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: aspirin attending: chief complaint: bright red blood per rectum major surgical or invasive procedure: blood transfusions fresh frozen plasma transfusions history of present illness: 73 yo m with esrd on hd, severe pvd s/p multiple interventions, pud/gerd, past ra thrombus on coumadin, who presents from routine hd with brbpr. the patient states that he otherwise felt well today when he had a large bloody bm during hd. he denies dizzyness, lightheadedness, cp, abd pain, n/v when this occurred. he states that prior to this he had been having regular brown bms frequently which he attributed to c. diff. he denies any black or tarry stool at that time, or pain with bowel movements. his vital signs were reportedly stable at that time, but he was referred to for further evaluation. . at the osh, initial vs hr 64, bp 140/68. orthostatics were 157/67->147/68, hr 53->76. he was noted to have another episode of brbpr with clots. initial labs with hct 38.9 9lats hct 40 per record), inr 15.4 (last inr 2.7 on ). iv access was attempted multiple times by surgery, including lij, lsc line unsuccessfully. ultrasound showed narrowing/stenosis. rij could not be performed given tunneled r hd line. groin line unable to be performed given extensive pvd and surgical history. a 20 guage piv was obtained and patient was transferred to . out osh, inr found to be 15.4. no record that patient received ffp or vitamin k. . on arrival, pt had additional moderate sized brbpr with clot. he otherwise feels well and denies any complaints except for fatigue. he denies f/c, ha, lightheadedness, cp, sob, n/v, abd pain, rectal pain, swelling, rash. his vitals were bp 156/64, hr 52, rr 20, 98% on ra. his inr was found to be 9.0, so he was given 10 mg of vit k and 2 units of ffp. after discussion with the gi fellow, decision was made to further monitor patient in the icu. past medical history: esrd on hd pvd (see below) gerd/pud asa -> egd with ulceration of posterior wall ? mds hyperlipidemia htn h/o c.diff dm2 prostate ca s/p xrt rcc s/p nephrectomy ra thrombus in blood dyscrasian, on hydrea h/o dialysis catheter thrombosis . psh (taken from vascular notes): 11/12 l cfa thromboendarterectomy w/ patch profunda plasty, l eia stenting - redo right interposition tube graft between external iliac artery and profunda femoral artery with 8 mm dacron tube graft, reopening of previous incision on right groin, release of contained hematoma and repair of leak at the distal anastomosis between dacron tube graft and profunda femoral artery on the right - diagnostic angio, right common iliac plaque seen on prior angiograms, occlusion of the dacron graft distal to the take-off of the right internal iliac artery. there is reconstitution of the right profunda femoral artery. complete occlusion of the superficial femoral artery and popliteal artery with only a small 1 cm opening in that popliteal vessel. reconstitution of the posterior tibial artery which continues down to the foot with a short 1 cm occlusion in the mid leg. there is no dp artery in the foot. there is a large posterior tibial artery with collaterals in the foot. - l jump graft. from the in-situ bypass from above the knee to below the knee to a posterior tibialis. - percutaneous balloon angioplasty of a left external iliac in-stent restenosis, percutaneous balloon angioplasty of the distal external iliac and proximal common femoral arteries, percutaneous balloon angioplasty of distal femoral to posterior tibialis in situ bypass graft and distal anastomoses, stent placement within the distal bypass graft - resection of common femoral artery aneurysm with 8 mm dacron graft from the external iliac artery to the profunda artery - left femoral endarterectomy with dacron patch angioplasty, left in situ femoral to posterior tibialis bypass graft - left external iliac artery stent, left external iliac artery percutaneous angioplasty r nephrectomy (hydronephrosis), tunneled dialysis cath social history: lives alone and semi-independent with wheelchair. smokes 1ppd x50 yrs. denies etoh use family history: noncontributory physical exam: vs: bp 156/65, hr 56, rr 18, 99% on ra gen: awake, alert, talkative, nad heent: eomi, anicteric sclera, mm moist, op clear neck: supple, central line attempts dressed, r tunneled hd line intact lung: ctab no wheezes or crackles heart: rrr nl s1 s2 no m/r/g abd: thin, soft, nt/nd +bs, no rebound or guarding, no masses back: no cva tenderness rectal: normal rectal tone, no stool in vault though exam limited by patient cooperation, dried red blood externally, no obvious bleeding in external structures ext: no pitting edema, warm skin: no rash pertinent results: admit labs: 139 | 103 | 41 / --------------- 84 5.0 | 23 | 5.9 \ . .. .. \ 12.1 / 6.5 ------ 487 .. / 37.5 \ . pt 72.5 ptt 48.9 inr 9.0 . imaging: . egd. 1cm duodenal ulcer with clot . echo. left ventricular cavity size and systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. a mass is seen in the right atrium measuring 3.0 x 1.4 cm. the mass appears to be attached to the eustachian valve or may be a prominent eustachian valve . no vegitation is seen in the tricuspid, aortic or mitral valves. the pulmonic valve was not adequately visualized. mild (grade i) diastolic dysfunction. no atrial septal defect is seen by 2d or color doppler. there are simple atheroma in the descending thoracic aorta. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. trivial mitral regurgitation is seen. there is no pericardial effusion. . stress test. . impression: no anginal type symptoms or ischemic ekg changes. nuclear report sent separately. brief hospital course: studies: abd u/s: 1. patent hepatic vasculature. 2. increased echogenicity of the portal triads, a nonspecific finding. while this finding may be seen in acute hepatitis as well as other entities, it can be considered a normal variant as well. please correlate clinically. the liver contour is not nodular and there are no signs of portal hypertension to suggest cirrhosis. picc line culture: negative hd catheter culture: positive for staph . #. gi bleed. no brisk bleeding while in icu, one episode of brbpr afternoon of . inr now down to 2.0-2.7, hct has remained stable on transfer. patient is prepped for colonoscopy but will not be done prior to transfer given supratherapeutic inr. tagged rbc scan showed delayed bleeding in llq, no indication for emergent angio, especially given pvd. underwent golytely prep prior to transfer to floor. ddx includes bleeding in sigmoid/rectum as pt s/p radiation for prostate cancer vs diverticulum vs avm. pt also with h/o duodenal ulcer but sxs and imaging more c/s with lower gib. gi, vascular , and general surgery have been following patient. patient was not emergently taken to angio or colonoscopy/flex sig. had bleeding study that showed bleeding from rectum. plavix and coumadin held. colonoscopy later showed two non-bleeding rectal ulcers and radiation proctitis. pathology showed normal mucosa with no evidence of ibd. patient's diet was advanced and his hct remained stable. he experienced no further episodes of melena/brbpr. his hct on dc was 38.6 and stable. . #. anticoagulation. patient noted to have a ra thrombus in . as outpatient, was anticoagulated with coumadin. found to have supratherapeutic inr to 9 on admission which has been reversed to 2-2.7 with po vitamin k and ffp. started on heparin drip when inr <2. after procedures was bridged back to coumadin. however after tte was negative for right atrial thrombus the heparin drip was turned off and coumadin was d/cd as the patient no longer had a reason to be anticoagulated and was at high risk of further bleeding from the gi tract. . #. esrd on hd. continued on home hd schedule (mwf). continued on nephrocaps, renvela. hd catheter replaced over wire on and subsequently found to be leaking a few days later so was changed over a wire. the catheter tip subsequently grew staph on culture. he was treated with iv vanco per hd protocol. . #. htn. antihypertensives (nifedepine, atenolol, lisinopril) held in context of gib. then restarted slowly. . #. bacteremia: patient had fever and blood cultures showed coag negative staph sensitive to vancomycin in bottles. started on vanco for a course of 14 days. source was presumed to be the hd line. the picc line was pulled and cultured with no growth. the hd line was changed over a wire and culture results showed staph on the tip. as the patient has such difficult access this was felt to be the best approach. he may need a replacement hd catheter placed eventually if he has persistent bacteremia although subsequent blood cultures taken here since the catheter was changed show no growth to date. . #pvd: held plavix in setting of gib. vascular surgeons thought no change to foot. in setting of bacteremia had foot xr that showed no evidence of osetomyelitis and vascular surgery felt the foot had not changed in appearance. he was restarted on his plavix as dr. felt it was necessary to keep his stents patent. . #. h/o c. diff. per patient, currently on flagyl for c. diff. in our system, had positive cdiff in 1/. patient's pcp was called and had not placed patient on long course of flagyl. cdiff cultures x 3 were negative. flagyl was d/cd. . #. hyperlipidemia. continued on pravastatin . #. possible blood dyscrasia/thrombocytosis. patient on hydrea as outpatient which was continued as an inpatient. he will follow up with his hematologist as an outpatient for further management. . #. diabetes. maintained on insulin sliding scale . #.chronic foot pain. continued on amytriptyline and percocet. . #. atrial tachycardia: patient had several episodes of acute tachycardia felt to be sinus tach vs atrial tachycardia usually associated with volume depletion after hd. his electrolytes were kept wnl and the dose of his beta blocker was increased with good effect. the patient remained asymptomatic with stable blood pressures and mentation throughout all episodes of the tachycardia. his beta blocker was up-titrated and he was sent home on toprol xl 50mg daily. medications on admission: plavix 75 mg daily atenolol 25 mg daily folic acid 1 mg daily nifedipine 30mg daily omeprazole 30 mg daily renvela 1600mg tid lipitor 10 mg daily nephrocap 1 cap daily percocet 1 tab tid prn coumadin 5mg daily --has not refilled since hydrea 500mg daily -- has not refilled since lisinopril 20mg daily --has not refilled since amitriptyline 25mg daily --has not refilled since discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 2. hydroxyurea 500 mg capsule sig: one (1) capsule po daily (daily). 3. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 4. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po every eight (8) hours as needed. disp:*20 tablet(s)* refills:*0* 5. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 7. toprol xl 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* 8. renvela 800 mg tablet sig: two (2) tablet po three times a day. disp:*180 tablet(s)* refills:*2* 9. lipitor 10 mg tablet sig: one (1) tablet po once a day. 10. amitriptyline 50 mg tablet sig: 0.5 tablet po hs (at bedtime). 11. vancomycin 1000 mg iv hd protocol please give after hd every other day 12. folic acid 1 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: hospice discharge diagnosis: lower gi bleed from rectal ulcers and radiation proctitis. atrial tachycardia. coagulase negative bactermia from hd catheter line discharge condition: the patient was normotensive, not tachycardic, afebrile, and with a stable hematocrit for >24hours before discharge. discharge instructions: you were admitted to the hospital with bleeding from your rectum. this bleeding likely happened because your blood was too thin. your plavix and coumadin were not given to you and you were given clotting factors and vitamin k to help your blood thicken. you then had a colonoscopy that showed the bleeding was from two ulcers in your rectum and possibly from injury to your rectum caused by radiation. you had an ultrasound of you heart to look for the clot in your heart. we did not see the clot in your heart so we have stopped your coumadin. you no longer need to take it. while you were here you were continued on your hemodialysis treatments every other day. your dialysis catheter needed to be exchanged and this was done. you had a fever from an infection in your blood that came from your dialysis catheter. you have been given antibiotics for this infection and should continue these antibiotics for four weeks. your hemodialysis doctor will give you these medicines when you go for your dialysis treatments. medication changes: change: omeprazole 30mg by mouth daily to omeprazole 40mg by mouth daily stop: coumadin stop: atenolol stop: nifedipine stop: lisinopril start: toprol xl 50mg by mouth daily start: vancomycin each time you go to dialysis they will dose this for you and you should continue this for 4 weeks. you should call your doctor or come to the emergency room if you experience light-headedness, dizziness, chest pain, shortness of breath, worsening foot pain, fevers, blood in your stool or black tarry stools, or any other concerning symptoms. followup instructions: please followup with your pcp . next wednesday at 10:45am. please continue your hemodialysis treatments at your regular clinic on mondays, wednesdays, and fridays once you are discharged from the hospital. your nephrologist should check your vancomycin level on when you go to hd. please follow up with your hematologist/oncologist, dr. , thursday at 3:00pm. fax procedure: venous catheterization, not elsewhere classified hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis closed [endoscopic] biopsy of large intestine transfusion of packed cells transfusion of other serum diagnoses: end stage renal disease abnormal coagulation profile esophageal reflux acute posthemorrhagic anemia personal history of malignant neoplasm of prostate methicillin susceptible staphylococcus aureus septicemia sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia long-term (current) use of anticoagulants infection and inflammatory reaction due to other vascular device, implant, and graft diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled anticoagulants causing adverse effects in therapeutic use personal history of malignant neoplasm of kidney other specified disorders of rectum and anus mechanical complication of other vascular device, implant, and graft late effect of radiation essential thrombocythemia ulcer of anus and rectum 

Answer: The patient is high likely exposed to