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: patient recorded as having no known allergies to drugs attending: chief complaint: found down, hypothermia, unarousable major surgical or invasive procedure: placement of r tunneled ij hemodialysis catheter ; d/c placement of l subclavian central line micu stay history of present illness: is a 66 year-old female who was found when neighbors noticed a foul smell and was found down, unarousable with a rectal temperature of 86f and bradycardic to the 40s. she was transferred to ??????s and intubated, found to be hypotensive, hypernatremic, and have a crit of 32 and was transferred to for further evaluation. she had no known past medical history, was unable to communicate, and had no known family members immediately available. past medical history: hypertension controlled with lopressor, avapro and hydrochlorothyazide. noted on ct to have vascular calcifications without evidence of aneurysm. hypercholesterolinemia presumed due to treatment with lipitor diabetes mellitus dicharge summary notes nph and regular insulin @ 14 and 4 units, respectively, . pulmonary embolus likely due to rle dvt in . started on lovenox and coumadin at that time. chronic renal failure with baseline creatinine of 1.3 to 2.2 per records. social history: lives alone in . unknown tobacco, etoh, drug history. sisters living in : , sisters: cell. family history: unknown. physical exam: on admission to medicine floor service: 95.6 78 136/63 12 98%, on 2l nc gen: well appearing female who is very pleasant heent: pupils surgical at inferior aspects and non-responsive to light. no cervical or supraclavicular lymphadenopathy. thyroid normal without nodules. neck supple. cv: rrr, split s2. no rubs, gallops or murmurs appreciated resp: lungs w/ decreased bs bilaterally r>l. no crackles. mild egophany at bases. abd: + bs. belly non-tender, non-distended. gu: deferred ext: no clubbing/cyanosis/. many petechiae on volar aspect of fingers. pupuric dorsal apect of r great toe. 2+ edema of hands and ble. exfoliation between b toes. derm: petechiae on hands as noted. evidence of tinea pedis on feet. neuro: cn iii-xiii intact visual acuity weak-patient able to see light/dark but not figures. eyes move purposefully and spontaneously. awake and alert, somewhat disoriented, but answers questions appropriately. bulk & tone somewhat diminished, with 4+ strength in ue. able to move all extremities spontaneously. pertinent results: 09:35pm wbc-5.9 rbc-2.75* hgb-5.9* hct-21.7* mcv-79* mch-21.3* mchc-27.0* rdw-19.8* 09:35pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 09:43pm po2-104 pco2-31* ph-7.32* total co2-17* base xs--8 comments-cotley 09:43pm lactate-1.9 k+-3.1* 09:35pm ck-mb-16* mb indx-2.1 ctropnt-0.21* brief hospital course: hospital course: after an extensive workup in the ed, she had activity that appeared to be a seizure, and was started on dilantin. she was extensively hydrated, and her hypernatremia was corrected from 162 to 140 over the next two days. she was noted to be in acute renal failure, thought to be due to an atn-type picture. she was also found to be hypothyroid and an initial echo showed an ef of <10% with global lv akinesis. she required pressor support for her hypotension and remained intubated for breathing support. her micu course by systems is as follows: cv: elevated cks on admission but no evidence of mi from troponins or ekg changes. echo on showed lv dysfunction as noted above, noting ef<10% as well as 3+ mr . also noted at that time to have a large lv thrombus as well as laa thrombus, for which she was started on iv heparin. over the course of her micu stay her hypotension resolved and gradually she developed mild hypertension, for which she was started on isordil and nifedipine. repeat echo performed shows global lv dysfunction but improvement in lvef to 20-25%, with left thrombi still visible. her ptt has been maintained in the 55-75 range and she was started on coumadin today. cardiology has been following closely. her hypothermia resolved with passive warming on admission, although she has had several episodes of mild hypothermia off and on over her hospital stay which has resolved with blankets and monitoring. neuro: seizure activity last noted on , eeg performed which showed global slowing without focal abnormalities indicative of a diffuse metabolic, toxic, or infectious process. was switched to keppra on . neurological exams have been non-focal to date, with a gradual improvement in mental status over the course of her micu stay. at the time of discharge, she is awake and talking but not completely oriented and very lethargic, but this is vast improvement over initial assessments. she has had an extensive head and neck workup upon admission which has been largely negative save for evidence of old lacunar infarcts. neuro has been following closely. as her mental status improved, it became apparent that the patient suffered from cortical blindness with associated neglect of her deficit; mri exam failed to demonstrate discrete lesions affecting her visual pathways. renal: acute renal failure with low urine output on admission and was started on cvvh and switched to hemodialysis on for which she had a tunneled rij catheter placed. urine protein to creatinine ratios since have been consistently higher than 3.0, indicative of a probable nephrotic syndrome, but u/a microscopy showed only scant muddy-brown casts. at the time of discharge, she had increased urine output and was started on an oral diuretic regimen. she did not require hemodialysis for 4-5 days prior to discharge and her creatinine remained stable. endocrine: long-standing niddm with unknown complications, and has required nph and sliding scale insulin during the micu admission. hypothyroidism initially treated with levothyroxine and iv t3, which has improved her lab values, and the iv t3 was stopped on , and she has remained on the levothyroxine. considerable thought has been given to the idea that this clinical picture may be one of myxedemic coma, and endocrine has been following as well, but is not convinced this is the case. she was also noted to have low cortisol response on admission and was started on iv steroids, has since been tapered down and is currently on a prednisone taper which was completed by the time of discharge. heme: ms. was markedly thrombocytopenic on admission with platelets around 30k, but this remained somewhat stable and has improved with platelet transfusions (3 total, most recently on ). her hematocrit on admission was low (21.7) and she has received a total of 6 units rbcs since admission (most recently 2 units on ). the heme service was constuled and felt that there was no evidence of ongoing hemolysis but that her iron studies show some indication of a possible chronic anemia unrelated to her iron levels, and a continually low reticulocyte count. if there are any future concerns, she should follow up with hematology. pulmonary: pt was intubated on admission and remained intubated until . during that time she was initially clear on cxr but developed bilateral layered effusions bilaterally (r>l) and a focal ground glass opacity in the lul. the effusion is thought to be evidence of chf, infection, or aspiration. the patient was started on a week course of ceftriaxone, flagyl, and levofloxacin shortly after admission, and finished her course on , with no evidence of infection since. serial cxrs have shown a gradual increase in size of the pleural effusions with atelectasis and collapse of the lower lungs. these effusions were felt to be secondary to heart failure and improved with diuresis. f/e/n: as noted the hypernatremia corrected over the first few days and her other electrolytes have remained reasonably stable with hemodialysis. she has a ngt placed and is currently receiving her enteral nutrition through this. she has been noted to have increasing edema, thought to be secondary to her poor renal output, which have been increasing somewhat lately. the patient was seen by speech and swallow and deemed safe for oral intake in a monitored setting. gu: treated for a yeast infection code: patient is dnr/dni dispo: transferred to a rehabilitation facility. medications on admission: unknown at time of admission. discharge medications: 1. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 2. miconazole nitrate powder sig: one (1) appl miscell. (2 times a day). 3. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po qd (once a day). 4. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day). 5. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 6. dorzolamide-timolol 2-0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 7. levothyroxine sodium 125 mcg tablet sig: one (1) tablet po qd (once a day). 8. levetiracetam 250 mg tablet sig: one (1) tablet po bid (2 times a day). 9. hydralazine hcl 25 mg tablet sig: three (3) tablet po q6h (every 6 hours). 10. ferrous sulfate 325 mg tablet sig: one (1) tablet po tid (3 times a day). 11. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 12. isosorbide dinitrate 20 mg tablet sig: two (2) tablet po qid (4 times a day). 13. epoetin alfa 2,000 unit/ml solution sig: 5000 units units/ml injection 1x/week (mo). 14. ascorbic acid 500 mg tablet sig: one (1) tablet po qd (once a day). 15. calcitriol 0.25 mcg capsule sig: one (1) capsule po qd (once a day). 16. warfarin sodium 7.5 mg tablet sig: one (1) tablet po hs (at bedtime). 17. heparin sod (porcine) in d5w 100 unit/ml parenteral solution sig: as directed intravenous asdir (as directed): discontinue heparin once inr theraputic. 18. insulin standing doses and sliding scale included. 19. bacitracin zinc 500 unit/g ointment sig: one (1) appl topical (2 times a day). 20. nifedipine 90 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). 21. captopril 12.5 mg tablet sig: 0.5 tablet po tid (3 times a day). 22. bumex 2 mg tablet sig: one (1) tablet po twice a day. discharge disposition: extended care facility: & rehab center - discharge diagnosis: hypothermia acute renal failure cortical blindness anemia seizure disorder hypothyroidism thrombocytopenia pleural effusions hypernatremia hypertension diabetes mellitus hypercholesterolinemia dementia discharge condition: stable to rehabilitation facility discharge instructions: take all medications as instructed. continue to follow inr. stop heparin once inr theraputic. follow up as below. continue to follow hematocrit, transfuse for hematocrit less than 30.\ please continue wound care. monitor right hd ij vein site (hd catheter pulled). monitor abdomen and all other groin folds, keeping them clean, dry. continue to follow blood pressure. pt was started on an ace inhibitor with goal of titrating up ace inhibitor and decreasing dose of hydralazine and isordil. followup instructions: please follow up with dr. on at 3:30 pm in the clinic in the building on the . call to reschedule. follow up with nephrology with dr. on at 3pm. call ( if you need to reschedule. you are on a wait list for a sooner appointment. . follow up with cardiology ( clinic) if your pcp feels that you need chf follow up. call to schedule if necessary. follow up with neurology with dr. , at 2:30 pm. you will be called for any earlier appointments as they become available. call if you need to reschedule the appointment. follow up with endocrinology for . stimulation test. at 10 am. dr. . at buiding, . call . md, procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances venous catheterization for renal dialysis transfusion of packed cells diagnoses: other primary cardiomyopathies thrombocytopenia, unspecified acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified other convulsions acute respiratory failure hyperosmolality and/or hypernatremia hypothermia 

Answer: The patient is high likely exposed to