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: hematemesis major surgical or invasive procedure: egd history of present illness: 45 year old male with history of chf woke up this morning vomiting black/red vomitus with chest pain. also having tan diarrhea. he says he has had episodes similar to this in the past. he initially presented to hospital. there he was given asa, ntg for his chest pain, ekg was unchanged, got reglan, morphine. his cardiac enzymes came back positive so he was transfered here for further evaluation. he had 1 unit prbcs hanging on arrival to ed. on arrival bp 165/98 and pulse 72. in the ed he was given 40mg iv protonix and 10mg sc vitamin k. he notes that he has had increasing le edema over several weeks. he currently notes upper abdominal pain. he has back pain consistent with his baseline where he sustained an injury. he denies nausea or chest pain at this time. he says he is pretty sleepy all the time and is not currently worse than normal. he was admitted in with nausea and vomiting an egd was performed as he was having some coffee ground emesis. the egd showed 4 avms that were cauterized, a duodenal polyp with normal pathology, and a small tear. past medical history: diabetes mellitus, type 1 complicated by episodes of dka and gastroparesis pvd s/p osteo of the 5th mtp s/p surgery history of hematemesis after vomiting (egd with esophagitis, duodenitis, barrett's esophagous and bx with ). candidal esophagitis anemia peripheral neuropathy duodenitis chf - dilated cardiomyopathy with ef 30-35% hypothyroidism ? esophageal varices (per osh records) recent mi (per osh records) social history: he lives with his brother and is separated from his current wife. has children from previous marriage. he smokes 1 pack per day for 30 years. he uses cocaine about 2-3 times per month, the last time was the thursday prior to this admission. he denies alcohol use. family history: his mother had an mi at the age of 54, and his father has diabetes. physical exam: physical exam 95.5 170/94, p 80, rr 20, 100% on ra gen: a and o times 3, very pale appearing heent: perrl, pale conjunctiva, op clear, mmm, erythema around eyes neck: no lymphadenopathy lungs: clear to auscultation bilaterally cv: rrr, nl s1s2, no murmers abd: epigastric tenderness to palpation, decreased bowel sounds, no rebound or guarding ext: 3+ edema to mid shin pertinent results: from osh: hct 28.9 from 34 on , plt 306, wbc 13.3 troponin t 0.08, inr 0.7 . ekg: nsr, nl axis, t wave flattening similar to prior, no ischemic changes. cxr: clear with no effusions kub and upright: no air fluid levels . 11:56pm type-art po2-167* pco2-36 ph-7.32* total co2-19* base xs--6 11:56pm lactate-1.2 10:58pm glucose-153* urea n-55* creat-1.5* sodium-137 potassium-4.4 chloride-113* total co2-16* anion gap-12 10:58pm alt(sgpt)-82* ast(sgot)-20 ld(ldh)-280* ck(cpk)-165 alk phos-285* tot bili-0.7 10:58pm ck-mb-17* mb indx-10.3* ctropnt-0.05* 10:58pm albumin-2.0* calcium-7.7* phosphate-4.0 magnesium-1.4* 10:58pm tsh-8.5* 10:58pm free t4-1.1 10:58pm wbc-12.0*# rbc-3.29*# hgb-10.0*# hct-27.6* mcv-84 mch-30.4 mchc-36.1* rdw-14.6 10:58pm plt count-227# 08:27pm hgb-11.9* calchct-36 08:20pm hct-32.3*# 08:20pm pt-10.8 ptt-20.9* inr(pt)-0.9 07:32pm wbc-4.2 rbc-1.42*# hgb-4.2*# hct-12.7*# mcv-89 mch-29.8 mchc-33.3 rdw-14.6 07:32pm neuts-86.2* bands-0 lymphs-8.9* monos-4.3 eos-0.5 basos-0.3 07:32pm hypochrom-normal anisocyt-occasional poikilocy-1+ macrocyt-normal microcyt-occasional polychrom-normal burr-1+ 07:32pm plt smr-low plt count-112* 07:32pm pt-22.7* ptt-54.8* inr(pt)-2.2* . echo: the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses are normal. the left ventricular cavity size is normal. there is moderate to severe global left ventricular hypokinesis. no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size is normal. right ventricular systolic function is borderline normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. significant pulmonic regurgitation is seen. the main pulmonary artery is dilated. the branch pulmonary arteries are dilated. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. . abdominal us with doppler: normal echogenicity of the liver with patent hepatic vasculature. decrease in the amount of ascites seen within the abdomen since the prior examination. right pleural effusion. a spot was not marked for paracentesis given the minimal amount of fluid. . cxr: 1. left subclavian line tip in the mid svc, without pneumothorax. 2. right basilar atelectasis versus aspiration. brief hospital course: 45 year old male with history of dm, chf, esophagitis presenting to with coffee ground emesis, nstemi, pna/pleural effusions, elevated lfts, nephrotic syndrome. . # nausea, vomiting, abdominal pain: in ed, there was a question of coffee ground emesis. he was given anzemet and reglan with minimal relief. a ct scan was negative for appendicitis. he declined nasogastric tube placement. his symptoms were consistent with gastroparesis, especially since his pain improved with reglan. he had right flank tenderness and right upper quadrant tenderness with rebound. an ruq ultrasound showed a normal gallbladder with no evidence of stones. an upright chest x-ray showed no evidence of free air. an abdominal plain film was negative for obstruction and free air. he was kept npo and maintained on iv fluids and a ppi. his symtoms were unlikely cardiac in nature since he ruled out for an mi by serial enzymes. head mri was negative for a cerebellar lesion that could contribute to nausea and vomiting. he required the addition of erythromycin in addition to his antiemetic regimen to control his nausea and vomiting. he then tolerated a gastric emptying study that showed rapid emptying of gastric contents within one hour. . # upper gib: it was suspected that patient's coffee ground emesis was due to prior avms vs. gastritis vs. - tear. in the micu, gi was consulted but because of his stable clinical condition, did not feel that he needed to have egd urgently, especially in the setting of a nstemi. in the micu, the patient received 1u prbc, and remained hemodynamically stable. he was on protonix gtt and then , hct goal was >28 in setting of nstemi. . he was sent to the medical floor on , and remained stable till 2:40 am and then had 240cc of hematamesis. patient's sbp at the time 170 and hr 20. gi was called, and pt returned to the micu. the next am, he was scoped and initially found to have esophagitis and a bleeding artery. initially, epinephrine injections were attempted to try to stop the bleeding but were unsuccessful. thus, he required banding, which stopped the bleeding. his hct was checked q6 hours thereafter and were stable. hence, he was called out again on to the floor. antihypertensives were held in the setting of the gib; the carvedilol was restarted on . asa was held because of ugib and in the setting of banding clips. patient was discharged on carvedilol. lisinopril or was not added per renal, since k and cr were increased. . # nstemi: this was diagnosed at the osh, and could be secondary to demand in setting of gib. cardiac enzymes were negative x3. ekgs daily were unchanged from previous. patient was chest pain free throughout admission, both in the micu and on the floor. . # elevated lfts: alt, ast, ap, ldh increased from 80s to 500s to 200s within 4 days. lfts were also elevated during time in the micu. hypotension did not occur during the patient's micu time. medical records from showed that patient had been worked up for elevated lfts in the past, and nothing had been found as an explanation (other than cocaine positive on urine screen). patient was asymptomatic. ruq us with doppler was wnl, lipid panel was wnl. the amount of ascites in the abdomen decreased over several days. patient must return for ercp on monday, , to assess for biliary sludge that may be causing acute obstruction. . # pleural effusions: bilateral pleural effusions we noted on ct chest. thoracentesis removed 1 l of serous fluid that was conistent with an transudate, likely secondary to chf and nephropathy. . # pneumonia: an area of opacity was noted on his initial chest x-ray, and it became more pronounced after hydration. he was maintained on iv antibiotics, levofloxacin and metronidazole, for probable aspiration pneumonia. he remained afebrile during his hospital course. . # anemia: he was found to be anemic on initial presentation, and his hematocrit dropped with hydration. because of his coffee ground emesis in the ed, there was concern for an upper gi bleed. an egd showed 4 avms that were cauterized, a duodenal polyp that had normal pathology, and a small - tear. there was no evidence of active bleeding. he remained hemodynamically stable without a drop in his hematocrit. studies were consistent with hemolysis, and he was coomb's negative. iron studies were consistent with anemia of chronic disease. . # type i diabetes: while he was npo, he was maintained on half of his usual nph dose and an insulin sliding scale. he never had evidence of dka. once he was able to tolerate solid food, he was transitioned to an aggressive insulin sliding scale with additional nph. the patient was discharged and told to continue his home regimen of insulin. . # anasarca: the etiology is likely secondary to congestive heart failure and nephrotic syndrome. he was aggressively diuresed during this admission, which resulted in a marked decrease in his edema. . # nephrotic syndrome: his protein to creatinine ration was in the nephrotic range, which is consistent with diabetic nephropathy. a 24 hour urine protein showed yield a total protein of abour 5g/day. due to the rapidly progressive proteinuria, a renal biopsy was performed. he will follow-up with dr. to discuss the results of the biopsy. patient's albumin 1.7, causing anasarca. renal consult suggested lasix 40 po qd and starting ace when k is wnl. . # chf: an echocardiogram showed that he has a dilated cardiomyopathy with and ejection fraction of 30-35%. he was gently diuresed to remove over 10 pounds during the hospital stay. he was placed on lasix 40 po qd on discharge. . # hypothyroidism: his tsh was found to be elevated to 5.9 in the setting of a t3 of 36 and a t4 of 1.1. he was started on iv synthroid (37.5 mcg) for probably subclinical hypothyroidism, and was discharged on synthroid 75 po qd. he will need outpatient tfts. . 6. fen: he was kept npo with maintenance fluids until he was able to tolerate solid foods. on hospital day 4, he was transitioned to clears, which he tolerated well. he was then transitioned to a full diabetic, heart-healthy, low sodium diet. his electrolytes were repleted as needed. . 7. code: full #. contact - ( medications on admission: insulin, hiss, nph 7 at night, 7 in am lisinopril 10 mg po daily reglan 10mg po qid protonix 40mg daily coreg 12.5mg daily vicodin prn toprol xl 50mg (told to stop taking this) hydralazine 10mg daily lomotil prn ? lasix and levothyroxine (not in medication bag but was on them at last visit) discharge medications: 1. sucralfate 1 g tablet sig: one (1) tablet po qid (4 times a day). disp:*100 tablet(s)* refills:*2* 2. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. pantoprazole 40 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* 4. synthroid 75 mcg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 5. coreg 6.25 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: gib possible passed gallstone discharge condition: good discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1l if you have these symptoms, call your physician or go to the er: - fevers/chills - shortness of breath - belly pain - nausea/vomiting - diarrhea - bloody stool or black stool you must call mass health at 1- and change your pcc to or . you may not be able to be seen by dr. until you have done this. please do this within 3 days. followup instructions: provider: , md phone: date/time: 3:30 you must come back this monday for ercp. go to , 4. procedure: thoracentesis endoscopic excision or destruction of lesion or tissue of esophagus transfusion of packed cells diagnoses: acidosis subendocardial infarction, initial episode of care unspecified pleural effusion congestive heart failure, unspecified acute posthemorrhagic anemia acute kidney failure, unspecified unspecified acquired hypothyroidism peripheral vascular disease, unspecified pneumonitis due to inhalation of food or vomitus angiodysplasia of intestine with hemorrhage hemorrhage of gastrointestinal tract, unspecified esophagitis, unspecified gastroesophageal laceration-hemorrhage syndrome diabetes with renal manifestations, type i [juvenile type], not stated as uncontrolled diabetes with neurological manifestations, type i [juvenile type], not stated as uncontrolled esophageal hemorrhage gastroparesis nephrotic syndrome in diseases classified elsewhere 

Answer: The patient is high likely exposed to