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: nausea, vomiting, hematemasis major surgical or invasive procedure: egd, arteriovenous graft revision, placement of tunnelled dialysis catheter, central line placement history of present illness: mr. is a 74 year old man with dm ii c/b triopathy, cri on dialysis (baseline cr 4), aortic stenosis, dilated cmp (ef 60%), and recent gi bleed who presents with nausea, coffee ground emesis, poor po intake, increasing confusion, and foul-smelling urine. he was recently admitted to in for vomiting and gi bleed from . workup there included egd which showed "narrowing, causing him to throw up" and a colonoscopy which showed "irritation, 80%-sure irritation and not cancer" per his son. his son, both egd and colonoscopy showed a source of bleeding, but the patient did not require any transfusions. his son noticed that his baseline mental status decreased while admitted, as he was more confused and unable to answer questions about his symptoms. he was discharged, and was initially incontinent of stool and still confused but then began to be more active with improved appetite after a week. he still required his son to administer medications, a task the patient had been able to do before. last week, his son noticed that the patient had poor po intake, and seemed weaker with less interest in the tv. four days ago, his son gave the patient a suppository and saw a bit of "fresh blood". last night, he observed his father vomiting; this morning, the patient had coffee ground emesis and his urine appeared dark brown and foul-smelling. he was brought to the ed> in the ed, vs: t 97.9 hr 80 bp 121/52 rr 20 o2 95% ra. he was described as endorsing chest discomfort but not true chest pain. ekg showed diffuse t wave flattening and cxr was negative. 1st set of cardiac enzymes showed troponin 0.10, which was decreased compared to prior troponin levels and consistent with decreased clearance to his poor renal function. he was given 325 mg asa. to evaluate for ugi bleed, ng lavage was performed which was negative for bleed. guaiac was positive with brown stool. he received 4mg zofran iv and 40 mg pantoprazole. u/a was obtained given his foul-smelling urine, which was positive for uti. he received ciprofloxacin iv 400mg. he is admitted for r/o mi, hydration given inability to tolerate pos, w/u of gi bleed, and uti. on arrival to the floor, the patient was not complaining of nausea, vomiting, or chest discomfort. his son had stepped out. the patient was unsure of prior chest pain, sob, hematemesis, foul-smelling urine, or dysuria. when his son returned, he noted that his father normally used a walker to ambulate and had not had any falls in the past ~9 months. he is to have follow-up on with gi for the "atypical cells" found on the colonoscopy. past medical history: type i diabetes mellitus, dx in complicated by: - peripheral neuropathy - retinopathy - nephropathy hypertension aortic stenosis chronic renal insufficiency spinal spondylosis idiopathic dilated cardiomyopathy bph compression fracture c4-5 bone cancer in childhood social history: mr. lives with his son and his son??????s wife and daughter in . his son has been very involved in his care since . he has another son, two biological daughters and an adopted daughter. his wife passed away 10yrs ago. he is a retired police officer. he has a 60 pack-year smoking hx, but quit many years ago. he used to drink ~8 drinks/day, but also quit some time ago and neither smokes or drinks anymore. family history: noncontributory physical exam: vs: t: 98.0 hr: 80 bp: 130/70 rr: 20 sat: 91% ra gen: pleasant, appears stated age, well-nourished, nad, ng tube in place. skin: pink, no rashes, no suspicious lesions, no jaundice heent: ncat. perrl, eomi, sclerae anicteric. dry mm, normal dentition. neck: supple, no lymphadenopathy, jvp flat. carotid upstrokes are brisk without bruits. cv: rrr, nl s1, s2. iii/vi crescendo-decrescendo murmur best heard at base with radiation to the carotids and abdomen. no rubs or gallops. resp: ctab. no rales, rhonchi or wheezes. abd: well-healed vertical scar on ruq. +bs, soft, nt/nd, no hsm, no rebound or guarding. back: no cva tenderness. rectal: guaiac: positive in ed ext: warm, well-perfused, no c/c/e. dp 2+ bilaterally. neuro: alert and oriented to person and "hospital" but not date. cranial nerves ii-xii intact. no gross focal deficits. pertinent results: 09:50am blood wbc-9.1 rbc-3.49* hgb-10.0* hct-31.4* mcv-90 mch-28.8 mchc-32.0 rdw-14.0 plt ct-223 07:00am blood wbc-8.6 rbc-3.75* hgb-11.2* hct-33.4* mcv-89 mch-29.9 mchc-33.5 rdw-15.0 plt ct-221 06:55am blood wbc-7.9 rbc-3.87* hgb-11.4* hct-34.1* mcv-88 mch-29.4 mchc-33.4 rdw-15.5 plt ct-177 09:15am blood wbc-12.7*# rbc-4.01* hgb-11.6* hct-36.0* mcv-90 mch-28.8 mchc-32.1 rdw-15.4 plt ct-164 02:10pm blood wbc-17.0* rbc-3.34* hgb-9.7* hct-29.7* mcv-89 mch-29.1 mchc-32.7 rdw-15.2 plt ct-130* 05:35am blood wbc-15.1* rbc-3.27* hgb-9.6* hct-29.4* mcv-90 mch-29.3 mchc-32.6 rdw-15.0 plt ct-148* 09:50am blood neuts-81.7* lymphs-12.0* monos-4.9 eos-0.9 baso-0.5 05:35am blood neuts-91.6* lymphs-5.3* monos-2.9 eos-0.2 baso-0 . 09:50am blood pt-13.6* ptt-23.1 inr(pt)-1.2* 02:55am blood pt-14.0* ptt-23.9 inr(pt)-1.2* 06:55am blood pt-13.0 ptt-25.2 inr(pt)-1.1 . 09:50am blood glucose-221* urean-23* creat-4.1* na-140 k-4.7 cl-92* hco3-36* angap-17 07:45am blood glucose-174* urean-33* creat-6.6*# na-142 k-3.5 cl-92* hco3-35* angap-19 06:55am blood glucose-319* urean-42* creat-7.0* na-135 k-4.2 cl-93* hco3-25 angap-21* 06:58am blood glucose-333* urean-42* creat-6.4*# na-136 k-4.0 cl-97 hco3-27 angap-16 05:35am blood glucose-181* urean-28* creat-4.3*# na-139 k-3.7 cl-103 hco3-30 angap-10 07:00pm blood albumin-3.1* calcium-8.5 phos-3.0 mg-1.6 07:45am blood calcium-8.8 phos-4.4 mg-1.9 06:55am blood totprot-5.8* calcium-8.2* phos-3.4 mg-2.2 05:35am blood calcium-7.9* phos-1.5*# mg-1.8 . 07:00pm blood alt-15 ast-26 ld(ldh)-236 ck(cpk)-96 alkphos-86 amylase-28 totbili-0.6 03:42am blood alt-11 ast-16 alkphos-83 totbili-0.5 07:00pm blood lipase-16 08:05am blood lipase-18 . 09:50am blood ck-mb-4 ctropnt-0.10* 07:00pm blood ck-mb-3 ctropnt-0.09* 02:55am blood ck-mb-notdone ctropnt-0.11* . 07:00pm blood vitb12-1756* folate-greater th 07:30pm blood caltibc-103* ferritn-1280* trf-79* 05:35am blood triglyc-57 07:00pm blood tsh-7.5* 02:55am blood free t4-0.93 . cxr chest, three views: there has been interval placement of an og tube with tip and side hole projecting below the diaphragm. the heart size is top normal and unchanged as are mediastinal and hilar contours. there is no pneumothorax or pleural effusion. right superior mediastinal fullness likely relates to tortuous vessels. no airspace opacification identified. the pulmonary vasculature is normal. no gross osseous abnormality. impression: no acute cardiopulmonary process. . head ct findings: the ventricles and sulci are prominent consistent with age- appropriate atrophy. periventricular white matter hypodensities are noted, consistent with chronic small vessel ischemic changes. there is no shift of normally midline structures. calcifications of the carotid arteries are noted. the visualized paranasal sinuses are clear. there is no evidence of hemorrhage. impression: no evidence of hemorrhage or shift of normally midline structures. chronic small vessel ischemic changes. . kub abdomen, two views: nonspecific bowel gas pattern with stool and gas seen in the large bowel. interval verteboplasty. there is an anterior fixation device at l5-s1. otherwise, no gross osseous abnormality. there is linear atelectasis versus scarring at the left lung base. phleboliths are seen in the pelvis. impression: no radiographic evidence for obstruction. . barium upper gi study the study was limited due to patient factors and aspiration. barium passes freely through the esophagus into the stomach, and there is no demonstration of mucosal abnormality or stricture. in the 50 minutes of the exam, barium did not pass into the small bowel. barium is seen in the tracheal tree secondary to regurgitation and aspiration. limited views of the stomach do not demonstrate a mucosal abnormality. there is an anterior fixation device, and there has been a vertebroplasty. impression: no transit of barium from the stomach: gastroparesis versus gastric outlet obstruction; recommend nuclear medicine gastric emptying study. . ct abd/pelvis impressions: 1. contrast material has progressed to the colon, indicating the absence of a complete obstruction. however, the large amount of retained barium in the stomach reflects a significant delay in gastric emptying. diagnostic considerations include severe gastroparesis or partial gastric outlet obstruction. 2. possible precipitation of retained barium in the stomach, with refluxed contrast material in the esophagus. nasogastric suctioning is recommended. 3. moderate ascites. 4. small layering gallstones. 5. extensive atherosclerotic calcification of coronary arteries, aorta and major branches. 6. aspirated barium at the right lung base. 7. upper lumbar vertebroplasty with retropulsed fragment of l2 into the spinal canal. . ue doppler findings: there is thrombus located within one of the patient's brachial veins as well as the basilic vein. there is no evidence of thrombus within internal jugular, subclavian, or axillary veins in which compressibility, flow, and augmentation is maintained throughout. these findings are discussed with dr. at the time of dictation. impression: 1. thrombus identified within brachial and basilic veins as noted. . cxr right internal jugular vascular catheter is unchanged in position, but new right internal jugular dialysis catheter has been placed, with tip terminating in expected location of proximal right atrium. no pneumothorax. moderate right pleural effusion has slightly increased in size, with adjacent increasing consolidation at right lung base. small left pleural effusion is also evident as well as minor atelectasis at the left base. high-density material is present adjacent to the right hemidiaphragm, likely due to aspirated barium, as reported on earlier radiograph of . deformity of proximal left humerus is likely due to old injury. impression: 1. increasing right effusion and adjacent right basilar consolidation. the latter may potentially be due to an evolving infection, possibly secondary to aspiration. 2. small left pleural effusion. brief hospital course: 74 year old man with dm ii c/b triopathy, cri on dialysis (baseline cr 4), aortic stenosis, dilated cmp (ef 60%), and recent gi bleed who presents with nausea, coffee ground emesis, poor po intake, increasing confusion, uti, and ?chest discomfort. briefly, pt was being treated for upper gi bleed and suspected severe gastroparesis when he missed an oral dose of amiodarone and went into rapid ventricular rate atrial fibrillation. he was then transferred to the ccu, where he was placed on an amiodarone drip until rate controlled. he was subsequently transferred back to the floor on po amiodarone. please see below for a summary of hospital course by problem: . *) nausea/coffee ground emesis, with poor po intake: pt had hx of severe gastroparesis with admissions for similar sx in the past. he had an egd on hd#2 which revealed a medium hiatal hernia, tortuous esophagus, erythema with single polyp/protrusion at the gastroesophageal junction, - tear, edematous antral folds, edematous duodenal mucosa, and a polyp in the stomach body. on hd#, pt began to have significant emesis and had an upper gi series, which demonstrated contrast in the stomach for >24hrs, consistent with prolonged gastric transit secondary to severe gastroparesis vs. obstruction. abdominal ct revealed contrast in the colon, ruling out complete obstruction, but differentiating between gastroparesis and partial gastric outlet obstruction was not possible with that exam. reglan did not lead to any improvement. an ngt was placed, but pt self-d/c'd on hd#9. pt was started on erythromycin with some improvement in vomiting, but this was d/c'd as pt's qt became more prolonged. given lack of improvement, concern for process other than gastroparesis was considered and repeat egd to further evaluate previously seen gastric/duodenal pathology. prior to this study, pt began to have significant bilious emesis. ngt was placed and again d/c'd by pt. egd was postponed secondary to medical instability. gi recommended restarting reglan and continued to follow pt. tpn was also started on hd#13. . *) gi bleed: pt was recently discharged from () after admission for gi bleed. he had an endoscopy and colonoscopy at that hospital which showed prepyloric antritis consistent with gastroparesis, esphagitis with mucosal ulceration, moderate-severe ischemic colitis, sigmoid diverticulitis, and internal hemorrhoids. in the first 24 hrs of admission, pt's hct decreased from 31->25, where it stabilized and then trended upwards throughout the rest of the admission. he had an egd with results as above. . *) atrial fibrillation: hx of a fib, not currently anticoagulated secondary to gi bleed. pt with significant emesis, missed one dose of po amiodarone and was found to be in asymptomatic rapid a fib on hd#6. he was transferred to the ccu, where he was quickly stabilized on amio drip then transitioned back to po. he was then transferred back to the floor on hd#7, where he remained in rate controlled sinus rhythm until hd#14, when he had an episode of a fib with rvr which was responsive to 10mg iv metoprolol. a few hours later, he returned to this irregular rhythm, which was then unresponsive to 10mg metoprolol and 30mg diltiazem, with resultant hypotension. given his cardiac instability, he was transferred to the micu for further care. . *) esrd: pt with r avf in place for m/w/f hd. on hd#10, pt unable to be dialyzed secondary to clotted fistula. he was evaluated by transplant surgery and taken to the or on hd#11 for revision of the fistula, which subsequently re-thrombosed in dialysis that day. a tunnelled catheter was then placed for continued dialysis. his medications were renally dosed while in house. . *) l upper extremity dvt: on hd#10, pt's left arm (site of peripheral iv) was noted to be edematous. he had a doppler study which revealed dvts in the basilic and brachial veins. he was started on a heparin gtt on hd#13, as the risk of hypercoaguability was determined to outweigh the risk of further gi bleed. . *) ?chest discomfort: no specific ekg changes to suggest ischemia; patient has no h/o cad. received asa in ed. repeat ekg with no change. three sets of cardiac enzymes were stable, not indicative of acs. pt did not have any further sx during this admission. . # dm ii: pt was on lantus and iss at home. his lantus dose was decreased given poor po intake. with the addition of intravenous nutrition, his blood glucose increased and dosages of insulin were appropriately adjusted. blood glucose was frequently elevated likely secondary to variable absorption of intake. . *) delirium: per son, likely developed during hospitalization at in mid-; pt has not returned to baseline since. used to dress himself, take his own meds, no memory deficits that son is aware of - could recall conversations and events from days, weeks, years ago. pt with flat affect, poor short term memory, and apparent cognitive deficits on this admission. head ct was normal. sx felt to be secondary to dementia, environment, and worsening renal failure. . *) uti: pt makes very little urine at baseline. u/a showed wbc, nitrite negative, rare bacteria. pt was started on ceftriaxone, but urine cx negative so abx d/c'd. . *) htn/idiopathic cardiomyopathy/aortic stenosis: last ef from 60%. pt has known moderate aortic stenosis. asa 81 mg held due to concern for gi bleed. amiodarone, metoprolol, and atorvastatin were continued. . *) hypothyroidism: pt had elevated tsh, thought to be secondary to decreased absorption of levothyroxine in setting of prolonged gastric emptying. levothyroxine dose was increased and changed to iv in setting of poor tolerance of pos. . *) fen: pt npo for first few days of admission. as emesis resolved, he was able to take sips of liquids, but still had poor po intake. nutrition recommended tube feeds, but pt declined. he was started on ppn, which was subsequently d/c'd out of concern for poor renal function. after dialysis was reiintiated, tpn was started. . pt was transferred to the micu on hd#14. after extensive discussion with the family upon arrival to the micu, the decision was made to discharge the patient to home with hospice care. medications on admission: amiodarone 200 mg--1 tablet(s) by mouth daily aspirin 81 mg--1 tablet(s) by mouth once a day coreg 12.5 mg--1 tablet(s) by mouth twice a day citalopram 40 mg--1 (one) tablet(s) by mouth at bedtime docusate sodium 100 mg--1 capsule(s) by mouth daily epogen 4,000 unit/ml--8,000 units by hemodialysis mon, wed, fri fludrocortisone 0.1 mg--1 tablet(s) by mouth daily at noon humalog 100 unit/ml--sliding scale at breakfast, lunch,dinner. no added insulin for bedtime lantus 100 unit/ml--30 units q morning lipitor 40 mg--1 tablet(s) by mouth daily levothyroxine 25 mcg--1 (one) tablet(s) by mouth once a day multivitamin --1 tablet(s) by mouth once a day nephrocaps 1 mg--1 capsule(s) by mouth daily senna 8.6 mg--1 tablet(s) by mouth daily b complex-c-folic acid 1 mg by mouth daily protonix carafate metoclopramide discharge medications: 1. morphine concentrate 5 mg/0.25 ml solution sig: 0.25-0.5 ml po q2h:prn as needed for shortness of breath or wheezing for 1 weeks: goal comfort . disp:*30 ml* refills:*2* 2. lorazepam intensol 2 mg/ml concentrate sig: one (1) po q2h:prn for 1 weeks. disp:*30 ml* refills:*0* 3. scopolamine base 1.5 mg patch 72 hr sig: one (1) transdermal every seventy-two (72) hours for 1 weeks: if needed for secretions. disp:*5 * refills:*2* 4. acetaminophen 325 mg suppository sig: one (1) rectal every four (4) hours for 1 weeks. disp:*30 * refills:*2* 5. prochlorperazine 25 mg suppository sig: one (1) rectal every four (4) hours as needed for nausea for 1 weeks. disp:*20 * refills:*2* discharge disposition: home with service facility: hospice discharge diagnosis: primary: hematemesis due to - tear/gastritis/esophagitis delirium a fib esrd severe gastroparesis dvt x 2 secondary: diabetes type i with triopathy htn idiopathic dilated cmp aortic stenosis hyperlipidemia renal insufficiency requiring dialysis bph compression fractures of spine spinal stenosis discharge condition: comfortable discharge instructions: you were admitted with bloody vomiting and found to have some inflammation of your stomach lining and esophagus. after family discussion we are planning on discharging you home with comfort measures. from hospice care phone (fax ) will come assist you at home this evening. if you have any questions overnight please call the critical care unit at or dr. office for assistnace. followup instructions: please follow up with dr. as needed. procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine other revision of vascular procedure hemodialysis venous catheterization for renal dialysis phlebography of other specified sites using contrast material diagnoses: other primary cardiomyopathies end stage renal disease urinary tract infection, site not specified congestive heart failure, unspecified unspecified acquired hypothyroidism atrial fibrillation aortic valve disorders diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled personal history of tobacco use hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) other persistent mental disorders due to conditions classified elsewhere diaphragmatic hernia without mention of obstruction or gangrene hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia hypotension, unspecified long-term (current) use of insulin dehydration gastroesophageal laceration-hemorrhage syndrome personal history of malignant melanoma of skin unspecified gastritis and gastroduodenitis, without mention of hemorrhage other complications due to renal dialysis device, implant, and graft diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy gastroparesis pathologic fracture of vertebrae impacted cerumen benign neoplasm of stomach 

Answer: The patient is high likely exposed to