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: demerol attending: chief complaint: hip fracture major surgical or invasive procedure: orif of r. hip. peg placement history of present illness: 82 yo woman with alzheimer's dementia, h/o pe in on coumadin(but inr 1.1 on admission), osteoporosis, h/o chronic back pain with t10/t12/l1 comp fx and l5/s1 disc herniation, chronic pain with multiple recent admissions for somnolence narcotics, and hx asp pna, who was admitted from nh s/p fall. per reports, the patient was watching tv and then was found on hands and knees on the floor, but had no witnessed fall. she was c/o r le pain. . in ed, vs 96.6 88 134/86 18 96%ra. right hip showed minimally displaced fracture of the femoral neck. cxr showed lll opacity concerning for early pna vs atelectasis. she received a total of 12 mg of morphine, levofloxacin 500 mg iv (given ? of asp pna), phenergan, anzemet given for episode of emesis. at this point the pt became somewhat somnolent, and the apg attg noted a new ? facial droop. it was determined that she needed a head ct prior to the or. her oxygen saturation (baseline 93-96% on ra) was 93-94% on ra, but reportedly dropped to the 80s although there is a ? of whether this was a poor tracing. she received naloxone for her mental status which resulted in a transient improvement. she was then intubated for her head ct (which was neg) and transferred to the micu for further management. upon intubation there was some question of whether gastric contents vs. sputum were sxned from her ett. past medical history: 1. alzheimer's dementia 2. severe back pain: mri showing t10, t12, l1 compression fractures, l5-s1 discherniation, mild spinal stenosis, and mod foramenal narrowing. on fentanyl patch at baseline, with multiple admissions for altered mental status in setting of narcotics. 3. pulmonary embolism at osh. 4. moderate aspiration on video swallow study on 5. gerd 6. hypothyroidism 7. anemia 8. htn 9. aspiration pna last admit to social history: lives alone in . no kids. hcp is , phone numbers below. her 2 brothers and one sister live in . smoking: none etoh: rare (heavy in the past to treat her pain per notes) illicit drugs: none family history: family history negative for stroke. sister has questionable event but was diagnosed as not-stroke. physical exam: vitals: t: 99.7, bp: 115/64, hr: 87 vent: ac 450x14 (breathing 17), fio2 100%, peep 5 gen: thin chronically ill appearing woman, intubated and sedated, not responding to voice/painful stimuli heent: nc, at, perrl, no clear facial droop although difficult to see as ett/tape in the way neck: jvd approx 6 cm chest: coarse upper airway sounds bilaterally anteriorly cv: regular, nl s1s2, hsm at lsb abd: + bs, soft nt, nt, no organomegaly ext: no le edema, bilateral erythema from ankles to upper calves neuro: intubated/sedated, unarousable to stimuli (on propofol) pertinent results: admission labs: 12:45pm pt-12.9 ptt-28.0 inr(pt)-1.1 11:20am glucose-109* urea n-34* creat-1.2* sodium-140 potassium-3.7 chloride-101 total co2-25 anion gap-18 11:20am calcium-9.2 phosphate-3.0 magnesium-1.7 11:20am wbc-14.5* rbc-3.41* hgb-9.3* hct-27.7* mcv-81* mch-27.2 mchc-33.5 rdw-16.9* 11:20am neuts-91* bands-0 lymphs-3* monos-1* eos-1 basos-0 atyps-4* metas-0 myelos-0 11:20am hypochrom-occasional anisocyt-normal poikilocy-occasional macrocyt-normal microcyt-normal polychrom-normal schistocy-occasional pertinent labs/studies: microbiology: urine : : >100k yeast : < 10k org/ml blood: : ngtd : ngtd sputum: : gram: 2+ gpc, 1+ . cx-sparse op flora : gram: >25 pmn, no microorgansimas cx: ngtd . radiology: : chest pa/lat - the heart size is normal, and there is no mediastinal or hilar lymphadenopathy. previously reported patchy opacity at the right lung base has cleared in the interval with only minimal residual linear opacity remaining in this area. however, there is a questionable new area of patchy opacification peripherally in the left lower lobe as compared to previous study. the bones are diffusely demineralized. there are stable compression deformities in the lower thoracic spine. . : portable chest - there has been interval placement of an endotracheal tube with the tip at the level of the clavicles. the cardiac silhouette, mediastinal, and hilar contours are normal. the pulmonary vasculature is normal. both lungs are clear without consolidations or effusions. the surrounding soft tissue and osseous structures reveal severe osteopenia and degenerative changes along the thoracic spine. there is no free air under bilateral hemidiaphragms. . : right hip: findings: a single intraoperative ap radiograph of the pelvis was obtained demonstrating interval bipolar hemiarthroplasty of the right hip with good alignment. skin staples are noted overlying the lateral pelvis. diffuse osteopenia is noted. there is a left femoral axis venous catheter. the left hip joint is unremarkable. impression: status post right bipolar hemiarthroplasty, in good alignment. discharge labs: 06:00am blood wbc-10.3 rbc-3.73* hgb-10.4* hct-30.8* mcv-83 mch-28.0 mchc-33.8 rdw-16.2* plt ct-521* 05:14am blood neuts-75.8* lymphs-19.7 monos-1.4* eos-2.8 baso-0.4 06:00am blood plt ct-521* 06:00am blood glucose-99 urean-16 creat-0.7 na-138 k-4.5 cl-102 hco3-28 angap-13 08:10am blood ck(cpk)-66 06:15am blood probnp-3335* 06:00am blood calcium-8.5 phos-3.0 mg-2.1 brief hospital course: #. right hip fracture: patient was admitted to micu after intubation in the ed awaiting repair for right hip fracture. the patient was on anticoagulation therapy with coumadin on admission with an inr of 1.5 at it's peak. the patient was given iv vitamin k and ffp for reversal of anticoagulation. the patient was noted after admission to have small hct drop form 27.7 to 23.5 for which she was given po 1u prbcs with appropriate bump. upon successful reversal of anticoagulation, the patient was taken to the or two days after admission to the micu with successful right hemiarthroplasty of the right hip. intraoperatively and perioperatively the patient received 400mg fentanyl and did not require any transfusions per report from operating team. the patient was trasnferred back to the micu for ongoing care and was started on lovenox 40mg sc qd as recommended by ortho (alternatively could use sc hep tid as well). on the floor, the lovenox was increased to 40 mg sc bid, a therapeutic dose, due to concern over prior pe in . this was continued without incident, although she was briefly changed to iv heparin before and after her peg was placed. she will be discharged with plan to continue lovenox until she is therapeutic on coumadin (i.e. 2 days after her inr is >2.0). pt was started and proceeded smoothly. . #. id - the patient was admitted to the micu intubated for airway protection in setting of mental status changes after receiving morphine, but with additional concern towards aspiration given some vomiting. the patient's chest film on admission did not demonstrate any definite infiltrates or consolidations. additionally the patient did not develop any leukocytosis. however, on the evening of admission the patient did have a fever with additional temp spike to 102 the am of her operation. the patient had a ua which was significant for small leuk esterase, many bacteria and > 50wbc. therefore, the night prior to her operation the patient was started on levofloxacin 25mg iv q12, which was increased to 50mg the following day. urine cultures were remarkable for only yeast however without any appreciable growth. the patient addiitonally had blood cultures none of which demonstrated any growth. sputum cultures x 2 were sent with gram stain remarkable for 2+ gpc and 1+ , however with only sparse oropharyngela flora growing in cultures. blood cx drawn , however, grew out which eventually were determined to be clostridia. patient was started on cefipime and flagyl iv. she remained afebrile and without elevated wbc throughout her stay once the antibiotics were started. further blood cxs were all negative. it is unclear whether the was "real" or a contaminant. she will be d/c'd on a 14 day course of po cipro/flagyl (d/c day ). . #. cv: patient was mildly hypertensive, but on transfer from micu to floor she became persistently hypotensive, with sbp 80-90. the hypotension was of unclear etiology. most likely hypovolemia, as fena < 1%, uop responded to fluids. heart failure unlikely given nl cxr, lack of elevated jvp or le edema, but bnp>3000. she had some ekg changes (apparently new q waves in the precordial leads) but was ruled out for mi. concern for sepsis but no new o2 requirement, not tachycardic, no fevers. stim test wnl. abg was normal. echo done showed some diastolic dysfunction, but ef 65 and no other abnormality. over the course of 48 hours she received several liters of ns, both in bolus and continuous form, and finally her blood pressure stabilized and urine output improved. for the remained of her hospital stay, she was normotensive with adequate urine output. toprol and hctz were held. . #. heme: on the floor, the patient was persistently anemic. she stayed just above her transfusion goal of 28, however after receiving several liters of fluid her hct dropped to 25 and then was stable. on she was transfused 1 unit of prbc's , and she remained with a hct>30 for the duration of her stay. . #. nephrology: patient had approximately 48 hours of low urine output in setting of above mentioned hypotension. probably pre-renal, w/ fena .37%. urine sediment shows no evidence of atn. after receiving fluids, her urine output improved dramatically and remained . . #. fen: there was significant concern for aspiration pna, and she was fed via ng tube. in the course of a speech and swallow consult, ms. aspirated custard, became hypoxic and developed an additional o2 requirement (2l to 4l). gi was consulted, and in discussions with her health care proxy it was determined that she needed a peg. this was done without complication on . she tolerated the procedure and subsequent tube feeds well before discharge. . #. alzheimer's dementia. the patient was continued on her outpatient dose of aricept. . #. hypothyroidism. patient was continued on her outpatient dose of levoxyl 75 mcg po daily. repeat tsh testing was considered but deferred given inability to interpet the findings well in an acutely ill patient. medications on admission: 1. levothyroxine 75 mcg daily (recently increased after tsh 8.7 on ) 2. fentanyl patch 150 mcg q 72 hr 3. miacalcin nasal 4. calcium/vit d 5. senna 1 tab 6. aricept 10 mg po daily 7. coumadin 2 mg about q 4th day based on inr 8. vitamin c 9. tylenol 1000 mg po q 6 hr 10. lidoderm 5% patches on 12hrs/off 12 hrs 11. toprol 50 mg daily 12. prevacid 30 mg po daily 13. hctz 25 mg po daily 14. mvi 15. feso4 325 mg po daily prn: trazodone, maalox, guaifenesin, dulcolax discharge medications: 1. levothyroxine sodium 75 mcg tablet sig: one (1) tablet po daily (daily). 2. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 3. fentanyl 100 mcg/hr patch 72hr sig: one (1) transdermal every seventy-two (72) hours. 4. fentanyl 75 mcg/hr patch 72hr sig: one (1) transdermal every seventy-two (72) hours. 5. miacalcin 200 unit/actuation aerosol, spray sig: one (1) nasal once a day. 6. calcium 500+d 500-125 mg-unit tablet sig: one (1) tablet po once a day. 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 8. donepezil 5 mg tablet sig: one (1) tablet po hs (at bedtime). 9. warfarin 2.5 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)): please adjust dose to inr 2-2.5. 10. acetaminophen 500 mg tablet sig: 1-2 tablets po q6h (every 6 hours). 11. metoprolol succinate 50 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day: please hold if sbp<120, hr<60. 12. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 13. iron 325 (65) mg tablet sig: one (1) tablet po once a day. 14. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid:prn as needed for constipation. 15. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h:prn as needed for shortness of breath or wheezing. 16. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 17. enoxaparin 40 mg/0.4ml syringe sig: one (1) subcutaneous q12h (every 12 hours): please give until inr>2.0, then give for 2 more days and discontinue. 18. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 7 days. 19. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 7 days. 20. dolasetron 12.5 mg/0.625 ml solution sig: one (1) intravenous q8h:prn as needed for nausea. 21. trazodone 50 mg tablet sig: one (1) tablet po qhs:prn as needed for insomnia. discharge disposition: extended care facility: & rehab center - discharge diagnosis: aspiration pneumonia. right hip fracture. gram negative rod bacteremia. hypotension. alzheimer's dementia. anemia. hypothroidism. discharge condition: aspiration pneumonia resolving. right hip fracture healing. gram negative rod bacteremia improved. hypotension resolved. anemia improving. hypothyroidism stable. alzheimer's dementia stable. discharge instructions: please take all medications as directed. please finish your 7 day course of ciprofloxacin and flagyl. please continue physical therapy on your right hip. please call your primary care doctor or return to the emergency room for shortness of breath, chest pain, bleeding, feeling like you may pass out, fevers, severe abdominal pain or hip pain, signs of redness or infection from your hip or gastric tube, or any other concerns. patient is being discharged currently on tube feeds of probalance at 25 cc/hr. please increase at a rate of 10 cc q6h as tolerated to goal of 55 cc/hr. please flush peg with 50 ml of water q6h, and check for residual q4h. hold feeds for residual of >150 cc. please continue daily sub-cutaneous injections of lovenox until your inr is 2.0. at that point, continue lovenox for 2 more days, and then you may stop it and just take coumadin, 2.5 mg qhs. please adjust coumadin dose as needed to goal inr of 2.0-2.5. please do daily cleansing around the peg site with hydrogen peroxide followed by 1 layer of gauze under the bumper. followup instructions: provider: , m.d. phone: date/time: 2:30 you have an appointment with your orthopedist, dr. , on tuesday, at 11:40am on the of the building, . please call if you need to change this appointment. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] partial hip replacement transfusion of packed cells diagnoses: anemia, unspecified urinary tract infection, site not specified unspecified essential hypertension unspecified acquired hypothyroidism unspecified fall pneumonitis due to inhalation of food or vomitus bacteremia alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance hypovolemia closed fracture of unspecified part of neck of femur other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms 

Answer: The patient is high likely exposed to