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: heparin agents attending: chief complaint: s/p fall from standing major surgical or invasive procedure: peg/trach ex lap and liver repair for liver laceration placement a line/central line/swan ganz history of present illness: pt is a 77 y/o man w/ hx of chf and hypertension who presents from hospital after falling from standing. pt reports that he hit his head, his rt elbow and the right side of his abdomen. he says he was getting up out of bed when he fell. he does not remember anything else about the fall. at the osh, pt denied loc. he complained of mid back pain (). his vitals on presentation to osh were 97.7 152/74 100 18 97%ra. pt was pale, alert and oriented. hct was found to be low at 35.8, with mcv of 90.7 and rdw of 19.5. platelets were low at 65. wbc was normal at 7.5. found to have sdh, transported to for further managment. during transport, pt was slow to respond to questions. pt had sinus tachcardia and complained of ha. he began to require o2 and was 100% on 4l. in the , pt received thiamine hcl 100mg/ml-2ml, multivitamin iv 10ml vial, folic acid 1mg/0.2ml syringe, morphine sulfate 2mg syringe, furosemide 40mg/4ml vial. pt is able to ambulate at baseline, but he reports that he does not ambulate very frequently. he sometimes uses a wheelchair. pt reports that he has had palpitations in the past. he does not recall getting dizzy when he stood up, however, pt's son reports that he often does complain of dizziness when he stands up. per son, pt has never blacked out before. he has never had an mi. at baseline pt reports that he has some swelling in his legs. pt reports that the swelling he has now is worse than usual but is unable to say when it got worse. son reports that the swelling has been coming and going for years. pt reports that he has a cough which is new. his cough is not productive. he denies fevers or chills. at home, never has required o2 but now has new o2 requirement. son reports that he has been more tired than usual this past week. pt has a history of recurrent pna. pt complains of headache, and low back pain. back pain is not new for him, but it is worse after his fall. in the pt was complaining of neck pain when c-spine collar was removed. pt denies sob, chest pain, n or v. past medical history: - chf - first diagnosed in ', echo in w/ ef of 45-50%, echo in w/ef of 60%, no wma - copd - fev1 of 0.6 l, never intubated per outside records - recurrent pna - last in - htn - gerd - chronic low back pain - for many years, ?osteoarthritis - cancer? - ?infected gallbladder - s/p percutaneous drainage in , cx grew klebsiella - gout - rheumatic fever - echo in shows nl aortic, mitral and tricuspid valves, trace mr, moderate tr - renal insufficiency with ace inhibitor in , now resolved . social history: pt lives on his own. reports that he cares for himself, but has 3 sons who live near by. tob - smokes for 61 years, ? ppd, ?stopped in etoh - denies, outside records indicate etoh use in family history: 5 brothers, one died, 3 healthy, not in contact with last brother, denies heart disease and dm, 3 sons healthy . physical exam: vitals - t99.2 bp 156/60 hr 84 rr 16 sao2 98% on 3l general - pale, thin, man, lying flat on a stretcher with neck in c-spine collar, nad heent eyes - conjunctiva erythematous r>l, pupils 2mm, sluggish response, but equal, unable to test for eom but no gross abnormalities noted ears - decreased hearing especially in left ear, tms obscurred due to wax throat - red, slightly swollen tongue, dry mm, lips cracked neck - unable to assess due to c-collar chest - speaks in full sentences, no use of accessory muscles, anertior lung exam w/ decreased breath sounds at apices bilaterally, otherwise good air movement, few crackles at both bases, no wheezes cv - rrr, nl s1 and s2 with iii/vi systolic murmur best heard at the llsb abd - +bs, soft, non-distended, moderately tender to palpation in ruq and rt flank, no rebound or guarding, negative rectal - per ed, guiaic neg, nl tone extrem - rt elbow with lac and swollen, able to move normally, 2+ pitting edema bilat up to high calf, cool feet, poor distal pulses, tender to palpation neuro cn ii - unable to assess cn iii, iv, vi - poor cooperation with tests of eom, but pt moves eyes in all directions when not instructed to cn v - reports normal facial sensation bilat cn vii - moves face normally cn viii - decreased hearing in both ears l>r cn ix, x - gag not assessed cn xii - tongue midline strength - pt reports that he "can't" lift legs off of bed, but reports that he usualluy walks a bit at home sensation - reports nl sensation to light touch and vibration in le bilat reflexes - 2+ in biceps, brachioradialis, patellar reflexes bilat, babinski equivical skin - dry and flaky thoughout, worst on feet, nails extremely long and thinkened, erosions on shins bilat mental status - aaox3, pt able to answer questions when can hear questions and wants to answer, non-cooperative with history and physical exam pertinent results: 08:55am wbc-6.9 rbc-3.21* hgb-9.1* hct-29.5* mcv-92 mch-28.3 mchc-30.8* rdw-19.5* 08:55am neuts-69 bands-0 lymphs-14* monos-8 eos-0 basos-0 atyps-0 metas-4* myelos-5* nuc rbcs-1* 08:55am hypochrom-normal anisocyt-1+ poikilocy-occasional macrocyt-occasional microcyt-occasional polychrom-occasional schistocy-occasional stippled-occasional teardrop-occasional 08:55am plt smr-low plt count-89* 08:55am pt-13.6* ptt-25.7 inr(pt)-1.2* 08:55am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 08:55am haptoglob-323* 08:55am albumin-2.8* 08:55am ck-mb-5 probnp-5930* 08:55am ctropnt-0.03* 08:55am lipase-13 08:55am glucose-99 urea n-22* creat-1.0 sodium-139 potassium-4.0 chloride-101 total co2-23 anion gap-19 05:33pm caltibc-174* vit b12-greater th folate-11.0 ferritin-1428* trf-134* 05:33pm iron-19* 05:33pm ck-mb-5 ctropnt-0.02* 05:33pm ld(ldh)-322* ck(cpk)-183* brief hospital course: a/p 77 y/o m w/ hx of chf and htn, who presented to osh after fall from standing. unclear if fall due to trip and fall or other cause, as pt has no recollection of event. at osh pt was found to have subdural hematoma and was transferred to the for further management. on admission pt was sent to the micu. neurosurgery and spine consults were obtained for recommendations regarding the patients subdural hematoma and l1/l5 compression fractures. the patient remained in a ccollar and on logroll precautions until such time that spine service cleared the cspine and provided a tlso brace for getting out of bed. neurosurgery followed until the subdural was proven stable. the medical service also worked the patient up for possible causes of syncope, none which were proven. not long into the patient's stay he aspirated chicken and rice subsequently developing pneumonia requiring intubation. his respiratory condition worsened to ards. he was empirically treated with vanc, zosyn, levoflox although no clear microorganism grew from his sputum even with good sputum samples obtained with bronchoscopy. pt also developed septic shock requiring pressors to maintain blood pressure. meanwhile, it was noted that the patient had a r elbow laceration with leaking bursa. the ortho service noted that the wound was not infected and could be adequately managed with wet to dry dressings. also, while on the micu service the patient suffered from anemia and thrombocytopenia as well as mild adrenal insufficiency. pt was given steroids. a hit panel was sent and returned negative. to maintain nutritional support the pt was placed on tube feeds. the patient also required other typical icu interventions for chf, hypernatremia, hypokalemia, hypomagnesemia. pt was maintained on pneumoboots and heparin sq for dvt prophylaxis as well as protonix for gi prophylaxis. on the the patient underwent peg and trach placement. this unfortunately was complicated by a liver laceration causing acute blood loss anemia and requiring exploratory laparotomy and liver repair. the peg was exchanged for a gj tube. post operatively the patient was transferred to the surgical trauma service. the patient required extensive volume and blood resussitation but did recover better than expected from this acute event. subsequently on the surgical trauma service, the patient again developed septic shock from a pseudomonas, enterobacter, and staph pneumonia with difficult sensitivity spectrums. this continues to be treated with vanc/cefepime/zosyn/flagyl. the patient did finally wean off pressors successfully. the patient was also worked up for cdiff which was negative, all line tips have been negative, and urine has been free of bacteria. the patient did again develop thrombocytopenia. hit panel was now positive. all heparin products were d/c'd, and the patient was changed to fondaparinux for dvt prophylaxis. the patient was given cardioprotective lopressor when tolerated. vent weaning has been particularly slow and diuresis particularly difficult. the patient has had mild renal failure associated with over diuresis. tube feeds have been restarted and are tolerated well. the j port is used, and the g port is clamped. podiatry has seen the patient for foot care. the patient has also developed a r forearm thrombophlebitis which is improving. due to assymmetric swelling a dvt study was performed to r/o rue dvt. pt did develop atrial fibrillation/flutter which required cardioversion. by the time of d/c the patient has cleared mentally only enough to track/aknowledge our presence at times, moves 4 ext minimally, and rarely follows commands. interval summary completion: before being able to be discharged to rehab, mr developed another episode of sepsis. he was pancultured, with a persistent psuedomonal pneumonia. he also developed a large sacral decubitis ulcer, which showed significant epidermal sloughing given his markedly edematous subcutaneous tissues. because of constant stooling, this ulcer became secondarily infected. he developed a septic shock recalcitrant to broad spectrum antibiotics, pressors, bicarbonate and steroids. he was made dnr by his health care proxy on , and ultimately succumbed to his disease on . medications on admission: - hydrocodone - lasix 20mg - protonix 40mg - lopressor 25mg - temozepam - ?nebulizer - has received advair, tiotropium, duoneb, albuterol in the past discharge medications: n/a discharge disposition: extended care facility: & rehab center - discharge diagnosis: subdural hemorrhage l1/5 compression fractures chf ards liver laceration pseudomonas and enterobacter and staph aureus pneumonias hit+ thrombophlebitis r olecranon bursa rupture/ulcer blood loss anemia metabolic alkylosis septic shock hyperglycemia hypokalemia hypomagnesemia atrial fibrillation/flutter hypernatremia discharge condition: deceased discharge instructions: n/a followup instructions: n/a procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube other electric countershock of heart percutaneous abdominal drainage percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus percutaneous [endoscopic] gastrojejunostomy closure of laceration of liver partial hepatectomy debridement of nail, nail bed, or nail fold injection or infusion of oxazolidinone class of antibiotics bursotomy diagnoses: pneumonia due to other gram-negative bacteria cellulitis and abscess of trunk urinary tract infection, site not specified acute posthemorrhagic anemia unspecified septicemia severe sepsis atrial fibrillation unspecified fall accidental puncture or laceration during a procedure, not elsewhere classified hypopotassemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure pneumonia due to pseudomonas pneumonitis due to inhalation of food or vomitus pneumonia due to staphylococcus, unspecified septic shock cellulitis and abscess of upper arm and forearm pressure ulcer, lower back anticoagulants causing adverse effects in therapeutic use hyperosmolality and/or hypernatremia closed fracture of lumbar vertebra without mention of spinal cord injury subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness disorders of magnesium metabolism injury to other intra-abdominal organs with open wound into cavity, peritoneum olecranon bursitis closed fracture of coronoid process of ulna 

Answer: The patient is high likely exposed to