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: nitroglycerin / plavix attending: chief complaint: syncope, melena major surgical or invasive procedure: esophagogastroduodenoscopy history of present illness: mr is an 84-y/o f with htn, cad (s/p stenting), gerd, pud and depression, who presents to the ed today after a syncopal episode and was found to have several large melanotic stools. . the pt reports she has noted some increase in her usual gerd sxs over the last few days, as well as some new, diffuse abd pain. the abd pain is described as , "achy" and "annoying" in nature, but non-radiating. earlier today the pt noted that both sxs were even worse than they had been. she was at her - having just moved from a nh earlier in the day - and was seated in a chair when she noted the sudden onset of lightheadness and felt like she was going to faint. the onset of sxs were not associated with any change in her activity (i.e., standing or stress); the pt does not think she lost consciousness and denies any resultant trauma. she denies any associated cp, palpitations, sob. the pt was taken to the ed for evaluation where she was noted to have a large melanotic stool; she reports she had never had anything similar in the past. the pt was treated with a ppi and hydralazine for an sbp in the 240s, and planned for admission to the floor, however she subsequently had two additional large bowel movements and thus is admitted to the micu for closer monitoring. . on ros, the pt denies the sxs described above. additional she has noted no fevers, change in vision or weight. she did note some chills earlier in the day today. no trouble swallowing. no diaphoresis or exertional dyspnea. no nausea or vomiting. no urinary sxs including frequency, urgency or dysuria. past medical history: - hypertension - coronary artery dz s/p bms to rca in - peptic ulcer disease - gastroesophageal reflux disease - tension headaches - depression social history: retired clerical worker. lifelong non-smoker. no etoh. lives now in an facility. daughter involved in care. family history: mother died in her 70s from pna. father died in 80s from unclear cause. physical exam: vs: t 98.4, bp 159/74, p 64, r 18, 94 ra gen: well-appearing elderly female, no acute distress. heent: perrl, eomi. mmm. conjunctiva well pigmented. neck: supple, without adenopathy or jvd. chest: bilateral crackles at the bases. cor: normal s1, s2. rrr. no murmurs appreciated. abdomen: soft, non-tender and non-distended. +bs, no hsm. extremity: warm, without edema. 2+ dp pulses bilat. neuro: alert and oriented x 3. cn 2-12 intact. motor strength intact in all extremities. sensation intact grossly. pertinent results: 06:50pm wbc-15.5* rbc-3.81* hgb-11.9* hct-35.7* mcv-94 mch-31.2 mchc-33.2 rdw-13.2 06:50pm neuts-89.9* lymphs-7.6* monos-2.0 eos-0.3 basos-0.1 03:00pm glucose-159* urea n-43* creat-1.9* sodium-138 potassium-4.9 chloride-105 total co2-21* anion gap-17 . egd: () blood in the stomach medium hiatal hernia non-bleeding erosions in the hiatal hernia erythema in the antrum otherwise normal egd to second part of the duodenum 06:55am blood wbc-9.2 rbc-3.34* hgb-10.4* hct-30.6* mcv-92 mch-31.1 mchc-33.9 rdw-13.2 plt ct-268 02:51am blood pt-13.0 ptt-25.3 inr(pt)-1.1 02:51am blood plt ct-195 06:55am blood plt ct-268 06:55am blood glucose-100 urean-27* creat-1.1 na-138 k-4.0 cl-103 hco3-27 angap-12 03:00pm blood ck(cpk)-76 01:35am blood ck(cpk)-43 08:00am blood ck(cpk)-56 07:29pm blood amylase-30 11:53pm blood ck(cpk)-65 06:55am blood ck(cpk)-62 03:00pm blood ck-mb-notdone 03:00pm blood ck-mb-notdone 03:00pm blood ctropnt-<0.01 01:35am blood ck-mb-notdone ctropnt-<0.01 08:00am blood ck-mb-notdone ctropnt-<0.01 11:53pm blood ck-mb-notdone ctropnt-<0.01 06:55am blood ck-mb-notdone ctropnt-<0.01 06:55am blood calcium-9.8 phos-2.6* mg-1.8 11:29am blood type- temp-36.1 fio2-21 po2-55* pco2-50* ph-7.30* caltco2-26 base xs--1 intubat-not intuba comment-room air . 9:45 am urine source: catheter. **final report ** urine culture (final ): escherichia coli. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s cefuroxime------------ 4 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s piperacillin---------- <=4 s piperacillin/tazo----- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s . tte: the left atrium is normal in size. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. left ventricular systolic function is hyperdynamic (ef>75%). there is a mild resting left ventricular outflow tract obstruction. there was no change in the left ventricular outflow tract gradient with valsalva maneuver. right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. impression: suboptimal image quality. normal biventricular systolic function. mild resting lvot gradient likely a result of the small left ventricular chamber size and hyperdynamic function. brief hospital course: 84 yo female presents with syncopal episode and multiple melanotic stools. egd w/ blood in stomach, but no active bleeding site. hct has been relatively stable as have vs. . #gib: the pt had an egd performed by the gi service which demonstrated blood in stomach, and non-bleeding erosions in the hiatal hernia, but no active bleeding site. unclear why pt had red blood in stool if source is from ugi tract, since pt does not seem to be bleeding large/brisk volumes. the pt's hct and vs remained stable and she did not require transfusion. the pt was treated first with iv ppi and then transitioned to po dosing. her home asa was held in the setting of the gib. restarting her asa regimen should be addressed in the future as an outpatient. in addition the need for further gib work up, including a colonoscopy would be discussed as an outpatient. . #syncope: multiple possible etiologies were considered including vasovagal, arrythmia, or hypoglycemia. the pt's history was not particularly suggestive for any of these. the syncopal episode was likely a combination of hypovolemic and vasovagal induced hypotension. the patient's pcp confirm that ms. is often liable, and she is orthostatic at baseline. an echo was obtained without major valvular findings to explain syncope. the echo did show a mild functional lv outflow obstruction and hyperdynamic ef which showed be followed up as an outpatient. . # cad s/p sent: pt complained of sharp substernal chest pain, reproducible, and worse with cough throughout the admission. this pain was low suspicion for acs and she was given cough suppressant for control of the pain. the family had concern that she often complains of this nature of chest pain and that this would repeatly bring her to the ed. the patient was told that the sharp chest pain, reproducible with cough and palpation of the chest is unlikely to be cardiac in nature and does not require emergent follow up. however ms. was encouraged to notify medical personal if she experiences chest pain of a different nature. during this hospitalization the pt also complained of substernal pressure in the setting of sbp of 210/95. given her cardiac history the patient was ruled out with cardiac enzymes x 3. there were no ekg changes as well. this pressure type pain did not reaccure but the pt was told to return to the ed if this pain reoccurred. . #arf: cr originally elevated to 1.9 on admission has returned to prior baseline with hydration. . #htn: the patient's bp was liable throughout the admission rapidly changing from sbp > 200 to orthostatic hypotension walking with pt. the spikes in bp were not accompanied by palpatations, diaphoresis or other sympathetic symptoms making a pheo unlikely. the orthostatic hypotension noted by pt with ambulation was improved with ivf. the pt's pcp confirmed that this bp pattern is not new for the patient and he prefered to keep the patient on her home regimen instead of a more aggressive regimen adopted in the hospital to prevent orthostatic hypotension and further syncope. further monitoring of the patient's bp and adjustments to medications may be warranted as an outpatient. . # asymptomatic bactiuria: pt had leukocytosis on admission which has resolved. suspected possible uti but ucult shows ecoli only 10,000-100,000 organisms /ml. the pt remained afebrile, hemodynamically stable, asymptomatic of urinary complaints. therefore there was no reason to treat. . #depression/psych: home medication regimen was continued. . #hypothyroid: home levothyroxine was continued. . #) fen: - regular/cardiac diet . #) ppx: ppi, pneumoboots, held heparin sq in setting of gib. . # code: full . #) disp: medications on admission: asa 81 mg daily zetia 10 mg daily synthroid 25 mcg daily seroquel 12.5 mg at bedtime and q8 hrs prn effexor xr 150 mg daily klonopin 0.25 mg vit b12 500 mcg daily atenlol 50 mg daily protonix 40 mg daily fersol 325 mg colace 100 mg apap prn discharge medications: 1. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 2. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 3. cyanocobalamin 500 mcg tablet sig: one (1) tablet po daily (daily). 4. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 5. seroquel 25 mg tablet sig: .5 tablet po at bedtime. 6. seroquel 25 mg tablet sig: .5 tablet po every eight (8) hours as needed for aggitation. 7. venlafaxine 75 mg capsule, sust. release 24 hr sig: two (2) capsule, sust. release 24 hr po daily (daily). 8. clonazepam 0.5 mg tablet sig: .5 tablet po bid (2 times a day) as needed. 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 11. mucinex 600 mg tablet sustained release sig: tablet sustained releases po twice a day as needed for cough. disp:*120 tablet sustained release(s)* refills:*0* 12. nystatin 100,000 unit/g cream sig: one (1) appl topical (2 times a day) for 2 weeks: apply to groin for fungal infection. disp:*qs one tube* refills:*0* 13. atenolol 50 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: vna discharge diagnosis: esophogeal erosions hiatal hernia hypovolemia /vasovagal syncope colon diverticulosis acute renal failure now resolved hypertension . secondary diagnosis: coronary artery disease gerd depression discharge condition: good discharge instructions: you were admitted to the hospital with syncope (passing out). you were found to have blood in your stool, for which we evaluated you with endoscopy. this showed small erosions in your esophogus which was likely the source of the bleeding. the bleeding stoped and your blood counts have remained stable. the gi doctors suggest that have a work up and possible colonoscopy as an outpt, you should discuss this with dr. . your passing out was do to your low blood volume and your low blood pressure with standing. your dizziness improved with fluids. . your blood pressure was very liable during this admission. it got very high at times, but it also droped low when you were standing. your pcp told as that this pattern is not new for you. the low blood pressure got better with fluids and you were able to walk around without symptoms. . your chest pain was evaluated and is not from your heart, you did not have a heart attack. it is likely musculoskeletal and make worse with your cough. . we made the following changes to your medication regimen: your aspirin was stopped. you were given nystatin cream to use on your groin for a rash - you can use this for 2 weeks. you were give mucinex for a cough. take this pills two times per day as needed. . please follow up with dr as detailed below. ( at 1:15pm) if you have another episode of passing out, increased chest pain, sob, dizziness, blood in your stool, or other symptoms worrisome to you call your doctor or go to the emergency room. followup instructions: you have an appointment with your pcp: : at 1:15am. at that time you should discuss whether to add aspirin back to your medication regimen, it is being held because of your bleeding in your gut. in addition you should discuss the need for further work up of your intestinal bleeding, including colonoscopy with dr. . procedure: other endoscopy of small intestine diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified unspecified acquired hypothyroidism depressive disorder, not elsewhere classified percutaneous transluminal coronary angioplasty status diaphragmatic hernia without mention of obstruction or gangrene hypotension, unspecified blood in stool old myocardial infarction hypovolemia syncope and collapse diverticulosis of colon (without mention of hemorrhage) other specified disorders of esophagus peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction tension headache 

Answer: The patient is high likely exposed to