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 attending: chief complaint: found down major surgical or invasive procedure: intubation and extubation history of present illness: 56 m w/ esld hcv and etoh cirrhosis, w/ locally advanced unresectable end-stage hcc s/p tace, trial of sorafenib &c1 xeolda, palliative chemo w/ capecitabine and cyberknife therapy, who presents from home after being found altered by his wife. reportedly, pt was in his usoh until this morning when he fell forward out of a chair, striking his forehead. he then went to bed at 8am and when his wife went to arouse him, she found him unresponsive so called ems. ems found him to have normal sao2 and fsbs. his wife who is his hcp states she has had similar episodes in the past but she is unable to say what those events were and how they were treated. she gives him his medications at home and denied possibility of overdose although pt is on massive doses of narcotics at home and has been admitted for narcotics overdose in the past, most recently from . . in the ed, vs initially 93 89/57 20 100% nrb. he appeared unresponsive to noxious stimuli and had no gag, so was intubated for airway protection via rapid-sequence without medications. initially he tolerated intubation without any medication but was moving extremities while in ct scanner so was given etomidate and succinylcholine. initial abg on 550x16 peep 5 fio2 100% was 7.49/ 43/ 164. . in the icu, he was intubated, sedated and not following commands. past medical history: -hcc s/p s/p resection in , recurrence in , s/p tace, trial of sorafenib, & c1 xeloda, currently s/p palliative chemotherapy 1 cycle with capecitabine (recently stopped 3 days prior to admission due to concern of worsening ataxia) -etoh cirrhosis -hcv -seizure disorder -bipolar disorder - psych hosp , sa in the with soma and etoh -anxiety disorder -peripheral neuropathy -chronic ataxia - unknown etiology -lyme disease -htn social history: lives w/ partner . currently on disability. prior prison sentence for assault many decades ago. etoh history in past, current use unknown. smokes ppd. history ivdu, none in 8 yrs. his partner does not think he is taking additional non-prescription opiate meds that she knows of. had recent admission for narcotics overdose. family history: father died of a type of bone cancer. paternal grandfather may also have had bone cancer. maternal grandfather had lung cancer. physical exam: admission exam: vs: t 103 hr 109 bp 109/65 rr 16 sao2 97% on 550x16 fio2 50% peep 5 gen: intubated, sedated not following commands heent: perrla 4-->2 cm b/l cv: tachycardic rate, regular rhythm no murmurs appreciated lungs: no crackles/wheeze anteriorly, coarse ventilated breath sounds abd: +bs soft nt nd, no hsm ext: no edema b/l le, w/w/p neuro: intubated, sedation . exam: vs: t: 98.3 143/92 76 18 95%ra ga: aox3, nad heent: sclera anicteric. perrla. no nystagmus. mmm. no lad. no jvd. neck supple. cv: rrr. iii/vi sem best heard at rusb, radiating to carotids. no pulsus parvus et tardus. pulm: ctab, fair aeration. decreased bs on l>r, mild inspiratory crackles. no egophony or tactile fremitus. no w/r/r. abd: soft, nd. ttp at epigastrium. +bs. no g/rt. neg hsm. neg sign. no fluid wave or shifting dullness. extremities: wwp, no edema. pts 2+. skin: no jaundice. neuro: cns ii-xii intact. +asterixis, no clonus. no pronator drift. resting tremor. no dysmetria or dysdiadhochinesia on exam. 4/5 strength distal muscle groups in ue and le, in large muscle groups in ue and le. fair performance on fnf. 2+ br. light touch,deep touch, and proprioception intact on ue c5-t1 and le l3-s1, but l>r. psych: unable to perform moyb (?effort), but can do dow forward and backwards. no dysarthria. good performance on go-no go level. recall at 0 mins, at 5 mins. pertinent results: admission labs: 01:04pm blood wbc-6.5 rbc-3.51* hgb-11.1* hct-33.5* mcv-95 mch-31.5 mchc-33.1 rdw-14.2 plt ct-330# 01:04pm blood neuts-76.9* lymphs-16.8* monos-3.9 eos-2.1 baso-0.3 01:04pm blood pt-14.1* ptt-31.9 inr(pt)-1.2* 01:04pm blood glucose-123* urean-10 creat-0.5 na-137 k-4.3 cl-98 hco3-35* angap-8 01:04pm blood ammonia-52 01:04pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 01:14pm blood glucose-117* lactate-1.0 na-142 k-4.5 cl-92* calhco3-36* 01:14pm blood hgb-11.3* calchct-34 . labs: . micro: blood cultures: pending urine culture: negative mrsa screen: negative sputum culture: s. pneumoniae, h. influenzae, gnrs . imaging: ct torso w/ con: 1. status post left lateral hepatic segmentectomy and cyberknife for the gastrohepatic lymphnode, with stable appearance of the resection margin. previosuly mentioned four lesions in the liver have slightly increased in size and are concerning for foci of hcc. stable appearing caudate lobe lesion worrisome for another hcc focus. 2. gastrohepatic lymph node, slightly smaller since the prior study. 3. interval appearance of new ground glass opacities in the lungs likely representing inflammatory process. . ct head w/o con: no acute intracranial process. . ct c-spine w/o con: 1. no evidence of an acute fracture. 2. stable appearance of multilevel degenerative joint changes, most pronounced at c5-c6 with posterior osteophyte disc complex formation mildly impinging upon the thecal sac without evidence of critical central canal stenosis. in the setting of high clinical suspicion for ligamentous or central cord injury, may consider mr. 3. large amount of fluid pooling in the pharynx and hypopharynx, which may put the patient at risk for aspiration. cxr : extensive bilateral consolidation in the lower lungs, right greater than left, most likely pneumonia. upper lungs are clear. pleural effusions are small if any. heart size normal. et tube in standard placement. nasogastric tube passes into the stomach and out of view. dr. was paged. liver u/s : 1. no significant ascites. 2. multiple liver lesions are better appreciated on ct scan. brief hospital course: 56 m w/ hcv and etoh cirrhosis w/ locally advanced unresectable hcc found down and unresponsive. . #altered mental status: etiology of unresponsiveness was unclear at time of admission. initial ct head was negative for acute process or for metastatic lesions. on admission, ddx included meniningoencephalitis vs. hepatic encephalopathy vs anticholinergic delirium vs. narcotic overdose vs. sepsis, with ddx for possible loc prior to admission including orthostatic syncope (especially given sepsis physiology and poor po intake prior to admission). given fever to 103.8 on admission to micu, sepsis was considered most seriously, and coverage was begun for sbp (h/o cirrhosis) and meningitis (fever and ams) with vanco/ceftriaxone/ampicillin/acyclovir. lactulose was also started given concern for possible hepatic encephalopathy. cxr ultimately showed development of pna, and sputum culture was positive for s. pneumoniae and h. influenza; thus, all abx but ctx were discontinued on . sedation weaned as tolerated, and patient was extubated . he was aaox3 following extubation and at baseline per outpatient providers and girlfriend. . #community acquired pna: while initial cxr on not concerning for acute process, subsequent cxr on showed development of extensive bilateral consolidation in the lower lungs (r>l), most likely pneumonia in the setting of fevers and hypotension. sputum culture from was positive for s. pneumoniae and h. influenza, both penicillin-sensitive. he was continued on ceftriaxone and other abx were discontinued. he defervesced and remained afebrile and normotensive throughout his course. he was weaned from the ventilator on , and on was stable for transfer to medicine floor. prior to transfer, patient was no longer requiring supplemental oxygen. on , he was transitioned to amoxicillin 875 po bid whch he will continue for total 10 day course. . #hypotension: patient hypotensive with sbp in 70s on day of admission, likely secondary to sepsis in setting of pna, as well as due to effects of sedating meds while intubated. patient responded to ivf boluses. pressures remained stable following aggresive ivf administration and antibiotics. no further events of hypotensoin on the medical floor. . #terminal hcc in setting of elsd etoh & hcv cirrhosis. patient did not have any evidence of ascites on exam, and ruq ultrasound did not show significant ascites. he was started on lactulose for his h/o cirrhosis. patient was seen by his outpatient heme/onc fellow, dr. , during this hospital course. he was also seen by palliative care, who discussed the option of hospice. patient was agreeable to hospice care and will be discharged with home hospice. . #seizure disorder, nos: patient was continued on divalproex while in-house. was monitored on seizure precautions. #cachexia: pt has cre of 0.4 and bun of 4, and relates hx of poor po intake. he endorsed to medical floor team that he and his partner could not afford food, however sw was consulted and he did not bring up these concerns. would consider nutrition f/u as outpatient, or possibly megace or other medication to stimulate appetite. . #ataxia: chronic problem per pt and per (lead to disability in ). neurology evaluation in was c/w with l5/s1 sensory neuropathy as well as central issue (nystagmus, ataxia), possibly a wernicke??????s encephalopathy. of note, pt has had two falls at home, both being followed by ams and requiring admission. mri showed bilateral foraminal narrowing at l5/s1, with nerve impingement l>r. pt ambulates with cane. he asserts that a neuropathy causing weakness and sensory problems led to him quitting his job on disability in . prior eval showed elevated tsh (which normalized two weeks after admission), normal rpr, elevated b12. evaluated by pt who recommended home pt, however patient went home on hospice. . #bipolar disorder c/b sa x4 and legal issues s/p multiple hospitalizations: denied active si,hi, hallucinations and illusions. also denied prior attempts at overdose, which he had been admitted to the hospital for in the psat. outpt psychiatrist, dr. , was consulted who recommended no inpatient intervention and outpatient f/u was scheduled. continued home thorazine . medications on admission: baclofen 20mg qid chlorpromazine 50mg qhs divalproex - 250 mg - 4 tabs gabapentin - 800 mg qid hydromorphone - 4-8mg po q4-6h prn pain morphine - 15 mg (ms contin) morphine - 30 mg (ms contin) prochlorperazine maleate 10 mg tablet q6h prn nausea ranitidine hcl- 150 mg docusate 100mg loperamide prn episode of diarrhea. take up to 8 tablets per day. medications: 1. baclofen 10 mg tablet sig: two (2) tablet po qid (4 times a day). 2. gabapentin 400 mg capsule sig: two (2) capsule po bid (2 times a day). 3. ranitidine hcl 150 mg tablet sig: one (1) tablet po bid (2 times a day). 4. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po tid (3 times a day). disp:*1350 ml(s)* refills:*2* 5. chlorpromazine 25 mg tablet sig: two (2) tablet po hs (at bedtime). 6. divalproex 500 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po bid (2 times a day). 7. hydromorphone 2 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 8. morphine 15 mg tablet extended release sig: one (1) tablet extended release po q12h (every 12 hours). 9. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po every six (6) hours as needed for nausea. 10. amoxicillin 875 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 5 days. disp:*11 tablet(s)* refills:*0* 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). disposition: home with service facility: hospice diagnosis: community acquired pneumonia condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). instructions: you were seen in the hospital for being found down at home. this was most likely due to being ill with pneumonia, for which you stayed in the icu and received iv antibiotics. your breathing and symptoms improved. you should continue taking antibiotics by mouth at home because you were found down at home, there was also a concern that your dosage of pain medications was too high. we decreased your ms contin to 15 mg twice a day and the dilaudid for breakthrough pain to 2 mg every 4 to 6 hours as needed for pain. if your pain is not being well controlled, please discuss this with dr. who can adjust your medications with you. changes to your medications: start taking amoxicillin (antibiotic) 875 mg twice a day for five more days start taking lactulose 15 mg four times a day decrease ms contin to 15 mg twice a day decrease hydromorphone to 2 mg every 4 to 6 hours as needed for pain (please cut the 4 mg pills you have at home in half) followup instructions: you should follow up with your oncologists in weeks, they will call you and let you know when your appointment is. department: psychiatry when: monday at 12:00 pm with: , md building: ra (/ complex) campus: east best parking: main garage name: , e location: community health center address: 409 , , phone: appointment: tuesday at 12:10pm department: hematology/oncology when: monday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: monday at 2:00 pm with: , md building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: tobacco use disorder unspecified essential hypertension chronic hepatitis c without mention of hepatic coma alcoholic cirrhosis of liver cachexia epilepsy, unspecified, without mention of intractable epilepsy encounter for palliative care malignant neoplasm of liver, primary pneumococcal pneumonia [streptococcus pneumoniae pneumonia] hyperosmolality and/or hypernatremia unspecified hereditary and idiopathic peripheral neuropathy bipolar disorder, unspecified pneumonia due to hemophilus influenzae [h. influenzae] 

Answer: The patient is high likely exposed to