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: allopurinol and derivatives attending: chief complaint: ams, fever major surgical or invasive procedure: central venous line history of present illness: history of present illness: 83 year old male with history of mild cognitive impairment, hyperlipidemia, bph, and gout presents with altered mental status, vomiting, and shaking chills. he was watching speak at the dnc and he began to feel very cold and started vomiting. as the night went on, he became more tired and less responsive and the wife called ems. she reported to them that he was not acting like himself and was talking nonsense. on transfer, he became more lethargic and even less responsive. patient triggered on arrival for altered mental status. sugar was normal. he took his first dose of donepezil tonight, but did not make any other medication changes. no other localizing symptoms to speak of. per urgent care note from dr. , he experienced malaise with numbness in his fingers and chills while in , about 4 weeks ago. he was taken to the local emergency room in that area (northern community hospital) and his symptoms of fever and malaise resolved since then. no definite cause of this acute illness was found. there was a concern about possible lyme disease because of exposure to deer near his home. the patient denies any tick bite and claims that he rarely goes out in his yard, where they do have deer. he was started on doxycycline for concern of potential lyme exposure given that they live in a wooded area. lyme serology eventually returned negative. the wife reports that his current symptoms are very similar to this presentation, but he appeared more confused this time. in the ed, initial vitals were: 122 102/55 28 91% 2l nc. he was following basic commands on arrival. rectal temp of 103. labs were notable for low wbc at 3.5 and otherwise normal cbc. creatinine on 1.3 close to baseline and lfts within normal limits. lactate originally at 4.3, then repeated at 5.7 after 2l ns. urinalysis unremarkable and cxr clear. head ct without acute intracranial process and moderate paranasal sinus disease, similar to prior. ct abd/pelv showed a hiatal hernia, cholelithiasis w/o cholecystitis, nonspecific perinephric stranding, enlarged prostate, small left fat-containing inguinal hernia (similar to prior ct in ). without obvious infectious cause, he was covered empirically with vanc/zosyn + ceftriaxone. lp refused by wife. pressures have trended down to the sbps 80s but wife also refused placement so patient was started on peripheral norepinephrine. 4th liter hanging prior to transfer and sbps in 90s with normal oxygenation. on arrival to the micu, he continued to be hypotensive despite uptitration of levophed and another 1l ns bolus. the wife is amenable to a central line placement here in the unit and willing to discuss further procedures needed for his care. the patient is having word-finding difficulties per his baseline and has trouble completing sentences. orientation is therefore difficult to assess. past medical history: pmh: uric acid nephrolithiasis s/p gu interventions in the past hypercholesterolemia gout (last attack 3 years ago) psh: l urs with laser and cystolithalopaxy with in cystolithalopaxy in social history: tob: distant history of smoking in 20s alc: rare illicits: none family history: - diabetes in uncles - in father physical exam: vitals: t: 98.2, bp:85/60, p: 101 r: 9, o2: 93% on 3l general: eyes closed, responds to command intermittently but is responsive to question, has difficulty forming his answers, no acute respiratory distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. fasciculations evident in calves bilaterally (patient unaware) neuro: cnii-xii intact, difficult to assess strength/sensation given inability to follow commands reliably. pertinent results: 08:13pm lactate-5.4* 07:24pm glucose-206* urea n-19 creat-1.4* sodium-138 potassium-4.6 chloride-104 total co2-18* anion gap-21* 07:24pm alt(sgpt)-20 ast(sgot)-27 alk phos-29* tot bili-0.3 07:24pm calcium-7.0* phosphate-3.8# magnesium-1.6 07:24pm wbc-38.7* rbc-4.29* hgb-12.8* hct-38.3* mcv-89 mch-29.8 mchc-33.3 rdw-13.7 02:52pm urine -lg nitrite-neg protein-30 glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-sm 02:52pm urine rbc-137* wbc-4 bacteria-few yeast-none epi-0 02:21pm lactate-6.8* culture: gnr sensitivities: mic expressed in mcg/ml _________________________________________________________ gram negative rod(s) | ceftazidime----------- s ceftriaxone----------- s ciprofloxacin--------- s gentamicin------------ s meropenem------------- s tobramycin------------ s imaging: echo impression: no vegetations or clinically-significant regurgitant valvular disease seen. normal global and regional biventricular systolic function. : no growth. kub : impression: no signs of obstruction or intraperitoneal free air. prostate us impression: 1. no evidence of an abscess within the prostate. 2. substantial bph with a prostatic volume of 72 ml, correlating with a predicted psa of 8.6. ct abdomen, pelvis impression: 1. no acute intra-abdominal process; moderate colonic fecal burden. 2. hiatal hernia. 3. enlarged prostate and left fat- and bladder-containing inguinal hernia. 4. mildly thickened left renal pelvis urothelium of unclear significance; no evidence of hydronephrosis or pyelonephritis. ct head w/o contrast impression: minimal paranasal sinus mucosal thickening. otherwise normal study. cxr impression: low lung volumes but no evidence of pneumonia. brief hospital course: assessment and plan: 83 year old male with prior history of mild cognitive impairment, gout, bph, and hyperlipidemia presenting with worsening mental status, vomiting, and hypotension after similar presentation 1 month prior. acute issues: # septic shock with altered mental status: his initial symptoms, including emesis and worsening disorientation and weakness, were concerning for a meningitis/encephalitis picture. his worsening lactate despite volume resuscitation and developing hypotension with bandemia were concerning for a septic picture. he was covered initially with ampicillin, ctx, acyclovir, and doxycycline. on the morning after arrival to the icu, cultures grew gram-negative rods and his wbc trended to a peak of 38. a rij was placed upon arrival to the icu and norepinephrine was titrated to maps>60. with gnrs, lp was deferred. cultures speciated pansensitive e. coli and his antibiotic regimen was narrowed to ceftriaxone. his leukocytosis continued to improve and his pressor requirement decreased dramatically. his mental status also improved to close to his baseline. id was also consulted and agree with the above treatment. to look for a source of his gnrs, we performed a prostate ultrasound which was negative. initial ct scan was done without po contrast, so this study was repeated to look for occult infection (i.e. abscess) and showed no evidence of abscesses. tte was performed to rule out endocarditis and ruq u/s did not show any significant findings to explain the gnr bacteremia. tick-borne illnesses were also explored, with negativeserologies. patient was transfered to general internal medicine floor on . iv ceftriaxone was continued to finish 7 day course of iv antibiotics, then patient was started on a 7 day course of ciprofloxacin to complete a total of 14 day course of antibiotics. last day of cipro will be . # drug eruption. patient had diffuse pruritic non-blanching macular rash on his thighs, abdomen, and upper arms. improved with sarna cream and ice. patient will follow up closely in outpatient setting with dr. . chronic issues: # mild cognitive impairment: his baseline mental status confound his current picture, but per his wife he was not at his most recent baseline on admission. he recently saw a cognitive neurologist, who instructed him to start donepezil to see if this would help him. his struggles are primarily with word-finding difficulties. he also responded robustly to low-dose quetiapine, resulting in significant somnolence. he was transferred out of the icu once he was awake and alert, and returned to baseline status within a day. donepezil held during the hospital course and restarted on discharge. # mild renal insufficiency: creatinine of 1.3 at recent baseline of 1.3-1.5. remained stable in the icu. # gout: no flare. his probenecid was held during the hospital course and restarted on discharge. transitional issues: - drug eruption medication started: - ciprofloxacin 500mg . first dose 9/14, last dose 9/20. medications on admission: preadmission medications listed are correct and complete. information was obtained from webomr. 1. meclizine 50 mg po x1 prn vertigo 2. clotrimazole cream 1 appl tp qhs to feet 3. ibuprofen 200 mg po daily pain 4. donepezil 10 mg po at noon with lunch 5. tadalafil *nf* 20 mg oral q72h prn erectile dysfunction 6. probenecid 500 mg po daily discharge disposition: home discharge diagnosis: primary: e. coli septic shock. secondary: acute confusion on chronic mild cognitive impairment. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , it was a pleasure taking care of you at the . you were admitted for altered mental status and fever. we found a serious bacterial infection in your . you were admitted to the intensive care unit where you received lots of fluids, intravenous antibiotics, and pressure support. after a few days you were transfered to the general medicine floor where you finished your 7 day course of intravenous antibiotics. you will go home and take antibiotic pills by mouth for another 7 days to complete the course of the antibiotics. you had a rash on your legs, abdomen and arms the last day and half of your stay. the rash is likely due to a reaction to the antibiotic ceftriaxone. this will likely start to spread over the next few days, and may itch. you can use the sarna lotion for itch, or over-the-counter hydrocortisone. call dr. if the rash spreads over the entire body, if you have severe itching, or if you develop any blistering at all. please call your primary physician . at if you have any signs of infection again. these include fevers, chills, cough, pain on urination, increased frequency of urination among other symptoms. please finish all the antibiotic we have given you. an appointment has been made for you with dr. on . however, he will likely see you sooner than that. he will call you in the next few days to schedule an appointment with him as early as tomorrow or monday. medications started: ciprofloxacin 500mg twice a day for 7 days starting friday followup instructions: department: internal medicine when: monday at 1:30 pm with: , md building: lm bldg () campus: west best parking: garage department: medical specialties when: monday at 11:20 am with: bone density testing building: campus: east best parking: garage department: cognitive neurology unit when: tuesday at 11:00 am with: , m.d. building: ks building (/ complex) campus: east best parking: main garage md, procedure: central venous catheter placement with guidance diagnoses: pure hypercholesterolemia severe sepsis gout, unspecified personal history of tobacco use hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) diaphragmatic hernia without mention of obstruction or gangrene septic shock dermatitis due to drugs and medicines taken internally calculus of gallbladder without mention of cholecystitis, without mention of obstruction metabolic encephalopathy dementia in conditions classified elsewhere without behavioral disturbance septicemia due to escherichia coli [e. coli] raynaud's syndrome diverticulosis of colon (without mention of hemorrhage) leukocytosis, unspecified internal hemorrhoids without mention of complication cephalosporin group causing adverse effects in therapeutic use inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent) mild cognitive impairment, so stated 

Answer: The patient is high likely exposed to