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: s/p fall major surgical or invasive procedure: orif of left femur intubation swan ganz catheter placement extubation history of present illness: 77 yo m w/ cad, htn, afib on coumadin presents after fall x 2. he reports generalized weakness for the last few days. 1 day prior to admission, he got up to walk to bathroom and he fell. no head trauma/loc or pain. on the day of admission, he again tried to get off the couch, after a few steps his "legs gave out" and fell to the floor. he could not get up 2/2 pain in his left leg. he was on the floor for 4 hours kicking his door with his right leg and screaming. around 4 am, he was found and ems was called. he denies cp, lightheadedness, sob, palpitations. he denies changes in vision. he denies fecal/urinary incontinence. he denies f/c/sweats/cough. . in the ed, he was mildly hypoxic - 89%ra. a cxr was done with question of pneumonia. he was given a dose of levofloxacin. the final read of the cxr was of concern of hump so a cta was done which was negative for pe and still with question of pna or atelectasis. he was also given aspirin and had 2 sets of ces checked for question of mi causing weakness. prior to leaving the ed, his bp dropped to 90/45 from 105/63. he was given an additional bolus of 1l ns. past medical history: 1. hypertension. 2. peptic ulcer disease. 3. gastroesophageal reflux disease. 4. atrial fibrillation. 5. coronary artery disease status post mi in with severely decreased left ventricular ejection fraction - 20% in 3/00,. 6. hypercholesterolemia. 7. history of liver abscess. 8. status post meckel diverticulum in . 9. status post nissen fundoplication in . 10. status post left inguinal hernia repair in . 11. status post small bowel hernia/resection in of . 12. type 2 dm. 13. dementia. 14. right inguinal hernia social history: he lives in . he never smoked. he drinks on m, w, fs a few beers/wine. his last drink was friday. he walks up and down 1 flight of stairs from his apartment to the dining room every day without shortness of breath. he rarely walks outside. family history: non-contributory physical exam: vs: temperature 100.3, hr 73, bp 90/50, rr 20 o2 sat 94%2l, respirations 20, wt 163lb genl: nad, no increased work of breathing heent: eomi, perrla, sclera anicteric, sl dry mm, no op lesions neck: jvp - 7cm, supple pulm: clear ant/lat cv: rrr, nl s1, s2, no murmurs, rubs, or gallops. abd: soft, nontender, and nondistended, positive bowel sounds. well healed midline scar, large right inguinal hernia ext: --lle: shortened and externally rotated, pain with all range of motion. pain to palpation left hip/femur. no hematoma noted. --rle: no clubbing, cyanosis or edema. distal pulses 2+ bilaterally, neuro: aandox3, cn 2-12 intact, m ue bl,rle, sensation intact. pertinent results: #cxr - right mid lung base opacity may represent atelectasis versus pneumonia. an underlying lesion cannot be excluded. . #cta: 1. airspace opacity in the right upper lobe, consolidative in nature, representing either atelectasis or pneumonia. 2. old rib fracture and fusion anomaly of two left posterolateral ribs, but no acute rib fracture. 3. no pulmonary embolism. . #ct head: prelim: atrophy; prior stroke in right frontal lobe; no evidence of intrancranial hemorrhage or acute injury . #ct c-spine: prelim: spondylosis; no evidence of fx or dislocation . foot xray: two views. there is a comminuted fracture of the distal shaft of the fifth metatarsal. there is moderate medial angulation at the fracture site. degenerative arthritic changes are present, most pronounced at the first metatarsophalangeal joint. there is a large plantar calcaneal spur. there is no evidence of dislocation. scattered atherosclerotic calcification is present. . hip xray: ap pelvis and two views left hip: there is a comminuted left intertrochanteric fracture with proximal displacement and varus angulation. the femoral head approximates well within the acetabulum. the right hip, bilateral sacroiliac joints, and pubic symphysis are unremarkable. no additional fractures are seen. impression: comminuted left intertrocahnteric fracture as described above. . #ecg nsr 80, , elev v3-v6-old . 11:37pm lactate-1.7 11:36pm wbc-12.0* rbc-3.29* hgb-11.5* hct-30.8* mcv-94 mch-35.0* mchc-37.4* rdw-13.4 11:36pm plt count-196 07:11pm ck(cpk)-1667* 07:11pm ctropnt-0.07* 07:11pm ck-mb-15* mb indx-0.9 12:15pm urine color-yellow appear-clear sp -1.014 12:15pm urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 12:15pm urine rbc-0 wbc-0-2 bacteria-few yeast-none epi-0 10:48am glucose-98 lactate-3.4* na+-136 k+-4.9 cl--100 10:30am glucose-103 urea n-36* creat-1.6* sodium-134 potassium-4.8 chloride-98 total co2-23 anion gap-18 10:30am ck(cpk)-* 10:30am ck-mb-21* mb indx-1.1 10:30am ctropnt-0.08* 10:30am calcium-8.5 phosphate-3.1 magnesium-2.2 10:30am wbc-15.4* rbc-4.21* hgb-14.0 hct-39.1* mcv-93# mch-33.1*# mchc-35.7* rdw-13.1 10:30am neuts-88.9* lymphs-4.8* monos-6.1 eos-0.1 basos-0.1 10:30am plt count-254 10:30am pt-18.3* ptt-30.6 inr(pt)-1.7* brief hospital course: mr. is a 77 year old male who presented after fracture of the left femur after feeling weak for 2-3 days at home. . mr. presented on with a fracture of the left femur after falling while in the bathroom at home. imaging revealed a femur fracture, no intracranial hemorrhage, no vertebral fractures. he had been taking coumadin for atrial fibrillation and had an inr of 1.7 on admission, repeat was 2.2. it was noted that his hematocrit on admission was 39 and a follow up hematocrit was 30.8. there was concern that mr. was bleeding from an unknown source and orthopedic surgery was held until the patient was medically cleared. a cxr done on admission showed a possible pna in the right upper lobe and the patient was started on levaquin. ct chest in the ed ruled out pe and also raised suspicion for pna. ct head showed no bleed, no acute process. . on subsequent hematocrits were stable and it was felt that the initial value was likely concentrated due to dehydration. he was cleared for the or on . of note, the night prior to going to the or, he triggered for a sbp of 89 and temperature to 101.9. he was given a fluid bolus and his blood pressure responded appropriately. his antibiotics were not changed at that time; he remained on levofloxacin. . he underwent orif of his l femur on , receiving 2 units of ffp and 2 units of prbc and following extubation he was brought to the pacu unresponsive. he arrived in the pacu in afib with rates in the 130s-140s. the pt appeared to be having difficulty with respiration and his abg was 7.12/89/114 (unclear how much fio2). he was given lasix 20 mg iv and after pt was noted to have repiratory distress; he was reintubated with etomidate 14 mg and succinylcholine 120mcg. propofol was given and pt was given lopressor 3 mg iv. his sbp decreased to the 80s, and he was given a 500 cc bolus with his sbp rising to the low 100s. a l ij cordis was placed with 4 mg iv morphine given prior. he also received flagyl 500 mg ivx1 (in addition to the levaquin he was taking for pna). ekg revealed elevations in v1-v4 (increased from prior) and stat bedside echo in the pacu revealed old septal akinesis/hypokinesis. cxr revealed persistent rml infiltrate without evidence of volume overload. on simv 600x12 wtih peep 5, ps 5, rate 12, fio2 50% pts abg was 7.33/44/184. the pt was weaned on his propofol to off and he was weaned on his vent to ps at 5/5 with tv of 500-800cc. on arrival to the micu from the pacu, the pt was found hypotensive with a sbp in the 60s. the following is his subsequent course: . #sepsis/sirs: pts sbp was in the 60s on arrival to the icu with temp of 103 f. the pt was started on levophed gtt and bolused 1 l ivf. stim test revealed a normal baseline cortisol level. a swans-ganz catheter was floated through the l ij cordis and revealed a svr of 700, cvp 14, wedge of 18, sv of 69, and co 4.5-6.5. thus, the main cause of the pts hypotension was felt to be sepsis rather than cardiogenic shock. over the first night in the icu, the pts levophed was weaned off, and he received a total of 4 l ns and 1 unit prbc (for hct of 27 and mixed venous o2 sat of 61%). the pts sbp rose to the low 100s. the only source for sepsis was the pts rml pna. blood cx, sputum cx, and urine cx were negative. he was called out to the floor on . while on the floor, he remained hemodynamically stable, afebrile. he will continue a 10 day course of levaquin and flagyl for possible aspiration pneumonia. . #respiratory failure: ms. initial abg was c/w hypercarbic resp. distress. he was unresponsive on arrival to the micu, so his hypercarbia was likely due to mental status changes. his mental status had greatly improved on the morning after transfer to the icu. in the pacu the pt had already been weaned to ps with 50% fio2, and he was taking in tv in the 500s with sats of 93-97%. he was extubated on the morning after transfer to the icu without complication. he was weaned to 2l on however o2 sat decreased to 88%. at that time he was noted to have crackles at the bases on exam. as his blood pressure had improved, he was restarted on lasix for duiresis. he remains on 2l, satting well at discharge. . #cad/demand ischemia: immediately following surgery, mr. had increased st elevations in the anterior leads on the ekg with rapid afib. these elevations resolved after the hr decreased. per cards, this elevation was likely due to anterior wall akinesis in the setting of tachycardia. stress in had shown fixed lesions of the apical/septal walls and akinesis/hypokinesis of these regions. stat tte revealed ef still severly depressed. metoprolol and ace were held in the setting of hypotension. the pts troponin trended up to 0.12 which was likely due to demand ischemia. pt was given pr asa while intubated and then po asa and lipitor were restarted after extubation. metoprolol and ace were held in the setting of hypotension. once hypotension resolved, his beta blocker was restarted on and increased to tid on . a small dose of an ace inhibitor was restarted on . he tolerated both medications well with stable bp. . #altered mental status: pts altered ms seemed to be related to oversedation as he was mentating better hours later. ddx included toxic metabolic, infection, stroke, nonconvulsive seizure. in addition, the pt was febrile to 103 with pna, which could certainly account for altered mental state. his ua from was clear. he was moving all extremities and following commands, so stroke and seizure were unlikely. on discharge, he was mentating well. he was able to correctly state person, place and time. . #afib: pt was in rvr post-op, likely secondary to fluid shifts and peri-op complication. pt spontaneously cardioverted to nsr after 3 mg lopressor. he was restarted on coumadin after surgery at a dose of 5mg qhs. this was changed to 2.5mg. on the day of discharge his inr was 2.7 and his discharge coumadin dose is 2.0. . #left femur fracture/ 5th metatarsal fracture: detailed hospital course above. after orif and micu course the patient was transferred to the floor. ortho continued to follow and the patient was able to weight bear on the left leg. on ecchymosis was noted on the left lateral malleolus, heel and plantar aspect of foot. a foot xray showed a fracture of the 5th metatarsal, likely incurred from the fall. he remained pain free and was comfortable on the day of discharge. he was anticoagulated with lovenox, until coumadin level reached >2.0. lovenox was d/c'd on . he will follow up with dr. on . . #systolic dysfunction: pt has ef 20-25%. he was given iv fluids as needed and lasix was initially held due to low blood pressures. lasix was restarted on for increased o2 requirement and crackles on exam. this improved his oxygen saturation and a standing dose was reinitiated on . . #dm ii: pt was maintained on ssi while in the hospital. he will be discharged on glucophage. . #dementia: aricept was held while pt was intubated and was restarted after extubation. his mental status while not sedated was appropriate. he was awake, alert and oriented x3. . #gerd: mr. was given protonix to prevent reflux. . #fen: after extubation and on return to the floor, the patient was seen by speech and swallow who felt that he could be advanced to thin liquids and ground solids. medications on admission: coumadin 2.5/3 aricept 10 daily lipitor 10 daily glucophage 500 mg atenolol 25 mg daily, lasix 40 mg daily, lisinopril 20 mg daily discharge medications: 1. donepezil 5 mg tablet sig: two (2) tablet po hs (at bedtime). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. atorvastatin 10 mg tablet sig: one (1) tablet po once a day. 4. glucophage 500 mg tablet sig: one (1) tablet po twice a day. 5. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 6. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 7. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 3 days: last day . 8. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 4 days: last dose on . 9. coumadin 2 mg tablet sig: one (1) tablet po at bedtime. 10. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 11. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). discharge disposition: extended care facility: - discharge diagnosis: primary: left femur fracture aspiration pneumonia sepsis anemia secondary: hypertension atrial fibrillation cad hypercholesterolemia diabetes mellitus dementia discharge condition: stable. the patient is breathing comfortably and satting well on 2l o2. he is mentating appropriately and oriented to person, place and time. discharge instructions: you were admitted to the hospital after a fall during which you fractured your left thigh and the small toe on your left foot. you had surgery to help repair the fracture of your leg. immediately after surgery your blood pressure was very low, likely because of pneumonia. this is why you went to the icu. you are currently on antibiotics to treat the pneumonia. you need to take antibiotics for a 10 day course. please take all medications as prescribed. you are taking coumadin 2mg daily. it is important that you have your inr checked regularly. if you begin to have fevers, chills, lightheadedness, dizziness, increased pain of your leg or foot or any other concerning followup instructions: you have the following appointments: 1. , md phone: date/time: 8:00 2. orhto xray (scc 2) phone: date/time: 7:40 you should follow up with dr. early next week. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube pulmonary artery wedge monitoring pulmonary artery wedge monitoring open reduction of fracture with internal fixation, femur transfusion of packed cells transfusion of other serum infusion of vasopressor agent diagnoses: esophageal reflux unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation other persistent mental disorders due to conditions classified elsewhere systolic heart failure, unspecified other specified forms of chronic ischemic heart disease pneumonitis due to inhalation of food or vomitus old myocardial infarction long-term (current) use of anticoagulants nonspecific abnormal findings in stool contents dehydration fall from other slipping, tripping, or stumbling rhabdomyolysis peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction closed fracture of intertrochanteric section of neck of femur history of fall closed fracture of metatarsal bone(s) inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified, recurrent 

Answer: The patient is high likely exposed to