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: keflex / heparin agents attending: chief complaint: upper gib bleed, icu transfer for hemodynamic instability. major surgical or invasive procedure: picc line placement hemodialysis upper endoscopy history of present illness: pt is a 79 yo female with cryptogenic cirrhosis and esophageal varices, diastolic chf requiring multiple hospitalizations in the past for exacerbation, who had presented to the hospital on (?) with arf and hypotension. wks prior to admission pt was complaining of worsening fatigue and insominia, pcp was concerned for recurrent chf exacerbation and hence increased lasix x2 over a course of 2 weeks. given ongoing symptoms of malaise and fatigue pt presented to osh, where she was found to be ind arf and hypotensive. her hospital was marked by icu stay and work up for infection and cardiogenic shock, which was negative. her renal function did not recover and patient was started on hd the day prior to transfer. on the day of transfer patient started vomiting brb during dialysis, requiring a total of 5 rbc and 1 unit of plt, egd revieled 3 cords, of which one was successfully banded. pt transferred to for further managment . on the floor, pt arrived sedated on propofol, and octreotide drip, with right hd cath ij, on vent. 30 cc of brb in oropharynx. past medical history: lower gib - colonoscopy with diverticulosis and angioectasias diabetes type 2 - on insulin (last a1c unknown) atrial fibrillation cad s/p stent to rca in and 2 bare metal stents to the lcx on acute and chronic diastolic chf (ef per records preserved but no records in our system) hypertension pulmonary htn dyslipidemia hypothyroidism (s/p thyroidectomy) breast ca s/p b/l mastectomies and tamoxifen (dr. ) s/p breast reconstruction copd thrombocytopenia recent icu admission at osh with staph aureus bacteremia infected 3rd left toe . cardiologist dr. pcp: . social history: social history is significant for the absence of current tobacco use; she quit smoking in . there is no history of alcohol abuse. patient lives with her husband; she used to work in a candy factory. she currently uses a walker and has home pt and . family history: there is no family history of premature coronary artery disease or sudden death. physical exam: icu admission exam: vitals: t: 97.4 bp: 130/60 p: 101 r: 16 o2: 100% on ac general: intubated. moves all extremities, responds to noxious stimuli heent: sclera anicteric, mmm, oropharynx 30 cc of brb neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 12:54am blood wbc-8.8# rbc-3.87*# hgb-11.9*# hct-34.1* mcv-88 mch-30.6# mchc-34.8# rdw-16.6* plt ct-41* 09:16am blood hct-32.2* plt ct-60* 11:42am blood hct-32.6* 01:30pm blood hct-32.1* plt ct-57* 03:50pm blood hct-32.2* 08:00pm blood hct-31.0* plt ct-46* 12:11am blood hct-31.1* plt ct-43* 04:05am blood wbc-6.3 rbc-3.34* hgb-10.3* hct-30.0* mcv-90 mch-30.9 mchc-34.4 rdw-17.1* plt ct-42* 11:04am blood hct-31.2* plt ct-40* 06:35pm blood hct-34.6* 12:54am blood neuts-89* bands-5 lymphs-1* monos-4 eos-1 baso-0 atyps-0 metas-0 myelos-0 12:54am blood pt-16.1* ptt-32.9 inr(pt)-1.4* 12:54am blood fibrino-247 12:54am blood glucose-82 urean-75* creat-2.3* na-145 k-4.1 cl-113* hco3-26 angap-10 12:54am blood alt-18 ast-26 ld(ldh)-209 ck(cpk)-71 alkphos-114 totbili-2.1* 12:54am blood ck-mb-notdone ctropnt-0.07* 12:54am blood lipase-14 12:54am blood albumin-3.2* calcium-7.7* phos-5.3*# mg-1.9 03:50pm blood crp-73.3* 03:50pm blood -negative 03:50pm blood anca-negative b 03:50pm blood cryoglb-pnd***** 01:41am blood lactate-0.9 01:41am blood freeca-1.11* . ecg baseline artifact. atrial fibrillation with controlled rate is suggested. low voltage. compared to the previous tracing of the rhythm has changed and the voltage is now lower. rate pr qrs qt/qtc p qrs t 94 0 88 338/397 0 143 149 . egd report osh: single colum cord one band placed, grade ii varices ekg: sinus rythm, no signs of ischemia . cxr widespread severe pulmonary opacification could be all edema, but the heterogeneous quality in the left lung suggests pneumonia and a 3-cm wide nodular opacity projecting superior to the left hilus could be a lung mass. moderate right and smaller left pleural effusion have increased since . heart is normal size. leftward shift of the lower mediastinum indicates some volume loss in the left lower lobe. et tube and nasogastric tube are in standard placements and a right jugular line ends at the junction of the brachiocephalic veins. . renal u/s 1. no hydronephrosis, nephrolithiasis, or solid renal mass. 2. renal parenchymal changes consistent with medical renal disease. 3. bilateral renal cysts. 4. ascites and right pleural effusion 5. splenomegaly. . cxr impression: increased pulmonary edema. unchanged pulmonary opacities. ct is recommended if left suprahilar opacity persists after resolution of acute chest pathology. . cxr impression: tubes and catheters in expected position. increased moderate right and small left pleural effusion with increase in basilar opacity, could be aspiration or pneumonia. minimal interstitial edema. . cxr in comparison with the study of , the left subclavian catheter has been pulled back to the mid portion of the svc. persistent moderate, partially loculated right pleural effusion. left retrocardiac opacification persists, most likely related to a combination of atelectasis and effusion, though superimposed pneumonia cannot be excluded. . echo impression: mild symmetric left ventricular hypertrophy with hyperdynamic left ventricular systolic function and elevated cardiac index. elevated ventricular filling pressures. at least moderate pulmonary hypertension. moderately dilated right ventricle with borderline normal function. trivial aortic and mild mitral regurgitation. . egd #varices at the lower third of the esophagus and gastroesophageal junction #congestion, petechiae and mosaic appearance in the whole stomach compatible with portal hypertensive gastropathy #normal mucosa in the duodenum #otherwise normal egd to third part of the duodenum . right upper extremity ultrasound impression: no evidence of right upper extremity dvt. brief hospital course: 79 yo female with cryptogenic cirrhosis and esophageal varices, diastolic chf requiring multiple hospitalizations in the past for exacerbation, who had presented to the hospital with acute renal failure, hypotension, and gastrointestinal bleeding. . # variceal bleed: outside hospital egd showed one esophageal varix that was banded. the patient received five units prbcs and one unit platelets prior to transfer from outside hospital. on admission, hematocrit was 34 and platelet count was 41. she had some bright red blood in her oropharynx on admission, but had no further episodes of hematemesis in the icu. she received one additional unit of prbcs the day of admission. her esophageal varices are most likely due to portal hypertension, though the precipitant to this bleed is unknown. she has a predisposition to bleeding due to thrombocytopenia and uremic platelet dysfunction. upon admission, she was placed on octreotide and ppi drip x 2 days, given ddavp x1, and one unit of platelets. per gi recs, she was then transitioned to ppi iv bid, nadolol 20 mg daily, and ciprofloxacin and carafate po for 7 day course (both cipro and carafate can be stopped on ). once patient was hemodynamically stable, gi performed repeat egd on , which showed 1 cord of grade ii varices as well as portal hypertensive gastropathy. gi recommends repeat banding in weeks. the patient continued to have small amounts of melanotic stool during admission, but her hematocrit remained stable. patient has a follow-up appointment scheduled with dr. in the liver clinic at . . # respiratory failure: the patient was intubated prior to transfer in the setting of acute hemodynamic instability during upper gi bleed. chest x-ray on admission showed evidence of pulmonary edema. the patient's respiratory status improved dramatically after multiple courses of hemodialysis and ultrafiltration to remove >3l fluid. she was successfully extubated on . at the time of transfer o2 sat was 98% on 3l shovel mask. chest xray showed interval improvement in pulmonary edema. at time of discharge, she is on 1-2l oxygen by nasal cannula with oxygen saturations in the mid to high 90s. . # renal failure: the patient has a history of chronic renal insufficiency due to diabetic nephrosclerosis with a baseline cr of 1.5. she was admitted to osh in acute renal failure and hd was initiated there. the etiology of this arf is unclear but likely largely due to prerenal atn. she was found to be aso+, and thus there could be some component of post-streptococcal glomerulonephritis. she was anca negative and urine sediment was not active. renal ultrasound showed increased echogenicity of both kidneys, but no hydronephrosis or renal masses. patient's urine output ranged from 100-200cc/day. a new tunneled hd line was placed . she was continued on hd, last dialyzed on , and per renal, it is unknown how much renal function she will recover. in addition, patient had frank hematuria on admission, which cleared rapidly with continuous bladder irrigation on hd1. for outpatient dialysis placement, a ppd was placed and was negative. hepatitis panel was negative. hepatitis b surface antigen negative, hepatitis b surface antibody negative, hepatitis c virus antibody negative. . # acute on chronic diastolic heart failure: the patient has chronic diastolic chf and was noted to be fluid overloaded with pulmonary edema on exam likely in the setting of multiple transfusions at osh. an echo was obtained on ,which showed hyperdynamic systolic function w/ ef 75%, at least moderate pulmonary htn, and dilated rv. the patient has baseline hypertension and home bp meds were held because patient was initially hypotensive. the patient required a nitroglycerin drip and emergent hemodialysis for flash pulmonary edema on one occasion in the icu. on nadolol was started for esophageal varices, with good bp control. . # thrombocytopenia: etiology is multifactorial in this patient, including portal hypertension with splenic sequestration. osh records indicated that patient may have history of heparin ab positive, but per hematology notes, this diagnosis was unclear. heparin antibody was rechecked and was positive. serotonin release assay was pending at time of transfer and argatroban was held pending this result. of note, patient did receive lovenox at osh, and heparin flushes x 2 days after admission here before this diagnosis was confirmed. . # anemia: likely both chronic component along with acute blood loss. patient continued on epogen 10000u tiw as well as iron supplementation, and hematocrit remained stable around 30%. . # type 2 diabetes: she can restart home lantus 25u qpm once she has stable glucose source. . # hypothyroidism: patient maintained on home dose levothyroxine. . # coronary artery disease: patient continued on lipitor 25 mg daily. aspirin was held in setting of gib. the patient was started on nadolol, but home antihypertensives were not restarted. . # confusion/dementia: patient oriented to self and "hospital". has some dementia, and per husband, was back to baseline on day of transfer. we limited narcotic administration and kept on soft restraints to maintain lines. . # atrial fibrillation: she remained in af, with rate in the 80s. initally her metoprolol was held for concern of gib. nadolol was then started in its place for varices prophylaxis. her rate remained well controlled. aspirin, as above, has been held, and she is not on any anti-coagualation due to concern of re-bleeding. . full code medications on admission: medications: on transfer octreotide levofloxacin ppi drip rbc propofol -------------------- meds on recent hosp course fluticasone salmeterol inhaler citalopram 20 iron ppi levothyroxine 50 daily insulin ss metolazone 5 mg 30 min prior to iv lasix dopamine gtt insulin glargine 10 iu atorvastatin 10 ppi propofol levofloxacin octreotide drip albuterol ipratropium bromide lorazepam tylenol epo bowel regiment po vanc for recent c-diff course finished?! discharge medications: 1. insulin regular human 100 unit/ml solution sig: per sliding scale injection asdir (as directed). 2. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed. 3. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day) for 7 days: last dose on . 4. epoetin alfa 10,000 unit/ml solution sig: one (1) injection mwf (mo,we,fr). 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours). 6. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 7. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). 8. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po daily (daily). 9. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 10. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 11. miconazole nitrate 2 % powder sig: one (1) appl topical (2 times a day) as needed. 12. ciprofloxacin 200 mg iv q24h please dose after hd on dialysis days 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 14. atorvastatin 20 mg tablet sig: one (1) tablet po at bedtime. 15. donepezil 10 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: primary diagnoses upper gastrointestinal bleeding, likely from esophageal varices acute on chronic renal failure, on dialysis . secondary diagnoses diverticulosis angioectasias atrial fibrillation diabetes type 2 on insulin hypertension hypothyroidism pulmonary hypertension chronic diastolic heart failure dementia discharge condition: vital signs stable. hematocrit stable. discharge instructions: you were admitted to the hospital because there was concern of upper gastrointestinal bleeding. at the time you were transferred from the outside hospital, you also had acute kidney failure and were placed on dialysis. we performed endoscopy to look at the esophagus and stomach for bleeding. there were varices (dilated veins) visualized in the esophagus, but no signs of active bleeding. the hematocrit remained stable during the entire admission. you received one unit of red blood cells when you were in the intensive care unit. we continued the dialysis while you were in the hospital. this is because the kidneys were not producing adequate amounts of urine. . we made the following changes to your medicines: 1. we stopped the lasix. 2. we stopped the lisinopril. 3. we stopped the metoprolol. 4. we stopped the aspirin. 5. we added nadolol. 6. we added ciprofloxacin. please continue through . 7. we added sucralfate. please continue through . 8. we added bronchodilator nebs (albuterol and ipratropium). 9. we added pantoprazole. . please note your follow-up appointments below. . please call your doctor or return to the emergency room if you develop lightheadedness, dizziness, change in mental status, or any signs of bleeding. please note that you will continue to receive dialysis after you leave the hospital. this may be stopped sometime in the future if your kidney function returns. followup instructions: , md phone: date/time: 11:30 , dpm phone: date/time: 11:40 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified other endoscopy of small intestine hemodialysis venous catheterization for renal dialysis diagnoses: thrombocytopenia, unspecified acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified cirrhosis of liver without mention of alcohol acute posthemorrhagic anemia portal hypertension unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation acute on chronic diastolic heart failure other chronic pulmonary heart diseases personal history of malignant neoplasm of breast percutaneous transluminal coronary angioplasty status chronic kidney disease, unspecified acute respiratory failure long-term (current) use of insulin esophageal varices in diseases classified elsewhere, with bleeding diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled diverticulosis of colon (without mention of hemorrhage) senile dementia with delirium 

Answer: The patient is high likely exposed to