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: morphine / prochlorperazine / tramadol attending: chief complaint: "abdominal pain, nausea and vomiting." major surgical or invasive procedure: none history of present illness: 27 yo hx of iddm and recent admission for ugi bleed and gastroparesis presents with back pain, abdominal pain, increasing n/v x1 day. she was in her usual state of health until this am, when she had an increase in low back pain (lbp is chronic from mvc). she describes the pain as sharp, in lower lumbar region, no radiation. she took her usual meds, including her insulin, but says she was not eating much due to the pain. started having diffuse abdominal pain and vomiting around 5 pm, emesis was bilious and non-bloody with no coffee grounds. estimates that she vomited x3 at home. states she was walking down the street and the back pain got so bad she could no walk anymore, so she called ems. in the ambulance, her fingerstick was found to be >500. . she says she has had been taking her insulin as prescribed, eating the same or less than normal. sugars have recently been in the 200s at home. cannot identify any precipitating factors leading up to today's . says she is "always chilled" but otherwise denies any recent fevers, abdominal pain (prior to today), diarrhea, dysuria (though notes increased frequency), cough, shortness of breath, or upper respiratory . . initial vitals in the ed were 98.8 128 148/101 18 100% ra exam was unremarkable. vomited multiple times in the ed, looked bilious. labs were remarkable for chem panel showing glucose of 686, cr 1.4, hco3 19 (anion gap 20), k >10.0 but grossly hemolyzed w repeat 4.5, phos 6.3. cbc remarkable for hct 32.3 (comparable to previous). ua with >1000 glucose, 80 ketones. urine cx pending. she was given 3l ns, 4 mg iv zofran, 1 mg diluadid x2. started on an insulin drip @ 7u/hr with no bolus. vitals on transfer were 98.0 118 138/96 18 100%ra . on arrival to the micu, the patient is actively vomiting bilious, non-bloody emesis. complaining of severe low back pain, appears uncomfortable. . review of systems: (+) per hpi (-) denies fever, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - diabetes mellitus type i: diagnosed age 16 in after her first pregnancy. - severe anxiety/panic attacks - previous admissions for nausea/vomiting with h/o esophagitis and with concern for diabetic gastroparesis on metoclopramide - esophagitis / h. pylori and again - stage i diabetic nephropathy - grade i esophageal varices seen on scope in , negative liver ultrasound, normal lfts, hep panel negative - anxiety/panic attacks - depression - hyperlipidemia - s/p mva - lower back pain since then. - s/p mva , ex-lap - g2p1ab1, s/p miscarriage in 06/00 3rd trimester, s/p c-section in , not menstruating secondary to being on depo-provera - genital herpes - h pylori, s/p 2-week triple therapy on social history: lives with her 9 yo son. on disability. - tobacco: quit "years ago" - alcohol: glasses wine or champagne at holidays/special occasions (none recently) - illicits: none, denies ivdu family history: grandmother with diabetes, no other significant family history physical exam: on admission: vitals: t: 97.5 bp: 155/100 p: 125 r: 24 o2 sat: 96% general: alert, oriented, actively vomiting and in moderate distress secondary to back pain : sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: tachycardic with regular rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: hypoactive bs, soft, mildly tender diffusely, non-distended, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. no skin tenting. . on discharge, pertinent exam findings include: neck: r neck puncture site where ij line was removed (no bleeding, dressing clean/dry/intact) resp: ctab, good air movement bilaterally; r axilla puncture site where pigtail catheter was removed (no bleeding, dressing clean/dry/intact) abd: soft, nt, nd pertinent results: urine: creat-25 sodium-59 potassium-16 chloride-17 ucg-negative osmolal-635 color-straw appear-clear sp -1.023 blood-neg nitrite-neg protein-neg glucose-1000 ketone-80 bilirubin-neg urobilngn-neg ph-5.5 leuk-neg labs on admission: blood: glucose-686* urea n-39* creat-1.4* sodium-130* potassium- greater th chloride-91* total co2-19* alt(sgpt)-24 ast(sgot)-83* alk phos-60 tot bili-0.5 lipase-34 calcium-10.0 phosphate-6.3*# magnesium-2.3 wbc-10.5# rbc-3.70* hgb-10.6* hct-32.3* mcv-87 mch-28.7 mchc-32.9 rdw-13.0 neuts-88* bands-0 lymphs-10* monos-2 eos-0 basos-0 atyps-0 metas-0 myelos-0 hypochrom-normal anisocyt-occasional poikilocy- occasional macrocyt-occasional microcyt-occasional polychrom-normal burr-occasional plt smr-normal plt count-201 blood tsh-1.0 micro: legionella urinary antigen negative stool clostridium difficile toxin a & b test negative blood helicobacter pylori antibody test positive mrsa screen-final negative labs prior to discharge: blood: wbc-7.6 rbc-2.93* hgb-8.7* hct-25.1* mcv-86 mch-29.6 mchc-34.4 rdw-13.4 plt ct-185 plt ct-185 glucose-250* urean-11 creat-1.1 na-136 k-3.4 cl-100 hco3-30 angap-9 calcium-8.4 phos-3.0 mg-1.7 cxr: interval re-positioning of right ij line with tip in low svc. cxr: there is a new large right pneumothorax surrounding the right lung with some mediastinal shift to the left. the right ij line is again visualized. there is no infiltrate or effusion. cxr: new right-sided pigtail catheter with reexpansion of the right lung. cxr: no pneumothorax. pigtail catheter no longer within the thoracic cavity. brief hospital course: assessment and plan: 27 yo hx of iddm and recent admission for ugi bleed and gastroparesis presents with increased back pain, abdominal pain, n/v x1 day, found to be hyperglycemic with diabetic ketoacidosis. . active issues: . # diabetic ketoacidosis: history and labs consistent with dka. glucose >500 in ambulance and 686 in the ed, ketones in urine, chem panel showed anion gap metabolic acidosis. there was no clear precipitating factor. when she arrived to the unit there was a delay in treatment because she lost both peripheral ivs. we could not get new peripheral access and so a right ij line had to be placed. of note, on her last admission, she also needed a central line placed. she was initially treated with an insulin pump that was titrated according to icu protocol. she was also given normal saline and her anion gap closed appropriately. when she appeared euvolemic, she was switched over to d5,1/2ns, and when her gap closed she was started on sub q insulin. she was initially started on her home dose lantus of 20 units in the am and then the regiment was transitioned to a pm dose, which is when she takes it at home. her fsg became stable. was consulted and followed throughout the hospital admission. pt was scheduled with f/u at . . # pneumothorax: hospital course was c/b large right-sided pneumothorax. approximately 1 day after transfer from icu to floor, patient developed tachycardia to the 140s. since patient was n/v and not tolerating pos, dehydration was suspected and pt was given iv boluses. tachycardia did not resolve. a cxr revealed a large right sided pneumothorax. thoracics was consulted, who placed a pigtail catheter. subsequent cxrs showed resolution of the pneumothorax. pt with no known risk factors for pneumothorax; pneumothorax thought to be secondary to r ij central line placement. however, developed several days after r ij was placed. . # abdominal pain: secondary to dka vs. hyperglycemic exacerbation of gastroparesis. abdominal exam was benign, but effort was made to rule out intraabdominal process. we intially held her reglan and then restarted it later on. we also sent off a stool pcr for h. pylori since it was unclear whether she had been treated appropriately in the past as well as c.diff. c. diff studies were neg. unsurprisingly, the h.pylori antibody was postitive, as pt has had h. pylori in past but the pcr was rejected and not run. as abdominal pain was decreasing, this was deferred for further w/u to the outpatient setting. patient was scheduled with gi follow-up. . # nausea and vomiting: continued her reglan and zofran. her last gastric emptying study showed she was on upper limits of normal. she had continued voiting at the time of transfer to the floor despites attempting to optimize her medications. there was some concern that she was forcing emesis when physicians were around because she seemed to tolerate food well and not vomit when no one was paying attention and then start vomiting when people entered the room. . # depresssion: psych and sw was consulted during admission, and did not feel patient was a danger to herself. they saw no role for inpatient psych admission, but suggested patient attend a day program at hospital and an intake interview was scheduled. psych also recommended close psych f/u and pt start a ssri. pt was started on celexa 20 mg qd, which she tolerated well. . # acute kidney injury: cr increased to 1.4 on admission from baseline of 0.8-1.0, likely secondary to dehydration from dka. she had good urine output and her creatinine improved with fluid rescusitation. . # hyponatremia: na 130 on admission, corrects to 136 when accounting for hyperglycemia. as she was fluid rescusitated with normal saline, she became hypernatremic. her free water deficit was calculated and she was treated appropriately with ivf. her sodium returned to within normal range. . # back pain: exacerbation of chronic back pain mvc in , no new trauma. she was treated with dilaudid iv 1mg q4h:prn and tylenol 1gm iv q8h. her home regiment of gabapentin and amytriptyline was continued. she was transitioned to a po regiment once she was able to tolerate po. her pain had improved at the time of transfer to the floor and plan was to wean off her dilaudid prior to discharge. psych was consulted during the admssion and recommended d/c pt's amytriptyline. patient was not discharged on amytriptyline. . #anemia: pt was admitted with hct of 32.2 and d/c with hct of 25.1. no signs or of active bleeding. pt started on iron supplementation and advised to follow-up as an outpatient for anemia w/u. . # transitional issues: -on discharge, pt's hemoglobin was 8.7 g/dl; please follow up on her anemia as an outpatient. medications on admission: amitriptyline 10 mg hs gabapentin 300mg tid lisinopril 10 mg qday (hold) lantus 20 units hs (hold) humulog sliding scale - 1 unit for every 40 mg/dl over 140 (hold) metoclopramide 10 mg with meals (hold) zofran 4 mg q8h prn nausea ativan - unknown dose, prescibed by outpatient psychiatrist discharge medications: 1. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). 2. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical prn (as needed) as needed for itching. 3. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for lower back pain: 12 hours on, 12 hours off as needed for lower back pain. 4. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 5. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. lantus 100 unit/ml solution sig: 20 u subcutaneous at bedtime. 7. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs. 8. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. disp:*15 tablet(s)* refills:*0* discharge disposition: home with service facility: nizhoni health system discharge diagnosis: primary diagnosis: diabetic ketoacidosis secondary diagnoses: pneumothorax discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted to after calling emergency medical services for increased back pain, abdominal pain and nausea and vomiting. you were found to have very high blood glucose levels and diabetic ketoacidosis, and admitted to the intensive care unit for further management to get your blood sugar decreased to a safe level. you saw a diabetes specialist to help manage your diabetes. you were also given medications for your back pain. your abdominal pain resolved with time. nausea and vomiting was a recurrent problem for you during this hospital admission, and you received medications to help with these . when you were able to eat again, you were discharged. you have been referred to a gastrointestinal specialist for further work-up of the causes underlying your abdominal pain, nausea and vomiting. you also saw a social worker and psychiatrist, who started you on a new medication for your depression. she also recommended a partial psychiatric program and close psychiatric care for better management of your depression and anxiety. on , a chest x-ray showed that you had a right-sided pneumothorax, which means that air had collected between your right lung and the chest wall. the thoracic surgery team put a tube (called a pigtail catheter) in your chest to drain the air. repeat chest x-rays showed that the pneumothorax had resolved. on , the pigtail catheter was removed. a chest x-ray done after removal of the tube looked stable. medication changes: start citalopram 20 mg po qd-- you were started on this medication to help with the treatment of your depression. stop amitriptyline 10 mg once nightly-- you should stop taking this medication. start ferrous sulfate (iron pill) 325 mg once per day. the iron pills may make your stools appear darker than usual. start ascorbic acid (vitamin c) 100 mg once per day. take the iron and vitamin c pills at the same time. for pain, you may take over-the-counter tylenol as needed (do not exceed 4 grams per day). you may also take the prescribed vicodin as needed for pain, but try to avoid taking the vicodin if you can. your follow-up appointments are listed below. it is important to attend all these appointments in order to feel your best. it was a pleasure taking care of you. please continue taking your other home medications without any changes. please don't hesistate to contact the hospital or your primary doctor with any concerning . followup instructions: please make sure you go to the following outpatient appointments that we have scheduled for you: please call thoracic surgery clinic () for an appointment in 1 week with dr. . you will need to have a chest x-ray done prior to this appointment; please ask the thoracic surgery clinic about how/when to get the x-ray when you call for the appointment. please call your pcp to schedule follow-up appointment by , . you will need to have your blood drawn next wednesday or thursday to check your blood counts prior to this appointment. you should go to your pcp's office to have the blood drawn. intake appointment at partial hospital program on wednesday at 9:15am. location: , ma. (. department: spine center when: thursday at 10:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: when: at 1:45 pm with: , md building: sc clinical ctr campus: east best parking: garage department: div. of gastroenterology when: at 10:00 am with: , md building: ra (/ complex) campus: east best parking: main garage name: , location: diabetes center address: one place, , , phone: when: , , 2pm procedure: insertion of intercostal catheter for drainage central venous catheter placement with guidance diagnoses: nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere other chronic pain abdominal pain, unspecified site anemia, unspecified acute kidney failure, unspecified hyposmolality and/or hyponatremia other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure iatrogenic pneumothorax long-term (current) use of insulin hyperosmolality and/or hypernatremia backache, unspecified gastroesophageal laceration-hemorrhage syndrome leukocytosis, unspecified helicobacter pylori [h. pylori] diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with renal manifestations, type i [juvenile type], uncontrolled diabetes with ketoacidosis, type i [juvenile type], uncontrolled gastroparesis esophageal varices without mention of bleeding panic disorder without agoraphobia major depressive affective disorder, single episode, moderate history of physical abuse 

Answer: The patient is high likely exposed to