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: penicillins / lidocaine / latex / ceftriaxone attending: chief complaint: abdominal pain major surgical or invasive procedure: central line arterial line history of present illness: 60yo female with history of ms d/o who presents with chief complaint of restlessness. per triage note, patient was brought in from rehabilitation center for abdominal pain. pt reportedly had a sexual encounter with her , who is also a resident at rehab, yesterday that involved "rough sex." patient is unable to give details of this event, but states it was consensual. she denies any vaginal pain, vaginal bleeding, rectal bleeding. she denies any other symptoms except for mild headache. she states she is here because she does not want to feel restless anymore. on arrival to the ed overnight, initial vs: t- 99.5, hr- 100, bp- 112/72, rr- 16, sao2- 97% on room air. labs were notable for wbc 19.2 with left shift, lactate 4.5. u/a showing moderate bacteria, > 182 wbc, large leukocyte esterase, positive nitrite. stox negative. serum tylenol 6. depakote level 69. cxr showed lll opacity, likely atelectasis and ct head demonstrated diffuse global atrophy with no acute intracranial process. ct abdomen showed "subtle loss of the corticomedullary differentiation of the left kidney with delayed excretion raises concern for pyelonephritis. mild left hydroureteronephrosis with an apparent intraluminal filling defect in the distal ureter which is non-specific and may represent debris, a non-calcified, stone, and soft tissue also remains a possibility. thick-walled bladder compatible with clinically known cystitis." after ct with contrast, pt became hypotensive, developed pain, and mottled skin. per ed, "presumably anaphylaxis." given epi, benedryl, steroids, pepcid and symptoms resolved. overall, in ed, patient received ativan, morphine, zofran, ceftriaxone, epinephrine, solumedrol, famotidine, benadryl. she received 3l ns, and repeat lactate was 3.6. vitals on transfer to the floor were t- 98.0, hr- 114, bp- 126/67, rr- 26, sao2- 100% on 3l nc. this morning she was found to have sbp in the low 90s with some somnolence as the patient was only responsive to sternal rub. she received 3l ns with improvement in mental status and sbp to 100s. hr remained in high 90s/low 100s. she was afebrile with no acute complaints. she is being transferred to the icu for concern of urosepsis. past medical history: -multiple sclerosis -secondary depression and psychosis -neurogenic bladder -sleep apnea - disorder social history: lives at rehab being wheelchair bound from progressive ms at rehab, consensual sexual intercourse, no concerns for abuse used to work at with pediatric early intervention program denies etoh, tobacco or illicit drug use family history: no family history of ms physical exam: admission exam: general: somnolent but responsive. heent: sclera anicteric, mmm, oropharynx clear, eomi neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: oriented to person and place. cnii-xii intact, strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact discharge exam: vitals: tmax 99.3, 98-112/64-72; 90-97; 18; 95%ra general: alert, awake, responsive and interactive, oriented to person, time, and place, occasionally thinks she is at rehab. able to count days of the week backwards from sunday to tuesday heent: sclera anicteric, mmm, oropharynx clear, has intraophthalmoplegia neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley draining clear urine ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: oriented to person, but not to place or time. cnii-xii intact, 2/5 strength in bilateral lower extremities, strength in upper extremities except left elbow flexor. grossly reduced sensation over lower extremities, gait deferred pertinent results: admission labs: 11:30pm blood wbc-19.2* rbc-4.53 hgb-12.8 hct-38.9 mcv-86 mch-28.2 mchc-32.9 rdw-13.6 plt ct-293 11:30pm blood neuts-84* bands-5 lymphs-1* monos-7 eos-0 baso-0 atyps-0 metas-3* myelos-0 11:30pm blood plt ct-293 11:30pm blood glucose-113* urean-22* creat-1.1 na-142 k-4.1 cl-103 hco3-26 angap-17 09:30am blood calcium-7.3* phos-3.2 mg-1.5* 11:30pm blood valproa-69 11:30pm blood asa-neg ethanol-neg acetmnp-6* bnzodzp-neg barbitr-neg tricycl-neg 03:05am blood lactate-4.5* ct abd/pelvis impression: 1. loss of the normal corticomedullary differentiation of the left kidney which raises concern for possible pyelonephritis. 2. delayed excretion of contrast involving the left kidney. mild left hydroureteronephrosis demonstrated to the level of distal ureter where there is an apparent filling defect which non-specific and may represent a stone, debris, or even possibly soft tissue. 3. thick-walled enhancing bladder compatible with clinically known cystitis. ct head : impression: 1. motion-limited examination demonstrating no acute intracranial hemorrhage or mass effect. 2. whit ematter hypodense foci- likely non-specific. however, correlate clinically to decide on the need for further workup with mri if not contra-indicated. micro: 11:50 pm urine site: not specified hem# 2237f . **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. piperacillin/tazobactam sensitivity testing available on request. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s 2:55 am blood culture **final report ** blood culture, routine (final ): escherichia coli. final sensitivities. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- <=1 s ceftazidime----------- 16 r ceftriaxone----------- 32 r ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s repeat blood and urine cultures since no growth to date at time of discharge. renal us: the right kidney measures 12 cm in size and the left kidney measures 12 cm in size. there is normal corticomedullary echotexture. ectasia of the left renal pelvis is seen. there is no evidence of hydronephrosis or nephrolithiasis. the urinary bladder appears within normal limits. the ureteral jets are seen bilaterally. discharge labs: 06:15am blood wbc-10.8 rbc-3.82* hgb-11.0* hct-33.3* mcv-87 mch-28.9 mchc-33.1 rdw-14.4 plt ct-249 06:15am blood plt ct-249 06:15am blood glucose-82 urean-10 creat-0.5 na-143 k-3.9 cl-105 hco3-29 angap-13 06:15am blood calcium-8.6 phos-4.0# mg-2.1 12:42pm blood lactate-1.4 brief hospital course: 60yo female with history of ms, neurogenic bladder and disorder who presents from rehab with altered mental status, found to have e. coli uti, bacteremia and sepsis, resolved with antibiotics. 1. e. coli uti, bacteremia, and sepsis- patient presented with altered mental status, elevated wbc, elevated lactate and positive ua. imaging concerning for pyelonephritis. she received ceftriaxone in the ed but developed possible anaphylaxis. initially treated in the micu given sepsis with temperature of 101 and tachycardic to the 130s. meropenem and vancomycin started in the micu. the urology service was consulted and they determined that the only indication for drainage would be if there is an obstruction; she has chronic hydronephrosis due to neurogenic bladder and reflux. an arterial line and a central venous access line were placed and patient given fluids. her urine and blood cultures both resulted e.coli sensitive to fluoroquinolones. her vancomycin and meropenem were discontinued and switched to cipro to complete a 14-day treatment course (last day ). uti appears related to sexual intercourse and neurogenic bladder. consider post-coital prophylaxis. 2. altered mental status- pt was initially lethargic upon her admission to the micu. she was extremely agitated on the night of and she was given seroquel and haldol which eventually calmed her down. her mental status waxed and waned during her stay in the micu and she was re-started on her home wellbutrin and divalproex. pt had a negative head ct. after transfer to the floor, patient continues to have waxing and mental status, but slowly improved over time. aaox3 on discharge. trazodone held in the setting of altered mental status, consider restarting as outpatient when stable. 3. possible anaphylaxis- patient became hypotensive to the high 70s while undergoing ct scan in the ed after receiving ceftriaxone. she received benadryl, steroid, famotidine and epinephrine with reponse in bp. rash resolved by the time of her admission to the micu. unclear if this is secondary to contrast vs ceftriaxone the patient received in the ed as she has a known penicillin allergy. 4. multiple sclerosis- patient takes glatiramer for relapsing ms. she is not on any other chronic medications (interferon beta 1a, natalizumab). she is taking baclofen and detrol for history of neurogenic bladder. copoxone was initially held in the setting of sepsis. restarted on discharge. her baclofen and detrol were continued at her home dose. 5. neurogenic bladder- patient has incontinence at baseline without urinary retention. detrol held in the setting of uti and sepsis. consider restarting as outpatient. 6. depression, disorder - pt was periodically with altered mental status and agitation during her stay in the micu. her home buproprion and divalproex were continued. 7. hyperlipidemia- continued on her home statin # transitional issues- pending hiv screening results, blood culture, urine culture (will communicate to dr. restart detrol after uti treatment restart trazodone once mental status completely back to baseline consider starting bactrim ds for postcoital prophylaxis medications on admission: bupropion 100mg divalproex 500mg qhs, 500mg qam, 250mg @1600 simethicone 40mg tid prn artificial tears detrol la 2mg qam, 2mg qhs copaxone 20mg qam injection trazadone 25mg qhs prn pravastatin 40mg qhs baclofen 20mg tylenol 650mg discharge medications: 1. bupropion hcl 100 mg tablet sig: one (1) tablet po bid (2 times a day). 2. divalproex 250 mg tablet extended release 24 hr sig: as directed tablet extended release 24 hr po three times a day: 500mg qhs, 500mg qam, 250mg at 1600. 3. simethicone 40 mg strip sig: one (1) po three times a day as needed for indigestion. 4. artificial tears ophthalmic 5. glatiramer 20 mg kit sig: one (1) kit subcutaneous qam (). 6. trazodone 50 mg tablet sig: 0.5 tablet po at bedtime as needed for insomnia. 7. pravastatin 40 mg tablet sig: one (1) tablet po at bedtime. 8. baclofen 10 mg tablet sig: two (2) tablet po bid (2 times a day). 9. tylenol 8 hour 650 mg tablet extended release sig: one (1) tablet extended release po twice a day. 10. ciprofloxacin 500mg (last day ) discharge disposition: extended care facility: for the aged - ltc discharge diagnosis: primary: uti pyelonephritis sepsis e. coli bacteremia 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: ms. , it was a pleasure taking care of you during your hospitalization. you were admitted because you had an infection in your urinary tract and blood stream. we treated this with antibiotics (bactrim), which you will continue till . we made the following changes to your medications: started ciprofloxacin twice daily (last day ) stopped detrol (please discuss restarting this with dr. stopped trazodone (please discuss restarting this with dr. followup instructions: follow up at rehab with dr. procedure: venous catheterization, not elsewhere classified arterial catheterization diagnoses: anemia, unspecified toxic encephalopathy severe sepsis unspecified sleep apnea septic shock dehydration multiple sclerosis septicemia due to escherichia coli [e. coli] cephalosporin group causing adverse effects in therapeutic use pyelonephritis, unspecified bipolar i disorder, most recent episode (or current) depressed, unspecified neurogenic bladder nos other anaphylactic reaction 

Answer: The patient is high likely exposed to