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: history of present illness: the patient is a 53-year-old female with a history of coronary artery disease (status post myocardial infarction times two and left anterior descending artery stent), end-stage renal disease (on peritoneal dialysis secondary to antineutrophil cytoplasmic antibody positive glomerulonephritis, status post transplant in which failed), and hypertension who was admitted to the medical intensive care unit for worsening shortness of breath, increased edema, and decreased oxygen saturations thought secondary to malfunctioning peritoneal dialysis catheter. the patient reports that the peritoneal dialysis catheter had decreased drainage over the last two to three days prior to admission. review of systems: review of systems at the time of medical intensive care unit admission was only positive for a slight cough with minimal clear sputum. otherwise, no nausea, vomiting, or diarrhea. no fevers or chills. no chest pain. no palpitations. no dizziness. no pain or drainage at the catheter site. initially, in the emergency department, the patient was found to have oxygen saturation on room air of 92%. the patient was treated with 40 mg of intravenous lasix and a nitroglycerin drip with a decrease in her blood pressure. the patient was then started on -level positive airway pressure with correction of her oxygen saturations. the patient was admitted to the medical intensive care unit for catheter placement for hemodialysis for hypervolemia and peritoneal cultures were obtained. in the medical intensive care unit, a hemodialysis catheter was placed and the patient received hemodialysis on the evening of and in the morning of . the renal team recommended giving the patient lactulose 30 ml by mouth q.6h. times 24 hours for repositioning of the peritoneal dialysis catheter and a repeat abdominal x-ray on in the morning to assess repositioning (the dialysis catheter was possibly positioned too high in the abdomen). the patient was transferred to the medicine service today for further management. currently, the patient is without complaints. she denies any shortness of breath, chest pain, nausea, or vomiting. she was given kayexalate to decrease her potassium and now with complaints of mild gassy pain. the patient had a low-grade temperature of 100.2 degrees fahrenheit with no chills. she does have a cough with clear sputum. otherwise, review of systems was negative. the patient had eight bowel movements today after kayexalate. past medical history: 1. end-stage renal disease (on peritoneal dialysis for the last two to three years). this secondary to positive antineutrophil cytoplasmic antibody and positive glomerulonephritis status post transplant in which failed. the patient was temporarily switched from peritoneal dialysis to hemodialysis in secondary to ventral hernia repair. 2. coronary artery disease; status post myocardial infarction times two with stents to the left anterior descending artery. 3. hypertension. 4. hypercholesterolemia. 5. scleroderma. 6. chronic right upper lobe mass. 7. claudication. 8. gastrointestinal bleed secondary to anticoagulation. 9. cardiomyopathy. 10. status post ventral hernia repair. medications on admission: (medications prior to admission included) 1. zestril 5 mg by mouth once per day. 2. lipitor 20 mg by mouth once per day. 3. calcitriol. 4. iron supplements 325 mg by mouth once per day. 5. nephrocaps. 6. epogen. 7. senna. 8. colace. 9. lactulose as needed. 10. renagel. 11. toprol-xl. 12. potassium supplements 10 meq by mouth once per day. medications on transfer: (medications on transfer to the floor included) 1. colace 100 mg by mouth twice per day. 2. senna one to two tablets by mouth twice per day. 3. doxercalciferol 2.5 mcg by mouth every day. 4. iron supplements 325 mg by mouth once per day. 5. sevelamer 800 mg by mouth three times per day. 6. nephrocaps one tablet by mouth once per day. 7. protonix 40 mg by mouth once per day. 8. atorvastatin 20 mg by mouth once per day. 9. toprol-xl 25 mg by mouth once per day. 10. epogen 15,000 units two times per week (on sunday and tuesday). 11. calcium carbonate 1250 mg by mouth three times per day 12. lisinopril 5 mg by mouth once per day. 13. lactulose 30 ml by mouth four times per day. allergies: no known drug allergies. social history: the patient lives with her husband and two children. she smokes one half of a pack of cigarettes per day. still with occasional alcohol use. no intravenous drug abuse. family history: family history was noncontributory. physical examination on presentation: physical examination revealed the patient's temperature was 101.2 degrees fahrenheit, her blood pressure was 145/78 (with a range of 112 to 145/55 to 78), her heart rate was 68 to 84, her respiratory rate was 16 to 22, and her oxygen saturation was 97% on room air. in general, the patient was alert and oriented times three. she was sitting comfortably and eating. she was in no apparent distress. head, eyes, ears, nose, and throat examination revealed pupils were equal, round, and reactive to light. the extraocular movements were intact. the oropharynx was clear. no lesions. no exudates. the mucous membranes were moist. the neck was supple and nontender. no jugular venous distention. no lymphadenopathy. pulmonary examination revealed bibasilar crackles. cardiovascular examination revealed a regular rate and rhythm. no murmurs, rubs, or gallops. the abdomen was soft, mildly distended, nontender, with positive peritoneal dialysis catheter in place with no drainage. there were normal active bowel sounds. extremity examination revealed needed. no calf tenderness. dorsalis pedis and posterior tibialis pulses were present bilaterally in the lower extremities. positive contractures in the left and right hands and feet; consistent with scleroderma. pertinent laboratory values on presentation: laboratories on admission revealed the patient's white blood cell count was 8.9, her hematocrit was 28.1, and her platelets were 152. the patient's sodium was 139, potassium was 5.1 (this sample was hemolyzed; previous sample was 4.2 just a few hours prior), chloride was 101, bicarbonate was 26, blood urea nitrogen was 43, creatinine was 10.3, and blood glucose was 87. her calcium was 8.6, her magnesium was 2.3, and her phosphorous was 5.4. hepatitis b surface antigen was negative. her creatine kinases were 56 and 48. her troponin was 0.12 and 0.15. her lactate level was 1.5. peritoneal dialysis catheter fluid showed gram stain with 2+ polymorphonuclear leukocytes, no microorganisms, and the culture was pending. assessment: the patient is a 53-year-old female with a history of coronary artery disease and end-stage renal disease (on peritoneal dialysis) who was admitted for pulmonary edema to the medical intensive care unit. this was most likely secondary to malpositioned peritoneal dialysis catheter. the patient was transferred to the medicine floor for further management. concise summary of hospital course by issue/system: 1. malpositioned peritoneal dialysis catheter issues: the renal service was consulted and followed the patient closely. a repeat abdominal x-ray after the morning of transfer on did not show improvement in the positioning of the peritoneal dialysis catheter; although, the catheter had indeed moved from the upper abdomen to the lower abdomen. lactulose 30 ml by mouth four times per day was initially given to increase gut motility in the hopes that the peritoneal dialysis catheter would reposition itself, but this was subsequently decreased in frequency of dosing and was only used as needed for constipation after it was shown to not be effective in repositioning the catheter. transplant surgery service was consulted to assess the necessity for surgical repositioning of the catheter, and they determined that the patient would most likely need repair laparoscopically or by an open procedure. the patient was tentatively scheduled for repositioning of this catheter on ; however, it was found that her peritoneal fluid may indicate possible peritonitis (described further below). because of the concern for infection, the patient's surgery was postponed; presumably until the infection would clear. however, the patient waited for over one week to have the peritoneal dialysis catheter repositioned. it was eventually determined that the patient would not be able to have the peritoneal dialysis catheter repositioned during this hospital admission since the transplant surgery schedule could not allow for this. thus, the patient was discharged with a perm-a-cath in place and was scheduled at the time of discharge for wednesday, , at 11:45 a.m. for peritoneal dialysis catheter adjustment to be done immediately after her hemodialysis treatment. the patient was instructed that should would have to keep nothing by mouth after midnight on the tuesday prior to this surgery. 2. end-stage renal disease issues: the patient's quinton catheter was pulled soon after her transfer to the medicine floor in anticipation of peritoneal dialysis catheter adjustment which was thought to be performed in one to two days after her transfer to the floor. however, with the development of the patient's positive cell count for peritonitis in her peritoneal fluid (to be described below), the patient's surgery was postponed to an indefinite date, and the patient had a temporary right internal jugular line placed by interventional radiology. when it became evident that the patient would not be receiving transplant surgery until an outpatient, she had this line removed by interventional radiology and a new perm-a-cath was placed. the patient was discharged with the new perm-a-cath tunneled catheter, and she had a hemodialysis appointment scheduled for monday, , at 4:30 p.m. and on wednesday, , at 6:30 a.m. in the meantime, the patient was continued on her nephrocaps, doxercalciferol, and sevelamer. her renal function remained stable throughout her hospital course. 3. infectious disease/peritonitis issues: on transfer to the medicine floor, the patient spiked a temperature to 101 degrees fahrenheit; although she appeared clinically stable. her abdominal examination remained benign. she was given one dose of gentamicin and vancomycin, and blood cultures were sent. the peritoneal dialysis fluid that was sent from the medical intensive care unit showed no organisms on culture and never had any growth. however, a cell count could not be added since it was not initially sent for, and the laboratory stated that the specimen was too old to have an additional cell count added on. thus, the patient had peritoneal fluid removed from the peritoneal dialysis catheter on during her hemodialysis treatment. this peritoneal dialysis fluid revealed a very high white blood cell count of 4775 cells, 30 red blood cells, 72% polys, 8% lymphocytes, 9% monocytes, and 1% eosinophils. the peritoneal dialysis fluid from the same date still revealed nothing on culture. this increased white blood cell count was worrisome for peritonitis secondary to her peritoneal dialysis catheter, even though the patient showed no clinical signs of peritonitis. transplant surgery was temporarily postponed for the malpositioned peritoneal dialysis catheter, and the patient was started empirically on cefazolin and ceftazidime for empiric coverage; recommended by the renal service for peritonitis secondary to peritoneal dialysis catheter. the patient was given antibiotics for a total of seven days, and the repeat fluid count on showed a significantly decreased white blood cell count of 145 and still no growth on cultures. on the fifth day of treatment with cefazolin and ceftazidime, the patient then began to manifest a generalized rash consistent with a drug rash. the cephalosporins were discontinued secondary to a presumed allergy, and the patient was given one dose of vancomycin for empiric coverage and was started on levofloxacin to finish a total of a 10-day course (she was given one dose of vancomycin and her levels remained therapeutic and she was given five more days of by mouth levofloxacin). the patient remained afebrile, and her rash soon resolved. the patient completed her entire course of antibiotics prior to discharge. 4. hypertension issues: the patient's blood pressures remained in a good range, and the patient was temporarily taken off her metoprolol and lisinopril when she demonstrated lower blood pressures during hemodialysis. these medications will likely be held until the patient is placed back on peritoneal dialysis, and they can be added on in the outpatient setting. 5. anemia issues: the patient continued to have a baseline low hemoglobin and hematocrit. she was continued on her iron supplements, epogen, and vitamin c was added to increase iron absorption. the renal team was asked whether we should consider increasing the dosage of epogen she was given twice weekly, but the renal team suggested that this be considered as an outpatient. 6. electrolyte issues: the patient's electrolytes remained stable after her hemodialysis treatments. she was continued on sevelamer for phos-binding which was increased to 1600 mg by mouth three times per day. calcium carbonate tablets were discontinued since her calcium was high. 7. coronary artery disease issues: the patient had slightly elevated troponin levels upon transfer to the medicine floor which was thought likely secondary to the patient's renal insufficiency. the patient showed no electrocardiogram changes. she had one episode of chest pain, and an electrocardiogram at that time showed slightly more prominent st-t wave changes. however, given that the patient's pain was not typical angina for her, and since she had a negative stress echocardiogram in (and per dr. has had a more recent negative echocardiogram), a further workup was deferred at that time. the patient remained asymptomatic for the rest of her hospitalization with no further episodes of chest pain. 8. pulmonary edema issues: the patient's pulmonary edema resolved after transfer to the medicine floor from the medical intensive care unit. the patient remained in good pulmonary status and had good oxygen saturations during her entire hospitalization. the pulmonary edema seemed to have resolved after diuresis with lasix in the medical intensive care unit. discharge disposition: the patient was discharged after her last hemodialysis appointment on . the patient was to have appropriate followup with dr. and hemodialysis appointment scheduled on monday, as well as wednesday, with presumed peritoneal dialysis catheter adjustment on wednesday, , after hemodialysis. condition at discharge: condition on discharge was stable. discharge status: the patient's discharge status was to home. discharge diagnoses: 1. congestive heart failure exacerbation secondary to peritoneal dialysis catheter malfunction. 2. peritonitis. 3. end-stage renal disease (now on hemodialysis). 4. scleroderma. 5. coronary artery disease. 6. hypertension. 7. hypercholesterolemia. 8. anemia. 9. chronic right upper lobe mass. medications on discharge: 1. atorvastatin 20 mg by mouth once per day. 2. protonix 40 mg by mouth once per day. 3. vitamin b complex/vitamin c/folic acid 1-mg tablet one tablet by mouth every day. 4. iron sulfate 325 mg by mouth once per day. 5. senna one tablet by mouth twice per day. 6. colace 100 mg by mouth twice per day. 7. sevelamer 1600 mg by mouth three times per day. 8. doxercalciferol 2.5 mcg by mouth every day. 9. epogen 15,000 units twice per week (on sunday and tuesday). 10. lactulose 30 ml by mouth twice per day as needed (for constipation). 11. vitamin c 500 mg by mouth once per day. discharge instructions/followup: 1. the patient was instructed to follow up with dr. at the on at 9:50 a.m. 2. the patient was scheduled for dialysis at on monday, , at 4:30 p.m. and on wednesday, , at 6:30 a.m. the patient was scheduled for surgery to readjust the peritoneal dialysis catheter at 11:45 a.m. directly after dialysis on wednesday, and the patient was instructed to remain nothing by mouth after midnight on tuesday night. 3. the patient was instructed to hold her blood pressure medications while she is on hemodialysis and then restart once she is back on peritoneal dialysis. 4. the patient was instructed to stop her calcium carbonate medication since she had high calcium levels. , m.d. dictated by: medquist36 d: 13:08 t: 08:41 job#: procedure: hemodialysis venous catheterization for renal dialysis non-invasive mechanical ventilation removal of peritoneal drainage device incision of peritoneum diagnoses: other primary cardiomyopathies anemia, unspecified congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease mechanical complication due to peritoneal dialysis catheter kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure complications of transplanted kidney unspecified peritonitis systemic sclerosis 

Answer: The patient is high likely exposed to