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: ace inhibitors attending: chief complaint: fever/chills, hypotension major surgical or invasive procedure: none history of present illness: 79m with af (on coumadin), diastolic chf, cri (cr baseline 1.4-1.6), h/o breast cancer, recently admitted for chf exacerbation, presents with fever/chills this afternoon. he also suffered from a mechanical fall in bathroom, but did not hit his head and also denies any loc. no syncope either. he reportedly only slipped on a film of water. however, he could not get up and ems was called. his heart rate was found to be the 170s. he received 8mg of cardizem iv and hr decreased to 80s, but also spbs to 80s. pt received 250cc ivf bolus with spb coming up to 120s. . in the ed, his vs were t103.8, hr 105, bp 130/28, rr 37 (down to 21 on nrb), o2 sats 83% on ra, requiring a nrb to keep sats in high 90s. his diastolic bp remained in the 20s and he received another 300ml ivf bolus. in addition, a r ij was placed as part of code sepsis. lactate was 2.7 but immediate repeat lactate was only 1.5. ua was positive. cr at baseline. wbc was 9.2 from baseline of 6 (with 92% neutrophils). ekg with af at 99. cxr with volume overload. bnp of . he received on dose of tylenol 650mg pr and vanco/levo/flagyl iv and was admitted for suspected sepsis. . on arrival in the icu, he was in nad with bp 90s/40s, satting well on nrb which could rapidly been weaned to nc. . on ros, he denied any chest pain, sob, palpitations, pain anywhere, current f/c. also no dysuria but urinary frequency. no new cough or sputum production (but mild, chronic dry cough). no increased salt intake or changes in his medications since his recent discharge. 3 lbs weight gain since recent discharge. was advised to take extra dose of 20mg torsemide per his cardiac rn this afternoon. in addition, ros positive as above. past medical history: diastolic chf atrial fibrillation male breast cancer s/p r mastectomy in hypertension dyslipidemia gout social history: drinks one drink per night. no w/d symptoms ever. no current smoking. last in . has been teaching physics at . family history: noncontributory physical exam: vs - t98.0, bp 102/42, hr 95 in af, 27, 94% on 4l nc, cvp 4 gen: elderly male in nad. oriented x3. irritable. heent: sclera anicteric. perrl, eomi. dry mm, clear op. neck: supple with jvp of 10 cm. cv: irregularly irregular, normal s1, s2. 2/6 sem at rusb. systolic murmur over mitral area with radiation to axilla. no thrills, lifts. no s3 or s4. chest: resp were slightly labored. no r/r/w. ctab. abd: soft, ntnd. no hsm or tenderness. ext: 1+ ankle edema b/l. 1+ dp pulses b/l skin: + stasis changes bilateral le. no ulcers, scars, or xanthomas. pertinent results: admission labs: 05:00pm wbc-9.2# rbc-4.71 hgb-13.9* hct-43.4 mcv-92 mch-29.6 mchc-32.2 rdw-17.4* 05:00pm neuts-92* bands-2 lymphs-0 monos-6 eos-0 basos-0 atyps-0 metas-0 myelos-0 05:00pm plt smr-low plt count-108* 05:00pm pt-20.3* ptt-28.3 inr(pt)-1.9* 05:00pm glucose-119* urea n-85* creat-1.3* sodium-136 potassium-4.2 chloride-96 total co2-25 anion gap-19 05:00pm calcium-8.7 phosphate-2.3* magnesium-2.3 05:38pm lactate-2.7* 05:00pm ctropnt-0.05* 05:00pm probnp-* . discharge labs: 05:50am blood wbc-7.5 rbc-4.14* hgb-12.5* hct-39.3* mcv-95 mch-30.1 mchc-31.7 rdw-17.6* plt ct-113* 05:50am blood glucose-127* urean-61* creat-1.0 na-141 k-3.9 cl-104 hco3-29 angap-12 05:50am blood calcium-8.5 phos-2.8# mg-2.4 . imaging: renal u.s. port impression: 1. no stones or hydronephrosis. 2. innumerable bilateral renal cysts. 3. large right-sided pleural effusion and small amount of intra-abdominal ascites. . prostate u.s. conclusion: prostatomegaly with particular enlargement of the central gland. no evidence of prostatic abscess. . ct abdomen w/o contrast impression: 1. bilateral pleural effusions, right greater than left and cardiomegaly. 2. multiple bilateral renal cysts, which are incompletely evaluated on this non-contrast study. no evidence of renal or ureteral calculi or hydronephrosis. 3. extensive calcification of the descending aorta and its branches. 4. small-to-moderate amount of free fluid within the abdomen and pelvis and generalized anasarca. . tte (complete) done the left atrium is markedly dilated. the right atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 70%). there is no ventricular septal defect. the right ventricular cavity is dilated. right ventricular systolic function appears depressed. the ascending aorta is mildly dilated. the aortic valve leaflets are moderately thickened. there is a small vegetation on the aortic valve (right cusp). there is a minimally increased gradient consistent with minimal aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened and somewhat shaggy in appearance suggestive of mitral valve vegetations. there is no mitral valve prolapse. an eccentric, posteriorly directed jet of moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the supporting structures of the tricuspid valve are thickened/fibrotic. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a small pericardial effusion. impression: aortic and mitral valve vegetations compared to the previous study of , increased valvular regurgitation and probable vegetatioons are seen. . chest port. line placement impression: 1. tip of left picc in lower right atrium, at least 6 cm from the cavoatrial junction. no pneumothorax. 2. enlarged cardiac silhouette with a globular shape, suggestive of pericardial effusion in addition to cardiomegaly. 3. larger moderate right pleural effusion. 4. fluid overload. brief hospital course: a/p: 79m who p/w urosepsis pan-sensitive e. coli, found to have aortic and mitral valve vegetations. . # septic shock: source is e. coli uti prostatomegaly. pt grew pan-sensitive e. coli in ucx and bcxs upon admission. pelvic ct negative for prostatic/renal abcess. surveillance bcxs were neg. from on. pt was initially started on levofloxacin. however, vegetations were noted on echo that were concerning for endocarditis although e. coli is not a common microorganism associated with endocarditis. infectious diseases service was consulted and recommended ceftriaxone x 4 weeks. he will follow up with repeat echo after completion of antibiotics and with infectious diseases. . # urinary tract infection: as above. . # acute on chronic diastolic congestive heart failure: bnp in ed was , unchanged from last admission). pt did receive ivf boluses on the field and in the ed. the patient's home dose of digoxin was continued, and he was placed on a low-salt diet. his diuretics (torsemide) and anti-hypertensives were initially held for hypotension. however, he had went into flash pulmonary edema after his episode of rvr, and on the first full hospital day he required gentle diuresis and initiation of his beta blocker for rapid ventricular rates. his anti-hypertensive were uptitrated slowly to torsemide 40 mg daily, metoprolol 50 mg , and losartan 25 mg daily, per dr. . he was titrated off o2 by discharge. he will follow up with the heart failure clinic. . # prostatomegaly with urinary retention: a foley catheter was placed, and the urology service recommended 2 weeks. he was also started on finasteride and tamsulosin. he will follow up with urology. . # atrial fibrillation: pt had a brief episode of rvr, which responded to cardizem in the field. hr was initially well-controlled on digoxin alone, but hr increased in setting of infection. he required re-starting of po metoprolol, which was titrated up as needed to metoprolol 50 mg . his coumadin was adjusted per inr. he will follow up with cardiology. . # aortic and mitral valvular vegetations: the differential is infectious vs. marantic. id recommended 4 weeks of abx followed by repeat tte, which was scheduled. the patient will f/u with id and cardiology. . # cri: creatinine stayed at baseline. . # renal cysts: ct noted large renal cysts; size appears unchanged from abdominal u/s in . pt will f/u with urology as outpatient. . # elevated alk phos: this has been trending up over the past year. ct abdomen showed no gb pathology. us may be considered for further workup as outpatient. . # htn: he was initially hypotensive and all anti-hypertensives were held. with recovery, he was re-started and titrated up to torsemide 40 mg daily, metoprolol 50 mg , and losartan 25 mg daily. pt will follow up with cardiology. . # hyperlipidemia: pt was continued on home regimen of statin and fibrate. . # gout: pt was continued on outpatient allopurinol. . # thrombocytopenia: plt count remained at baseline. . # breast cancer: pt was continued on outpatient regimen of femara. . # full code medications on admission: 1. atorvastatin 10 mg po daily (daily). 2. gemfibrozil 600 mg po daily (daily). 3. losartan 100 mg po daily (daily). 4. letrozole 2.5 mg daily 5. acetaminophen 325 mg po q6h (every 6 hours) as needed. 6. docusate sodium 100 mg po bid (2 times a day). 7. senna 8.6 mg po bid (2 times a day) as needed. 8. warfarin 1 mg po 3x/week (mo,we,fr) 9. warfarin 2 mg po 4x/week (,tu,th,sa). 10. digoxin 125 mcg po daily (daily). 11. metoprolol tartrate 25 mg po bid (2 times a day). 12. chlordiazepoxide hcl 5 mg po daily (daily) as needed. 13. torsemide 80 mg po daily (daily). 14. hydrochlorothiazide 12.5 mg po daily (daily): please administer at the same time as the demodex. 15. k-dur 20 meq tab sust.rel. po once a day. 16. allopurinol 300 mg daily discharge medications: 1. outpatient lab work please draw weekly cbc, bun, cr, and lfts until course of ceftriaxone complete. please fax results to (, attention to dr. . 2. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 3. gemfibrozil 600 mg tablet sig: one (1) tablet po daily (daily). 4. losartan 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. letrozole 2.5 mg tablet sig: one (1) tablet po daily (). 6. warfarin 1 mg tablet sig: 1-2 tablets po hs (at bedtime): please take 1 mg every mon/wed/fri and 2 mg every tues/thurs/sat/sun. 7. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 8. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 9. chlordiazepoxide hcl 5 mg capsule sig: one (1) capsule po daily (daily) as needed for anxiety. 10. allopurinol 300 mg tablet sig: one (1) tablet po daily (daily). 11. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). disp:*30 capsule, sust. release 24 hr(s)* refills:*2* 12. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po once a day. disp:*90 capsule, sust. release 24 hr(s)* refills:*0* 13. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 14. finasteride 5 mg tablet sig: one (1) tablet po once a day. disp:*90 tablet(s)* refills:*0* 15. ceftriaxone-dextrose (iso-osm) 2 gram/50 ml piggyback sig: two (2) gram intravenous q24h (every 24 hours): to be completed on . disp:*qs until . gram* refills:*0* 16. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever, pain. 17. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 18. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 19. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 20. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed. 21. outpatient line care saline 5-10 cc sash prn heparin 100 units/ml 3-5 cc sash prn 22. torsemide 20 mg tablet sig: two (2) tablet po once a day. disp:*60 tablet(s)* refills:*2* discharge disposition: home with service facility: homecare discharge diagnosis: primary: septic shock urinary tract infection hypoxia acute on chronic diastolic failure aortic and mitral valvular vegatations . secondary: urinary retention atrial fibrillation chronic renal failure hypertension hyperlipidemia gout thrombocytopenia discharge condition: stable discharge instructions: you were admitted for urinary tract infection leading to septic shock. you were treated with antibiotics. you will need to continue the antibiotic ceftriaxone for a total of 4 weeks (last day will be ). you will need to follow up with infectious diseases, and an appointment has been made for you. you will need weekly lab tests when you are on the antibiotic ceftriaxone; these will need to be faxed to the infectious clinic. you will also need a follow-up echocardiogram after completion of your antibiotics. this has been scheduled for you as well. . you were thought to have a urinary tract infection because of your enlarged prostate. the urology service has seen you while you were in the hospital. it was recommended that you keep the foley catheter in for 2 weeks and you were started on flomax and finasterid per urology's recommendations. an outpatient appointment with urology has been made for you. . please take your medications as prescribed. in addition to the medications mentioned above, several other medications have been changed. due to low blood pressure while you were sick, your hydrochlorothiazide has been discontinued. your torsemide has been decreased to 40 mg daily and losartan has been decreased to 25 mg daily. please follow up with dr. on when to restart the hydrochlorothiazide and resume your regular doses of torsemide and losartan. . please resume your warfarin dosing prior to admission, which was 1 mg mo/we/fr and 2 mg /tu/th/sa. you will need close follow up on your inr because of the new antibiotic. . if you develop fevers, lightheadedness, shortness of breath, chest discomfort, weight gain or any concerning symptoms, please call your primary care physician . at or go to the emergency department. followup instructions: you have a follow-up appointment with dr. of urology on at 10am. the clinic number is . . you have an appointment with dr. at the heart failure clinic on at 10:30am. the clinic number is (. . you also have an appointment with dr. on at 8am. the clinic is in the process of getting you a sooner appointment and will contact you at home if this can be done. his clinic number is (. . you also have a follow-up appointment with dr. of infectious diseases on at 10:30 am. his clinic number is . prior to your follow-up appointment, you will need an outpatient echocardiogram. this has been scheduled for at 2pm. the clinic number is . . please also follow-up with your primary care physician . within 2-3 weeks. since he has moved to , you will need to call ( to re-register under their system before you can make a follow-up appointment. procedure: venous catheterization, not elsewhere classified diagnoses: thrombocytopenia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified unspecified septicemia severe sepsis gout, unspecified atrial fibrillation acute on chronic diastolic heart failure personal history of malignant neoplasm of breast chronic kidney disease, unspecified other and unspecified hyperlipidemia hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) septic shock long-term (current) use of anticoagulants retention of urine, unspecified acute and subacute bacterial endocarditis other specified cystic kidney disease 

Answer: The patient is high likely exposed to