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: penicillins attending: chief complaint: hematemesis major surgical or invasive procedure: : egd history of present illness: 79yo f with multiple myeloma c/b esrd on hd recently discharged from where she was found to have 3 gastric ulcers that were cauterized as the source of an upper bleed who re-presented to the evening of with 1 hour acute onset severe nausea, vomiting x 1, bright red blood. in the , she denied abdominal pain, melena, brbpr, dyspnea, and chest pain. she further denied any dizziness or lightheadedness. ems noted large puddle of brb @ scene. pt was noted to be tachycardic but normotensive during transport. patient is currently undergoing therapy for multiple myeloma with high dose steroids. she denies any significant hx of nsaid use. it is unclear if she has been previously evaluated for h pylori infection. in the , initial vs were: 98.8 f (37.1 c). pulse: 101. respiratory rate: 20. blood-pressure: 121/67. oxygen saturation: 98%. at , she got 2l ns, hr improved to 80. started on pantoprazole gtt. she was admitted to the - icu, but is now being transferred here for further care, particularly anticipated difficultly in crossmatching her for transfusions. vitals prior to transfer (midnight): t 98.5, hr 89, rr 20, bp 114/57, weight 66.42kg on arrival to the micu, patient's vs were 98.4 114/71 97 99% ra. the patient reported fatigue but denied any abdominal pain or further episodes of vomiting. she further denied chest pain or shortness of breath review of systems: (+) per hpi, patient also notes 10 lb wt loss over the past few months (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies shortness of breath, cough, dyspnea or wheezing. denies chest pain, chest pressure, palpitations. denies constipation, abdominal pain, diarrhea, dark or bloody stools. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - type 2 diabetes, diet controlled - hypertension - total abdominal hysterectomy - appendectomy - benign colonic polyps and - degenerative arthritis of the spine social history: originally from . moved to the us with husband in the 50's. lives independently with her husband in . 3 grown children who live in the area. smokes 1/2 per day for many years. occ etoh but 'lost the taste for it' suddenly in . denies illicit drugs. import social history family history: her father died of metastatic gastric cancer. her sistert died of unknown cancer. her mother may have had renal failure. physical exam: physical exam on admission: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, + pallor of the mucous membranes, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, 1-2/6 sem lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-distended, bowel sounds present, no organomegaly, mild tenderness to palpation, no rebound or guarding gu: no foley ext: warm, well perfused, 1+ pulses 2+ edema to the mid shin bilaterally neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, gait deferred. physical exam on discharge: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, 1-2/6 sem lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding gu: no foley ext: warm, well perfused, 1+ pulses 2+ edema to the mid shin bilaterally neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, gait deferred. pertinent results: admission labs: 06:30pm hct-24.1* 05:57am glucose-123* urea n-32* creat-1.0# sodium-144 potassium-4.4 chloride-112* total co2-25 anion gap-11 05:57am estgfr-using this 05:57am ctropnt-<0.01 05:57am calcium-7.7* phosphate-4.0 magnesium-1.6 05:57am wbc-10.0 rbc-2.08* hgb-6.1*# hct-19.3*# mcv-93 mch-29.3 mchc-31.6 rdw-15.4 05:57am neuts-81.9* lymphs-12.0* monos-4.4 eos-1.3 basos-0.3 05:57am plt count-327 05:57am pt-11.5 ptt-25.9 inr(pt)-1.1 discharge labs: 06:45am blood wbc-5.7 rbc-2.99* hgb-9.2* hct-27.2* mcv-91 mch-30.6 mchc-33.7 rdw-14.7 plt ct-285 06:45am blood neuts-72.5* lymphs-17.4* monos-7.3 eos-2.2 baso-0.6 09:46am blood pt-10.6 ptt-28.3 inr(pt)-1.0 06:45am blood glucose-90 urean-20 creat-1.0 na-144 k-3.4 cl-108 hco3-29 angap-10 06:45am blood alt-12 ast-10 ld(ldh)-198 alkphos-70 totbili-0.3 06:45am blood calcium-8.7 phos-4.3 mg-1.7 egd: impression: normal mucosa in the esophagus erythema and congestion in the duodenal bulb compatible with duodenitis ulcers in the stomach (endoclip) otherwise normal egd to third part of the duodenum recommendations: continue ppi infusion for the next 48 hours. can then transition to 40mg pantoprazole po repeat endoscopy in 12 weeks liquid diet today if no further bleeding can transition to regular diet tomorrow. check serum hpylori and treat if positive avoid all nsaids and etoh. additional notes: the attending was present for the entire procedure. the patient's home medication list is appended to this report. final diagnosis are listed in the impression section above. estimated blood loss = zero. no specimens were taken for pathology. l-spine : there are five non-rib-bearing lumbar-type vertebral bodies. there is scoliosis with convexity to the right side which is mild. there are no definite compression deformities. there are again seen severe degenerative changes, worst at l1-l2 and l2-l3, with disc space narrowing, endplate sclerosis, and vacuum gas phenomenon. this is unchanged since the skeletal survey. there are extensive abdominal aortic calcifications. the evaluation of sacroiliac joints is limited by the bowel gas pattern. bilateral hip joints are relatively preserved. multiple myeloma labs: 02:35pm blood pep-hypogammag b2micro-3.4* igg-404* iga-56* igm-19* ife-trace mono free kappa, serum 935.6 h 3.3-19.4 mg/l free lambda, serum 16.7 5.7-26.3 mg/l free kappa/lambda ratio 56.02 h 0.26-1.65 brief hospital course: 79 yo female with multiple myeloma c/b esrd (previously on dialysis) and recent upper gi bleed from gastric ulcers s/p cautery who presented to the evening of with nausea and hematemesis, transferred here for ongoing care in the setting of being a difficult crossmatch for blood, s/p egd with clips applied x 2. active issues: # hematemasis: on admission, hct was 19, but pt remained hemodynamically stable in the icu. pt has known gastric ulcers that have bled in the past. on hd2 she went for egd that revealed duodenitis and one non-bleeding gastric ulcer in the antrum that was clipped with endoclips achieving hemostasis. post procedure and s/p 3 units of , pt's hct remained stable at 26-27. she was continued on pantoprazole drip for 48 hrs post procedure and then transitioned to po pantoprazole. pt did not have any additional episodes of melena or hematemesis and her hematocrit remained stable. h pylori returned negative. # multiple myeloma: was referred to oncologist in ( ) after d/c from bmt service in . she is currently on her second cycle of velcade dex, last treatment was 2 weeks prior to admission. she is due for another round of velcade and dex that will be performed on , . this was discussed with dr. during admission. labs showed a much improved free kappa to lambda light chain ratio. # back pain: pt complained of lumbar back pain. l-spine x-ray was negative for lytic lesions or compression fractures. her pain regimen was transtioned to oxycodone 2.5-5 mg q6h prn and oxycontin 10 mg qam, given concern over tylenol dosing with vicodin. # urinary tract infection: pt's urine grew 10-100k of enterococcus, pansensative. pt was discharged on amoxacillin 500 mg tid x 7 days after confirmed that she had received this medication in the past without complication. inactive issues: # esrd: patient previously required hemodialysis. last treatment was prior to d/c from . dialysis was held throughout this hospitalization and her creatinine remained at 1.0 with no significant electrolyte abnormalities. she continued to urinate normally after removal of foley catheter. # htn: in setting of gib, her home antihypertensives were held while in the icu. amlodipine was restarted before transfer to the floor # dm: diet-controlled, placed on sliding scale insulin as an inpatient. medications on admission: d/c summary - gets meds from in , husband was unable to confirm doses at patch norvasc 5 mg daily colace 100 mg b.i.d. protonix 40 mg daily percocet p.r.n. pain. per pharmacy in renvala 800 mg two tablets tid zofran 8 mg q8h omeprazole 40 mg daily dexamthasone with chemo patch one daily vicodin 5/500 q6h nephrocaps daily acyclovir 200 mg q12h (pt states no longer taking) amlodipine 10 mg daily fluconazole 200 mg daily (15 with no refills) discharge medications: 1. renvela 800 mg tablet sig: two (2) tablet po three times a day. 2. zofran 8 mg tablet sig: one (1) tablet po three times a day. 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day for 30 days. disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 4. dexamethasone with chemotherapy 5. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 6. nephrocaps 1 mg capsule sig: one (1) capsule po once a day. 7. fluconazole 200 mg tablet sig: one (1) tablet po once a day for 15 doses. 8. amlodipine 5 mg tablet sig: one (1) tablet po once a day. 9. oxycodone 5 mg tablet sig: 0.5-1 tablet po every six (6) hours as needed for pain for 2 weeks. disp:*60 tablet(s)* refills:*0* 10. oxycodone 10 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po qam (once a day (in the morning)) for 14 doses. disp:*14 tablet extended release 12 hr(s)* refills:*0* 11. amoxicillin 250 mg capsule sig: two (2) capsule po q8h (every 8 hours) for 7 days. disp:*42 capsule(s)* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: primary: upper gastrointestinal bleed secondary: multiple myeloma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was sincere pleasure taking care of you during your hospitalization at . you were transferred with a recurrence of gastrointestinal bleeding. we performed a procedure to place a few "clips" on an ulcer in your stomach. you blood counts remained stable after this procedure. you are now safe to be discharged home. you will have your next round of chemotherapy with dr. on . followup instructions: please follow-up with dr. on at 1pm for your next round of chemotherapy procedure: endoscopic control of gastric or duodenal bleeding diagnoses: end stage renal disease urinary tract infection, site not specified depressive disorder, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other acquired absence of organ retention of urine, unspecified multiple myeloma, without mention of having achieved remission chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] lumbago acquired absence of both cervix and uterus personal history of colonic polyps spondylosis of unspecified site, without mention of myelopathy 

Answer: The patient is high likely exposed to