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: nausea major surgical or invasive procedure: ercp cardioversion history of present illness: 53 yo f patient of the good dr. with a past medical history significant for esrd, dm, hcv, htn, chf, now with one day of abd pain and emesis. patient reports she was at the store when she felt onset of intense nausea and suprapubic/epigastric pain. pt has had vomitting but unable to quantify how many times. denies constipation, diarrhea, fevers, chills, hematemesis. denies etoh ingestion or abuse of naroctic medications. also denies illicits. although pt has a history of missing hd appointments, she was at her last dialysis session on friday. . in the ed, patient vs significant for 97.1 88 171/85 16 99 on ra. ua looked positive. abdomen was noted to be soft, and patient was without cva tenderness. cbc without leukocytosis. nauasea responded to zofran 4mg ivx1 and gi cocktain, and abd pain responded to morphine 2mg ivx1. patient was given ns 500 cc. no abx were administered, though levaquin was ordered as a one time dose. ct a/p prelim read significant for small hiatal hernia, but no other noted abnormalities. patient was transferred to the dialysis unit prior to transfer to the medicine floor. at hd, pat had uf 1.3 l off. initially htn 200/94, but decreased to 138/79 with uf. noted to be somnolent at hd, but was not noted to be somnolent in the ed. . of note, patient was admitted with headache to to . she presented with ha that was felt to be consistent with migraines. headache improved with better bp control. patient high blood pressures likely due to missed hd appointment prior to admission. she as continued on home antihypertensive regimen. pt was originally treated with ctx for positive ua, and cx only grew mixed . . at the time of this assessment, patient lethargic but arousable. she is a poor historian secondary to lethargy and slow response. she is reporting vague suprapubic pain, pain at hd line, and ha consistent with her migraine. she is no long having nausea. she denies tongue biting and loss of bowel/bladder continence. . ros was otherwise essentially negative. the pt denied recent unintended weight loss, fevers, night sweats, chills, dizziness or vertigo, changes in hearing or vision, including amaurosis fugax, neck stiffness, lymphadenopathy, hematemesis, coffee-ground emesis, dysphagia, odynophagia, diarrhea, constipation, steatorrhea, melena, hematochezia, cough, hemoptysis, wheezing, shortness of breath, chest pain, palpitations, dyspnea on exertion, increasing lower extremity swelling, orthpnea, paroxysmal nocturnal dyspnea, leg pain while walking, joint pain. past medical history: -coag-neg staph (mrse) hd line infection, catheter changed over a wire on , on vancomycin -esrd on hd, on hd since . -dm2 -htn -hyperlipidemia -hep c -chronic diastolic chf (ef 75% in ) -lll segmental pe () -migraine -depression -narcotic dependence, on methadone -lymphedema -l heel pressure ulcer - ? h/o of seizure one year ago - not on ppx - fracture to her left leg and right wrist in at the social history: lives with mother . former employee of social services/dss. 2 sons, 1 daughter. 1 son was murdered (). smokes 1/2ppd x 20 years. rare etoh. last snorted heroin in . denies ivdu. family history: brother died of mi at 56. father died of cva @ 85. mother has sle, htn, asthma. physical exam: on admission vitals: t: 97.3 bp: 154/90 p: 88 r: 20 sao2: 98% ra fs: 140 general: lethargic but arousable. nad. somewhat slow verbal response. heent: ncat, perrl, eomi, no scleral icterus, mmm, no lesions noted in op neck: supple, no significant jvd or carotid bruits appreciated pulmonary: distant breath sounds, no wheezes, ronchi or rales cardiac: rr, nl s1 s2, no murmurs, rubs or gallops appreciated abdomen: soft, nt, nd, normoactive bowel sounds, no masses or organomegaly noted. neg. . extremities: 2+ le edema, 2+ radial, dp pulses b/l. no cva tenderness. right side wrist swelling, nontender. lymphatics: no cervical, supraclavicular, axillary or inguinal lymphadenopathy noted skin: no rashes or lesions noted. neurologic: alert, oriented x 3. noted difficulty relating history, marked mostly by slow response but answers are accurate and appropriate. cranial nerves ii-xii intact. 4/5 strength throughout. with lifting of arms, marked tremulousness, but no asterexis. no deficits to light touch throughout. pertinent results: ========= labs ========= 09:00am blood wbc-7.9 rbc-4.08* hgb-12.3 hct-38.7 mcv-95 mch-30.1 mchc-31.7 rdw-17.6* plt ct-173 01:51pm blood wbc-10.0 rbc-4.34 hgb-12.8 hct-40.2 mcv-93 mch-29.6 mchc-32.0 rdw-16.9* plt ct-203 08:00am blood wbc-9.8 rbc-4.46 hgb-13.4 hct-42.3 mcv-95 mch-30.1 mchc-31.8 rdw-16.7* plt ct-223 09:22am blood wbc-9.3 rbc-4.61 hgb-13.4 hct-43.7 mcv-95 mch-29.1 mchc-30.6* rdw-16.5* plt ct-250 05:15am blood wbc-9.1 rbc-4.18* hgb-12.6 hct-39.7 mcv-95 mch-30.2 mchc-31.8 rdw-16.2* plt ct-230 06:59am blood wbc-6.0 rbc-3.24* hgb-9.6* hct-30.4* mcv-94 mch-29.7 mchc-31.6 rdw-16.0* plt ct-180 05:18am blood wbc-5.2 rbc-3.18* hgb-9.6* hct-29.7* mcv-93 mch-30.1 mchc-32.3 rdw-15.6* plt ct-157 09:00am blood alt-46* ast-31 ld(ldh)-223 alkphos-295* totbili-0.2 01:51pm blood alt-36 ast-40 ck(cpk)-70 alkphos-256* amylase-179* totbili-0.4 08:00am blood alt-41* ast-61* ld(ldh)-248 ck(cpk)-64 alkphos-251* amylase-151* totbili-0.6 09:22am blood alt-45* ast-63* alkphos-223* amylase-148* 01:51pm blood lipase-239* 08:00am blood lipase-85* 09:22am blood lipase-109* 03:00pm blood ck-mb-7 ctropnt-0.19* 01:51pm blood ck-mb-notdone ctropnt-0.44* 08:00am blood ck-mb-5 ctropnt-0.36* 09:22am blood ck-mb-8 ctropnt-0.34* ========= radiology ========= ct abdomen/pelvis 1. moderate-sized hiatal hernia with distal esophageal wall thickening, new from prior study. findings likely reflect esophagitis, and can be evaluated with endoscopy and/or upper gi. 2. diverticulosis without diverticulitis. 3. fibroid uterus. 4. oblong hyodense lesion adjacent to the left wall of the bladder, measuring 3.2 cm, similar in size from . this appears separate from the ovary, and is of uncertain significance or origin. an mr is recommended for further evaluation . ct head there is no evidence of infarction or hemorrhage. -white matter differentiation is preserved. the ventricles and sulci are normal in size and configuration. the calvarium and soft tissues are normal. the visualized paranasal sinuses and mastoid air cells are clear. . cxr in comparison with study of , the cardiac silhouette is again at the upper limits of normal in size with no evidence of vascular congestion, pleural effusion, or acute pneumonia. ========= micro ========= urine culture (final ): mixed bacterial ( >= 3 colony types), consistent with skin and/or genital contamination. 06:59am blood wbc-4.3 rbc-3.23* hgb-9.7* hct-29.6* mcv-92 mch-29.9 mchc-32.6 rdw-15.6* plt ct-177 05:18am blood wbc-5.2 rbc-3.18* hgb-9.6* hct-29.7* mcv-93 mch-30.1 mchc-32.3 rdw-15.6* plt ct-157 02:45pm blood hct-29.5* 09:22am blood neuts-55.4 lymphs-34.4 monos-9.3 eos-0.2 baso-0.6 06:59am blood plt ct-177 05:18am blood plt ct-157 12:44am blood pt-14.2* ptt-41.9* inr(pt)-1.2* 06:59am blood glucose-104 urean-45* creat-6.9* na-138 k-3.4 cl-96 hco3-30 angap-15 05:18am blood glucose-74 urean-40* creat-6.0*# na-141 k-3.7 cl-100 hco3-31 angap-14 06:59am blood glucose-63* urean-31* creat-4.8*# na-141 k-3.1* cl-97 hco3-32 angap-15 06:59am blood alt-38 ast-64* alkphos-148* amylase-138* 05:18am blood alt-39 ast-72* amylase-48 06:59am blood alt-38 ast-68* alkphos-150* totbili-0.5 06:59am blood lipase-36 05:18am blood lipase-23 06:59am blood ggt-224* 09:22am blood lipase-109* 09:22am blood ck-mb-8 ctropnt-0.34* 06:59am blood calcium-8.7 phos-5.6* mg-1.7 05:18am blood calcium-8.4 phos-6.3* mg-1.8 06:59am blood totprot-5.7* albumin-3.3* globuln-2.4 calcium-8.4 phos-5.3*# mg-1.8 09:00am blood %hba1c-7.2* 06:59am blood angiotensin 1 - converting -pnd 05:46am blood lactate-1.5 _ _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ blood cx, central line: staphylococcus, coagulase negative. isolated from one set only. corynebacterium species (diphtheroids). brief hospital course: ## abdominal pain: patient initially reported suprapubic pain, and medical team felt this was secondary to possible cystitis. however, by hd #2 pain was mostly isolated to ruq and labs were concerning for pancreatitis. ua significant for > 50 wbc, moderate le and few bacteria, but cx only shows mixed , less likely uti or pyelonephritis. cardiac enzymes elevated, but likely at baseline given renal dysfunction and prior biomarkers in the setting of esrd. an ercp was pursued that showed ulcers in the lower third of the esophagus and erythema and congestion in the duodenal bulb compatible with duodenitis. hiatal hernia. normal biliary tree and complete pancreas divisum. otherwise normal ercp to the third part of the duodenum. patient was started on double dose ppi and will need repeat egd with biopsies after 8weeks of therapy. diet was gradually advanced to regular and abdominal pain much improved. . ## change in ms: improved markedly by hd #2. likely over medication at home with methadone, ativan and seroquel. given persistent nausea, there was some concern for benzo withdrawal. patient was placed on a ciwa but did not require any administration. . ## svt: on , patient was found on routine vitals check to have tachycardia to the 130s. ekg was consistent with atrial flutter. at the time, patient did not have iv access. the medical team attempted peripheral access without success at first. a trial of po betablockers was initiated but hr did not respond. iv access was finally obtained and with a single dose of iv lopressor patient dropped her sbp to the 90s. in this setting, patient was transferred to the ccu team for further care. in the ccu, the patient was found to be in new atrial flutter. poorly controlled pain and adrenergic surge from pancreatitis was considered as the cause of new onset atrial flutter. the patient was initially treated with diltiazem iv with some rate control. she underwent a tte to rule out presence of thrombus, anticoagulated with a heparin drip, then underwent dc cardioversion. she remained in nsr following. as her tte showed evidence of lvh, she was also started on standing metoprolol. patient remained in nsr after transfer back to the floor. . ## esrd on hd: mwf schedule. patient continued on hd schedule. renal followed patient while in house. . ## dmii: last a1c 9.3 in . a1c 7.2 implying reasonable control over last several months. fs below 300 in house. patient continued lantus and iss in house with good blood sugar control. . ## anemia: patient's hematocrit remained around 29-30 while in house. her baseline appears to be 30-40. patient did have guiac positive stool in house therefore heparin gtt held. patient had a work up in for occult gi bleed with normal colonoscopy and egd demonstrating erythema in antrum consistent with gastritis. . ## depression: patient continued on celexa. . ## chronic pain: patient continued on methadone and given po morphine for breakthrough pain secondary to pancreatitis. . ## oblong hypodense lesion in bladder noted incidentally on ct of abdomen and pelvis. patient will need mri follow up as outpatient. . ## elevated tsh: tsh elevated to 4.3 during admission. patient will need outpatient thyroid function tests to evaluate for possible hypothyroidism. . ##: blood culture: one set of blood culture from patient's central line grew coag neg staph and diphtheroids. line was pulled and patient demonstrated no signs of infection therefore this was thought to be contenement. medications on admission: aspirin 81 mg po daily methadone 20 mg po tid atorvastatin 20 mg po daily omeprazole 20 mg po daily senna 8.6 mg tablet po bid cholecalciferol (vitamin d3) 400 unit tablet po daily docusate sodium 100 mg po bid nephrocaps 1 tab po daily quetiapine 100 mg po qhs calcium acetate 1334 mg po tid citalopram 20 mg po daily nicotine 14 mg/24 hr patch amlodipine 5 mg po daily lantus 8 u qhs lisinopril 40 mg po daily discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*0* 2. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* 5. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 6. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 7. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). 8. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 9. methadone 10 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*0* 10. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*0* 11. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 13. quetiapine 25 mg tablet sig: one (1) tablet po once (once) for 1 doses. 14. oxycodone 5 mg capsule sig: one (1) capsule po every hours as needed for pain. disp:*25 capsule(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: pancreatitis gastritis atrial flutter discharge condition: stable discharge instructions: you were admitted for nausea, vomiting, and abdominal pain and developed atrial flutter. you were transferred to the intensive care unit where you were cardioverted and your heart rate returned to rate and rhythm. with regard to your abdominal pain, you underwent ercp which demonstrated severe severe esophagitis. you were given morphine for pain and started on a medication called protonix for your esophagitis. please avoid nsaids including ibuprofen, motrin, advil. . with regard to your medications, your lisinopril was decreased to 10mg daily and you were started on metoprolol 12.5mg 2xday. . on ct scan of your abdomen lesion was noted in your bladder. you will need a follow up mri as outpatient arranged by your pcp to further evaluate this. . your thyroid hormone (tsh) was elevated during this admission. you will need further thyroid tests as an outpatient to fully evaluate this. . please call you doctor if you have chest pain, shortness of breath, nausea, vomiting, increased abdominal pain, or any questions or concerns. please keep your follow up appointments as outlined below. followup instructions: , md phone: date/time: 3:00 (cardiology) , m.d. phone: date/time: 3:00 (nephrology) provider: , md phone: date/time: 9:00 (gastroenterology) 02:30p ,, md ctr, medical unit (primary provider) procedure: venous catheterization, not elsewhere classified hemodialysis atrial cardioversion endoscopic retrograde cholangiopancreatography [ercp] diagnoses: end stage renal disease anemia, unspecified congestive heart failure, unspecified chronic hepatitis c without mention of hepatic coma diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled depressive disorder, not elsewhere classified atrial flutter poisoning by benzodiazepine-based tranquilizers accidental poisoning by benzodiazepine-based tranquilizers hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease poisoning by other antipsychotics, neuroleptics, and major tranquilizers esophagitis, unspecified migraine, unspecified, without mention of intractable migraine without mention of status migrainosus unspecified gastritis and gastroduodenitis, without mention of hemorrhage acute pancreatitis chronic diastolic heart failure unspecified disease of pancreas poisoning by methadone accidental poisoning by methadone accidental poisoning by other specified tranquilizers 

Answer: The patient is high likely exposed to