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: penicillins / bactrim attending: chief complaint: transfer from nh for hypotension and hypoxia major surgical or invasive procedure: none history of present illness: mr. is an 83 yom with dementia, type 2 diabetes mellitus, bladder cancer s/p resection and bcg treatment, and recently discharged for uti who was at his nursing home yestderday when found to be having chills and lower extremity numbness. his vitals were taken and was found to be afebrile 95.7, hypotensive (79/57), tachycardic (120) and hypoxic (o2sat: 81% on ra). his bilateral le were found to be cold and purple. he was warmed up and put into bed and his bp stabilized in 110s, he was placed on nonrebreather and his o2 sats came up only to 87%. per records he did not have any mental status changes. . of note, osh records from mr previous d/c summary in omr report he has had multiple recent utis over the past few months including multi drug resistent enterobacter on , proteus on , as well as klebsiella in . mr. was recently discharged from on for uti with pseudomonas resistent to cipro. this admission was complicated by delirium and le dvt for which an ivc filter was placed due to concurrent hematuria. he is not currently anticoagulated. he was discharged on meropenem for 6 days. on (the day prior to admission) he presented to the ed b/c of hematuria and passage of clots. he was seen by urology and foley irrigation was performed and he was sent out on levofloxacin with plans to undergo cystoscopy with bladder biopsies and possible resection of turbt as an outpatient. however, the following day he had his hypotensive event described above and was sent to the ed. . in the ed his vitals were 98.0 110 130/60 18 99. however, his bp dropped to 90/60 bp with sats in the 80s and a lactate of 6. cxr showed no acute pulmonary process. he was given vanc and meropenem and, had an ij placed, 6 l fluid, and foley showed gross hematuria. he was transfered to the micu with concern for urosepsis where his pressure stabilized and he did not require pressors. he was transfered to the medicine floor. . upon ariving to the floor vitals were 99.2 122/60 91 20 97% on ra. . ros: difficult to understand pt, unsure if from dementia or adentulous. pt alert but oriented only to self, knew he was in but could not name hospital. denied pain, sob, but stated he was cold and thirsty. past medical history: 1. pulmonary embolism (, ivc filter, not on anticoagulation) 2. pancreatitis 3. dementia 4. type 2 diabetes mellitus 5. hypertension, but not on antihypertensives 6. bph 7. bladder cancer - s/p transurethral resection in - completed bcg treatment (missed treatment 5 uti) 8. s/p stab wounds 9. h/o rpr - treated in 10. s/p penile implant 11. osteoarthritis social history: per previous records, patient could not complete full history with me due to his delirium and dementia. home: lives in facility occupation: retired long-distance truck driver etoh: remote history of social alcohol use; denies etoh in > 45 years tobacco: remote history of 1 ppd smoking history, could not tell me when he quit drugs: denies family history: could not complete due to patient's dementia. physical exam: vs: 100.4 133/74 76 20 98% ra general: alert, oriented to self only, lying comfortably in bed heent: dry mucous membranes, edentulous, pupils equal and reactive neck: supple, jvp not elevated, no lad. right ij in place, appears clean and dry. lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: 2+ pitting edema in left le and 1+ on right, chronic venous stasis changes to skin of both les; dps difficult to palpate, but feet are warm neuro: cn grossly intact. uses both upper extremities purposefully. foley with red urine in bag. responded to questions, but difficult to make out his answers, mildly agitated, not really holding coherent conversation. pertinent results: labs on admission: 10:00am blood wbc-11.7* rbc-4.20* hgb-10.4* hct-32.8* mcv-78* mch-24.8* mchc-31.7 rdw-14.7 plt ct-257 10:00am blood neuts-82.9* lymphs-11.6* monos-4.7 eos-0.4 baso-0.3 10:00am blood pt-14.4* ptt-26.4 inr(pt)-1.2* 10:00am blood glucose-138* urean-33* creat-1.3* na-144 k-3.9 cl-100 hco3-30 angap-18 05:25pm blood alt-17 ast-16 ld(ldh)-268* alkphos-76 totbili-0.3 05:25pm blood lipase-68* 05:25pm blood ctropnt-<0.01 07:43pm blood hgb-8.4* calchct-25 o2 sat-91 08:48pm blood glucose-133* lactate-1.2 05:22pm blood lactate-6.0* k-5.0 labs on discharge: 05:53am blood wbc-6.6 rbc-3.38* hgb-7.9* hct-26.0* mcv-77* mch-23.2* mchc-30.2* rdw-18.1* plt ct-423 06:56am blood wbc-8.0 rbc-3.57* hgb-8.2* hct-27.5* mcv-77* mch-23.0* mchc-29.8* rdw-17.5* plt ct-421 06:56am blood glucose-141* urean-12 creat-0.6 na-136 k-4.5 cl-99 hco3-29 angap-13 06:56am blood calcium-9.0 phos-3.0 mg-1.6 05:43am blood wbc-7.6 rbc-3.50* hgb-8.2* hct-26.6* mcv-76* mch-23.5* mchc-30.9* rdw-18.0* plt ct-495* 05:43am blood glucose-144* urean-11 creat-0.6 na-134 k-4.3 cl-97 hco3-30 angap-11 05:43am blood calcium-9.1 phos-2.9 mg-1.8 ******** cxr : findings: lung volumes are markedly diminished with resultant bronchovascular reorientation at the lung bases. no consolidation or edema is evident. tortuosity of the thoracic aorta is slightly accentuated due to the low lung volumes. similarly, cardiac size is mildly accentuated, but remains overall within normal limits. no definite effusion or pneumothorax is seen. extensive degenerative changes are again seen throughout the thoracic spine. there are multiple bilateral rib deformities, presumably due to remote trauma, relatively stable when compared to the prior exam. impression: markedly low lung volumes with no acute pulmonary process identified. renal u/s: findings: the right kidney measures 11.0 cm. the left kidney measures 13.1 cm. no stones, hydronephrosis or solid mass is identified. within the lower pole of the right kidney is a 1.6 cm simple-appearing cyst. there is also a 1.6 cm simple-appearing cyst within the upper pole of the left kidney. no perinephric fluid collection is identified. limited views of bladder reveal foley catheter, with the bladder decompressed. there is a heterogeneous 6.7 cm mass in the bladder with vascular waveforms obtained, compatible with the patient's known bladder mass. impression: 1. no evidence of hydronephrosis. 2. no evidence of perinephric abscess or fluid. cxr : cardiomediastinal silhouette is stable. right picc line tip is at the level of superior svc. heart size is normal. mediastinal contour is unremarkable. there is questionable new small focal opacity at the mid portion of the left lung that might represent subpleural atelectasis/nodule seen on the chest ct from , with no new consolidations demonstrated. the known pulmonary nodules are partially imaged on the current study due to the suboptimal sensitivity of this portable chest radiograph. multiple rib fractures, bilateral, are unchanged since the prior study. the ivc filter is in place. . ct chest without iv contrast: there are numerous pulmonary nodules throughout all lobes of the lungs consistent with metastatic disease, presumably from the patient's known bladder cancer unless there is an additional unknown primary neoplasm. these are larger in the lung bases, measuring up to 12 mm bilaterally (2:36, 2:34). there is no significant pleural effusion. there is bilateral mild subsegmental dependent atelectasis. the trachea and bronchi are patent to the subsegmental levels. there is no mediastinal lymphadenopathy. note is made of multiple slightly prominent axillary lymph nodes, which are not pathologically enlarged by size criteria. there are numerous coronary artery calcifications, as well as calcification of the aortic arch. a right upper extremity picc terminates with the catheter tip in the lower svc. limited axial imaging of the upper abdomen is fairly unremarkable, although numerous renal hypodensities are again seen, which are most consistent with cysts, although better demonstrated on prior imaging studies. the superior most aspect of an infrarenal ivc filter is seen (2:56). small hiatal hernia is present. osseous structures demonstrate numerous left-sided chronic rib fractures at t1-9 as well as right-sided rib fractures at t1-6. no suspicious lytic or sclerotic lesions are seen. there is mild degenerative change of the thoracic spine. impression: 1. innumerable bilateral pulmonary nodules consistent with metastatic disease. 2. no mediastinal lymphadenopathy. 3. chronic rib fractures bilaterally. 4. renal hypodensities most consistent with cysts, better demonstrated on prior studies. brief hospital course: 83yo gentleman with h/o bladder cancer, recurrent utis, and dementia called out from the micu for continuing treatment of urosepsis. hospital course by problem as follows. . # urosepsis: patient received 7 l ivf with improvement in blood pressure, never needed vasopressor support. he was started on meropenem given prior urine cx sensitivities. he was transferred to the floor the following morning. his renal function returned to baseline after volume repletion. ucx pseudomonas 10-100k, sensitive to cefepime, ceftaz, gent, , , tobra. recurrent utis across last several months with documented history of proteus, enterobacter, klebsiela and pseudomonas, current urine cx showing pseudomonas. no other clear source of infection as he did not have infiltrate on cxr, no cough, no abdominal pain, bcx ngtd, and no lines on admission. picc line placed and he was treated for 14days with meropenem. urology consulted. recurrent uti's likely bladder cancer and urinary retention. a foley catheter was placed at admission. this was taken out overnight on . he passed his trial of void with a 100 cc residual volume. he was noted to be incontinent of urine at baseline. . # bladder cancer, hematuria: urology took for cystoscopy-> 7cm tumor, unable to resect via scope. ct to assess for invasion/ lymph node involvement-> no clear evid of invasion or ln involvement however mult lung nodules concerning for metastatic disease. med onc consulted-> rec chest ct for accurate staging, bx for tissue diagnosis, and agreed to follow when outpatient. given massive dvt and need for anticoagulation, discussion had with family/urology/ radiation oncology about possible palliative procedures to stop hematuria and allow for anticoagulation. decision was made to proceed with palliative radiation tx as family wished to avoid any further invasive procedures. palliative care also consulted. patient underwent palliative radiation in attempt to control hematuria so that he could have anticoagulation given his large lower extremity dvt as below. . # dvt: h/o pe dvt with ivc in place not anticoagulated due to history of hematuria. patient noted to have swollen l leg-> leni-> dvt from l common fem to l popliteal. ct scan done for staging as above showed dvt extended up to dvt filter. anticoagulation attempted however was d/c'd as hematuria increased and patient dropped his hct. palliative radiation therapy was given with the goal to control hematuria, however the patient did continue to bleed with anticoagulation. given that he bled enough to require multiple transfusions during this admission, it was ultimately felt that anticoagulation should be held with the decision to re-start deferred to the outpatient setting. . # low grade fevers: following treatment with meropenem for urosepsis as above, patient developed recurrent low grade fevers. no clear source. ucx, bcx, and cxr negative for infection. wbc stable. in the end, thought likely due to dvt. by discharge, still having once daily temperatures to 99 f. . # delirium : continued on aricept. ms waxed and waned however never returned to baseline. he frequently became agitated, pulling at his picc line and foley. he frequently required soft restraints to prevent him from injuring himself and occasionally required haldol (ecg checked and qtc wnl). after his catheter was removed the restraints were removed and he was overall much more calm. . # anemia: baseline hct 32-35, current hct 25, likely hematuria. iron studies were consistent with underlying anemia of chronic disease. guiac was negative. he was transfused a total of 5 units of prbcs during this admission given blood loss from his friable bladder tumor. his hct was stable around 26 prior to discharge. . # hypernatremia, mild, asymptomatic: likely poor po water intake. encouraged po intake of water and this resolved on its own. . # type 2 dm: controlled with iss in house. medications on admission: imipenem 750mg im started for 3 days ertapenem 1gm im qday x 4 days, started decubrite 1 tab qday tylenol 650mg q4h po prn lasix 30mg po qday levaquin 250mg po x 7 days, started donepezil 5mg hs gabapentin 300mg qday imdur 30mg qday famotidine 20mg po bid prn itch novalog ssi senna 1-2 tabs prn vitamin d3 400mg, 2 tabs qday colace 100mg citaloprom 20mg qday discharge medications: 1. famotidine 20 mg tablet sig: one (1) tablet po every twelve (12) hours. disp:*30 tablet(s)* refills:*2* 2. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). tablet(s) 3. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 4. donepezil 5 mg tablet sig: one (1) tablet po hs (at bedtime). 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever or pain. 8. polyvinyl alcohol 1.4 % drops sig: 1-2 drops ophthalmic prn (as needed) as needed for dryness. disp:*1 bottle* refills:*2* 9. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 10. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day). 11. polyethylene glycol 3350 17 gram/dose powder sig: one (1) packet po daily (daily) as needed for constipation. 12. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 13. insulin instructions please continue to take your humalog insulin --sliding scale as taken during this admission. a full sliding scale regimen is outlined below for the nurses to follow. to be taken as needed at meal times and at bed time discharge disposition: extended care facility: - discharge diagnosis: primary: 1. urosepsis 2. bladder cancer 3. deep venous thrombosis secondary: 1. dementia / deliriium 2. type 2 diabetes mellitus 3. hypertension, but not on antihypertensives discharge condition: mental status:confused - always level of consciousness: lethargic but arousable activity status: bedbound discharge instructions: it was a pleasure taking care of you during your admission at . you were admitted for a urinary tract infection. you were treated with antibiotics. you had a catheter in your bladder for some time, but we took this out and you were able to urinate on your own. you received a course of radiation to help improve your bladder cancer symptoms. you have a previous diagnosis of left lower leg blood clot. we were unable to give you anticoagulant medications for this as you continued to have significant blood in your urine, requiring blood transfusion, after receiving these. we have changed some of your medications during your admission. please continue, start, or stop your medications as below: - continue citalopram 20 mg daily - continue donepezil 5 mg daily - continue famotidine 20 mg twice daily - continue polyethylene glycol for constipation as needed - continue senna for constipation prevention - continue vitamin d 800 units daily - stop fexofenadine - continue colace 100 mg twice daily - continue tylenol as needed for pain/fever as written - continue using humalog insulin as needed with a sliding scale at meal times and bedtime as taken prior to this admission - stop lasix; discuss re-starting this medication as an outpatient. - continue getting subcutaneous heparin three times daily while in followup instructions: please follow up with dr. . and dr. from urologic oncology on at 1 pm. . dr. office was called and notified that you will be going back to the . upon return to the you will be seen by her nurse practitioner, jiyan (#). ms. will help to coordinate your next visit with dr. at your facility. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified other cystoscopy transfusion of packed cells diagnoses: acidosis urinary tract infection, site not specified unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia hyposmolality and/or hyponatremia severe sepsis other persistent mental disorders due to conditions classified elsewhere hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure septic shock retention of urine, unspecified hypoxemia gross hematuria acute venous embolism and thrombosis of deep vessels of proximal lower extremity hyperosmolality and/or hypernatremia pseudomonas infection in conditions classified elsewhere and of unspecified site other transfusion reaction malignant neoplasm of dome of urinary bladder 

Answer: The patient is high likely exposed to