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: iv dye, iodine containing contrast media attending: chief complaint: respiratory distress secondary to pneumonia, leading to ards renal failure major surgical or invasive procedure: 1. endotracheal intubation 2. arterial line placement 3. central venous line placement 4. hd line placement 5. initiation of hemodialysis history of present illness: ms is a 67-year-old woman with stage iv-v ckd preparing for renal replacement therapy, hypertension, insulin-dependent dm, anemia, hypertension, and gout, who presented to ed yesterday for nausea, vomiting, diarrhea for one week, and a cough that had worsened after an episode of emesis. she had been prescribed a z-pack by her pcp several days prior to presentation for presumed uri, but had not taken them due to a concern of worsening diarrhea. on arrival in , she appeared pale and lethargic and had projectile vomiting. she was intubated for hypoxic respiratory failure with o2 sats in 70-80s. she had 300 cc bilious output from her ogt. cxr showed a rml consolidation suggestive of pneumonia, and patient was given ceftriaxone and metronidazole out of concern for respiratory failure due to aspiration pneumonia. she was also given duonebs, three doses of iv lopressor, and 250 cc ivf, followed by 60 mg iv furosemide due to cxr signs of pulmonary edema. labs revealed elevated leukocytosis with left shift, mild hyponatremia & hyperkalemia, acute on chronic kidney injury, normal lactate, and hypoxemia. cardiac enzymes were elevated (trop 0.071 -> 0.244, mb 6.7) and there was concern patient had suffered an nstemi. she was given pr aspirin, started on a heparin gtt and transferred to ccu, with change of sedation from propofol to fentanyl & midazolam en route. . overnight in the ccu, further review of ecg revealed sub-mm st depressions in v3-v6. the patient had a bedside tte that showed mildly reduced lvef 45% and mild-mod mr. antibiotics were broadened to vancomycin, levofloxacin, piperacillin/tazobactam and metronidazole. she was given a dose of furosemide 40 mg iv at 0100. rij was placed in effort to preserve peripheral vessels for dialysis access. her map were generally stable but started to decrease in the 50s around 7:00 am. cvp between . she was bolused 1l ns. repeat labs revealed ongoing leukocytosis with bandemia and stabilization of creatinine. troponint peaked at 2.73, with ck-mb in range. her ventilator settings have been on assist/control 400x16-17, with fio2 60-80% and peep 12. . this morning, the patient is inubated and partially sedated, but is interactive, answering questions and following commands. she endorses nausea, diarrhea, and discomfort from the ett. she says she has had subjective fevers and acknowledges that she was not taking antibiotics at home, but cannot recall what they were prescribed for. denies chest pain, abdominal pain. past medical history: -stage iv-v kidney disease with baseline creatinine 3.5 (first fistula attempt failed awaiting second evaluation for fistula) -intermittent hyperkalemia -anemia secondary to renal disease on aranesp -known kidney stone -hypertension -gout -diabetes on insulin - diabetic neuropathy s/p l 5th toe amputation social history: marital status: single. children: none. occupation: office manager for an insurance agency. tobacco: none. alcohol: none. family history: fam hx + for hypertension. mother: died ami age 57 was diabetic father:died ami age 82 was diabetic siblings 4 sisters, 2 with diabetes and alive, one sister died of copd and the other of pancreatic carcinoma physical exam: admission exam: general: intubated, awake, interactive, appears older than stated age heent: +mild conjunctival injection, no icterus/pallor. perrl 3 -> 2 mm bilaterally. mmm neck: supple, rij in place without surrounding erythema or drainage, no jvp or lad cv: rrr, normal s1 + s2, no murmurs, rubs, gallops lungs: diffuse rhonchi and occasional wheeze with vent sounds heard anteriorly and laterally. abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly ext: warm, thin, no edema or cyanosis, 2+ dp/pt/radial. no foot ulcers; s/p l 5th toe amp neuro: strength limited due to sedation but generally without focal deficits. 2+ reflexes bilaterally, gait deferred discharge exam: 92, 98% on 3l, 140/75 general: awake, appropriate heent: no icterus/pallor. perrl neck: supple, r tunneled line without surrounding erythema or drainage, no elevation of jvp cv: rrr, normal s1 + s2, lungs: crackles improved, no wheezes abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly ext: warm, thin, no edema or cyanosis, 2+ dp/pt/radial. no foot ulcers; s/p l 5th toe amp neuro: increased strength, gait deferred pertinent results: labs upon admission: 07:25pm blood wbc-21.1*# rbc-3.27* hgb-9.6* hct-28.9* mcv-88 mch-29.4 mchc-33.3 rdw-15.6* plt ct-223 07:25pm blood neuts-75* bands-19* lymphs-2* monos-3 eos-0 baso-0 atyps-0 metas-0 myelos-1* nrbc-1* 07:25pm blood pt-12.8* ptt-90.0* inr(pt)-1.2* 07:25pm blood glucose-257* urean-81* creat-3.5* na-142 k-5.1 cl-98 hco3-24 angap-25* 11:00pm blood alt-26 ast-55* ld(ldh)-356* alkphos-78 totbili-0.2 05:59am blood lipase-9 07:25pm blood ck-mb-19* mb indx-8.6* ctropnt-2.49* 11:00pm blood ck-mb-17* ctropnt-2.73* 05:59am blood ck-mb-11* mb indx-8.6* ctropnt-2.25* 07:25pm blood calcium-9.1 phos-5.0* mg-2.3 03:00am blood albumin-2.5* calcium-7.9* phos-4.2 mg-1.8 09:03pm blood type-art po2-65* pco2-40 ph-7.44 caltco2-28 base xs-2 labs prior to discharge: micro: date 6 lab # specimen tests ordered by all all blood culture influenza a/b by dfa rapid respiratory viral screen & culture sputum stool urine all inpatient stool clostridium difficile toxin a & b test-final inpatient blood culture blood culture, routine-pending blood culture blood culture, routine-pending stool fecal culture-final; campylobacter culture-final; clostridium difficile toxin a & b test-final stool fecal culture-final; campylobacter culture-final; fecal culture - r/o vibrio-final; fecal culture - r/o yersinia-final; fecal culture - r/o e.coli 0157:h7-final; clostridium difficile toxin a & b test-final sputum gram stain-final; respiratory culture-final urine legionella urinary antigen -final sputum gram stain-final; respiratory culture-final influenza a/b by dfa direct influenza a antigen test-final; direct influenza b antigen test-final rapid respiratory viral screen & culture respiratory viral culture-final; respiratory viral antigen screen-final sputum gram stain-final; respiratory culture-final blood culture blood culture, routine-final blood culture blood culture, routine-final urine urine culture-final urine legionella urinary antigen -final . reports: tte: poor image quality. the left atrium is moderately dilated. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thicknesses and cavity size are normal. overall left ventricular systolic function is probably mildly depressed (lvef= 45 %). a regional wall motion abnormality cannot be excluded (poor images of the mid to distal lv). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. an eccentric, posteriorly directed jet of mild to moderate (+) mitral regurgitation is seen. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. . cxr: impression: ap chest reviewed in the absence of recent chest radiographs. et tube, right internal jugular line, and nasogastric tube are in standard placements respectively. in addition to a widespread infiltrative pulmonary abnormality that could be pulmonary edema, there is more focal consolidation and a strong suggestion of cavitation in the juxtahilar right lung, pneumonia until proved otherwise. since the heart is normal size and pleural effusion is small, if any, this could be noncardiac edema. no pneumothorax . ct chest/abd: impression: . 1. cystic lesion in the left adnexa, similar in appearance to , but larger. extending superiorly from the cystic structure, there is soft tissue prominence alone the course of the left gonadal vein. the cystic structure may represent the left ovary with cysts. alternatively, the soft tissue prominence more superiorly may be a prominent left ovary. additional differential considerations for the soft tissue prominence include fluid tracking along the pelvic wall/gonadal vein, hemorrhage or a fibrous lesion. the right ovary is normal size but also appears cystic, similar to . the ovaries could be evaluated by nonurgent/outpatient pelvic ultrasound. consider nonurgent/outpatient pelvic mri to evaluate left soft tissue prominence as it is probably too high to be evaluated by ultrasound. if pelvic mri is going to be performed, the ovaries could be evaluated at that time. 2. bilateral consolidations and nodular opacities compatible with multifocal pneumonia & ards, with aspiration being a consideration as well given the predominantly dependent distribution. 3. while no pulmonary mass is definitely identified, it could be obscured by the consolidation. small bilateral pleural effusions. 4. fat-containing ventral hernias. 5. extensive atherosclerosis, which has significantly increased since . . renal us: impression: 1. non-obstructive renal calculi within the upper pole of the right kidney. limited views of the left kidney. no evidence of hydronephrosis bilaterally. 2. limited doppler images show normal arterial and venous flow at the renal hilum. cxr: impression: 1. new right internal jugular hemodialysis catheter ends in the right atrium just beyond the atriocaval junction. 2. worsening mild pulmonary edema. 3. stable bilateral moderate pleural effusions. brief hospital course: this is a 67-year-old woman with a history of ckd stage iv-v, dm2, htn, anemia, and gout, presenting with hypoxemic respiratory failure multifocal pneumonia/ards, with cardiac enzyme leak c/w nstemi, intubated, then extubated. hospital course c/b worsening of her ckd requiring initiation of hemodialysis. # hypoxemic respiratory status/ards: due to infectious process given bilateral multifocal infiltrates seen on cxr, leukocytosis with bandemia, and history of productive cough. sputum unrevealing and all cultures negative. finished 10 day course of vancomycin, zosyn, levaquin with resolution of her fevers and leukocytosis. the patient was initially intubated and ventilated using ardsnet protocol. the ventilator was easily weaned and she was maintained on nasal cannula after extubation. after extubation, the patient continued to have pulmonary edema due to her worsening renal failure and anuria. the patient was started on hd and weaned off her o2. even after diuresis, the patient had a r sided effusion on cxr. this is likely fluid, but she should be re-imaged in 1 month to check for resolution. . # chronic kidney disease: the patient had stage 4 ckd before admission, with the plan to initiate dialysis in the near future. during the admission, the patient's kidney function continued to decline and she was anuric. due to her fluid overload, hd was started. she tolerated tunneled line placement and three consecutive session of hd and uf. the patient was started on sevelemar and nephrocaps. her medications were renally dosed. she will need to f/u with renal and continue tiw hd. . # nstemi: the patient had st depressions and increased troponins. she was medically managed on aspirin, statin, and metoprolol. her ekg normalized and tte did not show wall motion abnormlaities. she will need cardiology f/u and possible stress. also, an acei should be started once the patient is established with hd. . # normocytic anemia: hgb just below baseline, no signs of acute bleeding. iron studies in past suggestive of anemia of chronic inflammation. no schistocytes reported on cbc; has elevated ldh but normal total bili argues against hemolysis. the patient will need epo supplementation. . # hyperlipidemia: a statin was continued. . # dm: glargine was increased to 15 for hyperglycemia. patient did not need sliding scale coverage. . transitional issues: 1. cystic lesion in the left adnexa, similar in appearance to , but larger. extending superiorly from the cystic structure, there is soft tissue prominence alone the course of the left gonadal vein. the cystic structure may represent the left ovary with cysts. alternatively, the soft tissue prominence more superiorly may be a prominent left ovary. additional differential considerations for the soft tissue prominence include fluid tracking along the pelvic wall/gonadal vein, hemorrhage or a fibrous lesion. the right ovary is normal size but also appears cystic, similar to . the ovaries could be evaluated by nonurgent/outpatient pelvic ultrasound. consider nonurgent/outpatient pelvic mri to evaluate left soft tissue prominence as it is probably too high to be evaluated by ultrasound. if pelvic mri is going to be performed, the ovaries could be evaluated at that time. . 2. we recommend chest xray in weeks (by ) to ensure resolution of pleural effusion . 3. cardiology outpatient follow-up for nstemi. . 4. patient should start ace-i once creatinine is stable medications on admission: allopurinol 200 mg daily atenolol 25 mg twice daily aranesp 60 mg q. 2 weeks lasix 80 mg daily lantus 12 units at night nifedipine extended release 90 mg daily renagel 800 mg t.i.d. with meals aspirin 325 mg daily iron 325 mg daily guanfacine 1 mg nightly for hypertension lidoderm patch zocor 20 mg nightly multivitamin discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). tablet, chewable(s) 2. sevelamer carbonate 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 3. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 4. insulin glargine 100 unit/ml solution sig: fifteen (15) units subcutaneous at bedtime. 5. atorvastatin 40 mg tablet sig: one (1) tablet po hs (at bedtime). 6. darbepoetin alfa in polysorbat 60 mcg/ml solution sig: sixty (60) mcg injection every other week. 7. multivitamin tablet sig: one (1) tablet po daily (daily). 8. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. tablet(s) 9. allopurinol 100 mg tablet sig: two (2) tablet po once a day. tablet(s) 10. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day): please continue until patient is out of bed. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: pneumonia end-stage renal disease, on dialysis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , it was a pleasure taking care of you during this admission. you were admitted to the hospital for difficulty breathing due to pneumonia, which was made worse because of your renal failure. during the first portion of your stay, you required a breathing tube to support you, but you were able to gradually come off of the breathing support. unfortunately, you experienced a further worsening of your renal failure, and had to be started on dialysis, which your body has been responding to well. several changes have been made to your medication regimen. stop taking lasix (furosemide) stop taking nifedipine stop taking guanfacine stop taking zocor start taking metoprolol 25 mg tablet -- one half tab 2 times a day start taking atorvastatin 40 mg tablet -- one tab at bedtime change aspirin 325mg daily to 81mg daily . it is very important that you see cardiology as an ouptatient as you had a small heart attack while you were here. you should also ask your nephrologist or primary care doctor about starting a medication called an ace inhibitor for your blood pressure and your heart. followup instructions: department: pat-preadmission testing when: tuesday at 7:45 am with: pat-preadmission testing building: cc campus: west best parking: garage department: west clinic when: wednesday at 8:30 am with: , rn building: de building ( complex) campus: west best parking: garage department: west clinic when: wednesday at 8:30 am with: , md building: de building ( complex) campus: west best parking: garage 09:00a cardiology clinic: -cc7 sc clinical ctr, cc7 cardiology (sb) procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis diagnoses: hyperpotassemia anemia in chronic kidney disease end stage renal disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery acute kidney failure, unspecified unspecified septicemia hyposmolality and/or hyponatremia severe sepsis atrial fibrillation diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin hyperosmolality and/or hypernatremia diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to