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: percocet / percodan attending: chief complaint: alcohol intoxication major surgical or invasive procedure: central line placement history of present illness: patient is a 62 yo lady with history of alcohol abuse, c.diff colitis, also s/p colectomy in with small pelvic abscess, admitted on for placement after being found intoxicated in her apartment, found lying in her feces, unable to care for herself per family. on admission patient was found to have low blood pressures 80/40s in the ed, given ns ~3l with little improvement. alcohol level 299 on admission. on remained hypotensive with bp raning 80-110s/40-60s but responded to fluid boluses. patient was essentially admitted for detox/placement. patient was a very poor historian, reported drinking vodka at home which she ordered by telephone to her apartment. patient has a brother and sister who live far away but concerned for her well being. patient denies any complaints on admission, no shortness of breath, chest discomfort, fevers. patient c/o ongoing diarrhea which was unchanged from prior. unclear wether patient was compliant with medications at home given intoxication. past medical history: - etoh abuse with admissions for etoh w/d at - questionable colon mass - s/p sigmoid colectomy (~16 cm) by path report at in with subsequent diarrhea - s/p l oophorectomy and hysterectomy in for mature cystic teratoma - s/p ovarian cystectomy in with prophylactic appendectomy - s/p orif of toe in 4/99 - s/p left knee surgery - rosacea - hand fracture - s/p normal pmibi in at - macrocytic anemia due to etoh use with normal b12 levels - hypoalbuminemia due to etoh use - c. diff + at in - fatty liver by u/s at in without ascites - chronic lacunar infarcts on head ct social history: drinks 2 drinks (vodka) daily - history of alcohol use since teenager per family smokes 80 pack-years lives alone retired travel , but wanted to become a postal worker. divorced with no children. has close contact with a brother in and sister who live out of state. family history: father died of lung cancer secondary to liver mets mother died in her 60's of emphysema, chf no cad/dm/cva physical exam: vs: 98.5 92/52 90 21 91% ra gen: nad, oriented, flat affect heent: red mildly swollen tongue, mmm, op clear, sclerae anicteric neck: jvp flat chest: enlarged ap diameter cv: tachycardic, regular, nl s1/s2, no murmurs pulm: clear bilaterally, decreased breath sounds but symmetric abd: soft, mildly distended, hypoactive bowel sounds, no tenderness even to deep palpation ext: + pitting edema bilaterally, room temperature, normal pulses neuro: 5/5 strength in upper extremities, does not lift legs off bed, cn ii-xii intact skin: no jaundice pertinent results: on admission: 12:10pm glucose-87 urea n-7 creat-0.5 sodium-130* potassium-3.6 chloride-90* total co2-29 anion gap-15 12:10pm alt(sgpt)-123* ast(sgot)-210* alk phos-203* amylase-20 tot bili-1.5 12:10pm albumin-2.5* 12:10pm ethanol-299* 12:10pm wbc-9.7 rbc-3.17*# hgb-12.1 hct-33.9*# mcv-107*# mch-38.0*# mchc-35.6* rdw-13.4 12:10pm neuts-68.1 lymphs-27.3 monos-3.7 eos-0.4 basos-0.5 12:10pm macrocyt-3+ 12:10pm plt count-212 . micro data: 12:07 pm urine **final report ** urine culture (final ): klebsiella pneumoniae. >100,000 organisms/ml.. trimethoprim/sulfa sensitivity testing confirmed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s gentamicin------------ <=1 s imipenem-------------- <=1 s levofloxacin----------<=0.25 s meropenem-------------<=0.25 s nitrofurantoin-------- 64 i piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s . 8:29 pm stool consistency: formed source: stool. **final report ** ova + parasites (final ): no ova and parasites seen. this test does not reliably detect cryptosporidium, cyclospora or microsporidium. while most cases of giardia are detected by routine o+p, the giardia antigen test may enhance detection when organisms are rare. cryptosporidium/giardia (dfa) (final ): no cryptosporidium or giardia seen. clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. reference range: negative. . rpr - non reactive legionella antigen - negative repeat stool cultures (multiple) - negative for c.diff toxin a . *****clostridium difficile toxin b assay test result reference range/units clostridium toxin b scrn detected none detected specimen source: fecal test performed at: institute hwy. capistrano, comment: source: stool . blood cx ; ; - no growth . catheter tip culture - no growth . 11:38 am pleural fluid pleural received at 4:07pm. **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. . urine cx , - +yeast . imaging: cxr : no evidence of acute cardiopulmonary process . echo : the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 70%). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. . le doppler : negative for proximal deep venous thrombosis bilateral lower extremities. . ekg :probable ectopic atrial rhythm borderline right axis deviation low limb lead qrs voltages poor r wave progression with late precordial qrs transition finding are nonspecific but clinical correlation is suggested for possible chronic pulmonary disease since previous tracing of , st-t wave changes decreased . xr pelvis : there are old fractures identified of bilateral sacral ala, right medial acetabulum, right superior and inferior pubic rami. no new fractures are identified. . ct abd/pelvis : 1. no evidence of psoas abscess, or process related to the patient's leg weakness. 2. anasarca, with new small pleural effusions, small amount of fluid within the abdomen inferior to the liver, small amount in the pelvis, and subcutaneous edema. 3. diffuse low attenuation of the liver has worsened since the prior exam, consistent with fatty infiltration. more advanced forms of liver disease are not excluded. 4. air within the bladder. please correlate with urinalysis. . mri l-spine : redemonstration of t12 compression deformity. mottled appearance of the sacrum and iliac bones consistent with osteopenia. no acute abnormalities of the lumbar spine identified, including no sign of discitis or spinal stenosis. questionable bladder dilatation. . emg : complex, abnormal study. there is electrophysiologic evidence for a moderate, generalized, sensorimotor, polyneuropathy with predominantly axonal features. there is also evidence for a mild generalized myopathic process without clear denervating features. the findings of polyneuropathy and myopathy preclude an accurate diagnosis of a superimposed right lumbosacral radiculopathy or plexopathy. in addition, a central process as a cause of the right leg weakness also cannot be excluded. . echo : compared with the findings of the prior report (images unavailable for review) of , no change other than trivial ai now seen. . cxr lateral/decubitus : bilateral layering effusions. . ct abd/pelvis/chest: impression: 1. marked increase of bilateral pleural effusions with atelectasis and edema, as well as increased ascites. no evidence of abscess. 2. increased subcutaneous edema throughout chest, abdomen, and pelvis. 3. healing fractures and wedge-shaped compression fracture. 4. no specific wall thickening of the ascending colon, probably due to increased ascites; however, colitis such as c. difficile colitis cannot be totally excluded. please correlate with the clinical findings and c. diff titer. . mri c-spine : no evidence of extrinsic cord compression or intrinsic cord signal abnormalities. cervical spondylosis as described above. . picc placement : successful placement of a 44 cm, double lumen picc line through left basilic vein with the tip in the superior vena cava. the line is ready to use. . ekg : sinus rhythm. low limb lead qrs voltage is non-specific. diffuse t wave abnormalities with prolonged qtc interval - clinical correlation is suggested for possible metabolic/electrolyte/drug effect, possible ischemia or possible cns event. since the previous tracing of no significant change. . ct head : impression: no significant interval change, or evidence of intracranial hemorrhage. . upon discharge: wbc 9.8, hct 30, plts 303 bun/cr 4/0.3 na 141 k 3.8 cl 103 hco3 29 brief hospital course: in summary, patient is a 62 y/o lady with h/o alcohol abuse, c.diff colitis, also s/p colectomy in with small pelvic abscess, admitted on for placement after being found intoxicated in her apartment, found lying in her feces, unable to care for herself per family. on admission patient was found to have low blood pressures 80/40s in the ed, given ns ~3l with little improvement. on the floor the patient remained hypotensive with bp ranging 80-110s/40-60s. she triggered twice for hypotension but responded to fluid boluses. patient remained asymptomatic throughout. patient was also being worked up for proximal right leg weakness and the w/up was negative including pelvic ct scan and emg. patient also found to have a pansensitive klebisella uti and completed a course of cipro x 7 days.patient was also being evaluated by gi for chronic diarrhea. she was admitted on po vanco for recurrent c.diff but was c.diff negative x 3 during this admission. as such, vanco was discontinued. gi was intending to do colonsocopy but this was deferred due to episodes of tachycardia and one episode of nsvt. ekgs showed low voltage but no other significant changes. patient also had two echos done which showed normal ef, no pericardial effusions. in terms of her hypotension, she had a random cortisol level and stim that were wnl and therefore was not started on steroids. . on patient again became hypotensive to 80s/doppler which again responded to fluids. patient later spiked a temperature of 102.4 and later desaturated to 83% on ra. inr was up to 3.4 and was previously normal. she was treated empirically with vanco, levo, and flagyl and transferred to micu. . in micu, patient was initially treated with vanco, zosyn, and flagyl. cxr showed b/l pleural effusion. patient remained stable w/out a clear source of infection. zosyn was stopped on . she is now transferred to the floor on po vanco/flagyl for presumed c.diff infection. . upon transfer to the floor: patient was transferred on 5 nc sating >95%. patient later desated to low 80s and o2 increased to 6l, patient later weaned on 4l, now sating 97%. patient also had 2 episodes of frankly blood stool. hct dropped from 34->28. vss. patient treated with zosyn and po vanco for presumed pneumonia and c.diff. patient initially doing well, alert, no complaints. later that evening patient went into what was thought to be v-tach with hr to 190s, patient continued to mentate, bp dropped to 70-80s/doppler. loaded with iv amiodarone with conversion to sr (hr 90s) and transferred to the micu again. cards/ep evaluation felt that this was v-tach as well but subsequently felt that this was svt with aberrancy. amio was d/ced and patient was put on beta blocker with good hr control. patient was called out from icu . evening, patient had gib w/crit drop from 34 to 28, spont increased am to 30 in am and 32.5 at noon. the same evening, the patient was found to be sob by rn then quickly converted to vtach @ 194 w/pressure 89/50 not substantially changed from floor baseline. pt's mental status was good throughout episode. pt spontaneously converted to sinus and was transferred to micu briefly. patient was treated empirically with steroids for oingoing low blood pressure. thoracentesis was also perforemed which showed a transudative effusion. patient was then diuresed with lasix. patient continued to be followed by cardiology, continued on beta blocker with good hr control. patient continued treatment for c. difficile colitis with flagyl/vancomycin. patient has remained stable over the last week maintaining good blood pressure, mentating well, diarrhea decreasing although still loose, afebrile, hr under good control. her nutritional status is also improved and she is consuming a po diet with supplementation. her magnesium level remains low however she is receiving repletion. would recommend long acting magnesium if able to get at the nursing home (this was not available through the hospital pharmacy). ekgs have been showing a prolonged qt interval. patient was evaluated by cardiology again who could not find an exact mechanisms. flagyl was discontinued given a few reported cases of prolonged qt syndrome with this medication. all other medications do not produce prolonged qt. the best explanation is her persistently low magnesium which must be continuously repleted and improvement in her nutritional status. ct head was performed to r/out bleed. this was negative. other testing was performed including anti-ro/ which are pending at the time of discharge. patient was refusing all other testing at the time of discharged and requested to leave the hospital and go to the nursing home without further intervention. she will need close pcp follow up and possibly cardiology follow up as an outpatient. patient's hct is also slightly low however she is not gi bleeding and she is scheduled for gi follow up. patient likely requires a colonoscopy in the near future. her lab studies are consistent with anemia of chronic disease. patient was guiac negative on discharge. hct stable at 30. . in terms of her individual problems: . # sepsis. likely secondary to chronic c.diff, found to be positive for toxin b on , diarrhea improving, still on po vanco and flagyl to continue until gi follow up. wbc down to wnl. afebrile. . # svt with aberrancy/prolonged qt on ekg. on metoprolol 37.5mg . no further episodes. hr well controlled. continue beta blocker at current dose. likely will need cardiology follow up in future to be arranged by pcp. electrolyte repletion required for prolonged qt. . # chronic diarrhea. secondary to c.diff, toxin b positive. on antibiotic treatment as above. continue ppi. . # hypotension: secondary to intravascular volume depletion to diarrhea, poor po intake, hypoalbuminemia. currently stable with ongoing treatment of underlying infection. patient received a tapering dose of steroids completed on . . # anasarca: unclear etiology, likely in part due to very poor nutritional status, long hx of etoh abuse, hypoalbuminemia. tolerating diuresis with stable bp. upon discharge her le edema was completely resolved, lung clear to auscultation which was significantly improved. she is discharged on 20 mg of lasix daily. continue lasix as blood pressure tolerates along with daily weights. patient scheduled for pcp follow up, chemistries should be repeated in two days and results sent to pcp or physician at rehab. continue fluid restriction 1500ml. . # anemia: macrocytic anemia etoh as well as anemia of chronic disease based on iron studies, elevated b12, nl folate; hemolysis labs negative; patient received total 5 units since admission. also with 2 x blood diarrhea, now resolved, hct low but stable. repeat cbc in two days. gi follow scheduled. . # etoh abuse. no evidence of withdrawal, did not require benzodiazepines by ciwa while in hospital. cont thiamine, mvi, magnesium supplementation. needs intensive rehabilitation. . # leg weakness - peripheral neuropathy, most likely alcohol induced. mri c-spine also performed given hyperreflexia - showing cervical spondylosis, no cord involvement. extensive w/up has been negative to date. requires intensive rehab, possibly neurology follow up in future. . # nutrition. very poor po intake, nutrition followed while in house, currently on regular diet with boost. patient had ng tube temporarily, now taking good pos. bun slightly improved from admission. please encourage po intake, frequent meals, boost as tolerated. continue vitamin supplementation. . # communication - brother ; sister . code: full medications on admission: medication on admission: vancomycin po discharge medications: 1. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day). 2. ascorbic acid 250 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 5. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 6. nicotine 7 mg/24 hr patch 24hr sig: one (1) patch 24hr transdermal daily (daily). 7. vancomycin 125 mg capsule sig: one (1) capsule po qid (4 times a day): ongoing until patient follows up with gastroenterology. 8. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day): hold for sbp <100, hr <55. 9. cholestyramine-sucrose 4 g packet sig: one (1) packet po bid (2 times a day). 10. therapeutic multivitamin liquid sig: one (1) po qd (). 11. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. 12. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 13. magnesium oxide 400 mg tablet sig: two (2) tablet po three times a day: if available please give long acting magnesium sr or magnesium lactate for prolonged effect. tablet(s) 14. outpatient lab work please check cbc and chem 13 including magnesium level on and provide results to physician on staff or alternatively fax to dr. at te: ( fax: ( 15. general care please do daily weights and provide results along with above laboratory data 16. lasix 20 mg tablet sig: one (1) tablet po once a day. tablet(s) discharge disposition: extended care facility: - discharge diagnosis: 1. c.difficile colitis 2. alcohol abuse 3. supraventricular tachycardia with rapid ventricular rate 4. lower extremity polyneuropathy/myopathy of unclear etiology discharge condition: good - diarrhea significantly improved, blood pressure stable, afebrile, no evidence of alcohol withdrawl discharge instructions: please take all of your medications as directed please follow up as listed below please contact your physician or return to the hospital if you have any fever, worsening diarrhea, headache/dizziness, chest discomfort, or any other complaints followup instructions: 1. provider: , md phone: date/time: 1:30 . 2. provider: . phone: date/time: 1:00 md procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances thoracentesis alcohol detoxification transfusion of packed cells transfusion of other serum diagnoses: pneumonia, organism unspecified anemia of other chronic disease unspecified pleural effusion urinary tract infection, site not specified unspecified septicemia unspecified protein-calorie malnutrition severe sepsis mononeuritis of lower limb, unspecified other specified cardiac dysrhythmias hypotension, unspecified intestinal infection due to clostridium difficile hemorrhage of gastrointestinal tract, unspecified septicemia due to anaerobes oliguria and anuria nonspecific abnormal electrocardiogram [ecg] [ekg] acute alcoholic intoxication in alcoholism, continuous edema myopathy, unspecified 

Answer: The patient is high likely exposed to