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: ambien attending: chief complaint: rectal bleeding and rectal pain major surgical or invasive procedure: none history of present illness: cc: hpi: this is a 74m with a history of a rectosigmoid polyp resection and subsequent rectal bleeding with multiple sigmoidoscopies c/b perforation requiring a hartmann procedure . he came back to the clinic today to discuss reversing his colostomy but was found to have new bright red rectal bleeding since this past thursday. the bleeding soaks four 4x4 gauzes per day. the patient denies any dizziness or loc associated with the bleeding. he does report rectal pain and a feeling of rectal fullness that has been present since his surgery in . he also complains of new pain to the left of the ostomy. he denies f/c/n/v. the ostomy is functioning well. of note, the patient has a mechanical av and mv for which he is on coumadin. his inr today was 2.9. past medical history: 1. cardiac risk factors: dyslipidemia, hypertension 2. cardiac history: # mechanical mvr/avr () rheumatic fever # atrial fibrillation s/p av node ablation, biventricular pacer () on anticoagulation # biventricular pacer . 3. other past medical history: # copd # asthma # gerd # osteoarthritis # bilateral total knee replacements oa # gout # hypothyroidism amiodarone # chronic kidney disease stage ii, baseline cr 1.6 # anemia # melanoma # obesity # etoh use # insomnia # hemorrhoids # h/o cellulitis # h/o mrsa pna # osteopenia # # s/p cholecystectomy # s/p appendectomy social history: social hx: lives with wife. family history: # mother d 85: asthma # father d 99 : pad, htn # siblings (5b, 2s): htn, unknown, rheumatic fever physical exam: pe: upon admission 97.1 69 132/70 20 98%ra gen nad, aaox3, mentating well cv rrr, audible clicks pulm ctab, no w/r/r abd soft, obese, ttp to l of ostomy and inferior to ostomy, no g/r, no hernias noted, incisions healing well but area of panniculitis inferior to ostomy, minimal erythema; ostomy retracted but functioning - brown stool and air in bag ext wwp, 2+ edema bilaterally in le dre: stricture ~4cm from anal verge, brb; on anoscopy, clots can be seen but no identifiable source of bleeding pertinent results: 06:00am blood wbc-8.3 rbc-3.44* hgb-9.5* hct-29.5* mcv-86 mch-27.7 mchc-32.3 rdw-17.3* plt ct-154 03:30pm blood wbc-7.5 rbc-3.47* hgb-9.6* hct-29.4* mcv-85 mch-27.6 mchc-32.6 rdw-17.2* plt ct-151 01:52am blood wbc-7.5 rbc-3.34* hgb-9.6* hct-28.4* mcv-85 mch-28.7 mchc-33.8 rdw-17.8* plt ct-156 11:10am blood hct-30.5* 09:59pm blood hct-26.5* 06:00am blood plt ct-154 03:30pm blood plt ct-151 03:30pm blood pt-24.0* ptt-30.5 inr(pt)-2.3* 01:52am blood plt ct-156 01:52am blood pt-30.0* ptt-33.7 inr(pt)-3.0* 04:18am blood pt-34.8* ptt-35.5* inr(pt)-3.6* 06:00am blood glucose-101* urean-17 creat-0.8 na-138 k-3.7 cl-104 hco3-26 angap-12 03:30pm blood glucose-131* urean-16 creat-0.8 na-137 k-3.6 cl-102 hco3-25 angap-14 06:00am blood calcium-8.8 phos-2.6* mg-1.8 03:30pm blood calcium-8.9 phos-2.4* mg-1.9 : cat scan of abdomen and pelvis: impression: 1. no evidence of leak of the hartmann pouch or pelvic fluid collection. 2. filling defects along the lower rectum/anus. this may represent hemorrhoids, hemorrhage, or other intraluminal lesions. please correlate clinically. 3. small fat-containing ventral hernia/abdominal wall defect. : ekg: ventricular paced rhythm. underlying atrial rhythm is uncertain, probably atrial fibrillation. since the previous tracing of no significant change. brief hospital course: 74 year old gentleman who presented to the acute care clinic with rectal bleeding. upon admission he was made npo, had intravenous fluids started and had imaging study done. he was monitored in the intensive care unit where he had serial hematocrits. the gi service was consulted. a cat scan of his abdomen did show a possible soft tissue mass within the rectum. he was taken to the operating room on where he had a rectal examination and sigmoidoscopy under anesthesia. he tolerated the procedure well without evidence of bleeding. he is preparing for discharge home with vna services. his vital signs are stable. he is tolerating a regular diet and has been ambulating. he is not having any active bleeding from his rectum. his hematocrit is stable at 29.5. he has resumed his pre-hospital medications including his coumadin. he has been evaluated by physical therapy for recommendations for his deconditioning. he has also been seen by the ostomy nurse. his last inr is 2.3. he will follow-up with his primary care provider for monitoring of his inr. medications on admission: : 1. warfarin 5 mg tablet sig: one (1) tablet po once a day: 1 tab on and friday, 1.5 tabs on all other days. 2. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 3. enalapril maleate 20 mg tablet sig: one (1) tablet po twice a day. 4. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). 5. levothyroxine 88 mcg tablet sig: one (1) tablet po daily (daily). 6. allopurinol 300 mg tablet sig: one (1) tablet po once a day. 7. colchicine 0.6 mg tablet sig: one (1) tablet po once a day as needed for gout. 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. 9. ciclopirox 0.77 % gel sig: one (1) application to abdomen folds topical twice a day. 10. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily). 11. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 12. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed for sob. 13. ipratropium-albuterol 0.5 mg-3 mg(2.5 mg base)/3 ml solution for nebulization sig: one (1) neb inhalation four times a day as needed for shortness of breath or wheezing. 14. loratadine 10 mg tablet sig: one (1) tablet po once a day. 15. orphenadrine citrate 100 mg tablet sustained release sig: one (1) tablet sustained release po twice a day as needed for back pain. 16. sildenafil 50 mg tablet sig: one (1) tablet po once as needed for sexual activity. 17. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 18. trazodone 50 mg tablet sig: to 1 tablet po at bedtime as needed for insomnia. 19. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day): hold for diarrhea. 20. sodium chloride 0.65 % aerosol, spray sig: three (3) spray nasal tid (3 times a day). 21. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 22. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation: hold for diarrhea. 23. nitrofurantoin discharge medications: 1. allopurinol 300 mg tablet sig: one (1) tablet po daily (daily). 2. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily). 3. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 4. ipratropium bromide 0.02 % solution sig: one (1) nebulizer inhalation q6h (every 6 hours) as needed for wheeze. 5. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation qid (4 times a day) as needed for wheeze. 6. colchicine 0.6 mg tablet sig: one (1) tablet po qam (once a day (in the morning)) as needed for gout. 7. warfarin 5 mg tablet sig: 1.5 tablets po 5x/week (,tu,we,th,sa). 8. warfarin 5 mg tablet sig: one (1) tablet po 2x/week (mo,fr). 9. levothyroxine 50 mcg capsule sig: one (1) capsule po once a day. 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 11. nitrofurantoin (macrocryst25%) 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 5 days. disp:*10 capsule(s)* refills:*0* discharge disposition: home with service facility: discharge diagnosis: rectal bleeding, stricture 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 rectal bleeding. you were monitored in the intensive care unit. during your stay, you had a blood transfusion. your vital signs and hematocrit are normal and you are now preparing for discharge home with vna services. please follow these instructions upon discharge: followup instructions: provider: , md phone: date/time: 12:50 provider: phone: date/time: 9:00 provider: clinic phone: date/time: 10:00 procedure: rigid proctosigmoidoscopy diagnoses: esophageal reflux hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified gout, unspecified atrial fibrillation other and unspecified hyperlipidemia heart valve replaced by other means osteoarthrosis, unspecified whether generalized or localized, site unspecified chronic obstructive asthma, unspecified knee joint replacement disorder of bone and cartilage, unspecified colostomy status hemorrhage of rectum and anus stenosis of rectum and anus chronic kidney disease, stage ii (mild) anal or rectal pain cardiac rhythm regulators causing adverse effects in therapeutic use other iatrogenic hypothyroidism 

Answer: The patient is high likely exposed to