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: codeine attending: chief complaint: pneumonia, altered mental status, e.coli urosepsis major surgical or invasive procedure: intubation and mechanical ventilation history of present illness: ms. is a 61 woman with urosepsis and altered mental status transferred from hospital in . . per notes, the patient presented complaining of weeks of not feeling well. her family states that over the last 2 days she developed increasing confusion and difficulty breathing. she did not take any meds for 2 days because she was at her father's funeral in ri. upon evaluation, she was found to have hypoxia, a right middle lobe infiltrate, and 48 bands. ceftriaxone and ciprofloxacin were administered. she grew pansensitive e.coli from her blood and urine. during her course, she developed delerium that was evaluated with a head ct and lp, which were both reported as normal. . transferred to for treatment and investigation of delerium and respiratory alkalosis. en route, she was intubated by med flight and an og tube was placed. past medical history: 1. fibromyalgia. 2. iddm. 3. hypercholesterolemia. 4. left bundle branch block. 5. tachycardia. 6. peptic ulcer disease. 7. status post hernia repair. 8. status post cesarean section. 9. status post tah. 10. status post bilateral knee replacement. 11. h/o asthma with intubations social history: married with supportive children. no tobacco or alcohol. quit tobacco 12 years ago. family history: unable to obtain physical exam: (initial presentation to ) t 104.4 bp 160/69 hr 120 98% on fio2 60% gen: intubated and sedated heent: et tube in place neck: large cor: tachy, regular pulm: rhonchi bilaterally abd: obese, distended, soft ext: hot with dp 2+ bilaterally . micro from osh: pansensitive e.coli from aerobic and anaerobic bottles. urine with >100,000 colonies pansensitive e.coli. csf without growth. csf: glucose 56 and protein 28, 3 wbcs 157 rbcs abd ct: perinephric fat stranding . ekg: sinus tach, q iii, f, late r wave progression, left axis deviation, normal intervals. pertinent results: 04:10pm blood tsh-4.8* 09:31pm blood type-art temp-38.7 rates-14/4 tidal v-519 peep-5 fio2-100 po2-167* pco2-48* ph-7.26* caltco2-23 base xs--5 aado2-529 req o2-85 intubat-intubated 03:37am blood asa-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-pos 10:26pm blood caltibc-239* ferritn-395* trf-184* 10:26pm blood ck-mb-2 ctropnt-0.01 04:39am blood ck-mb-2 ctropnt-<0.01 03:46pm blood ck-mb-4 ctropnt-<0.01 09:27pm blood ck-mb-2 10:26pm blood alt-26 ast-23 ld(ldh)-308* ck(cpk)-41 alkphos-327* totbili-1.0 05:00am blood alt-13 ast-14 alkphos-254* amylase-59 totbili-0.7 10:26pm blood glucose-201* urean-38* creat-1.2* na-146* k-4.6 cl-111* hco3-20* angap-20 07:15am blood glucose-193* urean-22* creat-1.0 na-139 k-3.6 cl-106 hco3-22 angap-15 06:00am blood urean-25* creat-1.4* na-143 k-3.3 cl-107 hco3-20* angap-19 04:00am blood neuts-73* bands-9* lymphs-12* monos-3 eos-3 baso-0 atyps-0 metas-0 myelos-0 10:26pm blood wbc-9.4# rbc-4.33 hgb-11.5* hct-33.3* mcv-77* mch-26.5* mchc-34.5 rdw-16.4* plt ct-264 06:00am blood wbc-9.3 rbc-3.81* hgb-10.2* hct-30.2* mcv-79* mch-26.8* mchc-33.9 rdw-17.2* plt ct-363 11:39am urine bnzodzp-pos barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg . mri brain the posterior fossa structures are unremarkable. there are several small areas of increased signal intensity on the flair images and bilateral cerebral white matter, which are nonspecific but could most likely represent chronic microvascular disease. no abnormality is noted on the diffusion-weighted images to suggest acute infarcts. the ventricles and extra-axial csf spaces are unremarkable. there is mild smooth enhancement of the pachymeninges diffusely, is likely benign, related to the recent lumbar puncture procedure and is unlikely to explain the patient's presentation. there is no leptomeningeal enhancement. the osseous and the soft tissues structures and visualized portions of the paranasal sinuses and the orbits are unremarkable. . mr angiogram of the circle of : bilateral cavernous ica and mca are patent and normal in caliber. the a1 segment of right aca is not visualized. bilateral a2 segments are supplied by single left aca which is tortuous in course. visualized segments of bilateral distal vertebral arteries are unremarkable. the basilar artery has an irregular contour, likely due to atherosclerosis. right fetal equivalent pca is noted; left pca appears normal. . impression: 1. no acute infarcts. 2. chronic microvascular disease. 3. benign appearing pachymeningeal enhancement, most likely related to the recent lp and unlikely to explain the patient's presentation. 4. no leptomeningeal enhancement. 5. absent a1; bilateral a2 segments supplied by single left aca; fetal equivalent of right pca. . cxr one supine portable view. comparison with . lung volumes are somewhat low. there has ill-defined increased density at the right base and in the retrocardiac area. the cardiac silhouette is prominent but may be exaggerated by portable technique. mediastinal structures are otherwise unremarkable. an endotracheal tube has been inserted and ends at the thoracic inlet. a nasogastric tube has been inserted and terminates below the diaphragm, off of the bottom of the image. . renal u/s: renal ultrasound: . the right kidney measures 10.6 cm. the left kidney measures 14.5 cm. there is no evidence of hydronephrosis or stones bilaterally. within the mid pole of the left kidney, there is a focal area of soft tissue that appears isoechoic to the cortex and extending into the renal hilum. this does demonstrate some heterogeneous echoes. given history of concern for pyelonephritis and/or abscess, abscess cannot be entirely excluded on this study. note should be made that prior ct and ultrasounds too demonstrate a similar extension of cortical-appearing tissue into this region; however, today these findings appear more prominent and more heterogeneous. the urinary bladder is catheterized. . impression: predominantly isoechoic 3.4 x 2.8 x 2.9 cm area within the left renal hilum in the mid pole which appears to be present to a partial degree on prior ct and ultrasounds from and respectively. no vascular flow is visualized within this area. although not typical of abscess appearance, abscess cannot be ruled out. another possibility includes growth of a soft tissue mass. recommend followup ct with contrast for better evaluation. . eeg: impression: this is an abnormal eeg in the waking and drowsy states, due to the bursts of generalized delta slowing and slow background activity. these abnormalities suggests an encephalopathy, which may be secondary to infections, medications, toxic metabolic abnormalities or ischemia. there were no eeg changes associated with the right hand tremors. . ct abdomen pelvis: ct abdomen with iv contrast: there is bibasilar atelectasis. the liver, gallbladder, pancreas, spleen, adrenal glands, and right kidney are unremarkable. the left kidney is slightly enlarged diffusely and heterogeneous in appearance with some perinephric stranding similar to prior study from . noted on today's contrast-enhanced exam is heterogeneous enhancement as well as a focal area of both enhancement and mass effect measuring 5.8 x 4.4 cm within the mid portion anteriorly. there is no definite fluid collection present. these findings are very suspicious for renal neoplasm. however, this could represent focal superimposed area of phlegmonous tissue. there is no evidence of hydronephrosis or hydroureter. the small and large bowel are unremarkable. there is no free fluid or free air. there is no retroperitoneal or mesenteric lymphadenopathy. diffuse aortic and iliac artery calcifications. the urinary bladder is catheterized contains a small of contrast. . 1. heterogeneous enhancement of the left kidney with focal 4.4 x 5.8 cm area of increased heterogeneity within the mid pole. these findings are concerning for renal neopasm. ddx includes diffuse pyelonephritis with underlying phlegmonous change. there is no specific fluid collection present. there is some surrounding perinephric stranding. there is no hydronephrosis or hydroureter. . cxr : mild pulmonary edema has cleared since . heart size is now normal, and the lungs are essentially clear. no pleural effusion. a left subclavian and a right picc catheter both end at the junction of the brachiocephalic veins. no pleural effusion. . cta 1. no evidence for pe. 2. atelectasis in both lower lobes. patchy opacities in the left lower lobe may also represents atelectasis, however, infection cannot be excluded. 3. 1.5 cm lesion in the atelectatic right lower lobe with eccentric calcifications. this may represent an infectious focus, however an underlying mass cannot be excluded and follow-up is necessary to document complete resolution. 4. calcified granuloma in the right upper lobe. . echo no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. a patent foramen ovale is present with slight left-to-right shunt across the interatrial septum at rest. there are probably complex nonmobile atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. biventricullar systolic function appears normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve. there is no pericardial effusion. normal ef. . mri abdomen: the right kidney measures approximately 12.5 cm in size. the left kidney is enlarged, measuring approximately 14.5 cm in size. the degree of cortical- medullary differentiation seen in the left kidney is decreased when compared to the right. in addition, the left kidney shows a diffusely heterogeneous signal intensity when compared to the right. regions of wedge-shaped signal abnormalities are seen extending to the periphery of the kidney in multiple locations, showing both areas which are of greater t2 signal than the background parenchyma, as well as others which appear somewhat decreased in signal. some of these lesions are hypoperfusing after the administration of iv gadolinium when compared to the background renal parenchyma. there is no evidence of frank abscess or drainable collection of the left kidney. minimal left-sided perinephric fat stranding remains present. there is no evidence of hydronephrosis. within the limits of this motion degraded examination, no mass lesion is identified within the left kidney. . impression: 1. markedly motion-limited. 2. diffusely enlarged left kidney, with regions of wedge-shaped signal intensity abnormalities extending to the periphery of the kidneys. these findings may be consistent with pyelonephritis, and the differential diagnosis also includes bland versus septic embolic disease. 3. no evidence of drainable abscess. 4. within the limits of this examination, no mass lesion is identified. however, greater sensitivity for detection of mass can be obtained if a mri is performed when the patient is able to cooperate and performed multiple breath holds. . brief hospital course: pt initially was transferred to on with urosepsis. she had presented to osh on with 2-3 weeks of not feeling well. was found to be hypoxic, have a rml infiltrate, and 48% bandemia. she was given ceftriaxone and ciprofloxacin; ucx and blcx grew pansensitive e coli. pt developed delirium as well, and head ct and lp were reportedly normal. she was transferred to for delirium and respiratory alkalosis, and was intubated en route. . her hospital course was notable for continued fevers after 5 days of antibiotics, which was concerning given that her cultures had shown pansensitive e coli. a renal u/s to look for perinephric abscess did show a l renal mass of unclear etiology. no urology felt likely not an abscess, mri obtained which ruled out abscess. pt developed hospital-acquired pna while in the icu and was treated with vanco/cipro. she required reintubation twice, first for the need to get further radiologic tests and her inability to handle these secondary to delirium (reintubated on ); extubated , then reintubated a second time for tachypnea, with new lll pna on cxr, thought likely to be a vap. 3 week course of abx for urosepsis completed (meropenem/cipro), and 7 days of vanco for hospital-acquired pna. in addition, tee on negative for endocarditis. . in terms of mental status, pt had been delirious at osh and continued to have delirium here. neuro followed the patient as well, and toxic-metabolic etiologies were thought most likely causing her delirium. mri brain was unrevealing, eeg c/w moderate encephalopathy, repeat ct scan without new defects (chronic microvascular disease noted). delerium improved rapidly during the remained of her stay. . other outstanding medical issues: #left renal abnormality nos: f/u mri and urology appointments have been made for the patient in . . #renal insufficiency, likely med related: the few days prior to discharge the patient had a mild bump in her cr (1.0-1.4). this needs to be followed closely at rehab. perhaps secondary to increased dose of (was on 160 qd at home; increased to 160 in house). ua unremarkable; fena 3%; urine eos mildly positive. ?ain? her metformin should be held at this time. rehab facility instructed to follow cr closely over next few days. . #1.5 cm atelectatic lung lesion: ct of the chest demonstrated a right lower lobe 1.5 cm nodule with eccentric calcifications that did not enhance with iv contrast. per , f/u is needed to ensure resolution (thought to be infectious at the time). . #anxiety: pt restarted on ativan (was taking prior to admission) for anxiety while in house. this can be titrated prn during her rehab stay. medications on admission: lipitor 20 mg qd lyrica 50 tid albuterol 2 puffs qid norvasc 10 mg qd ranitidine 300 hs premarin 0.625 qd ibuprofen 800 mg tid diovan 160/25 qd amitryptiline 100 hs starlix 120 tid metformin 850 tid zetia 10 qd accolate 20 actose 30 qd paroxetine 30 qd nasonex ativan discharge medications: 1. nateglinide 60 mg tablet sig: two (2) tablet po tidac (3 times a day (before meals)). 2. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 4. pioglitazone 15 mg tablet sig: two (2) tablet po daily (daily). 5. lyrica 50 mg capsule sig: one (1) capsule po three times a day. 6. albuterol 90 mcg/actuation aerosol sig: one (1) inhalation inhalation every 4-6 hours as needed for shortness of breath or wheezing. 7. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 8. zantac 300 mg tablet sig: one (1) tablet po at bedtime. 9. zetia 10 mg tablet sig: one (1) tablet po once a day. 10. zafirlukast 20 mg tablet sig: one (1) tablet po twice a day. 11. paxil 30 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 12. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). disp:*1 inhaler* refills:*2* 13. lorazepam 0.5 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. tablet(s) 14. insulin regular insulin sliding scale discharge disposition: extended care facility: rehabilitation discharge diagnosis: primary diagnoses 1. ventilator associated pnuemonia 2. uti 3. e. coli bacteremia, urosepsis 4. delerium, resolving 5. left renal abnormality nos 6. renal insufficiency, likely med related 7. 1.5 cm atelectatic lung lesion, f/u needed secondary diagnoses: dm, type 2 h/o asthma requiring intubations fibromyalgia hypercholesterolemia lbbb pud s/p hernia repair, c section, tah discharge condition: stable discharge instructions: please contact your primary care provider should you have any fevers, chills, night sweats, abdominal pain, night sweats, burning with urination, or any other serious complaints. it is very important to speak with dr. about obtaining a f/u ct scan of your lungs are there was an abnormality that needs to be followed up on. in addition, you have a follow up mri scan of your kidneys as well as a urology appointment in . followup instructions: provider: , md phone: date/time: 1:00 provider: mri phone: date/time: 9:20 (do not eat for 4 hours before the test) . please make an appointment to see your primary care doctor within 1-2 weeks. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more diagnostic ultrasound of heart insertion of endotracheal tube insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: pneumonia, organism unspecified toxic encephalopathy unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified severe sepsis candidiasis of other urogenital sites asthma, unspecified type, unspecified chronic kidney disease, unspecified acute respiratory failure long-term (current) use of insulin septic shock iron deficiency anemia, unspecified septicemia due to escherichia coli [e. coli] knee joint replacement myalgia and myositis, unspecified nonspecific (abnormal) findings on radiological and other examination of genitourinary organs acute pyelonephritis without lesion of renal medullary necrosis 

Answer: The patient is high likely exposed to