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: nausea, abdominal pain, and bilious emesis consistent with small bowel obstruction major surgical or invasive procedure: 4/16 l inguinal hernia repair thoracentesis tracheostomy/peg placement history of present illness: the patient is an 85 y/o f with abdominal pain x3 days with nausea and vomiting nonbloody bilious emesis. she has not had a bm x5 days and reports feeling quite distended. she is passing only minimal if any flatus. her pain is global and crampy in nature. it does not radiate. this has never happened to her before. she is not tolerating po's. the patient denies any fevers, chills, rhinorrhea, cough, sore throat, chest pain, shortness of breath, dysuria, hematuria, brbpr, travel, sick contacts, strange foods. she reports that she has been urinating a normal amount but that it is a little dark. she has not been taking her lasix. ngt was placed by er which immediately put out 2200 cc bilious material. she reports feeling significantly better since decompression. virtual colonoscopy in revealed 3.2 x 2.4 cm polypoidal villous-type adenoma in the right colon. egd essentially negative at that time. past medical history: pancreatic cyst, mitral valve disease, severe tricuspid regurgitation, aortic regurgitation, history of rheumatic fever, mvr, chronic atrial fibrillation, congestive heart failure, iron deficiency anemia, hypertension, seizure disorder, ccy, left inguinal hernia, cerebellar infarcts social history: no alcohol. no cigarette smoking. she is accompanied by her son at the time of presentation family history: non contributory physical exam: at the time of discharge: - vitals stable (afebrile, hr in 70s, sbp ~120), maintaining adequate oxygenization on trach collar during the day, cpap overnight - sleepy but arousable, alert, and conversant - lungs with crackles and diminished breath sounds bilaterally - heart irregular - abdomen soft but distended, g-tube in place without erythema or drainage; midline incision clean, dry, and intact with steri-strips intact; no significant tenderness to palpation - 1+ peripheral edema pertinent results: at the time of discharge: - her inr was therapeutic on oral coumadin with a level of 3.6 on - her wbc was normal, and was 6.8 on - her hematocrit was stable and 27.8 without evidence of bleeding - of note, her serum bicarbonate had increased slowly to a level of 45 on , with current plan to begin acetazolamide to normalize her labs brief hospital course: the patient presented to the ed, and underwent a kub which demonstrated multiple dilated loops of small bowel consistent with a small bowel obstruction. she was admitted, resuscitated with ivf, and underwent serial examinations. the cardiology service was consulted for assistance with management. she was loaded with digoxin, given vitamin k to reverse her coumadin, and started on a heparin drip for anticoagulation. her bowel obstruction did not clinically improve, and she was therefore taken to the operating room on for lysis of adhesions and l inguinal hernia repair. there was no evidence of intestinal ischemia at that time, and no bowel was resected. she tolerated the procedure somewhat well, although she did require vasopressors during the case. she ultimately had difficulty weaning from ventilatory support, and she was extubated and subsequently re-intubated. she was found to have pleural effusions, and given the tenuousness of her respiratory status, she underwent thoracentesis on where 700 cc of fluid was removed. despite this, she continued to require ventilatory support and discussions were undertaken regarding the utility of tracheostomy and peg placement. the family agreed to this, and on she underwent bedside percutaneous tracheostomy and peg placement in the sicu, which she tolerated well. she was thereafter transitioned back onto enteral coumadin once she was tolerating tube feeds via her g-tube. her current clinical situation and plan, by system, will be described below. neuro: the patient's mental status at the time of discharge was good - she is awake, alert, and responding appropriately to commands (speaking with use of a pmv). her pain was well controlled peri-operatively, and she is experiencing no pain at the time of discharge, requiring only occasional tylenol for relief. cv: she remained in atrial fibrillation throughout her hospital course, and was appropriately rate-controlled with digoxin. she had no significant hemodynamic events during her icu stay. she remained anti-coagulated and was on coumadin at the time of discharge for her mechanical valve. her home lopressor and lisinopril doses had not been resumed, although should she develop hypertension this can be re-started at rehab. pulm: as described above, she had significant difficulty weaning ventilatory support throughout her hospital stay, and eventually underwent tracheostomy. she was treated for pneumonia transiently with vancomycin/zosyn but was off all antibiotics at the time of discharge. her ventilatory support was weaned slowly, and at the time of discharge she was tolerating trach collar during the day and was being rested overnight on cpap for mild tachypnea. her tracheostomy site was clean, dry, and intact without bleeding. gi: following her exploratory laparotomy and hernia repair, the patient slowly regained bowel function. she began to pass flatus and have bms, and continued to do this at the time of discharge. of note, the patient failed speech and swallow on largely because of her respiratory status at the time. at the time of discharge, the patient was tolerating her tube feeds at goal (nutren pulmonary at 35cc/hr), and although she had mild abdominal distention she had no nausea or vomiting. her abdominal incision was clean, dry, and intact without breakdown, erythema, or discharge. gu: she has a foley catheter and has continued to make adequate urine output throughout the duration of her hospital stay (>25cc/hr). at the time of discharge, she had developed a metabolic alkalosis and was receiving acetazolamide and holding her home dose of lasix, although this can be re-started at rehab if her bicarbonate normalizes. heme: as mentioned above, she was transitioned to a heparin drip throughout her hospital stay (which was titrated), and following peg placement was transitioned back to enteral coumadin. she had received doses of 10 mg, 7.5 mg, and 5mg, and at the time of discharge her inr was 3.6 and she was receiving 5 mg daily. this will need to be titrated at rehab for goal inr 2.5 - 3.5. id: the patient was empirically treated for pneumonia during her hospital stay but by the time of discharge was afebrile, off all antibiotics, and with a normal wbc count. she had no evidence of any infectious process at the time of discharge. she was being screened for ventilatory rehab because of her tracheostomy and requirement for the ventilator. medications on admission: digoxin 125' lasix 80' lisinopril 10' toprol 100' coumadin 5' ca vit d iron 325' discharge medications: acetazolamide 250 mg iv q12hrs (no lasix at this time) digoxin 0.125 mg daily colace, senna mvi insulin ss coumadin 5 mg daily (to be titrated) discharge disposition: extended care facility: & rehab center - discharge diagnosis: s/p small bowel obstruction secondary to hernia respiratory failure s/p tracheostomy pancreatic cyst mitral valve disease severe tricuspid regurgitation aortic regurgitation history of rheumatic fever mvr chronic atrial fibrillation congestive heart failure iron deficiency anemia hypertension seizure disorder s/p ccy cerebellar infarct discharge condition: stable discharge instructions: please continue tracheostomy care and routine g-tube care. please leave steri-strips on abdominal incision and allow them to fall off over time. please call your doctor or return to the emergency department for any of the following: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down fluids or your medications. *you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *you see blood or dark/black material when you vomit or have a bowel movement. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *your pain in not improving within 8-12 hours or is not gone within 24 hours. call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. followup instructions: please call dr. office () to schedule a follow-up appointment in 2 weeks. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances thoracentesis percutaneous [endoscopic] gastrostomy [peg] temporary tracheostomy closed [endoscopic] biopsy of bronchus other lysis of peritoneal adhesions bronchoscopy through artificial stoma unilateral repair of inguinal hernia, not otherwise specified diagnoses: pneumonia, organism unspecified anemia in chronic kidney disease abnormal coagulation profile unspecified pleural effusion acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation chronic kidney disease, unspecified rheumatic heart failure (congestive) heart valve replaced by other means acute respiratory failure alkalosis long-term (current) use of anticoagulants mitral valve insufficiency and aortic valve stenosis epilepsy, unspecified, without mention of intractable epilepsy personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits anticoagulants causing adverse effects in therapeutic use hyperosmolality and/or hypernatremia diseases of tricuspid valve intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection) inguinal hernia, with obstruction, without mention of gangrene, unilateral or unspecified,recurrent 

Answer: The patient is high likely exposed to