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: aspirin / penicillins / bactrim attending: chief complaint: vaginal bleeding major surgical or invasive procedure: central line picc line history of present illness: 75 f nh resident h/o breast ca, cva, admitted from ed for sepsis because of elevated lactate. the patient was noted at the to have vaginal bleeding x 2days and was sent to the ed for further evaluation. the patient was started on cipro empirically at the nh. in the ed, the pt was found to have wbc 29.3, lactate 5.6, though stable vitals. initial vs: t97.4 p 85 187/1 30 93% 3l. because of the lactate, sepsis protocol was initiated. r ij svo2 catheter was placed. the patient was given 3l ivf, as well as empiric levo/flagyl to cover urine and pulmonary pathogens. cta chest was done to rule out pe given the low level o2 requirement and ct abdomen was done to evaluate the vaginal bleeding and hematuria. this revealed no pe, though was otherwise unrevealing. the patient was admitted to micu green for further management. past medical history: past medical history: 1. hypokalemia. 2. breast cancer, status post radiation therapy with lumpectomy in . 3. cerebrovascular accident. 4. history of falls. 5. arthritis. 6. status post hysterectomy. 7. hypertension. 8. recurrent urinary tract infections. 9. cardiomegaly seen on chest x-ray. 10. osteoporosis. social history: pt is a resident of nursing home. no tob, occasional etoh, no drugs family history: nc physical exam: physical exam: vs: t 96.5 p 96 bp 130/60 o2 100 on ra gen: pleasant, awake, alert oriented to self and place heent: perrl, mmm neck: no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or thyroid nodules resp: cta b/l cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e neuro: oriented to self and follows simple command, moves all ext when asked, smile symetric pertinent results: ekg: sr 100 with pacs. lad. isolated q in v1. ct abd w&w/o c study date of 8:38 pm no evidence of bladder mass, as clinically questioned. diffuse bladder wall thickening that may represent cystitis. interval, partial decompression of the collecting system. horseshoe kidneys with multiple hypoattenuating lesions, many of which are too small to characterize but most likely represent cysts. multiple hypoattenuating lesions in the liver, likely cysts. diffuse osteopenia and deformity and ankylosis of lumbar spine. cta chest w&w/o c&recon study date of 10:55 pm no evidence of pulmonary embolism. horseshoe kidneys with multiple hypodense lesions, the largest of which represent cysts but most of which are too small to fully characterize. additionally, the ureters are mildly dilated with small filling defects which may represent clot. hyperdense material within the bladder likely represents blood in setting of gross hematuria. enlargement of the right adrenal gland may represent adenoma though this is unclear in setting of prior malignancy. recommend correlation with outside studies if available before pursuing followup/ further evaluation. 4mm right lower lobe nodule requires 3 month followup to ensure stability unless outside studies have demonstrated stability of this lesion over a number of years. hypodense hepatic lesions, too small to characterize and not definitively representing cysts in the setting of prior malignancy. hypodense pancreatic lesion too small to carachterize. diffuse osteopenia with deformity and ankylosis of the lumbar spine and canal narrowing likely. ct head w/o contrast study date of 6:16 pm no acute intracranial pathology, including no sign of intracranial hemorrhage. 11:16pm lactate-5.8* 10:17pm glucose-200* lactate-4.8* 10:17pm hgb-9.5* calchct-29 09:09pm lactate-4.5* 09:09pm o2 sat-68 08:10pm urine color-red appear-cloudy sp -<=1.005 08:10pm urine blood-lg nitrite-pos protein->300 glucose->1000 ketone->80 bilirubin-mod urobilngn-4* ph-7.0 leuk-lg 08:10pm urine rbc->1000 wbc->50 bacteria-mod yeast-rare epi-0 07:44pm ck(cpk)-21* 07:44pm ck-mb-notdone ctropnt-0.01 07:32pm lactate-5.3* 07:25pm pt-11.9 ptt-23.4 inr(pt)-1.0 06:21pm lactate-5.6* 06:18pm hgb-12.5 calchct-38 05:10pm glucose-250* urea n-31* creat-1.6* sodium-147* potassium-4.1 chloride-111* total co2-19* anion gap-21* 05:10pm estgfr-using this 05:10pm alt(sgpt)-31 ast(sgot)-22 ld(ldh)-324* alk phos-93 amylase-73 tot bili-0.5 05:10pm lipase-14 05:10pm albumin-3.6 calcium-9.1 phosphate-4.1 magnesium-2.2 05:10pm cortisol-128.4* 05:10pm wbc-29.3*# rbc-4.46 hgb-12.2 hct-36.4 mcv-82 mch-27.3 mchc-33.4 rdw-16.2* 05:10pm neuts-64 bands-22* lymphs-2* monos-9 eos-0 basos-0 atyps-0 metas-3* myelos-0 05:10pm hypochrom-1+ anisocyt-2+ poikilocy-2+ macrocyt-1+ microcyt-1+ polychrom-normal ovalocyt-2+ schistocy-1+ burr-1+ acanthocy-2+ 05:10pm plt smr-normal plt count-353 brief hospital course: whie in the micu, her lactate improved and her blood pressure remained stable. she was found to have horseshoe kidneys and what appears to be blood clot in renal pelvis as well as in bladder. ct also reveals very enlarged bladder c/w retention of chronic nature. ua on admit c/w uti (+nitrites, mod bacteria).on ct of chest/abd. urology was consulted. she was started on cbi due to hematuria. she was started on empiric vanco/cipro/aztreo (given pcn allergy) and gnr in her blood. pt was subsequently transfered to cc7, where she continued empiric vanco/cipro/aztreo until blood and urine cx results revealed providencia stuartii which was resistanst to cipro, and sensitive to azotreonam. id was consulted, and recommended continuation of azotreonam for 14 day course (first dose 6/25); a picc was placed and central line was d/ced. cbi with clear drainage on , and repeat ct urogram on showed no evidence of bladder mass, diffuse bladder wall thickening c/w cystitis and itnterval, partial decompression of the collecting system, multiple hypoattenuating lesions in liver and horseshoe kidney, most likely cysts. on , pt found to have drop in hct from 25.1 to 21.9. ldh was normal and haptoglobin was elevated indicating dic with intravascular hemolysis unlikely, pt was guaiac negative. 1 unit prbc was transfused, and hct rose to 25.4. pi pt's hct has been stable since, and is 27.4 at discharge. because the pt was admitted with urosepsis which likely arose diabetic atonicity of the bladder and subsequent reflux into the collecting system, urology recomended that pt be discharged with indwelling foley catheter to decompress the urinary system. while admitted the pt has been hypokalemic, hypophosphatemic, and hypomagnesemic on multiple occasions, requiring repletion. pt has continued to have low grade fevers (100.8 on and 100.6 on ). pt already has defined pathogen on culture, known to be sensitive to azotreonam so plan is to continue full course of azotreonam with no need to reculture unless fevers become high grade. on day of discharge pt given potasium phosphate 40 meq and neutraphos packets upon discharge due to k 3.1 and ph 2.5. at rehab lytes should continue to be checked and repleted twice a week. pt has been evaluated by speech and swallow, and pt to recieve gorund solids, thin liquids and ensure tid. medications on admission: cipro 250 started asa 81' metoprolol 25" lisinopril 2.5' actonel 35 qweek fluticasone nasal tramandol 25" aricept 10' namenda 10" senna/dulcolax/fleets os-ca; prilosec discharge medications: 1. insulin regular human 100 unit/ml solution sig: per sliding scale injection qachs. 2. namenda 10 mg tablet sig: two (2) tablet po twice a day. 3. donepezil 5 mg tablet sig: two (2) tablet po hs (at bedtime). 4. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 5. sodium chloride 0.9 % 0.9 % solution sig: ten (10) ml injection daily (daily) as needed: flush picc. 6. heparin lock flush (porcine) 100 unit/ml syringe sig: one (1) ml intravenous daily (daily) as needed: followed by 10 ml ns flush. 7. aztreonam 1 g recon soln sig: one (1) recon soln injection q8h (every 8 hours): last dose 7/9 to complete 14-day course. 8. aspirin 81 mg tablet sig: one (1) tablet po once a day. 9. metoprolol tartrate 25 mg tablet sig: one (1) tablet po twice a day. 10. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. 11. actonel 35 mg tablet sig: one (1) tablet po once a week. 12. fluticasone 50 mcg/actuation aerosol, spray sig: one (1) nasal once a day. disp:*1 30 day supply* refills:*2* 13. tramadol 50 mg tablet sig: one (1) half tablet po twice a day. 14. os-cal 500 + d 500-125 mg-unit tablet oral 15. senna 8.6 mg tablet sig: two (2) tablet po at bedtime. 16. fleet enema 19-7 gram/118 ml enema sig: one (1) rectal once a day as needed for constipation. 17. dulcolax 10 mg suppository sig: one (1) rectal once a day. 18. milk of magnesia oral discharge disposition: extended care facility: - discharge diagnosis: urinary tract infection sepsis anemia dementia diabetese mellitus ii acute renal failure discharge condition: occasional low-grade fever. vital signs stable. discharge instructions: you were admitted with a urinary tract infection and sepsis. you are being treated with iv aztreonam with plan to complete a 14-day course. followup instructions: you should follow-up with your primary care physician . . please call to schedule follow-up. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnoses: anemia, unspecified urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis other persistent mental disorders due to conditions classified elsewhere atony of bladder hydronephrosis other specified anomalies of kidney 

Answer: The patient is high likely exposed to