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: bactrim attending: chief complaint: confusion, elevated creatinine major surgical or invasive procedure: none history of present illness: 69 year old male with a history of htn, hld, prostate cancer s/p turp in , who presents with increasing confusion over last few weeks. per history, patient has had recent scrotal infection treated with ciprofloxacin and bactrim. labs drawn at his pcp's office showed creatinine of 16, wbc 15k. he was seen at at , and was hypotensive on presentation with maps in the 50s, and right ij was placed. patient received 5 liters ivfs before transfer to . potassium was noted to be 6.7, with improvement to 5.2 with fluid administration. his venous ph was 7.14. there was noted scrotal erythema, with no perineal involvement, but an indurated left testicle, for which he was started on vancomycin/cefepime. patient was a daily alcohol drinker for many years, but reportedly has not had a drink in two weeks. . at , initial vs were t 96.4, hr 81, bp 126/49 on levophed, rr 20, sat 100% 2 liters. patient was slow to respond in questioning, aox1-2. there were noted tremors, and patient is a daily alcohol drinker. physical exam showed scrotal erythema with no subcutaneous emphysema, with an indurated and firm left testicle. wbc count was 24k with 97% neutrophils, hematocrit was 31. inr was 1.2. potassium was 5.8, with creatinine 12.9, with bun 181. bicarbonate was 6, with anion gap 26. albumin was 3.3. lipase was 80. serum alcohol level was negative. urology was consulted and did a rectal, with tenderness to palpation of the prostate, concerning for possible prostatitis or abscess. renal was also consulted, and recommended 3 amps nahco3 push, and nahco3/d5w 150 cc/hr for 2-3 liters, with urine lytes and osmolality pending. urine output was 600 cc. clindamycin given for possible fournier's gangrene. urine and blood cultures were sent and are pending. urinalysis was with pyuria, large blood, moderate leukocytes, and moderate bacteria. current vitals are bp 98/48, p 73, sat 97% on 2 liters. access is right ij, 18 g in right hand, 18 g in left forearm. patient has a bair hugger. foley is in place. patient has received two liters at , for a total 7 liters. ct is to be performed, and scrotal ultrasound is ordered. . on arrival to the micu, patient is without pain. he reports no current problems. past medical history: prostate cancer s/p turp hypertension hyperlipidemia (etoh abuse by report) social history: - tobacco: none reported - alcohol: several drinks per day, but reported to have not had a drink in two weeks - illicits: none reported family history: non-contributory physical exam: admission physical exam: vitals: t: 97.3 bp: 104/40 p: 79 r: 22 o2: 97% 2 liters o2 general: alert, oriented x 0-1, no acute distress heent: sclera anicteric, mm dry, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad, ij in place cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley in place, scrotal erythema with area of pustular drainage, no evidence of necrosis or emphysema, left testicle is indurated and tender to palpation, right testicle unremarkable ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: aox3, noted left facial droop, otherwise non-focal neuro exam . discharge physical exam: vitals: 98.8 110/59 70 18 99ra general: alert, laying comfortably in bed, oriented x 2 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: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: scrotal erythema, left testicle is indurated and tender to palpation, right testicle unremarkable; no evidence of drainage, crepitus; foley in place draining clear yellow urine ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: aox3, noted left facial droop, otherwise non-focal neuro exam pertinent results: admission labs: 08:15pm blood wbc-24.8* rbc-3.07* hgb-10.4* hct-31.9* mcv-104* mch-33.8* mchc-32.5 rdw-13.1 plt ct-398 08:15pm blood neuts-97.0* lymphs-1.8* monos-1.0* eos-0.2 baso-0.1 08:15pm blood glucose-127* urean-181* creat-12.9* na-138 k-5.8* cl-106 hco3-6* angap-32* 08:15pm blood albumin-3.3* 02:50am blood calcium-6.8* phos-9.3* mg-2.2 . pertinent 08:15pm blood pt-13.2* ptt-27.3 inr(pt)-1.2* 08:15pm blood alt-25 ast-40 ck(cpk)-161 alkphos-49 totbili-0.2 04:14pm blood ck(cpk)-869* 04:43am blood ck(cpk)-226 08:15pm blood lipase-80* 08:15pm blood ck-mb-7 08:15pm blood ctropnt-0.06* 02:50am blood ck-mb-53* mb indx-9.9* ctropnt-1.63* 08:41am blood ck-mb-90* mb indx-10.4* ctropnt-3.59* 04:43am blood ck-mb-15* mb indx-6.6* ctropnt-2.99* 09:47am blood vitb12-greater than 09:47am blood tsh-0.12* 11:06am blood t4-5.3 t3-56* 08:15pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 08:26pm blood lactate-1.3 08:15pm urine color-straw appear-cloudy sp -1.010 08:15pm urine blood-mod nitrite-neg protein-30 glucose-neg ketone-10 bilirub-neg urobiln-neg ph-5.0 leuks-lg 08:15pm urine rbc-29* wbc->182* bacteri-mod yeast-none epi-0 08:15pm urine casthy-8* 08:15pm urine wbc clm-occ mucous-rare 08:15pm urine eos-negative 10:18pm urine hours-random creat-49 na-94 k-10 cl-74 10:18pm urine osmolal-365 10:18pm urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg 11:15 am rapid plasma reagin test (pending): negative . discharge labs: 05:51am blood wbc-5.4 rbc-2.31* hgb-7.6* hct-23.1* mcv-100* mch-32.7* mchc-32.7 rdw-13.5 plt ct-184 - transfused 1 unit prbcs for above hct 05:51am blood pt-11.7 ptt-27.8 inr(pt)-1.1 05:51am blood glucose-96 urean-17 creat-0.9 na-136 k-3.9 cl-104 hco3-23 angap-13 05:51am blood calcium-8.3* phos-2.7 mg-1.6 . micro 6:00 am blood culture: pending . and urine culture: no growth. . 1:32 am blood culture: no growth. . urine culture (final ): no growth. chlamydia trachomatis, nucleic acid probe, with amplification (final ): negative for chlamydia trachomatis by pcr. . neisseria gonorrhoeae (gc), nucleic acid probe, with amplification (final ): negative for neisseria gonorrhoeae by pcr. . : -> urine culture : final 06/03/12-1027 no growth; blood culture preliminary 06/02/12-1200 no growth to date. . ecg sinus rhythm. qs deflections in leads v1-v3 with t wave inversion suggesting an anteroseptal myocardial infarction, age indeterminate. low qrs voltage in the precordial leads. no previous tracing available for comparison. intervals axes rate pr qrs qt/qtc p qrs t 77 172 80 68 . cxr : there is a right internal jugular catheter projecting into the upper aspect of the right hemithorax. the tip overlies the area of the svc. both lungs are currently clear. there are no obvious effusions. impression: central line projection at the level of the svc. no acute process or significant change seen in either lungs since the last examination. . ct abd & pelvis w/o contrast impression: 1. limited examination. nonspecific diffuse mesenteric and retroperitoneal fat stranding. mild prominence of the pancreatic head could indicate acute pancreatitis. 2. possible sigmoid colitis or mass. recommend colonoscopy after resolution of patient's acute symptoms. 3. scrotal cellulitis and hydroceles, but no drainable fluid or gas. 4. severe atherosclerosis. 5. small pleural effusions and lower lobe aspiration. 6. non-obstructing bilateral renal stones. . echocardiogram the left atrium is mildly dilated. left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with probable mild hypokinesis of the mid to distal anterior septum. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. . impression: suboptimal image quality. probable mild regional left ventricular systolic dysfunction (distal lad disease). no pathologic valvular abnormality. . ct head w/o contrast impression: no evidence of acute intracranial hemorrhage. no evidence of acute major vascular territory infarction. please note that mri is more sensitive for the detection of acute infarction and should be considered in the correct clinical setting. . scrotal u.s.; duplex dop abd/pel limited the right testis measures 2.6 x 3.2 x 4.0 cm and is of normal echogenicity. it has normal vascular flow. the right epididymis is unremarkable. the left testis measures 3.1 x 3.0 x 4.0 cm and has normal echogenicity; however, has markedly increased vascular flow throughout as well as increased vascular flow in the epididymis. there is also a small left mildly complex hydrocele. no intratesticular masses are identified however non-shadowing calcification are noted in the left. . impression: marked hyperemia of the left testis and epididymis consistent with orchitis/epididymitis. . renal u.s. findings: the right kidney measures 12.6 cm. the left kidney measures 11.9 cm. there is no evidence of hydronephrosis, renal masses, or nephrolithiasis. there is no perirenal fluid. a foley is present within the bladder. the bladder is collapsed. impression: no evidence of hydronephrosis, renal masses, or nephrolithiasis. . cxr : a right upper extremity picc is in place with its tip just beyond the level of the cavoatrial junction. this might be withdrawn 3 cm to ensure a lower svc location. a right ij central venous catheter is unchanged in appearance with its tip in the mid svc. the lungs are notable for left basilar opacity, likely atelectasis. there are probable small bilateral effusions, which could be confirmed with a lateral view. the cardiac silhouette is normal in size, the mediastinal contours are normal. there is no pneumothorax. . prostate ultrasound : the prostate is of normal size, measuring 3.1 x 3.1 x 4.4 cm, with a calculated volume of 22 cc and a predicted psa of 2.65. small right-sided calcifications are seen. no masses or nodules are otherwise present within the prostate. the seminal vesicles are normal. a foley is seen within the bladder. brief hospital course: 69 year old man with a history of prostate cancer s/p turp in who presented with increasing confusion, acute kidney injury, leukocytosis, found to be in septic shock secondary epididymo-orchitis. patient was initially cared for in the icu for a 5 day course. his course was complicated by , nstemi, and delirium. . # sepsis due to epididymo-orchitis: patient s/p turp approximately 4 weeks prior to presentation complicated by a scrotal infection treated with ciprofloxacin/bactrim. patient presented with increasing confusion, leukocytosis and hypotension, consistent with sepsis. exam revealed erythematous and indurated left scrotum. urology evaluated the patient and did not feel there were signs of necrotizing fasciitis. ultrasound revealed changes suggestive of epididimoorchitis. patient was treated with vancomycin/cefepime/clindamycin. patient initially required levophed but was weaned off within 48 hours. urine cultures ultimately unyielding. gc and chlamydia pcrs were negative. id was consulted regarding full course of treatment and recommended continuing cefepime and vancomycin iv for a 21 day course. clindamycin was discontinued on . repeat prostate ultrasound was unremarkable. the patient will complete his course of antibiotics on . # acute kidney injury/ainb with frank hematuria: patient presented with creatinine of 12. renal failure likely secondary to atn in the setting of septic shock, and ain from bactrim (prescribed as outpatient). there was also concern for some component of obstructive uropathy with some evidence of retention on placement of foley. renal ultrasound revealed no hydronephrosis. patient did not require dialysis. his creatinine improved rapidly with fluid administration. the patient developed a post-atn diuresis with significant urine output requiring close monitoring and aggressive volume repletion. creatinine improved to 1.0 on day of discharge. he continued to suffer from urinary retention, with an inflamed prostate. a 3-way catheter was placed for urinary retention the day prior to discharge and drained dark red urine (merlot in color). urine cleared almost immediately without further intervention (urine light yellow at time of discharge). he required 1 unit rbcs. the patient should keep foley catheter in place until follow up with urology in 2 weeks. repeat creatinine should be drawn in rehab on . nstemi: on , the patient had an nstemi with peak troponin 5.5 in the setting of renal failure due to increased cardiac stress and hypotension from sepsis. cardiology was consulted and recommended a heparin drip x 48 hours. patient was continued on asa, plavix, statin. he was started on metoprolol. his cardiac enzymes down-trended, and the patient remained stable from a cardiovascular standpoint for the remainder of admission. due to hematuria the day prior to discharge, plavix was held for 5 days. the patient should resume plavix 75 mg po daily on . the patient was transfused 1 unit prbcs prior to discharge for anemia to decrease stress on heart. acute encephalopathy: patient with waxing and mental status, agitation, pulling at venous access lines during admission to icu. he was intermittently oriented to person/place/time. patient with numerous risk factors for delirium, including age, sepsis, uremia, history of stroke, etoh abuse, electrolyte abnormalities, and icu environment. patient was initially treated with escalating doses of haldol and zyprexa; however these medications were unsuccessful. seroquel standing and prn doses provided some benefit. on transfer to the floor, with resolution of acute kidney injury and improvement in infection the patient's delirium began to clear. at time of discharge, he was alert, oriented x 2, and pleasant, without agitation. he no longer required seroquel. the patient was discharged on trazodone 25 mg qhs as needed for insomnia to help with day/night reversal. # etoh abuse/dependence: patient is a reported daily alcohol drinker, but with negative serum alcohol level. this history was unclear at the time of presentation and patient was not placed on ciwa protocol on admission. he was started on folate, thiamine, and a multivitamin. the patient should avoid alcohol intake in the future. # hypertension: initially held antihypertensives in setting of acute kidney injury and hypotension. he was started on metoprolol 12.5 mg in the setting of nstemi. the patient's metoprolol was continued at discharge. enalapril and hydrochlorothiazide were held at discharge. the patient should discuss resuming these medications with his pcp as an outpatient. # hyperlipidemia: chronic. the patient was continued on home atorvastatin. # possible colon mass: incidental finding on ct scan during initial work up. unclear if actually a mass or not. recommend colonoscopy once acute issues stabilize to exclude malignancy. ============================================= transition of care issues - the patient should follow up with cardiology and urology as scheduled - patient with 3-way foley catheter placed day prior to discharge (). foley draining clear yellow urine on day of discharge. foley should remain in place until patient follows up with urology, as he has history of urinary retention s/p turp. - picc line placed in anticipation of prolonged course of antibiotics. the patient should continue iv vancomycin and cefepime until . - please check creatinine, cbc, vancomycin trough on . - patient to undergo physical therapy at rehab - please start plavix 75 mg daily on () - colonoscopy once medically stable to exclude underlying colon cancer medications on admission: atorvastatin 80 mg po qhs enalapril 20 mg po daily clopidogrel 75 mg po daily hydrochlorothiazide 25 mg po daily finasteride 5 mg po dailyi ciprofloxacin 500 mg po bid trimethoprim-sulfamethoxazole 800 mg-160 mg po bid mentax 1% topical cream discharge medications: 1. atorvastatin 80 mg po hs 2. aspirin 81 mg po daily 3. cefepime 2 g iv q12h 4. vancomycin 1000 mg iv q 12h 5. docusate sodium 100 mg po bid 6. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 7. metoprolol tartrate 12.5 mg po bid hold for sbp<100, hr<60 8. multivitamins 1 tab po daily 9. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 10. thiamine 100 mg po daily 11. trazodone 25 mg po hs:prn insomnia 12. folic acid 1 mg po daily 13. tamsulosin 0.4 mg po hs 14. finasteride 5 mg po daily 15. clopidogrel 75 mg po daily please start on !! 16. senna 1 tab po bid:prn constipation discharge disposition: extended care facility: nursing & rehabilitation center - discharge diagnosis: septic orchitis acute interstitial nephritis non-st elevation myocardial infarction delirium discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , . you were admitted to the hospital with a severe infection of your left testicle, confusion, and renal failure. you were treated with antibiotics for your testicular infection, and it improved. you will remain on 8 more days of iv antibiotics while you are at rehab. you should follow up with urology regarding the infection as scheduled below. . your renal failure was likely due to your severe infection and an allergic reaction to a medication used to treat your testicular infection before you came to the hospital (bactrim). the medication was stopped, and your renal function improved to normal. please add bactrim to your allergy list. . while you were in the icu, your infection caused enough strain on your heart to have a small heart attack. you should continue aspirin, metoprolol, and atorvastatin. your plavix was stopped at discharge. please restart your plavix 75 mg daily on . followup has been arranged with your cardiologist as below. . you did have significant confusion for much of your hospital stay. this was likely due to a combination of the severe infection, renal failure and being in a new unfamiliar place. as your infection and renal function improved, your thinking cleared. . you did have urinary retention and blood in your urine prior to discharge. you should stop your plavix for 5 days, and restart it on to help prevent more bleeding. you should keep your foley catheter in place until you follow up with urology in 2 weeks. . several of your home medications were changed this hospital admission: start cefepime 2gm iv every 12 hours for 8 days (stop ) start vancomycin 1gm iv every 12 hours for 8 days (stop ) start aspirin 81 mg daily start metoprolol 12.5 mg twice a day start folic acid 1gram daily start thiamine 100 mg daily start a daily multivitamin start tamsulosin 0.4 mg daily start trazodone as needed for insomnia start plavix 75 mg daily on stop enalapril until further instructed by your pcp stop hydrochlorothiazide until further instructed by your pcp stop ciprofloxacin stop trimethoprim-sulfamethoxazole. please add this medication to your home allergy list. followup instructions: please follow up with your primary care physician on from rehab: , a. . scheduled appointments: . department: cardiac services when: monday at 3:20 pm with: , md building: sc clinical ctr campus: east best parking: garage . department: surgical specialties when: monday at 1:30 pm with: , md building: campus: east best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: acidosis subendocardial infarction, initial episode of care acute kidney failure, unspecified unspecified septicemia severe sepsis personal history of malignant neoplasm of prostate alcohol abuse, unspecified other and unspecified hyperlipidemia septic shock acute glomerulonephritis with other specified pathological lesion in kidney other encephalopathy hematuria, unspecified delirium due to conditions classified elsewhere other specified retention of urine benign essential hypertension orchitis and epididymitis, unspecified 

Answer: The patient is high likely exposed to