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: patient recorded as having no known allergies to drugs attending: chief complaint: right tibia-fibula fracture major surgical or invasive procedure: intubation hemodialysis picc line placement orif history of present illness: 83 yo wf w/pmhx sx for esrd on hd, cad w/3v dz and stents to rca, lmca, lad, lcx, chf with ef40%, htn, hl, dm2, tia, and pvd s/p fem- bypass who presents with tibia-fibula fracture today after a fall. she was walking down the stairs at 3 pm this afternoon, when she fell down, with twisting out of her right leg while falling. she denies head trauma, cervical trauma, loc, lightheadedness, sob, or cp related to her fall. she was immediately brought to the er after her fall. she lives with her husband and daughter, and has limited vision. per her daughters, she also has a uti, with dysuria, but has not had fever or chills. past medical history: 1. end-stage renal disease, on hemodialysis since . episodes of hypotension with dialysis. 2. coronary artery disease, status post right coronary artery stent in with thrombus, in-stent restenosis in elevation mi. --cath : widely patent previously placed lmca stents. the mid lad had a 50% focal stenosis. the odl lcx stent was patent. the ostial rca stent was patent. there was a 30% focal restenosis within the distal prtion of the previous stent. 3. congestive heart failure with an ejection fraction of 40%, +1 mitral regurgitation. --echo : . lvh. lvef 40-45% with basal to mid inferior and inferolateral hypokinesis. moderate as. trace ar. mild ms. mild mr. art htn. 4. hypertension. 5. type 2 diabetes complicated by nephropathy, neuropathy and retinopathy status post laser photocoagulation. 6. depression. 7. hyperlipidemia. 8. history of transient ischemic attack 15 years ago with slurred speech and unsteady gait per the patient. 9. glaucoma. 10. cataracts. 11. peripheral vascular disease, status post bilateral femoral-popliteal and left femoral-tibial bypass. 12. cervical spondylosis with myelopathy status post anterior cervical diskectomies infusion c3-6 complicated by postoperative dysphagia. 13. h/o rectal ca in s/p poly removal. last colonoscopy in with 1 polyp removal, 3 others bx social history: nonsmoker, nondrinker. housewife. she lives with her husband. she lives with her daughter, who is very involved with her care. family history: nc physical exam: vs: t 95.6 hr 83 bp 123/45 rr 12 o2sat 100% ra. heent: anisocoria eye surgery. perrl. no conjunctival injection. no nystagmus. mmm. no oral ulcers or exudate. bilateral carotid bruits. hrt: rrr. grade ii/vi blowing, decrescendo murmur at lusb with radiation to neck. lungs: limited exam immobility. ctab at bases. abd: s/nt/nd +bs. no hsm. no masses. ext: thready pulses bilaterally in dp/pt. av fistula in left arm with bruit. no fluctuance or erythema at site. neuro: sensation to lt intact in le. able to move lle. rle in dressing. pertinent results: 7:01p 7.01pm pt: 11.7 ptt: 26.1 inr: 0.9 4:50p 141 99 81 / 212 agap=24 ------------ 4.7 23 5.6 5.9 \ 11.7 / 302 ------- 37.5 n:70.8 l:20.2 m:5.7 e:2.8 bas:0.5 hypochr: 1+ macrocy: 1+ x-ray tibia-fibula : findings: the images are slightly limited due to the splint. there are multiple surgical clips in the medial aspect of the leg from prior vein harvesting. there is a comminuted fracture of the proximal tibia with an oblique component in the shaft which is minimally displaced. there is also a fracture of the fibular neck with lateral displacement of the head of the fibula. vascular calcifications are noted. impression: fractures of the tibia and fibula. ct of the chest without and with iv contrast: there are moderate-sized, bilateral pleural effusions with reactive collapse/atelectasis. there is no evidence of pulmonary embolism. there are mild increased septal lines and scattered ground-glass opacities consistent with fluid overload. the aorta is of normal caliber throughout the chest without evidence of aneurysm or dissection. there are marked coronary artery calcifications and wall calcifications within the aorta. the airways are patent down to the segmental bronchi. an et tube terminates within the trachea. the ng tube courses below the diaphragm into the stomach. there is a right subclavian cvl with the tip terminating within the svc. there are scattered, non-pathologically enlarged mediastinal nodes. ct reconstructions: there is no evidence of pulmonary embolism. bone windows: no rib fractures are seen. 03:58pm blood wbc-23.3* rbc-3.92* hgb-12.4 hct-40.6 mcv-104* mch-31.5 mchc-30.5* rdw-23.6* plt ct-228 05:32am blood wbc-24.3*# rbc-3.87* hgb-12.0 hct-40.5 mcv-105* mch-31.1 mchc-29.7* rdw-23.9* plt ct-258 10:15pm blood wbc-15.5* rbc-3.68* hgb-11.6* hct-39.2 mcv-107* mch-31.5 mchc-29.5* rdw-23.9* plt ct-211 03:30am blood wbc-14.4* rbc-3.77* hgb-11.5* hct-39.5 mcv-105* mch-30.7 mchc-29.2* rdw-23.9* plt ct-236 04:11am blood neuts-62 bands-9* lymphs-15* monos-7 eos-7* baso-0 atyps-0 metas-0 myelos-0 nrbc-3* 10:15pm blood neuts-78* bands-1 lymphs-11* monos-5 eos-0 baso-0 atyps-4* metas-1* myelos-0 05:32am blood neuts-83.4* lymphs-13.8* monos-2.5 eos-0.1 baso-0.2 03:58pm blood glucose-97 urean-24* creat-3.5* na-149* k-4.4 cl-113* hco3-20* angap-20 05:32am blood glucose-124* urean-22* creat-3.3* na-150* k-3.3 cl-113* hco3-22 angap-18 03:58pm blood alt-13 ast-25 ck(cpk)-13* alkphos-265* 10:15pm blood lipase-14 03:58pm blood ck-mb-notdone ctropnt-1.42* 05:32am blood ck-mb-notdone ctropnt-1.24* 10:15pm blood ck-mb-notdone ctropnt-1.26* 03:58pm blood calcium-10.3* phos-2.4* mg-1.8 08:06am blood vitb12-1069* folate-8.0 08:06am blood tsh-3.9 02:30pm blood cortsol-47.3* 02:00pm blood cortsol-42.9* 01:04pm blood cortsol-30.5* 06:50pm blood type-art po2-69* pco2-43 ph-7.28* calhco3-21 base xs--6 06:50pm blood lactate-3.0* 02:29pm blood lactate-2.5* na-145 k-4.2 11:03am blood lactate-2.5* k-3.1* brief hospital course: on admission, she was hypothermic at 95.6, bp 123/45, and 100% on ra. ecg was unchanged from prior. her pain was controlled with morphine 2 mg iv q6h prn. on , she was taken to the or for an orif of her fracture. in the or, she received a total of 600 cc ns, versed, succinylcholine, phenylephrine, metoprolol, glycopyrrolate, morphine iv (6 mg), etomidate, fentanyl (200 mcg), cisatracurium, neostigmine, dolasetron, and propofol. her ebl was reported as minimal. her bp was in the 80s/40s and she was begun on neosynephrine. while in the pacu, she was also hypoxic to the 60s for 25-30 minutes. her abg at this time was 7.36/52/89. cxr showed low inspired lung volumes but no clear edema. because of her hypotension and hypoxia she was transferred to the micu at this point. * in the micu the pt was changed from neosynephrine to levophed. she had hd on . during hd she became tachycardic to 150-170 with a drop in bp to 82/40. bps rose after 200cc fluid and 300 rinseback given. her rhythm was determined to be atrial tachycardia and she came out of it on her own. ekg post hemodialysis showed st depression in v3-v6? around this time the patient was noted to have an enzyme leak with trop 2.54 (was .34 before), ck 2064 (was 306), mb 127 (was 11). heparin drip was started at that time. on the patient was witnessed to aspirate jello. on the patient also had hemodialysis. during hemodialysis pt went into atrial fibrillation, hr to 150s and sbp to 47. hd terminated, and she was dccv at 200 and 300 j. 150 mg amio was given x 2 and she was then started on an iv drip, she was shocked again at 300 j. after approximately 20 minutes on amiodarone she revereted to nsr. she was intubated during this process for airway protection. she was also begun on vancomycin, flagyl, and cipro in the micu. * pt was transferred to the ccu on b/c of hemodynamic instability during hd and continued hypotension possibly secondary to cardiogenic shock. on the floor she was hemodynamically stable on a levophed drip. a subclavian line was placed and swan showed pcwp of 28, cvp 18, pas/pad 55/34 and co/ci 5.2/2.65 and estimated svr 761. she was found to have severely elevated lfts but this was thought to be secondary to shock liver from hypotensive episode. a gb u/s showed no evidence cholecystitis and no ductal dilitation but showed a dilated gb. lfts trended down over the next few days. she was extubated w/out incident. * in the ccu she has had several problems managed: 1. hypotension: on admission to the ccu the pt was continually hypotensive. this may have been due to fluid shifts during surgery and exacerbated by hd but sepsis was also thought to be contributing since she was hypothermic, her svr was reduced, and she developed a cellulitis over her wound on pod 7. she was pressor dependent on levophed for the early part of her stay in the ccu. this was eventually weaned off and the pt ran sbp in the low 100s. however, during hd she frequently became hypotensive and levophed was again started for a few hours to maintain her sbp over 100. since vasopressin was used in the peri-hd stage to maintain her bp because of concern of possible bowel ischemia. two days prior to d/c, both pressors were stopped and the pt was started on midodrine (her outpt med to prevent hypotension during hd) and she tolerated hd w/out problem. and ace were held throughout her admission. . 2. rle tibial fracture/cellulitis: she became febrile on in the micu and was on vanc, flagyl and cipro on admission to ccu on with continued fevers. the cipro and flagyl were stopped quickly in the ccu b/c there was no source for fevers. on was found to have cellulitis over incisions from orif. the pt was then hypothermic over the next 24 hours and her systemic vascular resistance dropped. during this time she was re-started on zosyn and id was involved. ortho contemplated taking her to or to clean out wound but the wound improved w/ abx therapy and the swelling slowly decreased. during this time, the pt was also noted to not be moving her r toes. neuro was consulted and thought that this may be a neuropathy secondary to the fracture and subsequent swelling. in the few days prior to her admission her mental status cleared and she began complaining of increased rle pain. she was started on morphine and tylenol after her procedure but this was noted to be sedating her and lowering her respiratory drive. morphine was stopped but the same problems were experienced with vicodin/gabapentin. pain service was consulted and we started ultram on their suggestion. her pain was better controlled using this medicine w/out sedation. ortho placed a vaccum dressing on . . 3. esrd: pt has been on hd since and, during this admission, had episodes of afib and hypotension during hd requiring pressor support. she was started on cvvh and tolerated this well. after she had been weaned off the pressors during the day, she was transitioned to hd. initially, she required levophed pressor support during the process but this was eventually changed to vasopressin. for the 2 days prior to d/c she was pretreated with midodrine and tolerated hd w/out the need for pressor support. her hd was changed from 3x/wk to daily during her ccu admission because of her respiratory problems and the thought that this was secondary to fluid overload. she was tolerating hd w/out pressor support outside of midodrine prior to callout to the floor. . 4. tachyarrhythmia: pt had episodes of afib during hd requiring cardioconversion during her micu course. she was started on amiodarone and has remained in sinus rhythm ever since. . 5. ventilation: the pt was extubated w/out incident during the first few days of her ccu stay. at this time, she was still requiring high levels of oxygen support that were eventually weaned down to 2l nc on her day of d/c. her cxr showed chf vs possible pneumonia which was treated with vanco/zosyn. she had fluid removed via hd and her respiratory status improved with this treatment. pulmonary was consulted and they felt that her respiratory difficulties were mainly due to lack of a respiratory drive w/ her narcotics along w/ chf. her narcotics were changed as above and, along w/ hd, this improved her o2 sats and subjective sob. . 6. chf: the pt has an ef of 25% and global hypokinesis. she had significant sob and cxr evidence of chf along with b/l pleural effusions. the chf improved markedly w/ hd but her effusions persisted until d/c. she was approximately euvolemic for her ccu stay as a whole. as above low dose toprol should be considered as an outpatient . 7. abdominal pain: pt intially had elevated lfts that were attributed to shock liver and resolved throughout her admission. she also began having grossly bloody stools accompanied by a hct drop requiring transfusion. gi was consulted and thought that diverticular bleed vs ischemic colitis were the most likely causes. tagged rbc scan was unrevealing. her mild coagulopathy was corrected with vitamin k and her gi bleed slowed. her hct remained stable for the week prior to d/c though she continued to be guaiac positive. her tube feeds were stopped during this episode but were restarted following its resolution. she tolerated 30cc/hr well and was taking pureed solids and thin liquids prior to d/c. the patient had an additional gi bleed in the week prior to d/c. she again required transfusion (3u) and was taken to colonoscopy which demonstrated a 4mm sessile polyp that was not removed. stigmata of bleeding was noted but no focus of bleeding was identified. scattered diverticula and hemorrhoids were seen. . 8. cad: the pt was maintained on her aspirin and statin were continued throughout her admission but her bp meds were held secondary to hypotension. she had an enzyme leak that was probably due to demand ischemia during her recurrent hypotensive episodes. she did not complain of cp throughout her stay in the ccu. her plavix was eventually d/c secondary to bleeding concerns. . 9. dm: she remained stable on her iss . after a protracted stay in the ccu, the patient was screened and accepted for transfer to facility. however, when orthopedics took out the staples on her leg wound, the wound dehisced and the internal hardware was open to the environment. she was taken back to the or for removal of her internal fixation and replacement of this with external fixation rods. she tolerated her surgery w/out event and was transfered to the sicu after the surgery. here she was again levophed dependent for several days and intubated. she was eventually successfully weaned from both the vent and the pressors and was called out to the floor for further care. on the floor, several problems were addressed. . 1. hypotension - although she had been quite stable in the ccu prior to her return to the or, her pressure on the floor was exceptionally labile. she tended to become severely hypotensive to the 70s after hd. this problem was exacerbated by the fact that her bp could only be taken on her l forearm as she had a picc line in her r upper arm and a fistula in her l arm. multiple different strategies were employed to keep her bp above 85 on the floor including frequent ns boluses, prbc transfusions, and alterations to the amount of fluid taken off during hd. none of these strategies worked very well and the patient continued to have episodes of hypotension nearly everyday. dr. consulted on the patient and an echo was obtained to evaluate her heart. her lv and rv function were improved since her last echo but she had severe mr and as on echo. dr felt that a proportion of her hypotension may have been due to this severe as and proposed a valvuloplasty. . 2. hd - just as the patient had problems w/ hypotension during her time on the floor, her hd treatment were also limited by this factor. the patient frequently became hypotensive to a sbp in the 60s while in the hd suite and required fluid boluses and albumin. the renal attending discussed withdrawing hd multiple times with the family but they refused. the possibility of peritoneal dialysis was also discussed with the family but her feeding difficulties and the possibility of placing a peg made this an impossibility. on , the pt. experienced an unwitnessed pea arrest on the floor. she was pulseless for approx. 5 min. she had been speaking with a family member who left the room for 5 minutes and on returning found the pt. unresponsive. cpr was performed, pt. was intubated, epinephrine, atropine were administered and the pt. regained sinus rhythm. she had a ct of the chest to look for pe/mucous plugging that may have accounted for the pea arrest. her electrolytes were normal. ct demonstrated patent bronchi to the level of the segmental bronchi and no pe. tamponade not suspected. she was hypotensive following the arrest and had increasing pressor requirements in the unit; it was unclear whether this was to a septic etiology vs. heart failure. she remained hypotensive on 3 pressors despite aggressive fluid resuscitation. family decided to make pt. dnr and following this cmo. pressors were withdrawn, patient extubated. she died of respiratory failure 1 hour after extubation medications on admission: 1. insulin nph 20u qam. ssi (regular). 2. midadrine 5 mg before hd. 3. quinine 650 mg before hd. 4. renagel 2400 mg tid. 5. nephrocaps 1 tab po qd. 6. mirapex 0.25 mg po qhs. 7. plavix 75 mg - two tabs po qd. 8. protonix 40 mg po qd. 9. zocor 20 mg po qd. 10. zoloft 50 mg po qd. 11. asa 325 ec qd. 12. colace 100 mg po qd. 13. disalcid 500 mg qd. 14. vitamin b50 1 tab qnoon. discharge medications: none discharge disposition: extended care facility: tcu - discharge diagnosis: tibial/fibula fracture hypotension atrial fibrillation chf end stage renal disease discharge condition: expired discharge instructions: expired followup instructions: expired md, procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube hemodialysis colonoscopy suture of vein 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 transfusion of packed cells removal of implanted devices from bone, tibia and fibula diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery other postoperative infection congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute and subacute necrosis of liver cardiac complications, not elsewhere classified atrial fibrillation aortic valve disorders accidental puncture or laceration during a procedure, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hypotension, unspecified cardiac arrest cellulitis and abscess of leg, except foot accidental fall on or from other stairs or steps septic shock hemorrhage of gastrointestinal tract, unspecified closed fracture of upper end of fibula with tibia disruption of external operation (surgical) wound 

Answer: The patient is high likely exposed to