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: heparin agents attending: chief complaint: ams major surgical or invasive procedure: paracentesis history of present illness: 54 year old male with pmh significant for hiv (on harrt, last cd4 629), esld, hcv cirrhosis presents from clinic w/ ams. . history taken from wife. over 7-10 days, pt has been ill w/ nausea, vomiting and diarrhea. wife thinks he's had at least 3 loose bm daily. he has had intermittent emesis, that she believes is non-bloody, non-biliary. he has had worsening abdominal distension as well, w/ very poor po intake. he was also complaining of abdominal pain. she did not take his temp, but states that he "felt hot." per wife, pt drinking etoh up until 2 months ago, very heavily ~ 1pint of vodka and 4-5 beers nightly. he has a h/o ivdu (heroin) but hasn't used in 2 years. . pt was referred to dr. by his pcp. exam he was found to be very altered and he was referred to the ed. . in the ed, vs were t 99.0, hr 94, bp 151/95, rr 20, o2 97%. on exam, he had + asterixis, ams, +abd distention/ttp. ruq us showed patent portal vein, cirrhotic liver with perihepatic ascites (not seen in other quadrants), and gb sludge but no signs of cholecystitis. ct head showed no acute intracranial process. his labs were notable for a na 127, k 5.4, cr 1.5, t bili 25.3, alt 212, ast 473, alb 2.6, inr 3.6, wbc 13.7, hct 35.7, plt 149. he was seen by hepatology. he received lactulose, ceftriaxone, albumin, and an amp of d5. he did not get paracentesis b/c of inr. 2 units of ffps started. he was subsequently transferred to the icu . in the icu, he was continued on ceftriaxone and lactulose. he was also started on d5ns for hyponatremia/hypoglycemia. for his coagulopathy, he received ffp as well as iv vitamin k. ir-guided paracentesis was performed performed but did not show any signs of sbp, but this was in the setting of having received iv antibiotics. . review of systems: unable to obtain as pt altered. (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: hiv on harrt hcv cirrhosis polysubstance abuse social history: - tobacco: "heavy" , wife - alcohol: 1pint of vodka and 4-5 beers nightly last drank 2 mo ago - illicits: h/o ivdu (heroin), last used (per wife) ~ 2 yrs ago family history: unable to obtain physical exam: admission exam: general: thin appearing male, jaundice heent: sclera icteric, dry mm, oropharynx clear neck: supple, jvp elevated above mandible, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: tachy, normal s1 + s2, no murmurs, rubs, gallops abdomen: distended, tense, minimally ttp, no spider angiomata gu: no foley ext: warm, well perfused, 2+ pulses, no edema neuro: oriented to self, able to state that he at deaconness. states the year is initially, then , but cannot state the month. pertinent results: admission labs: 11:20am plt count-149* 11:20am neuts-69.5 lymphs-24.4 monos-5.7 eos-0.1 basos-0.3 11:20am wbc-13.7* rbc-3.43* hgb-12.6* hct-35.7* mcv-104* mch-36.7* mchc-35.2* rdw-16.2* 11:20am asa-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 11:20am afp-29.0* 11:20am albumin-2.6* 11:20am lipase-42 11:20am alt(sgpt)-212* ast(sgot)-473* alk phos-250* tot bili-25.3* dir bili-15.0* indir bil-10.3 11:20am estgfr-using this 11:20am glucose-48* urea n-16 creat-1.5* sodium-127* potassium-5.4* chloride-97 total co2-24 anion gap-11 12:41pm pt-35.3* ptt-43.1* inr(pt)-3.6* 03:00pm ammonia-115* 10:22pm pt-40.3* ptt-46.2* inr(pt)-4.2* 10:22pm plt count-119* 10:22pm wbc-10.1 rbc-2.86* hgb-10.6* hct-30.0* mcv-105* mch-37.0* mchc-35.3* rdw-16.2* 10:22pm ethanol-neg 10:22pm calcium-8.7 phosphate-2.0* magnesium-2.5 10:22pm glucose-64* urea n-14 creat-1.2 sodium-130* potassium-3.4 chloride-100 total co2-26 anion gap-7* 11:30pm urine mucous-rare 11:30pm urine hyaline-4* 11:30pm urine rbc-1 wbc-3 bacteria-few yeast-none epi-<1 11:30pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-lg urobilngn-4* ph-5.5 leuk-neg 11:30pm urine color-dkamb appear-hazy sp -1.012 11:30pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-pos 11:30pm urine osmolal-389 11:30pm urine hours-random urea n-578 creat-98 sodium-26 potassium-34 chloride-27 15:05 ascites wbc rbc polys lymphs monos mesothe macroph 171* 93* 41* 6* 7* 3* 43* peritoneal fluid totpro glucose creat ld(ldh) amylase 0.5 77 0.9 38 15 totbili albumin 2.3 less than 1 discharge labs: 05:30am blood wbc-7.6 rbc-2.62* hgb-9.8* hct-28.6* mcv-109* mch-37.5* mchc-34.3 rdw-16.8* plt ct-76* 05:00am blood wbc-10.9 lymph-33 abs -3597 cd3%-95 abs cd3-3408* cd4%-30 abs cd4-1095 cd8%-56 abs cd8-* cd4/cd8-0.5* 05:30am blood glucose-99 urean-8 creat-0.8 na-134 k-3.7 cl-103 hco3-25 angap-10 05:30am blood alt-88* ast-179* alkphos-156* totbili-21.7* 01:45pm blood caltibc-129* ferritn-1686* trf-99* 05:25am blood vitb12-greater th folate-9.0 07:30am blood cortsol-6.7 01:45pm blood hbsag-negative hbsab-positive hbcab-negative igm hbc-negative 01:45pm blood -positive * titer-1:40 11:20am blood afp-29.0* 01:45pm blood igg-2387* test result reference range/units hcv genotype, lipa 1a 06:25 ca -9 test result reference range/units ca -9 14 <37 u/ml microbiology: blood cultures x 2 negative mrsa screen negative vre screen negative urine culture negative c. diff toxin negative hcv viral load 2,260 iu/ml. 3:05 pm peritoneal fluid peritoneal fluid. **final report ** gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. rpr nonreactive 11:40 am immunology hiv-1 rna is not detected. 12:20 pm urine source: cvs. **final report ** urine culture (final ): enterococcus sp.. 10,000-100,000 organisms/ml.. yeast. 10,000-100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ <=2 s nitrofurantoin-------- <=16 s tetracycline---------- <=1 s vancomycin------------ 1 s imaging: ct head non-con : some motion through the inferior most images. otherwise, no evidence of acute intracranial process. please note that mri is more sensitive in detecting small intracranial lesions. ruq ultrasound : 1. doppler assessment of the main portal vein and their branches shows patency and hepatopetal flow. 2. cirrhotic liver and ascites. 3. distended gallbladder with sludge without gallbladder wall edema or pericholecystic fluid. cholecystitis cannot be entirely excluded based on this study, if there is high clinical concern. if high clinical concern for cholecystitis, could further evaluate with a hida scan. chest xr : small bilateral effusions with associated atelectasis. mild pulmonary edema pelvis (ap only) study date of 10:38 pm findings: there is an apparent urinary catheter in the urethra and bladder. the tip of this is not well visualized. no metallic radiopaque foreign body is seen. no bone lesion or fracture is seen. - liver or gallbladder us (single organ) study date of 1:57 pm abdominal ultrasound: again noted is a heterogeneous nodular shrunken liver consistent with a known history of cirrhosis. the largest hypovascular nodule noted on mri in segment2 was poorly seen despite multiple attempts at positioning at visualizing this segment of the liver. the lesion within segment next to the gallbladder is slightly hypoechoic in comparison to the surrounding parenchyma measuring 2.5 x 2.5 x 3.8 cm and is in close proximity to the main hepatic artery and the main portal vein. the other peripheral lesion within segment vi, abutting the hepatorenal space is also seen and hypoechoic in comparison to the surrounding parenchyma measuring 2.1 x 2.6 x 3.7 cm. one additional echogenic nodule within segment vii/viii is noted with no clear correlate on the mri, measuring 7 x 11 x 14 mm. the other lesions within segment v on the mri are not clearly seen. moderate amount of ascites remains. impression: 1. unchanged appearance to known cirrhotic liver. the segment and segment vi lesions are son visible and could be attempted for percutaneous biopsy. the lesion locations would make the procedure technically challenging and high risk given the proximity to surrounding vessels, gallbladder and kidney. the segment ii and v lesions are not clearly seen. a moderate amount of ascites persists and a paracentesis would have to be done prior to the procedure to minimize any risk of capsular bleeding. 2. 1 cm hyperechoic nodule, likely within segment vii or viii without clear mri correlate. - ct abd w&w/o c study date of 3:26 pm impression: 1. four lesions displaying mild arterial enhancement and washout meet imaging criteria for hcc within segment v/viii (one lesion), segment vi (two lesions), and segment (one lesion). none is greater then 3 cm. 2. two lesions within segment ii display only washout but without increased arterial enhancement. the smaller more posterior lesion is more concerning as it shows washout to surrounding liver on portal and delayed venous phases with a more vague larger anterior lesion of uncertain significance only seen on most delayed phase. both are hyperdense on non-contrast ct. additional small segment viii lesion also only seen on most delayed images without arterial enhancement. these may represent dysplastic nodules or hypovascular hcc's. 3. known cirrhotic-appearing liver with sequelae of portal hypertension including abdominal/esophageal varices and splenomegaly as well as mild-to-moderate amount of ascites. edema within the large bowel presumably related to congestive enteropathy. 4. biliary sludge and gallstones as seen on prior mri. small pancreatic head cyst is of doubtful significance for this patient and can be watched on future exams. 5. small left pleural effusion. brief hospital course: 54 year old male with pmh significant for hiv (on harrt, last cd4 629), esld, hcv cirrhosis w/ possible left lobe liver cancer, who was being admitted to the icu w/ ams # cirrhosis: the patient has known hepatitis c, both by history as well as by viral load in hospital, as well as a reported heavy history of etoh use. on admission, given reported episodes of fevers at home as well as abdominal pain, there was serious concern for sbp, and the patient was started on empiric antibiotics with ceftrixaone. ruq u/s showed a cirrhotic liver and ascities, but without evidence of cholecystitis or pvt. additionally, there was no evidence of gi bleed. subsequent diagnostic tap did not reveal any evidence of sbp, however, as noted above, this was in the setting of having already received antibiotics. the patient completed a course of ceftrixaone for presumed sbp, and subsequently started sbp prophylaxis with cipro. the patient underwent an mrcp secondary to concerns from patient's pcp about possible liver lesions. mrcp discovered five liver lesions of various sizes, detailed in the results section of this report. two of these lesions were amenable to biopsy, but given the patient's history, multiple lesions, and potential complications of biopsy, the patient in consultation with physicians here elected not to performed the biopsy, as the results were felt to be almost certain to reveal malignancy (perhaps hcc versus cholangiocarcinoma) that would not be amenable to treatment; the patient indicated he did not want to know if this were the case. palliative care was consulted, and provided counseling regarding resources for palliative care. the patient was made dnr/dni. a repeat triphasic ct confirmed that the pattern of filling of the lesions in the liver was consistent with hcc. prior to discharge, the patient received a therapeutic tap and was discharged on 20 mg of furosemide as well as 50 mg spironolactone. # ams: on admission, the patient was noted to be altered. ams was felt to be secondary to decompensated liver failure as well as a component of sbp. some of the patient's alteration in mental status was also presumed to medication effect, and initially the patient's home dose of methadone was decreased; however, this was up-titrated back to his home dose on discharge. the patient also received hepatic encephalopathy prophylaxis with lactulose and rifaximin. on discharge, the patient was noted to be aaox3, follwoing commands, and conversant, and without any asterixis (he had had very prominent asterixis on admission). # hiv: the patient's haart therapy was discontinued in house secondary to concerns for liver toxicity, specifically from abacavir. on discharge, the patient was noted to have a cd4 count in in the 1000s, with an undetectable viral load. haart therapy was not restarted on discharge, and was deferred to the outpatient setting. the id team indicated that the patient's haart could safely be restarted once the lfts were less than 2 x the uln. # htn: the patient's amlodipine and lisinopril on hold given initially the concern for the patient's illness in the setting of presumed infection; he was not restarted on these medications upon discharge as he had been normotensive in house. # etoh abuse: per wife's report, the patient has not had alcohol in over two months. patient did not exhibit any signs/symptoms of withdrawal, and was discharged from the hospital on a multivitamin. # renal insufficiency: the patient's creatinine appeared to normalize over the course of his admission with albumin and iv fluid. # hypona: the patient was noted to be hyponatremic on admission, likely secondary to dehydration, which resolved with hydration. # hypoglycemia: the patient on inital admission to icu was noted to be hypoglycemic requiring a d5w gtt. this hypoglycemia was presumed secondary to acute infection with sbp; the patient remained normoglycemic throughout the remainder of his admission. an am cortisol was sent off to rule out adrenal insuffiency as a cause of hypoglycemia, but am cortisol was within normal limits. # chest pain: not currently bothersome to patient. however, he does describe a long history of intermittent chest pressure with may require outpatient follow-up. medications on admission: home meds (confirmed with girlfriend who read off of pill bottles) -epzicom 1 tab q day -prezista 800 mg daily -norvir 100 mg softgel 1 q day -lisinopril 10 mg daily -ondansetron 4 mg 1 tab up to tid -omeprazole-20 mg -fluoxetine 10 mg daily -amlodipine 5 mg daily -ibuprofen 800 mg 3x daily discharge medications: 1. fluoxetine 10 mg capsule sig: one (1) capsule po once a day. 2. omeprazole 20 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po twice a day. 3. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po three times a day as needed for nausea. 4. lactulose 10 gram/15 ml solution sig: thirty (30) ml po three times a day. disp:*1 quantity sufficient* refills:*2* 5. rifaximin 550 mg tablet sig: one (1) tablet po twice a day: please take this medication for hepatic encephalopathy prophylaxis. disp:*60 tablet(s)* refills:*2* 6. multivitamin tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 7. methadone 10 mg tablet sig: fifteen (15) tablet po once a day. 8. cipro 250 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 9. spironolactone 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 10. methadone 10 mg tablet sig: fifteen (15) tablet po daily (daily). 11. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service facility: discharge diagnosis: primary diagnosis: - spontaneous bacterial peritonitis secondary diagnosis: - multiple liver lesions discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: mr. , it was a pleasure taking care of you in the hospital. you were admitted to the hospital because you had been having some abdominal pain and had some alteration in your mental status. after performing some images, we believes that you had an infection in the fluid which had accumulated in your abdomen, and treated you with an appropriate course of antibotics. when you finished these antibiotics, we started you on an antibiotic you will need to take indefinitely to prevent you from getting another infection. our hiv specialists saw you and indicated that your current liver disease made it very dangerous for you to continue taking your hiv medications, all of which have been stopped. you should not restart these medications until you have consulted with your hiv physician and your provider . we also performed some imaging of your liver; your primary physician had noted that one of the lobes of your liver had a lesion on it. when we took more pictures of of your liver, we saw that your liver had five different lesions on it. after discussions with you, you elected not to have us perform a biopsy. we got a ct scan which showed that this is likely to be liver cancer, however after discussion with you we decided that treating it would likely not make your life better and potentially make it worse. when you leave the hospital: - stop epzicom 1 tab daily (discuss with your primary care doctor when and if to restart this) - stop prezista 800 mg daily (discuss with your primary care doctor when and if to restart this) - stop norvir 100 mg daily (discuss with your primary care doctor when and if to restart this) - stop lisinopril 10 mg daily (discuss with your primary care doctor when and if to restart this) - stop amlodipine 5 mg daily (discuss with your primary care doctor when and if to restart this) - stop ibuprofen 800 mg 3x daily - start furosemide 40 mg daily (this is for the fluid in your abdomen and legs) - start spironolactone 100 mg daily (this is for the fluid in in your abdomen and legs) - start ciprofloxacin 250 mg daily (you will need this to prevent you from getting infections in the future) - start lactulose 30 ml three times a day; take this as needed in order to have 3 bowel movements a day - start rifaximin 550 mg tablet twice a day - start multivitamin daily we did not make any other changes to your medications, so please continue to take them as you normally have been. followup instructions: name: pa- location: family health center address: , , phone: appointment: wednesday 2:30pm department: liver center when: friday at 3:00 pm with: , md building: lm campus: west best parking: garage procedure: percutaneous abdominal drainage percutaneous abdominal drainage diagnoses: thrombocytopenia, unspecified abnormal coagulation profile anemia, unspecified unspecified essential hypertension cirrhosis of liver without mention of alcohol hyposmolality and/or hyponatremia other and unspecified alcohol dependence, in remission chronic airway obstruction, not elsewhere classified opioid type dependence, continuous disorders of phosphorus metabolism unspecified disorder of kidney and ureter other ascites asymptomatic human immunodeficiency virus [hiv] infection status spontaneous bacterial peritonitis hypoglycemia, unspecified unspecified viral hepatitis c with hepatic coma 

Answer: The patient is high likely exposed to