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: acute blood loss anemia, gi bleed, gastric ulcers, ventilator associated pneumonia, acute systolic chf, diarhea major surgical or invasive procedure: intubation esophageal gastroduodenoscpy history of present illness: year old female with anemia, systolic chf, atrial fibrillation previously on coumadin, erosive gastritis, pvd with recent fall on with hip fracture s/p left total hip replacement placed on aspirin/lovenox, who presents with hematemesis and massive gi bleed. patient by report developed 24 hours of hematemesis and melena, along with syncope in the setting of the bleeding. at presentation to the outside hospital ed, her hematocrit was 16 from 27 the day prior and ng lavage was positive, but she was not given blood because she was a difficult crossmatch. she was transferred to for further management. in the ed, she arrived with sbp in the 50s. patient was guaiac positive, ngt putting out blood and small amount of clots. she received a ppi drip, 4 units prbcs transfusion, 1 unit ffp (inr 1.3 at osh, 1.6 here) and 1 bag of platelets with improvement in her pressures to sbps 110s. however, she again became hypotensive and was given a fifth unit of blood. initially she was 100% on nrb was and 96% on ra, but she became markedly hypoxic after the blood transfusions. given her need for an endoscopic procedure, her elderly age and frail status, her lvef of 30% with demand ischemia on ekg, she was intubated in the ed. a surgical consult was obtained and recommended following gi/egd results along with serial hematocrits. gi was consulted and recommended egd. the patient was sent to the micu intubated and sedated. an egd was performed with results below, which were injected with epinepharine. on she was given one dose of iv lasix and extubated, however shortly thereafter she developed low grade fever, cough productive of brown sputum and an infiltrate on chest xray, so was diagnosed with hospital acquired pneumonia. she was also noted in florid chf with a bnp of 45,000. additional iv diuresis was performed with improvement. she was transferred to the floor for further management. of note in the micu, a meeting with the family changed her code status to dnr/dni. on the floor her chf was treated with continued lasix. past medical history: 1. systolic heart failure (ef 30-35 ) 2. atrial fibrillation on warfarin 3. hypertension 4. dyslipidemia 5. pvd s/p fem bypass 6. uterine tumor, s/p total hysterectomy > 45yrs ago 7. cystic kidneys, with one reportedly "underdeveloped" 8. esophageal ulcer and gastritis on egd 9. normocytic anemia- does not want colonoscopy 10. bilateral aortoiliac bypass 11. diverticulitis 12. depression/anxiety 13. benign cysts in breast removed x 2 social history: the patient lives in a two family house in , ma. she was never married and currently lives in the lower half of the house with her sister-in-law (another octogenerian). she formerly worked as a greeting card maker in a factory and retired over 20 years ago. she is still quite independent and can do her own shopping and meal preparation. pt admits to smoking one pack/day for around 25 years and quitting entirely when she was in her 40's. she drinks wine very rarely on holidays and denies any history of other drugs. . she eats a healthy diet that she prepares at home and tries to limit her sodium and fluid intake. she tries to exercise by walking daily, but her walking is limited by leg pain. family history: mother has h/o of loss of consciousness from "heart problems" that eventually caused her death. father died of cirrhosis (non-alcoholic). physical exam: vitals: t: 96.9 bp: 114/75 p: 75, r: 18 o2: 96% ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, no lad lungs: bibasilar rales cv: irregular rate rhythm, normal s1 + s2, 3/6 systolic ejection murmur abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, 1+ edema pertinent results: 07:45am blood wbc-9.4 rbc-3.49* hgb-10.6* hct-32.1* mcv-92 mch-30.5 mchc-33.2 rdw-16.6* plt ct-330 08:10am blood wbc-18.9* rbc-3.59* hgb-10.5* hct-32.2* mcv-90 mch-29.2 mchc-32.6 rdw-16.2* plt ct-357 03:37am blood hct-27.7* 12:10am blood wbc-23.3* rbc-3.31* hgb-10.1* hct-29.3* mcv-89 mch-30.5 mchc-34.5 rdw-14.3 plt ct-295 09:45pm blood wbc-21.4* rbc-3.25*# hgb-9.8*# hct-28.6*# mcv-88 mch-30.2 mchc-34.3 rdw-14.3 plt ct-322 06:45pm blood wbc-14.8* rbc-1.82*# hgb-5.5*# hct-16.6*# mcv-91 mch-30.4 mchc-33.3 rdw-14.7 plt ct-324 05:50am blood neuts-89* bands-4 lymphs-5* monos-0 eos-2 baso-0 atyps-0 metas-0 myelos-0 06:45pm blood neuts-80* bands-4 lymphs-10* monos-1* eos-0 baso-0 atyps-0 metas-3* myelos-2* 07:45am blood plt ct-330 07:45am blood pt-13.2 ptt-26.5 inr(pt)-1.1 06:50am blood plt ct-392 06:50am blood pt-13.1 ptt-27.7 inr(pt)-1.1 06:30am blood pt-14.7* ptt-27.7 inr(pt)-1.3* 08:10am blood pt-16.4* ptt-29.6 inr(pt)-1.5* 07:50am blood pt-15.4* ptt-28.5 inr(pt)-1.4* 05:50am blood pt-19.8* ptt-33.8 inr(pt)-1.8* 04:15am blood pt-37.4* ptt-53.1* inr(pt)-3.9* 02:52pm blood pt-24.3* ptt-38.3* inr(pt)-2.3* 03:51am blood pt-22.5* ptt-36.0* inr(pt)-2.1* 05:30am blood pt-21.2* ptt-33.3 inr(pt)-2.0* 12:10am blood pt-15.2* ptt-31.5 inr(pt)-1.3* 06:45pm blood pt-17.7* ptt-33.4 inr(pt)-1.6* 07:45am blood glucose-110* urean-28* creat-1.3* na-140 k-3.5 cl-108 hco3-21* angap-15 12:35pm blood creat-1.5* k-2.7* 05:50am blood glucose-107* urean-48* creat-1.6* na-140 k-2.8* cl-113* hco3-16* angap-14 06:45pm blood glucose-177* urean-83* creat-1.3* na-138 k-3.7 cl-110* hco3-19* angap-13 06:45pm blood alt-20 ast-17 alkphos-66 totbili-0.5 06:45pm blood lipase-29 02:52pm blood probnp-* 07:45am blood calcium-7.7* phos-3.0 mg-1.6 12:10am blood calcium-6.7* phos-4.0 mg-1.5* 06:45pm blood albumin-1.9* 04:15am blood vanco-3.7* 05:51am blood type-art temp-35.8 peep-5 fio2-50 po2-159* pco2-34* ph-7.33* caltco2-19* base xs--6 intubat-intubated 12:26am blood type-central ve ph-7.26* 06:55pm blood ph-7.31* comment-green top 05:51am blood lactate-0.7 12:26am blood glucose-158* lactate-1.0 06:55pm blood glucose-164* lactate-2.4* na-134* k-3.6 cl-111 calhco3-18* 12:26am blood freeca-1.03* 06:55pm blood freeca-0.95* 12:42pm urine color-yellow appear-hazy sp -1.016 12:42pm urine blood-tr nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-tr 12:42pm urine rbc-1 wbc-6* bacteri-few yeast-none epi-1 transe-1 12:42pm urine castgr-3* casthy-6* 5:35 am mrsa screen source: nasal swab. **final report ** mrsa screen (final ): positive for methicillin resistant staph aureus. 12:42 pm urine source: catheter. **final report ** urine culture (final ): gram negative rod(s). ~4000/ml. 12:42 pm stool consistency: not applicable source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). 2:52 pm serology/blood source: line- aline. **final report ** helicobacter pylori antibody test (final ): negative by eia. (reference range-negative). 6:07 am stool consistency: watery source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). 8:29 pm sputum source: expectorated. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): budding yeast with pseudohyphae. 2+ (1-5 per 1000x field): gram positive cocci in pairs. smear reviewed; results confirmed. respiratory culture (final ): moderate growth commensal respiratory flora. escherichia coli. moderate growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ =>32 r ampicillin/sulbactam-- =>32 r cefazolin------------- =>64 r cefepime-------------- <=1 s ceftazidime----------- 4 s ceftriaxone----------- <=1 s ciprofloxacin--------- 1 s gentamicin------------ <=1 s meropenem-------------<=0.25 s piperacillin/tazo----- 8 s tobramycin------------ <=1 s trimethoprim/sulfa---- =>16 r 6:19 am stool consistency: loose source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). endocscopy report date: , findings: esophagus: contents: clotted blood was seen in the esophagus. stomach: contents: red blood and clotted blood was seen in the stomach fundus. the clot was able to be moved by rotating the patient and there were no additional findings underneath the clot. excavated lesions multiple () superficial non-bleeding ulcers that had a clean base without a visible vessel, adherent clot, or oozing, ranging in size from 3 mm to 6 mm, were found in the antrum. 10 cc of epinephrine 1/ was injected into each ulceration with success. duodenum: mucosa: a small superficial ulcer was seen in the duodenal bulb that had no stigmata of bleeding, clean based. no therapy was applied. there was no fresh blood in the duodenum, which was inspecte to the 2/3rd portion of duodenum. ampulla visualized and was unremarkable. impression: blood in the esophagus ulcers in the antrum (injection) blood in the stomach abnormal mucosa in the duodenum otherwise normal egd to second part of the duodenum recommendations: routine post procedure orders monitor hct q6h. repeat inr and maintain <1.5 with ffp. continue iv ppi gtt. keep intubated until gi team reassesses in a.m. to determine if repeat scope is indicated. if worsening hemodynamics overnight or evidence of repeat active bleeding, please inform gi fellow. avoid nsaids and anticoagulants. ecg study date of 7:01:22 pm sinus rhythm. diffuse st segment depression suggestive of global myocardial ischemia. compared to the previous tracing of st segment depression in the anterolateral leads as well as inferior leads is more prominent. clinical correlation is suggested. intervals axes rate pr qrs qt/qtc p qrs t 93 200 94 324/381 42 46 -146 cta pelvis w&w/o c & recons study date of 9:50 pm impression: 1. no definite evidence of aortoenteric fistula. 2. colonic distention, mild wall thickening and mucosal hyperenhancement consistent with colitis that may be infectious, inflammatory or ischemic. 3. pleural effusions, periportal edema and diffuse subcutaneous edema. 4. hiatal hernia, increased in size. 5. extensive atherosclerotic disease with aortobiiliac graft as detailed above. 6. diverticulosis. 7. cholelithiasis. chest (pa & lat) study date of 3:39 pm bilateral pleural effusion is moderate, persistent accompanied by bibasal atelectasis with some potential progression of the size of the effusion. there is slight upper lobe redistribution of the vasculature which is mildly physiologic due to bibasal large areas of atelectasis. there is no pneumothorax. there are no new consolidations. extensive calcifications of the aorta are demonstrated. brief hospital course: yo f s/p fall on with recent left total hip replacement on aspirin and lovenox with episode of hematemesis and hematocrit 16 with guaiac positive stool. 1. acute blood loss anemia due to gi bleed due to gastric ulcers - upper gi bleed: hct 16.6 down from baseline in low 30s. there was some initial concern for aorto-enteric fistula but this was ruled out via ct scan above. - gi was consulted with urgent egd performed in the micu - underwent massive transfusion protocol, hct > 25-28 - h. pylori was negative - ppi - follow up with gi - off anticoagulation - transfusion likely cause of chf exacerbation 2. ventilator associated pneumonia - complete course of vancomycin and zosyn on evening - will get last dose at - no further coughing 3. acute on chronic systolic chf - last echocardiogram demonstrated ef 30-35% - acei, diuresis, metablocker - almost at baseline at time of discharge, and will likely need several more days of agressive po diuresis # cad native vessle: - signs of demand ischemia on ekg on admission, which was treated with massive transfusion protocol, hct > 21 - held coumadin and asa - continue acei/beta-blocker # atrial fibrillation: - currently rate controlled well with metoprolol - coumadin held given massive bleeding # depression: - continued citalopram # chronic kidney disease stage iii - renal dosing - cautious diuresis - monitor createnine # communication: patient * # code status: - spoke to nephew, 12:30 p.m. (health care proxy). confirmed dnr/dni medications on admission: 1. citalopram 20 mg tablet sig: one (1) tablet po daily 2. digoxin 125 mcg tablet sig: one (1) tablet po every other day 3. folic acid 1 mg tablet sig: one (1) tablet po daily 4. lisinopril 20 mg tablet sig: one (1) tablet po daily 5. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 7. warfarin 2 mg tablet sig: one (1) tablet po once a day: as indicated by coumadin clinic. 8. cyanocobalamin 1,000 mcg/ml solution sig: one (1) injection injection once a month. 9. omega-3 fatty acids capsule sig: one (1) capsule po once a day. discharge medications: 1. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po tid (3 times a day). 2. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 3. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed for diarrhea. 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 5. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 6. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 7. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 8. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 9. vancomycin 1000 mg iv q 24h hospital aquired pneumonia stop after dose 10. piperacillin-tazobactam 2.25 g iv q6h hospital acquired pneumonia stop after dose discharge disposition: extended care facility: home - discharge diagnosis: primary: 1. upper gi bleed 2. gastric ulcers 3. ventilator-associated pneumonia 4. chf exacerbation, acute on chronic, systolic secondary: 1. s/p hip fracture and hip replacement 2. paroxysmal atrial fibrilation discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - requires assistance or aid (walker or cane) discharge instructions: it was a pleasure taking care of you during your stay at . you were admitted with a gastrointestinal bleed which was caused by ulcers in your stomach. you were treated with blood transfusions as well as other blood products and a procedure to find the cause of your bleeding. during this procedure they were able to inject your ulcers with epinephrine, a drug that can help stop them from bleeding temporarily. we also stopped your warfarin, which you were on to thin your blood, since this can contribute to bleeding. we have made some changes to your medications. these include the following: start taking pantoprazole 40mg twice per day. this is to protect your stomach from too much acid which can worsen your ulcers. stop taking your digoxin. you can discuss whether or not to restart this medication with your primary care physician. taking your warfarin (coumadin). you can discuss whether or not to restart this medication in the future with your primary care physician. please follow up with gastroenterology at the appointment listed below. please also follow up with your primary care physician, . , once you are discharged from your rehabilitation facility. his office can be reached at . finally, please follow up with your orthopedic surgeon as previously directed. followup instructions: gi md: dr. specialty: gastroenterology date/ time: monday, at 1:30pm location: , bldg , ma phone number: please follow up with your orthopedic surgeon as previously directed. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube arterial catheterization endoscopic control of gastric or duodenal bleeding diagnoses: other iatrogenic hypotension urinary tract infection, site not specified congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation personal history of tobacco use dysthymic disorder other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) acute respiratory failure long-term (current) use of anticoagulants gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction hypoxemia carrier or suspected carrier of methicillin resistant staphylococcus aureus hematemesis esophagitis, unspecified hyperosmolality and/or hypernatremia ventilator associated pneumonia acute on chronic systolic heart failure atherosclerosis of native arteries of the extremities, unspecified diverticulosis of colon (without mention of hemorrhage) hip joint replacement other specified gastritis, without mention of hemorrhage duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation, without mention of obstruction aftercare following joint replacement 

Answer: The patient is high likely exposed to