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: gib major surgical or invasive procedure: colonoscopy history of present illness: pt is a 75 yo f with morbid obesity, af on coumadin, and porphyria who presents with an acute onset of gi bleed. she noticed brbpr in her bed pan this morning at her nursing home. her vs were stable at the time (bp 148/78) she reports 3 bloody bms at her nursing home after being given lactulose 2 am, another 2 at , and 1 in the ed. pt was unable to report the consistency and color of the blood her body habitus, but states she was told it was 'red and bloody' and clotted. she reports she may have been on antibiotics ('some penicillin') recently but does not know the results. her inr was recently supratherapeutic to 4.7 on -> 3.6 on .8 on , and 2.0 on . her coumadin was held from - for her supratherapeutic inr. she also reports a history of diverticulitis 30 years ago, but no bleeding. she denies any recent ibuprofen or alcohol use. no uncooked hamburgers or fresh water ingestion. she was transferred to , where she recieved 1 u prbcs. labs significant for a cre of 1.3, inr of 2.5, and hct was noted to be 29.3 she had 2 pivs placed and was transferred to for further management. . in the ed, initial vs were: 97.8 128/62 67 16 97% on ra. labs notable for hct stable at 28.6 and cre of 1.2. she refused ng lavage. maroon colored blood clots admixed with stool were noted in the ed. patient was crossmatched for 4 and prbcs, and was given 10 mg iv vitamin k in the ed. gi was consulted in the ed, who recommended inr reversal and npo for possible colonoscopy tomorrow vs. tagged rbc scan. she was transferred to the micu for treatment of active gi bleed. on transfer, vs were afebrile 66 161/62 14 94% on room air. . on the floor, she denies any fevers, chills, cough, abdominal pain, nausea, vomiting, lh, dizziness, or syncope. she has chronic sob from her asthma. she reports she is bedbound but can be transferred to a wheelchair. she reports a lle laceration on transfer from bed to wheelchair a few day ago that is s/p repair. past medical history: asthma lower extremity cellulitis morbid obesity, home bound at nursing home htn hypercholesterolemia atrial fibrillation on coumadin dmii gout chronic constipation social history: lives in nursing home, recently moved there 1 month ago multiple medical problems and multiple hospital admissions for viral illness/asthma exacerbations. used to be an elementary school teacher in . - tobacco: denies - alcohol: denies - illicits: denies family history: no family hx of ibd. physical exam: general: obese f lying in bed, alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: increased expiratory phase, wheezes in upper lung bases cv: irregularly irregular rate, no murmurs, rubs, gallops abdomen: soft, obese, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pitting edema bl, chronic venous stasis changes bl, bandages over lle wound c/d/i; 1+ pulses, no clubbing, cyanosis or edema . on discharge pe: vitals: 96.2 172/100 (agitated) 83-90s 18 93%ra i/os: neg 5l so far pain: denies access: lue picc gen: nad, obese female heent: mmm cv: irreg irreg, no m resp: ctab, no crackles, +exp wheezing abd; soft, very obese, nontender, +bs ext; 2+ b/l le and ue edema neuro: a&ox3, grossly nonfocal-at baseline skin: chronic venous stasis changes ble with bandages over lle wounds c/d/i; psych: easily frustrated gu +foley-->will remove . pertinent results: wbc hgb 9->10s stable hct 28->31 2u->29->32s stable bun/creat 31/1.2-->10/0.8 inr 2.2->1.3 lfts wnl trop 0.03->0.01 . . imaging/results: cxr : impression: technically limited study. lateral view demonstrates moderate bilateral pleural effusions. otherwise, no new gross focal abnormality concerning for pneumonia . c-scope : impression: polyp in the colon diverticulosis of the sigmoid colon, descending colon and ascending colon two prominent folds at approximately 25cm. erythema of the mucosa was also noted in this area likely due to scope trauma. ulceration in the anus-->biopsy otherwise normal colonoscopy to terminal ileum recommendations: follow-up biopsies. pt will need repeat colonoscopy in near future for removal of polyps. brief hospital course: 75 year old female with h/o afib on coumadin, morbid obesity, dm, gout, remote diverticulitis who was admitted from with hematochezia in setting of therapuetic inr. initially presented to osh. recieved 1u at osh and transfered to . admitted to micu. recieved 2u more prbc for active hematochezia and 2u ffp and vitamin k for inr 2.5 at osh. refused ngt but low suspicion for ugib as she remained stable. strong suspicion for diverticular bleed given acute history and spontaneous resolved. her hct stabilized around 30s and she was transfered out of micu . plan was for egd/, but this was delayed by a few days because of both poor prep and difficulty arranging for or time (couldnt do in gi suite due to weight). finally underwent colonoscopy on , egd not done due to high risk procedure and low suspicion for ugib. c-scope showed diverticulosis, rectal ulcer (would not have expected such a brisk bleed), and polyps (nonbleeding)-->likely diverticular bleed. she needs f/u c-scope for removal of polyps in future (not done due to recent bleed). gi will contact with biopsy of rectal ulcer to r/o malignancy. will reccommend it should be safe to resume prior dose of coumadin after 1week (so less risk for bleeding from rectal ulcer biopsy site). also asa 81 was resumed. her hct was above 30 for 4days before discharge. she was tolerating diet. placed on po ppi daily (on asa/coumadin). other issues during this hospitalization: her creat was 1.3 on admission. she got blood and gentle fluids. creat improved to 0.8 and was stable thereafter. she was total body volume overloaded acute dchf (hypoxia, ue/le edema, wheezing) and got iv lasix x2 with neg 5l and creat remained stable. she will be discharged on lasix 40mg daily and her creat should be followed. kept on lisinopril at higher dose. presumed not on bb due to bad asthma. her afib was not rate controlled and she was started on dilt which was titrated to 240mg (hr 80s). also her bp was not controlled and her lisinopril was increased to 10, dilt added as above, and lasix added as above. her bp was 120/80s but would go to 180sbp when she was anxious/upset. her o2 sats were okay 92% during day but she would desat at night, likely osa, she has refused cpap in past. can consider giving nocturnal o2 so can avoid stress on heart/hypoxia. asthma was stable on claritin and inhalers. some fluid component to wheezing, improved with diuresis. rest of meds are kept the same. . below is progress note from day of discharge 75 year old female with h/o afib on coumadin, morbid obesity, dm, gout, remote diverticulitis who is admitted with hematochezia in setting of therapuetic inr. stable. transfered out of micu . awaiting egd/ on , delayed due to poor prep and issue related to body habitus. has issues with afib/rvr and dchf. . acute gi bleed: patient likely with lower gi bleed given history of diverticulosis and hds while active hematochezia. lower suspicion for ugib. hct 29-30 stable after total 3u prbc. inr reversed with ffp and vit k. -c-scope with diverticulosis, rectal ulcer (would not have expected such a brisk bleed), and polyps (nonbleeding)-->still suspect was a diverticular bleed -needs f/u c-scope for removal of polyps in future -gi will contact with biopsy of rectal ulcer to r/o bleed -egd not done because high risk, again, very low suspicion for ugig, d/c iv ppi, place on oral -resume coumadin in 1 week -can resume asa now . arf:unclear baseline. creat 1.3 on admission, down to 0.9 after gentle fluids. pt is total body volume overloaded and has effusions on cxr -no more fluids -s/p lasix 40mg iv and 20mg iv on , creat 0.8--> so far pt about negative 5l -start on lasix 40mg qd-can titrate to as bp and creat tolerates -lisinopril-titrate dose . acute diastolic chf: effusions on cxr. got fluids. needs better rate control (afib and gets albuterol) and bp control. previously on lasix. no recent echo. clinically overloaded with edema, hypoxia -s/p lasix iv and . -start lasix 40mg daily--titrate as bp, creat tolerates -o2 sats good during day but needs o2 at night -dilt started and titrated to 240mg-->hr is now in 80s -unclear why not on bb, but possible due to recurrent asthma exacerbations. -d/c foley . asthma: recurrent admissions for this. currently requiring 2l o2 which is new. no clear asthma flare, more likely fluid component as above -continue duonebs prn, advair, claritin 10mg daily . atrial fibrillation/rvr: rates were not well controlled while here. was not on any nodal blocking agents. patient with chads-2 score of 3, warranting anticoagulation (htn, age, diabetes). coumadin was held in setting of acute gi bleed. -will resume coumadin in 1 week given they biopsied rectal ulcer yesterday--notify -dilt started and titrated to 240mg-->hr is now in 80s . htn: was difficult to control: titrated lisinopril to 10mg and added dilt as above. also started lasix 40mg daily . dm: -ssi while here. doesnt appear to be on anything at -ace-i as above . dyslipidemia: cont simva 40mg daily. okay to resume asa 81 . chronic pain: - continue home pain meds, including neurontin 900mg and vicodin/tylenol prn . atypical cp: pt endorsed atypical cp on admission. ekg with non-specific st-t wave changes. she has cad risk factors including age, htn, hld, obesity. trop negative x2.. continue statin, acei. started ccb. asa resumed. . le wounds: continue wound care. . op: ca+vit d and vitamins . fen/proph: hliv, monitor and replete electrolytes, hold bowel regimen, diabetic diet, hold ac, scds, po ppi, continue vitamins . dispo/code: full code (confirmed). plan to d/c back to today. communication: patient/son medications on admission: simvastatin 40 mg po qhs lisinopril 5 mg po daily neurontin 900 mg po bid colchicine 0.6 mg po bid propoxyphene-n w/ apap 1 tablet po bid asa 81 mg po daily b complex/folic acied 1 tablet po daily vitamin d iu po daily claritin 10 mg po daily coumadin 5.5 mg po daily vicodin 1 tablet po prn: pain colace 100 mg po bid calcium + vitamin d 1 mg po bid advair 500/50 1 puff inh bisacodyl 10 mg po:prn constipation tylenol 650 mg po:prn mom discharge medications: 1. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for sob. 3. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain,fever. 4. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for asthma. 5. gabapentin 300 mg capsule sig: three (3) capsule po bid (2 times a day). 6. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 7. colchicine 0.6 mg tablet sig: one (1) tablet po bid (2 times a day). 8. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 9. diltiazem hcl 240 mg capsule, sustained release sig: one (1) capsule, sustained release po daily (daily). 10. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 11. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 12. propoxyphene n-acetaminophen 100-325 mg tablet sig: one (1) tablet po twice a day. 13. b complex-folic acid 0.4 mg tablet sig: one (1) tablet po once a day. 14. biscolax 10 mg suppository sig: one (1) rectal once a day. 15. senna 8.6 mg capsule sig: one (1) capsule po twice a day. 16. colace 100 mg capsule sig: one (1) capsule po twice a day. 17. aspirin 81 mg tablet sig: one (1) tablet po once a day. 18. lasix 40 mg tablet sig: one (1) tablet po once a day. 19. coumadin 5 mg tablet sig: one (1) tablet po at bedtime: start on . titrate dose for inr . 20. vicodin 5-500 mg tablet sig: one (1) tablet po every hours as needed for pain. 21. calcium 500 + d 500 mg(1,250mg) -200 unit tablet sig: one (1) tablet po twice a day. 22. milk of magnesia concentrated 2,400 mg/10 ml suspension sig: one (1) po once a day as needed for constipation. discharge disposition: extended care facility: health care - discharge diagnosis: hematochezia-likely diverticular bleed acute blood loss anemia afib, rvr acute diastolic heart failure htn uncontrolled discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: bedbound. discharge instructions: you were admitted for rectal bleeding. this is likely from diverticulosis. you got total 3u blood and some ffp to reverse your coumadin. your bleeding spontaneously stopped and you remained stable. after some delays, you underwent colonoscopy which showed diverticulosis. this also showed a rectal ulcer and a biopsy was taken which is pending at the time of discharge (gi will contact you with results). you also had colon polyps. you need these removed at some point as they could be cancer. please arrange a colonoscopy with your gastroenterologist to arrange this. you can resume your coumadin in one week. resume your aspirin now. a few new meds were started: lasix 40mg daily (for your swelling) and diltiazem 240mg daily (for fast heart rate). your lisinopril was increased for high blood pressure. protonix was started to protect you from ulcers followup instructions: please arrange a follow up with a gastroenterologist of your choice to perform colonoscopy to remove polyps . the nursing home will make a follow up with your primary care doctor when you are ready to leave procedure: venous catheterization, not elsewhere classified closed [endoscopic] biopsy of large intestine biopsy of anus diagnoses: congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified gout, unspecified atrial fibrillation asthma, unspecified type, unspecified other and unspecified hyperlipidemia morbid obesity long-term (current) use of anticoagulants other constipation acute diastolic heart failure diverticulosis of colon with hemorrhage benign neoplasm of rectum and anal canal ulcer of anus and rectum disorders of porphyrin metabolism 

Answer: The patient is high likely exposed to