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: ibuprofen attending: chief complaint: bloody diarrhea major surgical or invasive procedure: endoscopy with clipping and injection of duodenal bulb ulcer history of present illness: 43fwith a history of hypertension and peritoneal tuberculosis s/p treatment who presented with bloody diarrhea after 4 days of brown diarrhea. she began having diarrhea 4 days prior to admission. on the day prior to admission she began passing bloody stool with each bowel movement, approximately 4-5 times during the course of the day. the blood was bright red and there are some clots mixed in by report. she denies any abdominal pain, chest pain, chest pressure, palpitations, or doe. otherwise she has not complaints. she denies taking any aspirin or nsaids. . in the ed, initial vs were: pain 0, t 96, hr 114, bp 157/90, r 16, 100% on ra. rectal exam was notable for bright red blood, anoscopy only showed a skin tag. gastroenterology was notified and she was started on a ppi iv bid. the patient received 3l ns. vitals on transfer were bp 144/93, hr 105, rr 30. on the medical floor, she was transfused two units of prbc for a hct of 25.8 with a goal hct of 30. however, her post transfusion hct was 23.8. she then had a large bm with brb, but flushed it down the toilet. a repeat hct was 24.3. an og lavage was attempted, but she vomited bright red blood. she was started on a pantoprazole drip in place of ppi iv bid. given her ongoing brbpr, hematemasis, and unchanged hct despite 2 units prbcs she was transfered to the micu for urgent egd and colonoscopy. of note, review of records revealed a known r colonic vascular ectasia in . she also has a history of miliary tuberculosis with peritoniteal involvement. . review of systems: (+) per hpi (-) denies fever. denies headache, lightheadedness or dizziness. denies sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness. denied vomiting, constipation or abdominal pain. no dysuria. denied arthralgias or myalgias. past medical history: - peritoneal tuberculosis, s/p treatment with ripe and b6 under direct observation therapy, completed in ? - hypertension on lisinopril + hctz - hemorrhoids - s/p tubal ligation - s/p surgery for "intestinal blockage" - sounds like bowel obstruction that complicated her last pregnancy. social history: ms. lives in with her husband and 4 children. she was born in , but immigrated to the us in . she works as a cna. no recent travel. she denies any tobacco, rare alcohol, no ivda. family history: mother died at 55 of an accident, father died at 65. one sister, one brother, four children without illness. physical exam: general: tachypneic, shivering under multiple sheets. alert, oriented, mild distress. heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: tachycardic, regular rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: well-healed midline incision, decreased bowel sounds, soft, non-tender, non-distended, no organomegaly ext: cool, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii grossly intact. pertinent results: admission labs: 05:43pm blood wbc-12.3*# rbc-2.66*# hgb-8.9* hct-25.8* mcv-97# mch-33.5*# mchc-34.6 rdw-15.5 plt ct-244 04:45am blood wbc-12.1* rbc-2.68* hgb-8.3* hct-24.3* mcv-91 mch-31.0 mchc-34.2 rdw-17.2* plt ct-164 05:43pm blood neuts-76.8* lymphs-17.1* monos-5.1 eos-0.4 baso-0.5 05:43pm blood pt-16.5* ptt-31.5 inr(pt)-1.5* 04:45am blood pt-17.0* ptt-32.9 inr(pt)-1.5* 04:00am blood fibrino-282 05:43pm blood ret man-4.6* 05:43pm blood glucose-140* urean-15 creat-0.6 na-133 k-3.3 cl-96 hco3-22 angap-18 05:43pm blood alt-27 ast-115* totbili-1.5 04:45am blood ld(ldh)-177 ck(cpk)-159* 04:09am blood alt-22 ast-135* ld(ldh)-369* alkphos-72 totbili-1.3 05:43pm blood lipase-57 05:43pm blood calcium-9.3 phos-2.9 mg-1.7 iron-114 04:09am blood albumin-2.7* calcium-7.7* phos-3.0 mg-2.1 05:43pm blood caltibc-289 ferritn-165* trf-222 04:45am blood vitb12-828 folate-8.6 06:58am blood free t4-1.0 06:58am blood hbsag-negative hbsab-positive hbcab-pnd igm hav-negative 11:12am blood smooth-negative 11:12am blood -positive * titer-1:80 04:45pm blood ca125-29 06:58am blood hcv ab-negative 05:54pm blood hgb-9.5* calchct-29 11:28am urine color-yellow appear-clear sp -1.017 11:28am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirub-neg urobiln-1 ph-6.5 leuks-neg 08:40pm urine rbc-0-2 wbc-* bacteri-many yeast-none epi-21-50 discharge labs: 04:45pm blood hct-26.5* 06:58am blood hct-26.0* 04:00am blood wbc-6.7 rbc-2.77* hgb-9.1* hct-25.5* mcv-92 mch-32.7* mchc-35.5* rdw-17.6* plt ct-160 06:58am blood pt-16.0* ptt-33.8 inr(pt)-1.4* 06:58am blood k-3.2* hco3-21* 04:00am blood glucose-81 urean-11 creat-0.7 na-138 k-3.4 cl-108 hco3-19* angap-14 06:58am blood alt-20 ast-103* ld(ldh)-183 alkphos-89 totbili-1.2 04:00am blood calcium-7.9* phos-3.6 mg-1.9 11:28 am urine source: catheter. **final report ** urine culture (final ): gram positive bacteria. ~1000/ml. organism. ~1000/ml. bcx negative x1 time taken not noted log-in date/time: 5:47 pm serology/blood **final report ** helicobacter pylori antibody test (final ): equivocal by eia. (reference range-negative). ekg sinus tachycardia. otherwise, no other significant diagnostic abnormality. no previous tracing available for comparison. cxr findings: frontal and lateral views of the chest are obtained. there is persistent elevation of the right hemidiaphragm. previously seen diffuse miliary nodules are not well appreciated on the current study, either due to resolution or due to differences in technique, as ct is more sensitive. no focal consolidation or pleural effusion is seen. cardiac and mediastinal silhouettes are unremarkable. impression: 1. persistent elevation of the right hemidiaphragm. no focal consolidation seen. 2. previously seen diffuse miliary pulmonary opacities not well appreciated on the current study, which may be due to resolution or differences in technique, as ct is more sensitive. investigation of transfusion rxn diagnosis, assessment and recommendations: ms. experienced a temperature increase of 2.6 degrees f in the 90 minutes following a leukoreduced compatible red blood cell transfusion. she had no further fevers during her hospital stay. the differential diagnosis includes acute hemolytic transfusion reaction (ahtr), septic reaction, febrile nonhemolytic transfusion reaction (fnhtr) and unrelated to transfusion. lab evaluation showed no evidence of hemolysis. a septic reaction is unlikely given rbcs are stored at refrigerated temperatures, resolution of fever without treatment and no additional symptoms such as hypotension. fnhtr is a possibility although leukoreduction signficantly reduces the incidence of these reactions. as such, other non-transfusion related causes of fever should be ruled out. no change in transfusion practice is recommended at this time. ct chest/abd/pelvis ct of the chest with iv and p.o.contrast: the airway is patent to the segmental level bilaterally. there is bilateral minimal linear atelectasis. focal pleural thickening is noted (2:26). there is no focal consolidation, pleural effusion, or pneumothorax. heart and pericardium appear unremarkable. there is no mediastinal, hilar, or axillary lymphadenopathy. ct of abdomen with iv and p.o. contrast: again noted, there is an 8 mm rounded, hypoenhancing lesion at the dome of the liver, unchanged when compared to prior study, most likely represents a benign cyst. the liver otherwise enhance homogeneously without evidence of intra- or extra-hepatic biliary dilatation. hepatic and portal veins are patent. gallbladder, spleen, pancreas, adrenal glands, stomach, small bowel appear unremarkable. contained extraluminal foci of air are noted (2:54, 2:55 and 2:56) surrounding the duodenal bulb, most likely related to status post procedure of duodenal ulcer clipping. there is no evidence of contrast extravasation. intraperitoneal hypoattenuating fluid is noted anteriorly and superiorly to the stomach(2:59), without concomitant wall enhancement to suggest active infection reaction, these findings most likely suggest retention cyst or lymphocele. the kidneys enhance and excrete contrast symmetrically. there is a 9 x 14 mm hypoattenuating lesion in the upper pole, most likely represent simple cyst, unchanged. there is no stone or hydronephrosis. there is no intra-abdominal lymphadenopathy. ct of the pelvis with iv and p.o. contrast: the bladder, distal ureters, adnexa, rectum, and sigmoid colon appear unremarkable. known submucosal fibroid is less well seen, measuring approximately 3.1 x 3.2 cm and is heterogeneous in attenuation. the patient is status post bilateral tubal ligation. there is no pelvic lymphadenopathy. there is no free air or free fluid. osseous structures: no suspicious lytic or blastic lesions are seen. impression: 1. extraluminal air surrounding the duodenal bulb, most likely related to recent surgical procedure. there is no contrast extravasation. 2. intraperitoneal fluid collection adjacent to the anterior wall of the stomach without wall enhancement to suggest active infectious process. these findings most likely suggest retention cyst of lymphocele. 3. small focus of pleural thickening without focal lung consolidation. brief hospital course: 43yof with h/o miliary/peritoneal tuberculosis s/p ripe/b6 tx for 1yr under direct observation therapy admitted with bloody diarrhea and hematemesis during admission, s/p endoscopy with duodenal bulb ulcer visualized which was injected and clamped, seen to have small amt of free air after procedure, and incidentally found 10cm perihepatic fluid collection. 1. ugib: originally with bloody diarrhea, and while og lavage was attempted pt had hematemesis and taken more urgently to endoscopy. duodenal ulcer was found, injected and clamped and hct stabilized through rest of admission, stable on discharge. is s/p 4u prbc's through admission. was never hemodynamically unstable, diet was advanced without complications. pt had equivocal hpylori serology, started on amoxicillin, clarithromycin, and ppi x2 wks, given high pretest probability. appt made to f/u with gi. 2. free air in abdomen: small amt of air seen on ct abdomen around area of proceduralized duodenum. abd benign by pe, no extraluminal extravasation, no hemodynamic compromise. gi felt this not clinically significant and stable to watch, may have been caused by clipping during egd. to be f/u'd in gi. 3. fluid collection: seen on ct torso, 10cm perihepatic, anterior to stomach. concerning in the setting of known miliary tuberculosis with peritoneal involvement, however pt without fevers, elevated wbc count, extensive ros for pulmonary and extra-pulmonary tuberculosis sxs completely negative, and abdominal exam benign; therefore not felt likely to be peritoneal tuberculosis. not clinically significant and gi recommended endoscopic u/s as an outpt. 4. transaminitis: unclear etiology of isolated elevated alt and inr, which did not respond to 3 days of vitamin k. abd u/s without evidence of cirrhosis or other acute pathology, only showing fluid collection as above. pt asymptomatic and no sequalae of liver disease on physical exam. negative serology for hep a and hep c. hepbsag negative, hepbsab positive indicative of immunity from exposure or vaccination (hepbcab still pending). smooth muscle ab negative and positive in low titer, diffuse pattern. as pt was stable, appt was made to f/u with hepatology for further assessment. 5. htn: home hctz and lisinopril was held in setting of gib, and pressures were stable and normal through admission. held on discharge, to be followed up as outpt. 6. h/o ovarian tuberculosis - given a history of ovarian involvement by peritoneal tuberculosis, we obtained a repeat ca-125, which was normal. medications on admission: - lisinopril/hydrochlorothiazide, 20 mg/25 mg daily discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day for 2 weeks. disp:*28 tablet, delayed release (e.c.)(s)* refills:*0* 2. clarithromycin 500 mg tablet sig: one (1) tablet po twice a day for 2 weeks. disp:*28 tablet(s)* refills:*0* 3. amoxicillin 500 mg tablet sig: two (2) tablet po twice a day for 2 weeks. disp:*56 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: 1. upper gi bleed from duodenal bulb ulcer, s/p endoscopy, clipping, and injection 2. left perihepatic fluid collection of unknown etiology 3. small amount of free air in abdomen after endoscopy 4. elevations in liver enzyme ast and in inr of unknown significance discharge condition: mental status:clear and coherent level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: you were admitted to with bloody diarrhea and found to have an ulcer in your duodenum that was bleeding. you underwent an endoscopic procedure to fix the bleed. your blood level was monitored and was steady, indicating that you were not having further bleeding. while you were here, you were also noted to have a fluid collection near your liver and some elevations in your liver enzymes. because this is not acutely affecting you, this will be worked up as an outpatient with the appointments listed below. the following changes were made to your medication list: 1. start amoxicillin, clarithromycin, and pantoprazole, as listed below. this is a regimen to clear a possible stomach infection that may have caused the bleeding. you will need to take this twice a day for two weeks. 2. hold hydrochlorothiazide-lisinopril. this blood pressure med was held while you were having active bleeding. you should reassess this with your primary care doctor. followup instructions: appointment #1 md: dr. specialty: internal medicine-primary care date/ time: 2:00pm location: , phone number: appointment #2 md: dr. specialty: gastroenterology date/ time: 3:30pm location: phone number: appointment #3 md: dr. specialty: gastroenterology-liver center date/ time: 1:20pm location: phone number: procedure: endoscopic control of gastric or duodenal bleeding transfusion of packed cells diagnoses: unspecified essential hypertension acute posthemorrhagic anemia perforation of intestine chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction nonspecific abnormal results of function study of liver 

Answer: The patient is high likely exposed to