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: no known allergies / adverse drug reactions attending: chief complaint: l it femur fracture major surgical or invasive procedure: left open reduction internal fixation history of present illness: ms. is a 78 y/o f with pmhx of dm ii and htn, who was initially aditted on to the orthopedics service with l femur fx from mechanical fall. she underwent left hip orif on . on pod #2 (), medical team was consulted for hypoxia. patient had 2-3lnc o2 requirement since surgery, but acutely worsened over the course of , where she was hypoxic to the 70s on ra, and low 90s on 10l ventimask. she was found to have pe on cta and was started on heparin gtt. she was also started on vancomycin and cefepime empirically for hcap before being transferred to the micu. while in the micu she was initially on nrb, but has been weaned to 3 o2. currently, patient is sleeping comfortably, but awakens easily. with her daughter translating, she notes persistent sob and cough. she denies any pain at this time, but has had persistent soreness from her surgical site. she reports having a fever 2 days ago. review of systems: (+) per hpi (-) denies headache, sinus tenderness, rhinorrhea or congestion. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. past medical history: dm ii htn social history: lives in , currently visiting family in the us. denies smoking, etoh or illicits family history: nc physical exam: admission physical exam: afebrile nad, alert x oriented x 3. ncat breathing comfortably on ra pulse regular bue: nontender, no deformity or echhymoses. no pain w/ rom. fires , tri, grasp. 2+dp lle: internally rotated. pain hip w/ log roll. no ttp thigh/knee/leg. fires /fhl/ta/gs. silt dp sp s s t. 2+dp. rle: no deformity or ecchymoses. no pain w/ rom. no ttp thigh/knee/leg. fires /fhl/ta/gs. silt dp sp s s t. 2+dp. discharge physical exam: vitals: tc 98.3, bp 134/61, hr 71, rr 18, o2 98% ra general: sleeping but easily arousable, no acute distress heent: sclera anicteric, mmm, oropharynx clear lungs: breathing comfortably without accessory muscle use. diffuse wheezing through the lung fields bilaterally, anteriorly. cv: regular rate and rhythm, normal s1 + s2, 2/6 sem heard best over lsb. abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding. ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. left hip incision with no erythema, drainage. neuro: cnii-xii intact, responds appropriately. moving all extremities. pertinent results: admission labs: 09:15pm blood wbc-15.5* rbc-4.53 hgb-12.1 hct-36.2 mcv-80* mch-26.8* mchc-33.5 rdw-13.2 plt ct-287 09:15pm blood neuts-84.7* lymphs-10.5* monos-3.2 eos-1.4 baso-0.3 09:15pm blood pt-10.7 ptt-30.1 inr(pt)-1.0 10:30pm blood glucose-261* urean-12 creat-0.7 na-137 k-4.6 cl-100 hco3-26 angap-16 12:01pm blood calcium-8.6 phos-3.1 mg-1.5* 05:56am blood %hba1c-7.6* eag-171* imaging: knee xray findings: two views of the left knee were obtained. severe osteoarthritic changes are seen, including lateral greater than medial joint space narrowing and adjacent tibial plateau irregularity. no suprapatellar joint effusion is seen. condylar spurring is noted. hip xray: findings: ap view of the pelvis and ap and lateral views of the left hip were obtained. there is a comminuted left intertrochanteric fracture with varus angulation of the left femoral head. no dislocation is seen. the pubic symphysis and sacroiliac joints are intact. degenerative changes are seen along the lower lumbar spine. soft tissue calcifications are seen overlying bilateral buttock at the level of superior iliac may represent calcified granulomas. impression: comminuted left intertrochanteric fracture with varus angulation of the left femoral head. hip xray post orif: findings: two spot films from the or were obtained. there is a total of 136.0 seconds of fluoroscopy time. there is interval placement of an intramedullary rod and hip screw. at the end of the procedure the alignment was good. cta : findings: the pulmonary vasculature is well opacified and with an eccentric nonocclusive filling defect noted in the subsegmental branches of the right upper lobe (3:14). no other lobes appear affected. heart size is normal without evidence of right heart strain. atherosclerotic calcifications are evident within the thoracic aorta without aneurysmal dilatation or dissection. ct chest: there is no supraclavicular or axillary lymphadenopathy identified. multiple lymph nodes are noted within the prevascular, right upper paratracheal and subcarinal space, none of which meet ct criteria for pathological enlargement. no hilar lymphadenopathy identified. secretions are evident within the segmental and subsegmental branches of the bilateral lower lobe airways with associated partial left lower lobe collapse. of note, area of left lower lobe collapse is hypodense to surrounding collapsed lung concerning for developing pneumonia (3:38). no pleural effusion or pneumothorax identified. limited assessment of the abdomen demonstrates a normal-appearing liver, pancreas, spleen, and bilateral adrenal glands. no suspicious lytic or blastic lesions identified. impression: 1. subsegmental pulmonary embolism of the right upper lobe. no right heart strain. 2. secretions within the segmental and subsegmental branches of the bilateral lower lobes and associated partial left lower lobe collapse with areas of relative hypodensity. findings consistent with aspiration complicated by developing pneumonia. no pleural effusion identified. echo : findings left atrium: elongated la. right atrium/interatrial septum: normal ra size. no asd or pfo by 2d, color doppler or saline contrast with maneuvers. left ventricle: normal lv wall thickness, cavity size and regional/global systolic function (lvef >55%). no resting lvot gradient. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic diameter at the sinus level. normal ascending aorta diameter. aortic valve: normal aortic valve leaflets (3). no as. no ar. mitral valve: normal mitral valve leaflets with trivial mr. no mvp. mild mitral annular calcification. calcified tips of papillary muscles. tricuspid valve: normal tricuspid valve leaflets with trivial tr. mild pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflet. no ps. physiologic pr. pericardium: no pericardial effusion. general comments: contrast study was performed with 1 iv injection of 8 ccs of agitated normal saline at rest. suboptimal image quality as the patient was difficult to position. conclusions the left atrium is elongated. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: no pfo or asd. normal global and regional biventricular systolic function. mild pulmonary hypertension. microbiology: 6:00 pm stool consistency: watery source: stool. **final report ** c. difficile dna amplification assay (final ): negative for toxigenic c. difficile by the illumigene dna amplification assay. (reference range-negative). 3:15 pm blood culture **final report ** blood culture, routine (final ): no growth. 1:36 pm urine source: cvs. **final report ** urine culture (final ): no growth. 5:09 pm blood culture source: venipuncture #1 and 2. **final report ** blood culture, routine (final ): no growth. hip unilat min 2 views impression 1. status post open reduction internal fixation of a comminuted left intertrochanteric femur fracture which secured in good anatomic alignment. 2. surgical hardware intact with no evidence for hardware failure. discharge labs: 07:25am blood wbc-14.9* rbc-3.50* hgb-9.1* hct-28.2* mcv-81* mch-26.0* mchc-32.2 rdw-16.0* plt ct-632* 07:50am blood pt-27.3* ptt-47.0* inr(pt)-2.6* 07:40am blood glucose-96 urean-11 creat-0.6 na-140 k-3.9 cl-110* hco3-20* angap-14 brief hospital course: hospital course by service: orthopaedic course: patient had mechanical fall and noted to have internally rotated left leg. films showed comminuted intertrochanteric fracture. admitted to ortho and underwent orif on . tolerated procedure well. on pod #2, became suddenly hypoxic - cta showed subsegmental pulmonary embolism and left pneumonia. patient was started on heparin gtt, levoflox, flagyl initially for aspiration pneumonia and transferred to micu. medical icu course- patient sent to icu due to increased oxygen requirement. patient placed on nrb initially and was able to maintain oxygen sat in the high 90's. given recent intubation and hospital stay of 48 hours, antibiotics were broadened to vancomycin/cefepime. she was continued on heparin gtt and initiated on coumadin. echo showed no right heart strain. oxygen was able to be weaned to nasal cannula and patient was transferred to the medicine floor. hypoxemia was felt to be more likely from pneumonia than pulmonary embolism given subsegmental nature of them. medicine floor course - vancomycin/cefepime were continued to complete 8 day course of antibiotics (completed ). the patient was successfully weaned from oxygen during her course on the medicine floor. heparin drip was discontinued on the floor, once coumadin was therapeutic (goal 2.0-3.0). the decision was made with her family to continue the patient on coumadin as opposed to transitioning to lovenox secondary to family's comfort with administration of lovenox injections. she will need to complete at least a 3 month course of coumadin for treatment of her pulmonary emoblism. as the patient as greater support in , the decision was made by the patient's family to transition her care to . dr. () of nj was personally contact by the inpatient team to notify the patient of her need for coumadin for treatment of pulmonary embolism and to make him aware that the patient will need her next inr check on , . the patient was seen by pt regularly and was able to bear weight as tolerated on her left lower extremity by day of discharge. orthopaedics followed the patient through her hospitalization. her surgical incision site was non-erythematous withour drainage throug her hospitalization. staples were removed by orthopaedics on day of discharge and repeat left hip films were obtained prior to the patient's discharge. orthopaedics evaluated the patient on day of discharge and evaluated films of the left hip; radiology noted that the fracture and hardware were unremarkable. in regards to her diabetes mellitus, the endocrine consult service initially followed the patient and agreed with discharging the patient on oral medications. patient's hypertension was controlled with atenolol and amlodipine through her floor course. transitional issues: - orthopaedic follow-up to be arranged by the patient's family. - inr to be monitored by dr. () of nj. goal inr 2.0-3.0 for the next 3 months. her next scheduled inr check is , by dr. . medications on admission: preadmission medications listed are correct and complete. information was obtained from patientfamily/caregiver. 1. metformin (glucophage) 1000 mg po bid 2. glimepiride *nf* 4 mg oral daily 3. amlodipine 5 mg po daily 4. atenolol 50 mg po daily discharge medications: 1. glimepiride *nf* 4 mg oral daily rx *glimepiride 4 mg 1 tablet(s) by mouth daily disp #*14 tablet refills:*0 2. metformin (glucophage) 1000 mg po bid rx *metformin 1,000 mg 1 tablet(s) by mouth twice daily disp #*28 tablet refills:*0 3. acetaminophen 650 mg po q6h 4. warfarin 1 mg po daily16 rx *warfarin 1 mg 1 tablet(s) by mouth daily disp #*7 tablet refills:*0 5. amlodipine 5 mg po daily rx *amlodipine 5 mg 1 tablet(s) by mouth daily disp #*14 tablet refills:*0 6. atenolol 50 mg po daily rx *atenolol 50 mg 1 tablet(s) by mouth daily disp #*14 tablet refills:*0 7. oxycodone (immediate release) 2.5-5 mg po q6h:prn pain rx *oxycodone 5 mg half to 1 tablet(s) by mouth every 6 hours disp #*56 tablet refills:*0 8. senna 1 tab po bid:prn constipation 9. docusate sodium (liquid) 100 mg po bid discharge disposition: home with service facility: rehab in nj discharge diagnosis: primary: left intertrochanteric femur fracture, hcap, pulmonary embolism, diabetes mellitus discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: it was a pleasure taking care of you during your hospitalization at . you were admitted to the orthopedic service because of a broken femur (hip bone) you had after a fall. they repaired this in the oeprating room. while you were recovering, you unfortunately developed a pneumonia and blood clots in your lungs. we treated this with antibiotics and blood thinners, respectively. your breathing status improved. you will be going to rehab to continue to gain strength and improve your ability to walk. take all medications as instructed. please note the following medication changes: you are being discharged home on a new medication called coumadin to treat the clot in your lung (pulmonary emoblism). you are also being discharged home on new pain medications- oxycodone and acetaminophen (tylenol)- to be taken as needed. if you find yourself taking oxycodone recently then take senna, colace to prevent constipation. keep all hospital follow-up appointments. you will need to have your blood check to ensure coumadin (blood thinning medication) is at the appropriate level on , by dr. in nj at , telephone number . it is extremely important that you keep this appointment. they are provided in a list for you in your discharge paperwork. followup instructions: you will need to go on , for a blood check to ensure that coumadin (blood thinning medication) is at the appropriate level on , by dr. in nj at , telephone number . please follow up with your orthopaedic surgeon, dr. when: please make an appiontment for 2-3 months after discharge department of orthopedics , 2 , phone: fax: md procedure: closed reduction of fracture with internal fixation, femur diagnoses: accidental fall on or from other stairs or steps iatrogenic pulmonary embolism and infarction surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled closed fracture of intertrochanteric section of neck of femur benign essential hypertension bacterial pneumonia, unspecified postprocedural aspiration pneumonia 

Answer: The patient is high likely exposed to