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: morphine attending: chief complaint: mental status change, fever, hypoxia major surgical or invasive procedure: rue avf thrombectomy hemodialysis history of present illness: in summary, pt is a 72 yo f h/o esrd on hd, dm ii, cad, systolic chf (ef 20%) admitted from outpt hd for clotted right avf, ms change, oral temp to 105, and hypoxic to 84% on ra. according to conversation with pt's daughters, pt was noted to be coughing frequently with meals at nursing home. had recently been admitted 1 month ago for ams in setting of hypoglycmie and uti. in ed, t 104.8, bp 138/49, hr 90, rr 32, o2 sat 100% nrb. cxr significant for cardiomegaly with mild pulm edema and new l basilar opacity concerning for pna. given vancomycin, zosyn, 1 l ivfs and admitted to . past medical history: -cad, s/p "silent mi" per patient -chf, systolic dysfunction with ef 20% -3+ mitral regurgitation, 3+ tr -dm, type 2 -esrd on hd -gout -depression -gerd -rheumatoid arthritis -anemia -hypercholesterolemia social history: lives at nursing home. has 6 children that live locally. quit smoking in the ; previously smoked approx 5cigs/day x30 years. rare etoh. family history: multiple family members with dm ii, otherwise non-contributory. physical exam: vitals not documented in admission note gen: opens eyes to stimuli, unable to follow commands heent: perrl, mm dry, neck supple pulm: bibasilar rales cv: nl s1+s2, iii/vi systolic murmur at lusb, flat jvp abd: s/nt/nd, +bs ext: 2+ dp b/l, trace edema. right avf without signs of erythema neuro: patient non-verbal pertinent results: labs on admission: 06:53pm wbc-10.6# rbc-3.50* hgb-12.2 hct-38.9 mcv-111* mch-35.0* mchc-31.5 rdw-19.4* 06:53pm neuts-87.4* lymphs-8.0* monos-3.2 eos-1.0 basos-0.3 06:53pm plt count-241# 06:50pm urine color-yellow appear-clear sp -1.019 06:50pm urine blood-neg nitrite-neg protein-30 glucose-neg ketone-tr bilirubin-sm urobilngn-neg ph-5.0 leuk-mod 06:50pm urine rbc-* wbc-21-50* bacteria-few yeast-none epi- 06:50pm urine hyaline-* 06:53pm digoxin-1.1 06:53pm albumin-3.6 calcium-10.5* phosphate-3.5 magnesium-2.1 06:53pm lipase-19 06:53pm alt(sgpt)-24 ast(sgot)-46* alk phos-255* tot bili-0.9 06:53pm glucose-186* urea n-36* creat-4.2* sodium-136 potassium-4.2 chloride-90* total co2-31 anion gap-19 07:01pm lactate-3.3* 07:08pm k+-4.0 micro data: urine cx - 1000 gpc urine cx - no growth urinary legionella antigen negative blood cx - no growth studies: cxr : 1. cardiomegaly with mild pulmonary edema. 2. new left basilar opacity concerning for pneumonia or aspiration. . nchct : no acute intracranial pathology. mri more sensitive for ischemia. . ct abd/pelvis : 1. slightly limited examination due to patient positioning and lack of oral contrast. no intra-abdominal source for infection identified. 2. patchy right middle and lower lobe opacities, some which are clearly compression atelectasis and others of which are suspicious for regions of pneumonia or aspiration. small right effusion. 3. extensive calcified atherosclerotic vascular disease. 4. slight interval decrease in possible exophytic right-sided fibroid. please note it is atypical for the fibroid to not have involuted more in a patient of this age. if alteration in care will occur, can consider further evaluation with a dedicated pelvic ultrasound and/or mri as no dedicated pelvic imaging of this lesion is noted at . . cxr : left lower lobe consolidation is persistent and unchanged. band-like atelectasis in the right base is new. there is no pneumothorax. if any, bilateral small pleural effusions are unchanged, greater on the left side. cardiomegaly is stable. . nchct : 1. no evidence of acute intracranial abnormalities. 2. unchanged marked enlargement of the ventricles since , out of proportion to the enlargement of the sulci, which may be related to central atrophy or normal-pressure hydrocephalus. clinical correlation is advised. . mri head : irregularity of left greater than right mca branch vessels. differential diagnoses include vasculitis, meningitis, or atheromatous change. cerebral atrophy, with ventricular enlargement. there is no obstruction, although communicating hydrocephalus cannot be excluded. . eeg : this is an abnormal routine eeg due to the slow background, the bursts of generalized slowing, and the intermittent projected bicentral slowing. these abnormalities suggest a widespread encephalopathy primarily of metabolic origin. there were no epileptiform features seen. . labs on discharge: na 143 k 4.9 cl 103 hco3 20 bun 47 cr 6.4 glu 113 ca .2 mg 2.3 phos 6.4 brief hospital course: 72 yo female with a pmh significant for esrd on hd, cad, chf with ef 20%, and dm type ii admitted with fever, ms change, hypoxia, and avf failure. . 1) fever: had temperature upon arrival to , which resolved within 24 hours. placed on vancomycin, zosyn for coverage for hospital acquired pna and left basilar opacity was seen on cxr, althought it was unclear if this was truly a new opacity vs. secondary to pulmonary edema. bld cxs with no growth. initial urine cx with 1000 gpc but then subsequent urine cx no growth. urinary legionella antigen negative. unable to obtain sputum cultures. there was also initial concern for meningitis; however, the family declined a lp and the pt's mental status did improve off of meningtic doses of abxs. she was then transferred to the medical floor where she remained afebrile. . 2) ams: ms change improved within 24 hrs of admission and aao x 2 upon transfer to floor. initial w/u with nchct negative, less likely meningitis/encephalitis given ms improvement on non-meningtis abx coverage as above. however, within 2 hrs of initial medical floor evaluation, pt became obtunded to sternal rub. fs 180s, ekg without ischemic changes, attempted abg x 3 without success in l wrist. vss, af throughout. stat nchct without acute change. did notice new neck stiffness on exam, and t here was a question of encephalitis/meningitis but it was felt to be unusual to develop meningitis in hospital. pt's ms eventually improved within 4 hours. neurology was consulted for question of non-convulsive status epilepticus and eeg obtained that showed no epileptiform waveforms but did reveal diffuse slowing suggestive of encephalopathy from metabolic causes. another lp was offered to the family, who again declined. pt was started on ceftriaxone and acylovir in addition to pre-existing vancomycin for meningitic/hsv encephalitis coverage. a mri head revealed irregularity of the mca branch vessels that can be suggestive of small vessel disease, meningitis, or vasculitis. the pt's mental status continued to remain poor, and after d/w the pt's pcp, confirmed that pt has had prior dx of alzheimer's, and the family, it was decided to make the pt comfort measures. abxs were discontinued, procedures should be avoided with the exception of hemodialysis. . 3) esrd/clotted avf: underwent placement of r temporary femoral hd line for hd access in setting of clotted r avf upon admission. the patient underwent avf thrombectomy by transplant surgery on ; however, revision failed and the pt required placement of a tunneled l ij hd catheter by ir on . the family is in agreement to continue hd for now in spite of being comfort measures; however, did agree to not place any further lines for hd access should her lij tunneled catheter fail. the family was made aware of the risks of infection with a tunneled catheter. . 4) cad: continued digoxin, asa, plavix. . 5) systolic chf: chronic. does have pulm edema on cxr, likely underduiresis as pt unable to be dialyzed upon presentation. o2 sats now improved after hd. pt was restarted on beta-blocker and acei upon transfer out of the icu. . 6) dm type ii: continued iss, fs qid. . 7) transaminitis: patient with elevated ast of unknown etiology. appears as if patient has had elevated transaminases since 3/. possibly med effect (i.e statin) but degree of transaminitis not high enough to hold statin in pt with known dm ii and cad. . 8) gout: continued allopurinol. . 9) psych: continued wellbutrin and prozac. . 10) fen: underwent s&s eval who cleared pt for ground solids, nectar thickened liquids with 1:1 supervision with meals. pt has poor po intake, will need to encourage po intake. given comfort measures, would be ok to offer pt thin liquids and solid foods. . 11) code: dnr/dni, comfort measures. the patient was at hemodialysis on the final hospital day prior to going back to nh with hospice care when she was noted to be hypotensive in the 80-90s after have 2.5 l uf taken off. given 1 l ivf bolus which then was followed by report of respiratory distress from hd unit. report of pt then becoming increasing obtunded, and then expired. family and pcp notified, family declined autopsy. medications on admission: phoslo 667 po tid simvastatin 40 mg qpm colace 100 mg senokot 2 tabs qod. compazine 5 mg q8h prn vit e 250 mg daily folate 1 mg daily nephrocaps 1 cap daily asa 81 mg daily allopurinol 150 mg daily digoxin 0.0625 qod lisinopril 7.5 mg daily reglan 10 mg qac plavix 75 mg daily humira 40mg/0.8 ml sc monthly metoprolol 25 mg zantac 75 mg wellbutrin sr 75 mg prozac 30 mg daily ativan 0.5 mg prior to dialysis discharge medications: none, pt expired discharge disposition: expired discharge diagnosis: primary diagnosis: altered mental status rue avf thrombus s/p thrombectomy hospital acquired pneumonia secondary diagnosis: congestive heart failure, systolic coronary artery disease end stage renal disease on hemodialysis diabetes mellitus type ii hypercholesterolemia gout depression anemia discharge condition: expired discharge instructions: you were admitted with fever, confusion, decreased oxygenation, and a clot in your av fistula. you were treated with iv antibiotics for a hospital acquired vs. aspiration pneumonia. a lumbar puncture was declined and you were also on iv antibiotics to treat a possible meningitis. while you av fistula was clotted, you had a temporary dialysis catheter placed for dialysis. this was removed and the transplant surgeons were unable to fix your av fistula. you then had a tunneled hd catheter placed. it was decided after meeting with dr. , the pt's pcp, the pt would be comfort measures with the exception of continued hemodialysis. it was decided that should this current catheter fail, the pt would not have another hd catheter placed. it was decided to make her as comfortable as possible and iv antibiotics were stopped. please take all medications as prescribed. the following changes were made to your regimen: 1) we have discontinued ativan prior to hemodialysis. 2) we have discontinued phoslo and replaced this with renagel as your serum calcium levels were elevated. 3) your medications were held when you were too sleepy to take them safely. it is important to keep you as comfortable as possible. this would mean avoiding hospitalizations in the future. your nursing home can help coordinate your care for comfort. followup instructions: none, expired. procedure: other revision of vascular procedure hemodialysis venous catheterization for renal dialysis diagnoses: pneumonia, organism unspecified end stage renal disease mitral valve disorders congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled gout, unspecified depressive disorder, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease chronic systolic heart failure rheumatoid arthritis accidents occurring in other specified places surgical or other procedure not carried out because of patient's decision kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other complications due to renal dialysis device, implant, and graft arterial embolism and thrombosis of upper extremity 

Answer: The patient is high likely exposed to