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: ciprofloxacin / augmentin attending: chief complaint: coffee ground emesis major surgical or invasive procedure: egd history of present illness: patient is severely demented at baseline and history was obtained via records. . this is a 76 y/o f with history of chf, afib on coumadin, htn, dementia who prsented from her living facility after vomiting coffee grounds earlier today. per records, patient was suffering from constipation. bowel regimen was aggressively uptitrated and on day prior to admission, patient was given magnesium citrate. patient began vomiting coffee grounds on several occasions. unclear if patient had fevers or chills, or abdominal discomfort. . in ed patient's initially vs were 99.7 140 167/110 22 99%4lnc. patient triggered for hr. exam was unrevealing. initial ekg demonostrated svt. patient was given a total of 12mg of adenosine which revealed atrial flutter. patient was given a total of 40mg iv diltiazem and 1lns. ngl was completed which showed 1l coffee grounds with clots. this apparently cleared with an additional 500cc ns. gi was consulted and planed to scope patient in am. patient was started protonix gtt. lab findings were significant for a wbc of 18, hct of 44.5 (both which were thought to be hemoconcentrated) and a na of 129 with cr of 1.2. inr was noted to be 3.3. patient received a total of 10mg of vitamin k and 1 unit of ffp. lastly pt spiked to 101; blood cultures were taken and pt was given ceftriaxone for ?uti. prior to transfer, vital signs were 125/62 144 (still in flutter) 98% ra. . in the micu, patient was resting comfortable complaining of thirst. past medical history: s/p cva htn dm a flutter neurogenic bladder obesity social history: lives at . per the patient, her son visits her frequently. family history: non-contributory physical exam: admission exam: vitals: 124/88 144 94% ra general: alert, not oriented heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema . discharge exam: vitals: 98.8 126/62 80 18 98% ra gen: alert and oriented to person, place, time but not to living situation heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: irregular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: incontinent ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema skin: coalesced diffuse erythematous blanching patch on upper back crossing midline. scaly. two 2 cm scaly plaques on bilateral knees. excoriations on right lower leg. itchy coalesced diffusely erythematous blanching patch on l buttocks neuro: facial droop on right, 0/5 strength of lue with atrophied left hand, and 3/5 strength of l gastroc and anterior tibial, all consistent with her baseline distant mca stroke. . pertinent results: admission labs: wbc-18.0*# rbc-5.70*# hgb-14.9# hct-44.5# mcv-78* mch-26.1*# mchc-33.5 rdw-17.0* plt ct-451* neuts-84.9* lymphs-10.2* monos-4.3 eos-0.4 baso-0.3 pt-33.1* ptt-29.4 inr(pt)-3.3* glucose-283* urean-25* creat-1.2* na-129* k-3.5 cl-83* hco3-30 angap-20 alt-8 ast-11 ld(ldh)-147 alkphos-76 totbili-0.6 calcium-10.3 phos-2.3* mg-2.8* . dishcarge labs: wbc-8.4 rbc-4.35 hgb-11.6* hct-35.2* mcv-81* mch-26.7* mchc-33.0 rdw-17.6* plt ct-254 glucose-152* urean-10 creat-0.8 na-136 k-3.4 cl-102 hco3-21* angap-16 calcium-8.8 phos-1.2* mg-2.0 . micro: 1:44 am mrsa screen source: nasal swab. **final report ** mrsa screen (final ): positive for methicillin resistant staph aureus. . imaging: egd: esophagus: mucosa: grade d esophagitis with stigmata of recent bleeding was seen starting at 15 cm from the incisors to the ge junction, compatible with severe erosive esophagitis most likely from gerd. stomach: excavated lesions multiple superficial non-bleeding ulcers ranging in size from 1 cm to 1 cm were found in the fundus, stomach body, and antrum . duodenum: mucosa: normal mucosa was noted. impression: grade d esophagitis in the from 15cm to the ge junction compatible with severe erosive esophagitis most likely from gerd ulcers in the fundus, stomach body, and antrum normal mucosa in the duodenum otherwise normal egd to third part of the duodenum recommendations: follow up in dr. clinic in 4 weeks start high dose ppi (protonix 40mg or equivalent) for 6 weeks avoid nsaids continue management per inpatient gi consult team . . ct abd/pelvis (): ct abdomen with iv contrast: there is dependent subsegmental atelectasis at the lung bases. the heart is enlarged without pericardial effusion. there is coronary artery and thoracic aortic atherosclerotic calcification. the liver, spleen, and bilateral adrenal glands are normal. the gallbladder is surgically absent. a poorly evaluated 13-mm hypodensity arising from the posterior aspect of the pancreatic body may be new from the prior study. there is fatty atrophy of the pancreas. the non-opacified stomach and intra-abdominal loops of small bowel are normal without evidence of obstruction. a nasogastric tube terminates in the gastric fundus. there is colonic diverticulosis without evidence of acute diverticulitis. there is mild bilateral hydronephrosis and hydroureter. within the right kidney, there is a fat-fluid level in an anterior interpolar calyx (2a:35). in addition, a fat-fluid level is noted within the mid right ureter (2a:66). multiple hypodensities in the bilateral kidneys are mostly new compared to and are too small to further characterize, but may represent cysts. there has been interval atrophy of both kidneys. in addition, cortical thinning in the upper pole of the right kidney suggests prior infection or ischemia. there is no free air or fluid in the abdomen. there are no mesenteric lymph nodes meeting ct criteria for pathologic enlargement. a left para-aortic lymph node measuring 16 mm is similar to the prior study (2a:42). there is atherosclerotic calcification of the abdominal aorta which is of normal caliber throughout. vascular calcifications are also noted in the branch vessels. ct pelvis with iv contrast: there is a tiny fat-fluid level within the anterior portion of the bladder (2a:82). the distal ureters are dilated bilaterally, and scattered areas of mild urothelial enhancement are seen bilaterally. the urinary bladder is distended with irregular and lobulated appearance of the wall, with diverticula. heterogeneity is noted in the region of the endometrium, possibly due to an underlying polyp or fibroid. adnexa and sigmoid colon are normal. there is a large amount of stool within the rectum. there is no free fluid in the pelvis. no pelvic or inguinal lymphadenopathy meeting ct criteria for pathologic enlargement is noted. bone windows: no suspicious lytic or sclerotic osseous lesion is identified. there is multilevel degenerative change of the thoracolumbar spine. impression: 1. no evidence of bowel obstruction. 2. irregular lobulated appearance of the bladder wall with diverticula suggests neurogenic bladder and clinical correlation is recommended. mild bilateral hydroureteronephrosis may be due to bladder distention. mild urothelial enhancement could be seen with infection and correlation with urinalysis and urine culture recommended. 3. chyluria, of unclear etiology. correlation with urine studies and history of instrumentation or prior urologic procedures is recommended. 4. renal scarring in the right kidney suggests sequela of prior infection or infarction. 5. 13-mm pancreatic body hypodensity for which mri could be obtained for further evaluation as clinically indicated. 6. heterogeneous endometrium, possibly due to polyp or a submucosal fibroid. correlation with non-emergent pelvic ultrasound recommended if not previously performed. the study and the report were reviewed by the staff radiologist. . echo (): there is mild symmetric left ventricular hypertrophy. the left ventricular cavity is unusually small. left ventricular systolic function is hyperdynamic (ef>75%). doppler parameters are indeterminate for left ventricular diastolic function. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets are mildly thickened (?#). there is no aortic valve stenosis. mild to moderate (+) 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 tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. impression: small lv cavity size with hyperdynamic lv systolic function. an abnormal lvot flow contour is seen but an lvot gradient is not present. mild to moderate aortic regurgitation. . . cxr (pa/lat): (): findings: as compared to the previous radiograph, there is no relevant change. lung volumes and moderate cardiomegaly with retrocardiac atelectasis, but no evidence of pulmonary edema or pneumonia. the presence of minimal pleural effusion on the left cannot be excluded. on the right, there is no pleural effusion. brief hospital course: 76 y/o f with chf, dementia, afib on coumadin presenting with coffee ground emesis found be in aflutter with rvr. # gi bleed: patient was admitted to the micu with coffee ground emesis that was confirmed with nasogastric lavage. patient was tachycardic (see below), however bp was stable. hct initially was 44. with hydration, her hct fell to 35 but then remained stable. patient received 1 unit of ffp and vitamin k for supratherapeutic inr however did not receive any packed rbcs. egd revealed multiple superficial non-bleeding ulcers in the fundus, stomach body, and antrum as well as severe esophagitis. she was started on pantoprazole 40mg . patient remained hemodynamically stable and was subsequently transferred to the general medicine floors. her hct remained stable around 35 with no further episodes of vomiting. she was able to tolerate po intake. she was discharged to continue high dose ppi and to have follow up egd in weeks. . # tachycardia: patient initially presented in svt and received 12mg of adenosine which revealed underlying afib/aflutter with rvr. hrs remained fluid unresponsive, however were treated with iv beta blockade. upon restarted home dual nodal blockade, hrs became appropriate. however, pt displayed evidence of tachy-brady syndrome, with heart rates up to 150s and down to 60s, so her diltiazem was decreased to 60mg tid she remained hemodynamically stable. her coumadin was initially held in the setting of an acute bleed. however, gi felt that her risk of stroke was greater than her risk of rebleeding, so her coumadin was resumed on discharge, to be bridged with lovenox. . # sirs: patient met sirs criteria by heart rate and wbc count. she received empiric treatment with ceftriaxone x1 in the ed. however, since no clear source of infection was identified, antibiotics were discontinued. her wbc decreased to 8.4 at time of discharge and pt was afebrile. her ua was significant for large leukocytes, 101 wbc, few bacteria, however as she was asymptomatic and her urine culture showed only mixed bacterial flora, she was not treated. . # : patient presented with elevated creatinine and hyponatremia, both which improved with gentle fluid resuscitation. . chronic issues: . chf: pt was dehydrated on presentation. she received gentle hydration and remained euvolemic during her hospital course. . dm: metformin was held during hospitalization. her bg was managed with sliding scale insulin. she was resumed on metformin upon discharge. . pain management: pt was managed on lidocaine patch only during hospitalization. she had no complaints of lower back pain. she may be able to dc percocet and continue only on lidocaine patch to decrease her constipation. . transitional issues: pt is dnr/dni. she has a follow up egd and gi appointment scheduled for 4 weeks from discharge. she also had several findings on ct that may deserve follow-up as an outpatient as described in her ct findings. as constipation seems to be an issue for her, she may benefit from pain control with lidocaine patch only, as she reported her pain was well controlled on that regimen while she was hospitalized. she was restarted on coumadin given that the benefit of stroke reduction seemed to outweight the risk of re-bleeding, per gi. she is being bridged with lovenox. we were unable to contact the son during her hospitalization, however the final decision to continue anticoagulation should be addressed with him. medications on admission: - ventolin hfa 90mcg 2 puffs in q6h prn - ipratropium/albuterol 3cc via neb qid prn wheezing - acetaminophen 1000mg po q4h prn - magnesium citrate 1 bottle po - diltiazem 90mg po tid - bisacodyl 5mg po qhs - milk of magnesia 400mg/5ml po 30cc qhs - lidoderm patch - percocet 5/325mg 1 tab po tid - coumadin - bupropion xl 150mg daily - metformin 500mg daily - docusate 100mg - metoprolol tartrate 50mg discharge medications: 1. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). adhesive patch, medicated(s) 2. bupropion hcl 150 mg tablet extended release sig: one (1) tablet extended release po qam (once a day (in the morning)). 3. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 5. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day). 6. warfarin 4 mg tablet sig: one (1) tablet po once daily at 4 pm. 7. acetaminophen 500 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 8. enoxaparin 80 mg/0.8 ml syringe sig: eighty (80) mg subcutaneous (2 times a day): can be stopped once inr theraputic for 24-48 hours. 9. metformin 500 mg tablet sig: one (1) tablet po once a day. 10. docusate sodium 100 mg capsule sig: two (2) capsule po twice a day as needed for constipation. 11. diltiazem hcl 60 mg tablet sig: one (1) tablet po tid (3 times a day). discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: upper gi bleed secondary diagnosis: atrial flutter discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms , it was a pleasure taking care of you at . you were admitted to the hospital because you had bloody vomit. you had an upper endoscopy that showed that you have severe acid reflux with ulcers in your esophagus and stomach. because of this, you were started on a new medication to control your stomach acid. you should take this medicine twice a day indefinitely. you will also need to follow up with the gastrointestinal doctors because they to repeat an endoscopy in weeks. your heart rate was also very fast when you came to the hospital. we gave you medication to slow your heart rate down, and then restarted your home dose of metoprolol and diltiazem. please make the following changes to your medications: 1. start taking pantoprazole 40 mg by mouth twice a day 2. your back pain was well controlled with a lidocaine patch while you were in the hospital. since this worked for you here, you may want to consider stopping percocet (it can make constipation worse) and using a lidocaine patch instead. 3. take lovenox followup instructions: department: west procedural center when: thursday at 8:00 am with: wpc room three building: building ( complex) campus: west best parking: garage department: gi-west procedural center when: thursday at 8:00 am with: , md building: building ( complex) campus: west best parking: garage department: div. of gastroenterology when: wednesday at 1 pm with: , md building: ra (/ complex) campus: east best parking: main garage please call patient registration at ( prior to appointment. procedure: other endoscopy of small intestine diagnoses: esophageal reflux congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hyposmolality and/or hyponatremia atrial fibrillation atrial flutter other persistent mental disorders due to conditions classified elsewhere constipation, unspecified other late effects of cerebrovascular disease gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction carrier or suspected carrier of methicillin resistant staphylococcus aureus obesity, unspecified do not resuscitate status anticoagulants causing adverse effects in therapeutic use sinoatrial node dysfunction precipitous drop in hematocrit chronic diastolic heart failure esophageal hemorrhage other esophagitis unspecified analgesic and antipyretic causing adverse effects in therapeutic use other late effects of cerebrovascular disease, facial weakness neurogenic bladder nos other musculoskeletal symptoms referable to limbs 

Answer: The patient is high likely exposed to