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: erythromycin base attending: chief complaint: creatinine of 7.0. nausea and vomiting. major surgical or invasive procedure: picc line placement . history of present illness: on admission to medical floor: . 66 year old male with type ii niddm, cad, recent discectomy complicated by right sided embolic cva, who presented to the with nausea/vomiting x 2 weeks at which point he was found to have a creatinine of 7 (baseline of 1). . patient has had nausea since his surgery (see below for history of recent hospitalizations). he reports that he has been unable to tolerate food as just the smell makes him nauseated. he has lost 54 pounds since his surgery. on he was started on 4 week course of ciprofloxacin for e. coli prostatitis. though his urinary symptoms resolved, since that time his nausea and vomiting have worsened. he was not been able to tolerate full meals, only ginger ale. his vomitus has been non-bloody, non-bilious and he has had no abdominal pain or cramping. he has been feeling weak and lightheaded. at his pcp visit with dr. , he was directed to the ed due to persistent vomiting and dehydration. while there his creatinine was found to be 7.0 and he was admitted to the micu. . during his icu course he was followed by the renal team (attending dr. who thought his renal failure to be multi-factoral atn due to volume depletion w/ ace and hypotension. patient showed some improvement with maitenance ivf, his lisinopril, metformin and nsaid were held. at no point did the patient need hd. his nausea and vomiting improved somewhat on scopalamine patch and anti-emetics, but patient continued to have vomiting. his bradycardia and hypotension were thought to be secondary to beta blocker toxicity in setting of arf; atenolol, lisinopril, glucagon and dopamine were held. patient began to receive ceftriaxone on for his prostatitis. patient has had a sore throat for two days, was strep negative. he was transferred to the medical floor on in stable condition. . review of systems: weak and fatigued, feels lightheaded when he stands up, but resolves when he lies down. he sleeps a great deal. no loss of consiousness. no fevers or sweats. 54 pound weight loss since surgery. no rash, pruritus, bruising, change in hair or nails. no headaches or trauma. no eye irritation or change in vision (though initially diminished on left after cva). wears glasses for and distance. no change in hearing. no epistaxis. no mouth sores or difficulty swallowing. has had sore throat with associated cough for two days. no chest problems or difficulty breathing. no chest pain or pressure, no palpitations. no abdomenal pain or cramping. occassional loose stools, but generally regular bowel movements. as above, patient has had nausea and vomiting. no dysuria, though patient was not able to urninate in the ed, has had foley catheter since this admisison. patient has had erectile dysfunction for several years. patient has osteoarthritis with tender finger, toe and left knee joints. patient has some calf pain on exertion - he has had claudication, he is unable to walk more than a block without pain. he has some abnormal sensation in his fingers and toes, things often feel "wet." he has had no nervousness, depression or change in memory. he often feels cold. . past medical history: recent hospitalizations: *: elective c5-c6 disectomy due right hnp with compression of exiting nerve root. episode of hemiparesis, with continued motor dysfunction. */06: "difficulty dressing and personality changes." assumed to be post operative left hemiparesis, found to be from right mca cva due to a pfo. had loose stools, c-diff negative. */06: "watery diarrhea." c-diff negative, but improved with empiric flagyl, planned 2 week empiric treatment. assumed diarrhea worsened by omega 3 fatty acids and aggrenox, both discontinued with associated improvement in symptoms. *: "fevers, dysuria, urgency and pelvic pain." ultrasound showed prostatic hypertrophy, psa elevated at 24.9, e.coli in urine culture = prostatitis; treated with iv ceftriaxone, discharged with 4 week course of ciprofloxacin and flomax. had loose stools on admission and discharge, c-diff negative. . medical history: 1) adenoma, most recent colonoscopy in with adenoma. followup recommended in one year. 2) coronary artery disease status post ptca of rca in . 3) atrial fibrillation on amiodarone, s/p cardioversion (summer ), currently off coumadin. 4) peripheral vascular disease status post bilateral femoral ptca in ; chronic claudication. 5) history of osteoarthritis in the hands, feet, c-spine, left knee. 6) hyperlipidemia, predominantly elevated triglycerides and low hdl. 7) diabetes type 2, managed with metformin. 8) obesity and obstructive sleep apnea. 9) kidney stones 10) radiculitis diagnosed in 07/. mri with foraminal narrowing c5-c6. 11) recent e. coli prostatitis: diagnosed on admission. 12) recent diarrhea: admission negative for c-diff but tx with flagyl, taken off aggrenox and symptoms improved. 13) hypothyroid: diagnosed < 1 year ago. . surgical history: 1) cervical radiculopathy s/p discectomy 2) cholecystectomy 3) history of left knee surgery. 4) acromioplasty, arthoscopic debridement, rotator cuff tear repair . social history: patient is married (wife ), has 6 children (4 from previous marriage, 2 from current marriage), and four grandchildren. patient lives with his wife, daughter and son. worked for 40 years at in purchasing department, waiting to return to work. habits: 40 pack year smoking history, quit 10 years ago. heavy drinker for 40 years, quit 10 years ago after elevated bilirubin, now occassional wine. denies use of any other drugs. patient is no longer sexually active due to erectile dysfunction of several years. family history: diabetes mellitus, peripheral vascular disease, coronary artery disease, lung and breast cancer physical exam: on admission to medical floor: general: pale appearing man in no acute distress, lying in bed. vitals: t: 98.2 bp: 134/70 p: 50 rr:18 96% on ra fingerstick 148 heent exam: head normocephalic, atraumatic; conjunctivae clear, sclerae anticteric, pupils equally round and reactive to light. extraocular muscles intact. visual acuity testing was deferred. oropharynx clear, moist mucus membranes, no posterior oropharyngeal erythema or exudate. neck: trachea midline. neck supple. thyroid not palpable. no cervical, axillary or supraclavicular lymphadenopathy noted. lung: clear to auscultation bilaterally on anterior exam. good breath sounds, decreased air movement. no crackles, wheezes or rhonchi throughout. some pain to palpation on left costal border. cardiac: regular rate and rhythm, 1/6 systolic murmur, no rubs or gallops, jvp not appreciated, no carotid bruits. abdomen: scars from previous cholecystectomy, active bowel sounds in all four quadrants. non tender, no palpable masses, no hepatosplenomegaly, no guarding or rebound. rectal: no tenderness or pain. extremities: warm, well-perfused. no clubbing, cyanosis, edema. 1+ dorsalis pedis pulses bilaterally. skin: skin warm and moist. no suspicious nevi, rashes, petechiae or ecchymoses. neurology: alert and oriented x3. cn ii-xii intact to direct testing. preserved sensation throughout. resting tremor in upper and lower left extremity. motor on right , on left . finger to nose and rapid alternating movements intact on right side, diminished and with tremor on left. no pronator drift. gait assessment deferred. pertinent results: chest x-ray (): no evidence of intrathoracic pathology. . ecg (): sinus bradycardia. prolonged qtc interval. since previous tracing of diffuse low amplitude t wave changes have decreased. . renal us (): no evidence of hydronephrosis or obstruction. bilateral renal cysts. . ecg (): sinus rhythm with rightward axis, low limb lead qrs voltages, q-tc interval appears prolonged but is difficult to measure. since previous tracing of , sinus bradycardia rate faster. . 06:49am blood wbc-4.6 rbc-3.13* hgb-9.3* hct-27.7* mcv-89 mch-29.6 mchc-33.4 rdw-15.0 plt ct-166 03:00am blood wbc-4.0 rbc-2.94* hgb-8.8* hct-27.7* mcv-94 mch-30.1 mchc-31.9 rdw-14.7 plt ct-157 10:05am blood wbc-9.0# rbc-4.02* hgb-12.1* hct-35.4* mcv-88 mch-30.0 mchc-34.1 rdw-14.8 plt ct-380 10:05am blood neuts-80.9* lymphs-15.4* monos-2.8 eos-0.5 baso-0.4 06:49am blood pt-13.3* ptt-28.6 inr(pt)-1.2* 04:57am blood pt-14.4* ptt-30.3 inr(pt)-1.3* 10:37am blood pt-15.8* ptt-27.3 inr(pt)-1.4* 06:49am blood glucose-87 urean-24* creat-4.0* na-147* k-3.7 cl-114* hco3-25 angap-12 06:55am blood glucose-106* urean-27* creat-4.4* na-147* k-3.8 cl-115* hco3-26 angap-10 04:57am blood glucose-98 urean-35* creat-5.0* na-145 k-3.9 cl-115* hco3-22 angap-12 05:57am blood glucose-92 urean-42* creat-5.7* na-145 k-4.0 cl-114* hco3-23 angap-12 05:45am blood glucose-113* urean-47* creat-5.8* na-144 k-4.0 cl-115* hco3-20* angap-13 04:14am blood glucose-130* urean-54* creat-6.0* na-143 k-4.0 cl-115* hco3-20* angap-12 03:57am blood glucose-193* urean-55* creat-6.4* na-136 k-3.7 cl-107 hco3-18* angap-15 02:07pm blood glucose-137* urean-56* creat-6.4* na-138 k-3.8 cl-109* hco3-18* angap-15 04:24am blood glucose-81 urean-53* creat-6.6* na-143 k-4.0 cl-112* hco3-19* angap-16 08:00pm blood glucose-58* urean-47* creat-6.4* na-148* k-4.1 cl-113* hco3-18* angap-21* 02:07pm blood ck(cpk)-37* 10:05am blood alt-17 ast-31 ck(cpk)-38 alkphos-78 amylase-34 totbili-1.0 02:07pm blood ck-mb-notdone ctropnt-<0.01 05:38pm blood ck-mb-notdone ctropnt-<0.01 10:05am blood ck-mb-notdone ctropnt-<0.01 06:49am blood calcium-8.0* phos-2.8 mg-1.7 08:00pm blood calcium-8.2* phos-4.8* mg-2.1 10:05am blood totprot-7.4 calcium-9.5 phos-5.1*# mg-2.2 03:00am blood caltibc-168* ferritn-543* trf-129* 04:24am blood -0.36 03:00am blood pth-48 05:38pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg . stool culture (): negative. . urine culture (): negative. . blood culture (): negative. brief hospital course: patient is a 66-year-old male with non-insulin dependent diabetes type 2, coronary artery disease status post ptca, peripheral vascular disease, hypercholesterolemia, status post c-spine surgery , with postop course complicated by left hemiparesis likely due to right mca cva in the setting of patent foramen ovale, who presented with creatinine of 7.0 and hypotension in the setting of several weeks of of nausea and vomiting. . 1) renal failure: patient was likely dehydrated secondary to prolonged nausea/vomiting and poor po intake. he continued to take lisinopril and atenolol which would further decrease his renal perfusion, leading to supratherapeutic levels of both and more hypoperfusion, likley resulting in acute tubular necrosis. on admission fena was 3.3%, consistent with intrinsic renal failure and acute tubular necrosis. renal ultrasound () showed no evidence of hydronephrosis or obstruction. urinalysis and urine culture both negative. patient had foley catheter inserted on admission and continued to make urine throughout hospitalization (foley was removed on ). patient received ivf throughout hospital stay. ace inhibitor, atenolol and metformin were held, medications were renally dosed. on admission () patient's creatinine was 7.0 (baseline creatinine is 1.0), was 6.0 on when transfered to medical floor, and 3.5 on . - patient's creatinine will be monitored every other day at skilled nursing facility, results will be sent to dr. office. follow up appointment with renal (dr. 10:30 am on ). . 2) bradycardia: on admission patient was taking atenolol and amiodarone, but was likely supratherapeutic due to renal failure. he was symptomatic with dizziness and light headedness with ambulation. ecg showed long qtc and no st changes. cardiac enzymes were normal. patient's blood pressure medications were all held. while in the micu patient received glucagon to attempt to reverse the effects of his beta-blocker. heart rate remained in the 50-60bpm range. - patient was discharged without his home medications of atenolol, amiodarone and lisinopril, due to prolonged bradycardia. will need to be restarted in future once bradycardia resolves. . 3) blood pressure: patient was hypotensive on admission. during micu stay patient had no fever or evidence of infection. urine, blood, stool cultures are negative to date. hypotension was likely secondary to bradycardia and multiple bp meds on board in addition to dehydration. patient received iv fluids throughout hospital course. most likely the result of medications supratherapeutic concentrations in setting of renal insufficency. once transfered to the medical floor his blood pressures trended up with sbps in the 150s. -patient was started on amlodipine 5mg on . patient will be discharged on this medication. . 4) nausea/vomiting: patient has had nausea and decreased appetite since disectomy on , and severe vomiting for several weeks pta. patient had been unable to tolerate most foods, with the exception of ginger ale. patient has had a 54 pound weight loss over the last several months. per patient, his nausea worsened when he received ciprofloxacin for prostatitis, but did improve once ciprofloxacin was discontinued (last dose 10/10). ciprofloxacin was held. patient's diet was slowly advanced - at time of discharge he was able to tolerate his meals without vomiting, though he still had some baseline nausea. patient received antoprazole throughout his hospital course, as well as multiple combinations of anti-emetics. - patient will be discharged on scopalamine, promethazine and metoclopramide for his anti-emetic regimen. he will also continue to receive pantoprazole. . 5) prostatitis: patient was diagnosed with e. coli prostatatis on admission (psa was 25, enlarged prostate seen on ultrasound) and was treated with iv ceftriaxone. at that time he was discharged with tamsulosin and 4 week course of ciprofloxacin. he received 2.5 weeks of ciprofloxacin, which was changed by his pcp on the day pta to bactrim due to concern for patient's nausea and vomiting, his tamsulosin was also stopped. as bactrim can cause increased creatinine levels, ceftriaxone 1gm daily was started on admission () and continued throughout the hospital course. urology team consult recommended continued tamsulosin and antibiotics treatment, tamsulosin was restarted. additionally, on admission patient was not able to void and received a coude catheter. this was removed on , patient was successfully able to void with post void residual of 118cc. - patient will continue to receive ceftriaxone for a full four week course (until ). - patient has follow up urology appointment with dr. on at 3:30 pm. . 6) anemia: patient's hematocrit was 35 on admission, but persisted in the 28-30 range (baseline of 40). iron studies () showed: iron (40), tibc (168), transferrin (129) and ferritin (543) consistent with anemia of chronic disease and his renal failure. patient was started () on epoetin 3000 units m/w/f (increased to 4000 units on ) and ferrous sulfate 325mg. - patient will continue to receive epoetin and ferrous sulfate at skilled nursing facility. . 7) type ii dm: home medications include metformin, which was held due to concern for increased risk of lactic acidosis in setting of renal failure. patient's glucose was monitored and he was kept on an insulin sliding scale. euglycemic over the past week. be due to decreased weight. - metformin should continue to be held until patient's renal function has improved. will need to reassess as outpatient with pcp. . 8) hypercholesteremia: patient continued to receive atorvastatin. fenofibrate was held. . 9) hypothyroid: patient's was 0.36 on . he continued to receive levothyroxine sodium 100 mcg po daily. . 10) cad: coronary artery disease status post ptca of rca in . troponins were negative on admission. patient received 81 mg aspirin daily during hospital stay. - patient will need to continue ace-inhibitor once creatinine stabilizes, as cardioprotective in diabetics; will need to be reassessed with pcp. . 11) atrial fibrillation: patient's rate is controlled with atenolol and amiodarone for paf status post cardioversion in and has been persistently in sinus rhythm since that time. coumadin has been deferred as patient has a chads score of 2 (1 point for htn and 1 point for diabetes). per his cardiologist dr. , his hisory of post-operative stroke does not enhance his current cva risk. anti-coagulation was deferred during this hospitalization. - amiodarone and atenolol were held at discharge. - patient has follow up appointment with his cardiologist, dr. , on at 10:00am. . 12) ppx: patient received pantoprazole, heparin sc, and pneumoboots. patient walked with pt and received ot as well. . 13) fen: patient received iv fluids. patient was hypophosphatemic and responded well to neutraphos. . 14) access: patient received picc during on . . 15) code: full . 16) dispo: patient did not qualify for acute rehab as his pt needs were not sufficient. patient was discharged to west acres skilled nursing facility where he will continue to receive pt, ot and monitoring of his creatinine. . medications on admission: 1. atenolol 12.5 mg once a day. 2. amiodarone 200 mg once a day. 3. aspirin 81 mg a day. 4. fenofibrate 48 mg a day. 5. levothyroxine 100 mcg a day. 6. atorvastatin 40mg po daily. 7. metformin 500 mg p.o. b.i.d. 8. fluticasone 50 mcg/actuation aerosol spray nasal daily (daily). 9. lisinopril 2.5 mg po daily. 10. loperamide 2 mg capsule sig: capsules po qid 11. ciprofloxacin 500 mg p.o. b.i.d. (patient was switched from ciprofloxacin to bactrim on an attempt to control his nausea) discharge medications: 1. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed): sliding scale will be attached. 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. tamsulosin 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po hs (at bedtime). 7. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 8. magnesium oxide 400 mg tablet sig: one (1) tablet po daily (daily). 9. promethazine 25 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 10. metoclopramide 10 mg tablet sig: 0.5 tablet po qidachs (4 times a day (before meals and at bedtime)). 11. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 12. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 13. scopolamine base 1.5 mg patch 72hr sig: one (1) transdermal every seventy-two (72) hours. 14. epoetin alfa 4,000 unit/ml solution sig: one (1) injection injection qmowefr (monday -wednesday-friday). 15. ceftriaxone 1 g recon soln sig: one (1) gram intravenous once a day for 3 days. 16. nystatin 100,000 unit/g powder sig: one (1) topical once a day for 10 days. 17. cepacol 2 mg lozenge sig: lozenges mucous membrane prn (as needed). discharge disposition: home with service facility: vna discharge diagnosis: acute renal failure. discharge condition: afebrile, stable vital signs, tolerating pos, ambulating without assistance. discharge instructions: **you were admitted with acute renal failure. you were treated with iv fluids and some of your medications were held. your creatinine levels have continued to improve. **in addition, your nausea and vomiting have improved. **you should continue the medications that have been newly prescribed. you will need to discuss restarting some of these medications with your pcp in the next week. **please call your doctor or return to the emergency room if you continue to have persistent vomiting and weight loss, weakness, lightheadedness, or if you have difficulty or stop producing urine. followup instructions: provider: , md phone: date/time: 1:00 provider: , md phone: date/time: 10:30am provider: . phone: date/time: 3:00 provider: , m.d. phone: date/time: 10:00 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances infusion of vasopressor agent diagnoses: anemia in chronic kidney disease acute kidney failure with lesion of tubular necrosis diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified acquired hypothyroidism peripheral vascular disease, unspecified percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified other specified cardiac dysrhythmias other shock without mention of trauma hypovolemia long qt syndrome other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use cardiac rhythm regulators causing adverse effects in therapeutic use prostatitis, unspecified persistent vomiting 

Answer: The patient is high likely exposed to