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: no known allergies / adverse drug reactions attending: chief complaint: s/p fall, alcohol withdrawal major surgical or invasive procedure: endotracheal intubation cardiopulmonary resuscitation history of present illness: mr is a 39m with hx etoh abuse, hx seizures, tx from for etoh withdrawal and s/p fall. last drink was 2 days ago. per ed report, he was found down after an unclear period of time by his father, and there was concern that he ahd a seizure at top of 13 stairs and fell to the bottom. in the eedham ed, he had a lactate fo 11. ct head, cervical spine, and torso were done given fall history, with no acute findings. he was transferred to given "concerning mechanism for fall". he was given kcl prior to transfer. . in the ed, the patient was awake, alert, with mild confusion, complaining of chest, back and l ankle pain. exam was notable for tongue lac (nonsuturable), neck nontender, c-spine cleared. he continued to be tachy to 130 despite 20mg iv valium. ankle swelling was noted, therefore ankle films were repeated and showed no obvious fracture. he was given 3 additional l of fluid, lactate went from 11 to 1.8, also got an additional 4 mg ativan in iv. vitals on transfer were hr 140s, 132/80, r 23. he was initially placed in a sling out of concern for small fracture of humerus seen on shoulder films. . in the micu, pt was initially aao x1, states he is in pain in his r shoulder and back. was drinking one pint of vodka/day, last drink . in the micu, pt initially had a hct of 19 and was transfused 2 x prbcs plus 6 pack of platelets. pt had coffee grounds on suctioning and was started on pantoprazole before being switched to omeprazole. pt also desaturated to 60s and was pulseless for 30 seconds, requiring 30 seconds of cpr and was intubated on . pt was extubated without incided on w/ no issues. pt may have had an apiration event but pt has not been febrile, and cxr is not concerning. while intubated, pt had continuous recording eeg but no seizure activity was noted. on presentation, pt was seizing, but has been very stable and only 0-1 on ciwa scale on day of transfer. pt did not have repeat egd due to egd at showing portal gastropathy and gastritis but no varices. of note, pt also has a r humerus greater tuberosity fracture. per micu staff, orthopedics was not formally consulted but recommended no sling and outpatient followup. . pt was transferred to floor on . on arrival to the floor, pt's vitals were: . review of sytems: prior to admission, but had no fevers, no chills, no weight loss, no nightsweats. no nausea or vomiting, no diarrhea or constipation. no chest pain or dyspnea. no palpitations. no focal numbness or weakness. no urinary symptoms. no abdominal pain. past medical history: htn pud etoh abuse complicated by withdrawal seizures, multiple prior aborted attempts at detox psoriasis (no formal diagnosis) depression social history: pt lives in with his father. not currently working. previously contractor / landscaper. 1 pt vodka/day, no tobacco, no illicits, no iv drug use. family history: mother had breast cancer. father diabetes. physical exam: vitals: t:99.7 bp:134/64 p:145 r: 18 o2:97% ra general: alert, orient x1.5, appears uncomfortable heent: sclera icteric, oropharynx clear, tongue bruised, eyes with saccadic movements and rolling back into the head during the exam neck: supple, jvp not elevated, no lad lungs: coarse upper airways sounds, no rhonchi/rales cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: a&ox3, cnii-xii intact, sensation and strength grossly intact in all extremities skin: erythematous plaques with silver scale on legs, bruising on extremities and back pertinent results: admission labs: 11:40pm glucose-140* urea n-8 creat-0.6 sodium-137 potassium-3.0* chloride-106 total co2-20* anion gap-14 11:40pm alt(sgpt)-19 ast(sgot)-136* ck(cpk)-350* alk phos-211* tot bili-10.6* dir bili-7.4* indir bil-3.2 11:40pm lipase-22 11:40pm ctropnt-<0.01 11:40pm ck-mb-6 11:40pm calcium-7.7* phosphate-1.1* magnesium-1.3* 11:40pm wbc-11.0 rbc-2.98* hgb-8.9* hct-27.8* mcv-94 mch-30.0 mchc-32.1 rdw-19.3* 11:40pm neuts-89.6* lymphs-5.5* monos-3.8 eos-0.9 basos-0.2 11:40pm plt smr-very low plt count-44* 11:40pm pt-17.7* ptt-32.2 inr(pt)-1.6* 11:40pm urine color-dkamb appear-clear sp -1.022 11:40pm urine blood-lg nitrite-neg protein-tr glucose-neg ketone-tr bilirubin-sm urobilngn-8* ph-7.5 leuk-tr 11:40pm urine rbc->182* wbc-4 bacteria-none yeast-none epi-0 11:45pm lactate-1.8 trauma plain films: ankles: impression: significant medial soft tissue swelling with no fracure. mild lateral clear space widening. right shoulder: right shoulder, four views: there is a fracture of the greater tuberosity, impacted and slightly comminuted. no other fracture. no dislocation. minimal ac joint spurring. the visualized portions of the right lung and ribs are unremarkable. head ct: impression: 1. resolved small falcine subdural hematoma. 2. no acute intracranial abnormality. : radiology ct head w/o contrast 1. resolved small falcine subdural hematoma. 2. no acute intracranial abnormality. . radiology duplex dopp abd/pel findings: echogenicity of the liver is within normal limits with no focal lesion identified. no intra- or extra-hepatic biliary dilation is seen. the cbd measures 3 mm. the gallbladder is mildly distended however no wall thickening or pericholecystic fluid is seen. no evidence of cholelithiasis. the spleen is enlarged measuring up to 14.5 cm. no free fluid is seen. the kidneys appear normal. the right kidney measures 11.6 cm and the left 12.9 cm. limited views of the pancreas are normal though the distal tail is obscured by overlying bowel gas. the aorta is not well assessed due to overlying bowel gas. doppler evaluation of the liver was performed. there is reversal of flow in the main portal vein as well as the anterior right portal vein. the left portal vein and posterior right portal vein demonstrates hepatopetal flow. the hepatic artery and major branches appear normal. the hepatic veins appear normal though the right hepatic vein cannot be followed in its entirety. the ivc, where visualized, appears normal. the splenic vein is patent. there is recanalization of the umbilical vein. there may be a small right pleural effusion, partially imaged. impression: findings consistent with cirrhosis and portal hypertension including recanalized umbilical vein and splenomegaly. there is reversal of flow in the main portal vein and anterior right portal vein. no free fluid is seen. . - ct cspine: mild c3-4 intervetebral disc herniation - ct torso: acute fracture of greater tuberosity of r humerus, r gluteal hematoma, cirrhosis with splenomegaly, esophageal varices, no ascites, unchanged from discharge labs: 06:25am blood wbc-8.9 rbc-2.90* hgb-8.9* hct-28.4* mcv-98 mch-30.8 mchc-31.4 rdw-20.3* plt ct-140* 06:25am blood pt-16.6* inr(pt)-1.5* 06:25am blood glucose-83 urean-12 creat-0.6 na-135 k-3.7 cl-102 hco3-23 angap-14 06:25am blood totbili-9.2* 06:25am blood mg-1.9 brief hospital course: 39 yo gentleman admitted with etoh withdrawal, s/p fall likely due to seizure, now with concern for ongoing seizure activity. . #. etoh withdrawal: patient with chronic etoh abuse and a history of withdrawal seizures, presented 2 days after last drink with evidence of seizures. story of fall downstairs was highly suspicious for seizure. given iv thiamine and iv ativan in ed. on arrival to the icu, the patient was confused and tremulous. around 7:30am the morning of admission, the patient became minimally responsive with his eyes rolling up. he was receiving boluses of iv ativan for withdrawal and began having difficulty protecting his airway, so the decision was made to intubate. he was difficult to intubate and became severely hypoxemic. he was pulseless for about 1 minute, during which time he received cpr. after intubation, his oxygenation improved. he was started on multivitamin, thiamine and folate. he was then continued on a midazolam infusion for sedation and control of seizures. continuous eeg monitoring showed just slow wave forms without further seizures. his mental status improved, and the next day he was able to be extubated. he did not require further benzodiazepenes. given that his seizures were in the setting of withdrawal, he was not started on antiepileptics. pt also did not show any alcohol withdrawal symptoms since and did not require benzodiazepenes for withdrawal. pt's electrolytes were repleted as needed, and he was treated with thiamine, multivitamins, and folate daily. . #. gi bleed / anemia: after og tube placement, patient had coffee grounds on suction. likely chronic from long-term alcoholism, and portal gastropathy. clinically stable. be exacerbated by gastritis. started on pantoprazole 40mg iv and continuous octreotide for 72 hours. hematocrit went down to 19, requiring transfusion of 2 units prbc. patient had a recent endoscopy at that did not have esophageal varices, so the decision was made to not do urgent endoscopy. his hematocrit stabilized and og suction mostly cleared prior to extubation. pt's hct was stable at 24 for several days and improved to 28 by day of discharge. pt was started on nadolol 40mg daily to try to decrease his portal hypertensive gastropathy. pt did continue to have blood-coated bowel movements due to his chronic hemorrhoids, which improved with his home nightly hydrocortisone suppositories. . # transaminitis: also with severely elevated bilirubin, consistent with alcoholic hepatitis. has a history of repeated episodes of alcoholic hepatitis. hepatology service was consulted. discriminant function of 37 suggests suggested a benefit from steroid therapy, so once his blood cultures and hepatitis serologies were negative, he was started on prednisone 40mg daily, which was continued with plateau of tbili at ~11. pt was therefore felt to be likely to benefit from full 4 week course of steroids and was continued on prednisone 40mg daily. however, given his rapid improvement, prednisone was discontinued on and bilirubin continued to downtrend to 9.2 on day of discharge. pt was also treated for several days with aggressive nutrition via ng feeding tube. nutrition consult did a calorie count and estimated that pt was consuming ~ 800 calories per meal. since our goal for alcoholic hepatitis was ~ calories per day, tube feeds were not deemed necessary, and feeding tube was discontinued no day of discharge. pt was instructed to eat large nutritious meals for the next few weeks to aid his recovering liver. pt was instructed not to restart his pentoxyfiline on discharge. . # s/p fall, r humeral greater tuberosity fracture: patient arrived with multiple ecchymoses consistent with fall. right shoulder films showed a small fracture of the greater tuberosity of the humerus. orthopedics was formally consulted and suggested sling and non-weightbearin status on r arm until he is seen in outpatient orthopedic clinic on . pt was started on vitamin d and calcium. . # possible subdural hematoma: ct head from showed a possible subdural hematoma in the falx cerebri. repeat imaging at showed resolution. pt did not have any further seizures. pt did not have any focal neurological deficits. . # ? pna: osh ct reportedly with features concerning for multilobular pna. pt certainly at risk for aspiration but did not have fever or leukocytosis. chest xr's at did no show any focal opacities or infiltrates. no antibiotics were given. pt remained afebrile and w/out any respiratory symptoms. . # st depressions on ekg: patient had st depressions in v2-v4 without any symptoms concerning for acs although pt unable to clearly articulate. likely rate related. repeat ekg showed resolution, and troponins remained negative. pt did not have any further concerning ecg changes or cardiac symptoms. . transitional issues: -pt needs to stop drinking alcohol. pt was given several choices for detox programs. 1) hospital in , which is an outpatient 5 days/week program. contact at . 2) in , which is an inpatient program. contact at . he is supposed to call one of these programs on monday, , and social worker will contact him to ensure he follows through. -pt needs to see orthopedics regarding further management of his small r humeral fracture. -pt needs derm follow-up / workup of his extensive rash -pt has a murmur of unclear etiology and states that he has never had any workup. medications on admission: citalopram - 20 mg tablet - 1 tablet(s) by mouth once a day folic acid - (prescribed by other provider) - 1 mg tablet - 1 tablet(s) by mouth once a day metoprolol succinate - 25 mg tablet extended release 24 hr - 1 tablet(s) by mouth once a day pentoxifylline - (prescribed by other provider) - 400 mg tablet extended release - 1 tablet(s) by mouth three times a day medications - otc magnesium oxide - (otc) - 250 mg tablet - 1 tablet(s) by mouth once a day milk thistle - (prescribed by other provider) - dosage uncertain multivitamin - (prescribed by other provider) - dosage uncertain thiamine hcl - (prescribed by other provider) - 100 mg tablet - 1 tablet(s) by mouth once a day discharge medications: 1. nadolol 20 mg tablet sig: two (2) tablet po daily (daily): hold for sbp < 90 or hr < 55. disp:*60 tablet(s)* refills:*0* 2. multivitamin tablet sig: one (1) tablet po daily (daily). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. hydrocortisone acetate 25 mg suppository sig: one (1) suppository rectal qhs (once a day (at bedtime)). 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 6. petrolatum ointment sig: one (1) appl topical tid (3 times a day) as needed for psoriasis. 7. tramadol 50 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. disp:*60 tablet(s)* refills:*0* 8. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 9. cholecalciferol (vitamin d3) 1,000 unit tablet sig: one (1) tablet po daily (daily). 10. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 11. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). discharge disposition: home discharge diagnosis: primary: alcoholic hepatitis alcohol withdrawal fracture of right greater tuberosity of humerus secondary: hemorrhoids discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , you were originally brought to the hospital by your father after he found you down at the bottom of the stairs. you most likely had an alcohol withdrawal seizure. you were transferred to for further care. you had to be intubated during your stay in the icu and you briefly needed cardiopulmonary resuscitation (cpr). your clinical condition improved with aggressive nutrition and with steroids. you will need to see a liver specialist (hepatologist) about your alcoholic hepatitis. you also had a small fracture of your right upper arm and you were seen by our orthopedic specialists, who wanted to treat your fracture with a sling for one week followed by arm exercises. you should continue to wear your right arm sling until you see your orthopedic surgeons on (see below). you should also see a dermatologist because your skin lesions may not be psoriasis. you must stop drinking alcohol, or you will likely shortly succumb to your disease. we have made the following changes to your medications: -start nadolol 40mg tablets, 1 tab daily -start vitamin d and calcium -start tramadol for pain, you can take it up to every six hours -stop pentoxyfiline followup instructions: department: orthopedics when: wednesday at 1:20 pm with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: orthopedics when: wednesday at 1:40 pm with: , np building: campus: east best parking: garage department: healthcare of when: thursday at 4:50 pm with: . , md building: (, ma) ground campus: off campus best parking: parking on site department: gastroenterology name: , md when: tuesday at 2:30 pm location: address: , , phone: department: dermatology notes: the dermatology department in / is working on a hospital follow up appointment in 1 month after your hospital discharge. if you have not heard from the office in 2 business days please call the number listed below. phone: ( procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances alcohol detoxification cardiopulmonary resuscitation, not otherwise specified other immobilization, pressure, and attention to wound video and radio-telemetered electroencephalographic monitoring diagnoses: thrombocytopenia, unspecified alcoholic cirrhosis of liver portal hypertension other convulsions acute respiratory failure other specified cardiac dysrhythmias cardiac arrest accidental fall on or from other stairs or steps carrier or suspected carrier of methicillin resistant staphylococcus aureus obesity, unspecified hematemesis other specified disorders of stomach and duodenum internal hemorrhoids with other complication external hemorrhoids with other complication precipitous drop in hematocrit acute alcoholic hepatitis alcohol withdrawal peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] nonspecific abnormal electrocardiogram [ecg] [ekg] acute alcoholic intoxication in alcoholism, continuous open wound of tongue and floor of mouth, without mention of complication alcoholic gastritis, without mention of hemorrhage closed fracture of greater tuberosity of humerus extradural hemorrhage following injury without mention of open intracranial wound, with brief [less than 1 hour] loss of consciousness 

Answer: The patient is high likely exposed to