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: zosyn / quinolones / ceftriaxone / flagyl / keppra / lisinopril / naprosyn / bactrim ds / phenytoin / nitrofurantoin / sulfa (sulfonamide antibiotics) attending: chief complaint: abdominal pain major surgical or invasive procedure: none history of present illness: 48 y/o aaf w/ spina bifida, mr, paraperesis, and urostomy p/w intense crampy abdominal pain and nausea w/ nbnb vomiting that started this morning. she states she feels her abdomen has been distended for an uncertain amount of time. she is also complaining of bilateral buttock pain and feels she has "cuts" on her buttocks. she is a poor historian given mental retardation. she denies fevers, chills, chest discomfort or difficulty breathing. . of note, patient was recently admitted for abdominal pain that presented similarly and had a negative work up including ct abdomen, ruq u/s and hida scan. she was treated w/a an aggressive bowel regimen and discharged after having daily stools. . in the ed vs: 97.1 70 104/63 16 98% ra. exam was notable for distended abdomen that was diffusely tender to palpation and tenderness over her bilateral buttock ulcers, which did not appear infected but center having some necrotic tissue, per ed. u/a showed evidence of infection. as patient is allergic to zosyn, quinolones, ceftriaxone, flagyl and bactrim, she was treated with macrobid in the ed, and also given morphine and zosyn for her pain and nausea. ct abd/pelvis in the ed showed moderate bilateral hydronephrosis, with diffuse bilateral hydroureters all the way to the ileual conduit which was concerning for distal obstruction. urology was consulted and evaluated pt in ed. they felt that since the pt had normal renal function, surgical intervention was not urgent and they would continue to follow her on the floor. . on the floor, pt is lying on her side complaining of pain, worse in her buttocks but also diffusely over her abdomen which she complains is distended. . all other ros negative except as above. . past medical history: 1. asthma/copd 2. hypertension 3. gerd 4. urostomy 5. h/o vre pyelonephritis 6. spina bifida (myelomengiocele) 7. paraplegia (documented, though patient can walk) 8. depression 9. mild mental retardation 10. psychogenic dysarthria and tremor 11. vs. pseudoseizures - eeg work-up at in frequent runs of regular bifrontal sharp delta activity although the clinical events which occurred during the record were not associated with eeg change 12. atopic dermatitis 13. back pain 14. genital herpes 15. uterine fibroid 16. uterine prolapse 17. diverticulosis 18. external hemorrhoids social history: lives alone in an apartment in . she is able to transfer w/ wheelchair. no assistance at home currently, noting that she does everything on her own. she reports compliance with her meds. no assistance at home currently, noting that she does everything on her owntobacco: 1 ppd etoh: drinks 2-3 beers a day. illicits: denies ivdu ever. history of smoking crack cocaine. family history: per previous report: 3 healthy children. mother - died of lung cancer. father - killed by his girlfriend. not in contact with her brother and sister. physical exam: vs: 97.2 136/74 66 18 98 % ra . gen: obese aaf in mod distress pain, lying on l side heent: eomi, perrla no scleral icterus cv: rrr nl s1 s2 lungs: ctab/l abd: +bs soft but distended, diffusely ttp all over abd ext: warm, well perfused 2+ distal pulses b/l neuro: a&ox3, able to answer questions appropriately skin: large area of skin breakdown and ulceration almost covering the entirity of buttocks worse on the right than left buttock, skin breakdown revealing pink granulation tissue w/ some central greyish-white necrosis but no obvious drainage or purulence, surrounding skin is not erythematous but is exquisitely ttp pertinent results: ct ab/pelvis with contrast impression: 1. interval development of mild hydronephrosis and moderate hydroureter bilaterally with ureteral dilatation extending to the ileal conduit which is mildly distended compared to prior studies. clinical correlation is recommended to exclude a possible distal obstruction of the urostomy, resulting in upstream dilatation of the collecting systems due to reflux and back pressure. no mechanical obstruction of the urostomy on this ct, however, is identified. 2. unchanged bilateral renal cortical thinning, compatible with scarring from prior infectious or ischemic insults. 3. no intra-abdominal abscess. 4. fibroid uterus. 5. spina bifida with meningocele. urine culture **final report ** culture workup discontinued. further incubation showed contamination with mixed fecal flora. clinical significance of isolate uncertain. interpret with caution. escherichia coli. >100,000 organisms/ml.. susceptibility testing requested by dr. # . sensitive to ( mic=0.032 mcg/ml). sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r . skin, right posterior shoulder, biopsy (a-b): 1. subepidermal bulla with superficial dermal edema and mixed neutrophilic, eosinophilic, and lymphocytic infiltrate (see note). 2. neutrophilic folliculitis. note: neutrophilic microabscesses are present in the superficial epidermis and within a follicle. no bacteria or fungi are seen on gram and pas stained sections, however the involved follicle is not present on these section. no interface dermatitis to suggest a fixed drug reaction is seen. the changes most suggest a bullous hypersensitivity reaction. the neutrophilic microabscesses may represent a feature of this reaction, however focal superinfection cannot be excluded. while clinically less likely, the histologic differential diagnosis includes an immunobullous disorder . . tissue biopsy gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. tissue (final ): no growth. anaerobic culture (preliminary): no growth. potassium hydroxide preparation (final ): no fungal elements seen. fungal culture (preliminary): no fungus isolated. acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (preliminary): . 07:35am blood wbc-14.0* rbc-3.41* hgb-10.5* hct-31.4* mcv-92 mch-30.7 mchc-33.3 rdw-15.5 plt ct-282 08:10pm blood wbc-9.2 rbc-4.08* hgb-12.1 hct-38.7 mcv-95 mch-29.7 mchc-31.3 rdw-14.9 plt ct-296 03:33am blood neuts-95.8* lymphs-3.4* monos-0.4* eos-0.3 baso-0.2 08:10pm blood neuts-69.0 lymphs-21.7 monos-2.7 eos-5.7* baso-0.9 07:35am blood glucose-74 urean-12 creat-0.7 na-139 k-4.0 cl-102 hco3-31 angap-10 11:08pm blood glucose-90 urean-15 creat-0.8 na-137 k-4.5 cl-107 hco3-19* angap-16 03:33am blood alt-27 ast-16 alkphos-115* totbili-0.5 08:20am blood alt-50* ast-67* ld(ldh)-197 alkphos-159* totbili-0.4 07:35am blood calcium-8.5 phos-3.5 mg-2.3 11:08pm blood calcium-8.0* phos-3.8 mg-2.1 08:19pm blood lactate-1.4 03:41am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-sm 09:30pm urine blood-sm nitrite-pos protein-neg glucose-neg ketone-neg bilirub-neg urobiln-1 ph-6.5 leuks-sm 03:41am urine rbc-1 wbc-5 bacteri-few yeast-none epi-<1 09:30pm urine rbc-* wbc-* bacteri-many yeast-none epi-0 brief hospital course: rash: on the morning of hd3, ms. developed a rash on her bilateral axilla concerning for drug reaction versus cellulitis. she also had a new leukocytosis overnight with a fever to 103. she was given tylenol and morphine for fever and abdominal pain and blood cultures were drawn. this morning, dermatology was consulted given previous history of drug sensitivity rashes. nitrofurantoin was discontinued. she was not on any other new drugs other than prn morphine for abdominal pain. over the course of the morning her rash worsened, spreading from her axilla to her drunk and developing bullae on the left hip. she has developed hypersensitity rashes during past admissions thought to be in relation to phenytoin. during her last admission for a rash on her thigh, she developed hypotension and was intubated for airway protection and transferred to burn unit for evaluation of her evolving rash. she was started on meropenem, clindamycin and vancomycin during that admission. imaging studies were not consistent with necrotizing facititis. review of discharge summary revealed skin biopsy pathology consistent with hypersensitivity reaction. in the setting of worsening rash, hypotension, and fever in the context of her past history she was transferred to the micu for further evaluation and treatment. in the micu, ms. well to fluid bolus and she was hemodynamically stable. she was initiated on meropenem and vancomycin for urinary tract infection and concern for superinfection of her skin. dermatology was consulted and biopsied her skin and recommended iv methylprednisone for likely hypersensitivity reaction. as ms. and her rash improved she returned to the general medicine floors. iv methylprednisone was change to oral prednisone, 60mg daily. vancomycin was discontinued as her rash did not appear infected. in preparation for discharge to home, meropenem three times a day was changed to daily . she was observed for 24 hours after initiating for possible drug reaction. she was discharged home and will complete her 14 days of antibiotic therapy. she will complete a steroid taper at home and follow up at her primary care physician. . abdominal pain/distention- etiology of abdominal discomfort and distention concerning for symptoms secondary to her urinary obstruction versus colicky pain from cholelithiasis versus constipation. work up in of this year, including a ct scan, hida scan, and ruq were unremarkable. absence of leukocytosis or h/o fevers not concerning for infectious process. ct on admission remarkable only for hydronephrosis and chlolelithiasis. history of nausea and vomiting yesterday without diarrhea or different eating habits. nausea and vomiting resolved on admission. pain is well controlled with tylenol and iv morphine 2mg for break through pain. she was continued on a bowel regiment with senna, colace, miralax, bisacodyl. lactulose was held as it may acutely worsen abdominal cramping. she was initially kept npo with iv maintenance fluids. over her hospital stay, ms. abdominal pain and distention improved. she was able to tolerate regular foods and had regular bowel movements. . urinary tract infection- wbc and few bacteria in urine were concerning for urinary tract infection in a patient with a urostomy and hydronephrosis. ms. has multiple allergies to medications. urine cultures have grown out pan-sensitive proteus in the past. pt has severe uterine prolapse with protruding cervix per night float admission. ms was started empirically in the ed on macrobid given allergy hx. she developed a drug allergy to likely macrobid after 24 hours of treatment and developed fevers and a leukocytosis concerning for hypersensitivity or urosepsis. she was briefly transferred to the icu for evaluation and treatment. antibiotic therapy was changed to meropenem and the switched to for treatment at home once daily. she tolerated both of these antibiotics well without evidence of reaction. . bilateral buttocks ulcers- although ms. reported these ulcers are new, past notes reveal long history of pressure ulcers. it does not appear ms. has significant home suport. on admission, no leukocytosis or history of fevers on admission and exam does not look infected intially. wound care was consulted and assessed right side wound to be stage 3 ulcer due to sloughing of skin and left side to be stage 2. her wounds were dressed daily by wound care with recommendations forwarded to ms. services. ms. will need education regarding frequent position changes to prevent further development of pressure ulcers at home. . 5. asthma/copd- ms. asthma flare on admission requiring several nebulizer treatments. she was continued on home singulair. medications on admission: on last discharge : miconazole powder 2% 1 appl tp :prn skin irritation montelukast sodium 10 mg po/ng daily acetaminophen 325-650 mg po/ng q6h:prn pain, fever pantoprazole 40 mg po q24h order date: @ 1209 citalopram hydrobromide 20 mg po/ng daily quetiapine fumarate 25 mg po/ng hs docusate sodium 100 mg po bid senna 1 tab po/ng :prn constipation heparin 5000 unit sc tid thiamine 100 mg po/ng daily discharge medications: 1. 1 gram recon soln sig: one (1) recon soln injection q24hrs () as needed for uti for 10 days. disp:*10 recon soln(s)* refills:*0* 2. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 3. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day) as needed for skin irritation. 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. prednisone 10 mg tablets, dose pack sig: as directed po once a day for 11 days: take 6 pills (total 60mg) on day 1 . take 3 pills (total 30mg) daily for 5 days starting . take 1.5 pills (total 15 mg) daily for 5 days starting . disp:*29 tablets, dose pack(s)* refills:*0* 6. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 7. quetiapine 25 mg tablet sig: one (1) tablet po hs (at bedtime). 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 10. divalproex 250 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po bid (2 times a day). 11. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 12. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for skin irritation. 13. morphine 15 mg tablet sig: 0.5 tablet po every six (6) hours as needed for pain for 10 days: do not drive or operate heavy machinery while using this medication. disp:*15 tablet(s)* refills:*0* 14. acetaminophen 325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. discharge disposition: home with service facility: , discharge diagnosis: primary: bullous hypersensitivity reaction secondary: urinary tract infection mild hydronephrosis and moderate hydroureter suggestive of urinary tract outflow obtruction. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. able to walk short distances with a walker. discharge instructions: you were admitted with abdominal and buttock pain. you had ulcers which were evaluated and treated by wound care. you were found to have mildly enlarged kidneys and urinary tract; urology recommended outpatient follow-up as your labs to assess kidney function remained normal. you were also found to have a urinary tract infection. this was treated with an antibiotic, nitrofurantoin (macrobid), that caused an allergic reaction on your skin. you were transferred briefly to the intensive care unit to care for you as recovered from this reaction. macrobid was discontinued and you were given steroids to help control your skin reaction per dermatology's recommendation. you were started on , antiobiotic to complete treatment of your urinary tract infection. you were kept overnight to make sure you did not develop a reaction to this new drug. the following changes were made to your medication list: - please continue to take for a total of ten more days. - please continue your prednisone taper for 11 more days as directed. - please take all your other medications as prescribed and review them with your primary care physician. followup instructions: department: primary care name: dr. when: wednesday at 10 am location: center address: , , phone: department: div of allergy and inflam when: at 9:30 am with: , rnc building: one place (, ma) campus: off campus best parking: parking on site department: surgical specialties when: thursday at 9:00 am with: dr. building: campus: east best parking: garage md procedure: venous catheterization, not elsewhere classified closed biopsy of skin and subcutaneous tissue diagnoses: other iatrogenic hypotension abdominal pain, unspecified site esophageal reflux urinary tract infection, site not specified unspecified essential hypertension other convulsions disorders of phosphorus metabolism pressure ulcer, buttock dermatitis due to drugs and medicines taken internally dysarthria chronic obstructive asthma, unspecified hydronephrosis backache, unspecified flatulence, eructation, and gas pain diverticulosis of colon (without mention of hemorrhage) spina bifida without mention of hydrocephalus, unspecified region paraplegia external hemorrhoids without mention of complication pressure ulcer, stage ii mild intellectual disabilities pressure ulcer, stage iii other artificial opening of urinary tract status leiomyoma of uterus, unspecified contact dermatitis and other eczema, unspecified cause other and unspecified anti-infectives causing adverse effects in therapeutic use abnormal involuntary movements fever presenting with conditions classified elsewhere uterine prolapse without mention of vaginal wall prolapse genital herpes, unspecified 

Answer: The patient is high likely exposed to