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 attending: chief complaint: obstructive uropathy/transfer from major surgical or invasive procedure: 1. bilateral percutaneous nephrotomy tubes (bilaterally) 2. cystoscopy with biopsy 3. picc line placement history of present illness: 79 year old m with chronic urinary retention secondary to prostate cancer (diagnosed in , grade 7, stage t-3, r seminal vessicle involvement at diagnosis). treated with xrt and hormonal rx at diagnosis. had turp , did well following this and self-cathed for urinary retention. (see urology osh note in back of chart for detail on urethral problems). in had foley placement complicated by false passage. since then difficultly cathing himself. saw his urologist prior to his admission to and was noted to have fecal material in his urine after a foley was passed. due to suspicion of enterovesical fistula the patient was admitted. upon admission his creatinine was noted to be 6.4 up from a baseline of 1.0. a gastrograffin enema and a cystogram was done showing a large filling defect involving the bladder, but no frank fistula. due to hyperkalemia is was ultimately admitted to the icu. a temporary dialysis line was placed and he was dialyzed for hyperkalemia. . of note, the patient was also noted to have lytic lesions of the spine and has been recieving radation to his lumbar spine. a biopsy has shown squamous cell carcinoma. . pt is a vague historian, but accurate with most details. past medical history: -cad -icd -hypercholestorlemia -prostate cancer w/ chronic urniary retention requiring self cath -treated with xrt, hormones in . grade 7, t3 at diagnosis) -known to have bone mets in r hip/pelvix and is currently undergoing xrt 13/15 treatments done) -dvt r leg - foley placement complicated by false passage social history: denies tob/etoh. ret. math teacher family history: no esrd physical exam: tmax: temp: 98.6 bp: 110/60 hr:100 rr:12 . general appearance: elderly, pleasant, comfortable, nad, eyes: anicteric ent: mmm, op without exudate or lesions, no supraclavicular or cervical lymphadenopathy, jvp to 12 cm, no carotid bruits, no thyromegaly or thyroid nodules respiratory: cta b/l with good air movement throughout. bibasilar rales cardiovascular: rr, s1 and s2 wnl, no murmurs, rubs or gallops appreciated. tachycardic. icd in place over l subclavian gastrointestinal: nd, +b/s, soft, nt, eextremities: no cyanosis, clubbing. 2+ edema skin/nails: warm, no rashes/no jaundice/no splinters heme/lymph: no cervical or supraclavicular lymphadenopathy gu: foley catheter in place draining scant amounts feculent urine pertinent results: admit labs ---------- 11:20pm wbc-14.0* rbc-3.24* hgb-9.6* hct-28.8* mcv-89 mch-29.6 mchc-33.3 rdw-13.2 11:20pm plt count-142* 11:20pm neuts-90.9* lymphs-4.8* monos-3.8 eos-0.5 basos-0.1 11:20pm pt-18.8* ptt-31.8 inr(pt)-1.7* 11:20pm glucose-119* urea n-41* creat-4.4* sodium-135 potassium-3.8 chloride-95* total co2-28 anion gap-16 11:20pm alt(sgpt)-14 ast(sgot)-21 ld(ldh)-219 alk phos-76 amylase-21 tot bili-0.6 11:20pm lipase-10 11:20pm albumin-2.5* calcium-7.2* phosphate-3.7 magnesium-1.7 . discharge labs -------------- . studies ------- renal ultrasound the right kidney measures 12.6 cm. the left kidney measures 11.9 cm. moderate hydronephrosis is seen within bilateral kidneys. no definite renal stone or mass is identified. bladder measures 11.3 x 7.7 x 7.5 cm and contains a large heterogeneous mass with internal vascularity consistent with tumor. a foley balloon is identified within the bladder. attempts were made to fill the bladder with saline to better evaluate the mass; however, patient could not tolerate more than 5 cc. impression: bilateral moderate hydronephrosis. large heterogeneous mass filling the bladder lumen consistent with tumor. . ct abdomen and pelvis study is compared with outside ( hospital) _____ ct, dated , as well as interval renal , dated . evaluation of the urinary tract, in particular, the bladder, is limited by the lack of intravenous contrast material. however, the bladder is markedly abnormal in overall appearance: it is quite distended, despite the presence of _____ heterogeneous, predominantly attenuation (40 ) material corresponding to the apparently known mass, demonstrated by , whose margins cannot be defined. the bladder also contains numerous small gas pockets, likely related to either the foley catheter placement, biopsy or other reasons; gi tract is not excluded, though none is demonstrated. there is ill-defined haziness in the adjacent fat of the prevesicular space of retzius, superficial to the air pockets, no definite extravesical extension is demonstrated. there is no adenopathy, and no other pelvic adenopathy is seen. since the previous studies, bilateral nephrostomy tubes have been placed, with pigtail loops in both renal pelves, draining externally and the previously-demonstrated hydronephrosis is no longer seen; there is persistent right more than left hydroureter, incompletely characterized. there is relatively slight perinephric soft tissue stranding, unchanged, and no significant air is identified in the upper urinary tract, though there is a small pocket of air in the left posterior pararenal space, likely related to the recent tube placement. there is no free retro- or peritoneal _____ air, and the small and large bowel loops are relatively well-opacified and not distended, with transit of contrast material into normal-appearing large bowel, and no extraluminal contrast to suggest bowel perforation. there is extensive, circumferential calcification of the thoracoabdominal aorta and its branches; the abdominal aorta measures some 2.9 cm in maximal diameter (2:46), without frank aneurysmal dilatation. there is no intramural hematoma or discrete peri-aortic fat-stranding to suggest "leak" limited evaluation of the _____. there is no free fluid in the abdomen. there is marked _____ cardiomegaly with multi-chamber enlargement. there is extensive diffuse coronary arterial calcification. dual-chamber cardiac pacemaker in situ, with apparently intact leads. there are small-moderate bilateral pleural effusions with associated passive atelectasis. there is also some interlobular septal thickening with patchy ground-glass opacity, as well as prominence of the more-anterior vessels, all consistent with underlying chf. a focal consolidation at the _____ aspect of the left lung base cannot be excluded. no pericardial effusion is seen. destructive process involving the right l5 vertebral body, extending into and largely replacing the cortex and right posterior elements _____ a large soft tissue component, displacing the thecal sac to the left, and deforming it. ______ the right neural foramen, inseparable from the exiting right l5 nerve root, likely preexistent. though there are multilevel degenerative changes elsewhere, no other destructive lesion is identified. there is anterior wedging of the t7 vertebral body, with a mixed sclerotic appearance which may represent a previously-treated metastasis or, alternatively, ______ hemangioma. no similar appearance is seen elsewhere. impression: 1. markedly abnormal appearance to the bladder, which is distended and may be largely filled with apparently-known soft tissue mass. this is incompletely characterized, due to lack of contrast enhancement. numerous air pockets in the bladder may relate to recent interventions, including biopsy, but should be correlated clinically. 2. status post interval placement of bilateral nephrostomy tubes with external drainage, and virtual complete resolution of hydronephrosis. 3. unremarkable large and small bowel, with no evidence of perforation, and no free fluid in the abdomen or pelvis. 4. extensive destructive lesion involving right lateral aspect of the l5 vertebral body and its posterior elements, with large epidural soft tissue component thecal sac in exiting right l5 nerve root. this could be further characterized by mr examination. 5. abnormal appearance of the t7 vertebral body, which could represent previously-treated metastasis and should be correlated with other clinical information. 6. multi-chamber cardiomegaly with dual-chamber cardiac pacemaker, and evidence of chf with bilateral pleural effusions and passive atelectasis. 7. ____ medial aspect of the left lung base. . echocardiogram the left atrium is elongated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is mildly dilated. overall left ventricular systolic function is moderately depressed (lvef= 30-40 %) secondary to severe hypokinesis of the inferior and posterior (inferolateral) walls. tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (area 1.2-1.9cm2). no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is no pericardial effusion. . brief hospital course: 1. obstructive nephropathy with acute renal failure. the patient was transferred for hospital after initiation of hemodialysis. after re-evaluation of his obstruction, bilateral percutaneous nephrostomies were placed with very rapid resolution of his arf to a serum creatinine at his baseline. a number of electrolyte abnormalities developed during his post-obstruction diuresis, such as hypocalcemia, hypokalemia, hypophosphatemia, and hypomagnesemia, which were corrected as needed. urology has recommended permanently leaving percutaneous nephrostomies and bladder catheter in place. bladder to be irrigated twice daily with 500 cc of normal saline via three way catheter. he was instructed to follow up with his long term urologist (dr. within one month, as his urinary catheters will likely need to be changed under cystoscopic guidance. 2. poorly differentiated maligancy in the bladder. urology and oncology consultation was obtained, and re-imaging by ultrasound and ct were done of the bladder mass. subsequently, a rigid cystoscopy was performed by urology which demonstrated fibrinous material in the urethra and large fibrinous mass adherent to the bladder wall, consistent with old clot material. the material was partially cleared, and a clean bladder wall was observed. biopsies were performed of the material. continuous bladder irrigation was started to help clear the mass. initial gram stains and studies demonstrated gram positive and gram negative bacteria and antibiotics were continued, and later tailored based on sensitivities. pathology demonstrated a poorly differentiated malignancy. oncology then requested the pathology slides of his spine biopsy to compare to the pathology from the cystoscopy. outpatient follow up with gu oncology was arranged pending pathology review for with dr. . 3. paroxysmal atrial fibrillation. the patient developed bursts of atrial fibrillation with rapid ventricular response. he was rate controlled with a titration of metoprolol tartrate, later converted to metoprolol succinate, and diltiazem. during his invasive studies, warfarin anticoagulation was held, with the plan to resume later; at the time of discharge this was being resumed at 10 mg daily with a heparin bridge, to be completed at the rehabilitation hospital. 4. thrombocytopenia. the patient developed a 30% drop in his platelets upon transfer, after significant exposure to heparin during dialysis and for dvt prophylaxis. preliminary heparin dependent antibodies were positive, and confirmation serotonin release studies were negative. heparin was later used as a bridge when initiating warfarin anticoagulation, without recurrence of thrombocytopenia. 5. left basilic vein deep venous thrombosis. the patient was restarted on warfarin anticoagulation with a goal inr , and covered with unfractionated heparin infusion on a weight based protocol with ptt monitoring. 6. possible enterovesicular fistula. numerous studies done at , and direct cystoscopy by urology here at failed to demonstrate a fistula; however, the enteric organism leading to his urinary tract infection argued for a fistula. a charcoal study was positive with the third urinary fraction (out of 4) positive; general surgery and urology were consulted again, and it was determined that the patient was not a suitable surgical candidate for fistula repair. 7. pseudomonal urinary tract infection. the patient was started on an initial fluroquinolone regimen and then changed to meropenem, before finally settling on imipenem regimen. a picc catheter was placed, and the patient is to complete a total 4 weeks of imipenem therapy. 8. diarrhea. c diff negative times 4 stool assays. attributed to mult stool softeners as well as charcoal given for enterovesicular fistula evaluation (twice). stool softeners held. medications on admission: on transfer from osh: atenolol 50 qd isordil 40 mscontin 15 q12 msir 15 q6 prn pain oxycontin 10 po q6 prn pain protonix 40 qd leviquin 250 q48 iv 1/2 ns w/ 2 amps nahc03 at 60 cc/hr discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed for pain. 4. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 5. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day). 6. potassium & sodium phosphates mg powder in packet sig: one (1) powder in packet po bid (2 times a day). 7. lorazepam 0.5 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 8. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 9. diltiazem hcl 30 mg tablet sig: one (1) tablet po qid (4 times a day). 10. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 11. warfarin 5 mg tablet sig: two (2) tablet po daily16 (once daily at 16). 12. imipenem-cilastatin 500 mg recon soln sig: five hundred (500) mg intravenous q6h (every 6 hours) for 17 days. 13. ondansetron hcl (pf) 4 mg/2 ml solution sig: four (4) mg injection q8h (every 8 hours) as needed. 14. heparin (porcine) in d5w 100 unit/ml parenteral solution sig: 1100 (1100) units intravenous once a day: 1100 units per hour continuous parenteral infusion; check ptt every 6 hours, adjust heparin dose according to sliding scale (included) until stable dose determined. heparin drip should be continued until inr has been therapeutic (between 2 and 3) for at least 48 hours. discharge disposition: extended care facility: medical center - discharge diagnosis: . upper extremity deep venous thrombosis . poorly differentiad cancer in the bladder . urinary obstruction with acute renal failure, status bilateral percutaneous nephrostromy tubes . locally invasive grade 7, t3 prostate cancer s/p radiation and turp on hormone therapy . squamous cell carcinoma of the bone . history of squamous cell carcinoma of the skin . coronary artery disease history of myocardial infarction . chronic systolic congestive heart failure status post aicd placement . paroxysmal atrial fibrillation . hyperlipidemia . history of lower extremity deep venous thrombosis discharge condition: fair, unable to ambulate with assistance. discharge instructions: please contact your primary care physician or report to the emergency department if you develop fevers, sweats, chills, nausea, vomiting, blood in your urine, or decreasing amount of urine. please contact your radiation oncologist to determine if you need to continue radiation treatments. followup instructions: call your primary doctor for a follow up appointment for within one month of leaving the hospital: , a call your urologist, dr. , for a follow up appointment for within one month of leaving the hospital. provider: , md phone: date/time: 2:00 provider: , md phone: date/time: 2:00 procedure: hemodialysis percutaneous nephrostomy without fragmentation percutaneous nephrostomy without fragmentation venous catheterization for renal dialysis other cystoscopy closed [transurethral] biopsy of bladder diagnoses: hyperpotassemia urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation personal history of malignant neoplasm of prostate other and unspecified hyperlipidemia chronic systolic heart failure personal history of venous thrombosis and embolism diarrhea other and unspecified coagulation defects secondary malignant neoplasm of bone and bone marrow pseudomonas infection in conditions classified elsewhere and of unspecified site malignant neoplasm of other specified sites of bladder hydroureter urinary obstruction, not elsewhere classified 

Answer: The patient is high likely exposed to