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: levaquin attending: chief complaint: change in mental status and foul smelling urine major surgical or invasive procedure: incision and drainage of right lower extermity clot left arterial line history of present illness: yo female with mmp who is being treated with lovenox for dvt found in , with hx of frequent utis and urosepsis with resistent klebsiella (most recent positive cx in ), who was in nsoh living with grand-daughter until 2 days ago when she was noticed to have increased somnolence, and stopped taling. she had diarrhea last week and decreased po intake over the past few days. she has stopped talking today which is unusual for her and usually indicates an infection. family does notice she seems to have a tender l leg. she is unable to walk at baseline she has had increased leg edema over the last several days. she has an upcoming appointment in clinic with dr. on monday. code status was reviewed and patient is full code at this point. . in the ed, has positive ua. started on meropenem. leni shows residual clot seen adjacent to vessel walls in the l cfv/sfv/. normal waveforms demonstrated. all vessels were patent. past medical history: - dvt on lovenox - right tkr, wheel-chair bound - htn - s/p cva - left thalamic and cerebellar with residual right-sided hemiparesis. - pmr - h/o asymptomatic r subclavian aneurysm - mild dementia - cataracts - fe deficiency anemia--egd showed gastritis & h pylori. did not want antibiotics. treated with zantac. colonoscopy (-) - chf echo ef 40% inf wall hypok mod as area 3cm, peak gradient 60, mean 38. 1+ai. pmibi neg with fixed inf defect - ugib due to pud seen on egd, - s/p pacer for complete heart block by dr. . social history: lives with two grandchildren who provide 24 hour care and also has vna.non-ambulatory s/p right tkr, uses wheel-chair. on last admit was recommended for thickened liquid puree diet. physical exam: 98.9 108/92 74 19 100% ra wt 102#, 4'8" gen: elderly, answers with one word, nad, responds to questions and commands heent: mmd, eomi, pupils constricted, prior surgery, chest: cta anterior cv: s1s2 3/6 sem loudest at lusb (creshendo-decreshendo) abd; hypoactive bs, soft, ntnd ext: lle with 2+ edema, no purulence or fluctuance neuro: responds to questions with one word answers, nods head, follows commands, moves all limbs pertinent results: admission labs: 7:35p 147 115 18 agap=15 -------------< 92 4.4 21 0.8 93 4.7 \ 11.2 / 232 / 33.7 \ n:64.9 l:29.4 m:3.7 e:1.9 bas:0.2 colorstraw appearclear specgr1.019 ph 5.0 urobilneg bilineg leuktr bldsm nitrpos prottr gluneg ketneg rb0-2 wbc21-50 bactmany yeastnone epi0 chest (pa & lat) 8:42 pmtechnique and findings: pa and lateral chest x-ray dated is compared to the pa and lateral chest x-ray of . there is a new large right pleural effusion. the heart displays stable enlargement. the mediastinal and hilar contours are unremarkable. the lungs show no focal areas of consolidation to suggest pneumonia. there is mild prominence of the perihilar pulmonary vasculature with peribronchial cuffing indicating mild congestive heart failure. left- sided pacemaker is in unchanged position. the aorta is calcified throughout its course. impression: interval development of right-sided pleural effusion. mild congestive heart failure. no focal areas of consolidation to suggest pneumonia. unilat lower ext veins left 8:03 pm impression: interval partial recanalization of the left common femoral, superficial femoral, and popliteal veins. cardiology report echo study date of conclusions: the left atrium is elongated. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is severely depressed with global hypokinesis and akinesis of the distal anterior wall /antero-septum and apex. no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. compared with the findings of the prior report (tape unavailable for review) of , the lvef has significantly decreased and the aortic stenosis is now severe. impression: severe aortic stenosis with severely depressed lvef. regional wall motion abnormalities c/w cad (multivessel). 11:52 am urine site: catheter **final report ** urine culture (final ): no growth. 7:35 pm urine site: catheter **final report ** urine culture (final ): culture workup discontinued. further incubation showed contamination with mixed fecal flora. clinical significance of isolate(s) uncertain. interpret with caution. gram negative rod #1. >100,000 organisms/ml.. gram negative rod #2. 10,000-100,000 organisms/ml.. brief hospital course: 1) uti: the patient was found to have a positive ua on admission. given her history of esbl resistant klebsiella utis in the past, she was treated with imipenem for 7 days per id (started ). her urine culture showed fecal contamination, but repeat urinalysis and culture was negative after 5 days of treatment with imipenem. 2) chf with severe as / pulmonary edema / pleural effusion - on the second morning of admission, the patient became markedly hypertensive and hypoxic with abg showing respiratory acidosis: 7.15/60/129. she had been given fluid boluses overnight for decreased urine output. she was felt to be fluid overloaded and also hypertensive which led to pulmonary edema and given lasix and nitro paste. she had unchanged ekg and a small troponin leak in the setting of increased demand, cxr showed pulmonary edema with pleural effusion which was felt to be likely chf related. she reponded well to bipap while in and was back to room air for the remainder of admission. she got an echocardiogram which showed ef of 30% and av area of 0.7 cm2, worse than previous echo in . she was converted to long acting toprol. an ace was considered but used with caution given her as. 3) rle swelling: the patient had a swollen bump on her left leg which appeared red, warm and fluctuent. general surgery was called to i&d this area. it revealed old clot with culture and gram stain negative on prelim results. she was treated with morphine for pain in this area after the procedure. three days later, it spontaneously started bleeding and surgery was called to bedside. pressure was applied. the recommendation was to discontinue wet to dry dressings as these can remove the scar tissue and exacerbate bleeding. 4) altered mental status - after beginnig the antibiotic therapy, the patient returned to baseline per granddaughter which was cooperative, responsive, and oriented occasionally only to herself. the night of pt was less responsive after 1:30 am (got 2 mg morphine at 12:30 am for pain and sob until 8 am. head ct was negative and glucose was normal. this resolved by 9 am so narcotic was most likely cause, and morphine was used sparingly after this. 5) bleeding/anemia: her hct was stable during admission until the am of when the rn noted bleeding out of l le i&d site and left old a-line site. pressure held and hemostatsis obtained. lmwh was at therapeutic level of 0.7, but her hct down to 23 the next and family refused transcusion less than 25. her lovenox decreased to qd dosing given her risk to bleed, family reluctance to transfusion, and that her repeat u/s showed recaunulazation (despite qd dosing and 0.3 lmwh). she received 1 unit prbc with lasix in the middle and had no shortness of breath or bleeding. she did not rebleed from this area or the left wrist in the last four days of admission and her hct was stable around 30. 6) dvt: treatment was continued for dvt previously noted. her lovenox was changed to dosing as factor x level was subtherapeutic. 7) htn: her lopressor was continued but changed to metoprolol. isordil was added to help with bp control. an ace inhibitor could also be considered but both agents used with caution given her as. 8) hypernatremia - she was noted to be hypernatremic on admission. her imipenem was changed to d5 water and free water intake was encouraged. she was maintained on low salt diet. her sodium improved to normal. 9) pmr - she was continued on prednisone 1 mg. 10) fen: per swallow eval last admit, the patient should be on thickened liquid puree diet, and is at risk for aspiration. family does not want feeding tube and feels this risk is acceptable. aspiration precautions. 11) her code status remained full during admission. this was extensively discussed with granddaughter and hcp pager . medications on admission: prednisone 1 mg tablet sig metoprolol tartrate 25 mg acetaminophen albuterol sulfate 0.083 % solution sig: one (1) treatment prn furosemide 40 mg tablet qd pantoprazole sodium 40 mg qd nystatin-triamcinolone 100,000-0.1 unit/g-% cream sig enoxaparin sodium 40 mg/0.4ml qd discharge medications: 1. prednisone 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 5. enoxaparin sodium 40 mg/0.4ml syringe sig: one (1) injection subcutaneous once a day. disp:*60 injection* refills:*2* 6. isosorbide dinitrate 10 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 7. docusate sodium 150 mg/15 ml liquid sig: one hundred (100) mg po bid (2 times a day). disp:*1 bottle* refills:*4* 8. furosemide 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 9. albuterol sulfate 0.083 % solution sig: one (1) nebulizer inhalation every six (6) hours as needed for shortness of breath or wheezing: and give extra dose of lasix for unresponsive shortness of breath. disp:*30 nebulizers* refills:*2* 10. atrovent 0.02 % solution sig: one (1) nebulizer inhalation every 6-8 hours as needed for shortness of breath or wheezing: and give extra dose of lasix for unresponsive shortness of breath. disp:*30 nebulizers* refills:*2* 11. metoprolol succinate 100 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). 12. adverse reaction no opiates or benzos! discharge disposition: extended care facility: - discharge diagnosis: urinary tract infection pulmonary edema hypertension congestive heart failure bleeding secondary: deep vein thrombosis diagnosed in , on lovenox polymyalgia rheumatica dementia discharge condition: patient was breathing comfortably on room air, was responsive, oriented only to herself. she was at her baseline per family. discharge instructions: you are being discharged to . please take the medication regimen listed below. if you have fevers, chills, bleeding, shortness of breath or other concerns, please call your doctor or return to the ed. followup instructions: please follow up with dr. , s. in weeks after discharge from rehab. procedure: arterial catheterization other incision with drainage of skin and subcutaneous tissue transfusion of packed cells diagnoses: polymyalgia rheumatica urinary tract infection, site not specified congestive heart failure, unspecified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute posthemorrhagic anemia aortic valve disorders other persistent mental disorders due to conditions classified elsewhere acute respiratory failure cellulitis and abscess of leg, except foot cachexia late effects of cerebrovascular disease, hemiplegia affecting unspecified side hyperosmolality and/or hypernatremia combined systolic and diastolic heart failure, unspecified acute venous embolism and thrombosis of unspecified deep vessels of lower extremity 

Answer: The patient is high likely exposed to