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: sulfa (sulfonamides) attending: chief complaint: hypotension, anorexia major surgical or invasive procedure: paracentesis. blood transfusion history of present illness: 54 y/o female with htn who was persuaded to go to hospital by her son after one month of nausea and vomiting after eating, leading to about two weeks of very poor po intake, along with new jaundice and several days of diarrhea. she denies weight loss, lymphadenopathy, uri symptomes, fevers, chills, headache, dyspnea, chest pain, abd pain, pale stools, dysuria, edema, or rash. she admits to dark urine over the last month and her family noted yellowing of her skin over the last week. . at hospital, t 97.3 bp 100/63 hr 80 rr 16. her sodium was 119, t bili 8.5, direct bili 4.5, ap 125, ast 98, hct 24 (baseline 40), alb 2.1, bun 20/cr 2.5, wbc 12.6, hct 24, plt 122. she had a distended abdomen. cxr was reportedly normal. she had hypotension to 66/40 which wwas somewhat responsive to fluids. she received 1.5 l of iv fluids without any urine output. . in the ed, she was afebrile at 98.6, with blood pressures in the 80's to 100's systolic, rr 22, sat 96%ra. ruq u/s showed moderate ascites, and ct showed ascites and small bilateral pleural effusions. her hct was 22, transfused 2 units prbc, and given 3.5 l ns. guaiac neg. treated empirically with levofloxacin and flagyl for intrabdominal infection. given decadron for stress dose steroids because of hypotension. past medical history: hypertension since etoh abuse social history: cleans houses for a living. lives with husband and dog in . mother lives nearby. has 2 sons. very concerned about the welfare of her husband and dog while she is hospitalized as she is main caretaker of the family. she is post-menopausal since age 40. patient does not smoke, admits to drinks a day, more on weekends, and denies iv drug use. family history: mother is living and has alcohol abuse problem, father smoked and died of emphysema. she is an only child. no family hx of liver disease. physical exam: gen: tired, but appropritate female in no distress. vitals: t 96.7 hr 97 bp 105/64 rr 19 sat 99% on 4 l nc heent: sclera mildly icteric, mouth dry, dentition poor, pupils equal, no nystagmus. neck: supple, no jvp, no bruits, no thyroid masses, no cervical lad. chest: left axilllary freely mobile, non tender lymph node palpable. lungs clear but with somewhat diminished bases. heart: regular with systolic flow murmur. abd: distended, dull to percussion, caput over upper abdomen, positive fluid wave, non tender. ext: trace pedal edema, good pulses. skin: facial lesions and one right sided back lesion. no palmar erythmea. no spider angiomata. neuro: a&o x3. cn intact. strength 5/5 throughout. toes downgoing. no asterixis. pertinent results: labs at admission: 06:25pm blood wbc-10.9 rbc-1.66* hgb-8.0* hct-22.3* mcv-135* mch-48.0* mchc-35.7* rdw-15.5 plt ct-132* 06:25pm blood hypochr-normal anisocy-2+ poiklo-normal macrocy-3+ microcy-normal polychr-normal how-jol-occasional pappenh-1+ 05:29am blood pt-22.6* ptt-40.6* inr(pt)-2.2* 06:25pm blood plt smr-low plt ct-132* 06:25pm blood glucose-103 urean-19 creat-2.1* na-123* k-3.5 cl-86* hco3-24 angap-17 06:25pm blood alt-21 ast-72* ck(cpk)-62 alkphos-100 totbili-9.1* 02:58am blood albumin-2.5* calcium-6.8* phos-2.5* mg-1.3* iron-89 . labs at discharge: 06:25am blood glucose-103 urean-6 creat-1.3* na-138 k-4.6 cl-105 hco3-24 angap-14 11:35am blood wbc-12.9*# rbc-2.36* hgb-9.6* hct-28.3* mcv-120* mch-40.5* mchc-33.8 rdw-22.8* plt ct-124* 11:35am blood plt ct-124* 06:25am blood pt-22.8* ptt-40.2* inr(pt)-2.2* . 05:12pm ascites wbc-55* rbc-40* polys-3* lymphs-3* monos-82* mesothe-7* other-5* 05:12pm ascites totpro-0.9 glucose-143 ld(ldh)-58 albumin-less than 1.0. . 02:58am blood hbsag-negative hbsab-negative hbcab-negative 06:25am blood hav ab-pnd 02:58am blood cea-3.3 afp-3.9 . imaging: liver u/s: 1. very limited study given large amount of intra-abdominal ascites. coarsened echogenic liver, which may be compatible with cirrhosis. 2. tiny 6-mm structure adherent to the posterior gallbladder wall which may be compatible with a small polyp. abd ct: 1. suboptimal study given lack of iv contrast administration and moderate-to- severe intra-abdominal ascites. diffusely heterogeneous appearance of the liver with with the suggestion of a mass lesion in the right lobe and nonspecific cyst vs hemangioma in the caudate lobe. mri is recommended for evaluation of the liver and pancreas. 2. pericardial effusion and small right greater than left pleural effusions. 3. cholelithiasis. cxr: cardiac size is enlarged. some upper zone redistribution is present and a degree of failure is probably present. some air bronchograms are seen behind the left heart and i suspect some consolidation in this area. . peritoneal : negative for malignant cells. . cxr : compared to previous examination, the retrocardiac volume loss has completely resolved. in a persistent manner, however, the right lung base shows subtle opacities with air bronchograms, that could correspond to pneumonia. additionally, a bilaterally present mild-to-moderate pleural effusion can be seen. the size of the cardiac silhouette is slightly enlarged. as compared to , suspicion of right-sided basal pneumonia and bilateral mild-to-moderate pleural effusions. brief hospital course: patient is a 54 y/o female with newly diagnosed alcoholic hepatits/cirrhosis and possible hepatorenal syndrome. she was admitted for hypotension and renal failure, which have improved significantly over her stay. however, she has a high risk of significant morbidity over the next 30 to 90 days given her df (48 pts) and meld score (24 pts). patient has been insistent over last couple of days that she wants to sign out ama despite the risks which she understands. she seems to be in denial about the severity of her disease. she completed her hospitalization, and she was discharged when stable with the agreement that she would have close follow up with her pcp, that then can arrange for her to be followed by a hepatologist closer to if she does not want to be followed here at . details by problem: hypotension: fluid responsive. never needed pressors. likely hypovolemia with superimposed liver disease, though differential also included sepsis. initially treated with /flagyl for possible sbp, but paracentesis without evidence of sbp so levo/flagyl d/ced. cxr showed lll , treated with azithromycin for 4 day course which she finished on her last day in the . #. cirrhosis: likely etoh. causing her transaminitis, hyperbilirubinemia. likely also contributing to her thrombocytopenia due to splenic sequestration. pt also had ascites on presentation, and ascitic fluid analysis shows no evidence of sbp. presented with elevated creatinine likley splanchinc vasoconstriction of cirrhosis. she was given over 10 l of ivf, albumin after paracentesis, and midodrine/octreotide and uop improved with decrease in creatinine. discriminant function calculated, and was elevated at ~60 and pt started on pentoxyfiline. after call out to floor, patient's lfts continued to improve, with coags, transaminases and tbili generally trending downwards and a corresponding upward trend in hct and plts. by the time of discharge she had an elevated ast and a tbili consistently elevated at 7.0. she was not encephalopathic. she had only superficial understanding of the severity of her disease, and her family seemed to have better understanding. she was discharged with pentoxyfylline for an additional 3 weeks for the alcoholic hepatitis. she was also given plenty of vitamin supplements, and a prescription for lactulose. she is to follow up with a hepatologist, either here at or at , closer to home. # lll consolidation: a retrocardiac opacity seen on cxr in the . treated with 4 day course of azithromycin, completed in the icu. she had periodic low grade temps and a cough while on the medical floor. the decision was made to initiate a 10 day course of levofloxacin for pneumonia. # arf: pt had elevated creat on admission, which trended down and then stabilized around 1.6. most likely due to splanchnic vasocontriction seen in cirrhosis. has recieved roughly 10 l ivf during her stay, albumin after paracentesis, and midodrine/octreotide. uop picked up particularly after starting midodrine/octreotide. it was not clearly hepatorenal syndrome, though this was treated. # macrocytic anemia: pt had iron studies that were c/w anemia of chronic dz, however this would be expected to cause microcytic rather that macrocytic anemia. b12 and folate levels are normal so nutritional causes of macrocytic anemia are less likely. most likely that the direct toxic effect of etoh is to blame for her macrocytic anemia. treated with thiamine, folate, and mvi. given the anemia and cirrhosis, she was offered and encouraged to have endoscopic evaluations for varicies and gastropathy, but she declined repeatedly. # etoh withdrawal: treated with ativan on ciwa while in the icu, and this was not an issue on the medical floor. # coagulopathy: pt recieved vit k x3, so nutritional causes are less likely. most likely etiology is depressed synthetic function of the liver in cirrhosis. did not have any bleeding and did not require ffp. # thrombocytopenia: likely splenic sequestion. montiored plts throughout stay and no acute drop. # anorexia: this was felt to be due to her severe medical illness (cirrhosis) and alcoholism. she claimed that she just did not like the food here, and would periodically consume supplements. she was a full code during the admission. medications on admission: lopressor 50 mg since discharge medications: 1. pentoxifylline 400 mg tablet sustained release sig: one (1) tablet sustained release po tid (3 times a day). disp:*30 tablet sustained release(s)* refills:*3* 2. hexavitamin tablet sig: one (1) cap po daily (daily). 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. cyanocobalamin 250 mcg tablet sig: one (1) tablet po daily (daily). 6. midodrine 10 mg tablet sig: one (1) tablet po three times a day. disp:*90 tablet(s)* refills:*0* 7. octreotide acetate 100 mcg/ml solution sig: one (1) injection injection q8h (every 8 hours). disp:*90 injection* refills:*0* discharge disposition: home discharge diagnosis: alcohol hepatitis and cirrhosis with possible hepatorenal syndrome. anemia thrombocytopenia anorexia discharge condition: stable, adequate renal function, ambulating without assistance. discharge instructions: you were admitted for anorexia and hypotension. while you were hospitalized, tests showed that you have liver disease due to alcohol, called alcoholic hepatitis and cirrhosis. this is a very serious condition with a considerable likelihood of severe illness or even death over the next several weeks. tests also showed that you have a moderate amount of fluid in your abdomen, as well as a mass in your liver. you were also found to have anemia related to alcohol, and there are also problems with your blood clotting due to your liver disease. you were also found to have poor kidney function related to your liver disease. your hypotension required a blood transfusion, and a procedure was performed to withdraw fluid from your abdomen. you were also started on a medication for your alcoholic hepatitis called trental, and another medication for your alcoholic cirrhosis called orvaten. you were also prescribed vitamin supplements to correct any nutritional deficiencies which might have contributed to your anemia. . you should continue to take these new medications as prescribed. you should also stop taking your previously prescibed medication, lopressor, as it can cause problems with your blood pressure in your current condition. it is extremely important that you abstain from drinking any kind of alcohol. it is also very important that you increase your nutritional status by eating full meals at breakfast, lunch and dinner, with ensure supplements whenever possible. . you should seek immediate medical attention if you experience any of the following symptoms: fevers, chills, nausea, vomiting, shortness of breath, dizziness, lightheadedness, fainting spells, or find blood in your stools, urine or vomit. followup instructions: you should follow up with your primary care physician within one week. you have an appointment at dr. office on thursday, , at 1pm. her phone is . . it is very important that you have a liver doctor follow up as well. if you cannot get a liver doctor near your home through your pcp, call the liver center at ( to schedule a follow-up visit in one to two weeks. procedure: percutaneous abdominal drainage transfusion of platelets diagnoses: thrombocytopenia, unspecified unspecified pleural effusion unspecified essential hypertension alcoholic cirrhosis of liver acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified hyposmolality and/or hyponatremia hypopotassemia other ascites diarrhea dehydration acute alcoholic hepatitis unspecified deficiency anemia jaundice, unspecified, not of newborn anorexia alcohol-induced persisting dementia 

Answer: The patient is high likely exposed to