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 / heparin agents attending: chief complaint: change in mental status major surgical or invasive procedure: none history of present illness: the patient is a 68 yo f with alcoholic cirrhosis with multiple admission for hepatic encephalopathy, diabetes, hypertension, cva who presents with acute mental status changes. the history was obtained from patient's daughter, who was very reluctant to give the history stating that she is sick of talking to multiple doctors. apparently, she last saw her mother at at lunch yesterday and she was perfectly fine. according to her, at baseline, she is a+o x3 and very independant. during all those past hospitalization, she was at most slightly confused. this time however, she was totally confused, not obeying commands, noncommunicative, nonsensical and refused po intake since am of admission. she has not been taking lactulose for one whole day. her daughter also claims that there might have been some mix up with lactulose doing at . she was sent to the ed at noon. in ed, her vital signs were t100.6 p91 bp105/55 r19 100% on ra. she was reportedly unresponsive downstairs, only moaning with sternal rub. she was started on levo/flagyl for empiric ?uti and given lactulose by enema amd started on d51/2ns and ffp. she was admitted to icu because of concern of respiratory status given that she was very somnolent on arrival to ed. lp was not done in the ed. ct head was negative for hemorrhage/shift.ruq ultrasound has no ascites. cxr was negative. kub show ileus micu: started on lactulose-> mental status started to improve, started on levo/flagyl, then bld cx grew gm + cocci past medical history: 1.cirrhosis etoh 2.depression 3.htn 4.s/p falls, last in secondary to mechanical fall 5.cholelithiasis s/p cholecystecomy 6.h/o stroke with resultant dysarthria 7.h/o thrombocytopenia 8.h/o gi bleed 9.osteoporosis 10.r ext weakness 11.type 2 diabetes mellitus 12.diffuse sm vessel disease of brain. social history: the patient is originally from barbados. she lives with her daughters and grandchildren in . smoked tobacco for approximately 50 yrs, < ppd. quit tob in . abstinent from etoh since . her hcp is her daughter (). family history: mother died at 74 with cirrhosis, dm and htn father died in late 70s of cva physical exam: gen- cachetic elderly woman heent- anicteric, oral mucosa dry, neck supple, oropharyn not visualized as patient refuse to open mouth cv- rrr, no r/m/g resp- ctab, no accessory muscle use abdomen- soft, nt/nd, no hepatosplenomegaly extremities- no pedal edema neurological- coherent and obeys command, appropriate pertinent results: imaging: tte - the left atrium is normal in size. left ventricular wall thickness, cavity size, and systolic function are normal (lvef 60%). no masses or thrombi are seen in the left ventricle. there is no ventricular septal defect. right ventricular chamber size and free wall motion 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. there is no mitral valve prolapse. there is no pericardial effusion. no vegetations seen. the absence of a vegetation by 2d echocardiography does not exclude endocarditis if clinically suggested. abdominal x-ray - probable mild ileus ct abdomen - cirrhotic liver with portal hypertension. nonspecific thickening of right colon. this is a recognized feature of chronic liver disease with portal hypertension. for that reason, colitis must be excluded on a clinical basis. multiple small low-attenuation lesions in the liver. these cannot be further characterized on the current study. abdomen x-ray - air-filled loops of small and large bowel, consistent with an ileus pattern. cxr - no acute cardiopulmonary process. ct head - no intracranial hemorrhage identified liver u/s - nodular liver, with no interval change in appearance in comparison to prior study. no new mass lesions are identified within the liver. a tiny amount of perihepatic fluid is noted. <br> cultures: blood - pending blood - pending blood - pending blood - pending blood - pending blood - coag negative staph urine - staphylococcus, coagulase negative. >100,000 organisms/ml. labs: 03:00pm blood wbc-6.0# rbc-4.08* hgb-12.2 hct-36.8 mcv-90 mch-29.9 mchc-33.1 rdw-16.4* plt ct-66*# 03:32am blood wbc-3.7* rbc-3.45* hgb-10.3* hct-32.5* mcv-94 mch-29.7 mchc-31.6 rdw-16.4* plt ct-52* 06:13am blood wbc-2.5* rbc-3.33* hgb-9.9* hct-29.6* mcv-89 mch-29.8 mchc-33.6 rdw-16.3* plt ct-39* 03:00pm blood neuts-78.9* lymphs-14.7* monos-4.9 eos-1.3 baso-0.1 06:33am blood neuts-67 bands-0 lymphs-14* monos-13* eos-6* baso-0 atyps-0 metas-0 myelos-0 03:00pm blood pt-15.6* ptt-30.4 inr(pt)-1.7 02:59pm blood pt-16.9* ptt-38.1* inr(pt)-2.0 06:13am blood plt ct-39* 03:00pm blood glucose-126* urean-8 creat-0.8 na-140 k-4.7 cl-106 hco3-24 angap-15 06:13am blood glucose-70 urean-2* creat-0.7 na-138 k-3.8 cl-110* hco3-20* angap-12 03:00pm blood alt-33 ast-38 alkphos-102 amylase-100 totbili-1.9* 07:55am blood alt-23 ast-32 alkphos-77 totbili-2.1* 03:00pm blood lipase-34 03:32am blood lipase-30 03:00pm blood ck-mb-notdone 03:00pm blood ctropnt-<0.01 03:00pm blood ck(cpk)-32 03:00pm blood albumin-3.2* 06:13am blood calcium-8.5 phos-2.4* mg-1.2* 05:50pm blood ammonia-179* 07:55am blood ammonia-50* 05:50pm blood afp-2.3 03:00pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 10:02pm blood type-art po2-96 pco2-30* ph-7.46* calhco3-22 base xs-0 intubat-not intuba 03:49pm blood lactate-4.0* 08:23pm blood lactate-2.8* 10:02pm blood lactate-3.3* 12:50pm blood lactate-3.3* brief hospital course: assessment and plan: 68 year old female, alcoholic cirrohsis, dm< htn, cva, admitted to micu for encephalopathy. transferred to floor on . 1. altered mental status - at the time of admission the thought was that the patient had hepatic encephalopathy because of poor complaince with lactulose. she was originally admitted to the micu for close observation of airway status. she did not require intubation. her ammonia level was elevated on admission consistent with previous admission for hepatic encephalopathy. she was given lactulose which was titrated up to bowel movements per day and her mental status gradually improved. during her time in the icu, 1/2 blood cultures grew coag negative staph (anaerobic bottle). her urine also grew coag negative staph. she was started on vancomycin. id was consulted and felt that the patient was not clinically septic and that the vanoc should be discontinued. she had received 5 days of vanco at this point. she has had daily blood cultures since none of which have been positive. they will need to be followed up. the patient has been encouraged to increase her po intake to prevent dehydration and hypotension. 2. alcoholic cirrhosis - the patient was continued on lactulose and it was titrated up to bowel movements per day. she was continued on aldactone which was held on several occassions secondary to dehydration and hypotension. she was also restarted on rifaximin per hepatology. 3. diabetes - the patient was continued on an iss while hospitalized. 4. hypertension - blood pressure was not elevated during this admission. 5. elevated inr (at baseline) - secondary to end stage liver disease. the patient had 3 doses of vitamin k during the admission secondary to elevated inr. 6. thrombocytopenia likely from chronic liver disease, at baseline. the patient was given sub q heparin in the micu. she was found to be hit positive and further heparin was discontinued. pneumoboots were used for dvt prophylaxis until the patient was ambulating. 7 ileus - the patient was nausea and vomiting on admission and found to have an ileus by kub. an ng tube was placed and the patient was npo. her symptoms gradually improved and she was tolerating a regular po diet by the time of discharge. a repeat kub showed resolving ileus. 8. general - pt and ot worked with the patient throughout the hospitalization. medications on admission: 30 ml lactulose qid protonix 40mg folate 1mg aldactone magnesium oxide 400 discharge medications: 1. lactulose 10 g/15 ml syrup sig: forty five (45) ml po qid (4 times a day). disp:*5400 ml(s)* refills:*2* titrate up to bowel movements per day 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. spironolactone 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. rifaximin 200 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* discharge disposition: extended care facility: - discharge diagnosis: hepatic encephalopathy discharge condition: stable discharge instructions: --please take all medications as prescribed. you must take enough lactulose to have bowel movements per day. this is very important. your lactulose is treating your liver disease. to avoid further hepatic encephalopathy you must increase your lactulose until you have bowel movements per day. --please go to all follow up appointments. you have an appointment with your liver doctor on at 9am (dr. . --return to the ed for any fevers, chills, abdominal pain, or increased confusion. --please increase your water/fluid intake every day to prevent dehydration or hypotension. followup instructions: provider: , .d. phone: date/time: 9:00 provider: , date/time: 9:40 please call dr. for a follow up appointment in weeks after leaving rehab. procedure: insertion of other (naso-)gastric tube diagnoses: thrombocytopenia, unspecified abnormal coagulation profile urinary tract infection, site not specified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled alcoholic cirrhosis of liver depressive disorder, not elsewhere classified personal history of other diseases of circulatory system osteoporosis, unspecified paralytic ileus hepatic encephalopathy 

Answer: The patient is high likely exposed to