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: amoxicillin attending: chief complaint: gib major surgical or invasive procedure: none history of present illness: this is a 53 year woman with pmh significant for diabetes s/p pancreatectomy and esrd on hd who presents with melena and "feeling crappy for 2 days. she was at baby shower at 11 am sat morning, noticed sugars higher than normal. she was also having of shortness of breath at rest. had decreased appetite but blood sugar still elevated. felt better, so didn't come to the ed. on sunday she had bloody stool and started feeling dizzy. she continued to feel worse and called ems to come to the ed. . in the ed she was noted to have melena but her vitals were stable. ng lavage was negative by the ed and by the gi consult attending. inital labs were notable for troponin of 0.11, abg with ph 7.30, k 8.0, and lactate of 5.2, glucose close to 400. she was treated with insulin, d50, calcium, bicarb for hyperkalemia, the k decreaed slightly to 6.9. her initial hct's came back hemolyzed, but eventually her hct was determined to be 18 and 1 unit of blood was started. her systolic bloodpressure trended down to the 100's from 130's and she was urgently transferred to the micu for further management. . today she has had intemittent sob at rest. has had some chest pain radiating to left arm but is now gone, not like previous mi which was silent, and lasted 30 minutes in ed. denies fevers but has had chills yesterday. had nausea, no vomiting. feels weak and slightly numb in hands. no changes in vision. able to move extremities. feels anxious. . past medical history: 1. dm type 1 2. htn 3. seizure history 4. dyslipidemia 5. hemorrhoids 6. chronic renal fialure 7. cad s/p nstemi in , cardiac cath showed 3vd, mild diastolic dysfunction, and mild mitral regurgitation 8. anemia: secondary to renal failure and chronic inflammation social history: married, lives with husband, worked in a school cafeteria until , quit smoking 22 years ago, 2 ppd x 8 years, non-drinker, no current drug use . family history: father had mi at 49, died age 76. mother has , had breast cancer age 40's. brother with . physical exam: pe: v: t98.2 p106 bp 166/88 12 100% ra gen: lying in bed, eyes closed, no apparent distress heent: perrla, mmm dry, ng tube in place resp: clear bilaterally no crackles cv: rrr nl s1s2 no murmurs, gallops, rubs abd: soft, nontender, nondistended, normoactive bowel sounds. lateral inverted v surgical scar with reducible 4 cm hernia. ext: no cyanosis, clubbing, edema. 1+ dp bilaterally. neuro: a+ox3, moving all extremities well. pertinent results: 11:15pm ck-mb-44* mb indx-5.5 ctropnt-1.13* 11:15pm ck(cpk)-796* 03:15pm wbc-10.3# rbc-1.79*# hgb-5.5*# hct-18.1*# mcv-101* mch-30.6 mchc-30.4* rdw-16.9* echo the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy. overall left ventricular systolic function is normal (lvef>55%). there may be mild focal inferolateral hypokinesis. tissue velocity imaging e/e' is elevated (>15) suggesting increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no pericardial effusion. compared with the report of the prior study (images unavailable for review) of /2204, left ventricular function is probably similar (images not available for direct comparison). egd- erosive gastritis, jejunitis, no ulcers very friable mucosa with stigmata of recent bleed. we are not convinced it is the sole source of her blood loss colonoscopy- poor prep but negative for source of bleeding. brief hospital course: this is a 53 year old woman with pmh of esrd and nstemi presents with malaise x 2 days, melena, and metabolic acidosis. . #) gi bleed with melena and presented with hct 17 but hemodynamically stable except tachycardia. pt had periodic melena since admission (?old blood). serial hct were stable for 24 hours prior to d/c. during this admission patient was followed by gi; an egd, colonoscopy done- but neither really accounted for source. patient was planned to get capsule endoscopy as outpatient. she was given iv ppi throughout the admission and d/c'd on po protonix . . #) metabolic acidosis - patient had a mixed picture contributing to metabolic acidosis with uremia (bun 120), dka (small acetone), lactic acidosis (lactate 5) with hyperkalemia with peaked t waves. insulin drip was d/c'd on monday (last day in icu) to lantus and iss. patient was initially started on vanco/levo but d/c'd after one day as low liklihood of infection. renal followed patient during this admission- their recs: included routine dialysis, restart renagel, and hold cinacalcet. acidosis resolved while in micu. subsequently bottles of blood cx from showed gram + rods- likely contaminant. because the patient looked well and had no signs of infection- she was not started on abx. urine cx neg, follow up blood cultures were negative to date at d/c. please follow up blood cultures from this hospitalization. . #) troponin leak - history of nstemi and 3vd and having chest pain. troponin chronically elevated including setting of nstemi. ekg not suggesting stemi. subsequently, ck 796, mb 44, mbi 5.5 and tropt 1.13--> ruled in for nstemi. restarted on low dose bb after first night of admission. held aspirin in setting of gib, plavix as no history of stents. she was continued on lipitor 80 qd . #) diabetes mellitus - wean insulin drip and started 4 units lantus (slightly lower than home dose) plus sliding scale. she was later transitioned to lantus 6u and riss . #) esrd on hd. has av fistula. patient was dialyzed emergently for hyperkalemia, acid base disturbance, and volume management in the setting of getting blood. then she was dialzyed on a regular schedule. restarted renagel when came out to medical floor and cinacalcet at d/c. . #) history of htn. held hydralazine, imdur due to bleed but continued beta blocker. we restarted ace day prior to discharge. . #) history of pancreatic ipmt and surgical resection - no active issues unless tumor seen on workup . #) history of seizures - continue phenobarb . medications on admission: per ed note - pt states list was taken by ed but is gone now) lipram (not generic) 4500 q6h hydralazine 50 mg po tid 150 mg po bid renagel 800 mg po 4x daily and prn sensopar 90 mg po qd plavix 75 mg po qd imdur 30 mg po qd aspirin 325 po qd lisinopril 10 mg po qd phenabarbatol 30mg (8 pills on non-dialysis days, 6 pills on dialysis days) daily humalog sliding scale depending on 1:13 carbs lantus 6 qhs lipitor 80 po qhs discharge medications: 1. phenobarbital 30 mg tablet sig: eight (8) tablet po qd non dialysis days (). 2. phenobarbital 30 mg tablet sig: six (6) tablet po qd after hemodialysis on dialysis days (). 3. lipram 4500 20,000-4,500- 25,000 unit capsule, delayed release(e.c.) sig: 4500 (4500) capsule, delayed release(e.c.)s po q6h (every 6 hours). 4. 100 mg tablet sig: 1.5 tablets po bid (2 times a day). 5. insulin glargine 100 unit/ml cartridge sig: six (6) units subcutaneous at bedtime: please use your sliding scale as prescribed in addition. 6. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 7. sevelamer 800 mg tablet sig: four (4) tablet po qid (4 times a day). 8. cinacalcet 30 mg tablet sig: three (3) tablet po daily (daily). 9. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 10. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 11. aspirin 81 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 12. imdur 30 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po once a day. discharge disposition: home discharge diagnosis: gastrointesinal bleed non st elevation mi diabetes type 1 hypertension history of seizures chronic kidney disease discharge condition: stable discharge instructions: please call if you have chest pain or shortness of breath we are holding your hydralazine, and plavix followup instructions: please call gi ( to schedule your capsule endoscopy please follow up with dr. within 2 weeks please follow up with dr. regarding restarting your hydralazine and plavix other appointments: provider: , md phone: date/time: 2:00 provider: study phone: date/time: 11:00 provider: , practice () date/time: 10:00 procedure: other endoscopy of small intestine hemodialysis colonoscopy transfusion of packed cells diagnoses: acidosis hyperpotassemia anemia in chronic kidney disease end stage renal disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery mitral valve disorders acute posthemorrhagic anemia other convulsions hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia old myocardial infarction hemorrhage of gastrointestinal tract, unspecified diabetes mellitus without mention of complication, type i [juvenile type], not stated as uncontrolled 

Answer: The patient is high likely exposed to