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: service: history of present illness: this is a 54-year-old gentleman with past medical history significant for end stage renal disease, peritoneal dialysis times one year, status post glomerular nephritis and renal transplant times three and aortic valve replacement secondary to calcific aorta who admission, also comes in with a little bit of back pain and some chills. she denied any localizing symptoms, no cough, no chest pain, no shortness of breath, no abdominal pain, no flank pain. he did have some mild nausea earlier the day of admission which seemed to have resolved. he called his primary care physician and was told to go to the emergency room. the day prior to admission the patient had an mra to and third finger on his right hand. past medical history: included end stage renal disease status post peritoneal dialysis times one year, post glomerular nephritis, renal transplant times three, chronic anemia, hypertension, aortic valve replacement secondary to calcific aorta, otitis and gi polyps. medications: prednisone 3.75 mg q d, atenolol 25/50, renagel, tums, aluminum hydroxide, prilosec, coumadin 5 mg and 3 mg, alternating. allergies: captopril which gave him a rash and talcum powder. family history: significant for father having esophageal carcinoma. patient denied any alcohol or drug use. no smoking history. occupation: patient is a plastic surgeon and was practicing doing his surgery two weeks prior to admission. physical examination: in the emergency room included a temperature of 101.7, heart rate 112, blood pressure 153/112. this is a pleasant white man lying in bed, appeared pretty sick looking. heent: pupils are equal, round, and reactive to light and accommodation. oropharynx was clear. anicteric sclera. neck was supple, no lymphadenopathy. chest was clear to auscultation bilaterally. cardiovascular was tachy, regular rate and rhythm, grade 3/6 systolic ejection murmur heard best at the apex. gi was soft, nontender, non distended, normoactive bowel sounds. gu, no cva tenderness, no flank pain. musculoskeletal: patient had right second and third finger ischemic at the fingertips, otherwise no cyanosis, no clubbing, no edema. skin with no evidence of any rashes. neuro, patient was alert, oriented. laboratory data: on admission included a white count of 12.6, hematocrit 29.4, platelet count 91,000, chem 7 of 138/4.9, 99/25, bun and creatinine 48/13.4, glucose 91, calcium 9.1, phosphorus 4.0, magnesium 1.7. differential on the white count was 71% polys, 10% bands, 14 lymphs, no eos, no basos. peritoneal fluid had two white cells, 19 rbc, 60 pmns, 30 lymphs, 20 monos. gram stain with no pmns, no organisms. urinalysis cannot be done because patient did not make any urine. chest x-ray was clear on admission. hospital course: on the patient had some respiratory failure and hypotension. as patient developed fevers, chills, with no obvious source of infection but developed some hypoxia, overnight was on nasal cannula, however, in the morning had increased respiratory rate and decreased o2 saturations with ph of 7.16 and increasing somnolence. the patient had ct scan to evaluate his questionable abdominal source, however, the patient was then admitted to the medical icu because he became hypotensive in the 70's but responded to minimal iv fluids. the patient was started on some vancomycin, gentamycin and flagyl for his ongoing fevers. in the medical icu the patient was noted to be hypotensive and also with an increased metabolic acidosis probably secondary to sepsis. the patient was started on some neo-synephrine and levophed for aggressive blood pressure control as well as some aggressive fluid management. the patient also started on levofloxacin for coverage and antibiotics. the patient was then on levo, flagyl, gent and vancomycin. the patient also was found to be in dic with an elevated pt, ptt. if the platelets were lower, the patient needed to receive some fresh, frozen plasma anticoagulation factors as well as some platelets for this support. the patient had right groin line placed as well as a left femoral line placed and some peripheral ivs as well. later on that evening at 4:30 p.m. on the patient became bradycardic with heart rate in the 30's with a low blood pressure. the patient was given atropine .5 mg, an amp of epi with resolving of increased heart rate, blood pressure and patient was also given calcium and some bicarb. then patient went into vt with the rate at about 200, was shocked about 200-300 joules and then was back in sinus rhythm with rate of 140 with a little bit of hypotension. the patient had his electrolytes repleted. the patient was found to be over breathing the ventilation with high respiratory rates despite the sedation with fentanyl and ativan. therefore, patient was paralyzed to maximize ventilation. the patient was also changed off the different pressors with levophed and vasopressin. the patient was then given hemodialysis instead of his peritoneal dialysis for the next couple of days. the patient was continued on his antibiotic regimen of ceftriaxone, vancomycin, levofloxacin, flagyl as well as vancomycin for his unknown source. the patient then had a pulmonary bronchoscopy to evaluate to see if there is any bacterial pneumonia but the patient had no evidence of anything on bronchoscopy. bronchial alveolar lavage was done which in turn was negative. the patient also had a tee for further evaluation with questionable endocarditis, however, no vegetations were seen on the patient's aortic valve. the patient was cultured numerous times in terms of his blood cultures as well as sputum cultures as well as peritoneal dialysis fluid, however, no source ended up ever growing out anything. complicated medical icu course: 1. id: septic shock. etiology of the septic shock was not entirely clear as chest x-ray, ct scans were just compatible with ards and multifocal pneumonia. however, no bug ever grew out. the patient was continued on vancomycin, gentamycin, levofloxacin, ceftriaxone. tee was performed to rule out endocarditis, however, was negative. the patient was continued on various pressors to support his blood pressure given the septic picture, such as levophed and vasopressin. as the patient remained in house, the patient ended up developing some c. diff colitis, probably secondary to all the antibiotics he was on. the patient was given a 10 day course of po vancomycin per his ng tube as well as being continued on the other antibiotics. the patient had his peritoneal dialysate fluid as well as various sputum cultures and blood cultures sent for any temperature spike that he had had. nothing had ever grown out of any of these cultures. the patient was continued on levofloxacin, flagyl, vanco, gentamycin for 14 day course total. the patient had all his medications renally dosed as patient has end stage renal disease. the patient had various tipped catheters of his central lines changed over wires as well as re-sited and tips were sent for culture, however, nothing ever grew out as well. the patient had ct scan of his abdomen times two which revealed a left iliopsoas abscess which eventually was drained, however, no bug or any white cells were found in that abscess. as well, patient had evidence on abdominal ct scan of an enlarged gallbladder which was drained, however, just revealed normal biliary substances with no bacteria, no pmns. the only thing that ever grew back besides the c. diff colitis was a sputum culture that was positive for mrsa on . the patient had various other negative blood cultures, sputum cultures as stated before under the id aspect of this. 2. renal: the patient was end stage renal disease, was started on hemodialysis as he first was admitted to the medical intensive care unit, however, eventually the patient went over to peritoneal dialysis as he did at home. the patient was continued pretty much on his outpatient regimen, however, while on dialysis the patient developed some glucose intolerance from the high dextrose levels found in the peritoneal dialysis fluid. the patient was started on an insulin drip and blood sugars were monitored closely while patient was on peritoneal dialysis requiring different insulin doses daily. eventually patient was placed on an nph dose as well as insulin being added to his peritoneal dialysis fluid. currently patient is pretty much on his own home dialysate as well as home dialysis schedule. 3. respiratory: patient was ventilator dependent on admission to medical icu on . the patient remained on the ventilator for full support until finally extubated on . the patient was very much sedated from all the medications that we gave him including fentanyl, ativan as well as paralysis. so it took awhile to wean the patient of the ventilator due to the excessive sedation. however, patient finally weaned on while minimal fentanyl and ativan drips which eventually were shut off and was able to sat well on nasal cannula o2 as well as a face mask. after patient was admitted to the medical intensive care unit and ventilated, the patient developed an ards type of picture and he was vented in a way to keep his total volumes low for decreased lung injury. the patient remained on the ventilator as i stated before until when he was extubated and patient had some satting. 4. gi: as stated before, the patient had c. diff cultures which eventually were positive. the patient was started and completed a 14 day regimen of po vancomycin and eventually had a repeat c. diff culture which was negative. the patient also developed evidence of some lower gi bleed as well as he has had melenic stools as well as an upper gi bleed with positive ng lavage. the patient had a colonoscopy done while in house on which showed some evidence of some ischemic colitis as well as a couple of polyps. the patient had some epinephrine injected into the part of the colon which was actively bleeding at the time. the patient's hematocrit remained stable after that and evidence of the gi bleed seemed to have decreased. the patient had evidence of some pancreatitis with rising amylase and lipase levels which probably was attributed to his septic picture. the patient also had a minimal elevation in his lfts but with normalization of his total bilirubin and his alkaline phosphatase, therefore it was thought that this was due to sepsis rather than a primary source of the gallbladder at the time until patient finally had the gallbladder drained which revealed that it was indeed just due to his npo status and having an enlarged gallbladder rather than having infectious cholangitis or such. 5. heme: patient was admitted to the medical intensive care unit in sepsis. the patient was in a dic type of picture. the patient required excessive platelets as well as blood transfusions as well as other coagulation factors for support of his dic picture. the patient also had to be on heparin for an avr replacement which he had had done previously so ptt was monitored pretty closely. 6. cardiovascular: the patient had a history of hypertension when he came in. he was on atenolol. the patient needed aggressive pressor support as well as fluid boluses to maintain his blood pressure while he was in the septic picture. the patient was on neo-synephrine as well as levophed as well as some vasopressin for support of his blood pressure control. the patient was weaned off of all pressors on and was hemodynamically stable, not requiring anymore pressor support. blood pressure at times was maintained with some fluid boluses as patient sometimes got a little bit hypotensive while he started peritoneal dialysis. however, that seemed to have resolved as we changed his peritoneal dialysate to make his fluid status pretty much even. 7. fluids, electrolytes & nutrition: the patient was started on tpn while in house and after extubation patient was on tube feeds. the patient has been tolerating tube feeds well, started on neo-pro for further nutrition while on tube feeds. he was started on criticare and tolerated it well. 8. endocrine: the patient had evidence of glucose intolerance secondary to the high dextrose as well as the sepsis picture, as well as the chronic prednisone that patient was taking at home. the patient was started, as i said before, on an insulin drip which was titrated to keep his blood sugars tightly controlled between 90 and 110, however, eventually patient was weaned off the insulin drip and was given nph insulin as well as insulin and his pd fluid for better blood glucose control. currently patient was getting the insulin and the pd fluid as well as sliding scale for control with fingersticks checked every two hours while undergoing the peritoneal dialysate. the patient was continued on stress dose steroids for the chronic prednisone he took at home. he was started on 100 mg qid of hydrocort and eventually was weaned down to 15 mg tid of hydrocort and eventually 10 mg of prednisone. 9. musculoskeletal/neuro: the patient was paralyzed after the intubation as the patient got hypotensive as well as patient was given high dose steroids. the patient, after being taken off the paralysis and being tailored down on the steroids, the patient continued to be extremely weak and fairly less spontaneous movements. after extubation the patient slowly gained a little bit of strength back as the fentanyl and ativan were wearing down as well as stronger as when he was having some physical therapy. the patient remained extremely weak, had very little spontaneous movements and difficulty speaking. the patient will need aggressive physical therapy to get back to his baseline as patient is a plastic surgeon and was fully active prior to coming into the hospital. i will update any further events that occur after this dictation on an addendum and will summarize the id course at that seems to have been his major issue during this admission. dr., 11-647 dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous abdominal drainage endoscopic destruction of other lesion or tissue of large intestine trocar cholecystostomy diagnoses: pneumonia, organism unspecified acidosis unspecified septicemia defibrination syndrome ventricular fibrillation acute pancreatitis unspecified vascular insufficiency of intestine 

Answer: The patient is high likely exposed to