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: penicillins / sulfa (sulfonamide antibiotics) attending: chief complaint: upper gi bleed major surgical or invasive procedure: egd - several ulcers and erosions in the duodenal bulb history of present illness: mr is an 80 year old man who per the va pharmacy is on warfarin, digoxin and insulin as well as anti-hypertensives, and who himself is a somewhat unclear medical historian, who presents with a two day history of dark stools. he says that on tuesday he had a "major black bowel movement" and was alarmed by this but did not know what to do so he drank water and went to bed. he says that he then had a black stool with additional red blood in the bowl today, and he called 911. he requested to go to the va which is where he gets all his care but was brought to the because it was closer. on review of systems he said that he had gotten light-headed on trying to get up from bed and was very weak and sometimes had to call 911 for this; he appears to have had several falls. denied chest pain, palpitations, or shortness of breath; he said that he sometimes has nausea which gets better when he drinks ice water. in the emergency department his initial vitals were 97.5, 114/70, 88, rr 14, 100% on room air. he was ng lavaged and by the ed resident's report did have some blood on the return which appeared to clear. he received 10 mg vitamin k and 2 units of ffp. he got 2 l ns. he had some intermittent systolic blood pressure in the 80s and 90s which responded well to iv fluid boluses and his hemodynamics were otherwise stable in the ed by report. he was also nauseous in the ed and received 2 doses of 4 mg iv zofran for this. he was transferred to the micu for further management. in the micu, he received no blood products. he underwent egd, which was remarkable for superficial ulcers in the duodenal bulb. he did not require pressors or intubation. he was transferred to the floor in stable condition. past medical history: atrial fibrillation hypertension diabetes hypercholesterolemia sleep apnea, on cpap congestive heart failure, unspecified social history: occupation: retired mechanical engineer; wwii veteran of air force, was translator of japanese drugs: denies tobacco: 30 py hx, quit 3 years ago alcohol: likes a bottle of wine a day, "but i keep running out of wine"; denies any hx of withdrawals other: lives alone, wife left him 3 years ago, not in family history: nc physical exam: temp 35.5 ??????c hr: 83 bp: 108/44(58) rr: 16 spo2: 100% in 2l general: nad skin: warm and well perfused, no excoriations or lesions, no rashes heent: at/nc, eomi, perrla, anicteric sclera, pink conjunctiva, patent nares, mmm, poor dentition, nontender supple neck, no lad, no jvd cardiac: irregularly irregular, s1/s2, 2/6 sem at base lung: ctab abdomen: nondistended, +bs, nontender in all quadrants, no rebound/guarding, no hepatosplenomegaly m/s: moving all extremities well, no cyanosis, clubbing or edema, no obvious deformities pulses: 2+ dp pulses bilaterally neuro: cn ii-xii intact pertinent results: imaging: ======= radiology cxr pa/lat : findings: the patient's condition required ap positioning. there is a slight increase in density in the lateral portion of the right lower lobe which may be partly due to patient's gynecomastia and a small right pleural effusion. cardiomegaly is unchanged. right-sided icd leads in appropriate position remain unchanged. impression: no significant change in the right lower lobe opacification. part of this density may be due to overlying gynecomastia. . egd : several superficial non-bleeding ulcers and erosions were found in the duodenal bulb. there was also duodenitis. ulcers appeared to be low risk for rebleeding, thus procedures were not performed for hemostasis. labs: ==== 10:30am blood wbc-8.2 rbc-3.17* hgb-9.4* hct-27.5* mcv-87 mch-29.7 mchc-34.3 rdw-15.2 plt ct-329 02:37am blood wbc-7.9 rbc-2.84* hgb-8.6* hct-24.3* mcv-85 mch-30.3 mchc-35.5* rdw-16.9* plt ct-269 02:40pm blood hct-26.2* 06:30am blood wbc-8.7 rbc-2.93* hgb-8.8* hct-25.4* mcv-87 mch-30.0 mchc-34.5 rdw-16.7* plt ct-277 05:45pm blood hct-25.5* 11:51am blood hct-27.9* 10:30am blood pt-19.2* ptt-27.6 inr(pt)-1.8* 04:39pm blood pt-17.4* ptt-26.2 inr(pt)-1.6* 02:37am blood pt-15.8* ptt-23.1 inr(pt)-1.4* 06:30am blood pt-14.8* ptt-23.8 inr(pt)-1.3* 07:45am blood pt-15.9* ptt-26.3 inr(pt)-1.4* 10:30am blood glucose-188* urean-65* creat-1.5* na-135 k-4.2 cl-98 hco3-23 angap-18 04:39pm blood glucose-221* urean-59* creat-1.3* na-139 k-4.4 cl-103 hco3-26 angap-14 02:37am blood glucose-204* urean-50* creat-1.2 na-140 k-4.3 cl-106 hco3-26 angap-12 06:30am blood glucose-147* urean-31* creat-1.1 na-141 k-3.9 cl-108 hco3-26 angap-11 07:45am blood glucose-131* urean-28* creat-1.2 na-140 k-3.7 cl-104 hco3-27 angap-13 04:39pm blood alt-14 ast-19 ld(ldh)-228 alkphos-46 amylase-88 totbili-0.6 06:30am blood alt-8 ast-17 alkphos-48 totbili-0.8 02:37am blood calcium-8.3* phos-3.0 mg-2.2 06:30am blood calcium-8.4 phos-2.5* mg-2.1 07:45am blood calcium-8.4 phos-3.5 mg-1.8 02:37am blood tsh-0.79 04:39pm blood digoxin-0.7* 04:39pm blood ethanol-neg micro: ===== blood cultures: ngtd rpr: negative h. pylori: pending brief hospital course: 80 yo male with history of chf, cad, a-fib on coumadin, pacer/icd placement with melena s/p egd without obvious source. duodenitis and gastritis: he was initially started on iv ppi and received 2u prbcs. he remained hemodynamically stable while in-house with a stable hct, and his egd revealed evidence of duodenal ulcerations. he remained on iv ppi for ~72 hours and then transitioned to po ppi , that of which he will require for 6 weeks. also, given that this may be due to h. pylori, serologies were sent and he was started empirically on triple therapy may need to contact if the serologies are negative, as he will not require treatment. rll consolidation: pt was initially started on levofloxacin in unit for concern of pneumonia, although the lack of fevers, cough or white count suggested the absence of infection and this was held. he remained hemodynamically stable with this change. cad native vessle, benign hypertension, atrial fibrillation: - cad - his asa and coumadin were held initially but restarted without complications prior to discharge. he was kept on his statin throughout the hospitalization. - pump - given the ongoing bleeding on admission his anti-hypertensives were held and then restarted 24 hours after the egd. he tolerated this well. - rhythm - pt has a-fib, on coumadin as an outpt. inr on admission was 1.4. his coumadin was restarted at 5mg, which is change in his basline of 5 mg alternating daily with 7.5 mg, and this will need to be followed in . the inr also may be affected due to the initiation of antibiotics. it is suggested that the patient go to the va on the monday following discharge. he was maintained on his home digoxin dosing throughout the hospitalization. obstructive sleep apnea: continued on cpap diabetes type ii uncontrolled: continue nph 9 units + humalog sliding scale alcoholdependence: the patient reports that he drinks a bottle of wine a day and serum tox was negative on admission. he was maintained on a valium ciwa scale although did not require treatment for withdrawal. he was given mvi, thiamine and folate and educated about the risks of continued alcohol use. falls: patient reports a history of falls that appear may be a result of medications. he reports them as happening when he stands quickly from a seated position, and denies any associated chest pain, diaphoresis or sob. he was seen by physical therapy who suggested home physical therapy. medications on admission: per va pharmacy absorbase topical ointment cyanacobalamin 1000 mcg/ml inj 1x/month digoxin 0.125 mg daily enalapril maleate 2.5 mg furosemide 40 mg insulin nph 18 units breakfast and hs; insulin regular 5 units at breakfast and dinner metoprolol succinate 100 mg daily simvastatin 40 mg daily warfarin 5 mg sat/sun/tues/thurs, 7.5 mg daily mwf miconazole powder nystatin cream discharge medications: 1. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. enalapril maleate 5 mg tablet sig: 0.5 tablet po bid (2 times a day). 7. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). 8. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*3* 10. metronidazole 500 mg tablet sig: one (1) tablet po bid (2 times a day) for 14 days. disp:*28 tablet(s)* refills:*0* 11. clarithromycin 250 mg tablet sig: two (2) tablet po q12h (every 12 hours) for 14 days. disp:*64 tablet(s)* refills:*0* 12. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. discharge disposition: home with service facility: homecare discharge diagnosis: primary diagnosis: ugib secondary to duodenal ulcerations. . secondary diagnoses: atrial fibrillation hypertension diabetes hypercholesterolemia sleep apnea, on cpap congestive heart failure, unspecified discharge condition: afebrile, stable vital signs, tolerating pos, ambulating without assistance. discharge instructions: you were admitted with an upper gi bleed that may be due to ulcerations that were seen in your small bowel. this may be due to a bacterial infection and we have started you on acid blockers that you'll need to take twice a day, and you've also been empirically started on a 2-week course of antibiotics and you will be contact if you can stop these earlier. . 1. please take all medication as prescribed. 2. please make all medical appointments. 3. please return to the emergency room if you have any concerning symptoms. followup instructions: please follow-up with your pcp as previously scheduled. procedure: other endoscopy of small intestine transfusion of packed cells transfusion of other serum diagnoses: obstructive sleep apnea (adult)(pediatric) coronary atherosclerosis of native coronary artery congestive heart failure, unspecified acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation long-term (current) use of insulin long-term (current) use of anticoagulants automatic implantable cardiac defibrillator in situ chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction duodenitis, without mention of hemorrhage helicobacter pylori [h. pylori] chronic diastolic heart failure 

Answer: The patient is high likely exposed to