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 / sulfa (sulfonamide antibiotics) / ace inhibitors / angiotensin recp antg&calcium chanl blkr / meloxicam attending: chief complaint: anemia major surgical or invasive procedure: transfusions with packed red blood cells and fresh frozen plasma history of present illness: 77 yo female with htn, dm, cri, on prednisone for ra, open laparotomy for perforated dudenal ulcer at on , and recently hosp from for high inr who was sent to the ed from for high inr and hct of 16.9. she was seen in ed on and found to have uti yeast > 100,000. she was started on ciprofloxacin 500mh on . per she has had no bloody/black stool or bleeding from her coccyx wound site. she has had no n/v. she has received 2.5mg po vit k on . wbc today at was 11. given increasing creatinine they were holding lasix on , and and giving 500ml po tid. vs prior to transfer to were 97/64 p103 100% ra. . in the ed, initial vs were t95.6 p98 (hr 77-92) bp108/77 (103-115/54-68) r22 (18-28) o2 sat 100%. in the ed hct was noted to be 16.9 (hct 25.7 2 days ago). inr was 5.3. patient was given 10mg po vit k and 1.5 units of blood. she was guaiac negative and ng lavage was not done given high inr and no evidence of gi bleed. she reported back pain and ct abd was negative for rp bleed. initially only had 25cc of pus looking uop. she received 80mg iv lasix and had made 250cc of urine by the time she arrived to the floor. her urine cx from grew >100,000 yeast. her ua from today had >50 wbc, moderate bacteria, and wbc. she was given iv ceftriaxone. her lung exam was notable for crackles at the bases. she was difficult to obtain access on and a right ij was placed. max hr in the ed was 92 and lowest bp was 103. vitals prior to transfer were t98 hr 78 bp 124/68 rr18 100% on 2l. cxr showed small bilateral pleural effusions. . on the floor, pt reports back pain worse this am than previously. however, she has been having the back pain since earlier this month after her abdominal surgery. . review of systems: (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. . past medical history: #. left deep venous thrombosis involving the internal jugular and brachial veins on coumadin #. hypertension - tte - ef >55%. mild ar #. dm2 - diagnosed , has been on insulin in the past but no longer takes any diabetes medications #. ckd - baseline creatinine 3.0 #. rheumatoid arthritis - diagnosed at age 50; 1:1280 - followed by dr. ; on chronic steroids #. hypothyroidism #. osteoarthritis #. possible sle, discoid lupus since with a positive right sided lymph node biopsy #. left renal mass detected in - pt doesn't want further w/u #. anemia - normocytic in past #. asthma #. history of low back pain #. c. diff colitis with recurrence 8 and #. ?cecal mass on ct - negative. cea 5.7 #. l renal mass #. ?coronary atherosclerosis #. h/o pna #. dysphagia #. utis- multiple recent utis + for yeast . allergies: ace inhibitors angiotensin recp antg&calcium chanl blkr meloxicam penicillins sulfa (sulfonamide antibiotics) social history: . social history: drugs: none tobacco: none alcohol: none other: the patient currently at nursing center, previously living in a home one floor above her daughters . family history: family history: father had dm, cad, htn. no cancer or stroke in family. . physical exam: physical exam on icu admission: vitals: t: 97.1 bp:152/58 p: 87-97 r:12 18 o2: 100% 1l gen: nad, aaox2-3 heent: moist mm, eomi grossly, op clear neck: supple cv: +s1+s2 rrr, ii/vi sem resp: mild crackles at bases bilaterally, no rales/wheezes abd: +bs, well-healing midline incision, soft, ntnd, no rebound or guarding, no palpable masses. ext: 2+ pitting edema bilaterally to knees, chronic venous statis changes, le warm and well perfused, faint dp pulses bilaterally. gu: foley in place and urine with gross pus neuro: cn: ii-xii, grossly intact. moving all extremities. ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . pertinent results: labs from : hct 25.4 inr 4.4 bun 59 creatinine 3.4 k 5.4 (? given kayexelate). note that was holding lasix x 3 days and giving 500ml po fluid per shift. . labs: . 10:02pm wbc-11.7* rbc-2.88*# hgb-8.7*# hct-26.5*# mcv-92 mch-30.3 mchc-32.9 rdw-15.6* 10:02pm neuts-86.2* lymphs-9.0* monos-4.3 eos-0.3 basos-0.3 10:02pm plt count-189 04:10pm urine color-amber appear-cloudy sp -1.014 04:10pm urine blood-sm nitrite-neg protein-75 glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 04:10pm urine rbc-* wbc->50 bacteria-mod yeast-none epi-0 12:56pm ph-7.48* comments-green top 12:56pm glucose-92 lactate-1.2 na+-137 k+-4.7 cl--113* tco2-18* 12:56pm hgb-5.3* calchct-16 12:56pm freeca-1.02* 12:45pm glucose-94 urea n-68* creat-3.6* sodium-139 potassium-4.8 chloride-112* total co2-17* anion gap-15 12:45pm alt(sgpt)-19 ast(sgot)-27 ld(ldh)-280* ck(cpk)-100 alk phos-397* tot bili-0.4 12:45pm ck-mb-5 12:45pm ctropnt-0.10* 12:45pm albumin-1.8* calcium-7.1* phosphate-6.0* magnesium-1.8 iron-30 12:45pm caltibc-108* vit b12-1095* folate-4.0 haptoglob-248* ferritin-645* trf-83* 12:45pm neuts-89.5* bands-0 lymphs-7.1* monos-3.0 eos-0.2 basos-0.2 12:45pm hypochrom-3+ anisocyt-1+ poikilocy-occasional macrocyt-1+ microcyt-1+ polychrom-occasional ovalocyt-occasional schistocy-occasional stippled-occasional teardrop-occasional 12:45pm plt count-269 12:45pm pt-48.6* ptt-46.2* inr(pt)-5.3* 12:45pm ret aut-3.3* . micro: urine cx : urine culture (final ): yeast. >100,000 organisms/ml. urine culture : 10,000-100,000 yeast images: cxr pa/lat: upright ap and lateral views of the chest: there are low inspiratory lung volumes. heart size remains enlarged but unchanged. pulmonary vascularity is not engorged. bibasilar opacities are noted, slightly worse on the right compared to the prior study, which may reflect atelectasis. there are small bilateral pleural effusions which are stable. clips from prior thyroidectomy are present. s-shaped scoliosis of the thoracic spine is again noted. impression: bibasilar airspace opacities, slightly worse on the right, likely reflective of atelectasis. infection is not fully excluded. small bilateral pleural effusions, unchanged. . ct abd/pelvis without contrast : evaluation of visceral organs is limited due to lack of intravenous contrast. small bilateral pleural effusions with adjacent areas of compressive atelectasis are unchanged. pleural based hyperdensity within the right lung base is unchanged. extensive coronary calcifications are noted. there is no evidence of retroperitoneal hematoma. moderate amount of ascitesis unchanged from exam. focal calcifications of the liver and spleen, likely represent prior granulomatous disease. tiny calcified gallstones are noted within the gallbladder. the pancreas and adrenal glands appear unremarkable. bilateral renal hypodensities, most likely renal cysts, unchanged. there is no evidence of mesenteric or retroperitoneal lymphadenopathy. intra-abdominal aorta is notable for calcified atherosclerotic disease without aneurysmal changes. there is no free air within the abdomen. . ct of the pelvis : moderate amount of fluid within the pelvis is unchanged. the rectum, bladder, and sigmoid colon appear unremarkable. moderate sized fat-containing right inguinal hernia appears unchanged. there is no free air within the pelvis. generalized anasarca is noted. osseous structures: no suspicious lytic or sclerotic lesions are identified. grade 1 anterolisthesis involving l4-l5 is unchanged. impression: 1. no evidence of retroperitoneal hematoma. 2. in comparison to exam, there are no significant change in moderate amount of ascites within the abdomen and pelvis. 3. small bilateral pleural effusions with adjacent areas of compressive atelectasis, unchanged. 4. cholelithiasis. . echo : the left atrium is elongated. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). doppler parameters are most consistent with grade i (mild) left ventricular diastolic dysfunction. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (valve area 1.2-1.9cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a very small pericardial effusion. impression: moderate symmetric lvh with normal global and regional biventricular systolic function. calcific aortic valve disease with mild stenosis/mild regurgitation. mild mitral regurgitation. moderate pulmonary hypertension. very small pericardial effusion. . lower extremity dopplers - negative dvt . venous ultrasound : findings: waveforms of the subclavian veins are symmetric bilaterally. on the left, the internal jugular vein is notable for isoechoic endoluminal contents and that vessel is incompletely compressible and shows only partial flow on color doppler analysis, consistent with non-occlusive thrombus. the left axillary, basilic and one of the left brachial veins are normal with appropriate compressibility and wall-to-wall flow on color analysis. the second left brachial vein shows absent compressibility and no flow on color doppler analysis. the cephalic vein is not identified, though note is made of subcutaneous edema in the expected region of the cephalic vein. impression: left deep venous thrombosis involving the internal jugular and brachial veins. cephalic vein not identified. . . ekg: old t wave inversion in i and avl brief hospital course: 77 year old woman who presented from for high inr (5.3), hct of 16.9, and no clear source of bleeding. the hct drop was from 25.7 to 16.9 in 2 days. she had no clear gi bleeding. she had guaiac negative stools in ed and in icu. she had recent laparotomy for perforation of duodenal ulcer at osh on so initially there was concern for possible intraabdominal bleed. ct torso showed no evidence of internal bleeding. folate and b12 levels were normal. with normal bilirubin, elevated hapto and only marginally elevated ldh hemolysis seemed unlikely. both asa and coumadin were held. she was admitted to the icu for close observation, although her hemodynamics were stable. she received 4 units of blood and 3 units of ffp. hct increased appropriately and have remained stable in the mid 30s. the exact cause of her presenting anemia remained unclear. she did not undergo endoscopy. she received one dose of coumadin 2.5 mg on while in the icu for history of dvt. subsequently her inr continued to rise significantly to 6.8. we sought the input of our hematology consult service. they felt that the increase was due to coumadin, given recent antibiotics use and poor nutritional status. in regards to her upper extremity dvt, it was line-associated and has been anticoagulated since then. hematology advised that the risk/benefit ratio favors discontinuing anticoagulation. she had persistent pyuria in urine and several cultures showed yeast. of note, several days prior to admission she was initiated on cipro for pyuria, although this proved not to be a bacterial infection. this admission our icu initiated fluconazole, but we have since discontinued it due to above inr issues. she remained asymptomatic. the patient had stage iv renal failure and hyperkalemia from losartan. losartan was discontinued and received several doses of kayexalate. her discharge was delayed because of hyperkalemia and her discharge potassium was 5.0. her home lasix was held at nursing facility but we increased the dose as she had severe edema up to the chest wall and hypoalbuminemia (anasarca; bilateral pleural efusions and ascites). because of her low gfr, lower doses of lasix are usually ineffective. we found no portal hypertesnion or thrombosis on ultrasound and no liver cirrhosis. the patient has a recent history of pancreatitis/pancreatic head enlargement on ultrasound from prior admission 1/. ultrasound mentions multiple pancreatic cystic structures which may be related to pseudocyst formation and/or previously characterized side branch ipmn. given these findings we have recommended gi follow-up in clinic. her pcp was also notified of these findings although she has been unable to see him lately because of her stays in rehab. we also diagnosed her with stage iii decubitus ulcer upon admission. she had no clinical wound infection. we stopped the losartan, clonidine and hydralazine and increased the metoprolol and she remained normotensive. her avarage in hospital bp in fact was low (124/76). if she becomes hypertensive hydralazine 50 mg tablet every 8 hours can be restarted. she was dnr/dni but family needs to consider comfort measures only. she was disharged back to but to a different floor per family request. pcp can reconsider starting aspirin only. potassium should be monitored with her low potassium diet. medications on admission: -amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). -metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po q 8 hrs ??????? daily -hydralazine 50 mg tablet sig: one (1) tablet po q8h (every 8 hours). -omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily -acetaminophen 650mg q6hrs prn - sodium bicarbonate 650 mg tablet sig: one (1) tablet po tid -humalog sliding scale -tylenol 650mg every q 6 hrs -aspirin 81mg daily -wellbutrin 100mg daily -clonidine 0.2 mg/24 hr 1 patch qfri -levothyroxine 50 mcg po daily -hydralazine 50mg q 8hrs -warfarin being held -lasix 40mg daily (holding since ) -losartan 50 mg tablet sig: two (2) tablet po daily (daily). -prednisone 5 mg daily . discharge medications: 1. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 2. sodium bicarbonate 650 mg tablet sig: one (1) tablet po tid (3 times a day). 3. bupropion hcl 100 mg tablet extended release sig: one (1) tablet extended release po daily (daily). 4. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 5. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 6. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 8. calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for gi upset. 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po three times a day. 10. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 11. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. 12. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for gas. 13. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: coolige house discharge diagnosis: coagulopathy from coumadin anemia, blood loss? deep venous thrombosis of upper extremity type ii dm without treatment pancreatic lesion stage iii decubitus ulcer hyperkalemia discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted with anemia (low red blood count) and abnormal labs that showed your blood was too thin. the exact cause is not clear, but we do believe that you are very sensitive to blood thinning medicines. you received several transfusions in the icu, where you stayed for close monitoring. a ct scan showed no sign of bleeding in your abdomen, and your stool was also negative for blood. the blood thinner (that you were previously taking for the clot in your arm) has been stopped. a review of your prior imaging studies from your admission for pancreatitis also showed an ultrasound with some cystic changes and enlargement in an area of your pancreas. you should see a gi specialist to further evaluate and follow-up these findings. your potassium was elevated and you were placed on a low potassium diet. some of your bp medications were stopped including a medication that elevates the potassium level (losartan). please follow up with your pcp in regards to your potassium, losartan, need for aspirin, and anemia followup instructions: the patient needs gi follow-up for pancreatic changes with possible ipmn (tumor) mentioned on ultrasound if family and patient want to pursue it further. department: rheumatology when: thursday at 10:30 am with: , md building: lm bldg () campus: west best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: hyperpotassemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled iron deficiency anemia secondary to blood loss (chronic) unspecified acquired hypothyroidism candidiasis of other urogenital sites chronic kidney disease, stage iv (severe) long-term (current) use of anticoagulants pressure ulcer, lower back rheumatoid arthritis do not resuscitate status anticoagulants causing adverse effects in therapeutic use other and unspecified coagulation defects hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified pressure ulcer, stage iii malnutrition of moderate degree acute venous embolism and thrombosis of internal jugular veins neoplasm of unspecified nature of digestive system acute venous embolism and thrombosis of axillary veins 

Answer: The patient is high likely exposed to