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: darvon / percocet attending: chief complaint: abdominal pain. reason for micu transfer: urosepsis. major surgical or invasive procedure: none. history of present illness: mr. is a 78-year-old gentleman with history of systolic chf (lvef 35%), atrial fibrillation on coumadin, and prostate ca s/p radical transferred from osh to the for treatment of possible cholecystitis with ctap concerning for ureteral obstruction with pyelonephritis. he originally presented to osh with complaint of groin pain radiating to the left flank x1 day. there was associated urinary incontinence, nausea, dry heaves, shortness of breath, and diaphoresis. at osh, he was found to be hypotensive. he was treated with ampicillin, given 4 liters of ivf, and started on peripheral dopamine. he was then transferred to for further treatment. in the ed, initial vital signs were hr 88, bp 88/53, rr 20, satting 92% on 2l. labs notable for white count of 19.2 with 18% bands, alt/ast of 70/70, normal tbili, lpase was 16, inr 3.5 (patient takes coumadin as outpatient). ua showed many bacteria, white count of 21-50 with positive leuk esterase and negative nitrite. patient underwent non-contrast ct of the abdomen/pelvis that demonstrated left ureteral stone with partial obstruction and perinephric stranding suggestive of pyelonephritis. there was gallbladder wall thickening, and thus the patient then underwent ultrasound that showed gallbladder wall thickening and no other changes to suggest cholecystitis. the patient received vancomycin and ciprofloxacin, was started on 5 mcg/kg/min dopamin, and rij cvl was placed. in addition, the patient was seen by urology and his cardiologist was , dr. , who agreed that his coumadin anticoagulation was for af and could be reversed as necessary, so the patient 2 units ffp and was admitted to the for further management. . currently, the patient is complaining of mild left flank pain radiating to his groin. he also endorses shortness of breath and orthopnea. . ros: as above, otherwise negative. past medical history: - cad s/p cabg () and pci () - chf (ef 35% ') - non-sustained vt s/p biv icd - a fib s/p ablation on coumadin - hyperlipidemia - prostate cancer s/p radical prostatectomy - hypogonadism with low testosterone - hernia repair - hydrocele repair - tonsillectomy social history: -retired apparel salesman -tobacco history: denies -etoh: denies -illicit drugs: denies family history: no hx of cad physical exam: admission: vs: 95.5 74 117/65 27 89%6l nc gen: age appropriate male in respiratory distress heent: mm dry. cv: s1+s2 pulm: bilateral crackles throughout the lung fields. abd: s/nt/nd +bs. +cva tenderness on left. ext: 1+ pitting edema bilaterally. neuro: aox3. . discharge: afebrile. 100/50 p69 18 96%ra resp: cta with very minimal basilar rales. good ae. ext: 1+ peripheral edema le b, to mid-shin. pertinent results: admission results: . 08:23am blood wbc-19.2*# rbc-3.70* hgb-12.0* hct-35.5* mcv-96 mch-32.5* mchc-33.9 rdw-14.2 plt ct-97* 08:23am blood neuts-79* bands-18* lymphs-2* monos-1* eos-0 baso-0 atyps-0 metas-0 myelos-0 08:23am blood hypochr-normal anisocy-1+ poiklo-normal macrocy-normal microcy-normal polychr-occasional 08:23am blood pt-34.2* ptt-39.2* inr(pt)-3.5* 04:11pm blood fibrino-616* 04:11pm blood fdp-0-10 08:23am blood glucose-180* urean-52* creat-2.1* na-138 k-4.4 cl-103 hco3-26 angap-13 08:23am blood alt-70* ast-70* alkphos-68 totbili-0.6 04:11pm blood ld(ldh)-259* totbili-0.8 08:23am blood ctropnt-<0.01 08:23am blood lipase-16 04:11pm blood calcium-9.2 phos-4.8*# mg-2.1 04:11pm blood d-dimer-2571* . ekg (): a-v sequential pacing. compared to the previous tracing of no change. . portable cxr (): 1. interval development of mild-to-moderate pulmonary congestion. 2. for better assessment, recommend repeating with pa and lateral views and better inspiration efforts. . cxr s/p line placement (): interval placement of a right ij cvl, but with the tip being obscured by the overlying pacemaker/icd catheter. if clinical concern remains high for potential malposition, recommend repeating the radiograph with double opaque views. . portable cxr (): indeterminate termination point of the new right ij cvl. recommend repeat lateral view for better assessment. . ct abdomen and pelvis (): 1. a 5 mm stone within the left mid ureter without hydronephrosis, though there is increase in perinephric stranding on this side. recommend clinical correlation with ua for presence of pyelonephritis. 2. gallbladder wall thickening. recommend further correlation with right upper quadrant ultrasound. 3. volume loss in the left chest with elevation of left hemidiaphragm and consolidation of the posterior portion of the left lower lobe likely infection. . ruq u/s (): gallbladder wall thickening without sludge or stones, with a normal appearing common bile duct. these findings may be related to chf, systemic inflammation, or hepatitis. recommend clinical correlation. . cxr (): the previous dictation requested oblique views if possible to evaluate the position of the right ij catheter, since it is superimposed by pacemaker leads. the current study is again a frontal view that is essentially identical to the previous study. unfortunately, it is again difficult to precisely document the tip of the ij catheter, which could be either in the lower svc or possibly within the right atrium. oblique views or, if possible, lateral projection would be helpful for precisely documenting the tip of the tube. . axr (): previously seen left ureteral stone is not clearly visualized in this radiograph. . cxr (): previous mild pulmonary edema has improved but severe left lower lobe atelectasis has not. heart is still moderately enlarged. no pneumothorax or appreciable pleural effusion. transvenous right atrial pacer, right ventricular pacer defibrillator lead and a third lead probably right ventricular as well are unchanged in their respective positions. previous right jugular line has been removed. no pneumothorax. . renal u/s (): mild residual focal caliectasis in the lower pole calyx of the left kidney without evidence of calculus. . discharge labs: wbc 7.8 hgb 10.5 hct 31.2 plt 129 143 104 30 / 89 4.4 32 1.4 \ date 12/10 inr 1.2 1.4 1.8 (on warfarin 4 mg) micro: urine culture: escherichia coli | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 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 bcx neg x 2 ucx pending brief hospital course: 78 y/o male with history of systolic chf (lvef 35%), atrial fibrillation on coumadin, and prostate cancer s/p radical transferred from osh to the for treatment of possible cholecystitis with ctap concerning for ureteral obstruction with pyelonephritis. . #. pyelonephritis with sepsis: patient presented from an osh with hypotension on peripheral dopamine, leukocytosis of 19 with a left-shift, and a urinalysis positive for leukocyte esterase, 21-50 wbcs and many bacteria. blood and urine cultures were taken. a cxr was unconcerning for a pneumonia. a ct scan revealed a non-obstructing 5 mm stone in the ureter of the left kidney without hydronephrosis. patient was seen by urology in the ed, and recommended conservative management with iv antibiotics and tamsulosin given size of stone and lack of hydronephrosis. given the septic physiology, a central line was placed, the patient received intravenous fluids to maintain a cvp of and was started on norepinephrine to maintain map > 65. the patient was started on vancomycin and ceftriaxone. urine culture eventually grew out pan-sensitive e. coli. a kub was ordered and no stone was detected. as the patient had been afebrile since admission he was transitioned to cefpodoxime 200 mg q12 to complete a full 14-day course (to be completed on ). ultimately, the patient's uti was attributed to an infected renal stone that was believed to have passed. patient should follow up with urology as an outpatient with a probable ct at that time to assess for residual stones. . #. acute renal failure: patient presented with serum creatinine of 2.1, up from a known baseline of approximately 1.2 (although tends to fluctuate). despite the unobstructive nature of the renal stone there was concern for post-obstructive failure vs. pre-renal failure given chf. urine electrolytes were consistent with a pre-renal etiology (fena 0.22%) but the patient appeared hypervolemic on exam. given hypotension, the patient's lasix were held. several days into admission the patient's renal function abruptly improved and his urine output increased with subsequent improvement in his creatinine. . #. pulmonary edema and chf: patient was initially hypoxic and satting 92% on 2l. cxr was unconcerning for infection but did reveal pulmonary congestion. patient has known systolic dysfunction with an lvef 35% with chf complicated by nsvt s/p aicd placement. unfortunately the patient was also hypotensive on arrival so his carvedilol, valsartan, and lasix were held. the patient was slowly weaned off of pressors. cardiology was consulted and recommended reintroduction of his home lasix, amiodarone and aldactone on the day of transfer to the medicine service. valsartan was restarted the following day () and carvedilol the next day (). . #. thrombocytopenia: patient had platelet count of 97 on admission. given septic physiology there was concern for possible dic. dic labs were negative with a fibrinogen of 616 and fdp of 0-10 (unable to use inr as patient on coumadin). thrombocytopenia was attributed to sepsis. platelet counts were monitored closely throughout the icu course and remained stable. his platelet count was improving prior to discharge. . #. cad: aspirin was initially held given concern for dic picture. statin was also held given mild transaminitis. carvedilol was held as per above. his aspirin, valsartan, and carvedilol were resumed during the hospitalization, which he tolerated well. his lipitor was resumed at the time of discharge. . #. atrial fibrillation s/p ablation: patient's inr was 3.5 on admission and coumadin was held as inr was supratherapeutic and there was concern for dic and possible procedural intervention (nephrostomy) for stone removal. coumadin was restarted without bridge, and his inr gradually increased. he remains subtherapeutic at the time of discharge (1.8); he will follow up with clinic within the next 1-2 days for inr check and dose titration as needed. . # hyperlipidemia: patient's lipitor dose was held during the admission due to mild transaminitis, however this was resumed at the time of discharge. . code: full contact: (wife/hcp) dispo: icu level of care. medications on admission: amiodarone 200 mg po q day lipitor 80 mg po q day carvedilol 25 mg po bid lasix 10-20 mg po q day spironolactone 12.5 mg po q day valsartan 160 mg po bid coumadin 4 mg po q1600 aspirin 81 mg po q day caltrate-600 plus vit d discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. lipitor 80 mg tablet sig: one (1) tablet po at bedtime. 3. carvedilol 25 mg tablet sig: one (1) tablet po twice a day. 4. furosemide 20 mg tablet sig: one (1) tablet po once a day. 5. spironolactone 25 mg tablet sig: 0.5 tablet po daily (daily): 30 minutes - 1 hour prior to lasix. 6. valsartan 160 mg tablet sig: one (1) tablet po bid (2 times a day). 7. warfarin 4 mg tablet sig: one (1) tablet po q 4 pm: please follow up with your coumadin clinic within the next 2 days. 8. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. caltrate-600 plus vitamin d3 oral 10. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). disp:*30 capsule, sust. release 24 hr(s)* refills:*0* 11. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation: may purchase over the counter. 12. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain: may purchase over the counter. 13. cefpodoxime 200 mg tablet sig: one (1) tablet po every twelve (12) hours for 8 days. disp:*16 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: # e.coli uti with septicemia # acute on chronic systolic chf # acute renal failure # cad s/p cabg discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted in transfer from another hospital with a severe urinary tract infection in the setting of a kidney stone which was preventing the drainage of urine. you were initially managed in our icu, and were treated with antibiotics. you also developed heart failure. you have improved from your infection, but you will need to complete a course of antibiotics. your heart failure has resolved, and you will need to follow up with your cardiologist. followup instructions: department: cardiac services when: tuesday at 3:00 pm with: device clinic building: sc clinical ctr campus: east best parking: garage department: cardiac services when: tuesday at 3:30 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage department: cardiac services when: tuesday at 1 pm with: device clinic building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified arterial catheterization diagnoses: thrombocytopenia, unspecified abnormal coagulation profile congestive heart failure, unspecified acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation personal history of malignant neoplasm of prostate coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status other and unspecified hyperlipidemia acute respiratory failure other specified cardiac dysrhythmias calculus of gallbladder with other cholecystitis, without mention of obstruction automatic implantable cardiac defibrillator in situ anticoagulants causing adverse effects in therapeutic use calculus of ureter acute on chronic systolic heart failure other testicular hypofunction nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] pyelonephritis, unspecified 

Answer: The patient is high likely exposed to