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: amoxicillin / adhesive bandage / dicloxacillin attending: chief complaint: unresponsive, encephalopathy major surgical or invasive procedure: paracentesis history of present illness: mr. is a 42-yo man with cirrhosis etoh + hcv on transplant list, pulmonary htn, severe diuretic refractory ascites, and recurrent hepatic encephalopathy, who presented to osh after being found unresponsive by his mother. has been doing well at home since his last hospitalization (see d/c summary dated ), until this morning. he has been having weekly therapeutic paracenteses, and his most recent one was yesterday under ultrasound guidance. he had 7l of clear yellow ascites removed, and fluid analysis showed no evidence of sbp. he did receive 4 bags of albumin. serum labs yesterday also showed hyponatremia of 124 and creatinine 1.8, so he was advised to stop his diuretic aldactone. per his mother, he missed his morning dose of lactulose because of the plan for the procedures, but did have two bowel movements in the morning. he received his prn codeine for hand and feet cramps, so his mother gave him a double-dose of lactulose in the evening as well, since she "knows that codeine binds him up". he was still doing well at 3am when she checked on him overnight, but this morning he was unresponsive, so ems was called. he was given narcan 1mg iv en route to osh ed without response. on arrival vs: temp 96.5f rectal, bp 90/62, hr 90, r 20, sao2 98% ra. he received an additional narcan 2mg iv without effect. labs were significant for wbc 5.8 w/ 87% pmns and 2% bands, hct 21.6, plts 68; na 128, k 5.8, cr 2.0; tbili 9.6, alb 3.1, inr 1.8, and lipase 592. serum etoh was negative, and abg was 7.54/27/484 on 100% fio2. he also received ivf ns 500cc bolus, lactulose 30ml, kayexelate 30g, and 1unit prbcs. he is transferred to micu for further care. past medical history: - hcv and etoh cirrhosis on transplant list - h/o sbp early on cipro prophylaxis - grade ii esophageal varices - recurrent hepatic encephalopathy on vegetarian diet - pulmonary htn - hypothyroidism - anxiety disorder - h/o etoh abuse, ivdu - osteoporosis of hip and spine per pt - anemia w/ hx of guaiac positive stool. - pulmonary htn social history: he lives with his mother. quit smoking , was smoking ppd. quit drinking etoh 11 years ago. prior remote hx of ivd as teen. no current drug use. family history: mother with dm and htn. father with rheumatic heart disease. physical exam: on admission: vs: temp 98.0f, hr 86, bp 111/56, r 11, sao2 99%ra gen: unresponsive but tries to open eyes to noxious stimuli, nad heent: perrl on opening, +icteric sclera neck: supple, unable to assess jvp lungs: cta bilat anteriorly heart: rrr, nl s1-s2, +loud p2 +s4 abdomen: nabs, soft/nt, mildly distended w/ fluid wave, reducible umbilical hernia extrem: 3+ ble edema to knees, 2+ pedal pulses neuro: unresponsive, +asterixis skin: jaundiced, + spider angiomata . pertinent results: labs from osh: wbc 5.8, hgb 7.5, hct 21.6, plt 68 diff: 87% pmns, 2% bands, 7l, 4m inr 1.82 na 128, k 5.8, cl 97, hco3 22, cr 2.0, gluc 113; ca 9.0, mg 2.7 lfts: alt 26, ast 43, alk phos 191, tbili 9.6, conj bili 2.5 tprot 6.5, alb 3.1, lip 592 serum etoh negative abg: 7.54/27/484/23.1/100% ammonia 307 . tests from osh: cxr: reportedly normal nchct: reportedly normal 12:50pm blood wbc-8.4 rbc-2.41* hgb-7.7* hct-22.9* mcv-95 mch-31.9 mchc-33.5 rdw-19.3* plt ct-94* 12:50pm blood pt-19.9* inr(pt)-1.9* 12:50pm blood creat-1.8* na-124* k-5.6* 05:00pm blood glucose-116* urean-35* creat-1.5* na-130* k-5.0 cl-96 hco3-23 angap-16 12:50pm blood totbili-15.1* 05:00pm blood alt-16 ast-43* ld(ldh)-236 alkphos-128* amylase-105* totbili-13.5* dirbili-6.2* indbili-7.3 05:00pm blood lipase-65* 05:00pm blood totprot-5.4* albumin-3.3* globuln-2.1 calcium-9.2 phos-2.5* mg-3.0* 05:29pm blood lactate-2.5* 06:30am blood wbc-8.4 rbc-2.59* hgb-8.2* hct-25.0* mcv-96 mch-31.7 mchc-32.9 rdw-20.0* plt ct-81* 06:30am blood pt-21.8* ptt-60.0* inr(pt)-2.1* 06:30am blood glucose-129* urean-35* creat-2.1* na-141 k-3.3 cl-106 hco3-24 angap-14 06:30am blood alt-22 ast-49* ld(ldh)-262* alkphos-195* totbili-12.9* 06:30am blood albumin-3.1* calcium-8.9 phos-2.5* mg-2.8* 07:15pm urine color-amber appear-hazy sp -1.018 07:15pm urine blood-lg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-sm urobiln-neg ph-6.5 leuks-mod 07:15pm urine rbc->50 wbc->50 bacteri-mod yeast-none epi-0-2 01:49pm ascites wbc-25* rbc-758* polys-4* lymphs-23* monos-0 mesothe-2* macroph-71* 02:40pm ascites wbc-130* rbc-490* polys-3* lymphs-13* monos-71* mesothe-7* macroph-6* 01:49pm ascites totpro-0.6 ld(ldh)-57 albumin-less than gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (final ): no growth. 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 (final ): no growth. fluid culture in bottles (final ): no growth. urine culture (final ): no growth. cxr: portable ap chest radiograph: feeding tube can be followed throughout the stomach, duodenum, treitz, to the proximal jejunum and then out of the field of view. low lung volumes. no pleural effusion or pneumothorax. cardiomediastinal silhouette is unremarkable. brief hospital course: 42 year-old male with cirrhosis etoh & hcv on transplant list, pulm htn, severe diuretic refractory ascites, and recurrent hepatic encephalopathy, who presented to osh unresponsive in the setting of getting codeine and missing one dose of lactulose, found to have an elevated ammonia and otherwise negative work-up for altered mental status. he required a brief stay in the micu, and was then transferred to the hepatic service. hospital course was as follows. 1. hepatic encephalopathy - in the setting of getting codeine and missing a dose of lactulose, also suggested by elevated ammonia at osh and fact that he had not moved bowels in >24hrs. other possibilities include variceal bleeding or sbp or hypercarbia secondary to known sleep apnea and refusal to wear cpap machine. had a paracentesis day prior to admission with 7l fluid removed, and fluid analysis showing no evidence of sbp. should consider possibilty of transient secondary bacterial peritonitis paracetnesis yesterday, but exam and labs on admission did not suggest infection. regarding variceal bleeding, he has known grade ii varices and h/o guaiac-positive stools, but hct was stable at osh and he responded well to transfusion. the patient was continued on cipro and rifaxmin. bedside u/s revealed no safe pocket of ascites and little overall ascites; he was not tapped. he was given lactulose q2hrs in the icu. his mental status improved with with increased bm's. he was then transfered from the icu to the liver/kidney service. on arrival to the liver service, his mental status was at his baseline. he was changed to lactulose five times daily and continued to do well. he was provided a cpap machine but refused to wear it given discomfort. his rifaximin dosing was increased from 200mg to 400mg tid. he was started on a vegetarian diet. the patient became encephalapathic again on and improved with increasing lactulose. the patient underwent paracentesis and 7l of fluid was removed on . the patient tolerated the procedure well and there was no evidence of infection. 2. cirrhosis/liver failure - etoh & hcv, on transplant list. has been complicated by ascites, encephalopathy and sbp. meld 28. he was continued on ursodiol, ciprofloxacin (500mg po daily given decreased absorption with tubefeeds), rifixamin (increased dose, as above). given creatinine at baseline and no evidence of bleeding, he was also restarted on spironolactone and furosemide. he was also continued on midodrine per his home regimen. also continued on tubefeeds for nutrition supplementation. the patient underwent paracentesis and 7l of fluid was removed on . the patient tolerated the procedure well and there was no evidence of infection. 3. anemia - has h/o guaiac positive stools, known grade ii varices. hct stable at osh, received 1unit prbcs with appropriate response. he was continued on his home ppi. 4. urinary tract infection: based on ua on admission - moderate bacteria, wbc>50, moderate leukocyte esterase. patient complaining of discomfort with catheter. complicated uti given catheter. urine culture was without growth. he was continued on ciprofloxacin 500mg po daily which is used for sbp prophylaxis. 5. thrombocytopenia: at baseline. likely related to liver disease. 6. hyponatremia: improved with cessation of diuretics. diuretics restarted; patient will need lab work as an outpatient to monitor sodium and creatinine. 7. pancreatitis: has history of pancreatitis, thought to be gallstones. suggested by elevated lipase >500 at osh. amylase and lipase here only mildly elevated. clinically did well - no abdominal pain, and good appetite. 8. pulmonary hypertension: continued iloprost per home regimen. 9. hypothyroidism: continued levothyroxine per home regimen. 10. obstructive sleep apnea: seen previously by dr. (), suggested settings for cpap at night. cpap at bedside, encouraged patient to use. **communication - (mother), ( (h), ( (c) **full code medications on admission: miconazole nitrate 2% powder 1 appl topical tid prn levothyroxine 88mcg po daily rifaximin 200mg po tid simethicone 40-80mg po qid prn gas pain zinc sulfate 220mg po daily ursodiol 600mg po qam cholecalciferol (vitamin d3) 800units po daily calcium carbonate 500mg po daily omeprazole 20mg po daily midodrine 7.5mg po tid ciprofloxacin 500mg po daily lactulose 30-60ml po qid: titrate to >6 bm daily iloprost 10mcg/ml nebulizer 2.5 ml inh 6 times per day magnesium oxide 400mg po bid codeine sulfate 15-30mg po bid prn pain oxygen 2l nc up to 8hrs / day (o2 sat at rest 98%, w/ activity 89%) . tube feeds: nutren 2.0 full strength; starting rate: 30 ml/hr; advance rate by 10 ml q4h goal rate: 30 ml/hr; hold feeding for residual >= : 100 ml; flush w/ 30 ml water q4h; other instructions: no residuals with post pyloric feeding tube discharge medications: 1. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for rash. 2. levothyroxine 88 mcg tablet sig: one (1) tablet po daily (daily). 3. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 4. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for gas pain. 5. zinc sulfate 220 mg capsule sig: one (1) capsule po daily (daily). 6. ursodiol 300 mg capsule sig: two (2) capsule po daily (daily). 7. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 8. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 9. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 10. midodrine 5 mg tablet sig: 1.5 tablets po tid (3 times a day). 11. ciprofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours). 12. lactulose 10 gram/15 ml syrup sig: sixty (60) ml po 5 times daily (): titrate to >6 bowel movements per day. 13. iloprost 10 mcg/ml solution for nebulization sig: one (1) ml inhalation 2.5ml - 6x/day (). 14. magnesium oxide 400 mg tablet sig: one (1) tablet po bid (2 times a day). 15. spironolactone 50 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 16. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 17. tubefeeds nutren 2.0 full strength; starting rate:10 ml/hr; advance rate by 10 ml q4h goal rate:30 ml/hr residual check:q4h flush w/ 30 ml water q4h discharge disposition: home with service facility: vna of southeastern mass. discharge diagnosis: primary: - hepatic encephalopathy - urinary tract infection secondary: - hepatitis c cirrhosis - obstructive sleep apnea discharge condition: alert and oriented x3; hemodynamically stable discharge instructions: you were admitted to on after being found unresponsive. you were admitted to the icu and treated with lactulose; your level of alertness improved drastically. you were transferred to the liver service on for further management. you were also found to have a urinary tract infection which was treated with ciprofloxacin, an antibiotic you take on a regular basis for your liver disease. you also underwent a paracentesis to remove fluid from your belly. a total of 7 liters was removed. you tolerated the procedure without complications. your medication regimen has changed. please review your medication list closely. in particular, it is very important that you take your lactulose as prescribed to prevent repeat episodes of unresponsiveness. please be sure to follow-up with your physicians as listed below. please return to the emergency department or call your physician for changes in your thinking, fever, abdominal pain, bleeding, or for any other symptoms which are concerning to you. followup instructions: please call dr. office to schedule an appointment for wed . , md phone: please follow-up with your pcp weeks. pcp: , procedure: enteral infusion of concentrated nutritional substances percutaneous abdominal drainage diagnoses: thrombocytopenia, unspecified obstructive sleep apnea (adult)(pediatric) anemia, unspecified urinary tract infection, site not specified chronic hepatitis c without mention of hepatic coma alcoholic cirrhosis of liver acute kidney failure, unspecified hyposmolality and/or hyponatremia unspecified acquired hypothyroidism other chronic pulmonary heart diseases osteoporosis, unspecified other ascites hepatic encephalopathy chronic pancreatitis 

Answer: The patient is high likely exposed to