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: cefazolin / penicillins attending: chief complaint: hypotension, hct drop major surgical or invasive procedure: egd blood transfusion history of present illness: 70-year-old man status post kidney transplant now on hd initially presented with dyspnea and epigastric pain. patient reports symptoms began suddenly yesterday while watching tv, with sudden sob and mild epigastric discomfort. pt reports that at some point today he had mild chest discomfort, similar to that he has regularly, and took a nitroglycerin. he denies nausea, vomiting, hematemesis, hematochezia or melena. he denies history of recent bleeding, dizziness, or light headedness. . in the ed, initial vital signs were:97.6 76 107/93 18 99%. cxr was clear. while he was in the ed he became hypotensive to the 80s and received several ivf totalling to 750cc. he had an episode of melena and coffee ground emesis. he was lavaged which resulted in bright blood (thought to be traumatic) that cleared quickly with few coffee grounds, no bile was drawn back. cta torso showed no pe or abdominal perforation. ekg also showed no st depressions in lateral leads, but troponin 0.06. renal was consulted and concerned about k of 6.1 and recommended urgent dialysis. during his ed stay he received 5mg iv morphine for epigastric pain, started on a protonix drip. pt was transfered to micu with 2pivs and stable vital signs. . in the micu, patient reports continued epigastric discomfort, but no further nausea, emesis, or melena. . ros: denies fevers, chills, change in weight, headache, dizziness, orthopnea/pnd or palpitations, urine production, lower extremity edema, new pains, rash. past medical history: : rx allergy: cephalosporins (cefazolin), s/p graft embolect - subdural hematoma: er - esrd s/p kidney transplant and rejection, now on hemodialysis - glomerulonephritis - cad: cardiac cath : completely occluded lcx (unchanged since ), 50% lesion lad (vs 30% prior) & completely stenotic rca - cath s/p 2 xience to rca after rotablation of heavily calcified artery - hyperparathyroidism - anemia - gout - hyperlipidemia - hypertension - eosinophilia (? 2o strongloides) - multiple lung nodules of unknown etiology - hypogonadism - obesity - bronchospasm - hx ppd positive but ruled out for pulmonary tuberculosis recently - chronic sdh s/p - left ij tunnelled catheter placement . past surgical history: - cardiac catherization on s/p 2 xience to rca after rotablation of heavily calcified artery. - - left brachial artery to cephalic vein primary av fistula. - - revision of av fistula with ligation of side branches - - creation of left upper arm arteriovenous graft, brachial to axillary. - - thrombectomy with revision of left arm arteriovenous (av) graft - cadaveric kidney transplant, right iliac fossa. (dr. - - right upper arm brachial - axillary graft (dr. - - rue avg fistulogram, angioplasty of intragraft partially occluding clot - - rue avg thrombectomy, fistulogram, arteriogram, 8-mm balloon angioplasty of outflow stenoses. - rue graft thrombectomy - tunneled hd catheter placement and av fistula ligation social history: -tobacco: smoked for a few years as a teenager -etoh: denies -illicits: denies -lives alone w cat; has three sons that are not very involved in his life; walks with a cane. has vna once a month and meals on wheels. -previously worked as a zoo keeper zoo family history: no history of kidney disease, + history for dm, htn physical exam: admission exam: general - well-appearing gentleman, sedated, in nad, no respiratory distress, warm to touch. heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear neck - supple lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - pmi non-displaced, rrr, no mrg, nl s1-s2 abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - wwp, trace edema bilaterally., 2+ peripheral pulses (radials, dps) neuro - awake, a&ox3, cns ii-xii grossly intact discharge exam o: 98.0 136/88 75 18 100%ra general - obese latino male in nad heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear neck - supple lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use. hematoma on back is unchanged. heart - pmi non-displaced, rrr, no mrg, nl s1-s2 abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - wwp, trace edema bilaterally, 2+ peripheral pulses (radials, dps) neuro - awake, a&ox3, cns ii-xii grossly intact pertinent results: admission labs 02:45pm blood wbc-11.6* rbc-3.17*# hgb-8.5*# hct-29.4*# mcv-93 mch-26.9* mchc-29.0* rdw-19.5* plt ct-183 09:48pm blood wbc-13.6* rbc-2.59* hgb-7.1* hct-23.9* mcv-92 mch-27.3 mchc-29.6* rdw-19.4* plt ct-168 02:45pm blood glucose-144* urean-137* creat-8.7*# na-137 k-6.1* cl-97 hco3-20* angap-26* 02:45pm blood alt-25 ast-20 alkphos-107 totbili-0.2 02:45pm blood albumin-3.4* calcium-7.5* phos-3.1# mg-2.9* . cardiac labs 02:45pm blood ck-mb-4 ctropnt-0.06* probnp-4103* 09:48pm blood ctropnt-0.05* 02:26am blood ck-mb-3 ctropnt-0.10* 09:53am blood ck-mb-4 ctropnt-0.15* . discharge labs 06:30am blood wbc-8.5 rbc-2.96* hgb-8.5* hct-28.1* mcv-95 mch-28.8 mchc-30.3* rdw-19.0* plt ct-153 06:30am blood glucose-119* urean-49* creat-8.1*# na-135 k-4.4 cl-94* hco3-27 angap-18 06:30am blood calcium-7.8* phos-3.7 mg-2.3 . ekg : sinus rhythm. left atrial abnormality with a change in atrial morphology compared to the previous tracing of . there are new st-t wave changes recorded in leads i and avl as compared with prior tracing which may represent active lateral ischemic process. followup and clinical correlation are suggested. . ekg : sinus rhythm. compared to the previous tracing of there is further improvement inthe inferolateral st-t wave abnormalities. followup and clinical correlation are suggested. . cxr : no acute cardiopulmonary process. persistent increased interstitial markings in the lungs compatible with chronic interstitial disease. interval resolution of the right mid lung opacity since prior. . cta : 1. no evidence of acute pulmonary embolism or acute aortic dissection. 2. extensive atherosclerotic disease involving the aorta, major visceral arteries and coronary arteries. 3. no evidence of bowel perforation or other acute abdominal pathology. 4. scattered colonic diverticulosis without evidence of acute diverticulitis. . egd : esophagus: lumen: a medium size hiatal hernia was seen. mucosa: a salmon colored mucosa distributed in a segmental pattern, suggestive of long segment barrett's esophagus was found. stomach: mucosa: localized erythema and erosion of the mucosa with no bleeding were noted in the antrum. these findings are compatible with moderate gastritis. duodenum: mucosa: diffuse continuous friability, erythema and congestion of the mucosa with no bleeding were noted in the duodenal bulb compatible with moderate duodenitis. excavated lesions five ulcers ranging in size from 4 mm to 6 mm were found in the duodenal bulb. two of these had visible vessel in center. 6 cc epinephrine was injected in one and 4 cc in the other. 2 endoclips were placed on the the larger ulcer successfully. impression: medium hiatal hernia moderate gastritis moderate duodenitis ulcers in the duodenal bulb mucosa suggestive of barrett's esophagus otherwise normal egd to third part of the duodenum brief hospital course: 70 yom with history of esrd on hd, cad s/p in , p/w epigastric pain, hematemesis, melena, and dyspnea x 1 day, found to have duodenal ulcers, s/p clipping and epinephrine, with course complicated by demand ischemia. . # hematemesis/melena, gi bleeding, acute bood loss anemia: pt with hct drop to 23.9 from 29.4 on admission. he received 2 units of prbc transfused on . he was briefly intubated for egd performed on which showed multiple duodenal ulcers, two with visible vessels. both were injected with epinephrine, and 2 endoclips were placed on the the larger ulcer successfully. he was quickly extubated without complication. hct remained stable thereafter. his diet was advanced to clears, and he was maintained on ppi. low dose aspirin 81mg was restarted given his cad, and decision to restart plavix was made. his cardiologist was , and a note from : . "this patient has a drug-eluting stent placed in for recurrent in-stent restenosis inside a prior drug-eluting stent from . he should be on uninterrupted aspirin for life as well as lifelong clopidogrel (or equivalent anti-platelet) therapy given the anatomical substrate of a bilayer of drug-eluting stents that puts him at very high risk for late and very late stent thrombosis. late stent thrombosis carries significant mortality and morbidity risks. the only circumstance for which we would consider stopping dual anti-platelet therapy would be intracranial bleeding." . he was put back on aspirin 325mg daily and plavix 75mg daily. he was started on low dose bb, and as he tolerated this well his home metoprolol succinate 100mg daily was restarted. because he is high-risk to bleed, and remains on dual-anti-platelet therapy, he should have several hct checks in the near future. his home ppi was also increased. . additionally, an h pylori serology was checked, and came back equivocal. as this is a potentially reversible risk factor, it was decided to treat him with ppi, metronidazole x 10 days (he has pcn allergy), and clarithromycin x10 days. . # hypotension: in the setting of his gib. this resolved, and he remained normotensive. we continued to hold his home antihypertensives in the micu and these were restarted on the floor, where his pressures remained stable. # demand ischemia: pt with ekg on admission showing ischemic appearing t waves in i and avl, as well as st-t wave flattening in leads v5-v6 andii and avf. this was concerning for ischemia, but eventually resolved on subsequent ekg. thought to be demand related to the setting of hypotension and anemia. aspirin 325 and plavix 75 daily were restarted. he was continued on his home pravastatin 10mg daily, and his ldl was at goal <70. he was symptomc free on discharge. . # interstitial lung diseae: initially maintained on iv methylprednisolone in the setting of his npo status, and once diet was advanced he was restarted on home dose of prednisone 30mg, with bactrim ppx. given his upper gi bleed, his pulmonologist was , and felt that his prednisone could be lowered to 20mg daily. he will f/u w/ pulmonary on . # ckd on hd: mwf dialysis sessions. dialysis was deferred on friday given hypotension, but was restarted the following day. he was continued on sevelemer, calcinet, and nephrocaps, though sevelemer dose was decreased, and calcium acetate started, per renal recommendations. last dialysis sessions was monday . . # cad, s/ : as above, initially held asa, plavix, bb given that patient was bleeding and hypotensive. he was maintained on his pravastatin 10mg daily. eventually, all cad meds (see above) were restarted. his aspirin and plavix should never be stopped, except in setting of truly life-threatening bleed, given the way this pt is stented puts him at very high risk for in-stent thrombosis. per dr : "need to balance the risk and consequences of recurrent gi bleeding vs. the risks and consequences of stent thrombosis in his rca. patients with stent thrombosis carry a 20-40% mortality and a 30-40% chance of a large non-fatal mi" . # gout: continued allopurinol. . # code status: full (confirmed) =================================== transitional issues # needs to have hct checked frequently in near future to ensure no recurrent bleeding # repeat egd 4-6 weeks, per gi. medications on admission: allopurinol 100 mg qod b complex-vitamin c-folic acid 1 mg daily clopidogrel 75 mg daily metoprolol succinate 100 mg daily sevelamer carbonate 800 mg 5 tabs tid pravastatin 10 mg daily aspirin 325 mg daily cinacalcet 30 mg tablet sig: 0.5 tablet po daily (daily). oxycodone 5 mg tablet q6h prn pain fluticasone 50 mcg/actuation spray daily albuterol sulfate 90 mcg/actuation hfa aerosol inhaler prn docusate sodium 100 mg daily bactrim ds (unclear if taking) discharge medications: 1. allopurinol 100 mg tablet sig: one (1) tablet po every other day. 2. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 3. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 4. sevelamer carbonate 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). 5. pravastatin 10 mg tablet sig: one (1) tablet po once a day. 6. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 7. cinacalcet 30 mg tablet sig: 0.5 tablet po daily (daily). 8. fluticasone 50 mcg/actuation spray, suspension sig: one (1) nasal once a day. 9. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) inhalation prn as needed for shortness of breath or wheezing. 10. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po m/w/f (). 11. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 12. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). disp:*90 capsule(s)* refills:*2* 13. prednisone 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 14. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 15. clarithromycin 500 mg tablet sig: one (1) tablet po twice a day for 10 days. disp:*20 tablet(s)* refills:*0* 16. metronidazole 500 mg tablet sig: one (1) tablet po twice a day for 10 days. disp:*20 tablet(s)* refills:*0* 17. docusate sodium 100 mg capsule sig: one (1) capsule po once a day. 18. outpatient lab work : hematocrit - please fax results to dr. . phone: fax: discharge disposition: home discharge diagnosis: duodenal ulcers, gastrointestinal bleed discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr , it was a pleasure taking care of you at . you were admitted for a gastrointestinal bleed. this was found to be from ulcers in your stomach. for this, you had an endoscopy, and the bleeding was stopped. changes were made to your medications, which should also help prevent more bleeding. your duodenal ulcers may be related to a stomach infection from helicobacter pylori. this is a common infection that can pre-dispose you to ulcers. you will receive 10 days of antibiotics to treat this infection. please have your blood counts (hematocrit) checked at dialysis on wednesday. you will follow-up with the gi doctors and likely need another endoscopy in 4 - 6 weeks. the following changes were made to your medications: ** decrease sevalamer to 800mg tablets, take three (3) tablets three (3) times a day (you had previously been taking 5 tablets 3 times a day) ** decrease prednisone to 20mg once daily (you had been on 30mg once daily) ** start pantoprazole 40mg by mouth twice daily (you will take this instead of the 20 mg daily dose you were previously taking) ** start calcium acetate 667mg tablet, 1 tablet three times a day with meals ** start metronidazole 500mg by mouth twice a day for 10 days ** start clarithromycin 500mg by mouth twice a day for 10 days followup instructions: department: bidhc when: monday at 10:45 am with: , md building: 545a centre st. (, ma) none campus: off campus best parking: department: div. of gastroenterology when: wednesday at 2:30 pm with: , md building: ra (/ complex) campus: east best parking: main garage department: pft when: thursday at 1 pm department: pulmonary function lab when: thursday at 1 pm with: pulmonary function lab building: gz building (felbeerg/ complex) campus: east best parking: main garage department: medical specialties when: thursday at 2:00 pm with: dr. /dr. building: sc clinical ctr campus: east best parking: garage procedure: other endoscopy of small intestine hemodialysis endoscopic control of gastric or duodenal bleeding diagnoses: hyperpotassemia end stage renal disease renal dialysis status acute posthemorrhagic anemia gout, unspecified percutaneous transluminal coronary angioplasty status diaphragmatic hernia without mention of obstruction or gangrene hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia hypotension, unspecified postinflammatory pulmonary fibrosis hyperparathyroidism, unspecified duodenitis, without mention of hemorrhage duodenal ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, with obstruction complications of transplanted kidney unspecified gastritis and gastroduodenitis, without mention of hemorrhage barrett's esophagus 

Answer: The patient is high likely exposed to