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: history of present illness: patient is a 46-year-old g0 with an last menstrual period of who presented initially at an outside hospital with bilateral complex adnexal masses and abnormal uterine bleeding. she recently was admitted at that hospital with acute renal failure, anemia, coagulopathy and a positive troponin. her admission was complicated by several days of malaise, anorexia, nausea, vomiting and diarrhea. she had also been bleeding heavily per the vagina and was found to have an elevated white count of 36,000 with pandemia. she had a hematocrit of 21. her lfts were elevated at that time. she had acute renal failure and positive ck and troponin. work-up at was significant for a ct which showed bilateral complex adnexal masses. she also had an elevated ca125. her renal function improved with hydration and transfusion. blood cultures were positive for e. coli and she was placed on antibiotics. she had an abnormal echocardiogram and positive hepatitis a. she was then transferred to for further management. during her hospital admission, all of her medical problems improved. cardiac evaluation including a stress thallium was within normal limits and she was placed on lopressor and aspirin. patient's hematocrit remained stable after transfusion and vaginal bleeding subsided. her white count came down to 14 and patient was continued on levofloxacin. her lower extremities were evaluated by doppler ultrasounds and those were normal. the patient's creatinine came down to 1.8. her abnormal liver functions also resolved during that hospitalization. with this history, she was sent to the gynecologic oncology service for further evaluation of the bilateral adnexal masses. she was admitted to as mentioned above and was admitted on the gynecology service from to . please see full dictation summary for details of the specific hospitalization. patient at that time was discharged on in stable condition with a plan to follow-up with dr. to schedule her surgery. there was concern at this time for endometrial and/or ovarian cancer with these symptoms. patient underwent a consultation with dr. on and the plan at that time was to undergo a exploratory laparotomy and potentially tumor debulking depending on the findings. she was consented for a total abdominal hysterectomy bilateral salpingo-oophorectomy and possible surgical staging. she was re-admitted on . at that time, she was noted to have significant amount of fatigue. her hematocrit was checked and was found to be 23%, a decrease from her previous admission of 29. patient received two units with inappropriate increase. after the second unit, the presumed source of bleeding was the ovarian cyst and with bleeding into her pelvic mass. patient was transferred to for further management as she was intended to have an operation with dr. initially. patient on admission on felt fatigued, but otherwise well. past medical history: significant for inferior intramural cardiac myocardial infarction, renal insufficiency with a baseline creatinine of 1.5, severe hypothyroidism and anemia. also a recent history of hepatitis a. past surgical history: negative. gynecologic history: irregular menses, no sexually transmitted disease, no history of fibroids or carcinoma. she is gravida 0. family history: stomach and bone marrow cancer. she denies tobacco, alcohol or drugs. medications: lopressor 50 b.i.d., aspirin 81 q.d., iron, colace and protonix 40 q.d. allergies: erythromycin. physical examination: vital signs on admission: patient's vital signs were noted to be stable. t maximum is 99.5. heart rate 86. blood pressure 140/80. respiratory rate 18 and 98% on room air. she was in no acute distress. neck had no masses or lymphadenopathy. a regular rate and rhythm on her heart. lungs were clear. abdomen was soft, nontender, nondistended, masses were palpable in the pelvic region bilaterally. pelvic exam was limited by body habitus. extremities showed 2+ edema on her right and 1+ edema on her left and some eczematous lesions. laboratories: her laboratories were pending at time of admission. in summary: she is a 46-year-old g0 with large adnexal masses ongoing anemia and bleeding, hemodynamically stable with hematocrit that was pending. the plan was to undergo a total abdominal hysterectomy bilateral salpingo-oophorectomy and possible staging for . she was given a bowel prep at that time and serial hematocrits were planned to be checked. additionally, she was monitored. here electrolytes were monitored and her renal function was monitored as well. on , she was noted to have a hematocrit of 29.9 and a creatinine of 3.4. she received five units of packed red blood cells at during the prior three days and her previous last serial hematocrit was 29%. the presumption was that she was bleeding into her ovarian mass. there was a notable elevated white blood count of 15, no signs of infection were noted. she was afebrile and a urinalysis and a culture were checked. renal: etiology of the renal insufficiency was not known from the patient's record. a repeat creatinine was sent to further monitor her renal function. pelvic mass: the plan was to proceed with surgery for evaluation of the pelvic masses. she underwent a bowel prep on hospitalization day one. her repeat hematocrit was 31.8 and creatinine was 3.9 increased from 3.4. there was a consideration of worsening renal function at that time and the possible causes including volume depletion, vascular disease, acute glomerulonephritis obstruction and acute tubular necrosis were considered. a urine electrolytes and creatinine were sent. urinalysis cns was sent. sediment, bun and creatinine, urine osmolality were run, as well as a renal ultrasound. her hematocrit later that afternoon was 31.8, bun was 33 and creatinine was 3.7. urine osmolalities were 181 with the rest of her laboratories pending. ultrasound obtained at that time showed a left ovarian mass, 10.9 x 11.3 x 11.3 which was septated, right ovarian mass which was 15.5 x 11.9 x 9.9. the uterus was not well visualized. the right kidney was 12.7 cm. the left kidney was 10.9 cm. there was bilateral hydronephrosis, left greater than right and no calculi were visualized. the consideration was likely that the renal function was secondary to a obstructive pathology and a renal consult was obtained. social work consult was obtained on hospitalization day two. also at the time, patient underwent exploratory laparotomy, subtotal hysterectomy, bilateral salpingo-oophorectomy, extensive lysis of adhesions. patient did well. please see full operative dictation and pathology for further results of this operative report. the operative findings included large tubo-ovarian abscesses bilaterally. the renal consult was obtained and recommended following her creatinine and re-imaging via ultrasound if the creatinine was falling and hydronephrosis resolved for evaluation of her elevated creatinine, as well as monitoring her ins and outs closely. they recommended renal dosing for all medications. patient was admitted to the intensive care unit overnight after her operation for closer monitoring and management of her complicated medical problems postoperatively. that evening, her pain was controlled with demerol and vistaril and her diet was advanced slowly. her jp drain was monitored. she had a foley and was encouraged to use this incentive spirometry. 2. renal: she was maintained on intravenous antibiotics with renal dosing and her creatinine was monitored and noted to be 3.3. 3. cardiovascularly: a troponin level was sent at that time as she had a previous history of myocardial infarction. her fluids were maintained at 125 an hour to follow her urine output. ins and outside were balanced. 4. hematology: hematocrit was stable after four units of packed red blood cells and they followed serial hematocrits overnight. 5. infectious disease: she was maintained on ciprofloxacin and flagyl following her white blood cell and awaiting cultures from intraoperative pathology. on postoperative day one, she was transferred out of the intensive care unit. she had been improved on her postoperative pain control and her jp drain was still monitored with a moderate output. she was out of bed as tolerated and her foley was maintained to gravity. her renal output was appreciated and her creatinine was noted to be 3.4 at midnight and 3.5 at 5 a.m. she had a negative troponin evaluation and her fluid, electrolytes were monitored closely over postoperative day one. her hematocrit was noted to be stable and she was continued on ciprofloxacin and flagyl. postoperative day two, she was noted to have decreased pain, out of bed, ambulating and tolerated fluids and with good pain control. her creatinine had noted to be decreased to 2.9 and her electrolytes were within normal limits. her hematocrit was notable stable at 29.5 and she was overall doing well. she was continued on ciprofloxacin and flagyl and her white blood cell had been decreased to 14. postoperative day three, she had a mild episode of chest discomfort which appeared most consistent with gastritis although with a history of a myocardial infarction, an electrocardiogram was monitored and cks were drawn. patient's cks were notable negative over the course of that day and her electrocardiogram showed no difference from her previous electrocardiogram. her chest discomfort resolved with the passage of gas. she was noted to have adequate urine output and her foley catheter was removed. she was continued on ciprofloxacin and flagyl and was noted to be afebrile with her white count improving. her creatinine also was notably improved over the course of the day. she was thought to have a resolution of her obstructive symptomatology. her creatinine at that point was 2.1. a renal ultrasound was scheduled for further evaluation of her potential obstruction hydronephrosis. postoperative day four, she had been improved over the following night. her wound incision had also noted to have a little erythema around the base of the incision. her exam was otherwise benign and she was continued to be monitored in her postoperative state. cardiovascularly, her chest pain resolved. her electrocardiogram was normal and her cks were negative. renal function: her creatinine decreased to 1.8 over this period of time. infectious disease: she was continued on ciprofloxacin and flagyl. oxacillin was begun for treatment of her cellulitis. she was maintained in house for monitoring of her wound infection. postoperative day number five, she was discharged home in stable condition. the evening of postoperative day four, she underwent a renal ultrasound which showed a resolution of her hydronephrosis on her right and a near resolution on the left. she felt well on postoperative day five and was able to ambulate, tolerate po and pain control was adequate. her physical examination was benign. her vital signs were all within normal limits. her laboratories showed her creatinine to be 1.4 even down from 1.8 and returned to her baseline. hematocrit was stable at 30. on day of discharge, she was status post exploratory laparotomy, bilateral salpingo-oophorectomy, lysis of adhesions for tubo-ovarian abscess. cardiovascularly: she was hemodynamically stable. hematocrit was stable and her central line was withdrawn. anemia: hematocrit was stable, renal function. she was evaluated by the renal team who believed that this was most consistent with a obstructive picture. her creatinine had returned to its baseline and she was overall well. her jp was pulled at that time as the output was minimal and she was maintained on the outpatient basis on ciprofloxacin, flagyl and dicloxacillin. she went home in stable condition and will follow-up with dr. in one week after date of discharge for her staple removal. discharge diagnoses: 1. bilateral tubo-ovarian abscess. 2. renal insufficiency. 3. postoperative care. discharge condition: stable. follow-up: she will follow-up with dr. . discharge medications: 1. protonix 40 mg po q.d. 2. percocet 5/325 1-2 tablets po q. prn. 3. synthroid 0.75 mg po q.d. 4. lopressor 50 mg po b.i.d. 5. flagyl 500 mg po b.i.d. for ten days. 6. ciprofloxacin 500 mg po b.i.d. for ten days. 7. dicloxacillin 500 mg po q.i.d. for ten days. , m.d. dictated by: medquist36 procedure: other removal of both ovaries and tubes at same operative episode other lysis of peritoneal adhesions release of urethral stricture diagnoses: other postoperative infection cellulitis and abscess of trunk accidental puncture or laceration during a procedure, not elsewhere classified other and unspecified coagulation defects pelvic peritoneal adhesions, female (postoperative) (postinfection) leiomyoma of uterus, unspecified endometriosis of uterus salpingitis and oophoritis not specified as acute, subacute, or chronic 

Answer: The patient is high likely exposed to