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: iodine; iodine containing / spironolactone attending: chief complaint: bright red per rectum major surgical or invasive procedure: none history of present illness: mr. is a 72 yo male with h/o crohn??????s (), cad, copd, chf, carcinoid tumor, diverticulosis who was recently admitted from for bloody diarrhea and found to have a crohn's flare; he was discharged to rehab on cipro, flagyl, and steroids. at rehab, he continued to have loose stools daily with some (per rehab, per pt he was only having bm/day); he also developed a stage 4 decubitus ulcer. on , he was found to be hypotensive to the 80s-90s and sent to the ed. in the ed, initial vs were: p 73, bp 114/44, rr 18, o2sat 96% ra. ct was concerning for colitis v diverticulitis, thought to be c/w crohn's with underlying diverticulosis on surgery and gi evaluation. he was given 2l ivf, vanc and zosyn and admitted. past medical history: 1. carcinoid tumor - s/p left lower lobe wedge resection per chart, being followed conservatively (pt denies surgery) 2. asthma/chronic bronchitis - spirometry from mixed obstructive and restrictive ventilatory defect, on intermitent home oxygen 3. coronary artery disease s/p cabg in cad, no cp since 4. chronic diastolic congestive heart failure 5. benign hypertension 6. obstructive sleep apnea not using cpap, using 2 l oxygen at night 7. glaucoma, both eyes 8. gout 9. lower gi bleed , no reoccurence 10. diverticulosis social history: home: lives in with his girlfriend's son. occupation: retired accountant. etoh: former history of heavy etoh. drugs: denies tobacco: denies family history: father - died at age of heart disease mother - died at 77 from an unknown pulmonary illness. physical exam: (admission labs) general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular, tachycardic, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, minimally epigastric tenderness without guarding or rebound, bowel sounds present, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema skin: ulcer below scrotum extending to anus neuro: aao x 3, nonfocal. pertinent results: admission labs 10:05am wbc-7.9 rbc-3.88* hgb-11.4* hct-36.3* mcv-94 mch-29.4 mchc-31.4 rdw-15.6* plt ct-367 10:05am neuts-83.7* lymphs-12.0* monos-3.5 eos-0.4 baso-0.3 10:05am pt-13.4 ptt-23.8 inr(pt)-1.1 10:05am glucose-120* urean-28* creat-1.4* na-147* k-4.2 cl-103 hco3-38* angap-10 10:05am alt-15 ast-12 ld(ldh)-124 alkphos-78 totbili-0.5 07:30am calcium-8.2* phos-2.7 mg-2.0 iron-43* other labs 07:30am caltibc-140* vitb12-908* folate-9.8 ferritn-295 trf-108* 07:30am calcium-8.2* phos-2.7 mg-2.0 iron-43* 05:21am wbc-8.0 lymph-8* abs -640 cd3%-66 abs cd3-423* cd4%-14 abs cd4-91* cd8%-52 abs cd8-332 cd4/cd8-0.3* 05:47pm igg-741 iga-202 igm-40 07:30am ret aut-1.7 10:05am lipase-47 02:39pm hapto-117 03:01am triglyc-89 05:21am tsh-0.57 05:21am free t4-0.91* 06:02am hbsag-negative hbsab-negative hbcab-negative 05:02am hiv ab-negative 06:02am hcv ab-negative cardiac enzyme trend 06:37pm ck(cpk)-25* 03:28pm ck(cpk)-38* 11:54pm ck(cpk)-21* 04:57am ck(cpk)-22* 12:03am ck(cpk)-21* 05:01am ck(cpk)-19* 03:06pm ck(cpk)-18* 01:30pm ck(cpk)-16* 09:04pm ck(cpk)-17* 05:21am ck(cpk)-12* 10:05am ctropnt-<0.01 06:37pm ctropnt-<0.01 03:28pm ck-mb-notdone ctropnt-<0.01 11:54pm ck-mb-notdone ctropnt-<0.01 04:57am ck-mb-2 ctropnt-0.01 12:03am ck-mb-notdone ctropnt-0.12* 05:01am ck-mb-notdone ctropnt-0.10* 03:06pm ck-mb-notdone ctropnt-0.08* 10:41am ctropnt-0.05* 01:30pm ck-mb-notdone 09:04pm ck-mb-notdone ctropnt-0.06* 05:21am ck-mb-notdone ctropnt-0.03* discharge labs: 04:17am wbc-5.2 rbc-2.99* hgb-9.5* hct-29.1* mcv-97 mch-31.7 mchc-32.5 rdw-22.5* plt ct-205 04:17am glucose-86 urean-20 creat-0.7 na-135 k-4.2 cl-96 hco3-30 angap-13 04:17am calcium-9.0 phos-4.0 mg-1.8 ct a/p () - impression: 1. extensive sigmoid diverticulosis with stable diffuse sigmoid mural thickening and mild stranding. degree of involvement correlates with extent of diverticulosis, favoring chronic diverticulitis as the primary process on underlying crohn's disease. direct visualization by colonoscopy is recommended after acute symptomology resolution for further evaluation. 2. stable pulmonary nodules consistent with known metastatic carcinoid tumor. 3. cholelithiasis without cholecystitis. 4. single locule of gas within bladder. please correlate with history of insrumentation. cxr () - findings: minimal linear opacities are present in the left base and may reflect atelectasis or scar. there is no consolidative opacity to suggest an infectious pneumonia. cardiomediastinal contours are within normal limits for technique. small left pleural effusion versus minimal pleural thickening appears unchanged. colon mucosal biopsies () - a. transverse colon: 1. chronic inactive colitis. 2. no viral cytopathic changes identified. b. descending colon: 1. active colitis with ulceration. 2. no viral cytopathic changes identified c. sigmoid colon: 1. active colitis with ulceration 2. no viral cytopathic changes identified. d. rectum: 1. active colitis with ulceration. 2. no viral cytopathic changes identified. note: no granulomata or dysplasia identified. immunohistochemical stain for cmv was negative in parts a and c gi bleeding study () - impression: active bleeding first occurring at 67 minutes in the area overlying the pelvis between the iliac arteries, although localization to a portion of the bowel was not possible. however, further delayed imaging between 90 to 120 minutes did not definitively redemonstrate bleeding. gi bleeding study () - impression: no active bleeding seen during the duration of the exam. colectomy sample () - colon, extended left colectomy: 1. multiple ulcers to varying depths, some transmural, with numerous cytomegaloviral (cmv) inclusions seen; see note. 2. diverticular disease with focal ulcers and cmv inclusions. 3. resection margins free of ulcer. 4. no evidence of chronic colitis/crohn's disease. stress test () - impression: no anginal type symptoms or ischemic ekg changes. nuclear report sent separately. impression: normal myocardial perfusion, with increased left ventricular cavity size and decreased systolic function compared to , most compatible with a non-ischemic cardiomyopathy. ct head () - impressions: no definite acute intracranial pathology seen. hypodensity along the left anterolateral aspect of the pons could represent streak artifact; however, old infarct could also have this appearance. if there is concern for acute infarction, mri with diffusion-weighted imaging would be recommended for more sensitive evaluation. note added in attending review: the well-defined wedge-shaped 19 mm hypoattenuating region in the left ventrolateral basis pontis (2:) appears oriented roughly orthogonal to the predominant axis of the streak artifact at the skull base. there may also be a small lacune in the right paramedian pons (2:12). thus, this likely reflects a chronic infarct. echo () - the left atrium is markedly dilated. the right atrium is moderately dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is severe regional left ventricular systolic dysfunction with severe hypokinesis of the left ventricle with sparing of the basal inferior/inferolateral/anterolateral walls. overall left ventricular systolic function is severely depressed (lvef= 25 %). the right ventricular cavity is moderately dilated with moderate focal apical hypokinesis. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate to severe (3+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. the end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. there is no pericardial effusion. compared with the report of prior study (images unable to be reviewed) of , biventricular systolic function, the severity of mitral regurgitation, and estimated pulmonary artery systolic pressure have worsened. cta chest () - impression: 1. no evidence of central pe. suboptimal examination for evaluating segmental and subsegmental pulmonary arteries. 2. new moderate pleural effusions with adjacent atelectasis. 3. incomplete evaluation of known widespread pulmonary carcinoid metastasis, due to respiratory motion and presence of effusions with compressive atelectasis. mri t spine () - conclusion: technically limited study. no overt thoracic disc or vertebral abnormality. bilateral pleural fluid. emg () - impression: technically difficult, complex, and abnormal study. the findings are suggestive of a generalized myopathy with myotonic features affecting predominantly lower extremities. the lack of denervation on needle emg argues against a superimposed acute or subacute lumbosacral polyradiculopathy or other neurogenic process. the poor activation noted in several muscles is likely the result of poor patient effort or central nervous system disease. mri pelvis () - impression: 1. degenerative changes at the lumbar spine, with more pronounced changes at l4-l5, and l5-s1. for more details, please refer to designated lumbar spine mri report from the same day. 2. normal sacral plexus, with no evidence of extrinsic compression on sacral nerves in the neural foramina. mri l spine () - mpression: 1. moderate right subarticular recess narrowing at l4-5 and mild left subarticular recess narrowing at l2-3 level. 2. increased signal in the soft tissues and muscles adjacent to the spinous processes in the lumbar region indicating soft tissue edema. clinical correlation recommended. no fluid collection is seen in the soft tissues. 3. no evidence of discitis or osteomyelitis. no evidence of epidural mass. cardiac mri () - impression: 1. normal left ventricular cavity size with normal regional left ventricular systolic function. the lvef was mildly depressed at 54%. there is cmr evidence of prior myocardial scarring/infarction in the mid to distal inferolateral wall. 2. normal right ventricular cavity size and systolic function. the rvef was normal at 59%. 3. the indexed diameters of the ascending thoracic aorta was normal and descending thoracic was mildly increased. the main pulmonary artery diameter index was normal. 4. biatrial enlargement. 5. note is made of patent left internal mammary artery conduit to left anterior descending artery and a saphenous vein graft. 6. a note is made of bilateral pleural effusions, lung base atelectasis, a right upper lung nodule and a small left renal cyst- all described above. peripheral flow cytometry () - interpretation. non-specific t cell dominant lymphoid profile; diagnostic immunophenotypic features of involvement by lymphoma are not seen in specimen. correlation with clinical findings is recommended. flow cytometry immunophenotyping may not detect all lymphomas due to topography, sampling or artifacts of sample preparation. cxr () - findings: a right picc line terminates with the tip at the cavoatrial junction. the lungs are clear. unchanged mild cardiomegaly without pulmonary edema. cardiomediastinal silhouette and hila are normal. no significant pleural effusion. microbiology: cmv viral load (final ): 39,900 copies/ml. cmv viral load (final ): 1,980 copies/ml. culture, routine (final ): staph aureus coag +. _________________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- 2 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s wound culture (final ): pseudomonas aeruginosa. >15 colonies. _________________________________________________________ pseudomonas aeruginosa | cefepime-------------- 2 s ceftazidime----------- 4 s ciprofloxacin--------- =>4 r gentamicin------------ 2 s meropenem-------------<=0.25 s piperacillin/tazo----- 16 s tobramycin------------ <=1 s gram stain, surgical incision (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci in pairs and clusters. _________________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r trimethoprim/sulfa---- <=0.5 s ******* pending studies: -4 cultures with no growth to date -anti- and anti-yo antibodies brief hospital course: this is a 72m c carcinoid metastatic to lung, cad s/p cabg, dchf and recently diagnosed crohn's now with severe colitis per flex sig from . # gi bleed/cmv colitis: pt has had progressively bad bloody diarrhea with recent admission for a similar presentation. pt had only been at rehab for 1 week when he returned with multiple bloody bm's and hypotension at rehab believed to be volume depletion bloody diarrhea. this was initially felt to be most c/w his presumed crohn's diagnosis as carcinoid does not cause bloody diarrhea and his stool cultures were negative including c diff x3. he was already on ciprofloxacin and flagyl from previous admission and these were continued. his prednisone was discontinued and salumedrol started instead. due to continued bloody diarrhea, on , pt had a sigmoidoscopy which showed diffuse ulcerations, cobblestoning, erythema, and friability extending to the distal transverse colon c/w severe crohn's disease as well as diverticulosis of the descending colon and sigmoid colon; 4 biopsies were taken which were negative for active cmv. after his flexible sigmoidoscopy he had several episodes of bright red per rectum believed to be oozing from biopsy sites. he was observed in the micu overnight without event. pt recieved infliximab on (hep serologies and ppd negative) with minimal effect. on , pt again had bright red per rectum with tachycardia and was again transferred to the micu. of note, pt had been transitioned back to prednisone from solumedrol on . in the micu pt continued to have intermittent brbpr with coincident hct drops for which he required several more units of prbcs. on , pt underwent cscy which was notable for a bleeding vessel in the sigmoid colon which was injected. on , pt underwent a bleeding study that showed no active bleeding. on , pt went to angio and found to have an intermittently bleeding branch of the left colic artery but too tortuous for intervention thus pt taken to or on and underwent l. colectomy with colostomy with specimen sent to pathology which returned positive for cmv inclusions. he was initially started on valgancyclovir and subsequently switched to iv ganciclovir per id. hiv, hepc and b were negative. he had visual complaints and ophtho was consulted with concern of fungal infection (see below). his cmv viral load improved and he was transitioned to po valgancyclovir. he will continue on this at discharge, and will follow-up with infectious disease. prior to discharge, the patient's surgical site was noted to have pus-like drainage from its inferior aspect. the surgery service opened this part of the incision and packed it, with plans to let it heal by second intention. swab cultures were sent and grew mrsa. this will be covered by the vancomycin course that had previously been started for the patient's positive culture (see below). # positive culture: on , the patient's picc dressing was noted to be coming off of his skin and his picc site appeared contaminated. cultures were drawn off of the picc, and then it was pulled. the picc tip was sent for culture. the culture from the patient's picc ultimately grew mrsa, and he was started on vancomycin iv. this will be continued for 14 days. no further cultures have grown anything. of note, the patient's picc tip grew pseudomonas; however, because this did not grow in any cultures, it was felt to likely be a contaminant. the patient had a new picc placed prior to discharge. this picc should be pulled when his 14-day course of vancomycin is complete. # cmv viremia: id was consulted on and recommend cmv vl which returned at 39, 900. he was initiated on iv ganciclovir and had a negative opthalmology exam for retinitis. he responded to therapy and on his cmv was 1,980. on , pt was switched to po valganciclovir with a plan for 21 days of induction therapy. of note, pt also found to have a cd 4: 91 (14%) with concern for possible cvid although he had a normal immunoglobulin profile. a peripheral flow cytometry was ordered and did not reveal any significant abnormalities. he will f/u with id on . he will get weekly cmv viral loads as an outpatient, which will be following by the infectious disease clinic. # ams/weakness: neurology consulted for ams on , and patient was found to have proximal muscle weakness. thought to be possibly secondary to cmv polymyositis. ck values with within normal limits and thyroid panel was not concerning. mri t spine was limited but revealed no specific abnormality. mri l spine showed moderate right subarticular recess narrowing at l4-5 and mild left subarticular recess narrowing at l2-3 level, as well as soft tissue edema around the spinous processes in the lumbar region. emg showed generalized myopathy with myotonic features affecting predominantly lower extremities. mri pelvis was also performed and did not show any significant abnormalities (see above for full report). the patient should follow-up with neurology after discharge. per neurology recs, anti- and anti-yo antibodies were sent and were pending at the time of discharge. # tachycardia: triggered multiple times on the floor and transferred several times to the micu (, ). his hr went up to 200s, sinus tach vs atrial tachycardia. thought more likely to be svt w/ aberrancy. he was treated w/ ivfs, prbcs, and monitored. his systolic pressue in the micu ranged 90s-120s. while on the surgical team, post-operatively, cardiology was consulted for tachycardia. they recommended deferring treatment for tachycardia, but suggested nodal agents/antiarrhythmics once more medically stable. tsh has been checked and was within normal limits. troponins on admission were <0.01, positive at 0.12 and downtrended to 0.06 . throughout his hospitalization he has been on various medications on and off for tachycardia including diltiazem, esmolol drip, standing metoprolol iv and po. a nuclear stress test was ordered that showed ef 20% (two years ago ef 50%) and an echo was done per cardiology request that showed biventricular dysfunction, ef 20%, mr/tr, rv volume/pressure overload (see below). follow-up cardiac mri, showing improvement of his ef to 54%. at the time of discharge, the patient's heart rate was stable on a regimen of metoprolol 25 mg tid. # hf: patient was intermittently treated with iv lasix though overall this had been held given the concern for bleeding and hemodynamic instability. overall, he was extensively volume resucitated with ivfs and prbc. though his admission he did develop an oxygen requirement 2l nasal cannula to nrb. cxr was notable for diffuse alveolar opacities c/w chf and pulmonary edema. he was restarted on lasix 80mg daily on , and his repiratory status improved. a nuclear stress test was ordered that showed ef 20% but normal perfusion (two years ago ef 50%) and an echo was done per cardiology request that showed severe hypkinesis of lv (ef 25%), dilated rv w/ hypokinesis, rv pressure/volume overload, worsening mr (3+), moderate tr (2+) and moderate pa systolic htn. troponins positive to peak of 0.12 as stated above and bnp not checked. cta was performed, which showed no evidence of pe but did show pleural effusions. thyroid studies were sent and were not concerning. there was some concern for the possibility of cmv myocarditis. however, cardiac mri was performed, which actually revealed an ef of 54%. at the time of discharge, the patient was stable on his home regimen of lasix (80 mg daily). his o2 sats were wnl on ra. # anemia: felt to be secondary to gi bleed. his hct trended down, and got total of 21u prbc throughout his hospitalization (last transfused ). hct remained stable at the time of discharge. # thrombocytopenia: developed thrombocytopenia with a nadir of 19 on . all heparin products d/c'd on for concern of hit. heme onc was consulted. hit antibodies were negative. his thrombocytopenia was suspected to be secondary to bone marrow suppression from cmv. platelet count improved and was stable at the time of discharge. # htn: patient admitted with hypotension that improved with ivfs and prbc. his lasix and antihypertensive medications were initially held. pressure medications were eventually restarted. pt was normotensive at the time of discharge. # cad: troponins were elevated but stable during pt's hospitalization. perfusion scan did not show perfusion defects pointing against acs. at times, he did complain of some chest discomfort, which seemed more pleuritic in nature. he was continued on his cardiac medications. his aspirin was held during his hospitalization, given his recent gi bleed. it was restarted at the time of discharge. # metabolic alkalosis: felt to be related to diuresis, given rising bicarb and low chloride. improved with acetazolamide administration. bicarb was improved and stable at the time of discharge. # visual complaints: ophtho was consulted. feel that os lesion could represent fungal process vs chorioretinal atrophy. pt will follow-up with ophtho soon after discharge. # ? diagnosis of crohn's disease: was treated with 1 dose of infliximab during his hospitalization. was seen by gi. steroids had initially been increased to solumedrol but were later tapered back to prednisone. of note, colectomy samples did not show evidence of crohn's. pt is being disharged on a prednisone taper. pt will f/u with gi as an outpatient. # anal fissure: pt noted to have large non-healing anal fissure. per gi, unlikely crohn's. pt's hypdrocortisone enemas were discontinued given severe irritation of perineal area. pt was followed by wound care service. pt will follow-up dermatology as an outpatient for further wound care recommendations. # carcinoid tumor: s/p left lower lobe wedge resection per chart, was being followed conservatively. appears to be primary lung rather than gi source per old imaging and prior heme/onc notes. pt will follow-up with heme-onc as an outpatient. # : noted on admission. likely dehydration. now resolved. # hypernatremia: noted on admission. likely volume depletion. resolved with ivf. # code status: pt was initially dnr/dni. however, later in his hospitalization, pt decided to reverse this and to be full code. medications on admission: senna dulcolax tylenol vit c mv flagyl 500 cipro 500 immodium prn metoprolol 25 lisinopril 20 daily nifedipine 60 sr daily dorzolamide 1 drop both eyes brimonidine 0.15% 1 drop both eyes artificial tears simvastatin 80 daily prednisone 40 daily hydrocort foam enemas protonix 40 lasix 80 daily pentasa 2000mg fluticasone nasal spray prn congestion 1.5l fluid restriction discharge medications: 1. vancomycin 750 mg recon soln sig: seven y (750) mg intravenous every twelve (12) hours for 9 days: day 1 = . pt should complete a 14 day course, ending on . 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. prednisone 5 mg tablet sig: 1-3 tablets po daily (daily): take 3 tablets (15 mg) daily from to . take 2 tablets (10 mg) daily from to . take 1 tablet (5 mg) daily from to . then, stop taking medication. 4. simvastatin 80 mg tablet sig: one (1) tablet po once a day. 5. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 6. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime): 1 drop to both eyes at bedtime. 7. dorzolamide 2 % drops sig: one (1) drop ophthalmic (2 times a day): 1 drop to both eyes . 8. brimonidine 0.15 % drops sig: one (1) drop ophthalmic (2 times a day): 1 drop to both eyes . 9. white petrolatum-mineral oil 42.5-56.8 % ointment sig: one (1) appl ophthalmic prn (as needed) as needed for dry eyes. 10. ipratropium bromide 0.02 % solution sig: one (1) nebs inhalation q6h (every 6 hours) as needed for wheezing. 11. furosemide 80 mg tablet sig: one (1) tablet po once a day. 12. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day): for dvt prophylaxis while patient is not ambulatory. 13. acetaminophen 500 mg tablet sig: two (2) tablet po every eight (8) hours as needed for pain: do not exceed 4 grams in a 24 hour period. 14. bisacodyl 5 mg tablet, delayed release (e.c.) sig: tablet, delayed release (e.c.)s po daily (daily) as needed for constipation. 15. senna 8.6 mg capsule sig: one (1) capsule po at bedtime as needed for constipation. 16. multivitamin tablet sig: one (1) tablet po once a day. 17. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day): please hold for sbp<100 or hr<60. tablet(s) 18. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily): hold for sbp<100. tablet(s) 19. valganciclovir 450 mg tablet sig: two (2) tablet po bid (2 times a day): please continue this medication until you see your id doctor on . 20. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 21. outpatient lab work patient should have the following lab work drawn weekly, beginning on monday : cmv viral load, chem 10 (na, k, cl, hco3, bun, cr, gluc), cbc. all laboratory results should be faxed to infectious disease r.ns. at (. 22. outpatient lab work patient should have a vancomycin trough level drawn prior to his 4th dose of vancomycin at the extended care facility. results should be faxed to infectious disease r.ns. at (. 23. general care order patient's picc line should be pulled when his vancomycin course is complete. 24. oxycodone 5 mg capsule sig: capsules po every six (6) hours as needed for pain. discharge disposition: extended care facility: health care center discharge diagnosis: primary diagnosis - gastrointestinal bleeding - cytomegalovirus colitis - cytomegalovirus viremia - anemia - thrombocytopenia - supraventricular tachycardia - anal fissure secondary diagnosis - coronary artery disease - asthma / chronic bronchitis - chronic diastolic heart failure - hypertension - obstructive sleep apnea discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you presented to the hospital with gastrointestinal bleeding. you ultimately had a surgical removal of part of your colon, which revealed that you had a viral infection in your colon. this virus was also found in your , you were started on antiviral medications. you will continue these medications as an outpatient. you hospital course was also complicated by several other problems, including fast heart rates, temporarily diminished heart function, weakness in your legs, visual changes, and a infection. you were seen by multiple consult services in the hospital, and you will follow-up with many of these services as an outpatient. you also had some problems with your surgical incision. as a result, part of the incision was opened and packed by the surgical service. you will follow-up in the surgery clinic in several weeks. you are now being discharged to an extended care facility, where you will continue to receive antibiotics and wound care. there were many changes to your medications while you were in the hospital. your medication list was reconciled prior to your discharge. you should follow the medication list that is provided to you at the time of discharge. weight goes up more than 3 lbs. it was a pleasure taking part in your medical care. followup instructions: you have the following follow-up appointments scheduled: #1 - department: neurology when: tuesday at 9:00 am with: , building: sc clinical ctr campus: east best parking: garage #2 - department: general surgery/ when: tuesday at 3:30 pm with: , md building: lm campus: west best parking: garage #3 - department: center when: monday at 12:50 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage #4 - infectious disease 10:00a dr. ami lm bldg (), basement id west (sb) ( #5 - hematology/oncology 11:30a , a. sc clinical ctr, #6 - gi 03:30p dr. ra (/ complex), gi fellows ( #7 - 11:00a ,teaching tuesday sc clinical ctr, clinic-cc2 ( procedure: parenteral infusion of concentrated nutritional substances open and other left hemicolectomy temporary colostomy arteriography of other intra-abdominal arteries closed [endoscopic] biopsy of large intestine endoscopic destruction of other lesion or tissue of large intestine anastomosis to anus transabdominal endoscopy of large intestine diagnoses: thrombocytopenia, unspecified obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified hemorrhage complicating a procedure other specified cardiac dysrhythmias alkalosis pressure ulcer, lower back chronic obstructive asthma, unspecified hemorrhage of gastrointestinal tract, unspecified hyperosmolality and/or hypernatremia other and unspecified infection due to central venous catheter cytomegaloviral disease pressure ulcer, stage iv disruption of external operation (surgical) wound acute on chronic combined systolic and diastolic heart failure anal fissure enteritis due to other viral enteritis myopathy, unspecified unspecified visual disturbance regional enteritis of large intestine surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation benign carcinoid tumor of the bronchus and lung 

Answer: The patient is high likely exposed to