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: lightheadness, coffee grounds emesis major surgical or invasive procedure: egd, blood transfusions history of present illness: this is a 66 year-old female with a history of who presents with left pica artery aneurysm s/p coiling , pvd s/p sma stenting, htn, hyperlipidemia presents with light-headedness. the patient reports that she was discharged from rehab 2 weeks ago. she states that over the weekend she was walking down the stairs and felt light-headed. she states that she "blacked out" for several seconds. she continued to feel dizzy and light-headed. the following day she states she was too weak to get out of bed and spent most of her time in bed. she continued to feel dizzy and weak this am. she reports vomiting coffee ground/black emesis x1. she also reports chronic black stools since she was started on fe supplements several months previously. has been taking asa 325mg, no other nsaids. she denied any hematochezia. she was seen by the vna today and advised to go to the ed. . she also reports chronic baseline cough. however, she reports that she has had increasing cough and sputum production. no fevers or chills. she does report that her grandchilden have been sick recently. . in the ed, vs 98.1, 123, 129/58, 18, 96%ra. patient labs were remarkable for a hct of 17.7 (baseline low-mid 20's, severely fe deficient with ferritin of 6). on exam she was occult blood positive, but no gross blood was seen. she was transfused 1u prbc, 2 piv, and given 40mg iv protonix. she was also given 3l ivf. gi was consulted and aware. wbc was 11.0, lactate 2.7. cxr showed possible early rul pna and given 750mg levofloxacin. the patient states the she had a egd and colonscopy 1 month prior at that was reportly normal. per prior d/c summary she underwent egd and colonscopy on at an osh which showed only ischemic colonic ulcer. past medical history: left proximal pica aneurysm w/mass effect on brainstem s/p coiling emphysema hypertension hyperlipidemia cholecystectomy peripheral vascular disease, mild celiac stenosis and moderate-to-severe sma stenosis s/p stent with known occlusion. s/p left ankle fracture tobacco abuse appendectomy depression social history: she is married with four living children. tobacco - quit in (prior 1 pack per day x 56 years. no etoh or other drugs. she works as bookkeeper for her husband family history: her mother ovarian ca, father with unknown ca physical exam: vitals: t:97.0 bp:148/63 hr:109 rr:15 o2sat:98%ra gen: elderly female in no acute distress, appears fatigued heent: eomi, perrl, sclera anicteric, mmm, op clear neck: no jvp no bruits, no cervical lymphadenopathy cor: rrr, no m/g/r, normal s1 s2 pulm: lungs ctab, no w/r/r abd: soft, nt, nd, +bs, no hsm, no masses ext: no c/c/e neuro: alert, oriented to person, place, and time. cn ii ?????? xii grossly intact, except mild facial droop on left. moves all 4 extremities. strength 5/5 in upper and lower extremities on right, but on left. patellar dtr +1. plantar reflex downgoing. skin: no jaundice, cyanosis, or gross dermatitis. no ecchymoses. pertinent results: 11:52pm wbc-10.3 rbc-2.32* hgb-6.8* hct-20.8* mcv-89 mch-29.4 mchc-32.9 rdw-16.7* 11:52pm plt count-412 03:55pm glucose-111* urea n-36* creat-0.7 sodium-140 potassium-4.1 chloride-102 total co2-28 anion gap-14 03:55pm estgfr-using this 03:55pm alt(sgpt)-8 ast(sgot)-8 alk phos-82 tot bili-0.1 03:55pm lipase-25 03:55pm wbc-11.0 rbc-1.87*# hgb-5.7* hct-17.7* mcv-95# mch-30.8# mchc-32.4 rdw-14.3 03:55pm neuts-77.7* lymphs-18.7 monos-3.1 eos-0.4 basos-0.2 03:55pm plt count-498* 03:55pm pt-12.3 ptt-24.3 inr(pt)-1.0 03:12pm lactate-2.7* most recent labs: na 139, k 4.4, cl 100, hco3 30, bun 10, cr 0.6, gglu 99 wbc 12.7, hct 27.1, plts 618 . imaging: chest xray: admission impression: right upper lung airspace opacity worrisome for an early pneumonia. most recent : 1. a new right picc line terminates in the mid svc without complications. 2. stable right pulmonary nodule warrants further investigation. pa and lateral chest radiographs are recommended for better visualization of this abnormality. in addition, a right lateral decubitus view would be helpful to evaluate the right lower lung abnormality. chest ct : 1. new right upper lobe well-defined homogenous opacity is most likely an abscess, although a necrotic soft tissue tumor is also in the differential. recommend 3-4 weeks of antibiotic treatment and follow up with chest x-ray to assess any change in size of this nodule and possible biopsy or pet scan at that stage if the mass remains unchanged. appearances. right lower and middle lobe collapse with persistent minor atelectasis with a smaller right pleural effusion. slight increase in the central lymph nodes as described athough these are not pathological by ct size criteria. stable right renal cyst and left adrenal adenoma. brief hospital course: 66f h/o l pica artery aneurysm s/p coiling , dysphagia, p/w coffee grounds emesis and acute blood loss anemia. 1. acute blood loss/anemia: on arrival to the , mrs. vital signs were stable and she was anemic to 17.7 (baseline hct mid 20s secondary to fe deficiency). presumptive diagnosis was upper gi source due to h/o coffee grounds emesis. melena hard to interpret due to fe therapy. she received 1 units prbcs in the ed and 2 units in the with appropriate hct bumps. on hospital day 2 her hct was stable in the low 30s without transfusions over the past 24 hours. she has not had further coffee grounds emesis. she was started on an iv ppi, put on maintenance ivf, and was made npo for planned egd on hospital day 2. she underwent egd, without obvious source. hct remained stable in the high 20s for the last several days, with most recent value 27.1. she will need small bowel capsule study as an outpatient. . 2. pneumonia: cxr at admission showed new infiltrate in rul, likely a pneumonia. wbc was 11 on day 1, up to 18.8 on day 2 (75% pmns, no bands), but she remained afebrile. initial lactate was 2.7. patient remained stable and did not complain of dyspnea or cough. she was started on levofloxacin for cap, with plans to broaden coverage if clinical picture worsened given recent stay at rehab. she was treated with levofloxacin, without clinical improvement. she then developed a rising o2 requirement, as well as worsening leukocytosis. cxr showed evolution of the right middle lobe infiltrate, and then after a trigger for hypoxia on , a new infiltrate on the right base. this was attributed to aspiration. her antibiotics were broadened to cefepime, vancomycin and flagyl. with this combination, her oxygen requirement improved and her leukocytosis improved. she will complete a 3 week day course of cefepime and flagyl. she will need repeat chest xray in 3 week verify resolution, given rounded appearance of pneumonia in right mid lung, as well as development at right base. this was also evaluated on ct, and appears consistent with pnemumonia, but could also reflect an early abscess, not amenable to drainage. given clinical improvement, she will be discharged on prolonged antibiotics with repeat imaging before the course is over. . 3. left proximal pica aneurysm w/mass effect on brainstem s/p coiling: she was seen by neurosurgery, who recommended outpatient follow up. she had chronic dizziness treated by meclizine. florinef was restarted. . 4. dysphagia: she has had chronic dysphagia since her aneurysm coiling. post egd, her swallowing was worse, but then improved as her discomfort improved. she was back to her baseline at discharge, with aspiration precautions, with nectar thick liquids and ground solids. . 5. hyperlipidemia: simvastatin restarted at discharge. . 6. depression/ anxiety: she is extremely anxious, and was treated with ativan as needed. . medications on admission: nexium 40mg calcium w/ vit d simvastatin 40mg daily effexor 50mg daily meclizine 25mg prn tizanidine 2mg prn asa 325mg daily senna ferrous sulfate 300mg florinef 0.1mg daily docusate 100mg tiotropium inhaler milk of mag xanaz 0.5mg prn bisacodyl 10mg daily tylenol 650mg miconazole powder discharge medications: 1. tiotropium bromide 18 mcg capsule, w/inhalation device : one (1) cap inhalation daily (daily). 2. alprazolam 0.25 mg tablet : one (1) tablet po tid (3 times a day) as needed for anxiety. 3. fludrocortisone 0.1 mg tablet : one (1) tablet po daily (daily). 4. ascorbic acid 500 mg tablet : one (1) tablet po daily (daily). 5. ferrous sulfate 325 mg (65 mg iron) tablet : one (1) tablet po daily (daily). 6. tizanidine 2 mg tablet : one (1) tablet po tid (3 times a day) as needed. 7. simvastatin 40 mg tablet : one (1) tablet po daily (daily). 8. cholecalciferol (vitamin d3) 400 unit tablet : two (2) tablet po daily (daily). 9. calcium carbonate 500 mg tablet, chewable : one (1) tablet, chewable po bid (2 times a day). 10. metronidazole 500 mg tablet : one (1) tablet po q8h (every 8 hours) for 3 weeks. 11. heparin, porcine (pf) 10 unit/ml syringe : two (2) ml intravenous prn (as needed) as needed for line flush. 12. dextromethorphan-guaifenesin 10-100 mg/5 ml syrup : five (5) ml po q6h (every 6 hours) as needed for cough. 13. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath, wheezing. 14. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day). 15. acetaminophen 500 mg tablet : one (1) tablet po every hours as needed for fever. 16. nexium 40 mg capsule, delayed release(e.c.) : one (1) capsule, delayed release(e.c.) po twice a day. 17. meclizine 25 mg tablet : one (1) tablet po twice a day as needed for dizziness. 18. iron (ferrous sulfate) 325 mg (65 mg iron) tablet : one (1) tablet po once a day. 19. chest xray 1 week, to assess right lower lobe and mid lobe 20. outpatient lab work cbc 21. cefepime 2 gram recon soln : two (2) g intravenous twice a day for 3 weeks. discharge disposition: extended care facility: rehab ans care center discharge diagnosis: 1) upper gi bleed with acute blood loss anemia 2) pneumonia 3) anemia-acute on chronic 4) chronic dizziness 5) pica aneurysm, s/p coiling. 6) anxiety 7) dysphagia discharge condition: stable; stable hct 27.1., platelets 612. o2 98% on 2l discharge instructions: you were admitted with a gi bleed, anemia, and pneumonia. no source was identified. you will need further testing in the outpatient setting to identify a source of bleeding. your asa was held. your pneumonia worsened and we had to give you stronger antibiotics. you have been doing well for the past 2 days, with improved oxygen. . medication changes: your aspirin was discontinued. it will need to be restarted at 81 mg after her small bowel study. . you will need a repeat chest xray as there is a possible nodule on your chest xray - in 1 week, and probably a chest ct . return to the er with recurrent bleeding, high fevers, trouble breathing, chest pain, palpitations. followup instructions: chest xray in 1 week to assess right base and right mid lung - ct if no improvement 1)please call for an appointment for the gi doctors: gastroenterology office visits east department: department of medicine operating unit: location: -rose 101/east office phone: ( office fax: ( departmental pager: 2) neurology provider: , md phone: date/time: 1:00 operating unit: location: e/tcc/8 3) you expressed an interest in having a sleep study you can speak to your primary care doctor about a referral for a sleep study. 4) please follow-up with your primary care doctor within the next 2 weeks. procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine diagnoses: pneumonia, organism unspecified acute posthemorrhagic anemia personal history of tobacco use depressive disorder, not elsewhere classified anxiety state, unspecified pneumonitis due to inhalation of food or vomitus hemorrhage of gastrointestinal tract, unspecified gastrostomy status dysphagia, unspecified 

Answer: The patient is high likely exposed to