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: bactrim / ambien attending: chief complaint: altered mental status major surgical or invasive procedure: intubation/extubation diagnostic paracentesis history of present illness: 56 y/o m with hcv cirrhosis with portal hypertension,portal hypertensive gastropathy, ascites with recurrent paracenteses ( last ) and encephalopathy transferred from an osh initial presenting with altered mental status. according to the osh notes the patient's mental status has been gradual declining days preadmission. his wife was giving increasing doses of lactulose last night and patient was having bowel movements, though was sleepy. he was found to be obtunded on the day of admission and ems was called, at arrival to the osh he was intubated for airway protection and sedated with vecuronium. the patient was given lactulose and zosyn . he recieved a ct of the head which was negative. patient thought to have uti leading to hepatic encephalopathy at the osh. ammonia level was up to 230 at osh. on transfer to he became agitated was given 2mg push of iv midazolam. . of note according to the patient's wife he has been taking "more and more" oxycodone recently, last time being , (his wife took away his oxycodone at that time) because of increasing back pain. he took approx. 30 pills in days according to his wife. night he was disoriented and confused. he also was constipated for approx. 3 days until teus morning when his wife start making sure he was taking his lactulose and his bm stabilized at 3-4/day. during the last three days pre-admission he has been oriented and interactive though sleepy. his wife found him this morning obtunded and unresponsive. she denies he has had any fevers or cough in the last few days. of note last week the patient felt nauseous for 2 days and vomtited a unknown number of times with worsening back pain. the nausea and back pain improved with oxycodone. . in the ed, initial vs were: temp:98.2 hr:130 bp:156/110 resp:16 o(2)sat:100 intubated rr 24, o2sat 100% on ac 500x16 peep 5 . patient received a diagnostic paracentesis to assess for sbp which was negative. he also recieved 30g lactulose x 1. . on the floor, vitals: t:98.8 bp:149/71 p:105 r:23 18 o2: 100% , the patient was intubated and a abg was obtained. the patient was switched to pressure support from assist control. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: - hepatitis c genotype 1, on liver transplant list, non-responder to pegylated interferon and ribavirin - pulmonary embolism (diagnosed ), on warfarin until - hypertension - depression - anxiety - migraines - cellulitis - obesity - left ankle fracture - colonic polyps - l2+l3 compression fractures, s/p kyphoplasty social history: - employment: case manager at the va, working with dual diagnosis and substance abuse counseling - spent years in and out of jail for selling drugs - tobacco: smoked 1ppd age 11 to 25 - etoh: former heavy use. last drink was - illicits: marijuana, pcp, , lsd, and heroin in the past. sober since . - married to wife (rn) family history: no family members have experienced fevers in the past few weeks, although children have had several tick bites. father deceased (48 ) from emphysema and mother deceased from 'old age.' no family history of malignancy. alcoholism in several family members. physical exam: on admission: vs: t=100.9, bp=128/66, hr=95, rr=18, o2 sat=97% ra general: well-appearing middle aged male in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple with jvp of 8 cm cardiac: rrr, normal s1, s2. no m/r/g. lungs: resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abdomen: soft, ntnd. liver edge palpable with slight ttp. extremities: no c/c/e. skin: no rash appreciated near bite sites (right clavicle and midline abdomen). pertinent results: on admission: 08:57am blood wbc-8.4 rbc-4.35* hgb-11.2* hct-33.4* mcv-77* mch-25.7* mchc-33.5 rdw-18.6* plt ct-66* 08:57am blood neuts-84.7* lymphs-8.7* monos-4.4 eos-1.7 baso-0.5 05:00am blood wbc-1.8* rbc-3.17* hgb-8.6* hct-24.9* mcv-79* mch-27.0 mchc-34.3 rdw-18.4* plt ct-26* 07:12am blood neuts-61 bands-0 lymphs-27 monos-7 eos-5* baso-0 atyps-0 metas-0 myelos-0 07:12am blood hypochr-1+ anisocy-2+ poiklo-3+ macrocy-normal microcy-3+ polychr-normal ovalocy-3+ tear dr. 08:57am blood pt-15.1* ptt-28.8 inr(pt)-1.3* . 08:57am blood glucose-151* urean-20 creat-1.3* na-136 k-5.2* cl-103 hco3-25 angap-13 03:10pm blood glucose-84 urean-20 creat-1.7* na-134 k-4.3 cl-100 hco3-29 angap-9 05:10am blood glucose-101* urean-20 creat-1.5* na-138 k-3.7 cl-102 hco3-28 angap-12 07:12am blood glucose-85 urean-20 creat-1.4* na-138 k-3.8 cl-105 hco3-25 angap-12 05:00am blood glucose-93 urean-19 creat-1.3* na-132* k-3.9 cl-104 hco3-24 angap-8 . 08:57am blood alt-50* ast-60* alkphos-182* totbili-1.9* 08:57am blood lipase-38 08:57am blood albumin-3.8 calcium-8.8 phos-4.2 mg-2.3 03:10am blood caltibc-386 hapto-51 ferritn-27* trf-297 10:50am blood ammonia-131* . 08:57am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg . 05:38pm blood type-art temp-37.1 tidal v-700 peep-5 fio2-50 po2-107* pco2-35 ph-7.44 caltco2-25 base xs-0 intubat-intubated 09:40am blood lactate-2.4* 05:38pm blood freeca-1.11* . 09:50am urine color-yellow appear-clear sp -1.029 09:50am urine blood-lg nitrite-neg protein-75 glucose-neg ketone-tr bilirub-neg urobiln-neg ph-7.0 leuks-tr 09:50am urine rbc-* wbc-0-2 bacteri-mod yeast-none epi-0-2 09:50am urine mucous-rare ovalfat-mod 09:50am urine bnzodzp-neg barbitr-neg opiates-neg -neg amphetm-neg mthdone-neg 09:50am urine color-yellow appear-clear sp -1.029 09:50am urine blood-lg nitrite-neg protein-75 glucose-neg ketone-tr bilirub-neg urobiln-neg ph-7.0 leuks-tr 09:50am urine rbc-* wbc-0-2 bacteri-mod yeast-none epi-0-2 09:50am urine mucous-rare ovalfat-mod 07:42pm urine hours-random urean-539 creat-137 na-36 k-49 cl-11 07:42pm urine osmolal-410 09:50am urine bnzodzp-neg barbitr-neg opiates-neg -neg amphetm-neg mthdone-neg. . 09:47am ascites wbc-248* rbc-523* polys-13* lymphs-18* monos-43* mesothe-2* macroph-22* other-2* . 07:12am blood pt-16.9* inr(pt)-1.5* 11:00am blood pt-16.7* inr(pt)-1.5* . imaging cxr : impression: endotracheal and nasogastric tubes in appropriate position as detailed above. very limited evaluation of the lungs given the profoundly low lung volumes. there is, however, extensive patchy opacity at the left lung and aspiration versus pneumonia is highly likely. . ct head w/o contrast : impression: no acute intracranial process. nasal secretions likely related to intubated status. . ruq ultrasound : impression: 1. cirrhotic liver. previously seen liver cyst and enhancing lesions are not identified on the current study. 2. patent main portal vein. 3. stable splenomegaly. 4. stable thickening of the gallbladder wall, likely secondary to hyperproteinemic state. culture data time taken not noted log-in date/time: 9:40 am blood culture trauma/arrest set#1. **final report ** blood culture, routine (final ): no growth. 9:47 am peritoneal fluid trauma/arrest ,peritoneal fluid.. **final report ** gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. 9:50 am urine site: catheter trauma/arrest,catheter\. **final report ** urine culture (final ): no growth. 8:55 pm sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): sparse growth commensal respiratory flora. brief hospital course: 56 y/o m with hcv cirrhosis with portal hypertension, portal hypertensive gastropathy, ascites with recurrent paracenteses (last ) and encephalopathy transferred from an osh with altered mental status and intubated for airway protection. . #altered mental status- given the patient's history hepatic encephalopathy is the most probable cause. the differential of this acute encephalopathy includes infection, drug overdose, or gi bleeding.the patient currently has no signs of gi bleeding. the patient has been afebrile and currently has no leukocytosis. on osh records the patient had a ua indicating a uti, however on the ua we obtained the results did not indicate a active uti. the patient also has been taking increasing amounts oxycodone in the last week which is a possible etiology causing his acute hepatic encephalopathy. he also has evidence of left lung field opacities which are consistent with pneumonia or aspiration. therefore it could have been the patient developed a pneumonia in the last few days as an outpatient or aspirated recently given his altered mental status and intubation. he was started empirically on levofloxacin for pna this was discontinued after 6 days for pancytopenia. sputum cx negative. ct head was negative for acute bleed or stroke and no history consistent with seizure like activity. all sedative drugs were stopped. he was stabilized in the micu and extubated w/o complication, and transferred to the general liver wards. he noted to have mild flap on transfer. patient received a diagnostic paracentesis to assess for sbp which was negative. lactulose and rifaximin restarted. urine and blood cx negative. ms continued to improve w lactulose and he reached ms baseline on the day after transfer out of the micu with noted resolution of asterixis at that time as well. . #respiratory status - the patient was on assist control on transfer and recently transitioned to pressure support with a stable abg after. will ensure the patient is ventilating appropiately by following his minute ventilation . will attempt to wean off the propofol to assess his mental status more appropiately. he was extubated successfully on . pt was comfortable on room air at time of transfer to general floor. . #pneumonia- has x ray evidence with left lung field opacities, though no leukocytosis or fevers. could be community acquired or aspiration as etiology. he was covered w levofloxacin for empiric pna on and this antibiotic was discontinued after 6 days for negative sputum, blood, and urine cultures. he also was asymptomatic. pt developed pancytopenia 4 days after initiation of levofloxacin. . #thrombocytopenia- according to our records the patient's platelet count is typically between 50-100. platelet count noted to downtrend 2 days after initiating levofloxacin. he did not require transfusion of platelets. would expect resolution of suppression w abstinence from antibiotics. plan to monitor on outpt setting w labs after discharge. pt was informed to seek medical attention if febrile, or active bleeding. . #anemia- according to the patient's history he has a microcytic anemia, and currently is consistent with baseline hematocrit. on admission pt had no active signs of gastrointestinal bleeding. he was guaiac negative on general floors. pancytopenia developed on and pt noted to have downtrending hct suppression from levofloxacin. he was transfused 2units of packed rbcs during his stay w/o any sign of active bleeding. hct stable at time of discharge. . #cirrhosis- on admission, this pt was on the transplant list however given his recent drug use/oxycodone abuse, it was decided to inactive him at the tuesday transplant meeting on . pt and family was notified. pt scheduled for outpt therapeutic paracentesis in next 2 weeks after discharge. ruq u/s shows patency and moderate ascites. no para indicated given no interval increase in abd girth or ascites and poor amt of fluid available on outpt attempt at para. . # : acute increase from baseline 1.2 to 1.7 on attributed to diuretics, poor po intake prior to admission. diuretics were held and he was administered volume challenge with albumin dosed 1gm/kg x 2 days and 75g x 1 day. creatinine downtrended close to baseline at time of discharge. plan to follow up at clinic appt. diuretics were held and plan to assess and restart at appt f/u w dr. in 2 weeks. . #substance abuse: pt admits to abuse of oxycodone prior to admission. social work consulted on admission and provided resources for follow up and referral to transplant psychiatry. opioids, narcotics, and benzodiazepines were avoided during his stay. he was discharged on a temporary amount of seroquel per inpt psychiatry recommendation prn insomnia. he was advised to follow up with outpt pcp for assessment and discussion about further sleep aides. was advised to avoid any potentially addictive medications. consider antidepressant as outpt. medications on admission: ergocalciferol (vitamin d2) 50,000 unit capsule one capsule(s) by mouth weekly for 12 weeks furosemide 40 mg tablet 1.5 tablet(s) by mouth once a day. lactulose 10 gram/15 ml solution 60 cc(s) by mouth three times a day. lidocaine 5 % (700 mg/patch) adhesive patch, medicated 2 adhesive(s) daily (daily) apply one to lower back, one to mid-back. leave on 12 hours, off 12 hours. midodrine 5 mg tablet 1 tablet(s) by mouth 3 times a day oxycodone 5 mg capsule 1 capsule(s) by mouth four times per day. potassium chloride 20 meq tab sust.rel. particle/crystal 1 tab(s) by mouth once a day rifaximin 550 mg tablet 1 tablet(s) by mouth twice a day spironolactone 50 mg tablet 3 tablet(s) by mouth once a day testosterone 1.25 gram per actuation (1 %) gel in * otcs * calcium carbonate-vitamin d3 500 mg (1,250 mg)-400 unit tablet 1 tablet(s) by mouth twice a day magnesium oxide 400 mg tablet 2 tablet(s) by mouth twice a day discharge medications: 1. calcium 500 with d 500 mg(1,250mg) -400 unit tablet sig: one (1) tablet po twice a day. 2. magnesium oxide 400 mg tablet sig: one (1) tablet po bid (2 times a day). 3. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). 4. midodrine 2.5 mg tablet sig: three (3) tablet po three times a day. 5. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po qid (4 times a day). 6. quetiapine 25 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)) as needed for insomnia for 5 days. disp:*5 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: opioid overdose hepatic encephalopathy discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital for altered mental status that appear related to the oxycodone you ingested. you were also confused which is likely related to constipation secondary to the painkillers. you required admission to the intensive care unit for monitoring and were given antibiotics for a presumed pneumonia found on chest xray. you will need to continue these oral medications for a full 7 day course (day 1 on ). . for your recent substance abuse, social work was consulted and they have provided you with resources for recovery and rehabilitation. it is essential that you abstain from drug and alcohol abuse given your significant liver disease. . the following changes were made to your medications: restarted midodrine for your kidneys and blood pressure. stopped oxycodone, sedatives stopped lasix and spironolactone (water pill) started seroquel to assist in sleep. you received a temporary supply, any sleep aides, painkillers, or other potentially addictive medications will need to be managed by one physician. address this issue with your pcp. . it is important that you avoid any addictive medications including sedatives, opioids/high potency painkillers, or benzodiazepines. . please follow up with your physicians as stated below. *you need to make an appt with your pcp for sometime in the next week.* followup instructions: department: transplant when: wednesday at 1:20 pm with: transplant clinic building: lm campus: west best parking: garage department: medical specialties when: wednesday at 11:40 am with: , md building: sc clinical ctr campus: east best parking: garage md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours percutaneous abdominal drainage diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified anemia, unspecified unspecified essential hypertension cirrhosis of liver without mention of alcohol chronic hepatitis c with hepatic coma acute kidney failure, unspecified portal hypertension opioid type dependence, unspecified accidental poisoning by other opiates and related narcotics dysthymic disorder acute respiratory failure other ascites poisoning by other opiates and related narcotics obesity, unspecified other specified disorders of stomach and duodenum backache, unspecified other specified antibiotics causing adverse effects in therapeutic use migraine, unspecified, without mention of intractable migraine without mention of status migrainosus personal history of colonic polyps 

Answer: The patient is high likely exposed to