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: demerol / codeine attending: chief complaint: hypotension/hypoxia major surgical or invasive procedure: intubation history of present illness: ms. is a 75 year old woman with diabetes, hypertension, atrial fibrillation, history of c. diff, and vertebral osteomyelitis who presented with hypotension and hypoxia. she was recently discharged on following surgery for her osteomyelitis. she had been at rehab when she had an episode of hypotension and hypoxia (low 80's). she was initially seen at an osh. she was given metoprolol 50mg po, lasix 80mg iv and noted to be hypotensive. a cta of the chest was negative for pe, but had bilateral pleural effusions. she was placed on dopamine. she did not receive ivf. she was transferred to for further management. . in the ed, initial vs were: 96.1 80/palp 90 14 95% on nrb. right groin line was placed. she received zosyn in the ed. she was on vancomycin and flagyl for osteomyelitis and c. diff. originally, she was transferred to the ccu out of concern for cardiogenic shock. she was diuresed, but then stopped making urine. her clinical picture was thought to be more representative of sepsis. she was given fluids and transferred to the micu. . in the micu, she was briefly on levophed until 8am this morning. of note, she was intubated during an mri on . her sbp has been maintained in the 100-110s today. she is currently on room air. her uop has improved. fena is 0.1%. she is currently receiving ivfs. an ultrasound revealed cirrhotic liver. a paracentesis removed 2 l. blood, urine, peritoneal cultures cxs are pending. she is currently on vanc/zosyn and flagyl for history of c. diff. . patient was having episodes of constipation. now with two bowel movements today. no complaints of pain, shortness of breath, or nausea. she states she is feeling much better. past medical history: past medical history: atrial fibrillation s/p ablation, not on coumadin iron-deficiency anemia gastritis per egd, insulin-dependent diabetes mellitus c/b neuropathy, retinopathy lumbar stenosis, s/p l5-s1 laminectomy (age 40) hypertension hyperlipidemia djd tremor steatohepatitis depression past surgical history: cataract surgery carpal tunnel release bilaterally tonsillectomy appendectomy cholecystectomy social history: patient currently lives in a house in , mass. she lives with her husband. she is now retired but formerly worked in medical records at hospital. she denies etoh, tobacco, and other drugs. mrs. reports attempting to maintain a diabetic diet, but admits to not being as good about it as she should be. she reports exercising by doing chores around the house. family history: diabetes ii physical exam: general: tired heent: no icterus cardiac: rr lung: crackles at bases abdomen: +bs, bruise on right lower quadrant, right groin line without erythema, left sided bandage that is clean and dry ext: 2+ le edema of feet, 1+ of half way up calf neuro: oriented to name, year, month, hospital, had difficulty naming months backward and asked, "if i can't do this, do i have to get another mri?" pertinent results: admission labs: wbc 16.6 / hct 33.3 / plt 491 na 144 / k 3.9 / cl 109 / co2 22 / bun 26 / cr 1.3 / bg 220 bnp discharge labs: wbc 10.9 / hct 27.1 / plt 540 na 143 / k 3.3 / cl 111 / co2 26 / bun 17 / cr 1.2 / bg 103 microbiology: blood cx negative urine cx yeast urine cx yeast peritoneal fluid culture - negative urine cx yeast studies: echo ()- the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild to moderate regional left ventricular systolic dysfunction with severe hypokinesis of the distal septum, anterior and inferior walls. there is a small apical left ventricular aneurysm with apical akinesis. the remaining segments contract normally (lvef = 45 %). the estimated cardiac index is normal (>=2.5l/min/m2). no masses or thrombi are seen in the left ventricle. right ventricular chamber size is normal with focal hypokinesis of the apical free wall. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. physiologic mitral regurgitation is seen (within normal limits). there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with regional systolic dysfunction c/w cad (distal lad distribution). compared with the prior study (images reviewed) of , basal septal and anterior function are improved, but apical dysfunction is now identified. mild pulmonary artery systolic hypertension is now identified. abdominal u/s- impression: shrunken nodular liver with diffuse ascites consistent with the provided history of cirrhosis. the main portal vein is patent. a small echogenic nodule abutting the capsule is visualized, incompletely characterized on this study. this lesion may be better evaluated with multiphasic ct or an mri of the abdomen if clinically indicated mri l spine 1. postsurgical changes with fluid collections related to the surgical hardware in the dorsal soft tissues, which may be postoperative seromas. underlying infection would be difficult to entirely exclude. corrleate clinically and with labs. 2. fluid collection in the left aspect of the retroperitoneum also may be postsurgical in nature, although underlying infection in this location would also be difficult to exclude. recommendations: postcontrast mri of the lumbar spine would probably not be helpful given the degree of susceptibility artifact in the region of the surgical hardware. ct of this region may be helpful to better assess the surgical hardware and any enhancement. cxr - left lower lobe sizable atelectasis and pleural effusion. no acute pulmonary infiltrates. cardiomegaly as before. echo ()- the left atrium is elongated. the right atrial pressure is indeterminate. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is moderate regional left ventricular systolic dysfunction with hypokinesis of the inferior wall and the distal half of the anterior septum and anterior walls, and the apex. the remaining segments contract normally (lvef = 35 %). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild to moderate (+) mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , left ventricular systolic dyfunction is more extensive and suggests multivessel cad (or myocarditis). the severity of mitral regurgitation is also increased. brief hospital course: 1. hypoxia: patient came in with drastically increased oxygen requirement. she was admitted to the ccu and then the micu with concerns for cardiogenic shock and sepsis. she was managed there initially with diuresis but then fluid administration given possibility of sepsis. she was briefly intubated. upon extubation, patient did very well. she continued to sat well on room air while here. she was found to have a left sided pleural effusion on chest x-ray and was on 2l nc (satting 97% on discharge). we checked room air sats also and patient was satting 96% on ra. given stable condition and good saturation on room air, we did not pursue a thoracentesis. she denied any symptoms of shortness of breath or dyspnea on exertion. 2. questionable sepsis: given that patient had elevated lactate and wbc, sepsis was a possibility. she was on pressors briefly while in the unit but was quickly weaned off. upon transfer to the floor, blood pressures normalized. zosyn was added to her prior regimen of vancomycin and flagyl. cultures did not grow anything so zosyn was discontinued shortly thereafter. patient remained hemodynamically stable during her hospitalization. there were no acute episodes of hypoxia or hypotension. lactate went from 2.4 to 1.2. she remained afebrile and her wbc trended down (was 10.9 on discharge- down from 16.6 on admission). 3. acute kidney injury- patient presented with creatinine of 1.7 and stopped responding to diuresis in the ccu. concern for sepsis arose given elevated lactate and hypotension. patient was most likely secondary to ischemic atn, as was thought to be the case during previous admission. fluid status was initially unclear though. she demonstrated signs of fluid overload on exam (3+ lle pitting edema, elevated jvp) but labs represented more of a pre-renal etiology (urine sodium < 10, hypernatremia, elevated creatinine). this was all complicated by her cirrhosis. we initially did not diurese or give the patient fluids. her creatinine improved daily. we considered giving her albumin or blood but were concerned of causing fluid overload in her lungs. we started her on lasix 20mg iv daily and she responded very well. creatinine was 1.2 on discharge. patient sent out with lasix 40mg po daily. 4. acute on chronic systolic congestive heart failure- patient had echo on admission given concern for cardiogenic shock. during previous admission, echo showed ef of 35-40% with new anterior and anteroseptal left ventricular systolic dysfunction with subtle inferior wall hypokinesis. echo on this visit showed improved ef of 45% and basal septal and anterior function. however, it showed new apical dysfunction. patient reported being very anxious and upset during hypoxic and hypotensive episode. she reports the symptoms occuring shortly after this anxious episode. given new apical akinesis and correlation with anxiety, there is a possibility that this is stress-induced cardiomyopathy. symptoms improved while here. repeat echo on revealed "moderate regional left ventricular systolic dysfunction with hypokinesis of the inferior wall and the distal half of the anterior septum and anterior walls, and the apex. the remaining segments contract normally (lvef = 35 %). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild to moderate (+) mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , left ventricular systolic dyfunction is more extensive and suggests multivessel cad (or myocarditis). the severity of mitral regurgitation is also increased." 5. cirrhosis- an ultrasound on revealed cirrhotic liver with no portal vein thrombosis. patient has history of steatohepatitis. lfts were within normal limits. she underwent a paracentesis during which two liters of fluid was removed. blood, urine, peritoneal cultures did not show any sbp or signs of active infection. 6. nutrition- patient had poor po intake on admission. she claimed it was due to the food and once she was discharged, her appetite was improved. she was initially on a soft (dysphagia) and nectar prethickened liquids diet. speech and swallow recommended a video study after which she was advanced to a ground and pureed (dysphagia) diet with supervision. in addition, patient was started on megace 40mg tid for appetite stimulation. she responded well and had much improved po intake by discharge. patient counseled on importance of nutrition, especially relating to her recovery. 7. osteomyelitis- no active issues while here. patient continued on vanc and flagyl. given elevated vanc troughs, patient discharged on vanc 500mg iv q24hr- last dose . she was continued on flagyl 500mg po q8hr for history of c.diff- last dose . 8. type 2 diabetes mellitus, controlled but with complications - continued on nph and sliding scale with good control of her sugars. 9. atrial fibrillation: patient rate controlled with metoprolol. metoprolol was initally held given concern of sepsis. as patient became more hemodynamically stable, metoprolol was resumed at home dose of 25mg po bid. 10. benign hypertension: see above. resumed metoprolol once patient was hemodynamically stable. 11. guaiac positive stools- patient found to have guaiac positive stools on admission. no active signs of bleeding (brown stool). she was started on pantoprazole 40mg po daily while here, which is to be continued on discharge. in addition, we ask that the patient gets a colonoscopy as an outpatient 12. iron deficiency anemia - chronic. hematocrit near baseline. patient continued on home iron supplementation. hematocrit remained stable while here. denied any fatigue or dizziness. fen: diabetic/heart healthy diet. ground and pureed (dysphagia) with supervision. ppx: dvt prophylaxis with heparin sc tid. bowel regimen- senna and docusate. ppi- pantoprazole 40mg q12 hr. code: full code communication: patient & is hcp, son : medications on admission: insulin sc (per insulin flowsheet) lidocaine 5% patch 1 ptch td daily; prn pain acetaminophen 325-650 mg po/ng q6h:prn pain/fever metronidazole (flagyl) 500 mg iv q8h miconazole powder 2% 1 appl tp amitriptyline 75 mg po hs aspirin 81 mg po/ng daily piperacillin-tazobactam 2.25 g iv q6h bisacodyl 10 mg po/pr daily:prn constipation senna 1 tab po bid:prn constipation simvastatin 40 mg po/ng daily docusate sodium (liquid) 100 mg po bid ferrous sulfate 325 mg po/ng daily trifluoperazine hcl 2 mg po daily heparin 5000 unit sc tid vancomycin 1250 mg iv q 24h discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 2. docusate sodium 100 mg tablet sig: one (1) tablet po twice a day as needed for constipation. 3. heparin (porcine) 5,000 unit/ml solution sig: one (1) inj injection tid (3 times a day). 4. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 5. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 6. megestrol 40 mg tablet sig: one (1) tablet po tid (3 times a day). 7. trifluoperazine 2 mg tablet sig: one (1) tablet po daily (daily). 8. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 9. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 10. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily; prn () as needed for pain: to affected area. leave on for 12 hours then remove . 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 12. amitriptyline 25 mg tablet sig: three (3) tablet po hs (at bedtime). 13. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain/fever. 14. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 15. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 16. vancomycin 500 mg iv q 24h start: in am 17. insulin fixed and sliding scale please follow attached scale 18. flagyl 500 mg tablet sig: one (1) tablet po every eight (8) hours. discharge disposition: extended care facility: - discharge diagnosis: primary: lumbar osteomyelitis, acute kidney injury secondary: hypertension, diabetes mellitus discharge condition: good. vital signs stable. discharge instructions: you were admitted to the hospital after having a hypotensive and hypoxic event while at rehab. while here, you recovered well. you were monitored closely and you improved daily. your oxygen requirement decreased, blood pressures normalized and kidney function improved. you denied any back pain. upon discharge, you were stable and comfortable. the following changes were made to your medications: 1. please start taking lasix 40mg by mouth daily 2. please start taking megace 40mg by mouth three times a day 3. please start taking pantoprazole 40mg by mouth daily weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: provider: , md phone: date/time: 11:30 please follow-up with your cardiologist, dr. . you should make an earlier appointment with him but you currently have an appointment on at 1:45pm. you can contact him at . he should discuss your echo results with you and possibility of outpatient stress test. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube percutaneous abdominal drainage diagnoses: acute kidney failure with lesion of tubular necrosis unspecified pleural effusion congestive heart failure, unspecified cirrhosis of liver without mention of alcohol unspecified septicemia severe sepsis atrial fibrillation unspecified osteomyelitis, other specified sites polyneuropathy in diabetes other and unspecified hyperlipidemia acute respiratory failure long-term (current) use of insulin septic shock intestinal infection due to clostridium difficile iron deficiency anemia, unspecified other ascites hyperosmolality and/or hypernatremia acute on chronic systolic heart failure background diabetic retinopathy diabetes with neurological manifestations, type ii or unspecified type, uncontrolled benign essential hypertension diabetes with ophthalmic manifestations, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to