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: heparin agents attending: chief complaint: transfer from ortho s/p embolic stroke major surgical or invasive procedure: r femur fracture repair history of present illness: 58 yo with dm, cad, htn s/p mechanical fall admitted to ortho for distal right femoral fracture, went for orif today with unremarkable intraop course until ~1hr into the procedure when she suddendly developed acute onset of hypotension and hypoxia, intraop tee revealed dilated rv/ra and impaired wall motion and large asd, concerning for acute embolic events. pulm angiogram by ir showed no clear pe but ?decreased flow to right pulm artery. ir did inject 50mg tpa into pulm artery and started her on no for pulm hypertension. venogram showed dvt but ir did put in a temp ivc filter. initial pa mean presssure was around 28 but later improved to around 17. ekg with more right-ish axis but otherwise no evidence of acute st/t changes. past medical history: htn dm ii cad s/p cath in 02': 2v disease, diffuse rca disease afib dyslipidemia morbid obesity s/p gastric bypass with 100 pound weight loss diabetic retinopathy (legally blind) hypothyroidism hyperparathyroidism (s/p rsxn) htn atrial fibrillation social history: .. family history: .. physical exam: pe: 114/46, 83, 94% on ac 500 x 16 -> 19-24 x 5 x 100%o2 gas pending gen: morbidly obese w lying in bed intubated in nad: non-resposive to verbal or noxious stim pup, 4mm, non-reactive, mmdry trach-collar with sm amounts of dried sputum: brown/tan secretions in suction hyperdynamic hs, rr 80's, no mrg s2 with normal split anterior fields clear, decrease bs on right anterior field 6cm surgical scar with steri strips, c/d/i g-tube, c/d/i obese, hypoactive bs, non-focal ext warm, no c/c/e neuro: movment to voice, noxious stim or spontaneous movement. toes upgoing bilat. pertinent results: 02:30pm wbc-15.1* rbc-5.11 hgb-13.8 hct-41.1 mcv-80* mch-26.9* mchc-33.5 rdw-14.1 02:30pm plt smr-high plt count-466* 02:30pm neuts-90.0* bands-0 lymphs-6.6* monos-1.8* eos-1.3 basos-0.4 02:30pm pt-12.3 ptt-25.4 inr(pt)-1.0. . 02:30pm glucose-167* urea n-24* creat-1.2* sodium-143 potassium-4.7 chloride-105 total co2-26 anion gap-17 . 02:30pm ck(cpk)-83 02:30pm ck-mb-notdone 02:30pm ctropnt-<0.01 08:25pm ck(cpk)-65 08:25pm ck-mb-notdone 08:25pm ctropnt-<0.01 . 03:25am blood wbc-10.5 rbc-2.40* hgb-6.6* hct-21.1* mcv-88 mch-27.5 mchc-31.2 rdw-17.4* plt ct-167 03:14am blood pt-12.8 ptt-24.3 inr(pt)-1.0 03:25am blood glucose-237* urean-82* creat-1.3* na-145 k-3.5 cl-113* hco3-24 angap-12 03:14am blood calcium-7.0* phos-1.5* mg-1.8 05:00am blood cortsol-77.1* 03:14am blood genta-5.3 brief hospital course: 58 yo with dm/cad admitted to micu with acute intraop hypotension and hypoxia, due to fat embolization. she was given tpa and started on iv heparin in the or by ir and had an ivc filter placed as well. her hemodynamics improved quickly and she only required transient pressor support. . 1. ortho: pt was admitted to the hospital and was taken to the or after being cleared by medicine for orif. her post-op course was complicated hypoxia and hypotension and she was transferred to the micu. . 2. neuro: pt was transferred to the micu post-op after becoming acutely hypotensive and hypoxic. an mri/mra revealed numerous embolic strokes among different teritories including cerebrum, cerebellum and brain stem. an ivc filter was placed. it was then determined that the embolic strokes were fat emboli via a patent foramen ovale. on , it was noted that the pt had increased right-sided weakness and a head ct was done which revealed hemorrhagic transformation of infarcts within left occipital, temporal, parietal and right parietal. pt was evaluated by neurosurgery and neurology who recommended conservative management. anticoagulants were stopped. in addition, an eeg revealed non-convulsive status. she was loaded on dilantin and depakote. after depakote load, she was found to still have a very active eeg so she was started on propofol until she broke out of status. over the next several days, pt was weaned off sedation and it was determined by hourly eegs that she was no longer having any seizure activity. it was extremely difficult to obtain therapeutic levels of dilantin and depakote. patient has required continued level checks with titration to maintain theraputic levels. she has regained no function during her micu stay. 3. respiratory failure: pt was transferred to the micu hypoxia. she was later found to have a pe fat emboli. during her stay in the micu, she would not tolerate a wean off the vent and she was eventually trached due to her thick resp secretions and poor mental status. she was then weaned off the vent onto trach mask. she occasionally became hypoxic on the floor mucous plugging and would require brief stays in the micu for mechanical ventilation. during her micu re-admission for respiratory distress requiring vent, she was weened several times but could not tolerate trach blow by for longer than 24 hours. additionaly, she was requiring frequent suctioning. ultimately, it was determined that she would require long term weening in a rehab facility. 4. hypotension: pt had multiple episodes of hypotension requiring pressors during her hospital stay. several episodes were due to mucous plugging and resolved after a rest on the ventilator. other episodes of hypotension were due to sepsis and as her infection was treated, she was weaned off pressors and her maps remained in the 70s. several days prior to discharge, her pressures were stable and required no interval interventions. 5. fever: pt completed a 8 day course of cefepime for ventilator associated pneumonia. her blood culture on and revealed coag-neg staph resistant to oxacillin so her right ij was discontinued and she was started on vancomycin for line-assoc bacteremia. a tee was negative for endocarditis. during one of her re-admissions to the micu when the pt was hypotensive and febrile, cultures were drawn and she was found to have klebsiella and pseudomonas growing in her sputum so she was started on zosyn. blood cx were negative. the pseudomonas later became resistant to zosyn so the pt's antibiotics were changed to imipenem. after two days of imipenem, she was found to have c diff and imipenem was discontinued with meropenem being resumed for the multiresistant pseudomonas and klebselia. she will complete a 14 day course of flagyl and meropenem. patient additionaly grew out resistant pseudomonas from a peg swab site. gent was added after this second strain of pseudomonas grew out with multiple resistant strains. she will complete a 5 day course of gentamicin. stop dates have been provided on her medication d/c information. patient remained afebrile x5 days prior to discharge with wbc trending down. 6. cad: in or pt became acutely hypotensive and hypoxic. tee showed rv enlargement with hypokinesis with pasp high 40s with right to left shunting across asd. ir did pulmonary angiogram which showed slow flow in rpa, but no definite thrombus. she was given tpa and had an ivc filter placed, despite no clear dvt on venogram. on admission to the icu, she was hypotensive requiring levophed. cardiac enzymes were sent and found to be positive (mbi 7.5). echo showed rv dilation with hypokinesis - bowing into left heart. lv with possible inferior wall motion abnormalitiy. these findings were likely consistent with fat embolus causing acute pulmonary htn with rv pressure overload. she has remained on asa prophylactically during her micu stay. 7. renal failure: pt's baseline creatinine is approximately 1.3. on admission to the micu, her creatinine was elevated to 2.5, likely hypotension during surgery. this resolved with fluids over the next several days. later in her hospital course, the creatinine increased again to 2.6 thought to be due to a combination of hypotension and possible ain from zosyn (though urine eosinophils were negative x 2). again, pt's creatinine returned to baseline with fluids. patient has required daily lasix to augment diuresis. 8. thrombocytopenia: late into the hospital stay, it was noted that her platelets were dropping (to a nadir of 43) and she was found to be positive for the hit-antibody. heparin was discontinued and her plts recovered. patient has recieved fondaparinux prophylactically with platelets trending toward normal values. . 9. anemia: uncertain etiology. patient has had stable crits in the low to mid 20s. patient was not transfused secondary to mild signs of chf and stable oxygenation on vent. no identified source of bleeding. likely secondary to chronic disease. 10. diabetes type2: patient has been difficult to control her glucoses during hospital stay given changes in tube feeds/concentrations/infections. patient with sugars ranging in 150-200's. controled w/sliding scale insulin and pm glargine. patient's sugars should resolve with resolving infection/stressors. 11. lines: left pic line, peg tube. 12. code: full code per husband, multiple family interactions w/social worker and staff to discuss patient's status and neurology belief of limited recovery potential. husband having vary difficult time handeling situation. fen: because of pt's hx of gastric bypass, pt had a g-tube placed by general surgery. on several occasions, the g-tube was dislodged but was easily replaced. patient is receiving tube feeds at goal w/out complication. tube feed recs are included in discharge information. medications on admission: meds on transfer: dextrose 50% 12.5 gm iv prn glucose<70 @ 1452 amiodarone hcl 200 mg po/ng daily @ 1452 bisacodyl 10 mg pr daily @ 1452 senna 1 tab po bid @ 1452 levothyroxine sodium 88 mcg po daily @ 1452 quetiapine fumarate 25-50 mg po prn agitation @ 1452 acetaminophen 325-650 mg po q4h:prn fever>101 @ 1452 lansoprazole oral suspension 30 mg ng daily @ 1452 simvastatin 10 mg po daily @ 1452 heparin 5000 unit sc tid @ 1452 miconazole powder 2% 1 appl tp prn @ 1452 nystatin oral suspension 5 ml po qid:prn @ 1452 aspirin 325 mg po/ng daily @ 1452 albuterol 0.083% neb soln 1 neb ih q6h:prn @ 1452 metoprolol 50 mg po tid dextrose 50% 25 gm iv prn @ 0825 riss and glargine valproate sodium 3000 mg iv q8h @ 1825 phenytoin 200 mg iv q8h start: in am @ 1838 discharge medications: 1. amiodarone hcl 200 mg tablet sig: one (1) tablet po daily (daily). tablet(s) 2. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 4. levothyroxine sodium 88 mcg tablet sig: one (1) tablet po daily (daily). 5. quetiapine fumarate 25 mg tablet sig: 1-2 tablets po prn (as needed) as needed for agitation. 6. acetaminophen 325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for fever>101. 7. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 8. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed). 9. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. 10. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 11. albuterol sulfate 0.083 % solution sig: inhalation q6h (every 6 hours) as needed. 12. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 13. meropenem 1 g recon soln sig: one (1) recon soln intravenous q12h (every 12 hours) for 10 days: patient should complete a 14 day course on . . recon soln(s) 14. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 6 days: patient should complete a 14 day course on . 15. fondaparinux sodium 2.5 mg/0.5 ml syringe sig: one (1) subcutaneous daily (daily): continue prophylactic treatment until coumadin theraputic. 16. warfarin sodium 2 mg tablet sig: one (1) tablet po hs (at bedtime): patient started on warfarin for dvt prophylaxis on . titrate dose by small incriments for goal inr of . patient cannot have heparin secondary to heparin induced thrombocytopenia. 17. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp<90, or pulse<60. 18. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). 19. valproate sodium 100 mg/ml solution sig: 1500mg intravenous q8h (every 8 hours): check levels periodacly for theraputic levels. 20. phenytoin sodium 50 mg/ml solution sig: 100mg injection q8h (every 8 hours): check levels periodically to check for theraputic levels. 21. gentamicin in nacl (iso-osm) 120 mg/120 ml piggyback sig: one (1) intravenous q24h (every 24 hours) for 3 days: patient should complete a 5 day course on . 22. insulin glargine 100 unit/ml solution sig: 13units subcutaneous at bedtime. 23. regular insulin sliding scale discharge disposition: extended care facility: - discharge diagnosis: primary: -comminuted right distal femur fracture. -introperative fat embolization. -rv failure. -cardiogenic shock. -paradoxical embolus from patent foramen ovale. -multiple embolic strokes: left occipital, temporal, frontal, deep thalamic, and right temporal, occipital lobes, as well as the right cerebellar hemisphere. -acute renal failure. -nstemi. -multi-infarct/hypoxic brain injury. -acute blood loss anemia. -right thigh hematoma. -ventilator associated pneumonia(klebseilla pna/multi resistant). -coagulation negative staph aureus bactermia. -pseudomonas skin infection at peg site. -chf on chest xray. -cdiff infection. secondary/pmh: 1. atrial fibrillation. 2. hypertension 3. diabetes mellitus type ii. 4. cad- 2vd s/p failed ptca of the proximal om2 chronic occlusion. 5. gastric bypass 6/. 6. hypercholesterolemia. 7. retinopathy, multiple laser treatments bilaterally. 8. primary hyperparathyroidism. 9. proteinuria. 10. hypothyroidism. 11. osteoporosis. 12. r cataract surgery. 13. c-section 14. osteoarthritis 15. laproscopic cholecystectomy . 16. gout. 17. thrombocytopenia nos - negative bone marrow biopsy. discharge condition: fair / stable discharge instructions: patient requires continued vent treatment, ween as indicated. patient requires continued tube feedings. patient requires continued nursing care. followup instructions: patient should be seen and assesed by a physician as dictated by rehab facilty policy. md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart interruption of the vena cava enteral infusion of concentrated nutritional substances injection or infusion of thrombolytic agent temporary tracheostomy open reduction of fracture with internal fixation, femur monitoring of cardiac output by other technique arteriography of pulmonary arteries other gastrostomy administration of inhaled nitric oxide infusion of vasopressor agent diagnoses: thrombocytopenia, unspecified subendocardial infarction, initial episode of care cellulitis and abscess of trunk 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 severe sepsis other chronic pulmonary heart diseases other convulsions acute and chronic respiratory failure anoxic brain damage cardiogenic shock ostium secundum type atrial septal defect long-term (current) use of insulin intestinal infection due to clostridium difficile infection and inflammatory reaction due to other vascular device, implant, and graft cerebral embolism with cerebral infarction fall from other slipping, tripping, or stumbling other pulmonary embolism and infarction pneumonia due to klebsiella pneumoniae pseudomonas infection in conditions classified elsewhere and of unspecified site staphylococcal septicemia, unspecified iatrogenic cerebrovascular infarction or hemorrhage infection of gastrostomy fat embolism other closed fracture of lower end of femur 

Answer: The patient is high likely exposed to