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: lethargy, confusion, nausea and vomiting major surgical or invasive procedure: cardiac catheterization with lad stent history of present illness: 59 year old w/ hx of iddm (followed by ), presented w/ days hx of nausea/vomiting, "feeling like a cold/flu" (per husband), chronic l shoulder pain, increasing lethargy, confusion. husband called ems day of admission for increasing lethargy. ems arrived to find fs 700s. she was transported to ed. she was noted to be lethargic and obtunded w/ glucose in 700s, + ketones, glucose, prot in her urine, with vbg 6.88/21/98, and started on insulin gtt at 10 units/hr. she was responding to noxious stimuli, tachypneic with p 99 bp 82/50 o2sat: 97% on 2l nc. she was given ns bolus x 2, then ns at 500cc/hr, total of 2.2l at osh. she was also given 10 units regular insulin, 1 amp nahco3, insulin gtt. cxr was negative for pna, ekg was concerning for stemi on her anterior leads. she was transferred to the for further management. . on arrival, she was lethargic, responsive to noxious stimuli. her rr was 30s, o2 sats in mid 90s on 4l-5l, bp 80s/50. ekg confirmed ste changes over v2-v4, cardiology was consulted. cxr was w/o pna. glucose was >700, u/a + ketones, wbc was 20k, lactate 6.3. ck and troponin was also elevated. code sepsis was called. r subclavian was attempted w/o success. cxr was w/o ptx. r groin fem line was placed in ed. she was given total 12l ns, 1 uprbc, levophed gtt was started. vanco/levo/flagyl/ctx was given. pt was intubated for airway protection in ed. past medical history: 1. iddm 2. dm neuropathy 3. dm retinopathy 4. l shoulder pain social history: lives with husband, has 2 adopted sons. smoked for 10 years, but quit 25 years ago, 1 ppd. rare etoh, no ivda. family history: father-died of aneurysm, mother- had aneurysm, but lived and died "of old age." physical exam: physical exam on transfer from micu to medical floor: vitals: t 99.9 bp: 100/50 p: 72-85 rr: 15 o2sat: 99% on ra general: well appearing female in nad. aox3. pleasant, cooperative. breathing comfortably on nasal cannula. heent: perrl eomi. mm sl dry op clear. no cervical lad. lungs: with bibasilar crackles. cv: rrr s1 and s2 audible. no s3, s4. abd: soft, nt, nd, + bs. well healed midline scar. no masses. no hsm. peripheral: 2+ dorsalis pedis pulses bilaterally. 1+ pitting edema ankles- mid shin. pertinent results: 09:42pm type-art po2-216* pco2-21* ph-7.38 total co2-13* base xs--10, glucose-301* urea n-50* creat-2.3* sodium-149* potassium-4.1 chloride-123* total co2-13* anion gap-17 09:22pm ck(cpk)-976* 09:22pm ck-mb-93* mb indx-9.5* ctropnt-4.14* 09:22pm wbc-20.8* rbc-3.52* hgb-11.3* hct-32.3* mcv-92 mch-32.0 mchc-34.9 rdw-15.1 05:37pm wbc-27.2* rbc-3.80* hgb-12.1 hct-35.5* mcv-93 mch-31.7 mchc-34.0 rdw-15.0 03:45pm wbc-25.0* rbc-3.53*# hgb-11.1* hct-34.6* mcv-98 mch-31.4 mchc-32.0 rdw-14.5, neuts-80* bands-4 lymphs-8* monos-4 eos-0 basos-0 atyps-0 metas-4* myelos-0 01:00pm ck(cpk)-213* 01:00pm ctropnt-0.42* 01:00pm ck-mb-13* mb indx-6.1* 01:00pm calcium-5.6* phosphate-4.6*# magnesium-1.6 01:00pm wbc-22.4* rbc-2.81* hgb-9.1* hct-29.1* mcv-104* mch-32.4* mchc-31.2 rdw-14.0 01:00pm neuts-80* bands-3 lymphs-8* monos-7 eos-0 basos-0 atyps-0 metas-2* myelos-0 nuc rbcs-1* 11:10am urine color-yellow appear-hazy sp -1.018 11:10am urine blood-lg nitrite-neg protein-30 glucose-1000 ketone-50 bilirubin-sm urobilngn-neg ph-5.0 leuk-neg 11:10am urine rbc-* wbc-0-2 bacteria-mod yeast-none epi-0 11:00am alt(sgpt)-17 ast(sgot)-34 ck(cpk)-171* alk phos-80 amylase-159* tot bili-0.3 11:00am lipase-115* 11:00am ctropnt-0.38* 11:00am ck-mb-10 mb indx-5.8 . imaging: cath report final diagnosis: 1. one vessel coronary artery disease. 2. successful stenting of the lad. comments: 1. selective coronary angiography of this right dominant system demonstrated single (1) vessel coronary artery disease. specifically the left main demonstrated no significant disease. the lcx also demonstrated no angiographic evidence of any flow limiting lesions. the lad had a hazy mid vessel lesion (60%) with timi iii flow distal. the rca was a large dominant vessel without any significant disease. 2. limited hemodynamics demonstrated a low central pressure (97/53 mm hg). 3. lv ventriculography was deferred. 4. successful stenting of the lad with a 3.0 mm cypher drug-eluting stent. . cxr portable impression: left subclavian cvl with tip in distal svc, no pneumothorax. chf with interval increase in pleural effusions bilaterally. . : cxr portable single portable chest radiograph demonstrates an endotracheal tube with its tip at the clavicular heads. a nasogastric tube is present with its tip coiled in the stomach. cardiomediastinal silhouette is within normal limits. prominent pulmonary vasculature and increased bibasilar pulmonary opacities represent mild chf. there are small-moderate bilateral pleural effusions. . : ct head impression: no intracranial hemorrhage or mass effect is identified. . : ct torso impression: 1. bilateral pleural effusions. additionally, there is extensive ascites and fluid within the mesentery. these findings, along with septal thickening within the lung parenchyma, may reflect third spacing of fluid and fluid overload. 2. there are bilateral patchy opacities within the lungs, predominantly at the lung bases, which may represent aspiration or multifocal pneumonia. . cxr portable impression: findings consistent with mild pulmonary vascular congestion. no pneumonia. . echo ef 40-50%. the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed (ejection fraction 40-50 percent) secondary to hypokinesis of the anterior septum and apex. no masses or thrombi are seen in the left ventricle. there is focal hypokinesis of the apical free wall of the right ventricle. mild to moderate (+) mitral regurgitation is seen. brief hospital course: micu course: the patient was admitted to the micu in critical condition. an arterial line was placed for close hemodynamic monitoring and to follow arterial blood gases. an insulin gtt was started at 10u/hr. the potassium, magnesium, phosphorus and calcium levels were monitored closely and repleted. the ph slowly improved, the anion gap slowly closed over the course of the first hospital night. the patient was ventilated on ac and the fio2 was weaned down, and the tidal volumes were decreased for lung-protective ventilation. ekg showed st elevations in the anterior leads, with elevations of the ck and troponin, and cardiology was consulted. the etiology of the ischemia was thought to be the severe acidosis from the dka, and medical management was optimized with asa, beta-blocker; a heparin gtt was held concern about the patient's episode of ugib. . renal was consulted on arrival to the micu; there was no need for emergent dialysis as the patient was making urine (at least 30cc/hr in the first day) and the acidosis was improving with ivf and bicarb and insulin. gi was consulted on arrival to the micu dark red blood in the ogt; ns lavage was performed and it cleared with 150 cc ns. the patient was started on dosing of a ppi for presumed stress gastritis vs small - tear vomiting. the patient's hct remained stable; no egd was performed. the patient was extubated w/o complication once the dka had resolved. the cardiac enzymes peaked and trended down. a cardiac catheterization was performed on and the lad was stented; plavix was added to the patient's medication regimen. . was following the patient and made recommendations about her insulin regimen. levaquin was started for a uti; the foley was removed. she was transferred to the floor in stable condition on . . the pt states she is currently feeling "great" on transfer to medical . she has no pain complaints, no sob, cp, palpitations. no f/c. no n/v. tolerating po well. pt reports hoarse voice and sore throat s/p extubation, but otherwise doing well. ambulating without difficulty. . a/p: 59 year old insulin dep diabetic woman presented on w/ dka, stemi, ?ugib, uti, admitted to ccu, now s/p insulin gtt transitioned to subcutaneous insulin, blood sugars stabilized, s/p cath on showing 1vd and cypher drug-eluting stent to lad, ?ugib in setting of ogt, now w/ stable hct and vs, and ?uti treated with levofloxacin full 7 day course, called out of ccu to medicine service. 1. status post diabetic ketoacidosis: her anion gap is closed with stable sugars, transitioned to long acting insulin, supplemented with a modified humalog sliding scale: pt to receive standing humalog based on fingerstick prior to a meal, then additional humalog (pt does this herself) based on her carbohydrate load. diabetes specialists have been following the pt throughout her stay. she is to go home on 12 units lantus qam, with modified sliding scale of humalog, and a carb adjusted humalog dose to be given by the pt (who knows how to count her carbohydrates and give herself a dose of humalog). her dka was thought possible insulin pump malfunction, and she is not to use her pump until she is seen as an outpatient by dr. , who will examine her pump at followup. we also consulted nutrition for teaching for diabetic diet. .. 2. resp faillure, resolved. the pt was extubated , without complications (intubation was for airway protection). explained to pt that hoarse voice and sore throat should resolve in a few days, likely intubation. she is satting well on room air. .. 3. cardiovascular a. coronary: stemi: s/p cardiac cath showing 1vd now s/p cypher des to lad. stemi felt likely hypoperfusion, acidosis and demand. she is to continue her asa/plavix/statin/beta blocker. an acei should be considered by her pcp in the future. aggressive control of her blood pressure was achieved this admission, her electrolytes were repleted for goal k>4, and mg>2. . b. pump: last echo done ef 40-50%, hypokinesis of the anterior septum and apex, mildly depressed syst fxn, 1+-2+ mr. she is to continue her bb, holding acei in setting of resolving renal failure. . c. electrical: s/p stemi, in nsr .. 4. ?ugib: the pt had dark blood on ngt on admission to ccu. ng lavage cleared after 150cc ns. gi consult recommended dosing of a ppi for presumed stress gastritis vs small - tear vomiting. the patient's hct remained stable; no egd was performed. she is to continue her ppi . .. 5. uti: with mod bacteria seen on ua, however urine cx neg. she has no other suspected infectious other suspected source. unclear from ccu signout whether + ua was from osh. appears to have neg urinalysis and urine cx here at . the pt received empiric tx for uti with levofloxacin, and will complete 7th day of abx . her foley was removed and she is urinating well. .. 6. fen- we repleted lytes for k>4, mg>2. the pt is tolerating po well and is on a cardiac/diabetic diet. .. 7. access- 2 piv .. 8. code-full (per d/w husband) .. 9. comm-husband (c) , daughter - (cell) medications on admission: topamax 200mg qday insulin lipitor 10mg qday neurontin 400mg qday zoloft 50mg qday diphnoxylate/atropine 1 tablet/prn for diarrhea discharge medications: 1. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 4. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. topiramate 100 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 6. gabapentin 300 mg capsule sig: one (1) capsule po q24h (every 24 hours). disp:*30 capsule(s)* refills:*2* 7. 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* 8. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. lantus 100 unit/ml solution sig: twelve (12) units subcutaneously subcutaneous qam. disp:*qs 100 unit/ml solution* refills:*2* 10. humalog 100 unit/ml solution sig: qs subcutaneous injection subcutaneous three times a day: count carbs and inject at each meal as you have been instructed to do. . disp:*qs 100 units/ml soln* refills:*2* 11. insulin order please check your fingerstick prior to each meal, and give yourself 2 units for fs 200-300 and 4 units humalog for fs 301-400. discharge disposition: home with service facility: discharge diagnosis: 1. diabetic ketoacidosis 2. st-segment elevation myocardial infarction status post stent placement 3. insulin dependent diabetes mellitus 4. diabetic neuropathy 5. diabetic nephropathy 6. chronic shoulder pain discharge condition: stable, good discharge instructions: if you experience any worsening of your symptoms, please report to the emergency department immediately. please take all of your medications as directed. please follow up with your physicians (see information below). followup instructions: 1. please follow up with , rn practitioner. the diabetes secretary will be calling you with your appointment time and sending a letter. dr. has also been paged regarding this. call for information. 2. you wil have an appointment with dr. with . you will receive a letter with an appointment time in the mail from diabetes. the office number is: . 3. you will need to follow up with cardiology. your appointment has been set for thursday, at 8:30am dr. . their office number is: . you will need to go to building, , floor 7. 4. you should follow up with dr. , primary care physician. should call for a follow up appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified coronary arteriography using two catheters injection or infusion of platelet inhibitor left heart cardiac catheterization insertion of endotracheal tube arterial catheterization transfusion of packed cells insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified unspecified septicemia severe sepsis acute respiratory failure defibrination syndrome septic shock diabetes with ketoacidosis, type i [juvenile type], not stated as uncontrolled hemorrhage of gastrointestinal tract, unspecified diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled 

Answer: The patient is high likely exposed to