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: massive hematemesis major surgical or invasive procedure: esophageal gastro-duodenoscopy transjugular intrahepatic portal-systemic shunt tube placement emoblization of gastric arteries history of present illness: 46 yo m with sleep apnea, gerd, asthma, no known hx of liver failure who presents hematemesis with bright red blood. he states 2 days prior to admission, he had brbpr and dark stools and felt pre-syncopal while sitting on a toilet as if things were "graying out". he however did not have any abdominal pain, nausea, vomiting at this time. he then went to work the day after and continued his daily desk job at an investment firm and did okay throughout the day. he after dinner then exactly at 9:10 pm began vomiting up a sink full of blood. he then felt extremely pre-syncopal in teh bathroom and may have had a period of syncope in the bathroom. his wife found him lying on the bathroom floor awake and called 911. he then got up and layed down on his bed. ems arrived at that time and he walked down the stairs and then was brought to the ed. his vitals on arrival were 98.8, 111, 108/64, 100% on ra. he then had 1.5l of bloody vomitus in the ed. his initial hct was 22 and he was given 2u of prbc and 2l of ns and his hct increased to only 25. he was transferred up to the icu urgently and gi plans doing a stat egd. . he states that he does not drink, no tobacco, does not use any nsaids/asa products. he does not have any hx of liver disease. stable gerd with diet control and prevacid. past medical history: gerd asthma osa social history: works, married, no tob, no etoh family history: none physical exam: temp 98.1, bp 133/84, hr 80, rr 21, o2 sat: 100% on 2l nc gen- lying in bed in nad, aaox3, obese heent- ng tube with bright red blood cv- tachy, regular, no m chest- ctab abd- soft, nt/nd, +bs ext- no edema bilaterally neuro- aaox3 pertinent results: 10:30pm blood wbc-8.5 rbc-2.59* hgb-7.7* hct-22.0* mcv-85 mch-29.7 mchc-35.0 rdw-16.5* plt ct-125* 02:40am blood wbc-7.2 rbc-2.98* hgb-8.9* hct-25.3* mcv-85 mch-29.8 mchc-35.0 rdw-15.0 plt ct-59*# 04:57am blood hct-29.1* 07:48am blood hct-28.1* 10:45pm blood wbc-16.8*# rbc-3.95*# hgb-12.0*# hct-32.7* mcv-83 mch-30.4 mchc-36.8* rdw-16.3* plt ct-118* 01:39pm blood hct-25.9* plt ct-61* 03:27am blood wbc-4.0 rbc-3.03* hgb-9.1* hct-26.7* mcv-88 mch-29.9 mchc-34.0 rdw-17.5* plt ct-131* 10:30pm blood pt-15.8* ptt-26.5 inr(pt)-1.4* 03:54am blood pt-15.6* ptt-32.1 inr(pt)-1.4* 11:30am blood fibrino-167 10:30pm blood glucose-216* urean-15 creat-0.9 na-141 k-3.6 cl-106 hco3-27 angap-12 03:01am blood glucose-120* urean-18 creat-1.0 na-143 k-3.6 cl-108 hco3-26 angap-13 03:27am blood glucose-129* urean-11 creat-0.7 na-142 k-3.3 cl-107 hco3-29 angap-9 10:30pm blood alt-29 ast-35 ld(ldh)-145 alkphos-59 totbili-0.9 02:00am blood alt-38 ast-53* alkphos-61 totbili-4.6* 10:54am blood dirbili-0.5* 03:30am blood alt-122* ast-177* alkphos-56 totbili-3.1* 03:30am blood alt-29 ast-48* totbili-1.2 10:30pm blood lipase-30 06:45pm blood probnp-150* 10:30pm blood albumin-3.2* calcium-8.4 03:54am blood calcium-8.5 phos-3.2 mg-2.0 08:23am blood iron-250* 08:23am blood caltibc-261 hapto-<20* ferritn-51 trf-201 03:30am blood hbsag-negative hbsab-positive hbcab-negative igm hav-negative 08:23am blood hbsag-negative hbsab-negative igm hbc-negative igm hav-negative 09:35am blood -negative 09:35am blood igg-1069 iga-361 igm-74 12:34am blood vanco-5.9* 05:09am blood type-art po2-139* pco2-54* ph-7.27* calhco3-26 base xs--2 06:42am blood type-art rates-18/ tidal v-650 peep-5 fio2-40 po2-104 pco2-39 ph-7.43 calhco3-27 base xs-1 -assist/con 01:58pm blood type-art po2-85 pco2-42 ph-7.46* calhco3-31* base xs-5 10:58pm blood lactate-2.5* 08:48am blood lactate-1.6 12:08am urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 12:08am urine color-yellow appear-clear sp -1.018 12:08am urine rbc-* wbc-0-2 bacteri-rare yeast-none epi-0 12:08am urine casthy-0-2 . tips procedure: impression: 1. successful placement of a tip using 10-mm x 94-mm wallstent. portosystemic gradient post-procedure was 7 mm h2o. 2. innumerous gastroesophageal varices are present, which were embolized by using 15 ml absolute alcohol and two 8-mm by 5-cm coils. the blood flow in the gastroesophageal varices has been decreased. . cxrs: starting on demonstrated mild vascular prominence, bibasilar opacities consistent with atelectasis, worsened over the week with addiotional fluid resuscitation. . : duplex dopplers: impression: 1. very coarse and echogenic liver consistent with chronic liver disease. 2. the portal vein is patent. however, the flow is slow and reversed. 3. the hepatic veins appear to be patent. . : ruq u/s: right upper quadrant ultrasound: limited study. there is a new tips in place. there is wall-to-wall flow demonstrated. the velocities are 18, 21, and 55 cm/sec in the proximal, mid and distal tips respectively. the hepatic veins and arteries are patent. the portal vein could not be imaged. impression: wall-to-wall flow within the tips, with slow velocities as described above. this could be related to the immediate post-procedure period, however, short interval follow up is recommended to ensure patency. . tips u/s: tips ultrasound: a tips is patent. there is wall-to-wall flow inside the tips. the main portal vein is patent. there is normal direction of flow in the main portal vein. the blood flow velocity in the main portal vein is 50 cm/sec which is adequate. there is no velocity gradient through the tips. the flow velocities in the tips are as follow: proximal tips 88 cm/sec. mid tips 115 cm/sec, and distal tips 930 cm/sec. the left portal vein was adequately imaged and there is reversed flow. impression: tips is patent with satisfactory flow velocities. no evidence of tips dysfunction. . echo : conclusions: the left atrium is moderately dilated. there is severe symmetric left ventricular hypertrophy. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef 80%). right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the number of aortic valve leaflets cannot be determined. the aortic valve is not well seen. there is no valvular aortic stenosis. the increased transaortic gradient is likely related to high stroke volume. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is no pericardial effusion. brief hospital course: 46 yo m with hx of gerd, asthma who presents with ugib, syncope. . # variceal bleed with blood loss anemia and hemorrhagic shock: patient presented with large amounts of hematemesis and pre-syncope. on arrival to the icu, he began vomiting ~2l of bright blood briskly. he had an emergent egd secondary to concern for variceal bleed with questionable nash given obesity. he was resuscitated with 7 units of prbcs and 2u of ffp. he was given unasyn iv x 1 and an octreotide bolus and drip were started given variceal bleeding. he had 3 large bore ivs in place. during the egd, he continued to have brisk hematemesis and bleeding varices were found. however, due to severe bleeding, the egd was terminated early and a decision was made to take him to the or for intubation and placement of a tube. after the was placed, the gastric balloon was inflated to 40 and the position in the stomach was confirmed by fluoro in the or. the patient was subsequently taken for embolization by ir, with etoh and coil embolization of varices. he continued to have a large amount of bleeding and an emergenct tips procedure was performed. u/s with dopplers was initially questionable for proper flows, however repeat u/s showed good flows s/p tips. the bleeding stabilized after a total of 12 units of prbcs. his hct remained stable, and the octreotide was discotinued and tube was removed. a dophoff tube was placed nasogastrally and tube feeding initiated without any recurrence of bleeding. . # resp failure: the patient was found to have a lll infiltrate initially on admission, completed 10 day levo course, also started on flagyl on admission, subsequently found to have c.diff in stool. plan to continue flagyl for additional 14 days (until ) for c.diff. - sedated on fentanyl, versed, took several days for sedation to wear off. pt was extubated on without any difficulty - he was about 10l positive after extensive fluid resuscitation, required lasix and diuril to remove the fluid, diuresed approximately 1-2 l daily. pt orthostatic once getting out of bed, likely long period of inactivity, stopped agressive diuresis. patient may remain fluid overloaded given suggestion of diastolic chf in presence of hyperdyamic ef on echo, although difficult to assess clinically. . # fevers: - pt continued to have high fevers on levo, flagyl, known sources included klebsiella pneumonia, c.diff colitis. he completed a 10 day course of levofloxacin, continue flagyl for additional 14 days. central lines were removed, no evidence of line infection. pt was also clinically felt to have sinusitis related to nasal intubation given presence of purulent nasal secretions. he defervesced after extubation. . # cirrhosis: - no significant hx of etoh, thought to be nash. hep b serology c/w previous vaccination, neg hep c, hep a - possible liver bx in the future, f/u with hepatology as outpt - echo revealed hyperdynamic left ventricular systolic function (ef 80%) - inr elevated initially, responded to po vitamin k. - started on rifaximin and lactulose for prophylaxis s/p tips, titrate to bms daily . #ppx - protonix twice daily, sc heparin . #fen: started on a soft diet after extubated, iniatially on tube feeds via dophoff gastric tube, repleted lytes prn . # acceess: r arterial line replaced . picc placed . . # full code . #contact - wife, cell: medications on admission: prilosec albuterol advair discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 2. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day). 3. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). 4. flagyl 500 mg tablet sig: one (1) tablet po three times a day for 12 days. tablet(s) 5. albuterol 90 mcg/actuation aerosol sig: one (1) inh inhalation twice a day as needed for shortness of breath or wheezing. discharge disposition: extended care facility: - discharge diagnosis: variceal bleeding cirrhosis obstructive sleep apnea discharge condition: stable discharge instructions: please follow-up with your primary care doctor after your rehabilitation. a follow-up appointment with your liver doctor to discuss further treatment plans. you were admitted with large amounts of bleeding requiring multiple invasive procedures to stop this bleeding. please take your lactulose and rifaximin every day in order to prevent toxins from building up as your liver will not clear them fully. do not hesitate to seek medical attention if you develop lightheadedness, dark or bloody stools, nausea, vomiting or any other concerning symptoms. followup instructions: please follow-up with your primary care physician your liver doctor an appointment in weeks. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization endoscopic excision or destruction of lesion or tissue of esophagus transcatheter embolization for gastric or duodenal bleeding transfusion of packed cells other irrigation of (naso-)gastric tube transfusion of other serum transfusion of platelets injection of anesthetic into spinal canal for analgesia intra-abdominal venous shunt insertion of sengstaken tube diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux congestive heart failure, unspecified cirrhosis of liver without mention of alcohol acute posthemorrhagic anemia acquired coagulation factor deficiency unspecified septicemia severe sepsis portal hypertension asthma, unspecified type, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus other shock without mention of trauma intestinal infection due to clostridium difficile morbid obesity esophageal varices in diseases classified elsewhere, with bleeding varices of other sites pneumonia due to klebsiella pneumoniae other chronic nonalcoholic liver disease acute sinusitis, unspecified 

Answer: The patient is high likely exposed to