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: renal failure, colitis, s/p colectomy/ostomy major surgical or invasive procedure: colectomy with end ileostomy history of present illness: in brief, patient is a 63 yo cambodian male with h/o htn, copd, past cva who was transferred from an osh after presenting with left sided weakness on , s/p aaa repair (5.5cm) on c/b pna, renal failure requiring intermittent hd, colitis, and hit. . patient intially presented on with 10-15 minutes of inability to move his left arm, which had happened previously. he was ruled out for mi and stroke. he was seen by surgery and had repair of a 5.5 cm juxto-renal aaa with aorto-bifemoral bypass on . his post-op course was subsequently complicated by acute renal failure, requiring multiple sessions of hd with tessio cath. he also developed necrotic/ gangrene of toes b/l s/p surgery, no intervention was performed. he also initially had persistent nausea, for which he was scoped from above and below. he was started on tpn due to poor nutritonal status. during the middle of his hospitalization, he developed pna (sputum + for enterobacter) and was treated with iv antibiotics. he also developed loose stools and a distended abdomen; stools were positive for c-diff and he was started on po flagyl. due to worsening abdominal symptoms and increasing wbc from 16 to 36 since , he underwent a sigmoidoscopy on which demonstrated pseudomembranous plaques, c/w c diff. the patient was then changed from po flagyl to iv flagyl and po vanc. however, he did not respond to treatment, and his wbc worsened and abdominal exam also worsened in terms of tenderness and absence of bowel sounds; therefore, concern for ischemic colitis was raised. he subsequently became more lethargic and was transferred back to the icu at the osh and sent directly to the micu at for further management. options of colectomy were raised at the osh, however there was concern that the patient would be too high-risk. his last hd was and was stopped as patient was making approximately 1 l urine/day. . ros: as per hpi, otherwise negative past medical history: 1. htn 2. hypercholesterolemia 3. 5.5 cm juxto-renal aaa, s/p aorto-bifemoral bypass on complicated by atn from underperfusion 4. old large r-posterior mca infarct 5. copd 6. acute renal failure due to atn from aaa repair 7. h/o inf wall mi with ef 46% - repeat tte with ef 30-35% and depressed global/lv systolic dysfunction 8. septic emboli to feet with gangrene 9. c. diff infection with toxic megacolon, s/p subtotal colectomy on with end ostomy placement social history: pt from originally, now living in the u.s for over 22 years. pt worked as a machinist. + smoker, occasional etoh. pt is married with 5 children and 11 grandchildren family history: non-contributory physical exam: vs: t 97.5, bp 124/68, hr 91, rr 20, 95%ra gen: elderly cambodian male, smiling, alert and talking softly heent: eomi, perrl, anicteric sclera, mmm, op difficult to appreciate neck: supple, full rom, no lad, jvp at 2cm above neck lung: good air movement, scant fine bibasilar crackles, heart: rrr, no m/r/g, nl s1 s2 abd: soft, mild tenderness throughout abdomen with mild guarding. well healing midline surgical scar with staples intact. ostomy pink with gas and output. + bs back: no tenderness to palpation ext: warm, well perfused. dry gangrenous toes bilaterally, no pitting edema or calf tenderness skin: warm, no rashes noted neuro: cn ii-xii intact, moving all extremities. difficult to perform detailed aspects of exam given patient's cooperation pertinent results: admission labs: 11:09pm type-art po2-275* pco2-39 ph-7.21* total co2-16* base xs--11 intubated-intubated 11:09pm glucose-238* lactate-1.3 na+-139 k+-3.3* cl--114* 11:09pm hgb-9.7* calchct-29 11:09pm freeca-1.09* 06:36pm lactate-1.5 04:49pm urine hours-random urea n-622 creat-80 sodium-21 04:49pm urine blood-sm nitrite-neg protein-30 glucose-250 ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 04:49pm urine rbc-* wbc- bacteria-few yeast-none epi-0-2 04:49pm urine granular-0-2 04:06pm glucose-145* urea n-127* creat-7.4* sodium-142 potassium-3.9 chloride-106 total co2-16* anion gap-24* 04:06pm estgfr-using this 04:06pm alt(sgpt)-44* ast(sgot)-49* ld(ldh)-324* alk phos-296* amylase-96 tot bili-0.5 04:06pm lipase-66* 04:06pm albumin-2.3* calcium-9.2 phosphate-5.3* magnesium-2.3 04:06pm wbc-38.6* rbc-4.37* hgb-12.7* hct-37.6* mcv-86 mch-29.2 mchc-33.9 rdw-16.1* 04:06pm plt count-510* 04:06pm pt-13.3* ptt-29.8 inr(pt)-1.2* 12:14pm blood caltibc-68* ferritn-greater th trf-52* 01:00am blood tsh-0.26* . discharge labs: 06:20am blood wbc-8.3 rbc-2.99* hgb-8.7* hct-27.0* mcv-90 mch-29.0 mchc-32.2 rdw-17.0* plt ct-397 06:40am blood neuts-64.6 lymphs-25.0 monos-3.5 eos-6.7* baso-0.3 06:20am blood pt-26.5* inr(pt)-2.7* 06:20am blood glucose-139* urean-20 creat-2.3* na-139 k-4.5 cl-111* hco3-21* angap-12 06:20am blood calcium-8.7 phos-3.6 mg-2.2 06:20am blood triglyc-373* hdl-23 chol/hd-7.0 ldlcalc-63 . imaging: ct abd/pelv: impression: 1. pancolitis, with markedly abnormal appearance of the entire colon, with severe bowel wall thickening, and dilatation. given history of c. difficile infection, this appearance is most concerning for toxic megacolon. 2. small amount of ascites, and fluid tracking within the abdominal mesentery. 3. evidence of previous abdominal aortic aneurysm repair with aortobifemoral graft. limited non-contrast evaluation is unremarkable. . echo: conclusions: the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy. there is mild regional left ventricular systolic dysfunction with severe hypokinesis of the distal half of the septum and anterior wall. the apex is mildly dyskinetic. there is mild global left ventricular hypokinesis of the remaining segments. no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. ef 30-35%. impression: global and regional left ventricular systolic dysfunction c/w diffuse process (multivessel cad, toxin, metabolic, etc.) . ecg : sinus rhythm. possible old inferior wall myocardial ischemia. poor r wave progression. cannot rule out old anteroseptal myocardial ischemia. non-specific st-t wave changes. no previous tracings for comparison. clinical correlation is suggested. . renal ultrasound 1. no downstream evidence of renal artery stenosis. 2. echogenic renal cortex consistent with medical renal disease. no hydronephrosis. 3. small amount of fluid in pouch. brief hospital course: 63 yo cambodian male with h/o cad, htn, copd, aaa s/p repair complicated by ischemic atn, hit, pneumonia and c. diff colitis with toxic megacolon, s/p colectomy with ileostomy. his hospital course is as follows: . colitis s/p colectomy: patient was initially transferred from the osh to the micu for further management. on arrival, the patient appeared septic with a concerning abdominal exam. ct scan showed likely toxic-megacolon. surgery was consulted and patient went for urgent colectomy with end ileostomy. his post-op course was complicated by intubation and pressor support which were eventually weaned off. his antibiotics were initially continued, but quickly discontinued as his wbc trended down and he remained afebrile. over the course of admission, his ostomy began to function well and his surgical scar remained healthy. after the patient was transferred to medicine, surgery continued to follow. his wound staples were removed on . ostomy continued to function well with good output. incision was well-healed. . acute renal failure: the patient was transferred in arf secondary from atn from his aortic surgery. renal was consulted. his creatinine was initially between , and plans were made for placement of a tunneled hemodialysis catheter. however, the patient subsequently began to make good urine with rapid improvement in his cr. prior to discharge, his creatinine appeared to stabilize at a new baseline around 2.2. he was otherwise continued on calcium for hyperphosphatemia. . mental status changes/foot drop: on arrival to , the patient was not oriented and delirious. though he did have residual left sided weakness, this was not thought due to an acute stroke. neurology was consulted and recommended treating for toxic-metabolic causes and deferring further imaging. he appeared to be more lucid with his family present, and had symptoms of sundowning at night. by the time of discharge, patient was being maintained on a low dose of night time zyprexa and had rare episodes of sundowning while admitted to medicine. . cardiac: the patient was transferred with known cad and history of previous inferior mi and ef 46%. the patient was taken to the or urgently preventing any possible re-vascularization. post-op, the patient was hypotensive requiring brief pressor support (dopamine and neosynephrine). during this time he was given aggressive ivf to maintain bp. because of this, he developed pulmonary edema making it difficult to extubate the patient after his colectomy. tte was performed showing an ef of 30-35% and global dysfunction (likely multifactorial from his cad, uremia, and acute stressors). once he was off pressors he was initiated on metoprolol and diuresed with lasix aggressively. his pulmonary status improved, though he became hypernatremic requiring free water. an ekg here showed an old inferior mi but was otherwise non-specific. he was started on a daily aspirin and statin prior to discharge. addition of an ace-i was deferred given his renal failure. . hit: per osh report, the patient had a drastic drop in his platelet count from 144 down to 55 over the course of 4 days. this was in the setting of heparin products given 4 days before. the patient was "strongly positive" for hit at the osh. heparin was stopped and his platelet count improved. after transfer, his platelet count dropped again in the setting of cvl and surgery. hit was positive again here. his platelet count recovered well and he had no evidence of thromboembolic phenomenon. after discussion with hematology, it was decided that his clinical presenttation was consistent with hit, and anticoagulation was initiated. coumadin was started with an argatroban drip bridge. argatroban was discontinued after his inr was noted to be therapeutic for 48 hours. inr was 2.7 at discharge, and he was discharged with instructions to titrate his coumadin to maintain an inr between 2 and 3. . gangrene: was felt to be secondary to his aortic aneurysm repair. vascular surgery was consulted on transfer who felt that his toes could be watched. his toes remained dry without signs of infection. he was discharged with outpatient followup with vascular surgery. . hypernatremia: after aggressive diuresis with lasix in the sicu due to pulmonary edema, the patient became midly hypernatremic with a peak sodium of 152. d5w was started for free water repletion. the patient was also encouraged to take free water po. his hypernatremia resolved after 3 days of free water repletion. he had no sodium abnormalities for the duration of his admission. . htn: treated with metoprolol in house. can be further titrated as an outpatient. . nutrition: the patient was found to be in poor nutrient balance in house. his caloric needs were heightened by his surgery. though tpn was given at the osh, we opted to provide enteral nutrition once his gut became function. dobhoff tubes were placed twice, each time being pulled out by the patient. he passed a swallow evaluation for ground solids, thin liquids with 1:1 supervision. nutrition was re-consulted for calorie counting. the patient was noted to eat more when his native food was provided by his family. oral intake continued to improve in addition to supplementation. . code: full medications on admission: atenolol (non-adherent) discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po three times a day. 2. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day) as needed. 3. sodium bicarbonate 650 mg tablet sig: one (1) tablet po qid (4 times a day). 4. lidocaine hcl 2 % gel sig: one (1) appl mucous membrane prn (as needed). 5. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 7. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for wheeze, sob. 8. olanzapine 5 mg tablet sig: 0.5 tablet po daily (daily) as needed for agitation. 9. olanzapine 5 mg tablet, rapid dissolve sig: 0.5 tablet, rapid dissolve po qhs (once a day (at bedtime)). 10. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed. 11. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. 12. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 13. epoetin alfa 4,000 unit/ml solution sig: 4000 (4000) units injection qmowefr (monday -wednesday-friday). 14. oxycodone 5 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for breakthrough pain. 15. warfarin 1 mg tablet sig: three (3) tablet po hs (at bedtime). 16. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 17. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 18. simethicone 80 mg tablet, chewable sig: 0.5-1 tablet, chewable po qid (4 times a day) as needed for gas. 19. insulin regular human injection discharge disposition: extended care facility: health network discharge diagnosis: primary diagnoses 1) heparin induced thrombocytopenia 2) c. difficile toxic megacolon status post colectomy with ileostomy 3) acute renal failure 4) gangrene 5) anemia secondary diagnoses 1) hypertension 2) hypercholesterolemia 3) copd 4) coronary artery disease status post myocardial infarction discharge condition: stable discharge instructions: you were admitted on after undergoing an abdominal aortic aneurysm repair at an outside hospital that was complicated by pneumonia, renal failure requiring intermittant hemodialysis as well as clostridium difficile colitis with toxic megacolon that required a subtotal colectomy with ileostomy on . you also developed dry gangrene of your toes on both feet after your aneurysm repair. you developed heparin induced thrombocytopenia that required you to be anticoagulated with argatroban and coumadin. you will continue to be treated with coumadin for the next 3 months. you will be discharged on a number of new medications. please take all the medications as written. if you develop any new abdominal pain, dizziness, confusion, chest pain, shortness of breath, bleeding or any other symptom that concerns you, please proceed to the nearest emergency department or call your primary care doctor as soon as possible. followup instructions: 1) follow up with dr. (surgery) on at 4:00 pm. call if you have questions or need to reschedule. 2) follow up with dr. (nephrology) on at 10:00 am. call if you have questions or need to reschedule. 3) follow up with dr. (vascular surgery) on , at 10:00 am. call if you have questions or need to reschedule. 4) call the department of hematology at to schedule a follow up appointment to address your heparin-induced thrombocytopenia. 5) call your primary doctor, dr. , at to schedule a follow up appointment after you are discharged from rehab. procedure: enteral infusion of concentrated nutritional substances other and unspecified partial excision of large intestine temporary ileostomy anastomosis to anus diagnoses: coronary atherosclerosis of native coronary artery pure hypercholesterolemia congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified candidiasis of mouth systolic heart failure, unspecified intestinal infection due to clostridium difficile old myocardial infarction anticoagulants causing adverse effects in therapeutic use ulcerative colitis, unspecified atherosclerosis of native arteries of the extremities with gangrene 

Answer: The patient is high likely exposed to