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 nursing home patient with past medical history significant for hypothyroidism, chronic renal insufficiency with a baseline creatinine of 1.6, and hypertension, who was noted to have a three day history of progressively worsening mental status. at baseline, the patient is apparently independent in all her activities of daily livings, ambulates with a walker, and is appropriately articulate. in addition, the patient is status post three falls over the past three days associated with slurred speech, and increasing confusion. patient's falls were all unwitnessed at the nursing home, but there was no reported loss of consciousness. according to nursing home notes, the patient's po intake was also poor for the past three or four days. of note, her outpatient lasix dose had been doubled to 40 mg q day on . on the night prior to admission, patient was noticed to be increasingly agitated. as a result, she was given a total of 1 mg of ativan. she was then found unresponsive with systolic blood pressure in the 70s, heart rate in the 50s, and was thus transferred to emergency department. review of systems: review of systems obtained from the patient's daughter was remarkable only for a chronic persistent pruritic dermatitis on the patient's legs and trunk for the past 2-3 years for which she has been followed closely by dermatology. of note, the patient is highly sensitive to various medications with a history of increased confusion when given drugs like celexa, , and remeron. in our emergency department, the patient was aggressively fluid resuscitated with 2.5 liters of normal saline without any response. as a result, she was started on a dopamine drip. she was started on empiric antibiotics consisting of vancomycin, ceftriaxone, and flagyl. she was also given stress dosed iv steroids. she was found to be hypothermic with a rectal temperature of 88.0 f. chest x-ray showed a right lower lobe infiltrate, but electrocardiogram was without any acute changes. the patient was also given a dose of glucagon for possible beta blocker overdose without any response. she was stabilized in the emergency department, and then transferred to the fenard intensive care unit for further management. past medical history: 1. hypertension. 2. hypothyroidism. 3. depression. 4. anxiety. 5. legally blind secondary to macular degeneration. 6. chronic dermatitis for the past two years accompanied by intractable pruritus, resistant to steroids (the patient was treated empirically for scabies in ). 7. left eye cataract. 8. sensitivity to various medications. allergies: 1. celexa (confusion). 2. (confusion). 3. ambien. 4. remeron (confusion). medications on admission: 1. benadryl 37.5 mg q hs. 2. lasix 40 mg po q day. 3. atenolol 50 mg po q day. 4. aspirin 325 mg q day. 5. levothyroxine 88 mcg q day. 6. tylenol prn. 7. bacitracin ointment . 8. doxepin 5% cream qid to pruritic areas. social history: the patient is a rehab resident. she was a former private secretary. she had two daughters, one of whom died of cancer. her other daughter is and is quite involved in her care. her home phone number is ( and cell is (. she has no documented tobacco, alcohol, or iv drug use. of note, she is dnr/dni in terms of code status. family history: noncontributory. physical examination: rectal temperature 88.0 f, blood pressure 105/56 on a levophed drip at 0.5 mcg, heart rate 40 and sating 100% on 70% face mask. in general, the patient was quite confused and disoriented. she responded only minimally to voice. pupils are equal, round, and reactive to light. sclerae are anicteric. mucous membranes are moist. oropharynx is clear, but poor dentition. cardiac examination revealed distant s1, s2, bradycardia, no audible murmurs, rubs, or gallops. lungs were clear bilaterally with decreased breath sounds at the right base. abdomen was soft and benign with good bowel sounds. extremities showed 1+ pitting pedal edema bilaterally, as well as positive dopplerable pulses bilaterally. skin showed a bilateral erythematous macular rash with confluent excoriations. there were multiple weeping open wounds and ulcerations. laboratories on admission: notable for a white count of 5.7 with 60% neutrophils, and 24% lymphocytes, hematocrit 28. platelets 307. inr 1.1. urinalysis was negative. bun 62, creatinine 2.6, potassium 5, sodium 142. lfts were all normal. amylase and lipase normal. tsh 4.6, t3 88, t4 1.2. random cortisol 15.9. arterial blood gas: 7.33, pco2 41, pao2 215 on a nonrebreather. lactate level normal at 1. head ct scan was negative for any acute processes. chest x-ray showed a questionable right lower lobe infiltrate. electrocardiogram showing normal sinus rhythm at a rate of 50, old right bundle branch block, old t-wave inversions in leads i, iii, v1, and v3. qtc interval slightly prolonged at 500. hospital course by problems: hypotension: the patient's hypotension on initial presentation remains of unclear etiology. it is thought that it was most likely due to beta blocker toxicity in the setting of acute on chronic renal failure. she was initially aggressively fluid resuscitated with normal saline, but soon developed evidence of congestive heart failure, so it was decided to be more gentle in terms of hydration. she was thus kept on levophed as a pressor for about 48 hours and then was successfully weaned off. she was given stress-dosed steroids initially, but as her random cortisol were normal, these were soon tapered off. she was pancultured and started on empiric antibiotics (vancomycin, ceftriaxone, and flagyl) with the thought that she may be displaying vasodilatory shock. but as her cultures remain negative and she remained afebrile, her antibiotics were soon stopped. her cardiac enzymes were cycled and were all found to be negative. after a few days, the patient's blood pressure returns back to baseline and she was found to be hypertensive with systolics between 130 and 175. as a result, she was started on low dosed metoprolol at 12.5 and low dosed captopril 6.25 tid. hypothermia: this too remains of unclear etiology. the patient's core body temperature returned back to normal with 24 hours of a bair hugger. her electrocardiogram displayed no signs of hypothermia both on admission and 24 hours later. she was able to maintain normal body temperature throughout hospital stay. acute on chronic renal failure: the patient's acute renal failure was thought to be due to a combination of prerenal azotemia in the setting of poor po intake along with increased lasix, as well as acute tubular necrosis in the setting of hypotension. the patient's medications were all renally dosed and all nephrotoxic medications were avoided. over the course of her admission, the patient's creatinine returned back to baseline at the time of this dictation. her urine output remained excellent during her hospital stay, and at no point did she display any acute indication for hemodialysis. congestive heart failure: with a fluid load on admission, the patient became hypoxic, and displayed clinical signs of congestive heart failure. an echocardiogram is to be obtained immediately prior to discharge to better assess the patient's ejection fraction and to evaluate for any valvular disease. daily weights were checked. strict in's and out's were monitored and a 2 gram sodium diet adhered to during her stay. immediately prior to discharge, the patient's chest x-ray showed increasing signs of pulmonary edema, so she was given 20 mg of po lasix as well as 20 mg of iv lasix with good results. at the time of this dictation summary, the patient is still slightly volume overloaded. as a result, she will be given a touch of lasix iv to keep her in's and out's negative 1 liter. her outpatient lasix dose is yet to be determined depending on the results of her echocardiogram. right lower lobe pneumonia: the patient developed low grade temperatures along with a leukocytosis during this admission. as a result, she was placed on a 10 day course of levaquin with good results. hypothyroidism: as the patient's t3 and t4 were found to be within normal limits, she was continued on her outpatient levothyroxine dose. anemia: the patient was found to have iron deficiency anemia and was thus started on daily iron supplements. her hematocrit dropped to 25.9 at one point with guaiac negative stools. as a result, she was transfused 1 unit of packed red blood cells. mental status changes: the patient's acute confusional state was thought to be likely due to a toxic metabolic encephalopathy due to a combination of medications as well as infection from her pneumonia. a head ct scan was obtained and found to be negative for any acute changes. the patient was given low dosed haldol during her hospitalization which was then discontinued to allow the patient to return to her baseline mental status. at the time of this dictation, the patient's mental status continues to wax and wane, and is still not quite at her baseline. all mind altering medications are to be avoided. dermatitis: a dermatology consult was obtained and the patient's chronic pruritic rash was thought to be consistent with asteatotic dermatitis. as a result, she was placed on aquaphor tid, bacitracin , sarna lotion , and protopic q day with dramatic improvement. nutrition: the patient was initially kept npo given her unresponsive state. as her mental status began to improve, her diet was slowly advanced as tolerated to a 2 gram sodium diet. nutrition was consulted, and it was decided to start the patient on boost pudding supplements to improve her nutritional intake. in addition, she was placed on aspiration precautions. hyperglycemia: the patient had a transient increase in her blood sugars while on iv steroids. during that time, she was placed on a regular insulin-sliding scale and her fingersticks were checked q6h. once the steroids were tapered off, the patient's sugars normalized. lines: the patient initially had a central line that was discontinued once she was weaned off her pressors. she also had a foley placed that was discontinued before discharge. prophylaxis: the patient was placed on protonix daily, heparin subq, and an adequate bowel regimen for appropriate gi and dvt prophylaxis. discharge diagnoses: 1. hypotension secondary to beta blocker toxicity. 2. acute on chronic renal failure secondary to prerenal azotemia and acute tubular necrosis. 3. congestive heart failure. 4. hypothyroidism. 5. mental status changes likely due to toxic metabolic encephalopathy. 6. anemia. 7. right lower lobe pneumonia. discharge medications: 1. colace 100 . 2. captopril 6.25 mg tid (to be titrated up as blood pressure allows). 3. protonix 40 q day. 4. levothyroxine 88 mcg q day. 5. metoprolol 12.5 mg . 6. levaquin 250 mg q48h x6 more days. 7. sarna lotion applied to skin tid prn. 8. protopic one application transdermally q day. 9. aquaphor ointment tid. 10. iron sulfate 325 mg q day. 11. heparin 5,000 units subq q8 until the patient is ambulatory. 12. bacitracin ointment to open wound on lower extremities bilaterally. 13. tylenol prn not to exceed 4 grams a day. discharge status: the patient was discharged in good condition to her . she is to continue with physical therapy for strengthening. all sedative medications should be avoided until the patient's mental status returns back to baseline. she is to complete a 10 day course of her po levaquin for her pneumonia. her captopril should be titrated up as her blood pressure allows. her echocardiogram results will need to be followed up upon. she is to remain on metoprolol instead of atenolol, as atenolol is renally excreted. she should be encouraged to take good po intake. she will be followed closely by her primary care physician, . at the . , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified congestive heart failure, unspecified acute kidney failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease ulcer of calf other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to