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: patient recorded as having no known allergies to drugs attending: chief complaint: e.coli sepsis and pneumonia major surgical or invasive procedure: intubation and mechanical ventilation peg placement tracheostomy history of present illness: 54 yo m with esrd hd-dependent, htn, dm, who p/w hypotension and bacteremia. pt had n/v/d x6 days and decreased po intake with fevers of 102 at home. he went for regularly scheduled hd 1 day pta where his hd site was noted to be infected and cath had reportedly fallen out the previous day. blood cultures were obtained and he continued his hd per nl protocol and was given 1 gm vancomycin empirically for the presumed infection. on the day of admission, the pt was called to come to the ed b/c bcx noted to be growing out gnr--pt notified. on questioning in , pt denied abd pain, but did admit to back pain (chronic). cxr showed large l pleural effusion with infiltrates.he received 3l ns, vanc, and gent. labs were notable for tbili 12.8 (dir 9.7), lactate 7.4 (-->6.6-->5.8), and plt 69. several attempts were made at central line placement, but given pt's agitation, this was unsuccessful. he was transferred to the floor, lsc was attempted, but unsuccessful, so r femoral line was placed and pt was electively intubated b/c of ams and sats dropping to the 80s. pt transferred to the micu for further managment. past medical history: esrd on hd anti gbm disease, on hd dm2 x 10yrs peripheral neuropathy htn chronic lbp herniated disks anemia, hx guaiac pos stools hx nepthrolithiasis s/p cervical laminectomy hx depression hx mssa bacteremia chf l av graft social history: married to wife unemployed disability tobacco 1ppd no etoh/ ivda family history: h/o dm and renal failure physical exam: bp 86/49, 98.3, 95, 18, 100%ra gen elderly, lying in bed, nad heent perrla, eomi, dry mm cvs rr faint heart sounds, no jvd pulm bibasilar crackles, r > l abd: bs present, soft, nontender, no rebound or guarding ext warm and dry, no edema pertinent results: 10:32pm type-art temp-36.9 rates-14/19 tidal vol-500 peep-5 o2-60 po2-156* pco2-47* ph-7.35 total co2-27 base xs-0 intubated-intubated vent-imv 10:32pm lactate-5.0* 09:00pm glucose-114* urea n-60* creat-9.8* sodium-142 potassium-4.5 chloride-97 total co2-28 anion gap-22* 09:00pm alt(sgpt)-114* ast(sgot)-80* ld(ldh)-272* alk phos-151* amylase-28 tot bili-12.2* 09:00pm wbc-9.1 rbc-3.35* hgb-10.8* hct-33.9* mcv-101* mch-32.4* mchc-32.0 rdw-15.7* 09:00pm neuts-66 bands-9* lymphs-7* monos-10 eos-0 basos-0 atyps-0 metas-8* myelos-0 09:00pm plt smr-very low plt count-77* chest (portable ap) 9:08 pm chest (portable ap) reason: please eval et tube placement medical condition: 54 year old man with esrd on hd, dm, who p/w gnr bacteremia, lll pna not intubated reason for this examination: please eval et tube placement indications: for assessment of et tube placement. portable ap chest: comparison is made to the prior study from same day and also . findings: there has been dramatic interval change when compared to exam from . the patient has a central cervical spine fusion in situ. the patient is now intubated and the et tube is identified in good position with its tip 4 cm above the carina.. evidence of extensive air space consolidation of the left side. silhouetting of the left heart border in the lingula, and also some partial silhouetting of the left lower lobe.this has progressed over the course of the day. in the right lung, there is faint opacification in the right mid zone. the lungs appear otherwise normal. the bones are unremarkable without evidence of dystrophy. impression: 1. extensive left sided air space consolidation. this likely represents pneumonia. other causes such as asymmetrical pulmonary edema,particularly given it's rapid progression, cannot be readily excluded, correlation with clinical history is recommended. 2. patient now intubated brief hospital course: breifly: this is a 54 yo man with dm and esrd due to anti-gbm disease who was admitted on with ecoli sepsis and pneumonia. he was intubated for respiratory failure, was unable to be weaned off, and a tracheostomy was placed. he then developed a necrotizing left lung pnemonia. he was stabalized and transferred out of the icu on in good condition. 1) bacteremia-- the patient presented with ecoli pneumonia and bacteremia thought to ne due to an infected hd line. the patient was started on double coverage for gram nbegative rods with zosyn, levoquin, and vancomycin to cover gram positive cocci. on , the vanco and zosyn was stopped, as only etiology on culture was gnr, and the patient was continued on flagyl and levoquin for 21 day course. blood cultures negative from on. on he was diagnosed with a necrotizing pnemonia. then vanco and zosyn were restarted and the other were stopped. vancomycin was stopped prior to his leaving the unit. he will need to coninue a total 4 week course of zosyn, which will be until . 2)septic shock--the patient has a increased lactate and hypotension on admission. he was resuscitated with 6 l of iv fluids then levophed was used to keep his map above 65. a full course of stress dose steriods was completed on . he remained normotensive or hypertensive off of pressors from on. 3)respiratory failure: elective intubation in the setting of mental status change and decreasing o2 sats. however, the patient has a large left lobe pneumonia and l pleural effusion contributing to hypoxemia. thoracentesis was attempted, but not the effusion was not tappable as it was all consolidated lll. cxr and chest ct from revealed nearly majority of left lung with solid consolidation, no evidence of empyema. his mental status and ventilation improved and he was weaned until when developed increasing copious secretions, good cough but decreased ms again. over , he continued with increasing secretions and worsening mental status, no longer with successful weaning of ventilator despite cxrs with no interval change (still with majority of lung solid consolidation). cxr with small ?cystic lesions in l upper lobe consolidation, ct chest consistent with large confluent lucencies of left lung likely secondary to necrosis and right lung base patchy infiltrates. bronch with large amount of grey purulent material from the left lung, bal sent for fungal, bacterial, viral, and pcp ; all were negative. pt had a tracheostomy on . he came off of the vent on and has been stable since. his o2 sats are 94 - 98 % on room air. however, he needs assistance managining with secretions - humidified tm, chest pt, guanefisin, head of the bed above 45 degrees, and avoiding dehydration. 4)thrombocytopenia: on admission, concerning for dic in setting of sepsis. however, with trending of dic labs, pt never with full manifestation of dic and thrombocytopenia resolved with d/c of zosyn. when zosyn was started again for pnemonia, the patient did not have thrombocytopeina and in fact had a reactive thrombocytosis from infection. 5) r ij clot discovered after unsuccessful line placement, pt started on heparin gtt and transitioned to coumadin. hos coumadin will need further titration in rehab. 6)esrd antiglomerular basement membrane disease: on hd since q t/th/sat. pt required qd or qod dialysis since admission, which was helpful in maintaining patient's delicate fluid balance in the setting of sepsis. now he is getting m,w,f dialysis during which at leadt 4 lbs is taken off. he gets dialysis through his fistula. 6)anemia: chronic anemia, guaiac +; likely chronic dz and esrd. he required several units of prbc transfusions early in micu course but remained stable since. he recieved periodic transfusions during dialysis to keep his hct above 30. he also recieved epogen at dialysis. 7)inc lfts: given his lab data on admission, ascending cholangitis was a concern and surgery was consulted to evaluate the need for emergent intervention. however, ruq us was negative for obstruction or cholelithiasis/ cholecystitis. bilirubin decreasing with improving clinical picture, likely jaundice of sepsis. 8) diabetes: he was maintained on insulin gtt for first two weeks of micu course, then transitioned successfully to glargine and sliding scale regular insulin with insulin added to his total parenteral nutrition. the glargline was stopped after a few days because his am bs were very low. how he is on nph that will need to be titrated up as his tube feeds are increased. he is covered by a regular iss as well. q6hour fs since his tf are continuous. 9) htn: after trach and peg placement, he had continued difficulty with hypertension with spb in the 190-200 range. these episodes were controlled with dialysis and intermittent titration of captopril and lopressor. he is not on amlodipine, captopril, lopressor, and hydralizine with blood pressures still in the 150 - 160. his hydralizine will need to be continually titrated up for a goal of sbp 130 - 140. 10) nutrition: he had a percutaneous enteral gastric tube placed on with no complications. he has been recieving tube feeds at 40/hour. this rate is being increased currently to 45/hour. once he tolerates this, add 40 of promod. 11) physical therpy: pt as been working with him extensively. currently he is non weight bearing. he will need continuing pt to regain his pre hospital function. 12) pain: the patient has chronic lower back pain secondary to herniated disk. he is no methadone and oxycodone for breakthrough. 13) mental status: the patient has been confused for many weeks now, as expected after a prolonged icu course. he is gradually clearing and is oriented to person and place, but not time. continue frequent reorientation and have family being in familiar items. avoid benzos and excessive short acting narcotics, as these measures have helped him during the past week. 14) diarrhea: the patient developed diarrhea. cdiff cultures are pending and metoclopromide was stopped. medications on admission: paxil 60 ad nifeipine er 60 qd lisinopril 40 ad p metoprolol 50 n methadone 10 oxycodone prn discharge medications: 1. paroxetine hcl 30 mg tablet sig: two (2) tablet po qd (once a day). 2. folic acid 1 mg tablet sig: one (1) tablet po qd (once a day). 3. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po qd (once a day) as needed. 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 5. chlorhexidine gluconate 0.12 % liquid sig: 15 ml mls mucous membrane tid (3 times a day) as needed. 6. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day) as needed. 7. captopril 25 mg tablet sig: four (4) tablet po tid (3 times a day). 8. amlodipine besylate 5 mg tablet sig: two (2) tablet po qd (once a day). 9. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po qd (once a day). 10. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 11. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours): per ng. 12. warfarin sodium 6 mg tablet sig: one (1) tablet po hs (at bedtime). 13. calcium acetate 667 mg tablet sig: four (4) tablet po tid w/meals (3 times a day with meals). 14. acetaminophen 500 mg tablet sig: one (1) tablet po q4h (every 4 hours). 15. oxycodone hcl 5 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed for back pain. 16. methadone hcl 10 mg tablet sig: 1.5 tablets po bid (2 times a day). 17. piperacillin-tazobactam 2-0.25 g recon soln sig: one (1) recon soln intravenous q12h (every 12 hours) for 4 days. 18. heparin lock flush (porcine) 100 unit/ml syringe sig: one (1) ml intravenous qd (once a day) as needed. 19. hydralazine hcl 50 mg tablet sig: 1.5 tablets po q6h (every 6 hours). 20. insulin nph human recomb 100 unit/ml cartridge sig: one (1) injection subcutaneous twice a day: 4 units nph sc bid. humalog insulin sliding scale starting with 2 units at fingerstick of 150, 4 units at fingerstick 200. discharge disposition: extended care facility: - discharge diagnosis: necrotizing ecoli pneumonia ecoli sepsis requiring pressors esrd and hd dmii discharge condition: stable with persistent secretions. 97% on 40% tm. tolerating tube feeds at goal. discharge instructions: call pcp if the patient developes fever, vomiting, or increased o2. will work on removing tracheostomy and peg once your pneumonia has cleared followup instructions: will need to follow up with nephrologist and pcp. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances hemodialysis percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy transfusion of packed cells diagnoses: thrombocytopenia, unspecified anemia in chronic kidney disease severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease septic shock abscess of lung pneumonia due to escherichia coli [e. coli] diarrhea infection and inflammatory reaction due to other vascular device, implant, and graft septicemia due to escherichia coli [e. coli] displacement of lumbar intervertebral disc without myelopathy jaundice, unspecified, not of newborn nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney 

Answer: The patient is high likely exposed to