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: ascites, clogged ng tube major surgical or invasive procedure: paracentesis x 5, placement of central line in left ij history of present illness: 52 m w/ hcv cirrhosis, stage i varices, vl 90k in , hx pv thrombosis, polysubstance abuse on methadone, who was previously on transplant list was admitted for evaluation of clogged nj tube. pt is malnurished and nj tube is for nutrition. he had a large volume paracentesis over 1 week ago (>6l) prior to screening colonoscopy (normal) and since then, he had not been taking good po's and the nj tube is clogged, resulting in fatigue. he also began to experience abdominal pain a couple of day prior to this admission. he denies f/c/nausea or vomiting/diarrhea. no melena. . on arrival to the floor, the patient's bp 70/p and he was hypothemic f oral, cold and clammy per report. no visible bleeding from below and guaiac negative. he was taken to the micu where the bp was found to be 98/76 and temp 97 rectal. guiac negative. per report, smelled like alcohol. past medical history: 1. hepatitis c cirrhosis diagnosed ten years ago. last viral load 90,700 in , ascites, status post a liver biopsy. 2. anxiety/depression. 3. polysubstance abuse. 4. history of arthroscopic knee surgery. 5. status post thoracentesis at . social history: the patient worked in a shipyard, former heavy alcohol, history of intravenous drug abuse, heroin, tobacco use. he reports now one cigarette per day with a fifteen pack year history. the patient is married and lives with his wife and son. family history: nc physical exam: pe: 97.0 84/49 79 94%ra 14 general: non-toxic, chronically ill, a&o x 2 (negative for place) heent: eomi, perrl, anicteric sclera, dry mm, nj tube in place. heart: rrr soft 2/6 sem, no rg lungs: clear abd: soft, distended, hypoactive bs ext: no edema, well perfused. neuro: asterixis. + horizontal nystagmus pertinent results: admission labs 11:15am wbc-12.4*# rbc-3.90* hgb-14.0 hct-40.3 mcv-103* mch-35.9* mchc-34.8 rdw-15.6* neuts-83* bands-6* lymphs-2* monos-9 eos-0 basos-0 atyps-0 metas-0 myelos-0 glucose-94 urea n-54* creat-2.3*# sodium-129* potassium-5.7* chloride-94* total co2-20* anion gap-21* albumin-2.6* calcium-8.8 phosphate-8.5*# magnesium-2.4 alt(sgpt)-50* ast(sgot)-84* ld(ldh)-225 alk phos-69 tot bili-9.1* lipase-11 . 03:23pm urine blood-lg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-sm urobilngn-4* ph-5.0 leuk-neg . ascites tot prot-1.6 glucose-82 ld(ldh)-125 albumin-less than 02:39pm ascites wbc-5250* hct-2.0* polys-95* lymphs-3* monos-2* . ct abd- 1. extremely limited study due to lack of intravenous contrast . massive ascites as seen previously. no evidence of bowel obstruction. marked cirrhosis and splenomegaly and evidence of portal hypertension. please note that evaluation of the liver lesions islimited. . cxr- there has been interval placement of ng tube with tip in the stomach. again seen are low lung volumes, however, the lungs are otherwise clear. the cardiac and mediastinal contours are stable, accounting for patient rotation. there has been no other significant interval change. brief hospital course: in the micu, the patient did not respond to fluid boluses and was placed on pressors. lactate was 6. he was found to have gram negative bacteremia with pan-sensitive klebsiella (2/4 bottles from ) and sbp also with klebsiella in bottles on . he was treated with ciprofloxacin and albumin. cxr unremarkable. he became hemodynamically stable and was taken off pressors on . he was noted to have large ascites on ct but team was only able to take off 0.5l fluid on due to clotting of paracentesis catheter. he was given albumin, platelets, and ffp post paracentesis. blood pressure has remained stable. hematocrit dropped from 29 on to 26 on , while it was 31 on admission. platelets have steadily declined from 61 on admission to 25 on . inr remained elevated around 2.0. renal failure improved from cr 2.7 to 0.7. lfts prominent for t bili of 9 ast/alt of 84/50. the patient was transferred to the floor on , and d/c home cmo on . # sepsis/hypotension: pt presented with a clogged ng tube as well as abdominal pain. his hypotension was likely secondary to a combination of dehydration and septic shock. he was found to be hypotensive, with elevated lactate. therefore he was given aggressive ivf's. a central line was placed and he was transiently started on dopamine. we held his nadolol. stimulation test demonstrated a cortisol level of 99, therefore he was not started on steroids and was quickly weaned off pressors. pressure slowly responded to this regimen. he was pan cultured and started on broad spectrum antibiotics. paracentesis and ascites laboratories were consistent with sbp. he grew out gram negative rods from both his ascitic fluid and blood. the cultures were positive for klebsiella, pan-sensitive. he was initially on ceftriaxone but this was changed to ciprofloxacin due to propensity for klebsiella to develop into esbl with 3rd generation cephalosporins. repeat paracentesis showed wbc trending down in fluid. ciprofloxacin was switched to po and the patient developed leukocytosis in both peripheral blood and ascitic fluid. he was put back on iv cipro, then on zosyn and vancomycin as ascitic fluid results became available. the next paracentesis showed fewer numbers of wbcs. the patient remained afebrile during these episodes, and his cxr showed only small lung volumes. antibiotics were d/c when he was made cmo on . . #abdominal pain: likely secondary to distention from large volume ascites and sbp. we continued him on lactulose and rifaximin and treated his sbp. in the micu we attempted a large therapuetic tap however was only able to drain 500cc due to the fibrous nature of the ascitic fluid and clogging of the tubing. however on the floor therapeutic taps yielded 5-6 liters regularly. ascitic fluid analysis with saag elevated at 2.6, ldh elevated at 125, and wbc 5250 with >90% neutrophils consistent with bacterial peritonitis. repeated paracentesis on with decrease in wbc to 3000 wbc but persistent left shift with >90% neutrophils. gnr in ascites fluid speciated as pan-sensitive klebsiella; continued to grow on peritoneal culture from . given pt's previous paracentesis 1 week prior to this admission and subsequent colonoscopy, there was a question of microperforation leading to secondary bacterial peritonitis (however, would have expected a polymicrobial infection in this case) vs. sbp. sbp was the most likely diagnosis. treated with vanc/zosyn on -> changed to ceftriaxone on -> cipro on . . #cirrhosis: he was initially on transplant list but was deactivated due to the severity of his illness and cachexia, as well as overall poor prognosis. he did not have gi bleeding. he was not severely encephalopathic. known portal vein thrombosis, grade i varicies and thrombocytopenia/coagulopahty. initially held his nadolol and diuretics in the setting of sepsis, but were able to restart after resuscitation. continued on lactulose and rifaximin. he received one unit of ffp and one unit of platelets on . . #arf: baseline cr of 0.7, peaked at 2.3 and subsequently returned to baseline. likely secondary to pre-renal state in sepsis and dehydration, as resolved with fluids. he did have urinary sodium less than 10 and developed hrs. he was put briefly on octreotide and midodrine, but these medications were d/c when he was made cmo on . he had low uop on so foley was placed with 250 cc uop. he was given albumin for volume expansion after each paracentesis. his renal function remained normal until discharge. . # h/o ivdu: he received methadone . . # pancytopenia: he had h/o thrombocytopenia and coagulopathy secondary to liver disease and splenomegaly. his hct remained stable throughout this hospitalization. . # fen: he was malnourished and cachectic; has had feeding tube in place as outpatient but tube was clogged on admission and was pulled in the icu. a nj was endoscopically placed on . tube feeds were poorly tolerated by the patient. he also maintained po intake . # ppx: pneumoboots, ppi, bowel regimen (lactulose) . # code: full code initially, changed to cmo, dnr-dni on according to the patient's wishes. . # dispo: home by ambulance with home hospice arranged, comfort measures only as arranged with wife and patient. medications on admission: 1. docusate sodium 100 mg capsule 2. rifaximin 400 mg tid 3. methadone 45 mg qd 4. alprazolam 0.5 mg 5. nadolol 20 mg qd 6. spironolactone 100 mg qd 7. furosemide 40 mg qd 8. lactulose 10 g/15 ml tid 9. omeprazole 20 mg qd 10. vitamin d 600mg discharge medications: 1. morphine concentrate 20 mg/ml solution sig: 2-20 mg po q 1 hr as needed for respiratory distress, pain. disp:*90 ml* refills:*0* 2. ativan 1 mg tablet sig: 0.5 - 2 tablet po every 4-6 hours as needed for anxiety, restlessness, nausea, vomiting. disp:*30 tablet(s)* refills:*0* 3. scopolamine base 1.5 mg patch 72 hr sig: one (1) patch transdermal every seventy-two (72) hours as needed for airway secretions. disp:*6 patch * refills:*0* 4. levsin/sl 0.125 mg tablet, sublingual sig: 1-2 tablets sublingual every 4-6 hours as needed for increased airway secretions. disp:*10 cc* refills:*0* discharge disposition: home with service facility: discharge diagnosis: primary diagnosis: sbp bacteremia acute renal failure end stage liver disease hypoxic respiratory failure . secondary diagnosis: cirrhosis hepatitis c anxiety/depression discharge condition: fair. being discharged home with hospice. currently on oxygen. discharge instructions: you were admitted and found to have sbp and acute renal failure. you were in the icu and were treated with medications to support your blood pressure and antibiotics to treat your infection. you were then transferred to the floor once you were stable. you underwent endoscopic placement of an njt for feeding. you also underwent multiple paracenteses to try to control your ascites, with minimal improvement. your ascites worsened to the point where it compromised your respiratory function. you discussed your status with dr. and decided to stop treatment and become comfort measures only. you were discharged home with hospice care. . please take all medications as advised by hospice. if you have any concerns about medications or symptoms, please call the hospice nurses. followup instructions: for any questions or concerns, please call your hospice nurse or dr. . procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage transfusion of other serum transfusion of platelets infusion of vasopressor agent diagnoses: acute and subacute necrosis of liver alcoholic cirrhosis of liver acute kidney failure, unspecified hepatorenal syndrome acquired coagulation factor deficiency other pulmonary insufficiency, not elsewhere classified severe sepsis other and unspecified alcohol dependence, in remission unspecified viral hepatitis c without hepatic coma other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure mechanical complication due to other implant and internal device, not elsewhere classified other septicemia due to gram-negative organisms dehydration nutritional marasmus other suppurative peritonitis portal vein thrombosis combinations of opioid type drug with any other drug dependence, in remission 

Answer: The patient is high likely exposed to