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: hypotension major surgical or invasive procedure: none history of present illness: . hpi: history of present illness: mrs. is a 66 year old female with history of rheumatic heart disease s/p mvr and recent tvr, afib, severe tracheomalacia s/p trach/peg, celiac disease who was recently admitted to from to for management of diarrhea and fever. during this admission the patient had a ct abd/pelvis revealing for colitis and ascites. the patient was treated empirically for c. diff with flagyl tid with report of significantly decreased diarrhea on discharge although no stool cultures are available for review. the patient underwent a 1.5l paracentesis this admission with cell count consistent with sbp, culture negative, for which the patient was treated with ceftriaxone during hospitalization and on discahrge. finally, the patient additionally had sputum cultures performed which revealed stenotrephomonas for which the patient was treated with bactrim although this was discontinued after 3 days given low clinical suspicion for pneumonia. the patient's tube feeds were resumed with report of improved adominal pain. a picc line was placed on for abx use. of note, prior to this admission the patient additionally was reported to have coag negative staph bacteremia-oxacillin resistant. blood cultures during this last hospitalization did not reveal any growth, a tte was performed which did not reveal any obvious vegetations. with regards to her remaining issues the patient was continued on lasix and aldactone for management of her ascites. the patient is suspected to have cirrhosis with portal hypertension secondary to severe tr. she was otherwise maintained on her outpatient medical regimen. the patient is now s/p trach/peg for severe tracheomalacia and significant right sided pleural effusion. she was noted to have a respiratory alkalosis, often overbreathing the vent, noted to be tolerating ps for several hours at a time of discharge. . the patient today at her facility was found to be hypotensive with sbp in the 80s. she received 300cc bolus with improvement of sbp to 103. ed course: vitals t- none recorded. hr: 126 bp: 110/70 - in the ed blood and urine cultures obtained. the patient was treated empirically with ctx, vanc, flagyl. a central line was placed and the patient was started on levophed for hypotension. the patient was given 2u prbcs. past medical history: -s/p cardiac cath for tvr procedure -tvr/ra reduction surgery via right thoracotomy ( 33 mm ce pericardial valve) c/b partial right lung collapse and persistent hypoxia -s/p bronch on showing moderate to severe tracheomalacia and left mild bronchomalacia. -s/p trach/peg on -mitral valve replacement, on coumadin. treatment for rheumatic ms. h/o mv commissurotomy in . -celiac sprue -does not have collagenous colitis with negative biopsies done at the last colonoscopy per dr. intolerance -elevated lfts -h/o af prior to mechanical valve placement -cirrhosis with cardiogenic ascites and ansarca social history: -married 4 kids -no current tobacco use. there is no history of alcohol abuse. family history: there is no family history of premature coronary artery disease or sudden death. physical exam: on admission: physical exam: vital signs: t- 97.2 bp: 97/46 (.153 levophed) hr: 126-127 afib rr: 24-27 o2: 97% ac: 450 x 15 (sp 9) fi2: 0.50 peep: 5 general: patient is a chronically ill appearing female, with buccal wasting but gross anasarca. patient is with trach in place, breathing relatively comfortably : ncat, , perrl. op: mmm, poor dentition neck: supple, no lad, no jcd + left ij chest: course breath sounds diffusely on inspiration and expiration. no obvious rales, very limited posterior exam cor: irregular, systolic click throughout precordium. no obvious regurgitant murmurs appreciated abdomen: moderately to severely distended. 3+ edema. firm although not rigid, + pain with palpation of the left lower quadrant, sense of fullness underneath with ? palpable mass/phlegmon. rectal: thin yellow stool in rectal vault, trace guaiac positive extremity: 4+ pitting edema to thighs, hyperpigmentation of le. dp not palpable secondary to anasarca foley: foley in place draning brown feculent material with visible debris . on discharge: : ncat, , perrla, mmm neck: supples heart: irregular rhytm, nl rate chest: anterior exam with clear breath sounds bilaterally abdomen: soft, nt, nd, peg tube ext: chronic venous stasis changes. 2 + b pitting edema foley in place pertinent results: . ecg: 120, afib, rad. qrs 130, +rbbb. deep twi v1-v4. unchanged from previous. . imaging: : portable chest - impression: post-line placement, without pneumothorax. unchanged appearance of the chest with marked cardiomegaly and bibasilar opacities most likely representing atelectasis, however, pneumonia cannot be totally excluded especially in the left lower lobe. clinical correlation is recommended. . : ct abdomen/pelvis impression: 1. multiple foci of intraperitoneal gas could be related to recent gastrostomy placement (when was this installed?) but intraperitoneal infection cannot be excluded. no evidence of extravasation of oral contrast. 2. wall thickening of the ascending colon and hepatic flexure. this is a common finding in cirrhosis complicated by ascites. however, it is pronounced enough to suggest possible underlying colitis. 3. cirrhosis. significant increase in volume of ascites, which is now large. 4. extensive body wall edema. 5. marked cardiomegaly and biatrial enlargement. 6. moderate right pleural effusion and atelectasis of the base of the right lower lobe. small left pleural effusion. . echocardiogram: conclusions: the left atrium is markedly dilated. no left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). the right atrium is markedly dilated. mild spontaneous echo contrast is seen in the body of the right atrium. left ventricular wall thicknesses and cavity size are normal. there is moderate global left ventricular hypokinesis (lvef = 35-40 %). right ventricular cavity size is increased with free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. a bileaflet mitral valve prosthesis is present. the mitral prosthesis appears well seated, with normal disc motion and transvalvular gradients. trivial mitral regurgitation is seen. the degree of mitral regurgitation seen is normal for this prosthesis. a bioprosthetic tricuspid valve is present. the tricuspid prosthesis appears well seated, with normal leaflet motion and transvalvular gradients. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. brief hospital course: #. left rp bleed - pt presented with hypotension; pt found to have a large left rp hematoma on ct abdomen. pt was aggressively rescusitated with 14 units of rbcs and cryoprecipitate and ffp. pt was evaluated by surgery who felt that she wouldn't need surgical intervention but more likely ir embolization if she were to become hemodynamically unstable. patient did not require further treatment of the rp bleed and her hcts remained stable. she was restarted on iv heparin and transitioned to coumadin for an inr goal of 2.5-3.5 and her hct remained stable during this transition phase. . # pt had culture of blood, urine, sputum, and stool. sent stool for c. diff toxin a+b, a is negative on first culture, toxin b still pending. -continue po vanc and po flagyl for c.diff x14 days (from ) -pt completed course of ceftriaxone for presumptive sbp . #. arf - patient initially had increased cr. this was thought to be due to atn from her gi bleed. cr trended back to her baseline upon discharge. . #fluid overload - patient is currently positive 7 liters for her length of stay. she has been diuresed with 80iv lasix and 5mg metolazone as tolerated for daily i/o goals of -1l. continues to need diuresis. . # - pt had 10,000-100,000 yeast in urine after her second foley change. she was treated in light of patients symptoms of dysuria/rash as well as the relative risk of fungal endocarditis given her mvr and tvr. she will be treated with a 14 day course of fluconazole 200mg which will finish on . the interaction with coumadin was noted, therefore the titration of coumadin to goal was done slowly. . #. afib with rvr - initially with increased hr, likely exacerbated by levophed. patient was continued on metoprolol 12.5mg tid. she is currently on heparin while she is titrated up on her coumadin. . #.mvr and tvr - anticoagulation was initially held because of rp bleed. after bleed stable, she was started on a heparin gtt while she was bridged back to her coumadin. we are treating the yeast infection to prevent the possibility of fungemia and risk to valves. . # hypernatremia: na has trended up with diuresis. at time of discharge, we were replacing her free water deficit with 200ml of free h20 q6 hours. medications on admission: medications: at admission = discharge medications: metronidazole 500 mg po tid ceftriaxone 2 g once daily x 8 days (10 day course) bactrim ds 160-800 mg: tablet po once a day colace 100mg po bid furosemide 20 mg daily spironolactone 25 mg daily senna 1-2 tablets po bid calcium acetate 667 mg tid with meals metoprolol tartrate 25 mg po bid aspirin 81 mg daily sertraline 50 mg daily albuterol-ipratropium 103-18 mcg/actuation 6puffs q 4 hours atorvastatin 10 mg daily ascorbic acid 90 mg/ml dropn once daily famotidine 20 mg po bid acetaminophen 160 mg/5 ml po q 6 hr prn beclomethasone dipropionate 80 mcg/actuation aerosol multivitamin 5ml po daily warfarin 5 mg po qhs lactulose 30ml po tid heparin porcine (pf) 10 unit/ml solution: weight based protocol pt, ptt goal 60-80 until inr 2.5-3.5. heparin flush picc (100 units/ml) 2 ml iv daily:prn . discharge disposition: extended care facility: - discharge diagnosis: hypotension diarrhea discharge condition: stable discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1200 cc/d followup instructions: please follow up with your pcp. call to make an appointment pcp: , . procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances transfusion of packed cells transfusion of other serum diagnoses: acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified cirrhosis of liver without mention of alcohol acute posthemorrhagic anemia unspecified septicemia severe sepsis portal hypertension candidiasis of other urogenital sites atrial fibrillation heart valve replaced by other means alkalosis septic shock intestinal infection due to clostridium difficile long-term (current) use of anticoagulants hyperosmolality and/or hypernatremia diseases of tricuspid valve gastrostomy status hemorrhage, unspecified chronic respiratory failure tracheostomy status other diseases of trachea and bronchus spontaneous bacterial peritonitis 

Answer: The patient is high likely exposed to