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: hypotension and parastomal bleeding major surgical or invasive procedure: - tips - tips revision intubation hd line placement dobhoff line placement central venous access endoscopies tee history of present illness: 59m well-known to our surgical service was recently admitted on and discharged on for evaluation of persistent bleeding from his ostomy site. has noted bloody output since his admission on (requiring multiple transfusions). during his recent admission, ct scan did reveal fairly prominent parastomal varices although endoscopy (through stoma) did not identify an area of bleed. bleeding appeared to stop prior to his discharge. his coumadin (portal arterial thrombosis) was held in anticipation of a tips procedure. his hct and inr on discharge were 28.7 and 1.4 respectively. patient has been doing well since his discharge. he arrived at his dialysis center but was found to be hypotensive (sbp 70). initially transferred to and then sent here. his dialysis was held and received a 500ml bolus. reports normal appetite. moreover, today's ostomy production has more gross blood compared to output prior to discharge. patient denies any symptoms of dizziness, nausea, vomiting, diarrhea, fevers. tolerating foods without issues. no orthostatics. otherwise asymptomatic. per patient, baseline bp are in sbp 90's. past medical history: pmh: hepatitis c cirrhosis, history of ugib - esophageal varices with portal gastropathy s/p banding in past, hx l leg cellulitis/necrotizing fascitis/osteomyelitis and group a strep sepsis , chronic thrombocytopenia, hypersplenism, mva , surgery to r leg, multiple fractures to l leg, c diff colitis, renal failure from atn(hd mwf), hepatic artery thrombosis, bile leak, stomal bleeding s/p endoscopy . psh: olt, re- for hepatic artery thrombosis, roux-en-y hepaticojejunostomy for bile leak, split thickness skin graft, total abdominal colectomy w/ ileostomy for worsening cdiff infection social history: denies tobacco use. no alcohol x 18 years. denies ever using iv drugs. lives with wife, has 6 children, 5 grandchildren. owns his own towing/auto body repair business. family history: son died of colon cancer, grand father died of colon cancer. no history of liver disease physical exam: physical exam: 98.3 84 81/50 18 1004l on arrival, general: nads, aaox3, comfortable chest: r hd line w/ no erythema or signs of infection lungs: clear, crackles at bases cardio: rrr abd: soft, incision c/d/i, nt, slightly distended, act bs, ostomy site with gross blood and stool, stoma pink and patent ext: + pedal edema, palpable distal pulses pertinent results: 05:58am blood wbc-3.1* rbc-2.63* hgb-8.1* hct-23.4* mcv-89 mch-30.8 mchc-34.6 rdw-20.6* plt ct-47* 05:27am blood wbc-4.3 rbc-2.98* hgb-9.1* hct-27.2* mcv-91 mch-30.5 mchc-33.4 rdw-20.3* plt ct-55* 04:27am blood wbc-3.8* rbc-2.66* hgb-8.0* hct-24.7* mcv-93 mch-30.1 mchc-32.5 rdw-20.2* plt ct-68* 03:46am blood neuts-81.6* lymphs-13.1* monos-4.7 eos-0.4 baso-0.3 05:58am blood pt-17.5* ptt-54.6* inr(pt)-1.6* 05:27am blood pt-18.4* ptt->150* inr(pt)-1.7* 02:45am blood pt-17.1* ptt-50.8* inr(pt)-1.5* 04:18am blood pt-21.2* ptt-50.5* inr(pt)-2.0* 05:58am blood glucose-93 urean-84* creat-5.5* na-136 k-3.6 cl-108 hco3-18* angap-14 04:27am blood glucose-128* urean-65* creat-4.4* na-137 k-3.4 cl-107 hco3-22 angap-11 04:57am blood glucose-163* urean-56* creat-4.0* na-133 k-3.5 cl-103 hco3-24 angap-10 03:05am blood glucose-84 urean-21* creat-3.2*# na-135 k-4.2 cl-103 hco3-25 angap-11 05:27am blood alt-8 ast-32 alkphos-170* totbili-1.5 04:27am blood alt-10 ast-32 alkphos-151* totbili-1.6* 03:05am blood alt-40 ast-91* alkphos-230* totbili-3.7* 04:36am blood albumin-2.1* calcium-7.6* phos-1.2* mg-2.0 05:30am blood calcium-8.3* phos-5.3* mg-1.9 blood culture, routine-preliminary {stenotrophomonas (xanthomonas) maltophilia}; aerobic bottle gram stain-final inpatient blood culture, routine-final { (torulopsis) glabrata}; anaerobic bottle gram stain-final blood culture, routine-final {enterococcus faecium}; anaerobic bottle gram stain-final; aerobic bottle gram stain-final 04:04pm pleural wbc-340* rbc-5925* polys-20* lymphs-71* monos-4* atyps-2* macro-3* 04:04pm ascites wbc-153* rbc-2700* polys-6* lymphs-75* monos-8* eos-2* atyps-6* macroph-3* 04:37pm ascites wbc-300* rbc-4350* polys-11* lymphs-76* monos-0 plasma-1* macroph-12* 1. similar appearance to multiple large areas of heterogeneous enhancement in the liver when compared to the previous study of , likely representing areas of infarct. the differential again includes biliary necrosis, cholangitis or other infectious processes. however, there has been no interval development of an organized hepatic collection. 2. thrombosis of the lower superior mesenteric vein, new since the previous study. 3. partial thrombosis of the superior aspect of the extended tips which is also new since the previous study. 4. focal dilation of the proximal jejunum, which may represent focal ileus. 5. pigtail catheter in the left lower quadrant. there is a moderate amount of remaining ascites, but this is much reduced in size since . 6. parastomal hernia involving loops of small bowel, which is unchanged. no evidence of obstruction. 7. moderate bilateral pleural effusions, right greater than left with adjacent compressive atelectasis. the left-sided pleural effusion has increased in size since the previous study. 8. continued extensive varices, splenomegaly and non-visualized hepatic arteries which are likely thrombosed, all unchanged since the previous study . interval development of multifocal extensive heterogeneously hypoenhancing hepatic areas, concerning for hepatic infarct/ischemia. ddx includes biliary necrosis, cholangitis, or other infectious process. cannot exclude early organizing intrahepatic abscess, but no definite thick-walled intrahepatic collection is noted. 2. interval placement of tips stent. assessment of tips patency is limited in this study, but the left portal vein appears widely patent, suggesting the tips is likely to be patent. 3. hepatic arteries not clearly visualized, likely remain thrombosed. 4. interval moderate increase of ascites, predominantly in the left lower quadrant, but without definite abscess. the presence of large amount of ascites increases risk of spontaneous bacterial peritonitis. 5. similar splenomegaly, measuring up to 21 cm. similar perisplenic and perigastric varices. 6. unchanged moderate right-sided pleural effusion, with bibasilar atelectasis, right greater than left. 7. similar right-sided parastomal hernia with loops of small bowel involved, but no bowel obstruction. status post colectomy with hartmann's pouch without surgical complications. 8. bilateral atrophic native kidneys, compatible with patient's history of end-stage renal failure. brief hospital course: mr. was admitted to dr. surgical service on for hypotension and anemia from persistent stomal variceal bleeding. with hypotension, he was admitted to the surgical intensive care unit. plan for tips procedure to divert portal blood flow to systemic circulation in order to minimize bleeding. repeat procedure on due to concerns of portal flow. shunts were extended and findings of occlusion of proximal portion. required neo for vasopressor support but was extubated immediately afterwards. patient tolerated a regular diet and then transferred to surgical floor on with stable blood pressures. displayed worsening encephalopathy on with increasing abdominal distention. diagnostic paracentesis with cytologies consistent with sbp. moreover, on , patient developed hematemesis. transferred to the sicu. he was intubated and upper endoscopies performed by gi, showed no active bleed but duodenal ulcers. after procedure, hemodynamically unstable and consistent with systemic infectious physiology. he was started on broad spectrum antibiotics and ct scan performed showing increasing abdominal ascites and pleural effusion. bedside ultrasound guided drainage of both collections, sent for culture and cytology. drains left in place to decompress both cavities. cultures returned enterococcus. he continued antibiotics (meropenem, vancomycin). daily surveillance cultures continued and returned positive. all central and access lines were removed and re-sited. however, continued to be bacteremic. no clear site identified. tee did not show any vegetations, suggesting likely infected tips. cultures then returned with yeast and vancomycin resistant enterococcus. his antibiotic regimen was switched to daptomycin. cultures again positive with stenotrophomonas. regimen switched to iv bactrim in addition to meropenem and daptomycin. hd continued as clinically needed based on clinical exam and electrolytes, transfused as needed for low hct, continued on all immunosuppression medications. on , patient decided to withdraw care and resort to home hospice for further care. he was coherent and mentally capable as this decision was made. he was discharged with palliative care recommendations on . for more detail, his hospital course can be summarized by the following review of systems neuro: pain was well controlled. on , found to be disoriented and encephalopathic, paracentesis showing sbp. he was started on antibiotics, lactulose and rifaximin. mental status improved and no more episodes until discharge. patient wishes to leave the hospital for home hospice. palliative care consulted and discharged with atropine sl drops, morphine and ativan. patient was coherent and able to make own medical decisions without compromise. this was confirmed by social worker, wife, sicu staff and surgical staff. cardio: pt with baseline hypotension while on midodrine and florinef. he continued to be hypotensive, requiring neo for additional pressor support. tte/tee procedures to assess for vegetations given patient's persistent bacteremia and were negative with normal cardiac function. no hemodynamic issues. pulm: patient intubated for his procedures. after tips, difficult to wean patient off the ventilator as he was dependent. pleural effusion drained. patient then successfully extubated and maintained on room air. no respiratory issues for remaining hospital stay. gi: patient with history of liver x 2 c/b hepatic artery thrombosis. anti-coagulation was held due to parastomal bleeding. tips to attempt to divert blood flow. abdominal fluid was drained via ultrasound guidance and external drain left in place. patient's lft continued to be abnormal as ct also suggested areas of necrosis. ct also demonstrated sma thrombosis. heparin was started to begin anticoagulation. as patient's clinical status worsened, he began to bleed again from his ostomy. hct trended and remained fairly stable. patient was re-listed for another liver but he refused. fen: patient electrolytes were checked daily and nephrology closely following for dialysis. due to poor oral nutrition, dobhoff enteral feeding were started. nutritional recommendations implemented. he continued on regular diet as well. fluid resuscitation closely monitored due to hd need. id: with sbp, patient started on meropenem given history of resistant e.coli. patient with septic physiology, started on empiric antibodies of vancomycin and flagyl. patient continued to be bacteremic. pls see lab section. daily cultures continued to be positive and microbe returned with enterococcus. this eventually became vancomycin resistant and switched to daptomycin. additional cultures positive for and stenotrophomonas. central, arterial and hd lines re-sited for persistent bacteremia. id consulted for recommendations and regimen switched to micafungin, daptomycin, and iv bactrim. tee revealed no cardiac source. ultimately, discussed with patient possible need for another liver to remove likely infected tips site. patient refused after understanding the risks and benefits. patient also kept on prograf immunosuppression. levels were checked and dosing adjusted daily. heme: patient transfused with blood as needed for hypotension and other products as needed. his total transfusion requirement for this hospital stay is 8u prbc, 4u ffp, and 2u platelets. he was also maintained on hep gtt for smv thrombosis. this was discontinued prior to discharge. disposition: patient to be discharged to home hospice. he understands the risk and benefits of his condition. he was completely mentally competent as he was making this decision. palliative care aware and to follow patient at home. he was discharged . medications on admission: mirtazapine 15'' prn. bactrim 400-80. zolpidem 5. ursodiol 300''. oxycodone 5 q4hrs prn. b complex-vitamin c-folic acid. tacrolimus . discharge medications: atropine gtt sl morphine po ativan discharge disposition: home discharge diagnosis: stomal variceal bleeding liver failure bacteremia - fungal, bacterial home hospice ftt discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: n/a call if questions to coordinator followup instructions: n/a procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified other endoscopy of small intestine diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances hemodialysis thoracentesis percutaneous abdominal drainage arterial catheterization injection of anesthetic into spinal canal for analgesia intra-abdominal venous shunt injection of anesthetic into spinal canal for analgesia intra-abdominal venous shunt diagnoses: thrombocytopenia, unspecified end stage renal disease unspecified pleural effusion acute posthemorrhagic anemia acute and subacute necrosis of liver other pulmonary insufficiency, not elsewhere classified hypopotassemia hypotension, unspecified bacteremia long-term (current) use of anticoagulants personal history of venous thrombosis and embolism other ascites streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] encounter for palliative care chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction encephalopathy, unspecified varices of other sites complications of transplanted liver surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other specified disorders of stomach and duodenum acute vascular insufficiency of intestine adult failure to thrive other and unspecified mycoses spontaneous bacterial peritonitis other colostomy and enterostomy complication secondary diabetes mellitus with other specified manifestations, uncontrolled 

Answer: The patient is high likely exposed to