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: penicillins / heparin agents attending: chief complaint: confusion and hypotension major surgical or invasive procedure: right internal jugular line placement and removal history of present illness: 57 m with hepatitis c cirrhosis, polysubstance abuse, history of noncompliance with appointments, presented today with confusion concerning for encephalopathy, with development of hypotension in ed this evening. patient unable to give accurate history due to encephalopathy. wife reports recent admission to osh for which he was discharged around . recent hospitalization for encephalopathy and worsening edema; diuretics were uptitrated; also treated for apparent pneumonia with levofloxacin - reportedly negative tap for sbp (also done for therapeutic purposes). wife notes that abdominal and leg swelling have worsened since discharge. also complained of chills without documented fever, mild cough, and no bowel movements x 3 days despite regular lactulose. . in the ed, noted to have leukocytosis to 12.4k with 80% neutrophils; also creatinine 1.6 (unknown baseline), hyponatremia to 126. sent for ultrasound and chest xray; upon return from studies was found to have bp 74/39 with pulse 59, dropped as low as 67/43. rij placed and levophed gtt initiated (received 1l+ ns). vanco and eventually aztreonam given (pcn allergy). ngt placed and ?lactulose given. upon arrival to floor, ngt out. past medical history: - hepatitis c cirrhosis, no known previous biopsy, has had decompensation in the past with ascites requiring therapeutic paracentesis, encephalopathy, esophageal varices s/p banding in (unknown severity of varices at that time); noted grade iii varices s/p banding in and of this year. history of elevated afp without focal lesions. no past treatments for hep c. follows with dr. . - asthma - polysubstance abuse including ivdu social history: occupation: former fisherman drugs: previous heroin addict; per wife no use since tobacco: less than ppd currently alcohol: per wife, none since other: married, 2 children in their 30s. family history: mother is living, age 80 and has a pacemaker. father is deceased, age 44 from an mi. one brother deceased, age 44 from hepatitis c and 3 sisters all living and in good health. physical exam: vitals: t96, hr 66, bp 116/86, r12, 100% on ra general appearance: well nourished, no acute distress, overweight / obese, no(t) anxious, no(t) diaphoretic eyes / conjunctiva: perrl, no(t) pupils dilated, icteric sclera head, ears, nose, throat: normocephalic, ng tube, mm slightly dry lymphatic: cervical wnl, supraclavicular wnl, no(t) cervical adenopathy cardiovascular: (s1: normal), (s2: normal), (murmur: systolic), holosystolic sm, best at lusb peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: not assessed), (left dp pulse: not assessed), distal extremities cool respiratory / chest: (expansion: symmetric), (percussion: resonant : ), (breath sounds: clear : , wheezes : rare) abdominal: soft, non-tender, bowel sounds present, distended, denies ttp, though appears to have some voluntary guarding. no rebound. difficult to asses hsm due to guarding. dependent dullness to percuss extremities: right: 3+, left: 3+ skin: not assessed, rash: bilat le, ?excoriation, jaundice neurologic: attentive, follows simple commands, responds to: verbal stimuli, oriented (to): (not year) and hospital, movement: not assessed, tone: normal, falls asleep easily pertinent results: 05:06pm glucose-155* urea n-54* creat-1.6* sodium-126* potassium-5.0 chloride-92* total co2-24 anion gap-15 05:06pm alt(sgpt)-137* ast(sgot)-130* alk phos-238* tot bili-5.4* 05:06pm lipase-65* 05:06pm albumin-2.6* iron-168* 05:06pm caltibc-179* vit b12-greater th folate-11.9 ferritin-greater th trf-138* 05:06pm ammonia-96* 05:06pm tsh-1.6 05:06pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 05:06pm wbc-12.4*# rbc-3.56* hgb-12.0* hct-35.3* mcv-99*# mch-33.6* mchc-33.9 rdw-15.2 05:06pm neuts-79.5* lymphs-12.6* monos-6.8 eos-0.9 basos-0.2 05:06pm plt smr-very low plt count-72* 05:06pm pt-17.2* ptt-37.3* inr(pt)-1.6* 08:59pm lactate-2.2* 07:10pm urine rbc-0-2 wbc-0-2 bacteria-few yeast-none epi-0-2 renal epi-0-2 07:10pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-sm urobilngn-4* ph-6.5 leuk-neg 07:10pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg marijuana-negative 07:10pm urine osmolal-539 07:10pm urine hours-random urea n-934 creat-92 sodium-38 tte (): the left atrium is mildly dilated. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened. no discrete vegetation seen (does not exclude). there is a minimally increased gradient consistent with minimal aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. trivial mitral regurgitation is seen. there is no pericardial effusion. impression: normal left ventricular cavity size with hyperdynamic systolic function. minimal aortic valve stenosis. liver ultrasound (): small amount of ascites in the right upper quadrant. the main portal vein is patent with antegrade flow. brief hospital course: 57 yo male with pmh of hep c cirrhosis admitted for hepatic encephalopathy and hypotension now with resolved encephalopathy and stable pressures. # previous episode of hypotension: patient initally had a leukocytosis, hypothermia, and hypotension which was concerning for spesis, however none of his blood cultures have been positive. he had no evidence of gib initially. his hematocrit followed as detailed below. he may also have been dry from overdiuresis given recent increase in his diuretic dosing. he was unable to have a diagnostic para due to the small amount of ascites present. he was empirically treated for sbp with ceftriaxone. his urine, blood, c.diff, cxr were negative. he was ultrasounded on multiple occasions but repeatedly with not enough fluid to safely tap for sbp evaluation. he required vasopresssors for a little over 24 hours and was then able to be weaned. regarding antibiotics, he was initially placed on vancomycin, aztreonam, and flagyl. with above negative workup, he was changed to ceftriaxone for sbp. also received 2 large doses (1.5 mg/kg on day 1 and 1 mg/kg on day 3) of albumin given presumed sbp. stress dose steroids for 2 days given recent prednisone course. he completed a 7 day course of ceftriaxone and was discharged on 250 mg of ciprofloxacin daily for sbp ppx. # anemia: the patient's hct dropped on hospital day 2 by 10 points in setting of aggressive hydration (his baseline is in the 30s). his stools were trace guaiac positive. his hct drop was likely dilutional in addition to small amounts of bleeding in the setting of hepatic coaglatopathy (trace guiaic positive stools, epistaxis, phlebotomy). he had a low haptoglobin and rising t. bili concerning for hemolysis; however these tests are difficult to interpret in liver patients and his hct remained stable after the inital drop. on discharge his hct was 27.2. # positive ua/ucx: the patient had a positive ua on (when he was on ceftriaxone). no antibiotics were added as he was already on antibiotics. the urine culture returned with mrsa. however the patient was asymptomatic, so another ua/ucx was sent and treatment was deferred. the second ua was negative and the urine culture was negative. it was thought that the inital urine culture was contaminated. # acute renal failure: the patient initally had arf with a cr of 1.6. this improved to his baseline (of 0.8 to 1.0) with ivf and resolution of his hypotension. # thrombocytopenia/? of hit: the patient was noted to have a 50% plt drop over his admission. his reported platlets at the osh were in the 70s to 90s and he was in the 40s here. he had a plt transfusion in the unit for epistaxis, but did not respond to the transfusion. dic labs were stable. likely his thrombocytopenia was due to a combination of liver disease, consumption, and possible splenomegaly. prior to his transfer out of the icu his blood was sent for hit ab test which returned positive. however, the team did no feel that he has hit because he had low probablity of hit prior to the test being sent. his plt ranged between 32 and 97 during this hospitalization and were 58 at discharge. # hepatic encephalopathy: the patient's confusion improved with lactulose since his admission. he had a history of decreased bowel movements prior to admission which is likely the precipitant to his encephalopathy. he was continued on lactulose with a goal of bowel movements per day. # hep c cirrhosis: the patient not on the list and is undergoing workup currently. he is followed by dr. . he had a history of grade iii gastric varices s/p banding multiple times (last in ). after his bp stabilized he was restarted on 40 mg of lasix and 100 mg of aldactone daily (he had previously been increased to 80 mg of lasix and 200 mg of aldactone). he was also restarted on propanolol and continued on a daily ppi. he was continued on lactulose as above. he had many labs sent as requested for his workup for liver transplantation. he will follow up at the liver center in . # asthma: the patient's asthma was stable. he was continued on his fluticasone inhaler and albuterol prn. medications on admission: lactulose 30 ml tid albuterol mdi fluticasone mdi lasix 80 mg daily (recent increase from 40 daily) spironolactone 200 mg daily (also recently increased) prednisone taper, completed yesterday propanolol 60 mg daily omeprazole 20 mg daily discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 2. propranolol 60 mg capsule,sustained action 24 hr sig: one (1) capsule,sustained action 24 hr po daily (daily). 3. spironolactone 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. fluticasone 110 mcg/actuation aerosol sig: two (2) puff inhalation (2 times a day). 6. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation every four (4) hours as needed for shortness of breath or wheezing. 7. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day): titrate to 3 to 4 bowel movements per day. 8. ciprofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours). disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary - spontaneous bacterial peritonitis hepatic encephalopathy secondary - hepatitis c cirrhosis asthma discharge condition: stable discharge instructions: you were admitted to the hosptial due to confusion, low blood pressure, and concern for infection. you were started on antibiotics for a presumbed infection in the fluid in your abdomen. your blood pressure stabilized. your confusion resolved with lactulose and was thought to be secondary to hepatic encephalopathy. your diuretics were decreased, you should take 40 mg of lasix daily and 100 mg of spironolactone daily. you were started on 250 mg of ciprofloxacin daily for spontaneous bacterial peritonitis prophylaxis. otherwise continue your outpatient medications as prescribed. call your primary doctor or go to the emergency room if you experience fevers, chills, shortness of breath, confusion, dizziness, abdominal pain, blood in your stool or dark black stool. followup instructions: an appointment was made for you to follow up with dr. : provider: clinic phone: date/time: 2:00 md procedure: venous catheterization, not elsewhere classified diagnoses: anemia, unspecified cirrhosis of liver without mention of alcohol acute kidney failure, unspecified acquired coagulation factor deficiency hyposmolality and/or hyponatremia portal hypertension asthma, unspecified type, unspecified hypotension, unspecified epistaxis spontaneous bacterial peritonitis unspecified viral hepatitis c with hepatic coma 

Answer: The patient is high likely exposed to