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: syncope major surgical or invasive procedure: upper endoscopy x2 history of present illness: ms. is a 59 year-old woman with a history of diabetes and hypertension who presents with nausea/vomiting and syncope, found to have a new anemia and likely gi bleed. . one week prior to admission, she reports a mild cough and runny nose; similar to an infection her husband had had earlier. she was taking nsaids for these symptoms . one day prior to admission, patient felt week and dizzy at work. she also had an upset stomach. she rested some but didn't feel significantly better so her boss sent her home. . at home, while trying to get water, she syncopized. she felt dizzy and lightheaded beforehand with mild shortness of breath and chest discomfort. she does not know how long she was out but did not feel that she hit her head. later in the morning, she felt extremely week and did not feel that she was strong enough to go to work. she later syncopized again. . in addition to the above, she reports two episodes of emesis with possible blood (reports seeing what she felt was a spicy sauce she had eaten). she is unsure of the amount of emesis produced. . when asked about bloody stools, she is unsure, reporting that does not usually look at her stools. she does recall one episode of very dark watery stool one month ago. she denies any abdominal discomfort or dyspepsia now or in the past. reports one episode of diarrhea the day prior to admission. ros otherwise negative for fevers, though she has had some mild chills. . regarding her insulin, she reports not taking any yesterday evening or this morning as she has had poor po intake. . in the ed, her initial temperature was 97.5, bp 102/75, hr 56. while getting the second unit of blood, she spiked a temp to 101.1 she also recieved 3 liters of ns. an ng was placed which showed dark blood which cleared after 500cc. her finger stick was >400 and she was started on an insulin gtt. . she was initially admitted to the icu where she had an egd, approximately 5units of prbcs were transfused (one stopped early due to fever and ?transfusion reaction). she had a significant cough which required narcotics for cough suppression. she felt that her pulmonary symptoms started to resolve by hospital day 4. she continued to be febrile, however. micu team consulted id who felt that this was most likely chemical pneumonitis and recommended adding flagyl if she continues to be febrile for aspiration pneumonia. they did not feel she was likely to have pertussis. radiologist did not feel ct had the appearance of aspiration pneumonia however. flagyl not added given improving condition. she also had a positive urine culture with e.coli sensitive to ceftriaxone. past medical history: 1. diabetes: a1c 8.9% () 2. hypertriglyceridemia - complicated by severe pancreatitis requiring hospitalization and surgery at hospital - tg 1523 () 3. abdominal surgery (ex-lap) 23 years ago in for abdominal pain. reports this is how her diabetes diagnosis was made. social history: has a real estate business but is also working as a restaurant manager. lives with her husband. denies smoking/drinking for over 30 years. family history: mother died of pancreatic cancer in her 60s; father died of cancer (?liver vs. lung) in his 80s. physical exam: vitals - t 100.9, bp 102/39, hr 54, rr 15, 97% on 3 liters gen - lying flat in bed. able to provide hpi. heent - mild conjunctival palor. right cheek with very mild echymosis and swelling. mildly tender. cv - regular. no murmurs. pulm - clear. no rales/wheeze. abd - soft and non-tender. midline scar noted. ext - warm. no edema. neuro - alert and oriented. moving all extremeties. no focal deficits. pertinent results: 05:10pm blood wbc-10.9# rbc-2.29*# hgb-6.3*# hct-19.6*# mcv-86 mch-27.6# mchc-32.3 rdw-14.8 plt ct-128* 01:49am blood wbc-9.8 rbc-2.65* hgb-7.7* hct-22.0* mcv-83 mch-28.9 mchc-34.8 rdw-14.7 plt ct-119* 02:37pm blood wbc-8.9 rbc-2.91* hgb-8.6* hct-24.4* mcv-84 mch-29.5 mchc-35.3* rdw-14.4 plt ct-115* 03:44am blood hct-19.9* 02:59am blood wbc-9.6 rbc-3.39*# hgb-9.9*# hct-28.9* mcv-85 mch-29.1 mchc-34.2 rdw-14.7 plt ct-142* 05:40am blood wbc-7.8 rbc-3.13* hgb-9.1* hct-27.3* mcv-87 mch-29.2 mchc-33.5 rdw-14.2 plt ct-293# 05:30am blood wbc-6.7 rbc-2.77* hgb-8.2* hct-23.5* mcv-85 mch-29.5 mchc-34.7 rdw-14.3 plt ct-237 01:05pm blood hct-24.6* 05:45am blood wbc-5.9 rbc-3.22* hgb-9.3* hct-27.2* mcv-85 mch-28.8 mchc-34.0 rdw-15.5 plt ct-259 05:55am blood wbc-5.0 rbc-3.02* hgb-9.0* hct-25.8* mcv-85 mch-29.9 mchc-35.1* rdw-15.6* plt ct-248 05:10pm blood glucose-408* urean-74* creat-1.5* na-132* k-3.6 cl-94* hco3-18* angap-24* 05:30am blood glucose-147* urean-30* creat-0.6 na-136 k-4.3 cl-104 hco3-25 angap-11 05:41pm blood pt-15.6* ptt-30.1 inr(pt)-1.4* 02:59am blood pt-12.5 ptt-29.4 inr(pt)-1.1 05:40am blood triglyc-272* . endoscopy impression: normal mucosa in the whole esophagus ulcer in the angularis (injection, thermal therapy) normal mucosa in the first part of the duodenum and second part of the duodenum otherwise normal egd to second part of the duodenum recommendations: 1. continue iv ppi drip for 72 hours and then iv bid as long as she is in hospital.after that she needs po ppi for 6 weeks and repeat endoscopy in 6 weeks to document healing of ulcer 2. check h. pylori serology and treat if positive 3. serial hct and transfuse prn . chest ct 1. extensive right lower lobe pneumonia. 2. additional multifocal areas of consolidation with peribronchovascular distribution (right lung greater than left). considering rapid development in 24 hours, this could potentially represent asymmetrical pulmonary edema especially considering the new septal thickening and history of treatment for gi bleed. however, rapidly progressive multifocal pneumonia is also possible. 3. incompletely imaged marked splenomegaly with large wedge-shaped defect suspicious for an infarct. dedicated abdominal imaging with ultrasound or ct would be helpful for more complete assessment, as communicated by phone to dr. on . 4. mediastinal and hilar lymphadenopathy, probably reactive in the setting of pneumonia. 5. probable fatty infiltration of the liver. . echocardiogram the left atrium is mildly dilated. the right atrial pressure is indeterminate. there is moderate symmetric left ventricular hypertrophy. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). transmitral doppler and tissue velocity imaging are consistent with grade ii (moderate) lv diastolic dysfunction. there is no left ventricular outflow obstruction at rest or with valsalva. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. . ? transfusion reaction - report diagnosis, assessment and recommendations: ms. experienced fever during the transfusion of packed red blood cells. the laboratory workup did not reveal any evidence of hemolysis. of note, her fevers continued after stopping the transfusion and new pulmonary infiltrate was detected on the chest x-ray the following day. in addition, there was also evidence of uti. septic reactions are very rare with red blood cell products and such a reaction would be extremely unlikely explanation to this patient's symptoms. febrile non-hemolytic transfusion reactions are in the differential for transfusion-associated fever, but are extremely unlikely with leukoreduced products and would not explain continued fevers. thus the patient's fever was most likely due to her underlying illness and not the transfusion. no change in transfusion practice is recommended at this time in this patient. . brief hospital course: #. acute blood loss anemia due to gi bleed: stabilized after injection/cautery large bleeding 1.5 cm ulcer at the angularis. h.pylori antibody serology was equivocal. have been due to nsaid use. transitioned from ppi drip to ppi po. she was hemodynamically stable once transferred to the floor. prior to discharge her hct trended down again. it was unclear if this was due to recurrent bleeding or slow erythropoeisis. ferritin was elevated suggesting adequate iron stores. on repeat endoscopy on the ulcer was injected and clipped (report not available at present). she was discharged with pcp followup and plans for followup endoscopy in ~2 months to document healing. she was discharged with empiric treatment for h.pylori after which she was to continue po bid ppi for a total of 6 weeks. . #. respiratory illness: on admission cxr lungs appeared clear; however with increased hydration a clear rll infiltrate declared itself. she was febrile into the 102 range and continued to be febrile despite coverage with ceftriaxone/azithromycin for cap. flu negative but she had been having symptoms for several days prior to dfa so this could have been a false negative. although id felt this might be aspiration, it did not appear so radiographically. overall, on transfer to the floor, she seemed to be improving clinically with improving cough and stable o2 sats on room air. she was continued on ceftriaxone and azithromcyin initially and then changed to levofloxacin on . she did continue to have fevers however. blood and urine cultures showed no growth, and sputum samples were all contaminated by upper respiratory secretions. she briefly received metronidazole for her fevers but this was not continued as she was felt to be doing well clinically. she had significant volume resuscitation so some of respiratory distress could have been to volume overload - she seemed to respond to one dose of lasix and subsequently had significant autodiuresis. . #. dka: presented with blood fingerstick >400 with a postive anion gap. was started on an insulin gtt in ed. gap closed; continued on dextrose containing iv fluids plus insulin gtt while npo. electrolytes repleted. transitioned to home dosing. had some low-normal blood sugars prior to discharge so given 60u 70/30 instead of home dose of 70u with instructions to incurease dosing if needed once she resumes her outpatient diet. (outpatient diet likely higher in carbohydrates - patient works in a restaurant and reports somewhat irregular eating habits) . # uti: e.coli. treated with ceftriaxone and then levofloxacin. . #. thrombocytopenia: appears chronic with a platelet count ranging in the 90-120 range since . no history of liver disease, though the elevated inr has no explanation. did have an enlarged spleen on chest ct. platelets had improved by time of discharge. . # splenic infarct on ct unclear etiology, likely chronic. she is having some chest wall pain which is most likely due to coughing as it is reproducible on palpation of ribs. . # hypertriglyceridemia gemfibrozil held in icu, restarted on floor for elevated triglycerides . #. acute renal failure: on admission, serum creatinine elevated at 1.5 from baseline of 0.5 in . this was likely a result of volume depletion. normalized during hospital course and patient restarted on hctz and ace-inhibitor . #. anion gap acidosis: likely from dka. lactate 1.5. resolved. . #. syncope: likely related to her anemia. appears that she did hit her head/face with one of her falls. ct head negative. medications on admission: 1. atenolol 25 mg daily 2. hydrochlorothiazide 12.5 mg daily 3. lisinopril 40 mg daily 4. gemfibrozil 600 mg 5. metformin - 1,000 mg 6. humulin 70/30 70 units discharge medications: 1. benzonatate 100 mg capsule sig: one (1) capsule po tid (3 times a day): for cough. disp:*21 capsule(s)* refills:*0* 2. prevpac 500-500-30 mg combo pack sig: one (1) tablet po twice a day for 14 days. disp:*28 tablets* refills:*0* 3. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 4. gemfibrozil 600 mg tablet sig: one (1) tablet po bid (2 times a day). 5. hydrochlorothiazide 12.5 mg capsule sig: one (1) capsule po daily (daily). 6. lisinopril 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 7. insulin 60units 70/30 insulin twice daily, can increase to previous dose of 70 units 70/30 insulin twice daily if blood sugars >200 8. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day for 4 weeks: start after prevpak is finished in 14 days. disp:*60 capsule, delayed release(e.c.)(s)* refills:*0* 9. outpatient lab work please check hematocrit on discharge disposition: home discharge diagnosis: primary: upper gi bleed aspiration pneumonia diabetes mellitus type ii hypertriglyceridemia urinary tract infection discharge condition: good, ambulatory without lightheadedness. hct has dropped slightly to 25 but egd injected and clipped bleeding from ulcer site. stable for discharge with close followup. discharge instructions: you were admitted to the hospital for a bleed from your stomach and you also had a respiratory infection as well. the bleeding may have been contributed to by the use of ibuprofen and it also may have been due to an infection with a bacteria called helicobacter pylori (although a test for this was negative but we still feel it is prudent to treat for it). . we have decreased your dose of lisinopril to 20mg and your blood pressure was well-controlled on this dose. . you need to take omeprazole for four weeks after the prevpak is finished and then have a repeat endoscopy (see below) . please return to the emergency room if you have lightheadedness, more vomiting of blood, large dark or tarry bowel movements, or any other new or concerning symptoms. followup instructions: please followup with dr. on tuesday at 3:30pm to check in post-hospitalization and to have your blood level (hematocrit) checked (rx for lab draw attached) . you will need to have another endoscopy in 6 weeks to make sure the ulcer in your stomach has healed. the number for the gi unit is (. dr. office can also help arrange this. procedure: venous catheterization, not elsewhere classified endoscopic control of gastric or duodenal bleeding endoscopic control of gastric or duodenal bleeding transfusion of packed cells diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified urinary tract infection, site not specified unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified hyposmolality and/or hyponatremia chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction other and unspecified coagulation defects diabetes with ketoacidosis, type i [juvenile type], uncontrolled splenomegaly unspecified analgesic and antipyretic causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to