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: patient recorded as having no known allergies to drugs attending: chief complaint: dyspnea major surgical or invasive procedure: - incision and drainage of right forearm abscess - intubation - extubation - picc line placement - picc line removal history of present illness: ms. is a 30 year old female with past medical history of hepatitis c, intravenous drug use, congenital birth defect, and chronic renal insufficiency who presented to with dyspnea. she reports that for approximately the last three days, she has had poor appetite, nausea, non-bilious non-bloody vomiting, loose stools, and poor urine output. for the last two days, actually, she has not self-catherized, as she has not felt the urge to urinate. she has had loose stools and vomiting, up to five episodes a day. she reports she has been drinking a little, but overall has had very poor po intake. she reports her breathing has been fast for at least the last 3-4 days. she came to today after feeling more short of breath. at , she was noted to have an abg of 7.18/pco2 8/po2 150, along with a bun of 98, creatinine of 9.0, potassium of 2.3, and temperature of 91-92 f. she was also tachypneic to the mid-30's. given the above findings, she was transferred to ed for further management after getting 1 liter of ns with 40 meq of kcl. in the ed, initial vital signs were: heart rate of 90, blood pressure of 116/70, respiratory rate of 36, and oxygen saturation of 100%. she received 100 mg of thiamine, 4.5 grams of zosyn, 1 gram of vancomycin, 4 grams of magnesium, and one amp of sodium bicarbonate. she received 40 meq of kcl in 1 liter of ns at and as well as in the ed. the renal team was consulted as well. at time of transfer to the icu, her heart rate was 90-105, oral temperature was 93.7, systolic blood pressure was 100-116, oxygenation was 100% on room air, and respiratory rate was 29-35. upon arrival to the icu, she reports she is feeling better and less short of breath. she denies any pain or other symptoms. review of systems: (+) per hpi, + chills last few days. + "fuzzy" thinking for last three days. + malaise (-) denies fever, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - hepatitis c - polysubstance abuse, including intravenous: heroin, cocaine, benzodiazapines, and barbituates - urogenic malformation with single kidney: status-post surgery with iliostomy and urostomy used for self-catherization three times a day. per records, described as cloacal extrophy with bladder and uretheral reconstruction surgeries; patient reports it is a neo-urethera and her native bladder. - chronic renal insufficiency: baseline reported around 1.6, history of hyponatremia and metabolic acidosis as well. admitted to with acute renal failure and metabolic acidosis. per notes, she has been prescribed sodium bicarbonate in the past but not taken it. - history of e. coli urinary tract infections - depression - history of seizure in setting of metabolic acidosis and possible ingestion/overdose - prior respiratory failure requiring intubation social history: patient lives with roommate and boyfriend. she identifies mother as her contact person. - : + ppd - alcohol: occasional, none recently. - illicits: history of cocaine, heroin, benzodiazepine and barbituate use. states last use was over one year ago. on disability, not currently working. family history: no history of renal disorders. physical exam: admission exam: vitals: t: 97.3 bp: 112/56 p: 89 r: 38 o2: 100% on room air. general: ill appearing, breathing rapidly, able to speak words heent: sclera anicteric, oropharynx clear with very neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally on the right, rhonchi and rales in the left lower lung field near the axillia, no wheezes, rales, ronchi cv: borderline tachycardic, regular, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. + ileostomy on right side with brown stool in bag, + ostomy catherization site in midline suprapubic area. gu: no foley ext: cool, delayed capillary refill, faint pulses, no clubbing, cyanosis or edema pertinent results: labs: initial (): glucose-89 urean-97* creat-8.7* na-133 k-2.4* cl-108 hco3-<5 wbc-21.5* rbc-2.94* hct-24.5* mcv-83 mch-28.3 mchc-34.0 rdw-17.1* plt ct-268 . discharge (): glucose-116* urean-20 creat-2.5* na-137 k-4.3 cl-102 hco3-25 angap-14 wbc-5.4 rbc-3.30* hgb-9.7* hct-29.4* mcv-89 mch-29.5 mchc-33.1 rdw-18.3* plt ct-200 . microbiology: - stool c-diff: negative - mrsa screen: negative - urine culture: negative - r arm abscess: sparse pansensitive s. aureus, k. pneumoniae - blood culture: negative - blood culture: e. coli . radiology: renal us : limited examination with no evidence of gross hydronephrosis. . ct abd/pelvis : 1. single pelvic kidney, which demonstrates a lobular contour with multiple hypodense an mild hyperdense lesions with no definite evidence of hydronephrosis. the ureter is not well seen; however, there is no definite obstructing calculus. punctate foci of calcification within the pelvic kidney can represent non-obstructive calculi or paranchymal calcification. evaluation is limited due to lack of iv contrast. 2. bilateral lower lobe pneumonia and/or aspiration. 3. splenomegaly. absent uterus, urinary bladder reconstruction, right colostomy. 4. multiple congenital osseous abnormalities and caudal regression with sacral meningocele or myelomeningocele. . ct head : no acute intracranial process. . ct chest/abd/pelvis : 1. no evidence of thoracic, abdominal pelvic abscess formation. 2. interval improvement of the previously seen multifocal pneumonia. residual small bilateral pleural effusions and bibasilar atelectasis. 3. unchanged single left pelvic kidney with a lobular contour and multiple hypodense lesions, likely cysts. no evidence of abscess formation or hydronephrosis. 4. unchanged urinary bladder reconstruction, urostomy, and right ileostomy. . mra head : there is evidence of vascular flow in both internal carotids, however both middle cerebral arteries appears thin, given the clinical history vasospasm cannot be completely excluded, correlation with followup mri or cta are recommended if clinically warranted. no evidence of acute ischemic changes are demonstrated on the diffusion-weighted sequences. . mr : tethered cord with myelomeningocele as described above, single pelvic kidney and absence of the uterus. the sacrum is not completely identified and is compatible with caudal regression. please see the ct of the abdomen for further details. there is no evidence of epidural abscess formation. right ue us : superficial abscess corresponding to the area of clinical concern. . ct head : no acute intracranial process. . mr : no evidence of hemorrhage, edema, masses, mass effect, or infarction. overall, normal study. . neurology: eeg : this video eeg telemetry began with the patient in electrographic status epilepticus, which appeared to be non-convulsive in nature based on review of the video, although some left thumb twitching was noted. on eeg, rhythmic sharp wave activity was seen in a widespread bilateral distribution varying from a three per second up to six to seven per second frequency. after administration of intravenous lorazepam on the afternoon of , the electrographic status epilepticus resolved and an underlying slow and disorganized background in the theta frequency range suggestive of a mild to moderate encephalopathy was seen. brief periods of recurrence of higher amplitude widespread bilateral rhythmic sharp activity were seen in the early morning hours of , but these did not persist. . eeg to : these exams illustrated interval improvement from eeg on with decreased evidence for seizure activities. the last exam report are as listed here: this telemetry captured no pushbutton activations. however, it captured numerous second periods of generalized rhythmic activity with a frequency of 5 hz and embedded sharp waves that are suggestive of seizure activity; however, with no clear clinical correlate. there were also a few sharp waves seen in the right central area suggestive of increased cortical irritability in that region. the background activity was, at times, mixed with slower frequencies of waveforms suggestive of a mild encephalopathy. brief hospital course: ms. is a 30 year old female with history of hepatitis c, polysubstance abuse, chronic renal insufficiency, cloacal extrophy s/p bladder augmentation with neoureter reconstruction with small bowel who presents with dyspnea, found to have significant acidosis and acute on chronic renal failure with hypokalemia. . micu course (): . #) acidosis: the patient presented initially with significant metabolic acidosis with ph 7.18 at , pco2 8, and po2 of 150. anion gap is 20. the patient has a history of non-anion gap metabolic acidosis thought to be secondary to her ileal bladder augmentation and wasting of bicarbonate. however, on admission she also had a gap metabolic acidosis likely secondary to her renal failure and uremia. this improved with fluid challenges and bicarbonate. . #) hypokalemia: the patient also had severe hypokalemia, thus far has received 80 meq in intravenous fluids. gi (eg vomiting and diarrhea) is likely part of etiology of hypokalemia. she also has a history of hypokalemia based on her records from and may not have been repleting it properly prior to hospitalization. she received over 500meq of potassium while in the icu. her magnesium was repleted aggressively as well. . #) bacteremia: the patient started growing out e. coli in blood culture bottles resistant to bactrim, ampicillin and cipro, and on initial presentation also had a profound leukocytosis. source of her infection was likely a urinary tract infection, however a urine sample proved difficult to obtain. . #) seizure: on micu day 3 , the patient had two episodes of tonic/clonic seizures. the patient was intubated for airway protection and and was started on meningitis dosing of antibiotics - vancomycin/cefepime and acyclovir. the patient was placed on droplet precautions. a ct of her head showed no evidence of acute bleed and an mri was obtained that showed evidence of a meningomyelocele at the l5 region but no evidence of temporal lobe enhancement. neurology was consulted, who also recommended a lumbar puncture; however this was not obtained as the patient's mother declined consent. as such, the patient could not be ruled out for meningitis, however a urine tox screen came back positive for cocaine. further history provided by the patient's mother indicated that the patient has had similar episodes in the past, and was in the setting of substance abuse and withdrawal. an eeg was obtained, which showed no further seizure activity and the patient was extubated without difficulty. . #) acute on chronic kidney injury: baseline renal function per notes appears to be around 1.6, likely in part due to congenital malformation, which includes a solitary pelvic kidney. the patient reported that she has not urinated/self-catherized in several days. initial creatinine was greater than 8, which improved with iv fluids. renal ultrasound was negative for hydronephrosis, and the patient was able to urinate, albeit was incontinent of urine. the patient was unable to self-catheterize despite using her custom made ureteral catheter made by the surgeon that performed her operation. with aggressive hydration, the patient's creatinine improved to 2.6 by the time of transfer from the icu. . #) anemia: unknown baseline. normocytic. b12 and folate were normal, and iron studies were consistent with anemia of chronic disease. she received 1 unit of prbcs while in the unit. . #) history of substance abuse: the patient was slowly tapered back up to her maintenance dose of methadone of 130mg a day. her cocaine toxicology screen came back positive. . #) right arm hematoma: the patient was noted to have a large bump on her right arm early in her micu course. the area felt fluctuant but had no erythema or warmth. bedside ultrasound showed what appeared to be a hematoma. however, on micu day 6, the patient was complaining of worsening pain and the area appeared hot and red. an ultrasound of the area to look for abscess was ordered and was performed after transfer to the medicine floor. . ========================================================= medicine floor course (): . # altered mental status. patient was noted to speak slowly and exhibit psychomotor retardation on the day of callout from micu. mmse at that time was notable for deficits in serial 7s and "world" backwards as well as with execution of multi-step task. the following morning, she was noted to have an episode of agitation (pushing staff away, yelling) associated with anisocoria. she was evaluated by neurology service who noted no focal deficits. stat head ct was negative, and 20-minute eeg study showed non-specific findings suggestive of encephalitis. mental status seemed to improve somewhat over the weekend, but on she was observed to be non-verbal, refusing medications, and not following most commands. no focal neurologic deficits at that time. she was again evaluated by neurology team, who suspected possible psychiatric/behavioral etiology; psychiatry consult was called. 24-hour eeg study was ordered; once leads were connected, it became apparent that the patient was in non-convulsive status epilepticus. she received 2 mg of iv lorazepam with immediate improvement in mental status (asking "where am i? what is happening?"). she was dilantin-loaded with 100 mg iv. she developed reactive sinus tachycardia to 140s, and was transferred to the micu on neurology recommendation for closer observation overnight. . # electrolyte imbalances, acute-on-chronic renal failure. patient initially required frequent electrolyte checks and supplementation of potassium, magnesium, calciium, and phosphate but electrolytes stabilized within 2-3 days following arrival to the floor. creatinine also stabilized at 2-2.3. . # right arm abscess. patient continued to experience right forearm pain/swelling after transfer to the floor, so repeat ultrasound was undertaken. this study revealed abscess of earlier hematoma. incision and drainage was performed on . culture grew mssa and klebsiella spp. she was continued on her current course of iv antibiotics with vancomycin and cefepime (started to treat her e. coli bacteremia), with plan to continue 7 days of therapy (ending ) with levofloxacin after iv course complete. . # urinary retention. on , patient was unwilling/unable to self catheterize. she was noted to have urine leaking out of her fistula, and bladder scan showed > 800 cc. because she cannot be catheterized by nursing staff due to complicated anatomy, urology was called for urgent foley placement under cystoscopic guidance. foley was initially clogged with mucous but was eventually flushed and functioned appropriately. urology recommendations were for ostomy bag fitted to fistula site (as patient was exhibiting evidence of skin irritation and continued to leak urine from this site) as well as for follow up with pediatric urologist dr. at (for his greater familiarity with congenital anomalies such as this patient has). . = = = = = = = = = = = = = ================================================================ micu course ii (): . patient transferred back to micu on after patient found to be less talkative and staring into space in the morning. she was found to be in non-convulsive status epilepticus on eeg and was sent to the micu prophylactically in case phenobarbital arose overnight. her dilatin level was found to be low at 2.2 so she was reloaded with an additional 1gm iv and started on 100mg tid of dilantin. she again became non-responsive at 3:55pm (opened eyes to voice but did not otherwise respond). she got 2mg iv ativan. neurology felt like these events were consistent with a seizure (most likely secondary to low phenytoin level). neurology recommend that we continue eeg monitoring. her mental status was much improved on am and patient did not have any further events while here. she did develop tachycardia to 130s (asymptomatic, sitting up in bed). she was given a 1l ns bolus with good response of her hr. given that she was seizure-free and mentating well, patient was transferred to 11 (medicine/neuro floor) on . . . medicine floor course (): . #) seizure: patient had multiple push button activations with staring spells when she was non-verbal or spoke with two word answers but followed command. these were not correlated with epileptiform activities on eeg. however, she responded to ativan 2mg iv. patient was therapeutic on dilantin at this time so she was loaded with keppra 1g x1 and continued on a maintenance dose of 500mg based on renal function. eegs continued to show epileptiform activity but this was improved from before. patient had been started on treatment in the micu for presumed meningitis but this was discontinued after 12 days of therapy given compromised renal function. . #) acidosis: patient was thought to be wasting bicarbonate through her neobladder. a vbg showed: 7.26/42/40/20 consistent with poorly compensated metabolic acidosis. she was therefore started on standing sodium bicarb with improvement in her electrolytes. she at the time of discharge she appeared stable on nahco3 650 mg po daily. she will have her electrolytes monitored within one week of discharge. her new nephrologists will follow her outpatient labs. #) abdominal pain: prior to discharge, patient developed abdominal pain. her physical exam was benign. her sodium bicarbonate was decreased as bloating may have contributed to her discomfort. she was tolerating pos and had unremarkable lfts. on the day of discharge, patient no longer had abdominal pain. . #) hypokalemia: the patient has had problems with recurrent hypokalemia during her admission. she received about 100meq of k+ over so she was started on a daily dose of 25meq on . this was stopped and her potassium remained stable on . she will have her electrolytes monitored one week after discharge. her electrolytes will be followed by her new nephrologist dr. and dr. . . #) acute on chronic kidney injury: baseline renal function per notes appears to be around 1.6, likely in part due to congenital malformation, which includes a solitary pelvic kidney. her creatinine continued to hover around 2.1-2.3 during the rest of her stay. she will follow up with nephrology after discharge. . #) anemia: she was started on epoietin alfa on and discharged on weekly epo to be administered by her mother, who is a nurse. . #) history of substance abuse: her urine toxicology was only positive for methadone. the patient was then maintained on her home dose of methadone of 130mg a day. her last dose of 130mg was given on at 7:00am. she was given the contact information for aa and for a drug treatment hotline. . #) right arm abscess: s/p incision and drainage. she received a course of vancomycin and cefepime. . #) anxiety: she had multiple episodes of anxiety, which would often prompt her to behave erratically and act out. she was started on sertraline and received prn doses of ativan for acute anxiety while here. she is to continue the sertraline after discharge. . #) sinus tachycardia/tfts: patient had persistent sinus tachycardia. it was unclear if it might be due to anxiety, hypovolemia, or increased adrenergic discharge given acute illness. tfts showed an elevated tsh at 24 with a normal free t4. as these were drawn in the setting of her acute illness and recent icu stay, would repeat as outpatient after she has recovered. she was not tachycardic upon discharge. . code: full . emergency contact: mother or aunt . . dispo: home with mother . medications on admission: - amlodipine 5mg po daily - hctz 25mg po daily - atenolol 50mg po daily - lovastatin 40mg po qhs - trazodone 1-2 tabs po qhs - wellbutrin 150mg po daily - aspirin 81mg po bid - fish oil 1 tab po bid - ibuprofen prn - benadryl prn - ca + vit d - multivitamin . medications on transfer: - heparin 5000units sq tid - clindamycin 600mg iv q8hrs - chlorhexidine gluconate 0.12% oral rinse 15ml po bid - ondansetron 4mg iv q8hrs prn nausea - colace 100mg po bid - senna 1tab po bid prn constipation - bupropion sr 150mg po qam - benadryl 25mg po q6hrs prn itching - morphine 2-4mg iv q4hrs prn pain - oxycodone 5mg po q3hrs prn pain discharge medications: 1. methadone 40 mg tablet, soluble sig: three (3) tablet, soluble po once a day. 2. phenytoin sodium extended 100 mg capsule sig: one (1) capsule po tid (3 times a day). :*90 capsule(s)* refills:*2* 3. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed for skin irritation. :*1 bottle* refills:*0* 4. epoetin alfa 10,000 unit/ml solution sig: one (1) ml injection once a week: to be given by subcutaneous injection with the help of your mom. :*4 ml* refills:*0* 5. sertraline 25 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*2* 6. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). :*60 tablet(s)* refills:*2* 7. sodium bicarbonate 650 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*2* 8. outpatient lab work please have your chem 10 and cbc monitored by . the results should be faxed to your new nephrologists dr. and dr. at (. discharge disposition: home discharge diagnosis: e. coli bacteremia (bloodstream infection) acute renal failure metabolic acidosis non-convulsive seizures post obstructive uropathy anemia of chronic disease discharge condition: alert & oriented x3. ambulating without issues. afebrile, hemodynamically stable, no pain, seizures controlled on oral medications. discharge instructions: you were admitted to the hospital because you had difficulty breathing and your kidney was not working well. you also had not been able to catheterize your bladder for a few days before then and we found that you had a bacteria in your bloodstream called e coli. . while you were in the hospital, you had a non-convulsive seizure and required phenytoin (dilantin) and keppra (also called leviteracetam). you were treated with antibiotics in case you had an infection that might be causing the seizures. it is important for you to take your seizure medications regularly. drinking alcohol, losing sleep, and being stressed can all cause you to have seizures. it is not safe for you to drive a car or swim alone because of these seizures. . many patients struggle with drug problems. we encourage you to follow through with the aa meeting and the drug treatment hotline that you discussed with our social worker. . it is very important that you take your medications consistently and as directed. . ***medication changes:*** started phenytoin (also called dilantin) for seizures started keppra (also called levetiracetam) for seizures started epo (erythropoietin) for your low blood counts; your mom can give you an injection once a week started sertraline 25mg daily for anxiety started sodium bicarbonate 650 mg by mouth daily to help keep your acid/base balance started miconazole powder for the skin irritation around your ostomy bag. followup instructions: please have your electrolytes and blood counts monitor by , . the results should be faxed to your new nephrologists dr. and dr. at (. . pcp: . office does not have any appointment available until . however, with her secretary's recommendation, we have scheduled you an appointment with one of her colleagues, dr. on at 10am. this is located in the internal medicine associates, suite c. . nephrology: at 1pm with dr. . building, building 'west specialties' neurology: at 8am with dr. building , urology: dr. at , at 12:00. , of building. . clinic: we will provide you with a letter to take to clinic so that you can continue your care there. . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube transfusion of packed cells diagnoses: acidosis thrombocytopenia, unspecified anemia in chronic kidney disease tobacco use disorder friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute kidney failure, unspecified unspecified viral hepatitis c without hepatic coma depressive disorder, not elsewhere classified cocaine abuse, unspecified hypopotassemia chronic kidney disease, unspecified acute respiratory failure bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site cellulitis and abscess of upper arm and forearm grand mal status metabolic encephalopathy other and unspecified coagulation defects opioid abuse, continuous ileostomy status sedative, hypnotic or anxiolytic abuse, unspecified other specified retention of urine meningitis, unspecified renal agenesis and dysgenesis dyspepsia and other specified disorders of function of stomach spina bifida without mention of hydrocephalus, lumbar region 

Answer: The patient is high likely exposed to