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: patient recorded as having no known allergies to drugs attending: chief complaint: nausea, vomiting and abdominal pain major surgical or invasive procedure: gastric emptying study renal ultrasound picc line placement mri abdomen ct abdomen history of present illness: 41 y/o m with dm, esrd with av fistula placed last week not yet on hemodialysis, and htn who p/w n/v x 3 days, scant hematemesis, severe intermittent llq pain radiating to left flank x 1 day, and temp to 100.2. he is admitted to the micu for dka. . according to him, the nausea started 3 days ago. on am of admission, he started vomiting "brownish liquid" multiple times. he also started experiencing left flank pain which is burning in nature and does not radiate. he claims that he has had similar pain in when he was hospitalized but he could not recall his diagnosis. he denies urinary symptoms, no h/o kidney stone, no trauma to left flank, no change in bowel movement, no melena. . in the ed, his vital signs were:p 140 bp 170/80 r16 patient refused ng lavage. he was guiac negative. ct abdomen was done without contrast but the ed radiologist confirmed that it is a good enough image to rule out abdominal pathology. . he was then found to be in diabetic ketoacidosis with approptiate respiratory compensation. his initial blood gas was 7.34/33/96, hco3 16, cr 7.0. insulin drip and d5 with hco3 were started. renal team was made aware but felt that he has no emergent need to dialysis. blood cultures and urine cultures were sent. cxr was negative. there was a concern for osteomyelitis and he was given one dose of vancomycin. . in the micu patient was placed on insulin gtt until anion gap was closed. at this time he was transferred to a regular medical floor. although anion gap had closed patient continued to have nausea, vomiting and abdominal pain. past medical history: -diabetes -end stage renal disease, not on hd yet -hypertension -right foot ulcer operation one week prior to admission for ? ostemyelitis vs hammertoe social history: denies smoking/tobacco history family history: diabetes in multiple relatives physical exam: t99.1 p112 bp 181/81 r12 100% on ra gen- comfortable, alert, nad heent- anicteric, mmm, neck supple cv- regular, tachycardic, no r/m/g resp- ctab - + bowel sound, non distended, left flank tender, diffuse mild ttp, no rebound, no guarding, no splenomegaly extremities- right toe in bandage, no edema, ulcer does not probe to bone, dp 1+ b/l pertinent results: 09:44pm glucose-497* urea n-46* creat-6.8* sodium-135 potassium-5.3* chloride-103 total co2-17* anion gap-20 09:44pm ck(cpk)-227* 09:44pm ck-mb-6 ctropnt-0.28* 09:44pm calcium-9.3 phosphate-4.5 magnesium-1.7 06:05pm type-art po2-96 pco2-33* ph-7.34* total co2-19* base xs--6 intubated-not intuba 06:05pm glucose-482* lactate-1.3 05:04pm lactate-2.7* 05:02pm urine color-straw appear-clear sp -1.019 05:02pm urine blood-mod nitrite-neg protein-500 glucose-1000 ketone-15 bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 05:02pm urine rbc-* wbc- bacteria-few yeast-rare epi-0-2 05:02pm urine amorph-few 04:55pm glucose-441* urea n-47* creat-7.0* sodium-134 potassium-5.4* chloride-103 total co2-16* anion gap-20 04:55pm alt(sgpt)-17 ast(sgot)-15 alk phos-120* amylase-49 tot bili-0.2 04:55pm lipase-29 04:55pm calcium-9.3 phosphate-4.3 magnesium-1.6 04:55pm acetone-small 04:55pm ethanol-neg bnzodzpn-neg barbitrt-neg 04:55pm wbc-10.1 rbc-3.78* hgb-9.0* hct-29.4* mcv-78* mch-23.9*mchc-30.7* rdw-15.2 04:55pm neuts-84.6* lymphs-12.9* monos-2.1 eos-0.3 basos-0.2 04:55pm hypochrom-2+ microcyt-1+ 04:55pm plt count-216 04:55pm pt-12.9 ptt-22.7 inr(pt)-1.1 06:12am blood wbc-7.5 rbc-3.31* hgb-8.6* hct-27.4* mcv-83 mch-25.9* mchc-31.3 rdw-15.6* plt ct-166 06:08am blood wbc-8.0 rbc-3.59* hgb-9.1* hct-29.7* mcv-83 mch-25.3* mchc-30.6* rdw-15.7* plt ct-168 05:51am blood wbc-7.6 rbc-3.16* hgb-8.2* hct-25.9* mcv-82 mch-25.8* mchc-31.4 rdw-15.6* plt ct-139* 06:12am blood glucose-53* urean-40* creat-6.7* na-140 k-4.4 cl-109* hco3-22 angap-13 06:08am blood glucose-118* urean-37* creat-6.4* na-140 k-4.4 cl-109* hco3-23 angap-12 05:51am blood glucose-254* urean-36* creat-6.4* na-137 k-4.5 cl-107 hco3-21* angap-14 06:12am blood ck(cpk)-116 06:08am blood alt-12 ast-13 alkphos-79 totbili-0.2 06:12am blood ck-mb-4 ctropnt-0.30* imaging ct abd/pelvis (): no acute intra-abdominal pathology identified given limitations of lack of iv contrast. specifically, there are no stones, perirenal stranding or hydronephrosis r foot xr (): 1) non-displaced fracture distal fourth metatarsal shaft. 2) focal lucency distal 4th metatarsal - in the appropriate clinical seeting, ddx includes osteomyelitis. 3) no other findings to confirm the presence of osteomyelitis. tte (): the left atrium is elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). regional left ventricular wall motion is normal. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. there is no aortic valve stenosis. the mitral valve appears structurally normal with trivial mitral regurgitation. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. gatric emptying study (): borderline normal gastric half-emptying time of 60 minutes. renal u/s (): there is no hydronephrosis. there is no evidence of perinephric abscess. mri abdomen (): markedly suboptimal examination, but within this limitation, apart from atelectasis in the left lung base, no abnormality or cause for the patient's symptoms is seen . culture data: 12:32 pm stool consistency: loose source: stool. **final report ** clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. reference range: negative. 8:10 am urine **final report ** urine culture (final ): no growth. **multiple sets of blood cultures negative during admission brief hospital course: 41yo m dm, esrd with av fistula placed recently, and htn admitted in micu for dka. etiologies of dka not determined but considered upper gi bleed, mi, infection. continued to have abdominal pain, n/v of unknown etiology once being transferred to general medical floor after anion gap had closed.. . # nausea/vomiting/abdominal pain: patient admitted to micu w/ abdominal pain, nausea and vomiting thought to dka in setting of elevated blood sugars and anion gap. symptoms continued once anion gap closed and dka resolved. patient had persistent nausea and vomiting during much of his hospital stay but responded well to anitemtics including anzemet, phenergen and ativan. question of gastroparesis in patient w/ dm but gastric emptying study essentially normal w/ no significant gastroparesis and patient had no significant improvement on trial of reglan. patient also noted left flank pain and epigastric pain during part of his admission. but no etiology was found for his symtpoms. lfts, amylase and lipase all wnl. kub not suggestive of obstruction. renal u/s obtained to evaluate for possible pyelo or paranephric abscess was negative. gi saw patient after an episode of blood tinged emesis. egd was performed that showed grade iii esophagitis c/w persistent n/v but no evidence of upper gib. patient was guaiac negative. a noncontrast ct during admission did not show evidence of pathology. an abdominal mri was obtained as contrast ct could not be done to renal function that was normal. patient had several episodes of diarrhea w/ negative c diff and resolved on own prior to discharge. stool cx ordered but not sent as patient disposed of samples prior to collection. before leaving hospital patient's sx had improved significantly w/ resolved abdominal pain and only intermittent nausea. patient tolerating po diet prior to being sent home. thorough w/u was essentially negative and it was speculated that sx may have been to uremia or unidentified virus that gradually resolved. patient sent home on po anzemet and phenergen. # upper gi bleed: patient had question of hematemesis while in micu and had some blood tinged emesis during admission with question esophageal tear vs. upper gi bleed. egd showed grade iii esophagitis as noted above thought to peristent n/v. discharged on protonix as per gi recs. asa held w/ ? upper gib but would consider restarting as outpatient. . # possible coronary ischemic event, elevated troponins that trended down, no ekg changes, no angina. thought that elevated troponins to renal failure and inability to clear. should be followed up as outpatient. patient occasionally had sinus tachycardia w/ no ekg changes that seemed directly related to increased pain and nausea. in days prior to discharge patient had no further episodes of tachycardia. patient should have a stress test done as an outpatient. patient maintained on b-blocker. . # dka had resolved in micu but blood sugars still elevated when initially sent to floor. precipitant not determined but likely to whatever had been causing nausea and vomiting. consulted for better glucose control and patient maintained on lantus and sliding scale humalog. patient switched back to home regimen of insulin prior to discharge as patient did not want regimen altered. sugars under much better control in days prior to discharge. patient will have vna to ensure that he complies with regimen. educated patient about importance of strict compliance and risks for recurrence of dka. # esrd: renal was consulted for possible hd but did not feel that it was urgent. patient was also reluctant to start hd until avf matured and was adamant about following up with own renal doctors. he is instructed to make a f/u appointment w/ them. thought that gi sx could have been to uremia. medications were renally dosed. patient was started on epogen which vna will help to administer. nephorcaps were given. . # anemia: decreased hct but unclear what baseline is. p/w questionable h/o hemetemesis and refused ng lavage, guiac negative. no evidence gib. microcytic anemia. iron studies c/w anemia of chronic disease. likely contribution from esrd as well. patient transfused during admission w/ good response. epogen started as noted above. hct should be followed as outpatient. . #r foot ulcer: patient recently with bone removed from foot at bumc for ? om vs. hammertoe. xr r foot not suggestive of om and podiatry here felt patient did not have osteomyelitis and did not recommend bone scan for further evaluation. medications on admission: aspirin clonidine hcl sc heparin hydralazine hcl insulin ss metoprolol nifedipine nephrocaps pantoprazole ambien discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 2. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 3. hydralazine 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). disp:*120 tablet(s)* refills:*2* 4. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 5. nifedipine 60 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). disp:*30 tablet sustained release(s)* refills:*2* 6. clonidine 0.1 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 7. dolasetron 100 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 8. promethazine 12.5 mg tablet sig: one (1) tablet po four times a day as needed for nausea. disp:*120 tablet(s)* refills:*0* 9. insulin nph/reg 70-30 innolet 70-30 unit/ml insulin pen sig: 40 qam, 20qpm units subcutaneous as directed. disp:*qs 1 month * refills:*2* 1. epogen-->5000 u three times a week to be administered by vna. discharge disposition: home with service facility: vna discharge diagnosis: diabetic ketoacidosis nausea/vomiting of unclear etiology discharge condition: stable discharge instructions: please take all your medications as prescibed. return to the emergency department if you have worsening symptoms or new symptoms that are concerning to you. followup instructions: please follow up with your primary care doctor within one week after discharge. , r. please follow up with your kidney doctor one week after discharge. please keep your podiatry follow up appointment for your post-surgery check up. procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine transfusion of packed cells diagnoses: anemia in chronic kidney disease hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease diabetes with ketoacidosis, type i [juvenile type], not stated as uncontrolled abdominal pain, left lower quadrant ulcer of heel and midfoot acute esophagitis persistent vomiting 

Answer: The patient is high likely exposed to