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: egd x2 ( and ) colonoscopy () endotracheal intubation history of present illness: 88 yo man with h/o a fib on coumadin and chf presents to ed c/o 3 days of black stools. denied lightheadedness, cp or sob at home. has chronic doe which is unchanged from baseline. denies hematemesis. mild nausea. patient denies nsaid use. in the ed, digital rectal exam revealed maroon stool in rectal vault and ng lavage was negative. egd done showed esophagitis, gastritis, duodenitis as well as shatzki's ring. patient was hemodynamically stable on admission. past medical history: chf - diastolic dysfxn (ef > 65% on echo ) chronic a fib x 15 years (failed cardioversion) on coumadin as with valve area 1.0 cm2 gout disc surgeries bph htn osa social history: lives alone. denies tobacco, alcohol, illicit drugs. worked as a lab technician. is independent of all adl's. drives, cooks, and shops for himself. he has no family that he is close to. family history: nc physical exam: t 97.4, 140/70, 91, 24, 100% on 2l gen - nad, a&ox3, slurred speech heent - perrla, eomi, mmm neck - no jvd heart - nl s1s2, rrr, iii/vi holosystolic murmur at apex and ii/vi sem at lusb radiating to carotids lungs - ctab abd - soft, mildly distended, nt, nabs, no masses ext - no edema pertinent results: labs on admission: 11:30 am hct 31.5, wbc 4.3, plts 128, inr 1.9 na 146, k 4.0, cl 112, co2 22, bun 27, creat 0.9 ck 93, trop t 0.01 ua negative studies: cxr heart size is unchanged; bilateral small pleural effusion with atelectasis. no chf noted. no pna. egd : schatzki's ring. erosions in the gastroesophageal junction. esophagitis in the gastroesophageal junction. gastric deformity. erythema in the antrum compatible with gastritis. ulcers in the duodenal bulb. erythema in the duodenal bulb compatible with duodenitis. head ct : stable appearance of the brain parenchyma from earlier in the day. no intracranial hemorrhage. kub : features of mechanical small-bowel obstruction. ct abd : 1. findings consistent with ileus. there are dilated loops of small bowel with air-fluid levels without transition point. 2. gallstone. 3. a small amount of fluid around the liver, around the gallbladder and in the pelvis. 4. cirrhotic liver. 5. persistent native portosystemic shunt. (right posterior portal vein to right hepatic vein) eeg : this is an abnormal portable eeg due to the presence of intermittent, focal delta frequency slowing involving the right anterior quadrant. this finding suggests subcortical dysfunction in this region and is a relatively non-specific finding with regard to an evaluation for seizures. in addition, the background rhythm is slowed with occasional generalized delta frequency slowing. this finding suggests deep, midline subcortical dysfunction and it is consistent with an encephalopathy. note was made of an irregular rhythm with occasional ectopy on the cardiac monitor. no epileptiform abnormalities were seen. cxr : 1) og tube terminating in the distal esophagus. it should be advanced to appropriately lie within the stomach. 2) retrocardiac left lower lobe atelectasis/consolidation. egd : - ulcer in the upper third of the esophagus, schatzki's ring, grade ii esophagitis in the gastroesophageal junction. a. upper esophagus, mucosal biopsy: 1.) squamous epithelium with active esophagitis and ulceration. 2.) no neoplasm identified. 3.) periodic acid-schiff (pas) stain for fungi is negative (positive control slide). colonoscopy : multiple non-bleeding diverticula in the entire colon and rectal varices. video swallow : video oropharyngeal swallow study: the study was performed in conjunction with the speech and swallow service. please refer to their note for recommendations and full details in the online medical record. various consistencies of barium were administered to the patient. there was premature spillover of thin liquids through straw to the level of the piriform sinuses. there is prolonged ap transport piecemeal swallow for all consistencies. bolus propulsion is mildly impaired. there is a small amount of ground solid residue in puree consistent in the valleculae, which clears after a subsequent swallow. there was penetration noted for consecutive straw sips of nectar thick liquid. a chin tuck maneuver effectively prevents penetration of straw sips. the barium pill passes freely without holdup. impression: no aspiration observed for all consistencies. however, there is moderate oral and mild pharyngeal dysphagia as described brief hospital course: 88 yo man with a fib on coumadin and chf presents with melena and maroon stool in rectal vault. egd done in the ed revealed gastritis, esophagitis, and duodenitis with signs of recent bleeding but no active bleeding. he was hemodynamically stable and transferred to the floor. he was noted to be obtunded on hd#2 and was transferred to the icu. patient transferred from floor after being intubated for airway protection secondary to altered mental status. felt that patient may have encephalopathy secondary to gi bleed. patient started on lactulose while in unit. patient had ct scan of head and eeg which were both negative. he was given 6 liters of prep for a colonoscopy and put out very minimal stool. felt that patient may have partial bowel obstruction. patient's hct stabalized felt that c-scope not urgent. patient after 2 days in the unit started to produce stool. felt better to have c-scope procedure done while patient on sedation and intubated. patient had c-scope and egd with push enteroscopy which was negative for any active bleeding. rectal varacies were indentified. after scope patient was weaned off sedation and exubated. during icu course patient had witnessed aspiration after coughing out trach tube. patient was started on antibiotic course for asp. pna after temperature spike and positive sputum cultures for klebsiella, e. coli, and pseudomonas. patient was initially put on levo/ceftaz and flagyl. later patient kept on just ceftaz and flagyl. patient's mental status gradually improved while in the icu and he was transferred back to the floor. 1) esophagitis, gastritis, duodenitis - no signs/symptoms of active bleeding. etiology unknown. patient denies recent nsaid use. h.pylori igg negative. he was continued on protonix. he initially receieved 2 units of prbc in the ed, hct remained stable during the rest of his hospital course. 2) delirium. likely related to encephalopathy precipitated by gib (elevated ammonia) vs meds from egd done in ed. likely with continued delirium after prolonged intubation and icu stay. his mental status is somewhat improved since starting lactulose although not at baseline. as per pcp, was independent of all adl's, cooking, and driving. - head ct negative. - eeg done on with right anterior bursts of delta slowing amidst theta/delta background consistent with encephalopathy. no epileptiform activity. - he was continued on lactulose for a goal of 3 bm's per day. 3) cirrhosis noted on abd ct (abd ct from with some evidence of cirrhosis). etiology unclear. liver team was involved in his care. ddx includes etoh (although no known history of etoh abuse), autoimmune (not likely given 1:40, igg 1210, anti-smooth muscle 1:20), hemachromatosis (fe studies wnl), infectious (unlikely given negative hep b and c viral load), celiac sprue (ttg wnl), pbc (igm wnl, ama pending at discharge ), cardiac congestion. - ruq u/s () w/o ascites - unconjugated bili not elevated, therefore less likely related to cardiac congestion as per liver - continued on lactulose for goal of 3 bm's per day 4) pneumonia - likely aspiration event when pt extubated. patient with sputum culture positve for pansensitive pseudomonas and klebsiella. patient remains afebrile, wbc slowly trending down. - he received 7 days of ceftaz, changed to po levo at discharge. he will continue an additional 7 day course. - received 4 days of flagyl, d/c'ed given sputum culture results 5) atrial fibrillation. he was moinitored for complete heart block, as pt has significant underlying conduction disease. his hr was well controlled on metop 12.5 . his coumadin was d/c'ed given recent gi bleed (last inr 1.7). decision to restart coumadin to be decided by pcp. 6) chf - known diastolic dysfunction, treated as outpt with lasix and lisinopril. currently not in chf. his lasix was dosed on a prn basis during this admission. he was euvolemic to volume deplete on discharge. his lasix should be restarted if he appears fluid overloaded. 7) bph - terazosin restarted at discharge. 8) osa. pt is not on bipap. should have outpt eval. 9) hypernatremia and contraction alkalosis. na and bicarb trending down on day of discharge. continue to hold lasix as pt appears volume deplete. to be restarted by pcp if indicated. 10) ileus noted on kub while in icu, resolved. pt had ngt to suction with bilious output in icu. tolerating po diet. 11) htn. bp well controlled. started on metoprolol 12.5 mg . lisinopril restarted at discharge. lasix being held as above. 12) fen - pt underwent video swallow. he did well on a ground diet with thickened liquids. medications on admission: lisinopril 10 mg po qd lasix 40 mg po qd coumadin terazosin discharge medications: 1. lactulose 10 g/15 ml syrup sig: thirty (30) ml po three times a day: please titrate to bm's per day. 2. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 3. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 4. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. levofloxacin 500 mg tablet sig: one (1) tablet po once a day for 7 days. 6. terazosin hcl 1 mg tablet sig: one (1) tablet po once a day: please titrate up as needed. . discharge disposition: extended care facility: - discharge diagnosis: gi bleed aspiration pneumonia hepatic encephalopathy discharge condition: stable discharge instructions: please call your primary care physician or return to the hospital if you experience bleeding, confusion, shortness of breath, fever >101,4, or any other concerns. please assess volume statis and consult pcp regarding lasix. pt was on lasix 40 mg daily as an outpt. currently being held secondary to volume depletion. please consult pcp regarding coumadin. pt was on coumadin as an outpt for afib, however currently being held for recent gi bleed. followup instructions: 1. please follow up with dr. when you leave rehab. you have the following appointments scheduled: 1. provider: , m.d. where: cardiac services phone: date/time: 1:15 2. provider: , m.d. where: center phone: date/time: 2:00 procedure: 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 enteral infusion of concentrated nutritional substances arterial catheterization colonoscopy esophagogastroduodenoscopy [egd] with closed biopsy transfusion of packed cells diagnoses: congestive heart failure, unspecified unspecified essential hypertension cirrhosis of liver without mention of alcohol atrial fibrillation aortic valve disorders acute respiratory failure pneumonitis due to inhalation of food or vomitus unspecified sleep apnea blood in stool long-term (current) use of anticoagulants paralytic ileus hepatic encephalopathy esophagitis, unspecified hyperosmolality and/or hypernatremia diastolic heart failure, unspecified diverticulosis of colon (without mention of hemorrhage) ulcer of esophagus without bleeding unspecified hemorrhoids without mention of complication 

Answer: The patient is high likely exposed to