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: demerol / sulfa (sulfonamide antibiotics) / promethazine attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization dialysis history of present illness: 81 year old woman with esrd from hypertensive glomerulonephritis s/p bilateral nephrectomy on dialysis, s/p recent admission for "multilobar pneumonia", admitted on after developing chest pain at rest. patient was admitted to lgh two weeks prior to this admission with fevers, ams, and cxr consistent with multifocal pna. at that time she was also have chest pain that was thought gi etiology. she had a barium swallow that showed marked dysmotility of the esophagus with tertiary contractions but no gerd or strictures. for the pna she was started on levoquin and her fevers trended down. she was then transitioned to rocephin and sent back to house. she was home for one day and then developed chest pain at rest. this responded to nitroglycerin at home. she was then taken to the ed at lgh. in the ed at lgh she had an ekg that showed st depressions in the lateral and anterior leads which was unchanged from prior ekgs. her troponin i was 4.15. ck was negative. she was admitted to lgh for nstemi. while admitted she remained painfree for several days. cardiology was consulted the next day and recommended cardiac cath as in retrospect it seemed that the multifocal pna may have been acute chf exacerbation that could have been related to ischemia. therefore the patient was started on heparin gtt, plavix, and aspirin and transferred to the lgh ccu to await catheterization. she received last dialysis saturday (removed 2.6 liters) via left arm fistula. she remained chest pain free for the next few days. on she underwent cath where she was found to have an 85% lad stenosis and a 95% lesion in a small rca. meds in cath lab included 0.5mg versed80cc contrast, 50 cc ns. sheaths were pulled as there were plans for her to have dialysis and then transfer to tomorrow for pci. however, following cath, pt developed 10/10 chest pain that was treated with 6mg morhine, zofran, ativan, sl nitro, iv nitro at 30mcg/min and was transferred to for pci (painfree). . vitals on transfer: hr 60sr, bp 150/50, satting 96% on 2l. . patient underwent second cardiac cath at during which she received 12mg fentanyl, 5mg iv hydralazine, and a nitro gtt for elevated bp. she had cypher stent placed in lad distally and second cypher stent placed in lm into proximal lad as well. . on admission to the ccu patient was somnolent but arousable. she was unable to answer complicated questions. she was not in pain. . as above patient was too somnolent to answer ros questions. past medical history: 1. cardiac risk factors: diabetes(-), dyslipidemia(+), hypertension (+) 2. cardiac history: -cabg: none -percutaneous coronary interventions: cath at lgh : lad ostial 85% small rca 90% lv s/d/e: 162/- ao s/d/m: 119/22/51 . -pacing/icd: none - admission for acute lv failure in . adenosine test reportedly negative for ischemia at that time with ef 56%. 3. other past medical history: - hypertension - esrd on dialysis - nephrectomy bilaterally for severe htn - paf - hx of gib from diverticuli and hemorrhoids (off anticoagulation) - rheumatoid arthritis - multiple joint replacements - anxiety/depression requiring ect social history: widowed. was at house rehab center. patient normally lives with her daughter who is the primary care giver. -tobacco history: none -etoh: none -illicit drugs: none family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: vs: t: 97.1 bp146/39 hr 76 rr 13 o@ 100% 2l general: elderly female in nad. heent: ncat. sclera anicteric. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 7 cm. cardiac: rr, unable to hear clear s1. soft s2 sm at rusb early peaking. radiating to carotids. lungs: ctab, no crackles, wheezes or rhonchi anteriorly abdomen: soft, ntnd. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. neuro: lethargic but arousable. pertinent results: 09:40pm glucose-131* urea n-70* creat-8.5* sodium-138 potassium-4.6 chloride-100 total co2-23 anion gap-20 09:40pm ck(cpk)-12* 09:40pm ck-mb-notdone 09:40pm calcium-10.4* phosphate-5.1* magnesium-2.9* 09:40pm wbc-21.0* rbc-3.38* hgb-9.7* hct-30.4* mcv-90 mch-28.6 mchc-31.8 rdw-22.7* 09:40pm neuts-91.2* lymphs-4.4* monos-2.6 eos-1.7 basos-0.2 09:40pm plt count-366 09:40pm pt-17.4* ptt-44.8* inr(pt)-1.6* 06:00pm glucose-158* urea n-68* creat-8.3* sodium-137 potassium-4.3 chloride-100 total co2-20* anion gap-21* 06:00pm ctropnt-1.10* ekg: : nsr std i,avl,v3-v6 : nsr std v4-v6 : nsr std <1mm v4-v6 : nsr std ii,iii,avf, v4-v6 at : nsr std i,v4,v5. <0.5mm std v6. twi avl . cardiac cath: lmca: diffuse moderate disease approx 50% lad: ostial 90%; proximal 70%, small d1 with 90% ostial disease lcx: large dominant with no significant disease rca: not injected. known small non-dominant with severe disease cypher stent placed in more distal proximal lad lesion and then second stent placed from lm ostium into proximal lad. . hemodynamics: ao pressure: 186/46 mean:100 tte: the left atrium and right atrium are normal in cavity size. there is mild symmetric left ventricular hypertrophy with normal cavity size. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened (?#). there is mild aortic valve stenosis (area 1.2-1.9cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: mild symmetric lvh with hyperdynamic lv systolic function. diastolic dysfunction with elevated filling pressures. mild aortic valve stenosis with mild aortic regurgitation. brief hospital course: 81yo f with h/o esrd on hd, htn, hl, acute chf exacerbation 1 month ago, admitted from osh with nstemi now s/p cath with des in lad and lmca # coronaries: s/p nstemi and des to lmca and lad. unclear timing of nstemi and may have been on prior admission (see below). continued aspirin, statin, increased beta blocker. no role of ace as had bilateral nephrectomies. she will need to continue plavix for at least 1 year. throughout her stay she continued to complain of chest pain, but admitted that this was very mild () and remained stable without intervention. # pump: had ef 56% on adenosine stress test at osh per report less than one month ago. in retrospect admission for "multifocal pna" was more likely for acute chf exacerbation. with trops elevated on this admission but cks not more likely that she had an ischemic event on last admission leading to acute chf and now the only enzyme elevated is troponin because 1) its half life is longer than ck and 2) she had renal failure. tte the day after cath showed diastolic dysfunction and lvh consistent with her history of htn but no wma. # rhythm: nsr during but h/o af. was continued amiodarone. not on coumadin because of history of gib. asa for anti-coagulation # hypertensive emergency: patient with h/o severe htn and elevated pressures in cath lab so was started on nitro gtt. was weaned off nitro gtt quickly, however, because of hypotension. during dialysis the next day no fluid was removed and her bps afterward were severely elevated. in this setting the patient had chest pain and lateral st depressions. she was replaced on the nitro drip with good bp response and resolution of the chest pain and ekg changes. she was placed on higher of nifedipine cr and labetalol with better bp control. she became hypotensive after dialysis and large bowel movements, thus labetalol was decreased to 100mg twice daily. her long-acting nifedipine was also discontinued as it was felt that better titration could be achieved with short acting agents in the short term. she is being discharged on labetalol 100 . please monitor bp especially in the peridialysis period. if severely hypertensive may attempt nitroglycerin 2% tp on an as needed basis, per physician . please note that she had episodes of asymptomatic hypotension after dialysis. # ams: on admission there were multiple etiologies for ams but most likely were: 1. multiple sedating medications during both caths, 2. no dialysis for 3 days (longest she's ever gone without dialysis), 3. pseudodementia from depression. lfts were wnl. sedating medications were held overnight. in the morning patient was back to baseline. had dialysis and then her hearing aid batteries were replaced the next morning and after these interventions she was able to mentate appropriately. did continue to be tearful and psych/social work were consulted. they did not feel there was an acute psychiatric problem and did not change any medications. the patient's mental status continued to improve and she was discharged at her baseline mental status. #. c. diff: patient developed large amounts guaiac positive loose stools and leukocytosis. stool was positive for c. diff. she was started on po vancomycin as flagyl would be dialyzed off in hd. her abdominal exam remained benign and the diarrhea resolved quickly. a two week course is planned for vancomycinin (d0=) #. esrd: was continued on t/th/sat hd schedule. #. gerd: continued ppi and added gi cocktail for pill-dysphagia. #. hl: continued statin access: peripheral line in foot and right ij triple lumen which was placed at osh , a-line prophylaxis: -dvt ppx with pneumoboots -bowel regimen with colace, lactulose per home regimen code: dnr/dni - confirmed with daughter. reversed only for cath. communication: phone #; # medications on admission: medications at home: zoloft 150mg qhs amiodarone 200mg daily aspirin 81mg daily phoslo 667mg three times daily colace 100mg daily lactulose 30ml daily nephrocaps one tablet daily nifedipine xl 60mg twice daily protonix 40mg daily requip 0.25mg qhs albuterol prn metoprolol 75mg twice daily renagel 1600mg three times daily neurontin 200mg qhs requip 0.25mg po qhs medications on transfer: amiodarone 200mg daily nephrocaps 1 tab daily phoslo 667mg po tid before meals plavix 75mg daily clotrimazole 10mg 5x daily metoprolol tartrate 75mg three times daily nifedipine sr 60mg twice daily pantoprazole 40mg daily prednisone 10mg daily ropinirole 0.25mg qhs sertraline 150mg daily renagel 1600mg three times daily aspirin 81mg daily colace 100mg twice daily senokot 2 tabs qhs discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily): do not miss or stop taking unless instructed by dr. . 4. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 6. sertraline 50 mg tablet sig: three (3) tablet po qhs (once a day (at bedtime)). 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 8. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 10. maalox advanced 200-200-20 mg/5 ml suspension sig: 15-30cc mls po qid (4 times a day) as needed for chest pain. 11. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed for evidence of thrush. 12. nitroglycerin 2 % ointment sig: one (1) inch transdermal q8h (every 8 hours) as needed for sbp> 160. 13. lidocaine hcl 2 % gel sig: one (1) appl mucous membrane prn (as needed). 14. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 15. vancomycin 250 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 2 weeks: first dose . 16. labetalol 100 mg tablet sig: one (1) tablet po bid (2 times a day): hold sbp<100, hr <60. 17. neurontin 100 mg capsule sig: two (2) capsule po at bedtime. 18. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. discharge disposition: extended care facility: discharge diagnosis: non-st elevation myocardial infarction end stage renal disease with hemodialysis depression discharge condition: stable discharge instructions: you were admitted because you had a heart attack. we evaulated the arteries that supply your heart and placed stents in the ones that were occluded. you were also found to have an elevated blood pressure and were given medications to treat this. we continued your dialysis regimen. you were found to have an infection of your large bowel cousing you to have diarrhea and we gave you oral antibiotics. please call your regular doctor or return to the emergency room if you have fevers, chills, diarrhea, low or high blood pressure, chest pain or any other concerning symptoms. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: followup instructions: primary care: , j. date/time: please call the office to schedule an appt 1 week after you are discharged from rehabilitation cardiology: , md , ( date/time: at 1:45pm. procedure: left heart cardiac catheterization coronary arteriography using a single catheter hemodialysis insertion of drug-eluting coronary artery stent(s) transposition of cranial and peripheral nerves insertion of two vascular stents excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on two vessels diagnoses: other iatrogenic hypotension anemia in chronic kidney disease end stage renal disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery esophageal reflux atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease dysthymic disorder hemorrhage complicating a procedure intestinal infection due to clostridium difficile rheumatoid arthritis altered mental status acquired absence of kidney mechanical failure of instrument or apparatus during kidney dialysis and other perfusion 

Answer: The patient is high likely exposed to