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: no known allergies / adverse drug reactions attending: chief complaint: septic shock, hypotension major surgical or invasive procedure: none history of present illness: this is a 72-year-old gentleman with a pmhx. significant for diabetes, hypertension, systolic chf, and iron deficiency anemia who is transferred from outside hospital with septic shock in the setting of severe c.diff colitis. apparently patient was being worked up for iron deficiency anemia and went for colonoscopy on . since that time he did not feel well, with diarrhea and fevers up to 102 (unclear if he received antibiotics peri-procedure). he presented to on where he was found to be hypotensive and c.diff positive. a ct scan of his abdomen showed pan-colitis without perforation. patient was transferred to on as wbc continued to rise, lactate was high, and there was concern for toxic megacolon. while at cardiology was consulted for persistent hypotension and an echo showed an ef of 15%. , cardiology was consulted for persistent hypotension and tachycardia, and an echo was done which showed ef of 15% (down from 40% in past). creatinine also continued to rise. upon transfer, vs in micu were 97.7, hr 127 was in a.fib, 108/74, 21, 93%. he was on phenylephrine and dobutamine until , during which time his blood pressures dipped from 60s-90s few times. was weaned off pressors and continued to do well. he was seen by surgery who recommended no intervention. patient was transferred to the floor on . he returned to the floor after a day or two, and developed progressive renal failure, possibly to hypotension. he became anuric, developed altered mental status, with respiratory distress. profoundly acidemic, he was sent to micu . before initiating hd, he was tried on lasix/dobutamine, but ef recently went from 30 --> 15%. he was initiated on hd; he didn't tolerate bipap, did well on autoset cpap. echo repeated at and found to be wnl (potentially on dobutamine). he was on po vanc and iv flagyl for a while (had +cdiff at osh, repeated here and was negative) -- continue to treat for 14 day course. stopped flagyl because taking the po vanc on a regular basis. had a s&s, he passed, he can eat. he was downgraded from micu to the floor, and did well. he had pain on urination, which was improving. bladder us revealed bph, so his tamsulosin was resumed at home doses (0.4mg qd). he received pt for reconditioning. he resumed po diet without problem. ros: patient denies chest pain, shortness of breath, abdominal pain, nausea, vomiting, or persistent diarrhea. he endorses a good appetitie. past medical history: chf (ef 15% from osh) t2dm non-insulin dependent osa, occassionally using bipap htn hyperlipidemia iron deficiency anemia bph. social history: mr. is an antiques dealer. he does not use tobacco or drink alcohol. he is independent with adls. family history: no history of chronic kidney disease. physical exam: admission physical exam vs: 97.3, 128/60, 86, 20, 96% on 2l general: well appearing, obese gentleman, no acute distress heent: mucous membranes slightly dry neck: jvp very difficult to assess but not obviously elevated chest: clear to auscultation bilaterally, no wheezes, rales, or rhonchi cardiac: distant heart sounds, irregularly irregular abdomen: +bs, distended, non-tender extremities: no edema bilaterally neuro: alert and oriented to person, place, time and event discharge physical exam: vs t 97.6 hr 93 bp 118/62 rr 18 100% 2l gen eating, sitting comfortably. alert, no acute distress. heent ncat mmm eomi sclera anicteric, op clear neck supple pulm good aeration, ctab no wheezes, rales, rhonchi cv rrr normal s1/s2, no mrg abd soft nt nd normoactive bowel sounds, no r/g ext wwp 2+ pulses palpable bilaterally, no c/c/e neuro cns2-12 intact, motor function grossly normal skin no ulcers or lesions pertinent results: 10:00pm wbc-16.8* rbc-5.49 hgb-10.0* hct-35.0* mcv-64* mch-18.1* mchc-28.5* rdw-18.0* 10:00pm neuts-89.2* lymphs-6.6* monos-4.0 eos-0.1 basos-0 10:00pm calcium-6.8* phosphate-3.4 magnesium-2.1 glucose: 170 creatinine: 3.2 bun: 67 k: 4.7 cl: 117 hco3: 15 kub : consistent with ileus. bladder and kidney us : findings: the right kidney measures 11.8 cm and the left kidney measures 11.8 cm. there is no hydronephrosis. no cyst or stone or solid mass is seen in either kidney. no perinephric fluid collection is identified. a scant trace of ascites is seen in the right lower quadrant. the amount of ascites is decreased since the prior ultrasound of . the pre-void bladder is moderately distended and is unremarkable. post-void imaging was attempted; however, the patient stated he was unable to void. the prostate is enlarged with a volume of about 90 ml. impression: no hydronephrosis. enlarged prostate. distended bladder. note is made that the patient was not able to void. echo repeated (): the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thicknesses are normal. there is mild regional left ventricular systolic dysfunction with hypokinesis of the inferoseptal segments. right ventricular chamber size and free wall motion are normal. there is abnormal septal motion/position. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. there is an anterior space which most likely represents a prominent fat pad. impression: normal left ventricular wall thickness with hypokinesis of the inferoseptal segments. mild mitral regurgitation. mild pulmonary artery systolic hypertension. compared with the prior study (images reviewed) of , the regional wall motion abnormalities are new. the lvef has decreased from 50% to 45%. due to the limited nature of the current study, a comprehensive comparison of all previously mentioned parameters could not be made. discharge labs: bmp and cbc 04:35am blood wbc-9.5 rbc-3.89* hgb-7.1* hct-24.3* mcv-63* mch-18.3* mchc-29.2* rdw-19.2* plt ct-149* 04:35am blood plt ct-149* 04:35am blood glucose-190* urean-43* creat-3.5* na-135 k-3.9 cl-98 hco3-30 angap-11 04:35am blood calcium-7.6* phos-3.0 mg-2.1 iron studies 12:15pm blood caltibc-183* ferritn-485* trf-141* brief hospital course: this is a 72-year-old gentleman with a pmhx significant for systolic heart failure, htn, diabetes type ii, and bph who was transferred from osh for septic shock in the setting of c.diff colitis and required micu care for a course complicated by causing atn and requiring initiation of hd, chf, hypotension, and respiratory failure. active diagnoses # septic shock severe c.diff: the pt presented to osh for endoscopy and colonoscopy for w/u anemia on . he then went to the er on with fever, abdominal pain, nausea and vomitting and was found to have leukocytosis, pancolitis on ct, and +c diff. there he received fluid resuscitation, was started on po vanco and flagyl and required blood pressure support. he was found to have an ef of 15% (down from previous ef of 40%). he was transferred to micu for concern of toxic megacolon/sepsis on . acs was consulted and felt the abdomen was not toxic. he was continued on vanco/flagyl in the micu, phenylephrine and dobutamine were weaned off, and he was continued to require ivf resuscitation. due to prolonged hypotension, he developed worsening /atn and a metabolic acidosis (requiring hd, see below). he was continued on po vanco (or pr when unable to take po) and flagyl. the pt was transitioned to entirely po vancomycin, (flagyl was dc-ed), and pt continued to improve, vanco was dced on after 14 day course. # anuric renal failure requiring hd: the pt developed atn (muddy brown casts) septic shock as well as poor forward flow worsening ef. the pt developed decreased urine output and anasarca and the decision was made to initiate hd. the pt had a tunnelled dialysis catheter placed and hd was initiated. he has successfully completed 6 sessions of hd with hopes to wean of hd as tolerated at an acute ltac. he had some recovery in renal function at the time of discharge but is still dialysis dependent, and this will need to be reassessed after discharge. # respiratory failure: pt required noninvasive ventilation in the setting of mixed metabolic and respiratory acidosis. tolerated bipap well and has been weaned to 2l nc. would recommend continuing cpap at night as he has known osa. # heart failure: patient with history of ef 40% found to have ef of 15% with negative trops at osh in the setting of sepsis. pt became clinically volume overloaded chf and atn and was started on hd (as above). repeat echo on showed ef 45%. initially decreased ef likely transient due to sepsis. he did have a focal wall motion abnormality on his most recent ef, and it was unclear if this was new. he should have repeat tte in several months and optimize medical management in the meantime. #ugib: he had one episode of coffee ground emesis in the setting of gerd history while in the micu. treated with pantoprazole. aspirin was held, and coumadin (for new afib) was not started. he had no further episodes and was guaiac negative at the time of discharge. # afib: there was a concern that he had afib without previous documentation of this condition, chads2 score 4. given one episode of coffee ground emesis, he was not started on coumadin. afib resolved and pt remained in sinus on the general medicine floor. likely transient in setting of sepsis. #nutrition: pt did not have po intake for approximately 5 days. during his stay he had one episode of aspiration witnessed . s&s eval placed and they recommened thin liquids and ground food along with aspiration precautions. pt continued to advance diet while in hospital. now on discharge, po intake is excellent. issue resolved #ams: pt with agitation and deierium in the setting of acute respiratory failure, that has resolved completely. chronic issues # iron deficiency anemia: patient with iron deficiency anemia and low mcv. unknown what osh colonoscopy demonstrated. iron studies indicated anemia of chronic disease. possible acute renal failure contributed. guaiac negative on discharge. he was transfused to 1unit of blood at dialysis on when his hct was 24.3. patient will need to follow-up with his gastroenterologists as an outpatient. #osa: stable, continue cpap at night. #diabetes mellitus: stable, was managed with a sliding scale insulin. holding glipizide and metformin given renal failure. transitional issues #continue dialysis #recheck hct , consider transfuse for hct <25. #once dialysis complete, the pt should be evaluated for reiniation of medications held due to renal failure (ie- lisinopril, glipizide, lasix, metformin). #code status: full code. prior notes mention dnr/dni, but this is incorrect, he is currently full code. medications on admission: --lisinopril 10mg daily --simvastatin 40mg daily --furosemide 40mg in am, 20mg in pm --carvedilol 12.5mg --metformin 1000mg --glipizide 10mg --tamsulosin 0.4mg daily --folic acid 1mg daily --feso4 discharge medications: 1. acetaminophen (liquid) 650 mg po q6h:prn pain 2. tamsulosin 0.4 mg po hs bph 3. trazodone 50 mg po hs:prn insomnia 4. nephrocaps 1 cap po daily 5. glargine 8 units dinner insulin sc sliding scale using hum insulin 6. simvastatin 40 mg po daily 7. pantoprazole 40 mg po q24h 8. docusate sodium 100 mg po bid constipation pt may refuse discharge disposition: extended care facility: - discharge diagnosis: c. difficile sepsis complicated by atn now on hd 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. , it was a pleasure taking care of you at in . you were transferred from to the medical icu at , and were admitted with sepsis from c. difficile. at in the intensive care unit, you were treated with antibiotics and medications to maintain your blood pressure. you were improving and transferred to the medicine floor. on the medicine floor, you stopped producing urine, developed some breathing difficulties, and had a decline in your mental status. you were subsequently readmitted to the intensive care unit. we think that your low blood pressure from the infection caused kidney damage. because you were not producing enough urine, you were started on hemodialysis. your breathing improved with cpap. and, your mental status improved. since you improved in the icu, and were again transferred to the medicine floor, where you improved overall. you continued dialysis, and you were given physical therapy to recondition your body. in addition, during hemodialysis, we transfused 1 unit of blood, because your red blood cells were lower than when you were admitted. followup instructions: with pcp after /c from ltac name: ,md specialty: priamry care location: medical associates address: , , phone: when: the office requests that you call personally for a follow up appointment. it is recommended that you visit your pcp within week of discharge. procedure: hemodialysis venous catheterization for renal dialysis arterial catheterization central venous catheter placement with guidance diagnoses: acidosis obstructive sleep apnea (adult)(pediatric) esophageal reflux acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified toxic encephalopathy diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia severe sepsis chronic airway obstruction, not elsewhere classified atrial fibrillation hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) acute respiratory failure septic shock intestinal infection due to clostridium difficile iron deficiency anemia, unspecified acute on chronic systolic heart failure 

Answer: The patient is high likely exposed to