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: morphine attending: chief complaint: altered mental status, crushing chest pain major surgical or invasive procedure: central line placement picc line placement arterial line placement attempted lumbar puncture history of present illness: 61 yo m with h/o alternative conduction disorder s/p ablation about 10 years ago and recent viral illness presents with acute onset altered mental status, fever, crushing chest pain, required intubation for airway protection. history is obtained from collaterals. per report from wife, patient returned home at around 10pm after driving the stop & shop truck. patient apparently reported not feeling well and thought that perhaps he caught something from his co-worker. was a&o x 3 on the day prior to admission, but woke up around 4-5am with shaking chill and shortness of breath, requiring inhaler. this morning, patient was home taking care of the dog. a maintenance person called to cancel an appointment today and the patient stated that he was not feeling well with overall weakness and substernal chest pain. wife was informed at work, and ems was called. patient was noted to be diaphoretic, tachycardic up to the 170s, htn up to the 200s/100s by ems. ekg was suggestive of ste. he was given 3 ntg without much relief. he was noted to be hypoxic requiring supplemental oxygen. morphine was not given b/c anaphylaxis rxn to morphine. upon arrival to the ed, vs t 100.4, bp 210s/110s, hr 150s. patient nodded "yes" to pain, but was unable to localize. he did not answer further questions. neurological exam was limited given mental status- apparently wiggled his toes but did not squeeze hands. his ue was noted to have a coarse tremor vs. shaking, but not rhythmic per report. right lower lip seemed to be drooping. he vomited 1x and had incontinence of stool x 2. ekg showed diffused ste but cardiology thought it is less likely stemi. labs were significant for wbc 7.5, h/h 14 and 42.8, plt 140, inr 1.1, fibrinogen 404, crt 1.3, lipase 20, serum tox screen negative, lactate initially 4.6--> 2.4. initial vbg 7.39/39/39/24. he received metoprolol 5 mg iv x 2 for tachycardia and hr improved to 130s with sbp down to 130s. he was subsequently paralyzed, intubated with etomidate and succ for airway protection given obtunded ms. underwent cta head which did not show hemorrhage or acute infarct, there was narrowing of left internal carotid artery. cta chest did not show aortic dissection, and had suboptimal quality to evaluate for pe. cta abd/pelvis was unremarkable by preliminary read. patient was then found to have sbp into the 60s, he had cvl placed in rij and was started on phenylephrine. he was started on antibiotics- 1000 vancomycin, 800 mg acyclovir, 2g ctx. he also received 5l of ivf, 975 mg acetaminophen pr, heparin bolus. neurology was consulted, and recommended lp. per report, lp was not attempted given body habitus and that patient may need ct guided lp. vs upon transfer t40.5c, 113/62 (on phenylephrine), 112 hr, 97% intubated, 15 rr. vent settings were cmv, 50% fio2, 550 cc tv, peep 5 , rr 20 on arrival to the micu, patient's vs. temp 102.5, hr 107, bp 98/63, o2sat 100%, rr 15 past medical history: - back surgery - alternative conductive disorder, s/p ablation ~ 10 years ago - osa - hypothyroidism - hypertension - hld - recent sinus infection about 1 week prior to presentation social history: - truck driver - had a prolonged drive yesterday without any break - married with 2 daughters - smoked, quit 30 years ago, < 1 ppd - infrequent etoh, once a month - denies drug family history: unknown physical exam: admission exam vitals: temp 102.5, hr 107, bp 98/63, o2sat 100%, rr 15 general: sedated, does not follow commands, intubated heent: sclera anicteric, + conjunctival edema, pupils 2 mm, sluggish but reactive to light, + corneal reflex, intubated neck: unable to appreciate jvp, rij in place cv: tachycardic, normal s1 and s2, no m/r/g resp: ctab, no w/c/r abd: obese, nt, bs+ extremities: warm, dry, 2+ dp pulses bilaterally gu: foley present neuro: unable to assess cn, strength or sensation. unable to elicit reflexes or babinski . discharge exam tm 100.4 (11am ), afebrile since, hr 60s, sbps 130s general: morbidly obese male appearing fatigued but in nad heent: perrl, eomi, mmm neck: from, no rigidity, no meningismus, unable to appreciate jvp given habitus heart: rrr, s1 s2 clear and of good quality, no mrg lungs: lungs cta bilaterally, moving air well and symmetrically abdomen: morbidly obese, soft/nt/nd, no rebound/guarding. gu: no supra-pubic tenderness extremities: 1+ pitting to knee improved from prior neuro: awake, a&ox3, cns ii-xii intact, muscle strength 5/5 throughout, sensation grossly intact throughout pertinent results: admission labs: 09:45am blood wbc-7.5 rbc-4.88 hgb-14.0 hct-42.8 mcv-88 mch-28.8 mchc-32.8 rdw-13.7 plt ct-140* 09:45am blood neuts-78* bands-4 lymphs-14* monos-4 eos-0 baso-0 atyps-0 metas-0 myelos-0 09:45am blood hypochr-normal anisocy-normal poiklo-normal macrocy-normal microcy-normal polychr-normal 09:45am blood pt-12.2 ptt-25.1 inr(pt)-1.1 09:45am blood fibrino-404* 09:45am blood glucose-183* urean-17 creat-1.3* na-141 k-4.4 cl-101 hco3-22 angap-22* 09:45am blood alt-26 ast-29 ld(ldh)-207 alkphos-50 totbili-0.6 09:45am blood ck-mb-2 ctropnt-<0.01 09:45am blood albumin-4.7 calcium-9.5 phos-1.9* mg-1.5* 09:50am blood type- po2-39* pco2-39 ph-7.39 caltco2-24 base xs-0 comment-green top 09:50am blood lactate-4.6* 10:01pm blood freeca-1.06* . troponins 09:45am blood ck-mb-2 ctropnt-<0.01 04:05pm blood ck-mb-21* mb indx-0.8 ctropnt-0.07* 11:52pm blood ck-mb-40* mb indx-0.6 ctropnt-0.06* 05:06am blood ck-mb-47* mb indx-0.6 ctropnt-0.03* 09:45am blood alt-26 ast-29 ld(ldh)-207 alkphos-50 totbili-0.6 09:45am blood ck(cpk)-247 . ck trend 04:05pm blood alt-60* ast-101* ck-2473* alkphos-60 totbili-0.5 11:52pm blood ck(cpk)-6925* 05:06am blood alt-417* ast-499* ck 7597* alkphos-46 totbili-0.7 05:14pm blood alt-474* ast-556* ck-8702* alkphos-49 totbili-0.9 12:01am blood alt-432* ast-542* ck 8867* alkphos-51 totbili-0.9 05:11pm blood ck(cpk)-6338* 05:38am blood ck(cpk)-5183* 05:39am blood ck(cpk)-2906* 06:00am blood alt-183* ast-152* ck(cpk)-1118* . discharge labs: 06:00am blood wbc-7.8 rbc-3.77* hgb-10.7* hct-33.1* mcv-88 mch-28.5 mchc-32.4 rdw-13.8 plt ct-136* 06:00am blood pt-13.9* inr(pt)-1.3* 06:00am blood glucose-94 urean-16 creat-0.7 na-141 k-3.7 cl-105 hco3-28 angap-12 06:00am blood alt-183* ast-152* ck(cpk)-1118* 05:39am blood calcium-8.5 phos-2.9 mg-2.1 urine 02:00pm urine color-yellow appear-hazy sp -1.033 02:00pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-lg 02:00pm urine rbc->182* wbc-56* bacteri-few yeast-none epi-0 02:00pm urine mucous-rare . micro 12:20 pm blood culture **final report ** blood culture, routine (final ): escherichia coli. final sensitivities. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ 4 s ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s urine culture (final ): escherichia coli. >100,000 organisms/ml.. _________________________________________________________ escherichia coli | ampicillin------------ 4 s ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s 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 ecg: admission sinus tachycardia. baseline artifact. left ventricular hypertrophy. delayed precordial r wave transition and left anterior fascicular block. tall peaked precordial t waves. no previous tracing available for comparison. clinical correlation is suggested. . ecg: sinus rhythm with slowing of the rate as compared with previous tracing of . left anterior fascicular block. delayed precordial r wave transition. low precordial lead voltage. compared to the previous tracing of the voltage has diminished. st-t wave changes have improved. otherwise, no diagnostic interim change. . cxr: impression: limited study due to respiratory motion and low lung volumes. no overt pulmonary edema identified. probably bilateral perihilar atelectasis. . cxr: endotracheal tube tip in standard position. nasogastric tube can only be visualized to the level of the mid esophageal region. please note that subsequent ct of the torso demonstrates a nasogastric tube tip to lie within the stomach. . cxr 1. right subclavian central venous line terminating at the atriocaval junction. 2. bilbasilar atelectasis. . cta head and neck 1. significantly limited study with high-grade stenosis of the left intracranial internal carotid artery in the cavernous and supraclinoid segments . 2. overall decreased caliber of left ica compared to the right ica is likely developmental. 3. patent intracranial vasculature. 4. no acute intracranial hemorrhage or large hypodense area to suggest acute infarction. . cta chest/abdomen/pelvis 1. no evidence of aortic dissection. 2. bibasilar atelectasis with probable aspiration particularly in the right lower lobe. 3. no evidence of acute abdominal pathology. . tte due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. no mitral regurgitation is seen. there is no pericardial effusion. impression: very limited study. grossly preserved biventricular systolic functino. no pericardial effusion seen. . cxr picc placement: impression: right subclavian picc line is present, tip overlying the distalmost svc. no ptx detected. brief hospital course: 61 yo m with h/o alternative conduction disorder s/p ablation presented initially for altered mental status, found to have gram negative bacteremia with likely dic while in micu now resolved. # gnr sepsis/shock. on admission, patient met multiple criteria for sepsis including tachycardia, fever, leukocytosis and known gnr bacteremia. arf and hematologic changes indicating end organ damage. unclear original source of infection initially. he had a cxr with no consolidation. ct of head chest and abdomen was unrevealing. he was intubated for airway protection. after intubation, his blood pressures fell to the 60s and he was started on phenylephrine and sent the micu. in the micu he was changed to levophed. his blood cultures grew gnr in bottles. his urine culture then grew pansensitive e. coli. due to fever and altered mental status, there was initial concern for meninigitis, and he was started on vancomycin, ceftazidime, acyclovir, and ampicillin. however given clinical improvement and lack of meningeal signs, the acyclovir and ampicillin where discontinued the following day. with the urine culture data, his antibiotics were narrowed to ceftriaxone. he was successfully weaned off pressures and extubated. patients clinically improved and was transferred to the general medicine service. patient was resucitated with 12l of ivfs. poor hygiene, urge incontinence and holding bladder for many hours on long truck drives with urinary stasis most likely cause of uti. serial blood cultures since negative since starting antibiotics. patient was changed to po ciprofloxacin prior to discharge and he remained afebrile. patient did have one temperature of 100.4 on am though with monitoring he remained afebrile for >24 hour prior to discharge. he was discharged with full 2 week course of antibiotics (ciprofloxacin) to treat uti and gnr bacteremia. # ams. acute onset in 24 hours prior to admission while feeling systemically ill. ct head/cta head/neck did not show acute process although does have narrowed left ica. there was question of seizure while in the ed, but most likely due to rigors in the setting of high fever. serum and urine drug screen revealed benzodiazepines only, which were given by the ed. neurology evaluated the patient while in the ed, however given already intubated and sedated their exam was limited. they recommended lp and mri, however given clinical improvement and known source of infection (e. coli bacteremia from urine/prostate) these studies were not performed. as infection was treated, mental status improved. with improved mental status the patient had no signs or symptoms of meningitis. mental status improved to baseline on discharge. #rhabdomyolysis: patient found to have elevated ck up to the 8000 likely secondary to overwhelming sepsis. he experienced renal insufficiency which improved with fluids. held crestor during admission and instructed patient to hold on discharge until consulting his pcp. should be held until ck normalizes. # demand ischemia: while septic in micu patient with elevated troponin to 0.06, ekg with tachycardia and diffuse ste. likely demand ischemia. ck mb trended up to 47 with trops flat at 0.03. trop <0.01 with improved mb as well with resolution of sepsis. patient had no other events regarding ischemia. aspirin was increased to 325mg daily and he was restarted on his home beta-blocker. # dic: thrombocytopenia and coagulopathy in setting of sepsis indicates dic. fibrinogen elevated but likely falsely elevated in setting of acute infection. with initiation of antimicrobials covering pan-sensitive e.coli his dic picture improved. platelets rebounded, inr improved to 1.3 and hct rebounded. # hypothyroidism: continued levothyroxine . # hypertension: patient was hypotensive requiring pressors so anti-hypertensives held until sepsis resolved. after resolution metoprolol and lisinopril were restarted which patient tolerated well. # hyperlipidemia - held statin in setting of rhabdomyolysis as above. transitional issues: - if pcp concerned for prostatitis (recurrent urinary tract infections, symptoms), then would prolong course of antibiotics (4-6 weeks) and/or referral to urology - holding crestor on discharge for elevated ck/resolving rhabdomyolysis, this should be restarted after complete resolution - dischargde on 325mg aspirin given demand ischemia while septic, can reduce to 81mg daily per pcp needs a follow up pcp appointment discharge - code: full - contact: wife/ (cell), (home), daughters and medications on admission: aspirin 81, multivitamin, coq10 200 mg daily, crestor 40 mg daily, ferrous sulfate 325 daily, fish oil daily, glucosamine 1500 mg daily, levoxyl 75 mcg daily, lisinopril 10 mg daily, proair 1 puff q6 hrs prn, pulmicort 180 mcg , toprol 50 mg daily, tylneol pm, vitamin b12 1500 mcg daily, vitamin d3 100 units daily discharge medications: 1. budesonide 180 mcg/actuation aerosol powdr breath activated sig: one (1) ih inhalation twice a day. 2. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation every six (6) hours as needed for shortness of breath or wheezing. 3. metoprolol succinate 50 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 4. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 5. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 6. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 7. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 8. fish oil oral 9. glucosamine 750 mg tablet sig: two (2) tablet po once a day. 10. ciprofloxacin 250 mg tablet sig: three (3) tablet po q12h (every 12 hours) for 12 days. 11. vitamin b-12 1,000 mcg tablet sig: 1.5 tablets po once a day. 12. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po once a day. 13. multivitamin tablet sig: one (1) tablet po once a day. 14. co q-10 200 mg capsule sig: one (1) capsule po once a day. discharge disposition: extended care facility: nursing & therapy center - ( center for rehabilitation and sub-acute care) discharge diagnosis: active: - e.coli sepsis - urinary tract infection and bacteremia - demand ischemia - resolved dic inactive: - obstructive sleep apnea - hyperlipidemia - hypertension - hypothyroidism discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: mr. , it was a pleasure treating you during this hospitalization. you were admitted to because of fever, confusion and chills. you were found to have e.coli bacteria in your urine and your blood which was causing your symptoms. you were in the medical icu for some time where you were given iv antibiotics and resucitated with a lot of iv fluids. with antibiotic use your blood pressures returned to . you were switched to oral medications and you continued to improve. the following changes to your medications were made: - start ciprofloxacin 750mg twice daily until - hold crestor (rosuvastatin) until intructed to restart by your primary care physician. is being held because of muscle break down and resulting kidney injury when you were very ill, which are still resolving - increase aspirin to 325mg daily, this was increased because of strain on your heart during this admission. you should continue the higher dose until instructed by your pcp other changes were made, please continue taking your home medications as previously prescribed. - you should follow up with your primary care physician after discharge from rehabilitation center. if you develop another urinary tract infection, you should discuss with your pcp about seeing urologist. followup instructions: be sure to follow up with your primary care physician after discharge from rehabilitation center. if you develop another urinary tract infection, you should discuss with your pcp about seeing urologist. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung insertion of endotracheal tube computerized axial tomography of head central venous catheter placement with guidance diagnoses: acidosis obstructive sleep apnea (adult)(pediatric) urinary tract infection, site not specified toxic encephalopathy unspecified essential hypertension acute kidney failure, unspecified severe sepsis unspecified acquired hypothyroidism personal history of tobacco use other and unspecified hyperlipidemia acute respiratory failure defibrination syndrome septic shock septicemia due to escherichia coli [e. coli] examination of participant in clinical trial rhabdomyolysis other acute and subacute forms of ischemic heart disease, other 

Answer: The patient is high likely exposed to