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: increasing dyspnea major surgical or invasive procedure: none history of present illness: 71-year-old woman with advanced end-stage ischemic cardiomyopathy with severe left ventricular contractile function with lvef of 10%, atrial fibrillation, -v icd, ckd, with past history of dvt, pe on coumadin who presents with increasing dyspnea. the patient was recently discharged from ccu on for chf exacerbation and was discharged to rehab facility. since that time, patient was hospitalized at two weeks ago for pneumonia. the patient reports that over the past week, the patient has had increasing dyspnea with exertion. at baseline, patient is unable to perform adls without the assistance of physical therapy. over the past week, there has been a noticible worsening in her physical limitations. the patient recently saw dr. as an outpatient and had her dose of torsemide increased from 20mg to 40mg and carvedilol was discontinued and switched to metoprolol tartrate 12.5mg . patient was taken to hospital for initial evaluation and was given another dose of torsemide 40mg x 1 and then transferred to as her cardiac care is here. patient's initial vs in the ed were 98.3 76 105/70 16 96 on 4lnc. pt was initially dyspneic, rr in 20s, wheezes bilaterally. ascities worse than in past few weeks. 2+ pedal edema. cardiac review of systems is notable for presence of chest pain at rehab, dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema. no palpitations, syncope or presyncope. past medical history: . ischemic cardiomyopathy (ef 10-25%) s/p biv icd 2. coronary artery disease status post ptca and stenting of the lad in . 3. h/o pe secondary to dvt s/p ivc filter 4. atrial fibrillation status post cardioversion and biventricular pacemaker implantation. 5. htn 6. obesity 7. pvd 8. small vsd 9. hypothyroidism past medical history: 1. cardiac risk factors: + dyslipidemia 2. cardiac history: -ischemic cardiomyopathy ef %15-20 s/p biv icd -cad s/p post ptca and stenting of the lad in . -cabg: none -pacing/icd: atrial fibrillation on anticoagulation and icd biventricular pacemaker 3. other past medical history: chronic kidney disease bilateral dvt s/ filter pulmonary embolism osteoarthritis hyperkalemia social history: pt lives alone but currently resides at rehab. she is not married. she reports a 20 pack year history, however she quit 30 yrs ago. denies etoh or illicit drug use. family history: mother had mi at age 50. father in good health. maternal uncle died of mi in his 50's. physical exam: vs: 99.5, 95/60, 80, 22, 94% 3l nc general: nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 15 cm. cardiac: pmi inferolaterally displaced, rr, normal s1, s2. holosystolic murmur at apex. lungs: bilateral rales to mid-lung fields. abdomen: soft, distended. + fluid wave. mild hepatomegaly. unable to palpate spleen. extremities: +2 ble edema. rle > lle. warm skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: dp 1+ pt 1+ left: dp 1+ pt 1+ pertinent results: admission labs: 12:30am wbc-6.2# rbc-3.60* hgb-11.3* hct-34.7* mcv-96 mch-31.3 mchc-32.5 rdw-18.6* 12:30am plt smr-normal plt count-182# 12:30am pt-28.4* ptt-36.3* inr(pt)-2.8* 12:30am ck-mb-notdone probnp-* 12:30am ctropnt-0.04* 12:30am alt(sgpt)-51* ast(sgot)-56* ck(cpk)-62 alk phos-194* tot bili-1.7* 12:30am glucose-112* urea n-48* creat-1.6* sodium-136 potassium-4.6 chloride-97 total co2-27 anion gap-17 . ekg: 0003: v paced at 69, w/ rad, bifascicular block. . tte : the left atrium is moderately dilated. the right atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is moderately dilated. there is severe regional left ventricular systolic dysfunction with anterior, septal and apical akinesis, as well as akinesis of the distal inferior wall (proximal lad distribution). there is mild hypokinesis of the remaining segments (lvef = 15-20%). no masses or thrombi are seen in the left ventricle. the right ventricular cavity is moderately dilated with severe global free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild to moderate (+) mitral regurgitation is seen. severe tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. . impression: dilated left ventricle with severe regional systolic dysfunction, c/w an extensive prior lad infarction. dilated right ventricle with severe systolic dysfunction. mild to moderate mitral regurgitation. severe tricuspid regurgitation. at least mild pulmonary hypertension. . compared with the prior study (images reviewed) of , severity of tricuspid regurgitation has increased. the other findings are similar. . rle us : no right lower extremity dvt. abd doppler : 1. distended hepatic veins and ascites, the constellation of findings can be seen in the setting of congestive heart failure. otherwise, normal doppler examination of the liver. . 2. no evidence of biliary pathology. . myocardial viability study : within limitation of current study, fixed defects in distal anterior and apical walls are consistent with scarring. improvement of inferior wall defect with correction is suggestive of myocardial viability. . lhc/rhc : comments: 1. selective coronary angiography of this right dominant system revealed one vessel coronary artery disease. the lmca had no angiographically apparent disease. the lad had mild instent restenosis of the prior stent. the lcx had no angiographically apparent disease. the rca was occluded and similar to prior. 2. resting hemodynamics on milrinone therapy revealed moderately elevated right and left sided filling pressures with an rvedp of 15 mmhg and pcwp of 20 mmhg. there was moderate pulmonary hypertension with a pasp of 42/20 mmhg. there was normal systemic blood pressure with central pressure of 108/63 mmhg. there was a low-normal cardiac index of 2.1 l/min/m2. there was no transaortic valve gradient on careful pullback from lv to aorta. 3. peripheral angiography revealed patent renal arteries bilaterally. . final diagnosis: 1. one vessel coronary artery disease. 2. moderate biventricular diastolic dysfunction. 3. moderate pulmonary hypertension. 4. normal systemic pressure. 5. low-normal cardiac index. 6. patent renal arteries. . kub : 1. there is no ileus or small bowel obstruction. 2. tubular radiopaque left paraspinal structure of unknown etiology warrants repeat ap and lateral radiograph. . brief hospital course: 71-year-old woman with advanced end-stage ischemic cardiomyopathy with severe left ventricular contractile function with lvef of 10%-15%, atrial fibrillation, -v icd, low cardiac output state, chronic kidney disease with past history of dvt, pe on coumadin. #. nyha class 4 systolic congestive heart failure, ef 15%. with severe volume overloaded on examination on admission. she had a low output state with known low ef and dilated ischemic cardiomyopathy. it was felt that she would likely need inotropic support and she was sent to the ccu for diuresis with milrinone gtt + lasix gtt + metolazone. the patient had significant diuresis on this regimen. it was felt that if there was viable myocardium currently hibernating low perfusion state, intervention may improve cardiac function. a myocardial viability study was performed and demonstrated inferior wall myocardial viability. lhc/rhc were performed but no intervenable targets were appreciated; additionally, the patient was thought to be a poor candidate for cabg/tr poor targets for grafts. it was therefore felt that the patient could only be maximized on medical therapy. diuresis was changed to po on to her precious dose of torsemide and metolazone was added daily to regimen. weight on discharge________. would follow lytes every other day until stable and weekly thereafter. # c-diff colitis - positive c. difficile toxin assay. patient was started on po metronidazole and cholesyramine with clinical improvement as gauged by frequency of diarrhea, fever, and wbc count. peak wbc 11.4. flagyl to be continued x 7 more days. once 2 week flagyl course is finished, can consider restarting immodium for symptomatic relief. # uti - patient was found to have uti klebsiella pneumoniae, pansensitive except for intermediate sensitivity to nitrofurantoin. she was started on ciprofloxacin for 7 day course, finished on . #. rhythm: she has a biv icd in place and was v-paced on ecg. she was monitored on telemetry. no events. #. coronaries: patient with mid-lad bms '. trop 0.04, ck-mb negative that was likely related to chf exacerbation. she was continued on a statin and aspirin. #. uri: she had been diagnosed with a uri prior to admission and had been started on zithromax. this was held in the hospital and sputum cultures were sent, found to be negative. pt is currently asymptomatic. #. asicites: she had significant ascities on exam and she was s/p 6l tap two weeks ago. it was felt her ascites was likely related to right-sided heart failure and would be difficult to resolve with diuretics. she was restarted on her home regimen of torsemide plus metolazone as noted above. #. lft abnormalities: she had a mild transaminities with an ap 190, tbili 1.7. it appeared to be obstructive pattern, likely related to congestive hepatopathy. resolved prior to discharge. #. h/o dvt/pe: she was anticoagulated with coumadin and has a filter in place. she had a rle u/s that showed no dvt. her inr today is _______. inr should be followed every other day until stable and weekly thereafter. # hypothyroidism: continued levothyroxine. # code: she was full code during this hospitalization. it is thought that she is end stage in regard to her chf with medical treatment her only option at this time. palliative care was not persued during this hospital stay but may be introduced by dr. / continues to have frequent hospitalizations. medications on admission: allopurinol 100mg daily amiodarone 200mg daily levothyroxine 125mcg daily asa 81mg daily zocor 20mg daily zithromax 250mg daily (until ) for uri torsemide 40mg po bid metoprolol succinate 12.5mg po bid digoxin 0.0625 mcg daily prilosec 20mg daily zinc 220mg po daily vit c 500mg po daily coumadin 2.5mg daily biscacodyl 10mg suppository daily prn for constipation milk of mag 30ml po daily prn for constipation melatonin 1mg po qhs prn for insomnia mvi immodium 2mg po 4x daily prn for loose stool discharge medications: 1. metolazone 2.5 mg tablet sig: one (1) tablet po once a day. 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 4. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 5. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 6. digoxin 125 mcg tablet sig: 0.5 tablet po daily (daily). 7. simvastatin 10 mg tablet sig: two (2) tablet po at bedtime. 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. metoprolol succinate 25 mg tablet sustained release 24 hr sig: 0.5 tablet sustained release 24 hr po twice a day. 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) vial inhalation q6h (every 6 hours) as needed for cough/sob. 11. codeine-guaifenesin 10-100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough: hold for sedation or rr < 10. 12. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 14 days: last day . 13. cholestyramine-sucrose 4 gram packet sig: one (1) po bid (2 times a day): do not give at the same time as levothyroxine, metolazone and digoxin. . 14. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm: check inr every other day. 15. torsemide 20 mg tablet sig: two (2) tablet po bid (2 times a day). 16. metolazone 2.5 mg tablet sig: one (1) tablet po once a day. 17. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed for dry nose. 18. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. discharge disposition: extended care facility: senior care center - discharge diagnosis: acute on chronic systolic heart failure clostridium difficile colitis klebsiella urinary tract infection. discharge condition: dry weight 100 kg. mental status:clear and coherent level of consciousness:alert and interactive activity status:out of bed with assistance to chair or wheelchair discharge instructions: you were seen at with heart failure. you were admitted to the cardiac care unit for diuresis with milrinone and lasix. we are discharging you home on the same heart failure regimen as you were admitted with and adding metolazone 2.5mg po daily in the am. you were found to have clostridium difficile colitis and were started on flagyl. you were also found to have a urinary tract infection and were treated with a seven day course of ciprofloxacin. weigh yourself every morning, call np if weight goes up more than 3 lbs in 1 day or 6 pounds in 3 days. followup instructions: cardiology: provider: . phone: date/time: 10:00 procedure: venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute kidney failure, unspecified unspecified acquired hypothyroidism hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other chronic pulmonary heart diseases peripheral vascular disease, unspecified chronic kidney disease, unspecified other specified forms of chronic ischemic heart disease intestinal infection due to clostridium difficile pressure ulcer, buttock automatic implantable cardiac defibrillator in situ personal history of venous thrombosis and embolism other ascites acute on chronic systolic heart failure pressure ulcer, stage ii 

Answer: The patient is high likely exposed to