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: sulfonamides / shellfish / iodine containing agents classifier / codeine / morphine / heparin agents attending: chief complaint: abdominal pain major surgical or invasive procedure: none history of present illness: ms. is a 64-year-old woman with a history of esrd on hemodialysis, cad s/p mi and pci, pvd s/p aorto-femoral bypass, diastolic heart failure, asthma, and chronic abdominal pain who presented with acute on chronic abdominal pain and is transferred to the for hypoxic respiratory failure. . she was last discharged on after presenting with acute on chronic abdominal pain. her evaluation was negative for acute etiologies and she was discharged with outpatient gi follow-up but was unable to keep her appointment. she was in her usual state of health until this morning when she awoke with worsening of her abdominal pain, nausea, two episodes of diarrhea with loose, watery stools, and three episodes of nonbloody emesis. she denied fevers, chills, but had a non-productive cough with thick sputum last night which had resolved by this morning. she was at yesterday and had 4.5l removed per her report, but she has had worsening shortness of breath since last thursday when she missed her session. she did undergo on saturday. . in the ed initial vital signs were 98.1 82 187/75 16 96%o2 sat on nrb. she was found to be hypoxic to 78%3l, hypertensive to sbps 180s, and tachypneic with abdominal pain described as sharp epigastric pain with radiation to her back, and her exam was notable for bibasilar rales and guaiac neg brown stool. she was given dilaudid iv .5 mg x 1 and 1 mg x 1 and placed on a nrb with o2 sat rising to 97%. a chest x-ray was performed and demonstrated bilateral patchy infiltrates and small pleural effusions, and she was given vanc/levofloxacin empirically for pneumonia. renal was contact for possible , and icu admission was requested for hypoxic respiratory failure. . on arrival to the floor, she is requesting pain medication for her abdominal pain and appears uncomfortable. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain or tightness, palpitations. denies wheezes. no dysuria. denies arthralgias or myalgias. denies rashes or skin breakdown. no numbness/tingling in extremities. no feelings of depression or anxiety. all other review of systems negative. past medical history: - "about 20" hospitalizations over the past 5-6 years for epigastric pain that has eluded definitive diagnosis. according to her primary care physician, carries a diagnosis of chronic pancreatitis, although this has not been confirmed. multiple attempts to have her seen in the outpatient gi unit have failed because she has not been able to keep her appointments. - coronary artery disease; s/p mi in (received stent to rca and right pda at ) - esrd diagnosed "10 years ago"; has received hemodialysis since that time. receives hd on tues, thurs, and sat. last was yesterday. baseline creatinine is in range. - peripheral vascular disease: s/p aorto-femoral bypass with atherectomy in after near total occlusion; multiple revisions of her aorto-bifemoral and cross femoral grafts since then - possible chronic mesenteric ischemia with known occlusion of inferior mesenteric artery. - exploratory laparotomy for pancreas divisum with sphincterectomy of her minor duct in - asthma - schizoaffective disorder - hypertension - insulin-independent diabetes mellitus (last measured hba1c 6.6% in ) - history of dvt and clots in aorto-femoral bypass - lumbar disc disease (with associated back pain) - hyperlipidemia - gastroesophageal reflux/gastritis ( egd) - chronic pancreatitis - s/p exploratory laparotomy for pancreas divisum with sphincterotomy of her minor duct in - benign pelvic mass, s/p r oophrectomy and hysterectomy - s/p cholecystectomy - s/p arthroscopy of right knee and medial meniscectomy in ' - heparin-induced thrombocytopenia (positive antibody) family history: siblings passed away from cad/heart attacks physical exam: on admission: gen: nad vs: 98 177/73 78 24 98%nrb heent: mmm, no op lesions, jvp undetectable, neck is supple, no cervical, supraclavicular, or axillary lad cv: rr, nl s1s2 no s3s4 mrg pulm: coarse bibasilar rales abd: bs+, soft, marked ttp in epigastrum. limbs: no le edema, no tremors or asterixis, no clubbing skin: no rashes or skin breakdown neuro: cnii-xii nonfocal, strength 5/5 of the upper and lower extremities on discharge: gen: nad vs: 97.4, 127/58, 64, 16, 97% ra heent: mmm, no op lesions neck: jvp undetectable, neck is supple cv: rr, normal s1 and s2, + 2/6 systolic murmur best at rusb, no rub or gallop pulm: ctab, minimal bibasilar crackles, no wheeze or rhonchi. abd: bs+, soft, minimal epigastric discomfort, non-distended, no rebound and guarding limbs: no le edema, no tremors or asterixis, no clubbing pertinent results: imaging: cxr: multiple areas of patchy opacity in the right mid-to-lower lung and possibly left lung base, raising concern for multifocal pneumonia. recommend followup to resolution. cxr: worsening pulmonary edema. new retrocardiac opacity likely representing atelectasis. abd x ray: in the single supine view, there is no evidence of large amount of free air within the peritoneal cavity. lateral decubitus views may be beneficial for further evaluation. air is seen within the colon and rectum. there are no dilated loops of small bowel or air-fluid levels to suggest obstruction. surgical clips are seen on the left margin of the pelvic inlet. no significant osseous abnormalities are identified. impression: no evidence a large amount of free air on this single portable supine view. if clinically indicated, we would recommend upright or lateral decubitus views for further evaluation. no evidence of small-bowel obstruction. echo: there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with focal basal inferior akinesis. the remaining segments contract normally (lvef = 45-50%). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild regional left ventricular systolic dysfunction, c/w cad. mild mitral regurgitation. moderate pulmonary hypertension. avf duplex hd access (prelim): no stenosis (pending final read) blood counts: 12:15pm blood wbc-8.1 rbc-4.71 hgb-11.0* hct-34.3* mcv-73* mch-23.4* mchc-32.1 rdw-18.9* plt ct-179 09:30pm blood wbc-11.6* rbc-4.64 hgb-10.8* hct-34.8* mcv-75* mch-23.2* mchc-31.0 rdw-18.7* plt ct-52*# 09:43am blood wbc-11.2* rbc-4.31 hgb-10.2* hct-32.2* mcv-75* mch-23.6* mchc-31.6 rdw-18.9* plt ct-57* 05:01pm blood parst s-negative 08:00am blood wbc-7.5 rbc-4.15* hgb-9.4* hct-31.1* mcv-75* mch-22.7* mchc-30.3* rdw-20.1* plt ct-133* chemistry: 12:15pm blood glucose-180* urean-17 creat-3.6*# na-129* k-greater th cl-92* hco3-27 09:30pm blood glucose-81 urean-19 creat-4.0* na-135 k-4.9 cl-95* hco3-26 angap-19 12:15pm blood lipase-46 09:30pm blood ck-mb-1 ctropnt-0.06* 12:15pm blood ck-mb-1 ctropnt-0.04* 09:43am blood glucose-127* urean-25* creat-4.8* na-134 k-4.5 cl-91* hco3-27 angap-21* 11:13am blood ret aut-3.0 11:13am blood vitb12-443 hapto-233* 11:13am blood d-dimer-3230* 11:13am blood fibrino-476* 11:13am blood tsh-1.4 11:13am blood vanco-6.8* 11:13am blood alt-15 ast-23 ld(ldh)-160 alkphos-156* totbili-0.3 08:00am blood glucose-195* urean-27* creat-5.5* na-131* k-4.2 cl-94* hco3-27 08:00am blood calcium-8.7 phos-1.5* mg-2.1 gases: 05:55pm blood type-art po2-65* pco2-52* ph-7.42 caltco2-35* base xs-7 intubat-not intuba comment-non-rebrea microbiology - blood cx negative x2 - mrsa screening negative brief hospital course: ms. is a 64-year-old woman with a history of esrd on hemodialysis, cad s/p mi and pci, pvd s/p aorto-femoral bypass, diastolic heart failure, asthma, and chronic abdominal pain who presented with acute on chronic abdominal pain and is transferred to the for hypoxic respiratory failure. # hypoxic respiratory failure: on admission it was believed that her respiratory failure was multifactorial with components of volume overload/pulmonary edema, and acute diastolic heart failure in the setting of hypertenion, and also pneumonia were also considered. given her past history signficant for multiple prior admissions for volume overload in the past, along with a cxr suggestive of fluid overload, fluid overload was the most likely diagnosis. she did not demonstrate clinical signs of infection, and improved with hd, but was started on antibiotics given the concern for possible infection. her respiratory status improved and she was transferred to the floor. patient continued to do while on the floor and was weaned off of o2 supplement. she completed a 6 day course of levofloxacin while in house. this can be followed up by her primary care physician # acute on chronic abdominal pain: patient has a long history of abdominal pain requiring multiple hospital admissions, with very poor outpatient follow-up. egd and colonoscopy performed in notable primarily for diffuse spasm of colon. she was started on iv dilaudid intially given her npo status for brief bowel rest. with advancement of her oral intake, she was switched to oral medication and transitioned to home medications as per her narcotics contract. she was discharged on home pain medications and will require refill per narcotics contract on . # thrombocytopenia: on admission, patient's platelets were 179. on day 2, plaetelets were 52. given the patient's history of hit, there was concern that the patient had accidentally gotten heparin. after discussion with the hd and floor teams, it was determined that she had not received any heparin in her flushes or dialysate. given this, her thrombocytopenia was determined to be secondary to either a drug effect or a platelet lysing effect of . her platelets remained stable at 57 on hospital day 3 and she was transferred to the floors with instructions to closely follow her platelet counts. heme was consulted with recommendation to transfuse if platelet < 50. it is possible that this could be from the antibiotics and it is negative for parasites or clumping. however, her platelet counts begin to climb without intervention. this should be followed closely by her primary care physician. # esrd on hemodialysis. she received hd on and in the setting of respiratory failure volume overload as described above. with the thrombocytopenia, there was some bleeding issue with the fistula. initially, a fistulogram was going to be performed, but patient has confirmed anaphylactic reaction to contrast dye. records from was obtained and showed that patient did have cardiac catheterization with angiography in the past and was pre-medicated to prevent the adverse effects. dopplar of her fistula did not show signs of stenosis. however, as her platelets climbed, her bleeding issue also resolved. she will continue to have her regular hemodialysis. this will be followed by her nephrologist. # history of cad s/p pci. non-active. she continued with home metoprolol, clopidogrel, rosuvastatin, imdur, and lisinopril. aspirin was held temporarily given her thrombocytopenia, was was re-initiated upon discharge. this can be followed up by her primary care provider. # hypertension, fluctuating. she continued on home meds and hd. see above for details. this can be followed up by her primary care provider and her nephrologist. # acute on chronic systolic/diastolic heart failure. ef estimated to be low on echo around the time of the acute exacerbation. she was treated with hd and supportive care. her symptoms improved. she may need to have repeat echo after resolution of her exacerbation to reassess baseline function at the outpatient basis. # schizoaffective disorder. non-active. she continued on amitriptyline, aripiprazole, and citalopram. no change was done. social work was consulted and found patient to have good resources, such as the pact team. she will follow up with her primary care providers and her psychiatrist. # asthma. patient continued with home medication. this can be followed up by her primary care provider. # diabetes mellitus, non-insulin dependent. her oral medications were held while in house. she was switched to an insulin sliding scale. patient did well in hospital and resumed her oral medication upon discharge. this can be followed up by her primary care provider. medications on admission: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: inhalation every 4-6 hours as needed for cough of wheeze. 2. amitriptyline 25 mg tablet sig: one (1) tablet po hs 3. amlodipine 5 mg tablet sig: one (1) tablet po once a day. 4. aripiprazole 15 mg tablet sig: one (1) tablet po daily 5. nephrocaps 1 mg capsule sig: one (1) capsule po once a day. 6. calcitriol 0.25 mcg capsule sig: one (1) capsule po once a day. 7. calcium acetate 667 mg capsule sig: one (1) capsule po tid 8. citalopram 40 mg tablet sig: one (1) tablet po once a day. 9. clopidogrel 75 mg tablet sig: one (1) tablet po daily 10. darbepoetin alfa in polysorbat 60 mcg/0.3 ml syringe sig: one (1) injection every other week. 11. ergocalciferol (vitamin d2) 50,000 unit : one capsule once a week 12. fentanyl 25 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 13. flovent hfa 110 mcg/actuation aerosol sig: one (1) inhalation 14. advair diskus 250-50 mcg/dose disk with device 1 inhalation 15. folic acid 1 mg tablet sig: one (1) tablet po once a day. 16. furosemide 40 mg tablet sig: one (1) tablet po twice a day. 17. glipizide 2.5 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. 18. hydralazine 50 mg tablet sig: one (1) tablet po tid 19. ipratropium bromide 0.02 % solution sig: one inhalation qid 20. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 21. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) topical once a day: 12 hours on 12 hours off. 22. metoprolol succinate 100 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po once a day. 23. omeprazole 20 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po once a day. 24. percocet 5-325 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. 25. prochlorperazine maleate 5 mg tablet sig: one (1) tablet po three times a day. 26. rosuvastatin 20 mg tablet sig: one (1) tablet po daily 27. sucralfate 1 gram tablet sig: one (1) tablet po qid 28. valsartan 160 mg tablet sig: one (1) tablet po twice a day. 29. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime). 30. ecotrin low strength 81 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po once a day. 31. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical 32. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po every six (6) hours as needed for indigestion. 33. acetaminophen 325 mg tablet sig: 1-2 tablets po tid prn 34. b complex tablet sustained release sig: one (1) tablet daily 35. docusate sodium 100 mg capsule sig: one (1) capsule po bid 36. ferrous sulfate 324 mg (65 mg iron) tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po bid 37. sevelamer carbonate 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 38. senna 8.6 mg capsule sig: one (1) capsule po bid:prn discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: inhalation inhalation every 4-6 hours as needed for shortness of breath or wheezing. 2. amitriptyline 25 mg tablet sig: one (1) tablet po hs (at bedtime). 3. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 4. aripiprazole 15 mg tablet sig: one (1) tablet po daily (daily). 5. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 6. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 7. calcium acetate 667 mg capsule sig: one (1) capsule po three times a day. 8. citalopram 40 mg tablet sig: one (1) tablet po once a day. 9. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 10. darbepoetin alfa in polysorbat 60 mcg/0.3 ml syringe sig: one (1) injection injection every other week. 11. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po once a week. 12. fentanyl 25 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours) as needed for pain: you will get your next prescription on . disp:*5 patch 72 hr(s)* refills:*0* 13. flovent hfa 110 mcg/actuation aerosol sig: one (1) inhalation inhalation twice a day. 14. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day): (advair). 15. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 16. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 17. glipizide 2.5 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po once a day. 18. hydralazine 50 mg tablet sig: one (1) tablet po tid (3 times a day). 19. ipratropium bromide 0.02 % solution sig: one (1) inhalation inhalation 4 times a day. 20. isosorbide mononitrate 30 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 21. metoprolol succinate 100 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po daily (daily). 22. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 23. percocet 5-325 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain: you will get your next prescription on . disp:*60 tablet(s)* refills:*0* 24. prochlorperazine maleate 5 mg tablet sig: one (1) tablet po three times a day. 25. rosuvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 26. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). 27. valsartan 160 mg tablet sig: one (1) tablet po bid (2 times a day). 28. zolpidem 5 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 29. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 30. camphor-menthol 0.5-0.5 % lotion sig: one (1) application topical twice a day. 31. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po every six (6) hours as needed for gas or indigestion. 32. acetaminophen 325 mg tablet sig: 1-2 tablets po every eight (8) hours as needed for pain: do not exceed 4 grams of acetaminophen (tylenol) especially if you are taking percocet. 33. b complex tablet sustained release sig: one (1) tablet sustained release po once a day. 34. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 35. ferrous sulfate 324 mg (65 mg iron) tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. 36. sevelamer carbonate 800 mg tablet sig: one (1) tablet po three times a day: please take with meals. 37. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 38. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) patch topical once a day: 12 hours on 12 hours off. discharge disposition: home with service facility: nizhoni discharge diagnosis: primary diagnosis: - hypoxic respiratory failure, resolved. - community acquired pneumonia - acute on chronic abdominal pain, not otherwise specified secondary diagnosis: - thrombocytopenia - end stage renal disease on hemodialysis (tuesday/thursday/saturday) - hypertension - insulin independent diabetes mellitus - history of coronary artery disease - acute on chronic systolic/diastolic heart failure - asthma - anemia - schizoaffective disorder discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to for abdominal pain that is worse than your regular pain and trouble breathing. you stayed briefly in an intensive care unit. it was thought the difficulty breathing was due to too much fluid in your lungs and also a pneumonia. you were treated with and antibiotics. your abdominal pain was not due to blockage in the bowel, and the discomfort was treated with bowel rest and pain medication. your symptoms improved over time. please note the following changes in your medications: none you are getting refills for your regular narcotics as stated in your narcotics contract. however, you will get the prescription for the following month from your primary care providers on . it will be important for you to follow up with your doctors below. you should have your primary care physician check your platelet count and electrolytes. you should continue to have your regular hemodialysis on tuesday, thursday, and saturday. weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: continue per outpatient routine. department: div. of gastroenterology when: wednesday at 11:15 am with: , md building: ra (/ complex) campus: east best parking: main garage department: when: wednesday at 11:20 am with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: hemodialysis diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified end stage renal disease other chronic pain abdominal pain, unspecified site renal dialysis status coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled asthma, unspecified type, unspecified peripheral vascular disease, unspecified percutaneous transluminal coronary angioplasty status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia acute respiratory failure old myocardial infarction other acute pain other and unspecified disc disorder, lumbar region unspecified gastritis and gastroduodenitis, without mention of hemorrhage acute on chronic combined systolic and diastolic heart failure schizoaffective disorder, unspecified other specified disorders of circulatory system 

Answer: The patient is high likely exposed to