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: penicillins / percocet attending: chief complaint: hypertensive urgency and ha major surgical or invasive procedure: none history of present illness: ms. is a 24 year old woman with esrd on hd, sle, malignant htn admitted with ha in the setting of hypertension. upon arrival to the ed, her vitals were 284/140, hr 67, rr 28, 100% on 4lnc. she was started on a nicardipine drip. she denied shortness of breath or chest pain. she is due for hd today. she has a left groin catheter which was recently placed and is causing her pain. she was also given dilaudid iv 1 mg x 2 with some relief. cxr was performed and showed no pulmonary edema. . upon arrival to the micu, patient denies ha, cp, sob, fevers, chills. patient reports mild abdominal pain at sight of left anterior abdominal wall hematoma and left groin pain at site of femoral hd line. she reports that she was taking her medications as directed, including coumadin for svc thrombus. briefly, 24 yo f with esrd on hd, sle, malignant htn admitted for ha in the setting of htn to 284/140 in ed. initially, she was treated with a nicardipine gtt to control her bp. her cardiac enzymes were flat, no new ecg changes. she was started on a heparin gtt with transition to coumadin for a svc thrombosis. htn secondary to med noncompliance. she was restarted on her oral bp. she missed her pm meds yesterday, so nicardipine was restarted, and then turned off this am. she received all her am bp meds. her bps have been in the 160s/90s. she had no neurological deficits. past medical history: 1. systemic lupus erythematosus: - diagnosed (16 years old) when she had swollen fingers, arm rash and arthralgias - previous treatment with cytoxan, cellcept; currently on prednisone - complicated by uveitis () and esrd () 2. ckd/esrd: - diagosed - initiated dialysis but refused it as of , has survived despite this - pd catheter placement 3. malignant hypertension - baseline bps 180's - 120's - history of hypertensive crisis with seizures - history of two intraparenchymal hemorrhages that were thought due to the posterior reversible leukoencephalopathy syndrome, associated with le paresis in that resolved 4. thrombocytopenia: - ttp (got plasmapheresisis) versus malignant htn 5. thrombotic events: - svc thrombosis (); related to a catheter - negative lupus anticoagulant (, , ) - negative anticardiolipin antibodies igg and igm x4 (-) - negative beta-2 glycoprotein antibody (, ) 6. hocm: last noted on echo 7. anemia 8. history of left eye enucleation for fungal infection 9. history of vaginal bleeding lasting 2 months s/p depoprovera injection requiring transfusion 10. history of coag negative staph bacteremia and hd line infection - and 11. thrombotic microangiopathy: may be etiology of episodes of worse hypertension given appears quite labile 12. obstructive sleep apnea, autocpap/ pressure setting , straight cpap/ pressure setting 7 pshx: 1. placement of multiple catheters including dialysis. 2. tonsillectomy. 3. left eye enucleation in . 4. pd catheter placement in . 5. s/p ex-lap for free air in abdomen, ex-lap normal social history: single and lives with her mother and a brother. she graduated from high school. the patient is on disability. the patient does not drink alcohol or smoke, and has never used recreational drugs. family history: negative for autoimmune diseases including sle, thrombophilic disorders. maternal grandfather with htn, mi, stroke in 70s. physical exam: vs: 176/105, 87, 18, 100% ra general appearance: well nourished, no acute distress eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic cardiovascular: 2/6 systolic murmur lusb respiratory / chest: (breath sounds: clear : ) abdominal: left ant wall abd hematoma, ttp extremities: right: trace, left: trace, left fem hd line without oozing or drainage skin: warm neurologic: aao x 3 pertinent results: 05:15am pt-13.7* ptt-33.6 inr(pt)-1.2* 05:15am hypochrom-2+ anisocyt-2+ poikilocy-2+ macrocyt-1+ microcyt-1+ polychrom-1+ spherocyt-occasional schistocy-occasional burr-1+ stippled-occasional teardrop-1+ bite-normal fragment-occasional elliptocy-occasional 05:15am ctropnt-0.08* 05:15am ck(cpk)-119 04:12pm ptt-120.8* 10:41pm ptt-144.8* 02:55pm ck-mb-notdone ctropnt-0.06* brief hospital course: 24 yo woman with hx of sle, ersd on hd, admitted with hypertensive urgency. patient was initially observed in the micu and placed on a nicardipine drip. patient was stablized on home medicaitons, suggesting medication non-compliance. additionally, patient presented subtheraputic on coumadin for svc thrombosis. patient was started on heparin ggt. after the nicardipine drip was turned off, patient was called out to the floor. heparin drip was continued until inr . pressures were managed to her baseline. pain medications were decreased as patient has hypoxia and altered mental status from over sedation, which was reversed with narcan. patient received dialysis 3x/wk as per outpatient schedule. # hypertension: pt with extensive history of repeated admissions for hypertension. patient's bp improved with nicardipine drip and after hd off drip on home po medication regimen. resumed oral antihypertensives with improved bp control. htn likely from renal disease, possible medication noncompliance, lupus. no evidence of mi. continued nifedipine, aliskerin labetalol, hydralazine, and clonidine at current doses. renal increased clonidine patch, and added nicardipine with improvement of bp control. pt is to follow up with an appointment in the next week to establish care at , and to re-check her bp and adjust medications further. # sle: stable, continued prednisone at 4 mg po daily. # left groin pain. permanent hd line was placed on . line and hematoma from prior peritoneal line on abdomen okay. no leukocytosis or fevers to suggest infection. patient was oversedated on dilaudid and had episode of oxygen desaturation which was reversed with narcan. patient was solmolent with morphine sr so that was d/c'ed as well, patient was given standing tylenlol and morphine ir prn. transplant surgery removed remaining sutures today from l groin. pt has a follow-up appointment in the next week with dr. (transplant surgery). she will be sent home with low-dose morphine ir and tylenol prn pain. if l groin pain should become uncontrollable on current meds, pt should return to the ed for re-evaluation. it is anticipated that pain should resolve, as line placement occured over 2 weeks ago. #esrd: renal following, continuing hd th/th/sat. caco3 was started for elevated calcium-phosphate product. pt will follow-up with dr. in the next 1-2 weeks. # anemia: pt's baseline is 26. this is likely secondary to aocd and renal failure. hct was stable on day of discharge at 25.9. # svc thrombus: pt has a history of an svc thrombus, and is on coumadin. she is supposed to be on lifelong anticoagulation due to recurrent thrombosis but inr subtherapeutic on arrival. heparin drip was stopped on the floor once the inr was theraputic. inr was therapeutic on day of discharge. pt will need an inr check in the next week at her follow-up with her pcp. # hocm: pt has evidence of myocardial hypertrophy on echo. she is currently not symptomatic. echo did not show evidence of worsening pericardial effusion. she was continued on her beta-blocker and other bp medications. # depression/anxiety: stable. she was continued on celexa and clonazepam. # osa: pt as continued on cpap for sleep with 7 pressure. # fen: regular diet # ppx: heparin drip --> coumadin, bowel regimen # access: piv x2 / permanent dialysis cath l fem # code: full # contact: (mother) # dispo: home with pcp and renal to re-check bp, inr level. follow-up with transplant surgery. medications on admission: clonidine 0.3mg / 24 hr patch weekly qwednesday hydralazine 100mg po q8h labetalol 800mg po tid hydromorphone 4mg po q4h prn nifedipine er 90mg po qday prednisone 4mg po qday lorazepam 0.5mg po qhs clonazepam 0.5 mg celexa 20mg po qday gabapentin 300 mg acetaminophen 325 mg q6h prn ergocalciferol (vitamin d2) 50,000 unit po once a month coumadin 4 mg daily aliskiren 150 discharge medications: 1. clonidine 0.3 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qwed (every wednesday). 2. hydralazine 50 mg tablet sig: two (2) tablet po q8h (every 8 hours). 3. labetalol 200 mg tablet sig: four (4) tablet po tid (3 times a day). 4. clonazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day). 5. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 6. gabapentin 300 mg capsule sig: one (1) capsule po bid (2 times a day). 7. prednisone 1 mg tablet sig: four (4) tablet po daily (daily). 8. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm. 9. aliskiren 150 mg tablet sig: one (1) tablet po bid (2 times a day). 10. nicardipine 30 mg capsule sig: one (1) capsule po q8h (every 8 hours). 11. morphine 15 mg tablet sig: 0.5 tablet po every eight (8) hours as needed for pain for 2 weeks. :*20 tablet(s)* refills:*0* 12. acetaminophen 325 mg tablet sig: 1-2 tablets po every six (6) hours. 13. clonidine 0.1 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qwed (every wednesday). discharge disposition: home discharge diagnosis: primary diagnosis: hypertensive urgency end stage renal disease discharge condition: stable, blood pressure moderately controlled, afebrile, tolerating pos discharge instructions: you were admitted for headaches and very high blood pressures. you were started on an iv medication for your blood pressure which controlled it. you were then started back on your home medications with improvement of your blood pressure. some of medications were increased as your hypertension was difficult to control. you were also started on a heparin drip while restarting your coumadin since you have a known clot in your veins. you will need to take the coumadin as prescribed by your doctor, and have your inr checked frequently per your pcp's recommendations. please take all medications as prescribed. it is important that you do not miss doses of your medications since your blood pressure is very sensitive to missed doses. please keep all scheduled appointments. if you develop any of the following concerning symptoms, please call your pcp or go to the ed: fevers, chills, chest pains, shortness of breath, nausea, vomiting, or headaches. followup instructions: provider: , md (renal) phone: date/time: 3:00 - will follow-up vitamin d level provider: , md () phone: date/time: 3:30 - will re-check your inr level provider: , md (transplant surgery) phone: date/time: 2:50p md procedure: hemodialysis non-invasive mechanical ventilation diagnoses: hypertensive chronic kidney disease, malignant, with chronic kidney disease stage v or end stage renal disease systemic lupus erythematosus thrombocytopenia, unspecified anemia in chronic kidney disease end stage renal disease obstructive sleep apnea (adult)(pediatric) renal dialysis status other opiates and related narcotics causing adverse effects in therapeutic use dysthymic disorder long-term (current) use of anticoagulants personal history of venous thrombosis and embolism hypoxemia abdominal pain, other specified site other postprocedural status 

Answer: The patient is high likely exposed to