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: melena and anemia major surgical or invasive procedure: -egd, endoclips x4 of bleeding vessel in duodenal bulb : transesophageal echocardiogram picc placement and removal history of present illness: 84 year old gentleman with recent hx stroke in , hx afib now off coumadin who presents with melena and hct drop. he has been at since his stroke. per their records he has had guiac positive stools for the past week, with hct drop on from 26->21 that responded to 2 units prbc with inc hct to 27. there was no overt bleeding at the time. at 2am on the day off admission to , he had sudden onset dark tarry diarrhea. he was hemodynamically stable with bp 120/56 and hr 75. he received one unit prbc's at prior to transfer; he received lasix 40mg after the unit. the patient does not know what his bowel movements have been like, but denies abd pain, n/v, no hematemasis, no cp, no sob, no confusion. review of systems is notable for slight residual weakness on the right side, but improvement expressive aphasia. he does still have dysarthria. review of systems is otherwise negative as noted in hpi. of note, he has failed speech and swallow in early , has doboff from . he is also being treated for aspiration pna at with levofloxacin and flagyl to end . in the emergency department, he has had one episode of melena. hct 20. he received one unit prbc's, on unit ffp, vit k 5mg iv and protonix 40mg iv. he refused ng lavage. he was hd stable. he was seen by gi who planned for egd. 2 18 guage iv placed. ekg with dig effect, trop neg x1. vital signs 83 124//44 16 98% ra current vitals 84 133/56 21 97% ra past medical history: - htn - chronic afib - bilateral hearing loss (uses bilateral hearing aids) - chronic bilateral inguinal hernias - anemia (previously refused work-up, , but guaiac neg) - polyclonal gammopathy () - adenocarcinoma of rul, s/p lobectomy () social history: - lives alone in an apartment. - widowed, son lives in - has several grandchildren - does not use a walker or cane. manages his adls, including cooking his own meals. - retired power plant worker. habits: - does not drink alcohol - does not use recreational drugs. - he is a former smoker, gave up over 15 years ago. - walks every day family history: - father died of an mi in his late 60s. - mother had a stroke in her 70s. - fh of colon ca (father) physical exam: general: pleasant, well appearing elderly in nad heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. mmm. op clear. neck supple, no lad cardiac: irregular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . jvp= 8cm lungs: no labored breathing, good air movement, diffusely ronchrous particularly on the left side abdomen: nabs. soft, nt, nd. no hsm extremities: no edema or calf pain, 2+ dorsalis pedis/ posterior tibial pulses. . neuro: a&ox3. appropriate. cn 2-12 grossly intact. speech with mild dysarthria preserved sensation throughout. 5/5 strength throughout with subtle weakness on right arm. + reflexes, equal bl. gait assessment deferred psych: listens and responds to questions appropriately, pleasant pertinent results: 02:48pm glucose-139* urea n-64* creat-1.0 sodium-139 potassium-4.6 chloride-104 total co2-27 anion gap-13 02:48pm ck(cpk)-55 04:05am ctropnt-<0.01 . 04:05am wbc-9.5 rbc-2.22* hgb-6.9* hct-20.7* mcv-93 mch-31.1 mchc-33.4 rdw-16.1* . admission cxr: single frontal ap chest radiograph: the mildly enlarged cardiomediastinal silhouette is stable in appearance. the pulmonary vasculature is within normal limits. there is persistent opacification of the left retrocardiac space. no new focal airspace consolidation is noted. there is bilateral apical pleural thickening, right worse than left. the right costophrenic angle is clear. there is an enteric tube traversing the expected course of the esophagus with the tip ending in the stomach. impression: persistent opacity in the left retrocardiac space. cannot exclude a superimposed pneumonia. if clinical concern remains high, recommend repeating with pa and lateral chest radiograph for better assessment. . egd: findings: esophagus: normal esophagus. stomach: other blood clot noted in the stomach body, active bleeding from pylorus, dobhoff tube pulled out. duodenum: excavated lesions a single spurting 5 mm visible vessel with shallow ulcer was found in the apex of duodenal bulb. 5 cc.epinephrine 1/ hemostasis with success. four endoclips were successfully applied for the purpose of hemostasis. impression: ulcer in the apex of duodenal bulb (injection, endoclip) blood clot noted in the stomach body, active bleeding from pylorus, dobhoff tube pulled out. otherwise normal egd to third part of the duodenum recommendations: continue iv ppi follow hct closely and tranfusion as needed please proceed with angio if active bleeding . echo : the left atrium is elongated. no left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). the right atrium is markedly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no systolic prolapse. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. impression: biatrial elongation. mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. . ekg: irreg in afib hr 80, downward sloping st segent in v2-v5 wnd ii, scopped st segment in v6, no st elevations, rrbb patterin in v2 . renal ultrasound: conclusion: 1. the kidneys are of good size, with no hydronephrosis, and good corticomedullary differentiation. 2. incidental note is made of a non-obstructing 2-mm calculus in the lower pole of the left kidney. . video swallow: impression: 1. aspiration with thin liquid consistency. 2. penetration with nectar-thick consistency which resolve with chin tuck maneuver. . tee : the left atrium is dilated. no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. the left atrial appendage emptying velocity is depressed (<0.2m/s). the right atrium is dilated. no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal (lvef>55%). there are simple atheroma in the ascending aorta. there are simple atheroma in the aortic arch. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened. no masses or vegetations are seen on the aortic valve. there are filamentous strands on the aortic leaflets consistent with lambl's excresences (normal variant). trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. mild to moderate (+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. no vegetation/mass is seen on the pulmonic valve. there is a trivial/physiologic pericardial effusion. impression: no vegetation identified. mild-to-moderate mitral regurgitation. minimal aortic stenosis with trace aortic regurgitation. moderate tricuspid regurgitation. brief hospital course: mr. is an 84 year old gentleman with a history of recent hemorrhagic basal ganglia stroke in and atrial fibrillation (on aspirin), who presented to the icu with melena and significant drop in hematocrit. . * acute blood loss anemia/gi bleed: on presentation, the patient had several episodes of melena, suggesting an upper gib. he remained hemodynamically stable. the patient was started on ppi drip. aspirin, doxazosyn, metoprolol and bowel regimen were held. the patient received a total of 4 units of prbc and underwent egd. a bleeding vessel was identified in the duodenal bulb, epinephrine was injected and 4 endoclips were placed. dobhoff tube was discontinued due to gi bleed. picc was placed for access and the patient was started on tpn feeds. post-procedure, hct was monitored closely q6hrs. the patient continued to have several melenic stools in the icu, but no fresh blood per rectum. over the next several days, the patient required several additional units of blood for slow decreases in hct, however hct eventually stabilized and the patient required no further transfusions. . he was transferred to the floor on where his hct has been generally stable but a slight drift downward. his bm on the floor became guaiac negative. he was restarted on asa 81mg on and tolerated it well in addition to his twice daily ppi which should be maintained. . *candidemia: after his picc had placed and tpn initiated, the patient spiked fever. his blood cultures subsequently grew yeast. he was started empirically on micafungin as well as vancomycin and cefepime (the antibacterials were soon discontinued). his yeast returned as which was senstive to fluconazole. his tte and tee were negative for vegetations and his surveillance cultures were negative. dilated eye exam was also unremarkable. he required antifungal therapy for 2 weeks (completed ). he will need a repeat dilated eye exam during the week of to ensure no persistent infection. . * recent basal ganglia stroke: was previously hospitalized due to hemorrhagic cva> his warfarin was discontinued at that time and should not be restarted. though he was discharged on asa, this was held in the setting of his bleed, cautiously restarted on . on , the pt was noted to have worsening r sided weakness and the neuro team was called for further evaluation. his repeat head ct revealed no new process, but that his basal ganglia lesion had evolved. his neuro exam was unchanged, but follow up recommendations were to obtain an mri. unfortunately, the pt could not tolerate the mri and he refused repeated attempts with ativan for claustrophobia. with treatment of his candidemia, his neuro exam improved and was felt to be exacerbated deficits from acute infection. . * acute renal failure/atn: on , his creatinine rose to 1.5, increased to the mid 2 range. renal was consulted and felt that his picture was consistent with atn in the setting of his candidemia, despite not having had a hypotensive episode. his urine eosinophils were negative his renal ultrasound was negative for hydronephrosis. with supportive care his creatinine stabilized and decreased to 2. lasix was initiated to aid in removal of edema. his oral lasix was increased to 40mg , and given lasix 20mg iv with good output of liters/day. he will be discharged on lasix 40mg . for the first week he should be run negative 1 liter per day, and even fluid balance thereafter. please check chem 7 2 days post d/c and weekly thereafter until renal function recovers. please have strict i/os and daily weights to aid in diuresis. should follow up with nephrology after discharge. . *afib: the patient was monitored on telemetry. in the icu he had some asymptomatic sinus bradycardia, metoprolol and digoxin were held. dig level checked, was actually low. metoprolol was and his hr has tolerated this. it is possible he may not need digoxin at this time for rate control, his last echo also showed normal ef. his aspirin was restarted at 81mg daily. warfarin is contraindicated given his hemorrhagic cva. . * aspiration pna: he finished a course of levo/flagyl that was started at outside facility on . however, the following day, the patient was noted to have increased leukocytosis and secretions, some evidence of retrocardiac opacification, with increased concern for aspiration in the setting of recent egd, was started on vanc, cefepime and flagyl to cover for hospital acquired and aspiration pna. over the next several days, flagyl and cefepime were discontinued as the patient remained afebrle with no positive cultures and no clear evidence of pna. vanco was continued as mrsa grew from sputum. he completed a 7 day course of vanco. . * nutrition: at rehab the patient was receiving tube feeds via dubhoff tube due to recent failing a recent swallow evaluation early , given recent cva. he was reassessed this admission and showed some improvement in video swallow study. he was started on nectar thick liquids, ground solids, crushed pills, with 1:1 observation with chin tuck for all po's. . *hx copd: we continued outpatient nebs. at the time of discharge, the patient is able to ambulate without sob or difficulty. . # bph - resumed doxazosin which he tolerated well . says his pcp is . call placed to pcp and have updated her on his hospitalization as of . daughter-in-law () . . code: dnr/dni medications on admission: 1. acetaminophen 325 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed for fever. 2. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 3. multivitamin tablet : one (1) tablet po daily (daily). 4. ascorbic acid 500 mg tablet : one (1) tablet po daily (daily). 5. calcium carbonate 500 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 6. cholecalciferol (vitamin d3) 400 unit tablet : one (1) tablet po daily (daily). 7. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 8. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 9. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours) as needed for sob wheezing. 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) inhalation q6h (every 6 hours) as needed for sob/wheezing. 11. digoxin 250 mcg tablet : one (1) tablet po daily (daily). 12. metoprolol tartrate 25 mg tablet : 0.5 tablet po tid (3 times a day): hold for hr < 55. 13. captopril 12.5 mg tablet : one (1) tablet po tid (3 times a day). 14. doxazosin 4 mg tablet : one (1) tablet po hs (at bedtime). 15. hydralazine 10 mg iv q6h:prn sbp > 160 16. levofloxacin 500 mg tablet : one (1) tablet po q24h (every 24 hours) for 7 days: duration: 7 days day 1 = . 17. metronidazole 500 mg tablet : one (1) tablet po tid (3 times a day) for 7 days: 7 days day 1 = discharge medications: 1. doxazosin 4 mg tablet : one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*2* 2. metoprolol tartrate 25 mg tablet : one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 3. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 4. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constip. 5. acetaminophen 325 mg tablet : 1-2 tablets po q6h (every 6 hours) as needed for pain. 6. combivent 18-103 mcg/actuation aerosol : 1-2 puffs inhalation every six (6) hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*2* 7. multivitamin tablet : one (1) tablet po once a day. 8. docusate sodium 50 mg/5 ml liquid : one (1) dose po bid (2 times a day). 9. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). disp:*60 tablet,rapid dissolve, dr(s)* refills:*2* 10. furosemide 40 mg tablet : one (1) tablet po twice a day. 11. digoxin 125 mcg tablet : one (1) tablet po 3x/week (mo,we,fr). 12. menthol-cetylpyridinium 3 mg lozenge : one (1) lozenge mucous membrane prn (as needed) as needed for dry mouth. discharge disposition: extended care facility: nursing & rehab discharge diagnosis: acute blood loss anemia/gi bleed peptic ulcer disease acute renal failure/acute tubular necrosis albicans fungemia h/o hemorrhagic cva atrial fibrillation hypertension, benign discharge condition: activity status:ambulatory - requires assistance or aid (walker or cane) discharge instructions: you were admitted with a gi bleed due to an ulcer, as well as a fungal infection in your blood stream. your were given blood transfusions and acid blocking medication with resolution of your bleeding. your fungal infection (candidemia) was treated with 2 weeks of fluconazole, finished . your aspirin was restarted at the advice of your neurologist. finally, you have suffered acute kidney injury from your medical illness. . please resume your home medications as before and take as prescribed, including a baby aspirin, with the following changes: aspirin 81mg daily metoprolol 25mg twice daily digoxin 0.125mg 3x/week protonix 40mg twice daily lasix 40mg twice daily. please titrate as needed to provide a diuresis of 1 liter negative for the first 7 days. . you will need a dilated eye exam during the week of to ensure there is no fungal infection there. . please return to the hospital if you experience any of the symptoms mentioned below. followup instructions: please follow up with your pcp 2 weeks after discharge: pcp: , . . please follow up with an ophthalmologist for your dilated eye exam during the week of . please follow up with your gastroenterologist and neurologist as needed . patient will need to follow up with a nephrologist to monitor his kidney function. can call to schedule an appointment in this area: ( procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances diagnostic ultrasound of heart endoscopic control of gastric or duodenal bleeding diagnoses: hyperpotassemia acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia hyposmolality and/or hyponatremia atrial fibrillation personal history of malignant neoplasm of bronchus and lung personal history of tobacco use hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) pneumonitis due to inhalation of food or vomitus pressure ulcer, lower back chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction other candidiasis of other specified sites hematuria, unspecified pressure ulcer, stage ii methicillin resistant pneumonia due to staphylococcus aureus other late effects of cerebrovascular disease, dysphagia dysphagia, unspecified 

Answer: The patient is high likely exposed to