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: ace inhibitors / gatifloxacin / shellfish derived / hydrocodone/acetaminophen attending: chief complaint: fall, hypotension major surgical or invasive procedure: surgiseal closure of head laceration history of present illness: 87ym with hx of copd, dchf, heart block s/p ppm, dm, and ckd who presented after a fall at nursing home. patient was found down on bathroom floor with copious bleeding from head and staff called ems. patient denied loc. recently hospitalized at va when found fallen in the stairwell after an op appointment at the va. discharged 4 days prior to current presentation with diagnosis of pneumonia. of note, patient had another fall one day after discharge from va. in ed, vitals 99.2, hr 64, bp 108/82, 16, 100% ra. labs showed leukocytosis to 10.1, lactate to 2.4, hct 28.5. sbp dropped to 80s which responded to 2l. head ct, abdomen/pelvis ct, and fast negative for bleeding. forehead laceration from fall bled profusely and sealed with gel foam. on floor he received ceftriaxone and flagyl for presumed pneumonia. was then found to be hypotensive to 80s despite numerous fluid boluses. hct dropped to 23.8. pt endorsed light-headedness, some difficulty breathing, +productive cough x2 weeks (no blood). rofs negative for abd pain, nausea, vomiting, diarrhea, chest pain, dysuria, weakness, numbness, tingling, headache. past medical history: -bladder cancer --hgt1 w/ cis, s/p bcg therapy with subsequent bcg-osis - was found to have suspicious etiology in and subsequently has had three atypical cytologies -heart block s/p ppm -atrial flutter -seborrheic keratosis -squamous cell carcinoma of skin -ckd 4 -senile cataract -hypertension - copd - chf (diastolic) - aaa (s/p endovascular repair) - with bleeding in small intestine during capsule endoscopy - could not identify source. -hyperlipidemia -dm type ii -prostate benign hypertrophy -colonic polyps social history: lives in nursing home x2 years. two children in , one locally in , one in . family history: denies any family history of diseases including blood/bleeding diseases and cancer. physical exam: general appearance: well nourished, no acute distress neuro: alert, oriented, appropriate. symmetric strength and sensation in all 4 extremities. symmetric smile. eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic, dry oral mucosa, large beefy tongue lymphatic: jvp at level of ears with double pulsation. cardiovascular: normal s1 and s2. grade iii holosystolic murmur at llsb which increases on inspiration. peripheral vascular: (right radial pulse: present), (left radial pulse: not assessed), (right dp pulse: not assessed), (left dp pulse: not assessed) respiratory / chest: (expansion: symmetric), (breath sounds: crackles : course, bilaterally at bases, l>r) abdominal: non-tender, bowel sounds present, no(t) tender: , somewhat firm, bruising diffuse at inferior aspect. extremities: right lower extremity edema: absent, left lower extremity edema: absent. extremities warm and dry. skin: warm neurologic: a&o x3attentive, follows simple commands, responds to: not assessed, oriented (to): place, date, time, movement: symmetric in all 4 extremities. pertinent results: 08:16pm glucose-47* urea n-73* creat-2.6* sodium-135 potassium-3.6 chloride-105 total co2-22 anion gap-12 08:50pm lactate-1.4 08:16pm alt(sgpt)-48* ast(sgot)-24 ld(ldh)-195 alk phos-122 tot bili-0.5 08:16pm lipase-268* 08:16pm ck-mb-5 ctropnt-0.14* 08:16pm wbc-14.4* rbc-2.17* hgb-7.4* hct-23.6* mcv-109* mch-34.1* mchc-31.5 rdw-17.2* 08:16pm pt-12.3 ptt-31.1 inr(pt)-1.0 . discharge labs: 06:30am blood wbc-9.4 rbc-3.01* hgb-10.0* hct-30.4* mcv-101* mch-33.4* mchc-33.0 rdw-19.7* plt ct-45* 06:30am blood glucose-149* urean-68* creat-2.3* na-136 k-4.9 cl-106 hco3-19* angap-16 06:30am blood calcium-8.3* phos-3.1 mg-2.3 . studies: cxr reason for exam: heart failure, received fluids. comparison is made with prior study performed the same day in the morning. cardiomediastinal contours are unchanged. small bilateral pleural effusions associated with adjacent atelectasis, left greater than right, are minimally increased from prior. pacer leads remain in place, as is the right picc. there is no pulmonary edema. . r hand xray findings: there is a comminuted fracture of the fifth proximal phalanx. . abd/pelvis ct impression: 1. no evidence of retroperitoneal bleed. 2. stable 5.5 cm infrarenal abdominal aortic aneurysm sac, status post endovascular repair. 3. slightly increased small bilateral pleural effusions and slight increased free fluid in the pelvis. 4. cholelithiasis. . transthoracic echo the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed (lvef= 45-50 %) with mid to distal septal and distal inferior hypokinesis. there is no ventricular septal defect. the rv appears dilated with preserved systolic function.the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. severe tricuspid regurgitation is seen. there is no pericardial effusion. compared with the prior study (images reviewed) of , regional lv systolic dysfunction is now present and the severity of tr has increased. . ct head impression: 1. no acute intracranial abnormality. 2. left frontal scalp laceration and subgaleal hematoma without underlying fracture. 3. bilateral sinus disease with air-fluid levels may indicate acute sinusitis. clinical correlation recommended. . ct spine impression: 1. no acute fracture or malalignment. 2. multilevel degenerative change with mild-to-moderate canal narrowing at c3-4 and c4-5 as above may predispose the patient to cord injury in the setting of trauma. if there is clinical concern for cord injury and there is no contraindication, mri is recommended for further evaluation. 3. unchanged mild compression deformity of c7. brief hospital course: 87 m with mmp, presents s/p fall and hypovolemia admitted to the icu for hypotension. . # hypotension: dropped to 80s in setting of elevated cr, lactate and compressable ivc. after 2l of ns in ed his blood pressure increased to the 110s. stim was normal, so unlikely adrenal insufficiency. no fever or leukocytosis so unlikely sepsis/infection. tsh was normal so not hypothyroidism. patient had echo with worsening ef (45-50%) and lv systolic dysfunction new since so it was felt that his hypotension was likely due to hypovolemia and poor forward flow in the setting of chf. acute mi was ruled out with ce flat x3 (though troponin 0.14 0.12 in setting of arf) he was not given any further fluid but transfused 3 units of prbcs. his blood pressure meds were held and he remained normotensive in the icu. back on the floor his pressures were stable but he was kept off of all anti-hypertensives on discharge. . # head laceration: head lac not actively bleeding and surgiseal was applied in the ed. general surgery was consulted in the icu and said that no further intervention is needed. the laceration will heal and the surgiseal slough off. . # r 5th digit fracture - he was elgvaulated by hand surgery and placed in a splint. advised to keep rue elevated. has hand clinic followup on . to continue pt and ot in rehab. . # macrocytic anemia: hct 28 on arrival and dropped to 23 after icf resuscitation. after two units of prbcs the patient's hct improved to 28 and after a 3rd unit his hct was >30. his retic was checked and was 5.8%. . # heart block s/p ppm, atrial fibrillation: coumadin on med list, but inr 1. coumadin was not restarted given head laceration and high risk of fall. his aspirin was also held per geriatrics recommendations (given chronic thrombocytopenia and history of gi bleeding). he was in atrial fibrillation with a paced rate of 60. his heart rate did not increase in the setting of hypotension, remaining at 60bpm. the ep team interrogated his pacer, finding that he is almost entirely in afib and paced at 60bpm. the pacer's responsiveness feature was activated and the basal rate was raised to 70bpm to hopefully reduce future hypotensive episodes. . # acute on chronic renal failure: cr 3 from baseline 2.3-2.5. after 2l ivf and 2 units prbcs his creatinine 2.1 so likely pre-renal azotemia. creatinine was back at baseline 2.3. . # ? copd: unclear if patient has copd or another underlying lung process. he was continued on his home nebs. . # chf (diastolic): lasix was held in the setting of hypotension. . # dm type ii: patient placed on a diabetic diet and his home insulin regimen. however, serum glucose in the am was 62 and he was taking poor pos so his nph was cut in half and he was continued on ssi. he was returned to his usual insulin dose for discharge. . # ? health care associated pneumonia - the patient was started on antibiotics (vancomycin and cefepime) while in the icu out of concern for pneumonia. course began on . these were then taped to ceftriaxone on , which was switched to cefpodoxime on discharge to complete a 10 day course ending . . # code - dnr/i, confirmed medications on admission: advair 25/50 1 puff spiriva 18mcg inhaler forticort nasal spray zocor 10mg po qhs effexor 75mg po qd remeron 50mg po qd asa 81mg po qd isordil 10mg tid lasix 100mg po qd colace 200mg po qd neurontin 200mg tid senna 1 tablet po bid colace 200mg po qd lactulose 10g/50ml??????20ml po qd insulin nph 15u qam regular insulin sliding scale qac &hs calcitonin ambien 5mg qpm discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer treatment inhalation q6h (every 6 hours) as needed for sob. 2. calcitonin (salmon) 200 unit/actuation aerosol, spray sig: one (1) spray nasal daily (daily): alternating nostrils. 3. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) puff inhalation (2 times a day). 4. gabapentin 400 mg capsule sig: one (1) capsule po q24h (every 24 hours). 5. lactulose 10 gram/15 ml solution sig: thirty (30) ml po once a day. 6. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 7. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 8. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 9. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 10. venlafaxine 37.5 mg capsule, sust. release 24 hr sig: two (2) capsule, sust. release 24 hr po daily (daily). 11. zolpidem 5 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 12. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain, fever. 13. bisacodyl 5 mg tablet sig: two (2) tablet po once a day as needed for constipation. 14. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day) as needed for heartburn. 15. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 16. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day). 17. multivitamin tablet sig: one (1) tablet po daily (daily). 18. nph insulin human recomb 100 unit/ml suspension sig: fifteen (15) units subcutaneous qam. 19. insulin regular human 100 unit/ml solution sig: as directed units injection qachs: please take per sliding scale. 20. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 21. cefpodoxime 200 mg tablet sig: one (1) tablet po once a day for 6 days: course to end on . 22. erythromycin 5 mg/g ointment sig: one (1) drop ophthalmic qid (4 times a day). 23. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed) as needed for dry eyes. discharge disposition: extended care facility: of discharge diagnosis: primary diagnosis: hypotension secondary to volume depletion, bleeding and possible sepsis secondary diagnoses: health-care associated pneumonia discharge condition: mental status: subacute delirium level of consciousness: alert, oriented to person and place activity status: out of bed with assistance to chair or wheelchair discharge instructions: you were admitted to the hospital after falling and cutting your head. the cut on your head was covered and your broke your finger, requiring a splint. you lost a lot of blood, requiring a total of 3 blood transfusions. your blood pressure was low, and you received several liters of fluid. you are now ready to go back to rehab and work on getting strong. . some changes were made to your medications: - your blood pressure medications (are being held to prevent further hypotension or low blood pressure) - your coumadin (blood thinner) is also being held - you are being given a course of antibiotics to end on weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: you will be seen by the doctors at your rehab facility. . follow-up in hand clinic on tuesday, . call the hand clinic at to make the appointment. procedure: venous catheterization, not elsewhere classified artificial pacemaker rate check diagnoses: pneumonia, organism unspecified mitral valve disorders congestive heart failure, unspecified acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation unspecified fall hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) pulmonary collapse open wound of forehead, without mention of complication hypotension, unspecified personal history of other malignant neoplasm of skin long-term (current) use of anticoagulants personal history of malignant neoplasm of bladder cardiac pacemaker in situ calculus of gallbladder without mention of cholecystitis, without mention of obstruction hypovolemia accidents occurring in residential institution chronic diastolic heart failure closed fracture of middle or proximal phalanx or phalanges of hand 

Answer: The patient is high likely exposed to