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: narc.analgesic, non-salicyl.analg.&barb. attending: chief complaint: jaundice, anemia major surgical or invasive procedure: picc placement dobhoff placement paracentesis history of present illness: ms. is a 44 year old female who was admitted on with lethargy, weakness, confusion, and new onset jaundice. per her husband, she had had diarrhea (green colored but no melena) for 2 weeks prior and she was taking immodium prn. per patient and husband, no new medication. she had had intermittent productive cough as well. no report of chest pain, shortness of breath, or lightheadedness at that time. per husband, she was disoriented and confused and had slowed speech. her skin turned pale and jaundiced over the next week. she had been taking "a lot" tylenol for plantar fasciitis prior to admission. . upon arrival to , she was found to be anemic with an initial hct of 9.1 and jaundiced although predominantly and indirect bilirubinemia. she was also hyponatremic to 116. her inr was 1.6, platelets of 62. her tox screen was positive for opiates, tylenol, and benzos. a non-contrast head ct was negative. she was hemodynacmially stable but she was admitted to the micu. . in the micu, she was trasfused 10 units of prbcs in 3 days. she had no obvious signs of gi bleeding, although she did have ongoing diarrhea though she was not on lactulose and was c.diff negative. hematology was consulted due to the predominance of indirect hyperbilirubinemia and they felt her anemia was multifactorial. she was treated with unasyn 1.5 g q6 hours since for unclear reasons. . upon arrival to the micu, she denies fevers, chills, nausea, vomiting, melena, brbpr, chest pain, shortness of breath. she does report ongoing diarrhea. she reports increased abdominal distention over the past few weeks. she reports chronic lower extremity edema. she denies suicidal ideation. . review of sytems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, constipation or abdominal pain. no dysuria. denied arthralgias or myalgias. past medical history: presumed alcoholic cirrhosis alcohol abuse with daily alcohol use, last drink bipolar disorder plantar fascitis endometriosis social history: patient is married, she previously drinks a bottle of alcohol/day, last drink . she denies current or former iv drug use. she smokes cigarrettes/day. family history: non-contributory physical exam: vitals: t: bp: 121/63 p:99 r: 21 o2: 97% on ra general: alert, oriented, no acute distress, slowed speach heent: sclera icteric, 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, + systolic murmur, no rubs, gallops abdomen: soft, non-tender, + distended with ascites, bowel sounds present, no rebound tenderness or guarding, unable to assess hepatosplenomegaly ext: warm, well perfused,+ b/l le pitting edema pertinent results: admission labs: 04:05pm blood wbc-9.1 rbc-3.02* hgb-10.5* hct-27.7* mcv-92 mch-34.6* mchc-37.7* rdw-24.7* plt ct-37* 04:05pm blood neuts-90.8* lymphs-5.7* monos-2.5 eos-0.4 baso-0.6 04:05pm blood hypochr-normal anisocy-2+ poiklo-occasional macrocy-2+ microcy-occasional polychr-1+ target-occasional schisto-occasional 04:05pm blood pt-24.1* ptt-50.4* inr(pt)-2.3* 04:05pm blood fibrino-112* 04:05pm blood fdp-40-80* 04:05pm blood ret aut-3.4* 04:05pm blood glucose-105 urean-27* creat-0.8 na-128* k-3.3 cl-88* hco3-32 angap-11 04:05pm blood alt-18 ast-75* ld(ldh)-221 ck(cpk)-20* alkphos-43 amylase-11 totbili-37.3* dirbili-23.1* indbili-14.2 04:05pm blood lipase-33 04:05pm blood albumin-2.5* calcium-8.9 phos-2.8 mg-2.1 iron-150 04:05pm blood caltibc-157* vitb12-greater th folate-5.7 hapto-<20* ferritn-1462* trf-121* 04:05pm blood hbsab-positive hbcab-negative hav ab-positive igm hbc-negative igm hav-negative 04:05pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 04:05pm blood hcv ab-negative 04:42pm blood type-mix temp-36.5 po2-110* pco2-45 ph-7.49* caltco2-35* base xs-9 intubat-not intuba comment-question s 04:42pm blood lactate-2.3* . micro: hbv viral load - not detectable hcv viral load - not detectable stool studies: no salmonella, shigella, campylobacter. no c. diff. e.coli 0157:h7 negative. peritoneal fluid: gram stain 2+ pmns, no organisms. cultures negative. peritoneal fluid: gram stain 2+ pmns, no organisms. cultures negative. peritoneal fluid: gram stain 1+ pmns, no organisms. cultures negative. urine cx: yeast >100,000. imaging: cxr - the right subclavian line tip, the low svc/cavoatrial junction. cardiomediastinal silhouette is unremarkable. lung volumes are very low with bibasilar opacities most likely consistent with atelectasis. no pneumonia. no pneumothorax or appreciable pleural effusion was demonstrated. the high position of the diaphragms may be explained by ascitis. ruq ultrasound: 1. nodular, shrunken heterogeneous appearance of the liver, consistent with cirrhosis. 2. ascites. 3. splenomegaly. 4. main portal vein thrombosis. ct abdomen w/o contrast; ct pelvis w/o contrast : impression: cirrhosis with ascites and splenomegaly. the presence of portal venous thrombosis, seen on the earlier ultrasound, cannot be assessed, particularly given the lack of intravenous contrast administration. ct head w/o contrast : no acute intracranial process. portable tte (complete) : the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. the tricuspid valve leaflets are mildly thickened. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. ct abd - 1. no apparent filling defects within the main portal vein to suggest thrombosis. 2. findings consistent with cirrhosis including ascites, varices, and nodular and shrunken appearance of the liver with caudate hypertrophy. 3. sludge within the gallbladder, unchanged. no evidence of intrahepatic or extrahepatic biliary dilatation. 4. subcentimeter hypodensity within the right lobe of the liver (2, 37), incompletely characterized on this single phase study. kub - ascites. no evidence of obstruction or ileus. ct abdomen w/o contrast; ct pelvis w/o contrast : 1. severe ascites with interval development of intraperitoneal hemorrhage. 2. small hypodense abnormality compatible with clot demonstrated projecting from the right flank parietal peritoneum. this may be the sequelae of recent instrumentation. 3. new development of right lower lobe consolidation, incompletely evaluated on this examination. portable abdomen : impression: severe ascites. no evidence of obstruction. chest (portable ap) : impression: since , dobhoff tube now ends in the upper-to-mid esophagus. right picc ends in the upper svc. cardiomegaly is unchanged. multifocal opacities, more prominent on the right increased, worrisome for progression of multifocal pneumonia. brief hospital course: 44 year old female with cirrhosis presumed secondary to alcohol abuse and tylenol overuse, s/ p 2 week stay in the micu (), briefly transferred to floor, then transferred back to micu on with worsening renal function, mental status change, and respiratory distress thought likely secondary to narcotics; after stabilization in mental status and improved uop and respiratory status, transferred back to floor on liver service. given poor prognosis and worsening liver disease and encephalopathy, pt was ultimately made cmo by family. #. anemia: hematocrit on admission to outside hospital was 9.1. the patient received 10u of prbcs prior to transfer and hematocrit on admission to our icu was 27.7. etiology of profound anemia is likely multifactorial, including anemia of chronic disease (according to iron studies), low-grade gi bleed (with guaiac positive stool), and possible viral gastroenteritis plus alcohol use resulting in marrow supresssion. reticulocyte count of 4 from osh argues against hemolysis and more towards marrow supression. there was concern for dic or ttp given low fibrinogen, elevated ptt, and thrombocytopenia, rare schistocytes; however, our suspecion was that these abnormalities are secondary to liver failure. mcv of 120 suggestive of alcohol abuse and liver failure. the liver service did not feel that concern for gi bleed was high enough to warrant endoscopy or colonoscopy during icu course. in addition, the patient had acute blood loss from intraperitoneal bleed likely secondary to paracenteses in the setting of coagulopathy. she had a diagnostic paracentesis on and on repeat diagnostic para on , ascitic fluid was blood-tinged. over the next several days the patient required 7u prbcs for multiple hct drops. therapeutic paracentesis on removed 2.5l of grossly bloody fluid with an ascitic hct of 8. ct abd at that time showed evidence of hemoperitoneum with possible bleeding vessel on the right parietal peritoneum. the patient was transfused multiple units of ffp (8-12u per day x 4days) and platelets. she was evaluated by both general surgery and transplant surgery, and neither team felt that operative correction of her bleeding was appropriate due to her extremely high mortality rate. by , the patient's hematocrit had stabilized and she no longer required blood transfusions or further ffp. #. cirrhosis: on admission, and throughout icu course, patient had mild transaminitis with thrombocytopenia, ascites, le edema, hepatosplenomegaly, and elevated inr to 2.5. this is likely secondary to cirrhosis from alcoholism, with a potential contribution of recent heavy tylenol use. per patient and husband, the patient had not been drinking for 1 month prior to admission. the patient had no history of liver biopsy, no prior egd/, and had never seen a hepatologist. the patient also had an ultrasound which showed portal vein thrombosis, which was not observed on ct scan. however, per radiology, ultrasound is a more sensitive test and thus the patient was presumed to have an acute portal vein thrombosis contributing to her worsening ascites and splenomegaly. the patient was not a candidate for anticoagulation or thrombolysis due to her high risk for bleeding complications. the liver team followed along while in the micu and the patient was treated with n-acetylcysteine for 3 days. she was also maintained on lactulose, octreotide, rifaximin, and a ppi. in addition, the patient had 2 diagnostic paracenteses, the second of which showed evidence of sbp. bladder pressures were monitored, and when bladder pressure was elevated >20mmhg on , the patient had a therapeutic paracentesis to remove 2.5l bloody ascitic fluid. #. sbp: on second paracentesis, the patient had evidence of sbp. she was treated with unasyn x3days, ceftriaxone x2days, and finally vancomycin/zosyn for 9 days. she was then transitioned to ciprofloxacin to complete a 2 week course on . ascitic fluid cultures were negative. the patient also had 2 kubs to rule out obstruction as cause of abdominal distension and abdominal pain, both of which were negative for obstruction. #. acute renal failure: the patient had elevation in creatinine with peak of 3.0. fena was <1%. differential included prerenal and hepatorenal syndrome. creatinine normalized after albumin infusion x3, which argues against hepatorenal. on hd 12, creatinine again elevated from 0.5 to 1.5, in the setting of having d/c'd octreotide and midodrine for one day. albumin infusion was given again, but discontinued on the floor. cr stabilized at 1.5. #. diarrhea: patient had diarrhea prior to admission and was not on lactulose/rifaximin. all stool studies were negative, though concern remained for viral gastroenteritis vs. med effect (was on magnesium oxide at osh). the patient was started on lactulose/rifaximin during this admission and she continued to have mild diarrhea on this regimen. pt also experienced rectal prolapse during this time. #. hyperbilirubinemia. patient has first onset jaundice in setting of heavy alcohol abuse and recent heavy tylenol use due to plantar fascitis. concerning for jaudice due to liver failure, though per osh report on presentation, hyperbilirubinemia was predominantly indirect (t. bili 17.1, d. bili 5.4). in the setting of getting 10 units of blood, t. bili rose to 37 with d. bili of 23. suspect that hyperbilirubinemia is related to liver failure, but may have element of hemolysis (though labs do not substantiate this - retic count 4, ldh normal, hapto undectable but liver patient). pt did not have any new signs of active bleeding or hematoma and no localizing symptoms. . #. altered mental status. patient had ams that waxed and waned but improved slowly in the icu. this was likely secondary to hepatic encephalopathy, sbp, and initially hyponatremia, which became hypernatremia during the second half of icu stay. head ct showed no evidence of acute intracranial process. mental status improved on day of transfer to floor from micu. patient was oriented x on the floor, with speech continuing to remain slow. mental status and level of alertness continued to wax and wane throughout stay prior to her expiration. #. thrombocytopenia: likely secondary to liver failure and sequestration due to splenomegaly. patient had evaluation for ttp and dic, which was difficult to interpret due to liver failure, but was not highly suspicious. rare schistocytes on smear with elevated ptt, low fibrinogen, and hyperbilirubinemia. however, ldh normal. as above, suspicion for dic and hus was very low. the patient received 2 u platelets while she had intraperitoneal bleed. platelets stabilized in the 50s. #. hyponatremia: patient was hyponatremic on admission, likely secondary to ascites and le edema. once tube feeds were started, the patient became hypernatremic. free water boluses and d5w was continued to correct serum sodium. . # urinary tract infection: the patient's urine grew yeast on and foley was changed. patient was receiving cipro for sbp already and thus no further antibiotics were added. . #. le edema: the patient had bilateral le pitting edema on admission, which was thought to be related to liver failure. however, cardiac function was evaluated with an echocardiogram, which showed normal lv systolic function and mild pulmonary hypertension. her edema persisted throughout the admission. . # h/o alcohol abuse: the patient completed 5 days of high dose thiamine. she was continued on multivitamins and folate. . # cmo: at family meeting, was ultimately decided by family, including husband that pt would not want to continue with aggressive medical management under these circumstances. pt was made cmo, with morphine iv/po sl made available. hospice arrangements were initiated. pt eventually expired prior to discharge to hospice, with family present at bedside. medications on admission: tylenol prn xanax 0.5 qid prn lexapro 30 mg daily (takes intermittently) zolpiden prn hydrocodone prn (not prescribed to her) discharge medications: n/a, expired discharge disposition: expired discharge diagnosis: cardiopulmonary arrest etoh cirrhosis discharge condition: n/a, expired discharge instructions: n/a, expired followup instructions: n/a, expired procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage diagnoses: acute posthemorrhagic anemia acute and subacute necrosis of liver alcoholic cirrhosis of liver acute kidney failure, unspecified hepatorenal syndrome hyposmolality and/or hyponatremia portal hypertension hemorrhage complicating a procedure other sequelae of chronic liver disease other ascites hepatic encephalopathy poisoning by aromatic analgesics, not elsewhere classified other and unspecified coagulation defects other and unspecified alcohol dependence, continuous other bipolar disorders spontaneous bacterial peritonitis portal vein thrombosis aspiration of fluid as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure accidental poisoning by aromatic analgesics, not elsewhere classified plantar fascial fibromatosis 

Answer: The patient is high likely exposed to