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: metformin / phoslo / glyburide attending: chief complaint: altered mental status major surgical or invasive procedure: temporary dialysis line placement tunneled dialysis line placement history of present illness: 54m with esrd hd-dependent, diabetes, mr coming in from dialysis to the ed with chief complaint of low grade temps (99.1) as well as altered mental status. . history was obtained partly from ed signout, partly from dialysis fellow, and partly from brother as patient is not responding to questions at this moment. . history of chronic exit site infections at his dialysis catheter site and new onset confusion today at hemodialysis. pt. has a r ij tunneled hd catheter that was last changed on , and per report from ed has had blood cultures grow coag-positive and coag negative staph in the past, for which he has been receiving vancomycing in hd. patient is unable to give history. . (hcp) - spoke to patient, who was lethargic, but mental state was ok. . in ed, initial vitals were, temp 98.4 hr 102 bp 144/87 rr 16 pox100%. cxr: unremarkable ekg: sinus tach 100 na/ni no stemi ct head: negative in ed: given vanc, zosyn ,ctx (only given vanco in ed). also noted to have hyperkalemia - given insulin, cagluc, started on d5 drip (for high lactate). - ua sent - - renal fellow called and asked to admit. - patient may need an lp - not done in ed. - need redosing of antibiotics. -being admitted to icu to altered mental status. - brother - is hcp full code) ( . . medications given in ed: insulin 10u regular iv x1, d5w 1lns, vancomycin, zosyn 4.5g iv. on exam there, was noted to be "alert but not oriented, unable to answer questions". lp was not done, lp as inpatient -> renal wants to do dialysis emergently and hold on lp until after. . patient was admitted for altered mental status. . on the floor, patient was obtunded . review of sytems: unable to obtain, given patient's obtunded mental state at time of admission. past medical history: esrd hd-dependent - 2 years now. diabetes - type 2. mr hx of atrial fibrillation when septic social history: lives at health center, per brother. : none etoh: none alcohol: none family history: unknown physical exam: admission exam: 98.4 hr 102 bp 144/87 rr 16 pox100% general: obtunded. heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: tachycardic, could not appreciate murmurs due to body habitus abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: a&ox1 (name only), responds to voice by opening eyes only, and occasionally answering questions . discharge exam: vs: tm 98.7 f, bp 124/72 hr 72 rr 18 100% ra general: sleepy, not interested in answering questions. heent: sclera anicteric, mmm neck: supple, jvp not elevated, no lad, r tunneled dialysis line in place, mild oozing from site, nontender, non errythematous lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs: 01:20pm blood wbc-7.8 rbc-4.74 hgb-13.6* hct-40.3 mcv-85 mch-28.8 mchc-33.9 rdw-15.4 plt ct-158 01:20pm blood neuts-81.5* lymphs-13.2* monos-4.0 eos-0.9 baso-0.4 01:20pm blood pt-10.9 ptt-28.6 inr(pt)-1.0 01:20pm blood glucose-81 urean-55* creat-10.8* na-138 k-6.8* cl-100 hco3-19* angap-26* 01:20pm blood alt-59* ast-52* ck(cpk)-127 alkphos-111 totbili-0.4 11:52pm blood calcium-9.3 phos-5.0* mg-2.2 11:52pm blood prolact-5.2 tsh-0.58 02:12pm blood lactate-2.2* k-7.1* 01:20pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg . discharge labs: 06:42am blood wbc-7.9 rbc-3.32* hgb-9.3* hct-28.4* mcv-85 mch-28.1 mchc-32.8 rdw-14.8 plt ct-231 08:17am blood pt-11.3 ptt-80.9* inr(pt)-1.0 06:42am blood glucose-150* urean-54* creat-10.0*# na-144 k-4.8 cl-101 hco3-27 angap-21* 06:42am blood alt-134* ast-90* alkphos-87 totbili-0.2 06:42am blood calcium-9.3 phos-6.9* mg-2.6 . imaging: cxr : semi-upright ap view of the chest: right-sided dual-lumen central venous catheter tip terminates in the cavoatrial junction. the heart size is normal. mediastinal and hilar contours are unremarkable. there is no focal consolidation, pleural effusion or pneumothorax. there is elevation of left hemidiaphragm. no acute osseous abnormality is seen. low lung volumes are present. impression: elevated left hemidiaphragm. no acute cardiopulmonary abnormality. . head ct : findings: there is no evidence of hemorrhage, edema, shift of midline structures, or major vascular territorial infarction. the ventricles and sulci are normal in size and configuration. no suspicious osseous lesions are identified. the visualized paranasal sinuses, mastoid air cells, and middle ear cavities are clear. impression: no acute intracranial abnormality . rue u/s : findings: grayscale and color doppler son imaging was performed of the bilateral subclavian, right jugular, right axillary, right basilic, and right cephalic veins. in one of the brachial veins, there is incomplete compressibility and echogenic material within it. there is still some discernable doppler flow in this vessel, indicative of a nonocclusive thrombus. impression: nonocclusive thrombus of one of the brachial veins. . tte : left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the aortic valve leaflets are mildly thickened (?#). no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mitral regurgitation is seen. impression: very suboptimal image quality. preserved global left ventricular systolic function. no definite valvular abnormality or pathologic flow identified. if clinically indicated, a tee would be better able to define any valvular pathology . venogram : impression: 1. bilateral upper extremity venograms demonstrate non-occlusive right brachial thrombus as on the prior ultrasound. moderate right subclavian stenosis is seen along the midpoint of the vein with extensive collateralization. mild-to-moderate stenosis of the central most portion of the left subclavian vein is also noted. 2. successful placement of right internal jugular temporary hd line with vip port. the line is ready to use. . microbiology: blood culture, routine (final ): parapsilosis. consultations with id are recommended for all blood cultures positive for staphylococcus aureus, yeast or other fungi. sensitive to fluconazole sensitivity testing performed by . . catheter tip-iv source: hd line. **final report ** wound culture (final ): parapsilosis. >15 colonies. sensitive to fluconazole. this test has not been fda approved but has been verified following clinical and laboratory standards institute guidelines by clinical microbiology laboratory.. sensitivity testing performed by . . csf;spinal fluid source: lp // csf #3. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. viral culture (preliminary): no virus isolated. hsv negative . other blood cultures negative at time of discharge. two blood cultures are pending. brief hospital course: 54m with esrd hd-dependent, diabetes, mr in from dialysis with chief complaint of low grade temps and ams. history of chronic exit site infections at his dialysis catheter site and new onset confusion at hemodialysis, now back to baseline. . active issues: # fungemia: pt has history of positive fungal cultures at dialysis for which he was previous treated with diflucan, last dose given . since then, he has continued to have positive fungal cultures without any apparent treatment. blood cultures here were positive for parapsilosis, sensitive to fluconazole. pt was evaluated by ophtho, with no evidence of any endophalmitis but he does have enlarged cup to disk ratio which should be followed as outpatient. tte was performed which was a very poor study but no valvular abnormalities noted. pt is now s/p tunneled dialysis line placement () and blood cultures have remained clear. infectious disease was consulted. given sensitivities, he was recommended to continue on fluconazole for a total of 6 weeks (last dose 1/23). his liver function tests and cbc with diff should be monitored every other week and results should be faxed to the infectious disease nurses. . # elevated lfts: pt noted to have increased lft to low 100s, which have remained stable. this is likely related to fluconazole. he has no history of hepatitis that we are aware of. his labs should be checked every other week. if his lfts continue to rise, he may need to be taken off fluconazole and switched to micafungin. . # rue dvt: pt was noted to have swelling in his right arm. an ultrasound revealed a clot in r brachial vein. he was started on a heparin drip with bridging to coumadin. his goal inr is . he remained subtherapeutic at time of discharge so he was sent to rehab for continued bridging. he was started on coumadin 3mg daily. he previously had been on coumadin and therapeutic at 5mg, however given concurrent fluconazole, he was started at a lower dose of coumadin. however, given that inr remained flat, he was increased to coumadin 4mg on discharge. he should have repeat inr drawn on . . #altered mental status: pt was admitted with altered mental status which improved within 24 hours of admission. he had an lp as work-up for is ams, which was unrevealing. it is likely that his ams was secondary to his fungemia. . # bacteremia: pt has had negative bacterial blood cultures while here, though he has been treated for coag negative staph with vanc 1gm and gentamycin 80mg for unknown bacteria at dialysis. his course of antibiotics was not well defined. however, he did complete 5 day course of vancomycin after his tunneled dialysis line was pulled as per id recommendations. . chronic issues: # esrd: pt is on hd x 2 years. he has a history of recurrent infections. during this admission, his tunneled line was pulled and initially had a temporary line placed. this was followed by another tunneled line placed once blood cultures remained clear. pt would likely benefit from more permanent hd access given his recurrent infections with lines. this should be discussed with the patient and his brother. had a venogram completed at this admission. . # atrial fibrillation: per pcp, has history of afib when septic, otherwise seems to remain in sinus rhythm. had previously been anticoagulated, but not in past 2-3 months. he will be discharged on his home dose of lopressor. he is also being anticoagulated, but for dvt rather than a fib. . # dm: pt is not on insulin at home, he is on glipizide 5mg. this was held while patient was hospitalized but resumed upon discharge. . #seizure disorder: pt was continued on home dose of keppra, 500 mg with additional 250 mg after hd. . transitional issues: pt is full code. . brother should be contact for any further questions: ( . he needs labs checked every other week, including cbc with diff and lfts while on fluconazole. . goal inr is . he should likely be anticoagulated for 3 months in setting of rue clot. medications on admission: glipizide 5 mg daily clonidine 0.1 mg , hold on mornings before hd folic acid 1mg daily keppra 250mg with dialysis, 500 mg on other days lopressor 100mg zyprexa 5mg qhs simvastatin 40mg daily aspirin 81 mg daily discharge medications: 1. clonidine 0.1 mg tablet sig: one (1) tablet po bid (2 times a day). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. glipizide 5 mg tablet sig: one (1) tablet po once a day. 4. olanzapine 5 mg tablet sig: one (1) tablet po hs (at bedtime). 5. sevelamer carbonate 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 6. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). 9. levetiracetam 250 mg tablet sig: one (1) tablet po after hd (). 10. lopressor 100 mg tablet sig: one (1) tablet po twice a day. 11. fluconazole 200 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)): continue until . 12. warfarin 1 mg tablet sig: four (4) tablet po once a day. 13. heparin drip diagnosis: dvt patient weight: 80 kg current infusion rate: 1150 units/hr target ptt: 60 - 100 seconds ptt <40: 3200 units bolus then increase infusion rate by 300 units/hr ptt 40 - 59: 1600 units bolus then increase infusion rate by 150 units/hr ptt 60 - 100*: ptt 101 - 120: reduce infusion rate by 150 units/hr ptt >120: hold 60 mins then reduce infusion rate by 300 units/hr 14. outpatient work pt should have inr checked on . 15. outpatient work cbc with differential, lfts checked on and thereafter weekly and faxed to: infectious disease r.ns. at (. all questions regarding outpatient antibiotics should be directed to the infectious disease r.ns. at ( or to on md in when clinic is closed. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: fungal infection renal disease on hemodyalisis secondary: diabetes discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you at . you were admitted because you were confused. we found that you had a fungus infection in your dialysis line. that line was removed and another one was placed. we also found that you had a blood clot in your arm so you were started on a blood thinner. . your blood pressure was low after dialysis today (85/40s). the dialysis doctors feel they have taken off more fluid than normal. you got 250cc bolus and your blood pressure came up to 110s so we feel that you are safe to go. if your blood pressure is low again tonight, you should get another fluid bolus. . please make the following changes to your medications: 1. start taking coumadin 4mg daily. 2. continue heparin drip until inr is theraputic at 2-3 on sliding scale attached. 3. start fluconazole 200mg daily until . 4. please hold all of your blood pressure medications unless your blood pressure is consistently greater than 120. . you should discuss with your brother the possibility of having more permanent dialysis access, as you seem to have problems with continued infections. the more permanent access has less risk of infection. . you will also need to follow up with the infectious disease doctors to monitor your antibiotics and blood counts while you're on the medication. followup instructions: department: infectious disease when: friday at 9:00 am with: , md building: lm bldg () campus: west best parking: garage all questions regarding outpatient antibiotics should be directed to the infectious disease r.ns. at ( or to on md in when clinic is closed. procedure: spinal tap incision of lung hemodialysis hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis incision with removal of foreign body or device from skin and subcutaneous tissue diagnoses: acidosis hyperpotassemia end stage renal disease renal dialysis status diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled gout, unspecified atrial fibrillation sepsis long-term (current) use of other medications disseminated candidiasis encephalopathy, unspecified unspecified intellectual disabilities other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy acute venous embolism and thrombosis of deep veins of upper extremity bloodstream infection due to central venous catheter 

Answer: The patient is high likely exposed to