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: gi bleed major surgical or invasive procedure: endoscopy x 2 with attempted sclerosis of duodenal ulcer intubation history of present illness: 49 year old female with down syndrome/tof admitted to hospital on for foot and abdominal pain. on hd 2, patient had decreased in hct and hematemesis (28-> 16%). she was intubated for airway protection and volume resuscitated with 8u blood/ivf. she had labile blood pressures and requiring levophed, neo and vasopressin. also found to have +troponin of 2.98 (cpk 1835) during stress event. upper endoscopy showed a duodenal bleed which was sclerosed and esophogeal stricture was dilated. patient had rebleed on with hct decreased to 14, requiring 6u prbc and repeat scope and sclerosis. rec'd total of 14 u prbc, and 4u ffp and 1u platelets. patient was weaned off steroids (?adrenal insuff). now transferred to for consideration of gi surgery. past medical history: tof- not seen by cards in 20 years. r ankle fracture osteopenia down's syndrome psychosis hypothyroidism gerd ?endocarditis psh: 1- septal repair- (partial leak) 2-shunt placement- 2 blalock-taussig cardiac shunts (18 mo, 3yrs) 3-cholecystectomy social history: lives with sister, no hx of tobacco, etoh, drugs. goes to day program family history: mother died at 84 with cva, father deceased at 89 with copd physical exam: on admit: vs tm 96.9, 122/56 p 75 o2 95% on ac tv 550 rr 12 fio2 40% vasopressin 2.4 o/n: tm 96.9 94-122/48-59 p 57-75 i/o=38/140=-102cc o/n-684/290=+394 urine output 250 in last 2 hours fenanyl 50, versed 2 vasopressin off since 2 a.m. gen: intubated, sedated heent: intubated but op clear, ogt with bilious output lungs: cta anteriorly heart: s1 s2 2/6 sem abd: soft nt, distended +bs, ext: no c/c/e, left fem aline, slightly cooler lle with good pulses right triple lumen on discharge: vss gen: awake, occ 1 word statements heent: mmm pulm: ctab cv: holosyst murmur, rrr abd: soft, nt, nd, +bs ext: no c/c/e pertinent results: 10:42am blood hct-30.8* 04:11am blood neuts-68 bands-1 lymphs-22 monos-8 eos-1 baso-0 atyps-0 metas-0 myelos-0 04:11am blood hypochr-2+ anisocy-1+ poiklo-occasional macrocy-normal microcy-normal polychr-normal 04:30am blood plt ct-308 04:30am blood glucose-93 urean-3* creat-0.9 na-141 k-3.3 cl-108 hco3-24 angap-12 03:07am blood alt-29 ast-38 alkphos-69 totbili-0.7 10:06pm blood ck-mb-12* mb indx-1.2 ctropnt-0.20* 04:30am blood albumin-2.0* calcium-7.5* phos-3.2 mg-1.7 cholest-58 04:05pm blood totprot-5.8* 04:30am blood vitb12-1297* folate-8.8 04:30am blood triglyc-46 hdl-21 chol/hd-2.8 ldlcalc-28 radiology ct abd: abnormal appearance to the second portion of the duodenum with extensive stranding and fluid surrounding it. foci of gas are seen in this region, which may be intraluminal, however, a contained perforation cannot be excluded. a focus free air is seen. there is a moderate amount of free fluid in the abdomen and pelvis. diffuse anasarca. bilateral moderate pleural effusions with associated atelectasis. ct abd: overall, there has not been any significant change compared to the previous examination of . bilateral pleural effusions and bibasilar atelectasis as before. no definite evidence for duodenal perforation. slight improvement in the anasarca. transthoracic echocardiogram: the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). the right ventricular free wall is hypertrophied. the right ventricular cavity is dilated. right ventricular systolic function is borderline normal. intrinsic right ventricular systolic function is likely more depressed given the severity of tricuspid regurgitation. there is abnormal septal motion/position consistent with right ventricular pressure/volume overload. the aortic valve leaflets are mildly thickened. mild to moderate (+) aortic regurgitation is seen. the aortic regurgitation jet is eccentric. the mitral valve appears structurally normal with trivial mitral regurgitation. the tricuspid valve leaflets are mildly thickened. there is moderate pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. there is a trivial/physiologic pericardial effusion. repaired tetralogy of fallot is present with overriding aorta, vsd patch, free pulmonic regurgitation (increased pulmonic velocities likely due to this rather than pulmonic stenosis although pulmonic region not fully visualized). cxr: there is a new patchy density in the right upper lobe, which would be consistent with pneumonia in the appropriate clinical setting. stable features of chf are noted. tip of the right cvl remains in the svc with no ptx. brief hospital course: patient is a 49 yo woman with down's syndrome, tetrology of fallot who presented with life threatening gi bleed at osh, for which she was intubated and underwent 2 upper endoscopies with sclerosing of a duodenal ulcer. she was transferred to for further management; her hospital course was notable for aspiration pneumonia and mrsa line infection. # gi bleed secondary to duodenal ulcer which is s/p sclerosis x 2- required 16u prbc at osh. given possible duodenal microperforation noted on initial abdominal ct, further endoscopic procedures were not pursued given high risk of complication. the surgery service was consulted, who did not recommend surgical intervention as they felt, given her cardiac/valvular disease, she was a poor surgical candidate. she was treated concervatively with proton pump inhibitor, and antibiotics (2 weeks of ciprofloxacin). given she was h. pylori antibody positive, she also completed a 14 day course of triple treatment. at time of discharge, her hematocrit was stable. she will follow-up with gastroenterology as an outpatient. # mrsa line infection: the patient will complete a 14 day course of vancomycin. transthoracic echocardiogram was without evidence of endocarditis, and her blood cultures rapidly cleared on antibiotics. # demand myocardial ischemia: in the setting of hypotension/gi bleed, the patient was noted to have an elevated troponin t (peak 0.25), which was felt to most likely represent demand ischemia. once she was hemodynamically stable, she was started on a beta-blocker. her ldl was 28 off a statin and, given recent gi bleed, she was continued off an aspirin. a stress test may be considered as an outpatient at the discretion of her primary care physician. # aspiration pneumonia: given new right upper lobe infiltrate noted on cxr, the patient was treated with a 7 day course of antibiotics. at time of discharge, she was stable on room air. a speech and swallow consult was obtained, who recommended a pureed/moist ground solid and thin liquid diet. # mechanical fall: the patient had 2 witnessed mechanical falls (becoming tangled in blankets/iv lines) on and . there was no apparant trauma/loc. a pt consult was obtained, who felt the patient was safe to discharge home with home physical therapy. full code medications on admission: prozac 30' synthroid .88mcg' piroxicam pepcid 20'' seroquel 200' enulose po bid iron/mvi ativan .5 mg prn agitation evista 60 po qhs discharge medications: 1. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for asp pna for 1 days. disp:*4 tablet(s)* refills:*0* 2. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 1 days. disp:*3 tablet(s)* refills:*0* 3. vancomycin in dextrose 1 g/200 ml piggyback sig: one (1) intravenous q 12h (every 12 hours) for 5 days. disp:*11 * refills:*0* 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* continue home medications minus aspirin. discharge disposition: home with service facility: gentiva discharge diagnosis: upper gi bleed duodenal ulcer h pylori positive downs syndrome catheter infection discharge condition: good discharge instructions: please call your doctor or emergency services for bright red blood in stool, dark-tarry stools, fainting, lightheadedness, dizziness, palpitations or heart racing, new headaches, fevers/chills, diarrhea, abdominal pain, vomiting blood, chest pain, shortness of breath. drink plenty of fluids. take iron supplementation to help increase blood counts (hct). please continue all antibiotics for their full course. followup instructions: please call your primary care doctor a follow up appointment please call gi to set up a follow up appointment. please call your primary care doctor an outpatient stress test. md procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances non-invasive mechanical ventilation transfusion of packed cells diagnoses: esophageal reflux urinary tract infection, site not specified congestive heart failure, unspecified acute posthemorrhagic anemia unspecified protein-calorie malnutrition unspecified acquired hypothyroidism tetralogy of fallot other specified forms of chronic ischemic heart disease acute respiratory failure pneumonitis due to inhalation of food or vomitus bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site infection and inflammatory reaction due to other vascular device, implant, and graft chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction hypovolemia helicobacter pylori [h. pylori] disorder of bone and cartilage, unspecified down's syndrome diverticulosis of small intestine (without mention of hemorrhage) tracheoesophageal fistula, esophageal atresia and stenosis 

Answer: The patient is high likely exposed to