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: history of present illness: the patient is a year old cantonese speaking only female immigrated to the united states in with a past medical history significant for end-stage renal disease on hemodialysis, history of seizure disorder since , and recent pneumonia, who initially presented from hemodialysis unresponsive, bradycardic and short of breath, and admitted to the medical intensive care unit. at the medical intensive care unit the patient was hypotensive and unresponsive to fluid boluses and started on dopamine, now off since , a.m. heart rate stable in the 40s to 50s, no telemetry events. started on ceftriaxone and azithromycin for a possible pulmonary process. chest x-ray was clear. lumbar puncture was negative. change in mental status improved to more alert. stools showed positive c. difficile and flagyl was started. a right upper quadrant ultrasound was negative and was done secondary to an increase in ggt and alkaline phosphatase. the patient was started on vancomycin secondary to one out of four bottles gram positive cocci, possibly secondary to a central line infection with central line now discontinued. the oxygen by nasal cannula was being weaned to off. chest ct scan on revealed possible reactivation tuberculosis with right apex opacities and now on respiratory precautions. the patient was now stable for call out to the medical floor. past medical history: 1. hypertension. 2. end-stage renal disease on hemodialysis. 3. history of recent pneumonia in . 4. low back pain. 5. upper gastrointestinal bleed in secondary to ibuprofen. 6. seizure disorder; first diagnosed with a seizure during hemodialysis in . 7. history of appendectomy. 8. status post colon perforation during colonoscopy with resection and temporary ostomy. allergies: no known drug allergies. medications: (on transfer) 1. flagyl 500 intravenous three times a day. 2. vancomycin 1 gram intravenously. 3. ceftriaxone one gram intravenously. 4. azithromycin 250 mg intravenously. 5. dilantin 100 mg intravenously twice a day. 6. subcutaneous heparin. 7. protonix 40 intravenously. 8. calcium carbonate. 9. nephrocaps. 10. renagel. social history: immigrated to the united states in ; nursing home. no smoking or alcohol use. son is , . physical examination: (on transfer) vital signs are temperature 99.1 f., maximum temperature 100.4 f.; blood pressure 132/68; heart rate 51; respiratory rate 14; o2 saturation 100% on two liters. general appearance: in no acute distress. somewhat alert and awake. makes eye contact. responds to verbal stimuli; mumbles. heent: no jugular venous distention, normocephalic, atraumatic. supple neck; oropharynx clear. moist mucous membranes, minimally reactive pupils bilaterally, small. cardiovascular: regular rhythm, bradycardic. normal s1 and s2. ii/vi systolic murmur throughout. lungs clear anteriorly and laterally. abdomen soft, nontender, nondistended with hypoactive bowel sounds. extremities: no signs of clubbing or cyanosis. no edema bilaterally. lower extremities with good pulses. neurologic: nonfocal. cranial nerves ii through xii intact with slightly decreased alertness. laboratory data: white blood cell count 13.6, hematocrit 32.9, platelets 189. chem-7 remarkable for a bun of 38 and a creatinine of 4.4 (the patient on hemodialysis with end-stage renal disease). glucose of 118. blood cultures one out of four grew gram positive cocci, in pairs and clusters which grew out to be vancomycin resistant enterococcus. all other blood cultures were negative to date. lumbar puncture was negative. cerebrospinal fluid culture: no growth to date. ck mb and troponin negative. dilantin level 4.9. central line tip culture with no significant growth. urine cultures negative to date. stool cultures c. difficile positive. fecal culture and campylobacter culture negative to date. chest ct scan on , showed previous granuloma infection with cluster of calcified granulomas at the left apex and right apex, opacities at the right lung apex, suspicious for reactivation tuberculosis; no other studies documenting stability. small bilateral pleural effusions, esophageal nodular thickening questionable for neoplasm. atrophic kidneys with two cysts, hepatic cysts and bilateral anterior rib fractures. summary of hospital course: the patient is a year old female with a past medical history of end-stage renal disease, hypertension, recent pneumonia, and seizure disorder, presenting initially to the medical intensive care unit with mental status changes, hypoxia, bradycardia, hypotension, and uremia, with hyperkalemia, now stabilized and improved for transfer to medical floor. 1. neurologic: the patient's mental status changes were thought to be secondary to toxic metabolic (uremia) and possibly infection. the family now reports that the patient's mental status is back to baseline when patient was transferred to medical floor. infectious causes were worked up and antibiotics were given empirically which were now discontinued upon transfer to the floor. the patient was continued on dilantin for a history of seizure disorder with dilantin level in the low end of therapeutic. the patient, for the remainder of her hospital stay, was stable neurologically. 2. infectious disease: the patient had some fevers since admission but was afebrile for the remainder of her hospital stay with a decreasing white blood cell count. the patient had initially been covered empirically with ceftriaxone and azithromycin with possible pulmonary process which has since then been discontinued with a clear chest x-ray and a chest ct scan clear of infiltrates. the patient had a negative lumbar puncture as well as negative urinalysis and urine culture. the chest ct scan did reveal concern for possible reactivation tuberculosis and the patient was placed in respiratory isolation upon transfer to the floor. three afb smears were obtained and were all negative. the patient did not have any active cough. the patient did have gram positive cocci that grew out from her right femoral line blood culture, one out of two bottles. peripheral cultures were negative. vancomycin had initially been started but then discontinued with surveillance cultures showing no growth to date. femoral line was discontinued in the medical intensive care unit and the culture was tipped which showed no significant growth. the patient did have stool that was positive for clostridium difficile and was treated with flagyl 500 mg p.o. twice a day renal dosed, and will continue for a total of 14 day treatment. while on the floor, the patient remained stable from an infectious disease standpoint. 3. pulmonary: the patient initially was found to be hypoxic while in the medical intensive care unit. eventually this was thought to be secondary to fluid overload and improved with dialysis upon admission to the medical intensive care unit. while on the floor, the patient was on nasal cannula at two liters saturating 98 to 100% and eventually was weaned to room air. the patient remained in respiratory isolation until ruled out for tuberculosis times three and negative afb smears. chest ct scan as above. while on the floor, the patient remained in stable respiratory condition. 4. renal: the patient received dialysis on her regular scheduled tuesday, thursday and saturday, while in the hospital. renal service was following throughout. the patient continued on her nephrocaps, renagel and tums. her initial uremia was resolved while in the medical intensive care unit. no other acute renal issues during hospital stay. 5. cardiovascular: the patient was hemodynamically stable upon transfer to the floor, off dopamine since the morning of . the patient had stable bradycardia during the medical intensive care unit stay and during hospital stay which eventually returned to sinus rhythm. the patient had initially been on 100 of atenolol per day, which was discontinued on admission. no significant telemetry events were noted during hospital stay. the patient has a history of hypertension and was eventually restarted back on her norvasc and a lower dose of lopressor as well as captopril for good blood pressure control. 6. gastrointestinal: the patient was treated and continued on flagyl for a total course of 14 days for positive c. difficile in her stool. the patient reportedly had guaiac positive stool initially during the medical intensive care unit stay, but her hematocrits have remained stable. the patient's right upper quadrant ultrasound was negative after being obtained secondary to an increase in ggt and alkaline phosphatase which, since then, have trended down. no other gastrointestinal issues were encountered while on the medical floor. 7. hematology: the patient's hematocrit remained stable throughout her stay on the medical floor. 8. musculoskeletal: the patient has a history of lower back pain since of of this year. the patient will be empirically treated with a pox ii inhibitor upon discharge. no further studies were obtained. 9. fluids, electrolytes and nutrition: the patient's diet was slowly advanced after a speech and swallow evaluation was obtained which showed that the patient was swallowing adequately. aspiration precautions were used initially until the patient's alertness returned to baseline. upon discharge, the patient was eating well. 10. code status: the patient remained a full code during hospital stay. disposition: the patient will return facility. discharge instructions: 1. physical therapy and occupational therapy will evaluate patient and the patient was safely discharged back to nursing facility. 2. the patient will follow-up with her primary care doctor as needed. condition at discharge: stable. discharge status: to nursing facility. discharge diagnoses: 1. end-stage renal disease on hemodialysis. 2. hypertension. 3. low back pain. 4. seizure disorder. 5. clostridium difficile positive stool on flagyl. discharge medications: 1. captopril 12.5 mg p.o. three times a day. 2. lopressor 25 mg p.o. twice a day. 3. norvasc 10 mg p.o. q. day. 4. dilantin 100 mg p.o. twice a day. 5. protonix 40 mg p.o. q. day. 6. flagyl 500 mg p.o. twice a day until . 7. calcium carbonate 1000 mg p.o. three times a day. 8. colace 100 mg p.o. twice a day. 9. sevelamer 800 mg p.o. three times a day. 10. nephrocaps one capsule p.o. q. day. 11. vioxx 12.5 mg p.o. q. day. , m.d. dictated by: medquist36 procedure: spinal tap incision of lung hemodialysis diagnoses: hyperpotassemia other convulsions hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified cardiac dysrhythmias intestinal infection due to clostridium difficile nonspecific abnormal findings in stool contents delirium due to conditions classified elsewhere personal history of tuberculosis 

Answer: The patient is high likely exposed to