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: dyspnea on exertion major surgical or invasive procedure: blood transfusion (2 units) history of present illness: 61m with h/o severe as, atrial flutter, esophageal ca/barrett's esophagus s/p esophagectomy p/w progressively worsening doe x 1 week and dyspnea at rest x 1 day. patient was evaluated by pcp w/ labs at 3 days ago. noted to be both heme positive and anemic to 22.4 (from baseline 39.1 ) at that time. he was then scheduled for colonoscopy this coming week to evaluate for gi bleed, last colonoscopy and egd 5 years ago were normal per patient. he denies chest pain, palpitations, light-headedness or syncope. no melena, brbpr rectum or hematemesis. he does note decreased po intake over the last 2 days due to decrease in appetite. denies asa use but has been taking a natural blood thinning supplement called nattokinase for the last 4 years. in the ed, initial vs were: 99.6 111/67 p 130 r 28 99% ra. ng lavage was negative, stool brown and hemoccult positive. h/h 6.2/20.9. he was transfused 1 unit prbcs and received a total of 600ml ns. on arrival to the micu, patient's vs 99.8 125/64 70 100%ra. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies cough. denies chest pain, chest pressure, palpitations. denies constipation, abdominal pain, diarrhea, dark or bloody stools. denies dysuria, frequency, or urgency. past medical history: -severe aortic stenosis- followed by dr. , 50-55% - esophagus/esophageal ca s/ esophagectomy ' -r tkr -partial pancreatectomy and splenectomy for pancreatic mass determined to be neuroendocrine tumor -reduction gastric volvulus ' -ventral hernia repair w/ mesh ' -atrial flutter social history: retired fireman, now works part time making deliveries for an autoparts store. lives with his wife, has 2 grown children. reports increased stress over the last month as his daughter's family moved into his house and will soon be moving to . no etoh since , 10ppd smoking history but quit . no illicit drugs. family history: father had mi at 80, lived to age . brother had mi at age 59, alive at 65. mother had dementia, deceased. no family h/o cancer. physical exam: admission physical exam vitals: 99.8 125/64 70 100%ra general: alert, oriented, breathing heavily and speaking in short sentences heent: sclera anicteric but pale, mmm, oropharynx clear, eomi, perrl neck: supple, jvp to jaw, no lad cv: irregularly irregular, + holosystolic murmur loudest at rsb, normal s1 + s2 lungs: +crackles at left base, diminished bs right base abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly, no rebound or guarding gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii grossly intact, moving all 4 extremities discharge exam: pertinent results: admission labs: 08:15pm wbc-13.3* rbc-2.71*# hgb-6.2*# hct-20.9*# mcv-77*# mch-22.7*# mchc-29.5*# rdw-17.7* 08:15pm neuts-78* bands-0 lymphs-18 monos-4 eos-0 basos-0 atyps-0 metas-0 myelos-0 nuc rbcs-18* 08:15pm pt-15.1* ptt-28.0 inr(pt)-1.4* 08:15pm calcium-8.4 phosphate-1.8*# magnesium-1.9 08:15pm ctropnt-0.01 08:15pm calcium-8.4 phosphate-1.8*# magnesium-1.9 08:15pm alt(sgpt)-12 ast(sgot)-16 ck(cpk)-22* alk phos-92 tot bili-0.3 08:15pm glucose-237* urea n-20 creat-0.8 sodium-131* potassium-4.6 chloride-101 total co2-21* anion gap-14 other pertient labs: 08:15pm blood ctropnt-0.01 03:56am blood ctropnt-<0.01 imaging: cxr findings: single portable ap view of the chest was obtained. the patient is status post esophagectomy and gastric pull-through with prominent persistent right base opacity seen. since the prior study, there has been overall diffuse increase in interstitial markings most consistent with pulmonary edema. there is blunting of the left costophrenic angle and a small left pleural effusion is likely present. the right costophrenic angle is stable in appearance. cardiac and mediastinal silhouettes are stable. tte left ventricular wall thicknesses and cavity size are normal. there is mild regional left ventricular systolic dysfunction with hypokinesis of the anterior septum. cannot exclude hypokinesis of the other segments. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets are mildly thickened (?#). there is severe aortic valve stenosis (valve area 0.8-1.0cm2). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: suboptimal image quality due to body habitus. the anterior septum (at least) is hypokinetic. the right ventricle is not well seen. assessment of the aortic valve is challenging due to suboptimal image quality and irregular rhythm. degere of aortic stenosis is probable severe. compared with the prior study (images reviewed) of , the anterior septum is hypokinetic and the aortic valve is severely stenotic. egd evidence of esophagectomy s/p gastric pullthrough. the anastomosis was carefully examined and appeared normal. food in the stomach. otherwise normal egd to third part of the duodenum. colonoscopy: diverticulosis of the sigmoid colon 8 mm polyp in the mid-transverse colon at 60 cm. given admission with concern for gastrointestinal bleeding polypectomy was not performed. normal mucosa in the whole colon without any evidence of bleeding. grade 2 internal hemorrhoids. prep is fair to poor throughout the colon. otherwise normal colonoscopy to cecum egd evidence of esophagectomy s/p gastric pullthrough. the anastomosis was carefully examined at 28 cm from the incisors and appeared normal. there was possible 5 cm segment of barrett's in distal esophagus. given concern for recent gi bleed biopsies are not performed. a large amount of fluid and food was found in the intrathoracic stomach. the liquid component is suctioned out but there is large amount of solid residue. antrum, pyloric channel are normal. otherwise normal egd to third part of the duodenum egd: the duodenum was not reached due to the food contents in the stomach. impression: food in the esophagus food in the stomach. capusle endoscopy placement in the stoamch, as it was impossible to pass to the duodenum given the food in the stomach. discharge labs: 06:30am blood wbc-8.6 rbc-3.64* hgb-9.0* hct-30.4* mcv-83 mch-24.7* mchc-29.6* rdw-18.5* plt ct-491* 06:30am blood wbc-9.9 rbc-3.54* hgb-9.1* hct-29.6* mcv-84 mch-25.6* mchc-30.7* rdw-18.7* plt ct-602* 06:30am blood wbc-9.9 rbc-3.54* hgb-9.1* hct-29.6* mcv-84 mch-25.6* mchc-30.7* rdw-18.7* plt ct-602* brief hospital course: 61m with h/o severe as, a flutter, esophageal cancer s/p esophagectomy p/w progressively worsening doe x 1 week and dyspnea at rest x 1 day found to have severe anemia (h/h 6.2/20.9), transferred to the floor and subsequently had likely aspiration event leading to respiratory distress. active issues #respiratory distress: initially the patient's dyspnea on exertion seemed to be consistent with symptomatic anemia given hct 20.9 from baseline 39.1. given h/o severe as, elevated bnp and pulmonary edema on cxr were concerning for chf and acute onset in the setting of increased emotional stress and raised concern for acs, however troponins were negative x2. he showed symptomatic improvement after blood transfusions and diuresis with iv lasix with the tranfusions. tte was obtained and showed mild regional lv systolic dysfunction w/hypokinesis of the anterior septum, severe aortic valve stenosis, and mild pulmonary artery systolic hypertension. the patient's oxygen requirement resolved. however, while on the floor he had several endoscopic procedures, and following the endoscopy to place a capsule for eval of his gib, he became acutely hypoxic and went into respiratory distress; cxr showed an extensive new process in his left lung, thought to be aspiration event. he was transferred to where he was started on zosyn for coverage of gi organisms. antibiotics were stopped after a few days. noninvasive ventilation was attempted but he did not tolerate this and was intubated. he remained intubated for two days as he had become tachycardic with weaning down to pressure support only and there was fear of flash pulmonary edema from discontinuation of ventilation in the setting of his severe as. on he was eventually weaned from the vent and did well. there was consideration of a chest ct to get a better sense of anatomy and question of possible emphysema given his large lung volumes despite his prior chest surgeries to help better determine his respiratory status, but the patient declined. his respiratory status continued to improve after transfer back to the medical floor. #hypotension: transiently required pressors in setting of sedation associated with propofol during intubation but was quickly weaned off when sedation was switched to midazolam. #anemia: hct on admission found to be 20.9 from baseline 39.1 in . concern for slow gib given guiaic positive stool and h/o esophageal ca, hd stable. last egd and colonoscopy 5 years ago were normal per patient. patient received 2 untis prbcs with bump in hct to 24.6. gi was consulted and he was scheduled for colonoscopy and upper endoscopy for monday. ppi was started. underwent egd on , which did not reveal source of bleeding. however, food was noted to be retained in stomach, and he had repeat egd/colonoscopy on under general anesthesia which showed barrett's on the endoscopy and normal colonic mucosa. in the meantime given his hemodynamic stability, he had been transferred to the floor. he underwent placement of a capsule into the stomach on as there was retained food in the stomach and it was unable to be placed into the duodenum. the capsule did not move beyond the stomach until the second day. patient did not evacuate the capsule during this study. hct had trended down on and he received 1 unit prbcs, for a total of four during his admission. hematocrit remained in the high 20s during the last days of his hospitalization and patient had no more clear episodes of gi bleeding. patient was discharged with omeprazole 40 mg po daily, but it was not clear that the patient was inclined to take the medication. #a flutter with rapid rate: patient developed atrial flutter with rates as high as 130-140. he was started on metoprolol for this and by the time of discharge, his heart rates were well controlled in the 70-80s, and did not significantly increase when ambulating. he opted not to start anticoagulation with coumadin despite his chads score and stroke risk given his recent gi bleeding for which clear source was not found. #as: severe as with ef 50-55% on tte 5/. he had a tte which showed severe aortic stenosis again with valve area 0.8-1.0cm2. ef was decreased from prior at 40-45%. patient was not interested in having a cardiac catheterization during this hospitalization for the aortic stenosis, but may be amenable as an outpatient. # gastroparesis - patient started on reglan, but this seemed to exacerbate his atrial flutter (made it faster) so it was discontinued. patinet was able to eat in the hospital without nausea or vomiting. # cad: cardiology service felt that the new mild hypokinesis seen on his echo was secondary to ischemia, and they advised starting aspirin 81 mg a day. he took it in the hospital and his hematocrit remained stable. he was discharged home with the medication, but it is not clear that he will take it - he told me he was nervous about bleeding. i urged him to continue to take it, as it would also offer some small amount of protection against thromboembolic disease given his atrial flutter. transitional issues - needs hct checked at pcps office; if he has ongoing gibleeding without a clear source, he will need outpatient prbc transfusions to keep hct above 25 given his cad medications on admission: preadmission medications listed are correct and complete. information was obtained from patient. 1. glargine 10 units breakfast 2. lisinopril 2.5 mg po daily 3. pravastatin 20 mg po daily 4. fish oil (omega 3) 1000 mg po daily discharge disposition: home discharge diagnosis: anemia- occult gi bleed atrial flutter severe aortic stenosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital with anemia (low blood count). you received four blood transfusions, and your blood count stabilized. you underwent multiple endoscopic procedures, which did not reveal a source of bleeding in your gi tract. you suffered an aspiration event during one of the endoscopies, and needed to be placed on a mechanical ventilator in the icu for two days. you were then transferred back to the medical floor. there, you were seen by the cardiology team, who helped stabilize your heart rate with a new medication. you were also started on aspirin and your blood count remained stable. medication changes: please start taking metoprolol xl 100 mg a day to keep your heart rate well controlled. cardiology advised a small dose of aspirin 81 mg daily please take omeprazole 40 mg daily to prevent further bleeding followup instructions: name: , md specialty: primary care when: friday at 1:45pm location: healthcare - address: , , phone: name: dr. specialty: cardiology when: wednesday at 10am where: phone: ( department: div. of gastroenterology when: tuesday at 2:30 pm with: , md building: ra (/ complex) campus: east best parking: main garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours other endoscopy of small intestine other endoscopy of small intestine colonoscopy transfusion of packed cells diagnoses: acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acquired coagulation factor deficiency atrial fibrillation aortic valve disorders atrial flutter acute respiratory failure pneumonitis due to inhalation of food or vomitus long-term (current) use of insulin other acquired absence of organ hemorrhage of gastrointestinal tract, unspecified benign neoplasm of colon diverticulosis of colon (without mention of hemorrhage) gastroparesis personal history of malignant neoplasm of esophagus personal history of malignant neuroendocrine tumor 

Answer: The patient is high likely exposed to