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: meropenem attending: chief complaint: hematemesis major surgical or invasive procedure: endotracheal intubation central venous line hemodialysis line history of present illness: the patient is a 28 year old male with a history of alcohol abuse who walked into the ed with the complaint of hematemesis. the patient has been a significant drinker for 5-6 years, reporting drinking 6 mixed drinks a day, with tremulations on withdrawl, but no prior seizure. for the last week, he has felt increasing weakness and fatigue, and has become slightly disoriented and confused. he reports no head trauma. 3 days prior to presentation, he began to notice that he was coughing up blood and mild epigastric tenderness. these episodes were occuring 2-3 times per day. he additonally noted black tarry stools, but unable to quantify the number of bowel movements. with mild abdominal discomfort, nausea, and hematemesis, the patient was unable to tolerate a po diet, but continued to drink. his last drink was the night prior to presentation. . on arrival to the ed, vitals were 97.8, bp 53/palp, hr of 143. he was immediatly given 1unit of unmatched prbc, a cordis was placed, and he was given 3l of ns. his bp improved, but the patient remained tachycardic. he has a low grade temp of 100.1, and blood and urine cultures were went. with a wbc of 23, the patient was given cipro/flagyl. a ct scan and laboratory evaluation was consistent with acute pancreatitis and hepatitis. an ng tube was placed and lavaged, at first showing coffee-grounds, but then developing bright red blood, and an octreotide gtt was started. the patient was admitted to the micu for further manegment. . on arrival to the flor, the patient's vitals were 99.9, hr 132, bp 115/80, 94% on ra. . review of sytems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. no dysuria. denied arthralgias or myalgias. . past medical history: depression alcoholism social history: patient originally from western mass. works for a it computing company. not married and without children, lives with a roomate in . significant alcohol use for 5-6 years, drinking 6 mixed drinks daily with withdrawl symptoms. 1.5 ppd of cigarrettes, denies drug use. family history: mother with dm2. physical exam: vitals: t: 99.9 bp: 115/80 p: 132 r: 18 o2 95% ra general: alert, oriented, appears uncomfortable with ng tube with coffee grinds to clamp heent: scleral icterus, markedly dry mm with dry blood on lips neck: supple, jvp flat, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: tachycardic with normal rhytyhm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, mild ruq tenderness and luq tenderness, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. tremulous. . pertinent results: bronch cytology negative for malignant cells. pulmonary macrophages, bronchial epithelial cells, and inflammatory cells, including eosinophils. . ecg study date of 10:22:14 am baseline artifact. sinus tachycardia. otherwise, within normal limits. no previous tracing available for comparison. read by: , intervals axes rate pr qrs qt/qtc p qrs t 135 122 76 300/431 62 27 59 . liver/gallbladder u/s limited study demonstrating marked liver echogenicity, consistent with fatty infiltration, although more severe liver disease including significant hepatic fibrosis and cirrhosis cannot be excluded on this study. there is no intrahepatic biliary dilatation, and the common bile duct measures 4 mm. there is normal flow in the portal vein. . ct abdomen w/contrast study date of 10:52 am impression: 1. diffuse peripancreatic stranding which, in the setting of known alcohol use is likely indicative of pancreatitis. necrosis is difficult to quantify though there appears to be roughly 30-40% necrosis. 2. enlarged diffusely fatty infiltrated liver. 3. orogastric tube terminating in the duodenum. . chest (portable ap) study date of 11:08 am impression: low lung volumes with clear lungs. no free air noted under the hemidiaphragms. . ct head w/o contrast 1. diffuse loss of -white matter differentiation concerning for global hypoxia or edema with hypodensities in bilateral thalami. 2. no hemorrhage, mass effect, or herniation. 3. fluid seen in bilateral temporal subcutaneous tissue. near-complete opacification of bilateral mastoid, maxillary, frontal, and ethmoid sinuses. . ct torso w/ contrast 1. new multifocal airspace consolidation, suspicious for acute infiltrates. 2. diffuse colonic wall thickening, which could reflect colitis. 3. diffuse soft tissue edema. 4. peripancreatic stranding, in keeping with pancreatitis. extent of necrosis cannot be evaluated on a non-contrast exam. there are no new peripancreatic fluid collections. . cta chest w&w/o c&recons, non-coronary study date of 3:24 pm impression: 1. no evidence of pulmonary embolus. 2. interval worsening of the consolidation of the dependent portions of the bilateral upper and lower lobes, which may represent atelectasis; however, a superimposed infection cannot be excluded. 3. marked fatty infiltration of the liver. . ct head w/o contrast 1. interval improvement in the -white matter differentiation, overall, suggesting slow resolution of diffuse cerebral edema. 2. no hemorrhage, herniation or evidence of acute vascular territorial infarction. 3. persistent opacification of paranasal sinuses, nasal cavity and mastoid air cells, likely related to intubation and supine positioning. . ct torso w/contrast study date of 4:31 pm impression: 1. persistent atelectasis/consolidation in the dependent portions of the lungs bilaterally. ground-glass opacity in the dependent portions of the lungs is suggestive of edema. 2. diffuse fatty infiltration of the liver with areas of sparing about the gallbladder fossa. 3. persistent area of necrosis within the pancreas as described above, not significantly changed. minimally decreased peripancreatic fluid collection. resolution of the collection previously seen adjacent to the greater curvature of the stomach. 4. unchanged diffuse colonic bowel wall thickening for which an infectious etiology is not excluded. 5. increased attenuation of the splenic vein. the sma and smv is patent. no evidence of pseudoaneurysm. . ct sinus : 1. near-opacification of the nasopharynx, sphenoid sinuses and ethmoid air cells. moderate-to-severe left maxillary sinus disease. mild right maxillary sinus disease. non-pneumatized frontal sinuses. 2. persistent opacification of bilateral mastoid air cells and middle ear cavity. ct head : no acute intracranial abnormality. . eeg : this is an abnormal routine eeg due to three independent focal onset electrographic seizures in the right posterior quadrant without obvious clinical correlate. the background rhythm was slow and poorly modulated indicative of a moderate to severe encephalopathy. there was also recurrent sharp activity seen over the right posterior quadrant indicative of acute cortical and subcortical dysfunction . eeg : this is an abnormal video-eeg study because of severe diffuse background slowing and attenuation, and continuous periodic lateralized epileptiform discharges (pleds) in the right posterior quadrant. these findings are indicative of a severe encephalopathy and a highly potentially epileptogenic focal structural lesion in the right posterior quadrant. compared to the routine eeg yesterday, repetition rate of pleds has decreased and there are no electrographic seizures. . abd u/s : nondistended gallbladder, with lumen entirely replaced with echogenic material, likely sludge. no shadowing stones identified. no hyperemic thickened wall. . gallbladder scan : 1. non-visualization of the gallbladder but cannot evaluate for cholecyctitis in the setting of poor hepatic function. 2. tracer excretion into the bowel is observed, excluding common bile duct obstruction. . ct abd/pelvis : 1. persistent atelectasis/consolidation in the dependent portion of the lungs bilaterally. 2. diffuse fatty infiltration of the liver. 3. continued evolution of areas of necrosis within the pancreas. new fluid collection anterior to superior segment of the duodenum, 5.6 x 2.9 cm, and along pancreatic uncinate process, 2.2 x 1.9 cm. 4. delayed enhancement of the kidneys, with no excretion of contrast, and dense material within the gallbladder; these findings could suggest renal failure, if clinically correlated. 5. similar appearance of the colonic bowel wall, which could be due to bowel wall collapse; however, infectious etiology cannot be excluded. 6. similar appearance of increased attenuation of the splenic vein. no evidence of pseudoaneurysm. brief hospital course: 28 year-old male with a history of alcoholism presenting with acute hepatitis, pancreatitis, and ugib. # hematemesis: he presented with complaints of hematemesis and was started on a ppi drip and octreotide prior to egd. he was found to have a diulefoy lesion on endoscopy but no active bleeding. he had no recurrence of hematemesis during his hospitalization. # pancreatitis: his lipase was elevated on presentation to 1600 in the setting of alcohol abuse. he underwent a ct that demonstrated significant pancreatitis necrosis, but no clear phlegmon. because he became hypotensive, febrile, and developed a leukocytosis, he was thought to be septic or in shock secondary to pancreatitis and was started on meropenem and aggressive ivf repletion, along with levophed and phenylephrine. the surgical service was also consulted but found no evidence of an abscess or pseudocyst requiring surgical intervention. repeat ct abdomen showed fluid collections around his pancreas and duodenum but thought to be sterile per surgery and not sampled; id agreed with this. kept on broad spectrum antibiotics. pt likely to continue to spike fevers due to necrotizing pancreatitis. # sepsis: as noted above, he became hypotensive, febrile, and developed a leukocytosis shortly after admission. he required levpohed and phenylephrine initially but was eventually able to maintain normal perfusion pressure with levophed alone. no clear source of infection was initially identified but he was treated empirically with several different antibiotic regimens because of concerns about inadequate coverage, allergic drug reactions, or new possible sources of infection. possible sources of infection considered included pancreatitis, cellulitis, c. diff given colonic wall thickening seen on abdominal ct, line infections, endocarditis, and sinusitis but most likely source thought to be necrotizing pancreatitis. hida with persistent sludge but not thought to have cholecystitis requiring intervention. there was evidence of fluid collections around his pancreas and duodenum but thought to be sterile per surgery and not sampled. his antibiotic courses included meropenem (; may have contributed to eosinophilia per id); aztreonam 6(/3- ; metronidazole iv (, , , ); vancomycin iv (; may have contributed to eosinophilia per id); daptomycin ( -> increased dose on ); linezolid (); vancomycin po (, ); vancomycin pr (); micafungin (, ); and cipro (, ). he did have one bottle of blood cultures grow coagulase negative staph, otherwise no source was found. his fever curve and leukocytosis trended down and antibiotics were slowly weaned off. he continued to spike fevers requiring restarting of pressors a few times for accompanying hypotension. however, these were thought to be due to necrotizing pancreatitis and expected to continue for a while. decision made not to tap abd fluid collections as he would be at very high risk of bleeding. he has continued to have recurring low grade fevers, tachycardia and tachypnea without any identified source (blood, urine, sputum cultures; cxr. his fevers at discharge were felt to be centrally driven and not from any organism. # respiratory failure: he was intubated for hypercapnia on in the setting of recent egd and shortly after admission. he was managed with assist control/cmv and underwent tracheostomy placement on by the thoracic surgery service. he was noted to have blood oozing around trach site with clots suctioned from trach and oropharynx. he received ddavp x 2 for this. on pt had pea arrest clot plugging (see below). bedside bronch was done by thoracics who determined that trach appropriately sized. no evidence of dic. completed a 24-hour course of amicar per heme-onc recs. pt eventually weaned to trach mask with fio2 40%. he did require additional ddavp on for return of bloody secretions but bronched with no evidence of bleed. he is able to clear most secretions on his own requiring occasional suctioning. # pea arrest: on , he developed respiratory distress progressing to cardiac arrest with pea reportedly lasting minutes. he received compressions and atropine with return of spontaneous circulation. a large clot was suctioned from trach with resolution before arrival of code team. further respiratory issues were addressed as above. # renal failure: he went into renal failure a few days after admission that was thought to be atn in the setting of sepsis and hypotension. he required cvvh therapy afterward. he then had a tunneled hd line placed on and started hd once blood pressures stable off pressors. renal function improved and no longer required hd after . with cr. of 0.8 and good uop on discharge from micu. # seizures/intercerebral edema: he underwent a head ct that demonstrated loss of /white matter differentiation on . on the same day, he also developed eye twitching concerning for seizure activity. neurology was consulted and recommended starting keppra and hypertonic saline to treat his edema, which was thought to be secondary to both volume overload in the setting of ivfs and toxic-encephalopathy, likely secondary to elevated ammonia. his cerebral edema improved significantly over the next several days, as a follow-up head ct demonstrated significant improvement. he also underwent an eeg that was nondiagnostic for seizure activity. after several weeks he again was noted to have seizure-like activity with twitching of the mouth and eye deviation upward. he was initially thought to be withdrawing from benzodiazepines as this activity occured in the setting of weaning his midazolam gtt and he was treated with higher doses of benzos, which are being weaned with change of valium to 5mg qhs on with plan for 2wks at this dose before d/c'ing. after an eeg showed only seizures in the occipital lobe, his keppra dose was increased. he then underwent a repeat eeg that was negative for seizures. upper extremity tremors thought more consistent with clonus and thought to be more reactive in setting of waking up. # acute hepatitis: this was thought to be secondary to alcoholic hepatitis, with a ct scan showing extensive fatty infiltration. # alcoholism: patient describd history of withdrawal symptoms but not prior seizure. last drink was night prior to presentation. he was given thiamine, folate, and vitamin b12. he was started on a ciwa but received fentanyl and midazolam after being intubated. # hyperbilirubinemia: initially this was attributed to his alcoholic hepatitis and pancreatitis. however, it continued to rise in the setting of receiving tpn. the tpn was d/c'd and the bilirubin decreased. #. adrenal insufficiency: the patient developed profound eosinophilia and was persistently hypotensive despite adequate antibiotic coverage for sepsis. stim test showed 0, 30, 60 levels of 12->18->19, but he was started on high dose hydrocortisone anyway with decrease in his eosinophilia and decreased pressor requirement. the steroids were then slowly weaned off prior to discharge. ... ... ... in essence, hospital course has been complicated by respiratory failure (currently with a trach), cyclic fevers (no organism identified, felt to be centrally mediated from the brain), and anoxic brain injury (possibly from pea arrest) with limited but improving neuro status. his low grade fevers with tachypnea have not been related to an infection, but rather his brain injury, as assessed by the neurologists here and also due to the lack of an isolated microorganism. medications on admission: prozac discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 8-15 puffs inhalation q2h (every 2 hours) as needed for sob, cough, bronchospasm. 2. heparin (porcine) 5,000 unit/ml solution sig: one (1) 5000 injection tid (3 times a day). 3. famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). 4. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever. 5. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 6. levetiracetam 100 mg/ml solution sig: one (1) 500 mg po bid (2 times a day). 7. diazepam 5 mg tablet sig: one (1) tablet po hs (at bedtime). 8. insulin please see attached insulin regimen discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary - diulefoy lesion - necrotic pancreatitis - hepatitis - respiratory failure - renal failure - cerebral edema/anoxic brain injury - seizures - likely colitis - adrenal insufficiency secondary - alcohol abuse - depression discharge condition: stable on trach discharge instructions: you were admitted with bloody emesis in the setting of alcohol abuse. you were intubated for an upper endoscopy, which showed a diulefoy lesion (ulcer). other studies also showed hepatitis and necrotic pancreatitis. you required reintubation for respiratory failure. you had multiple complications during your hospital stay, including cerebral edema, seizures, likely colitis, renal failure, adrenal insufficiency, and fevers which are centrally driven by the brain. a trach was placed as you still require ventilatory support, but the above issues are now stable. you are being transferred to a rehab for further care. the following changes were made to your medications: - tyleonol 650 mg every 6 hrs for fevers - albuterol inhaler every 2 hrs for wheezing - diazepam 5 mg by mouth at night for 2 weeks - famotidine 20 mg every 12 hours - lasix 40 mg daily - heparin 5000 units sq three times a day - insulin - keppra 500 mg twice a day please take all medications as prescribed. please call your doctor or 911 if you develop chest pain, difficulty breathing, change in mental status, dizziness, bleeding, severe pain, or any other concerning symptoms. followup instructions: please schedule follow-up with your pcp on discharge from rehab. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances other endoscopy of small intestine insertion of endotracheal tube hemodialysis venous catheterization for renal dialysis arterial catheterization other intubation of respiratory tract temporary tracheostomy closed [endoscopic] biopsy of bronchus closed biopsy of skin and subcutaneous tissue injection or infusion of oxazolidinone class of antibiotics diagnoses: thrombocytopenia, unspecified other and unspecified noninfectious gastroenteritis and colitis toxic encephalopathy acute kidney failure, unspecified unspecified septicemia severe sepsis other convulsions acute respiratory failure cardiac arrest anoxic brain damage septic shock cerebral edema glucocorticoid deficiency other and unspecified coagulation defects acute pancreatitis other and unspecified alcohol dependence, continuous acute alcoholic hepatitis dieulafoy lesion (hemorrhagic) of stomach and duodenum 

Answer: The patient is high likely exposed to