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: brbpr major surgical or invasive procedure: colonoscopy history of present illness: 83yo m with atrial fibrillation on coumadin and recent ischemic stroke s/p peg h/w gib. pt was in his usoh at rehab until this am when he noted having a bowel movement of stool with bright red blood. no rectal pain, no previous episodes of this, no abdominal pain. denies sob, cp, nausea/vomiting, dizziness, lightheadedness. patient has history of guaiac positive stools felt to be related to radiation proctitis and had colonoscopy in which showed continued proctitis as well as sigmoid diverticulosis. of note, patient was recently discharged on when he presented with an acute r-sided mca infarct. inr was therapeutic so no tpa was administered. course complicated by a hospital acquired pneumonia that was treated with a 8 day course of vanc and zosyn. he also had one blood culture that came back growing (torulopsis) glabrata. tte and hiv negative, so source was unclear. started on micafungin 100 mg iv q24 hr for a fourteen day course to end on . peg was placed on for due to repeated speech/swallow failure. prior to d/c to , some blood was noted in the peg residuals. in the ed, initial vs were: 100.2 98 124/70 18 98%. labs notable for inr elevated to 5.2, hct 32.6. peg lavage showed bright red blood. patient received 2u ffp, 10mg iv vitamin k, ppi bolus. guaiac showed bright red blood in stool. on arrival to the micu, patient had medium amount of bright red blood without clots or stool. patient denied abdominal pain, chest pain, or shortness of breath. . micu course: on arrival to the micu, patient had bm's with medium amount of bright red blood without clots or stool. patient denied abdominal pain, chest pain, or shortness of breath. crit dropped 6 points. peg lavage in ed lavage was positive for blood. was hd stable and did not require pressors but antihypertensives were held. rec'd 2units of prbcs, 2units ffp. early am on re-bled, 2 large melanotic stools, at ct abd/pelv without any identifiable source. bleeding stopped spontaneously. crit nadir 26, currently 28.8. thought to be from radiation proctitis, diverticulosis, or bleed related to peg tube. called out to floor for further management and evaluation. of note he finished his 14 day course of micafungin (last day = ). past medical history: r-sided mca infarct with residual left sided weakness and mild dysarthria atrial fibrillation - on coumadin ischemic stroke - left insula and left frontal (some gait instability no other deficits) type ii dm - hba1c 6.4 prostate cancer s/p radiation and hormonal therapy in ?osa low back pain social history: - patient is a preacher at a pentecostal church - married - he has 2 children who are 52 and 53 yo. he denies tobbaco, alcohol and illicit drug use. family history: - his father died of cancer (unknown) in his 80's - his mother died of unkown cause in her 80's - brother with dm physical exam: vitals: afebrile, hr 80s-70 irreg, bp 120-130/60s 97%ra general: oriented and largely appropriate but can be tangential, nad heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl cv: irregular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly. peg site c/d/i gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema general: cooperative, nad. extremities with no edema, pulses palpated. neurologic: mental status: awake, alert. conversant. dysarthria. mild difficulties with word finding. cn:ii-vi intact. vii: left sided facial droop left side upper extremity motor . left lower -. right side upper/lower . sensory: decreased sensation to light touch on left side. gait: deferred pertinent results: 03:25am blood wbc-7.8 rbc-3.59* hgb-10.6* hct-31.0* mcv-86 mch-29.6 mchc-34.3 rdw-15.0 plt ct-276 06:15am blood wbc-6.5 rbc-3.54* hgb-10.5* hct-31.2* mcv-88 mch-29.6 mchc-33.5 rdw-14.5 plt ct-296 05:42am blood wbc-8.3 rbc-3.71* hgb-10.9* hct-31.8* mcv-86 mch-29.4 mchc-34.3 rdw-15.0 plt ct-262 05:33am blood wbc-6.8 rbc-3.47* hgb-10.5* hct-30.6* mcv-88 mch-30.2 mchc-34.2 rdw-15.0 plt ct-273 06:39am blood wbc-8.6 rbc-3.16* hgb-9.5* hct-27.2* mcv-86 mch-30.0 mchc-34.8 rdw-15.3 plt ct-266 06:47am blood wbc-8.5 rbc-3.57* hgb-10.8* hct-31.6* mcv-88 mch-30.2 mchc-34.2 rdw-14.7 plt ct-317 06:00am blood wbc-7.3 rbc-3.40* hgb-10.2* hct-29.4* mcv-86 mch-30.0 mchc-34.7 rdw-15.3 plt ct-269 05:03am blood wbc-7.1 rbc-3.34* hgb-10.1* hct-28.9* mcv-87 mch-30.4 mchc-35.1* rdw-15.4 plt ct-257 06:09am blood wbc-5.6 rbc-3.41* hgb-10.3* hct-29.5* mcv-86 mch-30.1 mchc-34.9 rdw-14.7 plt ct-245 02:30am blood wbc-6.7# rbc-3.46* hgb-10.5* hct-29.9* mcv-86 mch-30.2 mchc-35.0 rdw-14.6 plt ct-240 01:21am blood wbc-3.8* rbc-3.37* hgb-10.1* hct-29.0* mcv-86 mch-30.1 mchc-34.9 rdw-15.0 plt ct-235 03:07am blood wbc-4.9 rbc-2.97* hgb-8.6* hct-26.7* mcv-90 mch-28.8 mchc-32.2 rdw-15.0 plt ct-275 08:35pm blood wbc-5.6 rbc-3.66* hgb-10.8* hct-32.6* mcv-89 mch-29.5 mchc-33.1 rdw-14.3 plt ct-362 ***** 08:40am blood pt-19.1* ptt-79.0* inr(pt)-1.8* 03:25am blood pt-17.1* ptt-64.0* inr(pt)-1.6* 09:05pm blood pt-16.5* ptt-66.2* inr(pt)-1.6* 06:15am blood pt-15.4* ptt-40.2* inr(pt)-1.4* 03:15am blood pt-14.8* ptt-69.7* inr(pt)-1.4* 05:42am blood pt-15.3* ptt-70.0* inr(pt)-1.4* 10:31pm blood pt-16.4* ptt-150* inr(pt)-1.5* 05:33am blood plt ct-273 05:02pm blood pt-25.7* inr(pt)-2.5* 06:47am blood pt-21.1* ptt-38.9* inr(pt)-2.0* 03:07pm blood pt-21.0* ptt-38.2* inr(pt)-2.0* 06:00am blood pt-21.9* ptt-39.8* inr(pt)-2.1* 05:03am blood pt-24.6* inr(pt)-2.4* 05:14am blood pt-28.2* ptt-41.7* inr(pt)-2.7* 06:09am blood pt-31.1* ptt-66.1* inr(pt)-3.0* 05:57am blood pt-25.8* inr(pt)-2.5* 01:21am blood pt-16.9* ptt-32.7 inr(pt)-1.6* 05:25pm blood pt-15.8* inr(pt)-1.5* 03:07am blood pt-20.9* ptt-43.0* inr(pt)-2.0* 08:55pm blood pt-52.3* ptt-83.7* inr(pt)-5.2* ******* 03:25am blood glucose-73 urean-8 creat-0.8 na-139 k-3.8 cl-104 hco3-26 angap-13 06:15am blood glucose-67* urean-9 creat-0.9 na-141 k-3.8 cl-107 hco3-25 angap-13 05:42am blood glucose-92 urean-10 creat-0.8 na-141 k-4.0 cl-105 hco3-27 angap-13 05:33am blood glucose-143* urean-14 creat-0.9 na-138 k-3.9 cl-103 hco3-28 angap-11 06:15am blood calcium-9.0 phos-3.2 mg-1.9 ==== cta abdomen pelvis final report indication: bright red blood per rectum with a history of diverticular disease, evaluate source of bleed. technique: mesenteric cta with and without contrast. coronal and sagittal reformations were provided and reviewed. dlp: 2049.18 mgy-cm. abdomen: the visualized portions of the lungs again show bilateral ground-glass opacities with a more consolidative-appearing process appearing on the right, predominantly in a peribronchovascular distribution. this has improved from prior. there are trace bilateral pleural effusions which are also improved. the heart size is enlarged. there is no pericardial effusion or pneumothorax. the liver enhances homogeneously without focal lesions. the gallbladder contains multiple gallstones without evidence of cholecystitis. there is no biliary ductal dilatation. a new wedge-shaped hypodensity is seen at the base of the spleen (3b:247). the pancreas and right adrenal gland are normal. again noted is diffuse thickening of the left adrenal gland without nodularity. the kidneys enhance symmetrically and excrete contrast without hydronephrosis. bilateral hypodensities likely represent cysts but are too small to characterize fully. a 2.9-mm non-obstructing stone is seen within the left kidney (2:36). there is no free air or free fluid. no retroperitoneal or mesenteric lymphadenopathy is seen. moderate atherosclerosis and soft plaque is seen throughout the abdominal aorta and at the bifurcation of the iliac vessels. the portal vein, splenic vein, and superior mesenteric vein are patent. a percutaneous g-tube is present. the stomach is unremarkable. there are no foci of contrast extravasation seen on the arterial or delayed phases to suggest the location of the bleed. pelvis: air seen in the bladder with foley catheter in place. the prostate and rectum are normal. minor diverticulosis is seen in the sigmoid colon without diverticulitis. there is no inguinal or pelvic lymphadenopathy. there is no free pelvic fluid. bones: there are no suspicious osseous lesions. moderate degenerative changes are noted about the lower lumbar spine marked by disc space narrowing and vacuum phenomenon at l3-s1. incidental note is made of a pectus excavatum. impression: 1. no source of bleeding identified. 2. wedge-shaped splenic hypodensity representing a splenic infarct. 3. widespread pulmonary consolidations, right greater than left, consistent with multifocal pneumonia, improved from prior. 4. cholelithiasis without cholecystitis and sigmoid diverticulosis without diverticulitis. 5. cardiomegaly. the study and the report were reviewed by the staff radiologist. dr. dr. approved: fri 4:46 pm ======== colonoscopy contents: the patient's g-tube was found to be passing through the descending colon. the tissue surrounding the tube was friable and demonstrated contact bleeding. mucosa: neovascularization in the rectum with no bleeding was noted. these findings are consistent with mild radiation proctitis. excavated lesions a few diverticula were seen in the left colon. diverticulosis appeared to be of mild severity. impressions: diverticulosis of the left colon proctitis in the colon foreign body in the colon otherwise normal colonoscopy to cecum brief hospital course: patient is an 83 year old male with chronic atrial fibrillation on coumadin s/p cva to right middle cerebral artery, s/p g-tube placement for feeding who presented to with bright red blood per rectum. patient was initially admitted to the medical icu due to several episodes of bright red blood per rectum. he had a subsequent drop in hematocrit of 6 points. he remained hemodynamically stable during this period. of note, his inr upon presentation was 5.2. he under went a cta abdomen which did not show an obvious source of bleeding. given that his hematocrit was stable and he had stopped bleeding per rectum spontaneously, a tagged rbc scan was deffered. in the icu he required 2units of reds cells and 2 units of ffp. from a prior hospitalization, there was one positive blood culutre which showed fungal growth which was possibly a contamination. he was treated with micafungin and there was no further evidence of fungemia. he coumadin was held in the micu and he was on a heparin drip to prvent cva from his atrial fibrillation. note patient has had prior r-mca secondary to atrial fibrillation. once his pressures were stable and he had definitively stopped bleeding, he was then transferred to the medical floor for further care and workup of his gi bleeding. following discharge from the medical icu, the patient was seen and consulted on by gastroenterology. gastroenterology recommended doing a colonoscopy to localize his bleeding. however given his elevated inr, his coumadin was held. in the interim he was placed on a heparin drip. we placed this patient on a heparin drip for the length of his stay at (except when it was discontinued for procedures for a few hours and subsequently restarted). *it is important that he is anticoagulated because he has chronic atrial fibrillation and he is status post stroke to the right middle cerebral artery.* it took several days for his inr to drop to an acceptable range to where the procedure could be performed safely without any increased risk of bleeding. during this time, he was on a heparin drip which was adjusted to a ptt from 60-100. on , the patient went for colonoscopy. the patient?????? gtube was found to be passing through the descending colon. the tissue surrounding the tube was friable and demonstrated contact bleeding. also, the colonoscopy showed a diverticulosis of the left colon, proctitis and then otherwise normal colonoscopy to the cecum. gastroenterology recommended that his inr remain between to prevent re-bleeding and also extreme care when managing the tube such that it does not migrate out of the stomach. general surgery was consulted, they felt that exploratory laparotomy at this juncture given that the patient was tolerating feeds through the percutaneous tube would be very high risk. after consulting with gastroenterology, general surgery felt that his g tube was safe to be used for feeding. gastroenterology recommended that the patient follow-up in 3 for endoscopic removal of the percutaneous gtube. in the interim, they recommended that the patient be fed through the peg, his coumadin to be restarted, and to follow up in 3 . the patient was subsequently restarted on his tube feeds, glucerna 85 ml's per hour and his coumadin was restarted at 1 mg. no changes were made to the patient's medications during his inpatient stay. transitional issues: chronic atrial fibrillation-inr of for atrial fibrillation. medications on admission: colace 100mg lantus 12u metoprolol 25mg po bid micafungin 100 iv qd (until ) nystatin 5ml qid simvastatin 10mg qhs lisinopril 20mg qd lovenox 120mg sc q24h (until ) coumadin 2mg daily allergies: none discharge medications: 1. colace 100 mg capsule sig: one (1) capsule po twice a day as needed for constipation. capsule(s) 2. insulin glulisine subcutaneous 3. insulin regular human 100 unit/ml solution sig: sliding scale injection qachs: sliding scale provided. 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po twice a day: hold for hr less than 55 or bp less than 100. 5. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 6. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 7. warfarin 1 mg tablet sig: one (1) tablet po once daily at 4 pm. 8. heparin (porcine) 1,000 unit/ml solution sig: see attached sheet injection adjust per ptt: weight based protocol until inr . 9. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 10. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q24h (every 24 hours). 11. heparin gtt at 750unit/hr discharge disposition: extended care facility: - discharge diagnosis: 1. acute lower gastrointestinal bleed attributed to percutaneous endoscopic gastrostomy tube traversing through the descending large bowel, with acute blood loss anemia. 2. atrial fibrillation requiring chronic anti-coagulation 3. chronic radiation proctitis status post radiotherapy for prostate adenocarcinoma 4. type ii diabetes mellitus 5. hypertension 6. hyperlipidemia 7. status post ischemic stroke to the right middle cerebral artery discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). transitional issues: *gtube safe for use. *gtube placement. currently in stomach however it may become dislodged if moved. must be very careful when handling tube. if patient developes an acute abdomen please have a very high suspicion that g-tube is emptying into his peritoneum. in this event, stat transfer to for surgical evaluation. discharge instructions: dear reverend , you were hospitalized for a lower g.i. bleed. this bleeding was a combination of the way your feeding tube is positioned in your large bowel and your very high level of blood thinner when you presented to the emergency department with bleeding. going forward, we will continue to use your feeding tube and restart you on your coumadin. it is imperative that your inr is a very closely monitored so that it does not get too high. also, please have your hematocrit or blood level checked twice a week. *you may continue to use the the feeding tube. however, if you notice any belly pain please let your physicians know, and this may be a surgical emergency requiring transfer back to . in approximately one month, you will need to have your feeding tube evaluated by gi for possible removal or revision. your doctors at rehab make a follow up appointment with your primary care doctor, md, upon discharge. in the meantime, please resume your normal rehabilitation activities. please resume your normal medications with the following changes: 1. we have started you on heparin while waiting for your inr to reach therapeutic levels, this should be continued for 2 days after your inr is therapeutic 2. we are discharging you on 1mg of coumadin per day (you were previously taking 2 mgs). your inr (coumadin) blood levels will be titrated and managed by the doctors . it was a pleasure taking care of you. sincerely, internal medicine. followup instructions: department: medical specialties when: wednesday at 9:00 am with: , md building: campus: east best parking: garage department: neurology when: friday at 1:30 pm with: , md building: sc clinical ctr campus: east best parking: garage name: , c. location: healthcare - medical group address: ,8th fl, , phone: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. department: div. of gastroenterology when: wednesday at 3:00 pm with: , md building: ra (/ complex) campus: east best parking: main garage md procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances colonoscopy diagnoses: acidosis unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation personal history of malignant neoplasm of prostate long-term (current) use of anticoagulants disseminated candidiasis other and unspecified coagulation defects late effects of cerebrovascular disease, aphasia diverticulosis of colon (without mention of hemorrhage) other specified disorders of rectum and anus radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other and unspecified mycoses hemorrhage of rectum and anus mechanical complication of gastrostomy surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation 

Answer: The patient is high likely exposed to