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: altered mental status requiring intubation major surgical or invasive procedure: intubation w/ mechanical ventilation history of present illness: the pt is a 48y/o m with pmh of hepatitis c, inoperable hcc and alcoholic cirrhosis admitted with encephalopathy after being found unresponsive with an empty bottle of oxycontin nearby. pt has a longstanding history of alcohol-induced cirrhosis and hepatitis c with associated portal hypertension, varices, ascites and encephalopathy, and hepatocellular carcinoma. his most recent scans are notable for recurrence of his hepatocellular carcinoma following his radiofrequency ablation (5/). at his most recent oncology visit on , he was found to have a rapid deterioration in his liver function and was felt not to be a candidate for further cancer-directed therapies. per report, on the day of this admission, he was found to be unresponsive by his family and was taken to . there he was intubated for airway protection in the setting of a gcs of 8. ct a&p demonstrated an advanced tumor of the left lobe of the liver and abdominal varices. rll consolidation consistent with pna was also seen. ct head negative for acute process. he was sent to for further managemnt. he was given zosyn and clindamycin as treatment for his pneumonia. og tube showed brown aspirate and he was given zantac for gi protection. on arrival to , t 95.9, hr 91, bp 136/96, rr 18. he was given 1 l ns and transferred to micu. past medical history: 1. cirrhosis child's class c, complicated by varices, encephalopathy, and ascites. 2. hepatitis c secondary to iv drug use. 3. hepatocellular carcinoma status post rfa in . 4. alcohol abuse, hx of dts. 5. polysubstance abuse with cocaine & heroin. 6. nephrolithiasis. 7. chronic back pain status post motor vehicle accident with multiple rib fractures. 8. depression. social history: the patient is currently living in a trailer on his mother's property in . social stressor is that his mother is going to kick him out and he needs to find a new location for his trailer. the patient is currently smoking 2 packs per week, has significant tobacco history of 1 to 2 packs per day x 30 years. alcohol use per hpi. no current iv, illicit or herbal drug use. he is not currently sexually active. he is on disability. recently broke up with his girlfried, which is an additoinal stressor and contributed to his increased drug and alchohol use. family history: he does not know of any liver disease or colon cancer. father with a history of alcoholism physical exam: vs - temp 97.5, bp 140/85, hr 83, r 18, o2-sat 100% ra general - chronically ill appearing man, comfortable heent - mild scleral icterus, no jvd, mmm, op clear lungs - cta bilat heart - rrr, iii/vi systolic murmur at apex abdomen - moderately distended, + shifting dullness, no hsm, nt, no rebound/guarding extremities - wwp, 3+ pitting edema of le's, 2+ peripheral pulses (radials, dps) skin - multiple spider angiomas on chest neuro - no asterixis, a/ox3 pertinent results: 06:15pm blood wbc-10.7 rbc-3.00* hgb-10.4* hct-29.3* mcv-98 mch-34.6* mchc-35.4* rdw-18.6* plt ct-223# 05:05am blood wbc-10.3 rbc-2.48* hgb-8.6* hct-24.5* mcv-99* mch-34.7* mchc-35.2* rdw-18.9* plt ct-192 01:49am blood pt-26.8* ptt-39.1* inr(pt)-2.7* 06:15pm blood glucose-128* urean-39* creat-1.1 na-126* k-3.3 cl-92* hco3-26 angap-11 05:05am blood glucose-79 urean-41* creat-1.3* na-131* k-3.3 cl-100 hco3-23 angap-11 06:15pm blood alt-39 ast-154* alkphos-119* totbili-11.2* 01:49am blood ammonia-140* 06:15pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 06:24pm blood lactate-1.9 11:53pm blood lactate-1.7 cxr the et tube is seen in situ with its tip approximately 13 mm from the carina. the ng tube is seen traversing the gastroesophageal junction and following a course towards the stomach. there are bibasal effusions along with atelectasis/probable consolidation at the lung bases. follow up with ap and lateral chest radiographs would be helpful to assess for atelectasis vs. consolidation. there is apparent deformity of the left humeral head which is not well visualized and if there is suspicion of trauma to the left shoulder joint, dedicated views of the left shoulder would be helpful. abd u/s 1. cirrhosis and large infiltrative mass in the left lobe of the liver consistent with patient's known hepatocellular carcinoma. there is probable new tumor ingrowth into the left portal vein which is non-occlusive. 2. moderate ascites 06:32am blood wbc-9.8 rbc-2.23* hgb-8.3* hct-24.4* mcv-110* mch-37.4* mchc-34.1 rdw-21.3* plt ct-106* 05:30am blood neuts-76.6* lymphs-15.4* monos-6.1 eos-1.6 baso-0.4 06:32am blood pt-24.8* ptt-42.4* inr(pt)-2.4* 09:45pm blood fibrino-257 05:20am blood glucose-104 urean-8 creat-0.7 na-132* k-2.7* cl-103 hco3-22 angap-10 06:32am blood alt-39 ast-102* ld(ldh)-402* alkphos-94 totbili-7.8* 05:20am blood calcium-7.3* phos-2.6* mg-1.3* 05:30am blood %hba1c-4.5* 05:09am blood ammonia-38 06:15pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 11:53pm blood type-art po2-263* pco2-39 ph-7.51* caltco2-32* base xs-7 brief hospital course: the pt is a 48y/o m with pmh of hepatitis c, hcc and alcoholic cirrhosis admitted with altered mental status requiring intubation for airway protection in the setting of suspected opioid overdose. encephalopathy - the etiology of the patient's ams was likely multifactorial involving end stage liver disease,?anoxic-insult given unknown down time, and opiate toxicity. head ct negative at osh. upon admission, the patient was sedated and intubated. pt began regimen of lactulose with >4bms per day; with a decrease in nh4 from 140-->38 during his micu stay. the patient's mentation improved during his admission, sedating medications were weaned down before extubation, and upon transfer out of micu he was a&o to person and place and following commands. pt. was on ciwa on transfer to floor and gradually cleared w/ less and less lorazepam. at time of d/c he was a/ox3 for several days. respiratory failure/pna ?????? pt was intubated for unresponsiveness and a gcs of 8 at an osh. ct of chest demonstrated rll consolidation c/w possible aspiration pna. upon admission to the micu, the patient was still intubated and sedated with propofol. empiric zosyn was started for coverage of aspiration pna which was changed to unasyn on . repeat cxr on showed improving lung fields with no signs of consolidation. sputum gs grew gpcs in pairs, chains, and clusters on . the pateitn was weaned off sedation on , extubated, and placed on 2lnc o2 with adequate oxygen saturation. upon transfer, the patient was stable from a pulmonary standpoint. on the floor he did not have any pulmonary distress, but did spike a fever to 102.5 while on unasyn, so he was switched to vanc/levo/zosyn. his cxr was negative and he quickly defervesced so abx were stopped after a short course. etoh cirrhosis/hepc/hcc ?????? per recent history, the patient has a h/o etoh abuse, his hcc is rapidly progressing and his liver function is rapidly declining. upon admission, he had many stigmata of liver disease, both on exam (encephalopathic, scleral icterus, palpable mass in epigastric area c/w hcc mass in left lobe, mild ascites, spider angioma, extensive ecchymosis) and laboratory testing (elevated inr and abnormal liver enzymes). pt was given vit kx1 without change in his inr. the liver team was consulted and followed the patient during his stay. an u/s of ruq on showed no signs of portal vein thrombosis, cirrhosis and large infiltrative mass in the left lobe of the liver c/w patient's known hepatocellular carcinoma; there is probable new tumor ingrowth into the left portal vein which is non-occlusive. pt. was offered hospice house but could not wait until this was available, he decided to leave ama. hx of heavy etoh abuse - the patient was maintained on ciwa scale with 1mg of ativan per protocol in the micu. the ativan was weaned to 0.5mg on and completely off two days later. pt. stated that he would continue to drink on d/c. hypotension: on , the patient developed hypotension to 80/40's. likely secondary to physiology of hepatic failure and possibly opioid toxicity. given ivf boluses and bolus of albumin with good response. home bp medications were held. pt remained hemodynamically stable afterwards. guaiac + ngt aspirate - pt with history varices and significant variceal bleeding, also etoh abuse. hct stable in mid-20's during admission and hemodynamics not c/w acute bleed. the patient was type and screened, adequate peripheral access was achieved and he was placed on a ppi and hct remained stable for the duration of admission. medications on admission: clonidine - 0.1 mg tablet - 1 tablet twice a day fluticasone - 50 mcg spray, suspension - 1 spray inhaled apply to each nostril twice daily folic acid - 1 mg tablet - 1 tablet(s) by mouth once a day furosemide - 40 mg tablet - 1 tablet(s) by mouth once a day lactulose - 10 gram/15 ml solutio- 30mls four times a day lidocaine - 5 % (700 mg/patch) adhesive patch, medicated - 1 patch daily wear 12 hours on then take off mirtazapine - 15 mg tablet - 1 tablet(s) by mouth at bedtime nadolol - 40 mg tablet - 1 tablet(s) by mouth daily nicotine - 14 mg/24 hour patch 24hr - 1 patch daily pantoprazole - 40 mg tablet, delayed release (e.c.) - 1 tablet po twice a day spironolactone - 100 mg tablet - 1.5 tablet(s) by mouth once a day medications - otc ferrous sulfate - 325 mg (65 mg) tablet - 1 tablet(s) by mouth daily hexavitamin - tablet - 1 tablet daily thiamine hcl - 100 mg tablet - 1 (one) tablet(s) by mouth once a day discharge medications: 1. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 2. rifaximin 200 mg tablet sig: three (3) tablet po bid (2 times a day). disp:*180 tablet(s)* refills:*2* 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 5. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 6. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. flonase 50 mcg/actuation spray, suspension sig: one (1) nasal twice a day. 8. nicotine 7 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 9. spironolactone 100 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 10. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 11. lactulose 10 gram/15 ml solution sig: thirty (30) ml po every six (6) hours. disp:*3600 ml(s)* refills:*2* 12. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. 13. furosemide 40 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 14. potassium chloride 20 meq tab sust.rel. particle/crystal sig: two (2) tab sust.rel. particle/crystal po once a day. disp:*60 tab sust.rel. particle/crystal(s)* refills:*2* discharge disposition: home discharge diagnosis: primary hepatic encephalopathy hepatocellular carcinoma secondary alcohol abuse hepatitis c discharge condition: against medical advice discharge instructions: you are leaving against medical advice. you have been diagnosed with hepatic encephalopathy and hepatocellular carcinoma. you will need to take your lactulose and rifaximin exactly as prescribed so that you do not become confused again. we stopped your clonidine and nadolol because your blood pressure was low. we started you on a calcium supplement because your nutrition was poor. we increased your spironolactone to 200mg daily and your lasix (furosemide) to 80mg daily because your legs were swelling with fluid. we did not change any of your other medications. we started you on rifaximin to help stop you from getting confused. please take all of your medications exactly as prescribed. if you have any confusion, fevers, chills, nightsweats, chest pain, shortness of breath, abdominal pain, bleeding, black tarry stools, vomiting blood or any other concerning symptoms call your doctor immediately or go to the emergency department. followup instructions: dr. phone: date/time: 4:10 , md phone: date/time: 3:00 , md phone: date/time: 11:30 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours diagnoses: anemia of other chronic disease chronic hepatitis c with hepatic coma alcoholic cirrhosis of liver portal hypertension secondary malignant neoplasm of other specified sites accidental poisoning by other opiates and related narcotics acute respiratory failure pneumonitis due to inhalation of food or vomitus insulins and antidiabetic agents causing adverse effects in therapeutic use other ascites poisoning by other opiates and related narcotics malignant neoplasm of liver, primary metabolic encephalopathy hypovolemia hyperosmolality and/or hypernatremia other specified hypoglycemia 

Answer: The patient is high likely exposed to