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: patient recorded as having no known allergies to drugs attending: chief complaint: melena major surgical or invasive procedure: endoscopy with banding of varices history of present illness: 53 yo m with cirrhosis, h/o upper gi bleed in , h/o hcv infection with sustained virologic response to ribaviron and interferon who presents to the ed with melena x 2 today. . per pcp records and the patient's own report, the patient was hospitalized at in with an upper gib. according to the patient no intervention was performed. about one month later the patient underwent egd which showed small erosions in the antrum, a small varix and the possibility of a watermelon stomach. a ct scan of the abdomen was then performed which showed portal hypotension, cirrhosis, and splenomegaly. the hepatologist that saw the patient at that time thought this was likely nash on top of cured hcv. also a possibility was sarcoid of the liver. the patient also uses etoh daily. since that time his pcp has done several egds and colonoscopies for monitoring. the last of these procedures was 9 months ago. the egd at that time was normal and colonoscopy revealed a which was removed. . last week, the patient was traveling in and ran out of his omeprazole. then, this morning he had two episodes of melena. he denies any associated symptoms including no abdominal pain, nausea, vomiting, diarrhea, constipation, brbpr, fevers, chills, sob, chest pain, palpitations, light-headedness, dizziness. . in the ed, initial vs were: t 98.6 hr 125 bp 154/85 rr 12 o2sat 100%. no jaundice. abdomen slightly distended but benign. stool guaiac positive. ekg showed sinus tach. hct 26.9 in ed but unclear baseline. platelets 148. lfts slightly elevated ast/alt. tbili normal but inr 1.5. ng lavage was negative. received 2l ns but still tachy to 112. started ppi bolus, followed by gtt. 2 units prbcs hung in ed. gi saw in ed and admitting to icu to scope. . vital signs on transfer were, t 98.8 hr 112 bp 136/74 sat 99%/ra. . in the icu, the patient had no complaints including no abdominal pain, shortness of breath, palpitations, chest pain, nausea, vomiting, or diarrhea. he had a low grade fever prior to hanging his prbcs. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain. denies dysuria, frequency, or urgency. past medical history: -hcv after needlestick at work, with sustained virologic reponse to interferon and ribaviron, last viral load undetectable . -gerd - surveillance egds negative thus far -sarcoidosis: noted to have hilar ln on cxr/ct chest in s/p biopsy/mediastinoscopy in . no symptoms and cxr neg in -dm2 - last a1c 6.3 -hl (: ldl 108 hdl 40) -colonic adenoma . colonoscopy : 7 hyperplastic polyps removed -ugib likely from ulcers documented in . healed per repeat egd a few months later -cirrhosis c/by varices (grade ), portal hypertension, splenomegaly social history: previously worked as rn at . now is a contractor. lives at home with his wife. 3 kids. - tobacco: occasional cigars on the golf course - alcohol: 2 beers or 2 glasses of wine per night. - illicits: none family history: dad had bleeding ulcer in his 70s. mom had a "nervous stomach". no history of gi cancers. physical exam: vitals: t:99.6 bp:148/83 p:113 r:18 18 o2: 99%ra general: alert, oriented, no acute distress heent: jaundice, dry mm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: tachycardic and regular. normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs: 01:00pm blood wbc-6.8 rbc-3.96* hgb-8.0* hct-26.9* mcv-68* mch-20.2* mchc-29.7* rdw-18.5* plt ct-148* 01:00pm blood neuts-71.9* lymphs-19.9 monos-4.5 eos-2.9 baso-0.6 01:00pm blood pt-16.8* ptt-29.5 inr(pt)-1.5* 01:00pm blood glucose-154* urean-16 creat-0.8 na-141 k-4.3 cl-107 hco3-26 angap-12 01:00pm blood alt-41* ast-75* alkphos-182* totbili-1.0 01:00pm blood albumin-3.8 calcium-9.1 phos-2.5* mg-1.9 . discharge labs: 07:25am blood wbc-5.5 rbc-4.96 hgb-11.1* hct-36.5* mcv-74* mch-22.4* mchc-30.5* rdw-22.6* plt ct-102* 07:25am blood pt-16.0* ptt-31.0 inr(pt)-1.4* 07:25am blood glucose-114* urean-10 creat-0.9 na-142 k-3.9 cl-109* hco3-25 angap-12 07:25am blood alt-33 ast-63* alkphos-134* totbili-1.5 07:25am blood calcium-8.1* phos-2.9 mg-2.2 . urinalysis: 06:25pm urine color-straw appear-clear sp -1.017 06:25pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-tr bilirub-neg urobiln-neg ph-7.0 leuks-neg 06:25pm urine rbc-0 wbc-0-2 bacteri-none yeast-none epi-0 . microbiology: blood cultures x 2: no growth urine culture: no growth mrsa screen: negative . abdominal ultrasound : 1. appearance of liver is consistent with provided history of cirrhosis. no focal liver mass seen. 2. patent hepatic vasculature, with normal hepatopetal direction of flow in the portal veins. patent umbilical vein and splenomegaly consistent with portal hypertension. small ascites. . egd : varices at the lower third of the esophagus (ligation) blood in the stomach. no evidence of portal hypertensive gastropathy. no evidence of gastric varices. otherwise normal egd to second part of the duodenum. brief hospital course: assessment and plan: 52 yo m with cirrhosis presents with bleeding from esophageal varices. . # upper gi bleed from esophageal varices: the patient presented with melena. hct was 26.9 on presentation. egd showed blood in the stomach and four cords of esophageal varices, one of which had stigmata of recent bleeding. two of the four varices were banded. the patient was transfused 4 units prbcs. his hct increased appropriately and remained stable thoughout the remainder of his hospitalization. the patient was treated with octreotide, pantoprazole, sucralfate and ceftriaxone. he was discharged on pantoprazole, sucralfate, nadolol, and ciprofloxacin. the patient will undergo repeat endoscopy on . . # cirrhosis: the patient has known cirrhosis, with contributing factors including nash, etoh use, h/o hcv infection (treated with ribaviron and interferon). the patient was advised to stop drinking etoh. started lactulose for prevention of encephalopathy. outpatient hepatology follow-up was arranged. . # diabetes mellitus, type 2: held oral hypoglycemics and treated with insulin while inpatient. discharged on metformin per home regimen. medications on admission: omeprazole 40mg metformin 500mg simvastatin 40mg daily ketoconazole 2% shampoo and cream discharge medications: 1. metformin 500 mg tablet extended rel 24 hr sig: one (1) tablet extended rel 24 hr po twice a day. 2. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day): to help with stomach pain. disp:*120 tablet(s)* refills:*0* 3. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 2 days. disp:*3 tablet(s)* refills:*0* 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 5. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. lactulose 10 gram/15 ml syrup sig: 15-30 mls po bid (2 times a day) as needed for constipation: adjust dose as needed to have loose stools per day. disp:*1 bottle* refills:*2* discharge disposition: home discharge diagnosis: variceal bleed portal hypertension caused by cirrhosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital due to bleeding. you were found to have a variceal bleed. you had a endoscopy and bands were placed to slop the bleeding. you will require a repeat scope in 2 weeks to see if further banding is needed. . please monitor your bowel movments. you were started on lacutlose to use as needed to prevent liver disease induced confusion called encephalopathy. make sure to have loose bowel movements per day. . to prevent further liver disease it is improtant for you to stop drinking alcohol. also, to eat a low salt (<1500mg per day) and low fat diet. . please keep your follow up appointments. . the following changes were made to your medications: -you were started on protonix twice a day, take to prevent bleeding in you stoach -you were started on lactulose. -you were started on , antibiotic, to prevent infection related to your variceal bleed, you through -you were started on nadolol 20mg to prevent further bleeding -you were started on sucralfate, to help with healing you esphagus followup instructions: endoscopy- provider: (st-3) gi rooms date/time: 9:30 provider: , md phone: date/time: 9:30 liver clinic- provider: , md phone: date/time: 11:40 pcp- , appointment thursday , 9am md procedure: endoscopic excision or destruction of lesion or tissue of esophagus diagnoses: cirrhosis of liver without mention of alcohol diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled portal hypertension sarcoidosis other and unspecified hyperlipidemia esophageal varices in diseases classified elsewhere, with bleeding hypovolemia 

Answer: The patient is high likely exposed to