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: sulfa (sulfonamide antibiotics) / influenza virus vaccine / pneumococcal vaccine attending: chief complaint: increased confusion after fall major surgical or invasive procedure: none history of present illness: the patient is an 81 year-old woman with a past medical history significant for hypertension, hyperlipidemia, type ii diabetes mellitus, multiple foot surgeries and infections, on aspirin and fondaparinux, who presents as a transfer for intraventricular hemorrhage. the history is obtained from the patient's daughter via the telephone as the patient is an unreliable historian. of note, she was admitted / to with a complaint of fever and vomiting, found to have an s. aureus bacteremia and suspected rle osteomyelitis. the right foot was surgically debrided on (cuboid bone removed), and fianl diagnosis was soft tissue infection and not osteomyelitis. she was discharged on oxacillin until , and planned "oral antibiotics for additional 4-6 weeks." a tee during that admission "showed no evidence of vegetations". she was treated with a course of levofloxacin for radiographic pneumonia. she was recently discharged home () after long hospital course at when she had a fall that same day while ambulating with bruise to her sacrum. confusion started on and had another am from her bed to floor, without apparent injury. after a third fall on w/o apparent trauma, she was brought by ems to mwh, where a head ct showed an intraventricular hemorrhage. she was transferred to for further management on . ros - this is somewhat limited as the patient is a poor historian. she reported long standing urinary incontinence. she thinks she lost a considerable amount of weight between her initial admission in and her discharge on thursday - 40lbs. the patient denied headache, visual difficulty, hearing changes, difficulty speaking, language problems, memory difficulty, difficulty swallowing, dizziness, lightheadedness or vertigo, paresthesias, sensory loss. the patient denied appetite changes, chest pain, palpitations, dyspnes on exertion, shortness of breath, cough, wheeze, nausea, vomiting, diarrhea, constipation, abd pain, fecal incontinence, dysuria, nocturia, hot/cold intolerance, polyuria, polydipsia, easy bruising, depression, anxiety, stress, or psychotic symptoms. past medical history: type ii diabetes mellitus mssa bacteremia in to chronic right foot osteo s/p 4 weeks of iv abx at osh then 10 weeks of dicloxicillin as an outpt. herpes zoster bilateral charcot joints multiple foot surgeries hypothyroidism hyperlipidemia rheumatioid arthritis hypertension left buttock decubitus ulcer chronic anemia peripheral arterial disease with bypass grafts to both legs bilateral total knee replacements social history: lives at home with her husband. denied tobacco, etoh, or illicit drugs. family history: non-contributory physical exam: vitals: t:101.4 p:96 bp:166/48 r:22 sao2:99% on 2 l. general: awake, cooperative, nad. heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: lungs cta bilaterally without wheezes or crackles cardiac: rrr, s1/s2 present, no murmur, rubs or gallops abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. has been receiving shots of anticoagulant in the stomach. extremities: no c/c/e bilaterally. bilateral surgical scars over knees and ankles. left knee is tender, but there is no effusion, erythema or change in temp compared with other parts of the leg. left ankle is severely deformed. right foot has stitches in the bottom. neither foot is tender. skin: no rashes or lesions noted. neurologic: -mental status: alert, oriented to hospital and . unable to relate history without difficulty - shortens time periods, initially said she only fell once. mildly inattentive, able to name months of year backward but skipped . language is fluent with intact repetition and comprehension. pt. was able to name both high and low frequency objects. able to read without difficulty. able to follow both midline and appendicular commands. there was no evidence of apraxia or neglect. pt. was able to register 3 objects and recall 0/3 at 5 minutes. the pt. had good knowledge of current events. there were no paraphasic errors. normal prosody. speech was not dysarthric. -cranial nerves: olfaction not tested. perrl 3 to 2mm and brisk. vff to confrontation. there is no ptosis bilaterally. funduscopic exam revealed no papilledema, exudates, or hemorrhages. eomi without nystagmus. normal saccades. facial sensation intact to pinprick. no facial droop, facial musculature symmetric. hearing intact to finger-rub bilaterally. palate elevates symmetrically. 5/5 strength in trapezii and scm bilaterally. tongue protrudes in midline. -motor: normal bulk, tone throughout. no pronator drift bilaterally. no adventitious movements noted. no asterixis noted. delt tri we fe ff c5 c6 c7 c6 c7 c8/t1 l 5 5 5 5 5 5 r 5 5 5 5 5 5 ip quad hamst df pf l2 l3 l4-s1 l4 l5 s1/s2 l 4- 5 5 5 nt 5 r 4- 5 5 5 4 5 -sensory: stocking deficit to all modalities. upper extremity and face were normal. no extinction to dss. -coordination: no intention tremor, dysdiadochokinesia noted. no dysmetria on fnf bilaterally. - reflex: no clonus tri bra pat an toes c5 c7 c6 l4 s1 cst l1 1 1 - - equi r1 1 1 - - equi -gait: unable to walk. refused an effort. pertinent results: admission labs: cardiac enzymes: 06:18pm blood ctropnt-0.02* 03:08am blood ck-mb-4 ctropnt-0.02* 02:00pm blood ck-mb-3 ctropnt-<0.01 06:25am blood ck-mb-2 ctropnt-<0.01 12:14am blood ck-mb-notdone ctropnt-<0.01 06:18pm blood wbc-11.2* rbc-3.02* hgb-9.7* hct-26.6* mcv-88 mch-32.0 mchc-36.4* rdw-14.5 plt ct-171 06:18pm blood pt-13.4 ptt-25.8 inr(pt)-1.2* 06:18pm blood glucose-134* urean-33* creat-1.1 na-138 k-4.7 cl-103 hco3-23 angap-17 03:08am blood alt-20 ast-27 ck(cpk)-418* 06:18pm blood calcium-9.2 phos-3.1 mg-1.3* iron-44 03:08am blood %hba1c-6.0* 03:08am blood triglyc-153* hdl-52 chol/hd-3.0 ldlcalc-74 discharge labs: 07:35am blood wbc-6.8 rbc-2.78* hgb-8.7* hct-23.6* mcv-85 mch-31.2 mchc-36.8* rdw-13.5 plt ct-267 07:35am blood plt ct-267 microbiology: time taken not noted log-in date/time: 11:04 pm urine add on @1103 hem # 2116r. **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. warning! this isolate is an extended-spectrum beta-lactamase (esbl) producer and should be considered resistant to all penicillins, cephalosporins, and aztreonam. consider infectious disease consultation for serious infections caused by esbl-producing species. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | amikacin-------------- 16 s ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- =>64 r ceftazidime----------- =>64 r ceftriaxone----------- =>64 r cefuroxime------------ =>64 r ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin---------- =>128 r piperacillin/tazo----- 8 s tobramycin------------ =>16 r trimethoprim/sulfa---- =>16 r ---------- 11:23 pm urine source: catheter. **final report ** urine culture (final ): no growth. ---------- 8:34 pm stool consistency: formed source: stool. **final report ** clostridium difficile toxin a & b test (final ): reported by phone to norren @ 4:55a . clostridium difficile. feces positive for c. difficile toxin by eia. (reference range-negative). a positive result in a recently treated patient is of uncertain significance unless the patient is currently symptomatic (relapse). ----------- blood cultures from , , , , 10/20, no growth to date ------------ diagnostic studies: ct head : hyperdense lesion within the right lateral ventricle likely represents an intraventricular mass, with associated hemorrhage, though further evaluation with mri with gadolinium is recommended. pelvis ct : impression: no acute fracture. please note, the examination is limited secondary to osteopenia. if there is continued clinical concern for fracture, an mri could be obtained. lumbar spine ct 10/14/08:1. diffuse osteopenia, which may limit the sensitivity for detection of nondisplaced fractures. 2. mild degenerative changes including grade 1 anterolisthesis at the l4-5 level and loss of intervertebral disc space height at the l5-s1 level. significant canal stenosis at the l4-5 level. an mri of the lumbar spine can be performed for further evaluation. cxr : pa and lateral views of the chest: the heart is mildly enlarged. the aorta is tortuous and the aortic knob calcifications are present. pulmonary vascularity is normal. the lungs are clear. no large pleural effusions or pneumothorax is demonstrated. there may be mild scarring within the posterior costophrenic angles. degenerative changes are seen within the thoracic spine. impression: no acute cardiopulmonary abnormality. transthoracic echocardiogram : he left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 70%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. there are focal calcifications in the aortic arch. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. impression: no definite vegetations seen xray bilateral feet : marked arthropathy involving the bilateral feet as described. diagnostic considerations include neurogenic osteoarthropathy (charcot). the sequela of chronic infection can have a similar appearance. bone scan : impression: positive three-phase bone scan in the hind and mid feet bilaterally with more focal area of increased uptake in the left midfoot. the findings likely reflect charcot arthropathy, although an underlying infection cannot be excluded. indium 111-wbc study or mri can be performed for further evaluation. head ct with and without contrast : findings: the pre-contrast images again demonstrate high density in the right ventricular atrium, indicative of hemorrhage. the previously noted small amount of blood in the left occipital is not apparent on the current study. there is mild-to-moderate prominence of temporal horns indicating early communicating hydrocephalus. this finding is unchanged from previous study. following contrast administration, no abnormal enhancement is identified. no other abnormal areas of enhancement are seen. impression: no change in size and appearance of the right-sided intraventricular hematoma. persistent mild prominence of temporal horns indicating early communicating hydrocephalus. no abnormal enhancement is seen surrounding the region of hematoma. white blood cell study :impression: increased tracer uptake in both feet is a non-specific finding, probably related to chronic inflammation due to extensive neuropathic changes; however, a component of bilateral osteomyelitis cannot be excluded with these findings. cxr : findings: in comparison with the study of , there is little change. enlargement of the cardiac silhouette persists without vascular congestion or pleural effusion. specifically no evidence of acute pneumonia. brief hospital course: this is an 81 year old female with history of type ii diabetes mellitus, hypertension, charcot feet, who initially presented with a fall and was found to have and intraventricular hemorrage. 1)intraventricular hemorrhage: intraventricular hemorrhage felt by neurosurgery to likely be secondary to trauma. hemorrhage did occur in setting of patient taking arixtra for "clots." pt was brought to outside hospital for evaluation after having multiple falls at home and was found by head ct to have an intraventricular hemorrhage for which she was transferred to for further management. head ct did not show evidence of fracture, nor did l spine films. however, this initial head ct was concerning for intraventricular mass, with associated hemorrhage. mri could not be obtained to clarify this question of a mass so ct head with contrast performed and showed right-sided intraventricular hematoma without any abnormal enhancement surrounding hematoma. patient was not felt to require surgical intervention. patient remained hemodynamically stable. patient not noted to have any motor or sensory deficits attributable to the hemorrhage. mental status has consistently been oriented to person, but not to place or time. part of her confusion/disorientation could certainly be attributed to her intraventricular hemorrhage versus delirium from her infections. patient is scheduled to have a brain mri on to assess resolution of hemorrhage. she is to follow up with dr. in neurology clinic. patient's arixtra was held during this hospitalization and she was not discharged on this medication. seroquel was also held given concern over confusion. patient can discuss whether or not to continue these medications with her primary care physician. 2)fevers: patient found to spike daily fevers from around until . patient found to have urinary tract infection positive for e.coli on that was treated with a course of nitrofurantoin. fevers continued in spite of uti being treated. infectious disease team was consulted and felt that intraventricular blood was most likely cause of fever, though uti and osteomyelitis were also considered. patient has had recent mssa bacteremias secondary to osteomyelitis of right foot. an extensive work-up for potential osteomyelitis was initiated. mri of right foot, tagged wbc scan and bone scan were all found to be equivocal. mri of left foot uninterpretable due to patient moving. patient's underlying charcot feet made differentiating osteomyelitis from her underlying inflammation very difficult. but given normal white cell count and no positive blood cultures suspicion for osteomyelitis remained low. patient had normal cxr and no clinical signs of pneumonia. on patient found to have clostridium dificile and was symptomatic with diarrhea. it is possible cdiff colitis could have contributed to the fevers. patient was started on flagyl 500mg po tid for this infection (day 1 of 14 day course ) at time of discharge patient had been afebrile for 48 hours and continued to have a normal wbc count. she should continue taking flagyl for a total of 14 days. 3) hyponatremia: patient noted to be hyponatremic to 129. urine osmolarity of 501 and urine sodium of 38 consistent with siadh. likely hyponatremia secondary to patient's interventricular hemorrhage. we fluid restricted patient to 1200 ml/day and sodium increased to normal range. would suggest continued fluid restriction, but increase fluids to 1500ml/day and monitoring serum sodium until intraventricular hemorrhage resolves. 4)hypertension: blood pressures have remained stable. neurology recommended keeping systolic pressure <160. patient was continued on carvedilol, amlodipine, clonidine and lisinopril. lisinopril dose was changed from 40 mg to 40 mg daily. 5)anemia: likely represents anemia of chronic disease, which is supported by iron studies during this hospitalization. 6)hyperlipidemia: patient continued on outpatient regimen of atorvastatin. 7) type ii diabetes mellitus: blood sugars remained stable. outpatient metformin was held. patient was continued on outpatient dose of lantus and sliding scale humalog insulin. metformin restarted at time of discharge. 8) diabetic peripheral neuropathy: stable during this admission. patient was continued on his outpatient regimen of gabapentin. 9)right gluteal ulcer/left gluteal ecchymosis: patient seen by wound care nurse who recommended atmos air mattress, repositioning every 1-2 hours, waffle boots for charcot feet, elevating legs, sitting on chairs for now more than 1.5 hours with pressure relief cushion in place. 10)hypothyroidism: patient was continued on outpatient regimen of synthroid. 11)rheumatoid arthritis: patient continued on her outpatient regimen of prednisone 5 mg daily. 12) osteopenia: patient was continued on her outpatient regimen of vitamin d and calcium. 13) gastroesophageal reflux disease: patient was continued on omeprazole 20 mg daily. 14) bilateral charcot feet: patient has follow up scheduled with her podiatrist dr. . she should continue to wear her custom footwear when walking. patient was a full code during this admission. medications on admission: levothyroxine 125 mcg daily omeprazole 20 mg daily aspirin 81 mg daily prednisone 5 mg daily colace 100 mg lisinopril 40 mg coreg 25 mg catapres 0.2 mg metformin 1,000 mg neurontin 300 mg tid norvasc 10 mg daily one daily multivitamin vitamin c 500 mg sr mirtazapine 7.5 mg daily lipitor 80 mg daily fish oil 1,000 mg daily seroquel 12.5mg daily zofran 4 mg every 4-6 hrs prn arixtra (fondaparinux sodium)2.5 mg/0.5 ml injection daily lidoderm 5 % patch prn. lantus 8 units at bedtime humalog 4 units before dinner tylenol extra strength 500 mg tab oral tablet(s) every 4-6 hrs prn discharge disposition: extended care facility: - discharge diagnosis: primary: traumatic intraventricular hemorrhage delirium urinary tract infection clostridium dificle colitis hyponatremia/siadh decubitus ulcer secondary: diabetes mellitus type ii rheumatoid arthritis - chronic steroids anemia of chronic disease bilateral charcot foot diabetic neuropathy hypertension hyperlipidemia prior osteomyelitis, right foot mssa bacteremia hypothyroidism gerd total knee replacement discharge condition: good discharge instructions: you were transferred to this hospital to manage bleeding in your head. the neurosurgeons did not feel you required surgery and you were initially managed by the neurology team. head ct at our hospital confirmed the blood in your brain. this blood did not result in any neurologic changes on examination. we think that your bleed was likely due to falling. during your fall you were on a medication that thins your blood called arixtra- we did not continue this medication. you will need to get an mri of your brain on . you will also need to follow up with dr. in the neurology department. during your hospitalization you were found to have fevers multiple days in a row. you were found to have an infection in your urine that we treated with antibiotics. you also had an infection in your bowel that caused you to have diarrhea, which we also treated with antibiotics. at the time you were discharged you had been without fever for over 48 hours. you were started on a new medication called flagyl to treat you clostridium dificile colitis. you will need to take this for another 13 days after you are discharged. we made the following changes to your medications: your arixtra was stopped. please do not restart this medication until you speak with your primary care physician. lisinopril was changed from 40 mg twice a day to 40 mg daily.(you can discuss this dosing frequency with your primary care physician). your seroquel was stopped becuase you were having some confusion and we did not want to further alter your mental status. you will need to follow up as listed below. if you experience a recurrence of fevers, or have chills, night sweats, chest pain , shortness of breath, or increasing weakness please call your primary care provider or come to the emergency department for evaluation. followup instructions: **mri of head at 1:30 in the **(podiatry): dr. thursday, 1:00 phone number: **(neurology) , md phone: date/time: 10:00 **(medicine)dr. 2:15 procedure: transfusion of other serum diagnoses: anemia of other chronic disease esophageal reflux urinary tract infection, site not specified long-term (current) use of steroids unspecified acquired hypothyroidism diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes other and unspecified hyperlipidemia other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with no loss of consciousness intestinal infection due to clostridium difficile pressure ulcer, buttock rheumatoid arthritis anticoagulants causing adverse effects in therapeutic use other disorders of neurohypophysis knee joint replacement fall from other slipping, tripping, or stumbling delirium due to conditions classified elsewhere disorder of bone and cartilage, unspecified pressure ulcer, stage ii benign essential hypertension arthropathy associated with neurological disorders 

Answer: The patient is high likely exposed to