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: tetanus,diphtheria toxoid attending: chief complaint: lightheadedness, itching major surgical or invasive procedure: none. history of present illness: 69 y/o female w/ htn, dm2, esrd (on peritoneal dialysis) who presents to the eu w/complaints of itching, lightheadedness. found to be hypotensive with sbp's to the 70's. the patient was recently discharged for peritonitis. treated initially with cefotaxime and vanco intraperitoneally. culture grew coag (-) staph and micrococcus. continued tx. w/ vanc and had quick resolution of presenting symptoms including abd pain, n/v/d. felt well on discharge. on wednesday she had her vancomycin dose. this morning she woke up and felt itchy and lightheaded upon standing. no loc, sob or chest pain. denies abdominal pain. + vomiting on the way to the eu x 1. denies f/c. reports taking care of her own pd at home, but has not weighed herself recently. she feels subjectively that she took off too much fluid. she denies recently cloudy or bloody effluent. now presents to the eu w/ hypotension. sbp in the 70's, tachy (108), hypothermic (t=96.3). given 25 mg benadryl iv, vanco 1gm iv, ceftriaxone 1gm iv, and dex 4mg iv. left femoral line placed. admitted to for further management of hypotension, r/o sepsis. past medical history: pmh: 1. end-stage renal disease (on hemodialysis from to which was changed to peritoneal dialysis in secondary to poor access). she has a history of prior peritonitis approximately four to five times; the last episode in . 2. hypertension. 3. type 2 diabetes diagnosed in . 4. status post parathyroidectomy. 5. depression 6. hyperlipidemia 7. gerd 8. stress test : no anginal symptoms or ischemic ekg changes social history: no etohno ivda family history: dad - died 72yo from heart disease mom - died at 74yo, had dm gm - dm physical exam: pe: vitals- hr 115, bp 94/57 (72) , t 98.7, 99% on ra gen- chronically ill appearing, uncomfortable itching, nad heent- eomi/perrla, muddy sclera, no scleral icterus. mucosa dry. neck- no jvd. no neck masses or lad cv- tachy, reg rythm. nl s1/s2. no m/r/g pulm- lungs cta bilat. no r/r/w abd- obsese, soft, mild tenderness at llq at pd site. pd site without erythema or purulent drainage. well-healed scar in rlq (from old pd cath). active bowel sounds. no hsm. ext- no c/c/e. 2+ pulses b. motor strength throughout. +mild asterixis bilaterally skin- diffusely dry, with copius linear excoriations on trunk/back/extremities. no ulcerations, no bleeding - neuro- anxious, tearful affect at times, but alert and oriented x 3. communication appropriate. cn ii-xii intact. sensation and motor function grossly intact. gait not assessed. rectal- guaiac + (per er note) pertinent results: na 141 cl 98 bun 38 glu 152 k 3.0 hco3 25 cr 10.3 anion gap= 18 ca: 10.8 mg: 1.7 p: 6.8 wbc 12.9 hct 33 plt 342 , mcv 90 pt: 13.2 ptt: 26.5 inr: 1.2 lactate 4.2-->3.2 cortisol- pending tsh - pending ast 17 alt 7 a/p 91 t bili 0.4 amylase 86 lipase 42, albumin 2.8 studies: blood cx- pending cxr: left mid zone opacity could represent atelectasis, but a pneumonia cannot be excluded brief hospital course: a/p: 69 y/o female w/ htn, dmii, esrd req peritoneal dialysis who p/w hypotension, elevated wbc and lactate=4.2 transferred initially to the for hypotension/sepsis mgmt. 1. hypotension- hypotension leading to hypoperfusion w/ elevated lactate on admission. possible etiologies inclue hypovolemic (dehydration, pd excess volume loss) vs distributive (sepsis, adrenal insufficiency). h/o recurrent peritonitis, most recently 1 week ago. it was suspected that she might have an infection and she was started on vancomycin, ceftazidime, metronidazole and ceftriaxone. as she responded to fluid resuscitation, she was stable and transferred to the service. she was tested for adrenal insufficiency with a cosyntropin stimulation test which was negative. at this time, all her antibiotics were discontinued with a negative peritoneal cytology for infection with the exception of ceftazidime which she received intraperitoneally with her peritoneal dialysis. her blood cultures remained pending and she never spiked a temperature. it was believed that her initial hypotension was a response to having dialyzed off too much fluid at home which the patient states occurred. her blood pressure returned to the 140-160s and she was restarted on her outpatient medication of norvasc 10 mg qd. 2. id- the patient was recieving vanco for coag neg. staph on recent culture prior to re-admission. rec'd last dose on , and one dose in eu. she did not receive subsequent doses of vancomycin as her random level was elevated. the metronidazole 500mg q8 and ceftriaxone 1g q24 were discontinued and she remained on the ceftazidime until the day of discharge at which time it was discontinued as peritonitis was unlikely. her elevated lactate was believed to be secondary to her chronic renal failure. 3. itching- likely secondary to uremia. also has mild asterixis on physical exam. bun not markedly elevated (38), but cr 10.3. tbili normal; liver enzymes normal. no new meds to suggest potential drug rxn. she received benadryl 25mg q4 prn and sarna lotion qid prn and her itching resolved. 4. esrd- requires chronic peritoneal dialysis. performs pd herself at home. she continued with pd and was followed closely by renal. she was discharged on a different pd regimen with 2 of 2.5% dextrose and 1 of 1.5% dextrose to decrease the likelihood of removing too much fluid as was believed to be the cause of her presenting symptoms. 5. hypercalcemia- h/o elevated pth, likely secondary hyperparathyroidism from esrd. s/p partial parathyroidectomy. calcium elevated on admission. was previously on calcitonin, but not currently on her med list. she was instructed to continue the use of her hectrol which she takes at home. 6. anemia: baseline hct 28-30, currently 33. likely anemia secondary to esrd/chronic dx. recieves epo qmonday. guaiac + on admission, so upper vs. lower gi bleed also a possibility (no prior history). no reported h/o hematuria, hematemesis. she was then guaic negative and her hematrocit stablized. 7. dmii: previously required insulin, but reportedly has been off hypoglycemic agents since she lost 40 pounds w/ dialysis, per patient. on chart review, bg's have ranged in 100-200 range on previous admissions. she continued on a sliding scale insulin regimen. 8. on the second to last day before discharge, the patient developed diarrhea, no melena. she was given imodim and stool cultures, ova and parasites, and a c.difficile toxin were sent and are still pending. she will be notified if they are positive and continued on metronidazole to treat the infection. 12. communication w/ daughters: health care proxy- ,; phone # medications on admission: acetaminophen 325 mg, epoetin alfa 4,000 unit/ml, amlodipine 5 mg po qd, atorvastatin 40 mg po qd, sertraline hcl 50 mg po qd, pantoprazole 40 mg po q24h, sevelamer hcl 800 mg po tid ,vancomycin 1gm qweek pd x 3 weeks (from ) discharge medications: 1. atorvastatin calcium 40 mg tablet sig: one (1) tablet po qd (once a day). 2. sertraline hcl 50 mg tablet sig: one (1) tablet po qd (once a day). 3. epoetin alfa 10,000 unit/ml solution sig: one (1) injection 2x/week (mo,fr). disp:*1 1* refills:*2* 4. amlodipine besylate 5 mg tablet sig: two (2) tablet po qd (once a day). 5. sevelamer hcl 400 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: hypotension secondary to hypovolemia, end-stage renal disease on peritoneal dialysis discharge condition: fair. discharge instructions: continue peritoneal dialysis with 2 x 2.5% dextrose and 1 1.5% dextrose. please resume hectrol as you were before admission. you may take imodium if you continue to have diarrhea. followup instructions: please schedule an appointment with dr. , your nephrologist, in 1 month by calling 1-. please follow up with your primary physician weeks. provider: , voice and speech clinic where: pa building ( complex) voice speech & swallowing phone: date/time: 10:00 provider: , voice and speech clinic where: pa building ( complex) voice speech & swallowing phone: date/time: 10:00 procedure: peritoneal dialysis diagnoses: acidosis anemia in chronic kidney disease esophageal reflux diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia 

Answer: The patient is high likely exposed to