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: altered mental status major surgical or invasive procedure: none history of present illness: this is a 71 year old woman with a history of chronic autoimmune hepatitis, pbc, sle who is transferred from an outside hospital for worsening altered mental status. . she was admitted to hospital on with n/v, abdominal pain, and altered mental status/delerium x2 days. she had diarrhea for 1 week prior to admission. her sister went to check on her and found her to be poorly responsive and had labored breathing (but had been speaking normally on the phone a few hours prior). in the ed at the osh, she was noted to be febrile as high as 104, tachycardic and had abdominal tenderness on exam. bp was initially stable but then dropped to sbp 70s. she was treated with ivf (unknown amount) and improved. cbc/diff had 31% bands. ua was positive for uti and lactate was 5.4. abg was 7.42/36/80. head ct on admission was negative. she was started on vancomycin, zosyn, and flagyl empirically and was admitted to the icu. . ct abdomen/pelvis showed acute colitis (concern for ischemia vs. infectious). surgery was consulted, and nonsurgical management was pursued given her benign abdomen and improving clinical status at that time. . she was transfused 1u prbc for worsening anemia (hct 32 -> 26, then 29 after transfusion). hct remained stable after that time. hematology was consulted and recommended supportive care. . urine culture grew e. coli sensitive to ceftriaxone. blood cultures grew group b strep 4/4 bottles ( to amp, levoflox, pcn, vanco; resistant to clinda, erythromycin, tetracycline). tte reportedly showed no vegetation. no paracentesis was performed. id was consulted, and recommended 2 week course of ceftriaxone. other antibiotics were d/c'd. . she was also seen by rheumatology consult (by her own rheumatologist) and was started on solumedrol empirically for sle flare (and for risk of adrenal insufficiency). gi was also consulted and recommended stopping the imuran and substituting the steroids, and to titrate lactulose for hepatic encephalopathy. . over the last 2-3 days, the patient's mental status worsened. this was felt to be multifactorial, possibly due to hepatic encephalopathy, sepsis. repeat head ct showed a small subarachnoid and a small subdural hemorrhage in the r frontal region. neurosurgery was consulted and recommended correcting coagulopathy (she received 6u ffp and 8u platelets on more ffp and 8 more platelets on for inr 1.7) and repeating ct scan tomorrow (no emergent need for decompression). . prior to transfer, the patient was hemodynamically stable, not intubated, and not on any pressors. on arrival, she remains stable, but is not able to give any details of her history. past medical history: autoimmune hepatitis dx primary biliary cirrhosis sle esld septic ankle (mssa) htn hyponatremia osteoporosis s/p ccy social history: lives alone. husband is deceased, no children. family history: no family history of liver disease. physical exam: vs: 97.5, 77, 151/67, 17, 92% on 2l nc. general: sleepy but arousable to voice. heent: perrl, anicteric, mm dry, op clear. lungs: ctab. heart: rrr, no m/r/g abd: +bs, soft, nt/nd. extrem: warm, dry, no edema neuro: awake, but not answering questions verbally. follows simple commands. moving all 4 extremities. . pertinent results: 08:56pm glucose-90 urea n-15 creat-0.4 sodium-148* potassium-3.2* chloride-112* total co2-31 anion gap-8 08:56pm estgfr-using this 08:56pm alt(sgpt)-27 ast(sgot)-37 alk phos-73 tot bili-2.7* 08:56pm albumin-3.0* calcium-9.7 phosphate-1.8* magnesium-1.8 08:56pm wbc-3.0* rbc-2.94* hgb-9.6* hct-28.3* mcv-96# mch-32.8* mchc-34.0 rdw-16.5* 08:56pm neuts-79.4* lymphs-15.8* monos-4.6 eos-0.1 basos-0.1 08:56pm plt count-42* 08:56pm pt-18.6* ptt-36.4* inr(pt)-1.7* radiology final report cta head w&w/o c & recons 4:11 pm cta head w&w/o c & recons reason: please eval for sinus thrombosis medical condition: 71 yo f with chronic autoimmune hepatitis, pbc, sle, ams and respiratory failure with sah/sdh seen on ct head reason for this examination: please eval for sinus thrombosis contraindications for iv contrast: none. cta head without and with contrast, . history: autoimmune hepatitis with altered mental status. subarachnoid hemorrhage seen on ct. is there evidence of dural sinus thrombosis? a non-contrast head ct was performed with contiguous axial images through the brain. subsequently, rapid axial imaging was performed during infusion of 70 ml of optiray intravenous contrast. comparison to a head ct of . findings: the non-contrast ct demonstrates slightly lower density of the right frontal subarachnoid blood than on the previous examination. otherwise, there have been no significant changes. there is no evidence of new hemorrhage. the ct angiogram demonstrates no significant abnormalities. the vertebral arteries, basilar artery, and internal carotid arteries and their major intracranial branches appear normal. images of the dural venous sinuses reveal no evidence of sinus thrombosis. conclusion: no evidence of dural sinus thrombosis. no arterial abnormalities are detected. no evidence of new hemorrhage. residual right frontal subarachnoid hemorrhage again identified. = = = = = = = = = = = ================================================================ echocardiography report , portable tte (complete) done at 10:15:47 am final referring physician information , , critical care & , e/ks-b23 , status: inpatient dob: age (years): 71 f hgt (in): 67 bp (mm hg): 160/78 wgt (lb): 224 hr (bpm): 69 bsa (m2): 2.12 m2 indication: endocarditis. ? icd-9 codes: 424.90, 428.0, 424.1, 424.0, 424.2 test information date/time: at 10:15 interpret md: , md test type: portable tte (complete) son: bzymek, rdcs doppler: full doppler and color doppler test location: west micu contrast: none tech quality: adequate tape #: 2008w002-0:00 machine: vivid echocardiographic measurements results measurements normal range left atrium - long axis dimension: *4.7 cm <= 4.0 cm left atrium - four chamber length: *7.0 cm <= 5.2 cm left atrium - peak pulm vein s: 0.2 m/s left atrium - peak pulm vein d: 0.5 m/s left atrium - peak pulm vein a: 0.2 m/s < 0.4 m/s right atrium - four chamber length: *5.3 cm <= 5.0 cm left ventricle - septal wall thickness: 1.0 cm 0.6 - 1.1 cm left ventricle - inferolateral thickness: 0.6 cm 0.6 - 1.1 cm left ventricle - diastolic dimension: *6.0 cm <= 5.6 cm left ventricle - ejection fraction: 40% to 45% >= 55% left ventricle - lateral peak e': *0.08 m/s > 0.08 m/s left ventricle - septal peak e': *0.06 m/s > 0.08 m/s left ventricle - ratio e/e': *16 < 15 aorta - sinus level: 3.2 cm <= 3.6 cm aorta - ascending: *3.5 cm <= 3.4 cm aortic valve - peak velocity: 1.4 m/sec <= 2.0 m/sec mitral valve - e wave: 1.1 m/sec mitral valve - a wave: 0.7 m/sec mitral valve - e/a ratio: 1.57 mitral valve - e wave deceleration time: 187 ms 140-250 ms tr gradient (+ ra = pasp): *26 to 44 mm hg <= 25 mm hg findings right atrium/interatrial septum: mildly dilated ra. left ventricle: normal lv wall thickness. moderately dilated lv cavity. mild-moderate regional lv systolic dysfunction. tdi e/e' >15, suggesting pcwp>18mmhg. no resting lvot gradient. no vsd. right ventricle: mildly dilated rv cavity. mild global rv free wall hypokinesis. aorta: normal aortic diameter at the sinus level. focal calcifications in aortic root. mildly dilated ascending aorta. aortic valve: mildly thickened aortic valve leaflets (3). no as. no masses or vegetations on aortic valve. mild (1+) ar. mitral valve: mildly thickened mitral valve leaflets. myxomatous mitral valve leaflets. no mass or vegetation on mitral valve. moderate mitral annular calcification. mild thickening of mitral valve chordae. calcified tips of papillary muscles. moderate (2+) mr. tricuspid valve: mildly thickened tricuspid valve leaflets. moderate tricuspid annular calcification. moderate tr. moderate pa systolic hypertension. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. pericardium: no pericardial effusion. regional left ventricular wall motion: n = normal, h = hypokinetic, a = akinetic, d = dyskinetic conclusions left ventricular wall thicknesses are normal. the left ventricular cavity is moderately dilated. there is mild to moderate regional left ventricular systolic dysfunction with hypokinesis of the basal to mid inferior and inferolateral walls. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. the right ventricular cavity is mildly dilated with mild global free wall hypokinesis. the ascending aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. the mitral valve leaflets are myxomatous. no mass or vegetation is seen on the mitral valve. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: no vegetations seen. focal lv systolic dysfunction. diastolic dysfunction. moderate mitral regurgitation. mild aortic regurgitation. moderate pulmonary artery systolic hypertension. if clinically suggested, the absence of a vegetation by 2d echocardiography does not exclude endocarditis. electronically signed by , md, interpreting physician 12:51 brief hospital course: this is a 71 year old woman with autoimmune hepatitis and pbc who presented with altered mental status, respiratory distress and colitis which cleared during micu course and was transferred to medical floor with resolution of her acute presentation. . # hypoxia: during her micu course she had developed respiratory distress which was thought to be due to aspiration pna in the setting of altered mental status. she was intubated for airway precaution an treated empirically with clindamycin. her respiratory status improved over the course of hospital stay with o2sat of 94% ra. . # gbs sepsis: unclear source - likely abdominal vs line. was initially treated with empiric vancomycin, zosyn, and flagyl which was switched to ceftriaxone to finish a 14 day course. surveillance and line blood cultures remained negative. ceftriaxone stopped on . . # diarrhea: given report of colitis and broad spectrum antibiotic treatment we discontinued lactulose and started flagyl po for c-diff prophylaxis (to finish a 10 day course on ). stool studies remained negative for c-diff. her symptoms improved subsequently. we stopped lactulose/rifaximin given she never was on this meds before and never was encephalopathic, this episode of mental status change most likely due to sepsis. . # uti: enterococcus uti, treated empirically with cipro. sensitivities not back at discharge and need to be followed up by rehabilitation center, to ensure proper coverage. cipro to continue until to finish a 5 day course, given recent complicated uti. . # liver disease: due to autoimmune hepatitis, pbc. impaired synthetic function, without signs of decompensation, d/c'ed lactulose/rifaximin as above. . # sah/sdh: followed by neurology and neurosurgery, essentially signed off now that patient improved and no further advancement od bleed on imaging. . # altered mental status: resolved. likely multifactorial with hepatic encephalopathy, sah, sepsis, hypernatremia, etc. sister also believes mental status worsened with high-dose steroids. repeat head ct showed sah, intraparenchymal hemorrhage, cta no mycotic aneurysm or sinus venous thrombosis. . # sle: unclear whether sle flare is contributing to current picture. no current issues. . # anemia: likely related to liver disease, but patient also had "hemorrhagic colitis" per osh records. cta negative. hct remained stable. . # hypernatremia: initially appeared dehydrated. resolved with correction of free water deficit. . # fen: regular diet . # access: lij placed , peripheral access, and d/c on . . # ppx: pneumoboots (no sc heparin given coagulopathy), ppi . # communication: sister (?hcp) c: ; h: . brother: . medications on admission: fosamax 70mg qsat mvi nadolol 20 mg daily forte 500mg imuran (restarted 2-3 weeks prior to admission) discharge medications: 1. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 2. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical q24h (every 24 hours). 3. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: one (1) treatment inhalation q4h (every 4 hours) as needed for wheezing/dyspnea. 4. ipratropium bromide 0.02 % solution sig: one (1) treatment inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 5. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). 6. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 2 days: last day . 7. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed: maximal daily dose 2 gram. 8. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day): last day of treatment . discharge disposition: extended care facility: & rehab center - discharge diagnosis: 1. broup b streptococcal sepsis 2. pneumonia 3. uti 4. colitis 5. subarachnoid hemorrhage 6. autoimmune hepatitis dx 7. primary biliary cirrhosis /esld 8. sle 9. htn 10. hypernatremia 11. osteoporosis discharge condition: good, afebrile, stable o2 sat discharge instructions: you were treated for infection, colitis, and mental status change. you had urinary tract infection, bacteremia, pneumonia, and subarachnoid hemorrhage. you are being discharged to rehab, as all your active medical issues resolved. however you need to continue taking some antibiotics to finish their course. please follow uup with your appointments as instructed. please call your doctor or 911 if you develop any fevers, chills, shortness of breath or any signs of infection, or if you have any other health concern. followup instructions: please follow up with your primary care doctor in 2 weeks! please follow up with our liver center : provider: , md phone: date/time: 11:45 md, msc, mph procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: systemic lupus erythematosus anemia of other chronic disease other and unspecified noninfectious gastroenteritis and colitis urinary tract infection, site not specified unspecified essential hypertension severe sepsis subarachnoid hemorrhage acute respiratory failure pneumonitis due to inhalation of food or vomitus osteoporosis, unspecified other chronic hepatitis hepatic encephalopathy hyperosmolality and/or hypernatremia streptococcal septicemia biliary cirrhosis 

Answer: The patient is high likely exposed to