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: patient is a 40-year-old male with type 1 diabetes mellitus x20 years, who has had diabetic ketoacidosis 4x in the past. patient had alcoholic binge for the past few days reporting drinking up to 20 beers a day. last night he had abdominal pain, nausea, vomiting, which he vomited bright red blood about "one basinful". patient felt fatigued and dehydrated, had a low-grade fever. denies chills, cough, urinary symptoms, or chest pain, minimal shortness of breath, and diarrhea. patient went to hospital, and then was transferred to . on route in ems, there were questionable peaked t's on his electrocardiogram. he was given calcium. in emergency department, his glucose was noted to be 641 with an anion gap of 34. the patient was started on iv fluids, given 10 unit insulin, protonix, zofran, and phenergan. nasogastric lavage revealed coffee-ground. gi was consulted. past medical history: 1. type 1 diabetes mellitus, neuropathy, retinopathy, and previous diabetic ketoacidosis x4. 2. alcoholism status post detox several times recently on disulfiram from to , but self discontinued. 3. history of upper gastrointestinal bleed three years ago. patient reports possibly having an esophagogastroduodenoscopy, but this was not confirmed. 4. hypertension. 5. ulcerative colitis diagnosed in . 6. gastroesophageal reflux disease. medications: losartan 50, ibuprofen 800 tid, gabapentin 600, 600, 300, aspirin 81 mg, insulin 30 of nph in the morning, regular in the morning, and in the pm he gets nph 4 and regular 4, olsalazine 500 mg . allergies: no known drug allergies. family history: no liver disease, alcohol abuse, ulcerative colitis, elevated cholesterol, or strokes. social history: alcoholism x25 years with approximately 12 drinks per day, 20 beers per day for the last three days, no tobacco use, lives in with family. patient is unemployed. the patient has a history of cocaine use five years ago. on physical examination, temperature was 101.1, pulse 131, blood pressure 148/67, sating 96% on room air. patient was pleasant, somewhat uncomfortable due to nausea. pupils are equal, round, and reactive to light. extraocular movements are intact. dry mucous membranes. oropharynx was clear. neck: no jugular venous distention. lungs were clear to auscultation bilaterally. cardiovascular: patient had tachycardia, but regular rhythm, no murmurs, rubs, or gallops. abdomen was soft, nontender, and nondistended, positive bowel sounds, no clubbing, cyanosis, or edema. neurologic: the patient was awake, conversant, and moves all extremities. laboratories on admission: sodium 144, potassium 5.7, chloride 98, bicarb 10, bun 27, creatinine 1.7, glucose 641, anion gap was calculated to be 32. calcium 10.1, magnesium 2.4, phosphate 9.2, alt 25, ast 29, alkaline phosphatase 118, total bilirubin 0.5, amylase 42, lipase 19. complete blood count: white blood cell count was 27.0, hematocrit 45.6, platelets 306. pt 14.1, inr 1.4, ptt 21.9. arterial blood gas on admission: ph 7.14, pco2 31, po2 98. blood cultures were sent. urinalysis was done which showed trace protein, no glucose, no nitrates, 2 white blood cells, no bacteria. chest x-ray showed no infiltrates. electrocardiogram shows sinus tachycardia with a rate in the 140s. normal axis and intervals. peaked t's which decreased after calcium. that was an ems strip. the electrocardiogram in the emergency department showed sinus tachycardia, 140s, normal axis, internal peaked t's over precordium, no st abnormalities. hospital course: 1. endocrine: the patient came in with diabetic ketoacidosis. the patient was started on aggressive fluid resuscitation with a potassium repletion as necessary and insulin drip was started during the course of the first day or two. his anion gap decreased and he was eventually switched to insulin-sliding scale, and insulin drip was discontinued. patient remained npo and during this time, was kept on insulin-sliding scale. near the end of his hospital course, the patient was put back on first a clear diet, and then a diabetic diet. he was switched over back on to his nph regimen first 20 in the morning and then increased to 30. on the night prior to discharge, the patient developed increased nausea and vomiting. it was noted that his anion gap was increased in the morning. his fingersticks went up to the 300s. patient was again aggressively hydrated and covered with insulin with resolution of his insipident diabetic ketoacidosis. on discharge, the patient was placed back on his nph 30 units in the morning, regular in the morning, and nph 4 in the evenings. 2. gi: gi was consulted. it was felt that the patient should be watched closely in terms of falling hematocrit. patient's hematocrit remained relatively stable during the course of admission dropping from 45.6 on admission to 36.2 likely due to dilutional effect. from that point, it gradually fell down to a low of 25 over several days, however, it then stabilized and returned to higher levels around 29 to 26. it was felt that the patient did not need emergent endoscopy however, he deserves endoscopy in the future given his history of gi bleed and presentation with hematemesis and coffee-ground emesis. on discharge his hematocrit was 27. 3. pulmonary: the hospital course was complicated by aspiration pneumonia. patient desated and required intubation on . the patient remained intubated until at which point he was extubated. during the course of his admission, he was noted to have a small pneumothorax in the right side. this pneumothorax remained stable and no chest tube was necessary. near the end of his discharge, after being extubated, he was still complaining of shortness of breath, but patient was sating in the high 90s on room air. he still has episodes of tachypnea, this is felt to be secondary to his retching and anxiety somewhat related to the fact that he had gone back into diabetic ketoacidosis. patient's tachypnea was transient and at time of discharge, he was breathing in the low 20s. patient was treated for aspiration pneumonia. he also has had a cough which has been treated with robitussin with codeine. 4. infectious disease: the patient was started on empiric therapy for aspiration pneumonia, levaquin and flagyl. he is currently on day nine of that therapy. he will be treated for a 14 day course of flagyl and levo. the patient is currently getting flagyl and levo by iv, however, once his nausea and vomiting improves, he should be switched to po. patient was a short 1-2 days of gentamicin, which was later discontinued. patient grew out coag-negative staph in vials on . he was started on vancomycin for presumed mrse from likely sources infected line as the patient had a picc line placed and left subclavian central line placed. he was also found to have in his urine and he was started on fluconazole. the vancomycin which is currently on day four should be continued for seven day course. fluconazole he is on will be treated for five days. he is currently on day four. patient's sputum also grew up group b strep, which is covered under the aspiration pneumonia antibiotic regimen. at time of discharge, the patient has been afebrile for over 48 hours. alcohol: the patient was put on .................... with ativan. initially he remained on that for seven days at which point it was discontinued. access: the patient had a central line placed and a swan ganz catheter was started in order to get accurate hemodynamic measurement. he also had a picc line placed for tpn while he was intubated. patient still has picc line in and will be transferred to the va with the picc line still in place. psychiatry: patient was seen by psychiatry, who feels the patient is very depressed, is hopeless, isolated, and discouraged. he has a past history of suicidal ideation. he reportedly pointed a gun at his head in the past. he likely represents a high risk for self harm at this point, and once medically cleared and with his mild delirium resolving, he should be transferred to inpatient psychiatric hospitalization. psychiatry recommends continuing a one-to-one sitter at this time for safety. they do not recommend making any changes to his medications at this point. they do however, recommend that once transferred to va, he should have permanent treaters versus resident treaters at the hospital. condition on discharge: stable. discharge status: transfer to hospital. discharge diagnoses: 1. type 1 diabetes status post diabetic ketoacidosis. 2. upper gastrointestinal bleed. 3. aspiration pneumonia requiring intubation and stay in the medical intensive care unit. . coag negative staphylococcus requiring seven day course of vancomycin. 5. urinary tract infection requiring five day course of fluconazole. 6. depression. 7. alcohol withdrawal. discharge medications: 1. vancomycin day four of 7-day course. patient is getting 1 gram iv q12 hours. 2. flagyl. patient is getting 500 mg iv q8 hours. he is on day nine of a 14-day course. 3. levaquin 500 mg iv q day. patient is on day nine of a 14-day course. 4. fluconazole 100 mg po q day. patient is on day four of a five-day course. 5. protonix 40 mg po q day. 6. heparin subcutaneous 5,000 . 7. multivitamin. 8. folic acid. 9. thiamine. 10. .................... 500 mg po bid. 11. robitussin with codeine 10 cc po q4 hours prn. 12. insulin-sliding scale nph 30 in the am, 40 units in the pm. 13. the patient's losartan has been withheld, but he should be started back at some point. 14. patient's gabapentin has also been withheld, but he can be resumed on this also. 15. his ibuprofen has been withheld for the time being until further workup of his upper gi bleed. 16. also his aspirin has been withheld at this time. follow-up plans: the patient will be transferred to the hospital, where he deserves a followup with gi for upper endoscopy at some point. he should also be followed by psychiatry. he needs a one-to-one sitter and once medically cleared, he should be transferred to inpatient psychiatry. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube pulmonary artery wedge monitoring alcohol detoxification other irrigation of (naso-)gastric tube diagnoses: urinary tract infection, site not specified other pulmonary insufficiency, not elsewhere classified pneumonitis due to inhalation of food or vomitus bacteremia diabetes with ketoacidosis, type i [juvenile type], not stated as uncontrolled alcohol withdrawal delirium bipolar i disorder, most recent episode (or current) depressed, unspecified alcohol abuse, episodic 

Answer: The patient is high likely exposed to