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: calcium channel blocking agents-dihydropyridines / macrolide antibiotics / cephalosporins / quinolones / ace inhibitors / potassium attending: chief complaint: shortness of breath major surgical or invasive procedure: tunneled hemodialysis catheter placement hemodialysis esophagastroduodenoscopy x 3- s/p treatment for duodenal ulcers history of present illness: ms. is an 85 year old woman with hx of hypertension, afib, stage v ckd, diastolic chf who presented with progressive sob x 2 weeks, progressive leg edema and doe x 2 months. patient denied any orthopnea or paroxysmal nocturnal dyspnea. mobility now significantly limited. also endorsed a cough for 2 weeks productive of green/ sputum. denied any fevers or chest pain. baseline creatinine was 3.8 in , bumped to 4.5 in setting of escalating diuretics, improved to 4.25 on when backed down on diuretics. patient believes that symptoms started after starting diltiazem, which worked well for her blood pressure. nephrologist recently stopped diltiazem and asked her to wrap her legs when not elevated. she had previously very poorly controlled hypertension, though now improved. in the ed, initial vs were: 97.2 62 126/43 20 84% ra. potassium was elevated to 6.4 with peaked t waves on ecg. qrs not widened. creatinine elevated to 6.3. bnp 16,000. swelling was notably significant to mid abdomen. she was noted to be comfortable speaking full sentences. lungs with crackles throughout. 2+ pitting edema to lower abd and + abdom tenderness. she was noted to have slight erythema bilateral anterior legs with no warmth. cxr showed rml/rll collapse similar to prior radiograph, increased vascular markings and pleural effusion, consistent with chf. patient was given insulin 10u with dextrose and kayexalate for hyperkalemia. bedside ultrasound without pericardial effusion. on the floor, patient appeared to have some increased work of breathing. endorsed orthopnea for several weeks, productive cough, increased leg edema up to the sacrum, and increased abdominal fullness. review of systems: she denied any abdominal pain prior to foley catheter insertion but now has discomfort. denies any fevers, chills, headache, dysuria, hematuria, or rashes. past medical history: htn a-fib chronic renal insufficiency d/t htn secondary hyperparathyroidism macular degeneration diastolic heart failure: chf echo mild lvh, mod diastolic dysfunction, pasp 39-62 positive lupus anticoagulant social history: 5pk-yr smoking history, quit 50 yrs ago. has family nearby. single, never married, no kids. worked as office manager for musician . niece is hcp. family history: father died of an mi at age 49. mother with htn, lived to her 90s. physical exam: admission exam: vitals: 97.3 122/72 63 24 92% 3l general: alert, oriented, seated upright visibly with increased work of breathing heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp elevated lungs: diffuse crackles, decreased breath sounds r lower base cv: irregular rhythm, harsh systolic murmur across precordium with softer s2 abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no ascites ext: warm, well perfused, 2+ edema up to the sacrum bilateral lower extremities, anterior shins mildly erythematous, no weeping pertinent results: admission labs: 02:35pm blood wbc-5.7 rbc-3.15* hgb-9.1* hct-28.9* mcv-92 mch-28.8 mchc-31.3 rdw-17.7* plt ct-221 02:35pm blood neuts-80.0* lymphs-13.4* monos-4.5 eos-1.2 baso-0.9 02:35pm blood pt-11.1 ptt-58.5* inr(pt)-1.0 10:10pm blood glucose-89 urean-110* creat-6.5* na-138 k-6.3* cl-105 hco3-24 angap-15 05:08am blood ld(ldh)-250 totbili-0.2 12:48pm blood caltibc-298 ferritn-43 trf-229 hepatitis serologies: 12:48pm blood hbsag-negative hbsab-negative hbcab-negative 12:48pm blood hcv ab-negative ppd negative: read 06:30am blood wbc-7.0 rbc-2.96* hgb-8.6* hct-28.0* mcv-95 mch-29.1 mchc-30.7* rdw-17.5* plt ct-168 08:20am blood wbc-9.1 rbc-3.16* hgb-9.1* hct-29.4* mcv-93 mch-28.8 mchc-31.0 rdw-16.8* plt ct-209 12:56pm blood hgb-8.4* hct-27.1* 06:38am blood wbc-9.2 rbc-3.07* hgb-8.9* hct-29.5* mcv-96 mch-29.0 mchc-30.2* rdw-17.0* plt ct-188 07:00am blood wbc-8.5 rbc-2.94* hgb-8.5* hct-28.1* mcv-96 mch-28.9 mchc-30.1* rdw-16.5* plt ct-186 07:25am blood wbc-8.5 rbc-3.02* hgb-8.6* hct-29.5* mcv-98 mch-28.5 mchc-29.2* rdw-16.6* plt ct-162 03:41am blood wbc-9.9 rbc-2.27* hgb-6.6* hct-21.0* mcv-93 mch-28.9 mchc-31.2 rdw-16.9* plt ct-160 01:44pm blood hct-19.5* 09:29pm blood hct-23.6* 04:07am blood wbc-16.6*# rbc-2.64* hgb-7.8* hct-23.7* mcv-90 mch-29.6 mchc-32.9 rdw-17.0* plt ct-140* 06:02pm blood hct-23.0* 03:38am blood wbc-14.9* rbc-2.32* hgb-6.9* hct-21.4* mcv-92 mch-29.6 mchc-32.1 rdw-17.0* plt ct-151 04:54pm blood hct-26.7* 07:46pm blood hct-23.1* 02:00am blood wbc-13.7* rbc-2.36* hgb-7.0* hct-21.2* mcv-90 mch-29.8 mchc-33.2 rdw-18.2* plt ct-172 02:19pm blood hct-31.5*# 04:37pm blood hct-29.3* 08:56pm blood hct-26.9* 03:05am blood wbc-12.5* rbc-2.76* hgb-8.5* hct-25.6* mcv-93 mch-30.7 mchc-33.0 rdw-17.6* plt ct-238 01:30pm blood hct-25.7* 08:53pm blood hct-22.0* 09:52pm blood hct-23.1* 05:40am blood wbc-13.7* rbc-2.00*# hgb-6.0*# hct-19.0* mcv-95 mch-30.2 mchc-31.8 rdw-17.9* plt ct-272 12:13pm blood hct-24.3*# 02:42pm blood hct-21.2* 08:16pm blood hct-25.6* 11:54pm blood hct-25.1* 04:08am blood wbc-18.1* rbc-3.02*# hgb-9.0*# hct-26.8* mcv-89 mch-29.8 mchc-33.6 rdw-18.7* plt ct-218 01:36pm blood hct-27.1* 08:34pm blood hct-23.9* 02:08am blood wbc-18.0* rbc-2.88* hgb-8.9* hct-26.0* mcv-90 mch-30.7 mchc-34.1 rdw-17.5* plt ct-263 08:20am blood hct-29.5* 01:06pm blood hct-28.6* 03:21am blood wbc-13.7* rbc-2.95* hgb-8.9* hct-27.1* mcv-92 mch-30.0 mchc-32.7 rdw-18.8* plt ct-330 02:57pm blood hct-28.0* 05:24am blood wbc-11.6* rbc-2.84* hgb-8.6* hct-27.1* mcv-96 mch-30.2 mchc-31.6 rdw-20.0* plt ct-260 07:20am blood wbc-12.6* rbc-3.01* hgb-9.1* hct-29.5* mcv-98 mch-30.3 mchc-31.0 rdw-19.8* plt ct-366 11:00am blood wbc-13.6* rbc-3.00* hgb-9.0* hct-29.6* mcv-99* mch-30.0 mchc-30.4* rdw-20.0* plt ct-326 07:20am blood glucose-87 urean-34* creat-3.9* na-140 k-3.3 cl-103 hco3-29 angap-11 07:20am blood calcium-7.7* phos-2.4* mg-1.9 imaging: - portable tte (complete) done at 11:23:13 am final - the left atrium is moderately dilated. the estimated right atrial pressure is at least 15 mmhg. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. there is abnormal diastolic septal motion/position consistent with right ventricular volume overload. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (valve area 1.2-1.9cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: hypertrophied left ventricle with vigorous systolic function. dilated and hypokinetic right ventricle with moderate functional tricuspid regurgitation and at least moderate pulmonary hypertension. calcific aortic valve disease with mild stenosis and mild regurgitation. mild to moderate mitral regurgitation. - chest (pa & lat) study date of 2:50 pm - impression: 1. increased vascular markings and interstitial edema suggestive of congestive heart failure. 2. collapse of the right middle and lower lobes, unchanged from . - chest (portable ap) study date of 7:43 pm - moderate pulmonary edema has worsened. moderate-to-large right pleural effusion has increased. bibasilar opacities have increased consistent with increasing atelectasis. small left pleural effusion also has increased. severe cardiomegaly is stable. hd catheter tip is in the right atrium. there is no pneumothorax. - venous dup upper ext bilateral study date of 1:13 pm - findings: patent bilateral subclavian veins with normal phasic flow. patent bilateral cephalic and basilic veins. the diameter of the right cephalic vein ranges from 0.15 to 0.26 cm and the right basilic vein ranges from 0.12 to 0.44 cm. the diameter of the left basilic vein ranges from 0.19 to 0.29 cm and left cephalic vein ranges from 0.12 to 0.48 cm. there is normal triphasic flow in the brachial arteries bilaterally without evidence of calcifications. significant calcifications are seen bilaterally in the radial arteries. the diameter of the right radial artery ranges from 0.20 to 0.48 cm and left radial artery from 0.18 to 0.37 cm. impression: 1. patent bilateral cephalic, basilic, and subclavian veins. 2. patent bilateral radial and brachial arteries. of note, there are significant calcifications in the bilateral radial arteries. . cta: impression: 1. duodenal bulb ulcer status post clipping without evidence of active extravasation. mucosal hyperemia likely reactive. 2. no colonic active extravasation. 3. pancreatic ipmn and pancreatic head ill defined hypoattenuating region, more dense than subjacent cystic ipmn lesions, which could be further assessed by mrcp on follow-up in 6 months. 4. 1.9 cm right adnexal cyst in this postmenopausal patient could be further assessed by ultrasound once acute issues resolve. 5. bilateral pleural effusions, right greater than left. 6. renal cysts, some of which too small to fully characterize. 7. cholelithiasis. brief hospital course: ms. is an 85 year old woman with history of paroxysmal atrial fibrillation, chronic diastolic heart failure, and chronic kidney disease (stage v) who was initially admitted for volume overload, and hyperkalemia requiring initation of hemodialysis and pneumonia. hospital course was complicated by worsening hypoxia requiring mechanical ventilation and upper gi bleeding due to a duodenal ulcer. #acute on chronic diastolic heart failure/acute on chronic renal failure, stage v: patient was admitted with decompensated heart failure, volume overload, and hyperkalemia. most recent tte was notable for severe diastolic heart failure as well as mild to moderate mitral regurgitation and tricuspid regurgitation. patient responded only mildly to high dose diuretics and required ultrafiltration for volume removal and dialysis for electrolyte disarray. she underwent tunneled right ij catheter placement on urgently without complications. she received hd with ultrafiltration of varying proportions for five days in a row, removing roughly 25 lbs of fluid the first week. she was transitioned from calcitriol po to iv hectol to be given with hemodialysis. she was started on calcium acetate and nephrocaps. she will be followed at dialysis with dr. on a tuesday/thursday/saturday hemodialysis schedule. she will discuss potential transition to peritoneal dialysis with her nephrologist as an outpatient. #pneumonia/hypoxemic and hypercarbic respiratory failure/atrial fibrillation: patient presented wtih pneumonia and was intubated for hypercarbic and hypoxemic respiratory failure due to lung collapse in the setting of pneumonia as well as volume overload from pulmonary edema. sputum grew moraxella so patient was started on doxycycline , as she has antibiotic allergies to cephalosporins, azithromycin, and quinolones. in the micu, antibiotics were broadened to vancomycin and zosyn; she completed a course for hcap and respiratory symptoms improved. given that there was significant atelectasis and intermittent lung collapse, patient was encouraged to use incentive spirometery every hour. she also has chronic rml and rll collapse which may be worked up for a potential obstructive lesion. #hypertension/atrial fibrillation: she had one episode of presumed flash pulmonary edema in setting of hypertension during this hospitalization. she was also felt to have worsening pulmonary edema when in rapid atrial fibrillation which occcurred paroxysmally during this admission. she was initially continued on home labetalol as her beta blocker but it was discontinued in the setting of gi bleed and then restarted upon discharge. please see below for info on aspirin/anticoagulation as the decision was made to discharge patient off all antiplatelet and anticoagulation due to gi bleed, but the decision to restart aspirin or therapeutic anticoagulation should be revisited in outpatient follow up based on the patient's clinical condition. #gi bleed: on , the patient had large amount of melena, along with hematocrit drop. gi was consulted and performed upper endoscopy, which visualized a bleeding duodenal ulcer, which was then clipped. patient was provided with phenotypically appropriate blood, which was cleared by a heme/onc consultant to prevent hemolytic anemia. (the patient has a history of antibodies to transfused blood and resultant hemolytic anemia.) on , the patient again had melena, along with a hematocrit drop. gi re-scoped the upper gi tract and saw no new ulcers and a well-healing duodenal ulcer with clips still in place. patient continued to have maroon stool so she underwent a 3rd egd on which showed small, raised hyperemic area distal to previous duodenal ulcer that was clipped. given the significant bleed anticoagulation and aspirin were held. in 2 weeks, aspirin 81mg daily can be restarted with the decision to increase aspirin to 325 or start therapeutic anticoagulation to be determined by the patient's pcp and gi depending on ulcer healing. #low grade fever: pt had tmax 100.6 on the day before discharge, however there was no clear infectious source, pt clinically appeared very well, and afebrile thereafter until discharge off antibiotics (>24 hrs). wbc count was 13.6 on discharge, stable, and improved from 18 a few days before. however, would consider ua/ucx at rehab to assess for uti as cause of low grade fever and relatively elevated wbc count in the absence of other symptoms. transitional issues: - patient to discuss potential switch to peritoneal dialysis with her outpatient providers - possible workup of rml and rll chronic collapse - monitor hd catheter insertion site, which has had some intermittent bleeding requiring pressure dressings. - patient will need follow-up for pancreatic ipmns and adnexal cyst seen on cta torso. - pt should have pcp follow up made when discharged from rehab -- she will need to have a hematocrit drawn within wks of discharge and if stable (last value stable at 29.6) then pcp should consider restart asa 81 for afib, if appropriate, with decision for full dose aspirin or coumadin to be decided in conjunction with gi depending on ulcer healing and persistent risk of gi bleeding -gastroenterology follow up appointment is being worked on and patient should follow up within 2 wks. please call location if not. consider whether patient will need re-scope to document healing. - please draw ua/ucx on arrival to and monitor for fevers. pan-culture if temp >100.4 medications on admission: folic acid - 1mg daily areds -preservation - 2 caps daily ferrous sulfate - 5gms - 1 tab daily miralax - prn constipation labetalol 200 mg - 2.5 tablets tid (total 500mg tid) furosemide 20 mg oral tablet daily comp stocking,knee,long,large miscellaneous (misc) misc wear daily to improve lower extremity swelling. calcitriol 0.25 mcg oral capsule take one tablet once a day beta-carotene,a, w-c & e/min (ocuvite oral) none entered epoetin alfa (procrit) 10,000 unit/ml injection solution inject 10,000u(1 ml) under the skin every week clonidine 0.2 mg oral tablet take 0.2mg tid calcium carbonate (tums) 200 mg (500 mg) oral tablet, chewable take 1 pill with lunch and dinner cholecalciferol, vitamin d3, (vitamin d) 1,000u - 2tabs daily discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 2. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. ferrous sulfate 325 mg (65 mg iron) tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 5. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po twice a day. 6. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 7. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 8. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation every six (6) hours as needed for shortness of breath or wheezing. 9. preservision areds 14, unit-mg-unit capsule sig: two (2) capsule po once a day. 10. miralax 17 gram powder in packet sig: one (1) packet po once a day as needed for constipation. 11. furosemide 20 mg tablet sig: one (1) tablet po once a day. 12. ocuvite oral 13. epogen 10,000 unit/ml solution sig: one (1) inj injection once a week. 14. compression socks, large misc sig: one (1) stocking miscellaneous once a day as needed for swelling: wear daily to improve lower extremity swelling. . 15. vitamin d3 1,000 unit tablet sig: two (2) tablet po once a day. discharge disposition: extended care facility: nursing & therapy center - ( center for rehabilitation and sub-acute care) discharge diagnosis: primary- gi bleed acute on chronic kidney disease chronic diastolic heart failure secondary- end-stage renal disease hyperkalemia uremia paroxysmal atrial fibrillation hypertension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted to the hospital because you were having increased difficulty breathing and worsening cough and leg swelling. you were found to have a very elevated potassium level because your kidney function had worsened quickly. you were also found to have worsening heart failure, which caused a lot of extra fluid buildup in your body. because your kidneys were no longer functioning well enough, they could not filter out the extra fluid, even with strong medications, so we had to start you on dialysis. you developed difficulty breathing requiring you to be transferred to the icu where you were put on the breathing machine. while there, you developed a gi bleed, likely from a duodenal ulcer. this was treated during a procedure called an egd and the bleed seems to have resolved. you have been very sick and have become quite weak, so you will need a lot of rehabilitation. you will go to acute care rehab from the hospital. the following changes were made to your medications: 1. stop labetolol daily 2. stop clonidine 3. start metoprolol succinate 25mg by mouth daily (instead of labetalol) 4. stop calcitriol -- this was held while you were admitted but this should be discussed with your nephrologist on follow up, whether you should restart this or not no other changes were made to your medications. followup instructions: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. we are working on a follow up appointment in gastroenterology at location for your hospitalization. you need to follow up within 2 weeks of discharge. the office will contact you at the facility within 2 business days. if you have not heard please call the office at . department: hematology/oncology when: wednesday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other endoscopy of small intestine enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis endoscopic control of gastric or duodenal bleeding endoscopic control of gastric or duodenal bleeding diagnoses: hyperpotassemia anemia in chronic kidney disease end stage renal disease pneumonia due to other gram-negative bacteria congestive heart failure, unspecified toxic encephalopathy acute posthemorrhagic anemia acute kidney failure, unspecified atrial fibrillation acute on chronic diastolic heart failure pulmonary collapse paroxysmal ventricular tachycardia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure fever, unspecified disorders of diaphragm foreign body in larynx inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation acute duodenal ulcer with hemorrhage, without mention of obstruction 

Answer: The patient is high likely exposed to