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: codeine / percocet / darvon attending: chief complaint: abdominal pain major surgical or invasive procedure: ultrasound guided paracentesis history of present illness: 71f with aih/cryptogenic cirrhosis and portal hypertension c/b fluid retention, hyponatremia, hepatic encephalopathy and hcc s/p rfa (solitary 2.0 cm segment iii liver lesion), moderate as, here with increasing abdominal pain for the past 4 days. she denies fevers, chills, sob, cp, diarrhea, constipation, or pain in other locations beside abdomen. she denies new weakness or fatigue. given h/o prior sbp, she sent to ed from liver clinic for evalation of sbp and etiology of worsening abdominal pain. she denies altered mental status initial vs in the ed: 96.6 122/58 87 18 98% on ra. exam notable for tender abdomen, but no nausea/vomiting, fevers, chills. labs notable for asymptomatic hyponatremia to 119. a dx tap was perform demonstrating only 72 wbc, but 9150 rbc's. urine lytes demonstrates na <10, osm 344. ua was significant for 26 epi's, mod bacteria, and 33 hyalian cast, but patient was asymptomatic. patient was given hydromorphone for pain. vs prior to transfer: 98 84 14 107/60 pain past medical history: 1. cirrhosis with portal hypertension 2. hypertension. 3. hyperlipidemia (monitored only.) 4. reported history of uc diagnosed 3 years ago on colonoscopy, but she is asymptomatic is not on pharmacologic therapy. 5. left knee arthroscopy. 6. left shoulder and elbow fracture with pins (unable to undergo mrs.) 7. left total hip replacement in . 8. total hysterectomy in the . 9. appendectomy at age 30. 10. tonsillectomy. 11. cholecystectomy in the . 12. osteoporosis. 13. systolic heart murmur. 14. reported history of pe/dvt, on coumadin in the . social history: she lives alone. no history of alcohol excess. lifelong nonsmoker. competent of all adls iadls. previously worked as a jewelry maker and . family history: no liver disease in family. physical exam: admission physical exam: vitals: 98.1 116/69 86 18 98% on ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 mid to late peaking systolic murmur with quite s2 abdomen: obese with somewhat tense, tender, distended, bowel sounds present, no rebound tenderness or guarding, ext: warm, well perfused, 2+ pulses, 4+ edema throughout lower extremities, no asterixis neuro: non-focal exam except axox3, able to perform serial days of the week accurate, and serial months backward accurately except for skipping may and . discharge physical exam: vitals: 98.0 104/61 84 18 95%ra, i:740ml o:inc bmx3 general: alert, oriented x3, in no acute distress heent: nc/at, sclerae icteric, per, eomi neck: supple lungs: normal respiratory effort, no accessory muscle use, clear to auscultation bilaterally, bibasilar rales, no wheezes or rhonchi cv: regular rate and rhythm, normal s1, mid to late peaking systolic murmur with quiet s2, loudest at rusb abdomen: obese, non-tender, nd, +bs, no rebound or guarding ext: warm, well perfused, 2+ pulses, le edema neuro: no focal neurologic deficits pertinent results: admission labs: 01:45pm blood wbc-7.0 rbc-3.62* hgb-12.5 hct-36.0 mcv-100* mch-34.6* mchc-34.8 rdw-14.6 plt ct-unable to 03:47pm blood pt-18.3* ptt-38.6* inr(pt)-1.7* 01:45pm blood glucose-115* urean-15 creat-1.0 na-119* k-3.9 cl-82* hco3-29 angap-12 01:45pm blood alt-24 ast-102* alkphos-189* totbili-5.0* 11:35pm blood osmolal-259* studies: ruq us (): 1. patent hepatic veins with normal pulsatility and without evidence for budd-chiari. 2. moderate amount of ascites, relatively unchanged from prior ct. 3. cirrhosis without focal lesions. tte (): the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are severely thickened/deformed. there is severe aortic valve stenosis (valve area 0.8-1.0cm2). trace aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. impression: severe calcific aortic stenosis. symmetric lvh with hyperdynamic systolic function. mild mitral regurgitation. ruq us (): 1. cirrhotic liver. splenomegaly. moderate amount of ascites. 2. doppler assessment of the main portal vein shows patency and appropriate directionality of flow. discharge labs: 07:30am blood wbc-5.2 rbc-2.82* hgb-9.4* hct-28.3* mcv-100* mch-33.3* mchc-33.2 rdw-17.9* plt ct-unable to 07:30am blood glucose-79 urean-27* creat-2.6* na-130* k-4.0 cl-94* hco3-27 angap-13 05:10am blood alt-24 ast-69* alkphos-192* totbili-9.8* 07:30am blood albumin-2.0* calcium-8.4 phos-5.1* mg-1.8 brief hospital course: ms. is a 71 yo female with a pmh of aih/cryptogenic cirrhosis and portal hypertension complicated by fluid retention, hyponatremia, hepatic encephalopathy and hcc s/p rfa (solitary 2.0 cm segment iii liver lesion), severe as, who presented with increasing abdominal pain for 4 days. # abdominal pain: upon admission the pt reported 4 days of worsening abdominal pain and distention. this was thought to be due to post-procedural pain from her recent rfa of an hcc 1.5 weeks prior to admission, as well as distention from ascites secondary to her cryptogenic cirrhosis. she had a diagnostic paracentesis performed in the ed which showed no evidence of sbp. she had a ruq ultrasound performed which showed patency of the hepatic vessels, as well as moderate ascites relatively unchanged from her prior ct scan on . she was given oxycodone 5mg q4h prn, which adequately controlled her pain. on a therapeutic paracentesis was performed with ultrasound guidance. this markedly improved her pain and distention. at time of discharge she did not have any abdominal pain. # hypervolemic hyponatremia: upon admission the patient's na was 119, down from a baseline of 125 during her last admission. this was thought to be due to hypervolemic hyponatremia secondary to her cirrhosis. she was asymptomatic with regards to the hyponatremia with no mental status changes. she was initially maintained on 1l of daily fluid restriction, and her home lasix and spironolactone were held in order to preserve sodium. however, over the course of 2 days this did not result in appreciable increase in her sodium, which ranged from 116-119 from . as such she was started on tolvaptan 15mg on , and her fluid restriction was liberalized. her tolvaptan was increased to 30mg daily on due to no increase in her sodium on the 15mg dose. she continued to have poor response to this so it was stopped and she was ultimately started on cvvh for removal of fluid with resolution of her hyponatremia. due to (see below) she was continued on hemodialysis and her diuretics were stopped. # acute kidney injury: patient developed progressive volume overload that was refractory to diuresis. she was initially started on octreotide and midodrine out of concern for hrs but ultimately transitioned to cvvh for removal of approximately 30kg of fluid. etiology of renal failure was thought to be predominantly due to cardiorenal syndrome with small component of hrs. patient was successfully transitioned to hemodialysis. she was continued on midodrine and hydrocortisone to support her blood pressures during dialysis given episodes of hypotension. eventually her sbp stabilized in 100-110's and hydrocortisone was stopped. she was discharged on midodrine 10mg tid. a tunneled hd line was placed for outpatient hd which she will have on a m/w/f basis. # hypoxic respiratory distress: patient developed increasing oxygen requirement in the icu initially requiring bipap and then mechanical ventilation. the cause of her distress was felt to be related to volume overload and improved with cvvh. she was successfully extubated and on nasal cannula at the time of transfer. she failed speech/swallow evaluation after extubation but per family wishes, her diet was advanced for comfort with the understanding that she remains at high risk for aspiration. # severe as: the patient had a history of as with an estimated valve area of 1.0-1.2cm from her prior echo in 5/. upon admission cardiology was consulted to assess whether or not her as might be leading to her fluid overload state. a repeat echo was obtained which revealed an aortic valve area of 0.9 consistent with severe aortic stenosis. cardiology was consulted who felt valvoplasty was not indicated in this patient given her multiple medical conditions and her high risk of morbidity with a surgical intervention. pt has follow up with dr. . # aih/cryptogenic cirrhosis: pt presented with worsening meld scores due to renal failure. patient is not a transplant candidate given her severe aortic stenosis. she was maintained on supportive treatment for her liver disease including lactulose for her hepatic encephalopathy and tube feeds for her poor nutrition. tube feeds were stopped on patient and families request because they felt she was able to take in adequate nutrition on her own. she was discharged on lactulose 15 ml po tid and neomycin sulfate 500 mg po q8h for prevention of hepatic encephalopathy. she was also discharged on ciprofloxacin hcl 250 mg po q24h for sbp prophylaxis. # goals of care: team meeting was held with liver, renal, and palliative care to discuss goals of care now that patient is dialysis-dependent. we reviewed her overall poor prognosis given the extent and incurable nature of her underlying liver disease. the renal team discussed the importance of continued hemodialysis and emphasized the fact that no fluid had yet been taken off during her hemodialysis sessions and that this would likely be required in the future. the decision of the meeting was to continue hemodialysis on the floor and see how she tolerates it. pt and her family decided that she would do best going home with hemodialysis. pt was provided with prescription for lift, wheel chair, and hospital bed which patient received and had set up in home prior to discharge. transitional issues: none medications on admission: the preadmission medication list is accurate and complete. 1. ciprofloxacin hcl 250 mg po q24h 2. acetaminophen 650 mg po q8h:prn pain 3. aspirin 81 mg po daily 4. furosemide 40 mg po daily 5. lactulose 30 ml po daily 6. lisinopril 5 mg po daily 7. spironolactone 100 mg po daily discharge medications: 1. hospital bed semi-electric hospital bed. patient requires this for severe debility; she is bedbound and requires maximal assistance for repositioning. wt 83.1 kg, ht. 66 in. 2. wheelchair standard wheelchair with elevating leg rests. patient requires this for severe debility. wt 83.1 kg, ht. 66 in. 3. alternating pressure pad patient requires this as she is completely bedbound, with multiple pressure ulcers. 4. lift please provide home lift. medically necessary because patient has significantly limited functional mobility and is dependent for sit to stand transfer. 5. acetaminophen 650 mg po q8h:prn pain 6. aspirin 81 mg po daily 7. lactulose 15 ml po tid 8. ascorbic acid 500 mg po bid rx *ascorbic acid 500 mg 1 tablet(s) by mouth twice a day disp #*60 tablet refills:*0 9. folic acid 1 mg po daily rx *folic acid 1 mg 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 10. miconazole powder 2% 1 appl tp qid rash rx *miconazole nitrate 2 % apply to fungal rash four times a day disp #*1 bottle refills:*0 11. midodrine 10 mg po tid rx *midodrine 10 mg 1 tablet(s) by mouth three times a day disp #*90 tablet refills:*0 12. sevelamer carbonate 800 mg po tid w/meals rx *sevelamer carbonate 800 mg 1 tablet(s) by mouth tid w/meals disp #*90 tablet refills:*0 13. vitamin b complex 1 cap po daily rx *b complex vitamins 1 tablet(s) by mouth daily disp #*30 tablet refills:*0 14. ciprofloxacin hcl 250 mg po q24h 15. tramadol (ultram) 25 mg po hs:prn pain rx *tramadol 50 mg 0.5 (one half) tablet(s) by mouth at bedtime disp #*15 tablet refills:*0 16. neomycin sulfate 500 mg po q8h rx *neomycin 500 mg 1 tablet(s) by mouth every eight (8) hours disp #*90 tablet refills:*0 discharge disposition: home with service facility: vna discharge diagnosis: cirrhosis hypervolemic hyponatremia hypotension volume overload end stage renal failure severe aortic stenosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms. , you were recently hospitalized for abdominal pain and distention. these symptoms were thought to be due both pain from your recent radiofrequency ablation of your hepatocellular carcinoma, as well as fluid in your belly, known as ascites, secondary to your cirrhosis. your ascites was drained under ultrasound guidance. you also developed hypotension, volume overload, and failure of your kidneys which requires hemodialysis. we also found that you have worsening of your aortic stenosis; you were evaluated by cardiology who determined that the risks outweighed the benefits of surgery. you will be discharged home and continue dialysis as an outpatient. followup instructions: dialysis center , phone: nephrologist: dr. scheduled: monday, wednesday, friday- **tuesday, at 6:00pm and friday, at 6:00pm- dr. will follow up with you at your next dialysis for your hospitalization. **special schedule due to the upcoming holiday** name: , t. location: internal medicine associates address: , , , phone: appointment: tuesday 1:00pm department: cardiac services when: monday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: cardiac services when: monday at 9:40 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis percutaneous abdominal drainage percutaneous abdominal drainage percutaneous abdominal drainage diagnoses: thrombocytopenia, unspecified end stage renal disease pure hypercholesterolemia urinary tract infection, site not specified congestive heart failure, unspecified cirrhosis of liver without mention of alcohol acute kidney failure, unspecified hepatorenal syndrome hyposmolality and/or hyponatremia portal hypertension atrial fibrillation aortic valve disorders acute respiratory failure other shock without mention of trauma other sequelae of chronic liver disease personal history of venous thrombosis and embolism other ascites malignant neoplasm of liver, primary do not resuscitate status esophageal varices in diseases classified elsewhere, without mention of bleeding leukocytosis, unspecified hip joint replacement mixed acid-base balance disorder personal history of pulmonary embolism personal history of traumatic fracture hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage v or end stage renal disease screening examination for pulmonary tuberculosis other acute postoperative pain 

Answer: The patient is high likely exposed to