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: ace inhibitors attending: chief complaint: dysarthria major surgical or invasive procedure: lower endoscopy sigmoid colectomy with anastamosis ng tube placement right subclavian central line placement power picc placement history of present illness: hpi: 86 m w/ hx multiple strokes in the past including r-mca, seizures, dm, was at his nursing home, where per report, he began having increasing confusion over 2-3 days and this morning was thought to have slurring of his speech, first noticed at 8:30 am. he was last known without slurred speech last night. he was transferred to er where a code stroke was called. he received a nchct which showed broad areas of prior infarct, most notably through a large r-mca territory. there was no acute bleed. pt was initally very agitated/screaming in ct as well as subsequently when an iv was attempted to be placed, but later calmed. that said, he was minimally cooperative with further attempts at exam. past medical history: multiple strokes, 1st was in and recovered full without sequelae, but later large r mca stroke hx pneumonia, likely aspiration hypertension dm ii dysphagia seizure disorder cad hyperlipidemia transitional cell carcinoma of the bladder s/p left nephrectomy hx dvt s/p ivc filter trigeminal neuralgia social history: no toxic habits family history: unknown physical exam: 96.9f 56 190/72 22 100%ra gen: lying in bed, screaming intermittently, and attempting to bite examiner, blanket, tele cords. heent: nc/at, moist oral mucosa. sclera erythematous b/l. neck: no tenderness to palpation, normal rom, supple, no carotid or vertebral bruit cv: rrr, nl s1 and s2, no murmurs/gallops/rubs lung: clear to auscultation bilaterally abd: +bs soft, nontender ext: no c/c/e neurologic examination: mental status: awake and alert, very agitated at times. able to state name as "" but does not state last name and does not respond to other orientation questions. refuses to follow commands. states "good" when asked how he is, otherwise there is abundant echolalia. he has fluent, accented speech without clear dysarthria, stating things like,"why are you bothering me?" and "leave me alone!" cranial nerves: pupils: r 4->3 mm, l 4 mm and apparently nonreactive, though also with cataract. no clear btt from either side. on primary gaze, there appears to be right-beating nystagmus, and during exam later, he appears to become less responsive, with eyes deviating right, and then slowing deviating to the left, all the while with right-beating nystagmus. (+) r facial droop. motor: normal bulk bilaterally. tone increased throughout. no observed myoclonus or tremor rue and rle appear quite strong, able to provide nearly unbreakable resistance during attempts to passively flex/extend. lue appears to have no mvmt, even to pain. lle has min flexion at ankle and ip to painful stim. sensation: withdraws or screams to noxious in all 4 ext. reflexes: +2 and brisk at the biceps b/l. there appears to be some asymmetry at the knees, w/ l brisker, and r not able to elicit. toes upgoing bilaterally pertinent results: admission labs: 13.3 12.2 >-----< 260 41.1 146 | 111 | 25 ---------------< 110 3.3 | 25 | 1.2 ca: 9.8 mg: 2.6 po4: 4.1 imaging/studies/path/micro: ct head : multiple bilateral chronic cerebral infarcts and small vessel ischemic changes. if an acute infarct is suspected, an mri is recommended for further evaluation. eeg this telemetry captured no pushbutton activations. routine sampling showed a moderately slow and disorganized background with an area of prominent focal attenuation over the right frontal region. there were no epileptiform features noted. overall, the background is suggestive of a moderate encephalopathy. echo : impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. mild mitral regurgitation. sigmoid colon path unremarkable colonic mucosa. two unremarkable lymph node identified. eeg impression: this is an abnormal portable eeg due a slow and disorganized background rhythm, which was also of low voltage consistent with a mild to moderate encephalopathy. medications, toxic/metabolic disturbances and infections are common causes. anoxia is also a possible etiology. no epileptiform discharges or electrographic seizures were seen during this recording ct head impression: extensive encephalomalacic change compatible with chronic bilateral cerebral infarction and small vessel ischemic change. note that detection for acute infarction is extremely limited in this setting and if of clinical suspicion, mr is recommended for further evaluation. urine : pan-sensitive e coli stool : positive for cdiff endoscopy , sigmoidoscopy: torsion noted at 20cm, untwisting and decompression applied , sigmoidoscopy: torsion noted at 20cm, untwisting and decompression applied torsion noted at 20cm, untwisting and decompression applied otherwise normal sigmoidoscopy to sigmoid colon , colonoscopy: colon lumen dilated, no volvulus noted. decompression applied. a 36 fr thoracic catheter provided by surgery placed alone the scope at 30cm down from anal verge. otherwise normal colonoscopy to splenic flexure . ct abdomen: 1. dilated fluid and contrast-filled loops of small bowel with interloop fluid. since contrast transits in to the colon, and rectum, these findings are compatible with a partial small-bowel obstruction. there is no free air. 2. region concerning for a fluid collection within the right lower quadrant in fact represents loops of bowel as these now fill with contrast. 3. no obstruction at the sigmoid anastomosis. 4. small fluid collection below the left anterior abdominal skin staples. 5. atelectasis with ground-glass opacities at bilateral lung bases. infection at this site cannot be excluded. 6. single right kidney containing multiple hypodensities, compatible with simple cysts but incompletely evaluated on this study. 7. ivc filter in place below the renal veins. 8. anasarca. . stool cx : 4:57 pm stool consistency: not applicable source: stool. **final report ** clostridium difficile toxin a & b test (final ): reported by phone to @ 3:51a . clostridium difficile. feces positive for c. difficile toxin by eia. (reference range-negative). a positive result in a recently treated patient is of uncertain significance unless the patient is currently symptomatic (relapse). brief hospital course: 86 year old gentleman with history of cva and seizures, dm2, hypertension initially admitted with seizure now and transferred to status post partial sigmoid colectomy with course c/b fevers and leukocytosis adn persisting altered mental status. . course: on arrival to the icu, patient was hypotensive likely secondary to meds on the floor (bb/ativan) and hypovolemia. he was also sinus tachy with fever/leukocytosis. he responded to ivfs. he was continued on vanc/zosyn/flagyl and pan=cultured. in regards to his seizures, patient was dialntin loaded x1, for witnessed seizure on the floor that resolved with iv ativan. he was continued on dilantin. his albumin corrected phenytoin levels were adjusted for a goal of 15-20. there was concern for status epilepticus and neurology was consulted. an eeg was abnormal and did not show evidence of seizure activity but was consistent with a toxic metabolic syndrome. his albumin was low resulting in a subtherapeutic dilantin level and his dose was increased. his stool was positive for c diff and he was treated with iv flagyl and enteral vancomycin via ngt. abdominal xrays were not consistent with illeus or toxic megacolon. a lue us was done for assymetric edema, but was negative for dvt. during his icu course he had episodes of hypotension that were treated with ivfs and broad spec antibiotics. his antihypertensive meds were held. patient also had episodes of apnea, desating to 80s and bipap at nighttime was started. abx course vanc ; zosyn cefepime . floor course: . sigmoid ileus/partial sbo: after admission for seizure and confusion, he was diagnosed with a sigmoid volvulus. he was taken for endoscopic decompression, but unfortunately this was unable to be corrected. surgery was consulted and the decision was made to undergo sigmoid colectomy with anastamosis, occurring on . post op course was complicated by abdominal distention and partial sbo. there was also concern for possible abscess based on ct scan on . however, with iv contrast this was found to be filled bowel and not abscess. his ileus was treated with ngt to suction and supportive care. he was continued on tpn for nutrition. his sutures were removed on . he was passing bowel movements. see instructions in d/c information for plan of progression to tf via ngt v. peg tube . seizure disorder: as above. neurology was consulted. he was loaded with dilantin and given ativan at the time of his seizure. his dilantin was initially 100mg , but was changed to 100mg tid, then back to based on levels. his goal corrected dilantin level is 15-20. he remained seizure free thereafter. . aspiration pna: during the course of admission, he was diagnosed with aspiration pneumonia. he was treated for a 5 day course of vancomycin and zosyn, completed on . . e. coli uti: treated with cefepime from . aspiration/nutrition: given his encephalopathy, he was deemed unsafe to tolerate pos. additionally, given his volvulus and ileus he was unable to tolerate tube feeds. medications were given via ngt. nutrition was provided by tpn. a power picc was placed on . ng tube was left in place for medications. tube feeding can be considered going forward. . c. diff infection: diagnosed on . given his risk he was started on po/pr vanco and iv flagyl. given past antibiotic usage, he should continue his course through . . encephalopathy: since admission, he remained markedly encephalopathic, not related to seizure. he would respond to verbal/physical stimuli with moaning and heavy breathing. occasionally he appeared to answer with "yes" or "no." however, he could not hold a conversation or interact meaningfully. this was attributed to his medical/surgical insults. he improved to being able to have conversation by discharge - on discharge is able to answer questions appropriately, and despite moaning frequently, he persistently denies pain. . goals of care: a family meeting was held on with his hcp and daughter in law. though he reversed his code status for the surgery, the decision was made at this meeting to make the patient dnr/dni with no escalation of care. tentatively wants to give his father time to improve, though we made it clear that the possibility of recovering to his baseline prior to admission was unlikely. the hcp is also considering palliative/hospice care, to be decided in the near future - at the time of discharge, in discussion with the family, pt. is dnr/dni, but all other care to continue. if pt. takes a turn for the worse, then family will reconsider palliative approach, but are not wanting this at time of discharge. discharge medications: 1. phenytoin 100 mg/4 ml suspension : one hundred (100) mg po twice a day: check levels every 4 doses and adjust to target of . 2. heparin (porcine) 5,000 unit/ml solution : one (1) ml injection tid (3 times a day). 3. polyvinyl alcohol-povidone 1.4-0.6 % dropperette : drops ophthalmic prn (as needed) as needed for dry. 4. citalopram 20 mg tablet : 0.5 tablet po daily (daily). 5. latanoprost 0.005 % drops : one (1) drop ophthalmic hs (at bedtime). 6. lorazepam 1 mg tablet : 1-2 tablets po q4h (every 4 hours) as needed for seizure, anxiety. 7. insulin lispro 100 unit/ml solution : as per sliding scale, qid units, insulin subcutaneous four times a day. 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath. 9. simvastatin 10 mg tablet : two (2) tablet po daily (daily). 10. vancomycin 250 mg capsule : two (2) capsule po q6h (every 6 hours): through . 11. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 12. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback : five hundred (500) mg intravenous q8h (every 8 hours): through . 13. vancomycin : 250 mg mg rectal four times a day: through as rectal enema. discharge disposition: extended care facility: discharge diagnosis: seizure, convulsive encephalopathy sigmoid volvulus partial sbo/ileus aspiration pneumonia e. coli uti c. diff colitis malnutrition discharge condition: mental status:confused - always level of consciousness:lethargic but arousable activity status:bedbound discharge instructions: patient was admitted with seizure and confusion. he was also found to have a sigmoid volvulus for which he underwent partial colectomy on with anastamosis. his course was complicated by encephalopathy, aspiration pna, e. coli uti, unable to eat, partial sbo, and c. diff. please continue all medications and treatments as written. followup instructions: please have patient follow up with his pcp as needed: pcp: , . procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances open and other sigmoidectomy dilation of intestine dilation of intestine dilation of intestine diagnoses: urinary tract infection, site not specified toxic encephalopathy unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified protein-calorie malnutrition other specified intestinal obstruction pneumonitis due to inhalation of food or vomitus intestinal infection due to clostridium difficile late effects of cerebrovascular disease, hemiplegia affecting unspecified side epilepsy, unspecified, without mention of intractable epilepsy hypovolemia hyperosmolality and/or hypernatremia acquired absence of kidney volvulus 

Answer: The patient is high likely exposed to