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: macrodantin / augmentin attending: chief complaint: back and neck pain major surgical or invasive procedure: cystoscopy - transvaginal biopsy - cytoscopy with clot evacuation - history of present illness: 77 year old woman with history of hypertension, hypothyroidism, significant vascular disease requiring multiple vascular surgeries including aorto-r carotid bypass for subclavian steal syndrome, and remote aortobifemoral bypass, seizure disorder, and subacute onset of atraumatic chest, back and neck pain, who was referred to ed from pcp's office today for worsening upper and lower back pain. her pain is primarily over her upper back and neck, as well as some bilateral anterior chest pain, all of which are worsened with movement. . these symptoms have been accompanied by worsening fatigue, anorexia and decreased functional status over the past several weeks. she typically is active, plays tennis and is totally independent in her adls. she currently has great difficulty with walking up stairs, lifting laundry, and exerting herself in other ways. she has lost 15 lbs over the past 1-2 months. she denies fevers, chills, or drenching sweats. denies tingling, numbness, paresthesias, bowel incontinence, or urinary retention. her pcp has recently considered the diagnosis of pmr as an explanation for her symptoms; the patient's pain did not respond to steroid therapy, and she completed a taper to off, this morning. . in the ed, initial vs: 97.6. 151/77. 78. 18. 97% ra. neuro exam was nonfocal, and pt had no focal or midline spinal tenderness. labs notable for leukocytosis with left shift, anemia (hct 34) and hyponatremia (129). u/a demonstrated pyuria, bacteriuria, and hematuria. cta of torso revealed obstructing bladder mass with hydronephrosis and hydroureter, lytic t6 lesions extending posteriorly into spinal canal, l3 compression fracture, and other mottled appearing cervical vertebrae concerning for metastatic disease. pt was given normal saline, 5 mg diazepam po, morphine 4 mg iv x2, and ceftriaxone 1g. spine was consulted and recommended mri for further characterization of vertebral lesions and spinal cord pathology. mri was ordered but pt was transferred to floor prior to mri, given delay. vs prior to transfer were 89 174/80 18 97%ra. . currently, she is accompanied by her daughter; both women are quiet and intermittently tearful, expressing concern about pt's life expectancy. she continues to have significant back and neck pain with movement, but feels more comfortable when she is still. denies any paresthesias or numbness. denies urinary symptoms, although may be having the urge to urinate more frequently than usual. she can pass urine easily when she needs to. past medical history: retinal ischemia w neovascular glaucoma hypothyroidism elevated homocysteine branch retinal artery occlusion (r) atherosclerosis, aortofemoral s/p ascending aorta to r common carotid bypass - s/p bypass graft, aortobifemoral hx of carotid artery occlusion (l) s/p carotid endarterectomy (l) hx of tobacco use (50 pack years discontinued ) macrocytic anemia hypertension osteopenia mitral regurgitation chronic kidney disease stage ii hx of seizure disorder hx of pasteurella infection (arm) urinary tract infection, chronic hx of pelvic fracture social history: lives at home with husband, who has prostate cancer. +50 pack-year tobacco history, quit in . daughter and family are close by and involved. family history: "heart disease" in parents and siblings. sister had breast cancer. no other cancer history. physical exam: admission exam: . vs - temp 98.0f, bp 190/92, hr 93, r 19, o2-sat 95% ra, pain, 48.7 kg general - thin elderly woman appears alert and interactive but depressed, nad heent - anisocoria with r > l pupillary dilation. eomi, sclerae anicteric, mmm, op clear neck - supple, decreased lateral rotational rom due to pain, no jvd, no carotid bruits heart - pmi non-displaced, rrr, nl s1-s2, no mrg lungs - ctab, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use back - no abnormal contours or trauma. no midline tenderness, scoliosis or kyphosis abdomen - nabs, soft/nt/nd, no masses or hsm rectal - normal sphincter tone extremities - thin, wwp, no c/c/e, 2+ peripheral pulses skin - no rashes or lesions neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout, patellar and achilles dtrs are 2+ and symmetric, cerebellar exam intact, gait assessment deferred due to pain . discharge exam: patient unresponsive to noxious stimuli in 4 extremities. pupils fixed and dilated to light. no heart sounds or breathing while listening over precordium for 1 minute. no pulses palpated in radial pulses or carotids bilaterally. pertinent results: admission labs: 05:34pm blood wbc-14.8*# rbc-3.27* hgb-12.1 hct-34.1* mcv-104*# mch-37.1* mchc-35.6* rdw-15.8* plt ct-278# 07:19pm blood pt-13.2* ptt-34.1 inr(pt)-1.2* 05:34pm blood glucose-113* urean-17 creat-0.9 na-129* k-3.5 cl-89* hco3-25 angap-19 05:34pm blood alt-12 ast-29 alkphos-210* totbili-0.3 05:34pm blood totprot-7.3 albumin-4.3 globuln-3.0 calcium-10.4* phos-3.9 mg-1.4* . microbiologic data: urine culture - coagulase negative staphylococcus blood culture (x 2) - no growth urine culture - no growth mrsa screening - negative blood culture (x 2) ?????? no growth blood culture ?????? no growth blood culture x2 - ngtd . imaging studies: mr cervical, thoracic, lumbar spine w/o c - extensive bone marrow changes of the cervical, thoracic, and lumbar spine as detailed above, representing osseous metastatic disease. compression fractures are identified at t3 and t6, the latter with mild retropulsion and indentation on the spinal cord. multilevel degenerative changes of the cervical spine with spinal canal stenosis. . liver or gallbladder us - distended gallbladder without stones or other sign of acute cholecystitis. mild intrahepatic biliary duct dilatation. severe right hydronephrosis, fully discussed on the recent cta torso from , likely secondary to bladder cancer. trace perihepatic ascites. . mr pelvis w&w/o contras - urinary catheter is noted within the bladder with thrombus identified in relation to the right ureteric orifice. abnormal region enhancing mass noted in the right distal ureter causing proximal right hydronephrosis and hydroureter concerning for either a transitional carcinoma of the right distal ureter versus a bladder mass invading the right ureteric orifice. diffuse osseous metastatic disease noted of the axial pelvic skeleton. . ct head w/ & w/o contra - no evidence of metastatic lesions to the brain or bones. mri would be more accurate in identifying metastatic lesions if not contraindicated. . ct abd & pelvis w/o con - right hydroureter and hydronephrosis, with hyperdense material distending the right renal pelvis, ureter and the bladder, compatible with hemorrhage. the biopsied periureteral mass likely responsible for the hemorrhage is not appreciated by non contrast ct. new low-density ascites, with small hyperdense component in the cul-de-sac. given the clnical history, this likely reflects bladder rupture, with the low-density fluid representing urine. the small hyperdense component in the cul-de-sac is attributable to the blood products seen within the bladder. left greater than right pleural effusions, with associated atelectasis. . 2d-echo - the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is at least 15 mmhg. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. there is mild regional left ventricular systolic dysfunction with fical mid anterior/anteroseptal hypokinesis, the remaining segments are hyperdynamic and thus the overall lvef is preserved. there is no ventricular septal defect. the right ventricular cavity is dilated with normal free wall contractility. there is abnormal septal motion/position. 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 severe mitral annular calcification. there is mild functional mitral stenosis (mean gradient 9 mmhg) due to mitral annular calcification. an eccentric jet of moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . chest (portable ap) - as compared to the previous radiograph, there is an increase in severity of the pre-existing pulmonary edema. this is reflected by increased interstitial markings, widening of the right aspect of the mediastinum, increase in diameter of the cardiac silhouette and, potentially, a small left pleural effusion. no other abnormalities are noted. the right venous introduction sheath is in unchanged position. . cxr: the left picc line can be seen to the level of the mid portion of left brachiocephalic vein. advancement by at least 6 cm is recommended to bring the tip of the picc line into the svc. the dobbhoff tube tip is below the inferior margin of the film, most likely in the stomach. the heart size and mediastinum are unchanged. widespread parenchymal opacities and bilateral pleural effusion is unchanged. brief hospital course: 77 y/o woman with significant vasculopathy, seizure history, hypothyroidism, chronic uti presenting with back pain found to be spinal mets from an obstructing periureteral mass. underwent transvaginal biopsy which showed urothelial carcinoma. hospital course complicated by perforation of the bladder and significant hematuria requiring 4 units of rbcs and transfer to micu. she also required emergent cystoscopy and had hypoxic respiratory distress. patient was transferred to the oncology floor when her respiratory distress improved with diuresis, however, returned to the icu after iv fluid administration for hypercalcemia worsened her respiratory status. as patient was not deemed to be a candidate for a radiation or chemotherapy for her primary cancer given her poor functional status, multiple discussions with the family, icu/medical team and palliative care team were had and patient was made comfort measures only. she was started on aggressive comfort measures to control her pain from osseous metastases and also to ease her breathing and died on . . # acute hypoxic respiratory failure: patient presented following her repeat cystoscopy with worsening oxygen requirement and she has acute hypoxia with 2d-echo showing systolic dysfunction with a prior anterolateral injury and evidence of hypokinesia that likely resulted in volume overload and flash pulmonary edema. she responded to lasix diuresis and her oxygenation improved. she was also given nebulizer treatments. her initial oxygen requirement was a non-rebreather and she quickly weaned to nasal cannula. she required a short return to the icu given some fluid administration needs and with diuresis and anti-hypertensive therapy her respiratory status stabilized. . # delirium: the patient developed delirium concerns this admission which was considered multifactoral in origin. her infection concerns were treated, her metabolic derangements were addressed and we felt her pain control and icu delirium was most likely contributing. we optimized her medication regimen, controlled her pain with dilaudid and optimized her sleep cycles. . # ureteral mass/urothelial carcinoma: she was initially sent to the ed for back pain. a ct of the torso revealed an obstructing bladder mass with mets throughout the lumbar, thoracic and cervical spine. urology was consulted and she underwent a cystoscopy on which showed an extravesicular mass, pushing into the right ureter and bladder. she was started on continuous bladder irrigation for hematuria. an mri showed that the mass was actually periureteral. she underwent a transvaginal ultrasound guided ir biopsy on . on , her hct dropped from 28->18 and her stomach became tense and distended. she was transfused 4 units of packed red cells and transferred to the micu. urology repeated her cystoscopy and noted a bladder tear which was conservatively managed with continuous bladder irrigation. . # hypercalcemia: transient elevation in serum calcium to 10-11 range in the setting of malignancy which improved with bisphosphonate administration, calcitonin and diuretic therapy; given her volume concern issues, fluids were deferred for calcium management. . # spinal mets: her back pain was initially concerning for pmr and was treated by pcp with steroids. she was discovered on ct torso to have diffuse mets to the spine. palliative care was called for assistance with pain management. she was given morphine and ms contin, as well as dexamethasone and gabapentin. dilaudid was switched to morphine due to confusion. neuro spine was consulted and recommened a tlso brace at all times when out of bed. radiation oncology was consulted for palliative radiation options. she initiated palliative spine radiation this admission. . # acute kidney injury: creatinine bumped on from baseline 0.9 up to 1.6. this was initially concerning for obstruction from clots in the bladder. she was given iv fluids initially and her creatinine improved to baseline. following resuscitation, her creatinine remained stable in the setting of diuresis needs. . # hypertension: hctz was stopped early on in hospital stay due to electrolyte abnormalities. metoprolol was restarted and uptitrated for hypertension and tachycardia given her episode of flash pulmonary edema and ongoing respiratory distress. her 2d-echo demonstrated cardiac dysfunction with a diastolic component which was treated with acei and beta-blocker therapy. . # pvd: status post aorto-carotid and aorto-bifemoral bypasses. on aggrenox at home. this was held in preparation for biopsy and remained off in the setting of bleeding. it was restarted after discussion with urology team, when bleeding from her bladder perforation stabilized . # hypothyroidism: has been high per pcp for unclear reasons. continued home levothyroxine . # seizure history: we continued phenytoin, vitamin b6 supplementation. . # uti: she has chronic utis per her pcp. was asymptomatic but was treated for 7 days with ceftriaxone then dicloxacillin for urine culture showing staph epi. medications on admission: aggrenox 25-200 lipitor 20 mg tab daily dilantin cap 100mg qam, 200mg qpm (phenytoin sodium extended) dilantin 60 mg caps (phenytoin sodium extended) qhs synthroid 300 mcg daily sertraline hcl 200 mg daily metoprolol succinate 25 mg xr 24h-tab (metoprolol succinate) hydrochlorothiazide 12.5 mg daily folgard rx 2.2 tabs 0.5-2.2-25 mg (folate-vit b6-vit b12) cipro 500 mg tabs (ciprofloxacin hcl) 1 po hs discharge medications: none. discharge disposition: expired discharge diagnosis: urothelial carcinoma discharge condition: expired discharge instructions: none followup instructions: none md procedure: enteral infusion of concentrated nutritional substances other cystoscopy other cystoscopy closed [transurethral] biopsy of bladder transurethral clearance of bladder transurethral clearance of bladder diagnoses: end stage renal disease malignant neoplasm of liver, secondary congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) hyposmolality and/or hyponatremia other chronic pulmonary heart diseases hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hemorrhage complicating a procedure acute respiratory failure methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site epilepsy, unspecified, without mention of intractable epilepsy gross hematuria secondary malignant neoplasm of lung acute diastolic heart failure hydronephrosis delirium due to conditions classified elsewhere secondary malignant neoplasm of bone and bone marrow hypercalcemia hemoperitoneum (nontraumatic) secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes neoplasm related pain (acute) (chronic) pathologic fracture of vertebrae hemorrhage into bladder wall malignant neoplasm of other specified sites of bladder body mass index less than 19, adult chronic lymphocytic thyroiditis rupture of bladder, nontraumatic chronic pyelonephritis without lesion of renal medullary necrosis 

Answer: The patient is high likely exposed to