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 attending: chief complaint: abdominal pain major surgical or invasive procedure: egd and colonsocopy with gastric biopsy, . history of present illness: 77 y/o wf was was initially transferred from for descending thoracic and infrarenal aortic aneurysms found after cta done for severe chest/epigastric pain with radiation to back. initially there was concern for dissection. patient arrived to with sbps in low 200s and hr in 50s and started on nipride drip. she had no other complaints except epigastric tenderness on exam. past medical history: 1. cva/stroke-no deficits except memory and aphasia(uncertain which side) 2. htn 3. gerd 4. hypercholesterolemia 5. skin cancer nos 6. right hip fx 7. s/p tah 9. 4.3 cm infrarenal aaa noted on ct 10. recent (4-5 months ago)pna 3 week stay at , details unknown. 11. ? dementia 12. no cardiologist. no history of cath. does not know of ett in past. dr at is pcp. social history: lives with husband at . has a son, , who is very involved in her care. tob: quit 10 years ago etoh: social drinker. family history: non-contributory physical exam: vitals: 97.3, 67(62-67), 111/69(111-154/70's), 97% 4l gen: nad, , pt had difficulty sticking tongue out all the way. op clear with mmm. neck supple, no jvd, no bruit appreciated. cv: regular, nl s1s2, no murmurs chest: decreased breath sounds at bases. isolated area of wheezes on r, b/l rhonchi at bases more prominent on expiration. abd: flat nt/nd nabs ext: no edema, 2+ pulses. warm and well perfused. full rom all ext with 5/5 strength. neuro: a+o x 3, slow but apporiate response to all questions, repeats answers, occasional word finding difficulties. pertinent results: 02:54pm lactate-2.0 02:28am urine color-straw appear-clear sp -1.033 02:28am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 01:50am urea n-30* creat-1.1 sodium-138 potassium-4.2 chloride-100 total co2-25 anion gap-17 01:50am alt(sgpt)-14 ast(sgot)-18 ck(cpk)-76 alk phos-96 amylase-71 tot bili-0.3 01:50am lipase-19 01:50am ctropnt-<0.01 01:50am ck-mb-2 01:50am calcium-9.2 phosphate-3.5 magnesium-2.0 01:35am wbc-12.1* rbc-4.60 hgb-13.1 hct-39.2 mcv-85 mch-28.4 mchc-33.4 rdw-13.5 01:35am neuts-62.6 bands-0 lymphs-30.9 monos-3.7 eos-2.3 basos-0.6 01:35am plt count-250 01:35am pt-12.3 ptt-30.1 inr(pt)-1.0 cta : impression: penetrating ulceration and aneurysmal dilatation of the descending thoracic aorta, with areas of intramural hematoma in the thoracic aorta. the areas of penetrating ulceration continue into the upper abdominal aorta, with a 3.7 cm infrarenal abdominal aortic aneurysm as described. cxr : there is widening of the mediastinum, which has a slightly ill- defined margin. while this may be positional, there are no prior radiographs for comparison. given that the recent ct scan, performed yesterday demonstrated an aortic ulcer with intramural hematoma and that there is a new left pleural fluid collection, clinical correlation and followup ct scan are recommended. cxr : left lower lobe pneumonia versus atelectasis. cxr : there is continued marked tortuosity of the thoracic aorta. please refer to recent ct scan report.there is continued left lower lobe consolidation most likely indicating atelectasis. the possibility of pneumonia cannot be excluded. there is continued small left pleural effusion. the lungs are clear otherwise. the heart is normal in size. no pneumothorax is seen. cxr : mild congestive heart failure with cardiomegaly and small bilateral pleural effusion. echo : mild symmetric left ventricular systolic function with preserved global and regional biventricular systolic function. mild mitral regurgitation. based on aha endocarditis prophylaxis recommendations, the echo findings indicate a low risk (prophylaxis not recommended). clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. culture results: urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. trimethoprim/sulfa sensitivity confirmed by -. presumptive streptococcus bovis. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s gentamicin------------ <=1 s imipenem-------------- <=1 s levofloxacin----------<=0.25 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s blood and sputum cx's neg. brief hospital course: 1. abdominal pain. this is a 77 f with history of htn, aaa, and cva who presented with acute onset of abdominal pain on . the patient was initially admitted to vascular surgery service. ct done at osh was concerning for aortic dissection. upon further evaluation of images and comparison with studies, it was found that descending aortic aneurysm was unchanged from 2 years ago and there was no dissection. on ct done at aaa size was measured 3.7 cm. her abdominal pain resolved without intervention soon after transfer. ct did show that she had several large gallstones within the gallbladder. there was no evidence of acute cholecystitis. possible etiologies of her abdominal pain included passing of a gallstone or gastritis (later confirmed on egd). lft's were wnl on admission. the patient was continued on ppi during this admission. she remained asymptomatic and was tolerating po's well. 2. uti. on , the patient developed t 102 with ucx positive for e. coli >100,000 and strep bovis in urine. she was started empirically on a 3-day course of bactrim. she was then continued on a 7-day course of levaquin per id because of better coverage of strep bovis with levaquin and also because of cxr finding concerning of pneumonia. would recommend repeating ua and culture after she completes treatment course to ensure resolution. 3. atrial fibrillation, new diagnosis. the patient was found with new onset afib with rapid ventricular response 130-150 with decrease in bp (sbp from 130 to mid 80s for 3 minutes). iv lopressor was given without success and she was loaded with iv amiodarone with subsequent return to nsr. cardiology were consulted. cardiology consultants advised to continue amiodarone po loading followed by 400 mg po bid dose x 7 days then 200 mg po daily. vascular surgery were reconsulted with question of anticoagulation in the setting of aaa and advised that aaa is not a contraindication to anticoagulation. the patient was started on anticoagulation with unfractionated heparin while in the hospital in anticipation of colonoscopy. after egd/colonoscopy, she was then started on lower dose coumadin, 3 mg daily, (as she was also on levaquin and amiodarone). given history of a prior stroke which puts her at a high risk for thromboembolic events, it was felt that the patient needs to be bridged with heparin to overlap with therapeutic inr x 2days. prior to discharge, the patient's son learned to do lovenox injections. her inr was 1.3 on the day of discharge (goal ). dr. will be the patient's outside cardiologist. dr. office was contact and they will follow . the patient was in sinus for the remained of her hospitalization. cardiology consultants recommended that the patient will absolutely need continuous loop recorder after her discharge. a close f/u appointment with dr. was arranged for the patient. of note, the patient's tsh and free t4 were checked and were 1.1 and 1.3 respectively. the patient did have an echocardiogram during this admission which showed normal ef, symmetric lvh and mild mr. there was no evidence of intracardiac thrombi. 4. h/o prior embolic stroke. the patient was continued on low dose aspirin. 5. aaa. stable, 3.7 cm. the patient needs tight bp control. goal sbp <130. 6. htn. the patient was continued on lopressor, imdur, and lisinopril. she had severe htn with sbp in 200's requiring doses of iv hydralazine. lopressor and lisinopril were titrated up. the patient c/o increased cough during this admission and an ace inhibitor was later changed to to eliminate it as a cause of her cough. (the patient was on a low dose prinivil as an outpatient). her bp medications will likely need further adjustment as an outpatient. 7. anemia. iron studies revealed low serum fe/tibc ratio, but ferritin was >500. b12 level was also low, 230. the patient was started on vitamin b12 supplements and was continued on iron supplements. given suspicion for iron deficiency anemia and need for chronic anticoagulation as well as finding of strep bovis in urine, gi were consulted and the patient underwent egd and colonoscopy which were significant for gastritis and diverticuli in duodenum and sigmoid but showed no evidence of malignancy in colon. stomach biopsy was done and the results are pending at the time of this discharge. gi recommended capsule endoscopy as an outpatient and this was scheduled for . instructions regarding bowel prep were communicated to the patient's son. 8. pulmonary. the patient was on inhalers including steroids as an outpatient. the was no h/o copd documented. she did not have evidence of bronchospasm and her only pulmonary complaint during this admission was cough, which could have been due to a respiratory infection, post-nasal drip or ? ace side effect. cxr intially showed evidence of ch which improved clinically throughout her admission. the patient was continued on lasix 20 mg po daily. ace was stopped to eliminate this as cause for cough. the patient was on levaquin for uti which will also cover a pulmonary source. clinically her cough was not worse at night. she was told to resume her outpatient inhalers and to continue with a nasal spray. she will follow up with her pcp. 11. hypercholesterolemia. she was continued on pravachol 12. code: full medications on admission: meds on admission: protonix 40 mg po qd actonel 35 mg po q week albuterol 2 puffs q4 hrs prn asa 81 mg po daily ferrous sulfate 325 mg flonase flovent 2 puffs lasix 20 mg daily imdur 30 mg po daily lopressor 75 mg po bid os-cal 500 mg pravachol 40 mg po qd prinivil 2.5 mg po qd zetia 10 mg po qd cipro (recently completed a 5 day course) meds on transfer: isosorbide dinitrate 20 mg po tid lisinopril 10 mg po daily acetaminophen 325-650 mg po q4-6h:prn metoprolol 100 mg po tid pantoprazole 40 mg po q24h dolasetron mesylate 12.5-25 mg iv q8h:prn nausea furosemide 20 mg po daily hydralazine hcl 10 mg iv q4h sulfameth/trimethoprim ds 1 tab po amiodarone discharge medications: 1. toprol xl 100 mg tablet sustained release 24hr sig: three (3) tablet sustained release 24hr po once a day. disp:*90 tablet sustained release 24hr(s)* refills:*2* 2. 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* 3. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 5. cyanocobalamin 500 mcg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 6. enoxaparin sodium 80 mg/0.8 ml syringe sig: one (1) subcutaneous q24h (every 24 hours) for 4 days: please consult dr. after you have inr checked on monday if you need to continue lovenox. disp:*4 pre-filled syringes* refills:*0* 7. isosorbide mononitrate 30 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). disp:*30 tablet sustained release 24hr(s)* refills:*2* 8. pravastatin sodium 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 9. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. levofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 4 days. disp:*4 tablet(s)* refills:*0* 11. actonel 35 mg tablet sig: one (1) tablet po once a week: take as before, before breakfast with full glass of water. 12. folic acid 1 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 13. warfarin sodium 1 mg tablet sig: three (3) tablet po hs (at bedtime): your irn needs to be closely monitored and dose adjusted. . disp:*10 tablet(s)* refills:*0* 14. albuterol sulfate 0.083 % solution sig: two (2) inhalation every four (4) hours as needed for shortness of breath or wheezing. 15. os-cal 500 mg tablet sig: one (1) tablet po twice a day. 16. flovent 44 mcg/actuation aerosol sig: two (2) inhalation twice a day. 17. flonase 50 mcg/actuation aerosol, spray sig: one (1) nasal once a day. 18. amiodarone hcl 200 mg tablet sig: two (2) tablet po as directed: please take 2 pills twice a day for 5 days then take one pill once a day and follow up with dr. . disp:*30 tablet(s)* refills:*1* 19. atrovent 18 mcg/actuation aerosol sig: one (1) inhalation every six (6) hours as needed for shortness of breath or wheezing. disp:*1 unit* refills:*0* 20. losartan potassium 50 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 21. outpatient work pt-inr and chem 7. please call results to dr. or dr. at (. discharge disposition: home with service facility: vna discharge diagnosis: primary diagnoses: 1. abdominal pain, self-resolved 2. atrial fibrillation with rapid ventricular response 3. urinary tract infection 4. hypertension secondary diagnoses: 1. abdominal aortic aneurysm 2. anemia 3. gastritis 4. diverticulosis, sigmoid 5. duodenal diverticuli discharge condition: asymtpomatic. vital signs stable. discharge instructions: please take all medications as prescribed. please keep all follow up appointments. you will need to have you inr monitored closely and coumadin dose adjusted as needed. dr. , your new cardiologist, will follow your inr. please follow up with dr. about your gi biopsy results. please return to care if you have chest pain, fever, abdominal pain, if you have bleeding that does not stop. followup instructions: cardiology: dr. ( on at 1:45 pm. you will need to be set up for cardiac monitor (continuous loop recorder) and your medications will likely need to be adjusted. you need to return for capsule endoscopy on , . you need to have bowel prep prior to the procedure. please follow the instructions that were provided to you. please come to the , building, , at 7:45 am. ( , md where: building (/ complex) endoscopy suite phone: date/time: 8:00) primary care: please call dr. ( to arrange for a follow up appointment within 2 weeks of discharge from the hospital. gi: dr. , , at 1:20 pm. procedure: colonoscopy esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension atrial fibrillation other chest pain abdominal pain, epigastric diverticulosis of colon (without mention of hemorrhage) atrophic gastritis, without mention of hemorrhage dissection of aorta, abdominal diverticulosis of small intestine (without mention of hemorrhage) 

Answer: The patient is high likely exposed to