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: history of present illness: this is a 60-year-old male with history of alcoholic hepatitis and cirrhosis, who is here electively for therapeutic peritoneal tap. patient has been experiencing some abdominal discomfort since his last tap approximately one week ago. he denies any shortness of breath at the current time. he has increased discomfort when lying down. he denies any nausea, vomiting, or abdominal pain. he denies any bleeding from the rectum or in his stool. he denies any lightheadedness, fever or chills. he is coming here electively for a tap in the setting of elevated inr and decreased platelets. he is also very malnutritioned, is coming up here for both hepatology workup and a nutrition consult. past medical history: 1. alcoholic hepatitis and cirrhosis. 2. acute renal failure. 3. diabetes mellitus. 4. hepatitis a antibody positive, but hepatitis b and c negative. 5. hyponatremia secondary to cirrhosis. 6. grade ii esophageal varices. medications at home: 1. colace 100 mg po bid. 2. protonix 40 mg po q day. 3. pentoxifylline 400 mg po tid. 4. vitamin k 10 mg po q day. 5. multivitamin one tablet po q day. 6. folate 1 mg po q day. 7. thiamine 100 mg po q day. 8. serax 10 mg q hs prn. 9. ursodiol 300 mg po tid. 10. lactulose 30 cc po bid. 11. compazine 10 mg po q6h prn nausea. allergies: none. family history: mother with diabetes, but no liver disease. social history: extensive alcohol use from age 20 to 40. he denies any tobacco use. physical examination upon admission: temperature is 97.2, blood pressure 100/57, pulse of 51, respiratory rate of 16, and 97% on room air. generally, this is a tired appearing, pleasant, jaundiced male in no acute distress. heent: icteric sclerae, sublingual icterus. mucous membranes are dry. neck: no jugular venous distention noted. cardiac: regular, rate, and rhythm, normal s1, s2. no murmurs, rubs, or gallops. pulmonary is clear to auscultation except for the bases which have decreased breath sounds bilaterally. abdomen is soft, nontender, normoactive bowel sounds. abdomen is quite distended. extremities: no clubbing, cyanosis, or edema noted. laboratories upon admission: white count 13.3, hematocrit 29.6 with mcv of 102, platelets 55. sodium 125, potassium 5.3, chloride 95, bicarb 23, bun 63, creatinine 1.5, glucose 147, calcium 8.7, phosphate 4.9, magnesium 2.9, inr 2.1, ptt 46.6, pt 17.7, alt 84, ast 70, ldh 172. alkaline phosphatase 158, amylase 28, total bilirubin 24.8. hospital course: 1. gastroenterology: ascites. given the patient's ascites, a paracentesis at bedside was performed and 3 liters of straw-colored fluid was removed. the fluid was sent for cell count and gram stain. the fluid came back showing 55 white blood cells with 12% neutrophils, 7% lymphocytes, and 26% monocytes, and 125 red cells. the gram stain of the fluid was negative for any organism. the mri of the abdomen that was done for liver workup showed large abdominal ascites, so a second paracentesis at bedside was attempted. however, only 100 cc of straw-colored fluids with some blood tinged fluid was taken out. the second paracentesis required about re-entries before it was deemed that no further fluid could be obtained. the fluid from the second paracentesis was also sent, and it showed 35 white cells, 7% neutrophils, 13% lymphocytes with 190 red cells. gram stain was also negative on the second paracentesis. liver transplant workup. a mri of the abdomen was obtained showing a cirrhotic liver with a volume of 1479 cc. also noted was a question of right accessory hepatic vein. also seen was esophageal varices, pseudocysts, left upper pole renal cyst, and large abdominal ascites. a subsequent abdominal ultrasound revealed that there was no right accessory hepatic vein. also done was a transesophageal echocardiogram for transplant workup showing left atrial dilation, mild symmetric left ventricular hypertrophy. an ejection fraction was greater than 55%. there were no valvular problems or pericardial effusion. hepatic encephalopathy secondary to cirrhosis. patient was initially continued on his ursodiol, trental, and lactulose for his hepatic encephalopathy. however, his trental was discontinued once he became bacteremic since the trental was not giving him any beneficial effect, and the roll of trental during sepsis is unknown, so the medication was discontinued. patient was also initially given some reglan to help him move his nasogastric tube to the postpyloric position, but then that was discontinued given that his mental status started worsening. despite lactulose administration, the patient continued to be less oriented, so a ct scan of the head was obtained showing no evidence of intracranial hemorrhage. he was continued on the lactulose, but he was still only alert and oriented times one to himself on of this hospitalization. gaseous distention secondary to lactulose use. patient's abdomen continued to be distended, but became quite tense during the hospitalization. a kub and upright chest x-ray was done showing no free air. however, the plain films did show a lot of gaseous distention of his , he was started on a fleet enema and simethicone to help relieve the gaseous distention from the lactulose use. coagulopathy secondary to cirrhosis. the patient came in with an inr of 2.1 upon admission. he was continued on his vitamin k supplements each day, but his inr seemed to worsen from 2.1 to 2.6. since he was no longer able to po given the decreased mental status, the vitamin k was discontinued. 2. hyponatremia: the patient came in with the sodium of 125. he was put on 1.5 liter fluid restriction and his sodium did resolve coming back up to 140. he was continued on the fluid restriction as possible. 3. acute renal failure from acute tubular necrosis likely to prerenal azotemia: the patient's creatinine was 1.5 upon admission, and did improve to 1.2 with administration of albumin and normal saline. however, his creatinine started worsening, so he was started on octreotide and midodrine. though this did help his creatinine improve temporarily, his creatinine then slowly crept up to 2.4. at this time, renal team was consulted and recommended that there should be an increase in the octreotide to 200 mcg subq tid and midodrine increased to 12.5 mg po tid. though suggested that the patient may need to go to the intensive care unit for a swan placement, so that he could be loaded with fluids, the hepatology service felt that the patient should be observed on the increases of octreotide and midodrine. 4. hematology/anemia of chronic disease and anemia secondary to blood loss: patient's hematocrit did fall down to 26 with guaiac positive stool. he is given 1 unit of packed red blood cells and bumped up appropriately to 30 after the transfusion. since his hematocrit did remain stable around 30, it was felt that he did not need any endoscopy at this time. his stool did become guaiac negative, but then became guaiac positive on . his hematocrit was checked twice a day, and remained stable around 30. 5. infectious disease: 1. mrsa and group b beta streptococcus bacteremia. after the mri showed large abdominal ascites, a second paracentesis was performed with re-entry of the needle to 4-5x. after the second paracentesis, patient started having right sided abdominal pain. a ct scan of the abdomen was obtained showing a sense of straining at the right flank and right lower quadrant consistent with a cellulitis. he was then treated empirically with vancomycin while his blood cultures on grew 4/4 bottles with gram-positive cocci. these organisms were then identified to be group b beta hemolytic streptococcus and mrsa. therefore, he was to continued on the vancomycin as renally dosed with getting vancomycin every time his level is less than 15. a vre rectal screen was obtained and shown to be positive. however, infectious disease was consulted and felt that the antibiotic regimen should not be changed and that vancomycin should still be the antibiotic choice given that the blood cultures did not grow any vre. surveillance blood cultures were obtained on , , and . the blood cultures were negative, and the rest of the blood cultures is nothing growth to date. a repeat ct scan of the abdomen was obtained showing fat stranding at the right flank with no worsening cellulitis. aspiration pneumonia: the patient was known to have aspirated a small amount of clear liquid and aspirated huge amount of tube feedings that was regurgitated during his video swallow study. when his white count climbed up to 16, beside being on the appropriate vancomycin for his mrsa bacteremia, a chest x-ray was obtained on showing low lung volumes, left upper lobe/lingula loss of translucency consistent with aspiration, and an increased retrocardiac opacity that may be consistent with atelectasis versus consolidation. at this time, patient was started on levaquin and flagyl to cover his aspiration pneumonia, and his white count did drop down to 12.5 from 16. a urine culture was also obtained to exclude the aspiration pneumonia, may not be the cause and urine culture was found to be negative. 6. endocrine: diabetes mellitus. given that the patient was put on a tube feeding with high glucose content, consult was obtained. he was then started on glargine 16 units subq q am with regular insulin-sliding scale. 7. nutrition: nutrition was consulted after day of admission, and recommend a placement of a postpyloric feeding tube. he was then started on nepro tube feeds, but then changed over to criticare because he was not tolerating the nepro. the nepro seemed to have caused a lot of nausea. however, he seemed to tolerate the criticare quite well, but he had too much high glucose content, so he was switched over to deliver. he was able to tolerate the deliver without nausea. a speech and swallow consult was obtained, and a subsequent video swallow study showed that he aspirated a small amount of thin liquids, and a huge amount of regurgitant feeding tube feeds. his mental status then worsened to a point that speech and swallow recommended that he be kept npo. once his mental status clears, they will perform another video swallow study to assess whether he does aspirate clear thin liquids. but at the current time, he should remain nothing per mouth. the rest of the dictation will be done by dr. as an addendum. , m.d. dictated by: medquist36 d: 12:18 t: 12:18 job#: procedure: enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage injection or infusion of other therapeutic or prophylactic substance other transplant of liver arteriography of other intra-abdominal arteries pulmonary artery wedge monitoring reopening of recent laparotomy site monitoring of cardiac output by other technique suture of artery open biopsy of liver diagnoses: acute kidney failure with lesion of tubular necrosis other postoperative infection acute posthemorrhagic anemia alcoholic cirrhosis of liver hepatorenal syndrome hematoma complicating a procedure bacteremia hemoperitoneum (nontraumatic) 

Answer: The patient is high likely exposed to