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: penicillins attending: chief complaint: found unresponsive major surgical or invasive procedure: central iv catheter (right ij) upper endoscopy history of present illness: 54 yo male with past medical history of type 1 diabetes mellitus, cad, esrd on hd, and alcohol abuse was admitted from the ed after being found unresponsive and with a blood glucose elevated to 1425. . he was reportedly found down at home surrounded by emesis and small pools of fresh and old blood. he was brought to where his vital signs were hr 121, rr 22, bp 213/99, and pulse ox 100% nrb. his labs were notable for wbc 23, na 126, k 5.4, co2 30.6, and blood glucose of 1425. he was started on an insulin gtt at 10 units per hour and received 1 gram ceftriaxone iv x 1. he was intubated for airway protection and was then transferred to for further management. at ed, temp 96.9, hr 114, bp 164/86, rr 20, pulse ox 100% vent. his ng tube was notable for dark fluid residuals, although hemoccult was not performed. he received 40mg iv pantoprazole, 1gram iv vancomycin, flagyl 500mg iv, propofol, and midazolam. per report, he received approximately 4l ns between and . past medical history: pcp: . () primary nephrologist: dr. () . type 1 diabetes mellitus failure to thrive coronary artery disease s/p mi in and cabg in right eye blindness gerd end stage renal disease on hd (qmwf at dialysis center) alcohol abuse social history: home: lives with daughter, independent of adls occupation: unknown tobacco: 2 ppd etoh: previous history of alcohol use, pt denies recent use drugs: denies per patient's dialysis nurse (), he has been very depressed since his wife passed away several years ago. he is very withdrawn and often comes to dialysis unwashed wearing clothes he has not changed for several days. brother-in-law: ; daughter: family history: not contributory physical exam: t 95.5 / hr 118 / bp 108/42 / rr 32 / wt 57 kg gen: sedated and intubated, dissheveled heent: op not visualized secondary to intubation, dry mucous membranes with dried blood on chin, no scleral icterus, pupils round and minimally reactive to light, normocephalic, atraumatic neck: supple, no lad, no jvd cv: tachycardic but regular rhythm. nl s1, s2. no murmurs, rubs or gallops lungs: cta, bs bl, no w/r/c abd: scaphoid, soft, nt, nd. nl bs. no hsm ext: no edema. 2+ dp pulses bl skin: scattered .25-1cm areas of hyperkeratosis without evidence of bleeding, discharge, erythema, or fluctuance; decreased skin turgor; no spider angiomas, no jaundice neuro/psych: intubated and sedated pertinent results: 09:50pm blood wbc-8.1 rbc-2.77* hgb-8.6* hct-27.5* mcv-99* mch-31.0 mchc-31.2 rdw-15.0 plt ct-279 03:45am blood wbc-2.6*# rbc-2.15* hgb-6.6* hct-19.9*# mcv-93 mch-30.7 mchc-33.1 rdw-15.3 plt ct-179 03:39am blood wbc-8.5# rbc-3.09*# hgb-9.3*# hct-26.7* mcv-87 mch-30.1 mchc-34.8 rdw-17.4* plt ct-174 05:56am blood wbc-7.5 rbc-3.76* hgb-11.5* hct-33.8* mcv-90 mch-30.5 mchc-34.0 rdw-15.8* plt ct-284 09:50pm blood pt-13.1 ptt-114.1* inr(pt)-1.1 09:50pm blood glucose-1088* urean-76* creat-6.9* na-133 k-4.0 cl-89* hco3-25 angap-23 05:56am blood glucose-162* urean-14 creat-4.9*# na-138 k-4.1 cl-99 hco3-31 angap-12 09:50pm blood alt-13 ast-13 ld(ldh)-207 ck(cpk)-88 alkphos-102 amylase-76 totbili-0.2 09:50pm blood ck-mb-5 ctropnt-0.10* 01:21am blood ck-mb-5 ctropnt-0.08* 05:56am blood glucose-162* urean-14 creat-4.9*# na-138 k-4.1 cl-99 hco3-31 angap-12 07:23am blood ck(cpk)-68 01:21am blood ck(cpk)-74 09:50pm blood alt-13 ast-13 ld(ldh)-207 ck(cpk)-88 alkphos-102 amylase-76 totbili-0.2 04:23am blood lipase-22 03:45am blood caltibc-131* ferritn-754* trf-101* 09:50pm blood osmolal-371* 03:45am blood osmolal-303 09:50pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 09:52pm blood type-art rates-20/0 tidal v-500 peep-5 fio2-100 po2-216* pco2-70* ph-7.26* caltco2-33* base xs-2 aado2-433 req o2-74 -assist/con intubat-intubated 09:27am blood type-art rates-/25 tidal v-454 peep-5 fio2-40 po2-136* pco2-40 ph-7.39 caltco2-25 base xs-0 intubat-intubated . cxr : 1. findings indicating underlying obstructive lung disease. 2. et tube and right ij catheter in good position, ng tube looped in the stomach with its tip pointing towards the ge junction, which should be repositioned. . tee: the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is no pericardial effusion. no vegetation seen (cannot definitively exclude). . ct head : 1. no evidence for intracranial hemorrhage or abscess. 2. paranasal sinus opacification as described. 3. mild brain atrophy and evidence for prior microvascular ischemia. . egd : esophagitis in the middle third of the esophagus, lower third of the esophagus and gastroesophageal junction compatible with severe reflux or (biopsy). erythema in the duodenal bulb and first part of the duodenum compatible with duodenitis. recommendations: continue ppi x 2 weeks, then daily ppi therapy. reasonable to treat with fluconazole 200mg daily x 14 days for possible , at least until path/micro results are confirmed. patient should have eventual outpatient colonoscopy because over 50 yrs old and anemic. . esophageal biopsy: granulation tissue with fibrinopurulent exudate. scant detached squamous cells. gms stain is negative for fungal forms. multiple levels are examined. . mri head : no definite acute infarct. moderate brain atrophy and mild-to- moderate changes of small vessel disease with left corona radiata lacune. lacunes in the left thalamus. soft tissue changes in the paranasal sinuses, which appear to be secondary to intubation. . cxr : the patient is extubated and the right internal jugular line is removed in the meantime interval. the right picc line tip terminates in mid low svc. the cardiomediastinal silhouette is stable as well as post-sternotomy wires. there is no hilar enlargement. slight increase in interstitial markings, especially in the perihilar and right lower lobe areas might represent mild volume overload. there is no pneumothorax or sizable pleural effusion. brief hospital course: 54 yo m with dm, cad, and esrd on hd admitted with hyperosmolar nonketotic state after being found unresponsive. . # altered mental status. patient was admitted with poor mental status in the setting of hyperglycemia. head ct and mri were only significant for chronic small vessel ischemic disease. on , he was extubated and his mental status appeared to be back at baseline after discussing with his long-term dialysis nurse. he remained alert and oriented throughout the rest of his hospital stay. . # hyperglycemia: it was unclear whether the patient had type 1 dm or insulin-dependent type 2 dm. his bs were elevated to 1400 in the ed with a significant anion gap, suggestive of dka. urine was not available to test ketones as patient has esrd. however, the micu team had the impression that the patient had hyperosmolar nonketotic coma given that the patient only developed diabetes in his 30s. there was concern that the causal event was infectious, although blood cultures and urine cultures were negative. further infectious work-up is discussed below. alternatively, there was concern that the patient was not faithfully taking his home medications. patient's hyperglycemia was treated in the icu and then he was transitioned to fixed and sliding scale insulin. his glucose control is made difficult by poor and inconsistent dietary intake. . # infection/sinusitis. patient's initial presentation was significant for tachycardia and leukocytosis concerning for septic picture. he was started on broad spectrum antibiotics. id was consulted, and he was given a 10 day course of vancomycin (completed), as well as 2 weeks total of ceftriaxone and metronidazole. there was no definite source discovered; blood and urine cultures, including fungal blood cultures, were negative at the time of discharge. cxr did not show infiltrate. pt was noted to have opacified sinuses on head ct. seen by ent on who did not see signs of invasive fungal infection; culture of sinuses negative, although antifungals were given because pt had budding yeast forms on his gram stain. . # esophagitis. patient had episode of bloody emesis at time of presentation. an upper endoscopy was performed and he was found to have severe esophagitis. it was unclear whether the esophagitis was due to or severe reflux disease. he was placed on antifungals (initially caspofungin, then switched to fluconazole) for a 2 week course. in addition, he was given ppi x 2 weeks, to be continued once daily thereafter. of note, his biopsy did not show fungal forms. he had no further episodes of bloody emesis, and his hct was stable at the time he was discharged. . # resp failure: patient was intubated in the micu for airway protection and increased secretions in the setting of poor mental status. following extubation, he was assessed by speech and swallow, who put him on a soft diet with thin liquids. . # esrd on hemodialysis. patient was followed by renal and dialyzed monday, wednesday, friday per his normal routine. his phosphate binders were stopped given persistently low phosphorous. nephrocaps should be continued. given his poor nutritional state, it was felt to be appropriate to put him on a consistent carbohydrate diet. . # history of cad s/p cabg, hypertension. patient's clonidine, lisinopril, norvasc, and toprol were continued. although he was admitted with minoxidil, he did not need it for control of his bp and it was stopped. . # depression. patient was admitted on mirtazapine, although there was concern that he might not have been taking it at home. his mirtazapine was held in the setting of his poor mental status. after discussing with his home dialysis nurse, it appeared that his mood was improved in the hospital as compared with his baseline. thus, his mirtazapine was not restarted. the team was concerned that he has significant depressive symptoms over the last several months (worse since his wife died a few years ago) interfering with his ability to care for himself. it is recommended that he get help from psychiatry for possible medication/counseling. . # history of alcohol abuse. tox screen negative for alcohol. patient denied recent use of alcohol. he was discharged on thiamine (gets folate in his nephrocaps) since it was unclear whether alcohol continues to be a problem for him. . # medication changes: - lantus decreased for am hypoglycemia - minoxidil stopped as not needed for bp control - phoslo stopped as phosphorous too low - reglan stopped for loose stools - mirtazapine stopped for altered mental status, as above - ppi started for severe esophagitis - antibiotics as discussed above . # comm: medications on admission: aspirin 81mg po daily clonidine .3mg po bid lantus 16 units qhs lisinopril 40mg po daily minoxidil 2.5mg po bid nephrocaps 1 tablet daily norvasc 10mg po dialy phoslo 2 tabs wid prilosec 20mg po daily reglan 10mg po qid remeron 50mg po qhs simvastatin 10mg po daily toprol xl 100mg po daily thiamine 100mg po daily discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary diagnosis: mental status change, hyperglycemia with possible hyperosmolar coma, esophagitis secondary diagnosis: hematemesis, dm, esrd on dialysis, cad, htn, sinusitis, depression discharge condition: patient's mental status had returned to baseline and his hyperglycemia had resolved. his vital signs were stable and he was afebrile. discharge instructions: you were admitted with high blood sugars with mental status change and concern for infection. you were treated in the micu, where your sugars were controlled and your mental status improved. you were given antibiotics and antifungals to treat your infection, which was felt to involve your sinuses. 1. please take all medications as prescribed. it is important for you to monitor your blood sugar regularly and take your insulin as directed. 2. please attend all follow-up appointments listed below. 3. please call your doctor or return to the hospital if you develop fevers, chills, decline in mental status, blood sugar > 350, pain with swallowing, or any other concerning symptom. followup instructions: please see your pcp . within 2-3 weeks of your discharge. it is recommended that you have a colonoscopy in the near future. you may also need to be evaluated by a psychiatrist. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube hemodialysis esophagogastroduodenoscopy [egd] with closed biopsy transfusion of packed cells diagnoses: pneumonia, organism unspecified end stage renal disease aortocoronary bypass status acute respiratory failure pressure ulcer, lower back esophagitis, unspecified other and unspecified complications of medical care, not elsewhere classified diabetes with renal manifestations, type i [juvenile type], uncontrolled esophageal hemorrhage unspecified sinusitis (chronic) nutritional marasmus diabetes with hyperosmolarity, type i [juvenile type], uncontrolled 

Answer: The patient is high likely exposed to