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: penicillins / zestril / diovan / hydrochlorothiazide / univasc / verapamil / cimetidine / bactrim / ketoconazole attending: chief complaint: hematochezia major surgical or invasive procedure: colonoscopy s/p epinephrine injections, three clips placed history of present illness: 80 year old cantonese woman with history of paroxysmal atrial fibrillation on coumadin, tachybrady syndrome s/p pacemaker placement, coronary artery disease, hypertension, bladder tumor, amiodarone induced pulmonary fibrosis, hemorrhoids and temporal lobe epilepsy (single seizure ) who presents with bright red per rectum. the patient developed painless rectal bleeding at 3pm and proceeded to have four bowel movmeents mixed with clots, the last two with loose stools. the patient's last bloody, clotted bowel movement was at 9pm before presenting to the ed. the patient endorsed "very active belly rumbling" but no frank crampy abdominal pain. she has chronic constipation at baseline and takes metamucil, occasionally sennakot. she underwent colonoscopy on with transverse colon polypectomy. the patient denied dizziness, chest pain, shortness of breath, decreased appetite. . in the ed, initial vitals were: t96.9, bp168/62, rr18, hr66, 97% on ra. the patient was admitted to the medicine service where she developed sensation of bloating at midnight and proceeded to "fill the toilet bowl" with , her daughter. the patient continued to "leak clots" per rectum at 4:30 am onto a pad. she was transfused one unit of prbc at 4:30am. she continued to bleed bright red , clotted , mixed with loose stools at 6am, 7am, 9am, 10:45am, 11am. she received another unit of prbc at 8:30am. the micu was called to evaluate the patient in the setting of ongoing bleeding and she passed two more bowel movements with loose stools (~250cc each time) at 12:30 pm and 1:30pm. the patient continued to deny dizziness, chest pain, shortness of breath, abdominal pain/discomfort. she did endorse some mild positional dizziness when going to the commode the last two times. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. past medical history: # paroxysmal a-fib/flutter/tachy s/p multiple cardioversions - followed by dr - on coumadin and dofetilide - prior amio, but stopped d/t pulmonary and thyroid toxicity - post-cardioversion pulmonary edema -status post dual-chamber pacemaker in the setting of tachybrady syndrome with a junctional rhythm. # valvular disease - followed by dr. . # cad - cardiac cath in with 2vd, mild mr, mod systolic and diastolic dysfunction # transient chf in setting of lad ischemia # hypertension - multi-drug resistent # bladder tumor - ctu on with likely tcc, s/p cystoscopy and cystoscopy for excision, most recent excision on # h/o + ppd # amiodarone induced pulmonary fibrosis - restrictive ventilatory defect in with fev1/fvc on 115% predicted # adrenal adenoma () # hemorrhoids # constipation # h/o pulmonary edema () # chronic pericardial effusions - not amenable to bx, no tamponade # temporal lobe epilepsy with single seizure () and none since with carbamazepine therapy # gastritis (hx h.pylori) social history: cantonese speaking woman who lives in with husband. she denies etoh, tobacco or illicit drugs. pt is accompanied by daughter who serves as translator. reports that she has no difficulty completing adls on her own, and that she has significant support at home from her husband. family history: no known family history of disease physical exam: admission physical exam: vitals: tm 98.0, tc 96.5, bp: 143/61 (105/52 on admission), p: 60, r: 18 o2: 98% on ra general: alert, oriented, no acute distress, mildly anxious heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes/rales/rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs/rubs/ gallops abdomen: soft, non-tender, non-distended, bowel sounds present (hyperactive), no rebound tenderness or guarding, no organomegaly skin: streaks of ecchymosis across back bilaterally and left antecubital region coining per patient gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: chemistry: 06:40am glucose-102* urean-9 creat-0.8 na-142 k-4.1 cl-105 hco3-28 angap-13 09:20am glucose-166* urean-9 creat-0.7 na-141 k-3.5 cl-106 hco3-25 angap-14 12:03am glucose-98 urean-15 creat-0.7 na-137 k-3.9 cl-106 hco3-25 angap-10 12:52pm glucose-106* urean-16 creat-0.7 na-140 k-4.0 cl-108 hco3-26 angap-10 08:00pm glucose-228* urean-19 creat-0.9 na-135 k-5.6* cl-100 hco3-30 angap-11 06:40am calcium-8.8 phos-3.5 mg-2.1 . coagulation profile: 06:40am pt-12.8 inr(pt)-1.1 12:03am pt-16.5* ptt-32.5 inr(pt)-1.5* 08:00pm pt-25.5* ptt-32.9 inr(pt)-2.4* . complete count: 06:40am wbc-5.4 rbc-3.06* hgb-10.2* hct-27.9* mcv-91 mch-33.2* mchc-36.4* rdw-16.1* plt ct-125* 09:20am wbc-6.4 rbc-2.90* hgb-9.6* hct-26.7* mcv-92 mch-33.0* mchc-35.9* rdw-16.0* plt ct-120* 03:30am hct-25.9* 09:00pm hct-27.6* 05:00pm hct-27.3* 06:00am hct-25.5* 12:03am wbc-7.6 rbc-2.94* hgb-10.0* hct-26.6* mcv-90 mch-33.8* mchc-37.5* rdw-16.0* plt ct-92* 05:47pm wbc-9.1 rbc-2.83* hgb-9.6* hct-25.7* mcv-91# mch-33.8* mchc-37.2* rdw-16.2* plt ct-103* 12:52pm hct-22.7* 02:38am hct-24.7* 08:00pm wbc-6.7 rbc-2.93* hgb-10.4* hct-28.9* mcv-99* mch-35.5* mchc-36.0* rdw-13.1 plt ct-171 . ekg sinus rhythm with left ventricular hypertrophy and repolarization abnormalities. compared to the previous tracing of no diagnostic change. . intervals axes rate pr qrs qt/qtc p qrs t 68 194 102 442/456 55 8 90 . micro: 6:00 am mrsa screen nasal swab. mrsa screen (final ): no mrsa isolated. . images: colonoscopy findings: protruding lesions a single sessile 1 cm polyp was found in the transverse colon. a single-piece polypectomy was performed using a hot snare in the transverse colon. the polyp was completely removed. a single sessile 5 mm polyp was found in the transverse colon. a single-piece polypectomy was performed using a cold snare in the transverse colon. the polyp was completely removed. excavated lesions several diverticula were seen in the whole colon. impression: polyp in the transverse colon (polypectomy) diverticulosis of the whole colon polyp in the transverse colon (polypectomy) otherwise normal colonoscopy to cecum recommendations: follow-up biopsy results colonoscopy in 3 years high fiber diet . colonoscopy the site of a previously removed polyp was identified in the transverse colon. the site was 1cm-wwide approximately, and actively oozing. 4 5 cc. epinephrine 1/ injections were applied for hemostasis with success. three endoclips were successfully applied for the purpose of hemostasis at the bleeding site. after careful washing of the area and further observation for 3-4 minutes, no further bleeding was seen. otherwise normal colonoscopy to cecum . . polypectomy pathology: . diagnosis: colon polyps, polypectomies: . a. transverse polyp: adenoma. . b. transverse: aggregates of bacterial forms consistent with actinomyces. no colonic tissue seen. brief hospital course: 80 year old woman with history of atrial fibrillation on coumadin, tachy-brady syndrome s/p pacemaker, coronary artery disease, hypertension, bladder tumor, amiodarone-induced pulmonary fibrosis, hemorrhoides, chronic pericardial effusions, temporal lobe epilepsy who presents with bright red per rectum status post colonoscopy with polypectomy. see below for detailed hospital course by issues. . # acute anemia/ loss from lower gi bleed patient presented with with clots per rectum and crampy abdominal pain likely due to lower gi bleed rather than from an upper gi source. she was transfused two units of packed red cells in the emergency department. her vitals in the ed and on transfer were normal and stable, but her inr was therapeutic for atrial fibrillation at 2.4. while on the floor she continued to have bright red clots from bowel movements every hour. she was transferred to the intensive care unit where repeat colonoscopy identified an actively oozing source in the transverse colon from a site consistent with recent polypectomy from . she received epinephrine and 3 endoclips were placed, all at the bleeding site. she received 5mg iv vitamin k for inr reversal to 1.5. subsequently, she was transferred back to the floor in stable conditions without further bleeding episodes. on the floor her hematocrit trends were 27.3 --> 27.8 --> (received 1 liter normal saline) --> 25.9 --> 26.7. as she left the hospital, she was hemodynamically stable and had no more grossly bloody stools. patient will have repeat pt/inr performed at primary care clinic on thursday . coumadin was resumed the day prior to discharge. . # atrial fibrillation the patient was paced at hr 60, which could mask a hemodynamic response to ongoing bleed. she is status post multiple cardioversions which was complicated by pulmonary edema. she took amiodarone but developed pulmonary fibrosis and had a history of thyroid aberrations. instead, she has been taking dofetilide with close electrolyte monitoring. she is on both aspirin and coumadin. her inr was therapeutic at 2.4 on admission but was reversed to 1.5 with vitamin k in the icu. on transfer she had one episode of atrial fibrillation with rapid ventricular response, which lasted only minutes before spontaneously returning to sinus rhythm. she was asymptomatic and normotensive through the entire episode. this episode was thought to be related to holding her metoprolol during the icu stay from concerns for hypovolemia. metoprolol tartrate was restarted on the medicine floor. she was in sinus rhythem with heart rate in the 60s throughout the remainder of her stay. as she left the hospital, she was on all home medications including warfarin, and had stable vital signs. inr on discharge was 1.1 and patient will resume home dose of coumadin, with inr check on thurday, , with pcp. . # actinomyces infection pathology reports from colonoscopy revealed actinomyces involvement from one of the samples from transverse colon. infectious diseases was consulted and will touchbase with the gi attending who performed the repeat colonoscopy prior to making treatment decisions. patient was discharged with a script for doxycycline, to be filled once dr. contacts the patient's family in the outpatient setting. . # hypertension her antihypertensives were held in setting of bleed. her home furosemide was held throughout the hospital stay but was restarted on discharge. . # tachybrady syndrome stable, with pacemaker . # coronary artery disease held felodipine, losartan and aspirin during lgib. all home medications resumed on discharge. . # temporal lobe epilepsy no episodes since . continued carbamazepine . # bladder tumor chronic, stable . # gastritis history of h.pylori, presumed treated. bleeding during this hospitalizatino was not consistent with brisk upper gi bleed. . transitional issues: - follow up with pcp for pt/inr on - follow up with infectious diseases regarding doxycycline treatment for actinomyces medications on admission: * carbamazepine 200mg daily * clonazepam 0.5mg qam, 1mg qhs * dofetilide 250mg daily * felodipine 10mg er daily * losartan 100mg daily * trazodone 50mg qhs * warfarin 5mg daily * aspirin 81mg daily * calcium citrate-vitamin d3 daily * metamucil daily discharge medications: 1. warfarin 5 mg tablet sig: as directed tablet po as directed: one pill (5mg) daily for six days per week, half pill (2.5mg) for one day per week. 2. carbamazepine 200 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po daily (daily). 3. dofetilide 250 mcg capsule sig: one (1) capsule po q12h (every 12 hours). 4. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 5. losartan 50 mg tablet sig: two (2) tablet po daily (daily). 6. calcium citrate + d oral 7. metamucil oral 8. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 9. felodipine 2.5 mg tablet extended release 24 hr sig: four (4) tablet extended release 24 hr po daily (daily). 10. clonazepam 0.5 mg tablet sig: two (2) tablet po qhs (at bedtime). 11. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 12. furosemide 20 mg tablet sig: one (1) tablet po qam. 13. bloodwork please have pt/inr test on thursday, . please send results to dr. , (, phone ). 14. doxycycline hyclate 100 mg capsule sig: one (1) capsule po twice a day for 30 days. disp:*60 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnosis: 1. hematochezia, per rectum 2. atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , . it was a pleasure taking care of you during your stay at . you were admitted to the hospital because you began to pass bright red from the rectum. this is likely due to your recent colonoscopy when two polyps were removed from your colon, and you began to bleed from one site. you were monitored closely in the intensive care and underwent urgent colonoscopy. the gi team placed three clips, which stopped your bleeding. you were also given vitamin k, which reverses the effects of coumadin on your ability to clot. you were then transferred back to the inpatient floor, where your red cell levels (hematocrit) stabilized. while your coumadin was held during your icu stay, it was restarted one day prior to your discharge. you were discharged after your vital signs stabilized and your stool stopped showing visible . . the pathology report for your colonoscopy showed some bacteria growth on the colonic polyps. infectious disease experts were called and they recommend no acute intervention. . medication changes: - none . please seek medical attention for any concerning symptoms. please attend your appointments below. please have inr checked with dr. at upcoming visit on thursday, . weigh yourself every morning. please call your doctor if your weight increases by more than three pounds. medication added: you have been given a prescription for :doxycycline 100mg twice daily for one month. *** please do not start taking this medication until you have spoken to dr . followup instructions: department: when: thursday at 10:10 am with: , m.d. building: campus: east best parking: garage md, procedure: endoscopic destruction of other lesion or tissue of large intestine diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension acute posthemorrhagic anemia atrial fibrillation hemorrhage complicating a procedure other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure postinflammatory pulmonary fibrosis long-term (current) use of anticoagulants personal history of malignant neoplasm of bladder cardiac pacemaker in situ localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy cardiac rhythm regulators causing adverse effects in therapeutic use actinomycotic infection of other specified sites 

Answer: The patient is high likely exposed to