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: atorvastatin attending: chief complaint: weight gain and shortness of breath major surgical or invasive procedure: none history of present illness: ms. is a 60 y/o female with htn, cad, copd, dm and hl who presented to following increased weight gain and sob. she explains that she has gained some 28 lbs since . she was first diagnosed with chf in . she endorses pnd, orthopnea and sleeps elevated in a hospital bed on 2 or more pillows. she has significant doe and she can only walk about 25 feet with her wheeled walker before she gets sob. she also endorses palpitations and rare chest pain "when she gets upset." she denies fevers, chills, nasea, vomiting, cough, hemoptysis or changes in bowels. her last bm was 2 days ago. . she was transferred to for cardiac cath. cath showed elevated right and left heart cath, wedge of 35. cuff pressures 30-40 mm hg less than central pressures. no intervention. she was then transferred to the floor. . on the floor she feels tired and thirsty. past medical history: 1. cardiac risk factors: + diabetes, + dyslipidemia, + hypertension 2. cardiac history: -cabg: none -percutaneous coronary interventions: stemi bms to lad -pacing/icd: none 3. other past medical history: # cad - nstemi and stemi () # hypertension # hyperlipidemia # diabetes mellitus # pad # aaa # diverticulosis # a fib on coumadin # cholecystitis # pneumococall meningitis in # nasal polyps # hidradenitis suppurativa # hypothyroidism # anemia # congestive heart failure with echo on showing ef of 40-45% with mr, tr and pr. social history: -tobacco history: smokes 1 ppd for 40 years -etoh: rare -illicit drugs: none family history: she has extensive history for cad with father and three brothers with known cad; otherwise non-contributory. physical exam: admission physical examination: vs: 96.4, 109/63, 104, 18, 100% 4l general: sleeping. nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. mmm. neck: supple. unable to assess jvp given body habitus. cardiac: very distant heart sounds. sounded rrr w/o mrg. lungs: very distant lung sounds with bibasilar crackles. no wheezes. abdomen: soft, ntnd. no hsm or tenderness. abd aorta not enlarged by palpation. c-section scar noted. extremities: + pitting edema in b/l le's pulses: right: carotid 2+ brachial 2+ radial/dp/pt's all non palpable left: carotid 2+ brachial 2+ radial/dp/pt's all non palpable . discharge physical examination: vitals - tm 97.7/tc97.4; hr 77; bp 130/99 (84-130/49-99) rr: 20 02 sat: 100% 2l in/out: 24h: (-3800cc); 8h (-980cc) weight: 114kg (130kg on admission) fs: 150 gen: obese, nad,. drowsy this am, sleeping comfortably, cv: very distant heart sounds, irregularly irregular, no murmurs appreciated lungs: ctab abd: bs+, obese, edematous, soft, non-tender, non-distended. extr: 2+ edema in lower extremities below knees, 3+ above knees. 2+ b/l radial pulses, pulses found by doppler in b/l le??????s. ulcers on heals are clean and appear to be healing. peripheral vascular: (right radial pulse: 2+), (left radial pulse: 2+), (right dp pulse: + by doppler), (left dp pulse: + by doppler) skin: no rashes. small circular lesions on bilateral hands. some excoriations on bilateral lower extremities, wrapped in bandages neurologic: drowsy this am, hard to arouse, consistent with prior mornings pertinent results: admission labs: 07:30am blood wbc-11.0 rbc-3.90* hgb-10.1* hct-32.5* mcv-83 mch-25.8* mchc-30.9* rdw-19.2* plt ct-289 07:30am blood plt ct-289 12:35pm blood ptt-120.9* 07:30am blood glucose-81 urean-67* creat-1.8* na-132* k-6.3* cl-93* hco3-29 angap-16 12:35pm blood glucose-pnd urean-pnd creat-pnd na-130* k-6.9* cl-92* hco3-pnd 07:30am blood calcium-9.2 phos-5.4*# mg-3.1* 12:55pm urine color-dkamb appear-cloudy sp -1.022 12:55pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-tr bilirub-neg urobiln-2* ph-5.5 leuks-lg 12:55pm urine rbc->182* wbc->182* bacteri-many yeast-none epi-0 . discharge labs 05:55am blood wbc-7.5 rbc-3.47* hgb-8.7* hct-30.9* mcv-89 mch-25.0* mchc-28.1* rdw-18.1* plt ct-193 05:55am blood glucose-107* urean-66* creat-1.6* na-134 k-4.0 cl-88* hco3-38* angap-12 02:33pm blood caltibc-416 vitb12-1116* folate-11.3 ferritn-51 trf-320 reports: cardiac cath final diagnosis: 1. two vessel coronary artery disease. 2. severely elevated left- and right-sided filling pressures. 3. severe pulmonary hypertension. echo conclusions: very poor image quality. the left ventricle is not well seen. there is no pericardial effusion. . microbiology: 12:55 pm urine source: catheter. **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. of two colonial morphologies. presumptive identification. piperacillin/tazobactam sensitivity testing available on request. ampicillin on request only. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s brief hospital course: 60 yo f with hx of cad, chf (ef 40-45%), dm, htn, hl, copd presenting with major chf exacerbation, at least 50lbs up, and hypotension. . # acute on chronic sytolic and diastolic congestive heart failure: patient presented with sob, pnd, orthopnea, crackles on exam, le edema. most recent echo per report showed ef or 40-45% per report. cath showed co 3.5 l/min. of note, her cuff systolic bp's are 40 points lower than central bp measured in cath lab. initially diuresed with lasix drip on the floor, but this was complicated by hypotension to sbp of 40. this value is of unclear significance, given it was a cuff pressure and may have been 40 points higher. she was transferred to the ccu for diuresis with central bp monitoring. she was briefly on dopamine but this was promptly stopped once it became clear that a sbp of 80's is normal for her. she was diuresed a total of ~35l negative during admission, using a combination of lasix, acetazolamide, and metolazone. she was also anemic (see below), and was transfused 2 units prbcs, which likely helped mobilize fluid. her edema is improved, but still has 2+ pitting edema up to her waist. she has a ways to go for her diuresis but is now on a stable regimen of lasix 80gm iv bid and spironolactone 25mg po daily. she should have her electrolytes checked twice daily while she is being diuresed by iv doses (has a picc line in). not currently on an acei as has been having problems with hypotension but should be started after diuresis is finished. should be on a heart healthy, 2g sodium, 1.5l fluid restricted, diabetic diet. . # hypotension: pt has extensive peripheral arterial disease, and as such her systolic blood pressure measured with a cuff is abotu 40mmhg lower than that measured centrally in the cardaic cath lab. systolic blood pressures in the 70's are tolerable for her because of this. . # hypokalemia: pt has been persistently hypokalemic during diuresis, and is now on potassium 40meq po tid. she should have her electrolytes checked while diuresing. of note, she was hyperkalemic on admission. she was put on spironolactone to help maintain a normal k+, increase diuresis, and to help treat her chf. potassium should continue to be checked daily at her rehab facility. . # coronary artery disease: as evidenced by prior stemi and nstemi. patient had elevated troponins at osh but unclear if this is nstemi or . ck-mb flat. cath showed occluded r, newly occluded lad since stent (no intervention done) collateralized from diag and circ. asa was decreased to 81mg po daily (from 325), plavix 75 mg daily continued, metoprolol tartrate changed to 12.5mg (from 50 ) hypotension, continued pravastatin 80mg daily. . # atrial fibrillation: remained in a-fib throughout admissiion. metoprolol mostly held hypotension, with rates remaining in the 70's-80's. now on metoprolol 25mg xl for rate control (changed from 50 ). on coumadin at home, was held for most of admission anemia with gi bleed (see below). restarted on , at lower than home dose at present. . # anemia: hct dropped to 22.1 at low point, baseline in high 20's. she had some blood-tinged sputum and melena, in the setting of wretching likely secondary to congestion. she was transfused 2 units prbcs without incidence, and hct remained stable in the low 30's. coumadin was restarted on , she continues on plavix 75mg daily, and asa was decreased to 81mg from 325mg daily. . # metabolic alkalosis: diuresis. should continue to improve as euvolemia is achieved and diuresis can be scaled back. . # acute kidney injury: likely vascular congestion and poor forward flow, exacerbated by intravascular volume depletion diuresis. baseline is cr 1.2-1.3, she went up to cr 2.2 at one point, and has now been trending back down to cr 1.7. . # chronic obstructive pulmonary disease: no evidence of exacerbation at this time. no wheezes on exam. pt continued on albuterol and ipratropium nebs and o2 as needed. . # diabetes mellitus: pt was on 74 units glargine qpm, had some issues with hypoglycemia so now on 30 units glargine. fbs running in high 100's. . transitional issues: 1. please make appt with dr. (outpt cardiologist) upon discharge 2. new appt with dr , heart failure specialist at 3. assess fluid status and change iv lasix to po once pt appears dry, dr. can assist with heart failure management 4. start lisinopril for afterload reduction as bp allows 5. uptitrate glargine as needed per fingersticks 6. pt will need intensive teaching regarding chf management at home 7. check lytes regularly while on iv lasix medications on admission: medications (admission meds): # o2 3-4l # tylenol 650 mg q 4 prn # mucomyst 20% 600 mg # aspirin 325 mg daily # vitamin d3 800 units daily # plavix 75 mg daily # colace 100 mg # lasix 40 mg iv daily (held recently) # ssi novolog # levemir insulin 74 units subq at bedtime # xopenex 1.25 mg inhalation q 6 hours prn # synthroid 75 mcg daily # lopressor 25 mg # niacin 500 mg qhs # nicotine patch 21 mg topically daily # nitrostat 0.4 mg sl q5 mins up to 3 doses # percocet 1 tab po q 4 as needed # senna 1 tab po at bedtime # silver gel topically # pravastatin 80 mg qhs # ocean nasal spray q4 hours as needed # spiriva 1 puff daily # coumadin (held recently) # heparin gtt discharge medications: 1. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for back pain. 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po once a day. 4. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. insulin lispro 100 unit/ml solution sig: 0-12 units subcutaneous four times a day: as per sliding scale. 8. insulin glargine 100 unit/ml solution sig: thirty (30) units subcutaneous at bedtime. 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) vial inhalation q6h (every 6 hours) as needed for wheeze. 10. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 11. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day: hold sbp <90, hr<55. 12. niacin 500 mg capsule, extended release sig: one (1) capsule, extended release po at bedtime. 13. nitroglycerin 0.4 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 15. pravastatin 80 mg tablet sig: one (1) tablet po once a day. 16. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po daily (daily). 17. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for fungal infection for 3 days. 18. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 19. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 20. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily) as needed for heartburn . 21. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 22. furosemide 10 mg/ml solution sig: eight (8) ml injection twice a day: 80 mg total . 23. warfarin 1 mg tablet sig: three (3) tablet po once daily at 4 pm. discharge disposition: extended care facility: - discharge diagnosis: acute on chronic congestive heart failure acute on chronic kidney injury coronary artery disease atrial fibrillation on warfarin chronic obstructive pulmonary disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , you were admitted to the hospital with worsening of your congestive heart failure. you were initially admitted to the floor where we started you on iv lasix. because your blood pressures dropped when we started this medication we transferred you a floor where they could watch you more closely. we have adjusted your medicines to help your heart work better and get rid of extra fluid. you were anemic and received a blood transfusion. the following changes were made to your medications: 1. discontinue mucomyst, xopenex, nicotine patch 2. decrease glargine to 30 units at night 3. decrease aspirin to 81 mg daily 4. decrease metoprolol to 25 mg once daily 5. start miralax for constipation 6. start miconazole powder for your rash 7. start iron for your anemia 8. start pantoprazole and ranitidine as needed for your heartburn 9. start spironolactone to help with your heart failure 10. increase the lasix to 80 mg iv twice daily 11. decrease your warfarin to 3mg daily thank you for letting us participate in your care. we wish you a speedy recovery. followup instructions: please make an appt with dr when pt is discharged. . department: cardiac services when: monday at 1:30 pm with: dr. building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnoses: other iatrogenic hypotension coronary atherosclerosis of native coronary artery tobacco use disorder urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other chronic pulmonary heart diseases percutaneous transluminal coronary angioplasty status hypopotassemia other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) alkalosis long-term (current) use of insulin blood in stool old myocardial infarction long-term (current) use of anticoagulants abdominal aneurysm without mention of rupture hypovolemia other atherosclerosis of native arteries of the extremities ulcer of other part of lower limb acute on chronic combined systolic and diastolic heart failure other diuretics causing adverse effects in therapeutic use other and unspecified escherichia coli [e. coli] 

Answer: The patient is high likely exposed to