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: this discharge summary dictation will cover the portion of the patient's hospitalization from his admission on , , up until . as i am going off service as of , a subsequent discharge summary dictation will cover the remainder of the hospital course including discharge diagnoses, discharge condition, and discharge medications, and followup. history of the present illness: (per admitting senior resident, dr. ): mr. is a 79-year-old man with a history of alcohol abuse, who was brought to the emergency department by his son, who found the patient on the floor of his apartment on the morning of presentation. the patient's son reported that the patient's mental status was not at baseline. mr. generally consumes a large quantity of alcohol (greater than ?????? of a pint per day) per his son, but stopped drinking approximately four days prior to presentation due to a death in the family. according to the patient's son, mr. has never had any withdrawal seizures or hallucinations nor any delirium tremens; however, he has not stopped alcohol frequently. mr. son stated that on the evening prior to admission, the patient was not "completely making sense," as the patient was making references to people who were not present. mr. , upon presentation, does not recall falling, but was found down next to his bed by his son on the morning of presentation, still exhibiting some mental status changes. the patient's only recent medical problem prior to presentation was gout times several weeks. (the patient was taking an herbal medicine from . the patient and the son do not know the name). otherwise, the patient denied chest pain, chest pressure, and shortness of breath. he admitted occasional dry cough, but denied fevers, chills, dysuria, orthopnea, paroxysmal nocturnal dyspnea, and lower extremity edema. the patient had been taking less p.o. fluid since discontinuing alcohol. past medical history: 1. the patient has a sporadic and infrequent history of followup with the primary care physicians. he recently changed primary care physicians to dr. . the patient has poor recall regarding his medical history. 2. hypertension. 3. gout. 4. alcohol abuse, as described above. 5. history of several inpatient hospitalizations related to alcohol abuse, according to his son. 6. history of "renal impairment," per the patient and his son. medications: 1. famotidine b.i.d. 2. herbal medication noted in the history of the present illness, type unknown. allergies: the patient has no known drug allergies. social history: the patient has a longstanding history of alcohol abuse as noted above. the patient's son reported that it may have been possible that the patient drank moonshine in his youth, when he was growing up in . the patient quit cigarettes 30 years ago. the patient lives alone. his son lives in an apartment above him. the patient's son is very involved in the patient's care. the patient had worked in managing a fence-building business. physical examination: examination on presentation revealed the following: (per admitting senior resident, dr. : temperature 98.7, heart rate 122, blood pressure 111/72, respirations 18, saturating 98% on room air. general: the patient is a pleasant thin man in no acute distress. heent: perrla, no jaundice or icterus. oropharynx moist. neck: supple, without lymphadenopathy. neck veins flat. cardiac: regular rhythm, tachycardia; no murmurs, rubs, or gallops. lungs: clear to auscultation bilaterally. abdomen: soft, nontender, positive bowel sounds. liver edge palpable approximately 4 cm below the costal margin. extremities: 1+ pitting edema at the right pretibial level; no edema on left, positive warmth on the right, especially at the right first metatarsophalangeal joint with some erythema and minimal tenderness in this area. neurological: the patient was alert and oriented times three. cranial nerves ii through xii intact with some decreased hearing in the left ear, which is chronic according to the patient. normal sensation to light touch in all four extremities. strength: bilaterally. laboratory data: laboratory data on presentation: cbc revealed the white count of 7.4, hematocrit 31.6, mcv 103, platelet count 109,000. chem 7: sodium 137, potassium 3.7, chloride 95, bicarbonate 22, bun 40, creatinine 4.0, glucose 108. coagulation studies revealed pt of 13.0, ptt 26.5, inr 1.2. urinalysis revealed moderate blood, low protein, one red blood cell, three white blood cells, moderate bacteria, two epithelial cells. lfts revealed alt of 8, ast 35, alkaline phosphatase of 111, total bilirubin 1.1, lipase 21, ck 147 with troponin of less than 0.3, ckmb 3. head ct performed in the emergency department revealed generalized atrophy; there was no evidence of bleed, shift, or cerebral edema. renal ultrasound performed in the emergency department revealed bilateral small echogenic kidneys consistent with chronic medical renal disease. specifically, the right kidney measured 8.7 in the long axis while the left kidney measured 8.2 cm long in the long axis. there was no hydronephrosis, evidence of stones, or masses in the kidneys bilaterally. chest x-ray revealed the heart to be normal in size with the lungs demonstrating no focal opacifications, chf, or pleural abnormalities. there was slight prominence of the mediastinum with contours bilaterally. the osseous structures were normal. ekg revealed sinus tachycardia at a rate of 110; axis was normal as were intervals. there was early r-wave progression, without st or t abnormalities. no prior study was available for comparison. hospital course: as the patient has been hospitalized for nearly three weeks now, the following summary will address the patient's major medical issues by system and problem: however, given the patient's extensive hospitalization, as well as his numerous medical problems, it is suggested that the reader peruse the patient's ccc records as well for any further details that may be desired. issues: mental status: as noted above, the patient has a longstanding history of alcohol abuse; approximately four days prior to presentation, the patient reportedly stopped drinking. the patient was fairly alert and oriented on initial presentation, although the patient's son had noted that the patient had been acting strangely and somewhat disoriented on the evening prior to and the morning of presentation. on the morning following admission, the patient exhibited significant agitation and disorientation. additionally, he exhibited tremulousness. the patient had been started on iv fluids, thiamine, and vitamins following admission. given his above noted agitation, disorientation, and tremulousness, the patient was started on ativan p.r.n. by ciwa scale. the patient was felt to have exhibited these withdrawal-like symptoms for the following three to four days after admission. the psychiatric service was consulted regarding the patient's presentation and condition with regard to his alcohol withdrawal and mental status changes. ultimately, the patient's ativan was discontinued, and he was later put on p.r.n. haldol for agitation. the haldol, as well, was discontinued, subsequent to this and currently the patient is not on any haldol or ativan. currently, the patient remains disoriented and perhaps delirious. the exact etiology of his mental status changes remains unclear. his mental status has waxed and waned intermittently throughout his hospitalization and it is felt by the primary consulting teams to be multifactorial in etiology. in terms of working up the etiology of the patient's mental status changes, he has had an exhaustive workup for infectious disease etiologies as will be described below including lumbar puncture, which was within normal limits. additionally, the patient has had two ct scans of his head, which have demonstrated diffuse atrophy, but which have otherwise, not revealed any findings that would explain his mental status changes. also, of note, lead level and tsh levels were within normal limits. currently, the neurology service is also following the patient regarding his mental status changes and overall condition. alcohol: as described above, the patient exhibited some evidence of alcohol withdrawal following admission. he was placed initially on the ciwa scale receiving ativan on a scheduled, as well as p.r.n. basis; subsequently the ativan was discontinued altogether. haldol was used intermittently for agitation, but it has also been discontinued at this time. the patient received b12, folate and thiamine following admission. he continues to received nutritional supplementation and he is being followed by the nutrition service. infectious disease: the patient's prolonged hospitalization has been marked by persistent fevers, only some of which can be explained by infectious etiology. as noted above, the patient underwent lumbar puncture on , results of which were within normal limits. additionally, cultures of the patient's csf, blood, sputum, urine, joint, and acidic fluid have been obtained. thus far, only two of these cultures have produced any organisms and these were felt to be most likely due to contamination. specifically, the patient had his left knee joint tapped on . on , fluid from this joint grew out rare methicillin-resistant staphylococcus aureus. also, the patient had sputum, which grew out some methicillin-resistant staphylococcus aureus as well. the patient has been on a host of antibiotics during his hospitalization. currently, he is on ceftazidime and vancomycin, as on , he spiked a temperature to 103 degrees fahrenheit rectally and he was found on chest x-ray to have an infiltrate. since beginning ceftazidime and vancomycin, the patient has been afebrile. other infectious disease concerns included the initial apprehension that the patient was suffering from osteomyelitis. however, as noted above, joint-fluid cultures have not decisively indicted such; additionally, plain films of the patient's affected foot were obtained on about and they were not noted to have evidence of osteoarthritis. currently, a ct scan of the patient's sinuses is pending. rheumatologic: as noted above, the patient has a longstanding history of gout. on admission, he was noted to have some joint swelling, erythema, and tenderness. this progressed fairly significantly following admission, such that a number of the patient's joints were affected. the rheumatology service was consulted regarding these issues; the consensus among the rheumatology and primary-team services was that the patient was, in fact, suffering from gout, albeit in a polyarticular manner. joint fluid was obtained from the patient's left and right knees. analysis of this fluid reveals gout crystals. as noted above, the left knee fluid did grow out rare methicillin-resistant staphylococcus aureus, although this was ultimately felt to have been a contaminate. subsequently, the patient's joint symptoms (including tenderness, swelling, and effusion) has dissipated almost completely. given concern for the patient's renal function, he has not been put on any nsaid treatment for gout. additionally, given concerns regarding fevers, as well as mental status issues, the patient has not been put on steroids therapy for gout. ultimately, he may benefit from long-term therapy once his other more pressing issues are addressed. renal and adrenal: as noted above, the patient had an elevated creatinine to 4.0 on admission. following the admission and with the administration of copious iv fluid, the patient's creatinine improved. nonetheless, the patient's urine output was noted to be tenuous at times. the renal service was consulted and continues to follow the patient. the patient was noted to have markedly depleted bicarbonate levels on several occasions (with levels as low as 12 noted). current consensus among the renal and primary teams is that the patient is suffering from acute tubular necrosis, perhaps as a result of intermittent hypotension. the patient has been aggressively hydrated with iv fluids and at times has required infusion of bicarbonate supplementation. in terms of the patient's adrenal issues, a random cortisol level drawn on was 15. a subsequent cortisol stimulation test, performed on revealed a pre-stem level of 13; ?????? an hour later, cortisol level was 19. these results were not felt to represent adrenal insufficiency and thus the patient remained off stress-dose steroids (especially given concerns regarding again his mental status and fevers). gastrointestinal: on , the patient's abdomen was noted to be markedly distended on physical examination. thus, a kub was obtained revealing dilated loops of small bowel. a subsequent ct scan of the abdomen again confirmed dilated loops of small bowel, with some subsequent passage of p.o. contrast to the rectum. the patient was made npo and ng tube was placed. the ng tube has remained in place since that time with copious outpatient of bilious fluid. the surgery service was consulted and followed the patient for some time. ultimately, they did not feel that the patient had any operative issues. currently, a repeat ct scan of the abdomen is pending, as there is some persistent concern for the possibility of small-bowel obstruction (rather than ileus). hepatology: the hepatology service was consulted. the patient is felt to be suffering from cirrhosis. he has been receiving lactulose pr, with little effect at this time. on , the patient exhibited some guarding on abdominal examination, thus, an abdominal ultrasound was obtained revealing numerous stones in the gallbladder (as was also noted on the ct scan); however, there was no evidence of cholecystitis. on , the patient underwent paracentesis, as he was continuing to exhibit fevers. results of the ascitic analysis were somewhat equivocal for evidence of .................... given the patient's recent course of antibiotics, there was some concern for partially treated partially treated ................... thus the patient was placed on ceftriaxone (currently he is on vancomycin and ceftazidime). pulmonary: the patient has small-to-moderate bilateral pleural effusion by chest x-ray. these developed approximately midway through his hospital course to this point. they have remained fairly stable, overall. on , as noted above, the patient spiked a temperature to 103 degree fahrenheit rectally. he was found to have a new infiltrate on chest x-ray and he was thus placed on ceftazidime and vancomycin. it should be noted that the infectious disease service has been following the patient throughout most of his hospital course. hematologic: the patient has exhibited anemia since admission. iron level was found to be low (18) while tibc was low at 191. ferritin was greater than 1000. transferrin was low at 147. b12 and folate were both found to be normal. hemolysis labs have been negative. thus far in the patient's hospitalization, he has received a total of four units of packed red blood cells. overall, the hematocrit has remained fairly stable. fluids, electrolytes, and nutrition: as noted above, the patient has had copious output from his ng tube. also, he has been persistently febrile. thus, the medicine service has tried to keep up with his copious fluid output via both iv fluid repletion and tpn, although this has been at times difficult to accomplish. in terms of electrolytes, the patient's electrolyte levels have remained, for the most part, stable. however, the patient has had low levels of bicarbonate on several occasions and this has required bicarb repletion by iv fluid and tpn. in terms of nutrition issues, the patient is followed by the nutrition service. he had a left arm pic line placed on about , through which he receives his tpn. the patient also receives vitamins and nutrients with his tpn, per the recommendations of the nutrition service. prophylaxis: the patient is on iv protonix. the patient is also wearing pneumoboots. chest pt has been ordered for the patient to improve his pulmonary status. additionally, an air mattress has been ordered for the patient, given his sedentary status. communication: the patient's children are very involved in his care. the patient's son, () , , has called almost every day to inquire about his father; additionally, the patient's son has visited him almost daily as well. the patient's daughter flew in from to see her father as well. various other family members have also been up to the hospital to see the patient. the medicine service has been in almost daily contact with the family regarding updates on the patient's status. code status: the patient's family wishes the patient to be full code. they noted that ultimately, the patient would not want to remain on prolonged life support if it were at all evident that there was little hope of ultimate recovery. nonetheless, in the acute setting of decompensation, they do feel that the patient would want to be intubated and defibrillated if necessary. thus, he is full code. this concludes the patient's discharge summary dictation for the patient's course from admission to . please see subsequent discharge summary addendum regarding the remainder of the hospital course. discharge diagnoses, discharge status, discharge medications, and followup. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified spinal tap incision of lung parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances percutaneous abdominal drainage other lysis of peritoneal adhesions diagnoses: pneumonia, organism unspecified acute kidney failure with lesion of tubular necrosis alcoholic cirrhosis of liver hepatic encephalopathy hernia of other specified sites, with obstruction other and unspecified alcohol dependence, continuous alcohol withdrawal delirium 

Answer: The patient is high likely exposed to