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: sulfa(sulfonamide antibiotics) attending: chief complaint: seizure major surgical or invasive procedure: intubation and ventilation right internal jubular central line placement history of present illness: this is an 84 year-old lady with pmhx of cad, htn, dm2, htn and pvd who presented from hospital after a witnessed siezure. the patient was in her usual state of health until one day prior to admission when she developed dysuria and urinary frequency associated w/ chills and poor am appetite. she went to her pcp's office who prescribed her macrobid. she took her first tab of macrobid around 4pm and had dry heaves within 30 min prompting referral to the ed. her temperature at that time was 98.9. she has had no recent illnesses, sick contacts, travel or trauma. she has reported no headaches or back/neck stiffness to her husband. on arrival to the osh ed she was being evaluated in triage where initial vitals were: initial vitals were: 99.5 110 18 149/81 96% on ra. at triage, she abruptly looked right, thrust her head back and decerbrate posturing was noted. she was brought to the ed where she was noted to be cyanotic but not pulseless. at the osh, she was administed 1mg ativan, and intubated with etomidate/succinate w/ propofol for sedation. initial labs were siginificant for wbc 18.1, lactate 11.6, creatinine 1.3, hct 38.1. a foley catheter was placed a 1 l ns was drained. a ct scan demonstrated no acute intracranial process. abg 7.38/35.4 301. 2 piv were placed. given there was no neurologist on site, a request for transfer to was made. in transit her blood pressures were noted to be in the 90s. she was hypotensive on propofol and started briefly on neosynephrine briefly. in the ed, initial vs were: 82, bp: 92/50, o2sat: 100, o2flow: intubated. she was intubated and sedated. her initial labs were significant for wbc 12.3, hct 27.2, plts 308, creatinine 0.8, lactate 2.6, lipase 25 and inr 1.1. a ct non contrast of her head revealed no acute intracranial process. a chest xray demonstrated an prominent aortic knob but no acute opacity. an ekg demonstrated sinus rhythm, na, ni. a neurology consult was obtained who felt her unresponsive episode was suspicious for a partial seizure that secondarily generalized. the most likely source of her seizure was felt to be sepsis of likely urinary source in the setting of high fever and hyponatremia. the neurology consult recommended lumbar puncture and treatment with acyclovir until hsv pcr returned negative. while in the ed her pressures dropped to the systolic 80s with maps in the high 50s and she spiked a fever to 103.4. she was administed 4l of ns and started on a levophed gtt. a right ij was placed. her sedation was changed from propofol to midaz/fent with improvement in her blood pressures. she was given cefepime for management of a possible uti, a acyclovir and vancomycin for complete empiric meningitis coverage. an lp was attempted by both the ed resident and attending and no csf could be obtained. she made 800cc of urine output prior to transfer and received rectal tylenol for her fever. in the micu she was hypotensive to the 90s and found to have hct 27 (baseline 38). she received 1u prbc in the micu. her hct remained stable with guaiac negative stool in the micu. ct head here was negative. neurology was consulted and recommended medical workup and keppra . after resuscitation and antibiotics she subsequently defervesced and stabilized hemodynamically. she was then extubated, which she tolerated well, and was transferred to the medicine floor. on transfer to the medical floor, vital signs were t 98.1 hr 105 bp 148/78 rr 20 o2sat 97% on ra. the patient felt well and had no acute complaints. past medical history: - cad s/p pci x 2 in - htn - pvd - dm2 (diet controlled) - hiatal hernia - oa - gout - breast cancer s/p l. masectomy and hysterectomy in - depression - gerd: schatzki rings, hiatal hernia - acalculous cholecystitis social history: - tobacco: none - alcohol: none - illicits: none - housing: lives with husband - family: has 4 children, multiple grand and great granchildren - code: dnr/ok to intubate family history: - no family h/o seizure disorder physical exam: admission physical exam: vitals: 100.5 154/68 19 99% on ps 5/5 fio2 40%. general: intubated and sedated heent: sclera anicteric, mmm, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, systolic mumur loud at the apex and upper sternal borders, exam limitde by ventilator exams lungs: on anterior exam clear to auscultation bilaterally abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, able to squeeze both hands command, wiggle her feet, intact patellar reflexes, down going toes. discharge physical exam: vs - t 98.6 bp 130/77 hr 86 rr 20 96% on ra general - well-appearing 82 yo f who appears comfortable resting in bed. neck - supple, no thyromegaly, no jvd. lungs - lungs clear to auscultation bilaterally. breathing unlabored. moving air well and symmetrically, no accessory muscle use heart - pmi non-displaced, rrr, 3/6 systolic ejection murmur heard best over the left sternal border. no rubs or gallops. abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - no c/c/e, 2+ peripheral pulses (radials, dps) skin - prominent ecchymoses on bilateral shoulders and arms. neuro - awake, a&ox3. pertinent results: 10:55pm wbc-12.3* rbc-3.23* hgb-9.2* hct-27.2* mcv-84 mch-28.6 mchc-33.8 rdw-14.7 09:15am wbc-10.9 rbc-2.91* hgb-8.1* hct-24.7* mcv-85 mch-27.9 mchc-32.9 rdw-14.7 03:00pm hgb-7.9* hct-23.8* 11:20pm glucose-144* lactate-2.6* na+-128* k+-3.0* cl--98 tco2-23 09:15am glucose-122* urea n-10 creat-0.7 sodium-127* potassium-3.3 chloride-96 total co2-19* anion gap-15 09:45pm glucose-116* urea n-8 creat-0.6 sodium-125* potassium-3.9 chloride-95* total co2-22 anion gap-12 11:05 pm blood culture #2. blood culture, routine (preliminary): staphylococcus, coagulase negative. isolated from only one set in the previous five days. sensitivities performed on request.. anaerobic bottle gram stain (final ): gram positive cocci in pairs in clusters. reported to and read back by # 0810. urine culture (final ): no growth. mrsa screen (final ): no mrsa isolated. 02:45am urine rbc-3* wbc-8* bacteria-none yeast-none epi-0 trans epi-<1 09:37am urine hours-random urea n-303 creat-47 sodium-120 potassium-52 chloride-150 ct head impression: no acute intracranial process. if clinical suspicion for an acute infarction is high, mri is the recommended study of choice. mri head impression: 1. there is no evidence of acute intracranial process. specifically, no evidence of acute ischemic changes are seen. 2. mild mucosal thickening is noted on the left maxillary sinus with fluid level as well as mucosal thickening at the ethmoidal air cells, there is opacity of the sphenoid sinus, likely consistent with an ongoing inflammatory process, please correlate clinically. cta chest impression: 1. no evidence of aortic dissection. discoid atelectasis along the aortic arch may contribute to the appearance of mediastinal widening. 2. large arterial thrombosis at the mid aortic arch between the origins of the left subclavian artery and an aberrant right subclavian artery (four supraaortic vessels). the thrombosis is adherent to the superior aortic wall and mildly narrows the origins of both subclavian arteries. discharge labs: 05:55am blood wbc-8.9 rbc-3.21* hgb-8.8* hct-26.4* mcv-82 mch-27.3 mchc-33.2 rdw-14.6 plt ct-362 05:55am blood plt ct-362 05:55am blood glucose-95 urean-8 creat-0.6 na-135 k-3.6 cl-100 hco3-25 angap-14 05:55am blood calcium-8.5 phos-2.1* mg-1.9 03:04am blood hapto-151 09:15am blood hbsag-negative hbsab-negative hbcab-negative hav ab-negative 02:45am urine rbc-3* wbc-8* bacteri-none yeast-none epi-0 transe-<1 brief hospital course: this is an 82 year-old lady with pmhx of cad, htn, dm2, htn and pvd who presented from hospital after a witnessed seizure and initial hospital course was remarkable for fever and hypotension. problem list: seizure: patient was intubated in the ed as she was unable to protect her airways, extubated the following day. etiology unclear and ddx includes metabolic disturbance vs infectious etiology vs toxic/medication induced. working diagnosis from neurology is seizure activity secondary to urosepsis. she has mild hyponatremia here and rapid correction at osh was considered, but ruled out once outside record indicated near normal sodium levels while at osh. presence of weakly positive urine in setting of treatment does not entirely explain a seizure. macrobid and her home medications do not classically lower your seizure threshold. significant cad/pvd at risk for stroke however ct and mri head demonstrates no evidence of structural abnormality to suggest seizure focus. eeg was negative for seizure activity, and since this was the patient's first seizure, neurology felt that continued aed therapy was not necessary, so keppra was discontinued and seizure precautions were removed. the patient has not had any seizure activity since her transfer from osh. hypotension: concerning for sepsis in setting fever, leukocytosis although urinary source not completely convincing in the setting of weakly positive urine a 1 day duration of sx. prolonged convulsive seizures can be followed by a period of hyperthermia and hypotension. started empiric management for meningitis x 1 day, but as patient's mental status improved drasticly emperic management was discontinued. urine culture negative. blood cultures () positive for gram positive cocci in clusters, likely contaminate, but vancomycin was started. cultures came back as coag-negative staph, so this was felt to be a contaminant, and vancomycin was discontinued. she will continue treatment with cefpodixime for 7 total days (last day- ) mediastinal widening: interval mediastinal widening on repeat cxr in ed. cta ruled out aortic dissection. aortic arch thrombus: the patient received a cta chest which showed an aortic arch thrombus, but the patient was asymptomatic. she does however have a 3/6 systolic ejection murmur which could be related. vascular surgery was consulted and they recommended conservative therapy with aspirin, plavix, and a repeat cta in one month. she will follow-up with vascular clinic in one month. anemia: hct at osh was 38.1. hct upon arrive 27.1, trended down to 22.8 am of . transfused 1 unit prbc. hct stablized at 26. down trending hct dilutional vs. loss into soft tissue vs active hemorrhage. on medicine floor, hct has been stable at 25-26. has been guiac negative and pt had a recent colonoscopy that was normal per patient. hemolysis labs including haptoglobin have been negative. etiology of anemia is unknown. coagulase negative staph bacteremia: noted in just 1 out of 2 bottles. felt to be contaminant. sepsis due to urinary tract infection: ceftriaxone started. ucx negative but was on abx; this is likely the nidus of infection that precipitated sepsis and seizure. will continue po cefpodoxime 200mg q12hours for full 7 day antibiotic course (last day- ) bilateral humeral fractures: patient reported only moderate pain in her bilateral upper extremities after her seizure. orthopedic surgery saw the patient and felt that nonoperative management would be ideal. she will follow-up with them in clinic. pt/ot followed while the patient was in house. hyponatremia: likely siadh since patient was euvolemic and urine lytes were consistent with this. resolved with fluid restriction. hypertension: home meds were on hold while hemodynamically unstable. over last several days of admission, the patient became hypertensive which is likely her baseline, so her home meds were restarted and she responded appropriately. coronary artery disease: s/p mi in w/ pci x 2. plavix and htn drugs held on admission but were resumed by discharge. asa, ezetimibe, rosuvastation and fenobirate continuted at home doses. depression: home dose of paroxetine gerd: continued home dose of rabeprazole. diabetes type 2: managed with insulin sliding scale. oral agents held. medications on admission: preadmission medications listed are correct and complete. information was obtained from patient. 1. nitroglycerin sl 0.4 mg sl prn chest pain 2. atenolol 25 mg po daily 3. aspirin 81 mg po daily 4. ezetimibe *nf* 10 mg oral daily 5. rosuvastatin calcium 20 mg po daily 6. clopidogrel 75 mg po daily 7. fenofibrate *nf* 160 mg oral daily 8. ramipril 10 mg po daily 9. senna 1 tab po daily:prn constipation 10. nystatin cream 1 appl tp 11. vitamin d unit po daily 12. hydrochlorothiazide 12.5 mg po daily 13. paroxetine 10 mg po daily 14. omeprazole 20 mg po daily discharge medications: 1. aspirin 81 mg po daily 2. clopidogrel 75 mg po daily 3. nitroglycerin sl 0.4 mg sl prn chest pain 4. ezetimibe *nf* 10 mg oral daily 5. rosuvastatin calcium 20 mg po daily 6. fenofibrate *nf* 160 mg oral daily 7. ramipril 10 mg po daily 8. senna 1 tab po daily:prn constipation 9. vitamin d unit po daily 10. omeprazole 20 mg po daily 11. paroxetine 10 mg po daily 12. hydrochlorothiazide 12.5 mg po daily 13. atenolol 25 mg po daily 14. acetaminophen 500 mg po q6h pain 15. oxycodone (immediate release) 2.5 mg po q6h:prn pain rx *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours disp #*20 tablet refills:*0 16. cefpodoxime proxetil 200 mg po q12h duration: 3 days last day- 17. polyethylene glycol 17 g po daily:prn constipation discharge disposition: extended care facility: healthcare, nh discharge diagnosis: primary- seizure urinary tract infection hyponatremia (resolved) anemia (stable) secondary- hypertension 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: you were admitted to the hospital after having a seizure. you were found to have a urinary tract infection, abnormal lab values and anemia. in addition, you underwent an x-ray which revealed fractures in both your arms. you were stablized in the icu and transferred to the medicine service for further management. you are being discharged to rehab. the following changes were made to your medications: 1. start taking cefpodixime 400mg by mouth every 12 hours for 3 more days (last day- ) please adhere to a 2l/day fluid restriction followup instructions: name: , d location: health address: , , phone: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. department: orthopedics when: tuesday at 8:20 am with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: orthopedics when: tuesday at 8:40 am with: , np building: campus: east best parking: garage department: neurology when: tuesday at 4:00 pm with: drs. / building: sc clinical ctr campus: east best parking: garage department: radiology when: monday at 1:15 pm with: cat scan building: cc campus: west best parking: garage department: vascular surgery when: monday at 2:30 pm with: , md building: lm campus: west best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours central venous catheter placement with guidance diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia personal history of malignant neoplasm of breast other convulsions peripheral vascular disease, unspecified depressive disorder, not elsewhere classified percutaneous transluminal coronary angioplasty status sepsis diaphragmatic hernia without mention of obstruction or gangrene constipation, unspecified old myocardial infarction osteoarthrosis, unspecified whether generalized or localized, site unspecified iron deficiency anemia, unspecified do not resuscitate status other disorders of neurohypophysis leukocytosis, unspecified acquired absence of both cervix and uterus embolism and thrombosis of thoracic aorta nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] acquired absence of breast and nipple other closed fracture of upper end of humerus accidental fall from wheelchair 

Answer: The patient is high likely exposed to