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: patient recorded as having no known allergies to drugs attending: chief complaint: hematemesis and hypotension major surgical or invasive procedure: egd with banding endotracheal intubation cvl history of present illness: 73 year old gentleman with a pmh significant for meld 21 etoh cirrhosis complicated by encephalopathy and varices, etoh abuse, htn, and recent mva admitted for hematemesis now transferred to the micu for hypotension, arf, and leukocytosis. the patient initially presented to an osh after developing a large amount of hematemesis (>1l per report) described as dark red blood with a hct of 19. the patient intubated for airway protection and then transferred to on . in the ed, he was noted to have a positive fast exam in the ruq with an initial hct of 21.7. of note, the patient was initially admitted to the t/sicu on the trauma service as had an mva 1 week ago and signed out ama. he was rescucitated with 4 units of prbc and 2 units ffp and was started on an octreotide gtt, protonix gtt, and ciprofloxacin for sbp prophylaxis. he underwent upper endoscopy yesterday that demonstrated 3 cords of grade 3 varices that were banded and a small non-bleeding duodenal ulcer. his hematocrit has since remained stable at 28-31. his hospital course has been complicated by hypotension (80s/40s) requiring vasopressors with norepinephrine and phenylephrine, a rising leukocytosis to 30.2 with a left shift, and acute renal failure with a peak creatinine of 2.5. . ros: unable to obtain as patient is intubated. past medical history: etoh cirrhosis with encephalopathy and continued etoh abuse as per pcp, has refused egd in the past, no awareness of hematemesis in the past htn hyperglycemia hyperlipidemia gout gerd hiatal hernia cholelithiasis hx of traumatic fx of nose bph hx of facial erysipelas social history: unable to obtain family history: unable to obtain physical exam: 98.5 94 97/45 25 100% ac 500x16,5,0.5 gen: intubated heent: scleral icterus, perrl, ett in place cv: nl s1+s2, ii/vi systolic murmur at base. pulm: bilateral rales (l>r) anteriorly abd: distended, umbilical hernia, +bs. -fluid wave ext: 2+ pitting edema bilaterally neuro: unresponsive. perrl pertinent results: egd : varices at the middle third of the esophagus, lower third of the esophagus and gastroesophageal junction (ligation) blood in the stomach body and antrum hiatal hernia seen ulcer in the first part of the duodenum otherwise normal egd to second part of the duodenum brief hospital course: 73m with cirrhosis, admitted with hematemesis secondary to esophageal varices. after a prolonged micu stay, he was transferred to the - service for further management. . hematemesis/anemia: patient found to have grade 3 varices and duodenol ulcers with banding. he was maintained on ppi, with stable hematocrit. on patient had bloody respiratory secretions, for which he was given vitamin k (since poor nutritional status). bronch showed only small abrasions as source for bleeding, likely suctioning. hematocrit, platelets, and inr remained stable during hospital course. on , patient underwent relook endoscopy which showed improvement to grade 1 varices and no intervention was done. plan upon discharge was for repeat scope in 3months. . liver disease/hepatic encephalopathy: on admission, transaminases were mildly elevated, with elevated inr and low albumin and worsening hyperbilirubinemia that resolved. he had an abdominal ultrasound with dopplers on , which showed patent hepatic flow and minimal ascites. ogt was placed by hepatology and he was maintained on lactulose and rifaximin starting on . on transfer to floors patient had poor mentation and was a&ox2 and had an episode of aspiration. a dobhoff was placed and patient was pan-cultured given deterioration in mental status. initial blood cultures grew out gram positive cocci, cxr with bibasilar consolidations, echo neg for vegetations, and patient was started on broad spec antibiotics. final blood cultures showed only contaminants with coag neg staph and so antibiotics were discontinued. patient was agitated and pulled out dobhoff three times, which had to be placed ultimately by ir. patient's mentation improved with lactulose. . hypotension: initially patient was hypotensive likely secondary to hypovolemia from hematemesis (large grade 3 varices of the esophagus). on admission, patient was 1 week s/p mva and had positive fast exam, but negative for acute trauma on cta. an echo on showed preserved lvef. also on admission, there was a concern for sirs in the setting of leukocytosis and vasopressor requirement. he was pancultured, with negative results to date, but given a 7 day course for hap vs sbp (vancomycin, zosyn, and cipro from to ) after having fevers, rigors, increased sputum production and potential aspiration pneumonia on cxr. he was maintained on map>65, uop>30 cc/hr, cvp>12, scvo2>70 with ivf bolus, colloid/blood products, and norepinephrine as necessary to maintain hemodynamic goals. he was weaned off pressors on . upon transfer to the floors, hypotension resolved. . respiratory failure: patient intubated for airway protection at osh. this likely was fluid overload originally, but with questionable pneumonia superimposed. he improved after diuresis and antibiotics and was extubated on without difficulty. while in the micu his goal diuresis was 1.5-2l daily, which was initially achieved with lasix drip. lasix drip was discontinued on , as patient was making good uop with metolazone and spironolactone alone. upon transfer diuretics were held given hypernatremia (see below). patient also had episode of aspiration in the micu and on the floor and was placed on aspiration precaution. as mentation improved patient was cleared by speech and swallow. . acute renal failure: creatinine has trended down from peak of 2.5 on admission to 1.4-1.5 during later part of stay in micu. he had been started on midodrine, octreotide, and albumin for possible hrs, but these were discontinued on . upon transfer to the floors, metolazone was held. the patient's creatine trended down to 1.1 on discharge. . cv: patient with ecg on admission without acute st-t wave changes suggestive of ischemia. cardiac biomarkers during admission with elevated ck in 400s with flat mb (ck 578 on ) but with rising tnt 0.08->0.19 suggesting demand ischemia and/or impaired clearance in setting of arf. tnt did trend down and ecg's normalized. . hypokalemia, hypernatremia: patient was persistently hypokalemic towards end of micu stay, likely secondary to lasix drip. he was requiring iv and po potassium repletion daily. upon transfer, his lasix drip had been stopped and potassium levels remained within normal limits. upon transfer patient had hypernatremia secondary to aggressive diuresis while in the icu. lasix and metolazone were not restarted, and patient was corrected with free water fluids. . nutrition: ogt was placed by hepatology and he was maintained on lactulose and rifaximin starting on . upon transfer patient had episode of witnessed aspiration, put on aspiration precaution and dobhoff was placed. dobhoff was pulled by patient as he was agitated and had to be replaced by ir twice. on discharge patient passed speech and swallow and was able to take in pos. . thrombocytopenia: likely secondary to sequestration in setting of liver disease and portal hypertension. platelets remained stable during her stay. . medications on admission: medications (home): obtained from family lactulose - dose unknown omeprazole 20 mg allopurinol 300 mg tramadol 50 g metolazone 2.5 mg ferrous sulfate 325 mg celebrex 200 mg spironolactone 25 mg bumetanide 2 mg benicar 20 mg potassium 20 meq . medications (on transfer): chlorhexidine gluconate 0.12% oral rinse 15 ml oral ciprofloxacin 400 mg iv q12h fentanyl citrate 25-100 mcg/hr iv drip infusion insulin sc calcium gluconate iv sliding scale magnesium sulfate iv sliding scale midazolam 2-4 mg iv q2h:prn anxiety norepinephrine 0.03-0.25 mcg/kg/min iv drip titrate to map > 60 octreotide acetate 50 mcg/hr iv drip infusion pantoprazole 8 mg/hr iv infusion potassium chloride iv sliding scale potassium phosphate iv sliding scale propofol 5-20 mcg/kg/min iv drip titrate to sedation . discharge medications: 1. lactulose 10 gram/15 ml syrup sig: 30-60 mls po qid (4 times a day): please titrate to 3 bowel movements daily. 2. pantoprazole 40 mg recon soln sig: one (1) dose unit intravenous twice a day. 3. allopurinol 300 mg tablet sig: one (1) tablet po once a day. 4. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 5. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). 6. nadolol 20 mg tablet sig: two (2) tablet po daily (daily). 7. folic acid 1 mg tablet sig: one (1) tablet po q24h (every 24 hours). discharge disposition: extended care facility: hospital discharge diagnosis: 1. esophageal variceal bleed 2. cirrhosis discharge condition: stable vital signs: afebrile, normotensive, breathing comfortably on ra ~600cc stool/day via flexiseal euvolemic to slightly negative fluid balance mental status: alert and oriented x3, at his best when his family is at the bedside, at his worst at night. some daytime somnolence. portuguese speaking only discharge instructions: you were admitted with bleeding from your esophagus, from varicose veins. we placed "bands" around these bleeding veins to prevent further bleeding, and this improved your condition. you will need to have another endoscopy in three months re-evaluate these veins, and ensure that they continue to do well. . we made the following changes in your medications: 1. you should increase your omeprazole from 20mg once daily to 40mg twice daily when you leave rehab 2. we have stopped your tramadol and celebrex 3. we are holding your metolazone, bumex, and lasix. the lasix may be restarted in rehab 4. we stopped your iron pills, as these may cause constipation 5. we stopped your benecar, as you blood pressure was normal 6. we stopped your potassium supplement. 7. we started a medication called rifaximin, which will help with your cirrhosis 8. we started a medication called nadolol, which will help prevent your varices from bleeding again 9. we started vitamins called folic acid. . please follow up as indicated below. . if you develop further bleeding with vomiting, black or bloody stools, dizziness, abdominal pain, confusion, or any other concerning symptoms, please return to the emergency room to be evaluated. followup instructions: when you complete your rehabilitation, please call our hepatology clinic and make an appointment to see one of our hepatologists regarding your diagnosis of cirrhosis, the phone number here is you have an appointment to have a repeat endoscopy on wednesday at 12:30pm. their phone number is procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus endoscopic excision or destruction of lesion or tissue of esophagus transfusion of packed cells transfusion of other serum diagnoses: thrombocytopenia, unspecified esophageal reflux urinary tract infection, site not specified unspecified essential hypertension acute posthemorrhagic anemia alcoholic cirrhosis of liver acute kidney failure, unspecified portal hypertension gout, unspecified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) hypopotassemia diaphragmatic hernia without mention of obstruction or gangrene other and unspecified hyperlipidemia acute respiratory failure other ascites esophageal varices in diseases classified elsewhere, with bleeding other disorders of plasma protein metabolism encephalopathy, unspecified hyperosmolality and/or hypernatremia ventilator associated pneumonia other and unspecified alcohol dependence, unspecified other nonspecific abnormal serum enzyme levels other abnormal glucose shock, unspecified duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation, without mention of obstruction 

Answer: The patient is high likely exposed to