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: altered mental status major surgical or invasive procedure: paracentesis history of present illness: 57 year old male with a pmh of hepatitis c cirrhosis c/b refractory ascites s/p tips in on lasix and aldactone, hepatic encephalopathy on lactulose and rifaximin, and 3 cords of grade ii varices in the lower third of the esophagus, bipolar, and djd who presents with altered mental status after a fall. today he was found by his landlord on the floor, when water started leaking into the apartment below him. he was confused, and vaguely remembered hitting his head, but had doesn't remember any events surrounding the event. he denies any symptoms of fever, chills, nausea, vomiting, incontinence, diarrhea, cough, chest pain, shortness of breath, myalgias or dysuria. in the ed he was initially aaox1. head ct showed acute on chronic subdural hemorrhage with 2mm shift. neurosurgery was consulted and felt this was encephalopathy, and not related to the ich. his vs were stable with bps in the 90s-100s. pulse was in the 70s, and he was 99% on ra. hct was at 27.9, creatinine 2.6, alt/ast: 199/566, inr 1.8. he was given 2 units ffp, vitamin k 10mg iv, typed and crossed x 4 units, 800mg of ibuprofen, started on a protonix bolus and gtt. access, 18 and a 20g. 2l ivf, vanc and cefipime with blood and urine cultures done. ibuprofen for pain, percocet. on the floor, he is uncomfortable where he hit his head and elbow. otherwise oriented x3 and current events. he has gross asterixis without any other gross neurologic abnormalities. review of systems: (+) per hpi; all others negative past medical history: 1) hcv genotype 1 and cirrhosis s/p pegylated interferon and ribavirin treatment x 2 without total viral load suppression. 2) history of alcohol excess - discontinued 3) refractory ascites s/p tips 4) bipolar disorder 5) degenerative disc disease social history: lives alone. currently on disability. has a brother-in-law/sister that live in . - tobacco: denies - alcohol: denies - illicits: denies (only prescribed pain medication) family history: no history of liver disease. family history of bipolar disease. physical exam: admission physical exam: general: alert, oriented x3, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally scant bibasilar crackles, no wheezes, rales, ronchi cv: normal rate and regular rhythm abdomen: soft, non-tender, mildly distended, + ascites, bowel sounds present, no rebound tenderness or guarding, palpable liver tip 3fb below the costal margin gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis. 2+ edema to the midshin neuro: aaox3, cn2-12 intact, no gross deficits. + asterixis. discharge physical exam: 98.2 114/60 89 20 98% net neg 300 gen: well-appearing, nad, a+o cv: rrr no mrg lungs: cta b/l abd: soft, non-tender, distended with ascites, large umbilical hernia is reducible ext: 2+ pitting edema pertinent results: admission labs: 10:20am blood wbc-6.1 rbc-2.68* hgb-10.1* hct-27.9* mcv-104* mch-37.8* mchc-36.2* rdw-18.6* plt ct-107* 11:20am blood pt-19.5* ptt-43.7* inr(pt)-1.8* 10:20am blood glucose-87 urean-91* creat-2.6*# na-137 k-3.7 cl-102 hco3-23 angap-16 10:20am blood glucose-87 urean-91* creat-2.6*# na-137 k-3.7 cl-102 hco3-23 angap-16 10:20am blood alt-199* ast-566* ld(ldh)-867* ck(cpk)-5045* totbili-2.0* 10:20am blood albumin-2.5* calcium-7.7* phos-3.8 mg-3.1* discharge labs: 04:40am blood wbc-3.1* rbc-2.18* hgb-8.0* hct-22.9* mcv-105* mch-36.8* mchc-35.1* rdw-16.2* plt ct-112* 04:40am blood pt-19.6* ptt-61.0* inr(pt)-1.8* 04:40am blood glucose-96 urean-15 creat-1.3* na-131* k-4.3 cl-100 hco3-24 angap-11 04:40am blood alt-19 ast-35 alkphos-102 totbili-1.1 04:40am blood calcium-8.4 phos-3.5 mg-1.7 tox screen: 10:20am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg. . liver/gb us impression: 1. patent tips shunt with stable velocities. 2. small stable right hepatic lesion unchanged from prior abdominal imaging. no new liver lesion identified. no biliary dilatation is seen. 3. splenomegaly. . ct head impression: 1. moderate-sized left subdural likely acute on subacute hemorrhage. 2 mm rightward shift of midline structures. 2. ovoid occipital subcutaneous lesion likely a sebaceous cyst but correlation with exam is recommended. . ct head impression: ??????1. no change versus comparison study three days ago. ??????2. stable subdural collection along the left frontal convexity layering dependently. stable shift of midline structures and ventriculomegaly. no evidence of new hemorrhage or hydrocephalus. paracentesis #1: 02:54pm ascites wbc-40* rbc-3770* polys-17* lymphs-12* monos-6* mesothe-11* macroph-54* paracentesis #2: (**sbp**) 03:00pm ascites wbc-1100* rbc-* polys-38* lymphs-6* monos-0 eos-4* mesothe-2* macroph-50* paracentesis #3: 02:17pm ascites wbc-110* rbc-860* polys-0 lymphs-7* monos-0 mesothe-1* macroph-92* brief hospital course: 57 year old male with pmh of decompensated hep c cirrhosis with multiple metabolic derangements and ams s/p fall, now with an acute on chronic sdh and arf. . . ams: was determined to be secondary to hepatic encephalopathy. possible precipitants included medications (opiates and depakoate), and medication non-compliance (though patient denies). infectious etiologies and gib were ruled out. paracentesis was initially negative for sbp on admission. given potential hepatic toxicity, depakote was held and pt was ultimately started on valproate. abd ultrasound was checked to evaluate the patency of his tips and it was determined that tips was shunting too much blood from gut resulting in worsening encephalopathy. a tips reduction was done and pt's encephalopathy improved. serial ammonia levels remained low after reduction. his lactulose was uptitrated and his rifaximin was continued. ich: this could have been contributing to ams on presentation though certainly not the cause given pt was encephalopathic when he fell. head ct showed an acute on chronic sdh with 2mm rightward shift. neurosurgery evaluated and felt there was no component contributing to his ams. he was monitored with q4 neuro checks which were stable. repeat head ct revealed stable lesion. neurosurgery signed off and pt will follow up with neurosurgery in 4 weeks time with repeat head ct. until that time he will continue on seizure prophylaxis with keppra arf: ck came back at 5045 contributing to the arf as well as volume depletion. hepatorenal syndrome was considered though thought to be less likely given improvement with ivf and clearance of his ck. his baseline creatinine was 0.8 to 1.0. ck trending down to normal within 3 days. pt's creatinine trended down and at time of discharge it was 1.3. resumed diuretics at lowered dose of lasix 40mg and spironolactone 100mg daily transaminitis: possibly in the setting of ischemia, or myolysis from being found down. seizure thought unlikely given no recent alcohol use and his negative serum etoh. possible medication effect with opiates and valproic acid. his valproic acid was held and an ultrasound was performed to evaluate the patency of his tips. tips was reduced as mentioned above. transaminitis improved, but still had impaired synthetic fxn at time of discharge underlying cirrhosis. depakote was restarted. anemia: baseline 32-36, hct on admission 27.9 with drop to 25 with hydration. fobt positive with brown stool in the ed. no hematemesis. denied any blood in his stool or urine. denies any increasing abdominal distension. most recent tap was on . hemolysis labs were + for low hap to, elevated lactate dehydrogenase, and . could have had some underlying hemolysis from high velocities in tips. pt's crit remained stable, and will need endoscopy/c-scope after discharge. liver decompensation: continued his lactulose and rifaximin. initially held his diuretics given arf and elevated ck. ascites continued to increase throughout hospitalization and a large volume paracentesis was performed on with removal of 3 liters of fluid spontaneous bacterial peritonitis: a diagnostic para performed on revealed sbp with ~330 neutrophils. started on 5day course of ceftriaxone and albumin with repeat albumin 3 days later. paracentesis performed on was also sent for diagnosis, revealing resolution of sbp. patient started on ciprofloxacin 500mg for sbp prophylaxis bpad: pt's mood stabilizer was d/ced in setting of transaminitis and ams. he was started on valproate, but will need close psychiatric follow up. his outpatient psychiatrist was called numerous times by psychiatry and the primary team but he did not return calls. psych consult reported that pt is not threat to self or others. also reported that he will not be able to get close enough follow up with a psychiatrist and will need to follow up with outpt psychiatrist or find a new one before discharge. transitional: # pt needs follow with psychiatry # follow up with nsg in four weeks with repeat ct of head medications on admission: - carvedilol 25mg - hydralazine 25mg tid - atorvastatin 80mg daily - plavix 75mg daily - asa 325mg daily - coumadin 5mg daily - 15 units insulin nph & regular human (70-30) - lasix 80mg daily - spironolactone 50mg tid - folic acid 1mg daily discharge medications: 1. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). 2. multivitamin tablet sig: one (1) tablet po daily (daily). 3. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day): titrated to bowel movements per day. 4. tramadol 50 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 6. divalproex 250 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po tid (3 times a day). disp:*90 tablet, delayed release (e.c.)(s)* refills:*2* 7. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 8. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 9. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. disp:*120 tablet(s)* refills:*0* 10. spironolactone 100 mg tablet sig: one (1) tablet po daily (daily). 11. ciprofloxacin 500 mg tablet sig: one (1) tablet po every twenty-four(24) hours. discharge disposition: extended care facility: life care center of discharge diagnosis: subdural hematoma hepatic encephalopathy cirrhosis bipolar affective disorder spontaneous bacterial peritonitis discharge condition: mental status: confused - sometimes level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you. you were admitted to the hospital for confusion and a fall. when you fell, you hit your head and this caused a small bleed inside your skull called a subdural hematoma. the neurosurgeons here examined you and we did two ct scans of your head and it was determined that the bleeding had stopped. your were started on keppra for seizure prophylaxis. during your hospitalization we also performed a procedure called a tips reduction. your tips was shunting too much blood away from your liver and this was contributing to your confusion (ie. hepatic encephalopathy). after the procedure your encephalopathy improved. you also underwent a paracentesis to remove fluid from your abdomen, and there was an infection so you were started on antibiotics. a repeat tap removed about 3l of fluid and showed that the infection had resolved. we have made the following changes to your medications: start: ciprofloxacin 500mg daily on to prevent recurrence of spontaneous bacterial peritonitis start: keppra 500mg twice daily decrease: spironolactone to 100mg daily decrease: lasix to 40mg daily followup instructions: please call to find a psychiatrist. this is extremely important and will be a prerequisite to being placed back on the liver transplant list department: transplant when: wednesday at 2:20 pm with: transplant clinic building: lm campus: west best parking: garage department: radiology when: thursday at 10:15 am with: cat scan building: cc clinical center campus: west best parking: garage department: neurosurgery when: thursday at 11:00 am with: , md building: lm campus: west best parking: garage procedure: angioplasty of other non-coronary vessel(s) percutaneous abdominal drainage insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) cranial or peripheral nerve graft insertion of one vascular stent procedure on single vessel diagnoses: anemia, unspecified alcoholic cirrhosis of liver acute kidney failure, unspecified other and unspecified alcohol dependence, in remission awaiting organ transplant status subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness bipolar disorder, unspecified home accidents spontaneous bacterial peritonitis unspecified viral hepatitis c with hepatic coma fall resulting in striking against other object 

Answer: The patient is high likely exposed to