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: hepatic encephalopathy major surgical or invasive procedure: colonoscopy esophagogastroduodenoscopy serial paracenteses thoracocentesis history of present illness: 61 yo m w/ hx etoh cirrhosis etoh, anemia, and hepato-renal syndrome presented to osh for routine paracentesis and was found to have hyperkalemia. patient is confused and unable to give any hx, all data is obtained from osh records though no d/c summary is present. per these records, patient get regular parcentesis the last prior to admission being . on presentation to osh on , he complained of abdominal pain, distension, sob, anorexia, generalized weakness. he denied melena, diarrha, fevers or chills. he was found to be hyperkalemic to 6.5 and had a cr of 4.3 and was transferred to er. . at osh, treated wtih kayexelate and potassium followed. lasix given for diuresis and nephrology consulted. continued on cipro for sbp prophylaxis. patient was tranfused prbcs for anemia. he was maintained on a low protein<45g/day diet. became increasingly lethargic and confused and was transferred for transplant work up and eval. past medical history: liver cirrhosis followed at by the transplant team anemia hepato-renal syndrome social history: lives alone, was a drinkier until , non-smoker. states he is a retired teacher (ap chem and physics teacher). healthcare proxy: . dr. is his pcp. doctor is dr. . family history: sister died of pancreatic cancer physical exam: 95.9 114/76 101 20 98% ra bg 217 180# gen: confused, mumbling, states "no i haven't" to almost all questions. not oriented to place or date. jaundiced heent: slight scleral icterus, mmm, tounge fasiculations noted, prrl cv: rrr s1s2 no m/r/g noted pulm: diminished left sided breath sounds, right side cta abd: ascites present, soft, not tensly distended, non-tender, ext: trace pedal edema neuro: oriented to self. does not know dates, location, president of the us. ++asterixis pertinent results: osh labs- : wbc 6.7 hct 27.3 plt 31 inr 1.6 pt 17.8 na 129 k 5.2 cl 101 co2 21 bun 782 cr 4.0 ca 8.5 : ast 33 alt 24 alk ph 92 45 lip 68 ha1c: 6.0 . ua : negative . renal us: large ascites. no calculus or obstruction of either renal collecting system. . cxr: large left pleural effusion / : pfts: fev1 45% fvc 41% fev1/fvc 110 tlc 46% dl/va 116% . : p-mibi: no anginal symptoms or ischemic ekg changes. calculated ef 78% with normal myocardial perfusion and wall size and motion. . : mri/a of liver: could not resolve hepatic arterial architecture. no liver masses, patent portal vein, small liver cyst . infectious serologies: hsv1&2, hcv, rpr, toxo igg/m, cmv igg/m, hbsag, hbcab: negative ebv igg+/igm-, vzv igg+, hbsab - borderline . tumor markers: ca19-9: 37, cea 5.7, psa 0.4 brief hospital course: 61 yo m with etoh cirrhosis on regular paracentesis at baseline, presented to osh with presumed worsened cr (unknown baseline), hyperkalemia and worsening mental status. transferred to for transplant evaluation and further work-up. in brief the patient arrived in hepatorenal syndrome, hepatic encephalopathy, and was later found to have strept viridans sbp and bacteremia. his acute presentation slowly resolved with octreotide/midodrine/albumin, lactulose/rifaximin, and antibiotics, respectively. in addition, he continued to have elevated blood sugars requiring insulin therapy. he was evaluated in collaboration between the hepatology team and the transplant surgery to determine his candidacy for transplant. his pre-transplant evaluation included multiple infectious disease serologies, non-invasive cardiac imaging, mri/mra of the liver, serial paracenteses, colonoscopy and egd, tumor markers, and dental evaluation. at the time of discharge he was stable to go home with close follow-up. he was listed for liver transplant. . # hepatic encephalopathy: the patient has a history of cirrhosis secondary to etoh. on presentation his inr was 1.7, alb was 2.6, total bili was 4.2 and ammonia level was 282. his transaminases remained within normal limits. he was very confused and had displayed prominent asterixis on exam c/w hepatic encephalopathy. he was started on lactulose, and rifaximin and observed in the micu. his confusional state cleared after several days of aggressive lactulose/rifaximin and antibiotics for the sbp. he was transferred to the medical floor for further management. his level of consciousness gradually improved as did his asterixis with continued therapy. by discharge he was conversant with content appropriate to questioning, attentive to interview and exams, and following directions appropriately to check blood sugars and administer insulin injections. . # spontaneous bacterial peritonitis: the patient has a history of refractory ascites which had been managed with weekly paracenteses. during the evaluation for the trigger for the encephalopathy, a diagnostic paracentesis was performed on the second day of his stay. it revealed wbc 387 rbc 1400 polys 48%. the patient had been taking levofloxacin as sbp prophylaxis at home so the <250 pmn count was still thought to represent sbp and thus merit treatment - initially with vancomycin/zosyn. the peritoneal fluid was later cultured revealing viridans streptococci which was sensitive to penicillins (and therefore cephalosporins) and the patient was switched to ceftriaxone on which he completed a 7 day course. serial diagnostic/therapeutic paracenteses were performed to follow clearance of the infection which was ultimately confirmed on . each paracentesis was accompanied with appropriate colloid replacement. the last paracentesis performed during this hospitalization revealed:..... following the therapeutic course of ceftriaxone, the patient will be maintained on bactrim ss prophylaxis as the prior microbe was resistant to quinolones. he is still likely to need regular therapeutic paracenteses to manage his ascites. . # bacteremia: blood cultures drawn on admission also grew viridans streptococci. the patient had a tte to evaluate for endocarditis which was negative. repeat blood cultures from hospital day 2 and 4 have resulted as negative. a dental consult was obtained to evaluate for an oral source to the bacteremia/sbp. no oral abscess or infectious nidus was found, but 2 teeth were recommended to be removed (see "teeth" section below). he did have a rij central venous catheter in place and the time the bacteremia was detected. although the line was not thought to be the culprit source for the infection, the line was pulled when adequate access was obtained. cath tip culture was negative. by the time he was stabilized and transferred to the medical floor he was afebrile and remained so for the duration of his hospital stay. . # hyperkalemia: upon arrival to the patient had a k level of 5.2. an ecg was obtained. he was treated with kayexalate, fluid and diuresis. the hyperkalemia was thought secondary to renal failure (see below). as the renal function improved his potassium level returned to . . # renal failure: the patient has a history of hepatorenal syndrome and although his baseline creatinine was unknown prior to admission, his dropping uop, euvolemic status, and pre-renal arf were consistent with hepatorenal syndrome. this diagnosis was further supported by low urinary protein/creatinine ratio, bland urine sediment, negative for hepatis serologies, negative cryoglobulin and no hydronephrosis by u/s. he was started on octreotide/albumin/midodrine. his creatinine was at a maximum of 4.3 on admission and slowly trended down with continued treatment. however, his creatinine showed some lability and concern persisted for the need for combined liver-kidney transplant. . # end-stage liver disease: the patient was evaluated in collaboration by the hepatology, nephrology, and transplant surgery teams. the pre-transplant evaluation revealed no contra-indications to transplant, and the patient was placed on the transplant list. for results of the pre-op evaluation, please see "pertinent results." . # hyperglycemia: the patient has no history of diabetes although he did have persistent elevated blood sugars. a glycosylated hemoglobin was normal at 6% and the hyperglycemia was managed with insulin. his blood sugar control improved with a twice daily dosing regimen of nph with a sliding scale for coverage. he will continue to monitor his blood sugars and administer insulin at home with assistance of vna and family members. received extensive teaching with nursing regarding insulin administration and blood glucose measurements. . # anemia: the patient was found to be anemic with hct of ~28% on admission this reached a nadir of 23.3% before recovering to >31% prior to discharge. there was no evidence of blood loss or hemolysis by smear examination. he had adequate iron, folate, and b12 stores. his anemia was largely attributed to his hypersplenism and underlying liver disease. he received epogen to stimulate his marrow, and he was transfused 3 units of prbcs during his stay. . # thrombocytopenia: the patient has a baseline thrombocytopenia secondary to hypersplenism. he required 6 platelet transfusions to support him while he underwent various invasive procedures. there were no precipitous declines in the platelet count to suggest hit, but heparin products were limited in their use nonetheless. . # teeth: during the evaluation for the source of the bacteremia, a panarex film was obtained and a dental consult was called. no infectious nidus to be indentified, however two teeth were noted to be diseased and meriting removal (teeth #5 and #13 both upper bicuspids). the patient was referred to the outpatient oral surgery department at for these teeth to be extracted while awaiting a liver to become available. . # fengi: the patient was gradually advanced to full regular diet as his condition improved. . # prophy: ppi, pneumoboots while on bedrest. # comm: sister . # code: full, does have living will in chart medications on admission: protonix 40, renagel 400mg tid, lactulose tid, levaquin 250mg qd, ssi, reglan prn, docusate prn, melatonin prn discharge medications: 1. trimethoprim-sulfamethoxazole 80-400 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 3. sevelamer 400 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 4. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours). disp:*2700 ml* refills:*2* 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 6. insulin - nph please check your blood sugar 4 times a day. please take 10 units nph in the morning and 8 units of nph at night. 7. octreotide acetate 100 mcg/ml solution sig: two (2) ml injection q8h (every 8 hours). 8. epoetin alfa 4,000 unit/ml solution sig: one (1) ml injection qmowefr (monday -wednesday-friday). disp:*qs ml* refills:*2* 9. midodrine 5 mg tablet sig: three (3) tablet po tid (3 times a day). disp:*270 tablet(s)* refills:*2* 10. insulin nph human recomb 100 unit/ml cartridge sig: as directed units subcutaneous once a day: please take 10 units in the morning and 8 units at night. disp:*qs ml* refills:*2* 11. insulin syringe syringe sig: as needed syringe miscell. four times a day as needed for low blood sugar: with needles. disp:*120 syringes* refills:*2* 12. one touch test strip sig: as needed miscell. four times a day. disp:*100 strips* refills:*2* 13. one touch ultrasoft lancets misc sig: as needed miscell. four times a day. disp:*100 lancets* refills:*2* 14. insulin regular human 100 unit/ml cartridge sig: as directed units injection four times a day as needed for high blood sugar: per sliding scale. disp:*qs ml* refills:*2* 15. syringe with needle (disp) 3 ml 20 x 1 syringe sig: as directed miscell. qmowefr (monday -wednesday-friday).: for epogen. disp:*30 syringes* refills:*2* discharge disposition: home with service facility: vna carenetwork discharge diagnosis: primary: liver cirrhosis hepatorenal syndrome hepatic encephalopathy hyperglycemia spontaneous bacterial peritonitis strep. viridans bacteremia left sided pleural effusion secondary: refractory ascites discharge condition: fair - tolerating oral medications, tolerating food, ambulating well. discharge instructions: please seek immediate medical assistance if you experience fevers, chills, increasing confusion, or noticeable decrease in your urination. take your medications as prescribed. you were started on insulin while in the hospital. this will require you to take fingerstick glucose measurements and then adjust your insulin requirements according to the following schedule: . wake up: 1) check blood sugar, 2) give insulin - 10 units of nph and regular insulin according to both the sliding scale and measured blood glucose, 3) eat 30 minutes after insulin. . 30 min before lunch: 1) check blood sugar, 2) give regular insulin according to sliding scale and blood glucose measurement, 3) eat 30 minutes after insulin. . 30 minutes before dinner: 1) check blood sugar, 2) give regular insulin according to both the sliding scale and blood glucose measurement, 3) eat 30 minutes after insulin. . bedtime: 1) check blood sugar, 2) give 8 units of nph and regular insulin depending on sliding scale and blood glucose measurement. . please have visiting nurse fax your blood test results to . her fax number is and her phone number is . please call ms. if you have any further questions about your home nursing. followup instructions: provider: ,ten day care 8 date/time: 2:00 . please call dr. on monday in the morning to schedule an appointment within one week of leaving the hospital. his numbers are the following: liver center phone: ; liver transplant phone: procedure: thoracentesis thoracentesis percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage closed [endoscopic] biopsy of large intestine transfusion of packed cells diagnoses: hyperpotassemia anemia of other chronic disease unspecified pleural effusion alcoholic cirrhosis of liver hepatorenal syndrome bacteremia hepatic encephalopathy benign neoplasm of colon other abnormal blood chemistry spontaneous bacterial peritonitis 

Answer: The patient is high likely exposed to