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: sob, bilateral chest pain major surgical or invasive procedure: 1.) pericardiocentesis 2.) flexible bronchoscopy, right video-assisted thorascopic surgery pericardial window and pleural biopsy. history of present illness: patient is an 83 year old male with multiple medical problems, including cirrhosis,s/p encephalopathy, dm2, htn, portal vein thrombosis, s/p stent lad , and multiple hospital admissions for chest and abdominal pain. patient states that over the last 3 weeks he has had increasing bilateral sharp chest pain, over the nipple areas. patient denies palpitations, jaw pain, arm pain, nausea,but reports some diaphoresis. patient also c/o sob worsening over the last 3 weeks. patient describes pnd and states he is not on home o2. patient also c/o midline sharp abdominal pain. patient has a history of multiple paracentesis. patient also c/o diffuse back pain and r.sided neck pain. he states that he has had all this pain before and it is due to his "water". patient cannot describe any measures that make his pain better or worse. he denies headache, dizziness, numbness, nausea, vomiting, diarrhea, or difficulty with urination. past medical history: 1. non-alcoholic steatohepatitis with associated cirrhosis. two discrete liver lesions in segment 2 and segment 8, initial core biopsy concerning for hcc, both s/p radiofrequency ablation in . recently found to have 3 new liver lesions concerning for hcc. known grade ii varices (7/). 2. non-obstructive cholelithiasis 3. bph 4. dm2 ?????? diet controlled 5. htn 6. receovered hepatitis a infection per serologies 7. benign polyps in the colon/gerd 8. recent admit for incidental portal vein thrombosis. no anticoag due to bleeding risk. 9. cad s/p stenting of the lad () medications: levothyroxine 88mcg po dialy mvi zolpidem 10mg qhs lactulose 30mg tid trazadone 50mg po hs paroxetine 10mg 2 po qd asa 325mg po qd spironolactone 50mg po qday prilosec 40mg po qday nadolol 20mg po qday welchol 625mg po daily imdur 30mg po qday doxazosin 2mg po qday plavix 75mg po qday social history: retired russian army general. 3ppd smoker, but quit 30 years ago. glasses of liquor/day, quit 30 years ago. lives with his wife of 60 years. family history: mother with gastric cancer, cad. son with brain tumor. physical exam: gen: nad, lying in bed, cooperative vitals: t.97 bp r.arm 110/58 l.arm 100/50 p64, rr 24 sat 97% 2l, pulsus <10 heent:perrla, eomi, no oropharyngeal lesions/exudates neck:no lad, no jvd chest:b/l air entry decreased breath sounds at bases, no w/r heart:s1s2 rrr, 2/6 systolic murmur loudest in aortic area, no r/g abd: ascites, +bs, diffusely tender to deep palp, no pulsatile masses, no bruits ext:no c/c/e 2+ pulses b/l neuro:aaox3, cn2-12 intact, motor ue le b/l, no gross sensory deficits. pertinent results: laboratory data: afp: <1.0 . (admission) na: 137; k 4.8; cl 103; hco3 27; bun 16; creat 1.0; gluc 118 ast 24; alt 24; ap 134; tbili 1.6; ldh 151 wbc 9.4; hbg 11.9; hct 36.5; plt 194 pt 14.9; ptt 41.2; inr 1.3 . pericardial fluid () totprot: 4.9 glucose: 89 ld(ldh): 320 amylase: 28 albumin: 2.8 wbc: 1420 rbc: polys: pnd lymphs: pnd monos: pnd . pericardial fluid gram stain () 1+ pmns fluid cx prelim: no growth anaerobic cx prelim: no growth . pericardial fluid cytology () : no malignant cells; mesothelial cells and many pmns . pericardial drain swab () final cx: no growth acid fast smears - no afb (cx pending) fungal cx prelim: no growth . pericardial fluid gram stain () 2+ pmns, 1+ gram negative rods fluid cx: pending anaerobic cx: pending . pericardial tissue () 1+ pmns, no organisms identified culture pending prelim fungal cx: negative . blood culture () - pending . studies: . chest, two views (): bilateral small pleural effusions, enlarged cardiac silhouette . echo (): lv systolic function is normal (lvef>55%). small to moderate sized pericardial effusion. ra diastolic collapse, no rv collapse. accentuated respiratory variation in mitral/tricuspid valve inflows. . echo () lv size and cavity normal. rv mildly dilated. there is a trivial/physiologic pericardial effusion. no sign of tamponade echo trivial pericardial effusion. . flexible bronchoscopy: no anatomic abnormalities. no blood, plugging, purulence, or endobronchial tumor encountered. there was some minimal thin secretions in the right lower lobe basilar segments. ct head : negative . cxr : the cardiomediastinal silhouette is unchanged including mild cardiomegaly and tortuous and calcified aorta. the left lung is clear. the right lung demonstrate unchanged linear areas of atelectasis especially in the right lower lobe. small right pleural effusion is again noted, unchanged. no pneumothorax is present. impression: no evidence for acute changes. . ekg's remained unchanged. brief hospital course: mr. is an 83 y/o m with known cad, htn, cirrhosis, portal vein thrombosis, h/o hcc, h/o hepatic encephalopathy admitted with chest pain and found to have a worsening pericardial effusion/cardiac tamponade compared to echo , now s/p r heart cath and pericardocentesis , and r. vats, pericardial window . . # pericardial effusion/ pre-tamponade: pt admitted on with chest pain and significant worsening of pericardial effusion on echocardiogram indicating tamponade. the etiology of the patient's effusion is unclear. has a prior known malignancy (hcc) with recent new liver lesions on ct of the abdomen; however, afp < 1, and pericardial fluid cytology was negative for malignant cells. patient underwent pericardiocentesis on with drainage of approximately 300cc serosanguinous fluid. on he underwent a right vats procedure with pericardial window and chest tube placement. due to a gram stain result on which showed gram positive rods in the pericardial fluid, he was treated with one dose of ceftriaxone. however it was felt that this finding was most likely a result of contamination because no other fluid or culture specimens showed bacteria, pt. was afebrile without a white count. antibiotics were held pending culture results. flexible bronchoscopy and thoracotomy showed no evidence of malignancy. patient's cultures were all negative. serial cxr's showed r. lower pleural effusion and r.lower lobe atelectasis. pain was given morphine for pain control. his last echo on showed a trivial pericardial effusion. he remained without symptoms of tamponade for the remainder of this admission. #sob-thought to be due to pain s/p procedures, possible ascites . #melena/brbpr: patient experienced melena on , brbpr , hct drop on , transfused. serial hct's followed. hepatology was closely following patient during this time and recommended iv ppi, octreotide iv. patient was temporarily transferred to the unit. brief micu course: patient transferred to micu team on due to the development of altered mental status after pericardial window and the development of a slow gi bleed. he was evaluated by the gi service and hct was monitored and found to be consistant with a slow bleed. patient had non-contrast head ct which found no acute changes. cardiac echo found a very small pericardial effusion without signs of tamponade. mr had spontaneous resoution of mental status changes and per liver team recommendation had a meeting with palliative care regarding long term treatment options and goals of care. he was transfered back to the floor on the same day. while back on 2, patient hct's remained stable, he had occasional guiac + stools with no gross blood. # hypertension: well controlled during hospitalization with sbp ranging in 110-120s. holding all antihypertensives s/p procedures. restarted on nadolol for varices. . # coronary artery disease: chest pain on admission does not appear to be due to acs (enzymes negative). on aspirin as per outpatient. plavix held for vats/ pericardial window procedure. asa and plavix were dc'd in light of recent bleeding. chest pain during admission was related to the chest tube placement and surgical intervention. it did not have qualities of angina and work up was negative. . # alcoholic vs cirrhosis: has been complicated by encephalopathy in the past. pt. managed at home with lactulose. patient developed altered mental status-delerium in hospital. his lactulose was increased during this time. possibilities included narcotic pain medication, hepatic encephalopathy, "hospital delirium", sleeping medication. however, patient's altered mental status returned to during this admission antihypertensives(nadolol, spironolactone) were held due to hypotension. nadolol and lasix were restarted and pt will be discharged on them. however, day of admission k was 5. spironolactone will be held for now and restarted as an outpatient with following of his electrolytes. additionally, patient has a h/o hcc. recent imaging suggests reoccurance of the disease. he has chronic "liver pain". he will be following up with dr. to adjust and monitor his nadolol, lactulose, lasix, and spironolactone and treatment of hcc. patient will also be discharged on cipro 500mg and finish on . he did not have enough ascites for diagnostic and therapeutic tap this admission. . # dm2: diet controlled. finger sticks were performed. # hypothyroidism: patient was continued on home dose levothyroxine. . # insomnia: ambien per home regimen with trazadone prn (home regimen). ambien eventually dc/d due to mental status changes and trazadone given. . # depression: home paroxetine. . # fen: patient was placed on a low sodium/cardiac diet. he was prophylaxed on ppi and given a bowel regiment. he was on sc heparin; however this had to be stopped secondary to bleeding. medications on admission: levothyroxine 88 mcg po daily mvi zolpidem 10mg qhs lactulose 30mg tid trazadone 50mg po hs paroxetine 10mg 2 po qd asa 325mg po qd spironolactone 50mg po qday prilosec 40mg po qday nadolol 20mg po qday welchol 625mg po daily imdur 30mg po qday doxazosin 2mg po qday plavix 75mg po qday discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day). 3. levothyroxine 88 mcg tablet sig: one (1) tablet po daily (daily). 4. paroxetine hcl 20 mg tablet sig: one (1) tablet po daily (daily). 5. trazodone 50 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 6. prilosec 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* 7. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation every four (4) hours as needed. disp:*qs * refills:*0* 8. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 9. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 11. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 9 doses: you will finish your antibiotic at the end of the day on . disp:*9 tablet(s)* refills:*0* 12. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: family care extended vna discharge diagnosis: 1.) pericardial effusion, early cardiac tamponade 2.) alcohol-related cirrhosis 3.) hypertension 4.) hypothyroidism 5.) gastrointestinal bleeding discharge condition: good, vitals stable, afebrile discharge instructions: you were in the hospital because of a pericardial effusion, or a collection of fluid around your heart. this fluid was initally drained with a needle and small drain put in place. then you underwent a surgery that allowed for a more permanent opening in your pericardiac sac (or sac of tissue that encloses the heart). then, you developed bleeding from your gastrointestinal tract. please continue to take all medications as prescribed and continue to keep all health care appointments as scheduled. if you have worsening shortness of breath or chest pain, fevers, notice blood in your stool or darkening of the stool, or your condition worsens in any way, seek immediate medical attention by calling your doctor's office or going to the emergency room. followup instructions: provider: , md phone: date/time: 10:30. please confirm with dr. when he would like to restart your spironolactone as your potassium today is 5.0 dr. - at 8:45am. to have bmp/electrolytes checked. provider: , md phone: date/time: 8:30 provider: , md phone: date/time: 12:15 provider: , md phone: date/time: 10:30 procedure: insertion of intercostal catheter for drainage fiber-optic bronchoscopy pericardiocentesis other pleural biopsy pericardiotomy transfusion of packed cells right heart cardiac catheterization diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled alcoholic cirrhosis of liver unspecified acquired hypothyroidism hematoma complicating a procedure personal history of tobacco use depressive disorder, not elsewhere classified percutaneous transluminal coronary angioplasty status family history of ischemic heart disease personal history of venous thrombosis and embolism malignant neoplasm of liver, primary hepatic encephalopathy hemorrhage of gastrointestinal tract, unspecified other specified diseases of pericardium insomnia, unspecified personal history of colonic polyps family history of malignant neoplasm of gastrointestinal tract 

Answer: The patient is high likely exposed to