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: transfer for gib major surgical or invasive procedure: abdominal angiogram egd colonoscopy gi capsul study history of present illness: 65 year old man with h/o stoke and rheumatic heart disease s/p mechanical mvr on chronic cooumadin admitted for gib. one day prior to admission, he felt lightheaded and his wife took his blood pressure at home: 70/40. he was admitted to osh on and was found to have a gib. first there was dark brown stools that progressed to frank blood. he reportedly had 6 units of prbc. his hct was 24 before transfer. inr was 1.9 on admission and 4.1 on . 2u ffp was given. upper and lower endoscopy was performed on . egd was unremarkable. per wife's report and progress notes, colonoscopy revealed old blood but no source of bleeding was found. colonoscopy was advaced to small bowel and there is a suspicion that the blood is coming from the small bowel. he is transferred to dr. service for "procedure." from talking to wife, it seems like there may be an angiography planned to isolate the bleed. . currently, the patient is hemodynamically stable. he is a poor historian due to memory loss from a stroke. his wife takes care of him and reports that he has the mental capacity of a child. . he denies chest pain, shortness of breath, abd pain, nausea or vomit. past medical history: cardiac history: # s/p mechanical mitral valve replacement x 2 for rheumatic fever # cva # chronic afib s/p ablation and pacemaker . percutaneous coronary intervention: none . pacemaker placed for afib. . other past history: # traumatic brain injury # memory loss from previous stroke # right inguinal hernia repair # appendectomy # tonsillectomy # adenoidectomy social history: he lives with his wife who takes care of him full time. he has limited mental capacity and memory since his stroke. he has remote trivial tobacco history. he does not use alcohol or illicit drugs. he does not have children. he reports that he was a dog trainer. family history: nc physical exam: vs - 100.4, 111/62, 85, 18, 94% ra gen: wdwn middle aged male in nad. oriented x 2, does not know date. mood, affect appropriate. memory poor. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with flat neck veins. cv: irregular, mechanical s1, normal s2. no m/r/g. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. abd aorta enlarged by palpation, about 5 cm. guaiac postive with trace bright red blood from rectum. ext: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: 10:46pm glucose-107* urea n-32* creat-0.8 sodium-140 potassium-4.1 chloride-108 total co2-26 anion gap-10 10:46pm estgfr-using this 10:46pm calcium-7.9* phosphate-3.1 magnesium-2.2 10:46pm wbc-8.3 rbc-2.41* hgb-7.5* hct-21.4* mcv-89 mch-31.3 mchc-35.2* rdw-15.8* 10:46pm neuts-80.3* lymphs-13.3* monos-2.9 eos-3.5 basos-0.1 10:46pm plt count-178 10:46pm pt-18.3* ptt-37.1* inr(pt)-1.7* 09:35am blood wbc-5.8 rbc-4.26* hgb-12.5* hct-38.5* mcv-90 mch-29.3 mchc-32.4 rdw-15.1 plt ct-371 05:45am blood wbc-5.6 rbc-4.24* hgb-12.6* hct-38.1* mcv-90 mch-29.7 mchc-33.1 rdw-14.9 plt ct-417 05:00am blood wbc-4.9 rbc-4.15* hgb-12.5* hct-37.6* mcv-91 mch-30.1 mchc-33.3 rdw-15.1 plt ct-451* 05:15am blood wbc-7.1 rbc-4.15* hgb-12.3* hct-36.9* mcv-89 mch-29.7 mchc-33.4 rdw-15.2 plt ct-407 02:35am blood ptt-54.7* 06:49pm blood ptt-40.0* 10:40am blood pt-12.7 ptt-34.6 inr(pt)-1.1 09:35am blood plt ct-371 05:15pm blood ptt-53.3* 05:45am blood plt ct-417 05:45am blood pt-12.5 ptt-65.7* inr(pt)-1.1 09:35am blood glucose-126* urean-15 creat-0.8 na-141 k-3.5 cl-106 hco3-27 angap-12 05:45am blood glucose-95 urean-17 creat-0.8 na-143 k-3.9 cl-109* hco3-26 angap-12 . brief history: 65 year old man with past history of mvr for rheumatic heart disease and required coumadin use was admitted with a gastrointestinal bleed of unclear source. endoscopy, colonoscopy and red blood cell scan as well as enteroscopy were unremarkable. he is referred for mesenteric angiography with heparin load provocation. indications for catheterization: gastrointestinal bleeding procedure: peripheral catheter placement was performed of a sims catheter in the celiac/gastroduodinal, sma and arteries. catheter placement was performed. peripheral imaging was performed. conscious sedation: was provided with appropriate monitoring performed by a member of the nursing staff. technical factors: total time (lidocaine to test complete) = 0 hour45 minutes. arterial time = 0 hour45 minutes. contrast injected: non-ionic low osmolar (isovue, optiray...), vol 155 ml, indications - renal premedications: fentanyl 50 mcg iv anesthesia: 1% lidocaine subq. anticoagulation: heparin units iv other medication: protamine 50 mg iv cardiac cath supplies used: .035 terumo, angled glidewire 180cm - allegiance, custom sterile pack comments: 1. selective mesenteric angiography revealed no evidence of avm or bleeding or other anomalies with and without heparin provocation. final diagnosis: 1. no source of gastrointestinal bleeding identified. brief hospital course: patient is a 65 year old man with h/o stroke and rheumatic heart disease s/p mechanical avr admitted for gib. the patient presented after negative colonoscopy and egd at the outside hospital. he was transfused an additional 3 units of blood cells immediately w/ presentation hct 21.4. tagged red blood cell scan on hospital day 2 was negative. given his tenuous blood pressure and ongoing hemorrhagic stools he was transferred to the micu for closer monitoring. he rec'd 1 unit of prbcs in the micu and was transferred back to the medical floor w/ stable bp. in the setting of 2 colonoscopies at the osh (which showed blood at the distal ileum) and negative tagged rbc scan, gi recommended provacative angiography for presumd avm. endoscopy revealed small duodenal ulcer (oozing), was initially thought to be not the source, it was couterized. provocative angio was negative for av-malformations or source of bleed. sice cauterization of ulcer pt's hct remained stable, and stools negative for blood. therefore coumadin was started, which upon discharg remains not therapeutic. h.pylori serology was positive and patient will finish 14 days of antibiotic. has a pacemaker in place. his rhythm flipped between atrial fibrillation, nsr, and pacing. he was anticoagulated w/ goal ptt 50-60. . mvr: mechanical valve s/p 2 replacements. anticoagulation goal was kept low at goal ptt 50-60 given risk of cva w/ mitral valve but with ongoing bleeding. . # right wrist pain with cellulitis: patient complained of right thumb/distal wrist pain, which has been present x 1 month. doppler was negative for dvt. hand x-ray showed djd of the first cmc and triscaphoid joint. anti-inflammatories were initiated for djd, trated with 7 days of vanco for presumed mrsa as pt had past staph positiv wound infection on the same site. medications on admission: coumadin discharge medications: 1. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed. 2. amoxicillin 250 mg capsule sig: four (4) capsule po q12h (every 12 hours) for 7 days: continue for 7 more to finish a 14 day course (for h.pylori). 3. clarithromycin 250 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 7 days: continue for 7 more days for a total course of 14 days for p.pylori. 4. warfarin 2.5 mg tablet sig: one (1) tablet po daily16 (once daily at 16). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 6. heparin (porcine) in d5w intravenous discharge disposition: extended care facility: lakes regional discharge diagnosis: primary - gi bleed secondary - history of stroke - mitral valve replacement, mechanical valve discharge condition: good, without gi bleed for more than 6 days (since intervention on duodenal ulcer). hematocrit unchanged over past 7 days discharge instructions: you were admitted to the hospital with a gastrointestinal bleed. you were given several units of blood. . your workup revealed a small bleeding duodenal ulcer, which was taken care of during the procedure . if you experience the following return for evaluation: fever greater than 100.5, lightheadedness, shortness of breath, dizzyness, chest pain, ongoing bleeding from your gi tract, low blood pressure. followup instructions: please see your primary care doctor in weeks. procedure: endoscopic control of gastric or duodenal bleeding arteriography of other intra-abdominal arteries transfusion of packed cells diagnoses: acute posthemorrhagic anemia atrial fibrillation heart valve replaced by other means long-term (current) use of anticoagulants cardiac pacemaker in situ chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction late effects of cerebrovascular disease, cognitive deficits helicobacter pylori [h. pylori] cellulitis and abscess of hand, except fingers and thumb osteoarthrosis, localized, not specified whether primary or secondary, hand 

Answer: The patient is high likely exposed to