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: no known allergies / adverse drug reactions attending: chief complaint: emphysematous pyelonephritis. major surgical or invasive procedure: arterial blood gases. history of present illness: 59f w/ h/o dm type 2 and gerd who is transferred from for concern for emphysematous pyelonephritis and possible pe. pt reports she developed left leg pain on - aching in her thigh not associated w/ back pain, paresthesias or weakness. no injury or trauma. she medicated w/ ibuprofen and later her husband's oxycodone w/ minimal relief. on taking the oxycodone on , patient vomited. the next day she developed abdominal cramping, increased nausea, palpitations and a headache. reports poor po intake and metallic taste in mouth. no cp, fevers, or chills. did have some increased "work of breathing and respiratory rate" which she now attributes to her diabetes. denies exertional component, pnd, hemopytsis or pleuritic symptoms. + dry cough. patient presented primarily due to the leg pain, nausea, and headache. she feels the respiratory symptoms were a relatively minor issue. denies h/o blood clots, recent surgery or immobilization. she denies any hematuria, dysuria, frequency, or increased urgency. of note, patient reports a prior uti diagnosed a month ago at nebh and treated w/ 7 days of antibiotics, though she does not remember which one nor what organism she grew. at that time, had no urinary symptoms but presented w/ malaise and w/u revealed leukocytosis w/ positive ua, negative cxr. . at , her blood sugar was found to be in the 300s with ketones in her urine. she had an elevated d-dimer so she underwent a ct chest which showed questionable small pes. she also had a ct of her abdomen and pelvis which showed right hydronephrosis with gas. ekg sinus tachy at 105 w/o any concerning st changes, q's or s waves. she was given flagyl and levaquin as well as 2 l ns, 1 tab vicodin, 2 mg morphine, and 10 units of insulin iv. she was transferred to for further management. . in the ed, initial vs were: 97.8 95 111/59 18 95%. fsbs was noted to be 284 for which patient received 5 units of regular insulin sc. labs here w/ na 132, anion gap of 15, normal lactate. ua with >182 wbcs, few bac, lg le, neg nit. a second read of the ct scans performed at was requested and was notable for a central filling defect in the posterior basal segment of the right lower lobe concerning for pe, though not fully characterized. also, confirmed r emphysematous pyelonephritis/ureteritis, and probable early l pyelonephritis on wet re-read. urology was made aware of the patient. the patient was started on heparin for likely pe after rectal exam was guaiac negative. she also received morphine 5 mg x1, dilaudid 0.5 mg x2, and zofran 4 mg x1. vital signs on transfer were: 97.1 po, 101/42, 95, 16, 95% ra. . currently, patient is comfortable and reports some mild nausea. denies abdominal pain. reports pain in the left thigh that has not improved w/ any of the narcotics she has received. . ros: denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, chest pain, diarrhea, constipation, brbpr, melena, hematochezia, dysuria, hematuria. past medical history: insulin dependent diabetes mellitus gerd social history: pt lives with her husband and works as a respiratory therapist. tobacco: none. alcohol: none. recreational drugs: none. family history: father died of aaa at age 73. mother died of breast cancer at age 49. physical exam: on admission: vs - temp 98.6f, bp 115/53, hr 91, r 18, o2-sat 95% ra wt 84.7kg general - well-appearing woman in nad, comfortable, appropriate heent - nc/at, perrla, eomi, sclerae anicteric, dry mm, op clear neck - supple, no thyromegaly, no jvd, no lad lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - rrr, no mrg, nl s1-s2 abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding back - no cva tenderness extremities - l thigh w/ tenders in it band region, slightly worsened w/ palpation; negative straight leg raise; negative ; no calf tenderness; wwp, no c/c/e, 2+ peripheral pulses (radials, dps) skin - no rashes or lesions neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout . on discharge: pertinent results: osh labs prior to admission: wbc 27.3 hct 37.6 plt 228; 85% polys, 8% bands d-dimer 4602; trop negative na 129, k 3.4, glucose 381, creatinine 1.0, lactate 1.5; anion gap 16 ua: neg nitrite, larg le, beta hydroxybutyrate 3.78 . labs on admission: 11:00pm blood wbc-21.6* rbc-3.87* hgb-11.2* hct-36.1 mcv-93 mch-29.0 mchc-31.2 rdw-13.6 plt ct-246 11:00pm blood neuts-90.1* lymphs-6.4* monos-3.1 eos-0.1 baso-0.3 11:00pm blood pt-12.1 ptt-23.8* inr(pt)-1.1 11:00pm blood glucose-243* urean-26* creat-0.8 na-132* k-3.6 cl-98 hco3-19* angap-19 07:05am blood ck(cpk)-24* 11:00pm blood ctropnt-0.02* probnp-1316* 06:20am blood calcium-7.6* phos-1.7* mg-1.7 07:05am blood acetone-small osmolal-293 10:41am blood type-art po2-83* pco2-29* ph-7.33* caltco2-16* base xs--9 11:04pm blood lactate-1.7 10:41am blood lactate-0.9 07:05am blood beta-hydroxybutyrate-pnd . labs on discharge: imaging & studies: osh ct chest: impression per rads: 1. suboptimal examination, with no central pulmonary embolus. questionable nonocclusive filling defect in the posterior basal segment of the right lower lobe. recommend repeat chest cta to reevaluate this finding. 2. left lower lobe pulmonary nodules measuring up to 8 mm. recommend three-month followup chest ct. . osh ct abd/pelv: impression per rads: ascending urinary tract infection, with right emphysematous pyelonephritis/ureteritis and left pyelonephritis. . leni (left): impression: no evidence of deep venous thrombosis in the left lower extremity. . echocardiogram (tte): impression: normal global and regional biventricular systolic function. mild pulmonary hypertension. . cta chest/ct abd/pelv: impression: 1. no evidence of pulmonary embolus. 2. unchanged right emphysematous pyelonephritis/ureteritis and left pyelonephritis. no abscess or fluid collection identified. 3. no retroperitoneal hematoma present. . renal u/s: impression: no hydronephrosis and no fluid collection identified. air within the right kidney, consistent with the known right emphysematous pyelonephritis. diminished right cortical vascularity may also relate to underlying pyelonephritis. brief hospital course: this is the brief hospital course for a 59 year-old female admitted to from on for management of emphysematous pyelonephritis. . #. dm2: with dka. infection migh have caused this patient with dm2 to go into dka. has ketones in blood (and had ketonuria at osh). no prior history to suggest ketosis-prone/flatbush dm. has gotten insulin sc and tonight got insulin 5units iv. initial anion gap 23, and though decreased to 11 in the setting of receiving insulin/bicarb for pre-cath hydration/iv fluids, there is concern that the gap could open again. her bg was monitored closely. she was given aggressive iv fluid hydration. she was initially maintained on insulin drip then transitioned to long acting and sliding scale short acting humalog with uptitration as necessary. her anion gap closed, patient remained stable and was transferred to the medicine floor. --she should follow up with the dm center for further management. . #. emphysematous pyelonephritis: with bacteremia. patient presented form osh with c/f emphysematous pyelo. osh blood cultres growing pan-s e. coli. wbc had been 26 at osh but now ~21. patient has been maintained on cefepime (started cefepime ) b/c of continued leukocytosis. now quite stable, afebrile with no signs of sepsis; urinating well, lactate normal, mentating fine, bp stable. urology was consulted and incomplete bladder emptying was ruled out. antibiotics were narrowed to ceftriaxone based on ucx sensitivities. a lag in resolution of leukocytosis was initally concerning, however, repeat imaging with ultrasound revealed no abscess or other complications. an infectious disease c/s was obtained, with recommendation to increase her dose of ctx. she continued to improve clincially on this regimen. - surveillance cultures needed - renal u/s in 3 weeks as an outpatient - needs long-term abx 3-4 weeks . #. lle pain: unclear etiology. no dvt per leni. ck normal. no hct drop while on heparin gtt to suggest r-p bleed. no suggestion of abscess, though team considering. team had asked for pt to have ct thigh/leg after cta and radiology suggested ordering it as a ct abd/pelvis with extension to mid-thigh but the thigh was not done. a cta chest was negative for pe. -f/ read of imaging . #. lung nodules: incidental. on cta chest a lll, ~8 mm in size w/ diffuse reactive lad was noted. -outpatient f/u ct in 3 months . #. gerd: stable. -continue home omeprazole . transitional issue: 1. left lower lobe pulmonary nodules measuring up to 8 mm. recommend three-month followup chest ct. 2. repeat renal u/s in 3 weeks. 3. f/u for diabetes. 4. pcp to follow count for resolution of leukocytosis. medications on admission: lantus 24 units daily novolog 6 units metformin 500 mg quinapril 10 mg daily omeprazole 20 mg daily discharge medications: 1. outpatient physical therapy patient requires outpatient physical therapy for strengthening and recovery of left leg function as well as overall deconditioning from an extended illness. 2. outpatient lab work weekly cbc with differential, alt, ast, t bili, alk phos, bun, and creatinine. please fax to infectious disease r.ns. at (. if any issues, phone# is (. 3. ceftriaxone 2 gm iv q24h rx *ceftriaxone 2 gram 2 grams intravenous daily disp #*42 gram refills:*0 4. glargine 34 units breakfast insulin sc sliding scale using hum insulin 5. metformin (glucophage) 500 mg po bid 6. quinapril 10 mg po daily 7. omeprazole 20 mg po daily 8. acetaminophen 650 mg po q6h:prn pain 9. docusate sodium 100 mg po bid 10. senna 1 tab po bid constipation 11. oxycodone (immediate release) 10 mg po q6h:prn pain please do not drive, operate machinery, or take other sedating medications while on this medication. rx *oxycodone 10 mg 1 tablet(s) by mouth every 6 hours disp #*20 tablet refills:*0 12. lancets,thin *nf* (lancets) freestyle lite lancets: use to check blood sugar miscellaneous four times a day rx *freestyle lancets use to check fingersticks four times a day disp #*1 box refills:*2 13. freestyle lite strips *nf* (blood sugar diagnostic) use to check fingerstick miscellaneous four times a day rx *freestyle lite strips use to check fingerstick four times a day disp #*1 box refills:*2 discharge disposition: home with service facility: home solutions discharge diagnosis: primary: emphysematous pyelonephritis e. coli bacteremia diabetic ketoacidosis secondary: diabetes mellitus hypertension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were transferred to due to concerns that you had a kidney infection and possibly a pulmonary embolus (blood clot in the lungs). we made sure you do not have a pulmonary embolus, so you do not need to be on blood thinners. but you do have a kidney infection, and the e. coli bacteria have caused gas formation in the kidneys (emphysematous pyelonephritis). you will be treated with intravenous antibiotics for a total of weeks, to be determined by infectious disease outpatient antibiotic clinic (appointment listed below). note that you also have a primary care appointment (listed below) which you should keep. you will need a repeat renal ultrasound in 6 weeks (during the week of ) to confirm that the gas in the kidneys has decreased. please remember to mention this to your primary care doctor. also, you should mention your left leg/thigh pain with your doctor. the cause is unclear; we made sure you did not have a bleed or a blood clot but your doctor might consider performing an mri to investigate a musculoskeletal cause. while you were here you were briefly in the medical icu for diabetic ketoacidosis, which is acid build-up in the blood because of very elevated blood sugars. you required an insulin drip for a short amount of time but then were reasonably controlled on subcutaneous insulin. your blood sugar elevation is likely due to your infection. you are being discharged on an increased insulin regimen, but it is possible that it will be able to be decreased as your infection resolves. please follow-up with diabetes (appointment listed below). you should check your fingersticks before meals and at bedtime. if you notice blood sugars of <80 or >300 please call at ( or on nights/weekends you can contact the covering physician (. we made the following changes to your medications: -start ceftriaxone (total course 3-4 weeks, day 1 was ) -start tylenol and oxycodone as needed for pain (do not drive, operate machinery, or use sedatives while you are on this medication) -increase basal lantus to 34 units a day -stop novolog -start humalog sliding scale (please see attached) followup instructions: primary care department: primary care name: dr. for dr. when: monday at 7:45 am address: 1 compass way, , phone: notes: dr. works in the same practice as dr. . after this visit you should make an appointment with your regular pcp. diabetes thursday at 2:00 pm one place , ( infectious disease outpatient clinic department: infectious disease when: thursday at 2:00 pm with: , m.d. building: lm campus: west best parking: garage ***note: you are currently scheduled for and infectious disease appointment at the same time. infectious disease will be calling you with a revised appointment time. if you do not hear back by tuesday please call them at to reschedule.*** procedure: central venous catheter placement with guidance diagnoses: esophageal reflux long-term (current) use of insulin other diseases of lung, not elsewhere classified septicemia due to escherichia coli [e. coli] hydronephrosis diabetes with ketoacidosis, type i [juvenile type], uncontrolled personal history, urinary (tract) infection acute pyelonephritis without lesion of renal medullary necrosis pain in limb 

Answer: The patient is high likely exposed to