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: variceal bleed major surgical or invasive procedure: endoscopic banding history of present illness: 62m w/ etoh cirrhosis decompensated with varices, htn, who presented to the ed with hematemesis on . the patient is unable to answer questions. history is from osh d/c summary. exam was notable for hypotension and tachycardia, and labs were notable for a hct 12.4 and inr 2.6 on presentation. he received 4u prbc in the ed and was admitted to the icu. he was seen by gi and had an egd which showed multiple cords of grade 2 esophageal varices with stigmata of recent bleeding. they did not band the varices. his hct after transfusion was 27. he was started on iv protonix and octreotide gtt. on the evening of , he had large volume hematemesis, hypotension to sbp 60s. he was intubated for airway protection and started on neosyncephrine and levophed. gi repeated egd and found an actively bleeding varix which they sclerosed. he received a total of 9u prbc and 4u ffp. levophed and neosynephrine were weaned on . he was subsequently hypertensive 160s-180s. on /3 bottles of his admission blood cultures grew gram positive cocci, later speciated to viridans strep, suspected enteric source with variceal bleed. no prior history of indwelling lines, endocarditis, or iv drug use. he was started on vancomycin and zosyn before culture speciation returned. surveillance blood cultures on from femoral line grew coag negative staph. admission urine culture grew 10-50k e. coli, but ua was not suspicious for uti. the patient developed loose stools and distended abdomen on in the setting of rising wbc, so stool was sent for c. diff (results not available) and patient was started on empiric metronidazole. octreotide gtt was d/c'd . he was extubated the morning of . post-extubation, he was noted to be confused and lethargic. his altered mental status was felt to be secondary to poorly metabolized versed. his ammonia level was 43, so hepatic encephalopathy was felt to be lower on the differential. he was transferred to for consideration of non-emergent tips. . on arrival to the micu, he was afebrile with hr 80s, bp 151/97, afebrile, 100% on ra. he was moving all extremities but not responding to name or following commands. he rarely spontaneously opened his eyes. past medical history: 1. etoh cirrhosis: decompensated with varices, h/o variceal bleed s/p banding 2. hypertension social history: lives with wife, . drink sometime between per wife. she is not aware of how much he drinks daily. occasional tobacco use. wife reports no history of drug use. family history: unable to obtain. physical exam: vitals- 98.0, 88, 151/97, 20, 98% ra gen- mildly agitated, not responsive to name, not following commands, rarely spontaneously opens eyes heent- icteric sclerae, pupils 1-2mm, ngt in place neck- supple, no jvd appreciated pulm- ctab but patient not cooperative with exam cv- rr, no murmurs auscultated abd- distended but fairly soft, tympanitic, no bulging flanks or appreciable dullness to percussion, no fluid wave, patient did not grimace to deep palpation extrem- l femoral tlc, trace ankle edema b/l, pneumoboots in place, dp/pt pulses full b/l neuro- occasionally spontaneously opened eyes during exam, moving all 4 extremities, did not cooperate with/resisted neuro exam pertinent results: wbc-18.2* rbc-3.74* hgb-11.1* hct-31.5* mcv-84 mch-29.8 mchc-35.3* rdw-15.7* plt count-103* - neuts-82.3* lymphs-11.3* monos-5.0 eos-1.2 basos-0.3 pt-16.5* ptt-34.7 inr(pt)-1.5* glucose-91 urea n-11 creat-1.1 sodium-141 potassium-3.9 chloride-114* total co2-20* calcium-7.7* phosphate-2.4* magnesium-1.8 alt(sgpt)-401* ast(sgot)-390* alk phos-74 tot bili-2.7* hep b and c studies pending urine cx, blood cx, catheter tip cx ngtd as of c diff toxin negative abdominal ultrasound: 1. small amount of right upper quadrant ascites. 2. patent portal vein. 3. decompressed gallbladder with stones and sludge within its lumen. gallbladder wall edema. this could represent third spacing due to low albumin. no albumin results are available on omr for this patient, and therefore correlation with laboratory values is recommended. if clinical concern exists for acute cholecystitis, consider a hida scan. single view cxr: an ng tube is present, tip beneath diaphragm. there are low inspiratory volumes. heart is probably not enlarged. there is no chf. there is bibasilar atelectasis. no gross effusion. slight prominence of the cardiomediastinal silhouette is likely accentuated by low lung volumes and lordotic positioning, probably also with unfolded aorta. tte: the left atrium is mildly dilated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) the estimated cardiac index is normal (>=2.5l/min/m2). transmitral doppler and tissue velocity imaging are consistent with normal lv diastolic function. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. there is a trivial/physiologic pericardial effusion. egd: 3 cords of grade ii esophageal varices. evidence of sclerotherapy of one varix in the lower third of the esophagus. 3 bands were placed successfully on the varices. friability, erythema, congestion, nodularity and mosaic appearance in the fundus compatible with portal gastropathy varices at the lower third of the esophagus and gastroesophageal junction (ligation) otherwise normal egd to second part of the duodenum brief hospital course: 1. variceal bleed: patient transferred 15u variceal bleed, s/p sclerosis of actively bleeding varix. patient's hematocrit subsequently stabilized and he remained hemodynamically stable. the liver service performed an egd that demonstrated 3 cords of grade ii esophageal varices with evidence of sclerotherapy of one varix in the lower third of the esophagus. 3 bands were placed successfully on the varices. the patient will need repeat egd in weeks for repeat evaluation and possible further banding. he will continue on pantoprazole 40mg qd and nadolol. 2. bacteremia: viridans strep from blood cultures at , presumed enteric source in setting of variceal bleed, initially on vancomycin at osh, but changed to ceftriaxone. pip-tazo was stopped given absence of gram negative aetiology for sepsis. was initially on metronidazole for empiric c. difficile treatment given diarrhea and marked leukocytosis, but c. difficile toxin was negative so this was discontinued. written for 2 week course of ceftriaxone from to . he was initially on vancomycin for coagulase negative staph but per osh culture data appears to be contaminant, so vancomycin discontinued. echocardiogram was done to assess for endocarditis and transthoracic echo was negative. per id the patient will need a transesophageal echocardiogram as an outpatient prior to completion of two week courses of ceftriaxone to determine whether he had endocarditis and will need a longer course of therapy. dr. , his primary care physician has been and will coordinate the tee. he should have cbc, electrolytes, and lfts remeasured as an outpatient while he is on the ceftriaxone to monitor renal and liver function. 3. alcoholic cirrhosis: decompensated with variceal bleed. wife denies history of encephalopathy, ascites, and sbp. liver enzymes elevated here, only mildly elevated ast on admission. management of variceal bleed as above. he was restarted on nadolol prophylaxis as above. 4. full code medications on admission: outpatient meds: protonix 40mg daily nadolol 20mg daily (?noncompliant) mvi folic acid 1mg daily thiamine 100mg daily . meds on transfer: protonix 40mg iv bid vancomycin 1g q12h piperacillin-tazobactam 3.375g iv q6h metronidazole 500mg iv q8h albuterol nebs q6h discharge medications: 1. thiamine hcl 100 mg tablet sig: one (1) tablet po once a day. 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. ceftriaxone-dextrose (iso-osm) 1 gram/50 ml piggyback sig: one (1) gram intravenous q24h (every 24 hours) for 8 days. disp:*7 gram* refills:*0* 4. picc line care picc line care per neht protocol. 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 6. nadolol 20 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: home therapy discharge diagnosis: variceal bleed etoh cirrhosis hypertension discharge condition: hemodynamically stable discharge instructions: you were admitted to the hospital with bleeding from veins in your esophagus. you required many blood transfusions to replace blood you lost from bleeding. endoscopic procedures at and here treated the varices with application of bands and with injection of solutions to prevent bleeding. you will need a repeat endoscopy in three weeks to reassess your bleed. in addition you were found to have an infection in your blood. you will need antibiotics for a total of two weeks through your iv. there is a chance that this infection may be affecting your heart. dr. will help you set up an appointment for a scan of your heart to determine whether you have this infection; if you do you will need to be treated for a longer period of time with antibiotics. please continue to take your medications as prescribed. please follow appropriate care for your picc line. if you develop bleeding, fevers, chills, confusion, or any other concerning symptoms please contact a physician . followup instructions: please follow up with your primary care physician . on thursday . you can call him at (. provider: (st-3) gi rooms date/time: 1:30 provider: , md phone: date/time: 1:30 provider: , md phone: date/time: 11:45 procedure: venous catheterization, not elsewhere classified endoscopic excision or destruction of lesion or tissue of esophagus diagnoses: unspecified essential hypertension alcoholic cirrhosis of liver bacteremia other ascites esophageal varices in diseases classified elsewhere, with bleeding streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus 

Answer: The patient is high likely exposed to