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 attending: chief complaint: mental status change, abdominal distention. major surgical or invasive procedure: none. history of present illness: this is a 70 year-old woman with h/o obesity, dm, ms x40 years, but mobile without walker and independent with adls. she fell on , suffered rib fractures and a non-displaced left pubic ramus pelvic fracture. after her first hospitalization she was discharged to rehab on ciprofloxacin for uti. she returned to the hospital from rehab with metnal status change, confusion, and abdominal distention. past medical history: ms (with gait disturbance and urinary incontinence) dm htn hyperlipid hypothyroidism social history: lives in , takes care of husband who is in hospice. family history: noncontributory. physical exam: physical exam at time of transfer to medicine service: vitals tm96.7, bp 140/70, hr 84, rr 30, 96% ra general elderly-appearing female in nad, breathing and speaking comfortably on ra; however, she becomes dyspneic with minimal movements in bed heent perrla, eomi, no scleral icterus, mmm, oropharynx clear neck no jvd appreciated, supple, non-tender chest clear to auscultation bilaterally anterior fields; no wheezes heart rrr, normal s1/s2, no murmurs or extra heart sounds appreciated obese, soft, no tenderness; bruising over lower abdomen c/w heparin injections; no guarding or rebound; no percussion or cough tenderness; not hypertympanic; normal to slightly hypoactive bs; rectal tube in place, draining loose brown yellow stool extremities trace pitting edema to mid shins; feet warm and well-perfused bilaterally pertinent results: labs at admission: 03:36pm blood wbc-35.2*# rbc-3.91* hgb-11.9* hct-34.2* mcv-88 mch-30.3 mchc-34.7 rdw-14.9 plt ct-584*# 03:36pm blood neuts-83* bands-6* lymphs-3* monos-6 eos-0 baso-0 atyps-0 metas-2* myelos-0 03:36pm blood pt-13.4 ptt-36.2* inr(pt)-1.2* 03:36pm blood glucose-343* urean-50* creat-1.6* na-133 k-4.3 cl-101 hco3-17* angap-19 03:36pm blood alt-25 ast-24 ck(cpk)-107 alkphos-108 totbili-0.5 03:36pm blood albumin-3.3* calcium-9.8 phos-5.0*# mg-2.0 . labs at discharge: 05:13am blood wbc-7.9 rbc-3.49* hgb-10.5* hct-30.1* mcv-86 mch-30.0 mchc-34.9 rdw-16.5* plt ct-358 05:13am blood glucose-81 urean-11 creat-0.8 na-140 k-3.9 cl-112* hco3-22 angap-10 05:13am blood calcium-8.2* phos-2.6* mg-1.8 . miscellaneous labs: 06:40am blood folate-5.3 06:40am blood %hba1c-7.5* 10:02am blood tsh-24* 10:02am blood t4-4.9 t3-50* calctbg-1.04 tuptake-0.96 t4index-4.7 06:40am blood crp-25.8* 06:40am blood pep-pnd 06:40am blood esr-95* . imaging : ct c/a/p: 1. undisplaced acute left lower rib fractures and nondisplaced fracture through the left inferior pubic ramus as described above. there is no pneumothorax. 2. up to 4 mm pulmonary nodules in the right lower lobe need followup with a chest ct in three months to ensure stability. 3. a filling defect in the upper pole calyx of the left kidney could represent a blood clot; however, the possibility of an urothelial neoplasm cannot be excluded and a renal mri is recommended for further assessment. ctoh: no hemorrhage ct abd: distended large bowel, cecum @ 9.8cm, inflammatory changes and fluid surrounding cecum and proximal asc colon, no transition point. no abscess, free air or pneumatosis. fracture of left posterior ribs. fracture of the left sacrum. fracture of the left inferior and superior pubic rami. cxr: no evidence of pneumoperitoneum. markedly dilated loops of large bowel. kub: unchanged kub: increased lob, mainly colon ctabd: colonic wall thickening in the ascending and proximal transverse colon, no free air, b/l pleural effusions l>r, fractures unchanged kub: compared to the study from the colon is no longer as distended. the stomach is distended with a large amount of material within it and gas seen crossing midline. gas is seen in loops of small bowel and large bowel. on the supine view there is no evidence of free air but this would be better assessed on the upright or lateral decubitus film. impression: distended stomach. . micro ucx: e. coli, 10,000-100,000 organisms/ml - pan-sensitive ucx: alpha strep or lactobacillus stool o+p negative ucx: pending : cdiff negative x3 : ucx negative : stool culture negative : rpr negative : cdiff negative x1 brief hospital course: 70 yo woman h/o hypertension, dmii, hyperlipid, hypothyroid, recent admission after fall for left non-displaced pubic ramus fracture, presenting from rehab on with abdominal distention, concern of c dif colitis in setting of recent cipro for uti. . hospital course on surgical service (): . patient presented from rehab dehydrated with mental status changes and abdominal distention, probable c diff (toxin negative). her white count was 30 at time of admission (see labs above). she had a dilated r colon (?opiate induced vs c.diff) and initially had no bowel movements or flatus. . she was seen by gi service who recommended for decompression with rectal tube and ngt, and continued avoidance of narcotics. she was switched to iv flagyl and po vanco and improved. however, she began having copious diarrhea, requiring up to 100-120 meq iv potassium daily. she never developed hypotension and her hr remained stable 70-80s. she was tranferred to the medicine service on for management of diarrhea. . . hospital course on medicine service (): . at time of transfer, she had no significant complaints. she had mild low right back pain, persisting from her fall. she denied abdominal pain, nausea or vomiting, dizziness or lightheadedness. she denied subjective fevers or chills. her hospital course by problem is below: . 1. diarrhea. our differential diagnosis for her diarrhea included infectious (c. dif versus bacterial), poor sphincter tone from deconditioning, or exacerbation of ms. stool cultures and c dif were re-sent, and these returned negative. we consulted neurology who felt that her fecal incontinence was unlikely related to ms flare and more likely related to dementia and deconditioning. they noted that she likely suffers from mild chronic dementia, with acute worsening in the setting of infection, narcotic use, and metabolic abnormalities. they recommended against mri as they had a low index of suspicion for spinal cord involvement. . we contined flagyl to complete a 14-day course and we removed her rectal tube. we reinvolved physical therapy as we felt that her incontinence was most likely related to deconditioning. with these conservative interventions the frequency of her loose stools decreased. furthermore, her stools are becoming more formed at discharge and we suspect that this will aid her ability to sense when she needs to void. . 2. pain control. we held all narcotics given our concern that narcotic-related constipation was largely to blame for her abdominal distention at time of admission. we treated her pain with standing doses of ibuprofen (with meals) and tylenol as needed. . 3. wound care. nurses have noticed that there is reddening of the skin in the sacral area, although no ulceration. they have been regularly treating the area with antifungal powder, cleaning and drying. she should continue to receive this care in rehab to prevent skin breakdown and decubitus ulceration. . 4. hypertension. we continued her outpatient losartan and increased her amlodipine to a dose of 10 mg once daily. we added hydrochlorothiazide at a dose of 12.5 mg once daily. . 5. hyperlipid. we continued her outpatient statin. . 6. hypothyroid. we increased her levothyroxine to 112 mcg when tfts showed slight hypothyroidism. . 7. diabetes. endocrinology was consulted for management of hyperglycemia during this admission. with their recommendations, we increased her dose of pioglitazone to 30 mg once daily, increased glyburide to 5 mg twice daily, and kept the metformin at 500 mg twice daily. her standing insulin dose has also been adjusted to 33u of glargine at bed time, with sliding scale humalog insulin as outlined in the medications. . 7. lung nodules. she will need outpatient follow-up imaging for lung nodules noted on chest ct . . 8. left renal mass. she will need outpatient f/u mri for urothelial neoplasm vs clot noted in the left kidney from ct abdomen . . she was kept on a diabetic diet. subcutaneous heparin was used for venous thrombosis prophylaxis. her code status is full code. medications on admission: meds (at time of transfer): 1. levothyroxine sodium 100 mcg po daily 2. losartan potassium 100 mg po daily 3. metronidazole (flagyl) 500 mg po q8h 4. acetaminophen 650 mg po q6h 5. oxycodone (immediate release) 5 mg po q4h:prn pain 6. albuterol 0.083% neb soln 1 neb ih q6h:prn 7. pantoprazole 40 mg po q24h 8. amlodipine 5 mg po daily 9. pioglitazone 30 mg po daily 10.atorvastatin 40 mg po daily 11.bisacodyl 10 mg pr daily 12.glyburide 5 mg po daily 13.heparin 5000 unit sc tid 14.tramadol (ultram) 25 mg po q6h 15.vancomycin oral liquid 125 mg po q6h 16.insulin sc (per insulin flowsheet) . meds (at time of admission/per recent d/c summary): 1. losartan 50 mg tablet sig: two (2) tablet po daily 2. amlodipine 5 mg tablet sig: one (1) tablet po daily 3. atorvastatin 40 mg tablet sig: one (1) tablet po daily 4. pioglitazone 15 mg tablet sig: two (2) tablet po daily 5. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily 6. levothyroxine 100 mcg tablet sig: one (1) tablet po daily 7. glyburide 5 mg tablet sig: one (1) tablet po daily 8. heparin (porcine) 5,000 unit/ml solution sig: one (1) inj injection (2 times a day): for dvt prophylaxis 9. metformin 500 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po daily 10. oxycodone 20 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h 11. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed 12. docusate sodium 100 mg capsule sig: one (1) capsule po bid 13. senna 8.6 mg tablet sig: one (1) tablet po bid 14. acetaminophen 500 mg tablet sig: two (2) tablet po q6h prn 15. insulin regular human 100 unit/ml solution sig: one (1) inj injection asdir (as directed): per sliding scale protocol. 16. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 17. ciprofloxacin 250 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 5 days. discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 2. losartan 50 mg tablet sig: two (2) tablet po daily (daily). 3. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. pioglitazone 15 mg tablet sig: two (2) tablet po daily (daily). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 7. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). 8. ibuprofen 600 mg tablet sig: one (1) tablet po q8h (every 8 hours). 9. glyburide 5 mg tablet sig: one (1) tablet po bid (2 times a day): take one dose in morning and one dose before dinner. 10. levothyroxine 112 mcg tablet sig: one (1) tablet po daily (daily). 11. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed. 12. insulin lispro 100 unit/ml cartridge sig: u subcutaneous four times a day: for blood sugar 0-80 mg/dl, give 4 oz. juice and 15 gm crackers; for blood sugar 81-100 mg/dl, give 4 units (or give 0 units at bedtime); for blood sugar 101-150 mg/dl give 6 units (or 0 units at bedtime); for blood sugar 151-200 mg/dl, give 8 units (or 3 units at bedtime); for blood sugar 201-250 mg/dl, give 10 units (or 5 units at bedtime); for blood sugar 251-300 mg/dl, give 12 units (or 7 units at bedtime); for blood sugar 301-350 mg/dl, give 14 units (or 9 units at bedtime); for blood sugar 351-400 mg/dl, give 16 units (or 11 units at bedtime); for blood sugar >400, give 16 units (or 11 units at bedtime) and notify md. :*qs qs* refills:*2* 13. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 14. insulin glargine 100 unit/ml cartridge sig: thirty three (33) units subcutaneous at bedtime. 15. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po once a day. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnoses infectious colitis constipation and ileus secondary to narcotic use . secondary diagnoses diabetes mellitus hypothyroidism hypertension hyperlipidemia recent non-displaced left-sided pelvic fracture discharge condition: vital signs stable. afebrile. discharge instructions: you were hospitalized for treatment of abdominal distention and diarrhea. we were concerned that you had an infection of the gastrointestinal tract. we were not able to confirm this infection because all of the culture data was negative. however, we treated you presumptively with a 14-day course of antibiotics to help clear infection if present. we also involved physical therapy in your care. with these treatments, your abdominal distention resolved and your diarrhea improved. . we have made several changes to your medications. they are as follows: 1. we increased the glyburide to 5 mg twice dialy. 2. we increased the amlodipine to 10 mg once daily. 3. we added hydrochlorothiazide at a dose of 12.5 mg once daily. 4. we changed the insulin regimen. 5. we incresed levothyroxine to 112 mcg once daily. 6. we stopped the lidocaine patch. 7. we stopped the oxycodone. . you have been seen by physical therapists during this admission who recommend discharge to rehab. please follow-up with your primary physician, . , after you leave rehab. followup instructions: please follow-up with your primary physician, . (. md procedure: venous catheterization, not elsewhere classified diagnoses: urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism other and unspecified hyperlipidemia morbid obesity paralytic ileus other constipation diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled dehydration multiple sclerosis other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria infectious colitis, enteritis, and gastroenteritis 

Answer: The patient is high likely exposed to