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: anemia, fatigue major surgical or invasive procedure: egd with injection and thermal therapy history of present illness: mr is a 60 year old male with history of etoh cirrhosis, known grade 1 varicies, history of duodenal ulcer, presents for evaluation of low hematocrit. patient was recently seen by his nephrologist, had labs drawn noting a hct of 20. patient reports dyspnea on exertion and cp with exertion for the last few weeks. he reports that the symptoms have progressed to the point that he is unable to do housework that he was typically able to do. he denies dizziness, light headedness, indigestion or abdominal pain. no cp at rest. +cough, not productive of sputum. denies nose bleed, hematemsis, melena, hemaotchezia, brbpr. denies constipation. denies easy brusing. no le edema. denies hematuria. denies worsening back pain. he does have history of hospitalization anemia requiring 2 units transfusion for hct of 24 (no evidence of bleeding was identified at that time) . in the ed, initial vital signs were: 98.0 84 155/58 18 100%. he was noted to have mild epigastric tenderness, no flank bruising or ecchymoses. ekg with no concerning changes. repeat hct was 18.7, inr 1.1. ng lavage was pink and did not clear after 500cc. hepatology was consulted with plan for endoscope in icu. he received 2 units prbcs in the ed, was t&c for 2 additional units. he was also started on an octreotide drip and protonix bolus and drip for presumed variceal bleed. . on arrival to the micu, patinet was alert and oriented. he consented to egd procedure which showed blood in them antrum. he was thought to have a dulofoy's lesion. he did not have any identified lesion. small grade i varices were noted, and not bleeding. . . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: alcohol-induced cirrhosis with a history of duodenal ulcer, 2 cords of grade 1 varices on egd renal cell carcinoma s/p cyberknife therapy and h/o renal failure t2dm hypertension h/o vre bacteriuria social history: social history: has not drank alcohol since , prior to that 8-10 beers per day, started drinking at the age of 12. grew up in southie, now lives in . does not smoke or use other drugs. he is retired from the secondary to health reasons. lives with wife, has 2 grown children. family history: significant for diabetes mellitus in his mother and father. there is no history of coronary artery disease. physical exam: admission physical exam: 98.1 153/71 79 17 100%ra general: alert, oriented, no acute distress heent: sclera anicteric, mm dry, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, systolid ejection murmur, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation . discharge physical exam: vs: 97.9 (98.9) 172/80 (148-185/73-88) 82 (75-86) 18 100ra (100ra) fsbs: 155-159 8-hr i/o; 1650/2050+brp, bmx2 general: well appearing, white male, who appears stated age. comfortable, appropriate and in good humor. no jaundice. heent: sclera anicteric. perrl, eomi. neck: supple with low jvp, no cervical lad. no carotid bruits. cardiac: rrr, diminished s1 and s2. mid-peaking systolic murmur loudest at lusb (no radiation to the carotids). lower-pitched holosystolic murmur at the llsb with radiation to the apex. lungs: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use, moving air well and symmetrically. ctab, no crackles, wheezes or rhonchi. abdomen: non-distended, soft, non-tender to palpation. normoactive bowel sounds. no hsm or tenderness. extremities: warm and well perfused, no clubbing or cyanosis. no lower extremity edema. pertinent results: admission labs: 03:15pm blood wbc-3.6* rbc-2.09*# hgb-6.7*# hct-20.6*# mcv-99*# mch-32.3* mchc-32.7 rdw-15.5 plt ct-117* 11:15am blood pt-11.6 ptt-31.8 inr(pt)-1.1 03:15pm blood urean-70* creat-3.0* na-137 k-5.0 cl-110* hco3-16* angap-16 03:15pm blood ck(cpk)-362* 03:15pm blood albumin-3.4* calcium-8.5 phos-3.8 03:15pm blood pth-93* . pertinent labs: 06:03pm blood tsh-0.57 11:15am blood alt-17 ast-26 alkphos-135* totbili-0.3 04:05pm urine blood-neg nitrite-neg protein-100 glucose-100 ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-neg 04:05pm urine rbc-2 wbc-<1 bacteri-few yeast-none epi-0 03:09pm urine hours-random creat-56 totprot-207 prot/cr-3.7* . discharge labs: 06:55am blood wbc-3.7* rbc-2.96* hgb-8.9* hct-27.9* mcv-94 mch-30.0 mchc-31.9 rdw-15.9* plt ct-88* 09:30am blood hct-26.1* 06:55am blood pt-11.4 ptt-31.2 inr(pt)-1.1 06:55am blood glucose-135* urean-54* creat-2.9* na-142 k-4.1 cl-117* hco3-17* angap-12 06:55am blood alt-19 ast-28 alkphos-134* totbili-0.7 06:55am blood calcium-8.0* phos-3.1 mg-2.4 . imaging: bone scan: whole body images of the skeleton obtained in anterior and posterior projections show no abnormal focal increased or decreased tracer uptake. the kidneys and urinary bladder are visualized, the normal route of tracer excretion. impression: no evidence for osseous metastatic disease. . ct chest: a 9-mm left lower lobe nodule demonstrates heterogeneous attenuation and a somewhat lobular contour (4:198). a 7-mm ground-glass nodule is seen in the superior segment of the right lower lobe (4:134). a 4-mm left fissural nodule is well circumscribed and solid (4:119). a 5-mm nodule abuts the left hemidiaphragm in the left lower lobe (4:210). a 3-mm solid nodule in the left lower lobe is adjacent to the heart (4:204). a 5-mm subpleural nodule is seen in the lingula (4:106). no focal consolidation, pleural effusion, or pneumothorax is seen. right hilar lymph node (2:29) is commonly seen at the upper pole of the right hilus. small mediastinal lymph nodes do not meet ct size criteria for pathologic enlargement. very dense calcifications are seen in the region of the mitral annulus, and less dense calcifications are seen along the aortic valve. left-predominant coronary artery calcifications are mild to moderate in severity. aortic arch calcifications are present. no pericardial effusion is present. the visualized portion of the thyroid appears homogeneous. this study is not optimized for evaluation of subdiaphragmatic structures, but within this limitation, no acute abnormalities are detected. upper abdominal varices are better seen on prior abdominal mr. a calcified gallstone is seen in the region of the gallbladder neck. atherosclerotic arterial calcifications are seen in the upper abdominal aorta and splenic artery. metallic density is seen adjacent to the right transverse process of a lower thoracic or upper lumbar vertebral body. just superior to this level in the right posterior subcutaneous fat, there is another metallic density and superior to this is a third metallic density posterior to a lower thoracic spinous process. right scapular sclerosis is noted. impression: 1. 9-mm left lower lobe pulmonary nodule, chronicity difficult to determine since this lesion is located at the margin of included lung fields from prior ct abdomen ( and ), but likely new. close interval follow up in 3 months is recommended. 2. dense calcification in the region of the mitral annulus. aortic valve and coronary artery calcifications, likely hemodynamically significant. 3. cholelithiasis. 4. right scapular sclerosis. . egd: 1 cords of grade i varices were seen in the lower third of the esophagus. stomach: mucosa: friability, erythema and petechiae of the mucosa with contact bleeding were noted in the antrum. these findings are compatible with portal hypertensive gastropathy. other: there was an area of antrum with active bleeding likely either from a dieulafoy or just from portal hypertensive gastropathy. 9 cc. epinephrine 1/ hemostasis with success. a gold probe was applied for hemostasis successfully. duodenum: normal duodenum. impression: varices at the lower third of the esophagus friability, erythema and petechiae in the antrum compatible with portal hypertensive gastropathy there was an area of antrum with active bleeding likely either from a dielofay or just from portal hypertensive gastropathy. (injection, thermal therapy) otherwise normal egd to second part of the duodenum brief hospital course: mr. is a 60 year old gentleman with a pmh alcholic cirrhosis with known grade i varices, who was admitted with acute on chronic anemia from upper gi source and dyspnea. . . active issues: # acute on chronic anemia: from to gastric bleed. patient had hct 18.8 on admission, with reported intermittent melena before admission. acute on chronic anemia most likely caused the patient's dyspnea. ng lavage showed pink fluid that did not clear. he received 5 units prbcs in the micu, with resolution of hct to 27. patient underwent egd on . this showed an active bleed in the gastric antrum, likely a dieulafoy lesion or from portal hypertensive gastropathy. bleeding lesion was treated with epinephrine and thermal therapy. subsequently, hct was stable, and patient was asymptomatic (dyspnea resolved). at the time of discharge, hct was 26.1. patient will have cbc checked on monday . . # dyspnea on exertion: symptoms present with exertion for two days prior to admission, with some chest discomfort. history was consistent with stable coronary disease symptomatic from exercise in the setting of severe anemia. there were no acute ischemic changes on ekg or ct scan. has had a recent cardiac workup which was unremarkable, however anemia was not severe at that time. symptoms resolved and remained absent after blood transfusions. . . chronic issues: # patient to have cbc checked on monday to monitor anemia. # pulmonary nodule was noted incidentally on ct scan. this should be followed up in 3 months with a ct scan. # hcp: wife (cell: ) # code: full (confirmed) # cirrhosis: complicated by periodic encephalopathy and varices. no encephalopathy, jaundice, bleeding varices or ascites noted during this admission. at the time of discharge, meld was 17. patient continued lactulose and rifaxmin. . # dm2: patient was covered with lantus and ssi. . # htn: held antihypertensives during acute bleed. he then resumed his home medications. . # insomnia: continue trazodone. . . medications on admission: amlodipine-benazepril 5 mg-20 mg daily furosemide 40 mg daily for lower extremity edema humalog ss lantus 15 units daily lactulose 30ml tid, titrate to bms daily omeprazole 20 mg daily rifaximin 550 mg trazodone 75mg qhs valsartan-hydrochlorothiazide 160 mg-12.5 mg qhs multivitamin daily discharge medications: 1. amlodipine-benazepril 5-20 mg capsule sig: one (1) capsule po once a day. 2. furosemide 40 mg tablet sig: one (1) tablet po once a day. 3. humalog 100 unit/ml solution sig: one (1) unit subcutaneous four times a day: per sliding scale. 4. lantus 100 unit/ml solution sig: fifteen (15) units subcutaneous once a day. 5. lactulose 10 gram/15 ml (15 ml) solution sig: thirty (30) ml po three times a day: titrate to bms per day. 6. rifaximin 550 mg tablet sig: one (1) tablet po twice a day. 7. trazodone 50 mg tablet sig: 1.5 tablets po at bedtime. 8. valsartan-hydrochlorothiazide 160-12.5 mg tablet sig: one (1) tablet po at bedtime. 9. multivitamin tablet sig: one (1) tablet po once a day. 10. ciprofloxacin 500 mg tablet sig: one (1) tablet po once a day for 3 days: through . disp:*3 tablet(s)* refills:*0* 11. outpatient lab work have cbc checked on monday . results faxed to: dr. (f: ), and dr. (f: ). 12. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 13. carafate 1 gram tablet sig: one (1) tablet po four times a day. disp:*120 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnosis: gastric bleed . secondary diagnosis: cirrhosis chronic kidney disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure to participate in your care here at ! you were admitted with worsening anemia, and were found to have a bleed in your stomach. this was treated with cauterization and injection. after you had this procedure, your blood count stabilized. your shortness of breath also improved. please note, the following changes have been made to your medications: - start ciprofloxacin 500 mg by mouth daily, through - start carafate 1 g by mouth four times daily continue all of your other medications as you had prior to this admission. please have your labs checked on monday , with results sent to drs. , and . please see below for instructions regarding your follow up appointments. wishing you all the best! followup instructions: the liver transplant department will contact you will date and time for appointment in the few weeks following your discharge. please call dr. office () to schedule a follow-up appointment during the week after discharge. md procedure: endoscopic control of gastric or duodenal bleeding other heat therapy diagnoses: acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled alcoholic cirrhosis of liver portal hypertension hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified long-term (current) use of insulin personal history of malignant neoplasm of kidney other and unspecified alcohol dependence, continuous insomnia, unspecified dieulafoy lesion (hemorrhagic) of stomach and duodenum 

Answer: The patient is high likely exposed to