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: this is a 49-year-old male with a history of hepatitis c and alcoholic cirrhosis also with a history of transjugular intrahepatic portosystemic shunt done in secondary to variceal bleeding who presents with bright red blood per rectum times two episodes that "filled the toilet." patient reports lightheadedness as well. the blood is mixed with brown stool. patient complains of having constipation for the previous two days and thus leading to increased straining, which then resulted in the bloody stool. in the emergency department the patient was hemodynamically stable with a blood pressure of 108/56, pulse 91, hematocrit 28, and inr of 2.3. his baseline hematocrit is around 33 and then three hours later his hematocrit dropped to 25. in addition, he had recurrent episodes of bright red blood per rectum while in the emergency department. he did not tolerate nasogastric tube placement, thus did not undergo nasogastric lavage. he was admitted to the medical intensive care unit on . his medical intensive care unit course: transfused three units of packed red blood cells and four units of fresh frozen plasma. an egd was performed as the most worrisome cause of gastrointestinal bleeding in his case would be recurrent gastric variceal bleeding. he was found to have gastropathy and esophageal varices with no active bleeding. several varices were banded. he had a right upper quadrant to evaluate tips which showed stenosis and, thus, he underwent revision of his tips on . in addition, he had alcohol-ablated varices during his tips revision. he was started on octreotide the day before the tips. past medical history: 1. child's class c cirrhosis secondary to alcohol and hepatitis c; on the transplant list. 2. hepatitis c diagnosed in . 3. multiple upper gastrointestinal bleeds secondary to varices. 4. peptic ulcer disease. 5. tips in with revision in complicated by local hepatic infarctions. 6. known hemorrhoids. 7. diabetes type 2. 8. lumbar disc herniation. home medications: 1. nph, 22 units in the morning, 22 units at night. 2. regular insulin, four units in the morning. 3. ursodiol 600 mg two times a day. 4. spironolactone 50 mg once a day. 5. protonix 40 mg two times a day. 6. lactulose one teaspoon three times a day. 7. caltrate. 8. mycelex troches, five, a day. family history: significant for his mother with diabetes and his father with alcoholic cirrhosis. he died at the age of 68. social history: he lives with his mom, is unemployed, has a history of smoking one pack per day times 20 years. has now weaned himself to a cigarette p.r.n. denies current alcohol use. has a history of marijuana use and intravenous drug use back in the '70s. physical examination upon transfer to the floor: vital signs: temperature is 100.8, heart rate ranges from 81 to 100, blood pressure 104 to 131/31 to 62, breathing 20, satting 95% on room air. fingersticks are anywhere between 110 and 120 on a regular insulin sliding scale. in general, he is in no acute distress, slightly jaundiced, answering questions appropriately. heent is positive for scleral icterus. pupils equal, round, and reactive to light. extraocular muscles are intact. clear oropharynx. internal jugular triple lumen in his right internal jugular. no lymphadenopathy in his neck. chest: he has spider angiomata. his lungs are clear to auscultation bilaterally. cardiovascular: regular rate and rhythm without murmur. abdomen: positive bowel sounds; quite distended; nontender; difficult to appreciate hepatosplenomegaly; positive fluid wave; almost a tense belly but nontender. extremities: a very slight slap; has asterixis on the left; pneumoboots in place with trace pedal edema. dorsalis pedis pulse is 2+ bilaterally. cranial nerves ii-xii intact. strength 5/5 throughout. sensation to light touch intact bilaterally. gait not tested, although later on patient is observed walking up and down the hallways and does not have difficulty. laboratory data: this patient's hematocrit nadired at 25 and was 35 upon discharge. white blood cells were within normal limits. patient consistently had low platelets in the 40s to 50s range. inr was 2.3 upon admission and went down with administration of fresh frozen plasma and one dose of vitamin k but then went back up on the day of discharge. chem-7 within normal limits and calcium 7.5 but corrected for the low albumin. phosphorous 3.3, magnesium 1.6. lfts: alt 82, ast 143, alkaline phosphatase 187, amylase 75, total bilirubin 9.4, albumin 2.0. studies: on egd: three cords of grade 2 varices on the lower esophagus, banded. portal hypertensive gastropathy. on right upper quadrant ultrasound showed ascites with left portal vein thrombosis, tips stenosis, and hepatopetal flow in the portal vein. tips revision with embolization of varices supplying the splenorenal shunt, enlarged gastric varices with absolute alcohol. there was balloon angioplasty of the tips and also a stent across the existing tips stent. pre-procedure portal hepatic gradient was 18 mm/hg; post procedure was 9 to 10 mm/hg. ekg on showed normal sinus rhythm, normal axis and intervals, no st-t wave changes or qs. no changes compared to 02/. hospitalization course: please refer to the medical intensive care unit course described above in the history of present illness. 1. bright red blood per rectum: the egd revealed portal gastropathy with no evidence of bleeding and had grade 2 esophageal varices times four with no bleeding. varices were banded. right upper quadrant ultrasound revealed narrowing of the tips, and thus patient underwent tips revision, as described above. right upper quadrant ultrasound on showed wall-to-wall flow in the tips. patient did have episodes of melena on and although no episodes of melena or bright red blood per rectum on the day of discharge and the day prior to discharge. he was kept on sucralfate and proton pump inhibitor. hematocrits were checked two times a day and were stable as of midnight the night prior to discharge through discharge. he has a colonoscopy scheduled as an outpatient on by dr. . additionally, nadolol was added on the day of discharge to decrease portal hypertension, which may have led to bleeding of the varices. it is unclear exactly what caused his bright red blood per rectum at this time. 2. anemia: patient had no significant coronary artery disease on recent exercise stress test and mibi. he was transfused for hematocrit less than 27. he was given a total of five units of packed red blood cells and four units of fresh frozen plasma. hematocrit upon discharge was 35, although this may reflect some hematoconcentration secondary to beginning diuretics on the day of discharge. 3. coagulopathy: inr of 2.3. he was transfused four units of fresh frozen plasma and given vitamin k times one at the beginning of his hospitalization course. his goal inr was 1.1 to 1.2 while bleeding. 4. ascites: spironolactone was held until his hematocrit was stable. the patient did spike a temperature to 101.7 at midnight on . blood and urine cultures were sent, and a chest x-ray was done, and a paracentesis was performed on by ultrasound which showed 100 red blood cells. this patient never displayed any mental status changes or abdominal pain with the spike in his fever to suggest spontaneous bacterial peritonitis. cultures at the time of discharge include no growth seen on fluid culture of the peritoneal fluid. blood cultures were pending at the time of discharge. urine culture showed mixed bacterial flora consistent with scant anterogenital contamination. he was started on nadolol, aldactone, and lasix on the day of discharge. 5. cirrhosis: patient is on the transplant list and was continued on his lactulose and clotrimazole troches. 6. fluid, electrolytes, nutrition: he was transitioned to a soft solids diet, diet, low salt. his electrolytes were followed closely. he was seen by nutrition, which recommended no supplements as of right now as his weight has been unchanged over the past two months. patient was educated on dietary issue. 7. diabetes: he was maintained on a regular insulin sliding scale with two fingersticks while in house. he was informed not to go back to his regular outpatient regimen of insulin as it may be too much as it may lead to hypoglycemia. he has a good understanding of diabetes and his diabetic regimen and is followed at , and he checks his fingersticks four times a day at home. 8. lines: the patient had a right internal jugular triple lumen which was needed for his tips revision and pulled on . good hemostasis was obtained, and the tips was sent for culture, which is pending at the time of discharge. discharge diagnoses: 1. gastrointestinal bleed. 2. esophageal varices. 3. hepatitis c. 4. alcoholic cirrhosis. 5. ascites. 6. diabetes mellitus. discharge instructions: 1. he should check in with the transplant coordinator on monday, . 2. he should have labs drawn on monday, , a cbc, inr, lfts, chem-7, and fax those to . 3. colonoscopy by dr. on at 10:30 a.m. 4. on at 2 p.m. 5. primary care physician with dr. on friday, , at 1:30 p.m., , sixth floor. 6. otorhinolaryngology appointment with dr. on at 8:45 a.m. 7. dr. ................... at the diabetes center on at 2:30 p.m. discharge condition: improved. disposition: to home. discharge medications: 1. lactulose 10 grams/15 ml. he should take 38 ml. p.o. four times a day, titrate to three to four loose stools a day. 2. ursodiol 600 mg two times a day. 3. pantoprazole 40 mg two times a day. 4. clotrimazole troches five times a day. 5. sucralfate 1 gram four times a day. 6. calcium carbonate 500 mg four times a day. 7. nadolol 20 mg a day. 8. spironolactone 100 mg a day. 9. furosemide 40 mg a day. 10. insulin regimen: he checks his fingersticks four times a day, and based on his fingersticks and the rise of his fingersticks, he will contact his physician for changes in his regimen. , m.d. dictated by: medquist36 d: 16:32 t: 16:41 job#: procedure: other endoscopy of small intestine angioplasty of other non-coronary vessel(s) percutaneous abdominal drainage endoscopic excision or destruction of lesion or tissue of esophagus insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) other endovascular procedures on other vessels transfusion of packed cells transfusion of other serum diagnoses: thrombocytopenia, unspecified chronic hepatitis c without mention of hepatic coma acute posthemorrhagic anemia alcoholic cirrhosis of liver portal hypertension other complications due to other vascular device, implant, and graft hemorrhage of gastrointestinal tract, unspecified esophageal varices in diseases classified elsewhere, without mention of bleeding 

Answer: The patient is high likely exposed to