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: hematemesis major surgical or invasive procedure: 5/8/115/8/11 exploratory laparotomy, antrectomy, roux-en-y gastrojejunostomy exploratory laparotomy, evacuation hematoma, suture ligation bleeding varix behind the head of the pancreas, and then suture ligation of bleeding varix in the anterior abdominal wall history of present illness: mr. is a 64yo m w/hx of etoh cirrhosis (child's class b, meld 17) and hx of grade i varices with prior gi bleeds who presents to as an osh transfer for hematemesis. . the patient originally admitted to hospital on with hematemesis, melena and altered mental status. the patient reports going out for dinner on () and felt well after this. he had 2 beers on . on he developed hematemesis and abdominal pain and came to hospital where he was found to have an upper gi bleed. hct dropped to from 30s to 21 at its lowest. he required 6 units prbcs. egd showed a duodenal ulcer with visible non-bleeding vessel which was injected with epi and clipped with 9 clips. hemostasis was obtained. he was transferred to the medicine floor and started on clears on . h. pylori antigen was negative. on he developed coffee-ground emesis and was transferred back to the icu. he was started on iv protonix gtt. repeat egd showed large clot and active oozing at the site of the prior duodenal ulcer. this was injected with epi but unable to be clipped again. gi stated there was no further endoscopic intervention that could be done. surgery was consulted and felt that he was not a surgical candidate and recommended that if he rebleeds he should have ir intervention. . the afternoon of transfer he developed recurrent hematemesis with ?50-100ccs of bloody emesis. his repeat hct was 31 at 2pm (from 30 at 4am that day). he was hemodynamically stable with bp of 132/67, hr 78. he continued to be nauseous at the time of transfer. he was on a pantoprazole gtt. of note he received 2 bags of platelets on for platelet count of 42. . on the floor, he complains of persistent nausea. he vomited ~20ccs of brown liquid on arrival. he continues to have epigastric abdominal pain. he denies constipation but states he has been having loose stools without melena or hematochezia. . review of sytems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. no dysuria. denied arthralgias or myalgias. . after arrival, to the icu, he had intermittent hematemesis and coffee ground emesis, but with stable hct. he required no further transfusions. he developed abdominal pain and distension, and underwent a ct scan that showed gastric outlet obstruction. an ngt was placed with drainage of almost 3l of bilious material. after placement, he felt improved. today prior to being transferred, he had a fever to 101.2. past medical history: etoh abuse etoh cirrhosis, child's class b, meld 17, c/b grade 1 varices seen on egd, portal htn barrett's esophagus multiple ugi bleeds since heterozygote for hemachromatosis cholecystectomy performed diverticulitis hemicolectomy 15 years ago tubular adenoma on colonoscopy , year f/u recommended macrocytic anemia social history: retired treasurer from in . lives alone, has 4 daughters in the area. prior smoker; smoked 1 ppd x 10 years, quit 35 years ago. previously drank heavily hard alcohol + wine for most of his life, quit drinking wine. had quit drinking hard liquor previously. currently drinks ~ 2 beers per day. denies illicit or iv drug use. family history: no hx of liver disease in the family. father with high cholesterol. mother with htn. physical exam: physical exam: vitals: t: 99.8 bp: 134/64 p: 70 r: 18 o2: 94% ra general: alert, oriented, no acute distress, speaks slowly heent: sclera icteric, mm dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, hyperdynamic s1, normal s2, no murmurs, rubs, gallops abdomen: soft, tender to palpation in epigastric area, 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: admission labs: wbc-8.0 rbc-3.10* hgb-10.7* hct-30.1* mcv-97 mch-34.6* mchc-35.7* rdw-18.2* plt ct-131* neuts-76.1* lymphs-12.0* monos-9.2 eos-2.3 baso-0.4 pt-17.4* ptt-32.4 inr(pt)-1.6* glucose-117* urean-12 creat-0.7 na-136 k-3.8 cl-101 hco3-27 angap-12 alt-29 ast-42* ld(ldh)-228 alkphos-79 totbili-3.9* lipase-66* albumin-3.1* calcium-8.4 phos-3.1 mg-2.3 . on discharge : wbc-8.2 rbc-2.91* hgb-9.4* hct-27.8* mcv-96 mch-32.3* mchc-33.9 rdw-18.9* plt ct-102* pt-21.2* inr(pt)-2.0* glucose-101* urean-22* creat-0.9 na-135 k-4.1 cl-100 hco3-29 angap-10 alt-17 ast-43* alkphos-103 totbili-2.5* calcium-7.8* phos-3.6 mg-1.9 brief hospital course: mr. is a 64 yo m w/hx of etoh cirrhosis who presented to an osh with an upper gi bleed, found to be due to a duodenal ulcer, transferred to for possible ir intervention. hct was initially stable. pantoprazole drip was administered. ct of abd/pelvis on revealed a large clot at the junction of d1 and d2 with resultant proximal gastric distension. on , an egd was performed with the following findings: varices at the middle third of the esophagus and lower third of the esophagus. blood was in the stomach. the area from the pyloric channel extending into and past the duodenal bulb was edematous, deformed, and ulcerated, to the point that it obstructed the view completely. the scope was able to pass but with difficulty. there was significant friability and oozing. the ulcer could not be evaluated. no intervention could be carried out. otherwise normal egd to just past duodenal bulb. surgery was consulted. on cta showed increasing size of the duodenal hematoma and an area concerning for active extravasation at d1. surgery service was consulted and on , he was taken to the or for antrectomy and roux en y gastrojejunostomy. postoperatively, the hct continued to decrease. abd/pelvic ct demonstrated a small anterior abdominal hematoma and a r paracolic gutter hematoma. active bleeding could not be assessed given that this was not a cta. the patient appeared stable and was transferred to the floor in the afternoon; however, by the evening his hct had fallen from 31 to 24, and the patient was transferred back to the sicu of ct of abdomen/pelvis showed partially loculated hematomas in ant omentum and r paracolic gutter with no evidence of bowel leak. hct did not increase despite multiple transfusions (hct down to 23 from 31) on , he was taken back to the or by surgeons, and for an exlap evacuation hematoma, suture ligation bleeding varix behind the head of the pancreas, and then suture ligation of bleeding varix in the anterior abdominal wall. multiple transfusions were given. he was then transferred back to the sicu. he remained intubated. a ruq u/s was done on to evaluate for portal vein thrombus. no thrombus was seen. there was reversal of flow (hepatofugal) in the portal veins. biopsy during surgery revealed duodenal ulcer with mural necrosis, and acute and chronic inflammation, consistent with perforation. on an abdominal ct was done for bilious drain output and tense abdomen. increased complex ascites was noted. given lack of enteric contrast extravasation and bilious catheter drainage, this is concerning for bile leak from the duodenal stump. volume overload was also noted with small bilateral pleural effusions and body wall edema. on he was extubated in am, however, he became more tachycardic and tachypneic requiring reintubation. on he was hypothermic with glucoses in 400s on insulin drip. given concern for fungemia, tpn was stopped and he was switched to micafungin. he was pan-cultured including the picc tip. hypotensive, required ns and albumin with neo on and off over the night. hct 29/3 -> 26.1. gave 2uprbc. tpn was restarted. on he was extubated. ng tube was removed and he started sips to clears. jp outputs appeared more bilious. the patient had fevers to 101.7 on pod 1 and 101.3 on pod 3. fluconazole, vanco and zosyn were started. blood cultures have been sent on multiple occasions and all have returned with no growth. fluid sent from the jp drains grew enterococcus and staph coag negative. antibiotics were switched to vanco and and micafungin was continued for broadened coverage due to bile leak from the duodenal stump. nystatin oral solution started for thrush on . the patient was transferred out of the icu on pod 6. mental status waxed and waned during the initial surgical course. he was kept npo secondary to the antrectomy, and was continued on tpn via picc line. the patient was slowly started on sips to clears and then to regular diet, however po intake has been very poor and calorie counts reflect less than half of caloric need being met. attempt was made to place feeding tube, however due to the antrectomy, placement was difficult and passage to the gastrojejunostomy was unable to be achieved. feeding tube attempt was d/c'd, the tpn was continued and the patient was allowed to eat. the tpn will be continued for now and on discharge to rehab. jp drains have remained in place and continue to have bilious appearing drainage, output typically up to 100 cc daily in recent days. ct of abdomen on showed continued hematoma and new concern for colonic wall thickening. the patient was started on flagyl for a 2 week course, c diff samples x 3 were sent and are all negative. the patient is not having diarrhea, wbc stable and wnl. his mental status has improved over the course of the hospitalization, however evaluation by physical therapy determined need for rehab placement, as well as need for continuing tpn and increased monitoring needs. incision has been c/d/i. he ambulates with assistive device and has had return of bowel function. medications on admission: folic acid 1mg po daily nadolol 40mg po daily prilosec 40mg po daily . discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 2. nadolol 20 mg tablet sig: two (2) tablet po daily (daily): hold for sbp < 100 or hr < 60 . 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 5. hydromorphone 2 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 6. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed for perineal rash: perineal rash . 7. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dry eyes. 8. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 9. metronidazole in nacl (iso-os) 500 mg/100 ml piggyback sig: five hundred (500) mg intravenous q8h (every 8 hours) for 6 days: until . 10. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 11. insulin regular human 100 unit/ml solution sig: follow sliding scale injection asdir (as directed). 12. lasix 80 mg tablet sig: one (1) tablet po twice a day: weight daily. if d/c tpn then 40 po bid. discharge disposition: extended care facility: northeast hosp discharge diagnosis: ugi bleed/varicele bleed duodenal ulcer delerium malnutrition and s/p antrectomy on tpn discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you will be transferring to rehab please call dr. office if you have nausea, vomiting (vomiting blood), inability to eat/drink, increased abdominal pain, incision redness/bleeding/drainage, jp drain outputs stop or volume increases significantly,bloody or black stools. no heavy lifting you should continue sponge baths for now and avoid showering or tub baths please weigh the patient daily and call the office for weight gain or loss of > 3 pounds in a day or 5 pounds in a week as lasix may need adjustment. if tpn is d/c'd please drop lasix dose to 40 po bid please keep ace wraps or hose on patient during the day and encourage feet up when sitting to avoid dependent edema followup instructions: , md phone: date/time: 3:00 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other endoscopy of small intestine insertion of endotracheal tube insertion of other (naso-)gastric tube partial gastrectomy with anastomosis to jejunum other laparotomy other digestive tract x-ray ligation and stripping of varicose veins, abdominal veins central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified acute posthemorrhagic anemia alcoholic cirrhosis of liver unspecified protein-calorie malnutrition portal hypertension acute respiratory failure varices of other sites esophageal varices in diseases classified elsewhere, without mention of bleeding barrett's esophagus diverticulosis of colon (without mention of hemorrhage) chronic or unspecified duodenal ulcer with hemorrhage and perforation, without mention of obstruction unspecified deficiency anemia other and unspecified alcohol dependence, episodic body mass index 25.0-25.9, adult chronic or unspecified duodenal ulcer with hemorrhage and perforation, with obstruction 

Answer: The patient is high likely exposed to