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: compazine / lisinopril / cephalexin attending: chief complaint: melena major surgical or invasive procedure: egd with epinephrine injection and endoclip of duodenal ulcer history of present illness: 46 year old male with etoh abuse and history of duodenal ulcer (), etoh pancreatitis (), gerd, htn, hemmorhoids, and possible ra presents with melena x 1.5 days with some hematochezia in addition. he reports the onset of black tarry stools at about 11am on . overnight through the morning of he had multiple (~8) episoides of melena. this then tappered off over the day and his last episode was at 2pm with just a scant amount of melena. he reports being slightly dizzy when he stands up. no loss of consciousness, 2 episoides of non-bloody emesis, epigastric pain. + anorexia, no cp, no sob, no fevers. notably patient had duodenal ulcer in treated with epi injection and cautery. he was h.pylori positive (serology) at that time and does not remember if he was treated. he was recently discharged from after a binge episode of drinking resulted in pancreatitis. he was discharged on omeprazole. since discharge he reports occasional drinking (although none in past week) and heavy aleve use (at least a dozen in past week). it is unclear if he has been taking his omeprazole regularly. in the ed, initial vs were: 99.6 74 116/63 16 100%. he was placed on ppi drip, type and cross 2 units was performed. gi evaluated and felt he was stable for egd in am. which he underwent. past medical history: 1. perforated duodenal ulcer in treated with epi injection and cautery 2. acute etoh pancreatitis , binging 3. hx of etoh abuse 4. htn 5. osteoarthritis/rheumatoid arthritis: seen by rheum at who feel c/w osteoarthritis, not ra 4. left hip dislocation and subsequently avascular necrosis of the left hip 6. appendectomy in social history: single, lives alone. gf is emergency contact. on disability after his hip replacement, formerly worked for town of in maintenance. tobacco- none ever etoh- per patient, occasional (~1 beer every 2 weeks), however on prior admission () stated he drank 4-5 drinks per night. reports a binging pattern with binges every few months. drugs- denies present or past. previous discharge summaries note former cocaine abuse > 20 years ago family history: father with lung cancer (smoker) and htn. mother years old with diverticulitis, htn, ulcer disease. brother is healthy. physical exam: admission exam vitals: 79, 115/66, 19, 100% ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, tender along epigastrum w/o rebound or guarding, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact discharge physical exam: vs - temp 98.2 f, 130/69 bp , 66 hr , 20 r , 100 o2-sat % ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, perrl, eomi neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, i/vi systolic murmur at llsb abdomen: soft, ttp in upper epigastrium, no hsm, nabs, no rebound tenderness or guarding ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema skin: no rashes or lesions neuro: awake, a&ox3, cns ii-xii grossly intact pertinent results: admission labs: 04:00pm blood wbc-5.0 rbc-3.20*# hgb-10.7*# hct-31.7*# mcv-99* mch-33.4* mchc-33.6 rdw-13.3 plt ct-220 04:00pm blood neuts-54.7 lymphs-29.8 monos-7.0 eos-7.6* baso-0.9 05:20pm blood pt-12.2 ptt-21.9* inr(pt)-1.1 04:00pm blood glucose-109* urean-12 creat-0.8 na-136 k-5.0 cl-101 hco3-24 angap-16 04:00pm blood alt-252* ast-300* alkphos-79 totbili-0.5 04:00pm blood lipase-31 03:59am blood calcium-8.3* phos-4.1# mg-2.0 05:29pm blood hgb-9.8* calchct-29 relevant labs: 10:02pm blood hct-25.5* 03:59am blood wbc-3.2* rbc-2.54* hgb-8.4* hct-25.0* mcv-98 mch-33.2* mchc-33.8 rdw-13.5 plt ct-149* 07:40am blood hct-27.0* 12:00pm blood hct-25.6* 05:32pm blood hct-26.0* discharge labs: 06:10am blood wbc-4.4 rbc-2.81* hgb-9.5* hct-27.9* mcv-99* mch-34.0* mchc-34.2 rdw-13.8 plt ct-223 01:40pm blood hct-28.3* microbiology: 9:35 pm mrsa screen source: nasal swab. **final report ** mrsa screen (final ): no mrsa isolated. imaging: kub impression: no evidence of free intraperitoneal air or bowel obstruction. cxr (pa/lat): the cardiac, mediastinal and hilar contours are within normal limits. the pulmonary vascularity is normal. the lungs are clear. no pleural effusion or pneumothorax is present. there are multilevel degenerative changes in the thoracic spine. multiple old healed right-sided rib fractures are again noted. there is no free air under the diaphragms. impression: no acute cardiopulmonary abnormality. no free air under the diaphragms. egd: ulcer in the lower third of the esophagus near the ge junction erythema in the stomach body and antrum compatible with gastritis erythema with erosion in the first part of the duodenum compatible with duodenitis ulcer in the first part of the duodenum (injection, endoclip) abnormal mucosa in the lower third of the esophagus otherwise normal egd to third part of the duodenum brief hospital course: 46 yo m w/ pmh of pud and alcohol abuse who presented with melena in the setting of using nsaids for pain who was found to have a duodenal ulcer, which was treated during endoscopy. active issues: # acute blood loss anemia due to gastric and duodenal ulcers with bleeding - patient has a history of peptic ulcer disease complicated by perforation in the past and was h. pylori postiive in the past. he was admitted with melena and hct drop from 44 down to 29 over two months. he was symptomatic with the anemia with dizziness. he was started on a ppi drip and admitted to the micu to monitor overnight, and his hematocrits were trended. he had no further bowel movements on his first night. he has a history of alcohol binging however with his nausea and vomiting it was non-bloody and non-bilious making - tear and varices less likely. egd on showed: ulcer in the lower third of the esophagus near the ge junction; erythema in the stomach body and antrum compatible with gastritis; erythema with erosion in the first part of the duodenum compatible with duodenitis; ulcer in the first part of the duodenum (injection, endoclip); abnormal mucosa in the lower third of the esophagus consistent with esophagus; otherwise normal egd to third part of the duodenum. he required intubation per gi requests. patient tolerated the procedure well, with stable hematocrits for the remainder of his hospitalization. given history of untreated h. pylori and findings on egd, he was treated with triple therapy for h. pylori: continuation of ppi, along with clindamycin and amoxicillin for a duration of two weeks. chronic issues: #alcohol dependence- patient had recent hospitalization for pancreatitis in the setting of alcohol binging. he did not score on the ciwa while in the micu. social work was consulted, and patient was counseled against further binge drinking habits. treated with thiamine, mvi and folic acid. #transaminitis: patient noted to have elevated transaminases, likely in the setting of etoh abuse. hepatitis serologies were sent and were negative. he should be vaccinated for hbv. transitional issues - should be immunized for hepatitis b - patient should have repeat endoscopy in weeks. he will be contact by gastroenterology to schedule follow up visit. medications on admission: preadmission medications listed are correct and complete. information was obtained from patient. 1. atenolol 100 mg po bid 2. omeprazole 20 mg po bid 3. ibuprofen 600 mg po q8h:prn pain 4. oxycodone-acetaminophen (5mg-325mg) 2 tab po q6h:prn pain discharge medications: 1. amoxicillin 1000 mg po q12h day 1 = for 14 days rx *amoxicillin 500 mg 2 capsule(s) by mouth every 12 hours disp #*54 capsule refills:*0 2. clarithromycin 500 mg po q12h day 1 = for 14 days rx *clarithromycin 500 mg 1 tablet(s) by mouth every 12 hours disp #*27 tablet refills:*0 3. omeprazole 20 mg po bid 4. atenolol 100 mg po bid 5. oxycodone-acetaminophen (5mg-325mg) 2 tab po q6h:prn pain discharge disposition: home discharge diagnosis: primary diagnoses: duodenal ulcer bleed barrett's esophagitis secondary diagnoses: hypertension osteoarthritis alcohol abuse discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure to participate in your care here at ! you were admitted for evaluation of an upper gastrointestinal bleed, which was found to be due to an ulcer in your small intestine (duodenum). this was treated with an injection of epinephrine and a clip. your bleeding resolved, and your blood counts were stable. you should continue pantoprazole, which will protect you against further bleeding. you should stop using an nsaid pain medications (ibuprofen, motrin, alleve, naproxen). while you were admitted, we started treatment for helicobacter pylori, which may be causing your stomach irritation, esophageal irritation, and ulcer diseases. please note, the following changes have been made to your medications: start clindamycin start amoxicillin it is especially important that you continue your omeprazole. please see below for your follow-up appointments. wishing you all the best! followup instructions: name: fonseka,janaki when: thursday at 9:30am location: rehab address: , , phone: you will be scheduled for a repeat endoscopy study in a few weeks. dr. from the gastroenterology department will contact you to schedule this. if you have questions or concerns for their team, please call: . procedure: endoscopic control of gastric or duodenal bleeding diagnoses: esophageal reflux unspecified essential hypertension acute posthemorrhagic anemia osteoarthrosis, unspecified whether generalized or localized, site unspecified chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction other and unspecified alcohol dependence, unspecified barrett's esophagus benign essential hypertension 

Answer: The patient is high likely exposed to