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 attending: chief complaint: pt. returned to 5 days after being treated at for hematuria and conservative management of a small bladder perforation from previous episode of fulgaration. pt. presented with hypotension, abdominal distension, and suspicion of pneumonia. major surgical or invasive procedure: - placement of central line in 1)right groin 2)left subclavian - s/p open cystotomy with bladder repair - placement of malecott supra pubic tube history of present illness: 77 y/o m with history of cap that underwent radiation therapy 5 years ago. pt. then with three episodes of hematuria and clot retention over past several months, two episodes managed at and one managed by the patient's primary urologist. pt. underwent fulgaration and cystoscopy by primary urologist prior to presenting to . on his second admission for hematuria pt. underwent a cystoscopy and it was noticed that he had a small bladder perforation. a retrograde cystogram was done and indicated that the perf was not intraperitoneal. pt. was managed expectantly, hematuria decreased, and pt. was sent home with a foley. pt. returned this admission with hypotesion, abdominal distention, and chest xr suspicious for pneumonia. past medical history: 1. moderately differentiated prostatic adenocarcinoma of the prostate, grade 3-4/5 of the left lobe s/p external beam radiation ' 2. s/p urethotomy for membranous urethral stricture ' 3. htn 4. niddm 5. s/p left hip hemiarthroplasty ' 6. s/p right knee surgery social history: married and lives at home very involved family family history: non-contrib physical exam: vitals: 96.8 59 103/59 20 94%ra wd, wn, nad ctab, no w/c/r rrr, no m/r/g soft, non-distended, non-tender, clean /dressing in place over incision site supra pubic tube and foley inplace - urine very light pink in color with cbi off with no clotting noted bilateral lower extremities and scrotal area with minimal edema pertinent results: 07:30am blood wbc-6.1 rbc-2.88* hgb-9.2* hct-26.4* mcv-92 mch-31.8 mchc-34.6 rdw-19.2* plt ct-205 01:56am blood wbc-7.2 rbc-3.44* hgb-10.5* hct-31.8* mcv-92 mch-30.6 mchc-33.1 rdw-16.3* plt ct-187 05:50am blood wbc-7.8 rbc-3.24* hgb-10.2* hct-29.5* mcv-91 mch-31.6 mchc-34.7 rdw-17.9* plt ct-221 05:40am blood wbc-9.0 rbc-3.58* hgb-10.9* hct-32.4* mcv-90 mch-30.5 mchc-33.8 rdw-16.0* plt ct-224 05:52am blood wbc-8.1 rbc-3.59* hgb-10.8* hct-32.6* mcv-91 mch-30.3 mchc-33.3 rdw-15.8* plt ct-243 05:34am blood wbc-8.5 rbc-3.64* hgb-11.4* hct-32.8* mcv-90 mch-31.3 mchc-34.7 rdw-16.6* plt ct-254 05:11am blood wbc-9.0 rbc-3.63* hgb-11.3* hct-33.0* mcv-91 mch-31.1 mchc-34.1 rdw-15.2 plt ct-226 01:54am blood wbc-10.9 rbc-3.78* hgb-11.6* hct-32.7* mcv-87 mch-30.6 mchc-35.4* rdw-15.5 plt ct-244 08:00am blood hct-33.9* 12:49am blood hct-31.1* 09:03pm blood hct-32.7* 05:39pm blood wbc-12.2* rbc-3.76*# hgb-11.6* hct-33.0*# mcv-88 mch-30.7 mchc-35.0 rdw-15.7* plt ct-179 04:48am blood wbc-12.7* rbc-3.20* hgb-9.8* hct-28.8* mcv-90 mch-30.7 mchc-34.1 rdw-16.2* plt ct-191 05:34am blood wbc-16.8* rbc-3.49* hgb-10.6* hct-30.7* mcv-88 mch-30.5 mchc-34.7 rdw-16.2* plt ct-171 06:35am blood wbc-15.0* rbc-3.16* hgb-10.2* hct-27.4* mcv-87 mch-32.3* mchc-37.3* rdw-16.5* plt ct-182 10:25pm blood wbc-12.7* rbc-3.81* hgb-11.6* hct-32.7* mcv-86 mch-30.6 mchc-35.6* rdw-16.3* plt ct-228 05:34am blood neuts-89.8* bands-0 lymphs-7.6* monos-2.2 eos-0.3 baso-0 06:35am blood neuts-71* bands-15* lymphs-7* monos-5 eos-0 baso-0 atyps-0 metas-1* myelos-1* 10:25pm blood neuts-53 bands-35* lymphs-10* monos-2 eos-0 baso-0 atyps-0 metas-0 myelos-0 05:34am blood hypochr-normal anisocy-occasional poiklo-normal macrocy-normal microcy-occasional polychr-normal 06:35am blood hypochr-normal anisocy-normal poiklo-1+ macrocy-normal microcy-normal polychr-normal ovalocy-occasional burr-occasional 10:25pm blood hypochr-normal anisocy-1+ poiklo-normal macrocy-normal microcy-1+ polychr-normal 07:30am blood plt ct-205 01:56am blood plt ct-187 05:50am blood plt ct-221 05:36am blood plt ct-263 05:34am blood plt ct-254 05:11am blood plt ct-226 01:54am blood plt ct-244 01:54am blood pt-13.6* ptt-33.0 inr(pt)-1.2 03:00am blood plt ct-224 02:48am blood plt ct-187 05:39pm blood plt ct-179 10:42am blood plt ct-182 03:31pm blood pt-13.4* ptt-42.9* inr(pt)-1.2 04:48am blood plt ct-191 11:26am blood pt-14.5* ptt-36.8* inr(pt)-1.4 05:34am blood plt smr-normal plt ct-171 06:35am blood plt smr-normal plt ct-182 10:25pm blood plt smr-normal plt ct-228 01:56am blood glucose-129* urean-11 creat-0.8 na-138 k-4.0 cl-103 hco3-27 angap-12 03:30pm blood k-4.1 05:50am blood urean-11 creat-0.7 05:40am blood glucose-118* urean-12 creat-0.7 na-137 k-3.9 cl-104 hco3-27 angap-10 05:52am blood glucose-102 urean-16 creat-0.8 na-137 k-3.9 cl-105 hco3-26 angap-10 05:36am blood glucose-135* urean-17 creat-0.7 na-136 k-3.9 cl-106 hco3-23 angap-11 04:18pm blood k-4.4 03:02pm blood urean-16 creat-0.6 k-3.8 05:34am blood glucose-123* urean-16 creat-0.6 na-135 k-4.1 cl-108 hco3-22 angap-9 02:39pm blood urean-16 creat-0.7 k-4.4 05:11am blood glucose-116* urean-17 creat-0.7 na-134 k-4.8 cl-109* hco3-19* angap-11 01:54am blood glucose-119* urean-13 creat-0.6 na-133 k-4.2 cl-108 hco3-17* angap-12 03:00am blood glucose-123* urean-11 creat-0.7 na-132* k-4.5 cl-109* hco3-18* angap-10 08:00am blood glucose-125* urean-13 creat-0.7 na-131* k-4.4 cl-106 hco3-18* angap-11 05:39pm blood glucose-128* urean-13 creat-0.7 na-131* k-4.3 cl-104 hco3-20* angap-11 10:42am blood glucose-140* urean-15 creat-0.7 na-128* k-4.1 cl-104 hco3-19* angap-9 05:34am blood glucose-140* urean-24* creat-1.3* na-129* k-4.9 cl-102 hco3-17* angap-15 10:25pm blood alt-18 ast-32 ck(cpk)-70 alkphos-141* amylase-19 totbili-0.8 10:25pm blood lipase-13 06:35am blood ck-mb-4 ctropnt-<0.01 10:25pm blood ck-mb-notdone ctropnt-<0.01 07:30am blood calcium-7.5* phos-2.9 mg-1.6 05:50am blood albumin-2.4* calcium-7.5* phos-2.5* mg-1.8 iron-25* 05:40am blood mg-1.9 05:52am blood mg-1.5* 05:36am blood mg-1.7 04:18pm blood mg-1.9 10:39am blood mg-1.9 08:00am blood albumin-1.8* calcium-7.6* phos-2.8 mg-3.0* 02:48am blood calcium-6.7* phos-2.8 mg-1.9 10:42am blood calcium-6.5* phos-3.1 mg-1.6 04:48am blood calcium-7.4* phos-3.1 mg-1.9 cholest-55 06:35am blood calcium-7.3* phos-4.6*# mg-1.5* 10:25pm blood albumin-2.6* 05:50am blood caltibc-147* ferritn-102 trf-113* 04:48am blood triglyc-58 hdl-21 chol/hd-2.6 ldlcalc-22 04:48am blood osmolal-271* 10:25pm blood holdblu-hold 10:25pm blood redhold-hold 05:50am blood prealbumin-test chest (pa & lat) 10:43 pm pa and lateral chest radiographs: there is atelectasis at the right lung base. there is mild prominence of the pulmonary vasculature, likely from poor inspiratory effort. the cardiac and mediastinal contours are stable in appearance. no pneumothorax is seen. no pleural effusion is seen. on the lateral image only, there is an opacity, which is slightly obscured secondary to blurring. the soft tissue and osseous structures are stable. impression: opacity on the lateral film in the costophrenic angle, possibly representing a pneumonia. the study and the report were reviewed by the staff radiologist. dr. dr. . ct pelvis w&w/o c 11:14 pm impression: 1. interval development of a large amount of ascites. 2. there is no evidence of hydronephrosis or asymmetric renal cortical enhancement. 3. several hypodensities are again seen within the kidney, which are too small to characterize. 4. opacities within the lung bases are consolidative in appearance and may represent a pneumonic process - clinical correlation is recommended. the study and the report were reviewed by the staff radiologist. dr. dr. cardiology report echo study date of patient/test information: indication: left ventricular function. height: (in) 65 weight (lb): 201 bsa (m2): 1.98 m2 bp (mm hg): 120/60 hr (bpm): 92 status: inpatient date/time: at 15:03 test: tte (complete) doppler: full doppler and color doppler contrast: none tape number: 2005w506-0:46 test location: west echo lab technical quality: adequate referring doctor: dr. measurements: left atrium - four chamber length: 5.2 cm (nl <= 5.2 cm) right atrium - four chamber length: 4.4 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: 0.9 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: 1.0 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 4.8 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 2.9 cm left ventricle - fractional shortening: 0.40 (nl >= 0.29) left ventricle - ejection fraction: >= 70% (nl >=55%) aorta - valve level: 2.8 cm (nl <= 3.6 cm) aortic valve - peak velocity: 1.9 m/sec (nl <= 2.0 m/sec) mitral valve - e wave: 0.7 m/sec mitral valve - a wave: 1.0 m/sec mitral valve - e/a ratio: 0.70 mitral valve - e wave deceleration time: 175 msec tr gradient (+ ra = pasp): 18 mm hg (nl <= 25 mm hg) interpretation: findings: left atrium: mild la enlargement. right atrium/interatrial septum: normal ra size. left ventricle: normal lv wall thickness, cavity size, and systolic function (lvef>55%). normal regional lv systolic function. right ventricle: normal rv chamber size and free wall motion. aortic valve: normal aortic valve leaflets (3). no as. no ar. mitral valve: normal mitral valve leaflets with trivial mr. mild mitral annular calcification. lv inflow pattern c/w impaired relaxation. tricuspid valve: normal tricuspid valve leaflets with trivial tr. pericardium: no pericardial effusion. conclusions: 1. the left atrium is mildly dilated. 2. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. electronically signed by , md on 15:16. physician: , . ct pelvis w/o contrast 1:02 pm ct pelvis w/o contrast; ct reconstruction reason: ct cystolgram for extravasation of urine medical condition: 77 year old man h/o prostate ca s/p xrt with subsequent hemorrhagic cystitis c/b bladder perforation (old?) now p/w abdominal pain, new ascities with wbc > cr 1.8 growing ecoli. reason for this examination: ct cystolgram for extravasation of urine contraindications for iv contrast: none. procedure: pelvic ct with ct cystogram. indication: 77-year-old man with history of prostate cancer, s/p xrt with subsequent hemorrhagic cystitis. h/o bladder perforation with new ascites and abdominal pain. assess extravasation of urine. impression: 1. bladder wall perforation in the right anterolateral aspect with free extravasation of the contrast media through the peritoneal cavity. 2. diverticulosis. the findings were discussed with dr. at the moment of the interpretation of the study (6 p.m.) brief hospital course: cc: hpi: mr. is a 77 year-old spanish speaking male with a history of prostate cancer s/p prostate irradiation in , and status post urethromtomy for a urethral stricture in , followed by an outside urologist. over the past few months, he has had recurrent gross hematuria, and underwent a cystoscopy about a month ago with fulguration. he was recently admitted in and again last week for similar complaints. during his most recent admission, he underwent a cystoscopy with clot evacuation, fulguration of the bladder mucose, and was found to have a right lateral wall bladder perforation (likely old injury), treated conservatively with foley drainage and abx. while in hospital, he required 4 units of prbcs for anemia. he was discharged on with a foley and on ciprofloxacin. he reports that he had residual hematuria at the time of discharge. this morning, he woke up to find his foley bag filled, with worse hematuria and a few clots. he was seen by dr. in the clinic today, who irrigated his foley without difficulty. during the day, however, the patient reports decreased urine output. he was seen by his vna nurse, and was found to have a low bp 80/60 (baseline 120/60). she advised him to go to the ed. he endorses abdominal pain, which he has had for >1 week, lower abdominal in location, non-radiating, constant. no n/v. no change in bm. at home, his daughter reports that he also had shortness of breath, and chills. no fever (measured temperature). no chest pain. + cough since discharged from the hospital, largely non-productive. + dizziness with standing. reportedly poor po intake over the past days. in ed, t98.9, hr 119, bp 100/49, rr 20, sat 96% on ra. ekg with new st depression in i and avl. cxr suspicious for pneumonia. he was seen by urology. irrigation of the foley was done without difficulty. he was given one dose of levofloxacin, asa 325, and hydrated. ekg in ed: nsr, rate 88 bpm, lad. lvh by voltage criteria. rbbb (old), mild qt prolongation. downsloping sts with twi in i, avl, v2. no qs. st-t changes new versus . relevant imaging data: cxr: opacity on the lateral film in the costophrenic angle, concerning for pneumonia. assessment and plan: 77 year-old spanish male, with a h/o prostate ca s/p external beam radiation, s/p urethrotomy for stricture, with h/o hematuria s/p recent clot evacuation, now with decreased uo and abdominal pain, arf, and pneumonia. 1) hemorrhagic cystitis: seen by urology in the ed, appreciate input. no indication for 3-way foley or cbi. recommendation to continue foley drainage, continue fluoroquinolone therapy (will change to levofloxacin to cover for both urinary and respiratory organisms). no evidence of clot obstruction. - levofloxacin 500 mg po qd - urology following. continue foley drainage. - pt. had paracentesis on from which his fluid showed a cr. of 1.8. the pt. went for a ct cystogram the next day that showed extravasation of contrast fluid into the peritoneal cavity. the pt. remained stable otherwise and or time was arranged to repair the bladder perforation. on the patient was taken to the or for formal exploration and repair. the pt. tolerated the procedure well and remained in the pacu overnight where he received extensive hydration and two units of prbcs. because we were unable to exutbate the patient he spent the next three days in the sicu slowly being weaned from the vent. three days later he extubated without difficulty and was transferred to the floor. the pt. slowly recovered on the floor. he was continued on antibiotics for a total of 10 days, gradually began eating a regular diet, slowly weaned off of supplemental o2, and gained strength over the next two weeks. pt. worked with physical therapy was seen by nutrition and had is urine output watched closely. the pt. had staples removed from the cephalad portion of his incision on pod 10 and subsequently the incision opened up. there was no evidence of infection and the wound is now requiring tid wet to dry dressing changes as it will close by secondary inteniton. the foley and spt remain in place and the pt. urine continues to be red. if the tubes appear to be clogging or collecting a significant amount of clots the pt. has been put back on cbi intermittently. pod 14 the foley catheter became clogged and after attempted flushing and removal of a significant amount of clots the foley was taken out. it was replaced by a new 20 french two way foley and the urine immediately became much more clear. pod 19 the pt. was kept off of cbi with his urine continuing to be light pink in color. the remainder of his staples were also removed on pod 19. the pt. had received two units of prbcs the day before for a hct of 24 and bumped to 31 and was feeling much better. however, while giving the first unit of blood the pt. felt short of breath. he received an additional dose of iv lasix and his shortness of breath resolved. with the second unit of blood the pt. was given lasix both pre- and post-doses without complication. pt. bleeding appears to have tapered and the pt. is ready for discharge to rehab. 2) abdominal pain: etiology unclear until ct cystogram performed and bladder perforation confirmed. much improved after repair and no return of ascites. 3) bandemia: infectious work-up to date remarkable for probable pneumonia on cxr. pt. was started on levoquin initially and switched to aztreonam per id recommendations. he completed a 10 day course of antibiotics because of the gn organisms seen in the peritoneal tap and to treat the questionable pneumonia. pt. is currently not requiring antibiotic therapy. 4) cv: ekg with new st depressions in i, avl in setting of relative hypotension. bp responding to ivf. suspect low bp dehydration in setting of poor po intake, continued lisinopril and hctz. pt. ruled out for mi. blood pressure continues to run lower that pre-admission. he has been maintained on lopressor 25 as blood pressures permit. are considering restarting other antihypertensive medications as his recovery continues. 5) dm type 2: hold metformin and glipizide for now. while in the hospital the pt. has been maintained on a riss requiring between 4-10 units per day. considering restarting antidiabetic medications as the pt. appetite returns and his eating habits return to normal. 6) lower extremity edema - pt. post-surgery and resuscitation has been placed on a standing order of lasix. this has helped with decreasing his fluid load over the past week, however, the pt. still is above his dry weight. he is to be continued on lasix 20mg po for 7 more days (through ). his bun/cr and potassium levels have remained stable and he has not required supplementation while taking the lasix. he will, however, require frequent lab checks to ensure his kidney function does not become compromised. medications on admission: lipitor 20 ' glipizide 20/10 metformin 1000/500 lisinopril 20' discharge medications: 1. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4-6h (every 4 to 6 hours) as needed for wheezing. 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). injection 3. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 4. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 5. insulin regular human 100 unit/ml solution sig: see sliding scale injection asdir (as directed). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. acetaminophen 500 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain, t>101.5: no more than 4gm per day. 8. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 9. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po bid (2 times a day). 10. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical prn (as needed). discharge disposition: extended care facility: for the aged - acute rehab discharge diagnosis: - h/o cap s/p radiation therapy - radiation cystitis - s/p repair of perforated bladder - diabetes - hypertension discharge condition: - good discharge instructions: - no showers yet - may take sponge baths - may eat a regular diet that is supplemented with protein shakes - should continue taking stool softeners as needed - no narcotics, pt. should only take tylenol for pain relief - should continue tid (wet to dry) dressing changes to abdomen - continue to monitor urine output - will have clots and occasionally be bloody for some time - please use cbi slowly as needed to keep clots from forming - continue po lasix - only 20 po qam for 7 more days - will need three time a week bun/cr and hct checks - return to ed or call clinic if t>101.5, chills, nausea, vomitting, chest pain, shortness of breath, inability to pass urine, or any other concern followup instructions: - pt. should call dr. office to schedule a follow-up appointment in 2 weeks. the number is (. ***call dr. at : pager # with any questions or concerns*** procedure: venous catheterization, not elsewhere classified percutaneous abdominal drainage control of hemorrhage, not otherwise specified transfusion of packed cells other suprapubic cystostomy irrigation of other indwelling urinary catheter other repair of bladder other repair of bladder diagnoses: pneumonia, organism unspecified acidosis other iatrogenic hypotension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified personal history of malignant neoplasm of prostate hemorrhage complicating a procedure other disorders of plasma protein metabolism dehydration irradiation cystitis late effect of radiation disruption of external operation (surgical) wound orthostatic hypotension other suppurative peritonitis rupture of bladder, nontraumatic 

Answer: The patient is high likely exposed to