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: no known allergies / adverse drug reactions attending: chief complaint: anemia, melena major surgical or invasive procedure: egd egd and colonoscopy colonoscopy capsule endoscopy history of present illness: ms. is a 70 y/o female with schizophrenia, chf (ef 10%), hypothyroidism, cirrhosis of unknown etiology (seen on abd ct ), constipation who was sent in from her facility due to a low hematocrit of 14, down from 41 in . according to pcp, presented to clinic this past thursday with lightheadedness and was thought to be dehydrated, orthostatic. the thought was that she may have been over-diuresed and lasix, spirinolactone was held. patient had follow up two days later along with labs drawn, which showed an acute hct drop to 14.1. difficult to obtain thorough history; patient endorses some decreased energy, feeling cold but exhibited disorganized thoughts and low attention. also has word finding difficulties, all likely chronic psychiatric history. . in the ed, initial vs were: 98.0 74 107/41 16 100% ra. she was noted to be guiac positive with gross melena. ng lavage was negative. she was stared on a iv ppi gtt and octreotide gtt. given 1 gram ceftiraxone. hemodynamically statble. 2 large bores . on arrival to the icu, vs stable at 97.2 78 100/87 95%ra. ros as above, otherwise negative, unobtainable. past medical history: - schizophrenia - cirrhotic liver with ascites - chf with ef 10% - pericardial effusion - h/o left ventricular thrombus - on coumadin - aortic aneurysm - hypothyroidism - rectal prolapse - tardive dyskinesia - constipation social history: recently quitr smoking 4 cigarettes per day. prior heavy etoh, quit years ago. no illicits. family history: she is unaware of any family history of serious illness. physical exam: admission exam vitals: t: afebrile bp: 100/87 p: 78 r: 18 o2:95%ra general: very pale, oriented but distractable, easily confused, no acute distress h/n: nc/at, dry mm, oropharynx clear lungs: ctab cv: rrr, no murmurs abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: +foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema discharge examination: 98.1, 101/56, 68, 18, 92-96% room air general: nad, comfortable, appropriate, oddly related, pleasant heent: nc/at, perrla, eomi, sclerae anicteric, mmm, op clear. neck: supple, no thyromegaly, no jvd at 90 degrees, no carotid bruits. heart: rrr, i/vi hsm lsb, no rg, nl s1-s2. lungs: mild crackles at bases, cta bilat after cough, no r/rh/wh, good air movement, resp unlabored. abdomen: soft/nt/nd, no masses or hsm, no rebound/guarding. extremities: wwp, no c/c/e, 2+ peripheral pulses. skin: no rashes or lesions. lymph: no cervical lad. neuro: awake, a&ox3, cns ii-xii intact, muscle strength 5/5 throughout, sensation grossly intact throughout pertinent results: egd : impression: erythema in the pylorus normal mucosa in the duodenum normal mucosa in the esophagus otherwise normal egd to third part of the duodenum recommendations: no varices seen during egd, but given her low crits, varices might be flat at this time. recommend transfusion to keep crit above 25. proceed with colonoscopy when crits better. for now, monitor crits closely, watch for further bleeding. continue octreotide drip and protonix drip pending complete gi workup. . tte : the left atrium is elongated. overall left ventricular systolic function is severely depressed (lvef= 25-30 %). a left ventricular mass/thrombus cannot be excluded. the right ventricular cavity is dilated with depressed free wall contractility. the aortic valve is not well seen. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: very poor technical quality due to patient's body habitus. overall left ventricular function appears severely depressed (? 25-30%), a focal wall motion abnormality cannot be fully excluded. no pathologic valvular abnormality seen. pulmonary artery systolic pressure could not be determined. the presence of lv thrombus could not be assessed given the poor quality of the study. if clinically indicated, focused views with definity could be obtained for better endocardial definition. . egd : impression: normal mucosa in the esophagus normal mucosa in the stomach normal mucosa in the duodenum otherwise normal egd to third part of the duodenum recommendations: follow up per inpatient gi team recommendations no source of bleeding found . colonoscopy : findings: stool throughout the distal rectum recommendations: please administer 4 liter golytely prep and will re-evaluate for repeat colonoscopy tomorrow . egd : impression: normal mucosa in the esophagus normal mucosa in the stomach normal mucosa in the duodenum otherwise normal egd to third part of the duodenum recommendations: follow up per inpatient gi team recommendations no source of bleeding found . cxr : questionable early infiltrate versus region of volume loss versus mass in the right lower lobe. recommend followup. . ct chest : 5 mm right upper lobe nodule. given her emphysema, this should be followed up with chest ct in months according to guidelines. . . colonioscopy : normal colonoscopy to the terminal ileum. . capsule endoscopy: final read pending. . no micro pending at time of discharge. . 07:00am blood wbc-5.6 rbc-3.42* hgb-9.6* hct-28.9* mcv-85 mch-28.1 mchc-33.2 rdw-15.3 plt ct-390 07:20am blood pt-14.1* ptt-27.4 inr(pt)-1.2* 06:32pm blood ret man-4.8* 07:00am blood glucose-86 urean-9 creat-0.9 na-143 k-3.6 cl-111* hco3-21* angap-15 06:32pm blood caltibc-493* hapto-232* ferritn-5.0* trf-379* brief hospital course: ms. is a 70 y/o female with schizophrenia, cirrhosis on abd ct , and chf (ef 25%) who was admitted with melena secondary to an occult gi bleed. she was on coumadin for a history of afib and prior lv thrombus--cardiology was consulted and the decision was made to discontinue coumadin. gi evalaution was unrevealing with 2 negative egds & unremarkable colonoscopy. capsule study is pending at the time of discharge. her hospital course is summarized in further detail below by major issues. . # acute blood loss anemia/ gi bleed: with the concern that may have variceal bleeding she was sent to the intensive care unit and started on a ppi and octreotide drip. upper endoscopy did not reveal varices, and only showed mild gastritis for which she was started on a proton pump inhibitor. the gastritis was unlikely to be the cause of her gi bleeding, and a second upper endoscopy was performed, which was unrevealing. an initial colonoscopy was unsuccessful due to incomplete preparation. she was transfused 5 units of packed red blood cells, with improvement of her hct to approximately 30 from an initial value of 14. her hematocrit remained stable after the initial transfusions and melena did not recur. a second colonoscopy was adequate and was unrevealing. a capsule endoscopy is pending at the time of discharge and results will be communicated by gastroenterology. she is tolerating a regular (low sodium diet) and has follow-up scheduled with gi. her hematocrit should be checked on . she has been in the 28-31 range after the initial transfusions. . # left ventricular thrombus: she had a history of a left ventricular thrombus diagnosed at hospital in , for which she had been on coumadin. subsequent transthoracic echograms performed at , most recently in , did not show evidence of thrombus. during this hospitalization, an echocardiogram on showed an ef of 25-30% however was a poor study and could not assess for thrombus.cardiology was consulted to determine her risk of thrombus given her low ejection fraction and history of atrial fibrilliation and prior left ventricular thrombus. cardiology recommended against anticoagulation given that she had a significant gi bleed the source of which had not yet been localized, and she was currently in sinus rhythm. cardiology did however recommend that a discussion be had between the patient and her outpatient cardiologist following management of her gi bleed--an appoiment has been made for this. her legal guardian should be present for this appointment. . # systolic chf(ef 25%): she had an acute exacerbation the setting of receiving volume with blood transfusions, a transient oxygen requirement resolved with diuresis. an echocardiogram on showed an ef of 25-30% which was improved from a prior. in the setting of the gib, her spironolactone, aspirin, carvedilol, and lisinopril were held. they were restarted prior to discharge. doses of coreg and lisinopril should be uptitrated, blood pressure permitting. she has a follow-up appointment in heart failure clinic within two weeks. at the time of discharge, she is euvolemic. her is hypoxia in the am 92-94% on room air seems to be primarily due to atelectasis as it resolves with incentive spirometry. . # hx of atrial fibrillation: she was on telemetry throughout this admission and was persistently in sinus rhythm. no atrial fibrillation was noted. amiodarone was continued. . # schizophrenia: she was continued on risperdol and cogentin during this hospitalization. mirtazapine qhs was restarted at the time of discharge. . # hypothyroidism: she was continued on her home dose of levothyroxine. tsh was slightly elevated in the setting of acute illness and should be repeated. . she remained a full code throughout this hospitalization. her legal guardian is her lawyer: : , medications on admission: levothyroxine 150 mcg daily lisinopril 5 daily metoprolol 25 spirinolactone 25mg daily amiodarone 200mg po daily asa 81 daily carvedilol 6.25mg furosemide 20 daily risperdone 0.5 qam/1mg pm cogentin 0.5mg po daily remeron 15mg qhs niferex-150 po daily psyllium fiber 3.4 g daily bisacodyl supp 10mg daily prn constipation ipratropium 1 neb q6h prn sob mvi discharge medications: 1. levothyroxine 75 mcg tablet sig: two (2) tablet po daily (daily): should be taken on empty stomach, 30 min prior to other meds. 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection (2 times a day): ok to discontinue if ambulating. 3. carvedilol 3.125 mg tablet sig: one (1) tablet po bid (2 times a day): hold sbp<100. 4. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 5. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 6. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. multivitamin tablet sig: one (1) tablet po daily (daily). 10. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 11. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily): gold sbp<100. 12. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 13. risperidone 0.5 mg tablet sig: one (1) tablet po qam. 14. risperidone 1 mg tablet sig: one (1) tablet po at bedtime. 15. benztropine 0.5 mg tablet sig: one (1) tablet po once a day. 16. niferex-150 forte 150-25-1 mg-mcg-mg capsule sig: one (1) capsule po once a day. 17. psyllium 3.4 g/5.8 g powder sig: one (1) po once a day. 18. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: one (1) inhalation every six (6) hours. 19. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) inhalation every six (6) hours as needed for shortness of breath or wheezing. discharge disposition: extended care facility: senior healthcare of discharge diagnosis: gi bleed, occult acute blood loss anemia acute on chronic systolic congestive heart failure atrial fibrillation schizophrenia discharge condition: mental status: clear and coherent. pleasant. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , you were admitted to the hospital because you were weak and dizzy. you were found to have a low blood count and black stools indicating that you were having a bleed from your gastrointestinal system. you had two upper endoscopies which did not reveal the cause of your bleeding. a colonoscopy was also unrevealing. a capsule study was done,, the final results of this will be communicated to you by the gastroenterologist who saw you in the hospital. you also had a history of heart failure, and initially needed oxygen. you were weaned off oxygen prior to discharge and restarted on your heart failure medicines. these will need to be adjusted at your extended care facility in conjunction with your heart failure specialist. we have stopped coumadin for the time being. you should not be taking this medication. you will have an appointment with your cardiologist so you can discuss the longterm benefits and risks of this medication. your legal guardian should be present at this appointment. weigh yourself every morning, notify your doctor if weight goes up more than 3 lbs. followup instructions: , k. at facility department: cardiac services when: wednesday at 10:30 am with: , np building: sc clinical ctr campus: east best parking: garage department: div. of gastroenterology when: tuesday at 1 pm with: , md building: ra (/ complex) campus: east best parking: main garage md procedure: other endoscopy of small intestine other endoscopy of small intestine colonoscopy colonoscopy other diagnostic procedures on small intestine diagnoses: congestive heart failure, unspecified cirrhosis of liver without mention of alcohol acute posthemorrhagic anemia unspecified acquired hypothyroidism atrial fibrillation unspecified schizophrenia, unspecified hemorrhage of gastrointestinal tract, unspecified acute on chronic systolic heart failure swelling, mass, or lump in chest 

Answer: The patient is high likely exposed to