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 attending: chief complaint: hypotension major surgical or invasive procedure: none history of present illness: 77-year-old female with hx type 2 diabetes, seropositive nonerosive rheumatoid arthritis, hypothyroidism, osteoporosis, and glaucoma who presented with weakness and fever, found be to hypotensive. per the records, the patient has a recent history of sacral decub ulcer. on the pt was initially evaluated and found to have "dime sized portion is pinkish white without obvious discharge at this time. the surrounding skin is indurated and erythematous without warmth" and does occasionally drain yellowish fluid. she was seen by the wound care rn on at which point it was described as "large area 5 x 4 cm irregular with intact blanchable erythema, along with distant satellite lesions related to increase moisture on skin from ui, along with non-breathable depends." she was started on critic aid clear antifungal skin barrier ointment. on f/u the pt's ulcerated area was felt to be healed, with continued erythema and signs of pressure. to aid in healing, the pt's humira was being held since and has not been restarted. subsequent to this the pt's daughters note increased joint pain (, elbows, knees, ankles, shoulders) and decreased mobility, which they have been treating with tylenol. on the pt was seen in clinic and complained of increased urinary frequency and her daughters noted malodorous urine and decreased appetite. ucx showed e. coli >100k cfu. she was prescribed bactrim ds for 3 days however after the first dose of bactrim she developed generalized weakness, excessive sleepiness, poor oral intake, and more difficulty with her mobility to the point that her daughter had to carry her to and from the bathroom. therefore no subsequent doses were given. they returned to clinic and requested change of abx at which point the pt was started on ciprofloxacin 500mg po bid x3 days. again she received one dose and the family felt she developed a rash, increased saliva and continued lethargy/fatigue so they gave no subsequent doses. per the daughters, the pt has had chills and weakness, and had a t 101.5 at 820pm last night. she did have a ha x1 yesterday but both daughters felt she was not altered. she also had diarrhea x2 days with 3-4bm/day which were yellow and liquidy. they deny blood in the stool or black tarry stools. of note, the pt's daughter states that she has had very limited po intake since when she took her dose of bactrim. she was also instructed to hold her glimepiride given decreased po intake, so it has been held since . they have been unable to check fsg broken glucometer. also, on examination of the pt's medications, she had two pill bottles with mmf, one was marked as "vitamina d" by the pharmacist, so the pt has been receiving 1g q12h of mmf for the last few days rather than her regular 500mg q12h. in the ed the pt was found to have vs: 99.2 (101.8) 88/36 101 16 98%ra. she triggered for hypotension at triage and nadired at 79/41. a central line was placed and she was given a total of 4l of ivf with cvp going from 4 to . she was also started on norepi and given hydrocort 100mg iv. labs showed na 118, wbc 22.9, hct 32.2. the pt received ctx 1g iv and vanc 1g iv. lp was attempted x2 "given no source" but failed. vitals on transfer 99.1 67 19 117/55 98%ra. on arrival to the micu, patient's vs 97.4 76 124/67 (on norepi) 98%ra. she was lethargic, sleeping but arousable. she denied pain but did endorse ttp at , elbows, shoulders and spine. repeat na 136, wbc 20.8, hct 29.7. past medical history: -dmii ( hbga1c 6.6%) -seropositive non-erosive rheumatoid arthritis (recent d/c of humira) -hypothyroidism -osteoporosis -glaucoma with blindness in left eye -allergic rhinitis -interstitial lung disease -sacral decubitus ulcer social history: the patient does not smoke or drink alcohol. she has been a housewife all her life. living with her daughter, . originally from . family history: noncontributory physical exam: admission pe general: emaciated female, fatigued, sleeping, but responsive to loud voice, complains of pain with movement heent: sclera anicteric, dry edentulouse mucous membranes, oropharynx clear neck: supple, jvp not elevated, no lad, ttp over c-spine cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: scattered crackles anteriorly abdomen: soft, thin, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: responds to questions, moving all extremities, did not participate with exam skin: purpura on bilateral forearms . discharge pe as above. dry crackles at lung bases. no joint swelling. conversant with her family. pertinent results: cxr impression: unchanged diffuse interstitial lung disease. no acute intrathoracic process. . 12:00 pm urine **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. 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 _________________________________________________________ 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 labs on discharge: 11:15am blood wbc-8.0 rbc-4.14* hgb-11.5* hct-34.8* mcv-84 mch-27.8 mchc-33.0 rdw-16.1* plt ct-481* 11:15am blood glucose-98 urean-10 creat-0.4 na-136 k-4.4 cl-101 hco3-28 angap-11 brief hospital course: this is a 77 yo f with a pmhx of ra previously on humira but discontinued due to worsening sacral decubitus ulcers, who was recently diagnosed with a uti but was unable to toelrate outpatient antibiotics who presentes with urosepsis . # sepsis: pt presented with sirs criteria (wbc 22, t 101.8), hypotension and recent uti with e.coli concerning for sepsis. regarging the hypotension, the pt with baseline sbp 90-120 (not on antihtn) presented to the ed with sbp 88 nadired at 79 and subsequently given 4l ns, hydrocort and started on levophed. a central line was placed. the hypotension was thought to be multifactorial decreased po intake c/b infection. infectious source likely e.coli urinary tract infection; while urine sterile from this hospitalization uc from showed pansensitive e. coli. this may have been because patient had received one dose of bactrim and one dose of cipro, which likely confounded labs. for this, she was treated with ceftriaxone. there was also concern for c.diff with a recent history of diarrhea, but c.diff toxin was negative. overnight, the patient pulled out the central line without any residual complication. in the icu, she was found to have sbps in 120s, and levophed was quickly weaned off. patient remained hemodynamically stable for remainder of micu course and was transfered to the floor. on the floor she did well and was transitioned to cefpodoxime. she will require an additional 1.5 days of antibiotics at discharge. # hyponatremia: pt with hyponatremia to 118 on presentation, down from 133 (). improved to 136 with 4l ns. this was thought to be secondary to hypovolemia. # stage i sacral decub ulcer: pt with sacral decub since for which she has seen wound care and hsa been using barrier cream. based on report appears improved though still stage i. importance of frequent repositioning discussed with family. # "rash": pt's family reported development of rash after cipro. however on exam, pt appeared to have purpura on upper extremities likely poor skin integrity from chronic pred and nutritional deficiencies. pt without thrombocytopenia. she was monitored for rash, with no complication. # rheumatoid arthritis: pt with chronic ra with +rf and +ccp. has been on multiple medications, most recently prednisone, mmf and humira. humira was held due to ongoing infection, decubs with noticable worsening in pain and functional status. of note, patient also accidentally received double dose of mmf in recent history. mmf and prednisone were continued. patient's primary rheumatologist was contact. inpatient rheumatology consult was recommended by him. the inpatient rheumatology team recommended continuing the current regimen until her antibiotic course was completed, and then re-starting humira. a follow-up appointment with dr. was scheduled within one week of the end date of her antibiotics. # weight loss and malnutrition the patient family was very concerned about the patient's 30 lbs weight loss in the last several months. the patients albumin was checked and was 2.9. nutrition was consulted and recommended supplements. the patient ate well while in the hospital, but per her family requires significant coaxing to eat at home. it was recommended that they continue to discuss this with the patient's primary care physician. # type 2 diabetes: held home glimepiride and put on insulin sliding scale while in-house. glimepiride was re-started at discharge. # transitional issues -follow up with rheumatology to discuss re-starting humira medications on admission: preadmission medications listed are correct and complete. information was obtained from family/caregiver. 1. alendronate sodium 70 mg po qweek 2. lumigan *nf* (bimatoprost) 0.03 % ou qhs 3. azopt *nf* (brinzolamide) 1 % ou tid 4. fluticasone propionate nasal 2 spry nu daily 5. glimepiride *nf* 1 mg oral daily 6. levobunolol 0.5% 1 drop both eyes 7. levothyroxine sodium 112 mcg po daily 8. mycophenolate mofetil 500 mg po bid 9. prednisone 5 mg po daily 10. ranitidine 150 mg po bid 11. acetaminophen 1000 mg po q12h:prn pain, fever 12. calcium 500 + d *nf* (calcium carbonate-vitamin d3) 500 mg(1,250mg) -400 unit oral 13. cyanocobalamin 500 mcg po qod discharge medications: 1. acetaminophen 1000 mg po q8h 2. azopt *nf* (brinzolamide) 1 % ou tid 3. cyanocobalamin 500 mcg po qod 4. levobunolol 0.5% 1 drop both eyes 5. levothyroxine sodium 112 mcg po daily 6. lumigan *nf* (bimatoprost) 0.03 % ou qhs 7. mycophenolate mofetil 500 mg po bid 8. prednisone 5 mg po daily 9. ranitidine 150 mg po bid 10. alendronate sodium 70 mg po qweek 11. calcium 500 + d *nf* (calcium carbonate-vitamin d3) 500 mg(1,250mg) -400 unit oral 12. fluticasone propionate nasal 2 spry nu daily 13. glimepiride *nf* 1 mg oral daily 14. cefpodoxime proxetil 200 mg po q12h duration: 3 doses rx *cefpodoxime 200 mg 1 tablet(s) by mouth q12 disp #*3 tablet refills:*0 discharge disposition: extended care facility: rehabilitation and nursing of discharge diagnosis: pansensitive e. coli uti with urosepsis ra malnutrition discharge condition: activity status: ambulatory - requires assistance or aid (walker or cane). level of consciousness: alert and interactive. mental status: confused - sometimes. discharge instructions: you were admitted to with low blood pressure and fevers. these were likely caused by a urinary tract infection. you were given iv antibiotics and iv fluids and you improved. you were evaluated by a physical therapist who recommended rehab. you will complete your course of antibiotics as an outpatient. after your antibiotics are completed you will see dr. to discuss re-starting your humira. followup instructions: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. name: , g. location: -division of gerontology address: , 1b, , phone: department: rheumatology when: wednesday at 3:00 pm with: , md building: lm bldg () campus: west best parking: garage procedure: spinal tap incision of lung central venous catheter placement with guidance diagnoses: anemia of other chronic disease urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified protein-calorie malnutrition unspecified glaucoma sepsis osteoporosis, unspecified postinflammatory pulmonary fibrosis pressure ulcer, lower back rheumatoid arthritis septicemia due to escherichia coli [e. coli] myalgia and myositis, unspecified unspecified cataract pressure ulcer, stage ii personal history of pulmonary embolism allergic rhinitis, cause unspecified body mass index less than 19, adult 

Answer: The patient is high likely exposed to