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 / methyldopa / clindamycin / sulfamethoxazole / trimethoprim / tylenol attending: chief complaint: gi bleed major surgical or invasive procedure: unsuccessful ir embolization technetium tagged rbc scan colonoscopy central line picc line right groin wound debreidment at bedside with vac placement history of present illness: ms. is a 78 yo woman with history of copd, a-fib, cad s/p nstemi in , ruptured rv from pacemaker placement who is transfered from hospital for l colonic bleeding seen on tagged red cell scan. she was at after a prolonged hospitalization at in 6/. she was discharged on , and at the nursing home was started on lovenox. she presented on to osh with brbpr. she received a total of 6 u prbc with hct trend from 26.9 -> 22 -> 28 (7th u on transfer) and 4 u ffp although inr on presentation was 1.2. gastroenterology apparently defered colonoscopy as they stated they would not be able to see with all the blood. a tagged red blood cell scan showed left colonic bleeding. she was transfered to for possible ir embolization. . initial vs were: t 98.9 p 101 bp 120/52 r 18 o2 sat 95% on 2l. patient was noted to have hct of 22 from 28 with copious bleeding from rectum so 4 u prbc were given. ir, gi, and surgery were called. . review of sytems: (+) per hpi pertinent for brbpr (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. . past medical history: - nstemi with unsuccessful pci of 99% lad stenosis - hospital course complicated by ruptured rv from pacemaker placement with tamponade requiring emergent intubation and femoral line placement. femoral line complicated by arterial thrombus requiring emergent thrombectomy by vasuclar surgery. also treated for vap during hospitalization. - atrial fibrillation - mitral valve prolapse - carotid stenosis - copd, oxygen (2.5l) and steroid-dependent - restrictive lung disease - s/p rul lobectomy - scc - htn - positive ppd s/p inh treatment - vertebral compression fractures . social history: lived in an assisted housing community, prior to but most recently at . she has a son and is widowed. ambulated when at home with a walker and a cane. -tobacco history: 52 pk year history of tobacco, quit -etoh: none -illicit drugs: none family history: mother with mi (age 78), cerebral aneurysm and avm. father unknown. physical exam: on presentation to micu: vitals: t 98.9 p 101 bp 120/52 r 18 o2 sat 95% on 2l general: alert, oriented, no acute distress heent: conjunctiva very pale, mmm, oropharynx clear neck: supple, jvp 6 cm, no lad lungs: rare wheezes and diminished breath sounds throughout, without rales, rhonchi cv: irreg irreg, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley draining clear yellow urine rectal: patient with copious brb per rectum ext: faint pulses, no clubbing, cyanosis or edema, r femoral wound with necrotic tissue, r le wound after fasciotomy. . pertinent results: 09:30pm wbc-10.3 rbc-2.60* hgb-7.8* hct-22.0* mcv-85# mch-30.1 mchc-35.5* rdw-16.5* 09:30pm plt smr-very low plt count-72*# 09:30pm pt-14.5* ptt-26.9 inr(pt)-1.3* . 09:30pm glucose-105 urea n-30* creat-0.7 sodium-142 potassium-4.1 chloride-103 total co2-29 anion gap-14 09:30pm alt(sgpt)-17 ast(sgot)-25 alk phos-42 tot bili-2.1* . 10:09pm urine blood-mod nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-4* ph-7.0 leuk-neg 10:09pm urine rbc-0-2 wbc- bacteria-few yeast-none epi-0 . hct trend: 05:25am blood hct-32.8*# plt ct-50* 08:27am blood hct-36.1 plt ct-50* 11:50am blood hct-30.5* plt ct-46* 02:27pm blood hct-26.0* 04:09pm blood hct-29.4* plt ct-124* 06:05pm blood hct-32.5* 09:47pm blood hct-31.2* plt ct-106* 04:06am blood hct-29.5* plt ct-110* 02:55pm blood hct-27.6* plt ct-90* 09:38pm blood hct-31.3* 03:52am blood hct-31.9* plt ct-91* 12:36pm blood hct-33.5* 03:17am blood hct-31.2* plt ct-93* . cxr - r sided volume loss with flat diaphragms, no infiltrates, picc and ng tube in place. . echo: left ventricular wall thicknesses and cavity size are normal. there is mild global left ventricular hypokinesis (lvef = 45 %). the right ventricular cavity is moderately dilated with mild global free wall hypokinesis. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. moderate to severe tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. . ekg: a-fib rate 80s, rbbb, twi in v1-2 unchanged from prior . gi bleeding study: impression: no defiinte evidence of gastrointestinal bleeding. increased activity within the low abdomen just left of midline is likely artifactual. . colonoscopy: limitations: poor preparation, therefore, small polyps might be missed and small avm might be missed too. when the whole colon, was reached. findings: excavated lesions multiple non-bleeding diverticula with medium openings were seen in the sigmoid colon and mid-descending colon. diverticulosis appeared to be of moderate severity. impression: diverticulosis of the sigmoid colon and mid-descending colon otherwise normal colonoscopy to cecum brief hospital course: ms. is a 78 yo woman with history of copd, a-fib, cad s/p nstemi in , ruptured rv from pacemaker placement who was transfered from hospital for l colonic bleeding seen on tagged red cell scan. she was at for rehab after a prolonged hospitalization at in 6/. she was discharged on , and at the nursing home was started on lovenox. she presented to osh on with brbpr. she received a total of 6 u prbc with hct trend from 26.9 -> 22 -> 28 (7th u on transfer) and 4 u ffp although inr on presentation was 1.2. gastroenterology apparently defered colonoscopy as they stated they would not be able to see with all the blood. a tagged red blood cell scan showed left colonic bleeding. she was transfered to on for possible ir embolization. 1. gi bleed: went for ir guided embolization, but unable to locate source of bleeding. - gi consulted for colonoscopy but bleeding not able to scope. hct continued to drop hct 36 -> 30.5 -> 26 and pt transfused, but repeat tagged rbc scan negative. colonoscopy showed diverticulosis in the sigmoid colon but no active bleeding. hct stabilized. pt was transfered out of the micu back onto the medicine floor where her stools continued to be guiaic negative. her hematocrits were stable for several days prior to discharge. 2. wound infection pt also has r femoral groin wound s/p r sfa thrombectomy, rle fasciotomy, and r femoral and external iliac endarterectomy. debrided at bedside and vac dressing placed. wound culture growing pseudomonas and mrsa. initially started on ciprofloxacin and meropenum but changed to cefipime resistence. per vascular, will change vac sun/tues/thurs. cefipime should be continued until he sees the vascular surgeon in a few weeks. they will decide whether the wound has healed enough to stop taking the cefepime. atrial fibrillation. patient noted to be in and out of a fib while in the micu. had episode of cp on , ekg with afib, hr low 100s. given lopressor 5mg x 1 with conversion to sinus. again svt with hr 170s, converted with 5 mg lopressor. was then started on amiodarone and remained stable afterward. she should continue on amiodarone and will need lfts, tfts, and pfts checked again in 3 months. pt transfered to medicine floor . denied cp, f/c/ urinary sx, blood in stools. + sob. remained stable with no evidence of bleeding. pt was restarted on , , lisinopril at a low dose. copd: on home o2 and steroid dependent. currently on prednisone taper. she will be discharged on 5mg daily which can be continued for two weeks, then 5mg indefinitely until she follows up with the pulmonologist which will be set up by the facility. she was continued on ipratropium and advair with nebulizers prn for wheezing. she is on baseline o2 2l by nasal canula at baseline with shortness of breath with minimal exertion. she will need to follow up with her pulmonologist in the next few weeks. r femoral wound: necrotic tissue present around prior thrombus site. vascular surgery placed wound vac which will be changed sunday/tuesday/thursday. she was started on cefepime and should continue until she sees the vascular surgeons in a few weeks. ppm site wound: this has been stable while the patient has been hospitalized. she may benefit from wound care evaluation to ensure it stays stable. acute on chronic systolic chf: patient has some shortness of breath after all of her transfusions and holding her lasix. she was restarted on her home dose of lasix with good urine output and improvement in her breathing. her electrolytes were stable afterward. cad s/p nstemi in : originally patient's aspirin and were held in the setting of her gi bleed. these were restarted after her hematocrit stabilized and she remained stable after initiating these. she was continued on her beta blocker and ace inhibitor after the hematocrit stabilized and her statin was also continued. medications on admission: medications at hospital: - nexium 40 mg daily - colace 100mg - senna 1-2 tabs prn - mvi - citalopram 20 mg daily - lovenox 40 mg daily - 75 mg daily - 325 mg daily - advair 250/50mg 1 puff - amiodarone 200 mg daily - simvastatin 80 mg daily - tiotroprium 1 cap daily - metorpolol tartarate 25 mg tid - lasix 40 mg po daily - trazodone 25 mg - lisinopril 10 mg daily - prednisone taper currently at 20 mg daily - zinc 220 mg daily - reg insulin ss - keflex 500mg tid (unclear course) - nystatin swish and swallow qid . medications on transfer: cefazolin 1 gm iv q8hr nystatin po qid regular insulin ss methylprednisolone 20 mg iv daily tiotroprium 1 cap daily esomeprazole 40 mg iv bid advair 1 puff ondansetron 4 mg iv q8hr discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 3. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 4. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 5. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 6. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 7. ipratropium bromide 17 mcg/actuation aerosol sig: one (1) inh inhalation every six (6) hours. 8. furosemide 40 mg tablet sig: one (1) tablet po once a day. 9. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. 11. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 12. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day) as needed for peri rash. 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 14. cefipime sig: two (2) grams every twenty-four(24) hours: please continue antibiotic until appt with vascular surgery on . 15. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: diverticulosis r femeral groin wound infection - pseudomonas atrial fibrillation secondary diagnosis: cad s/p stemi copd discharge condition: gi bleed resolved. vital signs stable. discharge instructions: you were transfered to from the hospital for embolization (or clotting) of your gi bleeding. you were taken by the interventional radiology team, but they were unable to stop the bleeding. you were transfused several units of blood in the intensive care unit. eventually your bleeding stopped and you had a colonoscopy which showed diverticulosis. your blood levels stabilized and you have not had any evidence of rebleeding. you also have an infection in your right grion where the blood clot was surgically removed. your wound was cleaned by the surgeons and you are taking antibiotics to treat the infection. you were also noted to have atrial fibrillation during this hospitalization. however, you were treated with medicine and your heart rhythm became normal again. we are discharging you with the new medication cefepime. you should continue to take this medication in addition to your home medications. please note your dose of lisinopril was decreased. this may be increased over time by your doctor as needed. you should return to the hospital if you notice any blood in your stool, bleeding from your rectum, blood in vomit, fevers, or have dizzyness, or chestpain. followup instructions: please follow up with your primary care provider (dr. in weeks. provider: , md phone: date/time: 1:30 please follow up with your pulmonologist in weeks to discuss your prednisone taper and have your pulmonary function tests checked as you were started on a medication that can affect your lungs. procedure: venous catheterization, not elsewhere classified colonoscopy arteriography of other intra-abdominal arteries nonexcisional debridement of wound, infection or burn application of pressure dressing diagnoses: thrombocytopenia, unspecified coronary atherosclerosis of native coronary artery mitral valve disorders other postoperative infection congestive heart failure, unspecified unspecified essential hypertension long-term (current) use of steroids acute posthemorrhagic anemia chronic airway obstruction, not elsewhere classified atrial fibrillation cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure cardiac pacemaker in situ methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site hyperosmolality and/or hypernatremia acute on chronic systolic heart failure diverticulosis of colon with hemorrhage subendocardial infarction, subsequent episode of care diseases of tricuspid valve pseudomonas infection in conditions classified elsewhere and of unspecified site non-healing surgical wound 

Answer: The patient is high likely exposed to