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: history of present illness: the patient is a 69-year-old man with a history of alcohol abuse who presented on with lethargy, abnormal labs, dehydration and a low blood pressure. the patient has long history of alcohol abuse with question liver disease. he also had a prior gi bleed in the past but is not known to have varices. he initially presented to emergency room on with complaints of weakness, trouble ambulating and requesting detox placement. he was discharged to for detox. upon arrival at , labs were drawn which revealed severely elevated liver function tests. this included an ast of 99, alt 32, alkaline phosphatase 496, total bilirubin 16.4, albumin 1.6. it also showed that he had a hematocrit of 22.2. the patient was managed for approximately 1?????? days with a ciwa scale, received 1-2 doses of serax. he was also started on levaquin for a question of pneumonia. however, on the evening of , the patient was found to be hypotensive and more lethargic. he was then transferred back to the emergency room for further evaluation and management. in the emergency room, a central line was placed and he was given aggressive iv fluid and rehydration including intravenous potassium chloride and potassium phosphate. a rectal was guaiac negative and ng lavage was also negative for gi bleed. a diagnostic paracentesis was performed which yielded only about 10-15 cc of straw colored fluid. this fluid was negative for suggestion of spontaneous bacterial peritonitis. the patient had a blood pressure in the 70-80 range systolic and was felt to be too unstable for the general medical floor and was transferred to the micu on the . past medical history: alcohol abuse with apparent liver disease. history of withdrawal with delirium tremens but no history of seizures. history of gi bleed, presumably secondary to gastritis. prostate cancer status post resection . pancreatitis. chronic hypocalcemia. status post fracture and open reduction and internal fixation of his left arm. coronary artery disease. cardiac catheterization showed an ef of 50%, mild to moderate single vessel disease of the left circumflex artery, 50% stenosing lesion was noted at the mid section of the artery. hypertension. medications: on transfer from , multivitamin, folate, thiamine, protonix, calcium carbonate, magnesium oxide, levaquin 500 mg, lasix, serax. allergies: aspirin. social history: the patient is married. he is a retired telephone repairman. he has a history of alcohol abuse, drinking at least 1?????? cups of brandy a day. his last drink was reportedly on . he also smoked ?????? pack per day times 30 years. physical examination: temperature 97.1, pulse 88-99, blood pressure 70/42-117/64, respiratory rate 26, o2 saturation 99% on four liters nasal cannula. the patient is a cachectic elderly african american male in no acute distress. he is lethargic. he is alert and oriented times two. heent: pupils equal, round and reactive to light and accommodation, there is positive scleral icterus. his oropharynx is clear. neck is supple. chest, bibasilar crackles without wheezing anteriorly. cardiovascular exam is regular rate and rhythm, no murmurs are appreciated. abdomen, positive bowel sounds, very distended. liver edge palpable about 5 cm below the right costal margin and nontender. tympanic abdomen. guaiac negative rectal exam. extremities, trace edema in both feet. neuro exam, alert and oriented times two but lethargic. does not cooperate with full neuro exam but moves all extremities. laboratory data: white blood cell count 16.0, hematocrit 23.7, platelet count 298,000, mcv 100, 74 neutrophils, 4 bands, 20 lymphs, 1 mono, 11 nucleated red cells, inr 1.4, ptt 35.5, sodium 139, potassium 3.0, chloride 106, co2 21, bun 19, creatinine 1.2, glucose 112, albumin 2.0, calcium 7.4, magnesium 2.1, phosphorus 0.6, alt 32, ast 112, alkaline phosphatase 523, total bilirubin 20.4, direct bilirubin 14.8, indirect bilirubin 5.6, amylase 210, lipase 213. chest x-ray, heart size within normal limits, low lung volume, no evidence of chf. blunted right costophrenic angle. no obvious pneumonia. abdominal ultrasound, no obvious evidence of cholecystitis. there is positive sludging and stones noted. no intra or extra hepatic ductal dilatation is noted. peripheral blood smear, target cells, poikilocytes, nucleated red cells, few teardrops, reticulocytes, no schistocytes seen. ekg, atrial tachycardia at 115, normal axis, short pr interval, long qtc, superior t wave, t wave inversions in v1, biphasic in leads v2 through v3, t wave flattening in 3, l. hospital course: the patient was admitted for management of his apparent fulminant liver failure. ct scan of his abdomen was performed after admission. this revealed bilateral pleural effusions, diffuse fatty liver, no intra or extra hepatic ductal dilatation, patent portal and hepatic veins, diffuse colonic thickening which appears to be consistent with pancolitis with some involvement of the terminal ileum. gallbladder shows some stones and sludging but no wall thickening. there is a small amount of fluid around the tail of the pancreas with no overt radiographic evidence of pancreatitis. diverticula were also noted. there is a moderate amount of free fluid in the pelvis. there is not an overt amount of ascites fluid. there is increased attenuation in the right lobe of the liver. the liver service was consulted as well as the surgical service to comment on the patient's liver failure as well as abdominal distention. the liver service felt that this was most likely consistent with a picture of fulminant alcoholic hepatitis. they did note that it is not uncommon to see mildly elevated transaminases in the presence of severely elevated alkaline phosphatase and total bilirubin. there were initial discussions regarding performing an mrcp vs an ercp. by the patient's amylase and lipase had decreased significantly. at that point, the liver service suggested holding off on performing an mrcp. it was also felt that the patient would likely not tolerate an mrcp given his history of claustrophobia. if he required sedation for the procedure, he likely would have required intubation for airway management. the liver service also felt that ercp was likely not indicated in his case regardless given the severity of his liver failure. it was felt that if he had the unfortunate complication of pancreatitis status post ercp, that his overall mortality would be unacceptably high. pentoxifylline was started initially to prevent the development of renal failure given his liver failure. however, this was later stopped due to the question of possible sepsis. the surgical service recommended no surgical intervention as an option at this time. they felt that the increase in the bilirubin, and the bowel wall thickening appeared to be related to his extensive liver failure. they felt no surgical intervention was indicated given his overall clinical picture. the patient was hemodynamically stable during his initial stay in the micu. he was transferred to the floor on . however, on the patient became increasingly confused and his temperature was noted to drop to 90. because of his confusion and severe hypothermia, he was returned to the micu service for further evaluation as he appeared to be rapidly deteriorating. also, the patient's blood pressure had again dropped to the 70 range. he received treatment with iv fluids, and antibiotics were continued for broad coverage of bowel flora. antibiotic regimen which had been started on initial admission to the micu included ampicillin, levofloxacin, and flagyl. his pentoxifylline was discontinued given the concern for the development of sepsis at this point. the patient's liver function tests showed a mixed picture of improvement vs deterioration. his total bilirubin gradually was decreasing after peaking in the 24 range. meanwhile his amylase and lipase had again returned to the 200 range after initial improvement. his abdominal distention was worsening and plain radiographs of the abdomen showed very distended loops of bowel. there was no overt evidence of obstruction. the patient was continuing to pass stool. the metronidazole was changed to an alternating dose between po and iv given the concern for c. diff colitis. there was no radiographic evidence of toxic megacolon. on the patient became hemodynamically unstable with blood pressures dropping to the 60's and 70's systolic range. he was emergently intubated for airway protection given his mental status, and he was started on pressors with dopamine initially. on the ventilator, the patient was hyperventilated to attempt to compensate for his severe metabolic acidosis. his serum ph ranged between 7.2 and 7.3 on the ventilator. on , the patient continued to deteriorate from a hemodynamic standpoint requiring the addition of two more pressor agents. he eventually was stabilized on a regimen of dopamine, norepinephrine, and vasopressin. the norepinephrine and vasopressin were maintained at maximum doses, while the dopamine was at the range of mcg/kg/minute. the patient's central venous pressure appeared to be low and he was continued to be aggressively hydrated with multiple iv fluid boluses. there was no obvious source of infection found at the time of this dictation, however, his white count did continue to trend upward into the 20 range. blood cultures have been sent again to seek a source of infection which may not be covered by his current antibiotic regimen. also, at this time we are considering repeating an ultrasound to look for any evidence of obstruction so that if his alkaline phosphatase continues to elevate despite the improvement in his total bilirubin and his other liver function tests. at the time of this dictation, the patient is still too unstable to have an mrcp performed nor would he potentially tolerate therapeutic ercp. extensive discussions have been held with the family to discuss his overall condition and poor prognosis. the patient's primary care physician, . , has also been involved in these discussions. at the time of this dictation, the patient's family has decided that he will remain a full code status. however, they wish that if he does have an arrest, that a prolonged code not be performed should he not be revivable in a quick manner. a discharge summary addendum will follow this discharge summary to summarize the remaining events during this hospital course. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube percutaneous abdominal drainage diagnoses: coronary atherosclerosis of native coronary artery unspecified essential hypertension unspecified protein-calorie malnutrition percutaneous transluminal coronary angioplasty status acute respiratory failure other shock without mention of trauma other and unspecified alcohol dependence, continuous acute alcoholic hepatitis 

Answer: The patient is high likely exposed to