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: morphine attending: chief complaint: hypotension at hd, chronic diarrhea major surgical or invasive procedure: picc line placement hemodiaylsis peg tube placement history of present illness: 60 yo m w/ hx of cad, pvd, esrd on hd who presents with hypotension at hd and chronic diarrhea of etiology. patient receives most of his care at in , ri and has multiple physicians. patient has been chronically ill, and has had multiple hospital stays at rw and rehab centers in ri, most recently for pelvis and femur fractures, complicated by severe pna. patient reports history of chronic diarrhea for > 1 year and enormous weight loss (60 lbs in 1 year). started gradually, had approximately bms daily (green, liquidy, non-bloody). no associated abdominal pain. has diarrhea with and without food, but is exacerbated with meals. has tried restricting lactose w/o effect. family reports no assessment for celiac sprue. has been followed by gi physician . , and has reportedly extensive work-up including endoscopies, and colonoscopies with biopsies. per family, no evidence of colonic masses or gi tract cancers noted. pt denies dysphagia, but has lost appetite recently. reports negative c. difficile and vre testing in the past few weeks. has not tried pancreatic enzymes. today, patient was at hd when rn there noticed patient looked ill, malnourished, and dehydrated. sbps dropped to 70 systolic during hd. patient was sent to for evaluation. patient admits to chronic cough with worsening sputum production. denied dysuria. in ed vs were 97.8 68 78/41 28 100. noted to have sbp to 78 in ed with cool peripheries, received 300 cc ns with improved of sbps to 110. received vancomycin 1 gram iv x1 and zosyn 4.75 grams iv x1, magnesium 2 mg iv x1, and perocet 1 tab x1. past medical history: esrd on hd since (unknown baseline cr) cad s/p cardiac stenting x 2 (, ) due to mi copd (on 3 l home o2) dm2 (no longer requiring insulin weight loss, controlled on oral only) pvd s/p stention ?hl iron deficiency anemia ?depression . psh: l femur/pelvic fx in (from a fall) c/b severe pna) l hip fx s/p amputation of all 5 left toes s/p back surgeries x 6 (due to injury) s/p multiple l shoulder surgeries s/p appendectomy social history: lives in ri with wife and daughter, both of whom are very involved in his care. is retired, used to work as an attendant in a mental health facility. 1200ppy smoking history, qhit 2 months ago. denies etoh use or ivdu. family history: fh of dm and cva in mother. denies fh of cancer, ibd, or celiac sprue physical exam: physical exam on admission: vs: 97.3 99/62 66 20 100% 3 l nc ga: cachectic m sitting in bed, aox3, nad heent: perrla. mm dry. no lad. elevated jvd. neck supple. cards: heart sounds distant. rrr s1/s2 heard. no murmurs/gallops/rubs. pulm: diffuse crackles throughout all lung fields. abd: soft, nt, +bs. no g/rt. neg hsm. neg sign. mild tenderness over suprapubic region. extremities: no edema. poor dps, pts, limbs cold. +amputated toes on left foot. skin: scattered echymoses and ?ruptured vesicles on extensor surfaces of elbows and knees covered in crust. neuro/psych: interacting appropriately. pertinent results: admission labs: 09:15pm glucose-83 urea n-14 creat-2.0* sodium-139 potassium-4.7 chloride-101 total co2-31 anion gap-12 09:15pm alt(sgpt)-22 ast(sgot)-73* ck(cpk)-59 alk phos-97 tot bili-0.9 09:15pm lipase-16 09:15pm ctropnt-0.15* 09:15pm ck-mb-notdone 09:15pm tot prot-5.2* albumin-2.5* globulin-2.7 calcium-7.8* phosphate-2.8 magnesium-1.4* 09:15pm iga-515* 09:15pm pt-20.7* ptt-34.9 inr(pt)-1.9* 10:20am %hba1c-5.1 10:20am triglycer-110 hdl chol-7 chol/hdl-7.9 ldl(calc)-26 09:15pm glucose-83 urea n-14 creat-2.0* sodium-139 potassium-4.7 chloride-101 total co2-31 anion gap-12 . ct abd/pel - 1. findings suggestive of pulmonary edema at the visualized lung bases. 2. right basilar bronchovascular opacity (15 mm) which could be attributed to atelectasis or a lung nodule, although infection cannot be excluded. follow-up chest ct within three months is recommended to evaluate further as a true lung nodule is not excluded. 3. pancreatic atrophy and calcifications consistent with chronic pancreatitis. 4. moderate gallbladder distention which can be seen in a fasting state. however, if there is clinical concern for a source of acute infection, an ultrasound could be considered as well as correlation with pertinent laboratory data. 5. extensive vascular calcifications including stents along the left common and external iliac arteries whose patency cannot be assessed on this study. 6. mild dilatation of the proximal small bowel, borderline in caliber with lack of distal passage of contrast. however, the appearance is felt more likely to reflect a mild ileus than obstruction, noting no sharp transition. however, if there is continuing clinical concern for obstruction, follow-up radiographs could be performed. 7. considerable stool throughout the colon, which is mildly distended, also suggestive of slow motility. the lower sigmoid and rectal walls show mild thickening, which is seen in a more patchy fashion elsewhere as well. this appearance could be seen with anasarca in the setting of renal disease, although mild colitis is difficult to exclude. the patient could be considered at high risk for ischemic colitis given the history of diarrhea and severe vascular disease, although usually associated ct findings would be least prominent in the rectum. 8. small amount of low-density ascites, which is nonspecific with splenomegaly. . cxr 1. findings are most consistent with moderate pulmonary edema, with moderate cardiomegaly. however, underlying infection is not excluded, and evaluation for such may be performed after appropriate diuresis. 2. dilated loops of bowel are incompletely assessed. recommend dedicated abdominal radiographs for more complete assessment. . ekg sinus rhythm. diffuse t wave flattening makes the q-t interval difficult to interpret. no previous tracing available for comparison. . cta chest : findings: there is no evidence of pulmonary embolism till the level of subsegmental pulmonary arteries bilaterally. the pulmonary arteries are normal in diameter as well as the aorta. extensive coronary calcifications and coronary stents are noted with a coronary stent being seen in lad and right coronary artery at least. heart size is enlarged. there is no pericardial effusion. small left pleural effusion is noted with no evidence of right pleural effusion. the imaged portion of the upper abdomen demonstrates the ng tube tip being in the stomach and otherwise is unremarkable within the limitations of this study that was not designed for evaluation of intra-abdominal pathology. extensive mediastinal lymphadenopathy involves the entire mediastinum and ranges up to 7.5 mm in the right upper paratracheal area, 12 mm in right lower paratracheal area, 1 cm in the prevascular area, 8.5 mm in aortopulmonic window, 2 cm in subcarinal and paraesophageal area with bilateral hilar lymph nodes ranging up to 1.5 cm. this lymphadenopathy might be reactive to the extensive parenchymal abnormality demonstrated throughout the lungs and mostly consisting of two types of findings: bilateral peribronchovascular opacities as well as confluent areas of ground-glass in the upper lungs, 3:14, with focal areas of ground-glass mostly located in the posterior segment of right upper lobe, 3:14, 15, 16, 18. the lower lobes are also involved as well as posterior segment of right upper lung, 3:24, 31, 37. the second abnormality is bibasal opacities, right significantly more than left. on the right, there are at least three consolidations in the right lower lobe with the lowest one mostly posteriorly located containing eccentric lucency, 3:68, approximately 12 mm in diameter that might represent a consolidation with a cavity. there are areas of air trapping, extensive and might be due to bilateral external bronchial wall thickening and secretions that are also seen in the main bronchi. though secretions in combination with patulous upper esophagus might be due to aspiration, although infectious origin as part of the extensive infectious process within the lungs cannot be excluded. the findings are unlikely to represent pulmonary edema. some of the focal opacities might potentially represent hemorrhage in the appropriate clinical setup. there are no bone lesions worrisome for malignancy. extensive degenerative changes are noted. no evidence of bone infection was demonstrated. echo conclusions: the left atrium is elongated. there is symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. cxr: the ng tube tip is in the stomach. cardiomediastinal silhouette is unchanged. there is no significant interval change in bilateral predominantly upper lobe parenchymal opacities as well as bibasal opacities involving the lung to a lesser extent compared to upper portion. the right picc line tip is in the right atrium and should be pulled back for approximately 4.5 cm to secure its position at low svc. small bilateral pleural effusion cannot be excluded. overall the appearance of the lung has improved compared to and 24, . brief hospital course: 60y/o man with multiple medical problems, numerous recent hospitalizations, esrd on hd, and chronic diarrhea and 60+ lb weight loss of unclear etiology who presents with hypotension at hd and diarrhea. . # diarrhea/weight loss. unclear etiology. has had numerous admissions for nausea/vomiting/diarrhea wouthout clear diagnosis. numerous negative c diff tests at osh, treated empirically for c diff in past without improvement. colonoscopy in showed cryptitis, crypt abscesses. possible causes include medication side effects, autoimmune, amyloidosis, pancreatic insuffiency, protein losing enteropathy, malignancy, infectious, bacterial overgrowth. given likely significant malabsorption, vitamin deficiency, and weight loss, amyloidosis and pancreatic insufficiency high on differential. ct abd showed signs of chronic pancreatitis and stool in colon suggestive of slowed motility. amyloidosis could explain patient's esrd. thought to possibly also have a component of gastroparesis as distended bowel loops and stool in bowels c/w slowed motility on ct, and patient vomiting what looked like "stool." medications possibly compounding problem. stopped , as diarrhea common side effect, as well as cholesterol agents. diarrhea was improved in-hospital, but also difficult to tell given poor po's (and patient soon made npo due to aspiration risk). infectious workup negative for c diff, e coli, salmonella, shigella, campylobacter, yersenia, vibrio, o+p. ttg-iga negative for celiac. unable to obtain stool collection for stool osmolality/lytes and fat content given cessation of diarrhea in house. spep and upep pending. intended to do colonoscopy and egd but patient decompensated from respiratory standpoint and forced to delay. #. nausea/vomiting/nutritional status. likely related to diarrhea. patient with very poor nutritional status, albumin of approx 2, and periodic vomiting. massive weight loss and cachexia, poor nutritional status. developed extremity edema likely low albumin, also with elevated pt/inr responsive to vitamin k suggestive of extreme malabsorption of fat absorbable vitamins. vitamin k level pending. also with elevated pth (despite normal corrected calcium) suggesting vit d deficiency. placed ng tube to improve nutritional status but was frequently held due to poor tolerance. have component of gastroparesis, given impaired intestinal mobility on ct and reports of "vomiting stool". patient had a peg tube placed on for ongoing tube feeds. . #. hypotension. likely due to overmedication with antihypertensives in the setting of volume depletion and hd. history of htn but has lost 60+lb and reports frequent symptoms of orthostatis, as well as freuqent low bp's at hd. decreased po intake, with gi losses. thought to be unlikely sepsis given normal wbc count on admission, lack of fever, and cool extremities. d/c'd norvasc and lasix, reduced lopressor from 25 to 12.5bid, held on hd days. bp improved. still with periodic hypotension to 90's systolic at hd, 0-2l removed at hd. . #. sob/copd/pulmonary edema/aspiration/hospital-acquired pneumonia. patient on 3l 02 at baseline. significant congestion on admission, thought to be c/w copd as well as pulmonary edema with resulting inability to maintain intravascular volume. then developed increasing dyspnea during hospital stay, spiked fever, leukocytosis. concern for pna, possible aspiration, either before npo or secretions. given poor reserve and poor nutritional status, decided to treat for hospital-acquired pneumonia. patient deteriorated from a respiratory standpoint with increasing 02 requirement and rr in 40s, unable to clear secretions weakness. transferred to micu on . initially covered pna broadly with vancomycin, cefepime, flagyl, and azithromycin, then scaled back to vancomycin and cefepime. vanc/cefepime continued to complete 8 day course. flagyl continued for 14 days for aspiration pneumonia given cavitary consolidation on chest ct. . #. uti. patient had dysuria, increased urinary frequency, and suprapubic tenderness on admission. found to have uti on admission with 750 wbc. initially treated with cipro and was covered with antibiotics for hospital acquired pneumonia. . #. delirium. patient with waxing and mental status, inattention, possible visual hallucinations. much of this is after hd session where he can be minimally responsive. other contributory factors including infection (uti, pna), medications, poor nutrition, and difficulty clearing secretions. his mental status improved with reduction of contributory medications (d/c'd percocet and oxycontin, quetiapine, and doxepin). . #. elevated inr/pt. thought to be vitamin k deficiency due to poor absorption of fat soluble vitamins as well as poor po's. inr and pt trended downwards with iv vitamin k. vitamin k level normal. patient had a peg tube placed on for ongoing tube feeds . # esrd on hd mwf. has been on dialysis since , reports being told esrd was dm. pt continued with hd inhouse. his spep was negative for amyloidosis. . #. sacral ulcer. unstageable per wound care team. likely stage ii or iii. position changes q2hour, frequent dressing changes, pain control with oxycodone. . #. anemia. normocytic, stable. known fe deficiency anemia on iron supplements. have acd. fe studies repeatedly ordered ?pending. likely with low epo, good candidate for procrit. could also have combination of fe deficiency anemia (microcytic) and folate of b12 deficiency (macrocytic), giving a normocytic picture, as patient known to have fe deficiency in past, and given diarrhea and poor nutritional state and possible malabsorption, may have depletion in stores in either of these. . #. dm2. hgba1c 5.1 on admission, suggesting hypoglycemic episodes in recent past. likely poor po's and weight loss. stopped , which is also known to cause diarrhea, placed on humalog sliding scale. sugars well controlled. . #. cad/pvd. pt was continued on asa and plavix. . #. ?hl. on tricor and welchol at home but lipid levels returned with hdl 7, ldl 26 total chol 55. his tricor and welchol were also held due to due to risk of gi upset. . #. psych. given delirium, pt was continued on sertraline 100 daily but quetiapine and doxepin were discontinued. . #. coping. family frustrated with patient's course and difficulties with care in ri, having difficulty coping with severity of patient's illness, patient at times feeling like he wants to go home and die. family meeting from resulted in wishes to continue hd, feed through peg tube, and full code. . #. chronic back pain: given his mental status, he was discontinued from his oxycontin 40 q12h and was treated with oxycodone prn, tylenol, and lidocaine patch. medications on admission: percocet 10/325 mg po q8h:prn pain oxycontin 80 mg po bid alprazolam 0.025 mg tid seroquel 300 mg po qhs doxepin 200 mg po qhs tircor 145 mg po daily prantin 0.5 mg po tidac if glucose > 150 metoprolol 25 mg po bid welchol 625 mg po qid ferrous sulfate 650 mg po daily mvi norvasc 5 mg po daily sertraline 100 mg po daily plavix 75 mg po daily protonix 40 mg po daily lasix 40 mg po daily advair inh 150/50 2 puffs daily albuterol inh as needed asa 81 mg po daily renal caps 1 po daily dephenoxyl atropine 2.5 mg tid discharge medications: 1. lisinopril 10 mg tablet sig: one (1) tablet po at bedtime: for total dose of 15 mg daily. 2. lisinopril 5 mg tablet sig: one (1) tablet po at bedtime: for total dose of 15 mg daily. 3. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 10 days. 6. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for cough, congestion. 8. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for sob/wheezing. 9. fluticasone 110 mcg/actuation aerosol sig: one (1) puff inhalation (2 times a day). 10. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily): to the back. 11. ferrous sulfate 300 mg (60 mg iron)/5 ml liquid sig: one (1) po bid (2 times a day). 12. multivitamin tablet sig: one (1) tablet po daily (daily). 13. cholecalciferol (vitamin d3) 400 unit tablet sig: three (3) tablet po daily (daily). 14. ranitidine hcl 15 mg/ml syrup sig: one (1) po daily (daily). 15. oxycodone 5 mg/5 ml solution sig: five (5) ml po q6h (every 6 hours) as needed for pain: pls hold for sedation. 16. acetaminophen 160 mg/5 ml solution sig: six y (650) mg po q6h (every 6 hours) as needed for pain, fever. 17. insulin lispro 100 unit/ml solution sig: 0-12 units subcutaneous asdir (as directed): pls see insulin sliding scale. 18. heparin (porcine) 5,000 unit/ml solution sig: 5,000 units injection tid (3 times a day). 19. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush: picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. . 20. metoprolol succinate 25 mg tablet sustained release 24 hr sig: 1.5 tablet sustained release 24 hrs po twice a day: for total of 37.5 mg . please hold on hd days. discharge disposition: extended care facility: - discharge diagnosis: primary: hospital-acquired pneumonia . secondary: aspiration end stage renal disease coronary artery disease chronic obstructive pulmonary disease hypertension diabetes mellitus depression anxiety discharge condition: hr 80-100s, sbp 120s-160s, 92-100% on 3l nc. pt does get hypotensive during dialysis so please do not give him any metoprolol on hd days. pt is also typically minimally responsive after hd sessions--will not respond to verbal or tactile stimuli--for the remainder of the day. hr 80-100s, sbp 120s-160s, 92-100% on 3l nc. pt does get hypotensive during dialysis so please do not give him any metoprolol on hd days. pt is also typically minimally responsive after hd sessions--will not respond to verbal or tactile stimuli--for the remainder of the day. discharge instructions: you were admitted with diarrhea. unfortunately, due to your pneumonia and resulting respiratory distress, you were unable to have a colonoscopy. all the blood work and stool studies have not shown a cause for you diarrhea. you will need to follow up with outpatient gastroenterology. . for your pneumonia, you received a course of antibiotics and your respiratory status has improved. you were noted to have a cavitary lesion on the ct scan of your chest. you will need to complete a 14 day course of the antibiotic metronidazole and have a follow up ct scan in 1 month. your primary care doctor will help you arrange this study. . in addition, you were noted to have a nodule at the base of your right lung and need a follow-up ct scan 3 months from your scan. followup instructions: as we discussed you were seen to have a cavitary lesion in your lung and need a follow ct scan in 1 month () after your course of antibiotics. in addition, you were noted to have a nodule at the base of your right lung and need a follow-up ct scan 3 months from your scan. your primary care doctor will help you arrange this study. please see your pcp . within 2 weeks of discharge from rehab. please follow up with gastroenterology regarding your diarrhea. please make an appointment with gi in 2 weeks with attending dr. and fellow dr. . the clinic number is (. procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine enteral infusion of concentrated nutritional substances hemodialysis percutaneous [endoscopic] gastrostomy [peg] diagnoses: other iatrogenic hypotension anemia in chronic kidney disease end stage renal disease other and unspecified noninfectious gastroenteritis and colitis congestive heart failure, unspecified toxic encephalopathy acquired coagulation factor deficiency candidiasis of other urogenital sites chronic airway obstruction, not elsewhere classified peripheral vascular disease, unspecified percutaneous transluminal coronary angioplasty status dysthymic disorder other and unspecified hyperlipidemia acute respiratory failure pneumonitis due to inhalation of food or vomitus old myocardial infarction pressure ulcer, lower back other diseases of lung, not elsewhere classified other antihypertensive agents causing adverse effects in therapeutic use hypovolemia chronic pancreatitis backache, unspecified unspecified intestinal malabsorption gastroparesis unspecified vitamin d deficiency pressure ulcer, stage iii diabetes with renal manifestations, type ii or unspecified type, uncontrolled malnutrition of moderate degree 

Answer: The patient is high likely exposed to