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: melena major surgical or invasive procedure: ir embolization (coil) of left gastric artery egd x 3 history of present illness: 53 yo m with h/o st. on transferred from where he presented with melena mixed with brbpr since 2 am morning of . patient reports not feeling well for 2 days prior to presentation - decreased po intake and emesis x 1 (non-bloody non-bilious). then he was awoken at 2 am morning of admission with melenous bm. had about 7 bms before arrival at icu. patient reported feeling lightheaded and diaphoretic. his inr one week prior to presentation was in the therapeutic 2.5-3.5 range. he also complained of lower abdominal cramping discomfort that he developed the night prior to admission, non-radiating. denied nsaids use. on presentation to the osh bp 80/palp, pulse of 68. inr was 4.89, hct 28.4. he was transfused 2 unit p rbcs, given 2 units ffp, vit k 10 mg sc, protonix 40 mg iv once, and transferred here. inr here 2.5. hct 23.4. . on the review of systems, he denies chest pain, nausea, vomiting, fevers, chills, abdominal pain, urinary urgency, frequency or dysuria. he complains of mild lower back pain. past medical history: 1. endocarditis, s/p st. av placement in 2. htn 3. hyperlipidemia 4. panic attacks/anxiety 5. s/p vasectomy 6. wisdom teeth removal 7. had a colonoscopy/egd in ri in "normal" per patient. social history: divorced. lives with parents. currently unemployed and applying for ssi/disability. previously worked as a chef. has three daughters ages 27, 19 and 18. mother is next of . tobacco: none for many years. alcohol: occasional etoh. ivdu denies. family history: father had a bleeding ulcer. no family history of colon cancer. physical exam: admission exam vs: 98.3; 86/59; 65; 16; 100 % on ra general: alert and oriented x 3; anxious appearing; lying in bed heent: nc, at, no scleral ictrus, perrl, conjunctiva slightly pale, mmm neck: supple, no lad cv: regular, mechanical s2, no m/r/g pulm: cta bilaterally abd: + bs, soft, nt, nd extr: no c/c/e pertinent results: 12:15pm pt-24.6* ptt-30.5 inr(pt)-2.5* 12:15pm plt count-230 12:15pm neuts-72.7* lymphs-21.0 monos-4.2 eos-1.3 basos-0.8 12:15pm wbc-7.0 rbc-2.72* hgb-8.2* hct-23.4* mcv-86 mch-30.3 mchc-35.2* rdw-14.3 12:15pm glucose-117* urea n-38* creat-0.6 sodium-143 potassium-4.3 chloride-115* total co2-21* anion gap-11 05:42pm alt(sgpt)-11 ast(sgot)-13 ld(ldh)-169 alk phos-31* tot bili-0.5 04:37pm albumin-2.4* calcium-6.5* 05:48pm lactate-0.5 09:01pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 09:01pm urine color-yellow appear-clear sp -1.020 egd : findings: esophagus: other there was a moderate sized hiatal hernia present about 38 centimers from the incisors. at the base of the hernia sac there was a 6 mm pigmented protuberence that resembled - tear. the area was injected with 7 cc's total of a 1:10,000 epi solution. the injections were performed in a four quadrant distribution. there was very good hemostasis and no evidence of further bleeding. 7 1 cc.epinephrine 1/ injections were applied for hemostasis with success. stomach: contents: there was a large fundic clot present. repeated attempts to aspirate the clot were unsuccessful. a orogastric lavage using and tube was then performed and small amounts of clot were removed. despite these manuevers the entire clot could not be fully cleared. erythromycin 250 mg iv was given in an attempt to facilitate gastric removal of the clot. we also switched to the endoscope with the largest suction channel that we had available to facilitate clot removal. duodenum: other there was no evidence of active bleeding in the duodenum. there was no evidence of any mucosal abnormalities to suggest a bleeding source in the duodenum. impression: there was a moderate sized hiatal hernia present about 38 centimers from the incisors. at the base of the hernia sac there was a 6 mm pigmented protuberence that resembled a - tear. the area was injected with 7 cc's total of a 1:10,000 epi solution. the injections were performed in a four quadrant distribution. there was very good hemostasis and no evidence of further bleeding. (injection) blood in the fundus there was no evidence of active bleeding in the duodenum. there was no evidence of any mucosal abnormalities to suggest a bleeding source in the duodenum. egd : findings: esophagus: normal esophagus. stomach: other large blood clot encompassing entire fundus. we were able to suction approximately 500 cc of clot material and liquid blood. duodenum: normal duodenum. impression: large blood clot encompassing entire fundus. we were able to suction approximately 500 cc of clot material and liquid blood. egd : findings: esophagus: normal esophagus. stomach: excavated lesions two superficial ulcers ranging in size from 2 mm to 4 mm were found in the stomach body. erythematous mucosa with patchy bluish areas and small erosions was noted along the posterior wall of gastric body along the lesser curvature. no active bleeding was noted. duodenum: normal duodenum. impression: superficial ulcers and surrounding gastritis in the posterior wall of gastric body along the lesser curvature. recommendations: sulcrafate suspension one gram four times daily continue ppi twice daily repeat upper endoscopy in 8 weeks. blood cx : no growth urine cx , : no growth h pylori ab: negative cxr : indication: fever. there has been interval extubation. the heart is upper limits of normal in size. there has been near complete resolution of left basilar atelectasis and interval decrease in size of a small left pleural effusion. there are no new areas of consolidation to suggest pneumonia. brief hospital course: 53 yo m with h/o st. aortic valve, on coumadin, who presents with melena, borderline hypotensive. . 1. ugi bleed - patient was admitted to the icu and seen immediately upon arrival to the icu by gi. gi began to perform an egd to investigate cause of bleeding. passing of the scope was difficult due to patient continually vomiting blood. they sucked out about 500cc of blood and clot. gi was able to visualize a hyperpigmented lesion next to an existing hiatal hernia that resembled tear. there was a very large clot in the fundus as well and they chose not to dislodge it. he was given a dose of erythromycin to later remove the clot. there was a concern that there was bleeding underneath the clot. he was transfused a total of 4 prbc's in the icu at and 2 units of ffp. upon repeat scope the next day () the clot in the fundus was still present and enlarged. since his hct was stable but not responding to the transfusion of prbc's appropriately, it was decided to involve ir for possible embolization of the left gastric artery. on , the patient underwent angiography via ir and the left gastric artery was coiled. no active bleeding was seen at this time. afterwards, the patient was stable and returned to the icu. he was tx'ed out of the icu on . within hours of arrival to the floor, he developed melena. the gi team took him back for an egd which revealed the following: findings: esophagus: normal esophagus. stomach: excavated lesions two superficial ulcers ranging in size from 2 mm to 4 mm were found in the stomach body. erythematous mucosa with patchy bluish areas and small erosions was noted along the posterior wall of gastric body along the lesser curvature. no active bleeding was noted. duodenum: normal duodenum. impression: superficial ulcers and surrounding gastritis in the posterior wall of gastric body along the lesser curvature. recommendations: sulcrafate suspension one gram four times daily continue ppi twice daily repeat upper endoscopy in 8 weeks. his hct remained stable and he had no further issues with bleeding during his hosp stay. 2. fever: on , the patient spiked a temperature of 101 and blood cultures, sputum culture, and urine culture were drawn along with a stat cxr. he was found to have a swollen right hand at the site of a previous peripheral iv lock. he was initially given iv vanco and then was subsequently changed to iv cefazolin when blood cultures remained negative. he completed a course of po dicloxacillin and his cellulitis completely resolved. he had no further fevers. all culture data was negative. . 3. st. jude's valve: patient's anticoagulation was reversed in the setting of his life-threatening bleed. once his hematocrit stabilized, anticoagulation was restarted. he was maintained on a heparin gtt and coumadin was started. his hematocrit remained stable. once his inr reached 2.3, decision was made to discharge the patient on lovenox for the remainder of his bridge. he is to have his inr drawn the day after discharge to continue coumadin dose adjustment. . 4. anxiety: patient has a history of anxiety with panic attacks. he has taken klonopin prn for this in the past and required a few doses while in house for mild anxiety. . 5. hypertension: patient's blood pressure was well controlled on atenolol 25 mg po qd. he was not sure what dose of beta blocker he normally takes at home. . 6. hypercholesterolemia: patient was continued on his home dose of atorvastatin. medications on admission: lipitor 20 mg po qd celexa (off lately) baby asa coumadin 5/7.5 mg alternating daily vicodin prn atenolol ? dose lasix ? dose clonazepam ? dose discharge medications: 1. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 2. enoxaparin 80 mg/0.8 ml syringe sig: one (1) injection subcutaneous (2 times a day): until inr greater than or equal to 2.5. disp:*10 injection* refills:*0* 3. 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:*2* 4. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. warfarin 5 mg tablet sig: two (2) tablet po hs (at bedtime) as needed for mechanical : please discuss with dr. to determine your dose for tuesday night. disp:*10 tablet(s)* refills:*0* 6. sucralfate 1 g tablet sig: one (1) tablet po qid (4 times a day): take this 1 hour apart from any of your other medications and 1 hour before meals. disp:*120 tablet(s)* refills:*2* 7. clonazepam 0.5 mg tablet sig: one (1) tablet po bid:prn. discharge disposition: home discharge diagnosis: upper gi bleed st. jude's valve hand cellulitis discharge condition: good, no further bleeding, hematocrit stable, tolerating regular diet discharge instructions: please call your doctor or go to the emergency room if you experience temperature > 101, abdominal pain, blood in your stool, chest pain, shortness of breath, dizziness, or other concerning symptoms. please take the lovenox injections until your inr is greater than or equal to 2.5. you are to follow closely with your doctor of your inr until then. please take 10 mg of coumadin tonight. you will have your inr checked tomorrow and should discuss with dr. how much coumadin to take on tuesday night. please stop taking your aspirin. please take all medications as prescribed. followup instructions: please have your blood drawn at dr. office tomorrow to check your inr. please follow-up with dr. on at 11:20 am. phone . please call to confirm your follow-up egd scheduled for at 11:00 am with dr. . phone: . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other endoscopy of small intestine other endoscopy of small intestine insertion of endotracheal tube endoscopic control of gastric or duodenal bleeding other endovascular procedures on other vessels arteriography of other specified sites transfusion of packed cells diagnoses: unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified heart valve replaced by other means gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction hemorrhage of gastrointestinal tract, unspecified gastroesophageal laceration-hemorrhage syndrome cellulitis and abscess of hand, except fingers and thumb 

Answer: The patient is high likely exposed to