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: strawberry attending: chief complaint: hematochezia major surgical or invasive procedure: egd (multiple) colonoscopy blood transfusion tagged red blood cell scan history of present illness: 86 yo f with hx of hypertension, gastric ca s/p bilroth ii in 06, now transfered from osh due to gi bleed. pt was admitted about a week ago to hospital due to brbpr. she underwent 4 egds with clippping of the gastroduodenal artery x 1. on her last egd she had a non-bleeding vessel in a ulcer at an anastomosis site. she had a ct scan that did not show metastatic disease. she was discharged home yesterday then reportedly had some rectal bleeding yesterday and today and returned to . she had a hct today at the osh of 33 and was given 1 liter ns. she was then transfered to . . in the ed, initial vs were: 98.4 86 144/69 16 98. pt was not able to quantify the bleeding or describe it. on exam the pt has melena in the vault. later she had a bm (1 tsp of mahogony stool). gi was consulted. piv 18g x 2 were placed. before the pt was transfered to the floor she had rigors and a temp of 102. then pt had brownish red emesis that was positive for blood, ~150ml. ngt was placed and pt was lavaged with 1000ml. at first the output was frothy and brown, later became green. blood cx were drawn. pt was given pantoprazole 40 mg, acetaminophen 650mg pr, lidocaine jelly 2% 5ml, ondansetron 2mg/ml-2ml, metronidazole (flagyl) 500mg. also given 2 liters ns. kub showed no free air. gi requested micu admission for scope. vs on transfer were hr 86 115/68 18 98%ra with ngt and repeat hct was 35. . on the floor, pt is a poor historian, but is feeling well. she c/o a gagging sensation from her ngt. no pain, sob, or other complaints. past medical history: -gastric ca hx with bilroth ii in 06 -recent gi bleed -htn -dementia (pt reports problems with memory since her 70s) -umbilical hernia repair social history: pt lives with 3 of her sons in . she has 11 children and is a widow. she enjoys singing love songs to her husbands portrait. she does not use any walking assistance devices and denies falls. able to walk and do adl's such as laundry/cleaning. son is hcp. multiple children very involved in her care. - tobacco: none - alcohol: none - illicits: none daughter plans to take her to appointments. family history: unable to elicit, secondary to dementia. physical exam: vitals: t: 100.6 bp: 141/52 p: 84 r: 17 o2: 95%ra general: alert, oriented to hospital, city and time, no acute distress heent: sclera anicteric, dry mm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley present with cloudy urine ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neruo: unable to state the months of the year backwards and dificulty spelling writing ******* notable components of exam on discharge: abdomen soft non-tender non-distended ambulating without difficulty conversational pertinent results: admission chemistry: 141 108 19 106 agap=13 3.7 24 1.3 . admission lft's: alt: 16 ap: 59 tbili: 0.5 ast: 20 lip: 37 . admission cbc: 91 8.5 > 9.9 < 185 29.4 n:73.2 l:22.6 m:2.3 e:1.4 bas:0.5 . admission coags: pt: 12.5 ptt: 26.3 inr: 1.1 . urine culture : urine culture (final ): beta streptococcus group b. >100,000 organisms/ml.. escherichia coli. 10,000-100,000 organisms/ml.. 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 piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s . 2/5 blood cultures - no growth final. . : tagged rbc scan: 1. no definite evidence of active gi bleed at this time. in case of continued clinical concern a repeat study in about 48 hours can be obtained. 2. intense uptake in the left upper quadrant is likely due to stomach uptake of free pertechnetate. visualization of the thyroid gland compatible with free pertechnetate contaminating the tracer. 3. left thyroid nodule. thyroid ultrasound is suggested for further evaluation. . egd: large amount of clot found in the stomach and at the anastomotic site of the efferent limb. the overlying clot was washed away with water flushes. there was an area of mucosa noted in this area with an ulceration with an area of adherent clot. this clot was not able to be washed away with flushes. question the possibility of an underlying bleeding vessel. a clip was noted from a prior upper endoscopy. four additional clips were placed with success. no active bleeding was noted. blood in the stomach otherwise normal egd to stomach recommendations: follow hematocrit closely. continue ppi . . colonoscopy; blood in the colon otherwise normal colonoscopy to transverse colon recommendations: continue to monitor hct. if continues to bleed, will need to consider repeat colonoscopy vs. bleeding scan. . egd: previous partial gastrectomy and gastrojejunal anastomosis ulcer on the jejunal wall 1 cm beyond the gastrojejunal anastomosis, with clips attached, no active bleeding otherwise normal egd to 20 cm beyond the gastrojejunal anastomosis recommendations: continue inhospital monitoring . egd: prior cratered ulcer was seen at the anastomotic site. three visible vessels were seen within the cratered ulcer. one clip was placed on the larger visible vessel (near the junction of the afferent and efferent limb). once the clip was placed, this area began to ooze. an additional clip was placed and then bicap thermal therapy was applied with successful hemostasis. one superficial ulceration without evidence of bleeding noted on stomach wall. previous of the stomach otherwise normal egd to gastrojejunal anastomosis. recommendations: follow hct. ppi . carafate slurry. npo. . h.pylori serology: helicobacter pylori antibody test (final ): positive by eia. (reference range-negative). . discharge labs: wbc 6.2 hb 11.3 hct 34.1 plt 194 cr 0.9 brief hospital course: 86 y/o f with hx of gastric cancer s/p surgical resection (bilroth ii) in p/w recent recurrent upper gi bleed now transfered from osh for recurrent bleeding, admitted to icu after having hematemesis and a fever, then transferred to the floor. . # upper gi bleed: pt has a hx of a gastric cancer s/p resection and now has had recurrent bleeds over last week at her anastomsis site and is s/p a clipping of a gastroduodenal branch. she was initially admitted to the micu where she received one unit prbc, however as ng lavage was negative and she remained hemodynamically stable she was quickly transferred to the general medical floor. gi, surgery and ir were consulted. followed the patient while in-house and given negative repeat nasogastric lavage, patient was transferred to the floor. prior to egd/colonoscopy, patient was continued on sucralfate, protonix iv with every 6-8 hour hematocrits. patient had egd/colonoscopy on . on patient felt lightheaded and saw double vision, in the setting of hemodynamic stability, and hct had dropped points. 2 units blood transfused, and hct bumped appropriately. the next morning, repeat egd performed that showed evidence of old bleed, but no active bleed. that same day, tagged rbc scan performed to attempt to localize source of bleeding, but did not show any definite gi bleed. patient next had a repeat egd on in which further clipping was done (see results section). after that final procedure, patient's hct was serially checked and remained stable. her diet was advanced and well tolerated. ppi changed to po. sucralfate continued. patient was ambulating and was notably pain-free throughout her entire time on the hospital floor. serology was positive for h.pylori and the patient was started on quadruple therapy for 2 week course. believe the anastamosis site s/p gastric cancer resection was vulnerable to ulceration/bleed, and in the setting of h.pylori infection resulted in further ulceration and hence the bleed. follow up with gi was arranged prior to discharge. . # fever: ua was positive therefore she was treated with ciprofloxacin. urine culture did then grow two species infection. treated for e.coli and beta strep in her urine (asymptomatic), with an antibiotic course. afebrile afterwards, without leukocytosis, without dysuria. . # renal failure: creatinine on admission to osh was 1.6 --> 1.3 on admission to but responded to 4 liters total of normal saline and one unit prbc to 1.2. continued hydration, in setting of npo and bleed, again brought cr down lower. on discharge, cr was stable and patient was without dysuria and was hydrating on her own through po. . # htn: blood pressures were mildly elevated in the setting of holding her home amlodipine and lisinopril given the recent gi bleed. these were continued to be held in the setting of bleed. beta-blocker started to help reduce patient's pre-op risk, in case had to urgently go to surgery. once gi bleed issue resolved and hct's were stable, stopped beta-blocker and restarted patient's home anti-hypertensive regimen. . # memory impariment / presumed dementia: patient is a very poor historian and has little short term memmory. unclear if she officially has a dx of dementia, but appears to on exam. patient was monitored closely for delirium, re-oriented frequently and tubes/drains were minimized when possible. without issues during this hospitalization. requires outpatient follow up. . # communication: son is hcp; he was updated throughout the hospital course. . # code: full, confirmed. medications on admission: (per d/c summary) -omeprazole 20mg -amlodipine 5mg po qday -lisinopril 10mg po qday -mv -fish oil . allergies: strawberries cause hives discharge medications: 1. senna 8.6 mg capsule sig: one (1) capsule po once a day as needed for constipation. disp:*30 capsule(s)* refills:*1* 2. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*1* 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 4. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 5. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 6. bismuth subsalicylate 262 mg tablet, chewable sig: two (2) tablet po qid (4 times a day) for 2 weeks. disp:*112 tablet(s)* refills:*0* 7. metronidazole 250 mg tablet sig: one (1) tablet po qid (4 times a day) for 2 weeks. disp:*56 tablet(s)* refills:*0* 8. tetracycline 250 mg capsule sig: two (2) capsule po q6h (every 6 hours) for 2 weeks. disp:*112 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: gi bleed. hypertension. urinary tract infection. dementia. helicobacter pylori infection. discharge condition: mental status:confused - sometimes level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: you were admitted to the hosptial with blood in your stool. your blood levels were monitored and you were rehydrated. you continued to have blood in your stool, the gastrointestinal team and the surgical team were consulted regarding your care. with multiple imaging studies by the gastrointestinal team to looks at your esophagus, stomach, and intestines, they saw evidence of bleeding at the stomach, near the site of your prior surgery where there was bleeding & an ulcer. you were transfused blood and iv fluids, and you had clips placed at the bleeding site. after the clips were appropriately placed, your blood counts were closely monitored and they remained stable for multiple days. we believe the bleeding had to do with a bacteria in your stomach as well as it being a complication at your prior surgical site where there was a bleeding ulcer. your diet was advanced to regular and you were tolerating that well; you were also feeling well and walking well. you had stopped bleeding, and on discharge your blood levels were stable. . you had a fever that resolved. you were found to have a urinary tract infection, and were treated with a course of antibiotics. . you spent a night in the icu and then were on the regular hospital floor. . changes to your medications include: - start metonidazole four times a day for 2 weeks - start bismuth four times a day for 2 weeks - start tetracycline four times a day for 2 weeks - start pantoprazole twice a day - start sucralfate four times a day - start senna daily, as needed for constipation - continue your other home medications . please see your primary care physician this and have her check your blood level to make sure that it is stable. on discharge from the hospital today (), your hematocrit level was 34.1). . please call your doctor or return to the hospial if you develop vomiting with blood, bloody stool, lightheadedness, shortness of breath, chest pain, or other symptoms that concern you or your family. followup instructions: please see your primary care physician: : specialty: internal medicine/ pcp / time: friday, :40pm location: , ma phone number: please have your blood count checked at this appointment to make sure that it is stable. . please see the following specialist for your stomach bleed: dr. , md - , . phone: date/time: at 4:00pm procedure: other endoscopy of small intestine colonoscopy endoscopic control of gastric or duodenal bleeding endoscopic control of gastric or duodenal bleeding diagnoses: urinary tract infection, site not specified unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified other persistent mental disorders due to conditions classified elsewhere dehydration helicobacter pylori [h. pylori] personal history of malignant neoplasm of stomach chronic or unspecified gastrojejunal ulcer with hemorrhage, without mention of obstruction 

Answer: The patient is high likely exposed to