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: penicillins attending: chief complaint: n/v, hypotension major surgical or invasive procedure: none history of present illness: the pt. is a 64 y/o f with a pmh of esrd on hd, dm, and htn presenting after dialysis with hypotension, nausea, vomiting and abdominal pain. the patient reports six episodes of emesis since hd with mild epigastric pain. per report temp to 100.5 at hd with complaint of aches and chills. 4l fluid taken off at hd, pre-treatment bp 96/58, post-treatment 169/92. t 97.8. . in the ed, initial vs were: t 102.9 bp 146/65, hr 110, rr 20 o2 92% ra. fs 215. blood cx sent. emesis x1. patient was given vancomycin 1gm iv, levofloxacin 500mg iv, flagyl 500mg iv, morphine 2mg iv. her bp fell to 94/43 and she was given 1 l ns. wbc 11.2, lactate 3.2. cxr demonstrated no evidence of infiltrate. ct abd/pelvis showed no evidence of colitis. per ed report, beside us showed limited views but a normal caliber aorta. . on arrival to the icu, the patient was resting comfortably. she denies lightheadedness. c/o b/l knee pain and low back pain unchanged from her baseline. the pt. reports increased fatigue x 1 week, she has had decreased mobility since her knee surgery in . she reports that typically post-hd she has increased enerygy, however she noted no improvement this week. denies fever, had chills last evening but temp was 97.8 at home. she c/o abd pain, similar to her chronic symptoms, mostly epigastric but burning symptoms occur in various locations with no clear pattern or relation to meals. denies cough, rhinorrhea. +frontal and occipital ha last pm. + chronic constipation, no diarrhea. her appetite is normal. past medical history: end stage renal disease on hemodialysis (tuthsa) - lsc hd catheter changed hx of back abscess - treated with i&d, vanc x 14 days diabetes mellitus type ii hypertension hypercholesterolemia coronary artery disease (nonobstructive on cath in , normal stress in ) constipation status post total abdominal hysterectomy status post c-section h. pylori s/p treatment in gastritis right knee subtotal medial meniscectomy and subtotal lateral meniscectomy with medial femoral chondroplasty social history: married and lives with husband, 2 children who live nearby, former home health aid. smokes < ppd x 40 years, quit in after being hospitalized for influenza. no etoh, no drugs. received the influenza and pneumococcal vaccines family history: + premature cad in brothers and mother. daughter with kidney disease. siblings with dm, cad, htn, cva, no cancer. physical exam: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, mild ttp epigastrium, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no edema skin: multiple scars from prev fistula attempts on both forearms, scar, scar - midback from prev. incision site, l sc site no erythema surrounding catheter + skin breakdown around adhesive dressing, no fluctuance, no drainage pertinent results: 01:15pm wbc-11.2*# rbc-3.97* hgb-12.7 hct-37.9 mcv-95 mch-32.0 mchc-33.5 rdw-15.1 01:15pm neuts-90.2* lymphs-4.6* monos-4.1 eos-0.8 basos-0.2 01:15pm plt count-203 01:15pm glucose-197* urea n-9 creat-2.9*# sodium-144 potassium-3.8 chloride-97 total co2-29 anion gap-22* 01:15pm alt(sgpt)-34 ast(sgot)-31 ck(cpk)-69 alk phos-193* tot bili-0.5 01:21pm lactate-3.1* 04:16pm lactate-2.3* 04:35am blood wbc-6.5 rbc-3.03* hgb-9.3* hct-28.8* mcv-95 mch-30.7 mchc-32.3 rdw-15.5 plt ct-207 04:35am blood glucose-98 urean-16 creat-4.6*# na-137 k-4.2 cl-98 hco3-28 angap-15 05:30am blood alt-20 ast-15 ld(ldh)-151 alkphos-143* totbili-0.3 01:35am blood lipase-36 01:15pm blood ck-mb-3 ctropnt-0.05* 04:35am blood calcium-10.3* phos-4.7*# mg-1.8 04:35am blood pth-1368* 06:35am blood vanco-9.8* 06:04pm blood vanco-12.4 05:55am blood lactate-1.2 1:00 pm blood culture **final report ** blood culture, routine (final ): presumptive peptostreptococcus species. isolated from one set only. bacillus species; not anthracis. sensitivity testing performed by sensititre. gentamicin = sensitive ( <=2 mcg/ml ). sensitivities: mic expressed in mcg/ml _________________________________________________________ bacillus species; not anthracis | clindamycin----------- 0.5 s gentamicin------------ s levofloxacin----------<=0.25 s vancomycin------------ <=1 s 1:15 pm blood culture **final report ** blood culture, routine (final ): bacillus species; not anthracis. sensitivities performed on culture # 266-9949d . anaerobic bottle gram stain (final ): gram positive rod(s). reported by phone to - # 2:30pm. consistent with clostridium and bacillus species. blood cx: , , , : no growth cardiology report ecg study date of 2:04:54 pm sinus rhythm. modest inferolateral t wave changes which are non-specific. compared to the previous tracing of there is no significant diagnostic change. cxr: impression: no significant change when compared to prior exam. ct- abd/pelvis: impression: 1. no evidence of colitis. 2. unchanged angiomylipoma of right kidney. multiple tiny hypodensities in the kidneys too small to accurately characterize. 3. several small nodules in the left adrenal gland likely not changed from but incompletely characterized on the current study. 4. atherosclerotic disease. ruq u/s impression: unchanged cholelithiasis with no secondary findings to suggest acute cholecystitis. tte the left atrium and right atrium are normal in cavity size. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is mild regional left ventricular systolic dysfunction with probable mild hypokinesis of the basal to mid inferolateral and lateral segments (suboptimal image quality limits interpretation). right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are moderately thickened. no masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. there is mild aortic valve stenosis (area 1.2-1.9cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. trivial mitral regurgitation is seen. no masses or vegetations are seen on the tricuspid valve, but cannot be fully excluded due to suboptimal image quality. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: suboptimal image quality limits interpretation. there is no evidence of endocarditis or abscess. calcification of the aortic valve and mitral annulus. mild aortic stenosis and trace aortic regurgitation. probable inferolateral and lateral hypokinesis. if clinically suggested, the absence of a vegetation by 2d echocardiography does not exclude endocarditis. compared with the prior study (images reviewed) of , the aortic valve is more calcified and there is now aortic stenosis and trace aortic regurgitation. the degree of tricuspid regurgitation has increased. the lateral/inferolateral hypokinesis was similar in appearance on the prior echo. brief hospital course: assessment and plan: the pt. is a 64 y/o f with a pmh of esrd on hd, dm, and htn presenting after dialysis with hypotension, nausea, vomiting and abdominal pain. . #. bacteremia - the patient presented with associated symptoms of n/v, but patient has hadh chronic abd pain and was not clearly changed from prior. a ct a/p showed no acute process. her lfts were wnl, with her alk ph mildly elevated. additionally, ruq u/s did was unremarkable. her cxr showed no clear infiltrate. the patient was initially treated with vancomycin 1gm iv, levofloxacin 500mg iv, flagyl 500mg iv and transferred to the icu. the patient symptomatically improved and her antibiotics were tailored to vancomycin and cipro and transferred to the floor. the patient's blood cultures did grow peptostreptococcus from one set and bacillus (non-anthracis) from another set. the patient did not have evidence of dental abcsess on exam. the patient remained afebrile and clinically stable. she underwent tte that did not show evidence of endocarditis. she will continue a 2 week course of vancomycin at hd. the patient remained stable and no further blood cultures were positive. . #. hypotension - the pt briefly dropped bp to 90s systolic in the ed. on review of hd flow sheets, the pt commonly has bp in this range post-hd. she had 4l taken off at dialysis the day of admission. the patient was given ivf and her pressures responded. her bp med were intially held. after transfer to the floor she was restarted on clonidine, lisinopril, while her diltiazem was held. she will follow-up with her pcp regarding restarting her diltiazem. . #. abd pain: the patient has a history of gastritis on egd, treated previously for h.pylori with f/u negative breath testing. she was continued on her ppi . she continued to have chronic abdominal pain, but it was not changed from her baseline. ct a/p showed no acute process. . #. end stage renal disease on hemodialysis - the patient with lsc hd catheter . she was continued on hd as scheduled t/th/sa. . #. diabetes mellitus type ii - she was initially continued on her home lantus 8u qam, 26u qpm. the patient's glucose were low during her hospitalization and her pm lantus dose was titrated down. this is likely due to adhereing to a diabetic diet while in the hospital. she was discharged on 8u qam and 24u qpm with follow-up with her pcp. . #. hypercholesterolemia - continue statin . #. constipation - continue bowel regimen . #. gastritis - continue ppi . #. fen: diabetic diet . # prophylaxis: subcutaneous heparin . # access: l sc hd, peripheral x2 . # code: full medications on admission: active medication list as of : citalopram - 20 mg tablet - 1 tablet(s) by mouth once a day; take half a tablet daily for the first week clonazepam - 0.5 mg tablet - half tablet(s) by mouth twice a day as needed for anxiety clonidine - 0.2 mg tablet - 1 tablet(s) by mouth twice a day diltiazem hcl - 240 mg capsule,degradable cnt release - 1 (one) capsule,degradable cnt release(s) by mouth every day in the afternoon flonase - 50mcg spray, suspension - 2 sprays in each nostril every day ketoconazole - 2 % shampoo - appy daily lisinopril - 40 mg tablet - 1 tablet(s) by mouth once a day norvasc - 10mg tablet - one by mouth every day omeprazole - 20 mg capsule, delayed release(e.c.) - 1 (one) capsule(s) by mouth twice a day oxycodone-acetaminophen - 5 mg-325 mg tablet - tablet(s) by mouth every 4 hours as needed for pain. do not drink, drive or operate heavy machinery while taking this medication. simvastatin - (prescribed by other provider) - 40 mg tablet - 1 tablet(s) by mouth once a day medications - otc acetaminophen - 650 mg tablet sustained release - 2 tablet(s) by mouth three times a day clotrimazole - 1 % cream - 1 applicator full applied at bedtime insulin nph human recomb - 100 unit/ml suspension - 8 units subcutaneous every morning and 26 units subcutaneous every evening discharge medications: 1. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 2. klonopin 0.25 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po twice a day as needed. 3. clonidine 0.1 mg tablet sig: one (1) tablet po bid (2 times a day). 4. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily). 5. ketoconazole 2 % shampoo sig: one (1) topical once a day. 6. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 7. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 9. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 10. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 11. tylenol 325 mg tablet sig: 1300 (1300) mg po three times a day. 12. clotrimazole 1 % cream sig: one (1) topical at bedtime. 13. insulin nph human recomb 300 unit/3 ml insulin pen sig: as directed subcutaneous twice a day: 8u qam/ 26u qpm. 14. vancomycin 1,000 mg recon soln sig: at hd intravenous at hd for 2 weeks: 2 week course last day: . 15. percocet 5-325 mg tablet sig: 1-2 tablets po once a day as needed for pain. disp:*12 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: bacteremia esrd on hd secondary: diabetes mellitus type ii hypertension hypercholesterolemia v coronary artery disease constipation gastritis discharge condition: stable, afebrile, normotensive, ambulating discharge instructions: it was a pleasure taking care of you while you were in the hospital. you were admitted to because of an infection in his blood. you were treated with antibiotics and improved. you also had an ultrasound of your heart that did not show any infection. you will continue vancomycin at dialysis for 2 weeks. please follow the medications prescribed below. 1) please stop taking your diltiazem for now given your low blood pressure 2) your night-time insulin was decreased to 24u. please continue your am dose as usual. 3) please take percocet prior to your pt sessions please follow up with the appointments below. please call your pcp or go to the ed if you experience chest pain, palpitations, shortness of breath, nausea, vomiting, fevers, chills, or other concerning symptoms. followup instructions: provider: , rn, cs phone: date/time: 9:40 provider: , md phone: date/time: 2:20 provider: phone: date/time: 3:30 provider: phone: date/time: 2:30 procedure: hemodialysis diagnoses: anemia in chronic kidney disease end stage renal disease renal dialysis status coronary atherosclerosis of native coronary artery pure hypercholesterolemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease long-term (current) use of insulin septic shock family history of ischemic heart disease other constipation surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation infection and inflammatory reaction due to other vascular device, implant, and graft septicemia due to escherichia coli [e. coli] unspecified gastritis and gastroduodenitis, without mention of hemorrhage acquired absence of both cervix and uterus 

Answer: The patient is high likely exposed to