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: morphine attending: chief complaint: bright red blood per rectum major surgical or invasive procedure: none history of present illness: from admission note: 59 y/o m with pmhx of esrd on hd, gi bleeds, cad and polysubstance abuse who was brought into the ed via ems after his wife witnessed a syncopal episode. pt was complaining of left sided chest pain but was drowsy on arrival. in the ed, initial vs were: t 96.8 p 60 bp 92/52 r o2 sat 100% on nrb. pt some new twi on ekg in v2-v6 and was being bolused for hypotension. at midnight, pt was noted to be having possible seizure activity with left eye deviation and foaming at his mouth. after this activity ceased, pt was post ictal and unable to be aroused. he was intubated with etomidate and rocuronium due to concern for inability to protect his airway. pt remained mildly hypotensive and hct came back at 24 (down from baseline of 30). he had a right femoral cvl placed and rectal exam revealed brown stool mixed with blood. og tube was placed and there was no evidence of hematemesis. pt was typed and crossed for 4u prbcs and bolused with a total 3l ivf. he received aspirin 325mg, zofran, protonix, vanc & zosyn for possible sepsis and was transferred to the icu. on arrival to the icu, pt was intubated and sedated. review of sytems: unable to obtain past medical history: # esrd on (tues/thurs/sat, dialysis, , ) # type 2 diabetes mellitus - peripheral neuropathy # cad s/p mi (patient cannot recall) - cardiac catheterization in without flow limiting stenoses - mibi in showed reversible defects inferior/lateral # chf with ef 30-35% ( tee) # atrial fibrillation/atrial flutter s/p aflutter ablation - not on anticoagulation # h/o atrial tachycardia s/p eps and ablation x 2 for l sided, triggered (not reentrant) atachs # hypertension # dyslipidemia: tc 101, ldl 54, hdl 29, tg 112 # history of gastrointestinal bleed: - duodenal, jejunal, and gastric avms s/p thermal therapy - diverticulosis throughout colon # chronic pancreatitis # ? hepatitis c, positive hcv ab in , subsequently negative x 2 , # gerd # gout s/p arthroscopy with medial meniscectomy # depression s/p multiple hospitalizations due to si # polysubstance abuse: crack cocaine, etoh, tobacco - frequent bouts of chest pain following crack/cocaine use # erectile dysfunction s/p inflatable penile prosthesis social history: he lives with a female partner in , ma. 42 pack-year smoking history, recently up to 6 cigarettes per day. he has a history of alcohol abuse, with dts and detoxification, with last drink on . history of crack cocaine use, with last use ~2 weeks ago. family history: father with alcoholism. mother with type 2 diabetes, renal failure, died at age 58. son with diabetes. cousin with cell disease. physical exam: on discharge: vss: 98, 133/86, 93, 22, 96% 2l finger sticks: 212, 238, 93 gen: well-appearing. nad. scratching skin. skin: numerous macular lesions diffuse over the trunk and limbs. no apparent involvement of the palms. heent: perrl. mmm cv: rrr. normal s1 and s2. no m/r/g. pulm: cta bilaterally. abd: soft, mildly distended. no rebound or guarding. ext: trace bilateral edema. neuro: a&ox3. pertinent results: ct head : findings: there is no intracranial hemorrhage, shift of normally midline structures, or evidence of acute major vascular territorial infarct. ventricular and sulcal size are unchanged. other than a small mucus-retention cyst in the right maxillary sinus the paranasal sinuses remain well aerated as are the mastoid air cells. the 3.4 x 1.1-cm hyperdense mass overlying the right occipital bone is unchanged compared to . impression: no intracranial hemorrhage or edema. cxr : again seen is moderate cardiomegaly. the endotracheal tube has been removed and the ng tube has been removed. there is a moderate right effusion with associated right lower lobe volume loss. there continues to be pulmonary vascular redistribution with perihilar haze, however, this is improved in appearance compared to the film from three days ago. ruq us : 1. no intra- or extra-hepatic bile duct dilatation. 2. no significant gallbladder disease with redemonstration of a tiny gallbladder polyp and likely adenomyomatosis. 3. increased hepatic echogenicity suggest diffuse fatty infiltration although more advanced forms of liver disease such as fibrosis/cirrhosis cannot be excluded. 11:00pm blood wbc-6.5 rbc-2.60* hgb-8.0* hct-24.9* mcv-96# mch-30.7 mchc-32.1 rdw-18.3* plt ct-254 07:45am blood wbc-6.4 rbc-3.08* hgb-9.2* hct-28.4* mcv-92 mch-29.9 mchc-32.5 rdw-17.0* plt ct-235 11:00pm blood neuts-74.7* bands-0 lymphs-16.6* monos-6.2 eos-1.9 baso-0.5 04:34am blood pt-15.0* ptt-27.6 inr(pt)-1.3* 07:45am blood glucose-91 urean-58* creat-6.9* na-135 k-5.5* cl-98 hco3-24 angap-19 11:00pm blood glucose-242* urean-40* creat-5.3* na-135 k-8.1* cl-91* hco3-29 angap-23* 07:45am blood alt-30 ast-27 alkphos-262* amylase-166* totbili-1.0 08:00am blood ggt-296* 11:00pm blood ck(cpk)-172 04:27am blood ck-mb-notdone ctropnt-0.29* probnp-* 07:15am blood albumin-3.6 iron-74 08:00am blood calcium-9.5 phos-4.0 mg-1.9 07:15am blood caltibc-328 ferritn-535* trf-252 04:27am blood vitb12-1252* folate-13.9 12:07pm blood ammonia-32 04:27am blood osmolal-310 04:27am blood tsh-3.8 11:00pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 03:01am blood lactate-3.9* rpr neg blood cultures neg brief hospital course: 59 y/o m with pmhx of esrd, gi bleed, cad and polysubstance abuse who presents with borderline hypotension, ms changes and gi bleed. # hypotension: suspected etiology most likely hypovolemia exacerbated by gi bleed, with further drop peri-intubation. given lack of tachycardia, fever or leukocytosis, sepsis was considered unlikely. pt remained in baseline wenkebach with rate in 70s-80s, without any additional symptoms or episodes on telemetry, specifically no intermittent complete heart block. bp improved with volume resuscitation. # ms changes/seizure?: suspect that hypotension lead to hypoperfusion and ms changes. it is unclear if there was true seizure activity prior to intubation. ct head negative for acute ic pathology. tsh, rpr, folate, vit b12 were all normal # gi bleed: pt with long standing history of avms and gi bleeds. og did not reveal any coffee grounds but frank red stool in vault. hematocrit stabilized after 2 units of prbcs, although with persistent maroon stools. pt was treated with iv ppi, and evaluated by gi who did not feel a scope was necessary at the time. on discharge pt was still having guaiac positive stools but hct remained stable at 28.4. # resp failure: pt was mildly hypoxic on arrival and cxr showed vascular congestion. ultimately, pt was intubated after possible seizure activity and decreased responsiveness with successful extubation on . # cad: cath in showed no flow limiting disease. he presented with cp and new twis in v2-v6. however, ck/mbs flat and troponin close to baseline given esrd. low suspician for acs but was monitored on telemetry. he was continued on a statin while asa and bp meds held. these were restarted prior to discharge once bp had stabilized. pt may be in decompensated heart failure but unclear given unusual presentation. # esrd on hd: pt was maintained on his usual hd regimen and tolerated all dialysis sessions well. # diabetes: pt was monitored qid and treated with humalog sliding scale. medications on admission: labetalol 100 mg tid amiodarone 200 mg daily lisinopril 10 mg daily atorvastatin 20 mg daily cinacalcet 30 mg daily pantoprazole 40 mg daily sertraline 100 mg daily multivitamin daily gabapentin 300 mg q48hr dilt-xr 180 mg daily diphenhydramine hcl 25 mg qid nph 15units & 10units qpm insulin lispro sevelamer 800mg tid discharge medications: 1. diphenhydramine hcl 25 mg capsule sig: one (1) capsule po q6h (every 6 hours) as needed. :*56 capsule(s)* refills:*0* 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. insulin continue nph 15units every morning and 10units every evening; also continue lispro as before. 4. sertraline 50 mg tablet sig: two (2) tablet po daily (daily). 5. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 6. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 7. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*2* 8. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*2* 9. sevelamer hcl 800 mg tablet sig: one (1) tablet po three times a day. 10. multivitamin tablet sig: one (1) tablet po once a day. 11. cinacalcet 30 mg tablet sig: one (1) tablet po once a day. 12. labetalol 100 mg tablet sig: one (1) tablet po three times a day. 13. lisinopril 10 mg tablet sig: one (1) tablet po once a day. 14. dilt-xr 180 mg capsule,degradable cnt release sig: one (1) capsule,degradable cnt release po once a day. 15. gabapentin 300 mg capsule sig: one (1) capsule po every other day. discharge disposition: home with service facility: discharge diagnosis: primary: syncope, gi bleed secondary: h/o gi bleeds, esrd on . discharge condition: stable, hct 28.4 discharge instructions: you were admitted for bloody bowel movements and syncope. the gastroenterology team evaluated you and decided there was no need to re-scope your colon, but recommended that you get a small bowel capsule study as an outpt. your blood counts stabilized with transfusion. please take all of your medications as prescribed and follow up with the below. please bring your prescription bottles to your appointment with dr . if you develop fever/chills, fainting, blood in your stool or any other concerning symptoms, please contact your doctor or go to the emergency room. it was a pleasure taking care of you, we wish you the best! followup instructions: provider: , dpm phone: date/time: 3:50 provider: , md phone: date/time: 1:40 md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube hemodialysis diagnoses: end stage renal disease coronary atherosclerosis of native coronary artery other, mixed, or unspecified drug abuse, unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes hemorrhage of gastrointestinal tract, unspecified hypovolemia 

Answer: The patient is high likely exposed to