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: hypoxemia, leukocytosis, and hypotension major surgical or invasive procedure: paracentesis x5 esophagogastroduodenoscopy colonoscopy history of present illness: 51m with etoh cirrhosis c/b refractory ascites requiring large volume q 1-2 weeks and h/o multiple variceal bleeds with grade varices initially presented to rih to replace ngt and was found to have hyponatremia na 120. on the floor, his ngt was replaced, and his hyponatremia was treated with fluid restriction. four days after admission on , he developed brbpr and hematemesis with hypotension sbp 70s. emergent egd revealed acute bleed from grade 2 varix which was banded and severe esophagitis. he received a total of 5 units prbcs, 4 units ffp, octreotide drip x 5 days and iv ppi . he was intubated for airway protection and on pressors transiently for approximately 2 days. rij placed . his hct remained stable and he had no further episodes of bleeding. labs significant for leukocytosis wbc 30. cx were negative but he was noted to have bilateral airspace disease on cxr so was treated for vap with vanco cefepime currently day . ongoing hypoxia with 3-4l o2 requirement was felt to be due to resolving infection as well as volume overlaod so he was diuresed with iv lasix, recently 40mg iv bid. hyponatremia resolved with na 139 at time of transfer. he was also started on tpn . . he is being trasnferred to for continuity of care and ongoing trasnplant evaluation. vs on transfer: 105/75 93 97.7 27 94%3l. . on the floor, the pt is comfortable and in no acute distress. he complains of abdominal fullness and discomfort, like he "needs a tap", and feels as if this has affected his breathing. he reports cough productive of white phlegm and sob which he feels is secondary to abdomen. his last paracentesis was more than 2 weeks prior, and he usually gets tapped every week (8-9l). he denies current fever or chills and denies change in baseline tremor. review of systems: (+) per hpi (-) denies fever, chills. denies headache, change in vision. denies or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. past medical history: - alcoholic cirrhosis - s/p umbilical hernia repair in - copd? social history: previously lived in , ri, but now living with his brother in , ri. currently on ssdi, used to work at a medical supply company. single, never married, no children. stopped etoh 1 year ago. prior smoker, 1 ppd since age 16, stopped 2 months ago, now using the nicotine patch. no h/o ivdu or intranasal cocaine. history of marijuana in past, none currently. family history: - mother died at age of 70 due to complications from a fractured hip; she had osteoporosis and hypertension. - father - stroke. -the patient has 7 siblings. -brother died in at 26 and 1 brother who died last year of a brain aneurysm at the age of 50. the patient states that the rest of his remaining siblings are alive, well and healthy. - no history of liver disease or liver cancer in his family. physical exam: on admission: vitals: t: p96 bp166/69 rr29 93% on 4l nc general: alert, oriented to place and month and year, not date, no acute distress heent: sclera icteric + sublingual icterus, mm dry, oropharynx clear neck: supple, jvp not elevated, no lad lungs: bilateral rhonchi r>l mid lung field and anterior lung fields bilaterally. occ exp wheezes cv: distant heart sounds. regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, distended with positive fluid wave, bowel sounds present, no rebound tenderness or guarding, + splenomegaly gu: foley draining dark yellow urine ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. peripheral wasting. skin: multiple spider angiomata on torso. gynecomastia neuro: + resting tremor. no asterixis . on discharge: vs tm 97.7 tc 96.7, bp 100/56 (91-105/56-75), hr 91 (79-91), 20, 95%ra wt 79.4 kg general: alert, oriented and appropriate heent: sclera icteric, poor dentition lungs: ctab, no rhonchi, rales, or wheezes cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, distended, + fluid wave, bowel sounds present, no rebound tenderness or guarding ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. peripheral wasting. skin: multiple spider angiomas on torso. gynecomastia, caput neuro: a and ox3, no asterixis pertinent results: osh labs: - - na139 k4.0 cl11 hco32 bun40 cr1.08 glu132. ast51 alt43 alkphos 146 tbili2.8 alb2.6 wbc12.2 hct28.1 plt90. 10:19pm glucose-179* urea n-49* creat-1.3* sodium-137 potassium-4.1 chloride-106 total co2-21* anion gap-14 10:19pm alt(sgpt)-42* ast(sgot)-52* ld(ldh)-226 alk phos-164* amylase-118* tot bili-2.0* 10:19pm lipase-100* 10:19pm albumin-3.1* calcium-8.4 phosphate-3.6 magnesium-2.1 10:19pm wbc-15.7*# rbc-2.99* hgb-10.0* hct-30.5* mcv-102* mch-33.5* mchc-32.8 rdw-17.7* 10:19pm neuts-87.2* lymphs-4.8* monos-5.4 eos-2.3 basos-0.3 admission labs: 10:19pm blood wbc-15.7*# rbc-2.99* hgb-10.0* hct-30.5* mcv-102* mch-33.5* mchc-32.8 rdw-17.7* plt ct-135* 10:19pm blood neuts-87.2* lymphs-4.8* monos-5.4 eos-2.3 baso-0.3 10:19pm blood pt-16.5* ptt-35.0 inr(pt)-1.5* 10:19pm blood glucose-179* urean-49* creat-1.3* na-137 k-4.1 cl-106 hco3-21* angap-14 10:19pm blood alt-42* ast-52* ld(ldh)-226 alkphos-164* amylase-118* totbili-2.0* 10:19pm blood albumin-3.1* calcium-8.4 phos-3.6 mg-2.1 01:55pm blood hapto-71 05:07am blood vitb12-greater th folate-greater th transplant workup: 10:16am blood ama-negative 10:16am blood -negative 10:16am blood igg-872 iga-523* igm-69 micro: blood cx- no growth c. diff- negative peritoneal fluid - gs negative; cx- no growth sputum- gram stain: >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): yeast(s). 1+ (<1 per 1000x field): gram positive rod(s). cx- respiratory flora blood cx- no growth urine cx- no growth blood cx- no growth urine cx- no growth peritoneal fluid- gs negative, cx prelim negative studies: tte- overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic root is moderately dilated at the sinus level. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. with injectin of aerated saline, there are 2 bubbles in the lv within 3 heart beats and a flurry of contrast after 6-7 beats. this is most consistent with transpulmonary shunting, although with several early bubbles, a concurrent pfo cannot be excluded. impression: likely transpulmonary shunting. normal biventricular systolic function. . cxr- #1. bibasilar atelectasis and small effusions. 2. dobbhoff tube coiled in the stomach. . cxr #2- left picc line ends at the junction of the brachiocephalic veins. lung volumes remain very low, but the clearing of opacification at the left lung base suggest that this was largely atelectasis. mild interstitial abnormality and plate-like scarring in the right lung are unchanged. heart size is normal. feeding tube coils in the upper stomach and passes out of view. no pneumothorax or appreciable pleural effusion. heart size normal. . egd- varices at the lower third of the esophagus and gastroesophageal junction. ulcer in the gastroesophageal junction. food in the whole stomach. granularity, erythema, congestion, abnormal vascularity and mosaic appearance in the whole stomach compatible with portal hypertensive gastropathy. successful endoscopic placement of 10fr -jejunal feeding tube to 130 cm from the nares. successful placement of 10fr -pharyngeal bridle. otherwise normal egd to third part of the duodenum . colonoscopy- angioectasia in the sigmoid colon. stool in the hepatic flexure and ascending colon. non-bleeding rectal varices were noted. no significant lesions were identified, although a small polyp could not be excluded at the hepatic flexure due to the presence of stool. otherwise normal colonoscopy to cecum . discharge labs: : wbc 7.2 hgb 9.6* hct 27.9* mcv 101* plt 115 : gluc 158* bun 42* crt 1.4* na 135 k 4.4 cl 105 hco3 20* : alt 23 ast 46* akp 157* tuberculosis 1.6* brief hospital course: 51yo man with etoh cirrhosis c/b refractory ascites s/p his 3rd episode of variceal bleed and banding who presents from outside hospital with resolving pneumonia, ongoing hypoxia . . #hypoxia: patient presented from outside hospital with oxygen requirement s/p treatment for a pneumonia. cxrs were repeated and showed resolving pneumonia. his persistent hypoxia was attributed to the resolving treated pneumonia, transpulmonary shunting (tte on consistent with this), likely smoking related parenchymal lung disease, deconditioning with poor clearance of upper airway secretions and restriction from large volume ascites. patient was treated with aggressive pulmonary toilet (chest physical therapy, incentive spirometry), frequent nebulizer treatments and large volume paracenteses (3 l on l on l on l on ) with marked improvement. on discharge, patient was breathing comfortably on room air. follow up: we recommend that his nebulizer treatments be continued as needed in the outpatient setting and the patient be encouraged to mobilize and use an incentive spirometer. . # alcoholic cirrhosis: patient with history of alcoholic cirrhosis c/b refractory ascites (typically gets taps every two weeks) and variceal bleeds x3, now s/p banding in osh. patient was initially continued on octreotide drip and iv ppi. octreotide was d/c-ed and patient was transitioned to oral ppi. he was started on nadolol which was titrated to 20 mg daily given limited blood pressure room. patient underwent egd to assess his variceal status after banding which showed an ulcer in the ge junction and 3 cords of grade i bands in the lower third of the esophagus. he was started on sucralfate in addition to his standing nadolol and ppi. he was given lactulose and rifaximin which were titrated to his mental status. he had some encephelopathy during his icu admission, but this resolved shortly after his transfer to the floor with aggressive lactulose treatment. he underwent diagnostic paracentesis in the micu (negative for sbp) and several therapeutic paracenteses (- 3l, 10l, 3l, 4l) which were also negative for sbp. patient was appropriately repleted with albumin post-tap. . as part of his transplant evaluation patient underwent echocardiogram w/ bubble study which showed transpulmonary shunting with supine room air abg po2 57, though the patient had no orthodeoxia. cardiology was consulted and felt that there was no need for further pre-transplant workup- should the patient develop cardiac symptoms they recommended possible cta of the coronaries. patient also underwent colonoscopy which showed angioectasia in the sigmoid colon and non-bleeding rectal varices. (negative), anti-smooth muscle (negative) and igg (nl), iga (c/w alcoholic cirrhosis), and igm (negative) were sent. follow up: patient will require pfts in the outpatient setting and f/u with his transplant hepatologist - these are scheduled for . . #. : patient's creatinine was elevated around 1.3 (and as high as 1.5) during this admission from baseline 0.8-0.9. this was attributed to poor volume status due to bleeding and diuresis in the osh. he responded partially to albumin, but creatinine on discharge remained stable around 1.3. other contributing factors may be increased intra-abdominal pressure secondary to ascites vs. hepatorenal syndrome. would recommend further evaluation and consideration of treatment for hepatorenal syndrome. . # anemia - patient's anemia was likely multifactorial and related to acute bleed and cirrhosis. received 2 units transfusion in the micu without active bleeding throughout his hospitalization. hct remained stable, guaiac negative, and patient was supplemented with b12 and folate. hemolysis labs were negative. . #hyponatremia: history of hyponatremia to 120 at admission to osh. this was attributed to the hemodynamics of his cirrhosis and recurrent ascites. patient was fluid restricted and became slightly hypernatremic once tube feeds were started. fluid restriction was removed and sodium normalized. . # hyperglycemia- patient became hyperglycemic (sugars in the 160s -180s) with tube feeds. he was started on an insulin sliding scale and typically received 8 units of sliding scale insulin daily. we recommend that this be followed up in the outpatient setting and patient evaluated further for diabetes and oral anti-hyperglycemics considered. during rehab stay, can consider a regular insulin sliding scale if sugars remain elevated. . # fen: patient was given a low sodium diet and was evaluated by nutrition specialists who restarted him on tube feeds. he was also supplemented with ensure, thiamine, folate, cyanocobalamin, and a multivitamin. his tubefeeds and vitamins should be continued on discharge. medications on admission: home meds: - albuterol inhaler 2puffs po daily - vitamin d2 50,000 units po weekly - lasix 80mg daily (on hold since due to hyponatremia) - lactulose 15ml po tid - prevacid 15mg po daily - spironolactone 200mg po daily (on hold since due to hyponatremia) - folic acid 0.4mg po daily . medications (from osh records): cefepime 1 g iv q12h vancomycin 1000 mg iv q 12h pantoprazole 40 mg iv q12h furosemide 40 mg iv bid lactulose 30 ml po/ng tid bisacodyl 10 mg po/pr daily:prn constipation docusate sodium (liquid) 100 mg po bid senna 1 tab po bid:prn constipation multivitamins 10 ml iv q24h folic acid 1 mg po/ng daily thiamine 100 mg iv daily nicotine patch 14 mg td daily discharge medications: 1. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day): please take enough to have bowel movements daily. 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). 4. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). 5. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). 6. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 7. multivitamin tablet sig: one (1) tablet po daily (daily). 8. cyanocobalamin (vitamin b-12) 100 mcg tablet sig: 0.5 tablet po daily (daily). 9. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 11. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed for cough. 12. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 13. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. discharge disposition: extended care facility: hospital - discharge diagnosis: alcoholic cirrhosis esophageal varices hepatic encephelopathy hypoxia acute kidney injury 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 taking care of you at the . you were transferred to this hospital from , where you were you bled from your esophageal varices (blood vessels in your throat) and were treated for a pneumonia. while you were at the , we helped improve your lung function with frequent nebulizer treatments and chest physical therapy. we also performed an endoscopy to examine your varices and a colonoscopy as part of your liver transplant evaluation. you were re-evaluated by a nutritionist who felt that you would benefit from continued additional caloric intake via a feeding tube. please continue to take your tubefeeds at home as the additional nourishment will help build your strength. your blood sugars were slightly elevated during this hospitalization- we recommend that you discuss this with your primary care doctor for further management. we have made the following changes to your home medications: - please start taking nadolol 20 mg daily - please start taking rifaximin 550 mg twice daily - please start taking sucralfate 1 g four times daily - please start taking pantoprazole 40 mg daily - please stop taking prevacid - please change your dose of lactulose to 30 ml three times daily - please change your dose of folic acid to 1 g daily - please start taking cyanocobalamin - please start taking thiamine you may continue to take albuterol and vitamin d as you were previously. please follow up for your pulmonary function tests (another component of your liver transplant workup) and your appointment with dr. as below. we wish you a speedy recovery. followup instructions: please follow up for your pulmonary function tests and your appointment with dr. : provider: ,interpret w/lab no check-in intepretation billing date/time: 10:00 provider: function lab phone: date/time: 10:00 provider: , md phone: date/time: 11:40 procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified other endoscopy of small intestine enteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage colonoscopy diagnoses: acute posthemorrhagic anemia alcoholic cirrhosis of liver acute kidney failure, unspecified hyposmolality and/or hyponatremia other and unspecified alcohol dependence, in remission portal hypertension personal history of tobacco use other sequelae of chronic liver disease other ascites gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction hypoxemia hepatic encephalopathy hyperosmolality and/or hypernatremia esophageal varices in diseases classified elsewhere, without mention of bleeding other specified disorders of stomach and duodenum ventilator associated pneumonia internal hemorrhoids without mention of complication other abnormal glucose nutritional marasmus body mass index between 19-24, adult 

Answer: The patient is high likely exposed to