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: tetracycline analogues / atenolol / tegaderm attending: chief complaint: gastrointestinal bleed major surgical or invasive procedure: none history of present illness: 69 year old female with h/o gib secondary to pud, extensive cad with recent percutaneous angioplasty and stenting of svg to rca conduit and om1 on chronic plavix and asa presenting with hematchezia. . pt recently hospitalized in ccu from for treatment of cardiogenic shock. on arrival patient noted to be persistently hypotensive. echo on admission showed depressed ef of 20-25%, diffuse wma and elevated ra pressures. echo was grossly unchanged from baseline (7/). ekg was also unchanged from baseline. patient was cathed which showed new distal occlusions in the om1 and 90% stenosis of the rca-acg bypass, des were placed in both. placed on pepcid for gib ppx. . her - hospital course was complicated: 1. fluid overload/kidney failure necessitating cvvh. she started on on cvvh with intermittent need for phenylephrine to maintain sufficient maps. phenylephrine was difficult to wean but ultimately pt was started on midodrine, sudafed and fludrocortisone to assist in raising svr. in total ~20 l were removed with cvvh. a new tunneled dialysis catheter was placed prior to discharge with plan to continue dialysis in rehab and ultimately resume outpatient hd. 2. leukocytosis/line infection. during stay her right tunneled dialysis line on the right was noted to be erythematous. cultures were sent from the line and 1 of 2 bottles grew gram positive rods, gram negative rods and gram postive cocci in pairs and chains. she was started on empiric vancomycin and zosyn antibiotic tx and completed a 10 day. . patient discharged to rehab on . noted this morning to pass several maroon color stools with clots. ems called; en route sbps noted to be sbp of 85 (per last d/c summary sbps 80s-90s). . in the ed, initial vs: 97.7 91 84/41 18 98% 6l nasal cannula. sbps increased to 110s prior to iv hydration. patient underwent ng lavage which demonstrated scant clots with predominantly bilious fluid; all clots resolved after flush with 500cc of ivf. gi consulted and recommended transfusion and initiation of ppi ggt, ct angio. patient transfused 2units of uncrossed rbcs and 1u of platelets. decision made to admit to micu for further mgmt. . on the floor, patient overall feeling "lousy". denies abdominal pain, nausea, vomiting, hematemesis. reports acute worsening of chronic non-productive cough. reports stable 2 pillow orthnopnea, stable edema. denies fevers, chills, sweats. past medical history: - cad s/p 4v cabg ' (lima to lad, svg to diag, svg to cx, svg to rca), des x3 to om1 (), bms to om1 (), bms x3 to lcx/om () - tia `97 or `98 - paroxysmal afib/flutter s/p multiple cardioversions '/'; d/c'd coumadin ~4yrs ago gib - esrd - copd on 3l home o2 (non compliant) - morbid obesity - hypertension - hyperlipidemia - pvd s/p angioplasty of anterior tibial artery (), s/p angioplasty of right dorsal pedis () - s/p l5 amp & metatarsal head resections - gib from pud ~4 yrs ago - osa - chronic anemia (baseline ~ 32) - c. diff colitis, toxin positive, in the absence of diarrhea - hypothyroidism - asthmatic bronchitis - sciatica - vertigo - mrsa hx social history: lives in , at home with her son, . she uses a wheelchair at baseline and is on 2 liters o2. she formerly worked as a homemaker and in meat wrapping. -tobacco history: quit smoking 30 years ago, smoked 2.5 ppd x 25yrs -etoh: no current alcohol use, none in past that she reports -illicit drugs: denies family history: mother died of breast cancer at age 60; sister died at 60 of glioblastoma; father died of lung cancer at 73; and sister died at 60 of heart disease; son died at , diabetic, of massive mi in physical exam: on admission: general: alert, sleeping but arousable, chronic hacking non-productive cough heent: sclera anicteric, mmm, oropharynx clear without exudates, lesions neck: supple, jvp hard to assess in setting of bilateral lines, no palpable lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema tld -- right tunnelled line -- left triple lumen . on discharge: t 96.6, bp 120/61, hr 92, rr 18, so2 93% ra chest: erythema surrounding dialysis line exam otherwise as above pertinent results: admission labs: 09:00pm blood wbc-14.6* rbc-2.74* hgb-7.1* hct-22.3* mcv-81* mch-25.9* mchc-31.8 rdw-18.8* plt ct-173 09:00pm blood neuts-86.1* bands-0 lymphs-8.2* monos-4.6 eos-1.0 baso-0 09:00pm blood pt-13.6* ptt-32.4 inr(pt)-1.2* 09:00pm blood glucose-65* urean-21* creat-2.5*# na-140 k-3.7 cl-102 hco3-31 angap-11 12:32am blood ck-mb-3 ctropnt-0.16* 03:29am blood ck-mb-4 ctropnt-0.18* 05:05am blood ck-mb-4 ctropnt-0.19* 12:32am blood calcium-8.0* phos-2.3*# mg-1.9 . cta 1. slightly decreased wall thickening at the hepatic flexure of the colon consistent with improving colitis. focal areas of colonic mucosal enhancement but no definite areas of active extravasation into the gi tract to suggest a site for gi bleeding. 2. hypodense lesion in the pancreatic head which may represent a cystic lesion or dilated side branch. recommend follow up mri in 1 year. 3. bilateral pleural effusions, stable from prior study. 4. moderate narrowing at the origin of the left renal artery. . cxr impression: since , right effusion has increased and now is moderate in quantity. bilateral lower lung atelectasis left more than right is stable as is left pleural effusion. stable, moderate to severe cardiomegaly. . discharge labs: 04:50am blood wbc-6.7 rbc-3.04* hgb-8.5* hct-26.2* mcv-86 mch-28.0 mchc-32.4 rdw-19.6* plt ct-183 04:50am blood glucose-91 urean-24* creat-4.0*# na-135 k-3.8 cl-96 hco3-30 angap-13 04:50am blood calcium-8.5 phos-3.9 mg-2.1 brief hospital course: 69 year old female with h/o gib secondary to peptic ulcer disease, extensive cad s/p cabg and ischemic cardiomyopathy with chronic systolic heart failure with recent des of svg-rca conduit and om1 one month ago on plavix and asa, and esrd on hd admitted with hematchezia. course was notbable for icu admission for atrial fibrillation with rapid ventricular response. . #gastrointestinal hemorrhage: the patient was initially admitted to the icu for atrial fibrillation but hemoatocrit was stable. a ng lavage was performed with no obvious bleeding but ?scant coffee ground. pt was managed with a ppi and a ct was performed which showed improved hepatic flexure colitis. the patient was transfused 3units prbcs and 1 units platelets and hematocrit remained stable. gi was consulted as was the patient's cardiologist dr. . asa and plavix were continued given recent stent placment and endoscopy was deferred given low likelihood of an intervenable lesion and the patients somewhat tenuous cardiopulmonary status. the patient was transferred to the floor and hematocrit remained stable without further evidence of hematochezia. ppi was discontinued and patient was placed back on h2blocker therapy as the most likely source of bleeding was felt to be mild hepatic flexure ischemic colitis on the background of dual anti-platelet therapy. . # a.fib chads score 4: not previously anticoagulated due to h/o recurrent gi bleeds. patient had been started on amiodarone on last ccu admission, but given rapid afib the patient was reloaded with amiodarone with conversion to sinus rhythm. patient was then transitioned to 200 mg by mouth daily which should be continued after discharge. . # acute on chronic cough. etiology includes pulmonary edema, copd exacerbation and pna (less likely) although felt most likely to be due to volume overload. patient treated with supportive care and hd intiatated on hd3. sputum cultures were sent which grew only normal upper respiratory flora. . #acute on chronic systolic heart failure: tte showed severe regional left ventricular systolic dysfunction and severe hypo to akinesis of the entire septum, anterior wall, and distal of the left ventricle. at time of discharge on pt's weight had decreased from 143kilos to 119 kilos. chest xray showed worsening bilateral pleural effusions. fluid was managed with hemodialysis and fludracortisone dosage was reduced as the patient was not hypotensive and tolerated hemodialysis well. . # cad. patient with extensive cad history. cath with new distal occlusions in the om1 and 90% stenosis of the rca-acg bypass and patient s/p des to occlusions. currently patient without complaints of chest pain or anginal equivalent. patient continued on asa, plavix due to risk of instent thrombosis. cardiac enzymes cycled and were consistent with baseline. during icu stay patient without signs or symptoms of active angina and she remained asymptomatic on the floor. . # copd. on home 3l nc. during last admission patient started on advair, ipratropium and albuterol nebs. she completed a short course of solumedrol, and a prednisone taper (finished on ). o2 sats were in low to mid 90's on ra at time of discharge. currently patient saturating 90-595% at baseline requirement of 3l. . # dm. home 70/30; 30 in am, 20u qhs with regular iss. home regimen continued. patient also continued on gabapentin for treatment of peripheral neuropathy. . # hypothyroidism. tsh and free t4 were wnl on last admission. continued on home levothyroxine 100mcg. #esrd on hd: patient was continued on hemodialysis for management of volume and continued on midodrine and fludracortisone. fludracortisone dose was reduced during admission. given probable ischemic colitis the dose of midodrine could be down titrated as tolerated by blood pressure to reduce risks of end organ ischemia. transitional issues: 1. incidental hypodense lesion on pancreatic head identified on abdominal imaging with recommended follow-up in one year. 2. follow-up with gastroenterologist as an outpatient. 3. fludricortisone dose was decreased from 0.2 to 0.1 mg at discharge. pt should be gradually tapered off over the next few weeks as tolerated. she should receive one week of 0.1 mg, then one week of 0.05 mg, then off. start date of taper is . medications on admission: x 70/30: 30u qam x iss x levothyroxine 100mcg qd x midodrine 10mg tid x omega 3 fish oils 1000mg x tiotropium bromide 18mcg/cap inhalation x vitamin b complex 1cap qd x bupropion xl 150mg qd x guaifenesin 100 tid x albuterol neb q6hrs x amiodarone 400mg tid thru x amiodarone 200mg qd (start on ) x asa 325mg qd x atorvastatin 40mg qhs x plavix 75mg qd x famotidine 20mg x fludrocortisone 0.2mg qd x fluticasone/salmeterol 250/50 1puff discharge medications: 1. insulin nph & regular human 100 unit/ml (70-30) suspension sig: thirty (30) units subcutaneous qam. 2. humalog 100 unit/ml solution sig: asdir units subcutaneous asdir: please use as directed by her prescribing physician. . 3. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 4. midodrine 10 mg tablet sig: one (1) tablet po three times a day. 5. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). 6. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 7. bupropion hcl 150 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 8. guaifenesin 100 mg tablet, chewable sig: one (1) tablet, chewable po three times a day. 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) nebulization inhalation q6h (every 6 hours) as needed for sob. 10. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 11. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 12. atorvastatin 40 mg tablet sig: one (1) tablet po hs (at bedtime). 13. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 14. famotidine 20 mg tablet sig: one (1) tablet po twice a day. 15. fludrocortisone 0.1 mg tablet sig: one (1) tablet po daily (daily). 16. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 17. gabapentin 300 mg capsule sig: one (1) capsule po qam. 18. heparin (porcine) 1,000 unit/ml solution sig: asdir asdir injection prn (as needed) as needed for line flush. 19. heparin flush (10 units/ml) 1 ml iv prn line flush dialysis catheter (temporary 3-lumen): thin non-dialysis (vip) lumen: all nurses: flush with 10 ml normal saline followed by heparin as above daily and prn. 20. senna 8.6 mg capsule sig: two (2) capsule po twice a day as needed for constipation. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: gastrointestinal bleed congestive heart failure end-stage renal disease atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: ms. : . you were admitted to with a gastrointestinal bleed that was most likely due to inflammation in your colon. there was initially concern that you would need a procedure called a colonoscopy but this was deferred as you were in the icu. the bleeding gradually stopped and it was felt that you were safe to return to rehab. you may continue to pass occasional blood clots for several days. . the following changes were made to your medications: 1. your dose of fludricortisone was decreased to 0.1 mg by mouth daily. 2. stop taking amiodarone 400 mg by mouth twice a day. your only amiodarone dose at this time should be 200 mg by mouth once a day. 3. stop taking your omega-3 supplement as this can increase your risk of bleeding. 4. start taking nephrocaps 1 cap by mouth daily. 5. your aspirin was changed to a 325 mg enteric coated formulation. continue to take 1 tablet by mouth daily. 6. stop taking coumadin. . no other changes were made to your medications and you should continue taking all other medications as previously prescribed. . weigh yourself every morning, md if weight goes up more than 3 lbs. followup instructions: no appointments were made for you as you are being discharged to a rehabilitation facility. please have the rehabilitation facility make an appointment for you with your primary care doctor and also dr. . procedure: hemodialysis diagnoses: end stage renal disease obstructive sleep apnea (adult)(pediatric) renal dialysis status congestive heart failure, unspecified unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified atrial fibrillation coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status peripheral vascular disease, unspecified personal history of tobacco use percutaneous transluminal coronary angioplasty status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia blood in stool morbid obesity chronic systolic heart failure iron deficiency anemia, unspecified other dependence on machines, supplemental oxygen 

Answer: The patient is high likely exposed to