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: fever, abd pain major surgical or invasive procedure: foley catheter placement history of present illness: 35m with paraplegia, recurrent uti and nephrolithiasis, and h/o recurrent mrsa peri-rectal abscesses presented with fever/chills, abdominal and testicular pain, and reported history of blood streaked emesis. he stopped taking his macrobid 1-2 weeks ago (non-compliance) and 3-4 days ago noticed his urine was foul smelling. he consistently self catheterizes at home and has frequent utis generally treated with vanc/zosyn per his report, microbiology shows history of mostly sensitive e.coli and enterococcus, most recent positive culture 6/. 4 days prior to admission he fell out of his wheelchair onto his groin and injured his testicle and he has had pain ever since. 3 days prior to admission he ate out at a restaurant and approximately 3 hours after eating vomitted several times with blood streaks in the emesis. since then he has not eaten much aside from a small amount of soup due to persistent nausea. he has generalized abdominal pain most intense near his umbilicus. he has had loose stools for the past 3 days as well, no melena or hematochezia. he has had a low grade fever over the past few days with chills. vitals in ed: 99.8 88 116/35 14 97% ra. exam notable for guaiac negative, pus per urethra, sacral wound, left teste tender, difficult foley placement. labs notable for lactate 2.1 wbc# 28.0 (88%pmn no bands) hct 34.5. u/a showed 21-50 wbc many bact mod leuk pos nitrite. given vanc 1 g iv, ceftriaxone 2 g iv, morphine, toradol, zofran. developed rigors in ed, hypotension to sbp 70s, improved to 110 after 4l ivf. has 2 large bore pivs. ed workup including ct abd/pelvis which showed heterogenous enhancement l kidney, no obv abscess. large peri-aortic ln near kidney. no hydronephrosis. scrotal u/s showed left epidydimitis. vital signs prior to transfer 79 125/46 18 94%ra. upon arrival to floor continued to have chills, but felt well and was hungry. denied sob, cp, lightheadedness, muscle weakness, dysuria, hematuria, dysphagia. of note patient presented to ed 2 days prior to admission with abdominal pain, nausea and vomitting, but left ama due to the long wait. past medical history: - paraplegia secondary to t2 fracture at age 2 following mva and many spinal surgeries with hardware - recurrent nephrolithiasis requiring surgical removal - mrsa perirectal abscess & bacteremia , requiring surgical flaps - recurrent utis - asd (secundum type) social history: - smokes 1 ppd, trying to quit - no ivdu - no etoh - lives at home with mother who helps to take care of him, is active via wheelchair, independent in adls and iadls, not employed. - not currently sexually active in past year, no history of stds. family history: - father with dm2 - 2 maternal aunts with breast cancer physical exam: physical exam on admission vs: tc 36.2??????c, hr 92, bp 99/54, rr 20, o2sat 98% ra gen: pleasant, comfortable, nad heent: perrl, eomi, anicteric, mmm, no oral lesions, no supraclavicular or cervical lymphadenopathy, no jvd resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e skin: no rashes/no jaundice/no splinters neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated. no pass-pointing on finger to nose. 2+dtr's-patellar and biceps physical exam on discharge vs: tm 36.9c, tc 36.9c, hr 61 (52-88), bp 133/82 (112/77-133/90), rr 19 (), o2sat 100% ra heent: perrl, eomi, anicteric, mmm neck: no supraclavicular or cervical lymphadenopathy, no jvd resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g abd: soft, nt, nd, + bs, no masses or hepatosplenomegaly ext: maldeveloped lower extremities, intermittently spasmodic, 2+ radial pulses. skin: skin breakdown at the left hip covered with mepilex. large circular area with scabbing and fresh pink subcutaneous tissue present neuro: alert and oriented x3, flaccid lower extremities b/l gu:+foley in place, left test very sensitive to light touch, trace edema, no erythema, right teste without tenderness/masses/edema, no penile discharge pertinent results: - cbc with differentials: wbc-28.0*# rbc-4.57* hgb-11.7* hct-34.5* mcv-76* mch-25.6* mchc-33.9 rdw-15.3 plt ct-270 neuts-88.1* lymphs-7.0* monos-4.4 eos-0.4 baso-0.1 - coagulations: pt-12.4 ptt-33.0 inr(pt)-1.0 - chem 10: glucose-91 urean-16 creat-0.8 na-135 k-3.3 cl-98 hco3-25 calcium-9.4 phos-2.7 mg-2.0 - lfts: alt-16 ast-22 alkphos-119 totbili-0.3 albumin-3.8 - lipase: 13 - lactate: 2.1* - ua: color-yellow appear-hazy sp -1.014 blood-lg nitrite-pos protein-75 glucose-neg ketone-150 bilirub-neg urobiln-neg ph-5.0 leuks-mod rbc-0-2 wbc-21-50* bacteri-many yeast-none epi-0-2 - cbc with differentials: wbc-17.8* rbc-3.87* hgb-10.0* hct-29.8* mcv-77* mch-25.8* mchc-33.5 rdw-17.5* plt ct-205 neuts-80* bands-2 lymphs-8* monos-10 eos-0 baso-0 atyps-0 metas-0 myelos-0 - lactate: 0.9 ================ microbiology ================ - blood cx (2x): pending - urine cx: gnr, >100,000 organisms/ml escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- 256 r tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r - chlamydia and neisseria gonorrhoeae: pending - stool: fecal culture pending, campylobacter culture pending, c. difficile toxin a&b pending ============ imaging ============ - scrotal u/s: the right testicle measures 2.7 x 2.1 x 3.7 cm. the left testicle measures 3.0 x 2.0 x 3.8 cm. the testicular echogenicity is normal without focal abnormalities. vascularity is normal and symmetric in the testes bilaterally. the right epididymis is mildly prominent by size with normal blood flow. the left epididymis is enlarged with marked hyperemia. impression: left epididymitis without orchitis. - cxr: frontal and lateral views of the chest were obtained. there has been interval removal of a left picc line. bilateral spinal rods are again noted. asymmetry of the hemithorax is stable. slight prominence of the left hilum is likely without significant change as compared to , given differences in technique and may relate to patient positioning. however, small underlying consolidation is not excluded and attention at followup chest radiographs is advised. the right lung is clear. no pleural effusion or pneumothorax is seen. - ct abd with iv and oral contrast: this is limited by the patient's marked rotary scoliosis and extensive metallic star artifact from the spinal fixation rods. the visualized lung bases are clear. the heart and pericardium appear normal. the liver, gallbladder, spleen, and pancreas appear unremarkable. the right kidney is normal. there is heterogeneous enhancement of the right kidney worrisome for pyelonephritis. there is no perinephric abscess seen. there is enlarged left paraaortic lymph node at the hilum of the left kidney measuring 3.4 cm, possibly suggestive of reactive lymphadenopathy. of note, this enlarged lymph node was seen in the prior study when patient presented with similar symptoms. there is no organized abscess within the kidney or in the perinephric area that would be amendable to drainage. the right ureter is tortuous (300b, 29). however, it can be traced distally emptying into the bladder. the left ureter is not visualized; however, there is no evidence of hydronephrosis to suggest obstruction on this current study. evaluation of intra abdominal loops of bowel with significant star artifact from the hardware. there does not appear to be any enhancing wall thickening of the colon to suggest colitis. - ct pelvis with iv contrast: there is no free air or free fluid within the pelvis. the bladder wall is circumferentially thickened and unchanged from prior consistent with known history of neurogenic bladder. rectum contains stool. the remaining bowel is unremarkable. numerous enlarged inguinal lymph nodes with the largest measuring 1.1 cm (2, 51). these are musculoskeletal. there is no evidence of hardware failure or spinal fixation device. there is thinning of the skin of the right ischium without any signs of gas within the soft tissue. as mentioned, there is marked rotary scoliosis. there are rods, hooks and cerclage wire is seen throughout the visualized distal thoracic and lumbar spine without any evidence of mechanical hardware failure. impression: 1. heterogenous enhancement of the left kidney worrisome for pyelonephritis. there no perinephric abscess. there is no hydronephrosis. 2. there is no perinephric, intraabdominal or intrapelvic fluid collection 3. there is no obvious evidence to suggest colitis. brief hospital course: 35m with paraplegia, recurrent uti/nephrolithiasis, and h/o recurrent mrsa peri-rectal abscesses presented with fever/chills, foul smelling urine, abdominal and testicular pain, and reported history of blood streaked emesis. #. pyelonephritis/uti. likely secondary to stopping his prophylactic macrobid 1-2 weeks ago and persistent self straight catheterizations. ct suggestive of pyelonephritis, no clear abscess. patient has had recurrent utis and nephrolithiasis in past, mostly e.coli sensitive to ceftriaxone, meropenum, zosyn and others. he has a history of mrsa colonization. he was stareted on vancomycin (d1, ) and meropenem (d1, ) due to risk for esbl. his antibiotics was switched to cefpodoxime on , with the plan to complete a total of 14 day antibiotics course starting from , so patient will complete his antibiotics course on . patient was instructed to see his urologist and id doctors 1 week of discharge to determine the long term antibiotics therapy and follow up of the gc/chlamydia, blood culture, stool culture results. #. abdominal pain/vomitting/nausea/diarrhea. resolved. likely gastroenteritis, may have been bacterial or viral contaminant in food from restaurant, possibly staph aureus secondary to acute nature of vomitting after eating. his symptoms completely resolved while in the hospital. he was started on pantoprazole 40 mg once daily for a trial for the scant hematemesis (which resolved, see below) for 2 weeks until , which can be followed up by his primary care physician. #. hematemesis, mild (streaks). resolved. likely vomiting, possibly small tear. no signs of coffee ground emesis to suggest pud. his symptoms resolved during icu stay. he did not require any transfusion. there was hct drop, but likely dilutional in nature as he is about 6l positive. he was started on pantoprazole 40 mg po daily for 14 days trial and zofran for nausea, and he gradually advanced from full liquid to regular without issues. he should be followed up by his primary care physician on trial of anti-acid. #. anemia, microcytic. baseline has anemia of chronic inflammation by previous iron studies. also the more acute change is likely dilutional given about 6l positive since admission to the icu and unlikely from the mild hematemesis noted above as that resolved. he does not have any active signs of bleeding after resolution of the mild hematemesis. this should be followed up by his primary care physician. #. epididymitis. improved. likely trauma. urology was curbsided and thought that his current symptoms can be managed conservatively with pain medications, nsaids, and elevation. if pain worsens, will need to repeat ultrasound and consult urology urgently. patient is aware of what to do if his testicular pain worsens. he was instructed to continue with elevation, nsaids, and acetaminophen. this will need to be followed up by his urologist. #. history of recurrent mrsa abscesses on buttocks. patient continues to have open wounds, requiring daily wound care. the area was dressed mepilex daily. patient should continue to have wound care. #. tobacco smoking. patient is in the pre-contemplation state and refusing nicotine patch. plan is to continue with education and encouraging cessation. this should continue to be addressed by his primary care physician. medications on admission: macrobid 100 mg capsule daily oxycodone prn for pain after surgeries, not taking regularly tylenol and nsaids prn fever discharge medications: 1. ibuprofen 800 mg tablet sig: one (1) tablet po three times a day as needed for pain: please take this with meals as it can be upsetting to the stomach . disp:*30 tablet(s)* refills:*1* 2. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain/fever: please do not take more than 4 grams a day. 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours) for 11 days. disp:*11 tablet, delayed release (e.c.)(s)* refills:*0* 4. cefpodoxime 200 mg tablet sig: one (1) tablet po every twelve (12) hours for 11 days. disp:*22 tablet(s)* refills:*0* 5. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. discharge disposition: home discharge diagnosis: urinary tract infection pyelonephritis epididymitis gastroenteritis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , you came to the hospital because of abdominal pain, nausea and vomitting as well as testicular pain and foul smelling urine. you were found to have a urinary tract infection that likely spread to your kidneys. you were successfully treated with antibiotics. the bacteria in your urine is resistant to the macrobid that you were taking at home. you have therefore been perscribed an antibiotic called cefpodoxime. you should continue on this until you see your doctor. your abdominal pain, nausea and vomitting was most likely secondary and infection from food that you ate. this resolved and you were able to resume a regular diet. we have started you on a 2 week course of an anti-acid for this. your testicular pain is secondary to trauma from falling from your wheelchair. an ultrasound was completed which showed that you have inflammation in your testicle. please continue to use ibuprofen and tylenol as needed for pain. elevating your testicle will help relieve the swelling. if your testicular pain worsens, please call your urologist for an emergent visit and further testing. please follow up your physicians to follow up on your recent hospitalization, antibiotics regimen, as well as the trial of anti-acids. we have made the following changes to your medications: - stop macrobid - start cefpodoxime 200mg by mouth twice daily until (11 more days) - start pantoprazole 40mg by mouth once daily until (11 more days) - start ibuprofen 800mg by mouth three times daily with meals as needed for pain - start tylenol 650mg by mouth every 4 hours as needed for pain followup instructions: please call your urologist, dr. , to make a follow up appointment within the next week for your urinary tract infection, antibiotics, and testicular inflammation. please call ( to schedule an appointment with dr. in urology. it is important to see him before you finish up your antibiotics. you should also see an infectious disease doctor, dr. or dr. , as well. please call ( to set up an appointment within a week before you complete your antibiotics. you should also see your primary care doctor, dr. , at the within a week to follow up the recent hospitalization as well as the trial of anti-acid. please call to set an appointment up. procedure: venous catheterization, not elsewhere classified diagnoses: other and unspecified noninfectious gastroenteritis and colitis tobacco use disorder unspecified septicemia severe sepsis septic shock pressure ulcer, lower back gastroesophageal laceration-hemorrhage syndrome paraplegia pressure ulcer, stage ii late effect of spinal cord injury late effects of motor vehicle accident acute pyelonephritis without lesion of renal medullary necrosis orchitis and epididymitis, unspecified 

Answer: The patient is high likely exposed to