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: sulfisoxazole attending: chief complaint: altered mental status major surgical or invasive procedure: endoscopy and colonoscopy history of present illness: 57 f with hep c cirrhosis, s/p liver transplant, recurrent hepatic encephalopathy, recently admitted with altered mental status from . during that admission, she was in the icu, then on the - service. prior to that she was recently admitted from at and then again from about at hospital for hepatic encephalopathy (also admitted on at least 2 other occasions in ). during last admission, was seen by transplant nurse y of 2nd olt. on discharge, patient was a & o x 3. . ems was called increasing ams. initial fs 120 w/ ems. in the ed, initial vs were 99.0, 107, 119/66, 17, 99/ra. pe notable 'moaning, nonverbal, protects airway and purposeful movement' and for guaiac negative. ruq u/s with no ascites to tap for sbp. cxr obtained and read as 'cannot r/o pna'. ekg with sinus tachycardia, early r-wave progression but no significant interval change from prior ua equivacol with wbc and bacteria, but no le or nitrites. labs with ammonia of 262. lfts without acute changes. given lactulose 60ml pr and unasyn 3g iv for uti and 2500ml ns. per ed resident, she was moaning and mumbling and minimally responsive but was protecting her airway. upon transfer, vs 99.4, 120, 135/92, 99%/ra. . past medical history: - cirrhosis hep c; s/p olt with recurrent hep c and autoimmune hepatitis (seen on biopsy); s/p ifn/ribavirin in past. complicated by recurrent hepatic encephalopathy, sbp prior to transplant per husband, gi bleeding (both brbpr and melena, last 3-4 months ago per husband, but per husband does not seem that she has ever required blood transfusions etc). - recurrent facial cellulitis of cheeks - asthma - dm - htn - osteoporosis - nephrolithiasis - h/o c.diff - zoster social history: lives with husband. denies etoh, smoking, drug use. family history: mother with some type of liver disease and chf. physical exam: on transfer to the hepato-renal service: vs - t 98.0, bp 118/86, p 68, rr 20, o2 sat 100% ra general - middle aged mildly jaundiced woman in nad, rambling heent - scleral icterus, mmm, op clear neck - supple, no thyromegaly lungs - ctab heart - rrr, no mrg, abdomen - well-healed scar. soft, distended, nontender. extremities - warm, no edema. bilateral lower extremities tender. skin - no rashes or lesions neuro - awake, a&ox3, appropriate, cns ii-xii grossly intact, no asterixis pertinent results: admission labs: 11:45am wbc-5.6 rbc-3.44* hgb-11.2* hct-33.1* mcv-96 mch-32.6* mchc-33.9 rdw-18.5* 11:45am neuts-59.2 lymphs-27.3 monos-9.5 eos-3.5 basos-0.5 11:45am glucose-119* urea n-18 creat-0.8 sodium-143 potassium-3.9 chloride-106 total co2-28 anion gap-13 lfts: 11:45am alt(sgpt)-93* ast(sgot)-121* ck(cpk)-51 alk phos-85 tot bili-5.4* 05:55am blood alt-77* ast-126* ld(ldh)-332* alkphos-83 totbili-4.3* urine: 12:12pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-9.0* leuk-neg 12:12 pm urine site: catheter **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml. presumptive identification. klebsiella pneumoniae. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | klebsiella pneumoniae | | ampicillin------------ <=2 s ampicillin/sulbactam-- <=2 s 8 s cefazolin------------- <=4 s <=4 s cefepime-------------- <=1 s <=1 s ceftazidime----------- <=1 s <=1 s ceftriaxone----------- <=1 s <=1 s cefuroxime------------ 4 s 2 s ciprofloxacin---------<=0.25 s <=0.25 s gentamicin------------ <=1 s <=1 s meropenem-------------<=0.25 s <=0.25 s nitrofurantoin-------- <=16 s 64 i piperacillin---------- <=4 s piperacillin/tazo----- <=4 s <=4 s tobramycin------------ <=1 s <=1 s trimethoprim/sulfa---- <=1 s <=1 s ruq us : 1. no focal hepatic lesions identified. 2. patent hepatic vasculature as described above. 3. no ascites. 11:45am albumin-2.2* brief hospital course: altered mental status: the patient was initially admitted to the medical icu for altered mental status. tox screen was negative, and hepatic encephalopathy or infection were considered most likely. she was given lactulose, titrating to 5 bowel movements per day, and treated for her infection (as below), and her mental status quickly improved to baseline. . urinary tract infection: urine culture grew pansensitive e coli and klebsiella. she was treated initially with unasyn and subsequently with augmentin for a total 5 day course. . cirrhosis: lactulose and rifaxamin were continued. lfts were stable. the transplant team evaluated the patient and obtained her recent biopsy results from to consider if she might be a candidate for re-transplant. meld was 27. there was some debate as to whether her recurrent cirrhosis s/p orthotopic liver transplant in represented autoimmune hepatitis or recurrent hepatitis c. recent hepatitis c viral load was 372 000. pre-transplant evaluation was continued, including pap smear and abg. she had recent pft and echo. . coagulopathy: inr was , likely secondary to advancing liver failure. she received po vitamin k for 3 days with no improvement. . anemia: iron studies suggestive of anemia of chronic inflammation. patient also noted to be guaiac positive. egd and colonoscopy were done, demonstrating a normal colon and only 2 cords of grade i varices in the esophagus. she did not require transfusion support. . urethral prolapse: the patient reported blood in her urine, which was confirmed on urinalysis. she was found on exam to have a prolapsed urethra. both the gynecology and urology services evaluated her. urology advised that no surgical intervention was necessary, and bacitracin ointment was applied to the mucosa to relieve irritation. medications on admission: - cellcept mg daily - prograf 0.5 mg qhs - xifaxan 400 mg tid - lactulose 60 ml q 4 hours - mag oxide 400 mg tid - metoprolol 25 mg - tums 2 tab tid - prednisone 10 mg daily - folate 1 mg daily - mvi - vitamin d daily - protonix 40 mg daily - lantus 8 units qhs - humalog sliding scale discharge medications: 1. mycophenolate mofetil 500 mg tablet sig: two (2) tablet po qam (once a day (in the morning)). 2. mycophenolate mofetil 500 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 3. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 4. lactulose 10 gram/15 ml syrup sig: sixty (60) ml po tid (3 times a day). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. prednisone 10 mg tablet sig: one (1) tablet po daily (daily). 7. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). 8. tacrolimus 0.5 mg capsule sig: one (1) capsule po qpm (once a day (in the evening)). 9. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 10. insulin glargine 9 units at bedtime 11. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. multivitamin tablet sig: one (1) tablet po daily (daily). 13. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 14. bacitracin zinc 500 unit/g ointment sig: one (1) appl topical qid (4 times a day): apply to urethra. disp:*1 tube* refills:*2* 15. insulin lispro 100 unit/ml solution sig: per sliding scale subcutaneous four times a day. discharge disposition: home with service facility: homecare discharge diagnosis: primary: cirrhosis s/p transplant with recurrent cirrhosis encephalopathy urinary tract infection prolapsed urethra anemia secondary diabetes hypertension discharge condition: stable. not confused. afebrile. discharge instructions: you were admitted with confusion and found to have a urinary tract infection. your urinary tract infection was treated with antibiotics which you have completed. while in the hospital you were found to have a prolapsed uretrha and seen by gynecology and urology. it should improve with time. the following medications were changed in the hospital: furosemide was added augmentin was added (unasyn started ) lactulose was decreased to three times daily otherwise, please continue all of your old medications. please return to the emergency department or call the liver clinic at if you experience fevers and chills, confusion, chest pain or shortness of breath, or other symptoms that are concerning to you. followup instructions: please follow up as below: dr. in liver clinic on at 9 am. the phone number is date/time: 9:00. . on you have three apts: 1. nutrition with phone: date/time: 10:00 2. transplant hepatology clinic: phone: date/time: 11:00 3. mammogram: radiology phone: date/time: 3:45 . you should also follow up with urology. please call ( to arrange an appointment. procedure: other endoscopy of small intestine colonoscopy diagnoses: anemia, unspecified urinary tract infection, site not specified friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site cirrhosis of liver without mention of alcohol diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled asthma, unspecified type, unspecified hepatic encephalopathy esophagitis, unspecified complications of transplanted liver esophageal varices in diseases classified elsewhere, without mention of bleeding other and unspecified coagulation defects prolapsed urethral mucosa 

Answer: The patient is high likely exposed to