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: past medical history: history revealed several recent hospitalization for urinary tract infection, fever of unknown origin, and confusion; dementia; end-stage renal disease on hemodialysis; coronary artery disease status post two myocardial infarctions. in the ed, the patient underwent a workup, which revealed an elevated white blood cell and a urinalysis suggestive of a uti. the patient was visited by the orthopedic surgery team, which examined her and found her to have signs and symptoms consistent with a left hip fracture. x-ray of the hip and left femur revealed a left intertrochanteric fracture of the femur. the orthopedic team consented her for an oris healthcare proxy, pending medical clearance of urinary tract infection, increased white blood cell count, increased coagulations, and evaluation of cardiac status. throughout the ed stay, the patient denied any fever, chills, diarrhea, constipation, urinary symptoms, respiratory symptoms, gi symptoms, or sick contacts. past medical history: 1. diabetes mellitus type 2, not on insulin. 2. end-stage renal disease on hemodialysis. 3. coronary artery disease with three-vessel disease and myocardial infarction in , and . last echocardiogram shows an ejection fraction of 45%. 4. chronic obstructive pulmonary disease. 5. peripheral vascular disease status post femoral/popliteal bypass. 6. gi bleeding secondary to arteriovenous malformation . 7. hypertension. 8. mitral regurgitation. 9. transient ischemic attacks. 10. dementia. 11. status post total abdominal hysterectomy, bilateral salpingo-oophorectomy. 12. status post h. pylori infection, resolved. social history: the patient is widowed; lives in home in . the patient denies current alcohol, drug, or tobacco use, but admits to heavy tobacco use in the past. medications: 1. senna q.h.s. 2. promod t.i.d. 3. zoloft 50 q.a.m. 4. imdur 60 q.d. 5. metoprolol 50 b.i.d. 6. nephrocaps q.d. 7. lipitor 20 q.d. 8. phoslo t.i.d. 9. protonix 40 q.d. 10. glyburide q.o.d. allergies: the patient is allergies to nifedipine and percocet. physical examination: examination revealed the following: vital signs: temperature 96.5, heart rate 68, blood pressure 140/99, respiratory rate 22, oxygen saturation 99% on room air. general: the patient was laying in bed in no apparent distress. heent: eomi, perrla, no oropharyngeal erythema, moist mucous membranes, normocephalic, atraumatic. neck: no lad, bruits, masses. cardiovascular: regular rate and rhythm, s1 and s2 normal. no murmurs, rubs, or gallops. pulmonary: left sided dialysis catheter in place on anterior chest. mild bilateral bibasilar crackles on auscultation. abdomen: positive bowel sounds times four, soft, nontender, and nondistended. extremities: the patient was missing several toes bilaterally secondary to amputation. there was no clubbing, cyanosis or edema. left leg is shorter than the right leg. there was tenderness to palpation over the left groin. vascular: nonpalpable pulses bilaterally in the lower extremities. laboratory data: pertinent labs in the ed: white blood cell count 23.7, hematocrit 41.3, hematocrit 12.6, platelet count 290,000, mcv 78, 3+ hypochromia, 2+ microcytosis, sodium 142, potassium 3.6, chloride 100, bicarbonate 26, bun 22, creatinine 4.1, glucose 171, anion gap 20, pt 13.4, inr 1.2, ptt 45.5. urinalysis: brown, cloudy urine with a few bacteria, large blood, nitrite positive, no yeast, 100 protein, no glucose or bilirubin, epithelials cells, urobilinogen of 1, ph 6, greater than 50 white cells, moderate 21 to 50 red blood cells. ekg: negative for acute changes. chest x-ray: negative for fracture or cardiopulmonary disease. cervical spine films: negative for fracture. films of the left hip revealed an intertrochanteric fracture of the left femur. ct of the spine revealed no fracture and left ij catheter site for peritoneal catheter. ct of the head was negative for masses or bleeds. old echocardiogram taken revealed mild lvh, mildly decreased systolic function. assessment and plan: this is a 87-year-old black female with dementia, poor historian status post fall with multiple medical problems chronically and an increase white blood cell count and uti acutely. the following was the plan decided upon admission of the patient. #1. orthopedic: left intertrochanteric fracture of the femur by x-ray. the patient was seen by the orthopedic department to under open reduction and internal fixation after medical clearance. pain is to be controlled with morphine sulfate with adequate breakthrough coverage as well. #2. infectious disease: increased white blood cell count and urinalysis consistent with uri in a patient with a recent history of frequent utis. urine culture pending. will treat empirically with cipro 500 mg q.24h. po and follow cbcs. the patient is afebrile and stable for now. no other infectious source suspected. #3. renal: the patient has end-stage renal disease on dialysis with a creatinine of 4.1, much greater than baseline. the patient usually gets dialysis on monday, wednesday, and friday. will arrange for hemodialysis to be done appropriately. #4. endocrine: diabetes mellitus with triopathy; stable with pain medications and placed on diet. #5. cardiovascular: status post myocardial infarction times two with 45% . the last cardiac catheterization was . currently, no symptoms with negative ekg. no need for rule out myocardial infarction, may need cardiac workup for ...................clearance. #6. prophylaxis: heparin subcutaneously, check coagulations. #7. fluids, electrolytes, and nutrition: and cardiac diet. #8. dementia: no sign of altered mental status from baseline or lethargy; will contact family to verify; can give ambien for sleep. hospital course: on hospital day #2, the patient was found to be unable to respond sensibly to questions. however, the vital signs remained stable with blood pressures in the 140 range. the heart rate was in the 80s, and she was saturating well and afebrile throughout the day. she was given ciprofloxacin for a second day to treated a supposed uti. the patient was somnolent, drowsy, and babbling at times. the physical examination was unchanged, however. labs showed an increase in the white blood cell to 25.9 with a left shift of 92% neutrophils. the patient underwent dialysis later that day. the plan on hospital day #2 was to continue working up the patient for potential increased white blood cell count of infectious etiology. on hospital day #3, the patient had no complaints that morning, but the patient was still disoriented and she did not know why she was in the hospital. vital signs were stable. the examination was normal. the patient was thought to be improving clinically and laboratory wise as the white count had dropped to 18 and the electrolytes were normal except for a magnesium of 1.4. because the patient had apparent petechiae on her feet, the patient's attending, dr. felt that it would be necessary to get a dic panel. the dic panel revealed the fibrinogen coming back elevated at 426 and the fibrin degradation products are equal to 10 to 40. as of hospital day #3 neither urine cultures nor blood cultures had come back positive for any growth and the plan was made to have the patient operated on the following day and then return to the medicine service. on hospital day #4, the patient was found to be hypotensive and tachycardiac on the floor. the patient was seen by her attending, dr. , who was worried about a possible pulmonary embolus. the patient was also displaying altered mental status very different from her baseline. because the blood pressures and oxygen saturations could not be adequately ascertained secondary to machinery problems on the floor and the patient's anatomy, the threshold for transfer was low. in the micu, the patient was started on heparin for possibly pulmonary embolus; broad antibiotic coverage with levofloxacin, vancomycin, and metronidazole, and morphine sulfate for pain. the patient remained hypotensive and remained hypotensive and relatively unresponsive to fluid boluses. the patient's source was never found, although suspicions were raised about a previous imaging study of the abdomen done in , which revealed an adnexal mass, which may be the source of infection. uti was found to apparently not be the cause of the patient's increased white blood cell count. the patient's decline in the clinical course was discussed with family members, who decided that comfort measures only be the center of care. in light of this, the micu care team discontinued all medications, except for morphine sulfate and discontinued dialysis. both of these wishes being those of the family. upon transfer from the micu back to the floor, the following pertinent labs were found: white blood cell count of 20, down from 29.5, but still high. hemoglobin and hematocrit of 10 and 32, platelet count of 254,000, electrolytes within normal limits, bun and creatinine of 13 and 2.3, very close to baseline. lfts were obtained and they were normal. the patient's inr remained elevated at 1.4. blood and urine cultures were still pending. a workup for pulmonary embolus was negative and included a chest x-ray, which was negative for chf or pneumonia and a ct of the chest, which was negative for any evidence of pe, as well as an upper extremity and lower extremity doppler, which was negative for dvt. ct of the head showed no evidence of acute pathology and ekgs were unchanged from the previous. the patient under ekg, which showed basal inferior and inferoseptal akinesis with impaired left ventricular relaxation, but no mentioned of an ejection fraction. the patient's medications in the micu were the following: 1. iv fluids. 2. tylenol p.r.n. 3. ketorolac iv. 4. levofloxacin iv. 5. heparin subcutaneously. 6. magnesium sulfate. 7. pantoprazole iv. 8. sliding scale insulin. 9. vancomycin iv. 10. metronidazole iv. on hospital day #6, the patient remained peaceful and calm in her room on a morphine sulfate drip, per the family's wishes. the patient was responsive and when asked, denied any pain, shortness of breath, palpitations, diaphoresis, or discomfort of any kind. the patient's vital signs had not been taken as she was comfort-measures only. in general, the patient appeared lethargic, but somewhat responsive. cardiovascular: bradycardia, s1 and s2 normal, no murmurs, rubs, or gallops. pulmonary: clear to auscultation bilaterally. abdomen: soft, nontender, nondistended, bowel sounds times four. extremities: cool. labs: chem 7 taken revealed a sodium of 141, potassium 3.8, chloride of 107, bicarbonate 28, bun 17, creatinine 0.6, glucose 106. the patient had ruled for a myocardial infarction earlier. the patient was continued on comfort- measures only. she was taken off telemetry. per the family's wishes, the patient did not receive dialysis on this day. in light of the patient's current status clinically, as well as in light of the decisions made about her care, the team felt it appropriate to discuss possibly transfer back to the nursing home for terminal care. case management was requested to look into the option of returning the patient to where she lives, which is the home. the case manager spoke with the family as well as with the nursing home and arranged for the patient's comfort-measure care to be continued at her residence. currently, we are waiting for the patient's power of attorney, a named to arrive in order to finalized details and sign the comfort-care dnr order verification, as well as finalize the discharge planning. a palliative care nurse was also consulted and she recommended that the following changes be made to the patient's medication regimen: 1. discontinued morphine drip. 2. start morphine sulfate 10 mg sublingual q.4h.p.r.n. 3. start ativan 1 mg sublingual p.r.n. 4. start scopolamine patch p.r.n. q.3 days. the changes were made and discussed with the family. condition on discharge: to home. discharge status: terminal. discharge diagnoses: 1. left hip fracture. 2. increased white blood cell count in setting of hypotension, cause unknown. 3. end-stage renal disease on hemodialysis. 4. diabetes mellitus type 2. 5. coronary artery disease. 6. chronic obstructive pulmonary disease. 7. peripheral vascular disease. 8. dementia. 9. large adnexal mass on previous imaging, unknown etiology. discharge medications: 1. morphine sulfate 10 mg sublingual q.4h.p.r.n. pain. 2. ativan 1 mg sublingual p.r.n. pain. 3. scopolamine patch p.r.n. q.3 days. p.r.n. is for secretions here. follow up plans: the patient's primary care physician will be notified as to the patient's current condition and terminal state. the primary care physician will then follow up with the family as to the patient's outcome. , m.d. dictated by: medquist36 procedure: hemodialysis diagnoses: nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere mitral valve disorders chronic airway obstruction, not elsewhere classified unspecified fall other persistent mental disorders due to conditions classified elsewhere alkalosis diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled closed fracture of intertrochanteric section of neck of femur 

Answer: The patient is high likely exposed to