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: sulfa (sulfonamides) / verapamil attending: chief complaint: c. difficile and ascites major surgical or invasive procedure: paracentesis arterial line placement history of present illness: mrs. is a 79 year old female with a history of hypertension, coronary artery disease, congestive heart failure, copd and lung cancer who was admitted to on with worsening diarrhea. the patient has been in and out of the hospital for most of the winter with recurrent pneumonia. her most recent infection was approximately three weeks ago. she was discharged to rehab and ultimately home. three days after returning home she began to experience diarrhea, up to bowel movements per day. she presented to on for her diarrhea. on admission she was found to have a wbc count of 40,000 with a diffusely tender abdomen. she was found to be c. diff positive. she was initially started on iv flagyl for c. diff as well as levofloxacin and prednisone out of concern for a copd flare. her antibiotics were switched to po flagyl and po vancomycin on out of concern that she was not improving. on this regimen she reports that the frequency of her diarrhea did decrease to bowel movements per day. her white blood cell count decreased from 42k on admission to 15.7 on . there was concern, however, that she was developing abdominal distention. she underwent an abdominal ct scan on which showed significant ascites throughout the abdomen, mucosal enhancement throughout the colon with probable diffuse wall thickening and thickening of the terminal ileum without evidence of obstruction. given concern for the ascites, the primary team at wanted to pursue paracentesis. her inr has fluctuated throughout her hospitalization at and on was 7.0. she received vitamin k 10 mg po x 1. her family requested that she be transferred to hospital for further care. on review of systems she denies fevers, chills, chest pain, shortness of breath, palpitations, pnd, orthopnea. she does endorse lightheadedness and feeling dehydrated. she endorses right sided abdominal pain, bowel movements per day. she continues to pass flatus. her abdomen has become increasingly distended over the past week. she denies dysuria or hematuria. she endorses chronic leg swelling which she reports has not worsened significantly over the past week. past medical history: hypertension coronary artery disease s/p mi and cabg x 2 tachybrady syndrome s/p pacemaker placement atrial fibrillation diastolic chf (ef 60%) copd - previously on home oxygen but not currently squamous cell lung cancer - s/p ressection in small cell lung cancer - s/p chemotherapy and radiation in as well as cranial xrt. social history: she lives in in an facility. she has a 50 pack year smoking history but quit many years ago. she is divorced. she occassionally drinks alcohol. family history: mother died at age 54 of heart disease. her father was an alcoholic. she has one sister who died of cancer of the back. physical exam: vitals: 96.3 bp: 82/58 hr: 117 rr: 18 o2: 98% on 2l general: elderly female, lying in bed, no acute distress heent: perrl, eomi, sclera anicteric, mm dry, oropharynx with trace thrush neck: jvp flat at 30 degrees, no lad cv: irregularly irregular, s1 + s2, soft sem at lusb, no rubs or gallops resp: bronchial breath sounds at bases, no wheezez, rales gi: distended, + fluid wave, mild tenderness to palpation in rlq, no rebound tenderness or guarding, +bs gu: foley in place draining clear yellow urine ext: wwp, 1+ pulses, 3+ pitting edema to thighs neuro: alert and oriented x 3, no focal deficits pertinent results: hematology: 06:00am blood wbc-10.8 rbc-4.28 hgb-12.4 hct-37.3 mcv-87 mch-29.0 mchc-33.3 rdw-15.6* plt ct-205 06:05am blood wbc-8.8 rbc-3.94* hgb-11.7* hct-34.6* mcv-88 mch-29.6 mchc-33.6 rdw-16.9* plt ct-212 06:00am blood neuts-94.4* bands-0 lymphs-2.9* monos-2.2 eos-0.4 baso-0.1 07:10am blood pt-32.0 inr-3.3 chemistries: 06:00am blood glucose-75 urean-26* creat-1.3* na-132* k-3.5 cl-101 hco3-18* angap-17 06:05am blood glucose-64* urean-17 creat-1.0 na-136 k-4.0 cl-107 hco3-18* angap-15 09:35am blood alt-15 ast-26 ld(ldh)-212 ck(cpk)-46 alkphos-85 totbili-0.4 06:00am blood calcium-7.6* phos-2.8 mg-1.8 other: 02:57pm blood caltibc-127* ferritn-513* trf-98* 09:35am blood cortsol-25.9* hepatology workup: 02:57pm blood cea-53* ca125-487* 08:45pm blood afp-9.1* 08:45pm blood ama-negative smooth-negative 09:35am blood hbsag-negative hbsab-negative hbcab-negative hav ab-negative 09:35am blood hcv ab-negative 02:57pm blood alpha-1-antitrypsin-208h 02:57pm blood ceruloplasmin-22 urinalysis: 08:07pm urine color-yellow appear-clear sp -1.009 08:07pm urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-tr 08:07pm urine rbc-* wbc-* bacteri-occ yeast-mod epi-0 08:07pm urine hours-random urean-209 creat-35 na-34 08:07pm urine osmolal-296 paracentesis: 03:32pm ascites totpro-1.8 albumin-1.3 03:32pm ascites wbc-100* rbc-9500* polys-63* lymphs-2* monos-28* mesothe-3* macroph-4* ekg: atrial fibrillation premature ventricular contractions or aberrant ventricular conduction extensive st-t changes may be due to myocardial ischemia repolarization changes may be partly due to rhythm low lead voltage imaging: chest (portable ap) 9:05 pm the patient has had median sternotomy and coronary bypass grafting. transvenous right atrial and right ventricular pacer wires extend continuously from the left axillary pacemaker, terminating alongside remnant leads originating in the right axilla. no pneumothorax present. pleural effusion, if any, is minimal. lungs grossly clear. heart size top normal. portable abdomen 9:05 pm there is apparent centralization of the bowel loops suggesting the presence of ascites. no evidence of free intraperitoneal air is visualized. no concerning bowel gas pattern is noted. the small bowel and large bowel loops are unremarkable. the visualized portion of the lung bases demonstrates small bilateral effusion. mild degenerative changes of the lumbar spine is noted. severe degenerative changes of both hip joints are also identified. echocardiogram : the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction with basal infero-lateral hypokinesis. there is no ventricular septal defect. the right ventricular cavity is dilated the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets are moderately thickened. there is a minimally increased gradient consistent with minimal aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. abdomen u.s. (complete study) port 9:18 am the liver is markedly heterogeneous in echotexture with nodular contour, likely representing cirrhosis or fibrosis. there is no focal liver lesion or intra- or extra-hepatic ductal dilatation. gallbladder is normal. common bile duct measures 3.4 mm. there is large amount of ascites in the right upper and bilateral lower quadrants. spleen is normal in size. right kidney measures 8.9 cm. left kidney measures 8.1 cm. there is a hypoechoic nodule in the right upper pole measuring 1 cm, likely representing complex cyst. there is no other solid lesion or stone or hydronephrosis. on doppler ultrasound study, patency and appropriate waveforms are seen in bilateral and main portal veins, main and left hepatic arteries, and three hepatic veins. art ext (rest only) 10:28 am findings: the abi on the right is 0.96 and on the left is 0.81. doppler tracings demonstrate triphasic waveforms diffusely on the right and through to the popliteal level on the left. volume recordings are in with the doppler tracings. upper extremity abi demonstrates 1.27 at the wrist level on the right and 1.17 on the left. arterial tracings demonstrate triphasic waveforms through to the radial levels bilaterally, ulnar waveforms are monophasic. volume recordings are in with the doppler tracings. microbiology: blood cultures : negative peritoneal fluid culture : gram stain with 2+ polymorphonuclear cells, no microrganisms. aerobic culture negative. anaerobic culture no growth to date. peritoneal cytology : negative for malignant cells. brief hospital course: mrs. is a 79 year old female with a history of hypertension, coronary artery disease, congestive heart failure, copd and lung cancer who was admitted to on with worsening diarrhea. triggered this morning for hypotension. clostridium difficile: the patient presented with clostridium difficle colitis which was refractory to initial management with po flagyl and po vancomycin. on admission she was also taking levofloxacin for presumed copd exacerbation. the levofloxacin was discontinued on admission to this hospital and she was placed on po vancomycin alone. when she was transferred to the icu she was also started on iv flagyl. on this regimen she showed significant clinical improvement with resolution of her leukocytosis and her diarrhea. prior to discharge the iv flagyl was discontinued. she will complete a ten day course of antibiotics from the date of discontinuation of levofloxacin. peripheral vascular disease: during this admission the patient was noted to have cool, cyanotic upper and lower extremities. she was seen by the vascular surgery consult service and underwent non-invasive vascular studies which showed mild-to-moderate left-sided tibial disease and small vessel disease in both hands. given her lack of symptoms, no interventions are planned. she can follow up with vascular surgery if she were to develop pain or claudication. hypotension: during this admission the patient's blood pressures were consistently in the 80s to 90s systolic. while in the medical intensive care unit she had an arterial line placed which recorded arterial blood pressures which were mm hg higher than cuff pressures recorded. given her peripheral vascular disease her systolic blood pressures were maintained in the 90s systolic to ensure adequte perfusion. atrial fibrillation/tachy-brady syndrome: the patient is s/p pacemaker placement for tachy-brady syndrome. on admission she was taking digoxin alone with suboptimal rate control. she was started on low dose metoprolol with improvement in her rate control and no change in her systolic blood pressures. she was continued on her coumadin with fluctuating inrs. on discharge she was taking 3 mg daily. she will need to have her inr monitored closely at rehab with her coumadin adjusted to acheive a target inr between . acute on chronic diastolic heart failure: during this admission she had an echocardiogram which demonstrated a preserved ejection fraction. clinically she showed evidence of total body volume overload with peripheral edema but also appeared intravascularly dry. on she developed acute respiratory distress and hypoxia. this was attributed to her chronic lung disease as well as acute pulmonary edema. she was treated with intravenous lasix with rapid improvement but required a short stay in the medical intensive care unit. given her ascites her diuretic regimen was changed to include lasix and spironolactone. given her hypotension her diuretics were kept at low doses. on discharge she continued to have significant lower extremity edema and ascites but her respiratory status was stable. copd: the patient has a history of copd and has required low dose home oxygen in the past. patient is not on home oxygen but has been in the past. on presentation she was being treated for a copd exacerbation with levofloxacin and prednisone. on admission her cxr and lung exams were clear. her levofloxacin and prednisone were discontinued. as above, she did have a significant episode of respiratory distress during this hospitalization which required transfer to the icu. it was thought that her respiratory distress was most likely secondary to pulmonary edema in the setting of borderline respiratory function at baseline. she was continued on her home doses of advair and spiriva. she also received albuterol nebulizers on a prn basis. osteoporosis: no active inpatient issues. her alendronate was held in the setting of her acute illness but was restarted at the time of discharge. anxiety: no active inpatient issues. she was continued on lorazepam 0.5 mg daily. restless legs: no active issues. she was continued on ropinirole. diet: during this admission there was concern that the patient might be aspirating while eating given her recurrent episodes of pneumonia this year. she was noted in the medical intensive care unit to have significant coughing while eating. serial cxrs showed no evidence of infiltrates. she was evaluated by our speech and swallow team who recommended ground solids while the patient was unable to wear her dentures and chew appropriately. by discharge they did not think that she exhibited signs of aspiration with thin liquids. her diet can be advanced from ground solids to regular consistency when she is able to wear her dentures. vaccinations: the patient recieved pneumovax during this admission. code: full code communication: daughter (h), (c). (w) medications on admission: coumadin 4 mg digoxin 0.125 mg every other day alendronate 70 mg qweekly lasix 80 mg daily klor-con 20 meq daily lorazepam 0.5 mg daily pantoprazole 40 mg daily ropinirole 1 mg po daily advair 250/50 daily tiotropium 1 cap daily benzonate 100 mg po daily multivitamin discharge medications: 1. ferrous gluconate 325 mg (37.5 mg iron) tablet sig: one (1) tablet po daily (daily). 2. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 3. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 4. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 5. digoxin 125 mcg tablet sig: one (1) tablet po every other day (every other day). 6. alendronate 70 mg tablet sig: one (1) tablet po once a week. 7. multivitamin capsule sig: one (1) capsule po once a day. 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. ropinirole 1 mg tablet sig: one (1) tablet po daily (daily). 10. benzonatate 100 mg capsule sig: one (1) capsule po once a day. 11. toprol xl 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 12. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 13. spironolactone 50 mg tablet sig: one (1) tablet po daily (daily). 14. warfarin 1 mg tablet sig: two (2) tablet po daily16 (once daily at 16): please check patient's inr on saturday, . please titrate coumadin for target inr between . . discharge disposition: extended care facility: - discharge diagnosis: primary: clostridium difficile atrial fibrillation chronic diastolic heart failure copd peripheral vascular disease discharge condition: stable. requiring significant assistance with ambulation. breathing comfortably on room air. discharge instructions: you were seen and evaluted for your diarrhea. you were treated for clostridium difficile with antibiotics. you were also evaluate by our liver service for the swelling in your abdomen and our vascular surgery service for your blue toes. please take all your medications as prescribed. the following changes were made to your medication regimen. 1. please take lasix 20 mg daily instead of 40 mg daily 2. please take spironolactone 50 mg daily 3. please take toprol xl 25 mg daily 4. please take coumadin 2 mg daily instead of 4 mg daily. her inr should be checked on saturday, and her coumadin adjusted to achieve a target inr between . please keep all your follow up appointments as scheduled. please seek immediate medical attention if you experience any fevers > 101.5 degrees, chest pain, shortness of breath, worsening abdominal pain or distension, worsening diarrhea or any other concerning symptoms. please keep all your follow up appointments as schedule. please seek immediate medical attention if you experience any fevers > 101.5 degrees, chest pain, difficulty breathing, worsening abdominal pain, increased abdominal swelling or any other concerning symptoms. followup instructions: please follow up with your primary care physician . one week after you are discharged from rehab. the office phone number is . provider: , md phone: date/time: 9:30 procedure: percutaneous abdominal drainage diagnoses: congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation personal history of malignant neoplasm of bronchus and lung acute on chronic diastolic heart failure aortocoronary bypass status peripheral vascular disease, unspecified candidiasis of mouth acute respiratory failure osteoporosis, unspecified intestinal infection due to clostridium difficile other ascites restless legs syndrome (rls) 

Answer: The patient is high likely exposed to