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: nausea, vomiting, abdominal pain major surgical or invasive procedure: nasogastric tube placement diagnostic and therapeutic paracentesis colonoscopy diagnostic and therapeutic paracentesis colonoscopy picc line placement -intestinal tube placement history of present illness: mr. is a 59 year old male with alcoholic cirrhosis, htn, and pud who was recently discharged from the hepatology service on where he was treated for hepatic encephalopathy and sbp with ciprofloxacin. after leaving the hospital he developed nausea, vomiting, and then abdominal pain. he has mostly stayed in bed and has had difficulty tolerating pos. vomiting has been bilious, non-bloody. he vomited once yesterday. he denies fevers or lightheadedness. he had one headache that resolved. no photophobia or neck stiffness. he has a chronic cough that has become slightly more productive of yellow sputum. he has some shortness of breath with exertion and ocassional lower chest discomfort. . upon arrival to the ed intial vitals were pain 8, t 98.5, hr 112, bp 139/85, rr 16, o2 sat 100% ra. exam notable for a protuberant and diffusely tender abdomen. labs notable for wbc count 18.1 with 6 bands on the diff, lactate 2.8. ct abdomen and pelvis was concerning for sbo with dilated loops of bowel. transplant surgery was consulted and recommended serial abdominal exams, ngt, foley, npo, foley, paracentesis, pan culture, and cxr. ngt had 1.5l of output. the patient underwent diagnostic paracentesis with 20cc of fluid removed. fluid was unremarkable, but patient received zosyn for concern for sbp. he also received 25g of albumnin per recommendation from the hepatology fellow. vitals prior to transfer to the floor hr 104, bp 120/73, rr 13, o2 sat 96% ra. . upon arrival to the floor the patient was comfortable and felt much better since insertion of the ngt. . review of systems: (+) per hpi (-) denies fever, chills, night sweats. denies rhinorrhea or congestion. denies palpitations. denies diarrhea , constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denies arthralgias or myalgias. denies rashes or skin breakdown. no numbness/tingling in extremities. no feelings of depression or anxiety. all other review of systems negative. . past medical history: -etoh cirrhosis -htn -pud -gerd social history: lives at home with his wife and son in . last drink about 3 months ago per family. pt. denies tobacco use. family history: non-contributory physical exam: . on discharge: . t - 98.6, hr - 106 (86 - 106), bp - 109/63, gen: comfortable, nad, ng tube in place, temporal wasting cv: rrr, s1, s2, no murmurs/rubs/gallops respiratory: clear to auscultation bilaterally, no wheezes, rales or rhonchi abd: distended, soft, non-tender, tympanitic to percussion, + bowel sounds ext: 2+ le edema to knees neuro: a&ox3 pertinent results: on admissionl 08:35pm plt count-171# 08:35pm hypochrom-normal anisocyt-1+ poikilocy-1+ macrocyt-2+ microcyt-normal polychrom-normal ovalocyt-occasional burr-occasional bite-occasional 08:35pm neuts-85* bands-6* lymphs-5* monos-4 eos-0 basos-0 atyps-0 metas-0 myelos-0 08:35pm wbc-18.1*# rbc-3.37* hgb-11.5* hct-35.3* mcv-105* mch-34.2* mchc-32.7 rdw-15.8* 08:35pm albumin-3.0* 08:35pm lipase-78* 08:35pm alt(sgpt)-16 ast(sgot)-35 alk phos-103 tot bili-3.6* 08:35pm glucose-97 urea n-47* creat-1.4* sodium-127* potassium-4.7 chloride-94* total co2-24 anion gap-14 10:15pm pt-12.8 ptt-26.2 inr(pt)-1.1 01:00am ascites wbc-260* rbc-3260* polys-26* lymphs-7* monos-0 mesotheli-11* macrophag-54* other-2* 02:16am lactate-2.8* 02:16am comments-green top 06:30am pt-20.5* ptt-41.6* inr(pt)-1.9* 06:30am plt count-159 06:30am wbc-14.4* rbc-3.21* hgb-11.0* hct-32.5* mcv-101* mch-34.1* mchc-33.7 rdw-15.2 06:30am osmolal-289 06:30am calcium-9.1 phosphate-3.2 magnesium-2.2 06:30am lipase-87* 06:30am alt(sgpt)-17 ast(sgot)-31 alk phos-91 tot bili-3.3* 06:30am glucose-67* urea n-42* creat-1.2 sodium-129* potassium-4.3 chloride-95* total co2-28 anion gap-10 06:38am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 06:38am urine color-yellow appear-clear sp -1.046* 07:17am lactate-2.4* 07:17am type- comments-green top 10:57am urine osmolal-637 10:57am urine hours-random urea n-976 creat-59 sodium-25 potassium-45 chloride-27 at discharge: - chemistry: na-132, k-4.6, cl-103, hco3-23, bun-42, cr-0.8, ca-7.9, mg-2.1, phos-4.3 - cbc: wbc-6.6, hct-24.8, plts 101, - coag: 20.1, inr - 1.9 - lft: alt - 21, ast - 46, ap - 122, ldh - 150, tbili - 2.5, alb - 2.3 studies: ct abdomen pelvis: impression: 1. massive ascites. 2. small-bowel is distened and large bowel is distended to the distal transverse colon where there is a relative transition point without obvious mass consistent with a large bowel obstruction. a barium enema is recommended for further investigation. 3. nodule at the liver dome is concerning for a hepatama. nodular densities along the left flank may be omental implants. recommend mr m for further evaluation of the liver lesion 3. dilated and fluid-filled esophagus and stomach. 4. small left pleural effusion. 5. portal vein patent. 6. subacute left rib fracture. 8. perisistent bilateral subcentimeter hypodensities, too small to characterize, statistically likely to be benign cysts. . mri abdomen/pelvis: impression: 1. cirrhotic liver with enhancing lesion with washout characteristics in the dome of the liver in segment viii, concerning for hepatocellular carcinoma. 2. massive ascites. 3. small left pleural effusion with adjacent atelectasis. 4. incompletely visualized gastrointestinal tract which demonstrates distention of the small bowel and large bowel as seen on recent ct. . colonoscopy: no mass or obstructing lesion was noted. preparation was noted to be poor. therefore, any smaller underlying lesions could not be completely excluded. retroflexion was not performed due to large amount of stool in rectal vault. . - decompression in icu colonic dilatation without overt mass lesion or external compression. stool throughout colon. decompression using colonoscope. please insert rectal tube. maintain in icu. . -abdominal xray: dilated loops of both small and large bowel are noted, with air also seen within the ascending and transverse colons. the overall degree of distention and appearance are not significantly changed from prior study, and may reflect an ileus. there is no free air or pneumatosis. . impression: no interval change in persistent small bowel dilatation, as well as dilated ascending and transverse colon. - abdominal xray: dobhoff tube in standard location, appears post-pylroic. brief hospital course: mr. is a 59 y/o m w/ esld etoh cirrhosis c/b ascites, sbp and pse who was admitted for nausea, vomiting and abdominal pain due to bowel obstruction. 1. bowel obstruction: mr. was discharged from the hospital on on ciprofloxacin to treat sbp with last dose scheduled to be . on admission, his repeat diagnostic paracentesis was negative sbp. the patient was found to have a large bowel obstruction with dilated large and small bowel loops. he had a colonoscopy, which showed no intraluminal mass, but it was a poor prep. the patient was given an ng tube to suction and was kept npo. his symptoms did not improve and he was unable to tolerate po. on hospital day 7, the patient started to complain of increased abdominal pain. there was concern for perforation versus obstruction. kub showed no signs of free air and repeat paracentesis was negative for sbp. in the afternoon, the patient became more sleepy (arousable to voice), with asterixis and was noted to have small bright red blood clots in his ng tube fluid drainage. he was transfered to the icu for closer monitoring and possible colonoscopy for decompression of ileus. . pt was admitted to micu for colonoscopy and possible decompression of his bowel. he underwent colonoscopy with decompression using colonoscope. following colonoscopy, the patient passed flatus and had a bowel movement. his condition improved and he was transferred out of the micu back to the floor. . mr. continued to have bowel movements and pass gas. his diet was gradually advanced to full diet, which he tolerated. his lactulose dose was decreased as he had discomfort from gas pains. his ng tube to suction was removed and he denied nausea and vomiting. . 2. esld alcoholic cirrhosis: initially the patient's lasix and spironolactone were held and the patient was intravascularly dry. they were re-started after he was volume repleted. lactulose and rifaximin were continued. the patient had two paracentesis, both were negative for sbp. in the second paracentesis on , 2l of fluid were removed. after re-starting diuretics, the patient had persistent peripheral edema as well as ascites. the patient's lasix dose was increased from 40 to 80 mg daily, and his spironolactone dose was increased from 100 to 200 daily. . the patient's mri showed concern for hepatocellular carcinoma. however, his afp was normal. no work-up was initiated in the hospital because of the patient's acute issues. . 3. acute renal failure: the patient had acute renal failure at time of admission with creatinine up to 1.4, from his baseline of 0.7. it was thought to be pre-renal in etiology from vomiting and poor po intake. it resolved to .6 during hospitalization with iv fluids and increased po intake. . 4. malnutrition: mr. is very malnourished. he presented with an albumin of 2.5. he was unable to tolerate po to his ileus. he started on tpn on and it was continued throughout the hospitalization. he was discharged on both a full diet and tpn. he also had a post-pyloric -intestinal tube placed to start enteric feeds as wll. . 5. anemia/thrombocytopenia: during the hospitalization the patient's hematocrit trended down to the mid-20s, from the low 30s on admission. iron studies on consistent with anemia of chronic disease. he had both normal folate and b12 levels. egd in consistent with portal hypertensive gastropathy and ulceration. platelets are low likely due to splenomegaly. throughout the hospitalization, the hematocrit remained stable in the mid-20s. the patient had small amount of blood from ng on (which resolved), but no other bleeding during admission. he was given a ppi twice a day. . medications on admission: home medications: (per discharge summary) 1. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 3. multivitamin tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 4. rifaximin 200 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*60 tablet(s)* refills:*2* 5. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 4 days. disp:*8 tablet(s)* refills:*0* 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po bid (2 times a day). 7. spironolactone 100 mg tablet sig: one (1) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 8. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po twice a day: titrate to bowel movements per day. disp:*1800 ml(s)* refills:*2* 9. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for nausea. disp:*30 tablet(s)* refills:*1* 10. phytonadione 5 mg tablet sig: one (1) tablet po once a day discharge medications: 1. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. multivitamin tablet sig: one (1) tablet po daily (daily). 4. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po daily (daily). 5. ciprofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours). disp:*30 tablet(s)* refills:*2* 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 7. furosemide 80 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 8. spironolactone 100 mg tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: extended care facility: northeast - discharge diagnosis: primary: large bowel obstruction abdominal ascites malnutrition acute renal failure alcoholic cirrhosis secondary: hypertension peptic ulcer disease discharge condition: stable discharge instructions: you were admitted to the hospital with abdominal pain and vomiting. you were found to have a blockage in your large intestine. you had a colonscopy that showed no large mass in your colon. you also had a nodule on your liver that was concerning for cancer. you had an iv placed to receive nutrition through your vein. you also had fluid removed from your abdomen, which did not show any infection or cancer cells. you had an tube placed through your nose into your intestine so that you could get adequate nutrition. please see below for your follow up appointments. the following changes have been made to your medications: 1. added ciprofloxacin 250 mg daily. this medication will prevent infection recurrence. please take it every day. 2. changed dose of lasix to 80 mg po daily 3. changed dose of spironolactone to 200 mg po daily 4. changed dose of lactulose to 15ml po, once per day followup instructions: , md phone: date/time: 1:00 (if he is unable to get appointment with his own gi - i called dr. office to get an appointment, they will get back to both me and patient). please call your pcp ( to make an appointment please call your gi doctor at ( to make an appointment procedure: venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage insertion of other (naso-)gastric tube colonoscopy dilation of intestine diagnoses: thrombocytopenia, unspecified anemia of other chronic disease unspecified pleural effusion unspecified essential hypertension alcoholic cirrhosis of liver acute kidney failure, unspecified portal hypertension other specified intestinal obstruction pulmonary collapse other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure paralytic ileus other ascites hepatic encephalopathy other disorders of plasma protein metabolism hemorrhage of gastrointestinal tract, unspecified dehydration other specified disorders of stomach and duodenum other complications due to other internal prosthetic device, implant, and graft other and unspecified alcohol dependence, continuous peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction kwashiorkor other impaction of intestine neoplasm of uncertain behavior of liver and biliary passages 

Answer: The patient is high likely exposed to