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: transferred from home with hyperammonemia. major surgical or invasive procedure: none history of present illness: 48 yo male with sickle cell anemia discharged yesterday from after three week hospitalization for acute liver failure thought due to sickle cell hepatopathy (with possibly some contribution from tylenol). on discharge, pt was tired and slow as usual, but alert and oriented x 3 without asterixis and with a creatinine of 1.0. pt was transferred to the bostonian, where he was noted to be lethargic with "lab abnormalities" today and transferred to the ed. these lab abnormalities include a sodium of 120, which was lab error (147 in ed), an elevated creatinine of 2.0, and hyperammonemia to 73. per pt, he reports he felt better yesterday but not more specific. he reports diarrhea this afternoon in the ed. in the ed, he was noted to be oriented x 3 but sleepy, as he was on discharge. however, he has new asterixis. he received lactulose and underwent u/s to rule out occlusive disease, now pending. a cxr showed some chf and bilateral small pleural effusions l > r. pt was admitted for delerium. past medical history: 1. acute liver failure, likely due to sickle cell hepatopathy, tylenol use possibly another contributor 2. atn, resolved 3. narcotic overdose 4. sickle cell disease 5. hepatitis c, on ifn alpha 6. s/p cholecystectomy 7. hemorrhoids 8. ppd + () social history: patient works as a pharmacy tech in a hospital. he denies etoh, tobacco, and drug use. physical exam: vs: 98.3, 72, 110/70, 18, 100%ra gen: cachectic, pleasant haitian man, conversing with eyes closed, appears as tired as he did during recent admission heent: small pupils, perrl, mmm, no plaque on tongue, right ij bandage cdi chest: decreased inspiratory effort, ctab, no wheeze, no crackles cor: rr, nl s1 s2, no mrg abd: +bs, soft, non-tender, no rebound, distended with some ascites ext: 1+/1+ pitting edema neuro: though pt is slow, he is alert and oriented x 3 and also knows the president's name, he has asterixis today, which he didn't have yesterday. pertinent results: * 06:30am blood wbc-16.5* rbc-3.21* hgb-8.7* hct-26.6* mcv-83 mch-27.1 mchc-32.8 rdw-19.1* plt ct-211 03:47am blood wbc-16.7* rbc-2.57* hgb-7.6* hct-22.2* mcv-87 mch-29.5 mchc-34.1 rdw-18.6* plt ct-94* 05:25pm blood pt-18.5* ptt-150* inr(pt)-2.2 06:30am blood plt ct-211 05:25pm blood pt-18.5* ptt-150* inr(pt)-2.2 03:47am blood plt smr-low plt ct-94* lplt-2+ 03:47am blood pt-18.6* ptt-50.6* inr(pt)-2.2 07:29pm blood fibrino-366 d-dimer-620* 07:29pm blood fdp-0-10 05:25pm blood glucose-83 urean-49* creat-2.0* na-147* k-3.6 cl-120* hco3-19* angap-12 03:47am blood glucose-136* urean-109* creat-6.0* na-145 k-4.5 cl-111* hco3-12* angap-27* 06:30am blood alt-45* ast-66* alkphos-389* totbili-51.7* 03:47am blood alt-44* ast-64* alkphos-159* totbili-61.5* 05:25pm blood albumin-2.4* calcium-10.3* phos-5.0* mg-3.2* 03:47am blood albumin-4.4 calcium-9.9 phos-7.5* mg-3.0* 05:25pm blood ammonia-73* 12:25pm blood ammonia-71* 05:34am blood tsh-0.14* 05:34am blood pth-24 05:34am blood cortsol-24.5* 05:25pm blood asa-neg ethanol-neg acetmnp-22.9 bnzodzp-neg barbitr-neg tricycl-neg 08:30am blood lactate-1.3 01:51pm blood lactate-1.9 12:38pm blood lactate-1.5 na-144 k-3.5 * ascites analysis ( 11:38am) wbc 9; rbc 16; polys 18; lymphs 31; monos 0; mesothe 2; macroph 49 * chest (pa & lat) 6:36 pm 1. mild increased interstitial opacities bilaterally consistent with left ventricular heart failure. 2. bilateral pleural effusions with reactive atelectasis. 3. retrocardiac left lower lobe collapse/consolidation. * liver or gallbladder us (single organ) 6:52 pm 1) unchanged micronodular liver, consistent with known hepatitis c. 2) patent portal veins with appropriate flow. 3) small to moderate amount of ascites. * duplex dop abd/pel limited 1:27 pm very limited exam secondary to the patient's inability to hold his breath. patent right main renal artery and vein. limited views of the left renal vessels, as discussed. * ct head w/o contrast 1:21 pm 1) no evidence of acute intracranial hemorrhage or mass effect. 2) irregular lucency within the right side of the sphenoid bone adjacent to the sphenoid sinus that is incompletely assessed on this limited ct study. a dedicated ct of the skull base should be performed for further evaluation, and which may simply represent artifact (volume averaging with adjacent soft tissue structures) as opposed to a pathological process * brief hospital course: . mr. is a 48 yo male with sickle cell anemia and hcv (undetectable vl, no prior liver bx) who has been on ifn tiw since at least ', just discharged 1 day pta for acute liver failure and atn, now readmitted from rehab with increased lethargy, hyperammonemia, and arf. today has increasing metabolic acidosis with increased leukocytosis, suspect infection. . 1) lethargy/delerium: he presented with altered mental status likely secondary to hepatic encephalopathy. pt was mentating slowly and with lethargy but he was alert and oriented x 3 on admission. initially, there was no change regarding his mentation from his recent discharge condition. asterixis was new, however. hyperammonemia and possibly narcotics likely contributing to his lethargy. ammonia level was still elevated to 71. lactulose was titrated to 3 bm per day. tox screen was negative except for acetaminophen, which could be because of slow metabolism d/t liver failure, as last known ingestion was early . over the course of his admission, his mental status progressively worsened and he became only oriented x 1. at this point, he could no longer take po's and lactulose could not be given. his worsening mental status was attributed to his worsening liver failure, which was thought to be related to vaso-occlusive complications of recent sickle crisis on last admission. the liver team also followed the patient during this admission. his liver failure was determined to be irreversible and he was not thought to be a transplant candidate given the his critical condition. . 2) metabolic acidosis and increased leukocytosis: initially, the patient's bicarb fell from 19 to 12, and wbc up from 18 to 30, which was concerning for infection. differential intially included infected left pleural effusion, spontaneous bacterial peritonitis, uti, or bacteremia. he was empirically covered with vancomycin and zosyn. a paracentesis was performed initially which ruled out sbp. blood and urine cultures were negative. no source of infection was ever identified. further into his hospital course, antibiotics were stopped, and his wbc count eventually trended down slightly. he remained afebrile. . 3) liver failure: this was likely due to sickle cell hepatopathy. his total bilirubin and coags continued to rise throughout his admission. ruq u/s was performed and ruled out venous occlusion. he had continued oozing of blood from his central line site, which dropped his hct. he was given ffp for supportive therapy to temporarily reverse his coagulopathy, as well as prbcs to maintain hct > 20. the liver team determined that he would not be a candidate for liver transplant. his liver failure was thought to be irreversible at this point. . 4) acute renal failure: prior to admission, his creatinine bumped from 1.0 to 2.0 in one day at rehab. the etiology of his renal failure was not clear on this admission, and was thought to be related to hepatorenal syndrome vs. atn. the renal service was consulted and felt that this was more likely to represent hepatorenal syndrome. of note, the patient had granular casts in his urine. urine eosinophils were negative. renal u/s was negative for obstruction. his renal arteries and veins were found to be patent. he was not thought to be a hemodialysis candidate based on how critical his condition was, and the fact that his renal failure was likely due to liver failure, which was irreversible. . 5) hypercalcemia: the patient developed hypercalcemia on this admission. the etiology was unclear. it transiently improved with ivf hydration. differential included hyperparathyroidism, thyrotoxicosis, malignancy, vitamin d intoxication, etc. none of which fit with his clinical picture. endocrine was consulted and suggested further work up with pth, tsh, upep/spep, as well as other more specific tests which were not sent. the pth was normal, tsh slightly low, and upep/spep pending at the time of discharge. . 6) hypernatremia: likely due to hypovolemia. he received d5 ns which improved his serum sodium. . 7) sickle cell anemia - the patient had minimal sickling on his peripheral blood smear, so his sickle cell crisis from last admission was thought to be inactive at this time. heme/onc followed the patient during this admission. they decided that exange transfusion would not be beneficial to the patient at this time. . 8) fen: initially, the patient was able to take po's. however, with the decline in his mental status toward the end of his admission, he was no longer able to take po's. . 9) dispo: given that his condition was critical and secondary to irreversible liver failure, a discussion was held with the family and the patient's mother decided to take him home with hospice care. the patient died in the hospital on complete comfort measures. medications on admission: 1. senna prn 2. bisacodyl 5 mg prn 3. metoclopramide hcl 10 mg qid prn 4. lactulose 30 ml po q8h prn 5. simethicone 6. folic acid 1 7. chlorhexidine gluconate prn 8. multivitamin 9. heparin sq tid 10. ursodiol 300 mg 11. morphine sulfate 15 mg q4-6hr prn 12. pantoprazole 40 qd 13. potassium chloride prn discharge disposition: home discharge diagnosis: 1) liver failure 2) acute renal failure 3) coagulopathy 4) mental status changes discharge condition: deceased discharge instructions: none followup instructions: none md, procedure: venous catheterization, not elsewhere classified percutaneous abdominal drainage transfusion of packed cells transfusion of other serum diagnoses: acidosis cirrhosis of liver without mention of alcohol chronic hepatitis c without mention of hepatic coma hepatorenal syndrome hyperosmolality and/or hypernatremia hypercalcemia sickle-cell disease, unspecified 

Answer: The patient is high likely exposed to