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: penicillins attending: chief complaint: upper gi bleed major surgical or invasive procedure: exploratory laparotomy, pyloromyotomy, oversewing gastric ulcer and ligation of the gastroduodenal artery. history of present illness: mr. is a 79m with a recent history of pancreatitis transferred from osh for management of ugi bleed. patient presented to osh on from nursing home with melena and hct of 24. patient was started on protonix gtt and transfused 3u prbcs. upper endoscopy was attempted at that time, however the patient did not tolerate the procedure and it was aborted. repeat endoscopy showed a large duodenal ulcer with exposed vessel. clipping was attempted however unsuccessful and associated with increased bleeding. ir embolization was attempted at that time but aborted due to poor access via calcified femoral vessels. patient continued to have melenic stool with downtrending hct and transfusion requirement. ct was performed and by verbal reportshowed active bleeding from the gda, necrosis of the head of the pancreas, and a previously identified psoas fluid collection that was decreased in size. patient underwent successful ir coiling of the gda via left axillary access on . since coiling, he has had persistent melena and required an additional 2u prbc today. since , he has received a total of 8u prbcs. he has been hemodynamically stable and not required pressors. of note, patient was admitted to osh in janurary for pneumonia, pancreatitis, and possible cdiff. stool cultures during this admission again showed positive cdiff for which he is receiving po vanco. patient currently denies abdominal pain, nausea, and malaise. past medical history: left inguinal melanoma s/p ifn-a, type ii diabetes, copd infection history: cdiff colitis, recurrent lle cellulitis + bacteremia from mssa, urinary tract infection, +mrsa and +vre by swab psh: left groin dissection , open cholecystectomy, amputation of left 2nd toe for melanoma social history: the patient is married and lives with his wife in , ma. he has 2 children, one daughter is a case manager at . he was a heavy tobacco smoker for 45+ years at 3 packs per day and quit in . he denies any alcohol use. he is a former construction superintendent. daughter is the health care proxy. family history: father and uncle with lung cancer. brother and father died of pancreatic cancer. physical exam: vs: 98.1, 74, 122/53, 20, 95% 2l gen: appears comfortable, a&ox3 cv: rrr resp: ctab, decreased breath sounds at bases abd: soft, nontender, nondistended, well healed right subcostal incision with reducible hernia, umbilical hernia reducible, 2 former drain sites with tegederm dressings c/d/i ext: warm, no edema, well healed left groin incision, well healed left 2nd toe amputation site, doppler dp b/l pertinent results: on admission: wbc-12.5* rbc-2.96* hgb-9.1* hct-25.6* mcv-87 mch-30.7 mchc-35.5* rdw-15.6* plt ct-118* pt-14.3* ptt-27.3 inr(pt)-1.3* glucose-159* urean-46* creat-1.0 na-145 k-4.3 cl-118* hco3-23 angap-8 alt-12 ast-14 alkphos-48 totbili-0.7 lipase-68* calcium-7.3* phos-3.7 mg-2.0 brief hospital course: mr. is a 79 y/o male who was admitted with upper gi bleed. he requires multiple transfusions of prbc. egd was performed noting large hiatal hernia,blood in the whole stomach, 3cm ulcer in the duodenal bulb (endoclip). he was started on a ppi drip and was take to the or by dr. who performed exploratory laparotomy, pyloromyotomy,oversewing gastric ulcer and ligation of the gastroduodenal artery.two jps were placed. postop, he was sent to the sicu for management. he remained there for 5 days. he was extubated on . hct remained stable. he passed some melanotic stools (expected). he continued on vanco pr for h/o recent c.diff. on , a feeding tube was placed and tube feeds were started. on , he transferred out to the med- ( 10). he require aggressive respiratory management with aggressive incentive spirometry, nebs, chest pt. on , he was somnolent and o2 sats were in the 88%range. he was pan-cultured and cxr done. cxr demonstrated bilateral pleural effusions and atelectasis. ua was positive. he was started on ciprofloxacin. urine culture isolated enterobacter aerogenes sensitive to cipro. a 5 day course was ordered for cipro. respiratory status improved. foley was removed and a condom cath was applied. pt worked with him and recommended rehab. he required lift to get oob to chair. on , feeding tube was inadvertently pulled out. a video swallow was then done by speech therapy which he failed. the following was noted: moderate-severe oropharyngeal dysphagia as described above including aspiration of thin and nectar thick liquids and pharyngeal residue of solids as well as evidence of his known esophageal dysmotility. safest recommendation remains npo with continued non-oral nutrition,hydration, and medication during his acute admission. of note, he was coughing up (with chest pt/vibration)green phlegm. repeat cxr was negative for pneumonia. o2 nc @2l was continued with sats in 92-94% range. on , feeding tube was replace, however, this clogged during the night. several attempts were replaced, but were unsuccessful due to patient being unable to tolerate. the decision was made to start tpn and re-assess next week. he remained npo. pr vanco for h/o c.diff finished on . last bm was on . abdominal jp drains were removed on and . right sided abd drain site appeared red due to drain irritation. abdominal incision appeared pink at staple insertion sites on right side where he also had some swelling and pain to touch. swelling was felt to be due to a seroma that was required no intervention at this time. he will f/u with dr. on . the plan is to transfer to rehab in . po meds were held. atenolol was switched to iv lopressor and iv cipro was continue for a total of 10 days (stop date ) for uti and respiratory status. last non-bloody bm was . medications on admission: omeprazole 20', glipizide 10'', pioglitazone 30', mvi', simvastatin 80 qhs, colace 100' qam, 200 , 81', oxybutynin chloride 5'', vit c 500'', vit b12 1000', folic acid 1', tylenol qid prn, feso4 325'', atenolol 50 qhs, tamsulosin 0.4', lisinopril 2.5', reglan 10''', ibuprofen 200' prn current hospital meds: vanco 250mg po qid, riss, ipratropium nebs, albuterol nebs, b12, morphine prn discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for wheeze/sob. 2. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 3. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 4. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. 5. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily): hold until passes swallow eval. 6. ciprofloxacin in d5w 400 mg/200 ml piggyback sig: four hundred (400) mg intravenous q12h (every 12 hours) for 11 doses. 7. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 8. heparin flush (10 units/ml) 1 ml iv prn line flush temporary central access-floor: flush with 10 ml normal saline followed by heparin as above daily and prn. 9. picc line care per protocol 10. tpn via central line daily. start day 1 bag on 11. folic acid 1 mg tablet sig: one (1) tablet po daily (daily): hold until passes swallow eval. 12. tamsulosin 0.4 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po hs (at bedtime): hold until passes swallow eval. 13. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 14. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily): hold until able to swallow. 15. oxybutynin chloride 5 mg tablet sig: one (1) tablet po bid (2 times a day): hold until passes swallow eval. 16. lopressor 5 mg/5 ml solution sig: five (5) mg intravenous every six (6) hours: hold for sbp <110 or hr 60. 17. hold po meds until repeat speech and swallow evaluation 18. nph insulin human recomb 100 unit/ml suspension sig: four (4) units subcutaneous twice a day: please monitor for need to adjust as patient off tf and starting tpn . 19. insulin regular human 100 unit/ml solution sig: follow sliding scale injection four times a day. 20. tylenol sig: six y (650) mg rectal every eight (8) hours as needed for pain. 21. pantoprazole 40 mg recon soln sig: one (1) dose intravenous twice a day. 22. ua, urine culture after cipro course completed discharge disposition: extended care facility: - discharge diagnosis: upper gi bleed duodenal ulcer c. diff colitis urinary tract infection s/p exploratory laparotomy, pyloromyotomy, oversewing gastric ulcer and ligation of the gastroduodenal artery. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , you were admitted to the surgery service for a procedure to fix your gastrointestinal bleeding. you have improved since surgery and at this time we think you should go to rehab to continue your recovery. please call dr. office if you have any of the following: temperature of 101, shaking chills, nausea, vomiting, increased abdominal pain, wound edges appear red, blood in your stool, dark/black stools or any other concerns. please refer to the attached medication reconciliation to see your most recent list of medications. thank you for letting us participate in your care. we wish you a speedy recovery. followup instructions: provider: , md phone: date/time: 3:00. procedure: parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances endoscopic control of gastric or duodenal bleeding other surgical occlusion of vessels, abdominal arteries suture of duodenal ulcer site incisional hernia repair pyloromyotomy diagnoses: unspecified pleural effusion urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified incisional hernia without mention of obstruction or gangrene intestinal infection due to clostridium difficile other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation seroma complicating a procedure chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction hyperosmolality and/or hypernatremia personal history of malignant melanoma of skin other toe(s) amputation status other specified diseases of pancreas other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms 

Answer: The patient is high likely exposed to