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: reglan / protonix attending: chief complaint: hypotension major surgical or invasive procedure: r ij placement history of present illness: mr. is a 54 yo man with esrd on home pd, cad s/p mi with 3-vessel disease, ischemic cardiomyopathy with ef 20%, who presents with hypotension. mr. reports that for the past 3-4 days he has been noting mild cough productive of white sputum. he has also noticed that his blood pressure, which is baseline systolic was 80 systolic today. he did feel light headeded but denies loss of consciousness or neausea. he denies any respiratory distress, fevers, urinary symptoms, focal pain, abdominal pain, nausea, vomitting, or other localizing symptoms. baseline exercise tolerance is ~1 block and unchanged recently. baseline 1-pillow orthopnea is also unchanged. he does endorse slight increase in chronic le edema . in the ed, initialy vs: bp 60/44, o2 90% ra in triage, but first set of vs in core bp 121/101, rr 19, hr 72, t 98.3. he was given 1.5l ns. cxr did not demonstrate any significant change from prior. exam was without localizing features apart from an elevated jvp. lij was placed and norepinephrine started. vancomycin 1 g and zosyn 4.5 g were also administered as well as 10 mg dexamethasone. urine and blood cultures were sent. bedside echo demonstrated global hypokinesis, thought to be similar to prior. ekg showed st depressions in v3-v6 and new qw in ii, new from prior. labs were notable for trop elevated above baseline but no ck elevation. cardiology was consulted. they felt that this was either demand ischmia or a missed cardiac event. they recommended plavix and , which were given, but no heparinization unless ck became elevated. subsequent ekgs were unchanged. vs prior to transfer (on .09 of norepinephrine): hr 78, bp 104/85, 20, 97% 4l, cvp 26 . past medical history: # recent septic shock: . suspected source was left foot ulcer/cellulitis. this was treated with vanc/cipro/zosyn, and stress-dose corticosteroids. wound swab from a lle ulcer grew mssa and antibiotics were changed to nafcillin x 1 day and then unasyn. he was sent home on keflex for a total 14 day course of antibiotics. no other positive culture data. # recent c diff infection: , s/p 21 days po vanc # insulin dependent diabetes type i - complications of neuropathy, retinopathy, gastroparesis (somewhat responsive to erthromycin) # renal transplant, , now on pd since - followed by dr # cad - 3vd, des to om - cardiac cath showed 3vd, no intervention was performed. - cardiac surgery planed for surgery pending resolution of medical issues - during admission for sepsis, pt noted to have demand ischemia with ck peaking at 647 and troponin 1.59. # systolic chf: echo showed ef 20 % with hypokinesis of the inferior septum and lateral wall; akinesis of the posterior wall. # polycythemia # pvd # htn # h/o osteomyelitis of r 5th metatarsal in # eosinophilic gastritis # stoke in with right hand weakness, resolved on its own social history: no smoking, etoh, or illicit drug use family history: one sister has a congenital problem. mother and another sister with bipolar disorder on lithium. physical exam: on arrival to micu: afebrile, bp 110/70 on .09 levophed, o2 97% ra, hr 70s general: comfortable appearing man lying flat in bed in no distress, friendly and conversant : sclera anicteric, moon face neck: supple, jvp to jaw lungs: bilateral expiratory crackles 1/3 up lung fields, no wheezing or rhonchi abdomen: soft, non-tender, distended, bowel sounds present, no rebound tenderness or guarding, pd catheter site clean, dry, nontender ext: cool distal extremities, faint pedal pulses. ~ 1 cm eschar on r heal, nontender and nonerythematous, s/p l 2nd toe amputation, site without skin lesions, 1+ pitting edema to mid-calf bilaterally on discharge: bo stable off pressors. pertinent results: admission labs: 08:10pm wbc-4.7 rbc-3.64* hgb-9.4* hct-30.4* mcv-84 mch-25.7* mchc-30.8* rdw-16.6* 08:10pm neuts-69.2 lymphs-20.4 monos-5.7 eos-4.6* basos-0.1 08:10pm glucose-169* urea n-66* creat-9.5*# sodium-134 potassium-3.4 chloride-93* total co2-22 anion gap-22 08:17pm lactate-2.7* k+-3.5 05:05am blood wbc-4.6 rbc-3.44* hgb-9.2* hct-29.2* mcv-85 mch-26.7* mchc-31.4 rdw-17.2* plt ct-175 05:05am blood glucose-117* urean-71* creat-8.2* na-134 k-3.8 cl-96 hco3-20* angap-22* 05:05am blood calcium-7.4* phos-10.6* mg-2.2 02:09am blood pth-1670* cxr: comparison is made with prior study performed six hours earlier. cardiomegaly is grossly unchanged. right ij catheter tip is in the svc. left lower lobe retrocardiac opacities have improved consistent with improved atelectasis. there is no pneumothorax. the component of mild pulmonary edema has resolved. there is persistent right lower lobe opacity consistent with aspiration or pneumonia. if any, there is a small right pleural effusion. brief hospital course: 54 year old man with 3vd, chf, recent sepsis, esrd on pd, dm1, admitted with hypotension. . # hypotension: differential includes cardiogenic vs distributive vs hypovolemic causes. among cardiogenic causes, this may represent an acute exacerbation of his chronic chf or a new cardiac event. he may be septic, although afebrile and without localizing signs or symptoms. cxr with possible rll infiltrate, not impressive.. awaiting urine. foot does not appear infected. regarding the possibility of hypovolemic shock, he may be over-dialyzed. he does state that he has noticed a decrease in his weight and poor po intake. . on admission to the micu, levophed was quickly weaned off. bp was initially 110s but trended down to the 90s. he received an additional 500cc of ivf. . svco2 was 77%, arguing against heart failure. tte was ordered to further evaluate. for the possibility of sepsis, vancomycin and piperacillin-tazobactem were started but discontinued after there was no evidence of sepsis. blood, urine, pd fluid, sputum cultures, stool for c diff if diarrhea were ordered. lactate was down trending. he was given stress-dose steroids. most likely was a combination of poor systolic function, poor po intake, and adrenal insufficiency. # ekg changes: patient has known 3vd and systolic dysfunction with ef 20% with new qw on ekg. although troponin was elevated significantly above baseline, ck was not. this likely represented a recent cardiac event with ck now resolved and troponin trending down. bedside echo in ed without clear evidence of new wma. official tte was ordered. per cardiology recommendations in , and plavix were continued and no heparinization. metoprolol and ace were held given hypotension. . he likely also had demand ischemia in the ed related to poor perfusion pressures with shock. cardiac enzymes were trended. . # esrd: c/b failed renal transplant, on nocturnal pd. no urgent indication for dialysis on admission, although bun/creatinine higher than previously in omr, likely secondary to missing hd the night prior. renal was consulted and pd started. sensipar, calcitriol, renagel were continued. per renal recommendation, cyclosporin was discontinued. . # anion gap: ag 19, from previously. likely secondary to renal failure and mildly elevated lactate. . # diabetes type i: he was given home dose of insulin lantus and humalog sliding scale. . patient stated his desire to be full code. medications on admission: cinacelcet 30 mg daily sevelamer hcl 800 mg tid w/ clopidogrel 75 mg daily prednisone 5 mg daily cyclosporine 25 mg daily metoprolol succinate 25 mg sr daiyl aspirin 81 mg daily simvastatin 80 mg daily calcitriol 0.25 mcg daily lantus 20u qam iss hydralazine 10 mg qid discharge medications: 1. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). 4. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 5. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 6. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 8. multivitamin tablet sig: one (1) tablet po daily (daily). 9. prednisone 5 mg tablet sig: one (1) tablet po once a day. 10. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 11. oxymetazoline 0.05 % aerosol, spray sig: one (1) spray nasal (2 times a day) as needed for nasal congestion for 3 days. 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 13. sevelamer hcl 800 mg tablet sig: three (3) tablet po three times a day. disp:*270 tablet(s)* refills:*2* discharge disposition: home with service facility: area vna discharge diagnosis: hypotension heart failure secondary: adrenal insufficiency end stage renal disease diabetes type i discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - independent discharge instructions: you were seen and treated in the hospital for low blood pressure requiring admission to the medical intensive care unit in order to maintain your blood pressure to adequte levels. the most likely cause of your low blood pressure may have been due to over-dialyzing with peritoneal dialysis at home resulting in removing too much fluid. it may also have been caused by your lack of appetite for five days resulting in reduced fluid intake. given new findings on your echocardiogram one other possibility for your low blood pressures may have been due to a mild heart attack. during your hospital course you were started on antibiotics for presummed septic infection but these medications have been discontinued given no signs or symptoms of infection. you were also started on high dose steriods because your body could not produce these steriods on its own during a stressful event such as low blood pressure. these high dose steriods will be stopped when you leave the hospital. you will need to schedule an appointment in two weeks with your cardiologist dr. as well as with your primary care physician . . your recommended diaylsis course is below: please start peritoneal dialysis with 1.5% dextrose alternating with 2.5% dextrose, 1700ml volume, 6 hour dwell and 4 exchanges. followup instructions: you will need to make an appointment with dr. , , m.d. within the next two weeks. provider: , md phone: date/time: 11:30 provider: lab phone: date/time: 10:45 md, procedure: venous catheterization, not elsewhere classified peritoneal dialysis diagnoses: anemia in chronic kidney disease end stage renal disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified peripheral vascular disease, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease old myocardial infarction chronic systolic heart failure personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypovolemia glucocorticoid deficiency hypotension of hemodialysis background diabetic retinopathy diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled gastroparesis diabetes with ophthalmic manifestations, type i [juvenile type], not stated as uncontrolled polycythemia vera eosinophilic gastritis, without mention of hemorrhage 

Answer: The patient is high likely exposed to