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: motrin / erythromycin base attending: chief complaint: melena major surgical or invasive procedure: egd history of present illness: 77 year old female with history of gi bleed , esophageal stricture, hypothyrodisim, recent aaa repair presents from her pcp's office with c/o black stool x 2 days. she states he has been having low energy since her operation. she was sent to rehab where she had a uti and c diff both treated with abx. since her arrival home, she has been fatigued. she noticed dyspnea on exertion with 10-15 feet and stairs (this is new for her) as well as palpitations. she denies chest pain but has sob with walking, occasional cough. no n/v. in the ed, sbp 90s with hr 100s. ng lavage was negative and cta abdomen was negative for aortoenteric fistula. of note, while in , she had multiple episodes of melena, for which she underwent a colonoscopy (small internal hemorrhoids), egd (fundal polyp, antral gastritis, bx negative for h. pylori), capsule endoscopy (small bowel erosion and thickened small bowel mucosal fold). past medical history: 1. esophageal stricture s/p dilation in , dr 2. gi bleed : colonoscopy (small internal hemorrhoids), egd (fundal polyp, antral gastritis, bx negative for h. pylori), capsule endoscopy (small bowel erosion and thickened small bowel mucosal fold 3. hypercholesterolemia 4. allergic rhinitis 5. borderline glaucoma 6. stress echo in : 7.5 min modified ; nonanginal chest discomfort in the absence of ischemic ekg changes. no echocardiographic evidence of ischemia to achieved workload. 7. s/p aaa repair 8. h/o c. diff 9. hypothyroidism 10. mild as social history: married, former hairdresser. former smoker, 1 ppd x 20 yrs, quit several years ago, no etoh, 2 children. family history: mother colon cancer. brother died of cad/esrd/dm physical exam: physical exam on admission vs: 98.0, hr 99, 99% ra, rr 18, 135/65 gen - alert, no acute distress heent - perrl, extraocular motions intact, anicteric, mucous membranes moist neck - no jvd, no cervical lymphadenopathy chest - clear to auscultation bilaterally cv - normal s1/s2, rrr, 3/6 sem rad to axilla and carotid, no rubs, or gallops abd - soft, nontender, nondistended, with normoactive bowel sounds, guaic deferred given done in ed, well healed surgical scar on left side of abdomen back - no costovertebral angle tendernes extr - no clubbing, cyanosis, or edema. 2+ dp pulses bilaterally neuro - alert and oriented x 3, cranial nerves intact, upper and lower extremity strength 5/5 bilaterally, sensation grossly intact skin - no rash pertinent results: laboratory studies on admission wbc-7.9 hgb-9.2 hct-28.3 mcv-97 rdw-15.2 plt count-383 neuts-73.7 lymphs-21.2 monos-4.4 eos-0.4 basos-0.2 sed rate-115 -> 61 () iron-58 caltibc-277 vit b12-499 folate >20 ferritin-136 trf-213 pt-21.0* ptt-33.7 inr(pt)-2.0* -> pt-12.2 ptt-18.6* inr(pt)-1.1 (possible laboratory error) fibrinoge-486 d-dimer-4174 ekg: nsr 80, avl tw inversion, poor rw progression, no st changes compared to radiology cxr: no acute process cta abd: 4.4-cm infrarenal aortic aneurysm status post graft repair without evidence of extravasation of contrast or aortoenteric fistula. moderate-sized hiatal hernia. tte: left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. 2. the ascending aorta is mildly dilated. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis. compared with the report of the prior study, there is no significant change small bowel enteroscopy: stricture of the gastroesophageal junction. normal mucosa in stomach, duodenum, and jejunum. brief hospital course: 77 year old female s/p aaa repair, history of esophogeal stricture/gi bleed, presents with melena and blood loss anemia. 1) gi bleed: this was most likely from an upper gi source, given melena. extensive prior work-up 12/05 (colonoscopy, egd, pill endoscopy) with only gastritis and small bowel erosion. the patient was initially admitted to the medical icu, where egd/small bowel enteroscopy showed only a distal esophageal stricture, but was otherwise normal to the jejunum. as mentioned above, a cta of the abdomen was negative for aortoenteric fistula in the emergency department. she received 2 units of prbc on for hct 26.4, after which the patient's hematocrit remained stable (35 at time of discharge). the gastroenterology service, who followed the patient during her hospital stay, recommended outpatient stricture dilation (the patient reported she would like to follow-up with dr. as an outpatient) and possible repeat capsule endoscopy (following dilation to prevent pill impaction in the esophagus). the patient was continued on a proton pump inhibitor. 2) acute blood loss anemia: this was due to upper gi bleed (see above). as mentioned above, hct stable at 35 following 2 units of prbc . iron studies were not consistent with iron deficiency anemia and vit b12/folate were within normal limits/high. the patient's hematocrit should continued to be closely followed as an outpatient. 3) dyspnea: most likely due to anemia, particularly given that it resolved following transfusion. ekg was without acute changes; cardiac enzymes negative x 2. transthoracic echocardiogram ef >55%, mildly dilated ascending aorta, mild as, no significant change since . 4) hypertension: the patient remained normotensive off her home dose of diovan. this can be restarted as an outpatient at the discretion of her primary care physician. 5) hypothyroidism: the patient was continued on her home dose of levothyroxine; tsh was within normal limits. 6) elevated esr: esr checked in the icu during acute gi bleed was elevated at 115, likely related to acute illness/stress response. the patient has no symptoms or physical findings consistent with temporal arteritis, and repeat esr had decreased to 61. this should be repeated following recovery from her acute illness and further work-up pursued at the discretion of her primary care physician. full code medications on admission: synthroid tab 0.1mg po daily, hold one day per week zocor tabs 20 mg (simvastatin) 1 po daily ativan tab 0.5mg (lorazepam) one po qhs prn meclizine tab 12.5mg (meclizine hcl) prn nexium 40 mg 1 po qd diovan caps 80 mg (valsartan) 1 po qd rhinocort aqua 32 mcg/act susp (budesonide (nasal)) 2 sprays each nostril qd miacalcin soln 200 iu/act (calcitonin (salmon)) 1 spray qd hycodan 5- vicodin 5-500 mg tabs (hydrocodone-acetaminophen) 1-2 tabs po q 6 hours prn pain discharge medications: 1. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 2. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 3. nexium 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 4. rhinocort aqua 32 mcg/actuation spray, non-aerosol sig: two (2) sprays nasal once a day. 5. calcitonin (salmon) 200 unit/actuation aerosol, spray sig: two hundred (200) units nasal daily (daily). discharge disposition: home discharge diagnosis: primary: upper gi bleed secondary: acute blood loss anemia, hypothyroidism, hypercholesterolemia, esophageal stricture, mild aortic stenosis discharge condition: good. the patient's hematocrit is stable at 35 without further evidence of rectal bleeding discharge instructions: 1) please take all medications as prescribed. you blood pressure is normal off your home dose of diovan; do not restart this medications until instructed to do so by your primary care physician 2) please follow-up as indicated below. 3) please follow-up with your primary care physician or come to the emergency room if you develop lightheadedness, shortness of breath, nausea, vomiting, abdominal pain, fevers, chills, rectal bleeding, persistant black stool, or other symptoms that concern you. followup instructions: 1) primary care: please call to schedule an appointment with your primary care physician (dr. ) to be seen within 1-2 weeks following discharge. - dr. will discuss restarting diovan - you should have a repeat esr checked, given it was elevated during your hospital stay. 2) gastroenterology: please call to schedule an appointment with dr. () - given recurrent gastrointestinal bleed of unclear source, an outpatient esophageal dilation and possible repeat pill endoscopy may be considered. md procedure: other endoscopy of small intestine transfusion of packed cells diagnoses: esophageal reflux pure hypercholesterolemia unspecified essential hypertension acute posthemorrhagic anemia unspecified acquired hypothyroidism aortic valve disorders blood in stool stricture and stenosis of esophagus 

Answer: The patient is high likely exposed to