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: patient recorded as having no known allergies to drugs attending: chief complaint: ams major surgical or invasive procedure: change of suprapubic foley rij placement history of present illness: 62 yo male with hx of cva, neurogenic bladder with indwelling suprapubic catheter with multiple prior admissions for utis, altered mental status, and sepsis (uti/pna). today he is being transferred from the nursing home for fever of 101.4, and mental staus change. he was found by ems to have a pressure of 70/40. brought to ed with initial vs: t 98.6 p 105 bp 70/40 r 16 o2 100% satra. patient was found to have pyuria, pan cultured, given vanc/zosyn, bladder cath exchanged, ij placed, initially fluid responsive (3l), but repeat sbp 80, levophed started. . on the floor, alert oriented with map of 90 after 2l ns and 0.05 of levophed . review of sytems: (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: s/p cva neurogenic bladder s/p suprapubic cath recurrent utis with klebsiella/pseudomonas non-hodgkins marginal zone lymphoma of the left orbit dx in 03 (s/p r-chop x 6 cycles) bells palsy bph hypertension partial bowel obstruction s/p colostomy hepatitis c cryoglobulinemia sle with transverse myelitis, anti-dsdna ab+ insulin dependant diabetic fungal esophagitis stage iv? urinary tract infections-pseudomonas & enterococcus social history: lives in a nursing home since . denies smoking, etoh, drug use. has sister close by () who he is close to. is a jehova's witness and in the past did not agree to transfusions. family history: non-contributory physical exam: 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 ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 09:05am wbc-28.2*# rbc-5.25 hgb-13.6* hct-42.6 mcv-81* mch-25.8* mchc-31.8 rdw-15.9* plt ct-167 01:23pm wbc-37.8* rbc-4.87 hgb-12.7* hct-40.5 mcv-83 mch-26.1* mchc-31.3 rdw-15.9* plt ct-153 06:27pm wbc-38.3* rbc-5.02 hgb-13.1* hct-41.6 mcv-83 mch-26.2* mchc-31.6 rdw-16.5* plt ct-157 10:08pm wbc-34.9* rbc-5.26 hgb-13.8* hct-43.4 mcv-83 mch-26.2* mchc-31.8 rdw-16.6* plt ct-152 03:26am wbc-26.8* rbc-4.66 hgb-12.4* hct-38.2* mcv-82 mch-26.6* mchc-32.4 rdw-16.5* plt ct-131* 01:23pm pt-16.4* ptt-38.4* inr(pt)-1.5* 03:26am pt-18.1* ptt-35.1* inr(pt)-1.7* 09:05am glucose-82 urean-26* creat-3.3*# na-135 k-4.6 cl-98 hco3-25 angap-17 01:23pm glucose-117* urean-22* creat-2.3* na-140 k-4.6 cl-109* hco3-20* angap-16 06:27pm glucose-158* urean-21* creat-2.2* na-140 k-6.3* cl-110* hco3-21* angap-15 08:48pm glucose-166* urean-21* creat-2.0* na-141 k-5.9* cl-108 hco3-23 angap-16 10:08pm glucose-183* urean-21* creat-2.0* na-142 k-5.5* cl-110* hco3-24 angap-14 03:26am glucose-287* urean-19 creat-1.7* na-142 k-4.7 cl-110* hco3-25 angap-12 03:07pm glucose-239* urean-17 creat-1.3* na-142 k-4.2 cl-107 hco3-27 angap-12 01:23pm alt-43* ast-62* ld(ldh)-331* ck(cpk)-3687* alkphos-74 totbili-2.2* 06:27pm alt-47* ast-87* ld(ldh)-394* ck(cpk)-5931* alkphos-75 totbili-2.5* 10:08pm alt-49* ast-92* ld(ldh)-356* ck(cpk)-6489* alkphos-76 totbili-2.1* 03:26am ck(cpk)-5158* 03:07pm ck(cpk)-3133* 01:23pm ck-mb-9 ctropnt-0.06* probnp-777* 06:27pm ck-mb-13* mb indx-0.2 ctropnt-0.03* 09:05am albumin-4.1 calcium-9.6 phos-2.3* mg-2.0 08:48pm calcium-8.1* phos-4.1 mg-2.4 09:13am glucose-82 lactate-4.3* na-136 k-4.2 cl-94* calhco3-25 09:53am lactate-2.7* 10:27pm lactate-1.8 . cxr: left ij catheter tip is in the upper svc. there is moderate pulmonary edema. there are low lung volumes. cardiac silhouette is top normal. bilateral pleural effusions are small. the cardiomediastinum is deviated towards the right side. this is a chronic finding. brief hospital course: this is a 62 yo male with neurogenic bladder and suprapubic cath, multiple past utis and urosepsis, with resolved septic shock on vanc/meropenem for urosepsis and flagyl for cdiff ppx. . # urosepsis: patient initially presented in septic shock and was hypotensive requiring levophed. given gross pyuria was assumed to be source, other possible considerations included infected stoma, suprapubic cathether site, cdiff. hct stable w/o signs of bleed, cardiogenic shock not consistent with current presentation, elevated trop, in the setting of shock and renal failure with flat ck suggesting demand ischemia. mixed svo2 suggesting septic shock. patient placed on vanc/meropenem for pyuria, wbc, bandemia, hypotension, fever, suggestin sepsis, given past sensitivity profile would favor changing to meropenem until new cultures back. hypotension appears to have caused acute renal failure. given stress dose steroid and tapered back to home dose. remains on meropenenem and flagyl until f/u with next week. . # neurogenic bladder with nephrolithiasis: pt reports scheduled surger on by dr. . per ct, no change of his non obstructing stone. significant leaking around suprapubic cath site. d/w , started on ditropan changed over to detrol. not concerned with leaking and will f/u with pt next week. . # history of c diff. given the severity of the sepsis on initial presentation, recent prolonged antibiotic use and hospitalization and previous c diff, started po vanc and iv flagyl. remains on flagyl until meropenem is stopped. . # rhabdomylasis ?????? cks peaked and now trending down, no evidence of significant muscle breakdown or compartment syndrome. stopped statin. fluid resuscitated. ck's trending down with improved renal fxn. . #. resolved altered mental status: appears similar to prior episode per review of discharge summary and patient is clinically infected. most likely due to sepsis and hypotension with underlying poor reserve. on the floor, ms change seems to have resolved. . #. acute renal failure: creatinine up to 3.3 in the setting of septic shock. most likely prerenal over the past several days and perhaps some atn. although pt with diagnosis of sle and anti-dsdna ab+ , his most recent creatinine 0.8 indicates acute process. . # completed romi: patient had elevated troponin in the setting of renal failure and shock. ck mbi negative. elevated ck from non-cardiac source. no ekg changes. issue resolved. . # leg pain: patient states pain is bilateral and longstanding. on gabapentin & oxycodone at nursing facility. on gabapentin, percocet (because of inavailability of oxycodone) and started on nortriptyline. . # stoma: likely benign given that stoma appears pink and is soft. no abd tenderness. stoma remained pink and non-tender t/o hospitalization. . # dm: on lantus & humalog (with meals & sliding scale) at baseline. d/c on meds close to home dose . . #. fen - regular diet. lytes were repleted prn. . #. ppx - hep sc tid. ppi (recent gastritis). hx of cdiff giving flagyl . # access: 2 pivs, r ij cvl . #. code - full, confirmed with patient. sister is hcp. products as patient is jehovah's witness (confirmed with him). . # communication: with patient and sister, . medications on admission: bactrim ds daily for uti ppx (finished 1 month course ) mvi prednisone 10 mg daily prilosec 40 daily ca/vit d 600 colace iron 325 gabapentin 1200 tid zocor 10 mg daily lantus 18 iu qhs humalog 8 iu with each meal standing humalog ss percocet 5/325 2tab tid senna 2 tabs discharge medications: 1. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 2. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 3. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 6. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 7. multivitamin tablet sig: one (1) tablet po daily (daily). 8. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours). x 4 days 9. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush. 10. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 11. meropenem 1000 mg iv q12h x 4 days 12. pantoprazole 40 mg iv q24h 13. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). 14. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). 15. gabapentin 300 mg capsule sig: one (1) capsule po q12h (every 12 hours). 16. potassium & sodium phosphates 280-160-250 mg powder in packet sig: one (1) powder in packet po tid (3 times a day) for 1 days. 17. nortriptyline 25 mg capsule sig: one (1) capsule po hs (at bedtime). 18. percocet 5-325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain. 19. tolterodine 2 mg tablet sig: one (1) tablet po bid (2 times a day). 20. insulin glargine 100 unit/ml cartridge sig: one (1) injection subcutaneous at bedtime: see attached insulin flowsheet. 21. insulin regular human 100 unit/ml cartridge sig: one (1) inj injection qawhs: see attached flowsheet. 22. heparin (porcine) 5,000 unit/ml solution sig: one (1) inj injection tid (3 times a day): please administer for dvt prophylaxis if pt remains in bed. discharge disposition: extended care facility: healthcare- discharge diagnosis: primary: urosepsis altered mental status acute renal failure secondary: neurogenic bladder dm2 peripheral neuropathy discharge condition: improved discharge instructions: you were evaluated and treated in the hospital for a systemic infection which likely originated with a urinary tract infection and acute renal failure. your renal function has returned to baseline and your infection is currently being treated with the appropriate antibiotics. you will need to continue the antibitoics for a total of 2 weeks and then you will continue on other antibiotics to prevent against further infections. you will also need to follow-up with your primary care doctor and your urologist. followup instructions: please follow-up with your primary care doctor dr. . we called his office today and were unable to get a follow-up appointment. he can be reached at . please follow-up with the unit phone:, your appointment is scheduled for at 10:00am procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified nonmechanical methods of resuscitation replacement of cystostomy tube diagnoses: acidosis systemic lupus erythematosus chronic hepatitis c without mention of hepatic coma diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) personal history of other lymphatic and hematopoietic neoplasms long-term (current) use of insulin septic shock personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure pulmonary congestion and hypostasis unspecified hereditary and idiopathic peripheral neuropathy rhabdomyolysis paraplegia other paraproteinemias colostomy status acute pyelonephritis without lesion of renal medullary necrosis neurogenic bladder nos pain in limb other causes of myelitis 

Answer: The patient is high likely exposed to