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: scopolamine / iv dye, iodine containing / levaquin attending: chief complaint: hypotension, urosepsis major surgical or invasive procedure: central venous catheter placement history of present illness: 80 y/o m with pmhx significant for metastatic lung cancer, cll/sll. was found to be unresponsive, twitching, and hypotensive at nursing home today. was initially being brought to ; however, en route, bp's dropped to 55/p and he was brought to . . on arrival to the ed, the patient's vs were 94/p, 108, 20, 100% on 4l. temp was 99.6, but then patient spiked to 102.8. cxr showed ? retrocardiac consolidation. given the pt's ams, ct head was performed and was negative for ich. labs were significant for a ua with 11-20 rbcs, >50 wbcs. given the high suspicion for urosepsis, the patient was given vancomycin and zosyn. there was some uncertainty regarding the patient's code status. per report, his wife and daughter reported that they felt that a dnr was warranted; however, the patient wants to remain full code. the decision was made to hold off on central line placement and to start treatment with peripheral pressors in the ed. he was given ivfs (5l total) as well as started on periperal levophed. by the time of transfer to the icu, the patient's bp had improved to the low 100's. vs at the time of transfer: temp 98.7 hr 101 p 106/52 rr 18 100% on 2l. . on arrival to the icu, the patient's vs were: t: 99.3 bp: 137/88 p: 96 r: 16 o2: 98% on 4l. the patient was moaning and coughing and was only oriented to person. he was not able to provide much of a history. per his wife, the patient has been less coherent than his baseline recently. she reports that he is normally quite coherent. she reports that she visited him today and that he wasn't feeling well. . . review of sytems: unable to obtain. the patient denies any complaints. past medical history: (per records): - h/o sepsis secondary to aspiration pneumonia - h/o proteus mirabilis and albicans in drainage culture of the abdomen - h/o aspiration - gastroesophageal reflux disease - history of cll and non-hodgkin's lymphoma, also sll lymphoma - nonsmall cell lung cancer resected in , later found to be node positive. patient was discovered to have metastatic adenocarcinoma/recurrent lung cancer with lymphangitic spread. he has progression of mediastinal lymphadenopathy, right upper lobe and left lower lobe lung nodules, prominent periaortic lymphadenopathy. - bedbound at baseline with history of decubitus ulcer - diverticulosis - g-tube dependent - depression - anemia of chronic disease - diabetes mellitus - history of recurrent pneumonia - right inguinal hernia repair. - history of upper gi bleed in , which showed esophagitis on egd in - rectosigmoid polypectomy in - h/o appendectomy as a child - h/o frx of pelvic bone after a fall in - h/o facial abscess following dental work social history: married for 58 years. currently living at since . has had some involvement with hospice there. has not been living at home since , which he had his lung resection. per medical records, pt has smoked in the part and drank occasionally (one to two beers a week). no illicit drug use. family history: per medical records, he has an estranged brother. his mother is deceased from old age. his father is deceased with a question of leukemia but never diagnosed. he has three children. physical exam: vitals: t: 99.3 bp: 137/88 p: 96 r: 16 o2: 98% on 4l general: moaning, coughing, oriented to person only heent: sclera anicteric, mmm, oropharynx clear, perrl neck: jvp not elevated lungs: exam limited by patient moaning; crackles noted in the lower lung fields on the left cv: exam limited by patient moaning; no murmurs, rubs, gallops appreciated abdomen: gastric tube present and noted to be loose-fitting, some drainage from g-tube noted, soft, non-tender, non-distended, bowel sounds present gu: foley in place ext: cool, 1+ radial pulses, no clubbing, cyanosis; trace pitting edema in the lower extremities; some difficulty palpating the pedal pulses pertinent results: admission labs 08:10pm blood wbc-8.0 rbc-3.80* hgb-10.3* hct-32.1* mcv-84 mch-27.2 mchc-32.2 rdw-15.8* plt ct-174 02:52am blood neuts-90.0* lymphs-6.1* monos-3.5 eos-0.2 baso-0.2 08:10pm blood pt-13.1 ptt-27.2 inr(pt)-1.1 08:10pm blood fibrino-466* 02:52am blood glucose-121* urean-31* creat-0.9 na-141 k-3.5 cl-115* hco3-17* angap-13 02:52am blood alt-25 ast-35 ld(ldh)-136 ck(cpk)-54 alkphos-163* totbili-0.5 08:10pm blood lipase-13 02:52am blood ck-mb-4 ctropnt-0.03* 08:10pm blood calcium-8.2* phos-3.6 mg-1.6 abg on admission 03:18am blood type-art po2-84* pco2-36 ph-7.29* caltco2-18* base xs--8 08:21pm blood glucose-82 lactate-2.2* na-140 k-3.9 cl-105 calhco3-21 urine studies 08:10pm urine color-yellow appear-cloudy sp -1.018 08:10pm urine blood-lg nitrite-neg protein-75 glucose-neg ketone-tr bilirub-neg urobiln-neg ph-5.0 leuks-mod 08:10pm urine rbc-* wbc->50 bacteri-mod yeast-none epi-0 micro data: blood culture, routine (final ): staphylococcus, coagulase negative. isolated from one set only. **no other positive blood cx's. 8:10 pm urine urine culture (final ): escherichia coli. >100,000 organisms/ml. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 8 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s 2:52 am urine urine culture (final ): escherichia coli. 10,000-100,000 organisms/ml. presumptive identification. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 8 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s cxr () - impression: markedly limited study. it is unclear to what extent interstitial opacities are acute versus chronic. there are likely as well accentuated by the profound low lung volumes. there is increased opacity at the retrocardiac left lower lobe, which may indicate a focal consolidation such as pneumonia if truly acute. it is difficult to place these findings in context without pulmonary symptomology. correlate clinically. ct head () - impression: 1. no acute intracranial hemorrhage. note that mri is more sensitive for ischemic process if clinical concern is high. 2. non-contrast head ct is limited in evaluation of intracranial metastasis. gadolinium contrast-enhanced mri is more sensitive. 3. likely chronic paranasal sinus disease with a component of fungal colonization, given high atenuatin of layering internal secretions. no osseous changes noted. 4. age-related involutional change. brief hospital course: micu course: given his hypotension and septic picture, the patient was admitted to the icu for further management. at the time of transfer, he was on peripheral pressors. given his positive ua, he was started on vancomycin/zosyn as broad coverage for suspected urosepsis. weaning of peripheral pressors was attempted overnight but was unsuccessful. on the following morning, when the patient remained on pressors and after his goals of care had been confirmed with his family, a central venous catheter was placed. on antibiotics, the patient's clinical status improved slightly. his pressors were weaned off. urine cx grew e.coli resistant to cipro. given the poor appearance of his cxr and his tenuous respiratory status, the patient was continue of vancomycin/zosyn for an 8 day course to cover for hcap. after that, his antibiotics were changed to ceftriaxone and then oral cefpodoxime. he should complete a 14 day course of antibiotics to cover for urosepsis which is due to end on . icu course was also complicated by some initial renal failure (which resolved with fluids) as well as delirium. multiple discussions were held with the patient's family regarding his goals of care. it was decided based on discussion with the patient, his wife and his daughter that he was dnr/dni. his respiratory status improved and he was discharged on 3l nc. he was sent back to rehab for further care. . code status: extensive discussion with the patient, his wife and daughter. the patient wishes to be dnr/dni. he would like to return to the hospital for reversible causes of illness but would not want aggressive measures to prolong suffering. . follow-up: antibiotics are cefpodoxime, to finish on for a total 14 day course. medications on admission: - benadryl 25 mg q8hrs prn - atropine 1% 2 drops sl q4hrs - hiss - lantus 5 units qhs - baclofen 10 mg q8hrs (for hiccups) - pantoprazole 2mg/ml 20 ml - guaifenesin 10 ml tid - hyosyne 1ml sl q4hrs - levothyroxine 112 mch dialy - liquid tylenol 640 mg q4hrs scheduled - neurontin 100 mg (250mg/ml soln) tid - sorbitol 70% solution 30ml daily - tramadol 50 mg qid - vitamin c 250 mg - acetylcysteine 10% vial, inhale 4 ml for sob - artificial tears - albuterol nebs - bisacodyl - fleet enema prn - simethicone prn - lorazepam 0.5 mg q6hrs prn - mom 30 ml daily prn - morphine sulfate 2.5 mg (0.125 ml) sl q4hrs prn - prochlorperazine suppository prn discharge medications: 1. insulin lispro 100 unit/ml solution sig: 2-8 units subcutaneous asdir (as directed): per sliding scale. 2. hyoscyamine sulfate 0.125 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual qid (4 times a day). 3. levothyroxine 112 mcg tablet sig: one (1) tablet po daily (daily). 4. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for pain: apply to each knee for 12 hours on, 12 hours off each day for knee pain. 5. gabapentin 100 mg capsule sig: one (1) capsule po tid (3 times a day). 6. cefpodoxime 100 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 4 days: last dose on . 7. pantoprazole 40 mg susp,delayed release for recon sig: forty (40) mg po once a day. 8. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulizer inhalation q4h (every 4 hours) as needed for shortness of breath. 11. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation q4h (every 4 hours) as needed for shortness of breath; wheezing. 12. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed for dry nares. 13. tramadol 50 mg tablet sig: one (1) tablet po qid (4 times a day). 14. lantus 100 unit/ml solution sig: five (5) units subcutaneous at bedtime. 15. baclofen 10 mg tablet sig: one (1) tablet po every eight (8) hours as needed for hiccups. 16. morphine 10 mg/5 ml solution sig: 2.5 mg po every four (4) hours as needed for pain. discharge disposition: extended care facility: senior healthcare of discharge diagnosis: primary diagnoses: 1. urosepsis 2. health care associated pneumonia 3. acute renal failure, resolved secondary diagnoses: 1. metastatic lung cancer 2. anemia discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: bedbound. discharge instructions: you were admitted to the hospital with a pneumonia and urinary tract infection which caused you to be very sick with low blood pressure. you were given antibiotics and improved. you need to complete a course of antibiotics with cefpodoxime for 4 more days (last dose on ). you should follow-up with your doctors at rehab. followup instructions: please follow-up with your primary care physician at rehab. procedure: enteral infusion of concentrated nutritional substances arterial catheterization diagnoses: pneumonia, organism unspecified anemia of other chronic disease diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified severe sepsis personal history of tobacco use other malignant lymphomas, unspecified site, extranodal and solid organ sites acute respiratory failure pneumonitis due to inhalation of food or vomitus pain in joint, lower leg septic shock malignant neoplasm of other parts of bronchus or lung other encephalopathy encounter for palliative care alzheimer's disease septicemia due to escherichia coli [e. coli] secondary and unspecified malignant neoplasm of intrathoracic lymph nodes delirium due to conditions classified elsewhere diverticulosis of colon (without mention of hemorrhage) gastrostomy status chronic lymphoid leukemia, without mention of having achieved remission vascular dementia, uncomplicated mixed acid-base balance disorder inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent) acute pyelonephritis without lesion of renal medullary necrosis dysphagia, unspecified 

Answer: The patient is high likely exposed to