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: dilantin / heparin agents attending: chief complaint: primary: 1. hypotension 2. diarrhea secondary: 1.esrd on hd: 2. hepatitis b 3. alcoholic cirrhosis 4. anemia 5.seizure disorder 6. alcohol withdrawl 7. gout 8. l knee replacement 9. htn 10. peri-op afib many years ago 11. hypothyroidism 12. pleural effusion status post decortication in 13. h/o mrsa line infection. 14. past surgical hx: notable for abdominal trauma from a stab wound and he underwent open exploration at that time. it is unclear as to what the results of that were. major surgical or invasive procedure: - placment of right femoral catheter - placement of left femoral 12 french triple lumen temporary dialysis catheter - removal of left tunneled ij hemodialysis catheter - thoracentesis of right pleural effusion - placement of a tunneled left ij 14.5-french hd catheter - removal of l femoral temporary hd catheter - placement of left picc line - removal of left picc line - placement of right picc line - removal of right picc line secondary to displacement - attempted placement of right ij line, attempted placement of right femoral line - placement of left femoral central line history of present illness: 61 m with h/o esrd on hd, etoh cirrhosis, hep b and hep c, seizure d/o, gout, htn, line infections, recently d/c'd after admit for 1 week history of diarrhea, now readmitted from hd for hypotension, continued diarrhea. prior to last admit, pt had 1 week of yellow watery stool, non-bloody, non-black, occuring about six times/day, worse at night. at that time, he denied nausea/vomiting, fever, chills, abdominal pain, chest pain, or sob, hematemesis, recent laxatives or antibiotics. c.diff was sent from the nh was negative. he did note progressive leg weakness over several months, and rn at the nh reported progressive mental status decline since , with lethargy, psychomotor retardation and confusion. during recent admit, patient had a ct of the abdomen that showed thickening of the ascending and transverse colon c/w colitis. stool cultures including ova + parasites, and c.diff were sent which came back negative. he was transiently on levo/flagyl but these were discontinued after negative stool culture. by hd#4, he was forming more formed stool, and in fact his stool became too hard and so he was re-started on a stool softener colace. it was felt that he likely had a viral enterocolitis, or less likely, an ischemic colitis from possible hypotensive episode during hd session. another possibility was a viral enteritis causing hypovolemia, then the resulting hypotension causing ischemic colitis. new acute onset of inflammatory bowel disease was thought very unlikely. patient was not felt to warrant a colonoscopy at the time, as he improved on conservative management. . since his discharge , 4d pta, the patient has had recurrence of his diarrhea, which he says only seemed to slow down somewhat but never went away. he is not clear what medicines he has been getting at , including if he has gotten any laxatives or stool softeners. he has been on a brat diet, so presumably they have held his laxatives as well. . patient was at hd today, with initial bp 134/74, which fell to 84/40. 300cc of ns was given, which brought up the bp to 92/60, but then it fell to 71/45. pt had 2.5h of hd, stopped early. received a total of 2100cc ns, and even with this and in t- sbp remained in 80s. denied cp, sob. when ems arrived, bp 115/80 sitting and 96/64 lying flat. was admitted for dehydration from continued diarrhea. bp in ed ranged 107-119/56-77, hr ranged 58-70. past medical history: esrd on hd: l hickman tunneled catheter. hepatitis b etoh cirrhosis anemia seizure disorder alcohol withdrawl gout l knee replacement htn peri-op afib many years ago hypothyroidism pleural effusion status post decortication in h/o mrsa line infection. past surgical hx: notable for abdominal trauma from a stab wound and he underwent open exploration at that time. it is unclear as to what the results of that were. social history: patient lives at home (). his wife died eight years ago from complications of intravenous drug abuse. he worked as a carpenter or painter and quit eleven years ago. he used to drink at least a pint of alcohol/day for many years. he denies tobacco or any other drugs currently. - patient reports he has a son and daughter, both of whom live in . patient reports he is estranged from his children and adamently reports he does not want them to be part of his care, nor does he want them contact. family history: non-contributory physical exam: physical exam: vitals: 97.2 118/60 66 18 95%onra 76.4kg gen: well nourished, breathing comfortably, not in pain, nad, slow to respond skin: no frank jaundice, though right arm with extensive ecchymoses and yellowing, plus one laceration over forearm heent: perrl, eomi, anicteric, dry mm, op clear, +tongue fascic neck: supple, no cervical lad, no jvd cor: rrr, nl s1, s2, syst murmur at apex, no rub/gallop lungs: rales way up bilaterally; poor air movement throughout abd: mildly obese, nondistended, decreased bowel sounds, tender to deep palp in all four quadrants as well as with tapping of ribs over liver; no guarding/rebound rectal: trace guaiac positive in the ed ext: tender bilateral knees to palpation and passive range of motion. neuro: inattentive, oriented x 3, slow to respond, fluent, tangential, intact comprehension. cnii-xii intact. strength, sensation to lt intact; +asterixis pertinent results: admit labs: 01:15pm wbc-4.0 rbc-3.96* hgb-12.1* hct-40.2 mcv-102* mch-30.6 mchc-30.1* rdw-18.7* 01:15pm plt count-92* 03:15pm glucose-98 urea n-7 creat-2.6* sodium-143 potassium-3.8 chloride-109* total co2-23 anion gap-15 01:15pm calcium-6.6* phosphate-2.5* magnesium-1.6 01:15pm glucose-91 urea n-7 creat-2.5*# sodium-139 potassium-5.8* chloride-107 total co2-22 anion gap-16 03:15pm alt(sgpt)-20 alk phos-175* amylase-27 tot bili-0.8 03:15pm lipase-12 03:15pm albumin-2.2* discharge labs: : wbc-13.1* hgb-8.4* hct-26.8* plt-61*# s/p transfusion for platelet count of 22 59% neutrophils, 25 bands . coags: 14.5*1 43.6* 1.4 . chem-7: glu-45* bun-33* cr-3.6* na-144 k-4.3 cl-107 hco3-24 ag-17 . heparin dependent antibody - positive heparin dependent antibody - negative serotonin release assay - negative . : c. diff toxin a - negative : c. diff toxin b - negative : c. diff toxin a - positive : c. diff toxin b negative blood cxs: no growth blood cxs: no growth blood cxs: no growth . abgs: : 7.32 / 228* / 45 / 24 : 7.30 / 193* / 46* /24 : 7.27 / 126* / 49* /23 . reports: radiology chest (portable ap)ap upright view of the chest: a central line is unchanged, terminating at the aortocaval junction. the cardiac and mediastinal contours are stable. a right-sided pleural effusion with associated atelectasis is again demonstrated and not significantly changed compared to the prior study. no evidence of pneumothorax. impression: no significant interval change compared to the radiograph of . . radiology ct abdomen pelvis: ct of the abdomen with iv contrast: a right-sided pleural effusion and bilateral lower lobe multifocal patchy opacities are again demonstrated not significantly changed compared to the prior study. the liver, gallbladder, pancreas, spleen, stomach, and adrenal glands are unremarkable. the kidneys are atrophic. enhancement of the renal parenchyma is noted. there is wall edema/thickening of the ascending colon. there is apparent wall thickening of the transverse colon as well that was also demonstrated on the prior study. the splenic flexure and descending colon is under-filled, however there also appears to be wall edema affecting these locations as well. note is made of free fluid tracking along the pericolic gutters, increased compared to the prior study. the appendix appears less enlarged compared to the prior study. the small bowel is grossly unremarkable and of normal caliber. there are no pathologically enlarged mesenteric or retroperitoneal lymph nodes. ct of the abdomen with iv contrast impression: 1. unchanged appearance of the chest compared to the prior study with a right-sided pleural effusion and patchy multifocal opacities. 2. wall edema/thickening of the ascending and transverse colon and possibly descending colon consistent with colitis with interval increase in free fluid tracking along the pericolic gutters. differential diagnosis includes infectious, inflammatory, and ischemic etiologies. . port chest: 1) persistent small curvilinear opacity at the left apex, which may reflect a small pneumothorax. 2) stable moderate to large partially loculated right pleural effusion with adjacent opacities in the right middle and lower lobes. . port chest: persisting moderate right-sided pleural effusion with progression of associated consolidation, which given the clinical history is likely consistent with pneumonia. no other significant interval change. . : left ue us- partially occlusive thrombus in the left internal jugular vein. possible partially occlusive thrombus in the left basilic vein along the picc. . : portable abdomen: 1. no free air. 2. ill-defined nodular density at the left lung base, likely infectious or inflammatory in etiology given that it was not present on the recent prior exam. followup recommended. : port chest: 1. stable position of left internal jugular venous access catheter. a right- sided picc has been removed. 2. increase in the patchy opacities at the left base. stable opacity at the right base. findings could be consistent with aspiration. 3. bilateral pleural effusions, right greater than left. . : port chest: impression: no short interval change. no pneumonia or overt fluid overload. brief hospital course: 1)hypotension/sepsis: pt has low baseline bp, likely related to his esld. a day after the sigmoidoscopy, he underwent hd where he was afebrile and stable, and was transported to the gi suite for possible colonoscopy but developed severe rigor and fever. he was hypotensive to 40-90's fluctuating. dopamine was started on the floor in addition to fluid boluses, and pt was transferred to the micu. bcx grew e.coli resistant to quinolones. he was initially on ceftriaxone and vancomycin but was tailored to ceftriaxone. he was later transferred to the floor where his bp was stable at sbp 90-110's. he also has adrenal insufficiency from long term use of prednsione for gout. so he received stress dose steroids of fludrocortisone and hydrocortisone since the hypotensive espisode. he was treated with ceftriaxone for the e.coli sepsis. the source was thought to be either from sigmoidiscopy or line related as he had femoral line in his right groin as well as tunneled hd line in his left ij. after temporary hd line was placed in the left groin, both of the old lines were removed. serial surveillance cultures have been negative. plan at this point was to place a tunneled hd catheter by ir. placement of this catheter was complicated by the fact that patient was having mental status change and did not have a health care proxy. after discussion with ethics, it was thought that placement of these catheters was medically necessary and both a tunneled left hd catheter and left picc line were placed. the left groin catheter was removed at this point. on , the patient was noted to have a brief desaturation on the floor down to about 89% on room air, which increased to 98-99% with non-rebreather. the patient was then successfully weaned down to low-flow nasal canula. at this point, the patient had completed ceftriaxone for his previous e. coli bactermiea, but was already receiving flagyl for a possible previous aspiration. blood cultures were sent. the patient was noted the day following to have a leukocytosis, which was also accompanied by abdominal pain. a sono was negative and a port chest and kub did not demonstrate any evidence of disease including free air. in the setting of this leukocytosis, the patient again became hypotensive and was empirically started on vancomycin iv and zosyn. additionally, c. diff toxin was sent which was positive depite having received 9+ days of flagyl. the patient was additioanlly started on po vancomycin and the flagyl was discontinued. the patient, who previously had been weaned back down to 10mg po qd of prednisone was again brought to his stress dose steroid of 100mg hydrocortisone qd for possible adrenal insufficiency. the patient was additionally given 1 unit prbc for low hct. in the setting of continued gi output, the patient additionally had a rectal tube placed on to avoid contamination of his sacral decubitus ulcer. on , patient's left arm was noted to be particularly swollen. a lue us revealed partial obstruction of the left ij and left basilic vein. the patient's picc was pulled and the patient was started on an iv heparin drip. the patient was scheduled to have an additional picc placed the following day. that evening, the patient was noted to have some epistaxis without hemodynamic compromise and the heparin drip was immediatley stopped. the patient was given 1 unit of blood overnight. the patient was fairly stable on the floor with sbp 100-110 with plans of possible discharge back to nursing facility, as this was what patient repeatedly told medical team he wished to do. on the morning of , the patient was seen in the a.m. and found to be disoriented, confused and audibly gurgling. the patient was ordered for a portable chest film, but was with satisfactory o2 sats on nc. while in hd, team was called as patient had acutely decompensated since his arrival. he was with mental deteriation and o2 sats to the high 70's and 80's. the patient was placed on a non-rebreather, an abg and stat port film were performed and the micu team was called to evaluate the patient. as the patient was dnr/dni it was determined that the patient may recieve pressors if necessary in the unit, but at most could receive bi-pap or cpap for ventilatory support. through the course of the day the patient was attempted to be weaned back to nc 5-6l, which failed. the patient was placed back on 100% o2 on non-rebreather, but was maintaining bp 90-110 without pressors. in the few days prior to these desaturations the patient was additionally becoming frequently hypoglycemic. the patient was not receiving insulin, and was given amps of dextrose as needed for hypoglycemic episodes as well as basal fluids with d5. overnight, the patient was seen by the nightteam, with similar report of o2 desat and gurgling. upon suction, frank blood was suctioned through a nasal trach tube. the patient was immediately given 1 unit of platelets for hrombocytopenia and the patient previously that evening had received i unit of ffp for an elevated inr. am labs revealed that the patient had 25bands and was currently unweanable from 100% non-rebreather. - prior conversations with the patient when he was lucid revealed that the patient was willing to continue hemodialysis, but only if he was able to go back to his retirement home for treatment. the patient reported clearly to the medical team he did not want to stay in the hospital indefinitely on hemodialysis and he did not want to die in the hospital, with his life being prolonged on hemodialysis. the patient had reported he wished to be dnr/dni and did not want his estranged family involved in his care. at the time of the most recent events above, the medical team including all particpiating physicians, nurses, and case manager discussed the case and what they thought the patient would have wanted given his condition, his poor prognosis, and poor chance of ever going back to retirement home with a qulaity of life he would have wanted. given the above and his recent medical decompensation, thought likely to represent sepsis and dic, the decision was made, agreed upon by all healthcare workers involed in his care, that mr. would not have wanted continued aggressive medical management. the decision was made to place the patient on comfort care, and all medical treatments including blood draws and hd were stopped. on the patient was placed on a morphine drip titrated to comfort. on the morning of , the patient was noted to be demonstrating an agonal breathing pattern. the patient quitely passed away within a few hours without incident. 1)colitis: the patient was recently admitted for the same symptoms. on last admission, all stool studies were negative and his diarrhea slowly resolved. he presented again with persistent diarrhea. ct of the abdomen showing wall thickening of the ascending, transverse, and descending colon. again, all of the stool studies were negative including c.diff toxin a and b upon admission. he underwent sigmoidoscopy which showed multiple patchy erythematous and edematous area but etiology was inconclusive. the plan was to send him for colonoscopy but patient became septic with e. coli bactermiea s/p sigmoidoscopy for which he was treated with ceftriaxone. after resolution of his septic episode, the patient continued to have diarrhea during his hospital stay, accompanied as well by abdominal pain. despite additional treatment with flagyl, which had been started for a likely aspiration pna, the patient's c. diff toxin a became positive on . the patient was additionally started on po vancomycin at this time 125mg po q6h for treatment of likely c. diff colitis. the patient was additionally given questrum 4 gm po qid to help solidify his bowel movements. the patient was additionally found during his stay to have frequent contamination of his sacral decubitus ulcer with feces. because of this, a rectal tube was placed while the patient experienced diarrhea to avoid contamination of his open wound. over the course of about a week, the patient's bowel movements became less freqient and better formed. the patient was with resolution of his diarrhea, without a rectal tube, and had his questrum dosing decreased to tid until the events as noted above. . 3)pneumonia: cxr in micu suggestive of possible pna as well as worsening right side pleural effusion which was tapped. the pleural fluid was consistent with exudate by light's criteria and is likely parapneumonic. he likely had aspiration pneumonia in the icu while his mental status was altered. flagyl was added in addition to ceftriaxone to cover for anerobes for pneumonia as well as empiric coverage for gi flora. remainder of hospital course is as noted above . 4)thrombocytopenia: he has a baseline thrombocytopenia from chronic liver disease. however, he had a drop in plt count to the 40's. hit antibody was sent which came back positive. repeat hit was negative as was serotonin release assay. . 5)mental status: progressively declining mental status since last ; unclear etiology. he became more confused and disoriented after the micu stay which was thoguht to be icu psychosis and toxic-metabolic picture. remainder of hospital course as above . 6)social: pt has no family member to contact and no health care proxy. his only contact of record is a friend/neighbor. ethics consult was otained to define a long term care as he is clearly dnr/dni. also he may need a legal guardianship. remainder of hospital course is as above. 7)nutrition: pt with albumin of 1.8 primarily from persistent diarrhea and decreased po intake from inumerous npo peri-procedure and icu stay. paient was started and weaner from tpn during stay. remainder of hospital course as above 8)gout: pt with long standing use of prednisone 10 mg qd for chronic gout. this was discouraged by rheumatology back in but has not been tapered. 9)hypothyroid: his synthroid dose was just increased to 50 mcg qd on last admission. was continued during stay. 10)code: dnr/dni-well documented. hospital course as above, deceased on medications on admission: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 3. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. levetiracetam 500 mg tablet sig: one (1) tablet po qd (). 5. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 6. divalproex sodium 500 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po bid (2 times a day). 7. divalproex sodium 250 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 8. sodium bicarbonate 650 mg tablet sig: one (1) tablet po bid (2 times a day). 9. hydrocodone-acetaminophen 5-500 mg tablet sig: 1-2 tablets po q8h (every 8 hours) as needed. 10. ibuprofen 400 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed. 11. epoetin alfa 10,000 unit/ml solution sig: one (1) injection asdir (as directed): qmwf at dialysis. 12. prednisone 1 mg tablet sig: as directed tablet po daily (daily): on prednisone taper: take 9 mg qd for 1 week, then taper by 1 mg/week. 13. levothyroxine sodium 50 mcg tablet sig: one (1) tablet po daily (daily). 14. colace 100 mg capsule sig: one (1) capsule po twice a day. discharge medications: none discharge disposition: extended care facility: healthcare - discharge diagnosis: 1. hypotension 2. diarrhea discharge condition: deceased discharge instructions: none followup instructions: none procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis thoracentesis flexible sigmoidoscopy transfusion of packed cells insertion of totally implantable vascular access device [vad] transfusion of other serum transfusion of platelets infusion of vasopressor agent diagnoses: hypocalcemia other and unspecified noninfectious gastroenteritis and colitis unspecified pleural effusion adrenal cortical steroids causing adverse effects in therapeutic use acute posthemorrhagic anemia alcoholic cirrhosis of liver acquired coagulation factor deficiency unspecified protein-calorie malnutrition severe sepsis unspecified acquired hypothyroidism unspecified viral hepatitis c without hepatic coma gout, unspecified atrial fibrillation other convulsions candidiasis of mouth hypopotassemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease defibrination syndrome other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus disorders of phosphorus metabolism septic shock intestinal infection due to clostridium difficile other complications due to other vascular device, implant, and graft pressure ulcer, lower back infection and inflammatory reaction due to other vascular device, implant, and graft anticoagulants causing adverse effects in therapeutic use hematemesis septicemia due to escherichia coli [e. coli] delirium due to conditions classified elsewhere other specified hypotension epistaxis viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta hypoglycemia, unspecified other adrenal hypofunction 

Answer: The patient is high likely exposed to