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: fish derived attending: chief complaint: hematemesis major surgical or invasive procedure: paracentesis upper endoscopy with banding x2 in distal esophagus history of present illness: mr is a 51yom with h/o psc cirrhosis c/b ascites, esophageal varices w/ prior hemorrhage, hepatic encephalopathy, prior sbp, portal vein thrombosis, on the transplant list, who initially presented to - psc cirrhosis c/b ascites, encephalopathy sbp, and bleeding esophageal varices, on transplant list - primary sclerosing cholangitis, dx - portal vein thrombosis - failed tips attempt - history of ugib in , , , - hcv: by history, had positive hcv with hcv vl in , but on follow up cleared hcv spontaneously - horseshoe kidney w/intermittent renal insufficiency - distant history of polysubstance abuse - history of dysphagia with normal barium swallow on - typical angina - chostrochondritis - depression - back pain - sleep apnea hospital w/ hematemesis. at rih he received 4 units of ffp and 2 units of prbcs, and got 2 egd's without intevention. he was then transferred to the sicu. he was not intubated. in the sicu, he has done well. he has remained hemodynamically stable, w/ stable hct, and has required no further blood product transfusion. he got on egd on , which showed very severe portal gastropathy, duodenitis, and two large varices in distal esophagus that showed stigmata of recent bleeding. two bands were placed on these varices. he remains on ppi drip, octreotide drip, and carafate 1g qid was started. also started on ceftriaxone 1g iv daily x5 days for sbp ppx in setting of variceal bleed. he was started on reglan for nausea. he is now called out to the - service. . on arrival to the floor, most recent set of vitals are 98.0 81 133/82 18 97%ra. he is a bit nauseous, but is breathing comfortably and otherwise feels well, w/o complaint. . ros: per hpi, denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, abdominal pain, diarrhea, constipation, brbpr, hematochezia, dysuria, hematuria. past medical history: - psc cirrhosis c/b ascites, encephalopathy sbp, and bleeding esophageal varices, on transplant list - primary sclerosing cholangitis, dx - portal vein thrombosis - failed tips attempt - history of ugib in , , , - hcv: by history, had positive hcv with hcv vl in , but on follow up cleared hcv spontaneously - horseshoe kidney w/intermittent renal insufficiency - distant history of polysubstance abuse - history of dysphagia with normal barium swallow on - typical angina - chostrochondritis - depression - back pain - sleep apnea social history: lives with his eldest of 2 sons. lots of family support (mother, sisters, ) - requires 24 hour care at home. not currently employed, on ssi. - smoking: quit > 16 yrs ago, 25 pack year history - etoh: history of abuse, last drink > 22 yrs ago - drugs: history of polysubstance abuse including cocaine, crack, barbiturates, amphetamines, and marijuana. none for 20 years. family history: no pertinent family history, including psc, liver disease, or other gastrointestinal disease. (has identical twin brother without above conditions). grandfather with diabetes. physical exam: admission exam (to medical floor): vs: 98.0 81 133/82 18 97%ra general: chronically ill appearign hispanic male, jaundiced, in nad heent: sclera icteric. mmm. cardiac: rrr with no excess sounds appreciated lungs: cta b/l with no wheezing, rales, or rhonchi. abdomen: distended, non-tender to palpation. no hsm or tenderness appreciated. no gaurding or rebound. extremities: edema half up shins. warm and well perfused, no clubbing or cyanosis. neurology: no asterixis, a1-b2-c3- correct. a+ox3, executive function intact, moving all extremities, walking about icu room discharge exam: vs: 98.2, 110/77. 63, 20, 100%ra i/o: 100/300 8hr, 1420/800 24hr, bm x 3 wt 83kg(), 81 kg (), 79kg (), 82kg () general: pleasant, good spirits, chronically ill appearing hispanic male, jaundiced, in nad. complains of abdom distension. heent: sclera significantly icteric, unchanged. mouth ulcerations resolved. purpura of left cheek unchanged. cardiac: rrr with no excess sounds appreciated lungs: cta b/l with no wheezing, rales, or rhonchi. abdomen: less distended today, non-tender to palpation. tympanic anteriorly, dull at dependent areas. no gaurding or rebound. incision in llq 7mm, leaking clear ascites, now with 2 stitches in place extremities: wearing socks. dull red, less induration, decrease in total area of involvement. neurology: no asterixis, a+ox3, a1b2c3 normal. moving all extremities, ambulating on own without support. pertinent results: admission: 06:06pm blood wbc-9.1 rbc-3.52* hgb-10.6* hct-31.4* mcv-89 mch-30.1# mchc-33.7 rdw-20.8* plt ct-51* 06:06pm blood pt-16.6* ptt-33.8 inr(pt)-1.6* 06:06pm blood fibrino-152* 06:06pm blood glucose-151* urean-38* creat-1.1 na-132* k-6.5* cl-96 hco3-23 angap-20 06:06pm blood alt-88* ast-91* ld(ldh)-380* alkphos-144* totbili-19.7* 06:06pm blood albumin-4.2 calcium-9.1 phos-3.4 mg-2.0 egd: small nonbleeding varices in upper and mid esophagus two large varices in distal esophagus, one with red sign very severe portal gastropathy old blood pooling in fundus but no active bleeding several discrete areas of prior endoscopic trauma, black in colour that cleared somewhat with irrigation salt and pepper duodenitis (ligation) otherwise normal egd to third part of the duodenum ascites: 03:16pm ascites wbc-100* rbc-1575* polys-37* lymphs-18* monos-0 atyps-1* macroph-44* 02:14pm ascites wbc-30* rbc-2500* polys-48* lymphs-18* monos-18* eos-3* mesothe-3* macroph-10* 10:45am ascites wbc-150* rbc-3200* polys-13* lymphs-4* monos-4* atyps-2* plasma-2* mesothe-1* macroph-73* other-1* discharge: 06:25am blood free t4-0.92* 06:45am blood tsh-0.25* 06:00am blood albumin-4.7 calcium-9.7 phos-2.3* mg-2.4 06:00am blood alt-78* ast-70* alkphos-130 totbili-20.9* 06:00am blood glucose-125* urean-33* creat-1.2 na-133 k-4.7 cl-99 hco3-25 angap-14 06:00am blood pt-18.4* ptt-48.0* inr(pt)-1.7* 06:00am blood wbc-6.2 rbc-3.08* hgb-9.5* hct-29.4* mcv-96 mch-30.9 mchc-32.3 rdw-23.3* plt ct-38* brief hospital course: mr. is a 51yom with h/o psc cirrhosis c/b ascites, esophageal varices w/ prior hemorrhage, hepatic encephalopathy, prior sbp, portal vein thrombosis, who p/w hematemsis/ugib due to esoph varices, banded in and stabilized in sicu on . then stabilized and called out of sicu on . course was complicated by worsening of renal function, which has improved in the last two days of admission. additionally, the patient's course was complicated by a flare of of his b/l lower extremeties. . in regards to the hematemsis, the patient's hct was stable through the remainder of the admission after variceal banding in sicu. the patient did not have melena, hematochezia, or hematemsis for the remainder of the admission. the patient was continued on iv ppi in the sicu and for two days afterwards. subsequently, the patient was continued on oral ppi. nadolol 20mg daily was also continued. ceftriaxone 1mg/day was continued x 5 days for sbp prophylaxis followed by ciprofloxacin 250mg . carafate was continued. anticoagulation was held. . in regards to the renal function, the patient's cr increased from a baseline of 1.1 to a peak of 2.0. the worsening renal function was likely related to large volume paracentesis and liver cirrhosis. the patient's diuretics were held, and 25% albumin at 1mg/kg was continued during the course of his admission until one day before discharge. on day of discharge the patient's cr was back to baseline at 1.2, and the patient was restarted at half his home dose. . in regards to the patient's leukocytoclastic vasculitis (), it was most prominent on the b/l lower legs. the patient was evaluated by rheumatology. the patient was then restarted on prednisone and colchicine. the patient's prednisone was tapered per rheumatology protocol. the skin lesions showed significant subjective and objective improvement during the course of admission. on the day of discharge the patient was no longer complaining of pain, the edema was significantly decreased, and the distribution of the lesions decreased as well. the patient was discharged with prednisone taper and set up with a follow up rheumatology appointment. (start prednisone po 30mg/day, start taper to goal 10mg daily + colchicine .6mg daily) . in regards to the patient's decompensated liver cirrhosis (meld 25-27), lactulose and rifaximin were continued given history of hepatic encephalopathy, diuretics were held due to poor renal function until the day of discharge. anticoagulation was held in regards to the patient's portal vein thrombosis history. patient required three therapeutic and diagnostic paracenteses. . the patient had several episodes of nsvt, cardiology was consulted, they were not concerned and did not recommend further evaluation. . transitional issues: - pt's tsh and ft4 were compatible with primary hypothyroidism - hcc screening medications on admission: 1. midodrine 10 mg po tid 2. lactulose 60 ml po qid 3. acetaminophen 650 mg po tid:prn pain 4. magnesium oxide 400 mg po bid 5. gabapentin 300 mg po q8h 6. simethicone 40-80 mg po qid:prn abd pain 7. lidocaine 5% patch 1 ptch td daily 12 hours on, 12 hours off 8. cholestyramine light *nf* (cholestyramine-aspartame) 4 gram oral 9. cyclobenzaprine 10 mg po hs:prn muscle spasms 10. ursodiol 500 mg po bid 11. torsemide 40 mg po daily 12. spironolactone 50 mg po daily 13. multivitamins 1 tab po daily 14. oxycodone (immediate release) 20 mg po q6h:prn pain 15. metoclopramide 10 mg po qid:prn nausea, before each meal 16. pantoprazole 40 mg po q24h 17. ciprofloxacin hcl 250 mg po q12h 18. calcium carbonate 500 mg po bid 19. citalopram 20 mg po daily 20. fentanyl patch 50 mcg/hr tp q72h 21. rifaximin 550 mg po bid 22. vitamin d 800 unit po daily 23. colchicine 0.6 mg po daily 24. fluconazole 200 mg po q24h duration: 4 days 25. vancomycin oral liquid 125 mg po q6h duration: 14 days 28. haloperidol 1 mg po hs . medications on transfer: 1. metoclopramide 10 mg iv q6h 2. ceftriaxone 1 gm iv q24h 3. octreotide acetate 50 mcg/hr iv drip infusion 4. citalopram 20 mg po/ng daily 5. oxycodone (immediate release) 15 mg po/ng q6h:prn pain > 6. pantoprazole 8 mg/hr iv infusion 7. fentanyl patch 50 mcg/hr tp q72h 8. lidocaine 5% patch 1 ptch td daily discharge medications: 1. cholestyramine 4 gm po bid 2. ciprofloxacin hcl 250 mg po/ng q12h 3. citalopram 20 mg po daily 4. colchicine 0.6 mg po daily rx *colcrys 0.6 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 5. fentanyl patch 50 mcg/hr tp q72h 6. gabapentin 300 mg po q8h 7. lactulose 60 ml po qid titrate to bms daily. 8. lidocaine 5% patch 1 ptch td daily 9. metoclopramide 10 mg po qidachs prn nausea 10. multivitamins 1 tab po daily 11. oxycodone (immediate release) 20 mg po q6h:prn pain > 12. pantoprazole 40 mg po q24h 13. nadolol 20 mg po daily hold for hr < 55 rx *nadolol 20 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 14. prednisone 25 mg po daily duration: 4 days rx *prednisone 5 mg 1 tablet(s) by mouth daily disp #*70 tablet refills:*0 15. rifaximin 550 mg po bid 16. spironolactone 50 mg po daily hold for sbp<90. notify ho if holding. 17. torsemide 20 mg po daily hold for sbp<90. let ho know if holding. 18. ursodiol 500 mg po bid 19. vitamin d 800 unit po daily 20. haloperidol 1 mg po hs:prn insomnia 21. acetaminophen 650 mg po tid:prn pain 22. magnesium oxide 400 mg po bid 23. simethicone 40-80 mg po qid:prn abd pain 24. cyclobenzaprine 10 mg po hs:prn muscle spasms 25. calcium carbonate suspension 500 mg po bid discharge disposition: home discharge diagnosis: primary diagnosis: -end stage liver disease with acute variceal bleed -acute kidney injury -recurrent ascites discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you at . you were transferred here for continued management of an acute bleed from your esophageal varices which was intervened upon by the gastroenterologists. your blood counts remained stable, however you began to develop worsened kidney function. we gave you albumin and stopped your water pills intermittently. you kidney function improved, and so we restarted your water pills. you really wanted to leave, so we are okay with you going home, however ideally we would want to watch your kidney function to ensure it does not worsen on the water pills. if you do not feel well for any reason, please call dr. or seek medical attention. while you were here, your vasculitis worsened and so you were restarted on a steroid (prednisone) taper. you will need to follow this steroid regimen carefully and make sure to schedule a follow up appointment with the rheumatology specialists. prior to your leaving us, you were leaking ascites from the site of a recent paracentesis. we placed stitches which seemed to have slowed the leaking. you can use a stoma bag over the incision and empty it intermittently if needed. please seek medical attention should the area begin leaking more rapidly or become painful or infected looking. you will need to have the stitches removed in 10 days (on monday ). the following changes were made to your medications: decrease torsemide to 20mg daily (from 40mg daily) stop midodrine stop warfarin, given your recent bleeding stop vancomycin stop fluconazole start nadolol 20mg daily start colchicine 0.6mg daily please make sure to follow this steroid tapering regimen to ensure your vasculitis does not flare up: start prednisone 25mg daily then take prednisone 20mg daily on then take prednisone 15mg daily on then take prednisone 10mg daily until your follow up appointment with rheumatology. you will need to call to schedule a follow up appointment with rheumatology: #(. you should be seen the week of to . please also continue to get your weekly blood draws. followup instructions: you will need to call to schedule a follow up appointment with rheumatology: #(. you should be seen the week of to . dr. office will call you with a follow up appointment for you during the first week of as you will have you have a repeat upper endoscopy. if you have any questions, his office number is: #(. you should schedule follow up with your primary care provider, , m. , within the next week. procedure: percutaneous abdominal drainage percutaneous abdominal drainage endoscopic excision or destruction of lesion or tissue of esophagus diagnoses: cirrhosis of liver without mention of alcohol acute kidney failure, unspecified unspecified acquired hypothyroidism long-term (current) use of anticoagulants other sequelae of chronic liver disease other ascites awaiting organ transplant status esophageal varices in diseases classified elsewhere, with bleeding duodenitis, without mention of hemorrhage other specified disorders of stomach and duodenum portal vein thrombosis other premature beats adjustment disorder with depressed mood other specified hypersensitivity angiitis 

Answer: The patient is high likely exposed to