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 / dilaudid / ciprofloxacin attending: chief complaint: hypoxia major surgical or invasive procedure: hemodialysis history of present illness: mr. is a 43 y/o man with esrd on hd s/p recent removal of transplant nephrectomy in , htn, and hepatitis c who presents with ongoing abdominal pain, hematuria, and difficulty breathing. the patient notes ongoing right lower quadrant abdominal pain at site of nephrectomy (done in ) since surgery. no real change in pattern or quality of pain. pain located directly over site of surgical incision. no diarrhea or vomiting but nauseated. no increase in pain today. has also had hematuria since his nephrectomy last month without change. hematoma was visualized at nephrectomy site on ct done . also complaining of dysuria with subjective fevers at home with unclear timeline (states that subjective fevers have occurred since his prior hospitalization). . in addition, patient notes recent orthopnea and increasing dyspnea at rest. he did not go to dialysis today (usual t,th,sat). has not missed any doses of medication per his report. he denies increased salt intake. he endorses chest pain while "fatigued" but does not further characterize. reports no chest pain at rest. no palpitations. has chronic right lower extremity edema per his report. no chest pain currently. . on arrival to our ed, the patient's initial vitals were t 98.2, hr 80, bp 152/106, rr 16, 100% on ra. bp in the ed ranged from 160s-170s systolic. he desaturated to 90 and then in to the 80s with sleeping and was placed on a nrb mask with improvement in sats to 100%. he received 2 mg iv morphine x 1 for abdominal pain. cxr demonstrated volume overload; renal was contact for possible dialysis tonight. transplant surgery was also consulted given his recent nephrectomy. . ros: + subjective fevers at home. no weight changes. no chills. denies headache, sore throat, difficulty swallowing, pain with swallowing. endorses chest pain while "fatigued" but does not further characterize. no cp at rest. dyspnea as above. no palpitations. nausea without vomiting. no hematemesis. no diarrhea or blood in stools. pain in rlq at site of prior nephrectomy. + hematuria as above. chronic rle swelling. no joint pain or rash. . patient was admitted to the micu. he had dialysis and his dyspnea improved some. called out of the micu when he was satting 100% on ra after dialysis and fluid removal. patient was started on cefpedoxime for trace + uti. . overnight, his o2 sat dropped to the high 80's on l nc. abg was done which showed po2 at 74. increased o2 to 4l nc and o2 sat improved to 95% on ra. at the same time the patient was complaining of chest pain. he said this pain was present at rest and constant. he said it was worse with inspiration, relieved somewhat by nitroglycerin. ce's sent and were at baseline. cxr done, showed continued fluid overload. . this am, the patient continued to feel chest pain with inspiration. he continues to feel short of breath. he reports diaphoresis, but consistent with his subjective fevers. he said the pain never really went away overnight even though he was given nitroglycerin. repeated ekg this am, no change. cycling enzymes. patient going to hd early this am. past medical history: * esrd secondary to fsgs s/p cadaveric transplant in , failed in now s/p nephrectomy of transplanted kidney in * hepatitis c virus * congenital single kidney * hypertension * depression * status post mva in with a right facial fracture and orbital zygomatic fracture * rem behavior disorder social history: lives with his wife, 2 step-sons, and 2 grandchildren. no pets. no current alcohol, tobacoo, or drug use. previously worked as a janitor. family history: reports brother had end-stage renal disease. physical exam: vs: t 97.9, bp 164/106, p 87, rr 16, 100% on nrb gen: alert, oriented, appropriately responsive heent: perrl bilaterally, eomi, sclerae anicteric, mmm, op clear, neck supple with prominent external jugular veins chest: left tunnelled ij hd catheter in place, site nontender lungs: crackles up 1/2 posterior lung fields with dullness to percussion at bases, decreased breath sounds at bases, no wheezing or rhonchi cv: rrr, 3/6 systolic murmur at lusb abd: normoactive bowel sounds, nontender without guarding or rebound throughout, incision at nephrectomy site well-healed with one area of point tenderness overlying apparent retained suture, no erythema or oozing from site ext: right av fistula with clean incision skin: no rash neuro: alert, oriented, cn ii-xii intact, moving all extremities without difficulty, sensation intact to light touch in all four extremities, toes downgoing bilaterally pertinent results: cxr: : worsening pulmonary edema and slight interval increase in size of small bilateral pleural effusions, left greater than right. . echo: : the left atrium is mildly dilated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 0-10mmhg. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is moderate global left ventricular hypokinesis (lvef = 30-35 %)., most prominent in the septum and anterior walls. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , the lvef has signficantly declined . cxr: : the double-lumen dialysis catheter tip is in the right atrium. the cardiomediastinal silhouette is stable. interval increase in bilateral perihilar opacities consistent with volume overload and current pulmonary edema. bilateral pleural effusions are present as well as bibasal atelectasis. . abd us: : 1. 4.7 x 2.2 x 2.9 cm thick-walled fluid collection in right lower quadrant has decreased in size from previous examination from . 2. bilateral pleural effusions. 3. gallbladder polyps. . cxr: : persistent but improved mild pulmonary edema. . us of av fistula: patent radiocephalic av fistula on the right. there are no focal velocity elevations to suggest stenosis in the outflow vein. the elevated anastomotic velocities with turbulence is characteristic and is difficult to correlate with any level of stenosis. suggest repeat exam with volumetric flow analysis to judge suitability of the fistula for dialysis. . cardiac mri: impression: 1. no significant obstructive coronary artery disease. 2. severely dilated left ventricle with mild global hypokinesis and no regional wall motion abnormalities. the lvef was mildly decreased at 42%. the effective forward lvef was moderately decreased at 31%. 3. moderately dilated right ventricular cavity size with mild free wall hypokinesis. the rvef was mildly depressed at 37%. 4. moderate mitral regurgitation. mild tricuspid regurgitation. trace aortic regurgitation. 5. the indexed diameters of the ascending and descending thoracic aorta were normal. the main pulmonary artery diameter index was mildly dilated. 6. moderate biatrial enlargement. 7. small bilateral pleural effusions. . lab results: 04:50pm blood wbc-4.7 rbc-3.67* hgb-9.9* hct-31.6* mcv-86 mch-27.0 mchc-31.4 rdw-20.3* plt ct-334 05:00pm blood wbc-5.1 rbc-3.53* hgb-9.5* hct-31.2* mcv-89 mch-26.8* mchc-30.3* rdw-19.5* plt ct-345 01:07am blood wbc-6.5 rbc-3.72* hgb-10.1* hct-33.0* mcv-89 mch-27.3 mchc-30.7* rdw-19.4* plt ct-393 09:22am blood wbc-5.4 rbc-3.78* hgb-10.0* hct-33.3* mcv-88 mch-26.6* mchc-30.2* rdw-19.3* plt ct-352 04:00am blood wbc-5.4 rbc-3.51* hgb-9.7* hct-30.9* mcv-88 mch-27.6 mchc-31.3 rdw-19.1* plt ct-316 04:40am blood wbc-6.0 rbc-3.56* hgb-9.8* hct-31.4* mcv-88 mch-27.5 mchc-31.3 rdw-18.7* plt ct-279 06:25am blood wbc-4.8 rbc-3.24* hgb-8.9* hct-28.3* mcv-87 mch-27.4 mchc-31.4 rdw-18.3* plt ct-268 06:35am blood wbc-4.1 rbc-3.22* hgb-8.9* hct-28.5* mcv-89 mch-27.6 mchc-31.1 rdw-18.2* plt ct-296 05:12am blood wbc-4.9 rbc-3.15* hgb-8.7* hct-27.1* mcv-86 mch-27.8 mchc-32.3 rdw-17.8* plt ct-321 04:50am blood wbc-4.4 rbc-3.03* hgb-8.2* hct-26.1* mcv-86 mch-27.3 mchc-31.6 rdw-17.7* plt ct-262 07:30am blood wbc-3.6* rbc-3.09* hgb-8.6* hct-26.4* mcv-85 mch-28.0 mchc-32.8 rdw-17.5* plt ct-285 07:30am blood wbc-3.6* rbc-3.09* hgb-8.6* hct-26.4* mcv-85 mch-28.0 mchc-32.8 rdw-17.5* plt ct-285 . 05:00pm blood pt-15.1* ptt-29.3 inr(pt)-1.3* 01:07am blood pt-15.3* ptt-35.6* inr(pt)-1.4* 09:22am blood pt-15.3* ptt-34.0 inr(pt)-1.3* . 04:50pm blood glucose-103 urean-38* creat-10.8*# na-140 k-4.9 cl-98 hco3-31 angap-16 05:00pm blood glucose-131* urean-55* creat-13.5*# na-139 k-7.9* cl-97 hco3-28 angap-22* 01:07am blood glucose-94 urean-59* creat-13.8* na-139 k-6.4* cl-96 hco3-26 angap-23* 09:22am blood glucose-93 urean-62* creat-15.0*# na-140 k-6.8* cl-98 hco3-24 angap-25* 04:00am blood glucose-90 urean-39* creat-10.4*# na-137 k-5.1 cl-96 hco3-24 angap-22* 04:40am blood glucose-96 urean-32* creat-8.6*# na-137 k-4.7 cl-98 hco3-28 angap-16 06:25am blood glucose-90 urean-51* creat-10.8*# na-135 k-5.4* cl-93* hco3-26 angap-21* 06:35am blood glucose-77 urean-37* creat-7.7*# na-134 k-4.8 cl-94* hco3-25 angap-20 05:12am blood glucose-89 urean-52* creat-10.3*# na-133 k-5.3* cl-93* hco3-25 angap-20 04:50am blood glucose-101 urean-69* creat-12.6*# na-129* k-5.7* cl-91* hco3-23 angap-21* 07:30am blood glucose-83 urean-42* creat-8.6*# na-135 k-5.3* cl-94* hco3-25 angap-21* . 05:00pm blood alt-25 ast-105* ck(cpk)-124 alkphos-68 01:07am blood alt-20 ast-24 ld(ldh)-297* ck(cpk)-66 alkphos-86 amylase-77 totbili-0.8 04:40am blood alt-21 ast-19 ld(ldh)-217 alkphos-73 totbili-0.7 . 09:22am blood ck(cpk)-55 04:00am blood ck(cpk)-49 12:50pm blood ck(cpk)-56 09:15pm blood ck(cpk)-43 01:20pm blood ck(cpk)-37* 02:04am blood ck(cpk)-33* . 05:00pm blood ctropnt-0.10* 01:07am blood ck-mb-notdone ctropnt-0.10* 09:22am blood ck-mb-notdone ctropnt-0.12* 04:00am blood ck-mb-notdone ctropnt-0.12* 12:50pm blood ck-mb-notdone ctropnt-0.13* 09:15pm blood ck-mb-notdone ctropnt-0.11* 01:20pm blood ck-mb-notdone ctropnt-0.11* 02:04am blood ck-mb-notdone ctropnt-0.08* . 01:07am blood totprot-7.2 albumin-4.6 globuln-2.6 calcium-10.3* phos-5.7* mg-2.5 . 09:22am blood calcium-9.9 phos-6.3* mg-2.5 04:00am blood calcium-9.7 phos-6.2* mg-2.0 cholest-110 04:40am blood calcium-9.5 phos-6.1* mg-2.0 iron-16* 06:25am blood calcium-9.3 phos-7.4* mg-2.3 06:35am blood calcium-9.3 phos-6.6* mg-2.0 05:12am blood calcium-9.6 phos-6.3* mg-2.2 04:50am blood calcium-9.2 phos-5.2* mg-2.3 07:30am blood calcium-9.6 phos-5.9* mg-2.1 . 04:40am blood caltibc-237* ferritn-332 trf-182* 04:50am blood hapto-147 . 04:00am blood triglyc-99 hdl-41 chol/hd-2.7 ldlcalc-49 . 09:22am blood tsh-2.8 . 01:07am blood cortsol-16.4 . 07:30am blood vanco-26.6* . 06:42am blood type-art fio2-94 o2 flow-4 po2-74* pco2-35 ph-7.49* caltco2-27 base xs-3 aado2-565 req o2-93 brief hospital course: 43 y/o man with pmh of esrd s/p failed transplant and subsequent nephrectomy admitted with worsening dyspnea and ongoing abdominal pain and hematuria. . # dyspnea/hypoxia: patient reported increased respiratory distress with hypoxia to the high 80s on room air. pt on hd, and missed hd on day prior to admission. cxr showed effusion, l > r initially. effusions have been present on x-rays and ct scans for past several weeks at least. size of effusion difficult to judge, but as has been chronic and is not massive, seems unlikely that accounts for current worsening dyspnea and hypoxia. by ultrasound, effusion could be tapped, but was not sufficiently large to explain dyspnea. renal consulted had ultrafiltration the night of admission for volume removal (4 kg). he then had another hd on . initally improved after dialysis on admission, then worsened. likely secodary to fluid overload and new onset decrease in systolic heart function, see below. able to wean off of new 02 requirement prior to discharge. . # chest pain: patient developed chest pain after being transfered out of the micu. most likely secondary to new onset systolic heart faiure and component of pericarditis from uremia. etiologies of new onset heart failure included bacteremia (see below), viral myocarditis, or high output failure from av fistula, as patient does not have evidence of severe cad and echo does not show sign of focal wall motion abnormality. although recent mibi showed moderate to severe lv cavity dilation and mild septal hypokinesis so likely has some degree of cad. patient also reports feeling subjective fevers for some time since his recent admission. support viral etiology. hiv and lyme antibodies negative. thyroid functin tests normal. most likely not amyloid as acute onset and does not show signs of diastolic dysfunction. be related to high output failure from av fistula. patient had a drop in his ef in the past when an av fistula was placed in . checked central venous 02 sat from hd line, consistent with high output failure. there was discussion to do an echo with compression of av fistula to determine if function improved, however the decision was made not to perform this due to potential compromise of the fistula with compresion. doppler of fistula showed normal flow, no sign of stenosis. increased metoprolol to 37.5, started on for increased ectopy, and discontinuing amlodipine, increased lisinopril dose to 20mg, eventually up to 40mg on . mri showed systolic heart failure increased function from previous echo, ef at 42%. started ibuprofen for pain control. patient will follow up with dr. for repeat echo and management. will continue ace, beta blocker and ibuprofen for management on discharge. . # gram positive bacteremia: most likely from hd line. started vancomycin on . dosed by hd. other blood cultures negative. planned on getting tee if more blood cultures became positive. daily surveillance cultures, all negative. will continue vancomycin for 2 week course. . # hematuria/uti: has been ongoing since nephrectomy in . recently seen by dr. in urology with plans for cystoscopy. urology seen while inpatient and recommended outpatient evaluation after antibiotic therapy with cefpodoxime for corynebacterium species in urine. will likely need cystoscopy and possible cystogram to evaluate the ureteral stump. procedure in acute setting made risky by possible uti. . # abdominal pain: pain seems localized over prior nephrectomy site without any guarding or rebound on exam. rlq ultrasound showed 4.7 x 2.2 x 2.9 cm thick-walled fluid collection in right lower quadrant has decreased in size from previous examination from . his symptoms resolved prior to discharge. . # esrd on hd: seen by renal team on arrival to the micu. patient received hd while inpatient with fluid removal by ultrafiltration for volume removal. continued sevelamer, nephrocaps, and calcium carbonate, adjusted doses per renal. av fistula us showed no sign of stenosis. patient will follow up with transplant surgery regarding when fistula will be ready for use. plan on patient getting hd on thursday after discharge. . # hypertension: increased metoprolol to 37.5 in an attempt to decrease ectopy. discontinued amlodipine as not indicated in high output chf increased lisinopril to 20mg initially, then up to 40mg prior to discharge. all in an attempt to get better bp control as patient has decrease in systolic function. discharged on new regimen. . # anemia: likely anemia of chronic disease from esrd. stable. recently noted to be iron-deficient, patient started on iron. trended hct while inpatient. . # depression/sleep difficulty: continued home imipramine, citalopram, and clonazepam . # hepatitis c: no active issues. . # fen: maintained on regular diet, electrolyte management per hd . # ppx: heparin sc tid, ppi per home regimen, bowel meds prn . # code: full, confirmed with patient. medications on admission: amlodipine 10 mg daily atorvastatin 10 mg daily celexa 20 mg daily clonazepam 1 mg qhs colace 100 mg imipramine 25 mg qhs lisinopril 10 mg daily lopressor 25 mg nephrocaps daily omeprazole 20 mg daily percocet 5/325 mg four times daily prednisone 1 mg daily (on taper, last week) renagel 800 mg tid senna 8.6 mg tums 1000 mg tid discharge medications: 1. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 2. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 3. clonazepam 1 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)) as needed for insomnia. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. imipramine hcl 25 mg tablet sig: one (1) tablet po hs (at bedtime). 6. lisinopril 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po bid (2 times a day). disp:*90 tablet(s)* refills:*2* 8. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap 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). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 10. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 11. sevelamer hcl 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). disp:*180 tablet(s)* refills:*2* 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 13. calcium carbonate 500 mg tablet, chewable sig: two (2) tablet, chewable po tid w/meals (3 times a day with meals). 14. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 15. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for pain. disp:*30 tablet, sublingual(s)* refills:*0* 16. ibuprofen 400 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*90 tablet(s)* refills:*0* 17. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous hd protocol (hd protochol). discharge disposition: home discharge diagnosis: primary diagnosis: congestive heart failure . secondary diagnoses: esrd htn anemia hepatitis c virus depression rem behavior disorder discharge condition: stable. discharge instructions: you were admitted to for abdominal pain and shortness of breath. the abdominal pain was found to be a result of your recent surgery. the surgeons were notified and determined that there was no intervention needed. . the shortness of breath was found to be a result of congestive heart failure. it was thought that the heart failure was due to your fistula that was placed in . you will need to take your medications that have been changed, see below, and follow up with the cardiologist, dr. , regarding repeating the echocardiogram and your medications. . these medications were changed during your hospitalization, you should continue to take them as they are prescribed: metoprolol 25mg twice per day lisinopril 40mg once per day pantoprazole 40mg once per day sevelamer 1600mg tid with meals ferrous sulfate 325mg once per day nitroglycerin 0.3mg as needed for chest pain ibuprofen 400mg every 6 hours as needed for chest pain (use this first) . if you experience worsening chest pain, shortness of breath, abdominal pain, fever, chills or any other worrisome symptoms please seek medical attention. followup instructions: please report to your dialysis clinic on thursday for your next dose of hemodialysis . please follow up with your transplant , , md phone:, on friday at 2:20pm . provider: phone: date/time: 3:00 . please follow up with dr. , your cardiologist, on monday at 4:20pm. . please follow up with your primary care physician, . , phone number ( in the next few weeks. md procedure: hemodialysis diagnoses: anemia in chronic kidney disease end stage renal disease urinary tract infection, site not specified congestive heart failure, unspecified chronic hepatitis c without mention of hepatic coma depressive disorder, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure bacteremia infection and inflammatory reaction due to other vascular device, implant, and graft acute systolic heart failure other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms 

Answer: The patient is high likely exposed to