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: levofloxacin attending: chief complaint: altered mental status due to sepsis secondary to urinary tract infection. major surgical or invasive procedure: intubation in the medical intensive care unit. history of present illness: year old wf with a history of hypertension and sepsis urinary tract infection, who originally presented to with altered mental status, transferred to on for further management of sepsis urinary tract infection. now called out to the general medicine floor following 9 day hospital course in the micu. . was originally transferred to due to persistent hypotension and bradycardia in the setting of positive urine analysis. was intubated for airway protection and started on vancomycin/zosyn. micu team attributed bradycardia to hyperkalemia on presentation and poor atenolol excretion acute kidney injury. required increasing pressor support with dopamine, norepinephrine, and vasopressin. of note, she had a positive ua on presentation here, though cultures from and here have remained negative (here she had corynebacterium in one culture which was likely a contaminant). she also had been taking ciprofloxacin prior to her arrival to for a uti. she has completed a 7 day course of vancomycin and 8 day course of zosyn. . pressor support was gradually weaned and patient was extubated on . her micu course has been complicated by new atrial fibrillation with rvr, for which she was initially given dilt iv and dilt po without improvement in her rate (100s-110s). she was started on an amiodarone load approx 36 hours after atrial fib onset and converted to sinus rhythm 6 hours later. . transition off of pressors was performed with albumin volume resuscitation. due to development of pedal edema and findings of mild interstitial edema on chest xray, patient was started on lasix gtt for volume removal which was transitioned to lasix iv boluses with goal removal of negative 1l daily. of note, she had presented with with baseline creatinine of 1.0, but her creatinine has increased to 2.0 in the micu. her lisinopril has been held. . hospital course also complicated by development of diarrhea with positive c. diff stool culture. started on iv metronidazole on . following extubation, she was evaluated by speech and swallow and not quite felt safe for diet, but able to take crushed meds. over the weekend, her diet was advanced by micu team without difficulty. . on the floor, patient reports that she feels fine, denies any complaints and wants to go home as soon as possible. reports that she had loose stools overnight. brown in color, no blood. past medical history: hypertension history of urosepsis social history: she lives at home with her sister. independent activities of daily living. family history: non-contributory. physical exam: vitals: tm and tc: 97.2. bp: 136/100 (124-136/88-100) gen: elderly woman, nad, very pleasant. heent: nc at, oropharynx clear but with dry mucous membranes neck: supple, no lad lungs: inspiratory wheezes appreciated on ausculatation. no rales appreciated. heart: rrr with nl s1-s2, no m/r/g. abd: soft, nt, nd, with positive bowel sounds in all 4 extremities. no g/r/r. no hsm. ext: 2+ pitting edema appreciated int he bilat ankles and feet. 1+ pedal pulses. neuro: alert and oriented times three. cn 2-12 intact. strength in all 4 extremities. pertinent results: laboratory data on admission: . complete blood count: 08:44pm blood wbc-10.9 rbc-4.20 hgb-12.1 hct-37.6 mcv-89 mch-28.8 mchc-32.3 rdw-14.4 plt ct-203 04:53pm blood wbc-26.0*# rbc-3.77* hgb-10.6* hct-31.9* mcv-85 mch-28.3 mchc-33.4 rdw-14.6 plt ct-198 08:44pm blood neuts-74* bands-16* lymphs-7* monos-0 eos-0 baso-0 atyps-2* metas-1* myelos-0 08:44pm blood hypochr-normal anisocy-1+ poiklo-2+ macrocy-1+ microcy-1+ polychr-normal ovalocy-2+ burr-2+ pencil-1+ tear dr 1+ . coagulation profile: 09:15am blood pt-14.7* ptt-32.2 inr(pt)-1.3* . basic metabolic profile: 08:44pm blood glucose-93 urean-73* creat-2.6* na-130* k-5.3* cl-108 hco3-10* angap-17 12:23am blood glucose-67* urean-72* creat-2.6* na-132* k-5.5* cl-109* hco3-11* angap-18 08:44pm blood calcium-7.6* phos-5.0* mg-2.2 12:23am blood calcium-7.7* phos-5.4* mg-2.1 12:23am blood cortsol-24.0* 03:04am blood type-mix po2-70* pco2-36 ph-7.08* caltco2-11* base xs--18 . cardiac enzymes: 08:44pm blood ck(cpk)-392* 12:23am blood ck(cpk)-291* 08:44pm blood ctropnt-0.02* 12:23am blood ck-mb-34* mb indx-11.7* ctropnt-0.02* . laboratory data on discharge: wbc: 5.1, hct: 25.8, plt: 400 na: 144, k: 3.5, cl: 105, hco3: 29, bun: 25, creatinine: 1.6, glucose: 99 . microbiology: urine culture : **final report ** urine culture (final ): corynebacterium species (diphtheroids). >100,000 organisms/ml.. . blood culture : no growth to date. . mrsa screen : negative for mrsa. . sputum culture : **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in pairs and clusters. 3+ (5-10 per 1000x field): gram negative rod(s). 1+ (<1 per 1000x field): gram positive rod(s). 1+ (<1 per 1000x field): budding yeast with pseudohyphae. respiratory culture (final ): moderate growth commensal respiratory flora. . urine culture : no growth. . stool culture : **final report ** clostridium difficile toxin a & b test (final ): reported by phone to m. powers, r.n. on at 0450. clostridium difficile. feces positive for c. difficile toxin by eia. (reference range-negative). a positive result in a recently treated patient is of uncertain significance unless the patient is currently symptomatic (relapse). . urine culture : no growth to date. . ecg : artifact is present. regular supraventricular rhythm which may be sinus. if clinically indicated, a repeat tracing may provide better diagnostic quality. tracing #1. . ecg : sinus bradycardia. the p-r interval is prolonged at 280 milliseconds. compared to the previous tracing sinus rhythm is now apparent and the p-r interval is prolonged. tracing #2. . ecg : sinus rhythm. the p-r interval is prolonged at 260 milliseconds. compared to the previous tracing there is no significant change. tracing #3. . chest radiograph : impression: 1. cardiomegaly with mild interstitial edema. 2. endotracheal tube tip 2.5 cm from carina. 3. kink noted within the right ij catheter. . echo : the left atrium is normal in size. the estimated right atrial pressure is 10-15mmhg. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the left ventricular inflow pattern suggests impaired relaxation. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: moderate to severe pulmonary hypertension. preserved left ventricular function. moderately dilated and hypokinetic right ventricle. . bilateral lower extremity ultrasound : impression: 1. no lower extremity deep venous thrombosis. . chest radiography : findings: in comparison with study of , the monitoring and support devices have been removed. continued enlargement of the cardiac silhouette with marked tortuosity of the aorta and there are moderate pleural effusions bilaterally and mild basilar atelectatic change. minimal fullness of pulmonary vessels is consistent with mild elevation of pulmonary venous pressure. . ct abdomen and pelvis : impression: 1. no evidence of nephrolithiasis. bilateral hydroureter with shaggy appearance of the ureteral lining without a focal point of narrowing to suggest obstruction that is most likely related to ascending infection from known urosepsis. no associated hydronephrosis, which raises possibility of a more chronic time frame. 2. subtle hypodensity seen projecting over the left renal vein of uncertain etiology that may be artifactual as the renal vasculature is suboptimally assessed on this non-contrast study, though if thrombosis is of clinical concern, a renal ultrasound can be obtained for evaluation. 3. cholelithiasis without secondary signs of cholecystitis. 4. diverticulosis without evidence of diverticulitis. 5. bilateral small-to-moderate simple pleural effusions and bibasilar atelectasis. . renal ultrasound : very limited study as the patient can not hold their breath. a structure that is likely the left renal vein is identified on the grayscale imaging, though colour analysis was not possible secondary inability to breath-hold. if clinical concern persists, mr may be better able to address the question. cxr lung volumes are much lower, probably due to atelectasis, and a contribution of small subpulmonic pleural effusions, greater today than on . atelectasis is present at the base of the left lung. moderate cardiomegaly and a generally very large and tortuous thoracic aorta are longstanding. right upper lung shows vascular congestion but pulmonary edema if present, is mild. left picc line can be traced as far as the mid svc. no pneumothorax. discharge labs: 2.9>32.2<244 pt 40.6, ptt 37.8, inr 4.3 147/3.6/107/32/24/1.6<94 ca 8.8, mg 2.4, phos 3.3 brief hospital course: year old caucasian female with history of hypertension and urosepsis, admitted to the micu with sepsis secondary to uri, with hospital course complicated by new atrial fibrillation with rvr in setting of pressors, arf, pulmonary edema attributed to volume resuscitation, and c. diff colitis. . #. sepsis urinary tract infection. patient initially presented to with altered mental status, found to have a positive ua, hypotension, bradycardia, and was started on vanco/zosyn as well as dopamine for bp support. she was transferred to on due to persistent hypotension and bradycardia, and she was intubated for airway protection. it was felt that her bradycardia was likely due to rention of atenolol in setting of acute kidney injury as well as hyperkalemia. initially in the micu, she was on dopamine, norepinephrine, and vasopressin for bp support. she had a rij cordis placed at for access. she had a positive ua on arrival here, though cultures from and here have remained negative (here she had corynebacterium in one culture which was likely a contaminant). of note, she had been taking ciprofloxacin prior to her arrival to for a uti. . during her micu course, she was weaned off pressors, and eventually was extubated on though was still kept on norepinephrine for bp support. her course was complicated by atrial fibrillation with rapid ventricular response in the setting of pressors, arf, pulmonary edema secondary to aggressive volume resuscitation, and c. difficile colitis following a 7 day course of vancomycin and 8 day course of zosyn. see below. at the time of discharge, all vitals remained stable. surveillance culture data has been negative thus far. . #. new atrial fibrillation with rvr. trigger was likely underlying infections (uti, c. diff) in the setting of critical illness and multiple vasopressors for blood pressure support. initially she was given diltiazem iv and po without much improvement in her rate, which remained in the 110s. she was started on an amiodarone load approx 36 hours after the initiation of her afib, and converted to normal sinus rhythm 6 hours later. she maintained sinus rhythm until , when she developed second episode of atrial fibrillation with rvr with rates in the 170s. iv diltiazem was given without significant effect and patient was started on diltiazem gtt. with uptitration of diltiazem gtt, blood pressure found to drop to the 80s-90s. digoxin 0.125mg po daily was initiated and diltiazem gtt was stopped. heart rate was still in the low 100s. warfarin 2mg po daily and heparin gtt were started. patient started on amiodarone with load however remained in afib. she had successful cardioversion to nsr on . she was anticoagulated with and inr >4 at discharge with coumadin being held x1 dose on . it should be held and restarted once her daily inr is <3.0. a lower dose should be started such as 1.5 or 1.0 with frequent monitoring. her amiodarone will be continued as an outpatient with plans for pulmonary funciton testing. . #. mild pulmonary edema. patient was transitioned off pressors, with albumin volume resuscitation but found to develop mild pulmonary edema on chest radiograph. echo demonstrated moderate to severe pulmonary hypertension, preserved lv function and cavity size, and a moderately dilated and hypokinetic right ventricle. she was started initially on lasix gtt for volume removal, and then transitioned to lasix iv bolus with net removal of approximately 1l per day. upon reaching the floor, repeat chest radiograph demonstrated mild fullness of pulmonary vessels. on physical exam, with notable 2+ pedal edema with oxygen requirement. due to elevated sodium and creatinine and suspicion that patient was euvolemic upon reaching the floor, further diuresis was discontinued upon reaching the general medicine floor. electrolytes and renal function were followed closely and stable at the time of discharge. she was making good uop however her outpatient doctors could consider lasix (she responded very well to 20mg iv) if she reaccumulates fluid. . #. acute renal insufficiency. while baseline appeared to be approximately 1.0, creatinine was found to be 2.6 on admission, likely due to volume depletion or hypotension in the setting of sepsis. lisinopril and atenolol were held. following aggressive diuresis in the micu, creatinine remained at 2.0. upon reaching the floor, diuresis was discontinued and creatinine improved. creatinine at the time of discharge was 1.6. patient will follow up with primary care physician in regards to lisinopril. . #. hypernatremia. while sodium was within normal limits upon admission, levels elevated gradually over hospital course. likely in the setting of lasix diuresis. free water deficit was calculated and has received 3l d5w administration upon reaching the medicine floor. sodium at the time of discharge was 147. will need daily sodium checks and should encourage po free water, and should consider d5w if continues to rise with the addition of lasix due to volume overload. . #. c.diff colitis. following completion of vancomycin and zosyn, patient developed diarrhea and found to have positive stool studies. started with iv flagyl on (but first day off of antibiotics is ) and will complete 14 day course (last day on ). at discharge, diarrhea had clinically resolved. without fever or leukocytosis. . #. urinary retention/hematuria. foley was placed in the micu to aid with strict i's and o's. upon reaching the general medicine floor, foley was discontinued, but failed voiding trial with bladder scan showing >500cc's. patient underwent straight catheterization with post void residual >500cc's. after failing second voiding trial, foley was replaced. noted to have hematuria, possible secondary to traumatic foley placement in the setting of heparin prophylaxis. foley was continued and urology was consulted, who recommended keeping foley in place for 2-3 days to allow detrusor muscle to regain form. ct abdomen and pelvis was performed and demonstrated bilateral hydroureter with shaggy appearance of the ureteral lining without a focal point of narrowing to suggest obstruction that is most likely related to her infection from known urosepsis. no associated hydronephrosis, which raises possibility of a more chronic time frame. there was also a question of a subtle hypodensity seen projecting over the left renal vein of uncertain etiology that may be artifactual. renal ultrasound was performed but was of poor quality. will continue outpatient workup with urology as an outpatient. will need to follow up with primary care physician as an outpatient to begin hematuria workup should symptoms persist. . #. hypokalemia. originally presented to the hospital with hyperkalemia which was reversed with calcium, resin binding. subsequently developed hypokalemia. potassium was repleted prn. given home prescription for daily potassium, hypokalemia may be chronic in nature. losses were also likely aggravated by diarrhea and poor po intake. potassium stable at the time of discharge. . #. swallowing difficulty. status post extubation, patient was found to have difficulty swallowing. was seen by speech/swallow in micu, cleared initially for crushed medications. diet was slowly advanced to regular diet, pureed consistency, and nectar prethickened liquids. she was placed on aspiration precautions with observed feeding. . #. anemia. patient with no active source of bleeding. stools were guiac negative. hematocrit was closely followed and has been stable. . #. deconditioning. secondary to extensive micu course. was seen by physical therapy who recommended transfer to rehabilitation center upon medical clearance. medications on admission: medications at home: lisinopril 20mg daily atenolol 50mg daily kcl 20meq daily . meds on transfer from micu to general medicine floor: flagyl 500mg iv q8hrs neutra-phos 1pkt heparin sq miconazole powder 2% topical qid prn skin breakdown ivf: 1000ml d5w @ 125ml/hr discharge medications: 1. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed for skin breakdown. 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 10 days: please continue three times a day, with last dose to be given on . disp:*30 tablet(s)* refills:*0* 5. atenolol 25 mg tablet sig: half tablet po bid (2 times a day): please hold if sbp < 100 or hr < 60. discharge disposition: extended care facility: - discharge diagnosis: sepsis secondary to urinary tract infection atrial fibrillation clostridium difficile colitis acute kidney injury pulmonary edema hypernatremia urinary retention discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - requires assistance or aid (walker or cane) discharge instructions: it was a pleasure taking care of you at . you were originally seen at for altered mental status, and were found to have a urinary tract infection that had spread to your blood. you were transferred to our hospital for further management. you have completed a course of iv antibiotics. you needed medications to sustain your blood pressure and needed to be placed on a breathing machine when you first arrived. your hospital course has been complicated by an irregular heart rhythm that was controlled with medications. you also developed diarrhea due to an infectious cause and were given medication to help you clear this infection. you also developed some fluid in your lungs that improved with diuretic medication. finally, you have developed some difficulty urinating, and will need a foley in place for several more days (until you see the urologist) to allow your bladder to regain its former shape. you will need to follow up with the urology physicians as an outpatient in regards to this matter. . you had an irregular heart rate called atrial fibrillation. you had a cardioversion on which made your heart beat regularly again. you had to start on a medication called coumadin to keep your blood thin. . we have made the following changes to your medications: - stopped lisinopril. please contact your primary care physician in regards to this medication. - stopped atenolol - stopped potassium chloride - started flagyl three times a day. please continue this medication with last dose on . - started coumadin. you were taking 2mg daily and your inr was high, so you will have to have this closely monitored and you will likely need a lower dose when you restart it when your inr is less than 3.0 - start amiodarone 400mg twice a day through . on change to 200mg daily. - start metoprolol xl 25mg daily . please seek medical attention should you develop pain with urination, inability to urinate, increased frequency of urination, fever, chills, nausea, vomiting, shortness of breath, chest pain, worsening diarrhea. followup instructions: please follow up with the appointments scheduled as below: please see your primary care physician, . , on at 2pm. phone: . dr. should refer you to a cardiologist within 1-2 months after your discharge. please see the urology physician, . , on at 11am. office is located in the building, . phone: . you should have outpatient pulmonary function tests to check your lung function as an outpatient. you should call the cardiology office to make an appointment within 1-2 weeks at . you can make an appointment with dr. if you like since that is who saw you in the hospital. you will need to have your inr checked daily until your inr is less than 3.0, then restart coumadin and continue to have your inr checked regularly. you will need daily sodium checks and should drink free water, and should consider d5w if continues to rise with the addition of lasix due to volume overload. your sodium was 147 at discharge. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified diagnostic ultrasound of heart insertion of endotracheal tube other electric countershock of heart diagnoses: acidosis hyperpotassemia subendocardial infarction, initial episode of care acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified unspecified septicemia severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other chronic pulmonary heart diseases hypopotassemia chronic kidney disease, unspecified acute respiratory failure other specified cardiac dysrhythmias septic shock intestinal infection due to clostridium difficile retention of urine, unspecified iron deficiency anemia, unspecified calculus of gallbladder without mention of cholecystitis, without mention of obstruction acute diastolic heart failure pulmonary congestion and hypostasis hyperosmolality and/or hypernatremia hematuria, unspecified diverticulosis of colon (without mention of hemorrhage) dysphagia, unspecified hydroureter 

Answer: The patient is high likely exposed to