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: penicillins / bactrim / albuterol / tetanus attending: chief complaint: compound r ankle fracture s/p fall at facility major surgical or invasive procedure: open reduction internal fixation right tibia/fibula wash out of wound removal of hardware picc placement history of present illness: 83f with a-fib (not on anticoagulation), diastolic chf (with history of rate-related flash pulmonary edema), htn, spinal stenosis, pmr on chronic prednisone, copd, colon cancer s/p resection who presented to the ed following a mechanical fall at facility overnight. . ros: no fevers/chills past medical history: atrial fibrillation; not on anticoagulation; rate-controlled diastolic chf (normal tte at in with lvef 55% and normal valve function) p-mibi (): fixed inferior wall defect colon cancer s/p resection in htn pmr on chronic prednisone anxiety disorder depression copd (on 3l home oxygen) chronic renal insufficiency (baseline creatinine 1.0-1.2) spinal stenosis right-sided tkr right-sided orif of hip fracture social history: she lives at crossing . she quit smoking 10 years ago. she ambulates with a walker. she has home o2. family history: non-contributory physical exam: t 99 bp 112/44 hr 57 rr 14 sat 98% on 3lnc gen: elderly woman in obvious pain heent: dry mm cv: irreg irreg, normal s1s2, no murmurs pulm: cta b/l abd: soft ntnd, normal bs extr: r ankle in cast, 1+ bilateral dp pulses, warm neuro: a&o x3 pertinent results: admission labs: 04:21am pt-11.2 ptt-22.8 inr(pt)-0.9 04:21am plt count-328 04:21am macrocyt-1+ 04:21am neuts-82.3* lymphs-12.1* monos-4.6 eos-0.8 basos-0.2 04:21am wbc-12.1* rbc-3.40* hgb-11.0* hct-32.2* mcv-95 mch-32.5* mchc-34.3 rdw-14.7 04:21am digoxin-1.5 04:21am ck-mb-notdone 04:21am ctropnt-0.07* 04:21am ck(cpk)-47 04:21am glucose-108* urea n-43* creat-2.1* sodium-129* potassium-3.8 chloride-79* total co2-45* anion gap-9 05:45am urine rbc-0 wbc-0-2 bacteria-occ yeast-none epi-0 05:45am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-sm 05:45am urine color-straw appear-clear sp -1.009 12:10pm freeca-0.93* 12:10pm hgb-8.4* calchct-25 12:10pm glucose-104 lactate-1.0 na+-133* k+-2.9* cl--99* 12:10pm type-art po2-241* pco2-41 ph-7.49* total co2-32* base xs-8 02:31pm freeca-1.04* 02:31pm hgb-10.4* calchct-31 02:31pm glucose-145* lactate-2.0 na+-134* k+-3.6 cl--94* 02:31pm type-art po2-216* pco2-43 ph-7.51* total co2-36* base xs-10 intubated-intubated 03:59pm pt-10.9 ptt-22.0 inr(pt)-0.9 03:59pm plt count-266 03:59pm wbc-17.0* rbc-3.43* hgb-11.2* hct-31.8* mcv-93 mch-32.8* mchc-35.3* rdw-15.9* 03:59pm calcium-8.3* phosphate-3.3 magnesium-2.8* 03:59pm ck-mb-notdone ctropnt-0.05* 03:59pm ck(cpk)-69 03:59pm glucose-174* urea n-33* creat-1.4* sodium-133 potassium-4.2 chloride-92* total co2-32 anion gap-13 04:13pm type-art po2-94 pco2-68* ph-7.37 total co2-41* base xs-10 06:25pm glucose-197* urea n-33* creat-1.5* sodium-133 potassium-4.2 chloride-92* total co2-33* anion gap-12 06:28pm temp-36.7 po2-102 pco2-70* ph-7.34* total co2-39* base xs-9 . micro: 5:20 pm tissue site: ankle bone r ankle. gram stain (final ): no polymorphonuclear leukocytes seen. 2+ (1-5 per 1000x field): gram negative rod(s). reported by phone to @2145 on . tissue (final ): non-fermenter, not pseudomonas aeruginosa. moderate growth. sensitivity testing performed by microscan. sensitivities: mic expressed in mcg/ml _________________________________________________________ non-fermenter, not pseudomonas aeruginosa | cefepime-------------- 4 s ceftazidime----------- <=2 s ceftriaxone----------- 16 i ciprofloxacin--------- 2 i gentamicin------------ 2 s imipenem-------------- <=1 s levofloxacin---------- s meropenem------------- s piperacillin---------- 64 i piperacillin/tazo----- <=8 s tobramycin------------ 2 s trimethoprim/sulfa---- <=2 s anaerobic culture (preliminary): no anaerobes isolated. . r tib/fib film (): bimalleolar fracture of the ankle, with severe widening of the ankle mortise and lateral displacement of the talar dome with respect to the tibial plafond. evaluation of the ankle fracture is severely limited due to an overlying splint. right total knee replacement without evidence of hardware-related complication. status post orif of a right femoral neck fracture with persistent deformity of the right femoral head/neck junction. . trauma cxr/pelvis x-ray (): 12 mm nodule that projects in the right mid lung. deformity of the left 10th rib laterally consistent with a fracture, age indeterminant. . head ct (): no evidence of acute intracranial hemorrhage. multiple vague hypodense foci in the cerebral white matter, consistent with sequela of chronic small vessel infarction. . ct c-cpine (): grade 2 anterolisthesis of c5 on c6, that is probably degenerative in nature; however, this cannot be unequivocally distinguished from a traumatic etiology without prior studies for comparison. multilevel degenerative changes as well. no fracture identified. . pmibi: interpretation: the image quality is good. left ventricular cavity size is normal. rest and stress perfusion images reveal a predominantly fixed moderately severe distal anterior and apical perfusion defect and a predominantly fixed mild septal defect. gated images reveal normal wall motion. the calculated left ventricular ejection fraction is 54%. no comparison studies. impression: on pharmacologic stress imaging, there is a predominantly fixed moderatel distal anterior wall and apical perfusion defect and a predominantly fixed mild septal defect. there is normal left ventricular wall motion with an lvef of 54%. . pharmacologic stress test: interpretation: this 83 yo female was referred to the lab for new onset atrial fibrillation & chf. the patient was infused with 0.142 mg/kg/min of iv persantine over 4 minutes. the patient denied any arm, neck, back or chest discomfort throughout the study. there were no significant st segment changes noted beyond baseline. the rhythm was atrial fibrillation with rare vpb's. there was an appropriate hemodynamic response. persantine was reversed with 125 mg of iv aminophylline. impression: no ischemic ekg changes noted beyond baseline. no anginal symptoms. nuclear report sent separately. brief hospital course: 83f with rate-controlled a-fib, diastolic chf, copd, spinal stenosis, pmr on chronic steroids here with compound r ankle fracture s/p orif. her hospital course is as follows: . compound r ankle fracture: patient was taken to the or for orif. team had trouble closing her wound given her friable skin, and vac was placed with a plan to close the wound at a later date. she also had difficulty and had a short stay in the icu. the patient was put on a dilaudid pca briefly for pain control, which was stopped after an episode of over sedation and hypotension after receiving ambien concurrently. the patient was taken back to the or for a wash out on and tolerated the procedure well. ortho maintained her on wet-to-dry dressings daily. however, they held off on bone grafting. likewise, plastics wanted to see good granulation of the wound. ortho decided to take the patient back to the or for and vac placement. she went to the or on with good result. wtd dressings were maintained. . chest pain/sob: the patient had episodes of chest pain with sob. during these times, she became more tachycardic. troponins were drawn and were mildly elevated. however, there were no ekg changes and her troponitis was thought to be demand ischemia. her cks remained flat. however, the patient had another episode and this time her troponin increased from 0.12 to 0.14. cardiology was consulted and raised the concern for ischemia. she was maintained on asa, bb, and acei. she was taken for a pmibi and pharmacologic stress test on . it showed irreversible defects. after cardiology reviewed the study, they determined that these defects may be artifact. they stratified her as low-intermediate risk for an intermediate risk operation. the patient's heart rate was optimally controlled and she was sent to the or. she can continue her toprol xl 250mg po qday . diastolic chf: the patient did have a history of rate related flash pulmonary edema. her low dose beta blocker was continued. her diuretics were held. shewas given gentle ivf to maintain pre-load and to treat a drop in urine otput. nevertheless, she did have 02 requirements during her stay. her outpatient lasix was re-started on to which she diuresed well. however, it was held again for over diuresis and contraction alkalosis. the patient was given gentle ivf with improvement of her contraction alkalosis. she maintained her baseline 02 sats. . afib: her afib was managed with low dose beta blockers for rate control. she was not put on anticoagulation given her surgeries. her bb was uptitrated to achieve better control from 25mg po bid to qid dosing per cardiology recommendations. we uptitrated her to 62.5mg po qid with improved control to 75-90, finally switching to toprol xl 250mg po qday. further titration can be addressed as an outpatient, though she is tolerating this well. . lymphocytosis: although the patient was on chronic steroids, she was started on vanco/flagyl cipro. urine culture was negative. her white count did trend down. her cipro/flagyl were d/c'd with negative culture data and a clean wound. she was continued on vanco for gram positive coverage for her open wound. however, repeat tissue culture grew pseudomonas sensitive to levaquin, which she was switched to. she will need continued levaquin while her wound is open - can be discussed with orthopedics regarding definitive course. . copd: maintained on supplemental 02 with prn nebulizers. . acute on chronic renal failure: her baseline cr is 1-1.2. her renal dysfunction was treated with gently hydration and improved to baseline. . c-spine anterolisthesis: cleared for surgery, but required fiberoptic intubation. . polymyalgia rheumatica: the patient was maintained on prednisone 5mg. however, she was started on stress dose steroids with hydrocortisone 50mg iv q6 for her surgeries. a random cortisol level was 2.9. she was put back on prednisone 5mg po qday after her surgery. however, she can begin a prednisone taper. . ? depression: patient was found to be tearful and pessimistic. psychiatry was consulted for depression. they agreed with depressive symptoms vs. adjustment and recommended anti-depressant. however, the patient adamantly refused. this should be re-considered as an outpatient. . code: dnr/dni for this admission. . to do for follow up: 1. patient has follow up with ortho to decide ultimate management of fracture. length of anticoagulation and antibiotics should be discussed. 2. patient is scheduled for a ct chest to follow up incidental lung nodule/fusiform aneurysm. test is scheduled for at 11am in 3. please arrange transport and have pcp enter requisition in computer system. 3. patient will need follow up tfts. 4. can start to taper prednisone gradually for her pmr. 5. ? depression. pt refused anti-depressants, may benefit in future. discuss psychiatry follow up as outpatient. medications on admission: lasix 60mg daily zaroxylyn 5mg daily flonase 0.025mg prn ipratropium nebs daily prednisone 4mg daily digoxin 0.125mg every other day percocet prn ambien 5mg at bedtime prn senna, diltiazem 30mg qid synthroid 100mcg daily neurontin 400 mg colace 100 mg discharge medications: 1. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 4. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. gabapentin 300 mg capsule sig: one (1) capsule po daily (daily). 6. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tidac (3 times a day (before meals)). 7. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 8. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 10. lorazepam 0.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for insomnia, anxiety. 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 12. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 13. enoxaparin 30 mg/0.3 ml syringe sig: one (1) subcutaneous q12h (every 12 hours): dvt prophylaxis. 14. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed). 15. sodium chloride 0.65 % aerosol, spray sig: sprays nasal tid (3 times a day) as needed. 16. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 17. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q6h (every 6 hours) as needed for constipation. 18. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day). 19. levofloxacin 250 mg tablet sig: three (3) tablet po q48h (every 48 hours): please continue for open wound. 20. metoprolol succinate 50 mg tablet sustained release 24hr sig: five (5) tablet sustained release 24hr po daily (daily). 21. cepacol 2 mg lozenge sig: one (1) lozenge mucous membrane prn (as needed). 22. oxycodone-acetaminophen 5-325 mg tablet sig: two (2) tablet po q 8h (every 8 hours). 23. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 24. morphine sulfate 1-5 mg iv q4h:prn pain for breakthrough pain only, hold for rr <12 discharge disposition: extended care facility: for the aged - discharge diagnosis: primary diagnosis: right compound distal tibia/fibula fracture . secondary diagnoses; atrial fibrillation diastolic congestive heart failure chronic obstructive pulmonary disease polymyalgia rheumatic lung nodule hypothyroidism hypertension discharge condition: good, afebrile, hemodynamically stable discharge instructions: please take all medications as prescribed. please keep all follow up appointments. please return to the hospital if you experience fevers/chills, chest pain, worsening leg pain or signs of infection, or any other symptoms that concern you. . patient is to follow up with orthopedics regarding her fracture . patient is scheduled for a ct chest on at 11am in 3. please arrange transport. please have pcp enter outpatient requisition for this test. . patient will need follow up thyroid function tests followup instructions: please follow up with orthopedics as below: provider: xray (scc 2) phone: date/time: 10:00 provider: , md phone: date/time: 10:20 . please follow up with your pcp . in weeks. . provider: scan phone: date/time: 11:15 procedure: venous catheterization, not elsewhere classified local excision of lesion or tissue of bone, tibia and fibula excisional debridement of wound, infection, or burn debridement of open fracture site, tibia and fibula open reduction of fracture with internal fixation, tibia and fibula transfusion of packed cells other immobilization, pressure, and attention to wound removal of implanted devices from bone, tibia and fibula other tenonectomy diagnoses: polymyalgia rheumatica unspecified essential hypertension personal history of malignant neoplasm of gastrointestinal tract, unspecified long-term (current) use of steroids acute posthemorrhagic anemia acute kidney failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation chronic kidney disease, unspecified cellulitis and abscess of leg, except foot osteoporosis, unspecified diastolic heart failure, unspecified knee joint replacement fall from other slipping, tripping, or stumbling acute pain due to trauma spinal stenosis in cervical region pseudomonas infection in conditions classified elsewhere and of unspecified site history of fall bimalleolar fracture, open other mechanical complication of other internal orthopedic device, implant, and graft major osseous defects tibialis tendinitis 

Answer: The patient is high likely exposed to