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: no known allergies / adverse drug reactions attending: chief complaint: fatigue, fever, dysuria major surgical or invasive procedure: none history of present illness: 71m w/pmhx sig secondary progressive multiple sclerosis, wheelchair bound, with dm2 on hypoglycemics presented to his pcp office with 24 hours of fatigue, decreased appetite, and decreased urination. pt reported that he normally self-caths q8h but did not feel the need to do so in the last 24 hours. reports that he has had gradually increasing weakness and decreased ability to transfer himself out of his wheelchair. he reported nasal congestion, cough, and malaise for several days prior. in his pcp's office, he was found to have pyuria and a wbc to 24, and was refered to the ed. in the ed, initial vs were: t 97.0 p 80 bp 104/43 r 20. he was noted to be resting comfortably, and reported continued penile discomfort and mild nausea. he was noted to have mild abdominal tenderness on exam. he was found to have a lactate of 6.3, wbc 26, and creatinine 2.8 (baseline ~1.0) as well as a k 8.5 and glucose of 601. . he was subsequently given 50meq of bicarb and calcium gluconate 2mg for membrane stabilization, and started on an insulin drip and given 4l ns, with subsequent decrease of his glucose to 467 and then 215. his potassium decreased to 4.8, but his lactate remained elevated at 4.9. he received ceftriaxone for his uti. he was subsequently noted to have a systolic pressure to 75, thus a central line was started and he was given empiric vancomycin and zosyn due to his prior mild abdominal tenderness on exam. however, a subsequent ct scan did not demonstrate an acute intraabdominal process. due to consistently low pressures, he was started on levophed before transition to the floor. on arrival to the micu, his initial vitals were t 95.3, p 81, bp 99/62, r 22, 98% on ra. he stated that he was comfortable but felt weak and very tired. his saline was switched to d51/2 and his insulin reduced. an arterial line was placed due to his need for invasive management and pressor support. review of systems: (+) per hpi (-) denies chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness. denies shortness of breath or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, or changes in bowel habits. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - multiple sclerosis (diagnosed in , secondary progressive, wheelchair bound since , followed by dr. at ) - cad (s/p cabg ) - dm (on oral hypoglycemics, hba1c 8.1% in ) - dvt/pe - neurogenic bladder (straight caths self tid x 15 years) - bph - htn - hyperlipidemia - history of mrsa per osh records - depression with fixation of ideas social history: he lives with his wife, bound to wheelchair, has help every day for 1 hr in the morning. he denies tobacco, alcohol or illicits. family history: no family history of coronary artery disease physical exam: pe at the admission: vitals: 98, hr 76, bp 116/58, o2 sat 97% ra rr 12-22 general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: distended, tender, not painful, bowel sounds present, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper extremities, cannot move lower extremities bilaterally, gait deferred, finger-to-nose intact pe at the discharge: vitals: 95.5 154/57 57 20 94ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: rrr nl s1 and s2. lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: distended, tender, not painful, bowel sounds present, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis, 2+ edema. neuro: cnii-xii intact, 5/5 strength upper extremities, cannot move lower extremities bilaterally, lying in bed, responding appropriately to questions. pertinent results: labs at the dmission: 04:10pm blood wbc-26.8*# rbc-4.77 hgb-14.3 hct-43.2 mcv-91 mch-29.9 mchc-33.0 rdw-13.3 plt ct-297 04:10pm blood neuts-60 bands-32* lymphs-4* monos-4 eos-0 baso-0 atyps-0 metas-0 myelos-0 04:10pm blood hypochr-normal anisocy-occasional poiklo-normal macrocy-normal microcy-normal polychr-normal 04:10pm blood hypochr-normal anisocy-occasional poiklo-normal macrocy-normal microcy-normal polychr-normal 11:47pm blood plt ct-228 04:10pm blood glucose-601* urean-55* creat-2.8*# na-128* k-8.5* cl-97 hco3-15* angap-25* 06:51pm blood alt-25 ast-16 alkphos-63 totbili-0.4 11:47pm blood calcium-8.9 phos-1.7* mg-1.6 04:31pm blood lactate-6.3* labs at the discharge: 09:30am blood wbc-6.3 rbc-3.86* hgb-11.0* hct-33.6* mcv-87 mch-28.6 mchc-32.9 rdw-13.3 plt ct-240 05:20am blood pt-16.5* ptt-34.2 inr(pt)-1.6* 09:30am blood glucose-137* urean-23* creat-1.0 na-138 k-4.3 cl-110* hco3-20* angap-12. cxr: 1. no evidence of acute disease. 2. soft tissue fullness in the aortopulmonary window, probably artifactual or post-operative. however, when clinically appropriate, standard pa and lateral radiographs are recommended with optimal inspiration in order to reassess when possible clinically. correlation with prior radiographs, if available, could also be helpful. ct of the abdomen: 1. no acute intra-abdominal or intrapelvic process detected. specifically, there is no abscess. the appendix is not visualized, however, no secondary signs of appendicitis are detected. 2. markedly enlarged prostate. 3. thickened bladder wall may represent chronic neurogenic bladder but superimposed uti cannot be excluded. 4. nonspecific mild dilation of both ureters, slightly greater on the right, with no evidence of renal, ureteral or bladder calculi, possibly representing chronic obstruction. urine culture (final ): klebsiella pneumoniae. >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 _________________________________________________________ klebsiella pneumoniae | ampicillin/sulbactam-- 4 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-------- 32 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s brief hospital course: 71m w/multiple sclerosis and dm2 presented with urosepsis and dka. # urosepsis: pt has long-term ms leading to neurogenic bladder and a need for constant self-catheterisation and predisposition for the uti. per history patient was catheterizing less frequently with large quantities due to reduced urge. he was briefly septic with elevated lactate and wbc count, and hypotension requiring pressors in the icu. he was initially started on broad spectrum antibiotics including vancomycin and zosyn subsequently changed to vanco, cefepime, and levofloxacin. urine culture eventually gre pansensitive klebsiella pneumonia. he was continued on a 14 day course of ciprofloxacin, last day . pt was educated on methods of reducing risk of uti including frequent catheterization using sterile technique. pt should be self catheterizing at minimum three times a day, but usually more frequently. no more than 400cc urine should be kept in the bladder at any given time. larger quantities of output suggest patient should be catheterizing more frequently (4-5 times daily). he is expected to require some assistance with catheterization at rehab. # diabetes:although the patient is a type 2 diabetic on oral hypoglycemics, on presentation he had positive urine ketones and acidosis with blood glucose in the 600s. although his glucose has been moderately well-controlled on his home regimen, his concurrent sepsis and ensuing inflammatory state may have his blood glucose has been responsive to insulin ss . as his renal function improved, medical team preferred to resume oral hypoglycemic agents, which was preferable to patient also. . # : probably prerenal in origin due to hypotension/urosepsis. creatinine was improved at time of discharge was 1.0. pt was also noted to have hydroureter suggesting post renal pressure and that more frequent catheterization may be indicated. # ms: pt presents with no acute neurological sequelae. his weakness is likely due to his hypotension and sepsis. at time of discharge patient was working with physical therapy, compentent with transfers on board, (reduced from baseline which is standing on transfers). he will require daily physical therapy for strengthening. # h/o dvt/pe: pt was maintained on anticoagulation. inr was subtherapeutic at time of discharge (inr 1.6). warfarin was increased to 5mg daily and will likely need close monitoring in the short term(every other day) until tirated to inr , then again after discontinuation of ciprofloxain on . # depression: patient seemed to be in low mood with increased fixation on certain ideas. for example he was initially very concerned with the idea of starting insulin and became very fixated. later it was regarding self catheterization. this was discussed with dr. . patient had previously been on celexa and seroquel as outpatient. they were held on admission, and continued to be held upon discovery that he had not been compliant with celexa. there was concern seroquel would cause sedation in the acute setting. can be restarted when patient at baseline health. pt was full code during his admission. contact person: wife medications on admission: -ciprofloxacin 500 mg oral tablet take 1 tablet every 12 hours for 5 days -furosemide 20 mg oral tablet take 1 tablet daily -warfarin 2.5 mg oral tablet take 3.75mg for 3 days (tues, thurs, sat), 5mg for 4 days or as directed -metoprolol succinate (toprol xl) 25 mg oral tablet extended release 24 hr 1 tab daily -zolpidem 10 mg oral tablet take 1 tablet at bedtime -simvastatin (zocor) 20 mg oral tablet 1 tablet in the evening every day -glyburide 2.5 mg oral tablet 2 tabs po tid -warfarin 2.5 mg oral tablet take 1 tablet daily or as directed -metformin 500 mg oral tablet 1 tablet tid -fenofibrate micronized 134 mg oral capsule take one every day -enalapril maleate 5 mg oral tablet 1 po qd -finasteride 5 mg oral tablet take 1 tablet daily -nystatin (mycostatin) 100,000 unit/g topical powder use as directed. -calcium carbonate-vit d3-min (caltrate 600+d plus minerals) 600-400 mg-unit oral tablet 1 tab daily -omega-3 fatty acids 1,000 mg oral capsule 1 caps daily -sennosides (senna) 8.6 mg oral tablet 1 tab twice daily -aspirin ec 81 mg tab, delayed release available over the counter -multivitamin capsule po (multivitamins) 1 daily discharge medications: 1. warfarin 5 mg tablet sig: one (1) tablet po once a day. 2. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours): last day . 3. furosemide 20 mg tablet sig: one (1) tablet po once a day. 4. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 5. zolpidem 10 mg tablet sig: one (1) tablet po at bedtime. 6. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 7. enalapril maleate 5 mg tablet sig: one (1) tablet po once a day. 8. finasteride 5 mg tablet sig: one (1) tablet po once a day. 9. nystatin 100,000 unit/g powder sig: one (1) topical once a day. 10. caltrate 600+d plus minerals 600 mg calcium- 400 unit tablet sig: one (1) tablet po once a day. 11. omega-3 fatty acids 1,000 mg capsule sig: one (1) capsule po once a day. 12. sennosides 8.6 mg tablet sig: one (1) tablet po once a day. 13. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 14. multivitamin capsule sig: one (1) capsule po once a day. 15. fenofibrate micronized 134 mg capsule sig: one (1) capsule po once a day. 16. glyburide 5 mg tablet sig: one (1) tablet po three times a day. 17. metformin 500 mg tablet sig: one (1) tablet po tid (3 times a day). discharge disposition: extended care facility: for the aged - macu discharge diagnosis: urosepsis multiple sclerosis acute kidney injury diabets mellitus discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: it was a pleasure to take care of you. you came because of the fever and urinary tract infection. the urine infection was so severe your blood pressure was low and you required icu stay. you were treated with antibiotics and your symptoms improved. while you were in the hospital your blood sugar were also high. this was treated with insulin. you were interested in treatements to prevent a bladder infection. we discussed with the infectious disease team and the urologiest that you should self catheterize your bladder more often. it is importnat that you have no more than 400 cc of urine in your bladder. catheterizing at minimum three times a day. also it is important that the catheter is sterile while doing the procedure. the following changes have been made to your medications: continue ciprofloxacin, last day . followup instructions: please follow up with your primary care doctor this week. she may request that you follow up with urology also. you will need follow up with clinic upon discharge from rehab. department: neurology when: monday at 11:30 am with: , md building: sc clinical ctr campus: east best parking: garage department: podiatry when: tuesday at 10:50 am with: , dpm building: ba ( complex) campus: west best parking: garage procedure: central venous catheter placement with guidance diagnoses: hyperpotassemia acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified unspecified septicemia hyposmolality and/or hyponatremia severe sepsis coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status depressive disorder, not elsewhere classified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other and unspecified hyperlipidemia disorders of phosphorus metabolism long-term (current) use of insulin personal history of venous thrombosis and embolism multiple sclerosis diabetes with ketoacidosis, type ii or unspecified type, uncontrolled neurogenic bladder nos other specified disorders of kidney and ureter hydroureter 

Answer: The patient is high likely exposed to