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: amoxicillin / glipizide / ciprofloxacin / bactrim / soriatane / potassium chloride / bupropion / calcium channel blocking agents-benzothiazepines / atenolol attending: chief complaint: dizziness, recurrent diarrhea major surgical or invasive procedure: cv line placement history of present illness: 65 year old woman with signficant pmh of atrial fibrillation on coumadin, lung cancer s/p resection , congestive heart failure, diabetes, cirrhosis, gastritis, and hypertension with recent admission for hypotension and dehydration at where blood cx were negative, c.diff x3 negative, and she was found to have a pansensitive e.coli uti treated with ceftriaxone. more recently she had an admission to ( - ) for dehydration, c.diff, possible diverticulitis, and sepsis with a rml pna. she was treated with vancomycin, cefepime, and flagyl and transiently required pressor support. she presents today with dizziness. today at home she c/o "feeling faint" after raising from seated position. she syncopized with loc for "a few seconds" and fell with a resulting left elbow abrasion. she denies headstrike or other tramua, cp, abdominal pain, dysuria, fever, chills, sweats, n/v, no associated tonic-clonic activity, incontinence of bowel or bladder, she did not appear post-ictal. at the time she was noted to be dry, pale and c/o headache since this am and palpitations and sob. she has had ~ watery bm the past few days with 4 this am. she is a+ox3. brought to the ed by ems. in ed, initial vs: 98.6, 86, 95/57, 16, 98%. in the ed she recieved a total of 1000ml. orthostatics were attempted but she was unable to stand without tachycardia and hypotension that was symptomatic. pressures were in 90s while seated. she was initially admited to to medicine, however considering she becomes tachy to 140s-150s with pressures in the 90s systolic she was admitted instead to the micu. on arrival to the micu, she is aox3 with piv placed. she was bolused with 1l ns due to hypotension and tachycardia. past medical history: -s/p left lower lobectomy () for large cell carcinoma of lung - chf (ef ~84 with mild mr, as) - a. fib on coumadin - dmii c/w peripheral neuropathy - pansenitive e.coli uti - c. diff - copd - chronic venous insuffiency le cellulitis - depression - anemia baseline hct 28.7 - hld - gastritis - nephrolithiasis - psoriasis - history of choleycystectomy - obesity - osteoporosis - hypercholesterolemia social history: lives with daughter. retired file clerk in a law office. current smoker 1 ppd (60 pack year history). no alcohol or illicits. ambulates with a cane because walker doesn't fit well in hallways family history: +fh for diabetes, no fh for malignances physical exam: admission: vitals: 98.2 135 93/53 17 96%ra general: alert, oriented, no acute distress heent: sclera are mildly icteric, dmm, oropharynx clear, eomi, perrl neck: supple, jvp ~, no lad cv: tachycardia with irregular rhythm, normal s1 + s2, systolic murmer, no rubs or gallops. lungs: mild crackles at bases, wheezes, ronchi abdomen: obese, soft, non-distended, bowel sounds present, no organomegaly, no suprapubic tenderness to palpation, no rebound or guarding, psoriasis patches gu: no foley ext: warm, well perfused, 1+ pulses, 2+ edema mid-shin, venous-stasis changes, no clubbing, cyanosis neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred. . discharge exam: vitals: t98.8 p 89 bp 124/46 o2 sat 93% ra gen: well appearing in nad neck: supple; jvp ~8cm, no lad heent: eomi intact, mmm chest: irregular rate, 3/6 sem murmmur lungs: mild crackles b/l at bases abodmen- soft ntnd, normoactive bs, extremities- 1+ b/l le edema, 2+ dp skin- chronic venous changes on b/l le; no ulcerations notes, multiple large erythematous plaques on back and chest pertinent results: admission: 12:00pm blood wbc-14.8*# rbc-3.61* hgb-9.4* hct-30.7* mcv-85 mch-26.0* mchc-30.6* rdw-19.7* plt ct-203# 12:00pm blood neuts-73.6* lymphs-18.2 monos-5.7 eos-2.2 baso-0.3 12:00pm blood glucose-128* urean-12 creat-1.0 na-143 k-3.6 cl-107 hco3-23 angap-17 02:20pm blood alt-19 ast-21 alkphos-102 totbili-0.5 02:20pm blood ctropnt-0.03* probnp-943* 06:44pm blood lactate-2.2* pertinent: 05:06am blood lactate-1.3 11:39am blood caltibc-238* ferritn-29 trf-183* 09:52pm blood ck-mb-2 ctropnt-0.02* discharge: 06:50am blood wbc-7.3 rbc-3.00* hgb-7.9* hct-25.3* mcv-84 mch-26.4* mchc-31.3 rdw-19.5* plt ct-105* 06:50am blood pt-14.9* ptt-30.9 inr(pt)-1.4* 06:50am blood glucose-141* urean-12 creat-0.7 na-142 k-3.5 cl-104 hco3-32 angap-10 02:20pm blood alt-19 ast-21 alkphos-102 totbili-0.5 06:50am blood calcium-9.3 phos-2.8 mg-1.5* studies: echo: the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (valve area 1.2-1.9cm2). mild (1+) aortic regurgitation is seen. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. echo impression: 1. right internal jugular venous access catheter terminates at the cavoatrial junction, status post partial withdrawal. 2. progression of pulmonary edema. cannot exclude superimposed consolidation. known right lower lobe spiculated lung lesion not well appreciated radiographically. brief hospital course: 65 year old woman with signficant pmh of atrial fibrillation on coumadin, lung cancer s/p resection , congestive heart failure, diabetes, cirrhosis, gastritis, and hypertension with recent admission for pna and c.diff presenting with syncope, found to be hypotensive and tachycardic admitted to the micu and volume rescucitated. . acute: # hypotension: ddx for this included hypovolemia, septic, and cardiogenic sources. given copious amounts of diarrhea and recent broad coverage with antibiotics, hypovolemia was considered more probable than sepsis. cardiogenic was considered in the setting of mild troponin elevation and palpitations and sob on ros. on arrival to the micu her lactate was 2.2. she was making adequate urine, although her cr was 1.0 up from 0.6 at last discharge. mentating without difficulty. blood cultures were sent, her stool was guiac negative, and she remained afrbrile. she responded well to 5l of ns and her pressures improved to sbp of 130's the following morning () with resolution of afib with rvr. vancomycin and phenylepherine were briefly utilized but were deemed unessesary given no source of infection, clinical improvement, and stabilization of vs. she was restarted on her home metoprolol once vitals stabilized. this was uptitrated to 37.5 for better rate control. her other bp medications including torsemide were held. these were restarted over the remainder of her hospitalization. she is currently hemodynamically stable and without diarrhea on vancomycin 500mg po q6h. . # syncope: likely related to volume depleted state given orthostasis. however did complain of palpitations so could conceivably be due to underlying atrial fibrillation. tte showed mild lvh, la enlargement, and mild valvular disease throughout. no evidence of diastolic or systolic dysfunction, and mild pulmonary artery hypertension was also noted. she responded well to fluid resuscitation as above. she was continually monitored on telemetry without return of rvr. her metoprolol was uptitrated to improved rate control. . # c.diff colitis: this is now her second episode since . should be classified as severe given age, white count, and icu admission. the current episode has occurred for the past month despited po flagyl and vanco 125 q6hrs. this was the likely precipitant of dehydration. belly exam unremarkable. her po vanc was increased to 500 q6hrs. by hod2 her diarrhea had resolved. she was discharged with follow-up with id for a po vanc taper given severe nature and recurrence, at least 2 weeks of full dose therapy. . # acute renal failure: baseline cr 0.6-0.7. currently 0.8 likely related to dehydration. her cr improved to baseline with ivf. . # cirrhosis, nos: new diagnosis on recent abdominal ct with no clear etiology. does not admit to alcohol abuse or ivdu. no tattoes or transfusions. no family history of liver disease. not encephalopathic. no ascites on exam. already has liver follow up scheduled. hep b negative. lfts and inr were ordered as were viral serologies. , ama, , and ferritin were also ordered. her anti-smooth muscle antibody was positive concerning for possible autoimmune hepatitis, and her were mildly positive. this should be discussed further with her hepatologist. . # atrial fibrillation: on arrival, not controlled. likely related to dehydration. currently on digoxin and metoprolol at home. anticoagulated with warfarin. her medications were held and her rate slowed down with ivf. once she was hemodynamically stable, her metoprolol was restarted and uptitrated to _37.5mg po bid for improved rate control. the role of digoxin was unclear in her therapy and was discontinued given room for increased metoprolol. given her superimposed renal failure, digoxin was held. her coumadin is being titrated up and she can follow up at rehab until she is therapeutic. . # chf, chronic diastolic: chronic stable issue. per report she had a recent ef = 55% via tte in which was grossly unchanged on repeat. currently appears hypervolemic. cxr on after five liters showed pulmonary edema. ivf were given judiciciously following resuscitation. repeat echo showed preserved ef. torsemide was held initially with hemodynamic instability, but patient complained of some orthopnea during admission and le edema worsened. her home torsemide was restarted as resulted. . #hld: chronic stable. she was continued on her home simvastatin 40 mg po daily. . chronic: #dm2, controlled: chronic stable. her metformin was held and she was started on a hiss and nph. her nph was increased to her home dose after she was tolerating po and became extremely hyperglycemic. we will restart her metformin at time of discharge . #anemia: chronic stable. normocytic. her h+h and platelets were decreased on hd#1 but this is likely secondary to hemodilution. she was started on po ferrous sulfate. iron studies showed mixed picture with some likely component of iron deficiency anemia. . #depression: chronic stable. her home medicationd were continued. transitional issues: # transition to rehab # follow-up with id for po vanco taper # follow-up with gi for recurrent c diff and strep bovis in urine. # follow up hepatology as anti-smooth muscle is positive # patient will need to be vaccinated for hepatitis b given radiology finding of cirrhosis and not immunized # trend h/h to make sure increasing on iron deficiency. recommend outpatient screening colonoscopy medications on admission: preadmission medications listed are correct and complete. information was obtained from webomr. 1. aspirin 81 mg po daily 2. calcium carbonate 500 mg po tid 3. digoxin 0.125 mg po daily 4. duloxetine 20 mg po daily 5. metformin (glucophage) 1000 mg po bid 6. enalapril maleate 20 mg po daily hold for sbp < 100 7. metoprolol tartrate 25 mg po bid hold for sbp < 100 and hr < 60 8. mirtazapine 30 mg po hs 9. pregabalin 150 mg po bid 10. simvastatin 40 mg po daily 11. vancomycin oral liquid 125 mg po q6h 12. nph 52 units breakfast nph 56 units bedtime insulin sc sliding scale using hum insulin 13. vitamin d 800 unit po daily 14. warfarin 3 mg po daily16 discharge medications: 1. aspirin 81 mg po daily 2. calcium carbonate 500 mg po tid 3. duloxetine 20 mg po daily 4. enalapril maleate 20 mg po daily hold for sbp < 100 5. nph 65 units breakfast nph 65 units bedtime insulin sc sliding scale using hum insulin 6. metoprolol tartrate 37.5 mg po tid hold for sbp < 100 and hr < 60 7. mirtazapine 30 mg po hs 8. pregabalin 150 mg po bid 9. simvastatin 40 mg po daily 10. vancomycin oral liquid 500 mg po q6h 11. vitamin d 800 unit po daily 12. warfarin 6.5 mg po daily16 13. clobetasol propionate 0.05% ointment 1 appl tp 14. ferrous sulfate 325 mg po daily 15. torsemide 60 mg po daily 16. metformin (glucophage) 1000 mg po bid discharge disposition: extended care facility: at discharge diagnosis: primary: c difficile infection secondary: hypotension, atrial fibrillation, acute renal failure, type ii diabetes discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms , it was a pleasure taking care of you during your recent stay at . you were admitted with a rapid heart rate and dehydration because of your c difficile infection. your oral antibiotic (vancomycin) was increased because you had apparently failed therapy. your diarrhea resolved. you will need a prolonged taper of this medication because you have failed therapy in the past. additionally your inr was low and so we increased your metoprolol. they will continue to adjust this at rehab. we also continued to change your metoprolol for better heart rate control. followup instructions: department: center when: tuesday at 9:30 am with: , m.d. building: sc clinical ctr campus: east best parking: garage department: cardiac services when: tuesday at 10:30 am with: , np building: sc clinical ctr campus: east best parking: garage department: when: wednesday at 10:00 am with: , pharm d building: sc clinical ctr campus: east best parking: garage 09:20a , b (liver center) lm bldg (), liver center (sb) department: infectious disease when: friday at 10:00 am with: , md building: lm bldg () campus: west best parking: garage name: , h. location: address: , 1, , phone: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. procedure: central venous catheter placement with guidance diagnoses: acidosis thrombocytopenia, unspecified pure hypercholesterolemia tobacco use disorder congestive heart failure, unspecified cirrhosis of liver without mention of alcohol acute kidney failure, unspecified atrial fibrillation personal history of malignant neoplasm of bronchus and lung other chronic pulmonary heart diseases diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes depressive disorder, not elsewhere classified hypopotassemia cellulitis and abscess of leg, except foot osteoporosis, unspecified intestinal infection due to clostridium difficile other acquired absence of organ long-term (current) use of anticoagulants iron deficiency anemia, unspecified obesity, unspecified personal history of urinary calculi dehydration other psoriasis chronic diastolic heart failure venous (peripheral) insufficiency, unspecified long-term (current) use of aspirin orthostatic hypotension personal history, urinary (tract) infection acquired absence of organ, lung 

Answer: The patient is high likely exposed to