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: no known allergies / adverse drug reactions attending: chief complaint: rising creatinine major surgical or invasive procedure: paracentesis : abo incompatible orthotopic liver transplant : chest tube placement : liver biopsy : ercp hemodialysis q monday, wednesday, friday history of present illness: ms. is a 66 year old woman with h/o hcv cirrhosis on transplant wating list who was admitted from rehab with rising creatinine concerning for hrs. . she was recently discharged on after an admission for hct drop and hyperk in the setting of aldactone. admission was complicated by refractory ascites and hepatic encephalopathy requiring a paracentesis which drained 4.5 l. she has been scheduled for serial weekly paracentesis most recently done on , and scheduled again for . . she is now being admitted today from today after being seen in clinic yesterday with labs at that time revealing rise in her creat to 2.1 (1.5, 1.3, 1.4) and t. bili 7.1 (3.2) bringing her meld up to 29. she is not on diuretics. she was scheduled for repeat paracentesis tomorrow as an outpatient and was to have picc line placed at that time due to poor iv access. . on the floor, she reports abdominal pain and distension, as well as le edema. she is having diarrhea at baseline from her lactulose. she reports occasional brb on the toilet paper with bms which has been attributed to hemorrhoids. vs t: 99.2 131/77 96 18 100% ra. . past medical history: - hcv cirrhosis type 1a c/b ascites, jaundice, encephalopathy, 1 cm enhancing focus in liver, diagnosed 12 years ago, likely secondary to blood transfusion in , she has never received antiviral therapy, she was diagnosed with cirrhosis 8 years ago, received abo incompatible liver transplant - htn - dm2 - left cataract surgery - hysterectomy for fibroids - s/p bladder prolapse surgery social history: she is divorced with 3 children. she was living with her daughter and 3 grandchildren, has a commode her in bedroom, and lives on the . she is a retired nursing assistant. she gave up smoking approximately 4 years ago. she does not drink alcohol and never used recreational drugs. she was discharged to after last admission. family history: her maternal aunt had congestive cardiac failure. her mother had , diabetes and hypertension. two sisters have diabetes. physical exam: admission physical exam: vitals: t: 99.2 131/77 96 18 100% ra general: pleasant female, a/o x3, somewhat somenelent, reporting mild abd pain heent: ncat, op clear, no lad neck: supple heart: rrr, harsh 2/6 systolic murmur throughout precordium lungs: ctab abdomen: distended, taught. tenderness worse in llq without rebound or . bs present extremities: 2+ pulses, 2+ edema neurological: a/o x3, + asterixis, cn2-12 intact, motor and sensory exams normal rectal: hemorrhoids (bleeding) with guaic positive mucous. prolapsed uterus. pertinent results: admission labs: wbc-11.2*# rbc-2.55* hgb-8.5* hct-25.8* mcv-101* mch-33.3* mchc-33.0 rdw-17.2* plt ct-51* neuts-76* bands-1 lymphs-11* monos-10 eos-1 baso-0 atyps-0 metas-1* pt-21.4* inr(pt)-2.0* urean-43* creat-2.1* na-129* k-4.3 cl-99 hco3-18* angap-16 alt-44* ast-81* alkphos-82 totbili-7.1* albumin-3.9 calcium-9.1 phos-2.6* mg-2.3 iron-97 afp-10.4* discharge labs: wbc-15.9* rbc-3.40* hgb-10.0* hct-30.3* mcv-89 mch-29.5 mchc-33.1 rdw-15.2 plt ct-578* pt-13.3 ptt-24.8 inr(pt)-1.1 glucose-111* urean-59* creat-2.6* na-139 k-4.7 cl-97 hco3-30 angap-17 alt-26 ast-24 alkphos-336* totbili-0.6 calcium-9.7 mg-2.2 albumin-3.2* phos-3.9 tacrofk-8.3 brief hospital course: 66-year-old woman with hepatitis c decompensated cirrhosis with ascites, recurrent hepatic encephalopathy on transplant list, now presenting with elevated creatinine and concern for hrs, found to have sbp. . # sbp/decompensated cirrhosis: pt with a meld of 30. she is on transplant waiting list currently. she has been receiving weekly serial therapeutic paracenteses and is due for her next one on , but we canceled this in the setting of her acute illness. diagnostic tap confirmed sbp (760 wbc and 64% poly's) and she was started on ceftriaxone, increased outpatient midodrine regimen and added octreotide as well as albumin. she was continued on rifaximin and lactulose. on she was cleared for liver transplant and underwent abo incompatible liver transplant. . # acute on chronic renal failure: cr up to 2.3 at presentation from baseline of 1.5 on raising concern for hrs. she has been off diuretics since her prior discharge. at the time of transplant she underwent cvvh in the operating room and then was continued on cvvh in the icu post transplant. she has been continued on intermittent hemodialysis using a tunneled hd catheter q monday, wednesday friday and will continue on this regimen. status of recovery of kidney function will be followed . # anemia: thought to be hemorroidal bleed and also from gastropathy seen on prior egd. colorectal surgery was consulted previously for hemorrhoids but the family and pt did not want to pursue surgery. patient's hct has been stable at 25 in the past but did drop to 18 at presentation. she received 2u prbcs. on the patientunderwent successful coil embolization of a distal jejunal branch of the sma with post-embolization angiograms demonstrating no further extravasation of contrast material. . patient completed the course of ceftriaxone for sbp, and based on most recent diagnostic tap it is determined that the patient is safe for transplant. on , an abo incompatible liver was available for patient and deceased donor (brain dead) abo incompatible (a to o) liver transplant (piggyback), portal vein to portal vein anastomosis, common bile duct to common bile duct anastomosis, no t tube, common hepatic artery to splenic artery, splenectomy was performed by dr . during the surgery the patient was maintained on cvvh. the patient received cc of crystalloid, 6 units fresh frozen plasma, 6 units of packed red cells, 3 units of platelets, cc of cell and urine output was 10 cc. estimated blood loss was 5500 cc. she was transferred to the sicu in stable condition. the patient received induction immunosuppresion per the abo incomaptible pathway to include 1000 mg solumedrol, cellcept and thymoglobulin. post operatively the abo incompatible pathway was continued with steroid taper, cellcept 1 gram , thymoglobulin was given for 5 total doses, and prograf was started on the evening of pod 1. she received cvvh while in the unit and was then transitioned to intermittent hd. daily anti a titers were followed. patient had received plasmapheresis prior to the liver transplant and then on pod 4 and 5, the igg titers were noted to be 1:8 and she received two additional plasmepheresis sessions on those days. she extubated on pod 2 the patient was having some difficulty with extubation, and following physical exam, a chest ct was performed confirming a large right sided pneumothorax and a chest tube was placed. this remained in placed until pod 6 with full resolution of the pneumothorax. the chest tube was d/c'd prior to her transfer to the regular surgery floor. the hemodialysis was continued throughout the hospital stay, her urine output has been incidental and creatine has continued to rise between hd treatments. she also continued to have intermittent extra treatments for ultrafiltration. le edema was gone, however she was still having an oxygen requirement. of note the patient often goes in and out of afib while on hemodialysis. the patient has not been anticoagulated. ast and alt have returned to , however the alk phos was noted to be increasing into the second week post op. bilirubin was stable around 0.8. a liver biopsy was performed on showing no evidence of rejection and no hepatitic c recurrence. there was however bile duct proliferation noted and an ercp was performed on . the ercp showed that there was a size mismatch between the donor bile duct and recipient. a sphincterotomy was performed and a plastic stent was placed. this will need follow up in 6 weeks. while ercp being performed, the patient had an episode of desaturation when being positioned for the ercp. she was intubated and following the procedure she was transferred to the sicu and remained intubated overnight. the following day she was able to be extubated. she still has an o2 requirement even at rest and requires approximately 4 l at rest and 6 liters with ambulation. the patient has received all post splenectomy vaccinations. patient was evaluated by physical therapy was rehab was recommended. medications on admission: 1. citalopram 20 mg tab: 0.5 tablet po daily 2. clotrimazole 10 mg troche: 1 troche qid 3. ergocalciferol (vitamin d2) 50,000 unit cap: 1 cap po qwk(mo) 4. omeprazole 40 mg cap: 1 cap po once a day. 5. cyanocobalamin (vitamin b-12) 500 mcg tab: 1 tab po daily 6. folic acid 1 mg tab: 1 tab po daily 7. rifaximin 550 mg tab: 1 tab po bid 8. lidocaine 5 %(700 mg/patch) patch: 1 patch daily prn pain 9. insulin glargine 100 unit/ml: 28 units subq at dinner time 10. insulin lispro 100 unit/ml: per insulin sliding scale subq qid 11. lactulose 10 gram/15 ml: 30 ml po tid 12. calcium carbonate 200 mg calcium (500 mg) tab: 1 tab, po bid 13. pramoxine-mineral oil-zinc 1-12.5 % ointment: 1 appl rectal 5x/day prnhemorrhoids. 15. ciprofloxacin 250 mg tab: 1 tab po q24h discharge medications: 1. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 2. fluconazole 200 mg tablet sig: one (1) tablet po q24h (every 24 hours). 3. acetaminophen 325 mg tablet sig: two (2) tablet po q8h (every 8 hours) as needed for pain/fever: maximum 6 tablets daily. 4. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 5. mycophenolate mofetil 500 mg tablet sig: two (2) tablet po bid (2 times a day). 6. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). 7. valganciclovir 450 mg tablet sig: one (1) tablet po 2x/week (we,sa). 8. tramadol 50 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 9. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day). 10. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection (2 times a day): until fully ambulatory. 11. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po q12 (). 12. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). 13. sucralfate 1 gram tablet sig: one (1) tablet po tid (3 times a day) as needed for gastric ulcer: give at 10 am, 2 pm and 10 pm. must be given 2 hours separate from immunosuppressives. 14. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed for insomnia. 15. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). 16. prednisone 5 mg tablet sig: 3.5 tablets po daily (daily): follow transplant clinic taper. 17. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 18. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation (2 times a day). 19. tacrolimus 1 mg capsule sig: two (2) capsule po q12h (every 12 hours). 20. insulin glargine 100 unit/ml solution sig: twenty two (22) units subcutaneous at bedtime. 21. epoetin alfa 3,000 unit/ml solution sig: one (1) ml injection 3 x/week at hemodialysis: adjust per anemia protocol. 22. ondansetron hcl (pf) 4 mg/2 ml solution sig: four (4) mg injection q8h (every 8 hours) as needed for nausea/vomiting. 23. insulin regular human 100 unit/ml solution sig: per sliding scale injection q 6 hours: follow qid finger stick blood sugars. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: hepatitis c liver transplant (abo incompatible) pneumothorax renal failure currently on hemodialysis large gastroesophageal junction ulcer (seen on ercp ) prolapsed bladder atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: please call the transplant clinic at for fever, chills, nausea, vomiting, diarrhea, constipation, increased abdominal pain, yellowing of skin or eyes, inability to tolerate food, fluids or medications, difficulties with the feeding tube or tube dislodgement, increased edema of ankles, difficulties with breathing, fluid overload, dialysis access issues. patient is to have labwork every monday and thursday with results to the transplant clinic fax . cbc, chem 10, ast, alt, alk phos, t bili, trough prograf level please do not change any medications without first discussing with the transplant clinic. please assure that sucralfate is given at least 2 (two) hours separately from immunosuppression. continue hemodialysis via tunneled hd line qmonday, wednesday friday continue tube feeds via post pyloric feeding tube followup instructions: , md, phd: date/time: 9:40 medical office building, , , ma . , md, phd: date/time: 9:40 medical office building, , , ma . , md phone: date/time: 9:50 medical office building, , , ma md, procedure: insertion of intercostal catheter for drainage continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube hemodialysis closed (percutaneous) [needle] biopsy of liver venous catheterization for renal dialysis percutaneous abdominal drainage endoscopic sphincterotomy and papillotomy endoscopic insertion of stent (tube) into bile duct other transplant of liver endoscopic excision or destruction of lesion or tissue of esophagus other lysis of peritoneal adhesions arteriography of other intra-abdominal arteries total splenectomy transcatheter embolization for gastric or duodenal bleeding therapeutic plasmapheresis other operations on lacrimal gland transplant from cadaver diagnoses: pneumonia, organism unspecified end stage renal disease abnormal coagulation profile diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic hepatitis c with hepatic coma alcoholic cirrhosis of liver acute kidney failure, unspecified hepatorenal syndrome iron deficiency anemia secondary to blood loss (chronic) portal hypertension atrial fibrillation personal history of tobacco use hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure iatrogenic pneumothorax peritoneal adhesions (postoperative) (postinfection) unspecified gastritis and gastroduodenitis, with hemorrhage mechanical complication due to other implant and internal device, not elsewhere classified other sequelae of chronic liver disease other ascites kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure awaiting organ transplant status esophageal varices in diseases classified elsewhere, without mention of bleeding surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation obstruction of bile duct examination of participant in clinical trial other specified peritonitis unspecified hemorrhoids with other complication family history of diabetes mellitus family history of other cardiovascular diseases other secondary thrombocytopenia 

Answer: The patient is high likely exposed to