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: penicillins / nsaids / magnesium / meperidine / paroxetine / famotidine / indomethacin attending: chief complaint: bright red blood per rectum major surgical or invasive procedure: colonoscopy interventional radiology artery coiling central line place egd history of present illness: 79 y/o m with history of esrd on hd, rcc and prostate cancer who presented from nursing home via osh on day of admission with brbpr. for the 2 weeks prior to admission, he had loose bowel movements although without blood. at 4pm on day of admission he was noted by the nursing home to have large amount of brbpr with passage of clots. he was brought into were initial vitals were 106/67 with heart rate 96 although he reportedly had an episode of systolic blood pressures to the 80s. he reportedly had an episode of syncope. hematocrit was 21. he was transfused 2 units of prbc at the osh and transferred to for further management. of note, he has not had a colonoscopy in > 10 years. no recent nsaid or prednisone use. he does take plavix daily for what appears to be carotid disease. in the ed, initial vs were: 96.8 139/72 97 17 100%2l. he passed large red clots with some bright red blood and dark black stool. hematocrit here was 30.7. he was transfused an additional 1u prbc. access with 3piv (16,18,20 gauge). transferred to micu for further management. on floor, passed small amount of dark clot. past medical history: 1. esrd on hd (mwf) 2. dm 3. renal cell ca 4. prostate ca 5. hyperlipidemia 6. gout 7. htn 8. depression 9. cognitive dysfunction past surgical history: 1. s/p prostatectomy ' 2. s/p right nephrectomy ' 3. s/p r avf ' 4. s/p lih repair social history: patient has lived in nursing home (radius in ) for the past three months. prior to this wife assisted with most . currently with limited ambulation. he has an approximately year pack history of smoking, quit in . he denies etoh and illicit drug use. family history: there is no family history of colon cancer. physical exam: vitals: 97/5 146/79 92 15 100%ra general: sleeping, responds to loud voice, nad heent: sclera anicteric, mmm, 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-distended, non-tender gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 11:51pm type- comments-green top 11:51pm lactate-2.1* 11:40pm hct-31.6* 08:50pm urine color-yellow appear-cloudy sp -1.017 08:50pm urine blood-mod nitrite-neg protein-150 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-mod 08:50pm urine blood-mod nitrite-neg protein-150 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-mod 08:50pm urine rbc->50 wbc->50 bacteria-mod yeast-none epi-0 08:50pm urine granular-0-2 07:59pm lactate-3.2* k+-4.7 07:59pm hgb-10.7* calchct-32 07:45pm glucose-163* urea n-45* creat-5.5* sodium-143 potassium-4.8 chloride-101 total co2-30 anion gap-17 07:45pm estgfr-using this 07:45pm alt(sgpt)-27 ast(sgot)-17 ck(cpk)-23* alk phos-67 tot bili-0.9 07:45pm lipase-93* 07:45pm ck-mb-notdone ctropnt-0.19* 07:45pm albumin-3.1* 07:45pm wbc-19.5* rbc-3.37* hgb-10.1* hct-30.7* mcv-91 mch-30.0 mchc-33.0 rdw-16.9* 07:45pm neuts-88.1* lymphs-9.1* monos-1.7* eos-0.8 basos-0.3 07:45pm plt count-194 07:45pm pt-12.6 ptt-23.1 inr(pt)-1.1 cxr (portable) : indication: leukocytosis, questionable pneumonia. comparison: no comparison available at the time of dictation. findings: the lung volumes are low. no pleural effusions. borderline size of the cardiac silhouette without evidence of pulmonary edema. moderate tortuosity of the thoracic aorta. no focal parenchymal opacities suggesting pneumonia. brief hospital course: 79 yo male with esrd on hd, rcc and prostate cancer, h/o dementia who was transferred from for evaluation and treatment of a lower gi bleed. . #) gi bleed: mr. initially presented to with a brbpr, and was then transferred to for further management. he was initially managed in the micu for closer monitoring, where he required blood transfusions but remained hemodynamically stable, so he was transferred to the floor. on he was started on a bowel prep for egd and colonoscopy on , he was able to tolerate the prep well. the egd showed normal mucosa in the esophagus, antral gastritis, patchy duodenitis in the duodenal bulb, and an otherwise normal egd to third part of the duodenum. colonoscopy showed a 10 cm area of erythema, ulceration and diffuse oozing/friability from cecum to proximal ascending colon. the mucosa in the terminal ileum appeared normal. two areas of erythema and ulcerations were noted in the transverse colon with an intermediate normal mucosa. the proximal of those two areas was about 10 cm. a single sessile polyp of benign appearance of 1.5 cm was found in the transverse colon. he went back to the floor post procedure, but that night he redeveloped a gi bleed and was transferred back to the micu. at that point he was evaluated by ir and underwent angiogram with coil embolization of a foci of angiodysplasia near the cecum. after discussion with the micu team, the patient and his family decided that he would not wish to pursue further surgical treatment. in total over his course he received 9 units of prbc's. the bleeding slowed, and on he started to have brown bowel movements. his hematocrit remained stable, so he was transferred to the general medicine floor. while the floor he did not have any further brbpr, and remained hemodynamically stable. his protonix was transitioned to po dosing, and he did not require any further blood products while on the floor. . #) leukocytosis: white count on admission was elevated at 19.5, given his loose stools prior to admission there was concern for a gi source of bleeding. his stool was sent for multiple studies, due to concern for possible infection that could have led to a gi bleed. however, infection with shigella, e.coli 0157 considered although timecourse of over two weeks with sudden change to hemorrhage and absence of constiutional symptoms or abomdinal pain appreared less consistent with is current presentation. in the work up for his leukocytosis urine and blood cultures were sent, the urine grew strep viridans and he was found to have coagulase negative staph growing in his blood cultures. he was started on treatment with vancomycin and completed a 7 day course. all surveillance blood cultures drawn after that point were negative. he also had a ct scan that showed colitis, for which he completed a 7 day course of ciprofloxacin. over the course of his hospital stay his leukocytosis improved. . #) esrd on hd: patient on m/w/f schedule with access being r. fistula, last performed on 3 days prior to admission at fresenius (). he was follwed by the renal team and dialyzed according to his stability at their discretion during this admission. his regular renal medications were continued, but when his phosphorus became low at the time of discharge it was suggested that his calcium acetate be decreased to twice daily administration. . #) elevated troponin: given the risk factors of dm and htn, cardiac enzymes were trended. elevated troponin persisted at 0.17-0.19, with flat ck and ck-mb. these troponins were therefore felt most likely secondary to esrd rather than an ischemic event, especially in the setting of no ekg changes. . #) hypertension: antihypertensives were initially held in setting of gib. once his bleed had stablized he was first restarted on labetalol prior to discharge. we recommend that his nifedipine be restarted the day after discharge and that it be held the morning of dialysis since he has had some episodes of low blood pressure while at dialysis. . #) hyperlipidemia/cad: patient's statin was initially held while in the micu, and his aspirn and plavix were also held in the setting of his gi bleed. his statin was restarted after he left the micu, and his aspirin can be restarted on . his plavix was not restarted due to concern about the increased risk of bleeding on dual anti-platelet therapy, and we would recommend continuing to hold his plavix given the severity of his gi bleed, this issue can be readdressed by his primary care physician after discharge. . #) gout: patient's home dose of allopurinol was initially held but was restarted on hospital day 1 and then continued throughout his admission. he did not have any signs of a gout flare during his stay. . #) cognitive decline: patient was continued on his home dose of donepizil and risperdal, attempted to maintain his day/wake cycle as best as possible to help prevent concurrent delirium while in the hospital. medications on admission: - lutein 20mg daily - allopurinol 100mg daily - asa 81mg daily - plavix 75mg daily - ranitidine 150mg - phoslo 3 caps tid - labetolol 200mg daily - aricept 5mg daily - simvastatin 40mg daily - nifedipine 60mg - xanax 0.5mg prn - risperidone 1mg daily - calcium acetate 667mg tid w/ meals - claritin 10mg daily - allopurinol 100mg daily - bisacodyl prn - polyethylene glycol prn discharge medications: 1. risperidone 1 mg tablet sig: one (1) tablet po hs (at bedtime). 2. donepezil 5 mg tablet sig: one (1) tablet po hs (at bedtime). 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain, fever. 4. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 5. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). 6. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 8. labetalol 100 mg tablet sig: two (2) tablet po daily (daily). 9. aspirin 81 mg tablet sig: one (1) tablet po daily (daily). 10. nifedipine 60 mg tablet sustained release sig: one (1) tablet sustained release po twice a day. 11. lutein 20 mg capsule sig: one (1) capsule po once a day. 12. claritin 10 mg tablet sig: one (1) tablet po once a day. 13. bisacodyl 5 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day as needed for constipation. 14. miralax 17 gram/dose powder sig: one (1) capful po once a day as needed for cold symptoms. discharge disposition: extended care facility: nursing & rehabilitation center - discharge diagnosis: primary: 1. lower gastrointestinal bleed 2. coagulase negative staph bacteremia 3. end stage renal disease on hemodialysis secondary: atrial fibrillation hypertension dementia discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: mr. , it was a pleasure taking care of you at . you were transferred to from with bleeding from your gi tract. during your stay you needed to be cared for in the intensive care unit for closer monitoring. the gastroenterologists did a colonoscopy that showed a large ulcer in part of your small intestine, but they could not stop the bleeding. then you were taken to interventional radiology and had a coil put in the bleeding artery to help slow down the bleeding. you required a lot of blood transfusions, but the bleeding slowed down and you were able to be transferred out of the intensive care unit. also during your stay you were found to have a positive blood culture, which we think was due to a line infection, and you were found to have a urinary tract infection. both of these infections were treated with antibiotics that were given at dialysis. after your blood counts had been stable for a few days we were able to restart your blood pressure medications. . changes made to your medication regimen: 1. stopped plavix 75mg daily due to the increased risk of bleeding 2. stopped ranitidine 150mg 3. started protonix 40mg daily please continue to take all other medications as previously prescribed followup instructions: department: div. of gastroenterology when: wednesday at 2:00 pm with: , md building: ra (/ complex) campus: east best parking: main garage procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine hemodialysis colonoscopy arteriography of other intra-abdominal arteries other endovascular procedures on other vessels diagnoses: thrombocytopenia, unspecified anemia in chronic kidney disease end stage renal disease renal dialysis status urinary tract infection, site not specified acute posthemorrhagic anemia gout, unspecified atrial fibrillation personal history of malignant neoplasm of prostate hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site angiodysplasia of intestine with hemorrhage duodenitis, without mention of hemorrhage personal history of malignant neoplasm of kidney other specified gastritis, without mention of hemorrhage neoplasm of uncertain behavior of stomach, intestines, and rectum ulceration of intestine 

Answer: The patient is high likely exposed to