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: heparin agents attending: chief complaint: gasteroenteritis, ?gib, hypotension major surgical or invasive procedure: cvl history of present illness: mr. is a 85 year old male with pmh intracranial hemorrhage with right-sided residual weakness, htn, hld, anemia, ckd, dementia who presents with fever. wife states that he was complaining of abdominal pain 5-6d prior, which resolved on its own after 2 days. she felt that he was excessively tired ever since he was put on keppra for a new-onset seizure that he suffered 1 month prior. per nursing home report, pt had fever of 103.7f. pt was found lying a large pool of dark brown stool. apparently reported vomiting x 1. no melena noted, no stomach pain. patient did not have any complaints but has dementia. prior to transport, pt's vitals at nursing home were t 103.7, hr 117, r 20, bp 108/61, o2 sat 90% on ra. he is full code per ed resident report (confirmed). on route, ems reported that the patient was initially unresponsive. however upon questioning in the ed, the ems denies such history. . in the ed inital vitals were temp 100.0f, hr 107, bp 137/80, rr 21, sat 97% ra. pt's bp gradually decreased to 78/36 over 3.5 hrs at 12.50p, then 68/35 on re-test. central line was placed, and pt was given 4l ns, with improvement in bp to 133/59. on exam he was noted to have guaiac positive brown stool. labs showed lactate 2.7, na 146, cr 1.8 ( cr 1.5-1.6), wbc 9.1 with pmn's 90.2%, hct 37, plts 102, coags normal, ua was negative. cultures were sent. lft's were unremarkable. ctap showed no acute issues. he was initially placed on cipro/flagyl for concern for bowel source. ngl showed feculent material with small amounts of blood. no evidence of obstruction from ct, and therefore ngt pulled out. gi was consulted and recommended protonix gtt and plan to likely scope tomorrow. surgery was consulted as well, and thought exam and ct were non-concerning. he had bp drop to 50s? around noon, and left ij was palced for access. levophed was drawn up, but never used, as pt was fluid responsive. he was given 3.5l ns with improvement in bp. lactate improved to 1.4. access left ij, 2 20's piv's. he had tmax 101.2. vs prior to transfer t 99.2 hr 82 133/59 rr 16 91% 3lnc. . on arrival to the icu, pt's vitals were 99.2f, bp 145/71, hr 96, rr 20, sat 93% ra -> 94% 2l nc. . pt was recently admitted in for preseptal cellulitis from . that hospitalization was complicated by acute renal failure and uti. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: 1. status post right intracranial hemorrhage in with residual left-sided hemiparesis 2. hypertension 3. hypercholesterolemia 4. falls 5. chronic bilateral shoulder and hip pain 6. chronic low back pain secondary to degenerative joint disease and spinal stenosis 7. emphysema on imaging 8. osteoporosis - the patient is on a bisphosphonate, calcium, and vitamin d. 9. median neuropathy on the right- s/p surgery . 10. anemia 11. bph 12. depression 13. vascular dementia 14. thrombocytopenia of unknown source noted in 15. c7 spinous process fracture 16. small 3rd ventricular hemorrhage in . past surgical history: 1. bilateral cataract surgery. 2. bilateral rotator cuff repair. 3. repair of cartilage of the left knee. 4. left mastoid surgery as a child. 5. right pronator tendonotomy, lengthening, and right carpal tunnel release . social history: married, 2 adult daughters retired - used to run a butcher shop smoked 1-2ppd x30 years former 1 glass/day alcohol, now abstinent x years ms aox2, forgetful but can carry on a conversation. walks with a walker. temporarily living in a ( in , ma) because of frequent, unexplained falls at home. family history: mother - died of cancer in her 70's father - died of an mi in his 60's no seizure hx no stroke hx physical exam: admission exam: vitals: t: 100.6f, hr 86, bp 161/67, rr 20, sat 95% 2l nc. general: sleepy, oriented x1, no acute distress, no pain : sclera anicteric, oropharynx dry neck: supple, jvp not elevated, no lad lungs: no use of accessory muscles, bibasilar inspiratory crackles cv: distant heart sounds, regular rate and rhythm, 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 present ext: warm, well perfused, 2+ pulses in upper extremities, cool and difficult to assess pulses in bilateral lower extremities. neuro: a&o to person, knows wife, following commands, does not state date or location, moving all extremities discharge: vs- tc 98.4 bp 153/76 hr 67 rr 20 98% ra gen: elderly man in nad. oriented to person and place, not time : perrl, eomi. mmm, op benign. neck: supple, no jvd. no cervical lymphadenopathy. no carotid bruits noted. cv: rrr with normal s1/s2, holosystolic murmur best heard at rusb chest: course crackles at right base abd: +bs, soft, ntnd. ext: wwp, no edema. 2+dp/pt b/l pertinent results: admission labs: wbc-9.1 rbc-4.35* hgb-11.9* hct-37.0* plts 102 neuts-90.2* lymphs-6.8* monos-2.2 eos-0.1 basos-0.7 pt-11.4 ptt-32.7 inr(pt)-1.1 lactate-2.4* alt(sgpt)-21 ast(sgot)-26 alk phos-65 tot bili-0.5 lipase-25 urine blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg rbc-2 wbc-1 bacteria-few yeast-none epi-0 . pertinent labs: test result ---- ------ heparin dependent antibodies positive (hit test positive) serotonin release assay pending on discharge: 07:15am blood wbc-3.7* rbc-3.09* hgb-8.4* hct-25.5* mcv-83 mch-27.1 mchc-32.8 rdw-13.3 plt ct-106* 07:15am blood glucose-98 urean-20 creat-1.4* na-141 k-4.3 cl-105 hco3-27 angap-13 07:15am blood calcium-8.2* phos-3.8 mg-2.2 03:36pm blood lactate-1.4 microbio: fecal culture (pending): campylobacter culture (pending): fecal culture - r/o e.coli 0157:h7 (pending): clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). blood cultures: negative urine culture (final ): no growth. cxray : right basilar opacification c/w aspiration. cannot r/o infection. cxay : resolution of right basilar opacification brief hospital course: mr. is a 86 yo m w/ pmh intracranial hemorrhage with right-sided residual weakness, htn, hld, anemia, ckd, dementia who presented with fevers, vomiting, and diarrhea with course complicated by acute on chronic thrombocytopenia and persistent fevers. . # hypotension: patient was admitted to the icu with hypovolemic shock. blood pressure improved with fluid resuscitation. volume loss was due to vomiting and diarrhea for 3 days prior to admission, and potential sepsis. vomiting/diarrhea was attributed to viral gastroenteritis. patient was initially on cipro/flagyl given instability, which was discontinued on transfer to the floor. pressures were stable to elevated throughout the remainder of admission. . # fevers: on admission, patient had three days of vomiting and diarrhea, concerning for gastroenteritis. u/a on admission did not show signs of infection and cxr was clear. patient was initially on ciprofloxacin/metronidazole as he was unstable to empirically treat bacterial gastroenteritis. patient continued to have low grade fevers on transfer to the floor. on hd3, patient spiked a fever to 101.2. urinalysis showed moderate bacteria, with 13 wbcs, +nitrites. patient's foley catheter was removed and he was started on ciprofloxacin as he had pan-sensitive e.coli in the past. cxr at that time showed mild consolidation in the right lower lobe. overnight on hd3, patient again spiked a fever up to 102.6. repeat cxr showed increased density in the right lower lobe. antibiotics were broadened to treat health-care acquired pneumonia with vancomycin and piperacillin-tazobactam. there was also concern for aspiration pneumonitis vs pneumonia given patient's dementia and debilitated state. he was evaluated by speech & swallow who saw no overt signs of aspiration, but recommend ground solids/thin liquid diet. video swallow also showed no signs of silent aspiration. patient continued to spike fevers, therefore it was felt that he was likely aspirating given rll consolidations which rapidly resolved, consistent with pneumonitis. he was changed to a pureed solid/nectar thick liquid diet and tolerated this well. . # thrombocytopenia: on admission, as above, patient's cbc was significantly hemoconcentrated and showed platelets of 100, dropping to 60s following volume resuscitation. patient has a history of thrombocytopenia, followed by hematology as an outpatient, which has been attributed to chronic illness and potentially medication effect. however, platelets always returned to low-normal. platelets dropped to as low as 46 during this admission which was concerning for hit. hit antibody was positive, and patient was started on argatroban drip. hematology was consulted to help better evaluate likely underlying cause of thrombocytopenia. further information from hit antibody revealed an optical density of 0.55, only weakly positive so low probability of being true positive. in addition, time course did not fit well with hit. peripheral smear showed evidence of abnormal wbcs and nucleated rbcs concerning for mds. hematology recommended outpatient management of the mds with patient's primary hematologist, dr. . argatroban was discontinued in light of new information, and patient was placed on fondaparinux for dvt prophylaxis, however given decreased renal function this was stopped and patient was placed on mechanical dvt prophylaxis. a serotonin release assay was sent as confirmatory test of hit. this was pending at the time of discharge. if it returns negative for hit, the patient can safely receive heparin agents in the future. . # acute on chronic renal failure: cr 1.5-1.6. bumped to 1.8 on admission in setting of hypovolemia, but was responsive to fluid resuscitation. creatinine remained around throughout the remainder of admission. medication was renally dosed given low gfr of approximately 30. losartan was held throughout admission, and hydrochlorothiazide was discontinued prior to discharge. . # htn: on admission, amlodipine 10mg daily, hydrochlorothiazide 25mg daily, aliskiren 300mg daily, losartan 100mg daily were all held in the setting of hypotension. amlodipine was restarted following volume resuscitation once patient became hypertensive. losartan was reintroduced into the patient's regimen at discharge. hydrochlorothiazide and aliskerin are still being held. . # dementia: remained at throughout admission, per report of wife. continued (memantine) 10mg daily. . # guaiac positive stool: patient had guaiac positive stool on admission, and throughout admission. however, his hematocrit remained stable. of note, initial cbc was significantly hemo-concentrated, as with fluid resuscitation, all cell lines returned to their normal and remained stable at this level. initial 10 point hematocrit drop was therefore not attributed to bleeding. he was evaluated by gi who felt that he did not need emergent colonoscopy, and should follow-up with gi as an outpatient. patient has known history of polyps and diverticula on last colonoscopy in . # history of seizure: recent admission for witnessed seizure at rehab, placed on keppra and pyridoxine. wife was concerned about the sedating effect of the keppra. outpatient neurologist reiterated the importance of continue anti-seizure medications, and felt that other options might be more sedating. patient was continued on keppra at outpatient dose and has neurology follow-up scheduled to further discuss this medication with patient and his family. . # hx cva: aspirin and statin were continued throughout admission. . # transitional issues: - serotonin release assay is still pending to confirm true heparin allergy - blood, urine cultures pending at the time of discharge - f/u scheduled with neurology, hematology, and gi - alter blood pressure regimen as necessary medications on admission: amlodipine 10mg daily aspirin 81mg daily ferrous sulfate 325mg daily hydrochlorothiazide 25mg daily omega 3,6,9 1200 capsule kcl 10meq qam and 20meq qpm daily losartan 100mg daily multivitamin 1 tab daily (memantine) 10mg daily calcium-vitd 500-200 x 2 tabs daily simvastatin 20mg daily aliskiren 300mg daily vitamin b-6 pyridoxine 100mg daily vit d3 400 iu daily levetiracetam 500mg discharge medications: 1. memantine 10 mg tablet sig: one (1) tablet po daily (). 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). 4. amlodipine 10 mg tablet sig: one (1) tablet po once a day. 5. pyridoxine 100 mg tablet sig: one (1) tablet po once a day. 6. multivitamin tablet sig: one (1) tablet po daily (daily). 7. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 8. simvastatin 20 mg tablet sig: one (1) tablet po at bedtime. 9. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 10. omega 3-6-9 1,200 mg capsule sig: one (1) capsule po twice a day. 11. calcium-vitamin d 600 mg calcium- 400 unit tablet sig: one (1) tablet po once a day. 12. losartan 100 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: 1. gastroenteritis 2. thrombocytopenia 3. myelodysplastic syndrome 4. pneumonia secondary diagnosis: # dementia # hypertension # history of seizure # history of stroke # history of intracranial hemorrhage discharge condition: mental status: confused - always. level of consciousness: lethargic but arousable. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , it was a pleasure taking care of you during your recent admission to . you were admitted because of vomiting and diarrhea causing your blood pressure to be very low. you were given fluids and your blood pressure improved. your vomiting and diarrhea improved on their own with time. in addition, during the admission, you had inflammation in your lung which was thought to be due to food going down the wrong route, into your lung. your diet was altered to help prevent this. the following changes were made to your medication regimen: - stop aliskiren - stop hctz followup instructions: department: neurology when: wednesday at 4:00 pm with: drs. & building: sc clinical ctr campus: east best parking: garage department: gastroenterology when: tuesday at 12:45 pm with: , md building: lm bldg () campus: west best parking: garage department: hematology/bmt when: tuesday at 2:30 pm with: , np building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: tuesday at 2:30 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: venous catheterization, not elsewhere classified diagnoses: pneumonia, organism unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified myelodysplastic syndrome, unspecified other and unspecified hyperlipidemia other shock without mention of trauma osteoporosis, unspecified other late effects of cerebrovascular disease nonspecific abnormal findings in stool contents vascular dementia, uncomplicated cerebral atherosclerosis intestinal infection due to other organism, not elsewhere classified history of fall late effects of cerebrovascular disease, hemiplegia affecting dominant side 

Answer: The patient is high likely exposed to