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 / sulfa (sulfonamides) attending: chief complaint: fever and ms change major surgical or invasive procedure: none. history of present illness: this is a 58yow with h/o end-stage multiple sclerosis, s/p total colectomy , transferred from with mental status change, tachycardia 140bpm, and t 102. she is non-verbal at baseline but communicates by head nod. on arrival to ed vitals 101.8, 139, 130/70, 22, 95%ra. initial lactate 3.0. she received 6l ns and lr in the ed and was treated with levofloxacin/vancomycin/metronidazole. she c/o abdominal pain that was sharp and constant (with prompting in questioning). she c/o nausea but denied vomiting. ct abdomen/pelvis showed no acute intraabdominal pathology. bp normalized with sbp 120s, and she was admitted to the floor. . soon after arrival to the medical floor her sbp dropped to 80s, hr 110s. she received additional 3l ns. abg 7.39/40/74 with lactate 0.8. she continued to c/o abdominal pain, pointing to pelvic region. blood pressure normalized 120s/70s, however, she became more tachycardic with hr 120s. she was transferred to the unit where she was treated with aztreonam for urosepsis. . on presentation she nods yes to abdominal pain, denies headache, chest pain, shortness of breath. past medical history: # multiple sclerosis, dx . her decline has only been in the past 18 months. she went from fully communicative before to nonverbal now. she was ambulating independently but started using a cane, then a walker, and is now bedbound. # s/p total colectomy + colostomy for "compaction and infection," (at and women hospital) # uti # depression/mood disorder # anxiety # hepatitis c # hepatitis b # optic neuritis # dysphagia . social history: lives at . friends in the community serves as her hcp family history: not known (patient nonverbal) physical exam: vitals: tm/c 99.3 hr 109 bp 91/61 sbp 91-113 rr 24 97%ra gen: anxious, grimacing at times during pe, nodding appropriately to yes/no questions skin: no rashes, + rle heel skin breakdown heent: perrl, anicteric, op clear, mmm neck: supple, no lad, jvp flat cv: tachy, regular, no mrg resp: ctab, no crackles, sl at bases, transmitted upper airway sounds abd: +bs, soft, + ttp suprapubically, no rebounding/guarding, g-tube, ileostomy bag ext: warm, well-perfused, contracted arms and legs, no edema, 1+ dp pulses b/l neuro: alert, appropriate, cn ii-xii intact, can move bue/ble with min arm movement and minimal toe wiggling, contracted with increased tone, 2+-3 b/l biceps reflexes. + pain with leg movement b/l (stable per nurse) pertinent results: 02:52am lactate-3.0* 03:00am plt count-473* 03:00am neuts-65.7 lymphs-26.1 monos-5.9 eos-0.2 basos-2.1* 03:00am wbc-17.2* rbc-4.62 hgb-15.1 hct-45.5 mcv-98 mch-32.7* mchc-33.2 rdw-13.3 03:00am lipase-18 03:00am alt(sgpt)-32 ast(sgot)-44* alk phos-72 amylase-59 tot bili-0.4 03:00am glucose-105 urea n-24* creat-0.4 sodium-140 potassium-5.0 chloride-102 total co2-25 anion gap-18 04:03am pt-11.8 ptt-24.7 inr(pt)-1.0 04:43am urine rbc-0 wbc-0-2 bacteria-many yeast-none epi->50 04:43am urine blood-tr nitrite-pos protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-8.0 leuk-mod 04:43am urine color-yellow appear-cloudy sp -1.013 06:51am urine mucous-few 06:51am urine 3phosphat-mod amorph-few 06:51am urine rbc-* wbc- bacteria-mod yeast-none epi-<1 renal epi- 06:51am urine blood-sm nitrite-pos protein-30 glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-9.0* leuk-mod 06:51am urine color-yellow appear-cloudy sp -1.028 09:15am neuts-58.7 lymphs-36.9 monos-3.6 eos-0.3 basos-0.5 09:15am wbc-11.9* rbc-3.46*# hgb-11.7*# hct-34.0*# mcv-98 mch-33.8* mchc-34.4 rdw-13.6 09:23am lactate-1.4 . cxr : right diaphragmatic elevation with bibasilar atelectasis. an underlying consolidation is not excluded, and dedicated pa and lateral chest x-ray is recommended. . cxr : unchanged from prior cxr : some right basilar atelectasis is demonstrated, but no definite new infiltrate is seen. fluid status is within normal limits and unchanged. cardiac silhouette is normal. . ct abd/pelvis: impression: 1. no evidence of acute inflammatory process within the abdomen or pelvis. status post total colectomy with right lower quadrant ileostomy. 2. bibasilar airspace disease, likely atelectasis. 3. left adrenal nodule, not completely characterized on this examination, further evaluation with dedicated adrenal ct or mri is recommended. 4. right hepatic hypodense lesion, too small to characterize. . le usn: no evidence of lower extremity deep vein thrombosis, bilaterally. . ruq usn: sludge and stones identified within the gallbladder. no evidence of cholecystitis or biliary dilatation. . abd/pelvic ct: 1. no significant change from study performed three days prior, with no new acute inflammatory process within the abdomen or pelvis identified. 2. small bilateral pleural effusions with associated segmental atelectasis, right greater than left. 3. nodular appearance of left adrenal gland again not completely characterized on this ct. 4. unchanged small hypoattenuating lesion within the liver. 5. tiny pulmonary nodule within the right lung. in the absence of malignancy, followup imaging within a year would be recommended to document stability. . abd xr:no evidence of obstruction or free intraperitoneal air. left basilar atelectasis. brief hospital course: this is a 58yo woman with end stage multiple sclerosis presenting with hypotension, tachycardia, fever, abdominal pain, and mental status change which was diagnosed as urosepsis who is s/p micu stay, now on meropenem. . 1. fever, hypotension, and ms change: the patient's fever, hypotension, and ms change were thought to be secondary to urosepsis given her + ua. she had an elevated lactate on admission and quickly became hypotensive. she was transferred to the micu, fluid resuscitated, and continued on levofloxacin/vancomycin/metronidazole which was then changed to aztreonam given her allergy history when her ua came back positive for proteus. a cxr was obtained and was concerning for pneumonia vs atelectasis. however, given no h/o cough, sputum production, chest pain, or sob, or oxygen requirement, this finding was attributed to atelectasis. the ddx also included adrenal insufficiency since patient likely treated with steroids for ms flares, and autonomic disregulation given h/o central neurologic degenerative disease. a cortisol stimulation test was preformed with a bump in cortisol level of only 6. however, at this point the patient's hypotension had improved while on empiric antibiotics. urine and blood cx were negative. the patient was hemodynamically stable with decreasing leukocytosis and was transferred to the floor. she spiked with a bump in her wbc ct and her coverage was broadened to meropenem and vancomycin. she subsequently defervesced and her leukocytosis resolved. she remained afebrile for > 48 hrs and vanco was discontinued. she remained afebrile for an additional 48 hrs and the patient was deemed well enough to be discharged on an additional 7 day course of iv meropenem. the picc line is ready to use and may be pulled after completion of her 7 day course of meropenem. . 2. tachycardia: the patient remianed in sinus tachycardia througout the duration of her hospitalization. the differential included anxiety, pain, resolving hypotension/infection, and pe. given the patients abd pain, pain seemed a plausible etiology. lenis were obtained which were neg for pe and the pt did not have an o2 requirement. her tachycardia improved during the duration of her hospitalization. . 3. abd pain: the patient complained of persistent abdominal pain throughout the course of her hospitalization. she had two ct of abd/pelvis which were negative for obstruction, colitis, pancreatitis, or abcess. her lfts were unremarkable. she was stooling well through her ostomy. c diff was negative x 2. as the patient had some skin breakdown around her ostomy site, this was proposed to be the cause of her pain. she was also started on reglan with the thought that gastric motility may have been affected, causing her abdominal pain and nausea. also, the epigastric location of her pain makes pud a possible etiology. her ppi was increased to and her abdominal pain resolved despite continued ttp upon exam. . 4. ms: the patient has end stage ms. she was continued on copaxone and baclofen per her outpt regimen. medications on admission: amitrytyline 50mg hs calcium vitamin d fluticasone 50mcg 2 sprays daily mvi valproic acid 250mg/5ml syrup, 13ml colace 100 neurontin 300 tid metoprolol 12.5 tid tylenol 650 q6 baclofen 5 qhs oxycodone 5 q6h prn prilosec 20mg daily copaxone 20mg sc daily discharge medications: 1. amitriptyline 50 mg tablet sig: one (1) tablet po hs (at bedtime). 2. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 3. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 4. fluticasone 50 mcg/actuation aerosol, spray sig: two (2) spray nasal daily (daily). 5. therapeutic multivitamin liquid sig: one (1) cap po daily (daily). 6. valproate sodium 250 mg/5 ml syrup sig: thirteen (13) ml po q12h (every 12 hours). 7. docusate sodium 50 mg/5 ml liquid sig: one hundred (100) mg po bid (2 times a day). 8. gabapentin 250 mg/5 ml solution sig: three hundred (300) mg po tid (3 times a day). 9. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). 10. acetaminophen 325 mg tablet sig: two (2) tablet po every six (6) hours. 11. baclofen 10 mg tablet sig: 0.5 tablet po qhs (once a day (at bedtime)). 12. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 13. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 14. glatiramer 20 mg kit sig: one (1) kit subcutaneous daily (daily). 15. meropenem 500 mg recon soln sig: five hundred (500) mg intravenous every six (6) hours for 7 days. 16. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). discharge disposition: extended care facility: - discharge diagnosis: urosepsis discharge condition: improved. bp stable and pt afebrile. discharge instructions: please return to the er or call your pcp if you experience increasing temperatures, change in mental status, or any other symptoms that are of concern. followup instructions: please follow up with your pcp . upon discharge. procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances replacement of tube or enterostomy device of small intestine diagnoses: acidosis urinary tract infection, site not specified intestinal bypass or anastomosis status severe sepsis unspecified viral hepatitis c without hepatic coma other septicemia due to gram-negative organisms multiple sclerosis aphasia abdominal pain, epigastric viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta colostomy status optic neuritis, unspecified bed confinement status 

Answer: The patient is high likely exposed to