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: no known allergies / adverse drug reactions attending: chief complaint: fatigue, weakness major surgical or invasive procedure: liver biopsy , (?) guided liver biopsy : exploratory laparotomy, evacuation of liver hematoma, opening of the diaphragm and evacuation of about 2 liters of blood from the right chest, placement of tube thoracostomy, repair of the diaphragm opening and liver biopsy. history of present illness: 57y f w pmh of hcv cirrhosis s/p olt with multiple admissions in last month presented to sicu on from home w complaint of worsening fatigue. family and vna noted increasing service need and son and sister who live nearby report concern about poor endurance as well. she has had a series of admissions over the last 2 months: transplanted for hcv cirrhosis and c/o nausea and fevers. her postop course was c/b persistent gi symptoms including n/v and poor po intake requiring tubefeeds. mid (approx 6 weeks post transplant) lfts started to go up requiring readmission and liver bx showed early recurrent hcv. she had intractable n/v during her 2 week stay. she was discharged home and reports worsening fatigue in the 3 days prior to admission. . on admission, her lfts were markedly increased; ast/alt doubled. of note, valcyte dc'd last admission. she currently has cmv viral load pending. she was continued on home tubefeeds. . currently pt, denies any nausea or vomiting since . no current complaints aside from poor appetite, fatigue and weakness. believes that she was in similar state of health at time of discharge on however was not engaging in adls until she went home and felt extreme fatigue. no fevers at home. stooling normally. no confusion. . ros: (+) per hpi (-) denies fever, chills, night sweats, headache, vision changes, rhinorrhea, congestion, sore throat, cough, shortness of breath, chest pain, nausea, vomiting, diarrhea, constipation, brbpr, melena, hematochezia, dysuria, or hematuria. past medical history: - chronic hepatitis c infection remote cocaine use (genotype 1). failed two courses of antiviral therapy in and , interferon nonresponsive. - biopsy-confirmed cirrhosis due to chronic hepatitis c . psh: - olt for hcv cirrhosis - hysterectomy at age 25 fibroids - umbilical hernia repair as a child social history: pt lives with her sister in . she denies smoking, etoh, or drugs. family history: gastric cancer - egd in did not show any abnormalities. physical exam: vitals: wt 49.3kg t 97.1 bp112/70 hr65 rr18 o2sat100/ra fs: 158-334 i/o: (on) 1160/625 bmx2 general: very thin, aaf, appears weak lying in bed, pleasant and conversational skin: no jaundice or rashes, warm, dry and intact, poor skin turgor heent: eomi, anicteric, conjunctiva pink, mmm, no oral lesions cardiac: rrr, nml s1/s2, no m/r/g lungs: poor respiratory effort, but ctab abdomen: normal bs all quadrants, flat, nt, no guarding or rebound extrem: wwp, no edema, 2+ radial/dp pulses neuro: a&ox3, no asterixis, cn ii-xii grossly intact, motor and sensory function grossly intact pertinent results: ruq u/s : 1. normal liver echogenicity. 2. no extra-, intra-hepatic biliary duct dilatation. 3. patent hepatic vasculature with appropriate waveforms. 4. echogenic material about porta hepatis, unchanged. 5. tiny 9-mm punctate echogenic focus with no internal flow in the right liver lobe, nonspecific, but likely hemangioma. 6. slightly delayed upstroke in the right hepatic artery similar to prior. . mri w/wo contrast 1. no evidence of biliary obstruction. 20 minutes post eovist administration, no biliary excretion was seen, indicating biliary dysfunction. 2. no evidence of portal stenosis, indicating a successful intervention. 3. hepatic arterial anastomosis cannot be assessed on the current study due to motion limited arterial sequence. 4. multilobulated cystic lesion in the uncinate process of the pancreas measuring 1 x 1.2 cm. a followup mrcp is recommended in one year. . chest xray pa/lateral : as compared to the previous radiograph, there is no relevant change. normal size of the cardiac silhouette. normal course of the dobbhoff tube. unremarkable structure and transparency of the lung parenchyma, no evidence of focal parenchymal opacities suggesting pneumonia. no pulmonary edema. no pleural effusions. . ruq u/s : 1. patent vasculature with normal directional flow and no post-biopsy complication identified. slight interval increase in resistive indices withinthe left hepatic artery, as well as unchanged systolic blunting in right hepatic artery, are nonspecific but could relate to underlying parenchymal abnormality. 2. trace right pleural effusion. . ugi series : abrupt change in caliber of the third portion of the duodenum, may represent sma syndrome . abd kub : portable ap chest radiograph was reviewed in comparison to . the jejunal tube is noted with its tip most likely in the proximal jejunum. contrast material is demonstrated in the colon, most likely related to fluoroscopy obtained on . there is no evidence of bowel wall dilatation demonstrated. air and contrast are seen till the level of the rectum. . ct abd/pelvis wo contast : 1. limited evaluation due to the lack of iv contrast and the presence of oral contrast causing significant streak artifact from the recent upper gi study. however, within this limited examination, there is no evidence of retroperitoneal hematoma. 2. non-contrast appearance of the pancreas is within normal limits; however, significant streak artifact obscures most of the head of the pancreas. 3. small to moderate ascites. 4. mildly thickened distal colon, likely due to underdistension. . rush liver bx: 1. prominent bile duct damage with associated portal/periportal neutrophils and minimal mononuclear inflammation, as well as numerous apoptotic hepatocytes most consistent with recurrent viral hepatitis c. 2. no endothelialitis or other features supportive of acute cellular rejection are seen. 3. marked canalicular and hepatocellular cholestasis with associated neutrophils and feathery degeneration of hepatocytes. 4. trichrome and iron stains are pending and will be reported in an addendum. . note: in comparison to the previous biopsy (s10-47976s), the current biopsy shows a marked decrease in the mononuclear component of the portal inflammation, but an increase in the extent of cholestasis. the amount of bile duct injury remains unchanged. the worsening of the cholestasis together with the focal sinusoidal fibrosis on the previous biopsy raises the possibility of fibrosing cholestatic hepatitis in this patient in the clinical setting of recurrent hcv with high viral load. . brief hospital course: 57 yo w with hep c cirrhosis s/p orthotopic liver transplant with fibrosing cholestatic hepatitis from recurrent hepatitis c seen on liver biopsy . , n/v & abdominal pain secondary to superior mesenteric artery syndrome. hcv viral load on was 1,790,000,000. daily interferon and ribavirin were started. repeat hcv vl on was 667,000,000. bilirubin peaked at 23.5, and slowly continued to trend down. given recent evidence showing a possible advantage of rapamune in post-transplant patients with recurrent hep c, cellcept and prograf were transitioned to just daily rapamune. levels were checked daily and dose adjusted appropriate. she was continued on bactrim and valganciclovir for prophylaxis. she experienced abdominal pain and nausea likely related to recurrent hepatitis c and superior mesenteric artery syndrome (as seen on upper gi series), that improved somewhat over the course of her admission. work up for infectious etiology was negative. ct a/p was unremarkable. she received post-pyloric tube feeds and symptom control with small doses of oxycodone as needed for pain with iv morphine for breakthrough, and zofran for nausea. ppi and reglan were discontinued during this admission, as the patient felt she was taking too many pills and this was causing the nausea. mood was depressed, and escitalopram was increasesd to 20 mg daily. social work was consulted and arranged a family meeting to discuss the continued need for support and frequent visits. psychiatry was consulted, who agreed with current medication management and recommended the possible addition of a stimulant in the future. tube feedings were given. dm was managed with basal, and sliding scale insulin to obtain reasonable control of the patient's blood sugar levels. twice during her admission bicarbonate decreased with urine lytes revealing a positive urine anion gap, suggestive of an rta. on the first occasion she was hyperkalemic, consistent with a type iv rta, and was started on fludrocortisone. this was then discontinued secondary to hypertension and hypokalemia. she also experienced hypernatremia that resolved with the addition of free water to tube feeds. repeat liver biopsy was done on . she developed worsening ruq pain over the following days with subsequent hct drop to 22 on from 32 on . platelet count had dropped to 93 from 143. liver duplex was done to evaluate for concern for hematoma. duplex demonstarted large subcapsular hematoma. prbc and plt were ordered. during initialy transfusion, she spiked a temperature to 101. cxr was done for worsening respiratory function. this revealed opacification of the right hemithorax consistent with accumulation of a large amount of pleural fluid. she was sent to ir for angio that showed active extravasation from r hepatic branch that was unable to be embolized. she was transferred to the sicu where she intubated for worsening respiratory status. ct a/p demonstrated large subcapsular liver hematoma causing indentation of the left lateral margin of the liver extending from the dome to the inferior edge. on hepatic duplex showed stable size of hematoma and patent vessels. she received 4u prbc, 1u ffp, 1u platelets with lasix after blood products. hct remained stable after 4th unit of prbc. vanco and zosyn were started. pan-culturing was done. on , she was taken to the or for exploratory laparotomy, evacuation of liver hematoma, opening of the diaphragm and evacuation of about 2 liters of blood from the right chest, placement of tube thoracostomy, repair of the diaphragm opening and liver biopsy for post liver biopsy ()hemorrhage. surgeon was dr. . postop, she was transferred back to the sicu for management. cxr on showed progressive decrease in the fluid within the right pleural space. cxr on showed small r apical ptx with slightly increased pleural effusion. there was increased lll atelectasis w/ slight mediastinal shift. on zosyn was discontinued. meropenem was started. she was extubated on . flagyl was added to antibiotic coverage on . on urine culture from isolated klebsiella. meropenum continued. repeat urine culture on isolated vre-enterococcus faecium. meropenum was switched to cefepime on . linezolid was started on . she was transferred out of the sicu. the remainder of the hospital course was notable for stable hct, but lfts continued to rise. liver dulplex demonstated patent hepatic vasculature, no biliary duct dilatation, no significant ascites, small subcapsular fluid collection. she remained afebrile with stable vital signs. overall, she was very debililitated. tube feeds continued. she was unable to swallow ribaviron and other pills. pt followed recommending rehab. mental status deteriorated. she experienced nausea and vomited the feeding tube out of position on . on , she became more lucid and expressed that she did not want the feeding tube replaced and wished to cease care/treatments, desiring to go home. a family meeting occurred and established code status of dnr/dni. given failure of interferon treatment and decompensation, palliative care was consulted. the family (sister , proxy, daughter and son) were in agreement to transfer to hospice. hospice was contact and a bed was available. iv morphine 2mg via picc was given ~ every 1.5hours for generalized pain. recommendations from palliative care for scheduled morphine elixir were made based on usage of mophine iv. during the day (), o2 sat dropped into the 80s and o2 nasal cannula was applied. she was arousable briefly to her name called, but was too weak to speak. she was transferred to hospice in . communication: (sister) home- cell code status: cmo/dnr/dni disposition: hospice medications on admission: 1. prednisone 10 mg tablet sig: one (1) tablet po daily 2. metoprolol tartrate 12.5mg po bid 3. polyethylene glycol 3350 17 gram/dose powder one dose daily 4. pantoprazole 40 mg tablet, delayed release (e.c.) every 24 hours 5. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). 6. metoclopramide 10 mg tablet sig: one (1) tablet po qidachs (4 times a day (before meals and at bedtime). 7. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical prn (as needed) as needed for pruritis. 8. tacrolimus 0.5 mg capsule sig: one (1) capsule po daily (daily). 9. insulin lispro 100 unit/ml solution sig: follow printed sliding scale units subcutaneous asdir (as directed). 10. miralax 17 gram/dose powder sig: one (1) dose po once a day. disp:*30 doses* refills:*2* 11. zofran 4 mg tablet sig: one (1) tablet po prn: every 8 hours as needed for nausea. discharge medications: 1. morphine concentrate 20 mg/ml solution sig: five (5) mg po every four (4) hours: see break thru orders. 2. morphine concentrate 20 mg/ml solution sig: 5-10 mg po prn: q2 hours as needed for pain. 3. ativan 0.5 mg tablet sig: 1-2 tablets po prn: q 4 hours as needed for shortness of breath or wheezing. 4. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 5. sodium chloride 0.9% flush 10 ml iv prn line flush picc, non-heparin dependent: flush with 10 ml normal saline daily and prn per lumen. discharge disposition: extended care facility: house discharge diagnosis: fibrosing cholestatic hepatitis from recurrent hepatitis c possible superior mesenteric artery syndrome diabetes mellitus hypertension depression malnutrition hematoma s/p liver biopsy discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: you will be transferring to hospice facility in please call the transplant office with concerns followup instructions: please contact the transplant center with questions transplant rn coordinator procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances closed (percutaneous) [needle] biopsy of liver arterial catheterization closed [endoscopic] biopsy of bronchus other incision of pleura insertion of (naso-)intestinal tube open biopsy of liver hepatotomy injection or infusion of oxazolidinone class of antibiotics diagnostic ultrasound of digestive system other repair of diaphragm diagnoses: acidosis unspecified pleural effusion urinary tract infection, site not specified toxic encephalopathy unspecified essential hypertension friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified other and unspecified alcohol dependence, in remission unspecified viral hepatitis c without hepatic coma hematoma complicating a procedure depressive disorder, not elsewhere classified hypopotassemia pulmonary collapse hemorrhage complicating a procedure other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation mechanical complication due to other implant and internal device, not elsewhere classified surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation do not resuscitate status complications of transplanted liver hyperosmolality and/or hypernatremia surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation chronic vascular insufficiency of intestine adult failure to thrive other specified disorders of liver other severe protein-calorie malnutrition cannabis abuse, in remission cocaine dependence, in remission other specified forms of effusion, except tuberculous amphetamine or related acting sympathomimetic abuse, in remission 

Answer: The patient is high likely exposed to