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: no known allergies / adverse drug reactions attending: chief complaint: acute on chronic kidney disease major surgical or invasive procedure: - paracentesis history of present illness: this is a 59 year old male with history of hepatitis c cirrhosis and recurrent hcc as well as stage iv ckd who presents today with on ckd. pt presented to renal clinic yesterday for evaluation of treatment for recurrent hcc. labs showed cr. of 5.9, which was new and therefore he was told to go to the ed. pt acknowledged edema, weight gain, and fatigue but denied fevers or chills. he also endorses a dry cough and congestion. the patient denies vomiting any blood or having any bloody or tarry stools. . in ed, vitals were 97.4 73 122/97 18 99% ra. exam notable for bilaterally warm, edematous legs, with calf tenderness. u/s negative for dvt. liver u/s negative for any acute pathology. no asterixis. received 2 mg iv morphine. . review of systems: (+) per hpi, patient also endorses a dry cough, congestion, and occasional shortness of breath while climbing stairs. he also endorses some left arm pain made worse with climbing stairs, worse in the am when he wakes up (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: #. cholelithiasis #. hepatocellular carcinoma - two bx lesions c (+) path - s/p rfa #. severe cellulitis of lower extremities requiring hospitalizations #. hep c genotype 1 - pegylated interferon, ribavirin (): viral relapse - liver bx (): stage 3 fibrosis, grade 2 inflammation - egd (): - tear, varices at the gastroesophageal junction and lower third of the esophagus, blood in the fundus - colonoscopy () polyps in appendiceal orifice, transverse colon, and sigmoid colon, otherwise normal - afp 9578 #. hypertension #. dmii: c/b neuropathy #. psoriasis #. anxiety #. gerd #. chronic anemia #. s/p laminectomy () #. chronic pain laminectomy managed by methadone #. s/p right ankle surgery () social history: lives at home alone. wife passed away in . he admits to occasional tobacco use. denies any recent use of etoh, illicit drugs or herbal medications. family history: family members with diabetes mellitus. no history of liver disease or liver cancer. physical exam: vs - temp 97.1 f, bp 134/66, hr 65, rr 18, 99% on ra general - well-appearing man in nad, comfortable, appropriate heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear neck - positive for jvd, no carotid bruits lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - pmi non-displaced, rrr, no mrg, nl s1-s2 abdomen - soft, some mild ttp in the rlq without rebound, protruberant abdomen with dullness to percussion extremities - bilateral lower extremity edema to the knees, venous stasis changes with cracking skin bilaterally skin - multiple areas on both hands with psoriasis neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout, dtrs 2+ and symmetric, mild asterixis pertinent results: labs on admission: 11:58am comments-green top 11:58am lactate-2.7* 10:20am glucose-156* urea n-72* creat-6.1* sodium-134 potassium-4.5 chloride-102 total co2-24 anion gap-13 10:20am alt(sgpt)-87* ast(sgot)-202* ld(ldh)-681* ck(cpk)-2158* alk phos-173* amylase-112* tot bili-2.4* 10:20am lipase-83* 10:20am ctropnt-0.10* 10:20am ck-mb-39* mb indx-1.8 probnp-1337* 10:20am albumin-1.8* calcium-8.5 phosphate-5.4*# magnesium-1.9 10:20am wbc-11.9* rbc-2.80* hgb-8.9* hct-27.9* mcv-100* mch-31.7 mchc-31.9 rdw-16.3* 10:20am neuts-70.9* lymphs-19.3 monos-6.9 eos-2.5 basos-0.5 10:20am plt count-209 10:20am pt-24.8* ptt-35.6* inr(pt)-2.4* labs on discharge: 04:25am blood wbc-8.7 rbc-2.62* hgb-8.1* hct-25.2* mcv-96 mch-30.9 mchc-32.1 rdw-20.0* plt ct-74* 04:25am blood plt ct-74* 04:25am blood pt-38.0* ptt-53.8* inr(pt)-3.9* 04:25am blood glucose-90 urean-58* creat-3.8* na-140 k-3.9 cl-104 hco3-23 angap-17 04:25am blood alt-56* ast-78* alkphos-69 totbili-5.0* 04:25am blood mg-1.9 microbiology: 1:18 am urine no growth. 11:50 am blood culture final no growth 8:52 am peritoneal fluid peritoneal fluid. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. fungal culture (preliminary): no fungus isolated. 08:52 ascites analysis wbc rbc polys lymphs monos macroph 245* * 30* 23* 0 47*1 ascites analysis wbc rbc polys lymphs monos macroph 16:44 * * 32* 38* 0 30* 4:44 pm peritoneal fluid peritoneal fluid. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (preliminary): anaerobic culture (preliminary): imaging: - ecg study date of 10:08:48 am sinus rhythm. q-t interval prolongation. early r wave transition. non-specific st-t wave changes. compared to the previous tracing of the ventricular rate has increased. - duplex dop abd/pel limited study date of 11:50 am impression: 1. coarsened liver texture consistent with known history of cirrhosis. 2. patent hepatic vasculature. smv not visualized due to overlying bowel gas. splenic vein patient at level of hilum. 3. increased size of hyperechoic lesion thought to be concerning for hepatocellular carcinoma. - bilat lower ext veins study date of 11:51 am impression: no definite evidence of bilateral lower extremity deep vein thrombosis. - chest (pa & lat) study date of 2:03 pm findings: frontal and lateral views of the chest are obtained. there are relatively low lung volumes. given this, no focal consolidation, pleural effusion, or pneumothorax is seen. no overt pulmonary edema is seen. the cardiac and mediastinal silhouettes are stable. brief hospital course: 59 year old male with history of hepatitis c cirrhosis and recurrent hcc as well as stage iv ckd who presents with on ckd. # variceal bleed: he had a very large upper gi bleed on secondary to known esophageal varices. the massive transfusion protocol was initiated, a right femoral cortis was placed, and he received 10 units prbc, 10ffp, 1cryo. placed for hemostasis and he was intubated for airway protection. removed on prior to egd, and 4 oozing varices were banded. he had no further bleeding episodes and transfused 2 units of ffp for elevated inr with some transient improvement and was extubated. stopped ocreotide and ppi drip and patient transfered to floor. after discussion with family, decision was made to make patient cmo. patient expired on . #. hepatitis c cirrhosis (decompensated): following esophageal bleed, and stably worsening liver function, it was felt that the patient was not a candidate for tips or liver . the hepatology team communicated this to the patient, and subsequent meetings with the family directed goals towards comfort. he had significant encephalopathy following extubation, and was not following commands though would arouse to voice. palliative care team was involved- he was placed on a fentanyl drip, and then dilaudid boluses for comfort. he expired on as above. # aockd: cr elevated from 3.2 on to 6 on admission. sources considered for decompesnation included sbp (paracentesis negative), gi bleed (guiaic negative, pt without symptoms), and portal thrombosis (ruq u/s was negative). per renal c/s urine sediment was bland. patient presentation felt to be most consistent with hepato-renal syndrome. patient was started on octreotide, midodrine, and albumine, with subsequent improvement in cr. both antihypertensive home medication (nadolol and nifedipine) were held in house, and given the patient was normotensive, were discontinued on discharge. diuretic medications were held in house, and were held upon discharge with a plan to follow up with nephrology. #. hepatocellular carcinoma: no further treatment indicated #. spontaneous bacterial peritonitis: the patient underwent a diagnostic and therapeutic tap on , which revealed evidence of greater than 250 pmns; he was started on ceftrixaone to cover spb. he was changed to vanco/cefepime/flagyl on to co-treat an aspiration event. he received 5 days of antibiotics, which were then discontinued due to cmo status change. #. dmii: patient noted to be hypoglycemic in the am with glucoses of 38 twice, and 54 in the am. the patient's night-time lantus was lowered to 32 u at night (per the patient, he had been taking 60 at night), and the patient was covered with ssi. #. hypertension: patient was not hypertensive in house, although he was off his blood pressure medication. #. thrombocytopenia: patient has platelt of 76, drop in 6 days from 207 on admission, and has intermittently received heparin here in house as well as on admission on . there is an intermediate probability that this patient has hitt based on the 4t score. however, heparin antibody was negative, and patient's thrombocytopenia was attributed to his liver disease, and heparin sc was restarted. #. elevated lactate: noted to be elevated on admission to 3.5. patient without anion gap currently, and without hypoperfusion physiology. lactate felt to be most likely secondary patient's known malignancy. #. elevated cardiac enzymes: likely elevated in the setting of kidney injury, and stable without chest pain and without acute changes on ekg. #. anxiety: manged with home dose clonazepam 0.5 mg daily prn #. gerd: managed with rantidine in house secondary to initial concerns for ain, was switched to home dose of pantoprazole 40 mg po q24h on discharge #. chronic pain: patient was started on 30 q am / 20 q pm doses of his home methadone given his acute kidney injury. as his creatinine improved, his pain medication was uptitated back to him home dose. # macrocytic anemia: most consistent with anemia of chronic inflammation given elevated ferritin, normal iron. b12 and folate wnl. medications on admission: 1. pantoprazole 40 mg po q24h . 2. ciprofloxacin 250 mg po q24h 3. ergocalciferol 50,000 unit po 1x/week 4. spironolactone 50 mg ablet po daily 5. nadolol 30 mg po daily 6. clonazepam 0.5 mg po daily prn anxiety. 7. furosemide 20 mg po daily 8. methadone 40 mg po qam, 30 mg po qpm 9. lactulose 15 ml po tid 10. insulin 11. calcitriol 0.25 mcg po daily 12. calcitriol 0.25 mcg po every other day 15. calcipotriene 0.005 % cream topical daily 16. rifaximin 200 mg po twice a day. 17. nifedipine xr 30 mg po once a day. discharge medications: none discharge disposition: expired discharge diagnosis: primary diagnosis: - hepatorenal syndrome - hepatitis c cirrhosis - hepatocellular carcinoma discharge condition: patient expired discharge instructions: mr. , was admitted because he was found to be in renal failure, his hospital course was complicated by a large variceal bleed. given his multiple comorbidities and decompensated liver disease, after a family meeting it was decided to make him comfort measures only and he passed away on inpatient hospice. followup instructions: patient expired procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous abdominal drainage endoscopic excision or destruction of lesion or tissue of esophagus diagnoses: thrombocytopenia, unspecified anemia in chronic kidney disease other chronic pain cirrhosis of liver without mention of alcohol acute kidney failure, unspecified hepatorenal syndrome portal hypertension unspecified viral hepatitis c without hepatic coma chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes anxiety state, unspecified acute respiratory failure other sequelae of chronic liver disease other ascites malignant neoplasm of liver, primary esophageal varices in diseases classified elsewhere, with bleeding encephalopathy, unspecified other specified disorders of stomach and duodenum spontaneous bacterial peritonitis shock, unspecified 

Answer: The patient is high likely exposed to