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: aspirin / heparin agents / morphine / tylenol attending: chief complaint: cc: pain control, hypotension major surgical or invasive procedure: right ij cvl placement picc placement history of present illness: 71 y.o. female with left tib/fib fracture recently admitted to micu green for pain control in the setting of hypotension necessitating dopamine, later found to have an enterobacter uti treated with meropenem and subsequently called out to the floor upon resolution of hypotension who is now being transferred back for an acute change in mental status. . patient had been doing well after being called out until yesterday when she triggered for being nonresponsive. of note, she had gotten dilaudid in the am for pain control and had undergone regularly scheduled dialysis with no complications. at the time of the acute change in mental status, a head ct was performed which was normal. an abg was also performed - 7.37/53/71 (previous abgs dating back as far as have shown normal co2 values). she became more responsive after the abg was performed, interacting appropriately and responding to verbal stimuli, however her mental status continued to wax and wane and a micu evaluation was requested. . in the ed, vitals were notable for a rr of 10 during most of the day, but otherwise vitals were stable. she was awake, alert and oriented to person and place. she correctly identified the month, but not the date or year. she was able to follow simple commands. asterixis was noted on exam, despite taking lactulose, recently increased from 30 ml tid to qid and rifaximin. given underlying acid-base disturbance in the setting of mental status changes, she was transferred to the icu for further management. . in the micu, she continued to be hypotensive, cta negative for pe, urine + enterococcus and started on meropenem. mental status improved once agreed to take lactulose. she also failed her stim so was started on steroids. her bp stabilized and she was off pressors and back to the floor. bp was stable during second icu admission. she did have a hct drop (see below) but heme/onc felt this was not hemolysis and there was no active bleeding but hemoccult + stools. . currently, patient reports some leg pain at fracture site but otherwise feeling well. she denies f/c, no dizzyness, no dysphagia, no chest pain, no sob, no cough, no pain, girth slightly increased, no dysuria, no hematuria. she has loose stool with copper tinge, no melena, no nausea/vomiting. past medical history: - vre uti (iv daptomycin) - admission /07 for altered ms hypotension - hepatic encephalopathy: multiple episodes s/p lactulose non-compliance - portal vein thrombosis but not anticoag for h/o gib - type 2 diabetes. - end-stage renal disease, on hemodialysis m/w/f - cirrhosis nash and acetaminophen toxicity. - gastric angioectasia with h/o gi bleeding in 4/. - diastolic chf. ef>55% by echocardiogram in 7/. mod mr and long mitral deceleration time - ?right sided pleural effusion: diagnosed on u/s , cxr showed a small effusion - stayed stable in subsequent imaging. - heparin-induced thrombocytopenia, ab+ in 1/. - history of seizure disorder, on . - history of infection in the left knee. - history of mrsa and clostridium difficile and vre. - history of gram-positive rod bacteremia in 4/. - status post orif of the left distal femur fracture in 12/. social history: she lives at home. her daughter is involved in her care. the patient currently denies alcohol use, tobacco use, and illicit drugs. family history: noncontributory. physical exam: physical exam: vs: 98.3 hr 54 rr 16 90/29 98% ra gen: comfortable, obese, jaundiced, nad neuro: pos asterixis. alert to person, place, month, situation. - cn ii-xii intact, pupils are 2mm and minimally reactive. left buccal fold slightly lower than right - motor: bilat upper prox/distal. right lower prox/distal. left lower not assessed - : intact to light touch throughout - reflexes: 2+ brachiorad bilat, 1+ knee/ankle on right. toes equiv on right. left lower ex not able to examine : jaundiced. subconjunctival hemorrhage on left lateral eye. mm dry. jvp flat cards: iii/vi systolic m w radiation to axilla. rrr, no heave lungs: decreased bs at right base, otherwise clear, no wheeze abd: obese, no caput, bs+ nt nd soft, no rebound. no obvious fluid wave. no shifting dullness skin: erythematous plaques under left breast and panus. ecchymotic lesions on right and left upper ex. left lower ex bandaged. extremities: lue av fistula w thrill. dp right dopplerable. intact left toes. guaiac: neg brown stool pertinent results: ekg: sinus brady, rate 50, left anterior fasc block, rbbb pattern, qtc 535, tw flattening diffusely, no other st-t changes. c/w prior. . cxr: stable right pleural effusion and a lower lobe opacity which may reflect effusion/atelectasis . pelvis and ankle: no fracture . left leg: acute fracture involving the proximal tibia and fibula metaphysis with approximately 6 mm medial displacement of the distal fracture fragment . ruq u/s note is made that this is a difficult study due to the patient's body habitus. the liver has a coarse echotexture appearance, but there are no lesions identified. there is no biliary dilatation and the common duct measures 0.5 cm. there is a partially shadowing echogenic structure within the gallbladder, which appears to be sludge with developing gallstone. there is no ascites identified. the spleen was not identified on this exam. . cxr: there has been removal of right ij central venous catheter. a right picc is seen with its tip terminating in the mid subclavian vein. there is interval resolution of pulmonary congestion and improvement in right pleural effusion which is now small-to-moderate. right lower lung opacities persist likely representing atelectasis. streaky atelectasis persists in the left mid and lower lung. otherwise no new pulmonary infiltrates are identified. the heart size remains enlarged. no pneumothorax is identified. . ammonia: 35 138 101 19 --------------< 137 3.7 25 4.3 ca: 9.1 mg: 2.0 p: 3.3 trop-t: 0.10 ck: 52 mb: notdone . wbc: 6.3 hct: 29.9 plt: 77 n:80.2 l:9.8 m:5.2 e:4.4 bas:0.3 . pt: 16.7 ptt: 36.1 inr: 1.5 (baseline: 1.5-1.8) . echo : mod symmetric lvh, ef 60-70%, +mr . cbc 05:00pm blood wbc-6.3# rbc-2.64* hgb-9.4* hct-29.9* mcv-113* mch-35.5* mchc-31.3 rdw-19.5* plt ct-77*# 03:11am blood wbc-10.7# rbc-2.52* hgb-8.8* hct-26.5* mcv-105*# mch-34.9* mchc-33.2 rdw-20.1* plt ct-68* 04:04am blood wbc-16.7*# rbc-2.40* hgb-8.7* hct-25.7* mcv-107* mch-36.3* mchc-33.9 rdw-20.2* plt ct-62* 03:40am blood wbc-7.5# rbc-2.24* hgb-7.9* hct-23.4* mcv-105* mch-35.3* mchc-33.7 rdw-20.7* plt ct-38* 04:51pm blood wbc-5.3 rbc-2.34* hgb-7.9* hct-23.5* mcv-101* mch-33.7* mchc-33.5 rdw-21.5* plt ct-27* 05:01pm blood wbc-5.0 rbc-2.52* hgb-8.7* hct-25.9* mcv-103* mch-34.5* mchc-33.6 rdw-21.5* plt ct-30* 06:02am blood wbc-5.2 rbc-2.23* hgb-7.6* hct-24.2* mcv-108* mch-34.2* mchc-31.6 rdw-21.2* plt ct-50* 05:10am blood wbc-4.4 rbc-2.53* hgb-8.7* hct-26.0* mcv-102* mch-34.2* mchc-33.4 rdw-20.9* plt ct-34* . abg 02:31pm blood type- po2-319* pco2-53* ph-7.35 caltco2-30 base xs-2 05:15pm blood type-art po2-71* pco2-53* ph-7.37 caltco2-32* base xs-3 07:41am blood type-art po2-80* pco2-45 ph-7.44 caltco2-32* base xs-5 . lactate: 03:57pm blood lactate-3.1* 05:15pm blood lactate-2.3* . misc 12:26pm blood cortsol-43.5* 03:32pm blood pth-161* 02:12pm blood ammonia-31 03:40am blood vitb12-* folate-9.0 05:10am blood calcium-8.6 phos-3.3 mg-1.8 03:06am blood alt-14 ast-21 ld(ldh)-220 alkphos-92 totbili-5.1* 04:18am blood alt-15 ast-20 alkphos-92 totbili-6.5* dirbili-4.1* indbili-2.4 . chem 7 05:00pm blood glucose-137* urean-19 creat-4.3* na-138 k-3.7 cl-101 hco3-25 angap-16 04:04am blood glucose-192* urean-35* creat-5.5* na-136 k-4.4 cl-105 hco3-21* angap-14 11:09am blood glucose-233* urean-25* creat-3.8* na-136 k-3.8 cl-101 hco3-26 angap-13 05:58am blood glucose-169* urean-24* creat-3.1* na-138 k-4.0 cl-101 hco3-27 angap-14 06:08am blood glucose-111* urean-24* creat-3.3* na-139 k-4.4 cl-104 hco3-31 angap-8 06:02am blood glucose-118* urean-29* creat-3.8* na-140 k-4.9 cl-105 hco3-30 angap-10 05:10am blood glucose-101 urean-24* creat-3.3* na-139 k-4.9 cl-103 hco3-31 angap-10 brief hospital course: 71 y.o. female with multiple medical problems, namely cirrhosis and current esbl uti who was transferred to the micu for change in mental status. . hosp course by problem: . ms: delirium intermittently thought initially hepatic encephalopathy vs infection vs medications. in the icu, she was hypotensive requiring pressors (see below). she also developed a uti which was treated. she initially refused lactulose but once she took it, started having bms and improved ms. she was transferred from micu to the floor and was stable for several days. she then was found to be hypoventilating after having received dilaudid. trigger called and she was transferred back to the unit. abg revealed mild hypercapnea but her sx improved rapidly without much intervention. we felt this was dilaudid in setting of pt with poor baseline ms (hepatic enceph) as well as urosepsis. her mental status was stable at discharge. . hypotension: baseline sbp 90s-100s. initially in the micu, she was at baseline but then she trended downward. she required urgent line placement and aggressive ivf repletion. hd was held for several days and she even required pressors and aggressive iv fluids. she had enterobacter uti and was treated with meropenem for plan for 10-14d of therapy. she also failed her stim so was started on steroids. her bp stabilized and she was off pressors and back to the floor. bp was stable during second icu admission. incidentally, cta neg for pe. she did have a hct drop (see below) but heme/onc felt this was not hemolysis and there was no active bleeding. she continued to have bp's in the 80-90's while on the floor, but was asymptomatic with stable hct's. her slightly low bp was attributed to diarrhea and the patient responded to gentle ivf boluses. . heme positive stools: the patient has history of upper gi bleeds and has known gastric angioectasia and grade i varices of esophagus. she continued to have maroon-colored stools this hospitalization but she remained asymptomatic and her hematocrit was stable. she continued her ppi and was restarted on propranolol once her bp normalized. her propranolol has been held due to low blood pressures. . cirrhosis: patient appeared encephalopathic on presentation but improved throught her stay and was oriented and interactive. she was compliant with lactulose and rifaximin but has been known to stop taking her lactulose. liver service followed patient and will see her in clinic. . uti: patient received meropenem, based on sensitivity profile, started on with 10-day total course. . esrd: on hd, seen by renal during her stay. . tib/fib fracture: s/p set in breslow brace. patient will f/u with orthopedics in 4 weeks with dr. . cautious pain control was initiated given h/o ams. . adrenal insufficiency: patient mildly abnormal stim test while hypotensive and received steroids which were rapidly tapered. . chf: history of diastolic dysfunction with significant edema on exam after aggressive hydration. she will continue to have fluid removed by hd. . diarrhea: the patient had multiple episodes of diarrhea with slightly low bp. her diarrhea was mostly likely secondary to lactulose and her dose was decreased, with decreasing bowel movements. c.diff was sent, neg x1. . dm: she was continued on iss . ppx - ppi - lactulose/rifaximin - seizure ppx with given seizure history - no anticoagulation given hit and previous gib; pneumoboots medications on admission: medications; confirmed verbally w daughter: lasix 40mg nondialysis days lactulose 30ml tid levetiracetam 500 mg daily rifaximin 400 mg tablet po tid (not taking at home) pantoprazole 40 mg tablet daily ursodiol 300 mg capsule po bid sevelamer 800 mg tablet tid w meals glargine 12u qhs lispro sliding scale propranolol 10 mg po bid . allergies: asa heparin (hit) morphine tylenol discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 2. sevelamer 800 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 3. ursodiol 300 mg capsule sig: one (1) capsule po bid (2 times a day). 4. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). 5. levetiracetam 500 mg tablet sig: one (1) tablet po daily (daily). 6. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po qid (4 times a day). hold for diarrhea. 7. propranolol 10 mg tablet sig: one (1) tablet po bid (2 times a day). discharge disposition: extended care facility: manor - discharge diagnosis: primary: enterobacter uti with sepsis proximal left tibial fracture hepatic encephalopathy secondary: diastolic heart failure. reversible inferior wall myocardial perfusion defect seizure disorder. cirrhosis secondary to non-alcoholic steatohepatits hepatic encephalopathy gastric angioectasia chronic renal failure stage v on hemodialysis. pancytopenia. diabetes mellitus type ii. hit antibody positive. portal vein thrombosis gallstone pancreatitis mrsa/clostridium difficile. s/p orif of the left distal femur fracture c/b septic knee discharge condition: stable discharge instructions: you were admitted with a leg fracture. you then developed a urinary tract infection with sepsis, which as now resolved. do not but weight on your left leg or walk on your own. if you have fevers or chills, please return to the emergency room. followup instructions: 1. please make an appointment to see your pcp: , . for follow-up. 2. provider: , md phone: date/time: 11:00 3. please call to make a follow-up appointment with the liver clinic. the phone number is: procedure: venous catheterization, not elsewhere classified hemodialysis thoracentesis arterial catheterization injection of antibiotic transfusion of packed cells transfusion of other serum diagnoses: chronic kidney disease, stage v congestive heart failure, unspecified cirrhosis of liver without mention of alcohol acute posthemorrhagic anemia iron deficiency anemia secondary to blood loss (chronic) severe sepsis other convulsions unspecified fall pulmonary collapse septic shock other septicemia due to gram-negative organisms hepatic encephalopathy glucocorticoid deficiency diastolic heart failure, unspecified diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled acute pancreatitis angiodysplasia of stomach and duodenum without mention of hemorrhage closed fracture of upper end of fibula with tibia nutritional marasmus calculus of bile duct without mention of cholecystitis, with obstruction esophageal varices without mention of bleeding edema 

Answer: The patient is high likely exposed to