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 attending: chief complaint: cc: emesis, diarrhea, fever major surgical or invasive procedure: none history of present illness: hpi: pt. is a 76 yo female with a history of esrd on hd, cad, atrial fibrillation, and dm2 who presents with a 1 day history of 3 episodes of nonbloody, nonbilious, clear emesis and 1 episode of nonbloody diarrhea. the patient woke up in her usoh this am when she suddenly developed 3 episodes of emesis and 1 episode of diarrhea. she reports that she did not eat breakfast this morning, and has had no change in her diet. she has a sick contact: a next door neighbor in rehab had vomiting and diarrhea recently. she denies abdominal pain/cramping, chest pain, palpitations, sob, dysphagia, cough, sore throat, ha, dysuria, neck stiffness. she does report passing gas. she has been tolerating po food and fluid. of note, she was discharged from for an ugib pud so has been off coumadin. on the day of admission she finished treatment for h. pylori (clarithromycin, flagyl, and ppi), which she reports giving her a sour taste in her mouth. . in the ed, her vital signs were temp 100.1, hr 88, bp 160/71, rr 18, sao2 100% on ra. the patient was given lunch in the ed. she had an ekg which showed nsr, in i, avl, no st changes. ct abdomen/pelvis, cxr, and abdominal films were negative for acute disease. wbc 12.1 -> 7.9. troponin 0.32 -> 0.26, ck 61 -> 50, and the patient was admitted for further work-up and to r/o mi. . on the floor, the patient continued to have no symptoms and reported no pain. she remained febrile to 102.2 and tachycardic to 120. she was given ivf ns 500 cc bolus x1, and her sbp became 90. she then received ivf ns 500 cc bolus x2, but her sbp remained 85. no ekg changes. micu was called for evaluation for transfer. past medical history: pmh: - esrd on hd qtues, thurs, satuday. baseline cr 3.5-5.0. s/p failed transplant . left av fistula. patient does not make urine. - ugib , received 3 u prbcs, egd showed ulcers in the antrum, above pylorus, at 12 o'clock and 2 o'clock. 2nd ulcer had visible vessel, nonbleeding. (thermal therapy). - cad s/p nstemi treated at , ?nstemi/demand mediated ischemia with recent gib. patient has a baseline troponin t of 0.08-0.16 ( records). - htn - hyperlipidemia - atrial fibrillation currently off coumadin ugib, s/p pacemaker placement - chf: per cards note echo : s/p mvr, mod-severe tr, atrial dilatation, lvef 45%, followed mostly at (last tte here ); report of eval at hospital : dr. , 55-60% with lvh and new wall motion abnormalities, severe phtn (>65mmhg). - pulmonary hypertension as above - dm2, last hga1c 6.7% on . - peptic ulcer disease, recently finished triple abx therapy (clarithromycin 500 mg daily, flagyl 500 mg po bid, protonix 40 mg ) for h. pylori - multiple pelvic fractures: ct pelvis ( ) showed multiple pelvic fractures involving superior and inferior pubic rami bilaterally as well as the right side of the sacrum. the patient is s/p orif of left hip fracture. this is well healed and no acute hip fractures are seen. - gerd - cirrhosis - ascities - inguinal hernia - lower extrem edema - valvular disease - stage ii/iii sacral decubitis ulcer - r sided sciatic pain social history: social hx: prior to recent admit with multiple pelvic fractures had been living at home, independent of adl's. since then she has been living in (rehab). no tobacco, occ. alcohol, no illicit drug use. supportive son. family history: family hx: nc physical exam: physical exam: vitals: temp 102.2, bp 94/34, hr 88, rr 20, sao2 93% on ra general: awake, alert, nad. alert to person, place, time. heent: ncat, dry mucous membranes. no pharyngeal erythema. no submandibular, supraclavicular, or anterior cervical lymphadenopathy. perrl. eomi. no nuchal rigidity. cv: regular rate. nl s1, s2, iii/vi systolic murmur best heard at apex. pulm: decrease breath sounds. bibasilar crackles. no wheezes/rhonchi. abd: positive bowel sounds. soft, ntnd abdomen. no masses. no guarding or rebound. guaiac negative in the ed. ext: 1+ pitting ankle edema bilaterally, 1+ dp pulses bilaterally. l av fistula in place. pertinent results: studies: ct abdomen/pelvis (): impression: 1. no evidence of obstruction or acute intra-abdominal pathology. 2. right-sided renal lesion concerning for carcinoma and not completely characterized on this single phase of contrast study. mri is recommend for further evaluation. 3. bilateral healing pelvic fractures, one of which involves the left acetabulum. 4. 9 mm partially calcified splenic artery aneurysm. . cxr (): impression: bilateral pleural effusions and associated atelectasis. no infiltrate or evidence of pulmonary edema. . abdomen films (): impression: subacute fractures of right superior and inferior pubic rami; no evidence of obstruction or free air. . ekg: nsr, no , elevation in v2, st depression in v6 (noncontiguous) . renal u/s (): impression: mixed solid and cystic right interpolar renal lesion as noted on ct examination. findings are still concerning for neoplastic involvement and dedicated mri examination is recommended. brief hospital course: 76 yo female with a history of esrd on hd, cad, atrial fibrillation, and dm2 who presents with a 1 day history of vomiting and diarrhea. . # fever. patient presented with a 1 day history of emesis and diarrhea, with a temperature of 100.1. ct abd/pelvis was without evidence of acute intra-abdominal pathology, cxr was without evidence of infiltrate, and abdominal film was without free air. wbc was initially 12.1 with a left shift, and lactate 0.8. the patient was transferred to the micu on the day of admission for fever up to 102.2 and hypotension; in the icu the fever defervesced without antibiotics and she remained afebrile. she most likely had a viral gastroenteritis causing her symptoms. patient was also tachycardic, which was likely a response to fever or dehydration, as patient denied any pain. blood cultures taken at that time were with no growth. (ua/urine cx not able to be done as patient makes minimal urine.) c. difficile toxin was negative x 3. fecal culture negative for salmonella, shigella, and campylobacter. diarrhea resolved spontaneously without intervention prior to discharge. . # hypotension: on admission, she had fever and hypotension down to 88/40. she was given ivf ns 500 cc bolus x2 without initial improvement in her bp. she was transferred to the micu, where her bp incrased up to 110s. she was transferred back from micu with sbp up to 110s. the patient also developed hypotension down to sbp in the 70s during 3 hd sessions when given iv lopressor and iv diltiazem for treatment of a fib with rvr into 140s-170s (see below). . # atrial fibrillation: patient initially in nsr on admission. patient has a dual chamber icd, followed by dr. at . her coumadin is being held for at least 1 month pending gi f/u s/p ugib at the beginning of . she was continued on asa 81 daily. beta blocker was initially held when patient was hypotensive. outpatient metoprolol dose was initially continued at 25 mg qmwf, 25 mg qhs qtuthsa. however, she was developing a fib with rvr into 140s-170s with hd, but this was increased to metoprolol 25 po bid for better hr control. the patient developed afib with rvr at 3hd sessions, treated with iv lopressor and diltiazem. she becomes hypotensive during these episodes (usually down to 70/30) but responsive to ivf boluses. the patient once c/o chest pain, ce negative x 3 at this time. digoxin was started on (renally dosed) with post-load digoxin level of 1.6 and no ekg changes consistent with digoxin toxicity. she was continued on a daily dose of digoxin at 0.125mg qd. f/u monitoring on showed level of 1.1. (digoxin levels should be monitored until they reach steady state.) . # erratic pacemaker firing: patient has a dual chamber icd, and is followed by dr. at . on telemetry, it was noticed that she had occasional pacemaker spikes on top of t waves. ep was consulted and interrogated her icd. she was found to have a normal functioning icd, and the spikes appeared to be undersensing of a fib waves with inappropriate atrial pacing. this was not thought to be dangerous. the patient will need to follow up with her outpatient electrophysiologist (dr. at ) upon discharge. . # renal lesion: ct abdomen showed a right-sided renal lesion concerning for carcinoma. renal u/s showed mixed solid and cystic right interpolar renal lesion as noted on ct examination concerning for neoplastic involvement. an mri was unable to be completed as patient has icd and rod in leg. the patient is unlikely a good surgical candidate. the patient is to follow-up with urology (dr. for further evaluation and management of this. . # esrd: patient was continued on usual hd schedule: qtues, thurs, satuday. baseline cr 3.5-5.0. she developed a fib with rvr and hypotension during 3 hd sessions as above, and they had to be terminated early. the patient received uf to remove total of 3kg prior to discharge. the patient continued nephrocaps and calcium, and patient received epogen with hd sessions (note: did not receive epo on - will need dose at next hd session.) she will need to reschedule her appointment with dr. in and mineral as she missed her appointment while in the hospital. she will also eventually need an endocrinology appointment to evaluate disease. . # elevated troponins: patient has a baseline elevated troponins per records (0.08-0.16). troponins here have been 0.32 -> 0.19 with flat ck-mb. ekg without any acute changes. continued asa 81 daily. . # hyperlipidemia: continued simvastatin. . # dm: continued nph , riss, fsbg qachs. . # chronic diastolic chf: stable . # subacute pelvic fracture: found on ct, seen again on pelvic ct here. patient given tylenol prn and oxycodone 2.5 mg po q6h prn while inhouse. . # sacral decubitus ulcer: daily duoderm dressing changes with saline cleansing. . # pud: patient finished pud treatment on the day of admission (clarithromycin, flagyl, ppi). continued protonix 40 mg . she has an appointment with dr. in gastroenterology on . . # on the patient was discharged in stable condition, afebrile with vss to rehab for further care. medications on admission: medications (per recent d/c summary): -oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. -docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. -senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. -calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). -acetaminophen 500 mg tablet sig: two (2) tablet po q12h (every 12 hours) as needed for pain. -b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). -albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) inhalation q2h (every 2 hours) as needed for wheezing. -ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. -metoprolol tartrate 25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)): on tu/th/sa, hold for sbp<100 and hr<60. -metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day): on m/w/f/sunday hold for sbp<100 or hr<60 . -heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). -metronidazole 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 11 days. -clarithromycin 250 mg tablet sig: two (2) tablet po daily (daily) for 11 days. -pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). -simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). -aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). -nph 16 qam, 3 qpm and hiss . allergies: codeine discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). 5. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 6. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) inhalation q6h (every 6 hours) as needed. 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 8. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for sob/wheeze. 11. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 12. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 13. oxycodone 5 mg tablet sig: 0.5 tablet po q6h (every 6 hours) as needed for pain. 14. digoxin 125 mcg tablet sig: one (1) tablet po every other day (every other day): last dose 10/24. 15. white petrolatum-mineral oil cream sig: one (1) appl topical (2 times a day) as needed. 16. insulin nph & regular human 100 unit/ml (50-50) suspension sig: one (1) vial subcutaneous once a day: please administer nph 16u qam, 3u qpm, and hiss as follows: gluc < 60 --> 4oz juice 61-150 --> 0u 151-200 --> 2u 201-250 --> 4u 251-300 --> 6u 301-350 --> 8u 351-400 --> 10u > 400 --> notify md. discharge disposition: extended care facility: - discharge diagnosis: primary: 1. gastroenteritis 2. hypotension 3. atrial fibrillation 4. right renal lesion secondary: 1. esrd 2. diabetes mellitus 2 3. peptic ulcer disease 4. chronic diastolic chf 5. subacute pelvic fractures 6. sacral decubitus ulcer 7. hyperlipidemia 8. hypertension 9. gerd discharge condition: stable, afebrile, vss discharge instructions: you were admitted to the hospital with vomiting and diarrhea, most likely due to a viral illness. during the admission your irregular heart rhythm became difficult to control, and your metoprolol was increased to 25mg twice a day every day. we also added a new medicine, digoxin. you were found to have a mass in your kidney which dr. in urology will follow. 1. take all medications as prescribed 2. please make all follow-up appointments 3. if you develop worsening fevers >101.5, chills, nausea, vomiting, diarrhea, chest pain, palpitations, shortness of breath, or any other concerning symptoms, contact your provider or report to the emergency department followup instructions: please follow up with your pcp 2 weeks of discharge: , . you have an appointment with dr. , m.d. on at 1:00pm, phone: for evaluation of a renal mass found on ct. . you need to make a follow up appointment with your outpatient elecrophysiologist, dr. , at . . you will need to reschedule your appointment with dr. in and mineral in center, (you missed your appointment because you were in the hospital). . you have an appointment with dr. in gastroenterology on at 11:00 in the building ( complex), endoscopy suites, gi west,room two procedure: hemodialysis diagnoses: end stage renal disease congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation other and unspecified hyperlipidemia unspecified disorder of kidney and ureter pressure ulcer, lower back automatic implantable cardiac defibrillator in situ chronic diastolic heart failure hypotension of hemodialysis intestinal infection due to other organism, not elsewhere classified 

Answer: The patient is high likely exposed to