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: history of present illness: this is a 77-year-old woman with a history of coronary artery disease, noninsulin dependent diabetes mellitus, and hypertension who was admitted to the ccu with hypotension and new atrial fibrillation in the setting of urosepsis. the patient was intubated for airway protection. she was in her usual state of health which was mildly confused and occasionally agitated but able to converse and propel herself in a wheelchair until the day of admission when she was noted by the nursing staff in her nursing home to be somnolent and diaphoretic with elevated fingerstick blood sugars. she was also relatively hypotensive with a blood pressure of 80/60. her white blood cell count at was 16,000 with 2% bandemia. she was transferred to for evaluation. at the nursing home, she had received 500 mg of levaquin. upon presentation to the emergency room in the afternoon, her vital signs revealed temperature 101.8, heart rate 109, blood pressure 107/43. intravenous fluids were initiated at that time. head ct was negative for bleed. blood pressure stayed in the high 90s systolic until the evening of admission when she developed atrial fibrillation with a rapid ventricular rate to 160-170. three cycles of cardioversion were attempted with apparent atrial rhythm induced but not sustained. an amiodarone drip with bolus, dopamine, and levophed were started. a right subclavian line and femoral arterial line were placed. the patient had a blood pressure of 60-90/palpable for approximately 90 minutes. a blood pressure of 150/110 was achieved with dopamine 20, levophed 30, and after 8 liters of normal saline. the dopamine was weaned to off in the emergency room. the patient was transferred to the ccu. she did transiently assume what appeared to be atrial rhythm. dr. and the ccu fellow were contact regarding the plan. the strategy was to intubate the patient and to use pressors/inotropics and cardioversion as needed but not to pursue catheterization. past medical history: the past medical history revealed coronary artery disease in ; hypertension; noninsulin dependent diabetes mellitus; diabetic retinopathy; status post cerebrovascular accident in ; status post cholecystectomy in ; right cataract; obesity; chronic low back pain; urinary incontinence; dementia/mild mental retardation. medications: zestril 10 mg q.d., ecasa 325 mg q.d., regular insulin sliding scale, multivitamins, lopressor 100 mg b.i.d., vitamin e 400 international units q.d., remeron 15 mg q.h.s., and health shakes. allergies: no known drug allergies. family history: the patient has a brother with coronary artery disease and diabetes. her , uncle, and a sister had no known medical problems. social history: the patient lives at nursing home. she was previously with her sister. she has a ten pack year smoking history. she was a hotel maid. she is a widow without children. she does not drink alcohol. physical examination: vital signs revealed atrial fibrillation with a ventricular rate of 130, blood pressure 120/72, o2 saturation 100%. arterial blood gas revealed ph 7.32, po2 415, oxygen saturation 100%. ventilation settings were 16x600, fio2 100, peep 5. in general, the patient was resting in bed, intubated and sedated. the skin was warm and dry. heent examination revealed normocephalic, atraumatic. the left pupil was round, regular, and reactive to light 3 to 2 mm. there was a right cataract. the patient was edentulous. there were upper isolated teeth. the neck was supple without lymphadenopathy. the lungs were clear to auscultation anteriorly with no wheezes. there was a right subclavian line. cardiovascular examination revealed irregularly irregular, normal s1 and s2, no s3, no s4, and no murmurs. carotids revealed normal volume and upstrokes, no bruits. the abdomen was soft, nontender, and nondistended with hypoactive bowel sounds. the extremities revealed no clubbing, cyanosis, or edema. there were 2+ dorsalis pedis and posterior tibialis pulses bilaterally. there was positive hyperpigmentation of the right shin. pertinent laboratory data on admission: white blood cell count was 10 with differential of neutrophils 52%, bands 24%, lymphocytes 14%, monocytes 4%, atypical lymphocytes 4%, metas 2. hematocrit was 44.7, platelets 328,000, pt 14.4, ptt 23.1, inr 1.4. urinalysis was turbid, specific gravity 1.025, positive blood, positive glucose, greater than 50 white blood cells, many bacteria. albumin was 3.3, magnesium 2.4, calcium 9.8, phosphorus 2.5, sodium 149, potassium 4.4, chloride 110, bicarbonate 22, bun 79, creatinine 1.6, glucose 480, alt 33, ast 74, alkaline phosphatase 126, amylase 133, total bilirubin 0.4, lipase 15, ck 362, mb 17, index 4.7, troponin greater than 50. arterial blood gas revealed 7.31/25/578. lactate was 6.8, potassium 3.5, calcium 0.79. the next arterial blood gas that same night revealed 7.25/27/501. the next arterial blood gas the next day revealed 7.42/35/276. on blood cultures twice were pending. urine culture was pending. electrocardiogram on revealed atrial fibrillation at 110, axis 97 degrees, intervals 0.128 and 0.455, st elevation to 1 mm in iii and 0.5 mm in avf, st elevation to 1 mm in v2-v3, 7 mm in v3-v4, depression in i and avl. another electrocardiogram revealed atrial fibrillation at 160, axis 87 degrees, intervals 0.94 and 0.485, st elevation of 1.5 mm in iii and 0.5 mm in avf, st elevation of 1 mm in v1 and v2-v4, and inversion in v5. the next ekg also on revealed normal sinus rhythm at 96, axis 68 degrees, and intervals 102, 0.88, and 0. elevation of 1 mm in iii and 0.5 mm in avf, st elevation of 1 mm in v1, 2 mm in v2-v3, 1 mm in v4, and st depression of 1 mm in i and avl. chest x-ray revealed left lower lobe atelectasis/consolidation, no pneumonia, right subclavian line, and ett in right main-stem bronchus pulled back. ct of the head was negative for intracranial hemorrhage. echocardiogram on revealed normal size left atrium, normal size right atrium, left ventricular thickness size normal, ejection fraction of 40%, right ventricular chamber/motion normal, no aortic stenosis or aortic insufficiency, no mitral regurgitation or mitral stenosis, no tricuspid regurgitation, mild pulmonary hypertension, and severe hypokinesis of all apical segments. in the apex, there was no thrombus. there was hypokinesis of the anterior septum, akinesis of the apex, no thrombus, and hypokinesis of the anterior septum and free wall. impression: this is a 77-year-old woman with history of coronary artery disease (positive troponins and abnormal echocardiogram, no catheterization) who presented with hypotension, increased ck and troponin, and new atrial fibrillation in the setting of urosepsis. hospital course cardiovascular/myocardium: the patient had an ejection fraction of 40% by echocardiogram on with residual hypokinesis. outpatient medication regimen consisted of ace inhibitor and beta blocker. it was decided to reassess the myocardial function after the episode of atrial fibrillation and hypotension was passed and to restart the ace inhibitor and beta blocker when the patient was no longer pressor or inotropic dependent. the patient's decreased blood pressure was thought to be secondary to sepsis and atrial fibrillation with good response to the dopamine and levophed. the levophed was weaned off by hospital day #2 with systolic blood pressures in the 110s over diastolics in the 60s. she was maintained on diltiazem drip for three days for atrial fibrillation but this was discontinued by hospital day #3. she was started on captopril on hospital day #2 and titrated gently. this was held on hospital day #4 for systolic blood pressure in the 70s that responded to gentle fluid boluses. a transthoracic echocardiogram on hospital day #4 showed progressive left ventricular dysfunction with an ejection fraction of about 20%. captopril was restarted on titrated. by the time of discharge, the patient's captopril was at 25 mg p.o. t.i.d. and lopressor was increased to 25 mg p.o. b.i.d. coronary: the patient had been recently admitted to prior to this admission. at that time her troponin was elevated with negative ck. a recent history of chest pain was elicited then. she had no health care proxy and at that time the decision was made to proceed with medical management rather than catheterization. aspirin was continued and heparin drip was placed for 48 hours initially and plavix was started. in addition on admission, the ekg had st elevations in the inferior and anterior leads with pseudonormalization in t wave inversion in the anterior leads. for this admission, it was also decided to manage the patient medically and she was not considered a catheterization candidate. her lipid panel was checked during this hospitalization with increased total cholesterol to 217. hdl was 25, ldl 149, and triglycerides 216. on , she was started on 10 mg q. day of lipitor. conduction: the patient had never had a history of atrial fibrillation. her left atrium was not enlarged on her recent echocardiogram. she developed the atrial fibrillation in the setting of fever and sepsis. cardioversion was attempted times three. she attained an atrial rhythm that was not durable. she was loaded with amiodarone. repeat cardioversion again was without durable response. the patient did have 20 minutes of spontaneous conversion. she was placed on amiodarone drip. it was considered on admission to consider an amiodarone load of 150 mg intravenously and then follow it by cardioversion. the diltiazem drip was stopped after 72 hours. she was initially on heparin for 48 hours. she spiked to 102.4 degrees farenheit on hospital day #3 and went back into atrial fibrillation at a rate of 120s and was restarted on heparin drip at that point and diltiazem drip and this was stopped the following morning on hospital day #4. again on hospital day #6, the patient had a fever to 99 degrees and went back into atrial fibrillation for two hours and then self converted to atrial rhythm. on discharge, the patient had been in atrial rhythm for three days and was on amiodarone 400 mg p.o. b.i.d. her tsh from was 1.3 indicating a normal thyroid function as a baseline. she will need to have pulmonary function tests in the future. her liver tests were also stable on discharge with an alt of 22, ast 41, alkaline phosphatase 91, total bilirubin 0.2. hypotension: hypotension was deemed to be due to two causes--sepsis versus atrial fibrillation. she responded well to pressor/inotropic support with aggressive rehydration. she received intravenous fluids for a while as she was ventilated. pulmonary: the patient was intubated and easily oxygenated and ventilated. she was gradually weaned off the oxygen. she initially had metabolic acidosis and was intentionally hypoventilated. her acidosis was thought to be likely secondary to lactic acidosis generation during an episode of hypoperfusion. her arterial blood gases were followed. the metabolic acidosis was also thought to be secondary to receiving 8 liters of normal saline in the emergency room. pressure support trial on hospital day #3 failed to decreases in her tidal volume. as the patient mobilized fluid and diuresed aggressively, she developed contraction alkalosis. in the setting of increased ph, the patient failed pf trials on hospital days #6 and #7 with low tidal volumes and setting off apnea alarms. as the metabolic alkalosis resolved with decreased diuresis and potassium supplementation, the patient was extubated on hospital day #9 on and maintained o2 saturations of 98-100% on 100% fio2 with a mask initially which was weaned off and by the time of discharge, she was having a good o2 saturation on room air. infectious disease: the patient was admitted with urosepsis. she had a recent discharge in during which she had an e. coli urinary tract infection at that time. she had no indwelling foley catheter on admission. she received one dose of p.o. levofloxacin 500 mg at the nursing home on the day of admission. intravenous levofloxacin was added. gentamicin was avoided because of the concern of nephrotoxicity. the patient's urosepsis was found to be secondary to proteus. she was on levaquin for two days when she spiked to 102.4 and was pancultured. she was started on vancomycin and ceftazidime. on hospital day #3, sputum culture was positive for methicillin-sensitive staphylococcus aureus and she was switched to oxacillin and ciprofloxacin. her white blood cell count climbed to 18.1 on hospital day #7 but eventually decreased to the point of 10.1 on . was the last day of her ciprofloxacin, having had a 10 day course, and her vancomycin was switched to oxacillin for methicillin-sensitive staphylococcus aureus pneumonia and upon discharge, she was on day 8 of 14. it was thought that if she spiked another fever or the white blood cell count rose again, she would have an ultrasound done of her kidneys done to rule out renal abscesses. three clostridium difficile tests were negative when she had diarrhea during this hospital stay. renal: the patient had a baseline creatinine of 0.6 to 0.8. on admission, the creatinine was 1.7. it was felt to be due to obstructive uropathy secondary to retention secondary to urinary tract infection. also there was a possibility of acute tubular necrosis secondary to ischemia or prolonged episode of decreased blood pressure. it was decided to avoid gentamicin because of its nephrotoxic nature. she had very low urine output on admission and was hydrated aggressively. she was initially hypotensive and received a total of 8 liters of normal saline in the emergency room. the patient's bun and creatinine stabilized over the course of her hospitalization stay with bun of 11 and creatinine of 0.5 on . she autodiuresed for three days and then with decreased urine output received lasix boluses which caused her to diurese aggressively for another three days with approximately 1-2 liters per day. on hospital day #8, the patient had contraction alkalosis and we tried to keep the patient even to slightly negative fluid balance. gastrointestinal: the patient was placed on protonix and colace as prophylaxis for gastritis and constipation. she was npo initially but started on tube feeds on hospital day #3. when she was found to have an albumin of 1.9, she was continued on tube feeds but these were held prior to extubation. she was extubated on and on , she was started on a cardiac/ diet. the patient did suffer from diarrhea during her hospitalization stay with a rectal tube in place. this was checked for clostridium difficile three times which were all negative. hematology: the patient was on a heparin drip for 48 hours. her hematocrit and platelets were stable throughout her hospitalization without requiring transfusions. heparin drip was restarted on hospital day #3 for recurrent atrial fibrillation but then it was discontinued. the patient's baseline hematocrit was in the upper 20s and on was 28.8. this anemia will need a workup as an outpatient. endocrine: the patient has noninsulin dependent diabetes mellitus. she has been on oral antihyperglycemics in the past but most recently she was on a regular insulin sliding scale. on admission, her fingerstick blood glucoses were in the 400s. she needed 32 units of regular insulin. it was decided to start an insulin drip on admission. this was quickly changed to regular insulin sliding scale as her glycemic control became better and she was continued on this with good glycemic control. fluids, electrolytes, and nutrition: the patient was on aggressive intravenous fluids at the beginning with bolusing as necessary. the patient had a massive diuresis and became euvolemic. her tube feeds which were started were held prior to extubation and she was started on p.o. meals on the morning of . during her diuresis, she was repleted with potassium aggressively and potassium was continued to be followed. on , potassium was 3.7 and she was repleted with 40 meq of k-dur. her diet started on was cardiac, low sodium, 1800 kilocalorie diet. neurologic/mental status: the patient has baseline dementia versus mild mental retardation. it was decided to resume remeron when she was taking good p.o. the patient also has a history of cerebrovascular accident in with a chronic right facial droop. once she was extubated, she was able to communicate appropriately. prophylaxis: the patient was on subcutaneous heparin b.i.d. lines: initially the patient had a right wrist a-line and right subclavian line as well as a foley catheter and rectal tube in place. her right subclavian line was discontinued on and a left peripheral iv line was placed instead. on , her radial artery line was discontinued. her rectal tube was also discontinued prior to discharge. code status: full code, the patient does not have a durable power of attorney although she does have a sister. she has mild mental retardation. it is unclear whether the patient is competent or not. disposition: the patient was transferred to the medical floor on and she was deemed to be stable at this point. a physical therapy consultation was requested. condition on discharge: stable. discharge status: back to nursing home. discharge medications: amiodarone 400 mg p.o. b.i.d., heparin 5000 units subq. b.i.d., oral medication equivalent to oxacillin will be started--unclear at this time which one--to complete a 14 day course for methicillin-sensitive staphylococcus aureus pneumonia, colace 100 mg p.o. b.i.d., plavix 75 mg p.o. q.d., regular insulin sliding scale, aspirin 325 mg p.o. q.d., zantac 150 mg p.o. b.i.d., captopril 50 mg p.o. t.i.d., lopressor 25 mg p.o. b.i.d., lipitor 10 mg p.o. q.d., protonix 40 mg p.o. q.d., remeron 15 mg p.o. q.h.s. discharge diagnoses: proteus urosepsis; atrial fibrillation; noninsulin dependent diabetes mellitus; hypertension; coronary artery disease. dr., 11-500 dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization diagnoses: acidosis anemia, unspecified urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other pulmonary insufficiency, not elsewhere classified atrial fibrillation alkalosis methicillin susceptible pneumonia due to staphylococcus aureus infection and inflammatory reaction due to other vascular device, implant, and graft 

Answer: The patient is high likely exposed to