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: the patient is a 41 year old white female with end stage liver disease secondary to primary sclerosing cholangitis plus auto immune hepatitis overlap with cirrhosis and hypertension who was complaining of vomiting which had begun the morning of her admission date. the patient stated that she had felt ill over the past night and after eating breakfast today had some projectile vomiting. she had a total of two episodes of emesis. she denied any nausea, blood in her emesis or bile in her emesis. the patient also complained of intermittent belly pain which she could not localize. she also had diarrhea, although she attributed this to being on lactulose. she noted that her belly had gotten larger over the past few days and that she has found it harder to concentrate recently. she also complained of weight loss since being discharged on , just three days previously from , where she had been a patient for approximately three weeks for treatment of hyponatremia secondary to diuretic use, anemia secondary to gastrointestinal bleeding, coagulopathy secondary to end stage liver disease, and resulting pulmonary and peripheral edema secondary to discontinuing diuretics. with respect to this current admission the patient states that in addition to the symptoms mentioned above, she also has noted some blood-tinged sputum of yellowish color when she coughs. she denies any shortness of breath but states that she has been generally winded and tired recently. she denies any urinary symptoms. past medical history: 1. primary sclerosing cholangitis/auto immune hepatitis overlap, causing end stage liver disease diagnosed in , sequelae includes massive hemorrhoids, encephalopathy and ascites; 2. hypertrophic pulmonary osteoarthropathy; 3. lower back disc herniation; 4. duodenal ulcers, status post esophagogastroduodenoscopy. family history: non-contributory, the patient has two children, ages 5 and 3 who are alive and well. social history: the patient denies alcohol, tobacco or drug use. medications prior to admission: 1. multivitamin one a day 2. vitamin d 400 units q.d. 3. calcium carbonate 800 mg q.i.d. 4. estradiol 600 mg b.i.d. 5. protonix 40 mg b.i.d. 6. aldactone 100 mg q.d. 7. -ciel 20 mg q.d. 8. levaquin 500 mg q.d. 9. lactulose 30 cc q.i.d. 10. lasix 40 mg p.o. q.d. 11. carafate 1 gm q.i.d. 12. mycelex 5 times a day 13. magnesium oxide 400 mg b.i.d. allergies: questionable allergy to sulfa. physical examination: vital signs, temperature 99.2, blood pressure 92/50, heartrate 76, respiratory rate 18. in general, ill-appearing, tired jaundiced thin female in no apparent distress. head, eyes, ears, nose and throat, yellow ictera, pupils equally round and reactive to light and accommodation. jaundiced under the tongue, no thrush. neck was supple with no masses or jugulovenous distension. cardiac examination, regular rate and rhythm, no rubs or gallops but a iii/vi murmur present at the left sternal border. pulmonary examination, clear to auscultation bilaterally. abdomen, positive bowel sounds, abdomen is distended but soft. positive splenomegaly. extremities, no cyanosis or edema, positive clubbing. laboratory data: laboratory data on admission showed white blood cell count 5, hemoglobin 10.9, hematocrit 31.5, platelets 60, mcv 92, sodium 134, potassium 3.9, chloride 100, bicarbonate 28, bun 21, creatinine 1.0, glucose 78, pt 17.1, inr 2.0, ptt 43.5, calcium 7.7, phosphorus 2.7, magnesium 1.8. alt 59, ast 90, alkaline phosphatase 169, amylase 118, total bilirubin 25. assessment/plan: the patient is a 41 year old female with end stage liver disease, admitted directly from clinic after presenting with a complaint of vomiting. the differential diagnosis that was generated to explain the patient's vomiting included gastric outlet obstruction, biliary obstruction, infection, gastrointestinal bleed, portal vein thrombosis and ascites and medication side effects. hospital course: the patient received an adequate workup in the hospital and the following is a system by system account of what took place: 1. gastrointestinal/hepatology - the patient's nausea and vomiting was worked up. esophagogastroduodenoscopy was performed the day of admission and was negative for any new bleed, erosion or mass. an ultrasound of the abdomen was also done to evaluate for portal vein thrombosis and ascites but it too was negative. because the patient's bilirubin was elevated a cholestatic or hepatic etiology was also feared. however, magnetic resonance cholangiopancreatography of the liver and gallbladder revealed no obstructive strictures, although in general the ductal distribution appeared to be more affected than previously. the patient was also worked up for infectious etiologies of her nausea and vomiting and those we mentioned below in the infectious disease section. with respect to the patient's hepatobiliary disease, it is important to note that the patient's alt was elevated ranging from 98 to 111 throughout the hospitalization; likewise her ast was also elevated and ranged from 136 to 212. the patient's ldh was high and ranged from 225 to 316; alkaline phosphatase ranged from 189 to 227. total bilirubin ranged from 35.6 to 42.5, and albumin was 2.1 to 2.8. the bilirubin was fractionated and shown to be mostly direct bilirubin although both direct and indirect bilirubins were increased. with respect to pancreatic enzymes, lipase ranged from 52 to 160 whereas amylase ranged from 85 to 150 during the hospitalization. on hospital day #4 the patient was noted to have asterixes, as well as experiencing changes in her mental status, i.e. lethargy, slurred speech. the patient's regimen of lactulose was increased so as to have four to six bowel movements per day. within a few days the patient's encephalopathy improved as there were no asterixes found on examination by hospital day #8. 2. fluids, electrolytes and nutrition - on hospital day #2 the patient developed hyponatremia, perhaps secondary to diuretic use as the patient had developed before in a prior admission. the sodium on was 125. the patient complained of fatigue and still some nausea but did not show any other signs or symptoms of hyponatremia. the hyponatremia had been treated since then with fluid restriction of 1 to 1.5 liters, holding all diuretics, , m.d. dictated by: medquist36 procedure: parenteral infusion of concentrated nutritional substances other endoscopy of small intestine diagnostic ultrasound of heart enteral infusion of concentrated nutritional substances other transplant of liver diagnoses: hyperpotassemia acute kidney failure with lesion of tubular necrosis other postoperative infection acute and subacute necrosis of liver hyposmolality and/or hyponatremia intestinal infection due to clostridium difficile other chronic hepatitis cholangitis acute pancreatitis 

Answer: The patient is high likely exposed to