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: diabetic ketoacidosis (hyperglycemia, polyuria, polydipsia, dehydration). major surgical or invasive procedure: none. history of present illness: patient is a 50 year old woman with a past medical history significant for sle (never been treated with steroids), peptic ulcer disease, non-insulin dependent diabetes (diagnosed three months ago but with no medical management) who presented with polyuria and polydipsia over the past two weeks. she relates needing to get up multiple times per night and during the day to urinate. she denies any urgency, incontinence, or burning with urination. in addition, she denies taking any recent steroids for her sle, nor any evidence of elevated blood sugars during her pregnancies. she denies any cold or heat intolerance. she denies any recent illnesses, nausea, or vomiting. in the four days before admission, her blood sugars were elevated, per her monitor. she did not have any evidence of altered mental status or confusion. in addition, patient denied any chest pain, shortness of breath, abdominal pain, diarrhea, or changes in vision. she denies any recent travel history, but does endorse that her grandson has been suffering from pertussis for some time and has been in her house on a daily basis. . on review, at admission, she related a history of back pain that started following an accident about 10 years ago. she noted that her back pain had changed somewhat in character, and felt like a pinching, located in the upper back, between her scapulae. past medical history: --sle (has never taken steroids) --diabetes (not on any meds; diagnosed a few months ago) --pud (+ h pylori. treated ) --vericose veins s/p stripping and ligation of the right great saphenous vein and stab avulsions of right lower extremity varicose veins. --lactose intolerance --possible depression --chronic upper back pain --abnormal pap 5/06 social history: lives with husband and 2 of her four children. has several grandchildren. she is originally from , came to the us in early . cleans houses. denies tobacco, past or present. occassional etoh use. denies ivdu. family history: father and several aunts and uncles and suffer from diabetes. physical exam: (on transfer from icu) t:100.1 bp:156/80 hr:80 rr:16 o2saturation:94% on room air gen: pleasant, well appearing mildly obese woman laying in bed. appears older than stated age. heent: no conjunctival pallor. no icterus. slightly dry mucous membranes. oropharynx clear. neck: supple. no cervical or supraclavicular lymphadenopathy. no jvd. cv: rrr. normal s1 and s2, but accentuated s1 in left upper sternal border. no murmurs, rubs or appreciated. lungs: clear to auscultation bilaterally. slightly decreased breath sounds in lower lung fields, bilaterally. no wheezes, crackles, or rhonci appreciated. abd: normal active bowel sounds in all four quadrants. soft. nontender and nondistended. no guarding or rebound. liver edge not palpated. no splenomegaly appreciated. no abdominal aortic bruit. ext: warm and well perfused. no clubbing or cyanosis. no lower extremity edema, bilaterally. 2+ dorsalis pedis and radial pulses, bilaterally. skin: no rashes, ulcers, petechiae, or pigmented lesions. no ecchymoses. no xerosis. neuro: alert and oriented to person, place, date. affect appropriate. cranial nerves ii-xii grossly intact. proprioception in big toes and light touch preserved throughout. pertinent results: labs: wbc hbg hct plt 4.0 11.9 35.0 216 6.4 14.5 41.4 198 . pt ptt inr 13.0 27.3 1.1 12.8 24.1 1.1 . na k cl hco3 bun cr glu 135 4.7 101 26 16 0.8 132 130 5.9 83 25 16 1.1 702 . ca po4 mg 9.4 4.5 2.0 10.8 5.1 2.2 . ast alt ldh ck ap lip tbili lact 31 37 396 144 135 28 30 0.8 2.9 . ckmb tnt <100 <0.01 <100 <0.01 3 <0.01 . hga1c 9.8 . acetone neg . hiv ab neg . gad-ab anti-islet cell ab pending pending . micro: urine: wbc rbc nitr glu ket leuk 21-50 pos neg tr sm 0-2 neg 1000 15 neg . urine culture: e.coli >100,000 organisms/ml, pansensitive e.coli 10,000-100,000 organisms/ml, pansensitive . blood culture: staph, coag negative staph, coag negative; gram positive rods (thought most likely contaminant and not treated). , , , negative . images: ekg (): sinus rhythm, normal ekg, rate 83, pr 142, qrs 96, qt/qtc 354/393 . cta chest w&w/o recon (): no evidence of acute aortic pathology or pulmonary embolism. small axillary lymph nodes up to 12 mm in size. . ct head w/o contrast (): no hemorrhage or mass effect. . portable cxr (): no acute pulmonary process. brief hospital course: hospital course/assessment/plan: patient is a 50 year old woman with a history of sle, pud, and recently diagnosed diabetes, but on no medical therapy, who presented to the ed with a blood sugar of 700 and an anion gap acidosis of 22. patient subsequently found to have a pan sensitive urinary tract infection and admitted to icu for medical management. transferred to medical team after insulin gtt. . . 1) diabetic ketoacidosis: patient presented with an anion gap acidosis of 22 and qa finger stick of 700. she was started on an insulin gtt in the ed. in the ed, a fem line was placed. she was continued on insulin gtt until gap closed and then was transitioned to lantus with iss. she initially did well; however, the next day her ag increased and she was placed back onto an insulin drip. consult recommend an increase of lantus to 26 u and iss. transferred to medical floor. -of note, patient initially complained of upper back pain and has documented msk back pain recently by pcp. dm is a risk factor for cad, pursued full ischemic work-up, although clinical suspicion very low. she had no elevation of cardiac enzymes and no ekg changes. -intraabdominal precipitant ruled out as she had no abdominal pain, nausea or vomiting, or changes in bms. -she has no history of taking glucocorticoids, which was a concern given her history of lupus, but patient confirms she does not and has never taken any medications for lupus. -infection was the most likely trigger, considering she did have a urine culture positive for e.coli. cxr did not reveal any evidence of pneumonia. . 2) urinary tract infection and questionable bacteremia: initially, the patient had no signs or symptoms to suggest infection; however, blood cultures on grew 1/2 bottles of coag neg staph and urine cx revealed e.coli >100,000. she was afebrile with wbc 6.4. she was started on bactim for uti. there was high suspicion for skin contamination in the blood culture. both blood cx and urine cx were repeated on . urine culture remained positive for e.coli 10,000-100,000. the blood culture again grew coag negative staph and gm positive rods. there was concern for bacteremia, so sensitivities were sent for this culture and the previously positive culture to see if they were of the same morphology, with the plan to treat as if bacteremia if they had the same sensitivities. it was decided not to treat empirically at the time due to low suspicion for bacteremia and no signs of endocarditis on exam. she continued to remain afebrile and with wbc <6 for remainder of hospital stay. repeat cultures were sent every day. by , all subsequent cultures had been negative, and the original cultures were growing too slowly to do sensitivities. it was felt that the low virulence of the original bacteria and lack of subsequent positive cultures indicated that both positive blood cultures were contaminants, and she was not felt to need tte to rule out endocarditis. -started on bactrim on . will continue to treat for ten day course from day of last positive urine culture. will be discharged with seven day course of bactrim. . 3) diabetes: her picture was in some ways atypical for dka because of older age of this patient and lack of serum ketones. however, her glucose was in the range for dka and she did have urine ketones. likely not hyperosmolar nonketotic hyperglycemia as she did not have mental status changes and glucose in the 700s is not as high as it typically presents in nkh. overall, her presentation is more convincing for dka, and this raises questions regarding which type of diabetes she has. she was initially presumed to be type ii diabetic. while type ii??????s can rarely go into dka, it is usually under great stress, and this raises speculation that she may be type i rather type ii diabetic. she could have had gradual autoimmune destruction of islets, and recently reached the point where she was in a state of absolute insulin deficiency, leading to frank dka. anti-gad and anti-islet cell antibody tests were sent to clarify type 1 or type 2 diabetes. pending on discharge. - continued to follow her during her admission, adjusting the glargine to 29 units qhs and modifying the insulin sliding scale. she will continue to be followed by dr. at . -nutrition was called for diet education. -social work was called for discussing new diagnois of diabetes. -she received bed-side teaching about how to take her blood sugars and give herself insulin injections. she was adept at measuring her blood sugar, injecting the insulin, and using the insulin sliding scale. -she has been recommended to follow up with pcp for further cv risk stratification following new diagnosis of diabetes, including stress test and lipid profile. . 4) chest/back pain: patient has documented msk back pain recently by pcp. ruled out with three sets of negative enzymes and no ekg changes. -as above, suggest cardiac stress test on pcp follow up. . 5) hypertension: patient was prehypertensive in the ed, and her blood pressure remained in the 130-140s here. she takes her bp regularly at home and reports it is usually in the range of 130-160 systolic. she does not take any meds at home. due to new diagnosis of diabetes, renal-protective ace inhibitor was started. -she was started on lisinopril 5mg qday, which will be continued. . 6) sle: she has never had a lupus flare, and currently has no symptoms consistent with flare, such as msk pain, eye problems, rash. . 7) abnormal pap: patient had an abnormal pap in , for which she is due to have a follow up pap at six months. -patient has been reminded to follow up with appointment for repeat pap smear. . 8) possible depression: patient also noted to have slightly depressed affect and social work consulted for new diagnosis. her mood improved markedly throughout her admission. she had strong family support. . 9) code: full. medications on admission: none. discharge medications: 1. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po bid (2 times a day) for 7 days. disp:*14 tablet(s)* refills:*0* 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. insulin glargine 100 unit/ml solution sig: one (1) 29 subcutaneous at bedtime. disp:*1 vial* refills:*10* 5. humalog 100 unit/ml solution sig: according to sliding scale according to sliding scale subcutaneous before each meal: check blood sugar before each meal, and dose humalog insulin according to the insulin sliding scale. . disp:*1 vial* refills:*12* 6. lancets & blood glucose strips combo pack sig: one (1) lancets miscellaneous four times a day: use to check finger sticks before every meal. disp:*100 lancets* refills:*2* 7. needle (disp) 30 g 30 x needle sig: one (1) needle miscellaneous four times a day: use to give insulin as directed. disp:*100 needles* refills:*10* 8. syringe syringe sig: one (1) cc miscellaneous four times a day: 1cc syringe for insulin. disp:*100 syringes* refills:*10* 9. glucometer elite classic kit sig: one (1) glucometer kit miscellaneous once: use as directed to check blood sugar before every meal and bedtime. disp:*1 glucometer kit* refills:*2* discharge disposition: home discharge diagnosis: primary: -diabetic ketoacidosis -e.coli uti . secondary: -diabetes: no medications on admission -systemic lupus erythematosis -lactose intolerance -depression -back pain -abnormal pap smear in -varicose vein removal in -peptic ulcer disease (h.pylori positive in ) discharge condition: stable. discharge instructions: -you were admitted to the hospital for fatigue, polydipsia, polyuria, and dehydration. your blood sugar was 700, and you were admitted to the icu. there, you were given insulin and rehydrated with fluids and potassium. once you were started on subcutaneous insulin, the iv insulin was stopped. once you were on subcutaneous insulin, you were transferred to medical team. -you were found to have a urinary tract infection and were started on the antibiotic bactrim which you will need to continue twice each day for the next seven days. -your blood pressure was elevated, and you have been started on a new medication, lisinopril 5mg, which you need to take once every day. -you had nutrition counseling and insulin training to learn how to take care of diabetes at home. you will need to check your blood sugars before each meal and give yourself insulin shots according to the scale you have been given before each meal. -you have a scheduled appointment with dr. at the clinic on (see below). -you should follow up with your primary care doctor, dr. . dr. office has been notified of your discharge from the hospital, and you should call their office to arrange an appointment in the next two weeks. diabetes increases your risk of cardiovascular disease, so we recommend that your pcp consider further cardiac risk assessment, including measuring cholesterol levels, hypertension control, and cardiac stress test. -you will need to have annual appointments with a podiatrist and an opthalmologist because diabetes can lead to neuropathy and retinopathy. this can be arranged through the clinic. -if you experience any high blood sugars, confusion, frequent urination, pain on urination, flank or bladder pain, chest pain, lower extremity edema, fever, chills, shortness of breath, or any other concerning symptoms, call your pcp or come to the ed immediately. -if you have any symptoms of flu, such as fevers, cough, sore throat, muscle pains, please contact your pcp . followup instructions: -you have been scheduled for a follow up appointment with dr. on at 2pm at the clinic. diabetes center is located across the street from the at: one place , ( . -you should schedule follow up with your pcp, . within the next two weeks. dr. , . -you also have an dermatology appointment with dr. on februar 14, at 10:15am. dr. () hospital, building - md, procedure: venous catheterization, not elsewhere classified diagnoses: systemic lupus erythematosus urinary tract infection, site not specified unspecified essential hypertension depressive disorder, not elsewhere classified dehydration chest pain, unspecified intestinal disaccharidase deficiencies and disaccharide malabsorption peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction diabetes with ketoacidosis, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to