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: transfer from for hypotension during dialysis and leukocytosis. major surgical or invasive procedure: none history of present illness: 71f with esrd on hd, iddm, pvd, af s/p ppm, cirrhosis, transferred from after becoming hypotensive(sbps to 80) yesterday during hemodialysis. 1 liter removed. aching in left neck and jaw. also reported vague abdominal pain over one week in addition to foul smelling urine and dysuria. trop to 0.3. 1 liter fluid bolus given with little response. the patient was started on peripheral dopamine at that time as well as vancomycin and zosyn after cxr with reported rll opacity and concern for hd catheter infection. ? of medication allergy, therefore placed only on cipro for uti at this time. ct abdomen given abdominal pain with bilateral pleural effusions, lll air space opacities. left adrenal mass, liver lesion, cholelithiasis, hyperdense mass in the right kidney midpole. ascites in the subcutaneous tissue and in the mesentery. pt continued to necessitate pressors max dopa at 5mcg but is refusing central line or a-line. to somnolent but arousable, afebrile, bp 110/48 on 4 mcg dopamine. . of note, admission for hypercarbic respiratory failure setting of osa, narcotic use vs pneumonia. 7 day course of ceftriaxone, azithromycin. vanc for suspicion of hd catheter infection. trop leak to 0.27, no ekg changes. mrsa wound cx , mrsa blood cx . note from dr. for non healing le ulcer to have vanc course, pt denies taking at hd. ros: mild abdominal discomfort, occasional nausea. denies fever, chills, hematemesis, reports baseline sob on 2l nc at home for presumed copd. past medical history: -esrd/cri - patient receives hd @ "" center in m/w/f. attempted hd yesterday no filtrate -iddm - course has been complicated by polyneuropathy, nephropathy, retinopathy, and charcot foot bilaterally. patient does not check her fs at home. followed by dr. ? in . -peripheral vascular disease -af - pt is s/p pacemaker placement. she is not anticoagulated due to multiple falls. -anemia -hyperlipidemia -cirrhosis secondary to cholestasis -hypertension -coronary artery disease- pt had three vessel disease on cardiac cath from . she is s/p nstemi in . stress test '. moderate, fixed perfusion defect in the inferior wall. mild global hypokinesis. -dilated ischemic cardiomyopathy- pt's most recent echo was . ef 40%; mod la/ra dilation; mild lvh/mild global hk (most prominent in the septum); 1+ mr. mod pulmonary htn -adrenal adenoma -s/p tah for leiomyoma -right facial droop in for which she declined workup or treatment. -depression -s/p mechanical fall, l elbow/olecranon fx on - conservative management social history: pt lives in her own home in . she has 24 hour help at this time, although recently helper can't come in over the weekend, the son has been speding more time with her. the patient rare walks with a walker and mostly gets about in a wheelchair. she is very close with her daughter, , who visits often and her son, , who is her healthcare proxy. his phone number is . dnr/dni. pt used tobacco in the past - quit 24 years ago. denies etoh or drug use. pt uses a wheelxhiar, not active. family history: fa - dm, cad; ma - breast ca; physical exam: vitals- t 98.9 bp 110/42 hr 65 rr 10 o2sat: 93% on 3l nc gen- sleepy appearing female responding to questions when asked heent- op clear, mmm, unable to assess jvp secondary to girth cv- bradycardic, rrr, no m/r/g resp- sparse crackles. dullness to percussion at bases bilaterally. poor inspiratory effort. hd catheter with hypoerpigmentation, no purulence. non tender to palpation. abd- distended. hyperactive bowel sounds. mild tenderness to palpation all quadrants. no rebound or gaurding. no dullness to percussion. no echymoses. ext- cool to touch. trace radial pulses. dopplerable pedal pulses. large stage 2 pressure ulcer right heel with green area. similar 2x2 inch ulceration over left lateral malleolus. decreased sensation below ankle. denuded skin intertriginous. contracture left 3,4,5 finger. skin- cool extremities. pt sleepy but alert oriented x 3. pt non compliant with cranial nerve exam. unable to assess strength or cn. pertinent results: on admission: 11:29pm blood wbc-13.8* rbc-3.29* hgb-11.2* hct-35.2* mcv-107* mch-34.0* mchc-31.8 rdw-19.9* plt ct-86* 11:29pm blood neuts-63 bands-0 lymphs-9* monos-27* eos-0 baso-0 atyps-0 metas-1* myelos-0 nrbc-1* 11:29pm blood pt-15.1* ptt-31.6 inr(pt)-1.4* 11:29pm blood glucose-191* urean-28* creat-4.3*# na-137 k-5.7* cl-97 hco3-30 angap-16 11:29pm blood alt-5 ast-7 ld(ldh)-198 ck(cpk)-22* alkphos-86 amylase-14 totbili-0.3 04:59am blood ck(cpk)-24* 11:29pm blood ck-mb-5 ctropnt-0.80* 04:59am blood ck-mb-6 ctropnt-0.73* 11:29pm blood albumin-3.5 calcium-7.8* phos-4.0# mg-1.9 01:16am blood lactate-1.2 brief hospital course: 72 yr old esrd on transferred from after presenting with hypotension post hd, with leukocytosis. . #cad/troponin leak: concerned in setting of hypotension with hemodialysis that patient developed demand ischemia. no acute changes in ecg per nwh, and ecg here show no acute changes. peak troponin 0.8, mb 6, ck 22. baseline tropinin due to ckd is about 0.3. patient's sensation of neck/jaw pain on the left side, her anginal requivalent, resolved over the night of . patient medically managed on asa, statin. b-blocker was held in the setting of hypotension requiring pressor support. - spoke with patient's outpatient cardiologist about event, dr. , who given patient recommended imaging only if patient would be willing to undergo a medical intervention. patient has declined any further medical interventions such as a cardiac catheterization. -pt discharged on prior home dose of metoprolol 12.5 mg po bid . #hypotension: patient has history of episodes of hypotension with dialysis. patient not febrile, but has had hd catheter infections before and due to the patient's poor access status the decision has been made to treat through possible infections ( last time access was changed). patient was started on vancomycin and zosyn at nwh, but patient required dopamine drip for pressures. given patient's troponins, icu team suspected the patient's persistent hypotension was more likely due to troponin leak with component of myocardial stunning than sepsis. patient had negative urine and blood cultures to date. patient has multiple sources for sepsis inc. pulmonary: rll opacification and bilateral consolidation/effusions, urine: scant urine, but + u/a, extremities: chronic venous/pressure ulcerations which have grown mrsa and pseudomonas in the past, and the most likely is hd catheter infection given patient per notes was supposed to be on vancomycin with hd for ? of line infection. plan is to treat with vanco for total two weeks () for presumptive hd line infection due to pt's leukocytosis and prior hx, although no further evidence per cxs, exam and hx. u cx. repeated - negative. . # abdominal pain: most likely due to constipation. pt required disimpaction during admission. on aggressive bowel regimen and passing stool on own. . abdominal pain in the setting of hypotension with hemodialysis - resolved. patient states she frequently gets abdominal pain with low pressures which resolve as soon as her pressures normalize. suspect chronic mesenteric ischemia. patient does not want aggressive interventions. will defer to pcp if desires further work-up. . #leukocytosis: resolved on antibiotics. to 14.6 at osh. treating for line infection emperically with vancomycin dosed at hd - last dose planned for . . #esrd: on hd (mwf) at in . no further episodes of hypotension during dialysis in hospital. #somnolence: resolved with antibiotics. patient alert and oriented *. pt with hypercarbic respiratory failure in the past; likely component of osa. patient does not tolerate cpap due to extreme anxiety. . #foot ulcers: concerning given hx., but no acute change - daily wound care continued. . #wrist fracture: pt's l forearm imaged as she sustained fall prior to admission to hospital (reportedly fell oob). imaging showed multiple fractures of the distal radius, distal ulna, fifth metacarpal, and scaphoid. degenerative changes at the first cmc joint. plastic surgery consulted and they recommended conservative management with thumb spica cast. . #thrombocytopenia: baseline platelets 50-100k, of uncertain etiology. documented negative hit antibody x 2 in past. . #cirrhosis: documented as secondary to cholestasis. continued ursodiol. #dmii-continued home dm regimen. . #code status: dnr/dni. medications on admission: meds on transfer from : renagel 1600 mg tid with food folic acid 1 mg daily protonix 40 mg daily lipitor 20 mg daily aspirin 81 mg daily zoloft 50 mg daily zosyn 2.25 mg iv q8 (dc'd) actigall 300 mg cipro 500 mg daily hep sub q lispro sliding scale discharge medications: 1. sevelamer 800 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. metoclopramide 10 mg tablet sig: 0.5 tablet po qidachs (4 times a day (before meals and at bedtime)). 8. senna 8.6 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 9. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed). 10. clonazepam 0.5 mg tablet sig: half tablet po qhs (once a day (at bedtime)) as needed for insomnia/anxiety. 11. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 12. metoprolol tartrate 25 mg tablet sig: half tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 13. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day). disp:*1 tube* refills:*2* 14. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 capsules* refills:*2* 15. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po every twenty-four(24) hours. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 16. insulin nph human recomb 100 unit/ml suspension sig: one (1) 35 units subcutaneous qam: note: this dose per discharge. continue prior home dose. . 17. insulin nph human recomb 100 unit/ml suspension sig: one (1) 15 units subcutaneous qpm: note: dose per discharge. continue prior home dose. 18. insulin lispro 100 unit/ml solution sig: one (1) sliding scale subcutaneous three times a day: use lispro sliding scale per prior home usage. discharge disposition: home with service facility: vna discharge diagnosis: ms you were admitted due to low blood pressure during dialysis. discharge condition: vital signs stable discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet. followup instructions: provider: , md phone: date/time: 10:40 procedure: hemodialysis diagnoses: anemia in chronic kidney disease end stage renal disease coronary atherosclerosis of native coronary artery cirrhosis of liver without mention of alcohol atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes peripheral vascular disease, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease ulcer of other part of foot constipation, unspecified other and unspecified hyperlipidemia other and unspecified angina pectoris infection and inflammatory reaction due to other vascular device, implant, and graft kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled hypotension of hemodialysis diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy venous (peripheral) insufficiency, unspecified 

Answer: The patient is high likely exposed to