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: gi bleed major surgical or invasive procedure: egd (endoscopic evaluation of esophagus, stomach, partial small bowel) x 2 capsule endoscopy x 1 prbc and platelet transfusions history of present illness: east hospital medicine attending admission note date: time: 23:50 the patient is a 85 year old male history of diverticulitis, gerd, appendectomy, cholecystectomy, htn, on daily asa 81 for primary prevention; who osh transfer for concern for gi bleed. he reports 6 weeks ago had abdominal pain in epigatrium. he saw his pcp who gave him prilosec and ranitidine and his symptoms improved. one week ago, he had recurrent pain associated with constipation. he presented to where he had ct abdomen that showed constipation. he received stool softeners which helped his symptoms and he was sent home. on friday , he had dental procedure and removed lower teeth, with no complications and no bleeding that he can recall. on saturday at 2am, he awoke feeling dizzy and fell on the floor hitting is left ribs and right ankle. has no memory of what happened. he then went to church. he had 5 bowel movements that were dark black and concerning for . he went to bed but awoke feeling weak. he called 911 and went to ed. he denied any chest pain, no diapharesis, but did feel some sob at time of admission to . at osh: vs t 96.9, jr 93, rr 18, 151/66, 100%ra. pt had episode of dark brown emesis. hct 18. he was started on protonix drip with bolus, given 2 l ivf and 2 prbc. exam with hemodynamic stability, benign abdominal exam, melanotic stool. ekg showed ?st depressions in v4-v5. sent to ed for further evaluation. in the ed inital vitals were, 98 77 134/56 18 99% pt was crossmatched 4 u prbc. ekg: sinus v4-v5 <0.5mm st depression. labs: hbct 21.4, hb 7.3, wbc 15, plt 190. na 130, k 4.9, bicarb 20. cr 1.0. inr 1.2, ptt 23.3 gi saw pt, no indication for gi lavage, recc micu admission for urgent endoscopy. concern for ekg changes in setting of gi bleed, sent to micu for close observation. vs prior to transfer: 77, 119/49, 12 97 on 3l access: two 18 guage. in the icu, he received an additional 2u prbc and 1u platelets. he remained pain free and underwent two egds, without finding the exact source of the upper gi bleed. on the floor, he has no complaints other than not being able to fall asleep. he denies cp, sob, dark stools, f/c, n/v or abdominal pain. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: htn sp thyroid surgery gerd ?pituitary adenoma social history: no etoh, no smoking. 5 children, used to be protestant missionary. 11 grandchildren, 2 great grandchildren. family history: no medical problems that he is aware of. physical exam: vitals: 97.1 113/60 52 20 98% ra, pain general: alert, oriented, no acute distress, moist mucus membranes heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, mild systolic murmur left sternal border abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema, mildly decreased skin turgor pertinent results: 05:40am wbc-15.1* rbc-2.40* hgb-7.3* hct-21.4* mcv-89 mch-30.2 mchc-33.9 rdw-14.1 plt ct-190 05:40am neuts-88.3* lymphs-9.1* monos-2.4 eos-0 baso-0.1 09:15am wbc-13.2* rbc-2.52* hgb-7.7* hct-22.0* mcv-88 mch-30.8 mchc-35.1* rdw-14.4 plt ct-161 03:35pm wbc-13.5* rbc-2.94* hgb-9.3* hct-26.2* mcv-89 mch-31.6 mchc-35.4* rdw-14.4 plt ct-133* 09:49pm wbc-12.2* rbc-2.62* hgb-8.3* hct-23.4* mcv-89 mch-31.5 mchc-35.4* rdw-14.6 plt ct-139* 02:01am wbc-12.5* rbc-2.57* hgb-7.9* hct-22.3* mcv-87 mch-30.8 mchc-35.4* rdw-14.9 plt ct-152 08:48am wbc-10.6 rbc-3.03* hgb-9.6* hct-27.0* mcv-89 mch-31.6 mchc-35.5* rdw-14.9 plt ct-126* 02:04pm hct-27.1* 05:40am pt-12.7* ptt-23.3* inr(pt)-1.2* 09:49pm pt-11.9 ptt-25.1 inr(pt)-1.1 05:40am glucose-227* urean-42* creat-1.0 na-130* k-4.9 cl-102 hco3-20* angap-13 02:01am glucose-136* urean-32* creat-1.0 na-136 k-3.9 cl-106 hco3-23 angap-11 05:40am ctropnt-<0.01 03:35pm ck-mb-4 ctropnt-<0.01 09:49pm ck-mb-4 ctropnt-<0.01 02:01am calcium-7.7* phos-2.4* mg-1.7 03:58pm lactate-1.2 06:50am urine color-straw appear-clear sp -1.015 06:50am urine -neg nitrite-neg protein-neg glucose-150 ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 11:40am urine color-straw appear-clear sp -1.017 11:40am urine -tr nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-tr 11:40am urine rbc-7* wbc-8* bacteri-none yeast-none epi-0 11:40am urine casthy-2* micro: urine : ngtd 2/13: ngtd ekg (): sinus rhythm with atrial premature beats. minor lateral st-t wave abnormalities. no previous tracing available for comparison. cxr (): findings and impression: no focal opacity to suggest pneumonia is seen. no pleural effusion, pulmonary edema or pneumothorax is present. the heart size is top normal. no free air is seen beneath the diaphragm. egd (): esophagus: mucosa: normal mucosa was noted. stomach: contents: old was seen in the stomach. duodenum: contents: old was seen in the duodenum. other findings: no active source of bleeding could be identified. impression: normal mucosa in the esophagus in the stomach and duodenum no active source of bleeding could be identified. otherwise normal egd to third part of the duodenum egd (): esophagus: lumen: a patent schatzki's ring was found. stomach: lumen: a sliding medium size hiatal hernia was seen. duodenum: excavated lesions a single periampullary diverticulum without any stigmata of bleeding was found in the duodenum. other findings: no was seen in the esophagus, stomach, or duodenum. impression: schatzki's ring duodenal diverticulum medium hiatal hernia no was seen in the esophagus, stomach, or duodenum. otherwise normal egd to second part of the duodenum . capsule endoscopy: prelim results per gi fellow is no evidence of bleed seen . 05:35am wbc-7.8 rbc-3.16* hgb-9.8* hct-27.8* mcv-88 mch-30.9 mchc-35.2* rdw-14.9 plt ct-199 05:40pm wbc-7.3 rbc-3.17* hgb-9.9* hct-27.9* mcv-88 mch-31.2 mchc-35.5* rdw-14.8 plt ct-184 05:35am glucose-131* urean-18 creat-1.0 na-137 k-4.2 cl-103 hco3-28 angap-10 05:35am ck(cpk)-89 05:35am ck-mb-3 ctropnt-<0.01 05:35am calcium-8.5 phos-3.7 mg-1.8 10:47am albumin-3.1* calcium-8.0* phos-3.4 mg-1.7 11:40am urine color-straw appear-clear sp -1.017 11:40am urine -tr nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-tr 11:40am urine rbc-7* wbc-8* bacteri-none yeast-none epi-0 11:40am urine casthy-2* 11:40am urine mucous-rare . microbiology: : mrsa screen negative : urine culture negative : cultures x 2 sets negative : h. pylori ab negative . tte (): impression: moderate bileaflet mitral valve prolapse with moderate-to-severe mitral regurgitation. moderate pulmonary hypertension. preserved regional and global biventricular systolic function. mild ascending aorta dilation. . brief hospital course: assessment and plan: . 85 m with 1 day of melanotic stool, hct 18, concerning for upper gi bleed. . #. gi bleed: p/w melena x 1 day with hct 18 at osh. pt was initially admitted to the icu and transfused 4 units prbc (6 total units transfused including 2 at osh), 1 bag of platelets with stabilization of hct in the high 20's. his asa was held and he was placed on iv ppi. pt underwent 2 egd's, the 1st showing some old in the stomach and duodenum, but no active bleed. repeat egd showed no and no source of bleed. pt was transferred to the general medical floor with stable hct and stable bp/hr. he had no more episodes of melanotic stools or brbpr, hematochezia, hematemesis. he then underwent a capsule endoscopy, which still showed no evidence of bleed. gi did not feel that searching for a lower source via c-scope was necessary, as the patient has had stable hct, no more episodes of bleeding, and his initial egd did show evidence of old , an upper gi source is still the most likely etiology of bleed. in d/w with the patient's pcp, decision was made to empirically treat the patient for h. pylori and to check a serum ab. the pt was discharged on a course of quad therapy (due to interaction between the standard triple therapy and his home meds, with clarithromycin and bromocriptine interacting), however, the outpt pharmacy could not fill the tetracycline due to a national shortage. this was confirmed with our inpatient pharmacist, and an alternative regimen is not available to be given with the pt's existing home meds. at this time, the pt's serum h. pylori ab had returned negative. as such, the patient was instructed not to fill and not to take the antibioic portion of the quad therapy, and to continue on ppi therapy only. this update was communicated to the pt's pcp via email. . # mitral valve disease: pt was noted to have murmur on exam. as pt has no other medical records here and no documented history of murmur or echocardiogram, a tte/echocardiogram was obtained, which showed moderate mvp and moderate-severe mr. the is preserved biventricular function. the patient denies any symptoms of volume overload, including no symptoms of orthopnea, pnd, le edema, weight gain, and/or sob/doe. he continues to remain physically active, and still shovels snow and splits wood at home. as such, he was not started on any diuretic therapy. these results were conveyed directly by phone to his pcp, will continue to follow and monitor him, and determine the need for serial tte and cardiology referral. per current guidelines, there is no need for endocarditis prophylaxis. . #. ekg changes: pt denies any chest pain. very subtle st depressions in v4-v5 that seemed to have overall resolved. troponin neg x3. this is unlikely acs as only 1 lead v4 has <0.5mm st depression. pt at risk for demand event in setting of anemia. has resolved. holding on asa for now since low likelihood of acs vs likelihood of active bleed. . #. sinus bradycardia: the pt was initially with normal hr, but once his hct stabilized after prbc transfusions, he was noted to have sinus bradycardia. he was monitored on telemetry, and had his cardiac enzymes. tte results are as mentioned above. pt was otherwise asymptomatic from his bradycardia, and he states a known history of sinus bradycardia. this was confirmed by his pcp. . #. leukocytosis: resolved, initially wbc 15, lactate 4 at osh, no localizing symptoms. repeat lactate 1.2. no fevers, no tachypnea, no tachycardia. would also consider stress response from gi bleed. importantly, he had a recent dental procedure with removal of several teeth, which puts him at risk for dental infection. endocarditis is less likely as no fevers, no chills, no clinical signs (no janeaway/osler/splinter hemorrhages) other then systolic murmur. cultures were negative and tte showed no evidence of vegetations. . #. hypocalcemia: likely multiple transfusions. assymptomatic. was repleted and remained stable. . #. hypertension, benign: stable, lisinopril held in the setting of possible gi bleed. re-started after hct stable and no evidence of bleed. . #. gerd: initially on iv pantoprazole, switched to po bid ppi on discharge. . #. code status: full code, confirmed with patient . # communication: pt, family (son, daughter), and pcp (via phone and letter) . # transitional issues: 1. f/u final capsule endoscopy results (will be contact by gi) 2. f/u with pcp 3. can resume asa when follows up with pcp if no episodes of bleeding . medications on admission: home medication list confirmed w pharmacy and patient: lisinopril 5mg daily omeprazole 20mg daily ranitidine 150mg asa 81mg daily bromocriptine 2.5mg daily thiamine 100mg daily discharge medications: 1. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day for 2 weeks. disp:*28 capsule, delayed release(e.c.)(s)* refills:*0* 2. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 3. bromocriptine 2.5 mg tablet sig: one (1) tablet po twice a day. 4. tetracycline 500 mg capsule sig: one (1) capsule po four times a day for 2 weeks. disp:*56 capsule(s)* refills:*0* 5. metronidazole 250 mg tablet sig: one (1) tablet po four times a day for 2 weeks. disp:*56 tablet(s)* refills:*0* 6. bismuth subsalicylate 262 mg tablet sig: two (2) tablet po four times a day for 2 weeks. disp:*112 tablet(s)* refills:*0* 7. thiamine hcl 100 mg tablet sig: one (1) tablet po once a day. discharge disposition: home discharge diagnosis: gi bleed, likely upper gi source presumed h. pylori anemia secondary to gib chronic -sinus bradycardia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital for bloody bowel movements, weakness, found to have low counts (anemia) and hypotension. you initially presented to an osh ed, you were then transferred to ed, admitted to the icu, and transfered to the general medical floor. you received and platelet transfusions to stabilize your bleed, and you were evaluated by the gi doctors 2 egd's and 1 capsule endoscopy. we saw evidence of old , but no active bleeding or source to explain the bleeding. your counts have remained stable after the transfusion. your case was discussed with your pcp, . , and we will treat you for presumed infection of your stomach/small bowel with h. pylori as a potential source of bleed. you also had an echocardiogram (ultrasound of your heart) to evaluate your heart murmur, and you have evidence of mitral valve disease with a leaky valve, this can predispose you to heart failure in the future, although currently you are asymptomatic. the results were conveyed to dr. , and you will follow-up with him regarding this issue. . please note the following medication changes: 1. stop aspirin. please follow-up with dr. to determine when to restart. 2. stop ranitidine 3. change omeprazole (prilosec) frequency x 2 weeks 4. start metronidazole 5. start bismuth 6. start tetracycline continue all your other previous home medications. . please follow-up with your doctor's appointment as listed below. . followup instructions: name: , md specialty: primary care when: friday at 9:30am location: healthcare - address: , , , phone: procedure: other endoscopy of small intestine other endoscopy of small intestine diagnoses: hypocalcemia esophageal reflux mitral valve disorders acute posthemorrhagic anemia hyposmolality and/or hyponatremia other specified cardiac dysrhythmias hemorrhage of gastrointestinal tract, unspecified leukocytosis, unspecified helicobacter pylori [h. pylori] benign essential hypertension 

Answer: The patient is high likely exposed to