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: percocet attending: chief complaint: sob major surgical or invasive procedure: thoracentesis x 2, paracentesis x 2 pleurodesis redo tips history of present illness: 58m with etoh cirrhosis s/p tips placement, hx of r hydrothorax with last etoh use in winter , who s/p day 7 for a thoracentesis and paracentis. patient presents today with sob. he feels most comfortable when he lies on his right side. he denies any chest pain or palpitations. he initially felt better after these interventions. however he has since noted increasing abdominal distention. he denies any n/v/f/c/abd pain. . in the ed, the patient's vitals were as follows: t98 bp 125/76 hr 102 r22 o2sat 97%ra. cxr showed a very large right-sided pleural effusion increased since the study. the liver fellow was contact who recommended admission and thoracentesis in the am. past medical history: 1. etoh cirrhosis: decompensated with ascites and varices, on transplant list 2. colonic adenoma: polypectomy in 3. esophageal varices: grade 1 on last egd in , s/p banding of grade ii varices in , h/o hematemesis in the past 4. cholelithiasis 5. partial colectomy: at in severe gi bleed after polypectomy 6. hernia repair social history: catholic priest. children. no tobacco. currently no etoh. formerly a heavy drinker (cannot quantify). currently living with parents. family history: no fam hx of cirrhosis/liver disease; 6 siblings, all healthy. parents both alive and healthy physical exam: vs: tc 98, bp 125/76 hr 102, rr 22, sao2 97%/ra general: chronically ill-appearing male in nad, able to speak in full sentences, lying comfortably in bed heent: nc/at, perrl, eomi, no scleral icterus,no lad, mmm, op clear chest: decreased bs over right lung base, no rrw cv: nl rate, s1s2, ii/vi hsm along lusb abd: soft, nt, distended, +fluid wave, no peritoneal signs ext: no c/c/e, wwp neuro: no asterixis, cn ii-xii intact, no motor or sensory abnormality pertinent results: studies: cxr: very large right-sided pleural effusion increased since the study. . : diagnostic and therapeutic paracentesis: approximately 2 liters of ascitic fluid removed. . : ruq usn: there is wall to wall flow within the tips. the velocity within the main portal vein is 40 cm per second. the velocities within the proximal, middle and distal tips are 98 cm per second, 141 cm per second, and 231 cm per second, respectively. the appropriate reversal of flow is demonstrated within the right anterior portal vein and left portal vein. these findings are similar compared to prior study. also noted are extensive varices within the oeft upper quadrant in the vicinity of the splenic hilum. . . : two chest tubes remain in place in the right hemithorax. additionally, two clamps overlie the lower right abdominal and chest wall with the tip of one of the clamps overlying the lower of the two chest tubes. very small lateral hydropneumothorax is identified in the upper right hemithorax corresponding to a site of previously composed of pleural fluid without definitive air within its contents on a previous exam. interstitial pattern in the right lung is again demonstrated likely due to asymmetric interstitial edema and there are minor atelectatic changes at the right lung base. subcutaneous emphysema has markedly increased in the right chest wall. . cxr picc placement: uncomplicated ultrasound and fluoroscopically-guided picc line placement via the right brachial venous approach with a tip positioned in svc. . . abd usn: small amount of likely ascites in the right upper quadrant. no significant pocket of ascites was identified that would be suitable to mark for paracentesis by the clinical staff. . cxr: small right pleural effusion has increased slightly in volume since and 9 following removal of right basal pleural tube. the apical tube is unchanged in position. consolidation in the posterior segment of the right upper lobe has recurred concerning for aspiration pneumonia. lungs otherwise showed generalized vascular congestion. mild edema present yesterday has resolved even though heart size has increased slightly. no pneumothorax. . . labs: 07:40pm blood wbc-9.4 rbc-2.72* hgb-9.1* hct-26.9* mcv-99* mch-33.6* mchc-33.9 rdw-18.7* 07:15am blood wbc-7.4 rbc-2.41* hgb-8.2* hct-23.8* mcv-99* mch-34.2* mchc-34.6 rdw-18.6* plt ct-73* 06:08pm blood wbc-7.3 rbc-2.95* hgb-9.9* hct-29.5* mcv-100* mch-33.6* mchc-33.6 rdw-17.6* 04:40am blood wbc-16.1* rbc-2.67* hgb-9.1* hct-26.1* mcv-98 mch-34.1* mchc-35.0 rdw-20.4* plt ct-96* 04:54am blood wbc-6.5 rbc-2.87* hgb-9.8* hct-27.6* mcv-96 mch-34.0* mchc-35.3* rdw-20.1* 06:23am blood wbc-6.5 rbc-2.48* hgb-8.1* hct-22.9* mcv-92 mch-32.8* mchc-35.6* rdw-18.1* plt ct-59* 04:38am blood wbc-6.6 rbc-2.89* hgb-9.6* hct-27.2* mcv-94 mch-33.3* mchc-35.5* rdw-18.7* plt ct-73* 05:33am blood wbc-8.1 rbc-2.83* hgb-9.6* hct-26.9* mcv-95 mch-33.8* mchc-35.6* rdw-20.1* plt ct-82* . 07:40pm pt-18.1* ptt-39.0* inr(pt)-1.7* 07:40pm plt smr-unable to 07:40pm hypochrom-normal anisocyt-2+ poikilocy-2+ macrocyt-2+ microcyt-normal polychrom-1+ ovalocyt-1+ teardrop-1+ fragment-1+ 07:40pm neuts-74.9* bands-0 lymphs-9.6* monos-8.4 eos-6.6* basos-0.5 07:40pm wbc-9.4 rbc-2.72* hgb-9.1* hct-26.9* mcv-99* mch-33.6* mchc-33.9 rdw-18.7* 07:40pm albumin-2.7* 07:40pm lipase-77* 07:40pm alt(sgpt)-17 ast(sgot)-43* ld(ldh)-308* alk phos-115 amylase-139* tot bili-7.1* 07:40pm estgfr-using this 07:40pm glucose-109* urea n-21* creat-1.3* sodium-134 potassium-4.2 chloride-102 total co2-25 anion gap-11 brief hospital course: a/p - 58 y/o male with etoh cirrhosis, recurrent ascites s/p tips with recent revision, recurrent hepatic hydrothorax, p/w sob. . . # hemetemesis: on , pt had episode of hemetemesis (1.3l bright red blood). pt refused ngt placement, his hemetemesis resolved, and on the following morning, decision was made not to attempt egd as it would require intubation, which was felt counter to pt's goals of treatment. he received 4u prbcs, with stabilization of his hematocrit. on , plan was to perform egd purely for paliative banding, however pt's hct had remained stable, thus no further intervention was pursued. . . # right hepatic hydrothorax: pt presented with right hepatic hydrothorax, felt his chronic abdominal asicites. attempt was made to revise his tips, however this was felt patent, with gradient of 6mm hg, thus pt went onto receive pleurodesis on . a chest tube was placed, however, output remained significant over the course of the next 2 weeks. fluid cultures revealed +mssa, which was treated with a course of nafcillin. ultimately, decision was made to remove chest tube, as it was felt that output would continue to remain significant despite maximal therapy of his liver disease. plan was to perform serial thoracentesis as needed. . chest tubes were removed, and pt continued to have significant drain site output. multiple stiches were placed however his output continued to be 500-1000cc daily. an ostomy bag was affixed to the site of his chest tube drains. given his goals of care, no further intervention was performed. his pain was controlled with oxycontin, oxycodone, and prn morphine iv for breakthrough pain. . . # ascites esld: pt received 2 paracentesis, with relief of his ascites. he was managed with diuretics initially, however these were held hyponatremia. elevated creatinine were noted on pt was noted to have rising creatinine, raising concern for hepatorenal syndrome sbp, given +cultures from pleural fluid (which was draining from asictes). he was treated with a 5d course of zosyn to cover for other gut flora. subsequently, his renal function improved, and he denied any abdominal pain. . . # elevated wbc - etiology unclear, pt notes some diarrhea overnight, thus concerning for c. diff (on cipro), ua dirty , though ucx were negative x 2. will repeat labs this morning, with diff, check stool cultures, repeat urine culture, and blood culture, and f/u on routine daily cxr given chest tube placement. . . # hyponatremia - pt presented with na 134, he has a h/p low sodium, felt liver disease. on his na was noted to be 121, his diuretics were discontinued, he was treated with 1l fluid restriction. he was breifly treated with octreotide/midrodine and albumin given concern for hepatorenal syndrome on . his na was trending up at time of discharge (136), however diuretics were held given his h/o dropping his sodium quickly on diuretics, and concern about restarting diuretics with his low blood pressures. given his goals of care, he will be discharged off of diuretics. . . # esld: from alcohol cirrhosis, pt not a transplant candidate ongoing alcohol consumption. he was treated with lactulose, rifaximin to prevent encephalopathy. he was discharged on nadolol 20 po qd. pt will cipro 250 mg po qd for sbp prophylaxis. given his poor prognosis from his liver dysfunction (tbil 13.2), recurrent hydrothorax, and hemetemesis, goals of care were changed to dnr/dni and plan was made to discharge pt to hospice. . . # anemia - baseline hct 27-30 upon presentation. he was found to be guaic positive, with hct floating down slowly throughout his admission, for which he received multiple transfusions (9u prbc) over ~2weeks. pt then had episode of hemetemesis on as above. his hct stablized without egd, after 5u prbc total, his last unit of prbc on resulted in hct 22-> 26-28. he has received a total of 13 units prbc this admission. . . # arf - pt presented with creatinine 1.3 (bl 0.9-1.1). on and again on pt had episodes of rising creatinine (peak 2.4 on ), which were concerning for hepatorenal syndrome given una<10, and failure to respond to fluid challenge. pt was treated with octreotide/midrodine/albumin, with rapid improvement in creatinine down to 1.1 on . he continues to make good urine ouptut. . . # dispo: goals of care discussion held on between pt and dr. (outpt hepatologist), plan was made to discharge pt to hospice. regarding hospice medications, please call his primary care physician , . if any additional questions exists, please contact his hepatologist dr. ((). medications on admission: hydroxyzine 25 mg po daily:prn bupropion (sustained release) 100 mg po qam lactulose 30 ml po tid folic acid 1 mg po daily furosemide 40 mg po bid spironolactone 100 mg po daily hexavitamin *nf* one cap oral daily ursodiol 300 mg po bid discharge medications: 1. bupropion 100 mg tablet sustained release sig: one (1) tablet sustained release po qam (once a day (in the morning)). 2. hydroxyzine hcl 25 mg tablet sig: one (1) tablet po daily (daily) as needed. 3. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day). 4. lorazepam 1 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 5. rifaximin 200 mg tablet sig: one (1) tablet po tid (3 times a day). 6. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: one (1) inhalation q6h (every 6 hours). 7. oxycodone 5 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for pain. 8. potassium & sodium phosphates mg packet sig: one (1) packet po bid (2 times a day). 9. sucralfate 1 g tablet sig: one (1) tablet po qid (4 times a day). 10. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 11. ciprofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours). 12. oxycodone 40 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). 13. lorazepam 0.5 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 14. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). 15. sodium chloride 0.9% flush 3 ml iv daily:prn peripheral iv - inspect site every shift 16. ondansetron hcl (pf) 4 mg/2 ml solution sig: one (1) injection q8h (every 8 hours) as needed. 17. morphine 2 mg/ml syringe sig: one (1) injection q4h (every 4 hours) as needed. discharge disposition: extended care facility: family hospice house discharge diagnosis: primary: hepatic hydrothorax ascites etoh cirrhosis hemetemesis (upper gi bleeding) secondary: colonic adenoma esophageal varices discharge condition: hemodynamically stable, afebrile, ambulating discharge instructions: you were admitted to the hospital with shortness of breath, this is being caused by fluid in your abdomen tracking into your lungs because of your severe liver disease. there is no further intervention available to you. you are being discharged to hospice. followup instructions: please follow up with your pcp as needed. pcp: , please arrange to be followed up with dr. at liver clinic as needed, ( procedure: insertion of intercostal catheter for drainage angioplasty of other non-coronary vessel(s) thoracentesis thoracentesis percutaneous abdominal drainage injection into thoracic cavity transfusion of packed cells angiocardiography of venae cavae procedure on single vessel diagnoses: hyperpotassemia acute posthemorrhagic anemia alcoholic cirrhosis of liver acute kidney failure, unspecified hepatorenal syndrome hyposmolality and/or hyponatremia chronic kidney disease, unspecified hematemesis 

Answer: The patient is high likely exposed to