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: patient recorded as having no known allergies to drugs attending: chief complaint: bilateral pe, recent sdh major surgical or invasive procedure: none history of present illness: mr is a 69 year old with past medical history significant for multiple prior deep vein thrombosis, pulmonary emboli, l. hip replacement and recent cva, presenting from osh ( hospital) with bilateral pulmonary emboli. he was recently discharged from the nsg service on s/p sdh evacuation to rehab. regarding the pt's - admission: he was admitted to nsg at after he had complained of a headache for several days and had multiple episodes of vomiting. his head ct revealed a large left sdh. he was taken to the or on for a left craniotomy for sdh evacuation. he became febrile to 101.8 early am on , sputum cultures were positive for gram + cocci in pairs, and lenis showed a left superficial femoral dvt that was determined to be a new partially occlusive dvt (with the pt's last documented dvt having occured in , after which he was begun on coumadin 6mg daily). no anticoagulation was safe to be administered in the immediate post-operative setting of sdh/surgery. sq heparin on hd2 and levofloxacin 4d course was started in the setting of low grade fever and sputum with gram + cocci. pt was discharged to rehab on heparin 5,000 unit/ml tid, and instructed to hold coumadin until . while at rehab, he had sudden onset sob at pt on . he was taken to an osh and had a cta that demonstrated large pes in both main pulmonary arteries and segmental branches with rv dilitation. the patient was started on a hep gtt at the osh, with a large bolus (8700 units) and was continued on heparin gtt. he was trasfered to for further management. . patient was transferred to with initial vs 99, 135/94, 97, 24, 97% on 100% fio2 on bipap. past medical history: htn hyperlipidemia h/o pulmonary embolism -- previously on warfarin -- s/p ivc filter placement l4-5, l5-s1 stenosis hip replacement left subdural hematoma left superficial femeral deep vein thrombosis left pca infarct social history: warehouse worker forced to quit 1 yrs ago due to l hip pain. no tobacco, no etoh family history: no family history of early cad or sudden cardiac death. physical exam: general: agitated. heent: perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: jvp 7cm. cardiac: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. ii/vi mid systolic murmur at llsb. no thrills, lifts. no s3 or s4. lungs: cta anterolaterally, no crackles, wheezes or rhonchi. abdomen: tympanitic, nt. distended. hypoactive bs. extremities: no c/c. 1+ lle edema. pulses: right: dp 1+ pt 1+ left: dp 1+ pt 1+ pertinent results: 06:05am blood wbc-15.3*# rbc-4.48* hgb-13.2* hct-39.8* mcv-89 mch-29.5 mchc-33.2 rdw-14.9 plt ct-191 06:05am blood neuts-89.2* lymphs-8.3* monos-1.5* eos-0.3 baso-0.7 06:05am blood pt-13.1 ptt-25.7 inr(pt)-1.1 06:05am blood glucose-277* urean-30* creat-1.1 na-133 k-8.4* cl-103 hco3-21* angap-17 06:05am blood alt-62* ast-123* ck(cpk)-247 alkphos-61 totbili-0.6 06:05am blood ck-mb-6 probnp-1778* 06:05am blood ctropnt-0.18* 02:24pm blood calcium-7.8* phos-3.3 mg-2.5 02:41am blood crp-256.3* tte: impressions: compared with the prior study (images reviewed) of , the right ventricle is now mildly dilated with moderate free wall hypokinesis and there is mild pulmonary artery systolic hypertension. mild-moderate mitral regurgitaiton is also now seen. ccath: final diagnosis:1. successful insertion of retrievable optease ivc filter via rcfv approach 2. continue heparin gtt and maintain therapeutic aptt 3. careful neurological assessment and follow up brain ct scan given history of sdh. ekg: sinus tachycardia. left atrial abnormality. right bundle-branch block. left anterior fascicular block. compared to the previous tracing of the rate has increased. there is inferolateral upsloping st segment depression. ct head: 1. unchanged or slightly smaller multifocal extra-axial hemorrhage as described above. other areas of hemorrhage as described above. follwo up as clinically indicated. 2. hypoattenuation in the left parietal lobe, likely represents evolving subacute infarct. lenis: bilateral common femoral and right deep femoral venous thrombosis. cta torso: impression: 1. new multifocal areas of ground-glass opacity within bilateral lung parenchyma most compatible with infectious etiology. 2. mildly decreased extent of bilateral pulmonary embolism within the right and left pulmonary arteries extending into the segmental and subsegmental branches. 3. fluid collection and enlargement of the left hip abductor muscles may represent hematoma, abscess, or infarction. this is also at the location of previous interventions in the left groin for ivc filter placement. clinical correlation is recommended. in case of clinical concern for abscess formation, an mri can be obtained for further evaluation. 4. renal cysts, liver cysts and enlarged prostate. echo : suboptimal image quality. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 50-55%). the rv is now well seen but appears normal in size (function cannot be adequately assessed on this study). the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. trivial mitral regurgitation is seen. tricuspid regurgitation is present but cannot be quantified. there is no pericardial effusion. compared with the prior study (images reviewed) of , rv apppears smaller however images are of poor quality. femoral vascular ultrasound: impression: 1. hematoma at the left groin. 2. no evidence of pseudoaneurysm arising from the left common femoral artery. the study and the report were reviewed by the staff radiologist. hip 2 view: history: hip prosthesis and fluid collection, evaluate for abscess or bone destruction. four views. comparison with . a left hip prosthesis remains in place. cortical margins are otherwise intact. bony mineralization appears normal. surgical clips are present in overlying soft tissues. incidental note is made of degenerative changes in the spine. impression: status post thr. no definite interval change. cxr: history: pulmonary embolism. hypoxia. one portable upright view. comparison with the previous study done . there is streaky density at the left lung base consistent with subsegmental atelectasis and/or parenchymal consolidation as before. the right lung remains clear. the heart and mediastinal structures are unchanged. impression: no significant change. portable abdomen: one portable supine view: the upper abdomen and lateral abdominal walls are not included. comparison is made with the previous study done . dilated air-filled loops of colon are again demonstrated down to the level of the sigmoid colon. some gas is noted in the region of the lower sigmoid colon and rectum. degenerative changes are again demonstrated in the spine and the left hip prosthesis remains in place. impression: nonspecific bowel gas pattern, which may represent colonic ileus. mri pelvis: impression: 1. 11.6 x 5.0 cm rim-enhancing fluid collection involving the adductor musculature of the left groin. while the presence of peripheral high t1 signal raises the possibility of a hemorrhagic component, the presence of infection cannot be excluded and diagnostic aspiration is suggested. 2. similar but separate 2.5-cm collection near the left common femoral vein access site. chest pa/lat: lordotic positioning makes it hard to assess the lower lungs. there could be a substantial new right basal atelectasis. the upper lobes are largely clear. heart size top normal, unchanged. mediastinal fullness in the paratracheal region, is stable since , when a chest ct showed this was due to a combination of tortuous vessels, mediastinal fat and atelectasis or consolidation in the right upper lobe anterior segments. findings of massive pulmonary emboli are not apparent on this conventional chest radiograph. ct guided aspiration: indication: 69-year-old man with status post ivc filter, now with rim-enhancing fluid collection in left groin and known left hip hardware. please perform aspiration of this lesion. after risk, benefits, alternatives and procedure were explained to the patient, written informed consent was obtained. a pre-procedure timeout was performed using three patient identifiers. initial ct imaging showed subtle hypodense fluid collection not well demarcated on this non-contrast study within the internal muscles of the left hip. site was marked, prepped and draped in usual sterile fashion. local anesthesia was achieved with lidocaine 1% buffered solution. moderate sedation was provided by administering divided doses of versed and fentanyl throughout the total intra-service time of 20 minutes during which the patient's hemodynamic parameters were continuously monitored. 18-gauge needle was used to aspirate the contents of the collection. small amount of bloody fluid was aspirated and sent to lab as requested. a bentson guidewire was also inserted into the collection and taken out. the patient tolerated the procedure well. no immediate post-procedure complications were noted. the attending radiologist, dr. , was present and supervised the whole procedure. impression: successful ct-guided aspiration of the left hip muscle fluid collection. brief hospital course: mr. is a 69 year old man with history of multiple dvt and pe, recent subdural hematoma s/p evacuation, presenting with massive bilateral pe. # bilateral pulmonary emboli: patient was found to have massive bilateral pulmonary emboli and extensive lower extremity dvts at an outside hospital. patient was transferred from outside hospital for possible thrombectomy via catheterization. thrombolysis was not done in setting of recent large subdural hematoma. on arrival to , an ivc filter was placed by interventional cardiology. patient was continued on heparin drip (with narrow goal ptt as close to 55-65 as possible) from the outside hospital and bridged to coumadin once ct scan confirmed no recurrence of subdural hematoma (). frequent neurological checks were done, and neurosurgery followed with the patient to monitor for signs of intracranial bleeding. patient required 5l oxygen by nc on presentation with fluctuating o2 requirement throughout hospitalization. o2 requirement peaked at 6l two days after presentation at which time he also spiked a fever to 101.3; he had some scant hemoptysis the following day which resolved. he also continued to have bursts of sinus tachycardia to the 140s with ambulation and bms. he was not on his home dose of metoprolol and verapamil at the time. he became supratheraputic on his coumadin after starting antibiotics for pneumonia (see below) and his coumadin was held. he was discharged on coumadin 2 mg a day with an inr of 2.1. he should remain on this dose until while the flagyl (which can potentiate the effects of coumadin and which was stopped on ) washes out of his system. on he should resume his home dose of coumadin 5 mg a day. he should continue to have daily inr checks at the rehab facility and make adjustments as needed until his inr becomes stable and theraputic. the pt requires no further follow up for his ivc filter was was left in place given the concern for future dvts. # subdural hematoma: patient had recent hospitalization on neurosurgery service for subdural hematoma, which was evacuated. neurosurgical team followed patient. head ct showed no recurrence of his subdural hematoma after heparin drip was therapeutic, and neurologic examination was stable throughout hospitalization. he will need to go to his follow up appointment with the neurosurgeon in one month and get a head ct. he has an appointment for . he should call if he needs to change this appointment with dr. . # hospital acquired pneumonia: the patient spiked fevers throughout his ccu stay, and on had an acute desaturation to 74% on ra. he was placed on non rebreather with return of his sao2. his temperature was found to be 105. he became hypotensive and required ns bolus. on a cxr showed new retrocardiac and left lower lobe opacity likely representing left lower lobe aspiration. a cta was done to evaluate pna and progression of pes, which showed bilat filling defects right and left pulm arteries + segmental branches left and right side, minimally decreased in size with no evidence of pna. a fluid collection was also incidentally seen in left hip abductor area (same side as ivc filter placed), representing a hematoma vs. abscess (see below). the patient was started on an 8 day course of vanc/cefepime/flagyl as well as nebulizers. he continued to have low grade fevers for a few days. his oxygen was weaned over time and he became afebrile without cough. he was satting 95% on 3 l oxygen the day of discharge. his last day of antibiotics was . of note, his flagyl likely wsa responsible for elevating his inr. therefore his warfarin dose was temporarily decreased and his inr should be followed until he is theraputic and stable. # groin hematoma: a cta was obtained on to evaluate for pneumonia and a fluid collection was also incidentally seen in left hip abductor area (same side as ivc filter placed), representing a hematoma vs. abscess. the next day on , pt developed worsening left hip/thigh pain. ortho was consulted due to concern for septic prosthetic joint as the patient had been having low grade fevers. ortho initially felt exam was concerning for septic hip, and rec'd aspiration by ir (however ir felt this was not possible while anticoagulated). hip x-rays were obtained and showed no bony destruction or evidence of osteomyelitis around l. prosthetic joint. ultrasound of the fluid collection was obtained and was consistent with hematoma. an mri was obtained which showed 11.6 x 5.0 cm rim-enhancing fluid collection involving the adductor musculature of the left groin. on ir performed a ct guided aspiration of the fluid and obtain 1 cc of fluid. no organisms or pmns were seen on gram stain and it was thought that it was simply a hematoma that was a complication of the ivc filter which should resolve over time. # abdominal ileus: patient was noted to have hypoactive bowel sounds and distended abdomen on presentation. patient denied any symptoms of nausea, and there was no evidence of obstruction on ct abdomen/pelvis. the ct showed rectosigmoid colon opacification which is of unclear significance. patient was initially kept npo, then advanced to a clear liquid diet which he tolerated well. he was given a bowel regimen and had multiple bowel movements. # urinary retention: in the ccu a foley catheter was placed. upon removal of the catheter, the patient was unable to void more than small droplets at a time. he was bladder scanned and it was found that he had over 900 ccs of urine in his bladder so the foley was replaced. it was difficult to replace the foley and a coude catheter was used successfully to replace it. the patient was started on tamsulosin 0.4 mg q hs. given the difficulty inserting the foley and likelyhood that the patient will retain again, he should keep the foley in place at rehab and wait a few days before attempting to undergo another voiding trial. he should then follow up with a urologist as an outpatient. # hypertension: home antihypertensives were held on admission in the setting of low normal blood pressures. patient was started on low dose lisinopril 5mg daily. his verapamil and metoprolol were also held. he should resume all of his home bp meds upon discharge. # hyperlipidemia: patient was continued on simvastatin. # code status: patient is dnr/dni medications on admission: medications at home: 1. acetaminophen 325 mg tablet po q6h (every 6 hours) 2. simvastatin 10 mg tablet po daily 3. verapamil 120 mg tablet sig: 0.5 tablet po q8h 4. levetiracetam 750 mg tablet po bid 5. heparin (porcine) 5,000 unit/ml tid 6. insulin lispro 100 unit/ml solution 7. aspirin 325 mg tablet po daily (daily). 8. metoprolol tartrate 12.5 mg po q6h 9. hydrocortisone acetate 1 % ointment 10. bisacodyl 5 mg tablet po bid 11. lactulose 10 gram/15 ml (30) ml po q6h 12. magnesium hydroxide 400 mg/5 ml thirty (30) ml po q6h (every 6 hours) as needed for constipation. 13. senna 8.6 mg tablet po bid 14. docusate sodium 50 mg/5 ml 15. polyethylene glycol 16. famotidine 20 mg tablet 17. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 4 days. tablet(s) 18. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 19. ondansetron 4 mg iv q8h:prn nausea 20. dilaudid 2 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. discharge medications: 1. acetaminophen 650 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain, fever. 2. simvastatin 10 mg tablet sig: one (1) tablet po once a day. 3. verapamil 120 mg tablet sig: 0.5 tablet po three times a day: please hold for hr < 60 or bp < 100. 4. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po every six (6) hours: please hold if bp < 100 or hr < 60. 5. levetiracetam 750 mg tablet sig: one (1) tablet po every twelve (12) hours. 6. aspirin 325 mg tablet sig: one (1) tablet po once a day. 7. hydrocortisone acetate 1 % ointment sig: one (1) rectal once a day. 8. bisacodyl 5 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po bid (2 times a day). 9. lactulose 10 gram packet sig: one (1) po every six (6) hours. 10. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po every six (6) hours as needed for constipation: for constipation. 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 12. docusate sodium 50 mg/5 ml liquid sig: one (1) po once a day as needed for constipation. 13. polyethylene glycol 3350 oral 14. famotidine 20 mg tablet sig: one (1) tablet po once a day. 15. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 16. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm for 2 days. 17. warfarin 5 mg tablet sig: one (1) tablet po once a day: to start . discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: bilateral pulmonary embolus left groin hematoma hospital acquired pneumonia secondary diagnosis: subdural hematoma hyperlipidemia hypertension 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: you came to the hospital because you were having trouble breathing. you were found to have blood clots in your lungs and legs. you had an ivc filter placed to prevent any more clot from going to your lungs. you were also found to have a blood collection in your groin which was likely a complication from this procedure. the interventional radiologists took the fluid out and saw that it was not infected. it should get better on its own with time. you were also found to have pneumonia and you were treated for this with antibiotics and have completed your course. you have not had any fevers for several days and we think your infection has cleared. you also developed difficulty urinating. a foley catheter was placed because of this. you should leave the catheter in for a few more days and then have it removed to see if you can urinate on your own. if you can't you may need to have a foley placed again. we started you on a medication for this which you should continue. you should have your primary care doctor set you up with an appointment with a urologist when you get home from rehab. in addition, you were found to have low levels of potassium. this is probably because of your diarrhea and nausea. you will need to take potassium suplements and have your levels monitored at the rehab facility. the following changes have been made to your medications: please start tamsulosin for your urinary retention please decrease your dose of warfarin to 2 mg once a day until monday () when you should resume your home dose of 5 mg a day. please follow up with your primary care docotr after you are discharged from rehab as well as with the neurologists. followup instructions: primary care: , h. phone: please make an appt to see dr. after you get out of rehabilitation. you should ask him to refer you to a urologist for the urinary retention you have been having. please also make a neurology appointment for a follow up appointment in one month. please call to make this appointment with dr. . you will also need to schedule a repeat head ct and can ask them about scheduling this at that time. procedure: interruption of the vena cava aspiration of skin and subcutaneous tissue diagnoses: pneumonia, organism unspecified hematoma complicating a procedure hypopotassemia pulmonary collapse paralytic ileus retention of urine, unspecified hypoxemia surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation acute venous embolism and thrombosis of deep vessels of proximal lower extremity other pulmonary embolism and infarction hip joint replacement right bundle branch block and left anterior fascicular block 

Answer: The patient is high likely exposed to