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: tramadol / advil / nsaids / hydrocodone attending: chief complaint: gi bleeding major surgical or invasive procedure: egd on and angiography on ivc filter placement ex-lap, duodenotomy, oversowing of ulcer, j-tube placement and liver biopsy history of present illness: this is an 86 year old gentleman with multiple medical problems who was found unresponsive at his nursing home and surrounded by bloody stools. he had recently been discharged on coumadin status-post a right hip repair. he has a history of black tarry stools in diagnosed as peptic ulcer disease. past medical history: 1. hypertension 2. chronic obstructive pulmonary disease 3. osteoarthritis 4. osteopenia 5. dementia 6. depression 7. status post bilateral inguinal hernia repair 8. status post bilateral cataract surgery 9. status post right total hip replacement social history: 1. no smoking 2. occasional alcohol 3. no drug use family history: non contributory physical exam: vital signs: bp 80/50 at , 110-137/48-53. hr 96. gen: responds to stimuli, non-conversant, not awake or alert heent: head nc/at, pale conjunctivae cv: sinus tachycardia pulm: ctab abd: soft, non-distended rectal: guaic positive, bloody output extr: pale pertinent results: 09:00am blood wbc-13.1*# rbc-1.66*# hgb-4.6*# hct-14.7*# mcv-89 mch-27.9 mchc-31.4 rdw-16.5* plt ct-530*# 04:14am blood wbc-9.5 rbc-2.82* hgb-9.0* hct-24.8* mcv-88 mch-31.8 mchc-36.2* rdw-15.7* plt ct-130* 01:56pm blood wbc-12.1* rbc-3.37* hgb-10.5* hct-31.7* mcv-94 mch-31.1 mchc-33.0 rdw-14.9 plt ct-386 05:30am blood wbc-10.8 rbc-2.94* hgb-8.5* hct-26.2* mcv-89 mch-29.0 mchc-32.5 rdw-16.6* plt ct-493* 06:30am blood wbc-8.5 rbc-3.03* hgb-8.6* hct-25.7* mcv-85 mch-28.4 mchc-33.4 rdw-17.7* plt ct-455* 09:00am blood neuts-79.7* bands-0 lymphs-16.0* monos-3.9 eos-0.2 baso-0.2 03:30pm blood neuts-76.8* lymphs-15.1* monos-5.7 eos-1.8 baso-0.6 09:00am blood pt-30.3* ptt-36.2* inr(pt)-6.9 11:15am blood pt-16.8* ptt-30.7 inr(pt)-2.0 03:06pm blood pt-15.3* ptt-29.2 inr(pt)-1.6 09:15am blood pt-16.1* ptt-42.5* inr(pt)-1.8 04:14am blood pt-13.5* ptt-28.2 inr(pt)-1.2 06:30am blood plt ct-455* 09:15am blood fibrino-181 09:00am blood glucose-229* urean-38* creat-1.1 na-143 k-5.1 cl-110* hco3-21* angap-17 01:46am blood glucose-126* urean-23* creat-0.8 na-147* k-3.8 cl-118* hco3-23 angap-10 09:30am blood glucose-97 urean-23* creat-0.7 na-140 k-4.6 cl-103 hco3-26 angap-16 09:00am blood ck(cpk)-20* 02:55am blood alt-34 ast-46* ck(cpk)-148 alkphos-48 totbili-0.7 04:00pm blood alt-29 ast-32 ld(ldh)-280* alkphos-206* amylase-63 totbili-0.5 07:02pm blood ck-mb-28* mb indx-12.1* ctropnt-0.63* 05:13am blood ck-mb-10 mb indx-7.9* ctropnt-0.70* 02:55am blood ck-mb-4 ctropnt-0.49* 01:24am blood ck-mb-notdone ctropnt-0.02* 01:46am blood calcium-6.4* phos-3.3# mg-1.6 02:55am blood albumin-2.1* calcium-7.1* phos-2.9 mg-1.8 04:00pm blood albumin-2.5* 10:50am blood albumin-2.5* iron-8* 10:50am blood caltibc-187* ferritn-434* trf-144* 04:00pm blood ammonia-29 04:00pm blood tsh-1.2 microbiology: urine cx: negative sputum cx: mrsa rectal swab: vre blood cx: pseudomonas urine cx: pseudomonas and serratia blood cx: negative urine cx: negative peri-j-tube swab: mrsa stool: negative for c. diff radiology: angiography:the procedure is performed by drs. and the attending physician, was present and supervising throughout. informed consent was obtained with the patient's sons. the patient was placed supine on the angiography table and his right groin was prepped and draped in standard sterile fashion. after infusion of 1% lidocaine, the right common femoral artery was accessed with a 19-gauge needle. wire was advanced into the abdominal aorta and the puncture needle was exchanged for a 5-french sheath which was attached to a continuous flush throughout the procedure. using a c2 cobra glide catheter, selective access into the superior mesenteric artery was obtained and arteriogram was performed. this demonstrated a patent superior mesenteric. there was equivocal extravasation of contrast from the region of the gastroduodenal artery; however, this determination was difficult due to the overlying transverse colon. next, selective access into the common hepatic artery was obtained with a c2 cobra glide catheter and angled glidewire. hepatic arteriogram demonstrated active extravasation of contrast from the region of the gastroduodenal- gastroepiploic junction as well as a branch of the superior pancreaticoduodenal artery. superselective access was obtained into the gastroduodenal artery. arteriogram performed at this position demonstrated active extravasation. superselective access was obtained into the gastroepiploic artery. arteriogram performed at this position demonstrated a patent gastroepiploic and confirmed that the catheter was distal to the site of extravasation in ideal location for snadwich technique of exclusion of the beeding source. based on the diagnostic arteriograms, it was decided that the patient was a good candidate for and would benefit from embolization. with gradual withdrawal of the catheter four 3 mm x 5 cm coils were deployed across the area of active extravasation in the gastroduodenal- gastroepiploic junction. superselective arteriogram of the proximal gastroduodenal artery demonstrated cessation of flow through this vessel. however, continued active extravasation was observed from a proximal branch of the superior pancreaticoduodenal artery. superselective catheter access was obtained into the superior pancreaticoduodenal artery towards the superior mesenteric artery and an arteriogram was done. it showed patent vessel and good catheter position distal to the bleeding site. three coils were deployed in the superior pancreaticoduodenal artery with gradual withdrawal of the catheter. a small amount of residual flow was observed on post- embolization arteriogram from the gastroduodenal artery. subsequently, three additional 3 mm x 5 cm coils were deployed across the proximal gastroduodenal artery. post- coiling arteriogram from the common hepatic artery demonstrated cessation of flow through the gastroduodenal artery and its branches including the gastroepiploic and superior pancreaticoduodenal. no further extravasation of contrast was observed. the catheter was subsequently removed. the sheath was secured with 0 silk suture. the patient was taken back to the intensive care unit in stable condition. there were no immediate post-procedure complications. impression: 1. active extravasation into the duodenum from the gastroduodenal- gastroepiploic junction and a branch of the superior pancreaticoduodenal artery. 2. successful coiling of the gastroepiploic, gastroduodenal, and superior pancreaticoduodenal arteries. post-embolization arteriogram demonstrated no further evidence of active extravasation abdominal ct: 1. wedge-shaped low density spleen lesion, somewhat improved since the last examination, representing an infarct. 2. low density lesion in the adrenal gland. a non-contrast ct scan of this region should be obtained on a nonemergent basis to ensure its benignity. 3. otherwise, no significant interval change. video swallow eval: weak oral phase with delayed swallow. silent aspiration of thin liquids, nectar thickened liquids, and purees. pharyngeal residue seen within the valleculae. chest ct: 1. wedge-shaped low-density area in the spleen, probably representing infarction. no evidence of abscess formation. 2. status post coiling of gastroduodenal arteries, with nonspecific fat stranding surrounding the coils. 3. small left pleural effusion. 4. gallstone. ivc placement: successful placement of a recovery ivc filter in the inferior vena cava. a retrievable filter had to be used since teh patient is potentially infected and superinfection of the filter without ability to remove it may have serious consequences. cta chest: no pulmonary embolus. bibasilar atelectasis and small bilateral pleural effusions. heat ct: no evidence of intracranial hemorrhage or mass effect. please note that mri is more sensitive than ct in the detection of acute ischemia if this is the clinical concern. see above report for additional findings. endoscopy: egd: small hiatal hernia there was no evidence of blood in the stomach. there was stigmata of ng trauma. there was no evidence of post bulbar bleeding. ulcer in the distal bulb otherwise normal egd to second part of the duodenum egd: a large blood clot starting in the distal portion of the duodenal bulb and extending past the duodenal sweep was noted. there was active oozing around the clot. despite multiple washings and use of polypectomy snare the clot could not be fully dislodged to visualize the source of bleeding. bright red blood was noted distal to the clot site. epinephrine was not used due to lack of visualization and ongoing myocardial infarction. cardiology transthoracic echo: the left atrium is elongated. the right atrium is moderately dilated. 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 normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve is not well seen. there is a minimally increased gradient consistent with minimal aortic valve stenosis. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. no vegetation seen (cannot exclude). brief hospital course: this is an 86 year old gentleman who presented as a transfer from his nursing home with bloody stools. he had a prolonged hospital course as summarized below: gi: the patient was admitted with hematemesis. his hematocrit was 14 in the er on presentation and ngt was bloody; he was intubated for aspiration precautions and immediately transfused with blood and ffp. endoscopy was performed with findings of bleeding duodenal ulcerations. this could not be controlled endoscopically and the patient was taken for angiography with embolization on the day after admission, with resolution of his bleeding. after further bleeding on he was taken to the operating room and underwent exp lap, duodenotomy, oversewn ulcer, j-tube placement and biopsy of liver mass. he was continued on a proton pump inhibitor. he failed various swallow evaluations and was fed through his j-tube. he had some diarrhea which improved with elemental formula. pulm: the patient remained intubated in the intensive care unit for several days. during this time he was found to have mrsa positive sputum which was treated. he was successfully extubated and had normal pulmonary functions through the majority of his hospital course. he had some chf that was effectively treated with daily lasix diuresis. neurology: during the hospital course he demonstrated periods of aphasia and dysarthria/dysphagia. he was evaluated by neurology and it was felt that this was consistent with his baseline dementia, with some component of overlying delirium. he remained stable throughout his hospital course and workup with head ct and eeg was consistent with encephalopathy but no acute process. heme: the patient was found to have superficial femoral vein clots. given the patient's need for anticoagulation from his prior hip surgery, and his risk for further gi bleeding, an ivc filter was placed for prophylaxis. his coagulation studies remained normal throughout his hospital course after reversal upon his admission. he was started on iron and folate supplementation for anemia. id: during the patient's prolonged icu and hospital course, he developed several infectious processes which were treated. he had pseudomonas in his urine and blood which was treated with a course of zosyn and follow-up studies were negative. he developed profound fevers during mid-late which were evaluated with serial cultures and echo studies with no positive cultures; these fevers eventually resolved. please see the listing of his culture date under "results" section. ortho: the patient worked with physical therapy but was essentially bed-ridden given his recent right hip surgery and dementia. dispo: per consultation with the patient's family and social work services, a rehabiliation bed was found for the patient. he was discharged with planned interval follow-up with dr. . discharge medications: 1. ferrous sulfate 300 mg/5 ml liquid sig: one (1) po daily (daily). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. oxycodone 5 mg/5 ml solution sig: two (2) ml po q8h (every 8 hours) as needed. 4. fluconazole 150 mg tablet sig: one (1) tablet po qweek (). 5. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day). 6. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection (2 times a day). 7. tamsulosin 0.4 mg capsule, sust. release 24hr sig: one (1) capsule, sust. release 24hr po hs (at bedtime). 8. sodium chloride 0.65 % aerosol, spray sig: sprays nasal tid (3 times a day). 9. beclomethasone diprop monohyd 0.042 % aerosol, spray sig: one (1) spray nasal (2 times a day). 10. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). 11. bisacodyl 10 mg suppository sig: one (1) suppository rectal hs (at bedtime) as needed. 12. lansoprazole 30 mg susp,delayed release for recon sig: one (1) suspension po bid (2 times a day). 13. albuterol sulfate 0.083 % solution sig: one (1) inh inhalation q6h (every 6 hours) as needed. 14. zinc oxide-cod liver oil 40 % ointment sig: one (1) appl topical prn (as needed). 15. acetaminophen 500 mg tablet sig: two (2) tablet po tid (3 times a day). 16. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 17. loperamide 1 mg/5 ml liquid sig: two (2) mg po qid (4 times a day). tubefeeding: probalance full strength; additives: banana flakes, 3 packets per day starting rate: 75 ml/hr; do not advance rate goal rate: 75 ml/hr residual check: q4h hold feeding for residual >= : 100 ml flush w/ 30 ml water before and after each feeding discharge disposition: extended care facility: for the aged - discharge diagnosis: primary: duodenal ulcer bleed secondary: dementia, pneumonia, urinary tract infections, tube-feeding dependence, copd, hypertension, depression, s/p r total hip replacement discharge condition: stable discharge instructions: please take medications as prescribed and read warning labels carefully. please follow intructions as previously discussed by dr. . if symptoms worsen, such as bloody vomitus, bloody or black stool, or fainting, please call or go to the emergency room. followup instructions: please follow up with dr. within 1-2 weeks. please call ahead of time to confirm appointment. (. please follow-up with dr. in orthopaedics at md, procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other enterostomy other endoscopy of small intestine insertion of endotracheal tube interruption of the vena cava enteral infusion of concentrated nutritional substances laryngoscopy and other tracheoscopy endoscopic control of gastric or duodenal bleeding transcatheter embolization for gastric or duodenal bleeding transfusion of packed cells other irrigation of (naso-)gastric tube transfusion of other serum open biopsy of liver other pyloroplasty diagnoses: anemia of other chronic disease subendocardial infarction, initial episode of care urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia chronic airway obstruction, not elsewhere classified atrial fibrillation infection with microorganisms resistant to penicillins other specified forms of chronic ischemic heart disease acute respiratory failure bacteremia methicillin susceptible pneumonia due to staphylococcus aureus diarrhea spinal stenosis in cervical region pseudomonas infection in conditions classified elsewhere and of unspecified site vascular dementia, uncomplicated cerebral atherosclerosis hip joint replacement candidiasis of skin and nails acute duodenal ulcer with hemorrhage, without mention of obstruction other voice and resonance disorders 

Answer: The patient is high likely exposed to