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: sulfonamides / ciprofloxacin / macrobid attending: chief complaint: bright red blood per rectum major surgical or invasive procedure: blood transfusion history of present illness: 81 yr old female with hx of multiple chronic medical problems including back pain requiring several narcotics who presents after she passed a blood clot from her rectum. six days prior to admission, pt had surgery (thiersch procedure) with dr. to correct her rectal prolapse. she was discharged home but returned 4 days later with complaints of constipation and she was sent home with bowel meds. one day prior to admission, pt had a normal bowel movement but today, pt has been passing blood clots all day. she complains of rectal pain but denied abd pain/lightheadedness. in ed, surgery performed an anoscopy without identification of bleeding source, no hemorrhoids. her first hct was stable but pt continued to have slow ooze. on labs, pt was found to have acute renal failure with a cr of 2.0 and k of 6.0. she had no ecg changes. she was given kayexalate and admitted to medicine. however, after receiving the kayexalate, she had a large bloody bowel movement with clots. at this point, her bp dropped to 100/50. she was bolused one liter with response to 120s. she was evaluated by gi, who felt that given her ongoing oozing, it would be difficult to visualize on scope. they recommended a tagged red blood cell scan. this was aborted after only 30 minutes as the pt again become hypotensive to the 70s/30s, continuing to pass bright red blood w/clots. the tagged scan, though difficult to interpret given that it was not a complete scan, demonstrated an active bleed in the sigmoid region. the patient was then admitted to the micu pending angio intervention. past medical history: -recent intubation in micu for pneumonia/sepsis (with likely component of narcotic overdose) -chf w/ef 40-45% -severe oa -hand surgery, trapezius removal (at ) -chronic lbp c/b lumbar radiculopathy and osteomyletis: staph osteo in remote past spinal stenosis s/p multi-level laminectomies - (t12 s1 laminectomy, l3-l4/l5-s1 fusion + graft) - for ?discitis/osteomyelitis (partial t11 laminectomy, re-do t12-l1 discectomy, l3-l5 fusion),path: no osteo, afb neg -: s/p nerveblocks -h/o vre > 10yrs ago -h.pylori -antral ulcer -hypertension -hypothyroid -diplopia, 6th nerve palsy - unknown etiology -anemia: possibly worsened w/ small bowel enteropathy w/ nsaids -baseline creatinine 1.7 -microvascular infarcts on mri brain -cluster ha -left hemicrania -neurogenic le claudication -degenerative arthropathy of b/l shoulders s/p surgery -h/o allergy shots (environemental allergies) -thoracotomy scar (unknown etiology) - s/p rectal prolapse repair . social history: no tob, no etoh, lives with husband, right now in rehab. has home pt, walks with a cane. family history: non-contributory physical exam: vs: in ed: temp 98.8, bp 137/59, hr 64, r 18, o2 100%ra gen: nad, ao x 3 heent: perrl, eomi, mm dry, sclerae anicteric neck: no bruits, supple, no jvd cv: regular with occ ectopy, no appreciable murmurs chest: clear, no wheezes abd: +bs, soft, nontender, nondistended; burn on abdomen heating pad; on rectal exam, bright red blood; + ecchymoses on buttocks ext: no edema, 2+ dp neuro: cn 2-12 intact, sensation and strength intact bilaterally pertinent results: 12:00am hct-32.3* 08:32pm pt-12.7 ptt-23.1 inr(pt)-1.1 07:57pm hgb-11.5* calchct-35 07:50pm glucose-115* urea n-36* creat-2.0* sodium-142 potassium-6.0* chloride-103 total co2-29 anion gap-16 07:50pm wbc-7.7 rbc-3.70* hgb-11.5* hct-33.0* mcv-89 mch-31.1 mchc-34.9 rdw-15.6* 07:50pm neuts-68.9 bands-0 lymphs-21.9 monos-6.7 eos-2.1 basos-0.4 07:50pm plt smr-normal plt count-137* ecg: sinus bradycardia atrial premature complex borderline left axis deviation - is nonspecific consider prior anteroseptal myocardial infarction since previous tracing of , sinus bradycardia rate faster and right precordial/anterior t wave changes less prominent cxr: lungs are clear. there is no pleural effusion or pneumothorax. mediastinum is normal in caliber. tubing projecting over the right supraclavicular fossa is probably oxygen tubing. no central venous catheter is identified with certainty. heart size is top normal and the lungs are grossly clear. tagged red cell scan: impression: active bleeding in the pelvis. the precise location of the site of bleeding cannot be made due to the limitation due patients clinical hypotension were not able to acquire additional images. however, it most likely occurred in the sigmoid colon. the possibility of small bowel hemorrhage is less likely. mesenteric angiogram: abdominal arteriogram and selective sma arteriogram demonstrates no extravasation of contrast. there is no evidence of active bleeding in the sma and branches. brief hospital course: 81yr old female with hx of multiple medical problems including recent rectal prolapse s/p corrective surgery 6days ago who presented with brbpr. . 1. brbpr: mrs. was found to have no bleeding at site of surgery (external incisions) and no evidence of internal or external hemorroids. her bleeding was felt to be likely lower gi source, and she underwent a tagged red cell scan that showed active pelvic bleeding, most likely in the sigmoid colon. she became hypotensive during the study however, and it was not fully completed. a subsequent mesenteric angiogram showed no sign of active bleeding. she was seen by surgery, who felt that there was nothing further to due as surgical sight does not appear to be involved. she had a normal colonoscopy 1-2 years ago, and gi did not want to rescope at this time given the risks due to her recent surgery, and the fact that she stabilized on her own. her hematocrit was followed closely, and she required one unit of prbcs before her hematocrit stabilized. it was stable for 2 days prior to discharge. she was initially npo, but then started on po liquids once hematocrit had stabilized the day prior to discharge. she tolerated this well, and is advancing her diet as tolerated on discharge. . 2. hypotension: mrs. initially hypotension was likely hypovolemic related to gi bleed, with component of vagal response as it appears to keep happening w/bms, then resolving. her home antihypertensive medications were held initially, and she was intermitantly bolused with normal saline. as her blood pressure normalized, it began to rise, and she was restarted on her beta-blocker first, at a lower dose, and then her lisinopril the following day. she is discharged on metoprolol 25 and lisinopril 10 qd. she will follow up with dr. , and her beta-blocker can be titrated up further as an outpatient. . 3. acute renal failure: over the past month, mrs. creatinine has fluctuated between 1.2 and 1.8. now, she came in with a creatinine of 2.0 and k of 6.0. this was felt to be likely due to dehydration vs hypovolemia from blood loss. no new meds have been started. she was given fluids and we followed her creatinine. we also gave bicarb prehydration given acute renal failure and contrast load for angiogram. . 3. hyperkalemia: as above, pt's creatinine is not much worse than her baseline and it has been elevated to 2.0 before with a normal k. no new meds have been started that could attribute to her hyperkalemia. ekg shows no changes and pt is s/p kayexalate in ed. we followed her k, and it completely normalized by the second hospital day. . 4. chronic pain: cont fentanyl patch, methadone, fiorcet, neurontin and prednisone to prevent withdrawl. pt is seen in pain clinic. on admission it was unclear whether pt had been off steroids recently, and she was given 2 doses of 50mg prednisone qd. we subsequently found out that she had just completed a taper at home. the prednisone was discussed with dr. who suggested that she change to 10mg qd dose until she sees him as an outpatient for follow up. this was done. . 5. htn: we initially held mrs. antihypertensives as discussed above. she was restarted on her metoprolol and lisinopril after her hemtocrit was stable and she was hemodynamically stable. she is discharged on metoprolol 25 and lisinopril 10 qd. she will follow up with dr. , and her beta-blocker can be titrated up further as an outpatient. we also held her asa, and this is not yet restarted. she should restart this per the recommendation of dr. . . 6. fen: mrs. was intially treated with ivf with boluses for low bp and low uop, and kept npo for possible procedures while her hct was still dropping. on stabilization, she was started on a liquid diet that she tolerated well. she is advancing as tolerated on discharge. . 7. ppx: mr. was on pneumoboots and a ppi. . 8. communication: w/pt and her husband . 9. access: mrs. was maintained with 2 large bore peripheral ivs . 10. code: full . 11. dispo: mrs. was cleared for safety at home by physical therapy and discharged home. per pt recs, she will receive home pt for further work on gait and blanace. she will follow up with dr. in one week. medications on admission: 1. gabapentin 300 mg q12 2. atorvastatin 80 mg qd 3. levothyroxine sodium 300 mcg qd 4. aspirin 325 mg qd 5. methadone 10 mg 5x/day 6. fentanyl 50 mcg/hr patch q72hrs 7. lisinopril 10 mg qd 8. prednisone 50 mg qd 9. pantoprazole 40 mg qd 10. docusate sodium 100 mg 11. metoprolol tartrate 100 mg 12. fioricet mg q4-6hr prn discharge medications: 1. gabapentin 300 mg capsule sig: one (1) capsule po bid (2 times a day). 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 4. levothyroxine sodium 300 mcg tablet sig: one (1) tablet po daily (daily). 5. methadone 10 mg tablet sig: one (1) tablet po 5x/d (5 times a day). 6. fentanyl 50 mcg/hr patch 72hr sig: one (1) 50 mcg/hr patch transdermal q72h (every 72 hours). 7. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). disp:*10 tablet(s)* refills:*2* 8. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 9. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 10. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po every 4-6 hours as needed for pain. disp:*30 tablet(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: primary: rectal bleeding secondary: anemia rectal prolapse, status post repair hypertension osteoarthritis hypothyroid antral ulcer spinal stenosis discharge condition: stable hematocrit, feeling well, rectal pain well-controlled, tolerating po diet, cleared by physical therapy. discharge instructions: please call your doctor or return to the hospital if you notice any blood from you rectum, maroon stools, tarry black stools, or feel lightheaded, have of more than f. please follow up with dr. . followup instructions: please follow up with dr. for an appointment in the next week. . he will continue to adjust your blood pressure medications back to your normal dose, and tell you when to restart your aspirin and colace. do not restart aspirin or colace until discussing with dr. . md procedure: aortography arteriography of other intra-abdominal arteries transfusion of packed cells diagnoses: hyperpotassemia anemia, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism osteoarthrosis, unspecified whether generalized or localized, site unspecified hemorrhage of rectum and anus 

Answer: The patient is high likely exposed to