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: history of present illness: this is a 66-year-old patient with end-stage renal disease on hemodialysis for several years. she was admitted on initially after finding some graft material protruding from her arm in a strange fashion. she was seen in the emergency department and sent to or for excision of graft aneurysm. this graft was sent for path on , however, no cultures were sent at that time. it is unclear whether the aneurysm was felt to be infected or not. patient was dialyzed through the graft later that same day and given one dose of vancomycin after blood cultures had been sent. patient was discharged home in good condition on , then represented on , when seen at home by her vna and found to be confused. on arrival in the ed, patient had a temperature of 102.1, blood pressure of 92/50s. she was given fluids with good response. her only complaints at that time were of belly pain and diarrhea. the patient was pancultured and received a chest, abdominal, and pelvic ct without evidence of obvious fever source. there were attempts at lp made both at the bedside and under fluoroscopy, which was unsuccessful secondary to patient's agitation. at 5 a.m. on , the patient was noted to be hypotensive again to 88/40. she was started on sepsis protocol. she was treated with vancomycin, gentamicin, and ceftriaxone. she was also noted to have new lateral t-wave inversions and a positive troponin with a negative ck and ck mb. past medical history: 1. end-stage renal disease on hemodialysis as noted previously. 2. diabetes. 3. hypertension. 4. left lower lobe opacity status post lung biopsy that was ct guided, biopsy results were consistent with benign tissue and the opacity has been stable for many months. 5. history of laminectomy at l5-s1. 6. history of left otitis media which progressed to mastoiditis and eventual brain abscess in . 7. patient is status post left tympanomastoidectomy as well as evacuation of brain abscess. 8. seizure disorder in the past. allergies: penicillin, lovastatin, meropenem, cefazolin, and cipro. penicillin - reaction is unknown. lovastatin - reaction is unknown, however, rash and lft abnormalities are reported as her allergy for both meropenem, cephazolin, and ciprofloxacin. medications at home prior to admission: 1. colace. 2. captopril 100 mg b.i.d. 3. norvasc 5 mg q.d. 4. levoxyl 200 mcg. 5. sertraline 50. 6. sevelamer 800 t.i.d. 7. valproic acid 250 mg in the morning, 500 mg at night. 8. aspirin. 9. nephrocaps. 10. albuterol. laboratories: patient's white count on admission was 12.2 with 85 neutrophils, 10 bands, hematocrit was 33.9, which was within the patient's baseline, platelets were 190. inr was 1.1 and ptt was 20.5. urinalysis was unremarkable. patient's lfts were within normal limits with an alt of 13 and ast of 26. ck was 180 and with a negative mb fraction and troponin was 0.18. patient had a sodium of 128, potassium of 5.8, chloride of 93, bicarb of 17, bun of 59, creatinine of 9.2, and a glucose of 85. calcium was 9.7. magnesium was 1.8 and phosphorus was 7.5. lactate was 1.3 and anion gap was 18. tsh was 3.8 and random cortisol was 48.5. ecg was notable for new t-wave inversions in i, ii, v4 through v6. her abdominopelvic ct had distended gallbladder without evidence of stones or sludge, thickened wall, but no pericholecystic fluid and no common biliary duct dilatation. there were otherwise no findings. cut through the bottoms of the lung showed a stable left lower lobe nodular consolidation consistent with previous ct examinations. in short, this is a 66-year-old female with end-stage renal disease status post graft revision excision on now presenting with change in mental status, fever, hypotension, and likely sepsis. hospital course: 1. hypotension: upon admission, it is felt that patient's hypotension was likely due to septic physiology. she was given fluids and easily resuscitated. her anion gap acidosis improved and she was started on broad coverage antibiotics with vancomycin and gentamicin. patient had an echocardiogram on , which demonstrated a supernormal ejection fraction. it is suggesting that cardiogenic shock was not likely to account for her initial hypotension despite her positive enzymes. patient remained hemodynamically stable for several days and again became febrile and hypotensive requiring hemodynamic support with pressors on . at that time, patient was started on broader spectrum coverage with antibiotics as will be discussed in the infectious disease section of this dictation. as of this dictation, patient has remained intermittently hypotensive requiring pressor support. she has been pressor free from until presently. although she remains low grade febrile, her white count has decreased and is felt that some of her hypotension at this point may be due to intervascular volume depletion from hemodialysis. 2. infectious disease: upon admission, there was marked concern that the patient's vascular graft was the source of infection. patient was seen and evaluated by transplant surgery service, who felt that given the benign appearance of the wound itself that the graft was not the source of infection. the patient, thus, underwent an exhaustive workup to exclude or include other sources of infection. patient had multiple blood cultures, sputum cultures, urine cultures as well as gallium scan, a right upper quadrant ultrasound, a mri, and a lumbar puncture. to date, none of her blood cultures or other cultures have been positive with the exception of a urine culture, which grew . patient was treated with a 10 day course of caspofungin for this potential source of infection. despite broad-spectrum antibiotics, the patient remained persistently febrile with elevated white count for continued period of time. transplant surgery was consulted intermittently to re-evaluate the possibility of the vascular graft as source of infection. they felt that in the absence of positive blood cultures, that it was unlikely to be the source of infection. at this writing, we have begun peeling back the patient's antibiotics and as of the time of this dictation, she is only on vancomycin, which she will complete a week course for presumed endovascular infection. 3. demand ischemia: the patient had a troponin leak on admission. this was presumed due to demand ischemia from her septic physiology and tachycardia. the patient was given aspirin and medically managed to the extent possible for her demand ischemia. the patient was initially in sinus rhythm upon admission, however, within the first several days after admission, she developed new onset afib with rapid ventricular rate. several of these episodes resulted in hemodynamic instability, which required electrical cardioversion to return the patient to sinus rhythm and hemodynamic stability. despite short period of sinus rhythm, the patient remained in afib with a rapid ventricular rate. the patient was amiodarone loaded in hopes of chemically cardioverting her. however, due to issues with a decreased hematocrit, she was never able to be fully anticoagulated. ............ , m.d. dictated by: medquist36 d: 20:35 t: 07:09 job#: procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung other endoscopy of small intestine insertion of endotracheal tube fiber-optic bronchoscopy hemodialysis other electric countershock of heart percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy diagnoses: acidosis subendocardial infarction, initial episode of care urinary tract infection, site not specified atrial fibrillation other convulsions hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure septic shock 

Answer: The patient is high likely exposed to