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: sob and abdominal distention major surgical or invasive procedure: paracentesis thoracentesis history of present illness: pt well known to me from my clinic. mr. is a 49 yom with new diagnosis of cirrhosis likely from hep b and c after hx of ivda. i saw him a few weeks ago in the clinic after hospitalization for ascities. he was doing well and losing weight on his diuretics. he phoned me 2 days pta stating he was become sob. i asked him at that time to go the the ed to be evaluated. he declined but made an appointment to be seen in the clinic today. he was seen and felt to have singnificant hypoxia with ambulation down to 86% on ra and extensive le edema and tense ascities. upon arrival to ed he was afebrile and still hypoxic on ra. he states he has been getting progressively more short of breath over past few days. he attributes this to laying on his right side and thinks the fluid from his belly has "rolled into my chest". no fevers or chills at home. abdominal pain is unchanged. he states he is taking his medications as directed. . ros positive for nausea, "watery vomitting", no blood in emesis. have bowel movements a day. past medical history: includes a motor vehicle accident and back pain, hepatitis b and c recently diagnosed as well as iv drug use x30 years. social history: the patient began smoking after his recent discharge. no alcohol use. he is unemployed. last worked a few years ago in a factory. he spends most of his day, he says, sleeping. family history: mother is living, 86 years old, with hypertension. he has a sister and a brother in good health. physical exam: t 98.3 bp 114/64 hr 88 rr 24 89% ra 96% on 2l general: temporal wasting, and appears chronically ill. heent: pupils equal, round, reactive to light. extraocular movements intact. there is no scleral icterus. some slight erythema in the throat. otherwise, oropharynx is clear. he also has on his right forehead a raised erythematous lesion approximately 1 cm in diameter that he states is an ingrown hair that has been present for a number of weeks. skin: he has multiple telangiectasias upon his chest as well as obvious collateral veins dilated across his chest and abdomen. there is no pallor and there is no sign of jaundice. neck: there is no lymphadenopathy. jvp appears to be elevated at approximately 12 cm. lungs: markedly decreased bs on right with dullness to percusion. also, on chest exam, the patient has bilateral gynecomastia. cardiovascular: regular rate and rhythm. normal s1, s2. no murmurs, rubs, or gallops. abdomen: distended, tense, tympanitic throughout. he has a significant ventral hernia when sitting up. bowel sounds present. i am unable to palpate his spleen or liver. extremities: he has 3+ pitting edema that rises approximately 3 inches past his knees. neuro: aox3 non-focal. no asterixis. pertinent results: 12:15pm glucose-78 urea n-19 creat-1.1 sodium-132* potassium-4.3 chloride-97 total co2-25 anion gap-14 12:15pm alt(sgpt)-31 ast(sgot)-48* alk phos-108 amylase-99 tot bili-2.1* 12:15pm lipase-59 12:15pm albumin-2.7* calcium-8.9 phosphate-3.3 magnesium-1.7 12:15pm wbc-4.5 rbc-4.21* hgb-13.5* hct-39.3* mcv-93 mch-32.1* mchc-34.5 rdw-16.4* 12:15pm neuts-70.7* lymphs-19.3 monos-8.0 eos-1.5 basos-0.5 12:15pm anisocyt-1+ macrocyt-1+ 12:15pm plt count-132*# 12:15pm pt-17.1* ptt-32.6 inr(pt)-1.6* _ _ _ _ _ _ _ _ _ ________________________________________________________________ radiology final report chest (pa & lat) 3:18 pm chest (pa & lat) reason: rule out infiltrate, chf medical condition: 49 year old man with ascites and sob reason for this examination: rule out infiltrate, chf indication: ascites, shortness of breath, evaluate for infiltrate versus chf. comparison: none. pa and lateral chest radiographs there is complete opacification of the right hemithorax. there is slight leftward shift of the trachea and heart suggesting that this is largely due to effusion, and most likely collapse. underlying left lung appears clear. radiology final report chest (pa & lat) 9:34 am chest (pa & lat) reason: please evaluate for interval change medical condition: 49 year old man with ascites and sob with righ side pleural effusion s/p paracentesis reason for this examination: please evaluate for interval change chest two views, pa and lateral history of ascites with shortness of breath and pleural effusion, status post paracentesis. there is total opacity of the right hemithorax with possible slight shift of heart to the left consistent with persistent massive right pleural effusion, unchanged since prior film of . minimal atelectasis is present at the left lung base. impression: complete opacification of the right hemithorax, likely secondary to effusion. underlying infection cannot be excluded. discussed with dr. at 4:15 p.m., . chest (portable ap) 3:01 am chest (portable ap) reason: please eval for interval change medical condition: 49 year old man with esld and effusion, now hypoxic to 80's on face mask. reason for this examination: please eval for interval change reason for examination: evaluation of known pleural effusion in patient with end-stage liver disease. portable ap chest radiograph compared to . the right hemithorax is almost completely opacified by large amount of pleural fluid with prominent mediastinal shifting. there is some small improvement of aeration of the right lung in the right upper lobe. the left lung is clear with no pleural effusion. impression: large amount of right pleural effusion, which is slightly less with small improvement in the aeration of the right upper lobe. radiology final report chest (portable ap) 11:20 am chest (portable ap) reason: interval change in pleural effusion/ptx medical condition: 49 year old man with esld and pleural effusion, ptx after thoracentesis reason for this examination: interval change in pleural effusion/ptx indication: end-stage liver disease and pleural effusion, post thoracentesis. comparison: . the large right pleural effusion has substantially increased in size in two days. left lower lobe linear atelectasis is unchanged. there is equivocal contralateral shift of the mediastinum. left lung is clear and no left pleural effusions are present. unilaterality of effusion without a significant mass effect (mediastinal shift) suggests a possible etiology beyond known end-stage liver disease. impression: worsening large pleural effusion. _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ radiology final report ct chest w/contrast 3:58 pm ct chest w/contrast; ct abdomen w/contrast reason: injury to thoracic duct, mediastinal mass or lymphadenopathy field of view: 39 contrast: optiray medical condition: 49 year old man with chylothorax, liver failure reason for this examination: injury to thoracic duct, mediastinal mass or lymphadenopathy. contraindications for iv contrast: none. indication: 49-year-old male with chylothorax, liver failure, injury to thoracic duct. assess for mediastinal mass or lymphadenopathy. no comparison studies. technique: mdct-acquired axial images of the chest, abdomen, and pelvis were performed with iv contrast. ct chest with iv contrast: there is an extremely large right-sided pleural effusion taking up nearly the entire right hemithorax causing right middle and right lower lobe entire collapse and partial collapse of the right upper lobe. this expansive right effusion is causing further mediastinal shift compared to one-day prior chest x-ray. there is compression upon the entire left lung. there are multiple patchy areas of ground-glass within the left upper and lower lobes, which could represent early development of pneumonia or atelectasis given compression. recommend clinical correlation. within the mediastinum, there is one area of soft tissue density likely representing a lymph node in the pretracheal region, however, recommend followup study post-drainage of effusion for better assessment of additional nodes within the mediastinum given that study is limited secondary to shift and image quality. ct abdomen with iv contrast: liver is small and nodular consistent with cirrhosis. there is a marked amount of ascites. gallbladder contains a small stone. pancreas is grossly unremarkable. spleen is enlarged. adrenal glands are not clearly visualized, however, no large masses are identified. the kidneys are unremarkable. the small bowel and large bowel are of normal caliber with no evidence of obstruction. there is soft tissue density seen within the retroperitoneum, seen surrounding the aorta at the level of the sma, however, difficult to assess whether or not soft tissue density represents normal or abnormal tissue given poor image quality. again recommend followup study after resolution of effusion and/or possibly ascites. ct pelvis with iv contrast: ascites extends down into the pelvis. urinary bladder is unremarkable. the prostate and rectum are within normal limits. few diverticuli within the sigmoid colon with no evidence of diverticulitis. bone windows: no suspicious lytic or blastic osseous lesions. impression: 1. extremely large right pleural effusion, increased in size compared to one-day prior, causing significant mediastinal shift, collapse of right middle and lower lobes, and compression of left lung. 2. borderline enlarged lymph node in the right pretracheal station. recommend followup ct scan for better assessment of both this as well as other possible nodes within the mediastinum following resolution of pleural effusion. 3. multiple patchy ground-glass opacities within the left upper and lower lobes, which could represent pneumonia in the appropriate clinical setting. also could represent atelectasis given compression from right pleural effusion. recommend clinical correlation. 4. marked ascites as seen on prior ultrasound. 5. cirrhotic liver and splenomegaly. 6. cholelithiasis. 7. questionable retroperitoneal soft tissue surrounding aorta at level of sma. recommend followup scan for better delineation of this lesion given poor quality of current examination. _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ radiology final report us abd limit, single organ 3:40 pm us abd limit, single organ reason: please scan all 4 quadrants and mark for paracentesis medical condition: 49 year old man with abd distension, hep b/c cirrhosis, here with ascites. reason for this examination: please scan all 4 quadrants and mark for paracentesis limited ultrasound scan of the abdomen. clinical details: chronic liver disease, evaluate for ascites. findings: large amount of intra-abdominal ascites, which appears simple on ultrasound. this is present throughout the four quadrants. cutaneous ink mark was placed overlying the largest depth of ascites in the right lower quadrant. at that point, the abdominal wall measures 1 cm in thickness with the ascites measuring over 5 cm in depth deep to the anterior abdominal wall at that level. conclusion: large amount of intra-abdominal ascites. _ _ _ _ _ _ _ ________________________________________________________________ cardiology report echo study date of patient/test information: indication: shortness of breath. height: (in) 72 weight (lb): 198 bsa (m2): 2.12 m2 bp (mm hg): 110/60 hr (bpm): 100 status: inpatient date/time: at 14:28 test: tte (complete) doppler: full doppler and color doppler contrast: none tape number: 2006w019-1:00 test location: west echo lab technical quality: adequate referring doctor: dr. measurements: left atrium - long axis dimension: 3.5 cm (nl <= 4.0 cm) left atrium - four chamber length: 3.1 cm (nl <= 5.2 cm) right atrium - four chamber length: 3.0 cm (nl <= 5.0 cm) left ventricle - septal wall thickness: 0.7 cm (nl 0.6 - 1.1 cm) left ventricle - inferolateral thickness: 0.8 cm (nl 0.6 - 1.1 cm) left ventricle - diastolic dimension: 4.0 cm (nl <= 5.6 cm) left ventricle - systolic dimension: 1.8 cm left ventricle - fractional shortening: 0.55 (nl >= 0.29) left ventricle - ejection fraction: 75% to 85% (nl >=55%) aorta - valve level: 3.5 cm (nl <= 3.6 cm) aorta - ascending: 3.0 cm (nl <= 3.4 cm) aortic valve - peak velocity: 1.4 m/sec (nl <= 2.0 m/sec) mitral valve - e wave: 0.9 m/sec mitral valve - a wave: 0.7 m/sec mitral valve - e/a ratio: 1.29 mitral valve - e wave deceleration time: 262 msec tr gradient (+ ra = pasp): <= 25 mm hg (nl <= 25 mm hg) interpretation: findings: large left pleural effusion. left atrium: normal la size. right atrium/interatrial septum: normal ra size. normal interatrial septum. no asd by 2d or color doppler. left ventricle: normal lv wall thicknesses and cavity size. normal regional lv systolic function. hyperdynamic lvef. no resting lvot gradient. right ventricle: normal rv chamber size and free wall motion. aorta: normal aortic root diameter. normal ascending aorta diameter. aortic valve: normal aortic valve leaflets (3). no as. no ar. no masses or vegetations on aortic valve. no as. mitral valve: normal mitral valve leaflets. no mvp. no mass or vegetation on mitral valve. mild (1+) mr. tricuspid valve: normal tricuspid valve leaflets. no mass or vegetation on tricuspid valve. mild tr. normal pa systolic pressure. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: no pericardial effusion. conclusions: the left atrium is normal in size. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). right ventricular chamber size and free wall motion are normal. 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. there is no aortic valve stenosis. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. electronically signed by , md on 14:57. _ _ _ _ _ _ _ _ _ ________________________________________________________________ cytology report pleural fluid procedure date of report approved date: specimen received: 06- pleural fluid specimen description: received 1500ml bloody fluid. prepared 1 thinprep slide. clinical data: patient with esld and effusion on the right. previous biopsies: 06- peritoneal fluid report to: dr. diagnosis: pleural fluid: negative for malignant cells. abundant reactive mesothelial cells, lymphocytes, histiocytes and red blood cells. diagnosed by: , ct(ascp) , m.d. _ _ _ _ _ _ _ _ _ _ ________________________________________________________________ 4:21 pm peritoneal fluid **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. _ _ _ _ _ _ _ _ _ ________________________________________________________________ 4:08 pm pleural fluid das,acu added 1741. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. acid fast smear (final ): no acid fast bacilli seen on direct smear. acid fast culture (pending): brief hospital course: 49 yo man with an extensive h/o ivda, hepatitis c, admitted with sob and abdominal distention. . #sob/ascities - likely related to cirrohsis. has been compliant with medications. but not eating a low salt diet. large right pleural effusion related to ascities. no fever, elevated wbc, or change in abdominal pain to suggest sbo. diagnostic and therapeutic paracentesis done on about 7 liters of chylous transudative fluid removed that was culture and cytology negative. his diuretics were increased to lasix 80 and spironolactone 200 mg . on monday 2.5 liters of chylous transudative fluid was removed from his right chest wiht interval improvement of his cxr. he recieved 4 mg of ativan peri-procedure. that evening he had an acute oxygen desaturation to the 80s on 4l. this was thought to be sedation from meds, no ptx but the fluid had already reaccumulated. he was put on a nrb with sats returning to the mid 90s. he spent one night in the icu for continuous o2 monitoring with out incident. he remained on the floor getting diuretics. a ct scan was done to look for cause of chylous nature of fluids (mediastinal adenopathy) but there was too much compression of structures to fluid to look and thoracic duct and near by structures. a second large therapeutic tap was done on and 5l of similarly colored fluid was removed (none sent to the lab). over the next few days o2 sats improved with more fluid taken off. he refused further thoracentesis. on monday his o2 sats were improved. however at this point his na began to drop and cr began to rise. it seemed he was developing hepatorenal syndrome. his diuretics wre stopped. his na continued to drop and cr rise. on wednesday , it was decided to treat his hepatrenal syndrome with octreatide and midodrine. he however became angry after a negative interaction with the hepatology team and decided to leave the hospital ama. #heroin addiction - pt stable on methadone 60 mg po qd. medications on admission: lasix 40 mg once a day, spironolactone 200 mg once a day, lactulose 15 ml t.i.d., protonix 40 mg once a day, and methadone 60 mg once a day provided by the methadone clinic. discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 2. methadone 10 mg tablet sig: six (6) tablet po daily (daily): provided by clinic. 3. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 4. lactulose 10 g/15 ml syrup sig: forty five (45) ml po bid (2 times a day). disp:*2700 ml(s)* refills:*2* 5. bacitracin zinc 500 unit/g ointment sig: one (1) appl topical qid (4 times a day). disp:*1 tube* refills:*2* 6. medical equipment please provide patient with hospital bed discharge disposition: home discharge diagnosis: cirrohsis pleural effusion ascities acute renal failure hyponatremia discharge condition: good discharge instructions: please return to emergency department if you have fevers, abdominal pain, or trouble breathing. . please restrict the amount of fluid you drink each day to 1l(that is equal to about 4 cans of soda) and restrict the amount of salt and sodium you take in. followup instructions: please come to clinic on thursday to have labs drawn at 1pm. please wait to speak with me after the labs come back. provider: , md phone: date/time: 1:30 . provider: , md phone: date/time: 1:40 md procedure: thoracentesis thoracentesis other incision with drainage of skin and subcutaneous tissue diagnoses: cirrhosis of liver without mention of alcohol acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified portal hypertension unspecified viral hepatitis c without hepatic coma opioid type dependence, continuous unspecified disorder of kidney and ureter hepatic encephalopathy viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta sebaceous cyst 

Answer: The patient is high likely exposed to