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: weakness, confusion major surgical or invasive procedure: blood transfusion ultrasound-guided paracentesis esophagogastroduodenoscopy colonoscopy history of present illness: mr is a 48 yo male with etoh abuse and chronic hcv infection, who presented to his pcp with complaints of generalized weakness, lightheadedness and yellow eyes. per her note, he was in detox several days prior to presenting and he states that he has not had a drink now in days. he states that his last episodes of drinking were not above average. denies any recent sexual contacts and denies any ivdu. given his clear jaundice on exam, his pcp sent him to for further evaluation. she was also concerned about encephalopathy. he was admitted to the floor on with likely alcoholic hepatitis. liver service followed him there and was concerned about his high discriminant function and poor level of consciousness. he was evaluated by the micu team and transferred to the micu for continued encephalopathy. during course there was also concern of pericholecystic fluid/acute cholecystitis and he has been followed by surgery. past medical history: 0. likely hepatic cirrhosis 1. etoh abuse, h/o dts / withdrawal seizures 2. hepatitis c (not confirmed here rna neg) 3. hypertension 4. h/o pancytopenia 5. ? h/o seizures in setting of head trauma 6. childhood asthma 7. depression 8. orbital fracture and small sdh s/p fall social history: pt has been homeless for many years, lived in shelters, with his mother, siblings and friends at times. he smokes one pack per day of tobacco. no intravenous drug use. regular alcohol use for many year. family history: non contributory physical exam: vitals: 98.9, 107/63, 93, 96% ra gen: well-appearing, nad, sleepy but arousable heent: sclera grossly icteric, perrl, eomi, op clear, mmm, sublingual icterus as well neck: supple, no lad cv: rrr, no m/g/r pulm: ctab, no w/r/r abd: soft, nt, nd, +bs, liver edge palpable 2cm below costal margin ext: no c/c/e neuro: aao to place, year, month, day and situation. cn ii-xii grossly intact, moving all extremities well. + asterixis. pertinent results: <b> labs on admission: () </b> hematology: 06:50am blood wbc-5.5 rbc-2.48* hgb-9.4* hct-26.3* mcv-106* mch-37.8* mchc-35.8* rdw-18.6* plt ct-113* 06:50am blood neuts-76.1* lymphs-15.9* monos-6.7 eos-0.9 baso-0.4 06:50am blood pt-20.0* ptt-43.1* inr(pt)-1.9* chemistry: 04:00pm blood glucose-84 urean-11 creat-0.8 na-133 k-4.1 cl-97 hco3-29 angap-11 06:50am blood alt-67* ast-185* ld(ldh)-174 alkphos-94 amylase-44 totbili-21.7* 06:50am blood lipase-19 06:50am blood albumin-2.5* calcium-8.9 phos-2.5* mg-1.8 iron-111 06:50am blood ammonia-81* other: 06:50am blood hbsag-negative hbsab-positive hbcab-positive igm hbc-negative igm hav-negative : hcv viral load: hcv-rna not detected. 10:03am blood ama-negative smooth-positive 10:03am blood -negative 06:50am blood afp-5.7 04:00pm blood phenyto-3.1* tox: 04:00pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-pos barbitr-neg tricycl-neg 01:21pm urine bnzodzp-pos barbitr-neg opiates-neg cocaine-neg amphetm-pos mthdone-neg <b> discharge labs: </b> hct 25.3 plt 92 inr 2.0 glc 91 bun 5 cr 1.3 na 136 k 3.5 cl 103 hco3 26 alt 27 ast 65 ldh 196 ap 117 tbili 8.8 <b> other labs: </b> anemia workup: 05:35am blood ret aut-5.3* 06:50am blood caltibc-120* ferritn-1100* trf-92* 06:50am blood hapto-49 05:47am blood vitb12-1668* folate-12.0 peritoneal fluid: 09:45am ascites totpro-0.6 glucose-100 ld(ldh)-34 albumin-less than 1 09:45am ascites wbc-111* rbc-46* polys-6* lymphs-3* monos-8* mesothe-1* macroph-82* wbc 23 rbc polys 42% alb < 1.0 <b> microbiology </b> 1:30 pm blood culture source: line-picc. anaerobic bottle gram stain (final ): gram positive rod(s) c/w corynebacterium and propionibacterium species. otherwise multiple blood, urine, and peritoneal fluid cultures were all negative. <b> radiology </b> 12:20 am # chest (pa & lat) somewhat limited examination secondary to low lung volumes. no definite superimposed acute cardiopulmonary process. 5:01 pm # ct head w/o contrast no acute intracranial process. radiology ct abd w&w/o c impression: 1. heterogenous liver attenuation in addition to striking portal adenopathy may indicate an acute hepatitis. conversely, an infiltrative liver malignancy cannot be excluded. this could be further assessed with multi-phasic mri. 2. mildly distended gallbladder, wall edema, and pericholecystic fluid. gallstones were visualized on previous ultrasound examination. however, in the setting of no significant right upper quadrant symptoms and no elevated white blood cell count, this seems unlikely to be consistent wtih acute cholecystitis. radiology mri abdomen w/o & w/con impression: 1. fatty infiltration of the liver. 2. mild gallbladder wall edema, which is nonspecific in the setting of trace ascites. 3. extensive periportal lymphadenopathy. 4. stigmata of portal hypertension including recanalized paraumbilical vein and anterior abdominal wall varices. 5. no focal pancreatic or liver lesions identified. radiology duplex dop abd/pel limi impression: 1. echogenic liver which is suggestive of fatty infiltration; however, liver fibrosis/cirrhosis cannot be entirely excluded. 2. portal venous, hepatic venous, and hepatic arterial systems are patent with appropriate flow. 3. no evidence of intra- or extra-hepatic bile duct dilation. ruq u/s impression: 1. no evidence of cholecystitis. normal appearing gallbladder without stones. no intra- or extra-hepatic biliary ductal dilation. 2. unchanged echogenic and heterogeneous liver parenchyma, without a focal mass seen. 3. small amount of ascites. renal u/s impression: normal renal son without hydronephrosis. egd 2 cords of grade 1 varices at the lower third of the esophagus erythema in the stomach body and antrum compatible with gastritis normal mucosa in the duodenum otherwise normal egd to third part of the duodenum colonoscopy polyps in the sigmoid colon and ascending colon diverticulosis of the whole colon grade 2 internal hemorrhoids unable to evaluate the cecum and valve because loop formation and patient's uncomfort and pain. otherwise normal colonoscopy to cecum ruq u/s impression: 1. mild heterogeneity in the liver echotexture, possibly slightly decreased from previous examination. no focal lesion detected. 2. no intra- or extra-hepatic biliary ductal dilation or gallstones. 3. splenomegaly. brief hospital course: 1) acute on chronic liver failure: most likely acute alcoholic hepatitis given known history of alcohol abuse, ast/alt > 2, and negative hepatitis viral serologies (negative viral load in the case of hep c). his presentation was initially concerning for an obstructive lesion given the new perihepatic lad on abdominal ct, but his ap was normal and a ruq u/s showed no obstruction. he had no additional risk factors for aquisition of other hepatitis viruses (no recent unprotected sex or ivdu). his presentation was also concerning for hepatic vein/ivc thrombosis, but a liver u/s with doppler was negative for clot. his autoimmune work-up (, anti-smooth muscle antibodies, soluble liver antigen, ceruloplasm, urine copper for wilson's disease) was negative. his hepatitis serologies indicated previous exposure but no active infection (hbsag neg, hbsab pos, hbcab pos, hbv dna undetect, hcv rna undetect, anti-hav neg). on discharge his bilirubin improved to 8.2, inr stable at 2.0, platelets 92. he had a liver mri that showed no focal lesions, but fatty infiltration, periportal lad, and signs of portal htn. he was started on prednisone 40mg po daily and lactulose 30cc qid. he continued to complain of vague ruq pain, so an u/s was repeated, with no changes noted. furthermore, his lfts have trended down and stabilized; his ast remained only slightly elevated at discharge, although his tbili was very high. he had elevated inrs (max 2.6, decreased to 2.0) which were treated w/ po vitamin k. outpatient liver clinic appointment scheduled to follow liver disease and consider transplant. 2) encephalopathy: patient was encephalopathic when admitted, with an elevated ammonia level. he was treated with lactulose 30-45cc qid, but his dose was later decreased to 30cc tid due to exacerbation of hemorrhoids and pain and blood with bowel movements. he was often reluctant to take his lactulose and had to frequently be explained the reason for taking it. he was also treated with rifaximin. overall his mental status has improved and he has been aaox3, but with some residual confusion. also, his gait is still slightly unsteady and he continues to have asterixis on exam. he is discharged on lactulose and rifaximin, which he must take regularly. 3) anemia: the patient had macrocytic anemia on admission (hct=27.7) and his hematocrit continued to slowly decrease during his stay. his b12 level was elevated and his folate level was normal. iron studies showed normal iron, decreased tibc, increased ferritin. blood smear showed occasional schistocytes and 2+ target cells. he had a normal egd and colonoscopy, although the cecum was not visualized. given his history and labs, he was thought to have anemia from chronic liver disease and possible bone marrow suppression due to alcohol use. have also been due to hemorrhoidal bleeding. he was transfused with prbcs to keep him above hct=21, receiving 9 units over the course of his admission. he had no s/sx of transfusion reaction and his hct was 25.3 at discharge. 4) fever: the patient spiked a fever to 101.9 on and was subsequently worked up for infection. cxr was negative for pneumonia x2, urine analysis and cultures were negative, and blood cultures were negative. initial abdominal ultrasound was negative for cholecystitis and showed trace ascites (<1cc), although he did have ascites later on, and received two ultrasound-guided paracenteses, negative for sbp. his fevers resolved and he had been afebrile from to , when he started spiking fevers again. on , he spiked a fever up to 104.5 with hypotension to 80s and tachycardia to 110s. pt was started on broad-spectrum antibiotics (vanc, levofloxacin, ), given copious ivfs and transfered to the micu with sirs criteria. on admission to the micu he was severely anemic to hb/hct of 5.7/16.9. pt was transfused 3u of prbc and a 1l of ns. his hb/hct elevated to 8.3/23.5 and stabilized. he was restated on lactulose and antibiotics for gi ppx. all cultures were negative. his bp and mental status improved. he was transfered back to the floor in stable condition mentating at baseline with stable vss and afebrile. 5) hyponatremia: patient had low-normal serum sodium at baseline, decreased to 131/132 at times during his stay. he appeared euvolemic with no evidence of third-spacing of fluid on exam. serum osmolality was 285 (within reference range). it is possile that these low-normal levels are secondary to cirrhosis and intravascular volume depletion, leading to increased fluid retention. it could also be due to hypertriglyceridemia. adrenal insufficiency is also possible, but less likely given his stable blood pressure. his sodium levels normalized prior to discharge. 6) alcohol abuse: patient had no signs of alcohol withdrawal during his hospital stay. he was continued on thiamine, folate, and multivitamin supplementation. advised extensively to stop drinking. 7) acute renal failure: patient had a creatinine spike to 2.6 from his baseline of around 0.8. renal consult felt this was prerenal rather than hrs, so octreotide & midodrine were stopped. his creatinine gradually improved to 1.3 and remained stable. 8) seizure history: patient has an unclear history of seizures, in setting of etoh withdrawal vs. head trauma vs. childhood issue. he was on phenytoin 100mg tid, but his drug level increased to 22.7, so he was decreased to dosing, and a repeat level was 20.7. medications on admission: dilantin 100mg tid zantac 150mg albuterol inh prn atenolol 25mg po daily thiamine mvi folate discharge medications: 1. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 5. phenytoin sodium extended 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed. 8. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 9. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed. 10. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). 11. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day): titrate to 3 bms daily. 12. pramoxine-mineral oil-zinc 1-12.5 % ointment sig: one (1) appl rectal hs (at bedtime) as needed. 13. hydrocortisone acetate 1 % ointment sig: one (1) appl rectal hs (at bedtime) as needed. 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. discharge disposition: extended care facility: house discharge diagnosis: primary: alcoholic hepatitis secondary: alcohol abuse history of hepatitis c infection anemia discharge condition: mental status has improved. afebrile with stable vital signs. discharge instructions: you were admitted to the with a diagnosis of acute on chronic liver failure and encephalopathy (changes in your mental status) due to the liver failure. you were kept in the hospital to watch your liver function tests, which have improved. you were started on lactulose and rifaximin, and must continue to take it and have at least 3 bowel movements a day. while in the hospital, you were found to be anemic. because your red blood cells were low, we gave you transfusions to increase your red blood cells. you were also given iv fluids and octreotide and midodrine, medicines to improve your kidney function. your kidney function has not yet returned to baseline but has improved. during your hospital stay, you also had fevers and low blood pressure. because of concern for infection, you were sent to the icu and your steroid treatments were stopped. no infection was found in your blood, urine, or the fluid in your abdomen. you were transferred back to the medicine service once your blood pressure normalized. you were given iv vancomycin, ciprofloxacin, and flagyl (antibiotics) for 7 days. please keep all follow up appointments and take all medications as prescribed. we have lowered your dilantin to twice daily based on your blood levels. please return to the hospital if you experience any of the following symptoms: - temperature greater than 101.5 - fevers, chills, sweats, nausea, sweating - increased confusion or flapping of your hands - increase yellowing of your eyes or under your tongue - increased weight gain or fluid in the abdomen/legs - increasing abdominal pain followup instructions: please follow up with your primary care physician, . , at health center on monday, @ 4:00pm. . provider: , md phone: date/time: 10:00 procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine percutaneous abdominal drainage percutaneous abdominal drainage colonoscopy transfusion of packed cells diagnoses: anemia of other chronic disease tobacco use disorder unspecified essential hypertension chronic hepatitis c without mention of hepatic coma acute posthemorrhagic anemia acute and subacute necrosis of liver alcoholic cirrhosis of liver acute kidney failure, unspecified acquired coagulation factor deficiency unspecified septicemia hyposmolality and/or hyponatremia sepsis other sequelae of chronic liver disease other ascites hepatic encephalopathy esophageal varices in diseases classified elsewhere, without mention of bleeding internal hemorrhoids with other complication benign neoplasm of colon other and unspecified alcohol dependence, unspecified diverticulosis of colon (without mention of hemorrhage) lack of housing acute alcoholic hepatitis alcoholic liver damage, unspecified 

Answer: The patient is high likely exposed to