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: penicillins / pneumovax 23 attending: chief complaint: gib major surgical or invasive procedure: colonoscopy history of present illness: 72 year old female with history of cad, cva, and siezure disorder presents to ed after witnessed seizure activity. daughter said pt slumped in chair, was nonresponsive, had right sided facial droop, and was diaphoretic. she was post-ictal afterwards. pt has history of had seizure disorder secondary to stroke in . prior to neuro event patient c/o crampy lower abd pain, after eating lunch. ems called, initially vitals bp 90/40s, diaphoretic, postictal. c/o crampy abd pain, having to go to bathroom in ambulance. in pt had 3 bed pans of brbpr. bp 160s-170s, pulse 50s (beta blocked), mentating well. no cp, no sob. complaining of intermittent crampy lower abdominal pain. received 300 ns, dilantin 500 mg iv, protonix 40 mg iv, and was ordered for a head ct (neg). she had 750 cc ng lavage which was all negative. no n/v/d, no melena prior to this. she was admitted to the micu, where she received several liters ns, changed to dilantin, underwent colonoscopy. past medical history: seizures hemorrhagic stroke, cad s/p cabg, alzheimer's, subtotal gastrectomy secondary to nhl (causing b12 def), cva, tia, htn, hyperlipidemia, b12 deficiency, hypothyroidism social history: daughter is hcp #, remote smoking, no etoh, no drugs, lives on her own, family is looking for . physical exam: temp 99.8/100.1 at 4pm bp 125/65 (100's-130's/40s-60s) hr 85 (60s-80s) rr 17 (14-26) i/o: 1800/1530 (los +5499) gen: nad pleasantly demented female heent: ncat, perrl, eomi, mmm, no nystagmus cv: rrr s1 s2 ii/vi sm at lsb no r/g resp: ctabl no r/r/w abd: soft, +nabs, llq tenderness to mild palp, no r/g, nd ext: no cyanosis clubbing or edema neuro: cn 2-12, aaox3, strength 5/5 b/l ue and le and sensation to lt grossly intact, 2+ dtr biceps (not able to elicit at knees) skin: warm, dry pertinent results: 03:25pm blood wbc-8.0# rbc-4.09* hgb-13.3 hct-39.2 mcv-96 mch-32.6* mchc-34.0 rdw-12.8 plt ct-169 03:25pm blood neuts-76.0* lymphs-17.0* monos-5.6 eos-1.2 baso-0.3 03:25pm blood pt-12.7 ptt-24.8 inr(pt)-1.1 03:25pm blood glucose-142* urean-21* creat-1.2* na-138 k-3.7 cl-104 hco3-23 angap-15 03:25pm blood alt-16 ast-23 ck(cpk)-128 alkphos-69 amylase-197* totbili-0.3 03:25pm blood lipase-54 03:25pm blood calcium-8.8 phos-3.9 mg-2.3 06:35am blood triglyc-39 hdl-54 chol/hd-1.9 ldlcalc-38 03:25pm blood carbamz-5.7 04:45am blood lactate-2.3* . micro: negative blood and stool culture . tagged rbc scan : focus of tracer accumulation in the pelvis does not change over 90 minutes of imaging and is most likely located in the rectum. this finding can be seen with hemorrhoids. no site of active hemorrhage is seen in the small or large bowel. if clinically indicated, additional imaging can be performed with a 12 hour delay. . cth : : no evidence of acute intracranial hemorrhage. unchanged right frontal encephalomalacia and evidence of chronic microvascular ischemia. . ekg: sinus bradycardia at 53 bpm with first degree a-v block (pr 220) left atrial abnormality, long qtc interval 463ms, extensive st-t changes are nonspecific since previous tracing of , no significant change . colonoscopy : erythema, friability and ulceration in the sigmoid colon compatible with likely ischemic colitis. erythema in the rectum. otherwise normal colonoscopy to sigmoid colon . cta abd w&w/o c & recons : 1) diffuse mild-to-moderate bowel wall edema, particularly in the rectosigmoid region, with suggestion of inflammation in the sigmoid, but without discrete fluid collection. this is consistent with the clinical diagnosis of ischemic colitis, particularly in the rectosigmoid region. no evidence of obstruction or perforation. 2) patent major branches, with vascular calcifications. patency of superior mesenteric vein and portal vein also demonstrated. no intraluminal filling defects identified, however, ischemia is not definitively excluded on the basis of this study. 3) cyst in right kidneys; low-density lesions in left kidney and liver, too small to fully characterize, but also probably representing cysts. 4) bilateral small pleural effusions. brief hospital course: a/p: 72 y/o f w/dementia, cad, cva, p/w seizures and brbpr: 1. gi bleed: she was followed by gi and surgery and had a tagged rbc scan which was consistent with a rectosigmoid bleed. she then underwent colonoscopy which showed ischemic colitis in that area while in the micu. she was placed on prophylactic gi antimicrobial coverage while in the icu. she did not require a blood transfusion and as she was stable, was transferred after colonoscopy to the floor. on the floor, ct angiogram of the abdomen was done to evaluate her bowel wall and vasculature was done as she was still having pain. this was again consistent with rectosigmoid ischemic colitis with significant bowel wall edema. her abdominal pain slowly resolved. her hematocrit did trend down slowly from 37-39 on the day of admission to 32 at discharge but she did not meet our criteria for blood transfusion. she has a baseline b12 deficiency for which she takes supplements, however, this anemia was thought to be from a slow gi ooze. her reticulocyte count was at 1.6. her diet was slowly advanced, and she tolerated this without difficulty. we placed her on a low dose aspirin instead of her prior full strength, weighing the risk of bleeding with the opposing risk of her significant underlying ischemic arterial disease. her antibiotics were discontinued. she was started on protonix iv and discharged on po protonix for gi prophylaxis. she will need a repeat colonsocopy or flexible sigmoidoscopy in weeks to assess for complete resolution. . 2. seizures: head ct ruled out bleed and she had no residual neurologic defects. given her history, and as she had a witnessed seizure she was loaded with iv dilantin 500 iv x1, then placed on standing dilantin iv while she was npo. once she was eating, tegretol was restarted and once the tegretol level was at goal (), the dilantin was discontinued. her nightly tegretol dose was increased. 3. arf: her creatinine peaked at 1.2 at admission. this resolved to baseline ~0.8, with hydration and was thought to be secondary to prerenal azotemia. . 4. cad: her asa was initially held, and her beta blocker was initially dosed at 1/2 her home dose in the micu. the beta blocker was eventually resumed at her full dose but her asa was restarted at 81mg instead on the floor, as discussed above. we continued her lisinopril and resumed her statin at transfer to the floor. . 5. ppx: maintained on protonix iv and then switched to po, pneumoboots . 6. adverse pneumococcal vaccine reaction: after receiving the pneumococcal vaccine, per hospital protocol for all patients in her age group who have not been previously immunized, the patient developed erythema, induration, and pain at the injection site in her right deltoid consistent with an adverse vaccine reaction. prior to receiving this vaccination, the patient's daughter and hcp had specifically been questioned about her mother's vaccination history and she denied that her mother had received the pneumoccocal vaccine in the past. the patient received standing tylenol, and prn ibuprofen, and ice packs for pain with improvement. the adverse reaction was duly reported to appropriate hospital and federal authorities. . 7. hypothyroidism: we continued her home dose of synthroid. . 8. alzheimers: she was mostly pleasantly demented, but sundowned with agitation and wandering requiring frequent redirection. her living situation was discussed with her children, and per her daughter and hcp, her children will personally provide 24 hour monitoring for her at the patient's home, with eventual plans to find a . they deffered our offer to help provide them with this service at discharge. she was continued on exelon once taking po's. . 9. glaucoma: she was continued on her home medications . 10. code: full . 11.communication: daughter (h) (c) cell (cell) son cell daughter (w) medications on admission: tegretol 200", lisinopril 20', b12 1000', toprol xl 50', ec asa 325', synthroid 25', exelon 1.5", lipitor 40', traratan 1gtt ou, azopt 1gtt tid, mvi, calcium " * meds on transfer to floor: levofloxacin 500 mg iv q24h ischemic colitis 1000 ml d5 1/2ns continuous at 125 ml/hr for ml acetaminophen mg po q4-6h:prn pain azopt *nf* 1 % ou tid metoprolol 12.5 mg po bid metronidazole 500 mg iv q8h ischemic colitis pantoprazole 40 mg iv q24h exelon *nf* 1.5 mg oral phenytoin 150 mg iv q8h levothyroxine sodium 12.5 mcg iv discharge medications: 1. brinzolamide 1 % drops, suspension sig: one (1) gtt ophthalmic tid (): ou. 2. rivastigmine tartrate 1.5 mg capsule sig: one (1) capsule po bid (). 3. levothyroxine sodium 25 mcg tablet sig: one (1) tablet po daily (daily). 4. atorvastatin calcium 40 mg tablet sig: one (1) tablet po daily (daily). 5. carbamazepine 200 mg tablet sig: one (1) tablet po qam (once a day (in the morning)). 6. metoprolol succinate 50 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). 7. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 8. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 9. tegretol 200 mg tablet sig: 1.5 tablets po at bedtime: 1 and 1/2 tablets every evening. disp:*60 tablet(s)* refills:*0* 10. tylenol 325 mg tablet sig: 1-2 tablets po every six (6) hours as needed for pain for 2 days: as needed for r arm pain. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: ischemic colitis lower gastrointestinal bleed blood loss anemia seizure adverse reaction to pneumovax coronary artery disease, s/p cabg hypothyroidism discharge condition: stable and improved with improved abdominal tenderness. stable hemtocrit for nearly 1 week, tolerating regular diet. discharge instructions: please seek immediate medical attention if you experience further episodes of blood in your stool, or have worsening abdominal pain, or if you experience fever, shaking chills, chest pain, shortness of breath, or other symptoms concerning to you. it is very important that you follow up with gastroenterology (see below). continue to take your medications as directed. we recommend that you increase you continue taking your usual 200mg tegretol every morning (1 tablet), but increase your tegretol dose slightly in the evening --you should now take 300mg (1 and tabs). your aspirin dose has been decreased to 81mg/day (a baby aspirin). have also been started on an medication called protonix for reducing stomach acid (reflux). continue to apply ice packs to your right arm to reduce the inflammation from the vaccine, and take tylenol as needed for pain. the redness and pain should resolve over the next days. please phone your pcp if the redness and pain in the right arm has not resolved by friday. please do not drive or use the stove. followup instructions: provider: , m.d. where: neurology phone: date/time: 9:30 you have an appointment with dr. , m.d., 12:30 in the suite, which is located at . please phone: with questions about your appointment. please follow up with your pcp, . within the next weeks. call to make an appointment. procedure: flexible sigmoidoscopy diagnoses: acute posthemorrhagic anemia acute kidney failure, unspecified unspecified acquired hypothyroidism aortocoronary bypass status other convulsions other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance unspecified vascular insufficiency of intestine 

Answer: The patient is high likely exposed to