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: this is a 77-year-old lady, with a history of crohn's disease, transferred from an outside hospital for work-up and treatment of severe gi bleed following colonoscopy. the patient was admitted on to outside hospital for profuse diarrhea after starting creon two weeks prior. hematocrit on admission was 34. the patient was treated with iv steroids, pancrease and cholestyramine for pancreatic insufficiency and bile stone malabsorption. on , she underwent colonoscopy to the neoterminal ileum notable for anastomotic opening slightly tight and friable lesions which were biopsied. biopsy of other random sites was also taken, as well as a less than 1 cm polyp which was also removed. following the procedure, the patient developed hypotension, decreased hematocrit, and an increased inr. the patient was then transferred to the outside hospital's icu. emergent colonoscopy showed old blood, but no active hemorrhage. this study did not reveal a source of bleeding. an egd was performed which was also negative. the patient was then transferred to for further evaluation. at the outside hospital en route to , the patient received a total of 2 liters of normal saline, 6 units of ffp, and 6 units of packed red blood cells. the patient experienced respiratory distress while in the ambulance and was intubated and given 80 mg lasix. upon arrival, she was emergently taken to the angio suite where she underwent embolization of the third branch of the superior mesenteric artery. this resulted in near-cessation of bleeding. the patient was admitted to the medical icu. past medical history: 1) crohn's disease: last colonoscopy in showed no active disease. her last admission to the hospital for crohn's was in for a crohn's flare for which she was treated with steroids; 2) status post right hemicolectomy; 3) status post anteriorly. cardiac exam revealed loa. 4) status post small bowel resection. 5) hypertension. 6) coronary artery disease. 7) left superficial femoral vein dvt. 8) hyperlipidemia. 9) history of lower gi bleeding. 10) status post appendectomy. 11) history of congestive heart failure. echo prior to current admission was within normal limits. allergies: penicillin. medications: 1) creon 10 mg 3 tablets tid, 2) gemfibrozil 600 mg , 3) atenolol 25 mg qd, 4) aciphex 20 mg qd, 5) effexor 35 mg qd for 7 days, then increase to 75 mg qd, 6) cholestyramine 1 package tid. social history: she lives alone with a pet cat. her daughter lives in and has been involved with her care. she denies any tobacco or alcohol use. her husband lives in a nursing home in . family history: noncontributory. physical examination upon arrival to micu: revealed a temperature of 97.3, pulse 124, blood pressure 143/75, 98% o2 saturation. generally, she was pale, visibly intubated, and sedated. her pulmonary exam was clear to auscultation bilaterally anteriorly. her cardiac examination revealed tachycardia without any murmurs, gallops or rubs. abdominal exam was notable for multiple abdominal scars. her extremity exam revealed no edema. laboratory: laboratory values were notable for a hematocrit of 26.6 which was down from 37.2 the day prior to arrival here at . the remainder of her serum electrolytes were within normal limits except for a calcium of 7.1. arterial blood gases revealed a ph of 7.1, pco2 56, po2 112. blood coagulation studies were notable for a pt of 13, inr 1.4, ptt 30. ekg dated from the outside hospital was notable for t wave inversions in leads iii and avf. chest x-ray was notable for left lower collapse and consolidation and small bilateral pleural effusions. summary of hospital course: the hospital course will be described by problem. in summary, this is a 77-year-old female with a history of crohn's disease, status post right hemicolectomy, status post coil embolization for massive lower gi bleed, who is now transferred to the for management of lower gi bleed. the patient was admitted to the micu following the embolization procedure on . the patient was then transferred to the floor on for continued medical care. 1) lower gi bleed: the patient had a massive lower gi bleed following colonoscopy and biopsy of various lesions within her colon. this bleeding was stopped primarily via embolization of the third branch of the sma. in the medical icu, she was volume resuscitated with several units of packed red blood cells and iv fluids. over the course of her micu stay, her gi bleeding slowly waned over the period of several days. her hematocrit stabilized to the lower 30s upon transferring to the medical floor. her bowel movements at that point were no longer grossly bloody. for the duration of her stay on the medicine service, she did not experience any bright red blood per rectum, and her bowel movements were heme negative. there was no evidence of occult bleeding by checking daily hematocrits which remained stable until her discharge. 2) congestive heart failure: during the course of her stay in the medical icu, she was vigorously resuscitated with fluids and blood, and subsequently was found to be in florid chf. a repeat echocardiogram was performed which revealed an ejection fraction of 25%. this was different from her previous echocardiogram prior to her admission which was within normal limits. the thought was that the patient had suffered an ischemic event to her heart leading to decreased systolic function. over the course of her icu stay, she developed chest x-ray findings consistent with heart failure, as well as clinical exam findings which included elevated jugular venous pressure, lower extremity edema, and bilateral dullness to percussion at the lung bases. when the patient was finally extubated prior to leaving the icu, she began to autodiurese at least 1.5-2 liters per day. after arriving to the floor, we continued to treat her with carvedilol and captopril which was later changed to lisinopril. she was also monitored for fluid loss by daily weights and daily in's and out's. for the duration of her stay in the hospital, she did not require any pharmacologic agents for diuresis. furthermore, as each day passed, her clinical exam findings improved. 3) pneumonia: in the icu, she was found to have sputum positive for klebsiella. there was also a suspicious retrocardiac opacity on chest x-ray. she was started on levofloxacin and zosyn initially until culture results revealed pansensitive klebsiella in the sputum, at which point zosyn was discontinued. levofloxacin was continued. 4) vocal cord paralysis/aspiration: following extubation in the medical icu, she was found to be unable to speak. a bedside swallowing study revealed aspiration of thin and nectar-like liquids. ent consultation revealed right vocal cord paresis with unclear etiology. a head and neck ct was performed to rule out any stroke or mass compressing the recurrent laryngeal nerve. these exams were negative. in the meantime, an ng tube was left in place. the patient was made npo. aspiration precautions were taken, and she was continued on her protonix prophylaxis 40 mg po bid. a few days after her transfer to the floor from the icu, the patient underwent a video swallowing study which revealed, again, aspiration of thin liquids and nectar-like fluids. the patient also aspirated solids. of note, she was found not able to cough reflexively to aspiration, and when cued to cough, she was unable to clear any aspirated content for any of the liquid. the decision was then made to establish a semipermanent feeding tube placement to obviate the need for an ng tube. the patient was taken to interventional radiology where she underwent placement of a gastrojejunostomy tube. following the procedure, there was a small amount of bright blood refluxing from the nasogastric tube which cleared several hours later. this was felt to be likely due to a small amount of postprocedural gastric bleeding. the gj tube was found to be in good working order, and she was restarted on her tube feeds via her new gj tube. the ng tube was then discontinued. 5) crohn's disease: the patient has a longstanding history of crohn's disease and is status post right hemicolectomy and small bowel resection. she currently has stable disease now on a regimen of prednisone. during her course here, she has not undergone any obvious manifestations of any ongoing crohn's flare. the gastroenterology service was consulted throughout her stay. 6) hypernatremia: this was thought to be due to a decreased amount of total body free water. during her course in the icu, as well as on the floor, she was given free water boluses. during her course on the floor, her sodium came back down to within normal limits. 7) acute renal failure: during her stay in the medical icu, her creatinine was found to be elevated over the first two days in the icu with a peak at 1.4. this was thought to be due to prerenal causes. with fluid resuscitation, her creatinine came back down to within normal limits. 8) mca aneurysm: when the patient had undergone a head ct for evaluation of her vocal cord paresis, an mca aneurysm was incidentally found. the patient underwent angiogram to better image the lesion which was followed by a ct angiogram. this was determined not to be an urgent issue by the neurointerventional radiologists. the patient will undergo follow-up therapy per neurointerventional radiology. 9) coronary artery disease: the patient has apparently experienced an ischemic event to her heart. while in the medical icu, laboratory tests revealed an elevation of her troponin levels to a maximum of 0.44, evidenced when she arrived to the floor she was given a persantine mibi test to evaluate for any ischemic myocardium. this test revealed: 1) moderate partially reversible defects of the distal anterior apex and inferolateral walls of the heart; 2) mild transient ischemic dilatation; 3) hypokinesis of the apex and septum with global ef calculated to be 49%. it was determined that the likely cause of her congestive heart failure was secondary to an ischemic insult to her heart. 10) vaccinations: the patient received pneumovax x 1. condition on discharge: good. discharge diagnoses: 1) gastrointestinal bleeding. 2) congestive heart failure. 3) pneumonia. 4) coronary artery disease. 5) paretic right vocal cord. 6) middle cerebral artery aneurysm. 7) crohn's disease. discharge medications: 1) prednisone 35 mg po qd 2) levofloxacin 500 mg po q 24 h until 3) lisinopril 5 mg po qd--hold for systolic blood pressure of less than 95 4) carvedilol 6.25 mg po twice a day 5) creon 10, 2 capsules po four times a day 6) pantoprazole 40 mg po q 12 h 7) cholestyramine 4 gm po twice a day 8) venlafaxine xr 37.5 mg po qd 9) insulin sliding scale 10) acetaminophen 325-650 mg po q 4-6 h prn fever 11) heparin 5,000 u subcutaneously q 12 h 12) vitamin d 400 u ng qd 13) multivitamin qd, 1,000. follow-up plans: 1. the patient will be discharged to rehabilitation. 2. the patient should also contact her primary care physician for management of her medical issues. 3. she should follow-up with her gastroenterologist with regards to her crohn's disease. 4. furthermore, she should be in contact with her primary care physician or her cardiologist for medical treatment of her coronary artery disease and associated congestive heart failure. 5. the patient should follow-up with dr. of otolaryngology for follow-up of her vocal cord paresis. 6. finally, the patient should be in contact with neurointerventional radiology department for outpatient management of her mca aneurysm. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances arteriography of cerebral arteries injection or infusion of other therapeutic or prophylactic substance insertion of other (naso-)gastric tube laryngoscopy and other tracheoscopy aortography arteriography of other intra-abdominal arteries percutaneous (endoscopic) jejunostomy [pej] diagnoses: subendocardial infarction, initial episode of care congestive heart failure, unspecified acute posthemorrhagic anemia cerebral aneurysm, nonruptured pneumonitis due to inhalation of food or vomitus hemorrhage of gastrointestinal tract, unspecified hyperosmolality and/or hypernatremia regional enteritis of small intestine unilateral paralysis of vocal cords or larynx, complete 

Answer: The patient is high likely exposed to