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: bright red blood per rectum major surgical or invasive procedure: 1. intubation and mechanical ventilation 2. mid-line placement for iv antibiotics history of present illness: 71 yr old male with h/o cad, s/p mi in with 2 lad stents placed at that time, on coumadin for low ef and lv akinesis, bipolar disorder, on lithium, who presented with chest pain and melena for evaluation. patient reports dark stool with intermittent brigh red blood per rectum with fall in hematocrit from 31 on to 22 on the day of admission. patient had one hour of chest discomfort with associated shortness of breath at rest the night prior to admission. the patient called his primary physician who referred the patient to the ed. patient was found to be in acute renal failure, lithium of 2.0 later developed t-wave inversions. also, found to have elevated inr and was stool guaiac positive. ros: no has, no lh, no dizziness, no cp/palpitations, no sob, no n/v, no vision changes. past medical history: bipolar disorder, stable on lithium congestive heart failure with ef 15% and akinetic wall coronary artery disease s/p myocardial infarction and stenting in 8/04chronic renal insufficiency social history: lives alone and worked in real estate. former smoker and etoh abuse, now stable with aa. family history: noncontributory physical exam: examination on admission: vitals: 98.9, 127/51, 73, rr 26, o2 97% on ra, abg on ra 7.43/27/69 general: alert and oriented, pleasant and cooperative heent: mmm, sclera mildly icteric cv: rrr, no murmurs pulm: mild crackles throughout abd: obese, + bowel sounds, soft, nontender, nondistended ext: wwp, trace pitting edema throughout, dp 1+ bilaterally, pneumoboots in place skin: no lesions pertinent results: labs on admission: 08:51pm hct-25.4* 11:15am ck(cpk)-46 11:15am ck-mb-notdone ctropnt-0.12* 11:15am lithium-2.0*# 11:15am pt-49.4* ptt-56.6* inr(pt)-15.4 02:55pm blood wbc-14.4* rbc-2.48* hgb-7.6* hct-21.6* mcv-87 mch-30.5 mchc-35.0 rdw-14.6 plt ct-285 11:15am blood glucose-112* urean-72* creat-3.0* na-137 k-5.7* cl-110* hco3-16* angap-17 06:26am blood ck-mb-4 ctropnt-1.37* 08:10pm blood ck-mb-37* mb indx-8.5* ctropnt-1.75* 03:09am blood albumin-2.7* calcium-10.5* phos-3.0 mg-2.7* 11:15am blood t4-7.3 free t4-1.3 11:15am blood tsh-3.2 cardiac echo: the left atrium is mildly dilated. left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated with severe regional dysfunction - with severe hypokinesis of the basal inferolateral and basal inferior walls, and near akinesis of the distal half of the septum, distal half of the anterior wall, and distal inferior wall. the apex is mildly aneurysmal and akinetic. no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened. trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. moderate (2+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. compared with the prior study (tape reviewed) of , moderate pulmonary artery systolic hypertension is now identified. overall and regional left ventricular systolic function is similar. 7:53 am sputum gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 3+ (5-10 per 1000x field): gram negative rod(s). respiratory culture (final ): oropharyngeal flora absent. serratia marcescens. moderate growth. sensitivities: mic expressed in mcg/ml _________________________________________________________ serratia marcescens | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s gentamicin------------ <=1 s levofloxacin----------<=0.25 s meropenem-------------<=0.25 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ 2 s trimethoprim/sulfa---- <=1 s labs on discharge: 06:15am blood wbc-9.6 rbc-4.25* hgb-12.4* hct-39.9*# mcv-94 mch-29.3 mchc-31.2 rdw-14.7 plt ct-653* 06:15am blood glucose-106* urean-29* creat-2.1* na-142 k-4.6 cl-112* hco3-20* angap-15 06:15am blood alt-137* ast-42* alkphos-148* totbili-0.6 06:15am blood calcium-10.0 phos-3.6 mg-2.2 06:10am blood triglyc-184* hdl-18 chol/hd-6.3 ldlcalc-59 06:10am blood hbsag-negative hbsab-positive hbcab-negative hav ab-negative 06:10am blood hcv ab-negative brief hospital course: 1. gastrointestinal bleed: mr. presented to this facility with an inr of 15.4 and reporting melena since his stenting and bright red blood per rectum for the past few days prior to admission. he denied hematemesis. he was thought to be coagulopathic due to his unmonitored use of plavix, aspirin, and coumadin for his left ventricular wall motion abnormalities. his inr improved with administration of vitamin k and 4 units of fresh frozen plasma. he also received 4 units of packed red blood cells for his hematocrit of 21. an egd revealed gastritis but no acute bleed. his coumadin, aspirin, plavix, beta blocker, and ace inhibitor were discontinued. placed on a twice daily ppi, he stabilized quickly and once his coagulopathy resolved, he required only one additional transfusion of packed red blood cells. he was found to be negative for h. pylori. his plavix and aspirin were restarted once his hematocrit had been stable for 2 days. 2. coronary artery disease: mr. is status post anterior st elevation myocardial infarction with stenting x 2 in of following a motor vehicle accident. he had been doing well until a few days ago when he noticed the onset of intermittent chest pain, mostly at rest. at times it was accompanied by dyspnea and might last up to 30 minutes. he also had some paroxysmal nocturnal dyspnea in the last few days. the night before admission he experienced chest pain that woke him from sleep and was accompanied by dyspnea and light headedness. he denied nausea, emesis, diaphoresis, or dizzyness. these symptoms resolved within 30 minutes. the morning of admission, he called his primary care physician who advised him to come to the emergency department for evaluation. at admission, he was on aspirin, plavix, an ace inhibitor, and a beta blocker. with the exception of the ace inhibitor, these were continued in their short acting forms during this admission. the ace inhibitor was held until his kidney function normalized. it was restarted on the day of discharge and the patient's blood pressures have tolerated it well. he will be continued on his current medication. if his renal function deteriorates, consider discontinuing ace inhibitor. 2. congestive heart failure: mr. has a history of chf with ef of 20% with rv apical akinesis and an apical left ventricular aneurysm. for this reason, he had been placed on coumadin during his previous hospitalization. in addition to aggressive diuresis to avoid volume overload, he received at least 8 units of blood products for his gib and to prevent further myocardial ischemia. although his ins and outs were negative, mr. soon developed respiratory failure. on the evening of admission, he suddenly became dyspneic, tachypneic, and diaphoretic. he was emergently intubated for flash pulmonary edema and upon introducing the endotracheal tube, large quantities of foamy red secretions emerged. the patient was restarted on coumadin, however, given his past medical history, he may not be a candidate for coumadin therapy. dr. will discuss with dr. , the patient's psychiatrist, whether the patient is reliable to remain on coumadin. please verify with dr. whether to send the patient home on coumadin prior to discharge form rehabilitation hospital. 3. cardiogenic shock: shortly after his intubation, mr. ' systolic blood pressures fell to the 70s. a pulmonary artery catheter was placed and norepinephrine, dopamine, and dobutamine drips were started. these pressors were titrated to maintain a mean arterial pressure greater than 65. his pulmonary artery catheter revealed pressures consistent with volume overload and cardiogenic shock (cvp 18, ra 15, rv 58/20, pa 58/27/40, pcwp 24). the patient's cardiac markers were cycled and were consistent with new ischemia, although a later transthoracic echo was unchanged. he was transfused intermittently to maintain a hematocrit greater than 30. 4. atrial fibrillation/svt: one day after placement of the pa catheter, the patient developed hypotension with a narrow complex tachycardia, which did not break with carotid massage. the dobutamine, dopamine, and norepinephrine were turned off. neosynephrine was started and a liter of normal saline was bolused with improvement in the bp to the 90's and 100's. when adenosine did not break the rhythm, which appeared to be atrial fibrillation, amiodarone was loaded. concomittently, electrical cardioversion with 100 then 200 joules was initiated, whereupon sinus rhythm was recovered. in the following days, the neosynephrine was weaned, the amiodarone was continued, and the patient remained in sinus rhythm with a brief episode of atrioventricular node reentrent tachycardia. once off pressors, beta blockade was initiated to rate control the patient. it was thought that these arrhythmias occured in the setting of cardiogenic shock and the irritating effect of the catheter on the myocardium. given these considerations, no av node ablation or long term amiodarone was indicated. 5. respiratory failure: mr. developed flash pulmonary edema in the setting of receiving several units of blood and fresh frozen plasma. he was emergently intubated and sedated. he remained on the ventilator until his cardiogenic shock was resolved and then was weaned. he did well until he became febrile and developed the onset of increasing secretions and oxygen desaturations. his endotracheal secretions grew out serratia and he responded well to piperacillin/ tazobactam. once the patient produced fewere secretions and his ventilator requirements decreased, he was successfully extubated. 6. acute renal failure: mr. ' baseline creatinine is 1.5 but when he presented, it was 3.1. his failure was though to be secondary to prerenal hypoperfusion due to the gi bleed, the myocardial ischemia, and the chf. his ace inhibitor had been started during his previous hospitalization in and likely contributed to the increase in the creatinine. both his ace inhibitor and the lithium were held until his renal failure resolved. once his cardiogenic shock resolved and perfusion to his kidneys improved, mr. ' creatinine trended down. in the interim, he developed hypercalcemia which was though to represent the action of lithium usually blunting the calcium sensing receptors on the parathyroid gland. it was believed that this would resolve once his lithium was restarted. he also briefly became hypernatremic, which was thought to be due to increased insensible losses during his febrile state (ventilatory associated pneumonia) vs rta and resolved with free water boluses and administration of iv d5w. the patient's sodium has been stable in the last few days prior to discharge. 7. bipolar disorder: mr. has a history of bipolar disorder and has been followed at this facility by dr. . according to the patient and his brother, he had been stable on lithium for about 4 years. in the interest of preserving his renal function, his lithium was discontinued and other medications were initiated. however, he developed severe depression and was placed back on lithium. when he presented to this facility, his lithium level was 2, much higher than his usual tight control of 0.5 - 1.0. this increase was thought to be secondary to his acute renal failure. dr. was contact and the decision was made to restart lithium with close monitoring. the patient will need close monitoring for his lithium level and follow up with dr. . dr. will be notified of the rehabilitation facility. 8. thrombocytosis - the patients platelet count has been trending up. the etiology of this is not entirely clear. the patient does not look actively infected to explain acute phase reactant effect. please monitor platelet counts closely. medications on admission: coumadin atorvastatin aspirin plavix lipitor lithium hctz protonix lisinopril 5 mg po qd toprol xl 50 mg po qd discharge medications: 1. atorvastatin calcium 40 mg tablet sig: two (2) tablet po qd (once a day). 2. aspirin 325 mg tablet sig: one (1) tablet po qd (once a day). 3. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po qd (once a day). 4. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day) as needed. 5. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 6. zolpidem tartrate 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 7. albuterol sulfate 0.083 % solution sig: one (1) inhalation q4h (every 4 hours) as needed. 8. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 9. warfarin sodium 2.5 mg tablet sig: one (1) tablet po hs (at bedtime): patient may benefit from higher inr. please adjust level to goal inr . please monitor closely as patient has history of supratherapeutic inr and gi bleed during recent admission. . 10. lithium carbonate 150 mg capsule sig: one (1) capsule po qhs (once a day (at bedtime)): please check lithium levels every days or as directed by dr. . please monitor closely and keep lithium level <1. 11. lisinopril 5 mg tablet sig: one (1) tablet po qd (once a day). 12. metoprolol succinate 25 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po qd (once a day). 13. piperacillin-tazobactam 2-0.25 g recon soln sig: one (1) recon soln intravenous q6h (every 6 hours) as needed for gnr in sputum for 4 days. discharge disposition: extended care facility: hospital - discharge diagnosis: cardiogenic shock atrial fibrillation acute renal failure gastrointestinal bleed, gastritis bipolar disorder congestive heart failure with ef of 15% coronary artery disease s/p mi and stenting ventilator associated pneumonia hypernatremia hypercalcemia transient atrioventricular node reentrent tachycardia discharge condition: improved. discharge instructions: please administer all medications as prescribed. please ensure that the patient has follow up after discharge form the hospital. followup instructions: 1. psychiatry - please reschedule if the patient is still at rehabilitation hospital , md where: ra (/ complex) hmfp phone: date/time: 2:40 2. primary care physician please call ( to schedule a follow up appointment with dr. in weeks after discharge from rehabilitation hospital. 3. cardiology please call ( to schedule a follow up appointment with dr. in weeks after discharge from rehabilitation hospital. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified other endoscopy of small intestine diagnostic ultrasound of heart insertion of endotracheal tube arterial catheterization pulmonary artery wedge monitoring transfusion of packed cells cardiopulmonary resuscitation, not otherwise specified injection or infusion of nesiritide diagnoses: subendocardial infarction, initial episode of care pneumonia due to other gram-negative bacteria congestive heart failure, unspecified acute kidney failure, unspecified atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure cardiogenic shock hemorrhage of gastrointestinal tract, unspecified 

Answer: The patient is high likely exposed to