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: right lower extremity swelling, abdominal distension, fevers major surgical or invasive procedure: paracentesis (diagnostic and therapeutic) x 2 history of present illness: 66 year old egyptian male, had been in for the past 8 months. he was brought from for medical care, transferred to from with rle cellulitis concerning for necrotizing fasciitis. febrile at osh to 102.1. plain films and ct of rle at osh with no subcutaneous air or fluid collections, no evidence of osteomyelitis. prior to transfer, he was given clindamycin 600mg iv and gentamicin 100mg iv. . patient had been experiencing rle leg swelling for 8-9 days while in . started as small area of erythema on his right leg, then rapidly spread up to the knee with signficant swelling and erythema. the son reports that the leg was weeping clear and purulent fluid, as well as blistering. apparently, the son took him to an egyptian 5 days ago, at which time he was given antibiotics (augmentin?), and received daily wound care with an antibiotic spray and dressing changes. there was also an injectable antibiotic apparently prescribed by the patient's brother, a physician in . the son has now flown his dad to the us for further management. the son states that the leg is significantly improved, with decreased erythema, swelling, and no more drainage. . the patient has reportedly had daily fevers and chills over the last week. son denies any water or animal exposures or bites. no pets at home. no history of tuberculosis in patient or in known contacts. the patient has been known to sleep outside on the balcony, and the son is concerned that this infection could have started as a mosquito bite. . patient also has been experiencing abdominal distention and upper abdominal pain x 4-5 days. no n/v/d. had normal bm yesterday. son states that the patient has had 30lb weight loss over the last 2 months. ct abdomen suggestive of a cirrhotic liver with splenomegaly and ascites. patient has no known prior history of liver disease. . in the ed, vs: 98.2 hr 95 bp 147/80 rr 16 98% on ra. in ed, the patient got another dose of clindamycin 600mg iv. a diagnostic paracentesis was done. surgery was consulted, who felt there was no indication for urgent debridement, but may need plastics consult for debridement/graft at some point. on speaking with micro lab, no growth on their blood cultures after 24h. plastics did bedside debridement after admission. . of note, when entering room to see patient today, noted melanotic stool on bed. exam aborted for time being, and patient transferred to micu for further care. underwent urgent egd, which demonstrated non-bleeding grade 2 esophageal varices, portal gastropathy, and multiple superficial duodenal ulcers s/p epi injection. stable overnight. past medical history: dm htn social history: non smoker, no etoh, no drug use. mormon, very religious. runs 2 miles per day. retired now, worked as a mechanic. denies going into any rivers recently, any work with river water. family history: nc physical exam: vs: hr 83, bp 116/46, rr 22, 95% sat on ra gen: lying in bed in no apparent distress heent: anicteric neck: no jvp, supple chest: crackles at bases bilaterally cv: nl s1/s2, rrr abd: distended, +fluid wave, nontender, tympanic to percussion; no stigmata of liver disease ext: large, superficial ulcerous region 5 x 5 cm along lower aspect of right leg neuro: a+o x3 pertinent results: 11:30pm wbc-13.7* rbc-3.40* hgb-9.8* hct-30.8* mcv-91 mch-28.8 mchc-31.9 rdw-15.9* 11:30pm plt count-574* 06:38pm wbc-14.3* rbc-3.72* hgb-10.5* hct-33.3* mcv-89 mch-28.3 mchc-31.7 rdw-15.9* 12:50pm glucose-160* urea n-76* creat-1.9* sodium-135 potassium-5.1 chloride-106 total co2-19* anion gap-15 12:50pm alt(sgpt)-24 ast(sgot)-45* ld(ldh)-255* alk phos-174* tot bili-1.8* dir bili-1.1* indir bil-0.7 12:50pm albumin-2.5* calcium-7.2* phosphate-4.2 magnesium-2.7* iron-25* 12:50pm hbsag-negative hbs ab-negative hbc ab-negative hav ab-positive 12:50pm hcv ab-positive* 12:50pm parst smr-neg 12:11pm urine hours-random creat-84 sodium-less than 12:11pm urine osmolal-566 02:00am urine blood-tr nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 02:00am urine rbc-0-2 wbc-0-2 bacteria-few yeast-none epi-0 10:59pm lactate-2.1* brief hospital course: a/p: 66 yo m with pmh of dm, htn presents with newly diagnosed cirrhosis, gi bleed, rle cellulitis, acute vs chornic renal failure and transferred from the micu to the floor for further management. . #. right lower extremity pain, swelling: the patient was admitted and treated for extensive lower extremety cellulitis. dermatology, infectious disease, and plastics were consulted. the patient underwent multiple debridment, vac placement, and skin graft by the plastics team. initial culture and pathology data were unrevealing. the history of lower extremity swelling and new onset liver disease (see below) raised red flags for schistosomiasis given its endemicity in . schistosomal antibodies were however negative. no infectious organism responsible for the cellulitis was convincingly found, with wounds growing only thought to be a contaminant and treated for several days with iv micafungin. broad spectrum antibiotics (vancomycin and zosyn) were started, picc line placed, and abx continued throughout hospitalization ( - ). all blood cx to date have been negative, cxr clear, and dopplers of lower extremity were negative for dvt. ultimately patient defervesced and respiratory status improved wth diuresis and large volume paracentesis of ascites fluid (see below). by the end of discharge, the right extremity cellulitis looked good. patient discharged with the following instructions: - daily dressing changes with xeroform, kerlix, ace wrap - skin graft donor sites on thigh open to air - can perform nonweight bearing ambulation with crutches for short periods - follow up with ortho as outpatient . #. hcv cirrhosis: ct from osh showed ascites, cirrhosis, esophageal varices, and portal hypertension. diagnostic paracentesis in ed was consistent with transudative ascites fluid, no sbp. initially ast, ap, and t bili slightly elevated, but trended down. right upper quadrant ultrasound showed no thromboses. anti-smooth muscle and rf were mildly elevated. hepatitis c serologies came back positive. schistosoma antibodies were negative. hepatology consulted and attributed new cirrhosis to hcv. during hospitalization, the patient experienced tachycardia and tachypnea with progressive abdominal distension. therapeutic paracentesis were performed x2 with between 3.5 to 4 l of ascites fluid removed; peritoneal data was without evidence of sbp. patient was started on lasix and spironolactone to control significant abdominal ascites and scrotal edema. diuretics were uptitrated with improvement in ascites. patient was vaccinated with first dose of hbv vaccine on and he will need repeat doses in one month and in 6 months. he is immune to hepatitis a per serology, so does not need to be vaccinated for this. . 3. increased creatinine: cr 1.9-2.1 (fena was < 1% and una ~ 11). patient's baseline was unknown, with some improvement after fluids. other etiologies were thought to be possible given hcv status (see above) including mpgn, although normal c3/c4 made this less likely. cryoglobulins were sent which were negative. patient was thought to have underlying ckd from hx of dm and htn. blood pressure was optimized and urine output remained appropriate. throughout hospitalization cr remained stable at 1.5-1.7. . 4. upper gi bleed: on admission, egd report showed multiple superficial bleeding duodenal ulcers that were injected and non-bleeding grade ii-iii esophageal varices. h pylori test came back positive. per infectious disease recommendations, clarithromycin was added to his antibiotic regimen and zosyn was shown to have some in effect on h. pylori. patient was thus treated for h. pylori with triple therapy and the plan for a follow up egd as an outpatient to evaluate healing ulcer. patient was maintained on a ppi and nadolol throughout hospitalization. . 5. hyponatremia: thought to be secondary to cirrhosis. on admission, na was 131 and remained stable throughout hospitalization. on discharge na was 133. . 6. normocytic anemia: hct 26-30 with unknown baseline. patient remained hemodynamically stable following sclerosis of ulcers (see above) and did not actively bleed throughout rest of hospitalization. hemolysis work up negative and iron panel consistent w/ anemia of chronic disease. . 7. dm: initially fs fluctuated between 200 and 400. lantus was progressively increased in the evening from 10 to 25 with improved control. . 8. nutrition: patient was supported by ngt feeds, given high nutritional requirements. a nutrition consult was done with a calorie count. ngt pulled and patient maintained good po intake. medications on admission: nifedipine insulin (unknown type) discharge medications: 1. nadolol 20 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* 2. lantus 100 unit/ml cartridge sig: twenty five (25) u subcutaneous at bedtime. disp:*1 vial* refills:*2* 3. 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:*2* 4. percocet 5-325 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain for 10 days. disp:*35 tablet(s)* refills:*0* 5. lancets one touch ultra soft lancets, use as directed. dispense 1 box, 2 refills 6. test strips use as directed three times a day. dispense 1 box, 2 refills. 7. lasix 40 mg tablet sig: 1.5 tablets po once a day. disp:*45 tablet(s)* refills:*2* 8. spironolactone 50 mg tablet sig: 2.5 tablets po once a day. disp:*75 tablet(s)* refills:*2* 9. xeroform petrolatum dressing 2 x 2 bandage sig: one (1) topical once a day for 3 weeks: please apply to wound daily. disp:*1 box* refills:*0* 10. insulin syringe-needle u-100 0.3 ml 30 x syringe sig: see below miscellaneous once a day: please use as instructed. please take 25u lantus daily with syringe. disp:*1 box* refills:*2* discharge disposition: home discharge diagnosis: - right lower leg cellulitis - hepatitis c cirrhosis - refractory ascites - grade ii esophageal varices - duodenal ulcer w/ bleeding - h.pylori - ckd stage iv discharge condition: stable for home discharge instructions: you were admitted with swelling in your right leg and an infection of the skin of the right leg. while in the hospital, plastic surgery operated on this area and cleared out the diseased tissue to help your infection heal. we also treated you with antibiotics for your leg infection. we also started you on nutrition through tube feeds that go through a nasal tube, because you needed a lot of protein to heal the leg. during your hospitalization, we also found that your liver was injured, probably because of infection by hepatitis c. it's unclear how you got hepatitis c, but it is very prevalent in . you will need to follow up with a gastroenterology to discuss treatment of your hepatitis c as an outpatient. given your liver disease, please do not take more than 2gm of tylenol per day. . while in the hospital, we also found that you had several ulcers in part of your intestine called the duodenum. it's likely that these ulcers formed because of an infection by a bacterium called h. pylori. you were treated with antibiotics for this. you should also avoid taking medications such as nsaids (anything containing ibuprofen) as well as alcohol, as these things can make the ulcers worse. . the medication changes we made during this hospitalization were: (1). omeprazole for your ulcer disease (2). percocet for pain, this has tylenol and codeine in it. please do not take more than 2gm a day of tylenol. please take percocet as instructed, this is a sedating medication. (3). nadolol for your esophageal varices. (4). lasix and spironolactone. these will help get rid of the fluid in your abdomen. (5). we have started you on lantus at night. (6). we have given you dressing changes: please apply xerform to right calf, then apply kerlex wrap, and then the ace wrap. your leg will need to be in a boot at all times. you can dangle your leg for 30min a day 4 times a day. for the next three weeks, you must use crutches when walking at all times. if you experience any chest pain, shortness of breath, worsening leg pain, abdominal swelling or tenderness, or any other concerning symptoms, please let your primary care doctor know or return to the emergency department. followup instructions: please follow up with gastroenterology at 2:00pm with dr. . his number is ( in suit 8e. please follow up with plastic surgery at 2:300 pm with dr. . their number is (. the clinic is located in clinical center , surgical specialties on . please follow up with infectious disease at 11:00 am with dr. . their number is (. procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage other skin graft to other sites excisional debridement of wound, infection, or burn excisional debridement of wound, infection, or burn excisional debridement of wound, infection, or burn endoscopic control of gastric or duodenal bleeding closed biopsy of skin and subcutaneous tissue diagnoses: acidosis anemia of other chronic disease cirrhosis of liver without mention of alcohol acute kidney failure, unspecified hyposmolality and/or hyponatremia portal hypertension unspecified viral hepatitis c without hepatic coma chronic kidney disease, stage iv (severe) hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified pulmonary collapse constipation, unspecified cellulitis and abscess of leg, except foot long-term (current) use of insulin other ascites chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction esophageal varices in diseases classified elsewhere, without mention of bleeding other specified disorders of stomach and duodenum helicobacter pylori [h. pylori] nutritional marasmus ulcer of calf diabetes with renal manifestations, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to