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: lithium / erythromycin base / cogentin / stelazine / clozaril attending: chief complaint: transfer from hospital for cvvh major surgical or invasive procedure: hd line placement l neck, cvvh intubation history of present illness: the patient is a 64-year-old male with multiple medical problems including a history of chronic kidney disease (stage iv) secondary to presumed lithium toxicity with renal tubular acidosis, history of endocarditis in and presumed endocarditis in , schizoaffective disorder, who was admitted to the hospital on for treatment of mssa bacteremia and presumed endocarditis with a six week course of nafcillin in the context of a hip fracture with hardware in place in the left hip. the hospital course at was complicated by 2 major gastrointestinal bleeds secondary to multiple duodenal erosions and ulcerations, severe malnutrition with anasarca and weakness. in the week preceding , the patient was noted to be less alert by the chronic medical service that was following him. he had been having continued diarrhea with a recent history of clostridium difficile colitis for which he was treated with flagyl and was again found to be clostridium difficile positive. the patient was also found to have a urinary tract infection with urine culture growing enterobacter cloacae. the patient's diarrhea and urinary tract infection were accompanied with volume depletion and metabolic acidosis. on , the patient became hypotensive with blood pressures in 80s/30s, nonresponsive to aggressive fluid hydration. he was transferred to the icu and started on levophed as well as increased antibiotic coverage. . in the icu, he was started on po vanc and continued on iv flagyl for treatment of cdiff. he had an episode of afib w/ rvr and is s/p cardioversion for hypotension. he was treated with vanc/zosyn for broad coverage in the setting of septic shock and continued on cipro for treatment of an enterobacter uti. he was afebrile during his icu course and has been off pressors for several days however his blood pressure was thought to be too low to tolerate hd so he was transferred to for cvvh. . on arrival, he states he feels mildly sob. he denies cough. he endorses r testicular pain. no f/c/n/v. he feels hungry and thirsty. past medical history: 1. bipolar disorder versus schizoaffective disorder with history of suicide attempts and ect tx (followed in the past by pact team ). 2. enterococcal endocarditis in . 3. questionable mssa endocarditis, : tee at was negative for vegetation and abscesses, so diagnosis of endocarditis was not clear. however, given mssa bacteremia at the time, and presence of hardware in the left hip, a six week course of nafcillin dating from first negative culture on , was recommended and completed on . 4. noninsulin dependent diabetes. 5. hypertension. 6. coronary artery disease status post myocardial infarction x2. 7. echocardiogram performed showing ejection fraction to 50%, focal thickening of the mitral and aortic valves, and mild pulmonary hypertension. 8. gastroesophageal reflux disease. 9. benign prostatic hypertrophy. 10. chronic kidney disease, stage 4 with nephrotic syndrome and renal tubular acidosis secondary to presumed lithium toxicity with a baseline creatinine of 2.5 while at the hospital. 11. dvt 12. recent h/o afib w/ rvr. 13. hyperlipidemia 14. s/p fall w/ occipital bleed 15. duodenal ulcers w/ 3 recent gi bleeds 16. l hip femoral neck fracture s/p hemiarthroplasty in 17. l radial fx social history: prior to his hospitalization for hip surgery and then transfer to the hospital, the patient lived in an apartment by himself with pact team support for psychiatric issues. he was at rehab from until . the patient has a girlfriend, , who visits him occasionally. the patient has a sister who is also his health care proxy who lives in but is very involved in his health care. the patient had a smoking history of 1.5 packs a day x30-40 years. the patient has a rare history of alcohol use. denies illicit drug use. family history: h/o bipolar disorder and depression in the family. physical exam: vitals: t: 98 bp: 129/51 p: 89 r: 16 o2: 92% on 2l nc general: groggy and slow to answer but awake, oriented, no acute distress heent: sclera anicteric, dry mm, oropharynx clear neck: supple, rij in place lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: distended, but non-tender, hyperactive bs ext: anasarca, wwp, able to move all extremities pertinent results: 03:24pm type-mix 03:24pm o2 sat-74 02:13pm type-art temp-37.8 po2-87 pco2-41 ph-7.26* total co2-19* base xs--8 comments-axillary 02:13pm lactate-1.7 na+-137 k+-3.3* 02:13pm freeca-1.10* 02:00pm urine hours-random urea n-280 creat-74 sodium-52 02:00pm urine color-yellow appear-cloudy sp -1.017 02:00pm urine blood-mod nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-lg 02:00pm urine rbc-32* wbc->1000* bacteria-none yeast-many epi-0 02:00pm urine wbcclump-many 01:16pm glucose-57* urea n-95* creat-5.5*# sodium-142 potassium-3.7 chloride-111* total co2-19* anion gap-16 01:16pm estgfr-using this 01:16pm alt(sgpt)-4 ast(sgot)-13 alk phos-66 tot bili-0.2 01:16pm tot prot-3.1* albumin-1.3* globulin-1.8* calcium-7.3* phosphate-7.7*# magnesium-1.8 01:16pm vit b12-1222* folate-16.8 01:16pm vanco-18.1 01:16pm wbc-18.0*# rbc-2.62* hgb-8.3* hct-26.1* mcv-100*# mch-31.8 mchc-31.9 rdw-18.5* 01:16pm neuts-77* bands-4 lymphs-12* monos-5 eos-0 basos-0 atyps-0 metas-1* myelos-1* 01:16pm hypochrom-occasional anisocyt-2+ poikilocy-normal macrocyt-1+ microcyt-normal polychrom-1+ 01:16pm plt smr-normal plt count-293 01:16pm pt-15.6* ptt-83.1* inr(pt)-1.4* brief hospital course: this is a 64 m w/ pmh of stage iv ck, 3 recent ugi bleeds in the setting of duodenal ulcers, recent tx for mssa endocarditis w/ 3+ ar, recent cardioversion for afib w/ rvr, transferred to for consideration of cvvh in the setting of hypotension and likely continuing septic physiology. . # hypotension: currently relatively hypotensive given h/o hypertension. vanc/zosyn were started on for empiric broad-spectrum coverage for septic shock at osh. blood cx from osh on w/ ngtd. had been afebrile during his icu stay at osh. wbc count 18 from 27 on the 14th. given leukocytosis, likely c/w continued sepsis. possibly from c diff colitis as seemed to improve with po vancomycin. patient was placed on continued po vanc and iv vanc/zosyn. his hypotension continued to progress. he was intubated for airway protection after he became acutely less responsive, diaphoretic and pale. his sister was called and she decided to make him cmo. the tube was removed and the patients blood pressure continued to drop until he passed at 855 pm. . # c. diff colitis: currently being treated w/ po vanc (d1 = ) and iv flagyl (unknown time course). has a history of chronic diarrhea of unknown etiolgy. - continue po vanc x 14 after last day of broad-spectrum antibiotics () . # acute renal failure on chronic renal failure: his baseline cr was 2.6 on admission to . cr now 5.6 on transfer. ? from atn from hypotension. has a h/o nephrotic syndrome w/ albumin of 0.7. clearly has anasarca. blood pressure on the low side so unclear if he would tolerate hd. - renal consult for possible cvvh-unable to place line on hd 2, on hd 3 acutely hypotensive and l ij line placed emergently. cvvh never initiated as patient made cmo. - renal diet - nephrocaps - phos binders given phos of 7.7 . # hypoxia: h/o smoking so likely has some underlying copd. likely a component of volume overload/pulmonary edema given renal failure. - continue ipratropium nebs - cxr - cvvh vs hd as above . # enterobacter clocae uti: per osh, blood cx from w/ ngtd. - cipro started on (no data), will d/c as now s/p an 11-day course - send ua/cx . # dvt: r superficial femoral vein thrombosis report. is very high risk for recurrent gi bleed. the risk/benefit ratio was discussed at and thought to favor anticoagulation. - heparin ggt-held given need for hd line, never re-initiated . # afib: currently in sinus. status post cardioversion on in the setting of hypotension. has been on heparin ggt and amio was started to prevent recurrent afib. likley afib occurred in the seting of septic shock from ? cdiff. - will discontinued amiodarone . # anemia: macrocytic. had an upper gi bleed during his last hospitalization and 2 additional gi bleeds at requiring 6 u prbc. this may also be c/b b12 deficiency as it appears that his b12 level was low in . - guiac stools - transfuse for hct < 21 . # decubitous ulcers: stage 1 sacral decubitous ulcer. - wound consult . # dm: bs well-controlled w/o insulin coverage at . - trend for now - add insulin ss if needed . # aortic regurgitation: 3+ on echo thus although ef > 55%, functionally his forward flow is not normal. . # bipolar disorder/schizophrenia: continue valproic acid, wellbutrin, seroquel, lamictal . # gerd: continue pantoprazole 40 mg given h/o duodenal ulcers and gi bleed during last hospitalization . # hyperlipidemia: continue simvastatin . # bph: hold terazosin as has a foley in place . # fen: no ivf, replete electrolytes, renal diet . # prophylaxis: heparin ggt, vre carrier, known cdiff + . # access: lines: 1- right ij line (placed ) - will order picc and d/c 2- right radial a-line (placed ) - will d/c if not needed . # code: full code . # communication: patient, sister ( . # disposition: pending above medications on admission: 1. ciprofloxacin 400 mg iv q. 24 hours. 2. zosyn 2.25 grams iv q. 8 hours. 3. vancomycin 1 gram iv daily (dose given daily depending on daily a.m. vanco trough). 4. vancomycin 250 mg p.o. t.i.d. 5. flagyl 250 mg iv q. 8 hours. 6. bicitra 10 ml p.o. b.i.d. 7. valproic sodium 750 mg p.o. b.i.d. 8. omeprazole 40 mg p.o. q. 12 hours. 9. epogen 40,000 units subcu once weekly. 10.lamictal 50 mg p.o. b.i.d. 11.calcitriol 0.25 mcg p.o. daily. 12.ipratropium bromide 0.5 mg 0.25% inhaled q. 4 hours p.r.n. shortness of breath. 13.tylenol 650 mg p.o. q. 6 hours p.r.n. temperature greater than 101. 14.atrovent inhaler q. 4 hours p.r.n. shortness of breath. 15.folic acid 1 mg p.o. daily. 16.cholecalciferol 400 units p.o. daily. 17.oxycodone 5 mg p.o. q. 6 hours p.r.n. pain. 18.wellbutrin sr 100 mg b.i.d. 19.seroquel extended release 200 mg p.o. q. h.s. 20.amiodarone 400 mg p.o. t.i.d. 21. heparin gtt with q6 hours ptts 22. novasource renal at 20 ml an hour around the clock with 250 ml normal saline flushes every 4 hours discharge medications: na discharge disposition: expired discharge diagnosis: expired secondary to cardiopulmonary compromise from sepsis likely c.diff. complicated by acute on chronic renal failure. discharge condition: expired discharge instructions: na followup instructions: na md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnostic ultrasound of heart insertion of endotracheal tube venous catheterization for renal dialysis diagnoses: end stage renal disease coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other pulmonary insufficiency, not elsewhere classified unspecified septicemia severe sepsis atrial fibrillation aortic valve disorders hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) pulmonary collapse hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease septic shock pressure ulcer, lower back acute venous embolism and thrombosis of deep vessels of proximal lower extremity accidents occurring in residential institution bipolar disorder, unspecified other psychotropic agents causing adverse effects in therapeutic use unspecified deficiency anemia pressure ulcer, stage ii schizoaffective disorder, unspecified nephrotic syndrome with unspecified pathological lesion in kidney 

Answer: The patient is high likely exposed to