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: patient recorded as having no known allergies to drugs attending: chief complaint: bleeding fistula major surgical or invasive procedure: hemodialysis by av fistula picc line placement history of present illness: mr. is a 74m with cryptogenic cirrhosis, h/o pe, chronically low bp, and esrd on hd recently discharged on who was brought to ed by ems after hd when he had persistent bleeding from fistula site. dialysis clamp placed and he had no further bleeding in ed. he was also noted to have positive blood cx from which were drawn due to hypotension and leukocytosis. he denied any other complaints of lightheadedness, dizziness, cp, sob, palpitations, orthopnea, cough, abdominal pain, n/v, decreased po intake, melena, hematochezia. diarrhea is stable at his baseline and he is incontinent of stool. . in the ed, initial vs were: t 98.6, p 73, bp 95/50, rr 17. he was comfortable in nad and had no further active bleeding from fistula site. due to positive blood cx from so he was given vancomycin 1g iv. pt was admitted to the floor with vitals on transfer t 97.6, p 100, bp 78/50 (baseline in ues 60s-70s), rr 16, o2sat 95%ra . on the floor, he reported feeling "lousy" but denied any other complaints as above. bp was 60/dopp in ue. previous notes stated that le bp's more reliable (baseline 100-120), so this was checked and also found to be 60/dopp although pt mentating at baseline. his midodrine (discontinued during admission) was restarted, and he was given 500cc ns x 2 without improvement so was transferred to the micu for further monitoring. . on evaluation, pt continues to report no significant change from baseline other than fatigue from his lengthy work-up today. . (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denies chest pain or tightness, palpitations. denies nausea, vomiting, constipation or abdominal pain. no dysuria. denies arthralgias or myalgias. past medical history: 1. cryptogenic cirrhosis: a portal hypertension, splenomegaly, and ascites per mri of abdomen. portal vein thrombosis noted on mri from as well as more recent ultrasound. 2. chronic kidney disease stage iv-v currently undergoing hemodialysis, possibly due to chronic nephrolithiasis, in turn caused by a bowel surgery, possibly combined with chronic hypokalemia and nonsteroidal use. more recently suggested that the possibility of amyloidosis be explored. the patient has secondary hyperparathyroidism due to renal failure. 3. chronic secretory diarrhea: carcinoid syndrome, neuroendocrine tumors, pellagra, microscopic colitis, hyperthyroidism, and infectious etiologies have been ruled out with an extensive workup in 06/. currently, attributed to a history of ileal resection. 4. history of pe during hospitalization at . formerly on coumadin is stopped in 01/. 5. a history of likely gallstone pancreatitis with lipase greater than 900 during hospitalization in 06/. 6. h. pylori gastritis treated in . 7. mgus by spep. 8. a 1.2-cm hypoechoic nodule on the left thyroid lobe without enlargement on ultrasound, follow up in . tsh remains normal. in 01/. 9. left inguinal hernia. 10. status post ileal resection in for possible crohn's disease. 11. status post surgical repair perforated ulcer in the . 12. status post surgical removal of renal stone in . 13. cataracts 14. paracentesis induced bowel perforation in social history: no tobacco, rare etoh. lives alone in . supportive family. his friend is a particularly important person in his life - called partner in some prior notes. family history: denies family history of liver or kidney disease. physical exam: vitals: t 96.3, p 108, bp 102/50, rr 14, o2sat 96ra general: cachectic male, tired but alert, oriented x 3, no acute distress heent: sclera slightly icteric, mm dry, + oral thrush, oropharynx clear neck: supple, jvp not elevated lungs: clear to auscultation bilaterally with faint crackles at bases, no wheezes or rhonchi cv: irregular rhythm with mild tachycardia, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, distended with +ascites. nontender. bowel sounds present, no rebound tenderness or guarding, +splenomegaly ext: cool to touch. dopplerable pulses, 3+ edema to upper thigh, no clubbing, cyanosis. rue av fistula with palpable thrill; no bleeding and bandaid c/d/i. neuro: oriented x 3. cn 2-12 intact. no asterixis. mae skin: dry, cracked skin throughout. 2 x 3 cm area of superficial ulceration over sacrum with pink granulation tissue. no erythema or purulent drainage. no stigmata of endocarditis appreciated pertinent results: labs on admission: 01:40am plt count-100*# 01:40am neuts-77.7* lymphs-17.8* monos-3.6 eos-0.3 basos-0.6 01:40am wbc-13.9* rbc-5.26 hgb-12.9* hct-42.1 mcv-80* mch-24.5* mchc-30.7* rdw-21.2* 01:40am alt(sgpt)-19 ast(sgot)-32 alk phos-232* tot bili-2.3* 01:40am glucose-90 urea n-17 creat-4.3* sodium-140 potassium-4.3 chloride-100 total co2-28 anion gap-16 02:23am pt-22.2* ptt-40.3* inr(pt)-2.1* 10:00am pt-23.8* ptt-42.6* inr(pt)-2.3* 10:00am plt count-99* 10:00am neuts-72.0* lymphs-23.8 monos-2.9 eos-0.6 basos-0.8 10:00am wbc-10.0 rbc-5.31 hgb-13.0* hct-42.8 mcv-81* mch-24.4* mchc-30.3* rdw-21.1* 10:00am antidgp-7 10:00am calcium-8.4 phosphate-3.5 magnesium-1.7 10:00am alt(sgpt)-21 ast(sgot)-35 ld(ldh)-383* alk phos-233* tot bili-2.0* 10:00am glucose-125* urea n-19 creat-4.7* sodium-139 potassium-3.9 chloride-100 total co2-27 anion gap-16 10:25pm pt-19.6* ptt-36.7* inr(pt)-1.8* 10:25pm plt count-110* 10:25pm neuts-82.9* lymphs-13.2* monos-2.9 eos-0.5 basos-0.4 10:25pm wbc-11.8* rbc-5.16 hgb-12.9* hct-41.5 mcv-81* mch-25.0* mchc-31.1 rdw-21.1* 10:25pm estgfr-using this 10:25pm glucose-193* urea n-14 creat-3.3*# sodium-136 potassium-3.2* chloride-99 total co2-29 anion gap-11 micro: - blood culture positive for e. faecalis (vancomycin sensitive) - blood culture positive for e. faecium (vancomycin resistant) - picc line tip culture no growth - blood culture pending, no growth - blood culture pending, no growth - blood culture pending, no growth - stool study negative for c. difficile toxin - blood culture pending, no growth - blood culture pending, no growth images/studies: cxr : frontal view of the chest: left-sided picc line with the tip at distal superior vena cava is seen. the right hemidiaphragm remains elevated. low lung volumes limit evaluation of the pulmonary parenchyma. right lower lobe atelectasis and right pleural effusion are present. a dense opacity overlying the liver may be a pulmonary mass or consolidation. there is no pneumothorax. opacity in the retrocardiac region is grossly stable and may represent atelectasis. there has been interval increase in stomach and small bowel loop dilatation. impression: 1. dense opacity overlying the liver may be a pulmonary mass or consolidation. right lower lobe atelectasis and pleural effusion. a ct of the chest is suggested for further evaluation. 2. interval increase in stomach and small bowel loop dilatation since . ecg : baseline artifact and extremely low voltage conspire to preclude adequate interpretation. the rhythm may be sinus with frequent atrial ectopy as previously recorded on . probable prior inferior and anterior myocardial infarctions without diagnostic interim change. ecg : sinus rhythm and frequent atrial ectopy. diffuse low voltage. probable prior inferior and anterior, as well as lateral, myocardial infarction. compared to the previous tracing of no diagnostic interim change. av fistulogram : final read pending at the time of discharge. preliminary read: no evidence of outflow stenosis. kub : findings: there is diffuse severe gaseous distention of the stomach, which has progressed since the earlier study of . the bowel gas pattern in the small and large bowel loops is unremarkable. multiple rounded calcific densities in the right kidney and pelvis represent renal and bladder calculi. no free air is seen in the left lateral decubitus radiographs. bibasilar atelectasis is noted. brief hospital course: 74m with cryptogenic cirrhosis and esrd on hd admitted with bleeding fistula and bacteremia with hypotension on floor; he was then transferred to the micu. the following issues were addressed at this admission. # hypotension: pt has chronically low bp with sbp 60s-70s ues and 100s-120s les but bp on arrival to floor was found to be 60/d in lue and /l. in retrospect, this may have been a false measurement as pt was mentating at baseline throughout and le bps on arrival to the micu measured back at baseline. his hypotension was felt to be multifactorial, related to his underlying renal disease, blood loss from his fistula, chronic diarrhea, and bacteremia (cultures from admission ultimately grew two species of enterococcus). he had a normal cortisol level of 22 from his prior admission in early , this was not repeated. elevated lactate to > 5 supported a role for sepsis/bacteremia. he was treated with 1 l of ivf initially, placed on midodrine, and treated with antibiotics for presumed sepsis. he received daptomycin as initial cultures grew gram positive cocci (ultimately enterococcus) and the patient was known to be swab-positive for vre in the past. surveillence cultures from forward were negative at the time of death. blood pressures initially returned to baseline at 90s-100s in lower extremities. however, he was no longer able to tolerate dialysis, as any attempt at dialysis was complicated by severe hypotension and altered mental status, even with midodrine and albumin. when he again became hypotensive at dialysis , cefepime was added to his antibiotics and he was transferred back to the icu where he was again given small boluses of fluid. when he was transferred back to the floor with stable pressures, but now with sbps in the 80s, it was decided that he would be dnr/dni and we would not re-attempt dialysis unless it was absolutely indicated. over the next week, the team met repeatedly with the patient's partner, mr. , his family and palliative care. the decision was made to make the patient comfort measures only on . he passed away peacefully the next morning. # sepsis/bacteremia: blood cultures from the day of admission were positive for e. faecalis and e. faecium as above. both organisms grew from only one bottle, raising the possibility that this may have been a contaminant; however, patient was treated based on overall clinical picture. patient received daptomycin given history of +vre colonization, and e. faecium indeed speciated as vanco-resistant. picc line was pulled in setting of presumed infection and tip was cultured though showed no growth. patient was afebrile during this admission, with maximum leukocytosis to 13.9 on admission trending down to ~11 at discharge. lactate was elevated to > 5 but trended down to 2.9 by . patient will continue on daptomycin dosed qhd, with an initial plan to complete a two-week course. when he became repeatedly hypotensive at dialysis, the daptomycin was continued. he had a rapidly rising inr with concern for dic. his antibiotics were broadened and he was given ffp. he initially improved, but later had refractory hypotension as mentioned above. # r av fistula bleeding: pt presented with his second episode of bleeding from av fistula in his last 2 hd sessions. he was seen by transplant surgery in ed and they felt bleeding had resolved; he underwent fistulogram which did not show abnormality (final read still pending at time of discharge). his hct trended down slightly from his baseline in the 40s to ~37, but he showed no further evidence of active bleeding. his inpatient hd sessions did not result in complications from fistula bleeding. . # chronic diarrhea: etiology unclear; this has been an ongoing issue and is in the process of outpatient work-up. patient was empirically treated for cdiff when chronic diarrhea worsened and he had a new white count. he was started on flagyl with a planned 14-day course with improvement in his diarrhea. he later had some fecal incontinence with repeated bouts with small amounts of liquid stool. his diarrhea improved as his oral intake dropped off. . # gastric distension: the patient had increasing abdominal distension and kub showed a very large gastric bubble. he did not have any pain and his abdominal exam remained benign, as he only experienced a sensation of fullness. an ng tube was placed and he was made npo with improvement in his symptoms. tpn was not given because he was not able to get dialysis. the ng tube was clamped and removed and he was able to tolerate small amounts of food. . # sacral decubitus ulcers: the patient was seen by the wound consult team with the following assessment: "the pt's sacral area has a large area of stage 2 breakdown with a small adjacent area of stage 3 at 1 o'clock. the stage 2 is approximately 5.5 x 2cm and is 100% red. there is moderate sersoang drainage without odor. the stage 3 is 0.7 x 0.4 cm and has a thin yellow covering. the surrounding tissue is warm and not indurated." his albumin was only 1.5, leaving little possibility of healing. the wounds were kept as clean as possible, and the patient did not have any pain in the area. . # oral candidiasis: this is concerning for immunocompromised state; patient has been known to refuse hiv testing in the past. he was maintained on nystatin swish and swallow during this admission. medications on admission: 1. rifaximin 200 mg tablet sig: one tablet po tid 2. omeprazole 20 mg capsule po bid 3. loperamide 2 mg capsule sig: one capsule po tid prn 4. b complex-vitamin c-folic acid 1 mg po daily 5. cholestyramine-sucrose 4 gram packet sig: one packet po bid 6. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for thrush. discharge medications: n/a discharge disposition: expired facility: - discharge diagnosis: primary: - bleeding av fistula - hypotension - bacteremia secondary: - end-stage renal disease - chronic diarrhea - stage 2 and 3 sacral decubitus ulcers discharge condition: n/a discharge instructions: n/a followup instructions: n/a procedure: venous catheterization, not elsewhere classified hemodialysis percutaneous abdominal drainage other bronchoscopy insertion of other (naso-)gastric tube arteriography of other specified sites diagnoses: thrombocytopenia, unspecified end stage renal disease cirrhosis of liver without mention of alcohol severe sepsis atrial fibrillation peripheral vascular disease, unspecified candidiasis of mouth hypopotassemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease defibrination syndrome other specified cardiac dysrhythmias cachexia surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation septic shock pressure ulcer, other site intestinal infection due to clostridium difficile infection with microorganisms without mention of resistance to multiple drugs pressure ulcer, buttock pressure ulcer, lower back secondary hyperparathyroidism (of renal origin) other ascites hypoxemia surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation diarrhea other and unspecified infection due to central venous catheter streptococcal septicemia calculus of kidney other complications due to renal dialysis device, implant, and graft unspecified intestinal obstruction leukocytosis, unspecified adult failure to thrive hypotension of hemodialysis nutritional marasmus pressure ulcer, stage iii nontoxic uninodular goiter pressure ulcer, hip hypothermia not associated with low environmental temperature chronic hypotension 

Answer: The patient is high likely exposed to