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: no known allergies / adverse drug reactions attending: chief complaint: dizziness, nausea/vomiting coffee grounds major surgical or invasive procedure: endoscopy history of present illness: 52yom speaking with hypertension and dyslipidemia presenting for nausea/bloody emesis, black stool, and dizziness. the patient reports he was experience abdominal pain for the past two days and noted black tarry stool the day prior to presentation. tonight, he woke up tonight at midnight with abdominal pain, nausea felt he had to have a bowel movement. he then had two episodes of dark bloody emesis with subsequent lightheadedness. he has no prior history of bleeding, denies significant alcohol use, denies history of liver disease, and reports minimal nsaid use occasionally for pain. he denies fevers, chills, chest pain, but does report epigastric pain. in the ed, initial vs were: 98.5 93 126/76 16 100% he was noted to have coffee ground emesis with dark blood x1 and an ngt was placed. ng lavage showed coffee grounds which did not clear, and his hct was found to be 29, down from a baseline of 42-45 most recently on . he had guiac positive black, tarry stool on rectal. the patient was noted to be pale, cool, diaphoretic, with epigastric pain and leukocytosis, and sugery was consulted for concern for perforation. cxr showed no evidence of free air under the diaphragm and surgery will follow along but recommended ct abdomen/pelvis which was ordered to be obtained en route to the icu. gi was consulted and recommended initiation of a ppi gtt which was started, and will perform an egd on arrival to the icu. the patient was given a dose of cipro/flagyl given his leukocytosis but remained afebrile in the ed. he was type and crossed 2 units and x2 gauge piv's were placed. his hr was in the 80's with bp's sustaining in the 130's, and he received a total of 2l ns. ekg showed no acute st changes per ed read. on transfer, vs were: 81 136/89 20 100%ra afebrile. he arrived with 2 units prbc which were ordered in the ed but not yet hung. on arrival to the micu, the patient denied any symptoms including abdominal pain, chest pain, shortness of breath, dizziness, or lightheadedness. he did have nausea with the ngt in place. past medical history: - hypertension - dyslipidemia social history: - tobacco: active smoker, 1ppd x at least 30 years - alcohol: reported initially etoh use once weekly, but later reported drinking 3-4 beers weekly. - illicits: denies he is married with four children and lives with wife and children in . he worked in the past as a forklift driver, now works various jobs. family history: nc physical exam: admission exam: vitals: 96.3 88 139/87 28 97%ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, ngt in place neck: supple cv: regular rate and rhythm, normal s1 + s2, gii holosystolic murmer at apex, no rubs or 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+ dp pulses, no clubbing, cyanosis or edema . discharge pe: vitals: 98.2 132/82 74 18 98%ra general: nad. speaking full sentences, smiling, mentating properly heent: sclera anicteric, mmm cv: regular rate, no m/r/g. lungs: ctab, no wheezes, rales, ronchi abdomen: soft nt, nd, no hsm ext: warm, well perfused, 2+ dp pulses, no cce pertinent results: adm labs: 01:40am wbc-18.8* rbc-3.29*# hgb-10.8*# hct-29.5*# mcv-90 mch-32.9* mchc-36.7* rdw-13.8 01:40am neuts-65.7 lymphs-27.8 monos-3.2 eos-2.8 basos-0.5 01:40am plt count-399 01:40am pt-12.5 ptt-18.9* inr(pt)-1.1 01:40am albumin-3.7 01:40am ctropnt-<0.01 01:40am lipase-25 01:40am alt(sgpt)-18 ast(sgot)-8 ld(ldh)-109 alk phos-78 tot bili-0.2 01:40am glucose-149* urea n-39* creat-0.6 sodium-140 potassium-4.6 chloride-104 total co2-26 anion gap reports: cxr : low lung volumes with bibasilar atelectasis. ct abd/pelvis : 1. no acute abnormalities in the abdomen or pelvis to explain patient's symptoms. nasogastric tube in a stomach which still remains somewhat fluid-filled. 2. left l5 pars defect. 3. age indeterminate minimal t11 anterior wedging. egd : medium hiatal hernia, blood in the fundus, - tear no esophageal varices, otherwise normal egd to third part of the duodenum . cxr : again seen is an area of volume loss or infiltrate in the right lower lobe.there is improved aeration in the left lower lobe. the right hemidiaphragm is mildly elevated. cardiac and mediastinal silhouettes are normal. the upperlungs are clear. . egd : normal mucosa in the stomach. clip in place at ge junction at site of previously reported tear bleed. no stigmata of continued bleeding found. erythema in the duodenal bulb compatible with duodenitis. otherwise normal egd to third part of the duodenum. recommendations: avoid all nsaid usage. continue protonix 40mg indefinitely. . discharge labs: 05:40am blood wbc-11.8* rbc-2.73* hgb-8.6* hct-24.7* mcv-90 mch-31.4 mchc-34.8 rdw-15.5 plt ct-411 01:40am blood pt-12.5 ptt-18.9* inr(pt)-1.1 05:40am blood glucose-100 urean-14 creat-0.6 na-141 k-4.1 cl-109* hco3-25 angap-11 05:40am blood calcium-8.8 phos-3.5 mg-2.1 brief hospital course: 52yom with hypertension and dyslipidemia presenting for coffee ground emesis, black tarry stool consistent with upper gi bleed. #. upper gi bleed: he had a hct on admission of 29 down from his baseline of 42-45 in the past year. he was given 3 units prbcs over the first 24 hours of hospitalization and then his hct remained stable. he had ng tube placed which initially drained dark bloody stomach fluid. he was started on octreotide and iv ppi drip. he had egd the morning after admission which showed a tear and lots of old blood with difficulty visualizing the whole stomach. repeat egd was initially planned for hd #2, but his hemoglobin and hematocrit remained stable and gi felt that repeat egd was not necessary. he was switched to ppi iv bid and octreotide was discontinued. ng tube was pulled and he was called out to the floor. on the floor, his hematocrit remained stable. gi did not recommend repeat inpatient endoscopy. his diet was slowly advanced, and he was tolerating a regular diet at discharge. it remains unclear as to the inciting event, as the patient reports that his first vomiting was bloody. a repeat egd did not reveal any other areas of concern. the patient was started on pantoprazole 40mg , and was instructed not to take nsaids. . #. leukocytosis: initially felt to most likely be a stress response from his gi bleed. he was given a dose of cipro/flagyl in the ed which was not continued. on further evaluation, it was noted that his leukocytosis was chronic and had been seen on labs as far back as . unclear etiology. this will need to be trended. his pcp was prior to transfer out of the unit. . # night sweats, cough, weight loss, smoking history: was concerning for malignancy. a pa/lateral cxr did not reveal any suspicious lesions. an abdominal/pelvic ct scan did not reveal anything suggestive of cancer. his wife states he has frequent night sweats when the patient is not ill, that he has not done any exercising that would lead to weight loss, and that he is cough more than he used to. however, per a different provider seeing the patient in-house, when asking the patient through his son, he states his sweats are when he has a cold, his wt loss is intentional, and is cough isn't that bad. it is unclear whether he is downplaying his symptoms, or if his wife is exaggerating. this may warrant very close monitoring, and may consider a chest ct as an outpatient. #. hypertension: his home lisinopril was held given acute gi bleed. . . transitional issues: - encourage pt to quit smoking! this was done in-house as well - unclear what precipitated his vomiting, his first episode was bloody. - tear was seen and clipped, but it is a bit strange for - tear to not be precipitated by any vomiting or retching. however, repeat egd did not reveal any other areas of concern in the stomach, esophagus, or duodenum. in the setting of a hiatal hernia, this makes it a bit more likely to have occured. perhaps he also was retching before vomiting and has not been telling us. - had some subjective complaints suspicious for malignancy. however pt tells a different story than his wife, and no suspicious lesions seen on cxr or ct ab/pelvis. see above - should be closely followed and may need an outpatient ct scan of chest if concerned. - follow up of persistent leukocytosis - need to restart lisinopril at pcp appointment. medications on admission: lisinopril - 40 mg tablet daily discharge medications: 1. 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* 2. outpatient lab work please check a cbc prior to your visit with dr. on and fax the results to (. discharge disposition: home discharge diagnosis: - tear tobacco abuse discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted for blood in your vomit. you were initially admitted to the intensive care unit for close monitoring. you were given blood transfusions given the amount of blood that you lost. your blood counts were followed very closely, and when they remained stable you were transferred to the medical floor. . you were evaluated by the gastroenterologists, and you had an endoscopy (a procedure that allows your doctors to the inside of your throat and your stomach). this revealed a small tear in your esophagus (the tube that connects your mouth to your stomach). this tear is likely the reason for your bleeding. your blood counts dropped slightly, and you were taken back for a repeat endoscopy. the repeat endoscopy did not reveal any other sources of bleeding. it did reveal an inflammation of a part of the gut that comes just after the stomach. you should take a new medication for this, called pantoprazole. . it is also very important that you stop smoking. smoking is incredibly dangerous, and is associated with many, many health problems, including cancer and heart disease. please try to quit, it is one of the most important things that you can do for your health. . please note the following medication changes: . please start: pantoprazole 40mg twice daily . please stop: lisinopril - this is a blood pressure medication. your blood pressures were in the normal range without this medication. you should stop taking it until you see your primary care doctor c next week. . please do not take any nsaids for pain (these are medications that include drugs like ibuprofin, aleeve, etc). if you need to take medications for pain, please take tylenol. . we have written you for a prescription to have your blood counts checked prior to your follow-up appointment with your primary doctor next week. followup instructions: department: internal medicine when: tuesday at 3:00 pm with: , md building: (, ma) campus: off campus best parking: free parking on site department: div. of gastroenterology when: tuesday at 1 pm with: , md building: ra (/ complex) campus: east best parking: main garage procedure: other endoscopy of small intestine endoscopic excision or destruction of lesion or tissue of esophagus diagnoses: tobacco use disorder unspecified essential hypertension diaphragmatic hernia without mention of obstruction or gangrene other and unspecified hyperlipidemia generalized hyperhidrosis gastroesophageal laceration-hemorrhage syndrome precipitous drop in hematocrit leukocytosis, unspecified 

Answer: The patient is high likely exposed to