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: demerol / ampicillin / niacin / mevacor / prilosec / erythromycin base / clindamycin attending: chief complaint: hypotension, sepsis, funguria, acute kidney injury major surgical or invasive procedure: picc line placement history of present illness: the patient is an 80 year-old female who was recently admitted following a fall to hospital, where she was treated for rll pneumonia requiring vanco/ertapenem at hospital from - . at the time of discharge, her creatinine was 0.6 which reportedly was her baseline value. . at the rehab facility, she was continued on vancomycin, but her vancomycin was discontinued when her creatinine was found to be 3.8. a vanco level was checked and found to be high (reportedly in the 40s). vancomycin was discontinued and ivfs given at rehab, but despite these measures, the cr worsened to 4.1 on subsequent measurement. she was also noted to be lethargic and with poor urine output (50cc/8hr). she also had been having non-bloody diarrhea that respected the night-time that had been occuring for the last 2-3 days. . she was taken to the ed, initial vitals were 98.0 63 86/46 16 98% 4l. supine: 90/39, 71; sitting: 89/40, 69. triggered for hypotension into sbp 80s. physical examinination notable for being fairly unremarkable. laboratory data significant for na 131, creatinine 4.0, wbc 15.0 (9% bands), hematocrit 24.6, inr 1.4, lactate 3.0. ua with moderate leukocyte esterase, large blood. blood cultures, urine cultures sent. ct abdomen/pelvis without contrast with bilateral effusion, atrophic pancreas, no hydronephrosis, possible colitis. cxr 1v reportedly without acute process. received ciprofloxacin iv, 2l ivf (pressures subsequently sbp 90s). on transfer to micu, 72 96/54 18 99% ra. past medical history: s/p spinal fusion l5-s1 in s/p laminectomy l5-s1 in gerd htn hypercholesterolemia chronic diarrhea diverticulosis gi bleed hiatal hernia anemia migraines hypothyroidism hemorrhoids chronic back spasms anxiety s/p cholecystectomy s/p appendectomy social history: most recently at (rehab facility) after hospitalization at hospital. prior to this she lived alone in in . two estranged daughters in ca, she did not want them to be contact. hcp is a friend, (. retired social worker. denies tobacco, alcohol, or illicit drug use. family history: non-contributory physical exam: admission exam: physical exam: vs: 97.3, 107/68, 81, 18, 100%ra general - chronically ill appearing elderly female in nad, sleeping comfortably but easily arousable heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear neck - supple, no thyromegaly, no jvd, no carotid bruits lungs +bibasilar crackles without significantly decreased breath sounds. no wheezes or rhonchi. good air movement, resp unlabored heart - rrr, no mrg, nl s1-s2 abdomen - soft/nt/nd, minimal tenderness to palpation, no masses or hsm, no rebound/guarding, well-healing surgical scar extremities - wwp, no c/c/e, 2+ peripheral pulses skin - no rashes or lesions lymph - no cervical lad neuro - awake, oriented to name, , month, year. cns ii-xii grossly intact, +asymmetric pupils (known prior surgery) muscle strength 4/5 throughout secondary to fatigue, sensation grossly intact throughout, steady gait gu: foley in place, no surrounding erythema . discharge exam: physical exam: vs: 97.7,128/70, 80, 18, 93%ra general - chronically ill appearing elderly female in nad, sleeping comfortably but easily arousable heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear neck - supple, no thyromegaly, no jvd, no carotid bruits lungs +bibasilar crackles without significantly decreased breath sounds. no wheezes or rhonchi. good air movement, resp unlabored heart - rrr, no mrg, nl s1-s2 abdomen - soft/nt/nd, minimal tenderness to deep palpation of rlq, extremities - wwp, no c/c/e, 2+ peripheral pulses skin - no rashes or lesions lymph - no cervical lad neuro - awake, oriented to name, , month, year. cns ii-xii grossly intact pertinent results: admission labs: 11:19pm urine hours-random urea n-182 creat-118 sodium-23 potassium-16 chloride-13 11:19pm urine osmolal-179 08:29pm glucose-90 urea n-24* creat-3.6* sodium-134 potassium-3.2* chloride-100 total co2-23 anion gap-14 08:29pm calcium-7.5* phosphate-5.2*# magnesium-1.7 iron-51 08:29pm caltibc-139* ferritin-630* trf-107* 08:29pm wbc-13.4* rbc-2.35* hgb-7.8* hct-22.5* mcv-95 mch-33.3* mchc-34.9 rdw-19.9* 08:29pm plt count-249 08:29pm ret aut-5.5* 12:46pm glucose-96 lactate-3.0* na+-130* k+-3.4* cl--93* tco2-25 12:30pm glucose-106* urea n-25* creat-4.0*# sodium-131* potassium-3.6 chloride-94* total co2-23 anion gap-18 12:30pm alt(sgpt)-6 ast(sgot)-14 tot bili-0.3 12:30pm wbc-15.0*# rbc-2.58*# hgb-8.4*# hct-24.6*# mcv-95# mch-32.4*# mchc-34.0 rdw-20.2* 12:30pm neuts-49* bands-9* lymphs-19 monos-11 eos-1 basos-0 atyps-1* metas-7* myelos-3* 12:30pm hypochrom-1+ anisocyt-2+ poikilocy-1+ macrocyt-2+ microcyt-1+ polychrom-1+ ovalocyt-1+ stippled-1+ 12:30pm plt smr-normal plt count-256 12:30pm pt-16.1* ptt-42.2* inr(pt)-1.4* 12:30pm urine color-yellow appear-cloudy sp -1.008 12:30pm urine blood-lg nitrite-neg protein-75 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 12:30pm urine rbc-0-2 wbc-21-50* bacteria-few yeast-mod epi-0-2 trans epi-0-2 renal epi- 12:30pm urine eos-negative . #lytes 12:30pm blood glucose-106* urean-25* creat-4.0*# na-131* k-3.6 cl-94* hco3-23 angap-18 08:29pm blood glucose-90 urean-24* creat-3.6* na-134 k-3.2* cl-100 hco3-23 angap-14 02:34am blood glucose-95 urean-23* creat-3.6* na-132* k-3.7 cl-98 hco3-23 angap-15 04:57pm blood glucose-99 urean-22* creat-3.3* na-129* k-3.5 cl-100 hco3-20* angap-13 06:00am blood glucose-94 urean-20 creat-3.0* na-133 k-3.6 cl-103 hco3-21* angap-13 04:03am blood glucose-97 urean-20 creat-3.0* na-132* k-3.7 cl-104 hco3-18* angap-14 08:23am blood glucose-98 urean-21* creat-3.1* na-135 k-3.9 cl-105 hco3-19* angap-15 05:18am blood glucose-99 urean-21* creat-3.2* na-135 k-3.9 cl-105 hco3-21* angap-13 04:33am blood glucose-113* urean-24* creat-3.3* na-137 k-3.9 cl-107 hco3-21* angap-13 . #cbc/diff 12:30pm blood wbc-15.0*# rbc-2.58*# hgb-8.4*# hct-24.6*# mcv-95# mch-32.4*# mchc-34.0 rdw-20.2* plt ct-256 08:29pm blood wbc-13.4* rbc-2.35* hgb-7.8* hct-22.5* mcv-95 mch-33.3* mchc-34.9 rdw-19.9* plt ct-249 02:34am blood wbc-14.1* rbc-2.75* hgb-9.0* hct-26.0* mcv-95 mch-32.6* mchc-34.5 rdw-19.3* plt ct-218 03:46pm blood hct-25.0* 06:00am blood wbc-13.4* rbc-2.84* hgb-9.1* hct-27.0* mcv-95 mch-32.0 mchc-33.7 rdw-19.3* plt ct-242 04:03am blood wbc-12.8* rbc-2.67* hgb-8.7* hct-25.6* mcv-96 mch-32.6* mchc-34.1 rdw-19.3* plt ct-276 08:23am blood wbc-10.8 rbc-2.57* hgb-8.4* hct-24.5* mcv-95 mch-32.9* mchc-34.4 rdw-19.3* plt ct-318 05:18am blood wbc-9.3 rbc-2.53* hgb-8.2* hct-24.0* mcv-95 mch-32.2* mchc-33.9 rdw-19.2* plt ct-339 04:33am blood wbc-11.0 rbc-2.62* hgb-8.5* hct-25.2* mcv-96 mch-32.2* mchc-33.6 rdw-19.6* plt ct-312 12:30pm blood neuts-49* bands-9* lymphs-19 monos-11 eos-1 baso-0 atyps-1* metas-7* myelos-3* 03:46pm blood neuts-57 bands-5 lymphs-12* monos-14* eos-1 baso-0 atyps-1* metas-5* myelos-5* 06:00am blood neuts-56 bands-1 lymphs-15* monos-16* eos-3 baso-0 atyps-1* metas-8* myelos-0 . #uti 12:30pm urine color-yellow appear-cloudy sp -1.008 12:30pm urine rbc-0-2 wbc-21-50* bacteri-few yeast-mod epi-0-2 transe-0-2 renalep- 12:30pm urine blood-lg nitrite-neg protein-75 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-mod 04:33am urine blood-neg nitrite-neg protein-neg glucose-neg 04:33am urine type-random color-straw appear-clear sp -1.006 ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-tr . microbiology - urine culture- positive yeast - blood culture (fungus/mycobacteria)- negative - c-diff- negative - blood culture- negative - urine culture- pending (ngtd) . radiology #cxr upright ap view of the chest: right picc tip terminates in the svc. the heart size is upper limits of normal, unchanged. mediastinal contours are stable. pulmonary vascularity and hilar contours are within normal limits. patchy opacities in both lung bases are present. these likely reflect atelectatic changes. no focal consolidation is noted. no pleural effusion or pneumothorax is present. no acute osseous findings are seen. impression: minimal patchy opacities in both lung bases likely reflect atelectasis. . #ct abd/pelvis study: ct of the abdomen and pelvis without contrast; coronal and sagittal reformatted images were also generated. comparison: ct of the abdomen and pelvis from . findings: abdomen: in the visualized portion of the chest, calcified atherosclerotic disease is seen involving the aortic valve and coronary arteries. a small pericardial effusion is also seen (2; 4). bilateral simple pleural effusions are seen, moderate on the right and small on the left, with associated bilateral lower lobe atelectasis. small hiatal hernia is present. within the limits of a non-contrast study, the liver, spleen and adrenal glands appear normal. the gallbladder has been removed. the pancreas is atrophic. the kidneys show no evidence of hydronephrosis or calculi. the small and large intestine show no signs of obstruction. oral contrast has progressed just into the proximal right colon. right colon is underdistended which likely makes the walls appear mildly thickened, but no adjacent fat stranding is noted. there is no lymphadenopathy or free air. small amount of free fluid is seen around the liver (2; 33). diffuse anasarca is seen. pelvis: the bladder is decompressed around a foley balloon. the patient is status post hysterectomy. rectum appears unremarkable. there is no pericolonic fat stranding but again trace free fluid is seen in the pelvis. diffuse anasarca is present. bones: patient is status post posterior spinal fusion of l5-s1 with grade 1 anterolisthesis of l5 on s1. additionally, a compression deformity is seen in the l1 vertebral body which is unchanged compared to the mr from . there is loss of intervertebral disc height at l3-l4 with vacuum phenomenon within the intervertebral disc. there are no aggressive-appearing lytic or sclerotic lesions. impression: 1. diffuse anasarca with trace ascites and bilateral small to moderate sized pleural effusions, right greater than left. 2. no definite evidence of colitis. apparent wall thickening of the proximal right colon is likely due to underdistention and mixing with oral contrast. no pericolonic stranding is present. . #cxr history: 80-year-old woman with new vomiting, evaluate for aspiration. impression: ap chest compared to , 2:11 a.m.: pulmonary and mediastinal vascular engorgement are new and although heart size is normal and pleural effusions are small if any, the interstitial abnormality in the lungs is most likely mild edema. dr. paged. . #cxr (prelim): no acute process. improved from 's chest x-ray. brief hospital course: 80 year-old female with chronic anemia, prior mrsa uti, and recent admission for rll pneumonia admitted to micu with , hypotension, leukocytosis/bandemia in context of recent nausea, poor po intake, diarrhea, uti. micu course in the micu (), she required fluid resuscitation and 1 unit prbcs for hypotension. she was treated for candidal uti with fluconazole (initially cefepime, linezolid until culture data returned). initially also received vancomycin po given concern for colitis based on symptoms and finding of bowel wall thickening on ct abdomen/pelvis on preliminary read; symptoms resolved, c. difficile toxin was negative, and final read changed to no evidence of colitis. creatinine (baseline 0.6) improved from 4.0 to 3.0 with fluid resuscitation; etiology suspected to be atn and component of prerenal azotemia. patient on admission wished to be dnr/dni. due to issues with delirium, her healthcare proxy, ( was contact. persistent agitation/delirium, psychiatry was consulted and recommend haloperidol 0.5mg po q4-6hr prn agitation and 0.5mg po hs. she was transferred from micu to medical service for further care. hospitial floor course 1. sepsis/hypotension. patient was afebrile, off fluids and hemodynamically stable on transfer to the floor. she remained afebrile, without leukocytosis, hemodynamically stable throughout her course, with blood pressures in the 110-120s systolic. the source of the sepsis was not fully ascertained. although her admission urine culture grew out fungus and she clinically improved on fluconazole in the micu, it seemed unlikely that fungal uti was responsible for her sepsis (blood cultures showed no fungus growth, patient was non-toxic appearing). her foley was discontinued, and a repeat ua was obtained, which was negative except for trace leukocytes and an additional urine culture was sent. with all of these findings, her fluconazole was discontinued. at the time of discharge, the patient remained afebrile, hemodynamically stable and all of her culture data was with no growth to date. we continued to hold all her anti-hypertensive medications, and her blood pressures were not elevated. 2. acute kidney injury. the presented initially with a cr of 4.0, very uop and urinary sediment that was consistent with atn. the etiology of the atn was thought to be secondary to hypotension (sepsis, ongoing diarrhea, decreased po intake) as well as nephrotoxic tubular injury (vancomycin level of 40 in rehab). per her micu course above, she was fluid-resusictated with some improvement of the cr to 3.0. on the floor, her urine output improved and her phosphorus came down to normal range. however, her cr. rose slightly to 3.3. nephrology recommended conservative management with no iv fluids, renally dosed medications, and expected her recovery from atn to be slow and perhaps incomplete given her age and the severity of the insult. she should follow up with her pcp regarding this issue. 3. diarrhea. the patient had been experiencing 2-3 days of non-bloody diarrhea during the initial onset of her symptoms in rehab. a stool c-diff was sent on admission and returned negative. no stool cultures were obtained. the diarrhea resolved on the floor without treatment and the patient reported that her stools were more formed at the time of discharge. 4. agitation/psych. as mentioned in above micu course, patient was seen by psych for persistent agitation/delirium. etiology thought to represent mixture of personality style, background of dementia with superimposed delirium in setting of hypotension and sepsis. her citalopram was discontinued, and she was started on mirtazapine 7.5 mg qhs. she was taken off of her prn valium which had been given at her rehab and started on both prn and standing pm haldol 1 mg qhs. qtc was obtained prior to each haldol administration and was consistently normal. her behavior was more appropriate on this regimen. per psychiatric consult's recommendation, patient was discharged on mirtazapine, and haldol as needed at bedtime, her valium and citalopram remained discontinued. she was counseled to follow up with her primary care physician regarding the management of these medications. 5. normocytic anemia. her hematocrit was found to be at 24 on admission, and she was transfused 1u prbc in the micu, but this hct value was reportedly around her baseline in the setting of myelodysplasia. she was guiac negative on admission and was mantained on gi prophylaxis. her hematocrit remained stable throughout her time on the floor until the time of discharge. medications on admission: milk of magnesia prn zantac 100mg po bid albuterol - d/c atenolol 25mg po daily hctz 25mg po daily - d/c lisinopril 5mg po qhs - d/c d5 1/2ns at 60cc/hour (500cc, then 1000cc, ) compazine 10mg po q6 hours prn nausea ertapenem 1 gram iv q24 hours vancomycin 1 gram iv bid duonebs tid valium 2.5mg po q6 hours prn anxiety oxycodone 5mg po q6 hours prn pan citalopram 5mg po daily vitamin d 50,000 units qweekly levothyroxine 75mcg po daily lipitor 40mg po daily asa 325mg po daily mirapex 0.125mg po daily colace 100mg po bid flovent 110mcg po bid discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath, wheezing. 2. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 4. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 10. polyethylene glycol 3350 17 gram/dose powder sig: one (1) po daily (daily) as needed for constipation. 11. mirtazapine 15 mg tablet sig: 0.5 tablet po hs (at bedtime). 12. haloperidol 1 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for agitation. discharge disposition: extended care facility: discharge diagnosis: sepsis, hypotension, urinary tract infection (yeast), kidney damage (acute tubular necrosis) discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. it was a pleasure taking care of you at . you were admitted for blood pressure, sepsis, and kidney damage. you were initially admitted to the intensive care unit, where you received fluids and were started on iv antibiotics, and you improved. your urine culture grew out yeast and your iv antibiotics were changed to oral antifungals and you continued to improve. . your kidneys were damaged by the blood pressure and iv antibiotics you were taking prior to your admission. once we stabilized your blood pressure, your kidneys began to show signs of improvement, althought we believe that recovery of function might take some time. you should be sure to follow up with your primary care doctor about this issue closely. . you also had some of your psychiatric medications changed during your hospitalization (see below) and you should follow up with your primary care physician and be referred to a psychiatrist as needed regarding the use of these medications. . we made the following adjustments to your medications: stopped valium 2.5mg po every 6 hours as needed anxiety stopped citalopram 5mg by mouth at night started mirtazipine 7.5 mg oral at night started haloperidol 1 mg po at night as needed for agitation . as a reminder, the following medications were discontinued at your rehabilitation facility due to blood pressure. we continued to hold your blood pressure because your blood pressure was not elevated. you should follow up with your primary care physician about these medication. stopped hctz 25mg by mouth daily stopped lisinopril 5mg by mouth at night stopped albuterol inhaler stopped mirapex 0.125mg po daily . your follow-up information is below. followup instructions: please schedule an appointment with your primary care physician 1 week for this hospitalization (sepsis, hypotension, urinary tract infection (yeast), acute tubular necrosis, and psychiatric medication adjustment. procedure: injection or infusion of oxazolidinone class of antibiotics diagnoses: anemia, unspecified esophageal reflux pure hypercholesterolemia acute kidney failure with lesion of tubular necrosis unspecified pleural effusion unspecified septicemia severe sepsis unspecified acquired hypothyroidism candidiasis of other urogenital sites chronic airway obstruction, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere diaphragmatic hernia without mention of obstruction or gangrene myelodysplastic syndrome, unspecified dysthymic disorder other postprocedural status do not resuscitate status encephalopathy, unspecified migraine, unspecified, without mention of intractable migraine without mention of status migrainosus delirium due to conditions classified elsewhere diverticulosis of colon (without mention of hemorrhage) leukocytosis, unspecified lumbosacral spondylosis without myelopathy acquired absence of both cervix and uterus arthrodesis status restless legs syndrome (rls) history of fall personal history of methicillin resistant staphylococcus aureus 

Answer: The patient is high likely exposed to