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: cephalosporins attending: chief complaint: hyponatremia major surgical or invasive procedure: diagnostic and therapeutic paracenteses bronchoscopy history of present illness: this is a 54 year old male with htn, copd, alcohol abuse transferred from with jaundice, abdominal distention and sodium of 104. originally presented with two weeks of abdominal pain with solid foods but not with liquids. when eats solid food gets constant abdominal pain over upper quadrants. two weekends ago noticed that abdomen became distended and remained so since. abdomen feels "tight" and has "pressure". denies cp or sob. no nausea, vomiting, diarrhea, dysuria. no similar prior history of either the abdominal pain or distension. went to ed today because pain was not getting better. at osh ed serum sodium was 104 and he was noted to be jaundiced. denies headache, confusion, falls, weakness, nausea, vomiting or diarrhea. transferred to for further workup. on arrival at the ed here vs were stable. he was started on hypertonic 3% ns at 35cc/hr in the ed. evaluated by hepatology. admitted to the icu for treatment with hypertonic saline. on arrival to the micu he appeared comfortable and in no acute distress. he has a long history of alcoholism. last drink 1 month ago. before that drank ~8 beers daily. reports often starting and stopping drinking in the past and states that there was no reason in particular he stopped drinking 1 month ago. past medical history: alcohol abuse copd htn s/p appendectomy social history: previously drank 8 beers daily. smokes 1 ppd. unemployed. previously worked as a machinist. family history: mother with gallstones. no family history of liver disease. family history otherwise noncontributory. physical exam: admission exam: vitals: t: afebrile bp: 120/56 p: 84 r: 18 o2: 94/ra general: alert, oriented, no acute distress heent: +icteric sclera, mmm, oropharynx clear, eomi, neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: faint bibasilar rales, occasional scattered expiratory wheeze, moving good air, otherwise clear abdomen: distended, non-tender, +bowel sounds, no organomegaly, negative , positive fluid wave and shifting dullness gu: no foley ext: 2+ pitting edema, warm, well perfused, 2+ pulses, no clubbing or cyanosis neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, gait deferred, finger-to-nose intact, no asterixis discharge exam: no vitals as cmo gen: nad comfortably watching television in bed heent: sclera icteric, eomi, perrla, mmm, dobhoff removed, spider angiomas over bridge of nose and cheeks neck: supple, no resp: crackles at bilateral bases, moving air well, no increased work of breathing cv: rate fast and regular, ns1&s2, no mrg gi: +bs, abdomen distended and soft with scattered spider angiomas, shifting dullness, reducible umbilical hernia, non-tender ext: 3+ ble edema r greater than l neuro: no asterixis, a&ox3. pertinent results: admission labs: 11:05am blood wbc-7.6 rbc-3.39* hgb-13.3* hct-36.5* mcv-108* mch-39.1* mchc-36.3* rdw-13.7 plt ct-133* 11:05am blood pt-26.2* ptt-46.3* inr(pt)-2.5* 11:05am blood glucose-105* urean-14 creat-0.5 na-104* k-4.7 cl-79* hco3-23 angap-7* 11:05am blood alt-99* ast-189* alkphos-112 totbili-17.1* 04:00pm blood calcium-7.3* phos-3.2 mg-2.0 discharge labs: 06:42am blood wbc-14.7* rbc-2.44* hgb-9.6* hct-27.8* mcv-114* mch-39.3* mchc-34.4 rdw-17.3* plt ct-161 06:37am blood neuts-80.8* lymphs-9.2* monos-6.2 eos-3.6 baso-0.2 06:42am blood pt-30.4* inr(pt)-2.9* 06:42am blood glucose-173* urean-111* creat-2.3* na-120* k-3.9 cl-82* hco3-23 angap-19 06:42am blood alt-54* ast-75* alkphos-72 totbili-11.2* 06:42am blood calcium-8.5 phos-6.7* mg-3.0* pertinent labs: 11:52pm blood caltibc-118* ferritn-2135* trf-91* 11:52pm blood hbsag-negative hbsab-negative hbcab-negative hav ab-positive igm hbc-negative igm hav-negative 11:23am blood hiv ab-negative 11:52pm blood hcv ab-negative micro: 10:07 am bronchial washings from apical segment rul. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): squamous epithelial cells. 3+ (5-10 per 1000x field): gram positive rod(s). 1+ (<1 per 1000x field): gram positive cocci. in pairs and clusters. smear reviewed; results confirmed. respiratory culture (final ): >100,000 organisms/ml. commensal respiratory flora. due to mixed bacterial types ( >= 3 colony types) an abbreviated workup will be performed appropriate to the isolates recovered from this site. haemophilus influenzae, beta-lactamase positive. >100,000 organisms/ml.. beta-lactamase positive: resistant to ampicillin. gram negative rod(s). 10,000-100,000 organisms/ml.. gram negative rod #2. 10,000-100,000 organisms/ml.. 2:21 pm fluid received in blood culture bottles **final report ** fluid culture in bottles (final ): escherichia coli. final sensitivities. piperacillin/tazobactam sensitivity testing performed by . enterobacter aerogenes. piperacillin/tazobactam sensitivity testing performed by . this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. final sensitivities. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | enterobacter aerogenes | | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s cefazolin------------- <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s piperacillin/tazo----- s s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s aerobic bottle gram stain (final ): reported to and read back by @ 0245 on - . gram negative rod(s). anaerobic bottle gram stain (final ): gram negative rod(s). 5:39 pm peritoneal fluid tube#3. **final report ** gram stain (final ): 4+ (>10 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (final ): albicans. rare growth. anaerobic culture (final ): no anaerobes isolated 4:50 pm fluid received in blood culture bottles peritoneal fluid. fluid culture in bottles (preliminary): . consultations with id are recommended for all blood cultures positive for staphylococcus aureus, yeast or other fungi. aerobic bottle gram stain (final ): budding yeast. 12:19 pm swab source: rectal swab. **final report ** r/o vancomycin resistant enterococcus (final ): enterococcus sp.. sensitivity testing performed by etest. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | vancomycin------------ r studies: ruq us: nodular echogenic liver compatible with cirrhosis. slightly eccentrically located small filling defect in the main portal vein suggestive of a small chronic non-occlusive thrombus. flow is present in the main portal vein. if confirmation or further delineation are needed clinically, ct or mr could be considered. adherent likely tumefactive gallbladder sludge including part of with a polypoid configuration measuring about 1.8 cm. attention on followup with ultrasound within six months is suggested to confirm that this is merely sludge rather than a solid polyp; this is seen in the context of more extensive solid-like sludge within the gallbladder, however. moderate ascites. . ct chest: right upper lobe nodule on chest radiograph corresponds to a right upper lobe cavitary lesion with slightly spiculated borders. a second smaller cavitary lesion in the left upper lobe is seen. the differential is broad and includes cavitary infection (including tuberculosis), septic emboli, necrotic tumor or metastases. nonspecific ground-glass opacities in the left upper lobe may be infection or other foci of the same process as the cavitary lesion. 3-mm left lower lobe nodule. trace bilateral pleural effusions. . pathology: sputum cytology: rare atypical squamous metaplastic cells; squamous cells, pulmonary macrophages, bronchial epithelial cells and many neutrophils. . bal cytology: negative for malignant cells. . cta torso impression: 1. no evidence for pe. 2. increase of inflammatory changes involving the upper lobes. cavitary lesions in the upper lobes bilaterally. the lesion in the right upper lobe has increased in size. due to the rapid change in size of the lesion, this is more consistent with an infectious process including tuberculosis. 3. increased subcarinal lymphadenopathy. 4. stable 6-cm mass in the liver which is indeterminate. further evaluation with mri is recommended to evaluate for features of hepatocellular carcinoma. 5. large amount of ascites. the previously identified free intraperitoneal air has resolved. 6. cholelithiasis without evidence for cholecystitis. . lower extremity us impression: 1. no dvt in the lower extremities. 2. nonspecific subcutaneous edema within the right calf. brief hospital course: 54 year old gentleman with a history of alcohol abuse, htn and copd who was transferred from after presenting complaining of abdominal pain/distention and found to have a sodium of 104, found to have alcoholic hepatitis and underlying alcoholic cirrhosis. course complicated by cavitary pneumonia and secondary peritonitis. in light of poor prognosis and non-candidacy for transplant, patient decided to withdraw aggressive treatment and was discharged to hospice. #acute alcoholic hepatitis: had 7-day prednisone course with resultant lille score 0.84, so prednisone discontinued, especially in setting of acute infection. dobhoff feeding tube in place and enteral feeding initiated, stopped when transitioned to cmo. # etoh cirrhosis: no recorded history of cirrhosis but patient not followed closely by pcp in outpatient setting. ruq u/s showed diffuse nodularity consistent with cirrhosis. no improvement of inr with iv vitamin k and high ast:platelet ratio, physcial exam findings consistent with long standing cirrhosis. not currently eligible for transplant as was actively drinking prior to this admission. would require longer term involvement with relapse prevention program. patient aware that his prognosis is grim enough that he would be unlikely to survive long enough to qualify for transplant, and felt that transplant itself would be a long challenging road. - hepatic encephalopathy: discharged on lactulose and rifaximin to maintain clear mental state. if unable to obtain rifaximin, increase lacutlose as needed for confusion - sbp: patient had sbp this admission, as above, discharged on cipro ppx to prevent sbp per discussion with family - varices: has not had egd, no known gib - ascites: diuretic refractory, s/p several large volume paracenteses this admission # hyponatremia: hypervolemic hypernatremia in setting of alcoholic hepatitis with new onset ascites with intake of free water in excess of sodium. adh from was 3.5 (within nl range), so less likely siadh. sodium was gradually increased on 3% hypertonic saline and fluid restriction. renal was consulted. on hypertonic saline was stopped and he was continued just on fluid restriction and daily lasix, and na increased to the low 130s. diuretics were held when patient had , sodium gradually downtrended. patient with sodium 120 when lab draws stopped. # secondary peritonitis: polymicrobial peritoneal infection with e. coli, enterbacter, and , possibly iatrogenic, as earlier paracentesis negative for sbp, vs. microperforation. ct with contrast did not show evidence of perforation, though one ct abdomen showed small amount of free air thought to be consistent with recent paracentesis, and had resolved on subsequent ct abdomen. patient was treated with fluconazole, vancomycin and zosyn, id was consulted. -dischaged on cipro only as above # cavitary pneumonia: noted to have cavitary lung lesions on admission, pulmonary was consulted, bal cytology negative for malignancy, ruled out for tuberculosis early on. initial plan was to treat with clindamycin for 4 weeks then re-image, with ct guided biopsy when tbili <6. had worsening of cavitary lesions and increased sputum production following 10 day course of steroidss, and rapid evolution was concern ing for active tuberculosis, and patient was ruled out again, with pulmonology and id following. also considered other causes of cavitary lung lesions including klebsiella, staph, fungal, etc, but sputum cultures were unrevealing. - patient treated with vancomycin and zosyn to cover pneumonia and peritonitis. - f/u quantiferon, hiv, fungal markers pending at discharge - discharged off of antibiotics except sbp prophylaxis as discussed above # septic shock: sirs criteria + lactic acidosis and elevated creatinine, hypotension with multiple potential sources, including cavitary hcap and peritonitis as discussed below. had brief micu admission for stabilization, did not require pressors or intubation. # hepatorenal syndrome: patient with acute kidney injury late in hospital course, low urine sodium, bland sediment and no response to albumin challenge consistent with hepatorenal syndrome type 1, possibly triggered or exacerbated by restarting of diuretics when he had stabilized from acute infections. midodrine/octreotide did not improve renal function and were withdrawn when goals of care transitioned to cmo. # malnutrition: severely malnourished. reported poor diet at home. given 500mg iv thiamine x3 days and then started on po thiamine. started on tube feeds while in hospital following nutrition consult, but this was discontinued when patient decided to stop aggressive treatment. chronic issues: # alcohol abuse: long history of heavy drinking. last drink 1 month ago so he did not require a ciwa. social work was consulted. patient not candidate for transplant as actively drinking up until this acute illness. #htn: home metoprolol was held for low blood pressures. # copd: continued on spiriva # tobacco abuse: nicotine patch transitional issues: ====================== unlikely to affect future management, but of note: - liver hypodensity on ct not further characterized on mri with gado as renal function not stable, but afp and ca -9 were normal - fungal markers, tuberculosis quantiferon pending at discharge, will not need to be follow up as patient transitioned to cmo - final cultures from peritoneal fluid were pending at time of discharge medications on admission: preadmission medications listed are correct and complete. information was obtained from patient. 1. metoprolol succinate xl 25 mg po daily 2. tiotropium bromide 1 cap ih daily discharge medications: 1. tiotropium bromide 1 cap ih daily rx *tiotropium bromide 18 mcg 1 capsule inhaled once a day disp #*14 capsule refills:*0 2. albuterol 0.083% neb soln 1 neb ih q4h:prn sob rx *albuterol sulfate 2.5 mg/3 ml (0.083 %) 1 neb(s) inhaled every 4 (four) hours disp #*30 box refills:*0 3. rifaximin 550 mg po bid rx *rifaximin 550 mg 1 tablet(s) by mouth twice a day disp #*30 tablet refills:*0 4. simethicone 80 mg po qid:prn gas rx *simethicone 80 mg 1 tablet by mouth four times a day disp #*30 tablet refills:*0 5. trazodone 50 mg po hs:prn sleep rx *trazodone 50 mg 1 tablet(s) by mouth at night disp #*14 tablet refills:*0 6. nicotine patch 14 mg td daily prn patient preferance rx *nicotine 14 mg/24 hour 1 patch to arm replace daily disp #*14 transdermal patch refills:*0 7. lactulose 15 ml po tid titrate to bms daily. rx *lactulose 10 gram/15 ml (15 ml) 15-30 ml(s) by mouth three times day disp #*1 bottle refills:*2 8. ipratropium bromide neb 1 neb ih q6h:prn sob, wheezing rx *ipratropium bromide 0.2 mg/ml (0.02 %) 1 neg inhaled every 6 (six) hours disp #*30 box refills:*0 9. ciprofloxacin hcl 500 mg po q24h rx *ciprofloxacin 500 mg 1 tablet(s) by mouth once a day disp #*30 tablet refills:*0 10. morphine sulfate (concentrated oral soln) 5-20 mg po q2h:prn pain or sob (0-1ml) 11. hyoscyamine 0.125 mg sl q4h:prn upper respiratory congestion 12. lorazepam 0.5-2 mg po q4h:prn anxiety/nausea/insomnia 13. spironolactone 50 mg po daily rx *spironolactone 50 mg 1 tablet(s) by mouth once a day disp #*14 tablet refills:*0 14. furosemide 40 mg po daily rx *furosemide 40 mg 1 tablet(s) by mouth once a day disp #*30 tablet refills:*0 15. lidocaine 5% patch 1 ptch td daily lower back 16. lidocaine 5% patch 1 ptch td daily low back pain 12 hours on/ 12 hours off rx *lidocaine 5 % (700 mg/patch) apply to lower back q24 hours disp #*1 box refills:*2 discharge disposition: home with service facility: old hospice discharge diagnosis: primary diagnosis: alcoholic hepatitis, alcoholic cirrhosis, cavitary hospital acquired pneumonia (organism unidentified; polymicrobial peritonitis, hepatorenal syndrome, malnutrition secondary diagnosis: hypertension, copd 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 caring for you at . you were admitted because your sodium was very low, and you had increased fluid in your abdomen due to damage to your liver caused by long-term alcohol use. you were also malnourished, and your diet was supported by tube feeds through your nose. during this admission you were also found to have very serious lung and abdominal fluid infections, as well as damage to your kidneys. you were given aggressive treatment for these problems, but did not improve significantly. you were not a candidate for liver transplant because of your recent alcohol use, and would have to be involved in relapse recovery for a while before being considered for transplant. given your poor prognosis, you made the decision to stop aggressive treatments. you were stable to be discharged to hospice according to these wishes. followup instructions: none procedure: enteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage closed [endoscopic] biopsy of bronchus central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified hyperpotassemia thrombocytopenia, unspecified tobacco use disorder unspecified essential hypertension alcoholic cirrhosis of liver acute kidney failure, unspecified hepatorenal syndrome unspecified septicemia hyposmolality and/or hyponatremia severe sepsis portal hypertension chronic airway obstruction, not elsewhere classified atrial fibrillation septic shock other ascites encounter for palliative care hepatic encephalopathy other and unspecified alcohol dependence, continuous acute alcoholic hepatitis other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms nutritional marasmus spontaneous bacterial peritonitis portal vein thrombosis other and unspecified escherichia coli [e. coli] 

Answer: The patient is high likely exposed to