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: compazine attending: chief complaint: melena major surgical or invasive procedure: egd x 2 picc line placement history of present illness: ms. s 67 year old woman with iron deficiency anemia, anorexia nervosa, and idiopathic chronic pancreatitis who presented approximately 1 month of melanotic stool. she describes this as intermittent "diarrhea"; per her report, the stool has been dark black, tarry, and loose. she wasn't having these stools with every bowel movement, but intermittently over the past several weeks. over the past few days, she has felt lightheaded, but without any vertiginous symptoms. she hasn't had chest pain, heartburn, vomitting, hematochezia. she has had her baseline epigastric pain. she does not drink alcohol, and she has not been using nsaids aside from a daily 81 mg aspirin. . this morning, she woke up and felt that she was having this "diarrhea" again, as well as nausea. as she was walking to the bathroom, she felt extremely lightheaded, and her legs gave out from underneath her. she did not hit her head or lose consciousness. she did have a large melanotic stool at the time which did also have visible red blood. her daughter called ems who brought her to . she was afebrile, bp 82/45, hr 85, and o2 sat 100% on room air. there, she was found to have a hematocrit of 13.9% with normal platelets and coagulation studies. she was given pantoprazole 80 mg iv bolus followed by a continuous infusion at 8 mg/hr; she was also given octreotide 100 mcg/hr bolus followed by 50 mcg/hr. she was given 1500cc of crystalloid and received 2 units prbcs. a third unit of prbcs was hung prior to transfer to . . review of systems: denies chest pain, dyspnea, pedal edema, rashes. otherwise, per hpi. past medical history: 1. chronic pancreatitis s/p puestow procedure 2. status post cholecystectomy. 3. known renal infarction. 5. anorexia and bulimia x 25 years. 6. gastritis. 7. copd 8. pulmonary nodules lul, lll believed inflammatory etiology. 8. bronchiectasis. 9. s/p orif in complicated by aspiration pneumonia and ards requiring mechanical ventilation times six weeks. 10. depression. 12. spinal stenosis s/p two back surgeries 13. hemorrhoids 14. chronic headaches; mr in microvascular ischemic changes. 15. anemia, baseline hct 33-34. 16. s/p tubal ligation. 17. s/p appendectomy. 18. s/p bilateral varicose vein removal 19. renal mass 20. depression social history: patient has 4 children, lives with one of her daughters. etoh: quit many years ago, previously 2 drinks per night tob: started at age 12, 1 ppd, about 50 pack years denies any recreational drug use family history: pt was adopted, does not know her family history physical exam: t 98.6 bp 75/51 on noninvasive cuff hr 73 rr 18 sat 100% on 2 l/min nasal cannula weight: 103 lbs gen: thin, pale middle-aged woman lying comfortably in bed, conversing easily heent: moist mucosae, oropharynx clear, no scleral icterus. neck: supple, jvp 6cm cv: rrr, ii/vi early-peaking systolic murmur loudest at rusb chest: cta b/l, no w/r/r abd: soft, moderate epigastric tenderness to deep palpation, no rebound/guarding, no hsm extr: warm, 2+ pt pulses, no edema neuro: alert, appropriate, cn 2-12 intact,5/5 strength in all four extremities pertinent results: labs from : wbc 6.7, hct 13.9%, plts 220 na 137, k 4.5, cl 104, hco3 27, bun 54, cr 1.11, gluc 176, ca 8.7, mg 1.4 ast 16, alt 19, tbili 0.3, alk phos 57, albumin 1.9, tot prot 3.9, amylase 97, lipase 34 ptt 23.5 sec, inr 1.0 06:55am blood hct-29.1* 04:27am blood wbc-5.3# rbc-2.95* hgb-9.4* hct-27.2* mcv-92 mch-32.0 mchc-34.8 rdw-16.2* plt ct-218 08:31am blood wbc-7.0 rbc-2.51*# hgb-7.9*# hct-23.0*# mcv-92# mch-31.5 mchc-34.4 rdw-16.3* plt ct-209 08:31am blood neuts-83.2* bands-0 lymphs-11.6* monos-4.6 eos-0.4 baso-0.2 07:05am blood pt-12.1 ptt-26.7 inr(pt)-1.0 06:55am blood urean-14 creat-0.8 06:30am blood glucose-93 urean-12 creat-0.8 na-140 k-4.2 cl-104 hco3-34* angap-6* 08:31am blood glucose-111* urean-47* creat-0.9 na-137 k-4.9 cl-109* hco3-26 angap-7* 08:31am blood alt-18 ast-14 ld(ldh)-123 ck(cpk)-63 alkphos-56 amylase-72 totbili-0.5 07:00am blood probnp-758* 08:31am blood lipase-30 07:05am blood calcium-8.8 phos-2.6* mg-1.9 06:30am blood rheufac-<3 crp-23.7* 06:12am blood vanco-26.2* 03:38pm urine color-yellow appear-hazy sp -1.009 03:38pm urine blood-mod nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-lg 03:38pm urine rbc-76* wbc-96* bacteri-few yeast-none epi-0 3:36 pm serology/blood source: line-a line. **final report ** helicobacter pylori antibody test (final ): negative by eia. (reference range-negative). - 2 sets of blood cultures: negative. 4:43 am urine site: catheter **final report ** urine culture (final ): enterobacter cloacae. >100,000 organisms/ml.. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter cloacae | cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- 64 i piperacillin---------- <=4 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s 6:35 am blood culture source: line-a-line. **final report ** blood culture, routine (final ): staphylococcus, coagulase negative. isolated from one set only. sensitivity requested by dr. # . coag neg staph does not require contact precautions, regardless of resistance. oxacillin resistant staphylococci must be reported as also resistant to other penicillins, cephalosporins, carbacephems, carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. please contact the microbiology laboratory () immediately if sensitivity to clindamycin is required on this patient's isolate. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. sensitivities: mic expressed in mcg/ml _________________________________________________________ staphylococcus, coagulase negative | erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin----------<=0.12 s oxacillin------------- =>4 r penicillin------------ 0.25 r rifampin-------------- <=0.5 s tetracycline---------- <=1 s vancomycin------------ 2 s anaerobic bottle gram stain (final ): reported by phone to @ 5pm . gram positive cocci in pairs and clusters. blood cultures on and negative at time of discharge. chest (portable ap) 8:57 am chest (portable ap) reason: pls eval lung parenchyma medical condition: 67 year old woman with abdominal pain, ugib reason for this examination: pls eval lung parenchyma history: abdominal pain and upper gi bleed, to evaluate lung parenchyma. findings: in comparison with the study of , there again is evidence of old healed apical granulomatous disease as well as chronic obstructive pulmonary disease. no acute pneumonia appreciated at this time. cardiology report ecg study date of 1:21:04 pm sinus rhythm low qrs voltages in limb leads since previous tracing of the same date, no significant change read by: , a. intervals axes rate pr qrs qt/qtc p qrs t 69 186 76 390/405 80 71 73 ct pelvis w/contrast 11:54 am ct abdomen w/contrast; ct pelvis w/contrast reason: gi bleed, hx. pancreatitis, npo, febrile, ? perforation, ordered with no oral contrast contrast: optiray medical condition: 67 year old woman with gi bleed and h/o pancreatitis, npo, febrile reason for this examination: r/o perforation of ulcer, no oral contrast contraindications for iv contrast: none. indication: 67-year-old woman with gi bleeding and history of pancreatitis and fever. please evaluate for perforation of ulcer. comparison is made to the prior study of . technique: axial mdct images were obtained from lung bases to the symphysis pubis after administration of optiray intravenously. no oral contrast was used. sagittal and coronal reformatted images were then obtained. ct of the abdomen with iv contrast: the visualized portion of the lung bases does not demonstrate any pulmonary nodule. dependent atelectatic changes are noted at both lung bases. moderate left and small right pleural effusions are visualized. the heart and great vessels appear normal. small axial hiatal hernia is visualized. the liver, spleen, and adrenal glands appear normal. there is mild scarring in the upper pole of both kidneys which is unchanged compared to the prior study. both kidneys demonstrate multiple small hypodense lesions which are too small to characterize. the pancreas contains multiple areas of coarse calcification with parenchymal atrophy and irregular pancreatic duct dilatation, all consistent with a diagnosis of chronic pancreatitis. there is mild intrahepatic and moderate extrahepatic bile duct dilatation with the common bile duct measuring up to 15 mm.this appearnce is stable since mr of abdomen performed in . the patient is status post cholecystectomy with moderate dilatation of the cystic duct remnant. the stomach, duodenum, and loops of small bowel and large bowel appear normal. no free air is noted within the abdomen and pelvis. surgical sutures of the prior bowel surgery are noted within the left lower quadrant area. no pathologically enlarged retroperitoneal or mesenteric nodes are visualized. ct of the pelvis with iv contrast: the urinary bladder, distal ureters, uterus and adnexa, rectum and sigmoid colon appear normal. moderate amount of ascites is noted within the pelvis. no free air is visualized. bone windows: no concerning lytic or sclerotic lesion is identified. the patient is status post dynamic hip screw placement on the left side. no concerning lytic or sclerotic lesions are identified. multilevel degenerative changes of the lumbar spine are noted with grade 2 retrolisthesis of l5 over l4. disc bulge is also noted at the level of l4-l5. impression: 1. no pneumoperitoneum or other signs of bowel perforation is noted. 2. unchanged chronic pancreatitis with moderate pancreatic duct dilatation. 3. unchanged multiple hypodense kidney lesions and bilateral kidny scarring. 4. moderate ascites. the etiology is unclear. 5. unchanged moderate right and small left pleural effusion. 6. unchanged moderate extrahepatic and mild intrahepatic bile duct dilatation since mr of abdomen performed in . 7. grade 2 retrolisthesis of l4 over l5 with a small disc bulge at the same level. : pa and lateral upright chest radiograph compared to and . the heart size is normal. mediastinal position, contour, and width are unremarkable. the apical fibronodular bilateral opacities are stable. interval development of bilateral small pleural effusion is demonstrated, especially between and , with minimal progression between and . there are no focal consolidations worrisome for pneumonia. there is no pneumothorax. the patient is not in failure. unilat up ext veins us left 5:35 pm unilat up ext veins us left reason: assess for thrombus associated with phlebitis medical condition: 67 year old woman with left ue phlebitis and gpc in blood reason for this examination: assess for thrombus associated with phlebitis indication: please evaluate for thrombus or phlebitis in a 67-year-old female with left upper extremity swelling. no comparison is available. grayscale, color flow and doppler images of the left upper extremity were obtained. the left internal jugular vein, subclavian vein, axillary vein, and brachial veins and cephalic vein demonstrate normal compressibility, respiratory variation in venous flow and venous augmentation. the basilic vein contains an occluding thrombus which starts in the antecubital fossa but does not extend into the deep venous system. this vein is non- compressible. impression: 1. thrombosis of the distal portion of the left basilic vein with no extension into the deep venous system. this is consistent with a superficial thrombophlebitis. pathology tissue: gi biopsies (2 jars). , - pending. echo: conclusions the left atrium is normal in size. the estimated right atrial pressure is 10-20mmhg. 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 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 appears structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve. there is borderline pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , no change. impression: no valvular vegetations seen. portable chest . clinical information: picc placement. comparison study: . findings: right picc terminates in superior vena cava. the lungs are clear with the exception of mild blunting of the costophrenic angles, stable. again noted is mild fibronodular scarring or stranding at the lung apices. the lungs are grossly clear. egd: findings: esophagus: normal esophagus. stomach: mucosa: erosions of the mucosa were noted in the antrum and stomach body. duodenum: excavated lesions a single cratered 2cm ulcer was found in the proximal bulb. the ulcer bed appeared necrotic with pigmented material suggestive of recent bleeding. there was thick dark material adherent to the ulcer (food vs. old blood) which could not be fully cleared. because it was difficult to get a clear view of the ulcer base and vessel, we decided against intervening at present. other findings: pictures could not be obtained due to technical difficulties with the computer. impression: erosion in the antrum and stomach body ulcer in the proximal bulb pictures could not be obtained due to technical difficulties with the computer. recommendations: - iv ppi 80mg bolus then 8mg/hr x 72 hours. - can then switch to iv ppi . - npo x 24 hours. - please check h.pylori serology and treat if positive. - clear liquid diet over weekend is ok if pt remains stable. will plan for re-scope on monday in endoscopy unit after futher stabilization. findings: esophagus: mucosa: normal mucosa was noted in the whole esophagus. stomach: mucosa: erythema and congestion of the mucosa were noted in the antrum. these findings are compatible with mild gastritis. cold forceps biopsies were performed for histology at the stomach antrum. duodenum: excavated lesions two ulcers were seen in the first part of the duodenum. the first ulcer measures 3cm in diameter with clean base and surrounding edema. the second ulcer measures 2cm with clean base and surrounding erythema.there was no active bleeding noted. cold forceps biopsies were performed for histology at the duodenal bulb- ulcer edge. other a 1 x 2cm soft submucosal lesion suggestive of lipoma was seen in the second part of the duodenum. this was not biopsied due to recent bleed. impression: normal mucosa in the whole esophagus erythema and congestion in the antrum compatible with mild gastritis (biopsy) ulcer in the first part of the duodenum (biopsy) a 1 x 2cm soft submucosal lesion suggestive of lipoma was seen in the second part of the duodenum. this was not biopsied due to recent bleed. otherwise normal egd to secondpart of the duodenum recommendations: 1. follow biopsy results and treat if positive for h. pylori. 2. need lifelong ppi po bid due to her co-morbid conditions 3. out-pt follow up with dr. in 4weeks. brief hospital course: 67 year old f with pmhx of chronic pancreatitis p/w 3 wks of melena, severe hct drop & necrotic duodenal ulcer seen on egd. #gi bleed: egd reports as above. patient treated with ppi and transfusion. per gi - will need lifelong ppi, avoid nsaids. asa stopped. h pylori serology negative. biopsy of ulcers taken at egd and pending. pt to follow up with dr for follow up of biopsy read and to see if h pylori positive. hypotension resolved with prbc. superficial thrombophlebitis: septicemia, coagulase negative staphylococcus: the patient developed superficial thrombophlebitis at the left brachial iv cath site. cath was removed and patient was treated with iv vancomycin for total 7 days. last day in . picc placed after negative culture and after pt was afebrile to continuation of iv antibiotics. on the day of discharge, vancomycin trough level was 26 and so dose was decreased to 1 gram q24 hours as per discussion with id fellow - dr . the patient should have vanco trogh level checked on to targert of . further management per physicians at rehab. also, bun, creat and cbc should be done to ensure stability. the patient should follow up with pcp for repeat blood cultures in weeks after the antibiotics completed for follow up labs. the patient has copd and cxr showed some changes as above. folow up cxr at discretion of pcp. urinary tract infection, catheter related, bacterial - foley cath removed. culture grew enterobacter sensitive to ciprofloxacin. last day of 7 day scourse is (i.e. day of discharge). history of chronic pancreatitis - pt has chronic pain and was treated with oxycontin with prn oxycodone. pancreatic enzymes with meals were continued. for depression - thioridazine, fluoxetine and trazodone were continued. patient had a stable mood and not suicidal or homicidal. medications on admission: fluoxetine 20 mg daily 1 cap tidac trazodone 150 mg qhs prn vitamin d 800 units daily chlorpromazine 25 mg daily ferrous sulfate 325 mg daily aspirin 81 mg daily acetaminophen prn thioridazine 25 mg tablet at 4pm daily discharge medications: 1. heparin flush picc (100 units/ml) 2 ml iv daily:prn 10 ml ns followed by 2 ml of 100 units/ml heparin (200 units heparin) each lumen daily and prn. inspect site every shift. 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 3. trazodone 50 mg tablet sig: three (3) tablet po hs (at bedtime) as needed. 4. vitamin d 400 unit tablet sig: two (2) tablet po once a day. 5. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 6. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 7. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 1 doses: evening dose on . 8. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for adbominal pain: hold for sedation, rr < 12. 9. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours): hold for sedation, rr < 12. 10. docusate sodium 100 mg capsule sig: one (1) capsule po twice a day. 11. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 12. thioridazine 25 mg tablet sig: one (1) tablet po q4pm (). 13. amylase-lipase-protease 33,200-10,000- 37,500 unit capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po qac. 14. vancomycin vancomycin 1000 mg iv q 24h (for 2 days); last day . discharge disposition: extended care facility: academy manor of - discharge diagnosis: acute blood loss anemia gastrointestinal bleeding hypotension - resolved superficial thrombophlebitis septicemia, coagulase negative staphylococcus urinary tract infection, catheter related, bacterial history of chronic pancreatitis history of copd discharge condition: stable. discharge instructions: you were treated for bleeding from ulcer in your stomach and also for a iv catheter related infection and a urine infection. it is recommended that you complete the course of antibiotics (vancomycin) that will be administered thru picc catheter. last day of antibiotic is . the rehab will monitor the levels of the antibiotic as well as your other blood work. follow up with dr - your primary care doctor to get blood work withing 10 days of your discharge from the rehab facility. also discuss with your primary care doctor about getting another lung xray. make an appointment with dr for results of biopsy (stomach) in the next 2-4 weeks. followup instructions: pcp: , . . call and schedule an appointment within 10 days of rehab discharge. the physicians at rehab will be caring for your further medical needs while you are there. dr . please call to make an appointment with dr in weeks for the results of the biopsy. procedure: venous catheterization, not elsewhere classified esophagogastroduodenoscopy [egd] with closed biopsy esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: unspecified pleural effusion urinary tract infection, site not specified acute posthemorrhagic anemia depressive disorder, not elsewhere classified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure hypotension, unspecified other complications due to other vascular device, implant, and graft iron deficiency anemia, unspecified other ascites phlebitis and thrombophlebitis of superficial veins of upper extremities chronic pancreatitis bronchiectasis without acute exacerbation unspecified gastritis and gastroduodenitis, without mention of hemorrhage infection and inflammatory reaction due to indwelling urinary catheter other staphylococcal septicemia acute duodenal ulcer with hemorrhage, without mention of obstruction anorexia nervosa lipoma of intra-abdominal organs 

Answer: The patient is high likely exposed to