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: lisinopril attending: chief complaint: abdominal pain major surgical or invasive procedure: nephrotube placed left kidney perinephric tube placed for left kidney decompression right ij central line replaced with a right ij temp hd line + vip port. trauma line placed left ij. arterial line left femoral artery placement of a tunneled hemodialysis vein catheter via the right internal jugular vein under ultrasound and fluoroscopic guidance placement of the double-lumen picc line into the distal superior vena cava under ultrasound and fluoroscopic visualization. history of present illness: 53 yof h/o hiv/aids cd4 at 602, vl 66 in , history of type 2 diabetes, diet controlled, remote castleman's disease, hepatitis c status post failed prior attempt at treatment, hypertension, and renal insufficiency who presents to ed via triage clinic with r flank pain, n/v that awoke her from sleep 0100 day of presentation. upon arrival in ed, found to have r hydro by u/s and r mid-ureteral calculus by ct a/p, presumed a protease inhibitor stone per radiology. also noted that there was gallstones but no signs of cholecystitis. initially temp 99.6 -> 101.6, got tylenol, systolics in the 130s with progressive tachycardia 80s -> 110s despite ivf. found to have cr 2.2 from baseline 1.4-1.5, u/a many bac with <1 epis. urology was consulted and preemptively requested 2g ceftriaxone (prior e.coli utis res to cipro), vanco given possibility of percutaneous procedure, coags. patient has become increasingly tachycardic during her emergency department stay and is now spiking fevers consistent with an obstructed pyelonephritis. patient underwent a perc nephrostomy via ir, will but admitted to micu for close monitoring given the risk of patient getting dramatically sicker. ekg showed sr@99 na ni std v4-6 (new). 20g piv r/l. past medical history: - castleman's disease - hiv, diagnosed in , cd4 of 668 and viral load undetectable on at an outside hospital - hepatitis c - shingles - migraines - htn - dm ii - mrsa - recurrent uti - hsv - pancytopenia haart medications social history: - lives at home in - has a daughter with hydrocephalus/seizure disorder, and is in a nursing home ( pediatric care). - works as a councilor - former heavy smoker, currently 1 pack q2 weeks. taking wellbutrin - former eoth abuse, none since - former ivdu, none since family history: - father died of mi - mother with diabetes - sister with lung cancer at age 38 and was a heavy smoker. - bother with diabetes - she had a second daughter, who was hiv positive and who died at age 3 physical exam: admission physical exam: vitals: t: bp:132/62 p:123 r: 18 o2: 96 general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema discharge pe: vitals: t 98.2 (tmax 98.6) 141/69 90 18 96% on ra general: awake, alert, and oriented to place and date, lying supine in bed, in some pain but no distress. heent: sclera anicteric, mmm, oropharynx clear neck: supple without lad lungs/chest: ctab cv: regular rate and rhythm, normal s1 + s2, s4 noted at apex, i-vi holosystolic murmur heard at the base. abdomen: +bs. l side of her abd was soft without ttp or guarding, but r side was firm to palpation with guarding. pt had a liver edge palpable 4-5 cm below the costal margin as well as a firm clotted hematoma palpable on the r side from the costal margin to the iliac crest. ttp on the r side without rebound. no splenomegaly. mild suprapubic ttp in r groin. ext: warm, well perfused. no c/c/e. 2+ peripheral pulses. neuro: cn ii-xii intact. neuromuscularly grossly intact throughout. pertinent results: labs -- . cbc: 02:30pm blood wbc-7.9 rbc-2.93* hgb-9.9* hct-28.7* mcv-98 mch-33.7* mchc-34.4 rdw-14.3 plt ct-119* 04:23am blood wbc-9.6 rbc-1.83* hgb-6.3* hct-18.0* mcv-98 mch-34.2* mchc-34.9 rdw-14.8 plt ct-64* 01:52pm blood wbc-12.6* rbc-2.41* hgb-7.8* hct-21.3* mcv-88 mch-32.2* mchc-36.6* rdw-16.3* plt ct-46* 04:13am blood wbc-10.2 rbc-3.85* hgb-11.9* hct-32.0* mcv-83 mch-31.0 mchc-37.2* rdw-15.1 plt ct-84* 04:00am blood wbc-7.2 rbc-3.28* hgb-10.2* hct-27.9* mcv-85 mch-31.1 mchc-36.5* rdw-16.6* plt ct-61* 04:12am blood wbc-13.6* rbc-3.76* hgb-11.4* hct-34.0* mcv-91 mch-30.4 mchc-33.6 rdw-16.0* plt ct-90* 09:49pm blood wbc-9.9 rbc-3.55* hgb-11.1* hct-31.5* mcv-89 mch-31.3 mchc-35.3* rdw-15.9* plt ct-102* 05:29am blood wbc-9.1 rbc-3.04* hgb-9.5* hct-27.7* mcv-91 mch-31.2 mchc-34.1 rdw-17.4* plt ct-127* . chem-7: 11:30am blood glucose-146* urean-35* creat-2.2* na-128* k-> 10 cl-104 hco3-21* 03:47pm blood glucose-228* urean-53* creat-3.5* na-131* k-6.5* cl-105 hco3-17* angap-16 03:47pm blood glucose-228* urean-53* creat-3.5* na-131* k-6.5* cl-105 hco3-17* angap-16 04:01am blood glucose-109* urean-23* creat-2.0* na-136 k-4.1 cl-102 hco3-21* angap-17 04:09pm blood glucose-107* urean-12 creat-1.5* na-135 k-4.4 cl-100 hco3-23 angap-16 04:12am blood glucose-97 urean-13 creat-2.2* na-135 k-4.3 cl-101 hco3-24 angap-14 01:56pm blood glucose-81 creat-3.3* na-137 k-5.1 cl-102 hco3-23 angap-17 06:03am blood glucose-62* urean-29* creat-4.1*# na-135 k-4.8 cl-97 hco3-26 angap-17 06:08am blood glucose-74 urean-24* creat-4.4*# na-128* k-4.0 cl-91* hco3-30 angap-11 05:43am blood glucose-74 urean-38* creat-5.6*# na-126* k-5.6* cl-91* hco3-27 angap-14 05:29am blood glucose-84 urean-22* creat-4.1*# na-126* k-4.4 cl-87* hco3-26 angap-17 . liver enzymes: 11:30am blood alt-55* ast-150* alkphos-93 totbili-0.6 04:13am blood alt-240* ast-856* alkphos-70 totbili-1.3 04:00am blood alt-71* ast-152* alkphos-109* totbili-2.5* 03:39am blood alt-6 ast-87* ld(ldh)-365* alkphos-135* totbili-3.5* 06:08am blood alt-3 ast-75* alkphos-129* totbili-2.3* 05:29am blood alt-5 ast-79* alkphos-120* totbili-2.9* dirbili-1.6* indbili-1.3 . abg: 02:02pm blood type-art po2-348* pco2-40 ph-7.25* caltco2-18* base xs--9 04:07am blood type-art po2-115* pco2-30* ph-7.48* caltco2-23 base xs-0 04:06am blood type-art po2-130* pco2-37 ph-7.42 caltco2-25 base xs-0 10:29pm blood type-art temp-36.1 tidal v-450 fio2-40 po2-155* pco2-47* ph-7.32* caltco2-25 base xs--2 intubat-intubated 04:22am blood type-art po2-115* pco2-51* ph-7.33* caltco2-28 base xs-0 . lactate: 11:31am blood lactate-1.2 k-7.6* 02:02pm blood lactate-2.8* 04:07pm blood lactate-0.9 . coags: 03:19pm blood pt-12.4 ptt-33.0 inr(pt)-1.0 03:55am blood pt-13.0 ptt-56.6* inr(pt)-1.1 04:23am blood pt-14.4* ptt-43.3* inr(pt)-1.2* 02:13pm blood pt-15.8* ptt-31.7 inr(pt)-1.4* 04:01am blood pt-13.2 ptt-26.9 inr(pt)-1.1 03:39am blood pt-13.9* ptt-28.6 inr(pt)-1.2* 05:29am blood pt-13.7* ptt-29.2 inr(pt)-1.2* . urine chemistry: 10:10am urine hours-random creat-74 na-38 k-24 cl-10 09:07am urine hours-random creat-132 na-37 k-30 cl-20 06:45pm urine hours-random creat-4 . urinalysis: 10:35am urine blood-sm nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-lg 04:14pm urine blood-tr nitrite-pos protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-sm 11:30am urine blood-lg nitrite-neg protein-300 glucose-neg ketone-neg bilirub-sm urobiln-neg ph-7.0 leuks-lg . microscopic urine: 10:35am urine rbc-5* wbc-64* bacteri-many yeast-none epi-<1 04:14pm urine rbc-1 wbc-25* bacteri-few yeast-none epi-0 11:30am urine rbc-63* wbc->182* bacteri-few yeast-none epi-0 . microbiology: 11:25 am blood culture **final report ** blood culture, routine (final ): escherichia coli. identification and sensitivities performed on culture # 330-0553b #1 . escherichia coli. identification and sensitivities performed on culture # 330-0553b #2 . second morphology. escherichia coli. type 3 . final sensitivities. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | amikacin-------------- =>64 r ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ 8 i meropenem-------------<=0.25 s piperacillin/tazo----- r tobramycin------------ 8 i trimethoprim/sulfa---- =>16 r aerobic bottle gram stain (final ): gram negative rod(s). anaerobic bottle gram stain (final ): gram negative rod(s). . 10:45 am blood culture **final report ** blood culture, routine (final ): escherichia coli. final sensitivities. piperacillin/tazobactam sensitivity testing performed by . escherichia coli. final sensitivities. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | escherichia coli | | ampicillin------------ =>32 r =>32 r ampicillin/sulbactam-- 8 s 4 s cefazolin------------- <=4 s <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s ciprofloxacin--------- =>4 r =>4 r gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s piperacillin/tazo----- s s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- =>16 r =>16 r aerobic bottle gram stain (final ): reported to and read back by dr. . on at 0400. gram negative rod(s). anaerobic bottle gram stain (final ): gram negative rod(s). . 10:35 am urine site: clean catch **final report ** urine culture (final ): culture workup discontinued. further incubation showed contamination with mixed skin/genital flora. clinical significance of isolate(s) uncertain. interpret with caution. escherichia coli. >100,000 organisms/ml.. predominating organism. interpret results with caution. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 8 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r . . imaging -- . ruq ultrasound : right hydronephrosis which could be secondary to a ureteral stone though none is clearly seen. ct may be performed to further assess as needed. cholelithiasis without signs of cholecystitis. trace free fluid. . ct abd/pelvis : right hydroureteronephrosis secondary to a 5-mm stone in the mid to distal right ureter. protease-inhibitor related urolithiasis should be considered. a subtle hyperdense focus in the lower pole of the right kidney may represent an additional intra-renal stone. cholelithiasis without cholecystitis. normal appendix. . renal ultrasound : mild residual hydronephrosis of the right kidney. the kidneys are noted to be diffusely echogenic bilaterally suggestive of diffuse parenchymal disease. . tte : symmetric lvh with normal global and regional biventricular systolic function. mild to moderate aortic regurgitation. mild mitral regurgitation. mild pulmonary hypertension. compared with the prior study (images reviewed) of , aortic regurgitation severity has increased. the other findings are similar . ct abd/pelvis : right hydroureteronephrosis secondary to a 5-mm stone in the mid to distal right ureter. protease-inhibitor related urolithiasis should be considered. a subtle hyperdense focus in the lower pole of the right kidney may represent an additional intra-renal stone. cholelithiasis without cholecystitis. normal appendix. . ct abd/pelvis : overall size of retroperitoneal/extraperitoneal hematoma is unchanged or possibly slightly smaller than the examination from , . exact measurements are difficult to compare given the very lobulated contour of this hematoma. assessment for active extravasation or bleeding is limited without iv contrast, although size stability over the last week is reassuring. appropriate positioning of both the percutaneous nephrostomy catheter and the perinephric drain, the latter within portion of the hematoma. cholelithiasis. punctate renal stone on the left. known vaguely demarcated 7 mm stone as previously described in the region of the right ureter as it crosses the iliac vessels. labs on discharge: 04:46am blood wbc-6.9 rbc-2.94* hgb-9.0* hct-27.2* mcv-93 mch-30.6 mchc-33.1 rdw-17.7* plt ct-109* 04:46am blood glucose-107* urean-19 creat-4.1*# na-129* k-4.7 cl-92* hco3-29 angap-13 06:07am blood alt-8 ast-82* alkphos-118* totbili-2.7* 04:46am blood calcium-9.0 phos-3.4 mg-1.8 brief hospital course: 53yo immunocompromised f with dm, hiv on haart, hep c, and ckd p/w obstructing r ureteral calculus and arf s/p nephrostomy tube placement c/b perinephric hematoma and hemorrhagic shock, as well as initial presentation of urosepsis requiring extended icu course, pressors, and respiratory support. she also developed acute on chronic renal failure with a multifactorial etiology, requiring hd. at discharge patient was requiring three time weekly hd. active issues # urosepsis: to pyelonephritis resulting from obstructive uropathy of the right kidney in the setting of mid-ureteral stone (see below for ddx/management of stone). blood and urine cx grew e.coli sensitive to cefazolin (treated w/ceftriaxone f/b meropenem f/b cefazolin). infection was complicated by septic shock requiring pressors in the icu. after coming to the floor she was consistently hemodynamically stable and afebrile. repeat urine cx were negative. as her ureteral stone was still present at discharge and likely was infiltrated with bacteria, and given her baseline immunosuppressed state, she was discharged on indefinite cefpodoxime until she has the stone removed by urology. # acute on chronic rf: baseline creatinine is 1.5. was 2.2 on presentation and went to 3.9 in the icu. the etiology was multifactorial, likely to pre-renal failure and atn in the setting of septic shock and hypotension, heavy contrast dye loads, compressive nephropathy to large perinephric hematoma, and obstructive nephropathy in the setting of ureteral stone. etiology of baseline ckd is unknown, thought possibly glucose intolerance w/ proteinuria, with hiv nephropathy thought to be less likely. she had a nephrostomy placed by ir to decompress the r ureter and received cvvhd in the icu. she then had a tunneled ij cath placed and received hd while on the floor. creatinine rose as high as 5.7 on the floor. her uop increased somewhat but she was still hd-dependent at the time of discharge. it is unclear what kind of renal recovery she will have. # r perinephric retroperitoneal hematoma: to nephrostomy tube drain placement. her hct dropped from 28 on admission to 18 and she required transfusion of 14 units prbcs, 4 units platelets, and 2 units of ffp in the icu. ir placed a perc tube drain in the hematoma which drained consistently old-appearing blood. her hct remained stable in the high 20's to low 30's and she was consistently hemodynamically stable and not tachycardic. ct abd/pelvis on showed no growth in size of the hematoma, along with evidence of organization. perc drain continues to drain. it needs to drain less than 10 cc's per 8 hours for it to be ready to be pulled. # r hydronephrosis and r mid-ureteral calculus: this was seen on ct and renal us. likely to a protease inhibitor. it led to obstructive nephropathy and resultant pyelonephritis and urosepsis (see discussion above). ir placed a r nephrostomy tube to decompress the ureter which consistently drained non-bloody fluid. urology was consulted and they plan to remove the stone at a later date when she is farther removed from her icu stay and more fully recovered, as this procedure can generate a significant bacteremia. # shock: urosepsis (distributive) and hemorrhagic (volume), requiring pressors in the icu. complicated by volume overload (including right pleural effusion), respiratory failure, and intubation. after extubation she remained hemodynamically stable in the icu and on the floor. # delirium: was delirious in the icu, consistent with the cam-icu criteria (acute onset w/ fluctuating course, inattention, and altered level of consciousness). likely to pain, infection, prolonged icu stay, liver dysfunction, and medication. she was treated with haldol in the icu and her potentially deliriogenic drugs were discontinued. after coming to the floor she became awake and attentive and no longer delirious # elevated liver enzymes: lft's rose to ast/alt 200's/800 with tbili to (direct). likely a combination of sepsis (was not high enough to be frank shock liver) in the setting of underlying hcv, with hiv meds possibly contributing. high direct tbili and alk phos could have indicated cholestasis but us showed no biliary dilation. liver enzymes trended back to baseline during the course of her admission, though tbili remained slightly elevated. chronic issues: # hiv: haart was initially held during her icu course per id recommendations and was restarted when she was stable on the floor. as discussed above, her ureteral stone was thought to be to a protease inhibitor. her new regimen at discharge included lamivudine, abacavir, ritonavir, and darunavir. # diffuse pruritis: per pt this is a chronic problem for which she has seen a dermatologist in the past. she said it has been attributed to chronically dry skin. her tbili, though elevated, was likely not high enough to produce this pruritis and she was not uremic. the pruritis improved with sarna lotion. . transition issues - pt is being discharged to - pt will f/u with her nephrologist, dr. , which will be arranged by pcp . - pt will require outpatient f/u with urology re. ureteral stone removal, also to be arranged by dr. . - she is being discharged on cefpodoxime for retained ureteral stone. -pt will f/u with ir for eventual removal of perinephric drain. pt will be contact by ir. medications on admission: medications: abacavir-lamivudine 600 mg-300 mg tablet by mouth once a day albuterol sulfate 90 mcg inh 1-2 puffs po q4-6hr prn cough atazanavir 300 mg capsule by mouth once a day with ritonavir ritonavir 100 mg tablet by mouth once a day\ bupropion hcl 150 mg tablet er po bid hold trazodone while taking trazodone 100 mg tablet po at bedtime clonazepam 0.5 mg tablet po bid prn anxiety diphenhydramine hcl 25 mg capsule po qhs prn itching famciclovir 500 mg tablet 1 tab po daily inc to po bid prn outbreaks freestyle lite test strips - - use as directed once a day hydrochlorothiazide 25 mg tablet po once a day valsartan 320 mg tablet po once a day aspirin 81 mg tablet po once a day loperamide 2 mg tablet po prn diarrhea not to exceed 16 mg in 24 hour period urea 10 % lotion - apply to feet twice a day discharge medications: 1. abacavir 300 mg tablet sig: one (1) tablet po bid (2 times a day). 2. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. 3. ritonavir 100 mg capsule sig: one (1) capsule po daily (daily). 4. bupropion hcl 150 mg tablet extended release sig: one (1) tablet extended release po qam (once a day (in the morning)). 5. clonazepam 0.5 mg tablet sig: one (1) tablet po twice a day as needed for anxiety. 6. diphenhydramine hcl 25 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for itching. 7. darunavir 400 mg tablet sig: two (2) tablet po daily (daily). 8. cefpodoxime 100 mg tablet sig: two (2) tablet po qhd (each hemodialysis). 9. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 10. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical (2 times a day) as needed for itching. 11. acetaminophen 650 mg tablet sig: one (1) tablet po three times a day as needed for pain. 12. nystatin 100,000 unit/ml suspension sig: five (5) ml po four times a day as needed for thrush. 13. ondansetron 4 mg film sig: one (1) po every eight (8) hours as needed for nausea. 14. senna 8.6 mg capsule sig: one (1) capsule po twice a day as needed for constipation. 15. sarna anti-itch 0.5-0.5 % lotion sig: one (1) application topical four times a day as needed for itching. 16. lamivudine 25 mg/5 ml (5 mg/ml) solution sig: five (5) ml po once a day: 25 mg (which is 5 ml daily). 17. famciclovir 125 mg tablet sig: one (1) tablet po qhd (with hemodialysis). 18. oxycodone 5 mg capsule sig: one (1) capsule po every hours as needed for pain. discharge disposition: extended care facility: in discharge diagnosis: ureteral stone hydronephrosis pyelonephritis with subsequent sepsis retroperitoneal bleed urosepsis hemorrhagic shock acute tubular necrosis acute on chronic renal failure discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure taking care of you during your hospitalization at . you were found to have a stone in one of the tubes in your body that helps you get rid of urine. this led to a back-up of urine that then became infected. you were treated with antibiotics to kill the infection. you also needed drainage of the blocked urine, which required the emergent placement of a nephrostomy tube (a tube placed in your kidney). you also had bleeding into your belly, which required transfusions of blood and other substances usually present in blood (platelets and clotting factors). because you were so sick, you required a breathing tube. once you were strong enough to breathe on your own, this was pulled. you were eventually transferred from the icu to the medical floor. the interventional radiologists (the people who placed the drain into your kidney and the drain into the blood clot in your belly) will help us to determine when to pull the drain in the clot in your belly. they will contact you at the rehab facility to arrange when to pull the drain. please call dr. , a urologist, to schedule an appointment within the next few weeks to discuss the management of the tube placed in your kidney. because of the infection and the stone, your kidneys were injured, and you required dialysis to help get rid of fluid and the normal substances that are excreted by the kidneys. unfortunately, you will require dialysis for a least the near future. they will give you dialysis at the rehab facility. you will be contact in the next few days with a urology appt. . you should note the following medication changes: 1. stop atazanavir 300 mg daily 2. stop hydrochlorothiazide 25 mg tablet po once a day 3. stop valsartan 320 mg daily 4. stop aspirin 81 mg daily 5. start cefpodoxime 200 mg po daily - you will need to take this until you have the stone removed from your ureter 6. start darunavir 800 mg daily 7. start nystatin oral suspension 5 ml po qid:prn thrush 8. start nephrocaps 1 cap daily 9. start ondansetron 4 mg every 8 hours as needed for nausea 10. start senna 1 tab twice a day as needed for constipation 11. start sarna cream as neede for itching followup instructions: please follow-up with your primary care doctor within one week of being discharged from the extended care facility. name: , k. md location: address: , 3rd fl, , phone: *it is recommended that you see dr. a couple weeks. please call his office to schedule an appointment. the interventional radiologists will call you to arrange follow-up to remove the percutaneous hematoma drainage catheter. we will contact you at rehab tomorrow with appointments to see dr. and dr. . procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube hemodialysis percutaneous nephrostomy without fragmentation venous catheterization for renal dialysis venous catheterization for renal dialysis arterial catheterization arteriography of renal arteries replacement of nephrostomy tube central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: hyperpotassemia acute kidney failure with lesion of tubular necrosis unspecified pleural effusion acute posthemorrhagic anemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified hematoma complicating a procedure chronic kidney disease, stage iii (moderate) acute respiratory failure other shock without mention of trauma calculus of gallbladder without mention of cholecystitis, without mention of obstruction surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled encephalopathy, unspecified hypovolemia septicemia due to escherichia coli [e. coli] hydronephrosis calculus of ureter asymptomatic human immunodeficiency virus [hiv] infection status pyelonephritis, unspecified 

Answer: The patient is high likely exposed to