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: history of present illness: the patient is a 60-year-old white female with a history of congestive heart failure and diabetes who comes in with hypotension, renal failure, and hypercalcemia. the patient was previously admitted in with a similar complaint and treatment for hypovolemia and found to have klebsiella, staphylococcus aureus, bacteremia. later found to have an elevated inr with guaiac-positive stool. her hematocrit had fallen, and the patient was given one unit of packed red blood cells. the patient went to the emergency department but refused to stay. the patient came to the emergency department today because of feeling "lightheaded." notes having diarrhea today. not watery. reports being constipated in the past five days. the patient denies melena, hematochezia, nausea, or vomiting. she reports initially feeling lightheaded when standing up which improved with time. also started having an increase in bowel movements which were black in color. the patient denies paroxysmal nocturnal dyspnea or orthopnea. she has increased swelling in the legs. no chest pain or shortness of breath. continues dopamine infusion at home. she denies fevers, chills, cough, abdominal pain, or dysuria. over the past week the patient had black stool one week ago and then took imodium which resolved her symptoms. the patient has been taking potassium supplements as well. in the emergency department, the patient's potassium was found to be 7.4. she was given calcium, insulin, glucose, and kayexalate times two. she was continued on vancomycin, and levofloxacin, and flagyl bolused with one liter of normal saline. her initial blood pressure was 52/30s. nasogastric lavage was negative. the patient was admitted to the coronary care unit team for further workup. past medical history: 1. coronary artery disease; status post coronary artery bypass graft in and myocardial infarction in . coronary artery bypass graft plus mitral valve repair in , internal mammary artery with coronary artery disease, saphenous vein graft to obtuse marginal, saphenous vein graft to right posterior descending artery. 2. chronic congestive heart failure (on home dopamine) and biventricular pacers. ejection fraction around 20%. stress mibi revealed severe inferior and lateral wall defects, fixed. 3. diabetes mellitus. 4. history of gastrointestinal bleed and arteriovenous malformation, status post cautery in . her baseline hematocrit is around 30%. 5. chronic renal insufficiency (with a baseline creatinine of 1.3 to 1.4). 6. peripheral vascular disease: known total occlusion abdominal aorta. 7. sp mcoagulase-negative line infection. 8. mitral valve replacement: mechanical prosthetic valve requiring coumadin. 9. ddd pacer, with atrial tachycardia recent revision. medications on admission: iv dopamine 8 mcg per kg per min, enalapril, spironolactone, carvedilol, lasix, bumex intermittant. antidepressants as noted on recent dc summary. coumadin, adjusted per inr. aspirin. statin. allergies: loprazolam, sulfa, codeine, and ceclor, and cephalexin. social history: the patient lives with her husband. physical examination on presentation: initial physical examination revealed the patient's heart rate was 80, she was afebrile, her blood pressure was 88/50, her respiratory rate was 18, and her oxygen saturation was 100% on 2 liters nasal cannula. head, eyes, ears, nose, and throat examination revealed sclerae were anicteric. pupils were equal, round, and reactive to light and accommodation. extraocular movements were intact. the mucous membranes were moist. the neck was supple. no lymphadenopathy. jugular venous pulsation at 12 cm. no bruits auscultated. pulmonary examination revealed no wheezes or crackles anteriorly. cardiovascular examination revealed normal first heart sounds and second heart sounds with a systolic click. the abdomen was soft, nontender, and nondistended. no hepatosplenomegaly. positive bowel sounds. extremity examination revealed 1+ edema in the lower extremities with diffuse chronic mottled appearance in the lower extremities. neurologic examination revealed the patient was alert and oriented times three. cranial nerves ii through xii were grossly intact. no focal motor deficits. pertinent laboratory values on presentation: laboratory values on admission revealed the patient's white blood cell count was 8.7, the patient's hematocrit was 27.5, and her platelets were 194, and her mean cell volume was 88. inr was 2.2 and partial thromboplastin time was 32.6. sodium was 127, potassium was 7.4, blood urea nitrogen was 75, and creatinine was 2.7. alkaline phosphatase was 79, total bilirubin was 0.3, alt was 13, ast was 22, amylase was 67, and her lipase was 39. albumin was 3.9. pertinent radiology/imaging: prior echocardiogram in revealed moderate tricuspid regurgitation, ejection fraction of 20%, right ventricular function decreased, right ventricle mildly dilated, severe left ventricular global hypokinesis, right atrial dilatation, la. mechanical mitral valve without overt masses. a chest x-ray revealed cardiomegaly and pacemaker. no evidence of infiltrates or evidence of volume overload. electrocardiogram revealed a rate of 60s, paced, with a atypical bundle-branch block pattern. concise summary of hospital course by issue/system: the patient was admitted for lightheadedness, increase in bowel movements, with questionable melena, and hyperkalemia. 1. cardiovascular issues: ischemia: no evidence of ischemia. has a history of a fixed perfusion deficits. the patient was continued with statin. aspirin was initially held in light of gastrointestinal bleed. the patient was continued with ace inhibitor. chronic iv dopamine was continued. the patient was continued on carvedilol and diuresed with appropriate electrolyte management. followed potassium and creatinine function. the patient was initially increased on dopamine drip to 10 mcg/kg per minute with an eventual wean to home baseline of 8 mcg/kg per minute with appropriate maintenance of her blood pressure; per her baseline. in addition, the patient was transfused one unit of packed red blood cells for hematocrit elevation to greater than 30. 2. hematologic issues: in terms of the patient's fall in hematocrit, nasogastric lavage was negative. given the patient's prior history of arteriovenous malformation, an esophagogastroduodenoscopy was performed. this revealed pinpoint bleeding in the second part of the duodenum which was cauterized with appropriate post procedural hemostasis. the patient's hematocrit remained stable status post procedure at 29 to 30. the patient was discharged with guaiac cards to follow with three serial stool samples to be brought to her next follow-up visit. given the need for anticoagulation, coumadin was restarted with a modified goal inr of 2 to 3. in addition, the risks of an aspirin was less significant than her need for her significant cardiac history and was continued on aspirin 81 mg by mouth once per day along with a proton pump inhibitor. the patient was to be monitored in two days for appropriate inr therapy. given the patient's recent antibiotic therapy, this was felt to have contributed to her elevated inr and will need to be monitored closely as she is currently off her fluoroquinolones. 3. fluids/electrolytes/nutrition/renal issues: the patient's increased creatinine was likely acute prerenal azotemia from acute gi bleed in setting of chronic poor perfusion. the patient's weight was monitored and bolused appropriately. blood and urine electrolytes were monitored maintaining even fluid status. increased dopamine for proper renal perfusion. spironolactone was held acutely in light of hyperkalemia. as well, potassium supplements were held. the patient's creatinine subsequently improved with good diuresis to 2.7 to 2.1. at the time of discharge, the patient's creatinine was 1.1; at her baseline. at the time of discharge, the patient's lasix was to be continued at 80 mg by mouth twice per day as well as 2 gram sodium diet with daily appropriate weight and volume . 4. infectious disease issues: given the patient's history of bacteremic klebsiella, and methicillin-resistant staphylococcus aureus, and fungal infection peripheral blood cultures were drawn and were no growth to date. cultures drawn at an outside hospital (at the ) on were without growth to date at the time of this dictation. appropriate followup would be recommended as final results were still pending and the patient is currently off antibiotics. the patient remained afebrile throughout with a negative chest x-ray on line status was without evidence of infiltration or infection. discharge status: the patient was discharged on with home care for laboratory and dopamine infusion. condition at discharge: condition on discharge was stable. medications on discharge: 1. atorvastatin 10 mg by mouth once per day. 2. carvedilol 6.25 mg by mouth twice per day 3. amiodarone 200 mg by mouth once per day. 4. epogen injections one times per week. 5. dopamine at 8 mcg/kg per minute. 6. sertraline 100 mg by mouth twice per day. 7. trazodone 50 mg by mouth at hour of sleep as needed. 8. pantoprazole 40 mg by mouth once per day. 9. furosemide 80 mg by mouth twice per day. 10. enalapril 5 mg by mouth twice per day. 11. spironolactone 25 mg by mouth once per day. 12. lorazepam 1 mg by mouth at hour of sleep as needed. 13. 60 mg by mouth twice per day. 14. colace 100 mg by mouth twice per day. 15. warfarin 5-mg tablets 0.5 tablets at 2.5 mg by mouth once per day. 16. aspirin 81 mg by mouth once per day. discharge instructions/followup: 1. the patient was given a sack of guaiac cards placed in ziploc bags times three to bring in to next appointment. 2. the patient was to have blood laboratory chemistries, chemistry-7, coagulations, and complete blood count drawn on for followup with dr. on . formal continue followup with advanced heart failure program was arranged in detail with patient prior to dc. 3. the patient was instructed to call if she developed shortness of breath, weight gain, lower extremity edema, fevers, chills, or nausea. 4. the patient was encouraged to resume a congestive heart failure diet as well as to increase exercise as tolerated. 5. the patient was instructed to call if she noticed any darkening in the color of her stool or any bright red blood per rectum. 6. the patient was again advised to avoid any use of cigarettes. , m.d. dictated by: medquist36 procedure: other endoscopy of small intestine endoscopic control of gastric or duodenal bleeding diagnoses: hyperpotassemia congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified aortocoronary bypass status peripheral vascular disease, unspecified heart valve replaced by other means angiodysplasia of stomach and duodenum with hemorrhage 

Answer: The patient is high likely exposed to