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: codeine / gentamicin / tessalon perle attending: chief complaint: rapid atrial fibrillation. major surgical or invasive procedure: placement of left subclavian tunneled dialysis catheter history of present illness: mr. is a 57 year old man with type 1 dm s/p failed kidney/pancreas in , cad with stents, rapid a fib, c fid colitis, hypotension, and end stage disease who presents in transfer from . he was recently hospitalized at from and was discharged to rehab. he was admitted to on from dialysis for rapid atrial fibrillation to the 130's, and had associated shart mid sternal chest pain. he also developed multiple watery stools in the preceding hours before dialysis. . at , his issues included rapid a fib, diarrhea, and hypoerkalemia. for his a fib, he was loaded on amiodarone and converted to sinus rhythm. he went back into a fib with further attempts at dialysis, and he was still in a fib at the time of transfer with stable blood pressure. for his diarrhea, a c dif test was positive, and he was started on flagyl and moved to the icu. since the time of admission, he has gone into atrial fibrillation three separate dialysis attempts. he was trasnferred for consideration of cvvh and alternative anti-arrhythmogenic agents or a definitive a fib procedure. . currently he is complaining of chest pain with inspiration, some abdominal pain, and left knee pain. all of these are complaints he's had for the last few days. he denies fever, chills, shortness fo breath. past medical history: 1. esrd: status pancreas-kidney transplant , status post cadaveric transplantation in , now requiring dialysis 3x/wk 2. cad: s/p myocardial infarction in , s/p lcx stenting in , s/p lcx and om3 stenting in , s/p mid-lcx stenting on ', s/p om3 restenting in ' 3. dm type i 4. hypothyroidism 5. hypercholesterolemia 6. cirrhosis from hep c (dx in '), viral load and hep b 7. cva in with residual left-sided weakness 8. pvd 9. diverticulitis, status post colostomy and hartmann's pouch in , status post reversal in , last colonscopy (): erythema, friability and granularity in the very distal portion of the colon, just inside the afferent limb of the stoma, with overlying clot. brown stool with no bleeding proximal to this. 10. pvd s/p multiple digit amputations 11. gerd 12. wheelchair bound after gentamicin related vertigo 13. paf: diagnosed in , continued on ccb and started on amio at that time, s/p pacer 14. benign prostatic hypertrophy, status post transurethral resection of the prostate. 15. sbp 16. chf with an ef:60% 8/05 17. c dif colitis social history: patient lives with his wife in and presented from home. they have two children who live nearby. he previously worked as a plummer but is now retired. he has a 30pk year smoking hx but quit 10 years ago. he denies ivdu and alcohol use. he uses a wheelchair. he uses a walker for transfers. family history: father died at age 56 of mi, with dm and a "big heart". mother died age 84 of "old age" s/p cva, with dm and htn. sister has grave's dz and brother died of 56 with dm. physical exam: vs: t 97.8 98/40 83 r12 98% ra gen: no apparent distress heent: pupils surgical bilaterally. mm dry. neck: no jvd resp: lungs clear bilaterally cv: rrr nl s1s2 no mgr abd: soft, diffusely ttp. +bs. ext: multiple amputated digits. warm, well perfused. neuro: alert, oriented, able to move all extremities and cooperative with commands. pertinent results: 08:46pm blood wbc-6.3 rbc-3.51* hgb-11.0* hct-33.5* mcv-95 mch-31.2 mchc-32.8 rdw-15.8* plt ct-191 09:30am blood neuts-90.5* lymphs-4.3* monos-4.1 eos-0.4 baso-0.6 08:46pm blood pt-13.7* ptt-31.4 inr(pt)-1.2* 08:46pm blood plt ct-191 08:46pm blood glucose-239* urean-35* creat-5.1*# na-136 k-4.0 cl-99 hco3-22 angap-19 08:46pm blood alt-26 ast-24 ld(ldh)-198 alkphos-344* totbili-0.3 03:32am blood alt-19 ast-20 ld(ldh)-184 alkphos-274* amylase-11 totbili-0.3 12:23pm blood ck(cpk)-30* 04:49am blood ck(cpk)-23* 03:32am blood lipase-7 12:23pm blood ck-mb-notdone ctropnt-0.10* 04:49am blood ctropnt-0.10* 08:46pm blood albumin-2.1* calcium-7.5* phos-5.7*# mg-1.9 05:24am blood tsh-1.3 05:46pm blood type- po2-37* pco2-43 ph-7.36 calhco3-25 base xs--1 . cxr: no acute cardiopulmonary process. . ecg: atrial fibrillation with a rapid ventricular response. since the previous tracing of the atrial fibrillation has developed. the q-t interval is shorter but still prolonged. clinical correlation is suggested. . chest ct: 1. no evidence for pulmonary embolus or aortic dissection. coronary artery and aorta atherosclerotic calcifications. 2. mild pneumobilia, unchanged from the ct of the abdomen and pelvis from presumably related to prior sphincterotomy. 3. mild anasarca and fluid within the visualized portion of the abdomen, incompletely evaluated on this chest ct. . l knee xr: ap and lateral radiographs of the left knee are reviewed. there is severe diffuse osteopenia, with extensive calcification of the vasculature. there is no evidence of fracture or dislocation. there is no evidence of osteomyelitis identified. . ue u/s: no evidence of dvt. . l humerus xr: ap and lateral radiographs of the left humerus are reviewed. there is diffuse osteopenia, with screws overlying the proximal ulna. there is no evidence of acute fracture or osteomyelitis identified. there is extensive vascular calcification seen. . l elbow xr: ap and lateral radiographs of the left humerus are reviewed. there is diffuse osteopenia, with screws overlying the proximal ulna. there is no evidence of acute fracture or osteomyelitis identified. there is extensive vascular calcification seen. . tte: 1.the left atrium is moderately dilated. the left atrium is elongated. 2. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). 3.right ventricular chamber size is normal. right ventricular systolic function is normal. 4.the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. 5.the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. physiologic mitral regurgitation is seen (within normal limits). 6.there is mild pulmonary artery systolic hypertension. 7.there is no pericardial effusion. . left gleno-humeral shoulder (w/ y view): . lue u/s: brief hospital course: #) gnr bacteremia/line infection: follow up blood cultures cont to be negative and the pt remained afebrile since with normal wbc. his shoulder was painfuls and initially thought to have been seeded, but plain film xray showed rotator cuff evulsion fracture. he was seen by orhtpedics for evaluation of the shoulder and they recommended physical therapy and possible steroid injection in the future if pain continues. tte was negative for endocarditis and source still remained unclear. is to continue a 14 day course of levofloxacin now day . . #) hypotension: was due to bacteremia and sepsis syndrom along with relative adrenal insufficiency although no cortisol stimulation test was done. we restarted on stress dose steroids on and started a wean 50mg qd on for the next 5 days and slowly taper by 10mg every 5 days until dose down to 10mg and then decrease by 2.5mg over 10 day intervals until back to baseline dose of 5mg qd. . #) paroxysal afib- remained either atrially paced or nsr since . tsh 1.3. metoprolol was administered prior to dialysis until it wsa discintinued on due to persistent hypotension and afib did not recur for dialysis. we continue amiodarone for rhythm control and held coumdadin for placement of dialysis access but restarted on discharge. . #) esrd: pt initially had suboptimal dialysis due to hypotension with afib, but cvvhd was not considered a long term solution. as sepsis syndrome resolved and diarrhea improved his hypotension and atril fibrillation resolved. tunneled line was placed by ir on and dialysis done for 2 days straight to get him back on his tues thurs sat schedule. we continued phoslo and calcium supplementation. . #) c diff: positive at osh; we continued flagyl po vanco but stopped the vancomycin on . pt will need prolonged course of at least 14 days due to peristent diarrhea. using lactobacillus to reinstate gi flora. #) pleuritic chest pain: differential diagnosis included cardiac, pulmonary, vascular. cxr was normal, cta was neg for pe, ecg was unchanged and pain sponstaneously resolved and was of unclear etiology. . #) iddm:we continued his lantus 4 qhs and riss. fs were high initially with high dose steroids but improved with steroid taper. . #) abdominal pain: pt reported this is chronic and stable on current pain regimen. it remained unclear if there was gi source of klebs pneumoniae bacteremia although gi flora was well covered with levofloxacin and flagyl except for enterococcus. no official ct abdomen read was obtained from the osh but impression was no acute pathology beyond colitis. we continued pain control with dilaudid prn, methadone, and amytriptylline. . #) anemia likely failure: epogen with dialysis, transfuse for hct<21. . code full medications on admission: medications at home: hectorol, epogen, venofer given at dialysis center amiodarone 200mg qd amitriptyline 10mg qhs asa 325mg qd lipitor 10mg qd phoslo colace fentanyl 100mcg q72hrs folate lantus 4u qhs iss isosorbide mononitrate 30mg qd levothyroxine 200mcg qd toprol xl 25mg mvi protonix prednisone 5mg qd . meds on transfer: sl ntg 0.4mg q5min prn iss d50 and glucagon prn hypoglycemia nephorcaps qd phoslo 1334mg po tid w/meals epogen 6000u sq qmwf with dialysis zemplar 1mcg iv qmwf zofran 4mg po q6hrs lantus 2u qhs benadryl 25 iv/po q4-6 hydroxyzine 25mg im/po q4-6 narcan 0.4mg iv prn toprol xl 12.5mg qd protonix 40mg iv qd vancomycin 250mg po q6hrs amiodarone 200mg falgyl 500mg po tid dilaudid 0.5-1mg po q1hr prn methadone 2.5mg po q8hrs solumedrol 20mg iv q8hrs discharge medications: 1. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed). 2. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 3. epoetin alfa 10,000 unit/ml solution sig: one (1) injection asdir (as directed). 4. hydroxyzine hcl 25 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day). 7. levothyroxine 100 mcg tablet sig: two (2) tablet po daily (daily). 8. methadone 5 mg tablet sig: one (1) tablet po tid (3 times a day). 9. amitriptyline 10 mg tablet sig: one (1) tablet po hs (at bedtime). 10. hydromorphone 2 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. 11. insulin glargine 100 unit/ml solution sig: four (4) u subcutaneous at bedtime. 12. insulin regular human 100 unit/ml cartridge sig: one (1) injection four times a day: riss fs 150-200 2u 201-250 4u 251-300 6u 301-350 8u 351-400 10u >400 md. 13. metronidazole 500 mg tablet sig: one (1) tablet po three times a day for 4 days. 14. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). 15. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 16. prednisone 10 mg tablet sig: one (1) tablet po once a day: please take 50mg for 5 days 40mg for 5 days 30mg for 5 days 20mg for 5 days 10mg for 5 days 7.5mg for 10 days 5 mg thereafter. 17. sodium chloride 0.65 % aerosol, spray sig: sprays nasal tid (3 times a day) as needed. 18. lactobacillus acidophilus 500 million cell tablet sig: one (1) tablet po qd () for 5 days. 19. levofloxacin 250 mg tablet sig: one (1) tablet po q48h for 10 days. 20. dolasetron mesylate 12.5 mg iv q8h:prn 21. warfarin 5 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: discharge diagnosis: klebsiella pneumoniae sepsis clostridium difficile colitis discharge condition: afebrile in normal sinus rhythm with diarrhea improving discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction:1500cc if you experience any fever, chills, diziness, worsening diarrhea, shortness of breath, bleeding from your catheter site you should call your doctor but if no doctor is available you should go back to the emergency room. followup instructions: provider: clinic phone: date/time: 2:00 provider: , : date/time: 2:30 please call pcp: , s. to schedule an appointment for post hospitalization follow-up. procedure: hemodialysis venous catheterization for renal dialysis diagnoses: anemia in chronic kidney disease end stage renal disease coronary atherosclerosis of native coronary artery pure hypercholesterolemia cirrhosis of liver without mention of alcohol chronic hepatitis c without mention of hepatic coma unspecified acquired hypothyroidism atrial fibrillation percutaneous transluminal coronary angioplasty status sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease intestinal infection due to clostridium difficile other septicemia due to gram-negative organisms infection and inflammatory reaction due to other vascular device, implant, and graft chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled 

Answer: The patient is high likely exposed to