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: nsaids attending: chief complaint: gi bleed major surgical or invasive procedure: 1. reoperative exploration of bleeding duodenal ulcer. 2. exploration of the vagi with division of prior missed posterior vagus. 3. antrectomy with roux-en-y reconstruction. history of present illness: mr is a 52m with hx of a duodenal perforation/bleeding ulcer () requiring emergent exploratory laparotomy and duodenal repair and ligation complicated by on-table cardiac arrest who p/w duodenal ulcer bleed. the pt states that in he developed a "bleeding ulcer and burst artery" for which he underwent oversewing of his duodenal ulcer c/b cardiac arrest. since then the pt has had no further episodes of gi bleed. . on monday the pt had hematemesis and bm with brbpr. he presented to where he was found to have sbps in the 70s. he underwent egd showing mild erosive esophagitis, gastritis with a nonbleeding ulcer in the stomach antrum, and large duodenal bulb ulcer extending from the bulb into the apexwith a visible vessel. 16-17cc of 1:10,000 epi were injected and an endoclip was placed over the bleeding vessel. the pt was discharged on protonix and sucralfate. . friday early morning the pt had a black tarry bm associated with lightheadedness, followed by multiple episodes of hematochezia. he became increasingly lightheaded and presented to . the pt arrived a noon with hr 130 and sbp in the 80s, and was found to have a hct 21.3. he was given 4u prbcs, 2u ffp, and 3l ns, started on a protonix gtt and transferred to for eval from ir and surgery. . at the ed the pt was 97 140/93 24 98%ra. his hct was 31.7 and he was without active bleeding. ir, gi, and surgery were made aware. the gi attg spoke with the gi who felt that the ulcer was too large and friable to manage endoscopically. ir felt that they should be a last resource as they are rarely effective in upper gi bleeds. surgery recommended initial management by gi and ir. . past medical history: htn ruptured disks --> chronic back pain hx duodenal ulcer s/p emergent exploratory laparotomy and duodenal repair and ligation complicated by on-table cardiac arrest tobacco dependence social history: , works as a musician. smokes 2 ppd x 30 years, still currently smoking. occasional etoh. last used marijuana 25 years ago, has experimented with multiple recreational drugs. family history: uncle with hx of ulcers physical exam: temp 98 bp 136/83 hr 103 rr 20 o2 sat 98%ra. general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 05:07am blood wbc-16.6* rbc-3.57* hgb-10.6* hct-30.2* mcv-85 mch-29.8 mchc-35.2* rdw-15.0 plt ct-282 04:33am blood wbc-18.8* rbc-4.10* hgb-12.1* hct-35.6* mcv-87 mch-29.6 mchc-34.0 rdw-15.2 plt ct-288 06:30am blood wbc-19.3*# rbc-4.21* hgb-12.6* hct-36.1* mcv-86 mch-30.0 mchc-35.0 rdw-15.0 plt ct-239 04:55pm blood wbc-12.9* rbc-3.73* hgb-11.1* hct-31.7* mcv-85 mch-29.7 mchc-35.0 rdw-14.3 plt ct-193 04:55pm blood neuts-81.5* lymphs-13.5* monos-4.3 eos-0.3 baso-0.3 05:07am blood plt ct-282 04:33am blood plt ct-288 05:35am blood pt-11.7 inr(pt)-1.0 05:07am blood glucose-96 urean-5* creat-0.5 na-139 k-3.4 cl-102 hco3-24 angap-16 04:33am blood glucose-78 urean-10 creat-0.8 na-138 k-4.7 cl-99 hco3-25 angap-19 06:30am blood glucose-97 urean-12 creat-0.9 na-140 k-3.6 cl-105 hco3-22 angap-17 05:35am blood alt-13 ast-19 alkphos-41 totbili-0.4 04:55pm blood alt-15 ast-19 alkphos-39* 05:07am blood calcium-8.2* phos-2.5* mg-1.9 04:33am blood calcium-8.4 phos-3.4 mg-2.1 : ekg: sinus rhythm. right bundle-branch block. diffuse st-t wave changes most prominent in leads iii, avf and v3-v4. consider myocardial ischemia. no previous tracing available for comparison. : cta pelvis: no evidence of active extravasation. probable surgical absence of the gda. 2. colonic diverticulosis. 3. 5-mm nonobstructing left renal : upper gi: . there is no passage of contrast beyond the stomach which appears dilated. : kub: 1) residual po contrast in the ascending colon. 2) non-obstructive bowel gas pattern. 3) 6 mm left kidney . cta chest/abd: 1. pulmonary parenchymal changes of ground glass opacity and thickening of interlobular septae with relative sparing of lung apices, detailed above, with appearance suggestive of noncardiogenic pulmonary edema type pattern. 2. mild dependent lung lower lobe basilar areas of consolidation could represent sequela of aspiration and/or early pneumonia in the correct clinical setting. 3. colonic diverticulosis. 4. intra-abdominal surgical changes of a recent roux-en-y procedure. no evidence of bowel obstruction. 5. no main, lobar or segmental pulmonary emoboli. 8:28 pm mrsa screen source: nasal swab. **final report ** mrsa screen (final ): no mrsa isolated. 8:30 pm serology/blood old s# s. **final report ** helicobacter pylori antibody test (final ): negative by eia. (reference range-negative). brief hospital course: this is a 52 year old gentleman with a history of a duodenal perforation/bleeding ulcer () that required emergent exploratory laparotomy with some type of oversewing of the ulcer. he had an unknown ulcer operation at that time that was aborted due to on-table cardiac arrest. at this time he p/w another major duodenal ulcer bleed. he initially presented to about with a gi bleed. he was found to have a large duodenal ulcer with a 'visible vessel' which was injected with epi and clipped, and he was started on a ppi and sucralfate. he was discharged to home soon thereafter. at the time of presentation he had a hct of 24 which was transfused up to 36.8 at discharge. the patient remained stable until the morning when he redeveloped a major bleed with simultaneous bright red hematemesis and hematochezia. he was found to have a hct of 21. he was transfused and transferred to for further management. he received 1 unit prbc in the emergency room. upon admission to the medical intensive care unit, he was made npo and given intravenous fluids. he remained hemodynamically stable without further evidence of bleeding. ir was consulted to evaluate the source of the bleeding, but there was no dominant artery on cta supplying the ulcer that could be embolized so they declined. gi felt they had nothing to offer the patient. on , the patient was taken to the or for repair of duodenal ulcer. please see operative report for further details. postoperatively, the patient was transferred to the floor and did well. pain was an issue and his pca was increased for better pain control. he was kept npo/ivf and ngt was in place. he was hemodynamically stable with good uop. pod 2, patient began to have flatus, pain was improved. ngt was removed and ugi was performed that showed no leak, but poor gastric emptying. on pod 3, patient was started on sips for comfort, he was continued on ppi , and dilaudid pca for pain. on pod4, patient began to have worsening abdominal pain, so his diet was backed down to npo. his jp drain although with minimal output was kept in place due to increased pain. patient was started on post gastrectomy diet on with several small meals each day. on the afternoon of , patient triggered for o2 saturation in the mid 80s on 6lnc. non-rebreather was placed and o2 saturation improved to 100. he was transferred to the icu for further management. cta of the chest showed no emboli, but was consistent with pulmonary edema. patient was diuresed and his oxygenation improved. serial cxrs showed improving edema. on , patient was stable and transferred back to the floor. his jp drain was removed, and he was continued on the post gastrectomy diet. diuresis with intermittent lasix was continued only briefly and then he was managed off lasix and his oxygen was weaned off. he continued with bronchodilator therapy for his longstanding copd along with the incentive spirometer and remained free of any other pulmonary problems. his abdominal wound had some mild erythema at the staple insertion sites and the staples were removed. he had a minimal skin separation at the lower pole (1cm) managed with dressing changes. the base was clean and healing nicely. he will have vna services to help him with that at home. he was tolerating a regular diet in modest amounts and was encouraged to eat 6 small meals a day. he was walking independently and his hematocrit was stable in the 30 range. he was discharged to home on . medications on admission: amlodipine 5mg fioricet prn migraine sucralfate prilosec discharge medications: 1. nicotine 21 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 2. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 5. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. acetaminophen 500 mg tablet sig: two (2) tablet po q8 (). 7. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation four times a day. disp:*1 unit* refills:*2* 8. ipratropium bromide 17 mcg/actuation hfa aerosol inhaler sig: pufss inhalation four times a day. disp:*1 unit* refills:*2* 9. hydromorphone 2 mg tablet sig: three (3) tablet po q3h (every 3 hours) as needed for pain. disp:*300 tablet(s)* refills:*0* discharge disposition: home with service discharge diagnosis: 1. gastrointestinal hemorrhage with shock due to recurrent refractory duodenal ulcer, probable missed vagotomy and duodenal stenosis. 2. pulmonary edema discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were transferred from with a second bout of rectal bleeding and dizziness after prior endoscopy for a bleeding duodenal ulcer. you required surgical repair, blood transfusions for anemia and pulmonary toilet due to your history of lung disease. you are being discharged to home with vna services to help you with wound care. please call your doctor or nurse practitioner or return to the emergency department for any of the following: *you experience new chest pain, pressure, squeezing or tightness. *new or worsening cough, shortness of breath, or wheeze. *if you are vomiting and cannot keep down fluids or your medications. *you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *you see blood or dark/black material when you vomit or have a bowel movement. *you experience burning when you urinate, have blood in your urine, or experience a discharge. *you have shaking chills, or fever greater than 101.5 degrees fahrenheit or 38 degrees celsius. *any change in your symptoms, or any new symptoms that concern you. please resume all regular home medications , unless specifically advised not to take a particular medication. also, please take any new medications as prescribed. please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. avoid lifting weights greater than lbs until you follow-up with your surgeon. avoid driving or operating heavy machinery while taking pain medications. incision care: *please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *avoid swimming and baths until your follow-up appointment. *you may shower, and wash surgical incisions with a mild soap and warm water. gently pat the area dry. *your abdominal wound requires saline damp to dry dressing changes on the lower portion due to skin separation. followup instructions: call the acute care clinic at for a follow up appointment in weeks for a wound check you should also follow up with your primary care provider weeks to see how you are doing. if you do not have a primary care doctor call at and one will be provided. procedure: other lysis of peritoneal adhesions reopening of recent laparotomy site partial gastrectomy with anastomosis to jejunum other selective vagotomy diagnoses: other chronic pain tobacco use disorder unspecified essential hypertension chronic airway obstruction, not elsewhere classified other shock without mention of trauma peritoneal adhesions (postoperative) (postinfection) hypoxemia chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction lumbago precipitous drop in hematocrit acute edema of lung, unspecified displacement of lumbar intervertebral disc without myelopathy unspecified analgesic and antipyretic causing adverse effects in therapeutic use personal history of sudden cardiac arrest other obstruction of duodenum chronic or unspecified duodenal ulcer with hemorrhage, with obstruction 

Answer: The patient is high likely exposed to