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: service: ccu history of present illness: patient is a 60 year old female with a history of hypertension, hypertrophic obstructive cardiomyopathy, breast cancer and depression who slipped in the bathroom on and broke her left hip. patient initially was evaluated and admitted by orthopaedics for open however, patient had an episode of worsening shortness of breath and hypoxia secondary to chf prior to surgery. patient was transferred to the medicine team on , and had continued worsening of her respiratory status with desaturations into the mid-80s in the context of aggressive diuresis with lasix. cardiology was consulted on , and they advised a blood transfusion and verapamil to minimize the patient's outflow tract gradient associated with her hypertrophic obstructive cardiomyopathy. patient was started on lopressor and given 2 units of packed red blood cells and gentle intravenous fluids at which time she was transferred to the coronary critical care unit on , for management of her congestive heart failure associated with hocm. additionally her hospital course prior to transfer to the ccu team was complicated by a temperature spike on , from an unknown source. past medical history: hypertrophic obstructive cardiomyopathy (hocm) which was diagnosed by an echo in showing an ejection fraction of 65% and a dynamic outflow tract gradient. hypertension. schizoaffective personality disorder along with major depression and anxiety disorder. medications prior to admission: included celexa 20 mg q.day, paxil 20 mg q.day, ativan 1 mg t.i.d., zyprexa 5 mg b.i.d., verapamil 240 mg b.i.d., albuterol, atrovent, premarin. physical examination: generally she was an anxious, but alert and oriented times three, obese female. heent: extraocular movements were intact. mucous membranes were dry. oropharynx was clear. neck exam no jvp, no thyromegaly, no cervical or supraclavicular lymphadenopathy. cardiovascular exam regular rate, normal s1, no s2 appreciated with a 3/6 systolic diamond-shaped murmur radiating to the axilla and abdomen. additionally, there was a diastolic decrescendo murmur appreciated at the apex. no rubs appreciated. lung exam clear to auscultation in the upper lung fields with bibasilar crackles. abdominal exam distended, tender to deep palpation diffusely with active bowel sounds, no rebound, no guarding, no hepatosplenomegaly. extremities: patient had 2+ dorsalis pedis and posterior tibialis pulses in the right lower extremity, but 1+ pulses in the left lower extremity, 2+ capillary refill bilaterally. no edema, no palpable cords, negative homans sign, positive pain to deep palpation of the left hip with decreased range of motion of the left hip. laboratory data: white blood cell count 9.7, hemoglobin 10.7, hematocrit 31.5, platelets 179, retic count 1.8. ua showed large amount of blood, negative nitrites, 100 mg/dl protein, negative glucose, negative ketones, small amount of bilirubin, 0.2 urobili, ph 5, negative leukocyte esterase, specific gravity 1.025. microscopic exam of the urine showed greater than 50 red blood cells, 6 to 10 white blood cells, no bacteria, no yeast, 3 to 5 squamous epithelial cells. chem-7 sodium 142, potassium 3.5, chloride 103, bicarb 29, bun 16, creatinine 1.4, no glucose done. ck was 378, mb 3, troponin 2.4. calcium was 8.9, phosphate 2.8, magnesium 1.9. patient had an echocardiogram done on , that showed an elongated left atrium with moderate symmetric left ventricular hypertrophy, left ventricular systolic function was hyperdynamic with an ejection fraction greater than 75% with a severe resting left ventricular outflow tract obstruction. findings were consistent with hypertrophic obstructive cardiomyopathy. right ventricular chamber size and free wall motion were normal. ascending aorta was mildly dilated. aortic valve leaflets were mildly thickened. mitral valve leaflets were mildly thickened. there was no mitral valve prolapse, mild 1+ mitral regurg, no pericardial effusion. compared with the previous study on , left ventricle is now frankly hyperdynamic and the intracavitary gradient is much higher. left ventricular cavity and stroke volume are smaller. cardiac output is probably low. ct scan of the pelvis and hip with 2 mm cuts was done on the day of admission, . it showed severely comminuted left acetabular fracture with axial migration of the femoral head into the pelvis, left superior and inferior pubic rami fractures, likely old pubic symphysis injury and no significant pelvic hematoma. chest x-ray on showed stable cardiomegaly, mediastinal and hilar contours were stable in appearance compared with previous exam on . lungs demonstrated no focal consolidation, pneumothoraces or pleural effusion. there was persistent elevation of the right hemidiaphragm. soft tissues and osseous structures were unremarkable. chest x-ray on , showed interval development of congestive heart failure with interstitial edema and a new left retrocardiac opacity mostly due to atelectasis or aspiration in this recently postoperative patient which is actually not true. an early focus of pneumonia would be considered less likely, but could not be excluded. ekg on on admission showed sinus rhythm, lvh with secondary st-t changes and no significant changes compared with previous tracing. hospital course: 1. cardiovascular system. coronary artery disease: patient has no known coronary artery disease. pump: strategy of treatment throughout the patient's ccu stay was aggressive negative inotropic administration with optimization of patient's intervascular volume. initially prior to transfer to ccu, patient was -diuresed and in setting of outflow tract obstruction and increaed castecholamine state developed worsening congestive heart failure. initial strategy included beta blockade with iv esmolol, pain control and gentle hydration. she later experienced decreased urine output ultimately determined secondary to transient acute renal failure. pulmonary artery catheter was placed on , which showed significantly elevated pulmonary artery pressures averaging in the 70s systolic and 30s diastolic with central venous pressures in the 30s and pulmonary capillary wedge pressures in the 30s. she was managed with target pad of 20-25 and cvp of mmhg. after the patient was brought back from the o.r. on , esmolol drip was continued, but weaned to off on , while p.o. lopressor was titrated up to a maximum dose of 100 mg p.o. q.i.d. additionally, verapamil was added on . echocardiogram was repeated on , that showed an ejection fraction of greater than 70% along with left atrium elongation with moderate symmetric left ventricular hypertrophy and normal cavity size with excellent systolic function. however, there was a severe resting left ventricular outflow tract obstruction with a difficult to assess magnitude due to anteriorly directed mitral regurgitation. right ventricular chamber size and free wall motion were normal. aortic valve leaflets were structurally normal with good leaflet excursion. there was no aortic regurg seen. mitral valve leaflets were structurally normal. there was systolic anterior motion of the mitral valve leaflets and anterior directed jet of moderate to severe mitral regurgitation was seen. pulmonary artery systolic pressure could not be determined. there was a trivial physiologic pericardial effusion. compared with the prior study on , the severity of mitral regurgitation had increased, but may be related to the dynamic gradient/valvular which was also present on the prior study. patient also required benalefarin drip administration for several days after surgery to maintain her blood pressure. however, this was able to be weaned as patient's sedation was able to be weaned and was completely removed on . rhythm: patient had no arrhythmias during her hospital course. she was on telemetry throughout her hospital course. her ekgs showed no evidence of arrhythmia or ischemia despite her slight ck and troponin leak noted during her transfer to the ccu. it was thought that these enzymatic abnormalities were a result of strain in the context of her hyperdynamic state. 2. pulmonary. patient was intubated electively prior to surgery and remained intubated on . patient was noted to have pulmonary edema with possible left sided infiltrate postoperatively. the infiltrate was thought to be either atelectasis or pneumonia. patient was thought to be at high risk for pulmonary embolism due to her left hip fracture and inability to increase her activity level in her sedated state. patient was given prophylactic subcutaneous lovenox both preoperatively and postoperatively for dvt prophylaxis. patient's largely elevated pulmonary artery pressures were thought to be a result of her chronic outflow tract gradient and likely chronic congestive lung picture. additionally, patient was fluid overloaded, however, pulmonary embolism could not be completely ruled out with such high pulmonary artery pressures. whether or not those pulmonary artery pressures are out of proportion to her pulmonary capillary wedge pressure could not be determined. orthopaedic surgery was consulted regarding empiric full anticoagulation for potential pulmonary embolism, however, they recommended that full anticoagulation not be pursued since it would almost definitely lead to significant bleeding into her postoperative hip. therefore, ct angio was not pursued as full anticoagulation could not be undertaken. patient was weaned off assist control ventilation to pressure support on , and was able to maintain several hours on pressure support without hypoxia or signs of respiratory distress. however, patient occasionally became agitated with the pressure support and was placed back on assist control and vacillated between assist control and pressure support throughout her time of intubation. 3. renal. patient's urine output had dropped to roughly 5 cc an hour prior to surgery as a result of a brief period of hypotension prior to transfer to the ccu. patient did not initially respond to fluid challenges. urine was spun down by the ccu team and analysis of the pellet revealed muddy brown casts and sloughed tubular cells which were consistent with acute tubular necrosis. however, due to the emergent nature of her left hip, she was taken to surgery despite her low urine output. additionally, her creatinine elevated from baseline of 1.0 to as high as 1.8. when patient returned from surgery after getting several liters of fluid, she began to increase her urine output and her creatinine diminished to her baseline levels by post-op day two. throughout the remainder of the hospitalization patient's urine output was perdigious and her bun and creatinine remained stable at her baseline levels. 4. musculoskeletal. patient had her hip fracture repaired via open reduction and internal fixation on . it was a technically difficult surgery with multiple approaches needed to facilitate the repair. patient lost 3.5 liters of blood and was transfused 11 units of blood, 7 units of ffp and 2 units of plasma during the procedure. patient continued to be followed by orthopaedics throughout her hospitalization. patient's wound showed no evidence of infection and the two jp drains were removed as their drainage became minimal. orthopaedics recommended two weeks of empiric antibiotic treatment with levaquin and kefzol. they also recommended against full anticoagulation for pulmonary embolism and recommended a prophylactic dose of subcutaneous lovenox to be given until patient's activity level was able to be increased. 5. infectious disease. patient initially spiked a fever two days prior to surgery and remained febrile both before surgery and after surgery with a high grade fever that never dropped below 101 and went as high as 103.6 until . initially patient was given one dose of renally dosed levaquin prior to surgery and then continued on levaquin and started on kefzol after surgery on . this regimen was switched to ceftaz and vanc on , due to gram negative rods that were noted on the gram stain of the patient's sputum and in the context of continued high grade fever. flagyl was added on , for anaerobic coverage. echo on was negative for endocarditis. patient was also noted on to have vaginal discharge consistent with yeast infection. she was started on vaginal nystatin suppositories on that same day. patient was also given one shot of iv fluconazole on as a definitive treatment for this presumed yeast infection. patient remained febrile, as noted above, to temperatures as high as 103.5 until and this was despite maximal tylenol dosing and additional ibuprofen dosing. it was thought that drug fever might be a possibility for this patient's fever, however, her antibiotics had been switched multiple times with no effect on her fever curve. it was thought on that patient's aggressive antipsychotic, antidepressant medical regimen could be the cause of her hyperpyrexia as neuroleptic malignant syndrome is a potential side effect of zyprexa. these meds were all discontinued, which included zyprexa, paxil and celexa, on , and patient, for the first time since , defervesced 24 hours after these medications were discontinued. infectious disease was consulted on , at the same time that the psych meds were discontinued. they recommended abdominal and pelvic ct exam as well as left hip ultrasound for identification of potential abscess formation. all these studies were negative as were three sets of blood cultures, two sets of urine cultures and three sets of sputum cultures. as a result of negative blood tests and negative studies, patient was discontinued off all antibiotics on , per id recommendations, which took into consideration the patient's break in her fever on that same day. patient was noted to have positive c.diff assay on , and patient again spiked a fever on , to 101.3 after being afebrile for 24 hours. this was thought to be the result of the patient's c.diff infection and only p.o. flagyl was started for coverage of c.diff. additionally, on , patient's swan-ganz catheter was pulled. right ij was changed over a wire and right art line was switched to left art line per id request. 5. fen/gi. patient had four days of post-op ileus after surgery and was not able to tolerate tube feeds. tpn was considered, but not started as patient's post-op ileus resolved on after reglan was started. patient developed c.diff colitis on . patient's bowel regimen was discontinued and patient was able to tolerate some tube feeds. additionally, patient's sedation was weaned significantly on . versed was weaned off and fentanyl was weaned to 25 mcg per hour which significantly improved patient's bowel activity. 6. neuro. patient was thought to have a relatively functional baseline mental capacity. however, patient remained relatively highly sedated several days post-op due to her multiple medications and prolonged psych drug regimen. psych drugs were discontinued on the 24th and sedation was weaned down on the 23rd, which led to significantly improved mental status. however, patient's status had not improved enough on the 26th to justify extubation as it was thought patient would not be able to tolerate due to her lethargic, sedated state. head ct was considered, however, this was not pursued due to patient's significant improvement on . however, this would be a reasonable study if patient's mental status did not improve. additionally, neurology could be consulted if patient's mental status does not improve. however, patient has at no time been completely weaned off all sedative medications because without these medications, she would not be able to tolerate her ventilation, which was thought to be necessary for her congestive heart failure up until . 7. prophylaxis. patient was given protonix for peptic ulcer disease and pneumo-boots along with subcu lovenox for dvt prophylaxis. patient had bilateral peripheral ivs for access and right ij for access and left art line that was resided on . patient is a full code. additionally, an addendum will be added to this discharge summary prior to the patient's actual discharge. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube arterial catheterization pulmonary artery wedge monitoring open reduction of fracture with internal fixation, other specified bone sequestrectomy, other bones diagnoses: acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified alkalosis intestinal infection due to clostridium difficile paralytic ileus closed fracture of pubis closed fracture of acetabulum 

Answer: The patient is high likely exposed to