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: ativan / plavix / premarin attending: chief complaint: bleeding from ostomy major surgical or invasive procedure: intubation tips () history of present illness: the pt is a 65 year-old male with alcoholic cirrhosis and h/o bladder cancer s/p ileal loop who transferred from osh with bleeding from his ostomy site. he initially presented with bleeding from ileal loop since the evening of . he reported ??????spirting?????? of blood from his ostomy. his initial hct was 18.6 at 0230. he was given a total of 5uprbc per nursing signout and most recent hct at 2100 was 22.4 ( down from 25 at 1823). at 2pm he underwent scope by gi that showed peri ??????stomal varices and evidence of recent bleeding. upper egd showed non-bleeding varices. at 3pm he had a large bleed with clots from the stoma. ebl 2400cc pressure dressing applied and he was started on octreotide at 50mcg/hour and systolic blood pressure dropped to 83-78 so he was started on neosynephrine peripherally. his inr was 1.6 and it is unclear how many units of he received, but it was between 2 and 5 units. prior to transfer he became hypotensive with sbps in the low 80s and was transiently started on a neosyneprhine gtt peripherally. his neopsynephrine was dc??????d during because he was normotensive. he was transferred to for evaluation for possible tips. of note, the patient had a similar bleed 3 weeks ago which resolved spontaneously amd for which the patient did not seek medical evaluation. past medical history: 1. alcoholic cirrhosis c/b esophageal varices 2. squamous cell carcinoma of the bladder s/p radical cystoprostatectomy with ileal loop diversion c/b osteomyelitis to pubis 3. cad s/p cath with stents to rca and om1. echo showed ef >75%. 4. iddm 5. htn 6. hyperchoesterolemia 7. alcohol abuse with h/o delirium tremens 8. appendectomy at hospital social history: lives with wife and son in . retired. drinks beer daily. non-smoker. family history: noncontributory. physical exam: vital signs: temperature was 99.6, heart rate 75, blood pressure 116/54, respiratory rate 17, and he was oxygenating 100% 2l nc general: this was a 63-year-old obese white male in nad but diaphoretic. heent: pupils were equal, round, and reactive to light. his oropharynx was clear. his mucous membranes were dry. sclerae were anicteric. neck: soft and supple with a normal thyroid exam, and no palpable lymphadenopathy. chest: crackles at right base greater than left base. cardiovascular: regular rate and rhythm without murmurs, gallops, or rubs. abdomen: obese, soft, min tender to palpation in epigastrium, ostomy site pink without active bleeding- with serosangoiunous drainage. no fluid wave or shifting dullness. skin: warm and dry without rashes. neuro: a+o x 3, minimal fine resting tremor, no asterixis. pertinent results: data: osh gi procedure: ileoscopy to the proximal end of the ileal loop: both ureteral orifices were identified and appear intact, there was no bleeding or bleeding site noted, but he did have some peri stomal varices noted, some with stigmata of bleeding. egd showed distal erosive esophagitis. 2 esophageal variceal chains; 1+ portal gastropathy and mild fundal variceal, and small duodenal varices. ekg: at osh 2033: nsr at 88, nl axis, nl intervals, q waves in 3,f no sttw changes 08:14pm glucose-238* urea n-21* creat-1.2 sodium-139 potassium-5.1 chloride-112* total co2-18* anion gap-14 08:14pm lipase-31 08:14pm ck-mb-notdone ctropnt-<0.01 08:14pm albumin-2.9* calcium-7.9* phosphate-2.2* magnesium-2.2 08:14pm wbc-9.7 rbc-3.16* hgb-8.7* hct-27.2* mcv-86 mch-27.7 mchc-32.1 rdw-15.8* 08:14pm neuts-90.3* bands-0 lymphs-5.8* monos-3.1 eos-0.4 basos-0.3 08:14pm hypochrom-1+ anisocyt-normal poikilocy-occasional macrocyt-normal microcyt-normal polychrom-occasional ovalocyt-occasional teardrop-occasional 08:14pm plt smr-low plt count-126*# lplt-1+ 08:14pm pt-14.4* ptt-25.0 inr(pt)-1.4 08:14pm fibrinoge-311 brief hospital course: this 65 year old gentleman with a history of alcoholic cirrhosis, metastatic bladder cancer s/p radical resection, cad, htn, iddm presented on with upper gastrointestinal bleed from ostomy varices. bleeding was successfully treated with embolization and tips procedure, however ensuing hepatic encephalopathy led to a waxing and delirium that could not be successfully treated despite lactulose enemas. his course was further complicated by klebsiella sepsis which resolved early in the hospital course with ceftriaxone treatment, hypernatremia, and hyperglycemia which was never successfully controlled. on the family decided to place the patient on hospice care, largely because of the lack of improvement in the patients mental status. all non-comfort medications were subsequently discontinued. in the ensuing days, attempts were made to find a suitable hospice care facility and an appropriate facility was found for the patient to transfer for . on the morning of the 14th pt. began becoming unresponsive and went into agonal breathing. the family was notified that the patient would probably pass away soon. with the family present, the patient went into respiratory arrest and expired. he was pronounced dead at 1:20 pm, . autopsy declined by family. the hospital course of this patient is summarized by problem below: 1. gi bleed: known cirrhotic with bleeding from ostomy varices. hepatology was consulted. further investigation via endoscopy revealed bleeding from varices around the stoma site. he was placed on octretide, and a tips procedure was attempted and was unsuccessful. the area was the embolized by ir. patient remained stable and a repeat tips was successful (done on ). the gradient was reduced from 30 to 8. in addition, repeat tips showed a portal vein clot and he was placed on heparin for 24 hours. however repeat tips showed no evidence of portal vein clot - therefore heparin was dc'ed. patient was given vitamin k and as needed to correct coagulapathy. -after the tips and embolization, gi bleeding resolved. 2. sepsis: patient grew 4/4 bottles positive for klebsiella. he was started in meropenem initially, but switched to ceftriaxone once sensitivities were back. in the setting of being infected he was also hypotensive, requiring pressors that were slowly weaned off. his cvp was closely monitered to keep his cvp >12. on transfer to floor, all surveillance cultures are negative and he has been afebrile while maintaining his blood pressure. -pt remained afebrile on the floor thereafter. 3. respiratory failure: initially he was intubated electively for his first tips. patient remained reintubated in his septci state post tips. as his clinical status improved, he was weaned from ventilator and extubated. - pt remained with o2 sats above 92% on room air. 4. encephalopathy: waxing and ms. difficult to assess what pt's baseline ms is. likely toxic-metabolic encephalopathy contributing factors have included hypernatremia, and liver disease s/p tips. hyperantremia corrected for now, will follow na. - aspiration precautions with aggressive suctioning - pt was placed on lactulose and rifaximin for the encephalopathy and received it while ng tube was in place. however pt self d/c'ed the ng tube and thereafter it was difficult to place ng again, he is receiving lactulose by enema at present. family aware and they have decided against ng tube placement. per nurses the pt had difficulty retaining lactulose enemas. lower volume/higher concentration solutions were therefore given with only slight improvement in rectal output. lactulose enema treatment proved unsatisfactory in this patient. -pt mental status improved slightly but this improvement was generally unsatisfactory. he did not show signs of being able to protect his airway and continually failed to exhibit gag reflex . 5. hypernatremia: pt's na was elevated upto 153 during the hospitilazation. likely secondary to intravascular depletion. pt was losing free water from several sources, gi tract on lactulose, osmotic diuresis (sugars in 300s) and low po intake. it was corrected over time with d5w and free water flushes in tf. . 6. alcohol withdrawal: patient is a heavy drinker and given history of dts, he was originally placed on a ciwa scale with ativan, and then this was switched to valium. he was given several hundred mg of valium before his agitation resolved. - after the initial rx there were no further issues with etoh withrdrawl 6. cad/htn: h/o mi- aspirin was held given bleeding. consider statin once other issues are stabilized. ekg was not changed. . 7. dm: riss. patient was transiently on insulin gtt for sugar control in the micu. he was placed on 50u glargine with riss. the initial glargine dose was increased upto 100 units daily yet pt required more than a 100 units of regular insulin to cover daily. was consulted and pt received 68 units am and a strict sliding scale. once pt was npo (ng d/c'ed) it was changed to 28 units in am and sliding scale with nothing for sugar < 150. on tpn glargine adjusted to 36 units in am with 90 units of ri in tpn. despite these measures, fs glucose remained in 200-300 range. when family elected for hospice care, pt was made npo and riss was adjusted for goal of avoiding hyperglycemia. on morning prior to expiration, fs was noted to be greater than 400, 7 units of insulin were given. . 8. non ag ma: likely from bicarb loss from ostomy, patient placed on bicitra and then calcium carbonate. non ag ma resolved 9. acute renal failure: developed renal failure in setting of sepsis, now resolved 10) cirrhosis- on nadolol, dc'ed octretide drip, ppi, and cont lactulose. pt receving lactulose by enema at present. 11) otitis exterma- on ctx, add cipro drops and erythromycin, f/u with ent in weeks. patient needs hearing aid evaluation. will need to be treated for 3 wks and then can d/c ear drops. 12) fen - dobhoff placed on . self d/c'ed by pt. he has failed speech and swallow evaluation twice, but family decided against replacement of ng tube. pt has been on for most of remainder of hospital course. tpn is now d'c'd. 13) code - family has decided to make this patient dnr/dni. -, family meeting with dr. , dr. , ms to discuss long term disposition. -, family elected to place this patient in palliative care. palliative care measures: 1. general -transfer to palliative care facility, code is dnr/dni. -all non-comfort medications discontinued. 2. glucose control -npo, still hyperglycemic, riss modified with primary goal of avoiding hypoglycemic episode. 3. agitation -controlled with haldol, olanzapine. 4. pain -controlled with morphine,acetaminophen. 5. ear infection -neomycin otic drops. 6. any respiratory distress may be treated with o2, inhalers. -, pt expired. medications on admission: meds on transfer: insulin sliding scale propanolol 20mg po bid neosynephrine gtt protonix 40iv octeotide 50mcg/hr discharge medications: medications prior to death: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 2. neomycin-polymyxin-hc 3.5-10,000-1 mg-unit/ml-% drops, suspension sig: four (4) drop otic qid (4 times a day). 3. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed. 4. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q4h (every 4 hours) as needed. 5. ciprofloxacin 0.3 % drops sig: three (3) drop ophthalmic (2 times a day) as needed for ear infection. 6. clotrimazole 1 % cream sig: one (1) appl topical (2 times a day). 7. haloperidol lactate 2 mg/ml concentrate sig: two (2) ml po bid (2 times a day) as needed for agitation. 8. insulin glargine 100 unit/ml solution subcutaneous 9. morphine 10 mg/5 ml solution sig: 2.5-5 ml po q4-6h (every 4 to 6 hours) as needed for pain. 10. olanzapine 5 mg tablet, rapid dissolve sig: 0.5 tablet, rapid dissolve po bid (2 times a day). 11. heparin flush cvl (100 units/ml) 1 ml iv daily:prn 10ml ns followed by 1ml of 100 units/ml heparin (100 units heparin) each lumen qd and prn. inspect site every shift scopolamine patch. discharge disposition: extended care discharge diagnosis: hepatic encephlopathy htn hypernatremia etoh abuse portal hypertension bleeding esophageal varices/ bleeding ostomy klebsiella sepsis respiratory distress alcohol withdrawal syndrome. discharge condition: expired md, procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances other endovascular procedures on other vessels transfusion of packed cells injection of anesthetic into spinal canal for analgesia intra-abdominal venous shunt diagnoses: pneumonia, organism unspecified anemia, unspecified pure hypercholesterolemia unspecified essential hypertension alcoholic cirrhosis of liver acute kidney failure, unspecified unspecified protein-calorie malnutrition portal hypertension acute respiratory failure other septicemia due to gram-negative organisms diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled hepatic encephalopathy esophageal varices with bleeding hyperosmolality and/or hypernatremia other and unspecified alcohol dependence, continuous alcohol withdrawal portal vein thrombosis other colostomy and enterostomy complication other acute otitis externa 

Answer: The patient is high likely exposed to