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: hemetemesis, dyspnea. major surgical or invasive procedure: upper endoscopy. history of present illness: 42 year-old male with type i diabetes, esrd on hd, poorly controlled htn, diastolic chf and multiple hospitalizations for chronic left flank pain with negative work-up, recently admitted for hypertensive crisis, now presents with hemetemesis, guaiac positive stool and dyspnea. . patient initially presented to the ed with his usual complaint of left flank pain and also nausea/vomiting. initial vital signs were t 97.9 p 114 bp 230/122 r 20 o2sat 95% on ra. he was given 2 mg ativan, 4 mg morphine. he then started to have hemetemesis about 20 cc and was noted to have guaiac positive stool. patient could not tolerate ng lavage. his o2 sat dropped to 85% on ra and 92% on nrb with cxr showing pulmonary edema. urgent dialysis was planned. central line was intially attempted on right groin with no success. left groin scv was finally placed. patient was started on nitro gtt. initial k was 5.3 without ekg changes. . micu course: the patient was dialyzed on with 2l fluid removed. the patient was dialyzed , uf 2l. the patient was dialyzed , uf 2l. the patient had improvement in shortness of breath. there were no further episodes of hematemesis. the patient's groin site was noted to bleed but this resolved with ddavp . . currently denies fevers, chills. denies chest pain, shortness of breath, cough. denies abdominal pain, nausea, vomiting, diarrhea. denies melena, hematochezia. past medical history: 1. diabetes mellitus, type i x 17 years, hba1c 5.8 2. esrd on hd t/th/sa at dialysis 3. hypertension, poorly controlled 4. right foot operation with bone excision "few months ago" 5. right foot ulcer "3-4 years ago" 6. depression with history of si and psychiatric hospitalizations, currently no si 7. esophagitis on egd with h. pylori negative 8. history of left flank pain since with extensive work-up and no organic etiology for pain social history: lives with mother in subsidized housing. has four children. former floor tech, quit 2 years ago and dialysis-dependent starting 1 year ago. no smoking, etoh, drugs. family history: diabetes in multiple relatives on both sides physical exam: on admission to the micu: vital signs: t 98.4 p 95 bp 180/97 rr 25 o2 sat 95% on 4l general: lying in bed, clutching head in pain, looks fatigued heent: anicteric, perrla, headache too painful to follow other commands, moist mucus membrane, neck supple, no jvd heart: regular, tachycardic, no r/m/g lungs: rales bilaterally, tachypneic, mild neck accessory muscle use, speaking in full sentences abdomen: soft, nontender, nondistended, no hepatosplenomegaly extremities: no edema, left groin line still oozing blood, right groin in pressure dressing neurologic: alert, hard to assess orientation because of headahce, perrla, does not cooperate with neuro exam, move all 4 extremities . on transfer to the floor: vital signs: t 99.6 p 97 bp 151/80 rr 20 o2sat 95%ra general: lying in bed, breathing comfortably, speaking full sentences heent: anicteric, perrla, moist mucus membrane, neck supple, no jvd heart: regular rate and rhythm, no r/m/g lungs: crackles at bases abdomen: soft, nontender, nondistended, no hepatosplenomegaly extremities: no edema, left groin c/d/i neurologic: alert, oriented x 3, moving all extremities well pertinent results: labwork on admission: 08:38pm wbc-6.8 rbc-4.69 hgb-12.5* hct-37.6* mcv-80* mch-26.7* mchc-33.2 rdw-16.2* 08:38pm plt count-192 08:38pm neuts-66.5 lymphs-22.5 monos-6.8 eos-3.9 basos-0.3 08:38pm glucose-260* urea n-27* creat-6.8*# sodium-138 potassium-6.2* chloride-98 total co2-28 anion gap-18 10:20pm type-art po2-72* pco2-45 ph-7.44 total co2-32* base xs-5 10:45pm pt-13.0 ptt-51.3* inr(pt)-1.1 . chest (portable ap) impression: findings consistent with pulmonary edema/fluid overload. no free air under the diaphragms or pneumothorax identified. . us extremity nonvascular port left/right impression: no evidence of hematoma. . chest (portable ap) findings: there is mild cardiomegaly. small bilateral pleural effusions and perihilar congestion persist. there is no pneumothorax. impression: moderate chf. . egd esophagus: mucosa: normal mucosa was noted. stomach: mucosa: diffuse patchy erosive gastritis was noted in the stomach. cold forceps biopsies were performed for histology at the stomach antrum and stomach body. duodenum: mucosa: normal mucosa was noted. impression: normal mucosa in the esophagus normal mucosa in the duodenum abnormal mucosa in the stomach (biopsy) . labwork on discharge: 12:03pm blood wbc-6.9 rbc-4.00* hgb-10.5* hct-31.2* mcv-78* mch-26.3* mchc-33.8 rdw-16.1* plt ct-228 04:45am blood glucose-44* urean-51* creat-11.6*# na-135 k-4.7 cl-96 hco3-25 angap-19 brief hospital course: 42 year-old male with esrd on hd, chronic left flank pain, type i diabetes, uncontrolled hypertension who presents with hemetemesis, guaiac positive stool and hypoxia. . 1. hypoxia. resolved soon after admission. cxr on admission consistent with pulmonary edema. the patient's presentation was likely secondary to flash pulmonary edema from hypertension and fluid overload from dietary indiscretion. the patient's last echocardiogram showed mild diastoic dysfunction; mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef >55%). this was unlikely ischemic with troponins trending down. the patient was dialyzed during admission with removal of ~6 liters. the patient was maintained on fluid restriction and low sodium diet. the patient was continued on bb and acei. . 2. hematemesis/guaiac positive stool. the patient had no further episodes of hematemesis during hospitalization. the patient's hematocrit dropped slightly as above. the patient had grade iii esophagitis on egd likely secondary to vomiting from uremia and diabetes. the patient underwent endoscopy prior to discharge which showed diffuse patchy erosive gastritis. the patient's guaiac positive stools were thought secondary to this upper gi source. the patient was tolerating a regular diet prior to discharge. the patient's protonix was changed from daily to twice daily. the patient tolerated a regular diet prior to discharge. the patient's aspirin was discontinued for now; the patient will follow-up with his primary care doctor regarding future use of aspirin. . 3. anemia/hematocrit drop. the patient's baseline hematocrit is mid-30s; hematocrit was 40 on admission and was 30 at the time of discharge. the drop was likely secondary to groin bleeds and hemetemesis. the patient likely has a component of anemia from chronic renal failure and iron studies in the past have been consistent with anemia of chronic disease. . 4. groin bleed. the patient was status post multiple cvl attempts in the ed. hematocrit fell to 30 from baseline mid-30s. bleeding stopped status post ddavp . bilateral us negative for hematoma . . 5. diabetes, type i. hemoglobin a1c 5.8 . complicated by nephropathy, neuropathy. the patient's evening nph was decreased prior to discharge for hypoglycemia. the patient was continued on reglan for nausea/vomiting thought secondary to diabetic gastroparesis. the patient will follow-up with after discharge. . 6. esrd secondary to diabetes. the patient was followed by renal throughout admission. the patient's usual dialysis is t/th/sat. the patient was dialyzed with removal ~6 liters. the patient was continued on calcium acetate and lanthanum. the patient's calcium acetate was increased prior to discharge per renal recommendations. . 7. left flank pain. patient has been hospitalized multiple times in the past with extensive work-up including ct abdomen, mri, and ultrasound without clear etiology for pain. psychiatric and medicine teams felt pain was psychosomatic in nature. the patient was given pain control with morphine prn, neurontin, klonopin, glycopryrolate, and doxepin. . 8. hypertension. the patient was continued on metoprolol, lisinopril, and nifedipine. there were no changes made to the patient's regimen on this admission. . 9. depression. the patient was continued on celexa and doxepin. medications on admission: lisinopril 40 mg calcium acetate metoclopramide 10 mg po qidachs docusate sodium 100 mg po daily aspirin 325 mg tablet po daily metoprolol 150 pantoprazole 40 mg po q24h simethicone 80 mg qid citalopram 20 mg mirtazapine 15 po hs gabapentin 300 mg capsule daily clonazepam 0.5 mg po tid doxepin 50 mg po hs glycopyrrolate 2 mg po tid nifedipine 120 mg qd insulin nph 20 units qam/12 qhs lanthanum 1000 mg po tid w/meals oxycodone 5 mg prn discharge medications: 1. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs (4 times a day (before meals and at bedtime)). 2. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 3. mirtazapine 15 mg tablet sig: one (1) tablet po hs (at bedtime). 4. gabapentin 300 mg capsule sig: one (1) capsule po q48h (every 48 hours). 5. clonazepam 0.5 mg tablet sig: one (1) tablet po tid (3 times a day). 6. glycopyrrolate 1 mg tablet sig: two (2) tablet po bid (2 times a day). 7. lanthanum 250 mg tablet, chewable sig: four (4) tablet, chewable po tid (3 times a day). 8. 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:*2* 9. calcium acetate 667 mg capsule sig: three (3) capsule po tid w/meals (3 times a day with meals). disp:*270 capsule(s)* refills:*2* 10. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 11. metoprolol tartrate 50 mg tablet sig: three (3) tablet po bid (2 times a day). 12. nifedipine 60 mg tablet sustained release sig: two (2) tablet sustained release po daily (daily). 13. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for heartburn. discharge disposition: home discharge diagnosis: primary: 1. hematemesis, likely from erosive gastritis seen on egd 2. hypoxia, likely flash pulmonary edema in the setting of hypertension . secondary: - dm1 x 17 years, hba1c 5.8 - esrd on hd normally t/th/sa at dialysis, mwsa the week of admission holidays - htn, poorly controlled - r foot operation with bone excision "few months ago" - r foot ulcer "3-4 years ago" - depression with h/o sa and psych hospitalizations, currently no si - esophagitis on egd with h. pylori negative - history of l flank pain as above since with extensive work-up and no organic etiology for pain. discharge condition: afebrile, vital signs stable. discharge instructions: please contact a physician if you experience fevers, chills, chest pain, shortness of breath, nausea, vomiting, black stools or blood in your stools, or any other concerning symptoms. . please take your medications as prescribed. it is very important you take all your medications. - you should take protonix 40 mg twice daily instead of once daily. - you should hold aspirin for now and speak with your primary care doctor aspirin. - your insulin was decreased to 10 units at night. your morning insulin is the same. you should measure your finger stick sugars four times daily. - your calcium acetate was increased to three tablets three times daily. . please keep your follow-up appointments as below. followup instructions: provider: , m.d. date/time: 1:30 provider: procedure phone: date/time: 1:30 . please call your primary care doctor, dr. , at to arrange follow-up within two weeks. you should follow-up your biopsy results with him at this time. . please call diabetes center to arrange follow-up regarding your diabetes. . provider: , md phone: date/time: 1:00 procedure: hemodialysis esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: hyperpotassemia anemia in chronic kidney disease end stage renal disease other chronic pain congestive heart failure, unspecified acute posthemorrhagic anemia depressive disorder, not elsewhere classified hemorrhage complicating a procedure hypoxemia abdominal pain, other specified site diabetes mellitus without mention of complication, type i [juvenile type], not stated as uncontrolled other specified gastritis, with hemorrhage hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage v or end stage renal disease 

Answer: The patient is high likely exposed to