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: upper gi bleed major surgical or invasive procedure: ercp with cautery history of present illness: 83m with af on coumadin, ischemic cmp, ef 20%, recently admitted with cholecystitis and choledocholithiasis s/p ercp with removal of cbd stone and sphincterotomy that presented to the ed today with lightheadedness and one episode of dark red blood per rectum night prior to admission, this was later complicated by pea arrest in the ercp suite this afternoon. . the pt originially presented to an osh on for abdominal discomfort, vomiting and sscp. at the osh the pt was febrile, blood cultures revealed pansensitive e.coli. ast 343, alt 269, tuberculosis 5.4. a ruq u/s was without evicence of gallstones, no intra or extrahepatic dilation. hida () and showed non-opacification of the gallbladder, consitant with acute cholecystitis. pt then sent to and on underwent ercp where they extracted cbd stone and performed a sphincterotomy and sphincteroplasty without complication. the patient arrived on the floor npo, on iv fluids and antibiotics. . the pt was discharged on and last night had three episodes of large stools brbpr and melanotic stools. the pt complained of lightheadedness to his son who then this morning had his father come to an osh and then and sent over to . . in the emergency department, initials vs 95.8 97 85/47 20 96%ra. his nitro patch was removed. inr was 1.4 and he was given vitamin k. patient evaluated by ercp who felt bleeding may be related to ercp and are planning repeat ercp. he had ng lavage with coffee grounds on return. sbp dropped to 80s and he received 1400cc ns with improved sbp to 100. the patient was seen briefly in the where his vitals were 96.9 76 155/110 18 on ra. the patients abdominal exam was benign at the time. the patient was subsequently sent to ercp for cauterization of the patient sphincterotomy site . at 3:25 at code blue was called in for a pea arrest during the patients ercp. during the code the pt underwent cpr for approximately 5 minutes at which time a pulse was detected. the pt was given a total of 4mg of epinephrine boluses. the pt was started on an epinephrine gtt, neosynephrine gtt and dopamine gtt while he received a total of 5 units of prbcs. the patient was brought to the where he was able to be weaned off the pressors. the pts ph fell to 7.03/35/117 with a bicarb of 9. the pt received at total of 7 units of prbcs (1 in the ed and 6 post code), 1 bag of platelets, 2 of ffp (inr of 1.9 -> 1.4), calcium gluconate (total of 4mg) and 1 amp of bicarb. . a meeting was held with the patients children that stated to continue to treat aggresively, however they stated that they would not wish their father to receive further chest compressions or shocks. past medical history: ischemic cardiomyopathy with ef of 20% atrial fibrillation hypertension hyperlipidemia h/o ventricular tachycardia, status post icd placement cad status post aortobi-iliac stent graft placement in h/o renal lesion, presumed carcinoma, treated conservatively h/o prostate cancer social history: pat. lives with wife who has alzheimer dementia, denies smoking, occasional etoh family history: no significant history of bleeding physical exam: t=94.6 bp=101/52 hr=67 rr=24 o2=98% physical exam general: intubated and sedated. heent: no conjunctival pallor. no scleral icterus. perrla/eomi. mmm. op clear. neck: supple, no lad, no thyromegaly. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . lungs: clear anteriorly, good air movement biaterally. abdomen: distended, slightly firm in ruq, otherwise soft extremities: no edema or calf pain, 2+ dorsalis pedis/ posterior tibial pulses. skin: no rashes/lesions, ecchymoses. pertinent results: admission labs 10.6 8.3 >---< 303 32.3 neuts-76.5* lymphs-18.0 monos-3.3 eos-1.8 basos-0.4 . chem glucose-136* urea n-55* creat-1.9* sodium-136 potassium-4.9 chloride-100 total co2-26 anion gap-15 . lfts: alt(sgpt)-34 ast(sgot)-23 ck(cpk)-29* alk phos-189* tot bili-1.7* 07:55am lipase-26 albumin-3.5 . pt-17.1* ptt-32.0 inr(pt)-1.5* . digoxin-1.1 . ua neg . ce 07:55am ctropnt-0.01 . post-code (icu admission) wbc-10.4 rbc-3.24* hgb-10.1* hct-32.5* mcv-100*# mch-31.1 mchc-31.1 rdw-13.7 . glucose-225* lactate-8.3* na+-130* k+-6.3* cl--108 tco2-14* calcium-6.4* phosphate-6.0*# magnesium-2.2 03:30pm blood lactate-8.3 01:50am blood lactate-1.6 . abg: type-art po2-436* pco2-33* ph-7.23* total co2-15* base xs--12 . 04:26pm ck-mb-3 ctropnt-<0.01 04:26pm ck(cpk)-23* 01:33am blood ck-mb-7 ctropnt-0.90* 03:55am blood ck-mb-7 ctropnt-0.76* . imaging cxr: the hardware is unchanged in position. the heart is again enlarged. the lungs are clear. no effusions are seen. no evidence of volume overload. . tte: the left atrium is dilated. the right atrium is markedly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis/akinesis (inferior/inferolateral akinesis/hypokinesis, apical akinesis/dyskinesis and hypokinesis elsewhere) (lvef = 15-20 %). no thrombus is seen but a left ventricular mass/thrombus cannot be definitively excluded. right ventricular chamber size is normal with probably mildly depressed free wall contractility. the aortic root is moderately dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. . ercp: blood in the major papilla - this was successfully treated with epinephrine and cautery. partial cholangiogram showed normal biliary tree. a biliary stent was placed. procedure was terminated due to hypotension. (stent placement)(injection, hemostasis) otherwise normal ercp to third part of the duodenum . echo : the left atrium is dilated. the right atrium is moderately dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is severe global left ventricular hypokinesis (lvef = 20-30%) with regional variation (there is extensive apical akinesis with focal dyskinesis; the rest of the left ventricle is hypokinetic). an apical mural thrombus is present. the clot is mural and not mobile. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). right ventricular chamber size is normal. with depressed free wall contractility. the aortic root is moderately dilated at the sinus level. 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 mild mitral regurgitation. there is no mitral valve prolapse. the tricuspid valve leaflets are mildly thickened. there is no pericardial effusion. compared with the findings of the prior study (images reviewed) of , an apical thrombus is now identified (may have been present before, but less well-visualized). . renal u/s : ultrasound images of bilateral kidneys and urinary bladder: right kidney measures 10.7 cm in length. the left kidney measures 10.6 cm in length. there is no hydronephrosis. 1.7 x 1.5 x 1.6 cm solid-appearing mass in the upper pole of the right kidney as seen on us exam of , . a 0.4 cm cyst in the lower pole of the right kidney is stable, accounting for technique. hypoechoic lesion of the left kidney contains two components, one measuring 2.7 x 2.4 x 2.0 cm and the other measuring 5.4 x 4.7 x 5.2 cm. this structure appeared more homogeneous and solid on prior ultrasound and currently appears more heterogeneous with layering echogenic debris, which may represent hemorrhage within the cyst. the urinary bladder is relatively collapsed. no ureteral jet could be demonstrated. impression: 1. no evidence of hydronephrosis. 2. left renal solid mass likely represents renal cell carcinoma. 3. hypoechoic lesion of the left kidney as described above can be further evaluated with an mri or ct depending on the patient's renal function. . discharge labs: 134 / 100 / 36 / 128 3.3 / 21 / 2.6 . alt: 19 ap: 115 tbili: 1.7 ast: 17 . 9.5 \ 12.9/ 160 /38.8 \ . stool cx: 1:13 pm stool consistency: not applicable source: stool. **final report ** clostridium difficile toxin a & b test (final ): reported by phone to at 10:30 am. clostridium difficile. feces positive for c. difficile toxin by eia. (reference range-negative). a positive result in a recently treated patient is of uncertain significance unless the patient is currently symptomatic (relapse). brief hospital course: 83m af on coumadin, cmp ef 20% s/p recent ercp with sphincterotomy complicated by upper gi bleed, admitted to the s/p pea arrest. . # acute blood loss anemia/gi bleed: was due to bleeding from ampulla given recent ercp. he was transfused aggressively with 9 units prbcs and platelets. he underwent ercp on with successful cautery from presumed source. he did experience a hypovemic pea arrest (see below). post procedure he did not experienced further bleeding, though he continued to pass old blood. his coumadin/aspirin were held in house and may consider resuming once no further bleeding and cautery healed. he will require repeat ercp in 4 weeks to remove his stent. please call dr. office to arrange this. please call him as well to determine when he may initiate his aspirin/coumadin. would repeat cbc in days, as well as lfts. . # pea arrest likely to hypovolemia from sphincteromy bleed: occured in setting of known gib, which occurred as a complication of ercp. pt was undergoing ercp intervention at the time of arrest, and bleeding site had been cauterized. hct fell to 25 from 38 two days ago requiring massive resuscitation and triple pressors. pt was rapidly weaned off of pressors after transfer to the icu. he received 9 units total prbcs. pt continued to have melanotic stools in the icu, but hct remained stable (had bumped to 41) without further transfusions on . anticoagulation with coumadin was held as per above. . # acute respiratory failure: patient intubated prior to ercp procedure, and was extubated the same day in the icu. . # ecg changes: pt with wide complex ventricular rhythm during arrest. cards consulted and felt "evidence of wide complex rhythm consistent with idioventricular ventricular rhythm likely secondary to metabolic disarray and reperfusion following resuscitation. the primary treatment for his rhythm is correction of his metabolic acidosis." repeat ecg showed improvement. tte showed ef 15-20%. his biomarkers rose in the setting of his arrest, likely demand related. . #. arf: likely secondary to hypoperfusion following hypotensive event, pt still produced 15cc/hr after event. creatinine continued to worsen, indicating likely atn. urinalysis demonstrated volume depletion as well. his cr rose to a high of 2.8. renal was consulted who felt he had atn plus volume depletion. he urinated copious amounts. with gentle ivf his creatinine started to improve. he should have repeat chem 7 in days, and nephrology evaluation if no improvement. please encourage pos. . # atrial pt was rate controlled off b-blocker. cardiac meds were initially held after arrest. pt had episode asymptomatic nsvt on and meds were restarted. pt was restarted on amiodarone, digoxin, carvedilol, spironolactone and lasix. given his massive bleed, his coumadin and aspirin were held in house. his digoxin was changed to every other day. his lasix and spironolactone were held in the setting of his arf. these can be restarted as his renal function improves. his asa/coumadin should be restarted asap (would discuss with gastroenterology). . #. acute on chronic systolic chf- tte showed stable ef 15-20%. patient appears mildly volume overloaded on and was restarted on lasix, spironolactone, as well as carvedilol, amiodarone and digoxin. he diuresed well to the lasix plus likely atn. however, his diuretics were held as his creatinine worsened. they can be restarted once his creatinine improves. . # mural thrombus: incidentally found on echo. asymptomatic. asa/coumadin should be restarted as per above as soon as possible and gi issues stable . # incidental renal cell carcinoma: found on renal u/s for work up for his arf. not thought the cause of his arf. this was discussed with his pcp, was mentioned on imaging at . the pcp and patient/family are aware, but he should follow up with a urologist at the advice of his pcp as soon as is feasible to discuss further options according to the patient's wishes. . code status: patients family does not wish the patient to receive further chest compressions or external defibrillations. pt was made dnr/dni after extubation. medications on admission: coumadin 4mg po daily coreg 12.5mg po bid amiodarone 200mg po bid spironolactone 12.5mg po daily digoxin 0.125 po daily nitro-patch 0.4mg/hr td overnight only lasix 80 mg po dialy zocor 20mg po qhs trazodone 50 mg po qhs colace 100mg po bid milk of magnesia prn zofran prn morphine 2 to 4 mg q3h prn discharge medications: 1. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). 2. digoxin 125 mcg tablet sig: one (1) tablet po every other day. 3. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day). 4. colace 100 mg capsule sig: one (1) capsule po twice a day. 5. trazodone 50 mg tablet sig: one (1) tablet po at bedtime. 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 8. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 9. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 13 days: through . discharge disposition: extended care facility: nursing & rehabilitation center - discharge diagnosis: acute blood loss anemia/ gi bleed pea cardiac arrest atrial fibrillation acute on chronic systolic chf acute renal failure hypertension, benign mural thrombus renal cell carcinoma 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: patient was admitted with large gi bleed after recent ercp. this was complicated by pea arrest due to hypovolemia, as well as acute renal failure due to acute tubular necrosis as a result of hypotension. he received 9 units of blood. his bleeding stopped with cautery during repeat ercp. he was also subsequently found to have a mural thrombus on echocardiogram. however, his anticoagulation has been held until his bleeding issues resolve. he was also found to have c. difficile infection. also, renal ultrasound demonstrated likely renal cell carcinoma. . medications changes: hold aspirin and coumadin until deemed safe to resume by gastroenterologist hold spironolactone 12.5mg daily until renal function recovers hold lasix 40-80mg daily until renal function recovers . he should follow up with pcp as soon as possible. additionally, he will need to have his biliary stent removed in weeks. also, he will need to see a urologist regarding his renal cell carcinoma . medications changes: stopped warfarin and aspirin due to bleed. should resume these medications asap and step-wise at discretion of pcp/gastroenterologist once bleeding stable and cautery healed, given atrial fibrillation and mural thrombus. followup instructions: pcp as soon as possible pcp: , . . please call the gastroenterology office (dr. in 1 week to schedule repeat ercp. please discuss the timing of resuming his aspirin and coumadin. ( . patient will need close urology follow up giving his renal cell carcinoma found on ultrasound. please call his pcp to help arrange this. procedure: endoscopic insertion of stent (tube) into bile duct diagnoses: acidosis acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified acute posthemorrhagic anemia cardiac complications, not elsewhere classified atrial fibrillation malignant neoplasm of kidney, except pelvis hemorrhage complicating a procedure other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure other specified cardiac dysrhythmias cardiac arrest long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ acute myocardial infarction of unspecified site, initial episode of care acute on chronic systolic heart failure benign essential hypertension 

Answer: The patient is high likely exposed to