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: quinidine / propranolol attending: chief complaint: drop in hct and elevated creatinine at rehab major surgical or invasive procedure: picc placement history of present illness: mr. . is a very nice 87 year-old gentleman with htn, diastolic chf (ef 65% 1/10), afib not on coumadin, and mild as, stage iv ckd who comes with a "drop" in his hct and elevated creatinine and weight. he has had multiple admissions recently for acute diastolic heart failure and was discharged to rehab. at rehab patient was eating well a "no salt added" food and feeling well, but nurses noted he was gaining weight (up to 13 pounds as of yesterday). his torsemide was increased to 60 mg twice a day, but he continued to gain weight. he uses his regular pillows, denies any shortness of breath, fever, chills, rigors. he uses his teds in both legs religiously and has noted mild to moderate swelling of his ankles. his activity is not impaired and he has good apetite. . patient also complaints of a productive cough with yellow sputum over the last 1-2 days without sob, fever, chills rigors, rashes, joint pains. he reports that he feels fluid dripping in the back of his trhought without any metal taste or preference of time of the day. food does not change it. there is no rhinorrhea, increased lacrimation, odynophagia, sick contacts. . patient denies any changes in his bowel movement, diarrhea, constipation . yesterday he had his hematocrit checked and per report it was very low (unkown value) with guaiac positive stools. per osh report he was very sleepy, but responded to verbal comands and was oriented x3. in his labs, they also found a creatinine of 3 and rehab considered that he was too complicated to be managed there and sent him to the emergency room at , where he had normal physical exam, stable vs and ecg showing rbbb and atrial fibrillation without signs of ischemia. . in our emergency room the initial vital signs were: t 96.8 f, hr 75 , bp 125/63 mmhg, rr 16 x', spo2 99% on ra and fsg 74. patient look comfortable and well. his sbp fluctuated from 80-120 mmhg. his hct was at his baseline at 23.5 (hct on was 24), plt 85, ptt of 35.3 with inr of 1.3 and bun 103, creatinine 3.0 and ap 317, lipase 159. patient refused ng lavage and had guaiac positive stools. given signs of gi bleeding (guaiac) and borderline low bp patient received 1 unit of rbcs. pt was also administered pantoprazole iv. he is admitted to the icu for hemodynamic monitoring for possible gib and hypotension. his vs were t f, hr 69 x', bp 94/52 mmhg, rr 18 100%. past medical history: -congestive heart failure with preserved lvef (65% 1/10) --> per dcs from , thought to have left hf leading to right hf without primary pulm htn -chronic atrial fibrillation, not on warfarin given recent ugib () -mild aortic stenosis (peak 25 mmhg ) -pulmonary artery hypertension (30mmhg + ra ) -mild mitral regurgitation -moderate tricuspid regurgitation -mild aortic insufficiency -mild ascending aortic dilatation (3.7 cm) -left ventricular hypertrophy -prostate enlargement (followed by dr. ) -hypertension -hypercholesterolemia -severe essential tremor, since (wwii) -venous stasis, followed by dr. hernia repair -hemorrhoid repair -history of mrsa cellulitis () -chronic renal failure: stage iv with egfr of 24 ml/min (mdrd). recommend to check pth every 3 months with target of 70-110 --history of mrsa cellulitis () . recent hospitalizations: to -- for chf exacerbation, given lasix ggt -- left foot cellulitis/fluid collection managed medically with vanc/cipro/flagyl -- afib subtherapeutic on coumadin so bridged with heparin with subsequent rectal bleeding, traumatic hematoma, oozing from newly placed picc line -- incidentaloma seen in pancreas on ruq u/s without further w/u . to -- also for chf exacerbation, given lasix ggt and metolazone -- supratherapeutic inr on admission, complicated by epistaxis and melena (gi followed but endoscopy was deferred) -- c diff colitis treated with ? both po flagyl and vancomycin, course should have been completed . to -- unresponsive while sleeping after trazadone; negative infectious work up -- 16 beat run of vt -- decreased metoprolol from 12.5mg->6.25mg -- renal failure attributed to torsemide and pre-renal social history: usually lives with wife, married for >50yrs, currently at rehab. 3 children. no tobacco, etoh, ivdu. retired, formerly worked manufacturing and distributing batteries. he smoked cigars for 2-3 years and quit >45 years ago. he has not smoked cigarettes. he does not drink alcohol on a regular basis. denies iv, illicit, or herbal drug use. family history: parents are both deceased. father (73 years; "heart" disease); mother (48 years; stomach cancer). he has 2 siblings (80- breast cancer, brother with ? abdominal cancer). he has 3 children (55, 53, 49 years; all well). a son has atrial fibrillation. physical exam: vital signs - temp 94.5 f, bp 142/121 mmhg, hr 67 bpm, rr 14 x', o2-sat 100% ra <br> general - well-appearing man in nad, comfortable, appropriate, not jaundiced (skin, mouth, conjuntiva) heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear neck - supple, no thyromegaly, jvp 10-12 cm, no carotid bruits lungs - mild right crackles at the base, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - pmi displaced to the left, nl s1-s2, s3 intermittently present, harsh sem in rusb radiating towards neck; sem in llsb without radiation, 2/6 systolic murmur on apex radiating towards axila and very mild diastolic murmur in apex abdomen - nabs, mildly tense/nt/nd, no masses or hsm, no rebound/guarding. extremities - wwp, no c/c/e, weak peripheral pulses (radials, dps) skin - no rashes or lesions lymph - no cervical, axillary, or inguinal lad neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout, dtrs 2+ and symmetric, cerebellar exam intact. pt with baseline hz tremors (intention tremors as well as rest) discharge exam: t95.1f, bp 90/56 (baseline for patient), hr 56, rr 18, sat 98%ra heart: irreg irreg, occasionally bradycardic; 3/6 systolic murmur lungs: decreased breath sounds at bases bilaterally, but otherwise clear abd: soft, non-distended, + bowel sounds + scrotal edema + trace lower extremity edema to knees, 2+ pitting edema in thighs bilaterally stage ii coccyx ulcer multiple venous stasis ulcers on lower extremities pertinent results: 06:48pm glucose-58* urea n-103* creat-3.0* sodium-141 potassium-5.0 chloride-102 total co2-26 anion gap-18 06:48pm estgfr-using this 06:48pm alt(sgpt)-23 ast(sgot)-42* ld(ldh)-243 alk phos-317* amylase-284* tot bili-0.7 06:48pm lipase-159* ggt-154* 06:48pm tot prot-6.1* albumin-3.6 globulin-2.5 calcium-8.9 phosphate-4.2 magnesium-2.7* 06:48pm vit b12-1729* folate-15.5 06:48pm wbc-6.4# rbc-2.66* hgb-7.7* hct-23.5* mcv-88 mch-29.1 mchc-32.9 rdw-19.3* 06:48pm neuts-88.8* lymphs-7.5* monos-2.9 eos-0.5 basos-0.3 06:48pm hypochrom-1+ anisocyt-1+ poikilocy-1+ macrocyt-normal microcyt-1+ polychrom-occasional spherocyt-1+ ovalocyt-1+ target-1+ schistocy-1+ acanthocy-1+ 06:48pm plt smr-low plt count-85* 06:48pm urine color-straw appear-clear sp -1.010 06:48pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg cxr : findings: pa and lateral views of the chest are obtained. there is marked cardiomegaly with no overt chf. there may be a small left pleural effusion. no definite signs of pneumonia. mediastinal contour is grossly stable. no pneumothorax is present. bony structures remain intact with a dextroscoliosis of the t-spine again noted. cxr : impression: persistent bilateral effusions. improved left basilar atelectasis. 11:14 am stool consistency: soft source: stool. **final report ** clostridium difficile toxin a & b test (final ): reported by phone to , @ 10:05 . clostridium difficile. feces positive for c. difficile toxin by eia. (reference range-negative). a positive result in a recently treated patient is of uncertain significance unless the patient is currently symptomatic (relapse). urine culture (final ): proteus mirabilis. >100,000 organisms/ml.. presumptive identification. sensitivities: mic expressed in mcg/ml _________________________________________________________ proteus mirabilis | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- 16 i cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ 8 i meropenem-------------<=0.25 s piperacillin/tazo----- <=4 s tobramycin------------ 4 s trimethoprim/sulfa---- =>16 r brief hospital course: mr. . is a very nice 87 year-old gentleman with htn, diastolic chf (ef 65% 1/10), afib not on coumadin, and mild as, stage iv ckd who comes with a "drop" in his hct and elevated creatinine and weight. . # c. difficile colitis: patient with h/o c. diff here with hypotension, diarrhea, in the absence of fever or leukocytosis, found to be c. diff positive by stool culture. he was treated with iv flagyl & po vancomycin on hd4. given that this is the patients third episode of cdiff colitis this year, he will need a prolonged course of tapered antibiotic therapy. iv flagyl was discontinued and he was continued on po vanc with plans for continued taper. his diarrhea improved. schedule for taper provided to rehab. . #. anemia / gib? - pt with hct of 23, normocytic (88), normochromic (32) with rdw of 19. his ferritin is 349, tibc 298, trf 229, iron 97 with iron/tibc of 32% on . his b12 1340 and folate >assay in . furthermore, pt has ckd stage iv and is not on epo. he was on coumadin until last month when he had a presumed ugib and nosebleed and required 1 unit or rbcs. at that point his coumadin was stopped. currently he has plt of 80, inr of 1.3 and ptt of 35. the patient's hct was trended and noted to be stable at ~24-26. gi was consulted and given the patient's baseline functional status, deferred egd/ for outpatient setting if at all. . #. hypotension - patient with persistent hypotension to the 70's systolic, likely to infection & cardiac disease that was response to gentle ivf boluses & prbc's. he was monitored closely and improved to baseline (systolic values 90-100). . #. acute on chronic diastolic heart failure - patient with ef of 65% gaining weight according to rehab (13 pounds), despite higher torsemide dose. he does not report any dietary changes and has been on "no salt added" diet. he takes his medications as prescribed and no signs of infections. no clear precipitant, however he is slowly gaining weight. given iv lasix 100 x1 on admission, which resulted in a transient decrease in the patient's blood pressure to the 70s sbp. as a result, the patient's home torsemide was held. his hypotension persisted, however, thought to be to his diastolic dysfunction. dr. , his outpatient cardiologist, saw him and recommended continued treatment with torsemide, to which the patient diuresed well. he should continue diuresis with torsemide 40mg , with daily weights; if the patient's weight increases > 160, torsemide dosing should increase to 80mg in am and 40mg in pm. if weight decreases < 145, torsemide dosing should decrease to 40mg daily. daily potassium levels should be checked, and potassium repletion (powder) provided. spironolactone was started on , and improved diuresis should be expected in the next few days. he should also require less potassium supplementation. . #. thrombocytopenia - pt has had multiple plt counts in the 130-140 range in various occasions. however, since the last admission they have been decreasing up to the point of 80,000 today. furthermore, patient has been on heparin during all this time. given a concern for hit, antibody was checked and was positive, but the serotonin assay was negative (not likely hit). however, all heparin products were avoided during the hospitalization. . # positive blood culture. 1/4 bottles growing probably micrococcus; all other subsequent cultures negative. thought contaminant. . #urinary tract infection: empirically started on ceftriaxone; culture grew proteus. he completed a 7 day course of ceftriaxone. . # pancytopenia: secondary to infection. improved over course of admission. . #. increased ap and ggt with elevated lipase and an abnormality on ultrasound suggestive of a pancreatic mass. gi was consulted and recommended an outpatient mrcp. . #. chronic atrial fibrillation - patient with chads2 of 2 who is on low-dose aspirin and had his coumadin recently stopped given gib. he is rate-controlled with metoprolol. tsh 3.9 in . given tenuous sbp, patient's home metoprolol was initially held, as was his asa in setting of gib; however, both were restarted through the admission. . #. chronic renal failure - patient with creatinine of 3 at the time of admission; improved to 2.0 at the time of discharge. . #. hypercholesterolemia - his last lipid profile included ldl 62, hdl 85, chol 156 and tg of 43 in . continued simvastatin. . #. vitamin d deficiency - pt with vd of 17. he is currently on maintainance therapy. he was continued on vitamin d at his home dose. . #. code - dnr/dni, confirmed with patient and family. medications on admission: phoslo 667 mg 2 capsules qid cholecalciferol 1,000 po daily omeprazole 40 mg po bid metoprolol 25 mg 0.25 tab simvastatin 40 mg po daily aspirin 81 mg po daily tylenol 325 mg po prn ipratropium bromide 17 mcg hfa 2 puff q4 hrs prn amonium lactate 12% topical cream preparation h 1% prn torsemide 60 discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. 2. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours): please taper: 125mg q6h; 125mg q12h; 125mg daily; 125mg; every other day 125mg; every third day; then stop. 3. ammonium lactate 12 % lotion sig: one (1) appl topical (2 times a day). 4. ipratropium bromide 0.02 % solution sig: neb inhalation q6h (every 6 hours) as needed for sob / wheezing. 5. torsemide 20 mg tablet sig: two (2) tablet po bid (2 times a day): if weight > 165lbs, increase to 80mg in the morning and 40mg at night; if weight < 145lbs, decrease torsemide to 40mg daily. 6. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 7. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 8. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 9. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po once a day. 10. aspirin 81 mg tablet sig: one (1) tablet po once a day. 11. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain / fever. 12. sodium chloride 0.9 % 0.9 % syringe sig: ten (10) ml injection prn (as needed) as needed for line flush. 13. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup sig: mls po q6h (every 6 hours) as needed for cough. 14. potassium chloride 20 meq packet sig: packets po once a day as needed for hypokalemia: according to scale: 3.6-3.8 give 2 packets; 3.3-3.5 give 3 packets; 3.1-3.2 give 4 packets; 3.0 or less, contact md. discharge disposition: extended care facility: newbridge on the - discharge diagnosis: 1) c. diff colitis 2) congestive heart failure 3) urinary tract infection 4) acute on chronic kidney failure 5) pancytopenia discharge condition: ambulatory: able to walk ~20 feet with rolling walker mid assist, difficulty with balance mental status: a&o x 3, hard of hearing discharge instructions: you were admitted for lethargy and diarrhea. you were found to have c. difficile colitis and were started on antibiotics. your hospital course was complicated by low blood pressures, a urinary tract infection, and decompensated heart failure. you have improved dramatically and are much closer to your goal weight of 145 pounds. you will continue to take weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: please follow up as follows: department: cardiac services when: thursday at 11:20 am with: , m.d. building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: thrombocytopenia, unspecified anemia, unspecified pure hypercholesterolemia unspecified pleural effusion urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) pulmonary collapse hypotension, unspecified intestinal infection due to clostridium difficile pressure ulcer, lower back proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site venous (peripheral) insufficiency, unspecified unspecified vitamin d deficiency pressure ulcer, stage ii ulcer of calf essential and other specified forms of tremor 

Answer: The patient is high likely exposed to