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: adbominal pain, bloody diarrhea major surgical or invasive procedure: sigmoidoscopy with rectal biopsies paracentesis total abdominal colectomy with end ileostomy on history of present illness: 48f with cirrhosis on transplant list, hx ulcerative colitis, transferred from osh where she was being treated for suspected flare of ulcerative colitis with c difficile positive stool. she has had nonbloody diarrhea since when she received an nj tube to improve her nutritional status related to decompensated cirrhosis. the nj tube was removed in because she tolerated it poorly and was not gaining weight as intended. she presented to her pcp in early , again for diarrhea and weight loss, and due to a high wbc count noted on labs was referred to osh er and subsequently hospitalized for acute cholangitis and an ulcerative colitis flare, and treated with zosyn and ertapenem and steroid enemas. she was discharged on , but re-presented to the osh on with abdominal pain, nausea, vomiting, and six bowel movements per day. she was unable to hold steroid enemas and stopped using them three days prior to admission. in the ed at osh, ct scan showed diffuse colitis with ileal involvement. she was admitted and treated with iv fluids, flagyl 500 tid, mesalamine mg , rectal mesalamine, pantoprazole, oral vancomycin 500 mg q6h, rectal vancomycin 500 q6h. her wbc count initially responded, decreasing from 20.3 on admission to 10.2, but on the morning of transfer it was again elevated to 18.6. her stools became bloody on . she was hypotensive with concern for low urine output (both of unspecified degree), and according to records received 4l of ns without improvement in bp but with abdominal distension. a cvl was placed and she was transferred to the osh micu and a central venous catheter was inserted. she was given 750 mg albumin, and 15 mg vitamin k for coagulopathy. labs on the morning of discharge from osh include: wbc 18.6, hct 38.2, platelets 352, bun 3, cr 0.56, ast 31, alt 17, alk phos 392, albumin 1.5, and tbili 1.1. on admission, the patient felt cold and complained of diffuse abdominal pain greater on the right of her belly. her nausea and vomiting had improved, although she had been given zofran at osh. she denies sick contacts. feels that her legs are swollen above. denies cough, sob, cp. past medical history: esld due to primary sclerosing cholangitis diagnosed in according to daughter, with recent decompensation in the past 12 months, including portal hypertension, hyperbilirubinemia, hypoalbuminemia, coagulopathy, and hepatic encephalopathy; required nj feeding tube for malnutrition with subsequent improvement. per and osh records, she has had recurrent ulcerative colitis episodes since , and recurrent c difficile infections since , although her daughter claims that the first c difficile infection was in at which time she says ulcerative colitis was first diagnosed on colonoscopy. past surgical history: denies. social history: lives with sister and sister's family in . denies tobacco, alcohol, or drugs. family history: (from omr and patient) mrs. is one of 7 siblings. she was born in , and her family fled to in . they lived in a refugee camp until when they left for the for 3 months, then eventually coming to the us directly to ri to live with her sister. since leaving , she's travelled to once, , and , , , and in the us. she's also been through the caribbean, but on a cruise ship with minimal on-shore time. physical exam: vs: 97.7f, 102, 101/73, 99% on 2l - general: tired appearing but in no acute distress, alert, oriented x3 - heent: normocephalic, atraumatic; perrl, eomi, sclera hazy but not icteric; oral mucosa moist; neck midline and supple without masses; no cervical, supraclavicular, or axillary lymphadenopathy - cv: tachycardic, no m/r/g - resp: ctab anteriorly, no respiratory distress - abd: rare bs, diffuse tenderness greater on the right uq and lq, minimal guarding, no masses, minimal distension - rectal: rectal tube in place draining slightly blood-tinged watery stool - ext: swelling with trace edema of the bilateral thighs, pressures stockings in place on bilateral lower extremities without edema, 2+ dp pulses bilaterally, all extremities wwp discharge: expired pertinent results: 06:23pm wbc-10.3 rbc-2.99* hgb-8.3* hct-26.9* mcv-90 mch-27.7 mchc-30.8* rdw-17.8* 06:23pm neuts-82.1* lymphs-11.8* monos-1.8* eos-4.1* basos-0.2 06:23pm plt count-191# 06:23pm pt-17.6* ptt-39.5* inr(pt)-1.6* 06:23pm glucose-128* urea n-3* creat-0.5 sodium-142 potassium-3.3 chloride-116* total co2-16* anion gap-13 06:23pm alt(sgpt)-13 ast(sgot)-22 ld(ldh)-97 alk phos-272* amylase-19 tot bili-3.1* 06:23pm lipase-14 pertinent results imaging: ruq u/s : 1. coarsened liver echotexture with ascites and splenomegaly, consistent with sequelae of portal hypertension. normal doppler study. 2. segmental intrahepatic biliary dilatation in the right and left hepatic lobes, consistent with diagnosis of primary sclerosing cholangitis. the degree of intrahepatic ductal dilatation on the left is mildly improved when compared to . 3. bilateral pleural effusions. ct abdomen : impression: 1. bilateral pleural effusions with adjacent compressive atelectasis. 2. hepatic cirrhosis with evidence of portal hypertension. 3. dilated intrahepatic biliary system with evidence of stricturing, consistent with provided history of primary sclerosing cholangitis. 4. worsening ascites and anasarca. 5. a haustral and featureless appearing colon consistent with provided history of ulcerative colitis. 6. bowel wall edema involving the colon, which can be either due to portal hypertension, colitis from either ulcerative colitis, or c. diff colitis. kub : impression: no evidence of megacolon. ct abdomen : impression: 1. interval decrease in bilateral pleural effusions with adjacent compressive atelectasis. 2. liver cirrhosis with evidence of portal hypertension as seen on prior. 3. mild interval worsening of the intrahepatic biliary dilation; correlate with lfts. evidence of stricturing and beading consistent with history of primary sclerosing cholangitis. 4. persistent anasarca. moderate ascites, with interval increase in size compared to prior. 5. ahaustral featureless colon in keeping with history of ulcerative colitis. diffuse colonic wall edema, appears more than typically seen in third spacing, may be related to history of ulcerative colitis or colitis of other etiology. 6. geographic regions of hyperemia in the liver may be perfusional in nature or might be related to cholangitis. 7. calcified focus, presumably gallstone, remains lodged without change in the cystic duct as on the prior ct examinations. rectal biopsy : rectum: chronic active colitis with ulceration (see note). note: no granulomas or dysplasia identified. the findings are not characteristic of ischemic colitis. no definitive cmv staining is seen. controls satisfactory. biopsy : 1. colon biopsies: a. descending colon: chronic mildly active colitis. b. sigmoid colon: chronic inactive colitis. c. rectum: chronic severely active colitis with ulceration. note: no granulomata or dysplasia identified. immunohistochemical stains are negative for cytomegalovirus on all biopsies; controls are adequate. sigmoidoscopies impression:loss of vascularity, erythema, congestion, ulceration and exudates in the rectum and distal sigmoid colon compatible with colitis (biopsy) otherwise normal sigmoidoscopy to distal sigmoid colon. : ulceration, granularity, friability, erythema, congestion and loss of the normal vascular pattern in the entire visualized segments of the colon. (biopsy) otherwise normal sigmoidoscopy to splenic flexure : improvement in colitis as compared to previous flex sig. 03:53am blood wbc-35.7*# rbc-3.01* hgb-10.2* hct-30.5* mcv-101* mch-33.8* mchc-33.4 rdw-24.7* plt ct-431 05:52pm blood neuts-96* bands-0 lymphs-3* monos-1* eos-0 baso-0 atyps-0 metas-0 myelos-0 05:52pm blood hypochr-normal anisocy-3+ poiklo-1+ macrocy-3+ microcy-1+ polychr-normal target-1+ burr-occasional tear dr 05:52pm blood pt-15.4* ptt-43.9* inr(pt)-1.4* 04:00pm blood glucose-86 urean-38* creat-0.9 na-139 k-3.4 cl-98 hco3-28 angap-16 03:53am blood ctropnt-0.01 05:52pm blood ck-mb-2 ctropnt-0.02* 04:00pm blood calcium-9.2 phos-2.5* mg-2.2 brief hospital course: ms is a 48 yo cambodian woman with a pmh of ulcerative colitis and primary sclerosing colangitis with cirrhosis currently on the liver transplant list who was transferred from an outside hospital with cdiff pancolitis as well as ulcerative colitis flare. leukocytosis/fevers: throughout ms. admission, her wbc were waxing and ranging from 10k-28k. unclear etiology. pt has remained afebrile and infectious workup (bcx, ucx, c. diff, cxr, biliary cultures, peritoneal fluid cultures) have been repeatedly negative. paracentesis was consistent with sbp on , but all prior paracenteses were inconsistent. she was given 3 doses of cefazolin and flagyl immediately post op from her tac. ms. became febrile on pod 7, and was started on vanc/zosyn and was transferred tto the unit for encephalopathy and tachycardia attributed to an infection. eventually after 7 days of antibiotics and a lack of change in her clinical status, antibiotics were discontinued and she was called out to the floor. she immediately became febrile, tachcardic with low sbps 80's-90's, and returned to the sicu. she was restarted on vanc/zosyn and stabilized. she was transferred to the floor the next day where antibiotics were continued, but continued to have low grade (99-100.5f) daily. repeat urine cultures demonstrated yeast, and in light of recalcitrant fevers micafungin was continued. during her second week on the floor a trial off antibiotics was attempted, and ms. developed higher grade (101-102f) fevers and vanc/zosyn were restarted on . upon transfer to , all cultures remained negative. per id recs vanc/zosyn were discontinued due to prolonged exposure meropenem was started. also a trial of methylprednisone was instituted with the suspicion of a possible crohns fare causing her abdominal pain and prior noted intestinal ulcers. ileoscopy was performed on and . biopsy of ulceration from was negative for cmv and afb smears. ileoscopy showed what looked like bowel ischemia, but mra abdomen was negative. the patient continued to spike temperatures, with unclear etiology. . after a goals of care discussion with the patient's daughter and sister, it was decided to make her dnr. she was ultimately made dnr and cmo, and all antibiotic therapy was stopped. . c.diff pancolitis- patient had evidence of positive c diff toxin at the osh, but all were negative here at . given this history she was treated with a 14 day course of po and rectal vancomycin and iv metronidazole. she was also covered empirically for sbp with cefepmine on arrival. although pt continued to have loose stool and high ileostomy output, her multiple c diff stool toxin tests have remained negative during this admission including those sent after the total abdominal colectomy. the patient continued to have high ostomy stool output and was continued on octreotide to help with her diarrhea. ultimately, the patient was made dnr and cmo and the goal was to treat her abdominal pain. . inflammatory bowel given pt's continued diarrhea and history of uc flares, pt had a sigmoidoscopy on showing friability and ulceration consistent w/ uc flare. rectal biopsies were also consistent w/ colitis. she was made npo and was started on iv solumedrol, with some response in her crp. after about a week of treatment she underwent a repeat sigmoidoscopy, which showed some improvement. pt was continued on iv solumedrol and started on cyclosporine to increase immunosuppression. her third flex sig showed some improvememnt in the colitis and she was transitioned to po prednisone and po cyclosporine. she originally was having >1l of diarrhea per day which reduced down to ~600ml daily. however, pt continued to have significant abdominal pain in intensity. given her lack of significant clinical improvement, very high inflammatory markers ( crp 107 and esr 90), gi recommended consulting colorectal surgery for possible colectomy. pt was discussed at length with multiple teams, and pt understand high operative risk but wants to proceed. pt had her tac with end ileostomy on . intra-op she had 3l of ascitic fluid taken off. she was then transferred to the colorectal service for postoperative care at this point. she was brought to the icu intubated post-operatively and was extubated on pod 0 without issue. she was continued on hydrocortisone 100mg q8 and cyclosporine. on pod1 she was noted to have a hct drop to 21.3 and was transfused 2urbc with a hct bump to 29 and was otherwise doing well. ostomy consult was initiated. she was noted to have continued tenderness to palpation. on pod 2 her t bili was up to 12 with a meld score of 17. she was doing well respiratory wise and was continued on a 3 day steroid taper. patient was given tpn for nutrition. on pod 3 tpn was continued, her abdominal pain persisted, her jp drain continued to have high output, and her ostomy only had sweat. her bilirubin began trending down at this point. her jp output was repleted with a combination of albumin and normal saline. ostomy site looked pink but without output at this point and she was tolerating small sips. she was noted to have bilateral pedal edema. on pod4 she continued to have jp output and was repleted for this. her ostomy continued to look good but only scant output. she was transitioned to a prednisone taper. by pdo 6 her jp continued to have high output as did her ostomy. she was actively repleted at this point. the patient's fluid balance proved difficult to manage as she had very high ileostomy output as well as high output of acities from the jp drain site. this was managed as needed with boluses of iv albumin, 1/2ns or ns, and tpn. the jp drain was removed from the abdomen after two weeks and the midline surgical incision as well as ileostomy site showed no sign of drainage of aicties. the patient was seen by the gastroenterology service after having almost 4 liters of ileostomy output and a ct scan which showed thickening in the small bowel without showing signs of improvment with metamucil wafers, she remained npo, high dose imodium, and tincture of opium. the patient was started on subcutaneous octreotide which had some affect on the output. on the dose of imodium was titrated up and she continued to show improvement. her elctrolytes were monitored closely throughout this time and she was repleated as necissary. at the time of transfer from the colorectal surgery service to hepatology, the patient's midline incision was closed and intact with staples and ileostomy was pink and draining liquid green stool. given consistently high ostomy output, crohn's disease was entertained as an etiology. post-operatively, ms. d significant output from her jejunostomy 2-3l daily which persisted despite tincture of opium and octreotide. fluids were repleted with 5% albumin. jejunal biopsy from demonstrated an ulceration which was negative for bacteria, cmv, and afb upon smear. ileoscopy from demonstrated ischemia, but mra abdomen was normal. . # psc/cirrhosis- patient has history of psc and has cirrhosis and is on the liver transplant list. she is childs class b and felt to have a poor outcome prognostically for having a colectomy, but after extensive discussions with gi, liver, transplant and colorectal surgery teams as well as with the patient, pt was taken for colectomy on (see above). her lfts slowly worsened during her admission with ast 20s and alt 10s, ap 200-300s, total bili worsening to ast 40s-80s, alt 30s-50s, ap 400-800, total bili 7-9s. meld score ~13-15. pt continued to have significant lower extremity edema and ascites, requiring multiple therapeutic taps, and albumin. . bilirubinemia: ms. total bilirubin (direct predominant) remained elevated at 6-10 through her stay, elevated from 3 on admission. the differential include progression of psc or cholangitis. the bilirubinemia did not improve significantly with antibiotic therapy or with ptc which was performed by ir on . the patient continued to spike fevers, and towards the end of started having increasing bilis, and it was thought that the biliary drain was obstructed; however, an ir study showed that it was patent. the patient's drain was ultimately pulled when she was made cmo. . pain management: ms. complained of diffuse pain worse in abdomen and proximal lle secondary to cutaneous zoster vs. ibd. pain management was consulted, and this pain improved but was not completely eliminated by tid gabapentin, qhs nortryptiline, fentanyl 75mcg/hr, and prn iv dilaudid (approximately 30mg daily). after goals of care discussion with family, the patient was made cmo and pall care and pain management were both following the patient. . derm: on the patient developed a vesicular rash over her right groin and thigh. this closely resembled herpes zoster. dermatology was consulted for recommendatons in this very complicated patient. the patient applied cool compresses to the rash for comfort. ms. was treated with a 10 day course of acyclovir. these zoster lesions crusted over by late . . cmv viremia: initially elevated on to 2040 and ms. was started on twice daily ganciclovir. subsequent cmv titres were negative, and ms. was decreased to daily dosing of gancyclovir on . she was then maintained on maintenance gancyclovir. . nutrition: the patient's nutrition labs were monitored closely during her inpatient stay. her nutrition status was maintained initially on tpn, but given concern for sepsis, tpn was discontinued. a dobhoff was placed while she was in the sicu and tube feeds were given at 70 cc/hr. . gi bleeding: transferred to micu on for hemodynamic monitoring from bloody ostomy output. concerned for ischemia so went to ir for contrast injection but everything patent. got 5mg vitamin k for inr of 1.9 and 2 units prbcs. developed chest pain; cxr showed pulmonary edema, patient given 40mg iv lasix. cardiac enzymes negative. responded well to diuresis. ostomy put out brown stool with no evidence of frank blood overnight. hct did not change much to transfusion. pt was stable so transferred to service. . the patient was ultimately made dnr and eventually cmo after ongoing discussions with her family. she expired overnight . post mortem examination was requested. medications on admission: metronidazole (flagyl) 500 mg iv q8h ondansetron 4 mg iv q8h:prn nausea folic acid 1 mg po/ng daily pantoprazole 40 mg iv q24h heparin 5000 unit sc tid lactinex *nf* (lactobacillus acidoph & bulgar) 1 million cell oral mesalamine dr 1200 mg po tid vancomycin oral liquid 500 mg po/ng q6h vancomycin enema 500 mg pr mesalamine (rectal) 4000 mg pr hs morphine sulfate 1 mg iv q4h:prn pain discharge medications: n/a discharge disposition: expired discharge diagnosis: primary: ulcerative colitis flare secondary: cirrhosis primary sclerosing cholangitis discharge condition: expired discharge instructions: n/a followup instructions: n/a md procedure: parenteral 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 percutaneous abdominal drainage closed [endoscopic] biopsy of large intestine flexible sigmoidoscopy other cholangiogram other permanent ileostomy other percutaneous procedures on biliary tract closed [endoscopic] biopsy of small intestine closed [endoscopic] biopsy of small intestine closed [endoscopic] biopsy of rectum closed [endoscopic] biopsy of rectum open total intra-abdominal colectomy diagnoses: urinary tract infection, site not specified cirrhosis of liver without mention of alcohol acquired coagulation factor deficiency unspecified protein-calorie malnutrition hyposmolality and/or hyponatremia portal hypertension candidiasis of other urogenital sites cachexia intestinal infection due to clostridium difficile other sequelae of chronic liver disease other ascites awaiting organ transplant status hepatic encephalopathy urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure cholangitis obstruction of bile duct cytomegaloviral disease pseudomonas infection in conditions classified elsewhere and of unspecified site infection and inflammatory reaction due to indwelling urinary catheter acute edema of lung, unspecified biliary cirrhosis unspecified peritonitis unspecified vascular insufficiency of intestine herpes zoster without mention of complication universal ulcerative (chronic) colitis other acute postoperative pain 

Answer: The patient is high likely exposed to