~90's despite receiving 3l ns. her baseline sbp is between 110-120's. upon transfer to the micu, her bp stabilized. the drop in her bp may have been early sepsis physiology given fever, history of recurrent uti's. she may also have some underlying autonomic dysregulation given paraplegia. she was started on vancomycin and zosyn given prior culture results which grew e.coli and enterococcus. after transfer to the floor on her bp remained stable sbp 110s-120s, no longer requiring ivf. 2)leukocytosis/fevers: patient noted to have wbc~14.0 and febrile on admission. cxray was not very revealing. her u/a was positive for leukocytes and nitrites but no wbcs and urine cx were negative. plastic surgery was consulted to see patient while she was in-house and recommended vac dsg changes q mwf. she continued to spike fevers until on vanc/zosyn but remained afebrile for the remainder of her hospital course. since her urine cultures and blood cultures were all negative, we explored other etiologies for her fever. she had a cta that did not show a pe but did show possible pna. she also had xrs of her hips to look for osteomyelitis given b/l decubitus ulcers. initial xr was poor study. esr was checked and was 105. mri showed abnormal marrow signal of b/l ischial tuberosities near areas of decubitus ulcers c/w osteomyelitis. zosyn was discontinued, vancomycin was continued and levofloxacin was added for gram negative coverage for her osteo. she will need 6 week course (5 more weeks of antibiotics). she will also need follow-up of inflammatory markers which trended down during hospital stay. 3)mental status changes: per son, the patient was less coherent on day of admission. this resolved rapidly with resolution of hypotension and fever. ct head was negative. 4)neurogenic bladder: patient has chronic sp foley catheter placement as a result of her paraplegia. the patient's son reported that her foley was not working appropriately. urology was contact on floor and performed sp catheter change and wound care was consulted for ostomy bag change around catheter. she was also reporting increased bladder spasms since baclofen was originally held in micu. spasms resolved with restarting baclofen and she had decreased leaking around sp catheter after catheter/bag change. 5)l trochanter ulcer: patient is followed closely by plastic surgery as an outpatient. she has a wound vac on her left lower extremity. wound care and plastic surgery were consulted and changed vac on mwf. she was continued on zinc sulfate. when findings of osteomyelitis were reported on mri, plastics was again contact and they did not feel that further debridement was neccessary at that time. she will follow up in plastics clinic. l buttock vac dsg changes should continue qmwf. 6.) left femur fracture: incidentally, patient noted to have comminuted l intertrochanteric femur fracture on mri. she denied any pain or h/o trauma. imaging also commented on osteopenia. she was started on calcium and vitamin d supplements as well as alendronate q week for atraumatic fracture. ortho was consulted and did not recommend surgery since she was non-weight bearing on that leg and did not have pain. could consider endocrine workup and/or bone density scan as outpatient. she will follow up in ortho clinic as outpatient. 7)gerd: continued on pantoprazole. 8)copd: pt reports she has "lung disease" but denies known h/o copd and pfts in were normal. she required 3l o2 nc while in hospital to maintain o2 sats around 94-95%. she reports that she was intermittently on 3l o2 at home, but it was unclear who started her home oxygen and what the original indication was. she was continued on outpatient regimen of advair and combivent. she has not seen a pulmonologist in the past, but follow up was arranged for pfts and an appointment was made with dr. . 9)depression: outpatient regimen was initially held given mental status. she was then re-started on gabapentin, nortriptyline, and bupropion. 10) code: dnr/dni medications on admission: gabapentin 900mg po tid nortriptyline 50mg po qhs bupropion 100mg po bid pantoprazole 40mg po daily aspirin 81mg po daily colace 100mg po bid zinc sulfate po daily hexavitamin po daily advair 250-50 combivent mdi discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. gabapentin 300 mg capsule sig: three (3) capsule po q8h (every 8 hours). 3. nortriptyline 25 mg capsule sig: two (2) capsule po hs (at bedtime). 4. bupropion 100 mg tablet sig: one (1) tablet po bid (2 times a day). 5. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: disk with devices inhalation (2 times a day). 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: aerosols inhalation four times a day as needed for shortness of breath or wheezing. 9. senna 8.6 mg tablet sig: two (2) tablet po every six (6) hours as needed for constipation. 10. hexavitamin tablet sig: one (1) tablet po once a day. 11. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily). 12. baclofen 10 mg tablet sig: four (4) tablet po tid (3 times a day). 13. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 5 weeks: do not take at the same time as your zinc. . disp:*35 tablet(s)* refills:*0* 14. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous q 12h (every 12 hours) for 5 weeks. disp:*70 * refills:*0* 15. sodium hypochlorite 0.5 % solution sig: one (1) appl miscellaneous asdir (as directed). 16. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed). 17. saline flush 0.9 % syringe sig: one (1) injection per neht protocol: per neht protocol. disp:*30 * refills:*2* 18. heparin flush 10 unit/ml kit sig: one (1) intravenous per neht protocol: per neht protocol. disp:*30 * refills:*2* 19. outpatient lab work please have cbc, bmp (including electrolytes and renal function), vancomycin trough level, esr and crp checked q week on wednesday or thursday x 5 weeks. fax results to dr. at . 20. home oxygen continue use of home oxygen. patient previously on 3l of supplementary oxygen at home. she should continue to use 3l of oxygen via nasal cannula unless instructed not to by a physician. 21. calcium carbonate 500 mg tablet, chewable sig: two (2) tablet, chewable po tid w/meals (3 times a day with meals). 22. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 23. alendronate 70 mg tablet sig: one (1) tablet po qthur (every thursday) as needed for hip fx. disp:*4 tablet(s)* refills:*2* discharge disposition: home with service facility: / vna discharge diagnosis: primary diagnosis: osteomyelitis secondary diagnosis 1. l proximal femur fx 2. t8 paraplegia anterior spinal infarct surrounding thoracic aneurysm repair 3. thoracic aneurysm repair () 4. hx of lll collapse/pna s/p mucous plug removal via bronchoscopy 5. htn 6. hyperlipidemia 7. gerd 8. chronic suprapubic catheter 9. utis, was on ppx bactrim until . fecal incontinence 11. depression 12. ?copd (pfts normal ), intermittently on 3l home o2, discharge condition: hemodynamically stable, afebrile, normotensive discharge instructions: you were admitted to the hospital with fever, low blood pressure, and confusion. this was most likely from an infection of the bones in your hips. we also found that you have a fracture of your left hip. you should not bear any weight on this leg and should have a repeat x ray in approximately 6 weeks to ensure that it is healing. we made the following changes to your medications 1. we added vancomycin 1g iv twice daily 2. we added levofloxacin 500 mg po daily 3. we added calcium and vitamin d supplements 4. we added alendronate 75 mg po q week please return to the er or call your primary care physician if you have fever >101, chills, shortness of breath, chest pain, or pain in your hips. followup instructions: please follow up with your primary care doctor dr. . call if you have any questions. he will see you at home. you should also have a repeat x ray of your left hip to ensure continued resolution of hip fracture. you will also need to have lab work done to follow safety labs and inflammatory markers. this will be drawn by nurses in your home. please follow up with dr. in pulmonary clinic. you have an appointment on wednesday at 8am. please arrive at 7:30am to complete paperwork and have pulmonary function tests prior to your visit. call if you have any questions or need to reschedule. please follow up with dr. in plastic surgery/wound care clinic on friday at 1:30pm. call if you have any questions or need to reschedule. please follow up with dr. in orthopedics clinic on thursday at 10:00am. call if you have any questions or need to reschedule. procedure: venous catheterization, not elsewhere classified diagnoses: esophageal reflux unspecified essential hypertension chronic airway obstruction, not elsewhere classified depressive disorder, not elsewhere classified other and unspecified hyperlipidemia personal history of other diseases of circulatory system pressure ulcer, other site other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation pressure ulcer, lower back urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure encephalopathy, unspecified paraplegia unspecified osteomyelitis, pelvic region and thigh personal history, urinary (tract) infection neurogenic bladder nos pathologic fracture of neck of femur late effect of complications of surgical and medical care mechanical complication due to urethral (indwelling) catheter 

Answer: The patient is high likely exposed to