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: bactrim attending: chief complaint: shortness of breath major surgical or invasive procedure: picc egd colonoscopy blood transfusion history of present illness: 66yo female with multiple medical problems including morbid obesity, obstructive sleep apnea, copd on 3 l o2, and likely diastolic dysfunction was admitted from the ed with shortness of breath. she reports that she was in the hospital in for shortness of breath thought related to a copd and chf exacerbation. she was initially admitted to the micu and then transferred to the floor. she was treated with levofloxacin and steroids with improvement in her symptoms. her hospital course was complicated by atrial fibrillation with rvr and guiac positive stool. she was discharged to rehab, where she was for 3 weeks. she then was doing relatively well and had tapered off her steroids. then over the last 24-48 hours, she has had increasing shortness of breath. her o2 sat is typically 96% on 3l and had declined to as low as 91% on 3l. review of systems is also notable for wheezing. she has chronic lower extremity swelling, orthopnea, paroxysmal nocturnal dyspnea, and dyspnea on exertion, which has been relatively unchanged. she otherwise denies fevers, shaking chills, night sweats, cough, nausea, vomiting, chest pain, sputum production, and lower extremity edema. review of systems is also notable for the following: - history of dvt in the past and coumadin was discontinued early due to melena. on review of systems, she denies any prior history of stroke, tia, pulmonary embolism, bleeding at the time of surgery, myalgias, joint pains, cough, hemoptysis, black stools or red stools. she denies recent fevers, chills or rigors. she denies exertional buttock or calf pain. all of the other review of systems were negative. upon arrival to the ed, vital signs were 99.5, hr 130s, bp 151/125, rr 21, 100% on nrb. exam with wheezing. ecg was unremarkable. she received aspirin 325mg po x 1 and 40mg iv lasix with 850ml uop. desat'd to 90s 4l. upon arrival to the floor, she reports significant improvement in her breathing. past medical history: 1. morbid obesity 2. obstructive sleep apnea 3. hypertension 4. ?peptic ulcer disease (no documentation in the e-files) 5. anemia 6. asthma 7. copd, o2 dependent 8. chf with preserved ef 9. h/o dvt; coumadin stopped because of melenic episode cardiac risk factors: dyslipidemia, hypertension cardiac history: cabg: none percutaneous coronary intervention: none pacemaker/icd: none social history: social history is significant for the absence of current tobacco use. pt quit smoking in . there is no history of alcohol abuse. family history: there is no family history of premature coronary artery disease or sudden death. her family history is notable for multiple family members with hypertension, father who died of lung cancer, and mother who died of cva and hypertension. physical exam: vs - t 97.6 / hr 70 / bp 88/36 / rr15 / pulse ox 98% on 5l gen: obese female in no acute distress. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple; jvp difficult to assess given patient's body habitus cv: pmi located in 5th intercostal space, midclavicular line. rr, normal s1, s2. harsh 3/6 systolic murmur heard best at the lusb. 3/6 systolic murmur heard also at the apex. no thrills, lifts. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. scattered wheezes and crackles bilaterally and throughout. abd: obese, soft, ntnd. no hsm or tenderness. no abdominial bruits. ext: no c/c/e. no femoral bruits. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pertinent results: admission labs 11:50am blood wbc-4.3 rbc-3.22* hgb-8.9* hct-28.8* mcv-89 mch-27.7 mchc-31.0 rdw-17.5* plt ct-139* 11:50am blood pt-13.5* ptt-25.5 inr(pt)-1.2* 11:50am blood glucose-108* urean-18 creat-0.9 na-144 k-5.0 cl-99 hco3-44* angap-6* 11:50am blood ck-mb-notdone probnp-1577* 11:50am blood ctropnt-0.02* 11:50am blood ck(cpk)-30 11:50am blood calcium-8.8 phos-4.0 mg-2.1 11:03am blood type-art o2 flow-4 po2-68* pco2-85* ph-7.35 caltco2-49* base xs-16 comment-nasal 10:55am blood %hba1c-5.4 testing ecg: atrial fibrillation with rapid ventricular response (118bpm). baseline artifact. diffuse st-t wave changes. compared to the previous tracing of st-t wave changes in the inferior leads are similar. no diagnostic interim change. cxr: 1. findings consistent with volume overload. 2. bilateral pleural effusions, left greater than right. 3. bibasilar atelectasis; underlying infection cannot be excluded. cxr: in comparison with the study of , there may be mild improvement in pulmonary vascular status, though some of this may be related to the differences in technique. enlargement of the cardiac silhouette persists as does a small-to-moderate left pleural effusion with left basilar atelectasis. colonscopy: fair preparation a single sessile 25 mm polyp of benign appearance was found in the proximal ascending colon methylene blue 0.002% solution was injected submucosally beneath the 25 mm in diameter proximal ascending colon polyp successfully successful complete endoscopic mucosal resection (emr) in a piecemeal fashion of the 25 mm in diameter proximal ascending colon was performed using a 15mm in diameter stiff snare successful argon plasma coagulation was performed on the entire surface of the post-emr site to prevent recurrence a single sessile 6 mm polyp of benign appearance was found in the proximal ascending colon. a single-piece complete polypectomy was performed using a cold snare. small angioectasia without bleeding was identified in the proximal ascending colon successful -cap treatment was applied to the small angioectasia identified in the proximal ascending colon multiple diverticula with medium openings were seen in the descending colon and sigmoid colon. diverticulosis appeared to be of moderate severity. small grade 1 internal hemorrhoids were noted recommendations: clear liquids when alert, awake, and at baseline follow for response/complications please call should severe abdominal pain or rectal bleeding occur please call dr. office () in 10 days to obtain biopsy results surveillance colonoscopy in 6 month's time after golytely preparation to reassess post-emr site in the proximal descending colon follow up with dr. as needed egd: normal mucosa in the esophagus erythema, congestion and nodularity in the antrum and stomach body compatible with mild gastritis (biopsy) normal mucosa in the duodenum (biopsy) recommendations: clear liquids when alert, awake, and at baseline follow for response/complications call dr. office () in 10 days to obtain biopsy results continue current medications procede with colonoscopy today follow-up with dr. as needed brief hospital course: 1. acute on chronic diastolic hf: this, in addition to atrial fibrillation and copd (addressed below), likely contributed to her dyspnea. pateint was started on furosemide iv then transitioned to a furosemide gtt and diuresed approximately 3l daily. (los ~30l diuresed total). then she was started on an oral diuretic regimen of torsemide 80mg po bid. this resulted in marked improvement in her symptoms. her oxygen requirement slowly improved and she was weaned down to her home o2 requirement of 3l. metoprolol was started and uptitrated to 75mg . potassium was repleted, this will continue daily as at rehab with every other day lab checks. as her blood pressure was borderline, an ace-i was not initiated. this will be discussed at her future cardiology outpatient appointment. . 2. atrial fibrillation with rvr: she was initially on a diltiazem drip for rate control, then transitioned to diltiazem po and metoprolol po. her rate was controlled to 70s-80s on this regimen, although she remained in atrial fibrillation. she was started on a full dose aspirin and heparin drip with plan to bridge to warfarin, although she had recurrence of gi bleeding, which is discussed below so heparin gtt was stopped and aspirin was continued. at discharge, she was on aspirin for anticoagulation only, with no coumadin as she has a high risk of rebleeding. this will also be discussed at her future cardiology appointment. . 3. copd: on 3l home o2. she had wheezing on initial exam which subsequently improved so was not initially managed as copd exacerbation. she then complained of productive cough and increased wheezing so was treated with a steroid taper, and 5 day course of azithromycin. her prednisone taper will be continued for 10mg for the next two days, followed by 5mg qd for one week, followed by 5mg every other day for the last week, then discontinued. she was also continued on her home regimen of spiriva, fluticasone-salmeterol, montelukast, and . theophylline was discontinued due to adverse effects and narrow therapeutic index as well as drug interaction. weaned 02 down to 95% on 3l. . 4. hypertension: on admission, she was borderline hypotensive, so her home bp medications were held. she was gradually uptitrated on diltiazem and metoprolol, which was well tolerated. her hypotensive episodes were the reason behind not starting an ace-i during this hospital stay. 5. anemia/recurrent gib: patient was tried on a heparin drip for her atrial fib, and had guaiac positive stools and a downtrending hematocrit. she was continued on a ppi. the heparin was stopped, although she continued to require occasional blood transfusions, 4 units in total. gi was consulted and performed egd/colonoscopy, which showed polyp and avm in colon that were intervened upon, and mild gastritis in stomach. gi recommended holding off anticoagulation for at least 7 and preferably 10 days after the procedure as well as follow up colonoscopy in 6 months. the patient's pcp will help her schedule this appointment. medications on admission: unsure of her medications. discharge medications after her previous hospitalizations 1. 60mg po bid 2. docusate 100mg po bid 3. lasix 40mg po daily 4. spiriva 1 inh daily 5. fluticasone-salmeterol 500-50mcg q puff inh 6. montelukast 10mg po daily 7. lisinopril 10mg po daily 8. pantoprazole 40mg po bid 9. ferrous sulfate 325mg po daily 10. prednisone 40mg po daily 11. potassium chloride 12. diltiazem 180mg po daily 13. theophylline 100mg po daily discharge medications: 1. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 4. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) inhalation twice a day. 5. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 7. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 8. diltiazem hcl 180 mg capsule, sustained release sig: one (1) capsule, sustained release po bid (2 times a day). 9. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 10. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 6 days. 11. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 12. torsemide 20 mg tablet sig: four (4) tablet po bid (2 times a day). 13. metoprolol tartrate 25 mg tablet sig: three (3) tablet po bid (2 times a day). 14. levalbuterol hcl 0.63 mg/3 ml solution for nebulization sig: one (1) ml inhalation q4h () as needed for wheezing. 15. prednisone 10 mg tablet sig: one (1) tablet po daily () for 2 days. 16. potassium chloride 10 meq capsule, sustained release sig: four (4) capsule, sustained release po once a day. 17. prednisone 5 mg tablet sig: one (1) tablet po once a day for 7 days: start . 18. prednisone 5 mg tablet sig: one (1) tablet po every other day for 7 days: start . discharge disposition: extended care facility: medical center - discharge diagnosis: primary diagnosis: 1. copd exacerbation 2. atrial fibrillation 3. acute exacerbation of chronic diastolic heart failure 4. morbid obesity 5. anemia 6. gi bleeding 7. urinary tract infection discharge condition: you are walking with a walker, eating, and breathing on your home oxygen requirement of 3l. discharge instructions: you were admitted to the hospital with shortness of breath. this was related to a copd exacerbation, heart failure, and an abnormal heart rhythm. for treatment of your copd, you were started on steroids and antibiotics. for treatment of your heart failure, you were diuresed aggressively with lasix to remove a lot of excess fluid. you also went into an abnormal heart rhythm called atrial fibrillation, which you have had before. atrial fibrillation comes with a risk of stroke, but you have not been able to take blood thinners due to bleeding in your gi tract. you had a egd and a colonoscopy performed which demonstrated a polyp in your colon as well as a prominent artery both of which were treated during the colonoscopy. you also had inflammation in your stomach. you should not take motrin. your breathing was much improved upon discharge from the hospital. . we have made the following changes to your medications: - theophylline: we have discontinued this medication due to multiple drug interactions. - coumadin: please do not restart this medication, until you are seen by dr. . - diltiazem: we have increased this medication from once a day to twice a day - metoprolol: we have started this new medication to help treat your heart rate - ciprofloxacin 500mg twice daily for 7 days (last dose 4/6 in the am) - torsemide 80mg by mouth twice daily - prednisone: will be tapered over the next weeks. you should take 5mg every day for the next week. then 5mg every other day for the week after. after those two weeks this medication can be discontinued. -your combivent was discontinued, spiriva was continued. . please seek immediate medical attention if you develop shortness of breath, chest pain, light-headedness, dizziness, passing out, increased swelling in your legs or arms, weakness, slurred speech, headache, fevers, shaking chills, night sweats, or diarrhea. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1.5l followup instructions: primary care: , () phone: date/time: at 10:40am. . gastroenerology: please call dr. office () to follow up your biopsy results in 10 days. please then also schedule a follow up colonoscopy in 6 months. . pulmonary: dr. phone: ( date/time: clinical center, , . monday at 1:00pm for pulmonary function tests, then appt with dr. at 1:30pm. . cardiology: dr. and dr. phone: date/time: 11:00 procedure: venous catheterization, not elsewhere classified endoscopic polypectomy of large intestine esophagogastroduodenoscopy [egd] with closed biopsy endoscopic destruction of other lesion or tissue of large intestine diagnoses: obstructive sleep apnea (adult)(pediatric) unspecified pleural effusion urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension iron deficiency anemia secondary to blood loss (chronic) atrial fibrillation obstructive chronic bronchitis with (acute) exacerbation acute on chronic diastolic heart failure other chronic pulmonary heart diseases pulmonary collapse morbid obesity angiodysplasia of intestine with hemorrhage benign neoplasm of colon diverticulosis of colon (without mention of hemorrhage) internal hemorrhoids without mention of complication mixed acid-base balance disorder other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms acute gastritis, without mention of hemorrhage 

Answer: The patient is high likely exposed to