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: percocet / cefazolin / vicodin / oxycodone attending: chief complaint: metabolic acidosis. major surgical or invasive procedure: none. history of present illness: the patient is a 47y/o f with a pmh of dm, etoh abuse, c. parapsilosis r knee septic arthritis/osteomyelitis recently admitted with delirium tremens/pres now presenting with hypotension, hypoxia and acute renal failure in the setting of recent c. diff colitis. . the patient was admitted on - with c parapsilosis septic knee joint and underwent debridement and drainage and discharged home on fluconazole. . she was then readmitted - with ams in the setting of etoh withdrawal. because of very high bps in micu (probably due to severe dts) and mri findings, the diagnosis of posterior reversible leukoencephalopathy (pres) was made. infectious w/u of cns was negative with negative csf and blood cx. upon aggressive bp reduction and control of etoh withdrawal the patient's mental status significantly improved. . the patient was discharged home from rehab on . pt reports she began drinking again daily after returning home from rehab. she was seen in clinic on and found to have a bp of 90/58 and pulse of 40. her metoprolol was decreased to 50mg q 12 from q 6 dosing. . she presented to osh on with nausea, vomiting and diarrhea x 1 day after finishing a course of vancomycin for c. diff colitis. reports diarrhea started on day of presentation with bm over 24 hrs. reported emesis and inability to take po. she was admitted to the icu. vancomycin was restarted and iv flagyl started. she was found to be hypotensive with sbp 85/49 and wbc of 17.9. abg 7.18/18/126 on ra. k 2.8. ag23. cr 3.4. she received iv and po bicarb. hct decreased to 24 and she was given 2u prbc. bp improved with volume resuscitation, did not require pressors. she was evaluated by nephrology and felt to have atn. gi performed an egd demonstrating gastritis. she developed respiratory distress the evening prior to transfer with abg 7.17/30/74 on 4l. she was started on bipap then transitioned to 6l nc prior to transfer. . she in now admitted to the icu for further management. on arrival to the icu, the patient is in no acute distress. denies any complaints. sating well on l. past medical history: type 2 diabetes since age 25. insulin-dependent peripheral artery disease s/p bypass-left lower extremity hypertension hypercholesterolemia hepatitis c c. parapsilosis right knee arthritis s/p open biopsy and synovectomy on currently on fluconazole alcohol abuse social history: 30 pack year smoking history, quit five years ago. per my interview no current alcohol or drug use but per neurology interview she generally drinks - 1 pint of "100 proof" daily. last drink was at least one day prior to admission. no history of dts or withdrawal seizures. also smokes marijuana daily. lives with her husband and 8 year old child. works as a cash administrator. family history: no known history of early neurologic deficits. physical exam: vitals: t 98.5 bp 128-134/59-61, hr 96-106, rr 12, o2 96% 2l gen: dishelved appearing heent: perrla, eomi, dry mm pulm: ctab, no wrr cv: rrr, nl s1/s2, no mrg abd: soft, non-distended, nabs, diffuse mild ttp extrem: no le edema, r knee with minimal swelling, grossly limited rom secondary to pain neuro: alert, oriented to self, does not recall recent events, speech spont & fluent, moving all ext. vitals on day of discharge: t98.2 hr 61 bp 146/58 rr 20 99% spo2 ra pertinent results: 11:32pm type-art po2-76* pco2-26* ph-7.36 total co2-15* base xs--8 11:32pm lactate-1.1 09:09pm glucose-221* urea n-42* creat-2.1* sodium-143 potassium-3.2* chloride-114* total co2-14* anion gap-18 09:09pm calcium-6.7* phosphate-3.7 magnesium-1.8 04:59pm type-art po2-50* pco2-25* ph-7.32* total co2-13* base xs--11 04:03pm ck-mb-12* mb indx-0.7 ctropnt-0.03* probnp-* 04:03pm albumin-2.9* calcium-5.9* phosphate-4.2 magnesium-1.9 04:03pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 03:35pm urine bnzodzpn-pos barbitrt-neg opiates-pos cocaine-neg amphetmn-neg mthdone-neg 02:38pm glucose-267* urea n-43* creat-2.4*# sodium-142 potassium-2.9* chloride-111* total co2-12* anion gap-22* knee oblique/ap/lat slightly decreased soft tissues in the right suprapatellar region but no significant changes in the alternating sclerotic and lucent regions of distal femur, patella, and proximal tibia. stable soft tissue density posterior to the right femur. cxr increased opacity is seen in the left lung field mid and upper regions. otherwise stable appearance to the right picc line and other bilateral infiltrates noted. no blunting of the cp angles. i do not see any definite cavitation at this time. . echo the left atrium is mildly dilated. the estimated right atrial pressure is 0-10mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. focal thickening at the tip of the right coronary cusp might have increased slightly. no masses or vegetations are seen on the aortic valve. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. there is small vegetation on the mitral valve (0.3cmx0.3cm) (clip ) at the coaptation point. an eccentric, posteriorly directed jet of mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (images reviewed) of , the mild mitral regurgitation is new with a small vegetation seen on the anterior leaflet at the coaptation point . blood wbc-9.5 rbc-3.11* hgb-9.0* hct-27.2* mcv-87 mch-28.8 mchc-33.0 rdw-14.6 plt ct-350 blood glucose-126* urean-15 creat-1.2* na-143 k-3.0* cl-108 hco3-24 angap-14 blood crp-30.4* blood esr-80* . mri knee w/ and w/o contrast: again seen is a moderately large knee joint effusion with enhancement of the residual synovium and/or joint capsule. numerous subcentimeter susceptibility artifacts anterior to the extensor mechanism and in the anterior joint space are unchanged and likely related to previous surgery. note is made of fluid extending outside the joint capsule, extending into the subcutaneous fat, along the lateral and posterolateral aspect of the knee (ser 6, im 18), unchanged from the prior study. cortical erosion of the articulating surfaces of the tibia as well as enhancement of the tibial plateau is unchanged and likely due to a combination of osteomyelitis, bone infarct, and secondary osteoarthritis. bone marrow edema, enhancement, and erosion along the posterior aspect of the patella is unchanged and are likely related to osteomyelitis, infarct, osteoarthritis, and an abutting bone fragment. bone marrow signal alteration and linear areas of enhancement in the femoral condyles is unchanged and may be related to osteomyelitis and/or bone infarcts. again seen is cortical irregularity and some areas of cortical disruption along the femoral condyles. no definite intraosseous or subcutaneous abscesses. impression: 1) the overall appearance is unchanged compared with . no change in bone marrow signal abnormalities in the femoral condyles, tibial plateau, proximal tibial metaphysis, and posterior patella, which likely reflects some combination of osteomyelitisand/or residual edema from treated osteomyelitis, bone infarcts, and secondary osteoarthritis. no new areas of enhancement or bone marrow edema. 2) moderately large joint effusion, unchanged since . . renal ultrasound: findings: the right kidney measures 12.6 cm. the left kidney measures 12.3 cm. no mass, stone or hydronephrosis is demonstrated within the kidneys. there is a trace right pleural effusion. the bladder is moderately distended without focal mass lesion detected within. impression: 1. no hydronephrosis. 2. trace right pleural effusion. labs on /9: wbc 9.7 hb 8.7 hct 27.2 plt 395 na 144 k 3.3 cl 110 hco3 24 bun 15 cr 1.5 gluc 81 ca 8.9 mg 1.9 phos 4.6 . hcv viral load (final ): 487,000 iu/ml. . brief hospital course: patient admited to the icu and then transferred to the floor. right knee c.parapsilosis septic arthritis/osteomyelitis - started diflucan on but noncompliant. knee exam appears stable, mri generally unchanged; did not feel it clinically warranted tapping. as renal function increased over micu stay, id advised increasing diflucan dose. now on months of po fluconazole. to follow-up with and id as outpatient. . possibe endocarditis: echo showed small new vegatation on anterior leaflet of mitral valve. not present on tee from early . discussed with cardiology and reviewed imaging together; follow-up in approximately 3 weeks with tte to see if change in imaging (appointment as outpatient). no tee necessary at this point in time. patient has never been bacteremic or fungemic. no new murmur auscultated, no spots or other findings suggestive of embolic disease seen by optho consult. . acute renal failure with hypokalemia, hypomagnesemia, and metabolic acidosis: hx nsaid abuse. gap and non-gap acidosis on admission, initially thought to be secondary to diarrhea, however low bicarbonate persisted beyond diarrhea cessation with associated hypokalemia, hypochloremia, hypernatremia. this raised the question of rta, but that is/was problem to invoke in setting of arf. renal consulted. pt treated with bicarb and then bicarb normalized. she continued to have some hyperchloremia, likely due to ivf which had previously been given. hypokalemia corrected with repletion ?????? may also be prolonged diflucan course or alcohol abuse. renal advised starting potassium citrate ?????? not on formulary, switched to bicitra; then d/c'd bicitra as renal function and acid/base status improved. renal advised po potassium and magnesium daily, and regular checks of electrolytes (chem 10) and renal function. . possible uti ?????? urine culture showed 10-100,000 klebsiella species. started ciprofloxacin, 7 day course (last day ). . clostridium dificile colitis: pt started on treatment course for c. difficile from osh. unclear how compliant pt has been with treatment course, and c.diff +ve at osh so decided to restart a treatment course here. initially on vanc/flagyl. c.diff culture negative x2 here in hospital. no diarrhea since admission. now just po vancomycin (last day ). . hypoxemic respiratory failure: possibly combination of dchf, aspiration, reactive airway disease. cxr shows findings consistent with volume overload; expiratory wheezes copd vs cardiogenic. had 02 requirement, successfully weaned with initial autodiuresis then minimal lasix. pt irritated by albuterol nebs, used atrovent nebs with good effect. aspiration precautions. patient weaned down to room air, spo2 100% at discharge and without sob. . hypertension: had been hypotensive in setting of prolonged diarrhea, dchf, decreased po intake. held antihypertensives, but then pressures were persistently elevated. so treated with metoprolol, clonidine, amlodipine, with dose adjustment as needed. lisinopril continued to be held due to arf, during hospitalization. if continues to be hypertensive, suggest that next med to be added/changed would be the addition of an ace inhibitor, ie; lisinopril (was on 40mg daily, would start at 10mg daily and titrate up, as tolerated by creatinine). plan to titrate down the clonidine, over 3 days, by halving dose each day (continuing tid though). . alcohol abuse with hx dts/pres: diazepam per ciwa protocol. got zyprexa in icu to provide some sedation with decreased benzo load and clonidine. sw consulted. no s/s of withdrawal while on floor. discussed alcohol cessation with patient. . diabetes mellitus, type ii, poorly controlled: continued lantus and insulin ss, with adjustments to treat hyperglycemia throughout hospital course. continue on sliding scale, and adjust as needed to treat blood sugars. . hypernatremia: corrected with free water drinking and d5w via iv. etiology unclear; perhaps hyperaldosterone state - please follow-up renin and aldosterone level tests, sent from on the patient - or renal tubular acidosis are questionable. encourage free water drinking/hydration. . hypokalemia, hypomagnesemia: unclear etiology, perhaps due to alcohol or renal disease. started daily po potassium and daily po magnesium, with regular electrolyte checks. again, please follow-up on renin and aldosterone level tests on this patient, sent out from laboratory. . hypocalcemia - pt had transient hypocalcemia raising question of hypopth or pseudohypopth, however pth level wnl and hypocalcemia resolved with repletion. . outstanding labs: renin, aldosterone, drawn at medications on admission: amlodipine - 5 mg daily fluconazole - 400 mg daily folic acid - 1 mg daily hydralazine - 25 mg tablet q 6 hrs hydrochlorothiazide - 25 mg daily ibuprofen - 800 mg tablet - q 8 hours insulin glargine - 100 unit/ml solution - 18 units qam to 45 units qpm lidocaine - 5 % (700 mg/patch) adhesive patch, daily lisinopril - 40 mg daily metoprolol tartrate - 50 mg tablet q12 omeprazole 20mg q12 vancomycin - 250 mg capsule - q 8 - stop zolpidem 10 mg qhs vitamin d-3 - 2,000 unit tablet - 50,000 iu weekly discharge medications: 1. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours): the last day to take this medicine is . 2. fluconazole 200 mg tablet sig: two (2) tablet po q24h (every 24 hours). 3. petrolatum ointment sig: one (1) appl topical (2 times a day) as needed for dry skin, such as forearm. 4. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day): please continue until patient is ambulating regularly. 5. zolpidem 5 mg tablet sig: two (2) tablet po hs (at bedtime) as needed for for sleep. 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. clonidine 0.2 mg tablet sig: one (1) tablet po tid (3 times a day) for 1 days: please give this dose for one day, 8/28/9, as we are tapering her down. 8. toprol xl 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 9. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 10. potassium chloride 20 meq packet sig: two (2) po daily (daily). 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 12. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 13. magnesium oxide 400 mg tablet sig: one (1) tablet po daily (daily). 14. sodium chloride 0.9 % 0.9 % parenteral solution sig: ten (10) ml intravenous prn (as needed) as needed for line flush. 15. humalog 100 unit/ml solution sig: one (1) subcutaneous qachs: please follow the attached sliding scale. adjust as needed for control of blood sugar. 16. clonidine 0.1 mg tablet sig: one (1) tablet po three times a day for 1 days: please give this dose for one day, on /9, as we are tapering down her dose. 17. clonidine 0.1 mg tablet sig: 0.5 tablet po three times a day for 1 days: please give this dose on , as we are tapering down this medicine. this will be the final day of treatment with clonidine. 18. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) patch topical once a day as needed for pain: please apply for maximum of 12 hours out of a 24 hour period. 19. outpatient lab work please check chemistry 7, calcium, magnesium, phosphate, on friday , and adjust repletion of electrolytes as necessary. 20. outpatient lab work please follow-up outstanding renin and aldosterone levels, ordered from , on this patient. discharge disposition: extended care facility: manor extended care facility discharge diagnosis: c.difficile colitis acute renal failure knee fungal () septic arthritis and osteomyelitis hypoxic respiratory failure metabolic acidosis hypokalemia hypernatremia hypocalcemia hypomagnesemia diabetes, insulin-dependent hypertension discharge condition: afebrile, diarrhea resolved, creatinine improved, knee pain at baseline, ambulating with assistance and walker. feels eager to leave hospital. discharge instructions: you were admitted to the hospital with diarrhea due to a bacteria called c.difficile. because of the dehydration due to the diarrhea, your kidneys were injured. as we rehydrated you, and treated your diarrhea with an antibiotic called vanocmycin, your diarrhea went away and your kidney function improved back to approximately your baseline. we continued you on the antibiotics you were on for your right knee infection (fluconazole) - the infectious disease team saw you and recommended that you continue on that antibiotic for between 6-12 months; they will explain the specific course to you when you go to your next appointment with them. for your knee pain, physical therapy saw you and recommended that you go to rehab. your breathing was initially dificult so you were on oxygen, but as that improved you were weaned down to room air. your potassium and magnesium levels were frequently found to be low, so we started you on pills for those. your sodium was frequently high, so we encourage you to drink water to stay hydrated. . please call your doctor or return to the hospital if you develop a fever >100.4, chest pain, shortness of breath, abdominal pain, re--occurrence of diarrhea, worsening right knee pain, or other symptoms that concern you. . please continue the oral fluconazole antibiotic (to treat your knee infection) daily until you see the infectious disease doctor, dr. , and then you will still continue that medicine for 6-12 months. . please continue to avoid drinking alcohol. . we have changed your blood pressure medication regimen so that now you are taking the following medications: -clonidine -amlodipine -toprol xl followup instructions: provider: , md (orthopedics) - phone: date/time: 11:30 . provider: xray (scc 2) phone: date/time: 11:10 . provider: , md (infectious disease). phone: date/time: 9:30 . transthoracic echocardiogram. date and time: at 11am. location: , , . phone number: procedure: venous catheterization, not elsewhere classified alcohol detoxification diagnoses: acidosis hypocalcemia pure hypercholesterolemia urinary tract infection, site not specified unspecified essential hypertension friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified viral hepatitis c without hepatic coma hypopotassemia acute respiratory failure long-term (current) use of insulin intestinal infection due to clostridium difficile hyperosmolality and/or hypernatremia atherosclerosis of native arteries of the extremities, unspecified alcohol abuse, continuous other candidiasis of other specified sites disorders of magnesium metabolism electrolyte and fluid disorders not elsewhere classified chronic total occlusion of artery of the extremities pyogenic arthritis, lower leg unspecified osteomyelitis, lower leg 

Answer: The patient is high likely exposed to