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: betalactams / ceftriaxone attending: chief complaint: altered mental status hypertensive emergency major surgical or invasive procedure: right internal jugular central venous line placement- history of present illness: pt is a 71yow resident at , presenting with change in mental status. on day prior to pres pt became increasingly lethargic, c/o mild abdominal pain. labs were checked and pt was noted to have leukocytosis. she was started on flagyl and iv fluids empirically for c. difficile colitis given recent history. she became increasingly lethargic there and today bp was elevated at 240/110. nitropaste was applied and patient was transferred to ed. . in the ed head ct was significant for acute occipital bleed 9mm x 7mm. she was seen by the neurology and neurosurgery services. the neurology service found her exam to be non focal and felt that her encephalopathy was not related to the bleed. they recommended blood pressure control, repeat ct head in 24 hours, and mri head once pt could remain still. . she was afebrile in the ed but was given vancomycin, ceftriaxone, and acyclovir out of initial concern for meningitis. once ct finding of bleed, and renal function showing slight worsening, it was felt that meningitis unlikely to be cause of encephalopathy and so no lp was performed. she received 1l ns in ed. . ros: answers no - no cp, sob, abd pain past medical history: htn dm ckd -stage iv, recently primary nephrologist dr. has been discussing starting hd hyperparathyroidism anemia glaucoma - legally blind depression - on remeron hypothyroidism mgus cad - nl dobutamine echo in - cath in with lad disease social history: ms. is a widowed mother of 12 children aged 37-50. she has more than 50 grandchildren. she currently lives at house. before that she lived with her and two children. she received home health care 5 times per week and also had a visiting nurse. takes care of ms. finances, and she seems to trust her. patient and daughter at bedside state that her living situation has certainly contributed to her depressed state and that she should not return there. according to ms. , her daughter is her health care proxy. she has never smoked, does not drink alcohol, and has not used drugs family history: non-contributory physical exam: on admission: 98 138/80 80 rr 14 98%ra quiet, no unprompted speaking pupils sluggish but reactive and symmetric op clear, adentulous, dry mucous membranes no jvd no tm no carotid bruits rrr nl s1s2 no mrg lungs with decreased bs b/l, clear abd soft nt nd nabs rectal with good tone, guaiac negative v soft brown/green stool ext w/o edema, wwp neuro: aa, answers when asked name "", all other questions answers yes/no only, cn 3-12 intact (blind), mae but not cooperating with strength exam, babinski downgoing, follows simple commands . pertinent results: studies: cxr: no acute cardiopulmonary process . . : ct abdomen/pelvis: impression: 1. intermediate density material in left colon, sigmoid, and rectum, which, in the absence of oral contrast administration reflects high density material such as calcium or even hemorrhage. no bowel wall thickening or other findings to suggest ischemia. 2. soft tissue lesion seen in the rectum. clinical correlation is recommended. 3. left hip destruction with fluid in the joint space as seen on previous examinations. 4. multiple renal cysts which are incompletely characterized on this examination, however, they are similar to the exam of . . ct head: impression: 1. acute hemorrhage within the left occipital lobe. no evidence of mass effect. 2. unchanged appearance of infarct of the left occipital lobe and unchanged appearance of small vessel disease. final attending comment: the above mentioned left sided acute bleed is in the temporal lobe, a tiny right anterior thalamic acute hemorrhage is also seen.findings are likely due to hypertension. . 4/1507 ct head repeat: impression: interval decrease in size of small left posterior temporal/occipital lobe intraparenchymal hemorrhage. stable right anterior thalamic tiny hyperdensity. no new lesions identified. . eeg: impression: this is an abnormal eeg due to the slow and disorganized background and the bursts of generalized slowing. this suggests a mild encephalopathy, which may be seen with infections, toxic metabolic abnormalities or medication effect. no epileptiform features were noted. . . labs: admission: wbc-8.0# rbc-4.08* hgb-12.6# hct-36.0 mcv-88 mch-30.8 mchc-34.9 rdw-15.3 plt ct-245 neuts-73.3* lymphs-22.9 monos-3.5 eos-0.1 baso-0.2 pt-12.2 ptt-26.4 inr(pt)-1.0 glucose-99 urean-58* creat-3.9* na-139 k-5.2* cl-106 hco3-23 angap-15 alt-19 ast-28 alkphos-62 amylase-133* totbili-0.5 lipase-43 albumin-4.3 calcium-12.7* phos-5.3* mg-3.2* freeca-1.59* . lactate-1.9 . 01:20am blood ck(cpk)-24* 07:55am blood ck(cpk)-24* 01:20am blood ck-mb-3 ctropnt-0.10* 07:55am blood ck-mb-notdone ctropnt-0.08* . tsh-0.94 pth-206* blood osmolal-311* . spep-abnormal b igg-2075* iga-209 igm-43 . blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg . discharge labs: wbc-5.5 rbc-3.11* hgb-9.1* hct-28.1* mcv-90 mch-29.4 mchc-32.5 rdw-15.2 plt ct-189 . glucose-101 urean-34* creat-3.3* na-142 k-4.0 cl-115* hco3-21* calcium-9.9 phos-4.4 mg-2.1 . . 05:50pm 01:28am blood . . micro:. . stool clostridium difficile toxin assay-negative blood cultures x2 sets negative urine urine culture-negative brief hospital course: ms. is a 71 year old female with who presented to the ed from rehab with a change in mental status in setting of hypertensive emergency, intracranial bleed, acute on chronic renal insufficiency, hypercalcemia. she was admitted to the micu for inital care to control her blood pressure and monitor her mental status. she was then transferred to the medical floor once her blood pressure was better controlled. her hospital course is described below by problem. . ### change in mental status: multifactorial including hypertensive encephalopathy, mild worsening of renal failure, possible c. difficile colitis, intracranial bleed, and hypercalcemia. her mental status returned to baseline with treatment of hypercalcemia and hypertension. (see below). she was then transferred from the micu to the regular medical floor. . ### occipital intracranial hemorrhage: a 9mm ich was seen on her original ct head on presentation to the ed. two consults were obtained, neurology and neurosurg, both teams felt there was no indication for surgery as the bleed was very small. her sbp goal was 130-160 given the bleed. a subsequent ct of the head showed a slightly smaller area of bleed suggesting resolution. . ### hypertension: her systolic blood pressure was initially 240. she was started on a labetolol drip initally, and then transitioned to oral agents including metoprolol, isosorbide moninitrate, clonidine and hydralazine. the doses were titrated upwards to achieve optimal control. upon discharge her blood pressure was within the 130-160 range. the doses can be confirmed on her medication list. . ### acute renal failure: on presentation, she had only slightly decreased gfr from baseline, and her urine lytes were consistent with a pre-renal picture. renal was consulted and felt that her initial presentation was unlikely purely uremic encephalopathy. there was no indication for urgent hemodyalisis. her cr returned to baseline at discharge (~3.3) and she was making adequate urine. she was treated with sevelamer (no calcium acetate given her hypercalcemia) to control her phosphate levels. she was started on sodium bicarb given her acidosis which was thought to be attributed to her chronic renal insufficiency. she has a follow up appointment with dr. , her outpatient nephrologist, in . . ### hypercalcemia: her hypercalcemia was likely secondary to tertiary hyperparathyroidism compounded by her renal insufficiency (her pth was elevated in the 200's). an spep was sent which was positive for monoclonal antibodies consistent with her history of mgus. she was treated with ivf (ns) and furosemide and her calcium returned to range. she was also given cinacalcet. . ### anemia: likely secondary to her chronic renal failure. she was on aranesp as an outpatient was treated with epogen while an inpatient. she was also continued on her iron supplementation. her hct was stable at baseline in the low 30's. . ### possible c difficile colitis: she had a recent history of c. diff and was complaining of abdminal pain at the rehab center. they empirically started her on metronidazole and it was continued in house. the final date of treatment should be for a total 14 day course. . ### diabetes: uncontrolled insulin dependent diabetes. she was continued on an insulin sliding scale and her blood sugars were fairly well controlled in house. . ### depression: her mirtazapine was originally held but was then restarted after she was out of the micu and on the medicine wards. . ### hypothyroidism: continued on levothyroxine 50mcg daily . ### fen: she had a speech and swallow consult which showed she did not aspirate despite her lack of teeth. she should continue to eat a cardiac/diabetic diet and have sugar free shake supplements with meals (tid). to do: please have labs checked on monday including cbc, sodium, potassium, chloride, bicarb, bun, cr, calcium, magnesium, phosphorous, glucose. medications on admission: mvi levothyroxine isosorbide rememeron metoprolol clonidine aranesp insulin flagyl - started past few days discharge medications: 1. sevelamer 400 mg tablet sig: two (2) tablet po tid (3 times a day). 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 3. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). 4. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 8 days: last day of treatment is . 5. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 6. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 7. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 8. clonidine 0.1 mg tablet sig: two (2) tablet po tid (3 times a day). 9. hydralazine 25 mg tablet sig: two (2) tablet po q6h (every 6 hours). 10. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 11. mirtazapine 15 mg tablet sig: two (2) tablet po hs (at bedtime). 12. sodium bicarbonate 650 mg tablet sig: one (1) tablet po bid (2 times a day). 13. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 14. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 15. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 16. aranesp injection 17. insulin lispro (human) 100 unit/ml solution sig: per sliding scale subcutaneous asdir (as directed). 18. outpatient lab work please have labs checked on monday including cbc, sodium, potassium, chloride, bicarb, bun, cr, calcium, magnesium, phosphorous, glucose. 19. finger sticks please check finger sticks for blood glucose before meals and at bedtime. use insulin sliding scale for correction. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: hypertensive emergency intracranial hemorrhage -small in the occipital lobe chronic renal insufficiency hypercalcemia . secondary diagnosis: anemia diabetes type 2 cad hypothyroidism hyperparathyroidism glaucoma - legally blind depression mgus discharge condition: stable. normotensive. discharge instructions: you were admitted with an altered mental status and were found to have very high blood pressure and a very small bleed in your brain. you were admitted to the medical intensive care unit and were given medicines to help your blood pressure. . your blood pressure medicine doses have been changed. please see the medication list for the new medications and doses. . you should have your blood pressure checked at least once a day to ensure it is below 160/90. if it is higher, please contact your physician. . you are being treated for c.diff infection empirically. the last day of treatment is . please continue to take metronidazole antibiotic as prescribed until then. . please have labs checked on monday including cbc, sodium, potassium, chloride, bicarb, bun, cr, calcium, magnesium, phosphorous, glucose. . please call your pcp or go to the emergency room if you have fevers >101, chills, shortness of breath, chest pain, altered mental status, or any other symptoms which are concerning to you. followup instructions: you should follow up with your pcp . . we were unable to make an appointment for you since it is the weekend. please call to schedule an appointment. you will need to have your creatinine and other labs drawn early next week. . the following appointments were in the computer and are listed below as a reminder for you: . provider: , rn phone: date/time: 9:30 . provider: , m.d. phone: date/time: 11:15 . provider: , m.d. phone: date/time: 10:00 md procedure: venous catheterization, not elsewhere classified diagnoses: hypertensive chronic kidney disease, malignant, with chronic kidney disease stage v or end stage renal disease chronic kidney disease, stage v diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism depressive disorder, not elsewhere classified intracerebral hemorrhage intestinal infection due to clostridium difficile hypertensive encephalopathy other hyperparathyroidism 

Answer: The patient is high likely exposed to