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: history of present illness: the patient is an 83-year-old male with a past medical history significant for noninsulin dependent diabetes mellitus, paroxysmal atrial fibrillation status post pacer, benign prostatic hypertrophy, and chronic renal insufficiency, with a recent hip fracture status post open reduction and internal fixation who, while on coumadin (inr equal to 3.5), developed an upper gastrointestinal bleed. the patient was admitted to an outside hospital on with complaint of epigastric pain, hematemesis, and melena, with an initial hematocrit of 31.5. the patient had an upper endoscopy on , with evidence of clot and bright red blood, however, the source of bleeding could not be localized. the patient went to the operating room on , where he underwent a laparotomy, gastrotomy and oversew of several gastric erosions. a jejunostomy tube was also placed at this time. the patient was reportedly stable from through , without evidence of recurrent bleed. on , the patient again had several bouts of melena with signs of confusion and lethargy and an acute drop in his hematocrit from 30 to 22. a nasogastric lavage was positive for active bleeding, and the patient was transfused two units of packed red blood cells. he remained hemodynamically stable, and again underwent an upper endoscopy which demonstrated diffuse gastritis. the patient was transferred to at this time as a result of deteriorating condition and intractable bleeding. prior to admission, the patient had also received a seven day course of vancomycin and tequin for a "polymicrobial bacteremia," with unclear source. subsequent blood cultures were reportedly negative. on arrival, the patient was found hemodynamically stable and asymptomatic, without evidence of active bleeding. he denied abdominal pain, chest pain, as well as lightheadedness/dizziness. the patient was admitted to the intensive care unit for close monitoring. past medical history: hypertension, paroxysmal atrial fibrillation status post pacemaker placement, chronic renal insufficiency, lacunar strokes, cholecystectomy, type 2 diabetes mellitus, left hip fracture with open reduction and internal fixation on , benign prostatic hypertrophy status post transurethral resection of prostate. medications on transfer: protonix 40 mg intravenously every 12 hours, levofloxacin 250 mg by mouth once daily, flagyl 500 mg by mouth every eight hours, metoprolol 25 mg by mouth twice a day, hydralazine 25 mg intravenously every six hours, timolol 0.25% one drop to each eye twice a day, haldol 0.5 mg intravenously every six hours as needed, ativan 0.5 to 1 mg intravenously every four hours as needed, oxycodone 5 mg by mouth every four hours as needed. allergies: include penicillin and aspirin. social history: the patient lives in with his wife of 55 years, has two sons. has a 30 to 45 pack year tobacco history, quit in , with occasional alcohol use. family history: noncontributory. physical examination: on admission, temperature 98.5, heart rate 70, respiratory rate 25, blood pressure 116/47, oxygen saturation 96% on room air. in general, the patient is a pleasant, thin, elderly male, who is alert but not oriented to place or date, in no acute distress. head, eyes, ears, nose and throat examination: normocephalic, atraumatic, pupils equal, round and reactive to light and accommodation, extraocular movements intact bilaterally, oropharynx clear, edentulous. neck: supple, full range of motion, with a right internal jugular venous catheter in place. no lymphadenopathy, no jugular venous distention noted. pulmonary examination notable for decreased breath sounds at the left base, otherwise clear to auscultation bilaterally, no wheezes, rales or rhonchi. cardiovascular examination: irregularly irregular heart rate with normal s1, s2, and a ii/vi systolic ejection murmur at the left lower sternal border, no rubs or gallops noted. abdominal examination: soft, nontender, decreased bowel sounds throughout, with a jejunostomy tube in place and a recent vertical scar from the epigastric region to the peripubic region, clean, dry and intact. extremities: trace ankle edema, 2+ pulses, and warm and well perfused. neurologic examination notable for alert, awake and oriented to name only, motor strength, sensation grossly intact, gait deferred. laboratories and studies: on admission, cbc with a white blood cell count of 10.2, hemoglobin 8.7, hematocrit 26, platelets 257. panel 7 was sodium of 141, potassium 4.3, chloride 107, bicarbonate 24, bun 68, creatinine 1.5, glucose 146. pt 12.8, with an inr of 1.1, ptt 30. liver function tests with an alt of 21, ast 19, alkaline phosphatase 96, total bilirubin 0.5. albumin 2.2, calcium 7.8, corrected calcium 9.2, magnesium 1.8, phosphate 4.1. electrocardiogram notable for atrial fibrillation at a rate of 67, with normal intervals, normal axis, unchanged from . hospital course by system: 1. gastrointestinal: the patient was followed by the gastroenterology team and initially underwent a bleeding scan, without evidence of bleeding from either the celiac or splenic artery. he then underwent an upper endoscopy on , with evidence of active bleeding, again without a bleeding lesion identified. the patient subsequently underwent urgent angiography on . there was no evidence of bleeding source identified during this procedure, and he underwent a prophylactic embolization of the left gastric artery. however, the patient continued to have drops in hematocrit requiring three additional units of packed red blood cells. he remained hemodynamically stable and, on , with no further episodes of melena or hematemesis, the patient was transferred out of the intensive care unit. again on , the hematocrit dropped, and upper endoscopy was completed, revealing gastric erosions and friability, with contact bleeding in the posterior stomach and hypertrophied brunner's glands in the duodenum. again a hematocrit drop was noted on , and the patient continued with intermittent episodes of large melena, requiring transfusion. a repeat upper endoscopy on demonstrated a visible vessel with recent clot in the fundus (likely dieulafoy lesion). the vessel was cauterized, and no further episodes of melena were noted from to , with a stable hematocrit. on , the patient was noted to have mildly elevated pancreatic enzymes, with an amylase to 124 and lipase to 95. this abnormality resolved spontaneously on , with normalization of the pancreatic enzymes. on , the patient again was noted to have a hematocrit drop, requiring one more unit of packed red blood cells. upper endoscopy was again repeated on to rule out active bleeding. a visible vessel was again visualized in the fundus of the stomach, again with fresh clot. at this time, the lesion was cauterized, injected with epinephrine, and clipped with four endoclips. since this intervention, the patient has had transient fluctuations in hematocrit, but no further evidence of active bleeding. he has received one unit of packed red blood cells since , and the hematocrit has remained stable between 31 and 34. on , the patient was noted to have a recurrent episode of melena, and was transferred to the intensive care unit for overnight monitoring. on repeat upper endoscopy, the endoclips were found intact, without evidence of active bleeding. the hematocrit remained unchanged, without transfusion required. the melena episode was felt to be secondary to retained stool, and the patient was returned to the floor. at this time, the patient was again noted to have mildly increased pancreatic enzymes. right upper quadrant ultrasound demonstrated cholelithiasis without evidence of sludge, common bile duct stones, signs of inflammation or pancreatic lesions. the pancreatic enzyme abnormality again resolved spontaneously. 2. infectious disease: on admission, the patient was status post a recent seven day antibiotic treatment course for a reported polymicrobial bacteremia. on , the patient spiked a fever to 101.4, with blood and urine cultures that demonstrated no growth. a chest x-ray at this time demonstrated bilateral lower lobe infiltrates, consistent with pneumonia vs. atelectasis, and the patient was started on empiric levofloxacin and flagyl. wound culture around the jejunostomy tube on grew pseudomonas and vancomycin-resistant enterococcus. the patient remained afebrile from on, and antibiotics were discontinued on after a seven day course. again on , the patient was noted to have an elevated white blood cell count, with evidence of a urinary tract infection. the patient was initially started on levofloxacin, however, the urine culture grew levofloxacin-resistant e. coli, and the patient completed a seven day course of bactrim. the patient was later found to have helicobacter pylori on upper endoscopy biopsy, and was started on a two week course of flagyl and clarithromycin (to end ). 3. hematology: the patient's hematocrit was followed closely throughout his hospital admission, with anywhere from every eight hours to twice a day hematocrits. he required a total of ten units of packed red blood cells during the course of his hospitalization at , and reported six units of packed red blood cells at the outside hospital prior to transfer. since , the patient has maintained a stable hematocrit between 31 and 34. 4. renal: the patient has a known history of chronic renal insufficiency with a stable baseline creatinine between 1.2 and 1.5. the patient developed acute on chronic renal insufficiency on , with a creatinine to 2.2. a renal consult was obtained, and it was felt that the patient's acute renal insufficiency was secondary to acute tubular necrosis, given multiple episodes of bleeding associated with hypotension. from that point forth, blood pressure medications were adjusted to maintain renal perfusion pressures, and all medications were renally dosed. the acute renal failure resolved. 5. cardiovascular: the patient has a history of hypertension, atrial fibrillation, and coronary artery disease. the patient's blood pressure medications were initially held during episodes of acute bleeds, and the patient remained hemodynamically stable. later blood pressure medications were again restarted to both control hypertension as well as rate control atrial fibrillation. the blood pressure medications were modified to maintain systolic blood pressures between 140 and 150 in order to maintain renal perfusion pressure. the patient remained in atrial fibrillation from the time of admission, adequately rate controlled with metoprolol. no episodes of chest pain were reported throughout the hospitalization. 6. neurology: the patient became intermittently somnolent and confused during episodes of bleeding. two ct scans of the brain were obtained, without evidence of acute hemorrhage or mass lesion. mental status changes consistently resolved spontaneously and completely after less than 24 hours. 7. fluids, electrolytes and nutrition: the patient's nutrition was maintained with total parenteral nutrition via a right internal jugular venous line (twice changed over a wire). tube feeds were delivered by jejunostomy tube, originally placed at the outside hospital, however, were frequently interrupted secondary to recurrent episodes of bleeding. ultimately, on , the jejunostomy tube fell out and, prior to replacement, the patient was given a trial of eating. the patient complained of decreased appetite and early satiety with consistently low calorie counts. however, after a normal gastric emptying study and colonoscopy, the feeding tube was abandoned and a picc line was placed to supplement nutrition during rehabilitation, with total parenteral nutrition until oral nutrition is adequate. 8. pulmonary: the patient was noted to have a persistent dry cough throughout the hospitalization. the etiology of the cough was felt to be related to the multiple upper endoscopic procedures, and was only transiently responsive to symptomatic therapy. further evaluation may be required. 9. musculoskeletal: on , the patient developed an acutely painful left knee. evaluation by rheumatology with microscopic evaluation of a small synovial aspirate demonstrated no white blood cells or crystals. serum uric acid levels were within normal limits. although no objective evidence for crystal disease was found, rheumatology felt the presentation was consistent with crystal-induced arthritis. the knee was injected with intra-articular steroids, which led to progressive clinical improvement. the patient underwent physical therapy on a regular basis, with efforts on increasing strength, improving gait, as well as transition and endurance. 10. endocrine: the patient has a known history of type 2 diabetes. four times a day finger stick glucose checks with sliding scale insulin were used to maintain glycemic control. insulin was included in total parenteral nutrition, minimizing the need for additional insulin use. 11. urology: the patient has a known history of benign prostatic hypertrophy, status post transurethral resection of prostate. the patient was maintained intermittently with a foley catheter throughout the admission. after the foley catheter was removed midway through the hospitalization, the patient was noted to have large urinary retention with 1600 ml of urine drained. the foley was replaced, and the patient continued to maintain good urine output. the foley was recently discontinued, and post-void residuals are pending. assessment: the patient is an 83-year-old male with a history of noninsulin dependent diabetes mellitus, paroxysmal atrial fibrillation, chronic renal insufficiency, and recurrent upper gastrointestinal bleed secondary to dieulafoy lesion, now with a stable hematocrit after cauterization and clipping on . condition on discharge: stable. discharge medications: 1. protonix 40 mg by mouth twice a day 2. lopressor 25 mg by mouth twice a day 3. timolol 0.25% one drop to each eye twice a day 4. flagyl 500 mg by mouth three times a day (through ) 5. clarithromycin 500 mg by mouth twice a day (through ) 6. tessalon perles 100 mg by mouth three times a day as needed for cough 7. nystatin swish and spit 10 cc by mouth once daily 8. heparin 5000 units subcutaneously twice a day 9. sliding scale insulin 10. total parenteral nutrition discharge diagnosis: 1. upper gastrointestinal bleed 2. type 2 diabetes mellitus 3. left hip fracture status post open reduction and internal fixation on 4. paroxysmal atrial fibrillation status post pacer placement 5. status post gastrotomy and oversew of gastric erosions on 6. benign prostatic hypertrophy status post transurethral resection of prostate 7. history of lacunar infarcts 8. chronic renal insufficiency 9. e. coli urinary tract infection 10. vancomycin-resistant enterococcal wound infection discharge instructions: the patient is to be discharged to an acute rehabilitation facility for physical therapy and refeeding. the patient will follow up with gastroenterology following discharge from the acute rehabilitation facility. , dictated by: medquist36 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other endoscopy of small intestine enteral infusion of concentrated nutritional substances colonoscopy endoscopic control of gastric or duodenal bleeding transcatheter embolization for gastric or duodenal bleeding endoscopic excision or destruction of lesion or tissue of stomach diagnoses: pneumonia, organism unspecified acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified acute posthemorrhagic anemia unspecified protein-calorie malnutrition atrial fibrillation retention of urine, unspecified chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction calculus of gallbladder without mention of cholecystitis, without mention of obstruction 

Answer: The patient is high likely exposed to