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: shellfish derived attending: chief complaint: fall with intracranial bleed major surgical or invasive procedure: none history of present illness: year old female with history of afib on warfarin, dmii, pvd, htn, tiax2, hl, cki, severe pulmonary htn presents s/p fall with head trauma resulting in bitemporal iph and sah. patient reports that she was reaching for something while seated in her wheelchair and fell forward striking the left side of her face on a table and then the floor. she reports no loss of consciousness. felt slightly dizzy prior to the fall, had some sensations of palpitations. denies any headache, loc, n/v, chest pain or blurred vision. . in the ed, initial vs were: 98.5, 81, 156/83, 20, 98% ra. patient received ct of head which showed bilateral sylvian fissure sah. ct maxilla found a non displaced fracture of the left anterior maxilla. patient was initially collared, but c-spine was subsequently cleared with ct. neurosurgery evaluated the patient in the ed, did not recommend emergent neurosurgical intervention. patient was loaded with dilantin 1 g iv. for a supratherapeutic inr of 3.6, patient was given 2 units of ffp as well as vitamin k 10 mg iv. patient was admitted to the micu for close monitoring. per ed report, patient was speaking clearly, awake, not confused, prior to transport. vital signs prior to transfer were: 88, 137/77, 19, 95% 2l. . in the micu, patient is awake but fatigued, alert and oriented to person place and time. complains of a little bit of pain in her left face, but says that it does not bother her unless she presses on it. past medical history: - atrial fibrillation, on coumadin - type 2 diabetes, on insulin lantus with hemoglobin a1c 8.6 in - pvd status post transmetatarsal amp in for ischemic ulcer and high-grade right ras and included left internal iliac artery with occlusion noted in the sfa as well as at the popliteal trifurcation. - hypertension - history of breast cancer, status post left mastectomy - mgus followed by dr. - history of tia in and likely tia in - hyperlipidemia - obesity - chronic renal insufficiency - baseline creatinine ~2 recently - severe pulmonary hypertension with rv hypertrophy by tte - s/p left bka - s/p bilateral cateract surgery social history: the patient lives with daughter and granddaughter. she does not smoke nor use any alcohol. she has skilled nursing and home health aides. family history: htn, dmii physical exam: admission physical exam: vitals: 96.4, 120/49, 92, 18, 85% ra general: aaox3, nad, comfortable, fatigued but easily arousable, cooperative with exam heent: bilateral surgical pupils, eomi, left periorbital swelling, slight tenderness to palpation over left maxilla, poor dentition, clotted blood in left upper mouth, no active bleeding, neck supple, no c-spine tenderness, no jvd, no lad cv: s1s2, irregularly irregular, no m/r/g chest: cta b/l, no w/r/r abdomen: soft, nd, nt, +bs ext: left bka, no e/c/c, 1+ peripheral pulse in right le neuro: normal affect, aaox3, good recall, able to recall 3 objects at 5 minutes, fluent speech. cn ii-xii intact, with exception of poor hearing in left ear. unable to evaluate pupillary response as they are surgical. 5/5 strength in ues and rle. sensation intact pertinent results: admission labs: . 03:50pm pt-34.9* ptt-33.4 inr(pt)-3.6* 03:50pm plt count-279 03:50pm neuts-77.0* lymphs-14.2* monos-5.7 eos-1.5 basos-1.5 03:50pm wbc-6.7 rbc-4.22 hgb-12.6 hct-38.5 mcv-91 mch-29.9 mchc-32.8 rdw-14.9 03:50pm ctropnt-0.01 03:50pm glucose-167* urea n-47* creat-1.8* sodium-136 potassium-9.3* chloride-106 total co2-26 anion gap-13 05:54pm k+-4.7 05:57pm urine rbc-* wbc->50 bacteria-many yeast-none epi-0 05:57pm urine blood-sm nitrite-pos protein-75 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 05:57pm urine color-yellow appear-hazy sp -1.013 . microbiology: . urine cx: > 100.000 organisms e. coli sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s . urine cx: no growth . blood cx: staphylococcus, coagulase negative | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- =>32 r tetracycline---------- 2 s vancomycin------------ 1 s . blood cx: no growth to date. . blood cx: gram positive cocci (see above for speciation and sensitivities). . imaging: . ct head w/o contrast: bilateral sylvian fissure subarachnoid hemorrhages. no fractures. . ct head w/o contrast: 1. multiple areas of subarachnoid hemorrhage that appeared to be resolving. this is most pronounced at the site of hemorrhage seen in the perimesencephalic cistern. 2. no evidence of new foci of hemorrhage. . ct sinus/mandible: non-displaced fracture of the anterior left maxilla with possible involvement of the root of the corresponding canine tooth. there is associated with soft tissue swelling. . ct c-spine: no fractures or malalignments. mild degenerative change with posterior osteophytes causing mild narrowing of the central canal. this increases the risk of cord injury, not assessed by noncontrast ct. if clinical concern for such injury is maintained, mri is indicated. . cxr: marked aortic tortuosity with widening of the superior mediastinum as noted previously. if there is clinical concern for aortic injury based upon mechanism or other clinical signs, cross-sectional imaging is advised. . r lower extremity ultrasound: no evidence of dvt. . echo: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the right ventricular cavity is mildly dilated with borderline normal free wall function. 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 masses or vegetations are seen on the tricuspid valve, but cannot be fully excluded due to suboptimal image quality. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . compared with the prior study (images reviewed) of , right ventricular function appears mildly reduced. there is no evidence of endocarditis on this technically limited study. the severity of mtiral regurgitation and tricuspid regurgitation are reduced. . brief hospital course: f with afib on warfarin, htn, dmii, hl, pvd, presents s/p fall with bitemporal sah . #. intracranial bleed: patient found to have bilateral subarachnoid hemorrhages in setting of fall and supratherapeutic inr. inr 3.6 on admission to ed, written to receive 2 units of ffp and 10 mg iv vitamin k for inr reversal, with goal <1.4. evaluated by neurosurgery, no need for urgent surgical intervention. on admission, patient with clear mental status, no neurological defects. was loaded with dilantin 1000 mg in ed for seizure prophylaxis, and continued on dilantin 100mg tid x 7 days (completed on ). sbp was maintained < 160. repeat ct head on showed resolving bleed. patient is instructed to hold all anticoagulation and antiplatelet therapy until her scheduled follow up with dr. in clinic. . # fevers: patient developed fever of 101.2 f on . she proceeded to have low grade temperatures of 99-100 f over the next two days. repeat ua and urinalysis were negative, cxr showed no focal consolidation, lower extremity ultrasound was negative for dvt. she denied any localizing symptoms. her blood cultures from returned with coagulase negative staph and empiric vancomycin was started. surveillance cultures showed an additional blood culture from positive for coagulase negative staph. due to two positive blood cultures on different days this was deemed to be a true bacteremia. she was continued on vancomycin. after four days of negative blood cultures a picc line was placed on . echo was performed on showing no evidence of endocarditis. vancomycin trough was measured on and was subtherapeutic. her vancomycin dose was increased on to 1 gram iv q24h. patient should continue vancomycin for a total of 14 days with last day being . please recheck vancomycin level prior to dose on to ensure patient is receiving adequate levels. her cbc and renal function should be monitored once a week while on this medication. . # lethargy: likely multifactorial: initiation of phenytoin (completed 7 day course on ), infection (though cxr, ua, and physical exam were unrevealing), sequellae from recent head bleed, daytime somnolence from osa, or hypoactive delirium given age, prolonged immobility, hospitalization, and underlying dementia. daughter is very concerned that her elevated glucose during admission is responsible for her lethargy (blood glucose 150-300) though this seems unlikely. abg ruled out hypercapnea. her lack of focal neurologic deficits makes embolic stroke less likely. ct head performed on without evidence of new bleeding. no witnessed convulsions or involuntary movements to suggest seizures. glucose and electrolytes within normal range during episodes. patient's concurrent fevers and bacteremia (see above) were likely major contributors as her mental status intermittently improved with antibiotics. patient continues to have extended periods of somnolence when in bed during the day, but with loud voice and tactile stimuli she arouses and oriented x 3. strongly recommend getting patient out of bed during the day and using her glasses and hearing aids at all times to help prevent delirium. . # a fib: inr supratherapeutic on admission at 3.6. not on any rate control agents at home. per neurosurg recs, inr kept <1.4 given intracranial bleed. warfarin and aspirin held. patient is not to restart these medications until she has been fully reevaluated in follow up at clinic. . # maxillary fracture: nondisplaced left maxilla fracture. also left upper teeth slightly loose. without much discomfort on exam. plastic surgery team evaluated the patient at admission, nothing to do acutely. dental consult obtained, said recommended oral surgery referral for diffusely poor dentition to discuss option of tooth extraction. recommend that patient readdress the option of tooth extraction with her primary care provider who can refer her to local oral surgeons. . # htn: patient's blood pressure remained stable on home lisinopril 10 mg daily. patient's blood pressure was monitored closely to maintain pressures < 160/100 to prevent rebleeding. . # uti: patient described symptoms of dysuria for 2-3 days prior to presentation.. ua with bacteria and >50 wbc, urine culture grew pansensitive e. coli. patient was treated with three days of ciprofloxacin. follow up urine culture showed no growth of bacteria. . # dmii: hba1c 7.3 in 3/. per daughter she has not taken any insulin at home for the last 4 months as she is managed with a strict diabetic diet at home. patient had persistently elevated sugars during this admission and required sliding scale insulin for coverage. recommend close monitoring and continued sliding scale during her rehabilitation. her daughter is adamant that patient should not receive any juice or fruit (despite carbohydrate counting). . # hyperlipidemia: continued on home simvastatin. . # ckd: baseline creatinine 1.7-1.8. patient's creatinine remained stable throughout admission and was 1.6 on day of discharge. . # osa: no formal diagnosis prior to admission. icu monitoring on presentation showed intermittent apnea and desatting to mid 70s while asleep. habitus also strongly suggestive of osa. patient's facial fracture prohibits cpap. she was maintained on supplemental oxygen via nasal cannula overnight while sleeping. . # code status: full (confirmed with health care proxy) . # emergency contact: . # dispo: rehabilitation. medications on admission: albuterol sulfate neb q6h prn sob, wheezing ammonium lactate 12 % cream aspirin 81 mg daily lisinopril 10 mg daily simvastatin 40 mg daily timolol 0.5 % drop 1 drop each eye warfarin 2.5 mg qmonday, 5 mg qsun,tues,wed,thurs,fri,sat ascorbic acid 500 mg daily discharge medications: 1. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 2. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q6h (every 6 hours) as needed for sob, wheezing. 4. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 5. ascorbic acid 500 mg tablet sig: one (1) tablet po once a day. 6. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 7. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) gram intravenous q 24h (every 24 hours). 8. heparin, porcine (pf) 10 unit/ml syringe sig: ten (10) ml intravenous prn (as needed) as needed for line flush. 9. insulin please continue sliding scale humalog insulin with meals and before bed. discharge disposition: extended care facility: senior healthcare of discharge diagnosis: subarachnoid hemorrhage hypertension fall bacterial urinary tract infection dm2 coagulase negative staph bacteremia discharge condition: hemodynamically stable, afebrile, fluent speech, extremely poor hearing (must yell to communicate with her even with her earring aids in place) and visual acuity, oriented to person, 'hospital', and month. requires assistance for all mobilization. discharge instructions: you presented to the emergency department after falling out of your wheelchair. you were found to have bleeding in your brain and a broken bone in your face. you were admitted to the icu and monitored closely overnight. your blood thinning medications were stopped and you remained stable. you were evaluated by the neurosurgery team who determined that there was no need for surgical intervention at this time. you were transferred to the medicine floor where you were closely monitored. . you were also found to have a urinary tract infection when you presented. you were treated with antibiotics and your infection resolved. . you developed increased drowsiness while on the medicine floor and were occasionally very difficult to wake from sleep. a repeat ct scan showed no worsening of your brain bleed. there were likely many things that contributed to your new drowsiness. this is likely due to your immobility, your elevated sugars, dehydration, seizure medications and your blood stream infection. . you also developed fevers several days into your admission. your evaluation showed no evidence of a new urinary tract infection, pneumonia, or blood clots that could be responsible for your fever. you were found to have a blood stream infection. it remains unclear how bacteria entered your blood. you will require 2 weeks of antibiotic treatment to ensure that the infection has cleared. . . you were found to have several loose teeth when you presented to the hospital. you were seen by a dentist who recommended that you be evaluated by a oral surgeon to discuss the option of having your teeth extracted. we were unable to schedule this follow up appointment with you as there is no oral surgeon at . please discuss this with your primary care provider and they will help you arrange any needed follow up. . the following changes were made to your home medications. 1) stop aspirin. it is very important that you do not restart this medication until instructed to do so by your neurosurgeon. 2) stop coumadin (warfarin). do not restart this medication unless instructed to do so by your physician. 3) start acetaminophen (tylenol) 325 mg tablet, take 2 tablets every 6 hours as needed for pain. 4) start vancomycin 1 gram iv daily for two weeks (last dose ) . it is very important that you keep all follow up appointments as listed below. followup instructions: please follow up with your primary care provider . within one week of discharge from your rehab facility. . department: radiology when: thursday at 10:15 am with: cat scan building: cc clinical center campus: west best parking: garage . department: neurosurgery when: thursday at 11:00 am with: , md building: lm campus: west best parking: garage . md procedure: venous catheterization, not elsewhere classified diagnoses: obstructive sleep apnea (adult)(pediatric) abnormal coagulation profile urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other chronic pulmonary heart diseases personal history of malignant neoplasm of breast peripheral vascular disease, unspecified other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) bacteremia long-term (current) use of anticoagulants staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus accidents occurring in unspecified place other malaise and fatigue closed fracture of malar and maxillary bones below knee amputation status subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness accidental fall from wheelchair 

Answer: The patient is high likely exposed to