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: wellbutrin attending: chief complaint: asymptomatic tachycardia major surgical or invasive procedure: none. history of present illness: this is a 63 year old female with a history of copd, dm ii and new diagnosis of atrial fibrillation who presents from for further cardiology evaluation of her atrial fibrillation. she was recently discharged from the ( to ) with a diagnosis of new onset atrial fibrillation/flutter. she was seen by the cardiology service (dr. during that admission and started on anticoagulation and antiarrhythmic therapy on amiodarone. she has been feeling well since discharge from that hospitalization until she was noted by her vna this morning during routine vitals check to have a hr to 130s. she was initially sent to , and found to have afib with rvr to 140s (remainder of vitals t 98.5, hr 146, bp 126/76 95% ra). she was given cardizem 20 iv then started cardizem gtt at 5mg/h then titrated to 10 mg/h. she continued to have rapid ventricular rate to 120s and was transferred to the for cardiology evaluation. in the ed, patient's vs were 97.4 bp 109/75 rr 16 93% ra, she was again noted to be in atrial flutter at 140 and was given diltiazem 10 mg iv. her hr persisted at 110-130s and bp transiently down to high 90s (lowest sbp 96), per review of edvs, appears to spontaneously resolve. she was given 3 l of ivf total in ed. she had a blood pressure rise to 110s at time of admission. in addition, she was noted to have diffuse wheezing and was treated for copd flare with methylprednisolone 125 mg, albuterol and atrovent nebs and levofloxacin. she reports dyspnea on exertion that started earlier this morning. also reports 2 days of productive cough of yellow sputum. denies fevers, and chills. also denies palpitations, chest pain, orthopnea, and lower extremity swelling. past medical history: atrial fibrillation copd dm type ii hyperlipidemia hypertension social history: former tobaccco use until 2 months ago. 100 pack years. lives alone, completes all adls alone. family history: non-contributory physical exam: vs: 96.1 110/70 rr 25 94% ra hr 135 gen: nad heent: at, nc, perrla, eomi, no conjuctival injection, anicteric, op clear, mmm, neck supple, no lad, no carotid bruits cv: rrr, nl s1, s2, no m/r/g pulm: expiratory wheezing, poor air movement abd: soft, nt, nd, + bs, no hsm ext: warm, dry, +2 distal pulses bl, no femoral bruits neuro: alert & oriented, cn ii-xii grossly intact, 5/5 strength throughout. no sensory deficits to light touch appreciated. no asterixis psych: appropriate affect pertinent results: admission labs: 08:00pm blood wbc-8.0 rbc-4.70 hgb-13.4 hct-38.8 mcv-83 mch-28.5 mchc-34.5 rdw-13.4 plt ct-374 08:00pm blood neuts-59.2 lymphs-34.0 monos-3.8 eos-2.4 baso-0.6 08:00pm blood pt-14.7* ptt-20.1* inr(pt)-1.3* 08:00pm blood plt ct-374 10:40pm blood glucose-101 urean-15 creat-0.8 na-145 k-3.2* cl-111* hco3-26 angap-11 05:56am blood alt-14 ast-14 ck(cpk)-47 alkphos-91 totbili-0.2 08:00pm blood ctropnt-<0.01 10:40pm blood calcium-8.1* phos-2.8 mg-1.2* 05:56am blood tsh-1.5 . . pertinent labs/studies: wbc: 8.0 (/) -> 20.4 () -> 12.5 () hct: ranged between 32.0 and 38.8 during this admission inr: 2.8 -> 2.1 -> 1.7 -> 2.0 -> 2.7 -> 2.6 -> 2.4 trop: <0.01 x2 digoxin: 0.05 -> 0.8 (subtherapeutic) microbiology: u/a (): small leukocytes, occasional bacteria. cx was consistent with skin contamination. u/a (): no leukocytes, few bacteria, no blood. cx showed no bacteria cdiff cx (): negative bcx (): negative . ecg (): atrial flutter at rate of 130, normal axis, depression lead ii, v3-v4. cxr (): left atrial enlargement with no pulmonary consolidation. . cxr (): in comparison with the study of , there is little change and no definite pulmonary vascular congestion. although there is straightening of the left heart border and vague suggestion of a double density behind the heart, there is no elevation of the left main stem bronchus that is characteristic of left atrial enlargement. echocardiography would be required to determine whether there is any chamber enlargement or valvular involvement . cxr (): in comparison with the study of , there is again some hyperexpansion of the lungs consistent with chronic pulmonary disease. no evidence of acute focal pneumonia. some atelectatic changes are seen at the left base. . cxr (): no significant interval change. slight decrease in bibasilar atelectatic regions. no evidence for pneumonia . echo (): the left atrium is elongated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 50-55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. . . discharge labs: 07:20am blood wbc-12.9* rbc-3.83* hgb-10.8* hct-32.0* mcv-84 mch-28.1 mchc-33.6 rdw-14.2 plt ct-304 07:20am blood plt ct-304 07:20am blood pt-24.6* ptt-27.6 inr(pt)-2.4* 07:20am blood glucose-103 urean-17 creat-0.9 na-138 k-4.3 cl-98 hco3-32 angap-12 07:14am blood calcium-8.5 phos-3.5 mg-2.0 07:20am blood digoxin-0.8* brief hospital course: 63 year old female with a history of copd and type ii dm who presents with a recent diagnosis of atrial flutter/fib found to be with rvr and copd exacerbation. . # atrial flutter/fib: patient was diagnosed with afib and aflutter during an admission to hospital in . she was not responsive to pharmacotherapy. she had a tee in the micu, which was negative for thrombus, and then underwent cardioversion in the micu. after transfer to the floor, she converted back into afib. she continued to vacillate between afib and nsr during her hospital stay. she was admitted on 200 mg amiodarone daily. she was placed on amiodarone 200 mg , verapamil 360 mg daily, and digoxin 0.125 mg daily, yet she still converted back into afib. she was thus tried on 40 mg short-acting verapamil tid, but this also did not put her back into continuous nsr. her rate continued to remain in the 110s to 130s despite maximal medical management, yet the patient remained asymptomatic and was successfully ambulating in the halls. she was discharged on 360 mg verapamil daily, 200 mg amiodarone , 0.125 mg digoxin daily, and a follow-up appointment with dr. on . . # constipation/diarrhea: patient had been constipated and was given a fleets enema on . she then had an episode of diarrhea and developed a leukocytosis to 20.2. patient was started on flagyl 500 mg tid for suspected cdiff, though a subsequent culture was negative. she had another formed bm 24 hours after abx were started, and her leukocytosis improved. patient had abdominal tenderness on physical exam, which resolved upon treatment with flagyl. patient was discharged on flagyl 400 mg tid for a total duration of 7 days treatment for suspected cdiff. . # copd exacerbation: patient was admitted with a copd exacerbation. she was placed on levofloxacin, methylprednisone, and albuterol/atrovent nebs on admission. she completed a five-day course of levofloxacin and was placed on a steroid taper. patient had repeated cxrs, which did not show any evidence of focal consolidation. she received xopenex and ipratropium nebulizations every six hours, alternating, and she was placed on a xopenex inhaler every two hours, as needed. patient's shortness of breath improved throughout her hospital stay, and she was able to ambulate in the halls without shortness of breath. . # type ii diabetes: patient has a history of type 2 diabetes, and she currently takes metformin at home. patient's metformin was held on admission to the hospital, and she was placed on a sliding scale insulin. her sugars remained well controlled during this hospital stay. . #code: full code medications on admission: advair diskus 250 mcg-50 mcg/ flonase 50 mcg daily spiriva daily xoponex cartia xt 240 daily coumadin 2.5 daily amiodarone 200 daily hctz 25 daily lipitor 80 daily asa metformin 500 klonipin 1 chantix 1 daily ranitidine discharge medications: 1. advair diskus 250-50 mcg/dose disk with device sig: one (1) puff inhalation twice a day. 2. fluticasone 50 mcg/actuation spray, suspension sig: one (1) spray nasal daily (daily). 3. levalbuterol hcl 0.63 mg/3 ml solution for nebulization sig: one (1) nebulization inhalation q4 hours (). 4. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 5. atorvastatin 80 mg tablet sig: one (1) tablet po once a day. 6. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 7. metformin 500 mg tablet sig: one (1) tablet po twice a day. 8. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day). 9. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm. 10. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*16 tablet(s)* refills:*0* 11. cyclosporine 0.05 % dropperette sig: one (1) dropperette ophthalmic (2 times a day). 12. verapamil 180 mg tablet sustained release sig: two (2) tablet sustained release po q24h (every 24 hours). disp:*60 tablet sustained release(s)* refills:*2* 13. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 14. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 15. spiriva with handihaler 18 mcg capsule, w/inhalation device sig: one (1) capsule inhalation once a day. discharge disposition: home with service facility: all care vna of greater discharge diagnosis: primary: atrial fibrillation/atrial flutter copd secondary: type 2 diabetes hypertension discharge condition: good. patient's vs are stable and she is ambulating in the . discharge instructions: you were admitted to the hospital because you were found to be in an abnormal heart rhythm, atrial fibrillation, and you appeared to have an infection in your lungs. you were placed on antibiotics for your lungs, and you were started on many new medications for your heart. while you were here, you also developed diarrhea, which we believe was caused by a bacteria called clostridium difficile. we placed you on a new antibiotic for this infection, and you have not had diarrhea for a few days. while you were here, we made the following changes to your medications: 1. we decreased your hydrochlorothiazide to 12.5 mg daily 2. we decreased your warfarin to 2 mg daily 3. we started you on verapamil 360 mg daily 4. we started you on digoxin 0.125 mg daily please take all medications as prescribed. please keep all previously scheduled appointments. please return to the ed or your healthcare provider if you experience shortness of breath, chest palpitations, chest pain, dizziness, fatigue, fevers, chills, or any other concerning symptoms. also, we are very glad that you stopped smoking. information was given to you on admission regarding smoking cessation and preventing relapses. vna will draw blood for coumadin levels after you leave the hospital. after the vna is finished, you can go to dr. office and get your coumadin level drawn there. dr. office will tell you how much coumadin to take every day based on your coumadin levels. followup instructions: primary care: provider: . date/time: at 9:15am. cardiology: dr. . date/time: at 2:30 pm in the office. procedure: diagnostic ultrasound of heart other electric countershock of heart diagnoses: mitral valve disorders unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation personal history of tobacco use atrial flutter constipation, unspecified other and unspecified hyperlipidemia intestinal infection due to clostridium difficile 

Answer: The patient is high likely exposed to