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: no known allergies / adverse drug reactions attending: chief complaint: hypoxia posterior hip dislocation major surgical or invasive procedure: reduction of left posterior hip dislocation picc line insertion history of present illness: 78m with hx of cabg in , cad, dm hx of hip frequent dislocation of artificial l hip, tripped over rug in apartment and fell, no head strike or loc. he felt hip out. in the ed, initial vs were:97.3 108 144/75 16, no o2 sat recorded, 3l nc(recorded).however resident noted patient to be tachypneic at 35 hypoxic to 50. patient did note several hours of shortness of breath today upon further questioning. cxr showed r pulmonary edema vs infiltrate, placed on nrb, then sats to mid90s-100. a ct scan was negative for pe, but did show right sided pneumonia, possible aspiration. patient noted to have elevated lactate 4.4. wbc 2.8 with n:59.5 l:33.2 m:5.4 e:0.9 bas:1.0. vanc/zosyn/levoflox given. trop of 0.05. ekg: sinus 92 na, iv conduction delay st depression i and avl. . in ed, ortho consulted and patient had procedural sedation with with fent (100)/versed (4) hip successfully reduced in ed. reversed sedation with flumazenil (0.2)/narcan (2), got 2l iv fluids for the lactate. . on arrival to the micu, patient's vs. 97.7/ 81/112/69/13 100% nrb. on recheck 91% on ra. 97% on 2l. patient denied any chest pain/sob. feels very well and is surprised to be admitted. past medical history: coronary artery disease status post cabg, diabetes recently stopped glyburide and metformin per his doctor , muscle weakness, nos spinal stenosis, lumbar mitral insuf/aort stenos pvd, nos hl social history: social history: lives by himself. has a home care nurse s every 2 weeks. uses a walker or cane and scooter when out of apartment. no smoking, no alcohol, no rec drugs. has a niece who lives in (cell) (work) is hcp according to patient. family history: family history: father with mi in 50s. brother with mi in 50s. no history of cancer physical exam: vitals: 97.7/ 81/112/69/13 100% nrb general: alert, oriented x3, no acute distress, nrb in place heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, holosystolic murmur radiates to both axilla and carotids, rubs, gallops lungs:rales in bilateral lung bases r>l., no wheezes, occasional ronchi abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred. left leg in knee immobilizer pertinent results: admission 09:45am blood wbc-2.8* rbc-3.81* hgb-10.3* hct-35.3* mcv-93 mch-27.2# mchc-29.3*# rdw-14.1 plt ct-144* 07:36am blood hct-28.4* 12:05pm blood hct-29.7* 09:45am blood pt-10.4 ptt-25.9 inr(pt)-1.0 04:24am blood plt ct-100* 09:45am blood neuts-59.5 lymphs-33.2 monos-5.4 eos-0.9 baso-1.0 04:24am blood ret aut-2.4 09:45am blood glucose-322* urean-23* creat-0.6 na-139 k-4.0 cl-98 hco3-29 angap-16 04:24am blood glucose-113* urean-14 creat-0.4* na-138 k-4.0 cl-104 hco3-30 angap-8 09:45am blood ck(cpk)-216 03:57pm blood alt-29 ast-46* ld(ldh)-225 ck(cpk)-482* alkphos-51 totbili-0.3 08:54pm blood ck(cpk)-516* 04:24am blood ld(ldh)-214 ck(cpk)-395* totbili-0.3 12:05pm blood ck(cpk)-379* 09:45am blood ck-mb-8 09:45am blood ctropnt-0.05* 03:57pm blood ck-mb-15* mb indx-3.1 ctropnt-0.34* 08:54pm blood ck-mb-15* mb indx-2.9 ctropnt-0.37* 04:24am blood ck-mb-11* mb indx-2.8 ctropnt-0.25* 12:05pm blood ck-mb-10 mb indx-2.6 ctropnt-0.19* 04:24am blood calcium-8.3* phos-3.0 mg-2.0 04:24am blood hapto-48 04:18pm blood type- ph-7.29* comment-green top 04:18pm blood lactate-0.9 09:56am blood lactate-4.4* 04:18pm blood freeca-1.02* 11:45am urine color-yellow appear-clear sp -1.029 11:45am urine blood-neg nitrite-neg protein-30 glucose-1000 ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-neg 11:45am urine rbc-3* wbc-1 bacteri-none yeast-none epi-0 11:45am urine casthy-1* 11:45am urine mucous-rare discharge 06:15am blood wbc-1.9* rbc-3.33* hgb-8.9* hct-29.1* mcv-87 mch-26.8* mchc-30.6* rdw-13.9 plt ct-125* 06:05am blood neuts-58.9 lymphs-29.5 monos-9.1 eos-2.2 baso-0.4 06:15am blood esr-15 06:15am blood glucose-126* urean-11 creat-0.5 na-141 k-3.6 cl-99 hco3-33* angap-13 06:05am blood alt-23 ast-28 ld(ldh)-225 alkphos-63 totbili-0.3 06:15am blood calcium-8.8 phos-3.8 mg-2.3 06:15am blood crp-5.8* micro blood culture, routine (preliminary): sensitivities requested by dr. () on . viridans streptococci. of two colonial morphologies. isolated from only one set in the previous five days. anaerobic bottle gram stain (final ): reported to and read back by dr. . rose on at 0145. gram positive cocci in pairs and chains. - blood cxs are no growth to date chest (portable ap) study date of 9:47 am impression: increased hazy opacity in the right lung, predominantly in the right greater than left base, which could represent asymmetric edema versus aspiration or infection. no pneumothorax. no laboratory data is available at the time of interpretation, which should be correlated as well as with clinical presentation. hip unilat min 2 views left port study date of 10:13 am impression: findings consistent with posterior dislocation of the prosthetic femoral head from the acetabular cup. cta chest w&w/o c&recons, non-coronary study date of 11:04 am impression: 1. bilateral lower lobe consolidations, likely reflecting pneumonia and/or aspiration, worse on the right. 2. right upper lobe and left apical ground-glass opacities, with neighboring smooth septal wall thickening, likely reflecting combination of inflammation/infection and mild edema. 3. no pulmonary embolus detected to the subsegmental levels. no acute dissection. 4. mildly prominent left para-aortic lymph node/ portable tte (complete) done at 9:53:07 am conclusions the left atrium is mildly dilated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is probably normal (lvef~55%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the ascending aorta is mildly dilated. the aortic valve leaflets are severely thickened/deformed. there is moderate to severe aortic valve stenosis (valve area ~1.0cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. there is no pericardial effusion. chest (portable ap) study date of 7:59 am findings: as compared to the previous radiograph, there is marked improvement of the pre-existing right parenchymal opacity. on the left, there is unchanged evidence of moderate retrocardiac atelectasis, potentially combined to a minimal left pleural effusion. unchanged status post cabg with stable size of the cardiac silhouette and stable sternal wires. pelvis ap there is some relocation of the left total hip arthroplasty. there is some asymmetric positioning of the femoral head suggestive of polyethylene liner wear with the femoral head positioned slightly more superolaterally within the center. no periprosthetic fractures are seen. vascular calcifications are present. brief hospital course: 78m with hx of cad s/p cabg, l tha with left hip dislocation s/p reduction, here with hypoxia in setting of likely pneumonia/aspiration. . active issues . #aspiration pneumonia with strep viridans bacteremia. patient presented with dyspnea, elevated lactate, hypoxia, and cxr/ct with evidence of pneumonia vs aspiration pneumonitis. patient initially received vancomycin, levofloxacin, and ceftriaxone for likely community-acquired v aspiration pna. he was initially admitted to the micu as he required a non-rebreather but he was quickly transitioned to nasal cannula and sent to the floor. he continued to improve clinically, remaining afebrile and without leukocytosis or an oxygen requirement. one of 4 blood cultures was postive for gram positive cocci, so vancomycin was also started. when the blood culture speciated to streptococcus viridans, vancomycin was discontinued and he was kept on ceftriaxone and levofloxacin. tee could not be performed to rule out endocarditis due to his tenuous aortic valve but as patient appeared clinically well and had a very low-grade bacteremia (only one positive culture out of many bottles), crp/esr were low and tte was negative for vegetations, there was a low suspicion for endocarditis so id recommended he be treated for two weeks of iv antibiotics for his bacteremia until . patient was discharged on oral levofloxacin as well to cover for atypical organisms. . #elevated troponin. presented with troponin of 0.05 that peaked at 0.37. cardiology was consulted who felt this was due to demand ischemia in the setting of his fall. patient was without chest pain throughout his stay. ekg showed no acute changes only borderline st depressions in i and avl. he was placed on asa, metoprolol 12.5mg , and continued on his statin. cardiology agreed with plan, and recommended considering an ace-i, however his outpatient cardiologist did not want to start it. patient remained chest pain free with stable ekgs throughout his stay. . #left hip dislocation. patient with total hip arthroplasty of left hip many years ago and has had multiple dislocations in past, this presentation is similar to his previous. it was reduced successfully in the ed. patient was initially placed in a lower lumbar to hip brace by orthopedics with restrictions on movement that were gradually loosened. at the time of discharge they recommended keeping him in the brace when out of bed only and with a maximum of 70 degrees hip flexion. at night, he should wear an abduction pillow. they recommended he continue in these braces until his hip can be evaluated for surgical repair. . chronic issues . #aortic stenosis: tte on this admission showed severe as (valve area 1.0cm2) with otherwise preserved ef. . #dm. maintained on insulin sliding scale in house. diet-controlled. . #htn. continued lasix 20mg daily, switched atenolol 12.5mg daily to metop 12.5 . . #hl. continued rosuvastatin 5mg daily . #gerd. continued omeprazole 20mg daily. . # melanoma: followed at va. was scheduled for biopsy this week which he missed due to this hospitalization. he is to follow-up with dermatology next week here at for an urgent appointment. . transitional issues - given his severe aortic stenosis, patient will likely require cardiac evaluation to determine whether he is a candidate for hip surgery - patient will need follow-up for his melanoma. we have arranged an appointment for him at for next week for biopsy. - patient will require repeat blood cultures two weeks after he has completed his antibiotic course to make sure his infection has cleared medications on admission: lasix 20mg qday multivitamin qday omeprazole 20mg qday atenolol 12.5mg qday calcarb 600 with vitamin d 1tab qday lactulose 10g/15ml 1tblespoon as needed for constipation ecotrin 81mg qday tylenol 650 qday rosuvastatin 5mg qday discharge medications: 1. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 2. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 3. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain/fever. 6. levofloxacin 750 mg tablet sig: one (1) tablet po daily (daily) for 3 days. 7. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 8. rosuvastatin 5 mg tablet sig: one (1) tablet po daily (daily). 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 10. lactulose 10 gram/15 ml solution sig: one (1) po once a day as needed for constipation. 11. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 12. ceftriaxone in dextrose,iso-os 1 gram/50 ml piggyback sig: one (1) unit intravenous q24h (every 24 hours) for 10 days. discharge disposition: extended care facility: newbridge on the - discharge diagnosis: primary hip dislocation aspiration pneumonia demand ischemia . secondary htn hl aortic stenosis coronary artery disease 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 mr. , you were admitted to because you fell, dislocated your hip, and were found to have trouble breathing. your hip was put back into place by our orthopedic surgeons who felt you should wear a brace to help keep your joint in place. you will likely require surgery to repair this hip. we have scheduled appointments with an orthopedic surgeon to evaluate your hip. you will need to talk to your cardiologist to determine whether you are a good candidate for surgery given your narrow aortic valve. your shortness of breath was thought to be due to some accidental swallowing of your stomach contents during your fall. we treated you with antibiotics and your breathing improved quickly. however, some bacteria was found in your blood, likely coming from this infection in your lungs. as a result you will need to be on intravenous antibiotics to make sure that all the bacteria in your blood is gone. for the lesions on your nose, we have arranged for the dermatologists to see you next week to determine whether it is melanoma. please bring your records from the va with you to this appointment. the following medications were changed during this hospitalization: start ceftriaxone intravenously for a total of two weeks to end on start levofloxacin until stop atenolol and start metoprolol 12.5mg twice a day . please continue your other medications as previously prescribed followup instructions: the doctor at rehab will follow-up this hospitalization. they will schedule you for an appointment with your pcp upon discharge. department: orthopedics when: thursday at 11:10 am with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: orthopedics when: thursday at 11:30 am with: , md building: sc clinical ctr campus: east best parking: garage department: dermatology when: thursday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage please bring your dermatologic records from the va to this appointment if possible. procedure: venous catheterization, not elsewhere classified closed reduction of dislocation of hip diagnoses: anemia, unspecified esophageal reflux unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status aortic valve disorders unspecified fall other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus bacteremia streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus hip joint replacement other acute and subacute forms of ischemic heart disease, other melanoma of skin, site unspecified dislocation of prosthetic joint 

Answer: The patient is high likely exposed to