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: topiramate / aripiprazole / shellfish / bee pollen attending: chief complaint: gastrointestinal bleeding major surgical or invasive procedure: egd tips dilatation history of present illness: ms. is a 43f with a history of alcoholic cirrhosis s/p tips, active alcoholism, and prior ugib attributed to duodenal varix who presents with dark red blood per rectum since 2am. she has had approximately 4-5 episodes of bleeding overnight. this am, felt lightheaded and called ems; she was brought into ed by ambulance. of note, last alcoholic drink was at ~3am. in the ed, initial vs were t 98.2, hr 110, bp 90/60, rr 16, o2 sat 100% 4l nasal cannula. after arrival, bp dropped to 70s/40s and patient received 1l ivf with ns; she was then ordered for 1 unit universal prbcs and t&c for additional 4 units (2nd unit on standby at time of signout). hct returned at 20 from remote baseline in upper 20s-low 30s, and inr was 2.0. gastric lavage was negative. hepatology consult was called, and the patient was started on pantoprazole and octreotide gtt and received one dose of ceftriaxone. ruq u/s with doppler was performed; no report available at the time of signout. bps were back in 90s/60s at time of signout. current access is 4 peripheral ivs: 20g, 22g, 16g, 18g. . on arrival to the micu, patient reports feeling overall poorly, though no pain except at site of left antecube iv. endorses nausea. no other symptoms. transport staff report she has filled two hats with what looks like "pure blood" since arrival in the ed. . review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies diarrhea, constipation, abdominal pain. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. past medical history: alcoholic cirrhosis s/p cholecystectomy gastroesophageal reflux disease bipolar disorder htn depression/anxiety social history: she lives with her husband and 2 children, ages 16 and 17. smokes 1pack every few weeks. used to be an accountant. denies other drug use. currently requests that husband and not be allowed to call her room and not be told any information. family history: non-contributory. physical exam: discharge exam vitals: t: 99.6 98.3 bp: 103/58 p: 83 r:16 o2:99% ra general: alert, oriented x 3, no acute distress. smells of . heent: mmm, oropharynx clear, eomi, perrl neck: supple, jvp flat, no lad cv: regular rate and rhythm (borderline tachycardic), normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley. ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: no tremor/asterixis. skin: grafting to the first and second digits of the hands bilaterally. left arm has large bicep hematoma and swelling with discoloration, 2 + left and right radial pulses with no numbness, and good motor function of fingers. pertinent results: admission labs 11:58pm d-dimer-1732* 10:21pm glucose-124* urea n-13 creat-0.5 sodium-129* potassium-4.1 chloride-100 total co2-23 anion gap-10 10:21pm ld(ldh)-178 10:21pm albumin-2.6* calcium-7.8* phosphate-3.3 magnesium-2.6 10:21pm haptoglob-<5* 10:21pm wbc-4.8 rbc-3.14* hgb-9.5* hct-26.2* mcv-84 mch-30.2 mchc-36.1* rdw-16.2* 10:21pm plt count-72* 10:21pm pt-16.3* ptt-28.8 inr(pt)-1.5* 10:21pm fibrinoge-131* 06:18pm glucose-142* urea n-13 creat-0.4 sodium-128* potassium-4.1 chloride-99 total co2-23 anion gap-10 06:18pm calcium-7.0* phosphate-3.4 magnesium-2.9* 06:18pm wbc-3.5* rbc-2.97* hgb-8.9*# hct-24.6* mcv-83 mch-29.9 mchc-36.0* rdw-15.9* 06:18pm plt smr-very low plt count-68* 06:18pm pt-18.1* ptt-28.3 inr(pt)-1.7* 04:03pm hct-26.3*# 03:45pm urine hours-random 03:45pm urine bnzodzpn-pos barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 08:57am comments-green top 08:57am lactate-2.2* 08:51am glucose-120* urea n-16 creat-0.5 sodium-128* potassium-4.1 chloride-95* total co2-22 anion gap-15 08:51am alt(sgpt)-28 ast(sgot)-64* alk phos-125* tot bili-3.1* 08:51am albumin-2.8* calcium-7.6* phosphate-3.8 magnesium-1.3* 08:51am asa-neg ethanol-238* acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 08:51am wbc-3.6*# rbc-2.42*# hgb-6.7*# hct-20.2*# mcv-84 mch-27.7 mchc-33.2 rdw-17.4* 08:51am neuts-73.3* lymphs-17.8* monos-7.8 eos-0.5 basos-0.6 08:51am plt count-120*# 08:51am pt-21.4* ptt-36.2 inr(pt)-2.0* . discharge exam 06:05am blood wbc-2.7* rbc-3.39* hgb-10.4* hct-29.1* mcv-86 mch-30.6 mchc-35.6* rdw-18.1* plt ct-43* 02:58pm blood hct-28.2* 06:20am blood wbc-2.3* rbc-3.69* hgb-11.3* hct-32.0* mcv-87 mch-30.6 mchc-35.3* rdw-16.3* plt ct-46* 05:44pm blood hgb-10.7* hct-29.9* 06:35am blood wbc-2.6* rbc-3.46* hgb-10.2* hct-28.4* mcv-82 mch-29.4 mchc-35.8* rdw-16.1* plt ct-40* 05:00pm blood hct-27.4* 12:53pm blood hct-26.2* 08:51am blood neuts-73.3* lymphs-17.8* monos-7.8 eos-0.5 baso-0.6 06:05am blood plt ct-43* 06:05am blood pt-20.2* ptt-34.9 inr(pt)-1.9* 06:20am blood pt-18.0* ptt-31.7 inr(pt)-1.7* 06:35am blood plt ct-40* 06:35am blood pt-19.0* ptt-33.3 inr(pt)-1.8* 02:31am blood plt ct-47* 02:36am blood plt ct-60* 02:36am blood pt-15.7* ptt-25.0 inr(pt)-1.5* 01:46pm blood fibrino-191 02:36am blood fibrino-178* 10:21pm blood fibrino-131* 06:05am blood glucose-126* urean-5* creat-0.5 na-133 k-3.0* cl-99 hco3-27 angap-10 06:20am blood glucose-112* urean-8 creat-0.7 na-134 k-3.4 cl-101 hco3-19* angap-17 05:44pm blood glucose-116* urean-9 creat-0.6 na-137 k-3.4 cl-101 hco3-27 angap-12 06:05am blood alt-18 ast-37 ld(ldh)-184 alkphos-102 totbili-4.3* 06:20am blood alt-19 ast-44* ld(ldh)-285* alkphos-89 totbili-4.9* 02:36am blood alt-20 ast-45* ld(ldh)-183 alkphos-81 totbili-5.8* 06:20am blood albumin-2.9* calcium-8.1* phos-3.1 mg-1.4* 05:44pm blood calcium-8.0* phos-2.9 mg-1.6 06:35am blood albumin-2.4* calcium-7.7* phos-3.7 mg-1.6 11:58pm blood d-dimer-1732* 08:51am blood asa-neg ethanol-238* acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 02:49am blood type- comment-green top 08:57am blood lactate-2.2* 02:49am blood lactate-0.8 . reports , micu-7 5:41 pm messenertic clip # reason: please perform a mesenteric angiograms and perform coiling o contrast: omnipaque amt: 145 medical condition: 43 year old woman with history of alcoholic cirrhosis s/p tips, active alcoholism, who presents with lower gi bleed reason for this examination: please perform a mesenteric angiograms and perform coiling of any bleeding vessels final report procedures: 1. portal venogram via the tips shunt. 2. pressure measurements in the portal and systemic venous circulation across the tips shunt. 3. transcatheter coil embolization of the bleeding duodenal varix. 4. stenting and balloon angioplasty up to 10 mm of the right hepatic vein stenosis. clinical indication: 43-year-old woman with history of alcoholic cirrhosis status post tips with active alcoholism who presents with acute lower gi bleeding. informed consent for the procedure was obtained from the patient's husband, after risks, benefits, and potential complications had been discussed. the patient was placed on the angiographic table in supine position and was intubated and sedated per micu protocol. skin of the right anterior neck was prepped and draped in a sterile manner. timeout protocol and huddle protocol were carried out prior to the procedure according to the hospital policy. anesthesia: local, 1% lidocaine. under real-time ultrasound guidance, using the high-frequency linear array transducer, dr. punctured the patent and fully compressible right internal jugular vein using the 21 gauge micropuncture needle. over a 0.018 guidewire, 21 gauge micropuncture needle was exchanged for a 4 french micropuncture sheath followed by advancement of 0.035 bentson guidewire into the infrarenal inferior vena cava. over a bentson guidewire, a 9.0 french 35 cm tip sheath was advanced into the inferior vena cava. cannulation of the right hepatic vein was expedient using a combination of 5.0 french mpa 1 catheter in combination with angled tip 0.035 glidewire. the glidewire was exchanged for a 0.035 amplatz guidewire through the mpa catheter and mpa catheter was exchanged for a 5 french straight flush catheter over the amplatz guidewire. portal venogram was obtained. tips shunt was noted to be patent. pressure measurements demonstrated 17 mmhg portosystemic gradient; with 25 mmhg pressure measurements throughout the tips shunt and in the portal venous basin, 18 mmhg in the right hepatic vein and 8 mmhg in the right atrium. massive duodenal varices are demonstrated on portal venogram. large duodenal varix was cannulated expediently using 5.0 french cobra gliding catheter. cobra catheter entered the duodenal varix in tandem with 0.035 angled tip glidewire. injection of the varix demonstrated active bleeding into the c-loop of the duodenum. coil embolization of the bleeding varix was performed using stainless steel coils of 3 cm x 8 mm profile and 8 cm x 10 profile, respectively. following coil embolization, active bleeding stopped on followup contrast injection. through the 5.0 french cobra gliding catheter, amplatz guidewire was reintroduced into the portal and splenic vein. a 10 mm x 42 mm wallstent was deployed in a telescopic manner through the tips shunt and across the right hepatic vein stenosis. balloon angioplasty was performed using 8 mm x 2 cm high-pressure balloon within the lumen of the tips shunt and 10 mm x 2 cm balloon outside the lumen of the tips shunt in the free right hepatic vein. portosystemic pressure gradient was reduced to 10 mmhg following stenting and balloon angioplasty. hemostasis at the puncture site was achieved without difficulty by manual compression. sterile dressing was applied. conclusion: 1. portosystemic gradient of 17 mmhg was detected. no intra-stent gradients were present. 2. right hepatic vein outflow stenosis. 3. stenting and balloon angioplasty of the right hepatic vein stenosis resulted in reduction of the portosystemic gradient to 10 mmhg. 4. massive duodenal varices with active bleeding in to the third portion of the duodenum demonstrated upon selective injection of the megavarix. 5. successful stainless steel coil embolization of the bleeding duodenal varix. the study and the report were reviewed by cxr findings: portable semi-upright view of the chest demonstrates low lung volumes, which accentuate bronchovascular markings. there is no pleural effusion, focal consolidation or pneumothorax. perihilar vascular congestion is noted. there is no pulmonary edema. heart size is normal. there is interval removal of endotracheal tube. multiple surgical clips and tips shunt catheter project over right upper abdomen. impression: low lung volumes following et tube removal. no focal consolidation to suggest pneumonia. brief hospital course: 43f with a history of alcoholic cirrhosis (still actively drinking), history of prior ugib though now s/p tips, who presents with several episodes of dark red blood per rectum, drop in bp, and hct of 20 concerning for active upper vs. lower gib. # respiratory failure: she was intubated on admission to the icu for airway protection for her egd and . when these were negative, she remained intubated for her cta and angio procedure. after the angio procedure, she was extubated in early pm, and performed well, but had prolonged sedation following extubation so po was not started. she was given 40 mg iv lasix for volume overload on her cxr, with a plan to restart her home furosemide regimen on the floor. was on room air on discharge with no respiratory symptoms. # gi bleed: negative and egd,except for medium non-bleeding grade 1 internal & external hemorrhoids were noted on with brb, and therwise normal egd to jejunum . had duodenal varices on cta. s/p ir guided coiling of duodenal varices, balloon dilation of tips, and stenting of the rt hepatic vein, reducing portosystemic pressure from 15 mg to 10 mg. gi bleed apprears to have stopped. she got a total of 11 u prbc, 2 u plt, 1 u ffp, 2 u cryo. she was given ctx, started on an iv ppi, as well as iv octreotide. upon leaving the icu, her octreotide was dc'ed, and she was placed on ctx and iv ppi. ceftriaxone discontinued on and she was discharged on home ppi. . # pancytopenia: likely secondary to liver cirrhosis. plts and wbc count are comparable to prior values; hct baseline is upper 20s-lower 30s as above. . # alcoholic cirrhosis: tips, portal vein are patent. current meld is 18-22 and child- class b-c. she remains an active drinker. followed by dr. though no recent visit in our system. transaminases, alk phos are roughly at her baseline; tbili and inr are higher than prior baseline. us reveals patent tips continued lactulose for bm per day. restarted home aldactone and lasix, # active alcoholism: active drinker, no known history of dts/seizure. blood alcohol 238 on arrival to ed. . transitional issues of note her potassium was 3.0 on discharge, she was supplemented, her primary care physician was called to follow up on electrolytes on friday and they are aware of the low potassium. medications on admission: reglan 10 mg po tid prn - omeprazole 40 mg po daily - trazodone 100 mg qhs - furosemide 60 mg po daily - spironolactone 150 po bid - lidoderm 5% patch last few months - thiamine hcl 100 mg po daily - folic acid 1 mg po daily - lactulose 10 gram/15 ml 30 ml po qid - lorazepam 0.5 mg po prn - multivitamin 1 tablet po daily meds on d/c summary : - rifaximin 550 mg po bid (per pt no longer taking) - risperidone 1 mg po bid (per pt no longer taking) discharge medications: 1. furosemide 40 mg tablet sig: 1.5 tablets po daily (daily). 2. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po qid (4 times a day). 3. rifaximin 550 mg tablet sig: one (1) tablet po bid (2 times a day). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 6. multivitamin tablet sig: one (1) tablet po daily (daily). 7. spironolactone 100 mg tablet sig: 1.5 tablets po bid (2 times a day). 8. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 9. lorazepam 0.5 mg tablet sig: one (1) tablet po every eight (8) hours as needed for anxiety : do not drive a vehicle with this medication . discharge disposition: home discharge diagnosis: primary diagnosis gastrointestinal bleeding alcohol hepatitis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure to care for you as your doctor. . you were brought to the hospital because of bleeding in the gastrointestinal tract. this bleeding was caused by your active alcohol abuse. please do not drink alcohol as it is life threatening. . we made no changes to your home medication list. . please follow up with the outpatient appointments below: followup instructions: name: , location: address: bldg, 5th fl, , phone: appointment: friday 10:00am department: liver center when: wednesday at 9:20 am with: , md building: lm bldg () campus: west best parking: garage md procedure: other endoscopy of small intestine angioplasty of other non-coronary vessel(s) colonoscopy insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) transcatheter embolization for gastric or duodenal bleeding cranial or peripheral nerve graft insertion of one vascular stent procedure on single vessel diagnoses: esophageal reflux tobacco use disorder unspecified essential hypertension alcoholic cirrhosis of liver iron deficiency anemia secondary to blood loss (chronic) hyposmolality and/or hyponatremia portal hypertension anxiety state, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure blood in stool compression of vein fever, unspecified varices of other sites other specified disorders of stomach and duodenum other and unspecified complications of medical care, not elsewhere classified bipolar disorder, unspecified other and unspecified coagulation defects other and unspecified alcohol dependence, continuous internal hemorrhoids without mention of complication external hemorrhoids without mention of complication acute alcoholic hepatitis alcohol withdrawal other pancytopenia 

Answer: The patient is high likely exposed to