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: no known allergies / adverse drug reactions attending: chief complaint: ams major surgical or invasive procedure: nephrostomy tube history of present illness: 80 yo male with history of parkinson's disease, dementia, cad, and chf with ef 25% who presented for altered mental status. he was last at his baseline yesterday at 10am. last night, his careworkers reported that he was refusing medications and hallucinating. over the past few days he has had his eyes closed more and has had a decreased appetite. last night, he was diaphoretic and uncovering himself in bed. he was very restless and pointing to his abdomen. this morning, patient remained altered and had one episode of emesis. his finger sticks were also higher than they were normall, elevated at 280 from 100. at baseline, pt speaks few words in greek and is bed-bound, but is responsive and recognizes familiar faces. in the ed, initial vitals were: hr85, bp 132/89, rr 16, 02 97% ra, rectal temp 101.2. he was responsive only to pain. -ua was grossly positive -he was given ceftriaxone -he was tachy with abd pain? ct abdomen performed and revealed 8-mm obstructing right mid ureteric stone with upstream hydronephroureter. -urology deferred to ir -ir to put in perc neph tube tonight -initial lactate 4.1 w/ markedly abnl ua suggestive of infection. pt received rectal tylenol, 2l ns. pt also given zofran for nausea after several episodes of gagging. -cxr nonacute. ct head negative for intracranial hemorrhage. -access 2piv most recent vitals prior to transfer: he went to ir for perc neph tube placement where he was on pressors during the procedure. an 8f catheter was placed on the right side draining to vac. on arrival to the micu, he will not respond to voice or noxious stimuli. family reports this is at his baseline at times. review of systems: unable to report. past medical history: 1. parkinson's disease, severe, with dementia 2. cad s/p stemi with pci/stenting of lad 3. chf with ef 25% in ' 4. hypertension 5. hyperlipidemia 6. dm on glypizide 7. chronic bilateral shoulder pain 8. appendectomy 9. dvt on chronic lmwh social history: lives with wife at home, and full-time caretaker. cannot walk with walker anymore, bed-bound. few greek words on occasion. cannot perform any adls. no tob/etoh/illicits. family history: non-contributory to current presentation physical exam: admission exam: vitals: tm 100.6 tc 99.8 hr 72 bp 141/39 rr 17 spo2 95/ra general: awake and alert, makes eye contact, appears comfortable heent: perrl, eomi, dry mmm neck: no carotid bruits, jvp not elevated lungs: ctab heart: rrr, normal s1 s2, no mrg abdomen: soft, nt, nabs, no organomegaly back: no cva tenderness appreciated, nephrostomy drain in place on right gu: foley in place extremities: trace le edema, 1+ dp pulses bilat neurologic: a&ox0, tries to communicate, follows simple commands by miming, moving all extremities, unable to cooperate with full neuro exam. fasked face with ridigity in upper extremities. discharge exam: vitals: t 98, hr 54 bp 130/60 rr 20 spo2 97% ra general: asleep, but easily arousable heent: perrl, eomi, moist mmm neck: no carotid bruits, jvp not elevated lungs: ctab heart: rrr, normal s1 s2, no mrg abdomen: soft, nt, nabs, no organomegaly back: no cva tenderness appreciated, nephrostomy drain in place on right gu: condom catheter in place. extremities: no le edema neurologic: sleeping, and slightly snoring pertinent results: admission labs: 01:45pm blood wbc-7.2 rbc-4.00* hgb-11.1* hct-35.0* mcv-88 mch-27.6 mchc-31.6 rdw-14.3 plt ct-158 01:45pm blood neuts-95.6* lymphs-3.2* monos-0.9* eos-0.3 baso-0.1 01:45pm blood pt-11.6 ptt-32.0 inr(pt)-1.1 01:45pm blood glucose-256* urean-32* creat-1.4* na-139 k-4.3 cl-104 hco3-24 angap-15 01:45pm blood alt-17 ast-15 alkphos-45 totbili-0.8 01:45pm blood albumin-3.6 calcium-9.0 phos-2.4* mg-1.8 lactate trend: 02:00pm blood lactate-4.1* 05:17pm blood lactate-3.5* 04:38am blood lactate-1.9 discharge labs: 06:40am blood wbc-6.7 rbc-3.74* hgb-10.4* hct-31.9* mcv-85 mch-27.7 mchc-32.5 rdw-14.2 plt ct-170 06:40am blood glucose-185* urean-18 creat-0.6 na-140 k-4.0 cl-104 hco3-28 angap-12 06:40am blood calcium-8.4 phos-2.7 mg-1.7 microbiology: 1:45 pm blood culture **final report ** blood culture, routine (final ): proteus mirabilis. final sensitivities. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml ________________________________________________________ proteus mirabilis | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- 8 r cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ 8 i meropenem-------------<=0.25 s piperacillin---------- s tobramycin------------ 4 s trimethoprim/sulfa---- =>16 r 2:10 pm urine **final report ** urine culture (final ): proteus mirabilis. >100,000 organisms/ml.. presumptive identification. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ proteus mirabilis | amikacin-------------- <=2 s ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ =>16 r meropenem-------------<=0.25 s tobramycin------------ 8 i trimethoprim/sulfa---- =>16 r imaging: # chest (portable ap) study date of findings: single ap upright radiograph of the chest was obtained. the lungs are slightly lower in volume but clear. there is no pleural effusion or pneumothorax. heart is top normal in size with normal cardiomediastinal contours. # ct head w/o contrast study date of findings: there is no intracranial hemorrhage, mass effect, edema, or shift of normally midline structures. the -white matter differentiation is preserved. there is extensive periventricular and subcortical white matter hypoattenuation, compatible with a small vessel ischemic disease. ventricles and sulci are prominent, compatible with age-related involution. suprasellar and basilar cisterns are patent. paranasal sinuses and mastoid air cells are well aerated. vascular calcifications are seen in the cavernous carotid arteries. the middle ear structures are symmetric. soft tissue density in bilateral external auditory canals likely represents cerumen. globes are intact with bilateral lens replacement. impression: 1. no acute intracranial process. 2. extensive age-related involution and small vessel ischemic disease. 3. if there is persistent clinical concern for ischemia, consider mri if not contraindicated. # ct abd & pelvis with contrast study date of ct abdomen: there is trace bibasilar dependent atelectasis. the heart is normal in size without pericardial effusion. multivessel coronary arterial calcifications are noted, with concurrent aortic valve calcification. the liver demonstrates no focal lesion. the gallbladder, spleen, and adrenal glands appear unremarkable. the pancreas is diffusely atrophic and demonstrates a 9-mm cyst in the head. there is no pancreatic ductal dilatation. the nephrograms are symmetric. there is moderate right hydronephroureter upstream of an 8-mm mid ureteric stone (2, 51). there is also a suggestion of urothelial hyperenhancement upstream of the stone, suggestive of pyelitis. there is no left-sided renal obstruction. no additional stone is seen. moderate stranding and free fluid is seen around the right kidney. small and large bowel loops are normal in caliber. trace free fluid is seen subjacent to the cecal tip. there is no intra-abdominal lymphadenopathy. great vessels are patent. moderate atherosclerotic disease is present throughout the descending aorta extending into branching vessels. there are bilateral renal cysts, some of which too small to fully characterize. ct pelvis: the bladder is partially distended, but demonstrates urothelial hyperemia and mural thickening, likely reflecting presence of cystitis. there is nondependent air and a foley catheter in place, possibly related to recent instrumentation. the prostate gland appears enlarged to 5.9 cm. there is significant fecal impaction within the rectum. no inguinal or pelvic sidewall adenopathy. no focal concerning lesion. multilevel lower thoracic spondylosis is present. impression: 1. 8-mm right mid ureteric obstructing stone with moderate upstream hydronephroureter, as well as urothelial hyperenhancement suggestive of pyelitis. consider percutaneous nephrostomy placement. 2. bladder thickening and urothelial hyperenhancement suggestive of concurrent cystitis. 3. bilateral renal cysts. 4. 9-mm pancreatic head cyst, statistically most likely to represent side branch ipmn, which could be followed by mrcp. # portable abdomen study date of findings: there is an 8-mm main ureteral stone seen on the right which appears to be similar in location as seen on the ct exam. right percutaneous nephrostomy tube catheter is in place. there is a nonspecific bowel gas pattern with air in both the colon and small bowel. there is no evidence of obstruction, ileus, or large amount of free air. there are degenerative changes in the lower lumbar spine. impression: 8-mm right mid ureteral stone in similar position as prior ct. brief hospital course: 80 yo male with history of parkinson's disease, dementia, cad, and chf with ef 25% who presented for altered mental status found to have a uti and an obstructing right mid ureteric stone with upstream hydronephroureter. his mental status improved with ceftriaxone treatment. active issues: # urosepsis: patient presented with fever, hypotension, and left shift with positive ua as the source. pt was found to have a uti with upstream hydronephroureter and acute kidney injury secondary to obstructing right mid ureteral stone. patient underwent urgent decompression of the right collecting system with percutaneous nephrostomy tube in ir. he was transiently hypotensive during the procedure requiring pressors, which the patient was quickly weaned from. he was initially placed on ceftriaxone, but then broadened to cefepime when blood cultures returned positive for gram negative bacteremia. however, he was narrowed back to ceftriaxone once speciation and sensitivities returned. his lactate was elevated on presentation, which normalized with ivfs. anti-hypertensives were held on admission. mental status improved after two days of antibiotics and blood cultures were negative for 48 hours before he was discharged. antibiotics will be continued for a total of 2 weeks, until . patient has a midline for antibiotic administration in his rehab facility. # : pt's creatinine noted to be doubled compared to patient's baseline on admission, likely secondary to obstruction from nephrolithiasis and prerenal state secondary to poor po intake and febrile illness. his creatinine trended down with resolution of obstruction and ivf. his serum creatinine improved with ivfs and correction of obstruction and are now to his baseline of 0.8. # altered mental status: this was attributed to fevers, uti, and dehydration from febrile illness. family reports he is now back to his baseline. chronic issues: # normocytic anemia: likely secondary to anemia of chronic disease. pt was guaiac negative in ed. his hct remained stable in icu and on medical unit. # dvt: pt was on sub therapeutic dosing of lovenox on admission. this was increased to 1.5 mg/kg/day prior to discharge. # chf: last ef reported 25%. pt was hypovolemic on admission and was fluid resuscitated. he appeared euvolemic on discharge and was satting well on room air. # cad/htn: pt was continued on his aspirin. his lisinopril and metoprolol were initially held for hypotension but these were resumed without problem on the medical unit. # hl: continued atorvastatin. # parkinson's: continued carbidopa-levodopa. initially his home seroquel was held given ams, but then tolerated it well once mental status improved. # dm: pt's glipizide was held while in house, but resumed on discharge. # constipation: continued miralax. also added colace, senna and bisacodyl. # urinary retention: patient required foley placement. started on flomax. #transitional issues: pt will be discharge to rehab for iv antibiotic treatment. he will need to follow up with urology on for continued treatment planning of his obstructing kidney stone. they will also determine whether his foley can be discontinued at that time. medications on admission: 1. atorvastatin 80 mg po daily 2. carbidopa-levodopa (25-100) 0.5 tab po tid 3. glipizide 10 mg po daily 4. lisinopril 5 mg po daily 5. metoprolol succinate xl 100 mg po daily 6. aspirin 81 mg po daily 7. quetiapine fumarate 12.5 mg po bid 8. polyethylene glycol 17 g po daily 9. enoxaparin sodium 60 mg sc daily discharge medications: 1. aspirin 81 mg po daily 2. atorvastatin 80 mg po daily 3. carbidopa-levodopa (25-100) 0.5 tab po tid 4. polyethylene glycol 17 g po daily 5. glipizide 10 mg po daily 6. lisinopril 5 mg po daily 7. metoprolol succinate xl 100 mg po daily 8. enoxaparin sodium 100 mg sc daily 9. quetiapine fumarate 12.5 mg po bid hold for sedation or rr<10. 10. ceftriaxone 1 gm iv q24h 11. docusate sodium (liquid) 100 mg po bid:prn constipation 12. heparin flush (10 units/ml) 2 ml iv prn line flush mid-line, heparin dependent: flush with 10 ml normal saline followed by heparin as above, daily and prn per lumen. 13. senna 1 tab po bid:prn constipation 14. outpatient lab work please have labs checked at your urology appointment on : cbc, chem 10, ast, alt, alk phos, total bili have results faxed to dr. phone: fax: icd 9:995.91 15. iv care please discontinue midline once antibiotic course is complete. 16. tamsulosin 0.4 mg po hs discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary: urosepsis right obstructing kidney stone urinary retention secondary: diabetes hypertension coronary artery disease parkinson's discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: dear mr. , it was a pleasure taking care of you. you were admitted to the hospital for altered mental status and were found to have a urinary tract infection that had spread to your blood stream, likely a result of blockage of your right urinary tract from a kidney stone in your right kidney. you were treated with intravenous antibiotics which you must continue taking to make sure that infection resolves. you have an appointment scheduled with urology on for follow up of your kidney stone. please make the following changes to your medications: # start ceftriaxone 1 gram every 24 hours, last dose 7/15 # start flomax 0.4mg qhs for urinary retention continue all other medications as prescribed. followup instructions: department: surgical specialties when: wednesday at 9:00 am with: urology unit building: sc clinical ctr campus: east best parking: garage procedure: percutaneous nephrostomy without fragmentation central venous catheter placement with guidance diagnoses: other primary cardiomyopathies anemia of other chronic disease other chronic pain coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified percutaneous transluminal coronary angioplasty status sepsis constipation, unspecified other and unspecified hyperlipidemia old myocardial infarction chronic systolic heart failure personal history of venous thrombosis and embolism do not resuscitate status dementia in conditions classified elsewhere without behavioral disturbance dehydration calculus of ureter dementia with lewy bodies pain in joint, shoulder region other specified retention of urine septicemia due to gram-negative organism, unspecified hydroureter 

Answer: The patient is high likely exposed to