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 / codeine / sulfa (sulfonamides) / heparin agents attending: chief complaint: ftt major surgical or invasive procedure: r ij cvc, egd history of present illness: hpi: 82 yo female with pmhx significant for dementia and cervical cancer who initially presented to on with nausea, vomiting, and weight loss. the patient had earlier been admitted to center on with acute renal failure, failure to thrive, persistent leukocytosis. renal us at osh showed moderate hydronephrosis on right, severe on left with loss of cortical tissue. there she had bilateral ureteral stents placed on for proximal mid-ureter tortuous kinking and proximal hydronephrosis bilaterally. the patient was discharged home but returned for failure to thrive. she was admitted to medicine and underwent a ct scan which showed a soft tissue mass in periaortic area causing a gastric outlet obstruction, along with a large fluid collection displacing the right kidney, thought to be a urinoma. an ng tube was placed, with return of fecal material. the patient subsequently developed hypotension and was transferred to the icu. . in the micu, the patient was started on pressors for hypotension and intubated. ir evaluated the patient and was able to drain the urinoma. fluid from the collection grew enterococcus and cns. she was extubated yesterday in the micu. today, pt. reports feeling well. she is anxious to go home and especially to start eating again. she denies abdominal pain, chest pain, sob, or nausea. she has not recently vomited past medical history: dementia djd hypertension h/o cervical cancer s/p radiation therapy 30 years ago h/o dvt in left leg 30 years ago social history: lives with husband and son; per notes no etoh, illicits, tob at home family history: nc physical exam: vs: bp 118/23, hr 160, rr 22-26, spo2 99% on 3l nc gen: pleasant, comfortable appearing elderly female, responding to yes/no questions appropriately, a&ox1 heent: perrl, anicteric, mucous membranes dry. ngt to suction with maroon blood in tube. neck: supple, no jvd chest: coarse breath sounds in all fields on anterior and lateral exam cv: tachy regular, no murmurs appreciated abd: soft, nontender, nondistended, with normoactive bowel sounds. right percutaneous nephrostomy tube in place. extr: le grossly edematous. + to thighs b/l. pertinent results: 06:56pm lactate-1.1 05:00pm glucose-123* urea n-48* creat-2.1* sodium-131* potassium-4.0 chloride-89* total co2-28 anion gap-18 05:00pm estgfr-using this 05:00pm calcium-9.3 phosphate-3.6 magnesium-2.2 05:00pm wbc-13.1* rbc-3.67* hgb-10.0* hct-28.1* mcv-77* mch-27.2 mchc-35.5* rdw-14.0 05:00pm neuts-91.2* bands-0 lymphs-5.7* monos-2.9 eos-0 basos-0.1 05:00pm plt count-756* 05:00pm pt-13.0 ptt-26.4 inr(pt)-1.1 05:00pm urine color-yellow appear-cloudy sp -1.011 05:00pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 05:00pm urine rbc-* wbc->50 bacteria-many yeast-none epi-0 08:15am blood wbc-25.9* rbc-2.86* hgb-7.6* hct-24.4* mcv-85 mch-26.5* mchc-31.1 rdw-14.7 plt ct-271 02:01am blood wbc-6.7 rbc-3.79* hgb-11.4* hct-32.3* mcv-85 mch-30.0 mchc-35.2* rdw-16.5* plt ct-110* 08:15am blood glucose-99 urean-51* creat-2.7* na-137 k-4.2 cl-107 hco3-18* angap-16 02:01am blood glucose-87 urean-33* creat-0.5 na-145 k-3.9 cl-114* hco3-23 angap-12 08:15am blood alt-10 ast-19 ld(ldh)-174 ck(cpk)-20* alkphos-69 amylase-35 totbili-0.4 07:18am blood alt-33 ast-33 ld(ldh)-359* alkphos-134* amylase-689* totbili-1.8* 06:34pm blood albumin-1.6* calcium-7.5* phos-4.4 mg-1.7 05:35am blood caltibc-164* ferritn-876* trf-126* 02:28pm blood triglyc-149 09:30pm blood cortsol-71.4* 12:12am blood cortsol-76.4* 09:08am blood type-art temp-36.7 rates-12/ tidal v-400 peep-5 fio2-100 po2-100 pco2-47* ph-7.19* caltco2-19* base xs--10 aado2-584 req o2-94 -assist/con intubat-intubated 07:42am blood type-art po2-77* pco2-39 ph-7.48* caltco2-30 base xs-5 06:56pm blood lactate-1.1 07:25am blood lactate-4.1* 07:42am blood lactate-1.4 reason: eval for pna medical condition: 82 year old woman with fever and leukocytosis reason for this examination: eval for pna pa and lateral chest, at 1812 hours history: fever and leukocytosis. comparison: none. findings: the pigtail catheter overlies the right renal fossa. the lungs are clear. the mediastinum is unremarkable. the cardiac silhouette is within normal limits for size. no pleural effusion or pneumothorax is evident. the right hemidiaphragm is elevated. no effusion or pneumothorax is seen. the osseous structures are unremarkable. impression: no acute pulmonary process. renal u.s. reason: r/o hydronephrosis medical condition: 82 year old woman with h/o persistent uti, recent admission at osh for arf where she had bilateral ureteral stents for hydronephrosis, admitted here with ftt, renal insufficiency and uti. reason for this examination: r/o hydronephrosis indication: history of persistent uti, recent admissions at outside hospital for acute renal failure with bilateral ureteral stent placement for hydronephrosis. now here with failure to thrive, renal insufficiency and urinary tract infection. evaluate for hydronephrosis. technique: gu ultrasound without comparisons. findings: the right kidney measures 13.5 cm, distended with severe hydronephrosis. the proximal aspect of a right ureteral stent is seen within the right collecting system. there are no stones seen on the right. the left kidney measures 8.8 cm, with moderate hydronephrosis. again, the proximal aspect of a left-sided ureteral stent is seen within the renal collecting system. evaluation of the bladder demonstrates echogenic catheter seen within the bladder. while it is difficult to trace catheter material to each of the two ureteral orifices, the orientation of the catheters suggest that both right and left ureteral catheters extend into the bladder. impression: bilateral hydronephrosis, right worse than left, with bilateral nephroureteral catheters. unilat lower ext veins left reason: r/o dvt, swelling medical condition: 82 year old woman with arf, dementia, uti, h/o dvt 30 years ago admitted with ftt. reason for this examination: r/o dvt study: unilateral lower extremity ultrasound on the left. indication: 82-year-old female with history of dvt 30 years ago. assess for dvt. comparisons: none. findings: -scale and doppler son of the left common femoral, superficial femoral, popliteal veins are performed. there is normal compressibility, flow, and augmentation. no intraluminal thrombus is identified. impression: no evidence of dvt of the left lower extremity. ct abdomen w/o contrast; ct pelvis w/o contrast reason: r/o ureteral obstruction. patient cannot receive iv contrast medical condition: 82 year old woman with hydronephrosis, failure to thrive, dementia here with acute renal insufficienty, severe right hydronephrosis and uti reason for this examination: r/o ureteral obstruction. patient cannot receive iv contrast due to creatinine clearance of 15 contraindications for iv contrast: renal failure, crcl 15 examination: ct abdomen and pelvis. indication: hydronephrosis and dementia. comparison: no old studies available for comparison. technique: a ct of abdomen and pelvis was performed with axial images taken from the lung bases to the symphysis pubis. oral contrast only was administered due to the patient's renal insufficiency. ct abdomen findings: note is made of bilateral pleural effusions. there is coronary artery calcification. the esophagus is distended with fluid. below the diaphragm the liver is visualized and is unremarkable given that this is a noncontrast ct. the spleen is normal. the adrenals are normal. the left kidney is reduced in size. a left ureteric stent is in situ extending from the left renal pelvis extending down to the bladder. two nonobstructing 2-3 mm renal calculi are identified in the left mid and lower poles respectively. on the right side the kidney is displaced anteriorly. there is severe hydronephrosis of the right kidney. a right ureteric stent is in situ extending from the renal pelvis down as far as the bladder. posterior to the right kidney, a large fluid collection is identified that measures 16 cm in sagittal x 9.5 cm in transverse diameter. the appearances are most likely consistent with a urinoma. the stomach is distended as far as the third part of the duodenum. there is significant vascular calcification noted of the aorta extending down into the common iliac arteries and the internal and external iliac arteries bilaterally. some soft tissue is noted at the level of the bifurcation of the aorta and extends along the common iliac arteries as well as the internal and external iliac arteries. the appearances may represent retroperitoneal fibrosis or may be secondary to metastatic disease from the patient's known history of cervical carcinoma. the remainder of the bowel where visualized is normal. some trace free fluid is seen in the abdomen. ct of pelvis findings: the bladder is visualized and the tips of the ureteric stents are identified. calcified fibroids are seen in the uterus. bony windows reveal degenerative change and scoliosis concave to the right. multiplanar reconstructions were essential in depicting the anatomy and identifying the pathology. impression: 1. soft tissue surrounding the distal aorta and extending around the common iliac vessels bilaterally and into these bifurcations consistent with retroperitoneal fibrosis or metastases secondary to patient's cervical carcinoma. 2. large fluid collection adjacent to the right kidney which is displacing it and most likely represents urinoma. 3. bilateral ureteric stents that are displaced medially in the inner lower one-third. 4. gastric outlet obstruction secondary to soft tissue mass in periaortic area. 5. bilateral pleural effusions. dr. was contact regarding these findings at the time of interpretation. interventional service on call was also contact. medical condition: 82 year old woman with sepsis and sbo ? urinoma reason for this examination: please drain indication: 82-year-old woman with sepsis, right hydronephrosis and small- bowel obstruction and urinoma. please drain. radiologists: dr. and dr. performed the procedure. dr. , the attending radiologist, was supervising throughout. procedure and findings: drainage of perirenal fluid collection: as seen on a recent abdominal ct dated , there was a known large fluid collection surrounding the right kidney, displacing the right kidney anteriorly and probably causing gastric outlet obstruction. a decision was therefore made to first attempt to drain the perinephric fluid collection. after the risks and benefits of the procedure were explained to the patient's family and a written consent was obtained, the patient was placed in prone position on the angiographic table. a preprocedure timeout was then performed to confirm patient identity and the procedure to be performed. using ultrasonographic guidance and local anesthesia, a 21-gauge chiba needle was advanced into the right perinephric fluid collection. contrast was injected demonstrating a multiloculated fluid collection. the needle was exchanged over a guide wire for an accustick sheath and the fluid collection was drained with multiple repositioning of the catheter, yielding 480 cc of purulent material and urine. after completion of the drainage, attention was then directed to the percutaneous nephrostomy. percutaneous nephrostomy placement: after the perinephric fluid collection had been removed, the right kidney was now located in normal position close to the posterior abdominal wall and easily accessible. using fluoroscopic guidance, a 21-gauge chiba needle was advanced into the caliceal system. the stylet of the chiba needle was then removed and an injection of contrast material demonstrated a dilated collection system which demonstrated several connections to the perinephric space indicating that these represented perforations likely due to the abnormally increased pressure caused by the upj obstruction. a 0.018 guide wire was then placed through the needle and the needle was exchanged for an accustick introducer system. subsequently, a 0.035 guide wire was advanced into the collecting system. an 8 french pigtail nephrostomy catheter was then inserted over the wire and the pigtail formed within the renal pelvis. a contrast nephrostogram confirmed correct tube position. through the catheter approximately 375 cc of blood-tinged purulent fluid was aspirated. the catheter was secured to the skin with sutures and a statlock device. the catheter was then connected to an external bag drainage. there were no immediate complications. the patient tolerated the procedure well. anesthesia included propofol drip and 1% local lidocaine. the patient's vital signs were monitored continuously throughout the procedure. impression: 1. successful drainage of right perihepatic fluid collection, resulting in virtually no residual drainable fluid and normalization of position of right kidney. 2. successful placement of an 8 french pigtail nephrostomy catheter within the right renal collecting system and drainage of purulent material. 3. right upj obstruction. reason: please drain medical condition: 82 year old woman with sepsis and sbo ? urinoma reason for this examination: please drain indication: 82-year-old woman with sepsis, right hydronephrosis and small- bowel obstruction and urinoma. please drain. radiologists: dr. and dr. performed the procedure. dr. , the attending radiologist, was supervising throughout. procedure and findings: drainage of perirenal fluid collection: as seen on a recent abdominal ct dated , there was a known large fluid collection surrounding the right kidney, displacing the right kidney anteriorly and probably causing gastric outlet obstruction. a decision was therefore made to first attempt to drain the perinephric fluid collection. after the risks and benefits of the procedure were explained to the patient's family and a written consent was obtained, the patient was placed in prone position on the angiographic table. a preprocedure timeout was then performed to confirm patient identity and the procedure to be performed. using ultrasonographic guidance and local anesthesia, a 21-gauge chiba needle was advanced into the right perinephric fluid collection. contrast was injected demonstrating a multiloculated fluid collection. the needle was exchanged over a guide wire for an accustick sheath and the fluid collection was drained with multiple repositioning of the catheter, yielding 480 cc of purulent material and urine. after completion of the drainage, attention was then directed to the percutaneous nephrostomy. percutaneous nephrostomy placement: after the perinephric fluid collection had been removed, the right kidney was now located in normal position close to the posterior abdominal wall and easily accessible. using fluoroscopic guidance, a 21-gauge chiba needle was advanced into the caliceal system. the stylet of the chiba needle was then removed and an injection of contrast material demonstrated a dilated collection system which demonstrated several connections to the perinephric space indicating that these represented perforations likely due to the abnormally increased pressure caused by the upj obstruction. a 0.018 guide wire was then placed through the needle and the needle was exchanged for an accustick introducer system. subsequently, a 0.035 guide wire was advanced into the collecting system. an 8 french pigtail nephrostomy catheter was then inserted over the wire and the pigtail formed within the renal pelvis. a contrast nephrostogram confirmed correct tube position. through the catheter approximately 375 cc of blood-tinged purulent fluid was aspirated. the catheter was secured to the skin with sutures and a statlock device. the catheter was then connected to an external bag drainage. there were no immediate complications. the patient tolerated the procedure well. anesthesia included propofol drip and 1% local lidocaine. the patient's vital signs were monitored continuously throughout the procedure. impression: 1. successful drainage of right perihepatic fluid collection, resulting in virtually no residual drainable fluid and normalization of position of right kidney. 2. successful placement of an 8 french pigtail nephrostomy catheter within the right renal collecting system and drainage of purulent material. 3. right upj obstruction. reason: ngtube placement medical condition: 82 year old woman with hypotension, acute abd, suspected abd perforation now s/p ngt, ett, and l ij placement reason for this examination: ngtube placement ap chest 5:48 a.m. on a.m. history: hypotension and suspected intestinal perforation. impression: ap chest compared to through : moderate bilateral pleural effusion has increased since , accompanied by worsening bibasilar atelectasis. heart is normal size. upper lungs are grossly clear. the semierect view should be sensitive for pneumoperitoneum, but none is seen. drains are noted in the right upper abdominal quadrant projecting over both renal fossae. nasogastric tube ends in the stomach. chest (portable ap) reason: r/o pneumonia medical condition: 82 year old woman with hypotension, acute abd, suspected abd perforation now s/p ngt, ett, and l ij placement now with acute mental status change reason for this examination: r/o pneumonia indication: hypotension and acute mental status change. assess for pneumonia. comparison: . upright ap chest: the left subclavian central venous catheter, partially imaged double-j left ureteral stent and right upper quadrant catheter are unchanged. again, there are low lung volumes, and evidence of left lower lobe collapse. small-to-moderate bilateral pleural effusions persist. it would be difficult to exclude an underlying infiltrate, though one is not definitely seen. the upper lungs are well aerated. impression: low volumes, left lower lobe collapse and bilateral effusions. ct abdomen w/contrast; ct pelvis w/contrast reason: gastric outlet obstruction vs other cause of sbo field of view: 36 contrast: optiray medical condition: 82 year old woman with small bowel obstruction reason for this examination: gastric outlet obstruction vs other cause of sbo contraindications for iv contrast: none. indication: 82-year-old female with small-bowel obstruction. comparison: . technique: mdct axial images of the abdomen and pelvis were obtained following the administration of iv optiray contrast. multiplanar images were reformatted. ct abdomen with iv contrast: moderate-sized bilateral pleural effusions with associated compressive atelectasis have increased. peripheral ground glass opacities within the left lung base likely represent infection or asymmetric pulmonary edema. there is a 6-mm pulmonary nodule in the lingula and linear atelectasis at the right lung base. the stomach is distended to the third portion of the duodenum. contrast transits distally into the small bowel. a 5-mm hypodensity in the left lobe of the liver cannot be fully characterized. the spleen, pancreas, and adrenal glands are unremarkable. double pigtail nu stents are seen in the right and left kidneys, appropriately positioned. a percutaneous nephrostomy stent has been placed within the right renal collecting system. layering contrast medial to the stent does not definitively lie within the ureter (series 2, image 33). the kidneys are unchanged in appearance and multiple hypodensities cannot be further characterized. a large urinoma posterior to the right kidney has now resolved. there is a moderate amount of loculated perihepatic ascites. there is significant vascular calcification within the aorta extending to the iliac arteries. poorly-defined retroperitoneal soft tissue is noted at the level of the bifurcation of the aorta and extending along iliac arteries. ct pelvis with iv contrast: calcified fibroids are seen in the uterus. the rectum and sigmoid colon are unremarkable. a foley catheter is seen within the bladder. osseous windows: reveale degenerative change and scoliosis concave to the right. impression: 1. unchanged gastric outlet obstruction with transition point likely at the third portion of the duodenum. 2. soft tissue surrounding the distal aorta extending to the common iliac arteries bilaterally representing retroperitoneal fibrosis versus metastasis. metastasis is favored given history of difficulty passing ureteral stents. 3. resolved right-sided urinoma. 4. increasing bilateral pleural effusions. 5. interval placement of right percutaneous nephrostomy tube. focus of layering contrast medial to the tube does not definitively lie within the ureter. 6. 6-mm lingular pulmonary nodule for which follow-up ct in three months can be performed. findings discussed with dr. on . chest (portable ap) reason: eval for aspiration pna medical condition: 82 year old woman with hypotension, acute abd, suspected abd perforation now s/p self removal of ngt with emesis and possible aspiration reason for this examination: eval for aspiration pna reason for examination: possible aspiration. portable ap chest radiograph compared to . the ng tube was inserted in the meantime interval with its tip in the stomach. the two nephroureteral catheters are unchanged in appearance as well as the right percutaneous nephrostomy. the bilateral pleural effusion and bibasilar atelectasis is unchanged but the opacity in the right upper lobe is new and might represent aspiration. no evidence of congestive heart failure is demonstrated. impression: 1. new right upper lobe opacity might represent aspiration or aspiration pneumonia. 2. unchanged bilateral moderate pleural effusion and bibasilar atelectasis. reason: please r/o acute cp process medical condition: 82 year old woman admitted to micu with ugib, tachycardia. reason for this examination: please r/o acute cp process indication: upper gi bleed, rule out acute cardiopulmonary process. comparison: . chest, one view: there has been interval removal of a left subclavian line and insertion of a right subclavian line with its radiodense guide wire projecting over the cavoatrial junction. an ng tube with its below the diaphragm is again seen. bilateral nephroureteral catheters and a right nephrostomy tube are again seen. there are unchanged bilateral pleural effusions, there is bilateral basal atelectasis. there is scoliosis and degenerative changes are seen in the spine. impression: 1. interval removal of a left subclavian line and insertion of a right subclavian line with its tip projecting over the cavoatrial junction. 2. unchanged moderate bilateral pleural effusions and bibasal atelectasis. 3. unchanged nasogastric, right nephrostomy tubes, and bilateral nephroureteral catheters. brief hospital course: 82 y.o. f with h/o dementia, cervical ca years ago s/p xrt who was initially admitted to general medicine for transferred to micu for sepsis, called out twice, and now returning to the micu for ugib. . briefly, patient was admitted to general medicine service, found to have evidence of gastric outlet obstruction and large urinoma on ct. admitted to micu for sepsis, likely source urinoma which grew out vse. pt treated with early goal directed therapy, urinoma drained and transferred to the floor in stable condition. pt re-admitted to the micu with evidence of ugib per ng as well as mental status changes on . in micu pt had no further evidence of bleeding and hct was stable after transfusion of one unit prbcs. given pt's stability, gi deferred egd at that time. in regards tho mental status changes, they shortly resolved on the morning of admissiona and appeared to be nocturnal delirium. pt transferred back to the floor on in stable condition but subsequently developed evidence of ugi bleed, with 300 cc maroon blood on ng lavage. egd was performed which revealed large clot extending from esophagus mid-esophagus all the way to body, too large for suction or other egd intervention. given obstruction at duodenum, she is unable to pass the clot distally. surgery felt that she was not a surgical candidate. at this point, in discussion with the family, the patient was made cmo and transfered to the floor for end of life care. she was kept comfortable with intermmitent suction by ngt, morphine as needed and continued protonix drip. she passed peacefully with family at bedside on . medications on admission: calcium carbonate 1000 mg tid clonazepam 0.5 mg namenda 10 mg (few years) nifedipine sr 30 mg daily protonix 40 mg daily magensium oxide 400 mg phoslo packet 1 pack furosemide 20 mg once a day nystatin 100,0000units 5-10 cc qid (20th-27th) mirtazepine 15 mg qhs discharge medications: none discharge disposition: expired discharge diagnosis: upper gastrointestinal hemorrhage discharge condition: expired discharge instructions: none followup instructions: none procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other endoscopy of small intestine other endoscopy of small intestine insertion of endotracheal tube percutaneous nephrostomy without fragmentation percutaneous abdominal drainage insertion of other (naso-)gastric tube transfusion of packed cells infusion of vasopressor agent diagnoses: acidosis thrombocytopenia, unspecified acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified severe sepsis other persistent mental disorders due to conditions classified elsewhere pneumonitis due to inhalation of food or vomitus hematemesis hydronephrosis streptococcal septicemia personal history of malignant neoplasm of cervix uteri other esophagitis nutritional marasmus acute pyelonephritis without lesion of renal medullary necrosis other specified disorders of kidney and ureter other ureteric obstruction abdominal or pelvic swelling, mass, or lump, unspecified site other obstruction of duodenum impaction of intestine, unspecified 

Answer: The patient is high likely exposed to