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: no known allergies / adverse drug reactions attending: chief complaint: hypotension major surgical or invasive procedure: none sigmoidoscopy sigmoid colectomy bladder resection gastropexy/gastrostomy colopexy for hiatal hernia sigmoid resection & repair of colovesicular fistula history of present illness: 87m found by his vna this morning to be confused (this is their first visit with him), called ems who noted patient to be "shaky and weak", vitals at that time were an hr in the 140s, bp 70/palp. fs 94. the patient was last noted to be normal sometime last week. . on arrival to the ed the patient triggered for hypotension wiht initial vitals hr afib 102.8 (rectal) 138, bp 99/50, rr 26, 94% 2l. he was noted to be a+o x 2, with a petechial lower extremity rash with some abdominal tenderness. bedside ultrasound was done to r/o pericardial effusion. lactate was noted to be 5 and cleared with 4l ivf. a u/a was checked and was clear, cxr revealed an enlarged r. hilum. cta revealed an increased aa with concenr for a psdeudoaneurysm off the ascending aorta or a focal dissection with thrombus formation. csurg was consulted and felt this was an old pseudoanneurysm. he had a r. ij was placed and levofed was starterd. he underwent lp and received vanc, zosyn, ctx. lp was performed and noted to be clear. vitals at the time of transfer 82 104/60 on .21 of levofed, 100% 4l. past medical history: -mgus -cva in with symptoms of veering to the right and problems with writing with the right hand -tia in with transient clumsiness and dysarthria -diabetes -hypertension -history of right bundle-branch block -history of recurrent pseudomonal utis -history of liver hemangioma -history of ascending aortic aneurysm measuring 4.3 cm -history of hypercholesterolemia -history of moderate as in on tte -multifactorial gait disorder secondary to lumbar stenosis and chronic small vessel disease -history of right common iliac aneurysm measuring 2.2 cm -paroxysmal afib with a rvr, has not been anticoagulated on warfarin due to an excessively high risk of fall but is on asa/plavix -h/o seizure (hospitalization in ) -pericardial effusion and tamponade w/o evident recurrence ( ) -djd of the spine -basal cell cancer social history: lives alone with 24 hour health aide. daughter is an infectious disease physician. and son are health care proxys. : 10 pack year history, quit >50 years ago. rare etoh. no illicit drug use. emeritus professor at business school. family history: no family history of arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. father and brother died of mi in early 50s. no family history of stroke or cancer. physical exam: admission exam: vitals: t:98 bp:137/74 p:82 r:24 o2: 97% general: a+o x 2 (self, daughter, place, ) : sclera anicteric, dry mmm, oropharynx clear neck: supple, jvp assessment not valid lying flat, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: irregular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops, non-hyperdynamic abdomen: milld ttp b/l upper quadrants, mild guarding bowel sounds present, gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema, linear petechial rashes on b/l shins pertinent results: admission labs: 08:40am plt count-267 08:40am pt-13.0 ptt-22.4 inr(pt)-1.1 08:40am neuts-93.7* lymphs-3.4* monos-0.7* eos-1.9 basos-0.3 08:40am wbc-4.8 rbc-3.06* hgb-8.9* hct-26.6* mcv-87 mch-29.2 mchc-33.6 rdw-20.0* 08:40am calcium-8.4 phosphate-2.4* magnesium-1.9 08:40am ctropnt-<0.01 08:40am alt(sgpt)-17 ast(sgot)-20 alk phos-76 tot bili-0.6 08:40am estgfr-using this 08:40am urea n-24* creat-1.2 09:04am freeca-1.12 09:04am glucose-91 lactate-4.9* na+-143 k+-3.0* cl--106 tco2-24 09:04am ph-7.50* 10:06am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 10:06am urine color-straw appear-hazy sp -1.008 10:06am urine uhold-hold 10:06am urine uhold-hold 10:06am urine hours-random 10:06am urine hours-random 01:59pm lactate-1.3 discharge labs: notable labs: 03:50pm cerebrospinal fluid (csf) protein-23 glucose-59 03:50pm cerebrospinal fluid (csf) wbc-2 rbc-1* polys-11 lymphs-40 monos-49 08:40am blood ctropnt-<0.01 microbiology: 3:50 pm csf;spinal fluid gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (preliminary): pending blood culture : pending x2 urine culture : 10:06 am site: catheter urine culture (preliminary): enterococcus sp.. >100,000 organisms/ml.. imaging: cxr : abnormal mediastinal and right hilum. this is of unclear etiology and the margins of the right hilar density are atypical for mass lesion. i suspect there is a large hiatal hernia, possibly intrathoracic stomach, which could account for the relatively atypical appearance, although this is difficult to confirm given the lack of lateral view and comparison studies. if clinically feasible, consider pa and lateral views for further evaluation. ct torso with contrast : 1. there is a focal contrast-filled outpouching off the anterolateral aspect of the ascending aorta originating approximately 6 cm from the aortic root. the neck of the outpouching, in open communication with the aortic lumen, is approximately 3.7 cm. the entire contrast-filled outpouching measures 8.4 cm ap x 6.4 cm transverse x 8.8 cm cephalocaudad. the lesion terminates just prior to the origin of the brachiocephalic artery. a small focus of adjacent mediastinal fat is noted laterally. there is no associated stranding or mesenteric fluid to suggest leak or rupture at this time. these findings highly suggest a pseudoaneurysm or possibly a very focal dissection. although a non-gated study, the gross course of the right coronary artery, in particular the origin is approximated and the lesion is remote to it. 2. there is a highly suspicious, circumferential, predominantly hypoattenuated lesion with relatively sharp transition zones both proximally and distally in a short segment of the sigmoid colon, approximately 5 cm in maximal length. posteroinferiorly, there is a hypoattenuated outpouching extending inferiorly and abutting the dome of the thick-walled collapsed bladder. no intervening fat plane is identified. there is an indwelling foley catheter balloon within the thick-walled bladder. it is unclear whether there is a large right posterolateral bladder diverticulum or whether the wall thickening of thebladder is asymmetric and involves the anterior and superior aspects only. the findings are highly suggestive of carcinoma pf the sigmoid colon with a possible contained inflammatory component extending to and possibly locally invading the dome of the bladder. an underlying fistula, therefore, cannot be entirely excluded. while the possibility of diverticulitis is entertained, the overall features of this lesion are much more consistent with that of colon cancer. 3. there is an irregular geographic area of hypoattenuation within the anterior right hepatic lobe mostly within segment viii but also involving a small component of segment vii with small eccentric hyperattenuating foci most consistent with a giant hemangioma. despite the presence of an apparent sigmoid cancer, this lesion is not consistent with a metastatic deposit. 4. there is a large hernia anterior to the hiatus involving a long segment of the transverse colon which is relatively moderately stool filled. there is no apparent obstruction. moderate-to-significant fecal loading is noted throughout the colon. 5. there is incomplete left lower collapse, predominantly involving the basal segments with relative sparing of the superior segment. subsegmental atelectasis is also noted in the left upper lobe and right lower lobe. no focal consolidation is seen. there is no superimposed edema. a small left pleural effusion is evident. 6. the heart is enlarged with extensive native coronary vessel calcification. no pericardial effusion is seen. aside from the obvious lesion in the ascending aorta detailed in #1 above, the aorta itself is relatively ectatic throughout its course with scattered calcified and non-calcified atheromatous plaque. the right common iliac artery measures 2 cm in maximal diameter. severe and extensive vascular calcification of the splenic artery is incidentally noted. 7. incidentals: small lipoma within the paraspinal musculature of the upper back, reference series 2, image #16, is noted. a compression fracture of l1 with significant vertebral body height loss is also noted. margins are smooth and well marginated suggesting chronicity. there is no posterior retropulsion. degenerative changes are noted diffusely throughout the thoracolumbar spine with multilevel bridging osteophytes are seen in the mid thoracic spine. numerous hypoattenuating lesions of the kidneys are present which are too small to further characterize. there is a large exophytic hypoattenuated lesion off the lateral aspect of the inferior pole of the right kidney. there is either a tiny focus of layering milk of calcium or possibly a small rim calcification noted. brief hospital course: the patient is an 87m with long and complicated past medical history admitted from the ed with new onset confusion, hypotension, and fever. hypotension/septic shock: he presented with sbp to 70s systolic, fevers, and eventually mounted a leukocytosis to 22.7 in the setting of a lactate greater than 5. he was aggressively resuscitated and cultured. a central venous line was placed in the ed. a lumbar puncture was performed due to confusion (near his baseline) and a patechial rash on his shins, though it was negative for meningitis. a ct torso was done in the setting of hypotension to evaluate a known aortic dissection, though this was stable. it did show a sigmoid apple-core lesion consistent with possible colon cancer. he was started on vanco/zosyn to cover potential bowel pathogens, with a translocation event suspected in light of abdominal pain on exam. he briefly required pressor support with aggressive fluids with normalization of his blood pressure. other sources of infection include a right lower lobe pneumonia which evolved on hd2, as well as a urinary tract infection growing enterococcus on culture. on the patient was transferred to the surgical service and taken to the operating room where a sigmoid colectomy and reduction of type iv hiatal hernia was performed. in order to completely remove the sigmoid mass, a section of the bladder had to be removed with the specimen and this was repaired primarily. the patient tolerated the procedure well and was transferred to the tsicu for further management. his levophed was weaned to off and he was extubated without difficulty. following extubation, the patients mental status improved and he was transferred to the floor for further management. # altered mental status: delerium is the most likely etiology, in this setting sepsis is the most likely etiology, though the patient is quite constipated on ct scan, and this could also precipitate delerium. there is no evidence of mi, hypo or hyper glycemia or new pain or pain meds driving this. this resolved after his operation and was not an issue for the remainder of his hospitalization. # colon cancer : apple core lesion seen in sigmoid colon concerning for colon cancer, especialy with guiac positive stools and anemia. specimen from colonscopy by gi demonstrated adenocarcinoma. this was removed inraoperatively and sent to pathology. part of dome of bladder also involved and was removed. fistulas repaired surgically. the patient will follow up with acs and primary doctor for further management. # hiatal hernia: large hiatal hernia seen with stool-filed colon passing into thorax. moving bowels without sign of obstruction. this was repaired in the operating room. # atrial fibrillation: patient was in afib and had episodes of rvr post-op. these responded to i.v. and po metoprolol. cards consulted and suggested anticoagulation and rate control. patient on lovenox and will follow up with pcp. # bph: - hold tamsulosin in the setting of hypotension # cad: on aspirin and plavix # dementia: - continue memantine for now . osteoporosis: - continue vitamin d . gerd: - continue ranitidine medications on admission: tamsulosin 0.4 mg capsule, ext release 24 hr po bid plavix 75 mg tablet daily memantine 10 mg po bid prn for dementia vitamin d 1,000 daily aspirin 81 mg tablet daily ranitidine hcl 150 mg po bid ciprofloxacin 500 po q12h for 7 days. discharge disposition: extended care facility: senior healthcare of discharge diagnosis: sepsis colon adenocarcinoma right ij thrombus discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to initially with septic shock. it remains unclear where the source of infection was, but you improved after a course of antibiotics. we did a ct scan which showed a mass in your colon. you had a sigmoidoscopy to evaluate it and biopsies were taken. the biopsies showed evidence of adenocarcinoma. the mass showed evidence obstruction of bowel, local invasion into the bladder, and fistulization. due to this, our general surgery team was consulted and performed sugery. in the surgery, part of your sigmoid colon was removed, as well as part of your bladder. the fistula between your colon and bladder was then closed. your stomach was anchored to your abdominal wall, and a hernia in your diaphragm was repaired. while in the hospital, you were found to have atrial fibrillation with fast heart rates (rvr). for this, you required i.v. and oral beta blocker medications. we consulted our cardiologists, who agree you should stay on this beta blocker medication. due to concern for possible clotting, they also suggest you be on blood thinners. you were started on lovenox. please follow up with your primary doctor to discuss further management of this. you also have a thrombus/clot of your internal jugular vessel. this is another reason why you have been started on blood thinners. you are scheduled to have another imaging test of this vessel in 5 weeks. please keep this appointment. you required a foley cathether to help you urinate. you will need to keep this cathether in until you follow up with us in 2 weeks. it was a pleasure meeting you and participating in your care. followup instructions: dr. office will contact you for follow up. if you do not hear from them, please contact them to set up an appointment. please follow up with our general surgery clinic in two weeks by calling . please let them know you have to have a voiding cystogram performed prior to your visit. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances flexible sigmoidoscopy open and other sigmoidectomy other gastrostomy partial cystectomy other and open repair of diaphragmatic hernia, abdominal approach fixation of large intestine to abdominal wall diagnoses: urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis atrial fibrillation hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) hypopotassemia diaphragmatic hernia without mention of obstruction or gangrene other and unspecified hyperlipidemia osteoporosis, unspecified septic shock long-term (current) use of anticoagulants other constipation streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] delirium due to conditions classified elsewhere unspecified intestinal obstruction malignant neoplasm of sigmoid colon acute venous embolism and thrombosis of internal jugular veins 

Answer: The patient is high likely exposed to