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: proxy / caffeine / butalbital / barbiturates / xanthines attending: chief complaint: fever, abdominal pain major surgical or invasive procedure: cvl, a-line history of present illness: patient is a 71 y/o f with pmh of esrd on hd, recent broncial hemorrhage, respiratory failure with trach, hx of multiple gi bleeds, nonresponsive at baseline presenting from rehab with coffee ground emesis and fever. the son reports that patient has been vomitting over the past month, nonbloody until this morning. she was brought in from rehab for evaluation of this. patient is unable to give review of systems. per the notes from rehab: at 8pm she was febrile to 101.2, she was diaphoretic and clammy, was given 250cc ns bps were 80s/40s. stable overnight until 545 am, when she had hypotension to 88/32 again, was diaphoretic. aspiration of gtube feeds showed 500cc of coffee ground fluid. per interview with the son, she is alert and speaks when not infected and her electrolytes are normal. she has been having emesis 3-4 times a day for the past month. this is been slowly improving with change in admisteration of aluminum hydroxide (daily instead of tid). her ca has also been high the past few days. her emesis also appeared more brown the past day instead of the color of tube fees. in the ed, her vitals were tmax 101.4, bp: 116-149/60-70 (left arm), hr 60-80, 96% on 100% bipap. gtube aspirated 300-400cc of coffee ground material. she was lavaged 7-800cc water which was persistently coffee ground. access was very difficult given her vasculopathy; ij was attempted but unable to thread and eventually a 3inch 18 guage angiocath was placed. she has a 20 guage in her left arm. she was given 10mg im morphine, vancomycin 1gm iv, zosyn 4.5 mgiv, ativan 1m, 2l ns, protonix 80mg iv once. she was put in bipap for reasons unclear, but possibly in the setting of morphine and ativan. also of note her pressure should be checked from her left arm. past medical history: 1)esrd on hd of unclear etiology. 2)respiratory failure s/p trach in , vent dependent until when she was successfully weaned 3)copd 4)chronic pleural effusions 5)recurrent aspiration pna 6)pvd, s/p r cea, s/p bilateral iliac stents and gangrene of toes bilaterally and autoamputating 7)htn 8)hypothyroidism 9)h/o gi bleeding 10)chf no previous echo here, so unclear 11)h/o cholesterol emboli syndrome 12)paroxysmal af 13)anemia 14)s/p multiple embolic cva )dementia 16)adenocarcinoma of the colon s/p resection in 17)hx of c.diff colitis 18)sepsis to pna d/c'd from micu social history: # personal: lives at rehab macu. divorced. three adult children. son is her hcp and is very involved # tobacco: former smoker. 3 packs per day x 13 years. # alcohol: occasional past use. family history: her parents lived until old age. one brother died of an mi in his 60s. another brother with schizophrenia. son with hypothyroidism. physical exam: vitals: t100.2 bp 93/39 p83 rr 19-28 98-100% on cpap 50% gen: resting, nad pulm: diminished bs, no w/r/r cv: hrrr, no m/r/g abd: diffuse ttp, firm. hypoactive bs. extr: multiple amputated toes, gangrene. no edema. pertinent results: ct abdomen with intravenous contrast: the left lower lobe is collapsed. there are bilateral small pleural effusions. there is trace pericardial fluid, likely physiologic. there are several segments of a bowel wall thickening, mucosal enhancement, and adjacent mesenteric edema, particularly at the distal ileum. some of these bowel loops demonstrate pneumatosis. the patient is post-resection of the right and the transverse colon, with ileocolic anastomosis. small amount of perihepatic free fluid is present. gallbladder is distended and contains numerous gallstones. kidneys are atrophic. pancreas and spleen are unremarkable. gastrostomy tube is in place. there is no free air in the abdomen. ct pelvis with intravenous contrast: there is diverticulosis of the sigmoid colon without evidence of acute diverticulitis. the uterus is atrophic. there is a small amount of free fluid in the pelvis. the rectal wall is thickened, though may be in part due to nondistention. extensive vascular calcifications are noted in the abdomen and pelvis. the celiac axis and sma are patent proximally, though there is stenosis at the origin of both vessels due to extensive atherosclerotic calcification of the abdominal aorta, which is normal in caliber. is not clearly enhancing, possibly secondary to atheroscleortic changes. bone windows: demonstrate no concerning lytic or sclerotic lesions. impression: 1. findings highly concerning for mesenteric ischemia and ischemic bowel in the sma territory. 2. small amount of ascites. 3. bilateral small pleural effusion, left lower lobe collapse. 4. cholelithiasis; gallbladder distention can be related to the fasting state. . ct chest/abd/pelvis findings: the right brachiocephalic vein is markedly attenuated. the right common jugular vein appears to be normal caliber. however, there is a clot in the common jugular vein, series 2, image 127, which is eccentrically positioned and occupies approximately 50% of the lumen. the takeoff of the right subclavian vein is not well seen; however, an attenuated right subclavian vein is identified as it courses through the axilla. a left internal jugular central line is identified. the left brachiocephalic vein, left internal jugular, and left subclavian vein appear to be normal caliber. there are diffuse atherosclerotic changes of the arterial vessels without evidence of significant thrombus. the superior vena cava is slightly attenuated in caliber. the central line coursing through the svc terminates at the svc/right atrial junction. there is no significant pericardial effusion. there are moderate bilateral pleural effusions with subjacent atelectasis, which appear to be increased in size from prior study dated . shotty mediastinal adenopathy is noted. the tracheobronchial anatomy appears normal. there is tracheostomy tube identified. esophagus appears unremarkable. there is a distended gallbladder, which measures high normal in diameter, at 4.9 cm, but is slightly decreased in diameter since the prior study. multiple calcified dependent gallstones are identified. there is mild amount of perihepatic and perisplenic fluid. there is no focal lesion identified in the spleen or liver. there is no intrahepatic ductal dilatation. there are atrophic kidneys without evidence of hydronephrosis. the pancreas appears unremarkable. there are atherosclerotic changes in the abdominal aorta, most prominent at series 2, image 60. patient is status post partial colonic resection and ileocolic anastomosis. there are fluid filled loops of large and small bowel with air/fluid levels but no evidence of bowel wall thickening, pneumotosis, or acute transition point. there is free fluid in the right lower quadrant as well as the pouch of . a gastrostomy tube is identified. there is no evidence of intraperitoneal free air. there is diverticulosis of the sigmoid colon. a right femoral venous line is identified. there are mild degenerative changes in the thoracolumbar spine. impression: 1. attenuated appearance of the right brachiocephalic vein with poorly delineated inflow from the right subclavian vein, possibly representing stenosis. eccentric clot in a normal caliber common right jugular vein. patent left brachiocephalic vein and svc, with a left- sided central venous catheter coursing to the svc/right atrial junction. 2. ascites. 3. increased bilateral effusions and bilateral lower lobe atelectasis. 4. findings suggestive of ileus, with no evidence of obstruction or pneumotosis. 5. distended gallbladder with cholelithiasis. the study and the report were reviewed by the staff radiologist. . ct torso ct torso with contrast indication: 72-year-old woman with mesenteric ischemia, renal failure, and septic shock, please evaluate chest, abdomen and pelvis for possible source of infection and in light of clinical concern for svc syndrome. technique: mdct-acquired axial images of the chest, abdomen and pelvis were obtained with hand injection of intravenous contrast via the left femoral central line. early and late arterial images were obtained. coronal and sagittal reformats were performed. comparison: . ct chest: the tracheostomy is in expected location. there is no significant axillary or hilar adenopathy. there are multiple small shotty mediastinal nodes. there are large bilateral pleural effusions, not appreciably changed. there is adjacent atelectasis. there are no pulmonary nodules. there is a central line in the left internal jugular vein. there is again posterior non- occlusive thrombus in the right internal jugular, which is not completely imaged. there is a highly stenotic but patent right brachiocephalic vein, which is diminutive but patent distally. the distal right subclavian vein is diminutive but patent. there is no evidence of svc thrombosis, although it is somewhat attenuated in caliber. there are diffuse vascular calcifications. there is cardiomegaly without pericardial effusion. ct abdomen: the study is somewhat limited as the patient's arms were down causing streak artifact. there is trace perihepatic and perisplenic fluid, less than on prior study. there is focal atrophy in segments iv a and b of the liver that may represent prior insult. there is no intra- or extra- hepatic biliary ductal dilatation. the gallbladder is distended containing gallstones. the pancreas and adrenals are normal. the spleen is somewhat nodular. the kidneys are atrophic. the patient had prior partial colonic resection and ileocolic anastomosis. there is a gastrostomy tube in place. the intra- abdominal small and large bowel is otherwise normal. there is no free air or adenopathy. there is diffuse anasarca. ct pelvis: there is sigmoid diverticulosis. there is a rectal tube. there is a left femoral line. there is trace free fluid in the pelvis. the skin nodules in the anterior abdominal wall are likely due to sub- cutaneous injections. the abdominal aorta is atherosclerotic as are the iliac arteries. there is complete or near complete occlusion of the left external iliac artery, with epigastric arterial collaterals. there is complete sfa thrombosis on the right, with some flow in the profunda femoris. impression: 1. posterior non- occlusive thrombus in right internal jugular, again seen but incompletely imaged. distal right subclavian and brachiocephalic veins diminutive but patent. no evidence of svc syndrome. 2. no evidence of intra-abdominal abscess 3. slight interval decrease in ascites. 4. bilateral effusions and atelectasis are not significantly changed. 5. severe atherosclerotic disease as described above. brief hospital course: on admission tot he hospital the patient was placed on broad spectrum antibiotic with vancomycin, flagyl, levofloxacin, zosyn, and gentamicin for coverage of gi flora, given her bowel ischemia. oral vancomycin was also added for empitric coverage of c.diff colitis, given her recent history of c.diff. she was placed on a norepinephrine drip for hypotension. cvvh was intiated given her hypotension. initial abdomenal ct showed extensive atherosclerotic disease and calcification of her sma, , and celiac axis, along with bowel distension and pneumatosis of her bowel wall. after being hospitalized for 10 days she developed a vent associated pneumonia and was placed on meropenem. chest ct revealed occlusion of the right subclavian, and brachiocephalic veins. as a result, the patient had increased facial plethora and edema of the subcutaneous tissues surrounding her neck. she continued to be hypotensive throughout her hospitalization and vasopressin was added on . a yeast infection was detected and she was given fluconazole iv for two days. the patient's cvvh line became infected and it was replaced over a wire. she was placed on vancomycin and the line was replaced. the replacement line became infected two days later. repeat ct torso on showed no radiographic evidence of bowel ischemia, however the patient persisted with intense abdominal pain with palpation. by the patient continued to be dependent on two vasopressors to maintain her blood pressure. she was vent dependent, and on cvvh. she was developing increased respiratory and metabolic acidosis. on , after family discussion, the patient was made cmo. her antibiotics and vasopressors were stopped. per her son's request, the cvvh was continued. the patient passed away at 9:40am on , of septic shock secondary to mesenteric ischemia. medications on admission: tylenol, alumnium hydroxide 45ml per gtube, b12 1', colace, fluticasone proprionate, folic acid, heparin 2500 q12h, dilauded 0.75mg po at dialysis, levothyroxine 200', lidoderm 5% 2 patch once a dat topically, nystatin 5ml qid, albterol q6h nebs, dulcolax 10prn, iartroprium q6hours, zofran 4 tid discharge disposition: expired discharge diagnosis: mesenteric ischemia septic shock discharge condition: expired procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis non-invasive mechanical ventilation arterial catheterization gastric lavage diagnoses: acidosis end stage renal disease renal dialysis status unspecified pleural effusion severe sepsis chronic airway obstruction, not elsewhere classified atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure pneumonia due to pseudomonas pneumonitis due to inhalation of food or vomitus compression of vein other specified septicemias septic shock intestinal infection due to clostridium difficile hyperosmolality and/or hypernatremia other and unspecified infection due to central venous catheter ventilator associated pneumonia acute vascular insufficiency of intestine other specified disorders resulting from impaired renal function other toe(s) amputation status gastrostomy status tracheostomy status kidney replaced by transplant candidiasis of vulva and vagina 

Answer: The patient is high likely exposed to