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: banana / melon flavor / avocado / iv constrast / lorazepam attending: chief complaint: urinary tract infection, developing urosepsis major surgical or invasive procedure: nephrostomy tube change flexible sigmoidoscopy with cautery history of present illness: micu hpi: this is a 66 year old female with a history of stage iv cervical cancer presenting with fever and urinary tract infection. her history of cervical cancer includes chemotherapy and radiation therapy; her last dose of chemotherapy was in - her radiation therapy has left her with multiple complications including radiation colitis, a right ureteral stricture, and cystitis. urology has been consulted for this stricture and had a nephrostomy placed last year; as a consequence, she has developed multiple urinary tract infections, including pan-sensitive e. coli and klebsiella. she takes macrobid for urinary tract infection suppression. her urologist has been consulting for the possibility of a right nephrectomy in order to prevent recurrent urinary tract infections and as the definitive treatment for her stricture. pt started ebrt . she was to start chemo but cr was 2.3, she had b/l percutaneous nephrostomy tubes w/ improvement in cr. pt received 1st weekly cisplatin 40mg/m2 . she received #2 , #3 . her most recent admission in was for severe diarrhea - at times bloody - which was attributed to radiation colitis after colonoscopy was performed. she was started on anti-spasmodics; she also had a urinary tract infection during that admission for which she was treated with ceftriaxone. on the morning of this admission, she developed a fever to 102 - she had no other symptoms. she has been anorexic for the past several weeks with decreased po intake. denies dizziness or lightheadedness. she denies dysuria; her nephrostomy output has been normal and has not changed in color or output. normal frequency. denies cough, chills, sweats, chest pain, abdominal pain, nausea, or vomiting. in the emergency room, she was slightly hypotensive with bps around the 90s - she received 2 l of fluid with improvement. a troponin was checked which was elevated at .23 with no ekg changes representative of ischemia. her sodium was low and potassium was also depressed; she received potassium. she was transferred to the micu given her transient hypotension. floor hpi: patient is a 66 year old female with a history of stage iv cervical cancer, currently inactive not on chemo-radiation, with history of nephrostomy tube for ureteral stricture with multiple prior admissions for urosepsis/utis with resistant gnrs who was admitted with fever and urinary tract infection. she was hospitalized in for diarrhea - at times bloody - found to be radiation colitis based on colonoscopy. also with uti treated with ceftriaxone during that admission (klebsiella pan-sensitive). on the morning of admission, patient febrile 102 but asymptomatic otherwise. denies dizziness or lightheadedness. she denies dysuria; her nephrostomy output has been normal and has not changed in color or output. normal frequency. denies cough, chills, sweats, chest pain, abdominal pain, nausea, or vomiting. in the micu she was hemodynamically stable and never required pressors. her uti was treated with iv ceftriaxone with defervescence. additionally she was found to have a 10 point hct drop and a bowel movement with maroon colored stools. she was transfused 2 units prbcs and she had no additional bloody bowel movements and her hct remained stable. per gi consult, when she was last seen in decision was made to repeat flex sigmoidoscopy with electro-cauterization of bleeding sites of proctitis. given repeat episode of bloody diarrhea gi indicated she will have a flex-sig with cautery after patient transferred to the floor. additional issues that were discussed included removal of nephrostomy tube. patient and family frustrated with nephrostomy and feel it is causing recurrent utis and sepsis, she would like it removed. dr. indicated to patient that the only way to dc nephrostomy tube would be to complete a right nephrectomy. the patient is agreeable with this plan. patient would like to see urology and uro-surgery while she is an inpatient. patient also with history of pan-hypopituitarism for which she is on chronic prednisone. she was not treated with vit-d/ca in the past and now has new pelvic fractures. past medical history: -cervical cancer: followed by dr. , discovered after post-menopausal vaginal bleeding/hematuria and was found to have a cervical mass w/ invasion of the posterior bladder wall. biopsies revealed a locally advanced, stage squamous cell cervical carcinoma. underwent nephrostomy tubes for hydronephorosis. she initiated radiation therapy of pelvis on with her last session . she completed 6 sessions of weekly cisplatin on . -status post resection of a benign pituitary adenoma at age 21 at with resultant hypopituitarism; she was previously followed at , needs endocrine f/u (hasn't seen in some time) -multiple utis since nephrostomy tube placement in : organisms including enterococcus (not vre), mrsa, e.coli (pan-sensative) -osteoporosis -multiple food allergies social history: she grew up in the west end of . she lives in , ma with her husband . they have two daughters, her eldest lives nearby, her daughter lives in new . her sister from , , is back in . hopes to travel to later this spring. the patient smoked approximately one-third to pack per day for 33 years, recently quitting. she had one alcoholic beverage daily until her illness. family history: - brother died of leukemia at age 64 in . pt was a match, donated peripheral blood stem cells. both parents had heart disease. physical exam: micu green admission exam heart rate of 90 with bp of 108/54, rr of 12, o2 sat of 95% on 2 l, afebrile gen: caucasian female, in no apparent distress cardiac: nl s1/s2 rrr no murmurs appreciable pulm: lungs clear bilaterally abd: soft, nontender, nondistended, no suprapubic tenderness ext: no edema noted, nephrostomy tube draining slightly cloudy urine rectal: guiaic positive stool transfer exam vs - afebrile, 130s/90s, 90s, 14, 98% ra general - well-appearing, pleasant 66 yo f who appears comfortable, appropriate and in nad heent - nc/at, perrl, eomi, sclerae anicteric, mmm, op clear neck - supple, no thyromegaly, no jvd, no carotid bruits lungs - lungs are clear to ausculatation bilaterally, moving air well and symmetrically, resp unlabored, no accessory muscle use heart - pmi non-displaced, rrr, s1-s2 clear and of good quality without murmurs, rubs or gallops abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding, no suprapubic tenderness. right nephrostomy tube in right flank is c/d/i without surrounding erythema, exudate or tenderness, nephrostomy bag with pink tinged urine. extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps) neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout, dtrs 2+ and symmetric discharge exam: afebrile, vss general - well-appearing, pleasant heent - nc/at, perrl, mmm, op clear lungs - lungs are clear to ausculatation bilaterally, moving air well and symmetrically heart - rrr, s1-s2 clear and of good quality without murmurs, rubs or gallops abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding, no suprapubic tenderness. right nephrostomy tube in right flank is c/d/i without surrounding erythema, exudate or tenderness, nephrostomy bag with clear-yellow urine. extremities - wwp, no c/c/e, 2+ peripheral pulses pertinent results: admission labs 07:00pm blood wbc-8.9 rbc-2.75* hgb-8.2* hct-25.0* mcv-91 mch-29.8 mchc-32.8 rdw-15.3 plt ct-337 07:00pm blood neuts-91.1* lymphs-5.0* monos-3.2 eos-0.3 baso-0.3 04:38am blood pt-14.4* ptt-31.1 inr(pt)-1.3* 07:00pm blood glucose-90 urean-9 creat-1.1 na-126* k-2.6* cl-89* hco3-21* angap-19 04:38am blood alt-13 ast-24 ld(ldh)-154 ck(cpk)-130 alkphos-121* totbili-0.6 07:00pm blood calcium-8.0* phos-1.7* mg-1.7 07:00pm blood lactate-1.9 troponin trend 07:00pm blood ctropnt-0.23* 04:38am blood ck-mb-3 ctropnt-0.21* 06:00am blood ck-mb-3 ctropnt-0.18* hct trend: 04:38am blood wbc-6.4 rbc-2.74* hgb-8.0* hct-24.6* mcv-90 mch-29.4 mchc-32.7 rdw-14.9 plt ct-248 (received 2 units prbcs) 08:18am blood hct-29.4* 06:00am blood wbc-7.0 rbc-3.37* hgb-9.6* hct-29.8* mcv-88 mch-28.6 mchc-32.4 rdw-16.1* plt ct-255 02:45pm blood hct-25.7* (flex sigmoidoscopy with cautery) 06:09am blood wbc-5.2 rbc-2.80* hgb-8.2* hct-25.3* mcv-90 mch-29.4 mchc-32.6 rdw-16.1* plt ct-212 03:14pm blood hct-25.9* 05:45am blood wbc-5.1 rbc-2.93* hgb-8.4* hct-26.2* mcv-89 mch-28.6 mchc-32.0 rdw-15.4 plt ct-241 discharge labs: 05:45am blood wbc-5.1 rbc-2.93* hgb-8.4* hct-26.2* mcv-89 mch-28.6 mchc-32.0 rdw-15.4 plt ct-241 05:45am blood glucose-122* urean-7 creat-0.8 na-136 k-3.9 cl-100 hco3-22 angap-18 05:45am blood calcium-7.9* phos-2.9 mg-1.5* microbiology: - ucx yeast - repeat ucx ngtd - bcx ngtd x2 reports: ct head with contrast: prelim - no mass, edema or hemorrhage - age related cerebral atrophy - no change from prior studies cxr impression: no acute cardiopulmonary abnormality. brief hospital course: 66 year old female with a history of stage iv cervical cancer, not currently treated with chemo-radiation, with history of nephrostomy tube for ureteral stricture s/p radiation with multiple prior admissions for urosepsis/utis including resistant gnrs, also with history of radiation proctitis and gi bleeds who was admitted to micu with fever and urinary tract infection concerning for sepsis also found to have gib and 10 point hct drop. # uti- chronic utis related to nephrostomy tube. history of resistant organisms in past but recent klebsiella pan-sensitive treated with ceftriaxone . ucx on this admission did not grow a pathogen but given her complicated history with recurrent episodes of sepsis, indwelling nephrostomy bag and fever on arrival to the ed she was treated with ceftriaxone. after initiation of antibiotics she defervesced and never showed signs of sepsis. negative ucx and bcx returned and she hemodynamically stable 48 hours after last fever so her antibiotic regimen was changed to ciprofloxacin 500mg po bid to complete a 14 day course. her neprhostomy tube was changed on and was uncomplicated. she wants a nephrectomy for definative treatment and final removal of nephrostomy tube. patient will have outpatient follow up with dr. and uro-surgeon dr. : outpatient nephrectomy and removal nephrostomy. she will also follow up with id as an outpatient regarding change in suppressive antibiotics given recent utis with macrobid resistance. # acute blood loss anemia - hct drop of 10 on admission from baseline and guiac positive stool in setting of patient with known radiation colitis/proctitis suggesting slow ooze from lgi track. received 2 units prbcs in the micu and hct remained stable therafter. gastroenterology was consulted and completed a flex sigmoidoscopy with cautery on . she had loose stools with clots following completion of procedure but hematocrit remained stable and without tachycardia or hypotension. # diarrhea: patient with persistant loose stools following flex sig. diarrhea likely related to gi ooze from practitis/colitis and recent cautery procedure, though hct stable so not actively loosing blood. she had no leukocytosis or fevers so c.diff unlikely. did order c.diff on morning of discarge though patient no longer having loose stools so could not give a sample. instructed patient to call her pcp or if loose stools restart. patient taking ciprofloxacin anyway which would cover most enteric pathogens. # headaches: has been having hedaches for some time as an outpatient. during admission with persistant bilateral frontal headaches, severe which was refractory to apap-caff-butalbital. only treatment which helped was low dose dilaudid. spoke to outpatient h/o fellow who reports has have been increasing in frequency over past 2 months. while rare for cervical cancer to metastasize to brain, favored caution and obtained ct head with contrast to evaluate for a mass since patient cannot tolerate mri. has documented allergy to contrast on her medical record though patient has had multiple ctas in our system and never had a reaction. despite that she was pre-medicated prior to ct and received contrast load without reaction. # troponin elevation - likely demand from uti and peri-sepsis. troponin downtrending and ck-mb flat. cardiology saw patient felt no acute ischemia/infarct and most likely demand in origin. patient denies and chest pain or sob type symptoms. trops downtrended and she had no events on telemetry # hyponatremia: hypovolumic hyponatremia, resolved after ivfs # stage iv cervical cancer - chronic, inactive without current chemoradiation treatment. s/p chemoradiation with ureteral stricture and colitis/proctitis. per report, dr. aware of patient and in agreement with treatment plan. recent ct scan showed no recurrence. # known pelvic fractures: appeared stable on imaging. has chronic pelvic pain due to this and is on hydromorphone at home for the pain. independent ambulation/adls. continued on opiates for pain control. started treatment with vitamin d and calcium while inpatient. given known osteoporosis and pelvic fractures would recommend bisphosphonate therapy to outpatient providers. # pan hypopituitarism. hx benign pituitary adenoma s/p resection many years ago. was on levothyroxine and low dose predisone for years as a result of hypopituitarism that followed. continued levothyroxine sodium 125 mcg po/ng daily and prednisone 5 mg po/ng daily transitional issues: - follow up final ct head read: prelim no masses - consider bisphosphonates as an outpatient - patient discharged without obtaining c.diff sample given no more loose stools. if patient begins having loose stools then would recommend c.diff testing - patient will have outpatient follow up with dr. and uro-surgeon dr. : outpatient nephrectomy and removal of nephrostomy tube - outpatient infectious diseaseto decide suppressive therapy given last ucx resistant to nitrofurantoin and risk of resistance with cipro suppressive therapy - follow up pending urine and blood cultures medications on admission: ergocalciferol (vitamin d2) - 50,000 unit capsule - 1 capsule(s) by mouth qweek - no substitution hydromorphone - 2 mg tablet - tablet(s) by mouth every four (4) hours as needed for pain levothyroxine - 125 mcg tablet - one tablet(s) by mouth daily lidocaine-prilocaine - 2.5 %-2.5 % cream - 2.5grams topically to port site as directed as needed for prior to accessing port nitrofurantoin monohyd/m-cryst - 100 mg capsule - 100mg capsule(s) by mouth at bedtime olanzapine - 2.5 mg tablet - tablet(s) by mouth q6 hours and qhs as needed for anxiety, insomnia potassium chloride - 20 meq packet - 2 packet(s) by mouth twice a day prednisone - 5 mg tablet - one tablet by mouth daily discharge medications: 1. olanzapine 2.5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for anxiety. 2. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 3. vitamin d3 2,000 unit tablet sig: one (1) tablet po once a day. 4. hydromorphone 2 mg tablet sig: 0.5-1 tablet po q4h (every 4 hours) as needed for pain: you should not drive or drink while taking this medication. disp:*15 tablet(s)* refills:*0* 5. levothyroxine 125 mcg tablet sig: one (1) tablet po daily (daily). 6. lidocaine-prilocaine 2.5-2.5 % cream sig: one (1) appl topical asdir (as directed). 7. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for cough. disp:*30 capsule(s)* refills:*0* 8. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. potassium chloride 20 meq packet sig: two (2) packets po twice a day. 10. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 10 days. disp:*20 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: active: - urinary tract infection - colitis-proctitis, radiation related - ureteral stricture s/p nephrostomy tube chronic: - cervical cancer - chronic utis - pan-hypopituitarism discharge condition: mental status: clear and coherent. activity status: ambulatory - independent. level of consciousness: alert and interactive. discharge instructions: ms. , it was a pleasure treating you during this hospitalization. your were admitted to because of a urinary tract infection and concern for sepsis. you were initially admitted to the medical icu for monitoring. you were stable and so you graduated to the medical floor. you were treated with iv antibiotics which were changed to by mouth medications after improvement in blood pressure and with return of cultures. you also had some bleeding from your colon/rectum and had a flexible sigmoidoscopy by gastroenterology. cautery during the procedure was completed to stop the bleeding, this was successful. you are being discharged in improved condition with plan to follow up with your primary care physician, and infectious disease doctor. the following changes to your medications were made: - start ciprofloxacin 500mg by mouth twice daily until - start benzonatate (tessilon pearls) by mouth three times a day as needed for cough - start hydromorphone (dilaudid) 1-2 mg by mouth every 4 hours as needed for pain. you should not drive or drink alcohol while taking this medication. - no other changes to your medications were made, please continue taking as previously prescribed. other instructions: - if you begin having loose stools, please see your primary care physician or to have a c.diff test completed. - you should discuss with your infectious disease doctor changing macrobid to a different antibiotic for suppression of urinary tract infections. followup instructions: department: gyn specialty when: at 2:30 pm with: , building: sc clinical ctr campus: east best parking: garage department: - adult med when: monday at 11:00 am with: , md building: (, ma) campus: off campus best parking: free parking on site department: surgical specialties when: thursday at 8:30 am with: , md building: campus: east best parking: garage infectious disease department 03:00p dr. ( lm bldg (), basement id west (sb) - please discuss with your infectious disease doctor about switching antibiotics from macrobid to a different antibiotic to control urinary tract infections we are working on a follow up appointment with dr. in the next 9-15 days. you will be called at home/rehab with the appointment. if you have not heard within 2 business days or have questions, please call procedure: endoscopic destruction of other lesion or tissue of large intestine replacement of nephrostomy tube diagnoses: urinary tract infection, site not specified acute posthemorrhagic anemia hyposmolality and/or hyponatremia personal history of tobacco use anxiety state, unspecified osteoporosis, unspecified osteoporosis, unspecified old myocardial infarction antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use headache encounter for palliative care angiodysplasia of intestine with hemorrhage secondary malignant neoplasm of lung urinary complications, not elsewhere classified removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation personal history of antineoplastic chemotherapy personal history of irradiation, presenting hazards to health other specified disorders of rectum and anus insomnia, unspecified stricture or kinking of ureter late effect of radiation radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure anorexia cardiac tamponade other artificial opening of urinary tract status secondary malignant neoplasm of other urinary organs gastroenteritis and colitis due to radiation surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation polyneuropathy due to drugs iatrogenic pituitary disorders personal history of benign neoplasm of the brain other specified forms of effusion, except tuberculous 

Answer: The patient is high likely exposed to