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: augmentin attending: chief complaint: hematemesis major surgical or invasive procedure: therapeutic paracentesis () esophagogastroduodenoscopy () history of present illness: 65 year old female with pmh of etoh cirrhosis c/b ascites recently discharged from on after hospitalization for acute liver decompensation, present with thrombocytopenia, hematemesis, and epistaxis. during prior hospitalization, patient was evaluated for hepatic decompensation with bilirubin rising from 1.1 to 10.1 over 2 months. although no definitive etiology was identified, an enterococcus uti and hepatotoxic drugs were felt to be partially responsible. of note, patient developed progressive thrombocytopenia while in the hospital with platelets falling from baseline of 148 on admission to 37 prior to discharge. she was discharged on 10 day course of macrobid for treatment of her uti. shortly after discharge from hospital on had nausea with nonbloody emesis x 5. the next day, she continued to feel nausea with dry heaves accompanied by small amounts of bloody phlegm. on monday, she developped vaginal spotting and frequent epistaxis which resolved with held pressure. she also noted loose dark, tarry stools x 2. she had slight dizziness with ambulation. denies any syncope, chest discomfort, or worsened dyspnea from baseline. no confusion, abdominal discomfort, or other complaints. this morning, patient presented to her pcp who drew blood work. platelets returned at 10,000 and she was referred to ed for further evaluation. in ed, initial vs were t 98, bp 126/44, hr 72, rr 18, spo2 98% on ra. hepatology was consulted and recommended ng lavage which was not performed. initial labs were remarkable for hct at baseline of 26, platelets of 11,000 and worsening hyponatremia to 121 from baseline of 130s. patient received protonix 80mg iv and vitamin k 5 mg x 1. two pivs were inserted, and patient admitted to the micu. ros: pertinent +: see above; c/o significant chronic h/a, stable chronic exertional dyspnea pertinent -: denies any fevers, chest discomfort past medical history: alcoholic cirrhosis with stage 4 fibrosis c/b ascites heterozygotic hemochromatosis hypertension depression alcohol abuse social history: currently living with granddaughter, retired -- etoh: stopped drinking 1 month ago, used to drink 4-5 daily -- denies ivda or tobacco family history: daughter with hemochromatosis. denies family history of liver disease. physical exam: vs: temp: bp:98/79 hr: 79 rr: 23 o2sat 97% ra gen: pleasant, comfortable, nad heent: perrl, eomi, scleral icterus, small amt crusted blood around nares, mmm, op without lesions neck: supple, jvp @ 10cm resp: cta b/l with good air movement throughout cv: rrr s1 and s2 wnl, grade ii/vi systolic murmur best heard lsb abd: +b/s, soft, nt, moderate amount ascites with shifting dullness to percussion ext: trace edema b/l neuro: aaox3. cn ii-xii intact. 5/5 strength throughout. rectal: trace guiac + per ed exam pertinent results: labs on admission: 11:10am pt-21.1* ptt-37.3* inr(pt)-2.0* 11:10am plt smr-rare plt count-11*# 11:10am hypochrom-normal anisocyt-occasional poikilocy-normal macrocyt-2+ microcyt-normal polychrom-normal 11:10am neuts-70 bands-4 lymphs-17* monos-6 eos-2 basos-0 atyps-0 metas-1* myelos-0 11:10am wbc-14.8*# rbc-2.41* hgb-9.0* hct-26.0* mcv-108* mch-37.6* mchc-34.8 rdw-16.7* 11:15am haptoglob-39 11:15am albumin-2.7* calcium-8.1* phosphate-3.2 magnesium-1.3* 11:15am lipase-26 11:15am alt(sgpt)-69* ast(sgot)-101* ld(ldh)-254* alk phos-197* tot bili-10.2* 11:15am glucose-103* urea n-12 creat-0.8 sodium-121* potassium-3.1* chloride-88* total co2-28 anion gap-8 11:28am lactate-2.3* . labs on discharge: 04:45am blood wbc-6.8 rbc-3.01* hgb-10.4* hct-30.3* mcv-101* mch-34.6* mchc-34.3 rdw-20.2* plt ct-74* 04:45am blood pt-24.7* ptt-44.8* inr(pt)-2.4* 04:45am blood glucose-88 urean-7 creat-0.6 na-128* k-3.2* cl-94* hco3-28 angap-9 04:45am blood alt-35 ast-67* ld(ldh)-245 alkphos-165* totbili-6.1* 04:45am blood albumin-2.8* calcium-8.0* phos-2.9 mg-1.3* . urinalysis: 12:40am urine color-yellow appear-clear sp -1.004 12:40am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-1 ph-6.5 leuks-neg 12:40am urine hours-random urean-217 creat-24 na-<10 k-8 cl-<10 12:40am urine osmolal-140 . ascites: 03:34pm ascites wbc-125* rbc-5200* polys-41* lymphs-16* monos-0 eos-1* mesothe-5* macroph-37* 03:34pm ascites totpro-1.3 glucose-97 albumin-less than . 04:43pm ascites wbc-250* rbc-* polys-48* lymphs-16* monos-21* mesothe-3* macroph-12* 04:43pm ascites totpro-1.8 ld(ldh)-65 albumin-less than . . chest (portable ap) study date of 5:59 pm cardiac size is top normal. there is no evidence of pneumonia, chf or aspiration. there is no pneumothorax or pleural effusion. . . chest (portable ap) study date of 10:33 pm lordotic positioning. low inspiratory volumes. allowing for this, there is possible cardiomegaly and mild prominence of the upper zone vessels, without overt chf. minimal patchy opacity at both bases likely reflects atelectasis. no definite consolidation. no effusion. no pneumothorax detected. . . cardiology report ecg study date of 12:50:06 pm sinus rhythm. within normal limits. compared to the previous tracing of leads v1-v2 are placed differently. read by: , intervals axes rate pr qrs qt/qtc p qrs t 65 164 92 458/466 76 -13 36 . . procedure date tissue received report date diagnosed by dr. /vf flow cytometry report flow cytometry immunophenotyping the following tests (antibodies) were performed: cd2, cd3, cd5, cd7, cd10, cd19, cd20, fmc7, hla-dr, kappa, lambda, cd45, cd23. results: three color gating is performed (light scatter vs. cd45) to optimize lymphocyte yield. cd45-bright, low side-scatter, lymphoid gated events are approximately 10% of total analyzed events. cd19 and cd20 co-expressing b cells comprise approximately 18% of lymphoid-gated events, and do not express aberrant antigens (cd5 or cd10). surface immunoglobulin expression is extremely dim and clonality cannot be reliably assessed. t cells comprise 67% of lymphoid gated events, and express mature lineage antigens. interpretation cell marker analysis demonstrates a non-specific t-cell dominant lymphoid profile. b-cell clonality could not be reliably assessed due to extremely dim expression of surface immunoglobulin light chain antibodies. correlation with clinical findings is recommended. flow cytometry immunophenotyping may not detect all lymphomas as due to topography, sampling or artifacts of sample preparation. . . egd report findings: esophagus: mucosa: mild esophagitis was noted. stomach: mucosa: patchy erythema and mosaic appearance of the mucosa with no bleeding were noted in the pylorus and whole stomach. these findings are compatible with gastritis and portal hypertensive gastropathy. no gastric or esophageal varices were seen. duodenum: normal duodenum. other findings: there was a slightly raised appearance of the pyloric tissue. this was soft, it was easy to pass the scope, and flattened with insufflation. it likely represents a more prominent area of normal tissue. . impression: esophagitis in the lower third of the esophagus. erythema and mosaic appearance in the pylorus and whole stomach compatible with gastritis and portal hypertensive gastropathy. no gastric or esophageal varices were seen. there was a slightly raised appearance of the pyloric tissue. this was soft, it was easy to pass the scope, and flattened with insufflation. it likely represents a more prominent area of normal tissue. otherwise normal egd to third part of the duodenum recommendations: recs per primary liver team. . . brief hospital course: the patient is an 65 year old female with alcoholic cirrhosis c/b ascites who presented with thrombocytopenia, hematemesis, epistaxis, vaginal bleeding, melena, and brbpr. . # thrombocytopenia: her thrombocytopenia may be due to liver disease, but the acute drop is more likely due to autoimmune causes, infection, or a medication effect. she did not receive heparin during her last admission per poe orders, and platelets as low as 11 are unlikely to be due to hit. augmentin and macrobid can cause thrombocytopenia, but the macrobid was not started until after her platelets started to drop. she was given multiple platelet transfusions while in the micu with continued thrombocytopenia. further evaluation for hit was not pursued. hematology consult was called and recommended ivig, flow studies for immunophenotyping, and h pylori serology. her h pylori antibody testing was positive. the immunophenotyping was unremarkable. her plt count increased to the mid 60s after receiving ivig, and had risen to the 70s by discharge. she did not require additional platelets after receiving ivig. . # hematemesis: the etiology of her initial hematemesis is unclear. it may have been - tear versus vomiting from epistaxis draining down the posterior pharynx. variceal bleeding, portal gastropathy, and pud were also possible. the patient's daughter reported that she had a recent egd that was negative for varices, but documentation of this was not obtained during the micu stay. she was given an iv ppi, but octreotide gtt and antibiotics were not given. her hct slowly trended down in the micu, requiring multiple rbc transfusions. her bleeding slowed considerably and she remained hemodynamically stable. an egd was performed on which showed only mild esophagitis and gastritis. she was continued on pantoprazole 40 mg iv q12h. on discharge, she was switched to omeprazole 20 mg po bid. . # helicobacter pylori: her h pylori serology was found to be positive and her egd showed patchy gastritis and gastropathy. she was started on a 14 day course of flagyl, clarithromycin, and omeprazole for eradication. amoxicillin was avoided given the possible relationship of augmentin with her recent thrombocytopenia. . # hyponatremia: she presented with na of 121 from baseline of 130s with no signs of altered mental status. her na improved and remained fairly stable in the mid 120s. lasix and spironolactone were restarted on without significant electrolyte abnormalities. . # esld: diagnostic paracentesis was negative for sbp. her meld was 23 on transfer from the icu and remained stable. she had significant ascites which is increasingly uncomfortable for her. she had a therapeutic tap for 4l on which had rbcs, but only 250 wbcs and 48% polys. her diuretics were restarted on with lasix 40 mg po daily and spironolactone 50 mg po daily. she tolerated these well. . # epistaxis: she continued to have epistaxis overnight after admission. ent was consulted and cauterized her left nostril with surgicel placement. packing was not required. the patient was written for prn oxymetazoline spray. her epistaxis largely resolved after cautery by ent. she was continued on epistaxis precautions (no nose-blowing, no straining, no heavy lifting). . # hypertension: her bp remained stable in 130s-140s. her atenolol was held in the setting of her recent bleeding, but restarted at discharge. . medications on admission: furosemide 40 mg tablet daily spironolactone 50 mg tablet daily atenolol 50 mg tablet daily folic acid 1 mg tablet daily thiamine hcl 100 mg tablet daily multivitamin daily macrobid 100 mg po twice a day for 10 days discharge medications: 1. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. acetaminophen 325 mg tablet sig: two (2) tablet po every eight (8) hours as needed for pain: do not take more than mg in 24 hours. 6. atenolol 50 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 7. spironolactone 100 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 8. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. disp:*15 tablet(s)* refills:*0* 9. outpatient lab work please draw blood on and check cbc/diff, chem10, pt, ptt, inr, ast, alt, and tbili. please forward results to dr (phone: , fax:). 10. metronidazole 500 mg tablet sig: one (1) tablet po twice a day for 14 days. disp:*28 tablet(s)* refills:*0* 11. clarithromycin 500 mg tablet sig: one (1) tablet po twice a day for 14 days. disp:*28 tablet(s)* refills:*0* 12. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. disp:*60 capsule, delayed release(e.c.)(s)* refills:*2* discharge disposition: home discharge diagnosis: primary diagnoses: thrombocytopenia ascites helicobacter pylori infection secondary diagnoses: alcoholic cirrhosis hypertension discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital for a low platelet count and bleeding from multiple parts of your body. you were initially sent to the intensive care unit, where you were given transfusions of blood, platelets, and clotting factors. your blood pressure and other vital signs remained stable, and you were transferred to the liver service. you received additional platelet transfusions and evaluation of your liver disease. you were also seen by the hematology department to help determine why your platelets were low. they recommended starting treatment with intravenous immunoglobulins. after receiving this treatment, your platelet count started increasing, and you did not require any additional platelet transfusions. the bleeding stopped, and your blood counts also started increasing. since your low platelets may have been caused by taking the antibiotic augmentin, you should avoid taking this medication in the future unless absolutely necessary. while on the liver service, you had a therapeutic paracentesis to remove ascites fluid from your abdomen and help make you more comfortable. several liters of fluid were removed. the fluid was tested and showed no evidence of infection. your medications were adjusted to slow the further accumulation of fluid in your abdomen. you also had an upper endoscopy (egd) to check for possible sources of bleeding in your esophagus, stomach, and the first part of the small intestine. the endoscopy showed some inflammation of the esophagus and stomach, but no major source of bleeding. a blood test was also sent which showed possible infection with bacteria called helicobacter pylori, which can lead to ulcers and inflammation in the stomach. you were started on medications to treat this infection and eradicate the bacteria. start: furosemide 40 mg by mouth daily start: spironolactone 100 mg by mouth daily start: omeprazole 20 mg by mouth twice daily start: metronidazole 500 mg by mouth twice daily for 14 days start: clarithromycin 500 mg by mouth twice daily for 14 days start: lorazepam 0.5 mg by mouth at bedtime as needed for insomnia. do not drive or operate machinery while taking this medication since it can make you sleepy and slow your reaction times. you should continue taking your other medications as indicated on your discharge medication sheet. you have several followup appointments scheduled as indicated below. you will need to have blood drawn for lab work prior to your visit with your pcp on . a prescription has been provided which you can use for this lab work. followup instructions: you have a followup appointment scheduled with your pcp on at 12:30pm. you should review your lab results at this visit. the clinic can be reached at if you have any questions or concerns. you have a visit scheduled with dr in a few weeks. department: transplant when: tuesday at 9:40 am with: , md building: lm bldg () campus: west best parking: garage md procedure: other endoscopy of small intestine percutaneous abdominal drainage injection or infusion of immunoglobulin control of epistaxis by cauterization (and packing) diagnoses: coronary atherosclerosis of native coronary artery urinary tract infection, site not specified unspecified essential hypertension alcoholic cirrhosis of liver hyposmolality and/or hyponatremia other and unspecified alcohol dependence, in remission portal hypertension depressive disorder, not elsewhere classified blood in stool other sequelae of chronic liver disease other ascites streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] obesity, unspecified hematemesis esophagitis, unspecified other specified disorders of stomach and duodenum other and unspecified coagulation defects unspecified gastritis and gastroduodenitis, without mention of hemorrhage epistaxis helicobacter pylori [h. pylori] other disorders of menstruation and other abnormal bleeding from female genital tract other secondary thrombocytopenia hereditary hemochromatosis 

Answer: The patient is high likely exposed to