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: gi bleed major surgical or invasive procedure: esophagogastroduodenoscopy history of present illness: mr. is a 63-year-old male with past medical history significant for erosive gastritis ( egd ), aortic stenosis with 3 x ( last mechanical valve placed in )on home coumadin, depression, htn, and hyperlipidemia who presented to with complaints of melanotic stools x 2 days. he states he had a total of total marroon colored stools over past 48 hours, and his last bowel movement was early this morning around 8 am. he is a limited historian but he feels that he "might" have also had some blood in 1 episode of vomitus last night. at osh he had a negative ng lavage and positive stool guiaic. at osh emergency room he was tachycardic per reports with hct of 28 (baseline 30) and inr was elevated to 7. he was given 1 unit prbcs and 2 units ffp and placed on iv protonix at osh before transfer here. he was also given 1mg ativan iv for anxious demeanor and concern for etoh withdrawal. also had ct head at osh after some mild confusion noted but imaging was negative. in ed here initial vitals were: t 98.8f, hr 93, bp 138/74, rr 16, o2 sat 97% ra. repeat ng lavage here in ed was again negative and he had positive stool guiaic. patient was given 10mg valium, 10mg iv vitamin k, and iv protonix continued. hct s/p 1 unit prbcs here was down to 25.1. inr was 2.7, pt 28, ptt 43.9. gi service consulted and plan was to trend hcts overnight, continue prbcs as needed and tentative plan was for morning egd in icu. on arrival to the icu he appeared to be in no distress but seemed slightly anxious with stuttering voice and tremulous. he was also confused regarding details of his history. vitals on arrival to icu were t: 97.5f, bp: 165/81, p: 91, rr:18, and o2 saturation 98 % on 2l nc. past medical history: -erosive gastritis ( egd ) -aortic stenosis with 3 x ( last mechanical valve placed in , inr goal is 2.5-3.5)on home coumadin for -depression -hypertension -hyperlipidemia, -h/o polio -alcoholism -benign essential tremor -abdominal lymphadenopathy -s/p traumatic splenectomy -s/p hernia repair -avn of bilateral hips social history: lives alone in house in but his daughter and son check in on him daily. he states he smokes occasional cigar and drinks anywhere from 4 to 12 beers a day, sometimes "more". denies any illicit drug use. he is divorced. retired police officer. family history: parents died young. mother history of depression and essential tremor. gm with open heart surgery (unclear indication) physical exam: micu admission exam vitals: t: 97.5f, bp: 165/81, p: 91, rr:18, o2: 98 % on 2l nc general: oriented x 1, answers "" to year, no acute distress, stuttering speech, pallid complexion heent: sclera anicteric, mmm, oropharynx clear, small maroon area of dried blood on side of lip, ngt in place neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, or rhonchi cvs: regular rate, loud systolic mechanical murmur over lusb. no rubs or gallops. abdomen: soft, non-tender, non-distended, normoactive bowel sounds present, no rebound tenderness or guarding, no organomegaly neuro: tremors over bilateral upper extremities, no asterixis, cns in tact, light toush sensation in tact throughout, gait assessment deferred gu: foley in place, draining yellow fluid skin: no telangiectasias, pale skin, no jaundice ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 11:30pm wbc-7.4 rbc-2.79* hgb-8.3* hct-25.1* mcv-90# mch-29.8 mchc-33.1 rdw-20.0* 11:30pm plt smr-normal plt count-169 11:30pm hypochrom-1+ anisocyt-2+ poikilocy-1+ macrocyt-1+ microcyt-1+ polychrom-1+ spherocyt-1+ target-2+ schistocy-2+ how-jol-1+ 11:30pm neuts-46* bands-3 lymphs-39 monos-11 eos-1 basos-0 atyps-0 metas-0 myelos-0 11:30pm glucose-98 urea n-8 creat-0.6 sodium-144 potassium-4.0 chloride-106 total co2-28 anion gap-14 11:30pm alt(sgpt)-22 ast(sgot)-46* alk phos-62 tot bili-1.4 egd esophagus: excavated lesions non-bleeding ulcerations noted at the ge junction with severe esophagitis. likely source of bleeding in the setting of supratherapeutic inr. stomach: mucosa: patchy erythema in antrum of stomach consistent with gastritis. duodenum: normal duodenum. impression: esophageal ulcer abnormal mucosa in the stomach otherwise normal egd to second part of the duodenum 06:37am blood wbc-10.6 rbc-3.64* hgb-10.8* hct-35.0* mcv-96 mch-29.6 mchc-30.8* rdw-20.0* plt ct-212 06:37am blood pt-14.1* ptt-95.6* inr(pt)-1.2* 06:37am blood glucose-95 urean-8 creat-0.7 na-141 k-4.1 cl-103 hco3-30 angap-12 06:37am blood calcium-8.9 phos-4.7* mg-2.3 03:48am blood vitb12-354 03:48am blood tsh-2.0 06:55pm urine color-yellow appear-hazy sp -1.014 10:31am urine color-amber appear-cloudy sp -1.012 06:55pm urine blood-mod nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln->12 ph-8.0 leuks-mod 10:31am urine blood-lg nitrite-pos protein-150 glucose-neg ketone-neg bilirub-sm urobiln-12* ph-7.0 leuks-mod 06:55pm urine rbc-71* wbc-104* bacteri-few yeast-none epi-1 10:31am urine rbc->50 wbc-21-50* bacteri-few yeast-none epi-<1 10:31 am urine source: catheter. **final report ** urine culture (final ): staph aureus coag +. >100,000 organisms/ml.. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | gentamicin------------ =>16 r levofloxacin---------- =>8 r nitrofurantoin-------- 32 s oxacillin------------- =>4 r tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s 3:50 pm serology/blood **final report ** helicobacter pylori antibody test (final ): negative by eia. (reference range-negative). time taken not noted log-in date/time: 11:34 am serology/blood chem# d. **final report ** rapid plasma reagin test (final ): nonreactive. reference range: non-reactive. brief hospital course: #. gi bleed: with report of melena, upper source of bleeding was suspected and patient treated with ppi, ffp, vitamin k for supratherapeutic inr and was admitted to the icu. patient transfused 1unit of prbcs, plus additional 2 units prbcs at . he was tachycardic on presentation to the er, thought due to anxiety and possible alcohol withdrawal, treated with benzodiazepines. bp remained stable. egd showed esophageal erosions and esophagitis. sucralafate was added at gi recommendations to be continued while inpatient, but can be discontinued at the time of discharge. given mechanical valve, iv heparin was started following endoscopy. his hematocrit subsequently remained stable. #. s/p mechanical : patient's inr was elevated at presentation. he denies taking excess doses of warfarin, though acknowledged he does not know his medications - he has assistance from family. he has reportedly refused visiting nurse services in the past and there is some concern that his medication assistance is not adequate. he was given vitamin k in the er given ongoing bleeding and then transitioned to heparin drip following egd. his coumadin was eventually restarted for an inr goal of 2.5-3.5. the heparin drip can be stopped when inr is therapeutic. #. alcohol withdrawal: patient drinks a substantial amount of beer at home and was placed on a ciwa scale for alcohol withdrawal. he received some valium per the ciwa scale but otherwise had uncomplicated withdrawal. it was recommended that he follow-up with psychiatry as an outpatient. #. confusion: patient had head ct at osh that per report showed no evidence of bleeding. neurologic exam here was nonfocal. he has been followed by cognitive neurology and felt to have "mild diffuse executive impairments most compatible with hypoxic or microembolic injury during surgery." his mental status remained stable. #. uti: patient noted to have an mrsa uti. he was started on bactrim which should be continued until . medications on admission: atorvastatin - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth once a day escitalopram - (prescribed by other provider) - 20 mg tablet - 1 tablet(s) by mouth once a day folic acid - (prescribed by other provider) - 1 mg tablet - 1 tablet(s) by mouth once a day propranolol - (prescribed by other provider) - 10 mg tablet - 1 tablet(s) by mouth twice a day protonix 40mg warfarin - (prescribed by other provider) - 4 mg tablet - 1 (one) tablet(s) by mouth once a day ferrous sulfate - (prescribed by other provider) - 325 mg (65 mg elemental iron) tablet - 1 (one) tablet(s) by mouth once a day multivitamin - (prescribed by other provider) - capsule - 1 capsule(s) by mouth daily discharge medications: 1. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 2. escitalopram 10 mg tablet sig: two (2) tablet po daily (daily). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. propranolol 10 mg tablet sig: one (1) tablet po bid (2 times a day). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 6. warfarin 2 mg tablet sig: two (2) tablet po once daily at 4 pm. 7. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 8. multivitamin tablet sig: one (1) tablet po daily (daily). 9. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. heparin (porcine) in d5w 25,000 unit/500 ml parenteral solution sig: one (1) unit intravenous continuous: please dose according to provided heparin sliding scale until inr is therapeutic. . 11. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po bid (2 times a day) for 6 days. disp:*12 tablet(s)* refills:*0* 12. warfarin 4 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnosis: upper gi bleed due to severe esophagitis and gastritis secondary diagnosis: alcohol withdrawal discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to the hospital due to bleeding from your gastrointestinal tract. your coumadin level (inr) was high on admission and it was felt this may have contributed to your bleeding. you underwent an egd which showed that you have inflammation in your esophagus and stomach that likely was the source of your bleeding. your blood count remained stable since this study. your coumadin was temporarily stopped on admission and you were given heparin to thin your blood while your coumadin level (inr) increased again. you will need to continue this medication until your inr is therapeutic. you were also given a medication called valium used in alcohol withdrawal. changes to your medications: added thiamine added bactrim for a urinary tract infection, you will need to finish a 7 day course of this medication. last day is . continue heparin iv drip until inr is therapeutic increased protonix to twice daily dosing followup instructions: you have the following appointments scheduled: name: , f. appointment: , , 1:45pm location: family physicians of address: , , phone: name: , appointment: , , 1:15pm address: phone: a psychiatry follow up has been recommended for you. to see a psychiatrist at , please call dr. at . if you prefer to see a psychiatrist closer to home, please contact your pcp for recommendation. if you are interested in seeking treatment for alcohism, please contact the following: 1. sstar, intensive outpt treatment program contact: 2. addiction treatment center, structured outpt addiction program and outpt mental health and substance abuse services ( md, procedure: other endoscopy of small intestine diagnoses: tobacco use disorder urinary tract infection, site not specified unspecified essential hypertension acute posthemorrhagic anemia depressive disorder, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere other and unspecified hyperlipidemia heart valve replaced by other means methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site other acquired absence of organ unspecified gastritis and gastroduodenitis, with hemorrhage other and unspecified alcohol dependence, unspecified aseptic necrosis of head and neck of femur leukocytosis, unspecified other and unspecified alcohol dependence, continuous ulcer of esophagus without bleeding alcohol withdrawal other esophagitis personal history of poliomyelitis essential and other specified forms of tremor 

Answer: The patient is high likely exposed to