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: hematemesis major surgical or invasive procedure: upper endoscopy history of present illness: ms is a 50 year old woman with poorly controlled type 1 diabetes, severe gastroparesis, end stage renal disease, on hd, presenting with one day of new hypertension, hyperglycemia and hematemesis. patient reports she felt well on the night prior to admission, but felt very poorly this morning after waking up. she reports her fasting blood glucose was 500 and systolic blood pressure was approximately 240/140. she denies any chest pain, shortness of breath, diarrhea, but does report vomiting blood. she also reports this is not a new event for her and that she frequently vomits dark material with frank blood in it. in the ed, patient with temp = 98.4 hr 130 bp 195/115 rr: 28 os sat: 99% ra. patient continued to feel nauseated and became severely hypertensive to 240's and considered to be symptomatic (nausea), iv labetalol 20mg x 1 was given and bp rapidly dropped to 96/55 in less than 1 hour, with ensuing global aphasia and acute mental status changes. neurology was consulted in the ed for this and per their recommendation, bp was less agressively treated. regarding the hematemesis, ng tube was placed and lavage with 500ml of ns without clearing of bloody, hemoccult positive contents. gi called, patient admitted to micu for further management. past medical history: 1. poorly controlled dm type 1, diagnosed in . followed at the (dr. . last hba1c 9.8 in at . av fistula on , currently seeing dr. for evaluation of kidney transplant 2. severe gastroparesis 3. diabetic neuropathy, with charcot joints 4. chronic renal insufficiency baseline cr ~4 .started dialysis in 5. hypertension 6. non-healing left foot ulcer with several foot surgeries 7. hx. of mrsa 8. h/o ugib 9. peripheral neuropathy 10. diabetic retinopathy s/p laser surgery (blind right eye) social history: lives with her husband and two sons, remote smoking history and occasional etoh. currently on disability. denies illicit / ivdu family history: she has cousins, uncle, and grandmother with dm. no history of strokes. no gi malignancies or disorders. physical exam: temp: 97.4 hr: 87 bp: 181/139 rr: 13 o2 sat: 98% gen: ill appearing woman, no acute distress heent: dry mucous membranes, eomi, peerl cv: tachycardic, ii/vi systolic murmur loudest at the lusb. lungs: cta bilaterally abdomen: ntnd, nabs ext: no clubbing /cyanosis/edema, no splinter hemorrhages, no osler nodes, no lesions. pertinent results: ================== admission labs ================== wbc-12.0* rbc-4.34 hgb-13.5 hct-41.9 mcv-97 mch-31.2 mchc-32.3 rdw-14.7 plt ct-334 neuts-85.5* lymphs-9.4* monos-3.4 eos-1.2 baso-0.5 pt-11.7 ptt-21.0* inr(pt)-1.0 glucose-458* urean-30* creat-5.4* na-136 k-4.2 cl-96 hco3-26 angap-18 ck(cpk)-62 ck-mb-notdone ctropnt-0.09* calcium-9.2 phos-5.2* mg-2.3 lactate-1.8 ======== ecg ======== nsr with evidence of lvh, twi in v1 and 1mm st elevation on v2. ============= radiology ============= portable frontal chest: mild cardiomegaly persists, unchanged. mediastinal and hilar contours are unchanged. there is no focal lung parenchymal consolidation, pleural effusion, or pneumothorax. there is no pneumomediastinum. the surrounding osseous structures are grossly unremarkable. impression: no acute cardiopulmonary process. ct head impression: no acute intracranial hemorrhage or large area of acute infarction. however, mr is more sensitive in the detection of acute infarction and can be considered if there is continued concern. upper extremity u/s impression: no evidence of left upper extremity dvt. the study and the report were reviewed by the staff radiologist. ============= eeg ============= impression: abnormal eeg due to the slow background and occasional bursts of generalized slowing. these findings indicate a widespread encephalopathy affecting both cortical and subcortical structures. medications, metabolic disturbances, and infection are among the most common causes. there were no areas of prominent focal slowing, and there were no clearly epileptiform features. ============= tte ============= the left atrium and right atrium are normal in cavity size. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). the estimated cardiac index is normal (>=2.5l/min/m2). 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 stenosis. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: trace aortic regurgitation with normal valve morphology. mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. ============= ecg ============= sinus rhythm. borderlne left axis deviation. possible left ventricular hypertrophy. leftward transition point, probably secondary to left ventricular hypertrophy. compared to the previous tracing of multiple abnormalities as noted persist without major change. brief hospital course: assessment and plan: ms. is a 50f with pmh s/f iddm c/b esrd on hd and gastroparesis. presented to the ed with hematemesis, hyperglycemia, with cultures drawn yesterday growing gpc's. . #. hematemesis: the patient reported. chronic hematemesis at home, with "coffee grounds", approximately 10 times and up to a cup full. the patient was typed and screened and followed with serial hcts that improved and no transfusion was needed. the patient was placed on an iv ppi and an octreotide drip while she awaited an egd. gi perfomed the egd and found gastritis, but no active bleeding ulcers or evidence of tear. gi also mentioned that she will need a colonoscopy in to f/u polyp and poor prep onprior colonoscopy. the patient was transferred to the floor and her hct remained stable until d/c home. . #. gram positive bacteremia: although patient without fevers or chills, rapid growth on blood cultures in setting of hemodialsys was concerning. given the patient's prior hx of mrsa, vancomycin and zosyn were started empirically. zosyn was stopped prior to transfer from the micu to the floor. on the floor, after a day of normal vital signs and reassuring cbcs, vancomycin was stopped. given the presence of a heart murmur on physical exam there was some concern for endocarditis, but a tte did not reveal any concerning vegetations. in the end, the blood cxs great coagulase negative staph and it was felt by the medicine team that this was likely a contaminant. #. hyperglycemia/dm: the patient was continued on lantus and iss. it was thought that her blood sugars may have been elevated in the setting of infection. there were no acute diabetic related issues during this hospitalization. . #. hypertensive urgency: improved, holding antihypertensives for now, would start metoprolol and amlodipine after patient begins taking po's. due to recent ams from suddent bp drop but active gib, would aim for goal sbp near 160-180 (30-40% decreased in first 24hrs) as a balance, unless actively symptomatic. the patient was restared on her antihypertensive medications on the medicine floor and she tolerated them well. she was frequently walked by nursing with no abnormal orthostatic vital signs. . #. dysarthria / altered mental status: it was thought that patient's altered mental status was due to over agressive bp lowering in the ed. head ct was negative. neurology was consulted and agree with this assessment, but prefered to do an eeg to r/o seizure. in setting of agressive bp lowering. at the time of d/c the final read on the eeg was pending, but neurology claimed they would be responsible to follow up with the patient's primary care doctor if any abnormalities were revealed that needed further workup. . #. gastroparesis: the patient's home metoclopramide was held in the icu and restarted on the medicine floor when she was tolerating po meals. there were no acute gastroperesis related issues during this hospitalization. . #. esrd on hd: the patient received her regularly scheduled hd. there were no acute renal issues during this hospitalization. . #. elevated cardiac enzymes: likely demand ischemia in setting of hypertensive urgency / emergency during last admission. . #. hyperlipidemia: holding home pravachol while taking po's. statin was restarted on the medicine floor when the patient was tolerating po memals. . #. fen: diabetic diet . #. ppx: pneumoboots, no heparin given bleeding. . #. access: piv's, low threshold for central access if iv access is lost. . #. code status: presumed full . medications on admission: 1. amitriptyline 25 mg po hs 2. amlodipine 5 mg po bid 3. metoprolol succinate 25 mg (xl) po daily (daily). 4. aspirin 81 mg tablet 5. pravastatin 20 mg 6. metoclopramide 10 mg qidachs 7. insulin lantus 30 units at night; 8. zantac 150 mg tablet po twice a day. discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 2. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 3. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 4. metoclopramide 10 mg tablet sig: 0.5 tablet po qidachs (4 times a day (before meals and at bedtime)). 5. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 6. colace 100 mg capsule sig: capsules po twice a day: for constipation . disp:*30 capsule(s)* refills:*2* 7. senna 8.6 mg tablet sig: two (2) tablet po twice a day as needed for constipation. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: 1) insulin dependent diabetes mellitus 2) end stage renal disease on dialysis 3) acute upper gastrointestinal bleed requiring endoscopy and serial hematocrit monitoring discharge condition: afebrile, good condition discharge instructions: you came to the hospital for hyperglycmeia and vomiting. in the er your blood pressure was very elevated. after getting some medication to lower your blood pressure, you were confused and there was some concern for stroke. your head ct was negative. it was thought that you most likely experienced your symptoms secondary to a drop in blood pressure. neurology performed an eeg as well to rule out any seizure activity. they will follow up with your primary care doctor regarding the results of this test. there was one specimen of your blood that grew bacteria, but it was thought that this was likely a contaminant. all of your other lab work indicated that you did not have a blood infection. you came in with some bleeding from the upper gi tract, but this seems to have resovled. your blood counts were stable and you did not vomit on the floor. you were started on pantoprazole, a proton pump inhibitor to decrease the acid secretion in your stomach and reduce your risk of stomach ulcers and bleeding from the stomach. please seek immediate medical attention if you experience any light headedness, loss of concioussness, chest pain, dizziness, fevers, chills, vomitting, dark or red stools, belly pain or any change in your condition. followup instructions: please follow up with your pcp . early next week and be sure to discuss with her your blood pressure medications. i have scheduled an appointment with a nurse practitioner ( ) that works with dr. to discuss your diabetes following this hospital admission on at 11 am. you already have an appointment with dr. scheduled for . you also have an appointment for an upper endoscopy at at 10:30 am to evalaute the reason for your stomach bleeding. md, procedure: other endoscopy of small intestine hemodialysis diagnoses: end stage renal disease anemia, unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia long-term (current) use of insulin unspecified gastritis and gastroduodenitis, with hemorrhage personal history of noncompliance with medical treatment, presenting hazards to health aphasia diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy gastroparesis peripheral autonomic neuropathy in disorders classified elsewhere 

Answer: The patient is high likely exposed to