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: patient recorded as having no known allergies to drugs attending: chief complaint: fall/confusion major surgical or invasive procedure: thoracocentesis history of present illness: 89-year-old gentleman who has a past medical history of known cad s/p cabg (lima-lad; svg-om1; svg-pda) in , multiple prior pci's, recent nstemi in thought to be demand, on plavix and asa, afib no longer on coumadin, hypertension, hyperlipidemia, and diet controlled diabetes, who presents s/p unwitnessed fall. he was admitted to the micu 1 day ago. patient does not recall fall or whether there was loc. he feel in his home from a standing position and hit his head. he was noted to have a scalp laceration that was bleeding badly on arrival to ed. he was estimated to have lost approx 1 unit of blood and so was given one in the ed. the scalp lesion was stapled by trauma . he was hypotensive to sbp 50s in the ed. in total he has received 2 prbcs and 3l ivf over the past 24 hours. his bp stabilizied and so a lower dose of his lasix was started this morning. ct head was negative. in addition, he was hypoxic in the ed, requiring at nrb for a short period of time. ct torson found a right sided non-diplaced rib fracture and a fairly large left sided pleural effusion which increased over the past 24 hours. a thoracentesis was performed and removed 1500 cc of blood fluid. it was felt that the effusion was secondary to rib fractures. he reported that he had been feeling unwell all week. he was found to have a uti; cutlure is postive for gnrs. he was initally given broad spectrum antibiotics but narrowed to ceftriaxone for uti. he currently feels well. he denies pain, sob, lightheadedness or dizziness. . . review of sytems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. . past medical history: cad h/o mi s/p cabg s/p pci dm, diet controlled afib following cabg not anticoagulated htn hyperlipidemia anemia oa bph s/p turp h/o scrotal hydrocele spinal stenosis carotid stenosis diverticulosis gerd h/o hernia repair h/o stroke h/o colon polyps labyrinthitis s/p detatched retina s/p tonsillectomy social history: non smoker. no etoh. married with 5 adult children. he is retired. prior to retiring he sold life insurance. family history: noncontributory physical exam: physical exam: vitals: tm: 98.8 tc: 96.8 bp: 100/58 p: 69 r: 19 18 o2: 99% ra. los 2 l positive. good uop 1.8 over last 24 hrs. general: alert, oriented x3, no acute distress heent: right scalp lac with staples in place, no oozing. sclera anicteric, op with dry mm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: dullness to percussion and decrease breath sounds on right ll. dressing from . cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, + colostomy ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cn grossly intact, mae. sensation grossly intact. pertinent results: general labs (cbc/lft's/cmp/coags) . 09:15am blood wbc-8.8 rbc-3.55* hgb-11.0* hct-31.8* mcv-90 mch-30.9 mchc-34.5 rdw-14.4 plt ct-340 09:05am blood wbc-6.7 rbc-3.43* hgb-10.4* hct-30.3* mcv-88 mch-30.3 mchc-34.4 rdw-14.5 plt ct-265 12:00pm blood neuts-81.3* lymphs-12.8* monos-5.0 eos-0.5 baso-0.3 09:05am blood pt-14.2* ptt-34.2 inr(pt)-1.2* 09:15am blood glucose-144* urean-19 creat-0.8 na-126* k-4.3 cl-91* hco3-27 angap-12 09:05am blood glucose-116* urean-13 creat-0.6 na-130* k-4.1 cl-98 hco3-28 angap-8 03:31am blood alt-7 ast-18 ld(ldh)-185 ck(cpk)-52 alkphos-81 totbili-1.3 09:15am blood probnp-5063* 09:05am blood calcium-8.1* phos-3.1 mg-1.8 . .. thoracentesis fluid analysis . pleural analysis wbc rbc hct,fl polys lymphs monos 17:58 2.0*1 pleural fluid 17:58 * * 82*2 12* 6* pleural fluid . . less than spun hematocrit performed differential reviewed by . . pleural chemistry totprot glucose ld(ldh) albumin 17:58 3.4 122 186 2.5 pleural fluid . . . urine culture **final report ** urine culture (final ): klebsiella pneumoniae. >100,000 organisms/ml.. klebsiella pneumoniae. >100,000 organisms/ml.. second morphology. sensitivities: mic expressed in mcg/ml | klebsiella pneumoniae | | ampicillin/sulbactam-- 8 s 8 s cefazolin------------- <=4 s <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s nitrofurantoin-------- 64 i 32 s piperacillin/tazo----- <=4 s <=4 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- =>16 r =>16 r . . . ekg- ectopic atrial rhythm and increase in rate compared to the previous tracing of . left ventricular hypertrophy with st-t wave change. intraventricular conduction delay. there is scooping of the st segments consistent with use of digitalis. clinical correlation is suggested. tracing #1 . intervals axes rate pr qrs qt/qtc p qrs t 74 170 118 442/ 122 . . . imaging . cxr chest, ap semi-upright: again seen is a moderate right pleural effusion, with partial redistribution along the lateral right hemithorax and lung apex, likely due to positioning. chronic loculated effusion and pleural thickening along the left lateral hemithorax and lung base are unchanged. there is continued moderate vascular congestion and interstitial edema. moderate cardiomegaly is present, with median sternotomy wires, mediastinal clips, and coronary bypass grafts. there is no pneumothorax. evaluation of the right middle and lower lobes is limited by superimposed effusion. mild retrocardiac atelectasis persists. diffuse skeletal demineralization persists, with s-shaped thoracolumbar scoliosis and severe degenerative changes. vascular calcification are seen in the upper left abdomen. multiple punctate calcifications in the left upper quadrant of the abdomen are compatible with splenic granulomas as seen on prior ct. . . cxr comparison: . . findings: moderate right and small partially loculated left pleural effusions appear unchanged. no visible pneumothorax. acute right rib fracture is again demonstrated. no new or progressive abnormalities. . impression: 1. stable moderate right effusion with compressive atelectsis. 2. continued cardiomegaly and interstitial edema. 3. chronic loculated left effusion and pleural thickening. . . . ct head- findings: there is no evidence of acute hemorrhage, large acute territorial infarction, or large masses. there is evidence of periventricular white matter hypodensities, in keeping with chronic vessel ischemic changes. hypodensity along the subcortical white matter in the right frontal lobe, appears unchanged, 2b:26. ventricles and sulci are prominent, stable. there is no hydrocephalus. there is no shift of midline structures. moderate calcification in the carotid arteries, 3b:27, bilaterally. minimal mucosal thickening is seen in the left maxillary sinus. there is no evidence of fracture. there is device in the right globe, 3b:33, correlate with history. . impression: no acute intracranial process. no fracture. . . ct neck findings: hypodensities in the thyroid gland could be further evaluated with thyroid ultrasound in a nonurgent setting. complete opacification of the visualized portion of the right lung apex. . no prevertebral soft tissue edema. the alignment of the cervical spine is grossly preserved. there are moderate-to-severe multilevel degenerative changes, and bones are diffusely osteopenic. with this limitation in mind, no definite fracture is seen. at level c6 posteriorly, there are osteophytes, impinging on thecal sac, and in a patient with mechanism of injury, these could put the patient at more risk for cord injury. multilevel narrowing of the cervical canal due to multilevel osteophytes. there is multilevel narrowing of the neural foramina; however, appears similar compared to mri, and incompletely evaluated. moderate calcifications along bilateral carotid arteries; cannot exclude a high-grade stenosis. . impression: 1. diffuse osteopenia with severe multilevel degenerative changes through the cervical spine. suboptimal evaluation of the cervical spine for fractures; however, no definite fracture is seen.incidental hemangioma of c6 vertebra. 2. no prevertebral soft tissue edema. 3. hypodensities in the thyroid gland, could be further evaluated with thyroid ultrasound in a non-emergent setting. 4. complete opacification over the imaged portion of the right lung apex. 5. moderate calcification at the cerotids, cannot exclude high grade stenosis. . . . ct chest/abdomen/pelvis ct chest: the airways are patent up to subsegmental level. there is a large right pleural effusion, with adjacent atelectasis. there is a small left pleural effusion with minimal atelectasis at the left lung base. there is minimal atelectasis in the lingula and left anterior lung, (3a:43). there is no evidence of pneumothorax. there are no pathologically enlarged lymph nodes i n the mediastinum, hilum, or axilla. there are scattered prominent lymph nodes in the mediastinum, however, do not meet the ct criteria for pathologic enlargement. . cta: there is no filling defect in the pulmonary arteries to suggest pulmonary embolus. patient is s/p remote cabg. there are severe calcifications in the coronary arteries. there is no pericardial effusion. the ascending aorta is slightly prominent, measuring 3.4 cm in diameter. . ct abdomen: the liver enhances homogeneously. there is a hypodensity in the right liver lobe, (3b:127), too small to be characterized. there is no evidence of liver laceration. there is no extra- or intra-hepatic biliary duct dilatation. the gallbladder appears normal. multiple small calcifications are seen in the spleen, likely suggesting old granulomatous infection. the adrenal glands and visualized loops of small and large bowel appear within normal limits. there is no evidence of bowel obstruction. pancreas is atrophic. there are moderate calcifications in the splenic vessels. . the kidneys enhance symmetrically and excrete contrast symmetrically with no evidence of hydronephrosis. there are bilateral hypodensities in the kidneys, too small to be characterized. stable small hyperdense cystic lesion in the interpolar region of the left kidney. there is no perinephric stranding. no free fluid or free air in the abdomen. there are no pathologically enlarged lymph nodes in the retroperitoneum or mesentery. there are moderate calcifications in the abdominal aorta and iliac vessels. . ct pelvis: the urinary bladder, prostate, and seminal vesicles appear within normal limits. there is a small fat-containing inguinal hernia, with a small amount of soft tissue as seen on prior, (3b:162). there is no free fluid in the pelvis. there is foley catheter in the urinary bladder. . osseous structures: there are similar fractures through the right eighth and ninth ribs, comminuted as seen on most recent ct. nondisplaced rib fracture in the postero-superior rib on the right, unable to compare to prior since that part of the chest was not included on prior ct. multilevel degenerative changes in the spine. . impression: 1. no filling defect in the pulmonary artery to suggest pulmonary embolus. . 2. large right pleural effusion with adjacent atelectasis. . 3. small left pleural effusion with minimal atelectasis at the left lung base, in the lingula, and in the left anterior lung. . 4. segmental right eighth and ninth comminuted rib fractures, similar to prior. nondisplaced rib fracture in the upper left posterior chest wall, uncertain if it is new since we do have prior ct chest to compare. . 5. additional incidental findings are described in the report, unchanged. . . . fluid analysis (pleural fluid) diagnosis: pleural fluid: negative for malignant cells. . brief hospital course: this is an 89-year-old gentleman with a history of cad s/p cabg in , multiple prior pci's, recent nstemi in , on plavix and asa, afib no longer on coumadin, htn, hl, dm2, bph, s/p unwitnessed fall. . . # s/p fall: unclear etiology based on history. be secondary to dehydration. does not appear orthostatic. no vertigo. history of carotid artery stenosis and cad, but no changes on ekg s/o cardiac etiology. was mildly dehydrated and found to have a uti, which may have caused confusion and falls. patient has a history of falls. ruled out for mi. improved with minimal intervention. evaluated by pt, who suggested inpatient rehabilitation. . # hypotension: initially hypotensive in the ed, most likely secondary to blood loss, dehydration, and hypertensive medications. resuscitated with 3 l ns and 2 u prbc's to maintain blood pressures in the 110's-130's. asymptomatic in this range. bp medications initially held on the floors due to concern of recurrent hypotension/blood loss status post fall. hct trended and stabalizaed around 30. was stable throughout hospital course. continued sotalol as well as furosemide 20 mg po daily upon discharge. valsartan was held because blood pressures were in the low hundreds range. furosemide dose decreased from 40 to 20mg in house and pt left on this dose. valsartan held on discharge for potential low bp in the presence of acute fall.. primary care doctor to decide when to restart/change dosing of these medications. . # pleural effusion: found to ahve significant right sided pleural effusion on admission xray. tapped effusion, drained 1.5 l of bloody fluid. no malignant cells present. thought to be potential hemothorax from broken rib. possible reaccumulation seen by hd3, but interventional pulmonology hesistant to tap given pt. is asymptomatic, breathing well on room air, and on continual clopidogrel administration. will re-evaluate as an outpatient as necessary, but did not re-tap patient during hospital stay. no further intervention pursued. mr. should have a follow up cxr in weeks. . # rib fracutre: found to have non-displaced rib fracture on right. asymptomatic during stay. no further intervention pursued. . # uti: patient with gnrs in urine found to be pansensitive (except to tmp/smx) k. pneumoniae. pt. received 5 days worth of ceftriaxone, and will continue to receive 5 days worth of cefpodoxime out of hospital for complicated uti. asymptomatic during hospital course. . # hyponatremia: initially 126. improved to 130s with iv hydration. likely initially hypovolemic hyponatremia. encouraged po intake with minimal ivf supplementation. ranged from 127-132 in house. pt. discharged at 128. encouraged not to drink free water but rather diluted juices. fluid intake limited to 2l per day. . # cad: s/p cabg and recent nstemi in . currently cp free and ruled out for mi by enzymes on this admission. last echo in showed ef 30%. held valsartan for several days due to bp 100-110's. had sotalol held a few times due to hypotension. continued on asa, plavix, and simvastatin for entire stay. lasix was given at 20 mg dose, but held for 2 days as pt appeared dry. discharged on all original cardiac meds (asa, plavix, sotalol, simvastatin, valsartan, furosemide), except furosemide and valsartan given at lesser dose of 20 mg and 160 mg qday respectively given possible overdiuresis that caused his dehydration/fall and relatively low blood pressures. . # systolic heart failure: pt. has prolonged cardiac hx as well as hx of hf flares. recently hospitalized in with hf exacerbation. last documeneted ef in was 30%. was maintained on bb, , with diuresis prn furosemide. did not have issues with being fluid overloaded while in the hospital. effusions felt to be traumatic injury rather than pulmonary congestion. discharged on home regimen with f/u with his cardiologist within the month. lasix was decreased to 20 mg daily and valsartan was held due to hypotension/low normal bp. pcp's decision to change furosemide dose and restart valsartan. pt encouraged to have po intake of fluids, but to limit intake to <2l / day and to weigh himself daily based on hx. of shf. . # afib: was initially in nsr. not on coumadin because of history of falls. was removed from tele 2nd day on the general medical floors, as he was not symptomatic/having fib waves. he was managed with sotalol and asa 325mg and plavix 75mg daily without issues. . #bph- history of difficulty urination, s/p turp. wife requested in house urology evaluation, but based on the lack of acuity of pt's symptoms, was deferred for outpatient management. had foley in place to manage uop, which was borderline on hd3/4 in the range of 400-500 cc's per day. bolused sparingly, 500 cc's ns once a day toward the end of hospital stay. uop normalized, and foley removed. pt encouraged to have po intake of fluids, but to limit intake to <2l / day and to weigh himself daily based on hx. of shf. . # diet controlled dm: managed with qid fingersticks, ssi, and diabetic diet without issues. . comm: (wife) code: full -confirmed with hcp . . . medications on admission: 1. sotalol 20 mg po bid 2. simvastatin 40 mg po daily 3. nitroglycerin 0.3 mg sl prn chest pain 4. tamsulosin 0.4 mg po qhs 5. omeprazole 20 mg po daily 6. multivitamin po daily 7. furosemide 80 mg po daily 8. valsartan 320 mg po daily 9. aspirin 325 mg po daily 10. clopidogrel 75 mg po daily 11. docusate sodium 100 mg po bid discharge medications: 1. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). tablet(s) 2. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. sotalol 80 mg tablet sig: 0.25 tablet po bid (2 times a day). 9. cefpodoxime 200 mg tablet sig: one (1) tablet po twice a day: please continue to take until for a total of 10 days worth of antibiotics. disp:*12 tablet(s)* refills:*0* 10. furosemide 20 mg tablet sig: one (1) tablet po once a day. 11. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. discharge disposition: extended care facility: - discharge diagnosis: primary: traumatic rib fracture pulmonary effusion (hemothorax) urinary tract infection . secondary: coronary artery disease status post coronary artery stents/angioplasty/bypass grafting history of myocardial infection diabetes mellitus atrial fibrillation hypertension hyperlipidemia hyponatremia anemia osteoarthritis benign prostatic hyperplasia spinal stenosis carotid stenosis diverticulosis gastroesophageal reflux disease stroke discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to the hospital after a fall in your home. prior to the fall, you were feeling confused which may have caused you to fall. you were found to be dehydrated and also have a urinary tract infection when you came to the hospital, which may have been contributing to your feelings of confusion. you had imaging done in the emergency department, which was negative for a bleed in your brain. images of your chest showed an old rib fracture on the right and an old collection of fluid around your right lung (most likely from your previous fall 1 month ago). you were taken to the intensive care unit because you were having difficulty maintaining oxygenation and keeping your blood pressure up. you had the fluid around your lung drained, which was mostly blood likely from your old rib fracture. you received 2 blood transfusions as you also had a cut on your head which bled a significant amount. these interventions helped stabilize your blood pressure and oxygenation. you were transferred to the general medical service, where your uti was treated. you remained stable for several days, and were transferred to a rehabilitation facility for further strengthing prior to going home. . . . while in the hospital, some of your medications were adjusted or even stopped briefly. the following changes have been made to your daily medications. . . stop taking : furosemide 40 mg by mouth daily start taking: furosemide 20 mg by mouth daily . stop taking: valsartan 320 mg by mouth daily (to be resumed by your pcp) . start taking: cefpodoxime 200 mg by mouth daily (antibiotic for uti) . . since you have a diagnosis of systolic heart failure, you should weigh yourself every morning, and md if weight goes up more than 3 lbs, as you may need to increase your fursoemide. . it has been a pleasure taking care of you ! followup instructions: you have an appointment with your primary care on at 2:30 pm. address: , , phone: . other appointments . department: cardiac services when: at 1 pm with: dr. building: sc clinical ctr campus: east best parking: garage . department: cardiac services when: thursday at 2:40 pm with: , md building: sc clinical ctr campus: east best parking: garage md procedure: thoracentesis closure of skin and subcutaneous tissue of other sites diagnoses: esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status unspecified fall hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) percutaneous transluminal coronary angioplasty status open wound of scalp, without mention of complication systolic heart failure, unspecified other and unspecified hyperlipidemia hypoxemia closed fracture of two ribs subendocardial infarction, subsequent episode of care traumatic hemothorax without mention of open wound into thorax 

Answer: The patient is high likely exposed to