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: aspirin attending: chief complaint: transfer from osh for ? failed tips major surgical or invasive procedure: paracentesis history of present illness: ms. is a 62 y/o female with alcoholic esld s/p tips for variceal bleed 2y ago, h/o ascites who was admitted to on with 2 weeks of increasing left leg edema, pain and erythema non-responsive to 5 days of kelfex for presumed cellulitis. (pt was afebrile throughout her admission at and wbc max was 10.6 with 84% polys.) she also had abdominal pain and increasing abd girth. she had no fever or chills, and had decreased appetite but says this is her baseline. patient had also noticed increased abdominal girth. otherwise had no complaints. she was admitted to for iv abx and diuresis. . at , she was treated with iv zosyn for lle cellulitis. leni of the l leg was negative for dvt, and doppler u/s of her abd showed a patent tips with high velocities, causing concern for tips stenosis. she had a diagnostic and therapeutic tap (3l removed) which showed no evidence of sbp. she was transfused 1 unit prbcs at osh. she was transferred to for further care and ? revision of tips. interestingly, her ammonia level was 19 at compared to her baseline there of 40-80. blood cultures from final read is negative. . at present, pt reports she is tired and lightheaded with decreased appetite. continues to have abdominal and b leg pain and states these are only slightly decreased from admission. . ros: denies ha, cp, sob, cough, n/v, dysuria, constipation. notes bilateral leg pain, abd pain, decreased appetite, diarrhea. past medical history: 1. parkinson's: ? new diagnosis. off transplant list. 2. esld from etoh cirrhosis: esophageal variceal bleed in , stage iii varices s/p 4 bands with rebleeding requiring intubation, placement and tips. h/o encephalopathy. 3. type 2 dm on insulin therapy 4. htn 4. gerd 5. h/o carpal tunnel surgery 6. chronic edema 7. h/o cellulitis 8. thrombocytopenia in setting of liver disease 9. (unclear site) social history: currently living at . quit tobacco 20y ago, quit etoh 20y ago per pt, denies other drugs. previously lived at home with her son, daughter and . family history: pt denies any illnesses in family. physical exam: pe: 98.2, 128/62, 88, 20, 100% ra, fs 139 gen: nad, lying in bed, answers questions appropriately heent: scleral icterus, perrl, ncat, erythematous cheeks and nose neck: no lad, supple cor: rrr, s1s2, flow murmur pulm: decreasd b bases, otherwise ctab abd: protuberant, decreased bs, tender to mild palpation, unalbe to assess for hsm due to extreme discomfort skin: jaundiced, spider angiomata on face, chest, arms, palmar erythema. ble skin appears thickened, dry, scaly and erythematous, although not definitely warm or cellulitic. ext: ble pitting edema - on r leg edema up to knee, on l leg edema at least halfway up thigh. neuro: oriented x 3, slow talking but alert, 4/5 strength b grips/biceps/triceps/plantarflexion/dorsiflexion. + asterixis pertinent results: on admission: 06:20am blood wbc-8.5# rbc-2.73* hgb-9.2* hct-28.3* mcv-104* mch-33.7* mchc-32.5 rdw-17.3* plt ct-87*# 06:20am blood neuts-81.6* lymphs-10.6* monos-6.3 eos-1.4 baso-0.1 06:20am blood pt-20.0* ptt-43.7* inr(pt)-1.9* 06:20am blood glucose-70 urean-20 creat-1.2* na-138 k-4.0 cl-99 hco3-33* angap-10 06:20am blood alt-5 ast-49* alkphos-162* totbili-8.4* 06:20am blood albumin-2.2* calcium-8.2* phos-3.3 mg-1.9 . iron studies: 05:15am blood caltibc-94* vitb12-1336* folate-7.8 ferritn-570* trf-72* . on discharge 07:10am blood wbc-6.5 rbc-2.42* hgb-8.7* hct-26.2* mcv-108* mch-35.9* mchc-33.2 rdw-16.7* plt ct-75* 07:10am blood pt-21.2* inr(pt)-2.0* 07:10am blood glucose-113* urean-16 creat-1.1 na-138 k-3.7 cl-97 hco3-33* angap-12 07:10am blood totbili-9.3* 07:10am blood calcium-8.7 phos-2.8 mg-1.8 . 11:05 am fluid received in blood culture bottles peritoneal fluid. aerobic bottle (preliminary): no growth. anaerobic bottle (preliminary): no growth. wbc 215* rbc 2874* n 2* l 31* m 0 meso 1* macrophages 66* totpro 1 glucose 108 creat 1.1 albumin less than 1.0 . 03:00pm urine rbc-2 wbc-12* bacteri-rare yeast-none epi-5 03:00pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-sm 03:00pm urine color-yellow appear-clear sp -1.013 3:00 pm urine source: cvs. urine culture (final ): <10,000 organisms/ml. . blood cultures 11/23 and no growth at time of discharge . ct abd/pelvis w and w/o contrast impression: 1. no evidence of pyelonephritis or diverticulitis. 2. evidence of chronic liver disease with ascites and irregular liver outline. ascites has worsened from prior study. 3. basal pleural effusions and atelectasis worse than on previous examination. 4. lumbar spine degenerative change with spinal canal stenosis at l2-3 and l4-5. 5. non-specific pancreatic head cystic abnormality--mrcp is recommended for further characterization. these have not changed form previous study. comparison. . doppler abdominal : 1. patent tips shunt with appropriate velocities which appear to be unchanged from the prior exam. 2. slight increase in size of simple right liver cyst. 3. single gallstone. 4. splenomegaly. 5. ascites. brief hospital course: ms. is a 62yo woman with h/o etoh cirrhosis s/p tips after variceal bleed who is transferred from after presenting there with increasing ble (l>r) edema and abdominal girth and found to have likely stenosed tips. . medical floor hospital course: . # cirrhosis patient carries a history of esld s/p tips. given increased le swelling, there was a concern that the tips was stenosed. abdominal showed no stenosis, however with increased (albeit unchanged) velocities. a venogram study was planned but was unable to be performed given medical decompensation (below). . the patient underwent diagnostic paracentesis on hospital day 2 which did not show evidence of sbp. on hospital day 6 the patient's ascites had increased, her abdomen became distended, and respirations were mildly impaired. she underwent therapeutic paracentesis, as is customarily performed on a weekly basis given her proclivity to re-accumulate ascitic fluid. paracentesis was attempted on the right lower abdomen, where she normally undergoes drainage, but was unsuccessful. repeat attempt on the left lower abdomen several hours later was successful in draining 5 l of serosanguinous fluid. fluid evaluation was negative for sbp and cultures were negative 2 days later. . she was also continued on nadolol 10mg po qday to prevent variceal bleeding. lactulose 30ml po qid was also titrated to 3 bowel movements per day for encephalopathy. . # ble edema and erythema ble edema was considered secondary to volume overload and not infection, as wbc was wnl and she was afebrile. diuresis was pursued w/ spironalactone / lasix. . # parkinsons home dose sinemet was continued. . # dm controlled with home lantus 50 units qhs and sliding scale. . # pancreatic cyst on ct scan patient was found to have a pancreatic head cyst abnormality. she would have followed up with an mrcp in weeks as an outpatient for further evaluation. . # psych: she was continued on citalopram and methylphenidate. . hospital course: on , patient was noted to have spontaneous bleeding from her mouth / gums and oozing from all her iv sites. coags were checked and inr was elevated at 2.5. although her mental status since admission was impaired (waxing/ level of consciousness and level of interaction), at approximately 5 pm she was noted to have increased somnolence and difficulty to arouse. furthermore, she was found to have several focal neurologic signs worrisome for a cns insult. given concern for intracranial pathology and coagulopathy, she was sent for a noncontrast ct of the head which was negative for ich. subsequently she developed a fever; labs were sent to work up dic. lab data was consistent with dic as well as ongoing blood loss. differential on cbc showed stippled cells but no schistocytes. neurology was consulted for altered mental status of unclear etiology. of note, labs drawn amidst the decompensation showed neutropenia w/ wbc of 600 (although this was likely a lab error as repeat wbc was 5600). she was written for cefepime and vanco for neutropenic coverage, although no doses were received. at the time of neurology evaluation, patients temperature was noted to be 103 f and sbps dropped into the 90s. repeat bp measurements then showed sbps in 70s. ivfs were started and a code blue was called. . at the time of the code blue, patient was noted to be breathing spontaneously without difficulty. abg checked at that time was 7.45/42/297 on nrb. patient had pulses but was unresponsive. sbps were 60s-70s. ivf was hung in pressure bags through piv until l femoral cvl was placed. dopamine gtt was also started with improved sbps to 110s w/ hrs to the 120s. she was then transferred to the micu for further management. code status was discussed with her healthcare proxy and she was reported to be dnr/dni but pressors were okay to use. . in the micu she was treated for presumed septic shock and dic. she was given cefepime, vanco, and flagyl and was volume resuscitated with prbcs, ffp, platelets, and cryogloblin. she required levophed and vasopressin to maintain maps >65. dic labs improved with blood products. blood cultures grew gram negative rods. overnight, repeating a ct of the abdomen was considered but the patient was felt to be too unstable to transport. by the following morning, pressors were weaned off and patient was more alert but complaining of severe abdominal pain with some rebounding. also required bipap for respiratory distress presumed secondary to volume overload in the setting of oliguria. surgery was consulted for possible acute abdomen. upon review of ct abdomen/pelvis performed on the previous day, there was concern for potential mesenteric ischemia. this was relayed to patient's son who was also her healthcare proxy. surgical options were discussed but it was decided to make the patient cmo. she died the following day from cardiopulmonary arrest at 0952 on . medications on admission: lasix 40mg po bid protonix 40mg po qday celexa 10mg po qday lantus 50 units qhs lactulose 2 tblspoons qid ritalin 5mg po bid mvi po qday nadolol 10mg po qday rifaximin 400mg po tid thiamine 100mg po qday zofran 4mg po q12h prn nausea robitussin prn cough benadryl 12.5mg po qhs prn itch potassium 20meq po qday sinemet 25/100 3 half tabs po tid aldactone 100mg po qday percocet qday prn pain novolog 5 units insulin slide scale discharge medications: expired discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired procedure: percutaneous abdominal drainage transfusion of packed cells transfusion of other serum infusion of vasopressor agent diagnoses: thrombocytopenia, unspecified esophageal reflux unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled alcoholic cirrhosis of liver acute kidney failure, unspecified unspecified septicemia severe sepsis paralysis agitans defibrination syndrome long-term (current) use of insulin septic shock other ascites hepatic encephalopathy acute vascular insufficiency of intestine cyst and pseudocyst of pancreas 

Answer: The patient is high likely exposed to