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: penicillins attending: chief complaint: missed major surgical or invasive procedure: esophagogastroduodenoscopy x2 multiple episodes of history of present illness: mr. is a 71 yo with esrd on hd, and depression, bipolar w/ current auditory hallucinations who presented 4 days post discharge to the ed since he missed hd. pt was admitted last week for chest discomfort on the setting of missing hd which resolved. he also had an admission on -31 for av fistula repair/thrombectomy done by vascular surgery. he presented to the ed after missing his hd yesterday. he had sign a contract with psych that he would not miss hd and was brought to the ed yesterday. in the ed he was found to be very pale and had a hct of 16.6 from 29 4 days prior on the day of his admission. he denies having any abd pain, melena or hematemesis. however pt continues to be delusional and not fully answering questions. . in the ed his vitals were 97.4, 83/40->93/49 (with baseline of sbp 140s-160s), hr 52, 100% on 4 l. his repeat hct was 13 and he was found to have + guaiac. he was given 1 unit of prbcs. k was 5.5, bun of 135, creat 167. . on arrival to the floor, pt appeared extremely pale with bp in the 80s/40s-50s, hr in 60s (in the setting of receiving bb in the am). pt is alert and o x 3, however dellusional and needing to redirect. ng lavage was done and he had coffee ground/brb via ng that did not clear with 1 l lavage. he was ordered 3 units blood and gi was called to evaluate pt. . ros: unable to give hx given pt is dellirius. past medical history: -mood disorder, previously dx bipolar (outpt therapist dr. ) -esrd lithium exposure and chronic interstitial nephritis on hd (tue//sat) -di from lithium toxicity -normal pressure hydrocephalus s/p drain at in (no shunt seen on imaging) -hypertension -anemia of chronic disease -h/o endocarditis -pulmonary lymphadenopathy past surgical history: -cabg x 4, resection of tumor from left ventricular outflow tract -left brachiocephalic av fistula placed -left forearm radiocephalic av fistula -appendectomy -tonsillectomy social history: he denied using tobacco but endorsed occasional alcohol use. he denied recreational drug use. he lives in an apartment by himself. his niece is his hcp. family history: history of depression in his father. physical exam: on admission: vs - 97.4, 83/40->93/49 (with baseline of sbp 140s-160s), hr 52, 100% on 4 l general - thin man, very pale, in no acute distress, inattentive heent - nc/at, poor dentition, dry mm neck - supple, lad, no jvd lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - rrr, no mrg, nl s1-s2 abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - lue av graft with erythema surrounding sutures, some warmth, swelling of lue. very faint thrill palpable over graft. 1+ lower extremity edema skin - no rashes or lesions neuro - awake, a&ox3, inattentive . on discharge vs: 96.0, 160/90, 80, 20, 97%ra general - thin man, nad heent - nc/at neck - no jvd lungs - ctab heart - systolic murmur heard best at rusb chest - indwelling catheter line in place on right c/d/i abdomen - soft, +bs, nt, nd extremities - lue av graft in place with decreasing lue swelling; steri-strips in place; thrill palpated, persistent left lower extremity swelling. pertinent results: admission labs: 11:10am wbc-5.8 rbc-1.62*# hgb-5.4*# hct-16.6*# mcv-102* mch-33.3* mchc-32.6 rdw-15.1 11:10am neuts-72.1* lymphs-21.0 monos-3.7 eos-2.5 basos-0.6 11:10am plt count-288 11:10am glucose-71 urea n-135* creat-6.7*# sodium-135 potassium-5.5* chloride-96 total co2-21* anion gap-24* 11:10am alt(sgpt)-14 ast(sgot)-23 alk phos-69 tot bili-0.1 11:10am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 01:24pm pt-15.1* ptt-28.6 inr(pt)-1.3* discharge labs: 06:00am blood wbc-8.0 rbc-2.61* hgb-8.4* hct-24.6* mcv-94 mch-32.3* mchc-34.3 rdw-16.6* plt ct-391 06:00am blood glucose-88 urean-61* creat-5.9* na-139 k-4.3 cl-94* hco3-32 angap-17 06:00am blood calcium-9.5 phos-6.3* mg-2.3 07:05am blood caltibc-215* ferritn-1176* trf-165* ______________ studies: ekg: sinus rhythm. right bundle-branch block/left anterior fascicular block. consider prior anterior myocardial infarction. compared to the previous tracing of the findings are similar. cxr: as compared to the previous radiograph, the patient has received a nasogastric tube. the tip of the tube projects over the pyloric region. unchanged position and course of the right hemodialysis catheter. unchanged partly organized left pleural effusion with subsequent left areas of atelectasis. no newly appeared focal parenchymal opacities. , egd: edematous and friable stomach with evidence of recent bleeding. epinephrine given and endoclips x2 were placed. , egd: no active bleeding, linear esophageal erosions. endoclips no longer present. , ct head: impression: 1. no acute intracranial hemorrhage or mass effect. 2. soft tissue swelling overlying the left frontal calvarium, with no subjacent fracture. 3. prominent ventricles, compatible with history of normal pressure hydrocephalus, unchanged since the ct examination. no shunt seen. correlate clinically. 4. mild mucosal thickening in the ethmoid air cells and sphenoid sinus. cxr: impression: no new focal airspace consolidation to suggest acute pneumonia. improved left lung base aeration but with persistent loculated pleural effusion and atelectasis. new small right pleural effusion. brief hospital course: mr. is a 71 year old man with a history of esrd, on hd, and multiple cardiac problems, s/p graft revision/thrombectomy who presented after missing hd and was found to have upper gi bleed. he was initially admitted to the micu. he underwent ng lavage with bright red blood and underlying significant anemia. gi did urgent egd that showed edematous and friable stomach with evidence of recent bleeding, but no discrete ulcers. received epi injection and 2 endo clips. plan was to continue ppi with eventual repeat egd. in setting of volume resuscitation and transfusion, patient required intubation volume overload. had two sessions with removal of nearly 4 liters of fluid and was successfully extubated on . the patient's psychiatric history also played a significant role in his course. he missed his session secondary to an irrational dislike of his center per his outpatient psychologist and was sectioned to the hospital against his will. he was seen by psychiatry in house who deemed him without capacity to make decisions regarding his well being and recommended chemical restraints (haldol, ativan) in the setting of his agitation and threatening behavior. he was transferred to the floor for further care, and his floor course is as follows: # refusal of care: pt intermittently refusing care, including hemodialysis and repeat endoscopy, labs, and vital sign checks. per psychiatry, pt has never been in a stable enough frame of mind to competently refuse , and some conflicting messages from patient, especially since has also expressed strident desire "to live" as recently as this admission (e.g. pt is full code). after (following emergent hd for uremia), mr. was more cooperative, although still refusing hd on occasion, vs checks, and lab draws. the medical, psychiatry, and renal teams met and decided to pursue emergency guardianship given that without hd, pt's clinical and mental state decompensate. the hcp was notified regarding intermittent refusal of care, that this refusal is against his best interest, and that emergency guardianship is being pursued. the hcp has had no questions, and urged us to call her if she can help in any way. social work and psychiatry continued to follow patient throughout his admission. initially, his niece, the hcp was going to be his gaurdian, but then at the last minute she backed out secondary to recently strained relationships with mr. . mr. therapist/case worker, mr. , wanted to be the patient's gaurdian. mr is intricately involved in the patient's care and he called frequently to discuss issues related to the patient. he spoke with the medical as well as the legal team frequently. ultimately we felt there was a conflict of interest to have mr. be the patient's gaurdian given her was also being payed by the patient for other services. it was also vague as the the actual role mr. played in the patient's life. mr. was appointed a independent gaurdian mr. who can be reached at . i spoke with mr. prior to discahrging the patient and he will receive a finalized copy of this discharge summary. . # psych: patient with history of severe depression with previous trials of ect and treatment with lithium. he was followed by psychiatry. as per prior admission note there is increased concern for auditory hallucinations, and patient expressed that these hallucinations tell him to refuse . started on oral haldol standing dose 1mg , ativan 0.5mg tid. venlafaxine was held. the patient was repeatedly evaluate by psychiatry and they felt he was doing better on this regiment at the time of discharge. he was sent home with follow up with his therapist mr. and referred to a day program at . . # upper gi bleed s/p 5u prbcs: pt with significant anemia on admission. hct remianed relatively stable following transfusion and egd, but patient continued to pass dark, guaiac positive stools. repeat endoscopy did not reveal active bleeding. he was started on an oral ppi twice daily for 8 weeks. his h/h continued to trend down throughout his stay, but his guaiac was negative on repeat exam. we spoke with and it seemed that he was not receiving his epo shots as prescribed. they restarted epo injections. however, since his hct had trended down to such an extent, 22.4, he was given 2 units of blood prior to transfer. after 8 weeks he will need to be transitioned daily ppi and follow-up in clinic. . # pt fell out of bed while sleeping during the last week of his prolonged hospital stay. he sustained small scratches on his forehead and ct head w/o contrast was negative. he was initially placed on fall precautions, but that was discontinued in the setting that he had been walking around with his walker and very stable for over a month. the incident occured while sleeping and had little to do with deconditioning, imbalance or syncope. the patient had no other events throughout his hospital stay. . # esrd lithium toxicity: pt requiring hd, but due to his psychiatric comorbidities, he has intermittently missed hd. renal followed the patient while he was hospitalized. he will need to follow-up with vascular surgery in regards to his new fistula. chem panel was trended as best as able given patient's intermittent lab refusal. . # hypertension: continued metoprolol and lisinopril. . # cad: continued simvastatin, but held aspirin given bleed risk. . # code: full . gaurdian: medications on admission: 1. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 2. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 3. cinacalcet 30 mg tablet sig: two (2) tablet po daily (daily). 4. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 5. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. 6. doxazosin 4 mg tablet sig: two (2) tablet po hs (at bedtime). 7. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 8. venlafaxine 75 mg capsule, sust. release 24 hr sig: two (2) capsule, sust. release 24 hr po daily (daily). 9. venlafaxine 37.5 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po daily (daily). 10. sevelamer hcl 400 mg tablet sig: six (6) tablet po tid w/meals (3 times a day with meals). disp:*540 tablet(s)* refills:*2* 11. clonazepam 1 mg tablet sig: one (1) tablet po at bedtime. discharge medications: 1. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 2. vitamin b complex capsule sig: one (1) capsule po once a day. 3. cinacalcet 30 mg tablet sig: two (2) tablet po once a day. 4. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 5. metoprolol succinate 100 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po once a day. 6. aspirin 81 mg tablet sig: one (1) tablet po once a day. 7. doxazosin 4 mg tablet sig: two (2) tablet po at bedtime. 8. sevelamer hcl 400 mg tablet sig: six (6) tablet po tid w/ meals. 9. haloperidol 1 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*0* 11. lorazepam 0.5 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*0* 12. vitamin c 500 mg capsule, extended release sig: one (1) capsule, extended release po once a day. 13. folic acid 1 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: nizhoni discharge diagnosis: primary: -upper gastrointestinal bleed . secondary: -mood disorder -end-stage renal disease -hypertension -anemia 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: mr. , you were hospitalized at because you had a bleed in your stomach and your blood level was very low. we had to give you a large blood transfusion, as well as have the gastroenterologists look into your digestive tract with a camera (esophagogastroduodenoscopy, egd). while you were hospitalized, you were resumed on your normal hemodialysis schedule. occasionally, you would refuse care, and for this reason, we spoke with the courts about how to best care for you. after speaking with the legal department here we felt that it would be best to pursue gaurdianship. you remained in the hospital while this was being established and on a guardian was appointed for you. this gaurdian will help you make medical decisions if you are unable to, but in no way will the gaurdian interfere with personal or financial matters. you are being discharged from the hospital with plan to resume and follow up with your pcp. guardians name is at . . please also give the sage program a call and set up to join the day program at hospital. i think that it would be valuable to go to this on days that you are not at . . please take your medications as prescribed. followup instructions: name: , l. location: primary physicians address: , , , phone: appt: friday, at 10:45am department: gastroenterology when: wednesday at 1 pm with: , md building: lm campus: west best parking: garage procedure: hemodialysis endoscopic excision or destruction of lesion or tissue of esophagus esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: anemia in chronic kidney disease end stage renal disease coronary atherosclerosis of native coronary artery acute posthemorrhagic anemia iron deficiency anemia secondary to blood loss (chronic) aortocoronary bypass status other shock without mention of trauma other encephalopathy hemorrhage of gastrointestinal tract, unspecified bipolar disorder, unspecified hypertensive chronic kidney disease, benign, with chronic kidney disease stage v or end stage renal disease 

Answer: The patient is high likely exposed to