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: e-mycin / motrin / oxycodone / ciprofloxacin attending: chief complaint: respiratory failure major surgical or invasive procedure: none history of present illness: this is a 43 year-old female with a history of alcoholic cirrhosis who had an diagnostic paracentesis on who presented with cultures growing gram negative anaerobes from ascitic fluid and was admitted for treatment of sbp. she developed some respiratory distress on , but sats remained stable. patient was taken to cta to r/o pe given slightly alkalemic abg. after patient returned to the floor, she began to have respiratory distress, requiring intubation. she is sent to the micu for further management. ct scan shows diffuse bilateral patchy opacities in all lobes, bp stable and afebrile. initial abg on a/c 600x14 peep 10 and fio2 1.0 was 7.40/48/119. of note, the patient received albumin the day prior to respiratory decompensation. past medical history: #. etoh cirrhosis with variceal bleed s/p banding , ascites #. gastric ulcer in setting of motrin use #. hypothyroidism #. s/p appendectpmy #. s/p tonsillectomy #. ureterocele- s/p repair #. gestational dm #. alcohol abuse social history: the patient is married and lives in . she has 2 sons, ages 5 and 12. her son (5) was diagnosed with dm in which was a major stressor. no tob, works as a law enforcement data analyst. recently committed to an inpatient treatment facility for alcoholism. family history: father - with ulcers, possible drug use. mother - copd, emphysema, depression, cervical cancer, mental health isssues, has not seen patient in 20 years. physical exam: vitals: t: 101 bp: 143/81 hr:94 rr:18 o2sat:95% on a/c 400x26 peep 10 fio2 1.0 gen: intubated and sedated eyes: perrl, eomi neck: obese cor: rr, nl s1s2 chest: diffuse rales, poor air movement abd: markedly distended with guarding, no rebound, +bs, no hsm, no masses ext: no c/c/e, no palpable cords neurol: prior to intubation: alert, oriented to person, place, and time. . skin: dressing from paracentesis attempt, and marking from ulrasound. no ecchymoses. pertinent results: 06:07pm blood wbc-14.9* rbc-3.48* hgb-13.1 hct-38.7 mcv-111* mch-37.7* mchc-33.9 rdw-14.7 plt ct-200 06:10am blood wbc-10.1 rbc-2.66* hgb-9.8* hct-29.5* mcv-111* mch-36.8* mchc-33.2 rdw-15.4 plt ct-230 06:07pm blood neuts-75.4* lymphs-19.1 monos-4.3 eos-1.1 baso-0.1 02:00am blood neuts-83.2* lymphs-10.9* monos-3.8 eos-2.0 baso-0.2 08:10am blood neuts-69.3 lymphs-21.6 monos-6.9 eos-1.9 baso-0.3 06:08pm blood pt-16.3* ptt-29.2 inr(pt)-1.5* 03:21am blood pt-20.7* ptt-40.3* inr(pt)-2.0* 02:59am blood pt-21.7* ptt-39.2* inr(pt)-2.1* 06:10am blood pt-19.9* inr(pt)-1.9* 06:07pm blood glucose-209* urean-16 creat-1.1 na-131* k-3.1* cl-90* hco3-29 angap-15 04:25pm blood glucose-118* urean-27* creat-1.3* na-137 k-3.9 cl-101 hco3-27 angap-13 03:59am blood glucose-149* urean-27* creat-1.0 na-148* k-3.7 cl-112* hco3-28 angap-12 08:10am blood glucose-220* urean-29* creat-1.5* na-138 k-3.6 cl-104 hco3-24 angap-14 05:06am blood glucose-118* urean-31* creat-1.7* na-139 k-3.4 cl-106 hco3-23 angap-13 05:33am blood glucose-130* urean-30* creat-1.8* na-135 k-3.9 cl-104 hco3-23 angap-12 06:10am blood glucose-95 urean-28* creat-1.7* na-139 k-4.2 cl-105 hco3-24 angap-14 06:10am blood glucose-96 urean-21* creat-1.6* na-140 k-3.8 cl-107 hco3-23 angap-14 06:07pm blood alt-55* ast-47* alkphos-149* amylase-61 totbili-3.1* 08:25pm blood alt-22 ast-33 ld(ldh)-281* alkphos-125* amylase-30 totbili-5.2* 06:10am blood alt-12 ast-40 alkphos-76 totbili-2.6* 05:30am blood calcium-8.7 phos-4.0 mg-2.0 05:35am blood albumin-5.3* calcium-9.7 phos-3.0 mg-1.5* 02:31am blood triglyc-69 hdl-8 chol/hd-6.1 ldlcalc-27 08:10am blood ammonia-126* 05:08am blood tsh-2.1 05:35am blood asa-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 10:23am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 05:50pm blood lactate-2.7* 10:26pm ascites totpro-0.7 glucose-263 ld(ldh)-45 amylase-13 albumin-less than triglyc-336 10:26pm ascites wbc-115* rbc-1340* polys-25* lymphs-18* monos-6* mesothe-19* macroph-32* 07:18pm ascites totpro-1.3 glucose-144 ld(ldh)-56 albumin-<1.0 triglyc-257 07:18pm ascites wbc-22* rbc-444* polys-10* lymphs-82* monos-3* mesothe-1* macroph-4* 02:00pm ascites albumin-less than 02:00pm ascites wbc-108* rbc-19* polys-13* lymphs-44* monos-21* mesothe-2* macroph-20* . . abg prior to intubation ph 7.47 pco2 44 po2 96 hco3 33 lactate:1.7 . abg post intubation: ph 7.40 pco2 48 po2 119 hco3 31 . imaging: : cta chest: diffuse ground glass opacities bilaterally, per radiology no pulmonary embolus. . : tte: the left atrium is normal in size. the right atrial pressure is indeterminate.a very small secundum type atrial septal defect cannot be fully excluded (suggested on color doppler, but could not be confirmed). left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. 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 mild pulmonary artery systolic hypertension. there is no pericardial effusion. compared with the prior study (images reviewed) of , the overall findings are similar. . : abd u/s: 1. diffusely increased liver echogenicity is compatible with known history of cirrhosis. 2. cholelithiasis with no evidence of cholecystitis. 3. ascites, with no significant change since the previous study. . ct head w/o contrast 5:45 pm ct head w/o contrast reason: cva? mass? field of view: 25 medical condition: 43 year old woman with etoh cirrhosis, acute mental status changes. reason for this examination: cva? mass? contraindications for iv contrast: none. ct of the head without contrast. indication: 43-year-old female with alcoholic cirrhosis presenting with acute mental status changes. comparisons: none. technique: non-contrast head ct. findings: there is no evidence of infarction, hemorrhage, shift of normally midline structures, hydrocephalus, or masses. the density values of the brain parenchyma are maintained. the visualized portions of the paranasal sinuses and mastoid air cells are clear. the soft tissues and osseous structures appear unremarkable. impression: normal study. . eeg study date of object: rule out seizure. referring doctor: dr. findings: abnormality #1: throughout the recording there were frequent and persistent bursts of mixed frequency theta and delta slowing in the left temporal region. background: included a reasonably well-formed 9 hz alpha frequency in posterior areas bilaterally during wakefulness. hyperventilation: could not be performed. intermittent photic stimulation: produced no activation of the record. sleep: the patient progressed from wakefulness to drowsiness and early stage ii of sleep with no additional findings. cardiac monitor: showed a generally regular rhythm. impression: abnormal eeg in the waking and sleeping states due to the frequent bursts of mixed frequency left temporal slowing. this suggests a focal subcortical dysfunction in the left hemisphere, but the tracing cannot specify the etiology. the background rhythm remained normal elsewhere and at other times, and there were no epileptiform features. brief hospital course: micu course: assessment: 43 year-old woman with alcoholic cirrhosis admitted with possible sbp, developed hypoxic respiratory failure/ards from question of aspiration, now s/p extubation but with poor mental status. . # mental status/hypernatremia: most likely from combination of hypernatremia, sedation from haldol. hepatic encephalopathy also possible, but has been stooling well with lactulose. the patient was administered free water to correct her hypernatremia, and her haldol was discontinued. she continued with paranoid delusions upon arrival to the floor. . # respiratory failure: unclear etiology. cta significant for bilateral patchy opacities in all lung fields. ddx includes aspiration event (appears most likely), trali (although very rare reports secondary to albumin), pulmonary edema, either cardiogenic or ards from sepsis (meets criteria). pe not seen on cta. she is s/p 6.5l paracentesis to relieve intra-abdominal pressure and improve pulmonary function. a sputum cx from revealed no growth. she was extubated on without complications. . #. spontaneous bacterial peritonitis/fevers: positive cultures and peripheral leukocytosis on admission. tap showed milky fluid and patient experienced marked tenderness after the tap, concerning for infectious process. patient initially covered with zosyn, ceftriaxone and flagyl. then ceftriaxone d/c'ed. repeat tap negative for bacteria x2. antibiotics were subsequently discontinued on per hepatology recs. patient then had elevated fever curve and lower blood pressures . thus, antiobiotcs (zosyn/flagyl) were restarted and she improved. she underwent paracentesis to relieve her increased abdominal pressure. antibiotics were d/c'ed again on because of the thought that her tachycardia and hypotension was due to her abdominal pressure, relieved after the paracentesis. her fevers, leukocytosis, and hypotension returned and antibiotics were restarted . of note, chylous ascites noted. she was administered and completed a 10 day course of vancomycin and meropenem. peritoneal cultures and blood cultures remained negative. . # cirrhosis - continued alcohol abuse. her rifaximin and lactulose were continued. she was restarted on nadolol with holding parameters on . she was restarted on furosemide and spironolactone 25mg on . her ppi was continued. . # depression - her citalopram was continued. . # hypothyroidism -her levothyroxine was continued. . transfer to floor . 43yof alcoholic cirrhosis admitted with possible sbp, s/p hypoxic respiratory failure/ards, septic shock, with recovered mental status and hepatorenal syndrome. . # mental status - patient continued with paranoid delusions on transfer to the floor. psychiatry evaluated patient and recommended discontinuing her celexa, adding haldol qid, attaining head ct and eeg. ct and eeg were negative. the patient's mental status improved within three days and her haldol was weaned down, while monitoring her qt interval on ecg. she was continued on rifaximin, thiamine, and lactulose. her haldol was eventually discontinued and her celexa was restarted. . # oliguria-patient developed oliguria soon after transfer to the floor. oliguria was unresponsive to fluid challenge and her creatinine peaked at 1.8. she was diagnosed with hepatorenal syndrome and administered daily albumin, octreotide, and midodrine. her diuretics were discontinued. after two days her urine output increased. her creatinine began to trend down. she was discharged home on midodrine, and her octreotide was discontinued. her diuretics were not restarted. . # spontaneous bacterial peritonitis - the patient completed her 10 day course of vancomycin and meropenem. her blood and ascitec fluid cultures were negative. the patient was discharged home with instructions to take bactrim for sbp prophylaxis. bactrim was chosen instead of cipro because the patient developed a prolonged qt after haldol administration. . # cirrhosis - continued alcohol abuse. the patient was continued on rifaximin, lactulose, and nadolol. she underwent an ultrasound guided therapeutic paracentesis on with removal of 6l. she was administered 50g albumin afterwards. . # alcohol abuse -patient met with social workers to discuss options for treatment of her alcohol abuse. . # anemia - guaiac positive with hct. macrocytic, likely liver disease, although seems to be modest change since hct >37. patient had no clinical signs of bloody emesis, brbpr, or melena. she remained hemodynamically stable, with stable hct, and was discharged with instructions to follow-up with dr. in two weeks. . # depression - her celexa was restarted before discharge. . # hypothyroidism - her levothyroxine was continued medications on admission: 1. nadolol 20 mg 2. rifaximin 200 mgpo tid 3. hexavitamin po daily 4. folic acid 1 mg po daily 5. cholecalciferol (vitamin d3) 400 unit po daily 6. calcium carbonate 500 mg po tid 7. citalopram 40 mg po daily 8. lactulose 10 gram/15 ml po bid 9. levothyroxine 175 mcgpo daily 10. furosemide 20 mg po daily 11. prilosec 40 mg capsule po daily 12. spironolactone 25 mg po daily discharge medications: 1. bactrim ds 160-800 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 2. rifaximin 200 mg tablet sig: one (1) tablet po tid (3 times a day). 3. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 4. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 5. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 6. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 7. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day): titrate to three bowel movements daily. 8. levothyroxine 175 mcg tablet sig: one (1) tablet po daily (daily). 9. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). 10. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 11. hexavitamin tablet sig: one (1) cap po daily (daily). 12. midodrine 5 mg tablet sig: 2.5 tablets po tid (3 times a day) for 1 months. disp:*225 tablet(s)* refills:*0* 13. outpatient lab work please have your blood drawn at the at dr. office and fax results to at . bun,cr,alt,ast,ap,total bilirubin, pt/inr, ptt. discharge disposition: home with service facility: homecare discharge diagnosis: alcohol cirrhosis septic shock ards hepatorenal syndrome ... discharge condition: measured qtc 438. discharge instructions: you were admitted for treatment of spontaneuous bacterial peritonitis and septic shock. you received a course of antibiotics to treat this infection. you will be sent home with antibiotics to prevent recurrence of this serious infection. you should seek immediate medical attention if you experience fever > 101.5, confusion, chest pain, shortness of breath, dizziness, or any other worrisome symptoms. please take all medications as directed. 1. start midodrine for hepatorenal syndrome (helps kidney function and blood pressure) 2. start bactrim to prevent infections. 3. stop lasix and aldactone. 4. stop cyclobenzaprine you should stop drinking alcohol. drinking alcohol will further injure your liver and could be deadly. you met with our social workers to discuss an alcohol treatment program at the . if you have trouble arranging this, please call dr. office. followup instructions: you should follow-up with dr. within 2 weeks to assess your liver and kidney function. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous abdominal drainage diagnoses: thrombocytopenia, unspecified anemia, unspecified alcoholic cirrhosis of liver acute kidney failure, unspecified unspecified septicemia severe sepsis unspecified acquired hypothyroidism acute respiratory failure septic shock diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled hyperosmolality and/or hypernatremia other and unspecified alcohol dependence, continuous spontaneous bacterial peritonitis 

Answer: The patient is high likely exposed to