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: patient recorded as having no known allergies to drugs attending: chief complaint: unresponsiveness major surgical or invasive procedure: -temporary hd catheter placement and removal -hemodialysis *1 history of present illness: mr. is a 53 year old man with recent thr, htn, and diabetes on insulin who was found unresponsive sitting in a chair in his halfway house by his superintendent. he was reportedly sitting in a chair and was completely unresponsive. when ems arrived they found him unresponsive and non-verbal but with stable vital signs. he was given 0.4mg naloxone with no response. on route to the hospital he vomited a small amount. in the ed he was unresponsive but was moving his head around. his vital signs in the ed were t 98.8 hr 88, bp 124/66 rr 11 saturating at 97% on room air. ct head and spine were unremarkable. chest xray was also unremarkable. urine tox was positive for opiates. serum tox was negative. ua was negative for leukocytes and nitrites; wbc , large blood, rbc negative. patient had a leukocytosis with a wbc of 22. he was given 1 dose of vancomycin. his creatinine was elevated to 8.9 (baseline 0.8) and he had a potassium of 6.3 with peaked t waves. patient was given bicarb, insulin, and glucose and his potassium decreased to 5.1. no kayexelate was given due to patient's altered mental status. nephrology was consulted and recommended rehydration at 125cc/hr, potassium checks, renal us with doppler, and pth level. patient was given a total of 2l ns in the ed and then admitted to the intensive care unit where he was moving all four extremities but only rarely followed commands and was not reliably responsive to voice. past medical history: -hypertension -diabetes mellitus on insulin (a1c 6.3% on ) -hypertensive cardiomyopathy (last echo 35% ef with septal/inferior hypokinesis) -hepatitis c virus (never treated) -h/o cholecystitis -s/p hip replacement -gambling addiction -h/o etoh and cocaine abuse, sober since social history: patient has lived at the house where he has lived for the past three years. he reports that he stopped drinking and cocaine several years ago. he receives health care through health care for the homeless. patient has long standing history of smoking and continues to smoker. family history: non-contributory physical exam: admission exam: t 98.8 hr 88, bp 124/66 rr 11 saturating at 97% general: easily awaked and startled, non-verbal heent: nc/at, will not allow me to open eyes well but pupils appear 2mm and symmetric neck: supple, no jvd or carotid bruits appreciated pulmonary: lungs cta bilaterally but difficult to assess with rhonchorous upper airway sounds cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: no c/c/e bilaterally, 2+ radial, dp and pt pulses b/l. skin: no rashes or lesions noted, no fistula, no medical patches neurologic: limited exam -mental status: drowsy but arousable with follow a few commands: smiled symmetrically once, squeezed right hand but then would not follow further commands, when arm raised above head patient does not allow arm to fall on his face, when turned patient grabbed out to stabalize himself -cranial nerves: unassessable but symmetric smile -motor: normal bulk, strength and tone throughout. not moving extremeties -dtrs:1+ biceps, brachioradialis, 2+ patellar and 1+ ankle jerks bilaterally. plantar response was flexor bilaterally. +myoclonus pertinent results: =================== laboratory results =================== on admission: wbc-22.1* rbc-3.95* hgb-13.1* hct-39.0* mcv-99* rdw-13.6 plt ct-191 ---neuts-77.3* lymphs-16.1* monos-6.0 eos-0.3 baso-0.2 pt-13.8* ptt-23.4 inr(pt)-1.2* fibrino-353 urean-51* creat-9.0* alt-54* ast-81* ld(ldh)-506* alkphos-148* totbili-0.5 albumin-4.2 calcium-8.7 phos-7.9* mg-1.9 osmolal-317* on discharge: wbc-12.4* rbc-3.12* hgb-10.3* hct-32.6* mcv-99* rdw-13.2 plt ct-220 glucose-239* urean-22* creat-1.2 na-137 k-4.1 cl-101 hco3-27 alt-35 ast-28 ck(cpk)-614* alkphos-96 totbili-0.8 calcium-9.1 phos-2.9 mg-1.6 other important labs: ck trend 04:20pm ck(cpk)-5015* 11:20pm ck(cpk)-6561* 04:28am ck(cpk)-6445* 08:34pm ck(cpk)-4367* 06:03am ck(cpk)-3207* 05:07pm ck(cpk)-* 11:06am ck(cpk)-614* cardiac enzymes: : ctropnt-0.05* : ctropnt-0.07* serum tox:asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg urine studies: -------------- tox screen : bnzodzp-neg barbitr-neg opiates-pos cocaine-neg amphetm-neg mthdone-neg osmolal-521 color-amber appear-clear sp -1.026 blood-lg nitrite-neg protein-75 glucose-1000 ketone-neg bilirub-sm urobiln-neg ph-5.0 leuks-neg urean-398 creat-327 na-33 castgr-0-2 casthy-* rbc-0-2 wbc-* bacteri-mod yeast-none epi-0 transe-0-2 color-yellow appear-clear sp -1.011 blood-mod nitrite-neg protein-tr glucose-300 ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-neg rbc-31* wbc-2 bacteri-none yeast-none epi-0 casthy-1* ============= microbiology ============= blood cultures *3: no growth nasal mrsa screen: positive for mrsa urine culture*2:ngtd =============== other studies =============== ekg (): normal sinus rhythm, rate 98, with probable left atrial abnormality. delayed precordial r wave progression, possibly a normal variant, possibly anterior myocardial infarction of indeterminate age. non-specific inferolateral repolarization changes. ct head and c-spine (): 1. no acute fracture or misalignment of the cervical spine. multi-level posterior osteophytes which increases risk of spinal cord injury. mri is more sensitive for evaluation of spinal cord or ligamentous injury. 2. mild paraseptal likely bullous changes of bilateral lung apices. miniscule left apical pneumothorax can not excluded. follow-up suggested. 3. 1.6 cm right thyroid nodule. ultrasound on a non-emergent basis is suggested. cxr (): severely limited study due to obscuration of the lung apices by the head, otherwise no acute intrathoracic abnormality. abd u/s (): 1. stones and debris in the gallbladder. 2. no evidence of stones or hydronephrosis bilaterally. ct head w/o contrast (): 1. no acute intracranial hemorrhage. no significant change since the prior study. 2. no soft tissue stranding or any significant abnormalities seen within the subcutaneous tissues to explain etiology of drainage. left foot radiograph (): reason for exam: pain in the lateral aspect. there is a question of a fracture in the distal phalanx of the fifth digit. there is no evidence of dislocation, sclerotic lesions or soft tissue calcifications. there is edema in the soft tissues adjacent to the base of the fifth metatarsal. the fifth metatarsal is normal. there is a small enthesophyte at the insertion of the achilles tendon. chest radiograph () impression: improving bibasilar opacities with residual right infrahilar opacity likely due to atelectasis. no definite new source of infection. brief hospital course: mr. is a 53 year old gentleman with past medical history notable for htn, diabetes mellitus, and recent total hip replacement found unresponsive in his halfway house with rhabdomyolysis and acute kidney injury. 1. altered mental status: the patient presented with altered mental status of unclear etiology. he was moving all four extremities and hemodynamically stable and afebrile but minimally responsive to commands. particularly given his leukocytosis occult infection was a major concern but he remained afebrile, chest radiograph and urinalysis were not consistent with infection, and patient never had meningismus or clinical signs of acute bacterial meningitis. he received one dose of vancomycin at presentation for unclear reasons. blood cultures remained sterile. toxicology screen was only notable for opiates, which the patient had been prescribed as he recovered from his hip surgery and he had not responded to naloxone on ems arrival. there was no osmolar gap and the patient's head ct was essentially benign. given acute kidney injury uremia was thought to be a possible cause of encephalopathy and he was dialyzed *1 with rapid improvement of his mental status and increased responsiveness. the patient dramatically improved over the ensuing day and returned to baseline. he remained with poor memory of the events leading to his presentation but could recall other events and converse in a reasonable manner. unfortunately, due to the patient's habitus an initial attempt at an lp was unsuccessful and given his dramatic resolution with dialysis, decreasing leukocytosis, lack of fever, and ability to deny headache it was not considered necessary to reattempt. likely cause of somnolence/delirium at presentation is thought to be uremia though the initial insult that caused patient to be immobile and develop rhabdomyolysis leading to and uremia is unclear. at the time of discharge patient's mental status was at baseline. * oliguric acute kidney injury: on presentation the patient had a cr of 9 up from a baseline reported at 0.8. given urinalysis findings of large blood on dipstick without cells and grossly elevated ck most likely etiology was thought to be rhabdomyolysis and myoglobinuria causing acute kidney injury. obstruction and postrenal insult was essentially ruled out by normal ultrasound. nephrology was involved in course from the ed where they recommended fluids. the patient eventually put out very poor urine and given this, his metabolic abnormalities (including hyperkalemia and hyperphosphatemia), and his continued alteration of mental status he had a temporary dialysis catheter placed and received hd *1 with rapid resolution of his metabolic abnormalities and mental status. shortly after that he began a brisk diuresis and required no further hd sessions or acute management of electrolyte abnormalities. therefore, his hd catheter was removed. his cr was down to 1.2 at the time of discharge. * rhabdomyolysis at presentation the patient had clear rhabdomyolysis and resulting kidney injury with elevated ck's and urine dipstick with large blood but few rbc's on microscopy suggestive of myoglobinuria. it was suspected the patient's rhabdomyolysis was secondary to prolonged immobilization in his chair and over his hospitalization he developed skin and tissue breakdown also suggestive of a prolonged immobilization. the reason for this prolonged immobilization is unclear. the patient's ck fell with fluids and improvement in his renal function and the last time it was checked it was slightly more than 600. * left foot vesicle the patient had hyperkeratotic, cracked skin on his feet and was noted to develop a large vesicle on his left lateral sole. this was evaluated by podiatry who lanced it yielding serous material without frank purulence. they did not recommend antibiotics and these were not started. the patient was discharged with outpatient podiatry follow-up. * skin breakdown the patient was noted to have skin breakdown with what looked like a friction ulcer in his gluteal cleft. this was evaluated by wound care who also noted areas of deep tissue injury and other ulcers on his lower body. these were thought consistent with a prolonged immobilization with some friction injury from sliding or unintentional movements while unconscious in a chair. these were all evaluated and showed no signs of acute infection. wound care was implemented and the patient will have vna to help continue this care as an outpatient. *hypertension the patient became hypertensive on his second hospital day and thus was restarted on his metoprolol and nifedipine at home doses. his lisinopril was held given he had acute kidney injury. as his cr was close to baseline (down to 1.2) and he was becoming more hypertensive again (sbp's in the 140's) his lisinopril was restarted at half dose (20 mg daily) on the day of discharge. he will follow up with his pcp to discuss when to increase this back to his standard home dose. *diabetes the patient was continued on his home insulin glargine dose as well as insulin sliding scale. his ac doses and metformin were held in the context of hospitalization and he was given sliding scale with reasonable control of his blood sugars. his ac humalog and metformin were restarted at discharge. given the patient evidenced minimal understanding of his diabetes or its management he received diabetes education in house and was set up to receive more as an outpatient. as he ran quite hyperglycemic in general it was considered safe to discharge him on his home scheduled insulin regimen with greater understanding required to start sliding scale at home. * slightly elevated lft's: on day of admission patient had elevated lfts with an alt 54, ast 81, alk phos 148, tbili 0.5. patient had gall stone on abdominal us. with improvement of mental status patient had benign abdominal exam with no nausea or vomiting. lfts were followed and normalized. most likely etiology of * diabetes patient has insulin dependent diabetes. he was started on an insulin sliding scale here in the hospital. an outpatient podiatry appointment was set up for him. *hypertensive cardiomyopathy the patient remained without signs of volume overload or clinical heart failure. he was continued on his beta blocker and acei was restarted prior to discharge. the patient was kept on subcutaneous heparin for dvt prophylaxis. there was no indication for gi prophylaxis so this was not started. he was full code. he tolerated a full diet prior to discharge. medications on admission: toprol xl 200mg qd nifedipine 120mg qd lisinopril 40mg qd aspirin 81mg qd naproxen 500mg lantus 58 units/day metformin 500mg humulog 6u ac nitrostat prn tramadol 50mg 1-2 tabs q6h prn pain citalopram 20mg qd discharge medications: 1. metoprolol succinate 200 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 2. nifedipine 60 mg tablet extended rel 24 hr sig: two (2) tablet extended rel 24 hr po once a day. 3. lisinopril 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 4. aspirin 81 mg tablet sig: one (1) tablet po once a day. 5. lantus 100 unit/ml solution sig: fifty eight (58) units subcutaneous once a day. 6. metformin 500 mg tablet sig: one (1) tablet po twice a day. 7. humalog 100 unit/ml solution sig: five (5) units subcutaneous tid w/ meals. 8. citalopram 20 mg tablet sig: one (1) tablet po once a day. 9. acetaminophen 325 mg tablet sig: two (2) tablet po four times a day as needed for fever or pain. discharge disposition: home with service facility: homecare discharge diagnosis: primary diagnoses: altered mental status rhabdomyolysis oliguric acute kidney injury secondary diagnosis hypertension diabetes mellitus discharge condition: stable, tolerating po discharge instructions: you came into the hospital because you were found unresponsive in your home. no cardiac, neurological, infectious, or toxic reason was found for your unresponsiveness. when you came into the hospital you were found to have damaged your kidneys and you were started on intravenous fluids. you also had one session of hemodialysis to remove some of the toxins from your blood that had accumulated given your poor kidney function. during your stay in the hospital your kidney function improved dramatically and returned to near baseline on your discharge from the hospital. to keep your kidneys healthy, we recommend that you continue to drink over 1l of water each day. while your kidneys recover we held and then restarted at a lower dose your lisinopril. otherwise please continue to take your medications as previously prescribed. should you develop any concerning symptoms, including shortness of breath, chest pain, severe abdominal pain, nausea/vomiting, fever, blurry vision, headache, you should seek immediate medical attention. followup instructions: podiatrist dr. tueday, , 1:45pm , primary care dr. :30am clinic procedure: hemodialysis venous catheterization for renal dialysis diagnoses: acidosis anemia, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified long-term (current) use of insulin other encephalopathy hematuria, unspecified delirium due to conditions classified elsewhere rhabdomyolysis long-term (current) use of aspirin ulcer of thigh unspecified hypertensive heart disease without heart failure cardiomyopathy in other diseases classified elsewhere keratoderma, acquired 

Answer: The patient is high likely exposed to