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: this is a 75 year old female with past medical history significant for diabetes mellitus, cad status post cabg, peripheral vascular disease and hypercholesterolemia, who presents to hospital on with shortness of breath. of note, on she was admitted to vascular surgery at for femoral popliteal bypass surgery. at that time preadmission creatinine was 1.5 and after bypass surgery she was in acute renal failure with her dye load and creatinine that had risen to 4. this was recovered to 2.0 during that admission. on she was readmitted with chf and at that time diuresed. an echo revealed an ejection fraction of 50% with mr tr. since that admission she has had progressive fatigue, malaise and decreased appetite with some dyspnea on exertion, pnd and increased peripheral edema in the setting of decreased urine output. she was admitted to hospital where she was found to have crackles and increased jvd with acute renal failure, bun 80, creatinine 4.7. she also had anion gap acidosis with a question of pneumonia on chest x-ray. at , therefore, she was given iv lasix in increasing doses with 500 mg of diuril for potentiation. she was started on a furosemide drip at 20 mg per hour. she was given iv nitroglycerin without effect. on the day of transfer to she had received 500 cc of fluids over two hours with worsened respiratory status and some lateral st segment depressions with elevated troponin. it is in this setting that the patient was transferred to . past medical history: hypertension. diabetes mellitus with resultant retinopathy and neuropathy. hypercholesterolemia. peripheral vascular disease. cad status post cabg in with lima to lad, svg to d1, om1 and pda. hypothyroidism. chf. gout. allergies: sulfa causes an unknown reaction. ace inhibitors result in hyperkalemia. medications: at hospital lasix 20 mg continuous drip, hydralazine 20 mg iv q.six, diuril 500 mg iv b.i.d., lopressor 12.5 mg p.o. t.i.d., simvastatin 20 mg p.o. q.h.s., iv nitroglycerin at 200 mcg per minute. at home lopressor 75 mg p.o. t.i.d., isordil 20 mg p.o. t.i.d., zocor 10 mg p.o. q.d., aspirin 325 mg p.o. q.d., levoxyl 100 mcg p.o. q.d., albuterol and atrovent p.r.n., hydralazine 50 mg p.o. t.i.d. social history: no history of tobacco or ethanol use. patient lives at home with her husband and son and is usually able to perform adls. contact information for her includes her daughter, home phone number , cell phone . physical examination: vitals temperature 97.3, blood pressure 132/44, heart rate 88, respiratory rate 19, o2 saturation 97% on cpap. in general, mild respiratory distress. heent perrl, surgical pupils bilaterally, eomi, anicteric, mucous membranes moist. cardiovascular regular rhythm, normal rate, no murmurs. elevated jvd. pulmonary crackles of the way up on the left and possibly on the right. abdomen positive bowel sounds, obese, soft, nondistended, nontender. extremities 3+ edema. dermatology left mid-abdominal healing injection site. neuro cn ii-xii intact. laboratory data: white count 15.7, differential 89 polys, 0 bands, 6 lymphs, 4 monos, hematocrit 27.0, mcv 91, platelets 309. pt 14, ptt 63, inr 1.4. electrolytes sodium 120, potassium 4.5, chloride 85, bicarb 13, bun 92, creatinine 5.3, glucose 236. ck 87. anion gap negative 22. calcium 8.5, phosphorus 7.5, magnesium 2.3. urine no evidence of dysmorphic red blood cells or casts. ekg from outside hospital revealed sinus rhythm at 81 beats per minute, normal axis and intervals, st segment depressions in avl, 1, . chest x-ray bilateral effusion with cephalization and curly b lines. hospital course: the following is as noted by , m.d., phd. on arrival to the coronary care unit patient was found to be in acute respiratory distress and feeling nauseous with some bright red blood per rectum in the setting of a heparin drip given her elevated troponin at hospital. heparin was discontinued at this time with resolution of her gi bleed. she was started on protonix 40 mg p.o. b.i.d. the nephrology service was consulted for urgent hemodialysis and renal fellow, dr. , saw the patient and after obtaining central venous access, he started hemodialysis with resultant removal of 4 liters of fluid. subsequently patient was managed in the ccu with initially intermittent bolus dose of furosemide. however, this was with minimal effect and, therefore, she was converted to a furosemide drip titrated to urine output of greater than 100 cc an hour. furosemide drip was increased to 40 mg an hour for one day with improvement in her urinary output and her overall volume status improved. however, given the possibility of increased ototoxicity at these doses, nephrology recommended decreasing the rate and starting nitrocor bolus and drip, which was done. over the next one to two days the patient's furosemide drip was decreased to 20 mg an hour with nitrocor drip accompanying. she was also started on metolazone 5 mg p.o. b.i.d. to augment her renal response to furosemide. patient had markedly good response to this regimen and over the next several hospitalization days diuresed a total of 10 liters at the time of this dictation. she had symptomatic relief with decreased shortness of breath and decreased oxygen requirement. on the day of this dictation nitrocor and furosemide drips were discontinued and the patient maintained on iv furosemide at 100 mg b.i.d. with 5 mg of metolazone scheduled b.i.d. 30 minutes before furosemide. this regimen thus far has been adequate in maintaining a negative fluid balance. in addition, the patient was also started and titrated up on hydralazine for afterload reduction and oral nitrates for her preload. the patient's renal function continued to improve throughout the hospitalization and at the time of this dictation her creatinine had improved steadily to 2.9. the patient also had an episode of chest pain and shortness of breath with ekg consistent with ischemia, but no evidence of st segment elevation. cardiac enzymes revealed relatively normal ck with peak at 265 and mb index of 11, however, with troponin which peaked at greater than 50, which is the laboratory maximum. given the patient's underlying medical conditions and after discussion with patient and family, it was decided to medically manage this non-st segment elevation mi as to avoid catheterization at least in the setting of acute renal failure in an attempt to preserve renal function and avoid hemodialysis. hematology. as noted, patient developed lower gi bleed in the setting of heparinization for a troponin leak as noted at hospital. heparin was discontinued on arrival to and patient was started on protonix 40 mg b.i.d. and transfused one unit of blood with appropriate rise in hematocrit. at the time of this dictation, patient's hematocrit was steadily improving and was up to 38. infectious disease. patient was started on a course of levofloxacin at hospital for pneumonia. therefore, we opted to continue a full course of seven days. she did well throughout the hospitalization without a temperature. she had no signs or symptoms of pneumonia. however, one day after discontinuation of levofloxacin, patient developed diarrhea and elevated white count to 21. therefore, this is concerning for the possibility of pseudomembranous colitis. therefore stool was sent for c.difficile and patient started on an empiric course of metronidazole 500 mg p.o. t.i.d. overall, the patient's clinical condition is markedly improved as compared with her admission. her acute renal failure is improving steadily as well as her chf. she has had no recurrent episodes of chest pain concerning for ischemia in the past three to four days. she is making steady clinical improvement and we anticipate that she will be able to transfer to the medical floor the following day. dr. will take over the care of the patient effective and he will complete the rest of this dictation. we anticipate, however, given the patient's clinical course, she will benefit from a cardiac regimen to include aspirin, beta blocker, ace inhibitor once her creatinine function improves. she will further benefit from both preload and afterload reduction. of course, she will need a diuretic regimen to maintain her fluid balance once she has achieved her dry weight. this will likely include metolazone and furosemide in some combination. we further anticipate that patient will benefit from a short course of rehabilitation. thank you very much for the opportunity to participate in the care of this very pleasant patient. , m.d. dictated by: medquist36 procedure: hemodialysis venous catheterization for renal dialysis diagnoses: pneumonia, organism unspecified acidosis mitral valve disorders congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hemorrhage of gastrointestinal tract, unspecified acute myocardial infarction of unspecified site, initial episode of care 

Answer: The patient is high likely exposed to