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: bactrim / tetanus toxoid attending: chief complaint: acute abdominal pain major surgical or invasive procedure: exploratory laparotomy; subtotal colectomy with end ileostomy history of present illness: history of presenting illness this patient is a 80 year old female with a history of chf and copd who complains of severe abd pain radiating ot her back. patient reports constipation for the past 5 days, blood in stool, and left leg numbness. patient comes from , where a ct scan ruled out aaa but shows evidence for ischemic colitis. the patient was hypotensive at the outside hospital and was started on neo. she was not given antibiotics. her last bowel movement was about an hour ago which consisted of diarrhea. timing: gradual severity: severe duration: hours location: abdomen context/circumstances: pain past medical history: past medical history: chf, osteoporosis, pacer, , cad, copd social history: lives at home. family history: nc physical exam: physical examination upon admission: temp: 98.5 hr: 110 bp: 115/28 resp: 18 o(2)sat: 100 normal constitutional: uncomfortable heent: normocephalic, atraumatic oropharynx within normal limits chest: clear to auscultation cardiovascular: paced. no murmur abdominal: soft, diffusely tender. rectal: heme positive gu/flank: no costovertebral angle tenderness extr/back: no cyanosis, clubbing or edema skin: warm and dry neuro: speech fluent psych: normal mood heme//: no petechiae pertinent results: 05:17am blood wbc-8.3 rbc-3.59* hgb-11.5* hct-36.2 mcv-101* mch-32.0 mchc-31.7 rdw-16.0* plt ct-309 10:15am blood wbc-8.4 rbc-4.02* hgb-12.8 hct-40.7 mcv-101*# mch-31.9 mchc-31.4 rdw-15.5 plt ct-391# pathology: tissue: colon: ileum and colon, exploratory laparotomy: 1. ischemic colitis with diffuse mucosal damage and focal submucosal edema and transmural acute inflammation; distal end demonstrates mucosal ischemia only. 2. proximal ileal resection margin, within normal limits. 3. five adenomata, measuring from 0.3 to 1.1 cm in greatest dimension; no high grade dysplasia or carcinoma seen. 4. regional lymph nodes, within normal limits. 5. medial calcification and atherosclerosis of arteries of mesocolon echo: the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is low normal (lvef 50-55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. chest (portable ap): the et tube tip is 5.5 cm above the carina. the pacemaker leads terminate in right atrium and right ventricle. cardiomegaly is unchanged. there is interval improvement of pulmonary edema, currently minimal. there is no substantial pleural effusion and there is no pneumothorax. right internal jugular line tip is at the level of mid low svc. linear opacities projecting over the pacemaker are new and most likely represents overlying findings , and unlikely to represent discontinued pacemaker leads but repeated radiograph to clarify this point is recommended. chest (portable ap): comparison is made to prior study from the chest radiograph from . there is a right-sided pacemaker distally tips in the right atrium and right ventricle, appropriately sited. there is a right ij central venous line whose tip is in the distal svc. endotracheal tube and nasogastric tube are appropriately sited. there is persistent cardiomegaly. there has been interval worsening of the left retrocardiac opacity. no significant pulmonary edema is seen. there are no pneumothoraces. ecg: sinus rhythm with ventricular premature beats. left axis deviation. first degree a-v block. intraventricular conduction defect with atypical left bundle-branch block. probable old anterolateral myocardial infarction. no previous tracing available for comparison. chest (portable ap): impression: 1. the patient is markedly rotated on the current examination. the endotracheal tube has its tip 4.4 cm above the carina. a nasogastric tube is seen coursing below the diaphragm with the tip not identified. a right internal jugular central line is unchanged in position with its tip in the proximal to mid svc. 2. there is worsening bilateral airspace process, likely pulmonary edema with increasing consolidation at the left base likely reflecting compressive atelectasis in the setting of a pleural effusion. a smaller right effusion is also likely evident. a right-sided dual-lead pacer remains in place with its leads terminating over the expected location of the right atrium and right ventricle respectively. no pneumothorax appreciated. heart remains enlarged. portable ap chest radiograph: a right dual-lead pacemaker device is noted with leads terminating in the right atrium and right ventricle. a nasogastric tube is noted with tip not clearly visualized in the field of view. a right ij catheter appears kinked as before; however, the tip projects over the upper svc in unchanged position from the prior examination. moderate cardiomegaly is stable. there is no pneumothorax. mild pulmonary edema is unchanged from the prior examination. stable left lower lobe opacity may represent pleural effusion with adjacent atelectasis; however, infectious process such as pneumonia cannot be completely excluded in the correct clinical setting. minimal opacification at the right lung base may also represent atelectasis versus aspiration pneumonitis or pneumonia chest(portable ap): impression: ap chest compared to : mild pulmonary edema and bibasilar atelectasis have both improved since . transvenous right atrial and right ventricular pacer leads follow their expected courses. pleural effusions are small if any. no pneumothorax brief hospital course: the pt initially presented to an osh with acute onset abdominal pain which began suddenly earlier that morning that was associated with non-bloody diarrhea. at the osh she was hypotensive to the 70's so was bolused with crystalloid fluids and started on pressors. a ct scan at the time showed diffuse non-specific colitis and she was transferred to for further care. on arrival in the ed she was noted to be hypotensive to the 90s with escalating doses of neo-synephrine. troponin' were negative, and patient's abdominal exam was consistent with peritonitis with mental status changes. after a discussion with the family and patient she consented to an exploratory laparotomy. she was given vancomycin, cipro and flagyl preoperatively. please see operative note for further details. at laparotomy patient was noted to have ischemic splenic flexure through sigmoid colon. her right colon was dilated and thin with a cecal bascule, a subtotal colectomy and end ileostomy was performed. a jp drain was left above her . post operatively she was transferred to the icu, intubated on dual pressors. a right femoral a-line placed. a tte was performed and her pacer was interrogated. cardiac enzymes were cycled without evidence for myocardial injury. by pod 1 she was off pressors with stable vital signs. she was started on intermittent lopressor for intermittent tachycardia that extended into pod 2. these episodes of atrial tach with nonsustained v-tach delayed extubation. cardiology and ep were re consulted. pod : patient was extubated, cardiology stated that no intervention should be performed for her atrial tachycardia aside from beta blockade. she was diuresed with intermittent lasix. ngt was continued. pod 5 tf started at 20ml/hr via ngt. pod 6 ngt was discontinued with flatus. patient was restarted on her home macrobid. ciprofloxacin and flagyl were discontinued after a 7 day course. speech and swallow was consulted and recommended thin liquids, pureed solids. jp drain d/c'ed. pt worked with her throughout her icu stay. nursing care helped with patient teaching. pathology returned ischemic colitis. on pod 7 patient was transferred to the floor where she remained stable with stable vital signs. the patient's outpatient cardiologist was contact and felt it was appropriate to initiate 3 mg warfarin daily with adjustment per inr due to new onset atrial fibrillation. she received her first dosage of 3 mg on and will require daily inr checks; most recent inr 1.1 . of note, the patient complained of left leg pain on pod9. no erythema or edema was noted at that time, but will require monitoring. additionally, she continued to tolerate a diet, which was advanced to soft solids, thin liquids and whole pills with thin liquids as tolerated following re-evaluation by speech and swallow on pod9. her ostomy continued to function well and was draining moderate amounts of semi-formed stool; stoma was beefy red. the ostomy rn assisted with care and teaching, but would require additional teaching for ongoing management. the patient was subsequently discharged to rehab on . medications on admission: neurontin 300 qam, 600 qpm, tramadol 100 qid, vicodin 5/500 q4h prn, trazadone 50 qhs, tylenol 1000 prn, spiriva inh, xopenex 0.63', lasix 20', baclofen 10', omeprazole 20', lidoderm 5% td, lisinopril 5', nitrofurantoin 100', simvastatin 20', mom 30', dulcolax 10', klor-con 10', fleets enema' discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for sob/wheeze. 3. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 4. tylenol 325 mg tablet sig: two (2) tablet po every 4-6 hours as needed for pain. 5. nitrofurantoin monohyd/m-cryst 100 mg capsule sig: one (1) capsule po daily (daily). 6. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 7. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 8. oxycodone 5 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. 9. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). 10. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed for to affected area: apply to affected breast & groin folds as directed. 11. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed for to affected area. 12. warfarin 1 mg tablet sig: three (3) tablet po once (once) for 1 doses: goal inr for afib. dose daily based on reaching inr goal. 13. insulin regular human 100 unit/ml solution sig: one (1) dose injection four times a day as needed for per sliding scale. discharge disposition: extended care facility: house nursing home - discharge diagnosis: ischemic colitis atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted to the hospital with with an acute condition of your intestines where blood flow was compromised requiring an operation to repair this condition. as a result you have a colostomy bag where stool can collect into a pouch. after your operation you also had another condition where your heart rate was too fast prompting that cardiology evaluate you. several recommedations for medication management of this were made and put into place. followup instructions: department: general surgery/ when: tuesday at 3:00 pm with: acute care clinic with dr phone: building: lm bldg () campus: west best parking: garage name: , np specialty: cardiology location: medical associates address: , , phone: when: at 11:40am name: i.,md specialty: primary care location: medical and walk- in center address: , 3rd fl, , phone: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances open and other right hemicolectomy exteriorization of small intestine artificial pacemaker rate check diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension unspecified septicemia severe sepsis chronic airway obstruction, not elsewhere classified atrial fibrillation acute respiratory failure osteoporosis, unspecified septic shock cardiac pacemaker in situ barrett's esophagus restless legs syndrome (rls) unspecified vascular insufficiency of intestine postprocedural fever paroxysmal tachycardia, unspecified 

Answer: The patient is high likely exposed to