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: penicillins attending: chief complaint: diarrhea major surgical or invasive procedure: 1. tte " impression: normal global and regional biventricular systolic function. mild aortic stenosis and regurgitation. at least moderate mitral regurgitation. moderate pulmonary artery systolic hypertension. biatrial enlargement." 2. multiple cxrs 3. ble us 4. r picc placement, removal 5. l wrist xray - "1. no acute fracture. 2. widening of the scapholunate interval is compatible scapholunate ligamentous injury. 3. severe degenerative changes of the stt and first cmc joints. apparent collapse of the trapezoid and trapezium as described." history of present illness: 84 y/o f with cad s/p stents, paf on coumadin, htn transferred from osh for further management of c.diff sepsis and volume overload. the patient underwent elective left total hip replacement at on . she developed diarrhea while at rehab post-operatively, however it is unclear from outside records whether this occurred in the setting of antibiotic therapy. after discharge from rehab she was prescribed po flagyl and immodium for persistent diarrhea. she was subsequently admitted to on for dehydration. she was treated with po vancomycin, po flagyl, and iv flagyl for c. diff colitis (positive toxin assay on ), and ivf for acute renal failure. wbc was . abd/pelvis ct on revealed diffuse colonic wall thickening but no bowel obstruction, and moderate ascites with generalized mesenteric inflammation/edema. she was transfused on u ffp on , and 1 u prbc and 3 u ffp. she was loaded with amiodarone for afib. right ij cvc was placed on for massive volume resuscitation and pressors (it appears she received neosynephrine f/b dopamine prior to transfer) in the setting of hypotension. she was then treated with albumin and lasix. abg the morning of transfer 7.17/73/81/26. at the time of transfer, she was receiving dopamine 2 mcg/kg/min and non-invasive mask ventilation, both of which were discontinued upon arrival. . ros: + unproductive , dry mouth, nausea with food/drink - fever, chills, sweats, ha, dizziness, lightheadedness, cp, sob, vomiting, abd pain, hematochezia, melena, calf pain past medical history: cad s/p stenting of lcx and rca per omr cath report paf le dvt htn hyperlipidemia urinary incontinence osteoporosis s/p orif and lth s/p hepatobiliary surgery s/p hysterectomy s/p cholecystectomy s/p rtk x 1, ltk x 2 social history: lives in , ma with husband; 3 children live outside of ma; no etoh, tobacco family history: non-contributory physical exam: pe - v/s: t99.2 hr 75 bp 120/66 rr 17 o2sat 99% on 4 l nc cvp 6 cmh20 gen: awake, alert elderly female comfortable heent: r > l pupil, reactive; sclera anicteric; very dry mucous membranes with crust-covered tongue; neck: no bruit cv: irreg irreg nl s1s2 iv/vi cres-decres murmur at base, iii/vi diastolic murmur at apex pulm: diffuse rhonchi, decr. breath sounds at bases, no wheezes abd: distended, soft, nt +bs, no rebound, guarding ext: warm, dry; trace pitting edema neuro: a+o x 3 pertinent results: admit ekg: ekg: afib hr 73, lad, nl intervals, diffuse tw flattening, unchanged c/w prior exam . micro: c. diff toxin positive - . imaging: osh ct abd/pelvis - 1. diffuse colonic wall thickening but no bowel obstruction. 2. moderate ascites with generalized mesenteric inflammation/edema. 3. surgical clips in the porta hepatis with some , represent reflux from the gi system. and bilateral le duplex u/s - negative for dvt v/q - low prob for pe cxr - bilateral pulmonary opacities, read pending . 149 115 37 --------------< 101 3.3 29 1.1 ck: 15 mb: 4 trop-t: 0.10 ca: 9.0 mg: 2.0 p: 2.9 alt: 9 ast: 12 ldh: 114 : 42 lip: 56 ap: 118 tbili: 0.6 alb: 2.9 tsh:4.4 vit-b12:831 folate:13.2 probnp: . iron: 21 caltibc: 81 ferritn: 518 trf: 62 . wbc: 11.8 hct: 30 plt: 215 n:89.5 band:0 l:6.6 m:3.6 e:0.2 bas:0.1 . ret-aut: 0.9 . pt: 17.2 ptt: 36.9 inr: 1.6 . echo: the left atrium is mildly dilated. the left atrial volume is markedly increased (>32ml/m2). left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is mild aortic valve stenosis (area 1.2-1.9cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: normal global and regional biventricular systolic function. mild aortic stenosis and regurgitation. at least moderate mitral regurgitation. moderate pulmonary artery systolic hypertension. biatrial enlargement. brief hospital course: 84 y/o f with cad s/p stents, paf on coumadin, htn transferred from osh for management of c. difficile septic shock. she was profoundly volume overloaded but stable off pressors and non-invasive ventilation. . #c. diff - she was no longer septic upon arrival. per id recs, pt was treated w po vancomycin, last day . pt does have diarrhea still but was seen by id again, who felt that it is unlikely to be from cdiff and recommended discontinuing vanc on . cdiff x3 on and have been neg. diarrhea may be secondary to tube feeds. should pt have any change such as fever, abdominal pain, worsening diarrhea, please check cdiff toxins again . # chf: came in with acute on chronic diastolic chf and profound fluid overload. echo showed nl lvef but mild ar, mod mr, mod tr. pt was placed on lasix gtt and diuresed aggressively. when transferred to the floor, pt did not have any edema on exam, she still had persistent but improving pleural effussions, and lasix had to be briefly held, as by labs she appeared volume contracted. pt has now been restarted on lasix 20mg po bid, which should be adjusted based on clinical status. please follow bmp periodically to ensure pt is not developing acute renal failure #afib - in micu, she developed afib with rvr. received 5 iv lopressor then had hr in the 30s transiently. pt had one other episode of transient asymptomatic bradycardia during sleep noted on tele. pt was loaded with iv amio in micu and now on amio 200mg qd. oral metoprolol has slowly been titrated and pt has tolerated it well. on floor, pt's hr remained in 100-110's at baseline w/ occ 130-140's w/ actitivty. metoprolol should be continued to be titrated as long as bp allows. pt has both afib and hx of dvt and is being transitioned w lovenox to coumadin. coumadin was increased from 2 to 3mg qd on , inr yesterday was still 1.2. please titrate coumadin for a goal inr of 2.0-3.0 and discontinue lovenox when inr therapeutic. . # lower gi bleed: in the micu, the patient was noted to have a small amount of blood clots and liquid blood in the rectal tube. lovenox and coumadin were temporarily held, although aspirin was continued. ng lavage was performed and was negative. the gi service was consulted and deferred a colonoscopy. ultimately, it was felt that her bleeding may have been from the rectal tube. received 1u prbc on . hct stable thereafter without any further gib. pt was restarted on lovenox and coumadin on . pt's h/h remained stable on the floor but gradually drifted down from 25 to 22. given that pt has cad, it was decided to transfuse 2 units prbc the day before transfer to acute rehab hospital. pt's hct appropriately rose from 22 to 30 on day of discharge. # - pt has productiver w/ whitish sputum but has remained afebrile w nl wbc. cxr continues to show stable b pleural effussions. pt will need ipratropium (avoid albuteral given afib) nebs and frequent suctioning to clear secretions. pt was needing 2l oxygen and sats were 96-99% on it. #cad - many risk factors, but low clinical suspicion for an event. trop only mildly elevated. she was on asa. lisinopril was discontinued to allow uptitration of metoprolol and should be started when bp allows. . #hx of htn - pt's bp gradually improving, was borderline in the 90-100's before. pt on metoprolol and lasix. once metoprolol has been titrated, if bp allows, ace-i should be started given cad . # contact: , husband, (home) pcp: , . . # code: dnr dni . medications on admission: meds (on admission to osh): coumadin 2.5 mg daily detrol benazapril imdur toprol xl tricor hctz . meds (on transfer): flagyl 500 mg po q8 flagyl 500 mg iv q8 vanco 250 mg po qid digoxin 0.25 mg po daily amiodarone 400 mg po daily albumin 25% 25 g iv q6 cholestyramine 1 packet qid dopamine gtt lasix 60 mg iv daily heparin 5000 u tid dilaudid 1 mg iv q4 lactinex reglan 10 mg iv q6 protonix 40 mg iv q12 ambien 5 mg qhs tylenol prn . all: pcn discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed: to inguinal region. 3. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed: for sleep. 4. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain/fever>101. 5. amiodarone 200 mg tablet sig: one (1) tablet po once a day. 6. enoxaparin 60 mg/0.6 ml syringe sig: one (1) subcutaneous q12h (every 12 hours). 7. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 8. warfarin 1 mg tablet sig: three (3) tablet po once daily at 4 pm. 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 10. ipratropium bromide 0.02 % solution sig: one (1) inhalation q4h (every 4 hours). 11. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed: for wheezing, sob, . 12. lasix 20 mg tablet sig: one (1) tablet po twice a day. 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. discharge disposition: extended care facility: - discharge diagnosis: cdiff colitis anemia atrial fibrillation hx diastolic heart failure moderate mr cad s/p stents hx of l le dvt djd hx of knee/hip replacements hx of osteopenia hx of rheumatic fever hx of htn hx of urge incontinence discharge condition: good discharge instructions: you were admitted to this hospital from another hospital because you had severe infection w/ c.diff colitis. you were given fluids and developed fluid overload. you were admitted to the icu and diuretics were given to remove the fluid. you were seen by id and they decided to treat you with oral vancomycin. your therapy is complete on and although you are still having some diarrhea, it is thought to not be due to persistent infection by id. should you notice worsening or bloody diarrhea, abdominal pain, or fevers/chills, please return to ed you have atrial fibrillation and we have been adjusting medications to control your heart rate. you are also anemic. at one point, you did have some bleeding due to irritation from the rectal tube but your blood count remained stable and you were evaluated by gi doctors who did not want to do a colonoscopy. you did receive 2 units of blood because you were very anemic. should you notice blood in stool, black stools or active bleeding anywhere, please see a doctor right away you will be working with therapists and nutritionists at the rehab facility followup instructions: please make appointment with the following when pt is discharged from acute rehab hospital. dr. , pcp, : , fax , address: , suite 8e, , dr, , cardiologist, ph: fax . address: , , procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances transfusion of packed cells diagnoses: anemia of other chronic disease coronary atherosclerosis of native coronary artery unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia severe sepsis candidiasis of other urogenital sites atrial fibrillation percutaneous transluminal coronary angioplasty status rheumatic heart failure (congestive) other and unspecified hyperlipidemia osteoporosis, unspecified septic shock intestinal infection due to clostridium difficile multiple involvement of mitral and aortic valves personal history of venous thrombosis and embolism hemorrhage of gastrointestinal tract, unspecified hyperosmolality and/or hypernatremia hip joint replacement mixed acid-base balance disorder 

Answer: The patient is high likely exposed to