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: transfer from osh for further management of acute renal failure, liver failure, anasarca, and hypothermia major surgical or invasive procedure: intubation and mechanical ventilation history of present illness: 80-year-old female with systolic heart failure, atrial fibrillation previously on coumadin, diabetes mellitus type ii, primary biliary cirrhosis-autoimmune hepatitis overlap syndrome previously followed by dr. transferred from osh with acute on chronic renal failure, liver failure, anasarca, pancytopenia, and hypothermia. per review of osh summary, she was initially admitted to hospital on with increased lower extremity edema, increased abdominal girth, and dyspnea on exertion. this was associated with decreased urine output, weakness, and nausea. hospital course at hospital was as follows: - acute on chronic renal failure - creatinine 3.5 on admission, up from 2.7 on . suspected secondary to atn vs. prerenal azotemia. urine protein to creatinine ratio 4.5 on . renal ultrasound wnl. initially anuric. with administration of ivf, albumin, and furosemide with increased output, and urine output increased during remainder of hospital course - until days preceding transfer. creatinine continued to rise. evaluated by renal service; hd line not placed secondary to thrombocytopenia, and recommended cvvh to minimize fluid shifts. renal biopsy considered but refused by family. - hyperkalemia - serum potassium 6.0 on morning of transfer. given kayexelate pr prior to transfer. - fluid overload - tte with ef 60% and no diastolic dysfunction. - aortic valve vegetation - noted on tte on . negative blood cultures. sle suspected, studies sent. - hematemesis - approximately 500cc on . hematocrit dropped from 29-31 to 25. egd with grade i varices, nonbleeding and erosive gastropathy. protonix gtt started; octreotide not started. she received 2+ unit prbc transfusions. - hypotension - midodrine started. sbp stable 90-100. - hypothermia - temperature decreased to 85.3 rectal on . blood cultures, peritoneal cultures negative to date. leukopenic with 22% bandemia. ertapenem started for suspected intraabdominal process. tsh 10, high t3, and borderline low t4. cortisol studies wnl. - cirrhosis - longstanding, and suspected secondary to aih/pbc. complicated by esophageal varices. albumin 2.8, inr 1.9. s/p paracentesis 2.6 liters with improvement in dyspnea. saag 1.4. ruq ultrasound with patent vasculature. hiv negative but cd4 248. hepatitis serologies negative. - thrombocytopenia - nadir 25, required platelet transfusions. s/p bone marrow biopsy on . hit antibody negative . concern for itp; solumedrol 20mg iv tid started . bone marrow biopsy performed , results pending. elevated d-dimer, fdp; no schistocytes on peripheral smear. - hematuria - right pleural effusion - altered mental status - associated with somnolence, confusion, and asterixis. suspected secondary to hepatic encephalopathy. - suspected malignancy - followed by dr. at osh. reportedly with concern for "multiple myeloma, poems syndrome, waldenastroms, amyloidosis, monoclonal gammopathy." inconclusive cytology of ascites, inconclusive but abnormal spep, normal bone scan, cea 6.6 (), afp wnl (), ca19-9 wnl (). of note, she was admitted to same osh in with acute on chronic renal failure and decompensated heart failure. this was also associated with large volume ascites, anasarca. her lasix dose was decreased and anti-hypertensive regimen changed. mulitple myeloma was suspected for an unknown reason and heme/onc evaluation was reportedly inconclusive. on arrival to micu, patient is non-verbal. she presents with family friends, who report she was conversant yesterday, but not today. review of systems: unable to obtain past medical history: - primary biliary cirrhosis with a crossover syndrome, negative ama and positive 1:320; liver biopsy () "consistent with a cholangitic hepatitis. possible etiologies include immune- mediated injury (psc, pbc), and drug-related damage." previously maintained on ursodiol. lost to follow-up after . - systolic heart failure - tte lvh, moderate la and rv enlargment, moderate mr, severe tr and mild ai, global hypokinesis ef 40%; repeat tte with ef 60%, mild lvh - atrial fibrillation previously on coumadin - chronic renal failure - type ii dm, hga1c 6.9 on - hyperlipidemia - hypertension - gallstones - h/o cva avm - h/o bell's palsy social history: (per osh summary) lives alone in , but family is involved in her care. able to do all her adls. no smoking history. denied etoh, illicit drug use. family history: unable to obtain physical exam: 87.0; 99/54; 70 (v-paced); 22; 93% 2l nc general: tracks with eyes; follows commands (protrudes tongue, squeezes hands; non-verbal heent: sclera anicteric, dry mucous membranes, oropharynx clear (limited view) neck: supple; jvp to angle of mandible at approximately 45 degrees lungs: shallow respirations; coarse breath sounds, likely related to upper airway noise; scattered rhonchi cv: decreased heart sounds; regular rate and rhythm; normal s1/s2; no murmurs appreciated; no friction rub appreciated abdomen: hypoactive bowel sounds; distended; no fluid shift; nontender; with ultrasound, minimal ascites seen gu: foley ext: cool; 1+ radial/dp pulses; 1+ edema to shins, and in arms neuro: squeezes hands bilaterally; protrudes tongue; positive asterixis pertinent results: 07:45pm wbc-3.2*# rbc-3.06*# hgb-8.9*# hct-26.1*# mcv-85 mch-29.0# mchc-34.0 rdw-20.3* 07:45pm neuts-46* bands-25* lymphs-8* monos-16* eos-0 basos-0 atyps-0 metas-5* myelos-0 nuc rbcs-48* 07:45pm hypochrom-2+ anisocyt-1+ poikilocy-1+ macrocyt-normal microcyt-1+ polychrom-normal spherocyt-1+ target-1+ burr-1+ teardrop-1+ 07:45pm plt smr-very low plt count-75*# 07:45pm pt-30.1* ptt-46.1* inr(pt)-3.0* 07:45pm fibrinoge-357 07:45pm alt(sgpt)-31 ast(sgot)-54* ld(ldh)-208 ck(cpk)-79 alk phos-125* amylase-175* tot bili-1.3 07:45pm albumin-3.1* calcium-8.7 phosphate-5.7* magnesium-2.9* 07:45pm haptoglob-118 07:45pm glucose-116* urea n-128* creat-4.8*# sodium-134 potassium-5.5* chloride-100 total co2-21* anion gap-19 cxr: single portable chest radiograph demonstrates cardiomegaly. there is mild congestive failure. there are small bilateral pleural effusions. there is mild bilateral bibasilar atelectasis. a single-lead pacer is present. ct head: no evidence of acute intracranial abnormalities. ct chest/ abdoman/ pelvis: ct chest: the patient is intubated with the tip of the endotracheal tube approximately 1.7 cm from the carina. there are moderate bilateral pleural effusions, greater on the right. there is bibasilar dependent atelectasis. in the right upper lobe (2:19, 2:21) are multifocal tree-in- opacities likely reflecting foci of infection. the airways are patent to the segmental levels bilaterally with air bronchograms, particularly in the left lower lobe. the heart is enlarged with pacer wires. there are coronary artery vascular calcifications. the central catheter tip terminates at the cavoatrial junction. no pericardial fluid is noted. there is no apparent axillary, hilar, mediastinal lymphadenopathy, but this evaluation is limited. ct abdomen: there is a large volume of intra-abdominal ascites or intra-abdominal fluid. evaluation of solid intra-abdominal organs is limited by lack of iv contrast, though given these limitations, the spleen, adrenals, pancreas, and kidneys appear normal. the liver appears small and may have a nodular contour. the gallbladder is not well visualized. there is a catheter within the stomach. loops of small bowel in the upper abdomen measured 2.5 cm in greatest dimension may reflect a slight degree of ileus. there is atherosclerotic disease of the abdominal aorta, but no aneurysmal dilatation. there is no free air within the abdomen. ct pelvis: there is large volume pelvic fluid. there are diverticula in the sigmoid colon. loops of colon appear grossly normal, though evaluation is limited. no free air is present in the pelvis. there is a foley within a decompressed bladder. a few locules of air adjacent to the foley catheter (2:99) likely represent air within the bladder secondary to foley instrumentation. there is a catheter within the rectum. bone and soft tissue windows: there is body wall anasarca. there are degenerative changes of the lower lumbar spine with grade 1 anterolisthesis of l4 on l5. there are erosive changes at bilateral sacro-illiac joints along the illiac surface. no suspicious sclerotic or lytic lesions are present. impression: 1. bilateral pleural effusions, right greater than left with atelectasis. tree-in- opacities in the right upper lobe may reflect infection or asymetric edema. 2. large volume of abdominal pelvic ascites. 3. minimally prominent loops of small bowel may reflect mild ileus; no bowel obstruction. 4. sigmoid diverticulosis, but no diverticulitis. 5. no free intra-abdominal air. 6. anasarca. brief hospital course: #. hypothermia: large differential, including infection (bandemia), hypothyroidism, ich, hypoglycemia. hypothermia falsely elevates hematocrit, interferes with coagulation cascade, and causes electrolyte derangements. patient was warmed with bear-hugger and given warmed iv fluids. temperatures were monitored closely. cultures were negative. ct abdomen performed showed pelvic ascites but there was not enough ascites on bedside ultrasounds for paracentesis. tsh was 10.0. she was monitored closely on tele and had intermittent episodes of hypothermia which resolved with a warming blanket. #. acute on chronic renal failure: per osh report complicated by significant proteinuria. also with hyperkalemia (improved from osh; ekg difficult to interpret given v-paced), fluid overload (maintained oxygen saturation on 2l nasal canula). concern for hepatorenal given known liver disease and stigmata of cirrhosis/portal hypertension, although synthetic function is relatively preserved. other etiologies includes microangiopathy related to known autoimmune hepatitis, nephrotic syndrome, atn, medication side effect, malignancy. evaluated by renal while here. did not undergo dialysis. #. hyperkalemia: ekg changes difficult to interpret given v-paced. potassium monitored closely- level decreased well while here. #. altered mental status: admission- non-verbal; responds to commands. by , patient was no longer responsive to verbal stimuli. most likely multifactorial in the setting of multiple active medical conditions. #. gi bleed: grade i varices/gastritis > sigmoid diverticulosis given melanotic stool and reported hematemesis last week. hematocrit decreased from am, and concern for falsely elevated hematocrit given hypothermia. she was on octreotide and ppi gtt while here. she had some melena while here- she required prbcs with appropriate bump in hct. #. anemia: secondary to gi bleed, as above. #. pneumonia: given altered mental status, suspect aspiration pneumonia. patient was on vanco and zosyn while here. # fen: warmed ivf, replete electrolytes, npo # communication: patient. daughter- . son- # code status: dnr/dni patient made cmo on . all medications (including pressors) were discontinued and she was placed on a morphine gtt. she was extubated and passed away within 30 minutes. medications on admission: albuterol sulf (ventolin hfa 2 puffs) inh every 4 hours as needed ertapenem (invanz) 0.5 gm iv daily - **note: iv/sq route methylprednisolone sod succ (solu-medrol) 20 mg iv every 8 hours - **note: iv/sq route midodrine (proamatine) 10 mg by mouth three times a day multivitamin tab (tab-a-vite) 1 tablet(s) by mouth daily ondansetron (zofran) 4 mg iv every 6 hours as needed - **note: iv/sq route pantoprazole sodium (protonix) iv drip at 10cc/hr - **note: iv/sq route discharge medications: n/a discharge disposition: expired discharge diagnosis: septic shock, respiratory failure, acute on chronic kidney failure discharge condition: expired discharge instructions: n/a followup instructions: n/a procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube diagnoses: hyperpotassemia acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hepatorenal syndrome unspecified septicemia severe sepsis portal hypertension atrial fibrillation chronic kidney disease, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus septic shock hepatic encephalopathy acute on chronic systolic heart failure biliary cirrhosis 

Answer: The patient is high likely exposed to