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: sulfa (sulfonamide antibiotics) / allopurinol / levaquin / keflex / zosyn / tamsulosin / tipranavir / probenecid / ambien attending: chief complaint: ams major surgical or invasive procedure: none history of present illness: 75yo f pmhx esrd s/p lr renal tx, w multiple recent admissions e. coli uti and bacteremia, ams , ams discharged for uti w ams re-presents w persistent fatigue since previous discharge and ams x 2d. per patient's family, pt has been disoriented and displaying erratic behavior; no associated fever/chills/dysuria, n/v/d, chest pain, cough, ha. family brought her to ed for further evaluation. she completed a course of cefpodoxime on of note patient has a hsitory of resistant hypertension with blood pressures at baseline in the 180s despite multi-antihypertensives. on recent admission her bp was elevated at 200s during her admission, and was 150-190s at the time of discharge. in ed, initial vital signs were 98.3 64 187/72 16 97%ra. labs notable for wbc 15.1 (n83), hct 31 (baseline), cr 4.3 (baseline high 2s, low 3s), lactate 1.0, trop .04, ua <1wbc, few bacteria. patient had unremarkable cxr, transplant kidney u/s grossly unchanged. her blood pressure went up to 230s and was staying in the 200s despite getting her home medications. she received .2mg clonidine, 20 furosedmide,100mg hydralazine and 100mg of labetalol at 10pm. she made urine but the volume was not recorded. given that her blood pressures were still elevated in the 200s she was started on a labetalol drip and transferred to the micu. at the time of transfer her sbp was 186. on arrival to the micu she was on the labetalol drip at 2mg/min with a bp of 170/110 and she was a+ox3 and aware of why she was in the hospital. she had no complaints specifically no headache, blurred vision, abd pain n/v. review of systems: she denies any dysuira, fevers, chills, changes in urine output or abdominal pain. she denies headache, changes in vision, dizziness. she denies any recent falls or unsteadyness on her feet. denies any changes in bowel mvoements or hematochezia. past medical history: s/p lr renal tx secondary to chronic recurrent utis, analgesic nephropathy and nephrocalcinosis htn - uncontrolled isolated seizure episode - thought to be secondary to zosyn administration anemia of chronic disease thrombocytopenia diverticulosis and dieulafoy lesions osteoporosis squamous cell cancer s/p mohs lower back pain due to lumar spinal stenosis herpes encephalitis hyperlipidemia hypothyroidism h/o tia peptic ulcer disease chronic tophaceous gout h/o right rectus sheath hematoma s/p cataract surgery h/o colonic polyps social history: she is married and lives with her husband. retired . they winter in , and she enjoys golfing. remote history of smoking tobacco- quit 40 yrs ago, smoked x20yrs. old outside hospital records indicate prior etoh use, though she denies any current use. family history: mother died from melanoma. no h/o colon cancer in family. physical exam: admission exam vitals: 98.7, 170/110, 68, 13 98ra general: alert, somulent nodding off, ill and cachectic but in nad. heent: sclera cloudy yellow. ptosis bilaterally, mmm, oropharynx clear with own dentition in place, unable to cooperate with eom exam neck: supple, jvp elevated to earlobe while at 15deg recumbency no lad cv: regular rate and rhythm, normal s1 + s2,systolic murmur, rubs, gallops lungs: faint crackles bilaterally throughout abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, dusky and echomotic on circumfrential lower extremities and lower arms bilaterally. one sore on mid back. 2+dp/pt pulses bilaterally. no peripheral edema. neuro: cnii-xii intact, movign all extremities without problems, following commands. tremulous with astreixis when attempting sustained grip discharge exam: vitals; t-97.6 bp-155/85 hr-70 rr-20 o2-97%ra pe: gen: no acute distress. laying in bed with covers pulled around her. heent: mmm. eomi. ncat neck: supple. no jvd cv: rrr. ns1&s2. 3/6 sem heard best at lusb. resp: poor inspiratory effort. b/l crackles consistent with atelectasisgi: bs+4. soft. non-tender. non-distended. no organomegaly ext: 2+ pitting edema. dark, dusky skin on all extremities. pertinent results: admission labs 03:10pm pt-11.0 ptt-41.7* inr(pt)-1.0 03:10pm plt count-194 03:10pm hypochrom-normal anisocyt-occasional poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 03:10pm neuts-83* bands-1 lymphs-7* monos-9 eos-0 basos-0 atyps-0 metas-0 myelos-0 03:10pm wbc-15.1*# rbc-3.26* hgb-9.8* hct-31.0* mcv-95 mch-30.2 mchc-31.7 rdw-13.9 03:10pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 03:10pm albumin-3.8 03:10pm ck-mb-2 ctropnt-0.04* 03:10pm alt(sgpt)-39 ast(sgot)-41* ck(cpk)-20* alk phos-125* tot bili-0.8 03:10pm estgfr-using this 03:10pm glucose-112* urea n-97* creat-4.3*# sodium-137 potassium-5.0 chloride-107 total co2-18* anion gap-17 03:20pm lactate-1.0 03:20pm type- comments-green top 05:00pm urine mucous-rare 05:00pm urine hyaline-1* 05:00pm urine rbc-2 wbc-<1 bacteria-few yeast-none epi-<1 05:00pm urine blood-neg nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-neg 05:00pm urine color-yellow appear-hazy sp -1.009 05:00pm urine bnzodzpn-neg barbitrt-pos opiates-neg cocaine-neg amphetmn-neg mthdone-neg 05:00pm urine hours-random urea n-467 creat-45 sodium-33 potassium-31 chloride-31 urine lytes : urean:467 creat:45 na:33 k:31 cl:31 feurea calculated at 46% . u/a : yellow hazy 1.009 ph 5.5 urobilneg bilineg leukneg bldneg nitrneg prot100 gluneg ketneg rbc2 wbc<1 bactfew yeastnone epi<1 . discharge labs: 05:58am blood wbc-10.9 rbc-2.17* hgb-6.5* hct-20.6* mcv-95 mch-30.1 mchc-31.8 rdw-14.6 plt ct-181 05:58am blood neuts-72.4* lymphs-19.7 monos-4.4 eos-3.2 baso-0.3 05:58am blood pt-11.5 ptt-33.3 inr(pt)-1.1 05:58am blood glucose-99 urean-42* creat-2.8* na-141 k-4.1 cl-106 hco3-27 angap-12 05:58am blood alt-26 ast-17 alkphos-92 totbili-0.7 05:58am blood calcium-9.0 phos-4.3 mg-2.3 02:46pm blood hbsag-negative hbsab-negative hbcab-negative 11:56am blood type-art po2-74* pco2-37 ph-7.37 caltco2-22 base xs--3 . pertinent labs: 02:27am blood ck-mb-1 ctropnt-0.04* 05:45pm blood ck-mb-1 ctropnt-0.04* 01:32am blood ctropnt-0.04* 03:10pm blood ck-mb-2 ctropnt-0.04* 11:56am blood type-art po2-74* pco2-37 ph-7.37 caltco2-22 base xs--3 02:46pm blood hbsag-negative hbsab-negative hbcab-negative 02:46pm blood hcv ab-negative . ppd: negative . micro: blood culture, routine-pending inpatient blood culture, routine-pending inpatient urine culture-neg urine culture-neg blood culture, routine-neg blood culture, routine-neg blood culture, routine-neg urine culture-neg mrsa screen mrsa screen-final inpatient urine culture-final esbl {escherichia coli} blood culture, routine-final emergency blood culture, routine-final emergency . images: head ct - no infarct nor intracranial hemorrhage ruq u/s - unremarkable appearance of the liver and gallbladder. no biliary dilatation. no hydronephrosis seen in the transplanted kidney. elevated resistive indices again noted as were reported on the prior transplant kidney ultrasound. r shoulder xr : there is some ac joint arthropathy. this is stable since the study. the glenohumeral joint is within normal limits. there are some cystic changes at the humeral head. there is also degenerative change of the glenohumeral joint with spurring anteriorly, new since study. the visualized right lung apex is clear. no acute bony injury is noted kub portable : nonspecific bowel gas pattern. no findings to suggest ileus or obstruction. limited assessment for free air. status post laminectomy and fusion at l4-5, with findings suggestive of hardware loosening. clinical correlation is requested. cxr portable : in comparison with the study of , cardiac silhouette is within normal limits and there is no definite pulmonary vascular congestion. hazy opacification at the bases, more prominent on the right, suggests small pleural effusions with compressive atelectasis. no discrete pneumonia is appreciated. central catheter tip again extends to the mid-to-lower portion of the svc. ekg : sinus rhythm. within normal limits. compared to the previous tracing of no interval change. u/s rue : brief hospital course: 75 year old female with a past medical history of end stage renal disease and transplant with chronic kidney disease and resistant hypertension with baseline blood pressure in the 180s who presented for altered mental status to the ed and developed hypertensive urgency with blood pressures in the 200s requiring labetalol drip for control. admitted to the icu for management of her blood pressure. diagnosed with esbl e.coli uti in ed and started on iv meropenem. transferred to floor after bp stabilized. pt became very lethargic and hypotensive on floor, and transferred back to micu. started hd and improved. some ams after transfer back to the floor, but clear on discharge. . active issues: #hypertensive urgency - patient has baseline resistant hypertension with sbps often in the 180s. per patient, she manages all of her medications herself, however, was missing her clonidine patch per ed. her hypertension could have been due to missing medications. there was concern that her altered mental status was related, however no evidence on ct head of hemorrhage. her renal function was also worsening, concerning for decreased perfusion to the kidneys leading to acute on chronic renal failure however a renal ultrasound of her transplanted kidney was normal. given her worsening renal function, losartan was held in the micu. she responded well to the labetalol, and her systolic blood pressure remained stable in the 150s-180s, which seems to be her baseline. she was transferred to the general medicine service once her blood pressure stabilized. unfortunately, as her home meds were restarted by the general medicine team, she developed relative hypotension to the 130s and altered mental status. she was transferred back to the micu, where her home verapamil and clonidine were withheld and she was bolused with ivf. low-dose verapamil and clonidine patch were slowly reintroduced, and sbp was again stabilized. transferred back to the floor. sbp ranged between 120's-170's on floor. . #altered mental status - there was concern that the patient was not acting like herself at home. she has a history of ams in the setting of uti and with her recent hospitalization for uti. initial concern for underlying infection. her urine was found to have a resistant strain of e.coli. meropenem was started and ams began to clear. after transfer to the floor she was oriented x3. ams developed again on the floor and pt became relatively hypotensive. see above. antibiotics were then broadened include vancomycin in the micu due to concern that her ams represented a worsening or new infection. she was pancultured, which found no infection. both meropenem and vancomycin were d/c'ed as they were thought to be contributing to confusion. after being transferred back to the floor, she was again pan-cultured and fever/wbc were trended. she had no signs/symptoms of active infection, so picc line was pulled. thought that ams likely secondary to uremia. after hemodialysis, patient lethargy and disorientation improved dramatically. ams may have also had a component of icu delirium. at time of discharge she was alert, responsive, and oriented x3. . #esbl e. coli uti: see above. history of multiple utis in the past requiring hospital admission. found to have esbl e. coli uti on this admission. started on 14 day course of iv meropenem, but only received 8 days total. thought that abx may be contributing to ams. she was recultured multiple times with no growth. her picc line was discontinued on day of discharge. id was consulted for prophylactic therapy and recommended that she not have prophylaxis at this time, and recommend urology follow-up. she had no fever or leukocytosis. . #diarrhea: pt developed watery diarrhea on day of discharge. c. diff pending. . chronic issues: #acute on chronic renal failure s/p transplant - she has chronic kidney disease with a baseline creatinine of ~3.1 over the past few months. repeat renal ultra sound in the ed was unremarkable. this acute worsening of renal function could be due to hypertension. urine lytes with feurea of 46% which is not clearly prerenal or atn. during her micu stay a foley was placed monitored urine output, we renally dosed medications, creatinine was trended daily, renal transplant was consulted, her immunosuppresive agents prednisone and cyclosporine were continued. the renal transplant team felt that her may be a result of failure. the hope was to prolong time to hemodialysis, and undergo av . however, her delirious state on the floor, compunded with hyperkalemia prompted initiation of hd via tunneled hd catheter. her ams improved quite dramatically and cr trended down to ~2. her hd schedule is mwf. transplant surgery has completed the work-up for av . they will contact the rehab facility with time and date for surgery . #hx gout/foot pain: currently pain free. extensive h/o gouty flares and allergic to allopurinol. after discussion with pharmacy, decided to restart low dose uloric at 20mg daily. . # hypothyroidism - this is a chronic issue. her thyroid function tests were checked and she was continued on her home levothyroxine. . #anemia of chronic disease- her hematocrit was higher on admission than her previous discharge hematocrit at 31.0, given that all of her hematologic cell lines are elevated she was likely hemoconcentrated at admission. she remained stbale during this admission with hct ~27-30% . #h/o seizure disorder: on keppra. in setting of zosyn use previous seizure ,and then again at osh earlier in when received another dose of zosyn. was followed by neurology on previous admission who recommended continuing keppra and will follow-up with them. . #h/o gi bleed: no gib during this admission. on protonix 40mg qday . transitional issues: - was very obstinate to care (refused any blood draws or medications multiple times), per transplant this is her pattern when infected. - outpatient id for consideration of suppressive therapy for recurrent utis - hemodialysis mwf - will be called re: surgery appt for av - f/u c. diff - please continue uloric in this pt with extensive h/o gout - downtrending hct, check cbc tomorrow, may continue to monitor twice weekly until ensure stability - h/ multiple uti's. no ppx recommended medications on admission: preadmissions medications listed are incomplete and require futher investigation. information was obtained from webomr. 1. aspirin 81 mg po daily 2. atorvastatin 20 mg po daily 3. calcitriol 0.25 mcg po every other day 4. clonidine 0.2 mg po bid hold for sbp<100 or hr<60 5. clonidine patch 0.3 mg/24 hr 1 ptch td qmon hold for sbp<100 or hr<60 6. cyclosporine (neoral) modified 100 mg po q12h 7. febuxostat 40 mg po daily 8. hydralazine 100 mg po tid hold for sbp<100 or hr<60 9. levothyroxine sodium 88 mcg po daily 10. losartan potassium 100 mg po daily hold for sbp<100 or hr<60 11. prednisone 5 mg po every other day 12. propranolol 120 mg po bid hold for sbp<100 or hr<60 13. sodium bicarbonate 1300 mg po tid 14. verapamil 120 mg po q8h hold for sbp<100 or hr<60 15. levetiracetam 500 mg po bid 16. acetaminophen-caff-butalbital dose is unknown po bid:prn headache 17. mirtazapine 15 mg po hs 18. furosemide 20 mg po prn edema 19. proparacaine hcl 0.5% opth. 1 drop both eyes q 8h discharge medications: 1. aspirin 81 mg po daily 2. clonidine 0.2 mg po tid hold for sbp <120 mmhg 3. cyclosporine (neoral) modified 75 mg po q12h 4. febuxostat 20 mg po daily 5. hydralazine 100 mg po tid hold for sbp<100 or hr<60 6. levetiracetam 500 mg po bid 7. levothyroxine sodium 88 mcg po daily 8. prednisone 5 mg po every other day 9. proparacaine hcl 0.5% opth. 1 drop both eyes q 8h 10. verapamil 20 mg po q8h hold for sbp<140 or hr<60 11. propranolol 120 mg po bid hold for sbp<100 or hr<60 12. bengay 1 appl tp :prn back muscle pain 13. lidocaine 5% patch 1 ptch td daily back pain apply to back 14. nephrocaps 1 cap po daily 15. pantoprazole 40 mg po q24h 16. calcitriol 0.25 mcg po every other day 17. atorvastatin 20 mg po daily 18. clonidine patch 0.3 mg/24 hr 1 ptch td qmon hold for sbp<100 or hr<60 discharge disposition: extended care facility: hospital for continuing medical care - ( center) discharge diagnosis: primary diagnosis: end stage renal disease e.coli urinary tract infection altered mental status resistant hypertension hypertensive urgency discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure caring for you at . you were admitted because you were confused and had very high blood pressure. you were admitted to the intensive care unit and started on medication through your veins to bring your blood pressure down. once it was down you were transferred to the - service and your home blood pressure medications were slowly added back. your blood pressure dropped too low on this service and you were transferred back to the intensive care unit. your blood pressure medications were added back slowly, and you came back to . here your blood pressure remained stable and you were discharged. on most of your home bp medications. because your kidney function is not as good as it should be, your furosemide and losartan were stopped. please stop taking these medications for now. they may need to be added back on at a later date depending on your bp. you had another infection of your urinary tract on this admission. you were started on antibiotics through your veins, but was stopped because the antbiotics might have been making you confused. you do not currently have an infection, but let your doctor know if you have any burning, difficulty urinating, or worsening confusion. your kidney function was decreased at time of admission. we thought this might be causing some confusion for you. you were started on hemodialysis, and your confusion got better. you will need hemodialysis on monday, wednesday, and friday. you will be scheduled with surgery to implant a , that you won't need a hd catheter. they will call you with this appointment. medications to change: clonidine 0.2mg twice a day to 0.2mg three times a day verapamil 120mg three times a day to 20mg three times a day uloric 40mg daily to 20mg daily cyclosporine 100mg twice a day to 75mg twice a day medications to start: pantoprazole 40mg daily nephrocaps daily bengay apply to back daily lidocaine patch apply to back daily medications to stop: stop losartan stop furosemide stop sodium bicarbonate stop butalbital stop mirtazipine followup instructions: department: neurology when: monday at 9:30 am with: , md building: campus: east best parking: garage ****we realize you have dialysis on this day but the appt is earlier in the morning in hopes that you could go before your dialysis. if this appt still does not work for you, please feel free to call the office to reschedule. department: surgical specialties when: wednesday at 4:00 pm with: , md building: campus: east best parking: garage department: infectious disease when: tuesday at 3:00 pm with: , md building: lm bldg () campus: west best parking: garage department: transplant name: dr. when: dr. office is working on a follow up appointment for you in days after your hospital discharge. you will be called with the appointment date and time. if you have not heard from the office in 2 business days please call the number listed below. location: address: , 7th fl, , phone: md, procedure: hemodialysis venous catheterization for renal dialysis central venous catheter placement with guidance diagnoses: hyperpotassemia anemia in chronic kidney disease end stage renal disease urinary tract infection, site not specified acute kidney failure, unspecified unspecified acquired hypothyroidism gout, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia personal history of other malignant neoplasm of skin osteoporosis, unspecified epilepsy, unspecified, without mention of intractable epilepsy personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits encephalopathy, unspecified surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation complications of transplanted kidney hypercalcemia other and unspecified escherichia coli [e. coli] chronic gouty arthropathy with tophus (tophi) 

Answer: The patient is high likely exposed to