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: history of present illness: the patient is a pleasant 60-year-old female with a history of gastritis and schizo-affective disorder who presented to the emergency coffee-ground emesis that started on in the evening and went over night until the morning of . the patient stated that she had a total of episodes of coffee-ground and also complained of some light-headedness, dizziness, and presyncope. she also stated that she experienced some shortness of breath, but this had been gone on for the past couple of days. she denied any chest pain or noticing any bright red blood per rectum. she stated that she never had this kind of emesis before. on arrival to the emergency department, her pulse was 95, blood pressure 113/54, respirations 14, 99% on 2 l. the patient denied any recent change in her medications. her inr in the emergency department was found to be 3.6, and so the patient received 2 bags of fresh frozen plasma, 2 l of intravenous fluids, and was typed and crossed for packed red blood cells. the gi team was also notified. past medical history: 1. hiatal hernia. 2. gastroesophageal reflux disease. 3. hyperlipidemia. 4. gastritis. 5. coronary artery disease status post myocardial infarction in with a catheterization that showed apical/anterolateral akinesis, left anterior descending with 80-90% stenosis and was stented. her most recent echocardiogram was in , which was a dobutamine echocardiogram, that showed reversible anterior apical ischemia. her echocardiogram from showed an ejection fraction of 30-35%, and no left ventricular thrombus seen. 6. schizo-affective disorder. 7. cerebrovascular accident with right-sided weakness. medications: protonix 40 mg p.o. q.d., metoprolol 12.5 mg p.o. b.i.d., neurontin 300 mg p.o. b.i.d., ativan 0.5 mg 2 tab q.a.m., risperdal 3 mg p.o. q.h.s., trazodone 50 mg p.o. q.h.s., multivitamin, coumadin 3 times a week; please note that the metoprolol and neurontin were stopped since the end of . social history: the patient denied any alcohol intake but stated that she does smoke. she lives in a group home. allergies: no known drug allergies. physical examination: vital signs: temperature 99.7??????, pulse 94, blood pressure 113/72, respirations 14, 97% on room air. general: the patient appeared drowsy but in no acute distress. heent: moist mucous membranes. poor dentition. neck: supple. no lymphadenopathy. no jugular venous distention noted. cardiovascular: s1 and s2. regular, rate and rhythm. no murmurs, rubs, or gallops heard. lungs: diffuse, coarse breath sounds bilaterally. abdomen: mildly distended. no peritoneal signs. soft. no rebound. no hepatosplenomegaly. no spider angioma. no caput medusa. the patient was complaining of some diffuse tenderness. extremities: thin, contracted, right upper extremity. no clubbing, cyanosis, or edema noted. laboratory data: on admission white count was 23, hematocrit 45.6, platelet count 450; sodium 145, potassium 5.5, chloride 39, bicarb 37, bun 20, creatinine 1.4, glucose 137; alt 14, ast 26, alkaline phosphatase 147, amylase 72, lipase 8, total bilirubin 0.6. electrocardiogram normal sinus rhythm at 95, right axis deviation, t-waves in ii, iii, and avf, poor r-wave progression, no signs of ischemia. chest x-ray showed right shoulder injury, ng tube below the diaphragm, large visible hiatal hernia, effusion of the right lung base. hospital course: 1. upper gi bleed: the patient had an ng tube placed in the emergency department, and coffee-ground emesis was suctioned out which did not clear. gi was immediately consulted who did an egd and found no active sights of bleeding; however, they did find a grade iii esophagitis and some gastritis. at that time it was decided that we should stop the anticoagulation, and the patient was to be started on protonix 40 mg p.o. b.i.d. in addition, gi recommended that the patient go for barium swallow. at that time, it was believed that the upper gi bleed was probably secondary to gastritis, worse with anticoagulation and hiatal hernia. the patient had barium swallow that was done on , that showed a large paraesophageal hernia but no evidence of any twisting or infarction at this time. according to the radiology attending, it would be ideal if surgery was consulted. the results were discussed with the patient, by both myself and by the attending dr. , about the importance of getting surgery involved, but the patient refused any surgery and stated that she would just take the oral medications at this time. the patient also was informed that if the patient does not go for surgery, then the patient may have her stomach infarcted and could possibly die. she is willing to take those chances. during the hospital course, the patient did not have any coffee-ground emesis, and the patient was tolerating p.o. well. 2. hypoxia: this was most likely secondary to aspiration pneumonia as per the chest x-ray. the patient did have 8-10 episodes of emesis which would account for that. at this time it was decided that the patient should be started on levofloxacin and flagyl for a 14-day course for treatment of aspiration pneumonia. the patient was initially requiring oxygen through nasal cannula, but two days before her discharge, her nasal cannula was removed, and she was doing well in room air, maintaining an oxygen saturation anywhere between 92-96%. the patient continued on antibiotics for ten more days after discharge. 3. urinary tract infection: the patient's urinalysis showed some white cells and some bacteria in her urine. at that time it was decided that since the patient is getting levofloxacin for aspiration pneumonia, she will be covered for urinary tract infection. a sensitivity was sent, but it was not back at the time of discharge. 4. cardiology: as per her echocardiogram report in , the patient has an ejection fraction of 30-35%. the patient is currently not on any cardiac medications. the question was brought up during her hospital course whether to start her on ace inhibitors, but given the fact that she had an elevated bun and creatinine, we decided to hold off on any medications at this time. in addition, beta-blocker was also not started because the patient was having a blood pressure anywhere between 90-100 systolic. in addition, aspirin was also held off because of her bleeding episode. the patient is to follow-up with her primary care physician . in about one week, and this issue needs to be readdressed, and the patient could possibly be restarted on any cardiac medications. 5. psychiatric: the patient has a history of schizo-affective disorder. the patient is currently stable and is to continue on current medications. 6. alkalosis: the patient initially presented with a bicarb of 37. her alkalosis was most likely secondary to contraction alkalosis given the fact that she was volume depleted and she had these multiple episodes of emesis. the patient received intravenous fluids throughout her hospital course, and her alkalosis had resolved. 7. fen: the patient was receiving intravenous fluids during her hospital course because she was npo and also because she developed alkalosis and an elevated creatinine which could indicate the patient was dry and was having prerenal acute renal failure. after receiving intravenous fluids, the patient's creatinine had dropped from 1.6-0.9, and on the day of discharge, her creatinine was 0.9, and her bicarb was down to 27. 8. heme: the patient's hematocrit has been in the range between 27 and 32-33. her initial hematocrit was 45, but on recheck was 33. her initial elevated hematocrit could be secondary to the fact that the patient was very dry. after intravenous fluids, this improved. the question was brought up whether we should transfuse her with 1 u to have her hematocrit above 30 given the fact that she has coronary artery disease, but the patient refused any blood transfusion. it was thoroughly discussed by both myself and the attending, but the patient still refused, and so transfusion was not given. the patient was started on iron sulfate 325 mg p.o. q.d. discharge status: the patient is being discharged back to her group home. condition on discharge: the patient is stable. discharge diagnosis: 1. upper gastrointestinal bleed. 2. schizo-affective disorder. 3. congestive heart failure. 4. coronary artery disease. discharge medications: ferrous sulfate 325 mg p.o. q.d., nicotine 14 mg transdermal patch q.d., neurontin 300 mg p.o. b.i.d., periosts 20 mg p.o. q.d., trazodone 50 mg p.o. q.h.s., risperidone 3 mg p.o. b.i.d., lorazepam 1 mg p.o. q.a.m., levaquin 500 mg p.o. q.d. x 10 more days, flagyl 500 mg p.o. t.i.d. x 10 more days. follow-up: the patient is to follow-up with her primary care physician, . , in one week and have her hematocrit rechecked and also to address cardiac medications. , m.d. dictated by: medquist36 d: 13:55 t: 14:45 job#: procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine barium swallow other irrigation of (naso-)gastric tube diagnoses: urinary tract infection, site not specified congestive heart failure, unspecified diaphragmatic hernia without mention of obstruction or gangrene pneumonitis due to inhalation of food or vomitus schizoaffective disorder, unspecified other specified gastritis, with hemorrhage reflux esophagitis 

Answer: The patient is high likely exposed to