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: patient recorded as having no known allergies to drugs attending: chief complaint: syncope, dizziness, intermittent doe major surgical or invasive procedure: avr with 23 mm ce pericardial valve subtotal colectomy/g-j tube placement/end ileostomy history of present illness: hospitalized x2 this year for anemia, dizziness, and fainting. had multiple transfusions after diagnosis of duodenal adenoma and angiodysplasia of colon. workup revealed sev aortic stenosis and referred for surgery. past medical history: duodenal adenoma angiodysplasia of colon gi bleed. h pylori anemia htn hernia repair bph diverticulosis remote mva head trauma with ? metal plate social history: lives alone(wife in nursing home). retired tobacco- quit 3 years ago(124 pack year history) etoh- none x 3 years no recreational drugs family history: sister mi at 84 yo physical exam: admission vs hr 56 bp 172/80 rr 16 gen nad pulm cta-b cor rrr 4/6 holosystolic murmur throughout precordium abdm soft/nt/nd/nabs. well healed abdm scar ext warm well perfused. edema 2+ bilat. pertinent results: chest (pa & lat) reason: evaluate pleural effusion history: evaluate pleural effusion. patient is status post avr. two views. comparison with previous study done on . there are small bilateral pleural effusions, unchanged. the lungs appear otherwise clear except for minimal streaky density at the right base most consistent with subsegmental atelectasis. the patient is status post median sternotomy. the heart appears large with cardiac size may be exaggerated by ap technique. the patient is status post median sternotomy and avr. mediastinal structures are otherwise unremarkable. the bony thorax is grossly intact. impression: persistent small bilateral pleural effusions not significantly changed. reason: reanal artery ultrasound, increasing creatinine from 1.2 to 2.9 reason for this examination: reanal artery ultrasound, increasing creatinine from 1.2 to 2.9 indication: 83-year-old man with aortic valve replacement and rising creatinine. evaluate for renal artery stenosis. comparison: ct chest without contrast dated . renal ultrasound with doppler examination: the right kidney measures 8.5 cm. renal doppler examination at the upper, mid, and lower pole demonstrate a slightly delayed upstroke with resistive indices ranging from 0.63 to 0.66. the left kidney measures 11.5 cm. doppler examination of the upper, mid and lower pole range from 0.71 to 0.74. there is no hydronephrosis, stones, or masses bilaterally. impression: findings suggesting right renal artery stenosis. cardiology report echo study date of patient/test information: indication: left ventricular function. s/p prosthetic aortic valve function. height: (in) 68 weight (lb): 198 bsa (m2): 2.04 m2 bp (mm hg): 113/62 hr (bpm): 78 status: inpatient date/time: at 14:50 test: tte (complete) doppler: full doppler and color doppler contrast: none tape number: 2006w045-0:45 test location: west echo lab technical quality: adequate referring doctor: dr. measurements: left atrium - long axis dimension: *4.7 cm (nl <= 4.0 cm) left atrium - four chamber length: *6.3 cm (nl <= 5.2 cm) right atrium - four chamber length: *5.8 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: *1.5 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: *1.6 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 5.4 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 3.3 cm left ventricle - fractional shortening: 0.39 (nl >= 0.29) left ventricle - ejection fraction: >= 55% (nl >=55%) aorta - valve level: 3.2 cm (nl <= 3.6 cm) aorta - ascending: 3.2 cm (nl <= 3.4 cm) aorta - arch: 2.7 cm (nl <= 3.0 cm) aortic valve - peak velocity: *2.8 m/sec (nl <= 2.0 m/sec) aortic valve - peak gradient: 32 mm hg aortic valve - mean gradient: 16 mm hg mitral valve - e wave: 1.0 m/sec mitral valve - a wave: 1.1 m/sec mitral valve - e/a ratio: 0.91 mitral valve - e wave deceleration time: 147 msec interpretation: findings: left atrium: mild la enlargement. right atrium/interatrial septum: mildly dilated ra. left ventricle: moderate symmetric lvh. normal lv cavity size. normal regional lv systolic function. overall normal lvef (>55%). right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic root diameter. aortic valve: bioprosthetic aortic valve prosthesis (avr). normal avr gradient. mitral valve: mildly thickened mitral valve leaflets. lv inflow pattern c/w impaired relaxation. tricuspid valve: normal tricuspid valve leaflets. pericardium: small pericardial effusion. conclusions: 1. the left atrium is mildly dilated. 2. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. overall left ventricular systolic function is normal (lvef>55%). 3. a bioprosthetic aortic valve prosthesis is present. the transaortic gradient is normal for this prosthesis. 4. the mitral valve leaflets are mildly thickened. 5. there is a small pericardial effusion. electronically signed by , md on 15:42 brief hospital course: mr was a direct admission to the operating room where he had an aortic valve replacement with a #23 ce pericardial valve. please see or report for full details. patient tolerated operation well and was transferred from or to cardiac surgery recovery unit following operation. patient did well in the immediate postoperative period, anesthesia was reversed and he was successfully extubated. on pod#1 the patient complained of abdominal pain an ultrasound r/o'd out cholestasis and lft's were normal. on pod 2 the patient experienced some post-op confusion and stayed in the icu to be monitored. ultimately transferred to the floor to begin advancing his activity level. on pod 4 the patients creatinine was elevated to 2.9 a renal us showed renal artery stenosis. a renal consult was initiated.foley was reinserted by the gu service. creatinine rose to 3.4 over the next several days. wbc rose and stool c. dificile was positive. flagyl was started. pre-renal acute renal failure continued with creatinine rising to 6.2. transferred back to the csru on . hepatobiliary consult done and -modal vancomycin therapy initiated for more complete management of c. dif. this evolved into sepsis, but the pt. refused colon surgery.id also consulted as well as general surgery for further evaluation for colectomy. a fib developed briefly and then converted to sr with lopressor. transfused on pod #12 and ct scan revealed diffusely thickened bowel. unfortunately, patient's wife expired at her nursing home this week, and patient unable to attend wake and funeral. this likely contributed to his agitation and refusal to be treated. afib occurred again on and was treated with amiodarone with conversion again to sr. agitation and outbursts continued and haldol was given to calm the pt. tpn started on as pt.was made npo after not tolerating clear liquids. stool incontinence continued. his scrotum continued to become quite edematous and he developed pressure ulcers on his coccyx/heels as he was not cooperative with turning frequently. wound nursing consult completed and recs noted. he began to tolerate clear liqs. again on . cipro given for uti. creatinine began to trend down, but wbc remained elevated. pt. agreed to flex. sig./subtotal colectomy on as ascites continued to develop, but then refused to allow further examination due to scrotal pain which then delayed surgery again. agreed to further care on and was reintubated in the csru prior to returning to or for colectomy/end ileostomy/g-j tube placement with dr. . extubated the next afternoon and tube feeds instituted. urology re-placed foley cath due to scrotal/penile edema. continued to make steady progress and was transferred back to the floor on .his abdominal wound developed a small opening and he continued to be followed by general surgery team. wet to dry dressings were instituted as well as additional abx coverage. he was cleared for discharge to rehabilitation on . medications on admission: protonix 40' atenolol metamucil iron 325' discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): hold for diarrhea. 2. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 3. acetaminophen 325 mg tablet sig: two (2) tablet po q4h (every 4 hours) as needed. 4. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. 5. atorvastatin 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 q24h (every 24 hours). 7. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: two (2) puff inhalation q4hrs/prn as needed for shortness of breath or wheezing. 8. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 9. losartan 25 mg tablet sig: one (1) tablet po daily (daily). 10. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 2 weeks. 11. insulin regular human 100 unit/ml solution sig: sliding scale injection qac&hs. 12. furosemide 10 mg/ml solution sig: one (1) 40 injection q12h (every 12 hours). 40 13. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 14. ampicillin-sulbactam g recon soln sig: three (3) recon soln injection q8h (every 8 hours) for 3 days: please give 3 gms q8 hours for 3 days. 15. heparin (porcine) 5,000 unit/ml solution sig: one (1) 5000 unit/ml solution injection injection tid (3 times a day). discharge disposition: extended care facility: tba discharge diagnosis: s/p avr(#23 ce pericardial) s/p colectomy/ileostomy/g-j tube placement pmh: duodenal adenoma, angiodysplasia of colon, gi bleed, anemia, htn, bph, h. pylori treated with abx. diverticulosis, remote mva with head trauma ? metal plate, c. diff. colitis with toxic megacolon discharge condition: stable discharge instructions: keep wounds clean and dry. ok to shower, no bathing or swimming. take all medications as prescribed call for any fever greater than 100, redness or drainage from wounds no driving until cleared by surgeon at postop visit no lifting greater than 10 pounds for 10 weeks from date of surgery. w-t-d dressing changes daily to abdominal wound. ostomy care per protocol. followup instructions: clinic in 2 weeks call to schedule appt dr. in 4 weeks call to schedule appt follow up with dr. in weeks follow up with dr. (gen .)in days procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified extracorporeal circulation auxiliary to open heart surgery parenteral infusion of concentrated nutritional substances diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances venous catheterization for renal dialysis temporary ileostomy open and other replacement of aortic valve with tissue graft open and other right hemicolectomy flexible sigmoidoscopy transfusion of packed cells percutaneous (endoscopic) jejunostomy [pej] diagnoses: acidosis coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified unspecified essential hypertension severe sepsis acute myocardial infarction of other anterior wall, initial episode of care atrial fibrillation aortic valve disorders chronic kidney disease, unspecified blood in stool intestinal infection due to clostridium difficile pressure ulcer, lower back pressure ulcer, heel septicemia due to anaerobes delirium due to conditions classified elsewhere angiodysplasia of intestine (without mention of hemorrhage) edema of male genital organs 

Answer: The patient is high likely exposed to