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: history of present illness: ms. is an 80-year-old spanish-speaking woman with an extensive medical history notable particularly for auto-immune hepatitis cirrhosis and encephalopathy who was recently discharged from on . she was discharged to rehabilitation facility. her last admission was notable for an endoscopic retrograde cholangiopancreatography that was complicated by acute renal failure and pancreatitis. on this admission, , the patient was brought from rehabilitation reportedly for a general decline in her condition that occurred over several days to weeks as well as an apparent complaint of more recent chest and abdominal pain. the records at the rehabilitation facility indicate the patient has been increasingly lethargic and confused over the past several days and exhibited worsening lower extremity edema. the rehabilitation facility was unable to maintain intravenous access. laboratories there revealed, among other things, an increased white blood cell count and worsening liver function tests. their records did not show any recent history of fever. the patient was unable to give history secondary to encephalopathy, for which she has had multiple admissions in the past for. to be clear, she has a history of multiple events hospitalization specifically for encephalopathy. on the last hospitalization (ending on ), she was admitted to the acove medicine service with vague complaints; including weakness, confusion, and mild epigastric tenderness. she was found to have an elevated bilirubin, and it was felt that common bile duct was dilated. she underwent an endoscopic retrograde cholangiopancreatography on . there was an unsuccessful attempt to cannulate the papilla despite sphincterotomy. post endoscopic retrograde cholangiopancreatography course was complicated by pancreatitis and acute renal failure which responded modestly to intravenous fluids and holding her ace inhibitor and diuretics. pancreatitis resulted in bile fluid. an endoscopic retrograde cholangiopancreatography on had a motion artifact but revealed changes in liver consistent with cirrhosis and portal hypertension. no dilation of intrahepatic or extrahepatic biliary ducts. there were stones/sludge in the gallbladder and thrombosis of the right anterior and right posterior branches of the portal vein. the patient was placed on actigall and sent to rehabilitation. her white blood cell count at that time was 16.6, total bilirubin was 3.2, and creatinine was 2.9. on this admission, in the emergency department, the patient was briefly hypotensive with a systolic blood pressure in the 80s which responded well to the intravenous fluids. also of note, at her rehabilitation facility, she was found to be in atrial fibrillation. during this hospital admission, she ruled out for a myocardial infarction. the congestive heart failure service was consulted during this admission. they recommended discontinuing her amiodarone and felt that the patient's fluid overload was secondary to cirrhosis and low albumin in conjunction with pulmonary hypertension that was not related to systolic dysfunction. the patient was also found to have a lower lobe pneumonia. she had been treated with levofloxacin and flagyl with an associated leukocytosis and hypothermia. her hospital stay, prior to being transferred to the medical intensive care unit, was complicated by acute renal failure (secondary to acute tubular necrosis), and relative hypotension with atrial fibrillation, and hypercalcemia (with calcium levels as high as 12), and creatinine as high as 3.6, and hypernatremia (her sodium was 155 when she was transferred to the medical intensive care unit). in addition, her total bilirubin had been rising with worsening coagulopathy. her inr was 2.7, and her total bilirubin was 4.3 when she was transferred to the medical intensive care unit. given her poor hospital course, the patient was initially do not resuscitate/do not intubate by the family; especially given her history of cirrhosis and auto-immune hepatitis. however, on , new members of the family had come from , and a family meeting was held, and her code status was reversed. she was transferred to the medical intensive care unit for management of her worsening coagulopathy, hypernatremia, hypercalcemia, and declining mental status. past medical history: (past medical history is notable for) 1. hypertension. 2. hypercholesterolemia. 3. type 2 diabetes. 4. paroxysmal atrial fibrillation. 5. status post bilateral hip replacement. 6. history of asthma. 7. osteoarthritis. 8. nephrolithiasis. 9. autoimmune hepatitis complicated by cirrhosis and hepatic encephalopathy. 10. lower gastrointestinal bleed. 11. multiple falls. 12. hemorrhoids. 13. history of dementia. 14. history of renal mass. 15. chronic thrombocytopenia. 16. she had a persantine mibi in with normal wall motion, and no perfusion defects, with a gated ejection fraction of approximately 63%. she had an echocardiogram on which showed 3+ tricuspid regurgitation, pulmonary artery systolic pressure of greater than 40, and 2+ mitral regurgitation. allergies: cephalosporins (unknown) and bactrim (she gets a rash). medications on admission: (medications at rehabilitation) 1. prevacid 50 mg p.o. once per day. 2. multivitamin one tablet p.o. once per day. 3. ursodiol 300 mg p.o. three times per day. 4. amiodarone 200 mg p.o. once per day. 5. iron sulfate 325 mg p.o. once per day. 6. insulin sliding-scale. 7. lactulose 20 cc (titrated to stools). 8. montelukast 10 mg p.o. once per day. 9. heparin 5000 units subcutaneously twice per day. 10. zoloft 50 mg p.o. once per day. 11. aspirin 325 mg p.o. once per day. 12. calcium carbonate 1250 mg p.o. twice per day. medications on transfer: (on transfer to the medical intensive care unit) 1. famotidine 20 mg p.o. twice per day. 2. vitamin k 10 subcutaneously times three days. 3. insulin sliding-scale. 4. renagel 800 mg p.o. three times per day. 5. multivitamin one tablet p.o. once per day. 6. ursodiol 300 mg p.o. three times per day. 7. tylenol. 8. lactulose 30 cc p.o. three times per day. 9. aspirin 81 mg p.o. once per day. 10. levaquin 250 mg every other day. 11. flagyl 500 mg three times per day. 12. subcutaneous heparin twice per day. social history: she is from . normally lives at home with her husband. she has been at rehabilitation since last discharged on . no apparent tobacco or alcohol use. no drug use. physical examination on presentation: physical examination on transfer to the medical intensive care unit revealed temperature was 95 degrees, temperature maximum was 95.2, heart rate was 92, blood pressure was 102/54, respiratory rate was 18, and oxygen saturation was 98% on 5 liters. she was alert but not oriented and moaning. scleral icterus. pupils were equal, round, and reactive to light and accommodation. extraocular movements were intact. jugular venous pulsation greater than 15 cm. her heart rate was irregularly irregular first heart sound and second heart sound. a iii/vi systolic murmur maximum at the right upper sternal border. no rubs or gallops. pulmonary examination revealed bilateral rhonchi anteriorly. hypoactive bowel sounds. hepatomegaly and splenomegaly were not noted. no pulsatile masses. pitting edema of 2+ bilaterally up to the knees in the lower extremities. pulses were 2+ in the bilateral lower extremities. she moved all four extremities. unable to cooperate with asterixis. pertinent laboratory values on presentation: laboratory data on , the day the patient was transferred to the medical intensive care unit, revealed white blood cell count was 16.6, hematocrit was 31.2 (had been 34.4), mean cell volume was 197, and platelets were 130. differential with polymorphonuclear leukocytes of 89%, bands of 2%, lymphocytes of 2% monocytes of 6% eosinophils of 1%. inr was 2.7 and partial thromboplastin time was 59.2. sodium was 155, potassium was 4.2, chloride was 123, bicarbonate was 20, anion gap was 13, chloride was 95, creatinine was 3.1, and blood glucose was 100. total bilirubin was 3, alt was 37, ast was 82, ld was 214, albumin was 2. her a.m. cortisol had been 12. spep was pending. calcium was 12. phosphorous was 6.4. lipase was 22. thyroid-stimulating hormone was 0.65. magnesium was 2.3. pertinent radiology/imaging: she had a renal ultrasound on which showed echogenic small kidneys with a small amount of ascites. she had a swallowing evaluation on which she failed and it was recommended that she be npo with nasogastric tube/tube feeds. maybe to attempt a video swallow if the patient's mental status improved. a chest x-ray on revealed cardiomegaly with a left opacity, pleural effusions bilaterally, ................. consolidation, evidence of fluid overload. , congestive heart failure with left lower lobe consolidation. she had an abdominal ultrasound on with a small collection of perihepatic ascites. hospital course by issue/system: the patient is an 80-year-old woman with autoimmune hepatitis admitted with worsening mental status who was transferred to the medical intensive care unit for treatment for hypercalcemia, hypernatremia, acute renal failure, and encephalopathy. 1. acute renal failure/electrolyte abnormalities: it was suggested that the acute renal failure is secondary to acute tubular necrosis, possibly relative to hypotension from an infection. the patient is normally hypertensive plus/minus her atrial fibrillation contributing to this. the patient was both fluid repleted for hypotension with half normal saline and also given free water to correct her hypernatremia. her sodium corrected from 150 to 143; however, her urine output remained to be quite poor, where her urine output on the first 24 hours on the unit was approximately 300 cc, and for the next 24 hours was approximately 280 cc; being approximately 2.7 liters positive over that time period. her hypercalcemia was treated with intravenous fluids, and this was chased with a little bit of lasix. later, phosphate was added to the regimen, and her calcium decreased to 11. 2. leukocytosis/hypothermia: the patient's hypotension was most likely secondary to an infectious source given the white blood cell count, left shift, hypothermia, and evidence of left lower lobe pneumonia. spontaneous bacterial peritonitis was a possibility, but the ascitic fluid was a small amount and was not amenable to tapping. the patient initially was placed on ciprofloxacin and flagyl. this was changed to vancomycin and zosyn for broader spectrum antibiotic coverage; including pseudomonas and methicillin-resistant staphylococcus aureus given the recent hospitalization and nursing home stay of the patient. there was some consideration to placing a swan-ganz catheter to measure the patient's cardiac output, systemic vascular resistance, mixed oxygen to see whether she was in cardiogenic shock or septic sepsis was causing the end organ dysfunction regarding her acute renal failure. however, given the patient's 10-day cordis and triple cordis was placed with a triple lumen placed through it initially on the patient's first night in the medical intensive care unit. this was done with family consent using ultrasound and giving the patient fresh frozen plasma prior to the procedure. however, it was later decided not to float this one given the patient's large tricuspid regurgitation which would confound the results. blood cultures, urine cultures, and sputum cultures were sent with no growth. 3. altered mental status: likely multifactorial; especially related to the hepatic encephalopathy which has caused the patient the same mental status in the past. likely contributions on this stay with uremia and infection. dictation ends. dr., 11-692 dictated by: medquist36 procedure: enteral infusion of concentrated nutritional substances diagnoses: congestive heart failure, unspecified cirrhosis of liver without mention of alcohol acute kidney failure, unspecified unspecified septicemia unspecified protein-calorie malnutrition atrial fibrillation pneumonitis due to inhalation of food or vomitus other chronic hepatitis hepatic encephalopathy 

Answer: The patient is high likely exposed to