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: tetnus / sulfa(sulfonamide antibiotics) attending: chief complaint: gi bleeding major surgical or invasive procedure: none history of present illness: this is a 69 year-old female with a pmh significant for chronic obstructive pulmonary disease (on home oxygen supplementation), coronary artery disease (s/p silent mi previosuly), non-insulin dependent diabetes mellitus, peripheral artery disease and diverticulosis, known hiatal hernia who presents with bright red blood per rectum. . the patinent presented to 1-week prior with the onset of shortness of breath. she was initially presumed to be having a copd exacerbation and recveived steroids, nebulizers and oxygen treatments with subsequent improvement and discharge to a skilled nursing facility. at the facility, she was noted to have grossly blood stools mixed with melena in the am on (at 2am) associated with hypotension. she denied lightheadedness, dizziness or palpitations. she had no nausea, emesis or abdominal pain. she had no cough, respiratory symptoms or hematemesis. she returned to the ed and was noted to have a hemoglobin of 7.2 g/dl (significant decline from baseline). she recived 1 unit of packed red cells and 1.5l of normal saline prior to transfer. she has been on prophylactic lovenox and asa. she denies recent nsaid use. . of note, her last colonoscopy and egd were 1-year prior and at that time noted evidence of diverticulosis. she reports that she has been admitted to almost annually with similar bleeding concerns and each endoscopy reveals resolved bleeding with a presumed divericular source. . in the ed upon transfer, initial vs 100.0 56 98/42 16 96% ra. her exam was notable for a moderate amount of maroon colored diarrhea per rectum. laboratory data noted a wbc 6.9, hemoglobin 9.5, hematocrit 30.9%, platelets 204 and inr 1.2. lfts were reassuring. a 22-gauge, 20-gauge and two 18-gauge peripherals were established for iv access. she received 1l ns x 1 in the ed and 1 unit of prbcs. gi and general surgery were consulted and agreed with micu transfer. . on arrival to the micu, she was mentating well without abdominal pain and appears stable. she was treated and stabilized in the icu before being transitioned to the hospital medicine service for ongoing management. she underwent an attempt at colonoscopy, although the preparation was not felt to be adequate to effectively rule out focal gi pathology. no upper gi pathology was noted on endoscopy. past medical history: 1. chronic obstructive pulmonary disease (on 2l nc home oxygen) 2. coronary artery disease (status-post silent mi without stenting; on asa for secondary prevention; had mi over 15 years prior and recent pharmacologic stress testing was reassuring) 3. history of hiatal hernia 4. history of diverticulosis 5. peripheral artery disease 6. non-insulin dependent diabetes mellitus 7. hyperlipidemia 8. gerd, reflux esophagitis social history: patient lives at home with her husband and has 6 children. denies tobacco use currently (quit 6 days prior); prior to that has a 50 pack-year history; denies alcohol use; no recreational substance use. patient is independent in adls and ambulates unassisted. worked at stop-and-shop as a cashier. family history: denies significant family history of cardiovascular disease, early mi, arrhythmia or sudden cardiac death. mother died of liver cancer at age 63 years. physical exam: #admission physical exam vitals: 98.0 59 113/52 16 97% 2l nc general: appears in no acute distress. alert and interactive. well nourished appearing. heent: normocephalic, atraumatic. eomi. perrl. nares clear. mucous membranes moist. neck: supple without lymphadenopathy. jvd unable to assess given habitus. cvs: regular rate and rhythm, ii/vi early systolic murmur, without rubs or gallops. s1 and s2 normal. resp: end expiratory wheezing in the bilateral bases. no rhonchi or crackles. stable inspiratory effort. abd: soft, obese, non-tender, non-distended, with normoactive bowel sounds. no palpable masses or peritoneal signs. extr: no cyanosis, clubbing; bilateral 1+ edema to the mid-shins, 2+ peripheral pulses neuro: cn ii-xii intact throughout. alert and oriented x 3. dtrs 2+ throughout, strength 5/5 bilaterally, sensation grossly intact. gait deferred. rectal: external peri-anal region without lesions, skin tags or fissures. digital exam reveals normal tone. no masses or internal hemorrhoids. bleeding noted on finger mixed with melenic maroon-colored stool. #discharge physical exam: vitals: t 99.1, hr 62, bp 118/52, rr 22, o2 sat 93% 2l nc. general: appears in no acute distress. alert and interactive. well nourished appearing. heent: normocephalic, atraumatic. eomi. perrl. nares clear. mucous membranes moist. neck: supple without lymphadenopathy. jvd unable to assess given habitus. cvs: regular rate and rhythm, ii/vi early systolic murmur, without rubs or gallops. s1 and s2 normal. resp: end expiratory wheezing in the bilateral bases. no rhonchi or crackles. stable inspiratory effort. abd: soft, obese, non-tender, non-distended, with normoactive bowel sounds. no palpable masses or peritoneal signs. extr: no cyanosis, clubbing; bilateral 1+ edema to the mid-shins, 2+ peripheral pulses neuro: cn ii-xii intact throughout. alert and oriented x 3. dtrs 2+ throughout, strength 5/5 bilaterally, sensation grossly intact. gait deferred. pertinent results: #admission labs: 02:12pm pt-12.5 ptt-23.8* inr(pt)-1.2* 02:12pm plt count-204 02:12pm neuts-82.1* lymphs-13.9* monos-3.8 eos-0.2 basos-0.1 02:12pm wbc-6.9 rbc-3.39* hgb-9.5* hct-30.9* mcv-91 mch-28.1 mchc-30.8* rdw-16.3* 02:12pm albumin-2.7* 02:12pm alt(sgpt)-18 ast(sgot)-13 ld(ldh)-136 alk phos-30* tot bili-0.3 08:23pm plt count-235 08:23pm wbc-11.2*# rbc-3.82* hgb-10.4* hct-34.1* mcv-89 mch-27.2 mchc-30.5* rdw-16.7* 08:23pm calcium-7.5* phosphate-3.3 magnesium-1.8 08:23pm estgfr-using this 08:23pm glucose-79 urea n-41* creat-0.9 sodium-144 potassium-4.7 chloride-110* total co2-32 anion gap-7* #pertinent/discharge labs: 01:00pm blood wbc-12.6* rbc-3.48* hgb-9.6* hct-31.4* mcv-90 mch-27.7 mchc-30.7* rdw-17.2* plt ct-214 06:10am blood wbc-12.3* rbc-3.47* hgb-9.5* hct-31.3* mcv-90 mch-27.5 mchc-30.5* rdw-17.1* plt ct-195 02:27am blood wbc-12.1* rbc-3.67* hgb-10.2* hct-32.8* mcv-89 mch-27.9 mchc-31.2 rdw-16.7* plt ct-193 02:00am blood wbc-11.7* rbc-3.77* hgb-10.3* hct-33.2* mcv-88 mch-27.4 mchc-31.1 rdw-16.7* plt ct-202 08:50am blood neuts-70.8* lymphs-24.7 monos-3.9 eos-0.4 baso-0.2 02:27am blood pt-11.9 ptt-25.6 inr(pt)-1.1 02:00am blood pt-11.4 inr(pt)-1.1 08:50am blood pt-11.9 ptt-20.3* inr(pt)-1.1 06:10am blood glucose-90 urean-12 creat-0.6 na-145 k-3.9 cl-103 hco3-34* angap-12 02:27am blood glucose-110* urean-19 creat-0.8 na-145 k-4.1 cl-105 hco3-36* angap-8 02:00am blood glucose-89 urean-32* creat-0.9 na-145 k-4.2 cl-108 hco3-35* angap-6* 02:00am blood alt-19 ast-15 alkphos-34* totbili-0.4 06:10am blood calcium-8.2* phos-3.2 mg-1.9 02:27am blood calcium-8.3* phos-3.3 mg-1.8 02:00am blood calcium-8.3* phos-3.9 mg-1.9 #microbiology: 6:32 pm mrsa screen source: nasal swab. **final report ** mrsa screen (final ): no mrsa isolated. #imaging: cxr : the lungs are hyperinflated, consistent with copd. the heart is likely enlarged. the aorta is calcified and unfolded. there is upper zone redistribution, but i doubt overt chf. no gross effusion. no frank consolidation. probable minimal atelectasis at both bases. tte : the left atrium is mildly dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). the estimated cardiac index is high (>4.0l/min/m2). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normal biventricular cavity sizes with preserved global and regional biventricular systolic function. mild pulmonary artery hypertension. dilated ascending aorta. #procedures: egd findings: esophagus: normal esophagus. stomach: normal stomach. duodenum: normal duodenum. recommendations: follow-up with the inpatient gi team for further recommendations. brief hospital course: brief clinical history: 69 yo f with a pmh significant for obstructive pulmonary disease (on home oxygen supplementation), coronary artery disease (s/p silent mi previosuly), non-insulin dependent diabetes mellitus, peripheral artery disease and diverticulosis, known hiatal hernia who presents with hematochezia mixed with melena and symptomatic anemia, who improved after 2u blood transfusion. she had a brief stay in the micu for gib and hypotension to ~80s systolic. while in the micu she had a tte and an egd done, both normal. her hematocrit stabilized and she was transferred to the inpatient medicine floor. patient had an attempt at colonoscopy in house to evaluate for presumed diverticulosis, but following an inadequate preparation for the first attempt, she deferred further attempts during this admission. as she had stopped actively bleeding, this was felt to be a reasonable option, and she was encouraged to pursue a formal repeat colonoscopy as an outpatient through her outpatient team. active issues: # gastrointestinal bleeding - patient presents with known history of diverticulosis on prior colonoscopy and hiatal hernia on asa for secondary prevention of mi and now presenting with acute onset of bright red blood per rectum with melanotic stools with subsequent hemodynamic instability. a lower gi source is suspected at this time. etiologies would include diverticular bleeding, angiodysplasia or vascular malformations, malignancy (although prior colonoscopy was 1-year prior makes this less likely), or colonic ischemia. of note, she has multiple prior admissions to osh for diverticular bleeding seen on colonoscopy. no significant abdominal pain, nsaid use, nausea or emesis to point towards an upper gi source. ng lavage deferred in the ed. patient had egd on , normal, no biopsies were done. . # chronic obstructive pulmonary disease - stable copd with home oxygen requirement. recent acute exacerbation with resolution. lungs stable on exam with end expiratory wheezing; oxygen status stable. home regimen includes nebulizers, albuterol and tiotropium inhalers with fluticasone-salmeterol. cxr from c/w copd with hyperinflated lungs, no evidence of consolidation or overt chf. the patient was kept on 2l o2 nc which is her baseline o2 requirement, and we continued her home nebulizer treatments along with inhalers. she had a mild minimally productive cough that was treated symptomatically with robitussin and showed no evidence of acute pulmonary infection. . # non-insulin dependent diabetes mellitus - carries a diagnosis of diabets mellitus, on oral hypoglycemics. no history of retinopathy, nephropathy or neuropathy. during her hospitalization, her home oral hypoglycemics were held and she was kept on an insulin sliding scale. she required modest amounts of insulin and had no hypo or hyperglycemic events. . # coronary artery disease - remote history of silent mi without recent cardiac cath or stenting intervention; pharmcologic stress testing reassuring in the past year, per report. no acute anginal symptoms in the setting of this gi bleeding episode. denies chest pain or exertional dyspnea. her asa and atenolol were held on admission in the setting of a gi bleed, in addition to her isosorbide mononitrate. prior to discharge, we restarted her asa given the stability in her blood counts and discussion with gi, as well as cardiac risk factors. # gerd, esohpageal reflux - we continued the patient on home regimen of omeprazole and ranitidine. . # hyperlipidemia - we continued the patient on her home dose of simvastatin 40 mg po daily. transitional issues: -patient restarted on atenolol and asa; vna will monitor hemodynamics and consult with pcp if there are any issues. -patient will follow up with pcp and gi later this month; plan for f/u colonoscopy as an outpatient, as the patient deferred further inpatient procedures at this time following the initial attempt. medications on admission: preadmission medications listed are correct and complete. information was obtained from patient. 1. atenolol 25 mg po daily 2. pregabalin 150 mg po bid 3. metformin (glucophage) 500 mg po bid 4. simvastatin 40 mg po hs 5. tiotropium bromide 1 cap ih daily 6. aspirin 81 mg po qpm 7. latanoprost 0.005% ophth. soln. 1 drop both eyes hs 8. fluticasone-salmeterol diskus (250/50) 1 inh ih 9. ranitidine 150 mg po hs 10. omeprazole 20 mg po daily 11. albuterol inhaler 2 puff ih q4h:prn wheezing 12. calcium polycarbophil *nf* 1300 oral 13. requip *nf* (ropinirole) 3 mg oral 14. nitroglycerin sl 0.4 mg sl prn chest pain every 5 minutes 15. isosorbide mononitrate 30 mg po daily discharge medications: 1. fluticasone-salmeterol diskus (250/50) 1 inh ih 2. latanoprost 0.005% ophth. soln. 1 drop both eyes hs 3. omeprazole 20 mg po daily 4. pregabalin 150 mg po bid 5. ranitidine 150 mg po hs 6. requip *nf* (ropinirole) 3 mg oral 7. simvastatin 40 mg po hs 8. tiotropium bromide 1 cap ih daily 9. furosemide 20 mg po qam 10. albuterol inhaler 2 puff ih q4h:prn wheezing 11. calcium polycarbophil *nf* 1300 oral 12. isosorbide mononitrate 30 mg po daily 13. metformin (glucophage) 500 mg po bid 14. nitroglycerin sl 0.4 mg sl prn chest pain every 5 minutes 15. aspirin 81 mg po qpm 16. atenolol 25 mg po daily discharge disposition: home with service facility: vna discharge diagnosis: diverticulosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mrs. , it was a pleasure taking care of you. you were admitted to the for blood in your stools. you were seen by the gastro-intestinal doctors and the surgery doctors and it was felt that you would do best with more intensive monitoring in the icu. you were given intravenous fluids, a unit of blood, and you were stabilized before being transfered to the regular medicine inpatient unit. you had an ultrasound of your heart, and the gi doctors looked in the top of your gastro intestinal tract with a scope and found nothing abnormal. you will follow up with the gi doctors with the to do a colonoscopy as an outpatient. we wish you and your family the best. followup instructions: name: , t. specialty: primary care when: wednesday at 2pm location: community physicians associates, inc. address: , , phone: name: , md specialty: gastroenterology when: tuesday at 2:15pm address: ,ste 8a, , phone: procedure: other endoscopy of small intestine diagnoses: coronary atherosclerosis of native coronary artery esophageal reflux diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified peripheral vascular disease, unspecified diaphragmatic hernia without mention of obstruction or gangrene other and unspecified hyperlipidemia old myocardial infarction diverticulosis of colon with hemorrhage other dependence on machines, supplemental oxygen 

Answer: The patient is high likely exposed to