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: patient recorded as having no known allergies to drugs attending: chief complaint: coffee ground emesis major surgical or invasive procedure: egd icu monitoring history of present illness: 73 yo m with a history of cad, dm2, cri, and alcohol abuse who was admitted from the ed for weakness and coffee ground emesis. he initially presented to the ed after his vna found he had fallen to the floor from his bed secondary to weakness, no loc. the patient had vomited "purple liquid" after drinking purple juice the day prior to admission. the patient reported some labored breathing on admission, but denied abdominal or chest pain, nausea, melena, fevers, chills, or nightsweats. in the ed, the patient had witnessed coffee ground emesis and guaiac positive stools, however no gross blood per rectum. his vital signs were stable with bp 130/80 and hr 110s. he refused ng lavage, was started on an octreotide drip for presumed variceal bleed, and iv ppi. he received 500ml of iv fluids. gi was consulted who recommended continuing iv ppi, potentially octreotide gtt given potential for variceal bleed, transfusion of 2 units prbcs. . the patient was transfered to the micu for close monitoring. during his short micu stay, the patient remained hemodynamically stable and hct remained stable. gi did not believe the patient needed to be emergently scoped, thus was postponed. as the patient did not have further episodes of coffee ground emesis, octreotide drip was discontinued and ppi was continued. as the patient has a large diabetic foot ulcer, the patient was given vancomycin and zosyn empirically, podiatry was consulted. past medical history: 1. cad: s/p mi in w/ stent 2. cri: baseline cr 1.5-2.2 3. chronic r foot ulcerations/infections: s/p r metatarsal head resection on , followed by podiatry 4. dm 2: c/b neuropathy, nephropathy, and chronic r foot infections. h/o microalbuminuria 5. h/o dvt w/ l filter 6. pvd 7. h/o squamous cell ca of left posterior auricular area (s/p removal by derm) 8. etoh abuse w/ alcoholic hepatitis 9. h/o cva with residual left foot weakness; mri in likely small acute cortical infarcts involving the right frontal lobe. extensive chronic small vessel infarcts. old right cerebellar infarct. 10. odontoid fracture in with traumatic horner syndrome l social history: 4 oz of vodka every night, 2ppd x60 years, retired builder. patient has never had dts, seizures, or passed out as a result of drinking. he left rehab facility against medical advice and states he lives alone. takes medications on his own with assistance of his visiting nurse (question of whether he has been compliant). as per nurse patient is non compliant with foot care and often walks on open ulcerated foot with no socks. family history: dm-mother, stroke-mother, physical exam: vs - t 96.9 hr 76 bp 131/65 rr 16 o2 sat 100% on ra gen- well nourished, nad heent- ncat. eomi. oropharynx clear. no cervical . mmm cv- rrr. no murmurs. chest- ctab. no wheezes or crackles. poor respiratory effort abd- soft, nt, nd. no masses. no rebound or guarding. no hepatosplenomegaly ext- wwp. no edema. right foot, under first phalynx, large open area, probes to bone. no eschar. cool le. skin- no erythema or spider angiomas. no jaundice or scleral icterus. neuro: alert oriented x3 pertinent results: studies: egd : impression: congestion, erythema and granularity in the gastroesophageal junction compatible with possible barrets esophagus (biopsy) ulcers in the antrum and pylorus (biopsy) the duodenal periampullary region appeared abnormal. i recommend evaluation with ercp to evaluate for possible neoplastic change. otherwise normal egd to third part of the duodenum recommendations: please call my office in weeks in order to obtain the results of your biopsies. please begin prilosec 20 mg po twice a day for 3 months. please start carafate 1 gm by mouth three times a day for 3 months. we will need to repeat an upper endoscopy in 8 weeks, . egd : impression: abnormal mucosa in the esophagus ulcers in the middle third of the esophagus small hiatal hernia ulcers in the antrum and stomach body ulcers in the first part of the duodenum otherwise normal egd to third part of the duodenum recommendations: follow up biopsy results from the recent egd. avoid all nsaids and -2 inhibitors. ppi. recommend prep today for colonoscopy in am for further work up of persistent melena. carafate 1 gram qid for esophagitis. will need a repeat egd in 8 weeks for f/u gastric ulcers and biopsy of the ge junction . colonoscopy: : impression: erythema and possible pseudomembrane in the sigmoid colon and descending colon (biopsy) blood in the cecum - bleeding site could not be identified. poor bowel prep obscured 25% of mucosal view. diverticulosis of the sigmoid colon and descending colon otherwise normal colonoscopy to cecum recommendations: follow-up with inpatient consult team. . ct abd: impression: 1. severe diverticulosis of the sigmoid colon, with mild prominence of the wall and folds of the sigmoid colon. this may be related to hypertrophy. however, there is a trace amount of fluid adjacent to the sigmoid colon. if clinically concordant, this can be seen with diverticulitis. 2. infrarenal abdominal aortic aneurysm with extensive atherosclerotic calcifications. 3. rounded hypodensity in the interpolar region of the right kidney, too small to characterize, likely reflects a cyst. 4. tiny gallstones, without evidence of cholecystitis. 5. honeycombing and pulmonary fibrosis within the visualized lung bases, similar to chest ct . . tagged rbc scan: impression: 1. rectal bleeding likely due to hemmorhoids at 72 minutes. bleeding likely started earlier, although the deep pelvis was not imaged during the first 60 minutes. no other areas of bleeding identified within the abdomen or pelvis. findings discussed with dr. . . cxr: findings: in comparison with study of , there has been placement of a nasogastric tube with its tip in the upper stomach. the side hole is in the region of the esophagogastric junction. little change in the appearance of the heart and lungs with stable diffuse chronic interstitial disease and mild cardiomegaly. . foot x-ray: impression: prominent soft tissue defect at both the plantar and medial soft tissues about the first mtp joint with an associated lucency and ossific fragment along the medial aspect of the base of proximal first phalanx that is highly concerning for osteomyelitis from adjacent known soft tissue ulcer. . cxr: impression: limited study. no gross acute cardiopulmonary process with unchanged diffuse chronic interstitial lung disease and right-sided volume loss. . lab results: 05:09pm blood wbc-22.0*# rbc-3.53*# hgb-10.4*# hct-32.4*# mcv-92 mch-29.5 mchc-32.2 rdw-17.4* plt ct-678*# 09:21pm blood wbc-21.6* rbc-3.29* hgb-9.7* hct-29.8* mcv-91 mch-29.5 mchc-32.6 rdw-16.7* plt ct-610* 06:30am blood wbc-19.2* rbc-3.39* hgb-9.9* hct-30.0* mcv-88 mch-29.2 mchc-33.1 rdw-16.8* plt ct-506* 05:05am blood wbc-26.2* rbc-3.25* hgb-9.6* hct-28.8* mcv-89 mch-29.5 mchc-33.3 rdw-16.9* plt ct-460* 06:40am blood wbc-24.4* rbc-3.47* hgb-10.1* hct-30.7* mcv-88 mch-29.1 mchc-33.0 rdw-17.0* plt ct-431 06:30am blood wbc-25.8* rbc-3.46* hgb-10.2* hct-31.5* mcv-91 mch-29.6 mchc-32.5 rdw-17.4* plt ct-459* 06:30am blood wbc-22.1* rbc-3.09* hgb-8.9* hct-27.4* mcv-89 mch-28.8 mchc-32.4 rdw-16.9* plt ct-464* 06:30am blood wbc-19.8* rbc-3.25* hgb-9.6* hct-29.0* mcv-89 mch-29.6 mchc-33.2 rdw-16.9* plt ct-486* 06:30am blood wbc-20.2* rbc-2.70* hgb-8.0* hct-23.7* mcv-88 mch-29.5 mchc-33.6 rdw-16.5* plt ct-470* 05:19am blood wbc-11.6* rbc-2.95* hgb-8.7* hct-25.3* mcv-86 mch-29.4 mchc-34.3 rdw-16.7* plt ct-436 05:56am blood wbc-11.9* rbc-3.29* hgb-9.6* hct-27.8* mcv-85 mch-29.3 mchc-34.6 rdw-16.5* plt ct-373 06:42am blood wbc-13.4* rbc-2.95* hgb-8.8* hct-25.7* mcv-87 mch-29.7 mchc-34.2 rdw-16.3* plt ct-347 05:48am blood wbc-13.6* rbc-3.39* hgb-10.2* hct-29.4* mcv-87 mch-30.2 mchc-34.8 rdw-17.1* plt ct-343 05:38am blood wbc-12.7* rbc-3.44* hgb-10.0* hct-30.0* mcv-87 mch-29.2 mchc-33.5 rdw-17.0* plt ct-326 09:00am blood wbc-9.0 rbc-3.20* hgb-9.5* hct-27.9* mcv-87 mch-29.8 mchc-34.1 rdw-16.5* plt ct-325 06:09am blood wbc-9.1 rbc-3.00* hgb-8.8* hct-26.1* mcv-87 mch-29.2 mchc-33.6 rdw-16.7* plt ct-334 02:02pm blood pt-16.0* ptt-35.8* inr(pt)-1.4* 09:26pm blood pt-14.7* ptt-33.0 inr(pt)-1.3* 05:56am blood pt-15.1* ptt-34.2 inr(pt)-1.3* 05:48am blood pt-14.5* ptt-32.5 inr(pt)-1.3* 03:55pm blood pt-14.2* ptt-31.7 inr(pt)-1.2* 03:45pm blood pt-14.1* ptt-30.7 inr(pt)-1.2* 05:09pm blood urean-69* creat-2.7*# na-138 k-5.1 cl-105 hco3-17* angap-21* 09:21pm blood glucose-181* urean-71* creat-2.8* na-138 k-5.6* cl-106 hco3-22 angap-16 06:30am blood glucose-110* urean-66* creat-2.7* na-141 k-5.2* cl-110* hco3-20* angap-16 05:05am blood glucose-70 urean-57* creat-2.3* na-143 k-4.3 cl-114* hco3-21* angap-12 06:40am blood glucose-60* urean-41* creat-1.7* na-144 k-4.1 cl-115* hco3-20* angap-13 06:30am blood glucose-66* urean-34* creat-1.7* na-143 k-3.9 cl-113* hco3-20* angap-14 06:30am blood glucose-109* urean-30* creat-1.8* na-142 k-3.9 cl-113* hco3-20* angap-13 06:30am blood glucose-127* urean-25* creat-1.8* na-141 k-3.8 cl-113* hco3-19* angap-13 06:30am blood glucose-133* urean-24* creat-1.9* na-139 k-4.2 cl-111* hco3-18* angap-14 05:19am blood glucose-137* urean-22* creat-1.8* na-141 k-4.2 cl-114* hco3-20* angap-11 05:56am blood glucose-126* urean-16 creat-1.5* na-143 k-3.5 cl-115* hco3-21* angap-11 06:42am blood glucose-117* urean-16 creat-1.5* na-144 k-3.7 cl-116* hco3-21* angap-11 06:42am blood glucose-117* urean-16 creat-1.5* na-144 k-3.7 cl-116* hco3-21* angap-11 05:48am blood glucose-87 urean-14 creat-1.4* na-143 k-3.5 cl-116* hco3-21* angap-10 05:38am blood glucose-106* urean-11 creat-1.2 na-142 k-3.2* cl-113* hco3-20* angap-12 05:38am blood glucose-106* urean-11 creat-1.2 na-142 k-3.2* cl-113* hco3-20* angap-12 09:00am blood glucose-142* urean-11 creat-1.4* na-141 k-3.9 cl-115* hco3-19* angap-11 06:09am blood glucose-168* urean-11 creat-1.2 na-144 k-4.3 cl-117* hco3-19* angap-12 09:21pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg brief hospital course: 73 yo m with a history of dm type 2, cad, cri, cva, alcohol abuse, but no known history of liver disease, who presented for a gi bleed. . # gi bleed: likely upper gi bleed as source of bleed given coffee ground emesis and brown guaiac positive stool, developed into melena during hospital course. over the course of the hospitalization the patient had melena daily with daily hct drops requiring a total of 10 untis of prbcs, the last of which he received on . however the patient's blood pressure remained stable during hospitalization. the patient had multiple diagnostic studies done during the hospitalization included two egds, a colonoscopy, ct abd/pelvis, and tagged red blood cell scan. the two egds showed peptic ulcer disease, gastritis, possible barrett's esophagus and a lesion at in the duodenal periampullary region concerning for malignancy. none of these lesions were bleeding during either egd. as neither of these egds showed evidence of active bleeding, a colonoscopy was done the following week which showed pseudomembranes and diverticulosis, as well as blood in the cecum, but no clear source of bleeding. the patient was thought to possibly have a small bowel source of bleeding, and was referred for capsule endoscopy, however the patient was unable to swallow the capsule. instead the patient had a tagged red blood cell scan and ct abdomen/pelvis which did not show conclusive evidence of acute bleeding. the presumed source was then determined to be multifactorial from the patient's peptic ulcer disease, gastritis and c diff colitis. the patient was hemodynamically stable without evidence of persistent melena for four days prior to discharge. his hct reached a baseline of high 20s to low 30s and did not change during this time. the patient will need to be seen by gi in four weeks to discuss possible repeat egd and ercp to evaluate periampullary duodenal mass. the patient was continued on sucralfate 1gm tid and pantoprazole 40mg , he should continue on these medications on discharge. . # c difficile colitis: diagnosed on . the patient had significant leukocytosis on admission and large loose stools. the patient had been empirically started on flagyl for his left foot osteomyelitis given previous history of infection with anaerobic bacteria. when the c diff toxin came back positive the flagyl was changed to po. the patient should be continued on flagyl for 7 days following the discontinuation of his antibiotic course for osteomyelitis. end date . . # osteomyelitis: patient had a large ulcerated lesion on r first metatarsal where the joint capsule and bone was exposed, with some drainage on admission. podiatry was consulted during admission. he was last seen by podiatry 2 weeks ago, where he was noted to have exposed joint capsule, and poor wound care. the did not believe the joint had an acute infection, however x-ray showed evidence of osteomyelitis. on patient was admitted with r hallux infection, then wound culture grew out enterobacter cloacae and was treated with cipro and vancomycin. has a history of chronic foot infections, non compliance with antibiotics and wound care. the patient was treated with vancomycin and zosyn initially, then changed to vanc/cipro/flagyl for coverage of mrsa and gnr in wound. as the gnr turned out to be e coli which was resistant to cipro, the patient was changed to ceftriaxone. the staph species was found to be sensitive to penicillin, but given his history of mrsa, he was continued on vancomycin. as the patient has a history of renal insufficiency, vancomycin levels were monitored. he was only supratherapeutic on two occassions. these leves should be monitored periodically during his stay at rehab and his dose adjusted accordingly. the end date for the vancomycin and ceftriaxone should be . at that time he should change to bactrim 1ds po bid and cefpodoxime 400 mg po bid for an additional 14 days (end date ). . # acute on chronic renal failure: cr on admission 2.7. baseline 1.6-2.0. likely prerenal in etiology given gi bleed. fena was 4%, consistent with atn or diabetic nephropathy. the renal failure improved with fluids. it was stable prior to discharge. . # alcohol abuse: as an outpatient the patient drinks 4oz of vodka daily. no history of dts, seizures, black outs. the patient was managed on ativan prn ciwa score >10 initially, but was discontinued the first week of his hospitalization. he was also initially placed on seizure and aspiration precautions. he was started on a mvi, folate, thiamine daily. he was given trazodone as needed for insomnia. social work was consulted. . # hyperkalemia: the patient has a history of hyperkalemia. this was likely secondary to the patient's acute on chronic renal failure, and ace i therapy. the patient's ace-i was discontinued and his hyperkalemia resolved. he should not be restarted on an ace-i as an outpatient. . # cad: history of mi in with stent placed. the patient's asa, bb and lisinopril were all held in the setting of a gi bleed. the patient was continued on atorvastatin. he was able to be restarted on metoprolol 12.5mg without a drop in his blood pressure. ace-i should not be restarted given hyperkalemia. . # type 2 diabetes mellitus: the patient has uncontrolled dm, complicated by neuropathy, nephropathy, chronic foot infections. the patient takes glipizide at home, however was discontinued during his hospital stay. the patient was managed on humalog insulin sliding scale instead with decent control of his blood sugars. . medications on admission: glipizide 2.5 mg po daily metoprolol 50mg po bid asa 81mg po daily atorvastatin 20mg po daily pantoprazole 40mg po daily cilostazol 100mg po bid lisinopril 5mg po daily unclear whether patient is to be taking abx for right foot chronic infection discharge medications: 1. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 2. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 3. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed. 6. b-complex with vitamin c tablet sig: one (1) tablet po daily (daily). 7. sucralfate 1 gram tablet sig: one (1) tablet po tid (3 times a day). 8. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 9. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours): please continue until . tablet(s) 10. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous q 24h (every 24 hours): please continue for until . please check a vancomycin trough twice a week and adjust dose accordingly. 11. ceftriaxone in dextrose,iso-os 1 gram/50 ml piggyback sig: one (1) intravenous q24h (every 24 hours): please continue until . 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 13. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day): hold for sbp < 90, hr < 50. 14. insulin lispro 100 unit/ml solution sig: per sliding scale subcutaneous four times a day. 15. outpatient lab work results, goal should be > 25. please check vancomycin trough twice a week. please contact on md with results. goal should be < 20. 16. clarithromycin 500 mg tablet sig: one (1) tablet po twice a day for 10 days: for h pylori infection. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary diagnoses: upper gi bleed secondary to peptic ulcer disease, h pylori gastritis c diff colitis osteomyelitis . secondary diagnoses: type 2 diabetes mellitus coronary artery disease renal insufficiency peripheral vascular disease alcohol abuse history of cva discharge condition: the patient was alert and oriented, hemodynamically stable and afebrile prior to discharge. discharge instructions: you were admitted to for evaluation of vomiting blood. you were found to have an ulcer in your intestines and inflammation of the lining of your stomach. these were determined to likely be the cause of your bleeding. you also were found to have an infection in your colon called c difficile. you were put on antibiotics for this infection. you were also found to have an infection called h pylori in your stomach, you will be treated for this infection as well. you were also found to have an infection in the bone of your foot. you were treated with antibiotics for this as well. . you will have to continue the iv and by mouth antibiotics for some time following discharge: flagyl 500mg three times a day end date ciprofloxacin 500mg twice a day iv end date vancomycin 1gm once a day, dosed renally by level end date clarithromycin 500mg twice a day end date . these other medications were added: sucralfate 1gm three times a day pantoprazole 40mg twice a day . these medications were stopped: aspirin lisinopril glipizide . these medications were changed: metoprolol decreased to 12.5mg twice a day . if you experience bright red blood per rectum, dark or black stools, abdominal pain, fever, chills, chest pain or any other worrisome symptoms please seek medical attention. followup instructions: please follow up with your primary care physician . in the next 1-2 weeks. the phone number to her office is . . please follow up with the gi physician, . , on friday :45pm on the on the of the . the number to reschedule this appointment is (. . please follow up with dr. in podiatry on at 1:10pm. the number to reschedule the appointment is ( procedure: venous catheterization, not elsewhere classified esophagogastroduodenoscopy [egd] with closed biopsy esophagogastroduodenoscopy [egd] with closed biopsy closed [endoscopic] biopsy of large intestine transfusion of packed cells local excision of lesion or tissue of bone, tarsals and metatarsals diagnoses: hyperpotassemia nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere coronary atherosclerosis of native coronary artery acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified polyneuropathy in diabetes peripheral vascular disease, unspecified percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified ulcer of other part of foot personal history of other malignant neoplasm of skin other late effects of cerebrovascular disease intestinal infection due to clostridium difficile old myocardial infarction chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction personal history of venous thrombosis and embolism barrett's esophagus helicobacter pylori [h. pylori] other and unspecified alcohol dependence, continuous atherosclerosis of native arteries of the extremities with ulceration acute alcoholic hepatitis acute osteomyelitis, ankle and foot long-term (current) use of aspirin diabetes with neurological manifestations, type ii or unspecified type, uncontrolled diabetes with renal manifestations, type ii or unspecified type, uncontrolled diabetes with peripheral circulatory disorders, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to