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: hypertensive urgency and hypoxia major surgical or invasive procedure: none history of present illness: patient is a 39 m with dm, esrd on hd, gastroparesis, autonomic dysfunction, cad (stemi, nstemi), ; was admitted to micu with usual nausea, vomiting, abdominal pain and hypoxemia of unknown origin. mr was recently admitted from with concern of line infection/positive blood cultures; started on vancomycin with hd. . pt. reported sudden onset n/v x4 on day of admission. emesis was non-bloody or bilious. no prodorome or associated symptoms, except slight abdominal pain, no diarrhea, occasional dry cough x 2+ months. . pt also reports being "high on fluid" as he notes that he senses that with increased abdominal girth and neck swelling. this onset of these symptoms could not be clarified by the patient. he reports being at a party the day before and drinking cranberry juice and water, but denies use of etoh, drugs or dietary indiscretions. this episode is similar in nature to previous exacerbations of gastroparesis per patient and renal attending who knows patient well (dr. . saw dr. (his cardiologist) on day of admission; was feeling ill at the time. he recommended increasing lisinopril and labetalol, adding hctz and stopping clonidine patch. . from icu admit note: "in the ed, patient received 20 iv labetalol for elevated bp; 4 mg iv ativan and 2 mg iv dilaudid. femoral cvl placed. initial vitals 97.8, hr 90, 190/120, 97% on ra. desatted to upper 80s on ra and ?lower into 70s per ed signout (but not documented in written notes), abg with po2 of 71. placed on 3 l nc. cxr with volume overload; cta obtained due to hypoxemia and was negative for pe. sbp range 170s-180s. in icu pt c/o abdominal pain, asking for dilaudid and ativan, 2 mg of each." . while in icu, patient completed romi, cta and repeat xrs did not show apparent pna and he continued to have a 2l o2 requirement. he was started npo, abdominal pain and n/v impoved and was then advanced to clears. pain was treated with iv dilaudid, iv ativan and zofran. cta review revealed a new lad aneurysm. pt underwent hd today where he received vanco per hd protocol and was deemed stable enough for transfer to floor. . pt. was seen in hd, nad, somewhat sleepy s/p ativan for nausea. in addition to above, he reported one episode of cp 2 d pta, lasting 30seconds, w/o associated symptoms and resolution on its own. he denied n/v, cp, sob, diarrhea, fevers, chills, ha, diplopia. past medical history: - diabetes mellitus type i - gastroparesis with chronic hospitalizations - esrd on hd since - autonomic dysfunction, frequent htn emergency & orthostatic hypotension - peripheral neuropathy - coronary artery disease, stemi in setting of cocaine, s/p bms to lad - aortic valve endocarditis () and (mssa tx with nafcillin) - frequent bacteremia/line infections, often coag neg staph. - prior line sepsis with klebsiella and enterobacteremia - esophageal ulceration: h pylori neg, active esophagitis seen on egd , h/ - tear - history of substance abuse (cocaine, marijuana, alcohol) - history of thrombosed av fistula in lue , -tex in place - fungemia completed caspofungin iv on - gi bleed associated with hypotension-colonscopy showed friable and inflammed ascending and transverse colon,suggestive either of ischemia or infection - nstemi in setting hypertension on social history: patient has a prior history of tobacco and marijauna use, but he does not currently smoke. he has a prior history of alcohol abuse and has been sober for 9 years. he has a past history of cocaine use. he currently denies illicit drugs. currently lives with his mother and brothers. family history: father deceased of esrd and dm. mother aged 50's with hypertension. two sisters, one with diabetes. six brothers, one with diabetes. there is no family history of premature coronary artery disease or sudden death. physical exam: on admission to micu: tmax: 36.3 ??????c (97.4 ??????f) tcurrent: 36.3 ??????c (97.4 ??????f) hr: 81 (81 - 86) bpm bp: 133/90(100) {133/90(100) - 167/123(134)} mmhg rr: 14 (14 - 25) insp/min spo2: 97% general appearance: no acute distress eyes / conjunctiva: no(t) perrl, + anisocoria, r 4->3, l 2.5->2 head, ears, nose, throat: normocephalic lymphatic: cervical wnl, no(t) cervical adenopathy cardiovascular: (s1: normal), (s2: normal), (murmur: systolic), apical sm peripheral vascular: (right radial pulse: not assessed), (left radial pulse: not assessed), (right dp pulse: not assessed), (left dp pulse: not assessed) respiratory / chest: (expansion: symmetric), (breath sounds: crackles : faint end inspiratory crackles at bases, no(t) wheezes : , diminished: bilat bases) abdominal: soft, bowel sounds present, no(t) distended, tender: diffuse in abdomen, voluntary guarding, hypoactive bs extremities: right: absent, left: absent skin: cool, no(t) rash: neurologic: attentive, follows simple commands, responds to: not assessed, oriented (to): place, day -1, movement: not assessed, tone: not assessed, slightly lethargic on transfer to the floor vs: tc: 96 ??????f hr: 84 bp: 149/110mmhg rr: 18 spo2: 95% ra general appearance: no acute distress heent - normocephalic, no lad. perrl, r 2->1.5, l 2->1.5 cv: s1, s2 nl, , sem at apex. pulm: cta b/l. abdominal: soft, bowel sounds present, nt/nd, bs+ skin: warm, dry, no edema, no lesions ext: warm, dry, no edema, r tunneled catheter, c/d/i. neuro: slightly sleepy, but arouses and maintains attention to voice, cn 2-12 intact, strength 5/5 b/l ue and le, sensory grossly intact, dtrs 2+. pertinent results: laboratory studies: 02:30pm blood wbc-9.9 rbc-3.80* hgb-9.6* hct-32.5* mcv-86 mch-25.3* mchc-29.6* rdw-20.4* plt ct-275 03:25am blood wbc-8.5 rbc-3.43* hgb-8.8* hct-29.2* mcv-85 mch-25.6* mchc-30.0* rdw-19.1* plt ct-288 07:00am blood wbc-6.3 rbc-3.85* hgb-10.0* hct-33.6* mcv-87 mch-25.9* mchc-29.7* rdw-19.4* plt ct-251 04:09am blood wbc-4.8 rbc-3.78* hgb-9.9* hct-31.6* mcv-84 mch-26.2* mchc-31.3 rdw-20.3* plt ct-272 02:30pm blood neuts-85.5* lymphs-7.6* monos-4.4 eos-2.2 baso-0.4 . 02:30pm blood pt-12.9 ptt-29.0 inr(pt)-1.1 . 02:30pm blood glucose-274* urean-60* creat-9.3*# na-140 k-5.8* cl-98 hco3-28 angap-20 03:25am blood glucose-124* urean-69* creat-10.5*# na-143 k-5.4* cl-101 hco3-29 angap-18 07:00am blood glucose-64* urean-37* creat-7.4*# na-138 k-4.3 cl-95* hco3-25 angap-22* 04:09am blood glucose-101 urean-45* creat-9.0*# na-136 k-4.8 cl-92* hco3-28 angap-21* . 02:30pm blood alt-12 ast-16 ck(cpk)-164 alkphos-115 totbili-0.1 10:30pm blood ck(cpk)-123 03:25am blood ck(cpk)-112 . 02:30pm blood ctropnt-0.22* 10:30pm blood ck-mb-6 ctropnt-0.24* 03:25am blood ck-mb-6 ctropnt-0.26* . 03:25am blood calcium-9.2 phos-8.6*# mg-2.1 07:00am blood calcium-8.4 phos-7.0*# mg-1.7 04:09am blood calcium-8.7 phos-7.7* mg-1.9 . 03:25am blood vanco-13.3 . 02:50pm blood type-art rates-/1 po2-71* pco2-48* ph-7.36 caltco2-28 base xs-0 intubat-not intuba vent-spontaneou micro: blood culture from - negative. . imaging/studies: . cxr - impression: findings most compatible with volume overload. repeat pa and lateral radiographs may be helpful once symptoms resolved. . cta - ct of the chest with iv contrast: there are extensive atherosclerotic calcifications involving the left anterior descending, left circumflex, and right coronary arteries. a focal area of aneurysmal dilatation of the distal left anterior descending coronary artery is evident, measuring 2.7 x 0.7 cm in the sagittal plane (2:81, 302b:43). the heart is moderately enlarged in size. there is no pericardial effusion. the aorta is normal in caliber and contour. there are no filling defects within the pulmonary arterial vasculature. a tiny linear defect within a right lower lobe subsegemental branch may represent mixing of contrast or other artifact (2:71). the pulmonary artery is enlarged, measuring 3.6 cm in diameter. prevascular lymph nodes measuring 10 and 6 mm in short- axis diameter are evident (2:35). a precarinal mediastinal lymph node measures 10 mm in short- axis diameter (2:34). there are no pathologically enlarged hilar or axillary lymph nodes. there is a small right- sided pleural effusion. lung windows demonstrate extensive septal thickening and diffuse ground-glass changes compatible with pulmonary edema. small hiatal hernia is noted. the imaged portions of the upper abdomen are otherwise unremarkable. there are no suspicious lytic or blastic lesions. impression: 1. no acute pulmonary embolism. 2. aneurysmal dilatation of the left anterior descending coronary artery. 3. enlarged pulmonary artery, indicative of pulmonary hypertension. 4. evidence of volume overload including small right-sided pleural effusion. 5. extensive coronary artery atherosclerotic calcifications. 6. mediastinal lymphadenopathy, likely reactive. . ecg - sinus rhythm. anteroseptal myocardial infarction, age indeterminate. possible left atrial abnormality. since the previous tracing of no significant change. tracing #1 read by: , j. intervals axes rate pr qrs qt/qtc p qrs t 82 184 78 396/434 37 11 46 . cxr - findings: in comparison with the study of , the pulmonary vascularity is now essentially within normal limits. enlargement of the cardiac silhouette persists. no evidence of acute focal pneumonia. . ecg - sinus rhythm with one ventricular premature beat. probable left atrial abnormality. anteroseptal myocardial infarction, age indeteminate. compared to the previous tracing of no significant change. tracing #2 read by: , j. intervals axes rate pr qrs qt/qtc p qrs t 87 182 80 392/439 55 -15 39 brief hospital course: 39 m with history of esrd on hd, dm c/b gastroparesis and autonomic dysfunction, cad s/p stemi, frequent admissions for nausea/vomiting and abdominal pain; now admitted with n/v/abdominal pain and hypoxemia. in the micu he was stabilized with pain medication and underwent hd with subsequent improvement of volume overload and resporatory function. he was transferred to the floor for further management on hd2. . # hypoxemia. patient had a new o2 requirement in ed/micu that had resolved with esrd. differential included hypoventilation from narcotics, pain/splinting (elevated pco2 on abg) and volume overload esrd, cad/ischemia. he was ruled out for pe and mi, had no apparent focal pneumonia clinically or on ct, but did have pulmonary edema on ct at presentation. after hd, this had resolved. repeat ecg was unchanged from priors w/ anteroseptal mi and possible lae. patient was continued on asa, statin, plavix and bbk. . # n/v/abdominal pain. similar to prior presentations was felt to be likely related to dm gastroparesis. his lipase and lfts were wnl. the abdominal pain improved slightly from hd2 to 3, however patient could not tolerate po diet w/ return of abdominal pain and n/v. he was given dilaudid iv for pain control and ativan iv as an antiemetic. reglan 10mg iv/po was continued throughout hospitalization. by hd 4, the nausea/emesis and abdominal pain improved significantly. pt. was switched to po medications and advanced to regular diet with good tolerance. he was discharged home with po reglan, dilaudid, vicodin and ativan for pain/nausea control and prevention of future episodes. . # esrd on hd & bacteremia. patient underwent two hd sessions while hospitalized. he had a tunnelled femoral line. his vancomycin for coagulase negative staph bacteremia from prvious hospitalization was completed. vanco trough measured was 13.3 and his dosing was adjusted per hd protocol. blood cultures were repeated and were negative. patient's phosphate levels were significantly elevated. he received only one dosde of aluminum hydroxide while hospitalized due to n/v. he was continued on lanthanum, nephrocaps as per home regimen. . # lad aneurysm. noted on cta, was new since . the case was discussed with cardiology and it was felt that no further work up or anticoagulation were required at this time, given the location distal to previous stemi site. this was also discussed with mr. ' outpatient cardiologist and will be followed as op. . # dm. poorly controlled during hospitalization with inconsistent dietary intake. he was continued on home dosing nph plus sliding scale. on hd4, bg control improved to bg > 150 throughout the day. patient was discharged w/ 5u of nph qam and regular insulin ss. gastroparesis was treated as above. gabapentin was continued as per home regimen. . # htn. this was poorly controlled since admission and required iv labetalol prn in micu. on the floor bps reanged to 160s/110s. antihypertensive medication reconcilliation was performed in consultation with dr. . it was noted that the patient has not benefited from hctz and relative hypotension with . mr. ' labetalol was increased to 200mg , clonidine patch was continued at 0.3mg qweekly and lisinopril was started at 20 and advanced to 40mg qd at time of discharge. bp at discharge 142/100 mmhg. . # cad s/p stemi. patient was asymptomatic. he was continued on asa, plavix, statin, bb. lisinopril was started prior to discharge. he will be scheduled as op for catheterization. . for prophylaxis he was placed on heparin sc and continued outpatient ppi regimen. . he was discharged in a hemodynamically stable condition with appropriate follow up. patient was pain free and free of n/v. medications on admission: 1. aspirin 325 mg daily 2. clopidogrel 75 mg daily 3. simvastatin 40 mg daily 4. clonidine 0.3 mg/24 hr patch weekly qsunday 5. labetalol 200 mg 6. lanthanum 1000 mg tid c meals 7. metoclopramide 10 mg qidach 8. b complex-vitamin c-folic acid 1 daily 9. gabapentin 300 mg with hd 10. pantoprazole 40 mg daily 11. zofran 4 mg tid 12. ativan 1 mg q4-6hrs prn 13. insulin nph 5 u qam 14. vicodin 5-500 mg tid prn 15. vancomycin with hd discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. clonidine 0.3 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qmon (every monday). disp:*14 patch weekly(s)* refills:*2* 5. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 6. gabapentin 300 mg capsule sig: one (1) capsule po qhd (each hemodialysis). disp:*30 capsule(s)* refills:*2* 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 8. lanthanum 1,000 mg tablet, chewable sig: one (1) tablet, chewable po tid with meals. disp:*90 tablet, chewable(s)* refills:*2* 9. labetalol 200 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 10. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). disp:*60 tablet(s)* refills:*2* 11. zofran 4 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*2* 12. insulin regular human 100 unit/ml cartridge sig: one (1) injection three times a day: as per your sliding scale provided to you. disp:*10 cartriges* refills:*2* 13. lorazepam 1 mg tablet sig: one (1) tablet po every 4-6 hours as needed for nausea. disp:*30 tablet(s)* refills:*0* 14. lisinopril 40 mg tablet sig: one (1) tablet po qam. disp:*30 tablet(s)* refills:*2* 15. insulin nph human recomb 100 unit/ml cartridge sig: five (5) units subcutaneous qam. 16. dilaudid 4 mg tablet sig: one (1) tablet po every 4-6 hours as needed for abdominal pain: gastroparesis. disp:*30 tablet(s)* refills:*0* 17. vicodin 5-500 mg tablet sig: one (1) tablet po every four (4) hours as needed for pain. 18. phoslo 667 mg capsule sig: one (1) capsule po three times a day. disp:*90 capsule(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: gastroparesis, pulmonary edema, uncontrolled hypertension secondary: diabetes type i, coronary artery disease, autonomic dysfunction. discharge condition: hemodynamically stable, without pain. discharge instructions: you were admitted to the hopital because you have developed an exacerbation of your recurrent abdominal pain and nausea and vomiting. in addition you were found to have fluid in your lungs, likely due to drinking too much fluid between dialysis sessions. initially, you had low blood oxygen levels and required supplemental oxygen, but once you went to dialisis, your oxygen levels improved as did your breathing. you were treated with pain medication, nause medication and went to dialisis. you were also continued on vancomycin for a blood infection, you did not have any fevers. you completed this antibiotic while in the hospital. you went to dialisis on your regularly scheduled days. at dialysis more blood cultres were drawn. in addition, you were found to have an anneurysm (small outpouching) of a blood vessel around your heart. your cardiologist's team saw you and felt that this will not require further intervention. you will need to follow up with your cardiologist for this as well as to have a heart catheterization. your blood pressure was also high during this admission. this was discussed in detail with your nephrologist dr. and the new regimen was provided for you (new medication includes lisinporil and you will continue labetalol and clonidine). you will need to follow up the blood pressure regimen and the blood culture results with dr. . should you experience new abdominal pain, chest pain, shortness of breath, palpitations, fever, chills, cough, faintness or any other symptoms concerning to you, please call your primary care provider or go to the nearest emergency room. please adhere to a regular diabeti, heart healthy diet. you were provided with prescriptions and refills for medications you are taking. followup instructions: please follow up with you pcp and the following providers: please call your pcp to follow up within two weeks. ( resident). . provider: , md phone: date/time: 11:00. , , cc7 cardiology please call dr. office to arrange follow up within one to two weeks: (. md procedure: hemodialysis diagnoses: hypertensive chronic kidney disease, malignant, with chronic kidney disease stage v or end stage renal disease anemia in chronic kidney disease end stage renal disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified percutaneous transluminal coronary angioplasty status bacteremia chronic systolic heart failure other and unspecified infection due to central venous catheter staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus diabetes with neurological manifestations, type i [juvenile type], uncontrolled gastroparesis aneurysm of coronary vessels peripheral autonomic neuropathy in disorders classified elsewhere 

Answer: The patient is high likely exposed to