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: lethargy, fevers. major surgical or invasive procedure: ng tube placement central line placement history of present illness: briefly, 79 yo m nh resident, h/o dementia, remote h/o saddle pe, mrsa, afib not on coumadin presumable due to temporal lobe hemorrhage, urinary retention with recurrent utis who presents with urosepsis. patient presented to with lethargy, fevers to 102, hr 180s afib, bp 100/90s. treated with zosyn, 2l ivf, and transferred to for further management on . on arrival to , pt was rigoring and minimally interactive, vs 100.2, 80, 132/74, 38, 94% nrb and then became hypotensive to 70s. he was rescusitated with 6l ivf w/o improvement in bp. neosynephrine was started after a r ij was placed. levophed was started due to persistent hypotension. in the micu, patient treated with zosyn (), growing proteus in urine resistant to amp and fluoroquinolones and piperacillin based on culture data from , here sensitive to zosyn and clinically improved. blood culture growing coag neg staph--sensitivities pending. also started to have loose stool, c.diff positive- started flagyl on . ng tube placed for feeding. pt developed arf with cr to 2.8 now resolved. patient now back on diltiazem for hr control and sbp stable. upon transfer to the floor, patient resting comfortably, denies pain, oriented to self and place. vss. past medical history: 1) bilateral saddle pulmonary emboli s/p ivc filter 2) delirium 3) alcohol withdrawal 4) dementia 5) urinary retention 6) complicated urinary tract infection 7) thrombocytopenia nos 8) large inguinal hernia 9) macrocytic anemia 10) history of alcoholism 11) hypertension 12) lung nodules nos 13) schizotypal personality disorder with paranoid ideation 14) does not report appendectomy social history: graduated hs, taught machine shop, and , rec'd bachelor's of science. was most recently teaching at occupational center in but quit in b/c "had enough money". family history: no h/o psychiatric illness per pt. mom died of gi cancer, dad died of heart failure physical exam: vs 97.1 122/62 90 24 96% ra gen: cachectic male, nad, lying flat in bed heent: op clear, dry, anicteric neck: supple, rij in place, c/c/i cv: nl s1/s2, irregularly irreg lungs: cta anteriorly abd: soft, nt ext: 2+ edema throughout. large scrotal edema neuro: oriented to self and place, follows simple commands, diminished strength throughout. pertinent results: admission labs: 11:08pm blood wbc-4.7# rbc-2.59* hgb-8.3* hct-24.9* mcv-96 mch-32.0 mchc-33.3 rdw-15.2 plt ct-101* 07:30pm blood wbc-1.3*# rbc-2.97* hgb-9.7* hct-29.9* mcv-101*# mch-32.8* mchc-32.5 rdw-15.0 plt ct-134* 11:08pm blood neuts-73* bands-22* lymphs-3* monos-0 eos-0 baso-0 atyps-1* metas-1* myelos-0 11:08pm blood pt-16.2* ptt-42.9* inr(pt)-1.5* 11:08pm blood glucose-75 urean-71* creat-2.4* na-140 k-3.9 cl-115* hco3-13* angap-16 11:08pm blood alt-95* ast-167* ld(ldh)-264* ck(cpk)-131 alkphos-202* amylase-52 totbili-2.2* 11:08pm blood albumin-2.0* calcium-6.2* phos-3.5# mg-1.5* uricacd-6.7 07:45pm blood lactate-8.8* discharge labs: 09:00am blood wbc-9.3 rbc-3.44* hgb-10.9* hct-33.4* mcv-97 mch-31.6 mchc-32.6 rdw-16.1* plt ct-182 09:00am blood plt ct-182 09:00am blood glucose-68* urean-27* creat-0.8 na-136 k-4.4 cl-106 hco3-23 angap-11 09:00am blood calcium-7.6* phos-2.4* mg-1.8 imaging: radiology final report chest (portable ap) 7:54 pm chest (portable ap) reason: eval for pna, ij placement medical condition: 79 year old man with sepsis, right ij reason for this examination: eval for pna, ij placement indication: sepsis, right ij placement. comparison: . single view chest, ap: there has been interval placement of a right ij cvl with the tip within the mid svc. no pneumothorax is identified. the pulmonary vasculature is within normal limits allowing for the supine technique of the exam. the cardiac and mediastinal contours are stable with unfolding of the aorta and wall calcifications. impression: right ij cvl tip within the mid svc. no evidence of pneumothorax. dr. approved: tue 9:05 pm radiology final report abdomen u.s. (complete study) 9:14 am abdomen u.s. (complete study) reason: eval for biliary diseasse/eval for hydro medical condition: 79 year old man with mild transaminitis reason for this examination: eval for biliary disease liver ultrasound on clinical history: elevated lfts. low albumin. findings: grayscale and color ultrasound of the abdomen was performed without priors available for comparison. the liver remains normal in size and echotexture. spleen remains normal in size. the splenic vein is prominent at the level of the spleno-portal confluence, which can be an early indicator of portal hypertension. gallbladder wall is markedly thickened with a small gallbladder lumen. no cholelithiasis or biliary dilatation is seen, and this likely is a manifestation of third spacing/hypoproteinemia. no focal hepatic lesions. portal vein remains patent, and flows in the proper direction. the kidneys remain normal in size and echotexture without hydronephrosis. impression: 1. marked gallbladder wall edema, without biliary dilatation or cholelithiasis, likely due to third spacing. 2. mild distention of the splenic vein, which may indicate early portal hypertension. continued surveillance advised. the study and the report were reviewed by the staff radiologist. dr. dr. approved: 10:22 am radiology final report scrotal u.s. 3:21 pm scrotal u.s. reason: eval for bowel loop strangulation or other mass. medical condition: 79 year old man with known inguinal hernia with scrotal edema and now with ecchymosis. reason for this examination: eval for bowel loop strangulation or other mass. scrotal ultrasound. clinical indication: 79-year-old male with known large inguinal hernia and scrotal edema and ecchymosis. to evaluate for bowel loop strangulation or other mass. comparison study: ct scan, , which demonstrated a very large right inguinal scrotal hernia containing both right colon and cecum as well as multiple small bowel loops. scans over the swollen ecchymotic scrotum were performed using deep abdominal and high-resolution linear probes. the left testis is small and high in position almost within the left inguinal canal, but is otherwise unremarkable. the right testis and epididymis are also small and similar in appearance to the left and are displaced medially by the large inguinal scrotal hernia sac. the free fluid within the hernia sac is clear, showing no signs of exudative characteristics. within the sac are multiple bowel loops, none of which shows active peristaltic activity. some of the small bowel loops have normal mucosal fold architecture, while other loops are more distended with effacement of the mucosal folds. some of the loops are fluid-filled and others are air-filled, but the walls of the various small bowel loops show no evidence of edema or air contained within the walls. neither is there evidence of free air within the sac. color flow and doppler assessment of the testes and epididymides show normal to perhaps slightly increased vascularity in both testes in a symmetrical distribution with normal pulsed doppler waveforms. color flow assessment of the bowel walls within the scrotal hernia also show vascular flow in all of the interrogated bowel loops. conclusion: large right inguinal scrotal hernia containing both large and small bowel. while the bowel is dilated and flaccid, there are no specific signs of ischemia or necrosis, and specifically there is no evidence of air within the bowel wall, edema within the bowel wall or lack of vascularity. however, since no contrast is available for use in ultrasound, the assessment for bowel wall ischemia is incomplete on this study and consideration of contrast-enhanced ct scan is recommended. these findings were discussed with dr. at 4:40 p.m. by telephone. dr. approved: 8:02 pm atrial fibrillation with rapid ventricular response. probable left anterior fascicular block. poor r wave progression. consider prior anterior myocardial infarction. since prior tracing of voltage in leads v1-v3 is decreased on the current study and the rate has increased. tracing #1 read by: , d. intervals axes rate pr qrs qt/qtc p qrs t 175 0 88 278/479 0 -43 -160 brief hospital course: briefly, 79 yo m nh resident, h/o dementia, remote h/o saddle pe, mrsa, afib not on coumadin presumable due to temporal lobe hemorrhage, urinary retention with recurrent utis who presents with urosepsis. patient presented to with lethargy, fevers to 102, hr 180s afib, bp 100/90s. treated with zosyn, 2l ivf, and transferred to for further management on . on arrival to , pt was rigoring and minimally interactive, vs 100.2, 80, 132/74, 38, 94% nrb and then became hypotensive to 70s. he was rescusitated with 6l ivf w/o improvement in bp. neosynephrine was started after a r ij was placed. levophed was started due to persistent hypotension. in the micu, patient treated with zosyn (), growing proteus in urine resistant to amp and fluoroquinolones and piperacillin based on culture data from , here sensitive to zosyn and clinically improved. blood culture growing coag neg staph--sensitivities pending. also started to have loose stool, c.diff positive- started flagyl on . ng tube placed for feeding. pt developed arf with cr to 2.8 now resolved. patient now back on diltiazem for hr control and sbp stable. upon transfer to the floor, patient resting comfortably, denies pain, oriented to self and place. vss. through the course on the floor, the patient's central line was removed. he received a speech and swallow eval finding that he could tolerate nectar thick liquids but did not swallow purees without coaxing. zosyn was changed to oral cefpodoxime on and given in nectar thick liquid. he continued to receive flagyl for c diff and diltiazem for afib. patients vitals continued to be stable and he continued to improve clinically. he had no delerium episodes, however, he removed his ng tube on . a repeat speech and swallow eval on indicated that patient could tolerate purees. patient is now medically stable and optimized on therapy to return to nh. medications on admission: cholecalciferol (vit d3) 400mg po daily hexavitamin daily thiamine hcl 100mg po daily folic acid 1mg po daily acetominophen 325mg prn haloperidol 1mg po bid quetiapine 25mg two tabs po bid discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 2. metronidazole 500 mg tablet : one (1) tablet po tid (3 times a day) for 16 days. 3. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 4. diltiazem hcl 60 mg tablet : one (1) tablet po qid (4 times a day). 5. miconazole nitrate 2 % powder : one (1) appl topical qid (4 times a day) as needed for rash. disp:*1 qs* refills:*0* 6. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily) as needed for prophylax. 7. cefpodoxime 100 mg tablet : two (2) tablet po q12h (every 12 hours) as needed for uti for 6 days. 8. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed for pain. discharge disposition: extended care facility: - discharge diagnosis: urosepsis afib dementia acute renal failure resolved failure to thrive anemia discharge condition: stable discharge instructions: you were treated in the hospital for a urinary tract infection that progressed to sepsis. you improved on antibiotics and you are being discharged back to your nursing home. please take your medicines as directed and keep follow up appointments. followup instructions: provider: , md phone: date/time: 1:00 provider: , m.d. phone: date/time: 9:30 also recommend outpatient neurology appointment clinic phone location 8 md, procedure: venous catheterization, not elsewhere classified transfusion of packed cells diagnoses: thrombocytopenia, unspecified anemia, unspecified urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified severe sepsis atrial fibrillation methicillin susceptible staphylococcus aureus septicemia other persistent mental disorders due to conditions classified elsewhere paralysis agitans septic shock intestinal infection due to clostridium difficile retention of urine, unspecified proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site infection and inflammatory reaction due to indwelling urinary catheter inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent) malnutrition of moderate degree schizotypal personality disorder 

Answer: The patient is high likely exposed to