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: history of present illness: the patient is a 77-year-old female with a history of diverticular bleeding, coronary artery disease, atrial valve replacement on coumadin, who presented with passing clots per rectum for three days. the patient had been having bright red blood per rectum two weeks prior to admission, but this had worsened over several days prior to admission. she denied fever, chills, nausea, vomiting. no chest pain. no shortness of breath. no recent antibiotic use. her baseline hematocrit is 38-41. she denied taking coumadin the night before admission. in the emergency room, she was noted to have continued bright red blood per rectum measuring approximately 300-400 cc. her hematocrit on arrival was 37.9; four hours after arrival was 37.0. in the emergency room, she was given 1 l of intravenous fluids but no ffp or vitamin k. she was hemodynamically stable and transferred to the floor. incidentally she had an appointment scheduled for the day after admission with dr. for her hemorrhoids. past medical history: 1. sigmoid diverticulosis seen on colonoscopy in . 2. atrial fibrillation. 3. status post atrial valve replacement, st. jude's valve. 4. coronary artery disease. 5. hypertension. 6. diabetes mellitus type 2. 7. chronic obstructive pulmonary disease. 8. congestive heart failure. 9. status post appendectomy. 10. status post partial thyroidectomy. 11. status post oophorectomy. 12. hypercholesterolemia. medications on admission: coumadin 2.5 mg p.o. q.d., glyburide 10 mg p.o. b.i.d., lopressor 37.5 mg p.o. t.i.d., lasix 40 mg p.o. b.i.d., captopril 25 mg p.o. t.i.d., glucophage 500 mg p.o. b.i.d., serevent 2 puffs b.i.d., zantac 100 mg p.o. b.i.d., digoxin 0.125 mg p.o. q.d., combivent mdi 2 puffs b.i.d., lipitor 10 mg p.o. q.d. allergies: penicillin causes a rash. social history: she lives alone. her daughter is supportive and lives in the area. she has a 20 pack-year tobacco history and quit many years ago. no alcohol history. physical examination: vital signs: on admission temperature was 98.7??????, blood pressure 140/80, heart rate in the 100-110s and irregular, respirations 16, oxygen saturation 95% on room air. general: the patient was pleasant and in no acute distress. heent: mucous membranes slightly dry. oropharynx clear. pulmonary: bibasilar rales. no wheeze. otherwise clear. cardiovascular: irregular rate. loud s2. there was a 1 out of 6 systolic murmur heard at the apex and the left upper sternal border. abdomen: soft, nontender, nondistended. positive bowel sounds. extremities: there was 1+ edema. neurological: the patient was alert and oriented times three. grossly intact. laboratory data: on admission white blood cells 6.9, hematocrit 37.9, platelet count 172; chem7 with a sodium of 131, potassium 4.2, chloride 90, bicarb 29, bun 15, creatinine 0.7, glucose 390; inr 5.6; digoxin level 0.6. electrocardiogram showed atrial fibrillation with a rate of 100, right bundle branch block, poor r-wave progression. there were no significant changes compared to electrocardiogram performed on . impression: this is a 77-year-old female with a history of diverticulosis, coronary artery disease, st. avr, who presented with bright red blood per rectum in the setting of an increased inr. hospital course: the patient was originally admitted to the general medicine floor but continued to pass clots and bright red blood per rectum. a repeat hematocrit was checked, and this was 30. her heart rate increased to the 160s, and while she with good mental status, it was felt that she was at hight risk for becoming hemodynamically unstable; therefore, she was transferred to the medical intensive care unit. 1. gastrointestinal: given the patient's history of diverticulosis, as well as hemorrhoids, it was felt that these were the two most likely sources of her gastrointestinal bleed. tagged red cell scans were performed, and neither of these were diagnostic. the gastrointestinal service was consulted. a colonoscopy was recommended to visualize the possible source of the gi bleed, and because the patient became anxious and went into respiratory distress during the bowel prep for this procedure, it was not reattempted. in the end it was felt that since the patient had colonoscopy only one year ago that had documented the diverticular disease, it was felt that a repeat colonoscopy would be poor yield unless she were to actively rebleed. in fact, she did not rebleed following her transfer to the medical intensive care unit, and the only further treatment instituted was anusol hc topically to her perianal area for her hemorrhoids. the patient was treated with protime pump inhibitor while on the medical intensive care unit, and we returned her to zantac following discharge. cardiovascular: it was very difficult to control the patient's rapid ventricular response to her atrial fibrillation during her hospitalization. in the medical intensive care unit, increasing doses of lopressor were administered up to 75 mg p.o. q.i.d. plus supplemental lopressor given intravenously. unfortunately this seemed to incite a mild flare of her chronic obstructive pulmonary disease as described below under pulmonary. therefore, she was weaned off of lopressor and started on a diltiazem drip. the diltiazem drip was weaned, and p.o. cardizem was instituted for total p.o. dose of cardizem 90 mg p.o. q.i.d., and following discharge, this was changed to cardizem cd 360 mg p.o. q.d. her rate was well controlled with this dose and ranged from 75 to 90. we continued the patient's digoxin and lipitor. she was admitted on captopril 25 mg p.o. t.i.d., but this was decreased to 12.5 mg p.o. t.i.d. given that her blood pressure was also well controlled with her cardizem. 3. infectious disease: the patient was found to have mild pneumonia. this was treated with levofloxacin 500 mg p.o. q.d. for a 14-day course. the last day of her levofloxacin dose should be . the patient also had a urinary tract infection which was found to be enterococcus susceptible to levofloxacin; therefore, levofloxacin treated both her pneumonia, as well as her urinary tract infection. 4. hematology: the patient's goal inr is 2.5-3.5 given her atrial valve replacement with a st. jude's valve, as well as her atrial fibrillation. she was admitted supratherapeutic with an inr of 5.8. the patient was given ffp, as well as vitamin k to reverse the inr. several units of blood were transfused given the patient's low hematocrit and documented coronary artery disease, as well as congestive heart failure. when the patient was transferred from the medical intensive care unit to the general medicine floor, she was subtherapeutic on her coumadin, so we treated her with lovenox 80 mg subcue b.i.d. this should be continued until her inr reaches 2.5. on the patient's home dose of coumadin, which was 2.5 mg p.o. q.d., the patient's inr stalled at 2.3; therefore, we increased her coumadin dose to 3.0 mg q.monday, wednesday, and friday, and 2.5 mg q.tuesday, thursday, saturday, and sunday. this should be continued until her inr is therapeutic between 2.5 and 3.5, and when this is achieved, her lovenox can be discontinued. 5. pulmonary: as mentioned during the patient's preparation for colonoscopy, she experience acute respiratory distress. it was actually unclear exactly why this occurred, but it could have been secondary to anxiety and underlying pneumonia, as well as possible contribution from her underlying chronic obstructive pulmonary disease. she required intubation for several days, following which she was extubated successfully without complications. she was then treated with nebulized albuterol and atrovent and later weaned off of these and treated with her regular metered dose inhalers. as mentioned, the patient had a pneumonia that was treated with levofloxacin successfully. 6. fluids, electrolytes, and nutrition: the patient received tpn while she was intubated on the medical intensive care unit. when she was extubated, she had a little bit of difficulty swallowing, so we consulted the speech and swallow service which helped us in performing a video swallow study. this was normal, and the patient did well with liquids and solids. her diet should be advanced as tolerated. 7. endocrine: the patient had good glucose control with glyburide, glucophage, and regular insulin sliding scale. condition on discharge: good. discharge status: discharged to rehabilitation facility at rehabilitation. discharge medications: cardizem cd 360 mg p.o. q.d., lipitor 10 mg p.o. q.d., serevent mdi 2 puffs b.i.d., combivent mdi 2 puffs b.i.d., zantac 150 mg p.o. b.i.d., digoxin 0.125 mg p.o. q.d., glucophage 500 mg p.o. b.i.d., glyburide 10 mg p.o. b.i.d., captopril 12.5 mg p.o. b.i.d., coumadin 3.0 mg q.monday, wednesday, friday, 2.5 mg q.tuesday, thursday, saturday, sunday, once the patient's inr reaches 2.5, this should probably be decreased to 2.5 mg p.o. q.d., her goal inr is 2.5-3.5, this should be followed closely while she is an outpatient, lovenox 80 mg subcue b.i.d. until her inr is therapeutic, levofloxacin 500 mg p.o. q.d. until , anusol hc topically to perianal area t.i.d. to q.i.d. p.r.n. discharge instructions: her diet should include thick liquids and solids, and she should advance to full solids as tolerated. the reason she is having some difficulties swallowing is that she is status post intubation. follow-up: she should follow-up with her primary care physician . . discharge diagnosis: 1. lower gastrointestinal bleed, probably diverticular plus hemorrhoidal. 2. pneumonia. 3. chronic obstructive pulmonary disease flare. 4. urinary tract infection. 5. atrial fibrillation with rapid ventricular response. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization insertion of rectal tube diagnoses: pneumonia, organism unspecified abnormal coagulation profile anemia, unspecified urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation heart valve replaced by other means diverticulosis of colon with hemorrhage 

Answer: The patient is high likely exposed to