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: lactose / morphine attending: chief complaint: s/p fall, l femur fracture, hypotension major surgical or invasive procedure: hemodialysis l femur orif history of present illness: 55f with complicated past medical history including cadaveric kidney transplant in , now on hd tu/th/sat, iddm, cad s/p cabg x3, s/p ppm placement, poor ambulation at baseline with right footdrop and bilateral heel ulcers chronically who presents after a trip and fall and found to have a left femur fracture. patient states she was reaching for a fan after getting out of her wheelchair and tripped and landed on her left leg. she denies any head strike or loss of consciousness. fall was unwitnessed but son ran in soon after and found her alert and oriented per patient report. fsg in 170s after fall. she denies any current headache, neck pain, chest pain, back pain, other extremity pain. last hd tuesday. patient was seen at outside hospital where she had an x-ray which showed a displaced angulated spiral fracture of her left femur and was transferred to for surgical management. of note, maximal exertion is achieved with bathing, which does not cause dyspnea at baseline but does cause fatigue, unchanged recently. she had n/v with prior mi, and does endorse nausea since tapering her prednisone off, but it is not exertional and she has not vomited. interestingly, the patient has been on prednisone since her renal transplant in at 5mg daily and remained on that dose until she experienced recent fractures (see below) and infections, at which point her transplant nephrologist dr. tapered her slowly over a 3 month period, which she finished on . bps have been low at baseline and she was previously on midodrine, now only getting prn with hd, though nephrologist has been considering having her take 1mg prednisone on hd days. of note, the patient suffered hip fractures in and of , both of which were repaired at . she believes she had a tte prior to operation in and lvef is below normal per her report. she had spinal anesthesia for her first operation and tolerated it well. she had what sounds like geta for the second and suffered a "small mi" per patient report. in the ed, initial vs: 97.7 92 88/31 15 100% ra. sbps noted to remain in the 80s-90s systolic (baseline per pt), as low as 70/26 and did not improve with total 600cc ns. she was also given 25mcg fentanyl iv for pain control. pt. was noted to have spo2 of 79% at one point in ed, which came up to 100% on 2l nc with positioning and was rapidly weaned off. ortho was consulted and recommended admission to medicine for preop clearance, npo for or in am. cxr unremarkable. femur films show spiral fracture. vs at transfer: 97 60 80/58 14 100% 2l nc. on arrival to the micu, she complains of cramping lle pain, . denies n/v/cp/sob. review of systems: (+) per hpi, otherwise negative past medical history: s/p cadaveric renal transplant in , failed esrd dm1 with ?hypoperfusion s/p mi on hd t/t/s cad s/p mi , cabg x3 ?af s/p ppm for syncopal events after mi iddm s/p subtotal colectomy in for diverticuli b/l hip fracture s/p tfn - , b/l decubitus ulcers on feet depression hypothyroidism glaucoma drop foot ?chf social history: lives with husband and son in . unemployed. no tobacco, etoh, illicits. family history: mother with htn, father with cabg x6, died of lung ca related to asbestosis. physical exam: admission physical exam: general: alert, oriented, no acute distress, appears older than stated age skin: areas of hypopigmentation noted over face, sternotomy scar heent: sclerae anicteric, mmm, oropharynx clear, eomi, pupils minimally reactive but equal b/l neck: supple, jvp not elevated, no lad, mult scars in area of r ij cv: regular rate and rhythm, normal s1 + s2, soft systolic murmur loudest at llsb lungs: dry crackles at the bases b/l, otherwise no wheezes, rales, rhonchi abdomen: somewhat firm, renal transplant scar in llq, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley in place ext: warm, well perfused, palp dp b/l, no clubbing, cyanosis or edema, lle shortened and rotatated, wiggling toes b/l, b/l heel ulcers wrapped in drsg c/d/i neuro: moving all extremities, motor exam deferred d/t pain of lle, alert and oriented discharge physical exam: vitals: tm 97.7 p 63 (63-77) bp 90/60 (90/60 - 139/28 (by machine)), rr 18, 100%ra, i/o= npo/anuric general: alert, pale, chronically ill-appearing middle-aged female in nad. interactive, pleasant. heent: sclerae anicteric, mmm, op clear. cn ii- grossly intact. no facial droop. heart: rrr, nl s1-s2, 2/6 sem at lsb. lungs: ctab, no wheezes, rales or rhonchi. abdomen: soft/nt/nd extremities: cool, no c/c/e, both feet wrapped bilaterally. left leg in knee imobilizer. r 4th finger wrapped in dressing, clean/dry/intact. feet in waffle boots. neuro: awake, a&ox3, cns ii-xii grossly intact pertinent results: admission labs: 07:34pm blood wbc-4.8 rbc-3.88* hgb-13.3 hct-43.5 mcv-112* mch-34.2* mchc-30.5* rdw-18.3* plt ct-222 07:34pm blood neuts-53.5 lymphs-29.1 monos-8.4 eos-8.5* baso-0.6 08:47pm blood pt-10.9 ptt-31.7 inr(pt)-1.0 07:34pm blood glucose-112* urean-28* creat-3.4* na-144 k-3.3 cl-102 hco3-29 angap-16 03:40am blood calcium-9.3 phos-3.2 mg-2.2 07:42pm blood lactate-0.7 discharge labs: 06:24am blood wbc-6.8 rbc-2.74* hgb-9.3* hct-30.5* mcv-112* mch-33.9* mchc-30.4* rdw-18.8* plt ct-330 08:45am blood pt-10.7 ptt-30.0 inr(pt)-1.0 06:24am blood glucose-96 urean-83* creat-4.1* na-136 k-4.8 cl-97 hco3-27 angap-17 06:24am blood calcium-9.1 phos-3.2 mg-2.4 imaging: femur (ap & lat) left two views of the left femur: there is a spiral fracture of the left femur with a small 4-cm butterfly fragment. note is made of diffuse calcification of the visible arterial vessels. the femoral component of a left femoral intramedullary nail is noted in appropriate position. impression: spiral fracture of the left femur with a 4-cm butterfly fragment. two views of the chest: the lungs are well expanded and clear. the cardiac silhouette is enlarged. the mediastinal silhouette and hilar contours are normal. no pleural effusion or pneumothorax is present. a left-sided pacer terminates with its leads in the right atrium and right ventricle. a right-sided dialysis catheter is noted in appropriate position. impression: no acute intrathoracic process. brief hospital course: 55f with esrd s/p failed transplant and on hd, cad s/p mi and cabg x3, iddm and previous hip fractures who presents for operative repair of spiral femur fracture in setting of mechanical fall, and found to be hypotensive in ed, at baseline per patient. . # hypotension: most likely near patient's baseline given patient's report, on hd. no tachycardia though on nodal blocking agents. lactate was within normal limits on presentation. no response to ivf in the ed. prednisone recently tapered so relative adrenal insufficiency could also be contributing. patient was started on midodrine 10mg tid. blood pressures were monitored and prior to orif with orthopaedics, the patient with systolic blood pressures in 80s-100s. she remained with bps 80s-100s systolic post-op and mentating appropriately. stress dose steroids also started and rapidly tapered from hydrocortisone 100mg q8h to 100mg q12h x 1 day, then 100mg daily x 1 day, then off. . # femur fracture: noted on plain films and evidence on physical exam. fracture occurred after clear mechanical fall, not syncopal episode. ortho consulted she underwent orif successfully. of note, patient has had peri-op mi with prior geta for hip fracture repair, no issues with spinal anesthesia. knee immobilizer was in place preop, started on warfarin postop for dvt ppx given esrd. at time of transfer from icu, pt. was ordered for pt and touchdown weight bearing of the lle. pain control with dilaudid pca post-op effective. pt was transitioned to po pain control with good results. . # osteomyelitis: pt. with previous amputation of r 4th digit, wrapped at time of admission. pt noted purulence and malodor on , plastics consulted, recommended plain films of r hand which were ordered. cultures were taken of the right 4th finger which grew pseudomonas sensitive to ceftazidime. a few days later the culture grew out citrobacter that was resistant to ceftazidime. the patient was then started on ciprofloxacin for a 14 day course. she was brought to the or on for debridement. the day prior to discharge had malaise and spike in white count. biopsies at the amputation site were sent and the site reportedly looked clean. cipro was restarted and leukocytosis resolved the following day . her amputation site and other ulcers appeared clean and without infection. cipro will be continued on discharge and course will be decided upon by hand at follow up on # decubitus ulcers: the patient has an ulcer on her left heel, the lateral side of her right foot and her left great toe. wound care saw the patient and left recommendations for dressing changes which will be followed up as an outpatient (see page 1 for explicit instructions). . # right 3rd toe dry gangrene: podiatry saw the patient and recommended 3-view films of the foot. after speaking with the patient's outpatient podiatrist at , it was determined that the gangrene is clinically stable and would not benefit from revascularization (see page 1 for explicit instructions for wound care). . # esrd: on hd t/t/s, last tuesday. no emergent indication for hd at this time. patient underwent hd thursday prior to or, next session performed am. continued nephrocaps and phoslo. . # cad: no signs or symptoms of acs at this time. previous cath in showed 3vd, being medically managed. continued asa 81mg, simvastatin. pt has cardiology follow up, may need icd evaluation given decreased ef on echo. . # iddm: no signs of dka/hhs on presentation. continued iss, reduced lantus in setting of npo and titrated back up. . # glaucoma: continued dorzolamide, timolol, alphagan eye drops. . # hypothyroidism: continued levothyroxine. transitional issues: - pathology from plastics surgery to amputate r fourth digit still pending, needs f/u. - pt needs good wound care to ensure that her decubitus ulcers on heels resolve. - f/u microbiology of wound swabs from and course of cipro based on results and sensitivities medications on admission: preadmission medications listed are correct and complete. information was obtained from patient. 1. dorzolamide 2%/timolol 0.5% ophth. 1 drop both eyes 2. brimonidine tartrate 0.15% ophth. 1 drop left eye 3. simvastatin 40 mg po daily 4. amiodarone 100 mg po daily 5. calcium acetate 667 mg po tid w/meals 6. levothyroxine sodium 88 mcg po daily 7. aspirin 81 mg po daily 8. nephrocaps 1 cap po daily 9. midodrine 10 mg po tid 10. glargine 3 units bedtime insulin sc sliding scale using hum insulin 11. paroxetine 20 mg po daily discharge medications: 1. aspirin 81 mg po daily 2. brimonidine tartrate 0.15% ophth. 1 drop left eye 3. calcium acetate 667 mg po tid w/meals 4. dorzolamide 2%/timolol 0.5% ophth. 1 drop both eyes 5. glargine 3 units bedtime insulin sc sliding scale using hum insulin 6. levothyroxine sodium 88 mcg po daily 7. midodrine 10 mg po tid 8. nephrocaps 1 cap po daily 9. paroxetine 20 mg po daily 10. amiodarone 100 mg po daily 11. iodosorb *nf* (cadexomer iodine) 40 grams topical daily necrotic toe apply daily to right 3rd necrotic toe * patient taking own meds * 12. oxycodone (immediate release) 5-10 mg po q4h:prn pain hold for sedation, rr < 12 13. simvastatin 10 mg po daily 14. ciprofloxacin hcl 250 mg po q24h duration: 14 days discharge disposition: extended care facility: hospital for continuing medical care - ( center) discharge diagnosis: left femur fracture osteomyelitis of right 4th finger 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 ms. , it was a pleasure taking care of you during your hospitalization. you were admitted for a fracture of your left femur and underwent a procedure to repair the break. you had low blood pressure after your operation and were transferred to the icu for monitoring. once you were stable, you were transferred out to the medicine floor and were seen by plastic surgery for an infection of your right fourth finger. you went to the operating room for amputation of your infected finger, and were treated on broad spectrum antibiotics to clear the infection. you have an appointment in hand clinic this tuesday (see appointment below); do not remove your dressing until you are seen by the specialists there. please be sure to follow up with your other appointments, as well (below). a few of your medications have changed; specifically, we have decreased your simvastatin as it can interact with amiodorone at doses higher than 10 mg. we are also sending you out with medication for your pain. followup instructions: follow up for care of your finger with hand clinic: department: orthopedics when: tuesday at 8:10 am with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: orthopedics when: tuesday at 8:30 am with: hand clinic building: sc clinical ctr campus: east best parking: garage follow up with your pcp's office: , 2 p.m. , , phone: follow up with your cardiologist, dr. midha :45 am 50 , phone: procedure: hemodialysis open reduction of fracture with internal fixation, femur repair of entropion or ectropion with wedge resection revision of amputation stump diagnoses: end stage renal disease anemia, unspecified unspecified acquired hypothyroidism atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status depressive disorder, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease ulcer of other part of foot other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure long-term (current) use of insulin pressure ulcer, other site old myocardial infarction cardiac pacemaker in situ pressure ulcer, heel complications of transplanted kidney other specified hypotension closed supracondylar fracture of femur diabetes with peripheral circulatory disorders, type i [juvenile type], uncontrolled diabetes with renal manifestations, type i [juvenile type], uncontrolled gangrene closed fracture of shaft of femur pseudomonas infection in conditions classified elsewhere and of unspecified site other acquired deformities of ankle and foot other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms other specified diseases of hair and hair follicles acute osteomyelitis, hand other amputation stump complication pressure ulcer, unstageable 

Answer: The patient is high likely exposed to