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: aspirin attending: chief complaint: hepatic encephalopathy major surgical or invasive procedure: therapeutic paracentesis x2 picc line placement endotracheal intubation history of present illness: history obtained from medical records as patient is intubated, obtunded, will follow basic commands but is unable to answer questions mr. is a 53 y/o m with a h/o hepatitis c, prior alcohol abuse and resultant cirrhosis who was initially brought in to hospital on , after being found down at home. the morning of he was found unresponsive at home by his father, per ems report at that time his blood sugar was 180 and he was given narcan with no response. per his sister who spoke to him the night before his admission, she felt that he was at his baseline. he was then taken to , in the er there he was intubated for airway protection and initially started on propofol, he was presumed to have severe hepatic encephalopathy, with an ammonia level of 560. a head ct head done on admission was negative for any acute process, his labs were notable for a cr of 1.5, his chronic anemia and thrombocytopenia, urine tox screen was positive for marijuana only. his inr was elevated to 1.9 from 1.4, t-bili was 1.6, albumin improved from 2.0 to 3.4 after replacement. of note the day prior to admission he had undergone an 8l paracentesis with only 25g of albumin replacement. during his course at , he was started on lactulose and rifaximin to treat hepatic encephalopathy, on he put out over 4l of stool. additionally, he was noted to be oliguric for the first 48 hours at , which improved with 175g of albumin. he had an ultrasound of his abdomen with dopplers that was a significantly limited study that showed patent vessels, cirrhotic liver, but without identification of the main portal vein and hepatic veins, along with moderate ascites. a kub showed a nonspecific bowel gas pattern, multiple chest x-rays without any evidence of pneumonia, just stable airspace disease at the left base. he remained anemic and thrombocytopenic without any evidence of active bleeding. a ct of his head and c-spine did not show any acute process. after recieving lactulose, rifaximin and albumin his mental status had mildly improved on transfer so that he was opening his eyes and moving extremities. he remained hemodynamically stable, with sbp's in the 110's-120's, and was on a t-piece for the last 24 hours, with a weak gag. he has a rij and piv's for access. currently, the etiology of his obtundation is thought to be hepatic encephalopathy and has had prior episodes of decompensation with noncompliance with his lactulose, which his family does admit happens fairly often. on arrival to the micu, his initial vs were: 99.8, 72, 163/44, 14, 100% on psv 5/5, 40% fio2. he is currently intubated . review of systems: unable to obtain as patient is obtunded past medical history: 1. diabetes. of note, his blood sugars are more controlled now on the same oral antidiabetic agents. 2. anemia. 3. hepatitis c cirrhosis complicated by grade 1 varices 4. history of alcohol abuse. 5. psoriasis. 6. barrett's esophagus social history: the patient lives with his 82-year-old father. is single and has no kids. his sister, , and his brother both live close by within a mile from his house. he also has a visiting nurse at home now which visits him once a week. he has history of tattoos and remote history of drug use; however, he denies any iv drug use. he also was a heavy alcohol drinker in the past; however, quit 20 years ago and has been sober since. he also quit smoking 20 years ago. states that by his old gi doctor he was given the permission for the use of medical marijuana and he grows marijuana at home, which he uses for his constant nausea. his nausea is worse when his ascites is large. . family history: negative for colon cancer, liver cancer. his grandfather has history of alcoholic-induced cirrhosis. . physical exam: pex on admission: general appearance: well nourished, initially wheezing and working to breath, improved post bronchodilator eyes / conjunctiva: perrl head, ears, nose, throat: og tube cardiovascular: rrr, +s1/s2 peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: wheezes and coarse throughout abdominal: soft, bowel sounds present, distended, site of prior para leaking ascitic fluid with bag for collection in place extremities: right lower extremity edema: 2+, left lower extremity edema: 2+, areas of ecchymoses on the anterior shin skin: warm neurologic: responds to: verbal stimuli, movement: purposeful, tone: normal pex on discharge: vitals: 98.4 117/56 69 18 99%ra general: a+ox3, improved but slow speech lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non tender, distended, + bowel sounds, no rebound tenderness or guarding, increased ascites (not tense), +umbilical hernia. ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cn ii-xii grossly intact pertinent results: labs on admission: 10:30pm blood wbc-5.8 rbc-2.58* hgb-8.2* hct-26.6* mcv-103* mch-31.6 mchc-30.7* rdw-16.7* plt ct-79* 10:30pm blood pt-20.3* ptt-57.8* inr(pt)-1.9* 10:30pm blood glucose-116* urean-45* creat-1.5* na-150* k-3.9 cl-126* hco3-16* angap-12 10:30pm blood alt-42* ast-53* alkphos-40 totbili-1.7* 10:30pm blood calcium-8.3* phos-3.0 mg-2.2 cholest-50 10:30pm blood triglyc-63 hdl-9 chol/hd-5.6 ldlcalc-28 12:08pm blood ammonia-40 04:32am blood iga-535* 04:07am blood vanco-7.1* 10:30pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 03:43pm blood type-art po2-122* pco2-27* ph-7.47* caltco2-20* base xs--1 intubat-not intuba 03:43pm blood hgb-7.6* calchct-23 o2 sat-99 10:30pm urine color-dkamb appear-cloudy sp -1.019 10:30pm urine blood-lg nitrite-neg protein-100 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.5 leuks-lg 10:30pm urine rbc->182* wbc->182* bacteri-few yeast-none epi-0 01:11pm urine casthy-4* 10:30pm urine mucous-occ 10:30pm urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg ascites fluid: 10:50am ascites wbc-8* rbc-3* polys-0 lymphs-0 monos-0 10:50am ascites totpro-0.7 albumin-less than 03:42pm ascites wbc-165* rbc-120* polys-3* lymphs-9* monos-6* mesothe-14* macroph-68* 03:42pm ascites totpro-1.9 ld(ldh)-79 albumin-less than micro: urine culture-negative bld cx negative x2 peritoneal fluid cx - negative blood cx negative hcv viral load- blood cx - negative x2 stool c. difficile negative urine culture (final ): staph aureus coag +. >100,000 organisms/ml.. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s nitrofurantoin-------- <=16 s oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s mrsa screen neg 10:30 pm blood culture source: line-central. **final report ** blood culture, routine (final ): viridans streptococci. isolated from only one set in the previous five days. sensitivity requested by dr. 9-0917. final sensitivities. sensitivity testing performed by sensititre. clindamycin <= 0.12 mcg/ml. sensitivities: mic expressed in mcg/ml _________________________________________________________ viridans streptococci | clindamycin----------- s erythromycin---------- 2 r penicillin g----------<=0.06 s vancomycin------------ <=1 s anaerobic bottle gram stain (final ): reported to and read back by @1715 on - . gram positive cocci. in chains. labs on discharge: 04:23am blood wbc-4.0 rbc-2.32* hgb-7.0* hct-22.7* mcv-98 mch-30.1 mchc-30.8* rdw-17.2* plt ct-74* 04:07am blood neuts-62.9 lymphs-27.3 monos-6.1 eos-3.3 baso-0.4 04:23am blood pt-18.0* ptt-48.4* inr(pt)-1.7* 04:23am blood glucose-204* urean-39* creat-1.3* na-137 k-3.8 cl-108 hco3-20* angap-13 04:23am blood alt-8 ast-51* ld(ldh)-219 alkphos-51 totbili-0.5 04:23am blood albumin-2.5* calcium-7.8* phos-3.0 mg-2.0 imaging: ekg: sinus rhythm. borderline low limb lead voltage. t wave inversions in leads v1-v2 may be related to lead position. no previous tracing available for comparison. clinical correlation is suggested. us: 1. nodular hepatic architecture with no focal liver lesion identified. no biliary dilatation is seen. 2. patent hepatic vasculature. 3. splenomegaly. 4. ascites. cxr: since prior radiograph, endotracheal tube, orogastric tube, and right internal jugular lines have been removed. pulmonary vascular congestion has significantly improved. bibasilar atelectasis is present. there are no lung opacities concerning for pneumonia or aspiration. mild enlarged heart size is stable. mediastinal and hilar contours are unremarkable. there is no pleural effusion. echo: the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). there is a mild resting left ventricular outflow tract obstruction. right ventricular chamber size and free wall motion are normal. the aortic arch is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: no valvular vegetations or abscesses apprecitated. normal left ventricular cavity size with mild symmetric left ventricular hypertrophy and preserved global and regional biventricular systolic function. mild resting lvot obstruction. mildly dilated aortic arch. mild aortic regurgitation. indeterminate pulmonary artery systolic pressure. rpt us: normal renal ultrasound. ascites. pfts: , m 53 pulmonary report spirometry, lung volumes, dlco study date of 2:40 pm spirometry 2:40 pm pre drug post drug actual pred %pred actual %pred %chg fvc 4.08 4.43 92 fev1 3.32 3.25 102 mmf 3.35 3.30 102 fev1/fvc 81 73 111 lung volumes 2:40 pm pre drug post drug actual pred %pred actual %pred tlc 6.30 6.52 97 frc 3.72 3.62 103 rv 1.82 2.08 87 vc 4.50 4.43 102 ic 2.59 2.90 89 erv 1.90 1.54 123 rv/tlc 29 32 90 he mix time 3.38 dlco 2:40 pm actual pred %pred dsb 16.44 27.42 60 va(sb) 5.86 6.52 90 hb 7.00 dsb(hb) 23.79 27.42 87 dl/va 4.06 4.21 96 brief hospital course: mr. is a 53 y/o m with a history of hcv/etoh cirrhosis, history of hepatic encephalopathy who was found down at home, admitted to an osh where he was intubated for airway protection, altered mental status from presumed hepatic encephalopathy, who has had some improvement after 1 day of lactulose and rifaximin therapy. patient found to have 1 bottle from growing strep viridans that was empirically treated with cefazolin for 2 wk course. . #) altered mental status: patient was found down at home, no evidence of ingestion as a cause, no obvious ingestion, no evidence of active infection initially. he was started on aggressive treatment of hepatic encephalopathy with lactulose and rifaximin. head ct on admission at the osh was negative, no evidence of gib or sbp. abd u/s excluded portal vein thrombosis. patient's mental status improved on treatment for hepatic encephaloapthy. it was discovered that patient had been unable to afford rifaximin due to insurance reasons and family members had mentioned that he may have been non-compliant with lactulose. medications were authorized and patient was able to get them as outpatient. # gpc bacteremia: patient had grwoth of bottles of gpcs from his blood. he was started empirically on vancomycin and switched to cefazolin for 2 wk course. tte was negative for endocarditis and surveillance bld cxs were all ngtd. perhaps could have been from intubation as patient did not have any oral procedures recently. no s/s of endocarditis. afebrile during admission. patient had picc placed and completed course at home. #) respiratory failure: intubated at the osh for airway protection, mental status appears to be slowly improving. he was quickly extubated without complication. . #) hcv/etoh cirrhosis: there was no evidence of decompensation during this admissin. patient completed tranplant workup. he was continued on home lasix, spironolactone, and nadolol. patient also had a couple of paracentesis for worsening ascites. #) diabetes: pt maintained on iss while hosptialized. medications on admission: -procrit 20,000 units per week -lasix 80 mg a day, -glimepiride 1 mg a day, -lactulose titrated to bm's per day -nadolol 40 mg a day -zofran 4 mg p.r.n. -protonix 40 mg daily -rifaximin which was not started -spironolactone 100 mg a day discharge medications: 1. cefazolin 1 gram recon soln sig: two (2) grams intravenous every eight (8) hours for 15 doses. disp:*30 grams* refills:*0* 2. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po qid (4 times a day). 3. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). 4. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 6. nadolol 20 mg tablet sig: two (2) tablet po daily (daily). 7. multivitamin tablet sig: one (1) tablet po daily (daily). 8. spironolactone 100 mg tablet sig: one (1) tablet po daily (daily). 9. glimepiride 1 mg tablet sig: one (1) tablet po once a day. 10. procrit 20,000 unit/ml solution sig: one (1) injection injection once a week. 11. outpatient antibiotic infusion pump for home iv antibiotics discharge disposition: home with service facility: discharge diagnosis: primary: hepatic encephalopathy strep viridans bacetermia secondary: hcv cirrhosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , you were admitted to the because of confusion due to hepatic encephalopathy. due to this you were initially intubated and requiried a breathing machine but after treatment you quickly improved and were extubated. during your admission we found that you had bacteria growing in your blood and started you on an antibiotic called cefazolin. your condition continued to improve and your returned to baseline. you will need to continue this antibiotic to complete a 14 day course which will finish on . for this reason you had a long term iv placed on your arm. medication changes: start: rifaxamin 550 mg twice a day start: cefazolin 2 g every 8 hours via provided pump until no other changes were made to your medications. it was a pleasure taking care of you. followup instructions: please keep the appointments below: department: nuclear medicine when: friday at 10:15 am with: nuclear medicine west building: cc campus: west best parking: garage department: transplant social work when: friday at 11:00 am with: , licsw building: lm bldg () campus: west best parking: garage department: nuclear medicine when: friday at 1:15 pm with: nuclear medicine west building: cc campus: west best parking: garage name: , j. location: hospital address: apc 5, , phone: appt: at 2:15pm department: transplant when: thursday at 10:00 am with: transplant fellow & building: lm bldg () campus: west best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage central venous catheter placement with guidance diagnoses: acidosis thrombocytopenia, unspecified anemia, unspecified urinary tract infection, site not specified chronic hepatitis c with hepatic coma alcoholic cirrhosis of liver personal history of tobacco use chronic kidney disease, unspecified acute respiratory failure bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site nausea alone other ascites personal history of noncompliance with medical treatment, presenting hazards to health hyperosmolality and/or hypernatremia streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus other psoriasis barrett's esophagus electrolyte and fluid disorders not elsewhere classified personal history of alcoholism mixed acid-base balance disorder other specified disorders of liver cannabis abuse, unspecified 

Answer: The patient is high likely exposed to