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: reglan / bactrim / labetalol / norvasc / codeine / zocor attending: chief complaint: fever major surgical or invasive procedure: w/ stent replacement. r ij tunneled line placement percutaneous intrahepatic drain placement and repositioning and upsizing history of present illness: hpi: ms is a 58 yo f with h/o dm1, cri, pvd, cad s/p cabg who was recently hospitalized for r sfa stent/plasty. she reports feeling well since her recent discharge on until this morning. today she was found at home by her son confused and agitated. she was brought to an osh where she was found to be febrile to 105 f with a positive ua. due to her confusion and abdominal discomfort, ct head and abdomen were performed and were reportedly negative. she was pan-cultured, started on iv levaquin for presumed uti, given 1400cc ivf and transferred to for continuity of care. . in the ed, vs: t 99.5 bp 108/68 hr 76 rr 18 spo2 100% ra. she received one dose of iv vancomycin, morphine 2 mg iv, 500 cc ivf prior to transfer to the medicine floor. . on arrival to the floor patient's primary complaint is feeling cold and tired. she denies any fevers, abdominal pain, dysuria, nausea, vomiting, chest pain, shortness of breath, or dizziness. . past medical history: medical & surgical history: 1. coronary artery disease status post 4v cabg in of . 2. dm1 complicated by retinopathy, neuropathy, nephropathy, gastroparesis on insulin pump. 3. hypertension. 4. chronic renal insufficiency with a baseline creatinine of 6.5. 5. hyperlipidemia. 6. hypothyroidism. 7. anemia. 8. left lung decortication secondary to pleural effusion in . 9. vancomycin resistant enterococcal infection. 10. peripheral vascular disease. 11. c section x2. 12. gout 13. h/o peptic ulcer disease (egd with erosive gastritis, hiatal hernia, gastroparesis) 14. r sfa stenting and angioplasty social history: unemployed, lives with her son, denies etoh, tobacco, or illicit drug use. she lives with her son in . unemployed. she quit tobacco in , but has a 30 pack year smoking history. she does not drink. she has one dog at home. family history: diabetes, chronic renal insufficiency, coronary artery disease, asthma and thyroid disease. physical exam: physical exam on admission: vitals - t: 97.6 bp: 132/60 hr: 77 rr: 18 02 sat: 100% general: shivering, appears chronically ill, nad, conversant, aox 3 heent: ncat, eomi, mmm, no oral lesions, poor dentition cardiac: rrr, no mrg lung: cta b, no crackles, no wheezes, nonlabored breathing abdomen: distended, pd catheter in place, tenderness on lateral abdomen, no cva tenderness, no guarding or rebound ext: warm, dry, no edema or cyanosis, dopplerable pulses bilaterally neuro: no focal deficits, moves all 4 extremities, cn 2-12 grossly intact derm: no rashes, ulcers . pertinent results: on admission : wbc-22.6*# rbc-2.40* hgb-7.8* hct-24.2* mcv-101* mch-32.4* mchc-32.1 rdw-15.2 plt ct-318 neuts-91.3* lymphs-3.8* monos-4.7 eos-0.1 baso-0.2 pt-30.8* ptt-38.4* inr(pt)-3.1* glucose-152* urean-42* creat-6.5* na-140 k-3.6 cl-100 hco3-27 angap-17 alt-46* ast-58* ck(cpk)-1186* alkphos-149* lipase-10 ck-mb-10 mb indx-0.8 ctropnt-0.14* glucose-146* lactate-2.1* k-3.7 cardiac enzymes: 06:30pm blood ck-mb-10 mb indx-0.8 ctropnt-0.14* 10:50am blood ck-mb-13* mb indx-1.0 ctropnt-0.31* 07:34pm blood ck-mb-20* mb indx-1.3 ctropnt-0.50* 02:48am blood ck-mb-21* mb indx-1.2 ctropnt-0.74* 11:13am blood ck-mb-15* mb indx-1.1 microbiology: blood cx: and with enterococcus (sensitivities listed below.) all subsequent blood cultures since then negative. enterococcus sp. | enterococcus sp. | | ampicillin------------ 16 r 16 r penicillin g---------- 16 r 32 r vancomycin------------ <=1 s <=1 s . u/a: large blood, protein, moderate leuks, small bilirubin urine culture: gram positive bacteria. >100,000 organisms/ml.. . fecal culture (final ): no salmonella or shigella found. no enteric gram negative rods found. campylobacter culture (final ): no campylobacter found. clostridium difficile toxin a & b test negative x 4. . peritoneal dialysate analysis: wbc rbc polys lymphs monos eos basos mesothe macro other 12:23am 145* 3* 44* 26* 19* 2* 4* 2* 3*1 peritoneal dialysate 06:19pm 104* 2* 64* 20* 0 1* 2* 13* peritoneal dialysate 02:07pm 275* 20* 71* 5* 18* 2* 4* peritoneal dialysate fluid 07:00am 430* 170* 73* 9* 0 6* 1* 3* 6* 2*2 peritoneal dialysate 12:23pm 790* 85* 85* 0 11* 3* 1* . bile culture: (torulopsis) . sparse growth strain 1. albicans. sparse growth strain 2. dialysis culture: and , but no growth on culture (torulopsis) . imaging: ct a/p : impression: 1. bilateral ground glass opacities within the lungs may be related to multifocal pneumonia. 2. given abnormal common bile duct stent position in combination with intrahepatic biliary ductal dilatation, the large ill-defined and irregular left hepatic hypodensity is felt to represent an abscess secondary to ascending cholangitis. at this time, an is recommended with stent replacement. if patient does not improve clinically, repeat imaging can be obtained in 48 hours and eventually percutaneous aspiration can be considered. 3. calcified bladder wall. 4. patent lower extremity vessels and right sfa stent graft with multifocal areas of narrowing involving the left popliteal and trifurcation vessels as well as the left sfa and popliteal arteries secondary to both calcified and noncalcified atherosclerotic plaque. . cxr : a new large region of right perihilar consolidation though accompanied by progression of mild pulmonary edema in the left lung, and probable increase in small left pleural effusion should be considered pneumonia until proved otherwise. borderline cardiomegaly is stable. right jugular central line projects over a vascular stent ending in the low svc. no tracheostomy tube. . echo : mild symmetric left ventricular hypertrophy with normal systolic function. no vegetations identfied. if clinically suggested, the absence of a vegetation by 2d echocardiography does not exclude endocarditis. compared with the report of the prior study (images unavailable for review) of , the severities of mitral regurgitation and tricuspid regurgitation have increased. moderate pulmonary artery systolic hypertension is now detected. . ekg : poor r wave progression. cannot rule out old anteroseptal myocardial infarction. modest inferolateral st-t wave changes which are non-specific. compared to the previous tracing of there is no significant diagnostic change. . old biliary stent removed sludge/stone like filling defect in distal cbd since the patient was on asa and plavix, a sphinterotomy was not performed new biliary stent placed with good flow of bile . cxr : relative to the prior exam, there has been marked improvement with no definite focal consolidation or superimposed edema noted at the current time. there is poor definition of the left costophrenic angle which may be at least in part technical. attention on follow up radiographs is recommended. . head ct : no hemorrhage or edema. evident mild small vessel ischemic disease. . us hepatotomy drain abscess/cyst : successful ultrasound-guided placement of an 8-french drainage catheter into a large left hepatic abscess/biloma. . fluoro guid plct/replct/remove central line successful repositioning of the right picc line with the tip terminating in the subclavian vein. the line is ready to use. . cxr : stent in the svc is unchanged. sternal wires are again visualized. a catheter is seen overlying the left upper quadrant. a right-sided picc line tip is difficult to visualize. it is at least in the svc. the lungs are clear without infiltrate or effusion. . ekg sinus rhythm. lead v5 unsuitable for analysis. compared to the previous tracing of there is no change. . ct abdomen 1. redemonstration of left and right hepatic hypodense collections. the collection on the left overall appears slightly smaller, though now contains a larger portion of gas, presumably related to the drainage catheter in place. the collection on the right is minimally changed. 2. ascites and free gas within the abdomen, presumably a sequela of peritoneal dialysis. 3. fat-containing ventral abdominal wall hernia. 4. numerous renal hypodensities bilaterally, some of which appear to be cysts, of other which are incompletely characterized. recommend attention paid to these areas on followup imaging. . ct abdomen left lobe abscess has slightly decreased in size as compared to the previous study. drainage catheter can be pulled out 3-4 cm for a more adequate drainage. right lobe abscess has similar size. . doppler ij veins patent internal jugular veins bilaterally. please note that the left internal jugular vein is of small caliber. brief hospital course: 58 year-old dm i, pvd, esrd on pd, cad s/p cabg who was presented with polymicrobial sepsis, 1week after d/c for r sfa stent/plasty (d/c ). presented to osh with fevers and positive ua. transferred to , found to have displaced biliary stent and two hepatic abscesses, likely cholangitis. now s/p , s/p hepatic abscess drainage and hepatic drain placement , which reveal in abscess and dialysis fluid. current antimicrobial regimen: vancomycin, cipro, flagyl, micafungin. #bacteremia/fungal peritonitis: on presentation, the patient was febrile to 105 and was found to have enterococcus and pan-sensitive klebsiella in blood cultures. she was initially managed with vanc/zosyn but then switched to daptomycin in place of vancomycin when sensitivies demonstrated vre. she also received aggressive ivf resuscitation and underwent a tte that was negative for vegetation. her polymicrobial septicemia was found to be secondary to displaced biliary stent (seen on ct) associated with two liver abscesses. on , she was transferred to the for an , during which old biliary stent removed and new biliary stent was placed with good flow of bile. after stabilization, she was transferred to medicine floor. on floor, for bacteremia, she was maintained on zosyn (for gnrs and anaerobes) and daptomycin (for vre). repeat ct imaging showed persistent large (6x8cm) left lower hepatic lobe abscess and smaller (2x2cm) right hepatic lobe abscess. left hepatic lobe abscess was drained and cultured on and a hepatic drain was left in place. of abscess fluid grew yeast. simultaneously, dialysis fluid cx's also grew yeast- . pt was started on micafungin. the hepatinc train had only suboptimal output, and repeat ct after one week of drainage showed only small interval decrease with loculated component. the drain was repositioned on . with worsening abdominal discomfort, rising wbc count from abdominal fluid, and lactate rise to 3.0 (now 1.6) the patient's pd catheter was removed by the transplant surgery team on . sensitivities were obtained were modified for the enterococcus on , demonstrating sensitivity to vanco. given that and her clinical improvement, one day prior to admission, her antimicrobial regimen was changed to vancomycin (for enterococcus), cipro (for gnrs), flagyl (for anaerobes), and micafungin (for fungal peritonitis). final pathology on the pd catheter tip is pending. given only small improvement in output from intrahepatic drain after repositioning, the patient had her drain upsized on the day of transfer. please see id sign out note, but they would plan on 4 weeks of micafungin treatment from removal of pd catheter on . they would persue a short course of continued antibiotics after removal of hepatic drain. the patinet has been afebrile for over 2 weeks prior to transfer. please contact dr. at with questions or concern. outpatient follow-up with dr. for repeat with sphincterotomy (which could not be performed because pt was on plavix) and brushings in 12 weeks once she can be safely off her plavix for 7 days is recommended. #elevated cariac markers: she has a history of cad s/p cabg. in the setting of her sepsis, the patient had evidence of cardiac demand ischemia, with troponin rise to 0.7, ck-mb to 25, and ck to 1700. the likely etiology of this increase in cardiac markers is more demand ischemia versus an acute coronary event. while her ck rise was prominent, it was dispropotional to mb rise with only minor rise of her index. additionally, the troponin rise is in the setting of esrd. these were thought to be a combination of ck rise from possible myositis in her lower extremities given diffuse thigh pain, along with demand ischemia. she was continued on aspirin and plavix, the latter which she had been started on after her sfa stent. the aspirin was eventually held given plan . beta blockade was avoided in icu because of her relative hypotension. once hemodynamically stable and lfts normalized on medicine floor, beta-blocker and statin were restarted at home-dose. asa was held prior to each ir procedure she had (insertion of hepatic drain, repositioning of hepatic drain) and will need to be re-started 24hrs after on . # elevated lfts: transaminitis were thought to be secondary to hepatic abscess and/or shock/ischemic liver. she underwent and new stent was placed, lfts improved. alt and ast rose to 700 and 1000 respectively on , and have been normalized since . # esrd: she has esrd and was admitted on peritoneal hd. her esrd is secondary to diabetic nephropathy. nephrology followed her during this admission. she was found to have fungal peritonitis (dialysis fluid cx's grew ), and it was decided that her pd catheter was a nidus of infection, and was removed without complication on . plan to transition to hd temporarily for until antimicrobial therapy can clear abscesses. she had done well throughout admission on pd. dopplers of ij veins day prior to d/c showed patent ij veins, but left ij small caliber. a right ij tunneled line was placed without complications. the patient requested transfer to for further manegment by her home nephrologist. # uti: at , she was found to have alpha hemolytic colonies consistent with alpha streptococcus or lactobacillus sp. she had coverage for this with her broad-spectrum antibiotics. her urine culture from outside hospital grew staph lugdunensis, which was covered by broad-spectrum antibiotics. however, given the high association between staph lugdunensis and endocarditis, id consultants recommended an outpatient tee to rule out endocardial damage/vegetations. given no stigmata of endocarditis and no evidence of bacteremia, this recommendation was ammended. # pvd: the patient recently underwent stent of r sfa, which raised concern of compartment syndrome on admission. however, the vascular service felt that this was unlikely. pt was continued on plavix. asa and coumadin were held for . asa was restarted 72 hours after. it was confirmed with outpatient nephrologist that coumadin was being administered to prophylactically keep potential hd catheter sites patent, but that outpatient nephrologist was ok with holding coumadin for period of weeks/months while in hospital. so coumadin was held for the duration of her stay. the patients plavix was held for upsizing of hepatic drain, and will need to be restarted on . #dm1: she has dm1 that is complicated by retinopathy, neuropathy, nephropathy, and gastroparesis. in the micu, she was started on an insulin ggt recs for poorly controlled finger sticks in the setting of infection, then transitioned to on a basal lantus regimen with iss. on the floor, she was continued on basal lantus and iss which was adjusted with the continued assistence of the consult. #diarrhea: patient has been with loose stool since arrival on medicine floor . likely antibiotics altering gut flora. stool cx neg for campylobacter, c.diff toxin a and b, enteric gnrs, salmonella, shigella. c.diff toxin neg , , , . # hypothyroidism: continued her home levothyroxine throughout hospital stay. # seizure d/o: pt was maintained on keppra prophylaxis. no active seizure activity. son stated that she was put on this b/c last year during a hospital admission, she had an isolated seizure episode, none since, none before. the keppra dose seems low, but we continued it and will defer to pcp to discontinue or make dose changes. medications on admission: home medications: per admission note plavix 75 mg daily omega-3 fatty acids capsule b complex-vitamin c-folic acid 1 mg daily rosuvastatin 20 mg daily pantoprazole 40 mg metoprolol succinate 100 mg tablet sustained release 24 hr losartan 100 mg daily levothyroxine 150 mcg daily levetiracetam 500 mg daily lanthanum 1000 mg tid with meals lactulose 30 ml tid gabapentin 200 mg qhs doxercalciferol 2 mcg daily clonidine 0.2 mg/24 hr patch weekly (saturday) dicyclomine 20 mg qid ranitidine hcl 150 mg bic senna 8.6 mg tablet daily acetaminophen 1000 mg tid prn insulin pump coumadin 4 mg daily gentamicin 0.1 % cream sig: qd prn around catheter metoprolol succinate 50 mg daily . transfer medications from micu to : acetaminophen 650 mg po q6h:prn pain or fever morphine sulfate 2 mg iv q6h:prn pain ondansetron 4 mg iv q8h:prn nausea levothyroxine sodium 150 mcg po daily levetiracetam 500 mg po daily lanthanum 1000 mg po tid w/meals gabapentin 200 mg po hs senna 1 tab po bid docusate sodium 100 mg po bid fish oil (omega 3) 1000 mg po bid doxercalciferol 2 mcg po daily nephrocaps 1 cap po daily bisacodyl 10 mg po daily:prn constipation ranitidine 150 mg po daily piperacillin-tazobactam 2.25 g iv q12h insulin 100 units/100 ml ns @ unit/hr iv drip infusion lactulose 30 ml po q8h:prn constipation rosuvastatin calcium 10 mg po daily metoprolol tartrate 25 mg po bid nystatin cream 1 appl tp miconazole powder 2% 1 appl tp :prn rash linezolid 600 mg iv q12h insulin sc plavix 75mg qd asa 81 mg qd discharge medications: 1. levothyroxine 75 mcg tablet sig: two (2) tablet po daily (daily). 2. levetiracetam 500 mg tablet sig: one (1) tablet po daily (daily). 3. doxercalciferol 0.5 mcg capsule sig: four (4) capsule po daily (daily). 4. gabapentin 100 mg capsule sig: one (1) capsule po daily (daily). 5. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous x1 (one time) for 1 doses. 6. lanthanum 500 mg tablet, chewable sig: two (2) tablet, chewable po tid w/meals (3 times a day with meals). 7. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 8. epoetin alfa 4,000 unit/ml solution sig: one (1) injection qmowefr (monday -wednesday-friday). 9. metronidazole 500 mg tablet sig: one (1) tablet po q 8h (every 8 hours). 10. gabapentin 100 mg capsule sig: two (2) capsule po hs (at bedtime). 11. micafungin 100 mg recon soln sig: one (1) recon soln intravenous daily (daily). 12. rosuvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 13. omega-3 fatty acids capsule sig: one (1) capsule po bid (2 times a day). 14. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 15. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 16. ciprofloxacin 250 mg tablet sig: one (1) tablet po q12h (every 12 hours). 17. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 18. acetaminophen 650 mg tablet sig: one (1) tablet po every hours as needed for fever or pain. 19. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po every 4-6 hours as needed for nausea. discharge disposition: extended care facility: - discharge diagnosis: #polymicrobial sepsis #fungal peritonitis #esrd #coronary artery disease/demand ischemia #type 1 diabetes mellitus secondary: #hypothyroidism #peripheral vascular disease #hypertension discharge condition: stable. discharge instructions: you were admitted with polymicrobial sepsis, most likely from a displaced and infected biliary stent. you were treated with aggressive antibiotics for the bacteria in your blood. the stent was removed and replaced. because of this infection, you had abscesses in your liver, which were drained, however not completely. you are being transferred to with a drain still in place in one of the abscesses in your liver and continuing on antifungals and antibiotics. you will require a trans-esophageal echocardiogram in the future to make sure you have no bacteria on your heart valves. this should be coordinated by your infectious disease doctor. when you were admitted to the hospital, your insulin pump had run out of insulin. you were put on an insulin drip in the icu, and after stabilization, your blood sugars were managed with basal lantus and insulin sliding scale. during your icu stay, you had experienced some episodes of low blood pressure as a complication of your infection. combined with your predisposition to heart disease, given your diabetes, your heart experienced a minor heart attack. after all your procedures were done, you were restarted on aspirin, metoprolol, and crestor to protect your heart. also, prior to this hospitalization, you recently had a stent placed in your leg. during this hospitalization, you were maintained on plavix as much as possible (given all your procedures) to protect your stent. you will be followed-up by vascular surgery at some point in the future. in addition, at some point in the future when you can be off plavix for 7days, you will require repeat . this can be coordinated by an outpatient gastroenterologist. followup instructions: outpatient follow-up with dr. for repeat with sphincterotomy (which could not be performed because pt was on plavix) and brushings in 12 weeks once she can be safely off her plavix for 7 days is recommended. provider: , md phone: date/time: 11:00 provider: 2 (st-4) gi rooms date/time: 11:00 pt currently has a id f/u given below. also can follow up with id staff at . , md phone: date/time: 10:30 procedure: venous catheterization, not elsewhere classified venous catheterization for renal dialysis endoscopic insertion of stent (tube) into bile duct removal of peritoneal drainage device percutaneous aspiration of liver diagnoses: end stage renal disease renal dialysis status anemia, unspecified urinary tract infection, site not specified acute and subacute necrosis of liver severe sepsis coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status polyneuropathy in diabetes hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia septic shock abscess of liver mechanical complication due to other implant and internal device, not elsewhere classified other septicemia due to gram-negative organisms epilepsy, unspecified, without mention of intractable epilepsy streptococcal septicemia cholangitis obstruction of bile duct diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with renal manifestations, type i [juvenile type], uncontrolled diabetes with ophthalmic manifestations, type i [juvenile type], uncontrolled background diabetic retinopathy other suppurative peritonitis infection and inflammatory reaction due to peritoneal dialysis catheter 

Answer: The patient is high likely exposed to