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: hematemesis major surgical or invasive procedure: egd with variceal banding history of present illness: 69 year old male with esophageal varices s/p banding presenting to osh from home after 3 episodes hemetemesis and epistaxis. taken to osh ed, pressures 40/20 started on dopamine and ns boluses. hct 25, inr 1.6 given 2 units blood and 2 units ffp, triple lumen femoral line placed. to , dopamine stopped en route. hct at 23, started on octreotide gtt. patient arrived without complaints rn and ed staff, but had 500 cc darkly blood emesis in the ed and was intubated. rt suctioned signficant amount of dark bloody fluid from mouth. liver team contact and coming in to see patient. no further blood products administered, patient transferred to micu for endoscopy. . transferred from micu after gib . hpi upon reaching floor: the medical history and hospital course were reviewed. briefly, this is a 69m with esophageal varices s/p banding presenting to osh from home after 3 episodes hemetemesis and epistaxis begining on the morning of . he was severely hypotensive, put on pressors, and given blood and ffp before being medflighted to . here, he was intubated for airway protection during egd , which showed a variceal bleed and was rebanded. he was extubated successfully . he has received blood transfusions to hct goal of 28. s/p tips he received iv ppi and octreotide drip. his hct has remained stable and the patient has not had recent episodes of lightheadedness or shortness of breath. he states his chronic angina is a sharp pain in the right chest as well as in the inner left arms slightly above the elbow. he occasionally takes nitro for this when it gets bad, ~once a week on average, and this helps. he states he has not had a stress test for eight years. . on the floor he complains of mild sob for one day, continued melena yesterday. he denies cp, dizziness, ha, palpitations, shoulder or jaw pain, hematochezia. past medical history: pmh: -cirrhosis-unclear etiology, no history of etoh or hepatitis. -portal hypertension -esophageal varices: s/p ugib x 2. banding twice (8 bands then 18 bands placed). last egd with extensive varices beginning inside cricopharyngeus and extending all the way to the ge junction. no normal mucosa and some scarred areas with new varices on top. in the stomach there were large varices in the cardia. mucosa of body and stomach with portal hypertensive gastropathy worst from last endoscopy. no banding done at this time. -diabetes mellitus -hypertension -rheumatic fever x 2 and a "rheumatic heart" -cad s/p mi--s/p 3v cabg at (confusion per wife re: 3v vs 1v). patient with chronic stable angina since procedure. -kidney stones s/p penile urethra surgery to remove the stone -migraine headaches -asbestosis . social history: married, no children, no tob, etoh, drugs. retired pipe fitter and was involved with asbestos removal. he lives in , ma with his wife. family history: mother died of mi at age 70, father died of mi at age 70. sister died of tuberculosis. physical exam: micu admission: pe: vitals: general: intuabted, sedated, dry blood over nose and mouth heent: perrl, anicteric neck: jvd not assessed car: rrr no murmur resp: coarse bs bilaterally-ant/lat abd: s/nt/nd/nabs ext: no edema skin: no jaundice pertinent results: admission labs: 02:20am pt-18.5* ptt-38.0* inr(pt)-1.7* 02:20am wbc-8.4 rbc-2.38* hgb-7.6* hct-23.0* mcv-97 mch-31.9 mchc-33.0 rdw-16.0* 02:20am neuts-84.1* bands-0 lymphs-11.9* monos-3.6 eos-0.3 basos-0 02:20am plt smr-low plt count-85* 02:20am calcium-7.6* phosphate-3.5 magnesium-1.9 02:20am glucose-226* urea n-30* creat-1.1 sodium-140 potassium-5.3* chloride-110* total co2-19* anion gap-16 05:00am fibrinoge-135* 05:00am albumin-2.4* calcium-7.1* phosphate-2.9 magnesium-1.9 05:00am alt(sgpt)-69* ast(sgot)-115* ld(ldh)-247 alk phos-49 amylase-98 tot bili-2.4* 05:00am lipase-27 05:25am type- ph-7.32* 05:25am lactate-3.6* 05:25am freeca-0.95* 08:30am ck(cpk)-144 08:30am ck-mb-10 mb indx-6.9* ctropnt-0.07* 04:07pm ck(cpk)-198* 04:07pm ck-mb-15* mb indx-7.6* ctropnt-0.12* 08:30am urea n-33* creat-1.1 sodium-139 potassium-5.0 chloride-110* total co2-21* anion gap-13 04:23pm glucose-128* lactate-2.1* 04:23pm type-art temp-35.8 tidal vol-450 peep-5 o2-50 po2-193* pco2-31* ph-7.46* total co2-23 base xs-0 intubated-intubated 08:09pm hct-26.1* . discharge labs: 12:40pm blood wbc-5.0 rbc-3.25* hgb-10.2* hct-29.9* mcv-92 mch-31.4 mchc-34.2 rdw-17.8* plt ct-55* 12:40pm blood glucose-83 urean-24* creat-1.2 na-137 k-4.2 cl-107 hco3-25 angap-9 05:10am blood alt-62* ast-56* alkphos-64 totbili-1.7* 12:40pm blood calcium-8.2* phos-3.0 mg-2.0 . other labs: 07:15am blood ck-mb-3 ctropnt-0.40* 04:55am blood triglyc-55 hdl-37 chol/hd-3.8 ldlcalc-92 ldlmeas-87 02:23pm blood hbsag-negative hbsab-positive hbcab-negative hav ab-positive 02:23pm blood smooth-positive 02:23pm blood -negative 02:23pm blood igg-1720* iga-702* igm-74 sla autoantibody 3.7 0.0-20.0 u 11:23am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirub-neg urobiln-1 ph-5.0 leuks-neg 11:23am urine hours-random creat-184 na-41 hcv viral load (final ): hcv-rna not detected. blood cultures : negative x 2 . imaging: chest (portable ap) 3:17 am ap supine chest: there is an endotracheal tube, which terminates 4.2 cm above the carina. the thoracic aorta is tortuous. lung volumes are low. there are extensive bilateral pleural plaques, many of which are calcified; there is asymmetric pleural thickening along the lateral left hemithorax. there is a patchy opacity in the retrocardiac left lower lobe, primarily, as well as more hazy opacity in the left mid lung. there is no definite evidence of pneumothorax. the patient is status post median sternotomy. overall, the lungs have an inhomogeneous appearance with many small patchy areas of opacity bilaterally. impression: 1. standard placement of endotracheal tube. 2. extensive asbestos related pleural plaques. asymmetric pleural thickening and/or loculated fluid on the left -- although nonspecific, this raises concern for mesothelioma. a ct of the chest is recommended to further assess these findings. 3. patchy opacities throughout both lungs, but particularly in the left lower lobe retrocardiac area and may be due to infection, aspiration, and/or atelectasis . ecg: nsr at 71 bpm, normal axis, long qtc, twf in avl . tte : the left atrium is normal in size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 60-70%) due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. . chest ct : 1. asbestos related pleural calcifications with a loculated effusion noted at the left base. while no masses are identified, further evaluation of the pleural fluid with direct sampling to exclude mesothelioma may be helpful as clinically indicated. 15mm paraesophageal lymph node as described. 2. extensive coronary artery atherosclerotic calcifications status post cabg. 3. cirrhotic liver with ascites. . chest (pa & lat) 11:39 am two views of the chest: bilateral pleural thickening and calcification is not significantly changed since prior radiographs. however, a prominent left pleural effusion with asymmetric left pleural thickening suggests the possibility of mesothelioma. the presence of minimal interstitial changes at the bases of the lungs is also consistent with previous asbestosis exposure. no significant change is identified since the prior study, given difference in technique. impression: pleural thickening/calcification and interstitial changes are consistent with asbestos exposure and possible asbestosis. moderate left pleural effusion/thickening with volume loss is concerning for mesothelioma. consider thoracentesis or pet-ct for further assessment. . transthoracic echo : conclusions the left atrium is normal in size. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the current study is superior in technical quality. the findings are likely similar. clinical implications: based on aha endocarditis prophylaxis recommendations, the echo findings indicate prophylaxis is not recommended. clinical decisions regarding the need for prophylaxis should be based on clinical and echocardiographic data. brief hospital course: a/p: 69 year old male with cirrhosis and esophageal varices presenting with variceal bleed requiring endoscopic banding, and asbestos-related lung injury. . # ugib: variceal bleed, emergent endoscopy with banding in the icu. pt resuscitated with blood products (given at : 4 prbcs, 2 plt, 1 ffp) to hct goal 28. given iv ppi and octreotide drip for 48 hrs as well as 5 days of iv ceftriaxone. he was stabilized and sent to the floor, though he continued to have melena. he was started on nadalol 20 after 48 hrs for secondary prevention. he did not require emergent tips, but was scheduled for rebanding on . . # resp f: pt was intubated for airway protection and procedure: egd. extubated successfully . #. cirrhosis: with gib and recent concern re: confusion per wife. ultrasound of liver: cirrhosis, patent veins. he was continued on lactulose post procedure for expected hepatic encephalopathy. tolerated well. inr at baseline, tbili and lfts were at baseline or below. . # hypotension: related to ugib. supported with fluid and blood products as above, currently resolved. . #. cad and rheumatic heart disease: pt w/ hx of mi and cabg. asa and heparin were held due to gib. he was given nitro prn for chronic stable angina. troponins trended up most likely due to demand ischemia given hypotension. echocardiogram showed preserved lv function and minimal valvular dysfunction and mild pulmonary artery systolic hypertension. he was rate controlled with beta blocker. cardiology was consulted for transplant workup. . #. asbestos lung injury - chest xray and ct chest showed lung changes related to asbestos exposure. cxrs concerning for mesothelioma, though ct less concerning as it showed no masses, though the 15mm paraesophageal lymphnode and loculated pleural effusion concerning. final cxr read returned after patient discharge and patient cancelled gi follow-up. findings of the radiology were communicated with the patient and the patient's pcp, . in , ma and copies of the radiology was sent to both the patient and dr. . a copy of this discharge summary is also being sent to dr. . per radiology, the patient may benefit from pet-ct or thoracentesis. if pet-ct is done, pleuroscopy with biopsy may be indicated. per dr. , mr. is receiving close follow up in his home town. he may benefit from follow up with pulmonology. . #. dm: dm: riss with fingersticks. glipizide was held. . #. code: full (confirmed with wife). wife states that patient would never want to be a vegetable, but would want resuscitation for reversible causes. . #. communication: wife . she will be unable to physically get to the hospital to visit her husband secondary to health, distance and car problems. would like to be called with updates. medications on admission: all: pcn . medications: nitro prn prilosec colace glipizide discharge medications: 1. nadolol 20 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 2. 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:*2* 3. sodium chloride 0.65 % aerosol, spray sig: sprays nasal tid (3 times a day) as needed. disp:*1 1* refills:*0* 4. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day). disp:*3000 cc* refills:*2* 5. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. cephalexin 500 mg capsule sig: one (1) capsule po q8h (every 8 hours) for 5 days. disp:*15 capsule(s)* refills:*0* 7. insulin regular human 100 unit/ml solution sig: one (1) unit injection asdir (as directed). discharge disposition: home discharge diagnosis: primary: upper gi bleed, s/p esophageal varices banding . secondary: cirrhosis protal htn esophageal varices dm htn hx of rheumatic fever cad s/p mi and cabg in hx of kidney stones migraine headaches asbestosis discharge condition: good. hematocrit stable. no hematemasis. taking po. discharge instructions: you were seen at for an upper gi bleed. you received an upper endoscopy during which your bleeding esophageal varices were banded. you were stabilized on the floor. you also experienced injury to your heart while you were bleeding. you will need to follow up with cardiology. . you should return to the ed or call your primary care provider if you experience blood in your vomit, black tarry stools, abdominal pain, worsening swelling in your belly, confusion, fever greater than 101.4 degrees f, or any other symptoms that concern you. followup instructions: you will need a repeat endoscopy. that will be scheduled with dr. for friday . you will also need follow up in the liver clinic with dr. . that is being arranged and you will be notified of the time and date of that appointment. please call this thursday if you have not heard from anyone regarding the need for repeat egd this friday. . please follow up with dr. of cardiology on tuesday at 11:20 am at clinic (). it is very important that you come to this appointment. please call if you need to cancel or reschedule this appointment. . you should also follow up with your primary care physician in the next 2-3 weeks. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified diagnostic ultrasound of heart insertion of endotracheal tube arterial catheterization endoscopic excision or destruction of lesion or tissue of esophagus transfusion of packed cells diagnoses: anemia, unspecified unspecified pleural effusion cirrhosis of liver without mention of alcohol acute kidney failure, unspecified pneumonitis due to inhalation of food or vomitus esophageal varices in diseases classified elsewhere, with bleeding other specified disorders of stomach and duodenum asbestosis rheumatic heart disease, unspecified 

Answer: The patient is high likely exposed to