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: chief complaint: vomiting, dehydration reason for micu transfer: dka, hypotension major surgical or invasive procedure: central venous line placement arterial line placement history of present illness: pt is a 69yof w/ h/o of iddm with no prior episodes of dka, htn, pvd, and celiac disease who presented with 4 days of n/v. she also reports poor po intake over the past several days (has not been able to tolerate even fluids), lightheadedness, dry mouth, visual changes x 2 days (objects look "bright" and slightly blurry). pt reports that she has been using her insulin, but has not checked fingersticks x 4 d after her glucometer stopped working. in addition, she has not taken po meds x 2-3 days. the pt has also has had some back pain after falling 1 1/2 weeks ago, but xray at her pcp's showed no fractures. she denied any diarrhea or fevers. her last bm wasa typical solid bm 2 days ago. she denied chest pain and sob although her sister noted that her breathing was more labored than usual. in the ed, the patient was hypotensive with sbps in the 60s and appeared confused. she received 4l ivf with poor response; therefore, a l ij was placed and the patient was started on levophed. her physical exam was notable for diffuse abdominal tenderness and crackles bilaterally. labs were notable for blood sugar 825 so patient was started on an insulin gtt. na 123, k 6.2, bicarb 6, cre 3.3, ag 36, and lactate 3.1. wbc was 19.8 and blood cultures and urine cultures were sent. the patient was also started on ua showed 1000 glucose, 10 ketones, 33 wbc and moderate bacteria with no nitrates and moderate leuk esterase. in the ed, the patient was started on vanc. labs were also notable for a trop-t of 0.78 and a probnp 3933 even though the patient has no history of chf. ekg showed sinus rhythm with tw changes in avl and st depression in leads ii and v3-v5; these findings are different from her old ekg. en route to the micu, the patient's vitals were hr 82 bp 100/39 100% on 2l. upon arrival to the micu, the patient's vitals were hr 99 bp 95/42 100% on 2l. the patient received a repeat ekg confirmed twi and st depressions seen in the ed. past medical history: type 1 diabetes c/b retinopathy and neuropathy hypertension breast ca legally blind s/p cholecystectomy hx of stage ii breast cancer hyperlipidemia celiac disease chronic utis on suppressive methenamine osteoporosis social history: she lives alone, no tobacco or alcohol use. family history: notable for several members with breast cancer. physical exam: admission vitals: t: 98.4 bp: 95/42 p: 99 r: o2: 100% on 2l general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly, no cvat bilaterally, no suprapubic tenderness gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: no focal deficits discharge: pertinent results: admission ================== 01:25pm blood wbc-19.8*# rbc-3.91* hgb-12.4 hct-39.3 mcv-100*# mch-31.7 mchc-31.6# rdw-13.4 plt ct-453* 01:25pm blood neuts-92.4* lymphs-4.0* monos-3.3 eos-0.2 baso-0.2 01:30am blood pt-9.4 ptt-20.8* inr(pt)-0.9 01:25pm blood glucose-825* urean-57* creat-3.3*# na-123* k-6.2* cl-81* hco3-6* angap-42* 01:25pm blood alt-31 ast-47* ck(cpk)-309* alkphos-132* totbili-0.3 01:25pm blood ck-mb-22* mb indx-7.1* probnp-3933* 01:25pm blood albumin-4.3 calcium-8.8 phos-9.5*# mg-2.4 02:49pm urine color-yellow appear-hazy sp -1.012 02:49pm urine blood-neg nitrite-neg protein-tr glucose-1000 ketone-10 bilirub-neg urobiln-neg ph-5.0 leuks-mod 02:49pm urine rbc-2 wbc-33* bacteri-mod yeast-none epi-<1 02:49pm urine casthy-25* 08:07pm urine color-yellow appear-hazy sp -1.012 08:07pm urine blood-tr nitrite-neg protein-tr glucose-neg ketone-tr bilirub-neg urobiln-neg ph-5.0 leuks-lg 08:07pm urine rbc-1 wbc-67* bacteri-none yeast-none epi-1 08:07pm urine castgr-8* casthy-2* urine culture (preliminary): escherichia coli. >100,000 organisms/ml.. prior to discharge: ======================= imaging: ========================= tte : the left atrium is normal in size. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is mildly depressed (lvef= 45 %) secondary to hypokinesis of the apical half of the anterior septum, anterior free wall, and lateral wall, with focal apical dyskinesis. the rest of the left ventricular segments appear hyperdynamic without outflow tract obstruction. right ventricular chamber size and free wall motion are normal. the aortic valve is not well seen. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. renal u/s : limited study. no evidence of hydronephrosis, stone, or mass in either kidney. cxr : portable ap upright chest radiograph was obtained. low lung volumes noted. allowing for this, the lungs appear clear. no large effusion or pneumothorax is seen. the cardiomediastinal silhouette appears normal. a calcified granuloma projects over the right lateral mid lung. bony structures are intact. brief hospital course: primary reason for hospitalization: ======================================= ms is a 69yof with a history of type 1 diabetes and htn who presented with nausea and vomiting found to have dka, a uti, and elevated troponin active issues: ===================== 1.) diabetic ketoacidosis: the patient was admitted to the micu and was placed on an insulin drip. she was hypotensive and required aggressive fluid repletion. after her anion gap was closed she was transitioned back to sc insulin and transferred to the medical floor. the precipitating factor for her dka was most likely a urinary tract infection although alternatively it could have been that the cardiac event triggered the dka and the uti is incidental. -the patient's home insulin regimen was modified in consultation with . nph was changed to 26 u am and 6 u pm. -she will follow-up closely with her endocrinologist at 2.) nstemi / cardiomyopathy: in the micu the patient was noted to have ekg changes and her troponin was as high as 3. initially there was concern for an acute coronary syndrome; however she subsequently had an echocardiogram which showed apical hypokinesis consistent with takotsubo/stress induced cardiomyopathy. this was likely due to physiologic stress from the dka and profound volume depletion. the patient's cardiac biomarkers began to trend downwards without any coronary intervention. she never had chest pain at any point. alternatively these ekg changes and biomarker elevations could be explained by a mid lad infarction but this was deemed less likely based on patient's history. cardiology was consulted who recommended that the patient continue aspirin and atorvastatin that she was already on. -dr. will see patient in cardiology clinic in ~3 weeks and will repeat an echocardiogram to assess for recovery of lv function and to determine whether further risk stratification (e.g. stress testing) is warranted. 3.) uti: cultures grew e. coli sensitive to ceftriaxone. the patient has a history of recurrent utis and this developed despite patient being on suppressive therapy with methenamine. - patient will go home on po cefpodoxime for a total course or 14 days antibiotic coverage - outpatient workup on why patient has recurrent utis 4.) acute kidney injury: creatinine peaked at 3.3, but returned back to baseline of ~1.0 with volume resuscitation. most likely it was pre-renal azotemia from volume depletion from dka. chronic issues: =================== #) celiac disease: - coninued gluten free-diet. transitional issues: ======================== # dr. will see patient in cardiology clinic in ~3 weeks and will repeat an echocardiogram to assess for recovery of lv function # communication: patient, (sister) # code: confirmed full medications on admission: preadmission medications listed are correct and complete. information was obtained from patientwebomr. 1. fosinopril *nf* 40 mg oral daily 2. atorvastatin 80 mg po daily 3. nph 30 units breakfast nph 10 units bedtime regular 10 units breakfast regular 8 units dinner 4. calcarb 600 with vitamin d *nf* (calcium carbonate-vitamin d3) 600 mg(1,500mg) -200 unit oral daily 3 tablets 5. omega-3 fatty acids-vitamin e *nf* 1,000 mg oral daily 6. aspirin 81 mg po daily 7. methenamine hippurate *nf* 1 gram oral 8. ascorbic acid mg po bid 9. actonel *nf* (risedronate) 35 mg oral qweek 10. multivitamins 1 tab po daily 11. codeine-guaifenesin *nf* 100 mg-10 mg/5 ml liquid oral 1 teaspoon(s) by discharge medications: 1. aspirin 81 mg po daily 2. atorvastatin 80 mg po daily 3. actonel *nf* (risedronate) 35 mg oral qweek 4. ascorbic acid mg po bid 5. calcarb 600 with vitamin d *nf* (calcium carbonate-vitamin d3) 600 mg(1,500mg) -200 unit oral daily 3 tablets 6. fosinopril *nf* 40 mg oral daily 7. multivitamins 1 tab po daily 8. omega-3 fatty acids-vitamin e *nf* 1,000 mg oral daily 9. cefpodoxime proxetil 400 mg po q12h duration: 6 days rx *cefpodoxime 200 mg 2 tablet(s) by mouth twice daily disp #*24 tablet refills:*0 10. codeine-guaifenesin *nf* 100 mg-10 mg/5 ml liquid oral 1 teaspoon(s) by mouth q 4 hrs prn 11. nph 26 units breakfast nph 6 units bedtime insulin sc sliding scale using hum insulin discharge disposition: home with service facility: homecare discharge diagnosis: primary - diabetic ketoacidosis - complicated uti - sepsis - nstemi and stress induced cardiomyopathy - constipation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: ms. , it was a pleasure taking care of you here at . you were admitted to the hospital because of nausea and vomiting. this was due to diabetic ketoacidosis. you were treated in the intensive care unit (icu) and your blood sugars came back down. you had some modifications made to your insulin which are detailed on the next page. you also were treated for a urinary tract infection (uti). you will need to keep taking antibiotics after you leave to complete a full course. we ask that you stop taking methenamine until you see dr. on . in addition you developed a problem with your heart called "stress induced cardiomyopathy". we think this was due to the stress on your body from your illness. you will need to see dr. in cardiology clinic as detailed below for further testing. followup instructions: department: endocrinology- diabetes center name: dr. when: tuesday at 2:30 pm. location: diabetes center address: one place, , phone: notes: please arrive 30 minutes prior to your visit with dr. . department: ophthalmology- diabetes center name: dr. when: thursday at 9:00 am location: diabetes center address: one place, , phone: notes: you will be seen by a senior technician prior to your visit with dr. . department: internal med. when: friday at 10:00 am with: , md building: (, ma) campus: off campus best parking: free parking on site department: cardiac services when: wednesday at 2:40 pm with: , md building: campus: east best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: acidosis subendocardial infarction, initial episode of care urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia hyposmolality and/or hyponatremia personal history of malignant neoplasm of breast unspecified fall polyneuropathy in diabetes sepsis constipation, unspecified other and unspecified hyperlipidemia long-term (current) use of insulin osteoporosis, unspecified celiac disease personal history of noncompliance with medical treatment, presenting hazards to health hypovolemia backache, unspecified atherosclerosis of native arteries of the extremities, unspecified other specified hypotension diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with ophthalmic manifestations, type i [juvenile type], uncontrolled diabetes with ketoacidosis, type i [juvenile type], uncontrolled legal blindness, as defined in u.s.a. background diabetic retinopathy takotsubo syndrome other and unspecified escherichia coli [e. coli] other fluid overload long-term (current) use of antibiotics 

Answer: The patient is high likely exposed to