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 / aldactone attending: chief complaint: gi bleed major surgical or invasive procedure: intubation tracheostomy peg history of present illness: 67 yo f with copd, chf, mvr, cri secondary to renovascular disease was reffered to ed for abnormal labs. . she came in today for routine labs and hct noted to be 18.8 (from 31.7 one month ago). has noted increased fatigue and sob. she says that she noted brbpr on toilet paper few days ago that she attributed to hemorrhoids. she says that when she walked in triage rn noted that she had bright red blood running down her leg (not documented). she denies melena but says that her stools are dark at baseline due to iron. . she had egd and colonoscopy done which showed gastritis and duodenitis, and 3 small colonic polyps (felt to be hyperplastic) which were not biopsied due to her need for anticoagulation and f/u colonscopy was recommended. she was treated with protonix, and clarithro/amox/protonix for positive hpylori. . in ed vs 98.1, 72, 112/25, 13, 100%2lnc--> hct noted to be 18.8. rectal: black guaiac positive stool. ng lavage was clear but without bilious return. her sbp dropped down to 60s and she was admitted to the icu for further w/u and treatment. . past medical history: past medical history: 1. rheumatic heart disease status post mitral valve prolapse x2 with a mechanical valve. 2. copd with a fev1 of 0.6. 3. chf with an ef of 20-30% by echocardiogram . 4. history of afib status post ablation/pacer. 5. peripheral vascular disease, history of aortofemoral bypass. 6. cad with a previous one-vessel disease by cath in '. 7. history of pulmonary hypertension. 8. history of bilateral renal artery stenosis. 9. chronic renal insufficiency with baseline creatinine of 1.6-2.4. 10. history of secondary hyperparathyroidism. 11. status post cholecystectomy .meds: coumadin 5 digoxin 0.0625qd colace 100bid lasix 40qd lisinopril 2.5qd toprol xl 25qd advair spiniva lipitor 10 protonix 40bid feso4 epogen . all: bactrim, aldactone social history: patient quit smoking 1 month ago, prior half pack per day, 50 pack year history. denies any alcohol use. she lives with her husband and son in a single floor apartment. family history: noncontributory. physical exam: pe vs 77/56 70 gen: nad heent:perrl, eomi, dry mmm lungs:ctab cor:rrr, deformed surgical chest abd:s, nt/ nd +bs ext:wwp, no edema, +1 dp rectal: black stool, ob positive, external hemorrhoids, non-bleeding pertinent results: labs on admission to icu 12:20am blood wbc-4.7 rbc-1.89* hgb-5.8* hct-18.8* mcv-100* mch-31.0 mchc-31.1 rdw-17.6* plt ct-184 02:17pm blood wbc-5.0 rbc-1.97*# hgb-5.9*# hct-19.6*# mcv-100* mch-29.8 mchc-29.9* rdw-17.4* plt ct-192 12:20am blood neuts-71.2* bands-0 lymphs-18.7 monos-6.9 eos-2.9 baso-0.4 12:20am blood hypochr-1+ anisocy-1+ poiklo-normal macrocy-normal microcy-normal polychr-occasional 12:20am blood pt-23.3* ptt-34.8 inr(pt)-3.4 12:20am blood plt smr-normal plt ct-184 02:17pm blood plt ct-192 02:17pm blood pt-21.5* inr(pt)-2.9 12:20am blood glucose-96 urean-91* creat-3.5* na-143 k-4.9 cl-110* hco3-23 angap-15 02:17pm blood urean-94* creat-3.7*# na-140 k-4.6 cl-106 hco3-24 angap-15 02:17pm blood alt-11 ast-15 04:40am blood ck(cpk)-58 04:40am blood ck-mb-notdone ctropnt-0.33* 01:25pm blood ck-mb-notdone ctropnt-0.24* 09:44pm blood ck-mb-notdone ctropnt-0.27* 04:40am blood calcium-7.8* phos-5.6*# mg-1.8 02:17pm blood tsh-4.9* 01:58am blood triglyc-133 hdl-34 chol/hd-3.7 ldlcalc-64 01:50am blood pth-183* 04:40am blood cortsol-20.4* 04:41am blood type-art temp-35.4 rates-16/ tidal v-500 peep-5 fio2-100 po2-190* pco2-46* ph-7.22* calhco3-20* base xs--8 aado2-485 req o2-81 -assist/con intubat-intubated 05:50am blood type-art temp-36.0 po2-228* pco2-43 ph-7.25* calhco3-20* base xs--8 intubat-intubated 04:41am blood lactate-1.4 10:12am blood lactate-1.0 04:41am blood freeca-1.03* 01:30pm blood freeca-1.10* labs on discharge 11:59am blood hct-32.3* 04:05am blood wbc-6.9 rbc-3.56* hgb-10.4* hct-32.0* mcv-90 mch-29.1 mchc-32.3 rdw-16.2* plt ct-180 03:32pm blood wbc-6.2 rbc-3.23* hgb-9.4* hct-28.8* mcv-89 mch-29.1 mchc-32.6 rdw-16.1* plt ct-192 03:18am blood wbc-7.1 rbc-3.36* hgb-9.7* hct-30.4* mcv-90 mch-28.8 mchc-31.9 rdw-16.5* plt ct-151 11:59am blood pt-16.1* ptt-92.1* inr(pt)-1.6 06:30am blood ptt-91.7* 04:05am blood plt ct-180 04:05am blood glucose-109* urean-85* creat-2.9* na-139 k-4.4 cl-112* hco3-17* angap-14 03:32pm blood glucose-117* urean-87* creat-2.8* na-140 k-4.5 cl-113* hco3-19* angap-13 04:05am blood calcium-9.0 phos-3.5 mg-2.4 03:32pm blood calcium-8.9 phos-3.2 mg-2.3 04:18am blood type-art temp-36.3 rates-20/ tidal v-500 peep-5 fio2-50 po2-175* pco2-29* ph-7.39 calhco3-18* base xs--5 -assist/con intubat-intubated brief hospital course: 1. gibleed: the initial concern was of upper gi (pylorus) vs. lower gi source. she underwent egd that did not reveal a source of bleed. on -5. surgery and interventional readiology was consulted. she was intubated initially for airway protection as she had copd and required sedation for comfort. she continued to have bleeding and required numerous (around 6 units of prbc and 6 units of ffp for coumadin reversal). she subsequently underwent angiography to find the source of bleeding that revealed 1) an irregular abdominal aorta with a patent aorto-bifemoral bypass graft. there is complete occlusion of the left renal artery.2)cclusion of the inferior mesenteric artery. 3) selective celiac arteriogram revealed irregularity within the gastroduodenal artery and tortuosity of the splenic artery. no vascular abnormality or pseudoaneurysm was identified.4) selective superior mesenteric arteriography revealed a focal moderate stenosis just distal to its origin with collateral filling of the left colic and superior hemorrhoidal arteries via the middle colic and sma branches. there was no evidence of active extravasation nor vascular abnormality identified.the sma stenosis was stented but no evidence of bleed was found. over the next day (3/5-6), she continued to experience dropping hct and underwent abdominal ct to rule out retroperitoneal bleed. the abdominal ct was negative for any such bleed. as her hematocrit stabilized on . she was restarted on heparin for her mitral valve replacement. she has had continued trace guiac positive stool throughout her hospital stay, but she never had another episode of new gi bleed. 2. mvr: she underwent emergent reversal of anticoagulation with ffp given acute gi bleed and hypotension on admission. she was restarted on heparin on after her hematocrit stabilized. her heparin was held again on briefly for tracheostomy and peg tube placement. her heparin was restarted on . her coumadin was restarted on . . 3. respiratory: severe copd (fev1 0.6) and chf (ef 20%). she was initally intubated for airway protection and given need for aggresive volume resuscitation and egd. she was attempted to wean from the ventilator on , but this was unsuccessful as she was likely to experience respiratory muscle deconditioning, fluid overload and baseline severe copd. disucssion was made with the family. she was tried briefly on bipap and given lasix and nebulizer but she failed to respond and was reintubated on and given her likely need for slow wean from ventilation . she underwent tracheostomy placement on . she is deemed to need slow wean from vent. she will go to a vent rehab facility for weaning. . 4. renal: she experienced acute on chronic renal failure likely due to volume depletion on admission with creatine bump to 3.5-3.7. this was improved with aggresive volume resuscitation and blood transfusion. her lisinopril was held. she was also started on dopamine drip briefly during her hospital stay along with lasix drip to help her mobilized her fluid given her chf status. her kidney responded by increasing urine outpt and decreasing creatine. she was followed by renal consult on this admission. she was deemed to be not hemodilaysis candidate on this admission as her kidney suffered an acute event. however, if her renal function does not improve in the near future, she will need an evaluation for hemodialysis. she is also to continued on regular epogen shot for chronic renal insuffiency . 5. chf: ef 20%. monitor volume status with fluid resusciation. her lasix was held this admission . 6. cad: h/o 1vd by cath in 95. her aspiring was held given her gi bleed. her beta-blocker was held given hypotension. transfuse for hct >28. 7. infectious disease- she developed fever and grew gram negative rod that speciated to be pan-sensitive serratia during this admission . she was treated with 10 day course of ceftazidime. she also grew mrsa from her sputum at the same time. she was also treated with 10 day course of vancomycin. she was placed on mrsa precaution during this hospitalization. . 8. fen. she was initially held on po diet given her gi bleed and procedures. she was later started on tube feed during intubation. she is getting tube feed through her peg tube on discharge. . 8. access:she received an right ij and left a-line during this admission for fluid resucitation and intensive blood pressure monitoring. . . discharge medications: 1. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 2. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 3. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed. 4. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 5. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 6. calcium acetate 667 mg tablet sig: two (2) tablet po tid (3 times a day). 7. sevelamer hcl 800 mg tablet sig: one (1) tablet po tid (3 times a day). 8. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 9. epoetin alfa 4,000 unit/ml solution sig: one (1) injection qmowefr (monday -wednesday-friday). 10. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po daily (daily). 11. lorazepam 0.5 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 12. lansoprazole 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 13. fludrocortisone acetate 0.1 mg tablet sig: 0.5 tablet po daily (daily) for 7 days. 14. metoclopramide 5 mg iv q6h 15. heparin sod (porcine) in d5w 100 unit/ml parenteral solution sig: one (1) intravenous asdir (as directed): please aim for ptt goal of 60-80 while pt is being transitioned to coumadin. 16. fentanyl citrate 25-100 mcg iv q4h:prn 17. coumadin 2.5 mg tablet sig: one (1) tablet po at bedtime: please check inr daily and adjust to goal inr 2.5-3.5. 18. prednisone 10 mg tablet sig: one (1) tablet po once a day. 19. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed): 2 unit for fs 150-200: 4 unit for fs 201-250; 6 unit for fs 251-300; 8 unit for fs 301-350; 10 unit for fs 351-400; 10 unit for fs 410 or greater and call house officer. 20. morphine sulfate 2 mg/ml syringe sig: one (1) injection q4h (every 4 hours) as needed. 21. sodium bicarbonate 650 mg tablet sig: two (2) tablet po bid (2 times a day). discharge disposition: extended care facility: - discharge diagnosis: chf chronic renal insuffiency copd discharge condition: stable discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction:1.5l please check inr daily and adjust coumadin to inr 2.5-3.5. coumadin to start on with 2mg coumadin. please stop heparin once inr is therapeutic for a couple of days. please do continous bladder irrigation and decrease frequency as needed to q2 then q4 and monitor for signs of blood clots and urine output. please call hospital if much increased hematuria, but hematuria should resolved over next several days. please check patient creatine daily and forward to facility doctor as pt may need hemodialysis in the future (no indication for hemodilaysis right now) stable creat @ 2.9. please have facility doctor arrange for renal clinic followup at if persistent high creatine as they may need to start hemodialysis in the future pt is adrenal insuffient. pt will need to be on 10 prednisone and 0.1 fludrocortisone indefinitely. followup instructions: please make appointment to see you primary doctor in 2 weeks md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other endoscopy of small intestine insertion of endotracheal tube angioplasty of other non-coronary vessel(s) thoracentesis other bronchoscopy percutaneous [endoscopic] gastrostomy [peg] arterial catheterization temporary tracheostomy arteriography of other intra-abdominal arteries insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) transfusion of packed cells transfusion of other serum diagnoses: acidosis abnormal coagulation profile anemia, unspecified coronary atherosclerosis of native coronary artery urinary tract infection, site not specified acute kidney failure, unspecified unspecified protein-calorie malnutrition chronic airway obstruction, not elsewhere classified infection with microorganisms resistant to penicillins other chronic pulmonary heart diseases rheumatic heart failure (congestive) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease heart valve replaced by other means acute respiratory failure hypotension, unspecified atherosclerosis of renal artery pneumonitis due to inhalation of food or vomitus methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site hyperosmolality and/or hypernatremia stricture of artery chronic vascular insufficiency of intestine angiodysplasia of stomach and duodenum without mention of hemorrhage other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms abnormal sputum 

Answer: The patient is high likely exposed to