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: meropenem / penicillins / carbapenem attending: chief complaint: hypotension major surgical or invasive procedure: none. history of present illness: this is 85 year old esrd on hemodialysis, cad s/p mi, afib and cva, presented with hypotension prior to beginning on (did not receive ). his last was monday . he was sent to the ed complaining of weakness for 1 week and generally feeling unwell. he appeared pale. denied pain. he was admitted for a similar episode of hypotension in that responded to ivf w/o infectious source found and he was discharged on midodrine and his metoprolol was stopped. . in the ed yesterday he was afebrile. bp 82/49. ros for infection was negative. he received 1 liter bolus. labs showed baseline anemia, and baseline electrolyte abnormalitis. notably k 4.7 and troponin 0.05. a ua was significant for ua >182wbc lg leuk sm bld mod bact 0 epi. urine and blood cultures - pending, lactate 1.6. at that point his vitals were stable 112/58 68 96% home oxygen. he underwent a cta of his torso which showed a stable aortic aneurysm/dissection. then started on vancomycin, levofloxacin, and flagyl for possible infection and transferred to the . . in the he was found to have pyuria and started on abx w/ urine cx pending. he was started on linezolid and tobramycin due to past resistance to antibiotics. d/ced given low suspicion of infx. he tolerated hemodialysis on the morning of w/out fluid bolus. he felt well and had 6 hours of obs w/ stable bps (sbp 97-121). . transfer vitals were 112/58 68 96% on 2l (home oxygen). . upon arrival to the floor on 7 mr. was feeling well. states that he has felt much better since this morning. no weakness, dizzyness, sob, or n/v. he does endorse decreased food intake over the past week. . . imaging: - bedside u/s: lg infrarenal aorta/iliacs c/f aneurysm vs dissection - ct torso: stable aneurysm ekg: 62 lad, rbbb w/ left anterior fascicular block, twi iii, avf consult: fyi'd renal . . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. primary care physician: , . past medical history: - esrd on hd (mwf) - cad s/p mi - afib, not anticoagulated - cvas x2, residual r sided weakness, from 12 then 5 ago - hx of gi bleed - nephrolithiasis - osa, not using cpap - iron deficiency anemia - depression - hx of c.diff - restrictive ventalatory pulmonary defect - pelvic and wrist fractures - recurrent utis, including vre and klebsiella - multiple episodes of line related bacteremia: - mrsa in treated for 6 weeks of vanc given possible clot in fistula. line removed. tte negative for vegetation. tee not performed. - esbl e.coli bacteremia in thought to be line related. - esbl e.coli bacteremia in . thought to be line related. s/p total 4-week course of meropenem/ertapenem. () for likely endovascular infection in setting of r ij clot. - esbl e.coli x 2 types, e. faecium unclear source despite extensive work-up (). s/p 4 weeks of vancomycin and meropenem. - esbl e. coli and e. faecium () thought to be line related s/p 2 weeks vancomycin/meropenem. - pansusceptible klebsiella pneumoniae thought 7mm cbd stone. s/p ercp and stenting. due for repeat ercp past surgical history - c2 fracture dislocation with progressive collapse s/p orif c2 and posterior instrumentation c1-c5 and left iliac crest bone graft placement, complicated by osteomyelitis. - right popliteal thrombosis s/p popliteal and tibial embolectomy and r below the knee popliteal and tibial vein path angioplasty - r avf placement - l ue fistulogram/angioplasty - lue fistulagram - lue fistulogram and angioplasty of central venous stenosis - l av brachiocephalic fistula - cataract surgery - r ureteral stent placement - i&d r wrist - r shoulder surgery - l cataract surgery - l knee surgery social history: lives with wife , wife of 62 ; see is his primary caregiver. is wheelchair bound but has a nurse to help with showering, daughter lives downstairs -h/o smoking ppd for 50 years, quit 20 years ago, occasional beer, none recently, no drugs. family history: non-contributory. physical exam: admission to medicine: vitals: t:95.9 bp: 142/82 p: 70 r: 18 o2: 99% 2l general: alert, oriented, no acute distress heent: sclera anicteric, mm dry, oropharynx clear neck: supple, neck collar in place lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly, no cva tenderness gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: aox3, cn ii-xii w/out decrement, perrl, rle strength, rue strength discharge: vitals: t:95.6 bp: 110/70 p: 74 r: 20 o2: 100% 2l general: alert, oriented, no acute distress heent: sclera anicteric, mm dry, oropharynx clear neck: supple, neck collar in place lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly, no cva tenderness gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: aox3, cn ii-xii w/out decrement, perrl, rle strength, rue strength pertinent results: admission: 12:05pm blood wbc-8.6 rbc-3.51* hgb-10.8* hct-33.0* mcv-94 mch-30.9 mchc-32.9 rdw-15.7* plt ct-179 12:05pm blood neuts-75.8* lymphs-17.3* monos-5.0 eos-1.6 baso-0.3 12:05pm blood pt-12.6* ptt-28.1 inr(pt)-1.2* 12:05pm blood glucose-98 urean-59* creat-5.6*# na-138 k-4.5 cl-100 hco3-25 angap-18 12:05pm blood alt-10 ast-11 alkphos-112 totbili-0.2 12:05pm blood lipase-18 12:05pm blood ctropnt-0.05* 12:05pm blood albumin-3.5 calcium-8.6 phos-4.1 mg-1.9 12:19pm blood lactate-1.6 05:20pm urine color-yellow appear-cloudy sp -1.014 05:20pm urine blood-sm nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-lg 05:20pm urine rbc-10* wbc->182* bacteri-mod yeast-none epi-0 05:20pm urine wbc clm-many blood cultures pending x2 urine culture pending cta abd & pelvis study date of 2:39 pm \ pending cta chest w&w/o c&recons, non-coronary study date of 2:39 pm pending brief hospital course: brief hospital course 85 m w/ hx of esrd on hd, cad, afib, cva w/ residual r sided weakness who presented from with hypotension. the cause of which is likely multifactorial including: decreased po intake, possibly worsening pulmonary hypertension, and changing requirements. . hypotension: he initially presented with hypotension of 82/49. the bp normalized in ed with one liter of ivf, which was reassuring. of note the patient had a similar episode of hypotension several months ago that resolved with ivf. blood cultures and urine cultures were sent with consideration of his prior infections (hx of esbl e.coli, vre, multiple episodes of sepsis). although the patient was initially started on vanc/levofloxacin/flagyl in ed and later transitioned to more narrow coverage (linezolid and tobramycin), antibiotics were ultimately discontinued as no infectious cause could be found. his wbc has remained normal and he has had no fevers. cxr did not show signs of pneumonia. blood pressure remained above 110 throughout the admission. pyuria was present on ua and likely reflects esrd on hd. bedside u/s in the ed demonstrated a large aortic aneurysm, which appears stable on ct scan, and unlikely to be cause of hypotension. no signs of bleeding. cultures need to be followed up as an outpatient. he was continued on mitodrine without uptitation per renal recommendation. a tte was performed to assess for cardiogenic cause of hypotension. the patient and his wife expressed a strong desire for discharge prior to formal interpretation of his tte. this will need to be followed up by his outpatient providers. his dry weight in hd was increased in an effort to prevent further peri-hd hypotension. . esrd on hd: patient has a mwf schedule. the last hd was on monday prior to admission. he missed his wednesday hd because of hypotension. while in the hospital he received hd on thursday and friday ( and ) which was well tolerated. renal saw the patient while in the hospital and was involved in his care. all meds were renally dosed. on his was optimized to leave him with a slightly higher dry weight. follow up was arranged with his primary physician and the clinic. . hx of cad: the patient does not have signs of active ischemia. there were no ekg changes from a recent comparison. the trop was 0.05 in this renal patient. considering bifascicular block and risk for total heart block, should discuss with pcp. statin and asa were continued. beta blockade continued to be held in setting of hypotension. . pulmonary hypertension: this was noted on tte from febuary of . he does not have signs of heart failure on exam; however, the concern was raised for the possibility of it being a factor in his episodes of hypotension. . incidental findings 1. eccentric bladder wall thickening, new from that needs to be correlated with u/a and cytology. a bladder ultrasound considered. he should follow up with his primary care physician. . transitional issues: 1. follow-up tte, follow-up bladder wall thickening 2. code: full code discussion initiated in inpatient setting. the patient expressed desire to remain full code despite expressing worsening quality of life. he will follow-up with his primary care physician. medications on admission: (per last discharge): 1. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). 2. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 3. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 4. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 5. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 7. gabapentin 300 mg capsule sig: one (1) capsule po at bedtime. 8. midodrine 5 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. ascorbic acid 1,000 mg tablet sig: one (1) tablet po once a day. 11. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 13. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 14. cyanocobalamin (vitamin b-12) 100 mcg tablet sig: one (1) tablet po daily (daily). 15. multivitamin tablet sig: one (1) tablet po daily (daily). 16. nortriptyline 10 mg capsule sig: one (1) capsule po hs (at bedtime). discharge medications: 1. calcium acetate 667 mg capsule sig: one (1) capsule po three times a day. 2. fluoxetine 20 mg tablet sig: one (1) tablet po once a day. 3. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) inhalation once a day. 4. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 5. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 7. gabapentin 300 mg capsule sig: one (1) capsule po hs (at bedtime). 8. midodrine 5 mg tablet sig: one (1) tablet po bid (2 times a day). 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. ascorbic acid 1,000 mg tablet sig: one (1) tablet po once a day. 11. docusate sodium 50 mg capsule sig: one (1) capsule po once a day. 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 13. acetaminophen 325 mg tablet sig: 1-2 tablets po every six (6) hours. 14. cyanocobalamin (vitamin b-12) 100 mcg tablet sig: one (1) tablet po once a day. 15. multivitamin tablet sig: one (1) tablet po once a day. discharge disposition: home discharge diagnosis: 1. hypotension 2. pre-existing end stage renal disease on hemodialysis, pulmonary artery hypertension, a-fib, coronary artery disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , you were admitted to the hospital for hypotension prior to receiving on wednesday (). in the emergency room your blood pressure was found to be 82/49. you received 1 liter of fluid intravenously and your blood pressure rose to 112/58. you did not have a fever and a work up for infection was all negative so far. blood and urine cultures were sent to the lab that need to be followed up. antibiotics were started initially; however, they were discontinued due to decreasing concern for infection. imaging of your stomach revealed that your abdominal aortic aneurism is stable. while in the hospital you were sent to the intensive care unit for further monitoring and then transferred to the medicine service. throughout your stay your blood pressure has remained stable. you received hemodialysis on and in keeping with your original schedule. please note that your parameters were changed on . also, it is important that you follow up with your doctor if you experience fatigue or dizzyness again. medication changes: none. follow up: -it is important that you follow-up with your primary care physician . regarding your blood and urine cultures. -your regimen has changed. your dry weight has been increased. -follow-up with your physician regarding the use of metoprolol. it is currently being held. followup instructions: department: when: tuesday at 2:30 pm with: , md building: (, ma) campus: off campus best parking: free parking on site department: transplant center when: thursday at 1 pm with: , md building: lm campus: west best parking: garage department: when: tuesday at 1:50 pm with: , md building: (, ma) campus: off campus best parking: free parking on site procedure: hemodialysis diagnoses: end stage renal disease obstructive sleep apnea (adult)(pediatric) renal dialysis status coronary atherosclerosis of native coronary artery atrial fibrillation hypotension, unspecified other late effects of cerebrovascular disease old myocardial infarction primary pulmonary hypertension iron deficiency anemia, unspecified hypovolemia other malaise and fatigue 

Answer: The patient is high likely exposed to