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: penicillins attending: chief complaint: weakness major surgical or invasive procedure: none history of present illness: history of present illness: mr. is a 49 year old man with a past medical history signifcant for alcoholism, depression, and a question of kidney and liver disease who was transferred from an outside hospital where he had presented with lightheadedness after a fall. he describes that 3 days ago he experienced left sided rib pain following syncope and a fall down stairs. this left sided flank pain prompted him to go to the er, where he was found to be in renal failure with a cre 9 and low k and mg, and a na of 130. his electrolytes were repleted and he was transferred to . he reportedly has been making normal urine volumes. on arrival to the ed, he complained of rib pain but per report was a poor historian. a head ct scan failed to reveal acute pathology and a ct abdomen revealed fat stranding around the pancreas and no hydronephrosis. in addition, he was found to have a 9th and 10th posterolateral left rib fractures. in the ed, he was be hypotensive to sbps in the 80s which persisted despite 4l of fluid boluses. a left subclavian cental catheter was placed to insure iv access. he required levophed for at 0.03mcg/kg/min to maintain an sbp in the 100s. he was then transfered to the micu. on arrival to the micu, he was found to be luicd and able to give an account of his medical history and recent event. he was still complaining of left sided rib pain but was otherwise asymptomatic. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies 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: htn depression tobacco use "?kidney problems" "?liver problems" social history: lives alone in apt. drinks alcohol daily 4-5 drinks for ~20 yrs. smokes 1 ppd. denies any other illicits. recently unemployed in as an automechanic. completed hs and college. has always worked as automechanic. married with 2 kids, separated 7 yrs ago, still sees them however. is close to his sister and (sister lives down the street from him). wishes to pursue aa. family history: non-contributory physical exam: physical exam: vitals: t:97.3 bp:106/71 p:84 r:13 o2:95% on ra general: alert, oriented, no acute distress answering question appropriately heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: left sided flank tenderness, abodmen is soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley draining clear yellow urine ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 11:53pm lactate-1.1 11:50pm glucose-98 urea n-50* creat-6.3*# sodium-135 potassium-3.6 chloride-103 total co2-20* anion gap-16 11:50pm ctropnt-<0.01 11:50pm wbc-8.5 rbc-2.31* hgb-8.2* hct-23.5* mcv-102* mch-35.5* mchc-34.8 rdw-17.7* 11:50pm plt count-224 11:50pm pt-13.2 ptt-33.6 inr(pt)-1.1 10:37pm urine blood-tr nitrite-neg protein-25 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 10:37pm urine rbc-0-2 wbc- bacteria-few yeast-none epi-0-2 07:34pm pt-12.8 ptt-23.2 inr(pt)-1.1 06:41pm lactate-2.2* k+-4.2 06:15pm alt(sgpt)-22 ast(sgot)-51* alk phos-124 tot bili-0.5 06:15pm lipase-93* ct abd 1. minimally displaced posterolateral left 10th rib fracture. evaluation limited given lack of iv contrast, but no evidence of splenic injury or hematoma. 2. apparent mild fat stranding around the pancreas, predominantly around the head and near the duodenum. differential includes pancreatitis or possible contusion from fall. please correlate clinically and with labs. 3. diffuse fatty infiltration of the liver. 4. hyperdense 1.1 cm nodule at the upper pole of the right kidney. could further assess with renal ultrasound on a nonemergent basis. ekg: diffiuse t wave inversion in ii, iii, avf, and v4-6 brief hospital course: is a 49 year old man who presented with left sided flank pain after a syncopal event and fall. he was found to have severe dehydration and acute renal failure. he presented in for a similar presentation of severe dehydration and acute renal failure. . acute on chronic renal failure: upon was found to have profound dehydration, acute pre-renal failure, and electrolyte abnormalities in the setting of chronic alcoholism and poor po intake. he received 4 liters of fluid in the ed, followed by 7 units of fluid in the micu and initially requried levophed to maintain his pressures. his urine output was carefully monitored in the unit and upon tranfer to the floor. on the floor he was given 2l lr over the course of 2 days in addition to po rehydration. his creatinine improved dramatically from 7.5 to 1.7 upon discharge. he tolerated po fluid and food intake well. u/a was negative. his calcium, potassium and magnesium was repleted as needed daily. . hypotension/syncope: the patient had an episode of syncope likely secondary to orthostasis and hypotension secondary to dehydration. upon arrival to the ed, his hypotension was initially refractory to fluids and required norepinephrine. ck and troponins were negative, echocardiogram did not find a cause, no infectious focus was found. the icu team was able to wean the patient off of the norepinephrine drip shortly after transfer from the ed. he was transferred to the floor and his blood pressure remained within normal limits and orthostatics were negative. . anemia: the patient was found to have macrocytic anemia most likely secondary to direct bone marrow effects due to chronic alcoholism. b12 and folate were normal. he was supplemented with folic acid, thiamine and multivitamins daily. he received 1 unit of prbc and hct remained stable thereafter. guaiac negative and no hematemesis to suggest ugib. no evidence of cirrhosis or cirrhosis, therefore no concern for variceal bleeding. it is recommended the patient follow up with his primary care physician regarding his anemia and continued counseling regarding cessation of alcohol. he should continue to take folate, thiamine and multivitamins daily. . etoh abuse: the patient's last drink was , states approximately 4-5 drinks daily. he has a history of delerium tremens, although only required diazepam x1. he was seen by social work for options for addiction treatment and plans on attempting to quit drinking. the importance of quitting drinking and maintaining adequate/regular daily food and fluid intake was extensively stressed. the patient's ast was elevated at 49, indicative of possible alcoholic hepatitis that should be repeated and monitored as an outpatient. . rib fracture: the patient has non-displaced l posterolateral 9th and 10th rib fractures secondary to his fall down stairs after his syncopal event. he achieved adequate pain control using a lidocaine patch at the site and acetaminophen. . kidney nodules: ct abdomen showed 'two exophytic nodules at the upper pole of the right kidney for which further evaluation is recommended. ultrasound or mri on a non-emergent basis is recommended for further characterization.' patient instructed to talk to dr. about this and he can make arrangements for these tests. . depression: the patient has not been taking his citalopram prior to discharge. we recommend he follow up with his primary care physician and possibly establish care with psychiatry to restart this medication with close follow up. . the patient was full code for this admission. *******patient eloped before being seen by the attending physician on the day of discharge and left without discharge paperwork ********* medications on admission: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. nicotine 21 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 3. citalopram 20 mg tablet sig: two (2) tablet po daily (daily). 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. multivitamins tablet, chewable sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* discharge medications: 1. omeprazole 40 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:*1* 2. multivitamin tablet sig: one (1) tablet po daily (daily). 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily) as needed for rib pain : please alternate patch 12 hours on and 12 hours off. disp:*30 adhesive patch, medicated(s)* refills:*0* 6. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. discharge disposition: home discharge diagnosis: primary diagnosis: marked hypovolemia/dehydration acute renal failure hypotension requiring pressure support in micu mechanical fall with 9th and 10th posterolateral left rib fractures alcoholism, continuous alcohol withdrawl- resolved depression anemia - macrocytic, normal b12 and folate syncope attributed to orthostasis kidney nodules discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital after falling down and injuring your ribs. you were found to have severe kidney failure. it seems this is related to becoming extremely dehydrated in the setting of drinking too much alcohol and not drinking enough non-alcoholic liquids. you also appear to have some malnutrition, possibly from not eating a healthy diet and drinking too much. while in the hospital we gave you many liters of fluid to rehydrate you and your kidney function has improved. we recommend you maintain regular food and fluid intake to prevent this from happening again. . we strongly recommend you stop drinking. please seek support and counseling in order to quit successfully through social work and support groups such as alcoholics anonymous. please do not hesitate to contact social work here at the hospital should you need help. . we made the following changes to your medications: - start omeprazole 40mg daily - start thiamine 100mg daily - start multivitamin 1 tab daily - start folic acid 1mg daily - start tylenol 650mg up to three times daily as needed for pain . please follow up with your primary care doctor g citalopram for your depression. . please take care. we wish you a speedy recovery. followup instructions: please call dr. office on monday morning to make a follow up appointment within the next two weeks to recheck your kidney function tests and follow up your anemia hospital admission. . please tell him that your ct scan of your abdomen showed 'two exophytic nodules at the upper pole of the right kidney for which further evaluation is recommended. ultrasound or mri on a non-emergent basis is recommended for further characterization.' you should speak to dr. about this and he can make arrangements for these tests. . please follow up with social work as needed for support and counseling regarding quitting alcohol. procedure: venous catheterization, not elsewhere classified diagnoses: acidosis tobacco use disorder acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified depressive disorder, not elsewhere classified chronic kidney disease, unspecified hypotension, unspecified accidental fall on or from other stairs or steps unspecified disorder of kidney and ureter dehydration closed fracture of two ribs other specified anemias other and unspecified alcohol dependence, continuous electrolyte and fluid disorders not elsewhere classified alcohol withdrawal orthostatic hypotension 

Answer: The patient is high likely exposed to