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: chest pain, palpitations, nausea, diaphoresis and confusion for one day. major surgical or invasive procedure: none history of present illness: mr. is an 88 year-old man with history of gastric adenocarcinoma s/p resection in , diabetes, hyperlipidemia and hypertension presents one day after experiencing sub-sternal chest pain. he states that he was in 2 weeks ago when he developed headache, abdominal pain and decreased oral inake. he subsequently traveled to and was in the care of family when he describes experiencing severe sub-sternal chest pain that began yesterday at 4pm with radiation to left arm and left jaw, which he decribes as "very uncomfortable," and was associated with palpitations, nausea and diaphoresis. patient was also noted by family members to be confused and have difficulty ambulating. he lay in bed the rest of the day without significant relief. this afternoon at 1 pm, the patient continued to describe chest discomfort and was flown from to where he was immediately the ed. . on review of systems, he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, bleeding at the time of surgery, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. all of the other review of systems were negative. . cardiac review of systems is notable for absence of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, palpitations, syncope or presyncope. . in the ed, initial vitals were t:96.7 bp:102/77 hr:86 rr:20 spo2:100% on 2l. he received 324mg of aspirin, 80mg of lipitor, 20mg of lasix iv, 4.5g of zosyn iv and 1g vancomycin iv. head ct revealed no acute intracranial process with bilateral parietal lobe atrophy. ekg revealed 2-4mm stes in anterior leads (v2-v4) with reciprocal stds in ii, iii and avf consistent with stemi. troponin was elevated to 5.04 with ck of 339 and ckmb of 8. the was then admitted to the ccu for further management of his stemi. past medical history: 1. cardiac risk factors: diabetes, dyslipidemia, hypertension 2. cardiac history: has longstanding history of diabetes, hypertension and hyperlipidemia. also with "valvular" heart disease which was diagnosed many years ago while in . 3. other past medical history: - peptic ulcer disease. - status post appendectomy. - gastric adenocarcinoma s/p subtotal resection in social history: -tobacco history: never used tobacco -etoh: denies alcohol use -illicit drugs: denies illicit drug abuse family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: admission exam: vs: t=98.6 bp=143/72 hr=76 rr=18 o2 sat=100% on 2l general: somnolent elderly man in in nad. he was oriented x 2 to name and hospital, (identified day of week but not year). mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 10 cm. cardiac: rr, normal s1, s2. no m/r/g. no thrills, lifts. no s3 or s4. lungs: resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: abdominal scar present. soft, ntnd. no hsm or tenderness. extremities: bl le edema, l>r. no clubbing discharge exam: patient deceased. on arrival to the patient room, there was no electrical activity on telemetry for 3 minutes. on exam, his pupils were fixed and dilated. he was not responsive to stimuli. there was no palpable pulse on 2 minutes of palpation and no heart beats auscultated on 1 minute of auscultation. patient was on the ventilator at the time of passing, and when the ventilator was stopped, there were no spontaneous respirations. pertinent results: admission labs (): cbc: wbc-18.0*# rbc-4.15* hgb-12.5* hct-35.5* mcv-86 mch-30.0 mchc-35.1* rdw-15.9* plt ct-332# neuts-84* bands-0 lymphs-8* monos-6 metas-1* myelos-1* nrbc-8* coags: pt-19.9* ptt-28.4 inr(pt)-1.8* chem: glucose-677* urean-98* creat-3.2*# na-125* k-5.9* cl-88* hco3-18* angap-25* phos-4.9*# mg-3.4* cholest-173 lactate-5.0* na-131* k-4.7 lfts: alt-196* ast-375* ld(ldh)-1238* alkphos-619* totbili-2.8* albumin-3.2* sugars/lipids: %hba1c-9.6* eag-229* triglyc-92 hdl-6 chol/hd-28.8 ldlcalc-149* ldlmeas-79 tsh-1.1 . hepatitis hbsag-negative hbsab-positive hbcab-negative hcv ab-negative . micro: bile specimen (): 6:18 pm bile gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram positive in pairs. fluid culture (final ): presumptive streptococcus bovis. sparse growth. anaerobic culture (preliminary): no anaerobes isolated. acid fast culture (preliminary): acid fast smear (final ): no acid fast bacilli seen on direct smear. no acid fast bacilli seen on concentrated smear. fungal culture (preliminary): no fungus isolated. . - c diff neg x 3 - bcx ngtd - ucx neg - o&p neg x 3 . imaging: head ct (): impression: 1. no acute intracranial process. 2. widening of the extra-axial spaces overlying both parietal lobes, likely due to atrophy . pa/lat cxr (): impression: mild pulmonary edema with small bilateral pleural effusions. patchy opacities in both lung bases may reflect atelectasis. . lle u/s (): impression: no dvt of the left lower extremity, though the calf veins were not visualized. . tte (): conclusions the left atrium is dilated. left ventricular wall thicknesses and cavity size are normal. there is severe regional left ventricular systolic dysfunction with akinesis of the anterior septum, anterior wall, lateral walls and apical segments. the apex is dyskinetic. a left ventricular mass/thrombus cannot be excluded. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is a very small pericardial effusion. impression: severe regional lv systolic dysfunction consistent with proximal lad ischemia/infarction. diastolic dysfunction. cannot exclude lv thrombus. mild to moderate mitral and aortic regurgitation. moderate pulmonary artery systolic hypertension. compared with the report of the prior study (images unavailable for review) of , wall motion abnormalities are new. the degrees of aortic and mitral regurgitation have increased. . ruq u/s (): impression: 1. echogenic liver consistent with fatty infiltration. no evidence of biliary obstruction. 2. minimal sludge within a distended gallbladder. specific signs of acute cholecystitis are not seen, however, if there is high clinical concern for acute cholecystitis, a gallbladder hida scan can be obtained for further evaluation. . ct abdomen and plevis (): findings consistent with acute cholecystitis. gallbladder wall distention with layering high-density sludge, pericholecystic fluid and stranding, all indicative of acute cholecystitis given patient's clinical picture. no other cause for acute infectious inflammatory response identified on ct. . ruq u/s (): impression: 1. collapsed gallbladder with cholecystostomy tube in place. 2. no intrahepatic biliary duct dilatation. 3. liver vessels patent. 4. small right pleural effusion. brief hospital course: assessment and plan: 88 year-old man with dm, htn and hld presents more than 24 hours after the onset of chest pain with evidence of stemi with ekg changes and elevated troponin but with normal ck/ckmb with evidence of q waves. # cad: pattern of st elevation in v2 to v4 with reciprocal changes in ii,iii and avf suggests an anterior wall mi. patient received 324mg of asa in the ed and 80mg of atorvastatin. treated medically for stemi as he was likely over 24 hours out from the initial event - cath defered. pt was started on heparin gtt, loaded with 300mg of clopidogrel and given 75mg daily starting in am. continued on asa and atorvastatin but ace-i held due to acute kidney infury. f/u ekg the next day with evidence of q waves which combined with normal ck/ckmbs and fact that history obtained after talking with family indicated that cp started at least 3-4 days before presentation made likely that pt had an mi but that had already completed infarcting by time of arrival to . tte showed severe hypokinesis in the anterior/lateral/apical area with decreased ef (20-25%) compared to prior also consistent with recent anterior mi. tte could not rule-out ventricular thrombus so heparin gtt continued but then later stopped when decision was made that pt would not undergo long-term anti-coagulation with warfarin. as noted below, pt developed worsened clinical status due to infectious and renal reasons and ultimately passed after family made decision to withdraw care. . # acute cholecystitis: initial labs showed significant elevation in transaminases as well as cholestatic labs (tbili, alk phos) and synthetic function alteration (elevated inr). unclear etiology so ruq u/s obtained. some gallbladder wall thickening with sludge but no clear signs of cholecystitis. transaminases actually trending up at same time that tbili/alk phos trending down. hepatitis panel showed immunization to hep b and no evidence of active hep c infection. pt then developed mild abdominal pain and an abdominal ct showed evidence of cholecystitis. pt went to ir on same day () for percutaneous gallbladder drain. he was started on vancomycin and pipercillin/tazobactam and id consult was obtained. id recommended continuing abx until cultures returned. cultures ultimately grew out streptococcus species most consistent with strep bovis. around same time of percutaneous drain placement pt had stopped making all urine and developed hypotension requiring pressor support. clinical picture was most consistent with sepsis from presumed infectious source in the gallbladder. our suspicion is that patient ultimately passed from complications of his sepsis. . # respiratory code: during morning of , but was suddently noted to aspirate and stopped breathing with heart rhythm suddently switching to pea. code blue was called and pea arrest protocol initiated. pt was intubated at bedside by anesthesia. spontaneous circulation was regained with cpr and pressors were started. after code was finished a sterile groin line was placed. patient stayed intubated for rest of hospitalization. . # altered mental status: initially related to his recent stemi vs abdominal process causing liver dysfunction vs icu/hospital delerium in the elderly. head ct in the er negative. tried to hold sedating medications and continue to reorient him as he is at high risk for delirium - pt later required low dose olanzipine 2.5mg qhs for delerium and agitation intermittently. when acute cholecystitis was diagnosed, suspicion increased that this was driving process for delerium. this improved with abx and perc drain for first day but then pt underwent respiratory code and was intubated for the rest of hospitalization until he passed. . # : most recent cr in our system was 1.7 in so unclear baseline, cr was 3.2 on admission, concerning that this could be poor forward flow in the setting of an acute ischemic event leading to heart failure. cr slowly trended down showing some improvement in renal function over the next few days. however, during afternoon of urine output started to drop off to anuric levels and was non-responsive to 3.5l of fluid bolus. this was thought most likely to septic shock as bp was lowish at the time and required pressor support. cr was continuing to trend up and pt was still anuric despite pressors and volume repletion on the day that he passed. . # goals of care: when pt initially entered the hospital it was with full code status. no health care proxy was designated and pt had 6 children who all participated in decision making although many of them lived out of state. after respiratory code on , family decided to make mr. dnr/dni but not yet cmo. during day of a family meeting was held at the families request. the daughter-in-law who lives in town as well as multiple grandchildren representing their various parents were present. none of the children were present. the family requested that the patient be extubated saying they did not want him on artificial life support any longer. multiple phone conversations were had with the children that evening and by midnight it was confirmed that all of the children were in agreement with this plan. before pt could be formally made cmo and extubated, pt became bradycardic and quickly went into asystole. he was pronounced dead at 04:40 on . family was contact and after discussion amongst family members they declined an autopsy. . # pump: on arrival, pt appeared to be in mild acute systolic heart failure likely to recent decrease in ef due to recent mi. pt had i/os monitored and echo confirmed decrased ef as noted above. pt started on iv lasix to removed extra fluid from new congestion. initially was able to make urine, but urine output later tailed off as renal failure worsened. despite this, pt never developed respiratory symptoms to fluid overload. . # rhythm: post stemi with no current evidence of arrythmia at this time. pt in sinus rhythm at time of presentation. due to recent mi, pt was monitored on tele during hospitalization and continued on metoprolol. rhythm stable throughout hospitalization until time when patient died. at this point he became quickly bradycardic and then went into asystole which lead to his passing. . # diabetes: patient with a h/o diabetes, no recent a1c in our system. initial sugars were very high with range in 500-600s in chemistry panels. pt started on aggressive iss wth extra regular insulin which dropped blood sugar too aggressively the first night. pt with a1c of 9.6 on initial check. held home actos/glyburide and placed on diabetic diet while in hospital. . # peptic ulcer disease: status resection, not currently on any therapy but given the initiation of dual anti-platelet therapy and heparin gtt will start famotidine 20mg . changed over to qd pantoprazole after 24hrs. . # asymmetric le edema: chronic per history but lle u/s showed no evidence of dvt. medications on admission: 1. metoprolol 50mg 2. valsartan 160mg daily 3. nifedipine 60mg daily 4. hctz 25mg daily 5. lipitor 60mg daily 6. actos 30mg daily 7. glyburide 20mg daily discharge medications: n/a discharge disposition: expired discharge diagnosis: patient deceased discharge condition: patient deceased discharge instructions: n/a followup instructions: n/a procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube percutaneous aspiration of gallbladder central venous catheter placement with guidance diagnoses: hyperpotassemia congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia severe sepsis acute myocardial infarction of other anterior wall, initial episode of care other and unspecified hyperlipidemia acute respiratory failure other specified cardiac dysrhythmias cardiac arrest septic shock acute systolic heart failure do not resuscitate status acute cholecystitis personal history of malignant neoplasm of stomach 

Answer: The patient is high likely exposed to