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: patient recorded as having no known allergies to drugs attending: chief complaint: nausea, vomiting, diarrhea, hypotension. major surgical or invasive procedure: 1. endotracheal intubation history of present illness: 62 m living at home though recently hospitalized c type 2 dm, chf, pvd, afib, alzheimers. recently hospitalized for lightheadedness and falls thought paroxysmal afib and for heel ulcers requiring iv abx. hx obtained from wife; pt. on recent d/c from hospital developed nausea, diarrhea. minimal po intake. discussed with pcp who suggested compazine suppositery but with minimal effect. progressed to vomiting day prior to admission. this morning, evaluated by visiting nurse and given poor po intake and concern for heel ulcer, pt. went to ed at hospital. at hospital, pt. noted to have cr 2.9 (elevated from baseline 1.0-2.2), bun 120, wbc 8.0. concern expressed for chf and transfered to . in ed, noted to be afebrile but hypotensive to 70s/40s c cr 3. treated for septic shock c placement of l subclavian, fluid resuscitation (3l ns), pressors (dopamine), levofloxacin, metronidazole. in icu, denies any abdominal pain, brbpr, melena, chest pain, difficulty breathing, light headedness, palpitations. does report some mild orthopnea but states this is normal for him. past medical history: 1. coronary artery disease 2. congestive heart disease - ef 25% to 30% () 3. hypertension 4. hypercholesterolemia (not on statin due to elevated lfts) 5. atrial fibrillation 6. peripherl vascular disease 7. diabetes mellitus, type 2 - c/b nephropathy, retinopathy and vasculopathy 8. chronic kidney disease, baseline cr 1.8-2.2 9. h/o cva 10. s/p carotid endarterectomy 11. left hallux ipj ulcer 12. alzheimer's 13. h/o elevated lfts - unknown etiology 14. glaucoma (right eye) social history: lives with wife, but has been at rehab since late ; more recently has been living at home with vna and hospital bed. remote tob, no etoh/drugs family history: non-contributory. physical exam: vs- 96.9, 86-104/51-69, 82-88, , 93-100 nc 4 lpm heent- jvp not elevated, op dry, skin tenting over forehead lungs- cta anteriorly, posterior lung fields inaudible heart- irregularly irregular, normal rate. sm across precordium c/w mitral regurgitation abd- obese, non tender, soft, bs+ ext- scattered ecchymoses over l arm, l chest. 2+ pitting edema to b/l thighs. cool feet, warm ankles. + 3cm diameter ulcer over r heel with granulation tissue at base but greenish discharge at perimeter accompanied by foul smell. neuro- a*o*3, difficulty with memory. pertinent results: admit labs: cbc: wbc-7.8 rbc-3.21* hgb-9.5* hct-30.0* mcv-93 mch-29.6 mchc-31.8 rdw-19.9* plt ct-267 neuts-75.3* lymphs-16.9* monos-6.7 eos-0.6 baso-0.5 coags: pt-17.2* ptt-31.4 inr(pt)-1.6* chemistries: glucose-67* urean-114* creat-3.0* na-135 k-5.4* cl-102 hco3-20* angap-18 calcium-8.8 phos-5.7* mg-2.8* lfts: alt-32 ast-47* ld(ldh)-211 ck(cpk)-51 alkphos-130* totbili-1.3 albumin-3.3* cardiac enzymes: 10:15pm ck-mb-notdone ctropnt-0.32* probnp-* 03:32am ck-mb-12* mb indx-23.5* ctropnt-0.29* 10:19am ck-mb-notdone ctropnt-0.29* 02:51am ck-mb-notdone ctropnt-0.51* 11:09am ck-mb-notdone ctropnt-0.45* blood gases: (11:35am) 7.46/24/152 lactate:4.3 (5:47am) 7.42/23/127 lactate:7.3 (4:20am) 7.43/20/147 lactate:7.1 (2:57am) 7.40/22/139 lactate:7.0 (12:20am) 7.27/30/42 (12:08am) 7.23/32/43 lactate:10.4 (11:19pm) 7.24/25/118 lactate:9.0 (9:55pm) 7.16/32/250 lactate:10.8 (7:21pm) 7.22/25/126 lactate:8.8 (4:45pm) 7.29/29/111 lactate:6.7 (4:00pm) lactate:6.2 ekg (): atrial fibrillation. low voltage in the limb leads. left bundle-branch block. occasional ventricular premature beat. compared to the previous tracing of left bundle-branch block has appeared. 2d-echocardiogram (): the left atrium is moderately dilated. the right atrium is moderately dilated. the estimated right atrial pressure is 16-20 mmhg. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is severely depressed with inferior/inferolateral akinesis and septal hypokinesis. the right ventricular cavity is dilated. right ventricular systolic function appears depressed. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. there is moderate thickening of the mitral valve chordae. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. ett (): this is a 57 year old man here for the evaluation of dyspnea. the patient received .142mg/kg/min iv persantine over 4 minutes. there was no chest, arm, neck or back pain. there were no ecg changes. the persantine was reversed with 125mg aminophylline iv. the rhythm was atrial fibrillation. the blood pressure and heart rate responses were appropriate for the infusion. no persantine-induced perfusion abnormalities. global hypokinesis suggestive of cardiomyopathy, with ef of 23%. a follow up rest study may be useful to assess for subtle myocardial perfusion changes. brief hospital course: 1. hypotension: likely cardiogenic versus septic. patient presented with a history of chf with low ef; cvps were elevated with low to normal sv02 which points more to the former. if this was septic shock, the most likely source is the heel ulcler, although the wbc was normal and the patient remained afebrile. in the setting of diarrhea and recent antibiotics, c.diff colitis was possible, but, again, the lack of wbc elevations made this less likely (also did not appear to be having loose stools during hospitalization time). aggresively volume resuccitated. initially on dopamine alone with dobutamine and levophed added at 2100 on . both dopamine and dobutamine were off two hours later (2300) with levophed continuing. on was transitioned to neosynephrine and vasopressin and the levophed was turned off (1700). when pressures fell to the 60s systolic, dopamine and dobutamine were added back (2100). the dobutamine was again on for just a short time (~3 hours) as his pressures seem to fall with this inotrope. neosynpephrine and vasopressin were also both weaned and the patient remained on dopamine alone until he was transferred to the ccu. there it was aggressive diuresis and the patient improved from a cardiovascular and renal standpoint. additionally the dopamine was weaned. the patient remained on pressors as he was hypotensive in their absence. after discussion with the family, it was determined that all cardiosupportive medications be withdrawn for the possible septic shock, vancomycin and zosyn were used. culture data were unrevealing, although a call to the osh showed that the patient had been given antibiotics without any cultures having been drawn. the patient remained on empiric antibiotics throughout the ccu course until it was determined that all supportive and therapeutic measures be withdrawn. 2. lactic acidosis: during the admission, the patient's lactate rose dramatically (1.5 on admission to 10). a resulting large anion gap acidosis resulted (ph as low as 7.16 with ag up to 26 with bicarb of 8). a bicarb drip was started to combat this. over the subsequent days, the lactic acidosis resolved and the patient's acid/base status improved. 3. code: on , a potassium was elevated (5.7) and the patient had short runs of vt. when sustained vtach occured (9:40p), he was shocked back into nrs with improved maps. given respiratory distress (sats dropped to 50%), quickly intubated using etomidate and succ. an amiodarone drip was started to keep the patient in nsr. the patient was successfully extubated while in the ccu and remained on telemetry with occassional pvcs and runs of what appeared to be vtach vs afib with aberrancy. after further discussion with the family, it was determined that the patient would not want heroic measures and all treatments were withdrawn and comfort measures were initiated. 4. acute on ckd: initially thought to be prerenal; after the patient coded and was severely hypotensive, atn was felt more likely. was oligo/anuric for one day but put out over 8 liters in 36 hours in the setting of lasix (initially 100mg iv, then iv gtt and thiazide). the patient's scr initially improved, although was gradually increasing the few days prior to discharge. 5. chf: was initially overloaded after given massive ivf. as above, put out over 8 liters in the setting of diuretics (may also have represented post-atn diuresis). he constantly required pressors for forward flow and became dramatically hypotensive in the absence of cardiosupportive medications. he remained on pressors until it was determined to initiate comfort measures. 6. elevated inr: inr appeared elevated (1.3-1.4) at baseline; increased to 2.4 during stay without having gotten any coumadin. lfts trended up mildly, but not to levels suggestive of ischemic hepatopathy. have been antibiotic, poor po. got vitamin k x 2 days. 7. lft abnormalities: presents with history of chronically elevated lfts (which is why he was not on statin therapy) and elevated amylase/lipase. is hepatitis sag/ab negative and hcv negative. have fatty liver, but cause of acute increase and increase in amylase lipase was unclear. congestive hepatoparthy also on differential at time of passing. 8. uti: elevated wbc on ua. antibiotics as above. 9. nausea/vomiting/diarrhea: presenting complaints. differential included viral versus c.diff colitis. resolved soon after admission 10. diabetes: hiss used. 11. heel ulcer: podiatry consulted with wound care recs used. 12. anemia: baseline hematocrit in the high 20s, low 30s. be secondary to ckd. hematocrit trended. . after discussion with the patient and the family, all were in agreement that comfort measures be initiated and the patient passed with family at the bedside. medications on admission: 1. asa 325mg daily 2. lasix 80mg daily 3. hctz 25mg daily 4. metoprolol 150mg daily 5. insulin - nph 15units at 10pm, 70/30 30units qam 6. donepezil 10mg daily 7. zoloft 50mg daily 8. miconazole powder 9. latanoprost eye gtt 10. ferrous sulfate 325mg daily 11. oscal 500 + d 12. compazine 12.5mg pr qhs discharge medications: none discharge disposition: expired discharge diagnosis: congestive heart failure discharge condition: deceased discharge instructions: none followup instructions: none procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: acidosis congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation chronic kidney disease, unspecified systolic heart failure, unspecified paroxysmal ventricular tachycardia acute respiratory failure cardiogenic shock septic shock alzheimer's disease diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled ulcer of heel and midfoot 

Answer: The patient is high likely exposed to