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: penicillins / watermelon / almond oil / hydralazine attending: chief complaint: nausea, vomiting, abdominal pain major surgical or invasive procedure: none history of present illness: mr. is a 33 yo m with dm type i, esrd on hd (t/th/s), htn with multiple past admissions for dka, who self-presented to the ed on with recurrent nausea and vomiting. he had been in his usual state of health until thursday evening, , when he suddenly developed nausea and multiple episodes of vomiting of a non-bloody, non-bilious emesis that lasted throughout the night. he also experienced progressively worsening abdominal pain, describing it as a "fire" diffusely located within his abdomen that was accompanied by new onset back pain. mr. reported that his presenting nausea and vomiting feels distinct from those associated with his past admissions for dka in severity and acuity. he denied any fever or chills at home, but did experience diffuse sweating. he denied recent cough or dyspnea; denied any constipation, diarrhea and change in bowel habits; denied dysuria and change in his urination. . mr. initially denied any significant changes in his oral intake prior to the onset of his symptoms, but upon further discussion mentioned that his refrigerator had stopped working in the middle of the week and he and his girlfriend had been eating out for most of their meals. additionally, on thursday evening he drank some juice that had been in the refrigerator and stated that he believes his symptoms are likely due to ingestion of juice "that had something growing in it," particularly as he had his first episode of vomiting soon after he drank the juice. . over the course of the night, mr. felt too ill to check his blood glucose level and administer his insulin. his symptoms became progressively worse, without any relief the next morning. he did not take his morning dosage of glargline or anti-hypertensives, and instead self-presented to the ed. . mr. insulin regimen consists of glargine 15 units in the morning with breakfast and lispro sliding scale injections. he reported that his blood sugars have been under reasonable control (~140s) over the past few days. his last hd prior to presentation (on thursday ) had been uneventful. after dialysis is blood glucose levels were in the 70s and he received some juice. he denies experiencing any recent dizziness, lightheadedness, or sensation that the room is spinning. . <i>per micu signout</i>: in the ed, initial vs t 100.8, bp 203/110, hr 112, rr 18, o2 100% ra. he was later febrile to 101.9 and was given 1 g vancomycin. his ast/alt/ap were elevated at 73/42/165 respectively. finger stick blood glucose (fsbg) was initially 712, with an ag of 25. he was given 10 units of regular insulin iv after which fsbg decreased to 583. he was then given another 10 units iv regular insulin followed by 10 units sc insulin. a r external jugular line was placed for access. he received a total 2l ivf. . while in the micu, mr. was initially placed on insulin gtt and later transitioned to glargine and lispro sliding scale as his diet was advanced. his ag (25 at presentation) decreased to 15. he was given oxycodone prn for pain and compazine for nausea. his alt and ap have decreased from their values at presentation, yet were still elevated on at 55 and 135 respectively. his ast normalized at 31. his ldh was elevated at 266. . currently, on the floor the patient has no acute complaints. he denies any nausea, vomiting or abdominal pain and reports feeling ready to go home. . ros: (+) per hpi as above. (-) per hpi as above, and denies recent weight loss or gain. denies sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath. he denies any sick contacts or recent travel. past medical history: # dm i since age 19, seen at . -- complicated by nephropathy, gastroparesis (patient denies), and retinopathy. -- followed at hgba1c of 10.2% on . # esrd/ckd: secondary to htn and dm1 -- hemodialysis t/th/sat at . -- on kidney/pancreas transplant wait list since 4/. # hypertension # anemia on epo with dialysis # depression # s/p appendectomy in . social history: lives in with girlfriend of 4 years; no children. recently lost his job and concerned about current financial situation. currently smokes 1-1.5 packs/week. denies recent etoh use and illicit drug use. family history: grandfather with dm and cad. physical exam: vs: 98.8 142/98 82 16 95ra general: sitting upright in bed, eating. appears to be in no acute distress. poor eye-contact throughout history and physical. heent: sclerae anicteric, eomi, mmm, oropharynx clear without erythema or exudate. neck supple. no cervical lymphadenopathy. no thyromegaly. lungs: no use of accessory muscles. able to complete full sentences. ctab, no wheezes, rales, rhonchi. no dullness to percussion. no cvat. cv: rrr. nl s1 and s2. no murmurs/rubs/gallops. no elevated jvp. abdomen: +bs, soft, nontender. appeared slightly distended. no rebound tenderness or guarding. no hsm. ext: warm, well perfused, 2+ dp and radial. no clubbing, cyanosis, edema. r lue av fistula with palpable thrill, not tender or erythematous . neuro: aox3. answers questions appropriately with good fund of knowledge of recent events. cniii-xii intact. no abnormal movements noted. pertinent results: 12:15pm blood wbc-10.3# rbc-4.33*# hgb-12.9*# hct-39.7*# mcv-92 mch-29.8 mchc-32.5 rdw-14.2 plt ct-201 12:15pm blood neuts-89.2* lymphs-6.7* monos-3.5 eos-0.4 baso-0.2 12:15pm blood glucose-712* urean-45* creat-8.5*# na-129* k-6.6* cl-82* hco3-22 angap-32* 12:15pm blood alt-73* ast-42* alkphos-165* 06:01am blood alt-55* ast-31 ld(ldh)-266* alkphos-135* totbili-0.4 01:30pm blood lipase-122* 12:58pm blood lipase-51 12:15pm blood ctropnt-0.15* 02:50pm blood ctropnt-0.14* 05:47pm blood calcium-8.6 phos-5.6* mg-1.7 02:50pm blood osmolal-324* 01:30pm blood acetone-small 05:47pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 01:37pm blood type- po2-105 pco2-40 ph-7.43 caltco2-27 base xs-1 05:48pm blood type-art po2-67* pco2-42 ph-7.44 caltco2-29 base xs-3 12:55pm blood glucose-greater th lactate-2.9* k-7.4* 05:48pm blood glucose-459* lactate-1.7 na-130* k-4.2 cl-86* . discharge labs: 05:50am blood wbc-5.3 rbc-4.31* hgb-12.9* hct-38.0* mcv-88 mch-30.0 mchc-34.1 rdw-13.7 plt ct-214 01:10pm blood glucose-108* na-134 k-4.2 cl-88* hco3-29 angap-21* . imaging: # kub : nonspecific bowel gas pattern and no evidence of acute abnormality. . # transthoracic echo : the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. overall left ventricular systolic function is moderately depressed (lvef= 30-35 %) with global hypokinesis and regional inferior akinesis. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. rv with mild global free wall hypokinesis. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. brief hospital course: mr. is a 33 yo m with dm type i, esrd on hd (t/th/s), htn with multiple past admissions for dka, who self-presented to the ed on with recurrent nausea and vomiting and fsbg of 712. . # dka: it is likely that mr. had a viral gastroenteritis or episode of food poisoning, leading to his nausea and vomiting, which in the absence of his regular insulin administration, triggered dka. though he denied any diarrhea or change in bowel habits, or subjective fever, mr. experienced diffuse sweats prior to his presentation and later became febrile following admission suggesting that infection is a likely precipant of dka. he received vancomycin in the ed, after which he was afebrile. his cxr did not demonstrate any acute pulmonary process, and on physical exam, his avf was neither tender or erythematous making pna and fistula infection a less likely cause of his symptoms. kub demonstrated no evidence of an acute abdominal process. urine culture demonstrated <10,000 organisms/ml. blood cultures were sent with no growth to date. . at presentation, patient's ag was 25 in the setting of fsbg >600. he was started initially on an insulin gtt at 7 u/h. fs were checked q1h and fell from 700s into the 100s over several hours. d5 1/2 ns was started, and insulin drip down-titrated to u/h. electrolytes were checked every four hours, and gap went from 25 on admission to 15, his baseline, during the first hospital night. his diet was advanced. upon transfer to the floor from the micu, his ag was 15. however at discharge, his ag was elevated to 17 with a bg of 108. his fs's had improved with increase of his lantus to 20 units. the patient insisted on discharge. prior to his discharge, diabetes consult was called and recommended he keep his outpatient insulin dosing after discharge. he was instructed to make a follow-up appointment with dr. , his diabetologist. . # systolic heart failure: during this admission, patient obtained an echo notable for mild lvh with moderate dilation and lvef = 30-35 % with global hypokinesis and regional inferior akinesis. of note, his lvef from prior echo in was 52%. he was switched from labetalol to carvedilol for known improvement in morbidity and mortality. he was informed of this new change in his cardiac function. he was set-up with outpatient cardiology follow-up for both his systolic heart failure and hypertension. . # hypertension: patient was initially hypertensive in the setting of not having taken any of his meds since yesterday morning. home doses of lisinopril amlodipine, and labetalol were restarted. his blood pressure has historically been difficult to control and should be monitored closely as his labetalol was changed to carvedilol in consideration of his heart failure. . # esrd on hd: patient was continued on dialysis schedule (t/th/s) via lue fistula and maintained on his home dosage of sevelamer during the course of his hospitalization. there was no acute indication for hd on admission (although his potassium was elevated, it improved with insulin administration). . # transaminitis: patient had elevated ast/alt upon presentation that is likely due to elevated glucose and triglycerides secondary to dka. with treatment of dka, transaminases have trended downwards and approached their baseline levels. no acute intervention was required. . # anemia: patient's anemia is likely secondary to esrd. has been stable throughout his admission and required no acute interventions. . # code status: full code. medications on admission: 1. amlodipine 10 mg daily 2. insulin glargine 15 units daily 3. insulin lispro sliding scale 4. labetalol 200 mg tid 5. lisinopril 40 mg daily 6. omeprazole 20 mg 7. ondansetron 4 mg q8h prn nausea 8. sevelamer 800 mg tid ac for control of serum phosphorus 9. sumatriptan prn discharge medications: 1. amlodipine 5 mg tablet : two (2) tablet po daily (daily). tablet(s) 2. lisinopril 20 mg tablet : two (2) tablet po daily (daily). 3. omeprazole 20 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po daily (daily). 4. sevelamer carbonate 800 mg tablet : one (1) tablet po tid w/meals (3 times a day with meals). 5. oxycodone 5 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for pain. 6. carvedilol 25 mg tablet : two (2) tablet po twice a day. disp:*120 tablet(s)* refills:*2* 7. insulin glargine 100 unit/ml solution : twenty (20) units subcutaneous once a day. 8. humalog 100 unit/ml solution : one (1) injection subcutaneous four times a day: please check finger sticks at breakfast, lunch, and dinner. please take humalog as directed by sliding scale. discharge disposition: home discharge diagnosis: primary diagnoses: diabetic ketoacidosis, systolic heart failure secondary diagnoses: end stage renal disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital for very high blood sugars (diabetic ketoacidosis). you initially went to the intensive care unit for iv fluids and an insulin drip. when your lab tests were improving, you were switched to subcutaneous insulin and transferred to the general medicine floor. you also had an ultrasound of your heart which showed that it is not squeezing as well as it should. you will need to follow-up with cardiologist regarding your heart function. you were dialyzed by the renal team. . the following changes were made to your medications: your labetalol was stopped. you were started on carvedilol. your insulin regimen was changed. followup instructions: department: hemodialysis when: tuesday at 7:30 am department: when: wednesday at 9:30 am with: post clinic building: sc clinical ctr campus: east best parking: garage department: cardiac services when: monday at 3:20 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: hemodialysis diagnoses: anemia in chronic kidney disease end stage renal disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere renal dialysis status congestive heart failure, unspecified depressive disorder, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease long-term (current) use of insulin chronic systolic heart failure awaiting organ transplant status dehydration diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with renal manifestations, type i [juvenile type], uncontrolled diabetes with ophthalmic manifestations, type i [juvenile type], uncontrolled diabetes with ketoacidosis, type i [juvenile type], uncontrolled background diabetic retinopathy gastroparesis nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] 

Answer: The patient is high likely exposed to