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: brbpr major surgical or invasive procedure: ir mesenteric angiography colonoscopy egd history of present illness: 78f with aflutter on coumadin, diverticulosis, s/p trach with episodes of hypercarbic respiratory failure; dm, breast ca, osa, pulmonary hypertension; sent from rehab with brbpr. episode of brbpr with clots with stable vital signs at 7pm evening of admission. also noted to have some increase in o2 requirement from 35% to 50% tm. . in the ed, initial vitals 97.8, 110/66, hr 48, r18, 98% 8l tm. sbps then dropped to 70s, came up with minimal (unclear how much) fluids. hct 24 (from 30 on ). started on 2 prbcs, 2 units ffp, 10 mg iv vit k. also complaining of abdominal pain. gi consulted. ngl negative. seeming fairly stable until opened up again with passage of large amount of brbpr; getting 2 more units prbcs and got profilnine. sbps tolerating blood loss (in 100s-110s); hr around 100. has gotten a lot of volume (4 prbcs, 2 ffp, 4l ns), has not needed vent thus far but may need this evening. considered ct for eval of ischemic colitis, but not done anticipation of contrast for angio procedure. also noted to have troponin bump to 0.13; cardiology contact and will consult on patient when/if needed. surgery and ir also consulted for management of large lgib, presumably diverticulosis related. go to ir tonight. also recieved zosyn for +ua. past medical history: past medical history: - hypertension - diabetes mellitus - breast cancer ddx: infiltrating ductal carcinoma - sleep apnea - s/p tracheostomy . hx acute and chronic resp failure in 's. - osteoarthritis right knee - multiple falls - systolic dysfunction global lv hypokinesis echo: lvef 50-55% - atrial flutter - atrial septal defect - mitral regurgitation - cor pulmonale 's - s/p stroke - obesity - spinal stenosis - lower gastrointestinal bleed - : neg colonoscopy - acute respiratory failure social history: normally lives at home, but has been at rehab since last hospitalization. denies alcohol, drug or current tobacco use. per her sister, she is a former smoker, but unclear what her pack year smoking history is. family history: dm physical exam: physical examination general appearance: well nourished, no acute distress, overweight eyes / conjunctiva: perrl head, ears, nose, throat: normocephalic, trach cardiovascular: normal s1/s2 respiratory / chest: clear anteriorly abdominal: soft, bowel sounds present, non-distended, diffuse mild ttp, obese extremities: 1+ pitting bilat edema neurologic: somewhat responsive, follows simple commands. pertinent results: labs: 04:28am blood wbc-8.6 rbc-2.82* hgb-8.6* hct-25.8* mcv-92 mch-30.4 mchc-33.3 rdw-17.5* plt ct-153 09:36pm blood hct-26.1* 02:14pm blood hct-25.5* 04:02am blood wbc-10.0 rbc-3.05* hgb-9.3* hct-26.8* mcv-88 mch-30.4 mchc-34.6 rdw-18.6* plt ct-180 09:02pm blood hct-27.5* 03:26pm blood hct-27.9* 08:51am blood hct-28.1* 03:10am blood wbc-10.8 rbc-2.94* hgb-8.9* hct-26.4* mcv-90 mch-30.3 mchc-33.7 rdw-17.9* plt ct-166 10:00pm blood hct-27.4* 05:13pm blood hct-28.2* 08:20pm blood wbc-6.9 rbc-2.51* hgb-7.7* hct-24.3* mcv-97 mch-30.5 mchc-31.5 rdw-17.2* plt ct-295# 07:03am blood wbc-13.7*# rbc-3.48*# hgb-10.6*# hct-30.6*# mcv-88# mch-30.4 mchc-34.5 rdw-18.2* plt ct-200 04:28am blood pt-13.3 ptt-30.5 inr(pt)-1.1 03:10am blood pt-13.7* ptt-32.5 inr(pt)-1.2* 10:00pm blood pt-14.0* ptt-33.6 inr(pt)-1.2* 05:13pm blood pt-13.8* ptt-33.3 inr(pt)-1.2* 04:28am blood glucose-82 urean-25* creat-1.3* na-144 k-3.7 cl-110* hco3-26 angap-12 04:02am blood glucose-106* urean-30* creat-1.5* na-145 k-4.0 cl-109* hco3-26 angap-14 03:10am blood glucose-127* urean-30* creat-1.2* na-146* k-3.2* cl-113* hco3-26 angap-10 10:00pm blood glucose-118* urean-31* creat-1.2* na-146* k-3.0* cl-111* hco3-27 angap-11 07:03am blood glucose-142* urean-30* creat-1.1 na-144 k-3.6 cl-112* hco3-25 angap-11 07:03am blood ck(cpk)-106 08:20pm blood alt-22 ast-26 ck(cpk)-85 alkphos-64 totbili-0.4 07:03am blood ck-mb-5 ctropnt-0.08* 08:20pm blood ck-mb-notdone ctropnt-0.13* 04:02am blood cortsol-14.0 04:02am blood tsh-0.30 imaging: cxr: impression: worsening pulmonary edema with left pleural effusion and retrocardiac opacity. superimposed infection cannot be excluded. repeat radiograph after appropriate diuresis to further evaluate the retrocardiac region is recommended. ir mesenteric angio: no sign of active bleeding, pseudoaneurysm, or angiodysplasia in the sma or territories. egd: impression: small hiatal hernia schatzki's ring erosions in the stomach body and antrum there were no peptic or duodenal ulcers and there was no blood seen in the stomach or duodenum. there was bile in the duodenum. otherwise normal egd to second part of the duodenum colonoscopy: diverticulosis of the sigmoid colon, descending colon, transverse colon and ascending colon blood in the colon no large mass of avms were noted. otherwise normal colonoscopy to cecum ct chest: impression: 1. no evidence of pneumomediastinum to suggest esophageal perforation. esophagus appears normal. 2. trace bilateral pleural effusions. atelectasis is seen in the left upper lobe along the major fissure and in the left lower lobe dependently. 3. massive cardiomegaly with right greater than left chamber enlargement. 4. ct findings suggestive of pulmonary arterial hypertension. 5. right adrenal nodule measuring 1.7 cm, which is not fully characterized on this study. 6. persistent bilateral nephrograms on this noncontrast ct scan. this contrast is likely related to the prior mesenteric angiogram performed on (over 24 hours ago). these findings are concerning for atn. brief hospital course: assessment and plan 78 f with mmp including dhf, osa, s/p trach, htn, dm, atrial fibrillation on warfarin, history of lgib diverticulosis in presents with rectal bleeding. . # brbpr ?????? admission for brbpr with hypotension and respiratory failure, likely diverticular bleed, s/p reversal with ffp, vitamin k, profilnine. patient given 6units prbc total for gi bleed, 3units on admission and 3units the following day with stable hct during hospital course. likely etiology determined to be diverticulosis given similar presentation in where colonoscopy showed diverticulosis. no evidence of ugi source given overall stability and negative ngl. patient was hypotensive intitially, responded well to ivf, but then was placed on dopamine overnight of admission for bp support. patient initially went emergently to angio but no bleed was identified. a colonoscopy was done which showed old blood, multiple diverticuli but no clear source of bleed. surgery recommended that patient is not a good surgical candidate if rebleeds. patient remained with stable hct x24hrs post-bleed and serial hct values were stable. ir was following patient and felt that no further intervention was needed given stable hct since angio. warfarin was held during hospital course. . # hypotension: patient with hypotension upon admission in conjunction with gi bleed that persisted despite adequate fluid recuscitation. patient was on dopamine for three days after bleed but was weaned off of dopamine on hd3 without complications or need for reinitiation of dopamine. echo done on with markedly dilated, hypokinetic right ventricle with severe tricuspid regurgitation that is directed towards the inter-atrial septum. severe pulmonary artery systolic hypertension with pressure/volume overload of the left ventricle. left ventricular function with ef>55%. echo determined to be related to overall fluid positive status for los due to pressors/fluid recuscitation/blood products given for gi bleed. random cortisol level 14, tsh 0.3. once dopamine waened off, no further blood pressure issues. pt is currently only on lasix 20 mg iv bid. as tolerated, her home antihypertensives may be reinitiated. she was on lisinopril 20 mg daily and diltizaem sr 120 mg daily prior to admission. . # respiratory failure. multifactorial respiratory failure with osa, chf exacerbation related to fluid recuscitation for gi bleed. patient on admission requiring placement on ventilator for respiratory support. cxr done on hd 1 am with left-sided chest white-out, possibly collapse. a ct chest was done for futher evaluation which was without e/o esophageal perforation, lll atelectasis/collapse but with l lung expanded, a small plueral. the patients am cxr continued to improve daily as she was weaned off pressors, continued on albuterol/ipratropium and decreased on her overall fluid intake. on hd 3 she was weaned off vent to trach collar successfully without further ventilator support requirements. she is currently volume overloaded and being diuresed wtih lasix 20 mg iv bid. once euvolemic, lasix dose may be titrated down to maintenance dose. . # bradycardia/nstemi. troponin bump to 0.13 with normal ck. likely demand in setting of large gi losses. cardiac enzymes trended down during hospital course and there was no further conern for cardiac ischemia. echo performed on hd4 as discussed above. bradycardia resolved during hospital course without further issues. . # chronic dhf- last tte shows grade i diastolic dysfxn and ef 50-55%. due to hypotension requiring dopamine during hospital course, patient was held on her home lasix and lisinopril. echo done on with markedly dilated, hypokinetic right ventricle with severe tricuspid regurgitation that is directed towards the inter-atrial septum. severe pulmonary artery systolic hypertension with pressure/volume overload of the left ventricle. left ventricular function with ef>55%. new echo findings felt to be due to elements of volume overload from fluids given during inpatient stay. she is currently volume overloaded and being diuresed wtih lasix 20 mg iv bid. once euvolemic, lasix dose may be titrated down to maintenance dose. . # atrial fibrillation. given high risk of bleeding, decision made not to restart warfarin anticoagulation while in the hospital. please discuss with her cardiologist, dr. on when to restart her anticoagulation. . # uti. continuous hospital exposures with risk for resistant organisms. u/a on admission concerning for uti. she was started empirically on zosyn on admission given exposures. subsequent ucx from ed on with e.coli sensitive to zosyn, cipro, ctx, . she was switched from zosyn to cipro on after sensitivities back. she will complete a full 7 day course which should end on . . # diabetes- seems like this is diet controlled, no diabetes medications on past d/c summaries, hgba1c 6.1%. her blood glucose was well controlled on sliding scale insulin. . # ckd- stage iii - baseline 1.2-1.5. during admission, cr from 1.1 on admission with rise to 1.5 and then trended down to baseline range. patient started back on lasix on hd 4. medications on admission: calcitriol 0.25 mcg daily anastrozole 1 mg daily lisinopril 20 mg daily simvastatin 10 mg daily ferrous gluconate 325 mg daily albuterol nebs q6h ipratropium nebs q6h warfarin 2mg po daily ?? dosing - not on med list currently but with therapeutic inr. lasix 20mg po daily diltiazem po 120 mg sr once a day prilosec 20 mg daily apap prn aloh prn heartburn mucomyst inhaled 200 mg insulin sliding scale discharge medications: 1. calcitriol 0.25 mcg capsule sig: one (1) capsule po daily (daily). 2. anastrozole 1 mg tablet sig: one (1) tablet po daily (). 3. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 4. albuterol 90 mcg/actuation aerosol sig: four (4) puff inhalation q4h (every 4 hours) as needed. 5. ipratropium bromide 17 mcg/actuation aerosol sig: six (6) puff inhalation q6h (every 6 hours). 6. ciprofloxacin 500 mg tablet sig: one (1) tablet po every twelve (12) hours: stop date . 7. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q24h (every 24 hours). 8. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) injection q8h (every 8 hours) as needed. 9. furosemide 10 mg/ml solution sig: twenty (20) mg injection (2 times a day). discharge disposition: extended care facility: for the aged - macu discharge diagnosis: diverticular bleed discharge condition: stable, good discharge instructions: you were admitted with a gastrointestinal bleed likely due to your diverticulosis in combination with your anticoagulation from your coumadin. during your hospital course, you needed a ventilator connected to your tracheostomy for respiratory support and required medications for blood pressure support. you were able to be weaned to your baseline respiratory status and baseline blood pressures. you will need to discuss with your primary doctors when and if should ever be restarted on your coumadin because you have a very high risk of bleeding again and another bleed could be life threatening. your care will be continued at the acute rehab facility. followup instructions: your care will continue at the rehabilitation facility through which you should arrange follow-up. provider: , m.d. phone: date/time: 3:40 provider: , m.d. date/time: 8:10 provider: , m.d. phone: date/time: 10:00 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other endoscopy of small intestine colonoscopy arteriography of other intra-abdominal arteries diagnoses: subendocardial infarction, initial episode of care urinary tract infection, site not specified congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure personal history of malignant neoplasm of breast atrial flutter chronic kidney disease, stage iii (moderate) acute and chronic respiratory failure hypotension, unspecified long-term (current) use of anticoagulants personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits obesity, unspecified diverticulosis of colon with hemorrhage diseases of tricuspid valve 

Answer: The patient is high likely exposed to