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: "not feeling well" major surgical or invasive procedure: l subclavian line placement history of present illness: mr. is a 75-year-old gentleman with no known past medical history (has not seen physician in decades, lives alone) who was sent to the emergency department by senior center after developing shaking chills. patient reports that he had been feeling lethargic and unwell for the past several months. states that over the past few weeks he found it more difficult to urinate, and has been having some lower abdominal pain. reports waking up in the middle of the night with fever, for which he was taking aspirin. reports pain with urination and gradually inability to urinate. no chills. does not weigh himself, but does report rings on finger are looser and pants are looser. he has found it more difficult to fit into his boots. has not showered in several weeks. only able to eat 1 meal a day at senior center. no visual changes. reported feeling dizzy while at senior center but no prior episodes. denied nausea/vomiting. felt thirsty. no diarrhea, but does report having a bowel movement when trying to urinate straining. no chest pain. no shortness of breath. reports abdominal pain resolved when foley was placed. . in the ed, vs were t 99.6; bp 152/98; hr 96; rr 18; o2 100% ra. patient developed hypotension to 85/30 and he was given 1 l ns. bedside abdominal u/s did not show dilated aorta? foley was placed and 1000cc urine was drained. labs revealed marked renal failure and hyperkalemia, for which he received insulin, kayexalate, bicarbonate. he was also given levofloxacin/flagyl for presumed sepsis and tylenol 1000mg for low-grade temp. he had an abdominal ct scan and was admitted to the floor for further management. past medical history: none social history: lives alone in . no family in area. used to work as industrial engineer. prior tobacco use, mostly pipes and cigars, quit 30 years ago. prior etoh use, quit 20 years ago. no ivda. visits senior center 1x/day for meals. last shower 5 weeks ago. family history: unknown physical exam: vs: t 99.3; hr 97; bp 85/47; rr 13; o2 97% ra gen: thin unkempt gentleman in nad, speaks softly, aox3 heent: poor dentition. op clear without exudate. perrl. eomi cv: s1s2 rrr. no mrg lungs: bibasilar crackles. otherwise cta abd: + bs. soft, nt. + distension. - fluid wave. ext: 2+ le edema. symmetric dps, full. lle with macropapular rash, sand-paper like. unkempt toes. neu: ao x 3. strength 5/5 ue and le. pertinent results: 09:02pm lactate-2.1*, 05:40pm lactate-4.1* 02:00pm lactate-2.9* 08:36pm glucose-107* urea n-106* creat-8.0* sodium-141 potassium-6.2* chloride-113* total co2-14* anion gap-20 08:36pm albumin-2.6* calcium-7.5* phosphate-3.7# magnesium-1.8 iron-6* 08:36pm caltibc-137* ferritin-611* trf-105* 08:36pm psa-722.5* 08:36pm wbc-20.1*# rbc-2.22*# hgb-6.4*# hct-18.7*# mcv-85 mch-28.7 mchc-34.0 rdw-16.9* plt-150 08:36pm neuts-86* bands-12* lymphs-0 monos-2 eos-0 basos-0 atyps-0 metas-0 myelos-0 01:55pm pt-14.8* ptt-31.6 inr(pt)-1.3* 01:15pm ck-mb-3 ctropnt-0.03* 01:15pm calcium-9.1 phosphate-6.0* magnesium-2.3 . urine 12:45pm urine color-straw appear-hazy sp -1.007 12:45pm urine blood-sm nitrite-pos protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-mod 12:45pm urine rbc-* wbc->50 bacteria-mod yeast-none epi-0-2 trans epi-<1 urine culture (final ): escherichia coli. >100,000 organisms/ml.. escherichia coli. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | escherichia coli | | ampicillin------------ <=2 s <=2 s ampicillin/sulbactam-- <=2 s <=2 s cefazolin------------- <=4 s <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s cefuroxime------------ <=1 s <=1 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s nitrofurantoin-------- 64 i 64 i piperacillin---------- <=4 s <=4 s piperacillin/tazo----- <=4 s <=4 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s . 1:45 pm blood culture **final report ** blood culture, routine (final ): escherichia coli. final sensitivities. escherichia coli. second morphology. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | escherichia coli | | ampicillin------------ 4 s <=2 s ampicillin/sulbactam-- <=2 s <=2 s cefazolin------------- <=4 s <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s cefuroxime------------ 4 s <=1 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s piperacillin---------- <=4 s <=4 s piperacillin/tazo----- <=4 s <=4 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s anaerobic bottle gram stain (final ): reported by phone to @ 0640 on . gram negative rod(s). aerobic bottle gram stain (final ): gram negative rod(s). blood cultures 12/24 8pm no growth, no growth clostridium difficile: negative . ct abd/pelvis non con. impression: 1. ill-defined mass within liver, for which further with dedicated mri is recommended. 2. bilateral hydronephrosis and hydroureter. obstruction at uvj secondary to bladder mass cannot be excluded on this non-contrast exam. recommend correlation with urine cytology and/or cystoscopy. 3. extensive retroperitoneal lymphadenopathy concerning for metastatic disease. 4. patchy sclerosis and anterior wedging of the t10 vertebral body concerning for pathologic fracture. evaluation for further osseous lesions may be performed with a nuclear medicine bone scan. . echo impression: normal biventricular cavity sizes with preserved global and regional biventricular systolic function. mild -moderate mitral regurgitation. pulmonary artery mild systolic hypertension. . bone scan impression: increased tracer activity in the t10 and t11 vertebral bodies consistent with metastatic disease activity. foci of mildly increased uptake in the posterior left t9 and t10 ribs consistent with rib fracture. no tracer uptake in the right kidney. . urine cystoscopy cytology: pending at time of discharge to be followed-up by urology and oncology. . - spep: monoclonal iga kappa 2% (100 mg/dl) of total protein immunoglobulin g 924 mg/dl immunoglobulin a 496* mg/dl 70 - 400 immunoglobulin m 31* mg/dl 40 - 230 - upep multiple protein bands seen, with albumin predominating, negative for bence- protein. by immunofixation no monoclonal immunoglobulin seen . discharge labs: 05:00am blood wbc-11.2* rbc-3.18* hgb-9.2* hct-27.3* mcv-86 mch-28.8 mchc-33.6 rdw-17.2* plt ct-281 05:00am blood pt-13.4 ptt-32.7 inr(pt)-1.1 05:00am blood glucose-87 urean-77* creat-3.3* na-138 k-5.3* cl-106 hco3-21* angap-16 05:00am blood albumin-2.7* calcium-8.4 phos-4.1 mg-1.9 brief hospital course: patient is a 75-year-old gentleman with no known past medical history who presented with urinary retention, renal failure, and hypotension . 1) renal failure patient with progressive urinary retention per history and evidence of pronounced hydronephrosis and hydroureter on ct, exact etiology unclear but likely due to metastatic disease from unknown primary; urinary retention, bone lesion, elevated alkaline phosphatase, and age raised suspicion for prostate ca / other gu cancer, foley was placed with 1l cloudy-pus filled urine drained initially. patient subsequently auto-diuresed copious amounts of urine, likely post-obstructive diuresis. renal function improved, with admission cr 9.0 to 3.3 on discharge. electrolytes were followed closely and treated accordingly. -- continue to monitor bun/creatinine and renally dose medications -- continue to monitor potassium and treat with -exelate for k>5.0 -- continue foley catheter until urology evaluates the patient . 2) hypotension/urosepsis on admission to icu, patient displayed sepsis physiology: lactate 4.1, bp 85/40s, cloudy urine, leukocytosis with bandemia; likely source of infection was urosepsis. patient was bolused aggressively with iv fluids. dopamine gtt was started to maintain map > 60 and quickly weaned off. patient was given fluoroquinolones for treatment of uti and urosepsis. wbc count was as high as 38k, and improved with antibiotic therapy. prostate exam was without evidence of prostatitis. -- continue antibiotic therapy to complete course, renally dose medications -- follow-up with urology for prostate biopsy after completing antibiotic course . 3) hyperkalemia patient with hyperkalemia on presentation, received kayexalate, insulin, bicarbonate. no peaked ts on ecg. secondary to renal failure. continued to remain elevated, was treated with serial -exalate and improved to within normal range. -- continue to monitor potassium and treat with -exelate for k>5.0 . 4) anemia patient with likely anemia of chronic disease with subsequent drop on admission (24 -> 18) likely dilutional from aggressive iv fluid resuscitation. patient was transfuse 2 units prbcs. patient was guiaic negative x 2. iron studies on pre-transfusion blood showed profound iron deficiency and patient was given parenteral iron therapy. patient also discovered to have by spep 2% iga kappa and negative upep indicating possible mgus which may be a factor in the patient's anemia. also noted to have 2% iga kappa by serum protein electrophoresis. patient evaluated by oncology and will be followed by oncology as an outpatient. -- continue po iron to treat iron deficiency after patient completes antibiotics -- follow-up with oncology as an outpatient . 5) diarrhea patient with significant amounts of diarrhea on presentation. presumed secondary to -exalate, but given marked leukocytosis, patient was started empirically on flagyl and clostridium difficile toxin was negative *2. flagyl was continued for a 10 day course. patient's stools became more formed and less frequent as kayexalate was decreased/stopped. . 6) dyspepsia - patient while in hospital endorses several episodes of dyspepsia usually after eating. patient, given no hypercalcemia, provided with tums prn with good result. . 7) ? malignancy ct abdomen with retroperitoneal lad and wedging on t10 concerning for pathologic fracture. history and ct findings raised suspicion for prostate ca and/or gu malignancy, prostate enlarged on ct, psa level in 700s. patient in need of cancer work-up after he completes treatment for his urosepsis. urology was consulted and will biopsy patient as outpatient. patient with outpatient follow-up scheduled with urology . -- follow-up with urology for prostate biopsy after completing antibiotic course -- follow-up with oncology as an outpatient . 8) ppx heparin 5000 sc tid for dvt prophylaxis . 9) full code medications on admission: aspirin prn discharge medications: 1. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 2. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 6 days: last day please note this medication is renally dosed, as the patient's creatinine improves it may need to be redosed. 3. metronidazole 500 mg tablet sig: one (1) tablet po bid (2 times a day) for 3 days: last day . 4. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for heartburn,upset stomach. 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever, pain. 8. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day): until patient regains mobility. 9. iron (ferrous sulfate) 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day: please start after completion of ciprofloxacin. discharge disposition: extended care facility: - discharge diagnosis: sepsis due to urinary source acute renal failure urinary obstruction urinary tract infection bacteremia hyperkalemia iron deficiency anemia dyspepsia discharge condition: afebrile, vital signs stable. discharge instructions: you were admitted for a severe urine infection, trouble urinating, and kidney failure. you were treated with antibiotics. a foley catheter was placed to allow you to urinate. your kidneys are recovering. you are ready to go to for rehabilitation to regain your strength. . while in the hospital your prostate was noted to be enlarged. in addition your psa was high. we are concerned you may have prostate cancer. the urologists will perform a biopsy as an outpatient and then, you will follow-up with the oncologists who discuss the results of the biopsy and the diagnosis. . please contact a physician if you experience fevers, chills, chest pain, shortness of breath, abdominal pain, nausea, vomiting, urinary retention, black stools or blood in your stools, or any other concerning symptoms. . please take your medications as prescribed. -you were started on tamsulosin for your urinary retention. -you were started on ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 6 days: last day for your urinary tract infection. please note this medication is renally dosed, as the patient's creatinine improves it may need to be redosed. -you were started on metronidazole 500 mg tablet sig: one (1) tablet po bid (2 times a day) for 3 days: last day . for your sepsis. -you were started on calcium carbonate for heartburn, upset stomach. -you have been provided with docusate sodium and senna as needed for constipation. -you have been provided with tylenol as needed for pain. -you will be started on iron for your anemia after you complete your antibiotics. - you have been started on heparin sc to prevent clots while you are in bed. . please keep your follow-up appointments as below. followup instructions: on discharge, you will need to see our urologists as an outpatient for management of your prostate issues. **please call on the urology office on thursday, to confirm the appointment and arrange for the prostate biopsy (it will likely be done on the 8th, but a provider at will need to confirm). please see provider: , md, urology phone: date/time: 8:15. the appointment is on , building . . you will be called by the oncology team with an appointment to follow-up. if you are not called their number is (. . please call to set up a primary care provider . the number is . the patient wanted to discuss this with his social worker at senior center before confirming; her name is (ph , email .us). the social worker has been emailed about this issue. procedure: venous catheterization, not elsewhere classified infusion of vasopressor agent diagnoses: pneumonia, organism unspecified hyperpotassemia anemia of other chronic disease urinary tract infection, site not specified acute kidney failure, unspecified severe sepsis septic shock malignant neoplasm of prostate retention of urine, unspecified diarrhea septicemia due to escherichia coli [e. coli] hydronephrosis pathologic fracture of vertebrae 

Answer: The patient is high likely exposed to