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: c. perfringens bacteremia major surgical or invasive procedure: intubation/extubation history of present illness: 51yo m pmhx polysubstance abuse, strep viridans endocarditis s/p st. mvr on coumadin, etoh and hcv cirhosis c/b ascites, prior gi bleeds (without known varices) initially presenting to osh from addiction for pancytopenia (wbc 1.1, hct 26, platelets 54), was found to be hypotensive (sbp80s) with strongly guaiac positive stools; he was started on octreotide and famotidine gtts with stabilization of hct in the upper 20, low 30s; also found to have low grade fevers, with blood cultures growing out gprs (clostridium perfringens, one of two bottles), for which he was treated with ciprofloxacin, clindamycin; source of bacteremia was felt to be cholecystitis based on exam and ct imaging that demontrated pericholestatic fluid, gallbladder wall thickening; patient was trasferred to for further surgical management on . patient was admitted to sicu. on further questioning patient endorsed ~3wks melena and nosebleeds prior to admission, also reported sharp, constant periumbilical pain, withut nausea/vomiting/constipation/diarrhea. regarding concern for cholecystitis, patient abx changed to vanco/zosyn per id recommendations, but then had hida scan w/o evidence of cholecystitis, edematous gallbladder attributed to ascites; given bacteremia had tte that did not demonstrate any signs of acute valvular pathology, but did demonstrate severe as. patient had heparin drip initiated for subtherapeutic inr. hepatology service was consulted given patient's cirrhosis. . remainder of sicu course was remarkable for continued fevers, hypotension requiring levophed drip and development of acute respiratory distress , o2sat high 80s, low 90s on nrb. patient was intubated for hypoxic respiratory failure (abg 7.30/53/63). cxr demonstrated bibasilar opacities, concerning for aspiration pna. as source of fevers/hypotension remained uncertain, patient's abx were broadened to meropenem and vancomycin. on day of transfer, patient underwent bronch without clear findings (no cultures sent). . on transfer to micu, the patient remained intubated and sedated, with piv, triple lumen , , flexiseal, foley in place. given patient intubated, unable to perform perform review of systems. past medical history: - hepatitis c and alcohol cirrhosis complicated by ascites, gi bleeds, unknown varices history - mitral valve repair (st. jude's valve) in for strep viridans bacterial endocarditis - cocaine abuse (clean for 8 years) - hepatitis c - positive anca/ - gerd - hypertension social history: works in construction. denies unprotected sex or for money/drugs. last hiv 6 months ago. currently homeless and living with his sisters, " to ." stays on the streets during the days, sisters at night. - tobacco: 1ppd > 25 years - alcohol: abuse in the last six months - illicits: cocaise use 8 years ago, no current ivdu family history: mother deceased at unknown age, father deceased at 73yo of mi, 7 sisters with one recently deceased from ?cva at age 45yrs. physical exam: on transfer to micu vitals: t 100.7 bp 122/62 hr 74 rr 26 sat 98%/vent fio2 40% general: intubated, sedated. not following. heent: sclera anicteric, mmm. neck: jvp not elevated. lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, ii/vi midsystolic murmur at rusb. abdomen: bowel sounds absent, distended, cannot assess tenderness in setting of sedation, +diffuse guarding gu: foley in place. +rectal. ext: warm, well perfused, 2+ pulses . discharge exam: avss nad, no longer jaundice rrr 2/6 sem abd mild distended, non-tender extr: 1+ pretibial edema pertinent results: bcx x2 ngtd bcx x2 ngtd bcx x2 ngtd bcx x2 ngtd bcx fungal and afb cultures ngtd stool cdiff tox and fecal cultures negative catheter tip negative urine , 16, 17 negative sputum gram stain and cultures negative . ruq: 1. essentially no significant change in comparison to prior study from . markedly thickened gallbladder wall with gallstones within the gallbladder lumen. given the patient's history of cirrhosis, the gb wall thickening is likely related to patient's underlying liver disease. 2. moderate ascites. 3. stable right pleural effusion. 4. splenomegaly. . cxr: cardiac size is normal. the aorta is tortuous. small bilateral pleural effusions, larger on the right side, are grossly unchanged with associated left greater than right lower lobe atelectasis. left picc tip is at the cavoatrial junction. there is no pneumothorax. cardiac size is normal. brief hospital course: hospital course 51yo m pmhx strep viridans endocarditis s/p st. mvr, cirhosis p/w gib, admitted with bacteremia, hypotension, course complicated by respiratory failure and intubation, who was subsequently extubated and transferred to general medicine floor. # c. perfringens bacteremia: per id, likely gi source, although no signs biliary obstruction on ct scan, and no evidence cholecyctitis on hida. diagnostic paracentesis was negative for sbp and tte neg for endocarditis. pt remained stable on meropenem/vanco but spiked fever once to 100.9 on general medicine floor. repeat blood cultures at that time were negative, repeat ruq u/s was unchanged, and attempt to repeat paracentesis was unsuccessful due to lack of tappable pocket. no further fever spikes were recorded and pt reported feeling well and denied subjective fevers. he remained stable and afebrile after this and received a 14d total course of vanc and meropenem, which was discontinued the morning of . # aspiration / hcap: pt w aspiration event in icu resulting in hypoxic respiratory failure leading to intubation; patient had initially been covered w zosyn/vanco for above bacteremia, then broadened with respiratory distress / fever episodes. he was extubated without issues and was weaned to room air on the general medicine floor. he continued to have a productive , but had no oxygen requirement on the general medicine floor. he was placed on nebs for a short course due to mild wheezing on exam, but denied shortness of breath throughout the rest of his hospital stay. he spiked one fever to 100.9 while on the floor but no cause was identified (see above). he finished a 14d total course of vancomycin/meropenem and reported significant improvement in breathing and by the time of discharge. #pancytopenia: chronic process per osh records, likely chronic cirrhosis; received 1 dose neupogen in sicu w rise in anc >1000. started on multivitamin and folate daily for anemia. arranged for outpatient follow up with liver specialist. #s/p mvr: pt has a mechanical valve with inr goal 2.5-3.5. he was started on a heparin drip to bridge coumadin. inr became supratherapeutic and coumadin was held until inr reached 1.7, after which coumadin was restarted at 2mg po daily. he will require outpatient follow up at coumadin clinic to follow up steady state levels on . #aortic stenosis: present on osh tte , now 0.8. pt was initially euvolemic but began to develop pitting edema in le bilaterally around , so spironolactone was started, as process was thought most likely secondary to liver disease. le edema continued to worsen and pt continued to have , a repeat cxr on was done which showed stable pleural effusions and no pulm edema. pt denied chest pain and was able to ambulate well on floor, so no further action was taken to address as and pt was arranged for outpatient follow up with cardiologist. #hcv/etoh cirrhosis: pt w cirrhosis c/b ascites. he was continued on thiamine, folate, mvi, and lactulose while in house. ascites was tapped at time of fever on admission and was negative for sbp. ascites remained stable throughout admission and had improved mildly at the time of discharge. pt began to develop pitting edema in the le bilaterally on and was started on spironolactone 100mg po daily with good diuresis. le edema initially worsened, then improved once patient started ambulating and mobilizing peripheral fluid. # guaiac pos stool - pt w guaiac pos brown stool on admission. hct remained stable throughout admission. he was continued on protonix, with plans to follow up with gi as an outpatient for egd and colonoscopy. ***note: patient departed from hospital before being given prescriptions, discharge instructions and follow up appointment dates, despite being instructed multiple times that he needed to wait for this before leaving. he could not be reached by phone. we faxed his prescriptions to his pharmacy, informed his pcp, faxed copies of his discharge summary to his pcp and cardiologist.*** transitional issues - studies pending on discharge: blood cultures (from ) - will need labs (cbc with diff, coags, electrolytes) drawn on - cardiologist should determine when to restart lisinopril - recommend gi appointment for egd and colonoscopy to follow up on guiac+ stool : . 1cm nodule within the right middle lobe, this may be infectious. would recomend follow up in 3 months or when current clinical situtation resolves.]] medications on admission: lisinopril 10mg daily omeprazole 20mg daily folic acid 1mg daily lisinopril 10mg daily warfarin 6mg daily trazodone 150mg qhs iron 65mg 2 tabs daily magnesium oxide 400mg vitamin c discharge medications: 1. multivitamin tablet sig: one (1) tablet po daily (daily) as needed for vitamins. disp:*30 tablet(s)* refills:*0* 2. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain,fever. 5. trazodone 150 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. disp:*30 tablet(s)* refills:*0* 6. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po bid (2 times a day) as needed for constipation: take as needed to have bm per day. disp:*1 bottle* refills:*2* 7. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for pain: apply for 12 hours a day, then remove for 12 hours. disp:*30 adhesive patch, medicated(s)* refills:*0* 8. hydrocortisone 0.5 % cream sig: one (1) appl topical tid (3 times a day) as needed for itching: apply to neck rash as needed for itching. 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 10. magnesium oxide 400 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 11. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. warfarin 1 mg tablet sig: three (3) tablet po once a day. disp:*90 tablet(s)* refills:*0* 13. hydrocortisone 0.5 % cream sig: one (1) application topical tid prn (as needed) as needed for neck itching: apply topically as needed 3 times a day for neck rash itching. disp:*1 tube* refills:*2* 14. outpatient lab work please draw cbc with differential, coagulation panel (pt, inr, ptt) and chem 10 on thursday, and fax results to dr. (fax # ) discharge disposition: home discharge diagnosis: primary diagnosis: clostridial bacteremia aspiration pneumonia / healthcare-associated pneumonia aortic stenosis secondary diagnoses: hcv/alcoholic cirrhosis mechanical mitral valve 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: thank you for letting us take part in your care at . you were transferred to our hospital because you had bacteremia, which is an infection in your blood. you also had pneumonia and required a short period of intubation due to respiratory distress. you were extubated when your breathing was stable and treated with antibiotics for both the bacteremia and pneumonia. an echocardiogram was done on your heart because to ensure your mechanical valve had not become infected by the bacteria in your blood (endocarditis). it did not show endocarditis, but did show that your aortic valve was very narrow (stenosed). you should follow up with your cardiologist to further evaluate this. you should continue your coumadin at 3mg daily for now and have your levels checked on wednesday. your doctor will adjust the dose according to the level. while you were here, you developed swelling in your legs and had fluid in your abdomen called ascites. this is common in patients with liver disease. we have arranged an appointment with a liver specialist for you to help you manage the swelling and discuss treatment options for liver disease. you may also need an egd, which is a test requiring a camera to look into your esophagus, to look for any bleeding because your blood counts were low. you were seen by physical therapy who recommended that you use a rolling walker until you are feeling stronger. we encourage you to use the walker and take short walks with it 3 times per day. the following changes were made to your medications: started: --multivitamin 1 tab by mouth daily --thiamine 100mg by mouth daily --spironolactone 25 mg by mouth daily --hydrocortisone cream 0.5% apply topically three times a day as needed for neck rash for itching --lactulose 15 ml by mouth twice a day as needed for constipation (take as needed to have bowel movements per day) changed: --warfarin 3mg by mouth daily (your dose may be adjusted according to your inr level; please continue to have your level monitored as you have been doing previously) stopped: --lisinopril 10mg by mouth daily please discuss with your cardiologist (dr. when you should start taking lisinopril again. please have your blood drawn on wednesday, (cbc with differential, coagulation panel (pt, inr, ptt), liver function tests (ast, alt, bilirubin) and chem 10) and have the lab fax results to dr. (fax # ) please attend the follow up appointments listed below to follow up on your hospitalization. your primary care doctor will also make you an appointment with a liver doctor for the near future. followup instructions: name: prior, s. location: community health center of address: , , phone: appt: at 4:20pm ***its recommended you see a liver doctor for your cirrhosis issues within 2 weeks of discharge. please discuss with dr setting up an appt with one in your area. name: , address: , , phone: appt: thursday, at 12:45pm procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube other bronchoscopy arterial catheterization central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified esophageal reflux tobacco use disorder unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified viral hepatitis c without hepatic coma aortic valve disorders sepsis alcohol abuse, unspecified heart valve replaced by other means acute respiratory failure pneumonitis due to inhalation of food or vomitus blood in stool long-term (current) use of anticoagulants septicemia due to anaerobes other and unspecified coagulation defects lack of housing calculus of gallbladder with acute cholecystitis, without mention of obstruction cocaine abuse, in remission 

Answer: The patient is high likely exposed to