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: patient recorded as having no known allergies to drugs attending: chief complaint: urosepsis and hypotension. major surgical or invasive procedure: endotracheal intubation to . history of present illness: is a 41-year-old right-handed man, with a history of anaplastic astrocytoma of the spine complicated by severe lower extremity weakness and urinary retention, s/p foley catheter, high-dose steroids, hypertension, chronic pain, who presented to the emergency room at on with increased weakness. the patients sister reports that he had been having fecal incontinence and diarrhea over the last week, and then developed sob and acute onset abdominal pain the day of admission. there were no fevers or cp, but were some chills. but he was on high-dose dexamethasone. ed course: he was noted to be somnolent and hypotensive. he was intubated for airway protection. cvl was placed and started on neosynephrine and levophed drips. given 8l ns fluids and broad spectrum antibiotics with vanco/zosyn. labs were notable for elevated lactate 7.1 and acute renal failure (creatinine 1.8). scans of head and torso with evidence of possible pneumonia (aspiration) but no other source. urinalysis was grossly positive. cardiology and surgery were consulted for questionable cardiogenic shock and acute abdomen, respectively. he was then admitted to the micu. micu course: he was weaned off vasopressors with repeated fluid boluses. levoflox and flagyl added to vancomycin and zosyn. c. difficile and legionella urine ag were negative. urine and blood cultures from the ed eventually grew e. coli sensitive to cephalosporins and antibiotics were tailored to cefazolin and flagyl. he was extubated on . but he developed chf with echocardiogram suggestive of takotsubos. he was auto-diuresed and started on ace inhibitor per cardiology; no beta-blocker given chronically bradycardic (hr 40-50s, asymptomatic). troponin peaked at 0.3 with flat cks. anticoagulation was discussed given apical akinesis but deferred due to risk of bleeding with underlying malignancy. his dexamethasone were continued at q12h. but he developed thrombocytopenia and heparin products stopped but hit negative so restarted and platelet counrs have subsequently improved. he had been holding chronic pain medications given recent intubation. he was transferred to omed for further care. currently the patient complains of mild abdominal pain and loose stools. denies sob but notes low o2 sats occasionally. no other pain including no chest pain. denies nausea or vomiting. he feels below baseline strength overall and fatigued. past medical history: anaplastic astrocytoma of the t-l spinal cord. hypertension pain (flexor spasms and neurogenic pain) past oncological history: -rle weakness 07/07-right knee gave out with difficulty walking and right anterior thigh numbness osh mri showed a spinal cord conus mass he had a myelotomy-dr. =anaplastic astrocytoma involved in field ratdiation t10-l1 to to 4860 cgy followed by 11 cycles of temozolomide 7 days on and 7 days off. this was followed by cpt-11 weekly x4 with avastin q2 weeks/ 2 weeks rest and repeat cycle = c1d22 cpt-11/avastin (d15 was held). social history: patient lives at home with his parents and sister. was wheelchair bound. he does not smoke cigarettes, drink alcohol, or use illicit drugs. family history: his grandmother has cancer. his mother has non-??????s lymphoma. his father has coronary artery disease. one of his brothers is a diabetic. physical exam: on presentation to : vital signs: temperature 97.6 f, blood pressure 115/69, heart rate 125, repiration 21, saturation 99% on ac fio2 100%, tv 680, rr 14, peep 5 general: intubated, sedated, overweight, nad skin: positive for macular purpuric rash on trunk and arms, blanching.heent: eomi, perrl, sclera anicteric, no epistaxis or rhinorrhea, mmm, op clear neck: no jvd, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline cardiovascular: distant heart sounds, s1s2 no audible m/r/g pulmonary: b/l ae coarse inspiratory breath sounds, +scant exp wheezing, c/r abdomen: no bs, soft, distended, ttp (evidenced by wincing on exam), no guarding. extremities: no c/c, 1+e, no palpable cords neurological examiantion: intubated, sedated, +rigors, squeezes hands, opens eyes on command. pertinent since extubation; extremities: 3+ edema at hands and feet neurological examination: his karnofsky performance score is 60. he is awake, alert, and oriented times 3. his language is fluent with good comprehension. his short-term memory is intact. cranial nerve examination: his pupils are equal and reactive to light, 4 mm to 2 mm bilaterally. extraocular movements are full; there is no nystagmus. visual fields are full to confrontation. his face is symmetric. facial sensation is intact bilaterally. his hearing is intact bilaterally. his tongue is midline. palate goes up in the midline. sternocleidomastoids and upper trapezius are strong. motor examination: he does not have a drift. his muscle strengths are at all muscle groups in the upper extremities. in the lower extremities, his right foot has no movement, while his right quadriceps and right ileopsoas have 2/5 strength. in his left lower extremity, there is weakness at his left and left tibialis anterior at 4-/5, as well as 4/5 strength at left quadriceps. his muscle tone is spastic in the right lower extremity. his reflexes are 2- at biceps, triceps, and brachioradialis bilaterally. his right knee jerk is 0 while his right ankle jerk is 5+. his left knee jerk is 2+, while the left ankle jerks is absent. his right toe is mute. sensory examination is notable for decreased sensation in both of his lower extremities up to t11 level. he can stand but he cannot walk. pertinent results: 11:40am wbc-2.1*# rbc-3.84* hgb-12.8* hct-36.8* mcv-96# mch-33.2* mchc-34.7 rdw-14.4 11:40am neuts-73* bands-7* lymphs-10* monos-9 eos-0 basos-0 atyps-0 metas-1* myelos-0 11:40am plt smr-low plt count-143* 11:40am hypochrom-normal anisocyt-1+ poikilocy-normal macrocyt-1+ microcyt-normal polychrom-normal 11:40am glucose-150* urea n-18 creat-1.8*# sodium-132* potassium-3.8 chloride-91* total co2-24 anion gap-21* 11:40am alt(sgpt)-74* ast(sgot)-28 ck(cpk)-35* alk phos-98 tot bili-1.2 11:50am lactate-7.1* 11:40am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 11:40am ck-mb-notdone 11:40am ctropnt-0.08* 09:05pm ck-mb-6 ctropnt-0.05* 09:05pm ck(cpk)-92 05:10pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 05:10pm urine rbc-* wbc->50 bacteria-many yeast-none epi-0 5:10 pm urine site: catheter **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. sensitivities: mic ______________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin---------- 32 i piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s 4:30 am blood culture source: line-central. blood culture, routine (preliminary): escherichia coli. identification and sensitivities performed on culture # 261-5711b . anaerobic bottle gram stain (final ): gram negative rod(s). aerobic bottle gram stain (final ): gram negative rod(s). rapid respiratory viral antigen test (final ): respiratory viral antigens not detected. specimen screened for: adeno,parainfluenza 1,2,3 influenza a,b and rsv. c. diff negative x 3 ecg: sinus tachycardia @118, no acute st/t changes. imaging: cxr: impression: no acute intrathoracic process. kub:impression: limited examination. nonspecific bowel gas pattern. evaluation for free air is limited. ct head: impression: no acute intracranial process. ct chest/abd/pelvis: impression: limited study given lack of intravenous contrast. 1. bibasilar consolidations. 2. properly positioned endotracheal tube, nasogastric tube, and right internal jugular central venous catheter. 3. no acute intra-abdominal or pelvic findings. oral contrast material is noted within the stomach and has not progressed throughout the bowel, and thus evaluation of the bowel is somewhat limited. 4. status post laminectomy t11-12 through t12-l1. 5. inflammatory changes of the right inguinal canal of uncertain significance or etiology echo: the left atrium is normal in size. the estimated right atrial pressure is 10-20mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is moderate to severe regional left ventricular systolic dysfunction with mid to distal lv akinesis. the estimated cardiac index is borderline low (2.0-2.5l/min/m2). right ventricular chamber size is normal. with mild global free wall hypokinesis. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. impression: severe regional left ventricular systolic dysfunction consistent with takatsubo cardiomyopathy. mild mitral regurgitation. no vegetations identified. if clinically suggested, the absence of a vegetation by 2d echocardiography does not exclude endocarditis. cxr: one portable upright view. comparison with . lung volumes are somewhat low. there is minimal streaky density consistent with subsegmental atelectasis. ill-defined increased density in the retrocardiac area may represent atelectasis or consolidation. mediastinal structures are unchanged. an endotracheal tube, nasogastric tube, and right internal jugular catheter remain in place. impression: limited study demonstrating retrocardiac density consistent with atelectasis or consolidation unchanged. shoulder x-ray:right shoulder x-ray examination within normal limits, except for tiny clavicular spur. brief hospital course: assessment/plan: the patient is a 41-year-old right-handed man with a history of progressive anaplastic astrocytoma of the spine on high-dose steroids presented with urosepsis. (1) urosepsis: initially in shock. e. coli grew from blood and urine cultures. required vasopressors and aggressive fluid resuscitation initially. resolved and transfered out of . since transfer to the flow there have been o further fevers or signs of infection. initially on iv transfered to po cipro (d1 = ) to complete 14 day course given bacteremia, finish urosepsis likely secondary to le paralysis, patient required significant effort to urinate and has poor sensation of a full bladder. (2) acute renal failure: prerenal due to hypotension from septic shock. resolved with correction of sepsis and aggressive ivf. on the floor lisinipril was resumed.hctz and lasix were used to correct volume overload, but subsequently discontinued hyponatremia. volume status stable. (3) cardiomyopathy/nstemi: due to sepsis. troponin leak from hypotension rather than ruptured plaque. echo with takotsubos. volume overload resolved after diuresis. cardiology was following and started ace. continue to monitor for signs of chf. (4) hyponatremia: he developed during diuresis with lasix and hctz, corrected with discontining diuretics. he later downtrending again, responed to ivf therefore likely hypovolemic hyponatremia. (5) thrombocytopenia: platlets trended down to 46, then recovered to 97 on day of transfer from icu. hit negative. likely to gnr septicemia. (6) right shoulder pain: increasing after pt, with movement last 2 days. tender over right ac joint. x-ray negative, continue oxycodone, tylenol prn. (7) diarrhea: possibly due to chemotherapy. considered c. diff although stools negative x 3. bowel movements are diminished prior to d.c. continue anti-motility agents prn. (8) anaplastic astrocytoma: located in the t-l spine, unresectable anaplastic astrocytoma s/p radiation. complicated by progressive lower extremity weakness and urinary retention. patient also has fecal incontanance. this is likely the cause of urosepsis. after discussion between dr. and family decided to pursue hospice, no longer getting treatment for tumer. continue narcotic regimen and decadron 4 mg . (9) hypertension: currently normotensive. continue lisinopril, diuretics d/c hyponatremia, beta blocker d/c for bradycardia. (10) anemia: this is likely secondary to chemotherapy +/- acd. hct stable at baseline. (11) code: now dnr/dni. (12) disposition: per dr , family agrees to hospice. code status changed to dnr/dni on . (13) communication: per patient and his sisters. medications on admission: dexamethasone 4mg diphenoxylate-atropine 2.5mg/0.025mg 2 tabs qid prn fluoxetine 20mg daily hctz 25mg, 1-2 tabs daily prn pedal edema lisinopril 10mg daily morphine concentrate 20mg/ml 0.5mg q8hprn pain ms contin 30mg oxcarbazepine 300mg, 1.5mg oxycodone 5mg q6h breakthrough pain prochlorperazine 10mg prn prior to chemo ambien 5mg hs prn colace 50mg tid discharge medications: 1. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 2. senna 8.6 mg tablet sig: 1-2 tablets po bid (2 times a day) as needed. 3. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 4. dexamethasone 4 mg tablet sig: one (1) tablet po q12h (every 12 hours). 5. captopril 12.5 mg tablet sig: 0.5 tablet po tid (3 times a day). 6. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for heartburn. 7. morphine 30 mg tablet sustained release sig: one (1) tablet sustained release po q12h (every 12 hours). 8. oxcarbazepine 300 mg tablet sig: 1.5 tablets po bid (2 times a day). 9. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insominia. 10. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 11. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 12. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed for greater than 2 episodes of diarrhea per day. 13. sodium chloride 0.65 % aerosol, spray sig: sprays nasal qid (4 times a day) as needed. 14. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for shoulder pain. 15. oxycodone 5 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 16. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po 3x/week (mo,we,fr). discharge disposition: extended care facility: nursing & rehabilitation center - discharge diagnosis: urosepsis pneumonia acute renal failure cardiomyopathy and nstemi anaplastic astrocytoma of the t-l spine secondary dx: hypertension hypercholesterolemia anemia discharge condition: comfortable and alert, afebrile. discharge instructions: you were admitted to the hospital for increased weakness and urinary retention. upon arrival to the hospital you entered septic shock from massive infection. you were intubated and sent to the intensive care unit for intensive management. you were found to have a urinary tract infection as well as an pneumonia. these were treated with a course of antibiotics. during your treatment course you had a heart attack which weakened your heart. after much discussion with the oncology team and your family it was decided that your spine cancer is progressing and is not curable. focus was transfered to making you comfortable and planning was made to transition to hospice care the following changes were made to your medication regimen: stopped: 1)diphenelexate-atropine 2)hydrochlorothiazide 3)lisinopril started: 1)maalox 2)famotidine 20mg 3)ambien 5mg for sleep 4)bactrim ds 1 tab on m/w/f please follow up with your doctors as detailed below. if you have worsening weakness, fevers, chills, abdominal pain, increased diarrhea, headache, shortness of breath, cough, chest pain, or any other worrisome symptom please seek urgent medical attention. followup instructions: please follow-up with your neuro-oncologist dr. as needed: (. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube diagnoses: pneumonia, organism unspecified other primary cardiomyopathies acidosis thrombocytopenia, unspecified subendocardial infarction, initial episode of care pure hypercholesterolemia urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified hyposmolality and/or hyponatremia severe sepsis acute respiratory failure septic shock antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use pressure ulcer, buttock diarrhea encounter for palliative care acute systolic heart failure septicemia due to escherichia coli [e. coli] other specified anemias paraplegia pain in joint, shoulder region neoplasm related pain (acute) (chronic) other specified retention of urine pressure ulcer, unspecified stage takotsubo syndrome wheelchair dependence malignant neoplasm of spinal cord 

Answer: The patient is high likely exposed to