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: hypotension major surgical or invasive procedure: right internal jugular central line placement history of present illness: this is a 65 y.o. spanish-speaking male with a h/o paraplegia, large sacral decubitus ulcer, stage iv, s/p recent abx course for osteo who presents from clinic with hypotension and chills. . pt had recently been treated for sacral decub and osteomyelitis for approx 11 weeks with vanco/zosyn (until ) without resolution (no improvement in his esr per id call-in note). he was seen by plastics on and wound looked "good" (per pcp note). he returned today to clinic complaining of increased back pain in last 2 weeks. bp 85/60 in the clinic (normal bp 130s/70s). reported also increased dressing changes at nursing home and subjective chills. of note, pt has also indwelling foley and had been on vantin for ?uti . . in the ed, his initial vs were t99.2, 87, 75/50, 15, 97%ra. he remained hypotensive despite 4l ivf. lactate was 1.2. wbc 9.2 without left-shift. esr was 130. cxr unremarkable. ua cloudy and positive for wbc and bacteria. id was called and it was decided to restart him on vanc/zosyn again. pt received also 10 mg of dexamethasone for presumed relative adrenal insufficiency. r ij was placed and pt was started on levophed gtt since still hypotensive despite 4l ivf. of note, trop was 0.17, cards was called. ekg was unremarkable but cards recommended cta to r/o pe. pt undergoing cta prior to admission. . on arrival to the icu, pt was still on low-dose levophed, mentating fine, with good uop. . on ros, pt c/o chills, dysuria, recent flu-like symptoms with cough, sputum (resolving), mild ha x3d (unchanged from prior). denies cp, sob, abdominal pain, n/v. past medical history: 1. paraplegia (fell 13 years ago working on construction) 2. depression 3. frequent urinary tract infections 4. gerd 5. indwelling foley with persistent l sided hydronephrosis (per last dc summary from ) 6. anemia (hct baseline 28-30) 7. sacral decubitus, stage iv, with recent osteomyelitis, s/p approximately 11 wks of vanc/zosyn (completed ), followed by id (dr. ) social history: no smoking, no alcohol, no drug use. currently at rehab. family history: mother: no history of mi, ca father: no history of mi, ca physical exam: vs: temp: 95.4 bp: 113/62 hr: 76 rr: 13 o2sat 98% ra; cvp 3 gen: pleasant, comfortable, nad, cachectic heent: perrl, eomi, anicteric, mm dry, op without lesions, poor dentition neck: no jvd, supple, rij in place. resp: cta b/l anteriorly cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt ext: no c/c/e, warm, good pulses skin: no rashes/no jaundice. large sacral decub, stage 4, 5x5 cm but clear margins, no purulent discharge. also l lateral knee ulcer, 1x1cm with clear margins. neuro: aaox3. moves ue b/l. paraplegic. pertinent results: . 131 96 62 =========== 130 4.9 25 1.2 . ck: 199 mb: 4 trop 0.17 ca: 10.1 mg: 2.4 p: 3.8 alt: 44 ap: 117 tbili: 0.2 alb: 3.4 ast: 31 : lip: 85 . wbc 9.2 hct 30.1 plt 377 n:59.1 l:30.3 m:5.5 e:4.3 bas:0.7 sed-rate: 130 . pt: 13.3 ptt: 28.8 inr: 1.1 . ua: cloudy, 21-50 wbc, neg nitrite, moderate bacteria . ekg in the ed: nsr @ 79, nl axis, nl itnervals, no acute st-t wave changes. 3h later ekg with sb at 45 and rsr' in v1 and v2. . studies: . cxr: no acute cardiopulmonary process. . cta: no evidence of pulmonary embolism or thoracic aortic dissection. . mri l spine: 1. status post resection of distal sacrum and coccyx with a soft tissue defect in the sacrococcygeal region. 2. the abnormal signal with enhancement of the s4 segment of the coccyx could be due to osteomyelitis. mild soft tissue changes are seen surrounding the tip s4 segment of the coccyx. 3. no focal abscess is seen near the tip of the coccyx. 4. slightly increased signal in the medial portion of the right psoas muscle, in its lower portion, could be due to mild inflammation. no abscess seen. 5. small cysts within the right kidney, with prominence of the right renal collecting system. . renal u/s: grossly unchanged exam with persistent mild-to-moderate left hydronephrosis. of note the left ureter was not able to be identified on today's exam due to obscuration from bowel gas. no renal or perirenal abscess is identified. brief hospital course: 65 y.o. spanish-speaking male with a h/o paraplegia, large sacral decubitus ulcer, stage iv, s/p recent abx course for osteo who presented from clinic with hypotension and chills. . # hypotension/sepsis: hypotension most likely due to sepsis. given pyuria and history of frequent utis, most likely source of infection is from the gu tract. pt also has sacral decubitus ulcer with recent osteomyelitis s/p abx; but no drainage and clean margins. esr has been rising from 100 since to 130 on this admission was concerning for recurrent osteo. had low baseline cortisol level but bumped appropriately after stim test, so relative adrenal insufficiency less likely. hematocrit remained stable, and there was no evidence of active bleeding. the patient also ruled out for mi as noted below. pt was initially admitted to the micu on a levophed drip, but this was rapidly weaned off after fluid resuscitation. the patient was then transferred to the floor and remained hemodynamically stable off pressors. vancomycin and zosyn were continued to treat both uti (given history of pseudomonas) and skin flora. mri of the l spine showed findings possibly consistent with recurrent osteo. wound care nurse and plastic surgery were consulted who did not feel that the wound was changed from baseline and not the source of his sepsis. renal ultrasound was done to rule out perinephric abscess given the hisotry of recurrent utis; this was negative for abscess. prostate ultrasound was also done to rule out abscess given history of elevated psa; this showed no evidence of a prostatic abscess or mass. infectious disease consult followed the patient during his hospital course and recommended an antibiotic course of zosyn 4.5g q8 to complete a 2 wk course for sepsis from presumed urinary source. a picc line was placed on and he was discharged to complete a 14d course (d#5 on day of discharge). . . # chronic sacral decubitus ulcer: patient is paraplegic; ulcer is stage 4, with exposed bone. covered skin flora with vanco as above. wound care nurse and plastic surgery consult evaluated the patient who did not feel this wound was infected and vancomycin was discontinued prior to discharge. a follow up appointment was made with plastics clinic to consider a bone biopsy once off antibiotics. . # positive troponin: initial cardiac enzymes were elevated in the emergency room, but the patient was asymptomatic. pt was evaluated by cardiology in the ed. ekg without acute st changes and cta without evidence of pe. serial enzymes trended downward, and the pateint ruled out for mi. further workup deferred to his pcp. . # anemia - recent baseline of 28-30. however, last hct at rehab from was 35. hct remained stable 26-30 during this hospital course with no evidence of active bleeding. . # elevated psa: this was checked by urology as an outpatient, and per omr notes urology was unable to reach the patient to follow up this result (possibly because the patient has been at rehab). prostate u/s done as above which did not reveal any masses or abscess. pt will need outpatient urology followup. . # paraplegia: has neurogenic bladder, indwelling foley. foley was changed on arrival due to positive ua. foley will need to be changed again midway through course of antibiotics. dvt ppx was continued. . # depression: continued venlafaxine . # dispo - full code. discharged back to to complete a 2 wk course of abx as above. medications on admission: prilosec 20 daily trazodone 50 qhs tylenol prn venlafaxine 75 senna colace 100 mom 30ml daily prn bisacodyl prn fleet enema prn vitamin c heparin sc tid oxycontin 20 qam / 10 qpm zinc sulfate 220 mg daily discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses: sepsis, likely from urinary tract infection chronic stage iv sacral decubitus ulcer . secondary diagnoses: paraplegia, anemia discharge condition: stable for discharge back to discharge instructions: you were hospitalized with low blood pressure, related to an infection, likely from a bladder infection. you should continue the antibiotics zosyn for 9 more days. continue taking all of your other medications as prescribed. please have your blood drawn 1 week after discharge as instructed below. please followup with your primary care physician, with your infectious disease physician as scheduled below. if you experience fevers, chills, shortness of breath, back pain, abdominal pain, or any other concerning symptoms, please call your doctor or return to the emergency room for evaluation. followup instructions: please make an appointment to followup with your primary care physician. . you have the following appointments already scheduled: provider: surgery clinic phone: date/time: 2:00 . provider: , md phone: date/time: 11:00 procedure: venous catheterization, not elsewhere classified diagnoses: anemia, unspecified urinary tract infection, site not specified unspecified septicemia unspecified osteomyelitis, other specified sites depressive disorder, not elsewhere classified sepsis pressure ulcer, lower back hydronephrosis paraplegia cyst of kidney, acquired neurogenic bladder nos 

Answer: The patient is high likely exposed to