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: history of present illness: the patient is a 66-year-old male with history of copd and alcoholic hepatitis, recently discharged from the hospital on with diagnosis of alcoholic hepatitis, who was found with complaints of shortness of breath and change in mental status x1 day. the patient noted to be warm and jaundiced. per records during admission, the patient was admitted for jaundice with a bilirubin peak of 38.8, which was down to 21.9 when he signed himself out against medical advice. during his admission at the va, he developed a non-oliguric acute renal failure with a discharge creatinine of 1.8. the patient initially admitted to an outside hospital where he was found to be afebrile with a blood pressure of 143/70 with a respiratory rate of 36, sating a 100 percent on 10 liters nonrebreather. he was intubated for unclear reason, suspect for protection in the context of poor mental status. on arrival to er, he received ceftriaxone, flagyl, lactulose and folate. past medical history: copd. history of alcohol abuse. alcoholic hepatitis. history of hepatic encephalopathy. medications: 1. thiamine. 2. albuterol. 3. aspirin. 4. flovent. 5. propranolol 10 mg p.o. t.i.d. 6. salmeterol. 7. pentoxifylline 400 mg p.o. t.i.d. with meals. 8. folate. 9. lasix 20 mg p.o. q.d. 10. cholestyramine. 11. lactulose. 12. omeprazole. 13. spironolactone 100 mg p.o. q.d. 14. compazine p.r.n. allergies: no known drug allergies. family history: noncontributory. social history: positive alcohol with history of binging. the patient lives with his girlfriend, planning to move to the after he closes on his house. physical examination: temperature 99.4 degrees, blood pressure 119/47, and heart rate of 67. the patient is on ac 500/16 with an fio2 of 50 percent, peep of 5 with peak pressure of 30 and plateau of 19. in general, he is intubated, sedated and paralyzed. heent: pupils equally round and reactive to light and accommodation. dry mucous membranes. neck: no jvd or lad. cardiovascular: regular rate and rhythm. no murmurs, rubs or gallops. pulmonary: clear to auscultation bilaterally. abdomen: decreased bowel sounds, soft, but distended with a fluid wave. positive palpable liver edge, no splenomegaly. extremities: no clubbing, cyanosis or edema. neurologic: no tone. paralyzed and sedated. skin: spider angiomas on face and ears, jaundiced, warm and dry. laboratory and diagnostic data: on admission, white count 20.3, hematocrit 35.7 down from a prior 38, platelets of 127, inr 1.6 with a ptt of 35.1. lactate 2.9, tylenol 5.2, serum aspirin, alcohol, benzodiazepine, barbiturate and tricyclics negative. ua: negative nitrite and leukocyte esterase, 0-2 white blood cells, no bacteria. chemistry is notable for potassium of 5.6, creatinine of 2.1, alt of 58, ast of 117, total bilirubin of 17.4 down from 21.9 when he signed himself out ama from the va. liver and gallbladder ultrasound: coarse and nodular liver consistent with cirrhosis. no ductal dilatation. portal vein patent. slightly thickened gallbladder wall. moderate to large amount of ascites. ct of the head without contrast: no shift or intracranial bleed. sinuses are clear. chest x-ray: et tube 4 cm above the carina, ng tube in place, 1-cm nodule in the right mid lung zone, bibasilar atelectasis. hospital course: this is a 66-year-old male with history of copd and alcoholic hepatitis, who recently signed himself out against medical advice from the hospital following an admission for acute alcoholic hepatitis with a peak bilirubin of 38.8, re-presented to an outside hospital with complaints of shortness of breath and delta ms, transferred here for continued care. acute alcoholic hepatitis: the patient presents with delta ms likely due to hepatic encephalopathy. thus he was continued on lactulose. his lasix, spironolactone and propranolol were held due to hypotension and hyperkalemia. the patient's liver function worsened over the course of this admission and likely was the underlying cause of his demise. alcohol abuse: the patient presents with history of heavy alcohol use. however, he had been abstinent for days while hospitalized at the va. he has no history of dts per his children. he was continued on thiamine and folate and showed no evidence of withdrawal. respiratory failure: the patient intubated at an outside hospital for unclear reasons; i suspect secondary to delta ms protection. however, the patient tachypneic and thus may have been compensating for a metabolic acidosis due to possible excessive lactate. initial abg consistent with a persistent respiratory acidosis, thus his ventilator settings were manipulated overnight to improve ventilation and his ph subsequently responded. he was maintained on scheduled nebulizers and initially started on 120 mg solu-medrol t.i.d. this was gradually tapered over the course of this admission. his admission was complicated by episode during which he bit his tube and required reintubation, during which he had vomiting and likely aspiration. he also self-extubated himself during the course of admission, again requiring reintubation. he was noted to have ongoing paradoxical breathing, likely due to his abdominal hypertension. large volume paracentesis did not improve his respiratory mechanics. in addition, lasix diuresis caused elevation of the creatinine and thus was not tolerated. thought was with renal recovery his bicarbonate would increase again permitting extubation. however, no interventions during the course of admission permitted extubation from the ventilator. acute renal failure: the patient presented with a creatinine of 2.1 up from his discharge creatinine from the hospital of 1.8. initial concern for prerenal failure due to hypovolemia in the setting of hypotension, however, as his urine output improved with fluid resuscitation and pressor support; however, his creatinine again later in the course of his hospital stay began to rise. his bladder pressure at that time was noted to be 23, a large volume paracentesis failed to result in a improvement in his creatinine and thus he was started on midodrine and octreotide for likely hepatorenal syndrome. his urine output subsequently improved with hope for renal recovery. as volume became an issue, lasix diuresis was attempted; however, his creatinine bumped in response to this and no further lasix was attempted. he ultimately required hemodialysis for an increasing metabolic acidosis. his worsening renal failure was attributed to likely a dense atn in the setting of his hypotension requiring pressor support. sepsis: the patient initially started on ceftriaxone and flagyl for concern for sbp versus aspiration pneumonia. his initial paracentesis was not consistent with sbp and his chest x-ray remained negative for infiltrate. nevertheless, he was continued on levofloxacin for a presumed pneumonia. blood cultures remained negative until later in his hospital admission following successful wean off of his initial pressors including dopamine and vasopressin, at which time, his blood cultures became positive for vancomycin-resistant enterococcus. of note, an initial stim test was done to rule out adrenal insufficiency and stimulated appropriately to 33.2. also, likely underlying his hypertension is systemic vasodilation secondary to hepatic disease. nevertheless, as stated above, following wean off of dopamine and vasopressin, the patient again became hypotensive. blood, urine and sputum cultures were sent. he was restarted on levophed as blood and urine subsequently grew out vancomycin-resistant enterococcus. he was thus continued on linezolid and ceptaz for a possible sbp and flagyl for a possible clostridium difficile in the setting of ongoing diarrhea. despite line changes and continued antibiotic support, the patient subsequently became fungemic. he was started on caspofungin. ct of the abdomen was negative for perforation and ercp was negative for cholangitis. his fungemia was likely secondary to severe immunocompromise due to his ongoing vre sepsis. on the day of his death, the patient's map decreased into the 40s. i was discussed with the patient's girlfriend regarding the futility of further fluid boluses or manipulation of his pressors. thus all pressors were discontinued; 15 minutes later, the patient agreed to follow up with extubation. the patient passed approximately 30 minutes following extubation. altered mental status: the patient's altered mental status was likely due to hepatic encephalopathy. he was continued on lactulose with minimal improvement. paracentesis was done to rule out sbp and remained negative. steroid-induced hyperglycemia: the patient continued on a regular sliding scale insulin for blood sugar control. elevated bilirubin and alkaline phosphatase: during the course of the patient's admission, his bilirubin and alkaline phosphatase increased concerning for obstructive-like picture. ultrasound negative for portal vein thrombosis or common bile duct dilation. likely these laboratory abnormalities are secondary to severe sepsis. right retroperitoneal psoas bleed: this issue developed following a right femoral line. the patient received ddavp, cryo and ffp to alleviate bleeding. on subsequent cts, this bleed was noted to be stable. fen: the patient started on tube feeds on . he received kayexalate for hyperkalemia and was started on renagel for hyperphosphatemia. he required frequent free water boluses for hyponatremia. as stated above, the patient's blood pressure dropped into the 40s despite pressor support. discussion with family resulted in decision to discontinue all pressors followed by extubation. the patient was pronounced dead at 12:30 p.m. on . dr., 12-aew dictated by: medquist36 d: 20:04:54 t: 04:46:51 job#: procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis arterial catheterization transfusion of packed cells endoscopic retrograde cholangiopancreatography [ercp] injection or infusion of oxazolidinone class of antibiotics diagnoses: alcoholic cirrhosis of liver acute kidney failure, unspecified severe sepsis acute respiratory failure septic shock other septicemia due to gram-negative organisms hepatic encephalopathy other and unspecified alcohol dependence, continuous 

Answer: The patient is high likely exposed to