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 71 year-old male with a history of end stage renal disease on hemodialysis and a history of gastrointestinal bleed, recent myocardial infarction and hypotension. the patient went to an outside hospital one week ago. he had been in his usual state of health, but had chest pain, twice went to the emergency department, but left ama. on he noticed bright red blood per rectum. his inr was found to be supratherapeutic at 3.8. the patient went to the emergency department with chest pain and received po and intravenous vitamin k, fresh frozen platelets and inr dropped to 1.0. hematocrit at that time was found to drop from 37 to 27. the patient was given 2 units of packed red blood cells. the patient had vague intermittent chest pain throughout admission to the outside hospital for which he received morphine and sublingual nitroglycerin. cks were negative, but troponin was .63 with an unknown baseline value. the patient was transferred to for the catheterization. upon being admitted to the service and sent for catheterization the patient was found to have maroon stool preprocedure. systolic blood pressure went from 105 down to 85. he received 250 cc bolus and blood pressure increased to 95. the patient was sent for the medical intensive care unit for further monitoring of hypotension. past medical history: 1. end stage renal disease on hemodialysis. the patient's sees dr. . the patient is aneuric and has an av fistula ni the left forearm with a history of clot. 2. hypercalcemia secondary to end stage renal disease and hyperparathyroidism with a pth of 491 in . 3. hypertension. 4. coronary artery disease with history of myocardial infarction in the anteroseptal region unclear when. 5. obstructive sleep apnea. 6. cerebrovascular accident in and left hemiplegia. 7. history of atrial fibrillation and rapid ventricular rate and primary av delay in . the patient was in normal sinus rhythm on coumadin after discharge. 8. catheterization revealed one vessel disease in left anterior descending coronary artery disease approximately 50% stenosis of the left circumflex, impaired ejection fraction at 40% and 1+ aortic regurgitation and 3+ mitral regurgitation. 9. history of ob positive stool in . 10. diabetes type 2 diagnosed in during inpatient admission, but no medical treatment. 11. right middle lobe pneumonia, history of aspiration. 12. history of left subclavian vein stenosis status post stenting. allergies: intravenous contrast requiring steroid use. social history: he lives with his wife whose name is who care for each other although the patient is not mobilized well given his left hemiplegia. the patient has a history of alcohol use unclear when. tobacco use of cigars on a regular basis. no illicit substance use. medications on admission: 1. coumadin 3 mg h.s. 2. nephrocaps daily. 3. renagel daily. 4. prevacid 30 mg q day. 5. atenolol 50 mg q day. 6. amiodarone 200 mg q day. 7. isosorbide 20 mg t.i.d. physical examination on admission: vital signs afebrile. heart rate 74. blood pressure 90/54. respirations 18. 99% saturation on 2 liters nasal cannula as well as on room air. in general, he was a cranky thin man laying at 45 degrees. heent he had moist mucous membranes. no elevation in jvp or jvd. cardiovascular regular rate, 3 out of 6 systolic murmur. no rubs. question of an s3. radial and dorsalis pedis pulses were 1+ bilaterally. lungs were clear to auscultation throughout. abdomen was soft, nontender, nondistended with positive bowel sounds. extremities were cool with no edema. pertinent laboratory studies: anemia with a hematocrit of 30.7, white blood cell count of 13.6 with 95% neutrophilia. electrolytes significant for bicarb of 27, bun 37, creatinine 6.3, and a potassium of 6.3. electrocardiogram revealed normal sinus rhythm at 60 beats per minute with lateral t wave inversions. electrocardiogram revealed no r wave progression and no r wave despite changes in lead placement. notably electrocardiogram sent from outside hospital taken on three days prior revealed normal r wave and normal r wave progression throughout all precordial leads. impression: our impression was that this is a 71 year-old man with a gastrointestinal bleed and hypotension whose treatment was complicated by end stage renal disease requiring hemodialysis and the patient having a history of congestive heart failure and systolic dysfunction and 3+ mitral regurgitation. the patient's hypotension was presumed stable and all antihypertensive medications were held. he received 1 liter intravenous fluid bolus and 1 unit of packed red blood cells. blood pressure was increased in maps were maintained 60 to 65. over the first night of admission the patient had 10 out of 10 chest pain in the substernal area with burning decreased with two sublingual nitroglycerin. no hypotension throughout event and no electrocardiogram changes from his baseline. the patient slept well that night without event and used cpap throughout the night. the patient persistent refused arterial blood gas and blood draws. the patient also had esophagogastroduodenoscopy to investigate source of gastrointestinal bleeding. bile was seen in the stomach and the esophagogastroduodenoscopy was normal to the third part of the duodenum and colonoscopy was recommended. the patient received additional bolus of intravenous fluids with no change in saturations. blood pressure was stable and the patient was transferred to the floor. cks were cycled after initial event of chest pain and were positive with an mb index of 12.3. cardiology consult was called and they recommended medical management and catheterization when the patient could tolerate anticoagulation. the patient was transferred to the floor when he was normotensive. hematocrits were followed carefully. the patient persistently refused drawing of blood despite the presence of triple lumen catheter in his right groin. the patient was given golytely for colonoscopy prep and had persistent maroon stool. hematocrit continued to drop. the plan of care was frequently complicated by patient's inability to recall conversations with the team over the course of his stay and he was repeatedly reoriented and reminded of why he was there and assured that care was being done in his best interest. the patient received additional one unit of packed red blood cells when hematocrit dropped again to 30%. the patient had second hemodialysis without event. given the patient's change in mental status and frequent memory impairment he had a head ct to rule out subdural hemorrhage and there was no evidence of bleeding. colonoscopy on revealed two ulcerations that were thought to be the probable sources of his gastrointestinal bleed. the patient had a polypectomy and there was another ulcer in the hepatic flexure consistent with ischemic colitis after hypotension. on the patient spiked to 102 temperature. blood cultures were sent from his right femoral groin line. fem line was discontinued and the tip culture was sent and line was resighted to the left femoral vein with interventional radiology's assistance. the line placement was extremely difficult given that he had multiple clots in multiple regions including the subclavians bilaterally and very narrow vessels in the femoral region bilaterally not allowing for the normal j wire to be passed through. after being febrile the patient had persistent rigors and was found to have gram negative rods grow in his blood cultures. the patient was covered with vancomycin and levofloxacin. the following day the patient spiked again to 102. four out of four blood cultures were found to be positive for gram negative rods. the patient was started on cipro and zosyn for double pseudomonal coverage. the following day the patient was noted to be bleeding from his av fistula site that was oozing stopping with pressure dressings applied. antibiotics were changed to levofloxacin po given sensitivities found on the gram negative rods. fistula stopped working. on repair was attempted with fistulogram. tissue plasminogen activator injection was done with no effect and fistula site persistently oozed. hematocrits were monitored carefully and were stable. the patient was sent to the operating room with vascular surgery to have fistula repaired without difficulty. final sensitivities of gram negative rods revealed enterococcus faecalis and salmonella. salmonella was susceptible to levofloxacin. vancomycin was continued for faecalis to be continued renally dosed for two weeks of treatment. hospital course: gastrointestinal bleeding and hypotension secondary to ulcerations in the ulcerations in the colon due to ischemic colitis secondary to hypotension as well as polyp. pathology of polyp on found in the descending colon revealed adenoma with high grade dysplasia. the patient was instructed to follow up with gastrointestinal as an outpatient for additional colonoscopies and management of this potentially cancerous condition. for non st elevation myocardial infarction that occurred on the patient was maintained on beta-blockers by mouth and nitroglycerin prn for medical management to follow up with cardiology a full two weeks after having his polypectomy at which time it was presumed that anticoagulation would be safe. for end stage renal disease on hemodialysis the patient had a left av fistula that clotted and led to excessive bleeding after tissue plasminogen activator use and then with repair in vascular surgery. the fistula was highly functional at the time of discharge and was used by dialysis on the day of discharge without any problems. the patient has hypercalcemia due to hyperparathyroidism. the patient was followed throughout his stay by renal consult and had hemodialysis three times weekly. the patient was maintained on sevelamer and calcium acetate and aluminum hydroxide to keep his calcium phosphate less then 70. he was maintained on nephrocaps and a renal diet and lytes were monitored carefully. the patient had a history of atrial fibrillation. he was in normal sinus rhythm throughout his stay and was maintained on amiodarone and anticoagulation was held despite concerns for subsequent cerebrovascular accidents. for fever and bacteremia, this was presumed due to femoral line. the patient had gram negative rods four out of four cultures that was salmonella sensitive to levaquin. the patient also had gram positive anaerobic rod in one bottle that was enterococcus faecalis managed on vancomycin for a two week course renally dosed. diabetes, the patient had no home treatment. he was maintained on a diabetic diet and glucose levels were less then 200 throughout his stay. obstructive sleep apnea, the patient was maintained on bipap each night. he had no home oxygen requirement and had no desaturations throughout his stay. dementia, this was presumed to be some baseline level of dementia without any evidence for reversible causes present as well as due to his history of cerebrovascular accident and left hemiplegia. the patient was managed with olanzapine prn and frequent reorientation. poor musculoskeletal strength and deconditioning, the patient was unable to care for self or transfer. he had physical therapy and occupational therapy assistance. the patient refused to go to rehab. the patient agreed to have home vna as condition for discharge with medical advice and he was set up for physical therapy and occupational therapy at home and he was able to transfer and ambulate with walker at the time of discharge. discharge diagnoses: 1. bacteremia. 2. diabetes type 2 with nephropathy uncontrolled. 3. renal failure chronic. 4. coagulation disorder not otherwise specified. 5. obstructive sleep apnea. 6. history of cerebrovascular accident. 7. left hemiparesis. 8. hypercalcemia. 9. subclavian stenosis. 10. anemia due to blood loss. 11. atrial fibrillation, paroxysmal. 12. myocardial infarction, non q wave myocardial infarction. 13. gastrointestinal bleeding. 14. hypokalemia. 15. hyperkalemia. 16. hypomagnesemia. 17. bacteremia. 18. fistula clot. medications on discharge: 1. atenolol 25 mg po q.d. 2. lipitor 20 mg po q.d. 3. amiodarone 200 mg po q.d. 4. multivitamin po q.d. 5. nitroglycerin prn. 6. calcium acetate two tablets po t.i.d. with meals. 7. trazodone 25 mg h.s. prn. 8. sevelamer 1600 mg po t.i.d. 9. levofloxacin 250 mg po q 48 hours for a 14 day course. 10. tylenol prn. 11. lisinopril 2.5 mg po q.d. 12. aspirin 81 mg q.d. 13. the patient was instructed to not take coumadin until he discussed it with his physician and discussed the benefits and drawbacks of anticoagulation given his multiple illnesses. 14. vancomycin 1 gram at hemodialysis for a total of a 14 day course. the patient was instructed to see his primary care physician on the day after admission. the patient was instructed to have an echocardiogram. the patient was instructed to see a cardiolgoist for a myocardial perfusion study or catheterization to prevent additional myocardial infarctions. the patient was instructed to have a colonoscopy on to evaluate for new polyps. vna was instructed to check the patient's blood pressure, monitor medication use and to help the patient ambulate with walker and transfer. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine other revision of vascular procedure hemodialysis angioplasty of other non-coronary vessel(s) injection or infusion of thrombolytic agent non-invasive mechanical ventilation endoscopic polypectomy of large intestine other transfusion of whole blood diagnoses: subendocardial infarction, initial episode of care iron deficiency anemia secondary to blood loss (chronic) atrial fibrillation bacteremia hemorrhage of gastrointestinal tract, unspecified benign neoplasm of colon other complications due to renal dialysis device, implant, and graft diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled unspecified vascular insufficiency of intestine 

Answer: The patient is high likely exposed to