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: dysphagia major surgical or invasive procedure: intubation endoscopy history of present illness: 88 year old female with hx of a. fib and right brachial artery embolism on dabigatran, cad, diastolic chf, htn, hypothyroidism presenting with dysphagia. pt was recently admitted for doe and melenotic stools; hct was found to be 22 from baseline 40. she underwent extensive gi workup including egd, colonoscopy and capsule endoscopy that was largely unrevealing for source of bleed. she was started on omeprazole for gastritis. she received total of 4 units prbcs during admission with hct in low 30s on discharge. she was discharged on lower dose of dabigatran and lower dose of atenolol. she was discharged to rehab where she had difficulties with constipation and intermittent dysphagia. she was discharged home approximately one week ago and has complained of intermittent dysphagia. on day of admission, she had difficulties even swallowing water. reports vomiting twice. in the ed, initial vs were: 96.6 50 167/69 16 94% ra. she was evaluated by gi who plan to perform egd tonight. anesthesia was called for intubation for mac anesthesia. cxr was unremarkable. ct chest showed fluid distention of the stomach and fluid layering up to mid esophagus. past medical history: cad s/p des to lad and om1, mild biventricular systolic/diastolic chf (compensated) reactive airway disease hypothyroidism hypertension hyperlipidemia osteoporosis previous pneumonia atrial fibrillation, not anticoagulated falls bilateral rotator cuff repair status post right hip repair . social history: quit smoking 9 years ago, glass wine per day. family history: sister - deceased from cva physical exam: admission physical exam 96.6 50 167/69 16 94% ra. general: alert, oriented x 3, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: irregularly irregular rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: bibasilar crackles, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis; trace b/l edema neuro: cnii-xii intact, following commands, moving all extremities discharge pe: t97.8, hr 77, bp 133/60, rr 18, 94% ra general: alert, oriented x 3, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: irregularly irregular rhythm, normal s1 + s2, 2/6 systolic murmur heard at r and l sternal border lungs: minimal bibasilar crackles, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis; trace b/l edema at ankle neuro: cnii-xii intact, following commands, moving all extremities pertinent results: admission labs 04:35pm blood wbc-5.5# rbc-4.39# hgb-10.5* hct-35.5* mcv-81* mch-24.0*# mchc-29.7* rdw-17.2* plt ct-123* 04:35pm blood neuts-83.4* lymphs-8.9* monos-6.7 eos-0.7 baso-0.3 04:35pm blood pt-14.9* ptt-50.3* inr(pt)-1.4* 04:35pm blood glucose-102* urean-23* creat-1.0 na-133 k-6.4* cl-92* hco3-28 angap-19 04:35pm blood calcium-8.3* phos-4.0 mg-2.3 04:35pm blood tsh-2.1 04:35pm blood digoxin-0.7* discharge labs 07:00am blood wbc-3.3* rbc-3.89* hgb-9.1* hct-31.1* mcv-80* mch-23.4* mchc-29.3* rdw-17.3* plt ct-108* 07:00am blood glucose-101* urean-22* creat-1.0 na-137 k-3.9 cl-99 hco3-32 angap-10 imaging cxr findings: pa and lateral views of the chest were obtained. cardiomegaly is again noted with diffuse ground-glass opacity concerning for pulmonary edema. bilateral pleural effusions are present, left greater than right with bibasilar consolidation, likely representing compressive atelectasis. no pneumothorax is seen. aortic calcifications again noted. bony structures are demineralized. impression: pulmonary edema, bilateral effusions and bibasilar atelectasis, stable cardiomegaly. ct chest 1. fluid distension of the esophagus suggesting dysmotility. 2. left adrenal nodule is incompletely assessed. elective evaluation with dedicated adrenal protocol ct may be performed as an outpatient. egd : impression: food in the whole esophagus erythema and friability in the lower third of the esophagus compatible with esophagitis retained fluids in stomach normal mucosa in the duodenum otherwise normal egd to third part of the duodenum recommendations: trial clears with close monitoring. continue ppi to allow esophagitis to heal. f/u tsh. barium swallow and esophageal manometry should be done to evaluate motility within the esophagus. can consider further motility evaluation if it becomes clear that the stomach as well as colon are involved as well and if the above is unrevealing. barium swallow findings: the patient has mild esophageal dysmotility. the primary stripping wave breaks in the mid to distal esophagus. there is a moderate amount of residual contrast in the esophagus after swallowing, even in the upright position. there is no abnormal dilation, stricture, or evidence of achalasia. the esophagus distends normally. the 13-mm tablet passes easily into the stomach. impression: mild esophageal dysmotility. no evidence of achalasia. manometry : no signs of achalasia, final read pending brief hospital course: patient is a 88 year old female with hx of a. fib and right brachial artery embolism on dabigatran, cad, diastolic chf, htn, hypothyroidism who presented with dysphagia and was found to have esophagitis and food particles throughout the esophagus without evidence of stricture on barium swallow. manometry showed no signs of achalasia. dysphagia: patient presented with intermittent dysphagia. she had a ct of the chest which showed large amounts of food in the esophagus with air fluid levels. she was intubated for her egd given food seen on ct scan and concern for aspiration. her egd showed large amounts of food in the esophagus as well as esophagitis without evidence of strictures or malignancies. food was removed and she was extubated without incident. barium swallow showed no stricture. manometry showed no signs of achalasia. she was advanced to clear liquids then full liquids and finally to a pureed diet which she tolerated. she was given pantoprazole iv initially and then started on po omeprazole 40 mg po bid. she was discharged on pureed diet after the nutrition specialist gave her diet education. etiology of dysphagia remains unclear. gastroenterology thinks esophagitis likely is contributing to esophageal dysmotility, though there is concern for dysmotility elsewhere in the gi tract including in the colon given constipation and the stomach as this was full of food. no clear metabolic cause for this has been discovered, however. patient will be closely followed by gi to discuss further work up as indicated. diastolic chf: torsemide dosing recently increased from 20mg to 40mg for worsening le edema. she initially appeared euvolemic on exam and torsemide was initially held. it was restarted when she developed an o2 requirement on . she then was oxygenating well on room air and had minimal le edema. her torsemide dose was subsequently decreased from 40 mg to 20 mg prior to discharge as she developed a contraction alkalosis and appeared euvolemic to slightly dry. she was instructed to weigh or if she developed lower extremity edema. intubation: pt electively intubated with fentanyl/versed for mac anesthesia/egd. she was extubated following the procedure without complications. atrial fibrillation: rate controlled on atenolol and digoxin. on dabigatran on off-label dosing for afib and right brachial artery embolism. hypothyroidism: tsh within normal limits. she was continued on her home levothyroxine. anemia: recent extensive workup for source of anemia was unrevealing (pt is s/p egd, colonoscopy, capsule endoscopy). hct remained at her baseline in low 30s. she will need a repeat colonoscopy in 6 months as outpatient thrombocytopenia: has long-standing thrombocytopenia. platelet count remained in her baseline range. she had no evidence of active bleeding # transition issues: 1. patient needs to be followed up on her dysphagia as outpatient, and further work up should be discussed with gi 2. patient needs to monitor her daily weight for appropriate volume status 3. patient needs a repeat colonoscopy in 6 months as outpatient 4. patient needs to be followed up for thrombocytopenia and leukopenia as outpatient with consideration of hematology follow up if this fails to resolve 5. patient complained of difficulty hearing, and found to have bilateral ear wax impaction. attempt to remove ear wax but unsuccessful. she was given prescription for carbamide peroxide to use as outpatient. 6. left adrenal nodule found incidentally on ct chest, should have adrenal protocol ct as outpatient to further assess # communication: (son, ; # code: full (confirmed with hcp) medications on admission: 1. digoxin 125 mcg tablet sig: 0.5 tablet po once a day. 2. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 3. fluticasone-salmeterol 500-50 mcg/dose disk with device sig: one (1) disk with device inhalation (1-2 times a day). 4. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 5. torsemide 40 mg tablet daily(recently doubled) 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for c. 8. dabigatran etexilate 75 mg capsule sig: one (1) capsule po tid (3 times a day). 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 10. simvastatin 40 mg tablet sig: one (1) tablet po once a day. discharge medications: 1. dabigatran etexilate 75 mg po tid 2. atenolol 25 mg po daily hold for sbp < 100 or hr < 60 3. torsemide 20 mg po daily 4. carbamide peroxide 6.5% 5-10 drop ad duration: 4 days rx *carbamide peroxide 6.5 % twice a day disp #*1 bottle refills:*0 5. digoxin 0.0625 mg po daily 6. docusate sodium 100 mg po bid 7. fluticasone-salmeterol diskus (500/50) 1 inh ih 8. levothyroxine sodium 100 mcg po daily 9. omeprazole 40 mg po bid rx *omeprazole 40 mg twice a day disp #*60 capsule refills:*0 10. senna 1 tab po bid:prn constipation 11. simvastatin 40 mg po daily discharge disposition: home with service facility: greater vna discharge diagnosis: primary: dysphagia secondary: diastolic heart failure, hypertension, atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital with trouble and pain with swallowing. you had an endoscopy to look at your esophagus and food was found within your esophagus as well as irritation of your esophagus called esophagitis. we also performed a barium swallow study which did not show any strictures. a study called esophageal manometry was performed and showed no evidence of achalasia. you can further discuss the final result with your gi doctor. please weigh yourself every morning, md if weight goes up more than lbs. followup instructions: please keep the following appointments: department: when: monday at 12:00 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage department: div. of gastroenterology when: wednesday at 2:30 pm with: , md building: ra (/ complex) campus: east best parking: main garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other endoscopy of small intestine insertion of endotracheal tube diagnoses: thrombocytopenia, unspecified anemia, unspecified coronary atherosclerosis of native coronary artery congestive heart failure, unspecified unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation acute on chronic diastolic heart failure asthma, unspecified type, unspecified personal history of tobacco use percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia osteoporosis, unspecified other constipation esophagitis, unspecified dysphagia, unspecified 

Answer: The patient is high likely exposed to