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: adhesive tape / ibuprofen / tramadol attending: chief complaint: ?melena vs. bright red blood per rectum major surgical or invasive procedure: colonoscopy history of present illness: 54yo m with pmhx of chronic rle pain and lymphedema, pafib, morbid obesity s/p gastric bypass, htn, and depression who presents with complaints of brbpr. friend noticed dark blood vs. brbpr (unclear which) when she came to check up on him at home. patient thinks that this may have started around 10pm the night prior to presentation. he has been 'oozing'. becaucse he is bed-bound, brought the patient to the ed for evaluation. patient reports some lightheadedness with sitting up. he has also noticed some shortness of breath. he reports some nausea, but denies vomiting. the patient reports that his last bm was on friday, which was reportedly normal per the patient. he denies any recent antibiotic use. he denies changes to his diet reporting that he has been eating more canned vegetables and occassionally raw vegetables, which he states taht he washes. he reports chills, but denies fevers. he also reports drinking botteled water. he reports that his brother has a new puppy at home; patient with a cat at home. reports some abdominal pain with his symptoms located near where his umbilicus was. in the ed, the patient triggered on arrival for hr 180-200s with atrial fibrillation w/ rvr. he had 2 piv 18 gauge ivs placed in the ed. in, the ed, the patient received a total of 3l ns; his hr responded to ivfs, so he was bolused again. pressures stable 110-130s spbs 70-80. hct 32.2 down from 36. he was t&c for 2 units. received no transfusions in the ed. mentating well. gi thought that his bleed liking from a lower source and were planning for scope tomorrow. if hd unstable get cta of abdomen- needs to be done on thrid floor given the patient's body habitus. tried foley placement, but this was unsucessful. on arrival to the micu, the patient is alert and interactive, answering questions appropriately. past medical history: -right hip fracture -hypertension -obesity -depression -mva - remote, with fracture right upper extremity, s/p orif -chronic right lower extremity lymphedema -atrial fibrillation: previously on coumadin. this was d/c'ed during his last admission in for a large hematoma and his low chads score in consultation with his cardiologist, dr. . -gastric bypass surgery in followed by dr. currently. (max weight 846lb, currently 450 lb). social history: non-smoker. denies etoh or drug use. patient is on disability. lives by himself in an apartment in ; bed bound given his obesity. family history: lung ca in mother and father, both were smokers, and both died of this, his mother at age 39. his sister has ovarian ca. his father also had gout. physical exam: admission exam: vs: t99.1 bp 98/56 hr 105 rr 20 96% on ra general: pleasant, nad, morbidly obese eent: perrl, eomi, sclerae anicteric, neck supple, moist mucous membranes, no ulcers / lesions / thrush cv: rrr, normal s1, s2, no murmurs / rubs / gallops pul: clear to auscultation bilaterally w/o wheezes / rhonchi / rales back: no focal tenderness, no costovertebral angle tenderness gi: normoactive bowel sounds, soft, obese. large scar present. no erythema over skin folds. no hepatosplenomegaly. tenderness to palpation inferior to umbilicus, and rlq. msk: no joint swelling or erythema extremities: rle is violaceous and chronically edematous. markedly tender to palpation over anterior leg just inferior to knee. lle is warm and well perfused. lymph: no cervical, axillary, or inguinal lymphadenopathy skin: no rashes, no jaundice neuro: awake, alert and oriented x3, cn 2-12 intact, strength bil, reflexes 1+ bilaterally, normal sensitivity psych: non-anxious, normal affect exam on discharge: 98.2 80 100/60 18 97 ra general: alert, oriented, no acute 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, ronchi abdomen: soft, mild tender to deep palpation in multiple areas. gu: no foley neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact ext: rle is red, chronically edematous. markedly tender to palpation over anterior leg just inferior to knee. right lower extremity with chronic lymphedema and chronic venous and skin changes including mild warmth and erythema with tenderness to touch. lle is warm and well perfused. pertinent results: admission labs: 09:20pm blood wbc-26.3*# rbc-3.60* hgb-10.5* hct-32.2* mcv-89 mch-29.1 mchc-32.6 rdw-15.4 plt ct-189# 09:20pm blood neuts-89.9* lymphs-4.4* monos-3.5 eos-0.1 baso-0.2 04:12am blood pt-14.5* ptt-23.6* inr(pt)-1.4* 09:20pm blood glucose-164* urean-33* creat-1.1 na-130* k-4.2 cl-95* hco3-22 angap-17 09:20pm blood alt-13 ast-23 ck(cpk)-45* alkphos-77 totbili-0.4 09:20pm blood ck-mb-1 09:20pm blood ctropnt-<0.01 04:12am blood ck-mb-1 ctropnt-<0.01 09:20pm blood albumin-3.0* calcium-8.5 phos-2.1*# mg-2.2 12:02am blood crp-greater th 12:02am blood vanco-15.0 06:02pm blood lactate-1.5 09:10am blood wbc-12.0* rbc-2.70* hgb-7.6* hct-24.5* mcv-91 mch-28.0 mchc-30.9* rdw-15.9* plt ct-480* discharge: 08:50am blood wbc-8.9 rbc-3.03* hgb-8.5* hct-27.3* mcv-90 mch-28.0 mchc-31.1 rdw-15.9* plt ct-615* 07:00am blood glucose-87 urean-14 creat-0.7 na-134 k-5.0 cl-95* hco3-32 angap-12 colonoscopy: grade 1 internal hemorrhoid without stigmata of recent bleeding. diverticulosis of the sigmoid colon of mild severity. the terminal ileum was identified and no blood was seen arising from the terminal ileum. old blood in the colon grade 1 external hemorrhoids otherwise normal colonoscopy to cecum and terminal ileum ct abdomen/pelvis: technique: non-contrast axial images were acquired from the lung bases to the pelvic outlet. upon review of these images, it was decided that the study was nondiagnostic due to poor penetration from the patient's body habitus. at that time, radiation dose was increased and a single axial slice was acquired. this too was deemed nondiagnostic and study was aborted. findings: lung bases are clear. heart size is normal without pericardial effusion. extremely limited evaluation of the abdomen and pelvis. patient is status post anterior abdominal hernia repair. no gross abnormalities evident within the liver or spleen. no large fluid collection evident. air noted in the bladder, possibly due to foley instrumentation, but due to study limitations, unabel to assess for foley. correlate clinically. no suspicious lytic or blastic lesions are identified. impression: nondiagnostic study despite repeated attempts with increased radiation dose. u/s: 1. complex fluid collection in the left flank, little changed from and present since , consistent with a chronic organized hematoma or seroma. 2. stable longstanding fluid collection in anterior abdominal wall surrounding implanted mesh, likely chronic seroma. u/s: suboptimal study due to patient's body habitus. mildly distended gallbladder with multiple gallstones. no son evidence of acute cholecystitis. mri impression: 1. extremely limited exam due to body habitus with field-of-view excluding known left flank fluid collection. anterior abdominal wall fluid collection without evidence of superimposed infectious process, likely represents postoperative seroma, unchanged compared to . 2. cholelithiasis without cholecystitis. 3. status post gastric bypass surgery. ct rle impression: 1. extensive circumferential right lower extremity subcutaneous stranding and edema centered about the right calf, compatible with known cellulitis. no subcutaneous gas or drainable fluid collection. 2. no evidence of arterial embolus in either lower extremity. : bilateral noninvasive lower extremity venous study clinical indication: 54-year-old male with chronic cellulitis, lower extremity pain, increased erythema. this is a technically limited study due to body habitus, in particular the swollen legs, which limits the ability to compress venous structures. however, color flow and pulse doppler waveform analysis shows full patency of the right and left venous system from the groin to the popliteal fossa. right and left common femoral waveforms are symmetric and normal bilaterally. compressibility of veins was adequate given the physical limitations of the study. the posterior tibial and peroneal veins could not be identified; however, due to the size of the swollen legs. conclusion: technically limited study with no evidence of dvt in right or left lower extremity. brief hospital course: 54yo m with pmhx of chronic rle pain and lymphedema, pafib, morbid obesity s/p gastric bypass, htn, and depression who presents with complaints of melena vs. brbpr also found to be in atrial fibrillation. # brbpr: bleeding acutely began prior to presentation. differential included bleeding internal hemorrhoids versus bleeding diverticulum versus colitis versus hemorrhagic infectious colitis. repeat hct in unit .7. he had no further episodes of large volume brbpr. he was prepped x 2 days for colonoscopy given h/o poor prep and overall risk associated with endoscopy given habitus. colonoscopy showed no clear source of bleeding, mild diverticulosis, grade 1 internal hemorrhoid, removed fecolith from appendiceal orifice. cta abdomen was attempted initially to localize source of bleed, but scan aborted after poor image quality with double dose radiation due to habitus. hematocrits remained stable and he was given po vitamin k for elevated inr. transfused 1 unit prbc at admission, none afterwards. cipro/flagyl initially started for concern for infectious colitis, stopped on hospital day #2. after transfer to the floor the patient's hematocrit remained stable with no more episodes of bleeding. #abdominal pain: evaluated by surgery, who thought that pain may be due to discomfort at point of tenderness on exam due to thin skin near area of mesh, no signs on exam of infected mesh and no new hernia on limited ct scan and mri. mri showed seromas which may be inflammed and contributing to pain. pt was seen by id who recommended no further intervention as patients fevers subsided and white count trended down. pt also states abdominal pain is improved. can follow up with gi and consider egd as an outpatient. # atrial fibrillation: patient responsive to ivfs in the ed. in the unit, the patient received ivf bolus as well as iv metoprolol with good response initially. further beta blockade limited by hypotension so he was given digoxin. he was eventually started on a diltiazem drip which was weaned to po metoprolol, with hr still well controlled with increased dose of metoprolol. chads2 score of 1, had not been on coumadin as outpt given to hx of pelvic hematoma, did not restart in context of gib. once transferred back to the floor, the patient continued to be be in afib w/ rvr >150. pt was switched to po diltiazem and metoprolol was discontinued. pt's hr was less than 100 following switch and spontaneously coverted to sinus rhyhthm on . # lower extremity edema/cellulitis: chronic in nature. patient has had lenis in the past that were negative. he did have significant pain in the rle and attempted to minimize narcotics. following transfer to the floor, patient notes his leg pain became acutely worse. on physical exam, it was noted to be more erythemic and warm. the patient was started back on vancomycin on with concern for mrsa cellulitis. the patient also had a rle ct scan to rule out nectrotizing fascitis with pain out of proportion to physical exam findings. the ct showed no nf, but did note cellulits. the patient was started on morphine and oxycodone for pain control as patient appeared in tremendous pain and said it was the worst he had ever experienced. he was transitioned to bactrim/keflex on to complete course. lenis on were done persistent pain which were negative. it it felt that his right lower extremity skin changes and pain are chronic which date back many years, even to . he has had multiple admissions for this reason and thus after this most recent treatment for cellulitis, pain control with increased gapapentin, tylenol was initiated. he is not to remain on chronic narcotics give history of abuse. the opiates were meant as short term solution. infectious disease has seen this patient throughout his admission and were never convinced he had cellulitis. they felt his coag neg staph in the blood was a contaminent and not related to his initial leukocytosis nor right lower extremity skin. #thrombocytosis: most likely reactive however platlet count continued to increase despite normalization of wbc. currently at 615 from high of 750 a baseline below 300. patient is on aspirin 325 daily. # htn: low sbps in light of atrial fibrillation at admission. held metoprolol and lasix initially, restarted metoprolol then converted to diltiazem. #access: right ij was attempted on floor unsuccessfully. patient then triggered for afib with rvr in 140s, bp 102/palp, which was baseline for day. transferred to micu, where 2 pivs placed until picc placement. # gerd: continued home omeprazole. # osa: previous diagnosis on home cpap. continued in house. transitions of care: -f/up with gi for further endoscopic evaluation -trend elevated platlet count as an outpatient. -full code -consider starting lasix to assist with lower extremity for edema- this may help his pain. medications on admission: preadmission medications listed are correct and complete. information was obtained from webomr. 1. acetaminophen 1000 mg po q8h:prn pain 2. triamcinolone acetonide 0.1% cream 1 appl tp tid:prn skin irritation 3. gabapentin 800 mg po tid 4. metoprolol succinate xl 200 mg po daily 5. docusate sodium 100 mg po bid 6. polyethylene glycol 17 g po daily 7. ferrous sulfate 325 mg po bid 8. furosemide 40 mg po daily 9. omeprazole 20 mg po daily 10. cal-citrate *nf* (calcium citrate-vitamin d2) 630-400 mg-unit oral 11. vitamin d 1000 unit po daily cholecalciferol 12. cyanocobalamin 1000 mcg po daily 13. multivitamins 1 tab po daily 14. miconazole powder 2% 1 appl tp qid:prn rash 15. aspirin 325 mg po daily discharge medications: 1. acetaminophen 1000 mg po q8h:prn pain 2. aspirin 325 mg po daily 3. docusate sodium 100 mg po bid 4. gabapentin 1200 mg po q8h 5. miconazole powder 2% 1 appl tp qid:prn rash 6. omeprazole 40 mg po daily 7. polyethylene glycol 17 g po daily 8. bisacodyl 10 mg po/pr daily:prn constipation 9. diltiazem 90 mg po qid hold for hr<60 or sbp<95 10. heparin 5000 unit sc tid 11. oxycodone (immediate release) 10-20 mg po q4h:prn pain hold for rr<10, sedation rx *oxycodone 10 mg tablet(s) by mouth q4ht disp #*30 tablet refills:*0 12. senna 1 tab po bid:prn constipation 13. cal-citrate *nf* (calcium citrate-vitamin d2) 630-400 mg-unit oral 14. cyanocobalamin 1000 mcg po daily 15. ferrous sulfate 325 mg po bid 16. multivitamins 1 tab po daily 17. triamcinolone acetonide 0.1% cream 1 appl tp tid:prn skin irritation 18. vitamin d 1000 unit po daily cholecalciferol discharge disposition: extended care facility: senior healthcare of discharge diagnosis: primary: gi bleed, cause uncertain, atrial fibrillation seconary: right lower leg lyphedema with cellulitis, 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 mr. , it was a pleasure taking care of you during your stay at . you came in due to blood in your stool and black stool. we found you to be anemic and transfused you with blood. you had a colonoscopy but it did not locate any bleeding. your bleeding stopped on admission. the bleeding was most likely caused by a diverticular bleed. in addition, you were having heart palpitations and were found to be in atrial fibrillation. we controlled your heart with medications and you rhythm returned to rhythm on . your right leg also bothered you during this admission and the pain became increasingly worse. you had a ct scan of the leg which showed cellulitis with no infection of the fascia. we treated your skin infection with iv and oral antibiotics and controlled your pain. please continue to take your home medications as directed. followup instructions: department: orthopedics when: wednesday at 9:55 am with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: orthopedics when: wednesday at 10:15 am with: , md building: sc clinical ctr campus: east best parking: garage department: cardiac services when: friday at 1:40 pm with: , md building: campus: east best parking: garage we are working on a follow up appt in the gastroenterology department in days. you will be called at home with the appointment. if you have not heard or have questions, please call . please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. name: dr. location: /east address: , e/cc-6, , phone: department: div. of gastroenterology when: wednesday at 3:00 pm with: , md building: ra (/ complex) campus: east best parking: main garage procedure: colonoscopy central venous catheter placement with guidance diagnoses: obstructive sleep apnea (adult)(pediatric) other chronic pain esophageal reflux unspecified essential hypertension acute posthemorrhagic anemia iron deficiency anemia secondary to blood loss (chronic) hyposmolality and/or hyponatremia atrial fibrillation cellulitis and abscess of leg, except foot morbid obesity retention of urine, unspecified diverticulosis of colon with hemorrhage internal hemorrhoids without mention of complication bariatric surgery status other lymphedema essential thrombocythemia pain in limb urethral stricture, unspecified fecal impaction body mass index 60.0-69.9, adult 

Answer: The patient is high likely exposed to