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: iodine containing agents classifier attending: chief complaint: hypotension major surgical or invasive procedure: none history of present illness: 85 year old female with cad s/p nstemi, pvd s/p left bka, esrd on hd presenting from a with hypotension. this is her third hospitalization this month. from she was hospitalized for lower gi bleed, complicated by hypoxemia. the hypoxemia was attributed to volume overload/chf and was found to have bilateral pleural effusions--she responded to ultrafiltration/hemodialysis. in regards to the gib, she was transfused 1 u prbc for hct of 25. she prepped for colonoscopy multiple times, but was unsuccessful. she was discharged to rehab with a plan for outpatient colonoscopy. she was hospitalized again on for lower gi bleed/guaiac positive stool at . her hct was stable. she refused preparation for colonoscopy and refused further work up of her effusions. she was discharged home with plan for outpatient colonoscopy. the day prior to admission, she went to hd and reports being fatigued out of proportion to her baseline. she was in bed all day, with decreased po intake. she was told her stool was guaiac positive--but she did not see it. on routine vitals, the day of admission, she was found to be hypotensive--per report from the ed, was 74/42. no documentation accompanies patient. she denied any symptoms at the time, but when she sat up in bed to eat breakfast, she reports dizziness. this symptom accompanied movement during the course of the day, but was not constant. she denied vertigo, blurry vision, chest pain, shortness of breath, abdominal pain or any other specific symptoms. she also reports a large stool this morning--but did not see it and cannot tell if it was bloody/black/loose. at arrival to the ed, her vitals were 97.8 95/50 82 18 100% 2l. she had a single decrease in her bp to 89/34, but responded to 500 cc bolus. her bp ranged 94-106/34-48. she was given 1 gram of ceftriaxone for presumed pneumonia given her leukocytosis and left shift. cxr demonstrated bilateral effusions and ct abdomen demonstrated bilateral effusions without an acute process. currently, she reports discomfort on her left hip from the bed. she is hungry. she denies chest pain, lightheadedness, shortness of breath, abdominal pain, ongoing loose stool, ongoing dizziness or any other complaints. past medical history: 1.cad s/p nstemi in . medically managed, felt not to be candidate for catheterization. plavix had to be stopped due to rectus sheath hematoma. post-mi echocardiogram demonstrated regional lv systolic dysfunction with inferolateral/basal inferior wall hypokinesis with ef of 50-55%, elevated lv filling pressure and 1+ mr. 2. pvd s/p left bka with dr. 3. insulin dependent diabetes mellitus 4. hypertension 5. hyperlipidemia 6. esrd on hd m/w/f 7. positive ppd -- hospitalized at , had 3 negative sputum 8. lower gi bleed--unable to tolerate colonoscopy prep as inpatient, plan for outpatient procedure 9. stage iv decubitus ulcer, 2 ischial ulcers and heel ulcer. 10. depression 11. colon cancer s/p resection social history: currently at rehab, lives alone with son in apartment below, no tobacco, alcohol or drugs. widowed family history: parents lived until 95. cause of death is unknown, but patient denies a family history of cad/mi or early cardiac death. physical exam: vs: 99 123/40 79 16 100% 2l gen: well appearing, no distress, speaking in complete sentences, hard of hearing heent: eomi, mm dry/op clear neck: no jvd visible chest: hd line c/d/i, nontender car: regular, distant, no murmur resp: markedly decreased bs on left, with audible sounds at apex posteriorly and audible over anterior, bs on right 1/2 up with crackles, no wheeze, no ronchi abd: s/nt/nd/nabs, ecchymoses over abdominal wall, liver palpable, nontender, small, nonbleeding external hemorrhoids ext: s/p bka on left--incision well healed. right leg in boot, ulcer is clean based and covered with gauze, no surrounding erythema, no edema back: dressed wounds neuro: cn ii-xii intact except hearing decreased bilaterally, strength 5/5 in ue, le bilaterally pertinent results: admission labs: 10:45am wbc-13.1*# rbc-3.04* hgb-7.8* hct-25.7* mcv-85 mch-25.7* mchc-30.4* rdw-18.4* 10:45am neuts-91.0* lymphs-5.7* monos-2.7 eos-0.2 basos-0.3 10:45am plt count-251 10:45am pt-15.2* ptt-27.1 inr(pt)-1.3* 10:45am ctropnt-0.29* 10:45am glucose-167* urea n-18 creat-2.6* sodium-143 potassium-3.3 chloride-100 total co2-34* anion gap-12 . ct abdomen: 1. significant bibasilar pleural effusions with mass effect on the adjacent lung parenchyma as described above. 2. no evidence of free air or fluid in the intra-abdominal cavity. 3. interval decrease of the right rectus sheath hematoma. 4. rectal wall thickening. recommend clinical correlation of possible prolapse. 5. diffuse diverticular disease without evidence of acute diverticulitis. 6. unchanged moderate-to-severe degenerative diseases. . cxr: there is a large left pleural effusion and moderate right pleural effusion with obscuration of bilateral hemidiaphragms. no pneumothorax is detected. the heart is not well delineated given effusions. a repeat chest radiograph may be helpful after left thoracentesis. . echo: the left atrium and right atrium are normal in cavity size. the estimated right atrial pressure is 0-10mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with hypokinesis of the basal 2/3rds of the inferior and inferolatreal walls. the remaining segments contract normally (lvef = 45 %). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is moderate pulmonary artery systolic hypertension. there is a prominent anterior fat pad.. compared with the prior study (images reviewed) of , moderate pulmonary artery systolic hypertension is now identified. regional and global left ventricular systolic function are similar. . urine cultures: preliminary staphylococcus and streptococcus. brief hospital course: 1. hypotension: patient had an associated leukocytosis with left shift concerning for infectious source. the patient remained normotensive during her hospital stay. she received 1 bolus of 500cc ns, and did not require any pressors. she was noted to have stage iii ulcerations on admission, and wound care was consulted. blood cultures were drawn and were negative at time of . she was found on urine culture to grow staphyloccocus and streptococcus, speciation pending at time of , and is being treated empirically with vancomycin for a total 10 day course, to be completed at dialysis. she was also transfused 1 u prbc for hct of 23, and hematocrit remained stable thereafter. . 2. bilateral effusions: noted over the last several admissions. likely related to volume overload/diastolic chf. patient has refused work up/thoracentesis in the past, and continues to refuse on this admission. she was weaned to 2l of oxygen at time of . she will need continued fluid removed at dialysis. . 3. lgib: recent admissions for lower gi bleed. unable to tolerate colonoscopy prep as inpatient, procedure scheduled for early . no stool in vault in ed for guaiac. hct was 23 on and patient given 1 u prbc given hypotension, positive troponin and history of bleeding. she remained stable throughout the remainder of her hospital stay. aspirin was held. . 4. cad: patient was noted to have an elevation in her troponin compared to baseline without comparable change in creatinine. had medically-managed mi in . continue beta blocker and statin. she was transiently given aspirin 325 mg daily, which was held again after she completed her rule out for an mi. she had an echo which was unchanged, and her ekg was unchanged as well. 5. hypertension: her antihypertensives were held transiently, but restarted after stabilization. 6. dm2: continued on outpatient lantus and ssi, with a slight decrease in the lantus dose. . 7. depression: continued remeron and celexa 8. esrd: she received hemodialysis while inpatient. 9. pvd: she was evaluated by vascular surgery during her inpatient stay. she will need to follow up with vascular surgery two weeks after . . 10. wounds: wound care was consulted. their recommendations for care of her stage iii ulcers were followed. she had no signs of infection in her ulcers. . 11. chest pain. patient had a transient episode of chest pressure the night prior to , which caused a delay in her . her ekg was unchanged, three sets of cardiac enzymes were negative, and her chest x-ray showed no new evidence of consolidation or worsening of her known effusions. she does have evidence of continued large left sided effusion and perihilar congestion, which will require fluid removal at dialysis to help resolve. given the highly atypical nature of her pain, and the fact that it improved once she fell asleep, it may have been related to anxiety around the process of . . she remained full code throughout her stay. medications on admission: celexa 15 mg po qhs simvastatin 40 mg qhs remeron 7.5 mg qhs oxycodone 5 mg po q6h prn metoprolol tartrate 25 mg po tid albuterol neb q4h prn wheeze guaifenasin 5 cc po q6h prn ntg sl prn ssi dulcolax prn, mom prn acetaminophen prn ativan 0.5 mg po prior to hd ecasa 325 mg daily--on hold until after colonoscopy lantus 10 u qhs nephrocaps omeprazole 20 mg daily sevelamer 800 mg tid lisinopril 5 mg po daily medications: 1. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 2. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime). 4. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 5. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 6. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed. 7. lorazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. sevelamer hcl 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 10. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 14. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 15. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 16. insulin glargine 100 unit/ml solution sig: per scale per scale subcutaneous four times a day. 17. vancomycin 1,000 mg recon soln sig: one (1) gm intravenous every seventy-two (72) hours for 5 days: per hd protocol, dose for vanc level <15. . disposition: extended care facility: care center - diagnosis: 1. hypotension 2. esrd on hd 3. acute blood loss anemia 4. lower gi bleed 5. stage iii pressure ulcers 6. bilateral pleural effusions 7. urinary tract infection condition: stable instructions: you were admitted with low blood pressures, which is likely from a urinary tract infection. you were treated with vancomycin which you will need to continue for a total of 10 days. this will be given to you at dialysis. followup instructions: please follow up with your primary care doctor from your rehabilitation facility. you have an appointment for a colonoscopy to be performed as an outpatient. provider: , md phone: date/time: 10:00 you will need to follow up with vascular surgery in 2 weeks after . please call to make an appointment with dr. at . provider: (st-3) gi rooms date/time: 10:00 procedure: hemodialysis transfusion of packed cells diagnoses: end stage renal disease renal dialysis status coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled peripheral vascular disease, unspecified depressive disorder, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia long-term (current) use of insulin old myocardial infarction pressure ulcer, lower back personal history of malignant neoplasm of large intestine streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] pressure ulcer, heel hemorrhage of gastrointestinal tract, unspecified staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus below knee amputation status chronic diastolic heart failure pressure ulcer, stage iv pressure ulcer, stage iii pressure ulcer, unstageable pressure ulcer, hip 

Answer: The patient is high likely exposed to