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: nafcillin attending: chief complaint: hematochezia major surgical or invasive procedure: capsule endoscopy history of present illness: mr is a 76 year old man with extensive pmhx including cad s/p cabg with stents, htn, hld, st. mechanical av (on anticoagulation), prostate ca and recent high grade mssa bacteremia now on cefazolin, presenting from rehab facility () with melenotic stools for the past four days. . patient reports he was doing well with rehabilitation, able to ambulate with the use of a cane and without any shortness of breath of chest pain. about 4 days prior to , he reports he started to notice very dark, tarry stools whenever he moved his bowels. he also noted these became more frequent and that he has getting increasingly more fatigued with minimal activity. patient reports he has had similar episodes in the past, however never associated with shortness of breath or fatigue. . in the ed, vital signs were initially: 98.2 72 130/44 18 100. blood pressures were checked at thigh due to concerns about pacemaker and picc line. patient received 2 units of ffp, pantoprazole iv and 2l ns. gi was consulted and patient was admitted to micu for further monitoring. at time of transfer, hr 81 138/59 21 98% 3l . micu course: was hd stable, never on pressors. got total of 7 units of prbcs. got 5 units of ffp to attempt endoscopy but never performed due to logistical issues and relative clinical stability. last bm 2 days ago. melenic. last transfusion yesterday, hct bumped appropriately 24-->28. most recent vs: 97.0 148/59 75 (vpaced) 24 100% 2l. access: picc and 1 18g piv. ep aware of him, no need to see here, f/u as outpatient. remains on cefazolin. inr 5.9 today. chronic neck pain from post-herpetic neuralgia. getting morphine prn. dnr/i. . review of systems: no fevers, chills, weight loss, diaphoresis, headache, visual changes, sore throat, chest pain, shortness of breath, nausea, vomiting, abdominal pain, constipation, pruritis, easy bruising, dysuria, skin changes, pruritis. past medical history: # cad s/p cabg (lima-lad, svg-om, svg-d, svg-rca) ; stented 3des to svg-om graft) # diastolic heart failure with hypertension and hyperlipidemia # recurrent gib - / colonoscopy:erosive gastritis, while colonoscopy showed diverticulosis, ectasias in rectum, mild radiation proctitis, and grade one hemorrhoids. 2nd episode: showed gastritis and ulcers with unremarkable biopsy. 3rd episode: show gastritis. patient suppose to get capsule study but never followed up. # st. mechanical avr in # endocarditis -- c/b complete heart block -- s/p ppm implantation # atrial fibrillation s/p cardioversion # prostate ca s/p lupron tx # gout # 4.4 cm aaa, last imaged # prior etoh abuse (a case of beer a day). he stopped drinking heavily about gib after drinking an excess amount of alcohol, endoscopy revealing several stomach ulcers, requiring 6 units prbc. # cataracts, s/p surgery bilaterally # borderline glaucoma # hematuria approximately 6-7 months ago (currently consulting with a urologist and oncologist). patient reports having a cystoscopy that was unremarkable.) # hx of cellulitis of right leg # hx of mild hepatitis # recent shingles social history: now at rehab from endocarditis , regularly lives at home with his wife and daughter, does not smoke or drink, quit smoking ~20 years ago, has about 20 years of 4ppd history. family history: father died of cad at age 65. physical exam: vs: 97.0, 166/95, 78, 16, 92 ra gen: no acute distress skin: pale, no rashes or skin changes noted heent: jvp 7 cm, distended neck veins, neck supple, no lad chest: lungs with soft bibasilar crackles cardiac: irregularly irregular, loud crisp sounding s2 over rusb, holosystolic murmur at left sternal border abdomen: non-distended, and soft without tenderness extremities: no edema, warm without cyanosis neurologic: alert and appropriate. cn ii-xii grossly intact. bue , and ble both proximally and distally. no pronator drift. reflexes were symmetric. downward going toes. pertinent results: labs on : 03:00pm blood wbc-8.7 rbc-1.92*# hgb-5.4*# hct-16.9*# mcv-88 mch-28.3 mchc-32.2 rdw-16.6* plt ct-341# 03:00pm blood neuts-87.9* bands-0 lymphs-8.5* monos-2.3 eos-0.9 baso-0.4 03:00pm blood pt-103.8* ptt-36.4* inr(pt)-13.0* 08:00am blood fibrino-399 03:00pm blood glucose-123* urean-74* creat-1.3* na-142 k-4.0 cl-107 hco3-21* angap-18 03:00pm blood ck(cpk)-14* 03:33am blood ck(cpk)-20* 03:00pm blood ck-mb-notdone 03:33am blood calcium-7.7* phos-3.6 mg-2.0 04:15am blood lactate-1.3 10:36am blood freeca-0.98* . labs on discharge: 06:14am blood wbc-8.2 rbc-3.16* hgb-8.7* hct-27.2* mcv-86 mch-27.7 mchc-32.1 rdw-15.3 plt ct-269 02:35pm blood neuts-86.3* lymphs-7.3* monos-2.8 eos-3.2 baso-0.4 06:14am blood plt ct-269 06:14am blood glucose-87 urean-12 creat-1.0 na-142 k-3.4 cl-107 hco3-28 angap-10 06:14am blood calcium-8.0* phos-3.0 mg-2.1 . tagged rbc scan: impression: no gi bleeding identified, though study is limited for evaluation of the stomach and small by the presence of free pertechnetate. . capsule study: pending at time of discharge brief hospital course: mr. is a 76 year old man with multiple medical problems, including external pacemaker, prosthetic aortic valve (on coumadin), and recent mssa bacteremia, presenting with supratherapeutic inr and gi bleeding. . # gi bleed: patient with prior episodes of erosive gastritis and gi bleed, also with known diverticulosis, aaa and history of paroxysmal atrial fibrillation. ddx would therefore also include aorto-enteric fistula, mesenteric ischemia, ischemic colitis, etc. concerning in setting of elevated inr as well. patient received 7 units of prbc and 7 units ffp in total during . a tagged red cell scan was done and no site of bleeding was found. gi recommended /capsule study. patient declined , but was amenable to capsule study, which he completed prior to discharge. these results will be reviewed with patient on gi follow-up appointment. hct had been stable for >5 days prior to discharge, and ranged from hct 26-28. discharge hct 27. patient informed to seek medical attention immediately for any signs/symptoms of bleeding from rectum. . # valvular heart disease/prosthetic valve endocarditis: patient with mechanical valve in aortic position, also with moderate mr/tr. patient has had prior prolonged hospitalization with prosthetic valve endocarditis, on treatment with iv cefazolin. his antibiotics were discussed with infectious disease physicians, and it was determined that patient had completed a sufficient iv antibiotic course; he was discharged on suppressive doxycycline 100 mg until f/u with clinic. . # supratherapeutic inr: unclear etiology of significantly elevated inr, although patient has been on iv antibiotics for a prolonged course and has likely erradicated intestinal vitamin k metabolizers. no other clear drug interactions noted. warfarin was held on for inr 13, and patient was given ffp as noted above. goal inr 2.5 to 3.5 given mechanical valve at aortic position with atrial fibrillation. inr on discharge was 3.8 prior to discharge. on date of discharge, coumadin was held. patient was discharged on new regimen of 3 mg coumadin daily, and this will be adjusted by primary care physician. inr check will be with results faxed to pcp. . # external pacemaker: patient with external pacemaker, placed in setting of complete heart block from prior endocarditis. patient met with cardiology physicians to discuss potential internalization of external pacer. however, given acute gi bleed and concerns for active abx regimen for prosthetic valve endocarditis, this was deferred until separate . patient was informed to discuss this separate for internalization with his primary care doctor, and he was provided the number for cardiology whereby he can arrange an appropriate time and date for this procedure. patient informed to keep this area dry, as he has been. . # diastolic heart failure: appeared slightly hypervolemic after gi bleeding issue resolved. he was placed on his home regimen of lasix and will continue this on discharge. of note, patient was started on acei on discharge, given normal renal function and for improved bp control. . # neck pain: chronic pain secondary to shingles. he continued his home regimen of oxycodone. . # dispo: discharge to home, now off iv antibiotics and on po doxycycline. has follow-up arranged with id, gi, and pcp. medications on : cefazolin 2gm q8h (last dose at 14:00) atorvastatin 40mg amlodipine 5mg daily aspirin 81mg daily famotidine 20mg daily metoprolol 50mg oxycodone 5mg prn warfarin 5mg daily furosemide 60mg daily bisacodyl docusate senna ascorbic acid eucerin cream ferrous sulfate 325mg multivitamin discharge medications: 1. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. famotidine 20 mg tablet sig: one (1) tablet po once a day. 5. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 6. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 7. coumadin 1 mg tablet sig: three (3) tablet po once a day. disp:*90 tablet(s)* refills:*2* 8. furosemide 40 mg tablet sig: 1.5 tablets po daily (daily). 9. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 12. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 13. multivitamin tablet sig: one (1) tablet po daily (daily). 14. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 15. outpatient work please have pt/inr blood-work drawn on and have results faxed to dr. at 16. doxycycline hyclate 100 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: 1. lower gastrointestinal bleeding . secondary: 1. hypertension 2. st. mechanical aortic valve, on coumadin 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: you were admitted to the hospital with bleeding, felt to be from a lower gastrointestinal bleeding source. your inr level was also very high. you received 7 units of red blood cell transfusion and 7 units of fresh frozen plasma in total. you initially had a gi bleeding study which did not show a brisk bleed. you met with the gi doctors who recommended and capsule study. you declined the former but accepted the capsule study. the capsule will be passed in the stool in the next several days. transmitted results will be reviewed by the gi doctors with you at gi follow-up. on discharge, your blood counts and hematocrit were stable. you will be on a lower dose of coumadin on discharge, and this will be titrated by your primary care doctor. . in addition, you met with the infectious disease doctors to discuss your antibiotic regimen on discharge. it was determined that you may discontinue your iv antibiotics. you will continue an oral antibiotic called doxycycline until your next infectious disease appointment. . you also met with the cardiology doctors during your . they did not recommend internalization of your pacemaker on this . please discuss this with your primary care doctor, and he can likely arrange an appropriate time and date for this procedure. please keep this area dry, as you have been. . medication changes/new medications: - decrease coumadin to 3 mg daily. please have results to dr. for management of coumadin dosing. - start lisinopril 5 mg daily for blood pressure control - stop iv cefazolin - start doxycycline 100 mg twice a day. this will continue until your next infectious disease appointment. . please seek medical attention for chest pain, shortness of breath, difficulty breathing, palpitations, abdominal pain, fevers, bleeding from the rectum, or any other concerns. please weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: an appointment has been made with your primary care doctor, dr. , on at 1:45 pm. his office will be contacting you directly if this appointment can be moved up. please call if you do not hear from his office. . an appointment with dr. (gi) has been scheduled for at 11:40 am. please call for any questions. . please call clinic at to schedule an appointment with the id doctors weeks time. please contact them earlier if any additional questions arise. . provider: . phone: date/time: 9:00 . please have your inr drawn on thursday, , and fax results to dr. office at . procedure: transfusion of packed cells diagnoses: other chronic pain abnormal coagulation profile congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia gout, unspecified atrial fibrillation personal history of malignant neoplasm of prostate coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status unspecified glaucoma percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia heart valve replaced by other means bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site abdominal aneurysm without mention of rupture hemorrhage of gastrointestinal tract, unspecified chronic diastolic heart failure long-term (current) use of aspirin 

Answer: The patient is high likely exposed to