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: lethargy, altered mental status, hypotension major surgical or invasive procedure: 1) femoral line placed at outside hospital and discontinued on 2) gastronomy tube placement on history of present illness: ms. is an 87 year old female with past medical history of chronic renal insufficiency, congestive heart failure, hypertension, anemia, and aortic stenosis and insufficiency who presents with hypotension. the patient had had poor po intake and had not been doing well for the last several months. she was noted to be hiding her medications under her pillow and very constipated. she was refusing to eat or drink or get out of bed. her family brought her to ed for further evaluation after they noted her to be "slumping" at times. her daughter reports that worsening constipation and mental status over the last few days was what prompted the ed visit. her daughter reports that recently the patient has needed to be spoon-fed medications. she has been lethargic "for months," but this has been worse over the last days. no fevers, chills, cough, or other significant reported symptoms. daughter reports that the patient "isn't much of a talker" but will say yes and no. she was transferred here from , where her presenting vital signs were: systolic blood pressure 68/48 right arm, 110/70 left, heart rate 79, respiratory rate 33 and temperature of 94.2 rectally. at , she was noted to have a lactate of 6.4. a left femoral line was placed. she was given two liters of normal saline and started on dopamine, however she became tachycardic so was switched to levophed. she was given 1 gram of vancomycin and 1 gram of ceftriaxone. she was guaiac negative there. she was given 300 mg aspirin for an elevated troponin of 0.806 (0.6 in 6/). she was then transferred to ed. in the ed, initial vital signs were: temperature of 95.7, heart rate of 80, blood pressure of 74/46, respiratory rate of 20, and oxygen saturation of 96%. repeat lactate was 4.9. intubation was discussed with family who wished to hold off unless absolutely critical. patient was placed on a nrb and tolerated ct of the abdomen which was negative for gi process. her levophed was titrated down after being given 3 more liters of ivf. she was noted to have profuse diarrhea; there was question of whether she had been given laxatives or disimpacted. she was placed on a bairhugger. notes make question of possible vaginal bleed, possibly after self-disimpaction of stool. upon arrival to the icu, her systolic blood pressure was in the 70-80 range. she is moving all extremities and inconsistently follows one-step commands such as open your eyes. she was moaning and yelling out at times. of note, patient was hospitalized at in after presenting with shortness of breath, lethargy, and decreased appetite. she was noted to have acute on chronic renal insufficiency with a creatinine bump from 1.5 to 2.1 and was hydrated. her synthroid dose was increased to 100 mcg at that time for a tsh of 11. she completed an antibiotic regimen for an urinary tract infection as well. an echo at that time demonstrated ef 55-60% with grade i diastolic dysfunction, mild aortic stenosis, mild aortic regurgitation, mild mitral regurgitation, moderate pulmonary artery systolic hypertension and tricuspid regurgitation, no pericardial effusion. in the icu she was continued on broad spectrum abx (flagyl, cefepime, and azithro) which were eventually d/c'ed since her blood culture results were consistent with contaminants-( blood culture from grew coag negative staph, 2 species ( pansensitive, resistant to quinolones and cefazolin)eventually, all were discontinued and switched to levaquin 250mg qd po for plan of 5 day course. c diff x2 are neg so far. an echo was performed which was negative for vegetations. she had acute on chronic renal failure which improved with hydration. she developed hypernatremia which is being treated with 1/2 ns. past medical history: - chronic renal insufficiency, baseline 1.5 reported in discharge summary from - congestive heart failure (ef 55-60% on tte from , consistent with grade i diastolic dysfunction) - aortic stenosis and insufficiency (mild with valvular area of 1.2-1.9 cm2, mild 1+ ar from echo ) - breast cancer - hypertension - anemia (hct of 26-29 noted in ) - hyperlipidemia - hypothyroidism - abdominal aortic aneurysm - dementia medications: - atenolol 25 mg - synthroid 75 mcg - trazadone 50 mg qhs - remeron 15 mg qhd - vitamin b12 1000 mcg monthly - vitamin d weekly (dose unknown) - lisinopril 5 mg - lasix 20-40 mg daily - megace 250 mg tid social history: patient lives at home with her daughter. she does not drink or use tobacco. she is ambulatory at baseline. family history: non-contributory physical exam: vitals: bp: 104/73 p: 81 r: 18 o2: unable to obtain general: moaning in bed, moving all extremities and rolling from side to side. heent: sclera anicteric, dry mucous membranes, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear anteriorly bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, systolic murmur radiates to carotid, soft diastolic murmur, s1 + s2, no rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place, brown stool noted. ext: feet warm, radial pulses doperable bilaterally but very difficult to palpate, non-palpable dp pulses but doperable, no cyanosis or edema neuro: unable to complete pupil examination, opens eyes on command. moving all extremities equally. calling out at times. skin: no lesions noted. pertinent results: cbc: 12.5>31.3<161 lactate 4.9 pt 14.8, ptt 25.8, inr 1.3 sodium 160, potassium 4.5, chloride 127, hco3 16, bun 82, crt 3.0, glucose 149 blood cx from : coag neg staph, pan-sensitive; coag negative staph, 2 different colonies, one pan-sensitive, the other resistent to cefazolin, levofloxacin, oxacillin, penicillin blood cx at ngtd , , , urine cx: >100,000 organisms of yeast c.diff negative tte : the left atrium and right atrium are normal in cavity size. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are moderately thickened. no discrete vegetation is seen (does not exclude). there is mild aortic valve stenosis (valve area 1.7cm2). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no discrete vegetation is seen (does not exclude). mild to moderate (+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild-moderate mitral regurgitation. mild aortic stenosis. moderate pulmonary artery systolic hypertension. mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. if clinically suggested, the absence of a discrete vegetation on transthoracic echocardiography does not exclude endocarditis. ct abdomen/pelvis : 1. likely ileus, but no bowel obstruction or abscess. 2. significant interval increase in infrarenal abdominal aortic aneurysm, especially infrarenal portion, with saccular non-calcified appearance concerning for risk of rupture. 3. flattening of the ivc, which is likely related to low fluid status. 4. unchanged right ureteral dilatation without obstructing cause seen. 5. basilar atelectasis. cxr : the lung volumes are low and there is volume loss in both lower lobes. compared to the prior study, the amount of volume loss/consolidation is increased in both lower lobes. brief hospital course: ms. is an 87 year old female with history of chronic renal insufficieny, diastolic congestive heart failure, anemia, and hypertension who presents with hypotension, leukocytosis, hypernatremia, and worsening renal function. 1) sepsis/hypotension: unclear source of infection, but cxr with question of infiltrate. empiric treatment with levaquin x 10 days. hypotension resolved and patient with good oxygen saturation on room air at time of discharge. 2) hypernatremia: developed in the icu from hypovolemia. responds well to ivf resuscitation. 3) acute on chronic renal insufficieny: prior baseline creatinine around 1.5. pt now has new baseline cr=1.2 4) anemia acute blood loss likely from foley catheter trauma to bladder. pt found to have blood with clots in urine. the pt's urethra also noted to have a urethral caruncle by urology evaluation which was very irritated. this may have had bleeding that pooled in the retrograde direction. in any case, the blood and clots were cleared with irrigation with a 3-way foley and the patient had no further recurrance of hematuria and hematocrit was stable at around 27. 5) mental status/failure to thrive/delirium: per daughter, has had marked decline over the last several months, worsening over the last several days. poor po intake. suspect this is multifactorial picture in setting of underlying dementia, hypernatremia, uremia, and probable infection. continue supportive care. per family reports she is now back to baseline. the patient is largely non-verbal, but this was determined to be somewhat voluntary. the patient will speak when she wants to. remeron and megace continued. geriatrics consulted during admission and was not sure that the patient actually has dementia---rather could have a delirium from her current medical issues. 6) acute on chronic diasolic heart failure: beta-blocker, lisinopril initially held for septic shock. the metoprolol but restarted after shock resolved. we did not restart the lisinopril yet. 7) hypothyroid: continue levothyroxine. 8) aaa: noted to have enlarged to 7 cm (last imaging in our system was at which time it was 4.6 x 4.0 cm). consider vascular consultation, but in discussing with family about goals of care---the global overall care for the patient should include nothing too invasive. 9) code status: dnr/dni. discussed with daughter, , and goals of care should be directed toward nothing too invasive. goal of treatments should be directed to only interventions that will improve the patient's quality of life. g-tube placement was acceptable to daughter. daughter or (cell) medications on admission: - atenolol 25 mg - synthroid 75 mcg - trazadone 50 mg qhs - remeron 15 mg qhd - vitamin b12 1000 mcg monthly - vitamin d weekly (dose unknown) - lisinopril 5 mg - lasix 20-40 mg daily - megace 250 mg tid discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) 5000 units injection every eight (8) hours. 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 3. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 5. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. metoprolol tartrate 25 mg tablet sig: one (1) tablet po twice a day. 8. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 9. acetaminophen 650 mg tablet sig: one (1) tablet po every four (4) hours as needed for fever or pain. 10. megestrol 400 mg/10 ml (40 mg/ml) suspension sig: ten (10) ml po daily (daily). discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: 1. sepsis, uncertain etiology, most likely pneumonia secondary diagnoses: 1. hypernatremia from hypovolemia 2. urinary tract yeast infection 3. hematuria secondary to foley trauma 4. anemia secondary to acute blood loss from urinary tract 5. acute on chronic renal failure 6. chronic diastolic heart failure 7. benign hypertension 8. hypothyroidism 9. possible dementia 10. abdominal aortic aneurysm discharge condition: stable for discharge. discharge instructions: you were admitted to the for evaluation and treatment. you had signs of infection that was likely from either pulmonary and/or urinary source. supportive treatment with iv fluids and antibiotics helped to normalize your blood pressure and your general condition. we treated you for both pneumonia and urine infection (yeast was found in your urine). you had blood with clots in your urine that was likely caused by irritation and trauma from having an indwelling foley catheter. this resolved completely during your hospitalization. because of poor food and fluid intake that has been long-standing, a gastronomy-tube was placed on for access for tube feeds to supplement inadequate oral intake. see the medication list for a list of your recommended medication regimen. followup instructions: you will be transferred to an extended care facility for continued rehabilitation. please follow up with your primary care physician for continued care of your medical problems. if you would like to set up an appointment with our clinic, you may contact the clinic at . seek immediate medical attention if you should develop worsening of your condition, develop fever, nausea, vomiting, low blood pressure, bleeding, or other concern. procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified acidosis congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism candidiasis of other urogenital sites acute on chronic diastolic heart failure aortic valve disorders personal history of malignant neoplasm of breast depressive disorder, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere chronic kidney disease, unspecified constipation, unspecified other and unspecified hyperlipidemia septic shock unspecified accident injury to bladder and urethra, without mention of open wound into cavity abdominal aneurysm without mention of rupture hypovolemia hyperosmolality and/or hypernatremia delirium due to conditions classified elsewhere adult failure to thrive hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified urethral caruncle 

Answer: The patient is high likely exposed to