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: demerol attending: chief complaint: increased work of breathing major surgical or invasive procedure: - intubation/ventilation - tunneled hd catheter placement - central line history of present illness: the patient is a 59y/o ww w/ a pmh significant for dm1 (c/b crf, neuropathy, and retinopathy), morbid obesity, and htn who was recently hospitalized for an episode of arf atn. this occurred in the setting of a osteomyelitis an ankle fx. she was sent back to her rehab center following this admission and there she developed dyspnea and anuria. her cr rose to 4.8 and she had a leukocytosis at 16. she was admitted and noted to have troponins in the 3 and was seen to have a nstemi but was not anticoagulated the feeling that her presentation represented a subacute event. she required a nrb during her early admission that was quickly weaned but, considering her fluid overload, renal was consulted and decided to proceed to hd. during this time, she also was noted to have a uti that was initially treated w/ levo/flagyl (b/c of a presumed aspiration pna at this time as well) but this was later changed to linezolid when it grew vre. on the floor, she had an episode of unresponsiveness for which a code blue was called. she was initially pulseless but returned to nsr w/ cpr. she was intubated during this code during which she was also noted to have a 12b run of vt. . during micu stay, pt's vent settings were weaned quickly. she received very little sedation and was comfortable on the vent. she was maintained on the vent for the first two days in the micu for her tunneled hd catheter placement and for initiation of hd. her line was placed on micu day #2 in ir without complications. hd was done the same day through the line and 1kg was removed. pt tolerated hd well. on micu day #2, she was changed to ps 5/5 and a rsbi on micu day #3 was 28. she was extubated on micu day #3 and maintained her o2 sats in high 90s. an insulin gtt was briefly started for high blood sugars but this was titrated off. a c. diff infection was treated w/ flagyl. . on ros today, the patient complains of "labored breathing" but denies any cp, abdominal pain, n/v, ha, weakness, paresthesias, visual changes, or palpatations. past medical history: s/p laser, neuropathy manifestation, diabetic nephropathy. crf 1.7 1 year ago. pcr . prot. for 5 years. ] - hyperlipidemia, nos - obesity - anemia of other chronic illness - on procrit for 2 years. on q 3 wk. large dose. only on procrit once every 3 weeks now, small dose. - hypothyroidism primary - hypertension, essential nos: - hyperparathyroidism (secondary) now on hectorol at hospital. - cva - 5, . of the left internal cap. social history: married and lives with her husband. 2 children, retired school teachers. no tob, no etoh. family history: father died of colon cancer physical exam: pe: 96.2, 133/36, 75, 100% 40%fm gen: obese woman lying in bed in nad, foley and rectal tube in place heent: eomi, perrla, mmm, o/p clear lungs: diffusely rhonchi cardiac: difficult to hear w/ coarse breath sounds but abdomen: obese, s/nt/nd, +bs, - hsm appreciated extremities: 2+ le edema bilaterally w/ trace ue edema as well skin: no rashes. l heel wrapped neuro: cn and strenght exam limited by lack of cooperation by patient, aao x3 pertinent results: admission labs: 05:32pm blood wbc-15.1* rbc-3.67* hgb-10.2* hct-31.5* mcv-86 mch-27.8 mchc-32.4 rdw-16.5* plt ct-283 05:32pm blood neuts-92.1* bands-0 lymphs-3.7* monos-2.0 eos-2.0 baso-0.2 06:30am blood neuts-86.3* bands-0 lymphs-7.5* monos-2.2 eos-3.7 baso-0.3 05:32pm blood hypochr-occasional anisocy-occasional poiklo-normal macrocy-normal microcy-occasional polychr-normal stipple-occasional 05:32pm blood plt smr-normal plt ct-283 06:33pm blood esr-115* 09:58pm blood ck(cpk)-9140* 05:46pm blood lipase-10 09:58pm blood ck-mb-118* mb indx-1.3 ctropnt-2.86* 05:32pm blood calcium-8.4 phos-6.9* mg-2.0 06:33pm blood vitb12-600 folate-10.5 06:33pm blood %hba1c-6.5* -done -done 03:45am blood tsh-6.7* 02:08pm blood cortsol-27.1* 02:08pm blood cortsol-38.2* 04:20pm blood cortsol-41.8* 04:30am blood hbsag-negative hbsab-negative hbcab-negative 06:33pm blood crp-216.0* 06:33pm blood pep-no specifi 12:26am blood vanco-13.4* 05:04pm blood hcv ab-negative 04:05pm blood glucose-180* lactate-2.0 na-138 k-6.4* cl-104 calhco3-22 05:32pm blood glucose-206* k-5.4* 04:05pm blood ph-7.19* comment-green top 07:24pm blood type-art temp-38.3 rates-/14 po2-113* pco2-41 ph-7.31* calhco3-22 base xs--5 intubat-not intuba comment-room air -cxr - lretrocardiac, r base, r upper lobe above minor fissure opacities suggestive of atelectasis but could be aspiration. -ekg: at time of event unchanged, sinus tach -abd xr - - non-diagnostic bowel gas pattern. no evidence of small bowel obstruction. -tte : mild sym lvh. lv size normal. ef >55% with no obvious wall motion abnormality (due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded). mild pulm artery systolic htn. . emg: complex, abnormal study. there is electrophysiologic evidence for a severe, ongoing, proximal myopathy with denervating features (as can be seen in inflammatory myopathy, critical illness myopathy or toxic myopathy). in addition, there is evidence for a severe, chronic, sensorimotor, generalized polyneuropathy with both axonal and demyelinating features, as can be seen in diabetics, although other causes of neuropathy cannot be excluded . micro - urine - vre, yeast (resolved) stool + for c diff (resolved) urine - yeast (resolved) . mri: 1. there is moderate cerebral and cerebellar atrophy. 2. there are areas of abnormal signal intensity in the brain parenchyma, the distribution of which suggests ischemic lesions including old lacunes in the thalami, probable small, old brainstem infarcts, and a probable old infarct in the right internal capsule. given the patient's age, demyelinating disease is a consideration but the matter lesions are unusual. 3. there is good flow in the distal internal carotid arteries, the distal vertebral arteries and the basilar artery. the major branches of the cerebral arteries are normal.there is no evidence of a significant stenosis. brief hospital course: 59f multiple icu admissions for problem respiratory function including repiratory arrest requiring intubation who was most recently transferred back to the micu on with increased secretions and decreased functional respiratory reserve, concerning for neurologic induced weakness. she had been transferred out of the micu 2 days prior () and while on the floor was noted to have marked increased purulent sputum on suctioning as well as increased residuals in her ng tube concerning for obstruction. furthermore, while on the floor she was continuing work-up for her subacute weakness which included an mri showing no cervical cord compression. her other medical problems include dm type 1 (c/b crf, neuropathy, and retinopathy), osteomyelitis s/p fracture, morbid obesity, htn, crf. she was originally admitted for this admission from rehab w/ volume overloaded and in renal failure. this early part of the hospitalization was also c/b nstemi which was medically managed, as well as a uti (vre), which was treated. . during her first micu stay (), pt's vent settings were weaned. she had a tunnelled hd line placed and dialysis was initiated. also the patient was found to have cdiff and started on flagyl. she was transferred to the floor on . . on the floor the patient had persistent hypoxia at times requiring a non rebreather. this was thought to potentially be due to vol overload vs muscular weakness. the patient has seemed to improve with hd. of note on the patient was having abdominal pain with tube feeds and had 1 episode of coffee ground emesis in ngt suction. this cleared quickly and did not recur. hct has remained stable. other ongoing problems include ulcers on both feet, followed by wound care. a sacral decubitus ulcer developed and was treated by wound care. . pt had an episode of hypotension to the 80's, hypoxia to the 70's, and unresponsiveness on prompting code blue & transfer back to micu. anesthesia required an oral airway and bag mask ventilation transiently but the patient quickly regained consciousness spontaneously. her bp normalized 120's and she was satting in the high 90's on nrb mask. ekg was unchanged and abg during the episode was 7.44/36/223. in micu she was started on zosyn for pneumonia, was transferred to the floor on after stabilization. . weakness: pt has had subacute (over wks) progression of profound muscular weakness and cks were as high as 9000s (w/low ck-mb). cks resolved spontaneously. an lp was done and was normal with negative culture. methylmalonic acid from the csf was normal and igg was nondiagnostic. her nifs were followed and approximately -40. an emg was done and c/w critical illness myopathy and dm neuropathy. an mri was done which showed nothing specific. pt never on steroids during this admission. diffdx also includes rheumatologic cause such as polymyositis. muscle bx () c/w icu myopathy as well as more chronic changes, but special stains are still pending. neuro plans for outpt follow up. during course, a gj tube was placed and tube feeds begun because of concern for pt's ability to swallow weakness (note: fasteners will need to be removed similar to sutures per radiology who placed gj tube). at time of discharge, patient lifting l arm > r, minimal movement of legs (none against gravity). . hypotension: she had several episodes of hypotension in the icu which initially resolved with fluids. no evidence of sepsis. on , pt's bp was persistently in the 90s/30s with maps in the 50s that didn't respond to 500cc bolus so she was started on low-dose levophed. renal evaluated the patient, and felt that the hypotension seemed to occur post-dialysis, and recommended a trial of mitodrine. she was started on this medication and was titrated levophed to off ; bp was stable afterwards. prior to discharge, patient restarted on beta blocker tx, particularly in light of recent nstemi, once bp was stable. bb should be held on am of dialysis. . diabetes: patient with poorly controlled dm. was transiently on insulin drip during 1st micu stay and then transitioned to lantus 50u . on , pt noted to have a blood sugar of 11 so lantus discontinued and consulted. now stable and titrating up lantus doses, with ss insulin as needed. glucoses ranging in high 100s-low 200s of late (110-261). . c. diff colitis: treated with flagyl, repeat toxin testing negative. . respiratory compromise: likely due to increased secretions from tracheobronchitis. pt was requiring sunctioning every hours. she was continued on zosyn x 10 days, last dose 1/28. glycoperolate nebs were started to help with secretions but stopped as they may have been thickening the secretions. weakness may have a component of her respiratory compromise. continues to be stable on nc with clear lung exam & cxr. a cta was performed which was negative for pe; did reveal some mild hilar lymphadenopathy. . cad: h/o severe cad, and ?nstemi (peak ck 9000s but peak mb only 173 so may be more noncardiac skeletal muscle) in early . cardiology followed peripherally and would consider cardiac cath in future. started on asa, now added beta blocker. intolerant of ace-i and by hx. . acute on chronic renal failure: patient now with esrd on hd likely from diabetes. cont renagel, phoslo. renal following. pt will require dialysis while in rehab. . fen: on tube feeds via g-j tube. note: fasteners will need to be removed similar to sutures per radiology who placed gj tube. . ppx: on ppi, heparin sub q. . medications on admission: insulin glargine 40 u hs bowel reg. renagel 1600 qac bethanechol 10 tid metoprolol xl 150 insulin (lispro) ss prozac 40 asa 81 simvastatin 80 synthroid 100 plavix 75 mvi bowel reg: senna, colace, mineral oil, dulcolax ciprofloxacin 500 daily discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 2. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 3. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 4. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily). 5. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 6. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed. 7. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 8. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours). 9. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day) as needed. 10. aloe vesta 2-n-1 skin cond 3 % lotion sig: one (1) topical qday () as needed for to periwound tissue. 11. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 12. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 14. collagenase 250 unit/g ointment sig: one (1) appl topical daily (daily). 15. gabapentin 300 mg capsule sig: one (1) capsule po q24h (every 24 hours). 16. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 17. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 18. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 19. dolasetron mesylate 12.5 mg iv q8h:prn 20. heparin lock flush (porcine) 100 unit/ml syringe sig: one (1) ml intravenous daily (daily) as needed. 21. morphine 2 mg/ml syringe sig: one (1) injection q4h (every 4 hours) as needed for pain. 22. lorazepam 2 mg/ml syringe sig: one (1) injection q6h (every 6 hours) as needed. 23. insulin glargine 100 unit/ml solution sig: 68 units subcutaneous at lunch. discharge disposition: extended care facility: - discharge diagnosis: - critical illness myopathy - respiratory arrest/hypotension - congestive heart failure - renal failure on hd - urinary tract infection (vre, treated, neg cx ) - c diff colitis (treated, negative toxin) - diabetes mellitus, triopathy (hyperkalemia)] - non-st-elevation myocardial infarction - hyperlipidemia - obesity - anemia chronic disease on procrit - hypothyroidism - hypertension - secondary hyperparathyroidism - cva left internal capsule discharge condition: fair discharge instructions: - take the medications as prescribed. - you will be working with physical therapy while at rehab. you will follow up with neurology regarding your muscle weakness and the results of the special biopsy muscle stains as scheduled below. - call a doctor, return to ed for: * fever * chest pain * shortness of breath * other concerns. followup instructions: 1. neurology: provider: , m.d. phone: date/time: 9:30 2. with your primary care doctor, call to schedule an appointment for a convenient time. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified spinal tap incision of lung insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis percutaneous [endoscopic] gastrojejunostomy cardiopulmonary resuscitation, not otherwise specified open biopsy of soft tissue injection or infusion of oxazolidinone class of antibiotics infusion of vasopressor agent diagnoses: hyperpotassemia end stage renal disease subendocardial infarction, initial episode of care urinary tract infection, site not specified congestive heart failure, unspecified other pulmonary insufficiency, not elsewhere classified candidiasis of other urogenital sites hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus cardiac arrest long-term (current) use of insulin intestinal infection due to clostridium difficile morbid obesity pressure ulcer, lower back unspecified hereditary and idiopathic peripheral neuropathy rhabdomyolysis diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled hypotension of hemodialysis ulcer of heel and midfoot diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled critical illness myopathy aftercare for healing traumatic fracture of lower leg 

Answer: The patient is high likely exposed to