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: patient recorded as having no known allergies to drugs attending: chief complaint: lower gi bleed major surgical or invasive procedure: egd small bowel capsule study blood transfusion history of present illness: 48 y.o. male with hyperlipidemia and past bleeding duodenal ulcer presenting with dark stools and hematochezia *4 days. he has had four episodes of gi bleeding since earlier this year. in , he had several days of dark stools with some mixed blood; upper and lower endoscopy revealed no active bleed. a similar episode occurred in , when upper/lower endoscopies and capsule study were all negative for active bleeding. more recently, he had dark tarry stools last month, for which he again sought care at hospital. per patient report, upper endoscopy revealed a bleeding duodenal ulcer that was both clipped and cauterized. colonoscopy revealed hemorrhoids and a single polyp, that was removed (pathologic diagnosis unknown). the patient does not think any of his upper endoscopies were accompanied by biopsies. he has not been treated for h. pylori infection. since his procedures in through this past weekend, the patient did not have any recurrences or other gi complications. on monday , he had recurrent dark, tarry stools. he saw his pcp, ordered labs notable for hct of 37 (per patient report). for the next several days, he continued to have dark tarry stools, but no other significant symptoms. this morning, he awoke at 4:00 am with palpitations and mild dyspnea, and had another bowel movement with dark stools and some blood on the toilet paper. denies abdominal pain, nausea, vomiting, or brbpr. he went to the ed at hospital, where he received 800 cc ns and iv famotidine for guaiac positive stool. there, an ng lavage was negative. he was transferred to for further evaluation. in ed, the patient reported lightheadedness, dizziness, and dyspnea (with movement). endorsed nausea but denied abdominal pain. his initial vs: 97.7 96 124/73 18 99% ra. hct 18.5. the patient was given 1 liter ns and iv pantoprazole. a second liter of ns was started. ecg showed sinus tachycardia at 96 bpm. he was seen by gi who recommended obtaining osh records for prior endoscopic reports, and repeating egd here. he was cross-matched for two units but no rbc's were transfused, prior to being sent up to micu. upon arrival to the micu, the two units of packed rbcs were ordered and transfusion was initiated. the patient reports feeling mild dyspnea with exertion, but denies abdominal pain, nausea, vomiting, or any more bowel movements of any kind since 4:00 am this morning. denies recent nsaid use. past medical history: -hx of gi bleeds x 2. most recent bleed in , found to have duodenal ulcer at hospital, which was clipped vs cauterized -hyperlipidemia -s/p motorcycle accident , with bowel resection, ileostomy and reversal. social history: lives at home with wife and children. remote smoker (quit >20 years ago). denies illicits or etoh intake. family history: mother: mi at age 70. father: mi at age 64. three children (two sons and one daughter) are healthy. no known gi disease in the family. physical exam: vs: temp:97.6 bp: 129/71 hr:104 (sinus rhythm) rr:18 o2sat 99% ra gen: pleasant, comfortable, nad. sitting up comfortably in bed. heent: mild conjunctival pallor. perrl, eomi, anicteric, mmm, op without lesions, no supraclavicular or cervical lymphadenopathy, no carotid bruits, no thyromegaly or thyroid nodules. jvp to 8 cm at 45 degrees. resp: cta b/l with good air movement throughout. no wheeze or crackles. cv: rr, s1 and s2 wnl, no m/r/g abd: soft, nt/nd. no masses or hepatosplenomegaly. no pulsatile masses. large eccentric vertical scar over upper abdomen. assymetric firm areas over upper quadrants "calcifications" per patient. guaiac positive stool in ed ext: no c/c/e skin: no rashes/no jaundice/no splinters. single skin tag on right lower back. neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. no sensory deficits to light touch appreciated pertinent results: on admission: 10:00am blood wbc-6.0 rbc-2.10* hgb-6.2* hct-18.5 notif mcv-88 mch-29.6 mchc-33.7 rdw-16.2* plt ct-206 10:00am blood neuts-67.7 lymphs-28.1 monos-3.3 eos-0.6 baso-0.4 10:00am blood pt-14.9* ptt-27.3 inr(pt)-1.3* 10:00am blood glucose-107* urean-19 creat-0.7 na-139 k-4.2 cl-105 hco3-30 angap-8 10:00am blood alt-22 ast-18 alkphos-53 totbili-0.5 10:00am blood albumin-3.7 01:04am blood calcium-7.7* phos-2.6* mg-1.9 06:31am blood lipase-51 10:06am blood lactate-1.3 10:06am blood hgb-6.5* calchct-20 11:40am urine color-yellow appear-clear sp -1.015 11:40am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-0.2 ph-6.0 leuks-neg on discharge: 05:50am blood wbc-5.0 rbc-3.31* hgb-9.4* hct-28.4* mcv-86 mch-28.3 mchc-33.1 rdw-14.7 plt ct-265# 05:50am blood glucose-93 urean-7 creat-0.8 na-142 k-3.7 cl-106 hco3-27 angap-13 05:50am blood calcium-7.9* phos-3.3 mg-2.2 blood culture, routine (final ): no growth. blood culture, routine (final ): no growth. urine culture (final ): no growth. 3:35 pm blood culture, routine (pending): 9:20 pm blood culture, routine (pending): ekg (no prior for comparison): normal sinus rhythm at 96 bpm. normal axis and normal intervals. no ischemic st or t wave changes. pathology report difficult crossmatch and/or evaluation of irregular antibodies study date of diagnosis, assessment and recommendations: mr. had a diagnosis of anti-k antibody at outside hospital which was confirmed at . anti-k antibody is clinically significant and capable of causing hemolytic transfusion reactions. in the future, mr. should receive k-antigen negative products for all red cell transfusions. approximately 91% of abo compatible blood will be k-antigen negative. a wallet card and a letter stating the above will be sent to the patient. egd : small hiatal hernia no bleeding site noted previous duodenal resection with end to side anastomosis of the distal bulb otherwise normal egd to third part of the duodenum abdominal xray : impression: 1. nonspecific bowel gas pattern without evidence of obstruction. unusual appearance in the upper abdomen with dense material, question heterotopic ossification iatrogenic material. clinical correlation is requested. if there is no prior imaging through this area, then a ct scan would be recommended for further assessment. 2. focal bone lesion in the left proximal femur. dedicated left proximal femur radiographs are recommended for further assessment. ct abdomen/pelvis w/contrast : impression: 1. abnormal ossification involving the anterior abdominal wall communicating with the costochondral junctions of the lower ribs and sternum is in keeping with heterotopic ossification after either surgery or trauma. 2. no evidence of small or large bowel obstruction. 3. multiple matted small bowel loops abutting the lower anterior abdominal wall suggests adhesions. chest (pa & lat) : the right hemidiaphragm is elevated. allowing for this, heart size is borderline. the aorta is minimally unfolded and slightly calcified. no chf, focal infiltrate, or effusion is identified. small bowel capsule study : procedure info & findings: 1. suture material at the duodenal bulb. 2. normal small bowel. no active bleeding site or ulcer (s) seen. brief hospital course: 48 y/o m with multiple episodes of gi bleeding over past year, with duodenal ulcers and polyps identified, presenting with guaiac positive stools and significant hematocrit drop over past 72 hrs. 1. gi bleed: pt initially presented with melena and was found to have hct of 18. he was transfused a total of 4 units in the icu and hct thereafter remained stable at 27-29. he was seen by the gastroenterology team who an egd that was unremarkable. the gi team subsequently performed a small bowel capsule study that also did not reveal any site of intra-abdominal bleeding. he was maintained on iv ppi gtt initially at the icu, then transitioned to iv ppi on the floor and eventually to po ppi by the time of discharge. pt did not complain of further episodes of melena during hospital admission and was monitored on telemetry without any significant events. he was advised to follow-up with his outpatient gastroenterologist on discharge. 2. fever: upon transfer from icu to floor, pt developed fevers peaking at 102. at the onset of his fevers, he complained of abdominal pain, distention, and difficulties passing flatus. abdominal x-ray was performed that did not show obstruction. pt was started on iv cipro, flagyl, and vancomycin for possible intra-abdominal infection. a ct abdomen revealed old changes from his prior surgery but no acute intra-abdominal process. a cxr and ua was also negative for any source of infection. urine culture and two sets of blood cultures were negative. (of note, two sets of blood cultures were still pending on discharge.) he improved markedly on the iv antibiotics. wbc decreased from 13 at time of fevers to 5 by time of discharge. fevers, abdominal pain, and obstipation resolved and he was transitioned to po cipro and flagyl. he was told to continue the po antibiotics at home for a total course of 10 days, for empiric coverage of bacterial translocation in the setting of gi bleeding. 3. ct findings: a ct abdomen was performed to evaluate for intra-abdominal process that could be causing pt's fevers and abdominal pain. the ct was negative for acute processes but revealed several incidental findings that pt confirmed were due to his prior bowel surgery. these included abnormal ossifications of the anterior abdominal wall and multiple matted small bowel loops consistent with adhesions. he was also noted to have a proximal femoral lesion suspicious for fibrous dysplasia which per patient was due to a bone biopsy he had had in the past. he also had an ivc filter with struts extending beyond the lumen of the inferior vena cava. this was discussed with an interventional radiologist who did not feel that this required intervention. 4. iron deficiency anemia: pt had hx of iron deficiency anemia and was taking daily ferrous sulfate supplements. his ferrous sulfate was temporarily discontinued while he was in the hospital to better distinguish between melena and dark stools and because he complained of constipation. he was discharged back on his home ferrous sulfate with the addition of a stool softener. 5. hyperlipidemia: no acute issues. he was continued on his home simvastatin. medications on admission: -simvastatin 40 mg po daily -protonix 40 mg po daily -ferrous sulfate 325 mg po bid discharge medications: 1. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 5 days. disp:*10 tablet(s)* refills:*0* 3. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 5 days. disp:*15 tablet(s)* refills:*0* 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 5. iron 325 mg (65 mg iron) tablet sig: one (1) tablet po twice a day. 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: melena fever secondary: hyperlipidemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking care of you at the hospital. you were admitted with dark stools and found to have a very low blood count. you were admitted to the intensive care unit where you received a blood transfusion. your blood counts rose with the transfusion and you were transferred to the general medicine floor where you complained of abdominal pain and were found to have a fever. an x-ray of the abdomen and a ct scan of the abdomen did not show any acute process. you were started on iv antibiotics for your fever and abdominal pain and improved significantly. you were transitioned to two oral antibiotics that you should continue to take for five more days (until monday ). for work-up of your dark stools, an egd was performed that was unremarkable. you also underwent a small bowel capsule study that also did not reveal any significant findings. you should follow-up with your gastroenterologist for continued monitoring of your symptoms. the following changes were made to your medications: 1) pantoprazole was increased to 40mg twice a day 2) ciprofloxacin 500mg every 12 hours was started (continue until ) 3) metronidazole 500mg every 8 hours was started (continue until ) 4) colace 100mg twice a day was started. this is a stool softener because your iron can cause constipation. please continue your iron supplements. followup instructions: please call your primary care doctor dr. to schedule an appointment with him in the next week. name: , e. location: health center address: , , phone: fax: please also call your gastroenterologist dr. at to make an appointment with him within 1-2 weeks of discharge. procedure: other endoscopy of small intestine other diagnostic procedures on small intestine diagnoses: other and unspecified hyperlipidemia other specified cardiac dysrhythmias blood in stool fever, unspecified precipitous drop in hematocrit personal history of colonic polyps personal history of peptic ulcer disease 

Answer: The patient is high likely exposed to