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: ruq pain major surgical or invasive procedure: none history of present illness: this is an 86 year old spanish speaking woman with a pmh significant for atrial fibrillation (on coumadin), ckd (cr 1.5), systolic chf (ef 10%), dmii, utis, htn, colon cancer s/p colectomy, depression and dementia who presents with ruq pain that started today. she was evaluated at her nursing home where there was concern for a possible biliary process. per her daughter who was with her earlier today the patient was close to her baseline mental status. . in the ed, initial vs were: 97.6 105 86/52 16 96% ra. her exam was notable for tender ruq with guarding. sbp remained in 80s to 90s. her labs were notable for luekocytosis 15 with 85% polys, no bands, elevated cr 2.2, mildly elevated ap and ast (159, 106), and lactate 3.4, glucose 67. her ua was notable for bacturia, pyuria, and leuks. a kub was done that did not show obstruction (my read) and ct abdomen/pelvis was notable for bilateral perinephric stranding and fluid and no gallbladder visualized. patient was given 20mg prednisone, flagyl and cipro for concern of gallbladder process, and 1amp d50 for hypoglycemia. she received a total of 1l ns in addition to the fluids in her antibiotics. on discussion with health care proxy, patient remains dnr/dni and does not desire invasive measures such as central line and pressors. vital signs on transfer were t 96.8, bp 89/56, hr 90, rr 21, o2 sat 100% ra. . of note, she was recently discharged after hospitalization at for hypoxia and altered mental status. she had an echo done significant for presumed ischemic cardiomyopathy with an ef 10% and bivent failure. she improved with diuresis and treatment for a pneumonia w/ levaquin. . on the floor, the patient was having ruq pain, but easily drifted off to sleep. she denied any cough, chest pain, nausea, vomiting, diarrhea, fevers, or chills. past medical history: - afib oncoumadin - systolic chf: echo ef 20% - dm2 (hga1c 7.6 ) - crf (creat 1.8-2.2) - mild dementia - depression - gerd - htn - venous insufficiency - h/o of colon cancer, s/p colectomy social history: lives at , denies smoking, alcohol and drugs. family history: non contributory physical exam: vitals: t: 95.7 bp: 95/62 p: 93 r: 17 o2: 97% ra general: elderly female, drowsy but easily arousable, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation anteriorly, no wheezes, rales, or ronchi cv: irregularly irregular, no murmurs, rubs, gallops abdomen: decreased bs, soft, ttp in the ruq, no rebound or guarding. gu: + foley ext: cool, pulses not appreciated, 1+ edema bilaterally neuro: oriented to self. moves all extremities. cranial nerves ii-xii grossly intact. pertinent results: admission labs 06:00pm glucose-67* urea n-60* creat-2.0* sodium-138 potassium-4.6 chloride-98 total co2-26 anion gap-19 06:00pm ph-7.43 comments-green top 06:00pm glucose-73 lactate-3.4* na+-140 k+-4.9 cl--95* tco2-29 06:00pm hgb-12.4 calchct-37 06:00pm freeca-1.04* . 06:00pm wbc-15.3* rbc-4.00* hgb-11.6* hct-36.0 mcv-90 mch-29.0 mchc-32.2 rdw-17.5* 06:00pm neuts-84* bands-0 lymphs-12* monos-4 eos-0 basos-0 06:00pm plt count-220 . alt(sgpt)-40 ast(sgot)-106* alk phos-159* tot bili-1.1 lipase-28 albumin 3.3* calcium-8.6 phosphate-3.7 magnesium-2.1 . 06:40pm urine color-amber appear-cloudy sp -1.016 06:40pm urine blood-tr nitrite-neg protein-75 glucose-neg ketone-tr bilirubin-sm urobilngn-1 ph-5.0 leuk-mod 06:40pm urine rbc-* wbc-21-50* bacteria-many yeast-none epi- . microbiology: urine cx contaminated blood cx no growth to date imaging: cxr: ruq us: impression: no cholelithiasis or secondary signs of cholecystitis to explain the patient's right upper quadrant pain. the gallbladder is small, possibly normal anatomy in this patient, though this should be correlated for possible history of previous partial cholecystectomy. . ct abdomen : impression: 1. perinephric stranding and perinephric fluid, nonspecific, though correlation clinically and with laboratory data for underlying infection. 2. cardiomegaly with diffuse body wall edema. . discharge labs: 05:35am blood wbc-5.9 rbc-3.91* hgb-11.7* hct-35.3* mcv-90 mch-29.9 mchc-33.0 rdw-16.7* plt ct-225 05:40am blood pt-16.9* inr(pt)-1.5* 05:40am blood glucose-94 urean-46* creat-1.4* na-139 k-3.6 cl-100 hco3-31 angap-12 brief hospital course: 1. pyelonephritis complicated by sepsis, requiring icu admission: ms was admitted to the micu with concern for biliary process given leukocytosis and worsening ruq pain. ua showed significant pyuria and bacteria and ct abdomen was suggestive of perinerphric stranding; no biliary abnormalities were visualized. a presumptive diagnosis of pyelonephritis was made. given her history of recurrent utis, she was started empirically on iv meropenem. although ua was positive, her urine culture was negative. day 1 of meropenem was ; we decided to treat her for a fourteen day course despite negative cultures given frequency of recurrent utis per outside hospital report and perinephric stranding seen on ct; last day of meropenem will be . . 2. acute renal failure, with chronic kidney disease, stage ii: her creatinine was noted to be elevated (baseline is 1.5) with her creatinine near 2.3, thought to be secondary to poor forward flow. her ef is only 10% and so to improve perfusion to her kidney, we initiated diuresis with lasix with a goal of -500 mls - 1 l. her creatinine improved mildly to 2.1 with lasix; she was transitioned to po bumetanide as per her home regimen of 4 mg . we held her ace inhibitor secondary to her acute on chronic renal failure. it will be started at discharge at a lower dose. . 3. atrial fibrillatoin with poor rate control, subtherapeutic inr: she continued to be in atrial fibrillation; her metoprolol was titrated up for rate control. her inr was subtherapeutic and she was started on iv heparin on in addition to her coumadin dose of 3.5 mg daily. she remained poorly rate controlled and was eventually started on metoprolol 50 mg q6 and diltiazem 30 mg po qid. she will be transitioned to daily formulations on discharge. she should have daily pulse checks for bradycardia, although there were no abnormalities on telemetry. . 4. diabetes mellitus, type ii, controlled: her metformin was held in the setting of renal failure; she covered on an insulin sliding scale. . 5. dementia: mild. no evidence of acute delirium. . disposition: after discussion with her nurse practitioner at her nursing home, and her family, she was discharged back to the with goal of transitioning to comfort measures. her heparin drip was stopped at discharge. medications on admission: citalopram 20 mg daily lisinopril 5 mg daily coumadin previously 4mg daily, current dose unknown metformin 500 omeprazole 20 mg daily aspirin 81 mg daily multivitamin senna 8.6 mg docusate sodium 100 mg atorvastatin 40 mg daily bumetanide 4 mg (per cardiology note , increased from 4 mg daily) metoprolol succinate 100 mg daily insulin glargine 100 unit/ml 6 units subcutaneous at bedtime. discharge medications: 1. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. citalopram 40 mg tablet sig: one (1) tablet po once a day. 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. toprol xl 200 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day: hold for sbp < 100. 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm: adjust by inr. 7. meropenem 500 mg recon soln sig: five hundred (500) mg intravenous q12h (every 12 hours) for 8 days: last day . 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 9. multivitamin tablet sig: one (1) tablet po daily (daily). 10. bumetanide 2 mg tablet sig: two (2) tablet po bid (2 times a day). 11. insulin lispro 100 unit/ml solution sig: six (6) units subcutaneous at bedtime. 12. novolog 100 unit/ml solution sig: sliding scale subcutaneous qac and qhs. 13. diltiazem hcl 120 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po at bedtime: hold for sbp < 100. 14. sodium chloride 0.9 % 0.9 % syringe sig: ten (10) ml injection q8h (every 8 hours) as needed for line flush. 15. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush. 16. senna 8.6 mg tablet sig: one (1) tablet po twice a day. 17. fleet enema 19-7 gram/118 ml enema sig: one (1) enema rectal once a day as needed for constipation. 18. dulcolax 10 mg suppository sig: one (1) suppository rectal once a day as needed for constipation. 19. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day: hold for sbp < 100. 20. outpatient lab work inr then as by inr. discharge disposition: extended care facility: house discharge diagnosis: pyelonephritis sepsis with organ dysfunction chronic systolic chf without acute exacerbation hypertension diabetes mellitus, type ii , controlled, without complications atrial fibrillation gerd chronic kidney disease, stage iii, with acute renal failure dementia, chronic discharge condition: mental status: confused - sometimes level of consciousness: lethargic but arousable activity status: bedbound discharge instructions: you were admitted with right sided abdominal pain, and were found to have a kidney infection. you improved with antibiotics. your heart rate was high and we changed your medications to control it. we also restarted your blood thinning medication for your irregular heart rate. . medication changes: coumadin as per inr, dosing recently: 2/26 3/5 mg, no dose , 5 mg, 4 mg. inr 1.5 toprol increased to 200 mg daily. diltiazem 120 mg daily added. lisinopril decreased to 2.5 mg daily. meropenem through for pyelonephritis. . repeat inr . follow every other day while on antibiotics. followup instructions: your nurse will see you once you return to the nursing home. . department: cardiac services when: tuesday at 1:30 pm with: , np building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: esophageal reflux congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other persistent mental disorders due to conditions classified elsewhere chronic systolic heart failure long-term (current) use of anticoagulants personal history of malignant neoplasm of large intestine chronic kidney disease, stage ii (mild) pyelonephritis, unspecified 

Answer: The patient is high likely exposed to