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 / codeine / iodine attending: addendum: mr. continued to have bp in the 100/50 range and metoprolol 25mg was occasionally held for sbp <100. he had intermittent episodes of non-sustained ventricular tachycardia, during which time he was asymptomatic. mr. also continued to be intermittently delerious and was evaluated by geriatric psychiatry, who recommended zyprexa 2-5mg qhs prn and setting adjustment re-orient patient. mr. on was noticed to have a melanotic stool, without a hct drop. gi evaluated him, and indicated that given his recent nstemi, he was high risk for a gi procedure. he should be re-evaluated in the future for possible further gi intervention to assess source of gi bleed. chief complaint: hypotension major surgical or invasive procedure: blood transfusion (2 units) history of present illness: reason for micu transfer: hypotension requiring pressors 81 year old male with h/o chf (ef 20%), cad s/p cabg in , afib on warfarin, vt s/p icd placement, gi bleed secondary to ?nsaid use, peripheral vascular disease s/p right sfa stent last week, ?dementia, presented with sob. in the ed, initial vs were: 08:02 0 97.8 83 92/74 18 98%. he triggered for bp 60s. physical exam was notable for red blood on rectal examination. labs were notable for hct 26 (at discharge was 27.5), inr 2, cr 1.9 (baseline 1.5). also trop 0.61 with ecg showing no changes by report. bnp 5900, lactate 2.8. patient was started on peripheral dopa but was tachy to 130s and switched changed to peripheral norepinephrine. on arrival to the micu, patient is comfortable and conversant. he denies any pain and has no acute complaints. his norepinephrine was decreased from .1 to 0.6 mcg/kg/hr. there was initial concern for upper gi bleed. pt reports dark brown stools with drops of blood at home, and reports state 1x 500cc melanotic stool in the micu. gi was , and stool was dark red, more consistent with lower gi/diverticular bleed. egd was not performed because of high risk cardiac status and higher suspicion for lower gi bleed. baseline hct 27-28, on admission hct 26, rec'd 1u prbcs, now 29, stable since admission. pt has a complex cardiac history and severe peripheral vascular disease. he has afib on warfarin. had sfa stent placed last week, started plavix. also started 10 day course of tmp/smz post-procedure. also has , with ef 20%, mitral and tricuspid regurgitation, and rv dysfunction, on tte. cardiology , no acute intervention recommended. pt will require lifetime anti-platelet therapy. per vascular surgery, plavix 30 days followed by aspirin for life. he has cad s/p cabg x 4 in , and vt s/p dual-chamber icd placement. on admission troponin 0.61 --> 0.47 --> 0.56. unsure of patient's baseline ms. , became combative, tried to leave. touched base with daughter and health care proxy, , see social history for details. does not understand reason for admission or circumstances that brought him to the hospital. ros negative except as per hpi. past medical history: # diabetes # hyperlipidemia # hypertension # peripheral vascular disease with chronic le ulcers # s/p resection of r 1st mt joint # s/p r bk -dp w/nrsvg # s/p plasty of bpg # s/p agram # arteriogram # r 3rd toe debrid by podiatry # right bk to pt bypass w/ nrsvg # , 20% (echo ) # cad s/p cabg x 4 in # vt s/p dual-chamber icd placement # atrial fibrillation on warfarin social history: married, has 6 children. denies tobacco. quit etoh 25 years ago. denies illicits. lives alone at estates retirement community. has occasional nursing help. manages his own finances. per daughter, he usually has fair understanding of his medical conditions, but has had a few episodes of confusion; he was found confused and wandering on previous admission family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission pe: o: 98.0 94-108/53-64 hr: 60-78 rr: 18 o: 90-98%ra i: 900 o: 450+ general: lying in no acute distress, answers questions appropriately heent: sclera anicteric, mmm, oropharynx clear, eomi cv: regular rate and rhythm, normal s1 + s2, 3/6 systolic murmur heard best at apex, no rubs or gallops lungs: mild bibasilar rales. no wheezes or rhonchi. abdomen: soft, non-tender, non-distended, bowel sounds present no organomegaly ext: warm, well perfused, dopplerable pulses by report, no clubbing, cyanosis, 1+ edema up to mid shin bilaterally, right foot bandaged, left foot with 2-3 cm erosion on left, dry, non-erythematous, small ulceration lateral right knee neuro: cnii-xii grossly intact, 5/5 strength upper/lower extremities, grossly normal sensation, aaox2 (person, place) discharge physical exam: vs: tm 98.3, bp 104/59, p 71, r 19, 100% on ra, fsg 126 general: lying in no acute distress, answers questions appropriately heent: sclera anicteric, mmm, oropharynx clear, eomi cv: regular rate and rhythm, normal s1 + s2, 3/6 systolic murmur heard best at apex, no rubs or gallops lungs: mild bibasilar rales. no wheezes or rhonchi. abdomen: soft, non-tender, non-distended, bowel sounds present no organomegaly ext: warm, well perfused, no clubbing, cyanosis, no edema, r leg clean stage ii ulcer, r buttocks hypoigmented lesions (not dermatomal distribution, not tender). neuro: cnii-xii grossly intact, 5/5 strength upper/lower extremities, grossly normal sensation, aaox2 (person, place) pertinent results: admission labs: 08:30am blood wbc-6.0 rbc-3.63* hgb-7.3* hct-26.0* mcv-72* mch-20.2* mchc-28.1* rdw-23.0* plt ct-357 08:30am blood neuts-67.4 lymphs-25.7 monos-6.0 eos-0.4 baso-0.5 08:30am blood pt-21.6* ptt-32.8 inr(pt)-2.1* 08:30am blood glucose-135* urean-27* creat-1.9* na-138 k-3.6 cl-99 hco3-23 angap-20 02:01pm blood glucose-146* urean-26* creat-1.8* na-140 k-3.3 cl-101 hco3-24 angap-18 02:01pm blood ck(cpk)-45* 08:30am blood ctropnt-0.61* probnp-5904* 02:01pm blood ck-mb-3 ctropnt-0.47* 02:01pm blood calcium-8.4 phos-3.5 mg-1.9 08:36am blood comment-green top 08:36am blood lactate-2.8* k-3.3 relevant labs: 08:30am blood wbc-6.0 rbc-3.63* hgb-7.3* hct-26.0* mcv-72* mch-20.2* mchc-28.1* rdw-23.0* plt ct-357 11:58am blood hct-27.4* 08:00am blood wbc-8.8 rbc-4.22* hgb-9.4* hct-32.4* mcv-77* mch-22.4* mchc-29.2* rdw-25.6* plt ct-294 09:10pm blood hct-30.4* 07:50am blood wbc-8.4 rbc-3.64* hgb-8.6* hct-28.6* mcv-78* mch-23.6* mchc-30.2* rdw-24.6* plt ct-250 07:55am blood wbc-8.1 rbc-4.01* hgb-9.4* hct-31.7* mcv-79* mch-23.3* mchc-29.5* rdw-24.9* plt ct-249 02:31am blood hct-28.5* 07:50am blood wbc-8.4 rbc-3.64* hgb-8.6* hct-28.6* mcv-78* mch-23.6* mchc-30.2* rdw-24.6* plt ct-250 07:55am blood wbc-8.1 rbc-4.01* hgb-9.4* hct-31.7* mcv-79* mch-23.3* mchc-29.5* rdw-24.9* plt ct-249 08:03am blood wbc-8.4 rbc-4.24* hgb-9.9* hct-33.9* mcv-80* mch-23.3* mchc-29.1* rdw-24.9* plt ct-207 09:50pm blood hct-33.8* 08:05am blood wbc-7.8 rbc-4.32* hgb-10.0* hct-34.8* mcv-81* mch-23.2* mchc-28.8* rdw-24.6* plt ct-270 07:50am blood wbc-7.8 rbc-4.39* hgb-10.3* hct-35.5* mcv-81* mch-23.4* mchc-29.0* rdw-24.5* plt ct-226 08:30am blood glucose-135* urean-27* creat-1.9* na-138 k-3.6 cl-99 hco3-23 angap-20 08:00am blood glucose-142* urean-24* creat-1.7* na-136 k-3.8 cl-97 hco3-25 angap-18 07:25am blood glucose-134* urean-24* creat-1.6* na-137 k-3.8 cl-101 hco3-28 angap-12 07:00am blood glucose-84 urean-25* creat-1.5* na-136 k-3.8 cl-101 hco3-26 angap-13 07:50am blood glucose-103* urean-22* creat-1.4* na-138 k-3.4 cl-100 hco3-29 angap-12 07:55am blood glucose-81 urean-22* creat-1.2 na-138 k-3.3 cl-99 hco3-29 angap-13 08:03am blood glucose-111* urean-24* creat-1.3* na-139 k-3.9 cl-100 hco3-31 angap-12 08:05am blood glucose-104* urean-24* creat-1.2 na-140 k-3.4 cl-99 hco3-31 angap-13 07:50am blood glucose-99 urean-26* creat-1.4* na-140 k-3.6 cl-98 hco3-31 angap-15 08:03am blood alt-17 ast-29 alkphos-81 08:30am blood ctropnt-0.61* probnp-5904* 02:01pm blood ck-mb-3 ctropnt-0.47* 02:40am blood ck-mb-2 ctropnt-0.56* 08:00am blood caltibc-285 ferritn-45 trf-219 discharge labs: 07:50am blood wbc-7.8 rbc-4.39* hgb-10.3* hct-35.5* mcv-81* mch-23.4* mchc-29.0* rdw-24.5* plt ct-226 07:50am blood plt ct-226 07:50am blood glucose-99 urean-26* creat-1.4* na-140 k-3.6 cl-98 hco3-31 angap-15 08:03am blood alt-17 ast-29 alkphos-81 07:50am blood calcium-8.7 phos-3.8 mg-1.9 microbiology: 8:30 am blood culture: blood culture, routine (final ): no growth. 9:35 am blood culture blood culture, routine (final ): no growth. 10:20 am urine urine culture (final ): <10,000 organisms/ml. 11:41 am mrsa screen source: nasal swab. mrsa screen (final ): no mrsa isolated. 11:58 am mrsa screen source: nasal swab. mrsa screen (final ): no mrsa isolated. imaging: ekg : atrial demand pacing. left axis deviation. inferior wall myocardial infarction, likely old. poor r wave progression of uncertain significance. intraventricular conduction delay and diffuse non-specific st-t wave abnormalities. compared to tracing #1 more atrial pacing is now seen. increased r wave in leads v3-v5 may reflect lead placement. otherwise, no diagnostic change. ekg : predominantly sinus rhythm versus ectopic atrial rhythm with atrial premature contractions and one apparently atrial paced beat. left axis deviation. prior inferior myocardial infarction. possible anterior wall myocardial infarction of indeterminate age. intraventricular conduction defect. diffuse non-specific st-t wave abnormalities. compared to the previous tracing of atrial fibrillation has been replaced by what appears to be predominantly sinus or ectopic atrial rhythm. st-t wave abnormalities are less marked in leads v5 and v6. clinical correlation and repeat tracing are suggested. cxr : lungs are well expanded with improved aeration at the left base. mild-to-moderate cardiomegaly is slightly improved with no appreciable residual pulmonary edema. no pleural effusion or pneumothorax. pacemaker/defibrillator is in unchanged position. echo : biventricular cavity enlargement with regional and global systolic dysfunction c/w multivessel cad or other diffuse process. pulmonary artery hypertension. at least moderate mitral regurgitation. severe tricuspid regurgitation. mild-moderate aortic regurgtiation. dilated ascending aorta. compared with the prior study (images reviewed) of , the right ventricular cavity is more dilated with more prominent free wall hypokinesis, the severity of tr is increased, and the estimated pa systolic pressure is lower (likely due to progressive rv dysfunction). ekg : sinus tachycardia. incomplete left bundle-branch block. compared to the previous tracing atrial pacing is no longer seen. brief hospital course: 81 year old male with h/o (ef 20%), cad s/p cabg, peripheral vascular disease s/p sfa stent, diabetes, presented with hypotension, now hemodynamically stable, no evidence of active bleed. active issues: # shock: yet unclear why he became hypotensive. cardiogenic cause most likely given significant history (please see below). gi bleed also likely explanation. echo revealed decreased wall motion compared to . sepsis is less likely as pt has been afebrile and improved without antibiotics. pt required pressors briefly, but weaned off and now stable with sbps in 100-110s, on a slightly modified (decreased) home bp regimen (see below). # gi bleed: most likely a slow lower gi / diverticular bleed. s/p 1u prbcs () appropriate increase in hct (26 to 28.8). on , hct was 27.2, received another 1u prbcs, hct bumped to 28.5. had evidence of moderate diverticuli () and moderate gastritis/duodenal ulcer on egd (), downtrending hct starting in . several reports of brbpr during hospitalization and melanotic x 1 on . egd not indicated at this time given high cardiac risk and lower clinical suspicion for upper gi bleed (however, as mentioned, gastritis, duodenal ulcer on prior egd). received omeprazole 40mg . will have follow-up with gi dr. . # anemia, acute on chronic: prior to admission baseline hct 26-28; during hospitalization, received s/p 1u prbcs in , increased appropriately and remained stable on the floor. hct was 27.2, pt received another 1u prbcs, and hct increased to 28.5. had several episodes of brbpr during hospitalization. anemia is microcytic - mcv 75; likely iron-deficiency anemia in the setting of recent slow gi bleed (per above, has diverticulosis). also have decreased production due to ckd. iron studies were normal. we continued home iron supplementation. f/u with gi for sources of gi bleeding. # supraventricular tachycardia - pt had an episode of svt on , with hr in the 140s. ekg consistent with atrial tachycardia, no ischemic changes. resolved with carotid massage, iv metoprolol, additional po metoprolol, and gentle ivf. given concern for gi bleed, checked hct, which was 30.4. home metoprolol 25mg xl was increased to metoprolol 50mg xl. ****high importance**** # peripheral vascular disease s/p stent with right le ulcer. warfarin and clopidogrel were briefly held given fear of gi bleed. restarted warfarin and clopidogrel. ******patient will need lifetime antiplatelet rx: per vascular & gi recs, will continue with warfarin & plavix until , then go back to warfarin & aspirin***** wound care nurse , and gave recommendations for management of foot ulcers. pt completed post-procedural antibiotics prophylaxis with trimethoprim/sulfamethoxazole on . # altered ms: delirium vs. baseline dementia. pt received haldol once in the for episode of agitation. touched base with family to reassess baseline mental status, and he seems to have baseline confusion. would try to avoid haldol in the future for moderately elevated qtc = 480. # (ef 20%): worsened from echo, cardiology evaluated, may have had a new coronary event undetected in nursing home, no acute intervention warranted. continued a change in dose of metoprolol (slightly increased), torsemide, lisinopril (lower dose). will follow-up with dr. in cardiology. # cad s/p cabg with troponinemia: ekgs unremarkable, echo revealed worsening wall motion abnormality, but no acute coronary event; continue medical management # on ckd cr peaked to 1.7, and returned to baseline 1.3-1.5: have been an element of hypoxic injury following shock episode, also a component of drug-related injury on tmp/smz (now complete) medical conditions: # atrial fibrillation: chads2 = 4 = 8.5% chance of stroke per year. continue anticoagulation as above. inr = 1.8 on d/c. # hypertension: not an active issue, currently controlled on home regimen # diabetes: held metformin (on ssi in hospital). will restart on dc. transitional issues: # pt must have lifetime antiplatelet therapy because he has right lower extremity stent. *******continue warfarin and clopidogrel until *******stop clopidogrel on and continue warfarin and aspirin thereafter for life********* # gastroenterology follow-up with dr. # cardiology follow-up with dr. # consider starting spironolactone given mortality benefit for severe if bp is rising # please make appointment with patient's pcp 1 week after discharge # please follow up creatinine / renal function in approximately 1 week, with pcp #lisinopril lowered to 2.5mg po qd in setting of borderline hypotension; please consider increasing back to 5mg when bp improves. #metoprolol in hospital 12.5mg po tid because of arrhythmia; please re-evaluate and consider reverting to metoprolol xl. medications on admission: . information was obtained from . 1. metoprolol succinate xl 25 mg po daily 2. metformin (glucophage) 850 mg po bid 3. acetaminophen 650 mg po q6h:prn pain 4. aspirin 325 mg po daily 5. bisacodyl 10 mg po daily:prn constipation 6. clopidogrel 75 mg po daily 7. ferrous sulfate 325 mg po bid 8. torsemide 20 mg po bid 9. omeprazole 40 mg po bid 10. pravastatin 40 mg po daily 11. docusate sodium 100 mg po bid 12. warfarin 2 mg po daily16 13. lisinopril 5 mg po daily 14. nitroglycerin sl 0.3 mg sl prn chest pain 15. sulfameth/trimethoprim ds 1 tab po bid duration: 10 days until discharge medications: 1. acetaminophen 650 mg po q6h:prn pain 2. bisacodyl 10 mg po daily:prn constipation 3. clopidogrel 75 mg po daily 4. docusate sodium 100 mg po bid 5. ferrous sulfate 325 mg po bid 6. torsemide 20 mg po bid 7. atorvastatin 80 mg po daily rx *atorvastatin 80 mg 1 tablet(s) by mouth daily disp #*30 capsule refills:*3 rx *atorvastatin 80 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 8. metformin (glucophage) 850 mg po bid 9. nitroglycerin sl 0.3 mg sl prn chest pain 10. olanzapine 2-5 mg po qhs:prn delerium rx *olanzapine 2.5 mg tablet(s) by mouth at night disp #*30 tablet refills:*0 11. pantoprazole 40 mg po q12h rx *pantoprazole 40 mg 1 tablet(s) by mouth two times per day disp #*30 tablet refills:*0 12. warfarin 5 mg po daily16 rx *coumadin 5 mg 1 tablet(s) by mouth daily disp #*10 tablet refills:*0 13. metoprolol tartrate 12.5 mg po tid hold for sbp <100, hr <55 rx *metoprolol tartrate 25 mg 0.5 (one half) tablet(s) by mouth three times per day disp #*30 tablet refills:*0 14. lisinopril 2.5 mg po daily rx *lisinopril 2.5 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 discharge disposition: extended care facility: for the aged - discharge diagnosis: primary diagnosis: hypotension secondary diagnosis: anemia, diabetes, hypertension, peripheral vascular disease, coronary artery disease, congestive heart failure, atrial fibrillation, gastrointestinal bleeding discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure being involved in your care during your recent hospitalization. you were admitted because your blood pressure dropped significantly, and you required medications to help your blood pressure. we were concerned that you were bleeding from your gastrointestinal tract because there was blood in your stool, and your blood counts were low. you received two blood transfusions and your blood counts went back up. you will need to follow up with your gastroenterologist for further evaluation of causes of bleeding. on , you had a stent placed to open up the vessels in your right leg. because of this, you will need to take blood thinners for the rest of your life, to prevent the stent from clotting up and cutting off the circulation from your leg. your heart does not pump as well as a healthy heart. please weigh yourself every morning, md if weight goes up more than 3 lbs. medication changes: # metoprolol xl 25mg daily was changes to metoprolol 12.5mg po tid because of your fast heart rate # pravastatin was replaced with atorvastatin 80 mg to more effectively treat your high cholesterol and protect your heart # your lisinopril dose was lowered from 5mg to 2.5mg because your blood pressure was low. please ask about increasing the dose back to 5mg once your blood pressure improves. transitional issues: #patient requires lifetime anti-platelet therapy because of right lower extremity stent, placed , pcp informed warfarin + plavix 30 days / - warfarin + aspirin, - forever # cardiology: worsening cardiac function; episode of atrial tachycardia; consider starting spironolactone # gastroenterology: evaluation for cause of lower gastrointestinal bleed sufficient to cause anemia followup instructions: department: div. of gastroenterology when: wednesday at 11:30 am with: , md building: ra (/ complex) campus: east best parking: main garage department: cardiac services when: thursday at 3:00 pm with: device clinic building: sc clinical ctr campus: east best parking: garage department: cardiac services when: thursday at 3:20 pm with: , md building: campus: east best parking: garage md procedure: arterial catheterization diagnoses: abnormal coagulation profile congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status peripheral vascular disease, unspecified chronic kidney disease, unspecified ulcer of other part of foot other and unspecified hyperlipidemia other specified cardiac dysrhythmias hypotension, unspecified old myocardial infarction chronic systolic heart failure long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ diverticulosis of colon with hemorrhage other alteration of consciousness hemorrhage of rectum and anus 

Answer: The patient is high likely exposed to