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: cough, fevers, melena major surgical or invasive procedure: upper endoscopy x 2 history of present illness: mr. is a 66 year old male with a history of severe gastroesophageal reflux disease s/p nissen fundoplication in who presented to clinic on the day of presentation with cough and fevers for four days. the patient reports that he felt well the week prior to admission. he developed fevers to 101 degrees associated with a dry cough for the past four days. he did not have associated nasal congestion, sinus pressure, or sore throat. he did not have any chest pain or shortness of breath. he happened to note that for one day prior to admission he had been having black bowel movements. he has been admitted for gastrointestinal bleeding in the past but does not remember ever having black stools. he denies abdominal pain, nausea, vomiting, hematemasis or bright red blooid per rectum. he denies lightheadedness, dizziness, or decreased urine output. he does note that he had taken two ibuprofen the week of admission for his fevers. in clinic his blood pressure was 112/70, heart rate of 88 and temperature of 100.7. his stool was guaiac positive on exam. in the emergency room his initial vitals were t: 99.0 hr: 79 bp: 137/72 rr: 20 o2: 97% on ra. he underwent ng lavage which was grossly positive for 500 cc of bright red blood. he had a chest xray which showed a possible right lower lung opacity. his initial hematocrit was 40. his blood pressures transiently dropped to the 80s systolic from the 110s and was responsive to fluids. he received 2 l of normal saline, 40 mg iv protonix and was admitted to the medical icu. in the medical icu he underwent emergent upper endoscopy which revealed old blood in the stomach and a large clot in the fundus but no active bleeding. he has since been hemodynamically stable. his hematocrit on transfer to the floor was 31.8. he has not required any blood transfusions. he did undergo a chest ct which showed likely aspiration pneumonia with reactive lymphadenopathy. he was started on levofloxacin and flagyl. on review of systems the patient currently denies lightheadedness, dizziness, chest pain, shortness of breath, nausea, vomiting, abdominal pain, dysuria, hematuria, low urine output, leg pain or swelling. he notes fevers at home as above with non-productive cough and melena. all other review of systems negative in detail. past medical history: gastroesophageal reflux s/p nissen fundoplication in 10/95 upper gastrointestinal bleeding in and sensorimotor axonal neuropathy anxiety and depression social history: works as a clerk. he lives with his wife and has no children. he does not drink, smoke or use iv drugs. family history: no history of coronary artery disease or diabetes. his brother had "esophageal problems" but he cannot specify. physical exam: vs: t: 99.4 hr: 72 bp: 130/60 rr: 20 o2 sat: 97% on 2l general: well appearing male in no acute distress heent: sclera anicteric, slight conjunctival injection in right eye with mild crusting, pupils equal and round, dry mm neck: supple, no lad lungs: bronchial breath sounds at bases, no wheezes or rales cardiac: rrr, nl s1 s2, no m/r/g abdomen - distended, soft, non-tender, hypoactive bs ext - no cyanosis, clubbing, edema neuro: a&ox3, no focal deficits pertinent results: hematology: 05:30pm wbc-10.1 rbc-4.42* hgb-13.7* hct-40.0 mcv-90 mch-31.0 mchc-34.3 rdw-13.7 05:30pm neuts-83.3* lymphs-11.0* monos-4.1 eos-1.1 basos-0.3 05:30pm plt count-247 07:35pm pt-12.2 ptt-24.5 inr(pt)-1.0 06:20am blood wbc-6.8 rbc-3.70* hgb-11.5* hct-33.4* mcv-90 mch-31.2 mchc-34.5 rdw-13.5 plt ct-316 chemistries: 05:30pm glucose-105 urea n-26* creat-0.9 sodium-141 potassium-4.4 chloride-107 total co2-26 anion gap-12 urinalysis: 09:00pm urine color-yellow appear-clear sp -1.023 09:00pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg imaging: chest (pa & lat): again noted are multiple healed right-sided rib fractures. an opacity in the right lower lung most likely represents middle lobe atelectasis, which is slightly more pronounced than on the prior study. an infectious process cannot be entirely excluded. there are no effusions and no pneumothorax. cardiomediastinal silhouette is unremarkable. ct chest w/contrast this examination is limited due to extensive motion artifact limiting the sensitivity for small nodules and ground-glass opacities. there are few prominent though non-pathologically enlarged lymph nodes along the left lower paratracheal station measuring 9 and 8 mm in width. there is an enlarged right hilar lymph node, 16 x 14 mm. there is no pericardial or pleural effusion. there is a moderate-sized area of consolidation within the left lower lobe and a smaller area of peribronchiolar ground-glass opacity within the right lower lobe. these findings along with history of gerd are in keeping with aspiration pneumonia. right middle lobe linear atelectasis is noted. there is a small amount of airway secretions, within the mid trachea. there is a peripheral hypodensity within the right lobe of the liver of approximately 1 cm. there is a 3.5 x 3.0 cm cystic pancreatic head lesion which (based on prior report -- imaging unavailable on pacs at this time) has not changed. there are similar-appearing bilateral simple renal cysts. suture material is seen at the gastroesophageal junction consistent with history of fundoplication. impression: 1. likely aspiration pneumonia with reactive lymphadenopathy. 2. recommend two-month followup ct post treatment to evaluate for resolution of right hilar lymph nodes. upper endoscopy : a large adherent blood clot was seen in the stomach fundus, unable to remove with suction or flushing. area under the clot not visualized. old blood was seen in the stomach, no fresh blood or bleeding site was seen. otherwise normal egd to second part of the duodenum. upper endoscopy : esophagus: mucosa: slightly irregular z-line of the mucosa was noted throughout the esophagus. stomach: lumen: evidence of a previous nissen fundoplication was seen. mucosa: patchy erythema of the mucosa without bleeding was noted in the fundus and stomach body. these findings are compatible with gastritis. excavated lesions multiple superficial non-bleeding ulcers ranging in size from 3mm to 5mm were found circumferentially around the pylorus. cold forceps biopsies were performed for histology and to rule out h. pylori at the stomach antrum. a single superficial non-bleeding 6mm ulcer was found in the antrum. microbiology: 4:49 pm sputum source: expectorated. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in pairs, chains, and clusters. 4+ (>10 per 1000x field): gram negative rod(s). respiratory culture (final ): moderate growth oropharyngeal flora. haemophilus influenzae, beta-lactamase negative. moderate growth. beta-lactamse negative: presumptively sensitive to ampicillin. confirmation should be requested in cases of treatment failure in life-threatening infections.. 7:05 am serology/blood heli added to acc#r. **final report ** helicobacter pylori antibody test (final ): negative by eia. (reference range-negative). brief hospital course: mr. is a 66 year old male with a history of severe gastroesophageal reflux disease s/p nissen fundoplication in who presents with cough, fevers and melena. upper gastrointestinal bleeding: patient presented to his primary care physician noting melena. his hematocrit was 40.0 on admission but this dropped to 33.6 the following morning. ng lavage in the emergency room was positive for gross blood. he underwent emergent upper endoscopy which revealed old blood in the stomach but no active bleeding. he did not require any blood transfusions. he was treated with bowel rest and high dose intravenous proton pump inhibitor. he underwent repeat upper endoscopy two days later which revealed multiple non-bleeding ulcers in the stomach. h. pylori serologies were negative. he was advised to discontinue his aspirin and any nsaids. he was discharged on omeprazole 40 mg daily. he will follow up with his primary care physician. aspiration pneumonia: on admission the patient had a cxr which was concerning for an infiltrate. he underwent chest ct which showed evidence of aspiration pneumonia and reactive lymphadenopathy. sputum cultures were positive for h. flu. he was started on levofloxacin and flagyl for a ten day course. this was switched to moxifloxacin on discharge. he should undergo repeat imaging of his chest in two months to ensure that the lymphadenopathy has resolved. conjunctivitis: the patient had evidence of mild conjunctival injection on the right side with crusting on admission. although it was felt that this was unlikely to represent a bacterial infection, given his systemic illness, he was treated with erythromycin ointment for five days. anxiety/depression: no active inpatient issues. he was continued on citalopram. medications on admission: citalopram 20 mg daily multivitamin aspirin 81 mg daily advil occassionally discharge medications: 1. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 2. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 7 days. disp:*7 tablet(s)* refills:*0* 3. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 8 days. disp:*24 tablet(s)* refills:*0* 4. erythromycin 5 mg/g ointment sig: 0.5 strip ophthalmic qid (4 times a day) for 3 days: to right eye. disp:*1 tube* refills:*0* 5. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*0* 6. multivitamin capsule sig: one (1) capsule po once a day. discharge disposition: home discharge diagnosis: primary: upper gastrointestinal bleeding aspiration pneumonia conjunctivitis discharge condition: stable. ambulating without assistance. breathing comfortably on room air. discharge instructions: you were seen and evaluated for your black stools. you had an upper endoscopy and were found to have ulcers in your stomach. you also were found to have pneumonia and were treated with antibiotics. please take all your medications as prescribed. the following changes were made to your medication regimen. 1. please take levofloxacin 500 mg once a day for 7 more days 2. please take flagyl 500 mg three times a day for 8 more days 3. please take omeprazole 40 mg once a day 4. please stop taking aspirin and advil until you see dr. . please use erythromycin ointment in your right eye four times a day for three more days for conjuncivitis please keep all your follow up appointments as scheduled. please seek immediate medical attention if you experience any fevers > 101.5 degrees, chest pain, difficulty breathing, worsening abdominal pain, persistent black stools or bloody stools or any other concerning symptoms. followup instructions: please follow up with your primary care physician . in one week. someone from his office will call you to help schedule an appointment. his office phone number is . md procedure: other endoscopy of small intestine insertion of other (naso-)gastric tube gastric lavage esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: esophageal reflux acute posthemorrhagic anemia anxiety state, unspecified hypotension, unspecified pneumonitis due to inhalation of food or vomitus blood in stool gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction conjunctivitis, unspecified 

Answer: The patient is high likely exposed to