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: no known allergies / adverse drug reactions attending: chief complaint: gi bleed major surgical or invasive procedure: intubation upper endoscopy with banding of varices tube placement and removal history of present illness: 71yo male with hep c cirrhosis who presents with hematemesis and syncope. he is visiting from , , where he apparently has a hepatologist. he syncopized while trying to make it to the bathroom at a dinner party. on the scene, bps were 124/82. he apparently was out for about 30 seconds, and when he came to he vomited large amounts of blood all over himself. he reported dark tarry stools for 2-3 days, but no bright blood. he reported increased abdominal girth. he was brought to , where initial vitals were 131/84 115 18 97%. he was not altered, but ng lavage brought up large amounts of bright red blood that did not clear. hct 33.7, plt 216, inr 1.38. he was intubated for airway protection with etomodate/succ and put on fent/versed. he was started on octreotide and pantoprazole gtts and given ceftriaxone. he was then transferred to the . in the ed, initial vs were: 94 112/70 20 97% on vent. he was seen by gi who did an endoscopy and placed . hct at 30.9. given 2 units prbcs. vitals prior to transfer were 107/72 80s on cmv with o2 sats of 99%. on arrival to the micu, patient is intubated and sedated with in place. bladder pressure 22 past medical history: - hepatitis c cirrhosis - arthritis - hypertension social history: he is originally nigerian but lives in . he is visiting his nephew for a conference of his clan. he ambulates with a cane because of leg pain. per his nephew he drinks only socially and does not drink daily. he does not smoke or take illicit drugs. family history: unknown physical exam: admission exam vitals: t: bp: p: r: 18 o2: general: intubated, sedated heent: sclera anicteric, perrl, mask over face securing tube neck: supple, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: +bs, distended and protuberant. no palpable fluid wave. gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing or cyanosis. trace le edema bilaterally. neuro: perrl. unable to follow commands. . discharge exam general: aox3, appropriate, pleasant neck: no jvd cv: rrr, no m/r/g lungs: ctab, no w/r/r abd: +bs, distended and firm but not tender ext: trace edema in the shins b/l, 2+ pulses pertinent results: admission labs 03:30am blood wbc-9.6 rbc-3.28* hgb-10.4* hct-30.9* mcv-94 mch-31.8 mchc-33.7 rdw-13.9 plt ct-243 03:30am blood pt-15.1* ptt-28.8 inr(pt)-1.4* 03:30am blood fibrino-152* 06:00pm blood glucose-118* urean-23* creat-1.0 na-142 k-4.7 cl-110* hco3-20* angap-17 03:30am blood alt-45* ast-60* alkphos-91 totbili-0.6 03:30am blood lipase-24 03:30am blood albumin-2.7* 06:00pm blood calcium-8.7 phos-4.6* mg-2.2 03:30am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 07:07am blood type-art temp-36.7 rates-16/ peep-5 po2-152* pco2-40 ph-7.38 caltco2-25 base xs-0 -assist/con intubat-intubated 03:40am blood glucose-136* na-137 k-5.9* cl-112* calhco3-21 03:40am blood hgb-10.1* calchct-30 07:07am blood freeca-1.10* . discharge labs 05:05am blood wbc-8.1 rbc-3.29* hgb-10.0* hct-30.5* mcv-93 mch-30.6 mchc-32.9 rdw-13.8 plt ct-242 05:05am blood pt-13.2* ptt-30.1 inr(pt)-1.2* 05:05am blood glucose-76 urean-11 creat-0.8 na-138 k-3.6 cl-105 hco3-24 angap-13 05:05am blood alt-48* ast-67* alkphos-113 totbili-1.0 05:05am blood calcium-7.9* phos-2.4* mg-2.2 03:15pm blood hbsag-negative hbsab-negative hbcab-negative hav ab-positive igm hbc-negative igm hav-negative 11:00am blood afp-126.1* 03:30am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 03:15pm blood hcv ab-positive* hcv viral load (final ): 1,630,663 iu/ml. . micro urine culture - no growth blood culture and - no growth peritoneal culture gram stain (final ): reported to and read back by @ 7pm . no polymorphonuclear leukocytes seen. 1+ (<1 per 1000x field): budding yeast. fluid culture (preliminary): albicans. sparse growth. staphylococcus, coagulase negative. sparse growth. anaerobic culture (final ): no anaerobes isolated. peritoneal culture gram stain (final ): 2+ (1-5 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. anaerobic culture (preliminary): no growth. fungal culture (preliminary): no fungus isolated. . imaging cxr: 1. endotracheal tube with its tip less than 1 cm from the level of the carina, suggest repositioning. 2. low lung volumes, and cardiomegaly, with bibasilar atelectasis. . egd findings: esophagus: protruding lesions 5 cords of grade iii varices were seen in the lower third of the esophagus. the varices were not bleeding. 4 bands were successfully placed. stomach: mucosa: diffuse continuous granularity, erythema and mosaic appearance of the mucosa were noted in the whole stomach. these findings are compatible with portal hypertensive gastropathy. despite pre-egd erythromycin and multiple attempts at suctioning the clot, fundus could not be completely visualized. but no gastroesophageal varices noted near ge junction. duodenum: not examined. . kub there has been placement of a large caliber tube in the stomach with a balloon in the region of the body of the stomach. the distal tip is in the stomach antrum. there are several non-dilated loops of air-filled small bowel. there is air seen in the colon. no free intra-abdominal gas is present. . ct abdomen and pelvis 1. liver demonstrates lobulated contour, compatible with patient's known history of underlying cirrhosis. portal vein is thrombosed. the thrombus extends into the right and left portal veins. there is possible enhancement of the thrombus, suggestive of tumor thrombus. the distal left portal vein is opacified. the liver is of heterogeneous enhancement. multiple hepatic hypodensities are present. ill-defined areas of hypodensities in the liver may represent infarction or infection in the appropriate clinical setting. 2. large amount of ascites. 3. bowel wall edema of the cecum and ascending colon may reflect third spacing, infectious, inflammatory, or ischemic causes. 4. small bibasilar consolidations, likely atelectasis, infection or aspiration. . cxr: the tip of the endotracheal tube has been pulled back and the tip is now 3 cm above the carina. there is again seen a left-sided picc line with its lead tip in the proximal svc perpendicular to svc wall. there are no pneumothoraces. the heart size is within normal limits. there is some atelectasis and low lung volumes at the lung bases. there are likely small bilateral pleural effusions. . brief hospital course: 71yo male with hepatitis c cirrhosis who presented with acute variceal bleed initially requiring intubation and placement that has since resolved. . # variceal bleed: presented with hematemesis and initial egd was without a clear lesion for intervention but suspected to be a variceal bleed. tube was placed and subsequently removed once patient stabilized. repeat egd showed 5 cords of grade iii varices in the lower third of the esophagus and 4 bands were successfully placed. patient was transfused a total of 2 units of prbcs and since then blood counts remained stable and he has had no further melena. a ct abdomen and pelvis showed a portal vein thrombus, and therefore was determined not to be a tips candidate. patient was started on pantoprazole and octreotide drips. pantoprazole was changed to iv bid and octreotide was continued for 72 hours. he also completed a course of ceftriaxone for 5 days. nadolol, oral proton-pump inhibitor, and sucralafate were started for prophylaxis and treatment of his recent bleed. # abdominal distension: patient markedly distended on exam. he was insufflated with quite a bit of air during his endoscopy with rising bladder pressures, relieved by placement of rectal tube and decompression of abdominal gas. bladder pressures trended down, urine output improved, and abdominal exam clinically improved. patient spiked a fever during his stay and diagnostic paracentesis initially grew coag-negative staph and albicans. repeat ct was performed which showed no signs of perforation so patient was empirically started on fluconazole for a total of seven days and zosyn for 48 hours. therapeutic paracentesis the following day revealed only small pockets of fluid. 700cc of fluid was drained and this fluid was negative for any organisms suggesting earlier sample was contaminated. patient remained afebrile and without leukocytosis for the remainder of his stay. his belly remained distended but this was felt to be potentially more related to tumor burden (see below) rather than ascites so he was not started on diuretics. despite low suspicion for infection, he will continue fluconazole for a seven day course. he was started on oxycodone for his discomfort. # hep c cirrhosis complicated by ascites and esophageal varices. hep c viral load was 1.6 million and hepatitis b serologies were negative. once variceal bleed stabilized, patient was started on nadolol for prophylaxis. given no history of encephalopathy or spontaneous bacterial peritonitis, ciprofloxacin, lactulose and rifaxamin were not initiated at this time. # possible hepatocellular carcinoma - patient had ct scan which revealed multiple irregular hepatic hypodensities and portal vein thrombosis, likely from associated tumor. afp was elevated to 126.1. patient will require further imaging with mri/mrcp and discussion of possible treatment of his likely hepatocellular carcinoma # s/p intubation: patient intubated at outside hospital for airway protection in the setting of gi bleed. when hcts stabilized, sedation was stopped and the patient was successfully extubated. # hypertension: he was transitioned to nadolol and his blood pressures remained well-controlled. his amlodipine was held at discharge as he was normotensive. transitional issues - further workup and management of his hepatocellular carcinoma will need to occur in - consider initiating diuretics if required for volume overload/blood pressure control - fluconazole course will end on and sucralafate will end on - the hepatology attending on service was , md whose telephone number is and address is , medications on admission: - amlodipine 10mg daily - atenolol 100mg daily discharge medications: 1. fluconazole 400 mg po q24h start: rx *diflucan 200 mg daily disp #*6 tablet refills:*0 2. nadolol 40 mg po daily hold for sbp < 100 or hr < 60 rx *nadolol 40 mg daily disp #*30 tablet refills:*0 3. oxycodone (immediate release) 5 mg po q6h:prn pain hold for sedation, rr<12 rx *oxycodone 5 mg every six hours disp #*20 capsule refills:*0 4. sucralfate 1 gm po qid rx *sucralfate 1 gram/10 ml four times a day disp #*32 milliliter refills:*0 5. omeprazole 20 mg po bid rx *omeprazole 20 mg twice a day disp #*60 capsule refills:*0 discharge disposition: home discharge diagnosis: primary hcv cirrhosis variceal bleed . secondary htn discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear mr. , you were admitted to the hospital after vomiting blood and losing consciousness. you had a breathing tube placed to protect your lungs as we controlled the bleeding. we found that the bleeding was coming from the esophagus and the stomach and we controlled the bleeding with banding of the blood vessels. we also performed a ct scan that showed some fluid in your abdomen and areas of the liver concerning for liver cancer. we removed a small amount of this fluid from your abdomen to make you more comfortable. once you are home, you will need a repeat endoscopy in three weeks to make sure the bleed is healing and an mri of the liver to rule out cancer. followup instructions: please follow-up with your gastroenterologist in once you arrive home. you will need to discuss further treatment for your possible liver cancer as well as repeat endoscopy to evaluate the the blood vessels in your gi tract. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours percutaneous abdominal drainage endoscopic excision or destruction of lesion or tissue of esophagus endoscopic excision or destruction of lesion or tissue of esophagus central venous catheter placement with guidance diagnoses: hyperpotassemia unspecified essential hypertension cirrhosis of liver without mention of alcohol chronic hepatitis c without mention of hepatic coma acute posthemorrhagic anemia portal hypertension hypopotassemia other ascites malignant neoplasm of liver, primary esophageal varices in diseases classified elsewhere, with bleeding varices of other sites staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus other specified disorders of stomach and duodenum syncope and collapse tachycardia, unspecified other candidiasis of other specified sites arthropathy, unspecified, site unspecified portal vein thrombosis duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation, without mention of obstruction 

Answer: The patient is high likely exposed to