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: mr. presented to on with a massive upper gastrointestinal bleed, altered mental status, acute renal failure, and coagulopathy. the patient's hematocrit was noted to be 14 at the outside hospital, creatinine was 3.6, and inr was 3.4. an octreotide drip was started, and the patient was transfused a total of 6 units of packed red blood cells and 4 units of fresh frozen plasma. a head computed tomography was performed which was negative for an intracranial hemorrhage but was for atrophy. an esophagogastroduodenoscopy demonstrated grade 2 varices and portal gastropathy. the patient was started on spontaneous bacterial peritonitis prophylaxis secondary to a history of ascites on a computed tomography scan from . mr. was transferred to for further management. of note, the patient was intubated for airway protection on presentation to hospital. mr. presented to via transfer on . an abdominal ultrasound demonstrated no portal venous flow and positive hepatofugal flow in the portal vein. an esophagogastroduodenoscopy was performed on which demonstrated grade 3 varices in the lower one third of the esophagus and middle one third of the esophagus. these varices were injected with morrhuate. also, there was - tear seen in the cardia and portal gastropathy was also commented upon. the patient was continued on levofloxacin and flagyl for a question of an aspiration pneumonia and spontaneous bacterial peritonitis prophylaxis. while in the intensive care unit, the patient remained on a proton pump inhibitor q.12h., an octreotide drip, and received a further 6 units of packed red blood cells and 6 units of fresh frozen plasma. since , the patient's hematocrit had been with q.8h. hematocrit checks, averaging between 34 and 35. also of note, the patient was started on nadolol. the patient was intubated on arrival and subsequently extubated on in the morning and remained on 4 liters nasal cannula with an oxygen saturation of greater than 93%. also notable was blood cultures on which were positive in bottles for coagulase-negative staphylococcus; 1/2 bottles on were positive for coagulase-negative staphylococcus; and negative blood cultures from and . secondary to these blood cultures and fevers, the patient's right femoral central venous line was changed to a right internal jugular central venous line on . as the patient had presented to the outside hospital in acute renal failure, with volume resuscitation the patient's creatinine decreased to 0.8 on the day of transfer to the medical floor. past medical history: 1. gastroesophageal reflux disease. 2. pancreatitis. 3. alcoholic cirrhosis with encephalopathy and ascites. 4. chronic anemia. 5. hypertension. 6. history of prior alcohol withdrawal seizures. allergies: erythromycin (causes a rash). medications on admission: atenolol, lasix, prilosec, spironolactone, and diazepam. medications on transfer to the medical floor: 1. octreotide 50 mcg per hour. 2. lactulose 30 ml p.o. three times per day. 3. regular insulin sliding-scale. 4. protonix 40 mg p.o. twice per day. 5. folic acid 1 mg p.o. once per day. 6. thiamine 100 mg p.o. once per day. 7. levofloxacin 500 mg p.o. once per day (started on ). 8. flagyl 500 mg p.o. three times per day (started on ). 9. nadolol 20 mg p.o. once per day. family history: family history is significant for alcohol and coronary artery disease. social history: the patient lives alone in an apartment. the patient is on disability. he smokes one pack per day and has attended alcohol anonymous meetings since . the patient did note binge drinking about one week prior to his presentation to the outside hospital. physical examination on presentation: physical examination on transfer revealed vital signs with a temperature of 100.2 degrees fahrenheit, heart rate was 86, blood pressure was 115/78, respiratory rate was 25, and oxygen saturation was 95% on room air. in general, chronically ill-appearing, in no acute distress. alert and oriented times two. head, eyes, ears, nose, and throat examination revealed sclerae were anicteric. mucous membranes were moist. the oropharynx was clear. pupils were equally round and reactive to light. extraocular movements were intact. the neck was supple. right internal jugular in place and intact, without erythema or tenderness. the chest examination revealed symmetric excursion. decreased breath sounds at the right base; otherwise, no wheezes, rhonchi, or rales. cardiovascular examination revealed a regular rate and rhythm. normal first heart sounds and second heart sounds. no third heart sound or fourth heart sound. no murmurs or rubs. no right ventricular heave appreciated. point of maximal impulse was not displaced. the abdomen was mildly distended. soft and nontender. normal active bowel sounds. the liver edge was not palpable. there were no spider angiomata or telangiectasia on the abdomen. several telangiectasias were noted, however, on the face. extremity examination revealed 1+ pedal and hand edema. dorsalis pedis pulses were 2+. neurologic examination revealed distal sensation was intact. quadriceps were 2 to 3+ bilaterally. biceps were 2+ bilaterally. no asterixis noted. pertinent laboratory values on presentation: laboratories on transfer revealed white blood cell count was 12.4, hematocrit was 35.1, and platelets were 61. sodium was 142, potassium was 3.6, chloride was 110, bicarbonate was 23, blood urea nitrogen was 16, creatinine was 0.6, and blood glucose was 118. calcium was 7.6, magnesium was 1.7, and phosphate was 3.4. prothrombin time was 19.2, inr was 2.4, and partial thromboplastin time was 34.6. pertinent laboratory values on discharge: laboratories on discharge revealed white blood cell count was 10.5, hematocrit was 34, and platelets were 130. prothrombin time was 18.4, partial thromboplastin time was 32.8, and inr was 2. potassium was 4.4. blood urea nitrogen was 9. creatinine was 0.8. liver function tests were significant for a total bilirubin of 1.7 and a ld of 290; otherwise, liver function tests were within normal limits. pertinent radiology/imaging: an abdominal ultrasound on demonstrated retrograde flow in the right portal vein. anterograde flow in the left portal vein with recannulized periumbilical vein noted. flow in the splenic vein was antegrade. there was no definite flow within the main portal vein; however, this may have been noted for technical reasons. there was splenomegaly and findings consistent with cirrhosis. the spleen was noted to be 14 cm. a chest x-ray on demonstrated a diminished patchy density at the right apex. perihilar opacities were persistent. a right pleural effusion was noted. there were multiple left-sided rib fractures noted. left elbow and left ankle plain films were significant for an irregularity in the later epicondyle; raising the question of chronic tendinitis in the left elbow. otherwise, there was no evidence of fracture. the ankle films demonstrated swelling of the soft tissue laterally. there were no apparent fractures. a right lower extremity ultrasound was significant for patent vasculature. no deep venous thrombosis was identified. an esophagogastroduodenoscopy performed on demonstrated grade 3 varices seen in the lower third of the esophagus and middle third of the esophagus. the varices were noted to oozing. five 2-cc sodium morrhuate injections were applied for hemostasis with partial success. - tear with a stigmata of recent bleeding was demonstrated in the cardia. the stomach was significant for diffuse discontinuous erythema, congestion, petechiae, and erosion of the mucosa with no bleeding noted in the fundus and in the stomach body. these findings were compatible with portal gastropathy. the duodenum was noted to be normal. microbiology results: blood cultures from were positive in bottles for coagulase-negative staphylococcus resistant to penicillin; and sensitive to oxacillin, levofloxacin, gentamicin, erythromycin, and clindamycin. 1/2 bottles on was positive for coagulase-negative staphylococcus resistant to gentamicin, levofloxacin, oxacillin, and penicillin. blood cultures from , , and were negative for growth at the time of this dictation. a catheter tip from the right femoral central venous line was cultured and was negative for growth on . impression: mr. is a 47-year-old gentleman with presentation to an outside hospital with a massive upper gastrointestinal bleed secondary to esophageal varices. the patient was transferred for further management to . the patient was stabilized with an octreotide infusion, multiple transfusions of packed red blood cells and fresh frozen plasma. an esophagogastroduodenoscopy performed demonstrated grade 3 varices which were partially treated with sclera therapy. status post sclera therapy, the patient's hematocrit levels remained stable with no significant decrements after . the patient's encephalopathy continued to improve throughout his hospitalization. hospital course by issue/system: 1. upper gastrointestinal bleed issues: mr. was transferred for further evaluation and management of a massive upper gastrointestinal bleed with a hematocrit of 14 on presentation. the patient's blood volume was supported with transfusions of packed red blood cells. the patient received a total 6 units of packed red blood cells while in the medical intensive care unit at . the patient's coagulopathy was also reversed with fresh frozen plasma while he was experiencing the acute hemorrhage. a esophagogastroduodenoscopy was performed which was significant for findings as described above. the patient remained on octreotide for five days after the bleeding was controlled. after the patient's last blood transfusion on , q.8h. hematocrit checks remained stable and above 30. the patient's octreotide was discontinued on . while hospitalized, the patient remained on protonix initially intravenously q.12h. he was subsequently switched to an oral regimen as the patient could tolerate. mr. was started on nadolol prior to discharge from the medical intensive care unit, and his heart rates decreased and remained in the 80s with this medication. the patient remained hemodynamically stable throughout his admission on the medical floor. mr. will require a repeat esophagogastroduodenoscopy as an outpatient. i contact the patient's gastroenterologist that had seen mr. while at hospital emergency department (dr. . the patient will schedule an appointment to see dr. within two weeks following discharge. 2. alcoholic cirrhosis with encephalopathy issues: mr. was originally intubated for airway protection secondary to the massive upper gastrointestinal bleeding. he was transferred to while intubated. there was concern with his prior history of alcohol withdrawal seizures and recent binge drinking prior to presentation. however, the patient had no episodes of withdrawal seizures while admitted in the medical intensive care unit or on the medical floor. upon extubation on and subsequent weaning of sedation, the patient's mental status continued to improve. mr. was maintained on a lactulose regimen to achieve two to three bowel movements per day. this regimen was lactulose 30 ml p.o. twice per day. upon discharge, the patient was alert and oriented to person, place, and time. he was noted to have no asterixis on examination prior to discharge. as mr. was noted to have ascites on computed tomography scan in , he was placed on spontaneous bacterial peritonitis prophylaxis with levofloxacin at hospital. this medication was continued for spontaneous bacterial peritonitis prophylaxis while at as well as treatment for an aspiration pneumonia in conjunction with flagyl. the patient remained afebrile throughout his hospitalization on the medical floor. 3. coagulopathy issues: mr. coagulopathy was initially treated with a transfusion of fresh frozen plasma while he was acutely bleeding. upon stabilization of his upper gastrointestinal bleed, mr. was administered oral vitamin k without reversal of his inr. the patient's inr trended up to 3 on . he was switched to vitamin k subcutaneously with a slow decrease in his inr to 2.2 on the day prior to discharge. 4. acute renal failure issues: mr. was noted to be in acute renal failure on presentation to the outside hospital with a creatinine of 3.6. upon volume resuscitation, the patient's creatinine quickly diminished from 2.9 on to 0.8 on the day prior to discharge. as the patient was being treated with diuretics for his known ascites, careful addition of spironolactone and lasix resulted in no further increase in the patient's creatinine. 5. right lower extremity edema issues: several days prior to discharge, the patient was noted to have increasing right lower extremity edema. mr. had been somewhat noncompliant with keeping his lower extremities elevated. however, a right lower extremity ultrasound was performed to evaluate for deep venous thrombosis. no deep venous thrombosis was demonstrated on this study performed on . stockings were applied and are recommended to continue to treat this edema. 6. infectious disease issues: as noted above, the patient was maintained on spontaneous bacterial peritonitis prophylaxis. secondary to the concern of aspiration pneumonia, the patient was to be treated with a 14-day course with levofloxacin and flagyl. the last dose was to be administered on . a question of an aspiration pneumonia was raised secondary to the patient's fevers, leukocytosis, and a right-sided infiltrate noted on . 7. nutritional issues: mr. diet was continually advanced. he tolerated and increasing amount of protein very well without evidence for worsening encephalopathy. at the time of discharge, the patient was receiving a diet restricted to 2 g of sodium and 1 g/kg of protein per day. discharge diagnoses: 1. upper gastrointestinal bleed. 2. esophageal varices. 3. - tear. 4. acute blood loss anemia. 5. thrombocytopenia. 6. hepatic encephalopathy. 7. ascites. 8. aspiration pneumonia. 9. coagulopathy. 10. edema. 11. hypokalemia 12. portal vein thrombosis; no anticoagulation per gastroenterology recommendations. medications on discharge: 1. levofloxacin 500 mg p.o. once per day (last dose to be administered on ). 2. flagyl 500 mg p.o. three times per day (last dose to be administered on ). 3. thiamine 100 mg p.o. once per day. 4. folic acid 1 mg p.o. once per day. 5. protonix 40 mg p.o. twice per day. 6. nadolol 20 mg p.o. once per day. 7. lasix 20 mg p.o. once per day. 8. spironolactone 50 mg p.o. four times per day. 9. lactulose 30 ml p.o. twice per day (goal bowel movements of two to three per day). discharge instructions/followup: 1. mr. was to follow up with dr. in two weeks after discharge. attempting to schedule an appointment with dr. at the time of this dictation. the patient was to call telephone number to schedule an appointment. the address is gastroenterology, , , . 2. mr. was to follow up with the liver service at the as directed by his gastroenterologist in . 3. while at , the patient was seen by dr. and dr. . discharge status: the patient was to be discharged to a rehabilitation facility; in . condition at discharge: condition on discharge was stable. , m.d. dictated by: medquist36 d: 16:17 t: 16:52 job#: procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances endoscopic excision or destruction of lesion or tissue of esophagus diagnoses: acute posthemorrhagic anemia alcoholic cirrhosis of liver acute kidney failure, unspecified pneumonitis due to inhalation of food or vomitus esophageal varices in diseases classified elsewhere, with bleeding hepatic encephalopathy gastroesophageal laceration-hemorrhage syndrome portal vein thrombosis 

Answer: The patient is high likely exposed to