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: confusion major surgical or invasive procedure: diagnostic paracentesis history of present illness: the pt is a 59-yo man with hcv cirrhosis complicated by encephalopathy, ascites, and spb, asthma, and hypertension, undergoing transplant work-up, who was admitted for altered mental status and hyponatremia. the pt had routine labwork done at physician diagnostics laboratory in on , which showed na 115, k 5.5, cl 84, co2 26, tbili 5.2, mg 1.9, and wbc 11.5, so he was called by the liver center to come in to the ed for evalation for new hyponatremia. the patient reports increasing fatigue, sleepiness, and episodes of confusion over the last week, as well as a 30-pound weight loss over the last one month. he also reports increased cramping. he was last seen by his hepatologist dr. on , at which point his spironolactone dose was increased to 200mg daily given significant edema, and he was also continued on furosemide 40mg daily. he denies any recent illness, or any fevers, chills, lightheadedness, cough, shortness of breath, chest or abdominal pain, nausea, vomiting, hematemesis, diarrhea, constipation, melena, hematochezia, dysuria, hematuria, myalgias, or arthralgias. he does note two episodes of brbpr yesterday, which he noted on the toilet paper when he wiped. he also notes having fewer bowel movements recently, with only one bowel movement in the last 72 hours, while he usually has bms daily. he states that he has been taking his lactulose regularly, 3x daily. . in the ed, vs - temp 97.6f, hr 66, bp 113/56, r 15, sao2 97% ra. he was noted to have involuntary muscle spasms in the rue, but was otherwise awake and a&ox3. he described weakness, and his brother noted confusion. he was thought to be dry on exam. guaiac negative. labs were notable for wbc 10.4 (71.3% pmns), hct 34.1, plt 62, inr 1.5, na 113, k 7.6 (hemolyzed specimen), cl 84, hco3 27, bun 10, cr 0.9, and ammonia 93. repeat k was 5.8, so he received kayexelate, and he received lactulose for his elevated ammonia level. he also received 400cc ns ivf for hypovolemic hyponatremia, with improvement of his na to 117. he is being admitted to the icu given the degree of his hyponatremia. . on the floor, the patient is sleeping comfortably with a respiratory rate of 6, but asking for valium for muscle spasms in his rue. he feels very dry and thirsty, and sleepy. past medical history: - chronic hepatitis c virus infection * unknown genotype, never treated * diagnosed , after he donated blood to the american red cross - cirrhosis * liver biopsy , results unknown * complicated by portal hypertension, ascites, peripheral edema, thrombocytopenia, grade 2 esophageal varices on endoscopy , encephalopathy manifested as memory loss - hypertension - asthma - s/p cervical laminectomy at - s/p angioplasty - s/p left shoulder arthroscopy - s/p abdominoplasty - colonic polyps s/p removal - psychologist: dr. , on bupropion, klonipin social history: social history: single, lives in with his brother. not currently working as he is on disability since , last worked as a mortgage broker and tennis court installer. - tobacco: 20 pack-year smoking hx. - alcohol: last alcoholic beverage at christmastime, has never been a heavy drinker. - illicits: quit smoking marijuana 10 years ago. snorted cocaine a few times at age 30. injected steroids during weightlifting career in -. no ivdu, no tattoos, no high-risk sexual encounters. - no blood transfusion hx, no family h/o hepatitis family history: - cad, no diabetes, no hyperchol - father died from complications of a cerebral aneurysm, also had premature coronary artery disease and obesity - mother died from complications of copd, having been a heavy cigarette smoker - brother is overweight, no other medical illnesses - grandmother had diabetes - grandfather had coronary artery disease physical exam: physical exam upon admission (reported by dr. : vitals: 95.8, 96, 126/62, 14, 98%ra general: confused appearing male with pinpoint pupils heent: non elevated jvp, mmm lungs: sparse basilar crackles cv: rrr no murmurs rubs or gallops abdomen: soft, no clear shifting dullness, mild tenderness to deep palpation, splenomegaly noted ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema + asterixis pertinent results: 10:50pm osmolal-262* 10:50pm na+-117* 10:45pm urine hours-random urea n-978 creat-103 sodium-37 potassium-72 chloride-36 10:45pm urine osmolal-673 10:45pm urine color-amber appear-clear sp -1.021 10:45pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-sm urobilngn-8* ph-6.5 leuk-neg 09:29pm comments-addon to # 09:29pm k+-5.8* 08:50pm ammonia-93* 07:50pm glucose-119* urea n-18 creat-0.9 sodium-113* potassium-7.6* chloride-84* total co2-27 anion gap-10 07:50pm estgfr-using this 07:50pm calcium-8.3* phosphate-3.3 magnesium-2.0 07:50pm wbc-10.4# rbc-3.30* hgb-12.3* hct-34.1* mcv-103* mch-37.3* mchc-36.1* rdw-15.1 07:50pm neuts-71.3* lymphs-19.8 monos-6.4 eos-2.1 basos-0.3 07:50pm plt count-62* 07:50pm pt-16.8* ptt-33.3 inr(pt)-1.5* brief hospital course: mr. is a 59 year-old gentleman with hcv cirrhosis c/b ascites who was admitted for hyponatremia and altered mental status, found to have pse from sbp. 1. hyponatremia- on admission, na 113. initially, was thought to be hypovolemic in origin due to increased fluid losses in setting of increased diuretic use. given, the progressive nature of symptoms, was thought to be subacute rather than an acute process. there was mild improvement with 400cc ns ivf given in the ed. initially, the patient was treated with light fluids to correct the levels deliberately. home diuretics were held. sodium levels increased slowly and trended at an acceptable rate with free water restriction and low sodium diet. by discharge, the patient's na was >130. could be siadh from pain/ infection. pts diuretics were held t/o admission and re-started at lower doses (100mg spironolactone and 40mg lasix daily) at time of discharge, with close follow-up in liver clinic w/ dr. on weds , with instructions to have labs drawn on to monitor electrolytes on diuretics. 2. altered mental status- likely etiology hepatic encephalopathy +/- contribution from hyponatremia. pse likely precipitated by severe sbp, found on dx tap (see below). pt had a sudden episode of confusion, inability to speak, and fluctuating facial droop on , prompting urgent neurologic evaluation including ct head, which was unremarkable, mri brain which showed no acute infarct and nonspecific white matter changes, and eeg which showed no evidence of seizure. likely etiology of pt's episode was hepatic encephalopathy, per neurology team. pt was treated with lactulose/rifaxamin as well as iv ctx for sbp and mental status improved dramatically throughout hospital course, returning to baseline at time of discharge. 3. spontaneous bacterial pt underwent diagnostic tap on showing wbc 35,500 and 90% polys. patient was treated with 7 day course of daily iv ctx as well as iv albumin on days 1 and 3. there was some concern for possible bleeding into the peritoneal cavity due to decreasing hct, but the patient stabilized, with improved abdominal exam. sensitivities on the peritoneal fluid were taken and pending upon discharge. cultures grew out pan-sensitive klebsiella pneumoniae. pt was discharged after completion of 7-day course iv ctx and was started on daily cipro prophylaxis. 3.) hyperkalemia: pt had a k of 7.6 upon admission. was thought to be increased k in setting of increased dose of spironolactone. no significant ecg changes wer enoted. pt??????s k+ improved w/ kayexalate and lactulose. 4.) anemia: patient noted to have significant drop in hct since admission. concern for bleeding into peritoneal fluid (as described above). hct stabilized while in icu. have been secondary to volume received. pt did not require transfusion in house and hct had remained stable for several days prior to discharge. 5.) hcv cirrhosis: now complicated by ascites, sbp and pse. for ascites, diuretics were initially held due to hyponatremia, but restarted at time of discharge w/ close f/u of electrolytes. sbp was treated w/ iv ctx x 7days w/ daily cipro ppx to start thereafter. pse treated w/ lactulose/ rifaxamin and pt returned to baseline ms prior to discharge. hcv vl 191,000 in 03/. pt to f/u w/ dr in liver clinic on weds . 6.) psychosocial issues: pt expressed concerns about his addiction to pain medications. pain meds were held during his hospital course and not restarted at time of discharge. pt was given rx for lidoderm patch at his request, for shoulder pain. he was seen by transplant social work and given outpatient resources for drug counseling and will continued to be followed by social work and psychiatry as an outpatient. medications on admission: - albuterol inhaler 90mcg 2 puffs prn sob - bupropion 150mg - klonipin 2mg prn anxiety - diazepam 5mg daily prn muscle spasms - ergocalciferol 50,000 units one a week - flovent 110mcg 1 puff - furosemide 40mg daily - hydromorphone 2mg 1-2 tabs q3-6hrs prn pain - lactulose 15cc tbsp prn 2-3x / day - salmeterol inhaler 50mcg 1 puff - spironolactone 200mg daily - cetirizine 10mg daily - magnesium oxide 400mg tid - testosterone 50mg/5gram 1% gel daily - pravastatin 10mg daily - aspirin 81mg daily discharge medications: 1. cipro 250 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 2. bupropion hcl 150 mg tablet sustained release sig: one (1) tablet sustained release po bid (2 times a day). 3. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 4. lactulose 10 gram/15 ml syrup sig: sixty (60) ml po qid (4 times a day). 5. pravastatin 20 mg tablet sig: 0.5 tablet po daily (daily). 6. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). 7. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q4h (every 4 hours) as needed for sob or wheeze. 8. testosterone 5 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 9. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po 1x/week (th). 10. fluticasone-salmeterol 100-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 11. fexofenadine 60 mg tablet sig: one (1) tablet po bid (2 times a day). 12. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po bid (2 times a day). 13. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). 14. klonopin 2 mg tablet sig: one (1) tablet po once a day. 15. diazepam 5 mg tablet sig: one (1) tablet po once a day. 16. spironolactone 100 mg tablet sig: one (1) tablet po once a day. 17. lasix 40 mg tablet sig: one (1) tablet po once a day. 18. zyrtec 10 mg tablet sig: one (1) tablet po once a day. 19. magnesium oxide 400 mg tablet sig: one (1) tablet po three times a day. 20. flovent hfa 110 mcg/actuation aerosol sig: one (1) puff inhalation twice a day. 21. outpatient physical therapy pls evaluate for risk to fall, steadiness of gait and determine duration/frequency of outpt pt course 22. lidoderm 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) topical once a day. disp:*30 * refills:*0* discharge disposition: home with service facility: discharge diagnosis: primary: altered mental status, hyponatremia, spontaneous bacterial peritonitis secondary: hepatitis c cirrhosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure being involved in your care, mr. . you were admitted with low sodium and altered mental status which was likely caused by an infection in the fluid in your abdomen. for this you were treated with a 7 day course of iv antibiotics (ceftriaxone). your medications have changed as follows: 1. we added ciprofloxacin 250mg daily- this medication helps prevent recurrence of infection. please take it every day. 2. your spironolactone dose was decreased to 100mg daily. 3. added lidocaine patch the rest of your medications have stayed the same. please continue to take them as you have been. followup instructions: you must see dr. in liver clinic ( bldg) next week on wednesday at 8:20 am before your appointment, please have your blood drawn on tuesday at any time between 8am-4pm in the basement lab you need to follow-up with your primary care doctor, dr. . please call her office at to schedule an appointment. , md phone: date/time: 10:30 procedure: venous catheterization, not elsewhere classified percutaneous abdominal drainage diagnoses: hyperpotassemia unspecified essential hypertension cirrhosis of liver without mention of alcohol chronic hepatitis c without mention of hepatic coma hyposmolality and/or hyponatremia portal hypertension hepatic encephalopathy spontaneous bacterial peritonitis 

Answer: The patient is high likely exposed to