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: gentamicin attending: chief complaint: weakness and lethargy major surgical or invasive procedure: none history of present illness: the pt is a 72 yo female with h/o mca embolic stroke in , htn, tachy-brady syndrome, breast ca, paf, dm ii, diastolic hf, and utis who presented to her pcp's office yesterday with le edema and was called into the ed tonight when labs came back pertinent for hyperkalemia. her son picked her up at home and on transport to the hospital she became weak and lethargic and required being carried out of the car into the or. . on arrival to the ed vitals were t97.2 hr77 bp137/61 rr17 o2 99% ra. she was found to have a uti and given her previous cx data was started on vancomycin and ctx. her exam was noticle for lethargy, but arousable, not speaking, and poor capillary refill. her cxr showed bilateral pleural effusions and ? of old femur fracture. her lab was notable for a lactate of 5.4, wbc of 10.5, creatinine of 1.4 (recent baseline 1.2). ekg with no evidence of hyperkalemia. while in the ed her sbps remained stable with lowest sbp in the 110s. she received a total of 2.5 l of fluid in the ed including abx). vitals prior to transfer were 97.2 77 137/61 17 99% on 2l. . on arrival she was somulent but arousable. vitals on arrival were 95.6 162/78 16 84% on ra. her o2 sat improved to the high 90s on a non rebreather. her gas on arrival to the floor was ph7.19 pco281 po2 255 hco3 32. she was placed on bipap and her gas improved to ph7.30 pco264 po2 86 hco3 33. she then dropped her pressures to sbp to 80s which responded to ivf bolus. she dropped her pressures 2 more times during her centralline placement which responded to bolus. a left ij was attempted and a r ij was ultimately placed. . review of systems: unable to obtain secondary to pt's mental status past medical history: 1: mca embolic stroke c/b hemorrhagic transformation on coumadin . (residual aphasia & r sided weakness) 2. hypertension 3. tachy-brady syndrome s/p pacemaker 4. paroxysmal atrial fibrillation 5. dm2 6. diastolic hf () 7. enterrococcal bacteremia treated with amp/gent, suspected source suspected rle cellulitis 8. breast cancer s/p axillary dissection and chemo/radiation 9. depression 10. endometriosis 11. shoulder pain 12. incontinence social history: russian-speaking.45 yr smoking hx. ppd. no etoh or illicits per her son. family history: father died at stroke at 74. physical exam: 95.6 162/78 16 84% on ra. gen: initially opening eyes, later no longer opening eyes to command heent: pupils equally round, periorbital edema, mmm, oropharynx clear neck: supple, elevated jvd lungs: no breath sounds at bases, decreased air movement throughout, no crackles, no rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: +bs, soft, non-tender, non-distended, no rebound tenderness or guarding ext: 1+ radial and dp pulses, 1+ pitting edema to the knees with ulcers in the lower extremities with clean bases pertinent results: labs on admission: 12:03am wbc-12.3* rbc-3.78* hgb-10.7* hct-35.1* mcv-93 mch-28.3 mchc-30.5* rdw-15.4 12:03am neuts-56.9 lymphs-35.4 monos-4.6 eos-2.5 basos-0.6 12:03am plt count-320 12:03am pt-14.8* ptt-25.4 inr(pt)-1.3* 05:30pm glucose-116* 05:30pm urea n-40* creat-1.4* sodium-145 potassium-6.1* chloride-98 total co2-35* anion gap-18 05:30pm urine hours-random creat-68 sodium-58 potassium-48 chloride-87 albumin-9.8 alb/crea-144.1* 05:30pm urine osmolal-493 . labs on discharge: 04:06am blood wbc-8.2 rbc-3.41* hgb-9.7* hct-31.0* mcv-91 mch-28.3 mchc-31.1 rdw-15.1 plt ct-397 04:06am blood pt-19.2* ptt-34.3 inr(pt)-1.8* 04:06am blood glucose-193* urean-21* creat-1.0 na-140 k-4.2 cl-103 hco3-31 angap-10 04:06am blood calcium-9.1 phos-3.8 mg-1.7 . micro: blood culture: micrococcus species . urine culture: proteus mirabilis ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- 8 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin--------- =>4 r gentamicin------------ 8 i meropenem-------------<=0.25 s piperacillin/tazo----- <=4 s tobramycin------------ 2 s trimethoprim/sulfa---- =>16 r . imaging: cxr: this exam is limited due to patient's body habitus and low lung volumes. there is left-sided pleural effusion with likely adjacent atelectasis. there is also a right-sided small pleural effusion causing blunting of the right costophrenic angle. heart is enlarged. the aorta is calcified and tortuous. there is no pneumothorax or evidence of congestive heart failure. bones are severely osteopenic. likely prior left humeral fracture is seen. impression: new bilateral pleural effusions, left more than right. cardiomegaly. no overt pulmonary edema. . echo: the left atrium is moderately dilated. no left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no systolic prolapse. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . cxr: compared to yesterday, the fluid level on the right has resolved. there is unchanged mild pulmonary edema, unchanged large layering bilateral pleural effusions with an unchanged retrocardiac opacity, likely atelectasis. unchanged left pacemaker terminating in the right atrium. impression: unchanged hypervolemia with mild pulmonary edema and moderate to large bilateral pleural effusions. . ct head: there is no acute intracranial hemorrhage. extensive encephalomalacia in the left mca territory, with gyriform mineralization, is unchanged and compatible with a left mca infarct with pseudolaminar necrosis. mild ex vacuo effect on the left lateral ventricle is most pronounced in the left temporal . there is no evidence of acute major vascular territorial infarct. periventricular white matter hypodensities are again noted, compatible with chronic microvascular ischemic disease. an opacified left ethmoid haller cell is again noted. the bones are unremarkable. impression: no evidence of acute intracranial abnormalities. large chronic left mca infarct. mri would be more sensitive for an acute infarct, if indicated. . left upper extremity ultrasound : no evidence of dvt of the left upper extremity. brief hospital course: 72 year old russian speaking female with h/o stroke, htn, dmii, a fib, tachy/brady s/p pacemaker, breast ca, and diastolic heart failure who presented with uti, hyperkalemia, and severe sepsis. 1. severe sepsis secondary to urinary tract infection: presented to ed with lactate of 5.4, leukocytosis to 12.3, intermittent hypotension and low urine output. in the emergency department, lactate decreased and hypotension resolved with iv fluid bolus. blood and urine cultures were drawn and placed empirically on vancomycin and ceftriaxone (subsequantly broadened to zosyn). cxr with no evidence of pulmonary infiltrate. source of infection attributed to urinary tract infection with grossly positive urinalysis. started on early goal directed therapy with placement of arterial and central venous line for hemodynamic monitoring. although blood pressure required brief support with levophed, hemodynamics normalized and patient defervesced. 1 of 2 sets of blood cultures from the emergency department grew micrococcus, which was thought to be a contaminent so vancomycin was discontinued. urine cultures returned with proteus mirabilis (see above for sensitivities). the patient's antibiotics were narrowed to ceftriaxone alone, with a plan to treat for 14 days. the patient will complete her course of ceftriaxone on . at that point, her midline can be removed. . 2. hypoxia/hypercarbia: upon admission to the intensive care unit, the patient was hypercapnic and in respiratory distress with abg of 7.19/81/255/32 on 100% nrb. hypercapnia was attributed to underlying lung disease with 45 yr smoking history. the patient responded well to bipap with decreasing co2 and was able to be transitioned quickly to 2-4l nc alone, although she did subsequently require intermittent noninvasive ventillation for hypercapnia. the patient was treated with bronchodilators and diuresis. at the time of discharge, the patient was breathing comfortably, with oxyggen saturations in the low to mid 90s on 0-2 l/min o2 by nasal cannula. . 3. acute on chronic renal failure: admitted to hospital with hyperkalemia of 6.1 and acute renal failure with creatinine of 1.6 from baseline of 1.2 in . ekg showed no changes associated with hyperkalemia. kidney injury was thought to be prerenal in etiology, related to sepsis. the patient's kidney function improved throughout her hospital stay and was 1.0 at the time of discharge. . 4. urinary trace infection, complicated by sepsis: the patient was found to have a urinary tract infection with proteus, sensitive to ceftriaxone with a mic of 4. the patient's sepsis was thought to be caused by urinary tract infection. . 5. chronic atrial fibrillation: the patient has a history of chronic atrial fibrillation. she is anticoagulated with coumadin, with her rate controlled by b-blockers. the patient was admitted with a subtherapeutic inr, and placed on heparin gtt with continuation of coumadin until inr > 2. inr became supratherapeutic to 4.1 in setting of new antibiotics and poor po intake, so coumadin was held. the patient's inr subsequently became subtherapeutic, so she was started on a heparin gtt, later transitioned to enoxaparin. the patient's inr was 1.8 at the time of discharge. she should have her inr checked daily until it is greater than 2.0, at which time enoxaparin should be discontinued and warfarin continued at the present dose of 4 mg daily. thereafter, the patient's inr should be checked twice weekly. goal inr is 2.0 to 3.0. the patient uses metoprolol for rate control. beta blockade was initally held due to hypotension. however, the patient had intermittent tachycardia to the 120s requiring doses of iv metoprolol. the patient's home dose of metoprolol tartrate was restarted and then reduced to 100 mg in the morning and 75 mg at night due to hypotension. . 6. ulcers on le: the patient has ulcers on her lower extremity, which are thought to be related to vascular insufficiency. there was no evidence of active skin or soft tissue infection. the wound care team was consulted and made recommendations for wound care. these recommendations have been included in the patient's page 1. . 7. acute chronic diastolic congestive heart failure: the patient has a history of diastolic heart failure. repeat echocardiogram showed ejection fraction of 55%. the patient was aggressively volume resuscitated, resulting in symptoms of volume overload. in the icu, the patient was diuresed with lasix 40mg iv. she subsequently developed hypotension requiring a 250cc fluid bolus. the patient was euvolemic at the time of discharge. lasix was discontinued given the patient's blood pressure of 100-140 and lack of edema. consideration can be given to restarting this in the outpatient. . 8. diabetes mellitus: metformin was held given heart failure and hypotension. the patient was initially treated with an insulin sliding scale. lantus 6 units at night was added to improve glycemic control. the patient was discharge on lantus 6 units at night, plus humalog insulin sliding scale. . 9. delirium: the patient developed waxing and mental status that was thought to be related to delirium. the cause of delirium was urinary tract infection. the patient's mental status improved throughout her hospital course, and she was at her pre-admission baseline at the time of discharge. . 10. hypertension: stopped lasix and lisinopril/hctz in the setting of low blood pressures. consideration can be given to restarting these medications in the outpatient setting. . 11. depression: continued venlafaxine. . 12. swallowing safety: the patient was evaluated by the speech and swallow service, who recommended a diet of thin liquids and soft consistency solids, pills crushed with puree, and strict 1:1 supervision when eating. 12. code status: full code medications on admission: atorvastatin 80 mg po daily furosemide 10 mg po every 2 days gabapentin 100 mg po bid lisinopril-hydrochlorothiazide - 10 mg-12.5 mg tablet po daily metformin 1,000 mg po bid (breakfast and lunch) metformin 500 mg po qhs metoprolol tartrate 100 mg po bid omeprazole 20 mg po daily venlafaxine 37.5 mg po bid warfarin 4 mg tablets as directed (daily per most recent anticoagulation sheet) humalin iss magnesium oxide 400 mg tablet po daily discharge medications: 1. atorvastatin 80 mg tablet : one (1) tablet po daily (daily). 2. heparin flush (10 units/ml) 1 ml iv prn line flush temporary central access-floor: flush with 10 ml normal saline followed by heparin as above daily and prn. 3. omeprazole 20 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po once a day. 4. venlafaxine 37.5 mg tablet : one (1) tablet po bid (2 times a day). 5. warfarin 2 mg tablet : two (2) tablet po once daily at 4 pm. 6. metoprolol tartrate 50 mg tablet : two (2) tablet po qam (once a day (in the morning)). 7. metoprolol tartrate 25 mg tablet : three (3) tablet po qpm (once a day (in the evening)). 8. insulin glargine 100 unit/ml solution : six (6) units subcutaneous at bedtime. 9. magnesium oxide 400 mg tablet : one (1) tablet po once a day. 10. enoxaparin 80 mg/0.8 ml syringe : eighty (80) mg subcutaneous (2 times a day). 11. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day) as needed for constipation. 12. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 13. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation inhalation q6h (every 6 hours) as needed for wheezing. 14. ipratropium bromide 0.02 % solution : one (1) inhalation inhalation q6h (every 6 hours) as needed for wheezing. 15. outpatient lab work check inr daily until >2.0. goal is 2.0 to 3.0. stop enoxaparin when inr > 2.0. inr should be checked twice weekly thereafter. please fax results to at at . 16. . ceftriaxone 1 gm iv q24h. last day = . 17. humalog insulin please see attached humalog insulin sliding scale. discharge disposition: extended care facility: senior healthcare of discharge diagnosis: primary: severe sepsis, caused by urinary tract infection . secondary: history of stroke hypertension diabetes mellitus, type 2 discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you came to the hospital because of a high potassium level. in the emergency department, you were found to have a urinary tract infection. you were admitted to the intensive care unit due to low blood pressure and difficulty breathing. you were treated with antibiotics, with improvement in your condition. . you had a special kind of iv called a midline placed in order to administer antibiotics. you will need to continue to receive daily antibiotic infusions through this line until . . there are some changes to your medications: start ceftriaxone and continue until . start lovenox (enoxaparin) and continue for 1-3 days (until your inr is >2.0). inr goal is 2.0-3.0. start colace and senna as needed for constipation start glargine 6 units at night. talk to you primary care doctor about when it will be okay to stop this. stop lasix (furosemide) stop neurontin (gabapentin) stop lisinopril-hctz stop metformin change metoprolol to 100 mg in the morning and 75 mg in the evening . weigh yourself every morning, md if weight goes up more than 3 lbs. . follow up as indicated below. followup instructions: please follow-up with dr. on at 10:30am at / . phone #. this is for a post-discharge follow-up appointment until you can get your next follow-up scheduled with dr. . . department: when: thursday at 4:10 pm with: , rnc building: campus: east best parking: garage . department: when: thursday at 1:55 pm with: building: campus: east best parking: garage . department: care center when: thursday at 3:15 pm with: , np building: campus: east best parking: garage md, procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified non-invasive mechanical ventilation diagnoses: tobacco use disorder urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure personal history of malignant neoplasm of breast chronic kidney disease, unspecified acute respiratory failure long-term (current) use of anticoagulants paralytic ileus other septicemia due to gram-negative organisms late effects of cerebrovascular disease, aphasia 

Answer: The patient is high likely exposed to