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: melena major surgical or invasive procedure: picc placement for tpn history of present illness: 69 year-old woman with a history of cad, chf, avm, achalasia anemia, new large brain mass affecting sella turcica and impinging on optic chiasm who presents with melena. patient was seen at today from rehab. patient had been constipated for 5 days without bm, then last night was given 4 enemas and is now incontinent of stool, diarrhea. at she was noted to have guaiac positive melanotic stools. she was therefore sent to ed. here only complaint at this time is generalized fatigue. she denied any lh, dizziness, syncope. no cp, sob, abd pain. states that she has had some recent nausea, but no vomiting. . recently admitted for work-up or large brain mass which was found to be pituitary adenoma on biopsy. to be seen by dr. next week. . in the ed she was ng lavage and was positive for bright red blood clots and coffee grounds. ecg showed questionable st elevations in v1-2 unchanged. 2 large bore iv's were placed. iv ppi was given. also given levoquin given wbc of 16.6. . in the micu the patient's hct was monitored and remained stable. she was continued on iv ppi and underwent egd that showed grade 4 esophagitis with contact bleeding in the lower third of the esophagus. she was kept npo. past medical history: 1. coronary artery disease with history of v. fib arrest, s/p lad stent and repeat cath in 2. chf - ef 30-35% in . 3. osteoporosis - early menopause, no history of hip fractures but verterbral compression fractures noted earlier this month. 4. depression 5. history of colonic avm and anemia of chronic blood loss 6. s/p appendectomy 7. hypertension 8. h/o achalasia, peptic stricture at eg junction 9. h/o tah and bilateral oopherectomy in her 30s social history: soc: patient lives with her brother and sister-in-law. she has 60 pack-year tobacco history but quit 20 yrs ago; denies etoh and drug use family history: fhx - multiple members in the family with who has had early tah and bilateral oopherectomy physical exam: t 97.5 bp 116/59 hr 98 rr 16 o2sats 100% ra gen: chronically ill appearing, cachectic, nad heent: ng tube in place, dry mm, perrl, eomi lungs: ctab heart: tachy no m/r/g abd: soft, nt, nd + bs, no hsm ext: no edema, normal peripheral pulses neuro: a&o times 3, sensation intact, strength normal, moving all 4 extremeties pertinent results: ng lavage in ed- 300cc with small amount of coffee grounds. after cxr revealed ng tube in esophagus this was removed. . ecg: sinus tachy at 107nl axis, nl intervals, lvh, twave inversion in lateral leads old. . cxr- ng tube is curled in the esophogus . egd : dilation at the lower third of the esophagus grade 4 esophagitis in the lower third of the esophagus erythema in the stomach body compatible with ng trauma food in the antrum otherwise normal egd to second part of the duodenum brief hospital course: a/p 69 year-old woman with a history of cad, chf, avm, achalasia anemia, new large brain mass affecting sella turcica and impinging on optic chiasm who presents with melena. . # pt has a long history of gibs from avm's. also history of achalasia and peptic stricture, which caused ngt to become curled in esophagus and had to subsequently be removed. pt admitted with guaiac positive stool and positive ng lavage. she was admitted to the micu for close monitoring of her hct and vital signs. she was given 2 large bore ivs. her hct was monitored q 4hr and remained stable. she was kept npo and given iv ppi per gi. she underwent egd that showed grade 4 esophagitis. gi recommended qid sucralfate and ppi. given her achalasia and poor po intake they recommended that the patient receive tpn for nutritional repletion given low albumin. once nutritionally replete may need g-tube in medium term. she was advanced to a regular diet and started on tpn following picc placement. she was transferred to a regular medicine floor. her hct trended down to 24.9 and given her cardiac history she was transfused one unit of packed rbcs. she had an appropriate bump in her hct to 29.8 and this remained stable >30 since. . # pt with recent luekocytosis during her last hospitalization but normalized on discharge. admitted with wbc of 16 with left shift. she received a dose of levaquin, however her leukocytosis resolved and she was afebrile. there was no obvious signs of infection. cxr showed no pneumonia. her leukocytosis resolved and she remained afebrile. blood cultures were sent and remained ngtd. levofloxacin was discontinued given no clear infectious source. on the day prior to discharge, ms. had leukocytosis with a u/a consistent with a uti (see below). her wbcs at time of discharge remain 12.7 but this is only after 1 day of treatment. cxr done was read as: "impression: markedly limited study secondary to positioning. as best can be determined there is no definite new focal opacity. there is a new indwelling picc line as above" and the leukocytosis upon discharge is being attributed to a uti. . # uti: on the day prior to discharge, ms. had leukocytosis with a u/a consistent with a uti. at time of discharge she has gram negative rods growing (speciation and sensitivities pending at time of discharge which should be followed post-discharge). we started a course of bactrim and she should continue this for 3 days and have follow up u/a and cultures in a week's time. . # hyponatremia- patient was initially hyponatremic to 132 on admission. resolved with hydration so it was thought to be secondary to hypovolemia. . # brain mass- worked up recently completed. recent biopsies showed pituitary adenoma. tsh/t4, stim were normal during last admission. lh/fsh were low. of note, sutures removed by neurosurg on day of discharge. -- follow up with dr. no urgent need for intervention. -- outpatient appointment scheduled and please call to confirm this. . # chf- ef 30-35%. no signs of failure at this time. -- watch for need of lasix given fluid resusitation . # anemia- chronic fe deficicient anemia, likely from chronic gib. iron supplemntation was restarted following endoscopy. . # pt with no recent chest pain or ecg changes. -- cardiac enzymes negative x2 -- no asa given ugib . # fen- patient was initially kept npo for her procedure. given her achalasia, the patient is only able to tolerate small amounts of food at one time. her gi doctors that she had had significant worsening of her nutritional status with low albumin and weight loss. it was felt that she will likely need a feeding tube for nutritional support as she is unable to meet her needs by mouth, however gi did not want to place a tube while her nutritional status was so poor. therefore, a picc was placed for tpn. she will likely need a few weeks of tpn to improve her nutritional status prior to g-tube placement. she was advanced to a regular diet given there was no contraindication to this and she was started on tpn. . # ppx- pneumoboots (held heparin s/p gib); ambulate with pt daily . # access- 2 piv's . # code- dnr/dni . # dispo- to rehab today . medications on admission: 1. calcium carbonate 500 mg tid 2. citalopram 10 mg tab qday 3. ferrous sulfate 325 mg qday 4. mirtazapine 7.5 mg qhs 5. nortriptyline 20 mg qhs 6. simvastatin 40 mg qday 7. sucralfate 1 g 8. ergocalciferol (vitamin d2) 50,000 unit po qsat 9. oxycodone 5 mg prn 10. zolpidem 5 mg qhs 11. dolasetron mesylate 12.5 mg iv q8h:prn 12. nexium 40 mg discharge disposition: extended care facility: northeast - discharge diagnosis: primary: ugib grade 4 esophagitis pituitary adenoma anemia achalasia . secondary: cad chf htn discharge condition: stable discharge instructions: please continue to take your medications as directed. . if you experience blood in your stool, difficulty breathing, chest pain, fainting, high fevers or other concerning symptoms call you doctor or come to the emergency room. followup instructions: provider: , md phone: date/time: 2:00 provider: , .d. phone: date/time: 10:20 provider: , west date/time: 9:45 procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances other endoscopy of small intestine insertion of other (naso-)gastric tube transfusion of packed cells diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified iron deficiency anemia secondary to blood loss (chronic) hyposmolality and/or hyponatremia personal history of tobacco use depressive disorder, not elsewhere classified percutaneous transluminal coronary angioplasty status esophagitis, unspecified esophageal hemorrhage achalasia and cardiospasm benign neoplasm of pituitary gland and craniopharyngeal duct gastrointestinal vessel anomaly senile osteoporosis 

Answer: The patient is high likely exposed to