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: history of present illness: the patient is a 69 year old female with a history of coronary artery disease, end stage renal disease on hemodialysis and congestive heart failure, who presented from home to the emergency department and was unresponsive. per the patient's husband, the patient had been at home in her usual state of health, independent of activities of daily living until the morning of admission, when she felt lethargic with shortness of breath. her cardiologist, dr. was called who instructed them to go right to the emergency department. in the emergency department, the patient was initially stable but then had an acute episode of unresponsiveness and low blood pressure. the episode was described as a thumping over to the left. there was no shaking, stiffening or eye rolling. neurology was called and head ct without contrast was found to be negative. she was intubated for hypoxia. after receiving oxygen, through the intubation, the patient was able to wake up and cooperate with a neurologic examination. per report from the husband, the patient had no complaints, no recent fever, chills, nausea, vomiting, diarrhea or constipation. no bright red blood per rectum. no melena, urinary symptoms. no chest pain or her anginal equivalent which is described as heavy arms. past medical history: 1. coronary artery disease, status post coronary artery bypass graft, aortic stenosis, 3+ mitral regurgitation. 2. end stage renal disease on hemodialysis times one year. 3. diabetes mellitus on insulin. 4. history of gastrointestinal bleed. 5. peripheral vascular disease. 6. congestive heart failure, ejection fraction of 20%. 7. ddd pacer secondary to complete heart block. 8. asthma. 9. glaucoma. 10. hypertension. 11. hypercholesterolemia. 12. history of heparin induced thrombocytopenia, type ii. 13. alcohol use. medications on admission: 1. amitriptyline 25 mg q.h.s. 2. nephrocaps two once daily. 3. phoslo two three times a day. 4. lipitor 20 mg once daily. 5. protonix 40 mg once daily. 6. imdur 30 mg once daily. 7. aspirin 81 mg once daily. 8. lopressor 100 mg twice a day. 9. plavix 75 mg once daily. 10. xalatan. 11. alphagan. 12. digoxin three times weekly. 13. advair one twice daily. 14. nph 20 units in the morning and 10 units at night. allergies: she reports allergy to aspirin leading to gastrointestinal bleed, intravenous dye leading to the cause of her renal failure, penicillin causing swelling and hives. social history: she lives with her husband who helps care for her and her two daughters. she quit drinking alcohol a number of years ago and has no history of tobacco use or illicit use. family history: her father died of acute myocardial infarction at age 59. her mother died of a cerebrovascular accident at age 68. physical examination: on admission, vital signs were temperature 99.8, blood pressure 100/40, pulse 70, oxygen saturation 100%, and respiratory rate of 12. in general, she was a pleasant woman with no apparent distress. she had slight scleral icterus. cardiovascular - regular rate and rhythm, normal s1 and s2, iii/vi systolic murmur. chest showed decreased breath sounds at her bases bilaterally. she had a soft, nontender, nondistended abdomen with normal bowel sounds. she had no edema of her extremities and no calf tenderness. neurologically, she was sedated so cranial nerves could not be assessed. laboratory data: blood gas shortly after intubation was 7.35, 31, 126. white blood cell count was 9.7, hematocrit 41.4, platelet count 233,000. sodium 130, potassium 6.3, chloride 85, bicarbonate 24, blood urea nitrogen 33, creatinine 5.6, glucose 219. ammonia was 118. lactate was 14.2. digoxin level was 2.6. alt 43, ast 157, amylase 2.2, total bilirubin 2.9, ck 88, mb 4.0, troponin 0.35. inr 1.3. white blood cell count differential had a 1% bandemia and 86% neutrophils. urinalysis revealed negative nitrite, negative leukocyte esterase. ct of the head as said showed no hemorrhage and chronic microvascular changes. chest x-ray showed cardiomegaly with congestive heart failure that improved after intubation. right upper quadrant ultrasound showed no ductal dilatation and normal portal venous flow. cta showed no pulmonary embolus, bilateral pleural effusions and moderate ascites in the abdomen. impression: this was a 69 year old woman with a history of coronary artery disease, congestive heart failure, end stage renal disease and diabetes mellitus with pacemaker, who presented with unresponsiveness. number one thought was syncope. the patient was put on telemetry and ruled out for myocardial infarction. respiratory failure that was seen during a mixture of mental status changes and hypoxemia. chest x-ray revealed congestive heart failure resolving quickly and oxygenation and ventilation adequate. elevated lactate level thought to be due to hypotension in the setting of liver dysfunction. there were no obvious medications leading to elevated lactate and acidosis was not striking. end stage renal disease was concerning for the cause, however, the patient was not overdue for dialysis. renal was consulted and dialysis was planned for the next day. final of right upper quadrant ultrasound revealed a cirrhotic liver with interval reversal of flow in the portal vein since one year ago when the last study was done. this was consistent with a worsening of cirrhosis. there was cholelithiasis without any evidence of cholecystitis. on day one of medical intensive care unit admission, the patient remained intubated and sedated. she ruled out for myocardial infarction. she had dialysis and 2.5 liters removed. electrophysiology saw the patient and was concerned about an electrical dysfunction as the etiology. initially her potassium was found to be 7.0 and her digoxin level was 2.6 and supratherapeutic. electrophysiology interrogated her pacer and found no electrical etiology to her syncopal episode. over the first three days of admission, her systolic blood pressure was stable and the patient extubated herself. when the patient was stable to be transferred to the floor, at that time the impression was that her episode of unresponsiveness was thought to be due to a transient ischemic attack versus encephalopathy due to uremia or hepatic source. her mental status is improved back to her baseline within two days. neurology consultation evaluated her and felt that there was no neurologic etiology to her syncopal episode. the patient was maintained on lactulose and had hemodialysis on a regular schedule. ct of her head did reveal a wedge shaped infarct pattern concerning for a cerebrovascular accident. the patient was not eligible to have a magnetic resonance scan given that she had a pacer in place. the patient's neurologic status continued to improve. the patient's amitriptyline was discontinued. she was instructed not to take it again for fear that it would interact with her other medications and somehow contribute to further episodes of unresponsiveness or syncope. the patient's mental status continued to improve. she continued to have hemodialysis. she had a physical therapy consultation who felt that she was better than her baseline and she was discharged home to be with vna services. regarding the patient's initial event of hypoxia, on day two, she extubated herself. she required minimal oxygen on nasal cannula. she was diuresed given the picture of congestive heart failure. she was treated with ten days of levaquin due to retrocardiac opacity that was found and thought possible pneumonia complicated the picture of hypoxia. on the day of discharge, the patient was breathing 95% in room air and had no episodes of shortness of breath. during her stay, the patient also had a temperature spike. sources were thought to be due to her lung or pneumonia post intubation. sputum was checked and it was nonspecific. the patient had a groin line that was discontinued. she was given vancomycin and levofloxacin. blood cultures never grew any organism. vancomycin was discontinued and levofloxacin was continued for the entire ten day course as stated above. for the patient's cirrhosis and ascites present, lactulose was continued. vitamin k was given. synthetic function of the liver was monitored. the patient did have transaminase elevation and inr increased to 2.0, total bilirubin increased to 2.9. this was thought to be due to hypotension and poor cardiac function at baseline. these values decreased towards normal at the time of discharge. for end stage renal disease, the patient had renal consultation. hemodialysis was continued per routine. renal followed closely. she was given a renal diet and her electrolytes were monitored very carefully with no further events. for fluids, electrolytes and nutrition - the patient was maintained on a renal, cardiac, diabetic two gram sodium diet. she received no intravenous fluids. electrolytes were monitored carefully and were within normal range. prophylaxis was maintained throughout admission with a proton pump inhibitor, aspiration precautions. the patient was given no subcutaneous heparin given her history of thrombocytopenia on heparin. she was given pneumatic boots, and she was put up into bed and ambulated regularly. code status - the patient was full code throughout her stay, however, it needs to be addressed further with the patient and her husband, their family and the primary care physician given that this was the patient's second intubation in a six week period with multiple chronic illnesses. throughout her stay, the patient progressively began to eat more towards her baseline. nph was increased back to her home dose. the patient had anemia that was found to be combined b12 or folate deficiency and chronic renal insufficiency. it was found to be stable and unchanged and she was at her baseline. at the end of hospital stay, the impression was that her syncopal event was due to a combination of encephalopathy, hypoxia and volume overload due to congestive heart failure and end stage renal disease and severe cirrhosis, all of which resolved with dialysis and lactulose. the patient was discharged home with instructions to weigh herself daily, call her medical doctor if she weighed more than three pounds increase, adhere to a two gram sodium diet, 1500cc fluid restriction, to take all her medications as prescribed. she was told to not take her digoxin or amitriptyline any more given her impaired renal function and delicate neurologic status. the patient was instructed to follow-up with her primary care physician, . , in one to two weeks, as well as with her cardiologist, dr. . condition on discharge: the patient was ambulating well with her walker, breathing in room air, eating and drinking well and euvolemic with an ejection fraction of 20%. discharge status: she was discharged to home with vna services. primary diagnoses: 1. chronic renal failure. 2. systolic heart failure. 3. critical aortic stenosis. 4. encephalopathy. 5. cirrhosis. 6. liver failure. 7. hypoxia. 8. hypokalemia. 9. hyperkalemia. 10. digoxin toxicity. 11. coronary artery disease. 12. diabetes mellitus type 2 complicated by nephropathy. 13. asthma. 14. glaucoma. 15. peripheral vascular disease. 16. hypertension. medications on discharge: 1. plavix 75 mg one once daily. 2. famotidine tartrate 2.2% drops, one drop twice a day. 3. calcium acetate 667 mg tablets, take three p.o. three times a day with meals. 4. aspirin 81 mg one once daily. 5. lipitor 20 mg p.o. once daily. 6. multivitamin two p.o. once daily. 7. latanoprost 0.005% drops one drop h.s. 8. tylenol p.r.n. 9. salmeterol 50 mcg one inhalation q12hours. 10. flovent 110 mcg inhaler two puffs twice a day. 11. lactulose 10 grams/15ml syrup, take 30ml p.o. three times a day. 12. levofloxacin 250 mg tablet, take one tablet p.o. q48hours for a total duration of ten days. 13. colace 100 mg take one tablet p.o. twice a day. 14. senna take one tablet p.o. twice a day. 15. bisacodyl take two tablets p.o. once daily as needed for constipation. 16. trazodone 50 mg p.o. q.h.s. 17. insulin nph 20 units in the morning and 10 units at night. 18. lopresor 12.5 mg p.o. twice a day. 19. protonix 40 mg p.o. once daily. 20. the patient was instructed not to take amitriptyline or digoxin any more. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube hemodialysis other oxygen enrichment diagnoses: hyperpotassemia alcoholic cirrhosis of liver hypopotassemia rheumatic heart failure (congestive) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure hepatic encephalopathy diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled 

Answer: The patient is high likely exposed to