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: vitamin k attending: chief complaint: rml collapse, bilateral pneumonia major surgical or invasive procedure: large volume paracentesis diagnostic paracentesis hemodialysis history of present illness: 47m h/o esld alcohol abuse and hcv, esrd on hd, who presents after large volume paracentesis of 8l and dialysis in . treated with 12.5gx4 of albumin. pt had a cxr on with showed right middle lobe collapse. dr. (renal) has been unable to get in touch with him about this result. he was contact at dialysis yesterday and was directly admitted for w/u of pulmonary process. upon admission, patient was alert and oriented to person and hospital. however, as the evening progressed, he became more somnolent. patient later desatted on room air to 84-88%ra which went up to 96% on 6l face mask. abg was done. ph was 7.38, pco2 48, p02 of 62%. repeat cxr again demonstrated r middle lobe collapse, thought unlikely to be result of infectious process. patient was intially started on levaquin empirically, but after he decompensated, coverage was advanced to vanco, zosyn. sputum gram stain from was positive for 4+ gpcs in pairs and chains. past medical history: --gi/liver cirrhosis untreated hcv, alcohol abuse, not transplant candidate esophageal varices s/p banding h/o sbp --gu esrd on hd t/th/sat (from atn, hrs) --heme anemia of chronic disease --pulmonary asthma --neuro/psych depression schizotypal personality disorder social history: # personal: lives with wife. # substance abuse: denies current tobacco, etoh, or drug use. heavy etoh use in past, prior iv drug use in , but last reportedly . former smoker. family history: # no history of liver disease. # maternal aunt with dm. physical exam: physical exam on micu admission: general: difficult to arouse. sat up for lung exam. very drowsy. vitals: t 97 92/54 (78-103) 74 (62-74) rr 10 96% 6l heent: unable to cooperate w exam, perrl neck: no stiffness, no masses, no lad, 2+ carotid pulses, no bruits, no jvp elevation chest: lungs rhoncherous throughout. heart: rrr. s1s2, no murmurs/rubs/gallops back: no cva tenderness, no spinal tenderness. abdomen: soft, (?)nontender, distended. umbilical hernia and ventral hernia. normal bowel sounds. no guarding, no rebound. ext: tense edema to the knees bilaterally with some chronic venous stasis changes. neuro: aao x 2 (knows name and ). he was very somnolent and poorly attentive. moving all extremities, but not cooperative with exam. asterixis noted on hand grip. pertinent results: ****************salient admission labs cbc: wbc-8.7 rbc-2.84* hgb-10.1* hct-33.6* mcv-118* mch-35.5* mchc-30.0* rdw-19.4* plt ct-68* . coags: pt-20.2* ptt-40.7* inr(pt)-1.9* . chemistry: urean-51* creat-8.6* na-135 k-4.1 cl-97 hco3-27 angap-15 hapto-<20* . lfts: alt-34 ast-56* alkphos-155* totbili-5.8* albumin-2.4* ammonia-114* . afp-<1.0 . tox screen: asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg . ascitic fluid: wbc-125* rbc-65* polys-33* lymphs-8* monos-43* mesothe-2* macroph-14* . ***************subsequent in-hospitalization labs: peritoneal taps: 04:00pm ascites wbc-88* rbc-134* polys-1* lymphs-10* monos-55* mesothe-6* macroph-28* 03:21pm ascites wbc-25* rbc-7350* polys-38* lymphs-25* monos-31* mesothe-6* . ***************microbiology: 5:32 pm fluid received in blood culture bottles **final report ** aerobic bottle (final ): no growth. aerobic bottle (final ): no growth. **********all subsequent blood cultures were negative . 10:54 pm sputum source: expectorated. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 4+ (>10 per 1000x field): gram positive cocci. in pairs and chains. 2+ (1-5 per 1000x field): budding yeast with pseudohyphae. 1+ (<1 per 1000x field): gram positive rod(s). 1+ (<1 per 1000x field): gram negative rod(s). respiratory culture (final ): heavy growth oropharyngeal flora. enterobacter cloacae. sparse growth. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. enterobacter cloacae. rare growth. 2nd morphology. this organism may develop resistance to third generation cephalosporins during prolonged therapy. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. for serious infections, repeat culture and sensitivity testing may therefore be warranted if third generation cephalosporins were used. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterobacter cloacae | enterobacter cloacae | | cefepime-------------- 4 s 32 r ceftazidime----------- =>64 r =>64 r ceftriaxone----------- =>64 r =>64 r ciprofloxacin--------- =>4 r =>4 r gentamicin------------ <=1 s <=1 s imipenem-------------- <=1 s 4 s meropenem-------------<=0.25 s 1 s piperacillin---------- =>128 r =>128 r tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s . 11:02 am urine source: catheter. **final report ** legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. . 4:00 pm peritoneal fluid **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (final ): no growth. anaerobic culture (final ): no growth. . 10:58 pm stool consistency: soft source: stool. **final report ** clostridium difficile toxin assay (final ): feces negative for c. difficile toxin by eia. . 4:00 pm peritoneal fluid **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (final ): no growth. anaerobic culture (final ): no growth. . ********************studies: . admission chest xray (portable ap) 8:38 pm impression: developing right lower lobe infiltrate. follow-up to resolution is recommended. . ct trachea w/o c w/3d rend 3:57 pm impression: 1. extensive areas of bronchial wall thickening, peribronchial inflammation, ground-glass and centrilobular nodules, likely due to an acute infection spreading via the airways (e.g. viral or mycoplasma). focal subsegmental right middle lobe atelectasis is likely due to transient bronchial impaction. 2. anemia. 3. lower esophageal thickening most likely related to esophageal varices in a patient with known cirrhosis, although focal esophageal abnormality cannot be excluded given the lack of intravenous and oral contrast. 4. bilateral symmetric gynecomastia. 5. ascites and stigmata of cirrhosis. 6. bilateral anterior healing rib fractures . portable tte (complete) done at 3:01:26 pm impression: normal study. normal biventricular cavity sizes with preserved global and regional biventricular systolic function. no intracardiac shunt identified. compared with the prior (non-contrast) study of , the findings are similar. . cta chest w&w/o c&recons, non-coronary 5:12 pm impression: 1. no evidence of pulmonary embolus. 2. bilateral lower lobe collapse and some consolidation with atelectasis of inferior aspect of right middle lobe. 3. evidence of cirrhosis and gross ascites. 4. multiple anterior rib fractures. . chest (pa & lat) 4:34 pm impression: infiltrates are present within both the right and left lower lobes consistent with ongoing pneumonia. no failure is seen. the costophrenic angles are sharp. no effusion to layer on decubitus films. brief hospital course: 47m h/o decompensated liver failure who presented after routine large volume paracentesis with cough, leukocytosis, and sputum gs positive for gpcs and cxr showing right middle lobe collapse, and with encephalopathy. pt was transferred to the micu x2 with respiratory distress and worsening mental status during his hospitalization. his hospital course is detailed chronologically: . while in micu for first time for hypoxia (occurred at hd), he did not require intubation. a-line placed. his respiratory status slowly improved on abx and as ms improved. he underwent tte w/ bubble study, which showed no intracardiac shunt or evidence of hepatopulmonary syndrome to explain hypoxia. ef >55%. bld cx's ngtd. legionella urinary ag negative. his abx regimen was changed to levofloxacin (from vanc/zosyn). his 02 requirement improved to 2l nc from 6l face-mask. abg on am of transfer was 7.41/43/80. . was transferred back to floor on given clearing ms and improved hypoxia. 2l taken off at hd. spiked on day of transfer, also productive sputum. pt was switched back to vanc/zosyn. was 86% on 2l at hd. sats went up to 96% on fm. after this, pt improved again. plans were made to discharge soon with outpt hd to resume. sputum from came back with enterobacter. abx switched to iv meropenem. . on , dialysis was performed again. 0.5l were taken off. pt developed again sob and desaturations to 80% on 2l nc. also brief episode of sharp, retrosternal cp associated, lasting for 2 min, relieved by 1x sl nitro and sitting up (per pt only fleeting episode of cp, per intern as described). asa 325mg was given. pt was placed on 100% nrb with improvement of sats. ph 7.38/48/61 (100%nrb). pt was also tachy to 120s. ekg showed no significant changes except for sinus tach. cxr with no significant change to previous from . pt was transferred back to icu for closer o2 monitoring on nrb, also airway monitoring during planned cta to r/o pe and possible intubation should his respiratory status worsen further. cta demonstrated large bilateral collapsed lower lobes and consolidation with atelectasis of inferior aspect of right middle lobe. antitussives were discontinued, with plan to institute aggressive chest pt; pt continued on meropenem for enterobacter in sputum from sputum cx. pt's o2sats improved while in micu without intubation or any aggressive intervention, and given stable respiratory status, was deemed stable to transfer to floor again. . his floor course since has shown marked improvement. he did continue to have desaturations at hd. after close examination, the renal team deemed this to be an allergy to a component of his hd filter. via trial and error we discovered a new membrane that did not evoke an allergic response with desaturations at hemodialysis. this membrane will continue to be used at his outpatient hd. his sevelemer was increased to 1600mg tid with meals and he continued on his nephrocaps. . while on the floor (i.e. when not at hd) mr. continued to demonstrate an o2 requirement for some time. it was unclear what the patient's exact pulmonary process might have been (likely multifactorial), and which intervention ultimately improved his hypoxia. it was felt that given his pneumonia was a likely contributor, as his sats improved with a course of iv meropenem x 12 days. also considered a reactive airways component as pt with h/o asthma and intermittent wheezing on exam. pulmonary was consulted and recommended beginning advair and standing albuterol/atrovent nebs. pe and intracardiac shunt were ruled out. an lvp was performed as it was thought that patient's tense ascited might be causing some splinting. . by discharge he had been weaned off his oxygen and was stable at 92% on ra. when exercising with pt he maintained his o2 sats in the mid to low 90's. he was scheduled for outpatient pulmonary followup with pfts. . another complication of his floor course was a slow but steady hct drop in the setting of being guaiac positive. with a history of bleeding varices, liver was concerned and we pursued an inpatient egd, but mr. refused. he received a total of 2 units of prbcs with more than appropriate responses, and was always hemodynamically stable. as such liver felt that a semi-urgent outpatient egd could be arranged. he was scheduled for this by the time of discharge. . in terms of his liver disease, he underwent a 5 liter lvp and a subsequent diagnostic tap, and each were negative for sbp. the diagnostic tap was persued a rising white blood cell count (as high as 38,000). the leukocytosis was probably more reflective of his allergic reaction to repeated attempts at dialysis, as no source for infection was seen on cxr or blood culture, and he was c. diff negative x 1. he was continued on his liver regimen of nadolol, lactulose, and rifaximin. we continued prilosec for history of upper gi ulcer. he was never grossly encephalopathic but his mental status was slowed at times, which appears to be near his baseline. meld scores were in the 33-34 range (has been deemed not to be a transplant candidate in the past). . prophylactically, he was on a ppi for h/o gastric ulcer, pneumoboots, and lactulose for a bowel regimen. . code: full throughout. medications on admission: rifaximin 400 mg tid nadolol 20 mg daily lactulose 60 ml qid nephrocaps 1 daily thiamine 100 mg daily folic acid 1 mg daily sevelamer 800 mg tid w/meals prilosec 20 mg albuterol 1-2 puffs q4-6hours prn flovent 2 puffs sucralfate 1 gm qid discharge medications: 1. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). 2. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). 3. lactulose 10 gram/15 ml syrup sig: sixty (60) ml po qid (4 times a day). 4. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 5. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 6. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 7. sevelamer 800 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). disp:*180 tablet(s)* refills:*0* 8. prilosec 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 9. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). disp:*2 disk with device(s)* refills:*2* 10. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation every six (6) hours. disp:*1 inhaler* refills:*2* 11. ipratropium bromide 17 mcg/actuation aerosol sig: one (1) puff inhalation every four (4) hours. disp:*1 inhaler* refills:*2* discharge disposition: home discharge diagnosis: primary: bilateral enterobacter pneumonia . secondary: allergic reaction to dialysis filter hepatic encephalopathy cirrhosis, end stage renal disease discharge condition: stable, without oxygen requirement, afebrile discharge instructions: you were admitted to the hospital with a pneumonia. you required oxygen and spent some time in the intensive care unit for closer monitoring. you received iv antibiotics in the hospital and slowly improved, requiring less oxygen. you do not need to take any more antibiotics while you are at home. you have a follow-up appointment scheduled with the pulmonary (lung) doctors as detailed below. . it also appear that you have developed an allergy to certain dialysis filters and membranes. as a result, the kidney doctors worked to find you a suitable replacement filter which you can use as an outpatient without developing an allergic reaction. this new filter will be available beginning at your first outpatient dialysis appointment, which is scheduled for this thursday . . while you were in the hospital your blood counts began to drop, and it appeared that you were slowly losing blood through your gi tract. you received several blood transfusions. the liver team recommended an upper endoscopy to look inside your stomach for a source of bleeding, but your refused this study as an inpatient. we strongly recommend that you have this study performed promptly as an outpatient. you have an appointment for this as detailed below. . you will be taking a new asthma medicine called advair, as well as 2 inhalers (albuterol and ipratropium). please take your medications as prescribed unless otherwise directed by your physician. . you should follow up with your primary care doctor, dr , within 1-2 weeks. please continue to keep your outpatient hemodialysis and all other appointments. . please return to the emergency room if you develop any worrisome symptoms such as bleeding from the rectum, shortness of breath, fever, chills, or chest pain. followup instructions: you have an appointment to follow up with the pulmonary team as follows: provider: function lab phone: date/time: 1:30 provider: ,interpret w/lab no check-in intepretation billing date/time: 1:30 provider: breathing test phone: date/time: 3:10 . you have an appointment to follow up with the gi team for your upper endoscopy as follows. please arrive at 12:30 for your appointment: provider: west,room one gi rooms date/time: 1:30 provider: , md phone: date/time: 12:30 . provider: , md phone: date/time: 11:00 . please follow up with your pcp . within 1-2 weeks. provider: , md phone: date/time: 4:00 procedure: hemodialysis percutaneous abdominal drainage percutaneous abdominal drainage arterial catheterization transfusion of other serum transfusion of coagulation factors diagnoses: anemia in chronic kidney disease end stage renal disease pneumonia due to other gram-negative bacteria acute and subacute necrosis of liver chronic hepatitis c with hepatic coma alcoholic cirrhosis of liver acquired coagulation factor deficiency other pulmonary insufficiency, not elsewhere classified iron deficiency anemia secondary to blood loss (chronic) depressive disorder, not elsewhere classified pulmonary collapse other ascites kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure asthma, unspecified type, with (acute) exacerbation nutritional marasmus unspecified adverse effect of other drug, medicinal and biological substance 

Answer: The patient is high likely exposed to