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: the patient is a 76 year old very pleasant gentleman with a past medical history significant for invasive adenocarcinoma of the stomach status post near total gastrectomy in , with roux-en-y anastomosis and partial jejunal pouch, cirrhosis, coronary artery disease and orthostatic hypotension who was admitted to on with complaints of nausea and dysphagia. at the mr. an esophagogastroduodenoscopy which showed esophageal varices and stricture. he has had three esophageal dilatations in the past for stricture at anastomotic site. dilation could not be performed at this time given his report of large varices. he was therefore transferred for evaluation. in addition, at , mr. had a transthoracic echocardiogram for evaluation of orthostatic hypotension which was unremarkable. he was noted to have significant orthostatic changes which was felt secondary to autonomic dysfunction after his florinef was discontinued. he instead was transferred to midodrine with some improvement in his blood pressure. other work-up at included paracentesis with albumin which showed saag greater than 1.1. cytology was negative for malignancy and there was no evidence of svp. he was unable to tolerate more than liquids while at the hospital secondary to coughing which was felt secondary to aspiration. on admission to , he was initially managed on the medicine floor. however, on hospital day number two, he was noted to have desaturations and tachypnea and was complaining of a feeling of an obstruction in his throat. he had been n.p.o. prior to this event. he was transferred to the medical intensive care unit and was maintained on 100% nonrebreather face mask for the first two days in the intensive care unit. he was slowly weaned off oxygen, however, had a respiratory event on hospital day number five, at which time he was intubated. the following morning, an esophagogastroduodenoscopy was performed and the remainder of hospital course will follow. past medical history: 1. history of pancytopenia. 2. invasive gastric adenocarcinoma status post near total gastrectomy in . he had an esophageal to jejunal anastomosis within a roux-en-y procedure. 3. he is status post three esophageal dilatations by esophagogastroduodenoscopy secondary to strictures at the anastomotic sites. 4. history of cirrhosis which was diagnosed in the 70s thought secondary to alcohol use. he has not had any alcohol use since time of diagnosis. 5. anastomotic site ulcer. 6. coronary artery disease status post angioplasty and stent. 7. autonomic dysfunction / orthostatic hypotension. 8. depression. 9. history of syncope. 10. transverse colectomy secondary to invasive gastric adenocarcinoma in . 11. vitamin d deficiency. medications at home: 1. zoloft 50 q. day. 2. folate. 3. florinef. 4. colace. 5. megace. 6. carafate. 7. lipitor. allergies: no known drug allergies. medications on transfer: 1. inderal 20 twice a day. 2. protonix 40 twice a day. 3. midodrine 10 three times a day. 4. colace 100 twice a day. 5. aldactone 50 twice a day. 6. zoloft 50 q. day. 7. lasix 40 q. day. 8. milk of magnesia p.r.n. social history: alcohol use: heavy drinking for approximately 24 years, quit 29 years ago. the patient is very active in alcoholics anonymous and has not had any alcohol since diagnosis of cirrhosis. tobacco use: twenty-four years, also quit 29 years ago; approximately one pack per day. no history of illicit drug use. the patient lives alone in , . he has no close relatives. his point of contact is his friend, chief whose phone number is . physical examination: on presentation to the medicine floor is temperature 95.1 f.; blood pressure 120/70; heart rate 82; respiratory rate 22; 97% on four liters oxygen by nasal cannula. in general, the patient appeared comfortable in no apparent distress. his pupils were equal, round and reactive. extraocular muscles are intact. mucous membranes were dry. oropharynx was clear. he had poor dentition. his heart was regular rate. no murmurs, rubs or gallops were appreciated. he had bilateral basilar crackles, right greater than left. on abdominal examination, he had hypoactive bowel sounds, soft, nontender, nondistended; a very large horizontal abdominal scar was present and he was dull to percussion throughout with a positive fluid wave. on extremities: no lower extremity edema. he had stockings on. his skin was dry with some ecchymoses over his chest and right upper extremity. he had some spider angiomas. on neurological examination he was alert and oriented times four. cranial nerves ii through xii were intact. he had four over five bilateral upper extremity strength, four over five lower extremities bilateral strength and sensation was intact. laboratory: on transfer white blood cell count 9.6, hematocrit 31.7 at his baseline; platelets 122. sodium 141, potassium 3.5, chloride 110, bicarbonate 22, bun 14, creatinine 0.7, glucose 108, albumin 2.1; total protein 4.7. ldh 196, total bilirubin 1.7, alkaline phosphatase 82. alt 5, ast 20, inr 1.4, uric acid 4.7. impression: this is a 76 year old gentleman with a history of gastric cancer status post near total gastrectomy with an esophageal duodenal roux-en-y procedure who has had three esophageal dilatations secondary to stricture at the anastomotic site, who was transferred from outside hospital for complaints of dysphagia and nausea. he was transferred for evaluation of tips procedure and repeat egd for evaluation of swallowing complaints which was thought secondary to aspiration. hospital course: 1. gastroenterology: as stated above, mr. main complaint included dysphagia which was thought secondary to mechanical obstruction at his anastomotic site from a history of gastric cancer treated in 10/. after intubation on hospital day number five, mr. an esophagogastroduodenoscopy which showed no stricture and a wide open anastomosis with visible aspiration of secretions. general surgery was consulted as well as gastroenterology for possible interventions as it was felt that the reason he was intubated was secondary to recurrent aspiration. the conclusions from both consultations obtained was that there was no surgical or endoscopic intervention. 2. respiratory distress: he was intubated on hospital day number five for respiratory distress secondary to persistent aspiration through his esophageal duodenal anastomosis. mr. was not able to be weaned from the ventilator given the development of metabolic acidosis which will be described below. he was finally on , and expired within a few hours. 3. enterococcus bacteremia: on , mr. had a one out of four blood culture bottles growing enterococcus which was sensitive to vancomycin. he had a subclavian line at that time which was discontinued and the catheter tip sent for culture which did not have any growth. he was continued on vancomycin intravenously for his bacteremia and remained afebrile. 4. leukocytosis: on hospital day number six and seven, the patient had significant and acute increase in his white blood cell count from 11 to 41. a differential at that time showed 7% bands. there was no clear source of infection, however, given the rapid and very high increase in his white count, clostridium difficile colitis was suspected. in addition, other diagnoses which were entertained were sepsis and mesenteric ischemia. a ct scan of the abdomen was performed which showed no evidence of abscess with some colonic thickening which was nonspecific. also of note, he had significant ascites which was tapped and showed 85 white cells and a saag of less than 1; therefore it was not felt that the patient had peritonitis as an explanation for his leukocytosis. he was placed on p.o. vancomycin and continued on intravenous flagyl and levaquin which were started on hospital day number two for presumed aspiration pneumonia. 5. altered mental status: mr. mental status was clear until the time of aspiration event on hospital day number five when he was intubated. he was continued on propofol and was taken off it on a number of occasions at which time mr. delirium did not recover. he was not oriented for the remainder of his hospital course. it was felt that this was mostly toxic metabolic in nature given his significant leukocytosis and likely hepatic encephalopathy. 6. hypotension: the patient was started on neo-synephrine at the time of his intubation on hospital day number five and was never able to be weaned off pressors. he responded well to intravenous fluid boluses at times, however, his pressors were continued. he had a number of reasons for his hypotension including acute issues such as sepsis, leukocytosis, sedating medications, nutritional deficiency as well as chronic issues which included baseline autonomic dysfunction. 7. legal issues: prior to intubation, mr. elected his friend, chief , to serve as his health care proxy and durable power of attorney. mr. has no relatives in the area. on , as mr. condition continue to deteriorate despite full effort and full life sustaining support measures. in accordance to the patient's wishes, chief elected to have mr. on and he expired within a few hours. an autopsy was requested, however, due to the fact that mr. is not a family member, this could not be performed under law. multiple attempts were made to contact any living family members, however, these were not successful. discharge diagnoses: 1. invasive gastric carcinoma status post total gastrectomy in with a transverse colectomy. 2. respiratory failure secondary to recurrent aspiration. 3. bacteremia. 4. leukocytosis which was likely secondary to clostridium difficile colitis, possible mesenteric ischemia. 5. hypotension. 6. aspiration pneumonia. 7. coagulopathy, acquired. 8. cirrhosis secondary to alcohol use. 9. ascites. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other endoscopy of small intestine insertion of endotracheal tube percutaneous abdominal drainage diagnoses: acidosis alcoholic cirrhosis of liver acute respiratory failure pneumonitis due to inhalation of food or vomitus bacteremia intestinal infection due to clostridium difficile hepatic encephalopathy 

Answer: The patient is high likely exposed to