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: ciprofloxacin / keflex attending: chief complaint: "edema" major surgical or invasive procedure: right heart catherization cvvhd (hemodialysis) history of present illness: 75 year old female with cad, chf ef 60%, dmii, copd presenting from dr. office with decompensated heart failure and episodes of chest pain. patient was recently admitted from and during admission had chest pain radiating to her jaw w/ associated shortness of breath. she underwent pmibi which showed reversivle lateral wall defects. given concurrent gi work-up it was felt that further cardiac work-up could be done as outpatient and consideration of cardiac catheterization. patient is somewhat difficult to get a history from, but does state she has had a couple of episodes of chest pain since her last discharge, is unable to tell me how long the episodes lasted or associated symptoms. she does feel like she continues to gain weight and feels that she has gained "80 lbs of fluid since last ." she has baseline leg swelling but this feels worse than usual and is uncomfortable. . patient is also complaining of bilateral knee pain since fall 3 days prior to admission. she was walking from her walker to bed and may have tripped. she thinks she fell on her knees and may have hit her head (although she is not sure). she has been ambulating since and does have quite a bit of pain at baseline for which she takes ultram. her baseline pain seems to be in bilateral knees and lower back at sight of prior back surgery. . ros: no fevers, chills, (+) nausea (?baseline), no vomiting, baseline abdominal pain, knee pain. orthopnea at baseline (2 pillow), no pnd. chest pain episodes as above. breathing feels somewhat worse than normal, no coughing. past medical history: r-sided heart failure with pulmonary htn. r heart cath in demonstrated elevated r filling pressures (rvedp 26 and pcwp 25) with prominent v-waves, and mod pulm hypertension. tte demonstrates normal lvef (60%), with mildly dilated rv and normal rv function cad: ?nstemi ' copd asthma dm2 hypertension depression anxiety restless leg syndrome h/o anasarca: in , thought r heart failure + hepatic dysfunction/low albumin h/o distal cbd stricture s/p ercp and sphincterotomy h/o runs of atrial tachycardia during admission gerd s/p tah s/p open cholecystectomy social history: lives at nh, moved last year from , has son in the area; +tob- 1ppd x 50y, denies etoh and drugs family history: father died of cva, mother died of colon cancer at unknown age physical exam: vs - 98.2f hr 76 bp 124/64 18 93ra 134.8kg gen: awake, alert although poor historian, nad, lying w/ hob elevated heent: perrl, eomi, anicteric sclera, op clear, mm sl dry neck: supple, obese, difficult to assess jvp cv: distant s1, s2, no appreciated murmurs pulm: clear to auscultation, limited air movement, no crackles, wheeze appreciated abd: normoactive bowel sounds, soft, obese, mild, diffuse ttp all quadrants, negative sign, no rebound or guarding ext: warm, chronic venous stasis changes, 2+ le edema b/l to knees. knees without effusion. small bruise on medial aspect of r knee. l knee with ttp below and above patella. full rom on knees and hips b/l. hips non-tender to palpation. back: well-healed surgical scar around l3-5 with ttp (pt states baseline) skin: no rash neuro: cn ii-xii intact, 5/5 strength in r prox and distal upper and lower extremity and l lower extremity. 4/5 strength in l hand grip and biceps ( carpal tunnel per pt and baseline) deltoid on l. . pulses: right: dp 1+ pt 1+ left: dp 1+ pt 1+ pertinent results: 03:58pm blood wbc-13.8* rbc-4.52 hgb-11.3* hct-34.4* mcv-76* mch-25.0* mchc-32.9 rdw-16.1* plt ct-207 09:15am blood wbc-14.5* rbc-4.89 hgb-11.8* hct-36.8 mcv-75* mch-24.2* mchc-32.1 rdw-16.3* plt ct-228 03:58pm blood glucose-137* urean-68* creat-2.9*# na-133 k-5.8* cl-91* hco3-33* angap-15 06:00am blood glucose-117* urean-73* creat-3.9* na-129* k-5.9* cl-87* hco3-31 angap-17 09:15am blood glucose-135* urean-83* creat-4.1* na-130* k-6.2* cl-86* hco3-35* angap-15 03:58pm blood alt-12 ast-16 ck(cpk)-105 alkphos-108 totbili-0.4 03:58pm blood ck-mb-4 ctropnt-0.11* 11:40pm blood ck(cpk)-84 06:00am blood ck(cpk)-73 06:56am blood ctropnt-0.18* 09:15am blood calcium-8.3* phos-6.3* mg-3.0* . brief hospital course: # acute renal failure - baseline 1.0 (2.0 at nursing home on , now rising 2.9->4.8). ace inhibitor and metformin held given acute renal failure. feurea 17 (c/w pre-renal). renal team was consulted. patient initiated on cvvh due to concern for uremia, given tremors and bun of 99. however, urine output was preserved and patient received a trial off of cvvh. renal function continued to improve and patient began to autodiurese. she is now at baseline renal function. she should have her renal function checked on monday and the results faxed to dr. office at (fax), phone . if her creatinine is increased by 30% from baseline of ., then the lisinopril and metformin should be stopped and restarted after renal function improves at a lower dose. . #. congestive heart failure - patient admitted initially with chest pain and shortness of breath. could not undergo left-heart catheterizaion due to renal insufficiency. however, right-heart catheterization demonstrated elevated filling pressures as above, likely due to diastolic dysfunction. patient was not actively diuresed, and oxygen saturation, daily weights, and fluid balance were monitored. cvp approx 10 when line was pulled. therefore was not recommended for further diurese especially given recent renal failure. . #. coronary artery disease - patient ruled out for active ischemia and did not have any new ecg changes. she was maintained on her aspirin and beta-blocker. ace inhibitor was held due to acute renal failure. during a previous admission, stress mibi showed reversible lateral wall defect. catheterization deferred on that admission as she was undergoing work-up for cbd papillary mass (path neg for malignancy). on this admission, cardiac catheterization was deferred until renal function improved and will be readdressed as an outpatient. . # dmii - held oral hypoglycemics (metformin, glipizide) while inpatient initially when in renal failure. once patient was with noramal renal function, she was transitioned back to home meds with better glucose control. continue humulin sliding scale. . # diarrhea - postive for c. difficile and started on metronidazole on . should complete a 2 week course of metronidazole (finishes ) . # history of fall - patient was unable to provide details. no apparent loss of consciousness. she may have hit her head. head ct neg for bleed. . # copd - continued outpatient regimen of tiotropium, fluticasone-salmeterol, and albuterol prn. . #. ppx: sc heparin, ppi, bowel regimen (pt constipated), contact precautions for h/o mrsa, vre, and c. difficile. . #. code: full discussed with pt and son by 6 team. neither would want prolonged intubation son, , is hcp: home: , work: , cell: pcp: . wants to remain involved medications on admission: potassium 10meq po qday hctz 50mg po qday lisinopril 20mg po qday dulcolax prn mom prn trazodone 125mg po qhs prn metoprolol 100mg po bid asa 81 qday ultram prn tiotropium 18mcg qday advair 250/50 inh fluticasone nasal spray albuterol inh prn lasix 80mg po bid protonix 40mg po qday montelukast 10mcg po qday calcium carbonate po tid cholecalciferol qday colace neurontin 400mg po tid glyburide 2.5mg qday mvi metformin 750mg lipitor 40mg po qday spironolactone 100mg po qday senna humulin sliding scale tramadol 50mg po q4-6 hrs prn oxycodone/tylenol 1-2 tabs po q4-6hrs prn discharge medications: 1. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 2. gabapentin 400 mg tablet sig: one (1) tablet po three times a day. 3. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for wheeze. 4. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 10 days. disp:*30 tablet(s)* refills:*0* 5. toprol xl 100 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po once a day. 6. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 7. trazodone 100 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 8. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 9. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) inhalation once a day. 10. fluticasone 50 mcg/actuation aerosol, spray sig: one (1) nasal once a day as needed for allergy symptoms. 11. montelukast 10 mg tablet sig: one (1) tablet po once a day. 12. calcium 500 with vitamin d 500-200 mg-unit tablet sig: one (1) tablet po three times a day. 13. colace 100 mg capsule sig: one (1) capsule po twice a day. 14. lipitor 40 mg tablet sig: one (1) tablet po once a day. 15. insulin lispro (human) 100 unit/ml solution sig: per sliding scale subcutaneous asdir (as directed). 16. tramadol 50 mg tablet sig: one (1) tablet po qid (4 times a day) as needed for pain. 17. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. 18. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 19. metformin 500 mg tablet sig: 1.5 tablets po bid (2 times a day). 20. spironolactone 50 mg tablet sig: one (1) tablet po once a day. 21. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 22. glyburide 2.5 mg tablet sig: one (1) tablet po daily (daily). 23. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. 24. metoprolol succinate 100 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po daily (daily). discharge disposition: extended care facility: healthcare - discharge diagnosis: congestive heart failure, exacerbation acute renal failure . diastolic heart failure diabetes discharge condition: afebrile, stable vital signs, tolerating pos, ambulating with assistance. discharge instructions: you were admitted with worsening of your heart failure and then also had worsening kidney function. you were briefly on dialysis and it improved. . weigh yourself every morning, md if weight > 3 lbs. adhere to a 2 gm sodium diet fluid restriction: 1500 l daily . please return to the ed if you have any shortness of breath, worsening of your edema, chest pain, vomiting, abdominal pain, fever, chills, passing out or other concerning symptoms. an antibiotic flagyl (metronidazole) was added for your intestinal infection - please complete the course as instructed. please abstain from all alcohol while on this medication as it will cause strong side effects. followup instructions: you should follow up with your cardiologist as well as your pcp. your appointment is on :45 am. you must call if you cannot make this appointment. . you should also follow up with dr. wednesday at 1pm procedure: hemodialysis venous catheterization for renal dialysis right heart cardiac catheterization diagnoses: congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified intestinal infection due to clostridium difficile diastolic heart failure, unspecified 

Answer: The patient is high likely exposed to