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: a 44 year-old rican female with a history of end stage liver disease secondary to hepatitis c on interferon and ribavirin with history of recurrent biliary strictures, status post biliary stent, status post biliary ballooning, an ultimately roux-en-y procedure with recent discharge from one week ago, now presenting with increasing somnolence and sleepiness at home. per the husband patient has decreased p.o. intake with solids and liquids, decreased urina output but still having bowel movement per day per her husband. there is a questionable history of increase in abdominal distention consistent with ascites. also nausea and vomiting for the two days prior to admission. was seen in liver clinic two days prior to admission with increase in total bilirubin to 26.2 and was sent home. patient presents today, brought in by her husband, with lethargy and unable to provide history. in the emergency department temperature is 99.6, pulse 84, blood pressure 134/87, respiratory rate 18, o2 saturation 97% on room air. wbcs increased from baseline consistent with a bandemia. cultures were sent and therapeutic paracentesis was performed. total bilirubin was 25.5, creatinine 1.7. chest x-ray consistent with worsening pleural effusion, seemed acute and chronic. patient given intravenous fluids and lactulose, levaquin, flagyl and transferred to the floor for further wore up and treatment. past medical history: 1) end stage liver disease secondary to hepatitis c from blood transfusion. status post living related door transplant with rejection in operating room, cadaveric transplant 24 hours later wit question cmv status. the transplant was performed . in noted increased liver function tests with mri showing biliary stricture of the anastomosis, endoscopic retrograde cholangiopancreatography with stenting. in biliary stent occlusion was noted with stents being replace. she was readmitted with a stent occlusion and the stents were removed and ducts ballooned. in presented with acute onset of ascites and right upper quadrant pain. liver biopsy was positive for active hepatitis c, was treated with interferon. portal vein ultrasound negative. the ascites was felt possibly secondary to hepatitis c. a large right pleural effusion was noted at that time but thoracentesis was performed with negative cultures. 2) recurrent biliary stricture , endoscopic retrograde cholangiopancreatography with stent placement and stent occlusion with tent replacement, status post stent removal with ballooning, status post treatment with ampicillin and gentamicin for cholangitis, status post a roux-en-y.procedure . 3) history of ascites. 4) history of chronic hepatic hydrothorax. 4) hepatitis c. 5) hypertension. 6) anemia. 7) diabetes. 8) hepatitis c induced fibrosing cholangitic hepatitis. 9) history of staph aureus positive urinary tract infection treated with vancomycin. medications: 1) actigall 300 mg b.i.d., 2) neural 50 mg b.i.d. times 40 mg q.d., 3) sandostatin 200 mg t.i.d., 4) midodrine t.i.d., 5) ribavirin 40 mg b.i.d., 6) k-phos q.i.d., 7) interferon. allergies: dilaudid which causes a rash. social history: she lives with her husband, denies any alcohol or smoking. physical examination: vital temperature - temperature 99.6, pulse 84, blood pressure 134/87, respiratory rate 18, o2 saturation 97% on room air. general: she is awake but somnolent lying in bed with eyes closed, groaning occasionally. follows some commands and answers some questions through husband as interpreter. patient is markedly jaundiced throughout hr entire body. head, eyes, ears, nose and throat: positive scleral icterus. pupils equal, round, reactive to light, unable to assess extraocular movements. dry oral mucosa with crusted secretions. neck supple with 7 to 9 cm jugular venous pressure. cardiovascular: regular s1 and s2, no murmurs. lungs clear bilaterally to anterior auscultation. abdomen distended, tense, mild right upper quadrant tenderness. no rebound or guarding. positive bowel sounds. positive abdominal striae with caput medusa. right hepatic tube without drainage. extremities 2 to 3+ pitting edema to the knees, no spider angiomata, no pulmonary erythema. neurologically no asterixis but difficulty to assess with compliance moving all four extremities. laboratory data: wbc 3.4, hematocrit 25.5, platelets 65, mcv 100, inr 2.3 with 87% neutrophils, 5% bands, 6% lymphocytes, 2% monocytes. sodium 147, potassium 4.6, chloride 116, bicarbonate 17, bun 24, creatinine 1.9, glucose 103, alt 33, ast 77, ldh 217, alkaline phosphatase 128, amylase 130, total bilirubin 26.4, albumin 2.8. urinalysis negative for blood, negative for nitrites, negative for protein, negative for glucose, 0 to 2 rbcs, no white blood cell count, rare bacteria and no squamous epithelium. cyclosporin level 85. electrocardiogram: normal sinus rhythm at 100 beats per minute, normal axis, normal intervals, low voltage, diffuse t wave flattening, no st or t wave changes, no q waves noted. chest x-ray: moderate effusion from the right side compared with . linear atelectasis, parenchymal scar in the right upper lobe. ascites analysis 500 wbcs, 625 rbcs, 90% polys, 5+ lymphs, 5% basophils, amylase 9, albumin less than .1. peritoneal culture pending at that time. hospital course: mrs. was admitted to on for ongoing work up and treatment of altered mental status, increasing bilirubinemia, increasing white blood cell count. she was treated with aggressive lactulose titrated to 4,000 a day initially. she was continued on her actigall and her interferon and ribavirin were held. in addition, she was continued on her neoral and it was redosed given that the levels were subtherapeutic. therapeutic paracentesis was performed for need for patient comfort. for her increasing creatinine she was continued with gentle intravenous fluids and additional albumin was considered. given that the patient was afebrile but had increasing white blood cell count from baseline consistent with bandemia there was concern for acute hepatitis versus svp versus cholangitis. she was started on ceftriaxone and flagyl initially. the following morning she was taken for esophagogastroduodenoscopy performed by dr. . at the esophagogastroduodenoscopy procedure they noted varices in the lower third of the esophagus with erythema and abnormal vascularity and mosaic appearance in the antrum and stomach compatible with gastropathy. there was blood in the fundus and the stomach body and food in the body but otherwise normal esophagogastroduodenoscopy to the second par of the duodenum. the recommendations at that time were to continue to administer lactulose rectally from the encephalopathy because the patient had only one bowel movement overnight despite q two lactulose p.r.n. in addition, the patient was noted to have 30 cc of coffee ground emesis and guaiac positive emesis this morning this was the reason for the esophagogastroduodenoscopy. in addition, the ct head examination was performed to rule out other causes of encephalopathy and this was negative. the patient's hematocrit dropped to 22.5 and was transfused two units of packed red blood cells. after the two units of packed red blood cells the patient's hematocrit was stable at 23.8. she continued to have lactulose per rectum with four bowel movements and improvement in her mental status. an infectious disease consult was obtained and recommended starting vancomycin to cover for possible urinary tract infection and t tube infections in the past. the following morning th patient was noted to have decreased urine output with 70 cc an hour with 70 cc noted over the course of the last eight hours. in addition, she vomited coffee ground emesis after being n.p.o. vital signs were stable but again was noted to have a low hematocrit of approximately 24 and was transfused two units of packed red blood cells. at this time the patient's inr was 2.5 and remained elevated despite vitamin k. patient had a paracentesis, was doing marginally better until that day when the paracentesis was performed and noted to have frankly bloody ascites. after the procedure the patient was observed to be nearly comatose due to concerns of altered mental status, airway protection and hemodynamic stability. patient was transferred to the intensive care unit. given the results of the paracentesis the feeling was the blood loss was into ascitic fluid rather than gastrointestinal tract or hemolysis. the cause of bleeding was felt to be possible oozing from the surface of the liver or gastrointestinal tract secondary to portal hypertension. doubtfully felt complication of the paracentesis to which was complicated by coagulopathy and thrombocytopenia. patient was transfused four units of fresh frozen plasma and one bag of platelets, received vitamin k subcutaneously and was transfused an additional two units of packed red blood cells. she was continued on intravenous protonix. the altered mental status was felt secondary to progressively worsening hepatic encephalopathy in the setting of the intra-abdominal bleed infection. lactulose was continued via nasogastric tube and per rectum. cardiovascularly she was hemodynamically stable and the fresh frozen plasma was given to help intravenous volume repletion. pulmonarily her o2 saturations were stable and she was placed on bipap for airway protection but did not require intubation during her intensive care unit course. in addition, the patient was continued on meropenem, vancomycin per the infectious disease service and cultures were drawn. patient's renal failure progressed to creatinine of 2.4 and this was felt secondary to decreased intravascular volume versus early hepatorenal syndrome. bipap was initiated with improvement in the respiratory component of her acidosis. renal team was consulted with consideration of the issue of acute tubular necrosis in the setting of decreased intravascular volume perfusing her kidneys. the heme team was consulted regarding the coagulopathy and was felt most likely consistent with increased liver disease. on the patient was deemed stable with no chest pain, shortness of breath or vomiting and she continued to complain of lethargy. however, mental status was markedly improved and was transferred to the floor. on the floor she remained stable with continued medical management. creatinine continued to rise worrisome for continued acute tubular necrosis. however, the bilirubin continued to rise and was deemed stable. hepatology service, dr. , discussed with service transfer for possible evaluation for repeat liver transplant. there was a bed available on and the patient was transferred to . the family member was notified and the husband alerted the hospital to transfer with the patient to . discharge status: patient is transferred to in stable condition. discharge medications: 1) prevacid 30 mg per nasogastric tube q.d., 2) regular insulin sliding scale, 3) reglan 10 mg intravenous t.i.d., 4) lactulose 30 cc p.r. q. 8 hours, 5) actigall 300 mg per nasogastric tube b.i.d., 6) sandostatin 200 mg subcutaneously t.i.d., 7) neoral 50 mg p.o. b.i.d., 8) meropenem 250 mg intravenous q 12 hours, 9) vancomycin 500 mg q 24 hours. 9) zofran 2 to 4 mg intravenous q 8 p.r.n. discharge diagnoses: 1. end stage liver disease. 2. acute tubular necrosis. 3. upper gastrointestinal bleed with esophageal varices. 4. altered mental status. 5. coagulopathy secondary to end stage liver disease. , md dictated by: medquist36 procedure: parenteral infusion of concentrated nutritional substances other endoscopy of small intestine percutaneous abdominal drainage diagnoses: acute kidney failure with lesion of tubular necrosis unspecified pleural effusion chronic hepatitis c without mention of hepatic coma portal hypertension esophageal varices in diseases classified elsewhere, with bleeding hepatic encephalopathy cholangitis complications of transplanted kidney 

Answer: The patient is high likely exposed to