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: procainamide attending: chief complaint: right hip fracture, hypotension and hypoxia major surgical or invasive procedure: -intubation and extubation - orif r hip history of present illness: mr. is an 86 year old gentleman with history of atrial fibrillation (on coumadin), history of sick sinus (s/p dual chamber pacer in ) and cad (ef>55% in ) presented with hip fracture s/p mechanical fall transferred from osh with hypotension (sbp 80s) and hypoxia with new o2 requirement. per patient, he was in his usual state of health the morning of admission when he fell on his buttucks while standing up from a seated position in the bathroom. he denied any mechanical slip, denied head strike or loss of consciousness. he reported that upon attempting to stand after the fall, he had severe right hip pain, but otherwise felt well. he denies any chest pain/pressure, palpitations, diaphoresis or nausea. no urinary/fecal incontinence, tongue-biting or unintentional movements. patient denies any headaches, double vision, blurry vision or focal weakness. per his wife, no post-ictal state; patient was conversant and interactive immediately afterward. . per patient, he has had a productive cough with green sputum (x3 day) and hemoptysis (x1 day). denies any recent fevers/chills, sob, tachypnea or pleuritic pain. denies any abdominal pain, nausea, vomiting, diarrhea. no polyuria, dysuria, pyuria or hematuria. patient without known sick contacts (lives at home, no recent hospitalizations) and no recent travel. received his influenza vaccine. . transfer vs from osh were 121/76, hr 78, 92% 5l nc, rr 16. in the ed, initial vs were t 97.6, hr 70, bp 103/57, rr 16, o2 100% 15l nrb. labs were notable for k 5.6, wbc 10.3, pmn 75%, inr 2.5. troponin negative, probnp (no baseline values). ua nitrite and leuk negative, but 17 wbc with few bacteria. pt had ct head showed no acute intracranial process. ct chest with contrast showed focal opacities on the right concerning for infection, given the presence of mediastinal and right hilar lymphadenopathy, but no pe. his cxr is concerning for pneumonia, and he received ceftriaxone at osh. pt received azithromycin in ed. he dropped pressure into 80s, and received 500cc ivf, though careful because of evidence of fluid overload based on elevated bnp at osh (pt received a small dose of lasix there). ortho was following, and planned for operative fixation which was done. . on arrival to the micu, he was breathing comfortably and able to speak in full sentences. he denied any complaints other than hip pain. though o2 sats were in high 80s-low 90s on shovel mask with 100% fio2. stable in high 90s on non-rebreather. vital signs otherwise notable for t=97.2, hr 70, bp 109/55. . review of systems: per hpi. otherwise, denies rhinorrhea, sore throat or congestion. denies wheezing. denies arthralgias or myalgias. reports ecchymoses on right elbow, resolving on left forearm (prior to fall). denies rashes or edema. past medical history: -chronic afib: mostly in sinus rhythm on amiodarone (2.8% of time in afib), on coumadin with current inr 2.5 (goal inr: ) -h/o sick sinus syndrome s/p dual-chamber pacemaker ; pacer interrogated in -coronary artery disease s/p cath in (stent in om1) and s/p left carotid endarterectomy: most recent tte on showed lvef>55%, moderate to severe mitral regurgitation (may be underestimated); mild aortic regurgitation; normal biventricular systolic function; severe left ventricular diastolic dysfunction (unchanged from prior in 08/). followed by dr. , most recently seen . -mitral regurg: stable per echo -hyperlipidemia. -h/o hypertension: well controlled w/o meds(sbp 110s-130s) -peripheral vascular disease: followed by dr. @ , no recent surgery/changes, per pt -chronic anemia: baseline hct high 30s-low 40s -dupeytren's contracture: r-hand 4th and 5th digits social history: 10 pack year smoking history, quit 30 yrs ago. denies etoh or illicits. lives with his wife, no . reports he is active, and able to complete all adls and basic chores. family history: noncontributory. mother died of mi physical exam: admission physical exam: vs:t 97.6, hr 70, bp 103/57, rr 16, o2 100% 15l nrb general: alert, oriented, no acute distress. pt speaking in full sentences, no accessory muscle use. exam limited pain from r-hip. heent: sclera anicteric, mmm, oropharynx clear neck: jvp (7cm) not elevated, no cervical or supraclavicular lad cv: 3/6 systolic murmur heard over entire left precordium, no radiation to neck; regular rate and rhythm, normal s1 + s2, no rubs or gallops; no carotid bruits lungs: rml inspiratory crackles; otherwise clear to auscultation anteriorly with no wheezes or ronchi abdomen: soft, non-tender, non-distended, bowel sounds present x4 quadrants, no hepatosplenomegaly; no suprapubic tenderness gu: foley in place ext: warm, well perfused, 2+ radial pulses, no clubbing, cyanosis or edema neuro: eomi w/o nystagmus, perrl, cnii-xii intact, 4/5 strength bl upper extremities, le strength deferred, grossly normal sensation, gait deferred . discharge physical exam: vs: t=97.6 bp=116/52 (90'-120'/50') hr=70' rr= 15 o2 sat= 92% 2lnc (was 96%ra earlier during the night) i/o 8hr 120/300, 24 hr 900/750 wt 67.1 kg -> 65 general: old gentleman in nad. oriented x3. mood, affect appropriate. sitting in bed comfortably. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 5 cm above sternal angle at 30 degrees. cardiac: psm best heard at apex. muffled s1 secondary to the murmur, normal s2. no rub or gallop. no s3 or s4. lungs: resp were unlabored, no accessory muscle use. ctab except for fine insp crackles bilaterally in the lower of lung fields, slightly at higher level on the right side, no wheeze or rhonchi. abdomen: soft, ntnd. no hsm or tenderness. + bs extremities: no c/c/e. distal pulses palpable +1 bilaterally in both upper and lower extremities. pulses: right: carotid 2+ dp 1+ pt 1+ left: carotid 2+ dp 1+ pt 1+ neuro exam: grossly intact pertinent results: cbc: 01:15pm blood wbc-10.3 rbc-4.14* hgb-12.8* hct-37.8* mcv-92 mch-30.8 mchc-33.7 rdw-14.1 plt ct-137* 01:15pm blood neuts-75.0* lymphs-18.0 monos-6.2 eos-0.6 baso-0.3 06:15am blood wbc-8.8 rbc-3.16* hgb-9.3* hct-29.3* mcv-93 mch-29.4 mchc-31.6 rdw-15.6* plt ct-325 . coagulation profile: 01:15pm blood pt-26.0* ptt-32.8 inr(pt)-2.5* 06:15am blood pt-26.2* ptt-35.2* inr(pt)-2.5* . blood chemistry: 06:39am blood vanco-13.6 01:15pm blo od glucose-100 urean-20 creat-1.5* na-138 k-6.0* cl-107 hco3-24 angap-13 02:50am blood calcium-7.6* phos-3.5 mg-1.8 06:15am blood glucose-95 urean-20 creat-1.3* na-137 k-4.7 cl-105 hco3-25 angap-12 06:15am blood calcium-8.4 phos-3.3 mg-2.2 . cardiac markers: 01:15pm blood probnp-* 01:15pm blood ctropnt-<0.01 04:30am blood probnp-4148* . connective tissue disease serology: 06:30am blood anca-pnd 06:30am blood -pnd 06:30am blood scleroderma antibody-pnd 06:30am blood ro & - 06:30am blood anti-gbm-pnd . abg: 10:22pm blood type-art po2-101 pco2-32* ph-7.40 caltco2-21 base xs--3 . endocrine: 06:30am blood tsh-0.86 03:43am blood cortsol-19.0 . imaging: -------- . ct head without contrast : findings: there is no hemorrhage, edema, mass effect or acute large territorial infarction. the extra-axial spaces are prominent, consistent with age-related atrophy, though small bilateral subdural hygromas may also be present. there is periventricular white matter hypodensity consistent with chronic small vessel ischemic disease. there is a small amount of fluid in the right sphenoid sinus. the remainder of the visualized portion of the paranasal sinuses, mastoid air cells and middle ear cavities are clear. there is no fracture. impression: no acute intracranial process. age-related atrophy and chronic small vessel ischemic changes. . ct c spine without contrast : findings: no acute fracture or malalignment is seen. the atlantoaxial and atlanto-occipital articulations are preserved. the prevertebral soft tissues are grossly symmetric and unremarkable. the bones are diffusely demineralized. there are multilevel degenerative changes with loss of disk space height, most significant at c5/c6. no significant spinal canal narrowing is seen. the visualized paranasal sinuses and mastoid air cells are clear. the included portions of the lung bases demonstrate emphysematous changes with areas of bronchiectasis and a more focal consolidation in the right upper lobe. these are better evaluated on the ct of the torso of the same day. impression: 1. no acute fracture or malalignment. 2. emphysema and right upper lobe consolidation better evaluated on accompanying ct of the torso of the same date. . ct chest,abdomen,pelvis with contrast : impression: 1. fibrotic and emphysematous changes within the lungs. more focal areas of opacification in the right are suggestive of superimposed infectious process. mediastinal and right hilar lymphadenopathy. follow up examination to ensure resolution is recommended. 2. no evidence of pulmonary embolism. 3. right femoral intertrochanteric fracture with associated soft tissue swelling. surrounding musculature is asymmetrically enlarged consistent with edema and/or intramuscular hematoma 4. wedge compression deformity at l4, of unclear chronicity, however, is not associated with paraspinal hematoma or retropulsion of fragments, and may be chronic. . echo: ---------------- the left atrium is moderately dilated. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the right ventricular cavity is dilated with normal free wall contractility. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are mildly thickened. there is partial posterior mitral leaflet flail. an eccentric, anteriorly directed jet of moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. . impression: probable partial flail of the posterior mitral leaflet with consequent moderate-to-severe, anteriorly directed, mitral regurgitation. left ventricular systolic function is probably normal. the right ventricle is not well seen but is probably mildly dilated with normal systolic function. . right lower extremity venous us: findings: grayscale and color doppler son were performed of the right lower extremity, demonstrating normal compressibility, color flow, and augmentation in the common femoral, superficial femoral, and popliteal veins. the posterior tibial and peroneal veins are not well visualized. . impression: no evidence of dvt in the right lower extremity, with limited calf vein assessment. . portable semi-erect chest: left pectoral dual-lead pacer with leads extending to the right atrium and right ventricle in unchanged position. dense mitral annular calcifications are noted. heart size is unchanged, there is persistent central vascular engorgement. pulmonary edema is minimally improved on the left where there is increased transparency of the lung, though is little unchanged on the right. there is no new parenchymal opacity to suggest pneumonia. there is no effusion or pneumothorax. impression: pulmonary edema, little unchanged on the right, though slightly improved on the left. no new effusion, pneumonia, or pneumothorax. brief hospital course: mr. is an 86 year old gentleman with history of afib (on coumadin w/inr=2.5), moderate to severe mitral regurgitation, history of sick sinus (s/p dual chamber pacer in ) and cad (ef>55% in ) presented with hip fracture s/p mechanical fall complicated by pneumonia, was in icu for oxygen requirement, hypotension and refractory afib, transferred to cardiology floor for further management of fluid, oxygen requirement, and afib after being stable. he was discharged to rehab in stable condition. . # hypoxic respiratory failure: patient reported productive cough x3 days prior to fall. on admission exam, was afebrile with inspiratory crackles in right middle lobe. abg 7.40/32/101 with increase aado2=572 indicative of shunt/v/q mismatch physiology. cxr concerning for r-sided pneumonia, ct with right focal opacities concerning for infection. in ed, new o2 requirement and transient hypotension (now resolved) with differential diagnosis most concerning for pneumonia, with apparently underlying lung pathology (considering amiodarone toxicity +/- copd). urine legionella was negative. . patient received one dose of ceftriaxone at osh and one dose of azithromycin in ed for treatment of presumptive community-acquired penumonia. no recent hospitalizations/time in nursing home. differential diagnosis was less concerning for acute pulmonary event (no evidence of pe/pneumothorax on chest ct) vs. mi (negative tpn, asymptomatic). no evidence of hemorrhage clinically, with hct stable at 38. currently appears euvolemic, given no jvd/peripheral edema. in the icu, patient completed antibiotic course of azithromycin 500 mg daily + ceftriaxone 1g iv daily. vancomycin was discontinued after 24 hours. patient remained on albuterol and ipratropium nebs q4h and prn, with chest physical therapy, incentive spirometry. despite above, hypoxemia persisted and cardiology was consulted once tte showed partial flail mitral valve leaflet and severe mr, which is probably sub-acute given that it was seen on an echo at recently. cardiology recommended diuresis with afterload reduction using lasix and captopril, which improved oxygenation to 2l nc. he was started on furosemide 20mg daily and discharged on it with a plan to add on lisinopril as tolerated by blood pressure. . # mitral regurgitation: he is likely too old and frail to have mitral valve surgery so this will need to be managed medically. . # afib s/p pacer: his home amiodarone was initially continued. on , patient went into atrial fibrillation with rapid ventricular response with hr 120. at other times, hr was down to 55 with subsequent drop in blood pressure. initially attempted digoxin load, but per cardiology, switched to amiodarone load. also, pacemaker sleep mode hr increased to 70. given his ct chest findings of bibasal fibrotic changes, pulmonary team was consulted and amiodarone was discontinued. given his orthostasis, diltiazem was discontinued. his heart rate remained in the 70's. he will be seeing dr at within 1 month (needs to be scheduled). office number: . . # fall: pt reports feeling lightheaded in setting of positional change. neurological exam nonfocal. differential diagnosis most concerning for vasovagal reaction vs. orthostatic hypotension vs. mechanical fall. less concerning for acute cardiac (asymptomatic and negative tpn), no arrhythmias on ekg, no acute pulmonary (negative ct for pe and pneumothorax) or seizure (no post-ictal phase). he received 500 cc ivf in ed, and is currently asymptomatic. head ct negative for acute process. he was orthostatic with physical therapy the day prior to his discharge. . # hip fracture: s/p orthostatic fall without prodromal symptoms. ortho was following. per ct pelvis, right femur intertrochanteric fracture with associated soft tissue swelling; no spinal abnormalities. he underwent orif r hip on . plan per orthopedics is right lower extremity: weight bearing as tolerated. staples need to be removed on ; ok to remove at rehab facility. please have patient follow-up with in orthopaedic trauma clinic in 4 weeks. patient may call to schedule an appointment. . # pulmonary fibrosis: he has been on amiodarone for several years. pulmonary team was consulted during his stay who felt his fibrosis is most likely secondary to amiodarone. his amiodarone was discontinued. connective tissue serologies were sent though the suspicion was relatively low. he will follow up with an outpatient follow up along with pulmonary function test and chest ct in months with dr (needs to be scheduled). office number: . # ? uti: pt without polyuria, pyuria, dysuria, hematuria. ua nitrite and leuk negative, but with wbc 17 and few bacteria. he was continued on ceftriaxone as above. . # cad: currently asymptomatic. of note, patient with significant mr valvular disease as noted above. continued home asa 81 mg po daily and pravastatin 40 mg. acei was initially added to reduce afterload but given his orthostasis it was disconitnued. . # hypertension: pt with sbps 110s-130s at baseline. controlled with diltiazem, acei. . # hyperlipidemia: continued home pravastatin 40 mg daily . # mediastinal lymphadenopathy: noted on ct chest , needs 6 month follow up. . ******************** transitional issues: ******************** - right hilar lymphadenopathy: follow up examination in 6 months to ensure resolution is recommended. - consider restarting lisinopril 2.5 mg daily as tolerated - staples need to be removed on - follow-up with in orthopaedic trauma clinic in 4 weeks. patient may call to schedule an appointment - full pfts, including dlco and lung volumes; chest ct - follow up with dr at in 1 month - follow up with dr in pulmonology in month medications on admission: amiodarone - 100 mg tablet po daily nitroglycerin - 0.3 mg tablet sl prn cp pravastatin - 40 mg tablet po daily warfarin - 3 mg po daily mf, 2 mg po daily stwts aspirin - 81 mg po daily discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm. 3. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 4. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 5. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet sublingual once a day as needed for chest pain: 3 tab, 5 min in between each. . 6. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. 7. furosemide 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary: 1. right hip fracture 2. community acquired pneumonia 3. severe mitral regurgitation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , . it was great pleasure to take care of you as your doctor. . you were transferred to from outside hospital for your right hip fracture in addition to your low blood pressure and fast irregular heart rate. . you were admitted to the icu for further management. you were treated for community acquired pneumonia. you also underwent hip repair with the bone doctors. you met with the cardiology doctors who removed extensive fluid from your lungs and adjusted your heart medications. you are being discharged to rehab, with plan for weight bearing as tolerated for the right lower leg, with staples that need to be removed on at rehab, and follow-up with in orthopaedic trauma clinic in 4 weeks. you will also need to see dr (heart electricity doctor)in 1 month time at and dr (lung doctor). . medication changes: - stop amiodarone - start albuterol as needed . please continue your other home medications. . please seek medical attention for any concerning symptoms. please keep your appointments below. followup instructions: follow-up with in orthopaedic trauma clinic in 4 weeks. patient may call to schedule an appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours arterial catheterization closed [endoscopic] biopsy of bronchus closed reduction of fracture with internal fixation, femur diagnoses: pneumonia, organism unspecified anemia, unspecified coronary atherosclerosis of native coronary artery pure hypercholesterolemia urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension atherosclerosis of native arteries of the extremities with intermittent claudication atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases personal history of tobacco use mitral valve insufficiency and aortic valve insufficiency occlusion and stenosis of carotid artery without mention of cerebral infarction acute respiratory failure postinflammatory pulmonary fibrosis long-term (current) use of anticoagulants cardiac pacemaker in situ enlargement of lymph nodes fall from other slipping, tripping, or stumbling closed fracture of intertrochanteric section of neck of femur cardiac rhythm regulators causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to