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 / aspirin attending: chief complaint: altered mental status major surgical or invasive procedure: nasogastric tube placement history of present illness: ms. is an 88 year old woman with a past medical history significant for breast cancer, dementia (unknown etiology), coronary artery disease,chronic anemia, atrial fibrillation, and congestive heart failure who presented on with nausea, vomiting, abdominal pain and increased confusion at her nursing home. in the ed, she had a fever to 104.8, blood pressure 63/37, wbc 40, and was given vanco/flagyl/ceftriaxone per the must protocol. for hemodynamic instability, the patient was transferred to the micu and required pressors for a period of time (levophed until , dobutamine until , and xigres until ) and had a nasogastric tube endoscopically placed due to hiatal hernia. she was found to have sepsis from a urinary source with 4/4 sets of blood cultures and urine culture positive for e.coli. she was started on iv ceftriaxone in the micu. chest x ray at the time was negative. she did not receive the sinemet for her parkinson's while in the micu and was increasingly rigid while there. past medical history: parkinson's disease breast cancer coronary artery disease dementia s/p splenectomy social history: lives at nursing home. grandson and daughter involved in her care. family history: non contributory physical exam: weight=162 in bed (8 pound loss since admission) tc 97.8 tm 98.3 bp 129/64;115-129/60-64 hr 60 rr 20 o2 100% ra gen: nad, awake, oriented to self. heent anicteric, mucous membranes moist and intact, oropharynx clear neck supple without adenopathy. no jugular venous distention. lungs clear to auscultation bilaterally cv regular rate and rhythm with normal s1 and s2 without murmurs, rubs, or gallops. abd soft, nontentder, nondistended, normoactive bowel sounds, no masses. ext: right upper extremity edematous. bilateral lower extremity pitting edema + at ankles. pedal pulses + neuro: alert, oriented to self, seldomly moves extremitie, little spontaneous speech, answers appropriately but sparsely or answers "i don't know" to questions, + cogwheel rigidity in the upper extremites more than the lower extremities. pertinent results: 06:25am blood wbc-7.0 rbc-3.63* hgb-10.2* hct-32.0* mcv-88 mch-28.1 mchc-31.8 rdw-16.8* plt ct-362 06:25am blood glucose-81 urean-9 creat-0.5 na-142 k-3.9 cl-104 hco3-28 angap-1409/06/04 10:52am blood calcium-8.8 phos-3.5 mg-1.6 08:32pm urine color-yellow appear-clear sp -1.015 nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-sm rbc-5* wbc-6* bacteri-few yeast-none epi-<1 caoxalx-rare amorphx-occ mucous-rare 8:32 pm urine culture (final ): no growth. urine culture (final ): escherichia coli. 10,000-100,000 organisms/ml.. gram positive rods. >100,000 organisms/ml.. unable to identify further. ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s gentamicin------------ <=1 s levofloxacin----------<=0.25 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s 1:00 pm blood culture aerobic bottle (final ): no growth. anaerobic bottle (final ): no growth. 3:58 pm blood culture aerobic bottle (final ): escherichia coli. ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s gentamicin------------ <=1 s levofloxacin----------<=0.25 s meropenem-------------<=0.25 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s anaerobic bottle (final ): escherichia coli (sensitivities from aerobic bottle). proteus mirabilis sensitivities: ampicillin------------ =>32 r ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ <=1 s gentamicin------------ 4 s levofloxacin---------- 1 s meropenem-------------<=0.25 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ 2 s trimethoprim/sulfa---- <=1 s head ct w/o contrast: no evidence of acute intracranial hemorrhage or mass effect. please note that mri/mra with diffusion weighted imaging would be more sensitive in evaluating for early infarction. right upper extremity venous doppler u/s: no right upper extremity venous thrombosis. echocardiogram: the left atrium is dilated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>50%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but not stenotic. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. the tricuspid regurgitation jet is eccentric and may be underestimated. there is a moderate sized pericardial effusion. there are no echocardiographic signs of tamponade. no right atrial diastolic collapse is seen. compared with the findings of the prior report (tape unavailable for review)of , mitral and tricuspid regurgitation are now evident. abdominal ct w/wo contrast: 1) large pericardial effusion. 2) diverticulosis without diverticulitis. brief hospital course: ms. is an 88 year old female with history of parkinson's disease and associated dementia, also chf, breast cancer, atrial fibrillation, who presented to the micu where she was treated for urosepsis. she has history of dysphagia and aspiration risk requiring nectar thickened liquids at her nursing home and had worsened dysphagia this admission with likely aspiration pneumonia. her mental status and dysphagia have improved over the hospital course as the patient's infection resolved and she was restarted on medical therapy for parkinson's disease. at discharge, she has no signs or symptoms of infection and appears to be at baseline mental status and swallowing ability of nectar thickened liquids is intact. aspiration pneumonia: the patient developed a low grade temperature and leukocytosis that was likely the result of aspiration pneumonia in setting of tube feedings. the patient has been afebrile without increased wbcs for several days and has one day left on a course of flagyl 250mg daily. aspiration precautions and careful feeding per recommendations may help prevent future aspiration. the head of the bed should remain elevated above 30 degrees at all times. because the patient's swallowing function is compromised, she is at risk for repeat aspiration. urosepsis: urine and blood cultures 8/23 were positive for pan-sensitive e.coli and proteus that was resistant to ampicillin. the patient completed a two week course of iv ceftriaxone. surveillance urine and blood cultures have subsequently been negative. avoiding foley catheter use is recommended if possible to decrease risk of future urinary tract infection. decreased mental status: in general, the patient's mental status waxed and waned during the hospital course but was overall improved at discharge. reasons for the temporary decreased mental status are multifactorial; she has underlying dementia, parkinson's disease that was briefly untreatable while in the icu, and had a component of infection-induced delirium. now she appears to be at baseline mental status, speaking and eating as she previously had been before admission per report by the nursing home. neurology service was consulted to aid in this evaluation. stroke unlikely since lacking clinical signs or evidence on ct scan. carotid u/s showed mild stenosis less than 40% bilaterally. the patient will continue taking sinimet for parkinson's and was started on enteric coated aspirin 81mg with protonix for stroke prophylaxis. parkinson's disease: this is likely a major contributor to dysphagia since parkinson's patients tend to hold food in their mouths a long time before swallowing. per neurology consult recommendations, the patient's dose of carbidopa/levodopa was decreased to 25/100mg orally tid (rather than qid which she was taking before). the patient continues to have cogwheel rigidity in the upper extremitis more than the lower extremitis and masked facies. her swallowing function has improved. dysphagia: contributors include dementia, h/o infection, and parkinson's. the day prior to discharge, a repeat swallow study was passed for nectar thickened liquids, which is what she was eating prior to admission. this is improved from last week when the swallow study was failed. she has tolerated nectar thickened liquids and some pureed food since when the ng tube was removed. use of free water protocol was recommended and will be provided at discharge. again, aspiration precautions are important. congestive heart failure: while there was no clear history of chf, the patient had a slight increase in perihilar opacities on chest xray and had episodes of increased work of breathing with accessory muscle use that subsided after administration of lasix. her home dose of oral lasix was continued whild following oxygen saturation, daily weight, and urine output. h/o atrial fibrillation: at discharge the patient is in normal sinus rhythm off diltiazem. her brief run of atrial fibrillation in the icu most likely secondary to urosepsis that has since resolved. transthoracic echocardiogram on showed no thrombus or vegetations. for dvt prophylaxis, use of subcutaneous heparin injections is recommended. at discharge, the patient is well appearing with good laboratory values. she is afebrile and continues to be alert, responding appropriately with short responses to some questions ("how are you?" "what's your name?"). she continues to do well with thickened necatar oral feeding. during the hospital visit, the patient's grandson and daughter were updated in person or by telephone. medications on admission: ranitidine lasix ditropan iron supplement multivitamin colace dulcolax actonel tamoxifen celebrex diltiazem senna lactulose carbidopa/levodopa discharge medications: 1. insulin regular human 100 unit/ml solution sig: per sliding scale injection asdir (as directed). 2. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours) as needed. 3. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 4. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 5. acetaminophen 160 mg/5 ml elixir sig: 650mg po q4-6h (every 4 to 6 hours) as needed. 6. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 7. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed. 8. senna 8.8 mg/5 ml syrup sig: one (1) tablet po bid (2 times a day) as needed. 9. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day) as needed. 10. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po tid (3 times a day). 11. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po qd (once a day). tablet, delayed release (e.c.)(s) 12. furosemide 20 mg tablet sig: one (1) tablet po qd (once a day). 13. flagyl 250 mg tablet sig: one (1) tablet po once a day for 1 days. 14. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 15. multivitamins oral 16. iron oral 17. ditropan xl 5 mg tab, sust release osmotic push sig: one (1) tab, sust release osmotic push po once a day. 18. actonel 30 mg tablet sig: one (1) tablet po once a week. 19. lactulose oral 20. dulcolax oral 21. colace oral 22. tamoxifen citrate 10 mg tablet sig: one (1) tablet po twice a day. discharge disposition: extended care facility: - discharge diagnosis: urosepsis urinary tract infection aspiration pneumonia breast cancer coronary artery disease dementia s/p splenectomy discharge condition: good; hemodynamically stable; no respiratory distress discharge instructions: please take all medicines as prescribed. followup instructions: please follow up with your regular doctor. procedure: other endoscopy of small intestine enteral infusion of concentrated nutritional substances insertion of other (naso-)gastric tube infusion of drotrecogin alfa (activated) diagnoses: thrombocytopenia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified severe sepsis atrial fibrillation pneumonitis due to inhalation of food or vomitus septic shock septicemia due to escherichia coli [e. coli] 

Answer: The patient is high likely exposed to