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: vancomycin attending: chief complaint: pain and bleeding at site of r av fistula major surgical or invasive procedure: hemodialysis catheter placement left ij placement arterial line placement history of present illness: 68 yof with esrd unknown etiology, copd on chronic steroids, who presents after bleeding from av fistula followed by hypotension, altered mental status. friday she had uneventful dialysis. saturday evening she was nauseated, vomited x 1. sunday spent mostly in bed with generalized malaise. in afternoon got up, noted her av fistula to have a "black spot" that "looked infected" so she put an antibiotic-impregnated bandaid on it. it began to ooze blood, and a concerned neighbor called 911. at hospital, after a nurse fistula, it opened into an arterial bleed through which she lost 150-400cc of blood. bleed was controlled with sutures and surgicel. her bp dropped from 125/79 to 80/60. she received 1 liter ns, and a dose of vancomycin iv which caused a red rash, treated with benadryl. vanc was discontinued and she was given ancef iv and transferred to ed. on arrival to our emergency department her vitals were t: 99.7 bp: 84/52 hr: 88 rr: 18 o2: 99% on ra. the fistula site demonstrated a palpable thrill, no erythema, the suture site was clean and dry. her k+ was 6.8 with peaked t waves on ekg, her sbps drifted into the 70s and her mental status declined. she received 4 l ns, calcium gluconate 2 gram iv x 1, 1 amp d50, 10 units regular insulin sc, 1 amp bicarbonate iv, zosyn 4.5 grams iv x 1 and was started on levophed. nephrology was contact for urgent dialysis evaluation. left ij placed for access after failed attempt at right ij. she was admitted to the micu. in the micu she received 5 liters ivf, was weaned off of levophed 12 hours after arrival. past medical history: - end stage renal disease on hemodialysis for two years - coronary artery disease (recent catheterization with normal coronary arteries) - diastolic heart failure (ef on recent catheterization 60%) - copd (on 2l home oxygen at night) social history: previous 40 pack year history but quit 4 months ago. no alcohol or illict drug use. lives by herself. family history: strong family history of cad in father and brother. physical exam: discharge physical exam: vitals: t: 98.5 bp: 110/70 p: 98 r: 19 o2: 91% on ra general: somnolent, oriented x 3, no acute distress heent: sclera anicteric, mm dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: scarce expiratory wheezes bilaterally, otherwise clear to auscultation bilaterally cv: regular rate and rhythm, normal s1 + s2, ii/vi sem heard best at lusb non-radiating abdomen: obese, soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley draining clear yellow urine ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. left upper extremity fistula with dressing in place. 2 sutures in place. no pus or erythema. palpable thrill present. pertinent results: chemistries: 11:54pm glucose-98 urea n-74* creat-10.5* sodium-140 potassium-6.8* chloride-100 total co2-23 anion gap-24* 03:00am glucose-71 urea n-73* creat-10.3* sodium-142 potassium-5.7* chloride-102 total co2-25 anion gap-21* 03:08am lactate-0.6 03:00am cortisol-33.5* 03:00am ck-mb-2 ctropnt-0.04* 03:00am ck(cpk)-45 06:27am type-art po2-64* pco2-54* ph-7.24* total co2-24 base xs--4 hematology: 11:54pm wbc-9.6 rbc-2.74* hgb-9.5* hct-28.6* mcv-104* mch-34.9* mchc-33.4 rdw-16.8* 11:54pm plt count-157 11:54pm pt-13.2 ptt-24.3 inr(pt)-1.1 urine studies: 01:15am urine rbc-0 wbc-0-2 bacteria-none yeast-none epi-0 renal epi-0-2 01:15am urine blood-neg nitrite-neg protein-30 glucose-100 ketone-neg bilirubin-neg urobilngn-neg ph-8.0 leuk-neg 01:15am urine color-yellow appear-clear sp -1.010 right upper extremity ultrasound : by report, the patient has a fistula, which is patent on color doppler examination. surrounding the fistula, there is hypoechoic material which likely represents a hematoma surrounding the vessel and less likely a pseudoaneurysm with thrombosis. this area measures approximately 1.4 x 1.2 x 1.1 cm. son exam over this region did prompt bleeding through the skin at which time the exam was terminated and dressing applied by the patient's nurse. cxr portable : cardiac silhouette is mildly enlarged. there is no focal consolidation. there are increased interstitial opacities consistent with fluid overload. there is no definite focal consolidation or pneumothorax. the osseous structures are grossly unremarkable. ekg: normal sinus rhythm, normal axis, normal intervals, no st segment elevation or depression, small amount of peaked twaves. brief hospital course: 68 yof with esrd unknown etiology, copd on chronic steroids, who presents after bleeding from av fistula followed by hypotension, altered mental status. on the medicine floor, she was alert and cheerful, with family in the room. # hemorrhagic shock due to acute blood loss anemia due to fistula bleeding: - differential considerations include septic shock given prodromal illness, possibly from site of av fistula and possibly her chronic steroid dosing; adrenal insufficiency chronic steroid use; and hypovolemic shock hemorrhage. blood and urine cxs were sent and remain negative. in the icu she received stress-dose steroid boluses, a dose of iv zosyn. she rapidly improved and when she arrived on the medical floors was stable clinically. she was observed with no recurrence of hypotension. # stage v chronic kidney disease: given the bleed the av fistula could not be used. a tunneled hemodialysis catheter was placed in the l subclavian, and she had hemodialysis the morning of her discharge. # hyperkalemia: resolved after calcium, d50, insulin treatments. of note she had dialysis while here. # acute blood loss anemia, anemia of esrd: hct stablized at 25.5. likely a mix of dilutional anemia (she received 9+ l ns in past 2 days), blood loss from fistula bleed, and chronic anemia of esrd. - follow hct as outpatient # copd: on 2l home oxygen at night. no history of intubations. uses cpap overnight for osa medications on admission: aspirin 81 mg daily bupropion 100 mg omeprazole 20 mg albuterol prn metoprolol 12.5 mg lasix 40 mg daily simvastatin 40 mg daily nephrocaps daily gemfibrozil 600 mg prednisone 10 mg daily tums 1 mg po daily lisinopril 2.5 mg po daily renagel 800 mg po tid discharge medications: 1. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 2. bupropion hcl 150 mg tablet sustained release sig: one (1) tablet sustained release po twice a day. 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 4. sevelamer hcl 400 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 5. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid on non-dialysis days (tu th sa ) (). 6. lisinopril 5 mg tablet sig: 0.5 tablet po daily on non-dialysis days (tu th sa ) (). 7. gemfibrozil 600 mg tablet sig: one (1) tablet po bid (2 times a day). 8. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 9. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 10. prednisone 5 mg tablet sig: two (2) tablet po daily (daily). 11. calcium carbonate 500 mg tablet, chewable sig: two (2) tablet, chewable po daily (daily). 12. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 13. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours). 14. lasix 40 mg tablet sig: one (1) tablet po once a day. discharge disposition: home discharge diagnosis: primary diagnoses: bleeding from av fistula hyperkalemia hypovolemic hypotension secondary diagnoses: - end stage renal disease, unknown etiology, on hemodialysis for two years - coronary artery disease (recent catheterization with normal coronary arteries) - diastolic heart failure (ef on recent catheterization 60%) - copd (on 2l home oxygen at night) - obstructive sleep apnea (uses cpap at home at night) discharge condition: afebrile, vital signs stable within normal limits, ambulating, tolerating po, alert & oriented. discharge instructions: you were admitted to from the hospital, after you had a bleed from your av fistula site, followed by a drop in blood pressure and a change in your mental status. at you were determined to meet criteria for shock from either blood loss, infection or both, and were managed for a day in the intensive care unit (icu). after the icu you were released to a medicine floor where you had a new temporary tunneled dialysis catheter placed, had dialysis, and were discharged home. no changes were made to your medications. if you should feel ill, lightheaded, dizzy, have chest pain or trouble breathing or renewed bleeding at your av fistula, or have any other medically concerning symptoms, please call your doctor or 911 or go to the emergency room. followup instructions: please call your cardiologist, dr. , thursday morning to confirm your appointment with him. telephone . you should also call on thursday, , to make an appointment to see your primary care provider, . , , to discuss this hospitalization. procedure: venous catheterization, not elsewhere classified hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis non-invasive mechanical ventilation diagnoses: hyperpotassemia end stage renal disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified long-term (current) use of steroids acute posthemorrhagic anemia chronic airway obstruction, not elsewhere classified other shock without mention of trauma surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other complications due to renal dialysis device, implant, and graft chronic diastolic heart failure 

Answer: The patient is high likely exposed to