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: no known allergies / adverse drug reactions attending: chief complaint: upper gi bleed major surgical or invasive procedure: upper endoscopy tips procedure central venous line placement endotracheal intubation history of present illness: mr. is a 31 yo man with alcohol abuse and new diagnosis of cirrhosis who was transferred from the icu for management of upper gi bleed. the patient was in his usoh until 10pm last night when he had >30 bouts of bright red hematemesis about 15 minutes apart with an estimated total amount of 2 l. he also had a large, black, tarry bowel movement. he called his pcp who referred him to the ed. . presenting vs were: t 98.7, p 148, bp 108/55, rr 20, o2sat 100% ra. labs showed hct 14.9, plts 126, inr 2.7. he was admitted to the icu and then taken shortly thereafter to the endoscopy suite. he was found to have an actively bleeding lesion, thought to be a dieulafoy's lesion and less likely a gastric varix. gi was able to place a clip but felt it was tenuous. they also noted an esophageal mass and a question of grade i esophageal varices. they recommended transfer to via for higher level of care. the patient was transfused a total of 5 units prbc and 4 units ffp at and was given 3.5 l of ivf and a banana bag. he also was given octreotide, zofran, and ativan 1mg. repeat labs prior to transfer showed hct of 17. he reportedly has not been hypotensive. at the time of sign-out, he was still recovering from conscious sedation in the endoscopy suite with the following vs: bp 91/30, p 111, o2sat 100% ra. per , his bps remained stable en route but he was tachycardic to the 120s throughout. . on arrival, pt had another melanic bowel movement. he reports feeling mildly nauseated and during his exam, had two small bouts of bilious emesis with a few dark clots. he denies any abdominal pain, chest pain, lightheadedness. . he reports having felt nauseated several times in the past week but had never had any previous episodes of hematemesis, melana, or hematochezia. he denies pruritis but has noticed jaundice of his eyes and skin for several weeks as well as yellow stools and occasionally dark urine. he has also noted increased abdominal girth for months. he denies any nsaid or tylenol use. he reports drinking alcohol socially since he was a teenager, then more heavily since age 22, with regular intake of pints of vodka daily in the past 1-2 years. he admits to prior cocaine and heroine use; denies ivdu. he has multiple tattoos done by a friend but reports testing negative for hiv and hepatitis after his most recent one. his birth mother also has a history of alcohol abuse but there is no known family history of liver disease. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies dysphagia, early satiety, or bloated sensation. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes. past medical history: alcohol abuse, likely cirrhosis h/o general tonic-clonic seizure thought to be alcohol-provoked h/o minor concussion in lone v. paroxysmal atrial fibrillation, attributed to stress s/p appendectomy s/p cholecystectomy in right club foot s/p surgery congenital presbyopia social history: works as a deli manager. lives with his , . - tobacco: smoking 1/2-1 ppd for at least 15 years. - alcohol: as above, drinks pints of vodka daily. - illicits: previous cocaine and heroin abuse but denies ivdu; reports being clean for 6 years. family history: adopted. as above, birth mother with likely alcohol abuse but no liver disease. birth father died of diabetes. biological brother and sister without known medical illnesses. no history of cad or cancers. physical exam: on admission: vitals: t 98.9, bp 138/74, p 90, rr 23, o2sat 94% 2l nc general: alert, oriented, appears uncomfortable but in no acute distress heent: sclera icteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular but tachycardic, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, hepatomegaly and splenomegaly present, fluid wave with shifting dullness present gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: aao x 3, mild tremor skin: mildly jaundiced with scattered spider angioma across chest. multiple tattoos. on discharge: *** pertinent results: admission labs: 05:09pm blood wbc-11.1* rbc-2.65* hgb-7.9* hct-23.2* mcv-88 mch-29.9 mchc-34.0 rdw-20.0* plt ct-88* 05:09pm blood pt-18.8* ptt-43.2* inr(pt)-1.7* 05:09pm blood fibrino-133* 05:09pm blood glucose-234* urean-13 creat-0.8 na-138 k-4.0 cl-106 hco3-23 angap-13 05:09pm blood alt-34 ast-131* alkphos-99 amylase-22 totbili-8.0* 05:09pm blood albumin-3.0* calcium-6.8* phos-3.1 mg-1.6 iron-182* . discharge labs: 04:40am blood wbc-16.8* rbc-3.05* hgb-10.0* hct-30.0* mcv-98 mch-32.9* mchc-33.4 rdw-22.0* plt ct-174 04:40am blood pt-21.5* ptt-45.8* inr(pt)-2.0* 04:40am blood glucose-153* urean-8 creat-0.7 na-135 k-3.8 cl-101 hco3-24 angap-14 05:45am blood alt-54* ast-166* alkphos-95 totbili-9.1* 04:40am blood calcium-8.6 phos-3.5 mg-1.6 05:45am blood vitb12-1484* 05:09pm blood caltibc-200* ferritn-50 trf-154* 05:09pm blood tsh-0.59 05:09pm blood hbsag-negative hbsab-positive hbcab-negative hav ab-positive 05:09pm blood ama-negative smooth-negative 05:09pm blood -negative 07:55pm blood hiv ab-negative . peritoneal fluid: 02:20pm ascites wbc-833* hct,fl-9* polys-89* lymphs-8* monos-3* 02:20pm ascites totpro-2.0 glucose-109 ld(ldh)-235 albumin-less than 01:46pm ascites wbc-1500* rbc-* polys-1* lymphs-15* monos-1* mesothe-13* macroph-70* 01:46pm ascites totpro-2.5 glucose-121 ld(ldh)-418 totbili-7.0 . chest x-ray: ap chest reviewed in the absence of prior chest radiographs: tip of the endotracheal tube is just above the level of the sternal notch, no less than 5.5 cm above the carina. with the chin elevated this is standard placement. lung volumes are low exaggerating mild interstitial abnormality and vascular congestion as well as heart size which is probably top normal. no pneumonia, pneumothorax or appreciable pleural effusion. . abdominal ultrasound: the findings are consistent with cirrhosis, splenomegaly, ascites and portal hypertension. portal venous system is patent but flow is hepatofugal throughout the portal and splenic veins. echo: the left atrium and right atrium are normal in cavity size. 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 diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. . ct head: no acute intracranial abnormality. . microbiology: urine culture: no growth blood culture: no growth peritoneal culture: no growth c.diff: negative brief hospital course: the patient is a 31 year-old male with history of etoh abuse who presents with massive hematemesis and melena (thought to be secondary to a bleeding gastric varix, banded at osh) and alcoholic hepatitis; his course was complicated by respiratory failure, alcohol withdrawal, and encephalopathy. . # upper gi bleed: prior to transfer to , the patient had an egd at osh, which revealed an actively bleeding dieulafoy's lesion versus gastric varix, which was clipped. upon arrival to , egd revealed non-bleeding gastric varices with no esophageal varices. patient presented with an hct of 23.2, and required a total of 10 units of prbc while in the icu to maintain hct. he was started on protonix and octreotide gtts. following egd, his protonix was changed to 40 mg iv bid and octreotide was continued for three days. patient was administered prophylactic dose of 1g ceftriaxone daily for five days. . the day following the egd, the patient underwent tips procedure by interventional radiology. this proceeded without complication, and follow-up ultrasound showing patent vessels. his hct remained stable following tips procedure ranging between 25 - 27. during his hospital course, he had no further episodes of gi bleeding. he was discharged home with po ppi. . # alcoholic hepatitis/cirrhosis: the patient presented without a previous diagnosis, however his elevated inr, bilirubin, ascites, and spider angioma were consistent with cirrhosis complicated by portal hypertension. ultrasound confirmed findings consistent with cirrhosis, splenomegaly, ascites, and portal hypertension. the etiology of his liver disease was believed to be etoh given the clear history, however given the patient's young age, he was ruled out for viral etiologies and autoimmune hepatits. the patient's acute clinical picture and laboratory findings was consistent with alcoholic hepatitis. discriminant function was approximately 40. this was believed to be the cause of his persistent leukocytosis and low-grade fevers throughout hospital course. at the time of discharge, his bilirubin was 9.1. he underwent tips procedure sucessfully, pressures improved from 16 to 12. he was started on lasix and aldactone following his icu course. he was discharged with lasix 40 mg and spironolactone 100 mg, to be further titrated with outpatient follow-up. he was also prescribed rifaximin to be taken as an outpatient. . # altered mental status/encephalopathy: believed to be multifactorial; contributions included hepatic encephalopathy, delirium (icu) and etoh withdrawal. patient's hepatic encephalopathy was treated with lactulose and rifaxamin. he was frequently reoriented and had tethering minimized. for evidence of alcohol withdrawal, he was administered ativan as necessary. patient remained a&ox1 when discharged from icu, though improved to a+ox3 over subsequent days with above interventions. as the patient's acute encephalopathy improved, he was observed to display underlying cognitive impairment, characterized by extensive confabulation despite good attention and orientation. there was suspicion of underlying wernicke's encephalopathy/korsakoff's due to patient's long-term alcohol intake. psychiatry evalauted the patient, but did not find evidence of wernicke's/korsakoff towards the end of his hospital course. he was discharged with mvi/thiamine/folate supplementation. he will follow-up with outpatient neurology. . # seizure: believed to represent withdrawal seizure, as patient's family provided history of prior seizures in setting of alcohol use. seizure occurred approximately 9-10 days following last alcoholic drink. no clear medications or electrolyte abnormalitites were implicated as cause. he was placed in restraints temporarily, though these were removed the following morning. he was continued on low-dose ativan for alcohol withdrawal with no further seizures. he will follow-up with outpatient neurology. # hypoxic respiratory failure: on hospital day 4 of admission, patient became acutely hypoxic and a respiratory code was called. there was concern for aspiration event in the setting of benzodiazepine use. patient was intubated. patient sucessfully extubated the next day when his condition improved. he completed a seven day course of vancomycin/zosyn as below. . # fever/leukocytosis: patient spiked fever to 100.4 on with cough and increased abdominal distension; aspiration pna and sbp were both on differential. patient underwent paracentesis, which was was grossly bloody and showed hgb of 9 with elevated wbc and polys. patient was started on vancomycin and zosyn for hcap and sbp coverage (though he did not strictly meet criteria for sbp when ascites sample corrected for hct) and recived 75 g of albumin on days one and three of treatment. after seven days of treatment, antibiotics were discontinued. subsequent fevers were attributed to ongoing alcoholic hepatitis. all urine, blood, and peritoneal cultures showed no growth. . # disposition: goal of disposition was inpatient alcohol treatment facility. this was unable to be coordinated given patient's insurance status. he was discharged home under his parents' supervision, and will initiate an intensive outpatient alcohol treatment program at the beginning of . medications on admission: none discharge medications: 1. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 2. furosemide 40 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 3. spironolactone 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 4. lorazepam 0.5 mg tablet sig: 0.5 tablet po at bedtime as needed for anxiety. disp:*15 tablet(s)* refills:*0* 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*0* 7. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 8. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary diagnosis: - alcoholic hepatitis - gastric varix status-post clip - respiratory failure secondary to aspiration - withdrawal seizure 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 . you were admitted to the hospital after vomiting blood, and spent time in the intensive care unit. during your stay in the icu, your blood counts remained stable. you were on a breathing machine for a period of time, and then this was removed after your condition improved. all of the medical problems that were treated during your hospital stay were related to alcohol use. the alcohol has caused extensive damage to your liver. consumption of alcohol after leaving the hospital could lead to even more severe consequences, including death. you will be discharged home to live under your parents' supervision until your intensive alcohol program begins at the beginning of . . please start the following medications after leaving the hospital. lasix spironolactone protonix rifaximin thiamine folic acid ativan (lorazepam) . should you experience any symptoms that concern you after leaving the hospital, please call your liver doctor or return to the emergency room. followup instructions: please follow-up at these times/places: . department: liver center when: thursday at 2:30 pm with: , md building: lm campus: west best parking: garage note: currently you have no insurance listed with us. if you are unable to pay out of pocket for this appt, please look into masshealth for insurance options. . department: neurology when: monday at 1 pm with: drs. & building: sc clinical ctr campus: east best parking: garage note: currently you have no insurance listed with us. if you are unable to pay out of pocket for this appt, please look into masshealth for insurance options. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified other endoscopy of small intestine insertion of endotracheal tube insertion of endotracheal tube other endovascular procedures on other vessels injection of anesthetic into spinal canal for analgesia intra-abdominal venous shunt phlebography of the portal venous system using contrast material diagnoses: pneumonia, organism unspecified anemia, unspecified tobacco use disorder alcoholic cirrhosis of liver other convulsions acute respiratory failure pneumonitis due to inhalation of food or vomitus other ascites encephalopathy, unspecified varices of other sites other and unspecified coagulation defects other and unspecified alcohol dependence, continuous other alteration of consciousness acute alcoholic hepatitis alcohol withdrawal chronic pulmonary heart disease, unspecified dieulafoy lesion (hemorrhagic) of stomach and duodenum esophageal varices without mention of bleeding cocaine abuse, in remission opioid abuse, in remission 

Answer: The patient is high likely exposed to