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: past medical history: 1. cerebrovascular accident with right hemiparesis and expressive aphasia. 2. vascular dementia. 3. degenerative joint disease. 4. hypertension. 5. atrial fibrillation, status post pacemaker for sick sinus syndrome. 6. chronic pain syndrome. 7. lower gastrointestinal bleed in with diverticuli and external hemorrhoids. egd in for dysphagia showed no evidence of ulcerations or varices. 8. depression. 9. hematuria with negative cystoscopy in . 10. history of syncopal event status post pacemaker placement. 11. complex partial seizure disorder with an eeg on , negative for epileptiform activity, positive for multifocal subcortical dysfunction related to cerebrovascular disease. 12. positive ppd since . 13. diastolic chf with a transthoracic echocardiogram in showing an ef of 70%. medications on transfer to rehabilitation: 1. tylenol 650 mg q. six hours. 2. artificial tears two drops o.u. b.i.d. 3. aspirin 81 mg p.o. q.d. 4. ritalin 2.5 mg q.d. 5. neurontin 50 mg q.h.s. 6. senna two tablets. 7. sorbitol 15 cc q.d. 8. depakote 625 mg p.o. b.i.d. allergies: 1. tetanus toxoid. 2. penicillin. 3. levaquin. 4. bacitracin. family history: noncontributory. social history: the patient is a permanent resident at the . she is dependent in all adls. she is dnr/dni. physical examination on admission: vital signs on presentation to the emergency department: temperature 96.9, blood pressure 89/50 which increased to 102/49 with 2 liters of intravenous fluid; however, dropped after two large episodes of lower gi bleed to systolics in the 60s, heart rate went from 70 to 120, respiratory rate 18, oxygen saturation 98% on 2 liters. general: the patient is noncommunicative, responds to some commands. heent: the oropharynx was clear. the mucous membranes were dry. the neck was supple without any lymphadenopathy. heart: regular rate to tachycardiac with no murmurs, rubs, or gallops appreciated. lungs: clear to auscultation bilaterally. abdomen: mildly distended with normoactive bowel sounds. she had no masses. her peg tube was clean, dry, and intact in the left upper quadrant. extremities: there were 2+ bilateral lower extremity edema at baseline. skin: intact without any rash. neurologic: she does not follow any commands, nonverbal. rectal: bright red blood and clots which were present in the patient's diaper. there was active extravasation of blood from the rectum. laboratory/radiologic data: on admission, hematocrit initially 31.5 which fell to 24 after two large extravasations of blood from her rectum. white count 10.5, platelets 272,000. sodium 140, potassium 5.7, chloride 105, bicarbonate 30, bun 29, creatinine 0.7, glucose 97. pt 12, ptt 32, inr 1.0. urinalysis performed showed large blood, nitrate positive, trace protein, many bacteria, whites with preliminary urine cultures growing out enterococcus. chest x-ray showed no evidence of aspiration with diffuse hazy increased opacity throughout the right main thorax compared to left which was thought to be technical artifact. there is no evidence of infiltrate on the limited study. impression: this is a 75 nursing home resident with multiple medical problems, as described above, who was admitted to the medical intensive care unit for large volume lower gi bleed thought secondary to diverticuli. hospital course: 1. gastrointestinal bleed: the patient was initially resuscitated in the medical intensive care unit with 7 units of packed red blood cells as well as 7 units of crystalloid. she was transiently on dopamine down in the emergency department and switched to neo-synephrine upon admission to the medical intensive care unit. her pressors were discontinued and her blood pressure remained stable after transfusion. the patient had a small episode of repeat bleeding episode at 2:00 p.m. on . the gastroenterology service who had been previously following her were contact and recommended embolization by interventional radiology. on , at 5:00 p.m., the patient was taken to interventional radiology who showed an active bleed in a small peripheral branch of the inferior mesenteric artery which supplied the distal descending colon. this bleeding artery was catheterized and embolized with a coil. follow-up angiogram after the embolization showed no evidence of extravasation of contrast material consistent with successful embolization of the bleeding site. after embolization, ms. had no repeat episodes of significant gi bleed although she continued to have some oozing of bright red blood which was thought consistent with residual from her prior bleed. hematocrit trended down slowly after her procedure and she was transfused an additional 5 units of packed red blood cells throughout her hospital stay. in total, ms. required 12 units of packed red blood cells during her hospital stay. of these, approximately 9 units were required for stabilization and an additional 3 units required to stabilization prior to her embolization and approximately 3 units were needed postembolization. she was placed on protonix for prevention of recurrent bleeding episodes. 2. congestive heart failure: per transthoracic echocardiogram in , the patient has a history of diastolic chf. throughout her hospital stay despite significant volume resuscitation the patient remained with stable oxygen saturations and chronic lower extremity edema at her baseline. she did not require any diuresis. 3. urinary tract infection: although the patient has a chronic indwelling foley and has had multiple recurrent urinary tract infections in the past, a urinalysis was sent on presentation due to what appeared to be excessive sediment in her foley catheter. the urine culture grew out preliminarily enterococcus. however, the ph of the urine was 9. she was started on a course of bactrim on for plans to complete a seven day course for a complicated uti. at her rehabilitation facility, the results of the urine culture including sensitivities of the enterococcus as well as possible presence of proteus should be followed-up. if proteus is found, the team suggests starting aztreonam in addition to the bactrim for improved coverage. 4. code status: on admission, the patient was initially dnr/dni which was confirmed by her son, health care proxy. to the critical nature of her condition, upon arrival to the micu, she was placed on cmo status and pressors at that point were discontinued as she appeared hemodynamically stable off pressors and without blood products. the feeling of the medical team as well as the family were to reverse the cmo status as she became more interactive. later that day, with the recurrent bleed, she was sent for embolization and, as described above, did very well after the procedure. currently, she is still dnr/dni. health care proxy is , phone number . 5. thrombocytopenia: on admission, the patient's platelets were 272,000. however, this trended down to 92,000 at the time of this dictation. it is unclear what her thrombocytopenia is from; however, this was felt either a component of dilutional due to significant amount of blood products and fluid she received versus any medication side effects. her only new medication is protonix which is not a common cause of thrombocytopenia; however, this could be discontinued should her thrombocytopenia not improve at rehabilitation. condition on discharge: stable. discharge diagnosis: 1. massive lower gastrointestinal bleed requiring 12 units of packed red blood cells. 2. status post embolization of branch of inferior mesenteric arteries supplying distal descending colon. 3. history of cerebrovascular accident with residual hemiparesis and aphasia. 4. vascular dementia. 5. history of diastolic congestive heart failure. 6. enterococcal urinary tract infection, possible proteus urinary tract infection. discharge medications: 1. depakote 625 mg p.o. b.i.d. 2. tylenol 650 mg p.r.n. 3. artificial tears, two drops o.u. b.i.d. 4. ritalin 2.5 mg p.o. q.d. 5. remeron 50 mg q.h.s. 6. protonix 40 mg p.o. q.d. 7. bactrim 20 cc p.o. b.i.d. started on to complete a seven day course. discharge disposition: the patient is to be discharged back to where she is a permanent resident. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified injection or infusion of other therapeutic or prophylactic substance arteriography of other intra-abdominal arteries transfusion of packed cells anoscopy diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified atrial fibrillation other convulsions other late effects of cerebrovascular disease late effects of cerebrovascular disease, hemiplegia affecting unspecified side diastolic heart failure, unspecified diverticulosis of colon with hemorrhage late effects of cerebrovascular disease, aphasia 

Answer: The patient is high likely exposed to