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: shellfish / flexeril attending: chief complaint: # lethargy # confusion # hyponatremia major surgical or invasive procedure: # micu intubation # l arm picc placement # bedside -gastric tube placement # fluoroscopy-guided -jejunal tube placement history of present illness: 48f h/o hep c cirrhosis c/b ascites, encephalopathy and ble edema, presented to clinic with lethargy, na = 113. pt reported that her mother, who helps pt manage her pills, also noted that pt was "making no sense" this morning. pt denied any recent alcohol or drug intake, and reported that she had a productive cough with somewhat yellow sputum. pt reported that she had not been having three bowel movements daily, and at least one day had no stools. . in the ed, she was oriented x 2, with positive asterixis. pt received albumin 50g. . on first arrival to the floor, pt denied fever, vomiting, diarrhea, dysuria, bloody stool, joint pain, muscle pain, sore throat, or changes in vision. pt endorsed hunger, fatigue, tremors, and dizziness. it was unclear whether pt endorsed or denied nausea as her account changed, and she was not focused during the interview. pt conducted her admission interview with her eyes closed, and spoke in a shaky mumble throughout. past medical history: (1) hepatitis c cirrhosis --encephalopathy --ascites --edema s/p tips () --hydrothorax --thrombocytopenia --hyponatremia (baseline 124-128) (2) asthma (3) adrenal insufficiency esld (4) gerd (5) anxiety social history: # recreational drugs: past iv drug use with needle sharing, last use 7 years ago. past drug-snorting. # alcohol: past alcohol use, last drink at age 46. # tobacco: past with 10 pack-year history # personal: single with one child. lives with mother, who manages medications # employment: former waitress, unemployed on disability. family history: # mother, 60s: dm2, htn, hypercholesterolemia # father, d. 51: copd, alcohol-induced cirrhosis # brother physical exam: vs = t 97.1, bp 106/50, hr 83, rr 26, o2 96%, fs 148 gen: tremulous in bed with covers pulled up and eyes closed throughout the interview heent: scleral ictera, mmm, cn ii-xii grossly normal cv: rrr, s1s2, iii/vi sem, no r/g pulm: cta @ l, decreased breath sounds at r base, no rales/rhonchi/wheezes abd: bs+, soft, nt, protuberant, no rebound. tympanic. ext: 3+ ble edema. + asterixis. neuro: slow to respond. a&o x 3. could not remember three words. pertinent results: admission labs: . 12:19pm glucose-137* k+-4.3 12:00pm glucose-155* urea n-18 creat-0.8 sodium-113* potassium-4.4 chloride-89* total co2-18* anion gap-10 12:00pm estgfr-using this 12:00pm alt(sgpt)-54* ast(sgot)-101* alk phos-377* amylase-69 tot bili-19.6* 12:00pm albumin-2.3* calcium-7.7* phosphate-3.1 magnesium-1.9 12:00pm ethanol-neg bnzodzpn-neg 12:00pm wbc-7.7# rbc-2.90* hgb-10.0* hct-28.9* mcv-100* mch-34.5* mchc-34.5 rdw-19.4* 12:00pm neuts-83* bands-0 lymphs-10* monos-3 eos-3 basos-1 atyps-0 metas-0 myelos-0 12:00pm hypochrom-normal anisocyt-occasional poikilocy-2+ macrocyt-2+ microcyt-normal polychrom-occasional schistocy-occasional burr-2+ bite-occasional acanthocy-occasional 12:00pm plt count-65* 12:00pm pt-23.8* ptt-50.5* inr(pt)-2.4* . # cxr : multifocal patchy opacities seen in the left upper and lower lung zones, with cardiomegaly. this may represent asymmetric pulmonary edema; however, aspiration/pneumonia cannot be excluded. the ill-defined opacity in the right upper lung zone seen on the prior study has resolved. a tips shunt is present. . # abd us : 1. minimal intra-abdominal ascites. there was insufficient fluid to mark a location for bedside tap. 2. patent appearance of the main portal vein. measured tips velocities are similar to comparison examination. . # cxr : impression: improved aeration in the upper lobes. persistent bilateral patchy opacities more confluent in the bases, greater on the right side. # cxr : findings: a pa and lateral of the chest were obtained and compared to the prior examination dated . allowing for differences in technique, there is no significant interval change. the left subclavian picc line is unchanged in position terminating within the expected region of the proximal superior vena cava. the enteric feeding catheter extends beyond the inferior margin of the film. the diffuse patchy opacities throughout both lungs are grossly unchanged. the left patchy opacity obscuring the left hemidiaphragm is unchanged. a persistent right pleural effusion is noted. cardiomediastinal silhouette is unchanged. impression: stable examination as above. # ruq ultrasound : findings: comparison is made to . the study is limited secondary to patient's inability to breath-hold. there is a large right pleural effusion. color flow imaging demonstrates a patent tips with wall-to-wall flow though velocities cannot be measured secondary to respiratory motion. the right portal vein is patent and appears to be hepatofugal though evaluation markedly limited. there is trace ascites in the pelvis, but inadequate for paracentesis. impression: 1. limited exam. patent tips with wall-to-wall flow. 2. trace ascites. brief hospital course: 48f h/o hcv cirrhosis, admitted to 10 with hyponatremia, hepatic encephalopathy, and questionable respiratory symptoms. . # pna: as pt reported syptoms of productive cough, admission cxr was obtained which demonstrated rul infiltrate suspicious for infection. in light of her recent hospitalization, pt was started on ciprofloxacin 400mg iv q12h () for nosocomial pna. to cover the possibility of aspiration pna as pt's hepatic encephalopathy persisted, abx were broadened to vancomycin ()/pip-taz ()/azithromycin (). abx were discontinued on given completed total abx course of approximately 10 days. serial chest xrays every other day showed gradual interval improvement. . # respiratory compromise: on admission, pt was ambulatory with no oxygen requirement, and pt was placed on home regimen of albuterol and fluticasone-salmeterol 100-50 mcg/dose . on , pt received 1 unit prbc for hct = 20.9. on , hd#3, patient c/o increasing sob, with rr = 30, pao2 = 61 on 4l nc, pco2 = 33, ph 7.44. repeat cxr demonstrated new l upper and lower lung infiltrates and likely volume overload. pt's acute respiratory compromise was considered to be possibly multifactorial, with contributions from asthma exacerbation, pna, fluid overload, and possible trali. tte performed in the micu demonstrated hyperdynamic ef, enlarged la, and no evidence of pulmonary htn. pt was intubated from to support respiratory capacity. on transfer to floor, pt had been extubated for four days, with improved respiratory status and o2sat in the mid-90s on 4l. she was weened down to 3l, where she remained stable. . # adrenal insufficiency liver failure: pt was initially maintained on her home regimen of prednisone 5 mg daily. upon transfer to the micu, stress dose steroids were administered in the setting of infection, respiratory compromise, and pt's background adrenal insufficiency. after transferring back to the floor, pt was transitioned ultimately to hydrocortisone to provide both glucocorticoid and mineralocorticoid activity. she is discharged on 20 mg hydrocortisone qday. . # asthma: after pt's episode of respiratory insufficiency, pt was continued on standing albuterol and fluticasone-salmeterol nebs, with home regimen of montelukast held. she continued albuterol and fluticasone/salmeteral nebs throughout her stay. . # overgrowth: in the micu, pt was started on casofungin x 4-5 days given yeast in sputum, as it was felt to be colonization. repeat sputum and urine cultures, however, demonstrated continued heavy yeast colonization, with urine growing c. glabrata, and sputum growing c. albicans (sensitive to fluconazole) as well as another yeast organism with indeterminate speciation. pt was started therefore on fluconazole 200mg daily on . per id recommendations, fluconazole was stopped since yeast was likely colonizer and not reflecting true infection. . # hcv cirrhosis: on admission, pt's meld was 27. on , pt was removed from the transplant list given respiratory compromise but was relisted after transferring back to the floor. pt's meld remained in the 20s during this admission. she will need to have weekly meld scores, reflected in weekly lab draws to be faxed to her hepatologist dr. , as outlined in the discharge plan. . # hepatic encephalopathy: pt was given regular doses of rifaximin, lactulose po, and lactulose pr, titrated to achieve four bowel movements daily. pt's mental status was noted to wax and wane throughout admission, and therefore an ng tube, later a n-j tube, was placed to prevent aspiration. pt was placed on pureed foods with sips of thin liquids only after a bedside speech and swallow noted no active aspiration, but the need for precautions. on day of discharge she was cleared by speech and swallow for a regular diet, but should be watched directly whenever she is eating to keep her from trying to swallow too much at once - one bit and sip at a time(per speech). her encephalopathy showed improvement daily. . # hyponatremia/hypernatremia: pt initially presented with na = 113 and total body water overload. pt therefore was intially fluid-restricted and administered albumin, with furosemide and spironolactone initially held. diuretics were later reintroduced. pt was noted to become hypernatremic (na = 155) in the micu after aggressive diuresis, and therefore ngt free water was given with normalization of na. free water was stopped when her na reached 130. on day of discharge, her na was 130. . # dm2: pt's blood glucose was controlled with hiss, with home regimen of glipizide first reduced and then ultimately held out of concern for hypoglycemia in the setting of hepatic dysfunction. pt was placed on glargine 12 units at bedtime to provide basal glucose control, which was subsequently increased to 17 and then 20 on day of discharge to better control her glucose. . # anemia: hct was noted to drift downwards to a low of 20.9 on , and pt was therefore transfused 1 unit prbc. on , pt was noted to have severe respiratory insufficiency, with pao2 = 61, requiring transfer to micu. there, pt was noted to have guaiac-positive stool in the setting of known hemorrhoids, no esophageal varices. hct ultimately stablized in the high 20s, near pt's preadmission baseline. . # hematuria: pt presented with gross hematuria on , with inr = 3.4. hematuria was considered to be due to spontaneous bleeding in the bladder given supratherapeutic inr and possible irritation from foley catheter. ffp 2 units were transfused with resolution of hematuria. on day of discharge, her hct was 25.9. . # uti: pt was noted to have entercoccus in urine culture on , treated with vancomycin. urinalysis on grew pan-sensitive klebsiella, and has been receiving a course of ciprofloxacin, to complete on . . # fen: pt was placed on a low na diet. after extubation, pt was given nutrenpulmonary tube feeds at 60cc/hr, cycled from 1800 hrs to 1200 hrs, to increase her caloric intake, which was then changed to continuous 24 hr. she passed swallow and is cleared to take a full diet, but should be watched directly whenever she is eating to keep her from trying to swallow too much at once (per speech). . # full code medications on admission: lactulose 30 g q8h prn hydroxyzine hcl 25 mg q6h prn for bilirubin-related itch rifaximin 400 mg tid albuterol prn ferrous sulfate 325 mg daily clotrimazole 10 mg troche qid montelukast 10 mg daily oxybutynin chloride 5 mg fluticasone-salmeterol 100-50 mcg/dose pseudoephedrine hcl 30 mg q6h prn lidocaine 5 %(700 mg/patch) patch daily lorazepam 0.5 mg prn clonidine 0.1 mg prednisone 5 mg daily pantoprazole 40 mg ec daily glipizide 5 mg prochlorperazine 10 mg q8h prn spironolactone 50 mg daily furosemide 20 mg daily metoclopramide 10 mg tid prn discharge medications: 1. lactulose 10 g/15 ml syrup : forty five (45) ml po tid (3 times a day). disp:*4050 ml(s)* refills:*2* 2. albuterol sulfate 0.083 % (0.83 mg/ml) solution : one (1) inhalation q4h (every 4 hours). 3. ipratropium bromide 0.02 % solution : one (1) inhalation q6h (every 6 hours). 4. albuterol sulfate 0.083 % (0.83 mg/ml) solution : one (1) inhalation q2h (every 2 hours) as needed for dyspnea. 5. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 6. rifaximin 200 mg tablet : two (2) tablet po tid (3 times a day). 7. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical daily (daily) as needed for back pain. 8. hydrocortisone 20 mg tablet : one (1) tablet po daily (daily). 9. folic acid 1 mg tablet : one (1) tablet po daily (daily). 10. furosemide 20 mg tablet : one (1) tablet po daily (daily). 11. spironolactone 25 mg tablet : two (2) tablet po daily (daily). 12. lactulose 10 g/15 ml syrup : forty five (45) ml po q4h (every 4 hours) as needed. 13. fluticasone-salmeterol 100-50 mcg/dose disk with device : one (1) disk with device inhalation (2 times a day). 14. ciprofloxacin 250 mg tablet : one (1) tablet po q12h (every 12 hours) for 4 days: please give through . 15. insulin sliding scale with glargine finger sticks qachs glargine 20 units qhs hiss per protocol attached 16. heparin flush 100 unit/ml kit : one (1) flush intravenous once a day: heparin flush for picc. flush daily and as needed. . 17. outpatient lab work lab work on and weekly thereafter. fax results to dr. at . labwork: pt/inr, chem-7 (sodium, potassium, chloride, bicarb, bun, creatinine), ast, alt, alk phos, total bilirubin. discharge disposition: extended care facility: & rehab center - discharge diagnosis: primary diagnosis: # hyponatremia # hypernatremia # hcv cirrhosis # hepatic encephalopathy # pneumonia # overgrowth # adrenal insufficiency . secondary diagnosis # asthma discharge condition: stable discharge instructions: you were admitted because you had a very low sodium level, and you were confused. we found that you had pneumonia and started antibiotics for you. you had a difficult time keeping your oxygen saturation normal, and therefore you had to go to the intensive care unit. there, you had to be intubated to breathe, and you continued receiving antibiotics. afterwards, you were able to breathe on your own, and you returned to 10. you continued to be very confused, so we gave you medications so that you could move your bowels. you were also found to have a urinary tract infection, and are currently on antibiotics for that. . we have given you some new medications: hydrocortisone 20mg daily folic acid 1mg daily ciprofloxacin 250mg every 12 hours until lactulose was increased to 45 ml three times titrated to 3 bowel movements with 45 ml as needed in addition. . you should be watched when you eat because of the potential to aspirate your food. you should eat one bite and one sip at a time. . you should return to the hospital or contact your primary care physician if you experience worsening concentration and mental status, increased bleeding, fever > 101.4 degrees f, worsening shortness of breath, or coughing up blood. followup instructions: provider: , md phone: date/time: 10:50 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus transfusion of packed cells transfusion of other serum transfusion of other serum insertion of (naso-)intestinal tube diagnoses: thrombocytopenia, unspecified anemia, unspecified esophageal reflux urinary tract infection, site not specified diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic hepatitis c with hepatic coma other pulmonary insufficiency, not elsewhere classified hyposmolality and/or hyponatremia asthma, unspecified type, unspecified pneumonitis due to inhalation of food or vomitus hyperosmolality and/or hypernatremia other and unspecified coagulation defects other specified hypotension other and unspecified mycoses carrier or suspected carrier of other specified infectious organism 

Answer: The patient is high likely exposed to