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: lethargy, fatigue major surgical or invasive procedure: none history of present illness: 86 year old male with h/o cryptogenic cirrhosis, chf, afib, dm, critical as, iga nephropathy and leukocytoclastic vasculitis who presents with altered mental status, fatigue, lethargy and jaundice. at baseline he is independent with a walker and was active yesterday. by the evening, he had decreased responsiveness and was not answering questions during the night. he has improving petechiae all over his body from a recent vasculitis. denies fevers, cough. brought to where initial vitals were 95.0 87/44. ammonia 101. ct head unremarkable. given vanco, zosyn, lactulose, 3l ns, and started on a dopamine gtt. treated with warmed ivf and a bear hugger. was with daughter and son-in-law. was then transferred to the ed. in our ed, initial vitals were 97.4 122 109/66 20 97% 2l nc. triggered on arrival for hypotension with bp's 80/60. exam notable for toxic appearing male with petechial rash c/w known leukocytoclastic vasculitis. fast u/s was negative. a right ij was placed. he was changed to a levophed gtt. given 500cc in our ed. does have mildly positive ua. considered lp but didn't due to lack of leukocytosis or fever. considered hepatic encephalopathy vs sepsis as etiology of his hypotension. ecg with mild st depressions in v1-v2. most recent vitals 97.6 88 110/47 19 100%4l. lactate wnl. pt was recently hospitalized for "acute liver decompensation." recent illness in and newly dx'd liver disease with jaundice, ascites, and portal thrombosis. was cardiac catheterized in consideration of as causing anasarca results showed: severe aortic stenosis (gradient of 53mmhg, valve area of 0.85cm2), mildly elevated filling pressures, mild pulmonary hypertension but insufficient to explain the degree of portal hypertension seen on exam. he was started on lasix, spironolactone and rifaximin. he followed with dr. at . first hepatology clinic visit (limited note) started lactulose, creat 1.7, bili 2.8, bp 100/60, slow afib. new pcp () on friday creat 2.3, ammonia 90, wbc wnl, bili 1.3, inr 1.3. family was unable to afford rifaximin as outpt. new medications include vitamin e and milk thistle per daughter. other new meds including pain killers. pt has been stooling regularly ( bms daily). on the floor, pt is drowsy and unable to answer questions very well. he knows he is in a hospital but not oriented to date and cannot provide medical history. family is at bedside and report recent hx of fatigue and lethargy since yesterday am. he was engaged and able to go out to dinner last night but noted to be very sleepy around 9pm and was poorly responsive and confused around 0100. they called an ambulance which took them to . he had no complaints during the day aside from some mild nausea and vomiting (vomited "1 tsp of peanuts" after dinner) and has some baseline dysphagia with coughing that was worse than usual yesterday. family denies increasing abd girth, abd pain, chest pain, sob, or constipation. code status confirmed full code by daughter/hcp. past medical history: hearing loss - wears a hearing aide congestive heart failure (last tte : mild symmetric left ventricular hypertrophy with normal global and regional biventricular systolic function. critical calcific aortic stenosis. mild mitral regurgitation.) atrial fibrillation arthralgias diabetes mellitus hypothyroidism critical aortic stenosis (valve area <0.8cm2) tonsillectomy polypectomy chronic l knee pain social history: italian is first language. lives with wife in . distant history of smoking (3 pack years), quit >40yrs ago. rare etoh. no illicits. family history: dm. no liver disease. physical exam: vitals: t: 97.5 bp:105/52 p: 86 r: 18 o2: 100/2l general: drowsy and lethargic, elderly male, lying in bed, nad, arousable heent: sclera slightly discolored (brown) but anicteric, oral mucosa pink/dry, oropharynx clear, tongue midline neck: supple, jvp not elevated, no lad lungs: bibasilar rales, poor respiratory effort cv: irregularly irregular rhythm, normal rate, normal s1 + s2, iii/vi crescendo-decrescendo murmur radiating to carotids and at apex, no rubs or gallops abdomen: soft, non-tender, mildly distended, positive fluid wave, bowel sounds present, no rebound tenderness or guarding, liver border palpated 4 fingerbreadths below costal margin, spleen not palpated gu: +foley, blood at urethral meatus, no scrotal edema ext: warm, well perfused, petechial rash diffusely distributed over torso + extremities, 2+ pulses, no clubbing, cyanosis, 3+ edema to mid-calves, mild non-pitting edema of b/l ue, +asterixis elicited pertinent results: admission labs: 12:25pm wbc-9.2 rbc-3.10* hgb-11.2* hct-32.5* mcv-105* mch-36.1* mchc-34.4 rdw-14.2 12:25pm neuts-81.8* lymphs-12.9* monos-4.2 eos-0.4 basos-0.7 12:25pm plt count-216 12:25pm glucose-134* urea n-47* creat-1.7* sodium-139 potassium-4.2 chloride-104 total co2-28 anion gap-11 12:25pm albumin-2.8* calcium-8.4 phosphate-3.2 magnesium-2.1 12:25pm alt(sgpt)-27 ast(sgot)-50* alk phos-164* tot bili-1.9* dir bili-1.1* indir bil-0.8 12:25pm lipase-50 12:25pm ctropnt-0.03* 04:08am blood tsh-5.2* 03:10pm blood free t4-1.3 04:08am blood cortsol-11.4 02:00pm blood ammonia-less than 6 discharge labs: 05:55am blood wbc-6.6 rbc-2.74* hgb-9.3* hct-28.6* mcv-104* mch-34.1* mchc-32.7 rdw-14.8 plt ct-120* 05:55am blood glucose-134* urean-43* creat-1.6* na-135 k-4.7 cl-101 hco3-25 angap-14 05:55am blood calcium-8.5 phos-2.9 mg-2.0 06:46am blood alt-20 ast-31 alkphos-138* totbili-1.6* microbiology: urine, blood cultures negative. radiology: chest port. line placement study date of impression: 1. right internal jugular line in upper to mid svc. 2. low lung volumes limit evaluation for pneumonia or small nodules. if desired, repeat study can be performed. 3. acute fractures of right lateral 6th-8th ribs. liver or gallbladder us (single organ) study date of impression: 1. partially distended gallbladder, with moderate wall thickening (possibly reactive). hida scan could be considered to evaluate for early acute or chronic cholecystitis. 2. cirrhosis, without detectable portal venous flow. gallbladder scan study date of impression: gallbladder filling and excretion is visualized with no evidence of acute cholecystitis. tib/fib (ap & lat) left study date of findings: no definite evidence of bony abnormality or gas in soft tissues. if there is serious clinical concern for osteomyelitis, mri would be the next imaging procedure. dup extext bil (map/dvt) study date of impression: 1. no evidence of dvt. 2. abnormal right groin doppler could be caused by a small arteriovenous fistula. suggest pelvic cta to look for possible fistulous communication in this region. brief hospital course: patient is an 86 yo man with pmhx sig. for cryptogenic cirrhosis, leukocytoclastic vasculitis, and critical as with a recent prolonged hospitalization who was admitted from with lethargy, acute mental status changes, and jaundice. at the time of admission he was septic and required vasopressor therapy in the icu. he was also noted to have hepatic encephalopathy and this imrpoved with lactulose therapy. please problem list below for details on hospital course. # septic shock: his hypotension on admission was concerning for evolving sepsis picture given hypothermia, hypotension, and tachycardia. he was started on levophed in the ed (transitioned from dopamine started at osh) and it was continued in the micu. he received 75g of albumin for fluid resuscitation given concern for third spacing. levophed was weaned within 48 hours without difficulty. tsh 5.2, t4 1.3, cortisol 11.4. pt also did not have any record of steroid use for his recent leukocytoclastic vasculitis. his blood pressure stabilized and has been attributed to a likely underlying infection/septic shock, though source was not clear. both urine and blood cultures were negative. hida scan was negative for acute cholecystitis. patient did not have appreciable ascites on ruq or bedside son to perform a paracentesis. he was started on vancomycin, zosyn empirically and changed to ciprofloxacin, flagyl when cultures returned negative. he is to complete a 14 day course. he did have some difficulty tolerating the full doses of his diuretics and these were titrated up slowly. # hepatic encephalopathy: mental status changes were attributed to septic shock and hepatic encephalopathy given history of cryptogenic cirrhosis and asterixis present on exam. lactulose and rifaximin was started and with stooling he had appreciable ms improvements. his mental status returned to baseline by discharge; asterixis had resolved. # cryptogenic cirrhosis: the patient has a history of cirrhosis diagnosed in . complete w/u of his liver disease during recent admission was negative including viral hepatitis (except for hav igg antibodies), hemochromatosis, autoimmune. mri was negative for pv thrombosis. bedside u/s not impressive for good ascites pocket. ruq obtained and showed cirrhosis w/o perihepatic ascites or pv thrombosis. home dose lasix and spironolactone was restarted at a lower dose given his low blood pressure. per icu team, pt's family exhibited some confusion regarding medications necessary for their father's cirrhosis management. they had been holding his diuretic and did not fill prescriptions for lactulose or rifaximin; the latter cost. they requested assistance with regard to medication access. social work was consulted. the importance of taking lactulose regularly was emphasized. # iga nephropathy: he continued to put out adequate urine via foley catheter, and his creatinine remained stable. # critical aortic stenosis: recent cardiac catheterization was notable for mildly elevated heart pressures and aortic valve measured to be 0.8 cm2. pa pressure was 32/16 and pcwp 20 mmhg. betablocker was held on admission for hypotension and restarted at a lower dose given low blood pressures. # atrial fibrillation: patient was rate controlled on the smaller metoprolol dose. coumadin was discontinued on prior admission after family meeting with continuation of low dose asa for stroke prevention. he was continued on a low dose aspirin but betablocker was held on admission. the issue of anticoagulation was not addressed during his stay. # leg ulcers: he has 3 ulcers on his rle, attributed to vascular insufficiency. wound rn consult recommended local care. tibia film was negative for overt signs of osteomyelitis. # diabetes mellitus type 2, controlled, with complications: fsbg were followed and he was treated with insulin while hospitalized, discharged on his home glyburide regimen. # guaiac positive stool: he had no frank brbpr or melena. his hct remained stable in house. consider colonoscopy as warranted. # code status: this was discussed in detail with daughter including the limited likelihood that mr. would survive a code. however, the family/patient feel strongly that he should be full code. *******transitions of care******* - patient is on lower doses of lasix, spironolactone, and metoprolol, limited by blood pressure. this should be increased as necessary/tolerated. - patient is noted to have brown, guaiac positive stool. hct during his hospitalization remained stable at 28-31. medications on admission: 1. levothyroxine 100 mcg tablet qd 2. petrolatum ointment 3. rifaximin 550 mg tablet (not taking) 4. aspirin 81 mg tablet, chewable qd 5. furosemide 80 mg tablet 6. spironolactone 75 mg daily 7. outpatient physical therapy patient will need wheelchair with elevated leg rest. 8. metoprolol succinate 50 mg qd 9. glyburide 5 mg tablet qd discharge medications: 1. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 2. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. furosemide 40 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 5. spironolactone 50 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 6. metoprolol succinate 25 mg tablet extended release 24 hr sig: 0.5 tablet extended release 24 hr po once a day. disp:*15 tablet extended release 24 hr(s)* refills:*2* 7. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. disp:*qs x 1 month ml(s)* refills:*0* 8. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 9 days. disp:*9 tablet(s)* refills:*0* 9. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 9 days. disp:*27 tablet(s)* refills:*0* 10. silver sulfadiazine 1 % cream sig: one (1) appl topical (2 times a day) for 2 weeks. disp:*qs x 2 weeks * refills:*0* 11. glyburide 5 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: homecare discharge diagnosis: sepsis shock hepatic encephalopathy discharge condition: level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). mental status: clear and coherent. discharge instructions: dear dr. , you were admitted to the hospital with confusion and low blood pressure. you improved with treatment for your liver disease (lactulose) and with antibiotics for your infection. it is very important that you continue to take your lactulose daily and only hold it if you have had more than 3 bowel movements that day. changes in medications: - your lasix dose was decreased to 40 mg twice a day. - your spirinolactone dose was decreased to 50 mg once a day. - your metoprolol xl dose was decreased to 12.5 mg once a day. - please continue to take the antibiotics ciprofloxacin and flagyl until . followup instructions: name: ,md specialty: gastroenterology address: , , phone: appointment: at 3:15pm name: , location: center address: , , phone: when: thursday, at 2:45pm please evaluate if need cardiology follow up before next scheduled appt in . procedure: central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified congestive heart failure, unspecified cirrhosis of liver without mention of alcohol diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified septicemia unspecified protein-calorie malnutrition severe sepsis unspecified acquired hypothyroidism atrial fibrillation aortic valve disorders hypopotassemia chronic kidney disease, unspecified loss of weight septic shock other sequelae of chronic liver disease nonspecific abnormal findings in stool contents hepatic encephalopathy hypovolemia hyperosmolality and/or hypernatremia other and unspecified coagulation defects hematuria, unspecified ulcer of lower limb, unspecified nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney other specified hypersensitivity angiitis 

Answer: The patient is high likely exposed to