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: amiodarone / ambien / amikacin / red dye / aminoglycosides / iodine / polysorbate 80 attending: chief complaint: epistaxis major surgical or invasive procedure: nose pack to left nosstril history of present illness: 78yo woman with afib on warfarin, chf ef 25% presented with spontaneous epistaxis to osh, drop in hct from 41 to 33. patient reports spontaneous bleeding from the left nostril on at 4am, continuing all day before presenting to . on presentation to osh ed her hct was 41.3, inr was 3.56. inr held and trended down to 2.48, hct to 33. left nostril was packed with anterior left rhinoket. she has also been having bleeding from the eye, and hematemesis and melena. however, she was noted to still be "oozing" posteriorly. over the course of her hospitalization patient was noted to have a hct drop from 41.3 on admission to 33, now to 27, but had not had any transfusions to date. patient has remained hemodynamically stable with normal renal function. she was transfered to per family request. she was initially admitted to the floor. she was noted to have hematemesis and black stools. she was transferred on the evening of admission to the icu for falling hct. in the micu, she was transfused one unit prbcs and was hemodynamically stable. review of sytems: (+) per hpi , dyspnea on exertion, stable. she has had only one prior nose bleed on several years ago managed conservatively at home. (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath. denies chest pain or tightness, palpitations. denies nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denies arthralgias or myalgias. past medical history: cardiac risk factors: dyslipidemia, hypertension . pacemaker/icd, in ( concerto device) . other past history: atrial fibrillation non-ischemic cmo (ef 25-30%) hypertension dyslipidemia anxiety liver cyst s/p partial hysterectomy tonsillectomy appendectomy breast cyst removed breast reduction surgery . social history: the patient is married and lives at home with her husband and daughter. she smoked tobacco and quit 21 years ago. she drinks etoh rarely. family history: brother and sister with atrial fibrillation and cardiomyopathy. father died of congestive heart failure at age 78. mother died from congestive heart failure and had benign brain tumors. physical exam: physical exam on admission: tmax: 98.3 ??????f tcurrent: 97.6 ??????f hr: 104 (91 - 104) bpm bp: 112/50(67) {95/37(52) - 128/62(111)} mmhg rr: 20 (7 - 25) insp/min spo2: 95% balance: 24 hour -275, since am + 875 ml general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, edema of lower eyelids bilaterally, left nostril with packing. no skin changes on left face compared to right, no edema. neck: supple, jvp not elevated, no lad lungs: decreased breath sounds at the bases, no wheezes, rales, ronchi cv: irreg irreg, 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 skin: no rash neuro: alert and oriented x 3, strength 5/5 in all extremiteis, sensation grossly intact. facial musculature symmetric, cn2-12 intact. physical exam on discharge: heent: left nasal packing removed, no further epistaxis, decrease in size of lower eyelid edema pertinent results: lab results on admission: 06:28pm blood wbc-22.9*# rbc-3.08*# hgb-9.5*# hct-27.9*# mcv-91 mch-30.8 mchc-34.0 rdw-14.3 plt ct-221# 06:28pm blood neuts-64.4 lymphs-32.2 monos-2.9 eos-0.1 baso-0.4 06:28pm blood pt-22.9* ptt-25.9 inr(pt)-2.2* 06:28pm blood glucose-200* urean-72* creat-1.1 na-140 k-4.3 cl-103 hco3-25 angap-16 06:28pm blood alt-12 ast-12 alkphos-31* totbili-0.6 06:28pm blood albumin-3.9 calcium-9.3 phos-3.2 mg-1.5* 08:10am blood %hba1c-6.4* eag-137* 09:13pm blood digoxin-0.9 09:44pm blood lactate-3.0* studies: cardiovascular report ecg study date of 5:52:48 pm baseline artifact. probable atrial fibrillation with short cycle length and long cycle length different morphology beats. the long cycle length is a ventricular paced beat. the short is either ventricular or aberration. conducted complexes have low limb lead voltage, leftward axis and intraventricular conduction delay of left bundle-branch block type. since the previous tracing of atrial fibrillation appears to be new. clinical correlation is suggested. radiology report chest (portable ap) study date of 9:11 am findings: in comparison with the study of , the previous elevation of the right hemidiaphragm is no longer seen. there are mild areas of increased opacification at the bases, most likely reflecting atelectasis. in the appropriate clinical setting, the possibility of supervening pneumonia would have to be considered. no evidence of vascular congestion. dual-channel pacemaker device remains in place. urine: 02:30am urine color-straw appear-clear sp -1.013 02:30am urine blood-sm nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 02:30am urine rbc-<1 wbc-0 bacteri-none yeast-none epi-<1 microbiology: 9:13 pm blood culture source: venipuncture. **final report ** blood culture, routine (final ): no growth. 9:13 pm mrsa screen **final report ** mrsa screen (final ): no mrsa isolated. 9:35 pm urine source: cvs. **final report ** urine culture (final ): proteus mirabilis. 10,000-100,000 organisms/ml.. presumptive identification. piperacillin/tazobactam sensitivity testing available on request. escherichia coli. 10,000-100,000 organisms/ml.. presumptive identification. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ proteus mirabilis | escherichia coli | | ampicillin------------ <=2 s =>32 r ampicillin/sulbactam-- <=2 s 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s ciprofloxacin---------<=0.25 s =>4 r gentamicin------------ <=1 s <=1 s meropenem------------- 1 s <=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s lab results on discharge: 07:40am blood wbc-18.1* rbc-3.04* hgb-9.0* hct-29.2* mcv-96 mch-29.6 mchc-30.8* rdw-16.5* plt ct-300 07:40am blood neuts-43* bands-2 lymphs-46* monos-6 eos-1 baso-0 atyps-2* metas-0 myelos-0 nrbc-9* 07:40am blood pt-12.8* ptt-23.7* inr(pt)-1.2* 06:50am blood glucose-115* urean-27* creat-0.8 na-138 k-4.5 cl-103 hco3-28 angap-12 brief hospital course: primary reason for hospitalization: patient is a 78 year old female with pmh of afib on coumadin, non ischemic cmy ef 30% who presents with epistaxis in setting of supratherapeutic inr and 13pt hct drop. she had a rhinorocket placed with residual oozing at first, but achieved hemostasis with the device in place. she had a brief unit stay for falling hct but is transferred back to the floor after receiving 1 unit prbc. she was found to have an elevated wbc and bacteruria and initiated treatment for uti. the nasal packing was removed with no further bleeding, and patient was discharged on lower coumadin dosing to be titrated as an outpatient. she was discharged on bactrim to complete a 3-day course for uti. . acute care: 1. acute anemia secondary to left-sided epistaxis: patient presented with extreme epistaxis with supratherapeutic inr. the epistaxis ceased after placement of rhino-rocket and she required 1 unit of prbc. she denies symptoms of hypovolemia such as tachycardia, light-headedness, and hypotension during admission. the nasal packing was removed, and patient was discharged home on reduced warfarin dosing to be titrated to therapeutic inr. . 2. leukocytosis: patient had an elevated wbc count prior to placement of nasal packing. cxr from osh has been clear, pulmonary exam unremarkable. she had a recent urine infection per family, but patient denied symptoms. this is likely a stress reaction from blood loss vs. uti being treated with the keflex on for tss prevention while the rhonirocket was in place. wbc rose again after the nasal packing was removed, which is felt to be possibly related to undertreated uti. her ua was not impressive for infection, but culture grew out e.coli and proteus. hewr cxr showed question pneumonia but patient had no dyspnea, cough, or fever. she was discharged on a 3-day course of bactrim for uti and with pcp . . chronic care: 1. afib- chads= 3: patient presented with a supratherapeutic inr and warfarin was held because of epistaxis. metoprolol was initially held when patient had epistaxis but later restarted. she was continued on digoxin as well. . 2. chronic systolic chf with ef 25-30%: patient exhibited no evidence of decompenastion on this admission. she has an internal defibrillator which by her report fired recently. ep evaluated and recs appreciated. they recommend home inr monitor. she received home metoprolol and losartan and home lasix and spironolactone before discharge. . 3. hyperlipidemia: continued simvastatin . transitions in care 1. code status: full, confirmed for this admission 2. contact: hcp (home) (cell) 3. medication changes: **start sulfamethoxazole-trimethoprim (bactrim ds) twice a day for 3 days (last dose 4/20) to treat your urinary tract infection ** you may use oxymetazoline spray in your nostril if it begins to bleed again. then call your doctor. do not use this medication more than three days in a row. 4. follow-up: name: ,md specialty: primary care/cardiology location: internal medicine associates address: , , , phone: when:tuesday, at 2:30pm dr specialty: otolaryngology phone: ( when: at 11am please bring a photo id and your insurance card to this visit 5. outstanding clinical issues: -patient needs titration and close monitoring of inr as an outpatient -patient's wbc count should be followed to resolution during treatment of uti medications on admission: losartan 25mg daily sivmastatin 40 digoxin 125mcg daily paroxetine hcl 20 mg daily spironolactone 25 mg daily metoprolol 50qam, 100mg qpm lasix 40 mg tablet daily warfarin 1.5 mg 4x/week warfarin 2.5mg 3x/week vitamin d 1000u daily discharge medications: 1. losartan 25 mg tablet sig: one (1) tablet po daily (daily). 2. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 3. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 4. paroxetine hcl 20 mg tablet sig: one (1) tablet po daily (daily). 5. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 6. metoprolol tartrate 50 mg tablet sig: one (1) tablet po once a day: pt also taking 100 mg at night for dose 150 for the day. 7. metoprolol tartrate 100 mg tablet sig: one (1) tablet po at bedtime: pt also taking 50 mg in the morning for dose 150 for the day. 8. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 9. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po bid (2 times a day) for 3 days. disp:*6 tablet(s)* refills:*0* 10. oxymetazoline 0.05 % aerosol, spray sig: one (1) spray nasal (2 times a day) as needed for epistaxis for 3 days: if nose begins to bleed again at home. disp:*1 bottle* refills:*0* 11. warfarin 2.5 mg tablet sig: one (1) tablet po 3 x a week: as directed for goal inr 2 - 2.5. 12. warfarin 1 mg tablet sig: 1.5 tablets po 4 x a week: as directed for goal inr 2 - 2.5. 13. outpatient lab work please check inr and wbc on friday and monday and fax results to dr. at discharge disposition: home with service facility: discharge diagnosis: primary: epistaxis urinary tract infection secondary: chronic systolic heart failure atrial fibrilation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you came to the hospital because you had a severe nose bleed. your family requested that you be transferred to where you were monitored in the intensive care unit. you had several blood transfusions. eventually your bleeding stopped. we recommend that your inr be kept between 2.0 and 2.5 in the future to try to prevent bleeding. you should have your inr checked twice a week. you also should sneeze with mouth open, no heavy lifting, do not blow nose for the next 2 weeks. you may use some nasal saline spray to keep your nostrils moist as needed. in addition, you were found to have an elevated wbc count. this can be seen in the setting of infections. we are treating you for a urinary tract infection with antibiotics called bactrim. please continue to take these antibiotics for the next three days. we would also like you to have your wbc count checked on friday to make sure that it is going down. please also weigh yourself every morning, md if weight goes up more than 3 lbs. please note the following changes to your medications: **start sulfamethoxazole-trimethoprim (bactrim ds) twice a day for 3 days (last dose 4/20) to treat your urinary tract infection ** you may use oxymetazoline spray in your nostril if it begins to bleed again. then call your doctor. do not use this medication more than three days in a row. followup instructions: name: ,md specialty: primary care/cardiology location: internal medicine associates address: , , , phone: when:tuesday, at 2:30pm dr specialty: otolaryngology phone: ( when: at 11am please bring a photo id and your insurance card to this visit md procedure: control of epistaxis by other means diagnoses: other primary cardiomyopathies urinary tract infection, site not specified congestive heart failure, unspecified acute posthemorrhagic anemia atrial fibrillation other and unspecified hyperlipidemia chronic systolic heart failure long-term (current) use of anticoagulants anticoagulants causing adverse effects in therapeutic use proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site epistaxis other and unspecified escherichia coli [e. coli] 

Answer: The patient is high likely exposed to