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: patient was a 61 year-old male with a history of alcohol related cirrhosis of the liver. patient with long standing history of alcohol consumption to the point that where he would pass out presented for transplantation. he quit drinking 6 years ago. starting in the patient had bleeding from esophageal varices for which he was status post banding multiple times most recently in . patient also had a history of hepatic encephalopathy with the first episode in . the patient has had 6 or so events during which he became confused and near comatose was admitted to the hospital and later discharged with complete resolution of symptoms. patient noted these episodes usually occurred after consuming high protein intake. patient was also status post paracentesis x 3 in the past 6 months each one removing large volumes of 3 to 5 liters respectively with last tap earlier in the month. patient denied recent hematemesis, variceal bleed, no blood in his stools, no abdominal pain, no shortness of breath, no chest pain, no nausea, vomiting, fever, chills, headache or dizziness. no blood or difficulty with urination. no history of bleeding problems or coagulopathy. patient started the transplant with process back in . no history of hepatitis or iv drug use. never experienced withdraw symptoms. past medical history: iddm since status post cardiac stent placement approximately 6 months ago. past surgical history: cholecystectomy in . in the spring of he had an lih repair, status post cardiac stent replacement. medications at home: lasix, insulin, aldactone, prilosec and inderal. allergies: no known drug allergies. no environmental allergies noted. patient became heparin induced antibodies. the patient is now allergic to heparin. social history: patient lives alone in that has 1 set of stairs for him to climb. no alcohol in 6 years. one pack of cigarettes per week x 10 years. no iv drugs or recreational drugs. he has a helpful significant other. she was present postoperatively. family history: noncontributory. review of systems: on admission the patient was able to walk several blocks with some shortness of breath. vital signs were 97.4, 63, 122/58, 16, 100% on room air. his weight was 77.4 kilos. he was a well developed, well nourished and in no acute distress, resting comfortably. heent pupils equal, round, reactive to light and accommodation. eoms intact. mcat. lungs clear to auscultation. no wheezes, rhonchi appreciated. cardiac regular rate and rhythm. normal s1, s2. no murmurs, regurg or gallop. no jvd appreciated. abdomen was soft, distended, tender to deep palpation right upper quadrant. bowel sounds positive. no spider angiomatas. no caput medusae were noted on extremities. pulses were 2+. no cyanosis, clubbing or edema. capillary refill was approximately 2 seconds. no asterixis. laboratories on admission: he had white count of 2.6, crit of 28.4 and platelets of 30. sodium 135, potassium 4.3, chloride 100, bicarb 28, bun 34, creatinine 2 and glucose of 213. ast 33, alt 201, alkaline phosphatase 178 and t bili 3.6. coags 15.3, 34.4 and 1.5. an ekg was normal. hemoglobin a1c was 5.5 back in . hospital course: patient was taken to the or on for piggy back liver transplant. surgeons were drs. and . assistants dr. and . anesthesia was general anesthesia. ebl was 4 liters. fluids in were 10 liters of crystalloid, 750 of albumin, 10 units of packed red blood cells, 6 units of platelets, 4 units of ffp and 1 unit of cryo. urine output was 1450. there were no complications. patient was transferred to the cicu and intubated, sedated. he had a jp, a foley an ng tube. he was npo. immunosuppression was started intraop with solu-medrol and cellcept and he also had a foley postoperatively. in the cicu he did well. vital signs were stable. hematocrit was initially 29.8. he did receive on postop day one 1 unit of packed red blood cells, 2 units of ffp and 6 units of platelets for platelets count of 68, white count of 5.2 and a crit of 28.1. creatinine increased to 2.1 on hospital day 1. jp medial put out 330 cc and lateral 1025 cc. lfts trended down on postop day 1 with an ast of 167, an alt of 179 and alk phos of 8.1 with a total bili of 1.2 down from 5.8. an ultrasound was done on postop day 1. ultrasound of the liver on postop day 1 demonstrated abnormal weight form in the main and right hepatic artery with no diastolic flow to inverted diastolic flow. a single tracing of the left hepatic artery demonstrated normal flow within that vessel. the portal vein and branches as well as the hepatic veins demonstrated normal flow. flow was also seen within the conduit. a duplex was again repeated on postop day 2 and again the conclusion was that the hepatic and portal veins were patent. the arterial assessment was suboptimal, but there was arterial flow in the main hepatic artery towards the bifurcation. the transplanted liver was normal in size. the left common, middle and right hepatic veins were patent with normal directional flow and spectral doppler wave form. main portal vein right and left portal veins were patent. the arterial assessment was a bit more difficult. arterial spectral signal demonstrated within the main hepatic artery with good systolic upstroke, arterial flow toward the origin of the right hepatic artery was demonstrable, but definite intrahepatic right or left segmental arterial flow was not demonstrated on that study. lfts continued to trend down with a total bili of 0.6 on postop day 7 and an ast of 40, alt of 115 and alk phos of 113. creatinine preoperatively was 1.5. this slowly increased to a high of 3.5 on postop day 8. nephrology was consulted. medications were adjusted slightly to accommodate this. a renal ultrasound was done that demonstrated slightly echogenic appearing right kidney, which was smaller then the left kidney that likely represented renal parenchymal disease. the arterial and venous flow on both kidneys was present. there was a moderate amount of free fluid seen within the lower abdomen. the patient was in the cicu initially. he did well there. he was weaned from the ventilator. he continued on his immunosuppression of solu-medrol taper, cellcept 1 gram b.i.d. and he was started on prograf on postop day 1. he was extubated on postop day 1. vital signs were stable. he continued to be afebrile throughout this hospital course. on postop day 3 he underwent an angio in the cath lab. on postop day 3 he underwent placement of stents into stent the celiac stenosis. he did well throughout that procedure. vital signs remained stable. post crit was 28.6. it was recommended that he be maintained on plavix 75 mg daily for 9 months. on postop day 3 his central line was down graded to a triple lumen central line. he did receive iv lasix for diuresis as his weight was elevated. his ng tube was removed on postop day 3. he remained on an insulin drip per protocol as he was on solu-medrol for immunosuppression. on postop day 4 he was transferred to the medical surgical unit where he remains on his immunosuppression of cellcept, prednisone and prograf. foley continued to drain urine in the range of 600 cc up to as high as 2600 with iv lasix. he was again transfused with a 1 unit of packed red blood cells on postop day 6 for hematocrit of 26 as well as 1 bag of platelets for a platelet count of 35. heparin induced thrombocytopenia antibody was checked and this was negative. a repeat duplex on the 21, there was interval development of mild diastolic flow in the right hepatic artery, resistive indicis in the main and right hepatic artery remained slightly elevated. there was equivocal appearance of wave forms and diastolic flow within the main and left hepatic arteries. all portal vessels and hepatic veins were patent with appropriate wave forms. this ultrasound was done postop angio with stent placement. chest x-ray on demonstrated no cardiopulmonary process. patient was transferred to medical surgical unit on with blood pressure 150/68, heart rate of 60 and respiratory rate of 20, 96% on room air. he was alert and oriented. breath sounds were decreased at the bases. he had a productive cough, raising some white secretions. he was encouraged to use his incentive spirometer. he was turned and encouraged to cough and deep breath. his abdomen appeared distended with positive bowel sounds. he was passing flatus. his abdominal dressing was intact. jp continued to drain serosanguineous fluid and he did have bilateral lower extremity edema. he did receive another unit of packed red blood cells followed by 48 mg of iv lasix post transfusion for hematocrit of 26. foley continued to drain clear yellow urine. he was insisted to get out of bed and he did quite well with that. post transfusion hematocrit was 29.1. a renal consult was obtained was obtained for rise in creatinine post liver transplant with his baseline creatinine of 1.6 to 2.0. renal recommendations were doing a renal ultrasound, sending urine for a sodium creatinine urea, nitrogen, protein, eosinophils and serum eosinophils. recommendations were to avoid nephrotoxic medications and with the consideration to switch prograf to rapamycin when appropriate. possible etiologies for atn were hypotension during surgery and nephrotoxic medications such as prograf. bactrim was maintained at every day. valcyte was adjusted to be given 450 mg po every other day. prograf levels reached a high of 13.2 on postop day 10. he was maintained on 3 mg twice a day of prograf and the range for prograf levels were 10.7 to a low of 7.5 on hospital day 15. he continued on 20 mg of prednisone and cellcept 1 gram b.i.d. physical therapy was consulted for weakness and decreased endurance. they recommended continued physical therapy for strengthening, safety and balance. a protein to creatinine ratio was done this revealed a value of 0.3. urine eosinophils were negative and a fena was 4 on lasix, therefore not applicable. patient continued to be maintained on lasix 40 mg po b.i.d. for diuresis. his weight continued to be elevated. preop weight was 80.3 and he went up as high as 82.6 on hospital day 4. this trended down to a low of 73.4 on postop day 14. he was seen by the physician for management of insulin and glucose as he had some blood sugars in the 200 range. his insulin was adjusted. toward the end of his hospital course his blood sugars were actually lower and he actually experienced hypoglycemia on 2 successive afternoons. his glargine was decreased as well as his sliding scale humalog insulin. foley was removed. he initially was able to void, but then developed some problems with incomplete emptying with some post void residuals of 415 cc of urine. a foley was replaced temporarily for half a day and then the foley was removed again. he was able to void on his own independently. again did demonstrate some post void residual in the 400 range. again he was recatheterized on for incomplete voiding. the foley was removed the next day and he was able to urinate independently for the remainder of the hospital course. on hospital day 10 his incision continued to drain large amounts of ascitic fluid. bulky dressing was applied. at that time he was receiving percocet for pain medication and tolerating this. due to a persistent leaking of ascitic fluid through the incision a wound vac was placed with drainage by suction. the wound vac drained a total of initially 325 cc for 1 day and then on the second day of placement it drained 70 cc. on hospital day 14 he complained of loose stool x 7. a c diff was sent off and at this time is pending. due to persistent thrombocytopenia hip antibody was sent off. this subsequently returned positive on the 22nd. the patient was not on heparin at that time and a sign was placed above the head for no heparin to be administered. his central line was changed over to a peripheral iv on postop day 11. he continued to diurese with significant decrease in edema in his extremities. on postop day 15 patient was stable, afebrile. blood pressure controlled with a high of 142/71 and a low of 120/100. po intake of 1660. urine output of 1415 with a white blood cell count of 5.7, hematocrit of 30.3, platelet count of 75 with a creatinine of 2.7. ast was 16. alt 30. alk phos 134, total bili 0.3, albumin 3.3. he remained on cellcept 1 gram b.i.d., prednisone 20 mg every day and prograf 3 mg po b.i.d. plan was to discharge patient on to skilled nursing facility for physical therapy to continue to work with the patient to increase endurance and balance. medications on discharge: albuterol nebs 0.83% neb 1 neb ih every 4 hours prn, anzemet 12.5 mg iv prn every 8 hours, colace 100 mg po b.i.d. to be held if stool output greater then 2 bowel movements per day, fluconazole 200 mg po every 24 hours, lasix 40 mg po b.i.d., insulin sliding scale and fixed dose of insulin. insulin 70/30 20 units in the morning, 12 units at lunch and 17 units at bedtime of 70/30. he also maintained insulin sliding scale of humalog starting at 161 to 200 mg per dl 2 units to be administered at that time. please see discharge medications. metoprolol 12.5 mg po b.i.d., cellcept mg po four times a day, percocet 1 to 2 tabs po prn every 4 to 6, protonix 40 mg po every 24 hours, prednisone 20 mg po every day, phenergan 12.5 mg prn every 6 hours iv, sevelamer 1200 mg po t.i.d., bactrim single strength monday, wednesday and friday, tamsulosin 0.4 mg po at bedtime. prograf 3 mg po b.i.d., valcyte 450 mg po every other day. plan: plan is for discharge to and rehab center with physical therapy with follow up appointment with dr. on at 10:20. discharge diagnoses: laennec cirrhosis status post piggy back liver transplant on . history of renal insufficiency. heparin antibody positive. history of insulin dependent diabetes mellitus since . cardiac stent placement approximately 6 months prior to admission. past surgical history as previously stated. patient in stable condition. , md, phd procedure: angioplasty of other non-coronary vessel(s) other transplant of liver arteriography of other intra-abdominal arteries insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) other operations on lacrimal gland transplant from cadaver diagnoses: thrombocytopenia, unspecified alcoholic cirrhosis of liver acute kidney failure, unspecified coronary atherosclerosis of unspecified type of vessel, native or graft percutaneous transluminal coronary angioplasty status esophageal varices in diseases classified elsewhere, without mention of bleeding urinary complications, not elsewhere classified diabetes mellitus without mention of complication, type i [juvenile type], not stated as uncontrolled portal vein thrombosis celiac artery compression syndrome 

Answer: The patient is high likely exposed to