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: history of present illness: this is a 67-year-old female with a past medical history of coronary artery disease, status post coronary artery bypass graft in who also has noninsulin dependent diabetes mellitus, hypertension, right artery stenosis with totally occluded left renal artery and 40-50% stenosis on the right with progressively worsening renal insufficiency since coronary artery bypass graft. patient had an arterial venous fistula placed on with subsequent initiation of hemodialysis. she has had six dialysis treatments, but now presents for outpatient revision of av fistula and placement of a permacath. intraoperatively, the patient became hypotensive for which she was begun on neo-synephrine in the operating room. postoperatively, the patient failed to wean off neo-synephrine in the recovery unit. a medical consult was placed and the medical intensive care unit team was called. postoperative course was also noticeable for 30 seconds of jaw pain, her anginal equivalent which was transient in intensity self resolving without other associated symptoms. the patient is also complaining of occasional shaking mainly in her lower extremities, accompanied by chills. however, she denies any fevers, cough, sore throat, shortness of breath, abdominal pain, diarrhea, flank pain, suprapubic pain or dysuria. past medical history: coronary artery disease, status post coronary artery bypass graft in which involved four vessels. also, noninsulin dependent diabetes mellitus, hypertension, renal artery stenosis by mri and , chronic renal insufficiency, progressive since coronary artery bypass graft and now on hemodialysis, peripheral vascular disease, history of atrial fibrillation, hyperlipidemia. outpatient medications: 1. lopressor or metoprolol 50 mg po b.i.d. 2. zantac. 3. glucoside 5 mg q.d. 4. regular insulin sliding scale. 5. isordil 10 mg t.i.d. 6. erythropoietin 4000 units two times per week, wednesday and saturday. 7. colace. 8. aspirin 325 mg q.d. 9. renagel 1600 mg t.i.d. 10. lipitor 40 mg po q.d. family history: father died of myocardial infarction at age 55. mother lived to age but she alzheimer's. social history: she is married and lives at home with her husband. she has a remote smoking history of one pack per day for 20 years but quit 27 years ago. she denies any alcohol use. allergies: no known drug allergies. physical examination: temperature 96.6. heart rate 66. blood pressure 101/56. saturating at 97% on room air. general: she is comfortable in no apparent distress. head, eyes, ears, nose and throat: anicteric. pupils equal, round and reactive to light. moist mucous membranes. no oral lesions. neck: supple, no jugular venous distention, no lymphadenopathy. heart regular rate and rhythm s1, s2 normal, 2/6 systolic ejection murmur at right upper sternal border crescendo-decrescendo. lungs: decreased breath sounds at left base. abdomen: obese, soft, nontender, normal active bowel sounds, no hepatosplenomegaly. back: no cva tenderness. extremities: no cyanosis, clubbing or edema. 1+ pedal pulses bilaterally. laboratories: hematocrit 24.4, ph 7.31, lactate .9, free calcium 1.14. sodium 127, potassium 5.0, chloride 94, bicarbonate 19, bun 58, creatinine 8.5, glucose 156. ck 38, ck-mb not done because ck was less than 200. troponin 0.7. imaging: portable chest x-ray done on showed double lumen catheter tip in distal svc. cardiac silhouette enlarged, stable since birth. left pleural effusion. pulmonary vascularity appears normal. no consolidation, no pneumothorax. assessment: the patient was a 69-year-old female with a history of progressive renal insufficiency since her coronary artery bypass graft. she had an av fistula placed on and required a revision of the av fistula and placement of permacath. during the postoperative course, she was unable to wean off of the neo-synephrine which had been started intraoperatively. she was brought to the intensive care unit and required handling of her pressor support. hospital course: by issues: 1. cardiac: she had ischemia. she had transient jaw pain intraoperatively. jaw pain was concerning because it is her anginal equivalent. because of this concern, she was followed for ck. her cks were initially negative. on , she developed further jaw pain with chest heaviness at 7 p.m. it was associated with shortness of breath. she had an electrocardiogram which showed no changes. her blood pressure at that time was 220/110 with a heart rate of 80 and 02 of 97%. she was started on oxygen, given two sublingual nitroglycerins, 5 mg of metoprolol with resolution of symptoms. her blood pressure decreased to 160/80. it was thought that the ischemia was secondary to weaning off her antihypertensive medications and was not having a reflexive hypertension. that is when she was restarted on her home medications of metoprolol 50 mg po b.i.d. and isordil 10 mg po t.i.d. ck and troponins were checked and were negative. she did not have any further episodes of ischemic type pain. 2. pulmonary: she received an a line in the intensive care unit. she was found to actually be hypertensive and not as hypertensive as had been previously thought. in the setting of her chest pain and jaw pain, she was converted. the pressors were weaned off completely. instead, she was actually given antihypertensive medications and restarting of her home medications including metoprolol 50 mg po b.i.d., isordil 10 mg b.i.d. there was some controversy over what her actual blood pressure was. when a line was placed in the right arm, right radial line, her blood pressure was actually 187/73. in her left leg, it was 98/49. in the operating room, her legs were used for measuring her blood pressure. there was some concern that she did have a drop in pressure during the operating room and though she was probably not hypotensive, it was a relative hypotension considering that it was a drop from her baseline in the operating room. the hypotension in the lower extremities was thought to be due to her severe peripheral vascular disease. she has risk factors including diabetes, hypertension and hypercholesterolemia. the relative hypotension during the operating room was thought possibly due to bacteremia given that the patient did have rigors and there was catheter manipulation. the blood pressure was then converted to the right upper extremity. in the operating room, her blood pressure dropped from 120 to 70 systolic. at that time, she was placed on a neo-synephrine drip. she was also found to have increased cholesterol. subsequently, she was started on lipitor. she was weaned off her pressors and was started on her antihypertensive medications. her metoprolol was increased to 75 mg po b.i.d. she was started on aspirin and isordil. in the future, an ace inhibitor might be employed to control her blood pressure. consequently the differential in her extremities was thought to be due to peripheral vascular disease and not coarctation in the aortic system. she was transferred to the floor on and was actually discharged on the same day and since there are cardiac issues, an ace inhibitor was considered but it was not started at this time. she presented with a confusing picture in that she was transferred to the medical intensive care unit because she was thought to be hypotensive. however, the blood pressure in her right upper extremities did not correspond with her lower extremity. it was thought that the difference was due to peripheral vascular disease in the lower extremities. the real pressure was thought to be in the right upper extremity and she received antihypertensive medications for it. 2. infectious disease: the patient was considered or at least was on the differential that she may have had a bacteremic episode including the hypertension in the operating room. the bacteremia may have been caused by manipulations in the catheter. she also had rigors in the operating room. she was started on antibiotics with the concern for infection. she had blood cultures and urine cultures which were negative. she was given vancomycin 1 gram which was also to be followed. gentamicin was also started 80 mg to begin after dialysis. because the cultures were negative, the antibiotics were discontinued. it was thought that she probably did have a bacteremic issue, that it was transitory and had resolved. 3. vascular: the patient was able to complete the surgery. the exact nature of what was needed was that she had had a left-sided av graft and a left ij permacath inserted on and she came in for vein mapping on because of clotting in the left upper extremity. she was actually admitted for thrombectomy and revision of the left upper extremity av fistula. she was also to have a right ij permacath placed as the left one had clotted off. the procedure was thought to be successful. she was able to continue with her renal hemodialysis. she appears to have follow-up appointment with dr. in two weeks for staple removal. the graft was considered not to be functional at least in the immediate setting. consequently, the permacath was used for hemodialysis. 4. renal: the patient required hemodialysis through the admission. she required fluid removal considering her left pleural effusion. she was continued on her erythropoietin and renagel. an extra hemodialysis session was done to remove fluid. 5. hematology: the patient was anemic. however, she is anemic chronically. she did receive a unit in the postoperative setting because of fear of her blood loss during her procedure and given her hypotension. 6. endocrine: she has diabetes and was continued on capozide. she also received her regular insulin sliding scale. follow-up: the patient was to follow up with her primary care physician and with dr. . she is to follow up with her primary care physician, . , in , clinic. the appointment was scheduled for at 10:45 a.m. discharge medications: 1. lipitor 40 mg po q.h.s. 2. erythropoietin 4000 units subcutaneous two times per week on saturday and wednesday. 3. renagel 1600 mg po t.i.d. 4. aspirin 325 mg po q.d. 5. metoprolol 75 mg po t.i.d. 6. atorvastatin as mentioned previously. 7. isordil. 8. dinitrate 10 mg po t.i.d. 9. glipizide 5 mg po q.d. discharge status: patient was to be discharged home. condition at discharge: patient was in stable condition. she did not need any antibiotics because her cultures were negative. discharge diagnoses: 1. hypotension and hypertension. 2. left av fistula thrombosis that underwent thrombectomy. , m.d. dictated by: medquist36 procedure: other revision of vascular procedure hemodialysis venous catheterization for renal dialysis diagnoses: coronary atherosclerosis of native coronary artery pure hypercholesterolemia aortocoronary bypass status percutaneous transluminal coronary angioplasty status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease atherosclerosis of renal artery other complications due to renal dialysis device, implant, and graft diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to