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: hematemesis major surgical or invasive procedure: none. history of present illness: 56 year old man with hiv, dm2, cad, h/o seizures, alcoholic cirrhosis and known varices s/p banding on initially presented to osh with bright red hematemesis. initial vs: temp 97.3f, bp 81/47, hr 111, r 22, sao2 99% ra with initial hct 31.6. he continued to have hematemesis with worsening hypotension (sbp 60s) despite ivf and prbcs (7l ns + 5units prbcs total). femoral cvl placed and he was started on dopamine and octreotide gtts and given protonix 40mg iv. endoscopy attempted but unsuccessful due to continued hematemesis. he was intubated and repeat endoscopy with successful sclerotherapy and placement of 2 bands (reportedly bands fired). he was transferred here for further care and concern given passage of maroon stool per rectum. . in our ed, initial vs were: hr 108 113/56 on dopamine 20 100%. he was continued on versed and fentanyl added for sedation. labs remarkable for hct 32, inr 1.5 from 1.2. he had no further bleeding and received ceftriaxone 1g and 2 units ffp. seen by gi who recommended octreotide and pantoprazole drips, ceftriaxone, q4hour hct and plan for repeat scope in am. vs prior to transfer: 107 94/53 on dopa 75mcg/kg/min 12 100% ac 500x18 peep 5 satting 100%. access includes 20g piv, 18g piv, femoral cvl. . on the floor, he is intubaetd and sedated but opens eyes to commands. . review of systems: unable to obtain past medical history: - etoh cirrhosis, c/b esophageal varices, s/p banding - hiv, on atripla - diabetes, on insulin - seizures - cad s/p mi - htn? - hypercholesterolemia? - depression/anxiety? social history: disabled. reportedly heavy etoh use with ongoing daily use, no tobacco or other drug use. family history: unable to obtain physical exam: on admission: vitals: t: bp: p: r: 18 o2: general: intubated, sedated, opens eyes to name and follows commands. heent: sclera anicteric, mm with dried blood around ett, no new blood, oropharynx otherwise clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally anteriorly, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, faint 2/6 systolic murmru lusb. no rubs, gallops abdomen: soft, non-tender, non-distended, hyperactive bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley draining dark yellow- urine ext: cool, well perfused, 2+ pulses, no clubbing, cyanosis or edema skin: no plamar erythema. faint spiders anterior torso and gynecomastia. no tremor of tongue or extremities on discharge: vs: tm 98.4 tc 97, 107/66 (103-137/65-79), 69 (65-80), 18, 95%ra general: pleasant male lying in bed in nad heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple lungs: clear to auscultation bilaterally, no wheezes, rales, or rhonchi. cv: regular rate and rhythm, normal s1 + s2, no m/g/r abdomen: soft, non-tender, non-distended, normoactive bowel sounds present, no rebound tenderness or guarding. ext: warm, well perfused, no clubbing, cyanosis, or edema neuro: alert and oriented x3. motor strength and sensory grossly equal and intact bilaterally. no asterixis. pertinent results: on admission: 10:19pm hct-35.6* 07:09pm type-central ve po2-47* pco2-44 ph-7.25* total co2-20* base xs--7 07:09pm lactate-1.7 06:38pm hct-33.0* 03:08pm ph-7.29* comments-green top 03:08pm freeca-1.03* 02:22pm glucose-189* urea n-12 creat-0.5 sodium-141 potassium-4.2 chloride-117* total co2-17* anion gap-11 02:22pm calcium-7.3* phosphate-2.9 magnesium-2.0 02:22pm calcium-7.3* phosphate-2.9 magnesium-2.0 02:22pm pt-14.0* ptt-26.1 inr(pt)-1.2* 11:04am type-central ve po2-43* pco2-47* ph-7.21* total co2-20* base xs--9 11:04am lactate-1.5 11:04am freeca-1.14 10:30am type-art rates-/22 tidal vol-500 o2-50 po2-136* pco2-37 ph-7.29* total co2-19* base xs--7 intubated-intubated vent-spontaneou 10:30am lactate-1.4 10:30am freeca-1.14 09:45am hct-28.8* 05:56am type-art tidal vol-500 peep-5 o2-50 po2-82* pco2-41 ph-7.22* total co2-18* base xs--10 intubated-intubated 05:56am lactate-1.5 05:56am freeca-0.99* 05:53am glucose-230* urea n-11 creat-0.5 sodium-137 potassium-4.4 chloride-116* total co2-15* anion gap-10 05:53am calcium-6.1* phosphate-2.4* magnesium-1.6 05:53am cortisol-25.7* 05:53am wbc-20.3* rbc-3.55* hgb-9.8* hct-30.6* mcv-86 mch-27.5 mchc-31.9 rdw-18.8* 05:53am hypochrom-2+ anisocyt-1+ poikilocy-1+ macrocyt-normal microcyt-1+ polychrom-normal ovalocyt-occasional burr-occasional teardrop-occasional 05:53am plt smr-very low plt count-76* 05:53am pt-16.3* ptt-25.8 inr(pt)-1.4* 03:21am type-art rates-/14 tidal vol-500 peep-5 o2-100 po2-181* pco2-41 ph-7.18* total co2-16* base xs--12 aado2-491 req o2-83 intubated-intubated vent-controlled 03:00am urine hours-random 03:00am urine gr hold-hold 03:00am urine color-straw appear-clear sp -1.009 03:00am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 02:04am lactate-1.4 01:50am glucose-261* urea n-9 creat-0.5 sodium-137 potassium-4.7 chloride-117* total co2-13* anion gap-12 01:50am estgfr-using this 01:50am alt(sgpt)-17 ast(sgot)-38 tot bili-1.9* 01:50am lipase-67* 01:50am albumin-2.7* calcium-5.7* phosphate-2.3* magnesium-1.4* 01:50am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-pos barbitrt-neg tricyclic-neg 01:50am wbc-18.2* rbc-3.81* hgb-10.3* hct-32.6* mcv-86 mch-27.1 mchc-31.7 rdw-18.7* 01:50am neuts-85.6* lymphs-8.7* monos-5.1 eos-0.3 basos-0.2 01:50am hypochrom-1+ anisocyt-1+ poikilocy-2+ macrocyt-normal microcyt-1+ polychrom-normal ovalocyt-occasional burr-2+ 01:50am plt count-150 01:50am pt-17.2* ptt-31.2 inr(pt)-1.5* other relevant labs: 10:23am blood hbsag-negative hbsab-positive hbcab-positive hav ab-positive 10:23am blood smooth-negative 10:23am blood -negative 02:45am blood wbc-6.6 lymph-17* abs -1122 cd3%-88 abs cd3-991 cd4%-39 abs cd4-440 cd8%-49 abs cd8-555 cd4/cd8-0.8* micro: blood cx- coag negative staph; no growth urine cx- no growth blood cx- no growth sputum source: induced. respiratory culture (final ): sparse growth commensal respiratory flora. pseudomonas aeruginosa. moderate growth. (pan sensitive) hiv-1 viral load/ultrasensitive (final ): hiv-1 rna detected, less than 48 copies/ml. clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. studies: duplex doppler abd u/s: right upper quadrant liver/gallbladder: the liver echotexture is coarse. this, and the inability of patient to hold his breath could obscure a focal lesion. the gallbladder is normal without evidence of stones. there is no intra- or extra-hepatic biliary ductal dilation. the common duct measures 5 mm. the kidneys are not well seen. the pancreas and aorta are obscured by bowel gas. the spleen is enlarged, measuring 15.4 cm. there is a small amountof ascites. doppler examination: doppler examination is limited as patient was unable to hold his breath due to the intubated status. the main, right anterior, right posterior, and left portal veins are patent, with forward flow. the right, left, and main hepatic arteries are patent with appropriate waveforms demonstrating sharp systolic upstroke and preserved flow through diastole. the right, middle, and left hepatic veins are patent with appropriate direction of flow. doppler evaluation of the ivc is limited. impression: 1. cirrhosis. 2. splenomegaly. 3. small amount of ascites. 4. limited assessment of the pancreas, aorta and kidneys. 5. normal doppler examination of the liver. cxr : greater opacification in the left lower lobe is probably worsened atelectasis. moderate-to-severe atelectasis in the right lower lung is stable or increased and small bilateral pleural effusions have increased as well. lung apices are clear. heart size is mildly enlarged, increased since the previous study. et tube in standard placement. cxr (s/p ngt placement): findings: as compared to the previous radiograph, the lung volumes have increased, likely to reflect an improved ventilation. unchanged size of the cardiac silhouette. minimal remnant retrocardiac atelectasis. normally positioned right-sided picc line. unremarkable course of the nasogastric tube, the tip of the tube is not visualized on the image. no pleural effusions. no focal parenchymal opacity suggesting pneumonia. . ct head- no evidence of acute intracranial abnormalities. . eeg- this eeg showed some low voltage patterns alternating with widespread alpha frequencies. overall, it suggested an encephalopathy with some medication effect. there were no areas of prominent focal slowing, but encephalopathies may obscure focal findings. there were no epileptiform features. on discharge: 05:57am blood wbc-3.5* rbc-3.27* hgb-9.3* hct-27.6* mcv-84 mch-28.5 mchc-33.8 rdw-18.3* plt ct-124* 05:57am blood pt-15.1* inr(pt)-1.3* 05:57am blood glucose-100 urean-7 creat-0.5 na-138 k-3.7 cl-111* hco3-22 angap-9 05:57am blood alt-21 ast-36 alkphos-137* totbili-0.5 brief hospital course: 56yo man with hiv, dm, h/o seizures, cad, etoh cirrhosis c/b esophageal varices initially presenting to osh with massive hematemesis variceal hemorrhage now s/p successful endoscopic banding transferred to for further management. # ugib/variceal bleed: per report, source of ugib felt to be variceal in nature from findings at endoscopy and hemostasis achieved with no further episodes of bleeding since banding on . passage of maroon stool (the reason for transfer) was felt to most likely represent blood in trasnsit from ugib rather than separate source. gi was consulted and recommended octreotide and ppi gtt; on was transitioned to daily ppi, octreotide drip d/c-ed on . repeat egd was not performed as patient did not have further episodes of variceal bleeding. patient received 5 days of ctx for sbp ppx. during icu course received 3 units of prbcs and 2 units ffp as there was some blood found in his ett. he was transferred out of the icu and his home nadolol was restarted and increased to 30 mg. he remained stable on the floor, with stable hct and no further episodes of bleeding. if the patient should rebleed in the future, it was felt that tips would be the next step in management. # hypotension: patient hypotensive on admission, likely secondary to hypovolemia and gib. blood pressure improved on arrival to icu and dopamine was weaned. as hemodynamics stabilized, patient became hypertensive and was restarted on his home enalopril, hctz, and nadolol with good pressure control. # etoh abuse c/b cirrhosis: at high risk for etoh withdrawal given positive level at osh, h/o seizures and reported daily use. pt received banana bag and was put on a ciwa scale. initially on fentanyl/versed for sedation while intubated, though was changed to propofol drip on . ngt placed on and tube feeds were started (the ngt was self d/c-ed on ). propofol shut off on and pt received valium only per ciwa protocol. ciwa was weaned. by the time of transfer to the floor patient was zero on ciwa. patient was started on lactulose secondary to altered mental status (see below). home nadolol dose was increased as above. social work was consulted and worked with the patient to find an appropriate rehab for alcohol abuse. he was instructed to follow up with his outpatient gastroenterologist dr. in , nh and schedule an egd to reassess his varices in the next 1-2 weeks. # hospital acquired pneumonia- patient developed hospital acquired pneumonia following extubation on . was treated with broad spectrum antibiotics and then coverage narrowed down to cefepime for 8 days to treat pan-sensitive pseudomonas. he required a brief period of reintubation () secondary to hypoxia and altered mental status (see below). on discharge, patient was breathing comfortably on room air and lung exam had cleared. # delirium- patient was noted to have altered mental status, with agitation requiring restraints. was noted to have left gaze deviation and neurology was consulted. recommended ct head (negative for acute process) and continuous eeg monitoring for seizures (drowsiness/mild encephelopathy, negative for seizures on and encephelopathy w/ some medication effect on ). patient was continued on his home keppra (has history of seizures). delirium was attributed to prolonged icu course, medications, and possible hepatic encephelopathy. he was started on lactulose, frequently reoriented, and symptoms gradually improved. he was alert and oriented x3 at the time of discharge. # diabetes: on insulin at home. was given glargine and humalog sliding scale while in house. # hiv: on haart. hiv vl was checked and was undetectable. cd4 count 440. patient was continued on his home atripla. # seizures: was continued on home keppra. was monitored on eeg with no epileptiform activity. # depression/anxiety: sertraline and seroquel were held while patient npo, but restarted once he was taking pos. medications on admission: - keppra 500mg po bid - gabapentin 300mg po bid - atripla - pravastatin 40mg po daily - protonix 40mg po daily - sertraline 150mg po daily - seroquel 25mg po bid - hctz 25mg po daily - nadolol 20mg po daily - enalapril 20mg po bid - novalog 70/30 10units daily discharge medications: 1. pravastatin 20 mg tablet sig: two (2) tablet po daily (daily). 2. sertraline 50 mg tablet sig: three (3) tablet po daily (daily). 3. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day). disp:*1000 ml(s)* refills:*2* 4. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). 5. nadolol 20 mg tablet sig: 1.5 tablets po daily (daily). 6. enalapril maleate 10 mg tablet sig: two (2) tablet po bid (2 times a day). 7. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. 8. quetiapine 25 mg tablet sig: one (1) tablet po bid (2 times a day). 9. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 10. gabapentin 300 mg capsule sig: one (1) capsule po twice a day. 11. efavirenz-emtricitabin-tenofov mg tablet sig: one (1) tablet po once a day. 12. insulin nph & regular human 100 unit/ml (70-30) suspension sig: ten (10) units subcutaneous once a day. 13. sucralfate 1 gram tablet sig: one (1) tablet po every six (6) hours. disp:*120 tablet(s)* refills:*0* discharge disposition: home with service facility: homecare discharge diagnosis: primary: alcoholic cirrhosis, complicated by esophageal varices alcohol abuse pneumonia delirium secondary: hiv diabetes mellitus seizure disorder htn hypercholesterolemia depression/anxiety discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you at the . you were admitted to the hospital because you were vomiting blood. you underwent endoscopy and banding of esophageal varices (enlarged blood vessels in your throat) at your local hospital in and were transferred here for further care. while you were here at the you were treated for a pneumonia and delirium. it is important that you stop drinking alcohol to prevent further damage to your liver and your health. you must also have a repeat upper endoscopy performed to evaluate your varices in the next 1-2 weeks- you can schedule that in or return here for this procedure as we discussed. please also follow up with your gastroenterologist in . we have made the following changes to your medications: - please increase your dose of nadolol to 30 mg daily - please start taking lactulose - please start taking sucralfate you may continue to take your other medications as you were previously. we wish you a speedy recovery. followup instructions: please schedule follow up with your outpatient gastroenterologist dr. . you will also need to have a repeat endoscopy performed to evaluate the status of your esophageal varices. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: acidosis toxic encephalopathy diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled alcoholic cirrhosis of liver dysthymic disorder acute respiratory failure pneumonitis due to inhalation of food or vomitus bacteremia long-term (current) use of insulin epilepsy, unspecified, without mention of intractable epilepsy esophageal varices in diseases classified elsewhere, with bleeding hepatic encephalopathy hypovolemia hyperosmolality and/or hypernatremia staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus ventilator associated pneumonia asymptomatic human immunodeficiency virus [hiv] infection status pseudomonas infection in conditions classified elsewhere and of unspecified site alcohol withdrawal 

Answer: The patient is high likely exposed to