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: patient recorded as having no known allergies to drugs attending: chief complaint: colitis major surgical or invasive procedure: arterial line placement history of present illness: m with h/o copd, s/p left lobectomy, rheumatic heart disease, paf on coumadin, htn who presented to osh on with bloody diarrhea, found to have collitis, transfered to for potential surgical issues and hypoxia management. . patient reports diarrhea beg (6 days pta). he was having bowel movement per day - liquid. no f/c, no nausea, no sick contacts. bms with occasional blood - 1-2 per day with 1-2 cc of blood 2 days prior to presentation to osh. patient was recently treated with abx for bronchitis. ct scan at showed pancolitis, with low suspicious for ischemic colitis. patient was admited for hydration, cipro/flagy were started. his inr was 4.2 upon admission. they had difficulty obtaining a stool sample due to lack of bms. subsequently, patient subsequently had a colonocopy on which showed distal sigmoid with intense areas of pathacy, hyperemic mucosa with moderate inflammatory changes. moderate diverticulosis was see in the sigmoid, no diverticulitis. the involvement was atypical for ischemic disease. there were not specific for c. diff either. patient's gastric distention improved with suctioning of air, functional stricture was appreciated at junction of sigmoid and distended colon - ? ogilvies. biopsies were taken from involved sigmoid colon/rectum. patient was also evaluted for hemoptysis as he has h/o rul spiculated nodule and lll lobectomy. patient coughed up 1 spood of blood, with resolution of hemoptysis. his inr continued to raise during his admission to 4.7. patient waws also given 5 mg of vitamin k. his hct remained stable, no ffp was hgiven. it was felt that bronchoscopy was not indicated. patient was subsequently transfered to for potential surgical intervention, hypoxia/sob, worsening liver, renal failure and on levophed for hypotension. . patient denies any fevers/chills, he reports minimal po intake with liquid diet, he also reports insertion of ngt on without relief of his symptoms. he denies any cp, no current sob, although overall has been more dyspnic x 3 days. he admits to persistent hemoptysis x 3 days, last episode 3 days ago. minimal amount. he denies any current abdominal pain. had a bm, well formed nonbloody this am. he has a foley catheter that was inserted . he also reports increased le edema since . past medical history: copd - fev 1.5 - 2.0 l s/p left lower lobectomy for benign tumor h/o of resolved spiculated rul nodule - evaluated by dr. in , felt to be inflammatory with no follow up necessary. nl bronchoscopy in at . h/o rheumatic heart disease mr (moderate) /mitral stenosis - valve area 1.5 - 2.0 paf on coumadin - patient had failed cardioversion in , due to persistence of afib, increase in weight, sob and worsening of nyha class to iv. during osh admission his hr was difficult to control with hr to 140s on bb, digoxin. patient is schedule for potential pvi in here at . has been on amiodarone in the past. chf 2000cardiac catherization w/o evidence of cad h/o tia htn hyperlipidemia bilateral hernia repair appendectomy malignant tumor (?muscle) in his leg social history: patient lives alone with his wife. quit tobacco 16 years ago. 50 + pack years. no daily etoh, several a week family history: nc physical exam: vitals on micu tx: 96.1 90(afib) 105/64 95%2lnc rr 14-19 vitals on floor: 96.6 100/60 90 20 96%2lnc gen: alert, though appears sleepy. heent: toungue moist, white exudate on posterior oropharynx neck: supple, no lad, prominent v waves appreciated on exam, marked jvp, pulsitile cv: rr, nl rate. nl s1, s2. systolic murmur heard best @ apex lungs: faint crackles bilaterally at bases abd: soft, nt, nd. nl bs. no hsm ext: 2+ grossly pitting edema. 2+ dp pulses bl skin: no lesions pertinent results: 06:24pm blood wbc-17.5*# rbc-4.12* hgb-12.5* hct-39.1* mcv-95 mch-30.2 mchc-31.8 rdw-15.6* plt ct-404# 03:39am blood wbc-16.4* rbc-4.19* hgb-12.7* hct-39.4* mcv-94 mch-30.3 mchc-32.2 rdw-15.6* plt ct-436 03:33am blood wbc-15.9* rbc-4.15* hgb-12.4* hct-38.0* mcv-92 mch-29.7 mchc-32.5 rdw-15.5 plt ct-368 06:10am blood wbc-17.4* rbc-4.64 hgb-13.7* hct-43.9 mcv-95 mch-29.6 mchc-31.3 rdw-15.7* plt ct-537* 05:45am blood wbc-18.7* rbc-4.50* hgb-13.5* hct-41.3 mcv-92 mch-29.9 mchc-32.6 rdw-15.3 plt ct-430 05:08pm blood wbc-16.4* rbc-4.24* hgb-12.8* hct-39.6* mcv-93 mch-30.2 mchc-32.3 rdw-15.9* plt ct-449* 03:36am blood wbc-22.7* rbc-4.51* hgb-13.4* hct-40.7 mcv-90 mch-29.7 mchc-32.9 rdw-15.8* plt ct-375 04:00am blood wbc-21.3* rbc-4.24* hgb-12.8* hct-38.6* mcv-91 mch-30.2 mchc-33.2 rdw-16.1* plt ct-446* 06:24pm blood neuts-84.5* lymphs-7.9* monos-7.2 eos-0.1 baso-0.3 03:36am blood neuts-90* bands-0 lymphs-1* monos-9 eos-0 baso-0 atyps-0 metas-0 myelos-0 nrbc-3* 03:36am blood hypochr-1+ anisocy-1+ poiklo-normal macrocy-normal microcy-normal polychr-occasional tear dr 06:24pm blood pt-38.8* ptt-38.7* inr(pt)-4.2* 03:39am blood pt-34.2* ptt-37.8* inr(pt)-3.6* 05:45am blood pt-26.5* ptt-34.5 inr(pt)-2.6* 04:00am blood pt-26.3* ptt-35.2* inr(pt)-2.6* 06:24pm blood glucose-118* urean-71* creat-3.4*# na-134 k-4.9 cl-100 hco3-19* angap-20 03:39am blood glucose-121* urean-75* creat-3.1* na-132* k-5.2* cl-102 hco3-17* angap-18 03:33am blood glucose-108* urean-87* creat-3.0* na-132* k-5.3* cl-100 hco3-19* angap-18 05:45am blood glucose-104 urean-111* creat-3.2* na-133 k-6.0* cl-99 hco3-20* angap-20 05:08pm blood glucose-240* urean-118* creat-3.6* na-130* k-6.9* cl-97 hco3-20* angap-20 03:36am blood glucose-109* urean-119* creat-3.2* na-132* k-4.6 cl-99 hco3-22 angap-16 05:26pm blood glucose-139* urean-120* creat-3.1* na-134 k-4.4 cl-96 hco3-23 angap-19 04:00am blood glucose-131* urean-122* creat-3.0* na-132* k-4.6 cl-96 hco3-24 angap-17 06:24pm blood alt-190* ast-207* ld(ldh)-293* alkphos-133* totbili-1.1 03:39am blood alt-173* ast-148* ld(ldh)-282* alkphos-124* totbili-1.1 06:10am blood alt-172* ast-154* ld(ldh)-354* alkphos-134* totbili-2.0* 05:08pm blood ld(ldh)-613* ck(cpk)-104 03:36am blood alt-124* ast-88* ck(cpk)-88 alkphos-123* totbili-2.4* 06:24pm blood lipase-28 03:39am blood lipase-26 06:10am blood probnp-* 05:45am blood probnp-* 03:36am blood ck-mb-notdone ctropnt-0.02* 06:24pm blood calcium-8.0* phos-6.4* mg-2.4 04:00am blood albumin-2.7* calcium-7.8* phos-6.9* mg-2.7* 06:10am blood tsh-5.9* 05:45am blood t4-8.1 06:24pm blood hbsag-negative hbsab-negative hbcab-negative hav ab-negative 06:24pm blood digoxin-2.4* 04:00am blood digoxin-1.2 06:24pm blood hcv ab-negative 10:08pm blood type-art temp-37.6 rates-/24 po2-69* pco2-30* ph-7.34* caltco2-17* base xs--8 intubat-not intuba 05:48pm blood type-art po2-52* pco2-41 ph-7.34* caltco2-23 base xs--3 intubat-not intuba 09:07am blood type-art temp-35 po2-65* pco2-33* ph-7.37 caltco2-20* base xs--4 intubat-not intuba 11:04am blood type-art temp-38 fio2-70 po2-92 pco2-42 ph-7.36 caltco2-25 base xs--1 intubat-not intuba 02:19pm blood type-art temp-38.8 po2-78* pco2-41 ph-7.36 caltco2-24 base xs--1 05:55pm blood type-art temp-36.4 po2-67* pco2-41 ph-7.38 caltco2-25 base xs-0 intubat-not intuba 08:28pm blood lactate-1.8 06:50pm blood glucose-153* lactate-1.8 na-131* k-4.7 cl-98* calhco3-20* . . studies: kub: this is a single frontal film of the abdomen, limited by motion artifact. gas is seen in some mildly distended loops of colon with the cecum measuring up to 8.2 cm. this study is not sufficient to completely assess the abdomen or bowel given the motion artifact. . cxr: there are no old films available for comparison. the heart is enlarged with bulbous contour which could be due to pericardial effusion versus cardiomegaly. there is an ng tube with tip off the film, at least in the stomach. there is a right ij line with tip in the svc. there is a moderate-sized right pleural effusion. there is probably also left pleural effusion with volume loss at both bases. there is hazy, ill-defined vasculature most marked in the right lower lobe and it is unclear if this represents some asymmetric pulmonary edema or an infectious infiltrate. . liver usn: sludge within the gallbladder, as well as gallbladder wall edema. in light of the patient's fluid overloaded state (including ascites and pleural effusion), gallbladder wall edema is nonspecific. the lack of son sign makes acute cholecystitis less likely. if there is continued clinical concern, nuclear medicine imaging could be obtained to evaluate for acute cholecystitis. . tte: the left atrium is markedly dilated. no left atrial mass/thrombus seen (best excluded by transesophageal echocardiography). the right atrium is markedly dilated. the estimated right atrial pressure is 10-20mmhg. left ventricular wall thicknesses, cavity size and regional/global systolic function are normal (lvef>55%). the right ventricular cavity is moderately dilated with moderate global free wall hypokinesis. there is abnormal diastolic septal motion/position consistent with right ventricular volume overload. the aortic root is mildly dilated at the sinus level. 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 moderately thickened with characteristic rheumatic deformity. there is mild mitral stenosis. there is moderate thickening of the mitral valve chordae. mild to moderate (+) mitral regurgitation is seen. the severity of mitral regurgitation may be underestiated due to acoustic shadowing. the tricuspid valve leaflets are mildly thickened and fail to fully coapt. moderate to severe tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a very small circumferential pericardial effusion. . impression: rheumatic valvular disease with mild mitral stenosis, mild-moderate mitral regurgitation, and moderate to severe tricuspid regurgitation. moderate to server tricuspid regurgitation. right ventricular cavity enlargement/free wall hypokinesis. pulmonary artery systolic hypertension. . . cxr: since the recent radiograph, there has been little change in congestive heart failure pattern superimposed upon severe upper lobe predominant emphysema. bilateral pleural effusions are also not substantially changed. slight improved aeration is noted within the left retrocardiac region with otherwise overall similar appearance to the recent exam. . brief hospital course: micu course: pt admitted to icu after initially presenting to osh icu . ct showed evidence of pancolitis, colonic dilation, and a functional stricture in the sigmoid colon just distal to the dilated colon. he was startedon cipro/flagyl and given ivf for hypotension. colonoscopy showed diffuse erythematous mucosa, diverticulosis without diverticulitis, sigmoid biopsy was performed. he was given vitamin k for peak inr 4.7. an ng tube was placed for decompression, but had minimal output and was removed. he was then started on a clear diet which he tolerated. . pt was also noted to be grossly volume overloaded, felt chf with afib. he was also started on a lasix drip for total body fluid overload pon . he was approximately 1l negative for length of stay. he was continued on coumadin. he was found to be transiently hypotensive, though was found to have sbp 20 mmhg higher on aline thannoninvasives in the micu. on he was transfered to the general medical floor after he was transitioned from lasix gtt to bolus dose lasix. . floor course: patient was given bolus iv diuresis, but responded poorly, and developed worsening renal failure and hypotension. on pt triggered for low uop. chf consult was obtained, which recommended restarting lasix gtt for his decompnesated chf in the setting of tr. pt was transferered to the cardiology service, but noted to be hypotensive with o2 sat in 80s on 3l. he received insulin, hco3, and d50 for high potassium, was started on the dopamine gtt and transferred to the ccu. . . ccu course: 76 m with h/o copd, chf (ef>55%) tr, rheumatic heart disease, paroxysmal atrial fibrillation, initially admitted to the micu colitis, course c/b pulmonary fluid overload, acute renal failure refractory to bolus lasix while on the general medical service, transferred to the ccu in setting of hypotension, hypoxia. . . # hypotension: was felt afib with rvr and poor atrial kick exacerbating chf with intravascular depletion bolus lasix dosing. also, consider systolic dysfunction although recent echo w ef 55%. infectious etiology also felt possible given recent colitis, though no elevation in temperature curve and wbc count initially trending down from admissions wbc 17->15.9, though did trend up to 22, thus pt switched to zosyn/vanco. pt was breifly on peripheral dopamine gtt after admission to ccu on for <24hrs. his sbp remained in the 90s off dopamine gtt, and his initial tachycardia improved somewhat and was felt exacerbated by dopa gtt. pt was then begun on lasix gtt as below to treat anasarca, however, this was limited by low sbp. attempts to introduce beta blockade for hr in low 100s afib even with esmolol were limited by low sbps. . given ongoing low bp, and inability to diurese pt with lasix gtt, discussion turned to placement of central lines for further pressor use and consideration of initiating hemodialysis to address volume overload. pt and family were in agreement that these aggressive measures were not compatible with goals of care, and decision made to change goals of care to comfort measures only on pm. lasix gtt d/c'd and pt started on prn iv morphine for air hunger. pt expird am. . . # chf: pt with profound right sided failure in setting of rheumatic valvular disease. pt remained profoundly volume overloaded, despite bolus lasix dosing on medical service. lasix gtt was restarted upon arrival to ccu without improvement, though efforts were limited by ongoing hypotension. consideration was given to initiating hemodialysis, though given pt and family's goals of care as above, this was deferred. . . # acute renal failure: hyaline casts seen, ?muddy brown. hypotension may have caused atn exacerbated by volume overload and heart failure. cr trending down with lasix gtt initially (3.6->3.0), though pt then became oliguring. given family decision not to pursue hemodialysis, and inability to remove fluid with lasix gtt, along with worsening hypoxia, decision made to switch goals of care to comfort measures only as above. pt was treated for hyperkalemia with inuslin, d50, hc03 prn. . . # atrial fibrillation: pt with chronic and paroxysmal afib, which was felt to be contributing to pt's hypotension as above. coumadin was held initially given anticipation of central line placement and possible hemodialysis, then deferred goals of care as above. pt failed dccv recently at osh. attempts to control rate with beta blockade, including esmolol, were limited by hypotension. . . # hypoxia: poor pao2 was consistent to pulmonary edema, though given failure respond to lasix gtt and desire not to be started on dialysis, treatment options severely limited. pt treated with nebulizer treatments prn, and ultimately with morphine gtt for air hunger once goals of care switched to focus on comfort. . . # colitis: upon arrival to ccu abd pain was resolving, pt was passing flatus. prior management desicions reflected belief of infectious, non-ischemic colitis. biopsy results from outside hospital were pending and were to be faxed to ccu. pt was initially continued on cipro/flagyl for planned day course, though switched empirically to zosyn/vanco on ongoing hypotension and concern for ongoing leukocytosis (20s). pt initially pt was npo then advanced to clear liquid diet as tolerated. . # uti: pt found to have positive u/a on (many bacteria, 21-50 wbc), he was already being covered with cipro as above, then covered with zosyn/vanco as above. . # transamintis: suspected congestive hepatopathy given evidence of cor pulmonale on echo. wide open tr and exam findings with prominent v waves correlate. medication list reviewed, no likely culprits. pt was treated for underlying chf as above. . # dispo: given pt's significant fluid overload, and failure to respond to lasix gtt, goals of care discussed extensively on with pt and daughter . pt and daughter declined aggressive intervention including dialysis, central lines, and intubation/resuscitation. pt initially drowsy, but able to a&ox3, and able to describe consequences of declining dialysis, specifically his likely death. decision made to pursue comfort measures only 5pm. plans made to pursue home discharge with hospice. . pt started on morphine iv prn for air hunger. pt expired on ~6am. . # comm: wife: . son : . medications on admission: meds on transfer to ccu: ipratropium bromide neb 1 neb ih q6h:prn maalox/diphenhydramine/lidocaine 15-30 ml po qid:prn albuterol 0.083% neb soln 1 neb ih q2h:prn metronidazole (flagyl) 500 mg po tid (since ) ciprofloxacin hcl 500 mg po q24h (since ) nystatin oral suspension 5 ml po qid dopamine gtt at 5 pantoprazole 40 mg po q24h docusate sodium 100 mg po bid fluticasone-salmeterol (100/50) 1 inh ih tiotropium bromide 1 cap ih daily . meds at home: coumadin 2.5 mg on mon/wed/fri, 5 mg other days lasix 40 mg daily digoxin 0.125 mg daily iron 65 mg daily toprol xl 12.5 mg daily asa 81 spiriva advair 100/50 one puff discharge medications: none (pt expired) discharge disposition: home with service facility: nursing services discharge diagnosis: pt expired discharge condition: pt expired discharge instructions: pt expired followup instructions: pt expired procedure: venous catheterization, not elsewhere classified arterial catheterization diagnoses: hyperpotassemia urinary tract infection, site not specified unspecified essential hypertension acute kidney failure, unspecified chronic airway obstruction, not elsewhere classified atrial fibrillation candidiasis of mouth rheumatic heart failure (congestive) colitis, enteritis, and gastroenteritis of presumed infectious origin 

Answer: The patient is high likely exposed to