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: macrobid attending: chief complaint: altered mental status major surgical or invasive procedure: endotracheal intubation history of present illness: east hospital medicine attending transfer to floor accept note the patient is an 86 yo f with h/o orthostatic hypotension and recent sah in sustained following a mechanical fall who presented to the ed this evening with acutely altered mental status with incoherent speech. for the past week, she has been having b/l "body" tremors including ue and head. the episodes last about 10 mins and are low amplitude. her daughter describes an episode where she begins to fall following the episode, but that she is speaking during the event and is not confused either during or after the episode. she also has been experiencing a -temporal headache that began on wednesday evening and was associated with decreased appetite, nausea and vomiting. the daughter's report that their mother described it as pressure like on both sides of her head. on the night prior to admission, she got up to use the bathroom and reported sustained a mechanical fall on to her left hip (not uncommon for her according to her daughter), following which she was "normal" and went back to sleep. she woke up in the morning, her home health associate noted that she "was not her self" and took her to see her pcp. head ct (nchct) was done and reportedly negative. she also had left hip films which revealed fractures of the l superior and inferior pubic rami (subacute vs old) with minor degenerative changes. her bp was recorded at 124/70. of note, the patient sustained a hip fracture over the summer. upon returning home, she slept from 2pm-5pm and upon wakening, she was acutely altered and confused with incoherent speech and was brought to the ed. in the ed, inital vitals were, 191/127, 94, 22, 98% on ra. a code stroke was called. she was electively intubated due to agitation so that she could undergo her imaging studies. a nchct preliminary showed no acute intracranial process. as per the neuro consult note, a cta of the head and neck showed normal vasculature with no thrombi or dissections and a ct perfusion study did not reveal any perfusion deficits. she was not given tpa as she thought to be outside of the therapeutic window. neurology reported her neuro exam was non localizing and that the etiology of her ams was not entirely clear. they are concerned for pres or a hypertensive encephalopathy given her dramatic swings in bp. of note, during her ed course, she spiked a fever to 102 f and was also found to have a ua c/w uti and was given ceftriaxone. she was then transfered to the icu for further management. vitals on transfer were, 103/79 98 rr 16 on vent, vt 400, peep 5, fio2 50%. she was hypertensive on arrival with a recorded sbp of 190. she was not given antihypertensives, however following sedation with propofol her sbp was in the 140s. she was switched from propofol to fent/versed just prior to transfer. of note, she dropped her bp to 82/55 while being moved to the stretcher and required a 500cc bolus. her bp then improved to 106/66. in the icu, her uti was treated with bactrim. she was subsequently extubated and her mental status was found to be at baseline. in the icu, her uti was treated with bactrim. she was transferred to the medicine floor for further management. on the medicine floor, she reports no problems. she endorses left hip pain only when she is moving around. she denies headache, chest pain, shortness of breath, diarrhea, fevers, chills, nausea, vomitting. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies visual changes, headache, dizziness, sinus tenderness, neck stiffness, rhinorrhea, congestion, sore throat or dysphagia. denies chest pain, palpitations, orthopnea, dyspnea on exertion. denies shortness of breath, cough or wheezes. denies nausea, vomiting, heartburn, diarrhea, constipation, brbpr, melena, or abdominal pain. no dysuria, urinary frequency. denies arthralgias or myalgias. denies rashes. no increasing lower extremity swelling. no numbness/tingling or muscle weakness in extremities. no feelings of depression or anxiety. all other review of systems negative. past medical history: - orthostatic hypotension, bp range on average 90-150 systolic. - sah () following ?mechanical fall during which she also sustained a orbital fracture - hyperlipidema - urinary incontinence - hip fracture, noted in . imaging studies not entirely clear, but daughter reported it is on the l and was incorrectly reported as r on ct. - chronic le edema - chronic hearing loss - osteoporosis social history: lives by her self, has hha but not 24 hrs, family attempts to fill gaps in supervision. has frequent falls primarily orthostatic hypotension sustaining injuries including sah, hip fx, facial fx. was in rehab following fall from a stair for 6 weeks in summer . family history: not relevent to presentation of altered mental status and uti in an 86 y/o f. physical exam: vs: 98.2 134/60 89 20 96%ra; 0/10 pain at rest; left hip pain with movement gen: no apparent distress, pleasant heent: no trauma, pupils round and reactive to light and accommodation, no lad, oropharynx clear, no exudates cv: regular rate and rhythm, no murmurs/gallops/rubs pulm: clear to auscultation bilaterally, no rales/crackles/rhonchi gi: soft, non-tender, non-distended; no guarding/rebound ext: no clubbing/cyanosis/edema; 2+ distal pulses; peripheral iv present; pneumoboots in place neuro: alert and oriented to person, place and situation; cn ii-xii intact, motor function globally derm: ecchymoses on left upper posterior thigh/butt pertinent results: 08:15pm blood wbc-9.8 rbc-3.46* hgb-11.3* hct-32.9* mcv-95 mch-32.6* mchc-34.3 rdw-13.3 plt ct-290 08:15pm blood pt-12.7 ptt-19.8* inr(pt)-1.1 04:30am blood glucose-148* urean-16 creat-1.0 na-136 k-4.2 cl-102 hco3-27 angap-11 04:30am blood alt-6 ast-24 ld(ldh)-153 ck(cpk)-136 alkphos-21* totbili-0.5 08:15pm blood ctropnt-<0.01 04:30am blood albumin-3.4* calcium-8.4 phos-4.0 mg-1.6 04:30am blood tsh-2.4 04:30am blood vitb12-565 folate-greater th 04:27am blood hapto-71 07:05am blood glucose-95 urean-10 creat-0.7 na-139 k-3.5 cl-103 hco3-26 angap-14 07:05am blood wbc-8.2 rbc-2.88* hgb-9.2* hct-27.2* mcv-95 mch-32.0 mchc-33.8 rdw-15.3 plt ct-277 urinalysis: 10:30pm urine color-straw appear-hazy sp -1.046* 10:30pm urine blood-sm nitrite-pos protein-30 glucose-neg ketone-tr bilirub-neg urobiln-neg ph-7.0 leuks-lg 10:30pm urine rbc-66* wbc-83* bacteri-many yeast-none epi-0 10:30pm urine casthy-2* 10:30 pm urine site: catheter **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- 8 r cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s imaging: cta head () impression: 1. no evidence of infarction, or hemorrhage. 2. no evidence of stenosis, occlusion, or aneurysm . 3. calcified plaque at the left distal common carotid artery causing approximately 25% stenosis. cxr () impression: endotracheal tube in appropriate position. trace right pleural effusion. mri head () impression: limited study. with this limitation in mind, there is no large territorial infarct seen on diffusion-weighted imaging. ct chest/abd/pelvis () impression: 1. massive left gluteal/posterior thigh hematoma measuring 12.9 x 7.7 x 19.8 cm. active extravasation cannot be assessed given the lack of intravenous contrast material. 2. multiple old fractures involving the left scapula, left posterior ribs, and left pelvic bones, as described above. 3. lingular pulmonary nodule measuring 2 mm requires no additional followup if this patient is a non-smoker and has no prior history of malignancy. otherwise, followup with a chest ct in one year is recommended. brief hospital course: 86 year-old woman with orthostatic hypotension and recent sah in following a mechanical fall presented to the ed this evening with acutely altered mental status with incoherent speech. #. delirium from metabolic encephalopathy: the patient presented with an acute alteration in her mental status which was originally concerning for a neurologic origin. a code stroke was called and her initial imaging (nchct, cta head, and ct perfusion imaging) did not reveal an acute neurologic cause. neurology was consulted and recommened an mri of the head to evaluate for other causes including pres or hypertensive encephalopathy, and while the study was limited by motion artifact, it did not reveal any neurology abnormalities. upon arrival, the patient was found to have a ua consistent with a uti. she was originally treated with antibiotics as below, and her mental status greatly improved and it seems most likely that her ams was a result of her infection. upon transfer from the icu, the patient was reportedly almost back at her baseline mental status which some residual confusion as per her daughter. she was alert and oriented to name and place, and was not oriented to year, but did know that it was . on the floor she is alert and oriented to name, place, and date, but does still get confused sometimes. #. orthostatic hypotension: upon arrival to the icu, the patients blood pressure was highly elevated. following her intubation, her bp began to drop and fluctuated widely early in her admission. her home medications for orthostatic hypotension were held and her sedation while intubated was limited to minimize swings in bp. following extubation, her bp remained more stable and her home medications were restarted. the day of transfer from the micu, her bp ranged from 123/55 to 166/77. - continue home midodrine and fludrocortisone #. urinary tract infection, e coli: patient's urinalysis was found to be consistent with uti. she was started on ceftriaxone and her mental status improved as above. when cultures returned, she was transitioned to bactrim in the icu. due to a concern for potential allergy to bactrim per icu and per ucx sensitivities, her bactrim was changed to ciprofloxacin. 5 total days of antibiotics were administered. #. anemia: stable. it was noted that the patients hematocrit had decreased from admission (34.9 to 24.0). hemolysis labs were done and were unrevealing. a ct scan of the chest/abdomen/pelvis was done which revealed a large hematoma surronding her left hip (consistent with the events surronding her fall prior to admission). she was closely monitored for compartment syndrome. she received a total of 4 units of prbcs while in the icu and her hematocrit stablized. #. respiratory status: stable. the patient was electively intubated for airway protection in the setting of her acute agitation and need for emergent head imaging. she was extubated without event the following afternoon and was satting well on room air prior to and after her transfer to the general medical floor. #. hip fractures: at the time of her fall prior to admission, the patient also fell onto her l hip. plain films done at her pcps office revealed left sided fractures, which were known from a prior fall. as above, the patient also underwent a ct scan which revealed a large hematoma around her left hip. - pain control with acetaminophen and lidocaine patch. avoid narcotic pain medications if possible as they may worsen her confusion. #. hyperlipidemia: the patient statin was initially held when she was intubated and restarted prior to her transfer to the general medical floor. continue home simvastatin. #. communication: daughter: : #. code: full code medications on admission: -potassium chloride 10 meq oral tablet extended release take 1 tablet twice daily or as otherwise directed -midodrine 10 mg oral tablet take one tablet three times daily or as otherwise prescribed -fludrocortisone (florinef) 0.1 mg oral tablet take 1 tablet daily until otherwise instructed -simvastatin 40 mg oral tablet 1 tablet every evening for cholesterol -calcium oral -multivitamin oral discharge medications: 1. midodrine 5 mg tablet sig: two (2) tablet po tid (3 times a day). 2. fludrocortisone 0.1 mg tablet sig: one (1) tablet po daily (daily). 3. simvastatin 40 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 4. potassium chloride 10 meq tablet extended release sig: one (1) tablet extended release po twice a day. 5. calcium 500 500 mg calcium (1,250 mg) tablet sig: one (1) tablet po twice a day. 6. multivitamin tablet sig: one (1) tablet po once a day. 7. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for left lower back. 8. acetaminophen 650 mg tablet sig: one (1) tablet po every hours as needed for fever or pain. discharge disposition: extended care facility: at discharge diagnosis: - metabolic encephalopathy - urinary tract infection - anemia from acute blood loss - left upper thigh hematoma - orthostatic hypotension discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - should not ambulate without assistance from another person to supervise. discharge instructions: you presented with delirium likely caused by urinary tract infection. ct scan of the head did not reveal a stroke. you were also found to have a low blood count and were found to have bleeding into your upper left thigh. you received blood transfusions. your confusion is improving, but you are not quite at your baseline yet. you will complete a course of antibiotics for your urinary tract infection. your blood count was stable after the blood transfusions. followup instructions: after you are discharged from rehab, you should make an appointment for follow-up with your primary care physician: name: , j location: - address: 291 independence dr, , phone: procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: urinary tract infection, site not specified toxic encephalopathy acute posthemorrhagic anemia other and unspecified hyperlipidemia acute respiratory failure disorders of phosphorus metabolism osteoporosis, unspecified fall from other slipping, tripping, or stumbling delirium due to conditions classified elsewhere oliguria and anuria orthostatic hypotension history of fall other and unspecified escherichia coli [e. coli] contusion of hip 

Answer: The patient is high likely exposed to