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: zoloft attending: chief complaint: hypotension, altered mental status major surgical or invasive procedure: none history of present illness: mr. is a 73yo m with a pmh of copd, htn, obesity, depression, who presents to the er from his nh for altered mental status and hypotension. mr. was seen in urology today and had his foley catheter replaced. on return to his nh, he was noted to look feverish and have altered mental status. his skin was noted to be warm and his bp was low at 78/palp. on arrival to the ed, his bp was 78/42 and his o2 sats were 86% on 2l nc and 100% on nrb. initial temp on arrival was 101.4 and he was tachycardic to 110. he was diaphoretic and was rigoring. he had 2 peripheral ivs placed, received 2l ns by bolus, and was given pr tylenol for his fever. cx (blood and urine) were drawn, cxr was performed, and he was then given ctx, vanco and flagyl. he was noted to have frank pus expressed from his foley catheter prior to obtaining ua and cx. despite the ivf, his bp dropped to 74/49 and attempts at a central line were made. a subclavian line was unable to be obtained despite multiple sticks. he was given levophed through a peripheral iv until a femoral line could be placed (his bp at that point had dropped to 63/45). once the r femoral line was in place, levophed was started in the femoral line with good response in his bp. levophed was titrated up to keep map >60. he went for a ct a/p with contrast which did not show a source of infection (showed fecal impaction, cholelithiasis w/o cholecystitis, and degenerative disease of his hip). he was disimpacted and had a bm, which was noted to be brown but guaiac positive. he had a bedside cardiac u/s performed which did not show any appreciable pericardial effusion. in total, he was given 5l ivf in the er, with 770 cc of uop. bp remained borderline on the levophed. he was transferred up to the micu for further management. . of note, pt has never been here before and we have no data on him. he is a poor historian and is unable to give reliable information about his pmh. past medical history: # lle dvt in # htn # copd # dm # urinary retention w/ chronic indwelling foley # chronic constipation # obesity # depression/bipolar disorder # gerd # b12 deficiency # dementia # pvd # essential tremor # venous stasis/cellulitis social history: lives at healthcare. is not married, has no children, but has family in the area (, ). smoked 1.5ppd x 15 yrs, quit "many years ago". no etoh. used to work as an elevator operator at . family history: pt unable to give history physical exam: vs - tc 99.3, tm 101, bp 118/85, hr 108, rr 18, sats 95% on 3l nc wt 91.6kg gen: obese, elderly male, staring straight at ceiling, minimally interactive, but answers questions appropriately, in nad. heent: sclera anicteric. pupils minimally rxtive, eomi. op clear, no thrush, mm dry. unable to assess jvp due to body habitus. cv: tachy, reg, normal s1, s2. no m/r/g. lungs: cta anteriorly, no crackles/wheezes/rhonchi. abd: soft, obese, ntnd. + bs. unable to assess for hepatosplenomegaly. ? subcutaneous lipomas in rlq (vs. areas of insulin injections). ext: no edema. no palpable pulses. le w/ chronic venous stasis changes. feet deformed. has bilateral skin patches on posterior aspect of calves, but no open wounds. 2+ radial pulses bilaterally. neuro: aaox2 (date, self). + tremor in arms bilaterally (at rest and with activity). skin: as above. has candidal rash on back/buttocks rn. pertinent results: 11:30pm pt-12.2 ptt-25.2 inr(pt)-1.1 11:30pm wbc-10.2 rbc-3.49* hgb-11.5* hct-32.3* mcv-92 mch-32.9* mchc-35.6* rdw-14.8 11:30pm albumin-3.4 calcium-9.6 phosphate-4.7* magnesium-2.2 11:30pm alt(sgpt)-16 ast(sgot)-28 ld(ldh)-422* ck(cpk)-92 alk phos-76 amylase-36 tot bili-0.3 11:30pm glucose-205* urea n-26* creat-0.9 sodium-139 potassium-4.9 chloride-104 total co2-23 anion gap-17 11:40pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-tr bilirubin-neg urobilngn-1 ph-5.5 leuk-lg 02:10am urine mucous-few 11:40pm urine color-yellow appear-slhazy sp -1.020 11:57am ck-mb-notdone ctropnt-<0.01 11:57am caltibc-181* ferritin-385 trf-139* 07:30pm d-dimer-2422* 07:44pm ck-mb-notdone ctropnt-<0.01 11:30pm ck-mb-notdone ctropnt-0.01 08:05pm cortisol-16.7 08:21pm cortisol-35.0* 09:16pm cortisol-44.3* 07:44pm tsh-0.62 . iron 42* ug/dl 45 - 160 hematologic iron binding capacity, total 179* ug/dl 260 - 470 vitamin b12 624 pg/ml 240 - 900 folate 9.9 ng/ml 2.0 - 20 ferritin 382 ng/ml 30 - 400 transferrin 138* mg/dl 200 - 360 . ekg: sinus tachycardia with atrial premature depolarizations. right bundle-branch block. left axis deviation. left anterior fascicular block. cannot exclude prior infero-posterior myocardial infarction. no previous tracing available for comparison. . cxr: chest (portable ap) 11:20 pm chest (portable ap) reason: fever and hypoxia medical condition: 73 year old man with reason for this examination: fever and hypoxia indication: fever and hypoxia. comparison: none. findings: portable chest upright radiograph reviewed. there is an ill- defined opacity in the right upper lobe. there is discoid atelectasis at the left base. the heart and mediastinal contours are remarkable for a tortuous aorta. no pleural effusions are identified. degenerative changes and possibly prior left humeral fracture are noted within a high-riding left humerus . cta chest w&w/o c &recons 9:35 pm cta chest w&w/o c &recons reason: pls r/o pe field of view: 36 contrast: optiray medical condition: 73 year old man with tachycardia, hypotension, and rv dilation on echo reason for this examination: pls r/o pe contraindications for iv contrast: none. indication: tachycardia, hypotension, right ventricular dilation on echocardiograph. technique: mdct was used to obtain contiguous axial images through the chest before and after administration of iv contrast. multiplanar reformats were also obtained. ct chest angio: there are aortic vascular calcifications; however, the aorta is not dilated. there is no evidence of dissection. coronary vascular calcifications are seen. no evidence of pulmonary embolism is identified. there is no pericardial effusion. ct chest before and after iv contrast: there is a small right thyroid lobe nodule. dependent low density material in the trachea probably represents retained secretions. there is a 5mm lung nodule in left upper lobe. there is atelectasis in the right lower lung in the posterior aspect. atelectasis is also seen in the posterior aspect of the left lower lung. no pleural effusions are seen. limited views of the abdomen are notable for markedly arthrosclerotic splenic artery. there is a small hiatal hernia. the gallbladder is markedly enlarged, and filled with high- density material, consistent in appearance with the large sludge-filled gallbladder seen on ultrasound of the same day. bone windows show diffuse demineralization; however, there are no lytic or sclerotic lesions. there is an s-shaped scoliosis. there are marked degenerative changes of the spine, with loss of disc height at all levels. there is right glenohumeral joint djd and healing fractures of several ribs. multiplanar reformats were essential in delineating the findings above. impression: 1. no evidence of pulmonary embolism or aortic dissection. 2. large dilated gallbladder filled with high-density material consistent in appearance with the ultrasound examination of the same day. 3. marked degenerative changes of the spine and an s-shaped scoliosis. 4. 5mm left upper lobe lung nodule; in the absence of known malignancy, noncontrast chest ct can be obtained in 12 months to ensure stability. 5. right thyroid lobe nodule can be correlated with thyroid ultrasound if clinically warranted. 6. dependent low density material in trachea is probably secretions, but attention to this area on future imaging is advised. . ruq ultrasound: medical condition: 73 year old man adm with sepsis, with abdominal pain, with gallstones on abd ct reason for this examination: pls evaluate for cholecystitis. indication: 73-year-old man with sepsis and abdominal pain with gallstones noted on recent abdominal ct. please evaluate for cholecystitis. right upper quadrant ultrasound: the imaged portion of the liver is normal in appearance. no focal liver lesions or biliary ductal dilatation is identified. the gallbladder is mildly distended and contains multiple echogenic stones. additionally, there is a large echogenic filling defect along the nondependent portion of the gallbladder, which does not appear to contain color flow. this may represent tumefactive sludge or hemorrhage, although mass cannot be excluded. there is no gallbladder wall edema, pericholecystic fluid, or son sign to suggest cholecystitis. the common bile duct measures 3 mm, which is normal. within the visualized right kidney is a 2.1 x 2.2 cm rounded anechoic focus consistent with a simple renal cyst. impression: 1. cholelithiasis without evidence for cholecystitis. additional finding of a large echogenic filling defect adherent to the gallbladder wall along the nondependent wall of the gallbladder may represent tumefactive sludge or hemorrhage; however, neoplasm cannot be excluded. further evaluation when clinically warranted is recommended. 2. 2.2 cm right simple renal cyst . ct abdomen w/contrast 2:02 am ct abdomen w/contrast; ct pelvis w/contrast reason: rp bleed? intraabdominal pathology? divertic field of view: 50 contrast: optiray medical condition: 73 year old man with hypotension reason for this examination: rp bleed? intraabdominal pathology? divertic contraindications for iv contrast: none. indication: hypotension, question intraabdominal pathology. comparison: none. technique: contrast-enhanced axial ct imaging of the abdomen and pelvis with multiplanar reformations was reviewed. ct abdomen with contrast: there is dependent bibasilar atelectasis. visualized heart is remarkable for mitral annular calcifications. evaluation of the upper abdomen is limited secondary to arm overlying the abdomen. no focal lesions are identified in the liver. the gallbladder is moderately distended with sludge and multiple stones. there is no pericholecystic fluid or gallbladder wall edema. the pancreas, stomach, adrenal glands are unremarkable. there are multiple hypodensities in the spleen that are not fully characterized. the left hemidiaphragm is markedly elevated. splenic artery calcifications are noted. kidneys enhance and excrete normally. multiple hypodensities in the kidneys are present, too small to characterize, possibly cysts. one 1.5cm lesion in the lower pole of the right kidney measures 24hu, perhaps a dense cyst but not fully characterized. small bowel loops are normal caliber. there is no free air or free fluid in the abdomen. no pathologic adenopathy is identified. ct pelvis with contrast: there is marked fecal impaction with the rectum distended with stool measuring 15 x 13 cm in axial cross section. foley is present with an empty bladder. atherosclerotic calcifications of the aorta and its major branches are noted. bone windows: there is significant diffuse osteopenia. there is severe degenerative change in the right hip with heterotopic bone formation, and post traumatic deformity with of the right proximal femur. no fluid collections in the right hip are identified. the osseous structures are also remarkable for marked rotatory shaped scoliosis with dextroscoliosis and lumbar levoscoliosis. significant degenerative changes are present in the spine. no suspicious lesions are identified. scout film demonstrates an intramedullary rod in the mid right femur. impression: 1. marked fecal impaction. 2. a distended gallbladder with cholelithiasis, but no definite evidence for cholecystitis. correlation with laboratories is recommended. 3. chronic osseous changes as described above. 4. bilateral renal hypodensities, not fully characterized, including a 1.5cm lesion in the right lower pole. ultrasound would be necessary for further characterization. . echo cardiology report echo study date of patient/test information: indication: congestive heart failure. shortness of breath. height: (in) 71 weight (lb): 227 bsa (m2): 2.23 m2 bp (mm hg): 874/41 hr (bpm): 102 status: inpatient date/time: at 14:25 test: portable tte (complete) doppler: full doppler and color doppler contrast: none tape number: 2006w050-0:58 test location: west micu technical quality: suboptimal referring doctor: dr. measurements: left ventricle - ejection fraction: >= 75% (nl >=55%) interpretation: findings: left atrium: normal la size. right atrium/interatrial septum: normal ra size. ra not well visualized. left ventricle: normal lv cavity size. normal regional lv systolic function. hyperdynamic lvef. right ventricle: dilated rv cavity. aorta: normal aortic root diameter. aortic valve: mildly thickened aortic valve leaflets (3). no as. no ar. mitral valve: mildly thickened mitral valve leaflets. moderate mitral annular calcification. no mr. pericardium: no pericardial effusion. general comments: suboptimal image quality - poor echo windows. conclusions: 1. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). 2. the right ventricular cavity is dilated. 3. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. 4. the mitral valve leaflets are mildly thickened. 5. no clear evidence of endocarditis seen brief hospital course: a/p: 73yo m w/ copd, htn, dm, and chronic urinary retention, presents with altered mental status, fever, and hypotension s/p replacement of new foley catheter. . # hypotension: the patient arrived at the emergency department tachycardic, with a fever and a low blood pressure. he was presumed to have sepsis from an unknown source. uti most likely given recent instrumentation by urology; could also be pneumonia or cholecystitis or gut flora translocation due to distended rectum). other causes of tachycardia considered included cardiac related (no prior ekg here, has rbbb), adrenal insufficiency, and hypovolemia. he was admitted to the icu and given over 5 l fluids, started on broad spectrum intravenous antibiotics, including flagyl, ceftriaxone, vancomycin, and levofloxacin. he required levophed for his first several hours of stay in order to keep his blood pressure up. after one day in the icu, levophed was successfully weaned off. the patient had one ua that appeared to show infection in the ed, but his follow-up urine cultures were negative for growth. blood cultures showed no growth. he passed a cortisol stim test. his antibiotics were peeled back to levofloxacin and flagyl and after two days on the general wards without complications, he was discharged on levofloxacin for 11 days to treat a presumed uti. as part of the patient's workup he received a ct scan of his torso which demonstrated no obvious source of infection. please see results section for further details. . tachycardia: the patient demonstrated asymptomatic tachycardia when transferred from the icu to the regular floor. this was thought secondary to withdrawal of betablockade (patient's beta blockers had been held when he came in with low blood pressure). the patient was controlled with oral beta-blockers, but sporadically had hr at roughly 90-100 while on the floor. he was asymptomatic and was discharged on his previous dose of oral betablocker. his beta-blocker could be titrated up at his long term facility as managed by his primary care physician. lung nodule: ct of the torso demonstrated a 5mm left upper lobe lung nodule, which could be followed up with a repeat ct in 12 months. . dm: the patient was controlled on insulin sliding scale. his metformin was held until the day before discharge because of receiving ct. . anemia: the patient has anemia. he would benefit from iron therapy in the outpatient setting. his measured iron level was low. in addition, he has guiac+ stools, which should be followed up with a colonoscopy in the outpatient setting. . medications on admission: lisinopril 2.5mg po qd flomax 0.4mg po qd cyanocobalamin 100mcg im q month (on the 9th) lactulose 30ml po qd asa 81mg po qd cipro 500mg po bid x 10d (? last dose on ) zyprexa 5mg po qam bactrim (last dose on ) lopressor 100mg po bid buproprion 100mg po tid artificial tears 1 drop each eye metformin 500mg po bid mvi 1 tab po qd vitamin c 500mg po bid combivent 2 puffs inh qid albuterol/ventolin prn riss ibuprofen/tylenol prn bowel regimen: soap suds enema, fleet's enema, mom, liquid discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 2. tamsulosin 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po hs (at bedtime). 3. lactulose 10 g/15 ml syrup sig: thirty (30) ml po once a day. 4. olanzapine 5 mg tablet sig: one (1) tablet po daily (daily). 5. bupropion 100 mg tablet sig: one (1) tablet po tid (3 times a day). 6. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: one (1) drop ophthalmic (2 times a day). 7. hexavitamin tablet sig: one (1) cap po daily (daily). 8. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 9. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed. 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 11. metformin 500 mg tablet sig: one (1) tablet po bid (2 times a day). 12. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 11 days. tablet(s) 13. metoprolol tartrate 100 mg tablet sig: one (1) tablet po twice a day. 14. insulin lispro (human) 100 unit/ml solution sig: 2-4 units subcutaneous asdir (as directed): administer according to usual sliding scale as directed. 15. lisinopril 2.5 mg tablet sig: one (1) tablet po once a day. 16. cyanocobalamin 1,000 mcg/ml solution sig: one (1) injection once a month. 17. combivent 103-18 mcg/actuation aerosol sig: two (2) puffs inhalation four times a day. 18. general care soap enemas, fleets enemas as needed 19. iron (ferrous sulfate) 325 (65) mg tablet sig: one (1) tablet po once a day: please do not begin taking iron until you have finished your course of antibiotics. . discharge disposition: extended care facility: healthcare- discharge diagnosis: primary: urinary tract infection sepsis . secondary: diabetes anemia copd htn bipolar discharge condition: stable tolerating po ambulating discharge instructions: you were hospitalized with low blood pressure and an infection. you were placed on antibiotics to treat a presumed urinary tract infection. you should continue taking levofloxacin, an antibiotic, for 11 days to treat this infection. . if you feel lightheaded, short of breath, woozy, or dizzy you should tell someone at your home and they may call an ambulance. also, if you feel chest pain, have fevers or urinary symptoms, you should call a physician. . there have been no other changes to the medications you were taking before you were admitted. however, supplemental iron is recommended. . you have occult blood in your stool. this should be followed up with a colonoscopy as scheduled by your primary care physician. followup instructions: please call at to schedule an appointment. . procedure: venous catheterization, not elsewhere classified diagnoses: anemia of other chronic disease esophageal reflux urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified septicemia chronic airway obstruction, not elsewhere classified personal history of tobacco use sepsis septic shock retention of urine, unspecified other diseases of lung, not elsewhere classified personal history of venous thrombosis and embolism bipolar disorder, unspecified tachycardia, unspecified 

Answer: The patient is high likely exposed to