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: patient recorded as having no known allergies to drugs attending: chief complaint: altered mental status and melena major surgical or invasive procedure: esophageogastroduodenoscopy , esophageogastroduodenoscopy , colonoscopy history of present illness: 88 year old male with recent gastrointestinal bleeds attributed to gastric ulcer, status post mechanical aortic valve replacement on coumadin, chronic kidney disease, history of nstemi in , with altered mental status and a hematocrit drop from his baseline of 30 to 20 after being transferred to a new long term care facility. he was found to be dizzy, confused, and weak to the point where he could not stand up. he is not demented at baseline per the family, but today he was exhibiting extensive mental slowing. his blood pressure was 100/60 with a heart rate of 60 and his hgb=6.7, hct=20.9. prior hgb was 10.7. he used to get his care at and presented with altered mental status and anemia in the setting of a gi bleed. he was also seen for anemia in setting of supratherapeutic inr. in the ed, initial vs: 97.5, 93, 123/67, 99% 3l. ekg shows right bundle branch block and left ventricular hypertrophy which was unchanged. his stools were guaiac positive and he has a sacral decubitus ulcer. his coumadin was not reversed and he was ordered 1 unit of blood, but could not receive it because he has antibodies that need to be screened for. he received po protonix. on the floor, the patient had active melena(about 7 pm) which given his anticoagulation status and difficulty with blood products was felt to require intensive care monitoring. he was transferred to the micu. past medical history: # listeria endocarditis s/p avr, suppressive amoxicillin stopped due to hemolytic anemia, previously on prednisone # hx recent gi bleeds: colonoscopy : noted normal colon, hemorrhoids # aortic mechanical valve, last inr 2.0 # gerd: egd with non-bleeding ulcers in esophagus and stomach # anemia from gi bleed of gastric ulcer vs. hemolytic anemia from avr # ckd 1.6-2.0 # cad s/p nstemi # h/o likely diastolic chf on diuretics # hyperlipidemia # hypertension # depression since death of his brother # prostate ca- s/p radiation # bladder/bowel incontinence # right lateral malleolus stage 1 pressure ulcer social history: he was born in ny and has been a book binder all of his life. he moved to to be closer to his son. does not smoke or drink currently. he was just transferred to rehab, but also lived at the . his brother recently died. he requires a significant degree of assistance in all his adls and iadls. family history: non contributory. physical exam: exam on admission: vitals - t: 98.1 bp: 150/68 hr: 76 rr: 20 02 sat: 97% on 3l general: pleasant, pale, elderly male, confused at times heent: mmm, conjunctival pallor, ncat, perrla/eomi, neck supple cardiac: rrr, mechanical click noted, systolic murmur at lusb lung: l crackles abdomen: soft, nt/nd, bs+ ext: no c/c/e neuro: he is oriented to person, place, and time, but does not know why he is in the hospital and clearly has mental slowing derm: grade sacral decubitus and heel ulcers pertinent results: admission labs: wbc-3.7* rbc-2.16*# hgb-7.1*# hct-22.3*# mcv-104*# mch-33.0*# mchc-31.8 rdw-18.2* plt ct-223 neuts-60.6 lymphs-26.5 monos-8.6 eos-3.4 baso-0.9 pt-21.8* ptt-34.3 inr(pt)-2.0* glucose-92 urean-30* creat-1.5* na-144 k-3.5 cl-108 hco3-27 angap-13 alt-5 ast-14 ld(ldh)-227 ck(cpk)-21* alkphos-55 totbili-0.8 calcium-8.7 phos-4.0 mg-1.8 hapto-<20* . cardiac enzymes with trop increasing to 0.51. ck-mb stable. . h. pylori -positive . mrsa - positive . blood smear without large amount of hemolysis . ekg: sinus with atrial ectopic foci, vs. ectopic atrial rhythm, rbbb, 1st (present on ekg at rehab), 1st degree av block, no signs acute ischemia . egd : small hiatal hernia ,normal stomach. no fresh or old blood seen. a single 8mm non-bleeding polyp was found in the second part of the duodenum. otherwise normal egd to third part of the duodenum cxr : no acute infiltrate, possible and mild vascular congestion, costophrenic angles clears . echo : suboptimal image quality. mild symmetric left ventricular hypertrophy with overall low normal left ventricular systolic function. lvef 50-55%. mechanical avr with normal gradients. moderate mitral regurgitation. moderate tricuspid regurgitation. (note: lvef 55% in per report) . egd : small hiatal hernia; normal stomach. no fresh or old blood seen. a single 8mm non-bleeding polyp was found in the second part of the duodenum. otherwise normal egd to third part of the duodenum . colonscopy : stool was found in the cecum, ascending colon, transverse colon, splenic flexure and descending colon. extensive washing was done, but due to the semi-solid nature of the stool the scope clogged multiple times. there was limited visualization of the colon- especially the right colon. small polyps and flat lesions could have easily been missed. no large lesion noted brief hospital course: 88 year old male with mechanical aortic valve on warfarin and hx of gastric ulcer who presented with melena and altered mental status. . # gi bleed: patient was admitted to the floor on but transferred to the micu due to melena and low blood pressure. patient received 2 units of packed red blood cells and 2 units of fresh frozen plasma. hematocrit bumped from 22 to 28. patient was started on proton pump inhibitor drip and transferred to floor after stabilization of hematocrit and vital signs. egd on was negative for source of bleeding. patient was started on heparin drip and developed recurrent bouts of hematemesis. patient was transferred to the on and received 1 unit of packed red blood cells on for a hematocrit down to 28.3 from 34. patient developed atrial fibrillation with rapid ventricular response. he was started on metoprolol 5mg iv every six hours with resolution of atrial fibrillation. hematocrit was stabilized in the mid 30s. on patient underwent a second egd which was again negative for active upper gastrointestinal bleed. patient was restarted on intravenous proton pump inhibitor. on pt was transferred back to the floor. heparin drip was started on and discontinued on hours prior to placement of nasogastric tube for bowel prep. colonoscopy on was limited by poor prep. however, no source of bleeding was identified. patient was bridged to coumadin with heparin drip after colonscopy. by discharge, his hematocrit was stable in the high 20s with no sign of active bleeding. he is to follow up with gi as outpatient when a capsule endoscopic study will be considered. . # aortic valve replacement with mechanical valve : given acute gastrointestinal bleeds with anticoagulation, warfarin was held until colonoscopy was conducted. warfarin 3.5mg daily was started on with heparin bridge. inr at discharge was 2.5. heparin drip was discontinued. . # atrial fibrillation: with one episode of rapid ventricular response that resolved with metoprolol iv and amiodarone drip. at discharge patient's heart rate was stable. . # chronic diastolic heart failure: echo on showsed ejection fraction of 50%. on furosemide (20mg daily)at home, which was held given gastrointestinal bleed. patient was significantly edematous. patient was diuresed with 20mg iv furosemide from to with significant improvement in edema. creatinine level rose but plateaued at 1.4. home dose of furosemide was held at discharge and could be restarted once creatinine stabilizes. . # gerd: pt was started on intravenous proton pump inhibitor on admission. he was transitioned to oral pantoprazole after colonoscopy. . # h/o cad s/p nstemi: aspirin and beta blocker were held given gastrointestinal bleed. metoprolol 25mg po bid was restarted on . given recent gi bleed and patient's being on warfarin, aspirin was held on discharge with decision to restart deferred to outpatient cardiologist. . # chronic kidney disease: creatinine remained stable. it elevated to 1.4 with diuresis. at discharge, creatinine was stable at 1.4. all medications were renally dosed. . # hyperlipidemia: patient was kept on home dose of statin . # urethral stricture: foley placed by urology because patient bled with insertion. patient noted to have urethral stricture. per urology, patient is to follow up with dr. either on wednesday or for a voiding trial. patient is to call ( to set up an appointment. foley should not be removed at rehab since it was difficult to place. . # contact: son (w) (h) (c) medications on admission: coumadin 3.5mg daily ecasa 325mg daily acetaminophen 650mg q4h prn vitamin d 1000 units daily calcium carbonate 650mg milk of magnesia 30ml daily ferrous sulfate 325mg lasix 20mg daily metoprolol 25mg omeprazole 20mg daily simvastatin 80mg qpm miralax daily discharge medications: 1. simvastatin 40 mg tablet sig: two (2) tablet po daily (daily). 2. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 3. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 4. vitamin d 1,000 unit capsule sig: one (1) capsule po once a day. 5. calcium carbonate 650 mg (1,625 mg) tablet sig: one (1) tablet po twice a day. 6. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 8. warfarin 1 mg tablet sig: 3.5 tablets po once a day. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: gastrointestinal bleed discharge condition: stable discharge instructions: you were admitted with changes in your mental status and blood in your stool. you were transferred to the icu twice because you had acute bleeding and your vital signs were not stable. you received blood transfusions because your blood level was low. we held your coumadin because of the bleeding. you underwent two endoscopies and a colonscopy and no source of bleeding was identified in your gi tract. your blood level is now stable and we have restarted you on your coumadin. please continue taking your coumadin. your inr will be monitored at the rehab facility. followup instructions: 1. gi follow up in 2 months . 2.please call to schedule a urology follow-up appointment with dr. on wednesday or 26 for a voiding trial. foley catheter should remain in place until then as it was very difficult to place. procedure: other endoscopy of small intestine other endoscopy of small intestine colonoscopy diagnoses: subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery acute posthemorrhagic anemia acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation personal history of malignant neoplasm of prostate diaphragmatic hernia without mention of obstruction or gangrene other and unspecified hyperlipidemia heart valve replaced by other means long-term (current) use of anticoagulants pressure ulcer, buttock pressure ulcer, lower back hemorrhage of gastrointestinal tract, unspecified hyperosmolality and/or hypernatremia chronic diastolic heart failure senile dementia with delirium pressure ulcer, stage ii chronic kidney disease, stage ii (mild) benign neoplasm of duodenum, jejunum, and ileum urethral stricture, unspecified 

Answer: The patient is high likely exposed to