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: latex / amoxicillin / percocet / propoxyphene attending: chief complaint: fall with multiple fractures major surgical or invasive procedure: : i&d/vac l leg, ex fix lle, splint r leg ( sat ) : i&d, closure, ex-fix adjustment lle; orif r distal tibia no further surgery other than removal of ex fix fixation of tibia and fibula history of present illness: ms. is a 75 year old spanish speaking f with a history of osa, asthma/copd, cad, chf (unkown ef), htn, dm on insulin, and ckd (cr 1.6-2.0, recently 3.0) who 'fell out of bed' and found at house with an open left tib/fib fracture. . in the er multiple films were done which showed negative ct head/c-spine/torso. xrays showed open tib-fib comminuted fracture, calcaneal fracture. she had a suspected right sided fracture as well. seen by in the ed and planned for surgery this morning. labs in ed were notable for elevated k (6.7) and acute on chronic renal failure (cr 3.2). she received kayexalate x1, 10u insulin, 1amp d50. for pain she was given 2mg dilaudid. she also received 1gram ancef. vital signs were t99, hr 71, bp 142/88, rr 16, 91% ra, 99% 2l. she was taken directly from ed to or pre-op area. . she was admitted and evaluated by the firm in the pre-op area where a repeat k was 7.0 and not following commands. she was given another round of insulin and d50, one amp of bicarb, and 1000mg calcium gluconate in the operating room. the case was discussed with the orthopedic team and anesthesia. given that the washout and ex-fix for an open fracture was necessary within 8 hours after injury, she was taken to the or. she remained hemodynamically stable with 100cc ebl. she remained intubated in the pacu given her mental status prior to surgery, and her thick secretions. her c-spine films were normal, but clearance was deferred as the patient's mental status was altered. . she was transferred to the micu due to difficulties extubating. it was felt to be due to increased secretions. her vs were t96.0, bp 160/40, rr 15 and hr 63, 100% on ac. an abg was 7.29/52/110 on ac 500x14, fio2 50%, peep of 5, at time of evaluation in the pacu. a cxr did not show any new changes compared to pre-op cxr. an ekg did not show any peaked t waves or new changes. sputum cultures were sent. past medical history: renal insufficiency (baseline cr 1.8-2 b/ & ) diabetes mellitus, type 2 chf cad gout depression (h/o hallucinations) osa asthma/copd hypercholesterolemia h/o angina gerd vaginal bleeding osteoarthritis right tib/fib fx (') social history: lives in nursing home. denies smoking or alcohol. no illicit drug use. patient is spanish speaking only, from , husband passed away after their move to the united states. family history: non-contributory. physical exam: physical exam on admission: vs: t96.0, bp 160/40, rr 15 and hr 63, 100% on ac 500x14, fio2 50%, peep of 5 gen: comfortable, sedated/intubated woman in nad heent: c-spine collar in place cv: regular, nl s1, s2, no s3 apparent, no m/r/g chest: expiratory wheezes, coarse bs b/l anteriorly abd: obese, pos bs, soft, nt/nd ext: left leg splinted; r ankle cast, 1+ edema on rle neuro: sedated, unresponsive to verbal commands; anisocoria (s/p cataract/lens implant). appears to be moving all extremities. no e/o facial asymmetry. pertinent results: ekg: pre-op: sinus bradycardia; no st segment changes or q waves. early r wave progression. post-op: nsr, no peaked t waves, no acute st changes. --------------- studies: knee xray: ap and lateral left knee: overlying casting material obscures bony detail. fracture is identified involving the proximal fibula. no joint effusion is detected. impression: non-displaced fracture of the proximal fibula. ct chest: ct of the chest without intravenous contrast: the lungs show mild dependent atelectasis. no pneumothorax, pleural or pericardial effusion is identified. the heart is enlarged and demonstrates coronary artery calcification. the thoracic aorta maintains a normal contour. note is made of enlargement of left lobe of the thyroid, which may represent a goiter, however, confirmation with physical exam and thyroid function tests is recommended. ---------------- ct of the abdomen without intravenous contrast: the liver, spleen, adrenal glands, and pancreas are within normal limits. the kidneys are atrophic. no intra-abdominal free air, free fluid, or lymphadenopathy is identified. intra-abdominal loops of large and small bowel maintain normal caliber without evidence of obstruction. the abdominal aorta demonstrates calcified atherosclerotic plaques, however, maintains a normal caliber throughout. ct of the pelvis without intravenous contrast: the rectum, sigmoid colon, bladder, uterus, and intrapelvic loops of small bowel are within normal limits. no free fluid or lymphadenopathy. bone windows: no suspicious sclerotic or lytic lesion is identified. note is made of diffuse osteopenia. impression: no evidence of intra-abdominal parenchymal organ injury. tib/fib: ap and lateral views of the tibia and fibula: overlying splint obscures fine detail. there is a comminuted fracture of the distal tibia and fibula. the distal fracture fragment is externaly rotated. additional fractures are identified involving the plantar surface of the calcaneus as well as the proximal fibula. cxr: impression: apparent widening of the mediastinum, which may be related to technical factors, however, ct or repeat chest radiograph with pa and lateral technique should be employed for further evaluation. cxr: comparison is made to prior radiographs from . there is an endotracheal tube with distal tip is at the level of the clavicles, 4.5 cm above the carina. the feeding tube is appropriately sited. there is persistent cardiomegaly and mediastinal prominence which is unchanged since the previous study. there is no focal consolidation or signs of overt pulmonary edema. there is widening of the left ac joint suggestive of prior surgery or trauma. ct head: impression: 1. exam is somewhat limited by motion, however, no evidence of intracranial hemorrhage. 2. a 3-mm rounded sclerotic focus is seen within the left mandibular condyle, which may represent a bone island, however, correlation with history of malignancy is recommended. right ankle: there is a large medial fracture plate in the distal tibia fixating a fracture through the distal tibia. there is also a compound complex fracture of the distal fibula. the alignment is grossly anatomic. the tibiotalar joint is slightly widened medially. there is generalized osteopenia. there is soft tissue swelling. left ankle: external fixation hardware is seen within the tibial shaft and in the calcaneus. there is a complex fracture involving the tibial metaphysis with multiple fracture fragments within the central portion of the bone. there is also a complex fracture of the distal fibular shaft at the same level. the ankle mortise is preserved. tte conclusions the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild to moderate regional left ventricular systolic dysfunction with focal hypokinesis of the distal half of the septum and, basal and distal inferior wall, and mid anterior wall. the remaining segments contract normally (lvef = 40%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets appear structurally normal with good leaflet excursion. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is top normal. there is an anterior space which most likely represents a fat pad. impression: mild regional left ventricular systolic dysfunction c/w cad (multivessel cad or other diffuse process). mild- moderate mitral regurgitation. clinical implications: based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. hematocrit at discharge was 26 brief hospital course: a/p : 75f h/o cad, dm2, ckd, presented to ed s/p fall at nursing home with open l tib/fib fracture, s/p external fixation left, right comminuted closed tib/fib difficulty extubating post-op increased secretions, transferred to icu for monitoring on ventilator. . # left open tib/fib fracture / right closed ankle fracture sustained after falling out of bed at rehab. : incision and dressing/vac dressing to left leg, external fixation of left lower extremity, splint to right leg by dr. . : i&d, closure, ex-fix adjustment lle; orif r distal tibia. follow up appointment scheduled with orthopedics on for stitches to be removed and determination of further orthopedic intervention. . # respiratory failure transferred to medical icu post-operatively for failure to wean from ventilator. thick, yellow tracheal secretions prior intubation noted. chest x-ray revealed left retrocardiac opacity and a left-sided pleural effusion. sputum gram stain with gram positive cocci but culture negative. given concern for infection, pt was started on levofloxacin and metronidazole iv, and was continued on cefazolin for prophylaxis s/p external fixation. metronidazole was discontinued. levofloxacin was administered for likely pneumonia for an 8 day course. she also has a history of chf (ef 40% on ). she was diuresed with furosemide to relieve pulmonary vascular congestion with good effect. she was extubated and subsequently maintained oxygenation/ ventilation on supplemental oxygen. she was weaned off oxygen and placed back on her furosemide dose. # enterococcus uti urine culture on grew enterococcus for, she completed 7 days of treatment with vancomycin, the culture was pan sesnitive. . # delirium mrs. was extubated on after which she time she experienced agitation and delirium which was thought to be due to a combination of post-injury/ post-operative pain, multiple tubes and lines/drains as well as underlying medical issues. lines were discontinued and restraints limited. the chronic pain service was involved and their recommendations were implemented in an effort to control pain and minimize delirium. upon transfer to the floor medications were stopped such as haldol, restraints and ngt were removed. patient's mental status returned back to her baseline within a few days. . # chronic kidney disease ms. baseline is 1.8-2.1 bur on admission was 3.2 on admission. she was followed by nephrology and their recommendations implemented. her creatinine gradually improved throughout her hospital and returned to her baseline. she was scheduled outpatient follow up with nephrology for continued following of her renal function. creatinine at discharge was 1.7, furosemide and lisinopril were restarted. . # diabtes hgb a1c 7.8 this admission. she was started on an insulin drip in the perioperative period and was transitioned to glargine and a siding scale. upon discharge she was on glargine 55 units and a regular sliding scale, titrate up as needed. # depression - on celexa . # osteopenia - likely secondary to ckd; alk phos nml; pth pending. will check 25-vit d. pt will need outpt bone mineral density study. . # communication: hcp . friend of pt. no family. . # full code. confirmed with hcp. medications on admission: lantus 90u hs novolin sliding scale lasix 30mg po daily celexa 30mg daily isosorbide mononitrate 120mg daily lisinopril 20mg daily oxybutynin 5mg daily ferrous sulfate 325mg daily senna 2 tabs daily colace 100mg flovent 220mcg 1puff gabapentin 300mg lopressor 50mg tid tramadol 50mg hs famotidine 20mg hs simvastatin 40mg hs trazodone 50mg hs allopurinol 100mg daily folate 1mg daily megace 200mg oxycodone 5mg q6h (start on ) apap recently completed course of bactrim x 10 days. discharge medications: 1. lantus 100 unit/ml cartridge sig: fifty five (55) units subcutaneous at bedtime. 2. novolin r 100 unit/ml cartridge sig: as directed injection four times a day: sliding scale as directed. 3. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 4. duloxetine 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 5. imdur 120 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 6. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po once a day. 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. oxybutynin chloride 5 mg tablet sig: one (1) tablet po once a day. 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 10. gabapentin 300 mg capsule sig: one (1) capsule po twice a day. 11. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 12. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 14. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 15. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 16. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 17. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 18. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 19. fentanyl 12 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 20. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed. 21. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 22. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 23. allopurinol 100 mg tablet sig: one (1) tablet po once a day. 24. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 25. heparin (porcine) 5,000 unit/ml syringe sig: one (1) injection three times a day: while immobilized. 26. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 27. hydromorphone 2 mg/ml syringe sig: one (1) injection q4h (every 4 hours) as needed: as needed for breakthrough pain. discharge disposition: extended care facility: - discharge diagnosis: left tibia and fibula fracture right ankle fracture left ankle fracture delirium enterococcus uti discharge condition: alert and oriented times 3 stable discharge instructions: you were admitted with left leg and bilateral ankle fractures. after your surgery you developed a urine infection and delirium which resolved. you were discharged back to the . you have follow up appointments with orthopedics in a few weeks to have your stitches removed and to determinte course of action. you also have appointments to follow up with your primary care doctor and with nephrology to ensure follow up of your kidney disease. return to the er if any further worrisome symptoms, otherwise all yur appointments have been set up for you. followup instructions: provider: / md phone: date/time: 11:00 provider: xray (scc 2) phone: date/time: 11:00 provider: , : date/time: 11:20 01:30p interpreter,spanish interpreters 01:30p , , renal div-cc7 (sb) md procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances debridement of open fracture site, tibia and fibula debridement of open fracture site, tibia and fibula application of external fixator device, tibia and fibula open reduction of fracture with internal fixation, tibia and fibula application of splint diagnoses: pure hypercholesterolemia urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified fall unspecified transient mental disorder in conditions classified elsewhere chronic kidney disease, unspecified streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] chronic obstructive asthma, unspecified acute on chronic systolic heart failure closed fracture of unspecified part of fibula with tibia open fracture of unspecified part of fibula with tibia 

Answer: The patient is high likely exposed to