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: tachycardia, low hct, guaiac + stool major surgical or invasive procedure: none history of present illness: east hospital medicine attending note date: time: 23:20 the patient is a ms. is a 58 year old f with multiple sclerosis with recent discharge for uti, altered mental status, bilateral dvt's, and new diagnosis of ovarian cancer, who presents with tachycardia and drop in hemoglobin/hematocrit and guaiac positive stools, but not gross blood. pt has no complaints but is only aox1. denies fevers, chills, nausea, vomiting, abd pain, back pain, black or bloody stool. pt recently admitted and started on lovenox for dvt and was discharged yesterday. had 5pt hct drop while in house in the setting of diagnostic paracentesis to eval for malignant ascites, transfused 1u prbc with good response (28->23->1 prbcs->28). has ivc filter in place. in the ed inital vitals were, 98.5 135 133/84 16 97% ra. exam was notable for guaiac positive dark brown stool, no gross blood. labs were notable for hct 22.3 from baseline hct 27 in the last month, and 37 in atrius in 1/. ngl was attempted but patient was unable to tolerate it. gi consulted and recommended 2 u prbcs and pantoprazole 40mg . troponins were negative x1. cr 1.2 (baseline 1.2-1.3). ua showed rbc 64, wbc 37, bacteria few, leuk mod, nitrite negative. cxr (prelim) shows atelectasis, no acute process. ecg showed sinus tachycardia. she was given ctx x1 for uti, 1 unit prbc's, iv pantoprazole. ct abd/pelvis showed new l paraspinal muscle hematoma likely lovenox, no active extravasation, ivc filter w/ unchanged r common/ext iliac clot. no evidence of intraabdominal bleed recent paracentesis. patient was admitted to the icu for tachycardia and concern for active bleed. vs prior to transfer 99.4 148/90 133 99 2lnc. on arrival to the icu, vs: t: 100.0 bp: 134/93 p: 128 r: 20 o2: 96% ra. patient lying comfortable in bed, without complaints. denies pain, admits to feeling tired. unable to give a history as she is a&ox1. on floor, she is reports no pain or problems. she only endorses feeling thirsty and hungry. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies visual changes, headache, dizziness, sinus tenderness, neck stiffness, rhinorrhea, congestion, sore throat or dysphagia. denies chest pain, palpitations, orthopnea, dyspnea on exertion. denies shortness of breath, cough or wheezes. denies nausea, vomiting, heartburn, diarrhea, constipation, brbpr, melena, or abdominal pain. no dysuria, urinary frequency. denies arthralgias or myalgias. denies rashes. no increasing lower extremity swelling. no numbness/tingling or muscle weakness in extremities. no feelings of depression or anxiety. all other review of systems negative. past medical history: - ovarian cancer - recently diagnosed - osteoporosis - multiple sclerosis, wheelchair bound with indwelling foley, - hyperlipidemia - frequent urinary tract infections - myelopathy - chronic pain syndrome social history: she lives in a skilled nursing facility. a brother is healthcare proxy. she has never smoked. she does not drink alcohol. family history: her mother had multiple sclerosis and died at age 72 years of mi. her father had hypertension, depression and died of pacreatic cancer at age 62 years. physical exam: vs: 99.9 105 140/87 18 100% 2l; pain 0/10 gen: no apparent distress heent: no trauma, pupils round and reactive to light and accommodation, no lad, oropharynx clear, no exudates cv: regular rate and rhythm, no murmurs/gallops/rubs pulm: clear to auscultation bilaterally, no rales/crackles/rhonchi gi: soft, non-tender, non-distended; no guarding/rebound ext: anasarca; no clubbing/cyanosis; 2+ distal pulses; peripheral iv present neuro: alert and oriented to person, place and situation; cn ii-xii grossly intact derm: no lesions appreciated pertinent results: labs: on : 09:00pm blood wbc-10.3 rbc-2.35* hgb-7.3* hct-22.3* mcv-95 mch-31.0 mchc-32.6 rdw-14.3 plt ct-501* 09:00pm blood neuts-86.1* lymphs-9.1* monos-3.7 eos-0.6 baso-0.4 09:14pm blood pt-12.6* ptt-28.2 inr(pt)-1.2* 09:00pm blood glucose-97 urean-34* creat-1.2* na-135 k-5.1 cl-102 hco3-23 angap-15 09:00pm blood ck(cpk)-15* 09:00pm blood ctropnt-<0.01 01:41pm blood hgb-8.5* calchct-26 5:31pm hct 31.0 4:47pm ua: source: catheter, color yellow, appear clear, specgr 1.024, ph 5.0, urobil neg, bili neg, leuk mod, bld sm, nitr neg, prot tr, glu neg, ket neg, rbc 7, wbc 53, bact none, yeast rare, epi 1 mucous: rare, nonsqep: <1 11:38am hct 29.0 05:50am na 137, cl 105, bun 31, glu 90, agap=16, k 5.0, co2 21, scr 1.1 ca: 7.2 mg: 1.7 p: 3.3 glu 94, hct 30.7 &#8710;, hgb 10.3, ca .4 &#8710;, plt 354 pt: 12.7 ptt: 26.4 inr: 1.2 chest (portable ap): left picc terminates at the superior cavoatrial junction. lung volumes are low, there is continued left lower lobe opacity with partial silhouetting of the hemidiaphragm, corresponding to atelectasis on prior ct. small left pleural effusion is also present. the right lung is clear. heart size is normal. old healed right anterior second through fourth rib deformities. impression: unchanged left lower lobe atelectasis and small effusion. the study and the report were reviewed by the staff radiologist. cta abd & pelvis: findings: there has been slight increase in moderate left and small right simple pleural effusions, with associated compressive atelectasis. the heart is normal in size, with physiologic pericardial fluid. abdomen: there has been interval decrease in moderate ascites post-paracentesis. subcutaneous gas is noted in the right lower quadrant at the site of paracentesis access, and tracks along the preperitoneal space. moderate ascites is present throughout the abdomen. there is diffuse omental caking, with lobulated enhancing masses encasing the entire upper peritoneum, particularly . soft tissue implants are also noted along the right hepatic lobe extending into pouch and along the right kidney and paracolic gutter, right anterior omentum, periportal space tracking along the falciform ligament, gastrohepatic ligament, and splenic hilum tracking inferiorly along the left paracolic gutter. there is centralization of bowel loops and viscera, compatible with malignant ascites. the liver enhances homogeneously, without focal lesions. gallbladder is partially collapsed, with mild wall edema secondary to third spacing. the pancreas is atrophic, but enhances normally. there is no intra- or extra-hepatic biliary ductal dilation. spleen is normal in size. the adrenals are normal. the kidneys are atrophic, with cortical thinning and lobulation suggesting prior ischemic or infectious injury, as well as multiple dystrophic calcifications. moderate hydronephrosis and proximal hydroureter persists, tapering gradually into the pelvis without evidence of obstructing stones. the stomach is normal. mild wall edema is noted in the first and second portions of the duodenum, likely due to third spacing. the distal small bowel is unremarkable. pelvis: again seen is a large pelvic mass measuring 14.7 cm ap x 12.7 cm tv x 12.5 cm si. this is a markedly heterogeneous appearance with irregular enhancement due to mixed solid and cystic components, internal septations, and coarse internal calcification. the cecum is anteriorly folded. a 1-cm pedunculated lesion along the medial wall of the ascending colon (600b:33) may represent an epiploic appendage. mild wall edema is noted in the hepatic flexure, likely due to third spacing. transverse and descending colon are unremarkable. the proximal sigmoid colon is encased within the pelvic mass and collapsed. however, there is partial reconstitution of the mid-sigmoid, as well as a patulous rectum with intact oral contrast passage, excluding physiologic obstruction. the uterus is contained within the right inferior aspect of the mass, and appears distorted, with retained fluid in the endometrial canal. the bladder and distal ureters are compressed inferiorly. a foley catheter is present, with balloon inflated at the bladder dome, and tip kinking the bladder anterosuperiorly. there is mild lumbar dextroscoliosis, with multilevel degenerative changes. transitional lumbosacral anatomy is noted at l5-s1 on the left. unchanged l2 compression fracture demonstrates 50% loss of anterior height. bilateral pars defects are noted at l4-l5, with grade anterolisthesis and near complete loss of disc space. there is minimal retrolisthesis at l5-s1. marked deformity of the sacrum, which is deviated to the left, with apparent post-traumatic deformity at s1-s2. pelvic girdle is also dystrophic. old healed fractures of the bilateral inferior pubic rami. there has been interval development of a 7.1 cm tv x 5 cm ap x 9.2 cm si intramuscular hematoma in the left paraspinal muscle, spanning the l1 through l4 levels. this demonstrates mixed hyper- and hypodense components, compatible with acute-on-subacute hemorrhage. there is no evidence of retroperitoneal extension. diffuse anasarca is present. ct arteriogram: there is no evidence of active arterial extravasation. note is made of superior compression and kinking of the celiac artery by an anomalous diaphragmatic crus, suggestive of median arcuate ligament syndrome in the correct clinical setting. superior/inferior mesenteric artery origins are widely patent. note is made of aberrant origin of the splenic artery from the superior mesenteric artery. ct venogram: there is no evidence of venous extravasation. the portal, splenic, superior and inferior mesenteric, and hepatic veins are widely patent. retrievable ivc filter is present, with tip at the level of the renal artery takeoffs. again noted is near-occlusive thrombus involving the distal right common and proximal right external iliac veins. left common femoral and superficial femoral venous clots have at least partially resolved. impression: 1. new left paraspinal hematoma, without active extravasation. 2. decrease in malignant ascites post-paracentesis. 3. diffuse metastatic omental caking and peritoneal seeding. 4. large pelvic mass, with distal ureteral obstruction and encasement of the sigmoid colon and uterus. 5. deep venous thrombosis, with ivc filter in place. brief hospital course: ms. is a 58 year old f with multiple sclerosis with recent discharge for uti, altered mental status, bilateral dvt's on lovenox, and new diagnosis of ovarian cancer, who presents with tachycardia, 5 point hematocrit drop, guaiac positive stools, and recent paracentesis complicated with bleeding. # anemia: on hct 22.3, down from 27 on discharge on . on lovenox for dvts, so has increased risk of bleeding. likely primarily due to new left paraspinal muscle hematoma seen on ct (7.1 cm tv x 5 cm ap x 9.2 cm si, spanning the l1 through l4 levels). gi was consulted - felt that the acute blood loss was more likely related to paraspinal hematoma rather than gi bleed. nonetheless, egd was considered, but patient declined. # tachycardia: she was also tachycardic during last , attributed at that time to hypermetabolic state and metoprolol was uptitrated from xl 75mg daily to 37.5mg tid. also be due worsened by acute blood loss (see above) and dvt. restarted metoprolol at slightly lower dose (25mg tid) to avoid rebound tachycardia. her hr decreased with blood transfusion and iv fluids to 90s-100s. metoprolol was held briefly for concern of further gi bleeding, however hr increased to 120s without further evidence of bleeding so metoprolol was restarted at 25mg tid just prior to trasnfer to medicine floor. hr improved since adding metoprolol. later, she was unable to take po metoprolol, so this was switched to iv metoprolol, initially 2.5 mg iv q6h, then up to 7.5 mg iv q6h. # dvt: she has an ivc filter placed and has been on lovenox since her last . we held her lovenox on , given concern for acute bleed. heparin ggt held in icu given concern for bleed. v/q scan from recent here showed low probability for pe. restarted iv heparin when hct stabilized. switched to lovenox 50 mg sc bid on (she had been on 60 mg sc bid at the time of last discharge). increased to 60 mg sc bid when hct remained stable. # uti: multiple previous uti's due to chronic indwelling foley. last hospitalization several days prior to showed urine culture of ampicillin sensitive enterococcus. ?reportedly needs lifelong ampicillin prophylaxis, so she was continued on this on . urine cultures here grew ~5000 yeast. two week course of ampicillin was completed on . . # ovarian cancer, probable: large pelvic mass visualized again. she was seen by atrius oncology here. . # multiple sclerosis: not on medications currently. on provigil and baclofen at home. restarted modafenil. . # encephalopathy: her baseline is a&ox3 and able to engage in conversation, though occasionally confused. was somewhat encephalopathic on her last as well, however this improved upon treatment of her uti. has had extensive work up recently at (lp, mri brain, etc) that did not reveal any significant abnormalities. according to her brother, her mental status has waxed and waned considerably in the last few weeks. the weekend of -15, she became more encephalopathic - she was awake and responded to questions, but in a nonsensical manner, repeating syllables, and unable to state her full name, though she did follow some instructions. #end of life care: over the last few days of her hospitalization, ms. had persistent encephalopathy, and became less interactive. infectious work-up was unrevealing. there was no clear reversible cause of her encephalopathy. she was unable to take her po meds, and her po intake of food was quite limited. she had anasarca. tpn was initiated. neurology was consulted - they thought that her encephalopathy was most likely toxic-metabolic, though paraneoplastic encephalopathy or non-convulsive seizures could also be playing a role. lumbar puncture was not done, as she had had a complication (hematoma) from an lp during a previous hospitalization, and findings of lp were very unlikely to change management. bedside eeg was done -showed generalized encephalopathy, but no seizure activity. oncology, palliative care, and neurology joined in meetings with the patient's brother, . given the extent of her cancer and her poor functional status, she was not a candidate for surgery nor for chemotherapy. in a meeting on , given ms. declining status, new signs of discomfort (groaning, poor responsiveness), no identifiable reversible cause of encephalopathy, and overall disease burden, it was decided (with and multidisciplinary team) to shift to comfort-focused care. she expired on at 4:12pm. her brother, , was present. medications on : 1. enoxaparin 60 mg/0.6 ml syringe sig: one (1) subcutaneous q12h (every 12 hours). 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for yeast infection. 5. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 6. modafinil 100 mg tablet sig: two (2) tablet po qday (). 7. metoprolol tartrate 25 mg tablet sig: 1.5 tablets po tid (3 times a day). 8. ampicillin 250 mg capsule sig: two (2) capsule po q6h (every 6 hours). 9. tylenol 325 mg tablet sig: two (2) tablet po every six (6) hours as needed for fever or pain. 10. colace 100 mg capsule sig: one (1) capsule po twice a day. 11. folic acid 1 mg tablet sig: one (1) tablet po once a day. 12. miralax 17 gram powder in packet sig: one (1) po once a day. 13. fosamax 70 mg tablet sig: one (1) tablet po once a week. 14. ibandronate 150 mg tablet sig: one (1) tablet po once a month. 15. baclofen 10 mg tablet sig: one (1) tablet po four times a day. 16. multivitamin tablet sig: one (1) tablet po once a day. discharge medications: none discharge disposition: expired discharge diagnosis: ovarian cancer, advanced, probable multiple sclerosis discharge condition: expired discharge instructions: n/a followup instructions: n/a procedure: parenteral infusion of concentrated nutritional substances diagnoses: other chronic pain urinary tract infection, site not specified toxic encephalopathy acute posthemorrhagic anemia acute kidney failure, unspecified pulmonary collapse other and unspecified hyperlipidemia atony of bladder osteoporosis, unspecified long-term (current) use of anticoagulants nontraumatic hematoma of soft tissue encounter for palliative care do not resuscitate status acute venous embolism and thrombosis of deep vessels of proximal lower extremity urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure multiple sclerosis tachycardia, unspecified infection and inflammatory reaction due to indwelling urinary catheter nutritional marasmus secondary malignant neoplasm of retroperitoneum and peritoneum malignant neoplasm of ovary 

Answer: The patient is high likely exposed to