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: codeine attending: chief complaint: chief complaint: abdominal pain, nausea. reason for micu admission: hypotension to sbp 80s. major surgical or invasive procedure: none. history of present illness: this patient is a very nice 86-year-old woman with history of aaa (4.8 cm), with plans for aaa repair at hospital next week, who was in her usual state of health until yesterday afternoon when, after donating blood for her upcoming surgery, she developed lower abdominal pain with nausea. at hospital, she underwent ct /pelvis with findings concerning for ischemic colitis, which is why she was transferred to . in the ed, initial vital signs were tm 101.2, hr 82, bp 132/79, rr 24, satting 97% on 2l by nasal cannula. cxr showed no infiltrate. ekg with normal sinus rhythm, no ischemic changes. ct scan from osh was reviewed by our radiologists and showed thickening of the descending and sigmoid colon with sparing of the splenic flexure and rectum, concerning for ischemia. notably, her hematocrit was 27.7 down from 38 on the previous day (at hosp). her lactate was 1.1. other labs were notable for alt 80 and ast 134 with tbili of 0.4 and inr of 1.1. white count was 7.7 with normal lipase. creatinine was 1.2 (down from 1.4 at hospital yesterday). on exam, patient was noted to have left lower quadrant tenderness and bright red blood per rectum. she was hypotensive to sbp 80s, and was volume rescucitated with 1l ivf and 1u prbcs. urine output was reportedly 250cc. she was given zosyn 4.5 mg iv x1, morphine 4 mg iv x1, zofran 4 mg iv x1, and tylenol 1 gm x1. she was then admitted to the icu for further treatment. prior to admission, patient was seen by both vascular surgery and general surgery. they recommended for cipro/flagyl, transfusion, serial hematocrits and lactates. vascular also wanted cta to evaluate for bowel wall thickening, which would be highly suggestive of ischemic colitis (cta is more specific for this finding). at time of admission to the icu, patient had hypotension to sbp 80s. otherwise, says that abdominal pain has improved. she feels overall "much better" than yesterday. mild nausea, no vomiting. no chest pain or shortness of breath. she does endorse lightheadedness when sitting. no urinary symptoms. no headache. no respiratory complaints. past medical history: past medical history: --abdominal aortic aneurysm, 4.8 cm, currently undergoing evaluation for repair --peripheral vascular disease --coronary artery disease --hypertension --hypercholesterolemia --hyperglycemia (patient denies diabetes diagnosis) --history of dilated intrahepatic and extrahepatic pancreatic ducts, s/p ercp --temporal arteritis, on chronic low-dose prednisone past surgical history: --s/p cholecystectomy --s/p appendectomy --s/p hysterectomy --s/p left lung lobectomy for ?cancer --s/p exploratory laparotomy and loa/ileal segment resection in for volvulus and sbo social history: - tobacco: remotes history, <25 pk-yrs total - alcohol: denies - illicits: denies family history: non-contributory. physical exam: vitals: t: currently afebrile, bp: 114/40, p: 76, rr 18, 97% 2l general: elderly woman, frail appearing, in no apparent distress heent: perrla, non-icteric sclera, dry mm neck: supple, no lad lungs: clear bilaterally posterior fields cardiovascular: rrr, normal s1/s2 abdomen: mild llq tenderness without rebound or guarding, negative sign, active bowel sounds rectal: red blood on exam glove (per ed examination) extremities: warm, well-perfused, non-edematous pertinent results: labs at admission: 05:40am blood wbc-7.7 rbc-2.95* hgb-9.2* hct-27.7* mcv-94 mch-31.3 mchc-33.3 rdw-14.0 plt ct-118* 05:40am blood neuts-87.1* lymphs-8.8* monos-3.4 eos-0.3 baso-0.4 05:40am blood pt-13.0 ptt-28.6 inr(pt)-1.1 05:40am blood glucose-152* urean-26* creat-1.2* na-141 k-4.4 cl-110* hco3-24 angap-11 05:40am blood alt-80* ast-134* alkphos-98 totbili-0.4 05:40am blood totprot-4.8* 03:21pm blood calcium-7.0* phos-3.6 mg-1.6 05:40am blood cortsol-21.4* 05:49am blood lactate-1.1 labs at discharge: . micro data: . blood culture blood culture - no growth to date blood culture blood culture - no growth to date stool clostridium difficile toxin a & b test- pending mrsa screen mrsa screen-pending inpatient stool fecal culture-pending; campylobacter culture-pending; clostridium difficile toxin a & b test- negative urine urine culture- negative mrsa screen mrsa screen-final - positive blood culture blood culture - positive {streptococcus species}; anaerobic bottle gram stain-final; aerobic bottle gram stain-final emergency blood culture blood culture - positive {streptococcus species}; aerobic bottle gram stain-final . imaging results: . cta/p: 1. thickening of the descending and sigmoid colon as described in the prior study without definite evidence of complicaions of mesenteric ischemia. given the patient's clinical presentation this remains a likely consideration and direct visualization should be considered for definitive evaluation and exclusion of inflammatory and infectious processes which also can produce wall thickening. 2. marked dilatation of the common bile duct, intrahepatic biliary system and pancreatic duct with possible mass of the duodenum at the ampulla. consider direct visualization by ercp or endoscopic ultrasound for further evaluation. 3. marked atherosclerotic vascular disease including the patient's known abdominal aortic aneurysm measuring 4.8 cm unchanged in appearance from the prior study with irregular plaque throughout its course as well as stenosis of the origins of the celiac artery, sma, and right renal artery. 4. occlusion of the right common iliac artery just inferior to the aortic bifurcation with reconstitution prior to the iliac bifurcation. high-grade stenosis of the left common iliac artery just inferior to the bifurcation. 5. left protrusio acetabuli. . tte the left atrium is elongated. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. physiologic mitral regurgitation is seen (within normal limits). the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. . impression: suboptimal image quality. mild aortic regurgitation. aortic valve sclerosis without discrete vegetation (does not exclude). normal biventricular cavity sizes with preserved global and regional biventricular systolic function. brief hospital course: an 86-year-old woman presents with abdominal pain, nausea, fever to 101, brbpr, and hematocrit drop in setting of recent blood donation for upcoming aaa surgery. she likely suffered transient ischemic colitis and developed streptococcus bovis bacteremia. she was treated with antibiotic therapy with resolution of her presenting symptoms. she will be followed up in the outpatient setting by her gastroenterologist regarding the significance of streptoccocis bovis. # hypotension: this patient presented with brbpr and hematocrit drop from 38 to 28 in setting of recent blood donation. suspect hypotension is secondary to blood loss versus hypovolemia. other considerations include infection (febrile in the emergency ) versus adrenal insufficiency. blood pressure is fluid responsive (patient now s/p 1l in the ed and receiving 3rd liter currently). patient without altered mental status although uop and cvp are low, suggesting intravascular depletion. patient was resuscitated with ivf and received 2u prbcs in total. her blood pressure came up with these interventions, and her hematocrit stabilized at 30. on the second hospital day, she began having fevers and blood cultures grew gram positive cocci, for which she was treated empirically with zosyn. on hd 6 her streptococci speciated to streptococci bovis. # streptococci bacteremia: on hd 2, the patient developed fevers and blood cultures grew gram positive cocci. she was treated emprically with zosyn for five days. a tte was performed and was not significant for vegetations, making endocarditis less concerning. on hd 6, blood cultures further speciated to streptococci bovis. infectious diseases was consulted to assist with appropriate therapy. a tee was deemed not necessary given prior tte. she was continued on ceftriaxone and flagyl was added for a total of 2 weeks antibiotic therapy. she should have blood cultures two weeks after antibiotic therapy is finished to be sure her blood cultures are clear. vascular surgery should be avoided until blood cultures demonstrate resolution of the infection. - 14 days of ceftriaxone and flagyl - blood cultures 2 weeks after discontinuation of antibiotic therapy # asymptomatic cbd dilatation: ms was noted to have have marked dilation of her common bile duct on ct abdomen. on review of her previous history, she was found to have cbd in at hospital and underwent extensive work-up with mrcp and swallow endoscopy which was unrevealing. concern when streptococcus bovis grew out in blood cultures given biliary dilatation and association with malignancy, although seeding may likely have occured to ischemic colitis. ms. d inpatient mrcp/eus. the significance of streptoccocus bovis and its association with malignancy was explained to ms. who understood the discussion. it is important that she receive an outpatient workup, colonscopy as soon as her ischemic colitis completely resolves. colonscopy deferred in inpatient setting given ischemic colitis. - gi follow-up: colonscopy, ercp/eus # abdominal pain and bright red blood per rectum: suspect ischemic colitis given history of abdominal pain preceding brbpr in setting of blood loss from donation. other considerations: infectious colitis, aortoenteric fistula, diverticulitis. she underwent cta with findings indicative of ischemic colitis. her abdominal pain and nausea improved with volume resuscitation and blood transfusions. # anemia: as above, baseline hct in ?mid-30s (was 38 prior to admission). suspect that hematocrit drop was secondary to blood donation yesterday and gi losses from ischemic colitis. she received in total 2 units of prbcs during this admission with stabilization of her hematocrit at 30. # transaminitis: patient without ruq pain; sign negative on exam. patient with history of dilated intra- and extrahepatic bile ducts, consistent with ct findings from this admission. her transaminases were downtrending on by hd 2. the increase was felt to be secondary to shock liver. # hypertension: her amlodipine and atenolol were held initially due to hypotension and were restarted. # hypercholesterolemia and vascular disease: hher statin was held initially given the elevated transaminase. aspirin was also for concern of active gi bleeding. with respect to the abdominal aortic aneurysm, she has been scheduled for an appointment with her vascular surgeon for follow-up . # hypothyroidism: she was continued on her home dose of thyroid replacement. the offices of ms. primary care physician, . , gi physician, . and vascular surgeon were notified of her admission and discharge summaries were faxed to each physician. medications on admission: --prednisone 5 mg once daily --levothyroxine --atenolol --simvastatin --aspirin --amlodipine discharge medications: 1. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine 75 mcg tablet sig: one (1) tablet po daily (daily). 3. atenolol 50 mg tablet sig: one (1) tablet po daily (daily). 4. simvastatin 20 mg tablet sig: one (1) tablet po once a day. 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 7. avapro 300 mg tablet sig: one (1) tablet po once a day. 8. vitamin d 400 unit capsule sig: one (1) capsule po once a day. 9. citracal regular 250-200 mg-unit tablet oral 10. multivitamin tablet sig: one (1) tablet po once a day. 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 12. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: one (1) intravenous q24h (every 24 hours) for 8 days. disp:*8 syringe* refills:*0* 13. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 8 days. disp:*24 tablet(s)* refills:*0* discharge disposition: extended care facility: , discharge diagnosis: 1. transient ischemic colitis, streptococci bovis bacteremia 2. abdominal aortic anyeurism discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted for treatment of transient ischemic colitis and positive blood cultures for the bacterium streptoccocus bovis. it is likely that when you were giving blood prior to your triple a repair, you experienced decreased blood flow to your intestinal tract causing a transient decreased oxygen supply. you were started on antibiotic therapy. our gastrointestinal team was consulted to help evaluate treatment. on ct imaging of your abdomen on admission noted dilation of your pancreatic ducts. this dilatation was evaluated by your gastroenterologist previously. it is imperative that you follow up with your primary gastroenterologist after this hospitalization for further evaluation, as this particular bacteria is sometimes associated with a malignancy. you will likely need a colonoscopy in the future for screening purposes. in addition to your regular medications: please continue to take intravenous ceftriaxone and oral metronidazole for a total of 2 weeks. you will need to have blood cultures drawn two weeks after finishing antibiotic therapy. please follow up with your primary care physician regarding these lab tests. you should not pursue any vascular surgery until these blood cultures are negative. you were also started on pantoprazole for your abdominal pain and gi bleeding. please continue to take this medications until directed otherwise by your primary care physician or gastroenterologist. followup instructions: name: , p address: ., , phone: appt: at 1:30pm name: , md address: 100 center ste 107c, , phone: appt: we are working on an appt with you within the next two weeks. the office will call you at home with an apt. if you dont hear from them by tomorrow, please call them directly to book an appt. procedure: venous catheterization, not elsewhere classified diagnoses: other iatrogenic hypotension thrombocytopenia, unspecified unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute and subacute necrosis of liver acute kidney failure, unspecified unspecified acquired hypothyroidism personal history of malignant neoplasm of bronchus and lung hypopotassemia other and unspecified hyperlipidemia bacteremia other specified disorders of biliary tract abdominal aneurysm without mention of rupture hypovolemia streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus acute vascular insufficiency of intestine 

Answer: The patient is high likely exposed to