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: nsaids/anti-inflammatory classifier / vancomycin / flagyl attending: chief complaint: septic shock, uti, gi bleed due to gastic ulcers, obstructing ureteral stone, hypokalemia major surgical or invasive procedure: left nephrostomy on egd on egd on history of present illness: 77 year old male with h/o cad s/p cabg and stent placement, pacemaker, hemorrhagic frontal cva with residual effects, prior dvt and pe (20 years ago), bph, type 2 dm, benign hypertension, ulcerative colitis (with h/o of admissions for gi bleeding) transferred from due to gi bleed and septic shock due to uti with obstructive kidney stone. patient is homebound at baseline but ambulates with walker and requires assitance with adl's. he has recent history of recurrent uti and had a cystoscopy on for work-up of persistent hematuria. he initially presented to ed after an unwitnessed fall at home on in the pm, unclear if there was loc, he was found by his wife on the floor, fully concsious and with no signs of trauma. he was able to be helped up and walk with his walker. following the fall he had a persistent cough and then developed large amounts of dark vomitus. he is on asa, not on coumadin or plavix. at was hd stable with sbp in the 140's, found to have positive ng lavage that did not clear, was noted febrile to 102, with positive ua and ct abdomen/pelvis showing 1cm obstructing left kidney stone at the upj. ct head and cxr showed no acute processes. 16g and 18g pivs were placed, he was started on ceftriaxone and protonix drip. he was guiac neg with stable hct. he was transferred to - per urology for placement of drainage nephrostomy. patient was last admitted to our institution in for uti with pan-sensitive e.coli. per his last pcp note from he was since treated twice for uti and had persistent microscopic hematuria despite completion of treatment. he does have known prostatic enlargement and some lower urinary tract symptoms and he is followed by dr. at nwh for this. he had cystoscopy on followed by 3 day course of cipro. ed course - initial vitals: 08:27 0 100. 73 147/69 12 99% 1l np - a+o x2, benign abdomen, non focal neuroexam. - ekg showed afib hr 70s, had asymptomatic nonsustained vt with pulse. - labs: wbc = 8.3, hct = 35.6 (from 37 at ), plt = 105. lactate = 3.7, cr 1.1: 31 (from 0.7:14 baseline), k = 3.3, mg = 1.6, p = 1.2, normal lft and coags, dirty urine with mod bacteria. he was in a wide complex tachycardia, and ep was consulted, who felt this was his usual atrial tachycardia with abberency. a repeat lavage posivice for cofee-grounds. recieved iv mg 2g + k 40mg, continued protonix drip, got early goal directed therapy. iv ceftriaxone given in osh. a nephrostomy tube was inserted with good drainage, with relief of the obstructing left ureteral stone. patient was initally placed on levophed in the icu. the ep team reprogrammed his pacer to address his aberent conduction. he was stabilized and transferred to the floor on . past medical history: - hemorrhagic frontal cva heparin about ~16 years ago - cad s/p quadruple bypass (lima-lad, svg pl/pda, svg-om) and later bms to ostial svg-pl/pda and ptca of lima-lad. - s/p dual chamber pacemaker in - depression - anxiety - h/o body dysmorphia, controlled on medication - type 2 dm ~ 20 years with peripheral neuropathy - h/o dvt complicated by pe about 19 years ago - h/o pna - htn - ulcerative colitis, last colonoscopy in showing erythema and ulcers in the rectum and sigmoid - bph - s/p neck surgery - h/o thrombocytopenia social history: lives with wife who helps with adls in . homebound but ambulates with walker. wife says she makes him walk 50 laps around the house daily. ex smoker 25 pack-year but quit 25 yrs ago. denies etoh and drug use. former contractor. no kids. family history: - father died in 80s dm - mother died in 70s alcoholism - brother died in 40s of esophageal hemorrhage - otherwise h/o mental illness physical exam: admission exam: vitals: t: 100.0, 156/73, 69, 20, 97% general: alertx3, no acute distress. heent: pale, anicteric, mmm skin: warm and dry neck: supple, jvp not elevated, no lad, surgical scar right neck. lungs: ctab, no wheezes, rales, ronchi cv: irregular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, normal bs, non-tender, no rebound tenderness or guarding, no organomegaly, no cva tenderness gu: foley in place with hazy concentrated urine ext: 2+ pulses, no clubbing, cyanosis or edema back: left nephrostomy in place pertinent results: 04:48am blood wbc-6.5 rbc-3.78* hgb-10.2* hct-30.9* mcv-82 mch-27.1 mchc-33.1 rdw-15.7* plt ct-82* 03:24am blood wbc-12.2* rbc-3.68* hgb-10.3* hct-29.3* mcv-80* mch-28.1 mchc-35.2* rdw-15.0 plt ct-78* 05:29pm blood wbc-10.5# rbc-3.88* hgb-11.1* hct-31.2* mcv-80* mch-28.5 mchc-35.4* rdw-14.9 plt ct-81* 09:00am blood wbc-8.3# rbc-4.30* hgb-12.2* hct-35.6* mcv-83 mch-28.4 mchc-34.3 rdw-14.6 plt ct-105* 09:30pm blood neuts-76* bands-12* lymphs-6* monos-4 eos-0 baso-0 atyps-0 metas-2* myelos-0 09:00am blood neuts-77* bands-17* lymphs-4* monos-2 eos-0 baso-0 atyps-0 metas-0 myelos-0 03:24am blood ptt-36.7* 01:07pm blood pt-13.4 ptt-22.1 inr(pt)-1.1 09:00am blood pt-13.5* ptt-22.6 inr(pt)-1.1 09:00am blood pt-13.5* ptt-22.6 inr(pt)-1.1 04:48am blood glucose-114* urean-7 creat-0.6 na-140 k-3.0* cl-110* hco3-24 angap-9 07:05am blood glucose-119* urean-8 creat-0.7 na-143 k-2.9* cl-113* hco3-24 angap-9 06:00am blood glucose-107* urean-9 creat-0.7 na-142 k-2.7* cl-110* hco3-24 angap-11 06:45am blood glucose-84 urean-30* creat-1.1 na-145 k-3.2* cl-114* hco3-24 angap-10 09:37pm blood glucose-132* urean-31* creat-1.2 na-145 k-3.2* cl-116* hco3-17* angap-15 01:07pm blood glucose-218* urean-28* creat-1.2 na-143 k-3.9 cl-111* hco3-20* angap-16 09:00am blood glucose-207* urean-31* creat-1.1 na-143 k-3.3 cl-107 hco3-26 angap-13 09:00am blood alt-18 ast-27 ck(cpk)-50 totbili-0.5 09:00am blood lipase-31 09:00am blood ctropnt-<0.01 04:48am blood calcium-8.2* phos-2.2* mg-1.6 07:05am blood calcium-8.3* phos-2.0* mg-1.8 06:00am blood calcium-8.4 phos-2.2* mg-1.5* 06:45am blood calcium-8.8 phos-2.3* mg-2.0 09:37pm blood calcium-8.2* phos-2.6* mg-1.8 09:00am blood albumin-3.6 calcium-9.5 phos-1.2* mg-1.6 09:02am blood type-art temp-36.3 po2-96 pco2-34* ph-7.38 caltco2-21 base xs--3 09:53pm blood type- po2-57* pco2-44 ph-7.28* caltco2-22 base xs--5 comment-green top 09:22am blood ph-7.30* 09:02am blood lactate-1.3 na-142 cl-3.4* 09:22am blood glucose-187* lactate-3.7* na-143 k-3.3 cl-104 calhco3-24 09:22am blood hgb-11.9* calchct-36 09:22am blood freeca-1.23 09:00am urine color-straw appear-hazy sp -1.042* 09:00am urine blood-mod nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-lg 09:00am urine rbc-92* wbc->182* bacteri-mod yeast-few epi-0 09:20am urine hours-random urean-447 creat-32 na-88 k-35 cl-100 09:20am urine osmolal-528 ecg study date of 8:39:46 am sinus arrhythmia. inferoposterior myocardial infarction of indeterminate age. non-specific anterior t wave changes. compared to the previous tracing of the precordial st segments are flatter. intervals axes rate pr qrs qt/qtc p qrs t 76 140 118 412/440 70 28 -29 intro cath renal pelvis for drainage study date of 2:50 pm impression: uncomplicated placement of an 8 french percutaneous left nephrostomy catheter with its retention pigtail loop within the renal pelvis. small amount of urine sample sent for laboratory analysis. renal u.s. study date of 1:25 pm impression: left nephrostomy tube in expected location. no hydronephrosis or hydroureter. multiple echogenic foci, which may represent air or less likely nonobstructive left renal calculi. egd wednesday, findings: esophagus: contents: digested food was found in the distal esophagus. stomach: lumen: a small size hiatal hernia was seen. contents: a food bezoar was found in the fundus. other multiple red circular lesions of the same diameter were noted in the stomach body. the three most distal lesions were entirely flat and located along lines of linear erythema. proximally, along the greater curvature, there were two circular lesions that were raised and almost polypoid. the final two lesions were flat with apparent submucosal hemorrhage. taken together, these lesions appeared consistent with significant ng trauma. this is plausible since the patient's ng tube was to suction for some time. nevertheless, we have no obvious explanation for his reported coffee ground emesis. duodenum: normal duodenum. impression: gastric bezoar circular lesions likely ngt trauma as noted above food in the distal esophagus small hiatal hernia otherwise normal egd to third part of the duodenum egd friday, findings: esophagus: mucosa: a salmon colored mucosa suggestive of short segment (about 2cm) barrett's esophagus was found. the z-line was at 37 cm from the incisors. biopsies were not taken given recent upper gi bleed. stomach: excavated lesions a single superficial 3-4 mm ulcer was found in the stomach body. there was no high risk associated stimgata. duodenum: contents: pills were found in the third part of the duodenum. impression: mucosa suggestive of short segment barrett's esophagus ulcer in the stomach body pills in the duodenum otherwise normal egd to third part of the duodenum brief hospital course: 77m with h/o cad s/p cabg and stent placement, pacemaker, hemorrhagic frontal cva , prior dvt and pe, bph, type 2 dm, hypertension, ulcerative colitis (with h/o of admissions for gi bleeding) transferred from with gi bleed and septic shock due to uti with obstructive kidney stone. # septic shock from bacterial uti with proteous, infected ureteral stone: admitted with fevers and positive ua in the setting of obstructive kidney stone and recent cystoscopy. blood cultures showed gram negative rods. urine culture grew proteus. - zosyn empirically for gram negative and anaerobe coverage in the setting of recent instrumentation/hospitalization, which was changed on to ceftriaxone with sensitivities. - pt was initially hypotensive to 70s on admission so gave fluid boluses and started on levophed, with good result, patient transferred to the floor on . - ct a/p at showed multiple left renal calculi with mild left hydronephrosis and delayed nephrogram c/w acute obstruction as well as cystitis. concern was for infected fluid collection behind stone so he underwent nephrostomy tube placement by ir to drain renal pelvic space behind stone. they recommended leaving nephrostomy tube in place until definitive stone treatment can be done, which is to be arranged when patient is stabilized with dr. at nwh. # hypokalemia, hypomagnesemia - patient has required almost daily supplementation. at the rehab he should have a daily potassium check, and supplementation as needed. his wife reports that at home he consumes many bannanas and he has a normal k at home, so this is likely some self-supplementation. he may require chronic oral supplementation, but would not initiate this until he is clinically stable. # upper gi bleed due to gastric ulcers: initially presented to outside hospital with coffee-ground emesis. gi was consulted and performed egd on which showed multiple circular lesions consistent with ng trauma, as well as large bezoar, with no evidence of recent or active bleeding. gi recommended placing patient on iv ppi and erythromycin to help propagate the bezoar. a repeat egd was performed on , which showed a superficial ulcer in the stomach body and short-segment barrett's esophagus. he received 1unit prbc while in the icu. hct remained stable thereafter in the 30's. he was transitioned to po ppi. he will remain on both the ppi and erythromycin until presenting to his followup gi appointment # fall: patient had fall at home prior to presentation. the etiology was unclear. ep was consulted to interrogate his pacemaker and found that he had an episode of asymptomatic wide-complex tachycardia. ep described it as an atrial tachy-arrhythmia with aberrancy and subsequently re-programmed the pacer to detect it at 135bpm. ct head showed no acute intracranial process. # atrial tachycardia with abberency - the patient frequently goes into a wide complex rhythm. this is abberent conduction, and was evaluated by the ep service with his primary cardiologist, dr. , who concurred that there is no need for urgent intervention. # acute renal failure: this was thought to result from a combination of septic shock as well as the obstructing calculus. improved with hydration, treatment of sepsis, and nephrostomy placement. discharge cr was 0.6. # extrapyramidal syndrome: the patient was noted to have tremor and bilateral cogwheel rigidity. most likely parkinson's or vascular ep syndrome but in the setting of enlarged ventricles on ct head, urinary incontinence and his h/o recurrent fall. patient may benefit from outpatient followup on this when not acutely ill. # thrombocytopenia: this is chronic and was relatively at his baseline. # cad s/p cabg / chronic systolic chf / benign hypertension: ischemic cardiomyopathy with ef 35-45% at baseline. held ace-i and bb initially in the setting of bleeding and sepsis. these were later reintroduced once his bp was stable. asa was held and remains held until the lithotripsy. # ulcerative colitis: continued asacol. # type 2 diabetes controlled without complications: continued standing nph and sliding scale # depression - continued lexapro, seroquel, ritalin # constipation - patient became highly constipated, but was succesfully treated with peg over 3 days. full code medications on admission: atenolol - 25 mg tablet - 1 (one) tablet(s) by mouth qam diphenoxylate-atropine - 2.5 mg-0.025 mg tablet - 1 tablet(s) by mouth twice a day as needed for diarrhea escitalopram - 20 mg tablet - 1 tablet(s) by mouth once a day mesalamine - 400 mg tablet, delayed release (e.c.) - 4 (four) tablet(s) by mouth four times a day quetiapine - 25 mg tablet - 1 tablet(s) by mouth daily ramipril - 5 mg capsule - 2 capsule(s) by mouth once a day ritalin - 20mg tablet - one twice a day simvastatin - 20 mg tablet - 1 tablet(s) by mouth at bedtime tamsulosin - 0.4 mg capsule, ext release 24 hr - 1 capsule(s) by mouth once a day medications - otc aspirin - (otc) - 81 mg tablet, delayed release (e.c.) - 1 tablet(s) by mouth once a day blood sugar diagnostic - strip - test twice a day cholecalciferol ( d3) d] - (otc) - dosage uncertain cranberry - 500mg cap - dosage uncertain nph insulin human recomb - 100 unit/ml suspension - inject 6 units qam discharge medications: 1. mesalamine 400 mg tablet, delayed release (e.c.) sig: four (4) tablet, delayed release (e.c.) po qid (4 times a day). 2. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 3. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush. 4. sodium chloride 0.9 % 0.9 % syringe sig: three (3) ml injection q8h (every 8 hours) as needed for line flush. 5. methylphenidate 10 mg tablet sig: two (2) tablet po bid (2 times a day). 6. quetiapine 25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 7. escitalopram 10 mg tablet sig: two (2) tablet po qhs (once a day (at bedtime)). 8. insulin regular human 100 unit/ml solution sig: one (1) sliding scale injection qachs: standard insulin sliding scale. 9. erythromycin 250 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q6h (every 6 hours). 10. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po daily (daily) as needed for constipation. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 13. ramipril 5 mg capsule sig: two (2) capsule po daily (daily). 14. ceftriaxone in dextrose,iso-os 1 gram/50 ml piggyback sig: one (1) gram intravenous q24h (every 24 hours): until lithotripsy procedure. 15. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. discharge disposition: extended care facility: at discharge diagnosis: septic shock gi bleed due to gastic ulcers barrett's esophagus obstructive nephrolithiasis acute kidney injury bacteremia urinary tract infection hypokalemia hypomagnesemia constipation chronic systolic chf cad bypass vessle depression discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted for treatment of your blood in your vomit, an infected kidney stone, and urinary tract infection with septic shock. you had an upper endoscopy which showed a large collection of undigested food in your stomach. repeat endoscopy showed a small ulcer in your stomach and abnormal lining of your esophagus called barrets esophagus. your infection was treated with iv antibiotics and medicine to support your blood pressure in the intensive care unit. you will need to complete antibiotics until you have your lithotripsy with dr. . you have also had low potassium levels, which the rehab will continue to monitor, and they can give you potassium as needed. medication changes: - followup instructions: please call today to make an appointment with dr. office at to arrange for your lithotripsy procedure department: cardiac services when: friday at 2:00 pm with: device clinic building: sc clinical ctr campus: east best parking: garage department: healthcare of when: friday at 11:00 am with: . , md building: (, ma) ground campus: off campus best parking: parking on site procedure: other endoscopy of small intestine other endoscopy of small intestine percutaneous nephrostomy without fragmentation central venous catheter placement with guidance diagnoses: anemia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified severe sepsis coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes depressive disorder, not elsewhere classified hypopotassemia diaphragmatic hernia without mention of obstruction or gangrene paroxysmal ventricular tachycardia constipation, unspecified long-term (current) use of insulin septic shock chronic systolic heart failure chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction cardiac pacemaker in situ other septicemia due to gram-negative organisms accidents occurring in other specified places personal history of venous thrombosis and embolism ulcerative colitis, unspecified calculus of ureter calculus of kidney disorders of magnesium metabolism barrett's esophagus other accidents other secondary thrombocytopenia unspecified extrapyramidal disease and abnormal movement disorder 

Answer: The patient is high likely exposed to