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: dilantin kapseal attending: chief complaint: missed dialysis/respiratory distress major surgical or invasive procedure: iv fistulagram intubation history of present illness: 63 y/o f w/ esrd iga nephropathy s/ failed crt on hd (mwf) through lue avf since , p/t ed w/ n/v/diarrhea and at least one episode of bloody stools and ili sx w/ worsening sob x 2-3d. because she was not feeling well, she missed hd today. she was unable to provide further hx in ed. initial ed vs: t 97.8 hr 80 170/78 18 94 % 2l exam was notable for tachypenic ill-appearing f w/ nonfocal abd tenderness l basilar crackles and an irregularly irregular tachycardic heart rate to 145. cxr was consistent with b/l patchy infiltrates concerning for pna vs. volume overload. labs showed k of 6.5, cr 8.6. telemetry showed several runs of nsvts and pt was symptomatic w/ nausea. she then began to have sustained runs of vts; ekg showed hyperacute t waves in v3-v5, wide complex tachycardia, and lbbb w/ poor r-wave progression. she received a total of 5g iv calcium gluconate, 10u regular sc insulin, kayexalate and 1 amp iv glucose. cardiology was consulted and felt arrhythmia was hyperkalemia and renal was consulted for stat hemodialysis given hyperkalemia and vt. she did not become pulseless, but as she had increasing tachycardia and tachypnea, rapid sequence intubation with rocuronium (instead of succinylcholine given hyperkalemia) and etomidate was performed in the ed. as ej blew during intubation, r- femoral cvl was placed for access. pt was initially placed on lidocaine gtt for tachycardia which was changed to esmolol gtt. pt also received ctx for presumed pna on cxr. vs: afebrile, 145, 145/66 100% on ac 350 x 20,peep 5 fio2 50% in the micu, emergent hd was initiated. past medical history: 1. atrial fibrillation/flutter: first diagnosed in . 2. end-stage renal disease on hemodialysis secondary to iga nephropathy s/p cadaveric kidney transplant in which has eventually failed, and started on hemodialysis in . 3. history of upper gi bleeding on with evidence of esophagitis, gastric ulcer, and bleeding duodenal vessel s/p clipping, cauterization and ppi. 4. diastolic heart failure supported by an echocardiography from . clinically asx. 5. history of malignant hypertension, which was complicated by seizure on . not on antiepileptic meds. denies h/o cva. 6. depression. 7. rheumatic fever in childhood social history: single, lives by herself in , and has no children. she quit smoking 25 years ago (10-pack-years). she rarely drinks alcohol, and denies illicit drug use. she used to work part-time in a coffee shop, but currently does not work. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. her father died at the age of 80. her mother died at the age of 64 from lung ca. she has a sister with breast ca. mi in uncle in his 60s. physical exam: on admission: vitals: tm 99.1 tcurr 97.2 bp: 154/65 p: 62 r: 18 o2: 98% ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp 8 cm, no lad lungs: soft, dry inspiratory crackles on right, no wheezes, rales, ronchi cv: regular rate and rhythm, loud av fistula thrill heard across precordium abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 1+ pitting edema to mid-shin neuro: cns2-12 intact, motor function grossly normal pertinent results: admission labs: 01:20pm wbc-5.0 rbc-3.87* hgb-11.9* hct-35.1* mcv-91 mch-30.7 mchc-33.9 rdw-18.3* 01:20pm neuts-86.5* lymphs-7.9* monos-4.4 eos-0.4 basos-0.7 01:20pm plt count-275 01:20pm glucose-124* urea n-81* creat-8.6* sodium-137 potassium-6.5* chloride-92* total co2-23 anion gap-29* 01:20pm pt-21.3* ptt-27.3 inr(pt)-2.0* 03:10pm probnp-> 04:17pm freeca-1.34* 03:17pm k+-6.5* 04:25pm type-art po2-86 pco2-59* ph-7.25* total co2-27 base xs-2 10:35pm tsh-4.5* micro: blood culture x 2- ngtd 2:40 am catheter tip-iv source: rt femoral. wound culture (final ): no significant growth. 11:27 pm sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): sparse growth commensal respiratory flora. 11:27 pm rapid respiratory viral screen & culture source: nasopharyngeal swab. **final report ** respiratory viral culture (final ): no respiratory viruses isolated. culture screened for adenovirus, influenza a & b, parainfluenza type 1,2 & 3, and respiratory syncytial virus.. detection of viruses other than those listed above will only be performed on specific request. please call virology at within 1 week if additional testing is needed. respiratory viral antigen screen (final ): negative for respiratory viral antigen. specimen screened for: adeno, parainfluenza 1, 2, 3, influenza a, b, and rsv by immunofluorescence. refer to respiratory viral culture for further information. blood culture- ngtd studies: ekg: baseline artifact. possible atrial flutter with variable block, predominantly 3:1. leftward axis. left bundle-branch block. prominent precordial t waves. since the previous tracing of the atrial tachyarrhythmia is new. the qrs complex is wider. left bundle-branch block pattern is new. clinical correlation is suggested. cxr: portable upright ap chest radiograph is obtained. there is central pulmonary vascular congestion and mild pulmonary edema. small right pleural effusion is noted. no pneumothorax is seen. impression: findings compatible with congestive heart failure/fluid overload. echo: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 65%). tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. mild (1+) aortic regurgitation is seen. mild (1+) mitral regurgitation is seen. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. compared with the findings of the prior study (images reviewed) of , the findings are similar. the acoustic texture of the left ventricular myocardium suggests an amyloid-type infiltration, as does the stiffness of the myocardium. findings consistent with restrictive cardiomyopathy. r neck ultrasound: no focal fluid collection or abscess. expansion and increased echogenicity of the right sternocleidomastoid muscle relative to the left, which may reflect myositis, of indeterminate etiology. adjacent prominent cervical nodes may be reactive. however, followup imaging following resolution of symptoms is suggested to ensure resolution of findings. cxr: small bilateral pleural effusions have both decreased. substantial residual consolidation is present at the left lung base, and although there is no pulmonary edema, there is mild cardiomegaly and persistent, though improved, pulmonary vascular congestion. brief hospital course: 63 f w/ esrd iga nephropathy s/ failed crt on hd (mwf) through lue avf since , here w/ n/v/diarrhea and severe volume overload after missing session of hd from viral gastrointestinal illness.. 1. respiratory pt was intubated tachypnea and her increased wob. her respiratory failure was attributed to a likely viral illness with superimposed volume overload. she underwent emergent dialysis on and again on (removal of appx 3l of fluid) and was extubated on . she was spiking temperatures and her cxr on showed a new infiltrate and thus cefepime was added to her vancomycin for coverage of hcap given her exposures at dialysis sessions. she was out for flu with a viral respiratory panel. her respiratory status improved greatly after several days of dialysis. treatment for health-care associated pneumonia with vancomycin/cefepime was completed for 7 day course through (and one more dose of vanco on during hd). 2. esrd/hyperkalemia- patient presented w/ hyperkalemia esrd and her missed dialysis session. her hyperkalemia did not improve w/ calcium gluconate, insulin, kayexalate, but improved after hd. patien had underlying swelling of her left ue near the site of her avf and had planned for a fistulogram as an outpatient. this was scheduled for her as inpatient prior to transfer to the floor. she received two dialysis sessions with 3l removed before being transferred to the floor with improvement in respiratory status. she had an iv fistulagram, and her fistula was dilated with a balloon. she will return to her normal dialysis schedule upon discharge. 3. atrial fibrillation: patient presented with af with aberrancy in the 110s-130s in the ed. she was initially continued on the esmolol drip but this was weaned soon after she arrived on the floor. she was continued on her home amiodarone with good rate control. she underwent a tte to rule out structural abnormality which showed a question of restrictive cardiomyopathy/stiffened myocardium suggestive of amyloidosis. her coumadin was held as she was going for ir fistulogram with likely dilation planned. once dilation was completes, she was restarted on coumadin per her home dosing with instructions to have inr checked the day after discharge. 4. hypertension medications on admission: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. calcium acetate 667 mg capsule sig: three (3) capsule po tid w/meals (3 times a day with meals). 3. citalopram 40 mg tablet sig: one (1) tablet po once a day. 4. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. sevelamer carbonate 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). 7. norvasc 10 mg tablet sig: one (1) tablet po once a day. 8. sensipar 60 mg tablet sig: one (1) tablet po twice a day. 9. coumadin 2 mg tablet sig: asdir tablet po asdir: 4mg on monday and friday, 2mg all other days. 10. kayexalate powder sig: one (1) dose po asdir: take every sunday and monday. discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. warfarin 2 mg tablet sig: one (1) tablet po tueswedthursatsun (). 3. warfarin 2 mg tablet sig: two (2) tablet po monfri (). 4. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 5. calcium acetate 667 mg capsule sig: three (3) capsule po tid w/meals. 6. amlodipine 5 mg tablet sig: two (2) tablet po m w f sun) hold on dialysis days . 7. sensipar 60 mg tablet sig: one (1) tablet po twice a day. 8. citalopram 40 mg tablet sig: 1.5 tablets po once a day. 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. sevelamer carbonate 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). 11. sodium polystyrene sulfonate powder sig: fifteen (15) grams po every sun mon. 12. vancomycin in d5w 1 gram/200 ml piggyback sig: 1000 (1000) mg intravenous hd protocol (hd protochol) for 1 days. disp:*1000 mg* refills:*0* 13. carvedilol 3.125 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: - end-stage renal disease - pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: ms. , you were seen in the hospital because of shortness of breath. this shortness of breath was likely secondary to volume overload from missing dialysis. you had a breathing tube placed in the emergency room to help your breathing. once the fluid was removed from your lungs with several days of dialysis, the breathing tube was able to be safely removed. while you were in the hospital, you also were treated for a pneumonia with iv antibiotics. you will receive vancomycin for one more day (monday ) during your dialysis session. we made the following changes to your medications: - started iv vancomycin as above. you will receive this one more time with hd. - started carvedilol 3.125mg daily for your high blood pressure. - increased your citalopram from 40 mg daily to 60 mg daily. please note that we discharged you on the same coumadin dose you were taking before you arrived. however, your inr is only 1.3 on discharge. you should call you clinic at on monday asap at to get your inr checked and your coumadin dose adjusted. because of your renal disease and heart failure, you should weigh yourself every morning, and call your doctor if weight goes up more than 3 lbs. it was a pleasure taking care of you during your hospital stay. followup instructions: department: post clinic when: thursday at 8:40 am with: dr building: sc clinical ctr campus: east best parking: garage this appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. this visit, you will see your regular primary care doctor in follow up. department: cognitive neurology unit when: friday at 1 pm with: , phd building: ks building (/ complex) campus: east best parking: main garage department: cardiac services when: wednesday at 9:40 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube hemodialysis angioplasty of other non-coronary vessel(s) procedure on single vessel diagnoses: other primary cardiomyopathies hyperpotassemia end stage renal disease renal dialysis status congestive heart failure, unspecified atrial fibrillation acute on chronic diastolic heart failure hematoma complicating a procedure personal history of tobacco use depressive disorder, not elsewhere classified paroxysmal ventricular tachycardia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure pneumonitis due to inhalation of food or vomitus compression of vein long-term (current) use of anticoagulants surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation complications of transplanted kidney hypertensive chronic kidney disease, benign, with chronic kidney disease stage v or end stage renal disease bacterial pneumonia, unspecified 

Answer: The patient is high likely exposed to