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: abdominal distention, confusion major surgical or invasive procedure: egd paracentesis history of present illness: 78m with cirrhosis hemochromatosis, prior gi bleed who is transferred to with hypotension and for evaluation for possible liver transplant. the patient was admitted to hospital on after his son brought him to the stating that the patient had increasing abdominal distention and confusion, worsening anorexia and lethargy over the prior months. of note, abdomen noted to be protuberant at 5/23 pcp visit and he was apparently admitted to medical center one month ago and had therapeutic 2l paracentesis (neg for sbp) performed and was discharged a few days later with plan for gi follow up as an outpatient. cr in at that time was noted to be 1.6-1.8, had been 1.3 in with normal bilirubin. labs at presentation this admission notable for wbc 6.2, hct 43, plt 212, na 132, bun 34, cr 2.06, albumin 3.2, tbili 1.2, ast 35, alt 6, ammonia 58. he was admitted to hospital for decompensated liver disease. cxr unremarkable. ct scan of the a/p showed massive ascites, shrunken liver suggesting cirrhosis, abdominal varices noted and esophageal varices suspected, gb with hyperdense material and nonobstructive stone in gb neck. abdominal ultrasound showed gb sludge without evidence of acute cholecystitis. on day prior to transfer, patient underwent diagnostic and therapeutic paracentesis with removal of 16l clear yellow fluid, counts were 88 wbc, 462 rbc, 3% pmns, albumin 1.6, protein 3.2, cholesterol 45, glucose 85. he was noted to be hypotensive to the 70s systolic post-paracentesis and he was given volume resuscitation with crystalloid and albumin. he was also noted to be nauseous on day of transfer, lipase normal. a r ij cvl was placed under sterile conditions, confirmed on cxr, and he was given a dose of albumin 25g 25% before he was transferred to for possible liver transplant evaluation in the setting of hrs. labs on day of transfer notable for cr 2.00, bun 29, tbili 0.5, albumin 2.6. vs at transfer: 97.7 50 90/61 18 97% ra. pt was admitted to the micu and had egd showing varices, but couldn't be banded due to intolerance of procedure. also noted candidiasis so started fluc. he eceived 5% 500ml albumin and his hypotension resolved. his renal function and encephalopathy appeared to be improving. he was called out to the floor. on the floor, he was pleasant, alert, oriented to place only, and had no complaints. review of systems: (+) per hpi, otherwise negative past medical history: cirrhosis diagnosed 1 year ago, due to hemochromatosis, c/b grade 3 esophageal varices, poral gastropathy, ascites hemochromatosis prior (variceal) gi bleed in s/p banding social history: lives in independently, divorced, girlfriend lives in apt. above his. retired painter. he does not, nor has he ever, drank alcohol with any regularity and he does not smoke. family history: mother died of cirrhosis, father died at 88 of old age, sister with liver cancer, brother with diabetes. physical exam: admission exam: general: alert, oriented to person, , home address, thinks he is at hospital on , no acute distress heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl, upper and lower denture plates noted skin: spider angiomata noted on upper chest, ecchymoses on upper extremities, no jaundice neck: supple, jvp not elevated, no lad, r ij cvl in place cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, distended with fluid wave, bowel sounds present, no hepatosplenomegaly, non-tender throughout, no rebound or guarding gu: foley with clear yellow urine ext: slightly cool, 1+ pulses, no clubbing, cyanosis, r hand with 1+ pitting edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, gait deferred, mild asterixis discharge exam: vs: 97.6, 100s/50s-60s, 50s, 18 100% 3l general: elderly male, appears comfortable heent: sclera anicteric. mm dry. right cvl c/d/i cardiac: rrr, no m/r/g lungs: decreased bs bilaterally anteriorly . abdomen: distended, non tender, dull to percussion at the flanks. extremities: 2+ pulses, no edema neurology: a/o 1, not cooperating with asterixis exam skin: multiple bruises on arms pertinent results: admission labs: 10:00pm blood wbc-5.8 rbc-4.07* hgb-13.1* hct-39.9* mcv-98 mch-32.1* mchc-32.8 rdw-14.9 plt ct-180 10:00pm blood pt-14.5* ptt-30.2 inr(pt)-1.4* 10:00pm blood glucose-88 urean-28* creat-1.7* na-139 k-3.1* cl-100 hco3-30 angap-12 03:47am blood alt-6 ast-19 ld(ldh)-126 alkphos-35* totbili-0.9 03:47am blood probnp-3524* 10:00pm blood calcium-8.3* phos-1.9* mg-2.1 03:47am blood caltibc-98* ferritn-218 trf-75* 03:47am blood hbsag-negative hbsab-negative hbcab-negative 03:47am blood smooth-positive * 03:47am blood -negative 03:47am blood igg-861 03:47am blood hcv ab-negative pertinent labs: 12:18pm blood wbc-5.6 rbc-3.21* hgb-10.1* hct-32.1* mcv-100* mch-31.4 mchc-31.5 rdw-15.9* plt ct-81* 05:04am blood pt-19.0* inr(pt)-1.8* 04:53am blood glucose-102* urean-41* creat-3.9* na-142 k-3.8 cl-106 hco3-24 angap-16 06:11am blood glucose-105* urean-50* creat-4.2* na-141 k-3.8 cl-104 hco3-24 angap-17 05:04am blood glucose-111* urean-57* creat-4.3* na-139 k-3.4 cl-104 hco3-22 angap-16 05:04am blood alt-4 ast-11 alkphos-33* totbili-0.9 03:47am blood hbsag-negative hbsab-negative hbcab-negative 03:47am blood caltibc-98* ferritn-218 trf-75* 03:47am blood smooth-positive * 03:47am blood -negative 03:47am blood igg-861 03:47am blood hcv ab-negative pertinent micro/path: 9:50 pm urine culture (final ): mixed bacterial flora ( >= 3 colony types), consistent with fecal contamination. 2:26 pm peritoneal fluid gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (final ): no growth. anaerobic culture (preliminary): no growth. 12:43 pm stool consistency: not applicable source: stool. **final report ** c. difficile dna amplification assay (final ): reported to and read back by dr. , , 9:43am. clostridium difficile. positive for toxigenic c. difficile by the illumigene dna amplification. (reference range-negative). 12:43 pm stool c. difficile dna amplification assay (final ): reported to and read back by dr. , , 9:43am. clostridium difficile. positive for toxigenic c. difficile by the illumigene dna amplification. (reference range-negative). blood cultures pending. pertinent imaging: ruq u/s with dopplers: 1. limited study. possible cavernous transformation of the main portal vein which may be secondary to a chronic thrombosis. there is flow within the left main portal vein. 2. large amount of ascites. 3. nodular and echogenic liver consistent with underlying cirrhosis. 4. gallstones and sludge within the gallbladder. tte: the left atrium and right atrium are normal in cavity size. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: suboptimal image quality. normal biventricular cavity sizes with preserved global biventricular systolic function. no valvular pathology or pathologic flow identified. cxr: there has been placement of a right ij central line with distal lead tip at the cavoatrial junction. the heart size is within normal limits. there are no pneumothoraces. lungs are grossly clear. bony structures are intact. brief hospital course: this is a preliminary discharge summary. full to be written. 78m with hemochromatosis leading to cirrhosis complicated by variceal bleed, portal gastropathy, and ascites who is transferred with hypotension, elevated creatinine, concern for hrs, and evaluation for liver transplant. patient's condition worsened and decision was made to pursue hospice/cmo. . # hypotension: the pt was afebrile and infectious workup was negative. we believed this was most likely related to fluid shifts and intravascular volume loss s/p 16l removal during paracentesis. he was aggressively hydrated with fluid and albumin, and his bp improved before he was called out to the floor. on the floor, he received an additional unit of albumin and was then stable. he appeared euvolemic on exam. his blood pressure remained stable on the floor w/ sbps in 80s-100s range. # c.diff colitis: patient was found to have positive c. diff test in setting of diarrhea. he was started on flagyl (day 1 = , end date ) with po metronidazole. diarrhea improving. will continue for 14day course. # cirrhosis: known previously to be due to hemochromatosis. ruq u/s did not visualize main portal vein but noted patent right portal vein. multiple serologies and antibodies were sent for cirrhosis workup. lactulose was started po with improvement in mild encephalopathy within first 24-48h. though the patient eventually refused to take po and was not taking his lactulose with worsening encephalopathy. of note, he had a 3l paracentesis on given recurrence of tense ascites. the fluid was negative for sbp. a family meeting was held and it was determined that he was not a transplant candidate. the patient's nutrition was extremely poor and he was not taking po. discussion about a feeding tube was held and the family determined that this measure was not within the patient's goals of care. . # acute kidney injury: likely hrs, with cr increasing despite albumin resuscitation. cr had improved to 1.7, then increased to 4.3. urine lytes showed a prerenal picture. he was placed on midodrine and octreotide and daily albumin to no effect. the pt was placed on maximum dosing of both of these medications and his kidney failure continued to progress. the decision was made by the pt and his family to stop this therapy as it was causing bradycardia and urinary retention. # coffee ground emesis: noted on without signs of active bleeding. he had egd on and was found to have 3 cords of grade ii varices. could not be banded as pt did not tolerate procedure long enough. he was maintained on infectious ppx with ctx for 7 days and a daily ppi # goals of care: palliative was consulted given the poor prognosis and decision made to pursue hospice and comfort measures only from this juncture forward. the pt was discharged to an extended care facility in order to provide hospice care. the pt, the family and the medical team came to this decision collectively. # bradycardia: hr noted to be in 50s at osh, now in 50s here as well. could be related to nadolol, unclear when last dose received. nadolol held, hr remained 50s-60s. # coagulopathy: inr 1.4, most likely related to liver disease, given po vitamin k. as his liver failure progressed his synthetic function has decreased and his inr continued to rise to 1.8 prior to discharge. # vitamin deficiencies: noted at osh. continued folate, thiamine, started mvi. # transitional: 1. pt was discharged to extended care facility for hospice care 2. continue flagyl for 14 day course 3. aspiration precautions as had mild aspiration event in hospital medications on admission: medications home: nadolol 20mg daily colace 100mg pantoprazole 40mg daily kcl 20 meq daily spironolactone 100mg daily furosemide 20mg daily . medications transfer: lactulose 30ml po tid (on hold presently) folic acid 1 mg daily prilosec 20mg daily thiamine 100mg daily zofran 4mg iv q6h:prn nausea discharge medications: 1. docusate sodium 100 mg po bid hold for loose stools 2. pantoprazole 40 mg po q24h 3. hydromorphone (dilaudid) 1-2 mg po q3h:prn pain, respiratory distress 4. lactulose 15 ml po bid 5. metronidazole (flagyl) 500 mg po q8h d1 discharge disposition: extended care facility: at nursing center - discharge diagnosis: liver cirrhosis kidney failure discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: mr. , it was a pleasure taking care of you at . you were admitted to the hospital with low blood pressure and abdominal discomfort from your underlying liver disease. unfortunately as your liver disease has progressed your kidneys started to fail. we attempted rescue therapy for your kidneys but unfortunately we were unsuccessful. we determined that no further medical therapy was available to help reverse the kidney disease. you, your family and the medical team have decided that leaving the hospital with hospice care was the most appropriate plan moving forward. the following changes have been made to your medications: stop: nadolol furosemide spironolactone change: lactulose 15ml twice per day new: metronidazole every 8 hours to complete a 14 day course which will end on hydromorphone for pain followup instructions: no further follow up is required procedure: other endoscopy of small intestine percutaneous abdominal drainage diagnoses: cirrhosis of liver without mention of alcohol acute and subacute necrosis of liver hepatorenal syndrome acquired coagulation factor deficiency other specified cardiac dysrhythmias intestinal infection due to clostridium difficile calculus of gallbladder without mention of cholecystitis, without mention of obstruction other ascites do not resuscitate status esophageal varices in diseases classified elsewhere, with bleeding hepatic encephalopathy varices of other sites other specified disorders of stomach and duodenum orthostatic hypotension candidal esophagitis other hemochromatosis 

Answer: The patient is high likely exposed to