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: zithromax / erythromycin base attending: chief complaint: melena and hypotension major surgical or invasive procedure: upper endoscopy duodenal ulcer biopsy and cauterization history of present illness: this is a 77 yo m with h/o dm ii, dementia, htn, copd, and recent admission for cellulitis on levo/flagyl/bactrim who presents from nursing home with melena and hypotension. patient reports one episode of melena yesterday which he describes as black loose stool. he denies any hematochezia, brbpr, bloody or coffee ground emesis, abdominal pain, fevers, or chills. he does reports some nausea. per report at his nursing home, bps were noted to be in the 70s along with decreased hct so he was transferred to . in the ed: temp 97.7, hr 83, bp 116/60. patient was given 1u prbc, ng lavage showed coffee ground emesis which cleared with 200cc lavage. on arrival to the sicu, patient denies diarrhea, melena, abdominal pain, bloody emesis, coffee ground emesis. otherwise ros negative. past medical history: past medical history: 1. hypertension. 2. type 2 diabetes. 3. chronic renal impairment. 4. peripheral vascular disease s/p stent to left sfa, s/p therectomy and pta of the right 5. atrial fibrillation. 6. hyperlipidemia. 7. chronic obstructive pulmonary disease. 8. body dementia. 9. cad s/p stents on plavix social history: currently lives in stone home. he continues to smoke at least one pack of cigarettes a day. denies etoh use, h/o ivdu. family history: not obtained physical exam: vs: bp 115/69 hr 91 rr 12 95% ra gen: aao x 3, lethargic, responds to verbal stimuli heent: eomi, perrla, dry mucous membranes, op clear neck: supple, no jvd appreciated cv: normal s1, s2. irregularly irregular. no m/r/g appreciated chest: +minor crackles at bilateral bases, +mild expiratory wheezes abd: soft, nt, nd, no hsm, normoactive bs ext: no peripheral edema, +1 distal pulses skin: erythema noted over bilateral lower shins, warm to touch, several overlying healing skin ulcers, no pus. rectal: +small amount black stool, guaiac +, +stage 2 ulcer of superior buttocks pertinent results: studies: . 4:19 pm swab source: r anterior le. wound culture (preliminary): staph aureus coag +. moderate growth. of two colonial morphologies. please contact the microbiology laboratory ()immediately if sensitivity to clindamycin is required on this patient's isolate. oxacillin resistant staphylococci must be reported as alsoresistant to other penicillins, cephalosporins, carbacephems,carbapenems, and beta-lactamase inhibitor combinations. rifampin should not be used alone for therapy. sensitivities: mic expressed in mcg/ml _______________________________________________________ staph aureus coag + | erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- 4 r oxacillin------------- =>4 r penicillin g---------- =>0.5 r rifampin-------------- <=0.5 s tetracycline---------- =>16 r vancomycin------------ <=1 s . 01:25am wbc-11.9* rbc-3.11* hgb-9.1*# hct-29.1* mcv-94 mch-29.4 mchc-31.4 rdw-14.0 01:25am neuts-74.7* lymphs-18.8 monos-5.4 eos-0.8 basos-0.3 01:25am plt count-449*# 01:25am pt-15.6* ptt-25.6 inr(pt)-1.4* 01:25am alt(sgpt)-23 ast(sgot)-25 alk phos-83 tot bili-0.3 01:25am glucose-86 urea n-51* creat-1.0 sodium-138 potassium-5.1 chloride-102 total co2-31 anion gap-10 01:31am hgb-9.8* calchct-29 05:45am hgb-9.3* hct-28.0* 08:39am hgb-10.0* calchct-30 brief hospital course: 77 yo m with h/o cad, dm ii, pvd, copd, cellulitis, who presented with melena and hypotension, and underwent embolization after duodenal ulcers were identified. # melena: patient with melena x 1, along with hypotension at nursing home and hct drop from 37.3 on to 29.1. gi was consulted. gi performed an egd on the morning of , which showed 2 duodenal ulcers, cauterized. pt was initially transfused 1 unit prbcs in emergency department. hct was 28, stable at 29.9-30 while on micu service. pt. was treated with ppi iv bid. bp meds were held. after discussion with gi, decision was made to continue plavix given pt's cad s/p stents, but asa was decreased from 325 to 81 mg. pt should discuss resumption of full dose asa with his pcp. # hypotension: likely in setting of ugib, was hemodynamically stable in micu. hct stable as above. did not require fluid boluses while on micu service or on floor. generally maintained good pressures 110-122 systolic while on floor. the patient was discharged on metoprolol succinate 100 mg tablet sustained release one per day. # cellulitis: patient with recent discharge for cellulits, on bactrim/levo/flagyl po. these antibiotics were discontinued as the wound culture showed resistance, and patient was started on vanco iv for 14 days first dose . # cad s/p stents - pt s/p pci of lad in with 2 bare metal stents. plavix continued and asa decreased to 81 mg as above. in the context of his hypotension on presentation, his home acei, bb, and statin were initially held. metoprolol was later introduced. we advise that the patient's pcp consider his ace-i as outpatient if pressures remain stable. # copd: patient lethargic on arrival, on o2. o2 stopped, abg taken, hypoxic to 89% transiently which improved immediately. abg 7.39/49/68. lethargy likely to lack of sleep. his tiotropium was continued, and albuterol nebs were ordered. # dm ii - pt continued on half dose nph while npo. # atrial fibrillation - hx of afib, not on coumadin. continued on asa 81mg as above. when patient was npo, he was continued on digoxin iv and his digoxin level was checked. as above, his beta blocker was held, and restarted at the end of his course with good results. patient should discuss restarting coumadin with pcp after gi tract has had some time to heal. # pvd - history of sfa stent: continued plavix, decreased asa dose as above. # dementia - held aricept, paroxetine while npo, these were reintroduced at the end of his course. # sacral ulcer: pt was seen by wound care. wound was dressed with wet to dry dressings. medications on admission: bactrim 80-400mg 2tabs po bid levofloxacin 500mg daily flagyl 500mg tid insulin sliding scale nph 36u sq furosemide 20mg daily digoxin 125mcg daily lisinopril 20mg daily toprol xl 150mg daily mvi paroxetine 10mg qam plavix 75mg daily spiriva 18mcg capsule daily thiamine 1 tab daily aricept 10mg daily simvastatin 40mg daily trazodone 37.5mg daily asa 325mg daily bisacodyl 10mg supp prn simethicone 30mg q6h prn milk of magnesia 30mg daily prn acetaminophen prn discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 2. tiotropium bromide 18 mcg capsule, w/inhalation device sig: one (1) cap inhalation daily (daily). disp:*30 cap(s)* refills:*0* 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: inhalation q6h (every 6 hours) as needed. disp:*120 * refills:*0* 4. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 5. nicotine 21 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). disp:*30 patch 24 hr(s)* refills:*0* 6. paroxetine hcl 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 7. donepezil 5 mg tablet sig: two (2) tablet po hs (at bedtime). disp:*60 tablet(s)* refills:*0* 8. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 9. trazodone 50 mg tablet sig: 0.75 tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*0* 10. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 11. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). disp:*30 tablet sustained release 24 hr(s)* refills:*0* 12. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 14. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous q 12h (every 12 hours) for 7 days. disp:*7 * refills:*0* 15. insulin nph human recomb 100 unit/ml cartridge sig: one (1) subcutaneous per sliding scale: according to sliding scale. disp:*30 * refills:*0* discharge disposition: extended care facility: - discharge diagnosis: bleeding duodenal ulcer lower extremity ulcers and cellulitis chronic atrial fibrillation stable coronary artery disease chronic systolic heart failure diabetes type 2, controlled, with complications hyperlipidemia chronic obstructive pulmonary disease hypertension discharge condition: good discharge instructions: please take all your medications as prescribed. please note that you will need to complete a 7 day course of iv vancomycin adminstered through the picc line. please return for fever, chest pain, shortness of breath, shaking chills, blood in urine or stool, non-healing wounds or ulcers, or any other concerning symptom. followup instructions: please call your pcp . at within 24 hours to make an appointment to take place withint the next week. please ask her to review your medications with you, as well as follow-up on those issues addressed during this hospitalization. please see dr. (phone:) on 9:30 please see , dpm (phone:) on 10:20 md procedure: venous catheterization, not elsewhere classified endoscopic control of gastric or duodenal bleeding transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified other and unspecified hyperlipidemia cellulitis and abscess of leg, except foot chronic systolic heart failure pressure ulcer, lower back dementia in conditions classified elsewhere without behavioral disturbance chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction atherosclerosis of native arteries of the extremities with ulceration dementia with lewy bodies ulcer of calf 

Answer: The patient is high likely exposed to