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: compazine attending: chief complaint: gastrointestinal bleed major surgical or invasive procedure: tips endotracheal intubation placement of central venous catheter history of present illness: patient is a 63 y/o female with uc s/p colectomy and colostomy 20 yrs ago and recently diagnosed cirrhosis after a variceal bleed in early requiring icu stay and a total of 11 units of prbcs. she presented at that time with bright red blood in her ostomy. the bleeding was eventual stopped when the surgery team put sutures in an actively bleeding vessel at the ostomy site on . afterward, a tagged rbc scan failed to reveal any extravazation of blood. gi scoped the ostomy and found no further sites of bleeding. she was discharged home on . 5 days ago she had the sutures removed from her stoma. she now represents with recurrent bright blood in her ostomy starting at 11 pm last night. she reported lightheadedness at the time of the bleeding. she denies cp, sob, n/v, hematemesis, abdominal pain, fevers. she had a mild nose bleed. she was taken to and then transferred to . in ed at she was transiently hypotensive to sbp 70s. she received 7 liters normal saline and 2 units prbcs. ng lavage in ed negative. currently she complains of chills, but denies lightheadedness, sob. past medical history: hypothyroidism ulcerative colitis gi bleed: bleeding vessel at ostomy cirrhosis, likely etoh anemia of blood loss and deficiency lower extremity cellulitis vs venous stasis social history: reports no alcohol since last admission. prior heavy intake - 2 bottles wine/day. no tobacco, but husband smokes 3 ppd family history: nc physical exam: vs: t 99.0 hr 96 bp 85/48 (in ed: low of sbp 70--> 96/60) rr 15 97% 4l gen: pale appearing, nad heent: op clear, anicteric, mmm, perrl neck: supple cv: rrr, no m/r/g pul: bibasilar crackles, o/w clear abd: soft, nt, midline scar, ileostomy in rlq recently emptied without stool or blood present. ext: 3+ tense pitting edema, areas of erythema over b/l medial shins, +warmth, no tenderness. neuro: a&ox3, speech fluent, moves all extremities. no focal deficits. pertinent results: tips procedure: after risks and benefits were explained to the patient and patient's family, written informed consent was obtained. the patient was placed supine on the angiographic table. the bilateral necks were prepped and draped in the standard sterile fashion. a preprocedure timeout was performed to confirm the patient's name, procedure, and site. using sterile technique, general anesthesia, and local anesthesia, an access was established to the right internal jugular vein using ultrasonographic guidance and micropuncture site. the access site was dilated and a 10-french vascular sheath was placed over the wire with the tip positioned in the superior vena cava under fluoroscopic guidance. a 5-french modified c2 catheter was then advanced through the sheath over the wire with its tip engaged into the hepatic vein under fluoroscopic guidance. the catheter was then advanced distally and venogram was performed. the catheter was then exchanged for a balloon occlusion catheter over the wire and co2 portogram was performed after inflation of the balloon. this was done in the frontal and lateral projections. the portogram confirmed the position of the balloon catheter within the right hepatic vein. a tips puncture site was then advanced through the sheath into the hepatic vein and the branch of the right portal vein was entered after several attempts with the needle. a guide wire was then advanced into the main portal vein and a multihole straight catheter was then placed over the wire with the tip in the main portal vein. pressure gradient was measured at the main portal vein, which was 34 mmhg. the venogram was performed through the catheter, which demonstrated multiple large collateral vessels. the liver parenchyma track was dilated with an 9-mm balloon with an inflation pressure up to 12 atm. a 10 mm x 94 mm wallstent was then deployed, extending from the main portal vein into the hepatic vein. the stent was then dilated with 10-mm balloon. pressure gradient decreased to 2 mmhg between the portal vein and the right atrium. the catheter was then repositioned into the main portal vein and followup venogram was performed. this demonstrated patent shunt, and decreased collateral vessels. the catheter and the sheath were then withdrawn into the ivc and then removed. hemostasis was achieved by direct manual pressure for 15 minutes. by the request of anesthesiologist, a triple-lumen central line was placed before the procedure through left internal jugular vein. the tip of the catheter is within the superior vena cava. the patient tolerated the procedure well and there were no immediate complications. impression: 1. successful transjugular intrahepatic portosystemic shunt placement with reduction of a pressure gradient between portal vein and right atrium at approximately 2 mmhg after the tips placed. . f/u day 1 post-tips doppler u/s: findings: the liver is normal in size, no focal lesions. no intrahepatic biliary dilatation. the tips stent is demonstrated between the posterior branch of the right portal vein and right hepatic vein. the stent appears patent with wall-to-wall flow on color doppler. doppler interrogation along the stent shows a velocity of 71 cm per second in its proximal portion, an elavated velocity of 210 and 256 cm in the mid portion and 142 cm at the distal end. these velocities above 200 cm per second require close followup. main portal vein is patent with a velocity of 41 cm per second. there is normal hepatopetal directional flow in the main and right portal vein towards the tips stent. inferior vena cava appears patent on color doppler as is the right hepatic vein. normal arterial waveform in the left hepatic artery. small amount of intra-abdominal ascites around the liver in the right upper quadrant. conclusion: 1. patent tips stent with expected hepatopetal directional flow in the main portal vein. elevated velocities in the mid portion of the tips stent over 200 cm per second. short interval followup with doppler is advised. 2. small amount of intra-abdominal ascites. . f/u day 3 post-tips doppler u/s: tips ultrasound: 2d, color flow, and doppler examination of the abdomen was performed and compared with . there is a tips stent in the posterior branch of the right portal vein and right hepatic vein. the stent appears patent with wall-to-wall color flow on doppler exam. doppler interrogation along the stent shows velocity of 107 cm per second in the proximal portion, 116 to 160 cm per second in the mid portion and 129 cm per second in the distal portion. these velocities are appropriate and have decreased in comparison to . the main portal vein is patent with velocity of approximately 59 cm per second. there is normal hepatopetal directional flow in the main and right portal vein toward the tips stent. the inferior vena is patent. there is appropriate flow in the main hepatic and left hepatic veins. there is normal arterial waveform in the common hepatic and anterior right hepatic arteries. there is a small amount of intra- abdominal ascites around the liver in the right upper quadrant.\ impression: 1. patent tips stent with appropriate velocities ranging from 107 to 160 cm per second. this is improved in comparison to the prior study. 2. small amount of intra-abdominal ascites. . bilateral lenis: findings: grayscale, color, and doppler images of the right and left common femoral, superficial femoral, and popliteal veins were obtained. normal flow, compressibility, augmentation, and waveforms are demonstrated. no intraluminal thrombus is identified. impression: no deep venous thrombosis in right or left common femoral, superficial femoral, or popliteal veins. . ap cxr: cardiac, mediastinal, and hilar contours are unchanged. the lung fields are clear. bilateral small pleural effusions have slightly improved. no evidence of chf or pneumonia. . ap cxr: compared to yesterday's portable film, there is now new opacity in the right middle lobe, which may represent pneumonia. bilateral pleural effusions may be slightly decreased. vertical left basilar atelectasis now slightly obscures the descending aorta and some consolidation may be present here as well. cardiac size is unchanged. a left subclavian central venous catheter has been placed and the tip is located at the level of the proximal superior vena cava. tips stent is identified in the right upper quadrant, new since yesterday's exam. lumbar dextroscoliosis is noted. conclusion: 1. new opacities in right middle lobe and left retrocardiac region, which could represent pneumonia or atelectasis. 2. decreased pleural effusions. 3. interim placement of left subclavian central venous catheter and tips stent. . pa/lat cxr: findings: left internal jugular venous access catheter appears in unchanged position with tip terminating in upper svc. the heart size and mediastinal contours are within normal limits. there are bilateral pleural effusions, right greater than left, and bibasilar atelectasis, slightly increased from the previous examination. tips stent in place in right upper quadrant. no pneumothorax. impression: 1. bilateral pleural effusions and bibasilar atelectasis, slightly increased. no definite evidence of pneumonia. 2. left internal jugular venous access catheter in satisfactory position. . pa/lat cxr: there has been no significant change since the prior film of , 06, other than removal of the left jugular cv line. no pneumothorax. bilateral pleural effusions and associated bibasilar atelectasis are again demonstrated and no new lung lesions are identified. . wbc-11.2 hct-20.0 mcv-98 plt ct-273 wbc-9.4 hct-28.0 plt ct-201 wbc-15.1 hct-29.6 plt ct-190 wbc-13.3 hct-26.4 plt ct-207 . pt-16.1* ptt-28.9 inr(pt)-1.5* pt-15.4* ptt-32.8 inr(pt)-1.4* fibrino-169 d-dimer-3003* . glucose-99 urean-10 creat-0.7 na-135 k-3.7 cl-105 hco3-20 glucose-138* urean-13 creat-0.8 na-138 k-4.2 cl-112 hco3-18 calcium-8.0* phos-2.7 mg-2.3 . alt-21 ast-61* alkphos-63 totbili-2.7* dirbili-1.5* indbili-1.2 alt-16 ast-34 ld(ldh)-225 alkphos-85 totbili-1.4 . 05:45am blood cortsol-10.0 08:11am blood cortsol-9.0 08:35am blood cortsol-9.9 . urine color-straw appear-clear sp -1.007 blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-neg urine cx: gram positive bacteria. 10,000-100,000 organisms/ml.. alpha hemolytic colonies consistent with alpha streptococcus or lactobacillus sp. brief hospital course: patient is a 63 y/o female with uc s/p colectomy and colostomy 20 yrs ago and recently diagnosed cirrhosis after a variceal bleed in early requiring icu stay and a total of 11 units of prbcs. she presented at that time with bright red blood in her ostomy. the bleeding was eventually stopped when the surgery team sutured an actively bleeding vessel at the ostomy site on . afterward, a tagged rbc scan failed to reveal any extravazation of blood. gi scoped the ostomy and found no further sites of bleeding. she was discharged home on . on , she had the sutures removed from her stoma. she represented with recurrent bright blood in her ostomy starting at 11 pm on . she reported lightheadedness at the time of the bleeding. she denied cp, sob, n/v, hematemesis, abdominal pain, fevers. she also had a mild nose bleed. she was taken to and then transferred to . in ed at she was transiently hypotensive to sbp 70s. she received 7 liters normal saline and 2 units prbcs. ng lavage in ed negative. on presentation to the micu, she complained of chills, but denies lightheadedness or sob. . during her admission, ms. was also diagnosed with alcoholic cirrhosis, with egd demonstrating portal gastropathy with grade i varices in the lower of her esophagus. she adamantly denied any resumption of her alcohol use during the intercedent time between hospital admissions. on initial exam in the micu, she had no evidence of ascites, and diuretics were held. vitamin k was given for inr 1.5. on arrival to the micu, ms. was transfused a total of 5u prbc. she had an ileoscopy on , which found friable tissue at the ioeostomy site exteriorly, with nonbleeding periileostomy varices. the first ileal portion showed portal hypertension ileopathy. the remainder of the examined ileum was normal. she was started on octreotide, and maintained on iv protonix . per gi and liver staff, ir consulted for tips procedure and possible embolization of prominent ileocolic vein. on , she had a 1l brb bleed via ostomy requiring an additional 2u prbc and tamponade against liver via foley. she had a successful tips procedure done on , and fall in pressure gradient to 2mmhg. she was extubated post-procedure without difficulty. l ij placed by ir on at time of tips as well. she was started on prophylactic rifaximin on . f/u us demonstrated resultant expected hepatopetal flow, but with elevated velocities to >200cm/sec. she remained stable, and octreotide was d/c'ed on . she had no further episodes of bleeding since her tips. her hct has continued to slowly trend down, but was been generally stable. . ms. has also been treated for le erythroderma, possible cellulitis, for which she had been treated as an outpatient with tw weeks of keflex. she states that her legs improved somewhat, but remained erythematous and edematous at time of admission, and she was switched to vancomycin on . she had lenis on , which showed no evidence of dvt. her vanc was d/c'ed on call-out to floor on since les did not appear cellulitic, and unclear whether initial appearance was due to cellulitis or venous stasis changes. she had no worsening of symptoms after d/c'ing vancomycin. . ms. ran a low-grade temp while in the micu, to 100.6 on , and then to 102.7f with rigors on after her tips, with increased o2 requirements. cxr demonstrated a new rml and l retrocardiac infiltrate, c/w pna or atelectasis. she was started on zosyn, and transiently required o2 by 75% ft, again, the day after tips. she was placed transiently on neosynephrine for maps in 50s, which was weaned off. her am stim test was abnormal (10.0 to 9.0 to 9.9), and was started on hydrocort and fludrocort. she has been receiving finger sticks and being maintained on a diabetic diet for blood sugars elevated to 190s, possibly in setting of infection vs steroids. on call-out to the medicine floor, ms. had been afebrile for 24 hours, and was feeling very well. she did have one transient episode of relative hypotension to sbp 70s on the morning of transfer, which responded well to 500ml lr. her baseline bbp is 90s, and she had no further episodes of hypotension below this level. . once called out to the floor, a pa/lateral cxr was done to better characterize opacities seen on ap film, which were read as more consistent with atelectasis. she was diligent about using incentive spirometry, and her o2 was quickly weaned to off. as ms. was doing extremely well clinically and afebrile, her zosyn and vancomycin were d/c'ed. she had no increase in oxygen requirement or new fevers after being observed for 48 hours. she did have an elevation in her wbc, matching the initiation of steroid therapy. primary team believed that episode of fever/rigors was transient bacteremia in setting of tips, and transiently increased o2 requirement was atelectasis, which resolved with use of incentive spirometry. since it was not believed that ms. was truly septic, but did not have appropriate response to stim test, she was d/c'ed home on 1 week prednisone taper. she was instructed to f/u with her hepatologist, with whom she had an appointment in two weeks. as she was not volume overloaded and had a recent tips procedure, she was not sent out on her home diuretic therapy. however, she was instructed to call her physician if she had increasing le edema or abdominal swelling to discuss reinitiation of diuretics. she was also instructed to return to the ed with any recurrence of fevers, shortness of breath, or for any other concerns. medications on admission: 1. pantoprazole 40 mg tablet 2. thiamine hcl 100 mg tablet sig: one (1) tablet po daily 3. multivitamin capsule sig: one (1) cap po daily (daily). 4. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 5. ferrous sulfate 325mg tablet sig: one tablet po daily 6. spironolactone 25 mg tablet sig: two (2) tablet po daily 7. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 8. levothyroxine 100 mcg tablet sig: one (1) tablet po daily 9. keflex discharge medications: 1. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 2. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for sleep. 3. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 4. ferrous sulfate 325 (65) mg capsule, sustained release sig: one (1) capsule, sustained release po once a day. 5. folic acid 1 mg tablet sig: one (1) tablet po once a day. 6. thiamine hcl 100 mg tablet sig: one (1) tablet po once a day. 7. multivitamin capsule sig: one (1) capsule po once a day. 8. prednisone 20 mg tablet sig: three (3) tablet po once a day for 7 days: : 3 pills once a day : 2 pills once a day : 1 pill once a day -14: pill once a day : stop. disp:*10 tablet(s)* refills:*0* 9. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 10. ostomy supplies convatec active life drainable pouch precut 1 " # dispense: qs one month refills: 2 11. ostomy supplies wafer #002 disp:qs one month refills: 2 12. ostomy supply adhesive remover wipes # disp: qs one month refills: #2 13. ostomy supplies no sting barrier wipes disp: qs one month refills:#2 discharge disposition: home discharge diagnosis: gi bleed portal ileopathy cirrhosis discharge condition: good discharge instructions: you were admitted with a gi bleed. you had a tips procedure to decrease the pressure in the blood vessels in your gi tract. you should follow-up in liver clinic in weeks and the number is listed below. you should return to the ed with any bleeding from your ostomy, fever, chills, shortness of breath, or for any other problems that concern you. you should not take your lasix or spironolactone for now. if you experience increased leg or abdominal swelling, you should contact your physician regarding whether you should restart these medicines. followup instructions: an appointment was scheduled with dr. in the liver clinic, but we have decided you should see dr. instead. please call on monday to make an appointment with dr. in weeks. when you call that number, please ask them to cancel your appointment with dr. (originally scheduled for ). procedure: colonoscopy transfusion of packed cells injection of anesthetic into spinal canal for analgesia intra-abdominal venous shunt diagnoses: pneumonia, organism unspecified acute posthemorrhagic anemia alcoholic cirrhosis of liver acute kidney failure, unspecified unspecified septicemia portal hypertension unspecified acquired hypothyroidism sepsis cellulitis and abscess of leg, except foot ulcerative colitis, unspecified varices of other sites esophageal varices in diseases classified elsewhere, without mention of bleeding other specified disorders of stomach and duodenum ileostomy status 

Answer: The patient is high likely exposed to