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: levofloxacin / allopurinol attending: chief complaint: bilateral hip pain major surgical or invasive procedure: left hip hemiarthroplasty right hip orif intubation picc placement history of present illness: 81 yo woman with pmh signficant for sle, gout, chf and mvr, severe osteoporosis who was admitted on to from nh, c/o bilateral hip pain. she denied trauma but had an overlying hematoma on the right side, however she does not "recall anything" at this point. plain x-rays showed bilateral hip fractures, intratrochanteric on one side and femoral neck on other. the patient was initially hypotensive to the 80s but then responded to fluids. she was admitted to medicine due to medical comorbidity. surgery was initally planned for but on that day, she developed hypoxemia and cyanosis and cxr showed pulmonary edema, so she was diuresed with lasix and bumex and she did well though her o2 sats remained in the high 90??????s on 2-3lnc. cardiology and pulmonary were consulted. pulmonary felt, that she likely has interstitial underlying lung disease as well that is contributing to her hypoxemia. duonebs were given. she was continued on betablockers for rate control but coumadin was held. she was not on any other form of dvt prophylaxis or anticoagulation. she was also found to have a uti from esbl-e.coli and was treated with zosyn. the patient was also noted to be thrombocytopenic, chronically around 65k which was attributed to sle. her anemia was ranging around a hgb 8.3-8.5. she was transfused 1 unit prbc??????s, hct 27.9 prior to transfer. the patient also has arf with an unclear baseline (last 1.0 in ) now creatinine 1.2 per last report. . she was admitted to on . she was evaluated by orthopaedics for operative repair of her hips. she was assessed to be fluid overloaded as part of her hypoxia. diuresis was started. there was concern about a pe, so a cta was done on which showed no pe, but did show bilateral pleural effusions with patchy ground glass opacities, apical interlobular septal thickening and peripheral reticulation. there was mediastinal and hilar adenopathy. . the decision was made to diurese further, and her oxygen requirement was decreased from 3l to 1l nc. she had a repeat ua which showed e.coli that was sensitive to bactrim, so the zosyn was changed to bactrim. . on she was felt stable to go to the or the following day for possible surgical repair of both hips. on she was taken to the or and the left hip repair was started. she was noted to have a large amount of bleeding, and an intraopeartive hct was 21% (from 30% the previous day). she was given 3u prbc intraoperatively. she was noted to have an arrhythmia vs st depressions on telemetry during this time. the decision was made to not proceed with the right hip at this time. . there was a postoperative attempt at extubation, which per report she failed due to rising co2. . at this time she is intubated, on a propofol gtt. . nh, no evidence of trauma. past medical history: 1) rheumatic heart disease - h/o rheumatic fever at age 11; s/p porcine mvr . s/p pacemaker insertion, also . h/o lv dysfunction. 2) paf 3) sle - reportedly associated with pneumonitis and pancytopenia. 4) s/p r total knee replacement - , c/b septic arthritis in mssa 5) hypothyroidism 6) old r hip surgery 7) gout 8) osteoporosis social history: she is a widow. she has family in the area. daughter and husband live nearby. previous tobacco use, she quit 30 years ago. she uses alcohol very infrequently. functional status is poor, she ambulates very little at baseline in a wheelchair. she lives in a nh. . family history: brother status post cabg at age 69. physical exam: on admission to micu: physical exam: vs t 99.0 bp 110/50 hr 70 rr 12 o2sat 100% on ac 500x12 rr 12 40% ge: intubated, sedated heent: nc/at, perrla, anicteric neck: no lad, jvd at 8cm, no carotid bruit, left ej in place cor: s1s2, regular rhythm, no r/g, split 2, iii/vi holosystolic murmur over apex. no rv heave. pulm: crackles about 1/3 up both lung fields anteriorlly. no wheeze. abd: + bowel sounds, soft, nd, nt skin: warm extremities, large hematoma over r knee, back not examined. ext: 1+ dp, 2+ edema, swelling of b/l hip. left hip bandaged with soft tissue swelling of thigh. rle shortened and externally rotated. gu: perineal bruising / hematoma with swelling of left labia > right labia. pertinent results: echo at osh: preserved lv function, r pulm htn, rv enlargement, tv 51mmhg . echo here: the left atrium is moderately dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is dilated. right ventricular systolic function is borderline normal. the aortic valve leaflets are mildly thickened. mild (1+) aortic regurgitation is seen. a bioprosthetic mitral valve prosthesis is present. the transmitral gradient is normal for this prosthesis. no mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. severe tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , left ventricular systolic function appears preserved. tricuspid regurgitation is now more prominent and pulmonary artery systolic pressure is now higher. . cta: 1. no evidence of pulmonary embolism. 2. bilateral pleural effusions with patchy ground-glass opacity, apical interlobular septal thickening, and peripheral reticulation. findings likely, at least in part, reflect a degree of hydrostatic pulmonary edema. it is unclear what component of these changes are chronic in nature. if indicated, followup ct after the patient's acute clinical findings have been treated may be performed. 3. numerous thoracic compression fractures, age indeterminate. 4. coronary artery and other vascular calcifications consistent with atherosclerosis. 5. mediastinal and hilar lymphadenopathy. . hip xray: 1. displaced right femur intratrochanteric fracture with pins in situ. 2. left femur fracture. . ct head: no acute intracranial pathology including no sign of intracranial hemorrhage. . r elbow: 2views: radial head fracture . bnp: 9000 at osh . admission ekg: afib, v-paced, hr 70, st scooping in i; throughout three sequential ekg on / patient is developing a twi in isolated v2 brief hospital course: # b/l hip fractures osteoporosis s/p repair: the patient was originally admitted with bilateral hip fractures, the left newer than the right, of unclear origin as there was no known trauma or fall. however, there was no suspicion of abuse and social work confirmed this. after some respiratory optimization, described below, and reversal of her inr with vitamin k and ffp, the patient underwent a left hemiarthroplasty on . intraoperatively, some abnormal appearing changes, possible st depressions, appeared on her telemetry and the operation limited to only the left side at that time. she was a difficult ween from the ventilator and was transferred to the micu for rule out acs and vent ween. she was ruled out by a normal ekg and 3 sets of negative cardiac biomarkers. she also required several units of prbcs for postoperative anemia. she was extubated shortly thereafter. she returned to the or for a right orif and removal of the preexisting hardware on . again, post operatively she developed respiratory distress and had to be reintubated and transferred to the micu. during her time in the micu, there was noted to be soft tissue swelling of her r knee and thigh but an ultrasound showed no dvt and no gross hematoma. after stabilization the patient returned to the floor and began working with physical therapy. she was wbat with anterolateral hip precautions. her pain was controlled initially with iv morphine and po oxycodone but she was eventually transitioned to percocet with good effect. she was also begun on calcium and vitamin d supplementation to augment her actonel usage. she was maintained on enoxaparin prophylaxis until her coumadin level returned to a therapuetic range. she will continue physical therapy at her rehabilitation center with a follow up with dr. in orthopedics. # respiratory distress: upon transfer from the osh, the patient had a new oxygen requirement of unknown etiology. after an initial concern of pe a cta was done that showed no pe but chronic interstitial lung disease with possible acute pulmonary edema overlying it. a repeat echocardiogram showed a preserved lvef but moderate to severe pulmonary hypertension. she carries a diagnosis of chf but discussions with the pcp could not further clarify its cause or current status. based on clinical status, it is likely diastolic dysfunction. prior to her first operation, the patient was diuresed with iv lasix with improvement in her oxygen requirement. after the operation, she was not able to intially extubated but was extubated within 24 hours and did well subsequently. she returned to the or on and developed postoperative respiratory distress and hypercarbia (abg 7.0/99/84), likely from fluid overload and sedation. she was reintubated, diuresed with iv lasix and extubated sucessfully the next day. the patient was weened from her o2 to room air and placed back on her outpatient regimen of 40mg lasix po bid and spironolactone 25mg po daily to maintain her current fluid balance. she remained stable on room air with minimal subjective shortness of breath. # anemia: over the course of her admission, the patient has required a total of 9 units of prbcs to be transfused for intra and postoperative blood loss, including a small amount of bleeding into her bilateral thighs. the last transfusion was on and her hematocrit has remained stable since with no further signs of bleeding. . # afib: initially her inr was reversed with vitamin k and ffp. she was maintained on good rate control using her metoprolol. after completion of her surgeries, her coumadin was restarted. her inr will need to be checked 2-3x/week until it is therapeutic with a goal inr of . her digoxin was also restarted after the completion of her surgeries. . # hyperkalemia: pt noted to be hyperkalemic post-op, with no peaked t waves on ekg (in setting of baseline intraventricular conduction delay). hyperkalemia resolved after administration of calcium, insulin, and d50; this issue has remained stable. . # prosthetic (porcine) valve/mvr: no need for continued anticoagulation for this reason. valve function appears to be good based on echocardiogram. . # arf: cr was noted to be 1.2 on admission and 1.7 at the osh, with no recent recorded baseline (last cr ). currently, this issue is resolved after blood transfusion with recent cr of 0.9 - 1.0. the etiology was likely prerenal with poor forward flow from chf. . # uti: e.coli uti here, noted on admission. reported as esbl at osh and initially got zosyn, however then found to be bactrim sensitive, which was treated with 7 day course of bactrim which finished . no further signs of infection. . # depression: patient continued on home regimen of citalopram 20mg po daily. . # hypothyroidism: patient continued on home regimen of levothyroxine 88mcg daily. . # fen: regular as tolerated. patient not hungry, so have added ensure tid to supplement . # prophylaxis: enoxaparin 40mg sc daily, pneumoboots, ppi po (home regimen), bowel regimen. . # access: picc . # code: dnr, not dni (form in chart), confirmed with daughter. . # comm: daughter , also hcp medications on admission: medications at home: actonel 35mg po daily mvi daily protonix 40mg po daily mom 30cc po prn bisacodyl supp one rectal prn mylanta 20cc po daily prn peptobismol 2 tsp po duonebs q6h prn citalopram 20mg po daily spironolactone 25mg daily digoxin 0.125mg daily vitamin c daily 500mg colchicine 0.3mg daily furosemide 40mg metoprolol 50mg tylenol loperamide 2mg po daily prn levoxyl 88mcg daily coumadin 5mg daily discharge medications: 1. hexavitamin tablet sig: one (1) cap po daily (daily). 2. enoxaparin 40 mg/0.4 ml syringe sig: one (1) subcutaneous daily (daily): continue until inr >2. 3. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 4. docusate sodium 50 mg/5 ml liquid sig: one hundred (100) mg po bid (2 times a day) as needed. 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 6. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 7. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 8. levothyroxine 88 mcg tablet sig: one (1) tablet po daily (daily). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. metoprolol tartrate 25 mg tablet sig: two (2) tablet po twice a day: hold for sbp<100 or hr<60. 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. calcium carbonate 500 mg tablet, chewable sig: 1.5 tablet, chewables po bid (2 times a day). 13. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po bid (2 times a day). 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 16. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 17. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 18. warfarin 5 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 19. actonel 35 mg tablet sig: one (1) tablet po once a day. 20. duoneb 0.5-2.5 mg/3 ml solution for nebulization sig: one (1) inhalation every six (6) hours as needed for shortness of breath or wheezing. 21. colchicine 0.6 mg tablet sig: 0.5 tablet po once a day. 22. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 23. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: - discharge diagnosis: bilateral hip fractures s/p l hemiarthroplasty () and r orif () diastolic congestive heart failure lupus with interstitial lung disease. discharge condition: all vitals signs stable, off oxygen. hematocrit stable. pain well controlled. discharge instructions: you were admitted with fractures of both hips. you also had some trouble breathing, requiring oxygen. this was likely from fluid build up in your lungs, backing up from your heart. this is called congestive heart failure. this fluid was removed using iv lasix and then will be kept off using the oral form of lasix you were previously on. your hip fractures were repaired surgically, however after each surgery, you had increased trouble breathing, requiring intubation and stays in the medical icu. however, you quickly recovered after more fluid was taken off with lasix. you also had a drop in your blood count after the operations, from blood loss during the operation and some bleeding into the legs after the operation. you received a number of blood transfusions to correct this. however, your blood count is now stable and you have no further signs of bleeding. you also had a small and temporary decrease in your kidney function upon admission, likely due to some dehydration. this improved and was normal by the time of discharge. you also had a urinary tract infection treated with a course of antibiotics, finished in the hospital. during your first operation, there was a concern about your heart based on the ekg taken during the operation. however, subsequent labs tests showed no damage to the heart and no heart attack. you were also given some pain medications to control your pain. these will continue at the rehab facility. you will also continue followup instructions: please call dr. office at ( to schedule a follow up appointment in the next 1-2 weeks. please call dr. office at to schedule a follow up appointment in the next few weeks. provider: clinic phone: date/time: 11:30 procedure: venous catheterization, not elsewhere classified partial hip replacement partial hip replacement open reduction of fracture with internal fixation, femur transfusion of packed cells removal of implanted devices from bone, femur diagnoses: systemic lupus erythematosus thrombocytopenia, unspecified anemia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified unspecified acquired hypothyroidism gout, unspecified atrial fibrillation other chronic pulmonary heart diseases acute respiratory failure hypotension, unspecified other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation cardiac pacemaker in situ hypoxemia heart valve replaced by transplant diastolic heart failure, unspecified rheumatic heart disease, unspecified street and highway accidents lung involvement in other diseases classified elsewhere pathologic fracture of other specified site pathologic fracture of vertebrae other osteoporosis pathologic fracture of neck of femur other mechanical complication of other internal orthopedic device, implant, and graft 

Answer: The patient is high likely exposed to