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: history of present illness: this is a 75-year-old female with multiple medical problems including coronary artery disease, congestive heart failure and chronic obstructive pulmonary disease who initially presented to the hospital on , after suffering a left hip fracture (displaced subcapital fracture). this occurred as a result of a mechanical fall, apparently related to left leg weakness the patient attributed to her diabetic neuropathy. on admission to she was placed in bucks traction while various medical workup occurred in preparation for planned unipolar hemiarthroplasty. she was given a course of amoxicillin for "bronchitis." urine grew klebsiella and e. coli although the patient reported "chronic utis" and it is unclear whether she had thrombocytopenia (platelets 60's) so the hematology service was consulted. they felt she should be transfused with platelets before and after the surgery. the cardiology service was consulted and felt she could safely undergo hip arthroplasty without further preoperative coronary evaluation. unfortunately, although medically cleared for surgery, the patient by that time had developed a significant coccygeal decubitus ulcer. she was transferred to rehab on for aggressive wound care in the hopes that hip surgery could be performed around the end of . at rehab careful wound care of the coccygeal decubitus ulcer was provided. she completed her seven day course of amoxicillin. chest x-ray on showed a left infiltrate with effusion, and borderline congestive heart failure. follow-up x-rays showed worsening of the infiltrate and effusion and aspiration pneumonia was suspected, so flagyl was begun on . her tsh was elevated (felt to be secondary to amiodarone) and her synthroid was increased from 12.5 mcg to 25 mcg q. day. on the orthopedic service saw her and discontinued the bucks traction. she was transferred here today for second opinion regarding the hip surgery. the patient is very eager to have the hip repaired and complains mostly of hip pain and related leg muscle spasm. she denies dyspnea or chest pain. she has had a cough that she says is old and chronic; minimal sputum production was reported. her appetite is poor and she has been receiving tpn. she says that she "ate a little bit" yesterday for the first time in days. the coccygeal ulcer does not bother her currently. past medical history: 1. coronary artery disease, status post coronary artery bypass graft times three in . the exact coronary anatomy at that time is unknown. 2. congestive heart failure, ejection fraction 20%. confirmed by echocardiogram. 3. chronic obstructive pulmonary disease (not currently on any inhalers). 4. mitral regurgitation confirmed by echocardiogram. 5. amiodarone induced hypothyroidism. 6. atrial fibrillation, currently in sinus rhythm status post cardioversion not on coumadin at the time of admission. 7. left subcapital displaced hip fracture . 8. diabetes mellitus type 2 of unknown duration. 9. chronic renal insufficiency likely secondary to diabetic nephropathy. baseline creatinine . 10. hypertension. 11. gout. 12. rheumatoid arthritis. 13. coccygeal decubitus ulcer. 14. gastroesophageal reflux disease. 15. lactose intolerance. 16. intermittent claudication. 17. colon cancer status post partial colectomy. 18. right carotid bruit (no history of transient ischemic attack or stroke). 19. thrombocytopenia. allergies: atorvastatin, cipro, clarithromycin, procainamide, macrolides, quinolones, nsaids, latex (reactions undocumented). medications on transfer: 1. allopurinol 300 mg p.o. q. day. 2. amiodarone 200 mg p.o. q. day. 3. artificial tears two drops o.u. t.i.d. 4. vitamin c 500 mg p.o. b.i.d. 5. lovenox 30 mg subcu q. day. 6. epo 40,000 units subcu q. wednesday. 7. iron sulfate 300 mg p.o. b.i.d. 8. riss 5 ml/200 mg p.o. b.i.d. 9. synthroid 25 mcg p.o. q. day. 10. nexium 40 mg q. day. 11. chondroitin 500 mg p.o. b.i.d. 12. metamucil one packet p.o. b.i.d. 13. flomax 0.4 mg p.o. q. hs. 14. milk of magnesia p.r.n. 15. senna two tabs p.o. b.i.d. 16. multivitamin one p.o. q. day. 17. flagyl 500 mg iv q. 8h. day no. five of seven. 18. zinc sulfate 200 mg p.o. q. day. 19. tylenol p.r.n. 20. alprazolam 0.25 mg p.o. q. 3h. p.r.n. 21. guaifenesin b.i.d. 22. percocet one tab p.o. q. 4h. p.r.n. 23. peripheral parenteral nutrition. family history: significant for lung cancer relative unknown at time of dictation at present. social history: married times 58 years. has five children, one in , one in and three locally. she has a 40 pack year history of tobacco use. occasional alcohol use. able to climb 13 stairs to enter her apartment on . no elevator. dnr/dni per report. physical examination on admission: temperature 97.7 degrees, blood pressure 140/60, pulse 54, respiratory rate 22, oxygenation 98% on two liters. general: alert, pleasant, elderly female lying very still in bed. heent: pupils equal, round and reactive to light and accommodation. extraocular movements intact. anicteric sclerae. moist mucus membranes. chest: bilateral basilar crackles, left greater than right. no wheeze. scattered rhonchi that clear with cough. cardiovascular: faint s1, s2. regular, no murmurs heard. abdomen soft, non-tender, non-distended. positive bowel sounds. extremities: two plus pitting edema to buttocks bilaterally. dorsalis pedis pulses not palpable. several scattered dark non-tender distal bullae approximately 3-4 mm diameter on toes bilaterally. not present on upper extremity. no cyanosis or clubbing. back not examined. plan to examine when more staff available to turn patient to examine decubitus ulcer. photographs in chart from documented. neuro examination: cranial nerves ii through xii grossly intact. alert and oriented times three. motor examination limited by hip fracture. sensation grossly intact to light touch. laboratory from outside hospital: pt 14.2, inr 1.3, sodium 138, potassium 4.2, chloride 107, bicarb 18, bun 56, creatinine 2.7, glucose 137, calcium 7.7, magnesium 2.3, phosphorus 2.6, triglycerides 117. albumin 14. : white blood cell count 6.2, hematocrit 32.6, platelet count 153,000. alk phos 185,000. total bilirubin 0.42. alt 36, ck 96, ldh 222, total protein 5.1, albumin 2.4. micro: clostridium difficile negative on and . urine culture negative on . electrocardiogram: : normal sinus rhythm of 64 beats per minute, right axis deviation, intraventricular conduction delay, poor r-wave progression, t-wave inversion in leads v5 through v6 and 1 and avl. no st segment deviation. radiology: chest x-ray on : left lower lobe infiltrate with effusion. right lung clear. cardiomegaly. hospital course: : the patient was admitted to the medicine service and was hemodynamically stable. was complaining of feeling tired and not able to sleep with some pain in her back over the location of the decubitus ulcer. labs on the first day at : white count 7.3, hematocrit 34.5, platelet count 149,000. the chem-7 was 137, 4.4, 107, 17, 59, 2.4 and 109. a chest x-ray at showed cardiomegaly with congestive heart failure and pulmonary edema. moderate left effusion, small right effusion. no pneumothorax. an orthopedic consult was obtained on the date of admission with dr. being the attending surgeon. at that time it was dr. opinion that the patient would not be a candidate for surgery until her decubitus ulcer infection was controlled. the patient would be started on deep venous thrombosis prophylaxis and nutrition would be consulted along with psychiatry secondary to the patient's dysthymia regarding her medical condition. : a psychiatry consultation was obtained. at that time it was recommended that the patient be started on remeron at 7.5 mg to help with her anxiety and depressed mood. the patient's lung examination was concerning for crackles half the way up on the left and one-third up on the right. given this finding along with the chest x-ray findings, it was recommended that the chf service would consult. dr. was asked to consult. on this date it was felt that the patient would be able to have the surgery and was actually typed, screened and cross-matched for two units of packed red blood cells in preparation for surgery. : dr. spoke with the patient's outpatient cardiologist who reported the patient is not usually in congestive heart failure and this was probably an acute exacerbation secondary to increased fluids due to the patient's poor p.o. intake. the patient was started on 60 mg of intravenous lasix on the morning of and 80 mg of intravenous lasix in the p.m. with only 300 cc of diuresis. at this time it was felt that the patient was a poor operative candidate and the surgery would have to be postponed. of note, there was also some concern about the patient's dysrhythmias. the patient had had left bundle branch block according to her outpatient cardiologist and also had a history of atrial fibrillation status post cardioversion and on the the patient was found to be in right bundle branch block. due to the acute exacerbation of congestive heart failure it was felt that the patient was at high risk for re-entering rapid atrial fibrillation and a cardiology consult was obtained. the cardiology consult felt that the patient would benefit from nesiritide as well as lasix and transferred to ______ two or three (cardiology floors) when available. the goal for diuresis would be one to two liters per day and to follow the oxygenation lung examination and chest x-ray. of note, wound care per protocol was applied to the decubitus ulcer. : the patient's code status was changed to dnr/dni by dr. after speaking with the patient and her husband. the patient had minimal diuresis of 250 cc overnight with lasix. the patient was continued on amiodarone for atrial fibrillation. the coccygeal ulcer continued to be dressed appropriately. the patient developed a new issue of hyperglycemia. the insulin sliding scale was adjusted accordingly. : the patient was transferred to the cardiology floor (far three) and nesiritide drip was started at 0.01 mcg/kg/min. the patient's diuresis was slightly improved at 400 cc in two hours on nesiritide and lasix 80 mg iv times one. the patient's lung examination had not improved. repeat chest x-ray showed persistent congestive heart failure with effusions as described above. the patient's nesiritide drip was increased to 0.15 mcg/kg. at this point the patient was becoming increasingly frustrated with the progress of her medical conditions. psychiatry continued to follow and felt that remeron might be contributing to her sedation and that her depression might be secondary to her multiple medical conditions. substantial discussion was conducted regarding the need for intracardiac monitoring while the patient was being diuresed. the patient, however, was extremely reluctant to undergo additional interventions such as swan-ganz catheter placement and was actually scheduled for the operating room on , despite her poor oxygenation at 99% on five liters nasal cannula and poor diuresis (chf). upon further discussion, the patient agreed to go to the coronary care unit for intracardiac monitoring during her diuresis and on , she was transferred to the coronary care unit. chest x-ray findings suggested a potential aspiration pneumonia. a transthoracic echocardiogram was obtained that showed an ejection fraction of less than 20%, moderate dilation of the right atrium. left ventricle: mild symmetric left ventricular hypertrophy, severe left ventricular systolic dysfunction. left wall motion: the following resting regional left ventricular wall motion abnormalities were seen: basal inferior - akinetic; mid inferior - akinetic; basal inferolateral - akinetic; mid inferolateral - akinetic; inferior apex - akinetic; lateral apex - akinetic. right ventricle dilated. moderate global. right ventricular free wall hypokinesis. aorta: aortic root is normal diameter. aortic valve leaflets are mildly thickened. mitral valve: valve leaflets mildly thickened, 3+ mitral regurgitation. in the coronary care unit a pulmonary artery catheter was placed in the left subclavian with cvp 25, pa pressure 57/28, pulmonary capillary wedge pressure 30, cardiac output 6.6, cardiac index 3.9, svr 21. the patient was on strict i's and o's, daily weights, daily chest x-ray. due to the patient's decreased svr, the patient was pan cultured for a question of sepsis. orthopedics continued to follow the patient in the coronary care unit. a nutrition consult was obtained due to the patient's poor p.o. intake. the decubitus ulcer continued to be dressed per standard protocol. : the patient continued to be hemodynamically stable, was breathing at 97% on three liters with an increased pulmonary artery pressure at 64/30. : the patient's levofloxacin and flagyl was discontinued after cultures showed no growth and the chest x-ray was most consistent with congestive heart failure. the patient was started on hydralazine 25 q.i.d. p.o. for afterload reduction. at this point the patient's only antibiotic was vancomycin 750 mg iv q.o.d. renally dosed. : a podiatry consult was obtained to evaluate the patient's risk of infection secondary to open bullae on her distal extremities with decreased sensation in the setting of diabetes preoperatively. at this time the patient was on hydralazine 25 q.i.d., lasix 10 mg drip per hour, metolazone 5 mg b.i.d. and nesiritide 0.02 mcg/kg/min, _____ 25 q.i.d. the patient responded well and was negative one liter over 24 hours. due to the fact that the swan-ganz catheter was no longer needed but central access was still desired, the patient had her subclavian line changed using the seldinger technique to a triple lumen catheter in the usual sterile fashion. of note, at this time the patient's platelet count was 81,000, creatinine 3.2. possibly as a result of the decreased platelets and/or uremic platelets, it was difficult to attain adequate hemostasis post procedure, therefore, lidocaine with epinephrine was injected at the site. after applying direct pressure for 30 minutes, finally after lidocaine with epinephrine adequate hemostasis was achieved. : due to the fact the patient's pulmonary artery pressures had declined and central intracardiac monitoring was no longer required, the patient was transferred to the floor on natrecor drip at 0.02 mcg/kg/min, hydralazine 20 q.i.d., lasix 20 mg drip per hour. : the patient's natrecor and lasix drip were discontinued as it was felt by the primary team as well as the chf service that the patient was back to her baseline dry weight of 65.5 kilograms and her lung examination had improved. this was confirmed by chest x-ray as well. of note, the patient's hematocrit had dropped to 29.5 and she was transfused one unit of packed red blood cells. the patient was made npo after midnight in anticipation of the repair of her left minimally displaced subcapital femur fracture on . : a left hip hemiarthroplasty was performed. surgeon under general anesthesia with an estimated blood loss of 250 cc. intraoperatively the patient received one unit of packed red blood cells and cc of lactated ringer's. the patient completed the surgery without complications and was hemodynamically stable and transferred to the post anesthesia care unit. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified diagnostic ultrasound of heart total hip replacement injection or infusion of nesiritide diagnoses: congestive heart failure, unspecified acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified unspecified fall systolic heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease right bundle branch block closed fracture of unspecified part of neck of femur 

Answer: The patient is high likely exposed to