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: haldol / darvon / keppra attending: chief complaint: altered mental status, ? hematemesis . pcp: ?dr. , community health major surgical or invasive procedure: intubation central venous line attempt arterial line history of present illness: 62yof with h/o etoh/hep c cirrhosis, psychotic, seizure d/o (none x many years), multiple admission for gi bleeds (portal gastropathy, grade 4 rectal varices) who now presents from rehab with altered mental status and ?hematemesis. she has been at acute rehab from and was reportedly doing well until early this morning when she was found to be somnolent/lethargic. there is some verbal report of perhaps hematemesis although amount and frequency is unknown (not documented on transfer paperwork). she was, thus, taken directly to ed for further evaluation and management. per verbal rehab report, she had been receiving all of her medications as prescribed upon discharge; it is unclear if she had been having regular bms. no report of increased cough, brbpr, but additional ros unclear. . of note, she was admitted for gi bleed. an egd on showed portal gastropathy only without any evidence of active bleeding. there was no evidence of varices. . prior to her most recent hospitalization, she was admitted for a signficant lgib s/p tips at which time she presented with black stools, lethargy, and confusion. hospital course in was complicated by respiratory failure to nosocomial pneumonia and pulmonary edema transiently requiring intubation. . in the ed, initial vitals revealed t 101.2 bp 178/113 hr 137 rr 24 o2 sat 100%. she was noted to have brb in her mouth without any obvious source of bleed within the oral cavity. she was noted to have altered mental status and was intubated for airway protection in this setting. a ct head was performed and read is pending. she received octreotide 50mcg iv x1, protonix 40mg iv x1, vitamin k 10mg sc x1, 2 units of ffp. additionally, she received ceftazidime 1g iv x1, flagyl 500mg iv x1, and vancomycin 1g iv x 1. it appears that blood culture x1 was collected, but not ua/culture. . abdominal u/s in the ed demonstrated interval decrease in the proximal, mid and distal tips velocity, but did show normal wall-to-wall flow was noted within the tips and the main portal vein and its branches. the tips device demonstrates abnormal pulsatile flow suggesting the presence of possible right heart failure. . pt admitted to the icu for further management of her altered mental status (s/p intubation for airway protection), sirs and probable sepsis and ? gib. after uneventful 1d course with improved ms (alert, oriented x2) pt transferred back to floor . . ros: unable to obtain from patient. past medical history: 1) iron deficiency anemia 2) gi bleed - presumed secondary to hemorrhoids, s/p tips; also w/ known portal gastropathy 3) sigmoid diverticulosis 4) schatzki's ring 5) duodenal polyps and duodenitis 6) mgus 7) ?etoh/ hcv cirrhosis followed by dr. 8) psychotic disorder 9) polysubstance abuse - etoh, cocaine, marijuana 10) copd 11) ?? h/o complex partial seizures social history: history of tobacco and etoh abuse. she is originally from , and changed her name when she became a practicing muslim. she worked as an administrative assistant when she was younger, but is now on ssdi (for schizophrenia and seizure disorder, per pt, both now quiescent). she was most recently discharged to rehab on . family history: mother: asthma, grandmother with diabetes, htn. no family history of liver disease or bleeding disorders. great aunt with epilepsy. physical exam: vs: temp: 99.9 bp: 146/86 hr: 89 nsr rr: 15 o2sat 100% gen: intubated, sedated. heent: pupils equal, 2.5mm, minimally reactive to light, +scleral icterus, blood in op with ?small anterior tongue laceration neck: no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or nodules resp: anteriorly w/ rhonchorus bs likely transmitted from upper airway, no wheezes cv: rrr, s1 and s2 wnl, no m/r/g appreciated abd: nd, +b/s, soft, nt, no masses, no appreciable ascites ext: 1+ dorsal hand edema b/l and dorsal foot edema b/l, 2+ dp and pt pulses b/l skin: no rashes neuro: unable to assess cn ii-xii. pt. unable to cooperate w/ full neuro exam given mental status/sedation. downgoing toes b/l. rectal: guaiac + brown stool per ed eval. pertinent results: 06:30am pt-18.4* ptt-48.9* inr(pt)-1.7* 06:30am plt count-124*# 06:30am neuts-87.3* lymphs-8.3* monos-3.0 eos-1.0 basos-0.3 06:30am wbc-12.1* rbc-3.21* hgb-10.5* hct-30.9* mcv-96 mch-32.9* mchc-34.2 rdw-17.6* 06:30am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 06:30am albumin-2.4* calcium-9.1 phosphate-4.0 magnesium-1.5* 06:30am ck-mb-notdone ctropnt-0.14* 06:30am lipase-82* 06:30am alt(sgpt)-37 ast(sgot)-54* ck(cpk)-68 alk phos-83 amylase-101* tot bili-5.2* 06:30am glucose-117* urea n-33* creat-1.5* sodium-139 potassium-3.9 chloride-106 total co2-22 anion gap-15 06:44am hgb-10.9* calchct-33 06:44am lactate-1.7 06:51am glucose-107* 06:51am type-art po2-304* pco2-33* ph-7.50* total co2-27 base xs-3 06:53am ammonia-105* 09:44am pt-17.9* ptt-50.6* inr(pt)-1.6* 09:44am hct-26.4* 11:10am hgb-9.7* calchct-29 11:10am type-art po2-521* pco2-37 ph-7.43 total co2-25 base xs-1 12:00pm urine mucous-many 12:00pm urine mucous-many 12:00pm urine rbc-7* wbc-52* bacteria-few yeast-none epi-0 12:00pm urine blood-mod nitrite-neg protein-100 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-mod 12:00pm urine color-yellow appear-hazy sp -1.013 12:00pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 12:00pm urine osmolal-449 12:00pm urine hours-random urea n-504 creat-65 sodium-92 06:28pm hct-24.6* 06:39pm type-art po2-474* pco2-35 ph-7.50* total co2-28 base xs-4 07:45pm ck-mb-notdone ctropnt-0.10* 07:45pm ck-mb-notdone ctropnt-0.10* 07:45pm ck(cpk)-42 10:30pm hct-23.8* 10:44pm o2 sat-99 10:44pm type-art po2-180* pco2-25* ph-7.50* total co2-20* base xs--1 discharge labs: complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:00am 6.9 2.38* 7.4* 23.0* 97 31.0 32.1 18.9* 118* basic coagulation (pt, ptt, inr) 06:00am 21.0*1 57.6* 2.0* renal & glucose glucose urean creat na k cl hco3 angap 06:00am 102 19 1.1 135 4.9 104 23 13 enzymes & bilirubin alt ast alkphos totbili 06:00am 21 31 68 3.4* . ekg: sinus tachycardia to rate 136. nml axis, nml intervals. poor r wave progression. tw flattening v1, ?tw inversion v2. . repeat ekg in icu: nsr rate 84, nml intervals and axis. twi in ii, iii, avf (new), tw flattening in v1-v2, twi v3-v6 (all old though more pronounced from prior). . echo: -left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 60-70%). -the right ventricular cavity is dilated. -right ventricular systolic function appears depressed. -the ascending aorta is mildly dilated. -there is no aortic valve stenosis. mild (1+) aortic regurgitation is seen. -the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. -there is moderate pulmonary artery systolic hypertension. -there is no pericardial effusion. . imaging: cxr: diffuse course linear opacities likely sequelae of aspiration pneumonitis. no significant change from prior (). . liver u/s: 1. interval decrease in the proximal, mid and distal tips velocity. six-week followup is recommended to ensure the stability of the tips function. 2. normal wall-to-wall flow was noted within the tips and the main portal vein and its branches demonstrate appropriate flow. 3. the tips device demonstrates abnormal pulsatile flow suggesting the presence of possible right heart failure. 4. small bilateral pleural effusion is noted. . ct head : no evidence of acute intracranial process. left-sided ngt in place; r>l opacification of nasal passage & visualized nasopharynx. mild mucosal thickening in right maxillary sinus. . eeg: encephalopathy, no e/o seizure activity . studies: egd: 1. schatzki's ring 2. erythema and congestion in the stomach body and fundus 3. erythema and congestion in the first part of the duodenum compatible with duodenitis 4. otherwise normal egd to second part of the duodenum . colonoscopy: grade 4 internal & external hemorrhoids. brief hospital course: 62yof with h/o etoh/hepc cirrhosis presents with altered mental status, fever, blood in mouth, ? hematemesis. in the micu, patient was intubated for airway protection given altered mental status. on transfer to floor, patient still confused but returning towards baseline on lactulose and started on iv antibiotics for gnr in urine and sputum and gpc in prs/clusters in sputum. she received one unit of blood for decreased hct thought to be oropharyngeal bleeding, etiology unclear, but stabilized bleeding after extubation. liver service is involved, no endoscopy indicated at this time. . hospital course by problem: . # altered mental status: the patient was admitted from rehab with altered mental status. she was intubated for airway protection in the ed. per extended care facility she has been taking lactulose and rifaximin although he hepatic encephalopathy could be contributing as the ammonia on presentation was 105 which is higher than previously (50-80, but ? in setting of encephalopathy). she was continued on lactulose and refamixin during her hospital stay. although the patient has a history of seizures ( she is not on any medication?) and did present with possible tongue trauma and oral bleeding, an eeg was performed which did not show any seizure activity. utox was negative making drug abuse unlikely despite recent history of crack cocaine abuse. ct head negative for bleed/acute intracranial process. she did receive empirc coverage for meningitis in the ed with ceftazadine and vanco given fever on presentation although she did not have any meningeal symptoms. meningitis was later thought to be less likely. a cxr was performed to evaluated for pna as a possible cause of ams and was found to be unchanged from prior. a ct chest did not pulmonary edema but no focal infiltrate suggestive of pna. sbp was also thought to be unlikely without ascites on ultrasound of the abdomen and without abdominal tenderness. evaluation of her tips showed decreased flow but per the hepatology team a revision of tips would likely worsen her encephalopathy. she was ultimately found to have a enterobacter uti and was initially started on zosyn and vanc. the enterobacter was then found to be resistant to zosyn - sensitive to cefepime and meropenem only- and she was switched to cefepime. her mental status improved to baseline. she had repeat u/a on 12.24 that showed clearance of infection. plan for 14d course for complicated uti/pna, for 6 more days on d/c. hepatology followed and decided against reevaluation of tips given clinical improvement with lactulose and treatment of uti. . # fever: wbc count elevated to 12.1 with 87% neutrophils. was febrile on presentation to ed concerning for infection. additionally she was tachycardic to 130s. she was admitted to the icu for sirs and s/p intubation. at least meets criteria for sirs and likely even sepsis (source not yet clear). her fever ws found to be due to a uti described above and resolved with antibiotics. notably, sputum gram stain did show gpc's and gnr's, but only gnr's grew on culture; clinically the patient did not appear to have pneumonia. she was only kept on cefepime as well as vanc for sputum mrsa given her improvement for treatment of her uti/pna, as above . # respiratory: patient reportedly not in respiratory distress on presenation, but rather intubated for airway protection given severely depressed mental status. she was never hypoxic in the icu or on the floor. cxr does show reticular opacities stable from most recent cxr previously billed as aspiration pneumonitis. ct showed pulmonary edema and she was given lasix iv, then transitioned to pre-admission diuretics. . # ?upper gi bleed: hct trending down and +blood removed form oropharynx. patient with known grade 4 rectal varices however guaiac + brown stools. also recent egd showed e/o portal gastropathy, but w/o e/o varices. she was started on octreotide in ed for ? variceal bleed. blood in ngt looks old so perhaps old from recent bleed/egd. other blood in mouth bright red and perhaps from tongue/mouth trauma. - q8h hcts - a-line placed; cv line attempt failed - appreciated liver involvement - ppi . # bleeding: patient was found to have oozing in posterior throat, central line and picc site after transfer to the floor. she did not appear to have uremia with a normal bun. her ptt was elevated and her platelets were decreased. she had received ppx heparin and heparin flush through picc last night and her plt have trended down although not by 50%. she was evaluated for hit - a hit ab was sent and was negative. heparin administration was discontinued. she was also given ffp for elevated ptt and likelihood of liver dysfunction. - was given 1 u prbcs on and another on 12.27 day of discharge with stable hct of ~21-23 at discharge. goal hct >21. . # elevated troponin: normal ck and ck-mb. troponin elevated to 0.14 (up from previous baseline even in setting of cri), now trending down. given dilated, hypokinetic rv, may be elevated in the setting of failure. does have poor r wave progression on ekg which is old as are, ekg now back at baseline. . # etoh/hep c cirrhosis: platelets 124 and within previous baseline. coags in the ed revealed inr of 1.7 which is also c/w baseline. albumin 2.6 on (not sent in ed). ast mildly elevated, alt, alk phos normal. t.bili elevated to 5.2 which is actually slightly down from baseline. meld of 22 on admission. - continue lactulose and rifaximin po - held lasix/sprinolactone initially, then restarted, but on day of discharge had hyponatremia to 128. pt. thought to be hypovolemic, so diuretics discontinued and given 1u prbcs - will follow up in first week of with dr. to determine whether diuretics need to be restarted . # acute on crf: appears to have had progessively worsening function since spring, . currently within most recent baseline. etiology not entirely clear. it does not appear to have been worked up previously although there has been ? hrs on old d/c notes. no other clear e/o cryoglobulinemia, but does have hep c. feurea 35.7%, borderline prerenal on ; lasix held for the past 2 days so unlikely to be pre-renal still. patient has not been hypotensive, making atn unlikely. urine eos positive but sparse and no peripheral eosinophilia or rash, making ain equivocal; however, the patient was on zosyn which could cause ain. - cryoglobulin levels negative - c3, c4 levels wnl - will f/u with dr. in renal as outpt. . # anemia: high normal mcv, elevated rdw. baseline fluctuates somewhat, but generally runs mid-upper 20s to low 30s. of note, hct was 30.9 on presentation from 28.9 upon discharge on . as above, likely secondary to chronic gi sources (portal gastropathy, hemorrhoids). -continue hct monitoring - pt likely transfusion dependent to certain extent; transfuse to maintain hct >21 or if acute drop, e/o bleeding -continue iron supplementation . # h/o seizure d/o: no documented history of seizures while at . has been off antiepileptic meds per omr notes since at least . given ams and tongue trauma, ? postictal although seems less likely given has yet to clear. - eeg negative for seizure . # copd: rhonchorus bs anteriorly likely transmitted from upper airway. without e/o bronchospasm on exam currently. - continue albuterol/ipratropium mdi via ett prn . # psychotic disorder: schizophrenia per pt. in old notes. not on any neuroleptic meds. appears to have received olanzapine on prior admissions. has "allergy" to haldol. - olanzapine prn started with olanzapine in evenings standing. . # f/e/n: replete lytes prn. npo. . # ppx: bowel regimen, ppi, sq heparin . # access: picc . # code status: full . # communication: daughter , d/c'd to with instructions to follow lytes and hct and for pt. medications on admission: 1. rifaximin 400 mg tid 2. lactulose 30 ml po tid-qid; titrate to 4 bms daily 3. nystatin 5 ml po qid prn 4. ipratropium bromide nebs q6h 5. albuterol sulfate nebs q6h prn 6. pantoprazole 40 mg po daily 7. furosemide 20 mg po daily 8. spironolactone 50 mg daily 9. ferrous sulfate 325 mg po daily discharge medications: 1. rifaximin 200 mg tablet : two (2) tablet po tid (3 times a day). 2. lactulose 10 gram/15 ml syrup : thirty (30) ml po qid (4 times a day). 3. ferrous sulfate 300 mg/5 ml liquid : five (5) ml po daily (daily). 4. albuterol 90 mcg/actuation aerosol : 1-2 puffs inhalation q6h (every 6 hours) as needed for sob, cough, wheezing. 5. ipratropium bromide 17 mcg/actuation aerosol : two (2) puff inhalation qid (4 times a day) as needed for sob, cough, wheezing. 6. olanzapine 5 mg tablet : one (1) tablet po bid (2 times a day) as needed for agitation. 7. olanzapine 5 mg tablet : one (1) tablet po hs (at bedtime). 8. pantoprazole 40 mg tablet, delayed release (e.c.) : one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 9. cefepime 1 gram recon soln : five hundred (500) mg intravenous once a day for 5 days. 10. vancomycin in dextrose 1 gram/200 ml piggyback : one (1) gram intravenous q 24h (every 24 hours) for 5 days. 11. ensure plus liquid : two (2) bottles po three times a day. discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses 1) hepatic encephalopathy 2) uti 3) pneumonia 4) altered mental status 5) anemia secondary diagnoses: 1) iron deficiency anemia 2) gi bleed - presumed secondary to hemorrhoids, s/p tips; also w/ known portal gastropathy 3) sigmoid diverticulosis 4) schatzki's ring 5) duodenal polyps and duodenitis 6) mgus 7) ?etoh/ hcv cirrhosis followed by dr. 8) psychotic disorder 9) remote polysubstance abuse - etoh, cocaine, marijuana 10) copd 11) complex partial seizures discharge condition: good, tolerating pos, satting well on ra, afebrile, sitting in chair with assist discharge instructions: you came to the hospital due to a change in your mental status as well as blood in your mouth. you were in the icu for part of your hospital stay due to concern for your mental status and breathing, and you were found to have both a respiratory and urinary tract infection for which you are being treated. additionally, your mental status is altered due to your liver disease. please take antibiotics as prescribed for 6 more days and continue lactulose and rifaxamin, titrated to loose bowel movements per day. please call your physician or return to the hospital for any of the following: bright red blood per rectum, black, tarry stools,chest pain, shortness of breath, inability to tolerate food, fever >101 or other concerns. followup instructions: you have the following appointments which you should attend provider , md phone: date/time: 2:20 provider: , m.d. phone: date/time: 9:00 md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube arterial catheterization transfusion of packed cells transfusion of other serum diagnoses: thrombocytopenia, unspecified urinary tract infection, site not specified alcoholic cirrhosis of liver acute kidney failure, unspecified unspecified septicemia iron deficiency anemia secondary to blood loss (chronic) hyposmolality and/or hyponatremia other and unspecified alcohol dependence, in remission sepsis chronic kidney disease, unspecified unspecified schizophrenia, unspecified pneumonitis due to inhalation of food or vomitus other emphysema hematemesis accidents occurring in residential institution other and unspecified coagulation defects stricture and stenosis of esophagus unspecified viral hepatitis c with hepatic coma open wound of tongue and floor of mouth, without mention of complication human bite 

Answer: The patient is high likely exposed to