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: sulfa (sulfonamide antibiotics) / adhesive tape / strawberry attending: chief complaint: hematemesis major surgical or invasive procedure: central line insertion arterial line insertion esophogeal balloon tips history of present illness: mrs. is a 72 year old female with a history of cirrhosis secondary to alpha-1 anti-trypsin disease c/b encephalopathy and varices (never bled in the past), copd, and type 2 diabetes who presented on with ams presumed due to hepatic encephalopathy, now admitted to the micu with upper gi bleeding. this evening she had a bloody stool followed by hematemesis of 2 cupfuls of blood. she remained hemodynamically stable (bp 100s, hr 80s). an ng tube was placed and lavage revealed blood and clot that did not clear after 300 cc's. hct returned at 29.6 (from 33.6). she was transferred to the icu for urgent endoscopy. . on arrival to the icu, she some lightheadedness, but denied cp or sob. denied prior variceal bleeding. a 3rd piv was placed and the first unit of prbcs was hung. she was consented for egd, but as the procedure was beginning, she vomited a very large amount of brb and clot. bp dropped to 80s/40s. 2 more units were rapidly transfused and she was urgently intubated for airway protection. peripheral phenylephrine was also briefly started. after a total of 5 units of prbcs were tranfused, bp had improved to 150s, so phenylephrine easily turned off. repeat endoscopy showed continued blood welling up into the esophagus and filling the stomach, unable to visualize/treat varices due to amount of blood. the procedure was aborted and tube was placed. ir and anesthesia were then consulted for urgent tips. past medical history: 1. hypertension 2. hyperlipidemia 3. type ii diabetes (x6yrs) 4. osa on cpap at home 5. osteoporosis 6. barrett's esophagitis (egd 2 yrs ago) 7. lll pneumonia 8. cirrhosis of the liver 9. copd (no hx smoking) 10. s/p hysterectomy 11. s/p laparascopy 12. s/p cataracts surgery . diverticulosis (on colonoscopy in ) social history: no etoh, no smoking(passive exposure for >20yrs), no illicit drugs. lives at home with 22yo grandson, completes adls w/o difficulty, husband passed away. family history: son and two brothers w/ hemachromatosis (two brothers passed away from cardiac cx). esophageal ca in sister. physical exam: at admission: vitals: afebrile 138/65 77 20 97% 2l general: elderly female in nad heent: sclera anicteric, mm with some dried blood, oropharynx clear 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: distended, dilated skin veins, soft, non-tender, non-distended, bowel sounds present, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: alert and oriented to hospital, date (almost monday), and self. + asterixis pertinent results: 11:09pm lactate-2.3* 11:00pm ascites tot prot-0.9 glucose-219 albumin-<0.3 11:00pm ascites wbc-260* rbc-285* polys-0 lymphs-30* monos-63* mesotheli-6* macrophag-1* 10:56pm urine color-yellow appear-clear sp -1.011 10:56pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 08:23pm glucose-194* urea n-33* creat-1.5* sodium-125* potassium-4.6 chloride-91* total co2-22 anion gap-17 08:23pm estgfr-using this 08:23pm alt(sgpt)-54* ast(sgot)-80* alk phos-221* tot bili-1.6* dir bili-0.6* indir bil-1.0 08:23pm lipase-64* 08:23pm albumin-3.1* 08:23pm ammonia-55* 08:23pm wbc-10.6 rbc-4.06* hgb-13.7 hct-39.0 mcv-96 mch-33.8* mchc-35.1* rdw-13.9 08:23pm neuts-79.0* lymphs-17.0* monos-3.6 eos-0.1 basos-0.3 08:23pm plt count-321 08:23pm pt-17.1* ptt-29.1 inr(pt)-1.5* brief hospital course: on arrival to the icu, ms some lightheadedness, but denied cp or sob. denied prior variceal bleeding. a 3rd piv was placed and the first unit of prbcs was hung. she was consented for egd, but as the procedure was beginning, she vomited a very large amount of brb and clot. bp dropped to 80s/40s. 2 more units were rapidly transfused and she was urgently intubated for airway protection. peripheral phenylephrine was also briefly started. after a total of 5 units of prbcs were tranfused, bp had improved to 150s, so phenylephrine easily turned off. repeat endoscopy showed continued blood welling up into the esophagus and filling the stomach, unable to visualize/treat varices due to amount of blood. the procedure was aborted and tube was placed. ir and anesthesia were consulted for urgent tips which was successfully performed. bleeding stopped and hct's were trended and remained stable. on cxr, a widened mediastinum was noted and a ct scan of the neck and torso were performed which did not show any evidence of disection, esophogeal perforation or evidence of complication from tips. after several hours of stable hct, the esophogeal balloon was deflated and removed. once stabilized, ms was transferred to the floor for further management. while on the floor, she required diuresis secondary to multiple blood products received in the icu. lasix and spirinolactone were given. she had persistent leukocytosis and received a diagnostic tap which was consistent with sbp. she was started on zosyn given her prior ceftriaxone course with question of cephalosporin resistant organisms; her white count mildly improved while on zosyn, however following discontinuation of antibiotics, her white count climbed > 20. a chest x-ray showed worsening consolidation so she was started on treatment for hospital acquired pneumonia. during treatment of her sbp, her renal function started to deteriorate with creatinine rising persistently > 2.0. treatment for hrs was initiated with octreotide, albumin, and midodrine, however renal function persistently deteriorated. given worsening renal function, a decision was made to transition her care to home with hospice. medications on admission: home medications: spironolactone 200 mg daily furosemide 80 mg daily - patient states she is on more than this, but cannot remember the dose simvastatin 80 mg daily cymbalta 20 mg daily aspirin 81 mg daily lactulose 20 g daily esomeprazole magnesium 40 mg daily levalbuterol tartrate 45 mcg, inh q4-6h prn budesonide-formoterol 160-4.5 mcg, 2 puffs vitamin c 500 mg daily calcium carbonate-vitamin d3 500 mg-400 unit milk thisten 140 mg flax seed oil 1000 mg . transfer medications: lactulose 30 ml po/ng tid albuterol 0.083% neb soln 1 neb ih q4h:prn shortness of breath levofloxacin 250 mg po/ng q24h aspirin 81 mg po/ng daily ascorbic acid 500 mg po/ng octreotide acetate 50 mcg/hr iv drip infusion calcium carbonate 500 mg po/ng vitamin d 800 unit po/ng daily pantoprazole 40 mg iv q12h docusate sodium 100 mg po bid senna 1 tab po/ng :prn constipation duloxetine 20 mg po daily simethicone 40-80 mg po/ng qid:prn gas fluticasone-salmeterol diskus (100/50) 1 inh ih simvastatin 80 mg po/ng daily sodium chloride nasal spry nu qid:prn nasal congestion heparin 5000 unit sc tid insulin sc discharge medications: 1. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. 2. symbicort 160-4.5 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation twice a day. 3. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day). disp:*1 unit* refills:*2* 4. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed for gas. 5. nutrition isosource 1.5 cal full strength or equivalent nestle formula goal rate: 35 ml/hr flush w/ 30 ml water q8h 6. nutrition pump for tube feeds, post-pyloric tube, bags for tube feeds 7. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 8. duloxetine 30 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 9. methylphenidate 5 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 10. midodrine 5 mg tablet sig: three (3) tablet po tid (3 times a day). disp:*270 tablet(s)* refills:*2* 11. ciprofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours). disp:*30 tablet(s)* refills:*2* 12. sarna anti-itch 0.5-0.5 % lotion sig: one (1) topical four times a day as needed for itching. disp:*30 * refills:*0* 13. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 14. insulin glargine 100 unit/ml solution sig: six (6) units subcutaneous at bedtime. disp:*1 month supply* refills:*0* 15. lancets misc sig: one (1) lancet miscellaneous four times a day. disp:*120 lancets* refills:*2* 16. insulin needles (disposable) needle sig: one (1) needle miscellaneous at bedtime. disp:*30 needles* refills:*2* 17. glucometer glucometer 18. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po four times a day as needed for gas. disp:*120 tablet, chewable(s)* refills:*0* 19. lift 20. hospital bed with 1/2 rails 21. over the bed table 22. air mattress 23. 3 l oxygen continuous 24. cans of isosource or nestle equivalent please provide isosource 1 month supply at 35 cc/hr continuous via feeding tube discharge disposition: expired discharge diagnosis: primary cirrhosis of the liver hepatic encephalopathy atypical pneumonia / hospital acquired pneumonia hepatorenal syndrome\n spontaneous bacterial peritonitis secondary hyponatremia discharge condition: mental status:confused - sometimes level of consciousness:alert and interactive activity status:ambulatory - independent discharge instructions: dear ms , it was a pleasure caring for you while you were in the hospital. you were admitted to with confusion and fatigue. these symptoms were most likely caused by your liver disease. you were given medications to improve your confusion. unfortunately, while you were here you experienced a serious bleed from varices in your esophagus. it was necessary to place a shunt to allow blood to bypass your liver to reduce bleeding from the varices. you tolerated this procedure very well. after the procedure, however, we found that you had some pneumonia and an infection in your abdomen. over the next several days, your kidney function started to worsen. we started treatment to help treat this, however despite treatment, your kidney function continued to worsen and has not recovered. while dialysis is an option to take the place of your kidneys, it is not without its risks: dialysis can cause your blood pressure to fall. in addition, you will need dialysis nearly three times a week, and the amount of energy you would need to put into getting dialysis would likely detrimentally impact the quality of your life and take time away that you can spend with your family. it's likely that dialysis would prolong your life in the short-term, however the impact of dialysis on your daily life would probably be detrimental. given these considerations, we had a discussion with you and your family, and you've decided dialysis is not something that you are considering at this time. we think this is an appropriate course of action. in the meantime, while you are at home, we would ensure that you continue to be comfortable. we will continue to treat your symptoms, including pain, shortness of breath, or whatever other discomfort you experience. we will continue some of the tablets that we have been giving you to slow the progression of your kidney disease. there are several medications that we have stopped that are not necessary - these changes are summarized below. we sincerely hope that in the coming days, our treatment plan will help keep you comfortable and at peace, and that this will allow to enjoy your time with your family. . the medication changes we made during this hospitalization are: (1) we increased your dose of duloxetine to 30 mg daily, you should continue to take this medicine. (2) we started methylphenidate which you can continue to take at a dose of 2.5 mg twice a day. this will help you stay alert and will improve your appetite. (3) we started midodrine, a tablet that will help slow the progression of your kidney disease. you should take 15 mg, three times a day by mouth. (4) we started ciprofloxacin, a tablet that prevents you from getting another infection in your belly. you should take 250 mg daily by mouth. (5) sarna lotion - you can apply this lotion four times a day as needed for itching. (6) pantoprazole 40 mg twice a day - this medicine helps protect your stomach from bleeding. (7) rifaximin - 400 mg three times a day - this will help keep your mind clear. (8) lactulose - you should take this medicine so that you have three to four bowel movements per day. this will also help to keep your mind clear. (9) simethicone - as needed for gas pain. (10) glargine - we have given you a prescription for glargine (insulin) which you do not need to start immediately. you should check fingersticks twice a day, once in the morning before breakfast and once at night before dinner. if sugars are persistently > 300, can start glargine 6 units at night. (10) you can stop the following medicines: simvastatin, aspirin, vitamin c, calcium, vitamin d, milk thistle, flaxseed oil. (10) there are several other medications that will be given you as part of hospice, including morphine for pain and benzodiazepines for shortness of breath. followup instructions: hospice care procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine enteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage injection of anesthetic into spinal canal for analgesia intra-abdominal venous shunt insertion of sengstaken tube phlebography of the portal venous system using contrast material diagnoses: pneumonia, organism unspecified obstructive sleep apnea (adult)(pediatric) unspecified essential hypertension cirrhosis of liver without mention of alcohol diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hepatorenal syndrome hyposmolality and/or hyponatremia chronic airway obstruction, not elsewhere classified osteoporosis, unspecified other ascites esophageal varices in diseases classified elsewhere, with bleeding hepatic encephalopathy barrett's esophagus alpha-1-antitrypsin deficiency autoimmune hepatitis 

Answer: The patient is high likely exposed to