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: morphine / codeine / ciprofloxacin attending: chief complaint: hematemesis major surgical or invasive procedure: upper endoscopy history of present illness: 42 year old homeless man with a pmh significant for etoh cirrhosis complicated by multiple episodes of esophageal varices bleed(grade i varices) with banding, chronic pancreatitis, and etoh withdrawl admitted to the micu for coffee ground vomiting and abdominal pain. patient was admitted twice within the last month with similar symptoms of coffee ground emesis and abdominal pain after heavy drinking. he had an upper endoscopy on which showed 1 cord of grade 1 varices, erosive esophagitis, and portal hypertensive gastropathy with no evidence of variceal bleeding. he was started on nadolol upon discharge. he also was found to have a trace ascites on us. at this admission patient reports drinking 1 quart of daily, and had binge drinking 2 days prior to admission followed by non-bloody vomiting. he than developed coffee ground vomit and presented to er. his chronic abd pain also increased yesterday. he denies black stools, red blood in his vomiting, brbpr, dizziness or syncope.and 3 episodes of hematemesis since 2 days prior to admission. he also reports associated abdominal pain (baseline ) described as intermitent sharp located in the epigastrum radiating to his back which was worse than his chronic abdominal pain. he noted to have dark stools in the last "few" days, but denies having any melena. he also denies having any shortness of breath, dizziness, lightheadedness, fever, or chills. . in the ed, vs 95.5 97/62 72 18 95%ra. the patient was guaiac negative in the ed, and received a protonix, dilaudid, zofran, ativan, and ciprofloxacin, for which he developed hives and received diphenhydramine. he was admitted to the micu for further management. . in the micu patient had ngl which was negative for blood and bile. he had an today which showed no varices, grade 2 esophagitis in the gastroesophageal junction and mild gastritis. he had no other episodes of vomiting. his hct has been stable at lower 30s, and vss. he was started on ppi iv and placed on ceftriaxone as prophylaxis given his prior reaction to cipro. he had no other episodes of vomiting or melena since admission. currently, he appears to be in nad laying comfortable on his bed. he states to continue to have epigastric abdominal radiating to his back which is at the same location as his chronic pancreatitis pain, but with worse intensity now and at home is pain level is usually . his vss: temp 97.7, pulse 63, bp 107/70, rr 11, o2 sat 94% on ra. . ros: as above, otherwise negative. past medical history: alcoholic cirrhosis with on with grade 1 varices. -variceal bleeds, 6 episodes from to s/p multiple bandings. bleed in was grade ii on , s/p banding. -chronic pleural effisions -chronic pancreatitis -alcohol dependence: heavy drinking started at age 30-35. has been to detox and dual diagnosis clinics in the past. has had periods of sobriety. h/o delirium with past withdrawal; no h/o seizures. -bipolar disorder and anxiety disorder nos, well controlled on citalopram, quetiapine, and ativan. has psychiatrist in the community. -s/p cholecystectomy on -s/p right acl replacement and meniscectomy in social history: currently homeless, occupation: previously employed as an electrician. divorced. has daughter in and son in . 12 year history of drinking 1-1.75 liters of vodka daily. denies tobacco or other illicits. his mother, , is his healthcare proxy family history: history of alcoholism. paternal grandfather died of prostate cancer. maternal grandmother died of mi; no other family h/o cvd. father alive, with h/o kidney cancer. mother and children healthy. physical exam: vs: temp 97.7, pulse 63, bp 107/70, rr 11, o2 sat 94% on ra. gen: age appropriate male in nad heent: sclerae anicteric. mm dry, op clear without lesions, exudate, or erythema cv: rrr, normal s1 and s2, no m/r/g pulm: ctab, no c/r/w abd: soft, nd, tender to palp on epigastric area, +bs, . no rebound or guarding. ext: no c/c/e. 2+ dp/pt bilaterally. neuro: aox3, no asterixis. pertinent results: on : impression: no varices grade 2 esophagitis in the gastroesophageal junction congestion in the whole stomach compatible with mild gastritis pancreatic rest about 1.2 cm found in antrum of stomach otherwise normal to second part of the duodenum cxay on : this film is very limited due to technique. there is a linear density projecting over the expected location of the esophagus with distal tip in the fundus of the stomach with a single loop. would recommend repeat films for definite confirmation. there is atelectasis at the left lower lobe. there are no signs for overt pulmonary edema or pleural effusions. no pneumothoraces are seen. ----------------- admission labs: ----------------- 10:20pm wbc-4.7# rbc-4.69 hgb-11.8* hct-36.9* mcv-79* mch-25.1* mchc-31.9 rdw-15.5 plt ct-211 neuts-53.1 lymphs-41.1 monos-2.0 eos-3.2 baso-0.6 pt-16.2* ptt-30.8 inr(pt)-1.4* glucose-123* urean-8 creat-0.8 na-145 k-5.0 cl-107 hco3-26 angap-17 alt-15 ast-58* alkphos-205* totbili-0.5 lipase-17 asa-neg ethanol-252* acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 10:25pm blood hgb-13.0* calchct-39 03:45am blood albumin-3.7 calcium-7.8* phos-3.5 mg-1.7 10:04am blood type- ph-7.34* ------------------ discharge labs: ------------------ 05:10am blood wbc-1.8* rbc-4.06* hgb-9.9* hct-31.5* mcv-78* mch-24.5* mchc-31.5 rdw-16.1* plt ct-161 05:10am blood neuts-44.6* lymphs-44.7* monos-5.4 eos-4.9* baso-0.3 05:10am blood pt-15.4* ptt-31.6 inr(pt)-1.3* 05:10am blood glucose-95 urean-6 creat-0.7 na-143 k-3.7 cl-104 hco3-32 angap-11 05:10am blood alt-11 ast-36 alkphos-187* 05:10am blood lipase-9 05:10am blood calcium-8.8 phos-4.2 mg-1.9 brief hospital course: 42 year old homeless man with a pmh significant for etoh cirrhosis complicated by multiple episodes of esophageal varices bleed(grade i varices) with banding, chronic pancreatitis, and etoh withdraw admitted to the micu for coffee ground vomiting and abdominal pain and now transferred to team. . # hematemesis: patient was admitted twice within the last month with similar symptoms of coffee ground emesis and abdominal pain after heavy drinking. he had an upper endoscopy on which showed 1 cord of grade 1 varices, erosive esophagitis, and portal hypertensive gastropathy with no evidence of variceal bleeding. he was started on nadolol upon discharge. he also was found to have a trace ascites on us. at this admission patient reports drinking 1 quart of daily, and had binge drinking 2 days prior to admission followed by non-bloody vomiting. he than developed coffee ground vomit and presented to er. in the differential there is ,erosive esophagitis and gastritis. patient is currently hemodynamically stable without further hematemesis. didn't show no varices and no active bleeding. he had an initial hematocrit drop from 36->30, now stable at 31.5. he is tolerating regular diet well prior to discharge. continue on ppi. he was also encouraged to stop drinking. we discuss the risks associated if he continues to drink with gi bleed, pancreatitis and death. patient verbalized understanding. he spoke to the social worker and told us that he was planning to attend aa meetings. . # liver disease: patient is an active drinker with multiple hospitalizations for variceal bleeds with banding. his lfts are wnl, except for ap sl elevated at 187 (but lower than prior admissions). he has missed follow-up appointments w/liver center. the patient received ciprofloxacin in the ed but developed hives and this was discontinued. as noted above we discussed the importance of him stop drinking and to follow-up with liver clinic. - ceftriaxone for upper gi bleed ppx- d/c this am - continue lactulose - placed back on home dose of nadolol given his prior esophageal varices history . # etoh: patient does not have a history of dts or withdrawl seizures. he was place on ciwa protocol with valium for scores >10. he did well and did not needed any valium. he was given thiamine and folate. social worked discuss sobriety option and how patient could afford to get housing, this would help him stay out of the shelter and away from the enviromental triggers. he was given information on possible housing places that he could afford. continue to talk about the importance of him quitting drinking and outpatient programs. uncertain if he could qualify for inpatient or if he would be willing to participate in shuch programs. . # anemia: hct currently at baseline (30-34), and stable. as noted above decrease from 36->30 at admission. recent work-up demonstrated fe/tibc of 8% with ferritin of 23, normal folate and b12 levels. . # chronic leukopenia: patient with low wbc count since , this however is the lowest level when compared to previous admission. he does have large spleen as per imaging, however plalets are within normal limits and he only has very mild anemia. -heme/onc consult as outpatient to evaluate for causes of leukopenia -currently asymptomatic . . #chronic pancreatitis: patient with complain of chronic abdominal pain related to chronic pancreatitis. lfts and lipase wnl, alk phos continue to be elevated, but trending down when compared to previous admssion. pt initially had dilaudid for pain which was d/c. he was restarted on home pain meds: oxycodone 5 mg po q6-8hrs prn. continue home pancreatic enzymes. post discharge patient left the in patient unit to go home and immidiately walked to the emergency room c/o abdominal pain and requesting iv pain meds. . # psych: history of bipolar disorder and anxiety. continue citalopram and seroquel as noted above, patient walked to the emergency room as soon as he was discharge from the inpatient unit asking for pain meds. drug seeking behavior. he was then discharged from the ed. he has a follow-up appointment with his psychiatrist on . he was encouraged to go to his appointment . fen: regular diet tolerating well . code: full (confirmed) . communication: , (mother) , medications on admission: home meds: sucralfate 1 gram po qid quetiapine sr 400 mg daily citalopram 40 mg daily lactulose 10 grams po tid thiamine 100 mg daily folate 1 mg daily oxycodone 5 mg po q6-8h prn for pain trazodone 100 mg po qhs prn amylase-lipase-protease 20,000-4,500- 25,000 unit capsule, delayed release(e.c.) po tid with meals mvi ativan 0.5 mg 1-2 tablets q8h prn for anxiety nadolol 10 mg daily feso4 325 mg po bid . transfer meds: ceftriaxone 1 gm iv q24h started on @ 0349 midazolam 1-3.5 mg iv once @ 1013 citalopram hydrobromide 40 mg po daily multivitamins 10 ml iv q24h diazepam 5-10 mg po q4h:prn for ciwa>10 pantoprazole 40 mg iv q12h quetiapine extended-release 400 mg po daily folic acid 1 mg iv q24h hydromorphone (dilaudid) 1 mg iv q4h:prn pain thiamine 100 mg iv daily lactulose 15 ml po tid titrate to 3 bm/day discharge medications: 1. quetiapine 200 mg tablet sustained release 24 hr sig: two (2) tablet sustained release 24 hr po daily (daily). 2. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 3. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po tid (3 times a day). 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. multivitamin tablet sig: one (1) tablet po daily (daily). 7. oxycodone 5 mg tablet sig: one (1) tablet po every 6-8 hours as needed for pain. disp:*20 tablet(s)* refills:*0* 8. amylase-lipase-protease 20,000-4,500- 25,000 unit capsule, delayed release(e.c.) sig: one (1) cap po tid w/meals (3 times a day with meals). 9. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 11. nadolol 20 mg tablet sig: tablet po daily (daily). 12. maalox 200-200-20 mg/5 ml suspension sig: ten (10) ml po three times a day as needed for heartburn. disp:*1 bottle* refills:*0* discharge disposition: home discharge diagnosis: primary: upper gi bleed . secondary: etoh dependance bipolar disorder cirrhosis chronic pancreatitis discharge condition: stable, tolerating regular diet and pain controlled on oral medications discharge instructions: you were admitted with upper gi bleed but you have not required any blood transfusions and your red blood cell counts have remained stable in house. you were evaluated by the gastroenterologist who performed an which revealed mild gastritis but no evidence of varices. . we have made no changes to your medications, except for: - start maalox . if you develop any chest pain, shortness of breath, significant bleeding, fevers or any other general worsening of condition that is concerning to you, please call your pcp or come directly to the ed. followup instructions: we recommend that you are seen by the hematology/oncologist for your persistently low white blood cell counts. you have an appointment scheduled with them on 03:00p with dr. sc clinical ctr, hematology/oncology-sc. phone: . you can see dr. at any time between 8:30am and 1pm on friday, at her walk in clinic. please call her office at if you have any questions. appointment with dr. , on at 9:30a m lm , liver center (sb) phone: please make sure to follow-up with your psychiatrist- appointment scheduled for md procedure: other endoscopy of small intestine insertion of other (naso-)gastric tube diagnoses: anemia, unspecified alcoholic cirrhosis of liver chronic pancreatitis bipolar disorder, unspecified other and unspecified alcohol dependence, continuous esophageal hemorrhage other esophagitis leukocytopenia, unspecified other specified gastritis, with hemorrhage 

Answer: The patient is high likely exposed to