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: sulfasalazine / morphine / nsaids / fosamax attending: chief complaint: fever and vomiting major surgical or invasive procedure: a line central venous line, rij, history of present illness: 80f with ra on prednisone and chronic diastolic chf admitted with hypotension and tachycardia. presented to pcp's office on the day of admission with headache and rhinitis beginning 3 days prior. symptoms followed with anorexia and nonbloody, nonbilious vomiting. reports fever as high as 103.4, dysuria, and epigastric pain which she attributes to dry heaving. reports constant nonradiating nonpositional substernal chest pressure beginning earlier this evening, without associated lightheadedness, diaphoresis, palpitations, nausea, dyspnea, or edema. reports that her weight is stable. never experienced chest pressure before. had a flu vaccine earlier this season. on exam in clinic t 99 o2sat 96%ra bp 86/60 hr 120 while standing and 90/60 hr 120 while supine. ekg showed newly discovered afib with rvr. referred to ed. triage v/s 98.0 120 119/81 14 95% 3l nc. rectal temp 102 bp 86/51 normal mentation guaiac negative. labs notable for lactate 0.7 (after 3l ns) wbc# 16.3 (86.5% pmn), bnp 7980, trop 0.09, u/a+. cxr showed cardiomegaly but no acute process. persistently hypotensive (map 50s) despite 3l ns - right ij was placed. started levophed gtt. given vancomycin 1 g iv, zosyn 4.5 g iv, asa 325, acetaminophen 1 g, 3l ns. v/s prior to transfer 118 93/52 (levophed 0.04 mcg/kg/min) 29 96%2l. past medical history: ra chronic diastolic chf hyperparathyroidism hyperlipidemia shingles osteoporosis djd adenomatous/hyperplastic polyps internal & external hemorrhoids s/p r thr (), bilat tkr social history: home health aide. lives with her husband in . former smoker, quit ~20 years ago. family history: two sisters have had "heart attacks" but are alive and well in their 80s. physical exam: physical exam on arrival to : v/s: t 98.3 bp 126/65 hr 133 rr 17 o2sat 98%2lnc. gen: appears well, respirations nonlabored heent: op clear dry mm neck: r ij site c/d/i flat neck veins resp: bibasilar rhonchi clear with coughing no wheeze cv: irreg irreg tachy nl s1s2 no m/r/g abd: soft ntnd normoactive bs ext: warm, dry tr pitting edema to mid-calves bilat no leg swelling skin: no rash neuro: aaox3 pertinent results: admission labs: 02:15pm blood wbc-16.3* rbc-4.21 hgb-13.4 hct-38.7 mcv-92 mch-31.8 mchc-34.5 rdw-13.8 plt ct-280 02:15pm blood neuts-86.5* lymphs-9.7* monos-3.4 eos-0.1 baso-0.4 02:15pm blood pt-14.8* ptt-28.0 inr(pt)-1.3* 02:15pm blood glucose-87 urean-21* creat-1.1 na-134 k-4.0 cl-94* hco3-27 angap-17 02:15pm blood alt-16 ast-31 ld(ldh)-245 alkphos-91 totbili-0.7 02:15pm blood probnp-7980* 02:15pm blood ctropnt-0.09* 02:40am blood ctropnt-0.09* 12:54pm blood ck-mb-7 ctropnt-0.05* 02:15pm blood albumin-3.4* calcium-8.7 mg-1.8 02:40am blood iron-12* 02:40am blood caltibc-215* hapto-295* ferritn-284* trf-165* 06:00pm urine color-yellow appear-hazy sp -1.010 06:00pm urine blood-tr nitrite-neg protein-75 glucose-neg ketone-tr bilirub-sm urobiln-neg ph-5.0 leuks-mod 06:00pm urine rbc-0-2 wbc->50 bacteri-many yeast-none epi-0 6:00 pm urine site: catheter discharge labs: 06:00am blood wbc-11.3* rbc-3.93* hgb-11.8* hct-37.3 mcv-95 mch-30.1 mchc-31.7 rdw-14.9 plt ct-361 06:00am blood glucose-80 urean-22* creat-0.9 na-143 k-3.9 cl-107 hco3-31 angap-9 06:00am blood calcium-8.1* phos-3.5 mg-1.8 06:55am blood ck(cpk)-66 06:55am blood ck-mb-6 ctropnt-0.03* 06:00am blood pt-27.2* ptt-34.3 inr(pt)-2.7* 10:28am blood %hba1c-6.4* eag-137* 06:55am blood triglyc-88 hdl-36 chol/hd-3.1 ldlcalc-59 06:55am blood caltibc-234* ferritn-229* trf-180* **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s ecg atrial fibrillation, average ventricular rate 123. early transition. diffuse non-specific t wave changes. no previous tracing available for comparison. cxr: pa and lateral views of the chest are obtained. the heart is moderately enlarged. mild interstitial prominence within the lungs could indicate chronic lung disease and clinical correlation is advised. no gross chf. no pleural effusion or pneumothorax. aorta is unfolded. bony structures appear grossly intact. impression: cardiomegaly. prominence of the interstitial markings could reflect interstitial lung disease for which clinical correlation is advised. echo -the left atrium is mildly dilated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 10-20mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size. regional left ventricular wall motion is normal. overall left ventricular systolic function is low normal (lvef 50-55%). there is no ventricular septal defect. right ventricular chamber size is normal. with borderline normal free wall function. 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 no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. brief hospital course: a/p: 80f with ra on prednisone and chronic diastolic chf admitted with shock and afib with rvr. #sepsis from urinary tract infection. patient presented with fever, dysuria, and positive ua on the background of hypovolemia poor oral intake and vomiting, complicated by rate-related hypotension from poor distolic filling time in the setting of rapid af. she required phenylepherine the night of icu admission. her initial antibiotics were vancomycin and zosyn, but vancomycin was discontinued as e coli was growing out on . she was switched from zosyn to ceftriaxone as the e. coli turned out to be pan-sensitive on . this was changed to po cipro on the medical floor. she will need 2 weeks of antibiotics for acute complicated urinary tract infection. she also received stress dose steroids given that she is on chronic steroids as an outpatient. this was weaned down to prednisone 20 mg with instructions to further wean to home dose. #atrial fibrillation with rvr: upon further review, pt states that this not new and she was told she had afib during an or procedure in the past. current afib with rvr likely promoted by increased sympathetic drive in the setting of septic shock and baseline chronic diastolic chf. pt had an echo showing mild-mod dilation of the l and r atria, mild symmetric lvh, ef 50-55%, mild to moderate +mr and mild pulmonary artery hypertension. her rate improved with antibiotics treatment for the underlying urosepsis. pressor was weaned and she was able to restart metoprolol. this dose was uptitrated to toprol xl 75 mg daily she continued with aspirin and was transitioned to coumadin with a heparin/lovenox bridge for chads2 score of 2. she will need to have her inr monitored in the outpatient setting with adjustment of coumadin as pt is taking cipro. #elevated troponin (0.09 on admit, decreased to 0.03): this was thought to be related to demand from af with rvr and sepsis. cardiac enzymes trended down. aspirin was continued, bb was uptitrated. simvastatin continued. #chest pain: pt reported chest pressure at home with some doe on occasion, relieved by rest. patient had 1 episode this admission. ekg was unchanged. cardiac enzymes x2 were flat; these troponins had trended down from admission troponins. cp occurred in the setting of hr ~150 afib. ddx includes angina from cad vs. poor rate control. bb was uptitrated. pt remained on asa. lipid panel ordered showing ldl of 59, aic of 6.4%. informed pt's pcp of the above. pt will be scheduled for an outpatient stress test for further evaluation. pt did not have any additonal episodes as an inpatient. #chronic diastolic chf: patient had elevated bnp upon admission to the hospital. echo as above showing ef 50-55%. pt's lasix dose was held while in the icu and initially on the medical floor. however, given development of crackles on exam, this was resumed on at a dose of 20mg daily, then titrated to 40 mg daily. (reported home dose 60mg daily). this can be uptitrated as needed and followed as an outpatient. #chest xray showing mild interstitial prominence within the lungs: this was read as "could indicate chronic lung disease and clinical correlation is advised". pt denies smoking. this may or may not be related to her underlying rheumatoid arthritis. pt did not have any respiratory difficulty and had good room air sats. this can be further worked up as an outpatient if indicated. #rheumatoid arthritis: pt continued on plaquenil. she got home dose prednisone which was later switched to stress dose steroid given hypotension from septic shock while in the icu. her steroid dose was changed to po on the floor and tapered down to prednsione 20mg upon discharge, which she was instructed to taper to her home dose of 5mg after 1 week. #comm: , husband, . medications on admission: medications at home (per atrius records) prednisone 5 mg plaquenil 200 mg simvastatin 20 mg daily alendronate 70 mg weekly furosemide 60 mg daily metoprolol 25 mg qam, 37.5 mg qpm omeprazole 20 mg daily caltrate+d 600 mg-400 iu 1 tab discharge medications: 1. hydroxychloroquine 200 mg tablet sig: one (1) tablet po bid (2 times a day). 2. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 3. alendronate 70 mg tablet sig: one (1) tablet po once a week. 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 5. caltrate-600 plus vitamin d3 600-400 mg-unit tablet sig: one (1) tablet po twice a day. 6. toprol xl 50 mg tablet sustained release 24 hr sig: three (3) tablet sustained release 24 hr po once a day. disp:*90 tablet sustained release 24 hr(s)* refills:*0* 7. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 8 days: last dose . 2 week course. disp:*16 tablet(s)* refills:*0* 8. outpatient work pt/inr. please have this checked in 2 days after discharge name: , location: - address: 291 independence dr, , phone: fax: 9. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 10. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*2* 12. prednisone 20 mg tablet sig: one (1) tablet po daily (daily) for 6 days: then change to 5 mg twice a day. disp:*6 tablet(s)* refills:*0* discharge disposition: home with service facility: americare vna discharge diagnosis: major: sepsis due to urinary tract infection atrial fibrillation with rapid ventricular rate minor: relative adrenal insufficiency chronic diastolic heart failure rheumatoid arthritis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , it was pleasure taking care of you. you were initially admitted to the icu with sepsis related to a urinary tract infection. you also were found to have atrial fibrillation with a rapid heart rate. for your infection you were given antibiotics with good effect. your symptoms have improved. for your atrial fibrillation, you were given increased doses of metoprolol to better control your heart rate. you were started on blood thinning medication called coumadin to decrease your risk of stroke. you will need your inr closely followed as an outpatient. you also reported chest pressure when your heart rate was fast. you will need to undergo a stress test soon to evaluate for possible disease in your heart's blood vessels. please discuss scheduling this test with your pcp . . you were also given increased steriods due to your current illness and this will need to be slowly decreased. medication changes: 1.coumadin 2mg daily 2.toprol xl 150mg daily 3.aspirin 81mg daily 4.prednisone 20 mg daily for 1 week, then 5 mg twice a day. 5.ciprofloxacin 250 mg twice a day until . please take all of your medications as prescribed and follow up with the appointments below. followup instructions: name: , location: - address: 291 independence dr, , phone: *someone from dr. office will contact you to book an appointment. you should follow up with the doctor within a week. if you dont hear from the office in 2 business days, please call the number above. please also follow up with your cardiologist dr. at within 2 weeks. her clinic number is . procedure: venous catheterization, not elsewhere classified arterial catheterization diagnoses: acidosis anemia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified atrial fibrillation sepsis rheumatoid arthritis hyperparathyroidism, unspecified glucocorticoid deficiency septicemia due to escherichia coli [e. coli] chronic diastolic heart failure 

Answer: The patient is high likely exposed to