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: hyperglycemia major surgical or invasive procedure: picc line placement history of present illness: 54 yo f with history of dmi, severe gastroparesis, htn, grave's disease and hep c, who presents with dka for the 3rd time in 2 months. the patient was last admitted from with dka, and was found to have a pan-sensitive enterococcus uti. the patient states that she started to note diffuse abdominal pain yesterday, typical of her diabetic gastroparesis. she describes this pain as crampy and sharp, coming in waves. she has vomited >10 times with bilious emesis. she describes mild mylagias, but no cough, rhinorrhea, sore throat, dysuria, vaginal discharge, diarrhea, headache, brbpr, or shortness of breath. she describes a chest pain in her lower left chest wall that has been constant over the past day and accompanying her abdominal pain. she denies drinking alcohol. she states she has been taking her insulin as prescribed. in the ed, the pts vitals were: tm 98.1 hr 130-150 bp 116-160/72-83 r 24-30 sat 100% 2 lnc. she was noted to have fs in the critical range with +urine ketones, and an anion gap of 37. she was given reglan 10 mg iv x1, 10 u sc insulin, 7 u iv insulin, and then a 5u/hr gtt. she received 3l of ns and a r femoral line was placed. cxr was negative for infiltrate, and ua appeared clean. past medical history: 1. dm type 1: years w/ dm: 5 age of diag: 48 year diag: several episodes of dka (last one in ), managed on 36u lantus plus hiss 2. diabetic polyneuropathy 3. hypertension 4. grave's disease s/p rai 5. reactive airway disease 6. seronegative arthritis, followed in rheumatology 7. hepatitis c, genotype 1a, biopsy with grade 1 inflammation, never been on antiviral therapy, acquired via blood transfusion during surgery in 8. gerd 9. migraines 10.bilateral knee arthroscopy in 11.s/p tah and pelvic floor surgery with bladder lift 12.depression 13. obesity 14. bone spurs in feet social history: no smoking/etoh/drugs. lives at home with 2 daughters. lives downstairs. does not work. family history: mother: died of colon cancer long h/o dm-2 physical exam: physical exam: vs: temp: 99.5 bp: 167/71 hr: 137 rr: 18 o2sat 100% ra gen: pleasant, fatigued, bilious fluid on initial exam : , eomi, anicteric, dry mm, op without lesions neck: flat jvd, supple, no lad resp: cta b/l with good air movement throughout cv: tachy but regular, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, diffusely tender but no rebound or guarding, no masses. neg . ext: no c/c/e, warm, 1+ bilateral dp/pt pulses skin: no rashes/no jaundice neuro: aaox3. moves all extremities. . on discharge, patient was afebrile with stable vital signs. her physical exam remain largely unchanged with the following exceptions. she was no longer or tachycardic. she continued to have diffuse mild abdominal pain, without rebound or guarding. pertinent results: 11:50am blood wbc-6.5# rbc-4.41# hgb-13.4# hct-40.4# mcv-92 mch-30.4 mchc-33.1 rdw-12.9 plt ct-479*# 11:50am blood neuts-93* bands-0 lymphs-6* monos-1* eos-0 baso-0 atyps-0 metas-0 myelos-0 11:50am blood glucose-681* urean-35* creat-1.5* na-132* k-5.9* cl-87* hco3-8* angap-43* 11:50am blood alt-23 ast-34 alkphos-115 totbili-0.7 03:20pm blood ck-mb-notdone ctropnt-<0.01 09:18pm blood ck-mb-notdone ctropnt-<0.01 06:01am blood ck-mb-5 ctropnt-<0.01 11:50am blood calcium-10.9* phos-7.0*# mg-2.1 06:23pm blood %hba1c-11.0* 03:20pm blood tsh-less than 03:20pm blood free t4-2.3* 01:15pm blood t3-89 05:38pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-pos barbitr-neg tricycl-neg 09:18pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-pos barbitr-neg tricycl-neg . . kub. impression: no radiographic evidence for obstruction. . cxr. impression: no acute cardiopulmonary process. brief hospital course: in summary, ms. is a 54 year old female with type 1 dm complicated gastroparesis and neuropathy, htn, hcv, admitted to micu with dka in setting of gastroparesis flare. . diabetic ketoacidosis: patient intially presented with dka and ag of 37. patient had gastroparesis flare and unclear if she was less compliant with her insulin. infectious workup was unrevealing. patient was treated with ivf, insulin drip with d5w, and antiemetics. patient was transitioned from insulin drip to glargine with insulin sliding scale. she was transferred to the floor once her gap closed. on the floor, she continued to use glargine and a humalog sliding scale. she was followed by while in house and will follow up with them on the after discharge. . type i dm: patient was diagnosed with type 1 diabetes 6 years ago. she was found most recently to have a hga1c of 11.0. she has had multiple recent admission for dka and her diabetes is complicated by peripheral neuropathy and gastroparesis. she was initially on an insulin drip but then trasitioned to glargine and sliding scale. she was followed by and will follow up. . gastroparesis: patient complains of nausea, and abdominal pain due to gastroparesis. gastric emptying study in showed markedly delayed gastric emptying and esophageal stasis. she was started on hyocyamine sl, an anticholinergic that causes gi smooth muscle relaxation. she was started on standing tylenol with prn nsaids and oxycodone. she was continued on standing reglan. she was treated with zofran as needed for nausea. . peripheral neuropathy: patient reported severe leg pain due to peripheral neuropathy. she was continued on gabapentin and amytriptyline. she was also placed on standing tylenol with prn nsaids and oxycodone for pain control. . grave's disease: patient has history of disease s/p radioablation. patient's tsh has alternated from being suppressed and being elevated over the past year. on admission, tsh was found to be undetectable with elevated free t4 but normal t3. it was difficult to interpret these result in the setting of acute illness. there was concern for medication noncompliance at home. she was continued on methimazole at 15 mg and started on propanolol to inhibit convesion of t4 to t3. she did not appear thyrotoxic on exam. she was followed by endocrine. she will need outpatient radioablation as she is refusing surgery. she will need her tfts checked as an outpatient. she will needs outpatient opthalmology follow-up. her outpatient physician at who follows her thyroid was made aware. . depression: patient is on amitryptyline at home, however serum tox was negative for tcas on admission, suggesting that patient is either noncompliant or was unable to tolerate it due to gastroparesis/dka. patient's utox also positive for benzos though patients was not known to be prescribed benzos. she was followed by social work because there was concern that an unstable home environment contributed her her multiple admissions. social work filled out paperwork for the patient to obtain "the ride" so she is able to get to her appointments. . asthma: albuterol was initially held due to hyperkalemia. she was continued on home fluticasone, montelukast. . cad: patient had negative stress in and normal echo with ef of 60-70% in . however, she is at risk for cardiac events given her severe and poorly controlled diabetes. she was continued on aspirin and statin. . seronegative arthritis: patient has a history of arthritis with normal rheumatoid factor. she was continued on sulfasalazine. . anemia: patient admitted with hct of 40 which fell to 25 in setting of aggressive ivf hydration. it remains difficult to determine her baseline hematocrit given that patient is frequently admitted for dehydration in setting of dka and then agressively resucitated causing hct to be hemoconcentrated and then diluted. colonoscopy in showed only internal hemorrhoids. anemia is likely from chronic disease and dilution from ivf. labs on discharge appear consistent with iron deficiency anemia. the patient will need outpatient follow up for her anemia. . hcv: lfts were checked and found to be within normal limits. no history of antiviral medications. . urinary tract infection: the patient was found to have a coag positive staph uti while in the hospital. she was discharged to complete a course of antibiotics. vna will obtain a repeat ua and culture to check that her urine has cleared of infection. these results will be faxed to her primary care doctor. . communication: hcp daughter , cell . medications on admission: trazodone 100 mg po hs (at bedtime) as needed for insomnia. albuterol 90 mcg/actuation aerosol sig: two (2) puff inhalation q6h (every 6 hours) as needed for sob, wheezing. flovent amitriptyline 25 mg po hs (at bedtime). gabapentin 300 mg qp q12h aspirin 81 mg tablet, po daily (daily). methimazole 10 mg po tid metoclopramide 10 mg po qidachs montelukast 10 mg po daily hexavitamin po daily pantoprazole 40 mg po q24h salmeterol 50 mcg/dose disk q12h simvastatin 10 mg po daily sulfasalazine 500 mg po tid oxycodone-acetaminophen 5-325 mg 1-2 tablets po q6h prn hyoscyamine sulfate 0.375 mg tablet, sl losartan 50 mg po daily lantus 20 units hiss flexeril 10 mg tid prn zelnorm 6mg 1 tab po tid ?valium discharge medications: 1. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 2. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. amitriptyline 25 mg tablet sig: one (1) tablet po hs (at bedtime). 5. gabapentin 300 mg capsule sig: one (1) capsule po q12h (every 12 hours). 6. methimazole 10 mg tablet sig: 1.5 tablets po bid (2 times a day). disp:*90 tablet(s)* refills:*2* 7. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). 8. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 11. sulfasalazine 500 mg tablet sig: one (1) tablet po tid (3 times a day). 12. hyoscyamine sulfate 0.125 mg tablet, sublingual sig: three (3) tablet, sublingual sublingual (2 times a day). 13. losartan 50 mg tablet sig: one (1) tablet po daily (daily). 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. propranolol 10 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*1* 16. lidocaine hcl 2 % solution sig: 1-2 mls mucous membrane tid (3 times a day) as needed. disp:*20 ml(s)* refills:*0* 17. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*2 tablet(s)* refills:*0* 18. glargine please take your glargine 16 units with breakfast and 18 units with dinner. 19. insulin sliding scale please continue your humalog (insulin) sliding scale as instructed on the worksheet. 20. outpatient lab work please check tsh, free t4, and t3. please check urinalysis and urine culture. discharge disposition: home with service facility: uphams corner home care discharge diagnosis: diabetic ketoacidosis gastroparesis diabetes mellitus type 1 complicated by peripheral neuropathy . secondary: hypertension disease hepatitis c reactive airway disease seronegative arthritis discharge condition: stable. discharge instructions: you were admitted with diabetic ketoacidosis and gastroparesis. you were restarted on your glargine and humalog sliding scale doses. you were seen by the and the endocrine service and will need to follow up in clinic on . . please schedule a follow-up appointment with your pcp, . within the next 2 weeks. you will have a follow-up urinalysis with your vna, and the results will be faxed to your pcp. . please check your fingersticks prior to each meal and prior to bedtime, record these numbers and bring them when you see your doctors. if you have a low blood sugar or feel symptomatic (lightheaded, dizzy, sweaty), please take some juice and recheck your sugars 15 minutes later, if still low please call your doctor immediately. if your glucose is greater than 400, please call your doctor immediately. . if you develop any of the following concerning symptoms, such as fevers, chills, nausea, , diarrhea, excessive sweating, increasing abdominal pain, chest pain, increasing thirst and urinary frequency, please call your doctor or come to the emergency department. . please follow up with your doctors . please take all your medications as prescribed. you were started on a new medication called propranolol for your disease. your methimazole dose was changed from 10 mg three times a day to 15 mg twice a day. please finish your course of antibiotics bactrim ds. you will complete your course tomorrow. followup instructions: gastroenterology provider: , md phone: date/time: 1:00 . hepatology provider: , md phone: date/time: 11:00 . diabetes center provider: , : date/time: 11:00am . please schedule a follow-up appointment with your pcp . within the next 2 weeks. the phone number is . procedure: venous catheterization, not elsewhere classified diagnoses: hyperpotassemia anemia of other chronic disease esophageal reflux urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified personal history of other infectious and parasitic diseases asthma, unspecified type, unspecified polyneuropathy in diabetes depressive disorder, not elsewhere classified long-term (current) use of insulin personal history of noncompliance with medical treatment, presenting hazards to health dehydration toxic diffuse goiter without mention of thyrotoxic crisis or storm staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with ketoacidosis, type i [juvenile type], uncontrolled gastroparesis family history of malignant neoplasm of gastrointestinal tract arthropathy, unspecified, site unspecified family history of diabetes mellitus 

Answer: The patient is high likely exposed to