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: hypotension major surgical or invasive procedure: none history of present illness: 56m homeless with history of hepatocellular carcinoma s/p resections, hep c cirrhosis, htn, psoriasis, and psych history significant for chronic alcohol dependence, polysubstance abuse, and depression who came in after being observed to have a seizure. per report patient started seizing and then fell to the ground. reports h/o seizures in past in setting of etoh withdrawal. when ems arrived on scene he was awake but not oriented. sbps en route in 90s. on arrival sbps 70s, febrile to 102.7, lactate at 11.9, creatinine 3 from 0.7. patient was noted to be tachycardic, rigid and agitated but moving all extremities and able to answer basic questions. shortly after arrival sbps fell to 50s. bps not responsive to 2l ivs. started on vanc/zosyn and levophed. cxr without e/o pna, ua relatively . blood and urine cultures pending. cvl placed. cvp ~10 after 3-4l. aggressive ivf, lactate trending down s/p 3-4l. head ct without acute cranial process. films showed c1 fracture which was by spine. bedside u/s showed plump ivc and no pericardial effusion. transferred to icu for further management. bp prior to transfer 120/90. on arrival to the micu he was agitated and shaking. oriented to place. requesting to be left alone to sleep. past medical history: hepatocellular carcinoma s/p resections hep c cirrhosis htn psoriasis alcohol dependence polysubstance abuse depression seizures in setting of etoh withdrawal social history: currently homeless, has been at rosscommon for rehab/shelter needs, has been inn as well. reports has 3 children, no contact with them, has a sister who is listed as his hcp. family history: noncontributory physical exam: admission pe: vitals: t: 100.7 bp: 144/65 p: 107 r: 22 o2: 99/2l. uop ~2l general: alert but severely agitated, oriented to place heent: sclera anicteric, dry mm neck: c collar cv: tachycardic, no murmur lungs: scattered sparse crackles, no wheeze, decent air movement abdomen: soft, non-tender, slightly-distended, +bs gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: tremor, moving all extremities, unable to cooperate with remainder of exam discharge pe: general: sleeping peacefully. no acute distress. oriented x3. lethargic heent: sclera anicteric, mmm. large laceration with staples in place over left parietal area appears non-infected. neck: c collar in place. cv: rrr. ns1&s2. nmrg lungs: b/l crackles improved from yesterday. good air flow. poor inspiratory effort abdomen: soft. mild ruq ttp with rebound guarding. no rebound, or rigidity. liver palpable ~2cm below costal margin ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: no tremor. moving all extremities. no asterixis skin: psoriatic lesion on b/l hands, kneecaps. abrasion on r. elbow dressed. pertinent results: admission labs: 07:45pm blood wbc-9.5# rbc-3.93* hgb-10.8* hct-34.1* mcv-87 mch-27.6 mchc-31.8 rdw-17.2* plt ct-138*# 07:45pm blood glucose-79 urean-18 creat-3.0*# na-133 k-5.1 cl-105 hco3-10* angap-23* 07:45pm blood ck(cpk)-1456* 11:39pm blood type-art temp-38.3 o2 flow-4 po2-142* pco2-34* ph-7.32* caltco2-18* base xs--7 intubat-not intuba 08:11pm blood lactate-11.2* 09:47pm blood lactate-3.4* 11:39pm blood lactate-2.4* 03:36am blood lactate-0.8 . discharge labs: 05:55am blood wbc-5.9 rbc-3.24* hgb-9.3* hct-28.3* mcv-87 mch-28.6 mchc-32.8 rdw-18.1* plt ct-124* 05:55am blood pt-12.0 ptt-31.6 inr(pt)-1.1 05:55am blood glucose-97 urean-11 creat-0.5 na-138 k-3.9 cl-107 hco3-23 angap-12 05:55am blood alt-40 ast-57* alkphos-98 totbili-0.7 05:55am blood calcium-7.9* phos-3.2 mg-1.8 . micro: blood culture, routine-pending blood culture, routine-pending sputum gram stain-final; respiratory culture-contaminated urine culture-neg blood culture, routine-pending blood culture, routine-pending urine culture-neg blood culture, routine-neg blood culture, routine-neg brief hospital course: 56 yo homeless m w/pmh significant for hcv cirrhosis and hcc that presented to the ed in septic state following witnessed tonic clonic seizure. volume resuscitated with ns and started on broad spectrum abx. stabilized and transferred to floor. treated for aspiration pna with resolution of fevers by time of discharge. . active issues: #sirs: pt was hypotensive with sbp in 70's and fever to 102.7 when presenting to the icu. bp responded well to volume resuscitation and pressures stabilized on first day of admission. pt had no recollection of events leading up to admission. fever resolved while on vancomycin and zosyn, but returned on the floor (see below). thought to be caused by aspiration pneumonia, however, initial chest xray unrevealing. patient was pan-cultured, however, all cultures remained negative. although fever recurred, no hypotension, tachycardia, or leukocytosis while on the floor. . #fever: developed recurring fevers to 101-102 despite being on broad spectrum antibiotics vancomycin and zosyn. wide differential included infection, medications, collagen vascular disease, and neoplasm. switched to po levofloxacin and metronidazole to treat for aspiration pneumonia after cxr positive for bll infiltrates and physical exam significant for productive cough and b/l dense crackles. despite this fevers persisted, so he received a ct torso to evaluate for hcc metastases vs. occult abscess. this was unrevealing. at time of discharge, he had been fever free for >24 hours, and had completed 3 days of a 10 course of metronidazole and flagyl. . #aspiration pna: see above. treated with empiric vancomycin and zosyn, then switched to levofloxacin/flagyl for aspiration pneumonia. received 3 days of 8 day course, and given prescription for outpatient meds. . #etoh withdrawal/abuse: patient seizure likely etoh withdrawal as head ct negative and no documented history of seizure in the past. seizure resulted in l. parietal scalp laceration, that was closed with staples. although patient states that he has not had alcohol in months, his bal was 64 in the ed. patient did not initially score on ciwa in micu, however, did so for several days on the floor. had not scored in >48 hours prior to discharge. pt ad no recollection of events prior to admission. this is consistent with korsakoff's dementia, though no ataxia, opthalmoplegia or confabulation. patient was started on thiamine and folate in-house, and discharged on these medications. . #c1 fracture: ct at time of admission significant for c1 fracture. by neurosurgery in icu, and instructed to wear neck collar for no less than 3 months. if he takes this off prior to this, there is chance of subluxation, paralysis, and death. . #: patient cr on admission was 3.0. resolved immediately after administration of ivf. back to baseline of 0.5-0.7 for several days prior to discharge. . chronic issues: #hypertension: patient bp was difficult to control. started on lisinopril 20mg qday per note in webomr, however, increased to 40mg qday at time of discharge. sbp 117 on discharge. . #hcc: he is known to have hepatocellular carcinoma. ruq u/s at time of floor transfer significant for enlarging lesion from prior exam suspicious for hcc. afp increased to 944 from 326 in . patient is being followed by dr. in . outside records were obtained, which showed that they were aware of his liver lesion, and that it was last with mri on . he was discharged with a follow-up with dr. on . . #hcv cirrhosis: well compensated hcv cirrhosis with no known hepatic encephalopathy, esophageal varices, sbp, or ascites. . transitional: #follow-up with dr. and pcp 2 weeks #will need to go to homeless shelter #staples in scalp need to be removed in 2 weeks () medications on admission: preadmissions medications listed are incomplete and require futher investigation. information was obtained from past note at dr. office. 1. multivitamins 1 tab po daily 2. fluocinonide 0.05% cream 1 appl tp qid 3. tamsulosin 0.4 mg po hs 4. lisinopril 20 mg po daily 5. omeprazole 40 mg po daily 6. fish oil (omega 3) 1000 mg po daily 7. gabapentin 800 mg po daily 8. olanzapine (disintegrating tablet) 10 mg po daily 9. methylphenidate (ritalin) 10 mg po bid 10. methylphenidate (ritalin) 20 mg po bid 11. zolpidem tartrate 10 mg po hs 12. bupropion (sustained release) 150 mg po bid 13. hydroxyzine 25 mg po q6h:prn anxiety discharge medications: 1. bacitracin ointment 1 appl tp apply to affected areas on scalp rx *bacitracin zinc 500 unit/gram apply to affected area twice a day disp #*1 tube refills:*0 2. levofloxacin 750 mg po daily rx *levofloxacin 750 mg 1 tablet(s) by mouth daily disp #*5 tablet refills:*0 3. lidocaine 5% patch 1 ptch td daily rx *lidocaine 5 % (700 mg/patch) apply to affected area daily disp #*14 unit refills:*0 4. metronidazole (flagyl) 500 mg po q8h rx *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours disp #*15 tablet refills:*0 5. bupropion (sustained release) 150 mg po bid 6. fish oil (omega 3) 1000 mg po daily 7. fluocinonide 0.05% cream 1 appl tp qid 8. gabapentin 800 mg po daily 9. hydroxyzine 25 mg po q6h:prn anxiety 10. methylphenidate (ritalin) 10 mg po bid 11. methylphenidate (ritalin) 20 mg po bid 12. multivitamins 1 tab po daily 13. olanzapine (disintegrating tablet) 10 mg po daily 14. omeprazole 40 mg po daily 15. tamsulosin 0.4 mg po hs 16. zolpidem tartrate 10 mg po hs 17. folic acid 1 mg po daily rx *folic acid 1 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 18. thiamine 100 mg po daily rx *thiamine hcl 100 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 19. lisinopril 40 mg po daily hold for sbp <100 rx *lisinopril 40 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 discharge disposition: home discharge diagnosis: primary diagnosis: aspiration pneumonia community acquired pneumonia alcoholic hepatitis alcohol withdrawal seizures c1 vertebral fracture secondary diagnosis: hepatitis c virus cirrhosis hepatocellular carcinoma alcohol abuse discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: mr. , it was a pleasure caring for you at . you were admitted after having a seizure. your blood pressure was very low and temperature was very high, so you were seen in the intensive care unit. your seizure was related to alcohol withdrawl. we believe you also have an infection of your lung called pneumonia. they treated you in the icu and your blood pressure improved, so you were transferred to the liver service. here you were continued on antibiotics for pneumonia, but you continued to have fevers. after switching the antibiotics, your fevers stopped, and you remained fever free for 24 hours prior to discharge. please continue taking the antibiotics by mouth through . you fractured a vertebrae during your seizure. the brain doctors and placed a neck collar on you. this must be left in place for the next 3 months to avoid further injury. if you remove this collar it could result in paralysis or death. your seizure is likely from alcohol withdrawal. you were treated with medication to prevent further withdrawal, and at time of discharge you displayed no symptoms of withdrawal. your liver function tests were elevated, indicating damage to your liver from alcohol. this is referred to as alocholic hepatitis. the only way to treat this is to stop all future alcohol intake. we looked at your liver with a machine that uses soundwaves to image, called an ultrasound. there is an area on your liver that is suspicious for recurrence of your hepatocellular carcinoma. we , who follows your condition, and made them aware you were here. they have recent imaging that shows the same thing we found. medications to start: start levofloxacin 750mg daily for 5 days (continue through ) start flagyl 500mg three times a day for 5 days (through ) start bacitracin: this should be applied to the scalp laceration to prevent infection increase lisinopril to 40mg daily followup instructions: dr. hepatology appointment 8:30am name: , i. location: healthcare for the homeless address: , , phone: appointment: wednesday 9:00am *if you need to be seen sooner please walk in to your pcps office anytime on monday . procedure: closure of skin and subcutaneous tissue of other sites diagnoses: pneumonia, organism unspecified acidosis unspecified essential hypertension cirrhosis of liver without mention of alcohol acute kidney failure, unspecified unspecified protein-calorie malnutrition other, mixed, or unspecified drug abuse, unspecified unspecified viral hepatitis c without hepatic coma other convulsions depressive disorder, not elsewhere classified open wound of scalp, without mention of complication hypotension, unspecified pneumonitis due to inhalation of food or vomitus rash and other nonspecific skin eruption malignant neoplasm of liver, primary fall from other slipping, tripping, or stumbling lack of housing acute alcoholic hepatitis closed fracture of first cervical vertebra alcohol withdrawal acute alcoholic intoxication in alcoholism, unspecified alcohol-induced persisting amnestic disorder systemic inflammatory response syndrome, unspecified 

Answer: The patient is high likely exposed to