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: haloperidol / valium attending: chief complaint: hypotension major surgical or invasive procedure: none history of present illness: 63m with pmh schizophrenia, cva w/ r hemiparesis, copd, colonic dysmotility recently admitted for sigmoid pseudo-obstruction treated with ngt and rectal tube decompression. he was also found to have fever, leukocytosis and wedge-shaped deformity in l kidney on ct consistent with pyelonephritis, was treated with 2 days of zosyn. a ua showed 19 wbc but no bacteria, so antibiotics were discontinued. on after pt discharged, blood cx + for pan-sensitive gnr. he represents to ed today from rehab with increasing fatigue and abdominal distension, found to have systolic blood pressure of 70, given 2l ivf bolus and transferred to ed. in ed initial vitals were 98.4 109 81/48 22 98% 4l, he was given 4l iv bolus and systolic blood pressure came up to 100. a right ij cvl was placed and he received cefepime, flagyl, and vancomycin. a ct scan showed redemonstration of wedged shaped areas of poor perfusion in l renal lower pole with minimally increased perinephric fluid suggesting pyelonephritis and b/l ureteral dilation with transition points in the distal pelvis. acs was consulted given abdominal distension and determined there was no obstruction, but persistent dilated colon with large fecal load in sigmoid and rectum. they recommended bowel regimen and consider rectal tube decompression. prior to transfer, sbp was in the 70's and he was started on 0.12 of norepinepherine. upon transfer to the micu, sbp is in the 90's. patient reports severe l flank pain and abdominal distension. history is limited by attention and mild disorientation (alert but o x 1), but he does also reports subjective fevers, dizziness and recent diarrhea. review of systems: (+) per hpi past medical history: paranoid schizophrenia seizure disorder cva with residual right hemiparesis copd hyperlipidemia htn past surgical history: ventral hernia repairs with mesh in and social history: lives at rehab. ongoing alcohol or tobacco use. reports remote smoking hx - quit over 10 years ago. family history: -aunt with scoliosis -father with seizures and hepatitis -mother with ? aneurysm, stroke, heart valve replacement physical exam: admission exam: vitals: 99.4, 102, 113/64, 98 4l nc general: nad heent: sclera anicteric, mmm, oropharynx clear neck: supple, no jvp cv: rrr, normal s1 + s2, no murmurs, rubs, gallops lungs: diffuse expiratory wheezing in all lung fields, no r/r appreciated. abdomen: distended but soft, tympanic, with reducible ventral hernia. tenderness to palpation of l flank and cva. no fluid wave. bowel sounds hypoactive but present in all four quadrants. organomegally cannot be assessed due to distention gu: foley in place draining yellow urine ext: warm, well perfused, 2+ pulses, r foot deformity neuro: a + o x 1 (says full name, place: "the apartment," day: friday). pertinent results: admission labs 10:00am blood wbc-16.7*# rbc-4.18* hgb-13.0* hct-39.0* mcv-93 mch-31.0 mchc-33.2 rdw-14.6 plt ct-216 10:00am blood neuts-88* bands-10* lymphs-1* monos-1* eos-0 baso-0 atyps-0 metas-0 myelos-0 10:00am blood glucose-154* urean-17 creat-1.3* na-137 k-4.3 cl-101 hco3-28 angap-12 10:00am blood alt-156* ast-240* alkphos-152* totbili-0.4 07:43pm blood calcium-7.7* phos-2.2* mg-2.7* 10:00am blood albumin-3.3* 10:07am blood lactate-3.4* micro blood culture blood culture, routine-pending inpatient urine urine culture-final inpatient urine urine culture-final inpatient mrsa screen mrsa screen-pending inpatient blood culture blood culture, routine-pending emergency blood culture blood culture, routine-pending emergency imaging kub impression: marked bowel distention, similar compared to . cxr the heart size is normal. the mediastinal and hilar contours are unchanged with tortuosity of the thoracic aorta again noted. there is no pulmonary vascular congestion. streaky linear opacities in the bases are compatible with subsegmental atelectasis. no focal consolidation, pleural effusion or pneumothorax is present. interposition of the colon between the diaphragm and liver is noted on the right. distended bowel loops are partially imaged within the upper abdomen. impression: mild bibasilar atelectasis. ct abd/pelvis impression: 1. redemonstration, though less conspicuous, of wedge-shaped areas of poor perfusion in the left renal lower pole with mildly increased surrounding perinephric stranding, suggesting pyelonephritis. 2. significant dilatation of the midportions of the bilateral ureters, left greater than right with collapse of the distal ureters and no hydronephrosis of renal cortical thinning to suggest acute or chronic obstructive process. findings could relate to megaureter, despite the distal ureters appearing normal in caliber. further evaluation with mri can be obtained to assess for a source of the ureteral caliber change. 3. significant stool burden within the rectum and sigmoid colon with massive upstream gas-filled distention of the colon consistent with provided diagnosis of pseudo-obstruction. no surrounding inflammatory changes to suggest proctitis. 4. 2.3 x 2.2 x 2.3 cm lobulated pericolonic lesion adjacent to the sigmoid colon, potentially a soft tissue mass. this too can be further assessed with mri. brief hospital course: 63m with paranoid schizophrenia, seizure disorder, cva with residual right hemiparesis, copd, hyperlipidemia, htn and recent admission for pseudo-obstruction of his sigmoid colon. ct during prior admission showed a wedge-shaped deformity in l kidney on ct consistent with pyelonephritis. after discharge, blood cultures grew e. coli. he now represents with hypotension and leukocytosis concerning for sepsis. active issues: #colonic pseudoobstruction. per notes patient has a history of chronic colonic motility dysfunction. reportedly has had evaluation at although i do not have that information, i suspect it may be due to central autonomic dysfunction secondary to cva. ct on admission showed that the colon was dilated and filled with air and fluid, slightly increased compared to recent prior study with significant fecal load in the rectum and sigmoid colon. in micu he received rectal tube but did not have improvement in distension and this was removed prior to arrival to the floor. ngt was placed but it was self d/c'd 12hrs later. rectal exam on the floor did not show stool impaction and dulcolax suppository and enema did not releive distension and constipation. 2mg iv neostigmine was administered on evening with substantial improvement in his distension and passage of large volume of liquid stool. one study showed that use of peg after neostigmine resulted in lower risk of recurrence. following this he was restarted on his home bowel regimen with polyethylene glycol and docusate liquid as well as milk of magnesium and psyillium. offending medications (ccb, opiates) were avoided. his calcium channel blocker was stopped. his diet was advanced and he tolerated a regular diet. at discharge his abdomen was soft and non-tender but was distended. . # sepsis / pyelonephritis: upon admission, patient met criteria for sepsis with a suspected renal source. blood culture from recent admission grew e.coli . his ct scan and physical exam were consistent with a left pyelonephritis. patient was initially started on broad spectrum antibiotics but then transitioned to ceftriaxone. it was discovered that patient was not given a dose on , which was communicated to the patient/family. surveillance cultures no growth to date but not yet finalized. afebrile, hemodynamically stable, normalized wbc count at discharge. reporting intermittent left abdominal pain but improving. he was changed to ciprofloxacin on and will complete another 12 days of this. he had an mri abdomen to further evaluate a possible pelvic soft tissue mass seen on ct. the mri revealed a small left pelvic hematoma. if the patient has persistent bacteremia despite antibiotics or develops symptoms concerning for systemic infection following antibiotic course would consider this a potential source of infection. . #hydro-ureter: on ct abdomen, noted to have dilation of mid portion of bilateral ureters with collapse of distal ureter and no evidence of hydronephrosis to suggest acute or chronic obstructive process. mri revealed likely congenital hydro-ureter without evidence of obstruction. . #knee pain: the day of discharge the patient reported onset of right knee pain during turning. on exam, generalized pain worse w/ passive range of motion. he does not bear weight at baseline. the knee did not appear warm, erythematous, or swollen. plain film was obtained, which revealed no fracture or effusion. pain controlled with tylenol and elevation on pillow. . #pelvic hematoma: noted on ct scan to have 2.3 x 2.2 x 2.3 cm lobulated pericolonic lesion adjacent to the sigmoid colon, potentially a soft tissue mass. mri ordered to further assess, which revealed an old hematoma in the left pelvic adjacent to the colon. # copd: patient presented with diffuse b/l wheezes on exam, which were felt to be due to atalectasis in the setting of abdominal distension and pain with deep inspiration (secondary to pyelo) vs. copd. he received albuterol and ipratropium nebulizers and had no further wheezing during hospitalization. . # : patient's admission cr was 1.3 from a baseline of 0.5. this was most likely due to atn in setting of sepsis vs. pre-renal azotemia. patient received ivf and cr improved to 0.7 at discharge. # transaminitis: patient presented with elevated transaminases, which were most likely due to hypoperfusion in setting of sepsis. enzymes trended down. chronic issues: #hypertension: his diltiazem was stopped due to concern for contribution to constipation. blood pressure ranged 120s to 130s sytolic off medication. consider ace-i if noted to be hypertensive in future. # paranoid schizophrenia: he was continued on his home regimen. would discuss with psychiatrist at next encounter if these medications could be adjusted as may be contributing to constipation. # hx seizure d/o: no seizure activity during stay. continued on oxcarbazepine. # gerd: cont omeprazole # transaminitis: patient presented with elevated transaminases, which were most likely due to hypoperfusion in setting of sepsis. enzymes trended down. . transitional issues: recheck lft in weeks to ensure normalization if symptoms of systemic infection in the future consider pelvic hematoma as potential infectious source outpatient gi follow up for colonic dysmotility medications on admission: the preadmission medication list is accurate and complete. 1. acetaminophen 325 mg po q6h:prn pain or fever do not exceed 4 grams daily 2. albuterol 0.083% neb soln 1 neb ih q4h:prn wheeze or difficulty breathing call ho before administration if hr >100 3. citalopram 40 mg po daily 4. fluticasone-salmeterol diskus (250/50) 1 inh ih call ho before administration if hr > 100 5. olanzapine (disintegrating tablet) 5 mg po qhs 6. olanzapine (disintegrating tablet) 20 mg po qam 7. oxcarbazepine 600 mg po hs 8. polyethylene glycol 17 g po bid hold for diarrhea 9. docusate sodium (liquid) 100 mg po bid hold for diarrhea 10. milk of magnesia 30 ml po q12h hold for diarrhea 11. omeprazole 20 mg po daily 12. aspirin 81 mg po daily 13. diltiazem 30 mg po bid 14. psyllium 1 pkt po daily hold for diarrhea 15. tamsulosin 0.4 mg po hs hold for hypotension discharge medications: 1. albuterol 0.083% neb soln 1 neb ih q4h:prn wheeze or difficulty breathing call ho before administration if hr >100 2. aspirin 81 mg po daily 3. citalopram 40 mg po daily 4. fluticasone-salmeterol diskus (250/50) 1 inh ih call ho before administration if hr > 100 5. olanzapine (disintegrating tablet) 5 mg po qhs 6. olanzapine (disintegrating tablet) 20 mg po qam 7. oxcarbazepine 600 mg po hs 8. ipratropium bromide neb 1 neb ih q6h wheezing 9. acetaminophen 325 mg po q6h:prn pain or fever do not exceed 4 grams daily 10. docusate sodium (liquid) 100 mg po bid hold for diarrhea 11. milk of magnesia 30 ml po q12h hold for diarrhea 12. omeprazole 20 mg po daily 13. polyethylene glycol 17 g po bid hold for diarrhea 14. psyllium 1 pkt po daily hold for diarrhea 15. tamsulosin 0.4 mg po hs hold for hypotension 16. ciprofloxacin hcl 500 mg po q12h duration: 12 days 17. bisacodyl 10 mg pr hs:prn constipation 18. tap water enema prn daily if constipation discharge disposition: extended care facility: for the aged - macu discharge diagnosis: acute pyelonephritis sepsis e coli septicemia colonic pseudo-obstruction hypertension benign h/o stroke with late effects copd 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 are being treated for a serious infection called e coli bacteremia that resulted from a bacterial uti and pyelonephritis. you were given iv antibiotics then changed to an antibiotic you can take by mouth. you were treated for severe constipation and large bowel pseudo-obstruction. followup instructions: 1. please talk with psychiatrist about adjusting your psychiatric medication in context of constipation 2. please follow up with your gastroenterologist at for further management regarding your colonic dysmotility procedure: central venous catheter placement with guidance diagnoses: acidosis hypocalcemia acute kidney failure with lesion of tubular necrosis severe sepsis chronic airway obstruction, not elsewhere classified other specified intestinal obstruction constipation, unspecified other and unspecified hyperlipidemia septic shock late effects of cerebrovascular disease, hemiplegia affecting unspecified side epilepsy, unspecified, without mention of intractable epilepsy nontraumatic hematoma of soft tissue septicemia due to escherichia coli [e. coli] examination of participant in clinical trial congenital obstruction of ureterovesical junction benign essential hypertension acute pyelonephritis without lesion of renal medullary necrosis paranoid type schizophrenia, unspecified other functional disorders of intestine 

Answer: The patient is high likely exposed to