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: hypotension at dialysis major surgical or invasive procedure: paracentesis history of present illness: 56 year-old male with hcv cirrhosis, esrd on hd, recent hypotension in the setting of large-volume paracentesis or dialysis presenting with hypotension to 56/32 15 minutes into dialysis the day of admission. the patient states he was "a little dizzy" at the time, however, denied presyncope, chest pain, shortness of breath, palpitations. the patient also complained of the gradual onset of sharp luq pain, nonradiating, after being placed in trendelenberg. the pain resolved when taken out of trendelenberg. he denied fevers, chills, sweats, nausea, vomiting, hematemesis, change in bm/day on lactulose, melena, recent hematochezia - he had one episode of brbpr only with wiping a few weeks prior. he was given 1l ns and transferred to the ed for further evaluation. . in the ed, initial vs: t 97.8 hr 110 bp 91/53 rr 20 sao2 98%ra. blood pressure subsequently dropped to 74/45. ekg unchanged from prior. chest x-ray showed question lll pneumonia. abdominal ct showed ascites but was otherwise negative for acute pathology. the patient received 4l ns with improvement in sbp to 90-100s. a therapeutic paracentesis was attempted but unsuccessful. the patient was given zosyn. . currently, the patient has no complaints. . ros: as above. denies headache, vision changes, rhinorrhea, congestion, pharyngitis, cough, myalgias. patient is anuric. review of systems otherwise negative in detail. past medical history: 1. hepatitis c and alcoholic cirrhosis: - complicated by encephalopathy, portal htn w/ portal hypertensive gastropathy, grade i varices, and ascites requiring q2-3weekly paracentesis - followed at the for liver transplantation - also followed by dr. 2. esrd: - on hd t/th/sa - followed by dr. in 3. hypertension/hypotension - the patient had several anti-hypertensives discontinued as the patient easily becomes hypotensive with dialysis 4. history of ivdu 5. neuropathy 6. osteoarthritis 7. seizures: - patient with a history of two seizures - once in , seizure in the setting of new diagnosis of renal failure, pneumonia, and alcohol use, second seizure in with generalized tonic-clonic seizure while at hd - mri in remarkable for localized area of encephalomalacia secondary to trauma - eeg in unremarkable 8. tobacco abuse 9. type 2 diabetes mellitus: - not taking medication currently - presented with dka in - followed at social history: lives on his own. currently unemployed. smokes pack per day. history of alcohol abuse in the past, non recently. history of ivdu, none recently. family history: non-contributory physical exam: on admission- . general: alert, nad heent: normocephalic, atraumatic. no conjunctival pallor. no scleral icterus. perrla/eomi. op clear. mmm. neck: supple, no lad. cardiac: regular rhythm, normal rate. normal s1, s2. no murmurs, rubs or . lungs: ctab, good air movement biaterally. no dullness to percussion or egophony in the lll. abdomen: nabs. mildly distended, bulging flanks, shifting dullness. no tenderness to palpation. extremities: trace edema b/l, 2+ dorsalis pedis/posterior tibial pulses. skin: no rashes/lesions, ecchymoses. neuro: aaox3. cn 2-12 are intact. normal strength in all four extremities. no asterixis. pertinent results: =========== micro =========== blood culture 5/30x2 - no growth to date at time of discharge . =========== labs =========== 07:40am blood wbc-7.1 rbc-4.00* hgb-12.9* hct-39.3* mcv-98 mch-32.2* mchc-32.7 rdw-19.6* plt ct-155# 01:10am blood wbc-6.6 rbc-3.53* hgb-11.3* hct-35.0* mcv-99* mch-32.2* mchc-32.5 rdw-20.5* plt ct-71* 04:55am blood wbc-7.0 rbc-3.64* hgb-11.6* hct-36.0* mcv-99* mch-31.8 mchc-32.2 rdw-20.7* plt ct-72* 04:50am blood wbc-7.5 rbc-3.66* hgb-11.7* hct-36.2* mcv-99* mch-31.9 mchc-32.3 rdw-19.2* plt ct-78* 08:54am blood glucose-93 urean-23* creat-8.5*# na-141 k-3.1* cl-110* hco3-16* angap-18 01:10am blood glucose-92 urean-34* creat-12.9*# na-137 k-4.1 cl-99 hco3-22 angap-20 04:55am blood glucose-83 urean-48* creat-15.9*# na-142 k-4.2 cl-103 hco3-19* angap-24* 04:55am blood glucose-87 urean-30* creat-12.0*# na-144 k-3.4 cl-104 hco3-25 angap-18 04:50am blood glucose-77 urean-35* creat-13.8*# na-141 k-3.5 cl-102 hco3-22 angap-21* 08:54am blood alt-29 ast-70* alkphos-131* totbili-2.3* 01:10am blood alt-40 ast-82* alkphos-192* totbili-2.9* 04:55am blood alt-35 ast-71* alkphos-159* totbili-3.3* 04:50am blood alt-40 ast-82* alkphos-208* totbili-2.9* 08:55am blood ammonia-162* . =========== radiology =========== ruq u/s - cirrhotic liver with a moderate amount of ascites. patent portal vein. . ct abdomen and pelvis 1. nodular liver compatible with underlying cirrhosis. there is moderate ascites. 2. no evidence for bowel obstruction or bowel ischemia. there is a single non-specific loop of mildly prominent fecalized small bowel in the left lower quadrant, which demonstrates normal mucosal enhancement and no distinct transition points. 3. atrophic kidneys compatible with underlying renal disease. 4. atherosclerotic disease of the abdominal aorta with aneurysmal dilatation. . cxr pa and lateral views. comparison with . the lungs now appear clear. the heart is normal in size. mediastinal structures are otherwise unremarkable. the bony thorax is grossly intact. a possible focal area of increased density at the left base is no longer identified. impression: clear lungs. brief hospital course: # hypotension: the patient has a recent history of hypotension as an outpatient thought due to fluid shifts or aggressive fluid removal during dialysis or large-volume paracentesis. his episode on admission may be due to hypovolemia or fluid shifts. sbp was back to 90-100s, which is his baseline per hd records after 5l ns, without evidence of fluid overload. also on the differential is infection, with possible sources spontaneous bacterial peritonitis versus pneumonia. the patient remains afebrile and without leukocytosis, however. culture data remained negative. hematocrit was down from baseline, however, the patient denies gastrointestinal bleeding. weight now 102.6 kg from recorded dry weight 95 kg (recent post-hd weight 99.2 kg). patient was treated transiently with vancomycin and zosyn which were stopped after 3 days and patient remained afebrile. he was discharged without antibiotics. . # abdominal pain: resolved. unclear etiology - may be due to reversible ischemia in the setting of hypotension as positional. ct abdomen negative for acute pathology. was treated with zosyn for potential sbp, but since pain resolved this felt to be an unlikely culprit. . # metabolic acidosis: the patient has a chronic metabolic acidosis likely due to renal failure, as well as lactic acidosis with baseline lactate 2.1-2.7, likely due to liver disease. . # anemia: macrocytic. recent hematocrit mid-to-high 30s, now 30 on admission. no evidence of active bleeding. baseline anemia likely due to underlying liver and renal disease. last egd with only grade i varices. initial ed laboratories were likely laboratory error. hct was stable and patient did not require any transfusions while in house. . # hcv and etoh cirrhosis: complicated by encephalopathy, portal htn with portal hypertensive gastropathy, grade i varices, and ascites requiring q2-3 weekly paracentesis. inr was elevated from recent baseline, however, other liver function tests stable. ruq u/s was unchanged, with comparable ascites and cirrhosis. patient is on the transplant list through . # esrd: continued on hd while in house. . medications on admission: pregabalin 75 mg po daily on hd days and 50 mg daily on non-hd days lactulose 30 ml po bid paricalcitol 1 mcg iv qhd epoetin alfa 10,000 unit sc qhd b complex-vitamin c-folic acid 1 mg po daily calcium acetate 1337 mg po tid w/meals folic acid 0.8 mg po daily oxycodone 5 mg q12h:prn pain discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 2. calcium acetate 667 mg capsule sig: four (4) capsule po tid w/meals (3 times a day with meals). 3. pregabalin 75 mg capsule sig: one (1) capsule po 4x/week (,mo,we,fr). 4. pregabalin 25 mg capsule sig: two (2) capsule po 3x/week (tu,th,sa). 5. lactulose 10 gram/15 ml syrup sig: sixty (60) ml po q6h (every 6 hours): please increase or reduce dose as needed to ensure 3 bowel movements daily. 6. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 7. epoetin alfa 10,000 unit/ml solution sig: one (1) injection injection qhd. discharge disposition: home discharge diagnosis: primary: hypotension with dialysis hepatic encephalopathy . secondary: end stage liver disease hepatitis c cirrhosis end stage kidney disease on dialysis diabetes discharge condition: vitals signs stable, afebrile discharge instructions: you were admitted because of low blood pressure with dialysis. we treated you with iv fluids and antibiotics and your blood pressure improved. we also treated you for confusion thought secondary to your liver failure. your confusion improved with lacutlose. your antibiotics were stopped because your blood cultures did not reveal an infection. . please continue to follow at the for possible transplant. . if you develop any of the following, chest pain, shortness of breath, cough, fever, chills, nausea, vomiting, diarrhea, headache, confusion or dizziness, please call your primary care doctor or go to your local emergency room. yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: followup instructions: please follow up with dr. , md phone: date/time: 9:10 . please follow up with dr. , md phone: date/time: 1:25 . provider: imaging phone: date/time: 1:00 . please follow up with dr. , md phone: date/time: 10:10 . please follow up with dr. , md phone: date/time: 11:00 md procedure: percutaneous abdominal drainage diagnoses: acidosis anemia in chronic kidney disease end stage renal disease renal dialysis status diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic hepatitis c with hepatic coma alcoholic cirrhosis of liver portal hypertension hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other ascites delirium due to conditions classified elsewhere hypotension of hemodialysis 

Answer: The patient is high likely exposed to