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: ace inhibitors / norvasc attending: chief complaint: bright red blood per rectum major surgical or invasive procedure: colonoscopy history of present illness: simvastatin coumadin b 12 feso4 mvi prilosec bisacodyl mirtazepine senna past medical history: 1. cardiac risk factors: hypertension, dyslipidemia. 2. cardiac history: -cabg: none -percutaneous coronary interventions: s/p ptca x1 15 years ago records not at the -pacing/icd: none 3. other past medical history: gastritis h.pylori + (treated) gout syncope renal insufficiency (creat ~ 1.6) venous insufficiency and lower extremity edema benign prostatic hypertrophy atrial fibrillation diastolic dysfunction with volume overload treated with lasix retinal vascular occlusion in thought plaque rupture not thrombotic event as therapeutic on coumadin at the time social history: originally from poland. worked in labor camp for a few years before emmigrating. also was in the service in the us. lives in , ma with his wife. history: former 15 pack-year smoker, quit 60 years ago. rare etoh use. no recent travel. no sick contacts. family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory physical exam: 98.4 132/62 57 18 94ra laying in bed, pleasant, no distress, speaks and understands english well. pale conjuctival mucosa. mouth moist, normal appearing, blood blister on edge of tongue, otherwise no lesions seen no jvd noted. no cervical, supraclav lad early 3-6 systolic murmur best at lusb, irregularly irregular ctab no w/c/r/r soft, nt nd, bs hyperactive no ble edema noted. pt more easily palpated than dp's. radial's 2+. no c/c/e and cap refill <2 seconds. pertinent results: on admission wbc 5.4 rose to 13.7 while febrile but dropped down to 9.8 after starting abx h/h 8.4 / 25.5 on admission and was stable around 28.7 on d/c plts 138 on admission and 264 on d/c pt/ptt/inr 17.1/29.1/1.5 --> normal by d/c chems significant for bun/cr 37/1.5 --> by d/c 27/1.5 and rest of chems within normal limits ce's negative x2 ua positive for mild infxn urine culture (final ): klebsiella pneumoniae. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ klebsiella pneumoniae | ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 2 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- 32 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s gib study interpretation: following intravenous injection of autologous red blood cells labeled with tc-m, blood flow and dynamic images of the abdomen for minutes were obtained. a left lateral view of the pelvis was also obtained. blood flow images show a small active bleed in the right lower quadrant. dynamic blood pool images show a small active bleed in the right hepatic flexure impression: small active right hepatic fexture gastrointestinal bleed. mesenteric angiography procedure and findings: after the risks, benefits and alternatives of the proposed procedure were thoroughly explained to the patient, informed consent was obtained. the patient was taken to the angiography suite and placed supine on the imaging table. the right groin was prepped and draped in the usual sterile fashion. a preprocedure timeout was performed. after local anesthesia with 10 ml of 1% lidocaine, access was gained into the right common femoral artery with a 19-gauge needle. a 0.035 guide wire was advanced through the needle into the abdominal aorta. the needle was removed and a 5 french sheath was inserted. the sheath was connected to a continuous side arm flush. a 5 french c2 catheter was then placed through the sheath over the wire into the right common femoral artery with the tip ending in the abdominal aorta. the wire was then removed. the c2 catheter was lodged into the superior mesenteric artery. arteriogram of the superior mesenteric artery taken in multiple projections was recorded digitally and showed no active bleeding site or vascular abnormalities involving branches of the ileocolic, right colic or middle colic arteries. the wire was then placed through the c2 catheter and the catheter was then removed over the wire. a 5 french sos catheter was then placed over the wire into the right common femoral artery and further advanced into the aorta and formed in the thoracic aorta. the wire was then removed. the sos catheter was then used to selectively catheterize the inferior mesenteric artery. arteriogram of the inferior mesenteric artery did not show any active bleeding site or other vascular abnormalities at the branches of the left colic artery, sigmoid branches, and superior rectal arteries. the c2 catheter was then removed. the sheath at the right groin was removed and hemostasis was achieved by manual compression of the right groin site for 15 minutes. a sterile dressing was applied. the patient tolerated the procedure well and there were no immediate complications. impression: mesenteric arteriogram of the sma and did not show any active bleeding or vascular abnormalities. if the patient continues lower gi bleeding, a repeat superselective arteriogram of the ileocolic and right colic and middle colic arteries could be repeated with possible transcatheter embolization. cxr findings: in comparison to the previous chest radiograph of , the multifocal pneumonia has almost completely resolved with subtle residual airspace opacities in the right lower lung. the cardiomediastinal silhouette is normal and unchanged. calcification in the thoracic aorta is stable, degenerative changes throughout the thoracic spine are moderate to severe. impression: resolving multifocal infection with persistent subtle airspace opacities in the right lower lobe brief hospital course: 82yo m with h/o afib on coumadin, dchf, cri, and s/p recent egd on showing erosive gastritis with some coffee grounds, polypectomy of 2 polyps at hepatic flexure, and diverticulosis in sigmoid colon, presented to with significant amount of bleeding per gi tract. was admitted to unit and resuscitated with blood products, 9u prbc's and 4u ffp, and s/p tagged rbc scan showing bleeding at hepatic flexure (at site of previous gi procedure), unsuccessful angiography, and s/p repeat colonscopy with clips applied to ulcers seen at hepatic flexure. 1. gib--pt went to unit and resuscitated with blood products, tagged rbc scan showed bleeding at sight of hepatic flexure. pt went to ir (after prophylactic bicarb and mucomyst) for angiography but no vessel was found for coiling. by morning bleeding had stopped entirely and he went for colonoscopy which showed two deep ulcers around the site of polypectomy from his prior colonoscopy. five clips were placed. another polyp was also discovered during the colonoscopy, but clipping was held in the setting of acute gi bleed. serial hct's initially showing some drop which required transfusion of one more u prbc's which were stopped early due to low grade fever as below. however, pt's vitals stable through continued stay on the floor and hct finally stabilized and was stable around 28 by the time of d/c. coumadin was held on first admission and continued to be held while pt was admitted. this will need to be addressed at further visits with pcp as pt has high risk for stroke with high chads2 score. asa at 325mg qday was continued. pt will also likely need repeat colonoscopy in the future as another polyp at the hepatic flexure was seen that was not removed due to pt already bleeding. we left this to the pt and his pcp to discuss the timing of this. 2. afib--pt did not have rvr and did not require rate control though stay. coumadin was held as above. 3. uti--while on the floor, the pt began having temperature in low 100's while receiving blood products. transfusion stopped, and pt continued to spike fevers through the next day, bcx and ucx, cxr done. ucx ended up being positive for pan sensitive klebsiella, and pt received 2d worth of fluoroquinolones (first cipro then levaquin) and was d/c'd with 5 day course more of cipro, renally dosed. the ucx coincided with pt's subjective feeling of increased urination and burning on urination as well. by time of d/c pt had not had fevers for a couple days and was clinically well. was never hemodynamically compromised during febrile episodes. 4. dchf/htn--pt's bp meds were held on amdission and slowly added back until day of discharge when pt was on full home regimen of clonidine, felodipine, lasix, hydralazine, and imdur. pt did not have symptomatic heart failure and did not require diuresis above his home po regimen except twice for a small amt of increased ble edema. 5. cad s/p distant ptci--was not an active issue during this admission and didn't have cp. ce enzymes negative x2. no evidence of ischmia on ekg. asa was restarted without incident. continued home simvastatin 6. cri--pt's baseline 1.5-1.7. got ivf's, bicarb and mucomyst for angio procedure and cr was stable and within baseline through rest of admission. by d/c was 1.5. 7. h/o gout--wasn't active issue, continued home allopurinol. medications on admission: ismn 60 mg s.r. daily simvastatin 40 mg qhs hydralazine 150 mg po tid felodipine 10 mg daily clonidine 0.1 mg tablet allopurinol 300 mg daily aspirin 81 mg tablet daily omeprazole 40 mg po bid warfarin 5 mg po daily lasix 120mg po qdaily b12 dosage uncertain, prescribed by other provider discharge medications: 1. allopurinol 300 mg tablet sig: one (1) tablet po once a day. 2. simvastatin 40 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 3. clonidine 0.1 mg tablet sig: one (1) tablet po bid (2 times a day). 4. felodipine 2.5 mg tablet sustained release 24 hr sig: four (4) tablet sustained release 24 hr po daily (daily). 5. hydralazine 50 mg tablet sig: three (3) tablet po tid (3 times a day). 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po bid (2 times a day). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. furosemide 40 mg tablet sig: three (3) tablet po daily (daily). 9. isosorbide mononitrate 60 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 10. cipro 500 mg tablet sig: one (1) tablet po twice a day for 5 days. disp:*10 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: active issues during this admission: 1. gib most likely from hepatic flexure where biopsies had been taken on recent colonoscopy in late . atrial fibrillation 3. diastolic congestive heart failure 4. coronary artery disease 5. chronic renal insufficiency 6. urinary tract infection with pan sensitive klebsiella discharge condition: by the time of discharge, the pt had a stable hematocrit, vital signs were normal and stable, no evidence of bleeding from anywhere, was ambulating without difficulties, and was taking good po food and liquids. discharge instructions: you were admitted to with blood in your stools and found to be anemic from blood loss. you received blood products at an outside hospital and when you arrived to you were admitted to the intesive care unit. you were given more blood products and your blood level stabilized. you also underwent procedures to localize the source of the blood loss. you then underwent a colonoscopy and the ulcers that appeared to be bleeding were clipped. your blood level stabilized and was stable. while you admitted, your blood thinner coumadin was held. your coumadin was not restarted on discharge, and you will need to discuss with your primary care physician when you should restart this medication. your blood pressure meds were also held out of concern for low blood pressures while you were actively bleeding. as your bleeding problem resolved, your blood pressure meds were restarted, and by the time of discharge you were taking all of your blood pressures meds: clonidine, felodipine, lasix, hydralazine, and isosorbide mononitrate. finally, you will also need to complete a short course of oral antibiotics for the urinary tract infection that you developed while admitted. please continue a 5 more day course of ciprofloxacin for a total of 7 days. you primary care doctor can then reassess whether you still have a urinary tract infection. please return to the hospital if you experience fevers, chills, night sweats, more bleeding with your bowel movements or evidence of bleeding from any other source, abdominal pain, or any other concerns. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: followup instructions: please follow up with , md phone: on tuesday at 2:15pm. during this visit please make sure you address the following 2 very important issues: 1. if and when you should restart your anticoagulation drug (coumadin/warfarin) for your atrial fibrillation 2. when to follow up with your gi doctors about a repeat colonoscopy to address the remaining polyp in your gi tract. they can schedule this for you, and they advised doing so in about 2-3 weeks. for your information, the physicians who performed your colonscopy were: dr. , and dr. . we have also made an appointment for you with dr. , md phone: on at 4pm. your original appointment in has been cancelled so that you can follow up with him sooner, on . for your information, you also have the following previously made appointment: provider: , md phone: date/time: 9:00 md, procedure: arteriography of other intra-abdominal arteries endoscopic destruction of other lesion or tissue of large intestine diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute posthemorrhagic anemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation chronic kidney disease, unspecified hemorrhage complicating a procedure blood in stool long-term (current) use of anticoagulants chronic diastolic heart failure ulceration of intestine 

Answer: The patient is high likely exposed to