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 / sulfa (sulfonamide antibiotics) / aspirin attending: chief complaint: right hip fracture major surgical or invasive procedure: endotracheal intubation central venous catheter placement intramedullary rod fixation of right peritrochanteric hip fracture history of present illness: ms. is a 60yo f w/hx of cad s/p imi pci to lcx , chf w/ef 20% s/p aicd, copd on 2l home o2, sle, scleroderma, recurrent c. diff who presents as a transfer from for hip fracture. she was previously admitted for c. diff pancolitis, discharged on on po vancomycin. during that stay she had a ct scan showing pancolitis. while walking into the house on , she tripped and fell off of 2 stairs. no loc. she was taken to were she was found to have a r intertrochanteric hip fracture which was displaced. she was evaluated by orthopedics and cardiology who recommended transfer to hospital for more sophisticated intraoperative cardiac monitoring and higher level postoperative surgical icu. . on arrival, she is somnolent and complaining of pain in the r hip. she denies chest pain, shortness of breath, fever. she has mild abdominal pain. per her husband and daughter, she has been having several () bms per day with some blood in the stool. otherwise, no complaints. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: - cad s/p imi, cardiac cath with pci to lcx, minor irregularities in lad and rca territories - chf, ef in was 55%, ef was 30%, ef 20%, thought to be due to systemic sclerosis - s/p aicd for low ef - severe pulmonary hypertension - systemic sclerosis with ischemia to l index finger with osteomyelitis - multiple episodes of c. diff diarrhea while on antibiotics - stress test without active ischemia - severe raynaud's syndome - sle/crest - copd on 2l oxygen, ? scleroderma lung disease - s/p rhc to evaluate response to vasodilator therapy, no response, pap 100mm hg, cardiac index 2l/min - gerd - occipital neuralgia - sbo/lysis of adhesions - meningitis , treated with braod-spectrum abx and developed c. diff social history: 25 pack year smoking history, quite smoking 11 years ago, no prior alcohol use. family history: nc, no history of autoimmune disease. physical exam: vs: 98.4 bp131/73 hr 97 94%on 4l general: appears older than stated age, lying in bed in nad heent: no scleral icterus. perrla/eomi. mmm. op clear. neck supple, no lad. cardiac: rr. normal s1, s2. no m/r/g. lungs: limited to due patient positioning and body habitus but clear anteriorly. abdomen: +bs. tender to palpation diffusely without rebound or guarding. non-distended. well-healed surgical scar in lower right abdomen. extremities: r hip rotated. 2+ peripheral pulses bilaterally in dp and pt. no edema. fingers demonstrate scleroderma changes. acrocyanosis of fingers and toes. neuro: alertness waxes and wanes through intervies. cn 2-12 grossly intact. pt unable to follow commands to squeeze fingers but able to move legs. unable to assess sensation as pt does not follow commands. pertinent results: discharge labs: 03:05am blood wbc-12.3* rbc-3.44* hgb-9.7* hct-30.7* mcv-89 mch-28.3 mchc-31.8 rdw-17.8* plt ct-352 03:05am blood glucose-101 urean-27* creat-0.9 na-146* k-3.8 cl-114* hco3-25 angap-11 04:06am blood alt-25 ast-39 ld(ldh)-254* alkphos-34* totbili-0.3 03:05am blood calcium-7.5* phos-1.8* mg-2.1 . micro: 3:08 am urine source: catheter. **final report ** urine culture (final ): klebsiella pneumoniae. >100,000 organisms/ml.. escherichia coli. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | escherichia coli | | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s <=2 s cefazolin------------- <=4 s <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s cefuroxime------------ <=1 s <=1 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s nitrofurantoin-------- 64 i <=16 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s <=4 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s . radiology: axr : abdomen, single view: bowel gas pattern is non-obstructive. there is interval improvement of small bowel dilatation as compared to . there is no evidence of pneumoperitoneum. air is visualized in the rectum. an ng tube is coiled in the stomach. scattered phleboliths are seen in the right hemipelvis. a gamma nail in the right femoral head is partially visualized. impression: no evidence of bowel obstruction. . cxr : findings: the support lines and tubes are unchanged. the evaluation is limited by motion. moderate cardiomegaly is unchanged. the lung volumes remain low, with right infrahilar and left retrocardiac atelectasis. small left effusion may be present. there is no pulmonary edema. . ct head : findings: there is no intracranial hemorrhage, edema, mass effect or vascular territorial infarction. ventricles and sulci are large bilaterally, consistent with global parenchymal volume loss. periventricular white matter hypodensities are also bilateral, the sequela of chronic microvascular ischemia. extracranial soft tissue structures are unremarkable. the included mastoid air cells are notable for partial opacification of the mastoid air cells on the right/underpneumatization. the visualized paranasal sinuses are clear. impression: 1. no acute intracranial hemorrhage. 2. partial opacification of the right mastoid air cells . echo : the left atrium is dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is small and underfilled. regional left ventricular wall motion is normal. there is mild global left ventricular hypokinesis (lvef = 50-55%), although in the context of a small cavity size, this may be slightly underestimated. the right ventricular free wall is hypertrophied. the right ventricular cavity is markedly dilated with severe global free wall hypokinesis. there is abnormal systolic septal motion/position consistent with right ventricular pressure overload. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. moderate tricuspid regurgitation is seen. there is severe pulmonary artery systolic hypertension. there is no pericardial effusion. impression: dilated, hypertrophied and markedly hypokinetic right ventricle. small left ventricle with mild systolic dysfunction. moderate tricuspid regurgitation. severe pulmonary hypertension. . femur x-ray six fluoroscopic images of the right femur demonstrate interval placement of an intramedullary rod with proximal gamma nail. this is fixating an intertrochanteric fracture of the right femur. there is good anatomic alignment and no hardware-related complications. the total intraservice time was 99 seconds. brief hospital course: assessment and plan: 60f with cad s/p imi, severe pulmonary htn c/b r heart failure, chronic lv diastolic dysfunction, sle, scleroderma, copd on home o2 admitted after r hip fracture now s/p orif, admitted to micu for respiratory failure and multifactorial distributive shock. #distributive shock: this was felt to by multifactorial including volume depletion and sepsis from uti, c. diff. she briefly required pressors. she was treated initially with vanc/cefepime and flagyl/po vanc for c. diff. when urine culture results returned, patient was changed to cipro according to sensitivity data to complete 7 day course . #respiratory failure: she was difficult to extubate due to severe pulmonary hypertension, copd, and volume overload with svt. she was treated for her pulmonary hypertension with her home regimen of sildenafil and bosentan when her bp stabilized. she was finally successfully extubated on . she is now satting 97% on 2l nc. she has a home o2 requirement of 2l. #mat vs sinus arrhythmia: metoprolol was uptitrated to 100 mg with good effect. there is no indication for therapeutic anticoagulation as unlikely to be fib/flutter. #pulmonary htn c/b r heart failure: tee showed dilated, hypertrophied, hypokinetic rv on tte. she was diuresis with iv lasix 20-40 mg prn to decrease burden on rv. she was continued on her outpt regimen of sildenafil and bosentan. #r hip fracture: she underwent r orif on . she was started on lovenox. #c. difficile infection: she was started on po vanco. she will continue for another 2 weeks after last dose of abx (through ) and then taper to 125mg po qid x 14 days, 125mg po bid x 1, 125mg daily x 1 week, 125mg qod x 1 week, 125mg q3 days x 2 weeks; no evidence of megacolon #cad s/p pci to lcx: she was continued on asa, statin, and bb. her plavix was discontinued given her post-op and since her pci was in . #sle: she was continued on hydroxychloroquine. fingers and toes demonstrate chronic acrocyanosis. medications on admission: medications on transfer: dilaudid prn pain revatio 20mg po tid spiriva 1 inhalation daily advair 500/50 1 puff metoprolol 75mg po bid plavix 75mg po qday gabapentin 600mg po tid lipitor 40mg po qday omeprazole 20mg po qday aspirin 81mg po qday lisinopril 2.5mg po qday tracleer 125mg po qday lasix 20mg po tid kcl 20meq po qday plaquenil 200mg po bid elavil 50mg po qday vancomycin po 125mg qid . home medications (per admission h&p at ) same as discharge meds discharge medications: 1. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical qday () as needed for r hip. 2. ciprofloxacin 250 mg tablet : one (1) tablet po q12h (every 12 hours) for 4 days. 3. enoxaparin 40 mg/0.4 ml syringe : one (1) injection subcutaneous daily (daily). 4. metoprolol tartrate 50 mg tablet : two (2) tablet po bid (2 times a day). 5. oxycodone 5 mg/5 ml solution : five (5) mg po q6h (every 6 hours) as needed for right hip pain: hold for rr<12, oversedation. 6. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inh inhalation q6h (every 6 hours) as needed for wheezing/sob. 8. ipratropium bromide 0.02 % solution : one (1) inh inhalation q6h (every 6 hours). 9. bosentan 125 mg tablet : one (1) tablet po bid (2 times a day). 10. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 11. senna 8.8 mg/5 ml syrup : one (1) tablet po bid (2 times a day) as needed for constipation. 12. docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po bid (2 times a day). 13. sildenafil 20 mg tablet : one (1) tablet po tid (3 times a day). 14. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 15. atorvastatin 40 mg tablet : one (1) tablet po daily (daily). 16. hydroxychloroquine 200 mg tablet : one (1) tablet po bid (2 times a day). 17. vancomycin 125 mg capsule : one (1) capsule po q6h (every 6 hours): please continue vancomycin orally (by mouth) 125 mg twice daily through monday, , followed by 125 mg daily x 1 week, then 125 mg every other day x 1 week, then 125 mg every 3 days for 2 weeks. 18. acetaminophen 160 mg/5 ml solution : 325-650 mg po q6h (every 6 hours) as needed for fever. discharge disposition: extended care facility: shaugnessy- discharge diagnosis: primary 1) hypoxemic respiratory failure 2) septic shock 3) acute complicated cystitis 4) clostridium dificile colitis 5) right peritrochanteric hip fracture secondary 1) pulmonary hypertension 2) supraventricular tachycardia 3) chronic obstructive pulmonary disease 4) systemic lupus erythematosus 5) raynaud's phenomenon discharge condition: clinically improved with stable vital signs on supplemental oxygen (2l via nc) discharge instructions: you were admitted to the hospital with a right hip fracture which was surgically repaired. there was difficulty getting you off of the ventilator probably because of your history of pulmonary hypertension and chronic obstructive pulmonary disease. you also had low blood pressures that were likely from c. dificile colitis and urinary tract infections. you were also noted to have an irregular heart rhythm, that was likely exacerbated by your infections, and your home metoprolol dose was increased (100 mg twice daily) please continue taking the antibiotic ciprofloxacin through . please continue vancomycin orally (by mouth) 125 mg twice daily through monday, , followed by 125 mg daily x 1 week, then 125 mg every other day x 1 week, then 125 mg every 3 days for 2 weeks. followup instructions: please ensure that a follow-up appointment is arranged with your primary care physician 1 week of discharge from the rehab facility. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart insertion of endotracheal tube closed reduction of fracture with internal fixation, femur diagnoses: systemic lupus erythematosus anemia, unspecified coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified severe sepsis chronic airway obstruction, not elsewhere classified other chronic pulmonary heart diseases percutaneous transluminal coronary angioplasty status other specified cardiac dysrhythmias septic shock intestinal infection due to clostridium difficile chronic systolic heart failure automatic implantable cardiac defibrillator in situ other septicemia due to gram-negative organisms septicemia due to escherichia coli [e. coli] fall from other slipping, tripping, or stumbling raynaud's syndrome volume depletion, unspecified closed fracture of intertrochanteric section of neck of femur systemic sclerosis psychic factors associated with diseases classified elsewhere 

Answer: The patient is high likely exposed to