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: ibuprofen / codeine / percocet / morphine attending: chief complaint: scheduled admission for lumbar spinal surgery major surgical or invasive procedure: stage 1: l34 lateral lumbar fusion mis for l34 nonunion stage 2: l34 psf with laminectomy history of present illness: ms. is a 70f with multiple medical problems including dm2, depression, h/o cva, cri, osa (non-compliant with cpap) and copd admitted on for planned l3-l4 posterior spinal fusion in two stages. on she underwent lateral interbody fusion at l3-l4 to provide interbody fusion support. on she went back to the or for the definitive l3-l4 fusion. post operatively in the pacu she remained intubated due to apnea and agitation. she also became hypotensive with maps in the 40-50s for which she was started on a low dose of phenylephrine. she was transferred to ticu for monitoring still intubated and on 0.2 mcg/kg/min. she remained neurologically intact on exam and was switched from propofol to precedex in the ticu. she was weaned off pressors, extubated, and transferred to the ortho floor on . on the patient was noted to be more somnolent and confused. she was therefore transferred to the medicine service for further management. ros: (+) per hpi (-) denied shortness of breath, chest pain, abdominal pain. past medical history: cognitive impairment. exact diagnosis unclear. htn copd, not on home o2 tardive dyskinesia from risperidone stroke, details unclear type 2 diabetes hypothyroidism chronic renal insufficiency hld osa on cpap/bipap (but does not wear) history of kidney stones incontinence gout depression morbid obesity psh: appendectomy cholecystectomy in kidney stone removal in d& , previous lumbar spinal fusion social history: - tobacco: none - etoh: none - illicits: none - lives in alf " " since her late 50s. previously worked as a book-keeper. never married or had kids. has a health aide who visits 7 days per week . goes to adult day care 4 days/week. family history: - brother with mental handicap - both parents with mental handicaps physical exam: at time of transfer to medicine service: vs: 98.8 154/49 81 18 97%2l bs 117 gen: agitated but is oriented to person, hospital (), and month heent: eomi, pupils are 2mm bilaterally and reactive to light, mmm, op clear neck: right ij cvl. no jvd appreciated although exam limited cvl & body habitus. echymossis on left neck ? ij attempt ? cv: regular rate and rhythm, no murmurs resp: ctab anteriorly, exam limited by body habitus and poor inspiratory effort gi: soft, obese, nt, nd no hsm, +bs gu: foley catheter in place ext: warm, well-perfused, obese, no c/c, 1+ lower extremity edema bilaterally, +pneumoboots, 2+ dp pulses bilaterally neuro: exam very limited by patient's mental status but grossly intact with no focal deficit. she does not open her eyes spontaneously, but opens when asked. she is able to state the reason why she was admitted to the hospital and the name of her surgeon. she is able to move all 4 extremities without limitation and sensation is grossly intact to light touch. prior to discharge: gen: oriented to person, hospital (), and month heent: eomi, perrl, mmm, op clear neck: no jvd appreciated although exam limited cvl & body habitus. echymosses on neck cv: regular rate and rhythm, no murmurs resp: ctab anteriorly, exam limited by body habitus and poor inspiratory effort gi: soft, obese, nt, nd no hsm, +bs gu: no foley ext: warm, well-perfused, obese, no c/c, trace lower extremity edema bilaterally, +pneumoboots, 2+ dp pulses bilaterally neuro: cns grossly intact.she is able to state the reason why she was admitted to the hospital and the name of her surgeon. she is able to move all 4 extremities without limitation and sensation is grossly intact to light touch. strength grossly intact with no focal deficit or assymetry. psych: patient occassionally yells that she wants to go home, which according to her hcp is her baseline when she is in unfamiliar surroundings. pertinent results: 02:41pm blood wbc-13.2* rbc-3.97* hgb-12.1 hct-36.6 mcv-92 mch-30.4 mchc-33.0 rdw-13.7 plt ct-222 06:11am blood wbc-11.9* rbc-3.67* hgb-11.0* hct-34.4* mcv-94 mch-29.9 mchc-31.9 rdw-13.8 plt ct-188 05:30pm blood wbc-26.7*# rbc-4.10* hgb-12.4 hct-38.4 mcv-94 mch-30.2 mchc-32.2 rdw-13.9 plt ct-232 04:42am blood wbc-21.1* rbc-3.21* hgb-9.7* hct-29.5* mcv-92 mch-30.3 mchc-33.0 rdw-14.3 plt ct-178 09:32pm blood wbc-20.4* rbc-2.92* hgb-8.9* hct-27.6* mcv-94 mch-30.5 mchc-32.3 rdw-14.2 plt ct-164 03:03am blood wbc-19.1* rbc-3.05* hgb-8.9* hct-29.2* mcv-96 mch-29.3 mchc-30.6* rdw-13.8 plt ct-221 10:32am blood wbc-13.7* rbc-2.86* hgb-8.5* hct-26.6* mcv-93 mch-29.7 mchc-31.8 rdw-14.1 plt ct-211 04:30am blood wbc-12.7* rbc-2.81* hgb-8.5* hct-26.3* mcv-94 mch-30.3 mchc-32.3 rdw-13.9 plt ct-221 05:14am blood wbc-14.4* rbc-3.01* hgb-9.0* hct-27.8* mcv-93 mch-30.0 mchc-32.4 rdw-13.8 plt ct-267 05:30pm blood pt-12.9* ptt-38.9* inr(pt)-1.2* 02:41pm blood glucose-91 urean-52* creat-1.2* na-142 k-4.5 cl-103 hco3-28 angap-16 05:14am blood glucose-123* urean-17 creat-0.7 na-142 k-4.0 cl-105 hco3-28 angap-13 05:38am blood wbc-11.4* rbc-2.81* hgb-8.9* hct-25.8* mcv-92 mch-31.5 mchc-34.4 rdw-13.3 plt ct-334 10:40am blood glucose-111* urean-12 creat-0.7 na-141 k-4.1 cl-103 hco3-30 angap-12 10:40am blood calcium-8.6 phos-3.2 mg-1.2* 06:11am blood calcium-8.7 phos-4.1 mg-1.7 10:32am blood calcium-8.8 phos-2.1* mg-1.7 10:32am blood tsh-0.53 10:32am urine color-yellow appear-hazy sp -1.012 10:32am urine blood-sm nitrite-neg protein-30 glucose-neg ketone-10 bilirub-neg urobiln-neg ph-5.0 leuks-lg 10:32am urine rbc-11* wbc->182* bacteri-few yeast-rare epi-1 transe-1 10:32am urine amorphx-rare 10:32am urine mucous-rare 10:32 am urine source: catheter. **final report ** urine culture (final ): yeast. ~8ooo/ml. lumbar spine () clinical history: patient with posterior fusion. findings: views of the lumbar spine from the operating room demonstrates interval placement of a disc prosthesis at likely l3-l4. however, the inferior aspect of the sacrum is not included on the field of view. the total intraservice fluoroscopic time was 76.1 seconds. please refer to the operative note for additional details. lumbar spine () findings: there has been interval l3-l4 posterior fusion including placement of an interbody fusion spacer, although depiction is limited. ecg () sinus rhythm. left axis deviation, left anterior fascicular block. poor r wave progression, may be due to left anterior fascicular block. possible left ventricular hypertrophy with st segment changes, possibly due to repolarization abnormality. no previous tracing available for comparison. leni () impression: no bilateral lower extremity deep venous thrombosis. brief hospital course: ms. is a 70f with multiple medical problems including dm2, depression, h/o cva, cri, osa and copd admitted on for l3-l4 posterior spinal fusion in two stages. post-op course complicated by respiratory failure, hypotension, uti and confusion which all resolved. active issues: ================ #) s/p lumbar spinal fusion: : l3-l4 lateral interbody fusion with interbody device and allograft. : revision posterior decompression with far lateral decompression and instrumented fusion l3-l4 with autograft and allograft. she is being discharged on dilaudid prn for pain and an as needed bowel regimen. she will follow-up with her surgeon dr. in clinic on . #) pyuria: patient developed delirium post-operatively which resolved after treatment with 3 days of iv ceftriaxone. however, urine culture later grew yeast (8000/ml), which was not subsequently treated since she was asymptomatic. #) leukocytosis: wbc count 13.2 on day of admission and peaked as high as 26.7 before trending back down to 11.4 prior to discharge. possibly was stress response from surgery although higher than one would expect from just that. however no fevers or localizing signs for systemic infection were noted. this was thought to be unlikely to be from cystitis alone. c. diff dna amplification assay was negative. she remained afebrile without any symptoms (with improved mental status) through day of discharge. #) acute blood loss anemia: related to surgery. never had any bloody or dark stools. hematocrit was stable for 4 days prior to discharge. #) confusion: likely multifactorial from post-operative delirium. she had already mostly improved by the following morning, even prior to receiving antibiotics. sedating medications were held and patient received antibiotics with complete resolution of symptoms and return to her baseline mental status by day of discharge, as confirmed by family member. #) diarrhea- the patient developed watery, non-bloody diarrhea on . she had been constipated and received aggressive bowel regimen prior to onset of diarrhea. other possibilities included c. diff but patient was afebrile with normal abdominal exam and had decreasing wbc. stool was sent for c.diff toxin and returned negative. this could also have been antibiotic-associated diarrhea after receiving ceftriaxone for 3 days. by discharge, diarrhea had improved. she is being discharged on as needed loperamide. chronic issues: ================== #) type 2 diabetes: patient is on levemir, metformin and sitagliptin at home. she has not been on an aspirin or an ace-i, which may be beneficial given her diabetic history. we will defer to her primary care physician on this matter. we resumed home regimen on discharge. #) copd: not on home o2 with no evidence of chronic co2 retention. continued prn albuterol. #) osa: not on cpap at home. #) depression: continued home duloxetine. transitional issues: ====================== - consider starting aspirin and ace-i as outpatient given diabetes. - contact: (cousin/hcp) medications on admission: duloxetine 30mg daily levothyroxine 125mcg daily omeprazole 20mg daily sitagliptin 50mg daily allopurinol 100mg metformin 850mg mirtazapine 7.5mg qhs gabapentin 100mg tid simvastatin 20mg qd potassium citrate 10 meq daily levemir flexpen subcutaneous 100 unit/ml 10 unit every day at bedtime albuterol inhaler prn discharge medications: 1. duloxetine 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 2. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 4. sitagliptin 50 mg tablet sig: one (1) tablet po once a day. 5. allopurinol 100 mg tablet sig: one (1) tablet po bid (2 times a day). 6. metformin 850 mg tablet sig: one (1) tablet po bid (2 times a day). 7. mirtazapine 7.5 mg tablet sig: one (1) tablet po at bedtime. 8. gabapentin 100 mg capsule sig: one (1) capsule po three times a day. 9. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 10. potassium citrate 10 meq tablet extended release sig: one (1) tablet extended release po once a day. 11. levemir flexpen 100 unit/ml (3 ml) insulin pen sig: ten (10) units subcutaneous at bedtime. 12. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation every 4-6 hours as needed for shortness of breath or wheezing. 13. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): 12 hours on/12 hours off. 14. acetaminophen 500 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. 15. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 16. senna 8.6 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)) as needed for constipation. 17. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 18. loperamide 2 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for diarrhea. 19. dilaudid 2 mg tablet sig: 0.5 tablet po every four (4) hours as needed for pain: hold for sedation, rr < 12. disp:*56 tablet(s)* refills:*0* discharge disposition: extended care facility: healthcare & rehabilitation center - discharge diagnosis: primary- non l34 with lumbar canal stenosis secondary- hypertension copd stroke type 2 diabetes hypothyroidism chronic renal insufficiency hyperlipidemia osa on cpap/bipap discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to the hospital for the following operation: lumbar decompression with fusion in two stages. while here, you were somewhat confused after the surgery but this resolved quickly. you were treated for a urinary tract infection and remained without fevers on discharge. you are being discharged to rehab before you go back home. no changes were made to your home medications. please use dilaudid 1mg by mouth as needed for pain and use a bowel regimen if you become constipated. per the orthopedic surgeons: immediately after the operation: - activity: you should not lift anything greater than 10 lbs for 2 weeks. you will be more comfortable if you do not sit or stand more than ~45 minutes without getting up and walking around. - rehabilitation/ physical therapy: o 2-3 times a day you should go for a walk for 15-30 minutes as part of your recovery. you can walk as much as you can tolerate. o limit any kind of lifting. - diet: eat a normal healthy diet. you may have some constipation after surgery. you have been given medication to help with this issue. - wound care: remove the dressing in 2 days. if the incision is draining cover it with a new sterile dressing. if it is dry then you can leave the incision open to the air. once the incision is completely dry (usually 2-3 days after the operation) you may take a shower. do not soak the incision in a bath or pool. if the incision starts draining at anytime after surgery, do not get the incision wet. cover it with a sterile dressing. call the office. - you should resume taking your normal home medications. - you have also been given additional medications to control your pain. please allow 72 hours for refill of narcotic prescriptions, so please plan ahead. you can either have them mailed to your home or pick them up at the clinic located on 2. we are not allowed to call in or fax narcotic prescriptions (oxycontin, oxycodone, percocet) to your pharmacy. in addition, we are only allowed to write for pain medications for 90 days from the date of surgery. - follow up: o please call the office and make an appointment for 2 weeks after the day of your operation if this has not been done already. o at the 2-week visit we will check your incision, take baseline x-rays and answer any questions. we may at that time start physical therapy. o we will then see you at 6 weeks from the day of the operation and at that time release you to full activity. please call the office if you have a fever >101.5 degrees fahrenheit and/or drainage from your wound. followup instructions: department: primary care when: tuesday at 11:30 am with: , md building: (, ma) campus: off campus best parking: parking on site md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours excision of intervertebral disc excision of bone for graft, other bones insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae insertion of recombinant bone morphogenetic protein intra-operative neurophysiologic monitoring refusion of lumbar and lumbosacral spine, anterior column, anterior technique refusion of lumbar and lumbosacral spine, posterior column, posterior technique other and unspecified repair of the anulus fibrosus diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux urinary tract infection, site not specified acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified depressive disorder, not elsewhere classified chronic kidney disease, unspecified other and unspecified hyperlipidemia acute respiratory failure morbid obesity personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits diarrhea nonunion of fracture delirium due to conditions classified elsewhere leukocytosis, unspecified orthostatic hypotension acquired spondylolisthesis spinal stenosis, lumbar region, with neurogenic claudication 

Answer: The patient is high likely exposed to