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: patient recorded as having no known allergies to drugs attending: chief complaint: hematuria major surgical or invasive procedure: cystoscopy history of present illness: the patient is an 83y/o gentleman with a past medical history of aortic stenosis s/p bioprosthetic avr, paf on coumadin s/p turp approximately 3 weeks ago presenting with hematuria. the patient reports that 1 week prior to presentation he passed 2 large blood clots with urination with small amount of bleeding. he had no further episodes of gross hematuria until this am. this am he reported an inability to urinate since 3am with gross blood and clots. the patient presented to ed where he underwent foley placement with continuous bladder irrigation for several hours and reported heamturia cleared. inr 1.6. he was sent home on bactrim and foley in place with urology follow up schedule for . . the patient represented to ed with recurrent hematuria from foley, continued pain and decreased urine output. on arrival to ed, initial vitals: t 97.7 hr 83 bp 145/62 98% on ra. he was found to have a hct of 23.2. t&s sent. he was given ceftriaxone 1gm iv, morphine 4mg ivx2, diluadid 1mg iv. urology was consulted and the a rouche catheter was placed with subsequent successful irrigation. inr found to be 3.1 and cr 1.8. 2u prbc ordered. . on arrival to the medical floor, the patient reports pain at foley catheter site. denies cp/sob. foley in place irrigative dark pink urine. past medical history: aortic stenosis s/p aortic valve replacement with - tissue heart valve cad s/p pci to rpda rheumatic fever paroxysmal atrial fibrillation hypertension hyperlipidemia tia 10-12 years ago benign prostatic hypertrophy subdural hematoma in status post cataract removal status post evacuation of a subdural hematoma social history: he lives with his wife and daughter in . he quit smoking 25 years ago and had a 25 pack year smoking history. he drinks one drink per day. family history: non-contributory physical exam: vitals: t 96.4, hr 88, bp 114/55, rr 20, o2 99% 3l nc gen: pleasant, nad cv: rrr, nl s1/s2, no mrg resp: ctab, no wrr abd: soft, nt/nd, nabs ext: no edema gu: rouche foley in place draining dark pink urine, clots present in bag pertinent results: 11:52pm ck(cpk)-74 11:52pm ck-mb-notdone ctropnt-0.02* 11:52pm digoxin-1.5 11:52pm pt-19.3* ptt-23.0 inr(pt)-1.8* 09:05pm hct-23.3* 03:10pm glucose-151* urea n-42* creat-2.2* sodium-138 potassium-5.0 chloride-107 total co2-23 anion gap-13 03:10pm calcium-8.1* phosphate-3.5 magnesium-2.4 03:10pm wbc-8.9 rbc-2.88* hgb-7.6* hct-23.6* mcv-82 mch-26.6* mchc-32.4 rdw-15.5 03:10pm plt count-203 03:10pm pt-21.6* ptt-25.3 inr(pt)-2.0* 12:27am glucose-139* urea n-39* creat-1.8* sodium-140 potassium-4.6 chloride-109* total co2-21* anion gap-15 12:27am estgfr-using this 12:27am wbc-8.1 rbc-2.86* hgb-7.6*# hct-23.2* mcv-81*# mch-26.4*# mchc-32.6 rdw-15.4 12:27am neuts-75.3* bands-0 lymphs-16.5* monos-7.1 eos-0.8 basos-0.3 12:27am hypochrom-2+ anisocyt-1+ poikilocy-occasional macrocyt-normal microcyt-1+ polychrom-occasional ovalocyt-occasional 12:27am plt smr-normal plt count-217 12:27am pt-31.4* ptt-150* inr(pt)-3.1* 08:16am pt-17.9* ptt-24.9 inr(pt)-1.6* 08:16am urine color-red appear-cloudy sp -1.020 08:16am urine blood-lg nitrite-pos protein->300 glucose-100 ketone-15 bilirubin-lg urobilngn-2* ph-8.5* leuk-lg 08:16am urine rbc->50 wbc-0 bacteria-occ yeast-none epi-0 hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 03:20pm 6.3 3.33* 9.8* 29.2* 88 29.5 33.7 16.9* 145* source: line-picc 04:52am 6.0 3.24* 9.5* 27.8* 86 29.4 34.2 16.3* 128* 3 04:18am 7.1 3.15* 9.0* 26.3* 83 28.4 34.1 16.8* 144* source: line-picc 08:16pm 27.8* source: line-picc 01:38pm 27.5* source: line-picc 04:04am 8.7 2.92* 8.3* 23.9* 82 28.4 34.7 16.1* 131* added retic ct 10:59am 09:15pm 23.8* 02:00pm 10.0 2.81* 7.8* 22.8* 81* 27.8 34.2 16.1* 164 09:05pm 23.3* 03:10pm 8.9 2.88* 7.6* 23.6* 82 26.6* 32.4 15.5 203 12:27am 8.1 2.86* 7.6*# 23.2*1 81*# 26.4*# 32.6 15.4 217 notified rn ew @ 1251am readback compelte verified by replicate analysis differential neuts bands lymphs monos eos baso atyps metas 12:27am 75.3* 0 16.5* 7.1 0.8 0.3 red cell morphology hypochr anisocy poiklo macrocy microcy polychr ovalocy 12:27am 2+ 1+ occasional normal 1+ occasional occasional basic coagulation (pt, ptt, plt, inr) pt ptt plt smr plt ct inr(pt) 03:20pm 145* source: line-picc basic coagulation (fibrinogen, dd, tt, reptilase, bt) fibrino 04:04am 182 fib added 10:58am hemolytic workup ret aut 04:04am 2.3 added retic ct 10:59am lab use only 03:20pm source: line-picc chemistry renal & glucose glucose urean creat na k cl hco3 angap 03:20pm 821 17 1.3* 139 4.5 109* 24 11 source: line-picc 04:52am 821 17 1.3* 139 4.3 109* 24 10 3 04:18am 851 24* 1.4* 139 4.3 110* 25 8 source: line-picc 04:04am 881 34* 1.8* 139 4.5 109* 25 10 03:10pm 151*1 42* 2.2* 138 5.0 107 23 13 12:27am 139*1 39* 1.8* 140 4.6 109* 21* 15 if fasting, 70-100 normal, >125 provisional diabetes estimated gfr (mdrd calculation) estgfr 12:27am using this1 using this patient's age, gender, and serum creatinine value of 1.8, estimated gfr = 36 if non african-american (ml/min/1.73 m2) estimated gfr = 44 if african-american (ml/min/1.73 m2) for comparison, mean gfr for age group 70+ is 75 (ml/min/1.73 m2) gfr<60 = chronic kidney disease, gfr<15 = kidney failure enzymes & bilirubin alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili 02:20pm 1151 source: line-picc new reference interval as of ;upper limit (97.5th %ile) varies with ancestry and gender (male/female);whites 322/201 blacks 801/414 asians 641/313 cpk isoenzymes ck-mb ctropnt 04:52am 3 0.06*1 3 02:20pm 6 0.04*1 source: line-picc 11:52pm notdone2 0.02*1 added dig at 0056 04 06 10 ctropnt > 0.10 ng/ml suggests acute mi notdone ck-mb not performed, total ck < 100 chemistry totprot albumin globuln calcium phos mg uricacd iron 04:52am 2.8* 7.8* 2.6* 2.3 3 04:18am 7.5* 2.7 2.5 source: line-picc 04:04am 7.8* 2.8 2.4 03:10pm 8.1* 3.5 2.4 cardiac/pulmonary digoxin 11:52pm 1.5 added dig at 0056 04 06 10 lab use only ltgrnhd greenhd edta ho redhold 12:27am hold 12:27am hold1 hold discard greater than 4 hours old blood gas blood gases type temp rates tidal v peep fio2 o2 flow po2 pco2 ph caltco2 base xs 01:54pm 7.39 whole blood, miscellaneous chemistry glucose lactate na k cl 03:23am 158* 1.6 136 5.1 105 hemogloblin fractions ( cooximetry) hgb calchct 03:23am 6.3* 19 calcium freeca 01:54pm 1.11* . . general urine information type color appear sp 08:16am red1 cloudy 1.020 abn color affect dipstick dipstick urinalysis blood nitrite protein glucose ketone bilirub urobiln ph leuks 08:16am lg pos >300 100 15 lg 2* 8.5* lg microscopic urine examination rbc wbc bacteri yeast epi transe renalep 08:16am >50 0 occ none 0 miscellaneous urine eos 03:28am negative 1 source: catheter negative no eos seen 08:16am chemistry urine chemistry hours urean creat na 03:28am random none detec1 none detec2 154 source: catheter none detected verified by recovery suspect invalid sample none detected verified by recovery highly unlikely that this is really urine other urine chemistry osmolal 03:28am 282 . . microbiology: 8:16 am urine site: catheter **final report ** urine culture (final ): no growth. . . radiographic studies: renal ultrasound () indication: patient is an 83-year-old male with recent turp for benign prostatic hypertrophy now admitted with hematuria and obstruction secondary to hematoma within the bladder. evaluate for hydronephrosis. examination: renal ultrasound. comparisons: comparison is made to remote ultrasound from . findings: the right kidney measures 11.4 cm. left kidney measures 11.5 cm. there is no evidence of hydronephrosis or nephrolithiasis. . re-demonstrated are multiple cysts. the largest in the right kidney measures 9.7 x 8.6 and is well circumscribed and completely anechoic with features compatible with a simple cyst. no internal vascularity is demonstrated. in addition, smaller cysts are noted on the right including a 2.8 x 2.7 cm simple cyst seen arising from the right upper pole, and a 2.9 x 2.3 cm cyst arising from the right lower pole. in addition, multiple simple cysts are noted on the left with the largest being within the right lower pole measuring 4.6 x 4.1 cm. . pre-void images of the bladder are provided. there is extensive amount of heterogeneous echogenicity demonstrated within the bladder most compatible with known history of blood clot. a foley catheter is noted within the bladder. there is prostatic hypertrophy with the prostate measuring up to 6.8 x 6.2 x 5.5 cm for a calculated prostatic volume of 121 cc. impression: 1) multiple simple cysts seen within both kidneys, otherwise unremarkable appearance of the kidneys with no evidence of hydronephrosis. 2) extensive heterogeneity seen within the bladder compatible with known history of blood clot within the bladder. 3) prostatic hypertrophy measuring up to 121 cc. cxr () history: aortic stenosis, to evaluate for pulmonary edema. findings: in comparison with study of , the degree of enlargement of the cardiac silhouette is less. no definite pleural effusions or vascular congestion at this time. no acute focal pneumonia. obliquity of the patient somewhat obscures detail of this patient who has intact midline sternal wires. transthoracic echocardiogram () the left atrium is mildly dilated. the right atrium is moderately dilated. there is moderate symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. a bioprosthetic aortic valve prosthesis is present. the aortic valve prosthesis appears well seated, with normal leaflet motion and transvalvular gradients. no aortic regurgitation is seen. the mitral valve leaflets are moderately thickened. there is moderate valvular mitral stenosis (area 1.5cm2). no mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. . impression: well seated, normally functioning bioprosthetic aortic valve. moderate mitral stenosis. moderate pulmonary artery systolic hypertension. symmetric left ventricular hypertrophy with preserved regional and global biventricular systolic function. . clinical implications: the patient has moderate mitral stenosis. based on acc/aha valvular heart disease guidelines, a follow-up echocardiogram is suggested in years. based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. brief hospital course: 83m h/o afib, on coumadin, s/p recent turp, admitted with hematuria, hypotension. . # hypotension - admitted to floor initially, but transferred to icu for hypotension, most consistent with acute blood loss aneima. ecg unremarkable. troponin weakly positive (0.02->0.06), felt likely demand. his inr was reversed with 2u ffp. sbps resolved with ivfs and ultimately required 11u prbcs as detailed below. he was empirically treated with ciprofloxacin despite negative blood and urine cultures at urology request. . # hematuria - s/p turp 3 weeks prior to admission, with significant bleeding requiring icu stay, no pressors, but 11u prbc transfusion as below. pt initially had rouche catheter and 3 way cbi. it was unclear why bleeding was occuring 3 weeks after procedure, though this was also in the setting of inr of 3.1. the patient was maintained on cbi (initially at 3l/hr) and would occasionally occlude the catheter with clot. this usually could be resolved with simple irrigation, but did require his foley catheter to be changed out twice. when his foley would occlude, his bladder would become distended with irrigant fluid and would cause the patient significant discomfort. . the patient was evaluated by the urology service, who reported significant clot still in bladder. the irrigation was slowly lowered to 1500ml/hr, though intermittent clot continued to be noted in the foley. urology took the patient to the or for cystoscopy on , and evacuated clot and cauterized the bleeding, friable prostate. cbi was contiued post-op for 1d. the patient received one dose of iv vancomycin prior to the procedure for sbe prophylaxis. on pod#2, cbi was discontinued by urology, and the 3rd port of his foley was clamped. he was discharged home with instructions to maintain this foley in place and continue ciprofloxacin empirically until he followed-up with dr. in clinic within 7 days of his discharge. pt agreed to be followed by home vna to assist with foley care. . # acute blood loss anemia - during his intensive care unit stay, the patient required 11 units of prbcs to be transfused, last transfusion on . his coumadin and aspirin were held, he received ffp as above. . initially, hematocrit stable around 23 despite transfusion, but bumped appropriately to 27 and remained stable at that level prior to transfer to the medical floor. upon arrival to the medical floor, hct remained stable for 72 hours, and was 29 on , prior to discharge on . . # paroxysmal atrial fibrillation - pt was continued on amiodarone, digoxin. metoprolol was initially held in setting of bleeding, but resumed at reduced dosage (12.5mg po qdaily), given relative hypotension. the patient was noted to be in nsr throughout his stay in the micu. . after extensive discussion regarding the risks/benefits of resuming anticoagulation with the patient and his daughter, , pt was discharged home off of coumadin, and aspirin, and instructed to resume these on when he follows up with dr. . he was instructed to scheduled a follow-up appointment with his primary care physician, ( , md ), no later than to discuss resuming coumadin/aspirin. he will also follow-up with his cardiologist, dr. , as per his previousy scheduled appointment. . # acute kidney injury - creatinine increased to 2.2 on admission, felt most likely hypovolemia vs. obstruction. renal ultrasound was performed and did not show obstruction but did show blood in the bladder. his outside hospital records were obtained that showed a baseline creatinine of 1.8. his home regimen of lasix was held. after discussion with his daughter, he had been on an ace inhibitor as recently as , this was not restarted. his creatinine trended down to a nadir of 1.4 at the time of transfer from the micu, and was 1.3 on discharge. . he was instructed to follow-up with his pcp no later than to have bun/cre checked and discuss resuming his usual regimen of lasix if his cre remained stable. . # cad s/p pci - initially, aspirin and metoprolol were held given acute bleeding. he was ultimately restarted on lower dosage metoprolol (decreased to 12.5mg ), and zocor, after being seen by dr. , the patient's cardiologist. . # chronic diastolic congestive heart failure - pt denied h/o chf, but was on lasix at admission. he underwent tte which revealed preserved ef (60%), e/a,<1, consistent with diastolic chf. tte otherwise revealed well seated, normally functioning bioprosthetic aortic valve. moderate mitral stenosis. moderate pulmonary artery systolic hypertension. symmetric lvh. he was clinically euvolemic on discharge, and given resolving arf, was discharged off of his usual regimen of lasix, with instructions to maintain low salt diet, weigh himself daily, call his pcp should his weight increase >2lb/day to discuss restarting his lasix. otherwise, he will f/u with his pcp no later than and discuss resume his lasix, as well as ace-inhibitor, which was discontinued in for unclear reasons, per daughter. . # hyperlipidemia - continued on statin. . # hypertension, benign - as above, pt was discharged on reduced dosage of metoprolol 12.5 mg po bid as per his cardiologist. . # h/o tia, cva ', h/o sdh ' - pt does not recall, per daughter, in , vision difficulty, unclear if embolic, seen at baptise. aspirin and coumadin were held as above. . # bph - pt admitted on tamsulosin, which was continued. per urology, he was started on finesteride, and oxybutinin. he will follow-up with urology as above. . # access - a rue picc was placed in icu, and removed prior to discharge. # code - pt was dnr/dni. # comm - daughter, , . medications on admission: cordarone 200 mg tab oral 1 tablet(s) once daily coumadin 5 mg tab oral 1 tablet(s) once daily ecotrin -- 81 qday flomax 0.4 mg 24 hr cap oral daily lanoxin 125 mcg tab oral 1 tablet(s) once daily lasix 40 mg tab oral 1 tablet(s) daily metoprolol tartrate 25 mg tab oral 1 tablet(s) twice daily magnesium oxide 400 mg tab oral 1 tablet(s) once daily prilosec otc 20 mg tab oral 2 tablet, delayed release daily omeprazole 40 mg cap, delayed release daily rhinocort aqua 32 mcg/actuation nasal spray nasal 1 spray,prn zocor 40 mg tab oral 1 tablet(s) once daily discharge medications: 1. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 2. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 3. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 4. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 5. magnesium oxide 400 mg tablet sig: one (1) tablet po once a day. 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 7. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 8. oxybutynin chloride 5 mg tablet sig: one (1) tablet po tid (3 times a day) for 7 days. disp:*21 tablet(s)* refills:*0* 9. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 7 days. disp:*14 tablet(s)* refills:*0* 10. finasteride 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 11. outpatient lab work please have lab work drawn on your visit with your primary care doctor, no later than , including bun/creatinine, and cbc. please have the results reviewed by your primary care physician. call dr. , to arrange this. discharge disposition: home with service facility: discharge diagnosis: primary: hematuria bph acute blood loss anemia acute renal failure secondary: paroxysmal atrial fibrillation s/p prosthetic avr cad s/p pci diastolic chf htn h/o cva, sdh. discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital with hematuria, felt due to coumadin and your recent prostate procedure. you received 11 units of blood, and underewnt cystoscopy, at which time friable bleeding tissue was addressed by urology. . you are being dishcarged home, off of coumadin, aspirin, and lasix, with a foley catheter in place. . you will need to follow-up with urology within 7 days of discharge, you will need to call dr. , in the clinic upon arriving home to schedule this appointment. . you will also need to follow-up with your primary care physician 7 days of your discharge to discuss restarting your lasix, discuss why you are not on an ace inhibitor, and and follow-up your blood count and renal function. . the following changes were made to your medication regimen: 1. your lasix was discontinued. you should weigh yourself daily, and call your primary care physician if your weight increases by >2 lb /day, to discuss restarting this. 2. your coumadin is being held. you should restart this medication no later than or when you see dr. . 3. your aspirin is being held. you should restart this medication no later than or when you see dr. . 4. your metoprolol dose was decreased to 12.5mg once daily. 5. you were started on finasteride. 6. you were started on a short course of antibiotics, ciprofloxacin for 7 days, or until you see dr. . 7. you were started on a short course of oxybutinin for bladder spasm. followup instructions: upon arriving home, you will need to follow-up with urology within 7 days of discharge, you will need to call dr. , in the clinic at ( upon arriving home to schedule this appointment. you should be seen no later than . . upon arriving home, you will also need to follow-up with your primary care physician , , within 7 days of your discharge to discuss restarting your lasix, discuss why you are not on an ace inhibitor, and and follow-up your blood count and renal function. please call him to schedule this appointment. , md . please follow-up with dr. at your previously scheduled appointment. you can discuss with him restarting your lasix also. procedure: venous catheterization, not elsewhere classified transurethral clearance of bladder control of (postoperative) hemorrhage of prostate diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified atrial fibrillation other chronic pulmonary heart diseases hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia hemorrhage complicating a procedure other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation long-term (current) use of anticoagulants gross hematuria heart valve replaced by transplant chronic diastolic heart failure benign essential hypertension 

Answer: The patient is high likely exposed to