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: hypotension major surgical or invasive procedure: none history of present illness: 66f with history of parkinson's disease, chronic hypotension recently started on midodrine, mds and iron deficiency anemia (baseline hematocrit 26), presenting now with hypotension and syncope. patient reports that over the past several days, has had decreased appetite and has not been eating well. baseline sbp in 80s per patient (started on midodrine 2 weeks ago), but sbp has now dropped to the 50s-60s. had syncopal episodes at home upon sitting/standing up, prompting her to seek ed evaluation. she denies any fevers, chills, chest pain, dyspnea, abdominal pain, n/v, hematemesis, diarrhea, or changes in bowel or bladder habbits. of note, did fall one week ago and has had low back pain. in the ed, initial vs were 97.5 108 67/36 20 98%. on exam, she was noted to have a dry oropharynx. on rectal exam, heme negative brown stool. labs notable for hgb/hct 4.9/14.6 (baseline 26), lactate 2.3. wbc 4.2, k 5.3 (hemolyzed specimen), co2 23, bun/cr 70/1.1, inr 1.4, trop <0.01. urine and blood cultures sent. a ct torso showed a functional ileus, no intraabdominal or retroperitoneal fluid collection, and no evidence of acute lumbar spine trauma. ct head showed no intracranial hemorrhage or calvarial fracture. the ed attempted ng lavage, but upon sitting patient up she syncopized and they were unable to do so. considered intubation, but patient alert and oriented on lying back down. placed 2 18g piv and r ij. transfused 3 units prbcs, and sbp has improved to the 90s. did not require pressors. was also started on broad spectrum abx with vanc/cefepime. gi consulted and will see as inpatient. vs prior to transfer p 97 93/52 17 100% ra. on arrival to the micu, patient's vs were 97.7, hr 96, bp 137/72, rr 15, 98%ra. review of systems: (+) per hpi, reports black stools since (husband says that this has been ongoing since she started taking iron), rlq pain, decreased appetite & po intake, 10-lb weight loss over the past few months, occasional palpitations associated w/feeling that she can't catch her breath. occasional constipation. right hip pain since fall. (-) denies fever, chills, night sweats, recent weight gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies shortness of breath, cough, dyspnea or wheezing. denies chest pain or pressure. denies abdominal pain, diarrhea, or bloody stools. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: -parkinson's disease, diagnosed in (dysphagia, lower extremity weakness) -type 2 diabetes mellitus, diagnosed in -igg-kappa monoclonal gammopathy with bone marrow biopsy on showing dyserythropoiesis, plasma cell hyperplasia (10-15%), and trisomy 5, reflecting myelodysplasia alongside her plasma cell dyscrasia -iron deficiency anemia (baseline hct 26) -elevated mma, recently started on vitamin b12 -orthostatic hypotension (recently started on midodrine) -dcis of l breast in , s/p excision followed by xrt (refused adjuvant hormonal therapy) -gerd (egd in reported mild esophagitis of the ge junction and lower esophagus, mild antral gastritis) -completed treatment for h. pylori in -constipation -inactive sarcoidosis with pulmonary involvement and erythema nodosum -l4-l5 spondylolithesis with disc protrusion, moderate to severe spinal stenosis at l4-5 level diagnosed by mri in , chronic low back pain x 7 years -history of neuroleptic malignant syndrome -urinary frequency/incontinence -h/o hematuria -right hip bursitis -history of left lower extremity dvt s/p warfarin -question of stroke 4-5 years ago when she apparently lost consciousness and had left arm weakness. -h/o gout social history: pt lives at home with her husband. ambulates with a walker. denies any history of smoking, etoh, drug use. family history: mother, father and 2 sisters with dm2, father with mi and htn died age 73, sister with htn. no history of ca or premature cad. physical exam: admission physical exam general: somnolent, oriented x 2 (person, place), no acute distress heent: sclerae anicteric, dry mm, oropharynx clear, eomi, perrl, mild bilateral lid lag neck: supple, jvp difficult to assess rij, no lad cv: regular rate and rhythm, normal s1,s2, ii/vi systolic murmur heard best at lusb, no rubs or gallops lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi abdomen: soft, non-distended, bowel sounds present, no organomegaly, mild rlq tenderness to palpation, no rebound or guarding gu:00 foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: difficult to perform with mental status, no focal deficit, moving all extremities discharge physical exam: as above with the exception that her mental status was clear and she was fully oriented. pertinent results: admission labs 06:35am wbc-4.2 rbc-1.47*# hgb-4.9*# hct-14.6*# mcv-99* mch-33.0* mchc-33.3 rdw-14.4 06:35am neuts-69.4 lymphs-27.3 monos-2.5 eos-0.6 basos-0.2 06:35am caltibc-161* haptoglob-157 ferritin-851* trf-124* 06:35am albumin-2.5* iron-105 06:35am ck-mb-2 06:35am ctropnt-<0.01 06:35am alt(sgpt)-11 ast(sgot)-19 ld(ldh)-256* ck(cpk)-227* alk phos-39 tot bili-0.1 06:35am glucose-144* urea n-70* creat-1.1 sodium-134 potassium-5.3* chloride-101 total co2-23 anion gap-15 06:42am lactate-2.3* 08:20am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 08:26am pt-14.5* ptt-27.9 inr(pt)-1.4* discharge labs: 07:15am blood wbc-3.2* rbc-3.46* hgb-10.7* hct-31.6* mcv-91 mch-31.0 mchc-34.0 rdw-15.5 plt ct-198 07:15am blood glucose-108* urean-13 creat-0.7 na-137 k-4.1 cl-107 hco3-27 angap-7* 05:03am blood calcium-8.5 phos-2.0* mg-2.0 brief hospital course: 66f with history of parkinson's disease, chronic hypotension recently started on midodrine, mds and iron deficiency anemia (baseline hematocrit 26), who presented to the ed with syncope and was found to be hypotensive with acute on chronic anemia. # hypotension: patient presented to the ed with bp 67/36. likely multifactorial etiology due to discontinuation of midodrine and blood loss given acute on chronic anemia. infectious etiology was considered unlikely given that pt remained afebrile, without leuocytosis,negative ua, no evidence of pathology on cxr or abdominal imaging, and improved clinically with fluids and transfusion. pt was given one dose vancomycin and cefepime for possible infection in ed which was d/c'ed. urine cultures were negative and blood cultures are still pending. pt was ordered for home midodrine 5mg which was held since she has maintained sbp>130. in fact, pt has had elevated sbp 130-190. pt had elevated lactate to 2.3 on admission which trended down to 0.6. # anemia: patient has a history of mgus/mds with baseline hgb/hct 8-9/23-25, but presented with severe acute on chronic anemia with hgb/hct 4.9/14.6. she was guaiac negative in the ed and has no clear source of blood loss. her hemoglobin responded appropriately to 3 units prbc (4.9->8.2). patient does report black stools since , however, her hematocrit was stable prior to today, and she also reported black stools during her admission. she takes iron supplements which could be contributing to dark stools. hemolysis is unlikely given normal t.bili and haptoglobin. pt had drop in hgb 8.2->7.4 on evening of and was transfused 2 units prbc with appropriate response to 10.9. gi consult recommended 2l prep and plan to perform egd/colonoscopy on friday . pt was continued on pantoprazole 40mg iv bid. in the past she has had a macrocytic anemia and was recently found to have an elevated mma so she was started on vitamin b12 supplementation. stool and serum h. pylori antigen pending per gi recs. an egd and colonscopy was performed. it revealed an esophageal ulcer in the distal third of the esophagus with overlying organized and adherent clot. moderate erythema and scattered white plaques in distal third of esophagus consistent with likely esophagitis. coffee ground material were noted in antrum and duodenal bulb. she will be discharged on high dose ppi and should have a follow up egd in 8 weeks. she should also complete a 1 week treatment of fluconazole treatment for the esophagitis. she tolerated regular diet without any difficulties. # syncope: patient denies a history of syncope leading to her presentation to the ed. no evidence of hemorrhagic or ischemic stroke on head ct. patient has no history of seizures. no evidence of cardiac ischemia on ekg and troponin <0.01 x 3. # prolonged inr: likely related to nutritional deficiency. patient reports poor po intake and has albumin of 2.5 on admission. pt was given vitamin k 5mg po with inr normalization 1.4->1.1. pt is currently on clear liquid diet for procedure, but will start regular diet with ensure supplements once patient is okay to eat. #parkinson??????s disease: pt was restarted on sinemet at home dose 2 tab q2h after not receiving medication since monday . pt received one dose at 6pm on and resumed 7am on and an hour later pt developed dystonia with flexion posturing of all 4 extremities and repetitive stereotyped movements of fidgeting with bed sheets. home neurologist felt that pt's hypotension, acute anemia and npo may have contributed to overmedication with sinemet, and recommended decreasing dose to 1 tab q2. neurology cosult team agreed with maintaining this decreased dose. pt's dystonia has resolved and her symptoms improved significantly on the lower dose. this level should be continued until she is reevaluated by her neurologist. # dispo: ms expressed interest in going home and had no interest in going to rehab. vna services were provided. medications on admission: midodrine 5mg tablet 1 tablet by mouth twice a day ammonium lactate - ammonium lactate 12 % lotion apply as directed once a day carbidopa-levodopa 25 mg-100 mg tablet 1.5 tablets by mouth every 2 hours starting 7am, 1 tablet every 2 hours starting at 1pm till 1am entacapone 200 mg tablet 1 tablet by mouth every 2 hours beginning at 7 am until 6 pm daily lidocaine 5 % (700 mg/patch) adhesive patch apply patches to affected area once a day for up to 12h/day tramadol 50 mg tablet 1 tablet by mouth three times a day as needed for back pain trazodone 50 mg tablet 0.5 (one half) tablet by mouth at bedtime acetaminophen 500 mg tablet 2 tablets by mouth 2-3 times a day bisacodyl 10 mg rectal suppository 1 suppository rectally as needed for constipation docusate sodium 100 mg capsule 1 (one) capsule by mouth twice a day ferrous sulfate 325 mg (65 mg iron) tablet 1 tablet by mouth twice a day naproxen sodium - aleve 220 mg capsule 1 capsule by mouth twice a day as needed for pain vitamin b12 mcg daily discharge medications: 1. carbidopa-levodopa (25-100) 1 tab po q2h between 1:00pm - 1:00am please give at 13:00, 15:00, 17:00, 19:00, 21:00, 23:00 & 1:00am 2. carbidopa-levodopa (25-100) 1 tab po q2h between 7:00 - 11:00am please give at 07:00, 09:00, 11:00. 3. comtan *nf* (entacapone) 200 mg oral q2h reason for ordering: wish to maintain preadmission medication while hospitalized, as there is no acceptable substitute drug product available on formulary. please give from 07:00 - 17:00 (07:00, 09:00, 11:00, 13:00, 15:00, 17:00). 4. bisacodyl 10 mg po/pr daily:prn constipation 5. cyanocobalamin mcg po daily 6. docusate sodium 100 mg po bid 7. ferrous sulfate 325 mg po daily 8. fluconazole 200 mg po q24h duration: 7 days rx *fluconazole 200 mg 1 tablet(s) by mouth daily disp #*6 tablet refills:*0 9. pantoprazole 40 mg po q12h rx *pantoprazole 40 mg 1 tablet(s) by mouth twice a day disp #*60 tablet refills:*0 10. midodrine 5 mg po bid hold for sbp > 130 11. senna 1 tab po bid:prn constipation 12. tramadol (ultram) 50 mg po tid:prn back pain 13. trazodone 25 mg po hs:prn insomnia discharge disposition: home with service facility: vna discharge diagnosis: syncope (loss of consciousness) upper gi bleed (esophageal ulcer) esophagitis parkinson's discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted to the icu for loss of consciousness, low blood pressure, and low red blood cell count. while in the hospital, you received a total 5 units of packed red blood cells and 2 liters of iv fluid. with this, your pressure normalized and there was no further loss of consciousness or light-headedness. to identify the reason for the low blood count, a egd (esophagogastroduodenoscopy) and colonoscopy was performed. the egd revealed an esophageal ulcer with an overlying clot and evidence of past bleed. for this, you should take protonix twice a day and should be followed up in 8 weeks for a repeat egd. there was also evidence of yeast esophagitis. you will be given a total of 7 days of fluconazole (medication). you were also noted to have more movement irregularities and this was attributed to too high sinemet levels. the sinemet was decreased to 1 tablet every 2 hours. please continue with this level until you see your neurologist. followup instructions: department: radiology when: friday at 12:40 pm with: radiology building: sc clinical ctr campus: east best parking: garage department: rehabilitation services when: monday at 12:00 pm with: , pt building: sc clinical ctr campus: east best parking: garage you will need a repeat egd in eight weeks. the clinic will be in touch to arrange this for you. procedure: other endoscopy of small intestine colonoscopy central venous catheter placement with guidance diagnoses: abnormal coagulation profile esophageal reflux acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled sarcoidosis myelodysplastic syndrome, unspecified iron deficiency anemia, unspecified pain in joint, pelvic region and thigh personal history of venous thrombosis and embolism do not resuscitate status hypovolemia personal history of irradiation, presenting hazards to health urinary incontinence, unspecified lung involvement in other diseases classified elsewhere ulcer of esophagus with bleeding candidal esophagitis spinal stenosis, lumbar region, without neurogenic claudication acquired spondylolisthesis peripheral autonomic neuropathy in disorders classified elsewhere other degenerative diseases of the basal ganglia 

Answer: The patient is high likely exposed to