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: lethargy. major surgical or invasive procedure: none history of present illness: 44 m h/o etoh cirrhosis, grade 1 esophageal varices, h/o ugib/lgib, (meld=34), developed increased abdominal girth and worsening abdominal pain over past 3-4 days. he describes diffuse upper abdominal pain, no focal ruq or luq pain. 2d pta, he notes 2 episodes of hemetemsis, dark blood, no bright red blood, +coffee grounds, ~1 cup volume. pt also describes 2-3d of dark, tarry stools, no brbpr. . on morning of admission, pt sent to ed by his wife increasing lethargy. pt presented to the ed with vs: 96.8 120 112/60 20-40 98%2l. he was felt to be in "intermittent respiratory distress." he was noted to have fsbs=45, and given amp d50. diagnostic tap performed showed +sbp (+wbc, many +rbc), pt given ctx 1g x 1. hct=25 (baseline 26-28), and given ?hememtesis, pt given 1u prbc. he was seen by the liver fellow, who was not initially concerned about gib. given concern for hrs, he was given 5% dextrose 75cc/hr (total 500cc given upon arrival to micu). tbil was 13.0 (baseline 3.0) abd usn showed common bile duct dilation (2mm->10mm currently), and plan was made for mrcp in am. pt also recevied 2mg iv ativan and lactulose was written for. abd usn showed cbd dilation, tbil 13.0. past medical history: 1. etoh cirrhosis, grade 1 esophageal varices , diverticulosis/polyp 2. iron deficiency anemia 3. htn 4. hypercholesterolemia 5. gout 6. gastritis 7. gerd 8. splenomegaly 9. chronic leukopenia/thrombocytopenia social history: denies tobbacco, 1 pint whiskey alcohol, ivdu. painter, disability. lives with wife. family history: alcoholism physical exam: vs: 95.9 126 89/73 79.3 kg 28 99%2l nc gen: uncomfortable, shallow rapid breath, jaundiced. heent: perrla, eomi, sclera icteric, op clear, mmm, no lad, no carotid bruits. 8-10 cm jvd. cv: regular, tachy, nl s1, s2, no m/r/g. pulm: cta b, no r/r/w. abd: firm, distended, +ruq tenderness to palation, + bs, liver appreciable 3-4 cm below costovertebral angle. + spider angioma. ext: warm, 2+ dp/radial pulses bl. neuro: alert & oriented x 3, though lethargic. cn ii-xii grossly intact. 4/5 strength symmetric @ triceps, biceps, delts, hip flexion, dorsoflexion, plantarflexion, limited by lethargy. pertinent results: 01:35pm blood wbc-4.1# rbc-2.59* hgb-8.7* hct-25.1* mcv-97# mch-33.5*# mchc-34.6 rdw-17.0* plt ct-57* 10:08am blood wbc-5.9 rbc-2.76* hgb-9.0* hct-25.6* mcv-93 mch-32.5* mchc-35.0 rdw-17.0* plt ct-34* 11:45pm blood wbc-6.2 rbc-2.82* hgb-9.4* hct-26.8* mcv-95 mch-33.1* mchc-34.8 rdw-17.1* plt ct-59*# 11:45am blood wbc-6.1 rbc-2.88* hgb-9.3* hct-26.5* mcv-92 mch-32.2* mchc-35.0 rdw-17.4* plt ct-39* 11:36pm blood wbc-6.2 rbc-3.05* hgb-10.1* hct-28.5* mcv-93 mch-33.1* mchc-35.4* rdw-17.9* plt ct-36* 12:09pm blood wbc-5.2 rbc-3.36* hgb-10.8* hct-30.6* mcv-91 mch-32.0 mchc-35.1* rdw-18.0* plt ct-38* 01:35pm blood pt-20.4* ptt-50.7* inr(pt)-2.0* 04:40am blood pt-22.7* ptt-52.2* inr(pt)-2.2* 11:45pm blood pt-18.6* ptt-42.6* inr(pt)-1.8* 03:39am blood pt-19.9* ptt-41.7* inr(pt)-1.9* 01:35pm blood glucose-45* urean-32* creat-3.0*# na-125* k-3.8 cl-95* hco3-11* angap-23* 04:40am blood glucose-66* urean-36* creat-3.4* na-126* k-4.0 cl-97 hco3-11* angap-22* 11:45pm blood glucose-68* urean-45* creat-4.1* na-128* k-3.4 cl-98 hco3-12* angap-21* 11:36pm blood glucose-74 urean-53* creat-4.9* na-133 k-4.0 cl-101 hco3-11* angap-25* 12:09pm blood glucose-89 urean-60* creat-4.8* na-135 k-3.5 cl-103 hco3-14* angap-22* 01:35pm blood alt-67* ast-454* ck(cpk)-196* alkphos-150* amylase-38 totbili-13.5* 11:40am blood alt-41* ast-227* ld(ldh)-342* ck(cpk)-107 alkphos-79 totbili-15.4* 05:29pm blood alt-30 ast-117* ld(ldh)-178 alkphos-94 totbili-20.0* 12:09pm blood alt-30 ast-99* ld(ldh)-198 alkphos-104 totbili-21.9* 01:35pm blood ctropnt-0.02* 07:40pm blood ck-mb-19* mb indx-13.3* ctropnt-0.02* 04:40am blood ck-mb-13* mb indx-11.4* ctropnt-<0.01 07:40pm blood calcium-6.4* phos-4.9* mg-1.0* 04:26am blood albumin-3.2* calcium-8.9 phos-4.5 mg-2.3 12:09pm blood albumin-3.0* calcium-8.1* phos-3.9 mg-2.2 01:35pm blood asa-neg ethanol-neg acetmnp-9.9 bnzodzp-neg barbitr-neg tricycl-neg 10:25pm blood type-art po2-94 pco2-26* ph-7.32* caltco2-14* base xs--10 07:08am blood type-art po2-80* pco2-27* ph-7.31* caltco2-14* base xs--11 05:25pm blood type-art po2-56* pco2-31* ph-7.31* caltco2-16* base xs--9 06:55pm blood type-art tidal v-600 peep-5 fio2-50 po2-87 pco2-30* ph-7.32* caltco2-16* base xs--9 intubat-intubated 04:18pm blood type-art temp-38.2 rates-/15 tidal v-500 peep-10 fio2-50 po2-90 pco2-46* ph-7.19* caltco2-18* base xs--10 -assist/con intubat-intubated 09:30pm blood type-art temp-36.1 rates-24/ tidal v-600 peep-10 fio2-50 po2-49* pco2-27* ph-7.35 caltco2-16* base xs--8 intubat-intubated vent-controlled 04:39pm blood lactate-2.4* 05:25pm blood glucose-80 lactate-1.3 na-125* k-3.3* cl-100 . studies: cxr: no acute cardiopulmonary process ekg: sinus tach, nl intervals, axis, no ste/std, twi in iii (old). . abd usn: 1. diffusely, echogenic liver, likely representing cirrhosis or fatty liver or combination of both, with massive splenomegaly with hemangioma, and moderate ascites and gallbladder edema as noted previously. normal direction but low and non-phasic flow in the portal vein, due to portal hypertension. 2. increase in size of dilated cbd measuring 1 cm. no obstructing stone or mass is seen on this ultrasound; however, the evaluation of distal cbd somewhat is limited. please correlate with lab values, and if indicated, please consider mrcp for further evaluation. brief hospital course: a/p: 44 m etoh cirrhosis, presented to ed with lethargy, hemetemesis, increasing abdominal girth and pain, found to have +sbp in ed, and diagnosed with hrs rising creatinine tx with octreotide/midodrine, course complicated by respiratory failure poor mental status resulting in intubation. goals of care ultimately switched to comfort measures only poor prognosis and pt expired. . . # cirrhosis: meld=34. h/o ugib/lgib, and recent nsaid use, continues to drink etoh daily, found to have +sbp in ed. pt followed by liver service with concern for hrs, ulimatley course complicated by respiratory failure poor mental status, hrs, and overall prognosis felt poor. goals of care switched to comfort measures only , and pt expired . . # +sbp/ascites - pt continued on ceftriaxone for sbp 1g q24h, with plan for consideration of repeat tap in 3d to ensure clearing infection. . # varices - hct baseline 26-28, down to 25 on admission, and 22 on admit to icu. pt transfused 2u prbc now with appropriate bump in hct and stablization of hct. pt continued on ppi iv bid. egd deferred as pt not felt actively bleeding per liver fellow. nadolol held in setting of ?gib however. . # arf - concerning for hepatorenal syndrome - baseline creatinine normal (0.9-1.0), up to 3.0, concerning for hrs versus abdominal compartment syndrome (bladder pressure measured 25, thus performed 1.4l therapetuic paracentsis, repeat bladder pressure 15). pt given 1l 5% albumin in ed. and given additional 1l ns now, as well as 1l d5w + folate, thiamine, mvi to complete fluid challenge. urine lytes failed to improve, and pt started on octreotide, midrodine per liver fellow. he was also treated with albumin 1.5 mg/kg ~ equals 100mg albumin of 25% albumin on day 1 (now) and on day 3, per hrs protocol. unfortunately creatinine continued to rise to 4.8. no evidence of hydronephrosis on abdominal usn . . # encephalopathy - lethargic on presentation to micu, pt had been on lactulose last admission, though not taking this currently, could also represent infection (sbp vs uti). pt treated for sbp as above, and started on lactulose without significant improvement in mental status, likely hepatic encephalopathy. . # alcohol withdrawal - pt continues to actively drink etoh, he was treated with bananna bag overnight, thiamine/folate repletion qdaily, and valium 5-10mg iv/po per ciwa. . # elevated tbil - likely etoh cirrhosis, ap is 100s, lower than previously. however abd usn shows increase dilation of cbd (2mm ->10 mm), however no evidence of cholecysistis (no stones, mild edema c/w cirrhosis), afebrile, no wbc count, though +bandemia. given meld, pt too sick for ercp, and plan for mrcp deferred given stable ap. pt covered with flagyl in addition to ctx as above for biliary tree infectious coverage. . # coagulopathy - likely poor synthetic function, rising 2.0->2.2. pt treated with vitamin k 5mg po x 3d. held off on ffp for now, however if hct dropping, will give ffp tonight. . # thrombocytopenia - baseline 70-100s, down to 30s, will transfuse for >30 given concern for active bleeding. ?uremic platelets. given 1u platelets on admission for ?procedure (mrcp) in am, though this was deferred. . # hyponatremia - felt likely cirhosis. pt treated with free water restriction 1l once eating, and kept npo while intubated. . . # respiratory - elevated rr, likely shallow breathing due to abdominal ascites versus respiratory compensation for metabolic acidosis. initial abg 7.32/26/94 on 2l nc. given abdominal compartment syndrome (bladder pressure 25), removed 1.4l via therapeutic paracentesis (no need for additional albumin per liver fellow). however respiratory status continued to worsen, and pt electively intubated for airway protection, however he self d/c'd ett tube , which was replaced after confirming initial goals of care with wife. ultimately decision made to switch goals of care to comfort measures only and ett removed. . . # cardiac - no known h/o cad, however elevated troponin this admission. feel acs unlikely given no ekg changes. ce followed, no asa/plavix given bleeding. . # rythym - sinus tachycarida - likely volume depletion versus etoh withdrawal vs infection (sbp). hr trending down 130s->108 with abx, ivf. lytes repleted, and pt maintained on telemetry. . # pump - elevated jvp, though clearly intravascularly depleted. pt treated with ivf as above given hrs. . # acid base - using 7pm labs and abg, 7.32/26/94, gap =17, delta-delta = 5, corrected hco3 = 17, thus pt has both ag acidosis and non gap acidosis. ddx of ag acidosis likely includes starvation ketosis, arf, lactic acidosis (trending down). non-gap acidosis ? diarrhea (though pt denies) versus rta, though feel unlikely. pco2 = 26, reflects appropriate compensation for metabolic acidosis (expected pco2 = 1.5(12) + 8 +/- 2 = 24-28). no osmolar gap: calculated osm = (2(127) + 59/1.8 + 34/2.8 + 0/4.6 = 269, measured osm = 279, gap = 10. plan was to trend hco3, if < 13, consider po bicitra or iv repletion (if ph declining). metabolic acidosis likely driving respiratory rate. . . # id/bandemia - most likely sbp, blood cultures pending, not urinating currently, no diarrhea, cxr clear. lactate trending down. bcx show +group b strep bacteremia on . peritoneal fluid cx ngtd. pt treated with ctx/flagyl. . . # hypoglycemia - etiology unclear (?sepsis), required amp d50 in ed, receiving d5w currently with fluid repletion, followed q2h overnight, and d/c in am as normalizing. . . # r knee pain - h/o gout. +effusion, not especially warm on micu admit. no erythema. plan was for tapping knee in future once pt more stable, for now will follow and treat symptomatically with ultram prn pain. . . #fen: k, calcium, mg, replete agreesively. pt kept npo, and given ivf as above, given 1l ivf ns only, and used 5% albumin (500cc) for fluid repletion otherwise, as preferred in cirrhotics. . #comm: wife () (work), (h), pcp () . . # dispo: pt initially full code, however felt to have extremely poor prognosis per liver fellow given worsening hrs, gib, and worsening mental status. after extensive discussion with family, decision made to switch goals of care to comfort measures only, and pt expired. medications on admission: medications (on last discharge summary ): nadolol 20mg po qdaily thiamine 100mg po qdaily sucralfate 1 mg po qid ranitidine 150mg po bid ferrous sulfate 325 mg po bid . . medications pt taking currently: ibuprofen 8-12 tablets qdaily for knee/abdomen pain. iron, b12, mvi. discharge medications: pt expired. discharge disposition: expired discharge diagnosis: pt expired. discharge condition: pt expired. discharge instructions: pt expired. followup instructions: pt expired. procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube percutaneous abdominal drainage transfusion of packed cells transfusion of other serum diagnoses: acidosis thrombocytopenia, unspecified esophageal reflux alcoholic cirrhosis of liver acute kidney failure, unspecified hepatorenal syndrome iron deficiency anemia secondary to blood loss (chronic) portal hypertension gout, unspecified sepsis hypoxemia esophageal varices in diseases classified elsewhere, with bleeding alcoholic polyneuropathy varices of other sites streptococcal septicemia acute alcoholic hepatitis leukocytopenia, unspecified acute alcoholic intoxication in alcoholism, continuous alcoholic fatty liver alcohol-induced persisting dementia alcoholic gastritis, with hemorrhage 

Answer: The patient is high likely exposed to