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: e-mycin / levofloxacin / aspirin / metronidazole / nitrofurantoin / tetracycline attending: chief complaint: shortness of breath major surgical or invasive procedure: none history of present illness: ms. is a year old woman with atrial fibrillation on warfarin admitted for multifactorial hypoxia secondary to pneumonia, pulmonary edema, and question of copd exacerbation, transfered to icu in setting of acute intracranial bleed s/p fall. she was started initially on vancomycin and zosyn for pneumonia, transitioned to community acquired coverage with cefpodoxime and azithromycin. she was also given lasix for pulmonary edema which improved her respiratory symptoms. there was also some concern initially for a potentialy copd exacerbation, so she was given a dose of methylprednisolone 125mg then switched to prednisone. she received one dose of prednisone, and it was discontinued. patient fell out of chair around 3:30am morning of micu admission. head ct showed small right subdural bleed, and mental status was alert and oriented x3. in late morning, patient complained of headache and had new word finding difficulties. neurosurgery was consulted and suggested repeat head ct 12 hours after previous one and reversal of inr. she was given 1 unit of ffp and 10mg iv vitamin k along with an extra dose of 40mg iv lasix in the late morning. because she sounded fluid overloaded on morning rounds, she had received an extra dose of 40mg iv lasix in addition to home dose 2mg bumex as well. after ffp, patient developed respiratory distress, presumed to be secondary to flash pulmonary edema. she was triggered on the floor for tachypnea. she received an extra dose of 40mg iv lasix in early afternoon, and a foley was placed. nitro paste was also placed. cxr showed pleural effusions, right greater than left, and pulmonary edema. micu consult was initiated, at which time, patient was verbally responsive to her name but not oriented and not able to hold conversation. she was weaned from face mask to 2l nasal canula, on which she was satting 93%. she underwent stat head ct which showed significantly expanded subdural hematoma bilaterally, left worse than right. she had an episode of nausea with dry-heaving on return to the floor. no mass effect was seen on ct. neurosurgery evaluated patient at bedside, had coversation with family that patient may recover if inr is reversed quickly. patient was given another unit of ffp and transfered to the micu for further management in setting of mental status and concern for potential respiratory instability. of note, patient was also noted to be having loose stools on the floor. stool sample was sent for c diff prior to micu transfer. on arrival to the micu, patient was somnolent and tachypneic, unable to converse past medical history: 1. hypertension. 2. hypothyroidism. 3. polymyalgia rheumatica off prednisone for >2yrs 4. history of upper extremity peripheral neuropathy. 5. peptic ulcer disease with history of gi bleed secondary to aspirin 7 years ago. 6. status post cholecystectomy. 7. diverticulitis 8. complete heart block s/p ddd pacer in 5/00 9. copd 10. cva in past with no residual deficit on plavix qod for gib 11. insulin resistance-with prednisone use in past 12. a fib - on coumadin since 13. ? polio when she was a child whicmh may have lead to her neuropathy? social history: she lives in in senior housing independent living. she gets dinner and she makes her other meals. her daughters buy her food. she is independent of adls and independent of accounting and meal preparation for breakfast and lunch. she does her own medications. her husband passed away 10 years ago. she uses a rolling walker to ambulate. she has 6 children - 4 sons and 2 daughter who are involved in her care. she does not smoke or drink alcohol but smoked 1ppd for approx 20 years up to age 62 (20 pack-years). no ivdu. her hcp: - she lives in ri retired billing supervisor at the family history: father: died of mi at 75 mother: died at 84 of heart attack brother: died of mi no other hx of copd, ca, dmii or cva. physical exam: admission physical exam: vitals: t: 97.5 bp: 146/46 p: 75 r: 36 o2: 96% on 2l nc general: sleepy appearing, not oriented, responding to name heent: sclera anicteric, pupils 2mm bilaterally and responsive to light neck: supple, jvp elevated lungs: harsh bibasilar crackles and bilateral expiratory wheeze cv: regular rhythm, normal rate abdomen: soft, non-tender, non-distended gu: foley draining very light yellow urine ext: warm, palpable dp pulses, no peripheral edema neuro: pupils symmetric and reactive, cannot cooperate with full neuro exam but moving all extremities on her own discharge physical exam: vitals: t: 97.8 hr 75 rr 15 bp 145/53 o2% 94% 2lnc general: lethargic but arousable. waxing and levels of conciousness. she squeezes fingers and wiggles toes with request. looks at you after hearing her name but appears aphasic and doesnt respond verbally. she appears in pain but is in nad heent: sclera anicteric, pupils 2mm bilaterally and responsive to light neck: supple, jvp not elevated lungs: patient not able to follow commands to breath deeply but sounds clear to auscultation cv: regular rhythm, normal rate, 2-3/6 systolic mumur heard throughout the precordium abdomen: soft, non-tender, non-distended, good bowel sounds. tenderness over iliac crest and patient points to iliac crest when in pain gu: foley draining yellow urine ext: cool but palpable dp pulses, no peripheral edema neuro: pupils symmetric and reactive, cannot cooperate with full neuro exam but moving all extremities on her own. arousable to name and squeezes hands and moves toes on request pertinent results: admission labs: 07:10am blood wbc-20.6* rbc-3.93* hgb-12.4 hct-35.3* mcv-90 mch-31.6 mchc-35.2* rdw-14.2 plt ct-314 07:10am blood neuts-90* bands-0 lymphs-4* monos-6 eos-0 baso-0 atyps-0 metas-0 myelos-0 07:10am blood pt-26.9* ptt-35.7* inr(pt)-2.6* 07:10am blood glucose-143* urean-30* creat-1.1 na-135 k-5.6* cl-99 hco3-24 angap-18 04:19pm blood type-art po2-65* pco2-36 ph-7.44 caltco2-25 base xs-0 discharge labs: 04:25am blood wbc-17.2* rbc-3.74* hgb-11.3* hct-33.3* mcv-89 mch-30.2 mchc-33.9 rdw-14.1 plt ct-243 04:25am blood pt-12.9 inr(pt)-1.1 04:25am blood glucose-168* urean-29* creat-1.0 na-145 k-4.0 cl-108 hco3-29 angap-12 04:25am blood calcium-8.9 phos-3.0 mg-2.3 inr: supratherapuetic 4.9 on floor before transfer to icu. in icu: after vitamin k and 2 units ffp 03:50pm blood pt-18.4* ptt-27.9 inr(pt)-1.7* 12:52am blood pt-13.7* ptt-25.1 inr(pt)-1.2* 04:51am blood pt-13.2 ptt-24.8 inr(pt)-1.1 07:03pm blood pt-13.0 inr(pt)-1.1 04:25am blood pt-12.9 inr(pt)-1.1 imaging: ct head new extra-axial collection measuring up to 6 mm in greatest thickness, ithout significant mass effect. no fracture serial ct heads ct head 1. dramatic short-interval increase in the left subdural collection, as well as new right-sided subdural collection, with foci of hypodensity in both representing hyperacute bleeding. increased associated mass effect with effacement of the ventricles and sulci as well as stable 6-mm rightward shift of the normally-midline structures. 2. trace amount of new subarachnoid hemorrhage inover the left parietal lobe serial ct heads without interval change x 4 (most recent ) hip x-ray : ap view of pelvis, two views left hip done with portable technique. there is large amount of bowel gas obscuring visualization of the pelvis. severe degenerative changes in the lumbar spine and sacroiliac joints. no discrete fracture of the proximal femur identified, but if this is clinically suspected, then ct or mri would be more sensitive for detection of subtle fractures radiographically occult. there is mild degenerative change of the femoro-acetabular joints. wrist x-ray : no fracture elbow x-ray : no fracture shoulder x-ray : no fracture brief hospital course: yo f pmhx afib on coumadin, diastolic heart failure, who initially presented to w hypoxia and shortness of breath, found to have a pneumonia and acute on chronic heart failure, course complicated by fall and bilateral subdural hematomas, now w improved respiratory status, residual stable confusion being discharged to rehab . active # pneumonia and acute diastolic chf: pt w o2 requirement, leukocytosis, initially treated for healthcare-associated pneumonia and heart failure exacerbation. pt was given vancomycin, pipercillin/tazobactam, and azithromycin. in setting of fall (see below) she was switched to vancomycin and cefepime concern that azithromycin could increase her inr. patient was diuresed w prn lasix with improvement in respiratory function. patient completed a full course of abx prior to discharge. . # subdural hematoma: course was complicated by unwitnessed fall . stat nchct demonstrated subdural hematoma. f9 complex, ffp, and vitamin k were given for anticoagulation reversal. patient was initally aox3 and attentive, but subsequently she developed ha and dysarthria. patient subsequently had rapid deterioration of mental status, but she remained without focal neurologic signs. repeat nchct demonstrated increased lsided subdural collection and new rsided subdural collection, small l parietal subarachnoid hemorrhage and mass effect. she was transferred to the icu. neurosurgery did not feel surgery was indicated her comborbidities. per neurosurgery recommendations, serial ct imaging was performed, without significant worsening. patient remained w waxing and waining mental status, and she developed worsening dysarthric, eventually demonstrating both expressive and receptive aphasia. per neurosurgery, this course is expected and she will likely have waxing and wainig mental status for some time before she returns back to baseline. . # altered mental status: as above, pt w waxing and waining mental status in setting of fall and subdural. pain was also felt to likely be contributing as well and was treated w tylenol, morphine and lidoderm patch. . # leukocytosis: patient w chronic leukocytosis, without significant findings on culture data or physical exam during this hospital stay. . # atrial fibrillation - patient on chronic coumadin, found to have a supratherapeutic inr of 4.9. in setting of fall, coumadin was held and inr was reversed. at time of discharge inr was 1. per neurosurgery consult, anticoagulation should continue to be held for one month after fall. would recommend conversation with family regarding risk/benefits of restarting anticoagulation vs future falls. . # hyperglycemia - patient was found to have elevated blood sugars during this admission, in the setting of several doses of steroids; she was placed on an insulin sliding scale. her sugars will need to be followed, with plan for eventual evaluation for diabetes . inactive # hypothyroidism - continued home levothyroxine dose. . # hyperlipidemia - continued home statin therapy. . transitional issues: 1. code status - patient dnr/dni 2. pending - at time of discharge blood cultures from , remained pending and will need to be followed up by rehab facility 3. transition of care: - neurosurgery follow up in 4 weeks ( at 10:30 for ct imaging, office appointment 11:15am) - blood pressure goal is sbp<160 - hold anticoagulation for one month after fall, can resume once discussion with family re: risks/benefits has been conducted medications on admission: home medications: 1. maalox as needed. 2. simvastatin 20 mg q.p.m. 3. simethicone 80 mg p.o. before meals. 4. lisinopril 5 mg daily (started at the in during her recent hospitalization). 5. amlodipine 10 mg daily. 6. bumex 2mg daily. 7. levothyroxine 75 mcg daily. 8. spiriva 18 mcg daily. 9. vitamin d3 1000 units daily. 10. oxazepam 30 mg at bedtime p.r.n. insomnia. 11. tylenol p.r.n. 12. coumadin as directed. discharge medications: 1. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 2. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 3. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 4. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 5. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for sob. 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for sob. 7. bumetanide 2 mg tablet sig: one (1) tablet po daily (daily). 8. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 9. acetaminophen 650 mg suppository sig: one (1) suppository rectal q8h (every 8 hours) as needed for pain/fevers. 10. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for body pain. 11. saline flush 0.9 % syringe sig: one (1) 3ml injection twice a day: please flush picc line with saline only. please do not flush line with heparin. 12. morphine 2 mg/ml syringe sig: 0.5 ml injection q4h (every 4 hours) as needed for pain refractory to tylenol. 13. ondansetron hcl (pf) 4 mg/2 ml solution sig: four (4) mg injection q8h (every 8 hours) as needed for nausea. 14. phenytoin sodium extended 100 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*90 capsule(s)* refills:*3* 15. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 16. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea/vomiting. disp:*40 tablet, rapid dissolve(s)* refills:*0* 17. acetaminophen 325 mg tablet sig: two (2) tablet po q8h (every 8 hours). 18. insulin lispro 100 unit/ml solution sig: sliding scale subcutaneous asdir (as directed): per printed sliding scale. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: pneumonia acute on chronic heart failure bilateral subdural hematomas ?copd ?diabetes mellitus discharge condition: mental status: confused - sometimes. level of consciousness: awake, but periods of rousable lethargy. activity status: out of bed with assist. fall precautions. discharge instructions: dear ms. , it was a pleasure treating you during your hospitalization. you were initially admitted to the hospital for pneumonia and acute worsening of your heart failure. you were treated with iv vancomycin and cefpodoxime/cefepime antibiotics for your pneumonia and you improved. your heart failure was treated with oxygen and taking your extra fluid off. during your hospitalization, you experienced a fall while in your room. as a result of the fall you developed subdural hematomas (bleeding in the brain) both on the left and right side of your head. because you were on coumadin, your blood was thin and made you more prone to bleeding into your brain injury; this was fixed by giving you factor 9 complex, vitamin k and fresh frozen plasma. your initial head ct showed subdural hematomas but serial ct scans after correcting your anticoagulation did not show changes in the hematomas (they were stable). you were occasionally confused and sleepy, which were felt due to the bleeding in your brain. according to neurosurgery, this is the normal course for subdural hematoma and you were discharged in stable condition to rehab for monitoring mental status, physical therapy and improvement in subdural hematomas. the following changes to your medications were made: - please do not take your home coumadin - please do not take any medications that can cause blood thinning including aspirin, plavix or ibuprofen, naproxen or any other non-steroidal anti-inflammatories. - please weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: name: , specialty: internal location: -/westw address: , , , phone: please discuss with the staff at the facility the need for a follow up appointment with your pcp when you are ready for discharge. . department: radiology when: wednesday at 10:30 am with: cat scan building: cc clinical center campus: west best parking: garage . department: neurosurgery when: wednesday at 11:15 am with: , md building: lm campus: west best parking: garage procedure: venous catheterization, not elsewhere classified central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation acute on chronic diastolic heart failure other and unspecified hyperlipidemia other emphysema long-term (current) use of anticoagulants cardiac pacemaker in situ diarrhea do not resuscitate status hyperosmolality and/or hypernatremia accidents occurring in residential institution subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness aphasia mononeuritis of unspecified site other alteration of consciousness accidental fall from chair 

Answer: The patient is high likely exposed to