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: percocet / codeine attending: chief complaint: found unresponsive major surgical or invasive procedure: none history of present illness: this is a 70 yof w/ a h/o chf ef 20%, dmii, cad , pvd, htn, copd, and ckd w/ a baseline cr of 2.0 who presents with not being "quite her self" x 1 days and found unresponsive at home by husband. fs was 20 given glucose and fs normal in er. initially upon presentation to er was obtunded and since has been improving. non cooperative to questioning. . in the ed, rectal temp 104. bp and hr had been normal as well as o2 sats normal. lactate 7. cvp was initially 13. given vanc and ceftriaxone (at meningitis doses) and flagyl. ct of abd / pelvis was s/p 3 liters ivf in ed. inr was 5.6. ekg j point elevation in v3, st depressions in v5-v6 which are not new. most recent set of vitals 36.7, 67, 107/68, 17, 100% on nasal cannula but now on non rebreather because svo2 is low. past medical history: pmh: 1. diabetes mellitus type ii on orals 2. cad 3vd 3. chronic systolic heart failure , ef 20% 4. multinodular goiter 5. hypertension 5. spinal stenosis 6. pvd s/p aortobifemoral bypass, left toe amputations 7. peripheral neuropathy 8. hyperlipidemia 9. depression 10. anemia 11. ckd stage iii with neuropathy, nephropathy 12. frequent falls/gait instability 13. cervical spondylosis s/p c4-7 laminectomy and fusion in 14. s/p choly 15. h/o sbos 16. copd social history: level of function prior to admission was ambulate household distances, wheelchair for community. lives in senior housing/elevator building with husband. used bedside commode in home. pack per day smoker for >40 yrs, denies etoh, denies illicit drug use. worked as salesclerk and for the turnpike. has five children, two living. family history: five children, three living. one from hiv, one shot, one drugs. husband reports both her parents died from "cancer i think, trouble breathing." one son has seizures. physical exam: vitals: t: 104.8 in er (axillary 95 in icu) bp: 125/70 hr: 64 rr: 15 w/ periods of apnea o2sat: 99-100% ra gen: patient is responsive to verbal stimuli, she is able to follow with her eyes the interviewer but unable to follow any other commands, she is unable to answer any questions. heent: peerl (3-4mm bilat), eomi, sclera anicteric, no epistaxis or rhinorrhea neck: jvp 14cm, no thyromegaly or cervical lymphadenopathy, trachea midline cor: rrr, hsm at llsb and at apex pulm: lungs ctab, no w/r/r, however patient not following commands so poor inspiratory effort abd: soft, nt, nd, +bs, no hsm, no masses ext: pitting 1+ edema to knees, darkening of skin on lower extremities. neuro: 1+ reflexes biceps, triceps, achilles, patellar reflexes all bilaterally symmetric, muscle tone is increased in the upper and lower extremities pertinent results: 07:19pm potassium-5.1 07:19pm ck(cpk)-85 07:19pm ck-mb-4 ctropnt-0.18* 04:36pm urine hours-random urea n-251 creat-87 sodium-56 04:36pm urine bnzodzpn-negative barbitrt-negative opiates-negative cocaine-negative amphetmn-negative mthdone-negative 01:49pm lactate-3.3* 01:49pm hgb-11.1* calchct-33 o2 sat-83 12:33pm lactate-3.2* 11:32am lactate-3.8* 11:25am ck(cpk)-75 11:25am ck-mb-3 ctropnt-0.16* 11:25am vit b12-greater th folate-greater th 11:25am free t4-0.79* 11:25am asa-neg acetmnphn-6.0 bnzodzpn-neg barbitrt-neg tricyclic-neg 10:37am type-mix intubated-not intuba comments-green top 10:37am lactate-4.5* k+-5.5* 10:37am o2 sat-84 08:44am comments-green top 08:44am glucose-122* lactate-7.6* na+-142 k+-6.3* cl--102 08:30am glucose-126* urea n-59* creat-3.9*# sodium-140 potassium-6.3* chloride-101 total co2-23 anion gap-22* 08:30am alt(sgpt)-412* ast(sgot)-1161* ck(cpk)-65 alk phos-103 tot bili-1.5 08:30am lipase-28 08:30am ck-mb-notdone ctropnt-0.21* 08:30am albumin-2.6* calcium-8.3* phosphate-6.9*# magnesium-2.0 08:30am tsh-36* 08:30am t4-4.4* t3-41* 08:30am hbsag-negative hbs ab-negative hav ab-negative igm hbc-negative igm hav-negative 08:30am wbc-11.5*# rbc-3.29* hgb-11.1* hct-35.5* mcv-108* mch-33.9* mchc-31.4 rdw-19.5* 08:30am neuts-86.7* lymphs-9.0* monos-4.2 eos-0.1 basos-0 08:30am plt count-197 08:30am urine rbc-0 wbc-0-2 bacteria-few yeast-none epi-0 08:30am urine blood-sm nitrite-neg protein-500 glucose-neg ketone-tr bilirubin-neg urobilngn-1 ph-6.0 leuk-neg 08:30am urine color-amber appear-clear sp -1.021 08:30am pt-49.2* ptt-33.9 inr(pt)-5.6* 08:30am plt count-197 08:30am neuts-86.7* lymphs-9.0* monos-4.2 eos-0.1 basos-0 08:30am wbc-11.5*# rbc-3.29* hgb-11.1* hct-35.5* mcv-108* mch-33.9* mchc-31.4 rdw-19.5* 08:30am hbsag-negative hbs ab-negative hav ab-negative igm hbc-negative igm hav-negative 08:30am t4-4.4* t3-41* 08:30am tsh-36* 08:30am albumin-2.6* calcium-8.3* phosphate-6.9*# magnesium-2.0 08:30am ck-mb-notdone ctropnt-0.21* 08:30am lipase-28 08:30am alt(sgpt)-412* ast(sgot)-1161* ck(cpk)-65 alk phos-103 tot bili-1.5 , ct abdomen/pelvis:impression: 1. limited study without oral or intravenous contrast. sensitivity for detecting abscess or bowel ischemia is markedly diminished. 2. umbilical hernia is seen containing non-obstructed bowel loops. 3. multiple bilateral non-obstructing renal stones without evidence of hydronephrosis. 4. cardiomegaly and bilateral pleural effusions. 5. ascites. 6. diffuse atherosclerotic disease. , tte:the left atrium is elongated. the right atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 10-20mmhg. there is mild symmetric left ventricular hypertrophy. the left ventricular cavity size is top normal/borderline dilated. there is severe global left ventricular hypokinesis (lvef = 15-20 %). no masses or thrombi are seen in the left ventricle. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. the right ventricular cavity is dilated with severe global free wall hypokinesis. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. moderate tricuspid regurgitation is seen. the tricuspid regurgitation jet is eccentric and may be underestimated. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. . cxr :impression: likely slight increase in right pleural effusion compared to with difficult comparison to because of differences in position. persistent chf and left lower lobe atelectasis. . ruq us: impression: very limited examination secondary to patient cooperation. patent hepatic veins and ivc. to-and-fro flow within the main portal vein may indicate underlying hepatic congestion or an underlying primary hepatic process. , ct head;findings: there is no evidence of hemorrhage, recent infarction, hydrocephalus or edema. there is an old lacune in the extreme capsule on the left. there is cerebral atrophy and small vessel ischemic change. the included paranasal sinuses and mastoid air cells are clear. there are no fractures. impression: no acute intracranial processes. old lacune. . cxr : impression: 1. low lung volumes and interval increase in bilateral pleural effusions and pulmonary vascular congestion. 2. paucity of abdominal gas suggesting ascites. brief hospital course: this is a 70 yof w/ a h/o chf ef 20%, dmii, cad , pvd, htn, copd, and ckd w/ a baseline cr of 2.0 found unresponsive by her husband. initial presentation was felt to be due to acute liver failure. her course was complicated by acute renal failue, liver failure, coagulopathy, and dic. below is her course by system. she was in the icu from , and then on the general medical floor. . # delerium/altered mental status/dementia: the patients acute change in mental status was ultimately thought to be due to the patient initially was found to be unresponsive by husband- seems as though she had been lethargic for at least 10 days. she also has been profoundly hypothyroid in the past and also has a ? of underlying alzheimers dementia with fluctuating mental status in the past as well. in the presence of fever, it was thought that patient was infected. given mental status was altered and no other localizing source,there was initial concern for meningitis. lp was not attempted because of elevated inr and thrombocytopenia. the patient was covered for several days with vanc/ctx/amp for empiric meningitis coverage (2 days) and then just ctx/flagyl for 3 days to cover for sbp. she ruled out for pneumonia with a negative cxr, head ct was negative, ct abd/pelvis negative, there was no clot in ivc on ruq us, and minimal ascites on ultrasound. the pt did have elevated tsh levels, but thyroid function is unreliable in this setting of acute illness. her tsh prior to admission was similar, and her levothyroxine had recently been increased to 88 mcg daily as an outpatient. the patient was started on lactulose as per below, and her mental status gradually improved. of note, recent mri showed changes most consistent with alzheimer's dementia. she had been seen by behavioral neurology by dr. , and it is felt she suffers from a mixed etiology disorder involving microvascular and probable alzheimer's disease encephalopathy. she was noted to have some rigidity and cogwheeling on exam, body dementia and parkinsons' need to be evaluated as an outpatient. she will follow up with neurology (dr. ) . # lactic acidosis: initial lactate of 7.6 on admission resolved with fluid resuscitation. . # renal failure: her creatinine was 3.9 on admission, with baseline of 2.0. thought to be prerenal, trended down with ivf. no hydronephrosis on ct scan. her hctz, lisinopril, and lasix were all held. after her renal failure was resolving with cr down to 2.3 and pt was in acute chf, lisinopril and lasix were restarted. . # acute hepatitis: the patient presented with picture c/w acute hepatitis, of unclear etiology. her alt was 412 and ast 1161 on admission. tox screen was negative. the patient was seen by hepatology and it was felt that perhaps her hepatitis was drug induced. she has known hepatitis c, but this was felt unlikely to cause her acute liver failure. liver us was negative for portal vein thrombosis. she was started on rifaximin and lactulose with improvement in her encephalopathy. hep b serologies, hep a serologies were negative. hep c viral load was greater than 1,000,000. she will need outpatient hepatology follow up (has follow up at the end of ). -hepatitis e ab ordered and pending . # coagulopathy: felt to be due to dic and worsening liver failure. schisotcytes were seen on initial smear, which improved. hematology/oncology was consulted and felt pt likely had dic. her platelets dropped to the 30s and then began to recover. her inr rose to 11.3 and then improved. she did receive some vitamin k. heparin dependent ab was negative. antithrombin (at), protein c, and protein s, factor v and viii levels were all low. hematology felt.... . # acute on chronic systolic heart failure: ef 15-20%. appeared stable on repeat echo this admission. pt also has mod-severe tr/mr. last stress test had shown no defect, but this was on rest imaging. per her cardiologist, dr. , the patient's heart failure is not likely ischemic in nature. this cardiomyopathy has been new since . the etiology of her chronic systolic heart failure is unclear. lasix, lisinopril, and hctz were held on admission for acute renal failure, hypernatremia, and dehydration. she was treated with several days of iv d5w. she was noted to have increasing pleural effusions, o2 requirement, and bnp of >70,000. her lisinopril was restarted once her creatinine was 2.3 and she was given iv lasix. her metoprolol was changed to carvedilol per dr. to give better afterload reduction. dr. advised against aladactone given her crf and predisposition to hyperkalemia. . # macrocytic anemia: b12 and folate were normal, her hct remained stable around 34 despite dic. . # fever: the patient had a fever of 104 on presentation. ultimately this was felt to be due to hepatitis. her initial work up was negative for any other acute infectious source. as per above, she was covered with antibiotics initially for concern of meningitis or sbp. her fever had resolved by hd #3. urine cultures grew yeast. her foley was removed. . # htn: the pt is on metoprolol, lisinopril and hctz at home. her hctz and lisinopril were held given her acute renal failure. her metoprolol was increased and she was started on norvasc. lisinopril was restarted after her acute renal failure resolved. , # ? cad: no history of recent stents in our system but on aspirin and plavix on admission. in fact, there is no evidence the patient has cad, but this keeps being written in her notes. she was cotinued on metoprolol and aspirin, but her plavix was held in the setting of dic/thrombocytopenia. per dr. , her cardiologist, the plavix does not need to be restarted as we have no evidence the pt has cad. . . # elevated d-dimer/fdp: the patient had a d dimer trending up to 7000, but no further evidence of dvt. leni of the bl le were negative for dvt. it is possible the pt has a pe which has been brought up before, but she could not have a cta due to her renal failure, no vq scan due to pulmonary edema, and no heparin given her thrombocytopenia and elevated inr. she had no dvt in either the l or r lower extremity and no portal vein clot on us. . thrombocytopenia: due to dic, the pts plts decreased to the 30s but gradually trended back up to ____ at the time of discharge. . #. lle dvt: diagnosed . was on coumadin as an outpatient. her coumadin was stopped given her dic and coagulopathy. repeat le us showed no dvt. in discussion with hematology oncology, it was felt further anticoagulation is not necessary. . .#. hypernatremia: thought to be due to poor po intake. the patient had a sodium up to 149, improved with d5w. . #. hypoglycemia/diabetes mellitus type ii, controlled, no complications: hypoglycemia on admission was thought to be in setting of liver failure. this was treated with several days of d5w infusion. she was maintained on sliding scale insulin. , # pleural effusions: be related to 3rd spacing in setting of acute illness, chronic chf. her chf was treated as per above. . #. hypothyroidism: labs unreliable in setting of acute illness. most recently pts levothyroxine had been increased to 88 mcg as outpatient due to elevated tsh. she was continued on this dose. . #. copd: no evidence of flare. she was continued on albuterol/ipratropium nebs prn . # depression: holding wellbutrin in setting of hepatic failure . #. fen. thin liquids, ground consistency solids; w medications on admission: colace coumadin 2 mg daily omeprzole 20 mg daily lasix 20 mg in am and 80 mg in pm vit d 400 plavix 75 mg daily metoprolol 25 mg daily lisinopril 40 mg daily hctz 25 mg daily buproprion 150 mg daily asa 81 mg daily neurontin 100 mg at night levothyroxine 75 mcg daily imdur 30 mg daily ultram ms discharge medications: 1. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). disp:*60 tablet, chewable(s)* refills:*2* 2. lactulose 10 gram/15 ml syrup : thirty (30) ml po tid (3 times a day). disp:*2700 ml(s)* refills:*2* 3. furosemide 20 mg tablet : one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 4. levothyroxine 88 mcg tablet : one (1) tablet po once a day. disp:*60 tablet(s)* refills:*2* 5. lisinopril 20 mg tablet : two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 6. carvedilol 25 mg tablet : one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 7. norvasc 5 mg tablet : one (1) tablet po once a day. disp:*60 tablet(s)* refills:*2* 8. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). disp:*60 tablet,rapid dissolve, dr(s)* refills:*2* 9. ipratropium bromide 17 mcg/actuation aerosol : two (2) puff inhalation qid (4 times a day). disp:*1 1* refills:*2* 10. tramadol 50 mg tablet : pill tablet po q12h (every 12 hours) as needed for prn pain. disp:*30 tablet(s)* refills:*0* 11. rifaximin 200 mg tablet : two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 12. bupropion 150 mg tablet sustained release : one (1) tablet sustained release po once a day. disp:*30 tablet sustained release(s)* refills:*2* 13. vitamin d 1,000 unit tablet : one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 14. plavix 75 mg tablet : one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 15. fluticasone-salmeterol 250-50 mcg/dose disk with device : two (2) disk with device inhalation (2 times a day). disp:*1 disk with device(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: acute liver failure acute renal failure diffuse intravascular coagulation hypoglycemia acute on chronic systolic heart failure delirium hypothyroidism discharge condition: stable discharge instructions: you were admitted with acute liver failure, acute renal failure, hypoglycemia, and delerium. you were treated supportively. you also developed acute heart failure, which was treated with diuretics. followup instructions: 1. neurology: dr. ; appointment on at 1 pm; building, , , phone: . 2. hepatology (liver doctor): provider: , md phone: date/time: 12:00 pm, at , , , liver center . 3. needs appt with dr. (a resident at ) 4. needs appt with dr. in weeks procedure: venous catheterization, not elsewhere classified diagnoses: other primary cardiomyopathies acidosis anemia in chronic kidney disease coronary atherosclerosis of native coronary artery congestive heart failure, unspecified chronic hepatitis c with hepatic coma acute kidney failure, unspecified unspecified septicemia chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes other and unspecified hyperlipidemia chronic kidney disease, stage iii (moderate) defibrination syndrome diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled long-term (current) use of anticoagulants personal history of venous thrombosis and embolism alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance hyperosmolality and/or hypernatremia acute on chronic systolic heart failure systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled nontoxic multinodular goiter 

Answer: The patient is high likely exposed to