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: demerol attending: chief complaint: diarrhea, hypotension major surgical or invasive procedure: right internal jugular venous line history of present illness: ms. is a 69 year old woman with history of chronic diarrhea, sarcoid, and atrial fibrillation who presented to the ed this afternoon with hypotension. she went to her scheduled gi appointment the afternoon of admission at which time her blood pressure was found to be 80/40. she was referred to the ed for further workup. . she notes that for the past several weeks, she has felt weaker and has been less able to move around. she reports that she has lost > 60 pounds since her diarrhea began in . she has had some nausea, long-standing diarrhea which occurs with any food, and long-standing dyspnea on exertion. she was recently treated for a uti with a 7-day course of ciprofloxacin, completed 2-3 days ago. she denies current urinary symptoms. . in the ed, her vitals were: bp 81/46, hr 70, rr 16, sat 100%ra. her potassium was elevated at 6.1, and she was given calcium gluconate, dextrose, bicarb, and insulin, along with kayexalate. blood cultures were drawn, and she was given dose of ceftriaxone. in the context of hypotension, hyponatremia, and hyperkalemia, she was treated for presumed adrenal insufficiency and given dexamethasone 10mg x 1. her blood pressure initially responded to 2l ns with systolic blood pressures in the 110's, but then it decreased to 80's systolic. she received 4 more liters of normal saline. a central line was placed. blood cultures were drawn, u/a showed moderate leukocyte esterase, and cxr was negative; she was given one dose of ceftriaxone. . past medical history: -remote history of sarcoidosis. -status post ventral hernia repair ~15 years ago -status post clip to inferior vena cava ~25 years ago -status post total abdominal hysterectomy ~25 years ago -status post cholecystectomy ~25 years ago -chronic atrial fibrillation status post an avj ablation with permanent pacemaker implantation -restless leg syndrome -chronic pancreatitis . social history: she lives in with her husband. she drinks socially. she quit smoking 16 years ago after smoking one pack per day. denies illicit drug use. family history: grandfather with dm. no heart disease/cancer. physical exam: physical exam on admission: . vs: t97.0f, bp 89/38, hr 70, rr 17, sat 97%ra, cvp 15-26 gen: pleasant, mildly uncomfortable, no acute distress heent: perrl, eomi, anicteric, dry mucous membranes, op without lesions neck: no supraclavicular or cervical lymphadenopathy, neck veins flat; rij triple lumen catheter in place resp: mild expiratory wheezes bilaterally cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e, warm, 2+ pulses; trace edema bilaterally skin: no rashes/no jaundice neuro: alert and oriented, conversational . physical exam on transfer: physical exam: vs: 95.6 112/65 70 16 98% ra gen: soft audible wheezing heard, speaking in complete sentences, pleasant female sitting in bed heent: eomi, perrl, ncat, op - no exudate, no erythema, mmm neck: no lad, jvp not elevated resp: moderate expiratory wheezing in all lung fields, decreased air movement, no rales/rhonchi cv: rrr, nl s1, s2, no m/r/g abd: ndnt, soft, nabs ext: no c/c/e skin: no rashes noted neuro: cn ii-xii grossly intact pertinent results: admission labs: ================ 14.5 8.4 >------< 397 44.5 mcv 84 neuts 73.6 lymphs 17.7 monos 6.5 eos 1.2 basos 1.0 . pt 51.5 ptt 54.5 inr 5.9 . 126 92 50 -----|-----|----< 84 6.1 16 1.7 . alt 15 ast 45 alk phos 85 amylase 59 lipase 91 bili 0.5 . ua: large blood, leukocytes moderate, rbc 0-2, wbc 0-2, bacteria-occ, epi . ph-7.26* glucose-38* lactate-1.4 na+-138 k+-4.2 cl--110 tco2-19* . pertinent labs during hospitalization: ====================================== fibrinogen 504, fdp 0-10 tsh 0.47, t4 5.4, free t4 0.87 . 02:50am blood cortsol-27.0* 02:51am blood cortsol-7.5 03:13pm blood cortsol-30.0* 03:13pm blood cortsol-35.0* 03:14pm blood cortsol-14.6 03:34am blood cortsol-7.1 06:33am blood cortsol-30.8* 03:14am blood type-art temp-36.7 po2-83* pco2-21* ph-7.36 caltco2-12* base xs--11 intubat-not intuba . inr trend: 5.9 - 7.3 - 1.7 - 1.4 - 1.4 - 1.7 - 2.4 - 3.5 - 3.8 cr trend: 1.7 - 0.7 (then stayed around 0.5 - 0.7 throughout admission) . fe 52 tibc 178 ferritin 498 trf 137 vit b12 393 folate 3.4 . carotene - pending urine histamine - pending tryptase - pending plasma histamine - pending . microbiology: ============== blood cx - negative blood cx - negative . fecal culture (final ): no enteric gram negative rods found. no salmonella or shigella found. campylobacter culture (final ): no campylobacter found. fecal culture - r/o e.coli 0157:h7 (final ): no e.coli 0157:h7 found. clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. viral culture (preliminary): no virus isolated so far. . c. diff negative c. diff negative . studies: ========= chest (portable ap) findings: supine ap chest radiograph is obtained. a single-lead pacer device overlies the right chest with lead tip positioned in the approximate location of the right ventricle. the lungs appear clear bilaterally, demonstrating no evidence of pneumonia or chf. no pleural effusion is seen. right apical pleural thickening is again noted. cardiomediastinal silhouette is stable. the visualized osseous structures are intact. impression: no pneumonia. . chest port. line placement findings: single bedside ap examination labeled "supine" is compared with similar examination obtained some 4.5 hours earlier. there has been interval placement of a right internal jugular double-lumen central venous catheter with its tip at the cavo-atrial junction and no supine evidence of pneumothorax. the overall appearance of the lungs is unchanged, with right more than left apical pleuroparenchymal scarring but no definite focal consolidation. the heart size and pulmonary vessels are probably unchanged with no posteriorly-layering pleural effusion. the right-sided unipolar cardiac pacemaker has intact lead with its tip projected over the rv apex (on this single view). . ekg ventricular paced rhythm. compared to tracing of no significant change. tracing #1 . ekg ventricular paced rhythm. compared to tracing #1 on no significant change. tracing #2 . chest (pa & lat) heart is moderately enlarged, with particular left atrial dilatation, and both heart size and mediastinal vascular congestion have increased since supine images taken on . there has also been an increase in pulmonary vascular caliber but no pulmonary edema. lateral view shows small bilateral pleural effusion, probably new. no focal pulmonary abnormality is present. transvenous right ventricular pacer lead follows the expected course. no pneumothorax. . small bowel only (barium) findings: scout kub is unremarkable, with incidentally noted 6 mm soft tissue calcification overlying the distal tip of the coccyx, likely correlating with a pelvic phlebolith on ct from 9/. barium passes freely through the small bowel, entering the colon within approximately 35 minutes, relatively faster than expected. small bowel caliber, contour, and mucosal pattern are normal. the terminal ileum is unremarkable. impression: normal small bowel with relatively fast transit of barium. brief hospital course: ms. is a 69 y.o. f with a history of chronic diarrhea since , sarcoid, and atrial fibrillation who presented with weakness, hypotension, hyperkalemia, and hyponatremia, admitted to the micu and then transferred to the medicine floor after stabilization. . # hypotension: initially considered ddx of infection/sepsis (especially given recent uti, which was pan-sensitive e. coli on ), adrenal insufficiency (given electrolyte abnormalities), and hypovolemia. baseline cortisol was within normal limits. was weaned off of pressors on . cultures were negative. most likely cause of hypotension was hypovolemia in the setting of severe chronic diarrhea x 4 months. . # acute renal failure: creatinine 1.7 on admission with baseline 0.3. most likely secondary to dehydration/hypotension. given ivfs. renal function monitored during hospitalization and continued to trend towards her baseline cr. . # chronic diarrhea: extensive workup, including ct, ercp, colonoscopy, egd, and ttg that have been performed without clear source for diarrhea. be secondary to chronic pancreatitis or osmotic causes of diarrhea and malabsorptive disorders, including lactose intolerance, celiac disease. c. difficile toxin x 3 was negative. tincture of opium was used to control diarrhea. she also had a rectal tube placed as she had peri-rectal trauma chronic diarrhea. once on the floor, gi was consulted and several lab tests were sent, including urine and plasma histamine as well as tryptase and carotene, which were pending on discharge. additionally, she had an barium swallow that was essentially negative with some increased transit time. ivfs for maintenance until pt started taking adequate po. strict i/os maintained. her rectal tube fell out during her hospitalization, but by that time, her diarrhea had slowed down significantly. by time of discharge, she was able to tolerate po intake without significant stool output. she was set up with a capsule study as an outpatient. antidiarrheals were prescribed for outpatient management. she was instructed to continue a lactose free diet. she is to follow up with her gastroenterologist. . # supratherapeutic inr: anticoagulated for atrial fibrillation. inr 5.9 on admission and trended up to 7 and was oozing from peripheral sites. thought likely due to nutritional deficiency in addition to recent ciprofloxacin for recent uti. she was given ffp and vitamin k , which decreased her inr to 1.7 at which time her coumadin was re-started. her coumadin dose was increased to 5 mg x 3 days, and then reduced to her normal maintenance dose. her goal inr was . she was supratherapeutic upon discharge, but was instructed to follow up with her pcp for an inr check. . # wheezing: pt was 95% on ra, but on admission to floor, she had diffuse wheezing. per pt, no h/o asthma, copd. cxr showed increased mediastinal congestion, no edema, and small bilateral pleural effusions. nebulizer treatments were continued as needed with resolution of wheezing. . # chronic diastolic heart failure: not seen on most recent echo from (). consider echocardiogram as outpatient. . # perirectal trauma: wound care team consulted and recommendations were ordered. . # atrial fibrillation: s/p avj ablation with pacemaker with coumadin for anticoagulation. coumadin re-started after inr corrected as above. # chronic pancreatitis: continued enzyme replacement. . # hyperlipidemia: continued tricor. . # htn: hypertensive at baseline. antihypertensives were held in the micu in the setting of hypotension/dehydration. she was restarted on her antihypertensives as an outpatient except for her nitroglycerin patch. . # f/e/n: ivfs. repleted lytes prn. insulin sliding scale. . # ppx: held bowel regimen given diarrhea, ppi, coumadin . # code status: full code . # communication: with patient and with daughter and hcp, : - cell - home . # access: piv . # dispo: home with close follow up for inr. to get capsule study as outpatient. medications on admission: ultram 50mg tid nitro patch 0.01mg on 12 hours, off 12 hours protonix 50mg q12h aldactone 25mg daily tricor 48mg daily lisinopril 5mg daily atenolol 50mg daily lasix 20mg daily viokase 4tab tid with meals neurontin 1200mg tid propythiouracil 100mg topamax 50mg mirapex 1 tab daily potassium 20mg daily coumadin 1mg daily . medications on transfer: medications on tranfser tramadol (ultram) 50 mg po tid pantoprazole 40 mg po q12h tricor *nf* 48 mg oral daily viokase 8 4 tab po tid w/meals gabapentin 300 mg po tid propylthiouracil 100 mg po bid topiramate (topamax) 50 mg po bid ipratropium bromide neb 1 neb ih q6h:prn albuterol 0.083% neb soln 1 neb ih q6h:prn acetaminophen 325-650 mg po q6h:prn sulfameth/trimethoprim ds 1 tab po bid duration: 3 days opium tincture 10 drop po q4h:prn warfarin 1 mg po daily16 potassium chloride 40 meq po once duration: 1 doses ondansetron 4 mg iv q8h:prn nausea prochlorperazine 10 mg iv tid nausea - give prior meals heparin 5000 unit sc tid discharge medications: 1. tramadol 50 mg tablet sig: one (1) tablet po tid (3 times a day). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 3. fenofibrate micronized 48 mg tablet sig: one (1) tablet po daily (). 4. amylase-lipase-protease 468 mg tablet sig: four (4) tablet po tid w/meals (3 times a day with meals). 5. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). 6. propylthiouracil 50 mg tablet sig: two (2) tablet po bid (2 times a day). 7. topiramate 25 mg tablet sig: two (2) tablet po bid (2 times a day). 8. opium tincture 10 mg/ml tincture sig: ten (10) drop po q4h (every 4 hours) as needed for diarrhea. disp:*qs * refills:*0* 9. warfarin 5 mg tablet sig: one (1) tablet po once a day: please do not take your coumadin until dr. says it is okay. 10. prochlorperazine 10 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 11. outpatient lab work please draw pt, ptt, inr on wednesday, and fax to attn: dr. at . 12. mirapex oral 13. aldactone 25 mg tablet sig: one (1) tablet po once a day. 14. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 15. atenolol 50 mg tablet sig: one (1) tablet po once a day. 16. lasix 20 mg tablet sig: one (1) tablet po once a day. 17. potassium chloride 10 meq tablet sustained release sig: two (2) tablet sustained release po once a day. discharge disposition: home with service facility: homecare discharge diagnosis: primary diagnosis: 1. chronic diarrhea of unknown etiology . secondary diagnosis: 1. chronic atrial fibrillation status post an avj ablation with permanent pacemaker implantation 2. chronic pancreatitis discharge condition: stable. discharge instructions: you were admitted for dehydration due to severe, chronic diarrhea. you were originally in the intensive care unit, but once stabilized, you were transferred to the medical floor. during your hospitalization, you were aggressively rehydrated. the gastroenterologists saw you while you were in the hospital. a small bowel follow through was performed that was essentially normal. some special labs were drawn and are still pending, but the gi doctors follow up on them when you see them in a few weeks. . please continue your medications as prescribed, except do not take the nitroglycerin patch you were on until you see your doctor. please keep all your medical appointments. you have been given a prescription for compazine to be used prior to meals for nausea. also, you were started on a lactose free diet while in the hospital. please continue this diet -- look for lactose free milk (i.e. lactaid) and other lactose free dairy products. . you will have your inr checked tomorrow, wed, by the vna nurses. they will fax your results to dr. who will let you know when you should resume your coumadin. . if you have any of the following symptoms, please call your doctor or go to the nearest er: fever>101, chest pain, shortness of breath, extreme lightheadedness/dizziness, abdominal pain, chronic diarrhea, bright red blood from your rectum, black stools, or any other concerning symptoms. followup instructions: you have been scheduled for an outpatient capsule study with dr. on tuesday, in the building no the at 7:45 am. ask for the motility room/gi suite. the gastroenterologists will mail you information about the study and how to prepare for it. if you need to reschedule, please call . provider: . (primary care) . dr. office will call you with your appointment, which will be next week. provider: clinic phone: date/time: 1:30 procedure: venous catheterization, not elsewhere classified diagnoses: hyperpotassemia congestive heart failure, unspecified acute kidney failure, unspecified hyposmolality and/or hyponatremia atrial fibrillation cardiac pacemaker in situ diarrhea chronic pancreatitis chronic diastolic heart failure 

Answer: The patient is high likely exposed to