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 / imuran / cephalosporins / sulfa (sulfonamide antibiotics) / reglan / latex / ampicillin / lactose / soy, lentals, beans attending: chief complaint: weakness, dyspnea major surgical or invasive procedure: picc placement history of present illness: 60 yo f w/ h/o renal and pancreatic transplants, dm type 1, diastolic chf, and cad who presents with weakness and dyspnea. of note, patient was discharged from yesterday after 3 day admission for sob, chest pain, which was attributed to chf exacerbation. she was diuresed three liters and discharged home on fluid restriction and dietary modification as well as home dose of lasix. at home, patient reported feeling weak and tired- sleeping a lot. was febrile to over 101 and started shaking at home. also noticed dysuria and malodorous urine. no frequency or urgency. developed some sob w/ fevers. called friend who on seeing her suggested visit. . in the ed, initial vs were: t102.4 p84 bp136/66 r14 o2 sat 95% ra. patient was given 1 g tylenol, 1 g meropenam, and 300 cc fluid bolus as she appeared clinically dry; ivf were stopped at that point as she complained of worsened dyspnea. she maintained sats in the high 90s on room air, but given tachypnea was admitted to the icu for monitoring. vs on transfer were hr110 120/70 rr25 o2 sat 97 3l. . in the icu, patient reported mild nausea, fever, and mild dyspnea. denied cp, cough, vomiting, hematemesis, abdominal pain, flank pain, diarrhea, melena, or brbpr. no headaches, myalgias or arthralgias. . review of systems: (+) per hpi (-) denies headache, sinus tenderness, rhinorrhea or congestion. denies cough or wheezing. denies chest pain, chest pressure, palpitations. denies vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies urinary frequency or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: #chf; diastolic dysfunction with preserved ef # s/p renal transplant () -- c/b chronic rejection -- second renal transplant () # s/p pancreas transplant -- with allograft pancreatectomy () -- redo pancreas transplant () -- admission for acute rejection (), resolved with increased immunosupression # diabetes mellitus type i -- c/b neuropathy, retinopathy, dysautonomia -- no longer requires regular insulin after the pancreas transplant, but has been given ss while on high-dose prednisone in house # autonomic neuropathy # sleep disordered breathing -- unable to tolerate cpap; uses oxygen 2l nc at night # osteoporosis # hypothyroidism # pernicious anemia # cataracts # glaucoma # anemia of ckd, on aranesp in the past # r foot fracture c/b rle dvt # chronic lle edema # recurrent e. coli pyelonephritis # s/p anal polypectomy () # s/p bilateral trigger finger surgery () # s/p left () social history: child psychiatrist, on disability. lives alone in . has a pca 8h/day. ambulatory with a prosthesis. denies alcohol, tobacco, or illicit drug use. family history: father with mi at 57 no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: physical exam on admission: vitals: t: bp: p: rr: spo2: general: alert, oriented, fatigued but interactive, shivering heent: exopthalmos, sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: bibasilar crackles, r>l, no wheezes, ronchi cv: tachycardic, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly; well healed midline incision back: no flank tenderness gu: no foley : warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . discharge: vitals: tm 98 tc 96.2 hr: 58 bp: 125/69 rr: 18 spo2: 100% i/o: 1640/2200 + 2 bm general: alert, oriented, pleasant heent: exopthalmos, sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: ctab, no wheezes, ronchi cv: rrr normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly; well healed midline incision gu: no foley : warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema, r arm with picc has bruise but no palpable hematoma pertinent results: labs on admission: 06:10am wbc-2.0* rbc-3.17* hgb-9.0* hct-28.1* mcv-89 mch-28.2 mchc-31.9 rdw-15.1 06:10am pt-11.2 ptt-24.9 inr(pt)-0.9 10:06pm lactate-1.0 09:00pm glucose-106* urea n-75* creat-2.0* sodium-134 potassium-4.8 chloride-100 total co2-22 anion gap-17 09:00pm alt(sgpt)-6 ast(sgot)-20 alk phos-61 tot bili-0.3 09:00pm lipase-27 09:00pm ctropnt-<0.01 09:00pm albumin-3.8 magnesium-2.2 09:00pm wbc-5.2# rbc-3.38* hgb-9.7* hct-29.7* mcv-88 mch-28.8 mchc-32.8 rdw-15.4 09:00pm neuts-80.8* lymphs-13.0* monos-4.0 eos-1.9 basos-0.3 09:00pm plt count-168 09:00pm pt-10.8 ptt-21.0* inr(pt)-0.9 09:00pm urine color-straw appear-hazy sp -1.009 09:00pm urine blood-tr nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-lg 09:00pm urine rbc-2 wbc-133* bacteria-mod yeast-none epi-<1 09:00pm urine hyaline-1* 09:00pm urine wbcclump-few 06:10am glucose-85 urea n-72* creat-2.0* sodium-135 potassium-4.5 chloride-100 total co2-25 anion gap-15 06:10am amylase-91 06:10am lipase-25 06:10am calcium-9.3 phosphate-4.4 magnesium-2.5 06:10am tacrofk-5.7 rapamycin-9.0 06:10am wbc-2.0* rbc-3.17* hgb-9.0* hct-28.1* mcv-89 mch-28.2 mchc-31.9 rdw-15.1 06:10am plt count-149* 06:10am pt-11.2 ptt-24.9 inr(pt)-0.9 . chest: impression: mild pulmonary edema with small bilateral pleural effusions, similar compared to the prior study. bibasilar air space opacities likely reflect atelectasis. . 8/ renal ultrasound: the transplanted kidney measures 11.3 cm. no evidence of hydronephrosis or perinephric fluid collection. the main renal artery and vein are patent with normal waveforms. resistive indices in the upper, mid and lower poles of the transplant kidney are 0.75, 0.74 and 0.72 respectively, previously ranging from 0.78 to 0.81. the bladder is collapsed about the foley and could not be well evaluated in this study. impression: 1. no perinephric fluid or hydronephrosis. 2. resistive indices in the upper, mid and lower poles of the transplant kidney range from 0.75 to 0.78. findings discussed with dr. at 9 pm on via telephone 05:34am blood wbc-2.6* rbc-2.95* hgb-8.6* hct-26.4* mcv-89 mch-29.0 mchc-32.5 rdw-15.3 plt ct-180 06:00am blood wbc-3.1* rbc-2.87* hgb-8.4* hct-25.9* mcv-91 mch-29.2 mchc-32.2 rdw-15.8* plt ct-203 06:00am blood neuts-54.8 lymphs-27.9 monos-11.3* eos-5.8* baso-0.1 05:34am blood glucose-79 urean-73* creat-1.6* na-137 k-4.6 cl-104 hco3-26 angap-12 06:00am blood glucose-82 urean-75* creat-1.5* na-138 k-4.3 cl-105 hco3-25 angap-12 05:34am blood alt-5 ast-18 ld(ldh)-170 alkphos-55 totbili-0.2 04:22am blood ck-mb-15* mb indx-8.3* ctropnt-1.11* 11:05pm blood ck-mb-13* mb indx-6.9* ctropnt-1.11* 05:34am blood calcium-10.3 phos-5.4* mg-2.4 06:00am blood calcium-10.0 phos-4.9* mg-2.7* 05:34am blood tacrofk-5.6 06:00am blood rapmycn-11.2 01:04pm blood type-art temp-37.6 po2-88 pco2-35 ph-7.43 caltco2-24 base xs-0 intubat-not intuba 01:04pm blood lactate-0.9 09:00pm urine blood-tr nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-lg 09:00pm urine rbc-2 wbc-133* bacteri-mod yeast-none epi-<1 09:00pm urine casthy-1* . 9:00 pm urine site: clean catch **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. piperacillin/tazobactam sensitivity testing available on request. tetracycline sensitivity requested by dr. . tetracycline sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | amikacin-------------- 8 s ampicillin------------ =>32 r ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tetracycline---------- r tobramycin------------ =>16 r trimethoprim/sulfa---- <=1 s . 9:00 pm blood culture #2. **final report ** blood culture, routine (final ): escherichia coli. identification and sensitivities performed on culture # 328-1435p . anaerobic bottle gram stain (final ): gram negative rod(s). aerobic bottle gram stain (final ): gram negative rod(s). brief hospital course: primary reason for hospitalization: 60f with pmh pancreatic and renal transplants, dm type ii, diastolic chf, htn, and hypothyroidism, recently admitted for chf exacerbation who presents with weakness, fevers, and hypotension suggestive of urosepsis. active diagnoses: # urosepsis: patient presented with weakness, fevers, hypotension in setting of dirty ua. she has history of urosepsis as recently as , when was treated for cephalosporin sensitive e. coli with meropenem for 14 days. given immunosuppression and altered anatomy, patient at higher risk for these infections. she was treated again with meropenam (renally-dosed) and vancomycin for empiric coverage. urine and blood cultures were sent. for the first few days of hospitalization, she was bolused with ivf for hypotension and her anti-hypertensives were held. her blood cx grew out e. coli, and she was continued on meropenem for total 14 days (complicated uti). the plan is to switch to ertepenem when discharged home (once daily iv). an urology consult was obtained for recurrent urosepsis, and outpatient follow-up was deemed ok. since pancreas is draining through bladder, she may have a stone in the bladder not visualized on renal u/s. cystoscopy might show something that can be removed. on floor, pt was stable, her mental status was at baseline and did not have any fevers. she was continued on iv antibiotics and renal function improved to baseline. she was discharged on an additional 6 days of ertepenam and will start fosfomycin for ppx. # sob/tachypnea: on admission, the patient experienced a subjective feeling of dyspnea not associated with hypoxia. she was satting in high 90s on 1-2l oxygen, which appears to baseline for her, as she uses oxygen at home. differential diagnosis included ischemic cardiac etiologies, pneumonia (no cough), chf (cxr similar to prior admission cxr), and anxiety. she was noted to have crackles on lung exam and to have slight pulmonary edema, but likely not much worse than baseline. her cardiac enzymes were checked and returned elevated (see below). she was continued on supplemental oxygen, and diuresis was initially held given her hypotension and possible sepsis. as her blood pressure improved, she was diuresed. on the floor pt was euvolemic and o2 saturations were normal on room air. at time of discharge, she was taking all home antihypertensives and diuretics. #nstemi: on admission, her troponin returned positive at 0.36 (she was discharged the day prior with troponin <0.01), ck 15, mb 10.6. she was noted on her last admission to have a lbbb, she is defined as having a nstemi (ekg changes masked), most likely secondary to demand instead of acs. she was started on a heparin gtt, asa, statin. her troponin was trended q8h and stabilized to 1.11 by hd3, so her heparin drip was turned off. on the floor she was stable without chest pain and her tele did not have any events. she was discharged on lisinopril, asa and carvedilol. she will follow up with cardiologist within next month. #diastolic chf: patient has dilated lv with preserved ef, as well as crackles on lung exam and cxr showing b/l pleural effusions and pulmonary edema similar to prior admission. her lasix, lisinopril and carvedilol were initially held for hypotension, but when her blood pressure improved by hd3, a lasix drip was started. on hd4, the lasix gtt was discontinued, and she was started on lasix 60mg iv bid with a goal uop of 1l/day. ett was obtained, showing a likely distal lad lesion, not cardiomyopathy, distal septal akinesis, 3+ mr which may have been associated with volume. her carvedilol dose was slowly increased back to her home dose as tolerated, and her doxasozin continued to be held. on the floor her pressures and kindney function improved and she was restarted on all home medications. she had an episode of orthostasis, but pressures continued to improve. # : patient presented with acute kidney injury, stable from discharge the day prior at 2.0. baseline creatinine appears to be around 1.6. her lisinopril was initially held. sediment muddy brown casts. a renal ultrasound showed no perinephric fluid or hydronephrosis. at the time of icu call out, cr stable at 1.9. at time of discharge her cr was 1.6. she will follow up with dr . # htn: on admission, was hypotensive from urosepsis, so carvedilol, doxazosin and lisinopril were held. as her bp improved, she was restarted on carvedilol, first at a lower than home dose and titrate up slowly to home dose of 12.5mg . doxazosin was restarted. at the time of icu call out, lisinopril was still held. on the floor her pressures improved and she was discharged on all home medications. # s/p renal and pancreas transplant: was seen by renal transplant and her sirolimus, tacrolimus, and prednisone were adjusted. her sacrolimus was discontinued, tacrolimus dose decreased to 1.5 , and started on hydrocortisone 100mg q8h. the hydrocortisone was tapered and she was eventually restarted on prednisone at 5mg daily. on hd3, she was restarted on rapamune 2mg daily and her tacrolimus 1.5 mg was retimed to 0600 and 1800 dosing. her tacro and levels were checked daily at 0530 (do not order with am labs). the goal levels for both rapamune and tacrolimus are and need to be checked daily. she was also given pancreatic enzyme replacement per home regimen. she was discharged on home tacro and doses. #history of c. diff: per id, she was started on empiric po vancomycin 125 q6h for 1 week following end of meropenem therapy. at time of discharge surveillance cdiff was negative and diarrhea had improved. she will continue po vanco until chronic diagnoses: # hypothyroidism: tsh was in normal range during last hospitalization (0.7 on ). she was continued on levothyroxine at alternate qod dosing of 112mcg and 100 mcg. # glaucoma: she was continued on eye drops and methazolamide per home regimen. transitional issues: - pt will need weekly labs on tuesdays: cbc, chem 10, tacro level, level - will need aranesp after d/c - needs podiatry for ingrowns - needs pt, prosthesis refit, ot, cards rehab code status: full code medications on admission: acyclovir 400 mg po q12h doxazosin 2 mg po qam doxepin 10 mg po hs levothyroxine 112 mcg qod levothyroxine 100 mcg qod lipase-protease-amylase 12,000-38,000 -60,000 unit capsule, po tid w/ meals methazolamide 50 mg po bid prednisone 5 mg po daily simvastatin 20 mg po daily folic acid 1 mg po daily omega-3 fatty acids 1 capsule po bid ipratropium bromide 0.02 % solution 1 inh q6h prn forteo 20 mcg/dose - 600 mcg/2.4 ml pen injector sig: one (1) ml subcutaneous daily. brimonidine 0.15 % drops sig: one (1) drop ophthalmic q8h dorzolamide-timolol 2-0.5 % drops sig: one (1) drop ophthalmic latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs aspirin 81 mg po daily calcium-vitamin d cyclosporine 0.05% dropperette albuterol sulfate 2.5 mg /3 ml (0.083 %) neb one inh q6hr prn lasix 20 mg po once a day sirolimus 2 mg po daily carvedilol 12.5 mg po bid tacrolimus 2 mg po q12h home oxygen 1-2l as needed discharge medications: 1. fosfomycin tromethamine 3 gram packet sig: one (1) packet po once a week: dissolve in ounces of water. can be taken with or without food. . initiate after completion of ertapenem course. . 2. acyclovir 400 mg tablet sig: one (1) tablet po q12h (every 12 hours). 3. doxepin 10 mg capsule sig: one (1) capsule po hs (at bedtime). 4. doxazosin 1 mg tablet sig: two (2) tablet po daily (daily). 5. levothyroxine 100 mcg tablet sig: one (1) tablet po every other day (every other day). 6. levothyroxine 112 mcg tablet sig: one (1) tablet po every other day (every other day). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. methazolamide 50 mg tablet sig: one (1) tablet po tid (3 times a day). 9. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 10. atorvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 11. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 12. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inh inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 13. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 14. 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. 15. ipratropium bromide 0.02 % solution sig: one (1) inh inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 16. teriparatide 20 mcg/dose (750 mcg/3 ml) pen injector sig: one (1) ml subcutaneous daily (). 17. sirolimus 1 mg tablet sig: two (2) tablet po daily (daily): administered at 6am. 18. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). 19. tacrolimus 0.5 mg capsule sig: four (4) capsule po q12h (every 12 hours). 20. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day): hold for sbp<100. 21. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 22. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever, pain. 23. gabapentin 100 mg capsule sig: one (1) capsule po daily (daily). 24. gabapentin 100 mg capsule sig: two (2) capsule po hs (at bedtime). 25. lisinopril 5 mg tablet sig: 0.5 tablet po hs (at bedtime). 26. cyclosporine 0.05 % dropperette sig: one (1) dropperette ophthalmic daily (). 27. brimonidine 0.15 % drops sig: one (1) drop ophthalmic q8h (every 8 hours). 28. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 29. lipase-protease-amylase 12,000-38,000 -60,000 unit capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po tid with meals. 30. dorzolamide-timolol 2-0.5 % drops sig: one (1) drop ophthalmic (2 times a day). 31. oxygen 1-2l prn sob or sats <91% 32. calcium 500 + d 500 mg(1,250mg) -400 unit tablet sig: one (1) tablet po once a day. 33. aranesp (polysorbate) 60 mcg/ml solution sig: one (1) ml injection once a month: please give monthly dose day pt arrives at rehab. 34. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 12 days: please continue until . 35. outpatient lab work weekly labs (tuesdays): sirolimus (rapamycin) level, tacrolimus level, cbc, chem 7 . fax to please fax to dr. at transplant center: 36. pentamidine 300 mg recon soln sig: one (1) inh injection once a month. . 37. ertapenem 1g iv daily until . . 38. outpatient lab work weekly labs (tuesdays): sirolimus (rapamycin) level, tacrolimus level, cbc, chem 7 . fax to please fax to dr. at transplant center: discharge disposition: extended care facility: hospital for continuing medical care discharge diagnosis: urosepsis nstemi chf discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear dr. , it was a pleasure taking care of you. you were admitted to the hospital for a complicated urinary tract infection that extended into your bloodstream (urosepsis). you had a change in mental status secondary to the infection and needed to be transferred to the icu. you also had a heart attack. you were treated with heparin for the heart attack. no other new interventions for the heart attack are necessary at this time. please continue all of your home medications with the following changes: start ertapenem for an additional 6 days (last day ) start after you finish ertapenem, start fosfamycin 3gm in 4 oz of water weekly for uti prophylaxis. start: vancomycin oral liquid 125mg by mouth every six hours until . start: atorvastatin 80 mg by mouth daily and stop simvastatin 20 mg by mouth daily change: lasix 20mg tab one tablet by mouth daily to lasix 20mg tab one tablet by mouth twice daily . weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: department: podiatry when: friday at 1:50 pm with: , dpm building: ba ( complex) campus: west best parking: garage department: radiology when: friday at 12:45 pm with: radiology building: sc clinical ctr campus: east best parking: garage department: cardiac services when: friday at 1 pm with: , np building: sc clinical ctr campus: east best parking: garage department: infectious disease when: tuesday at 9:30 am with: , md building: lm campus: west best parking: garage **you will also be seeing dr. your transplant nephrologist at this visit as well. department: urology when: monday at 10:30 am with: , md building: campus: east best parking: garage md procedure: central venous catheter placement with guidance diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified severe sepsis unspecified acquired hypothyroidism unspecified glaucoma osteoporosis, unspecified septic shock diarrhea dehydration surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation septicemia due to escherichia coli [e. coli] complications of transplanted kidney chronic diastolic heart failure other dependence on machines, supplemental oxygen sleep disturbance, unspecified 

Answer: The patient is high likely exposed to