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: hematuria, shortness of breath major surgical or invasive procedure: intubation/extubation, mechanical ventilation multiple paracenteses thoracentesis x2 (bilateral) nasogastric tube placements orif of hip fracture history of present illness: 56 yo m c h/o hep c cirrhosis on transplant list intially admitted 2 days prior with hematuria, sob. patient unable to confirm history now as he is intubated. . per floor admission note: patient states that he noticed his urine was dark red this am. denies f/c, chest pain, n/v, abd pain, change in bowel habits, flank pain, dysuria, increased frequency, hematemesis, melena, or hematochezia. patient has no h/o hematuria or nephrolithiasis. the patient states that his urine has been gradually clearing since this morning. he can urinate without a catheter and has had no evidence of clots or obstruction. . the patient also notes gradually worsening sob over the past several weeks. he had been stable on diuretics and has not required a paracentesis in two years. however, he states that he had recently broken his ankle and had been in rehabilitation in . during his time in rehabilitation, he felt that his fluid status was worsening and he began to notice weight gain, worsened abdominal distention, ble swelling, and slowly progressive worsening sob. he was seen in liver clinic twice over the past month, at which time his diuretics were uptitrated. he had followup scheduled this wednesday, at which time he expected that he would need to be tapped again. . of note, the patient had been admitted to with pleuritic cp and sob and was found to have bl small ptx and a left pleural effusion which was borderline exudative/transudative and of unclear etiology. he was followed in pulm clinic, they felt his ptx was likely severe coughing. they thought that the elevated ldh was the large amount of rbc and that the tpr was more consistent with a transudative process. . in the ed, vs 97.0 66 106/58 16 98% ra. patient was found to have plt count of 39 and inr of 1.9, which represents his baseline. ua showed evidence of hematuria without evidence of red cell casts. cxr showed l-sided pleural effusion. patient was admitted to et for further workup of his hematuria and sob. on transfer, vs 64, 110/54, 28, 97% ra. . since admission he underwent thoracentesis on given continued sob and large l pleural effusion. per report had thoracentesis in , appeared more exudative than prior with some concern for tuberculosis per primary team. id was contact and noted prior negative sputum x 1 with negative ppd. procedure consulted for repeat thoracentesis this admission. thought needed belly tapped to see if that helped. got 3.5 l off night, but respiratory status did not improve. subsequently, fell overnight and broke left hip with femoral neck fracture. prior to or continued to some oxygenation problems but was not hypoxic on ra but could not lie flat. went to the or, got 4 bags platelets and 2 bags ffp. was intubated but had difficulty continuously desatting on his lateral side so they had to abort the procedure. rij and r arterial line in place. cxr with r side white-out. r paracentesis done in pacu. 2.5 l serosanguinous fluid. getting 0.8 mcg neo. oxygenation better. . upon admission to the micu, patient is still in the pacu, sedated on propofol/fentanyl and needed phenylephrine. unable to confirm history further. . ros: see above. all other systems negative. past medical history: (per omr, cannot confirm) 1. cirrhosis: - secondary to hepatitis c (from blood txn) - listed for liver transplant, meld 19 - afp 2.3 () - 3 cords of grade ii and 1 cord of grade 1 non-bleeding varices () - ascites requiring paracenteses q2-4 weeks previously but well controlled now - h/o hepatic encephalopathy - h/o sbp on cipro prophylaxis 2. hepatitis c: - genotype 1, viral load 412,000 iu/ml () - failed interferon tx (thrombocytopenia) 3. history of cva, w/ mild residual r sided weakness 4. heterozygous for h63d for hemochromatosis 5. hypertension 6. osteoporosis 7. h/o ptx with pleural effusion thought to be transudative by pulm in clinic 8. progressive le weakness thought to be parkinsonism or manganism chronic liver disease by neuro in 9. s/p r ankle fx in social history: (per omr, cannot confirm) married and lives with his wife. formerly worked as a custodian. history of smoking but quit 10 years ago. smoked 1ppd x years. denies alcohol or drug use. family history: (per omr, cannot confirm) significant for alzheimer disease in mother and an unspecified cancer in father and brother. physical exam: vitals - t: 98.7 bp 123/60 hr 65 rr 18 100/cmv 40% general: sedated, intubated, jaundiced heent: ncat, perrl, anicteric cardiac: rrr s mrg, distant heart sounds. lung: cta anteriorly and in axilla, difficult to assess posteriorly abdomen: +bs, soft, distended, no grimace to deep palpation, mild eccymoses ext: wwp, 2+ pulses, 2+ pitting edema to shins bilaterally neuro: sedated pertinent results: 134 100 12 105 agap=12 3.7 26 1.0 . alt: 20 ap: 164 tbili: 4.3 alb: ast: 39 lip: 44 . cbc 101 3.8 > 11.3 < 39 33.3 n:75.7 l:10.4 m:6.9 e:4.9 bas:2.0 . pt: 20.5 ptt: 42.3 inr: 1.9 . abdominal ultrasound with dopplers: 1. cirrhotic liver with sequela of portal hypertension including worsening ascites and unchanged splenomegaly. no focal hepatic lesion. 2. normal doppler interrogation of the liver. 3. site for paracentesis marked in the left lower quadrant. . pleural fluid: transudative x2, negative for malignant cells . ct head non-con: no fracture or recent hemorrhage. . bilateral hip films: displaced left femoral neck fracture. . ankle films: .... brief hospital course: this is a 56 year old male on the liver transplant list for hepatitis c cirrhosis complcated by esophageal varices, hepatic encephalopathy, worsening ascites, and h/o sbp on cipro prophylaxis also with pmh of cva with r-sided weakness who originally presented for hematuria and shortness of breath but had a prolonged hospital course complicated by altered mental status secondary to hepatic/metabolic encephalopathy, an in-hospital fall resulting in a left femoral neck fracture requiring orif followed by an icu stay after the procedure for hypotension requiring pressors and prolonged intubation, as well as multiple paracenteses and thoracenteses. . # l femoral head fracture: unfortunately, the patient fell in the hospital resulting in a traumatic fracture of his left femoral head which required an orif. he has childs- class c cirrhosis and was a high operative risk for a high risk procedure. however, it was deemed that the benefits of the procedure outweighed the risks. the patient was intubated for surgery, but then acutely decompensated when placed in the lateral decubitus position. he briefly required neosynephrine in the icu to maintain blood pressures. his respiratory condition improved after a large volume thoracentesis bilaterally. of note, the patient's post-operative chest x-ray was concerning for white-out of right lung fields but he did respond well to mechanical ventilation. on post-operative day #1, the patient was found to be in mild hypovolemic shock in the setting of significant peri-operative blood loss. he was transfused 4 units prbc, 2 units platelets, 1 unit ffp and hence, extubation was deferred until post-operative day #2 given his significant volume overload with transfusion products. on post-operative day #3, patient was started on active diuresis for concerns of pleural effusions/volume overload on chest xray and physical exam. patient diuresed well to lasix 60mg iv, cardiac status remained stable by ekg and troponins, and ruq ultrasound was negative for ascites that could push on diaphragm and compromise respiratory status. he was then transferred back to the floor off of pressors and on nasal cannula. currently he is satting well on room air with occasional prn nebulizer treatments. he was continued on calcium and vitamin d, but can only start on alendronate bisphosphonate therapy starting per ortho protocol s/p fracture due to bisphosphonate effect on bone remodeling. he will also need to continue on lovenox 30mg until to complete 4 weeks of treatment to prevent dvt. his left hip wound is currently edematous, but intact without purulence. . # hepatitis c cirrhosis - his meld score was tracked throughout his admission and remained around 19. he is on the transplant list. he was continued on cipro for sbp prophylaxis, nadolol, as well as his lactulose/rifaximin regimen. the patient's nutritional status was a major issue during this hospitalization. several ng feeding tubes were placed because the patient would pull them out. finally an ng tube was placed and bridled and the patient will continue on nutren 2.0 tube feeds at 50cc/hr in addition to a soft dysphagia diet. several diagnostic and therapeutic paracenteses were performed during her stay. he did not develop sbp and his most recent paracentesis was performed with a total of 8 liters removed. he was administered albumin iv per protocol after each paracentesis. . # ams - following transfer to the floor from the unit, the patient had altered mental status with slurred speech and waxing/ orientation and alertness, although he had no significant asterixis on exam. no focal neurologic deficits were appreciated. he was given lactulose. given concern for ongoing slurred speech even with improved alertness and orientation with the patient's history of cva, an mri of the head was ordered which did not show any acute pathology. it is likely that his ams was related to a hepatic, a metabolic (related to his fluctuating sodium levels, see below) as well as a postoperative encephalopathy/syndrome. he was also found to have a uti and will be completing a 14 day course of bactrim ds . . # fluctuating sodium levels - the patient developed worsening hypernatremia following transfer to the floor from the unit, peaking at 154. it was felt that this was likely excessive gi losses from aggressive lactulose regimen intended to clear his possible hepatic encephalopathy. his lactulose was temporarily held and he received aggressive free water flushes and iv d5w. his sodium continued to be difficult to bring down in this setting and lasix diuresis was re-initiated concomitantly with increased free water flushes. eventually the patient became hyponatremic on this regimen thought to be secondary to aggressive diuresis. his diuretics were held starting and the patient was started on a 1.2 liter po fluid restriction and his free water flushes were discontinued. his sodium was 130 on discharge and he will be discharged off of diuretics. his labs will be checked next week and his diuretic regimen may be restarted based on these lab values. . # hematuria - this manifestation resolved spontaneously with no evidence of obstruction or clots. hct was 33.3 on admission which was stable from hct checked 3-4 weeks prior. it is suspected that this was due to a spontaneous bleed in setting of thrombocytopenia/coagulopathy cirrhosis. . # thrombocytopenia/anemia - former felt likely due to hepatic dysfunction and splenomegaly/splenic sequestration. responded to 8 units platelets and remained stable in the 40s on discharge. patient's anemia was felt in part due to recent surgical intervention, recent hematuria, chronic disease, low-grade hemolysis and dic by labs. patient was transfused aggressively with 12 units prbc in the setting of his recent surgery and concern for hypovolemic shock. . # code: the patient's code status was confirmed as full code thoughout his hospital stay. . # contact: the patient's wife and hcp can be reached at . she is very involved in her husband's care and was contact with frequent updates throughout his hospital stay. medications on admission: cipro 250mg po daily citalopram 10mg po daily folic acid 1mg po daily furosemide 40mg po bid lactulose 30-60 grm po 3-4x daily prn nadolol 20mg po daily compazine 10mg po bid prn nausea rifaximin 600mg po bid spironolactone 200mg po daily calcium carb - vit d3 1 tab multivit omeprazole 20mg po bid . allergies: nkda (per omr, cannot confirm) discharge medications: 1. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day): please titrate to bms per day. 2. rifaximin 200 mg tablet sig: three (3) tablet po bid (2 times a day). 3. ciprofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours). 4. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). 7. lactulose 10 gram/15 ml syrup sig: sixty (60) ml po q4h (every 4 hours) as needed for constipation. 8. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 10. multivitamin tablet sig: one (1) tablet po daily (daily). 11. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 12. vitamin d 400 unit tablet sig: one (1) tablet po twice a day. 13. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) ampule inhalation q4h (every 4 hours) as needed for shortness of breath or wheeze. 14. ipratropium bromide 0.02 % solution sig: one (1) ampule inhalation q6h (every 6 hours) as needed for sob. 15. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 16. enoxaparin 30 mg/0.3 ml syringe sig: thirty (30) mg subcutaneous q12h (every 12 hours): please stop this medication on . 17. sulfamethoxazole-trimethoprim 800-160 mg tablet sig: one (1) tablet po bid (2 times a day): please stop . 18. compazine 10 mg tablet sig: one (1) tablet po twice a day as needed for nausea. 19. fosamax 70 mg tablet sig: one (1) tablet po once a week: please start this medication on . please give to the patient on an empty stomach and have him sit up for 30 minutes after administration. 20. outpatient lab work please check cbc, chem-7, pt, ptt, lfts (ast, alt, alkaline phosphatase, total bili, albumin) on monday and fax to liver transplant clinic, attention: dr. discharge disposition: extended care facility: hospital - discharge diagnosis: hepatitis c cirrhosis, osteoporosis, left femoral neck fracture s/p orif, hypernatremia, hyponatremia, hepatic encephalopathy, malnutrition, urinary tract infection discharge condition: mental status: confused - sometimes activity status: out of bed with assistance to chair or wheelchair level of consciousness: lethargic but arousable discharge instructions: you were admitted to hospital for evaluation of blood in your urine and shortness of breath. the blood in your urine spontaneously resolved and your shortness of breath was found to be due to fluid accumulation in your lung which needed to be tapped. during your admission you also developed hepatic encephalopathy and fluctuating sodium levels in your blood which was thought to be the major causes for your change in mental status. unfortunately, you fell during your hospital stay and fractured your left hip which required surgical repair. your nutritional status was also a concern during your hospital stay and a nasogastric tube was placed with a bridle to ensure that your nutritional status will be able to be maintained on constant tube feeds. . the following changes have been made to your home medication regimen: -you will increase your vitamin d to 400iu twice daily -you will be started on albuterol/ipratropium nebulizer treatments as needed for your wheezing and shortness of breath -you can start taking dulcolax as needed for constipation -you will be on lovenox 30mg injections twice daily until -you will be started on fosamax 70mg weekly starting to improve you bone strength -you will continue on bactrim ds twice daily for 2 more days to complete a 14 day course for a urinary tract infection . please follow-up with all of your outpatient medical appointments listed below. followup instructions: please follow-up with all of your outpatient medical appointments listed below: . 1. provider: , md phone: date/time: 2:20 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances thoracentesis percutaneous abdominal drainage percutaneous abdominal drainage arterial catheterization partial hip replacement closed [endoscopic] biopsy of bronchus diagnoses: thrombocytopenia, unspecified unspecified pleural effusion unspecified essential hypertension cirrhosis of liver without mention of alcohol acute posthemorrhagic anemia chronic hepatitis c with hepatic coma acute kidney failure, unspecified acquired coagulation factor deficiency unspecified protein-calorie malnutrition portal hypertension unspecified fall osteoporosis, unspecified other late effects of cerebrovascular disease other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other respiratory complications varices of other sites esophageal varices in diseases classified elsewhere, without mention of bleeding surgical or other procedure not carried out because of contraindication other malaise and fatigue hematuria, unspecified leukocytopenia, unspecified other closed transcervical fracture of neck of femur body mass index 31.0-31.9, adult 

Answer: The patient is high likely exposed to