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 attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization with intervention. history of present illness: 83yo female with known cad (s/p mi in '70s and cath x7), htn, afib, chf (ef 35%), transferred from osh for cardiac catheterization. pt has been in usual state of health until 2 months previous to admission when pt had a cva resulting in a 2 month hospitalization at . pt was subsequently transferred to life care nh for rehab where she developed severe diarrhea and dehydration. pt was transferred back to where she was tx'd with flagyl for c.diff. while being transferred from to rehab pt experienced brief episode of chest tightness. pt reports onset of sub sternal chest tightness while being transferred from hospital to rehab center. chest tightness was unlike any other chest pain or gerd sx experienced previously and did not radiate to any other location. lasted less than 1 min and resolved with rest (no medical intervention). chest tightness was associated with sob and sensation of "panic" or inability to breath, but no diaphoresis, n/v, lightheadedness, faintness. pt does admit to night sweats but this has been ongoing for some time now and has been atributed to cml and cll. pt also admits to stable pillow orthopnea that has not changed recently. pt deneis pnd, doe. . ros: 7 bm last night within 12 hours (less watery) . transfered from micu on : pt transfered to icu post cath with gib. egd neg. found to have small sigmoid ulcer and internal hemorroids. hct stable over 24 hours after transfused 2 units. pt has no complaints of cp/sob. diarrhea has greatly improved. past medical history: -cad -htn -cva with residual left sided weakness -chronic afib -chf (ef 35% by ett mibi on at ) -gerd -cll -cml -?dm? social history: pt is from and only speaks portugese. pt denies tobacco, alcohol or illicit drug use. family history: - pt is only one with heart disease, stroke, blood clots in family. physical exam: pe: vs: bp: 161/48 hr: 43 afib rr: 12 sao2: 100% on 3l gen: elderly woman lying in bed at 30 degrees in no acute distress, only speaks portugese, but speaking in complete sentences. heent: l surgical pupil with whitish "cloud" in superior nasal region (10 o'clock). r pupil round, responsive to light, oral pharynx clear, mmm, dentures in both upper and lower jaw. neck: no jvp appreciate, asymmetric prominent carotid pulse at base of left neck with positive bruit cv: irregularly irregular, s1, s2, no murmurs, rubs, gallops chest: cta bilaterally abd: soft, nt, nd, bs+ back: no cva tenderness buttocks: 3 pressure ulcers in midline sacral region (largest is 4cm x 1cm stage ii, with smaller ones approximately 2cm x 2cm and 2cm x 1cm stage ii ulcers). tender to palpation. vaginal exam: white ulcers at 6 o'clock with ?irregular borders (limited by pt's pain/intolerance of exam). ext: pigmentation of skin laterally on leg up to knees (as per daughter due to allergic rxn from 3 years ago, is improving), no clubbing, cyanosis, edema neuro: a+o x3, cn ii-xii grossly intact. strength: right ue with left ue , right le with left le pertinent results: 08:55am inr(pt)-1.0 04:14pm plt count-446*# 06:00pm digoxin-0.6* 10:03pm plt count-445* 10:03pm ck-mb-notdone 10:03pm ck(cpk)-27 10:03pm potassium-3.5 electrocardiogram performed on: atrial fibrillation with well controlled ventricular response left axis deviation - possible left anterior fascicular block left ventricular hypertrophy diffuse nonspecific st-t wave abnormalities since previous tracing of , atrial fibrillation is new electrocardiogram performed on: sinus rhythm. compared to the previous tracing of atrial fibrillation with a rapid ventricular response persist as do the ischemic appearing st-t wave abnormalities in leads i and avl. the t wave inversions recorded on the tracing of can now be compared with the current ecg showing less prominent t wave inversions in leads v2-v6 but without diagnostic interim change. clinical correlation is suggested. cath: final diagnosis: 1. severe single vessel coronary artery disease status post ptca and stenting of the rca. 2. moderate two vessel coronary artery disease involving the lad and lcx. 3. moderate left ventricular systolic dysfunction. 4. severe central hypertension. comments: 1. coronary angiography of this right dominant system revealed moderate two vessel disease and severe single vessel disease. the left main coronary artery demonstrated an ostial 40% stenosis. the lad contained a 40% stenosis in the mid vessel and mild luminal irregularities throughout. the lcx demonstrated moderate diffuse disease in the mid vessel. the omb revealed diffuse disease. the rca contained moderate diffuse throughout with 90% tandem stenoses in the mid vessel and a long 90% stenosis in the proximal pda. 2. limited resting hemodynamics were performed upon entry. left sided filling pressures were mildly elevated (lvedp was 20 mm hg). severe central hypertension was noted (aortic pressure was 200/90 mm hg). there was no significant gradient across the aortic valve upon pullback of the catheter from the left ventricle to the ascending aorta. 3. left ventriculography revealed a contrast calculated ejection fraction of 38%. inferior akinesis and anterolateral hypokinesis were noted. moderate mitral regurgitation was noted. 4. successful placement of overlapping 2.5 x 28 cypher drug-eluting stent (des) and 2.5 x 23 mm cypher des in the proximal to mid-rca, postdilated most proximally with a 3.5 mm balloon and in the midvessel with a 2.75 mm balloon. final angiography demonstrated no residual stenosis, no angiographically apparent dissection, and normal flow (see ptca comments). 5. successful placement of overlapping 2.5 x 8 mm cypher des and 2.5 x 28 mm cypher des. final angiography demonstrated no residual stenosis, no angiographically apparent dissection, and normal flow (see ptca comments). colonoscopy: impressions: grade 1 internal hemorrhoids ulcer in the cecum otherwise normal colonoscopy to cecum recommendations: no lesions that would account for hematochezia were localized. would reccomend push enteroscopy. egd: normal egd to second part of the duodenum brief hospital course: ms. is a 83yo woman with h/o cll/cad/af admitted on from osh for cp/romi, transferred for elective cath. her cath on revealed severe 1vcad s/p ptca and stenting of the rca. was placed on 18 hours of integrillen and plavix 150mg po qd (double the dose as patient has asa allergy). patient off coumadin for af. on 9/27am patient had 5 episodes of brbpr. was orthostatic on exam 175 sbp flat--->76 sbp standing. hct still 35 but no time for hemodilution. patient taken for egd--> normal with mild gastritis. family reports no h/o gib with normal c-scope ~1 years ago. pt transferred to the micu on for stablization, and colonscopy revealed small sigmoid ulcer and hemorroids. pt given 3 units of prbc with improvement of hct from 28 to 33.5. pt transferred back to floor on , and her hematocrit and vital signs remained stable until discharge on . aside from the gi bleed, her hosital course was complicated by a mulit-drug resistent proteus urinary tract infection, being treated treated with oral cefpodoxime with improvment of symptoms. gib: d/t sigmoid ulcer +/- hemorroids in setting of aggressive antiplatelet therapy. colonoscopy showed only small, non-bleeding sigmoid ulcer, some internal hemorrhoid. push enteroscopy (to assess small bowel) was within normal limits. as per gi, bleeding likely secondary to small ulcer/hemorrhoids in setting of high-dose antiplatelet therapy. serial hematocrits continue to be checked for stability. plavix was decreased to 75mg qd from 150mg (pt has apirin allergy), and coumadin was held, to be restarted on . she is on a proton pump inhibitor 2x's/day. coronaries: s/p cath with intervention of rca. given gib, metoprolol and lisinopril initially held but were restarted as bp tolerated. can titrate up metoprolol to 50mg as tolerated. cont statin 80mg qhs, cholestyramine 4g once daily, decreased plavix to 75 qd (pt with asa allergy). rhythm: chronic af. continue rate control with digoxin and metoprolol. holding coumadin until given gi bleed. ecg with small persistent inferior st elevation, asymptomatic. ectopy on tele, and lytes were continuously repleted. pump: last ef 55% with htn. pt monitored for fluiod overload given receiving blood products and fluids, without any signs of overload. cll: continue hydroxyurea and allopurinol, outpt heme f/u diarrhea at osh: 2 c diff negative during admission. pt was continued on osh vancomycin regimen po 125 qid prophylactically. 14 day course (unitl ) uti: multidrug resistent proteus: started on levo, then aztreonam, then d/c'd on or cefpodoxime for 8 more days. pt's symptoms were resolving on discharge. stage ii sacral decubiti: barrier protection and wound care qd, duoderm. vaginal ulcer: unlikely pressure ulcer, outpt gyne for biopsy. hyperpigmented rash across body: may need outpt derm follow-up. prophylaxis: c diff precautions, bowel regimen, protonix, pain code:full communicate w/family medications on admission: hydroxyurea 500mg every other day allopurinol 150mg once daily digoxin 0.125mg qhs lisinopril 10mg once daily atenolol 25mg lipitor 10mg once daily protonix 40mg once daily vancomycin 250mg q6hours after transfer from ed these meds added: cholestyramine 4 g qd simvastatin 40 mg atenolol d/c'd, started lopressor 50 plavix 150mg qd all: -pcn (sulfas) -lasix?, asa? flagyl? (all given at previous hosptial without problem) discharge medications: 1. hydroxyurea 500 mg capsule sig: one (1) capsule po every other day. (). 2. allopurinol 100 mg tablet sig: 1.5 tablets po qd (once a day). 3. simvastatin 40 mg tablet sig: two (2) tablet po qd (once a day). 4. digoxin 125 mcg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 5. cholestyramine 4 g packet sig: one (1) packet po qd (once a day). 6. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 8. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po qd (once a day). 9. lisinopril 20 mg tablet sig: two (2) tablet po qd (once a day). disp:*60 tablet(s)* refills:*2* 10. vancomycin hcl 10 g recon soln sig: one y five (125) mg recon soln intravenous q6h (every 6 hours) for 6 days: take for 6 days after discharge. 11. warfarin sodium 3 mg tablet sig: one (1) tablet po at bedtime: start taking this medication 3 days after you leave the hospital, (), as directed by your doctor. . disp:*30 tablet(s)* refills:*2* 12. cefpodoxime proxetil 200 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 8 days: take until . disp:*16 tablet(s)* refills:*0* 13. diphenhydramine hcl 25 mg capsule sig: one (1) capsule po q12h (every 12 hours) as needed for itching prevention for 10 days: take as needed 30minutes before your antibiotic cefpodoxime to prevent itching. disp:*20 capsule(s)* refills:*0* 14. metoprolol tartrate 25 mg tablet sig: 1.5 tablets tablets po twice a day: take 1.5 tablets (37.5mg) twice daily. tablet(s) discharge disposition: extended care facility: hospital - discharge diagnosis: cad thrombocytosis cml/cll gerd anemia due to blood loss vaginal ulceration sacral decubiti rash anxiety chronic atrial fibrillation hypertension discharge condition: fair discharge instructions: please take all of your medications. please follow up with your doctors. you must take plavix 75mg daily for life or unless your cardiologist says it is okay to change this recommendation. he may increase the dose. call your doctor if you have bright red blood from your rectum, chest pain, shortness of breath, pain with urination. followup instructions: primary care: please follow up with your pcp 2 weeks of discharge. if you need a new primary care doctor call to get an appointment here at center. cardiology: please follow up with your cardiologist within 2 months of discharge. if you need a new cardiologist call for an appointment here with dr. or someone else if you like. continue taking vancomycin the antibiotic that treats c.diffile dirarrhea, for 6 days after discharge. see a gastroenterologist if it recurs. you have an ulcer in your vaginal region, you need to see the gynecologists for this, call if you want to see one at . talk with your primary care doctor about the rash on your body and to see if undergoing allergy testing would benefit you. you may not have a true allergy to lasix/furosemide or aspirin and taking these medications would help your heart greatly. talk with your doctors about echocardiogram of your heart in the next month to evaluate its function restart coumadin 3mg daily on as directed by your doctor. continue taking your antibiotic for a multi-drug resistent proteus urinary tract infection for 8 more days. provider: , appointment should be in 2 weeks provider: , . follow-up appointment should be in 2 months procedure: coronary arteriography using two catheters angiocardiography of left heart structures other endoscopy of small intestine other endoscopy of small intestine injection or infusion of platelet inhibitor left heart cardiac catheterization arterial catheterization colonoscopy transfusion of packed cells insertion of drug-eluting coronary artery stent(s) diagnoses: coronary atherosclerosis of native coronary artery intermediate coronary syndrome urinary tract infection, site not specified unspecified essential hypertension iron deficiency anemia secondary to blood loss (chronic) atrial fibrillation pressure ulcer, other site long-term (current) use of anticoagulants pressure ulcer, lower back rash and other nonspecific skin eruption hemorrhage of gastrointestinal tract, unspecified proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site chronic myeloid leukemia, without mention of having achieved remission 

Answer: The patient is high likely exposed to