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: ams major surgical or invasive procedure: intubation at osh, extubation diagnostic paracentesis history of present illness: 55yom with etoh induced cirrhosis on list (meld 16 on ), dm ii, pancytopenia and multiple admissions for hepatic encephalopathy who presents from an osh with acute change in ms. records, the following history was provided by his significant other. she states that over the past week the patient has been more confused. he has continued on his medication regimen and taken lactulose as directed. he has been moving his bowels regularly. on the morning of , she was unable to wake him up in the morning. she called ems. on arrival, ems found the pt obtunded. blood sugar noted to 400. he was taken to the . . at , he had a head ct which was normal. he was intubated for airway protection. ua neg. cxr showed an increased density at the left base which could be air-space disease. tox screen neg. asa and tylenol levels neg. given 2 units prbc's. ammonia level 344- started on lactulose q1hr. cbc did show wbc 1.9 with 80% neutrophils and 25 bands. glucose 329. . pt recently admitted to for recent symptoms from to . then admitted to from until again with confusion. . past medical history: # etoh induced cirrhosis - portal hypertension - grade i esophageal varices - diuretic refractory ascites. - on list after a recent 40lb weight loss, meld score 19 - multiple admissions to and for hepatic encephalopathy - s/p tips with frequent revisions and then closure in secondary to hepatic encephalopathy # pancytopenia -chronic from underlying liver disease -baseline hct in mid 20s -baseline platelets in 20-40 # ckd with baseline cr 1.0 # dm2, insulin dependent # s/p cholecystectomy for porcelain gallbladder in # carcinoid tumor in gastric fundus # osa (doesn't use his home bipap) # squamous cell skin ca on left shoulder # morbid obesity # chronic venous stasis social history: lives with fiancee (refers to as "wife") in . 8py h/o smoking, quit age 26. h/o alcohol abuse, quit ~. remote marijuana/cocaine use in the 60s-70s, no ivdu. unemployed at present. he previously worked as the director of food & beverage services on a cruiseline in the hawaiian islands. family history: mother died at age 56 of a cva. father died at age 84 alzheimer's. sister with type ii diabetes, seizures. brother with heart disease. another brother is healthy. physical exam: vs - temp f98.6, bp 135/62 , hr 81, r18 , o2-sat 100% fi02 40% general - ill appearing man in nad, sedated and ventilated heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear neck - supple, no thyromegaly, no jvd, no carotid bruits lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - pmi non-displaced, rrr, no mrg, nl s1-s2 abdomen - grossly distended, typanitic, dialted veins across abd extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps) skin - small puncture on lateral aspect of left knee with mild erythema, no drainage or purulence, no warmth or swelling. . pertinent results: admission labs: 01:55am blood wbc-2.1* rbc-3.13* hgb-10.2* hct-29.7* mcv-95 mch-32.6* mchc-34.4 rdw-18.6* plt ct-26* 01:55am blood neuts-79.4* lymphs-9.8* monos-7.6 eos-2.7 baso-0.4 01:55am blood pt-18.5* ptt-36.1* inr(pt)-1.7* 01:55am blood glucose-223* urean-36* creat-1.0 na-133 k-3.7 cl-104 hco3-24 angap-9 01:55am blood albumin-3.1* calcium-8.8 phos-2.8 mg-1.8 02:18am blood ammonia-103* . liver us: limited with patent main portal vein, main hepatic artery, and middle hepatic vein. a moderate amount of ascites. spot marked for paracentesis in right lower quadrant. tips occlusion, an unchanged finding. brief hospital course: 55 yo male with etoh cirrhosis on list, dm ii, pancytopenia and multiple admissions for hepatic encephalopathy who presents with confusion and found to have hepatic encephalopathy. # acute change in mental status: the differential diagnosis initially included hepatic encephalopathy, infection (sbp, pna, uti), etoh. his etoh level was negative and his utox was negative at . he had a ct head which was negative. he had a negative ua and a cxr with a question of a lll density, and pt had left shift with bands at osh suggestive of infection and possible pna. here the patient was afebrile with nl wbc without a left shift or bands. cxr here showed a left sided effusion, but no pneumonia. he also had an elevated ammonia initally at 344 which was suggestive of recurrent hepatic encephalopathy. he had been intubated at for airway protection and was transferred to our micu where he was extubated and transferred to the floor as his mental status improved while being treated with lactulose and rifaxamin. he had an abdominal u/s with dopplers which showed an unchanged tips occulsion. he had a diagnostic paracentesis which was not consistent with sbp, however one of the peritoneal cultures sent grew out e.coli. this was thought to be a contaminent as he had only 56 wbc and 3% poly on examination of his peritoneal fluid. he was initially treated with ceftriaxone and was clinically improving, however the e.coli which grew out was not sensitive to ceftriaxone, supporting that the e.coli was a contaminant. he was discharge on prophylactic ciprofloxacin. prior to discharge he was told that if he were to develop any warning signs including fever, abdominal pain, or chills, he should go to the emergency room immediately. # esld: on the liver list for cirrhosis. last meld 16 on . the patient was continued on nadolol, lasix, and aldactone. # dm ii: the patient was monitored with qid finger sticks and was continued on nph and sliding scale insulin. # anemia: baseline hct 23-28. he received 2 units prbc's at osh. here his hct remained within his baseline. # pancytopenia: his plt baseline runs from 22 to 40. he developed no signs of active bleeding here and his plt remained >20. medications on admission: nadolol 20 mg po daily acidophilus 3 capsules po once a day. miconazole nitrate 2 % powder sig: one topical pantoprazole 40 mg tablet delayed release po q24h rifaximin 200 mg 3 tablet po bid lactulose 30ml po 3-4 times daily: titrated to bowel movements daily. furosemide 120 mg po daily spironolactone 50 mg po bid insulin lispro sliding scale and take your insulin nph 75 units every morning and 70 units every evening. metoclopramide 10 mg tablet 0.5 tablet po tid oxycodone 5 mg po q6h prn pain. discharge medications: 1. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). 2. spironolactone 25 mg tablet sig: two (2) tablet po daily (daily). 3. rifaximin 200 mg tablet sig: three (3) tablet po bid (2 times a day). 4. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q4h (every 4 hours). 5. oxycodone 5 mg tablet sig: 1-2 tablets po at bedtime as needed for 10 days. disp:*20 tablet(s)* refills:*0* 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. ciprofloxacin 500 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 8. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 9. lasix 80 mg tablet sig: 1.5 tablets po once a day. 10. reglan 5 mg tablet sig: one (1) tablet po three times a day. 11. insulin lispro 100 unit/ml solution sig: sliding scale units subcutaneous per sliding scale. 12. insulin nph human recomb 100 unit/ml suspension sig: seventy five (75) units subcutaneous qam. 13. insulin nph human recomb 100 unit/ml suspension sig: seventy (70) units subcutaneous bedtime. discharge disposition: home with service facility: discharge diagnosis: primary: hepatic encephalopathy . secondary: etoh induced cirrhosis - portal hypertension - grade i esophageal varices - diuretic refractory ascites. s/p tips ckd with baseline cr 1.6 dm2, insulin dependent discharge condition: stable, afebrile. discharge instructions: you were admitted with confusion and possible sbp. your ascitic fluid was negative for sbp. one of the cultures did grow out e. coli, however, given that you improved on just ciprofloxacin, and you were essentially asymptomatic aside from confusion, we think that this was a contaminant. that being said, you will go home on ciprofloxacin as prophylaxis and this should be taken everyday. additionally, if you develop worsening confusion or belly pain at home and/or you have fevers or chills, you should return to the hospital as soon as possible. followup instructions: provider: west interventional/prostate us radiology phone: date/time: 1:00 provider: , md phone: date/time: 9:30 md procedure: percutaneous abdominal drainage transfusion of other serum transfusion of platelets diagnoses: anemia in chronic kidney disease diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled alcoholic cirrhosis of liver other and unspecified alcohol dependence, in remission portal hypertension chronic kidney disease, unspecified morbid obesity other ascites hepatic encephalopathy esophageal varices in diseases classified elsewhere, without mention of bleeding venous (peripheral) insufficiency, unspecified need for prophylactic vaccination and inoculation against influenza 

Answer: The patient is high likely exposed to