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: fenofibrate attending: chief complaint: nausea and vomiting major surgical or invasive procedure: upper endoscopy gastric emptying study history of present illness: 66 yo m pmh cirrhosis s/p olt , s/p hernia repair , recently admitted with gastroenteritis who now presents with nausea and vomiting for the past two days. he reports vomiting "hundreds" of times per day, mostly dry heaving. po intake has been very little. no bm x 4 days. he is passing gas. he did notice some abd distension over the past few days which has improved. he has been having constant diffuse abd pain since hernia repair. in addition, he has had some chills but no fevers. . in the emergency department initial vitals were t: 97 hr: 88 bp:167/125 rr:18. chm7 demonstrated arf with cr 8.1. k was 5.6. no peaked t's on ecg. pressure dropped suddently to 70's and he got another 4l ivf. pressure came up to the 100's systolic. pressure then dropped after 6th bag ivf to 70's again. rij placed and levophed started. renal consult team and hepatology made aware. . in the icu, pt reports nausea slightly improved after getting zofran. reports that he has felt "winded" the past few days, though no chest pain. no other complaints. . review of systems: (+)ve: (-)ve: fever, chest pain, palpitations, rhinorrhea, nasal congestion, cough, sputum production, hemoptysis, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, diarrhea, constipation, hematochezia, melena, dysuria, urinary frequency, urinary urgency, focal numbness, focal weakness, myalgias, arthralgias past medical history: olt liver cirrhosis followed at by the team anemia hepato-renal syndrome left incision hernia repair with mesh . social history: lives alone, was a drinker until , non-smoker. states he is a retired teacher (ap chem and physics teacher). healthcare proxy: . dr. is his pcp. gi doctor is dr. . family history: sister died of pancreatic cancer physical exam: tmax: 37.2 ??????c (99 ??????f) tcurrent: 37.2 ??????c (99 ??????f) hr: 100 bp: 106/77(95) {106/77(85) - 131/93(102)} mmhg rr: 24 (12 - 27) insp/min spo2: 100% heart rhythm: st (sinus tachycardia) gen: pleasant, nad heent: nc/at, perrl, mmm, op clear pulm: ctab, no wheezes or crackles card: regular, no m/r/g, +s1, s2 abd: soft, non-tender, non-distended, well healed triangular scar ext: no le edema neuro: no gross deficits,5/5 strength in all 4 ext pertinent results: i. labs a. admission 12:55pm blood wbc-8.9 rbc-4.04* hgb-12.6* hct-39.2* mcv-97 mch-31.2 mchc-32.1 rdw-16.7* plt ct-178 12:55pm blood neuts-92.4* lymphs-3.7* monos-3.6 eos-0.1 baso-0.1 12:55pm blood pt-12.8 ptt-25.3 inr(pt)-1.1 12:55pm blood glucose-317* urean-81* creat-8.1*# na-133 k-5.6* cl-101 hco3-10* angap-28* 12:55pm blood alt-10 ast-11 alkphos-85 totbili-0.1 12:55pm blood lipase-18 05:15pm blood calcium-6.9* phos-6.6*# mg-1.4* 12:55pm blood albumin-4.0 05:15pm blood acetone-moderate osmolal-313* 05:54am blood pth-167* 05:15pm blood cortsol-31.2* 12:55pm blood tacrofk-10.4 04:24pm blood ph-7.03* comment-green top 08:15pm blood po2-142* pco2-22* ph-7.11* caltco2-7* base xs--21 04:24pm blood lactate-1.3 05:37pm blood glucose-191* lactate-1.5 na-138 k-5.2 cl-117* calhco3-9* 05:37pm blood hgb-11.0* calchct-33 12:02pm blood freeca-0.95* b. urine 04:20pm urine color-yellow appear-clear sp -1.016 04:20pm urine blood-neg nitrite-neg protein-75 glucose-neg ketone-tr bilirub-sm urobiln-neg ph-5.0 leuks-neg 04:20pm urine rbc-0-2 wbc-0-2 bacteri-occ yeast-none epi-0-2 05:30pm urine hours-random creat-481 na-11 k-29 cl-22 totprot-42 prot/cr-0.1 ii. microbiology mrsa screen mrsa screen- negative blood culture blood culture, routine-negative blood culture blood culture, routine-negative urine urine culture-final {staphylococcus, coagulase negative} iii. radiology a. cxr () history: right ij placement. findings: in comparison with the study of , there has been placement of a right ij catheter that extends to the mid portion of the svc. no evidence of pneumothorax. continued opacification at the left base consistent with atelectasis and effusion. b. kub () impression: 1. nonspecific bowel gas pattern with no evidence to suggest ileus or obstruction. 2. chronic unchanged left lower lung lobe atelectasis. c. renal us () impression: no evidence of renal obstruction, thinning of the right renal cortex, likely chronic. three biopsies - pathology pending, viral studies pending viral culture: r/o cytomegalovirus-preliminary; varicella-zoster culture-preliminary; viral culture: r/o herpes simplex virus-preliminary gastric emptying study: patient consumed: egg beaters: 90% water: 100% toast: 100% jelly: 100% immediately following the oral ingestion of the radio-labeled meal, the patient was placed supine in the gamma camera. continuous anterior and posterior images of tracer activity in the stomach and bowel were recorded for 45 minutes. delayed anterior and posterior images were obtained at 2, and 3 hours. residual tracer activity in the stomach is as follows: at 45 mins 65% of the ingested activity remains in the stomach at 2 hours 26% of the ingested activity remains in the stomach at 3 hours 6% of the ingested activity remains in the stomach discharge labs: 07:40am blood wbc-3.7* rbc-2.61* hgb-8.5* hct-24.6* mcv-94 mch-32.5* mchc-34.6 rdw-16.4* plt ct-109* 07:40am blood glucose-124* urean-18 creat-1.8* na-140 k-4.7 cl-109* hco3-25 angap-11 07:40am blood calcium-8.1* phos-2.3* mg-1.8 07:40am blood tacrofk-14.6 brief hospital course: 66 yo m pmh cirrhosis, s/p olt, s/p hernia repair who presented with nausea and vomiting, initially admitted to the micu with hypotension and acute on chronic renal failure, that both resolved by discharge. . # nausea/vomiting - had egd which showed ulcerative esophagitis, gastritis, and duodenitis. biopsy and viral cultures pending at time of discharge. started on pantoprazole, no more episodes of vomiting as inpatient. tolerated pos well. gastric emptying study was normal and showed no evidence of gastroesophageal reflux. . #. hypotension: likely related to volume depletion in setting of intractable vomiting and little po intake. no clear source of infection given afebrile, nl wbc ct, nl cxr, benign ua. antibiotics were not initiated. bp returned to with aggressive ivf administration, and remained hemodynamically stable. blood cultures and urine cultures negative. random cortisol level was normal. . #.metabolic acidosis: likely related to acute on chronic renal failure and starvation ketoacidosis. lactate was normal. patient was initially started on insulin gtt and d5 gtt out of concern for diabetic ketoacidosis. received bicarb in unit and anion gap resolved by the time of transfer to floor. . # acute on chronic renal failure: likely pre-renal etiology in setting of vomiting and low po intake past few days. fena was 0.1%. cr improved to baseline with ivf administration. renal ultrasound negative for obstruction. hctz was held because of , should be discussed with pcp regarding restarting. . #. s/p liver : per , tacrolimus initially held and home myfortic was changed to mmf iv. subsequently, tacrolimus and myfortic were re-started (iv mmf d/c'd). per surgery, discharged home on tacrolimus 2mg po bid. follow-up labs should be checked on thursday and should be faxed to the surgery clinic to dr. . pending studies - egd biopsy results and viral studies - restarting hctz medications on admission: 1. myfortic 180mg 2. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 3. sulfamethoxazole-trimethoprim 400-80 mg tablet : one (1) tablet po every other day (every other day). 4. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 5. tacrolimus 1 mg capsule : three (3) capsule po q12h (every 12 hours). 6. ferrous sulfate 300 mg (60 mg iron) tablet : one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 7. nph insulin human recomb 100 unit/ml suspension : fourteen (14) units subcutaneous once a day. 8. lopressor 50 mg tablet : one (1) tablet po twice a day. 9. pravastatin 20 mg tablet : one (1) tablet po once a day. 10. insulin regular human 100 unit/ml solution : follow sliding scale injection four times a day. 11. hydrochlorothiazide 12.5 mg tablet : one (1) tablet po once a day: resume on sunday. 12. nph insulin human recomb 100 unit/ml suspension : eight (8) units subcutaneous pm. 13. calcium carbonate-vitamin d3 600-400 mg-unit tablet : one (1) tablet po twice a day. 14. tricor 145 mg tablet : one (1) tablet po once a day: no substitution generic causes diarrhea. 15. lisinopril 5 mg tablet : one (1) tablet po once a day. 16. lamivudine 100 mg tablet : 0.5 tablet po once a day. . discharge medications: 1. mycophenolate sodium 180 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po bid (2 times a day). 2. sulfamethoxazole-trimethoprim 400-80 mg tablet : one (1) tablet po every other day (every other day). 3. aspirin 81 mg tablet : one (1) tablet po once a day. 4. tacrolimus 0.5 mg capsule : two (2) capsule po q12h (every 12 hours). 5. ferrous sulfate 300 mg (60 mg iron) tablet : one (1) tablet po daily (daily). 6. lamivudine 10 mg/ml solution : fifty (50) mg po daily (daily). 7. lisinopril 5 mg tablet : one (1) tablet po once a day. 8. tricor 145 mg tablet : one (1) tablet po once a day. 9. vitamin d-3 400 unit tablet, chewable : one (1) tablet, chewable po twice a day. 10. calcium carbonate 600 mg (1,500 mg) tablet : one (1) tablet po twice a day. 11. insulin nph & regular human 100 unit/ml (70-30) cartridge : fourteen (14) units subcutaneous once a day. 12. insulin nph & regular human 100 unit/ml (70-30) cartridge : eight (8) units subcutaneous qpm. 13. insulin regular human 100 unit/ml cartridge : see below units injection qachs: please resume prior sliding scale. 14. pravastatin 20 mg tablet : one (1) tablet po once a day. 15. lopressor 50 mg tablet : one (1) tablet po twice a day. 16. pantoprazole 40 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 17. outpatient lab work please check chem 7 and tacrolimus level on and fax results to surgery center . discharge disposition: home discharge diagnosis: primary diagnosis: acute renal failure metabolic acidosis hypotension secondary diagnosis: s/p liver 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 caring for you in the hospital. you were admitted to the icu with nausea and vomiting. you had a low blood pressure requiring blood pressure medications to bring it up. and you had damage to your kidneys from severe dehydration which has returned to its baseline function. you had an endoscopy that showed gastritis, esophagitis, and duodenitis. and gastric emptying study done that showed normal movement of your stomach. the following changes were made to your medications: we added: pantoprazole 40mg po every 12 hours we changed: tacrolimus to 2mg twice daily we stopped: hydrochlorthiazide - you should talk to your primary care physician about restarting this at your next appointment lansoprazole - you do not need this medication while you are taking pantoprazole followup instructions: please make an appointment to follow up with your liver doctors and your primary care doctor in the next 2 weeks. department: digestive disease center when: tuesday at 7:30 am with: , md building: building (/ complex) campus: east best parking: main garage department: endo suites when: tuesday at 7:30 am provider: , md ( surgeon) phone: date/time: 10:30 procedure: venous catheterization, not elsewhere classified esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: acidosis diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified chronic kidney disease, unspecified hypotension, unspecified long-term (current) use of insulin duodenitis, without mention of hemorrhage dehydration liver replaced by transplant unspecified gastritis and gastroduodenitis, without mention of hemorrhage other esophagitis 

Answer: The patient is high likely exposed to