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: delirium major surgical or invasive procedure: removal of left tibial hardware left tibial washout with wound vac placement history of present illness: history limited by patient's decreased mental status, with collateral obtained from orthopedic floor team and chart. this is a 42 yo male with a history of dm, osa, seizure disorder, bipolar disorder who was admitted to orthopedics on for removal of external fixator and orif of his left tibial plateau fracture. this am (pod #2), he was found to be somnolent and oriented times one, from a baseline of full orientation. his chem 7 revealed an am glucose of 28, with fs of 44. he was given juice with added sugar, briefly increased to 97, but then fs decreased to 41. he then received amp of d50 and repeat fingerstick was 98. merit was called for medicine consultation given hypoglycemia and altered mental status, in addition to new renal failure in the setting of oliguria. at the time of merit resident assessment, the patient was somnolent and would arouse to voice, able to state his name and that he was in a hospital, date was "friday," but would fall asleep quickly. he was noted to have occasional jerks of his extremities suggestive of asterixis. also, he was on 4l of o2 by nc given hypoxia to 88% on ra, which is new. his most recent vs were: 100/48 90 18 95%,3l. an abg was obtained and only showed mild co2 retention. the micu resident was notified of his issues and it was agreed to transfer to the icu for closer monitoring. regarding his recent hospitalization, he was admitted to from after a motorcycle accident and underwent external fixation of a left tibial plateau fracture, left proximal fibula fracture, with fasciotomies for compartment syndrome on the left lower extremity. this was notable for development of post-op agitated delirium, which was comanaged with psychiatry. upon arrival to the icu, the patient was minimally responsive and quite sleepy, however was following commands. past medical history: htn dm seizure disorder ptsd and bipolar disorder osa, reportedly noncompliant with cpap in hospital social history: denies etoh or substance use to me. per omr, h/o incarceration for shooting his wife in the context of a drinking binge. family history: nc physical exam: micu admission physical: vs: temp: 98.9 bp:140/53 hr:95 rr:10 o2sat 97% 2 l gen: pleasant, comfortable, nad heent: pupils constricted and minimally responsive, anicteric, mmm, op without lesions, no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or thyroid nodules resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, soft systolic murmur heard throughout precordium, no gallops/rubs abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: warm, well perfused; no cyanosis, no edema; bandage on left leg is c/d/i; skin: no rashes/no jaundice/no splinters neuro: aaox3. moving extremities and following commands. no sensory deficits to light touch appreciated. pertinent results: 11:28am glucose-164* urea n-17 creat-1.0 sodium-137 potassium-5.0 chloride-104 total co2-25 anion gap-13 11:28am estgfr-using this 11:28am wbc-24.2*# rbc-3.17* hgb-8.7* hct-27.1* mcv-85 mch-27.5 mchc-32.3 rdw-13.9 11:28am plt count-643*# 11:28am pt-15.1* ptt-28.6 inr(pt)-1.3* 05:36am blood ck(cpk)-546* 07:20am blood asa-negative ethanol-negative acetmnp-10 bnzodzp-negative barbitr-negative tricycl-negative 07:20am blood lithium-1.0 07:20am blood tsh-1.5 11:13am urine color-amber appear-clear sp -1.017 11:13am urine blood-neg nitrite-pos protein-75 glucose-neg ketone-tr bilirub-sm urobiln-12* ph-7.0 leuks-sm 11:13am urine rbc-0 wbc-* bacteri-many yeast-none epi-0 01:02pm urine osmolal-236 01:02pm urine hours-random urean-257 creat-152 na-11 k-25 cl-14 . cxr there are low lung volumes. mild cardiomegaly is accentuated by the low lung volumes. the lungs are grossly clear. there is no pneumothorax or pleural effusion. . other labs: 06:25am blood ck(cpk)-266 06:25am blood lithium-1.0 . discharge labs: 06:55am blood wbc-12.5* rbc-3.27* hgb-9.3* hct-28.0* mcv-86 mch-28.3 mchc-33.1 rdw-14.6 plt ct-418 06:55am blood glucose-128* urean-7 creat-0.9 na-138 k-4.1 cl-103 hco3-29 angap-10 06:55am blood calcium-9.2 phos-3.2 mg-1.6 brief hospital course: 42yo m with bipolar d/o, type ii dm, and osa originally admitted to orthopedics for hardware removal who was transferred to the micu for hypoglycemia and delerium. when sugars and metal status had improved, he was tranfered to the medical floor. . # left tibial fracture s/p orif: initially admitted to the hospital from rehab for removal of external fixator on . postoperative pain was managed with tylenol atc and low dose oxycodone prn. he went back to the or for a washout on . pt saw patient and recommended home with home pt. . #. altered mental status: likely multifactorial including hypoglycemia, infection, and medication build up from arf causing decreased elimination. notably, seroquel, ativan, lithium, duloxetine, dilaudid, and gabapentin build up in setting of arf. psych was consulted who recommended putting patient on a bzd taper, which he finished on the day of discharge. he was also started on haloperidol 5mg tid. over, time, the patient's delirium improved, and haloperidol was d/c prior to discharge. his qtc was monitored while on haloperidol and did not prolong. he was found to have a urinary tract infection (see below). #. hypoglycemia: patient transferred to micu in setting of ams with hypoglycemia in 40s. etiology of hypoglycemia likely caused by medication error as patient was started on glyburide 10mg following surgery. furthermore, clearance of glyburide was reduced given acute kidney injury (see below). hypoglycemia was corrected with d10 and d5 gtt which were weaned off once blood sugar had normalized, and patient was called out to the medical floor. he was maintained on sliding scale humalog on the floor and will be discharged home with his outpatient dose of metformin. . # uti: urine culture from grew pseudomonas. patient was initially treated with zosyn, and when the organism was found to be fairly pan-sensitive, he was switched to po ciprofloxacin to complete a 14 day course for a complicated uti as patient had a foley in the micu which was d/c upon transfer to the floor. . # low grade fever, leukocytosis: improved with initiation of treatment for uti, but source was unclear initially. lateral leg incision was draining serosanguinous fluid, and orthopedics took pt back to or for a washout . he was put on ancef initially then switched to vanco for gram (+) coverage. wound gram stain showed pmns but no organisms, and cultures were negative. per ortho recs, pt will be d/c with a 2 week course of keflex. . #. acute renal failure: oliguric on admission. fena 0.2% that was consistent with pre-renal etiology and resolved with fluids. his home enalapril was initially held but re-started when arf resolved. pt was prophylaxed with sq heparin initially, then switched back to lovenox when arf resolved. he should continue lovenox as an outpatient as laid out by ortho. . #. hypoxia: on admission to micu, abg c/w hypercapnia likely hypoventilation given patient's ams. resolved with resolution of delirium. . # anemia: hct down to low 20's from baseline of high 20's. had 700 cc of ebl in or, anemia most likely from or blood loss. received 2units rbc's and hct bumped appropriately and was stable throughout the rest of the admission . #. bipolar disorder/ptsd: initially held home seroquel, clonazepam, ativan, trazodone, duloxetine, lithium in setting of arf and ams. slowly restarted meds and renal doses which were changed back to home doses once renal function returns. however, pt was tapered of bzds as noted above and will be discharged without any lorezapam or clonazepam. . #. osa: reportedly noncompliant with cpap in micu, but did not showing evidence of apnea on monitor. however, on the medical floor, pt was using his cpap and tolerating it well. . #. seizure disorder: held gabapentin/bzds in setting of arf and slowly restarted and titrated back to home dose when arf resolved. . #. htn: given low dose of diltiazem, in preparation for discharge, dilz was d/c and enalapril was increased to 20mg daily. pt will follow up with pcp upon /c. . #. hyperlipidemia: held gemfibrozil in setting of arf and elevated ck. continued pravastatin upon discharge. medications on admission: home medications 1. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. enoxaparin 40 mg/0.4 ml syringe sig: one (1) syringe subcutaneous daily (daily) for 4 weeks. 4. lithium carbonate 300 mg tablet sustained release sig: two (2) tablet sustained release po bid (2 times a day). 5. clonazepam 0.5 mg tablet sig: four (4) tablet po daily (daily) as needed for prn anxiety. 6. gabapentin 300 mg capsule sig: three (3) capsule po q8h (every 8 hours). 7. hydromorphone 2 mg tablet sig: 1-2 tablets po q4h:prn as needed for pain. 8. quetiapine 300 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 9. enalapril maleate 10 mg tablet sig: one (1) tablet po daily (daily). 10. glucophage 1,000 mg tablet sig: one (1) tablet po twice a day. 11. pravastatin 80 mg tablet sig: one (1) tablet po once a day. 12. cymbalta 60 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po once a day. 13. diltiazem hcl 30 mg tablet sig: one (1) tablet po once a day. 14. trazodone 100 mg tablet sig: two (2) tablet po at bedtime. 15. ativan 0.5 mg tablet sig: 1-2 tablets po tid: prn. discharge medications: 1. lithium carbonate 300 mg tablet sustained release sig: two (2) tablet sustained release po bid (2 times a day). 2. enoxaparin 40 mg/0.4 ml syringe sig: one (1) injection subcutaneous daily (daily). 3. enalapril maleate 10 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 4. gabapentin 300 mg capsule sig: three (3) capsule po tid (3 times a day). 5. quetiapine 300 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po qhs (once a day (at bedtime)). 6. trazodone 100 mg tablet sig: two (2) tablet po hs (at bedtime) as needed for sleep. 7. acetaminophen 500 mg tablet sig: two (2) tablet po q6h (every 6 hours). disp:*240 tablet(s)* refills:*2* 8. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain not relieved by tyenol. disp:*10 tablet(s)* refills:*0* 9. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 7 days. disp:*14 tablet(s)* refills:*0* 10. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. 11. pravastatin 80 mg tablet sig: one (1) tablet po once a day. 12. docusate sodium 100 mg capsule sig: one (1) capsule po once a day: hold for loose stools or more than 2 bowels movements per day. 13. senna 8.6 mg tablet sig: two (2) tablet po at bedtime: hold for loose stools or more than 2 bowels movements per day. disp:*60 tablet(s)* refills:*2* 14. keflex 500 mg capsule sig: one (1) capsule po twice a day for 2 weeks. disp:*28 capsule(s)* refills:*0* 15. duloxetine 60 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po once a day. discharge disposition: home with service facility: all care vna of greater discharge diagnosis: primary: s/p hardware removal and washout left tibia urinary tract infection . secondary: diabetes sleep apnea discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: mr. , . thank you for coming to for your medical care. you were admitted to the hopital so the orthopedic surgeons could remove the hardware from your left leg. your blood sugar got low, so you were transfered to the medical intensive care unit (micu). you were also confused in the micu. when your sugars were stable, you came to the regular medical floor. the surgeons took you back to the or to clean the operation site. you were started on antibiotics for a urinary tract infection. you should continue to take ciprofloxacin for 7 more days to finish your course. . we made the following changes to your medications: - please stop taking ativan (lorezapam) and klonapin (clonazepam). the psychiatrists thought these medicines contributed to your confusion. - please stop taking glyburide. we think this is responsible for your low sugars. - please start taking ciprofloxacin 500mg twice a day for the next 7 days. - please start taking keflex (cephalexin) 500mg twice a day - please stop taking diltiazem. - please increase your enalapril to 20mg daily - you may take tylenol (acetaminophen) 1000mg every 6 hours for pain. you may take 5mg of oxycodone every 4 hours for pain not relieved by tylenol. we have given you a small supply of pain medicine. you should discuss the amount of pain you are having when you see your primary care doctor later this week. - while on the oxycodone, please take docusate and senna regularly to prevent constipation. stop taking these medications if you have loose stools or more than 2 bowel movements in one day. - please continue taking enoxaparin injections twice a day for at least 2 more weeks. you should discuss the need for this medication when you see the orthopedic surgeons. followup instructions: you should call your psychiatrist to make an appointment. . name: thavaseelan, s. location: internists address: , , , phone: appointment: thursday 11:30am . department: orthopedics when: thursday at 12:00 pm with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage . department: orthopedics when: thursday at 12:20 pm with: , np building: campus: east best parking: garage procedure: other incision with drainage of skin and subcutaneous tissue open reduction of fracture with internal fixation, tibia and fibula closed reduction of fracture without internal fixation, tibia and fibula removal of implanted devices from bone, tibia and fibula diagnoses: acidosis obstructive sleep apnea (adult)(pediatric) other postoperative infection urinary tract infection, site not specified acute posthemorrhagic anemia acute kidney failure, unspecified other and unspecified hyperlipidemia cellulitis and abscess of leg, except foot diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled epilepsy, unspecified, without mention of intractable epilepsy hypoxemia surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation bipolar disorder, unspecified delirium due to conditions classified elsewhere closed fracture of upper end of fibula with tibia pseudomonas infection in conditions classified elsewhere and of unspecified site posttraumatic stress disorder other noncollision motor vehicle traffic accident injuring motorcyclist 

Answer: The patient is high likely exposed to