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: no known allergies / adverse drug reactions attending: chief complaint: gib major surgical or invasive procedure: esophagoduodenoscopy - history of present illness: 67 spanish-speaking female with hx of cirrhosis c/b hepatic encephalopathy, variceal bleeding, cva, schizoaffective d/o pw hematemesis. the patient was in her usual state of health until 2 day prior when she developed small amount of coffee ground emesis and melena. she presented to the osh ed and was noted to have altered mental status which by report is close to her baseline. initial vitals were: 97.5, 131/53, 85, 16, 97% ra. she had hematemesis in the ed and ngt was placed with return of "bright red blood". lavage did not clear after 250cc of ivf. gi was consulted and she had egd. egd with no clear source of bleed, 1+ varices with no stigmata of bleeding, clot in stomach. she was started on cipro, flagyl, octreotide, pantoprazole and was given 2u prbc. for her ams she had an elevated ammonia and was given lactulose enema x1 with reported improvement in her mental status. other labs included: wbc 9.6, hb 11.2, hct 33.9, plt 118, inr 1.2, lfts nl bili, alt 42, ast 90, bun 38, cr 0.88, co2 20, ammonia 139.5. repeat hct were: 33.9 -> 28.9 -> 33.1 -> 31.1. she had a ct abdomen with no acute intra-abdominal pathology, cirrhotic liver, subcutaneous foci of air overlying rlq, and irregular density within stomach lumen. the patient seemed hd stable without any evidence of gib following the egd. given no icu beds at osh she was transferred to for further evaluation and management. vitals at transfer were: 99.1, 103/45, 81, 16, 98% ra and access was 2 18g ivs. on arrival to the micu, vitals were: 98.7, 82, 129/50, 23, 96% ra. patient was able to answer questions with nodding head yes and shaking head no. only able to verbalize "lalala" which per son is her baseline since stroke years ago. patient denied any pain currently. past medical history: past medical history: - cirrhosis c/b hepatic encephalopathy, varices: patient diagosed 2 years ago in setting of variceal bleed. no hx of etoh - dm2 - schizoaffective disorder - hyperlipidemia - seizure d/o - h/o cva, muliple cva has residual right sided weakness, unable to speak, but can interact. social history: nursing home due to cvas. no hx of etoh/smoking/drug use. uses wheelchair. family history: family hx of stroke, diabetes, cad physical exam: admission exam vitals: 98.7, 82, 129/50, 23, 96% ra. general: no acute distress heent: sclera anicteric, mm dry, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: obese soft, non-distended, bowel sounds present, no organomegaly, no tenderness to palpation, no rebound or guarding rectal: black stool, guiac + ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii intact, 4/5 strength upper/lower extremities on right side full on left, grossly normal sensation, 2+ reflexes bilaterally, gait deferred. able to answer only with "lalala" . discharge exam: vs - 98.6, 131/56 bp , 60 hr , 17 r , o2-sat 97% ra i/o: 24 hr 1696/2425 (1000 stool, 1425 urine) general - elderly appearing woman, comfortable, nonsensical speech heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear neck - supple lungs - diffusely wheezy with transmitted upper airway noses, resp unlabored, no accessory muscle use heart - rrr, no mrg, nl s1-s2 abdomen - nabs, soft/nd, no masses or hsm, no rebound/guarding, very mildly tender to deep palpation extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps); right hand contracted with splint in place, tender to manipulation; 2x4cm hematoma above left antecubital fossa skin - no rashes or lesions neuro - awake, unable to follow commands, mild asterixis pertinent results: admission labs 10:30pm wbc-3.8* rbc-3.48* hgb-10.2* hct-31.0* mcv-89 mch-29.2 mchc-32.8 rdw-15.8* 10:30pm neuts-56.4 lymphs-36.5 monos-4.2 eos-2.6 basos-0.4 10:30pm plt count-78* 10:30pm glucose-240* urea n-27* creat-0.6 sodium-148* potassium-3.7 chloride-112* total co2-27 anion gap-13 10:30pm alt(sgpt)-42* ast(sgot)-45* ld(ldh)-212 alk phos-73 tot bili-0.8 10:30pm albumin-3.2* calcium-7.9* phosphate-2.4* magnesium-1.7 10:30pm pt-14.4* ptt-23.4* inr(pt)-1.3* 10:10pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-tr bilirubin-neg urobilngn-2* ph-6.0 leuk-mod 10:10pm urine rbc-167* wbc-54* bacteria-many yeast-none epi-1 10:43pm lactate-2.1* hct trend: 10:30pm blood hgb-10.2* hct-31.0* 02:56am blood hgb-9.8* hct-30.8* 03:08am blood hct-33.1* 12:40pm blood hct-31.2* 07:50pm blood hct-32.2* 03:32am blood hgb-10.1* hct-31.1* 04:10am blood hgb-10.6* hct-32.0* critical care: 02:08pm blood type-art po2-30* pco2-57* ph-7.31* caltco2-30 base xs-0 10:43pm blood lactate-2.1* 03:50am blood lactate-2.0 02:08pm blood lactate-2.6* discharge labs: 06:00am blood wbc-2.0* rbc-3.36* hgb-9.4* hct-31.0* mcv-93 mch-27.9 mchc-30.2* rdw-15.7* plt ct-66* 06:00am blood pt-14.3* ptt-28.6 inr(pt)-1.3* 06:00am blood glucose-235* urean-11 creat-0.6 na-141 k-3.4 cl-106 hco3-27 angap-11 06:00am blood alt-52* ast-46* alkphos-97 totbili-0.6 06:00am blood calcium-8.0* phos-3.0 mg-1.6 . egd findings: esophagus: lumen: a sliding small size hiatal hernia was seen. protruding lesions 2 cords of grade ii varices were seen in the lower third of the esophagus. one of themshowede stigmata of recent bleeding (red sign). 1 band was successfully placed. other no evidecen of active bleeding stomach: mucosa: localized discontinuous mosaic appearance of the mucosa with no bleeding was noted in the stomach body. these findings are compatible with mild portal gastropathy. localized discontinuous erythema of the mucosa with no bleeding was noted in the antrum. protruding lesions one single large varix was seen in the fundus. red blood was identified surrounding the area of the varix. after irrigation with normal saline no active bleeding was identified. duodenum: mucosa: normal mucosa was noted in the first part of the duodenum and second part of the duodenum. other no evidence of ulcers, polyps or active bleeding impression: varices at the lower third of the esophagus (ligation) small hiatal hernia no evidecen of active bleeding varices at the fundus mosaic appearance in the stomach body compatible with mild portal gastropathy erythema in the antrum normal mucosa in the first part of the duodenum and second part of the duodenum no evidence of ulcers, polyps or active bleeding otherwise normal egd to third part of the duodenum recommendations: 1. continue ocreotide gtt 2. continue ppi gtt 3. continue iv abx (total of 7 days) 4. check hct q6 hrs (transfuse to keep hct 24-29) 5. if more episodes of bleeding will need emergent tips 6. check ruq us with dopplers 7. keep patient npo until tomorrow 8. keep patient in the icu abdominal ultrasound with dopplers : the liver is coarse and echogenic, denoting hepatic steatosis. no focal intrahepatic lesion or intrahepatic bile duct dilation is seen. the cbd is not dilated, measuring 3 mm. the gallbladder is surgically absent. the spleen is enlarged, measuring 14.0 cm. there is no ascites. wall-to-wall color flow is seen within the left, mid, right hepatic veins, left, right anterior and posterior portal veins, main portal vein, and main hepatic artery, all demonstrating appropriate waveforms and flow direction. impression: 1. patent hepatic and portal veins, and main hepatic arteries, demonstrating appropriate waveforms and flow directions. 2. echogenic liver denotes hepatic steatosis. more advanced disease such as cirrhosis or fibrosis cannot be excluded with this technique. 3. splenomegaly. tte : the left atrium is mildly dilated. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. the estimated cardiac index is normal (>=2.5l/min/m2). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is high normal. there is no pericardial effusion. impression: suboptimal image quality. normal biventricular cavity sizes with preserved global biventricular systolic function. mild mitral regurgitation. high normal pulmonary artery systolic pressure. brief hospital course: 67f with hx of cirrhosis and varices, cva, seizure disorder, schizoaffective disorder, diabetes admitted with hematemesis and melena, found to have esophageal varix. . active issues: #upper gi bleed: patient with hx of cirrhosis and varices presented to an osh following several episodes of melana. an egd was performed which did not show clear evidence of bleeding. no icu bed was available at the osh so she was transferred to . she was treated with iv ppi, octreotide gtt, and ceftriaxone for a planned 7 day course. an egd performed at showed a gastric varix and an esophageal varix which looked like it may have recently bled. one band was placed on the esophageal varix. she was restarted on her nadolol. her hct remained stable, and octreotide was discontinued. her pantoprazole was switched to po. she was restarted on her home medications prior to discharge without hypotension or repeat bleeding. she had a midline placed for antibiotic administration, but this infiltrated so her antibiotics were transitioned to cefpodoxime. she developed a large left arm hematoma from the midline, which should be monitored at the nursing home. she will need complete a 5 day course of cefpodoxime. . #ams. per osh ed, patient was altered with elevated ammonia. this improved with lactulose, which is a home medication for the patient. she also has hx of cva, schizoaffective disorder, and seizure disorder though these appear to be controlled. on the morning of she was observed to be somnolent with reduced mental status. her lactulose was increased and by evening she returned to her baseline mental status per family observation. a rectal tube was briefly placed to facilitate care; this was removed when her lactulose was reduced to home dosing schedule. . chronic issues: #cirrhosis. etiology of her cirrhosis is unclear. her family she does not have a history of heavy etoh use and her viral hepatitis panel was negative at the osh. nash cirrhosis versus autoimmune etiologies possible. we initially held her spironolactone, furosemide and nadolol. after she clinically stabilized we restarted the nadolol and her home diuretics prior to discharge. . #aspiration: patient was observed to cough while eating despite sitting upright. speech and swallow evaluation was performed and cleared the patient for soft diet and full liquids. she was able to take medications safely with apple sauce. . #dm: patient on lantus at night, 70/30 in am, metformin, iss. we held metformin but continued her insulin. her metformin was restarted on discharge. . #cva: per records from osh and nursing home not on aspirin or plavix, likely due to high bleeding risk. she was continued baclofen 20mg po tid . #schizoaffective disorder: stable. we continued her venlafaxine 150 mg er po qam and abilify 10mg po bid. . #seizure: stable. continued keppra 500 mg po bid . transitional issues: # pt should be on cefpodoxime for a 5 day course, last dose to be given . . # pt should be started on pantoprazole 40 mg daily. she should be monitored for any signs of recurrent bleeding. . # pt developed large left arm hematoma from midline. please keep this arm elevated and apply warm compresses until this resolves. medications on admission: 1. vicodin 5mg/500mg po qhs 2. metformin 1000mg po bid 3. multivitamin 1 tab po daily 4. vitamin d3 50,000 u po qmonthly 5. furosemide 40mg po daily 6. venlafaxine 150mg er po qam 7. spironolactone 25mg po daily 8. nadolol 20mg po daily 9. miralax 17g po daily 10. baclofen 20mg po tid 11. abilify 10mg po bid 12. lactulose 30ml po bid - bm per day 13. calcium/vitamin d 500mg/200iu po bid 14. keppra 500mg po bid 15. novolog 70/30 16 units qam 16. lantus 10units qhs 17. bisacodyl 10mg pr daily prn constipation 18. fleet enema pr q3days prn 19. trazodone 50mg po q6h prn agitation 20. acetaminophen 325mg po q4h prn pain 21. vicodin 5mg/500mg po q4h prn pain 22. milk of magnesium 30ml po daily prn constipation 23. acetaminophen 650mg pr q4h pain or temp 24. albuterol 0.083% inhaled q4h prn cough/wheeze 25. novolin r u-100 insulin sliding scale discharge medications: 1. hydrocodone-acetaminophen 5-500 mg tablet sig: one (1) tablet po at bedtime as needed for pain. 2. metformin 1,000 mg tablet sig: one (1) tablet po twice a day. 3. multivitamin with minerals capsule sig: one (1) capsule po once a day. 4. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 5. venlafaxine 75 mg capsule, ext release 24 hr sig: two (2) capsule, ext release 24 hr po daily (daily). 6. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 7. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). 8. miralax 17 gram/dose powder sig: one (1) packet po once a day. 9. baclofen 20 mg tablet sig: one (1) tablet po three times a day. 10. aripiprazole 10 mg tablet sig: one (1) tablet po bid (2 times a day). 11. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day): bm/day. 12. calcium 500 + d 500 mg(1,250mg) -200 unit tablet sig: one (1) tablet po twice a day. 13. levetiracetam 500 mg tablet sig: one (1) tablet po twice a day. 14. novolog mix 70-30 100 unit/ml (70-30) solution sig: sixteen (16) units subcutaneous qam. 15. lantus 100 unit/ml solution sig: ten (10) units subcutaneous at bedtime. 16. bisacodyl 10 mg suppository sig: one (1) supp rectal once a day as needed for constipation. 17. fleet enema 19-7 gram/118 ml enema sig: one (1) enema rectal every seventy-two (72) hours as needed for constipation. 18. trazodone 50 mg tablet sig: one (1) tablet po every six (6) hours as needed for agitation. 19. acetaminophen 325 mg tablet sig: one (1) tablet po every four (4) hours as needed for pain: no more than 2g/day. 20. milk of magnesia 400 mg/5 ml suspension sig: thirty (30) ml po once a day as needed for constipation. 21. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation every four (4) hours as needed for sob, wheeze. 22. insulin regular hum u-500 conc 500 unit/ml solution sig: one (1) unit injection four times a day: per sliding scale. 23. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 24. vitamin d2 50,000 unit capsule sig: one (1) capsule po once a month. 25. cefpodoxime 100 mg tablet sig: one (1) tablet po twice a day for 5 days: for 5 days, last dose 4/30. discharge disposition: extended care facility: skilled nursing & rehabilitation center - discharge diagnosis: primary: esophageal varix s/p banding cirrhosis hepatic encephalopathy . secondary: h/o cva diabetes discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: bedbound. discharge instructions: dear ms , it was a pleasure taking care of you at . you were transferred to this hospital from hospital with gastrointestinal bleeding. an endoscopy showed a varicose vein in your esophagus, which is the likely cause of this bleeding. this was banded, a procedure which should reduce the change of future bleeding. after the procedure you had no further signs of bleeding. during your stay you became more tired and confused than normal. your home lactulose was increased, as this was thought to be due to your liver disease. with this medication change you returned to your normal mental status. we made the following changes to your home medications: - start pantoprazole daily - start cefpodoxime 100 mg every 12 hours for 5 days for uti also, it is important than you use no more than 2 grams of acetaminophen per day. note that each vicodin tablet has 500mg, so you may use no more than 4 of these per day even if you use no other tylenol. please see your outpatient hepatologist (liver doctor) in weeks for follow up. please follow-up with your primary care physician and gastroenterologist as listed below. followup instructions: please follow up with your gi physician and the physicians at the nursing home. please see your gi doctor within the next 2 weeks. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours endoscopic excision or destruction of lesion or tissue of esophagus central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified urinary tract infection, site not specified cirrhosis of liver without mention of alcohol acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hyposmolality and/or hyponatremia portal hypertension hematoma complicating a procedure diaphragmatic hernia without mention of obstruction or gangrene other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure long-term (current) use of insulin other late effects of cerebrovascular disease epilepsy, unspecified, without mention of intractable epilepsy esophageal varices in diseases classified elsewhere, with bleeding hepatic encephalopathy varices of other sites other specified disorders of stomach and duodenum schizoaffective disorder, unspecified other and unspecified escherichia coli [e. coli] muscle weakness (generalized) 

Answer: The patient is high likely exposed to