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: history of present illness: this is a 65-year-old woman with a history of metastatic rectal cancer to her spine and liver status post chemotherapy, most recently with folfox last received six weeks ago, status post colostomy in who presents with increasing right greater than left lower extremity weakness over the period of two weeks. the patient slumped to the ground on the day of admission and was unable to get up even with the assistance of her husband and daughter. therefore, she came to the emergency department. she denies any fall or back pain worse that her baseline pain. no urinary incontinence. no fevers or chills. she does report intermittent and variable pain in her legs with movement that changes location as well as intensity. additionally, she does report some electrical tingling in her bilateral insteps with head flexion. past medical history: 1. metastatic rectal adenocarcinoma diagnosed in . (a) she is status post 5-fluorouracil and oxaliplatin; completed in . (b) she is also status post laparoscopic colostomy in as well as port-a-cath placement in . (c) her disease is metastatic to the liver and throughout her spine. (d) additionally, she has pleural effusions. 2. status post colostomy. she has had occasional recurrent bleeding from the ostomy site. 3. anemia. allergies: penicillin (which causes a rash). medications on admission: 1. protonix 40 mg by mouth once per day. 2. coumadin 1 mg by mouth once per day. 3. oxycontin 10 mg by mouth every day. 4. oxycodone as needed. 5. colace and senna as needed. 6. iron 325 mg by mouth once per day. 7. vitamin c. 8. calcium. 9. peridex as needed. 10. zometa every month. social history: the patient is married. she lives with her husband. she has , home physical therapy, and home health aide. she denies alcohol or tobacco use. she uses a walker for ambulating. family history: noncontributory. physical examination on presentation: temperature maximum was 100.7 degrees fahrenheit, temperature current was 98.6, her blood pressure was 104/60, her heart rate was 82, her respiratory rate was 16, and her oxygen saturation was 96% on room air. in general, this was a partially bald, pleasant, elderly woman in no acute distress. head, neck, chest, cardiovascular, and extremity examinations were within normal limits. abdominal examination was notable for an ostomy with mild bleeding, although not perfuse. otherwise, the abdominal examination was unremarkable. neurologic examination was notable for 4/5 strength in the bilateral deltoids, biceps, and triceps. distal upper extremity strength was . iliopsoas was to bilaterally. knee flexion and extension was . plantar and dorsiflexion was 4+/5. toe extension was . the deep tendon reflexes were 2+ in the upper extremities bilaterally and 0 to 1+ patellar and ankle reflexes. the toes were downgoing. pertinent laboratory values on presentation: white blood cell count was 16.3 (with 86% polys and 4% bands), her hematocrit was 30.4, and her platelet count was 167. chemistry-7 was notable for a sodium of 132, her bicarbonate was 17, and her creatinine was 1.1. her lactate was 1.6. pertinent radiology/imaging: a magnetic resonance imaging of the spine essentially showed diffuse but unchanged metastatic disease to the spine as well as severe spinal stenosis at l4-l5 that was compressing nerve roots. no cord compression. a chest x-ray showed no infiltrate or effusions and a port-a-cath in place. assessment: this is a 65-year-old woman with metastatic rectal cancer to the spine and liver, status post chemotherapy six weeks ago, with two weeks of progressive lower extremity weakness. physical examination showed proximal muscle weakness. magnetic resonance imaging showed diffuse metastases, l4-l5 spinal stenosis squeezing on the nerve roots, but no change since the magnetic resonance imaging. brief summary of hospital course by issue/system: 1. lower extremity weakness issues: the etiology of this remains unclear. possibilities include myopathy (perineoplastic versus steroid-induced) versus additive effects of spinal stenosis and metastases versus leptomeningeal spread. both neurology service and radiology/oncology service were consulted. given the absence of cord compression, it was felt that radiation therapy would unlikely be effective. an electromyogram was done that showed only very mild myopathy; not enough to explain symptoms. a lumbar puncture was done by interventional radiology on that showed no infection, and the cytology was negative for malignant cells, making leptomeningeal spread less likely despite the increased cea. it was doubtful that this was a steroid-induced myopathy. nevertheless, all steroids were held since admission. her muscular pain was treated with oxycontin and oxycodone titrated to control her pain. after this evaluation, it was felt that the weakness was likely related to her cancer or some sort of perineoplastic syndrome. therefore, chemotherapy was started on to hopefully improve her weakness. 2. metastatic rectal cancer issues: cea had nearly doubled in the last month, so there was an increasing concern that the weakness was secondary to perineoplastic syndrome or to central nervous system and meningeal involvement. a repeat abdominal pelvis computed tomography was unrevealing and showed unchanged disease. she was started on a low-dose continuous 5-fluorouracil infusion on . 3. infectious disease issues: initially, the patient had only low-grade fevers and an elevated white count on admission. however, several days into her hospital course, blood cultures drawn on showed 4/4 bottles positive for escherichia coli, and ceftriaxone was begun on . however, on the night of , the patient spiked a temperature to 104.9. she had mental status changes, was tachycardic, and tachypneic; and gentamicin was started. the fever resolved, but she started to have a decrease in her blood pressure. she received a total of 4 liters of normal saline, and her systolic blood pressure was still in the 70s by the next morning, so she was transferred to the intensive care unit where she stabilized after receiving a total of 5 liters. her antibiotics were changed to levofloxacin, flagyl, gentamicin, and vancomycin. infectious disease service was consulted. it was felt that the escherichia coli was likely secondary to gut translocation from the site of her rectal cancer. an abdominal and pelvic computed tomography did not show any abscess. she stabilized and was transferred back from the unit to the floor. however, several days later, she began spiking fevers again to 102. this was felt to either be likely from continued gut macroperforation from her cancer or possibly due to a noninfectious etiology. her temperature came down with the continued antibiotic therapy, and chemotherapy was started on in an effort to decrease her tumor and therefore decrease the likelihood of macroperforation. blood cultures since the 4/4 bottles positive for escherichia coli on have been negative to date. 4. anemia issues: on the day after admission, after receiving intravenous fluids, the patient's hematocrit decreased to approximately 23. her anemia is felt to likely be secondary to chronic disease, although she also has had some intermittent bleeding for her ostomy site. she received a total of 4 units of packed red blood cells, and her hematocrit was now roughly stable. she showed no evidence of acute disseminated intravascular coagulation when she had sepsis. due to the small oozing and bleeding from her ostomy site, her low-dose coumadin has been held and she received 10 mg of vitamin k subcutaneously times one dose. 5. acute renal failure issues: acute renal failure resolved after receiving intravenous fluids. 6. long-term care plans: the patient is currently considering what she wishes as far as long-term care plans go. she is rethinking her code status. additionally, she is obtaining more information about hospice care. however, currently, we are continuing to treat her infection with antibiotics and continuing chemotherapy in the hopes that it will improve her lower extremity weakness. note: the remainder of the hospital course will be dictated by the physician taking over her care. , m.d. dictated by: medquist36 procedure: spinal tap incision of lung transfusion of packed cells injection or infusion of cancer chemotherapeutic substance diagnoses: anemia, unspecified malignant neoplasm of liver, secondary acute kidney failure, unspecified hyposmolality and/or hyponatremia sepsis septicemia due to escherichia coli [e. coli] secondary malignant neoplasm of bone and bone marrow malignant neoplasm of rectum myopathy, unspecified 

Answer: The patient is high likely exposed to