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: no known allergies / adverse drug reactions attending: chief complaint: hypotension major surgical or invasive procedure: -foley catheter and 3-way continuous bladder irrigation -triple lumen central venous catheter. history of present illness: 83m with h/o prostate cancer s/p radiation c/b radiation proctitis 8 years ago. biba from alf w/hypotension and lightheadedness with confusion and disorientation this morning per alf. recent hospitalization () for hematuria. positive ua for pseudomonas with no treatment at that time. foley placement recurrent hematuria. started on cipro for pseudomonal uti . pt endorses fatigue and chills but no cp, sob, abdom pain, hematochezia, prior uti, fever. . ems noted bp to be 69/33 in the ed inital vitals were 99.6 77 104/44 18 100%ra. despite triage vs, sbp remained in 80s. he was intermittently fluid responsive to 4l. r ij placed without difficulty, confirmed on cxr. initial lactate 3.5, repeat 2.1. bedside ultrasound showed plump ij. cxr with no clear infiltrate. empirically given vanc/zosyn, when ua returned positive, given cipro iv as well. initially ordered for ct torso d/t lack of source, but now with positive ua so ct cancelled. took only sips of po contrast. trop 0.02 with no prior, given asa 81mg x4. ekg showed partial rbbb, no st changes, no priors. vs at transfer: 98 84 121/44 21 95% 2l nc. . upon arrival to the icu, pt. denies fevers or chills, reports no dysuria, abdominal pain, or cp/sob. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. past medical history: prostate ca s/p xrt chf cad s/p ptca aaa s/p repair ischemic cardiomyopathy gerd hl htn parkinson's disease spinal stenosis h/o gib essential tremor cri, baseline cr 1.1-1.3 (nh says 1.5, but most recent value in epic is from and was 1.1) past surgical history: coronary artery angioplasty left total knee replacement right total hip replacement left and right knee arthroscopy s/p turp esophageal dilatation s/p aaa repair s/p ivc filter social history: he is widowed, five children. he is a retired contractor. he has 80-pack-year smoking history and smoked 30 cigars per day for two years. no drug use. he is wheelchair bound secondary to his knees. he is able to transfer himself, but not walk. lives at rehab. he denies any history of illicit drug use. he drinks rarely with maximally 2 drinks per occasion. family history: mother- physical exam: admission physical exam: vitals: t 97.6 hr: 81 bp: 138/60 rr:11 o2: 97% general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, slight wheezes. no rales, rhonchi. cv: regular rate and rhythm, normal s1 + s2, ejection murmur 2-3/6, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, large liver appreciated on exam. gu: 3-way 20 gauge foley draining yellow urine, erythematous edematous scrotum with testicular tenderness limiting exam ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . discharge physical exam: vs: tm afebrile hr 60s-70s bp 130-150s/60-70s rr 18 sao2 96-98% ra i/o: incontinent but voiding after foley removal general: nad uncomfortable eyes: anicteric perrl ent: mmm oropharynx clear hard of hearing neck: no lad jvp: cvs: rrr w ectopic beats nl s1 s2 no mrg no edema. 3/6 sem rusb lungs: no rales no wheeze comfortable. diffuse expiratory wheeze. excellent aeration. abdomen: soft nontender bowel sounds present no hepatosplenomegaly skin: no rashes warm dry decubitus ulcers: gu: l scrotum erythematous but reduced from yesterday with reduced edema. not warm to touch and non-tender to palpation. lymph: no cervical lad no axillary lad no inguinal lad neuro: oriented x3 fluent speech. mild resting tremor of the hands and arms bilaterally psych: alert calm mood/affect: appropriate pertinent results: admission labs: 10:40am blood wbc-31.3*# rbc-3.36* hgb-9.9* hct-28.3* mcv-84 mch-29.4 mchc-34.9 rdw-15.3 plt ct-206 10:40am blood neuts-81* bands-13* lymphs-2* monos-4 eos-0 baso-0 atyps-0 metas-0 myelos-0 10:40am blood hypochr-normal anisocy-normal poiklo-normal macrocy-normal microcy-normal polychr-normal 01:03pm blood pt-14.6* ptt-26.6 inr(pt)-1.3* 10:40am blood glucose-95 urean-39* creat-2.1* na-138 k-3.6 cl-99 hco3-25 angap-18 10:40am blood alt-13 ast-27 ck(cpk)-457* alkphos-77 totbili-1.3 10:40am blood lipase-8 10:40am blood ctropnt-0.02* 10:40am blood ck-mb-3 10:40am blood calcium-8.1* phos-2.9 mg-1.7 10:40am blood crp-196.4* 10:40am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 10:57am blood lactate-3.5* 12:59pm blood lactate-2.1* 01:25pm urine color-yellow appear-hazy sp -1.020 01:25pm urine blood-mod nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-lg 01:25pm urine rbc-25* wbc->182* bacteri-few yeast-none epi-0 transe-1 01:25pm urine wbc clm-few mucous-rare 10:40am urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-pnd mthdone-neg 10:57am urine amphetamines, gc/ms-pnd relevant studies: imaging: -cxr () impression: stable small left-sided pleural effusion with associated atelectasis. no definite focal consolidation is seen. -tte () the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 5-10 mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity size is top normal/borderline dilated. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. scrotal us: impression: 1. multiseptated fluid surrounding the left testis and epididymis. the left epididymis appears thickened in comparison with the contralateral side and there is increased blood flow in the left epididymis and testis. 2. findings are suggestive of a left-sided epididymo orchitis. 3. no concerning mass lesions. small epididymal head cysts as described. discharge labs: 06:20am blood wbc-17.1* rbc-3.20* hgb-8.7* hct-28.1* mcv-88 mch-27.1 mchc-30.9* rdw-15.3 plt ct-208 06:20am blood glucose-91 urean-24* creat-1.0 na-140 k-4.1 cl-108 hco3-26 angap-10 06:20am blood calcium-8.2* phos-2.6* mg-2.1 brief hospital course: 83m with h/o prostate cancer s/p brachytherapy and radiation c/b radiation proctitis and prostatitis with hematuria, bph, recently diagnosed pseudomonal urinary tract infecton admitted with septic shock probably related to epididymo-orchitis from previous urinary tract infection. . #septic shock/urinary tract infection/epididymo-orchitis: patient was admitted with hypotension to the icu requiring transient vasopressor support. labs were notable for leukocytosis with bandemia. he was emprically treated with vancomycin, ciprofloxacin, and zosyn and then changed to vancomycin and meropenem as previous urine cultures grew pseudomonas with intermediate sensitivity to zosyn. he improved and was transferred to the medical floor. he was seen by urology in the icu and exam was consistent with epididymo-orchitis which was confirmed by testicular ultrasound without evidence of abscess. blood and urine cultures were no growth. therefore, given that initial urine culture with pseudomonas was from and antibiotics were not started until it was felt that the patient's sepsis was due to deep seeding of epididymis/testicular bed from pseudomonal uti and not from a failure of cipro since we would have expected bacterial growth if the causal organism was resistant to ciprofloxacin given how ill the patient was on presentation. also, although there was consideration of scrotal cellulitis when vancomycin was started, it was later felt that this presented epididymo-orchitis and not cellulitis. therefore, patient was discharged on ciprofloxacin for quinolone sensitive pseudomonal urinary tract infection and epididymo-orchitis for a total of 3 weeks after discussion with urology. the patient will follow up in clinic in 3 weeks. . #bph: doxazosin was held initially for hypotension and foley was placed. there was no blood clots noted on bladder irrigation. foley catheter was removed once hemodynamically stable and patient was able to void, although incontinent of urine. patient was discharged to restart doxazosin at half his home dose (4mg po qhs-since it had been held for a few days) to reduce risk of postural hypotension (as he already has parkinson's disease). this can be increased to usual home dose of 8mg po qhs in days from discharge if tolerated well. . #hematuria: although patient had had hematuria recently, continuous bladder irrigation was performed during hospitalization and there was no evidence of bleeding from the urinary tract. aspirin 81 was resarted on discharge. . #congestive heart failure, chronic, diastolic: initially betablocker and diuretics were held as patient was hypotensive. home betablocker and lasix were restarted on day of discharge. . #acute renal failure: this was felt to be related to septic shock and improved with hydration and improvement in blood pressure. nephrotoxic medications were held. renal function improved to baseline on discharge. . #wheeze: patient had intermittent wheezing which seemed unrelated to his volume status. he said this was chronic but he does not carry a diagnosis for this. he was discharged on combivent inhalers/duonebs prn with further workup deferred to his outpatient pcp. . #coronary artery disease: since patient did not have any further hematuria, he was restarted on his home aspirin 81mg po daily. . #parkinson's disease: patient was continued on his home sinement and ropinorole. . #pernicious anemia: home b12 was continued. . #gerd: ppi was continued. . #code:full . #disposition: patient was discharged back to his previous rehabilitation facility. he should have electrolytes checked in 7 days to monitor electrolytes and renal function to ensure they are stable. he should follow up with pcp and urology as noted in discharge paperwork. medications on admission: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. toprol xl 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 3. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 4. doxazosin 4 mg tablet sig: two (2) tablet po hs (at bedtime). 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: 0.5 capsule, delayed release(e.c.) po daily (daily). 6. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po tid (3 times a day): please give doses at 8am, 1pm and 7pm). 7. ropinirole 1 mg tablet sig: three (3) tablet po tid (3 times a day): please give doses at 8am, 1pm and 7pm. 8. lasix 20 mg tablet sig: one (1) tablet po once a day. 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 10. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 11. vitamin b-12 1,000 mcg/ml solution sig: one (1) dose injection once a month 12. tylenol 325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). tablet(s) 2. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 3. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: 0.5 capsule, delayed release(e.c.) po daily (daily). 5. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po tid (3 times a day): please give doses at 8am, 1pm and 7pm. 6. ropinirole 1 mg tablet sig: three (3) tablet po tid (3 times a day): please give doses at 8am, 1pm and 7pm. 7. vitamin b-12 1,000 mcg/ml solution sig: one (1) injection injection once a month. 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. furosemide 20 mg tablet sig: one (1) tablet po once a day: hold if sbp<100. 10. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily): hold if hr<60, sbp<100. 11. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 18 days. 12. doxazosin 4 mg tablet sig: one (1) tablet po hs (at bedtime): if patient tolerates for 3 days would increase to 8mg qhs. hold if sbp<100. 13. duoneb 0.5 mg-3 mg(2.5 mg base)/3 ml solution for nebulization sig: one (1) neb inhalation every six (6) hours as needed for shortness of breath or wheezing: can be tried for symptomatic treatment of wheezing. if no relief would not continue. discharge disposition: extended care facility: for the aged - ltc discharge diagnosis: sepsis urinary tract infection epididymo-orchitis acute renal failure 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 for sepsis from a urinary tract infection and infection of your testicles (epididymo-orchitis). your blood pressure was low and you were intially admitted to the intensive care unit. you improved with antibiotics and were seen by the urology service. you are being discharged on a course of antibiotics (ciprofloxacin) which you should continue for 3 weeks. your foley catheter was removed and you were able to urinate well without it. should you have recurrence of bleeding in your urine or have difficulties urinating you may require a catheter to be replaced, but we will try to avoid that if possible. you should follow up with your urologist and pcp as noted below. followup instructions: please have your rehab or family schedule a follow up appointment with dr. at clinic in weeks from discharge. his office number is . please also call your pcp to set up an appointment in the next 2-4 weeks. name: , j location: medical group address: , ste 3c, , phone: fax: department: surgical specialties when: thursday at 1:45 pm with: , md building: campus: east best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: other primary cardiomyopathies esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis personal history of malignant neoplasm of prostate paralysis agitans septic shock accidents occurring in other specified places chronic diastolic heart failure pseudomonas infection in conditions classified elsewhere and of unspecified site other accidents orchitis and epididymitis, unspecified 

Answer: The patient is high likely exposed to