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: doxycycline attending: chief complaint: altered mental status major surgical or invasive procedure: pheresis catheter placement, right neck plasmapheresis history of present illness: 77 f with a medical history of dm, htn, and distant history of breast cancer. she presents with acute altered mental status of 1 day duration. the history is obtained through the family as the patient is acutely altered. patient had episode of diarrhea this morning and family needed to carry her back to her bed. she was confused, sleepy and disoriented. episode of diarrhea was reported as dark with possible blood. additionally patient complained of left lower quadrant abdominal pain (). family deny patient complaining of headache, vision difficulty, chest pain, sob or urinary symptoms. patient's baseline mental status is alert and independent of all adls. family additionally report episode of feeling "a little more confused" this past wednesday which resolved and yesterday more fatigue but otherwise her usual state of health. family deny new medications. on arrival to the ed vs t 94.6, bp 152/80, hr 88, rr 16, 92% nrb. tmax 100.9. bp ranged 124-154/81-82. patient given levaquin, vancomycin, zosyn. patient started on a heparin drip due to elevated troponin. she was admitted to the micu for altered mental status. in the micu, the diagnosis of ttp was made. she was started on daily plasma exchange on . her mental status improved and she was transferred to the floor. past medical history: diabetes hypertension peptic ulcer disease shingles carpal tunnel breast cancer: she breast cancer in , and it sounds like there were lymph nodes removed. she has not had any problems since then. she did have a mastectomy. questionable history of discoid lupus social history: she never smoked, no alcohol use. she lives with her son and daughter in law. she was a systems analyst. family history: no early coronary artery disease. no other cancers. physical exam: admission physical exam: gen: holding head in pain. disoriented - unable to name name, place, date or family. unable to hold conversation. heent: perrl, drymm, op without lesions, no jvd. resp: anterior - cta b/l with good air movement throughout cv: tachycardic, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e skin: no rashes/no jaundice/no splinters neuro: disoriented. moving all extremities. strength intact throughout. unable to follow commands for complete physical exam. rectal: trace guaiac positive in ed pertinent results: admission labs: 02:55pm wbc-5.7 rbc-3.26* hgb-10.0* hct-28.0* mcv-86 mch-30.6 mchc-35.7* rdw-18.8* 02:55pm hypochrom-2+ anisocyt-2+ poikilocy-2+ macrocyt-2+ microcyt-2+ polychrom-occasional target-occasional schistocy-2+ bite-occasional acanthocy-2+ 02:55pm neuts-46* bands-12* lymphs-28 monos-8 eos-0 basos-0 atyps-4* metas-2* myelos-0 02:55pm plt smr-rare plt count-23* 02:55pm glucose-238* urea n-55* creat-2.1* sodium-134 potassium-4.3 chloride-99 total co2-23 anion gap-16 02:55pm albumin-3.0* calcium-8.7 phosphate-5.7* magnesium-1.6 02:55pm alt(sgpt)-32 ast(sgot)-132* ld(ldh)-3550* ck(cpk)-265* alk phos-72 tot bili-2.4* dir bili-0.3 indir bil-2.1 03:03pm pt-12.7 ptt-29.6 inr(pt)-1.1 pertinent labs: 08:09am blood aca igg-3.6 aca igm-4.1 08:09am blood lupus-neg 08:09am blood -positive * titer-1:320 05:15pm blood hiv ab-negative 01:04am blood adamts13 evaluation- <5 hepatitis b ab positive hbv viral load (final ): hbv dna not detected. : sjogren's antibody (ss-a) 5.3 pos a rnp antibody 6.7 pos a sm antibody <1.0 neg discharge labs: imaging: ct a/p on admission: limited evaluation due to the lack of contrast. diffuse stranding in the retroperitoneum and along the lateral ascending colon is of uncertain etiology. a repeat ct after hydration and repeat creatinine is recommended with iv contrast (paque for the high creatinine) and oral contrast to further help to determine the cause. ct head: no acute intracranial process. cxr on admission: the lung volumes are slightly low, but no focal consolidation, pleural effusion or pneumothorax is seen. the cardiomediastinal and hilar contours are within normal limits. small extrapulmonary calcific density adjacent to the right lateral third rib overlying the scapula is seen, question an osteochondroma arising from the scapula versus the rib, unchanged. video oropharyngeal swallow study date of impression: penetration with thin liquids. otherwise, no gross aspiration or penetration. 06:40am blood wbc-9.1 rbc-3.16* hgb-9.8* hct-29.3* mcv-93 mch-31.0 mchc-33.4 rdw-16.9* plt ct-223 06:40am blood glucose-45* urean-36* creat-1.7* na-141 k-3.3 cl-102 hco3-29 angap-13 brief hospital course: patient is a 77 yo woman with hypertension and diabetes who presented with ttp on . 1. ttp, complicated by renal failure, hemolytic anemia, and acute encephalopathy: she was intially admitted to the icu and a pheresis line was placed. she was started on daily plasma exchange on and high-dose steroids. rheumatology, hematology, and the pheresis team followed closely. her mental status improved, and her platelet count began to recover with this treatment, but plateaued. she was started on weekly rituximab due to slow improvement. with rituximab, her platelets improved and her last dose of plasma exchange was on . she requires 1 additional dose of rituxan on and then she will follow-up with hematology as an outpatient. she will be discharged on a slow steroid taper with bactrim and ppi prophylaxis as well as new insulin because of elevated blood sugars while on prednisone. at the time of discharge, her renal dysfunction had improved from a cr peak of 3.4 back to 1.7 where it appears to have plateaued. her anemia is stable with hct of 29 without signs of ongoing hemolysis. during her hospitalization she did require multiple blood transfusions. her platelets rebounded to >200. . rheumatology was consulted as there was concern about a possible history of lupus, and it was unclear if this may have been contributing to her resistance to treatment. further clarification with her outpatient providers revealed that she does not have a history of lupus, but instead had a history of relapsing polychondritis and possible pulmonary vasculitis. several rheum markers were positive, including ssa and rnp, but she had no other evidence of systemic rheumatologic illness. she was evaluated by rheumatology consult service and would like to transition her care to . she will follow-up as an outpatient with her opthalmologist and then rheumatology for further management including timing of re-initiation of plaquenil. . the patient's hypertension was poorly controlled off of lisinopril and atenolol (due to renal failure). she was changed to metoprolol with hydralazine and imdur in addition to her home amlodipine. her bp medications require further titration as an outpatient. . diabetes mellitus, uncontrolled without known complications. blood sugars were elevated in the setting of high dose steroids, and holding of januvia. insulin was started and will continue while the patient receives steroids. medications on admission: amlodipine - 5 mg tablet - 1 tablet(s) by mouth daily atenolol - 50 mg tablet - 1 tablet(s) by mouth daily hydrochlorothiazide - 25 mg tablet - 1 tablet(s) by mouth once a day sitagliptin - 100 mg tablet - 1 tablet(s) by mouth daily cholecalciferol (vitamin d3) - 1,000 unit tablet, chewable - 1 tablet(s) by mouth daily omega-3 fatty acids - 1,000 mg capsule - 1 capsule(s) by mouth daily discharge medications: 1. alcohol swabs pads, medicated sig: one (1) topical four times a day. disp:*1 box* refills:*2* 2. glucometer test strips please dispense 1 box (120) glucometer test strips for the contour glucometer. refills: 2. 3. lancets please dispense 120 lancets for blood sugar testing. refills: 2. 4. lantus solostar 100 unit/ml (3 ml) insulin pen sig: eighteen (18) units subcutaneous at bedtime: dose according to insulin regimen. disp:*4 pen* refills:*2* 5. humalog kwikpen 100 unit/ml insulin pen sig: one (1) subcutaneous four times a day: dose according to sliding scale. disp:*20 pens* refills:*3* 6. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 7. metoprolol succinate 50 mg tablet extended release 24 hr sig: three (3) tablet extended release 24 hr po once a day. disp:*90 tablet extended release 24 hr(s)* refills:*2* 8. prednisone 10 mg tablet sig: per taper tablet po daily (daily): 5 tabs daily for 7 days, then 4 tabs daily for 7 days then 3 tabs daily for 7 days then 2 tabs daily for 7 days then 1 tab daily for 7 days. disp:*105 tablet(s)* refills:*0* 9. januvia 100 mg tablet sig: one (1) tablet po once a day. 10. vitamin d-3 1,000 unit tablet, chewable sig: one (1) tablet, chewable po once a day. 11. omega 3 fish oil 684-1,200 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours): take this while on prednisone. disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 13. isosorbide dinitrate 10 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 14. hydralazine 50 mg tablet sig: one (1) tablet po q8h (every 8 hours). disp:*90 tablet(s)* refills:*2* 15. bactrim ds 800-160 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: ttp acute renal failure hemolytic anemia left eye conjunctivitis hypertension uncontrolled type 2 diabetes without complications relapsing polychondritis and pulmonary vasculitis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with low platelets due to ttp. you were treated with steroids, plasma pheresis, and rituxan. you required multiple blood transfusions. your platelet count improved and is now stable. continue on a slow prednisone taper as prescribed. you require an additional dose of rituxan as scheduled at the hematology clinic. while on prednisone, you must take bactrim prophylaxis and insulin as prescribed. please follow-up with the opthalmologist and then your rhematologist to consider when to restart your plaquenil. you were found to have high blood pressure and new medications were added. you were started on hydralazine and imdur. your atenolol was changed to metoprolol. followup instructions: 9:00am clinic center, appointment with for rituxan dose. department: ophthalmology name: dr. when: monday at 2;30 pm location: diabetes center address: one place, , phone: department: when: thursday at 11:20 am with: , md building: campus: east best parking: garage department: hematology/oncology when: thursday at 1:30 pm with: , md building: sc clinical ctr campus: east best parking: garage department: hematology/oncology when: thursday at 1:30 pm with: , md building: sc clinical ctr campus: east best parking: garage department: rheumatology when: thursday at 11:15 am with: , md building: lm bldg () campus: west best parking: garage procedure: venous catheterization, not elsewhere classified therapeutic plasmapheresis injection or infusion of cancer chemotherapeutic substance diagnoses: acute kidney failure, unspecified personal history of malignant neoplasm of breast hypopotassemia disorders of phosphorus metabolism fever, unspecified acquired hemolytic anemia, unspecified other disorders of bone and cartilage thrombotic microangiopathy diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled encephalopathy, unspecified hyperosmolality and/or hypernatremia disorders of magnesium metabolism other specified diseases of pulmonary circulation jaundice, unspecified, not of newborn personal history of peptic ulcer disease nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] benign essential hypertension conjunctivitis, unspecified 

Answer: The patient is high likely exposed to