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: aldactone attending: chief complaint: dark stools concern for gib major surgical or invasive procedure: upper endoscopy history of present illness: this is a 56 year old man with a history of congenital heart disease s/p recent admission for mvr/pvr, and afib on coumadin, who was referred in from with melena/black stools x2 days and anemia. . the patient was unaware of having had melena or brbpr until he was told by staff at his rehab that he had black stools. he has felt well. he denies abdominal pain, n/v, diarrhea, constipation. he also denies cp, sob. he reports having an appetite, but of note, he has been npo and has been tube fed since he failed a video swallow on during the last admission. . in the ed, vs: 99.5, 100, 140/67, 100% on tcm stool guaiac + hct noted to be 21.8 (range 23-28 on last admission, 23.2 at time of discharge). inr 1.6. he was given protonix 40mg iv x1, vitamin k 10mg. 1 unit of prbcs was started and 2 units of ffp were ordered (1 given so far). gi was consulted. past medical history: #congenital heart disease -s/p pulmonic valvulotomy in -s/p vsd repair -: redo sternotomy, pvr (porcine), mvr (porcine), vsd closure, pfo closure #chf #s/p trach, open j-tube in #dm #anxiety #depression #a fib #rbbb #rle varicosities #s/p r hernia repair #s/p appy social history: disabled never used tobacco occasional etoh family history: father had mi at age 55 physical exam: vs: 98.0, 97, 112/61, 100% on 40% tcm general: nad, lying in bed heent: perrl, anicteric, mmm, trach collar in place lungs: cta anteriorly, no wheezes or crackles heart: rrr, iii/vi systolic murmur at the apex abdomen: +bs, soft, nt/nd. j tube in place, c/d/i. open midline abdominal wound. rectal: guaiac + greenish black stool. extrem: + pitting edema b/l. pertinent results: 12:29pm blood wbc-8.0 rbc-2.43* hgb-7.1* hct-21.8* mcv-90 mch-29.5 mchc-32.7 rdw-16.2* plt ct-257 09:00pm blood hct-21.2* 04:11am blood wbc-6.4 rbc-2.65* hgb-7.5* hct-24.3* mcv-92 mch-28.4 mchc-30.9* rdw-16.3* plt ct-216 09:01am blood hct-24.4* 04:35am blood wbc-5.5 rbc-2.67* hgb-7.7* hct-24.4* mcv-91 mch-28.8 mchc-31.6 rdw-16.7* plt ct-216 12:29pm blood pt-17.3* ptt-31.1 inr(pt)-1.6* 04:11am blood pt-13.7* ptt-38.1* inr(pt)-1.2* 04:35am blood pt-12.2 ptt-26.9 inr(pt)-1.0 12:29pm blood glucose-109* urean-52* creat-0.9 na-145 k-3.5 cl-100 hco3-41* angap-8 04:11am blood glucose-79 urean-37* creat-0.7 na-147* k-4.0 cl-104 hco3-38* angap-9 04:35am blood glucose-83 urean-26* creat-0.7 na-152* k-4.0 cl-108 hco3-40* angap-8 08:56am blood glucose-103 urean-23* creat-0.7 na-148* k-3.9 cl-105 hco3-38* angap-9 12:29pm blood calcium-8.3* phos-3.9 mg-2.6 04:11am blood calcium-8.6 phos-3.4 mg-2.5 04:35am blood calcium-8.8 phos-4.3 mg-2.5 reports and studies findings: esophagus: normal esophagus. stomach: mucosa: mild erythema of the mucosa compatible with gastritis was noted in the antrum. the antral mucosal folds were also somewhat prominent, though benign in appearance. duodenum: normal duodenum. impression: mild gastritis otherwise normal egd to second part of the duodenum recommendations: follow hct continue ppi if the patient shows signs of continued bleeding would consider colonoscopy and possible capsule study additional notes: the findings on egd do not explain the patient's melena. the procedure was done by the attending and gi fellow. brief hospital course: # anemia/black stools: the patient was found to be anemic upon arrival into the ed at 21.8, down fom his discharge hematocrit of 23.2 from , and was guaiac positive on rectal exam. he remained hemodynamically stable. serial admit hcts 21.78 --> 1unit prbc --> 21.2 -> 1unit prbc -> 24.3, and remained stable for 24hours. he had an upper egd which showed mild gastritis but was otherwise unremarkable. a colonoscopy was recommended as an outpatient. # atrial fibrillation / anticoagulation the patient was admitted on coumadin with goal 2.0-2.5 for inr, but it was unclear to us if he was on coumadin for afib or for his recent bioprosthetic valves. the matter was discussed with cardiothoracic surgery, who noted that the patient did not require anticoagulation for the valves as it was not standard of practice here. the coumadin was held, and the patient instructed to discuss the risks/benefits with his pcp. # respiratory: patient is trached and peg'd s/p his recent extensive cardiac surgery. current regimen at rehab is to be on tcm 40% during the day and ac at 500x10, peep 5, fio2 40% at night. patient was fully off the vent at time of last discharge, but he was restarted on the vent at night. his usual evening ambien and clonazepam were quite sedating for the patient, and this was felt to be the cause of his need for assist control ventillation at rehab. we recommend that sedatives be minimized and that he be weaned from needed ac/ventilator support at night. # hypernatremia: the patient's sodium was 145 on admission, and rose to 152 the morning of discharge, likely in context of being npo. his free water boluses were increased in his tube feeds. on recheck at 9am of day of discharge, his sodium was 148. he should continue to receive free water boluses of 250cc every 4 hours. lasix is being held. his chemistries should be checked daily for the next two days. # congenital heart disease: s/p recent surgery. no cad on cath in . metoprolol was to resume on discharge. # h/o peptostreptococcus bacteremia the patient completed a 14 day course in total, and was discharged off of vancomycin. # anxiety/depression: continued home meds (fluoxetine, klonopin) . # dm/glucose control: continued home insulin regimen - half-dose glargine while npo. fs qid. . # fen: patient is npo and gets tube feeds at baseline. his tube feeds were restarted. . # access: picc, piv. . # ppx: iv ppi was changed to home lansoprazole for discharge. pneumoboots for dvt prophylaxis. . # code: full ---- to do: outpatient chem 7 on outpatient chem 7 on md to review labs immediately. if md not available, please fax results to pcp medications on admission: -atorvastatin 20 mg tablet : one (1) tablet po daily -ascorbic acid 500 mg tablet : one (1) tablet po bid -fluoxetine 20 mg capsule : one (1) capsule po daily -lansoprazole 30 mg tablet,rapid dissolve po daily -docusate sodium 100mg po bid -aspirin 81 mg tablet, chewable : one (1) po daily (daily). -albuterol prn -ferrous sulfate 300 mg/5 ml liquid : one (1) po daily -clonazepam 0.5 mg -metoprolol tartrate 25 mg tablet : one (1) tablet po bid -zolpidem 5-10 mg hs prn -furosemide 60 mg po bid -vancomycin in dextrose 1 gram/200 ml piggyback : one (1) intravenous q 12h (every 12 hours) for 7 days: is day . (1g q12h per d/c summary, 1g q24h per rehab med list) -insulin glargine 100 unit/ml solution : twenty units qhs -insulin lispro 100 unit/ml solution : per sliding scale qid -warfarin to target inr 2-2.5. -combivent qid -glucerna tf at 90cc/h discharge medications: 1. atorvastatin 20 mg tablet : one (1) tablet po daily (daily). 2. ascorbic acid 500 mg tablet : one (1) tablet po bid (2 times a day). 3. fluoxetine 20 mg capsule : one (1) capsule po daily (daily). 4. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 5. miconazole nitrate 2 % powder : one (1) appl topical qid (4 times a day) as needed. 6. albuterol sulfate 2.5 mg/3 ml solution for nebulization : one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 7. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours). 8. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) as needed. 9. acetaminophen 160 mg/5 ml solution : ml po q6h (every 6 hours) as needed for for pain. 10. clonazepam 0.5 mg tablet : one (1) tablet po bid (2 times a day) as needed for anxiety, insomnia. 11. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr once a day. 12. aspirin 81 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po once a day. 13. ferrous sulfate 300 mg/5 ml liquid : three hundred (300) mg po once a day. 14. metoprolol tartrate 25 mg tablet : one (1) tablet po twice a day. 15. insulin glargine 100 unit/ml solution : twenty (20) units subcutaneous at bedtime. 16. insulin lispro 100 unit/ml solution : sliding scale coverage subcutaneous four times a day. 17. nutrition tube feeds glucerna tube feeds starting rate: 20 ml/hr; advance rate by 10 ml q4h goal 90cc/hour residual check: q4h hold feeding for residual >= : 100 ml flush w/ 250 ml water q4h 18. outpatient lab work chem 7 on chem 7 on md to review results immediately. if md not available at rehab, fax results to pcp 19. combivent 18-103 mcg/actuation aerosol : one (1) inh inhalation four times a day. discharge disposition: extended care facility: - discharge diagnosis: primary: gi bleed, unspecified secondary: congenital heart disease s/p pulmonic, mitral valve replacement, vsd, pfo closure diabetes mellitus anxiety depression atrial fibrillation chronic systolic congestive heart failure ef 45-50% discharge condition: stable hematocrit at 24. 98.0 bp 97/54 hr 87 sat 100% rr15 discharge instructions: you were admitted with concern for a gastrointestinal tract bleed. you were transfused two units of red blood cells. you underwent an upper endoscopy which showed no acute bleed. your medications were changed. your vancomycin was completed, and your coumadin was held. please discuss restarting coumadin with your primary care provider. if you develop fever, chills, red blood per rectum, black and tarry stools, fainting or near fainting, or other concerning symptoms, please return to the hospital followup instructions: you have a follow-up appointment with dr. on monday at 11:45am ** transportation must be arranged pcp: , procedure: other endoscopy of small intestine enteral infusion of concentrated nutritional substances transfusion of packed cells transfusion of other serum diagnoses: congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation bacteremia blood in stool chronic systolic heart failure iron deficiency anemia, unspecified hyperosmolality and/or hypernatremia unspecified gastritis and gastroduodenitis, without mention of hemorrhage tracheostomy status 

Answer: The patient is high likely exposed to