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: sulfa (sulfonamide antibiotics) / suprax / paxil / penicillins attending: chief complaint: altered mental status, fever, hypotension major surgical or invasive procedure: percutaneous nephrostomy tube placement history of present illness: the patient is a year old resident of rehab who presents with altered mental status. she was recently started on a course of cipro (d1 ). today had addominal pain and chills. was noted to be hypotensive to 94/62. she had urinary retention and a foley was placed. . in the ed, initial vs were: 98.3 69 113/66 18 96% ra. labs were notable for leukocytosis with bandemia, thrombocytopenia, acute renal failure and lactate of 3.8. she was given vanc and cipro. she was given only 500cc of ns for ivf due to hyponatremia. . on arrival her family states that on tuesday () she had severe flank pain and on wednesday () had pain that reminded her of menstrual cramping. last night she became acutely confused but denied pain. at baseline, she has short term memory loss but is oriented x3 and very active. her mental status represented an acute change and she was also lethargic. other notable recent past medical history is a tooth infection treated with a course of antibiotics 3 weeks ago. she was suppossed to have the tooth removed but this did not occur. she had resolution of her symptoms. . currently she denies pain, chest pain, dyspnea, abdominal pain. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: niddm htn high chol dementia cataracts melanoma (completely excised) s/p hysterctomy social history: - tobacco: none - alcohol: h/o very occaisional - illicits: none family history: noncontributory physical exam: admission exam: general appearance: thin eyes / conjunctiva: perrl, ecchymoses on tongue head, ears, nose, throat: normocephalic cardiovascular: (s1: normal), (s2: normal), (murmur: no(t) systolic, no(t) diastolic) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (breath sounds: crackles : bilat bases, no(t) wheezes : ) abdominal: soft, non-tender, bowel sounds present extremities: right lower extremity edema: absent, left lower extremity edema: absent, no(t) cyanosis, no(t) clubbing skin: warm, no(t) rash: , no(t) jaundice, many many sks neurologic: follows simple commands, responds to: verbal stimuli, movement: not assessed, tone: not assessed, cns intact discharge exam: vitals: t:96.9 bp:160/70 (140-180/70-81) p:64 (64-80) r:18 o2: 94% ra i/o: --/600+500nephro; 1130/1050++bm general: sleeping but easily rousable, oriented to self and date, year, no acute distress, speaking in full sentences heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, did not appreciate bibasilar crackles at this time, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley draining clear yellow urine; l pcn draining serosanguinous fluid. no cvat. ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema skin: multiple sebborrheic keratoses and nevi neuro: cn 2-12 intact. tangential, spelling words frequently. perseverates and repeats important life dates. pertinent results: 12:00pm blood wbc-20.6*# rbc-3.55* hgb-10.7* hct-30.1* mcv-85 mch-30.0 mchc-35.5* rdw-13.2 plt ct-54*# 12:00pm blood neuts-88* bands-6* lymphs-3* monos-3 eos-0 baso-0 atyps-0 metas-0 myelos-0 12:00pm blood pt-14.6* ptt-29.0 inr(pt)-1.3* 12:00pm blood fibrino-918* 12:00pm blood ret aut-pnd 12:00pm blood glucose-224* urean-50* creat-2.0* na-120* k-4.9 cl-86* hco3-20* angap-19 12:00pm blood alt-19 ast-55* ld(ldh)-257* alkphos-66 totbili-0.9 12:00pm blood albumin-3.5 calcium-8.2* phos-2.9 mg-1.6 12:00pm blood hapto-pnd 12:00pm blood osmolal-pnd 12:00pm urine color-yellow appear-hazy sp -1.014 12:00pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-lg 12:00pm urine rbc-7* wbc-54* bacteri-few yeast-none epi-0 12:00pm urine casthy-4* 12:00pm urine mucous-rare 03:33pm urine hours-random creat-87 na-21 k-89 cl-20 03:33pm urine osmolal-449 11:55 am blood culture **final report ** blood culture, routine (final ): escherichia coli. final sensitivities. piperacillin/tazobactam sensitivity testing confirmed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>256 r ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- 0.5 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s aerobic bottle gram stain (final ): reported to and read back by dr. on at 0630. gram negative rod(s). anaerobic bottle gram stain (final ): gram negative rod(s). other blood and urine cultures pending. imaging: chest (portable ap) study date of 6:13 am frontal chest radiograph: there is increased perihilar indistinctness and diffuse ground-glass opacity with small bilateral pleural effusion and cardiac enlargement in keeping with congestive heart failure. retrocardiac opacity has increased and may reflect atelectasis. again seen is mild prominence in the region of the ascending aorta. attention to this area should be paid on followup chest radiographs. there is no pneumothorax. . chest (portable ap) study date of 5:07 pm frontal chest radiograph: there has been mild improvement in the degree of pulmonary edema. cardiomediastinal silhouette is stable. there is unchanged retrocardiac opacity as well as a moderate-sized left-sided pleural effusion. there is a linear lucency at the right lung apex. this may represent line, however, a pneumothorax is not excluded. recommend repeat chest radiograph. impression: 1. improving pulmonary edema. 2. left-sided pleural effusion and retrocardiac opacity. 3. lucency at the right lung apex may represent line from an overlying skin fold. recommend repeat chest radiographs. . ct abd & pelvis w/o contrast study date of 4:10 am findings: ct abdomen: lung bases demonstrate small bilateral pleural effusions with adjacent compressive atelectasis. the coronary arteries are calcified. evaluation is limited without iv contrast. the non-contrast appearance of the spleen, adrenal glands, liver, and stomach are within normal limits. a calcified gallstone is noted within the gallbladder. there is diffuse fatty atrophy of the pancreas, making it hard to fully visualize. there is diffuse calcified atherosclerotic disease of the intra-abdominal arterial vasculature. there is a small amount of ascites. the non-contrast appearance of the right kidney is within normal limits. there is mild-to-moderate hydronephrosis of the left kidney with mild surrounding fat stranding with hydroureter seen down to the level of the mid ureter. however, the ureter is not definitively seen beyond this point. a candidate distal left ureter may be seen with calcification versus multiple small obstructing stones in the distal left ureter (300b:30 and 2:64-71). ct pelvis: there is a large amount of stool within the rectum. the bladder is decompressed with a foley catheter. the uterus is absent. there is small amount of free fluid within the pelvis. intrapelvic loops of bowel are within normal limits. there is no inguinal or pelvic lymphadenopathy. bone windows: there is grade 1 anterolisthesis of l4 on l5, likely due to degenerative changes. impression: 1. limited evaluation given lack of iv contrast. mild-to-moderate hydronephrosis of the left kidney with mild surrounding fat stranding with hydroureter. the distal left ureter is not definitely seen, but may contain calcification of the ureter versus multiple small obstructing stones. alternatively, this could represent a small calcified branch artery off the internal iliac artery. 2. small amount of ascites. 3. small bilateral pleural effusions. 4. cholelithiasis. renal u.s. port study date of 12:13 am findings: the right kidney measures 12.3 cm. it is normal in appearance without hydronephrosis, stones or mass. there is a trace amount of fluid surrounding the lower pole of the right kidney, however. the left kidney measures 10.1 cm and demonstrates moderate hydronephrosis. there are no renal stones or masses. the proximal ureter is dilated; however, an obstructing cause is not seen as overlying bowel gas limits evaluation. the bladder is decompressed with a foley catheter and not well seen. impression: 1. moderate hydronephrosis of the left kidney. the obstructing cause is not identified on this study. 2. normal appearance of right kidney. trace amount of fluid surrounding the lower pole of the right kidney. 3. bilateral pleural effusions. ct head w/o contrast study date of 12:34 pm findings: there is no evidence of any intra-axial or extra-axial hemorrhage. there is good -white matter differentiation. there is disproportionate atrophy seen in the frontal lobes bilaterally. there is no evidence of large mass cerebral edema or shift of midline structures. there is some periventricular white matter hypodensities suggestive of small vessel ischemic disease. there is no evidence of any underlying fracture. mucus retention cysts are seen within the sphenoid sinuses. minimal mucosal thickening of the ethmoid air cells is noted. mastoid air cells are well pneumatized. impression: 1. no evacute intracranial process. 2. mucosal retention cysts in the sphenoid sinuses brief hospital course: yo f p/w sepsis likely uti, hyponatremia, and delirium. # urosepsis: u/a positive for pan-sensitive e coli with blood cultures growing gnrs. patient met sirs criteria. previously had flank pain concerning for pyelonephritis though u/s and ct not suggestive of active infection or any current obstruction. given l mild hydronephrosis she may have previously passed a stone. patient with persistent hypotension and elevated wbc after two days of antibiotics and it was felt infectious source not likely well controlled. on , ir placed percutaneous nephrostomy tube. patient was continued on ceftriaxone and then switched to po cipro given senstitivities showed e coli was pan sensitive. plan was to complete a 14 day course of abx (day 1 =; day 14 = ). pt improved and was able to go to floor. pt continued to recover and remain stable with improved mental status and vs. pt was discharged back to rehab with planned follow-up with urology and ir (ir placed nephrostomy tube). . # altered mental status: per family, patient with dementia at baseline, but was more altered on admission. differential diagnosis included delirium in setting of urosepsis, cipro med effect and hyponatremia. patient's mental status improved with treatment of urosepsis and treatment of hyponatremia. on floor she was very alert and pleasant, telling jokes and interacting with staff appropriately. delerium had cleared and pt had returned to baseline. . # hyponatremia: likely hypovolemic hyponatremia, may be component of siadh in setting of sepsis though low urine na. sodium acutely dropped from 128 to 120, now improved to 132 in the icu after patient received volume with ns. . # acute renal failure: likely to sepsis vs hypovolemia (pre-renal). concern for obstructive component. improved with fluid and decompression of obstruction. . # thrombocytopenia: no ttp per heme-onc. be sepsis vs med effect. dic work-up unrevealing. likely secondary to sepsis. . # anemia: as above, no evidence of ttp. be due to anemia of chronic inflammation vs renal failure. hct at recent baseline. . # dm2: held metformin while in house, iss. . # hld: continued statin, held aspirin. . planned follow-up with urology and ir: pt will be seen by urology on for follow-up and determination if additional intervention is required. per ir, regarding care of percutaneous nephrostomy tube: check site daily for signs of infection. if soiled or erythematous, change dressing and monitor. as wound heals, dressing changes can be transitioned to once per week or unless the dressing becomes soiled however site should be monitored daily for signs of infection. dressing should be changed once per week or unless the dressing becomes soiled. pt will also need to have a routine exchange of the tube every 3 months unless urology chooses to intervene (this has been scheduled for ). if a problem occurs with the tube or urology requests an earlier tube exchange or change, please call the interventional radiology clinic services number to make the necessary arrangements. as above, pt will be seen by urology on by urology for follow-up to ensure improvement and to determine if additional interventions are required. f/up remaining blood and urine cultures f/up nephrostomy tube and resolution of infection; question remains if further intervention will be needed to remove obsturction medications on admission: acetaminophen 650 q4h prn asa 81 daily kcl 10 meq daily simvastatin 20 daily atenolol 25 mg hydrochlorothiazide 25 mg daily metformin 1000mg calcium carbonate 1300 daily ciprofloxacin 250mg (received 2 doses, first dose 5/26 am) d5 normal saline @ 75 cc/hr x 13 hours, 20 min discharge medications: 1. tylenol 325 mg tablet sig: 1-2 tablets po every four (4) hours as needed for pain. 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. potassium chloride 10 meq tablet extended release sig: one (1) tablet extended release po once a day. 4. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 5. atenolol 25 mg tablet sig: one (1) tablet po twice a day. 6. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. 7. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. 8. calcium carbonate 500 mg calcium (1,250 mg) tablet, chewable sig: two (2) tablet, chewable po once a day. 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 11. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 9 days: to complete a total of 14 days of abx. day 1 = day 14 = . disp:*9 tablet(s)* refills:*0* 12. percutaneous nephrostomy tube nephrostomy site should be checked daily for signs of infection. if soiled or erythematous, change dressing and monitor. as wound heals, dressing changes can be transitioned to once per week or if the dressing becomes soiled however site should be monitored daily for signs of infection. tube will also need to have a routine exchange of the tube every 3 months unless urology chooses to intervene. an appointment has been made for . however, if a problem occurs with the tube or urology requests an earlier tube exchange or change, please call the interventional radiology clinic services number to make the necessary arrangements. discharge disposition: extended care facility: for the aged - ltc discharge diagnosis: primary: -altered mental status, fever, hypotension due to e coli sepsis secondary to uti and nephrolithiasis -acute renal failure due to obstruction and acute infectious process secondary: hypoxia thrombocytopenia anemia hypertension discharge condition: mental status: clear and coherent but with baseline mild dementia level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you came to the hospital because you were experiencing altered mental status, fever, decreased blood pressure and were found to have and bacterial infection of your urinary track as well as a blockage of your left kidney because of stones. you were admitted to the internsive care unit where you recieved antibiotics, fluids and a tube was placed to help to decompress your left kidney and drain the urine. your symptoms improved and you were able to be moved from the intensive care unit to the regular floor. you continued to make improvements and it was felt you could be discharge back to rehab to complete your recovery there. you will have close follow-up with your regular doctor as well as urology and interventional radiology (the doctors who placed the tube to help drain your kidney). . the following changes were made to your medications: - please start taking cipro to complete your 14 day course of antibiotics (day 1 =). - please continue to take all of your other home medications as prescribed. percutaneous nephrostomy tube: your site should be checked daily for signs of infection. if soiled or erythematous, change dressing and monitor. as wound heals, dressing changes can be transitioned to once per week or unless the dressing becomes soiled however site should be monitored daily for signs of infection. you will also need to have a routine exchange of the tube every 3 months unless urology chooses to intervene. an appointment has been made for you already. however, if a problem occurs with the tube or urology requests an earlier tube exchange or change, please call the interventional radiology clinic services number to make the necessary arrangements. you will also be seen by urology on for follow-up to ensure improvement and to determine if additional interventions are required. please be sure to keep all follow-up appointments with your primary care doctor, urologist and other health care providers. . it was a pleasure taking care of you and we wish you a speedy recovery. followup instructions: please be sure to keep all follow-up appointments with your primary care doctor, urologist and other health care providers. department: surgical specialties when: wednesday at 10:00 am with: urology unit building: sc clinical ctr campus: east best parking: garage department: radiology care unit when: friday at 7:00 am building: de building ( complex) campus: west best parking: garage **nothing to eat or drink after midnight the night before** department: radiology when: friday at 8:30 am building: cc clinical center campus: west best parking: garage procedure: percutaneous nephrostomy without fragmentation diagnoses: thrombocytopenia, unspecified urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hyposmolality and/or hyponatremia severe sepsis other persistent mental disorders due to conditions classified elsewhere pulmonary collapse iron deficiency anemia, unspecified septicemia due to escherichia coli [e. coli] hydronephrosis delirium due to conditions classified elsewhere other seborrheic keratosis 

Answer: The patient is high likely exposed to