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: sulfa (sulfonamide antibiotics) attending: chief complaint: bilateral femur fractures major or invasive procedure: : s/p orif bilateral proximal femur fractures : picc placed, l arm, catheter switched to double lumen power picc on : egd (upper endoscopy) : percutaneous cholecystostomy tube history of present illness: 30m with hx of muscular dystrophy who is wheelchair dependent at home fell after transfer and was down for several hours. ems was activated and he was found to have bilateral femoral fractures, and initially admitted to the orthopaedics service at this hospital. pt has significant le contractures and weakness 2/2 muscular dystropy as well as diffuse osteopenia. he has a significant hospital course that can be found below in this document. past medical history: muscular dystrophy bipolar disorder chronic opioid use with chronic pain seizure d/o (last seizure 5 years ago) osteoporosis social history: reports smoking 1ppd for the past 6 years. denies etoh. lives with a roommate in independent living. family history: non-contributory physical exam: gen: in pain. oriented x3. skin: b lateral hip incisions w staples clean/dry/intact, back not assessed due to pt's lack of mobility heent: nc/at. sclera anicteric. eomi. dry mm, op clear, no exudates or ulceration. neck: supple, jvp not elevated. cv: regular rate & rhythm, no mrg chest: cta b abd: obese, soft, ntnd. no hsm or tenderness. ext: edematous and cool in all extremities, + strength throughout. no calf tenderness. on discharge: afebrile, all vital signs stable general: alert and oriented, no acute distress resp: reg even rate no audible wheeze cardiac: rrr, no rubs, murmurs, gallops extremities: right/left lower/upper incision: intact, no swelling/erythema/drainage dressing: clean/dry/intact sensation intact to light touch, neurovascular intact distally, capillary refill brisk, 2+ pulses, weight bearing: full/partial/non weight bearing pertinent results: imaging: ct lower extremity: impression: bilateral femur fractures. diffuse pelvis and thigh muscle atrophy. : gallbladder u/s: acute cholecystitis with no definite vascularity identified within the material in the gallbladder lumen. mrcp 1. no evidence of enhancement in the large area of abnormal signal intensity within the lumen of the gallbladder. this therefore most likely represents an area of sludge or debris. small gallstones within this cannot be excluded. however, given the suggestion of vascular flow on ultrasound within this tumefactive gallbladder mass, recommend targeted followup assessment by ultrasound prior to any potential intervention to help reconcile the discrepency between ultrasound and mri findings. 2. thickening of the gallbladder wall and heterogeneous enhancement are compatible with cholecystitis. 3. no biliary dilatation. 4. bibasal pleural effusions and basal collapse/consolidation. 5. diffuse muscle atrophy compatible with background history of muscular dystrophy. ct folded gallbladder with marked edema on its wall, this is compatible with acute cholecystitis. small free abdominal fluid. bilateral lower lobe atelectasis and small bilateral effusions. : duplex ultrasound: no le dvt echo the left atrium is dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is mild global left ventricular hypokinesis (lvef = 45-50 %). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: mild global lv hypokinesis. no significant valvular abnormality seen. head ct: no intracranial hemorrhage or skull fracture. le ct: bilateral femur fractures. diffuse pelvis and thigh muscle atrophy. 10:49pm wbc-15.3*# rbc-4.47* hgb-12.5* hct-37.3* plt ct-281 09:29pm wbc-25.1*# rbc-4.02* hgb-11.8* hct-34.8* plt ct-353 06:08am wbc-6.3 rbc-3.29* hgb-10.3* hct-29.7* plt ct-311 06:11am wbc-8.0 rbc-3.41* hgb-10.6* hct-30.6* plt ct-335 12:28pm pt-16.5* ptt-35.2* inr(pt)-1.5* 05:47am esr-20* 09:48am ret aut-1.6 10:49pm glucose-96 urean-7 creat-0.1* na-138 k-3.9 cl-98 hco3-31 09:15am glucose-111* urean-5* creat-0.1* na-136 k-4.4 cl-99 hco3- 01:34pm glucose-131* urean-5* creat-0.1* na-136 k-3.5 cl-97 hco3- 06:11am glucose-70 urean-6 creat-0.3* na-142 k-3.9 cl-98 hco3-34* 01:34pm alt-18 ast-17 ld(ldh)-220 alkphos-72 totbili-0.8 06:42am alt-62* ast-58* ld(ldh)-344* alkphos-179* totbili-0.6 06:08am alt-16 ast-15 alkphos-167* totbili-0.4 08:54am ck-mb-notdone ctropnt-0.01 06:31pm ck-mb-notdone ctropnt-0.02* 10:54am ck-mb-4 ctropnt-0.02* 09:15am calcium-8.3* phos-2.3* mg-1.6 01:34pm calcium-7.9* phos-2.7 mg-1.6 06:11am calcium-8.6 phos-3.2 mg-1.9 05:47am crp-69.7* 06:42am ferritn-507* discharge labs; complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:44am 8.8 3.71* 11.2* 33.3* 90 30.3 33.7 15.3 359 renal & glucose glucose urean creat na k cl hco3 angap 06:44am 146* 24* 0.2* 140 4.5 104 29 12 brief hospital course: in brief, mr. is a 30 y/om with muscular dystrophy who was admitted to the orthopaedics service with bilateral femoral fractures, whose course was complicated by aspiration pneumonia requiring intensive care unit but no intubation, course complicated by stress ulcers and significant upper gi tract bleed requiring intensive care, endoscopy-directed therapy, and significant blood transfusion, and also hospital course complicated by low grade fever and found to have acute cholecystitis requiring percutaneous cholecystostomy tube placement. he has had poor po intake and was started on tpn. over the hospitalization he has had progressive anasarca that is now significantly improving with iv furosemide. he has chronic pain issues, and is being managed with his home regimen of ms contin and prn hydromorphone as well as adjuvant medications. at time of discharge, he is afebrile, but has not been getting out of bed. his po intake remains marginal. his issues are discussed in more detail below: hip fracture: mr. is a 30 y/om with muscular dystrophy (bmd) who was initially admitted to ortho with bilat subtrochanteric femur fractures after fall at home. on , he had bilateral intramedullary rod fixation. he tolerated the surgery and was placed on lovenox for post dvt prophylaxis. on pod#1, he received 2un prbc on for a hct of 23.3 (prev 30); post transfuse hct was 30.5. he will follow-up with ortho (scheduled). aspiration pneumonitis: on pod #2 () he developed a fever (104) and had an increase in his o2 requirement. he was subsequently transferred to the medical icu for probable aspiration pneumonia. he did not require intubation. he completed a course of vanco/zosyn/azithro from . chronic pain: while in the micu, he also had an acute exacerbation of his chronic pain and was seen by the acute pain service. his pain has been somewhat difficult to control throughout his admission. of note, he had frequent issues with chronic pain and is a chronic opioid user who has required multiple medications on board, including ketamine and dilaudid pca, during his stay. he was discharged on a regimen of mscontin 30mg tid w/ po dilaudid for breakthrough pain. there were multiple reports of him being too sedated for pain meds but him still asking. peptic ulcer/stress ulcer bleed while on the hospital floor, developed coffee ground emesis and although normotensive, he was tachycardic to the 110s. his hct decreased from mid to upper 20s (25-28) to 21. he was started on iv ppi and he received 2 units of prbcs overnight, as well as 4 units ffp for inr 1.6 (? nutritional deficit). on the morning of , he received 2 units of prbcs, continued to tachycardic, and went down to endoscopy. he was transfused another 2un and was transferred to the micu for monitoring and serial hcts. in the micu, the pt had some lightheadedness and weakness and developed maroon stools. on the morning of , his hct was 23; he was transfused 2un prbcs and 2un ffp, his ppi was converted to a drip, and had an egd. the egd showed 3 large ulcers measuring about 3cm in diameter and few small (less than 1 cm) ulcers in the pre-pyloric area, all suggestive of stress ulcers. the large ulcers were treated w/ epinephrine. he received an addition 1un after the egd. on , the pt's hct was stable and he returned to the floor. in total, pt rec'd 14un prbcs and 7un ffp over course of admission. psychiatry upon return to the floor, the pt seemed very depressed. he was seen by psychiatry who felt that his current medication regimen was appropriate and no changes were made. his mood steadily increased and then plateaued for the rest of his admission. . cholecystitis/fever following his return to the medical floor after gib, the pt developed a fever. he was, and remains, high risk for , he was worked up for dvt and pe. he had neg le ultrasounds and cta did not reveal pe or pneumonia. a wound consult was obtained to evaluate for sacral decubiti or other skin breakdown that could cause a fever. it was noted that his alk phosphatase was rising and it was decided to get a ruq ultrasound and acute cholecystitis was diagnosed. he was started on ciprofloxacin and flaygl. given his multiple comorbodities, it was decided that percutaneous intervention w/ a cholecystostomy tube was the best treatment. while ultrasounding for placement, a mass was discovered within his gallbladder lumen. this mass appeared to have pulsatile flow, and an mri was obtained for further characterization. this revealed that the mass was likely sludge or debris, and a f/u ultrasound appeared more reassuring that this was not a true mass. on , ir placed a perc cholecystostomy tube. he would still need a cholecystectomy but in approximately 6 weeks. he was to follow up with dr. . plan is for perc chole drain to remain in place until f/u with dr. . hypernatremia/anasarca his hospital course was complicated by hypernatremia and severe anasarca. his hypernatremia improved slowly. he developed scrotal edema which also had decreased in size by the time of discharge. he was treated with alternating lasix and albumin. he was seen by nutrition but he had been npo for 3-4 days prior to discharge while waiting for treatment of his inflammed gallbladder. . urine growth he did grow enterbacter cloacae in one urine sample but this resolved after his foley was changed. . nutrition he was started on tpn for poor po intake, though will need fluid balance carefully monitored and may need more furosmide. he was started on a riss while on tpn. medications on admission: lyrica, risperidol, trazadone, baclofen, lexapro, ms contin, oxycodone, lamictal, klonopin discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever or pain. 2. risperidone 0.5 mg tablet sig: two (2) tablet po daily (daily). 3. trazodone 50 mg tablet sig: 1.5 tablets po hs (at bedtime) as needed. 4. escitalopram 10 mg tablet sig: two (2) tablet po daily (daily). 5. clonazepam 0.5 mg tablet sig: one (1) tablet po tid (3 times a day). 6. morphine 30 mg tablet sustained release sig: one (1) tablet sustained release po q8h (every 8 hours). 7. amitriptyline 10 mg tablet sig: one (1) tablet po hs (at bedtime). 8. baclofen 10 mg tablet sig: one (1) tablet po tid (3 times a day). 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 10. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 11. multivitamin tablet sig: one (1) cap po daily (daily). 12. modafinil 100 mg tablet sig: one (1) tablet po qam (). 13. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 14. polyethylene glycol 3350 100 % powder sig: one (1) po daily (daily) as needed for constipation. 15. miconazole nitrate 2 % powder sig: one (1) appl topical prn (as needed). 16. morphine 30 mg tablet sustained release sig: one (1) tablet sustained release po q8h (every 8 hours). 17. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed. 18. lamotrigine 100 mg tablet sig: one (1) tablet po bid (2 times a day). 19. pregabalin 25 mg capsule sig: two (2) capsule po tid (3 times a day). 20. ondansetron 4 mg iv q8h:prn nausea/vomiting 21. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 22. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 23. milk of magnesia concentrated 2,400 mg/10 ml suspension sig: thirty (30) ml po every six (6) hours as needed for constipation. 24. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. 25. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po q6h (every 6 hours) as needed for constipation. 26. insulin regular human 100 unit/ml solution sig: sliding scale injection every six (6) hours: while on tpn. discharge disposition: extended care facility: northeast - discharge diagnosis: bilateral proximal femur fractures aspiration pneumonia upper gi bleed acute cholecystitis discharge condition: stable, tolerating clear liquids (can advance as tolerated), pain adequately controlled discharge instructions: you were admitted to the hospital after your broke your legs. you had surgery and had rods placed in your thigh bones. you also developed pneumonia and ulcers in your stomach. you were also treated for cholecystitis or infection of your gallbladder. you had a tube placed into your gallbladder in order to help drain your gallbladder. your were started on a medicine called pantoprazole. this is a medication for your stomach ulcers. please do not stop taking it unless directed to do so by your doctor. please see the list of medications for all of your other medications. please adhere to your follow-up appointments. they are important for managing your long-term health. please return to the hospital or call your doctor if you have temperature greater than 101, shortness of breath, worsening difficulty with swallowing, chest pain, abdominal pain, diarrhea, or any other symptoms that you are concerned about. followup instructions: , specialties cc-3 (nhb) phone: date/time: 1:30 ortho xray (scc 2) phone: date/time: 9:00 , pa (orthopaedics) phone: date/time: 9:20 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances endoscopic control of gastric or duodenal bleeding open reduction of fracture with internal fixation, femur open reduction of fracture with internal fixation, femur transfusion of packed cells transfusion of other serum trocar cholecystostomy diagnoses: other chronic pain acute gastric ulcer with hemorrhage, without mention of obstruction urinary tract infection, site not specified acute posthemorrhagic anemia unspecified protein-calorie malnutrition opioid type dependence, continuous acute respiratory failure pneumonitis due to inhalation of food or vomitus osteoporosis, unspecified epilepsy, unspecified, without mention of intractable epilepsy other acute pain hyperosmolality and/or hypernatremia bipolar disorder, unspecified closed fracture of subtrochanteric section of neck of femur calculus of gallbladder with acute cholecystitis, without mention of obstruction disorder of bone and cartilage, unspecified unspecified analgesic and antipyretic causing adverse effects in therapeutic use accidental fall from wheelchair myotonia congenita 

Answer: The patient is high likely exposed to