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: codeine / sulfa (sulfonamides) / vancomycin / ciprofloxacin attending: chief complaint: transferred from hospital after syncope in the setting of atrial fibrillation, bradycardia, s/p v fib arrest treated w/ dccv. major surgical or invasive procedure: cardiac catheterization electrophysiology study permanent pacemaker placement history of present illness: 77-yo-woman w/ mmp including atrial fib and valvular heart disease initially had unwitnessed syncope this am while toileting. before using the bathroom, she had been feeling nauseated and fatigued. awoke on the toilet after loc of uncertain duration and called ems, who arrived to find the pt nauseated, dizzy, and mildly dyspneic, w/ hr 30 and bp 140/80. ems treated w/ atropine 0.5 mg iv x 2, resulting in hr increased to atrial fib in the 70s, bp increased to 160/100. she was then transported to hospital ed. . at hospital ed, her hr was again in the 40s w/ bp 210/90, and she was reportedly mentating well. fifteen minutes later, she was found to be unresponsive w/ telemetry interpreted as ventricular fib. no documentation regarding pt's bp or pulse status at that time, but cpr was started, pt was intubated, and amiodarone 150 mg iv given as bolus dose. after "a few seconds" the rhythm converted to ventricular tach and then to atrial fib w/ pvcs. she was then admitted to the ccu. . in the ccu, she was extubated easily. amiodarone gtt was started, but stopped soon after because hr decreased to 30s. pt was transfused 2 units ffp in prep for placement of transvenous pacing wire. before the procedure, she had episode of v tach --> v fib treated w/ dccv at 200 joules, resulting in return to atrial fib. the pacing wire was then placed through right femoral vein. after the pacer demonstrated appropriate capture and paced rhythm at 70 bpm, amiodarone gtt was resumed at 1 mg/hr. she is now transferred to the ccu for further care. . currently, she c/o mild right sided chest pain w/ no cough, dyspnea, palpitations. ros reveals increasing doe over past 2 months requiring wheelchair for excursions outside the home; otherwise unreliable given acute delirium. past medical history: - atrial fibrillation: on coumadin - valvular heart disease: mild to mod ar, mild mr, mod to severe tr - htn - bradycardia: in setting of concurrent beta blockade and calcium channel blockade - pulm htn: tte w/ lvef 65-70%; pa pressure 65 mm hg - copd: fev1 0.97 --> 1.12 after bronchodilators - lung ca: bronchoalveolar ca s/p l lobe resection - colon ca: t3n1 adenoca s/p right hemicolectomy - hypothyroidism - anxiety disorder - mrsa bacteremia after thoracotomy - s/p cholecystectomy social history: smoked 60 pack-years, but quit 2 years ago. there is no history of alcohol abuse. family history: non contributory physical exam: vs: t 97.1, bp 143/68, hr v paced at 70, rr 23, o2 sat 100% 2l/m nc gen: elderly woman lying flat in bed, speaking in full sentences in nad, w/ visual hallucinations. heent: anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with no jvd. cv: faint reg s1/s2, + 2/6 systolic murmur at llsb, no s3/s4/r pulm: poor breath sounds anteriorly, no wheezes or crackles abd: +bs, soft, ntnd, + 2cm supraumbilical surgical scar ext: warm, no edema, faint right radial and strong left radial pulses, strong right dp, no palpable left dp, strong left femoral pulse. neuro: alert, oriented to person only, cn 2-12 intact, strength throughout except rle not tested because of indwelling temp pacer, sensation to fine touch intact throughout. pertinent results: ekg initially demonstrated atrial fib w/ rate 50, nl axis, nl int, twi diffusely, st depression v4-v6. . admission labs: 138 102 16 -------------< 167 3.7 21 1.3 ca: 9.3 mg: 2.0 p: 3.2 tsh:3.7 free-t4:1.2 dig: <0.2 cholesterol:117 triglyc: 87 hdl: 56 ldlcalc: 44 . 10.7 14.7 >----< 241 32 . pt: 37.4 ptt: 50.9 inr: 4.1 . dishcarge labs: wbc 23 (stable in low 20's after onset of infectious diarrhea) hct: 30.7 on discharge (stable in low 30's throughout) inr: 4.1 - 3.7 - 1.3 - 1.5 - 1.8 --1.9 () creatinine: 1.6 (stable 1.6-1.8) ck 159 - 138 - 156 mb 8 - 7 - 21 trop 0.13 - 0.10 - 0.19 na: 138 - 131 - 128 - 126 - 126 - 127 () . micro: blood 6/13 x 2: no growth urine ; : klebsiella pan sensitive. urine : no growth . ***stool : c.diff positive . radiology: carotids: minimal plaque with bilateral less than 40% carotid stenosis. . echo: there is moderate to severe regional left ventricular systolic dysfunction with mid to distal septal akinesis and apical dyskinesis/akinesis.. there is focal hypokinesis of the apical free wall of the right ventricle. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is moderateto severe pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. . : cardiac cath: 1. selective coronary angiography of this right dominant system revealed no obstructive cad. the lmca, lcx and lad had no angiographically apparent flow limiting stenoses. there was a fistula from the lad to the lv. the rca was a dominant vessel with a large embolus in the distal vessel. there was a small embolus in the av nodal branch. 2. limited resting hemodynamics revealed systemic hypertension. 3. left ventriculography was deferred. final diagnosis: 1. no obstructive coronary artery disease. 2. embolus in distal rca and av nodal branch. . echo: the left ventricular cavity size is normal. lv systolic function appears depressed. there is mid septal akinesis/hypokinesis and apical septal hypokinesis. right ventricular chamber size is normal. there is focal hypokinesis of the apical free wall of the right ventricle. the aortic valve leaflets (3) are mildly thickened. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is at least mild-moderate mitral regurgitation (not fully assessed). the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a small pericardial effusion. there are no echocardiographic signs of tamponade. compared with the prior study (images reviewed) of , left ventricular systolic function appears improved. . : ruq ultrasound: 1. no biliary dilatation. 2. distention of the central right renal collecting system, likely indicating a upj obstruction. ct may be performed for further evaluation if clinically indicated. ultrasound cannot exclude pyelonephritis. . : ct abd: 1. moderate-sized right pleural effusion and adjacent airspace disease which may represent compressive atelectasis, however, infection cannot be excluded. 2. extrarenal pelvis on the right. no evidence of obstruction. 3. left posterolateral hernia containing retroperitoneal fat, of uncertain cause given the lack of evidence of surgery in that region. 4. partial right colectomy with post-surgical changes. 5. sigmoid diverticulosis without evidence of diverticulitis. 6. presacral edema, which may be related to fluid overload given the presence of diffuse subcutaneous edema. . : cxr: mild cardiac failure and right pleural effusion with associated atelectasis . : ct chest: 1. moderate right pleural effusion with associated compressive atelectasis. 2. ill-defined patchy opacity with air bronchograms in the superior posterior aspect of the left lower lobe. it would be helpful to compare with old studies to assess for interval change. in this patient post-cardiac arrest, this could represent a focus of aspiration or infiltrate. neoplasm cannot be excluded, and followup by ct (after treatment within three months) is recommended. 3. 7 mm right middle lobe nodule. three-month ct followup is recommended. 4. multiple bilateral rib fractures. 5. centrilobular emphysema, mild-to-moderate. 6. cardiomegaly and coronary artery disease. 7. extensive subcutaneous edema, without evidence of pulmonary edema. brief hospital course: ms. is a 77-year-old woman w/ atrial fib, valvular heart disease including severe tr, pulm htn, copd, htn, hypothyroidism, lung ca s/p lul resection, colon ca s/p hemicolectomy, now transferred from ccu w/ temporary pacer after syncope in the setting of bradycardia and v fib arrest s/p dccv. hospital course by problem: . #) rhythm: afib at baseline, was being worked up for pacer by outpatient cardiologist (dr. , syncope, now with episodes at osh of polymorphic v-tach and ventricular fibrillation. given patient's month long increased shortness of breath, there was concern that the patient had a painless ischemic event that resulted in decompensated cardiac function and worsening heart failure. we checked ce and performed echo to assess for poor ef and did not find this. we monitored the patient on tele and interrogated the temp pace daily. she had a slow intrinsic rate/rhythm in the 40s. the pacer was confirmed by cxr. ultimately (after rx of infection) the patient had a pacer placed without an aicd given her relatively normal ef. this was performed on without complication. . #) id: the patient had a rising wbc and was treated with macrobid for uti. her white count continued to rise and she was transitioned to zosyn for broader coverage. ultrasound was worrisome for possible hydronephrosis on the right kidney. followup ct abd showed an extrarenal pelvis and no evidence of hydronephrosis. urine culture grew pansensitive klebsiella and she was changed to to augmentin and completed a 10 day course of antibiotics. once her infection seemed appropriately treated, a pacer was placed as above. she then was noted to have diarrhea and although initial stool cultures were negative for c.diff patient had a positive culture on . she is currently on a 14 day course of flagyl. her wbc remains elevated at 20 however she remains afebrile and clinically improved. her stool out put is approximately loose stools per day. . #) cad: recently failed an outpatient stress test. ce and cath as above. echo as above. we treated with asa and statin. we also treated with a heparin gtt given her afib but also embolic disease seen on cath and was then started on coumadin without a heparin bridge. she did not experience chest pain, and there was no obstructive coronary disease on cath save for the embolic event to the av nodal branch and distal rca which remains of questionable clinical significance. per cardiology consultation, patient remained on anticoagulation likely for the long term given her underlying a.fib. . #) pump: as above. pump function initially impaired but this was thought vfib arrest, compressions, and dccv. repeat echo was improved. aicd not recommended. cxr showed mild/mod failure so the patient was initially diuresed. she is discharged off lasix and acei due to dehydration and hyponatremia. she may eventually require prn lasix and and acei may be added once her remain function remains stable. her weight should be measured daily to follow her volume status and lasix given should her weight increase by kgs over a 2 day period. . #) copd: well controlled w/ spiriva and albuterol as an outpt; we continued these interventions. . #) tachynpnea: patient was often tachypneic ranging from 20-30s but with no hypoxia. given her history of both colon and lung cancer, a ct scan of the chest was obtained which was as above. we recommend a followup ct in three months to assess interval change of 7mm right middle lobe opacity and lll patchy opacity. she was tachypnic at baseline, thought to be multifactorial = chest bruising, anxiety, effusion. her oxygen saturations remained stable on room air. diuresis was held as above given dehydration. . #) hyponatremia: reached a nadir of 126. this was thought to be secondary to aggressive diuresis. her urine lytes were consistent with pre-renal azotemia and not siadh. we also considered pulmonary process given her tachypnea and history of lung cancer thus obtained the ct chest as above. her sodium is stable on discharge at 127 however she requires close monitoring of her electrolytes. . #) htn: controlled w/ diltiazem and lisinopril as outpt. we treated with bb, spironolactone and lasix in house. upon discharge she is on a beta blocker alone with good blood pressure control. lisinopril may be added back as an outpatient if needed. . #) anxiety: diazepam at low doses as needed. . #) hypothyroidism: controlled w/ levothyroxine . #) communication: hcp . #) full code. medications on admission: allergies: - sulfa - vancomycin - cipro - codeine . medications at home: - diltiazem 120 mg qam, 60 mg qpm - lisinopril 5 mg daily - coumadin 4 mg alternating w/ 2 mg every other day - lasix 100 mg po every other day - synthroid 75 mcg daily - valium 2 mg po qhs prn - spiriva daily - albuterol inh prn discharge medications: 1. coumadin 2 mg tablet sig: two (2) tablet po at bedtime. disp:*60 tablet(s)* refills:*2* 2. albuterol 90 mcg/actuation aerosol sig: two (2) puffs inhalation every four (4) hours. disp:*1 inhaler* refills:*2* 3. atorvastatin 40 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*0* 4. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 5. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 6. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 7. diazepam 2 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for agitation. 8. lasix 20 mg tablet sig: one (1) tablet po once a week as needed for weight gain more than 2 kgs. 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed. 11. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 12. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 13. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 14. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 15. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. 16. metronidazole 500 mg tablet sig: one (1) tablet po three times a day for 11 days: start date . discharge disposition: extended care facility: rehab & care center discharge diagnosis: primary: - c.diff diarrhea - syncope - urinary tract infection - polymorphic vt - chronic atrial fibrillation - pacer dependent bradycardia - transient ischemic attack, resolved - long qt in setting of bradycardia - congestive heart failure, systolic - hypertension - copd - hyponatremia - persistent right pleural effusion secondary: - valvular heart disease: mild to mod ar, mild mr, mod to severe tr - pulmonary htn - bronchoalveolar lung ca s/p left lobe resection - colon cancer: t3n1 adenoca s/p right hemicolectomy - hypothyroidism - anxiety disorder nos - hx of mrsa bacteremia after thoracotomy - s/p cholecystectomy discharge condition: fair - stable o2 saturation, able to get out of bed to chair, needs ongoing physical therapy and rehabilitation, no further episodes of malignant tachyarrythmias s/p permanent pacemaker placement. discharge instructions: you came in after having syncope in the setting of atrial fibrillation, bradycardia and having a polymorphic ventricular tachycardia arrest, felt secondary to bradycardia and consquent long qt. you developed a urinary tract infection and we treated with iv antibiotics. you required a temporary pacer and ultimately had a permanent pacemaker placed by dr. once the infectious issues were felt to be resolved. . please take all of your medications as instructed. please followup with your pcp and cardiologist as instructed. if you notice any significant palpitations, chest pain, worsening shortness of breath, abdominal pain or leg swelling, please contact your pcp or come to an emergency department for an evaluation. followup instructions: provider: clinic phone: date/time: 10:30 . please followup with your pcp, . on @ 10:45am . please have a followup ct of your chest within 3 months to assess interval change. md, procedure: coronary arteriography using two catheters left heart cardiac catheterization insertion of temporary transvenous pacemaker system initial insertion of transvenous lead [electrode] into ventricle initial insertion of single-chamber device, not specified as rate responsive artificial pacemaker rate check diagnoses: hyperpotassemia tobacco use disorder unspecified pleural effusion urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute kidney failure, unspecified hyposmolality and/or hyponatremia unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation personal history of malignant neoplasm of bronchus and lung other chronic pulmonary heart diseases mitral valve insufficiency and aortic valve insufficiency rheumatic heart failure (congestive) anxiety state, unspecified atrioventricular block, complete intestinal infection due to clostridium difficile old myocardial infarction personal history of malignant neoplasm of large intestine ventricular fibrillation unspecified transient cerebral ischemia diseases of tricuspid valve long qt syndrome tachypnea 

Answer: The patient is high likely exposed to