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: gantrisin / lactose attending: chief complaint: 66 year old woman admitted to with altered mental status major surgical or invasive procedure: dialysis twice weekly history of present illness: hpi: the patient is a 66 year old woman with mmp including dm1, cad, esrd on hd, uti recently admitted to for hypotension felt to be secondary to antibiotic associated diarrhea. during that hospital stay she was hypotensive on presentation which resolved with ivf. she completed her prior course of tobramycin for the uti and was started on empiric po flagyl for presumed c dif although c. dif tox a was negative x3 and toxin b was pending on discharge. she was discharged from to the day prior to this admission. . at , midnight vitals were reported as a fingerstick of 186, bp 103/55 and temp of 99.4. the patient was responding to verbal commands. at 4am, she was was found to have altered mental status and a fs was 21. she was given d50 but no improvement. she transferred to for further evaluation. in the ed she was minimally responsive but gradually improving. upon arrival her vital signs were bp 80/50, hr 80, spo2 100 ra upon arrival she was also hypothermic to 91.1 degrees axillary. cxr showed concern for early rll pneumonia. urine positive for 21-50 wbc, mod leuk, many bacteria and large blood, a ct head was unremarkable. she was given vanc/levo/flagyl and placed on a warming blanket. in addition, she received 10mg iv decadron. on arrival at the floor the patient was alert and responsive, wbc count was within normal limits and vital signs were stable. she was set up to receive hemodialysis. past medical history: 1. dm type 1 x 35 years. previous admissions for dka and hypoglycemic episodes. her dm is complicated by peripheral neuropathy, proliferative retinopathy (left eye blindness), and nephropathy. followed at . 2. chronic renal failure: appears to dm and cr has been 5 over past few months. on hemodialysis. 3. cad - nstemi in the setting of hospitalization for dka, nuclear stress test : p-mibi, without fixed or reversible defects, normal wall motion. ef 72%. 4. hypertension 5. history of osteomyelitis, status post left transmetatarsal amputation. 6. history of herpes zoster of left chest in . 7. bezoar, disclosed on ugi series . 8. achalasia 9. carpal tunnel syndrome social history: she lives at home with her son, who is mentally retarded. past history of etoh use. ex-smoker, quit in . previously smoked for 8yrs. no history of illicit drug use. family history: mother - dm sister - breast ca, dm brother - htn - sle, d. renal failure physical exam: on admission: p 105, bp 96/63, rr 20, o2 100%ra, t 98.7 heent: no jaundice lungs: cta cvs: reg abd: soft, nt, bs+ ext: no edema rectal: brown semiformed stools. guaiac neg per nurse pertinent results: 11:00am pt-17.6* ptt-58.2* inr(pt)-1.6* 11:00am wbc-12.7*# rbc-4.14* hgb-11.2* hct-36.6 mcv-88 mch-27.0 mchc-30.6* rdw-16.5* 11:00am glucose-88 urea n-16 creat-3.8*# sodium-136 potassium-5.0 chloride-103 total co2-24 anion gap-14 06:20am ctropnt-0.06* 07:55am urine blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-mod 07:55am urine rbc-0-2 wbc-21-50* bacteria-many yeast-occ epi-0-2 urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with skin and/or genital contamination. cxr - ill-defined opacity within the right lower lobe, which may represent atelectasis, however, early airspace consolidation cannot be entirely excluded. . ct head - there is no hemorrhage, mass effect, hydrocephalus, or shift of normally midline structures. low densities are seen within the periventricular and subcortical white matter reflecting chronic microvascular ischemic disease. the -white matter differentiation is preserved. the ventricles and sulci are prominent reflective of age-related involutional change. the visualized paranasal sinuses and mastoid air cells remain normally aerated. note is made of phthisis bulbi of the left globe brief hospital course: # altered mental status - pt experienced altered mental status in the setting of severe hypoglycemia. differential included acute intracranial event, infection, and non-convulsive status/seizure. ct scan of head negative for acute process. patient received antibiotics w/ improvement but unclear source of infection. pt does have seizure history, however no evidence to support recent epileptic event. likely, mental status was altered in the setting of extremely low blood sugar. patient cleared with resolution of hypoglycemia. #right wrist cellulitis - patient developed worsening right wrist pain after admission. patient was not able to state the duration of pain, but does state that it had been days rather than weeks. afebrile, no elevation of wbc count. pain from physical trauma v. infection/tenosynovitis. - plastics hand consult stated that no intervention was needed. - plain films right hand - no fracture, no gross abnormalities - vancomycin with dialysis was continued for 10 day course, with hd dosing, given high likelihood of mrsa in this diabetic, institutionalized patient . # labile blood glucose/type i diabetes - differential for hypoglycemia prior to admission included infection v. insulin excess. pt stated that she did not eat dinner the night before admission night but was given a full dose of glargine. she had a mildly elevated wbc of 12.7 on admission. cxr was likely atelectasis however an early pneumonia could not be excluded. bs on arrival to the floor 267. patient received 10mg iv decadron in the ed which could explain recent elevated bs. - sliding scale insulin used for fixed meal time dose - glargine was adjusted on several occasions - at time of discharge is 16 units q hs. this was an increase in response to high daytime glucose levels but will need to continue close monitoring of fingersticks. #diarrhea - pt continued to have loose bowel movements, gradually improving towards the end of her hospital course. this was presumed to be nonspecific antibiotic-associated colitis. - c.diff negative - continue flagyl to 14 day course from . # ?pneumonia - cxr in ed suggested atelectasis vs early pna, but patient improved with vanc and levo. a repeat cxr was not convincing for a pna # ?uti - patient with known history of citrobacter infection. f/u c&s showed skin contamination. additional antibiotics were not given. # esrd on hd: continued hd as scheduled tthsat # cad - h/o nstemi. she was continued on asa and statin, and restarted on metoprolol 12.5 tid # conjunctivitis - s/p course of cipro eye drops, improved. # code: note, patient is dnr/dni per hcp medications on admission: heparin 5,000 unit tid atorvastatin 80 mg daily aspirin 81 mg daily folic acid 1 mg daily acetaminophen 325-650 mg q6h:prn metoprolol tartrate 37.5 mg tid calcium carbonate 500 mg pantoprazole 40 mg q24h b complex-vitamin c-folic acid 1 mg daily metronidazole 500 mg tid ciprofloxacin 0.3 % drops sig: 1-2 drops ophthalmic q4h (every 4 hours) for 4 days. epoetin alfa 2,000 unit qhd psyllium 1.7 g insulin glargine 10 units at bedtime humalog sliding scale discharge medications: 1. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 2. insulin regular human 100 unit/ml solution sig: one (1) injection with meals an at bedtime. 3. atorvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 8. epoetin alfa 10,000 unit/ml solution sig: as per renal injection asdir (as directed). 9. vancomycin dosed with dialysis - to complete a 14 day course (day of discharge = day 10) discharge disposition: extended care facility: hospital- discharge diagnosis: septicemia diabetes mellitus cellulitis right wrist hypovolemia diarrhea - possibly antibiotic-associated decubitus ulcers hypertension urinary tract infection discharge condition: stable discharge instructions: continue to follow fingersticks closely. physical and occupational therapy to build strength. monitor right wrist cellulitis. followup instructions: provider: , dpm phone: date/time: 11:00 provider: , date/time: 2:00 provider: , m.d.: schedule upon discharge from rehab procedure: hemodialysis diagnoses: anemia in chronic kidney disease end stage renal disease other and unspecified noninfectious gastroenteritis and colitis coronary atherosclerosis of native coronary artery infection with microorganisms resistant to penicillins other convulsions polyneuropathy in diabetes personal history of tobacco use methicillin susceptible staphylococcus aureus septicemia pulmonary collapse hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease disorders of phosphorus metabolism long-term (current) use of insulin old myocardial infarction pressure ulcer, lower back diarrhea hypovolemia other specified visual disturbances other specified hypotension diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with ophthalmic manifestations, type i [juvenile type], uncontrolled long-term (current) use of aspirin hypothermia cellulitis and abscess of hand, except fingers and thumb achalasia and cardiospasm diabetes with other specified manifestations, type i [juvenile type], uncontrolled proliferative diabetic retinopathy carpal tunnel syndrome other conjunctivitis accident due to excessive cold of other specified origin 

Answer: The patient is high likely exposed to