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: roxicet / penicillins / aspirin attending: chief complaint: abdominal pain, epistaxis major surgical or invasive procedure: interventional radiology coil embolism of bilateral internal maxillary arteries. history of present illness: patient is a 52 year old male with past medical history of throat and neck cancer status-post trache and peg, cirrhosis, and recent septic arthritis, who presents with several days of diarrhea and inability to maintain intake via peg. his wife relates that starting on saturday evening () patient began to have some diarrhea. she gave the patient gatorade via his peg, as this has worked well in similar situations in the past. he then developed mild abdominal cramping, but this progressed to more constant abdominal pain, especially in the epigastric region, over the last two days. the patient was unable to tolerate his tube feeds or even gatorade. today he developed an episode of emesis, which was the only occurrance of his since his tracheostomy. after the emesis, and due to his pain and inability to tolerate po's via his peg, he sought medical attention. . his wife reports that he has mainly had watery diarrhea with some mucous, no blood. . in the ed, his initial temperature was 97.1, hr 71, bp 180/112, rr 20, 99% on room air. he was given iv dilaudid for the pain, zofran, 1 l of d5ns, labetolol 20 mg and then 30 mg iv, levofloxacin 750 mg iv x1, and flagyl 500 mg iv. a ct abdomen/pelvis and cxr were completed. . upon arrival to the floor, patient reports that his pain is much improved and minimal at present. he did have one more episode of emesis which the patient denied leaving through his trach tube. past medical history: past medical history: 1. squamous cell cancer vallecula/tonsillar, x 2, s/p trach, peg, xrt, chemo, possible recurrence noticed on recent pet, but decision to wait until for further eval given good functional status at present. 2. liver cirrhosis secondary to etoh, complicated by splenomegaly, esophageal varices (last egd with grade 1 varices) with prior bleeding. prior hepatic encephalopathy. 3. reported history of portal vein thrombosis, though i can not find when this happened. most recent ct abdomen without thrombosis, mri in with normal flow. no current anticoagulation. 4. seizure disorder, last seizure >2 years ago. 5. chronic pancreatitis secondary to etoh. 6. status post g-tube placement 7. status post tracheostomy 8. history of multidrug resistant klebsiella, mrsa 9. psoriasis social history: he lives at home with his wife. is ambulatory. former alcohol use, no tobacco. family history: brother died of mi at 34. physical exam: vs: 96.7 152/90 64 20 98% on 35% general: chronically ill appearing male, in nad, comfortable. heent: dry scaling skin over face, forehead. mucous membranes dry. no oral lesions. no scleral icterus or conjunctival pallor. neck: trach in place, on lesions, neck supple. cardiac: rrr, s1, s2, no m/g/r appreciated lungs: bronchial breath sounds diffusely throughout (may represent upper aitway secretions), slightly decreased at bases. no wheezes, rales. abdomen: peg in place- site without erythema. mild tenderness to deep palpation in the epigastric region. no rebound tenderness, no guarding, no distension. +bs. no shifting dullness. extr: warm, scaling white plaques over knuckles of left hand. dp/pt/radial 2+ bilaterally. neuro: a&ox3, was only able to nod yes or no. pertinent results: 04:00pm blood wbc-6.3# rbc-3.83* hgb-12.4* hct-32.9* mcv-86 mch-32.3* mchc-37.7* rdw-15.4 plt ct-130* 07:45am blood wbc-11.5*# rbc-4.06* hgb-12.7* hct-35.0* mcv-86 mch-31.3 mchc-36.4* rdw-15.6* plt ct-155 04:00pm blood neuts-90.3* lymphs-5.2* monos-3.9 eos-0.5 baso-0.1 04:00pm blood glucose-119* urean-10 creat-0.7 na-126* k-3.6 cl-90* hco3-23 angap-17 02:00am blood glucose-124* urean-12 creat-0.7 na-125* k-3.8 cl-90* hco3-24 angap-15 08:10pm blood glucose-99 urean-13 creat-0.8 na-124* k-3.6 cl-84* hco3-26 angap-18 07:45am blood glucose-97 urean-21* creat-1.0 na-122* k-3.7 cl-89* hco3-22 angap-15 04:00pm blood alt-24 ast-37 alkphos-311* totbili-1.0 04:00pm blood albumin-4.3 02:00am blood calcium-9.0 phos-3.0 mg-1.7 uricacd-3.4 02:00am blood osmolal-256* 02:00am blood tsh-11* 10:55am blood free t4-0.93 04:12pm blood lactate-1.1 11:15pm blood lactate-1.6 07:15am blood glucose-88 urean-22* creat-0.8 na-131* k-3.6 cl-99 hco3-22 angap-14 04:08pm blood glucose-92 urean-26* creat-1.2 na-127* k-3.9 cl-90* hco3-26 angap-15 .ct abdomen: 1. subtle wall thickening of the transverse and descending colon, which may be due to hypo-albuminemia versus early colitis. 2. cirrhosis with inhomogeneous liver enhancement, can not exclude underlying liver lesions. 3. new small amount of perisplenic fluid. 4. splenomegaly and esophageal varices consistent with portal hypertension. cxr: : new density in the left lower lobe is suggestive of a focus of pneumonia. please ensure followup to clearance. . cxr: findings: in comparison with the study of , there is again small area of increased opacification at the left base that could represent a developing pneumonia. right lung and upper portion of the left lung are clear. tracheostomy tube is in place. . gi tube check: impression: expected position of g-tube. brief hospital course: assessment and plan: patient is a 52 year old male with past medical history of throat cancer and cirrhosis who presents with several days of loose watery stools and inability to tolerate po's. . # diarrhea: resolved. initially, his differential included a viral gastroenteritis, c. difficile given recent antibiotic use for extended period, obstruction, ischemic, among other causes. he did not have significant ruq tenderness to suggest cholangitis, or rlq tenderness to suggest appendicitis. he has had no sick contacts, travel, or unusual food consumption. ct ruled out obstruction, demonstrated colitis. we initially held his lactulose and made him npo. since his admission he did not have any diarrhea. on , we added back his lactulose and he had two episodes of loose. a c. difficile screen was sent, which was negative. a stool culture sent was pending at time of discharge. on , we restarted his tube feeds, albeit slowly. he was given reglan and zofran for nausea. . of note, the pt had crampy abdominal pain on admission. his chronic pain medication was increased to dilaudid 1mg q3hrs. we consulted hepatology to see if his cirrhosis and chronic pancreatitis could be contributing to his pain, nausea, vomiting, and diarrhea. they suggested that this likely represents gatroenteritis and recommended bowel rest. if the diarrhea and vomiting were not to improve they suggested an egd and colonoscopy. . # lung opacity: no history of worsening secretions, cough, rigors. suspect that patient likely aspirated in setting of emesis, as wife reports emesis in patient's mouth as well as in trache. no rales or significant areas of dullness on lung exam. there may have been some pneumonitis. the cxr on showeds evolving opacification concerning for pna. his legionella ab was negative. he was initially started on levofloxacin iv, but switched to po as the patient tube feeds were resumed. in retrospect, a lower lobe aspiration pneumonia could cause upper gi symptoms such as nausea and vomiting. he will be dicharged on a 10 day course of levaquin. . # hypertension: per wife, baseline bp is usually 85-110's systolic. his initial sbp was in the 150s-170s, but a large degree of this was secondary to pain and discomfort. in the ed, he was given one dose of 10mg labetalol. when his pain and gastrointestinal symptoms resolved, his bp hovered in the 110s-130s. of note, when he was fluid restricted overnight, he had an episode of hypotension to 90s/60s, which resolved with one 500cc bolus of ns. at time of discharge his bp is well controlled in the 100-110's/70-80. . # hyponatremia: patient's sodium at admission was 126 (with a baseline appears in the low 130s) initially, we thought that this could be due to dehydration to emesis and diarrhea and history of stopping his tube feeds. he was given 2l of fluid overnight and was found to have a na of 122 in the am on hd#1. his urine osms at the time was 557 with a una of 119. after consulting with renal, they felt that his hypona could be a result of siadh. we started him on strict fluid restrictions with his na improving to 124. however, on hd#2, his na was 122 and the pt had one episode of hypotension as stated above. we started him on maintenace fluids and ordered 1g salt tabs tid. over the course of hd#2, his na improved to 127. with more fluid restriciton, his na improved to 131. therefore, he could have been dehydrated in the setting of underlying siadh. hyponatremia resolved over the ensuing days and was in the normal range at time of discharge . #chronic pancreatitis: stable. . # cirrhosis: does not appear de-compensated at present. no fevers or significant ascites to suggest sbp, but this would be consideration if he were to have developed a fever. his lfts appear to be at baseline. we continued nadolol given history of varices. we initially held lactulose in setting of diarrhea, but restarted once diarrhea had resolved. . # pain: patient on po dilaudid solution at home, not available here. he responded well to iv dilaudid 1mg q3hrs during his hospital course. see pain management as above. abdominal pain improved since admission. abdominal pain continued to improve after transfer to the floor and at time of discharge the patient had no abdominal pain. . # seizure disorder: we continued home medications of keppra and neurontin. . # hx throat/neck cancer: we continue maintanence medications (nystatin, bactroban, nebs, scopolamine patch, etc). . # hypothyroidism: his tsh was elevated on admission. though his free t4 was wnl, we felt that he may still be hypothyroid. therefore, we doubled his dose of levothyroxine to 50mcg qd. he will followup with his pcp re his thyroid hormone . # fen: hyponatremia as discussed above. restarted tube feeds slowly . patients diet was advanced from continuous to bolus feeds per his home regimen. the patient was administering his own feeds at the time of discharge . # ppx: hep sq, on home ppi, no need for bowel regimen. hospital summary from through mr. was transferred to the east surgical service on when a ct scan of his abdomen show minimal free air under the left hemidiaphragm and pneumatosis of the right colon. he was afebrile and hemodynamically stable. his initial lactate was 0.9 and his wbc was 4.5. he had no complaints of abdominal pain and was nontender on physical examination. due to his ct findings and concerns for the need for an urgent operation he was transferred to the east surgical service under the care of dr. for close monitoring. he was also started on broad spectrum antibiotics. he continued to remain pain free and nontender on examination over the next 3 days. serial lactates remained normal. wbc remained normal. on he developed profuse epistaxis that resolved with packing and compression. he had a repeat nosebleed later that evening. his hematocrit remained stable, but his inr increased from 1.4 to 4.1. he was transferred to the icu for close monitoring. ent was consulted and packing was placed in both nares. he was sent to angiography where his bilateral internal maxillary arteries were both coiled. his bleeding subsequently stopped and he was transferred to the ent service for further management as his abdominal issues had resolved. hospital course : a heme-onc consult was obtained to address his coagulopathy on the night of his icu admission. it was felt that the etiology of his clotting disorder was multi-factorial and likely related to a combination of underlying liver disease, antibiotics, pneumonia, and nutritional deficiency. they recommended checking labs frequently and maintaining hgb>10 and platelets >50. the patient recieved prbc's on two occasions for low hgb/hct while on the ent service. the epistat packings remained in his nose for 2 days after the coiling at which time they were removed and replaced with surgicell absorbable packing. the patient was kept in the icu overnight for observation to assure he had no rebleeding. his lytes, cbc, and coags were checked frequently to assure that he had no continued issues. he was transferred to the floor 24 hours after having the epistats removed. once on the floor his labs continued to be checked, his tube feeds were advanced and his pain medication was administered. a pt consult was ordered for clearance to home with services. pt saw the patient and determined that he was safe to d/c home with his previous level of home services. the patient had no reoccurence of his acute bleeding and his lab values were at unchanged since his transfer from the icu to the floor. he continued to expectorate a small amount of rust colored sputum from his tracheostomy, but did not require more than 1 or 2 suctions a day. at the time of discharge, the patient was administering his own bolus tube feedings, ambulating without assistance, voiding without difficulty, using humidified oxygen via his trach mask, and his pain was well controlled via narcotics administered via his g-tube. lastly, his wife was given additional training in appropriate trach care and suctioning per her request. medications on admission: 1. gabapentin 250 mg/5 ml solution : one (1) po tid (3 times a day). 2. levetiracetam 100 mg/ml solution : fifteen (15) ml po bid (2 times a day). 3. ipratropium-albuterol 18-103 mcg/actuation aerosol : puffs inhalation q6h (every 6 hours) as needed. 4. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) as needed. 5. nadolol 20 mg tablet : one (1) tablet po daily (daily). 6. lorazepam 0.5 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for anxiety. 7. metoclopramide 5 mg/ml solution : five (5) mg injection qid (4 times a day) as needed. 8. mupirocin calcium 2 % cream : one (1) appl topical (2 times a day). 9. levothyroxine 25 mcg tablet : one (1) tablet po daily (daily). 10. scopolamine base 1.5 mg patch 72 hr : one (1) patch 72 hr transdermal q72 h (). 11. clobetasol 0.05 % ointment : one (1) appl topical (2 times a day). 12. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 13. lactulose 10 gram/15 ml syrup : thirty (30) ml po three times a day. 14. dilaudid-5 1 mg/ml liquid : po q 4hrs prn as needed for pain. discharge medications: 1. gabapentin 250 mg/5 ml solution : one (1) po tid (3 times a day). 2. levetiracetam 100 mg/ml solution : fifteen (15) ml po bid (2 times a day). 3. ipratropium-albuterol 18-103 mcg/actuation aerosol : puffs inhalation q6h (every 6 hours) as needed. 4. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) as needed. 5. nadolol 20 mg tablet : one (1) tablet po daily (daily). 6. lorazepam 0.5 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for anxiety. 7. metoclopramide 5 mg/ml solution : five (5) mg injection qid (4 times a day) as needed. 8. mupirocin calcium 2 % cream : one (1) appl topical (2 times a day). 9. scopolamine base 1.5 mg patch 72 hr : one (1) patch 72 hr transdermal q72 h (). 10. clobetasol 0.05 % ointment : one (1) appl topical (2 times a day). 11. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 12. lactulose 10 gram/15 ml syrup : thirty (30) ml po three times a day: hold for >3 bowel movements per day. 13. dilaudid-5 1 mg/ml liquid : po q 4hrs prn as needed for pain. disp:*960 ml* refills:*0* 14. levothyroxine 50 mcg tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 15. sodium chloride 0.65 % aerosol, spray : sprays nasal (2 times a day). disp:*1 bottle* refills:*2* 16. dilaudid 4 mg tablet : 1-1.5 tablets po every four (4) hours as needed for pain. disp:*20 tablet(s)* refills:*0* 17. zofran 4 mg/5 ml solution : ml po every eight (8) hours as needed for nausea. disp:*300 ml* refills:*0* discharge disposition: home with service facility: americare at home inc discharge diagnosis: gastroenteritis pneumonia vomiting diarrhea abdominal pneumatosis epistaxis discharge condition: hemodynamically stable, tolerating tube feeds, afebrile discharge instructions: you were admitted with a complaint of vomiting and diarrhea. over the course of your hospital stay, your diarrhea resolved as did your vomiting. these may have been caused by a viral gastroenteritis or as a consequence of a lower lobe pneumonia. a chest x-ray showed signs of a pneumonia, which may have started when some emesis was aspirated into the respiratory system. we started you on an antibiotic, levofloxacin. at this time you have completed an adequate course of antibiotics and do not require additional antibiotics. you were also observed for a lower sodium level. it initially trended down, but by discharge it has normalized. we just ask that you talk to your primary care provider about your sodium levels. during the admission we increased your dose of levothyroxine to 50mcg every day since we felt that you levels of thyroid hormone were a little low. please talk to you primary care doctor regarding this change as well. epistaxis (nose bleeding): you had a large amount of bleeding from your nose that was stopped using a combination of intranasal packing and also embolism of the bleeding arteries by our interventional radiologists. in addition, you were seen by our hematology-oncology department for a change in your blood coagulation levels. this was felt to have contributed to your bleeding and you were given blood products to help treat the clotting abnormalities. at this time your studies are at baseline. an absorable packing was placed in your nose after removal of the other packing to help prevent rebleeding at the site, please be aware that these packings may increase mucous output from your nose until they dissolve. you may also notics a some small blood streaking in your mucous. this is completely normal. if you start to have larege bleeding of bright red blood again, spray both nostrils with afrin and hold pressure for a few minutes to see if the bleeding stops. if it does not, call dr. office or come to the emergency room for evaluation. please return to the emergency room if you develop a fever >101.5, have severe vomiting or diarrhea, increased shortness of breath, chest pain, increasing abdominal pain, inability to tolerate your tube feeds, or for any other symptoms that concern you. followup instructions: please call dr. office for a followup appointment after discharge within a week after discharge ( primary care provider: fern, rnc phone: date/time: 10:40 please have your pcp obtain chest x-ray in 4 weeks and followup regarding your low sodium (now resolved), thyroid hormone, and pneumonia (also resolved) (next appointment with dr. . provider: , md phone: date/time: 8:15 provider: , m.d. phone: date/time: 10:40 provider: , md, phd: date/time: 2:30 procedure: enteral infusion of concentrated nutritional substances arteriography of cerebral arteries control of epistaxis by anterior nasal packing endovascular (total) embolization or occlusion of head and neck vessels diagnoses: unspecified essential hypertension alcoholic cirrhosis of liver portal hypertension unspecified acquired hypothyroidism pneumonitis due to inhalation of food or vomitus epilepsy, unspecified, without mention of intractable epilepsy dehydration esophageal varices in diseases classified elsewhere, without mention of bleeding chronic pancreatitis other disorders of neurohypophysis other psoriasis epistaxis gastrostomy status tracheostomy status intestinal infection due to other organism, not elsewhere classified other specified disorders of peritoneum 

Answer: The patient is high likely exposed to