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: penicillin g attending: chief complaint: coffee-ground emesis major surgical or invasive procedure: upper endoscopy history of present illness: 72 yo f with ckd stage iii, ra, dm2, sle, atrial tachycardia, diastolic chf, dvt s/p filter, djd comes from clinic for report of coffee ground. per ems report she vomited coffee ground emesis and has guaiac + stool. the ed did not obtain further history. of note patient gets all her care at where she was recently admitted on for back pain and was found to have t7, t8, t11 and possibly l1 compression fxs. at the time of admission her cr was 1.5, hct was 38.2, plts 185. she was treated with tlso brace, tylenol, ultram, lidoderm, neurontin, percocet and calcitonin. it was recommended she receive rehab but she refused to go. at discharge cr was 1.58. in the ed, 97.8 154 136/78 16 94%. triggered for hr. fsbs 97. ekg: initially peaked ts. cxr: mild fluid congestion. foley placed and given insulin, calcium, d50. ck, lfts, ca, mg, phos. given ceftriaxone for ?uti. ngl not performed. renal u/s ordered. had 3l and hrs improved with fluids to 110s. guaiac positive in the ed. prior to transfer 98.7 89 116/84 16 99% 2l. upon arrival to the icu, patient without complaints. she reports actually feeling improved and less nauseated than earlier. she has difficulty recounting her medical history and does not remember why she was sent to the hospital today. she does say that she had had 1-2 weeks of nausea, vomiting and diarrhea. she reports the diarrhea is chronic and denies blood in diarrhea. denies cp, sob, cough, fever, chills, or palpitations. she also reports recent clinic trips for her right heel because her family asked her to go. endorses weakness in bilateral upper and lower extremities that has worsened over the past couple of weeks. reports poor appetite and poor po intake in the last couple of weeks for unclear reasons. review of systems: (+) 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. denied constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: -compression fxs -bowel and bladder incontinence -spondylosis and spondylolisthesis at f5-s1 with disk herniation at l3-l4, l5-l5 and l5-s1. -dchf -dm2 a1c 6.7% -ckdiii(baseline(~1.2-1.5) -cad -secondary hyperparathyroidism -ra -sle -h/o atrial tachycardia -h/o right carotid artery stenosis -gerd -h/o pulm nodule -vit d deficiency -dvt s/p ivc filter -osteoporosis -h/o c. diff -s/p b/l knee replacements -s/p cholecystectomy -s/p hysterectomy social history: lives in apartment alone, denies alcohol, tobacco, or illicit drugs. family history: dm in mother and father physical exam: vs: temp: 97.5 bp:144/115 hr:94 rr:20 o2sat 97% on ra. gen: pleasant, chronically ill, elderly female, comfortable, nad heent: perrl, eomi, anicteric, drymm, op without lesions, no supraclavicular or cervical lymphadenopathy, jvp to 7mmhg, no carotid bruits, no thyromegaly or thyroid nodules resp: poor inspiratory effort, crackles at b/l bases l>r, cv: rr, s1 and s2 wnl, no m/r/g abd: nd, evidence of prior surgeries, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c, 1+edema to b/l midshins skin: no rashes/no jaundice/no splinters, wound on right heel that is 1 inch in diameter with fluctuance and purulence surrounding wound. neuro: aaox2(not hosptial, thought kidney clinic). cn ii-xii intact. 4-/5 strength b/l upper ext, b/l lower extremities. no sensory deficits to light touch appreciated. no pronator drift, 2+dtr's-patellar and biceps discharge physical exam vs: t: 99.2, bp 137/69 (100s-130s/50s-70s), p72 (60s-100), rr 18, 97/ra gen: pleasant, chronically ill, elderly female, comfortable, nad heent: ncat, jvp not elevated resp: clear bilaterally except cv: rr, s1 and s2 wnl, no m/r/g abd: nd, evidence of prior surgeries, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c, + edema in the les neuro: a+o x . pertinent results: admission labs: 09:00pm blood wbc-15.6* rbc-4.89 hgb-13.1 hct-41.7 mcv-85 mch-26.8* mchc-31.4 rdw-15.0 plt ct-238 09:00pm blood neuts-91.1* lymphs-5.4* monos-2.6 eos-0.3 baso-0.5 09:00pm blood pt-12.4 ptt-21.3* inr(pt)-1.0 09:00pm blood glucose-154* urean-70* creat-4.6* na-134 k-6.7* cl-94* hco3-21* angap-26* 09:00pm blood alt-27 ast-32 ck(cpk)-71 alkphos-95 totbili-0.4 09:00pm blood lipase-21 11:34am blood ck-mb-2 ctropnt-0.02* 04:14am blood ctropnt-0.03* 09:00pm blood calcium-10.2 phos-7.6* mg-2.7* renal ultrasound : no evidence of hydronephrosis or renal calculi on this limited examination. bilateral foot radiographs : no definite radiographic evidence of osteomyelitis. if there is high clinical suspicion, an mri is recommended. cxr (portable ap) : mild pulmonary vascular congestion and probable small bilateral pleural effusions in the setting of low lung volumes. egd: impression: erosions in the antrum ulcer in the antrum (biopsy) friability in the fundus otherwise normal egd to third part of the duodenum recommendations: follow-up biopsy results gi bleeding likely due to antral ulcer. cont ppi until repeat egd in 8 weeks. if possible, stop asa (defer to primary team). if not, will need to remain on ppi indefinitely (can decrease to daily pending results of repeat egd). await bxs for h pylori. if pos, pls treat, and check breath test in 8 weeks for proof of eradication. pls arrange for repeat egd (8 weeks) upon discharge. echo the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the estimated cardiac index is normal (>=2.5l/min/m2). the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. the estimated pulmonary artery systolic pressure is normal. significant pulmonic regurgitation is seen. there is no pericardial effusion. impression: suboptimal image quality. mild symmetric left ventricular hypertrophy with preserved global biventricular systolic function. dilated aortic sinus. brief hospital course: 72 yo f presents with coffee ground emesis found to have acute on chronic renal failure. she had an egd performed that revealed gastric ulcer but no active bleeding. she had downtrending hct following the egd (30--25). pt transfused one unit and post-transfusion hct 32.8 and was stable on subsequent check. # upper gi bleeding / acute blood loss anemia / gastric ulcer: patient initially admitted to the icu until she demonstrated hct stability. she was treated with pantoprazole . egd diagnosed gastric ulcer. transfusion of 1 unit prbc with stable post-tranfusion hct. asa was stopped and continued to be held at discharge. biopsies taken in egd and tests including h. pylori pending at the time of discharge. discharge hct 32.9. # on ckd. baseline cr 1.5. on admission, cr 4.6 with fena 2.2% and feurea 21% with most likely etiology pre-renal from hypovolemia potentially in setting of gib. renal ultrasound showed no hydronephrosis. diuretics and cozaar were held. the patient was given multiple fluid boluses for low urine output with some improvement in her creatinine. renal was consulted, and her urine sediment was bland. given her lab studies, we continued with fluid resuscitation and she did not have any respiratory problems. , she did start to have le edema after ~10l of ns throughout her hospitalization. her cr returned to 1.8 at time of discharge. # hyperkalemia: the patient presented with k 5.9, likely secondary to , renal failure, spironolactone. in the emergency department, she was given d50, glucose and calcium in the ed. she was given 2 doses of kayaxalate in the micu, with resolution of her hyperkalemia. this was continued to be trended and was normal on the medical floor. # tachycardia: sinus seemingly improved with fluids. however pt appears to have lbbb on admission with peaked tw that improved on repeat ekg which is likely rate related. her cardiac enzymes were normal, and she was ruled out for mi. a low level bb was started (metop 12.5 mg pobid) and was continued at time of discharge. # leukocytosis: the patient presented with leukocytosis, with infectious source unclear. cxr does not r/o pna althought no cough or hypoxia. she has been recently hospitalized which is important to keep in mind and has a h/o cdiff. she is endorsing diarrhea which she says is unchanged. she also is immunosuppressed on steroids and plaquenil. did get ceftriaxone in ed for unclear etiologies. blood urine and stool culturse were sent. these were negative (c-diff negative), and ua ucx showed group a strep (we felt likely contaminant). given lack of dysuria sxs, we held abx. her leukocytosis and fevers resolved without further intervention. # heel ulcer: could be potential source of infection. bilateral foot x-rays were unremarkable. podiatry was consulted and unroofed her right heel blister. there was some serous drainage without frank pus. wound care saw the patient and recommended further conservative management (see page 1 for details). ultimately did not feel this was cause of fever/leukocytosis. # weakness: patient profoundly weak on admission. ck normal. could be prednisone related myopathy vs effects of spinal disease, versus effects of hyperkalemia. this started to improve over time while on the medical floor. this should be f/u as an outpatient expectantly. # cad: no symptoms of acs. does have rate related left bundle branch which could represent ischemia. ruled out mi with serial cardiac enzymes. as above, held and asa given gib and arf. we started low dose metop tartrate as above. # dm type ii: managed with insulin sliding scale while in micu. we continued ssi on the medical floor. this was discontinued at time of discharge, to be titrated at her ecf. # ra/sle: continued prednisone 2.5 mg daily and plaquenil 200mg daily. # chronic diastolic chf: cxr read and pulmonary vascular congestion but looks pre-renal which could be hypoperfusion. the patient had room air saturations in the upper 90s during fluid resuscitation. we held aldactone and lasix during hospitalization, to be f/u as an outpatient. # osteoporosis with vertebral compression fractures. - continued aledronate, calcium and vitamin d after clarifying meds with pharmacy. pt has a tlso brace at rehab which she was use again after discharge. # follow up issues: - medications being held at time of discharge that should be considered for restarting: asa, losartan, aldactone, heparin sq - new medications: metop 12.5 mg po bid, protonix 40 mg pobid (changed gabapentin dose for renal dosing) - pending tests: gi bx for h pylori and path - needs to be f/u and possible initation of triple therapy if h pylori positive. medications on admission: -cozaar 25mg daily -aldactone 25mg daily -lasix 40mg daily -asa 81mg daily -prednisone 2.5mg daily -plaquenil 200mg daily -vitd -alendronate70mg po weekly -vitamin d 50,000 u weekly -immodium 2mg 2 tablets tid -ranitidine 300mg daily -celexa 20mg daily -mvi daily discharge medications: 1. prednisone 2.5 mg tablet sig: one (1) tablet po daily (daily). 2. hydroxychloroquine 200 mg tablet sig: one (1) tablet po daily (daily). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 4. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 5. celexa 20 mg tablet sig: one (1) tablet po once a day. 6. alendronate 70 mg tablet sig: one (1) tablet po once a week. 7. trazodone 50 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 8. gabapentin 300 mg capsule sig: one (1) capsule po once a day. 9. lasix 40 mg tablet sig: one (1) tablet po once a day. 10. vitamin d 50,000 unit capsule sig: one (1) capsule po once a week. 11. acetaminophen oral 12. senna laxative 8.6 mg tablet sig: 1-2 tablets po once a day as needed for constipation. 13. lidoderm topical 14. percocet 5-325 mg tablet sig: 1-2 tablets po four times a day as needed for pain. 15. multivitamin oral 16. tramadol oral discharge disposition: extended care facility: healthcare centere discharge diagnosis: primary diagnoses: - upper gi bleed - peptic ulcer disease - acute on chronic kidney injury - hyperkalemia secondary diagnoses: - vertebral compression fractures - diabetes mellitus 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 during your hospitalization. you were admitted to for a gastrointestinal bleed and you had an endoscopy done in order to look for the cause. we feel that the reason you bled is because of an ulcer that was seen on the study. we started a new medication for you that you should take for the time being. you were also seen by the kidney doctors who needed some more iv fluids, so you got that too. we've changed some medications because of your kidneys, which have been detailed below. please make the following changes to your medications - start taking pantoprazole 40 mg by mouth twice daily - start taking metoprolol tartrate 12.5 mg by mouth twice daily - change your gabapentin to 300 mg by mouth daily - stop taking the following medications: aspirin, losartan, aldactone, heparin sq please follow up with your physicians as indicated below followup instructions: department: podiatry when: wednesday at 8:00 am with: , dpm building: ba ( complex) campus: west best parking: garage procedure: esophagogastroduodenoscopy [egd] with closed biopsy other incision of skin and subcutaneous tissue diagnoses: acidosis systemic lupus erythematosus hyperpotassemia coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified long-term (current) use of steroids acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified coronary atherosclerosis of unspecified type of vessel, native or graft chronic kidney disease, stage iii (moderate) osteoporosis, unspecified other left bundle branch block chronic systolic heart failure chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction rheumatoid arthritis personal history of venous thrombosis and embolism secondary hyperparathyroidism (of renal origin) pressure ulcer, heel other malaise and fatigue urinary incontinence, unspecified leukocytosis, unspecified lumbosacral spondylosis without myelopathy displacement of lumbar intervertebral disc without myelopathy pressure ulcer, stage ii full incontinence of feces spondylolisthesis 

Answer: The patient is high likely exposed to