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: iodine / penicillins / morphine / flagyl / allopurinol / erythromycin / tetracycline / septra / ramipril attending: chief complaint: altered mental status, bloody diarrhea major surgical or invasive procedure: intubation and extubation central line placement and removal arterial line placement and removal history of present illness: 70m h/o ulcerative colitis, coronary disease s/p mi and cabg, cva, cri, afib on coumadin, recent diagnosis cirrhosis c/b esophageal varices presents with 2 days decreased po intake, vomiting, and bloody diarrhea. of note, he was recently d/c'd from after being admitted for 1 month of melena, loose stools, and fatigue and found to have uc flare and diagnosed with hepatic cirrhosis of unclear etiology (?psc planned for outpatient ercp to evaluate). he was discharged on hydrocortisone enemas and asacol for uc and ursodiol for ?psc. the patient is currently unable to answer many medical questions due to altered mental status, although he can respond yes/no. per the family, he saw dr. and was doing well except for diarrhea that was improving after dr. started him on prednisone 50mg daily 2 days earlier with plans to taper by 10mg qweek. he travelled to montreal in with his wife. on became more lethargic and confused and was admitted to hospital for encephalopathy that resolved with lactulose. the family knows of no infectious source isolated. he was discharged 1 week later off prednisone, asacol, or the hydrocort enemas; family was told to give him lactulose prn and therefore had not been giving many doses. post-discharge he was improved mentally but overall weak. for the past two days, he has had decreased po intake as well as nausea and fatigue. the patient's daughter and wife also noticed bloody diarrhea, characterized as loose brown stools with bright red blood and some clots, up to 5 times per day which is at his recent baseline. he was returning from yesterday to be seen by his hepatologist, dr. , and vomitied x1 (nbnb) and developed increased lethargy/confusion. presented to ed for evaluation. in the ed, he was hypotensive to 80/60 that improved to sbp 90 with ivfs. otherwise vitals were afebrile with rr 18-22 and o2sats 98% ra. labs notable for hct stable at 38, inr 2.0, normal wbc, cre 3.9 (baseline 2.0), mild transaminitis, ammonia 109, lactate 3.9, ag 16. u/a negative. cxr not performed. exam without asterixis, distended abdomen but nontender, g+ brown stool. hepatology was consulted. he was given lactulose 30ml, ciprofloxacin 400mg iv, and decadron 10mg iv. admitted to icu. ros: per wife no fevers, chills, dysuria, abdominal pain. only recent complaint was mild low back pain. patient denies pain but otherwise unable to assess due to mental status. ?increased abdominal distention per daughter. according to prior notes, anorexia has been a problem for the patient over the past 2 months and there has been a reported pound weight loss. past medical history: uc c/b sbo () with multiple recent admissions for flares afib on coumadin systolic chf c/b vt w/ icd/pm ( 7304) cva () w/ residual r-sided weakness (when off coumadin) cad s/p mis, cabg x 5 () chronic renal insufficiency (baseline ~1.8-2.0) nephrolithiasis gout dm2 h/o r hand fx h/o pna social history: -tob: quit 20 yrs ago -etoh: none -illicits: none -living situation: lives w/ daughter and wife currently... moves between , and . -occupation: retired car salesman. family history: non contributory physical exam: vitals: t: 95.4 bp: 106/57 hr: 76 rr: 17 o2sat: 97% ra gen: chronically ill-appearing male, no acute distress, altert and reponds to verbal commands with yes/no answers appropriately heent: eomi, perrl, sclera anicteric, mm very dry, op clear neck: jvp flat, no cervical lymphadenopathy, trachea midline cor: rrr, 3/6 sem at lsb, normal s1 s2, radial pulses +2, pacer pocket c/d/i left shoulder pulm: lungs ctab anterior, no w/r/r abd: soft, nt, nd, +bs, dullness to percussion at flanks ext: no c/c/e, no palpable cords neuro: a&ox1. cn ii ?????? xii grossly intact. moves all 4 extremities. unable to assess further due to mental status. skin: no jaundice, cyanosis, or gross dermatitis. no ecchymoses. pertinent results: 02:45pm glucose-215* urea n-65* creat-3.9* sodium-134 potassium-5.2* chloride-102 total co2-16* anion gap-21* 02:45pm alt(sgpt)-70* ast(sgot)-73* alk phos-170* tot bili-1.3 02:45pm lipase-149* 02:45pm albumin-2.6* 02:45pm %hba1c-6.9* 02:45pm ammonia-109* 02:45pm digoxin-2.0 02:45pm wbc-10.1 rbc-3.96* hgb-12.4* hct-38.0* mcv-96 mch-31.2 mchc-32.5 rdw-16.0* 02:45pm neuts-81.7* lymphs-12.2* monos-4.7 eos-1.1 basos-0.2 02:45pm pt-21.2* ptt-35.8* inr(pt)-2.0* 02:45pm plt count-227 tte : the left atrium is moderately dilated. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated w ith an apical left ventricular aneurysm. there is moderate to severe regional left ventricular systolic dysfunction with akinesis of the basal half of the inferior and inferolateral walls and distal septum, anterior and apical walls. the remaining segments contract normally (lvef = 25-30 %). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets are moderately thickened. there is moderate aortic valve stenosis (area 1.2 cm2). mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . impression: extensive regional left ventricular systolic dysfunction c/w multivessel cad. moderate aortic valve stenosis. moderate mitral regurgitation. moderate pulmonary artery systolic hypertension. . ble us: impression: no evidence of deep vein thrombosis of the right or left lower . chest ct : impression: 1. bilateral multifocal peri-bronchovascular consolidation, likely due to multifocal infection, or hemorrhage, very less likely pulmonary edema. 2. minimal bilateral pleural effusion. 3. left pacemaker. prior sternotomy for cabg. cardiomegaly. left ventricular apical myocardial calcification, likely due to left ventricular aneurysm. 4. signs of anemia. 5. enlargement of main pulmonary artery, suggesting pulmonary hypertension. 6. biliary sludge and gallstone, ascites, and signs of cirrhosis. dense liver, could be due to repeated transfusions, less likely hemochromatosis. 7. aortic, aortic valvular and coronary artery calcifications. 8. bilateral gynecomastia. brief hospital course: note: please problem list at the bottom: . 70m h/o ulcerative colitis, coronary disease s/p mi and cabg, cva, cri, afib on coumadin, recent diagnosis cirrhosis c/b esophageal varices presents with 2 days decreased po intake, vomiting, and bloody diarrhea admitted to icu for hypotension and ?gi bleed. . his altered mental status was felt to be due to hepatic encephalopathy and improved on lactulose. his hypotension was felt to be due to dehydration although infection was considered and he was covered for sbp with cipro for a small pocket of ascites that was untappable. his bloody diarrhea was thought to be due to a uc flare and he was started on prednisone 40mg qd. his mesalamine was eventually restarted with good control of his diarrhea. . he was called out to the liver-kidney service where his diuretics were stopped due to acute on chronic renal failure, thought to be from his dehydration. however, he developed respiratory distress requiring transfer back to the icu and intubation. cxr and ct chest revealed volume overload with a possible multifocal pneumonia, and he was put on a lasix drip, neosynephrine drip, and broad spectrum antibiotics (vanc/aztreonam/levaquin). after aggressive diuresis, his respiratory status improved and he was weaned off the pressor, extubated, and called out to the non-teaching hospitalist service by family request. . on the floor he continued to improve until he was breathing on room air with normal o2 sats. his mental status remained at baseline with lactulose ensuring daily stools. his platelet count was noted to be dropping (it had fallen earlier in his hospital course to a nadir of 48 but improved spontaneously so heparin sc was not stopped at that time). when the platelet count reached 78, antibiotics and heparin sc were stopped, and hit ab was sent. the antibiotics were also felt to be unnecessary at this point as he had received seven days of treatment, his cxr showed marked improvement with diuresis indicating that his respiratory distress was more likely caused by volume overload rather than pneumonia, sputum cultures had not grown any organisms, and he had been clinically stable for several days. . as he continued to improve and with the return of his kidney function to baseline, his medications were adjusted to match his regimen before hospitalization as much as possible. aspirin and coumadin that had been held for concern for gi bleed were restarted with no evidence of further bleeding. nadolol and enalapril that had been held for hypotension were gradually restarted. amiodarone and spironolactone were still held and may be restarted as an outpatient. he was switched back to oral lasix. the patient had been started on nph insulin for better glycemic control, and he was switched back to his metformin. . the patient had become severely conditioned by this time and physical therapy evaluation strongly recommended rehab. however, the family insisted on taking the patient home despite repeated recommendations by the medical team that this could prolong the patient's length of recovery. as long as the patient can have 24 nursing care, which the family assured they would provide, home was deemed a safe environment and he will also receive vna and home pt services. the family as repeatedly advised on the importance of outpatient followup. . 70m h/o liver cirrhosis c/b esophogeal varices, hematochezia, ulcerative colitis, coronary disease s/p mi and cabg, cva, cri, afib on coumadin, called out of micu after intubation for chf/multifocal pneumonia, now improving. . # respiratory failure: this was likely from chf after lasix was held on the floor for acute renal failure. he had a multifocal pna as well. he was extubation , lasix was then continued as per his home regimen though at an increased dose and his breathing was stable on room air. . # chronic systolic heart failure: ef 20-25% per osh records, s/p icd for vt w/ dual-chamber pacemaker. he was diuresed to euvolemic currently. lasix was increased to 40mg daily (was decreased to 20mg prior to hospitalization) as cr improved. digoxin and nadolol were continued at discharge. . # multifocal pna: the culture data showed no growth although he was treated with antibiotics due to clinical suspicion in setting of respiratory failure rquiring mechanical ventilation. he received vanc/aztreonam/levo for 7 days. . # thrombocytopenia: sequestration, sepsis, and medications were considered as causes. pf4 was negative. . # gi bleed: there is a history of esophogeal varices. also related to uc given recent flare and discontinuing medications the week before admission. he required one unit of prbcs transfusion on and the hct remained stable thereafter. he was continued on lansoprazole. coumadin was restarted. he was started on steroids for uc flare changed solumedrol for ulcerative colitis back to prednisone 40mg po daily, uc seems to be stable. you have a follow-up appointment with dr. . . # hepatic encephalopathy: lactulose was used to treat hepatic encephalopathy. rifaximin was added to the regimen was well. . # ulcerative colitis: followed by dr. . recent flare noted on c-scope . patient had been non-compliant with medications for the past week coinciding with worsening of his symptoms. prednisone was continued during the admission and the symptoms improved. on discharge the plan was established to taper off the prednisone and resume treatment with the topical agents. he will follow-up with his outpatient gastroenterologist. . # cirrhosis: stage iv based on varices, ascites, splenomegaly. followed by dr. previously but patient and family would prefer to follow up with dr. . etiology of cirrhosis was unclear. possibility of psc with uc was entertained and an outpatient ercp was recommened by liver within 2 weeks of discharge. ursodiol was continued for ?psc; may eventually need mrcp/ercp as an outpatient. spironolactone can be restarted on an outpatient. he was continued on nadolol. . # acute on chronic renal failure: creatinine was elevated to 3.9 during the admission though trended down to 1.2 by discharge. . # cad: s/p multiple prior mi and cabg revascularization. - restarted low-dose aspirin given stable hematocrits, restarted coumadin as above - restarted beta blocker and acei as above - continued statin . # afib: a-v paced. - continued digoxin - held amiodarone, per cards, may consider restarting as an outpatient - beta blocker and coumadin were initially held then later restarted - cardiology consultants followed during the admission . # cva: reported to have had stroke in past in setting of not being on coumadin, complicated by residual deficits (right sided weakness). restart coumadin. residual deficits likely potentiated by critical illness . # dm2: insulin drip discontinued , started on iss, was on nph for better glucose control (sugars increasing likely from prednisone). prior to discharge, he was switched back to metformin in anticipation of discharge. the dose was increased because of worsened sugar control in the setting of prednisone use. the plan was to discontinue prednisone at discharge. . # leukocytosis: there is no clear reason for elevation, no focal signs of infection at this point. diff shows left shift. ua with only few bacteria, neg nitrite/le, send c.diffx3 (negx2). predinosone may be contributing. he was encourage to call his physician for any signs or symptoms of infection. . # fen: low salt diet po, replete lytes prn . # access: piv, picc . # ppx: ppi, pneumoboots . # code: full . # dispo: pt recommending rehab, and it is the strong opinion of the medical care team that he should have rehab to maximize his rehabilitation potential, especially given his prior stroke. the patient and family prefer that he go home and voiced understanding of the risks of this plan including a longer rehabilitation time and that this is not recommended. as pt has recommended 24-hour care if he goes home, they have agreed to arrange for this and the necessary equipment to care for him at home. . # comm: (daughter) (; cell ( medications on admission: nadolol 40 mg po once a day aspirin 81 mg po daily enalapril maleate 5 mg po once a day digoxin 62.5 mcg po daily amiodarone 200 mg po daily furosemide 20 mg po daily spironolactone 12.5 mg po daily pantoprazole 40 mg po q24h ferrous sulfate 325 mg po daily atorvastatin 40 mg po daily warfarin 1 mg po daily nitroglycerin 0.3 mg sublingual as needed metformin 500 mg po twice a day. mesalamine 2400 mg po bid ursodiol 300 mg po tid hydrocortisone 100 mg/60 ml enema hs colchicine 0.6 mg po once a day as needed for gout discharge medications: 1. lift disp: #1 2. 3-in-1 commode disp: #1 3. nadolol 20 mg tablet sig: two (2) tablet po daily (daily). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. enalapril maleate 5 mg tablet sig: one (1) tablet po daily (daily). 6. digoxin 125 mcg tablet sig: tablet po daily (daily). 7. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 9. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 10. warfarin 1 mg tablet sig: one (1) tablet po hs (at bedtime). 11. metformin 500 mg tablet sig: one (1) tablet po at bedtime. 12. ursodiol 300 mg capsule sig: one (1) capsule po tid (3 times a day). 13. mesalamine 400 mg tablet, delayed release (e.c.) sig: six (6) tablet, delayed release (e.c.) po bid (2 times a day). 14. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day). disp:*2700 ml(s)* refills:*2* 15. outpatient lab work please check chem 7, cbc, inr on monday . recheck inr every 3 days or as directed by dr. (pcp). fax results of labs to dr. office (phone number ). 16. metformin 500 mg tablet sig: two (2) tablet po qam. 17. rifaximin 200 mg tablet sig: two (2) tablet po three times a day. disp:*180 tablet(s)* refills:*2* 18. insulin regular human 100 unit/ml cartridge sig: one (1) injection prn sliding scale: please dispense one cartridge. disp:*1 * refills:*2* 19. prednisone 10 mg tablet sig: taper as below tablet po once a day for 4 days: 2 tabs daily for 2 days 1 tab daily for 2 days. disp:*6 tablet(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: primary: hepatic encephalopathy, dehydration, acute on chronic systolic heart failure secondary: s/p cva, hypertension, hyperlipidemia, ulcerative colitis, atrial fibillation, coronary rtery disease, chronic renal insufficency, diabetes mellitus 2 controlled with complications discharge condition: good, stable, bed-bound, residual right-sided weakness, tolerating pos, pain-free, o2 sat high mid- to high-90s on room air discharge instructions: you were admitted for altered mental status and hypotension. you were treated for hepatic encephalopathy and dehydration and found to have kidney failure. you developed complications of congestive heart failure and required intubation and aggressive diuresis, after which you improved substantially. your kidneys have improved and no signs of infection have been found. because of your severe deconditioning from chronic and critical illness, we have strongly recommended that you go to a rehabilitation facility to maximize your chances of a full recovery. however, you have decided to return home instead and have acknowledged understanding that this plan of action may delay your recovery. you should have constant supervision and treatments as described below. do not take amiodarone at this time. this may be restarted as an outpatient at the discretion of your cardiologist. do not take your spironolactone at this time. this may be restarted as an outpatient at the discretion of your gastroenterologist/liver specialist. do not take your hydrocortisone enemas, sinc you are now on prednisone. it is important to check your blood sugars regularly since the prednisone can cause them to rise. we have resumed your coumadin as you have been stable with no further signs of bleeding. have your inr checked on monday and thereafter per your primary care physician. if you have worsening mental status, decreasing blood pressure, increasing weights greater than three pound weight gain in one day, increasing shortness of breath, chest pain, abdominal pain, or any other concerning signs or symptoms, call your doctor or come to the emergency room. followup instructions: you have a follow up appointment with dr. (gi) on at 1:30pm. call her office at with any questions. you have a follow up appointment with dr. (liver center) on at 3:30pm. call his office at with any questions. follow up with your primary care pysician within 1-2 weeks. call dr. office at to make an appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube injection of steroid injection or infusion of other therapeutic or prophylactic substance arterial catheterization closed [endoscopic] biopsy of bronchus transfusion of packed cells transfusion of other serum diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified cirrhosis of liver without mention of alcohol acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation aortocoronary bypass status personal history of tobacco use chronic kidney disease, unspecified nausea with vomiting other and unspecified hyperlipidemia acute respiratory failure hypotension, unspecified loss of weight long-term (current) use of insulin blood in stool other late effects of cerebrovascular disease old myocardial infarction long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ other ascites personal history of noncompliance with medical treatment, presenting hazards to health diarrhea hepatic encephalopathy ulcerative colitis, unspecified dehydration esophageal varices in diseases classified elsewhere, without mention of bleeding acute on chronic systolic heart failure diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled hypothermia personal history of allergy to other specified medicinal agents personal history of allergy to penicillin 

Answer: The patient is high likely exposed to