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: motrin / chlorhexidine attending: chief complaint: hepatic hydrothorax with bloody thoracentesis major surgical or invasive procedure: : right video-assisted thoracoscopic surgery evacuation of hemothorax, removal of clotted hemothorax, talc pleurodesis. history of present illness: 53 yom with hcv and etoh related cirrhosis (childs class c) on list complicated by chronic hydrothorax (always on right) requiring thoracentesis throughout past year, ascites, pvt, hepatic encephalopathy, grade 1 varices, and h/o sbp. over the past few months he has been needing biweekly taps. he reports that the amount of fluid taken out has decreased per tap from initially 5-6l now down to 2-3l. he was tapped on for 1.3l. there is no history of infection related to the thoracentesis and per patient he has never had talc/pleurodesis. over past week his taps have been showing signs of blood and so he was admitted for evaluation by thoracic surgery for possible chest tube placement with talc/pleurodesis. he has required frequent banding for esophageal varices and has failed tips procedure in past. he was started on cipro ppx after admission for sbp in 3/. he has recent pna now s/p azithromycin course with residual cough but sob, cp, fevers/chills. states that he has been gaining weight over the past few months. in brief, this is a 53yo m pmhx hcv cirrhosis c/b encephalopathy, varices, sbp, portal vein thrombus, ascites w recurrent hepatic hydrothorax, hypervolemic hyponatremia (on tolvaptan), initially presenting after patient had bloody thoracenteses, with patient remaining hemodynamically stable w unchanged hct; hospital course notable for r chest tube placement and pleurodesis by thoracic surgery on hospital day 3; prior to undergoing chest tube placement, patient developed whole body , blanching, maculopapular, thought to be allergic reaction to chlorhexadine wash. over 12 hours after chest tube placement and pleurodesis, patient had 400cc serosanguinous output; uop fell overnight to <10cc/hour; hr increased from 70s to 150s, sbps 130s to 90s, and patient developed new o2 requirement (initially on room air, slowly escalating to 4l then nonrebreather). cxr did not demonstrate signs of ptx or new infection; given worsening symptoms, patient transferred to micu for further management. past medical history: - hcv cirrhosis, c/b esophageal variceal hemorrhage, ascites, portal vein thrombosis, hepatic hydrothorax, episodes of encephalopathy - chronic hyponatremia - type ii dm - h/o smv thrombus, portal vein thrombus, not anticoagulated - thrombocytopenia - arf - h/o klebsiella bacteremia -s/p inguinal and umbilical hernia repair social history: social history: lives with roommate in . has girlfriend. -tobacco: none -etoh: quit 25 years ago -drugs: former drug use, including ivdu with cocaine. patient denies drug use during past 25 years. family history: mother and father with dm2 physical exam: admission exam: vs - 97.5 88 107/66 14 98%ra general - moderate distress, sitting up in bed heent - perrl, mm dry, op clear neck - supple, +8cm jvd lungs - mildly decreased lung sounds @ right base, otherwise clear with good air movement, + accessory muscles heart - tachy, no mrg abdomen - nabs, distended, tympanitic, nontender, no rebound/guarding extremities - wwp, 1+ edema to mid-shin, no c/c skin - small wound over rle, c/d/i; maculopapular over extremities and trunk, blanching neuro - aox2-3, cns ii-xii grossly intact, no asterixis discharge exam: general - comfortable in nad heent - perrl, mm dry, op clear neck - supple, jvp flat lungs - ctab heart - rrr, no mrg abdomen - nabs, distended, tympanitic, nontender, no rebound/guarding extremities - wwp, 1+ edema to mid-shin, no c/c skin - maculopapular over extremities and trunk neuro - aox3, no asterixis pertinent results: admissoin exam: 07:00am blood wbc-4.6 rbc-2.74* hgb-8.6* hct-26.2* mcv-96 mch-31.6 mchc-33.0 rdw-16.3* plt ct-57* 07:00am blood neuts-58 bands-0 lymphs-9* monos-10 eos-23* baso-0 atyps-0 metas-0 myelos-0 07:00am blood pt-18.5* inr(pt)-1.7* 07:00am blood creat-1.0 na-139 k-4.2 cl-108 07:00am blood totbili-2.0* labs on admission to micu: 12:37am blood wbc-9.3# rbc-3.75* hgb-11.7* hct-33.8* mcv-90 mch-31.2 mchc-34.6 rdw-17.4* plt ct-103* 09:44am blood neuts-85* bands-0 lymphs-1* monos-6 eos-7* baso-0 atyps-0 metas-1* myelos-0 03:15pm blood pt-22.5* ptt-40.2* inr(pt)-2.1* 12:37am blood glucose-66* urean-12 creat-0.8 na-137 k-3.9 cl-104 hco3-24 angap-13 03:15pm blood alt-12 ast-46* totbili-5.2* 09:44am blood calcium-8.0* phos-3.6 mg-1.8 11:53pm blood lactate-4.4* 03:40pm blood freeca-0.91* lactate trend: 10:13am blood lactate-5.8* 03:40pm blood lactate-5.6* 11:53pm blood lactate-4.4* 09:15am blood lactate-2.8* 03:33pm blood lactate-3.6* 07:31pm blood lactate-3.0* . imaging: cxr: impression: slight increase in size of small-to-moderate right pleural effusion. tte (prelim): impression: normal biventricular function. no echocardiographic evidence of pe, though is not definitive test for evaluation of pulmonary embolism. cxr: there is a small right apical pneumothorax. there is a right-sided chest tube with distal lead tip in the right apex and the second chest tube at the right base. there has been decreased size of the right small pleural effusion. there is coarsening of the bronchovascular markings without signs for overt pulmonary edema. atelectasis at the right lung base is seen. cardiac silhouette and mediastinum are grossly within normal limits. cxr: findings: there is a right-sided chest tube with tip in the apex. there is no pneumothoraces. there is a right-sided pleural effusion with some loculation along the right chest wall. this is stable. heart size is stable.there is improvement of pulmonary vascular marking and congestion. there is some atelectasis versus developing infiltrates at the lung bases, which are stable. the right ij central venous catheter has the distal lead tip in the proximal right atrium. . abd us limited four-quadrant ultrasound of the abdomen demonstrates a trace amount of ascites in the perihepatic and perisplenic regions. given the trace ascites and the patient's elevated inr, this was deemed unsafe for a diagnostic/therapeutic paracentesis. . cxr pa and lat impression: 1. no pneumothorax after chest tube removal. 2. persistent small bilateral pleural effusions. discharge labs: . 04:25am blood wbc-4.1 rbc-2.79* hgb-8.7* hct-25.5* mcv-92 mch-31.0 mchc-33.9 rdw-16.9* plt ct-30* 04:06am blood neuts-67 bands-1 lymphs-9* monos-3 eos-20* baso-0 atyps-0 metas-0 myelos-0 04:25am blood plt ct-30* 04:25am blood pt-21.8* inr(pt)-2.0* 04:25am blood glucose-311* urean-23* creat-0.9 na-137 k-3.6 cl-106 hco3-25 angap-10 04:25am blood alt-11 ast-30 ld(ldh)-209 alkphos-57 totbili-2.0* 04:25am blood albumin-2.2* calcium-7.5* phos-2.8 mg-1.5* . urine 06:44pm urine rbc-75* wbc-7* bacteri-few yeast-none epi-1 transe-<1 06:44pm urine blood-mod nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 06:44pm urine hours-random urean-271 creat-160 na-20 k-48 cl-14 . pleural fluid analysis 08:40am pleural wbc-685* hct,fl-4.0* polys-26* bands-1* lymphs-24* monos-0 eos-30* atyps-3* plasma-1* macro-15* 08:40am pleural totprot-2.4 glucose-204 ld(ldh)-570 . micro stool neg for o&p cmv viral load negative pleural fluid and pleural bx negative bacterial, acid fast and fungal cx blood cx negative . pleural fluid cytology: negative for malignant cells . pleural bx: right pleural debris, excision (a): chronic fibrinous and organizing pleuritis. right pleura, biopsy (b): chronic fibrosing pleuritis. brief hospital course: 53yo m pmhx hcv cirrhosis c/b varices, ascites w recurrent hepatic hydrothorax, presented with recent history of blood thoracenteses in liver clinic. admitted for eval by thoracics for cp and talc pleurodesis. course was complicated by and hypoxia s/p ct placement requiring short stay in micu. . # hepatic hydrothorax: pt was previously receiving biweekly thoracentesis for management of hepatic hydrothorax but past several taps have come back bloody with hct of pleural fluid ranging from 4 to 13. pt was evaluated by thoracic surgery and ct with talc pleurodesis was performed twice. post procedure, course was complicated by pain and hypoxia requiring transfer to micu (see below). pleural fluid analysis was consistent with hepatic hydrothorax and cultures and cytology were negative. pleurodesis ultimately was successful and chest tube pulled when drainage stopped. on day prior to discharge, cxr revealed no new effusion indicating successful pleurodesis. . # - pt transferred to micu with hypoxia in setting of recent chest tube placement. ptx, pe and worsening pleural effusion were all ruled out. pt was splinting and taking small breaths from pain procedure which could have exacerbated his ability to oxygenate well. pt was also noted to be overly sedated when he became hypoxic which was most likely to high dose narcotic administration. cxr revealed r cardiac border infiltrate and pt's wbc increased to 27k. in setting of ams, aspiration pneumonia was diagnosed and pt was started on vancomycin, levaquin and zosyn for broad spectrum coverage. his oxygen saturation remained stable on 2l nc in icu and he was transferred back to the floor. pt was weaned off of o2 and oxygenation improved. on floor zosyn was d/ced. he was treated with vancomycin and levaquin for a total of seven days. . # distributive shock - pt w hypotension to sbp 80s, tachycardia, borderline febrile on floor, but afebrile by the time he was transferred to unit. blood cultures never speciated but pt met sirs criteria and had suspected pna suggesting sepsis as cause of shock. cvps in unit were consistently <8 which responded to 500cc fluid boluses suggesting distributive rather than cardiogenic etiology. he was empirically covered with vanc/zosyn and he received 8 l of 500cc boluses over course of micu stay until his cvps were consistently around . his ascites worsened in setting of chest tube draining hydrathorax and 8l ns boluses. pt remained normotensive when he returned to the floor. # - pt developed diffuse pruritic morbilliform eruption over extremities and trunk one day after washing with chlorhexadine soap for or. derm evaluated pt and determined that is drug reaction most likely secondary to systemic antibiotic. most likely culprits are azithromycin (which the pt took 10 days pta, and is known to cause delayed morbilliform eruption) or pcn (took zosyn during admission). derm felt that is not typical for hypersensitivity to chlorhexadine. pt was treated with zyrtec, sarna, clobetasol cream and antihistamines. at time of discharge, had improved but was still present. pt was advised not to take chlorhexadine, and avoid azithromycin. . # anemia - secondary to iron deficiency and acd. pt had several crit drops to low 20's but never had any source of acute bleed. . # cirrhosis - pt w hcv cirrhosis with varices, ascites, prior history of sbp and hepatic encephalopathy. chronic and stable on floor with worsening ascites in setting of multiple fluid boluses. in unit diuretics were held and restarted when he hit the floor. ascites improved with diuresis and pt was not given paracentesis. after icu stay, pt had ileus secondary to narcotics. his lactulose was held transiently and narcotics were tapered. ultimately he started moving his bowels again and lactulose was restarted. he did not experience any episodes of encephalopathy at this point. pt was d/ced on all of his home medications. # eosinophilia: h/o peripheral and pleural fluid eosinophilia, uncertain etiology. chronic thoracenteses have been documented to cause peripheral eosinophilia with pleural eosinophilia. stool was negative for o&p and pt was not on any medication that would be responsible for eosinophilia. #. chronic hyponatremia: pt w h/o hyponatremia thought to be cirrhosis, maintained on tolvaptan, with normal na levels. during stay in icu, tolvaptan was held, but restarted when pt was transferred back to floor. he was discharged on home dose with low na and fluid restricted diet. . #. dm: pt was continued on home glargine and iss. transitionals: - final pleural bx read - avoid chlorhexadine in future. avoid azithromycin - needs outpatient paracentesis - f/u with thoracics and in hepatology clinic medications on admission: - folic acid 1mg daily - furosemide 80mg in am and 20 at pm - lactulose 30ml - prochlorperazine maleate 10mg q6h prn - rifaximin 550mg - spironolactone 100mg daily - ursodiol 250mg tid - ferrous sulfate 300mg daily - simethicone 80mg qid prn - thiamine hcl 100mg daily - calcium qid prn - nadolol 20mg daily - ciprofloxacin 250mg q24hr - tolvaptan 60mg daily - omeprazole 20mg - vitd 50,000 units qweekly - glargine 20 units qam, 34 units qhs - humalog sliding scale discharge medications: 1. ciprofloxacin 250 mg tablet sig: one (1) tablet po once a day: sbp ppx. 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). 4. furosemide 20 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 5. spironolactone 100 mg tablet sig: one (1) tablet po once a day. 6. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po bid (2 times a day) for 5 days. 7. lactulose 10 gram/15 ml solution sig: thirty (30) ml po twice a day: restart this dose 6 days after discharge. 8. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6hr prn as needed for nausea. 9. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). 10. ursodiol 250 mg tablet sig: one (1) tablet po tid (3 times a day). 11. ferrous sulfate 300 mg (60 mg iron) tablet sig: one (1) tablet po daily (daily). 12. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for gas. 13. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 14. calcium carbonate 500 mg calcium (1,250 mg) tablet, chewable sig: one (1) tablet, chewable po four times a day as needed for indigestion. 15. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). 16. tolvaptan 30 mg tablet sig: two (2) tablet po daily (daily). 17. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 18. vitamin d 50,000 unit capsule sig: one (1) capsule po once a week. 19. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical tid (3 times a day) as needed for . disp:*1 bottle* refills:*0* 20. clobetasol 0.05 % lotion sig: one (1) appl topical (2 times a day) for 14 days. disp:*1 bottle* refills:*0* 21. cetirizine 10 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for , itching, allergy symptoms. disp:*60 tablet(s)* refills:*2* 22. insulin glargine 100 unit/ml solution sig: twenty (20) units subcutaneous qam. 23. insulin glargine 100 unit/ml solution sig: thirty four (34) units subcutaneous at bedtime. 24. humalog 100 unit/ml solution sig: 1-19 units subcutaneous four times a day: as per home sliding scale. discharge disposition: home discharge diagnosis: right hepatic hydrothorax/hemothorax. shock morbilliform drug peripheral mild eosinophilia of unknown origin 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. you were admitted to the hospital for several bloody thoracenteses. we found that your blood count was low and treated you with two units of blood. you also had a procedure done by cardio-thoracic surgery called a talc pleurodesis. the purpose of this procedure is the scar the lining of your lung against your chest wall to prevent fluid from re-accumulating in that space. a chest tube was placed to help the scarring process. the surgeons removed the chest tube and you did not re-accumulate fluid in your lungs. however, there is still a possibility that the fluid can come back. as such, we are scheduling you for another thoracentesis on friday , which you can cancel if you do not feel that you will need it at that time. . of note, your hospital course was complicated by pneumonia, increased difficulty breathing, and decreased blood pressures. you were transferred to the icu for a day and treated with with iv fluids, pressors and iv antibiotics. we treated your infection and you will not need any more antibiotic treatment. when you returned from the icu your abdomen was distended and it was determined that you had an ileus, likely secondary to narcotic medication. we held your lactulose for several days and your ileus improved. . you also developed a skin due to a medication you took. although this happened right after you washed with chlorhexadine, it is also possible that the azithromycin that you recently took caused a delayed allergic reaction. please avoid both of these medications in the future. . we have made the following changes to your home medications: change lactulose to 15 ml by mouth twice daily. please take this dose for five days and then restart your normal lactulose dose: 30 ml by mouth twice daily. . please start the following medications: camphor-menthol 0.5-0.5 % lotion one (1) appl topical tid (3 times a day) as needed for . clobetasol 0.05 % lotion one (1) appl topical (2 times a day) for 14 days. cetirizine 10 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for . . -continue your other home medications as previously prescribed. followup instructions: department: radiology care unit when: friday at 7:00 am building: de building ( complex) campus: west best parking: garage follow-up with dr. 2:00 on the clinical center chest x-ray radiology 30 minutes before your appointment. department: when: wednesday at 9:20 am with: clinic building: lm campus: west best parking: garage md procedure: thoracentesis percutaneous abdominal drainage injection into thoracic cavity thoracoscopic drainage of pleural cavity thoracoscopic pleural biopsy central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified anemia of other chronic disease anemia, unspecified cirrhosis of liver without mention of alcohol hyposmolality and/or hyponatremia portal hypertension unspecified viral hepatitis c without hepatic coma hypotension, unspecified rash and other nonspecific skin eruption other ascites hypoxemia esophageal varices in diseases classified elsewhere, without mention of bleeding portal vein thrombosis eosinophilia other specified forms of effusion, except tuberculous 

Answer: The patient is high likely exposed to