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: morphine attending: chief complaint: gi bleed major surgical or invasive procedure: none history of present illness: 57m with cad s/p mi with lv hypokinesis, afib, chf ef 30%, dm2, htn, esrd on hd (last done on saturday ) who reported weakness and fatigue at dialysis. hct at that time was 12. patient has also had one week of intermittet melena with 2-3 stools ranging from black/tarry to brb, associated with fatgue, lightheadedness, doe. patient denies any fevers, chills, recent etoh use, asa use, nsaid use, recent travel, uncooked foods. patient also denies any hematemesis, hemoptysis, dysphagia, abdominal pain, abdominal cramping, tenesmus. patient's gi bleed is also temporally associated with chest pain, reported as a squeezing pain radiating to the l arm. ck: 133 mb: 6 trop-t: 0.18. baseline tn is 0.16. . patient did not go to dialysis as on and also has stopped taking all medications since . patient crack cocaine on day pta. . multiple previous workups have included at least six endoscopies, three colonoscopies, one enteroscopy, and a capsule camera study, and all have been negative, except for small avm's in the duodenum seen and cauterized on one study and minor jejunal erosions noted on the capsule camera study. . most recent egd was and was normal and last colonoscopy was on that showed blood throughout the entire colon and ti abd bleeding source was not identified. . in ed patient was hemodynamically stable with hct of 12. gi and renal made aware. patient did have some chest pain in the ed with ekg was unchanged and initial enzymes were negative. past medical history: 1. type ii diabetes mellitus 2. cad s/p mi, mibi in showed reversible defects inferior/latateral 3. chf with ef 20-30% and severe global hypokinesis 4. hypertension 5. dyslipidemia 6. atrial fibrillation 7. hisrory of gastrointestinal bleed: duodenal, jejunal, and gastric avms, s/p thermal therapy; sigmoid diverticuli 8. chronic pancreatitis 9. hepatitis c 10. gerd 11. crf, baseline 3.9-5.3 12. gout, s/p arthroscopy with medial meniscectomy 13. depression, s/p multiple hospitalizations due to si 14. polysubstance abuse: crack cocaine, etoh, tobacco 15. erectile dysfunction, s/p inflatable penile prosthesis social history: smokes 3 cigs/day. hx of alcohol abuse, with dts and detoxification. active crack cocaine use. family history: father with alcoholism, cousin with cell. mother with renal failure, d. 58. twin brother and son with kidney disease. physical exam: vitals - t 97.6 bp 131/77 hr 84 rr21 99%4l general: laying in bed, nad skin: extremities, warm and well perfused, no excoriations, no rashes heent: at/nc, eomi, perrla, anicteric sclera, pale conjunctiva, mmm, no lad, no jvd cardiac: rrr, nl s1, s2 lung: ctab abdomen: nondistended, +bs, nontender in all quadrants, no rebound/guarding, +hepatomegaly 7cm below costal margin m/s: moving all extremities well, no cyanosis, clubbing or edema, no obvious deformities pulses: 1+ dp pulses bilaterally pertinent results: 07:25pm ck(cpk)-104 07:25pm ck-mb-6 ctropnt-0.18* 07:25pm hct-20.2* 04:36pm glucose-317* urea n-57* creat-5.8* sodium-136 potassium-4.6 chloride-100 total co2-25 anion gap-16 04:36pm calcium-9.1 phosphate-5.0* magnesium-2.3 04:36pm wbc-5.8 rbc-2.05* hgb-5.1* hct-16.5* mcv-80* mch-24.7* mchc-30.7* rdw-17.9* 04:36pm neuts-76.7* bands-0 lymphs-15.0* monos-6.1 eos-1.5 basos-0.6 04:36pm hypochrom-2+ anisocyt-normal poikilocy-1+ macrocyt-normal microcyt-normal polychrom-1+ schistocy-1+ 04:36pm plt count-289 04:36pm pt-13.4* ptt-26.6 inr(pt)-1.2* 01:16pm wbc-6.4 rbc-1.87*# hgb-4.6*# hct-14.9*# mcv-80* mch-24.5* mchc-30.8* rdw-17.1* 01:16pm neuts-82.7* bands-0 lymphs-11.1* monos-4.8 eos-1.0 basos-0.4 01:16pm plt count-372 12:20pm glucose-276* urea n-58* creat-5.7*# sodium-137 potassium-5.1 chloride-98 total co2-24 anion gap-20 12:20pm ck(cpk)-133 12:20pm ctropnt-0.18* 12:20pm ck-mb-6 12:20pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 12:20pm pt-13.0 ptt-25.6 inr(pt)-1.1 chest (portable ap) 12:24 pm chest (portable ap) reason: eval for ptx, chf medical condition: 57 year old man with chest pain at site of hd catheter reason for this examination: eval for ptx, chf history: 57-year-old male with chest pain at the site of hemodialysis catheter. comparison: radiographs . single portable view of the chest: a left subclavian large-bore dual-lumen catheter reaches the high atrium. cardiomegaly, interstitial edema, and bilateral pleural effusions (right greater than left), have not changed significantly since the prior exam. the bony thorax is normal. impression: overall no change since . please note that radiographic examination cannot address the site of catheter insertion. av fitulogram sch 7:43 am av fitulogram sch reason: please eval fistula contrast: optiray medical condition: 57 yo male with cad, htn, esrd on hd. ? high pressures within fistula per renal team. reason for this examination: please eval fistula indication of exam: this is a left av fistulogram for a 59-year-old male with end-stage renal disease. high pressures during dialysis. radiologists: the procedure was performed by drs. and , the attending radiologist, who was present and supervising throughout the procedure. procedure and findings: after informed consent was obtained from the patient explaining the risks and benefits of the procedure, the patient was placed supine on the angiographic table, and the left arm was prepped and draped in the standard sterile fashion. using palpatory technique and after injection of 1 cc of 1% lidocaine, the av fistula was accessed with a 21 gauge needle pointing towards the venous outflow. a 0.018 guide wire was placed. the needle was then exchanged for a 4.5 french micropuncture sheath. the inner dilator and the wire were removed, and hand injection of contrast demonstrates good positioning of the micropuncture sheath within the left cephalic vein. serial venograms were performed at the level of the arm, shoulder and chest, for possible venous outflow stenosis. diagnostic venograms demonstrate two areas of narrowing, one within the fistula in the proximal cephalic vein, and proximal to the level of the junction of the cephalic vein with the axillary vein. collateral formation/flow was identified. based on these diagnostic findings, it was decided that the patient would benefit from balloon dilation of these lesions. the micropuncture sheath was then exchanged for a 6 french vascular sheath over a 0.035 wire. a roadmap venogram was obtained, and a 6 mm balloon was advanced over the wire up to the level of the narrowings, and several balloon dilations were performed at dilations up to 15 atm. a second area of narrowing was dilated with a 7 mm balloon up to 10 atm. the balloon was removed. followup venogram demonstrated partial angiographic improvement of venous outflow after dilation. films were also obtained for evaluation of the arterial anastomosis without any significant stenosis seen. the patient tolerated the procedure well. impression: 1. left av fistulogram demonstrates two areas of venous narrowing at the level of the proximal cephalic vein near the fistula and near the junction of the cephalic vein with the axillary vein. 2. partial angiographic improvement after angioplasty with 7 and 6 mm balloons. us extremity nonvascular right 12:12 pm us extremity nonvascular right reason: r/o dvt, swelling medical condition: 58 year old man with right arm swelling reason for this examination: please rule out upper extremity dvt indication: right upper extremity swelling. comparisons: none. findings: scale, color and spectral doppler ultrasound images of right upper extremity veins were obtained. flow and compressibility is demonstrated within both internal jugular veins. additionally, the right axillary, subclavian, brachial, basilic and cephalic veins are patent and compressible. the right axillary, subclavian, brachial, and basilic veins demonstrate normal respiratory phasicity and response to distal augmentation. impression: 1) no evidence of right upper extremity deep vein thrombosis. brief hospital course: #gi bleed: patient was intially admitted to the icu for management of his gi bleed. his hct was intially 15 but after 7 units of prbcs, patients hct had improved to 30 and remained stable. patient was seen by gi who felt that given the patients extensive history of gi bleeds and multitude of studies that have been done, there was no acute need for intervention. the previous workups have included at least six endoscopies, three colonoscopies, one enteroscopy, and a capsule camera study, and all have been negative, except for small avm's in the duodenum seen and cauterized on one study and minor jejunal erosions noted on the capsule camera study. patients hct was stable once transferred to the floor. he was started on a ppi. patient was stable upon discharge. . #esrd on hd: patient with last hd on saturday prior to admission. he received hd on first 2 days of admission given extensive volume overload and then resumed on his regular outpatient schedule. an av fistulogram was done which showed stenosis at the venous anastomosis and angioplasty was done x4 with partial resolution. renal was aware of the results. he remained in the hospital an additional day in order to make sure the av fistula was functioning well. . #cad: s/p mi - pt has ruled out x3. asa was initially held given gi bleed but resumed on hospital day #4. patient was continued on his statin and labetolol. he remained chest pain free during remaining stay. of note, his amlodipine, isosorbide and lisinopril were held during hospitalization given his normal bp and use of cocaine prior to admission. he was restarted on his lisinopril on the day of discharge given his slightly elevated bp. his amlodipine and isosorbide were held upon discharge. . #dm: patient continued his home insulin regimen. . #depression/delirium/substance abuse-the patient has a long history of cocaine abuse. he had positive cocaine urine tox screen while in the hospital. he admits to cocaine use on the days prior to admission. in addition, the patient has a known history of depression. he has poor follow up, however, with the outpatient appointments made for him on prior hospitalizations. patient was seen by psychiatry during his stay for agitation and delirium which occured during his initial icu stay. it was felt that the patients delirium was secondary to not being dialyzed for over a week. the patient received seroquel for his agitation. he also had a 1:1 sitter while in the icu. the patients mental status improved after he received dialysis. the sitter was removed. the patient remained depressed but had no suicidal ideation. he was evaluted by social work to make further recommendations regarding his follow up. he will be attending a partial hospitalization program at on mondays, wednesdays, and fridays the day after admission. . medications on admission: aspirin 325 mg tablet amlodipine 5 mg tablet atorvastatin 20 mg ferrous sulfate 325 * pantoprazole 40 mg thiamine hcl 100 mg folic acid 1 mg lisinopril 40 mg sevelamer 800 mg tablet tid with meals labetalol 100 mg tablet isosorbide mononitrate 30 mg daily nph insulin 30 qam / 20 units qpm discharge medications: 1. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. atorvastatin 20 mg tablet sig: one (1) tablet po hs (at bedtime). 4. insulin nph human recomb 100 unit/ml cartridge sig: one (1) 30units qam subcutaneous once a day: please return to your home regimen. 5. insulin nph human recomb 100 unit/ml cartridge sig: one (1) 20 units qpm subcutaneous at bedtime: please resume your regimen. 6. sevelamer 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 7. labetalol 100 mg tablet sig: one (1) tablet po bid (2 times a day). 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 9. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 10. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). discharge disposition: home discharge diagnosis: gi bleed discharge condition: improved discharge instructions: you were admitted to the hospital for bloody stools and fatigue. you had what is called a gi bleed. you were admitted to the intensive care unit for monitoring and treatment. you received 7 units of blood to improve your blood levels. in addition, you had some blood tests to rule out any evidence of ischemia to your heart. these were all negative. in addition, you had a av fistulogram to evaluate the av fistula in your left arm. the vessels were re-opened by what is called angioplasty. it is crucially important to your health that you stop using cocaine, as this can damage your already compromised heart function. your next dialysis session is on thursday and you will continue to follow a tuesday, thursday, saturday dialysis schedule. we stopped 2 medications that you had previously been taking for blood pressure. you will not take your isosorbide mononitrate or your amlodipine. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet. you should return to the ed with fatigue, dizziness, black or bloody stools, recurrent chest pain, shortness of breath, fevers, chills, nausea, vomiting, or for any other problems that concern you. you will need to follow up with your pcp as below. followup instructions: you will be attending a partial hospitalization program at on mondays, wednesdays, and fridays starting tomorrow. you have been given information about this program by the social worker. you also should keep the following appointments: provider: , md phone: date/time: 12:10 dialysis provider: , center - non billing phone: date/time: 8:30 provider: , dpm phone: date/time: 8:20 procedure: hemodialysis angioplasty of other non-coronary vessel(s) procedure on single vessel diagnoses: end stage renal disease congestive heart failure, unspecified chronic hepatitis c without mention of hepatic coma atrial fibrillation systolic heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease blood in stool chronic pancreatitis other complications due to renal dialysis device, implant, and graft cocaine dependence, continuous other and unspecified alcohol dependence, continuous hereditary hemolytic anemia, unspecified 

Answer: The patient is high likely exposed to