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: beta-blockers (beta-adrenergic blocking agts) / tetanus / tuberculin,purif.prot.deriv. / metoprolol attending: chief complaint: bloody emesis and brbpr major surgical or invasive procedure: egd on and history of present illness: pt is a 59yo m with bright red bloody emesis and brbpr. the pt is s/p variceal banding on with 5 bands for an acute variceal bleed with brbpr and epigastric pain. at that time the pt was noted to have a hematocrit of 31.1, and he was observed at until . subsequently the pt did well and was advanced to po solids, and he was planned to be discharged today, but then had "black" diarrhea all day and was vomiting "dark brown" material x1 around lunch, as well as diaphoresis and right anterior abdominal wall tenderness, without radiation. the pt was re-evaluated by the mds there and they determined that the pt would be a poor candidate for a repeat egd, and the pt was transferred here to for evaluation and presumptively for a tips procedure. at today the pt's hematocrit continued to fall and he was transfused 4 units of prbc, and then transfered here. . on arrival to the micu the pt was complaining of abdominal pain, had an sbp of the 90's, hr 120's. story c/w outside records. past medical history: - etoh abuse - etoh cirrhosis - variceal bleeds - erosive esophagitis and gastic varicies - cva and left hemiplegia - iddm - schizophrenia - anemia - hypothyroidism - obesity - htn - hl - migranes - copd social history: patient lives in a nursing home. he denies recent alcohol use and says it was "in the past", he denies smoking or other drugs. he is originally from and has children in . he has a sister in . he does not have a hcp. family history: non-contributory. physical exam: physical exam on admission: t: 98.9 bp:92/45 p:116 r:16 o2: 99 general: alert, oriented to person, place, time, event, talking in fluent sentences. heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: obese, tender to palpation over right anterior abdominal wall, no body wall ecchymoses, no tenderness to percussion, no rebound, no guarding, no organomegaly appreciated though physical exam is severely limited. gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. dried blood between legs. physical exam on discharge: o: 99.3, 97.6, 144/67, 87, 20, 99%ra heent: mmm, dentures in place neck- unable to assess jvp due to habitus cardiac: rrr, 2/6 systolic murmur in lusb, no gallops or rubs appreciated lungs: clear to auscultation bilaterally. abdomen: obese, soft, nontender, unable to palpate liver or spleen tip. no capute medusae. no appreciable shifting dullness. extremities: 2+ edema bilaterally 2+ pulses. skin- no palmar erythema. multiple actinic keratoses on the back. pertinent results: labs upon admission: . 01:50am blood wbc-11.0 rbc-3.92* hgb-12.0* hct-33.7* mcv-86 mch-30.6 mchc-35.6* rdw-14.9 plt ct-241 01:50am blood neuts-86.8* lymphs-9.7* monos-2.7 eos-0.5 baso-0.3 01:50am blood pt-15.8* ptt-26.2 inr(pt)-1.4* 01:50am blood glucose-237* urean-12 creat-1.0 na-140 k-4.4 cl-106 hco3-28 angap-10 01:50am blood alt-95* ast-140* ld(ldh)-377* alkphos-77 totbili-0.8 01:50am blood lipase-44 01:50am blood albumin-2.9* calcium-7.7* phos-3.3 mg-1.8 11:11pm blood freeca-1.03* . labs upon discharge: . 05:45am blood wbc-1.4* rbc-2.85* hgb-8.8* hct-26.6* mcv-93 mch-30.7 mchc-33.1 rdw-15.8* plt ct-226 05:45am blood pt-15.4* ptt-29.4 inr(pt)-1.3* 05:45am blood glucose-162* urean-5* creat-0.7 na-139 k-3.6 cl-104 hco3-24 angap-15 05:45am blood alt-116* ast-24 alkphos-81 totbili-0.6 05:45am blood calcium-7.7* phos-2.5* mg-2.0 . imaging: echo : the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. left ventricular systolic function is hyperdynamic (ef>75%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the left ventricular inflow pattern suggests impaired relaxation. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . : abd us: impression: 1. limited study. findings consistent with hepatic cirrhosis with patent hepatic vasculature. 2. small amount of ascites. 3. splenomegaly. 4. no evidence of gallstones or cholecystitis. . : cxr: findings: there are mild bilateral lower lobe opacities likely atelectasis. minimal pulmonary vascular congestion is seen. widening of the mediastinum is attributed to the tortuous course of thoracic aorta. the heart size is normal. pleural effusion if any is minimal on the right side. no opacities concerning for pneumonia. . blood cultures: , , : ngtd urine culture: : negative . egd : . esophagus: protruding lesions 5 cords of grade iii-iv varices were seen in the lower third of the esophagus. the varices were not bleeding. excavated lesions two ulcers ranging in size from 5 mm to 5 mm were found in the lower third of the esophagus. one had stigmata of recent bleeding. both ulcers seemed to be post-banding ulcers. . stomach: mucosa: normal mucosa was noted. duodenum: mucosa: normal mucosa was noted. impression: varices at the lower third of the esophagus ulcers in the lower third of the esophagus normal mucosa in the stomach normal mucosa in the duodenum otherwise normal egd to third part of the duodenum recommendations: continue ppi and octreotide infusion. add carafate as well. if he should bleed again, he will need tips procedure. further management per liver team. additional notes: the attending was present for the entire procedure. the patient's home medication list is appended to this report. final diagnoses are listed in the impression section above. estimated blood loss = zero. no specimens were taken for pathology . egd : . esophagus: protruding lesions 2 cords of grade ii varices were seen starting at 36 cm from the incisors in the lower third of the esophagus. 2 bands were successfully placed. 1 band was placed below the ulcer. excavated lesions a single oozing 6 mm ulcer was found in the on the previously banded esophageal varix. stomach: contents: red blood was seen in the whole stomach. other no gastric varices were seen. duodenum: normal duodenum. other findings: bile in duodenum. impression: varices at the lower third of the esophagus (ligation) ulcer in the on the previously banded esophageal varix blood in the whole stomach no gastric varices were seen. bile in duodenum. otherwise normal egd to second part of the duodenum recommendations: serial hct, transfuse if hct<24 or active bleeding cont' octreotide gtt, ppi gtt, ceftriaxone 1 g daily, lactulose, carafate 1 g qid no ng tube placement additional notes: the procedure was performed by the attending physician and fellow final diagnoses are listed in the impression section above. estimated blood loss = zero. no specimens were taken for pathology . brief hospital course: 59 yo male with history of alcoholic cirrhosis and variceal bleeding s/p recent banding on , presented with recurrent variceal bleeding. . #. variceal bleeding: he was initially admitted to the micu on with hypotension and tachycardia believed to be secondary to a variceal bleed. he was intubated initially for airway protection prior to egd. endoscopy showed 5 cords of grade iii-iv nonbleeding varices in the lower third of the esophagus, and two post-banding ulcers, with one having stigmata of recent bleeding, no interventions were performed at that time. he received 2 units of prbc. he was transferred to the floor on . he was doing well with no additional melena or hematochezia until when he developed hematochezia and had a 7 point hct drop. he was transferred to the micu where he underwent repeat egd which showed 2 cords of grade 2 varices in the lower of the esophages and an oozing ulcer on the previously banded esophageal varix. he received an additional 2units prbc. he was monitored on the floor after his octreotide and ppi drips were stopped and he had no further episodes. he was not started on a beta-blocker due to concern for worsening of his reactive airway disease and a history of possible beta-blocker allergy. his protonix drip was changed to protonix 40mg po bid. he will follow up with the hepatology departement in the next 1-2 weeks for likely re-scope. if he rebleeds, then consideration for a tips may be warranted. . #hepatitis- patient developed shock liver in the setting of his gi bleed with his lfts increasing into the ast and alt of 700s and were downtrending and resolving at the time of discharge. . #. abdominal pain: pt's abdominal pain is atypical for a variceal bleed, which generally are painless. the pt presented intially to the osh on with abdominal pain as well. on the ct performed then the pt was seen to have a duodenitis. the clinical relevance of this is not certain. us was performed, which did not show signficant ascites. . # fever: unclear etiology. sbp was considered, though he did not have any obvious ascites to tap. regardless, he was treated empirically with a course of ceftriaxone 2g daily with transition to cipro 500mg on discharge. he should complete a total of 10 days of antibiotics to be completed . he remained afebrile on discharge with negative cultures to date. . # pt noted to develop leukopenia with a total wbc=1.4 on discharge. the origin of this was unclear. it was thought that this could have been in the setting of his ceftriaxone course and thus this was changed to cipro as above. however, he was continuing to nadir on discharge. it is also possible that his risperidone could have been contributing. we recommend a follow up cbc within a week after discharge. his outpatient providers to should address whether to continue his risperidone. . # sob- patient had several episodes of shortness of breath while in house. it was likely multifactorial from his known reactive airway disease, significant anemia in the setting of ugib, volume overload, and possible transient hepatopulmonary syndrome in the setting of his shock liver. he was continued on nebs, and his diuresis was adjusted to lasix 40mg daily and spironolactone 50mg daily. on discharge his sob had markedly improved. . #. iddm: pt was maintained on a regimen of lantus 20u qhs and humalog ss. note that his lantus regimen was much less aggressive in-house than at home. this is likely due to eating a different diet in-house. thus, we increased his lantus to 36u qhs on discharge to account for this, but this is still less than his home dose. note that re-uptitration of his insulin may be warranted if glucose control is not adequate. . #. volume overload: pt noted to become more volume overloaded while in house. it appears he is on lasix 40mg daily at home, but this was held in the setting of his bleeding. we restarted this along with spironolactone 50mg daily on discharge. . #. schizophrenia: not an active issue. continued home risperidone, though this may be further addressed by outpatient providers given the possibility of this medication contributing to his leukopenia . #. hypothyroidism: not an active issue. continued home levothyroxine. . #. hl: not an active issue. initially held simvastatin , be restarted in the future after resolution of lfts . # follow-up/transitional -cbc should be followed up within the next week to ensure resolution of leukopenia - consider changing risperidone in setting of leukopenia -final blood cultures still pending on discharge -whether to restart statin should be addressed as outpatient medications on admission: advair 250/50 1 puff cepacol 1 tab q4hrs prn cough docusate 100mg tab - 2 tabs qhs ferrous sulf 325 1 tab folic acid 1mg qday furosemide 40 mg po qday vicodin 1 tab latanoprost 0.005% 1 drop l eye qhs levothyroxine 225mcg qday lisinopril 5mg po qhs kcl er 10meq cap qday prilosec otc 20mg po qday risperidone 1.5mg po qhs simvastatin 10 mg po qhs albuterol 0.083# i unit q4h ibuprofen 600mg po qhs prn for pain lactulose 30ml tid prn for constipation proair hfa 2 puffs q4hrs prn sob/wheeze humalog 20 u qam, 20 u qlunch 40u qdinner lantus 74u qam lantus 36u qpm bisacodyl prn fleet enema prn milk of mag prn discharge medications: 1. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime): in left eye. 2. risperidone 3 mg tablet sig: one "half" tablet tablet po at bedtime: 1.5mg . 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 5. cyanocobalamin (vitamin b-12) 100 mcg tablet sig: one (1) tablet po daily (daily). 6. levothyroxine 25 mcg capsule sig: one (1) capsule po once a day: take in addition to 200mcg dose. total dose of 225mcg. 7. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). disp:*120 tablet(s)* refills:*2* 8. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day): please only give so patient has 3 bowel movements per day. 9. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 3 days. disp:*6 tablet(s)* refills:*0* 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 11. furosemide 40 mg tablet sig: one (1) tablet po once a day. 12. spironolactone 50 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 13. advair diskus 250-50 mcg/dose disk with device sig: one (1) puff inhalation twice a day. 14. cepacol sore throat 15-3.6 mg lozenge sig: one (1) mucous membrane every four (4) hours as needed for sore throat. 15. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po twice a day. 16. potassium chloride 10 meq tablet extended release sig: one (1) tablet extended release po once a day. 17. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization inhalation 18. proair hfa 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation every four (4) hours as needed for shortness of breath or wheezing. 19. lantus 100 unit/ml solution sig: thirty six (36) units subcutaneous qpm. 20. humalog 100 unit/ml solution sig: see below subcutaneous see below: 20 units given with breakfast 20 units given with lunch 40 units given with dinner. 21. levothyroxine 200 mcg tablet sig: one (1) tablet po once a day: total dose of 225mcg. 22. outpatient lab work please draw cbc and complete metabolic panel during the week of . discharge disposition: extended care facility: extended care center - discharge diagnosis: primary: variceal bleed, alcoholic cirrhosis, shock liver, shortness of breath secondary: diabetes mellitus type ii, 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 taking care of you while you were here at . you were admitted to our hospital from another hospital for concern that you were having bleeding in your stomach and esophagus. you had had two bleeds at that hospital. when you arrived here you were in the intensive care unit (where we looked inside your esophagus and stomach) to see if there was bleeding and did not see any, so there was nothing done at that time. you were then on the regular hospital floor. we kept you on some medicines to prevent you from bleeding and watched you over the next few days. you developed some bright red blood in your stools and you were transfered to the intensive care unit to be monitored and had another endoscopy(look inside the esophagus and stomach) and they saw an ulcer that was bleeding ontop of one of the varices (blood vessels that had previously bled). they put a couple of bands on this to stop the bleeding and gave you a blood transfusion and you were feeling better and had no more bleeding. you will need to stay on the pantoprazole twice a day for now, as well as need to have another endoscopy to have the varices taken care of. you also had a fever when you arrived to our hospital, and we are not exactly sure where the infection is coming from. because you can get infections with having these type of bleeds we put you on iv antibiotics at first and then switched this to a pill antibiotic called bactrim which you will need to finish the course of when you leave. your white blood cell count (indicating body's response to infection) got very low while you were on the iv antibiotic and we think this caused it to drop too much. we stopped that medicine, but this will need to be followed-up by your primary care doctor to make sure it gets back up into the normal range. for your diabetes- your blood sugars were well controlled on a much lower dose of insulin (20u at bedtime) than you receive at home. so we will ask you to stop your morning dose of lantus when you return home. you should have your blood sugars closely monitored while you are at home, and adjustments can be made further. you developed some worsening swelling of your legs during your stay, most likely due to all of the blood transfusion that we were giving you. we are adding another medication call spironolactone to your medication list to help you get more fluid off of you. it will also be important that you stick to a low sodium diet. transitional issues: pending labs: none medications started: 1. ciprofloxacin 500mg tab by mouth twice a day (to finish course on ) 2. spironolactone 50mg tab by mouth once a day 3. pantoprazole 40 mg by mouth twice a day 4. sulcrafate (for the stomach) medications changed: 1. lantus- please stop morning dose of lantus, and continue to check blood sugars before each meal medications stopped: 1. omeprazole (taking another form of it) 2. simvastatin (because liver function not back to normal) 3. ibuprofen- this is an nsaid and these should not be taken given history of bleeding ulcer on the esophageal varix follow-up- 1.you will need to have your varices (blood vessels that are exposed) in your esophagus, banded again and you will need to schedule this appointment (see below) 2.your blood sugars should be monitored closely and medication changes should be made based on these numbers when you are eating your home diet 3.your primary care doctor will need to recheck your liver function tests and determine if you should be restarted on your simvastatin if they feel it will be beneficial. followup instructions: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. liver clinic follow up- unfortunately we were unable to schedule this appointment for you prior to discharge. you will need to follow-up with dr. in the liver clinic at within 10-14 days, to have another endoscopy with (banding and obliteration of your varices). to make this appointment please call procedure: other endoscopy of small intestine insertion of endotracheal tube endoscopic excision or destruction of lesion or tissue of esophagus diagnoses: unspecified essential hypertension acute posthemorrhagic anemia acute and subacute necrosis of liver alcoholic cirrhosis of liver other and unspecified alcohol dependence, in remission portal hypertension unspecified acquired hypothyroidism unspecified schizophrenia, unspecified other and unspecified hyperlipidemia long-term (current) use of insulin late effects of cerebrovascular disease, hemiplegia affecting unspecified side fever, unspecified other ascites obesity, unspecified chronic obstructive asthma, unspecified esophageal varices in diseases classified elsewhere, with bleeding migraine, unspecified, without mention of intractable migraine without mention of status migrainosus ulcer of esophagus without bleeding neutropenia, unspecified other fluid overload hepatopulmonary syndrome 

Answer: The patient is high likely exposed to