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: history of present illness: mr. is an 82-year-old male with a past medical history significant for benign prostatic hypertrophy (status post transurethral resection of the prostate in ), gout, hypertension, chronic renal insufficiency ?, hypothyroidism and thrombocytopenia, status post cerebrovascular accident, and anemia requiring transfusion of packed red blood cells. he was most recently hospitalization on , during which time he was treated for dehydration and acute renal failure. in addition, during that hospitalization, the was noted to have a systolic blood pressure in the 85-110 range and all of his antihypertension medications were discontinued. in addition, he was noted to have a left facial droop, and right tongue deviation, and mri was ? lacunar stroke. the patient was then placed on aggrenox. he was discharged to rehabilitation, and had been doing well and had been at home with . on , vna found the patient supine, blood pressure 100/60, sitting blood pressure 60/40, and standing blood pressure 40/palpable. although he lives in an assisted-living facility. he has had a weight loss of approximately 20 pounds over the past six months. he denied any change in appetite. he denied any chest pain, shortness of breath, or urinary signs or symptoms. he denied any fevers, chills, nausea or shaking. he denied any bright red blood per rectum. he denied any melena. he has positive constipation alternating with loose bowel movements. he did complain of dizziness when he changed positions from supine to standing or supine to sitting, but he denied any loss of consciousness and denied any confusion. after the vna found the patient to be orthostatic hypotensive, the patient was sent to the emergency department. he was given aggressive intravenous fluids, and his orthostatic hypotension responded to three liters of intravenous fluids. his initial examination was notable for brown, guaiac negative stool, but several hours later, he had sudden, explosive episodes of melena. the patient then had a nasogastric lavage done, which was clear. a gi consultation was obtained and evaluated the patient and initially, an upper endoscopy was planned. a type and cross was sent. the patient continued to have profuse melena was admitted directly to the medical intensive care unit. past medical history: 1. cerebrovascular accident. 2. transient ischemic attack. 3. venous stasis ulcers. 4. chronic renal insufficiency ? 5. benign prostatic hypertrophy status post transurethral resection of the prostate in . 6. cataracts. 7. hypertension. 8. left eye amaurosis. 9. gout. 10. hypothyroidism. 11. anemia requiring transfusion. 12. history of thrombocytopenia. medications on admission: 1. levothyroxine 25 mcg p.o. q.d. 2. tylenol p.r.n. 3. aggrenox one tablet p.o. b.i.d. 4. allopurinol 100 mg p.o. q.d. 5. tums. 6. promod one scoop b.i.d. 7. vitamin c 500 mg p.o. b.i.d. 8. ensure. social history: he is a retired clerk. he denied any alcohol or drug history. he denied any smoking history. allergies: the patient has no known drug allergies. family history: none. physical examination: on admission temperature was 98.8, heart rate 108, blood pressure 91/58, respiratory rate 60, o2 saturation 98% on room air. heent: mucous membranes were dry. neck: jugular venous pressure flat. lungs: bilaterally clear to auscultation. cardiovascular: normal. abdomen: positive bowel sounds, soft, nontender, nondistended abdomen. guaiac negative stool initially. no costovertebral angle tenderness. extremities: lichenification of his hands with excoriation was noted; erythema with venous stasis of bilateral lower extremities, two small ulcers (1.5 cm), clearly demarcated, on the right lower extremity, well granulated, one ulcer on the left lower extremity/lateral calf, well granulated. ekg: normal sinus rhythm with a heart rate of 99, left ventricular hypertrophy, normal intervals, no acute st and t wave changes. the ekg was compared with . laboratory data: on admission white blood cells was 12.6, hematocrit 27.4, platelet count 211, mcv 95, sodium 141, potassium 5.7 (slightly hemolyzed), chloride 109, bicarbonate 25, bun 49, creatinine 1.1, glucose 106, pt 14.2, ptt 31.5, inr 1.3. impression: an 82-year-old male with a history of cerebrovascular accident and dehydration who was noted to have orthostatic hypotension (standing blood pressure 40/palpable), when vna visited him. his initial examination was notable for negative guaiac and brown stool. however, several hours later in the emergency department, he was noted to have profuse episodes of melena. ogt lavage was done, which revealed no bright red blood, and only brown-tinged fluid, which cleared with lavage. hospital course: 1. gi bleed: the patient was admitted directly to the medical intensive care unit and was typed and crossed for blood, and was transfused initially five units on hospital night number one. however, a repeat ogt lavage was done which revealed again, no bright red blood, and brown-tinged fluid, which cleared with lavage. given the fact that the nasogastric lavage was negative, and there was no change in his acute condition, and there was no obvious active life-threatening hemorrhage, the gi service deferred on an emergent endoscopy. the patient's hematocrit was checked q. 8 hours while in the medical intensive care unit, and his hematocrit was stable after transfusion of another unit of packed red cells (for a total of six units) in the medical intensive care unit. the question of an emergent/urgent endoscopy was approached again with gi and since the patient was hemodynamically stable, and his nasogastric lavage was negative, in the setting of a new large pneumothorax, and without obvious life-threatening active hemorrhage, gi deferred on endoscopy until the patient was more medically stable. however, it was felt that if the patient did become hemodynamically unstable, gi was always available to do an emergent therapeutic intervention. throughout the patient's admission he had a rectal tube in place, and large amounts of melena were produced every day. even though the patient had melena, his hematocrit was checked initially q. 8 hours in the medical intensive care unit and later q. 12 hours on the floor and his hematocrit remained stable x 4 days. the patient will likely continue to have melena for a couple of weeks, until his entire gi system has been cleared out. given that the patient's hematocrit remained stable, there did not appear to be any active blood loss. on , one day after the chest tube was pulled, gi did an esophagogastroduodenoscopy to evaluate for the cause of upper gi bleed. they found in the stomach, a single cratered nonbleeding 15 mm ulcer in the pylorus. there were changes of the ulcer base consistent with ulcer healing. there was no visible vessel. there was distortion of the pylorus, and edema of the surrounding mucosa. a cold forceps biopsy was performed for histology. the duodenum was normal. gi recommendations were to continue proton pump inhibitor, no non-steroidal anti-inflammatory drugs, follow up the biopsy results. in addition, the patient will be scheduled to have a repeat endoscopy in eight weeks to document ulcer healing and for possible repeat biopsy to exclude malignancy. during the hospital course, he had two large-bore peripheral ivs at all times. his hematocrit was checked q. 8 hours in the medical intensive care unit and q. 12 hours while on the floor and has been stable at 29-31%. he was on iv protonix (ppi) 40 mg iv q. 12 hours. in addition, there was no aspirin, no aggrenox, no non-steroidal anti-inflammatory drugs given. as an outpatient, the patient should continue the protonix, but will be changed to a p.o. form. the patient should not have any aspirin, aggrenox, or any more non-steroidal anti-inflammatory drugs, until further directed to do so by gi. 2. pulmonary: the medical intensive care unit course was complicated by an iatrogenic pneumothorax, which was caused status post numerous left subclavian central line placement attempts. the patient's pneumothorax was moderate to large sized and cardiothoracic surgery was called to place a chest tube. a chest tube was placed on without event. initially, the chest tube had air leaks, which later resolved. the thoracic service continued to follow the chest tube throughout his admission and repeat chest x-rays were obtained to evaluate the progression/resolution of it. on , cardiothoracic surgery pulled the chest tube, and a repeat chest x-ray obtained showed that the pneumothorax was slightly smaller in size. the patient was stable on room air and had o2 saturations of 95-99%. the patient was comfortable on room air and did not require any supplemental oxygen at that point in time. in addition, the patient had a large amount of subcutaneous emphysema/crepitus on his left hemithorax. this had decreased over several days of his hospital admission, but was still present. 3. hematology: the patient is a difficult crossmatch secondary to numerous antibodies. the patient had a type and screen sent every three days, and always had three units of packed red cells ready/reserved for this patient. it took several hours for the patient to be crossmatched for a unit, secondary to his numerous antibodies. the patient was transfused a total of......units of packed red cells in the medical intensive care unit, and did not require any more transfusions while on the floor. 4. acidosis: the patient developed a nonanion gap acidosis (low bicarbonate of 17), hyperchloremic (117). this was likely secondary to an expansion acidosis, given his aggressive iv fluid hydration with normal saline. when the patient was transferred to the floor, the patient's intravenous fluids were changed from normal saline to lactated ringer solution (which has bicarbonate in it), and his intravenous fluids were continued at 125 cc an hour. over the next three to four days on the floor, his bicarbonate slowly increased to 20, and his chloride decreased to 110. there appeared to be resolving hyperchloremic nonanion gap acidosis. 5. bilateral leg ulcers/chronic venous stasis: the patient's home regimen was continued with bactroban ointment, and normal saline wet-to-dry dressing changes on his ulcers q. day. in addition, the patient's legs were wrapped with kerlix, because there was a significant amount of oozing/weeping. of note, the patient wears compression stockings at home. he stated that in the rush to get him to the hospital, these were left at home. if possible, the patient should be continued on these compression stockings, which the patient says help his leg edema and oozing a great deal. 6. prophylaxis: the patient was given subcutaneous heparin for dvt prophylaxis. pneumoboots were not placed on this patient, secondary to them being too painful to his lower extremities. 7. fluids, electrolytes and nutrition: the patient was given fluid resuscitation with normal saline at 150 cc/hour in the medical intensive care unit, which was changed to lactated ringer solution at 125 cc/hour on the floor. the patient was kept initially n.p.o. and as it seemed that his gi bleeding had resolved, and hematocrit was stable, he was transitioned to sips of clears. while on the floor, he was given sips of clears as well. after his esophagogastroduodenoscopy, which showed a healing ulcer, he was transitioned to clears, to full liquids, and is now tolerating a regular diet well. 8. ins and outs: the patient has no history of coronary artery disease or congestive heart failure. strict i's and o's were kept on this patient, which included his rectal tube, chest tube, intravenous fluids, and urine output. the patient did not show any signs of pulmonary edema or elevated jugular venous distension throughout his aggressive intravenous fluids hydration. urine output was good and there were no problems with the discontinuation of his foley catheter. the patient had a transurethral resection of the prostate in . the patient continued to have melena, have his hematocrit was stable and it is likely that his melena will continue for a while. 9. hypothyroidism: the patient was continued on levothyroxine 24 mg p.o. q.d. disposition: the patient is status post egd x 1 day and doing well. his hematocrit is stable. he is afebrile and hemodynamically stable. he is saturating 95-99% on room air. he is comfortable breathing at room air. the patient feels well, and is ready to go for rehabilitation. he has expressed the desire to get out of bed and to begin walking and working himself again. the patient is discharged to a rehabilitation center. discharge diagnoses: 1. upper gastrointestinal bleed, secondary to pyloric ulcer. 2. anemia, secondary to acute blood loss, requiring transfusion. 3. pneumothorax, status post chest tube placement and removal. 4. hypothyroidism. 5. venous stasis disease/leg ulcers. 6. intravenous fluid expansion acidosis. 7. numerous antibodies and his blood, difficult crossmatch. 8. fifteen mm pyloric ulcer, showing evidence of healing. discharge follow up: the patient will follow up with his primary care physician, . . the patient will follow up with gi for a repeat egd in eight weeks to document ulcer healing, and possible repeat biopsy to exclude malignancy. discharge instructions: 1. the patient should continue to use a proton pump inhibitor. 2. patient is absolutely not to use any non-steroidal anti-inflammatory drugs, aspirin, or aggrenox. 3. the patient should had a hematocrit checked twice a week. if there is evidence of decreasing hematocrit (patient's hematocrit is currently stable at the 29-31% range) to less than 26-27%, recommend investigation. *the patient's past medical history includes thrombocytopenia as well as chronic renal insufficiency. however during this hospital admission, his platelet count has been in the range of 140,000 to 211,000. the patient does not show signs of thrombocytopenia at this point in time. in addition, the patient has a past medical history listed of chronic renal insufficiency. however, on the day of discharge, as well as the day before discharge, the patient's creatinine was 0.9 to 1.0, with a bun of 16 to 20. these laboratory values do not reflect any element of chronic renal insufficiency. discharge medications: 1. protonix 40 mg p.o. q. 12 hours. 2. levothyroxine 25 mcg p.o. q. day. 3. heparin 5,000 units subcutaneous q. 12 hours, while patient is in bed. if the patient is ambulating with physical therapy, this may be discontinued. 4. tums. 5. vitamin c 500 mg p.o. b.i.d. 6. ensure. 7. promod one scoop b.i.d. 8. allopurinol 100 mg p.o. q.d. 9. bactroban ointment (mupirocin cream 2%), one application b.i.d. to skin ulcers. 10. tylenol 325-650 mg p.o. q. 4-6 hours p.r.n. 11. miconazole powder 2% one application b.i.d. p.r.n. to his taenia. 12. protonix 40 mg p.o. q. 12 hours. 13. absolutely no non-steroidal anti-inflammatory drugs, aspirin, or aggrenox. , m.d. dictated by: medquist36 procedure: insertion of intercostal catheter for drainage venous catheterization, not elsewhere classified esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: acidosis acute posthemorrhagic anemia iatrogenic pneumothorax other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction emphysema (subcutaneous) (surgical) resulting from procedure venous (peripheral) insufficiency, unspecified ulcer of calf 

Answer: The patient is high likely exposed to