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: no known allergies / adverse drug reactions attending: chief complaint: transfer from for transfusion reaction, diarrhea x 2 months major surgical or invasive procedure: egd/colonoscopy picc line placement history of present illness: patient is a 72 year-old female with a past medical history of gout, hypothyroidism, recent diagnosis of iron deficiency anemia who presented to the micu yesterday from after becomeing hypoxic and hyptensive during a blood transfusion. patient reports that in during a routine physical, hct was found to be 25 from roughly 34-40, wbc count in the 20s, platelets of 650. this prompted a hematology workup for malignancy. bone marrow biopsy was done and per d/c summary did not show any primary hematologic malignancy and was "most suggestive of iron deficiency anemia" with reactive leukocytosis and thrombocytosis. she was then started on fe pills. simultaneously, around the beginning of , she began to notice diarrhea, described as one loose bowel movement per day along with intermittent vomiting, associated with 15 pound weight loss, decreased appetite and po intake. she had a ct scan of her abdomen/pelvis ordered by her pcp last week, which showed "thickening of the wall of the terminal ileum consistent with acute inflammation and associated mildly enlarged mesenteric lymph nodes." . she was scheduled to undergo an outpatient egd/colonoscopy on . she saw her pcp on this date, who was concerned about her presenting complaint of sob, and thus sent her to the day clinic for transfusion of 2 units prior to the procedures for persistent anemia. after receiving lasix with the first unit of blood, and became hypotensive with a systolic blood pressure in the 60's. iv fluids were started and her blood pressure came up; with systolics in the 100's and hypoxic. she had another ct scan abd/pelvis done, which showed new terminal ileitis but also thickening of the colon wall, mildly dilated small bowel likely representing paralytic ileus, reactive enlargement mesenteric lymph nodes, and pericholecystic fluid. ruq u/s was done and showed distended gallbladder as well as wall thickening representing edema, however, there were no stones or son sign. cipro/flagyl was started, then started to ceftriaxone/flagyl and patient was transferred to the icu (secondary to concern for qtc). she was febrile to 102, and recieved roughly 5 l ivfs, sating 97-99% on 2-3l. in light of hct continuing to drop to 21, and the fact that she was a difficult crossmatch at , she was transferred to for transfusion of blood products and crossmatch tests that could more rapidly be obtained. . upon arrival to icu, hct dropped 26.2 -> 22.6 -> transfused 1u prbc -> 24.2 -> transfused 1u prbc -> 28.5 without event. gi was consulted. gi was consulted and an egd/colonoscopy was performed today, which showed: diverticulosis of the sigmoid colon, descending colon, transverse colon and ascending colon, and stricture at the ascending colon through which the scope could not pass, and abnormal mucosa in the esophagus, erythema and congestion in the whole stomach. as patient's clinical status had stabilized, antibiotics were stopped. she will get mr enterography tomorrow for visualization of remainder of colon. on transfer, patient is afebrile, hr 72 128/55, 95% ra. past medical history: low back pain compression fx gout s/p right knee replacement s/p right rotator cuff repair s/p hysterectomy s/p fall 1 yr ago social history: lives alone, is a retired teacher. smokes cigarettes per day. denies etoh, drugs. family history: father is alcoholic physical exam: admission pe: . vs: temp: afebrile bp:128 / 55 hr: 72 rr: 18 o2sat 95% ra gen: pleasant, comfortable, nad, lying flat in bed as position best for back pain heent: perrl, eomi, anicteric, mmm, op without lesions, no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or thyroid nodules resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e skin: no rashes/no jaundice/no splinters neuro: aaox3. cn ii-xii grossly intact. rectal: guiac negative x 2 . discharge pe: . o: 98.4 127/60 95 20 99% ra gen: pleasant, comfortable, nad, lying flat in bed heent: perrl, eomi, anicteric, mmm, resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, no m/r/g abd: nd, dull pain in upper quadrants b/l, no sign, no guarding or rebound, +b/s, soft, nt ext: no c/c/e; surgical scars on l leg well healed with no swelling or bruising skin: no rashes/no jaundice/no splinters neuro: aaox3. cn ii-xii grossly intact. pertinent results: admission labs: . 06:08am blood wbc-32.9* rbc-3.27* hgb-7.9* hct-26.2* mcv-80* mch-24.2* mchc-30.2* rdw-21.5* plt ct-584* 06:08am blood neuts-98* bands-0 lymphs-1* monos-1* eos-0 baso-0 atyps-0 metas-0 myelos-0 07:30am blood pt-14.1* ptt-30.5 inr(pt)-1.2* 03:52pm blood esr-92* 05:50pm blood esr-83* 06:08am blood glucose-79 urean-11 creat-0.7 na-140 k-4.0 cl-108 hco3-23 angap-13 06:08am blood alt-14 ast-62* ld(ldh)-828* alkphos-84 totbili-0.7 06:08am blood totprot-4.6* albumin-2.1* globuln-2.5 calcium-7.2* phos-2.0* mg-2.3 06:08am blood pep-no specifi igg-1108 iga-377 igm-155 ife-no monoclo 11:00am blood hiv ab-negative 05:25am blood vanco-16.3 06:08am blood ttg-iga-8 . endoscopy abnormal mucosa in the esophagus (biopsy) erythema and congestion in the whole stomach (biopsy, biopsy) (biopsy) otherwise normal egd to third part of the duodenum . colonoscopy : diverticulosis of the sigmoid colon, descending colon, transverse colon and ascending colon stricture at the ascending colon (biopsy) erythema and ulceration in the ascending colon (biopsy) (biopsy) grade 1 internal hemorrhoids the colonoscope was withdrawn and the upper endoscope was used to reach the stricutred area. this, too, could not be advanced. as a result the procedure was lengthy and aborted in the ascending colon at the site of the stricture. otherwise normal colonoscopy to ascending colon . biopsies: a. gastroesophageal junction/z-line: squamous epithelium, within normal limits; no glandular tissue present. b. body: corpus mucosa with mild chronic focally active inflammation; stain negative for organisms with satisfactory control. c. antrum: chronic inactive gastritis; stain negative for organisms with satisfactory control. d. duodenum: duodenal mucosa, within normal limits. e. ascending colon ulcer: mild lamina propria fibrosis and architectural disarray; multiple levels examined; see note. f. stricture: mild lamina propria fibrosis and architectural disarray; multiple levels examined; see note. g. colon, random: within normal limits. note: the changes are nonspecific, but raise the possibility of healed previous injury. . mr enterography: 1. wall thickening, mural edema and hyperemia involving the cecum, ascending colon and approximately 15-cm segment of the terminal ileum, almost certainly from crohn's disease. more proximal terminal ileum and distal ileum involvement appears more chronic. cicatrization in the mid ascending colon with fixed narrowing as seen on clonoscopy. no phlegmon, abscess or fistula formation. 2. ectasia of the infrarenal abdominal aorta and the left common iliac artery. 3. inferior mesenteric-lumbar venous shunting and possible small venous malformation in the left upper pelvis. . echo : the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. brief hospital course: 72 year-old female with a history of chornic low back/knee pain, hypothyroid, 2 months of diarrhea, weight loss, iron-deficiency anemia, radiographic evidence of ileitis/colitis, initially presented s/p transfusion reaction, colonsocopy showing ascending colonic strciture, eneterography consistent with crohn's, course complicated by c diff and coag negative staph bacteremia. . #. diarrhea, crohn's, and c. diff: patient's history of chronic, non-bloody diarrhea for 2 months, in conjunction with weight loss, malabsorption, and lower abdominal cramping likely indicate crohn's disease. patient had multiple ct scans from which indicated colitis and ilietis. initial colonoscopy at showed a stricture in the ascending colon through which the endoscope could not be passed. biopsies from the stricutre and imaged parts of the colon showed pathology consistent with chronic fibrosis. to obtain more detailed imaging of all sections of the gi tract, mr enterography was performed, which showed hyperdensity of contrast and bowel wall thickening in areas of the colon and terminal ileum, which is indicative of crohn's disease. at around this time, patient's diarrhea worsened, white blood cell count began to increase, she began to spike fevers, and c. diff toxin assay returned positive. she was initiated on a course of po vancomycin, began on , for a total of 2 weeks. diarrhea was improving back to her baseline prior to discharge. the gi service felt that once her course for treatment of c. diff colitis is complete, she would begin treatment for presumed inflammatory bowel disease with entocort 9 mg daily, to begin on monday . the plan is to perform a repeat colonsocpy after treatment with steroids for eventual dilation of the stricture. on discharge, she was still having loose bowel movements per day, with intermittent abdominal pain and cramping relieved with defecation. she was tolerating a low residue diet at the time. she will also be discharged on a ppi. . #. coag negative staph aureus bacteremia: on , blood cultures drawn on returned as growing coag negative staph aureus in bottles. patient was started on 7-day course of iv vancomycin, completed on . survellience cultures had no growth by the time of discharge. patient had a picc line placed on and after the blood cultures returned positive, the picc line was pulled. tte showed no evidence of vegetations and she had no other signs or symptoms of endocarditis. she was afebrile at the time of discharge. . #. transfusion reaction: patient experienced an acute hemolytic reaction while getting transfused at secondary to inappropriately cross-matched blood. upon arrival, she was seen by the blood bank team, who determined that she had an anti-fya antibody in her blood. after appropriate cross-matching, she received 2 units of prbcs without a transfusion reaction, and her hematocrit increased appropriately to a baseline of 28-30. per the blood bank team, in the future, ms. should receive fya-antigen negative products for all red cell transfusions. approximately 34% of abo compatible blood will be fya-antigen negative. a wallet card and a letter stating the above will be sent to the patient by the blood bank team. . #. fe deficiency anemia: patient's iron studies indicated that she has a likely iron-deficiency anemia in combination with an anemia of chronic disease. likely source of the anemia is crohn's and subsequent malabsorption in the terminal ileum. she was maintained on oral iron, and will be discharged on iron 325 once daily. her baseline hematocrits have been 28-30, 29.8 on the day of discharge. . #. atelectasis/oxygen saturation: patient had several days of bordeline-low o2 saturations ranging 88-92% on room air on the several days prior to discharge. these saturations would increase to 99% on room air when patient was asked to take a deep breath in. multiple cxrs indicated that the patient had bilateral atelectasis, likely secondary to immobility. she had no other signs or symptoms of pneumonia or pulmonary embolism. she was repeatedly encouraged to use the incentive spirometer, even though she seems to be non-compliant with it. upon discharge to acute care facility, she will need to be encouraged both to get out of bed and ambulate and to use the incentive spirometer. . #. nutritional status: patient's albumin on admission was 2.1, likely secondary to malabsorption and protein-losing enteropathy from chronic inflammatory bowel disease as above. she was not tolerating pos well upon admission and was maintained on tpn for several days until the picc line had to be pulled secondary to bacteremia (see above). albumin several days prior to discharge had improved to 2.4. she was tolerating a low residue diet and was counseled on foods to avoid that would help to reduce her symptoms. . #. chronic knee/low back pain: patient has history of chronic low back and knee pain, for which she previously took roxicet while at home. while she was unable to take pos, her pain was maintained with iv morphine. when she was able to tolerate pos, she was transitioned to po morphine 15 q6 as needed. she repeatedly would ask for iv pain meds and exhibited some evidence of narcotics dependence. it was explained to her that she no longer needed iv morphine and thus it would not be given to her. patient needs encouragement for physical therapy and ambulation, even given chronic pain. . #. depression: patient has had depression for several years, and has been an ongoign issue. she was continue on fluoxetine 20 mg once a day. . # gout: patient's indomethacin was stopped as she was not in an acute flare and nsaids can contribute to her chronic diarrhea and anemia. she was continued on allopurinol. . # hypothyroidism: tsh checked during admission and was wnl. she was continued on levothyroxine 50 mcg. medications on admission: allopurinol 300mg daily indomethacin 75 mg daily levothyroxine 50 mcg daily prozac 20mg daily roxicet prn tylenol prn citracal/vitd daily mvt daily discharge medications: 1. allopurinol 300 mg tablet sig: one (1) tablet po daily (daily). 2. calcium citrate-vitamin d3 500 mg(calcium) -400 unit tablet, chewable sig: one (1) tablet, chewable po once a day. 3. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po bid (2 times a day). 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. levothyroxine 25 mcg tablet sig: one (1) tablet po every other day (every other day). 6. vancomycin 125 mg capsule sig: one (1) capsule po q6h (every 6 hours) for 7 days: end date: . 7. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 8. alum-mag hydroxide-simeth 200-200-20 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed for reflux/abd discomfort. 9. morphine 15 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 11. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours). 12. budesonide 3 mg capsule, ext release 24 hr sig: three (3) capsule, ext release 24 hr po once a day: start: . discharge disposition: extended care facility: - discharge diagnosis: inflammatory bowel disease acute hemolytic transfusion reaction clostridium difficile colitis coagulase negative staph aureus bacteremia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were seen in the hospital for both diarrhea and an abnormal reaction to a transfusion of red blood cells. your diarrhea was likely secondary to a chronic process called inflammatory bowel disease. you will start an anti-inflammatory called entocort next week. you will also be seeing the gastrointestinal doctors within the next few weeks as listed below. . while you were in the hospital, you also acquired an infection called c diff colitis. you will be trated for one more week with an antibiotic called vancomycin. once you complete this antibiotic, you will start the entocort next week. . we also found that you had a bacteria in your blood called coagulase negative staph aureus. we treated you with 7 days of iv vancomycin for this infection. . our blood bank doctors discovered that your reaction to the transfusion was caused by inappropriately cross matched blood. it was found that you have an antibody in your blood called anti-fya antibody. in the future, you should receive fya-antigen negative products for all red cell transfusions. a wallet card and a letter stating the above will be sent to the patient by the blood bank team. . we made the following changes to your medications: stopped indomethacin stopped roxicet added ferrous sulfate twice daily added oral vancomycin every 6 hours for another 7 days added entocort once a day to start on monday added morphine 15 mg every 6 hours as needed for pain added pantoprazole 40 mg twice a day added simethicone as needed for abdominal bloating and discomfort . it was a pleasure taking care of you during your hospital stay. followup instructions: department: div. of gastroenterology when: wednesday at 2:00 pm with: , md building: ra (/ complex) campus: east best parking: main garage procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances esophagogastroduodenoscopy [egd] with closed biopsy closed [endoscopic] biopsy of large intestine diagnoses: other chronic pain unspecified acquired hypothyroidism gout, unspecified depressive disorder, not elsewhere classified bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site intestinal infection due to clostridium difficile iron deficiency anemia, unspecified lumbago malnutrition of moderate degree acute hemolytic transfusion reaction, incompatibility unspecified 

Answer: The patient is high likely exposed to