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: levaquin attending: chief complaint: hypotension; loss of consciousness; diarrhea major surgical or invasive procedure: central venous line placement. history of present illness: this is a 79-year-old woman with esrd on hd, htn, and hyperlipidemia who is admitted from rehab facility after episode of weakness, slurred speech, and hypotension during physical therapy. she recently had a uti and c.diff infection as noted below. . she was recently admitted to in early of this year for musculoskeletal chest pain. at that time she was found to have a uti and was treated with a course of antibiotics. she subsequently developed c.diff (as per patient and daughter report) and was treated at rehab. patient states that diarrhea resolved, but then returned over the past 4 days. she says that during pt this morning, she developed lightheadedness and dizziness; she felt hypotensive as she had on prior occasions. patient denies acutal syncope, but per nursing home report she actually lost consciousness. ms. was brought to where code stroke was called. patient was evaluated by neurology team who found no deficits. a ct scan of her head was negative for any acute pathology. . patient was found to be hypotensive on admission to 82/60. she was given 2l of ivf without much effect. white count was 8.1 and lactate was 2.2. echo performed at the beside was negative for large effusion. patient received iv flagyl (was ordered for vanc and ceftriaxone but never got them), had a rij placed, and was started on levophed. on transfer from ed, vitals were: 97.3 77, 94/45, 17, 96% on 2l. past medical history: -chf -esrd on hd (since )- tuesday, thursday, saturday -hypertension -hyperlipidemia -gout -osteoporosis -dry senile macular degeneration -rheumatic fever (last occurrence at age 12) -anemia -s/p open fracture of intertrochanteric section of femur (slipping on wet steps; she denies any loss of balance or presyncope) -several left sided rib fractures -h/o c.diff () with recurrence->severe c.diff this admission social history: she has a 45-year history of smoking 1 ppd. no current tobacco. she drinks alcohol rarely (4-5 times per year), and coffee rarely. . retired elementary school secretary (32 years). lives in with her divorced son; her other son also lives in . she spends about half the year in . she occasionally visits daughter in . she is currently in a rehab facility in (was moved from one in to be closer to family) after a recent hip fracture and repair in . she will live with her daughter once leaving rehab. family history: mother had breast cancer, died of colon cancer at 88. father died of lung cancer at 64. paternal grandmother had heart disease, stroke, breast cancer, and thyroid disease (had surgery), died at 76 from stroke after fall. maternal grandfather died of mi at 94 or 95. uncle had breast cancer, died of lung cancer at 94. cousin had thyroid disorder. physical exam: admission: vs: afebrile, hr: 77, b: 99/40 (on levophed), sp02 95% on ra general: well appearing, no acute distress neck: jvp elevated 3cm above clavicular line chest: crackles in left lower base cardiac: regular rate and rhythm abdomen: +bs, soft, non-tender ext: warm and well perfused, no edema neuro: alert and oriented x3 morning of discharge: vs - tc=tm98.4, 130/68 (130-160/66-78), 78, 20, 97%ra loose bm x2 yesterday; x1 this shift exam at 0710 gen: nad cv: rrr, slight systolic murmur pulm: ctab, no crackles/wheezes abdomen: soft, nt, +bs ext: wwp, no erythema, no edema. pertinent results: admission labs: 01:30pm blood wbc-8.1 rbc-3.01* hgb-8.6* hct-26.1* mcv-87 mch-28.5 mchc-32.9 rdw-18.6* plt ct-324 01:30pm blood pt-13.7* ptt-22.3 inr(pt)-1.2* 01:30pm blood ret aut-1.9 01:30pm blood glucose-105* urean-48* creat-5.5*# na-135 k-4.5 cl-95* hco3-29 angap-16 01:30pm blood alt-10 ast-10 ld(ldh)-122 alkphos-81 totbili-0.7 01:30pm blood albumin-2.8* 01:30pm blood hapto-267* 01:38pm blood lactate-2.2* . admission imaging: head ct: no acute process. chest xray: mild cardiomegaly. small left pleural effusion. minimal left basilar opacity, likely atelectasis. . anemia workup: 03:56am blood hypochr-2+ anisocy-2+ poiklo-1+ macrocy-1+ microcy-1+ polychr-normal ovalocy-occasional ellipto-1+ 05:53am blood caltibc-101* vitb12-1597* folate-18.7 ferritn-1855* trf-78* . ekg : sinus rhythm with one ventricular premature beat. non-specific anterolateral st-t wave changes. compared to the previous tracing of lateral st-t wave changes are slightly more prominen but still appear non-specific. . ekg changes workup: 01:30pm blood ctropnt-0.08* 01:30pm blood probnp-* 12:56am blood ck-mb-2 ctropnt-0.06* . ekg : sinus rhythm. frequent ventricular premature beats. compared to the previous tracing of there is no definite change. . infection/inflammation/micro: 04:00pm urine blood-lg nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg 04:00pm urine rbc-54* wbc-11* bacteri-mod yeast-none epi-0 transe-<1 04:00pm urine castgr-3* urine culture no growth final blood culture x 2 no growth to date, final pending c.diff a&b toxin: positive 04:33am blood lactate-1.2 12:56am blood ck(cpk)-42 . abdominal xray: no definite findings suggestive of c. diff colitis, however there it insufficient air in the colon to evaluate for bowel wall thickening. . discharge labs: 06:50am blood wbc-5.3 rbc-3.37* hgb-9.1* hct-29.9* mcv-89 mch-27.0 mchc-30.5* rdw-17.7* plt ct-332 06:50am blood glucose-82 urean-30* creat-3.5* na-140 k-3.9 cl-104 hco3-28 angap-12 06:50am blood calcium-8.9 phos-2.8 mg-2.2 brief hospital course: ms. is a 79-year-old woman with end stage renal disease on hemodialysis, htn, and hyperlipidemia who developed a recent uti and c.diff infection while at a rehabilitation facility status post fall. she was admitted to the intensive care unit with hypotension. a bedside echo showed no large effusions. a stroke code was called, but a neurology evaluation was negative for deficits and head ct was negative for acute intracranial process. she clinically improved and was transferred to the floor on hospital day 2. below is a summary of her hospital course by problem: . 1. hypotension: she was hypotensive to the 80s/40s on admission and was resuscitated with fluids and was briefly on vasopressors in the intensive care unit but quickly weaned off. her hypertension medications were held. her blood pressure improved with crystalloids, she remained afebrile, her white count remained normal, and her hypotension was attributed to volume loss from diarrhea and possibly the toxic effects from clostridium difficile. she clinically improved overall on antibiotics for c.diff, was otherwise without symptoms or signs of sepsis physiology afterwards, and remained hemodynamically stable for the remainder of her admission. . 2. clostridium difficile and diarrhea: she was first initiated on intravenous flagyl and vancomycin and then transitioned to oral vancomycin alone on hospital day 2 when she was noted to have another c.diff infection. her diarrhea clinically improved, and the decision was made to continue a 14-day course of oral vancomycin. she was initially on a bland diet but tolerated a regular diet by hospital day 3 without difficulty, once her diarrhea improved. . 3. ekg changes: on admission, she was noted to have st depressions in leads v4, v5, and v6, and her bnp was elevated to greater than 24,000. the changes were attributed to demand ischemia secondary to her hypotension. . 4. hypertension: at home she is on amlodipine, clonidine, and labetalol. these were held due to her hypotension on admission. as her blood pressure improved, her home dose of labetalol was added on hospital day 3. on recommendation from renal, amlodipine and clonidine were not restarted, and she was instructed to follow up with her primary physician and dialysis team to restart these medications in the next few days to goal blood pressure <130/80. . 5. end stage renal disease: the renal team continued to follow her course and make recommendations. she was restarted on her home dialysis schedule. . she remained on prophylactic subcutaneous heparin and an h2 blocker. she was discharged on hospital day 5 in good condition, with instructions to complete a total 14 day course of vancomycin. she will return back to her rehabilitation facility and follow up with her primary physician. medications on admission: 1. amlodipine 10 mg tablet sig: one (1) tablet po once a day. 2. aranesp (polysorbate) injection 3. colace 100 mg capsule sig: one (1) capsule po once a day. 4. famotidine 20 mg tablet sig: one (1) tablet po q48h (every 48 hours). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. labetalol 200 mg tablet sig: one (1) tablet po bid (2 times a day). 7. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po bid (2 times a day) as needed for constipation. 8. sevelamer hcl 400 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 9. temazepam 15 mg capsule sig: one (1) capsule po hs (at bedtime) as needed for insomnia. 10. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual once a day as needed for chest pain: may repeat x 3, if you need more than once please call your physician. 11. clonidine 0.1 mg tablet sig: one (1) tablet po every eight (8) hours as needed. 12. dulcolax 5 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. famotidine 20 mg tablet sig: one (1) tablet po q48h (every 48 hours). 3. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 11 days: please be sure to take all your doses of antibiotics and complete the entire course of medication. disp:*qs capsule(s)* refills:*0* 4. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain or fever. 5. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 6. labetalol 200 mg tablet sig: one (1) tablet po bid (2 times a day). 7. aranesp (polysorbate) injection 8. peg 3350-electrolytes 227.1-21.5-6.36 gram powder in packet sig: one (1) po twice a day as needed for constipation. 9. sevelamer hcl 400 mg tablet sig: two (2) tablet po three times a day: take with meals. 10. temazepam 15 mg capsule sig: one (1) capsule po at bedtime as needed for insomnia. 11. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) sublingual once a day as needed for chest pain: repeat up to three times. if you need it more than once, please call your physician. discharge disposition: extended care facility: livingcenter - heathwood - discharge diagnosis: clostridium difficile infection. anemia. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: ms. , it was a pleasure taking care of you. you were admitted to after developing diarrhea and losing consciousness at your rehabilitation center. you were found to have very low blood pressure and were given intravenous fluids and medications to help raise your blood pressure in the emergency department. you were also given antibiotics for your diarrhea. you were seen by general neurology and the stroke service and they both believed that there was no indication that you had a stroke. since your blood pressure remained low, you were transferred to the icu, where you continued to receive fluids and antibiotics. your diarrhea improved with oral vancomycin, and tests confirmed that you have a clostridium difficile infection causing your diarrhea. you will continue oral antibiotics until for this infection. you were also started back on hemodialysis and will continue your usual schedule. your blood pressure increased and you were restarted on your home dose of labetalol. after discussion with renal specialists, it was decided not to restart your amlodipine or clonidine at this time. your blood pressures are somewhat elevated now, and you will need to adjust these medications with your primary physician. you are being discharged back to your rehabilitation facility. we started you on oral vancomycin 125 mg every 6 hours (four times a day). please continue to take this until . we also started you on neprhocaps (b complex-vitamin c-folic acid), 1 tablet daily, as recommended by the kidney doctors. we stopped your amlodipine and clonidine. you can restart them as needed, but should be careful to ensure that your blood pressure does not drop too low. we stopped your colace and dulcolax. you may restart them, if needed, after your diarrhea resolves. followup instructions: she should resume her normal tuesday, thursday, saturday dialysis schedule at . the patient needs to follow-up with her pcp after discharge from rehab. procedure: venous catheterization, not elsewhere classified hemodialysis diagnoses: end stage renal disease renal dialysis status anemia, unspecified unspecified pleural effusion gout, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia osteoporosis, unspecified intestinal infection due to clostridium difficile volume depletion, unspecified nonexudative senile macular degeneration 

Answer: The patient is high likely exposed to