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: anemia major surgical or invasive procedure: esophagogastroduodenoscoy (egd) history of present illness: mr. is an 88 year old man with paroxysmal atrial fibrillation and atrial tachycardia which are now persistent, coronary disease status post inferior mi in , status post dual-chamber pacemaker for impaired av nodal conduction in , and chronic kidney disease who presents today from care center a hct of 23. hct in the ed found to be 23*. ekg showed slow atrial fibrillation without p waves, with atypical rbb, leftward axis, and some t wave flattening in the precordium (normally has twave inversion across precordium). 2 large bore ivs placed. guaiac positive from below with black stool, assumed to be secondary to the patient ingesting blood. the patient was consented for blood, and a cxr showed a worsening and possibly loculated r pleural effusion. he also received 1 u prbc in the ed. at rehab, his labs on in the am were notable for cr 1.4, k 5, hct of 23, inr 4.2 of note, 3 weeks ago he was admitted to hospital where he was diagnosed with pneumonia. he was discharged to rehab where he has been for several weeks. while at rehab, he developed a bloody nose from his right nares and has undergone packing which needs to remain in place until friday . he had been receiving amoxicllin clavulonic acid as part of his regime for packing. in the ed, initial vs: 99.3 95 123/62 18 99% 4l nasal cannula. labs were notable for: k 5.2, bun 51, cr 1.5 (baseline 1.6 since ), hct 23.2* (baseline 34), mcv 99*, inr 4.5*. the patient was given 1 g ceftriaxone and 500 mg azithromycin for a presumed pna. he was transfused 1 u prbc, and sent up with a second unit. of note, for med changes, his lasix has been decreased from 40 mg b.i.d. his metoprolol succinate 25 mg once a day is now carvedilol 12.5 mg b.i.d. his lisinopril 2.5 mg was discontinued recently as well. he denies any lightheadedness or chest pain. no shortness of breath. does have a junky sounding cough. review of systems: positive for "chills" at night, a cough for the past several days which has turned from dark red to a tannish color, melena (black stool) for a week. denies fever, night sweats, headache, vision changes, rhinorrhea, sore throat, shortness of breath, chest pain, abdominal pain, nausea, vomiting, diarrhea, constipation, brbpr, hematochezia, dysuria, hematuria. denies dizziness or lightheadedness. past medical history: - dilated cardiomyopathy with an ef of 25% with chronic systolic and diastolic heart failure - mitral regurgitation status post bioprosthetic mvr, - persistent atrial fibrillation and atrial tachycardia - coronary artery disease status post imi in with a most recent left heart catheterization in showing no flow-limiting disease - av conduction disease status post dual-chamber pacemaker in - chronic kidney disease stage iv with baseline creatinine of 1.8 - trigeminal neuralgia status post trigeminal nerve ablation - gastritis and duodenitis - orchiectomy for a testicular mass in , and diverticulosis social history: social and family history were reviewed and remain unchanged. he was living with his family, but is now at a rehab. he is a former probation officer. he has no history of tobacco or drug use and drinks occasional alcohol. family history: there is no family history of premature coronary artery disease, heart failure, or sudden death. physical exam: admission physical exam vs - temp f, bp 115/49 hr 61 rr 28 )2 sat 100% on 2 l general - nad, comfortable, appropriate heent - nc/at, perrla, eomi, sclerae anicteric, mmm neck - supple, no thyromegaly, no jvd appreciated lungs - dullness to percussion on the r, crackles at the l base, mild accessory muscle use heart - irreigularly irreigular, nl s1/s2 abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - wwp, 1+ peripheral edema b, 2+ peripheral pulses (radials, dps) skin - eccymosis on the l hand neuro - awake, a&ox3 discharge physical exam pertinent results: admission labs 05:30pm blood wbc-8.4 rbc-2.34*# hgb-7.2*# hct-23.2*# mcv-99* mch-30.7 mchc-30.9* rdw-13.2 plt ct-193# 05:30pm blood neuts-88.6* lymphs-6.1* monos-4.0 eos-1.1 baso-0.2 05:30pm blood pt-45.4* ptt-36.0 inr(pt)-4.5* 03:54pm blood urean-40* creat-1.4* na-141 k-5.5* cl-105 hco3-27 angap-15 05:30pm blood ck-mb-9 05:30pm blood ctropnt-0.15* 11:10pm blood ck-mb-8 ctropnt-0.14* 06:25am blood ck-mb-8 ctropnt-0.16* 12:30pm blood ck-mb-7 ctropnt-0.15* 11:10pm blood ck(cpk)-951* 06:25am blood ck(cpk)-1037* 12:30pm blood ck(cpk)-1019* 06:25am blood calcium-8.1* phos-3.6 mg-2.8* discharge labs microbiology blood cultures x2: pending sputum culture gram stain (final ): contamination with upper respiratory secretions. respiratory culture (final ): test cancelled. imaging chest (pa & lat): increased moderate-to-large right pleural effusion which may be partially loculated, with overlying atelectasis, underlying consolidation cannot be excluded. brief hospital course: icu course . 88 year old man with paroxysmal atrial fibrillation and atrial tachycardia which are now persistent, cad s/p inferior mi in , status post dual-chamber pacemaker for impaired av nodal conduction in , and ckd who p/w a gi bleed in the setting of a supratherapeutic inr. active issues # hct drop/gi bleed: per pt report, has been having melanotic stools over the past week. also, due history of gastritis and duodenitis, gi was consulted who performed an (egd) once the patien was transferred to the icu so that he may receive mac anesthesia. pt is now s/p 4 units prbcs and 2 units ffp. his aspirin and coumadin were held for the duration of his hospitalization. the egd showed gastritis and doudenitis with duodenal ulcer which was clean based. h. pylori serology was added and ppi continued. # cad: patient denies any cp, but had elevated troponin at 0.14-0.16 x4, with a borderline normal ck-mb, although still slightly elevated from prior. ekg shows some non-specific t wave flatting, and patient denies chest pain, with troponemia concerning for the demand in the setting of a low hct. 2nd troponin trending down. his home carvedilol and simvastatin were continued, though aspirin was held. # elevated inr: likely elevated in the setting of antibiotic useage for nasal packing as well as antibiotic usage for pna as treated at hospital 3 weeks ago. antibiotics were held during the admision, as well as warfarin. # hypoxemia: in the ed was treated as pna, and has had pna in the past, but currently does not have wbc count or fever, but does endorse productive sputum, though adequate sample was unable to be obtained for culture. the care referral form make a note of an exudative r pleural effusion (possibly infectious, now possibly loculated per report) at his osh stay, which was also found on chest x-ray here. nasal packing that patient had placed about 1 week prior to admission due to epistaxis was removed on hd #1. pt was also administered extra doses of lasix due to the blood products he received so as not to fluid overload him. chronic/inactive issues # cki: at baseline. no active issues. # dilated cardiomyopathy with chronic systolic heart failure: not currently exhibiting signs of heart failure. extra doses of lasix given due to blood products he was supplied, as above. his home carvedilol was continued. # nasal bleeding: pt's nasal packing was removed on hd #1 prior to transfer to the icu for egd. # hyperkalemia: pt's lisinopril was held given high k, and came down with administration of lasix. # atrial fibrillation: carvedilol was continued for rate control. coumadin (and asa) were held given bleeding. # insomnia: pt was continued on home lorazepam 0.5 mg qhs prn insomnia transitional issues -h. pylori ab needs to be followed medications on admission: amoxicillin/clavulanate 875/125 mg twice a day for 7 days (started ) multivitamin prn carvedilol 12.5 mg twice daily lasix 20 mg daily duoneb prn lorazepam 0.5 mg at bedtime as needed for insomnia simvastatin 80 mg daily coumadin 5 mg as instructed for goal inr 2 to 3 aspirin 81 mg daily discharge medications: 1. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 2. multivitamin tablet sig: one (1) tablet po daily (daily). 3. carvedilol 12.5 mg tablet sig: one (1) tablet po bid (2 times a day). 4. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 5. furosemide 20 mg tablet sig: one (1) tablet po bid (2 times a day). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day. disp:*30 tablet, chewable(s)* refills:*2* 8. multivitamin tablet sig: one (1) tablet po daily (daily). discharge disposition: extended care facility: care center - discharge diagnosis: gastrointestinal bleed, likely from a duodenal ulcer. supratherapeutic inr. nose bleed. elevated cpk and liver function tests. complicated and loculated right pleural effusion. dilated cardiomyopathy with systolic heart function. chronic kidney disease. insomnia atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear mr. , it was a pleasure taking care of you during your hospital stay at . you were admitted due to a low blood count. your low blood count was likely caused by bleeding from your upper gastrointestinal tract. the gastrointestinal doctors performed (a scope that looks into your esophagus, stomach, and first part of the intestine) and found that you had an ulcer in your small intestine that might have been the cause of your bleeding. the treatment for this is time, medicine to control the acid in your stomach, and sometimes antibiotics. we took a test to see if you'll need the antibiotics, called an h.pylori test. your primary care doctors monitor the results and let you know the answer. while you were here, your inr was very high. your coumadin was held during your hospitalization. upon discharge, you should not take your coumadin for several days. it needs to be restarted in the near future. the doctors at rehab tell you when you should start taking the medication again. also, your nasal packing was removed while you were here. nothing else needs to be done regarding this problem for now. because of your chest xray we got a computed tomography (ct) of your chest. this shows that you still have a pleural effusion on the right side of your chest. we talked to the pulmonologists (lung doctors) here about trying to drain the fluid, but we decided that it didn't need to get done right now. dr. team was involved with the decision, and we'd like you to make an appointment to see him in his office in two (2) weeks. additionally, you need to have your blood drawn in one (1) week time to check the level of a blood test called cpk. it is important that you weigh yourself every morning, and call your doctor if your weight goes up more than 3 lbs. please make the following changes to your medications. please start taking: ----------> pantoprazole 40mg, once daily. please stop taking: xxxxxxxxxxx simvastatin 80mg, once daily xxxxxxxxxxx coumadin 5mg, but this may be restarted in the future. please continue taking your other home medications as prescribed. followup instructions: you will need to call the pulmonology clinic on tuesday to schedule an appointment to be seen by dr. at ( to make an appointment to be seen in two (2) week's time. additionally, you already have the following appointment to keep: department: cardiac services when: friday at 1 pm with: device clinic building: sc clinical ctr campus: east best parking: garage department: cardiac services when: friday at 1:40 pm with: , m.d. building: sc clinical ctr campus: east best parking: garage department: adult specialties when: wednesday at 9:50 am with: , md building: (, ma) campus: off campus best parking: parking on site md procedure: other endoscopy of small intestine control of epistaxis by anterior nasal packing diagnoses: other primary cardiomyopathies hyperpotassemia abnormal coagulation profile coronary atherosclerosis of native coronary artery congestive heart failure, unspecified chronic kidney disease, stage iv (severe) atrial fibrillation old myocardial infarction long-term (current) use of anticoagulants cardiac pacemaker in situ chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction heart valve replaced by transplant precipitous drop in hematocrit diverticulosis of colon (without mention of hemorrhage) epistaxis insomnia, unspecified anomalous atrioventricular excitation chronic combined systolic and diastolic heart failure other specified forms of effusion, except tuberculous 

Answer: The patient is high likely exposed to