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: light-headedness, anemia, gi bleed major surgical or invasive procedure: balloon enteroscopy - by drs. and video capsule study - history of present illness: mr. is a 74yo male with h/o ckd, anemia of chronic inflammation, bph, and chronic foley catheter w/ recurrent utis, who on experienced acute onset of light-headedness while walking through his house. his symptoms were associated w/ diaphoresis and weakness, but no chest pain, shortness of breath, or syncope. he has been having black stools for at least several months, initially thought to be related to iron pills, but he denies any hematochezia. also denies any abdominal pain, nausea, vomiting, hematemesis, or weight loss. on presentation to ed his hct was found to be 11.7, hgb 3.7, and he was initially tranfused 2 units prbcs. ng lavage did not show any active bleeding. of note, he had recently been transfused 2 units as an outpatient in a "medical day care" setting for a hct of 18.8, approximately one week prior to admission. hct at had previously been 29.4 on . he had never had an egd or colonoscopy. no prior history of gi bleeding. does have signficant history of alcohol abuse, though has been sober for the past 6 months. until recently he had been poorly complaint with outpatient medical follow-up. . during his admission to , he was transfused a total of 9 units prbcs over 4 days, with last transfusion earlier today. despite this ongoing transfusion requirement, he remained hemodynamically stable. he underwent egd on which was normal. colonoscopy showed fresh and old blood throughout his entire colon and distal terminal ileum, but no focal bleeding sources. he did have scattered diverticuli throughout the colon, and small internal hemorrhoids. he had a push enteroscopy to 140cm which was unrevealing, and no active bleeding or avms were noted. small capsule endoscopy however showed a possible bleeding source in the small bowel. the prolonged capsule time prohibited better localization, but there was concern for a possible subtle lesion such as dieulafoy's. ct angiography was not obtained given his ckd. he was transferred to for full enteroscopy and potential surgery. of note he was also found to have a uti positive for mrsa and enterococcus that was vancomycin sensitive, and he was switched from ceftriaxone to vancomycin on . . on arrival to the micu, patient is comfortable and without complaints. he denies any current nausea, vomiting, or abdominal pain. does report nausea while at , in the setting of his bowel prep for the colonoscopy. prior to admission, he denies having any dyspnea on exertion. he is being treated for a uti and has a chronic foley; denies any symptoms associated with this infection including fever or suprapubic pain. . review of systems: (+) per hpi. did have chills, now resolved. has chronic bilateral hip pain secondary to arthritis. has psoriasis. occasional palpitations. (-) denies fever, night sweats, significant weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain or chest pressure. no myalgias. past medical history: - chronic kidney disease stage iv, baseline creatinine 2.7. - iron deficiency and anemia of chronic disease. - bph, wearing chronic foley catheter for 3-6 months - recurrent uti, mostly citrobacter and proteus sensitive to rocephin. - hemorrhagic cystitis. - psoriasis. - alcohol abuse and withdrawal, sober for 6 months. - djd and psoriatic arthritis. - paroxysmal atrial fibrillation during a hospitalization. - osteoarthritis. - vitamin b12 deficiency. - hyperparathyroidism. - echocardiogram in showed ef of 65% to 70% with moderate tr and lvh. social history: lives at home with his wife. uses and walker sometimes. reports remote tobacco use, but none for past 50 years. has history of alcohol abuse (1 to 2 bottles of wine every day for 20 years), but has been sober 6-7 months. denies illicit drug use, including any ivdu. family history: no family history of colon cancer. physical exam: admission exam: vitals: t: 98.2 bp: 136/84 p: 76 r: 11 o2: 98% ra general: alert, oriented, no acute distress heent: perrl, eomi, sclera anicteric, mmm neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley in place ext: warm, well perfused, 2+ dp pulses, no edema neuro: cnii-xii grossly intact, 5/5 strength upper/lower extremities skin: psoriatic plaques on arms and hands bilaterally pertinent results: admission labs: 07:13pm blood wbc-10.8 rbc-3.25* hgb-9.6* hct-28.0* mcv-86 mch-29.7 mchc-34.4 rdw-18.6* plt ct-314 07:13pm blood pt-11.3 ptt-28.9 inr(pt)-1.0 07:13pm blood glucose-93 urean-42* creat-2.3* na-139 k-4.5 cl-108 hco3-21* angap-15 07:13pm blood calcium-7.9* phos-3.4 mg-2.0 . abdomen ct without iv contrast: small bilateral pleural effusions are present, greater on the left (2:4), with mild adjacent compressive atelectasis. no nodules or masses are detected. the heart size is normal, and there is no pericardial effusion. . oral contrast distributes throughout the stomach and proximal small bowel. thickening at the pylorus is likely peristalsis (2:24). there is a small duodenal diverticulum (2:25). tiny duodenal diverticula are also present near the ligament of treitz (300b:27). there is no bowel obstruction. there is no mesenteric or retroperitoneal lymphadenopathy, and no free air or free fluid. . an endoscopic capsule is seen within the mid portion of the descending colon (2:38). diverticula are scattered across the sigmoid colon and the ascending colon (300b:30) without evidence of diverticulitis. . tiny gallstones are present (2:21). the liver, spleen, adrenal glands, and pancreas are normal. . both ureters are thickened (300b:33, 38); however, there is no hydronephrosis. both kidneys are slightly atrophic. mild perinephric stranding is symmetric and likely within normal limits. . pelvic ct without iv contrast: a foley catheter resides within a collapsed bladder, which demonstrates markedly thickened walls measuring up to 1.3 cm (301b:41, 2:70). these features were also seen on the ultrasound examination from . . scattered iliac and inguinal lymph nodes are at the upper limits of normal in size (2:78). there is no intrapelvic free fluid. . osseous structures: there is no acute fracture. severe osteoarthritic changes are seen throughout both femoroacetabular joints, with central loss of the joint space, with substantial subchondral cystic change and sclerosis, with large hanging osteophytes (300b:39). there is slight loss of disc heights of l5 (301b:41). anterior disc bulges at l4/l5 and l5/s1 are present. extensive lateral osteophytosis is seen throughout the lumbar spine (300b:37). . impression: 1. no bowel mass detected on this non-contrast enhanced study. an endoscopy capsule is located at the mid descending colon. if there remains a need to localize bleeding, a tagged rbc study could be considered; though if renal function improves, a multiphase ct using volumen oral contrast and iodinated iv contrast could also be helpful. 2. duodenal, ascending colonic, and sigmoid diverticula, with no evidence of diverticulitis. 3. ureteral and bladder wall thickening, likely secondary to chronic obsrtuction. correlation with any prior urological workup is recommended. 4. cholelithiasis. 5. severe bilateral hip osteoarthropathy. . single balloon enteroscopy : findings: esophagus: -mucosa: normal mucosa was noted. stomach: -mucosa: normal mucosa was noted. duodenum: -mucosa: normal mucosa was noted. jejunum: -mucosa: normal mucosa was noted. spot tattooing with success. ileum: not examined. impression: normal small bowel enteroscopy to distal jejunum no blood or bleeding lesions noted. spot tattooing with success at the most distal point reached . gi bleeding study (tagged rbc scan) : interpretation: following intravenous injection of autologous red blood cells labeled with tc-m, blood flow and dynamic images of the abdomen for minutes were obtained. a left lateral view of the pelvis was also obtained. . blood flow images show normal abdominal flow. there are no abnormal areas of hyperemia. . dynamic blood pool images show no evidence of bleeding during the time of the study. . impression:no evidence of bleeding during the time of the study. . video capsule study : gastric passage time: 0h 17m, small bowel passage time: 4h 45m, . procedure info & findings 1)no active bleeding site seen in the small bowel. 2) a single non-bleeding angioectasia is seen in the distal jejunum. 3)a few lymphangiectasias in the proximal jejunum. 4)old blood seen in the cecum. . summary & recommendations summary: no active bleeding site seen in the small bowel. a single non-bleeding avm in the distal jejunum. a few lymphangiectasias. old blood seen in the cecum. brief hospital course: primary reason for hospitalization: 74m with h/o ckd, anemia of chronic inflammation, bph, and chronic foley catheter w/ recurrent utis, transferred now from for further evaluation of gi bleeding and acute blood loss anemia, with course also notable for mrsa and enterococcal uti. . active issues: . #. gi bleed with acute blood loss anemia: based on work-up at prior to transfer, gi bleed was felt to be most likely secondary to small bowel etiology. gi and surgery were consulted and followed closely. he had a ct abdomen/pelvis and tagged rbc scan which were unrevealing. he had a video capsule study which showed single non-bleeding angioectasia in the distal jejunum, thought likely to be the source of his bleed. since he was no longer actively bleeding, and his hct was stable, it was felt that he could be safely discharged with close monitoring at a rehab facility. he should have his hct monitored every other day (or more often if he experiences melena or brbpr), and transfused rbcs for hct <21. should he experience re-bleeding, would recommend that he return to the hospital for gi angiography and embolization to stop the bleed. . # uti: patient with h/o chronic foley and recurrent utis. urine culture at revealed mrsa and enterococcus sensitive to vanco, and vanco started at . patient was afebrile, without leukocytosis, on transfer and vancomycin was discontinued. however he spiked a temp to 100.6 on and was restarted on iv vancomycin. he should complete a 14 day course for complicated uti, to end on . . #. ckd: patient's cr elevated to 3.7 on admission to , though subsequently returned to baseline of 2.6. acute on chronic kidney failure was likely seconary to pre-renal azotemia in the setting of acute blood loss. . chronic issues: #. bph: continued flomax 0.4mg daily per outpatient regimen. continued finasteride per outpatient regimen. #. b12 deficiency: continued vitamin b12 1000 mcg po daily per outpatient regimen. . #. paroxysmal atrial fibrillation: was in normal sinus rhythm on admission. held metoprolol given gi bleeding, and he should resume his metoprolol on discharge. patient has not been on anticoagulation, though chads2 score 0 based on available history. he should start asa 81mg daily in the future once gi bleed has resolved. . transitional issues: - he has a follow up appointment scheduled with the gi service at -. - he should have his hgb/hct monitored closely after discharge with a transfusion goal of hct > 21. if any signs of gi bleed he should be evaluated immediately. - no medication changes during this hospitalization. - he maintained full code status during this hospitalization. medications on admission: home medications: - iron 325 mg p.o. b.i.d. - vitamin b12 1000 mcg p.o. daily. - flomax 0.4 mg p.o. daily. - finasteride 5 mg p.o. daily. - metoprolol 25 mg p.o. daily. . medications on transfer: nexium 40mg iv bid vancomycin 1gm iv daily flomax 0.4mg po daily vitamin b12 1000 mcg po daily zofran prn maalox prn discharge medications: 1. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime). 2. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). 3. cyanocobalamin (vitamin b-12) 500 mcg tablet sig: two (2) tablet po daily (daily). 4. metoprolol succinate 25 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 5. vancomycin in d5w 1 gram/200 ml piggyback sig: one (1) gram intravenous q 24h (every 24 hours) for 8 days: take until . discharge disposition: extended care facility: northeast - discharge diagnosis: primary diagnosis: acute blood loss due to gi bleed urinary tract infection secondary diagnoses: chronic kidney disease benign prostatic hypertrophy osteoarthritis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to because you were anemic due to a bleed in your gi tract. you had a video capsule study which showed a small area that was bleeding in your small bowel, but the bleeding has stopped. your blood counts have remained stable, and we feel it is safe for you to leave the hospital with close monitoring of your blood counts. we have also arranged for you to follow up with a gastroenterologist. if you experience dark tarry stools or see blood in your stool, please contact your physician immediately or go to the ed. you were also treated for a urinary tract infection while you were here. we started you on iv antibiotics, and you should continue the antibiotic for a total of 2 weeks. we made the following changes to your medications: - start iv vancomycin 1g every 24 hours for urinary tract infection. you should continue this antibiotic until . we made no other changes to your medications. please continue taking your medications as prescribed by your outpatient providers. we have scheduled appointments for you to follow up in the clinic at . please see below for your appointment times. if you are unable to make an appointment, please call and reschedule. it has been a pleasure taking care of you at and we wish you a speedy recovery. followup instructions: name: , md address: , , phone: appt: at 2:15pm md procedure: other endoscopy of small intestine other diagnostic procedures on small intestine diagnoses: anemia of other chronic disease urinary tract infection, site not specified acute posthemorrhagic anemia acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation personal history of tobacco use other b-complex deficiencies hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) chronic kidney disease, stage iii (moderate) osteoarthrosis, unspecified whether generalized or localized, site unspecified iron deficiency anemia, unspecified hyperparathyroidism, unspecified streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site angiodysplasia of intestine with hemorrhage urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure diverticulosis of colon (without mention of hemorrhage) internal hemorrhoids without mention of complication infection and inflammatory reaction due to indwelling urinary catheter tricuspid valve disorders, specified as nonrheumatic alcohol abuse, in remission personal history, urinary (tract) infection psoriatic arthropathy 

Answer: The patient is high likely exposed to