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: wellbutrin / ciprofloxacin attending: chief complaint: altered mental status major surgical or invasive procedure: percutaneous nephrostomy tube (left) history of present illness: ms. is a 64 year old female transferred from for altered mental status and hyperkalemia. she was originally seen by her pcp after her husband found her with ams. her pcp had found elevated potassium and sent her to the ed at . there she was delirious and removed her pivs. at that time she reported abdominal pain and ct of the abdomen should left-sided hydroureter and hyrdonephrosis near the surgery site from prior colostomy. she also had a positive urinalysis and was given flagyl 500mg iv and ceftriazone 1g iv. the gynecologic oncologists at who had performed her initial surgery evaluated her and felt it was not related to her procedure. she also had a head ct showing no intracrainal hemorroage. she was given 10mg haldol and ativan 2mg and there was concern for a proglonged qtc. cr was acutely elevated to 2.8. a foley was placed and she was transferred to . of note, her son died a week ago of possible suicide. in the ed, initial vitals were: 99 57 189/90 16 100%rat. patient had a piv placed. she required a possey for restraints and removed 3 pivs. ekg showed qtc with 452. on the floor, pt was very confused and unable to answer most questions except for yes or no, but not always appropriately. past medical history: hospital admission for rectal bleeding -clear cell vaginal ca s/p resection with descending colostomy; finished xrt 3 months ago -type 2 dm -htn -gerd -hypercholesterolemia -endometriosis s/p exploratory laparotomy, lysis of adhesions, resection of left pelvic lymph nodes; had a hysterectomy and uso in for the endometriosis oncologic history clear cell vaginal ca - presentation: with vaginal bleeding stage iiib, fungating mass at vaginal cuff with ext to pelvic sidewall on the left side and posteriorly to the rectosigmoid, but not through the muscularis. - pet scan revealed a 4.5 x 4.0 cm fdg avid mass superior to the left side of the vaginal cuff. no abnormal fdg focus was identified elsewhere. - underwent 6 wks cisplatin and daily xrt - per tumor board rec, s/p exlap, resection of pelvic nodes, and diverting colostomy and s/p interstitial implants for brachytherapy - implants did not penetrate tumor - s/p colostomy by dr. - disease ext to the serosal surface of the bowel - underwent cyberknife rt social history: lives with husband. she denies tobacco, drug, or alcohol use. no h/ . family history: her mother had breast cancer in her 50s. physical exam: on admission: vitals: t: 98.3 bp: 189/90 p: 98 r: 18 o2: 100% general: not orietated, somulent, opens eyes to voice, only answers yes or no, not always appropriate, no acute distress heent: sclera anicteric, dry mm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi back: no cva tenderness cv: regular rate and rhythm, normal s1 + s2, systolic murmur loudest at llsb abdomen: soft, slightly tender in left quadrant, non-distended, bowel sounds present, gu: foley present ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: ct ab/pelvis impression: 1. left hydronephrosis and hydroureter to a moderate degree with transition at the left cuff soft tissue mass and surgical clips/fiducial seeds. 2. left vaginal cuff mass that is poorly defined without contrast but inseparable from the left posterior lateral aspect of the bladder, the left anterolateral aspect of the rectum, the sigmoid colon, the left levator ani, the left superior obturator internis and possibly the left sciatic nerve. it is uncertain how much of this is tumor versus scarring. 3. cholelithiasis without evidence of cholecystitis. 4. a 1.8 cm segment 4a liver lesion is likely a cyst but incompletely characterized in this patient with known cancer. 12:17pm urine rbc-0-2 wbc-* bacteria-occ yeast-none epi-<1 12:17pm urine blood-tr nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-sm urine culture (final ): <10,000 organisms/ml mixed bacterial flora ( >= 3 colony types), consistent with fecal contamination. admission labs: 12:17pm wbc-8.5 rbc-2.96* hgb-8.1* hct-25.9* mcv-87 mch-27.4 mchc-31.3 rdw-14.0 12:17pm plt count-383 12:17pm glucose-90 urea n-17 creat-2.3* sodium-140 potassium-3.5 chloride-103 total co2-24 anion gap-17 discharge labs: 05:38pm blood wbc-8.4 rbc-3.25*# hgb-9.5*# hct-28.9*# mcv-89 mch-29.1 mchc-32.7 rdw-14.4 plt ct-417 06:09am blood glucose-92 urean-12 creat-1.5* na-140 k-3.6 cl-109* hco3-25 angap-10 brief hospital course: 64 year old female with h/o vaginal clear cell ca who presented to with ams, elevated potassium, and acute renal failure and was found to have hydroureter and obstruction. she was originally admitted to the medical icu and then transferred to the floor for further care. # acute renal failure/renal obstruction: her creatinine on admission was 2.8 on presentation to and she was hyperkalemia. ct abdomen showed hydroureter on the left side and she had a positive urinalysis. her renal failure was thought to be both prerenal and caused by obstruction. she received a percutaneous nephrostomy tube on the left side by interventional radiology without complication. she also received iv fluids and her creatinine trended down to 1.5 on discharge. she also had a positive urinalysis at and was started on treated with cefepime for a complicated obstructive uti. she will need at least two weeks of treatment with cefepime depending on the duration of her nephrostomy tube and when her urine cultures are clear. she was discharged with iv antibiotics and was instructed to continue her antibiotics for a least two weeks until she is seen by ir for possible internalization of her nephrostomy tube. there is some concern that recurrence of her cancer is causing obstruction on the left side, and further imaging/workup will likely be needed as an outpatient. # altered mental status: she was acutely delirious on admission, likely from her uti, renal obstruction, hyperkalemia, and uremia. her ams resolve with treatment of her renal failure and hyperkalemia. she had a negative head ct and had returned to baseline mental status at the time of discharge. # hypertension: she was hypertensive throughout her admission. initially her home dose of lisinopril was held due to acute renal failure. however, as her renal failure resolved it was restarted prior to discharge. she was also started on amlodipine for closer bp control. she still had high blood pressures (190's/90's), typically at night, throughout the hospitalization and was managed occasionally with iv hydralazine. she remained asymptomatic during these episodes. # type 2 diabetes mellitus: she was managed on an insulin sliding scale and her metformin was held during her stay. it was restarted at discharge. # anemia: she has a history of anemia. her hematocrit trended down slightly during her stay, thought to be related to her nephrostomy tube procedure. prior to discharge, she received 1 unit of blood with an appropriate bump in her hematocrit. she should have her hematocrit checked as an outpatient. she did not have any episodes of rectal bleeding during this admission. # hyperkalemia: resolved with ivf and resolution of her renal failure. she was monitored on telemetry for any ecg changes associated with increased potassium but did not have any. # vagnial cancer: she is status-post treatment but there is some concern for recurrence vs scarring on the outside hospital ct scan. she is concerned about possible recurrence and will need close follow-up with surgery or gynecologic oncology. her fentayl patch was continued while in house. # history of gi bleed: she has a recent history of rectal bleeding, but had no episodes during her stay. she was continued on her home ppi. # depression/anxiety: she recently lost her son to suicide and expressed some depressive symptoms such as sadness and some lack of energy. she was continued on her home dose of citalopram and discharged on her home ativan. she was encouraged to follow-up with a mental health provider. # communication: with patient and her husband ; cell: # code: she was dnr/dni during this hospitalization, confirmed on admission to the floor medications on admission: citalopram 40mg qday fentanyl 12mcg/hr patch q72 h lisinopril 40mg qday lorazepam 1mg prn q6h for nausea metformin 500mg metoprolol 100mg morphine 15mg q4h prn pain omeprazole 20mg qday ondansetron 8mg tid prn nausea miralax qday coalce 200mg discharge medications: 1. heparin, porcine (pf) 10 unit/ml syringe sig: two (2) ml intravenous prn (as needed) as needed for line flush. disp:*100 ml(s)* refills:*0* 2. cefepime 1 gram recon soln sig: 0.5 g intravenous once a day. disp:*15 doses* refills:*0* 3. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 4. miralax 17 gram powder in packet sig: one (1) dose po once a day as needed for constipation. 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 6. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). disp:*40 tablet(s)* refills:*0* 7. metoprolol tartrate 50 mg tablet sig: two (2) tablet po bid (2 times a day). 8. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*0* 9. fentanyl 12 mcg/hr patch 72 hr sig: one (1) patch 72 hr transdermal q72h (every 72 hours). 10. morphine 15 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 11. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 12. zofran 8 mg tablet sig: one (1) tablet po three times a day as needed for nausea. 13. lorazepam 1 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. 14. metformin 500 mg tablet sig: one (1) tablet po twice a day. discharge disposition: home with service facility: home care solutions discharge diagnosis: primary diagnosis: acute renal failure secondary diagnoses: altered mental status hypertension type ii diabetes discharge condition: good, ambulating independently, vital signs stable discharge instructions: you were admitted to the hospital with altered mental status and acute kidney failure. you initially went to the intensive care unit and were given iv fluids and had a nephrostomy tube (a tube from your kidney to your skin) placed. in addition, your potassium level was very high. your kidney failure and your high potassium resolved. you were also found to have a urinary tract infection at an outside hospital and you are now being treated with iv antibiotics. changes to your medications: added amlodipine 10mg po daily (for blood pressure) added cefepime 500mg iv daily until your primary care doctor l radiologist tells you that you can stop. if you experience any chest pain, shortness of breath, altered mental status or confusion, call 911 or go to the hospital immediately. if you have fevers, abdominal pain, diarrhea, constipation or other symptoms, go to the hospital or call your primary care doctor. it is important that you go to your follow-up appointments as scheduled. you need to be treated with antibiotics for at least two weeks until your urine cultures are clear or until your nephrostomy tube is removed. you will need to follow-up with your primary provider or interventional radiology to ask when to stop taking your antibiotics. you had a urine culture drawn before you left the hospital that is still pending at this time. in addition, your blood count (hematocrit) was low during your hospitalization. you were given one unit of blood before discharge. it is important that you have your hematocrit checked when you visit your primary care doctor. you should also have your kidney function (creatinine) and blood pressure checked as you had high blood pressure during your hospitalization and you were started on a new blood pressure medication. followup instructions: you have the following appointments: provider: , md phone: date/time: 11:30 provider: , md phone: date/time: 3:30 provider: , md phone: date/time: 2:45 you should also follow-up with interventional radiology (ir). their office will be in contact with you regarding a follow-up appointment. if you do not hear from them in the next 2-3 days, please call their office to make an appointment. md, procedure: percutaneous nephrostomy without fragmentation diagnoses: hyperpotassemia anemia, unspecified esophageal reflux pure hypercholesterolemia urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified dysthymic disorder hydronephrosis colostomy status personal history of malignant neoplasm of other female genital organs secondary malignant neoplasm of large intestine and rectum other ureteric obstruction 

Answer: The patient is high likely exposed to