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: hematemesis major surgical or invasive procedure: egd egd egd with enteroscopy left thumb incision and drainage history of present illness: mr. is a 75 year old male with cad s/p cabg, systolic heart failure and chronic kidney disease history. he reports having vertiginous episode for 30 seconds with subsequent vomiting of 200 cc of dark red blood. he does not report chest pain, shortness of breath, lightheadedness, syncope, presyncope, melena or brbpr. he has never had hematemesis. he reports using ibuprofen for past three days for his gout. in the ed, initial vs were: 97.2 62 127/52 18 100%ra. ng lavage showed coffee ground with bright red blood which was not cleared with lavage. 2 units of prbc have been typed and crossed. started pantoprazole 80 + gtt. 2 18 iv. last vitals: 72 134/70 18 100%ra. on arrival to the micu, he reports feeling well. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - coronary artery disease * cabg (): lima to lad/vein to om/vein to distal circ/vein to d2 - hypertension - chronic kidney disease, stage iii-iv - congestive heart failure * ef 35-40% (), moderate lvh, mild as - hypercholesterolemia - spinal stenosis * s/p lumbar laminectomy and fusion l3-l5 () - s/p hip replacement () - s/p hemorrhoidectomy - diabetes mellitus * a1c 6.3 () - osteoarthritis social history: the patient currently at rehab since his last discharge. he usually lives with his wife and two sons. ambulates with a walker. quit smoking 12 years ago. smoked 100 ppy history. family history: brother had rheumatic fever. physical exam: admission physical exam: vitals: t: bp: p: r: 18 o2: general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact discharge physical exam: vitals: tc 97.9 tm 99.2 bp 135-153/55-66 hr 56-66 rr 18 o2sat 99(ra). general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: rrr, normal s1 + s2, ii/vi systolic ejection murmur best heard at rusb abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well-perfused, 2+ pulses, no clubbing, cyanosis or edema, no tophus or evidence of inflammed joints neuro: cns2-12 intact, motor function grossly normal pertinent results: admission labs: 08:05am blood wbc-8.9 rbc-4.18* hgb-12.0* hct-36.0* mcv-86 mch-28.7 mchc-33.3 rdw-14.8 plt ct-171 08:05am blood neuts-70.0 lymphs-21.4 monos-6.0 eos-2.1 baso-0.5 08:05am blood pt-11.3 ptt-32.7 inr(pt)-1.0 08:05am blood glucose-179* urean-70* creat-2.0* na-141 k-4.8 cl-102 hco3-28 angap-16 08:05am blood alt-51* ast-33 alkphos-116 totbili-0.3 08:05am blood albumin-3.6 12:32pm blood calcium-8.3* phos-3.0 mg-2.1 08:13am blood hgb-11.8* calchct-35 09:18am urine color-straw appear-hazy sp -1.011 09:18am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-lg 09:18am urine rbc-1 wbc-54* bacteri-none yeast-none epi-2 09:18am urine casthy-28* 09:18am urine mucous-rare . imaging: findings: mild cardiomegaly is again noted. lung volumes are low, likely exaggerating pulmonary vasculature which is mildly prominent. no focal consolidation or pneumothorax is detected. there is possibly a small left pleural effusion. an esophageal catheter is incompletely evaluated due to exposure. sternal wires are noted. impression: low lung volumes with cardiomegaly and possible small left pleural effusion. incomplete evaluation of esophageal catheter, which possibly terminates in the mid esophagus. per discussion with dr. by dr. by telephone at 21:02 on , this tube may possibly be in place intentionally within the mid esophagus. if gastric placement is desired, advancing the tube is recommended if not contraindicated for this patient. . egd (): esophagus: normal esophagus. stomach: excavated lesions a few non-bleeding localized erosions were noted in the antrum. cold forceps biopsies were performed for histology. duodenum: normal duodenum. impression: erosions in the antrum (biopsy) otherwise normal egd to third part of the duodenum . egd (): irregular z line was noted. biopsies of this area was obtained. (biopsy) normal mucosa in the whole stomach normal mucosa in the whole duodenum otherwise normal egd to third part of the duodenum . small bowel enteroscopy (): esophagitis normal mucosa in the whole stomach normal mucosa in the whole duodenum normal mucosa in the proximal jejunum otherwise normal egd to jejunum . thumb xray (): findings: three views of the left thumb demonstrate thumb within a splint. there are degenerative changes at the first ip joint with osteophytes and joint space narrowing. there are also severe osteoarthritic changes at the first cmc with intra-articular bodies and large osteophytes with joint space narrowing and cystic change. it is unclear as to whether there is a superimposed fracture at the base of the first metacarpal or background degenerative changes. no acute fracture identified in the distal aspect of the thumb. hematology labs: 12:44pm blood hypochr-2+ anisocy-1+ poiklo-1+ macrocy-normal microcy-normal polychr-normal ovalocy-1+ tear dr 12:44pm blood ret aut-1.4 12:44pm blood ld(ldh)-171 07:02am blood vitb12-509 folate-13.1 ferritn-52 12:44pm blood caltibc-276 hapto-142 trf-212 micro: 6:55 am serology/blood **final report ** helicobacter pylori antibody test (final ): negative by eia. (reference range-negative). 8:58 am thumb abscess source: l 1st digit. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 3+ (5-10 per 1000x field): gram positive cocci. in pairs and chains. wound culture (preliminary): beta streptococcus group b. moderate growth. anaerobic culture (preliminary): labs on discharge: 07:01am blood wbc-8.9 rbc-3.29* hgb-9.6* hct-28.2* mcv-86 mch-29.1 mchc-33.9 rdw-15.6* plt ct-169 07:01am blood glucose-166* urean-29* creat-1.3* na-141 k-4.0 cl-106 hco3-27 angap-12 07:01am blood calcium-8.7 phos-3.2 mg-2.0 brief hospital course: primary reason for admission: mr. is a 75 year old male with coronary artery disease (cad) status post bypass surgery (cabg), chronic systolic heart failure and chronic kidney disease admitted with hematemesis. active diagnoses: # hematemesis: patient was originally admitted to the icu where he was started on pantoprazole drip, but did not require transfusions to maintain and hematocrit greater than 30. he did have a hematocrit drop from 36 to 31 one day after admission, but his hct stabilized after the drop and did not require any transfusion while in the micu. patient remained hemodynamically stable in the icu. no clear source of bleeding was seen on egd, but full view was precluded by food in the stomach. upon transfer to the flor, he was tolerating food well. repeat egd the day after transfered showed no source of bleeding, no ulcers. yet, hematocrit continued to drop to 26, but the patient was asymptomatic. the initial drop since admission may reflect re-equilibration of the hematocrit, which did not change during the acute blood loss. due to the drop in hct, however, a third egd was performed, now with push enteroscopy, showing esophagitis but no other abnormalities. esophagus was very friable and bled with touch by scope, thus may be source of patient's guaiac + stools. patient's hct stabilized around 26. the 10pt drop since admission was explained by reequilibration as well as improper bone marrow response. retic index is low, and by iron studies, patient is mildly iron deficient. hemolysis labs are negative. b12 and folate levels are good. rbc morphology shows evidence of some teardrop cells, suggesting possible mds. patient probably also does not have enough reserve from iron deficiency, epo deficiency, ?mds or thalassemia (of italian descent and has documented anemia for long time), to generate a response to acute blood loss. patient received 1 unit of blood onthe floor for symptomatic anemia (dizziness), which increased his hct 1pt. per hematology, inpatient workup for thalassemia or mds would be confounded by iron deficiency, so should continue supplementation and pursue outpatient work-up. patient was continued on iron supplementation and prilosec 20 (higher dose may cause marrow suppression). we strongly recommended that the patient avoid all forms of nsaids, and educated the patient and his wife regarding the expected risks of taking these or other acid-increasing medications or foods. they expressed understanding regarding this plan and recommendations. #. cad/systolic heart failure: his blood pressure medications were held in the icu given the concern for development of acute blood loss hemorrhage. upon transfer to the floor, he was restarted on home carvedilol, lisinopril, spironolactone, and his blood pressure remained around 130s-150s systolic. his home diuretics were held as his hct did not stabilize. he received one dose of iv lasix after the blood transfusion for increased peripheral edema. # htn. antihypertensives were originally held in the icu due to recent hematemesis. upon transfer to the floor, patient was restarted on lisinopril and carvedilol per home regimen and blood pressure remained in the sbp 130s-150s. # left thumb felon. on the day prior to discharge, patient's left thumb was noted to be swollen, tender, and erythematous. per his wife, he has had an infection of his thumb before requiring i&d. he was started on zosyn and doxycycline and hand surgery was consulted. he was diagnosed with a felon and his thumb was i&d'd, the pus sent for culture. he was discharged on 14 days of doxycycline with instructions for dressing changes for his thumb, and of note, he and his wife deferred visiting nurse services, but noted they were familiar with dressing changes from his prior finger infection. he was provided with follow-up information regarding hand/plastics follow-up. chronic diagnoses: # gout. patient has hx of gout per his pcp. aspirations have always been negative for septic arthritis. patient states he currently has pain in the small joints of his hands consistent with previous gout flares. he was continued on colchacine per his home regimen. # dmii. most recent hgba1c was 6.3% in . patient takes glipizide at home and not on insulin. in house, he was maintained on a iss and his glipizide was held. . # osa. patient has o2 sats in the high 90s during the day, but dips to the mid-80s at night while sleeping. he snores and has been told before by wife that he has brief episodes of apnea. patient was told he should receive outpatient sleep study. transitional issues: patient will follow up with his pcp and in surgery clinic, appointments set up for week after discharge. he was also encouraged to pursue an outpatient sleep study to work up sleep apnea. all recommendations were discussed at the bedside by the medical team, and with the patient's wife present. their questions were addressed to their satisfaction. emergency contact: (wife and hcp) medications on admission: carvedilol 12.5 mg po bid colchicine 0.6 mg po bid furosemide 80 mg po qam and 40 mg po qpm glipizide 5 mg po qdaily lisinopril 40 mg po qdaily omeprazole 20 po qdaily spironolactone 12.5 mg po qdaily discharge medications: 1. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). 2. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 3. furosemide 40 mg tablet sig: 1-2 tablets po twice a day: please take 2 tablets in the morning and 1 tablet in the evening. 4. spironolactone 25 mg tablet sig: 0.5 tablet po daily (daily). 5. glipizide 5 mg tablet sig: one (1) tablet po once a day. 6. colchicine 0.6 mg tablet sig: one (1) tablet po q 12h (every 12 hours). 7. iron (ferrous sulfate) 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 8. ascorbic acid 500 mg tablet sig: one (1) tablet po bid (2 times a day). 9. doxycycline hyclate 100 mg capsule sig: one (1) capsule po q12h (every 12 hours) for 14 days. disp:*28 capsule(s)* refills:*0* 10. augmentin 875-125 mg tablet sig: one (1) tablet po every twelve (12) hours for 14 days. disp:*28 tablet(s)* refills:*0* 11. betadine skin cleanser 7.5 % soap sig: one (1) swab topical once a day: please use to clean wound/dressing changes. disp:*1 bottle* refills:*0* 12. protonix 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* discharge disposition: home discharge diagnosis: primary diagnosis hematemesis anemia left thumb felon discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , . you were admitted to the hospital because you were vomiting blood. the gi doctors looked at your esophagus, stomach, and small intestine but did not find a source of the bleeding. you were treated with antacids and we monitored the levels of your blood to make sure you did not need blood transfusions. since you blood level dropped a little more a few days into your hospital stay, you received two more endoscopies, both of which found no active source of bleeding, but a very friable esophagus from inflammation. your blood level stabilized later during your hospital course. you were also found to have swelling and tenderness in your left thumb. we started you on antibiotics for an infection. hand surgeons evaluated your thumb as well, drained some pus, and dressed the wound. please note that the following changes have been made to your medications: - please start taking omeprazole 20mg twice a day for the next 8 weeks - please start taking doxycycine and augmentin twice a day for a total of 14 days (until ) - please start ascorbic acid (vitamin c) - aspirin was listed on your medication list, but your wife stated that you were not taking this, so we are taking this off your medication list - please follow the following instructions for dressing changes: dilute betadine soaks three times a day and replace dressing afterwards, keep wick in until follow-up in hand clinic. ***sometimes people have bleeding in their stomachs when they take extra pain medications such as ibuprofen (motrin, advil, aleve) or aspirin. you should try to avoid these when possible. if you need to take them for pain (like your gout), you should only take the pain medications with food and do not exceed 2400 mg per day. wound care for left thumb abscess drainage wound: soak in 50% betadyne and 50% saline three times a day for half an hour and wrap in gauze afterwards (has appointment with hand surgery on ) followup instructions: please follow-up with the following appointments: department: hand clinic when: tuesday at 9:30 am with: dr. ( specialty: orthopedic surgery department: medical group when: wednesday at 1:45 pm with: dr. specialty: internal medicine building: (, ma) campus: off campus best parking: on street parking procedure: other endoscopy of small intestine other endoscopy of small intestine other incision with drainage of skin and subcutaneous tissue esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: obstructive sleep apnea (adult)(pediatric) congestive heart failure, unspecified acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic kidney disease, stage iv (severe) gout, unspecified aortocoronary bypass status chronic systolic heart failure hematemesis hip joint replacement arthrodesis status long-term (current) use of non-steroidal anti-inflammatories (nsaid) felon 

Answer: The patient is high likely exposed to