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: heparin agents attending: chief complaint: bilateral lower extremity dvts major surgical or invasive procedure: colectomy with ileostomy history of present illness: 66 year-old man with history of ulcerative colitis, recently admitted to with lower gi bleed (hct 15, transfused 6 units prbc) as well as bilateral dvt s/p ivc filter 3 weeks ago. patient during the past week has been having worsening bilateral lower extremity edema, some ecchymosis and petechiae in left foot > right foot, and starting today with excruciating pain lle < rle, coldness, weakness and decreased sensation of the dorsum of his l foot. patient was initially treated with anticoagulation at the outside hospital when his dvt was first diagnosed, but given his gi bleed this was stopped and his coumadin was resumed for the past couple of days. his last bowel movement was today and it was melena. ct of bilateral lower extremities on arrival to showed extensive dvts beginning at the level of ivc down into bilateral calves, and the patient was bolused 4000 units heparin in the ed and transferred to the floor on a heparin gtt. past medical history: ulcerative colitis (last colonoscopy : sigmoid with active chronic colitis without granulomas, no evidence of ischemic colitis) lower gi bleed (brbpr - , hct 15, transfused 6 units prbc, c. diff negative, colonoscopy with severe ulceration from anus to 70 cm / splenic flexure, negative h. pylori, iv solumedrol and asacol 1200 mg tid, egd mild gastritis, flagyl / levaquin initially but discontinued when stool cultures negative for salmonella, shigella, campylobacter, and e. coli. flex showed severe ulcerative colitis, contraindicated to anticoagulate, therefore ivc filter was placed). past surgical history: - tonsillectomy - ivc filter (initially presented with lle dvt, had ivc filter placed, then re-presented with rle dvt: not candidate for tpa or thrombectomy by vascular surgery, ct chest with rul/rll and lul segmental pe's--main pulm a 2.5 cm--fragmin and coumadin initiated) social history: single, works in a grocery store and lives with his brother. a history of drinking half to a full pint 5 days per week, but has not had a drink for almost two months. smokes 1.5 packs per day since the age of 13. denies illicit drug use. family history: does not know his father's medical history. mother died of breast cancer in her 60s and did not have known abnormal clotting. his brother has problems with pancreatitis. physical exam: on admission on : vitals: t 97.2 hr 67 bp 90/59 rr 16 so2 97% ra gen: a&o, nad heent: no scleral icterus, mucus membranes moist cv: rrr, no m/g/r pulm: clear to auscultation b/l, no w/r/r abd: soft, nondistended, nontender, no rebound or guarding, normoactive bowel sounds, no palpable masses dre: normal tone, + guaiac occult blood ext: bilateral severe le edema with ecchymosis and petechiae on both feet l>r. weakness of the toes and decreased sensation of the dorsum of the foot (left worse than right). rle has more edema and is colder than the lle, but less tender. pulses: fem dp pt 2+ dop dop dop right 2+ dop dop dop on transfer out of tsicu on : vs: t 100.0, bp 146/74, hr 80, rr 16, o2 98% on room air pain: none. gen: nad heent: eomi, mmm, mouth is full of oral secretions, no lesions in oral cavity chest: ctab, good air movement cv: rrr abd: soft, minimally tender, nondistended, normal bowel sounds, vertical incision stapled, sero-sanguinous fluid leaks from incision ext: wrapped in ace bandage neuro: alert, cn 2-12 intact, somewhat fluent speech, oriented to name, hospital, . able to count backwards from 10 to 1. unable to recite days of the week backwards. psych: calm pertinent results: colon pathology : 1. terminal ileum, colon and appendix, ileo-colectomy (a-m): - chronic moderately-to-severely active colitis with pseudopolyps and ulcerations, focally involving submucosa and superficial muscularis propria. - active disease present at both resection margins. - appendix, within normal limits. - three lymph nodes with no malignancy identified (0/3). - no granulomata or dysplasia identified. 2. colon, "true distal margin" resection (n-p): - chronic severely active colitis with deep ulceration; involving the entire segment. - no granulomata or dysplasia identified. 3. terminal ileum, resection (q-s): segment of small intestine, within normal limits. cytology, left pleural fluid : atypical. - rare atypical epithelioid cells, favor reactive mesothelial cells. - background mesothelial cells, histiocytes, and neutrophils. cell block, left pleural fluid : atypical; atypical epithelioid cells favor reactive mesothelial cells. by immunohistochemistry, cytokeratin cocktail (keratin ae1/ae3, cam 5.2), calretinin, and wt-1 highlight mesothelial cells. cd15 highlights background inflammatory cells. no immunoreactivity is seen for b72.3, -31, or cea (absorbed). ct bilateral lower extremities : extensive deep venous thrombosis beginning at the level of the ivc filter extending inferiorly. on the right, thrombus is seen throughout the lower extremity to the calf veins. on the left, thrombus extends through the common iliac vein after which there is reconstitution with intermittent non-occlusive thrombus in the common femoral an proximal superficial femoral vein. occlusive clot is again present within the popliteal vein extending into the calf veins on the left. ct chest with contrast : impression: 1. extensive subcutaneous mediastinal, peritoneal and retroperitoneal areas. no definitive leak points identified, though an intestinal source is most likely given large amount of left upper abdominal gas and history ulcerative colitis flare. 2. large, layering nonhemorrhagic pleural effusions responsible for atelectasis. 3. two diaphragmatic pleural calcifications, not necessarily asbestos-related. 4. 1.4 cm left adrenal nodule is statistically an adrenal adenoma. ct abdomen and pelvis without contrast : 1. no evidence of an intraabdominal leak or extraluminal orally administered contrast noted. 2. moderate bilateral pleural effusions with associated atelectasis. 3. unchanged pneumomediastinum and retroperitoneal air. 4. large amount of subcutaneous fluid and edema likely related to iatrogenic fluid overload. ecg : sinus bradycardia with baseline artifact. compared to the previous tracing probably no significant change. cxr : there is no evident pneumothorax or enlarging pleural effusions. cardiomediastinal contours are unchanged. there are low lung volumes. left picc tip is in the mid svc. ng tube tip is in the stomach. bibasilar atelectases, larger on the right side, are stable. calcified granulomas in the right upper lobe are again noted. ill-defined rounded opacity in the left upper lobe is persistent. when clinically feasible ct is recommended for further evaluation. dup extext bil (map/dvt) study date of impression: peristent near-complete occlusion of the deep bilateral lower extremity veins. minimal flow in the right common femoral, deep femoral, and greater saphenous veins and left greater saphenous vein. ct abd & pelvis with contrast study date of impression: 1. postoperative sequelae as described above, with a small amount of residual free fluid and severe anasarca, though no evidence of intra-abdominal or pelvic abscess. 2. extensive severe deep venous thrombosis in the bilateral femoral vasculature, iliac vasculature in the lower portions of the ivc, below an infrarenal ivc filter. there is no evidence of more proximal venous thrombus. 3. left lower lobe pulmonary nodular opacity. unclear if true nodule or focal atelectasis/inflammation. recommend repeat chest ct in 3months. . video swallow: impression: penetration but no gross aspiration with thin consistency liquid. moderate pharyngeal residues. . microbiology" 3:12 pm swab source: leg l dorsal foot.. **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. 1+ (<1 per 1000x field): gram positive cocci. in pairs and singly. wound culture (final ): this culture contains mixed bacterial types (>=3) so an abbreviated workup is performed. any growth of p.aeruginosa, s.aureus and beta hemolytic streptococci will be reported. if these bacteria are not reported below, they are not present in this culture.. staph aureus coag +. moderate growth. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. this isolate is presumed to be resistant to clindamycin based on the detection of inducible resistance . pseudomonas aeruginosa. rare growth. piperacillin/tazobactam sensitivity testing performed by . sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | pseudomonas aeruginosa | | amikacin-------------- 4 s cefepime-------------- 2 s ceftazidime----------- 2 s ciprofloxacin--------- =>4 r clindamycin----------- r erythromycin---------- =>8 r gentamicin------------ <=0.5 s =>16 r levofloxacin---------- =>8 r meropenem------------- 4 s oxacillin------------- =>4 r piperacillin/tazo----- s rifampin-------------- <=0.5 s tetracycline---------- <=1 s tobramycin------------ =>16 r trimethoprim/sulfa---- <=0.5 s vancomycin------------ 1 s anaerobic culture (final ): no anaerobes isolated. fungal culture (final ): no fungus isolated. a swab is not the optimal specimen for recovery of mycobacteria or filamentous fungi. a negative result should be interpreted with caution. whenever possible tissue biopsy or aspirated fluid should be submitted. brief hospital course: 66 year-old man with a history of ulcerative colitis and severe gi bleed requiring 6 units prbc transfusion, history of pe s/p ivc filter placement presented to with a large burden of dvt. he transferred to the for vascular surgery evaluation. given a recent gastrointestinal bleeding episode, vascular surgery deemed him to not be a candidate for catheter-based thrombolysis therapy and recommended anticoagulation, ace wraps, elevation, and monitoring. . upon arrival to the , his platelets were noted to be downtrending and there was concern for possible heparin-induced thrombocytopenia (hit). he was transitioned to argatroban gtt for anticoagulation. hematology was consulted and onsidering the patient's low platelet count and the correlation with the initiation of heparin, argatroban was continued until his platelet count recovered and he transitioned to warfarin. . the patient was also having a uc flare with continuing bloody diarrhea despite being on very broad medical therapy. cxr and ct chest on both noted pneumomediastinum and subcutaneous air. the ct noted some abdominal free air, but no obvious source was identified. ct abd/pel found no definitive source for the air, there was no extravasation of contrast. thoracic surgery and colorectal surgery were concerned for colonic perforation. he was emergently taken to the or on and found to have a perforated transverse colon and fecal peritonitis. a total colectomy and ileostomy was performed. he required 4 units of prbc and 3 units of ffp. . from the or, he was transferred to the tsicu for further management. his tsicu course was complicated by new onset atrial fibrillation requiring cardioversion and amiodarone. he also developed bilateral pleural effusions requiring bilateral pigtail catheters until they were removed on . he was subsequently transferred to medicine for further management. by active problems: # dvt/pe/hit: has history of pe s/p infrarenal ivc filter placement. presented this admission with large clot extending from the ivc filter down both legs. he was anticoagulated with a heparin gtt and transferred to for vascular surgery evaluation. vascular surgery felt he was not a candidate for catheter-based thromboylsis or thrombectomy given his ongoing bloody diarrhea and recent admission to an osh for gi bleed requiring 6 units prbcs. . upon arrival to , his platelets were noted to be trending down. he was transitioned to an argatroban gtt for anticoagulation. he continued to have severe swelling of his les up to the lower abdomen because of his extensive clot burden. his warfarin was at one point restarted, however his inr because very supratherapeutic, thought to be poor nutrition with low levels of vitamin k. his albumin at admission was 1.6, which supported this theory. his inr was reversed prior to going to the or, as described below. . he never had a history of dvt or pe until a few months prior to admission. he may be hypercoaguable from his uc, however this is not a new diagnosis for him. anticardiolipin and at iii were sent and were essentially normal. there was concern that he may have an underlying malignancy which has caused him to become hypercoaguable. there was concern for lung or pancreatic malignancies. . he was started on argatroban, and, when platelets above 150,000, warfarin was started. when inr reached four, both were overlapped by two days, and then argatroban was discontinued. pt may require lifelong anticoagulation. he will be following up in hematology clinic for further care-see below. # anemia: complicated initially by bloody diarrhea and being on anticoagulation. he has had 8 units of prbc this hospitalization (4 units in or). last transfusion was on ; received 2 units prbc with appropriate increase hct. hct 26.5 on day of dc. hct ranged in mid 20's during admission. . # purpuric rash: at admission, he was found to have a non-blanching linearly oriented rash on his ankles and the dorsum of his feet bilaterally. these were thought to be caused by his thrombocytopenia and his pressure from the ace wraps used to control his severe edema. there was also consideration of vasculitis from his uc flare as a cause for the rash. wound care was consulted and the lesions were dressed with xeroform initially and subsequently adaptic dressings. further into his hospitalization, there was sloughing of the skin and dermatology was consulted. wound cultures growing mrsa and pseudomonas. derm recommended the following: - vzv and hsv cultures negative - continue mupirocin ointment tid - polymyxin ointment (though stop if irritating as this can be a contact allergen) - continue xeroform, kerlex, ace bandage this is was resolving on its own by the end of the hospital stay. . # dysphagia: speech and swallow previously found the patient to have signs and symptoms of aspiration and oral/pharyngeal residue. pt previously npo and was receiving tf, but now cleared for modified diet by video swallow. dht and tf were discontinued on . currently appears to be tolerating oral diet. he had a video swallow after which he was cleared to have thin liquids and ground food. his oral intake did improve after encouragement by our nurses. other problems: # ulcerative colitis and recent gi bleed-stopped prednisone and asacol that pt was taking prior to admission. . # colonic perforation at admission, the patient presented with a uc flare with worsening bloody diarrhea. gi was consulted and he was started on mesalamine, hydrocortisone enemas and prednisone 20mg . he continued to have bloody diarrhea during this admission, although the frequency and amount improved with the above medications. as discussed below, there was concern for colonic perforation in the setting of his uc flare and he was taken to the or for a total abdominal colectomy and ileostomy on . he was followed by the colorectal surgery service, and his staples and binder will need to remain in place indefinately per the surgical team. . # atrial fibrillation and svt: he was noted to have multiple episodes of svt, thought to be avnrt vs avrt on telemetry. he was mostly asymptomatic during these episodes and most broke spontaneously. on , he went into atrial fibrillation. he was electrically cardioverted and started on amiodarone. he subsequently remained in nsr. he will remain on amiodarone for 1 month's time, until . # bilateral pleural effusions thought to be a transudative effusion from fluid overload. s/p thoracenteses and pigtail catheter placement (left) and (right). pigtail catheters removed on without evidence of fluid reaccumulation on follow up imaging. # acute kidney injury: around the time when he developed pneumomediastinum and free abdominal air, he began to have . his fena was very low at 0.1%. he had been receiving a large amount of ivf during this admission, however given his poor venous return from his massive dvt and very low albumin, much of this fluid was being third-spaced. his renal function has now returned to . creatinine 0.7 upon dc. . incidental radiographic findings/pathology that will need further work up as an outpatient. 1.renal hypodensities 2.r.upper lob granuloma 3.l. adrenal 1.4cm nodule 4.pathology-pleural fluid and pleura-rare atypical epitheliod cells, favor reactive mesothelial cells 5.nodular opacity over left 4th rib-left lower lobe pulmonary nodular opacity. unclear if true nodule or focal atelectasis/inflammation. recommend repeat chest ct in 3months. medications on admission: - asacol 1200 mg tid - iron 325 mg tid - mci ??? - protronix 40 mg daily - thiamine 100 mg daily - prednisone 20 mg - atenolol 25 mg daily - coumadin 2.5 mg daily - percocet prn pain discharge medications: 1. mupirocin calcium 2 % cream : one (1) appl topical tid (3 times a day). 2. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 3. atenolol 25 mg tablet : one (1) tablet po once a day. 4. acetaminophen 650 mg/20.3 ml solution : one (1) po q6h (every 6 hours) as needed for pain or fever. 5. amiodarone 400 mg tablet : one (1) tablet po once a day: until . 6. warfarin 2 mg tablet : one (1) tablet po daily (daily). 7. ferrous sulfate 300 mg (60 mg iron) tablet : one (1) tablet po daily (daily). 8. loperamide 1 mg/5 ml liquid : one (1) po daily (daily). 9. oxycodone 5 mg/5 ml solution : 2.5 mg po q8h (every 8 hours) as needed for pain. 10. calcium carbonate 200 mg calcium (500 mg) tablet, chewable : one (1) tablet, chewable po tid (3 times a day). 11. cholecalciferol (vitamin d3) 400 unit tablet : two (2) tablet po daily (daily). 12. thiamine hcl 100 mg tablet : one (1) tablet po once a day. discharge disposition: extended care facility: - discharge diagnosis: ulcerative colitis flare colonic perforaction s/p total colectomy with ileostomy bilateral dvts heparin induced thrombocytopenia 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 to the hospital with dvts (blood clots in both legs) as well as a flare of your colitis. unfortunately, you developed a hole in your colon and you had to have your colon removed. you now have an ileostomy for passage of stool. for your blood clots, you will remain on coumadin for the rest of your life, and will need to get blood levels (inr) checked regularly. you should not receive heparin again. you have an filter to prevent clots from getting to your lungs. we advise you to leave that filter in place. you briefly had an irregular heart beat. your heart beat is now normal, but you should take a medication called amiodarone for a total of one month. . medication changes: 1.start coumadin/warfarin 2.start amiodarone for a total of 1 month 3.change protonix to lansoprazole 4.stop prednisone 5.stop asacol 6.start loperamide . please take all of your medications as prescribed and follow up with the appointments below. . wound care: you may shower, but do no submerge your wound or bathe. -the staples and abdominal binder are to remain in place indefinately. followup instructions: department: hematology/oncology when: friday at 10:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: friday at 10:00 am with: , md building: sc clinical ctr campus: east best parking: garage . name: , y. md location: address: , , phone: *we are working on a follow up appointment in colon and rectal surgery with dr. for you hospitalization. you need to follow up within 2 weeks of discharge. the office will contact you at home with an appointment. if you have not heard within 2 business days please contact the office at the above number. procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for less than 96 consecutive hours enteral infusion of concentrated nutritional substances other electric countershock of heart thoracentesis other permanent ileostomy open total intra-abdominal colectomy diagnoses: acidosis esophageal reflux tobacco use disorder unspecified pleural effusion long-term (current) use of steroids acute kidney failure, unspecified iron deficiency anemia secondary to blood loss (chronic) atrial fibrillation perforation of intestine candidiasis of mouth paroxysmal ventricular tachycardia cachexia long-term (current) use of anticoagulants methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site acute venous embolism and thrombosis of deep vessels of proximal lower extremity other disorders of plasma protein metabolism other pulmonary embolism and infarction delirium due to conditions classified elsewhere pseudomonas infection in conditions classified elsewhere and of unspecified site peritonitis (acute) generalized unspecified disease of pancreas heparin-induced thrombocytopenia (hit) other specified disorders of skin acute venous embolism and thrombosis of deep vessels of distal lower extremity other venous embolism and thrombosis of inferior vena cava dysphagia, oropharyngeal phase interstitial emphysema surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation universal ulcerative (chronic) colitis 

Answer: The patient is high likely exposed to