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: no known allergies / adverse drug reactions attending: chief complaint: fever major surgical or invasive procedure: egd history of present illness: 82y/o cambodian-speaking man with dm, htn presents with one day of subjective fever and night sweats. pt reports single episode of nausea with a little vomit last night, with no identifiable triggers. ros positive for black stools and cough of 1 mo. of note, pt had a cystoscopy on . denies weight changes, ha, cp, sob, abd pain, focal neurol deficits, abnormal bowel movements, hematochezia. in the ed initial vital signs were 98.6, 85, 109/64 (baseline sbp 150's), rr 16, sat 100%. exam was notable for guaic + stool. neuro, abd, heart, lung exam unremarkable. labs were notable for wbc to 15 (baseline 6), hct 27.5 (baseline 41), bun of 70, cr of 1.4 (baseline 1.0-1.1), ast/alt (41/57), lactate 4.0, ucx pending. patient underwent cxr was did not show any acute cardiopulmonary process, ekg showed sinus at 82. foley placed, ng lavage showed scant flecks of coffee grounds. protonix 40mg iv was given. he was type and crossed for 3us. patient was seen by gi consult, who were not concerned for acute gi bleed, but suggest admission to medicine with tele. patient was admitted for an upper gi bleed workup. initially slated to come to the floor, but he became hypotensive to 91/50, map <65. there was concern for end organ ischemia given lactate of 4. he was reassigned to icu. bp improved to 123/50 after 1l bolus; 2nd liter hanging on transfer. pt had a recent admission in , he was admitted to the acute care surgery service for management of sbo, which resolved with conservative managment. ct scan showed liver and kidney hypodensites (see below). due to hematuria, he had a recent cystoscopy where the bladder neck was unremarkable. the ureteral orifices were normal in position and the left was slightly gaping but otherwise unremarkable, tiny punctate lesions throughout some of the bladder mucosa, nonsuspicious, nonspecific potentially consistent with prior infection or inflammation. past medical history: gout dm htn social history: - tobacco: smokes cigarettes per day - etoh: occasional - illicits: none family history: no family history of to suggest common ugi bleeds. physical exam: admission pex: vitals: 98.6, 85, 109/64, 16 @ 100% general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, many metal teeth lungs: diffuse expiratory wheezes cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley ext: warm, well perfused, no clubbing, cyanosis or edema ========================== discharge pex: v/s: 96-98.7, 160-180/76-96, 68-80, 18-20, 100% ra fs: 201, 146, 198, 168 general: wdwn in nad. alert and oriented. no central or peripheral cyanosis; no jaundice, no palor. heent: ncat. sclera anicteric. +arcus bilat, perrl, clear op. neck: supple; no jvd; no lad. cardiac: rrr, soft heart sounds, normal s1, s2; no s3, s4. no m/r/g. lungs: ctab abdomen: +bs. soft, ntnd, no rebound, no guarding. no hsm. gu: no foley extremities: wwp, no cyanosis, no edema. 2+ pulses. skin: no rashes, bruising, lesions. neuro: cn2-12 intact; 5/5 strength distally and bilaterally. pertinent results: admission labs: 04:00pm blood wbc-15.4*# rbc-2.85*# hgb-9.4*# hct-27.2*# mcv-96 mch-33.1* mchc-34.7 rdw-13.8 plt ct-220 04:00pm blood pt-13.5* ptt-25.7 inr(pt)-1.1 04:00pm blood glucose-157* urean-70* creat-1.4* na-142 k-4.4 cl-108 hco3-21* angap-17 04:00pm blood alt-57* ast-41* ld(ldh)-136 alkphos-80 totbili-0.2 04:00pm blood caltibc-270 vitb12-530 folate-12.3 hapto-274* ferritn-165 trf-208 05:27pm blood lactate-4.0* labs on discharge: 06:30am blood wbc-13.6* rbc-3.30* hgb-10.6* hct-31.0* mcv-94 mch-32.1* mchc-34.2 rdw-14.8 plt ct-250 06:30am blood glucose-159* urean-19 creat-1.1 na-144 k-4.2 cl-107 hco3-29 angap-12 06:30am blood calcium-9.3 phos-3.1 mg-2.0 02:27am blood gastrin - wnl micro data: 2:27 am serology/blood chem# l used. **final report ** helicobacter pylori antibody test (final ): negative by eia. reference range-negative). 10:00 pm mrsa screen source: nasal swab. **final report ** mrsa screen (final ): no mrsa isolated. 8:20 pm blood culture #2. **final report ** blood culture, routine (final ): no growth. 8:20 pm blood culture #1. **final report ** blood culture, routine (final ): no growth. 7:20 pm urine site: catheter **final report ** urine culture (final ): proteus mirabilis. >100,000 organisms/ml.. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ proteus mirabilis | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s 4:00 pm urine site: clean catch **final report ** urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with fecal contamination. studies: cxr: 1. no evidence of acute cardiopulmonary process. 2. two left upper lobe pulmonary nodules are again visualized with one measuring 4 mm and the other measuring 3 mm. elective chest ct is again recommended in the outpatient setting for further evaluation. egd: impression: small polyp/thickened fold seen in the distal esophagus. (biopsy) ulcers in the pylorus, antrum, stomach, and body (biopsy) otherwise normal egd to third part of the duodenum recommendations: will mail a pathology report in weeks follow-up with dr. and dr. for endoscopy in 8 weeks. treat h. pylori if positive protonix 40mg additional notes: the attending was present for the entire procedure. final diagnoses are listed in the impression section above. estimated blood loss = zero. specimens were taken for pathology as listed above. brief hospital course: 82y/o cambodian speaking man with dm, htn presents with one day of subjective fever and night sweats, here with anemia, leukocytosis, lactic acidosis, concern for gi bleed. . # upper gi bleed: pt presented with dark stools times 1 mo, which he had melena in ed, hct drop from 1 mo ago from 41->28 then on repeat dropped to 23. also found to have coffee grounds on ng lavage. egd shows evidence of chronic ulcers but no active bleeding seen. hct remained stable after transfusion of 2u prbc in low thirties. patient was started on ppi 40mg iv bid and converted to protonix 40mg po bid as outpatient. baby asa held initially but given no active bleed and h/o cad, restarted upon d/c. patient has afib and chads score of 2, should have discussion with pcp regarding whether or not to start coumadin. gastrin level, pending at time of d/c, came back wnl, notified pcp. pylori - pending at time of d/c, came back negative, notified pcp need to f/u on biopsy of esophageal polyp -will need follow up endoscopy in 2 months . # proteus uti: ua elevated wbc and ph c/w uti. urine culture grew proteus mirabilis >100,000 org/ml. pt is symptomatic, including fevers, hypotension and leukocytosis. started on zosyn but narrowed to cipro after . returned for total of 10 days. patient discharged on ciprofloxacin twice daily through and was given a prescription for the rest of the course. patient was placed on ivf initially but then did not require it. - blood cx ngtd x3 days . # : likely pre-renal or associated with uti. normalized after ivf/abx; creatinine back to baseline 1.1. resolved. . # transaminitis: mild, likely poor liver perfusion in the setting of infection. no ruq pain, so unlikely that the biliary tree is the infectious source. could consider ruq us and hep serologies if ast/alt rise. patient trended and no rise in lfts. - restarted home statin - will need hepatitis serologies done as outpatient with pcp. . # anemia: likely acute blood loss. workup send from the ed including: fe studies, b12, folate, hapto, retic count, ldh. boarderline macrocytosis, but normal b12 and folate deficiency. normal hapto. . # htn: antihypertensives held initially and patient became tachycardic to 100s and hypertensive to 190s, asx. upon restart of medication, patient continued to be hypertensive & slow to respond with home dosage. upon d/c continues to be hypertensive in 160s, asx. restarted on home atenolol, dilt doses & doubled lisinopril to 20mg daily. - will need to be followed as an outpt to obtain better control of blood pressure. . # dm: resume metformin and glipizide. iss while in house. . # gout: restart home allopurinol at 1/2 dose (100mg daily). patient's renal function dictates that max dose should be around 150mg daily; can uptitrate as outpatient by pcp 100mg daily not suffice. . # code: full (confirmed via interpreter phone) . . pending tests: egd esophageal polyp biopsy - pending . . transitional issues: -patient will need to follow up with pcp regarding results of egd biopsy. also, will need f/u egd in 2 months. -patient's anticoagulation regimen should be evaluated by pcp, whether or not coumadin should be started. -patient's bp not optimally controlled; sent home on home meds but will need careful titrating. -following changes to meds start ciprofloxacin twice daily through start protonix 40mg twice daily increase lisinopril to 20mg daily decrease allopurinol to 100mg daily hold warfarin medications on admission: 1. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 2. diltiazem hcl 180 mg capsule, extended release sig: one (1) capsule, extended release po daily (daily). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily): take with food. 4. simvastatin 10 mg tablet sig: two (2) tablet po daily. 5. metformin 500 mg tablet sig: two (2) tablet po bid: resume when taking a regular diet. 6. glipizide 5 mg tablet sig: one (1) tablet po daily. 7. docusate sodium 100 mg capsule sig: one (1) capsule po tid : hold for loose stool. 8. allopurinol 100 mg tablet sig: one (1) tablet po twice a day. 9. lisinopril 10 mg tablet sig: one (1) tablet po daily discharge medications: 1. diltiazem hcl 180 mg capsule, extended release sig: one (1) capsule, extended release po daily (daily). 2. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 3. atenolol 25 mg tablet sig: one (1) tablet po once a day. 4. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 5. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 6 days: to end on . disp:*13 tablet(s)* refills:*0* 6. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily): take only once per day. disp:*0 tablet(s)* refills:*0* 7. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. 8. docusate sodium 100 mg capsule sig: one (1) capsule po tid (3 times a day): hold for loose stool. 9. glipizide 5 mg tablet sig: one (1) tablet po once a day. 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 11. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day. discharge disposition: home discharge diagnosis: primary: peptic ulcer disease, urinary tract infection, lactic acidosis, hypertension secondary: atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking care of you at the . you presented to the hospital with symptoms of fever and nightsweats and were found to have a urinary tract infection as well as a decreased red blood cell count. we have placed you on ciprofloxacin, an antibiotic that you will need to continue taking through . also, we performed a thorough evaluation of your decreased blood count and dark stool & found that you had chronic ulcers in your stomach which may have bled in the past. we have placed you on 40mg protonix twice daily and held your aspirin to help heal these ulcers. we have tested you for infection and other causes for these ulcers. you will need to follow up with your pcp 1 week of discharge for these results as well as the resolution of your urinary tract infection. during your hospitalization, we also found you to be hypertensive and have doubled your lisinopril to 20mg daily. please discuss this with your pcp when you see her in 1 week as well. we also cut down your dose of allopurinol (for gout) from 100mg to 100mg daily due to your kidney function. your pcp can help adjust this medication dose but we believe the most you should take is 150mg daily. the following changes were made to your medication regimen: start ciprofloxacin twice daily through start protonix 40mg twice daily increase lisinopril to 20mg daily decrease allopurinol to 100mg daily hold warfarin we wish you a speedy recovery and hope that you feel better soon. followup instructions: please call your pcp, . at for a followup appointment so that she can see you within 1 week of discharge. please follow up with drs. and at the end of for repeat upper endoscopy. please schedule this with his office. procedure: esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: acidosis tobacco use disorder urinary tract infection, site not specified unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified gout, unspecified atrial fibrillation blood in stool proteus (mirabilis) (morganii) infection in conditions classified elsewhere and of unspecified site other specified disorders of esophagus nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] chronic gastric ulcer without mention of hemorrhage or perforation, without mention of obstruction 

Answer: The patient is high likely exposed to