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: l thigh pain major surgical or invasive procedure: none history of present illness: 52 y/o with pmh of etoh cirrhosis and multiple back surgeries who presents with l thigh pain and swelling for two days. patient reports that he initially injured his leg when he bumped into his metal shop table 10 days ago. he hit the outside of his leg and initially felt fine. two days later he noticed a small bruise there and the area felt firm. 3 days ago he mowed his lawn and went about his usual activities without much difficulty. the following day he awoke and his entire thigh was bruised, swollen and very painful. the pain has made it difficult to walk. he initially presented to an osh ( hospital) where ct scan was done that did not show a fluid collection, however there was muscle edema. they were unable to measure leg pressures and due to concern for compartment syndrome he was sent to . they did give his 3 gms of unsayn for potential infection. . the patient reports that he felt some numbness on the outside of his leg during the ambulance ride but denies weakness. he has a l footdrop at baseline. he denies fever, chills, cough, cp, sob and abdominal pain. . in ed initial vitals were t 99.7 bp 131/71 hr 100 rr 17 o2sat 99%ra. he was evaluated by ortho who reviewed osh ct. ortho felt that his exam was not consistent with compartment syndrome and recommended further imaging with mri and follow cks. received 8mg morphine at osh and 4mg dilaudid here. past medical history: --biliary colic/chronic pancreatitis: (per note) hepatitis serology negative , 1:80, antismooth muscle negative. saw dr. . ct per report two stable cysts no other lesions, but u/s ? multiple nodular densities. --etoh cirrhosis, followed by dr. in staughton -> no h/o varices, gib, or ascites --h/o etoh abuse : pt denies alcohol, does report drinking o'douls a non-alcoholic beer --s/p cholecystectomy --psoriasis --chronic lower back pain/post laminectomy syndrome: ms contin 60/30/60 fair pain control. residual left foot drop. no recent falls records. -- htn currently off all medications --s/p multiple back surgeries following mva in , ', ', ', now with hardware in lower back (plates and screws) -- h/o tremor -- hands h/o dry eye since eye surgery social history: lives with his wife. on disability for back problems. 3 children from prior marriage. prior heavy drinker, primarily wine socially. no etoh for two years except 2 glasses of wine on his anniversary. denies tobacco use and illicit drug use. family history: mother had breast cancer father had prostate ca no h/o heart disease or dm physical exam: pe (patient post-ictal at time of exam) vitals: t 98.9 (max 100.3), bp 158/73, 97% ra, rr20, hr 105-110 general: lying in bed, tremulous, diaphoretic heent: perrl, eomi - no nystagmus, op with small blood, tongue with bit on left-side, mm dry, +scleral icterus, visual field full to confrontation. neck: no lad, supple, no jvd, no stiffness heart: tachy, normal s1/s2, 2/6 sem lungs: ctab no wheezes, crackles, rhochi abd: +bs, ntnd, soft, firm liver edge, liver 5-6cm in midclavicular line, no ascites, mild enlargement of spleen ext: l thigh with extensive echymosis from above knee to inguinal area, lateral thigh is firm and tender to touch, anterior and medial thigh soft. edema on l that extends from groin to knee. pedal pulses palpable and feet warm. femoral pulses 2+ bilaterally. neuro: alert and oriented to self only. cn ii-xii intact, tongue slightly to right of midline, but also avoiding left side due to new laceration. patient with increased tone in b/l lower extremity and brachial reflex 2+ brisk b/l. sensation intact to light touch, asterixis delt tri grip qd ham df pf rt: 5 5 5 5 3 4 4 5 left: 5 5 5 5 5 5 5 5 skin: nummular erythematous, scaly plaques present on both shins as well as surrounding patches of hyperpigmentation c/w psoriasis, spider angiomas. pertinent results: osh : hct 27.5, wbc 4 (auto diff with 71n, 17l, 10m, 1e, 0.5b), plt 65, inr 1.6, dbili 2.9, tbili 6.6, amylase 629, lipase 63, alkaline phosphatase 160, ast 106, alt 38, ck 277. . na 135, k 4, cl 99, co2 24, bun 12, cr 0.7, bg123. . ua clear, leuk small, protein tr, glucose neg, ketones 15, bili positive, nitrite positive. wbc 0-2, rbc 0-2, urine bacteria negative. . ct : impression: no femoral fracture or dislocation, diffuse subcutaneous edema and possible edema of the left adductors and quadriceps muscle are seen without discrete hematoma. findings could represent diffuse left thigh cellulitis and myositis. 09:00pm blood wbc-3.3* rbc-2.47* hgb-9.1* hct-25.1* mcv-102* mch-36.8* mchc-36.2* rdw-14.2 plt ct-57* 03:01am blood wbc-3.9*# rbc-2.36* hgb-8.2* hct-24.1* mcv-102* mch-34.8* mchc-34.0 rdw-15.8* plt ct-89* 07:00am blood wbc-6.8 rbc-3.14* hgb-11.0* hct-31.7* mcv-101* mch-35.0* mchc-34.7 rdw-15.6* plt ct-131* 09:00pm blood neuts-62.0 lymphs-27.8 monos-6.2 eos-3.3 baso-0.6 04:50am blood neuts-75.1* lymphs-13.6* monos-10.6 eos-0.7 baso-0.1 . 09:00pm blood pt-19.0* ptt-31.1 inr(pt)-1.8* 03:10am blood pt-18.3* ptt-31.4 inr(pt)-1.7* 03:23am blood pt-18.5* ptt-33.9 inr(pt)-1.7* . 03:38am blood fibrino-155 05:24pm blood ret aut-5.1* . 09:00pm blood glucose-102 urean-12 creat-0.7 na-137 k-3.7 cl-104 hco3-24 angap-13 03:01am blood glucose-98 urean-10 creat-0.5 na-140 k-3.8 cl-111* hco3-24 angap-9 05:24pm blood glucose-105 urean-12 creat-0.5 na-138 k-3.9 cl-108 hco3-23 angap-11 07:10am blood glucose-83 urean-11 creat-0.6 na-140 k-3.5 cl-110* hco3-19* angap-15 07:00am blood glucose-75 urean-10 creat-0.5 na-140 k-3.9 cl-110* hco3-18* angap-16 05:30am blood calcium-8.5 phos-3.2 mg-1.4* 03:01am blood calcium-8.5 phos-3.2 mg-1.7 07:10am blood calcium-8.9 phos-3.0 mg-1.8 07:00am blood calcium-9.0 phos-3.2 mg-1.7 . 09:00pm blood alt-32 ast-95* ld(ldh)-269* ck(cpk)-192* alkphos-126* totbili-5.7* 07:43pm blood alt-29 ast-72* ld(ldh)-279* ck(cpk)-244* alkphos-102 amylase-469* totbili-5.8* 03:38am blood alt-29 ast-70* alkphos-97 amylase-448* totbili-7.1* dirbili-2.4* indbili-4.7 04:15am blood alt-22 ast-46* ld(ldh)-239 alkphos-108 totbili-5.9* 07:10am blood alt-28 ast-60* alkphos-105 totbili-7.0* 07:43pm blood lipase-66* 03:38am blood lipase-59 . 09:00pm blood caltibc-263 vitb12-1279* folate-12.2 ferritn-247 trf-202 03:38am blood caltibc-248* vitb12-1211* folate-10.9 hapto-<20* ferritn-238 trf-191* . 09:30am blood ammonia-48* 09:30am blood tsh-1.5 . 07:50am blood crp-19.6* 07:50am blood esr-46* . 09:00pm blood asa-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 09:30am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg . 02:57pm blood type-art temp-37.8 peep-5 fio2-100 po2-350* pco2-32* ph-7.48* caltco2-25 base xs-1 aado2-347 req o2-61 -assist/con intubat-intubated 03:22am blood type-art temp-38.0 po2-117* pco2-37 ph-7.45 caltco2-27 base xs-1 intubat-intubated 05:03am blood type-art temp-38.3 po2-89 pco2-33* ph-7.51* caltco2-27 base xs-3 03:39am blood type-art po2-121* pco2-31* ph-7.48* caltco2-24 base xs-1 . leni left lower extremity venous ultrasound: grayscale and doppler son of the left common femoral, superficial femoral and popliteal veins were performed. these demonstrate normal compressibility, augmentation, color flow and waveforms. no echogenic intraluminal thrombus is identified. there is moderate edema within the regional soft tissues with no discrete fluid collection seen. impression: 1. no evidence for lower extremity dvt. 2. moderate nonspecific edema in the regional soft tissues. no discrete fluid collections are seen. . lspine findings: no previous images. extensive posterior fusion is seen involving l3 through s1 with metallic screws and bony spacers. the alignment appears to be quite well maintained. interspace narrowing is seen in several levels. . ct head ct head: no evidence of hemorrhage, edema, mass, mass effect, hydrocephalus, or recent infarction is seen. small hypodensities in the subinsular white matter is consistent with chronic ischemic changes. prominence of the ventricles and extra-axial csf spaces is not out of proportion for the patient's age. there is no evidence of hydrocephalus. the soft tissues, osseous structures, and orbits are unremarkable. the visualized paranasal sinuses and mastoid air cells are well aerated. impression: no evidence of hemorrhage. . cxr cardiac size is top normal with left ventricular configuration. the lungs are clear. there is no pneumothorax or sizeable pleural effusion. impression: no evidence of acute cardiopulmonary abnormalities . lp cerebrospinal fluid: atypical. atypical epithelioid cells (see note). lymphocytes and monocytes. note: a rare cluster of epithelioid cells is present, too few to characterize, but a reactive process is favored. . abd u/s 1. diffusely echogenic liver, compatible with fatty infiltration. more severe forms of liver disease, including advanced hepatic fibrosis/cirrhosis cannot be excluded. 2. portal hypertension with reversal of flow in the anterior right portal vein and a recanalized periumbilical vein with splenic varices . 6/7 l leg mri impression: heterogeneous mass within the left vastus intermedius and vastus lateralis with associated extensive subcutaneous and soft tissue edema. this mass may represent a hematoma, however, an infection cannot be fully excluded. please note that evaluation for abscess is limited as no intravenous contrast was administered. mr imaging with contrast upon resolution is recommended. . eeg impression: likely normal portable eeg in the drowsy and sleeping states with no areas of prominent focal slowing and no clearly epileptiform features. the study was limited by lack of normal waking backgrounds. if clinically indicated, the study could be repeated for better assessment of waking background morphology. several episodes of arm shaking were noted by the technician; review of the tracing demonstrated movement artifact. . 6/8 l leg mri unchanged heterogeneous mass within the left vastus intermedius and lateralis muscles which likely represents a hematoma; however, infection cannot be fully excluded as no intravenous contrast was administered. there is associated extensive soft tissue swelling and edema within the left thigh. follow up mri with contrast upon resolution is recommended. . ruq u/s impression: 1. echogenic liver suggestive of fatty infiltration. other forms of liver disease such as cirrhosis or fibrosis cannot be excluded. 2. no evidence of portal vein thrombosis. 3. reversed flow in the anterior branch of the right portal vein, unchanged since the prior study. 4. no evidence of ascites. . spine mri technically limited study due to the presence of extensive lower lumbar metallic hardware. no definite signs for the presence of discitis, osteomyelitis, or an epidural abscess. other findings as noted above. . 2d echo the left atrium is elongated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%) right ventricular chamber size and free wall motion are normal. 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, but cannot be fully excluded due to suboptimal image quality. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: no endocarditis, abscess or signficant valvular regurgitation seen. normal global and regional biventricular systolic function. no diastolic dysfunction or pulmonary hypertension. . cxr findings: a bedside frontal chest radiograph is compared to , . the patient has been extubated. the lungs are clear aside from mild bibasilar atelectasis. cardiomegaly with a left ventricular configuration and tortuous aorta are stable. the pulmonary vasculature is normal. impression: no acute cardiopulmonary process. . ctu impression: 1. no evidence of renal stones or renal masses to suggest malignancy. there are multiple renal hypodensities which are too small to characterize. 2. there is recanalization of the paraumbilical vein as well as splenomegaly suggestive of chronic liver disease. 3. 3mm lung nodule. if the patient is at high risk for lung cancer, follow- up in 1 year to assess stability is recommended. cancer. . brief hospital course: 52 y/o m with h/o etoh cirrhosis who presents with l thigh pain and swelling following trauma. transferred from osh with concern for compartment syndrome. shortly after arrival to , pt had tonic-clonic seizure, likely alcohol withdrawal, and was transferred to the micu. he was managed in the icu until hd#8, when he was called out to the floor. please see below for clinical course by problem. . *) l thigh hematoma: degree of swelling and bruising seems out of proportion to trauma, however has coagulopathy from liver disease predisposing him to bleeding. was sent from osh given concern for compartment syndrome but thigh soft, distal pulses intact, ck 192. leni negative for dvt. ortho was consulted and did not believe the presentation was suggestive of compartment syndrome. he had left leg mri that did revealed a likely hematoma. his pain was controlled with iv morphine. on hd#11, pt was seen by pt, who recommended inpatient rehabilitation with physical therapy. . *) seizure: likely tonic-clonic based on observation. unclear etiology, but likely alcohol withdrawal as does have a prior history of seizure in setting of alcohol and narcotic withdrawal. pt has no abnormal findings on head ct, no known thyroid disease, normal na and normal renal function. no apparent syncope or cardiac arrhythmias, or severe hypoglycemia. eeg was without epiletpiform features and lp was unremarkable. pt was seen by neurology. he was placed on a ciwa scale. he had no further seizures throughout the hospitalization. . *) fever: pt had persistent fevers throughout admission. originally attributed to hematoma, but fever persisted despite reduction in size of hematoma. mri of the leg showed no abscess. mri of the spine also showed no abscess. cultures were unrevealing. tte unremarkable. cxr w/o pna. was empirically given vanco and zosyn, but both abx were discontinued as there was no clear source of infection. id was consulted and recommended repeating imaging studies for further evaluation of questionable abscess, but pt was not febrile over last 3 days of hospitalization. . *) anemia: unknown baseline. concern for hemolysis with dropping hct vs continued bleeding into left leg. likely component of chronic disease with marrow suppression from liver disease and etoh. mcv elevated. also have some hyperslenism given all cell lines down. hct was stable and slowly increasing throughout hospitalization. . *) respiratory difficulty: pt was intubated for mri and upon extubation, exhibited tachycardia, tachypnea, and agitation. he was reintubated and extubated successfully on hd#8. he was maintained on o2nc and successfully weaned by hd#10. . *) swallowing dysfunction: pt had speech/swallow eval after extubation and found to have coughing/concern for aspiration. pt was made npo and ngt placed for tubefeeds (pt desired). unfortunately, pt d/c'd ngt. diet advanced on hd#9, but rn with concern for coughing during meal. repeat speech/swallow eval suggested pt could advance to soft solids/nectar liquids with observation at all meals, which he tolerated well. . *) confusion: pt frequently not oriented to place or time, perseverating on issues. felt to be secondary to hepatic encephalopathy, as workup for sources of infection or organic neurologic issues unrevealing. on day of discharge, mental status seemed much improved, with pt engaging easily in conversation. . *) cirrhosis: secondary to chronic etoh, followed by dr. in staughton. coagulopathic with inr 1.8 so decreased synthetic function, elevated bilirubin, ast, alt all c/w mod-severe liver cirrhosis. also thrombocytopenic, no baseline available. coags, platelets overall stable/improved throughout hospitalization. pt to continue outpatient follow up with hepatologist. . *) chronic back pain: pt on morphine sr at home. unable to receive home dose secondary to frequent sedation. pain control with po morphine prn. . *) psoriasis: pt given sarna lotion for symptomatic relief. . pt was discharged to rehab on hd#11 for further pt/ot. medications on admission: meds (confirmed with pcp and patient): morphine sr 60mg qam and qpm morphine sr 30mg in afternoon viagra prn discharge medications: 1. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for itching. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 4. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po qid (4 times a day). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. morphine 15 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. discharge disposition: extended care facility: - discharge diagnosis: primary: -l thigh hematoma -alcohol withdrawal -persistent fevers of unknown origin -benign hypertension secondary: -chronic back pain discharge condition: stable for transfer to rehab discharge instructions: you were admitted after sustaining an injury to your left leg, with concern for continued bleeding and infection. you were transferred to the icu after having a seizure, which was likely secondary to alcohol withdrawal. because you have had a recent seizure, by law for 6 months (until ). . while in the icu, you had continued fevers, which raised concern for an infection. the infectious workup was overall negative. you had multiple imaging studies which did not reveal extension of the hematoma or an abscess. . while in the icu, you were intubated for an mri and had difficulty with breathing upon extubation, which eventually resolved. . you also had difficulty eating, which was likely from sedation and deconditioning. you should continue to eat soft solids and thick liquids until further cleared by speech and swallow. . your blood pressures were elevated while in the hospital. you should follow up with your pcp for further evaluation and possible treatment of hypertension. followup instructions: you should follow up with your primary care physician and your hepatologist upon discharge from rehab. md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization transfusion of packed cells transfusion of other serum transfusion of platelets diagnoses: other chronic pain unspecified essential hypertension alcoholic cirrhosis of liver portal hypertension other convulsions hepatic encephalopathy contusion of thigh backache, unspecified other psoriasis alcohol withdrawal arthrodesis status family history of malignant neoplasm of breast tachypnea family history of malignant neoplasm of prostate striking against or struck accidentally by furniture without subsequent fall 

Answer: The patient is high likely exposed to