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: penicillins attending: chief complaint: s/p fall, hypotension major surgical or invasive procedure: none history of present illness: 77 year old woman with a history of severe copd on 2l home o2, chf, and atrial fibrillation on coumadin transferred from with presumed urosepsis and multiple orthopedic injuries s/p fall. per history, the patient was started on bactrim yesterday for left lower extremity cellulitis. yesterday afternoon, she was found down by her husband with presumed mechanical fall without loc. she was brought to . at that time, the patient was able to provide an hpi. she stated that she hit her back and went down without head strike or loc. she endorsed total body pain, r > l. she denied chest pain, shortness of breath, or nausea. for her fall, she underwent ct scans of the head, c-spine, chest, abdomen and pelvis, these were essentially benign. orthopedic workup that revealed a right humeral surgical neck fracture and right intertrochanteric hip fracture. at , the patient was found to be hypotensive. right ij was placed. she did have a lactate of 5, she received 4 l of normal saline, she was initially started on norepinephrine. she also received flagyl, vancomycin and levaquin. she underwent cardiac workup, and was found to have an nstemi, with troponin > 1. she received a full strength asa. she was transferred to for further management. . on arrival to the ed, initial vs: 97.8 112 71/33 20 96% 4l. ekg showed afib with hr depr laterally with <1mm ste v2-3 c/w prior. she was evaluated by atrius cardiology, who felt that ekg looked similar to previous ekgs at . ua positive. inr 4.2. vs prior to transfer: 98.8 106 106/44 16 95%. . on arrival to the micu, the patient is unable to respond to questions . review of systems: unable to obtain due to ams. per transfer records, patient had dirrhea prior to admission. past medical history: copd, very severe (on 2l home o2) atrial fibrillation congestive heart failure hypercholesterolemia vitamin d deficiency tobacco dependence gout, unspec adrenal adenoma mitral valve insuffic peripheral vasc disease, unspec carotid artery stenosis / occlusion coronary artery disease social history: currently smokes 0.5 ppd x 40 years. family history: brother with cad, pvd; mother with wegeners granulomatosis physical exam: admission physical exam: vitals: t: 98 bp: 95/52 p: 134 r: 14 o2: 85% 4l general: lethargic; able to tell me name is "", otherwise unable to answer questions; opens eyes to command heent: sclera anicteric, mm dry with crusting lips neck: supple, jvp not elevated, no lad cv: tachycardic irregularly irregular s1, s2; no murmurs, rubs, gallops lungs: scattered ronchi bilaterally; no wheezes, rales; moderate air movement abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley draining dark reddish urine ext: right lower extremity inverted and foreshortened; right upper extremity with band of ecchymosis around arm, edematous; left lower extremity with venous stasis changes and two ulcerations on anterior shin, ulcerations without drainage; feet cool; pt pulses monophasic by doppler neuro: opens eyes to command; has frontal hand grip bilaterally . discharge physical exam: patient expired on confirmed absence of cardiac sounds, pulse, breath sounds. pupils fixed and dilated with negative corneal reflexes. pertinent results: admission labs: 06:03pm blood wbc-14.2* rbc-3.93* hgb-11.9* hct-38.0 mcv-97 mch-30.3 mchc-31.3 rdw-13.8 plt ct-164 06:03pm blood neuts-95.1* lymphs-1.8* monos-2.9 eos-0.1 baso-0.1 06:03pm blood pt-42.4* ptt-49.3* inr(pt)-4.2* 04:00pm blood glucose-113* urean-29* creat-0.8 na-146* k-4.3 cl-114* hco3-23 angap-13 04:00pm blood alt-41* ast-70* ck(cpk)-845* alkphos-58 totbili-0.4 04:00pm blood ck-mb-21* mb indx-2.5 04:00pm blood ctropnt-0.19* 04:00pm blood albumin-3.1* calcium-7.3* phos-4.2 mg-1.6 04:05pm blood lactate-1.7 . labs on day patient expired: 03:04am blood wbc-15.4* rbc-3.71* hgb-10.9* hct-35.4* mcv-96 mch-29.5 mchc-30.9* rdw-14.2 plt ct-184 03:04am blood neuts-92.2* lymphs-3.1* monos-2.9 eos-1.7 baso-0.1 04:34am blood pt-126.8* ptt-59.8* inr(pt)-13.2* 03:04am blood glucose-266* urean-45* creat-1.6* na-137 k-4.7 cl-106 hco3-22 angap-14 04:26pm blood alt-55* ast-112* ld(ldh)-405* alkphos-51 totbili-0.2 06:00am blood ck(cpk)-2582* 06:00am blood ck-mb-36* mb indx-1.4 ctropnt-0.33* 03:04am blood calcium-8.3* phos-5.6* mg-2.3 05:08am blood d-dimer-800* 03:04am blood osmolal-304 . urine studies: 04:00pm urine color-red appear-hazy sp -1.016 04:00pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-lg 04:00pm urine rbc-146* wbc->182* bacteri-many yeast-none epi-2 04:00pm urine casthy-6* 04:00pm urine amorphx-rare 04:00pm urine wbc clm-few mucous-rare . micro: blood cultures x 2: no growth to date urine culture: negative urine legionella antigen: negative brief hospital course: 77 year old woman with a history of cad, chf, and a fib on coumadin admitted s/p fall with hypotension and multiple orthopedic injuries: # hypotension: patient transferred from osh with hypotension following a fall. she was found to be in likely septic shock, either from a urinary or pulmonary source. she had a grossly positive ua on admission, but urine culture sent following initiation of antibiotics at the osh negative. chest x-ray with increasing retrocardiac and right upper lobe opacities. she was repleted with fluids and started on norepinephrine for pressure support. norepinephrine required rapid uptitration, and the patient was given bicarbonate to optimize ph for pressors. vasopressin was then added. she was also started on vancomycin, cefepime, and azithromycin to cover for pulmonary and urinary sources. given her cardiac history and elevated troponin, she also underwent echo to evaluate cardiac or obstructive sources for her hypotension. she was found to have an ef of 25% with severe tr. thus, obstructive physiology from a possible fat embolism related to her hip fracture may contribute to her hypotension. as atrial fibrillation with rapid ventricular response also likely contributed to her hypotension, she was also rate controlled as below. no evidence of bleed from hip fracture. with persistent hypotension and significant discomfort/agitation as below, the patient was made comfort measures only at the request of her family. pressors were discontinued. the patient died with profound septic shock and hypercarbic/hypoxemic respiratory failure on . # hypercarbic and hypoxemic respiratory failure: patient admitted with hypoxemia requiring non-rebreather; markedly increased from baseline requirement of 2l for copd. over the first 2 hours of admission, she became increasingly obtunded, and was found to have a significant respiratory acidosis with co2 narcosis (abg 7.96/102/88). she was placed on non-invasive ventilation, given code status of dni, with mild improvement in hypercarbia and mental status. she was treated with nebs, and was taken on and off non-invasive ventilation as patient tolerated throughout her admission. regarding the etiology of respiratory failure, the patient may have had worsening pneumonia as above. she was covered with vancomycin, cefepime, and azithromycin. however, presentation also concerning for fat embolism caused by hip fracture. given tenuous respiratory status, the patient remained with altered mental status, and intermittently uncomfortable from a respiratory perspective throughout admission. she was transitioned to comfort measures only as above. she was started on morphine for pain and air hunger. # atrial fibrillation with rvr: chronic, rate-controlled at home on metoprolol succinate with warfarin for anticoagulation. on admission, the patient was transitioned to an esomolol drip for rate control once metoprolol wore off. she was then transitioned to digoxin with poor rate control. the patient was evaluated by atrius cardiology, who recommended loose rate control given concern that tachycardia is a compensatory response to hypotension. digoxin discontinued with acute kidney injury and transition to cmo. # supratherapeutic inr: as above, patient on home warfarin for atrial fibrillation. she was admitted with an inr of 4.2 in the setting of poor nutrition, recent antibiotics, and sepsis. coumadin was held. head ct at negative for bleed. throughout admission, inr continued to increase rapidly to 13, concerning for consumptive coagulopathy. dic labs were negative and hematocrit remained stable. the patient was given 10 mg iv vitamin k to reverse supratherapeutic inr. # chronic chf with ef 25%: patient with chronic chf, but echo on admission with worsening tr from baseline, concerning for obstructive physiology. home medications held given severe hypotension and renal failure. # : patient with creatinine increase from 0.8 to 1.6 over the first 36 hours of admission. likely due to atn in the setting of severe hypotension. medications were renally dosed. # right hip and right shoulder fracture: s/p mechanical fall. patient evaluated by orthopedics with recommendation for or repair of hip fracture. per ortho, patient did not need surgical repair of right shoulder fracture. the patient did not go to the operating room due to her hemodynamics as above. she was treated with iv tylenol for pain control. low dose iv fentanyl was added with mild improvement in respiratory status. the patient was transitioned to iv morphine for worsening pain and agitation with transition to comfort measures only. # elevated cardiac enzymes: patient transferred from outside hospital out of concern for nstemi. however, cardiac enzyme elevation occurred in the setting of elevated cpk, likely from mild rhabdo caused by fall. elevated troponin likely from demand ischemia. mb-index remained normal. patient received full strength aspirin at osh. cardiac enzymes were trended to peak. ekgs unchanged from baseline. medications on admission: warfarin 1 mg oral tablet, take 2-3 tablets daily or as directed by ams. simvastatin 80 mg oral tablet, take of a tablet daily metoprolol succinate 50 mg oral tablet extended release 24 hr, take 1 tablet daily lisinopril 5 mg oral tablet, take one tablet daily furosemide 20 mg oral tablet, 1 by mouth once daily cholecalciferol, vitamin d3, (vitamin d) 1,000 unit oral tablet, 1 tab daily discharge disposition: expired discharge diagnosis: hypercarbic and hypoxemic respiratory failure septic shocks hip fracture pneumonia discharge condition: patient expired on procedure: non-invasive mechanical ventilation arterial catheterization diagnoses: pneumonia, organism unspecified acidosis abnormal coagulation profile coronary atherosclerosis of native coronary artery tobacco use disorder acute kidney failure with lesion of tubular necrosis unspecified septicemia severe sepsis chronic airway obstruction, not elsewhere classified atrial fibrillation unspecified fall peripheral vascular disease, unspecified atrial flutter acute respiratory failure cellulitis and abscess of leg, except foot septic shock diarrhea encounter for palliative care do not resuscitate status rhabdomyolysis home accidents closed fracture of surgical neck of humerus fat embolism closed fracture of intertrochanteric section of neck of femur other dependence on machines, supplemental oxygen other acute and subacute forms of ischemic heart disease, other other nonspecific findings on examination of urine 

Answer: The patient is high likely exposed to