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: patient recorded as having no known allergies to drugs attending: chief complaint: abdominal pain major surgical or invasive procedure: : 1. exploratory laparotomy. 2. reduction of internal volvulus of the small bowel. 3. small-bowel resection with primary anastomosis. history of present illness: 67 year old man with medical problems including dm type 2, mechanical , ascending aorta repair with graft cad s/p cabg,hx of vf arrest s/p aicd who presents with acute onset severe abdominal pain at 10am yesterday am. states was previosly feeling well, tolerating pos and having regular bms when this started. never had pain like this before, diffuse, crampy. + nausea, no vomiting. last bm yesterday, normal, no blood. denies diarrhea. no fevers or chills. in the emergency department, he was noted to be hypotensive, started on vasopressors, received 3l ivf with labored breathing and thus intubated in ed. he was admitted to to the sicu. past medical history: cad s/p cabgx3 - h/o vf arrest s/p icd placement; required explantation for mrsa pocket infection with reimplantation , s/p lead removal - mechanical , . , - ascending aorta repair c graft - chf (ef 20% per tte ) - high grade cons bacteremia in c/b high grade cons, vre bactermia while on vancomycin , s/p 4 weeks daptomycin and explantation of icd leads - pseudomonas uti s/p cefepime x 14 days, now pseudomonas uti s/p meropenem x 14 days - r lateral foot ulcer s/p debridement s/p zosyn x 14 days - dm2 c/b neuropathy - hep c (dx , 2.38 million iu/ml. seen by hepatology, note emphasizes deferring ifn/ribavirin tx for now given infections, etc.) - htn - hlp - pvd s/p l bka - hypothyroidism - h/o opiate dependence, ?benzo dependence - acute on chronic sdh, - h/o r scapula fx - h/o mrsa elbow bursitis, - h/o closed bimalleolar fx s/p repair, removal of hardware social history: lives in , though has been in rehab for much of the past few months. former cab driver. social history is significant for the current tobacco use of 40 pack years. there is no history of alcohol abuse or recreational drug use. lives with common-law wife of 35 years who is a home health aid. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: on admission: vs: t96.0 66 80/50 24 100% facemask gen: ill appearing man, sleepy, answering questions with difficulty heent: sclera anicteric. mmdry cv: irregular irregular lungs: labored breathing. diffuse bilateral rales abdomen: distended, diffusely tender with rebound and guarding rectal: trace guaiac pos . at discharge: avss/afebrile. gen: well in nad. heent: sclerae anicteric. o-p clear. neck: supple. lungs: cta(b) cor: irregularly irregular abd: midline incision with steri-strips c/d/i. lower aspect incisional wound 5cm x 3cm x 2cm granulating, clean. wet-to-dry packing . bsx4. appopriately tender to palpation along wound, otherwise soft/nt/nd. extrem: no c/c/e. neuro: a+ox3. pertinent results: on admission: 12:15am pt-48.6* ptt-61.5* inr(pt)-5.2* 12:15am plt count-158# 12:15am neuts-90.2* lymphs-5.2* monos-4.0 eos-0.4 basos-0.2 12:15am wbc-8.2 rbc-3.68* hgb-8.5* hct-28.7* mcv-78* mch-23.1* mchc-29.7* rdw-19.7* 12:15am urine gr hold-hold 12:15am calcium-6.7* phosphate-2.6* magnesium-1.7 12:15am lipase-15 12:15am alt(sgpt)-25 ast(sgot)-33 ld(ldh)-196 alk phos-59 tot bili-0.4 12:15am glucose-228* urea n-40* creat-1.2 sodium-139 potassium-3.6 chloride-106 total co2-22 anion gap-15 12:44am lactate-2.2* 04:30am pt-21.6* ptt-41.8* inr(pt)-2.0* 04:38am lactate-2.9* 04:45am pt-24.2* ptt-43.7* inr(pt)-2.3* 06:11am freeca-1.04* 06:11am hgb-9.2* calchct-28 06:11am glucose-223* lactate-3.9* na+-137 k+-4.2 cl--103 07:58am pt-19.1* ptt-42.3* inr(pt)-1.7* 07:58am plt count-212 07:58am wbc-14.8*# rbc-3.85* hgb-9.3* hct-30.6* mcv-80* mch-24.1* mchc-30.4* rdw-19.2* 07:58am calcium-7.6* phosphate-2.4* magnesium-2.2 07:58am ck-mb-notdone ctropnt-0.03* 07:58am glucose-230* urea n-43* creat-1.6* sodium-140 potassium-3.6 chloride-106 total co2-21* anion gap-17 . prior to discharge: 06:29am blood wbc-4.4 rbc-3.21* hgb-9.0* hct-27.7* mcv-86 mch-28.0 mchc-32.5 rdw-22.5* plt ct-119* 06:29am blood plt ct-119* 06:29am blood glucose-157* urean-16 creat-0.8 na-132* k-4.3 cl-91* hco3-34* angap-11 06:29am blood calcium-8.4 phos-2.8 mg-1.8 04:20am blood pt-26.4* ptt-48.8* inr(pt)-2.6* . imaging: cxr interval worsening of mild pulmonary edema. moderate bibasilar atelectasis in the setting of low lung volumes. ct abd: findings concerning for mesenteric ischemia with portal venous air, with focus of air seen in mesentery centered about loops of small bowel in the right mid abdomen with air circumferentially surrounding the lumen suggestive of pneumatosis and associated mesenteric stranding (301b:18-27). vascular event may represent etiology, though swirling configuration suggests internal hernia. cxr improved basilar aeration. cvl well placed cxr new b/l poorly defined pulmonary opacities, some w/ nodular configuration. cxr interval increase in diffuse widespread airspace consolidation, ?ards. multifocal pneumonia. co-existing ards is also possible. lung ct head ct : echo: ef 20-25%, pcwp>18, + mr, dilated lv, global hypokinesis cxr: worsening pulmonary edema. evidence for bilateral pleural effusions, which may have increased as well. cxr:mild-to-moderate pulmonary edema has improved since cxr: cardiomegaly, bilateral pleural effusions and atelectasis, overall appearing minimally changed. . microbiology: sputum mrsa mod growth. bcx: staph coag neg 1/2 bottles bal mrsa sputum: mrsa, sparse gnr bal: mrsa bal: negative c diff neg catheter tip neg . pathology: specimen submitted: ileum. diagnosis: ileum, segmental resection: 1. ischemic enteritis with focally transmural necrosis and associated serositis. 2. one unremarkable resection margin; opposite resection margin with mucosal ischemic changes and acute inflammation of the superficial submucosa. clinical: ischemic bowel, acute abdomen. gross: the specimen is received fresh labeled with the patient's name, ", ", the medical record number and "ileum." it consists of a segment of small bowel measuring 92 cm in length and 3 cm in average diameter. a portion of mesentery is attached to the small bowel that measures 2 x 4 x 3 cm. the specimen is not oriented. the mesentery is unremarkable. the serosa of the bowel is focally erythematous and dusky looking. there are two staples measuring 3.7 and 5.2 cm. the specimen is opened along the antimesenteric surface to reveal fecal material and blood within the lumen. the mucosa in the central portion of the bowel measuring 34 cm in length is erythematous, brown and dusky looking. no masses or polyps are identified. no perforation site is identified. the bowel wall within the affected area measures up to 0.2 cm in thickness. normal looking bowel measures up to 0.4 cm in thickness. the specimen is represented in cassettes as follows: a = 5.2 cm stapled margin, b = 3.7 cm staple margin, c = section of affected bowel, d = transition between effected and normal bowel, e-g = fat. brief hospital course: the patient with multiple medical problems was admitted to the general surgical service on for evaluation of an acute abdomen likely from ischemic bowel. he was admitted to the sicu. he was made npo, started on iv fluids, a foley catheter and cvl were placed, empiric iv vancomycin and zosyn were started, and he was given fentanyl iv prn for pain and valium for sedation. he was emergently brought to the operating room, where he underwent exploratory laparotomy, reduction of internal volvulus of the small bowel, and small-bowel resection with primary anastomosis(reader referred to the operative note for details). he was found to have ischemic bowel with obstruction, peritonitis, and an internal volvulus of the small bowel. he was returned to the sicu for post-operative care. . sicu/ticu events - : 1 u prbc, 750 lr intraop, to icu post op. on neo and epi. transfused 1 u for hct 28. febrile to 101. pm - spike to 101.2, decreasing pressor requirements and lactate. pan-cxs sent. left subclavian placed. bloody guiac + bm overnight. hct drifting down. gpc on blood culture 1/2 bottles . : bronch and bal.abx started after bal : low uop. large heparin requirement given ffp 2 untis for ? atiii def. ps trial failed changed back to rate. tpn started. : concern for depressed mental status in am. concern for septic emboli to brain/eyes/lungs. mental status improved in pm w/o intervention except for holding of propofol. also concern for pt's high need of heparin to stay in therapeutic level. peripheral smear sent.leni negative. : bedside tte w/ hyperdynamic lv, fena 0.2%, given 3 unit of blood,he had melanotic stool, but hd stable, started on d5w at 30cc/h, creatine improving. acutely became diaphoretic sat down to 88% pt labored and desynchronous with ventilator, tachycadic high bp w/ map 110, tachycardic 120, cvp 26. patient had flush pe lasix bolus given, patient sedated, abg improved - extubated pm, started on bipap. back on lasix gtt, started carvedilol, started bridge to coumadin. re-intubated due to fluid reaccumulation : extubated. doing well. picc placed : to ticu for resp distress, bipap responsive, cardiac diet now, restarted carvedilol, ace, aldactone, required bipap o/n after brief desat bipap during the day and extra lasix 20mg iv x1, negative for the day, bipap overnight, held coumadin x 1 for inr 5.8 : opening of abdominal wound. held coumadin for inr 5.7. : started glargine, removed foley, restarted coumadin 3mg. : coumadin reduced to 2mg. . 9 events: on , the patient was transfered to the inpatient floor. he arrived on a diabetic/low sodium regular diet, oral medications, voiding without assitance, with iv linezolid and meropenem continued. coumadin was continued, and monitored closely to maintain a therapeutic goal range of 2.5-3.5. the inr on was 2.6. . during this hospitalization, the patient ambulated early and frequently, was adherent with respiratory toilet and incentive spirrometry, and actively participated in the plan of care. the patient's blood sugar was monitored regularly throughout the stay; lantus and sliding scale insulin was administered as indicated. labwork was routinely followed; electrolytes were repleted when indicated. . at the time of discharge on, the patient was doing well, afebrile with stable vital signs. the patient was tolerating a diabetic/low sodium regular diet, ambulating with assistance, voiding without assistance, and pain was well controlled. he was discharged to an extended care facility for rehabilitation and nursing care. the patient received discharge teaching and follow-up instructions with understanding verbalized and agreement with the discharge plan. . services consulted during admission: infectious disease, otolaryngology, cardiology, pulmonary, social work, physical therapy, and occupational therapy. medications on admission: amiodarone 200 mg daily atorvastatin 40 mg daily polyethylene glycol 3350 17 gram/dose amitriptyline 10 mg hs docusate sodium 100 mg senna 8.6 mg captopril 25 mg tid lactulose 30 q8h (every 8 hours) as needed for constipation. aspirin 81 mg daily lorazepam 0.5 mg q4h as needed for anxiety levetiracetam 500 mg qhs gabapentin 400 mg q8h ( warfarin 5 mg daily oxycodone 5 mg q4h as needed for pain. acetaminophen 500 mg q8 hours as needed for pain bisacodyl 10 mg prn albuterol sulfate 90 mcg 2 puffs ih q6h prn ipratropium bromide 17 mcg/actuation qid ( meropenem 500 mg q6 spironolactone 25 mg daily torsemide 20 mg metolazone 5 mg metoprolol 12.5 mg potassium chloride 20 meq once a day insulin glargine 40 units subcutaneous at bedtime insulin lispro per sliding scale discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever or pain. 2. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. docusate sodium 100 mg capsule sig: one (1) capsule po tid (3 times a day) as needed for constipation. 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 6. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 8. warfarin 2.5 mg tablet sig: one (1) tablet po daily at 16:00: st. mechanical ; inr goal 2.5-3.5. 9. ondansetron 4 mg iv q8h:prn nausea 10. oxycodone 5 mg/5 ml solution sig: 5-10 mg po q6h (every 6 hours) as needed for pain. 11. ativan 0.5 mg tablet sig: tablet(s) (give sl) po every 6-8 hours as needed for anxiety. 12. atorvastatin 40 mg tablet sig: one (1) tablet po at bedtime. 13. torsemide 20 mg tablet sig: one (1) tablet po twice a day. 14. metolazone 5 mg tablet sig: one (1) tablet po twice a day. 15. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po twice a day. 16. potassium chloride 10 meq tablet sustained release sig: two (2) tablet sustained release po once a day. 17. levetiracetam 500 mg tablet sig: one (1) tablet po at bedtime. 18. neurontin 400 mg capsule sig: one (1) capsule po three times a day. 19. amiodarone 200 mg tablet sig: one (1) tablet po once a day. 20. amitriptyline 10 mg tablet sig: one (1) tablet po at bedtime. 21. captopril 25 mg tablet sig: one (1) tablet po three times a day. 22. insulin lispro 100 unit/ml solution sig: 4-22 units subcutaneous as directed per humalog insulin sliding scale. 23. lantus 100 unit/ml solution sig: forty (40) units subcutaneous at bedtime. 24. medication: morphine sulfate 2-4 mg iv q6h:prn breakthrough pain only discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary: 1. ischemic bowel. 2. bowel obstruction. 3. peritonitis. 4. internal volvulus of small bowel. 5. multifocal pneumonia . secondary: 1. cad 2. history of vf arrest s/p icd placement 3. mechanical st. on coumadin prophylaxis inr goal 2.5-3.5) 4. chf (ef 20%) 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: weigh yourself every morning, md if weight goes up more than 3 lbs. . please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. avoid driving or operating heavy machinery while taking pain medications. please follow-up with your surgeon and primary care provider (pcp) as advised. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *if you have steri-strips, they will fall off on their own. please remove any remaining strips 7-10 days after surgery. *the lower incision wound will be cared for by your nurse. car is a wet-to-dry dressing changed twice daily. . coumadin (warfarin): what is this medicine used for? this medicine is used to thin the blood so that clots will not form. how does it work? warfarin changes the body's clotting system. it thins the blood to prevent clots from forming. what you should contact your healthcare provider : signs of a life-threatening reaction. these include wheezing; chest tightness; fever; itching; bad cough; blue skin color; fits; or swelling of face, lips, tongue, or throat, severe dizziness or passing out, falls or accidents, especially if you hit your head. talk with healthcare provider even if you feel fine, significant change in thinking clearly and logically, severe headache, severe back pain, severe belly pain, black, tarry, or bloody stools, blood in the urine, nosebleeds, coughing up blood, vomiting blood, unusual bruising or bleeding, severe menstrual bleedin, or rash. call your doctor if you are unable to eat for several days, for whatever reason. also call if you have stomach problems, vomiting, or diarrhea that lasts more than 1 day. these problems could affect your coumadin??????/warfarin dosage. coumadin (warfarin) and diet: certain foods and beverages can impair the effect of warfarin. for this reason, it's important to pay attention to what you eat while taking this medication. until recently, doctors advised taking warfarin to avoid foods high in vitamin k. this is because large amounts of vitamin k can counteract the benefits of warfarin. however, recent research shows that rather than eliminating vitamin k from your diet, it is more important to be consistent in your dietary vitamin k intake. these foods contain vitamin k: fruits and vegetables, such as: kiwi, blueberries, broccoli, cabbage, sprouts, green onions, asparagus, cauliflower, peas, lettuce, spinach, turnip, collard, and mustard greens, parsley, kale, endive. meats, such as: beef liver, pork liver. other: mayonnaise, margarine, canola oil, soybean oil, vitamins, soybeans and cashews. limit alcohol. alcohol can affect your coumadin??????/warfarin dosage but it does not mean you must avoid all alcohol. serious problems can occur with alcohol and coumadin??????/warfarin when you drink more than 2 drinks a day or when you change your usual pattern. binge drinking is not good for you. be careful on special occasions or holidays, and drink only what you usually would on any regular day of the week. monitoring: the doctor decides how much coumadin??????/warfarin you need by testing your blood. the test measures how fast your blood is clotting and lets the doctor know if your dosage should change. if your blood test is too high, you might be at risk for bleeding problems. if it is too low, you might be at risk for forming clots. your doctor has decided on a range on the blood test that is right for you. the blood test used for monitoring is called an inr. use of other medications: when coumadin??????/warfarin is taken with other medicines it can change the way other medicines work. other medicines can also change the way coumadin??????/warfarin works. it is very important to talk with your doctor about all of the other medicines that you are taking, including over-the-counter medicines, antibiotics, vitamins, or herbal products. followup instructions: please call ( to schedule a follow-up appointment with dr. (surgery) in 2 weeks. . provider: , md phone: date/time: 1:10 provider: , m.d. (pcp) date/time: 11:50 provider: , md phone: date/time: 10:15 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other partial resection of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances exploratory laparotomy arterial catheterization closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus small-to-small intestinal anastomosis intra-abdominal manipulation of small intestine injection or infusion of oxazolidinone class of antibiotics diagnoses: acidosis abnormal coagulation profile coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute kidney failure, unspecified severe sepsis unspecified acquired hypothyroidism unspecified viral hepatitis c without hepatic coma hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified aortic valve disorders diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes personal history of tobacco use chronic kidney disease, unspecified paroxysmal ventricular tachycardia ulcer of other part of foot other and unspecified hyperlipidemia heart valve replaced by other means acute respiratory failure cardiogenic shock long-term (current) use of insulin blood in stool old myocardial infarction automatic implantable cardiac defibrillator in situ anticoagulants causing adverse effects in therapeutic use hyperosmolality and/or hypernatremia acute vascular insufficiency of intestine acute on chronic systolic heart failure atherosclerosis of native arteries of the extremities, unspecified precipitous drop in hematocrit below knee amputation status volvulus methicillin resistant staphylococcus aureus septicemia unspecified peritonitis methicillin resistant pneumonia due to staphylococcus aureus atherosclerosis of other specified arteries opioid abuse, in remission 

Answer: The patient is high likely exposed to