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: history of present illness: this is an 84 year-old female with a history of crest, diverticular disease, irritable bowel syndrome, and prior upper gi bleed in secondary to avm and gastritis. her previous ugib required hospitalization, which was notable for a hematocrit of 16 on admission, 11 units of packed red blood cells transfusion during stay, 2 units of fresh frozen platelets, esophagogastroduodenoscopy showing gastritis and normal duodenum, cauterization of a gastric avm, and angiography followed by embolization of left gastric artery. she presented to the emergency room at this time with a chief complaint of two days of dark stools, left lower abdominal pain and weakness. she denied chest pain, shortness of breath, lightheadedness, fevers or chills, and night sweats. no bright red blood per rectum, no hematemesis. in the emergency room she was found to be in no acute distress and with a temperature of 99.5, blood pressure 143/53, pulse 86, respirations 16, 98% on room air. nasogastric suction revealed 200 cc of coffee grounds and lavage with 250 cc h20 showed coffee grounds and a bright red tinge, but lavage was stopped, because of patient discomfort. central line in femoral vein was placed and she was given one liter of normal saline. past medical history: 1. sjogren's with sicca syndrome crest with a history of dysphagia and dyspepsia (followed by gastroenterologist dr. ). 2. hypertension. 3. hypothyroidism. 4. irritable bowel syndrome with chronic diarrhea, constipation and abdominal pain. 5. diverticula seen on colonoscopy . 6. chronic obstructive pulmonary disease with bronchiectasis, right bronchial sclerosis. 7. history of bladder stretching. past surgical history: 1. cholecystectomy. 2. pericholecystectomy hernia repair. 3. hysterectomy. social history: three pack years of smoking, quit twenty years ago. drinks no alcohol. family history: son has crohn's disease times forty two years. allergies: penicillin and sulfa. medications on admission: 1. atenolol 50 mg q.d. 2. aldactone 25 mg t.i.d. 3. lasix 20 mg q.d. 4. synthroid 175 micrograms q.d. 5. prevacid 30 mg q.d. 6. evoxac 30 mg t.i.d. 7. serax 50 mg b.i.d. 8. multivitamin once a day. physical examination: general, thin elderly woman in no acute distress. vital signs temperature 99.5. blood pressure 120/60. pulse 86. respiratory rate 18. skin normal capillary refill, plus telangiectasias on the back. heent right ptosis. no scleral icterus. pupils are equal, round and reactive to light. extraocular movements intact. mucous membranes are dry. no lower dentition. neck supple. no lymphadenopathy. jugular veins flat. chest clear to auscultation bilaterally. cardiovascular regular rate and rhythm. s1 and s2. 3 out of 6 systolic murmur loudest at right upper sternal border. no gallops or rubs. abdomen flat. scar along right abdomen. positive bowel sounds, nondistended. no tenderness to palpation. no hepatosplenomegaly. extremities no clubbing, cyanosis or edema. fingers and toes cool to touch. 2+ radial and dorsalis pedis pulses. rectal guaiac positive in the emergency department. neurological alert and oriented times three. pleasant affect. cranial nerves ii through xii are intact. no asterixics. laboratories and studies: white blood cell count 11.1, hemoglobin 10.3, hematocrit 27.9, platelets 235, mcv 85, mch 29.3, mchc 34.4, neutrophils 87.9%, lymphocytes 8%, bands 0, monocytes 2.6%, eosinophils 1.1%, basophils 0.1%, sodium 128, potassium 4.6, chloride 94, bicarbonate 27, bun 47, creatinine 1.1, glucose 122, calcium 8.5, magnesium 1.8, phosphate 2.8. pt 13.4, ptt 30.1, inr 1.3. urinalysis negative. electrocardiogram heart rate 84 beats per minute, normal sinus rhythm, left axis deviation. no acute ischemic changes. hospital course: 1. gastrointestinal: the patient presented with an upper gastrointestinal bleed with a hematocrit of 29.9, melena left lower quadrant pain and coffee grounds with red tinge on nasogastric lavage. to look for a source of bleed, several procedures were done. an esophagogastroduodenoscopy was done on , which showed diffuse gastritis and a normal duodenum consistent with what was seen during admission a year before. on , enteroscopy showed improved gastritis and a normal duodenum and jejunum. colonoscopy on showed retained melena and multiple nonbleeding diverticula, but no source of bleeding. a tagged red cell scan on did not identify a source of gastrointestinal bleeding either. h-pylori antibody test was negative. she was on supportive therapy with protonix 40 mg b.i.d. and carafate, but she had continuous gastrointestinal bleed as manifested by guaiac positive stools, both melena and bloody stool and unstable hematocrit throughout most of her stay. on the evening of (hospital day fifteen), the patient had a dramatic gastric bleed with a hematocrit drop from 27.7 to 17.4. the patient became more tachycardic then baseline to 130s, but maintained her blood pressure. nasogastric lavage at this point revealed bright red blood with clots that did not clear with 420 cc of h20. she was transferred to the micu where she received 6 units of packed red blood cells and 2 units of fresh frozen platelets. she was taken to the ir the next morning where the left gastroduodenal artery was embolized empirically. by hospital day seventeen, the patient decided that she wanted no more blood product transfusions and wanted cmo. on the evening of hospital day seventeen, the patient was transferred back to the medicine floor with stable hematocrit of 36.7. however, one day after the transfer, her hematocrit dropped to 24.1 with bloody diarrhea. the patient reexpressed her wishes for cmo and did not want any more laboratory tests or any blood product transfusions. by hospital day twenty the patient appeared stable with stable tachycardia and blood pressure. it appeared that gastrointestinal bleeding either slowed or stopped, so after discussion between the patient and the family and a hematocrit check was done, which at the value of 26.4 showed that she had stopped bleeding. two more units of red blood cells were transfused to increase her hematocrit to at least greater then 30. 2. hematology: at presentation the patient's hematocrit was 29.9 and was unstable throughout most of the admission. she received a total of 20 units of packed red blood cells. some hematologic workup was done to look for other causes of continued bleed, which was negative for gic, hemolysis and disease. two of five studies (epinephrine and arachidonic acid) for platelet aggregation were abnormal so she was given desmopressin intravenous times two doses ( and ) and one bag of platelets, which did not help stabilize her hematocrit. a total of 5 units of fresh frozen platelets were also given, because of multiple red blood cells could have diluted the concentration of her clotting factors and less likely, because of the possibility that she had a coagulopathy given one ptt value. hematology/oncology consult did not feel that the patient had platelet aggregation abnormalities or a coagulopathy. 3. cardiovascular: the patient's antihypertensive medications (atenolol, aldactone, lasix) were held during her hospital stay so that if she were to stop bleeding briskly, her sympathetic system may respond appropriately to maintain blood pressure. her vital signs remained stable with a blood pressure in the 140s/80s and heart rate in 80s until hospital day five when she started having sinus tachycardic 100 to 130s. at this time she also developed a urinary tract infection, so the tachycardia was thought to be secondary to infection or dehydration. she was given normal saline intravenous to lower the heart rate to the 110s. during the remainder of th hospital course her heart rate remained elevated in the 100s. when it rose again to 120 to 130s or the patient was symptomatic with palpitations, administration of normal saline intravenous helped control the tachycardia. after the precipitous hematocrit drop on hospital day fifteen, the patient's cardiac enzymes were checked and they revealed a mild enzyme leak with ck 118 and 128, mb 8 and 9 and troponin 0.9. however, full enzyme cycling was not done, because the patient decided on full cmo measures. the patient was also found to have 3 out of 6 systolic murmur loudest at right upper sternal border, radiating to subclavian arteries. consider outpatient workup with primary care physician. 4. pulmonary: during the micu stay, where she was given 6 units of packed red blood cells and 2 units of fresh frozen platelets she developed dyspnea and bilateral pleural effusion. she was given 2 doses of lasix 20 mg intravenous after which her dyspnea improved. 5. infectious disease: on hospital day five the patient spiked a temperature to 101.5. urinalysis showed 245 white blood cells and blood culture was negative. she was treated with levofloxacin 500 mg once a day for eight days. during the micu stay her white blood cells spiked to 19.9, but she was afebrile and there was no clear source of infection (no pneumonia on chest x-ray, negative urine culture). the white blood cells went down to 12.3 after transfer to the medicine floor. 6. lines: access on this patient was difficult to obtain and maintain. access ranged as follows, femoral central line, peripheral line and left ij central line by ir. 7. fen: potassium, calcium, magnesium and phosphate were repleted as needed. 8. endocrine: synthroid was continued for hypothyroidism. 9. crest/sjogren's: the patient uses evoxac at home for , but this was held during hospitalization. as it is a cholinergic agonist it could have led to increased gastric motility and dampen cva response to hypotension. discharge condition: stable. the patient will be discharged to rehab with clear instructions on how she would like to be cared for if she were to present with recurrent gastrointestinal bleed. discharge medications: 1. protonix 40 mg b.i.d. 2. atenolol 20 mg once a day hold for systolic blood pressure less then 110, heart rate less then 60. 3. synthroid 175 micrograms q.d. 4. ativan 0.5 mg po b.i.d. 5. darvocet one tab prn q 6 hours. 6. msir (oral solution) 10 to 30 mg po prn q 4 hours. 7. colace 100 mg po b.i.d. hold for diarrhea. 8. imodium 2 mg po prn q 6 hours. 9. zolpidem 5 mg po prn h.s. 10. evoxac 30 mg t.i.d. 11. multivitamin q.d. follow up: to arrange with dr. of gastroenterology and the patient's primary care physician . . discharge diagnosis: upper gastrointestinal bleed secondary to gastritis. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified other endoscopy of small intestine other endoscopy of small intestine injection or infusion of other therapeutic or prophylactic substance colonoscopy gastric lavage arteriography of other intra-abdominal arteries diagnoses: abnormal coagulation profile unspecified pleural effusion urinary tract infection, site not specified congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified unspecified gastritis and gastroduodenitis, with hemorrhage angiodysplasia of stomach and duodenum with hemorrhage sicca syndrome systemic sclerosis 

Answer: The patient is high likely exposed to