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: codeine / oxycodone attending: chief complaint: hypotension, diarrhea major surgical or invasive procedure: arterial line history of present illness: 89 year old male with htn, chf (ef 40%), chronic aspiration, celiac sprue and recently diagnosed iga nephropathy with hemodialysis initiation in and subsequent transfer to a nursing home, who presents with a 2 weeks history of diarrhea, found to be hypotensive at rehab. . the patient states that he has been having diarrhea for the last week or so at rehab. he describes the diarrhea as soft stool (not entirely unusual for him given his celiac disease), about 7 or so times per 24 hours. he is not sure whether or not it is bloody. he has become progressively more fatigued over the week, but otherwise has been feeling well. he denies any fevers or chills, dysuria, cough, shortness of breath. . of note, he had a recent hospitalization at in for acute on chronic renal failure at which time he was diagnosed with iga nephropathy and started on hd. during this hospitalization he was diagnosed with c. diff which was treated initially with flagyl, but later changed to po vancomycin given concern that flagyl was contributing to mental status changes. he completed a course of treatment at this time, extended to last 5 days after completion of concurrent antibiotics for a pneumonia. he reports symptomatic improvement in the interim. . on arrival to the ed, vitals were 98.6, 112, 80/42, rr 20, 100% on ra. his blood pressure subsequently dropped to 69/39. he received 2l ivf while in the ed. a femoral line was attempted unsuccessfully. he received levofloxacin and flagyl. while in the ed he was noted to have 2-3 episodes of ventricular tachycardia on telemetry lasting about 15 seconds during which time he was asymptomatic. an ekg after the episodes demonstrated sinus tachycardia with t wave flattening throughout the precordium, no st segment changes. 1st set of enzymes with troponin elevation, though normal ck. patient denied any chest pain currently, or in the past. he was given asa 325 mg x 1 and transferred to the micu. code confirmed as dnr/dni. past medical history: 1) hypertension 2) biventricular chf: last echo . lvef 40%, with rv systolic function mildly depressed as well. also with signs of diastolic dysfunction. 3) gout 4) chronic renal insufficiency with superimposed acute renal failure; renal biopsy in with iga nephropathy. started on hd during hospitalization in . 5) celiac sprue 6) history of aspiration pneumonia 7) history of mrsa pneumonia 8) history of clostridium difficile infection 9) anemia of chronic inflammation social history: patient currently living in a nursing home since last admission. prior to this he was living at home with his wife and daughter in , who helps take care of them. his wife is 86; they have been married for 59 years, and have 3 children, two of whom are in the area. he used to drink a drink or so per day; denies any heavy drinking, and hasn't drank in about a year. he used to smoke a ppd for many years, but quit 20 years ago. denies ivdu. family history: non-contributory. physical exam: t 95.4, bp 60/22, hr 68, rr 15, 100% on ra. i/o: /0 in ed, 450 since arrival to micu. gen: cachectic caucasian male, conversant, resting comfortably in bed. heent: dry mucous membraines. neck: strong carotid upstrokes. jvp not elevated. cor: rr, normal rate, no murmurs, rubs, or gallops, though heart sounds are distant. lungs: clear to auscultation bilaterally with decreased breath sounds at l base and dullness to percussion. abd: normoactive bowel sounds, soft, non-tender, non-distended. groin: r groin with bandage in place, no bruit or hematoma. extr: extremities warm. no edema. rectal: per ed, guaiac negative. pertinent results: admission laboratories: 06:45pm wbc-29.4*# rbc-3.90*# hgb-12.9*# hct-42.8# mcv-110* mch-32.9* mchc-30.0* rdw-21.2* 06:45pm neuts-68 bands-27* lymphs-2* monos-0 eos-2 basos-0 atyps-1* metas-0 myelos-0 . 06:45pm glucose-119* urea n-31* creat-4.3*# sodium-144 potassium-4.2 chloride-102 total co2-26 anion gap-20 06:45pm calcium-8.3* phosphate-2.4*# magnesium-1.9 . 06:45pm pt-14.1* ptt-27.6 inr(pt)-1.3* . discharge laboratories: 05:30am blood wbc-6.4 rbc-3.21* hgb-10.5* hct-33.1* mcv-103* mch-32.6* mchc-31.7 rdw-22.9* plt ct-134* . 05:30am blood glucose-78 urean-35* creat-3.2* na-141 k-4.5 cl-105 hco3-27 angap-14 06:10am blood albumin-1.7* calcium-7.5* phos-3.3 mg-2.1 . 06:10am blood pt-16.3* ptt-35.4* inr(pt)-1.5* . culture data: blood cultures ( and ): negative stool c diff (, , and ): negative . 02:39am stool clostridium difficile toxin b assay-detected brief hospital course: 1) hypotension: on admission, there was clinical concern for sepsis given hypotension, leukocytosis, and hypothermia. he was covered empirically with broad spectrum antibiotics (vancomycin, levofloxacin, and metronidazole). however, cultures remained negative, and he responded promptly to aggressive fluid resuscitation. he was given ivf boluses to maintain a map > 55. by hd #, he was maintaining adequate blood pressures without fluid boluses. he completed a 7 day course of levofloxacin. flagyl was changed to vanco po for tx of c diff. a cosyntropin stimulation test was normal. . 2) diarrhea: felt most likely from c. diff colitis. he was started on empiric metronidazole on admission and stool samples sent for c diff toxin assay. toxin a assays returned negative x 3, and toxin b assay was sent. his diarrhea improved somewhat with empiric metronidazole therapy, but continued to persist. despite negative laboratory data, there was high clinical suspicion for c diff. oral vancomycin was added for coverage of metronidazole resistant c diff, with prompt response and near resolution of his diarrhea. c diff tox b assay returned positive the day prior to discharge. by that time, he was having semiformed bowel movements per day. . 4) ventricular tachycardia: he had ventricular tachycardia in the ed, possibly secondary to chronic scar given biventricular failure. he had no signs of active ischemia. troponin was chronically elevated and unreliable in setting of end stage renal disease, with a normal ck. he had no further ventricular tachycardia on telemetry. . 5) atrial tachycardia: he had intermittent atrial tachycardia during his hospitalization, with a rate of around 100. he seemed to tolerate this well, without associated hypotension or symptoms. his outpatient regimen of low dose metoprolol was resumed prior to discharge. . 6) iga nephropathy/esrd: dialysis was held for a number of days after admission as his electrolytes continued to remain within normal limits and he was not fluid overloaded even after aggressive fluid resuscitation. dialysis was eventually resumed, with last session prior to discharge on . he was continued on epogen 5000 units qhd and nephrocaps. phosphate binders were held as his phosphate was low. . 7) chf: he had a history of biventricular heart failure, both systolic and diastolic, therefore fluids were given judiciously initially. he continued to appear hypovolemic by exam, and never had any signs of fluid overload other than mild bipedal edema. . 8) mixed respiratory and metabolic acidosis: he initially had what appeared to be an acute respiratory acidosis based on abg, with additional metabolic ag acidosis (ag at 16, and expected much lower given last albumin 2.2), in part secondary to lactic acidosis, possibly also contribution of unmeasured anions in renal failure. it is unclear what caused his respiratory acidosis. his metabolic acidosis resolved with treatment of his sepsis and decrease in his lactate. . 9) eosinophilia: he was noted to have a chronic eosinophilia. a cortisol level was checked to rule out addison's disease, which was normal. . 10) chronic tophaceous gout: continued on allopurinol. . 11) celiac sprue: continued a gluten-free diet and pancreatic enzyme replacement. . 12) thrombocytopenia: noted to have thrombocytopenia during the last hospitalization at which time a hit antibody was negative. his thrombocytopenia was felt secondary to medications (though unclear which ones), and nadired at 51. during this hospitalization his platelets were in the low 100 range. it was noted that he has a concurrent anemia with elevated mcv (with normal b12), and large platelet forms. this could possibly represent myelodysplastic syndrome an outpatient hematology consult is something to consider should his blood counts worsen. . 13) anemia: see above regarding possibile mds. he was severely hemoconcentrated on admission with a hematocrit > 40, dropping to 30 the following day after aggressive ivf hydration. his hematocrit subsequently remained at around 33, which is near his baseline. . 14) corneal ulcerations: diagnosed with bilateral exposure keratopathy and corneal ulcerations by ophtho during last admission. continued natural tears in house. . 15) fen: he was advanced to a pureed, gluten free diet with thickened liquids once clinically stable. after a repeat swallow evaluation with video swallow study, he was advanced to thin liquids, but maintained on pureed solids. . 16) his code status was verified as dnr/dni. . pcp . (). medications on admission: acetaminophen 500 mg q6 hours milk of magnesia prn, bisacodyl prn methylphenidate 10 mg po qam pancrease 1 cap po before meals tid cyanocobalamin 500 mcg po daily allopurinol 100 mg po qod folic acid 1 mg po daily vitamin c 500 mg po daily calcium acetate 667 mg po tid with meals cholestyramine 1 packet po q 8 hours chlorhexidine 30 ml? ophthalmic lubricant 1 application ou daily nephrocaps 1 tab po daily metoprolol 12.5 mg po tid discharge medications: 1. methylphenidate 10 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 2. amylase-lipase-protease 20,000-4,500- 25,000 unit capsule, delayed release(e.c.) sig: one (1) cap po tid w/meals (3 times a day with meals). 3. cyanocobalamin 500 mcg tablet sig: one (1) tablet po daily (daily). 4. allopurinol 100 mg tablet sig: one (1) tablet po every other day (every other day). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 7. polyvinyl alcohol 1.4 % drops sig: two (2) drop ophthalmic daily (daily). 8. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 9. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 14 days. 10. epoetin alfa injection 11. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). discharge disposition: extended care facility: armenian nursing & rehabilitation center - discharge diagnosis: clostridium difficile collitis diarrhea hypotension secondary to dehydration end stage renal disease on hemodialysis chronic tophaceous gout celiac sprue exposure keratopathy discharge condition: stable, resolved diarrhea, stable blood pressure discharge instructions: 1) continue your medications as prescribed. - you were started on an antibiotic called vancomycin for an infection causing your diarrhea. continue for 2 weeks. 2) weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet. fluid restriction: 1.5l 3) follow up as directed below. 4) call if you have worsened diarrhea, abdominal pain, lightheadedness, chest pain, shortness of breath, nausea, fevers, or any other concerns. followup instructions: follow up with dr . call to schedule. md procedure: hemodialysis arterial catheterization diagnoses: acidosis end stage renal disease congestive heart failure, unspecified unspecified septicemia unspecified protein-calorie malnutrition severe sepsis paroxysmal ventricular tachycardia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease septic shock intestinal infection due to clostridium difficile celiac disease hypovolemia hyperosmolality and/or hypernatremia chronic diastolic heart failure nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney 

Answer: The patient is high likely exposed to