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: this is an 89-year-old woman resident of with a history of chronic obstructive pulmonary disease, congestive heart failure, and hypertension, admitted from due to several episodes of hematemesis at nursing facility. per records she has had nausea and vomiting over the past two weeks with jaundice noticed the day of admission. by ms. report she denies fevers, chills, diarrhea, melena, or hematemesis prior to this recent episode. she cannot quantify how many times she has vomited, but denies abdominal pain, or history of ulcer disease. per chart she is alert and oriented x 3, independent, with 100% activities of daily living. her last admission to was in . in the emergency department ms. was noted to be very jaundiced. bilirubin was 8 (6.9 direct), white blood cell count 25, alkaline phosphatase over 1,000. right upper quadrant ultrasound showed common bile duct 13 mm, distended gallbladder, no choledocholithiasis, no obstructing mass. in the emergency department the patient had hematemesis of about 1-2 liters of coffee ground emesis, cleared with 750 cc of nasogastric lavage. the patient was hemodynamically stable. blood pressure was about 170 systolic, heart rate in the 80s, with an hematocrit of 34.2, which dropped to 31. she was treated with normal saline boluses, and protonix intravenously. endoscopic retrograde cholangiopancreatography fellow was called and scoped in the am. the patient is dnr/dni. past medical history: 1. chronic obstructive pulmonary disease. 2. congestive heart failure. echocardiogram showed normal biventricular function, moderate mr, moderate to severe tr, and pulmonary hypertension. 3. hypertension. 4. deep venous thrombosis of left popliteal, right popliteal, and stv in . 5. vre in . 6. clostridium difficile in . 7. left hemispheric stroke with residual right hemiplegia, upper extremities greater than lower extremities. 8. peripheral vascular disease status post femoral-popliteal bypass on the left side. medications on admission: tylenol 650 once daily; norvasc 2.5 once daily; aspirin 325 once daily; os-cal 500 once daily; colace 100 b.i.d.; estraderm patch q. three days; beclomethasone; aerobid 4 twice a day; axid; 60 mg once daily; zestril 5 mg once daily; citrucel; m.v.i.; and detrol. allergies: penicillin, keflex, captopril, erythromycin, and shellfish. physical examination: on admission her temperature was 100.3, pulse 89, blood pressure 188/45, respiratory rate 20, 97% on room air. in general she was a thin, elderly lady lying in bed in no acute distress. head, eyes, ears, nose and throat - normocephalic, atraumatic, extraocular movements intact, sclerae icteric, pupils small, 2 mm, surgical, oropharynx dry. chest had rales at the right base. heart was regular rate and rhythm with a 2/6 systolic ejection murmur at the right upper sternal border. the abdomen was soft with bowel sounds, healed mid lower abdominal scar, nontender, no hepatosplenomegaly noted. extremities had 1+ bilateral edema. the right lower extremity was in an aircast. rectal examination showed guaiac-positive stools, brown. neurologic examination showed her to be alert and oriented x 3, moving all four extremities. ultrasound showed dilatation of intrahepatic and common bile duct 13 mm, distended gallbladder, no pericholecystic fluid, positive dilated bile duct, no choledocholithiasis, no obstructing mass, normal kidneys. there was a 2-cm simple cyst in the right kidney. laboratory studies: on admission her white count was 25.7, hematocrit 34.2, platelets 506, sodium 130, potassium 4, chloride 91, bicarbonate 27, bun 18, creatinine 0.8, glucose 115, alt 316, ast 369, alkaline phosphatase 1097, bilirubin 8.7 with direct of 6, amylase 79, lipase 98, inr 1.3, and partial thromboplastin time 28. hospital course: this is a -year-old female resident of admitted with at least four days of intermittent nausea, vomiting, and jaundice x 1 day with coffee ground emesis. 1. gastrointestinal: the patient underwent endoscopic retrograde cholangiopancreatography which had demonstrated stenosed and ulcerated distal esophagus and a duodenal mass suggestive of cancer, which was biopsied. there was moderate common bile duct dilatation and successful plastic stent placement in the common bile duct. the patient subsequently underwent ct of the abdomen for further staging, which demonstrated three hypodense lesions in the liver (the biggest at 13 mm) and an atrophic pancreas. a hypodense mass of 20 mm was noted in the head of the pancreas which abuts the superior mesenteric vein but does not compress it. the patient was also noted to have pleural effusion bilaterally and a hiatal hernia. no other nodes or significant lymphadenopathy was noted on ct of the chest and pelvis. ulcerations in the esophagus were treated with protonix b.i.d. the patient was able to tolerate food very well after her procedure and no further hematemesis was noted. the patient's hematocrit remained stable and on the day of discharge was noted to be 34.3 down from 38 on the day of admission. the patient's white count also decreased and the patient will continue a course of levofloxacin for seven days after endoscopic retrograde cholangiopancreatography as prophylaxis. liver chemistries were noted to taper down and on discharge, alt was 201, ast 179, alkaline phosphatase peaked at 1,402, but dropped down to 1,084, and total bilirubin was down to 3.1. 2. oncology: biopsies from the periduodenal mass are still pending but likely a metastatic adenocarcinoma to the liver. we contact and spoke with the oncology fellow who will attempt to arrange follow up for the patient in clinic with dr. . until biopsy results have returned, the patient should not and will not start chemotherapy at this point and will not be followed in the hospital for this. 3. infectious disease: the patient was noted to have low-grade fevers status post procedure and will continue antibiotics for six to seven more days. white blood cell count was noted to be decreasing from 19 on admission to 16.2 on the day of discharge. 4. cardiovascular: the patient has a history of hypertension and congestive heart failure. zestril had been held on admission but was restarted and the patient responded well, however was noted to have blood pressures ranging 140s to 170s systolic, and probably should be followed up in the next week or two for a possible increase of zestril. code status: dnr/dni. fluids, electrolytes and nutrition: the patient was noted to have hypomagnesemia and was repleted with two to three days of magnesium oxide; also noted to be hypocalcemic, and will receive tums x 3 days with meals. she was also noted to be hypophosphatemic and received neutra-phos with meals and responded quite well to this treatment. disposition: the patient will be discharged back to center. the patient will follow up with oncology, dr. , at a to be determined date. the patient should have electrolytes followed and repleted in the next 1-2 weeks. discharge medications: 1. levofloxacin 500 mg p.o. once daily x more days. 2. flovent 2 puffs b.i.d. 3. albuterol metered dose inhaler two puffs q. 4-6 hours p.r.n. 4. protonix 40 mg p.o. b.i.d. 5. tums 500 mg p.o. t.i.d. x two more days. 6. neutra-phos two packets p.o. x 1 at nursing home. 7. magnesium oxide 400 mg p.o. t.i.d. x 2 more days. 8. zestril 5 mg p.o. once daily. 9. colace 100 mg p.o. b.i.d. 10. milk of magnesia 30 cc p.o. q. 4 hours p.r.n.. 11. dulcolax 10 mg p.o./p.r. b.i.d. p.r.n. 12. trazodone 50 mg p.o. q.h.s. p.r.n. 13. norvasc 2.5 mg p.o. once daily. 14. os-cal 500 once daily. 15. estraderm patch q. 3 days. 16. citrucel, m.v.i., 60 mg b.i.d., aerobid, and beclomethasone. discharge condition: fair. discharge diagnoses: 1. possible adenocarcinoma of pancreas. 2. esophageal ulcerations. 3. liver lesions. dr., 12-806 dictated by: medquist36 procedure: endoscopic sphincterotomy and papillotomy closed [endoscopic] biopsy of small intestine diagnoses: malignant neoplasm of liver, secondary mitral valve disorders congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified malignant neoplasm of head of pancreas primary pulmonary hypertension late effects of cerebrovascular disease, hemiplegia affecting unspecified side diseases of tricuspid valve 

Answer: The patient is high likely exposed to