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: confusion, change in ms, hypoxia, humeral fracture major surgical or invasive procedure: none history of present illness: patient is an 83 yo man w/ h/o cad s/p cabg >25 yrs ago, s/p icd, afib not on coumadin, htn who was admitted after mechanical fall with proximal left humeral fracture on . at time of initial admit, patient had rec'd 2 mg sc morphine, 2 percocets in the emergency room with subsequent dramatic change in mental status, but was noted to be clear and oriented prior to administration. he denied head trauma or loc during fall. has been having "almost" falls lately with some frequency. . since admission, patient has been having waxing and mental status, worsened by narcotics and benzos, as above. xray showed comminuted, displaced fracture of left proximal humerus. seen by ortho, given sling, and told to be non-weight bearing. pt consult obtained. had transient low bp on to 80's/60's, thought to be due to wrong medication/antihypertensive doses (family unsure of doses/ meds). this improved with dose adjustments. cr also elevated during admission, thought to be mostly chronic per notes (but no baseline), given hydration. . past medical history: information limited- no records here cad s/p cabg years ago chf icd early/mild dementia per medical record this admission cri? baseline unclear afib not on coumadin cataracts w/ ?left sided blindness social history: visiting from berkshires; wife having surgery here; family history: not elicited physical exam: t 101.1 bp 113/76 p 134 af? vpaced r 24 sat 93% 4l gen: elderly, dysarthric, garbled speaking man, agitated, calling out heent: mm dry; nc in place, left surgical pupil, right is 2 mm and reactive, eomi intact but not to command, tongue midline neck: jvp flat; supple cv: icd palpated, midline scar; tachy, regular chest: poor effort/cooperation; decreased breath sounds at bases w/ some crackling; no wheeze abd: soft, non tender, nabs extrm: thin; non edematous, left shoulder with severe ecchymoses; tender to palpation and any movement. in sling. neuro: babbling, incoherent, responsive to voice/command/pain; cn exam limited selective-command following but tongue midline, eomi but not to command (spontaneous), slight left sided facial droop; down going toes bilaterally w/ withdrawal to pain, slightly rigid lower extremities- no clonus; hyper reflexive achilles, patellar, biceps (3+) bilaterally, squeezes hands and wiggles toes to command, moving all extrm spontaneously, speech is garbled with intact comprehension to some extent but unable to formulate meaningful sentences. able to give one word answers. pertinent results: 2 views left shoulder: comminuted, displaced fracture of the left proximal humerus. ct head: there is no intraaxial hemorrhage. there is no shift of normally midline structures, acute fractures, loss of the -white matter differentiation, or major vascular territorial infarct. the ventricles and sulci are prominent consistent with mild brain atrophy. there is low attenuation of the centrum semi-ovale consistent with chronic microvascular ischemia. there is a low attenuation in the left basal ganglia consistent with an old lacunar infarct. this study is degraded secondary to patient motion and streak artifact. there are prominent low density extra-axial spaces over the right convexity and in the left parafalcine region, most likely representing subdural hygromas or chronic subdural collections. there is no evidence of an acute subdural hematoma. there is no mass effect. b/l le dopplers:negative bilateral lower extremity doppler examination. . ct head: 1. no evidence of intracranial hemorrhage or edema. 2. cerebral atrophy. 3. widening of the right extra-axial space likely secondary to atrophy and/or a subdural hygroma. . cxr:mild pulmonary edema has developed accompanied by numerous small right pleural effusion. severe cardiomegaly is stable. atrial biventricular pacer leads are in standard placements. no pneumothorax. . : ef 15-20% mild pulmonary edema has developed accompanied by numerous small right pleural effusion. severe cardiomegaly is stable. atrial biventricular pacer leads are in standard placements. no pneumothorax. . ct of the left shoulder without contrast: a reference is made to a prior radiograph dated . there is a complex, comminuted fracture through the surgical neck of the left humerus with anteromedial angulation of the humeral shaft. a small fracture involving the distalmost aspect of the clavicle is likely also present. the acromioclavicular joint is preserved. the humeral head is normally seated within the glenoid, without evidence of dislocation. an unusual dense ovoid bony "nodule" is present adjacent to the fracture site and is of unclear etiology. ? sclerotic focus within the bone (e.g. bone island which was "released" by the fracture or possibly a dense loose body in the joint space. there is surrounding soft tissue hematoma and effusion. incidental note is made of a 3.3 x 1.7 cm lipoma along the lateral aspect of the proximal humeral shaft. impression: comminuted, displaced fracture through the surgical neck of the left humerus as above. small distal clavicular fracture. unusual ovoid density, as described. . right upper extremity ultrasound: grayscale, color, and doppler son of the right internal jugular, right subclavian, right axillary, right brachial, right basilic, and right cephalic veins were performed. the most superiorly located brachial vein is noncompressible and does not demonstrate any wall to wall color or venous waveforms. these findings are suggestive of thrombosis involving the superior brachial vein. the remaining veins otherwise appeared normal with wall-to-wall color flow, normal waveforms, and normal compressibility. impression: noncompressibility of the superior right brachial vein, with lack of color flow and absent venous waveforms, findings consistent with venous thrombosis. . renal ultrasound: large left renal cyst with a thick septation with calcification falling in the bosniak ii f category. a four to six month followup is recommended. there is no evidence of hydronephrosis or renal stones. . right upper quadrant ultrasound: this examination was extremely limited due to altered mental status. no ascites is seen. this study should be repeated when the patient is more able to cooperate with the exam . : abdominal ultrasound with liver doppler examination: the gallbladder is not visualized. the common bile duct is not dilated at 3 mm. the liver parenchyma is normal in echo texture without focal nodules or masses. there is a moderate right-sided pleural effusion. the right kidney measures 11.4 cm. there is an exophytic 2.9 x 2.8 x 2.5 cm simple cyst off the lateral aspect of the right kidney. the left kidney measures 12.4 cm, with a 7.5 x 6.2 x 6.9 cm cyst, which a thin septation and mild calcifications. the spleen is not enlarged. the pancreas is poorly visualized secondary to overlying bowel gas. doppler examination reveals normal flow and phasicity within the main and right portal veins, demonstrating hepatopetal flow. normal flow and phasicity is seen within the main hepatic artery. all hepatic veins are patent, with appropriate flow. increased phasicity is consistent with underlying right heart failure. impression: 1. all hepatic vessels are patent with normal directional flow. increased phasicity within the hepatic veins is consistent with underlying right heart failure. 2. normal appearing liver parenchyma without focal nodules or masses identified. 3. no evidence of hydronephrosis bilaterally. simple cyst in right kidney. cyst with internal calcification and thin septation within left kidney. 4. moderate right-sided pleural effusion. . cxr: 1. mild congestive heart failure. 2. increasing atelectasis or pneumonia in the left lower lobe. . cxr: low lung volumes have worsened; there is more consolidation at both lung bases, worrisome for pneumonia. moderate cardiomegaly is stable. upper lungs show pulmonary vascular congestion but no edema. tip of the right pic catheter is in the svc. right atrial and left ventricular pacers and right ventricular pacer defibrillator leads are unchanged in their respective positions. no pneumothorax. . successful placement of a 37-cm 4 french single-lumen picc by way of the right brachial vein with tip at the superior vena cava-right atrial junction. the catheter may be used immediately. . blood cx: with gram positive cocci : blood cultures: with gram positive cocci r femoral line tip for culture: final - no growth : blood culture off picc - no growth : blood culture off picc - no growth : blood culture peripheral - no growth : blood cultures: no growth : urine culture - no growth . ekg: most recent from 23:37 with af rate 138 normal axis; intermittent v pacing spikes; s1 qiii tiii present. ivcd, no ischemic changes. 06:30pm ck(cpk)-94 06:30pm ck-mb-3 ctropnt-0.03* 07:45am glucose-121* urea n-43* creat-1.8* sodium-143 potassium-4.2 chloride-108 total co2-26 anion gap-13 07:45am plt count-139* 07:45am pt-14.0* ptt-27.3 inr(pt)-1.3 brief hospital course: 83 m with multiple medical problems after mechanical fall with proximal humerus fracture complicated by delirium. . 1. altered mental status: patient initially presented to medicine service with opiate induced delirium as he had been given 2 percocet tablets and 4mg of morphine for pain control before being seen by medicine service. his delirium, likely exacerbated by pain from recent fracture, hypoxia/infection from pneumonia, also may have some degree of uremia from rising creatinine and persistent renal failure. fat emboli syndrome was also high on the differential given his elevated lfts and worsening renal failure. pe was also on the differential, however this was felt to be less likely given the other reasons for hypoxia and delirium, and given his poor renal function, cta was not done during admission. he was also ruled out for mi. patient was intermittently agitated. he was hypotensive at 1 point and had limited iv access and was sent to the icu, but did not require intubation. opiates were avoided as much as possible. a pain consult was obtained hoping that pain control would help with his delirium. however, due to his multiple medical problems they felt that aggressive intervention would not be possible. they recommended ultram and standing tylenol. his delirium persisted and he became progressively more tachypneic and looked uncomfortable. tiny doses of morphine were give (total of about 2 mg in 24 hours). he remained tachypneic and then became hypoxic and went into respiratory failure on . he was intubated and sent back to the icu. from a respiratory status he improved and it was felt that he could be extubated, however he remained heavily sedated after fentanyl and versed were discontinued. it was unclear if he would do well on extubation given his mental status, however he tolerated it well and sats were in high 90's in 4 l nc. he remained delirious only answering to what his name is, but otherwise was disoriented. a family meeting was held in the icu, and it was decided that the patient would want to be dnr/dni but medical management would be continued. although they did not make him comfort measures only, the family stressed that he should be made as comfortable as possible. he occasionally became agitated and seemed somewhat uncomfortable when he returned to the floor. ultram was restarted with hopes of controlling his pain without giving morphine and zyprexa was ordered prn. geriatrics followed the patient throughout his hospital stay and they agreed that we should treat all of his medical issues and control his pain, given this was likely contributing to his delirium. would continue scopolamine patch for secretions and suction prn, continue aspiration precautions until mental status clears, ultram and tylenol for pain. . 2. id: patient developed pneumonia most likely secondary to aspiration given his altered mental status he was treated with 12 days of levofloxacin, 8 days of flagyl and 10 days of vancomycin. his blood cultures from and grew coag negtaive staph sensitive to vancomycin. however, on he spiked a fever to 104 and became hypoxic, chest x-ray looked like worsening pneumonia most likely to continued aspiration. he went into respiratory distress, was intubated, brought to the where he was also on pressors and was started on zosyn, he received a full 7 days of zosyn, was afebrile with improving respiratory status, was extubated and began maintaining his sats at 98-100% on 4 l nc. at discharge, he was on no antibiotics and all cultures from on were negative. . 3. respiratory failure: it was thought that his respiratory failure was due to pulmonary edema along with pneumonia. it is likely that he was continuously aspirating. on serial cxr there was pulmonary edema and o2 sats did improve with diuresis. on his respiratory status rapidly declined, blood gas showed a metabolic acidosis. cxr revealed worsening pneumonia and patient was tachypneic and hypoxic and eventually began having apneic episodes. he was intubated, sedated and taken to the icu where he was started on pressors and zosyn for pneumonia. it was thought that his rapid decline was secondary to worsening pneumonia and mucous plugging. he was extubated and was satting 98-100% on 4 l nc after treatment with 7 days of zosyn. . 4. access: multiple attempts were made to get iv access including piv in his foot, central lines and femoral lines. lone placement was limited by his agitation, edema, pacemaker, right brachial artery thrombus, and fractured left arm. a femoral line was briefly placed as patient was in desperate need of hydration, but was discontinued after 2 days after which time a picc line was place. however, patient was bacteremic and picc was pulled and he was treated with antibiotics and then a picc was replaced. at discharge he has a right picc which was left in place given all of his issues with iv access. 5. renal: probably arf on crf. patient had rising creatinine from pcp's office: cr 1.7->2.2 (rising on 4 consecutive readings every 2-3 weeks) prior to admission. his creatinine peaked at 2.9, he did not receive any contrast, but has gotten some ibuprofen. no signs of active sediment with muddy brown casts consistent with atn as well, good uop and renal u/s showed no signs of obstruction. urine lytes c/w prerenal etiology. creatinine improved with hydration, but his fluid status was precarious given his low ef. he did have worsening pulmonary edema after hydration and responded well to 40 of iv lasix. he was positive about 10 liters during admission but appears euvolemic on discharge. also, patient was hypernatremic to 157 during the time it was difficult to gain iv access. a renal consult was obtained and agreed with our management of replete his free water. his free water deficit was estimated at 4-5 liters. he received 5 liters d5w and his sodium was within normal limits and remained normal for the rest of his hospital stay. his hco3 remained about 18 throughout most of his hospital stay. the reason for this is unclear. it is possible that he has an rta, but renal was not re consulted. can consider further work up after resolution of his acute medical problems. . 6. humerus fx/pain control: orthopedic consulted and had no plan for surgery and to follow as outpatient. they recommended continuing sling with swath for 6 weeks and non-weight bearing of left arm. his arm remained edematous and ecchymotic thorough out admission and the patient was reevaluated for possible compartment syndrome, but ortho did not think this was likely. pain control with tylenol 1000 mg q 6h and ultram . he should follow up with orthopedics as an outpatient. 7. cardiac: patient has cad and is s/p cabg and had an icd placed for unknown reasons but likely due to low ef. patient also has known echo in with ef of 30% (as per pmd)with ischemic changes including enlarged left ventricle and mitral and aortic regurgitation. on this admission echo was repeated and revealed ef 15-20%. he was ruled out for mi on admission as he complained of some mild substernal chest pain. cardiac enzymes were negative and ekg revealed no ischemic changes. he had no further episodes throughout admission. his blood pressure medications were held for hypotension and renal failure. however, given his low ef and valvular disease would recommend titrating captopril as blood pressure tolerates. . 8. heme: patient's inr was 1.2 on admission and on hod#3, inr peaked at 2.2; on hod# a hematology consult was obtained to evaluate for possible dic/ttp picture given anemia and thrombocytopenia. however, there were no schistocytes on smear and these abnormalities began to normalize, therefore no further work up was pursued. it has been steady in the 1.8-2.0 range. . 9. elevated lfts: lfts began to elevate on hod#9. abdominal ultrasound was negative and there was no other reason to explain this. he did become hypotension, but not to a significant extent and enzymes are not high enough to indicate shock liver. it was thought this may have been to an overall inflammatory response due to fat emboli syndrome. his lfts continued to improve over the course of hospitalization. . 10. fen: patient was hypernatremic as mentioned above, but this has since resolved. currently has ng in place with tf as 600 cc/hr and d5 1/2 ns at 50 cc/hr. given his chf and renal failure his fluid status had to be closely monitored. on discharge he appeared euvolemic. . 11. code: dnr/dni. family would like complete medical management, but also think comfort is very important so would consider pain medications even if this worsened his mental status. medications on admission: levoflox 250 mg qd iv today day 1 metoprolol 12.5 qd changed to 5 mg iv q6 hr when made npo isosorbide 40 mg po bid bisacodyl protonix 40 mg qd asa 162 po qd oxybutynin 5 mg tid lipitor 10 mg qd quinine 260 mg qod magnesium oxide 280 qd donepezil 10 mg qd heparin sc tid psyllium colace 100 mg doxepin 25 qd mvi tylenol 1 g q 4hr discharge medications: 1. doxepin 25 mg capsule sig: one (1) capsule po hs (at bedtime). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 4. psyllium 1.7 g wafer sig: one (1) wafer po daily (daily). 5. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. 6. donepezil 10 mg tablet sig: one (1) tablet po hs (at bedtime). 7. magnesium oxide 400 mg tablet sig: two (2) tablet po daily (daily). 8. quinine sulfate 260 mg tablet sig: one (1) tablet po qhs qod (). 9. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 10. oxybutynin chloride 5 mg tablet sig: one (1) tablet po tid (3 times a day). 11. aspirin 81 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po 2 caplets daily (). 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 13. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed. 14. isosorbide dinitrate oral 15. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po daily (daily). 1. doxepin 25 mg capsule sig: one (1) capsule po hs (at bedtime). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 4. psyllium 1.7 g wafer sig: one (1) wafer po daily (daily). 5. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. 6. donepezil 10 mg tablet sig: one (1) tablet po hs (at bedtime). 7. magnesium oxide 400 mg tablet sig: two (2) tablet po daily (daily). 8. quinine sulfate 260 mg tablet sig: one (1) tablet po qhs qod (). 9. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 10. oxybutynin chloride 5 mg tablet sig: one (1) tablet po tid (3 times a day). 11. aspirin 81 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po 2 caplets daily (). 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 13. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed. 14. isosorbide dinitrate oral 15. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po daily (daily). discharge disposition: extended care facility: for the aged - discharge diagnosis: primary 1. humeral fracture 2. delirium 3. acute renal failure 4. chf secondary 1. a. fib 2. cataracts discharge condition: delirium, oriented to self only, respiratory status stable, afebrile, ngt in place discharge instructions: please take all of your medications as directed. you should follow up with orthopedics for your humeral fracture. followup instructions: call the orthopedics clinic for a follow up visit 4-6 weeks. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances diagnoses: congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft unspecified fall percutaneous transluminal coronary angioplasty status acute respiratory failure pneumonitis due to inhalation of food or vomitus hyperosmolality and/or hypernatremia drug-induced delirium closed fracture of surgical neck of humerus 

Answer: The patient is high likely exposed to