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: lisinopril attending: chief complaint: diarrhea major surgical or invasive procedure: none history of present illness: mrs. is an 84 yo f h/o cri, htn, gerd, colon ca, neprhotic syndrome, dc'd after low anterior resection of colon. now p/w 1wk h/o diarrhea worsened one day prior to admission, found to have wbcc 30 in ed, admitted and started on both p.o. vanco and iv flagyl. began to have brbpr on , on had flex sigmoidoscopy showing pseudomembranes with recurrent c.diff vs. bowel ischemia as etiology. then developed some sob/fluid overload and was started on lasix and neseritide gtt's. had had some intermittent afib which was thought to be contributing to presumed diastolic dysfunction. tx to ccu for worsening tachypnea and oliguria on nesiritide and lasix gtt. was cardioverted chemically with good result. also developed acute on chronic renal failure for which nephrology has been following, zenith of 6.0, now back at baseline creatinine of 2.0's. past medical history: recent admission to from to for treatment of likely viral gastroenteritis, pna, transaminitis, discharged to rehab in - ras: mri () atrophic r kidney, mod stenosis of r renal artery, l renal artery normal - cri/nephrotic range proteinuria: baseline cr 2.5; followed by dr. (nephrology) - pvd/claudication - nephrotic range proteinuria - gerd - htn: poorly controlled (sbp in 200s), echo ef >55%, mod ar, mild mr, ascending aorta mildly dilated, abdm aorta mildly dilated, ao valve leaflets mildly thickened - hyperlipidemia - total chol 255 (), ldl 138 (), hdl 31, (), tg 312 () - glaucoma - rheumatic fever - anemia - - mid 30s - hyperkalemia - osteoarthritis - osteopenia social history: living alone independently prior to last hospitalization. several children and grandchildren in the area who are involved in her care. denies alcohol or tobacco use. family history: noncontributory. physical exam: tm 95.7, bp 108/50, p 93, r 25, 98% ra perrl. op clr jvp not appreciable. regular s1,s2. no m/r/g lca b/l +bs. soft. nt. nd. 2+ lower and upper ext edema pertinent results: admission labs: . cbc: wbc-41.4*# rbc-4.35 hgb-13.0 hct-37.5# mcv-86 mch-29.8 plt 167 diff: neuts-93.1* bands-0 lymphs-5.6* monos-1.1* eos-0.1 basos-0.2 . chem 7:glucose-81 urea n-64* creat-4.1*# sodium-135 potassium-5.1 chloride-103 total co2-20* anion gap-17 albumin-1.8* calcium-7.3* phosphate-4.0 magnesium-2.0 . lfts: alt(sgpt)-10 ast(sgot)-24 alk phos-150* tot bili-0.4 . ct: 1. extensive pan colitis consistent with the clinical diagnosis of c-dif colitis. there is no evidence of toxic megacolon or perforation or abscess. 2. new small bilateral pleural effusions. 3. small amount of ascites. . right ij central line with the tip in the right atrium. no evidence of pneumothorax. . micro: cdiff : negative cdiff : negative cdiff : negative cdiff : negative cdiff : negative * blood cx : negative urine cx : <10,000 organisms brief hospital course: 84 yo f w/ h/o cri, htn, h/o nephrotic syndrome, w/ diarrhea, c.diff pos at rehab, failure to respond to flagyl, w/ elev wbc, and negative ct. a brief-problem based hospital course is outlined below. 1) presumed c.diff infxn- admitted and started on p.o. vancomyin and iv metronidazole, w/ addition of levofloxacin for broad spectrum coverage given recent abd surgery. cholestyramine was initially given for toxin binding. wbc was 30 on admission and trended down with abx; however, c.diff toxin neg x5, so diagnosis remains presumptive. c. diff b toxin was sent and was negative as well. she completed a 3 week course of po vanco and iv flagyl antibiotics, which was completed on . she subsequently remained afebrile without further diarrhea, and was able to tolerate po's. 2) pt began having episodes of brbpr on with resultant slow hct drop. gi and surgery were consulted. pt had no abdominal pain, but given recent surgery and low albumin, we were concerned that the bleed may be evidence of ischemic bowel or dehiscence. pt was also having intermittent episodes of tachycardia, raising the possibility that she was having embolic phenomena with acute ischemia. however, she had no abdominal pain to suggest this. colonoscopy was done on , showing severe c dif vs. ischemic bowel. surgery found that pt was not surgical candidate and believed her bleeding and mucosal damage was c dif and would continue to improve. biopsy results showed no evidence of c.dif, but given pt's tenuous status, po vanco and iv flagyl were continued while awaiting toxin b. it is quite possible that the mucosal changes seen on colonoscopy were the result of c dif infxn, which had been treated w/abx and resolved, leaving the mucosae to heal. as well, gi felt there may be a superimposed ischemic insult. no further work-up was performed since she had good clinical resolution of her colitis, following completion of cdiff treatment. 2) acute renal failure w/ cri- renal team was consulted on admisison. baseline cr is approx 2.0. on admission this was significantly elevated to 4.1. fena was c/w prerenal etiology and patient had r ij placed in ed, started on ns for volume resusciation. this was undertaken slowly given that pt had an albumin of 1.4 and pleural effusions were noted on ct. fluids were changed to 1/2ns w/ bicarb on hd2. cr trended down each day and the patient has maintained oxygenation. alb/cr ratio not c/w nephrotic range proteinuria- thus it was felt that the low alb was likely multifactorial. pt initially required boluses of 500cc ns to maintain uop ~20-30cc/hr. with hydration and improvement in her diarrhea, her cr steadily decreased and returned to baseline of 1.6. she was seen by renal who felt that her increase in creatinine may have been secondary to atn/hypotension and recommended avoiding aggressive overdiuresis. she did subsequently require aggressive diuresis given her rapid afib/chf with lasix and niseritide drips. however her creatinine remained at baseline of 1.7-2.0 with diuresis. she did develop a transient metabolic alkalosis, which was felt likely from volume contraction alkalosis. therefore her lasix was weaned to 40mg daily and her bicarb trended back down to 30. her creatinine was stable at 1.6 at the time of discharge. 3) pt was noted to be mildly thrombocytopenic on admisison. unclear why it was low when patient presented. most likely extreme inflammatory/sirs response (given elev lactate on admission). her plt count dropped to 95 and dic workup and hit ab were sent, both negative. her plt count rose as her clinical condition improved and remained in normal range for the duration of her hosital course. 4) htn - pt's baseline sbp is in the 180s-200s range. on admission, bp was low 3rd spacing and early sepsis. her bp responded to fluids and she remained relatively normotensive. she was continued on metoprolol for hr/bp control and isordil/hydral was added for afterload reduction. 5) chf - evidence of chf on initial cxr. her ef was found to be 40% (previously normal), bringing up concern for ischemic event precipitating her failure. in support of this she was noted to have wall motion abnormalities on echo with inferoseptal/basal hypokinesis. diagnostic catheritization was not performed due to her renal insufficiency and decompensated chf. she was managed medically, and on the chf service was consulted for management. she was initiated on aggressive diuresis with iv lasix for goal -1.5l per day. she was transferred to the ccu briefly on for more tailored therapy and diuresis for her chf (lasix boluses and nesiritide) with good effect (negative approximately 500 cc overnight). she was transferred back to the floor on lasix boluses. due to continued evidence of volume overload she was given 160mg iv + started on lasix drip at 10mg/hr. then started nesiritide (1mcg/kg) followed by gtt at 0.01mcg/kg/min. diuresed well to this and maintained bp well, however after increasing natrecor to 0.015, went back into rapid afib. stopped natrecor on . stopped lasix gtt on given persistent good diuresis. now tapered down to 40mg daily lasix/day + afterload reduction w/ isordil/hydral on . at the time of discharge, she was felt to be euvolemic with goal of matching ins and outs daily. we will continue her on this regimen upon discharge. 7. atrial fibrillation: initially converted from raf by medical cardioversion performed with procainamide gtt in the ccu at 13mg/kg/hr x10min load followed by 2mg/hr for 2h trial. became hypotensive to 60's systolic, but subsequently recovered. then again went into raf on early am. initially hr controlled w/ iv lopressor/iv dilt. then medical cardioversion w/ procainamide. became hypotensive to 70's systolic after about 10 minutes on procainamide , this was stopped and her blood pressures normalized. she then converted 10 min later to nsr. she has been in nsr the remainder of her hospital course. she is not on coumadin due to risk for bleed. in addition, amiodorone was discussed as a medical option for continued rythm control. however, given the side effect profile, the family and patient were more comfortable with holding off on adding amiodorone at this time. they understand that there is a higher risk of conversion back to atrial fibrillation and increased risk for stroke without amiodorone. we will continue rate control with metoprolol as mentioned at 25mg tid, and may titrate up as needed to maintain hr <80. 8. cad- wall motion abnormalities on echo w/ inferoseptal/basal hk. currently chest pain free. continuing with medical management. on statin/b-blocker. no plan for cath at this time given her renal insuff/co-morbiditites. also holding off on aspirin currently given her bleed risk. this will be re-addressed as an outpatient through her pcp . . 9. anemia- initially had episode of gi bleed with blood loss anemia requiring 3 units of packed red blood cells. hematocrit subsequently normalized. however, she subsequently was noted to have a low, but stable, hematocrit at 28-29. repeat stool guaiacs were all negative and she had no further evidence of bleed or hemolysis. iron stores were also found to be within normal limits, with low tibc and high ferritin suggesting anemia of chronic disease. this was felt likely secondary to chronic renal insufficiency. she was started on epo 2,000 units q m,w,fr on . the goal transfusion criteria would be 30 given her history of cad, however, we have held off on further transfusion at this time given her known chf with recent severe volume overload. we have set transfusion goal at hct>28, and transfused with 1 unit packed red blood cells and 20mg iv lasix for hct <28. 10. tachypnea- resolved. her transient tachypnea was felt likely secondary to volume overload. there was no evidence of infiltrate by cxr. her abg at the time on showed 7.29/43/99. her respiratory status subsequently improved that same day on following iv lasix and atrovent nebulizers. avoided albuterol nebulizers over concern for tachycardia. 11. f/e/n- started on tpn for nutritional supplementation. she also had a swallow study which showed ability to tolerated regular solids and thin liquids. she has been taking in po's as tolerated, but has continued to require tpn to reach nutritional goals. this will be continued upon discharge at rehab. medications on admission: aspirin 81mg--one by mouth every day calcium --one tablet three times a day clonidine hcl 0.1 mg--4 tablet(s) by mouth twice a day colace 100mg--take one pill twice a day as needed for constipation lasix 20 mg--1 tablet(s) by mouth once a day lopressor 50mg--one half tablet by mouth twice a day nizoral 2%--use as directed norvasc 10mg--one by mouth every day phoslo 667mg--two tabs three times a day with meals per renal pletal 50mg--as per dr tylenol/codeine no.3 30-300mg--one tablet by mouth q 6 hours as needed for pain ultram 50mg--one half tablet by mouth twice a day as needed for leg pain vitamin d unit--one tablet q week discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for fever, pain. 2. brimonidine tartrate 0.15 % drops sig: one (1) drop ophthalmic q8h (every 8 hours). 3. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 4. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed for dry nasal mucosa. 5. albuterol sulfate 0.083 % solution sig: one (1) inhalation q3-4h () as needed. 6. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 7. atorvastatin calcium 10 mg tablet sig: one (1) tablet po daily (daily). 8. timolol maleate 0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 9. loteprednol etabonate 0.5 % drops, suspension sig: one (1) ophthalmic daily (). 10. brinzolamide 1 % drops, suspension sig: one (1) ophthalmic (2 times a day). 11. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 12. famotidine 20 mg tablet sig: one (1) tablet po daily (daily). 13. hydralazine hcl 25 mg tablet sig: one (1) tablet po tid (3 times a day). 14. isosorbide dinitrate 10 mg tablet sig: one (1) tablet po tid (3 times a day). 15. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 16. epoetin alfa 2,000 unit/ml solution sig: one (1) ml injection qmowefr (monday -wednesday-friday). discharge disposition: extended care facility: & rehab center - discharge diagnosis: 1. rapid atrial fibrillation 2. congestive heart failure (ef 40%) 3. hypotension 4. gastrointestinal bleed 5. coronary artery disease 6. refractory c.diff 7. non-healing surgical wound 8. deconditioning 9. malnutrition 10. contraction alkalosis 11. chronic renal insufficiency discharge condition: stable. discharge instructions: you are being discharged to rehab. please follow-up with dr. 1-2 weeks after discharge from rehab. followup instructions: please follow-up with dr. 1 week after discharge from rehab. you may call to make an appointment at procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of large intestine transfusion of packed cells injection or infusion of nesiritide diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified esophageal reflux congestive heart failure, unspecified acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) unspecified protein-calorie malnutrition atrial fibrillation candidiasis of mouth hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease atherosclerosis of renal artery intestinal infection due to clostridium difficile personal history of malignant neoplasm of large intestine hemorrhage of gastrointestinal tract, unspecified diastolic heart failure, unspecified 

Answer: The patient is high likely exposed to