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: past medical history: 1. chronic obstructive pulmonary disease 2. congestive heart failure. 3. coronary artery disease. 4. diabetes mellitus type 2. 5. depression. allergies: the patient has no known drug allergies. medications on transfer: 1. .................... 2. flagyl 500 p.o.t.i.d. 3. ciprofloxacin 400 b.i.d. 4. fluconazole 100 iv q.d. 5. serevent 2 puffs b.i.d. 6. pulmicort 2 puffs b.i.d. 7. cardizem cd 180 q.d. 8. prednisone 20 b.i.d. home medications: lasix 40 q.d.; singular 10 q.d.; paxil 20 q.d.; aspirin 81; imdur 60 b.i.d.; -dur 300 b.i.d.; fosamax 10 q.d.; celebrex 100 times four; reglan 10 q.a.m.; q.p.m.; prednisone 20 b.i.d.; insulin 24 q.a.m. 14 q.p.m. physical examination: general: this is an obese, elderly woman laying in bed in mild distress. heent: oropharynx clear without lymphadenopathy. extraocular muscles are intact. cor: regular rate and rhythm, no murmurs. pulmonary: no wheeze, clear to auscultation bilaterally. abdomen: obese, tender to palpation diffusely, tympanetic, diffusely ecchymotic. rectal: guaiac negative. formed stool in vault. extremities: there was 1+ pitting edema bilaterally of extremities. laboratory data: laboratory data revealed the following: white count 7, hematocrit 35.2, platelet count 239,000, sodium 134, potassium 3.4, chloride 99, bicarbonate 27, bun 14, creatinine 0.2, glucose 168, calcium 6.4, ionized .97, phosphorus 1.8, magnesium 1.6, abg 7.42, 44, 71, alt 24, ast 20, alkaline phosphatase 78, amylase 4, lipase 7, total bilirubin .3, albumin 1.9. outside data, sputum 3+ , 2 normal flora; , 3+ actineobacter. imaging: ct of the abdomen at outside hospital revealed diffuse thickening of the colonic wall consistent with pseudomembranous colitis, relative opacity in the upper pole of the left kidney question tumors; kub prominent markings, increased gas, question colitis; chest ct revealed bilateral upper lobe emphysema with bullous changes, no pneumonia or effusion, lingular infiltrate. chest x-ray on admission: consolidation of both lower lobes, which may be consistent with pneumonia or aspiration. abdomen: not included. gases present through slightly dilated colon, but no evidence of toxic megacolon. hospital course: the patient was admitted to the icu. ct scan on the following day showed atelectasis, right lung base, free fluid in the abdomen, surrounding liver and spleen, fluid within the right lateral soft tissues measuring than 10 haustral units and not felt consistent with hemorrhage. distention of large bowel without intra-abdominal air. no air within the bowel wall. there was concern about the fluid tracking into the soft tissue. it was attempted to be aspirated under ultrasound guidance and 2 cc of fluid were aspirated, but no large fluid collection. that fluid was gram-stain negative and, therefore, grew. the patient was made npo, iv fluids, started on p.o. vancomycin and flagyl. kubs were followed serially throughout the icu course. the gastrointestinal department was consulted. the department of surgery was also consulted, followed and felt that the patient did not need surgical intervention at that time. the flagyl was then changed to iv. rectal tube and frequent turning were initiated, however, the patient had no stool output. the patient was started on tpn for nutrition. from a pulmonary standpoint, nebs and mdi were continued. prednisone was being tapered. the patient had transient hyponatremia to 129, thought secondary to quick mix and not resolved. few episodes of decreased urine output, which was treated with iv fluids and resolved on . the patient was noted to have nine bands up from three on and down from 41 on admission on . on , the patient was felt stable for transfer to the medical floor. on that day it was noted that the left upper extremity was larger than the right and there was concern for clot. ultrasound was done, which was negative for dvt. hospital course: (by system) gastrointestinal: the patient's abdominal examination was followed serially. gastrointestinal department and surgery department continued to follow the patient. kubs were done serially to assess the amount of distention. on ct of the abdomen was repeated, which showed no evidence of abscess formation or microperforation. there was no interval change in the colonic distention or mild thickening in the sigmoid. there was a slight interval increase in the dilatation of the small bowel loops with multiple air-fluid levels consistent with ileus. stable amount of free fluid. interval increase in regional interstitial nodular opacification of the left lower lobe which might have been a developing pneumonia. given the patient's discomfort nasogastric tube was placed and a large amount bilious fluid was returned. the ng tube was continued for decompression. the patient was followed by the gastrointestinal department and surgery department. the gastrointestinal department was considering doing a flexible sigmoidoscopy given that we had no diagnosis. all c. difficile cultures sent were negative and there were no outside cultures that were positive. the patient had several lactates done for concern of ischemic bowel, however, lactates were all within normal range. on the day of planned sigmoidoscopy on , the patient required transferred to the icu. please see below. therefore, it was deferred. during the icu stay the abdominal examination slowly improved and the department of surgery signed off. the patient completed a full course of flagyl and vancomycin for presumed c. difficile colitis. she was started on clears and she was tolerating clears. diet was slowly advanced. on flexible sigmoidoscopy was performed. this showed ulceration, granularity, and friability, erythema and pseudomembranes in the colon concerning for c-difficile colitis versus ischemic colitis, biopsy taken, sent stat and pending at this time. the patient was also continued on protonix. infectious disease: the patient completed a full course of flagyl and vancomycin for presumed c. difficile colitis. the patient remained afebrile throughout the hospitalization, however, this was felt possibly related her steroids and that she was immunocompromised. white count was monitored and it was noted that the patient was having increasing bandemia. on blood cultures were drawn and these were found to be positive for staph coagulase negative. the infectious disease department was also consulted and followed the patient. she was treated with iv vancomycin for this. catheter tip from the central line was culture. the central line was removed on and this was positive for staphylococcus coagulase negative. it was felt this was the source of her bacteremia. the patient continued to have positive blood cultures on the 11th and 12th. therefore, she was to be continued on an extended 14 day course of vancomycin. additionally, there was concern that this could be an endovascular source, given the high-grade bacteremia. transthoracic echocardiogram was performed on , which showed la and lv thickness, normal size, lv function could not be assessed. aortic root mildly dilated, mild pulmonary artery systolic hypertension, no evidence of endocarditis. on , the patient developed chest pain without ekg changes. the hematocrit dropped with unclear etiology and given her high-grade bacteremia, she was transferred back to the icu for closer monitoring. on the 14th transesophageal echocardiogram was done, which showed no evidence of endocarditis. the patient had a left subclavian line put back in on given her peripheral access was difficult. the patient completed a course of iv fluconazole and this stopped. it was started for uti, thrush, and also bowel coverage given her distention. on transfer to the icu repeat ct scan of the abdomen was done. findings were consistent with incomplete small-bowel obstruction, transitional zone distal ileum, oral contrast in the terminal ileum, large bowel unchanged fluid in the peritoneal cavity, slight increase in right pleural effusion, atelectasis in left lower lobe, consolidation in the left lower lobe. therefore, the patient was started on levaquin to cover the pneumonia for a ten day course. pulmonary: on admission, prednisone was tapered given her infection. it was tapered to 20 q.day. however, it was noted that when the patient started stooling, occult fragments were seen and there was concern for her absorption. she was changed to solu-medrol iv. she was continued on nebulizer treatments followed by rt, mdis and oxygen p.r.n. the patient continued to be bronchospastic intermittently and solu-medrol dose was increased. the patient was noted to improve significantly for one day and she was changed to p.o.prednisone the following day. she again was noted to be more bronchospastic and she complained more of shortness of breath. therefore, given the concern that she was not absorbing the medications from her gastrointestinal tract she was switched back to iv solu-medrol at 20 b.i.d. renal: during the first stay in the icu, she had some decreased urine output, however, this was thought to be intravascular depletion and this resolver her creatinine and the bun remained stable. during the second icu stay from to diuresis with lasix was initiated given the patient's anasarca, which was thought secondary to her low albumin. however, it was noted that the bicarbonate rose after diuresis and it was felt that she had a contraction alkalosis, so diuresis as was then held. alkalosis began developing. hematology: the hematocrit was noted to drop from stable in the low 30s to 25 on the 12th. it was repeated and found to be 27, but on the 13th it was 4.1, unclear etiology, as the patient was guaiac negative. reticulocyte count was noted to be 4.4, haptoglobin 201, ldh was elevated, total bilirubin was not, and they felt that the ldh was not secondary to hemolysis. no source was found. the patient was transferred two units of packed red blood cells and the hematocrit stabilized. it was also noted on that the platelets started to fall. on they were noted to be 113. dic panel was sent and it was negative. hit antibody was negative. platelets then rebounded within normal limits. on , the patient again had a hematocrit drop from the day before 37.7 to 31.9, however, it was stabler and monitored. after that, hemolysis labs at that time were also negative. cardiovascular: at the outside hospital the patient had a mild troponin leak of 0.6 with cks all less than 100. during the hospitalization here she was continued on aspirin and cardizem. on the 12th, when she developed chest pain, ekg was unchanged. she was rule out by cardiac enzymes for mi. blood pressure was monitored and it was within reasonable control. edema: the patient at one point had been thought to have left upper extremity edema greater than right, however, upper extremity ultrasound was done and this was negative. additionally, on the 17th, it was felt that she had increased left lower extremity edema and tenderness. ultrasound was done and it was negative for dvt. it was felt that patient's edema was secondary to iv fluids and nutritional status. pain: the patient had various muscular complaints in her legs and arms. ck was sent to look for myositis and it was negative at 29. it was felt likely that this was secondary to being in bed and anasarca. the patient was treated with ultram which helped. endocrine: the patient's fingersticks were monitored. tpn insulin was increased, as well as she was followed with a regular insulin sliding scale. she was continued on prednisone as above. fluids, electrolytes, and nutrition: the patient was continued on tpn for nutrition. the department of nutrition followed the patient. electrolytes were repleted as needed. prophylaxis: the patient had heparin and in her tpn. when the heparin was stopped briefly and withdrawn she was maintained on pneumoboots. she was continued on protonix. pt and ot worked with the patient. addendum will be added to the complete hospital course. dictated by: medquist36 procedure: parenteral infusion of concentrated nutritional substances diagnostic ultrasound of heart percutaneous abdominal drainage non-invasive mechanical ventilation closed [endoscopic] biopsy of large intestine diagnoses: pneumonia, organism unspecified cellulitis and abscess of trunk diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled candidiasis of other urogenital sites chronic airway obstruction, not elsewhere classified intestinal infection due to clostridium difficile infection and inflammatory reaction due to other vascular device, implant, and graft 

Answer: The patient is high likely exposed to