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: no known allergies / adverse drug reactions attending: chief complaint: hypotension in cardiology clinic major surgical or invasive procedure: none history of present illness: ms. is a -year-old female admitted for hypotension, fevers, leukocytosis, and decreased po intake x1 week. pt is mildly disoriented and a poor historian at time of admission. the pt has a pmhx of cad s/p cabg x3, severe aortic stenosis s/p valvuloplasty with improved ischemic & valvular cardiomyopathy (ef 50% in ), who was sent in from cardiology clinic after a routine scheduled visit showed that the pt had a leukocytosis, hypotensive reportedly to sbp 80s (bp 80/40, t 100.7, wbc 16 in nursing home today), and fever to 101. for that she was sent to the ed. the pt reports that if she weren't referred to the ed that she wouldn't have wanted to go by herself. the pt at the time of clinic visit had no chief complaint except decreased po intake x1 week, and increased b/l leg edema, but reports that she is normally edematous. pt denies sob and cp, no abdominal pain, no change to bowel or bladder habbit, no headache, no neck pain, no change in vision, no new confusion. patient reportly endorsed minimal dry cough reported by cardiologist but denies to us. . in the more recent past, the patient was recently admitted with pancolitis in through . during that stay she was treated non-operatively, had two negative c.diff toxins, and that the pt improved with medical management, and was subsequently discharged from the hospital on . on the day of discharge she suffered a fall at home that resulted in a subdural hematoma and the pt was re-admitted here for neuro checks, during which time the pt's coumadin and asprin were stopped. she was discharged to a rehab facility and over the past week she has felt progressively weaker with less energy. notes from the rehab facility indicate that about a week ago her blood pressures started to drop. on her lisinopril and lasix were both held for hypotension and her bp has not recovered. of note, during past admission and clinic visits her bp has been in the 80's to the low 110's. . even more distantly, the pt is s/p a balloon aortic valvuloplasty in , which was complicated by a cva without lingering defiecits. intervally after that the pt had a repeat echo which showed that her lvef improved from 25% to 50%. . in the ed, initial vs were 97.6, 74, 89/42, 20, 93%ra. labs were notable for wbc 16.3 w/85% polys & no bands and bnp (was on ). troponin <0.01 & lactate 1.8. hematocrit stable at 32; creatinine 1.5 (recent baseline 1.2-1.6). ua negative; 10 hyaline casts. patient received ~300cc fluid. bedside u/s showed collapsing ivc, was negative for pericardial effusion. cxr with no acute process. blood cultures were sent and she was started empirically on vancomycin 1g iv, levofloxacin 750mg iv, flagyl 500mg iv. given ongoing hypotension, a left ij central venous line was placed and she was started on levophed (currently sbp 110s on levophed @ 0.09mcg/min). an hour prior to transfer in the ed, had a rectal temp 100.8. vs on transfer were 99.6 po, hr 94, 105/48, 21, 100%ra. past medical history: 1. cad, severe aortic stenosis with of 0.8 cm2, cabg: 3v cabg recent catheterization with widening of her aortic valvuloplasty complicated by cva. 2. diabetes mellitus type 2. 3. hypertension 4. hyperlipidemia. 5. ischemic and valvular cardiomyopathy with an ef 20-25% 6. history of left breast cancer, grade 3. 7. right rotator cuff tendinopathy. 8. right biceps tendinitis. 9. polymyalgia rheumatica. 10. osteoporosis. 11. moderate mitral regurgitation 12. history of squamous cell carcinoma. 13. moderate mr 14. severe as: symptoms started in 15. atrial fibrillation: coumadin, amiodarone . past surgical history: 1. right mastectomy. 2. coronary artery bypass graft 22 years ago. 3. hysterectomy. 4. excision of left dorsal hand squamous cell carcinoma. 5. right fourth trigger finger release. social history: housing: facility. has a daughter nearby who is her emergency contact. occupation: was a homemaker. functional status: very active, exercises 3x week, does treadmill, aerobics and yoga. tobacco/etoh/illicit drugs: denies family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission exam vs: t: 100.4 bp: 117/37 p: 66 r: 14 o2: 95% ra general: alert but not completley oriented. oriented to person, place, generally to events, to date and month and year and president. pt seems confused why she's here, is slow to speak, but does so with complete and fluent sentences. heent: sclera anicteric, mmm, oropharynx clear. no step offs, depressions, or tenderness to palaption. lij in place and covered with occlusive dressing. neck: supple, jvp to 2cm above clavicles when 45* recumbant, no lad cv: regular rate and rhythm, diminished s1 and s2 with pan-systolic systolic murmurs in rusb, lusb, and at left apex. lungs: diffuse mid-inspiratory crackles in bases, left more than right, about way up chest wall. abdomen: no body wall ecchymoses, no percussion tenderness, soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley to gravity with dark colored urine. ext: warm, well perfused, 2+ pulses, no clubbing or cyanosis. noted for 2+/3+ symmetric edema to the legs b/l coming up to mid-calf. skin: intact without any defects. reported birth mark to anterior left thigh. . discharge physical exam vitals - tm/tc 100.7/97.9 bp 103-47 (102-116/40-50) hr 66 (66-80) rr 18 sao2 95%ra (94-98%ra) in/out: 2180/920 weight: 53 kg general: frail, elderly lady, nad. alert and oriented x3. very pleasant. heent: ncat. eomi, mmm. neck: supple with jvp of 3cm above sternal notch. cardiac: rrr, diminished s1 and s2 with pan-systolic murmur in rusb, lusb, and at left apex, which radiates to the carotids. lungs: diffuse mid-inspiratory crackles in bases, about the way up chest wall. abdomen: soft, ntnd. normoactive bowel sounds. extremities: 1+ symmetric edema to the legs b/l coming up to mid-calf. pulses: right: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ left: carotid 2+ femoral 2+ popliteal 2+ dp 2+ pt 2+ pertinent results: admission labs 05:50pm blood wbc-16.3*# rbc-3.79* hgb-11.0* hct-32.9* mcv-87 mch-29.1 mchc-33.6 rdw-16.5* plt ct-221 05:50pm blood neuts-85* bands-0 lymphs-9* monos-5 eos-0 baso-0 atyps-1* metas-0 myelos-0 05:50pm blood pt-13.7* ptt-26.8 inr(pt)-1.2* 05:50pm blood glucose-98 urean-35* creat-1.5* na-135 k-4.7 cl-95* hco3-30 angap-15 05:50pm blood alt-10 ast-24 alkphos-71 totbili-0.4 05:50pm blood probnp-* 05:50pm blood ctropnt-<0.01 05:50pm blood albumin-2.6* . discharge labs: 06:10am blood wbc 7.2, rbc 3.69, hgb 10.3, hct 33.4, mcv 91, mch 27.8, mchc 30.7, rdw 15.6, plt 275 06:10am blood pt 14.8, ptt 28.6, inr 1.3 06:10am blood gluc 101, bun 24, cr 1.2, na 134, k 4.9, cl 103, hco3 27 06:10am blood ca 6.9, phos 2.4, mg 2.4 . imaging tte: the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 0-5 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild to moderate regional left ventricular systolic dysfunction with hypokinesis of the basal and mid septal, inferior, and inferolateral segments. right ventricular chamber size is normal. with mild global free wall hypokinesis. the ascending aorta is mildly dilated. the aortic valve leaflets are moderately thickened. there is critical aortic valve stenosis (valve area <0.8cm2). mild to moderate (+) aortic regurgitation is seen. the aortic regurgitation jet is eccentric, directed toward the anterior mitral leaflet. the mitral valve leaflets are mildly thickened. there is moderate thickening of the mitral valve chordae. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with normal left ventricular cavity size. mild to moderately depressed left ventricular hypokinesis of the basal and mid septal, inferior, and inferolateral segments. mild global right ventricular free wall hypokinesis. critical aortic stenosis with mild to moderate aortic regurgitation. mild to moderate mitral regurgitation. normal pulmonary artery systolic pressure. left pleural effusion. compared with the prior study (images reviewed) of , the mildly to moderately depressed left ventricular systolic function and regional wall motion abnormalities are new. the severity of aortic stenosis has increased and is now critically stenosed (the lvot gradient has decreased), although visually and by transvalvular aortic gradient it is more consistent with moderate to severe aortic stenosis and appears unchanged. the pulmonary artery systolic pressure has normalized. . chest (portable ap): persistent cardiomegaly without evidence of congestive heart failure. slightly improved left retrocardiac opacity is likely due to a combination of atelectasis and effusion. remainder of the lungs are grossly clear, but lung apices are partially obscured and cannot be fully assessed. . unilat up ext veins us: grayscale, color and doppler images were obtained of the right ij, subclavian, axillary, brachial, basilic, and cephalic veins. normal flow, compression, and augmentation are seen in all of the vessels. no evidence of deep vein thrombosis in the right arm. . head ct w/o contrast: previously seen right parietal subdural hematoma has significantly decreased in size and density with a small residual subdural hemorrhage (series 2, image 19). there is no new acute intracranial hemorrhage, edema, masses, mass effect, or acute territorial infarction. unchanged encephalomalacia in the left superior parietal lobe (series 2, image 20) from prior injury. small lacunar infarcts are seen in the basal ganglia and in the left subinsular region. moderate-to-severe atherosclerotic calcification of the cavernous segments of the carotid artery. paranasal sinuses and mastoids are clear. no fracture. brief hospital course: f with hx of severe as, moderate ar/tr, a-fib, sent from cardiology clinic for hypotension and found to have c diff. . acute # c. difficile infection - pt presented with hypotension, low grade fever and leukocytosis to 12.5 without bandemia. she developed diarrhea and was found to be positive for c. diff toxin. she was started on po flagyl on and will continue treatment for a total of 14 days. . #. hypotension: the pt's blood pressure seems to be baseline about sbp 80-110. etiology of her hypotension is most likely contributed to by worsening as and hypovolemia secondary to gastrointestinal losses due to c. difficile infection. a repeat echo showed critical as, worsened after the valvuloplasty in . pt's bp is 70s/40s with good mentation when not on pressor. her troponin is neg x2 with no ekg changes. she was first started on lisinopril 2.5mg daily and her carvedilol was held due to persistently low blood pressures. she was given small fluid boluses to maintain intravascular volume. . #. : was 1.5 on admission, but back to baseline of 1.2 by . could have been pre-renal or end organ dysfunction from poor perfusion. pt was given small fluid boluses to maintain uop and cr back to baseline. creatinine was 1.2 upon discharge. . chronic #. afib: longstanding problem with no acute issues this admission. she was continued on amiodarone at her home dose. . #. dm2: home metformin was held and put her on iss while in-house. . #. cad: asa was initially held due to recent sah but head ct on showed a significant interval decrease in size and density of the right parietal subdural hematoma. asa was re-started on per her pcp. . #. htn: due to hypotension this admission, her home carvedilol was held. . #. hl: pt was continued on her home simvastatin. . #. hypothyroidism: pt was continued on her home levothyroxine. . #. osteoporosis: on alendronate at home. held while in house. medications on admission: - ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po twice a day: do not take with thyroid hormone - carvedilol 3.125 mg tablet sig: one (1) tab po bid (2 times a day) - simvastatin 40 mg tablet sig: one (1) tablet po once a day. - alendronate 70 mg tablet sig: one (1) tablet po once a week. - metformin 850 mg tablet sig: one (1) tablet po once a day. - levothyroxine 50 mcg tablet sig: one (1) tablet po once a day - amiodarone 200 mg tablet sig: one (1) tablet po once a day - multivitamin tablet sig: one (1) tablet po daily - cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po daily - ranitidine hcl 150 mg tablet sig: one (1) tablet po daily - tylenol extra strength 500 mg tablet sig: one (1) tablet po once a day as needed for pain - ondansetron hcl 4 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. - docusate sodium 100 mg capsule sig: one (1) capsule po tid (3 times a day) - recently discontinued from lasix and lisinopril discharge medications: 1. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po bid (2 times a day): after lunch and dinner. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation: please hold for diarrhea. 3. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. alendronate 70 mg tablet sig: one (1) tablet po once a week: give on monday. 5. metformin 850 mg tablet sig: one (1) tablet po once a day: give after lunch. 6. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily): give before breakfast. 7. amiodarone 200 mg tablet sig: one (1) tablet po at bedtime: give at hs. 8. multivitamin tablet sig: one (1) tablet po daily (daily). 9. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po at bedtime. 10. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 9 days. 11. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily): give after lunch, hold sbp < 100. 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 13. ranitidine hcl 150 mg tablet sig: one (1) tablet po at bedtime. 14. furosemide 20 mg tablet sig: one (1) tablet po once a day: please start once diarrhea is resolved. discharge disposition: extended care facility: - discharge diagnosis: c difficile colitis acute on chronic kidney injury atrial fibrillation severe aortic stenosis discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you had fevers and an elevated white blood cell count that we believe was due to the infection in your colon. you were started on flagyl, an antibiotic to treat this infection for a 2 week course. your kidney function also worsened because of dehydration, your kidney function is almost normal now. weigh yourself every morning, call dr. if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. . we made the following changes to your medicines: 1.discontinue carvedilol as your blood pressure has been low 2. start metronidazole pills to treat your bowel infection 3. restart lasix when the diarrhea goes away followup instructions: department: cardiac services when: thursday at 3:00 pm with: , md building: sc clinical ctr campus: east best parking: garage . department: radiology when: thursday at 1:15 pm with: cat scan building: cc clinical center campus: west best parking: garage . department: neurosurgery when: thursday at 2:15 pm with: , md building: lm campus: west best parking: garage . department: cardiac services when: wednesday at 4:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: venous cutdown diagnoses: other primary cardiomyopathies polymyalgia rheumatica mitral valve disorders congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortocoronary bypass status aortic valve disorders chronic kidney disease, unspecified other and unspecified hyperlipidemia hypotension, unspecified intestinal infection due to clostridium difficile hypovolemia subdural hemorrhage disorder of bone and cartilage, unspecified chronic combined systolic and diastolic heart failure 

Answer: The patient is high likely exposed to