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: gib major surgical or invasive procedure: interventional radiology embolization of r gastroepiploic artery 2 egds secretin stimulation test history of present illness: 72yo m with h/o prostate ca with bone mets on chemotherapy (taxotare) monthly and steroids (decadron) with chronic pain on naprosyn at home, presented to on the 17th with 48hrs of hematemesis and melena. hct on arrival was 20.4 and bp only in the 50s. given ivf and prbcs. egd showed ulcerative gastropathy with multiple ulcers but no active source of bleeding so no intervention. these were felt chronic steroids and naprosyn use. he was started on ppi and sucralfate and monitored in icu for 1-2 days. hcts stabilized at 25 (after 5 units) but bun continued to rise suggesting continued bleeding. on another egd showed an arterial bleed in the post-bulbar region. it could not be clipped but was injected with epinephrine which stopped the bleeding at least intraporcdurally. however, the patient was dizzy and hypotensive on . hematocrt found to be 17 so given more transfusions and went to the or for an ex lap where they did a duodenectomy and oversewing over arterial bleed site in the ulcer. since surgery the patient has been hemodynamically stable however his hct has trended from 32 to 25 today. today he got a unit of blood but he only bumped to 26.5 and concerned that he may be oozing from somewhere so transferred here for further care including possibly an angiogram and embolization. last episode of melena was the night prior to transfer. he received a total of 18units prbcs and 2units of ffp while at the other hospital. other issues while he was hospitalized was surrounding his pain. he had a dilaudid pca but was not using it well (forgetting to hit the button) so was switched to fentanyl boluses (50-100mcg every couple of hours). in addition he had a leukocytosis that was attributed to a leukamoid reaction from stress reaction from the gib. he also had a urine culture that grew esbl sensitive to bactrim, ceftazadime, amikacin. he had been being treated with levoquin but the ecoli was resistent to this and since it was presumed bacteriuria this was stopped. there is no mention of whether the foley was changed. . on the floor, patient was feeling ok. his only complaint was dry mouth and pain in the abdomen around his insertion site. . review of systems: (+) per hpi (-) denies fever. denies cough, shortness of breath, or wheezing. denies constipation - last bm last night. past medical history: (per records) prostate ca complicated by bone mets received chemotherapy monthly at , was due iddm htn chronic renal insufficiency obesity osa not on cpap at home depression anxiety history of urosepsis from obstruction recent neck abscess drained in may with continued dressing changes chronic left facial droop and left-sided weakness 2/2 myelitis social history: lives at home with wife. 4 children and 9 grandchildren. uses wheelchair at baseline. - tobacco: never - alcohol: none in 20 years - illicits: none. family history: not contributory physical exam: admission exam: general: alert, oriented, no acute distress heent: sclera anicteric, very dry mm, oropharynx clear, ngt in place draining blackish red fluid lungs: clear to auscultation bilaterally anteriorly, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, sm rusb. no rubs, gallops abdomen: soft, ttp along surgical site without rebound or guarding. surgical site with no erythema, induration, jp drain in place draining serosanguinous fluid. non-distended per patient he has a "big belly" at baseline, bowel sounds present but hypoactive gu: foley in place ext: sacral edema bilaterally with lower extremity edema worse on left than right (per patient the lower extremity edema on left is baseline) neuro: left facial droop and left partial paralysis (patient still able to write but with difficulty). a+ox3. able to describe entire history. discharge exam: vs: t:98.2 bp:158/78 hr: 62 rr:18 o2sat:99% on ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear lungs: clear to auscultation bilaterally anteriorly, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, sm rusb. no rubs, gallops abdomen: soft, ttp along surgical site without rebound or guarding. surgical site with minimal erythema, noinduration, tension sutures in place. non-distended, bowel sounds present gu: no foley ext: 1+ le edema bilaterally neuro: left facial droop and left partial paralysis (patient still able to write but with difficulty). a+ox3. pertinent results: from osh: wbc 32, hct 26, plt 179k, na 145, k4.3, cl 121, bicarb 22, bun 40, creatinine 1.6, calcium 8.2, mg 1.9, inr 1.3, ptt 16.3 . micro: cultures including urine pending from osh. urine cx: e.coli, h. pylori negative, cmv viral load pending images: upper extremity venous study: no dvt in upper extremity ct abd and egd also done - no report in the records from osh cxr: report with lll atelectasis . ekg from osh (report no actual image sent over): nsr with lafb and marked st abnormality suggesting possible inferior subendocardial injury new from prior. these changes resolved on repeat after prbc transfusions. ir embolization for gi bleed: 1. right common femoral arteriotomy. 2. celiac, sma, angiograms and subselective gastroduodenal, right gastroepiploic and inferior pancreaticoduodenal arteriograms. 3. embolization of the distal right gastroepiploic artery with gelfoam. 4. post-procedure angiography. findings: 1. blush but no active extravasation seen in the distal right gastroepiploic. gelfoam embolization of the distal right epiploic. 2. variant anatomy of the splenic and left gastric with takeoff after a long segment celiac axis. 4. no active extravasation seen from the gda, inferior hepatic pancreaticoduodenal or visualized branches of the sma. impression: successful gelfoam embolization of the distal portion of the right gastroepiploic artery. pathology: diagnosis: gastric ulcer: fundal mucosa with focal chronic inactive inflammation; multiple levels taken. stains for cytomegalovirus are negative (controls satisfactory). stain for h. pylori will be sent as an addendum-see note.. note. dr. notified , 10:55 a.m. with diagnosis of unremarkable fundal mucosa---"will do levels and cytomegalovirus stain". addendum: stains for h. pylori (a) are negative; controls satisfactory. addendum added by: dr. /ttl date: clinical: melena. anemia. gross: the specimen is received in one formalin-filled container, labeled with the patient's name, ", ", the medical record number and "gastric ulcer." it consists of multiple tissue fragments measuring up to 0.3 cm entirely submitted in cassette a. egd report blood in the fundus and cardia ulcers in the stomach body (biopsy) oversewn duodenal ulcer seen, with protruding sutures. no active bleeding seen from this site. ulcer in the second part of the duodenum erythema and congestion in the duodenum there was intermittent fresh blood in duodenum noted. this suggested intermittent active bleed. no clear source in the duodenum could be identified. a large clot in the fundus/cardia could not be washed off and may have obscured a source of bleeding. otherwise normal egd to third part of the duodenum egd report 2 esophagitis in the distal compatible with erosive esophagitis (injection) punctate erythema in the stomach compatible with gastritis ulcers in the body (injection) erythema in the bulb compatible with duodenitis ulcer in the 11 0clock ulcer in the duodenal bulb - suture material present polyp in the distal duodenum beyond ampulla otherwise normal egd to third part of the duodenum 05:54am blood wbc-5.7 rbc-2.73* hgb-8.5* hct-25.0* mcv-92 mch-31.2 mchc-34.1 rdw-15.2 plt ct-283 05:32am blood wbc-5.7 rbc-2.73* hgb-8.4* hct-25.7* mcv-94 mch-30.7 mchc-32.5 rdw-15.3 plt ct-304 brief hospital course: 72 yo m with h/o prostate cancer with bone mets, htn transferred from outside hospital for upper gi bleed s/p duodenectomy with continued upper gi bleed # gi bleed: he was initially admitted to the icu on and was noted to have about 220ccs of bright red blood from his ng tube. vitals remained stable. underwent angiography at that time and had r gastroepiploic artery embolized with gel foam. while in the icu, he was transfused several units of prbc and was on pantoprazole gtt and npo initially, then transferred to ppi and clears. serum h pylori and cmv viral load were negative. started on tpn for nutrition. gi, ir and surgery consult teams were following. after transfer to the floor, hct was 24 but hct continued to slowly trend down and he was noted to have liquid black stool, so he was made npo once again and received several transfusions with 2 units per day for several days. egd was performed on also was noted to have liquid black stool, so had an egd on that showed fresh blood but no source of active bleeding. eventually hct stabilized around 28, however began to drop again. ng lavage was performed and was negative, and patient was taken to egd for a second time on . egd showed erosive esophagitis, which was injected with epinephrine, gastritis, and multiple ulcers, and a bleeding sessile polyp in the duodenum (which was not biopsied). after this egd, pt continued to have occasional melena however hgb and hct remained stable around 25-26. patient received a total of 16 units prbc while hospitalized at . hct 25.2 on discharge. he will be discharged to an ltach where he will continue to have daily hct checks. he will also continue pantoprazole 40 mg iv bid after discharge. # ulcer/bleeding workup: given numerous bleed sources and multiple ulcers, workup was performed for zollinger syndrome with serum gastrin level, which was normal, but given high suspicion secretin stimulation test was done which is still pending on discharge. biopsy of ulcer was performed that showed no evidence of malignancy and was negative for h. pylori. heme/onc service was consulted as well for workup of possible bleeding diathesis, vwf, factor xiii, bleeding time, fibrinogen all within or near normal limits and thought not to have bleeding disorder by the heme/onc team. patient took only one dose of naproxen and denied other nsaid use prior to admission, so this is unlikely to be source of multiple ulcers. # pain control/ s/p duodenectomy: patient had duodenectomy and ex lap on at outside hospital. wound remained clean, dry and intact with staples and retention sutures in place. staples were removed prior to discharge, per dr. (surgeon from hospital who performed operation), however retention sutures are to remain in for one month after surgery and should be removed on . pain control was attained with iv dilaudid prn initially and was transitioned to po dilaudid when able to take po. also received tylenol three times a day. # hypertension: initially home lisinopril was held given active gi bleed, but was restarted at low dose during admission. he was restarted on lisinopril and is being uptitrated to his home dose of 60 mg daily, now at 20mg daily on discharge. # fluid overload: reportedly at the osh he had anasarca and was given 20mg iv lasix. further diuresis was initially held to ascertain hemodynamic stability in the micu. when the patient arrived to the floor he continued to be very edematous from the continued transfusions he required. we continued to monitor his fluid status as well as his vitals which remained stable during the rest of this admission, however pt was given several doses of iv lasix on the floor for symptomatic relief given anasarca. # leukamoid reaction: patient was on decadron but wbc count has trended upward to a peak of 32. per osh records they felt this was stress reaction from gib. patient also had asymptomatic bacteriuria with esbl growing from catheterized urine during icu course, was not treated given no symptoms or fever. his foley catheter was discontinued and his wbc decreased throughout hospital course. # presumed acute renal failure: unknown baseline but patient had creatinine up to 2.3 at osh presumed hypotension/hypovolemia. trended down to 1.1 at time of micu transfer and has remained stable on the floor. # neck abscess: treated at osh, on admission was treated with wet-dry dressings # prostate ca complicated by bone mets: held naproxen and steroids given acute gi bleed, although patient denied taking any nsaids except for one single dose of naproxen prior to admission. was due for chemotherapy on , however given patient was still hospitalized this was not done. outpatient oncologist was contact to update. # dm blood glucose was well-controlled on iss along with regular insulin in tpn # hl: initally statin was held, restarted when able to take po # depression: prozac was held initially while patient was npo then restarted once diet was advanced. oxazepam was also continued when patient able to take po # transitional issues: -please keep wife informed of patient care: his wife is : -please continue the tpn: non-standard tpn volume(ml/d): 2050 amino acid(g/d):110 dextrose(g/d):385 fat(g/d):55 trace elements will be added daily and standard adult multivitamins nacl:80 naac:0 napo4:10 kcl:50 kac:0 kpo4:0 mgs04:16 cagluc:8 insulin(units): 55 this is the total volume of solution per 24 hours. -please remove the abdominal retention sutures 1 month after surgery (on ) after contacting dr. at -please follow up with medical oncologist, dr. at at within 2 weeks of discharge . medications on admission: (from records) acetaminophen with codeine 1 tab q6h compazine 10mg po q6h decadron tapered off just prior to admission dilaudid 1mg q4h lantus 10 units sc qhs and regular 4units before meals lisinopril 60mg daily ativan 0.5mg q6h prn naproxen 250mg norvasc 5mg daily oxazepam 5mg qhs prozac 20mg daily zocor 80mg daily zofran prn . medications on transfer: octreotide gtt at 50mcg an hour pantoprazole gtt at 9mg per hour benadrl 25mg iv prn fentanyl 50-100mcg iv q12h fluoxetine 20mg daily hydralazine 10 iv q6h prn metoprolol 5mg iv q4h standing novolog iss maalox 30ml q4h reglan 10mg iv q6h prn oxazepam 15mg po qhs simvastatin 80mg qpm carafate 1gm q6h discharge medications: 1. fluoxetine 10 mg capsule sig: two (2) capsule po daily (daily). 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 5. oxazepam 15 mg capsule sig: one (1) capsule po hs (at bedtime) as needed for insomnia. 6. cortisone 1 % cream sig: one (1) appl topical tid (3 times a day) as needed for skin rash. 7. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). 8. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 9. pantoprazole 40 mg recon soln sig: one (1) recon soln intravenous q12h (every 12 hours). 10. norvasc 5 mg tablet sig: one (1) tablet po once a day. 11. zocor 80 mg tablet sig: one (1) tablet po once a day. 12. heparin (porcine) 5,000 unit/ml cartridge sig: one (1) injection three times a day. 13. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 14. heparin, porcine (pf) 10 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for line flush. 15. sodium chloride 0.9 % 0.9 % piggyback sig: one (1) ml intravenous q8h (every 8 hours) as needed for line flush. 16. heparin lock flush (porcine) 100 unit/ml syringe sig: one (1) ml intravenous prn (as needed) as needed for de-accessing port. 17. insulin lispro 100 unit/ml solution sig: asdir subcutaneous asdir (as directed): as directed per sliding scale. discharge disposition: extended care facility: - discharge diagnosis: upper gastrointestinal bleed discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: it was a pleasure taking care of you at . you were transferred to our facility after experiencing a gastrointestinal bleed. the source of your bleed has been difficult to ascertain but we were able to find and treat several areas thought to be bleeding on the last endoscopic procedure performed. since that time you gastrointestinal bleeding has appeared to stop. changes to your medications stop taking acetaminophen with codeine stop taking compazine stop taking decadron stop taking dilaudid stop taking naproxen change to lisinopril 20mg daily, but the next hospital should slowly increase to your home dose of lisinopril 60mg daily; stop taking your insulin; the next hospital will tell you what to take and right now you are getting insulin in your tpn; (at home, please continue your lantus 10units injected qhs and regular insulin 4units before meals) followup instructions: please make an appointment with your medical oncologist dr. at at two weeks after discharge. please see your primary care provider 2 weeks of discharge name: , r. location: medical associates- address: 325 river ridge dr, , phone: please contact dr. at regarding retention suture removal that should occur on . also call dr. to determine if you need a follow up surgical appointment. procedure: parenteral infusion of concentrated nutritional substances endoscopic control of gastric or duodenal bleeding endoscopic excision or destruction of lesion or tissue of esophagus esophagogastroduodenoscopy [egd] with closed biopsy arteriography of other intra-abdominal arteries transcatheter embolization for gastric or duodenal bleeding diagnoses: obstructive sleep apnea (adult)(pediatric) urinary tract infection, site not specified long-term (current) use of steroids acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic kidney disease, unspecified dysthymic disorder long-term (current) use of insulin long-term (current) use of other medications malignant neoplasm of prostate unspecified gastritis and gastroduodenitis, with hemorrhage paralytic ileus chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction other postprocedural status obesity, unspecified esophagitis, unspecified other psoriasis secondary malignant neoplasm of bone and bone marrow hemiplegia, unspecified, affecting unspecified side esophageal hemorrhage hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified other esophagitis facial weakness other fluid overload malnutrition of moderate degree cellulitis and abscess of neck benign neoplasm of duodenum, jejunum, and ileum personal history of infections of the central nervous system leukemoid reaction 

Answer: The patient is high likely exposed to