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: upper gi bleed major surgical or invasive procedure: egd history of present illness: 46 year old male with etoh cirrhosis, c/b severe esophagitis, esrd due to hepatorenal syndrome, presenting with upper gi bleed. patient has longstanding history of etoh cirrhosis, taken off transplant list last year in setting of alcohol relapse and loss to followup. reportedly had recent egd showing gastritis, but no varices. per ed, reported having melenous stools for the past few days. vomited two buckets brb at with sbp 140s, hr 140s. trended down to sbp 80s. hb initially 3, 9 units prbcs and 9 units ffp at osh. hct 9 with platelets of 28. got 9u prbc, 9 units ffp at with sbps up to 140s. repeat hgb was 9, hct 20. . on arrival to ed, initial vs: hr 130. repeat labs notable for hct of 23.7, plts 28, inr 1.5, cr 2.9, t bili 7.3, ast 1600, alt 360. repeat hct 29 ruq u/s was performed with preliminary read showingpatent portal vein and recanalized umbilical vein. cholelithiasis. no large ascites. patient intubated for aspiration risk and egd performed at bedside in ed with no evidence of varices, but severe esophagitis. started on ppi and octreotide drip. at , got 4 units prbcs, 2 ffp, 1 plts and ca gluconate. bp stable while at at 110s-120s. patient was subsequently admitted to the icu for further treatment. had one melanotic stool. . on arrival to the micu, patient is intubated and sedated. unable to obtain further history. patient has two 18g peripheral ivs and one femoral cvl. past medical history: (#) mrsa bacteremia treated with vancomycin (#) etoh abuse with h/o seziures ? during intoxication (#) etoh liver disease-- acute etoh hepatitis in (was not started on corticosteroids due to gi bleed, uti and ); was started on pentoxyphyline to prevent hrs with a planned 4 week course from (last day ); negative hepatitis a, b and c serologies. (#) hemodialysis dependent-- since last admission, dx multifactorial with atn +/- nsaids +/- hrs; hd through tunneled line tuthsat (#) gastroesophageal reflux disease (#) seizures in setting of heavy alcohol consumption, seen by a neurologist who did not feel that it was a primary seizure disorder (first ) (#) mva - right femur fracture with placement, pelvic fracture (#) asthma social history: has never smoked. drank vodka daily until recently, but denies drinking in the past 4 months (last drink first week of ). never has used iv drugs. lives with girlfriend, . has 2 children, daughter 17, son, 16 who live with their mother who the patient is still very close to. pt formerly worked at mass electric. family history: mother - deceased alcoholic liver disease father - deceased cancer, diagnosed in his 40s. no other family history of cancer. physical exam: vitals: t: 99.6 bp: 134/53 p: 125 r: 18 o2: 98% on cmv general: sedated, intubated, opens eyes on command, shakes head yes and now, intermittently following commands heent: sclera icteric, dry blood around mouth, ett in place neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: distended, soft, nontender, large umbilical hernia gu: foley in place ext: warm, well perfused, 2+ pulses, 2+ pitting edema bilaterally on lower extremities up to knees with superficial erythema bilaterally, rue fistula with palpable thrill and audible bruit neuro: moves all extremities, opens eyes on command and shakes head yes/no, follows commands intermittently discharge exam: 98.4, 134/65, 80. 20, 95% ra gen: aox3, nad heent: scleral icterus cv: rrr, referred murmur from av fistula site across precordium lungs: slight decreased breath sounds of r base consistent with pleural effusion with partial reaccumulation ext: + le edema, tense, slightly erythematous, but no signs of infection. neuro: nonfocal pertinent results: admission labs: 12:40am glucose-142* urea n-86* creat-2.9*# sodium-143 potassium-3.7 chloride-96 total co2-12* anion gap-39* 12:40am alt(sgpt)-365* ast(sgot)-1615* alk phos-97 tot bili-7.3* 12:40am lipase-88* 12:40am albumin-3.0* 12:40am wbc-7.5# rbc-2.54*# hgb-7.9*# hct-23.9*# mcv-94 mch-31.3 mchc-33.2 rdw-16.2* 12:40am neuts-89.4* lymphs-5.0* monos-5.3 eos-0.2 basos-0.2 12:40am plt count-28*# 12:40am urine blood-mod nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.5 leuk-neg 12:40am urine rbc-5* wbc-3 bacteria-few yeast-none epi-0 12:40am urine mucous-rare imaging: egd : 1. keep patient intubated and npo 2. continue ocreotide gtt @ 50 mcg / hr 3. continue protonix gtt @ 8 mg hr 4. ceftriaxone 1 gram iv q24 for a total of 7 days 5. check hct q12 hrs 6. transfuse to keep an hct of 25-27 7. try to keep plt > 50 and inr < 1.5 8. once bp and hr stable will need a non selective beta-blocker 9. follow hepatology recs ruq ultrasound: impression: 1. coarsened and echogenic hepatic parenchyma with the sequelae of portal hypertension including splenomegaly and recanalized paraumbilical vein with patent portal vein and no evidence of ascites. 2. cholelithiasis without cholecystitis 3. large right pleural effusion ap cxr : impression: 1. nasogastric tube in the distal esophagus, could be advanced 15 cm. 2. large right pleural effusion and mild pulmonary edema with cardiomegaly, new since . cxr : findings: as compared to the previous radiograph, the patient has been extubated and the nasogastric tube has been removed. the extensive right pleural effusion has minimally decreased in extent, the evidence of moderate pulmonary edema is still present. unchanged size and appearance of the cardiac silhouette. discharge labs: 05:25am blood wbc-1.8* rbc-3.15* hgb-9.8* hct-31.2* mcv-99* mch-31.0 mchc-31.3 rdw-19.1* plt ct-37* 05:25am blood glucose-83 urean-58* creat-3.1* na-141 k-3.9 cl-106 hco3-23 angap-16 05:25am blood pt-16.1* ptt-33.3 inr(pt)-1.5* 05:25am blood alt-80* ast-71* alkphos-119 totbili-16.6* 05:25am blood calcium-8.6 phos-3.2 mg-1.7 brief hospital course: 46 year old m with etoh cirrhosis meld of 32, ckd, presenting with massive upper gi bleed. . 1. gi bleed: patient with large volume hematememsis and coffee ground emesis, with hct of 9 at osh. transfused 9u prbc, 8u ffp and 10u plts. hct up to 23 on arrival and up to 29 on repeat. no evidence of varices on previous egds, but hepatology performed egd bedside in ed which showed severe esophagitis and severe portal gastropathy, and still no evidence of varices. started on octreotide and ppi drips, which were continued for 72 hours. started on iv ceftriaxone 1 gram iv q24hrs, which was switched to cipro 500mg which he completed a 7 day course. the patient's hct remained stable around 30 on the floor. he was transitioned to protonix. he was given sucrafate for esophagitis. he will have a repeat egd in 12 weeks after starting ppi (already scheduled). . 2. narrow complex tachycardia: the patient's hr was sustained in the 140s during one night of admission. ekg showed a narrow complex tachycardia most consistent with an svt. vagal maneuvers were attempted without success. the patient was given low dose beta blockers. he spontaneously converted to nsr the next morning. he remained in nsr during the remainder of his hospitalization. . 3. pleural effusion: the patient had a moderate to large r sided pleural effusion seen on cxr. this was new from , but likely subacute and c/w hepatic hydrothorax. a thoracentesis was performed that showed a transudate. cytology is pending on discharge. 4. alcohoic cirrhosis: patient with alcholic cirrhosis and meld score of 31. no longer a candidate for transplant given alcohol relapse and loss to followup. lfts elevated significantly above baseline likely secondary to gi bleed and hepatic decompensation. these continued to trend down. the patient will be discharged with plan for relapse prevention. the patient understood that he risks death if he continues to consume alcohol. . 5. ckd: patient previously on hd in the past for hepatorenal syndrome. cr 2.9 on admission, which is below previous baseline, but trended up slightly. he has a right sided fistula. he had adequate urine output and his electrolytes were stable. follow-up: - the patient had a leukopenia on discharge, likely from nutrition and medications. this should be followed as an outpatient to ensure it is trending up. - f/u cytology from pleural fluid medications on admission: (from d/c summary ): - xifaxan 550 mg tab 1 tablet(s) by mouth twice a day - omeprazole 20 mg cap, delayed release2 capsule(s) by mouth twice a day - sucralfate 1 gram tab 1 tablet(s) by mouth four times a day - lasix 40 mg tab oral 1 tablet(s) twice daily - celexa 20 mg tab oral 1 tablet(s) once daily - folic acid 1 mg tab oral 1 tablet(s) once daily - mag-oxide 400 mg tab oral 1 tablet(s) twice daily - thiamine 100 mg tab oral 1 tablet(s) once daily - metoprolol tartrate 25 mg tab oral 1 tablet(s) twice daily - allopurinol 100 mg tab oral 1 tablet(s) once daily discharge medications: 1. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). 2. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 7. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 8. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 9. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 10. lactulose 10 gram/15 ml syrup sig: sixty (60) ml po daily (daily). 11. metoprolol tartrate 25 mg tablet sig: one (1) tablet po twice a day. discharge disposition: home with service facility: , discharge diagnosis: upper gi bleed etoh cirrhosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital with a severe gi bleed that required many blood transfusions. you underwent an egd that showed severe inflammation of the lower part of the esophagus and large vessels in the stomach. you were on a ventilator initially in order to protect your lungs. your bleeding resolved and your blood counts remained stable. you had lower extremity muscle weakness. you will be discharged to rehab in order to help regain your strength. please take your medications as prescribed. please attend all of your follow-up appointments. please refrain from drinking any alcohol. medication changes: these will be relayed to your facility. they will give you a list when you leave from there. followup instructions: department: liver center when: tuesday at 1:40 pm with: building: lm campus: west best parking: garage department: digestive disease center when: thursday at 1:30 pm with: , md building: building (/ complex) campus: east best parking: main garage department: endo suites when: thursday at 1:30 pm procedure: other endoscopy of small intestine thoracentesis diagnoses: end stage renal disease renal dialysis status esophageal reflux unspecified pleural effusion alcoholic cirrhosis of liver portal hypertension asthma, unspecified type, unspecified other specified cardiac dysrhythmias hemorrhage of gastrointestinal tract, unspecified esophagitis, unspecified hyperosmolality and/or hypernatremia other and unspecified alcohol dependence, unspecified 

Answer: The patient is high likely exposed to