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: hypoxia/altered mental status major surgical or invasive procedure: intubation history of present illness: 40m w/ recent onset cirrhosis, recent w/u for transplant likely nash. went back to to sort out insurance, and was having chronic diarrhea when he presented to in early for diarrhea/nausea and was d/c'd . he represented on with chills, diarrhea, vomitting and 2 syncopal episodes after standing from seated position. he was noted to have waxing and mental status and had paracentesis which showed 140 wbcs w/ 51% polys. there is no culture data available. his mental status continued to wax and wane over the next few days but he was ambulatory and a/ox2. over night he became acutely non-responsive after vomiting large amounts of feculent material. his wbc increased to 16.5 and he was intubated for airway protection. after intubation he required norepinephrine and got a cvl. he was started empirically on vanc/zosyn. ct abd did not show obstruction. . in icu bp 107/61 map 77, hr 74, 16, 36.4 . in flight, patient was given some ativan for agitation, and his fio2 was increased to 60% for transport, up from 30% while on the floor. . on the floor, the patient was stable, and his fio2 was initially decreased to 50%. cvp was 14 w/ peep 5. past medical history: -child- score 11/ class c cirrhosis/nash -crohn's disease since age 13, s/p ex lap, no history of bowel resection -h. pylori -primary biliary cirrhosis (diagnosed at st. hosp?) -r. hydrothorax () transudative effusion -morbid obesity/osa -anemia of chronic dz. episode with hgb 7.5(hospt with transfusions ) - hospital. -hyperkalemia/hypoalbuminemia -depression/adjustment disorder -?inguinal hernia on the right side social history: reports being an active in martial arts prior to recent decompensation. denies tobacco, reports occ. etoh use. no ivdu. previously lived in , recently moved back to (lives in/near , ). currently not working. married and divorced twice with last divorce 2 years ago. has grandmother who is involved in his care. family history: no family history of cardiac disease, liver disease, cancer or renal failure. mother bipolar d/o. father emphysema, cad. physical exam: on transfer to micu: vitals: t:96.5 oral bp:107/78 p: 92 on vent fio2:51% o2sat 99% general: ncat, intubated heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: bilateral air entry with decreased breath sounds over lower right lung field. cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: distended, obese, no organomegaly, some ascites noted. gu: foley in place ext: warm, well perfused, 2+ pulses, +2 pitting edema bilaterally, +1 edema in upper extremities. pertinent results: 07:34pm o2 sat-76 07:34pm type-central ve temp-35.6 rates-/15 tidal vol-550 peep-5 o2-50 po2-45* pco2-40 ph-7.42 total co2-27 base xs-0 intubated-intubated vent-spontaneou 07:43pm o2 sat-93 07:43pm type-central ve po2-109* pco2-36 ph-7.44 total co2-25 base xs-0 08:30pm plt count-191 08:30pm neuts-81.0* lymphs-12.6* monos-3.3 eos-2.6 basos-0.5 08:30pm wbc-8.2 rbc-2.53* hgb-7.8* hct-24.7* mcv-98 mch-30.8 mchc-31.6 rdw-17.4* 08:30pm triglycer-56 08:30pm albumin-2.2* calcium-7.3* phosphate-3.1 magnesium-2.0 08:30pm alt(sgpt)-18 ast(sgot)-24 ld(ldh)-81* alk phos-86 tot bili-1.6* 08:30pm estgfr-using this 08:30pm glucose-82 urea n-14 creat-0.9 sodium-143 potassium-3.8 chloride-115* total co2-24 anion gap-8 09:19pm urine granular-0-2 09:19pm urine rbc-0-2 wbc-0-2 bacteria-occ yeast-none epi-0-2 09:19pm urine blood-tr nitrite-neg protein-25 glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 09:19pm urine color-amber appear-clear sp -1.044* 09:19pm urine osmolal-704 09:19pm urine hours-random urea n-554 creat-355 sodium-14 potassium-greater th chloride-25 09:24pm type-art temp-35.8 rates-/14 tidal vol-550 peep-5 o2-50 po2-118* pco2-36 ph-7.45 total co2-26 base xs-2 intubated-intubated vent-spontaneou . ct abd: 1. no suspicious hepatic lesions identified. known underlying fatty infiltration of the liver with sequelae of portal hypertension noted including recanalized paraumbilical vein. third spacing involving the gallbladder wall with mild amount of intra-abdominal ascites and mesenteric induration and mild cecal/ascending colonic edema, all likely secondary to underlying portal hypertension. 2. scattered enlarged mesenteric lymph nodes, presumably reactive. mild dilatation and air-fluid levels of the small bowel suggestive of mild ileus. 3. moderate right simple pleural effusion. new infectious or inflammatory centrilobular and tree-in- opacities within the left lower lobe with mild bronchiectasis and bronchial wall thickening. 4. conventional arterial anatomy. accessory right hepatic vein draining into the ivc. . echo: the left atrium is mildly dilated. the right atrial pressure is indeterminate. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). doppler parameters are most consistent with normal left ventricular diastolic function. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the detected pulmonary artery systolic pressure is lower. . left upper ext u/s: no dvt in left upper extremity. . cxr: as compared to the previous radiograph, there is unchanged position of a left picc line and a nasogastric tube. unchanged presence of a right pleural effusion. however, the extent of the effusion has decreased in the interval. . ruq u/s: 1. limited study due to large amount of bowel gas obscuring portions of the left hepatic lobe and the pancreas. 2. where visualized, no focal liver lesion is seen. 3. left portal vein not visualized due to bowel gas, otherwise hepatic vasculature is patent. in particular, main and right portal veins are patent with normal hepatopetal flow. 4. evidence of portal hypertension, with splenomegaly and small ascites. 5. right pleural effusion. . ct head: no evidence of acute intracranial process. brief hospital course: mr. is a 40 year old man with a history of esld nash, transferred here for acutely decompensated encephalopathy with intubation for airway protection. . # encephalopathy - likely decreased bowel movements from ileus. ct head negative for bleed at osh. ileus likely caused by electrolyte abnormalities from 2 months of preceding diarrhea and pt had bowel surgeries in the past for crohn's disease with small bowel/colonic anastomoses. ct scan showed bowel edema which may be ascites and can cause malabsorption. pt has been oriented and non-encephalopathic since extubation. having several bowel movements on lactulose. rifaximin was started as well. will continue these as outpt. . # ileus - as above, likely from electrolyte abnormalities from chronic diarrhea. no evidence of complete sbo at osh, erythromycin was started then discontinued to help move bowels. lactulose and rifaximin will be continued as outpt. diet was successfully advanced and pt was able to tolerate full diet prior to discharge. . #esld/cirrhosis - cirrhosis nash diagnosed on biopsy in , c/b ascites, recurrent r hydrothorax and encephalopathy. unable to do diagnostic para because there was not enough fluid. pt began to undergo liver transplant work-up on this admission. we continued lactulose, rifaximin. ultrasound of liver showed no signs of thrombosis or flow impedance. ct scan did not show suspicious liver lesions. echo and pfts were done as part of transplant work-up. increased lasix dose and spirinolactone to manage peripheral edema. has recurrent r side hydrothorax which was drained once on initial presentation in . stable on cxr and not drained on this admission given pt's good respiratory status. will follow up with dr. for the remained of pre-transplant evaluation. . # aspiration - intubated at osh for aspiration vomiting feculent material from ileus. cxr showed signs of aspiration pneumonitis, pt completed a 7-day course of vanc/zosyn. prior to discharge had no oxygen requirement and was afebrile. all cultures were negative (of note, pt had one culture at osh that grew propionobacterium, which was likely a contaminant). . # anemia - hct around 23-24 throughout admission. received 2u rbcs on . no evidence of active bleeding, no blood in stool, likely chronic. no evidence of hemolysis. will follow this up as outpt. encouraged pt to take home iron supplement. medications on admission: medications: 1. furosemide 20 mg tablet sig: two (2) tablet po daily (daily). disp:*28 tablet(s)* refills:*0* 2. spironolactone 25 mg tablet sig: four (4) tablet po daily (daily). . outpatient meds: 1. melatonin 6 at bedtime 2. vitamin d3 1000 daily 3. iron chews 3 times daily 4. vit c 500 d 5. spironolactone 100 dialy 6. zofran q6h prn nausea 7. lasix 40 daily 8. oxycodone 5/500 two tabs q6hrs prn pain. . medications on transfer: 1. versed 5mg q 5 minutes as needed for agitation/anxiety 2. lactulose enema 200g/l twice daily 3. pantoprazole iv 40 daily 4. rifaximin 200mg via ng q8hrs 5. spironolactone 50mg ng daily 6. vancomycin 1000 iv q8 7. zosyn 4.5gm q6hrs 8. norepinephrine 4mg -8mg continuous infusion 9. propofol (as needed for sedation) 10.vitamin d 1000 daily 11. vitamin c 500 daily 12. zofran iv 4mg q8hrs 13. lasix 80mg ng daily 14. albuterol nebs 15. potassium 20meq ng 16. oxycodone as needed 10mg q2hrs for pain discharge medications: 1. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 2. spironolactone 50 mg tablet sig: one (1) tablet po once a day: please take one 50mg tablet and one 100mg tablet, for a total of 150mg of spironolactone every day. disp:*30 tablet(s)* refills:*2* 3. spironolactone 100 mg tablet sig: one (1) tablet po daily (daily): please take a total of 150mg spironolactone a day. disp:*30 tablet(s)* refills:*2* 4. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po bid (2 times a day). disp:*1800 ml(s)* refills:*2* 5. furosemide 40 mg tablet sig: 1.5 tablets po qam (once a day (in the morning)): please take 60mg (1 1/2 tablets) of lasix in the morning and 40mg (1 tablet) of lasix in the evening. disp:*90 tablet(s)* refills:*2* 6. ascorbic acid 500 mg tablet sig: one (1) tablet po daily (daily). 7. iron oral 8. zofran oral 9. cholecalciferol (vitamin d3) 400 unit tablet sig: 2.5 tablets po daily (daily). 10. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*2* discharge disposition: home discharge diagnosis: 1. aspiration pneumonia 2. hepatic encephalopathy 3. cirrhosis 4. hydrothorax discharge condition: alert, oriented x3 self ambulating discharge instructions: you were transferred to because of your breathing, confusion, and swelling in your extremities. you were intubated in the icu and treated with antibiotics for a pneumonia. you were extubated successfully. your confusion and swelling is due to your cirrhosis, liver disease. we started you on two medications called lactulose and rifaximin. these medications will help prevent confusion. lactulose will cause you to have increased stools, you should have at least 3 bowel movements per day. we also started you spironolactone and increased your lasix dose, these are water pills that should help reduce the amount of swelling you have. while you were here we also started a transplant work up. you have an appointment to follow up with dr. (see below) in the clinic. . we have made the following changes to your medications: 1. start lactulose, titrate to at least 3 bowel movements per day 2. start rifaximin 3. start sprinolactone 4. increase lasix from 40mg daily to 60mg in the morning and 40mg in the afternoon 5. stop oxycodone, because of your liver disease this will make you sleepy and confused 6. albuterol as needed for wheezing . you can continue the rest of your medications. followup instructions: please follow up with: . pcp : wednesday, at 1:30pm with: dr. phone: where: . , . department: transplant when: thursday at 2:20 pm with: , md building: lm bldg () campus: west best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified arterial catheterization colonoscopy diagnoses: obstructive sleep apnea (adult)(pediatric) anemia, unspecified cirrhosis of liver without mention of alcohol acute respiratory failure pneumonitis due to inhalation of food or vomitus morbid obesity paralytic ileus diarrhea hepatic encephalopathy dehydration benign neoplasm of colon personal history of other diseases of digestive system other specified forms of effusion, except tuberculous 

Answer: The patient is high likely exposed to