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: transferred from osh for septic shock, ards, arf and possible need for cvvh major surgical or invasive procedure: cordis central line placement temporary dialysis line placement tunnelled dialysis line placement endotracheal intubation paracentesis history of present illness: ms. is a 45 year old female with a history of etoh hepatitis/cirrhosis with septic shock on pressors, aspiration/ards, transfer from hospital for cvvh for volume overload. she was initially admitted to hospital on after her nurse practitioner for the homeless found her with multiple empty vodka bottles scattered around her apartment. np had seen her intoxicated in the past and did not feel like her behavior at that time could be explained by intoxication alone and brought her to the ed. on admission to osh, her etoh level was <10. she had elevation in her liver function tests with ast/alt 279/66, inr 1.6, tbili 17.4. ammonia was 168 on presentation. cr 0.5 on presentation. k 1.9, phos 1.2 on presentation. tylenol level was negative. she was intially treated for acute hepatic failure and hepatic encephalopathy. she did not receive steriods. she was started on lactulose and her mental status improved. she began to spike fevers on to 101-102. blood cultures from eventually grew mssa in bottles and she was started on vancomycin/cefepime. blood cultures repeated on and were negative. a u/a from grew e. coli, not yet speciated. with mssa and e. coli results, vanco/cefepime changed to zosyn. an abdominal ct scan also obtained which showed evidence of pancolitis and patient was started on empiric oral vancomycin despite c diff toxin stool assays being negative x 4. on , urine output began to decline and cr increased from 0.6 -> 1.3. around the same time her blood pressures began to decrease. she was initially fluid responsive but then became refractory. on , a cordis was placed. she received several units of ffp prior to line placement due to worsening coagulopathy and following the line placement she became hypoxic and acutely sob. she was placed on bipap without improvement in abg and she was eventually intubated. cxr at that time showed diffuse bilateral infiltrates. an echo was obtained and prelim read showed preserved systolic function. pa catheter placement was attempted unsuccessfully(cvp ~20, rv 60s/20, pa 40s??/20 at 80cm, unable to wedge). concern for aspiration and pulmonary edema and vent requirements rapidly increased. most recently on ac with tvs of 350 cc, peep of 18, fio2 of 100%. she has a persistent vasopressor requirement, currently on levophed 4 micrograms/min, and remains anuric with most recent cr of 3.1. tbili has continued to rise to 18 and she has become increasingly coagulopathic. past medical history: # alcoholic hepatitis/cirrhosis # h/o aspiration pneumonia # htn social history: intermittently estranged from her family. homeless until 3 months ago. now lives alone. history of heavy etoh use. + current tobacco, unknown amount. h/o crack cocaine use, but no known ivdu. family history: non-contributory physical exam: admission physical exam: t: 100.3 bp: 93/54 hr: 100 rr: 40 o2 100% ac 350x28 fio2 60% peep 12 bladder pressure: 11 gen: intubated, sedated heent: perrl, + scleral icterus and orbital edema, could not assess o/p neck: right ij in place, difficult to assess jvp, no masses/thyromegaly/bruits noted. cv: tachycardic, rrr. + systolic and diastolic murmurs, no rubs or gallops lungs: coarse bs bilaterally, but no w/r/c abd: large scar noted; no bs, distended; difficult to assess hsm due to thick scar, but liver felt to be 4cm below ribs; no masses noted ext: no cce. dimished dp pulses bl; bounding radial pulses bl skin: no rashes/lesions, + ecchymoses on medial aspect of lle neuro: intubated, sedated. moves all 4 extremities. responds to verbal stimuli, does not withdraw to pain pertinent results: studies from hospital on transfer: : 7.34/31/64 on ac 400x32 fio2 55% peep 15 145 119 9 ----------< 183 3.5 17 3.7 ast 109 alt 34, inr 2.0, tbili 19.7 ammonia 86 : ck 44 6.1>--<53 24.6 culture data: ucx from >100k e. coli viral data: hiv non-reactive micro: stool cx (-), c.diff (-), urine cx from pansensitive e.coli >100,000 organisms/ml blood cx from gpcs, id and sensitivity pending admission labs: 02:40pm blood wbc-8.8 rbc-2.68* hgb-8.5* hct-25.9* mcv-97 mch-31.9 mchc-33.0 rdw-21.2* plt ct-71* 02:40pm blood neuts-84.0* lymphs-13.3* monos-1.7* eos-0.7 baso-0.3 02:40pm blood fibrino-499* 02:40pm blood glucose-115* urean-55* creat-3.8* na-146* k-3.0* cl-113* hco3-18* angap-18 02:40pm blood glucose-115* urean-55* creat-3.8* na-146* k-3.0* cl-113* hco3-18* angap-18 02:40pm blood alt-31 ast-127* ld(ldh)-420* ck(cpk)-28 alkphos-42 totbili-19.8* 02:40pm blood albumin-2.9* calcium-7.6* phos-4.1 mg-2.3 02:47pm blood lactate-2.5* 02:47pm blood type-art temp-37.9 po2-165* pco2-40 ph-7.28* caltco2-20* base xs--7 intubat-intubated 04:37pm blood cortsol-34.9* 04:37pm blood hbsag-negative hbsab-positive hbcab-negative 04:37pm blood hcv ab-negative microbiology data: blood cultures from , x 2, x 2, x 2, x 2, x 2, : negative urine cultures from : negative urine legionella from : negative sputum cultures from , , : negative sputum cultures from : yeast (contaminant) stool c. diff toxin a&b from , , , x 2: negative stool o&p from , : negative key imaging: admission cxr from : there is diffuse opacification of the lungs bilaterally which is consistent with multifocal pneumonia versus ards. the heart size is mildly enlarged. the mediastinal silhouette is within normal limits. abd us: 1. cirrhotic liver, ascites, and splenomegaly, reflecting chronic liver disease. 2. non-occlusive thrombus within the main portal vein, with extremely slow flow throughout the portal venous system. patent hepatic veins and hepatic artery. 3. possible subhepatic fluid collection. tte: the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. ct torso w/ contrast: 1. pancolitis, likely due to c. difficile. 2. ascites. 3. hypodense kidneys that do not excrete contrast. according to dr. , the patient is on continuous dialysis. 4. pulmonary edema. no pleural effusion. 5. questionable fullness of the left adrenal gland, with no definite nodularity. attention should be made on the next follow-up. ct sinuses: 1. no evidence of acute sinusitis. 2. periapical lucencies associated with the maxillary incisors as described above, concerning for abscesses. . labs: na 144, k 3.1, cr 3.9, bun 60 wbc 9.5, hct 27.2, plt 96, inr 2.3, tbili 28.9 brief hospital course: alcoholic hepatitis, cirrhosis: ms. was admitted with profound alcoholic hepatitis complicated by shock, ards and arf requiring hemodialysis. her liver injury was likely in large part due to shock liver in the setting of baseline cirrhosis. (of note, other liver studies performed at the osh were negative including tylenol levels, , anti-mitochondrial antibodies, sm ab, rnp ab and hepatitis serologies.) imaging at showed evidence of cirrhosis, ascites and splenomegaly, as well as a non-occlusive thrombus within the main portal vein. total bilirubin maxed at 41 and trended downwards though was still persistently in the range of 29 at the time of discharge. the liver service followed her while in house; she is considered ineligible for a liver transplant given her substance abuse history. treatment with steroids and pentoxifylline was not pursued. she was started on ciprofloxacin for sbp prophylaxis. her hepatic encephalopathy was treated with lactulose and rifaximin. the results of cmv serologies were not obtained from the osh and may require followup shock: the origin of the patient's shock is presumed sepsis in the setting of fevers and findings of mssa bacteremia and e coli uti. she was also noted to have a pancolitis of unclear etiology (initially thought to be c diff though multiple stool studies were negative for c diff toxin). she had a negative tte to rule out endocarditis. she was treated with vancomycin and zosyn for the bacteremia and urinary tract infection. she also received empiric therapy with oral vancomycin and then oral flagyl for possible c diff. she did require vasopressors while in the icu. respiratory failure: the patient became hypoxic and required intubation in the setting of oliguric renal failure, volume challenge with ffp, and trendelenberg positioning for line placement while in the icu. her respiratory compromise may have been due to aspiration and/or flash pulmonary edema. she did develop bilateral pulmonary infiltrates concerning for ards. she received low-volume ardsnet ventilation. with treatment of the source of sepsis and dialysis the patient was successfully extubated. acute renal failure, requiring renal replacement therapy: ms. was thought to be in arf from profound atn in the setting of shock. urine output was minimal on admission with normal bladder pressure, and she eventually became fully anuric. the renal service followed her while in the hospital, and she was started on cvvh. blood pressures remained quite low weeks into admission, requiring cvvh dependence. in the final weeks of her hospitalization the patient was able to tolerate 3 times weekly scheduled hd. a tunneled dialysis line was placed by ir into the left ij. she remains dependent on midodrine for blood pressure elevation to allow significant filtration during hd. hypernatremia: on na had risen to 152. this was felt to be hypovolemic given inconsistant po intake secondary to altered mental status, ongoing diarrhea from lactulose, increasingly aggressive diaylsis. a free water deficit was calculated to be 4l. with hd and 1 l d5w her na improved to 144 on . the sodium should be trended at rehabilitation. thrombocytopenia, anemia: halfway through the admission, ms. had progressive thrombocytopenia with gradual decline in platelet counts from 143 () to less than 5 (). she also had persistently low hct in the low 20's, refractory to transfusions and without signs of overt bleeding. this was thought to be multifactorial related to liver disease, acute illness causing bm suppression, drugs (specifically zosyn & famotidine), and auto-immune mediated destruction (coombs positive, low haptoglobin). the heme-onc service was following the patient. a trial of iv solumedrol was begun on with gradual improvement in platelet counts and stabilization of hct. she was eventually transitioned to a prolonged prednisone taper. her platelets were stable around 100 prior to discharge. she is to follow up with hematology. mental status: the patient had persistent altered mental status during her hospitalization. this was felt potentially due to multiple etiologies including hepatic encephalopathy, toxic-metabolic encephalopathy (including potentially due to markedly elevated t bili), uremia (with bun peak at >100), sepsis and hypoxic brain injury. for a long period after extubation, the patient was a&ox1 to person only and was noted to perseverate on the word 'forty-four thousand.' in the days prior to discharge, the patient was at times more verbal, speaking in full sentences. at best she is oriented to person and place and still was waxing and levels of arousal and orientation. . sacral decub: the patient has stage 3 sacral decubitus ulcers. she was treated throughout her hospitalization by the wound care nursing team. she requires ongoing care of these sites. . the health care proxy, (h) , (w) , (c) confirmed that the patient is full code. medications on admission: medications at home: atenolol medications on transfer from osh: vancomycin po 250 mg q6h started zosyn 2.25 grams q6h started propofol gtt levophed gtt nadolol 40 mg daily insulin sliding scale lactulose pantoprazole 40 mg heparin sc 5000 units tid tpn discharge medications: 1. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed: not to exceed 2 gm daily. 2. miconazole nitrate 2 % powder : one (1) appl topical qid (4 times a day) as needed. 3. nystatin 100,000 unit/g cream : one (1) appl topical 5x/day (5 times a day) as needed. 4. midodrine 5 mg tablet : two (2) tablet po tid (3 times a day). 5. lactulose 10 gram/15 ml syrup : thirty (30) ml po tid (3 times a day): titrate to 1 liter of stool daily . 6. ciprofloxacin 250 mg tablet : one (1) tablet po q24h (every 24 hours): for sbp ppx. 7. rifaximin 200 mg tablet : two (2) tablet po tid (3 times a day). 8. ipratropium bromide 0.02 % solution : one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 10. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr po bid (2 times a day). 11. epoetin alfa 4,000 unit/ml solution : two (2) ml (8000 units) injection qmowefr (monday -wednesday-friday). 12. zinc sulfate 220 mg capsule : one (1) capsule po daily (daily). 13. ascorbic acid 250 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 14. calcium carbonate 500 mg tablet, chewable : one (1) tablet, chewable po tid (3 times a day). 15. heparin (porcine) 5,000 unit/ml solution : one (1) ml (5000 units) injection tid (3 times a day). 16. nystatin 100,000 unit/ml suspension : ten (10) ml po qid (4 times a day) as needed for thrush. 17. sevelamer hcl 400 mg tablet : two (2) tablet po tid w/meals (3 times a day with meals). 18. b complex-vitamin c-folic acid 1 mg capsule : one (1) cap po daily (daily). 19. sodium chloride 0.9% flush 10 ml iv prn line flush temporary central access-icu: flush with 10ml normal saline daily and prn. 20. insulin regular human 100 unit/ml solution : 2-12 units injection asdir (as directed): while on steroid taper. 21. prednisone 10 mg tablet : 1-6 tablets po as directed: 6 pills on , then 5 pills qd for 5 days, then 4 pills daily for 5 days, then 3 pills daily for 5 days, then 2 pills daily for 5 days, then 1 pill daily for 5 days, then 0.5 pills daily for 5 days. discharge disposition: extended care facility: radius rehab discharge diagnosis: septic shock hepatic encephalopathy shock liver thrombocytopenia, likely secondary to itp subacute renal faliure anemia alcoholic hepatitis cirrohsis decubitis ulcers discharge condition: stable, tolerating hd well. discharge instructions: you were admitted with multiple complex medical problems. likely you had overwhelming infection. this led to significant injury to your liver, kidneys, lungs and possibly brain. you completed a course of antibiotics for the infection. you are doing much better however you require ongoing care of multiple issues. . you must follow-up with a liver specialist for ongoing care of alcohol induced cirrhosis complicated by shock liver. . you must continue to receive hemodialysis 3 times weekly on monday, wednesday and friday. . complete a taper of the steroid prednisone for treatment of low platelets likely due to antibodies against your platelets, called itp. follow-up with a hematologist to further discuss this issue as well as your anemia or low numbers of red blood cells. . you must receive wound care at the site of your sacral decubitus ulcers or pressure sores on your back. . you will receive physical rehabilitation at a nursing facility. . take all medications as prescribed. . attend all follow-up appointments. . call your doctor or return to the hospital for any new or worsening fevers, chills, vomiting, diarrhea or any other concerning symptoms. followup instructions: you will continue to receive dialysis, wound care and rehabilitation through your nursing facility. . hematology (low platelets and low red blood cells): provider: , md phone: date/time: 10:30 . hepatology (liver): , md phone: date/time: 11:00 . establish new primary care after you leave the nursing facility. if you would like to be seen at please call to schedule an appointment. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis percutaneous abdominal drainage diagnoses: chronic kidney disease, stage v acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified acute and subacute necrosis of liver alcoholic cirrhosis of liver severe sepsis methicillin susceptible staphylococcus aureus septicemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure anoxic brain damage septic shock paralytic ileus methicillin susceptible pneumonia due to staphylococcus aureus pressure ulcer, lower back other ascites acquired hemolytic anemia, unspecified hepatic encephalopathy hyperosmolality and/or hypernatremia immune thrombocytopenic purpura acute alcoholic hepatitis portal vein thrombosis pressure ulcer, stage iii universal ulcerative (chronic) colitis 

Answer: The patient is high likely exposed to