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: ciprofloxacin / naprosyn / metoprolol / amlodipine / sulfa (sulfonamides) / verapamil / nsaids attending: chief complaint: dysuria, fever major surgical or invasive procedure: egd and colonoscopy history of present illness: 82yo f with pmh significant for chf, cad, type ii dm, pvd, and cri (cr ranged from 1.4 to 3.3 in last 4 months) who presents with hypotension in setting of recurrent uti. pt first developed sx od dysuria 1 week ago and gave ua/urine cx to vna for testing. since then, has had persistent dysuria and her baseline incontinence, but no f/c/rigors/n/v/change in her back pain. this am, her daughter noted that the patient was "breathing funny" while she was sleeping and when ms. , she felt she was breathing harder so she went to the er. . per the er, the patient was sent there in f/u for a positive urine culture. on arrival to the er, ms. had a temp of 102, bp 122/80, hr 88. however, she quickly became hypotensive to 77/40. labs revealed a lactate of 2.8 and code sepsis was initiated. she never had alteration in her mental status, tachycardia, or respiratory distress. she had a central line placed without incident and was given 1l of ns and 1u prbc with improvement in her sbp to 90s. she was then transferred to the for further management. . of note, the er resident considered further imaging of the patient's spine given her h/o of low back pain, recurrent utis and the question of epidural abscess raised during her last hospitalization earlier this month. she never obtained imaging as discussed at that time. on physical exam, the er resident found decreased rectal tone, trace guaiac + stool, and saddle anesthesia. however, the patient is unable to fit in the mri scanner on the , is claustrophobic, and has refused mri in the past. a ct of the spine w/ contrast was not performed given her rising cr (1.9). . ros: dysuria x 1 week -> urine cx denies f/c, denies wt loss/night sweats denies cp/palp + sob (baseline), walks 10 ft before getting inc pain (?claudication) denies n/v/d + urinary incontinence (chronic), denies bowel incontinence + constipation -> able to have bm this am denies increased back pain, well controlled on tylenol past medical history: 1. diastolic chf (ef 38% on cardiac cath with an akinetic posterobasal wall, a severely hypokinetic inferior wall, and moderately hypokinetic anterobasal, anterolateral, and apical walls, and mild mr) echo : lvef>55% 2. cad: cath: des to mid-lcx, om1, and mid-lad in -during cath 3. dmii c/b peripheral neuropathy 4. oa 5. ibs 6. pvd s/p right popliteal to dp bypass 7. chronic venous insufficiency 8. urinary incontinence 9. hx uterine cancer s/p tahbso 10. hx breast cancer s/p lumpectomy 11. hx tias 12. cervical radiculopathy 13. benzodiazepine dependence social history: quit smoking >20 years ago. 20-40 pack year history. lives at home with two daughters on the . widowed. denies alcohol use. she is irish in descent. she ambulates with a walker at home. worked in a shipyard during wwii. family history: mother died in 60's w/cad. physical exam: vs - tm 102, tc 96.7, bp 100/30 (78-122/22-60), hr 70s, rr 18, sats 94-95% on ra, cvp 9-11 gen: wdwn obese elderly f in nad, appears younger than stated age. heent: ncat. sclera anicteric, perrl, eomi. op clear, no exudates or erythema. no jvd appreciated, though r ij in place. dsg is c/d/i. no lad. cv: rr, normal s1, s2. ii/vi sem best heard at lusb. no r/g. resp: crackles at bases bilaterally, but no wheezes or rhonchi. abd: soft, ntnd. + bs. no organomegaly. ext: chronic venous stasis changes/erythema bilaterally to shins. + pitting edema up to mid shin bilaterally. could not feel dp pulses. 2+ radial pulses bilaterally. feet warm, dry. no c/c. point tenderness over s1/l5 vertebrae, w/o radiation. neuro: cn ii-xii grossly intact, aaox3. strength 4+/5 in ue and le bilaterally, both distally and proximally. dtr 1+ at patella bilaterally. toes downgoing bilaterally. decreased rectal tone, but no evidence of saddle anesthesia. sensation intact to light touch and pin throughout saddle distribution. pertinent results: 09:52pm hgb-9.4* calchct-28 o2 sat-83 09:33pm glucose-54* urea n-56* creat-1.6* sodium-138 potassium-3.6 chloride-100 total co2-30 anion gap-12 09:33pm calcium-9.0 phosphate-4.0 magnesium-2.3 09:33pm wbc-8.8 rbc-2.97* hgb-9.3* hct-25.6* mcv-86 mch-31.3 mchc-36.2* rdw-15.6* 09:33pm neuts-65.8 lymphs-25.8 monos-5.5 eos-2.7 basos-0.3 09:33pm plt count-282 05:01pm comments-green top 05:01pm lactate-1.3 05:01pm hgb-8.8* calchct-26 o2 sat-93 04:19pm type-mix comments-green top 04:19pm glucose-119* lactate-2.1* 04:19pm hgb-8.7* calchct-26 o2 sat-97 02:15pm urine color-amber appear-hazy sp -1.013 02:15pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 02:15pm urine rbc-0 wbc-21-50* bacteria-many yeast-none epi-0 02:15pm urine hyaline-0-2 01:59pm glucose-164* lactate-2.8* k+-4.4 01:40pm glucose-170* urea n-60* creat-1.9* sodium-136 potassium-4.3 chloride-97 total co2-29 anion gap-14 01:40pm ck(cpk)-65 01:40pm ck-mb-notdone ctropnt-0.03* 01:40pm calcium-9.2 phosphate-4.0 magnesium-2.2 01:40pm wbc-9.5 rbc-2.74*# hgb-8.7* hct-24.2*# mcv-88 mch-31.7 mchc-35.9* rdw-15.3 01:40pm neuts-68.2 lymphs-26.6 monos-4.3 eos-0.7 basos-0.2 01:40pm plt count-295 01:40pm pt-12.4 ptt-28.0 inr(pt)-1.1 cxr: no evidence of chf or increase in cardiac size. l ankle xr: there is medial and lateral malleolar soft tissue swelling without signs for fractures or dislocations. extensive vascular and soft tissue calcifications are seen throughout the ankle. the talar dome is intact. there is enthesopathy at the attachment of the achilles tendon and a plantar spur present. colonoscopy: normal colonoscopy to cecum additional notes: the efficiency of colonoscopy in detecting lesions was discussed in detail with the patient. it was explained that colon cancer and colon polyps may on rare occasions be missed during a colonscopy. the attending was present during the entire procedure routine post-procedure orders. no source of bleeding found, may follow up with outpatient capsule endoscopy. egd: normal egd to second part of the duodenum additional notes: the attending was present for the entire procedure. routine post-procedure orders. no source of bleeding. follow up with outpatient capsule endoscopy. brief hospital course: # sepsis: unclear why sepsis protocol was initiated, given that lactate was only 2.8, but patient improved since its initiation. patient has pseudomonal uti and back pain. treated for urosepsis, probable pyelonephritis. improved on cefepime and completed 2 week course. had a ua on discharge that was checked showing continued pyuria, but had just completed 2 weeks of antibiotics. she will need a repeat ua and ucx followed up in the next week as an outpatient. she should follow up with her urologist. . # decreased rectal tone: unclear etiology, however exam appears stable from earlier this month and clinical history does not support an acute change. most optimal study, after talking with both neurology and radiology, would be mri. if not mri, then ct of spine w/ contrast. very little utility in ct of the spine w/o contrast in this situation. since her neuro exam appeared stable, decision was made to hold off on attempting imaging as patient refused mri. she is willing to have an outpatient open mri however. she had no other neurologic deficits during her hospital stay. # uti: pansensitive pseudomonas from osh cx. given levofloxacin and vanco in er, though has reported allergy to levofloxacin (quinolones). switched to cefepime, given pansensitive organism and the fact that pt has tolerated cephalosporins in the past. unclear why pt has h/o recurrent utis (h/o pansensitive e.coli and klebsiella utis as well). was followed by urology 2 yrs ago, had cystoscopy that was not significant for any anatomical abnormalities, no increased bladder volumes and post-void residuals suggestive of overflow incontinence. follow up with urologist. will need follow up ua as outpatient in next week. . # cri: baseline is somewhat unclear given fluctuating levels over the last year (cr has been anywhere from 1.4 to 3.3). on admission was 1.9 and now down to 1.3. diuretics restarted and remained on same home medications. . # htn: will continue coreg (for chf/cad). diuretics held initially then restarted when sepsis resolved. . # cad: has h/o multivessel disease s/p multiple stents. troponin now 0.03, ck 65. story not c/w angina or ischemia, but hypotension may have caused some mild demand ischemia. ekg w/o any acute changes. - cont asa, bblocker, plavix, lipitor, nitrate, bumex . # chf: cont. imdur/bumex . # dm type ii: last hgba1c was 7.8 in . on nph + hiss at home. pt with low blood sugars on admission to 57, low blood sugar this am in 50s c symptoms of "hot flashes." improved to 70s after eating breakfast. restarted home insulin. . # anemia: pt's baseline hct in low 30s, noted to be 24.7 in er, guaiac positive, given 1u prbc. pt. with persistently low hct in 26-28 range with no symptoms but persistently guiac positive stool. had egd and colonoscopy that did not reveal any source of bleeding as an inpatient. pt's hct remained stable in this range, and gi recommended f/u for outpt. capsule study. she can follow up with dr. for this. . # oa/chronic pain: stable on home regimen. no acute increase in pain requirement currently. . # urinary incontinence: ongoing problem. gu w/u neg to date. no pvr, no anatomic abnormalities (though pyelogram not done yet). last urology appt was in . - tolterodine and detrol la . # hypothyroidism: dx in , tsh was 4.5, corrected to 1.4 in on levothyroxine. - cont levothyroxine at home dose . # h/o uterine/breast cancer: currently not active issues. xr on no signs of bony or metastatic disease. . # fen: - ivf boluses to keep sbp >90 or cvp 8-12 - check lytes , replete prn - regular , low salt, heart healthy diet . # access: - rij placed , picc- pulled at d/c . # ppx: - heparin sc - ppi - bowel regimen . # code: full, confirmed by hcp on . . # comm: hcp or cell . medications on admission: 1. insulin nph human recomb 100 unit/ml cartridge sig: as dir as dir subcutaneous twice a day: 25 untis sc qam and 15 units sc qpm. 2. insulin lispro (human) 100 unit/ml cartridge sig: as dir as dir subcutaneous four times a day: sliding scale humalog, please resume your regular scale. 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 4. atorvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 5. isosorbide mononitrate 60 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). disp:*30 tablet sustained release 24hr(s)* refills:*2* 6. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 7. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 8. hyoscyamine sulfate 0.125 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual qid (4 times a day) as needed for prn stomach cramps. 9. carvedilol 12.5 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 10. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 11. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for sob, wheezing. 12. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 13. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 15. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. 16. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 17. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 18. tolterodine 2 mg tablet sig: one (1) tablet po bid (2 times a day). 19. bumetanide 2 mg tablet sig: 1.5 tablets po bid (2 times a day). 20. gabapentin 300 mg capsule sig: two (2) capsule po q8pm (). disp:*480 capsule(s)* refills:*2* 21. multivitamin capsule sig: one (1) cap po daily (daily). 22. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 26. detrol la 4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po once a day. 27. ativan 0.5 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 28. glyburide 5 mg tablet sig: two (2) tablet po once a day. 29. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. discharge medications: 1. insulin nph human recomb 100 unit/ml cartridge sig: as dir as dir subcutaneous twice a day: 25 untis sc qam and 15 units sc qpm. 2. insulin lispro (human) 100 unit/ml cartridge sig: as dir as dir subcutaneous four times a day: sliding scale humalog, please resume your regular scale. 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 4. atorvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 5. isosorbide mononitrate 60 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). disp:*30 tablet sustained release 24hr(s)* refills:*2* 6. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 7. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 8. hyoscyamine sulfate 0.125 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual qid (4 times a day) as needed for prn stomach cramps. 9. carvedilol 12.5 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 10. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 11. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for sob, wheezing. 12. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 13. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 15. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. 16. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 17. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 18. tolterodine 2 mg tablet sig: one (1) tablet po bid (2 times a day). 19. bumetanide 2 mg tablet sig: 1.5 tablets po bid (2 times a day). 20. gabapentin 300 mg capsule sig: two (2) capsule po q8pm (). disp:*480 capsule(s)* refills:*2* 21. multivitamin capsule sig: one (1) cap po daily (daily). 22. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 23. phenazopyridine 100 mg tablet sig: one (1) tablet po tid (3 times a day) for 3 days. disp:*9 tablet(s)* refills:*0* 24. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day). disp:*qs 2 weeks* refills:*2* 25. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day). disp:*qs 1 week* refills:*2* 26. detrol la 4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po once a day. 27. ativan 0.5 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 28. glyburide 5 mg tablet sig: two (2) tablet po once a day. 29. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. 30. open mri please have a lumbosacral spine mri done to r/o spinal stenosis. 31. outpatient lab work cbc to be done or and results faxed to pcp. discharge disposition: home with service facility: discharge diagnosis: sepsis due to pyelonephritis occult gastrointestinal bleeding discharge condition: stable discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1500cc please continue your regular medications. please have your blood count checked either or . you will need to have a follow up spinal open mri. please also follow up with your pcp regarding your low blood count and blood in your stool. followup instructions: 1.provider: . phone: date/time: 10:00 2. provider: , m.d. date/time: 12:00 3. please have your hematocrit checked by the nurse or to make sure these are stable. 4. please also arrange with your pcp to have an open mri of your l and s spine procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine colonoscopy transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension unspecified septicemia severe sepsis unspecified acquired hypothyroidism personal history of malignant neoplasm of breast diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified personal history of malignant neoplasm of other parts of uterus brachial neuritis or radiculitis nos hypotension, unspecified personal history of other diseases of circulatory system osteoarthrosis, unspecified whether generalized or localized, site unspecified hemorrhage of gastrointestinal tract, unspecified backache, unspecified atherosclerosis of native arteries of the extremities, unspecified diastolic heart failure, unspecified other specified anemias venous (peripheral) insufficiency, unspecified irritable bowel syndrome pyelonephritis, unspecified 

Answer: The patient is high likely exposed to