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: meperidine attending: chief complaint: gi bleed major surgical or invasive procedure: tube placement intubation tips revision cordis placement venogram with variceal coiling history of present illness: 45 f w/ pmh of etoh cirrhosis s/p tips x 2 on list and pancreatitis transf from osh w/ ugib. per hospital, patient was admitted after having 2 pints of coffee ground emesis. her hgb steadily dropped from 9 on admission, 8.4 to 7.8 the next day. this afternoon, had bright red emesis. underwent egd and had grade iii esophageal and gastric varices. her octreotide drip was increased to 100/hr for transfer and she received 2 units of packed rbc. per physician at , patient bp ranged from 80-100 during stay, with hr in 85-90. she has been receiving rifamixin and cipro for sbp prophylaxis and has never been encephalopathic during her hospital stay. on the floor, patient 103/52 89 14 100 ra. she denies any pain, aside from chronic pain for her hip. is currently not nauseated, febrile or having chills. she has not had any chest pain, shortness of breath or lightheadedness. her stools have been dark and tarry over the last couple of days and she has felt fatiqued. past medical history: osteoarthritis h/o alcohol abuse benzodiazapine abuse alcohol-induced cirrhosis () s/p tips alcohol-induced pancreatitis gastroesophageal reflux disease ovarian cysts caesarian-section x2 appendectomy tubal ligation thrombocytopenia social history: lives with husband and 16 y/o daughter in me. limited employment secondary to health. 12 pack-year smoking history, currently ppd. etoh abuse. benzodiazapine abuse. family history: mother 64 died of emphysema father 67 died of etoh related dz physical exam: vitals: t:98.7 bp:108/53 p: 77 r: 12 o2: 100 ra general: alert, oriented, no acute distress, nonjaundiced heent: sclera slight yellow hue, mmm, oropharynx clear neck: supple, jvp 7-8, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, uncomfortable on palpating ruq, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: labs on admission and discharge: . 06:44pm blood wbc-3.2* rbc-3.27*# hgb-10.2*# hct-27.8*# mcv-85 mch-31.3 mchc-36.7* rdw-14.8 plt ct-59* 05:40am blood wbc-10.7# rbc-4.38 hgb-13.6 hct-37.4 mcv-85 mch-31.2 mchc-36.5* rdw-15.7* plt ct-131*# 05:40am blood hypochr-normal anisocy-normal poiklo-normal macrocy-normal microcy-normal polychr-normal . 06:44pm blood pt-15.0* ptt-32.2 inr(pt)-1.3* 05:40am blood pt-15.9* ptt-31.2 inr(pt)-1.4* . 06:44pm blood glucose-98 urean-22* creat-1.2* na-138 k-6.7* cl-110* hco3-24 angap-11 05:40am blood glucose-103 urean-16 creat-1.2* na-141 k-3.7 cl-105 hco3-23 angap-17 . 06:44pm blood alt-26 ast-73* ld(ldh)-559* alkphos-57 amylase-100 totbili-2.3* 05:40am blood alt-36 ast-73* ld(ldh)-437* alkphos-113 totbili-12.1* . 06:44pm blood albumin-3.2* calcium-7.9* phos-2.8 mg-1.7 05:40am blood albumin-3.9 calcium-9.3 phos-3.2 mg-1.8 . 05:50am blood pep-no specifi igg-801 iga-241 igm-500* ife-no monoclo 03:21pm blood freeca-0.99* 09:14pm blood freeca-1.14 . urine studies: . 04:11am urine color-yellow appear-clear sp -1.039* 04:11am urine blood-lg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-sm urobiln-1 ph-5.0 leuks-neg 04:11am urine rbc-* wbc-0-2 bacteri-occ yeast-none epi-0 09:41am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-sm urobiln-8* ph-8.0 leuks-neg 09:41am urine color-amber appear-clear sp -1.019 . microbiology: . sputum cx: gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): budding yeast. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. 2+ (1-5 per 1000x field): gram positive rod(s). respiratory culture (final ): rare growth oropharyngeal flora. yeast. sparse growth. . bcx - - negative. ucx - yeast. . imaging/studies: . cxr : pa portable upright chest radiograph: the heart size is normal. mediastinal and hilar contours are unremarkable. the lungs are clear. there is no pneumothorax or pleural effusion. a tips stent overlies the liver and multiple coiled wires overlie the epicardium, which are unchanged. impression: no acute cardiopulmonary process. . ruq us : . impression: 1. patent tips with stable velocities. patent portal veins with appropriate direction of flow. 2. echogenic liver but no focal lesions identified. no biliary dilatation. 3. small right pleural effusion. no ascites. . tips revision: . impression: 1. portal venogram demonstrating focal area of stenosis at the proximal aspect of the tips which responded to angioplasty with a 10 mm balloon. 2. reduction of portosystemic gradient from 10 mmhg to 5 mmhg post angioplasty. 3. uncomplicated coil embolization of gastric varix from mid splenic vein. no reflux of contrast was seen in proximal or mid splenic vein beyond the region of previously placed coils. 4. placement of central venous triple-lumen catheter via the right internal jugular vein. the catheter is ready to use. plan: the patient is to return to the medical intensive care unit and possibly undergo a ct scan to evaluate patency of direct splenocaval shunt seen on ct performed . . variceal embolization : . impression: 1. near-complete embolization of the varices at the esophagogastric junction with amplatzer vascular plug and coils. 2. if the patient rebleeds again, pure etoh can be used for embolization. . cxr : . impression: ap chest compared to : small right pleural effusion layering posteriorly has increased since . lungs are clear. heart size normal. no left pleural effusion or pneumothorax. et tube in standard placement, right supraclavicular central venous introducer tip projects over the mid svc and a or sengstaken tube is positioned with the fundic balloon inflated, in standard placement. . cxr : . the previously seen or sengstaken tube was removed and replaced by an og tube with the og tube tip being currently in the stomach. the tips is in unchanged position as well as the coil embolization of gastric varices. the et tube tip is approximately 3 cm above the carina. the right internal jugular line tip is in mid-svc. right pleural effusion is demonstrated. left subpulmonic effusion cannot be excluded. . ruq us : . impression: 1. patent tips with improved velocities, as described. patent portal veins with appropriate direction of flow. 2. echogenic liver with no focal lesions identified. 3. partial visualization of right pleural effusion. no ascites. . pelvic u/s : . impression: limited study - within these limitations no son evidence for polyps, fibroids, or abnormal endometrial stripe. if vaginal bleeding persists, consider son or hysteroscopy for more complete evaluation. . brief hospital course: this is a 45 f w/ pmh of etoh cirrhosis transferred from osh for massive hematemesis, received total of 8u prbcs, underwent a tips revision, tube placement, variceal embolization and was transferred from icu to the floor w/ stable hct for further management. while on the floor, hct has been stable, encephalopathy improved. patient developed episodes of vaginal bleeding 40-50cc x2. she was evaluated by obgyn and underwent a pelvic ultrasound. her bleeding was felt to be perimenopausal and follow up with obgyn was arranged prior to discharge. patient was not encephalopathic, her hct was stable. her bilirubin was elevated from baseline, this was felt to be due to gib and multiple transfusions patient received. she was discharged with appropriate follow up. please see below for problem based, detailed account of hospital course. # gi bleed: the patient was transferred directly to the micu. she has known grade iii esophageal varices and gastric varices. she was started on octreotide drip, iv ppi. her propranolol and spironolactone were held. the night of admission, an emergent endoscopy was performed, however gi was unable to visualize the source. with ngt placement, showed bright blood and she received 3 units of prbcs that night and a total of 8u during her icu stay. the day after admission, she was taken to the ir suite for revision of her tips procedure on . the pressures were decreased, however the patient had another episode of ugib upon returning to the floor. the patient was transfused 2 units of prbcs and platelets. the patient continued to have hematemesis, thus the patient was intubated and tube was placed by gi. she was then taken back down to the ir suite for angiography. she was found to have an anamolous ivc leading to 8 significant varices. she underwent coiling of these varices, including gastric varix from mid-splenic vein. varices at esophagogastric junction were embolized with coils at the feeding from the hepatic vein. on , the was pulled, and she was transfused an additional 2 units of platelets and one unit of prbcs. she was able to be extubated without difficulty on and did not have any significant output following extubation. patient was then transferred to the floor. . patient did have known grade i-ii esophageal varices and gastric varices. she continued to have melanotic stools for one day, which then resolved, but remained guiac positive. she has had no hematemesis after transfer from the icu. hct remained stable around 30-34 and was 37 at time of discharge. once on the floor, her octreotide was discontinued and she was changed to po ppi. patient was treated with 500mg ciprofloxacin for gib. no ppx was provided no ascites on multiple imaging modalities. her propranolol was restarted and uptitrated to 40mg . . # etoh cirrhosis: meld score as of was 12. her inr was 1.3 - 1.4, cr ranged between 1.0 - 1.3 and tbili was elevated from baseline 2 to 12 (likely due to gib). she was to undergo evaluation w/ dr. at for a possible liver , however was hospitalized here prior to that. on admission, the patient was continued on rifaxamin, lactulose w/ goal of 3 bm per day. her home ciprofloxacin was switched to ceftriaxone in the setting of the acute bleed. she was then able to be switched back to cipro prior to leaving the micu. a paracentesis was attempted on , however there was an insufficient pocket. on transfer to the floor, she did not show signs of encephalopathy, there were no ascites. she was continued of lactulose and rifaximin. her tbili 7.6 -> 12, mostly direct. a repeat u/s was performed to assess for tips patency, flow and ascites. tips was patent w/ nl flow and there were no ascites on reassessment. elevated bili was felt to be likely due to gib. at time of discharge, patient was continued on rifaxamin 400 tid, lactulose w/ goal of 3 bm per day and she was restarted on propranolol as above. spironolactone from home regimen was discontinued given no ascites and to allow room for uptitration of propranolol. . # thrombocytopenia: recent range 72-100,000. likley from cirrhosis and splenomegaly. the patient had episodes of decreased platelets, the lowest of which was 36, for which she received transfusions while actively bleeding. her platelet count improved to 69k. baseline range 72-100,000. at time of discharge, platelet count was 131. # osteoarthritis: worst area in left hip. the patient takes oxycodone as an outpatient. the patient was started on morphine and fentanyl for pain control. a lidocaine patch was also initiated. . # vaginal bleeding. pt. w/ ~ 50cc x2 of vaginal bleeding in setting of 36k of platelets. inr was 1.4. lmp 2wks ago, but pt. w/ ammenorrhea since onset of liver disease w/ spotting q6mo. last pap 3 years ago in clinic in me, reportedly negative. patient had no gyn care since. patient has had tubal ligation, and c/s x2, but otherwise no other obgyn surgeries. no pain or discharge. not sexually active in over 6mo. nt abdomen on exam. no source of bleeding on transvaginal us identified. given sx consistent with menstruation,it was felt that the bleeding was physiologic and will spontaneously resolve, per obgyn consultation. appropriate obgyn follow up was arranged. . patient was discharged in a hemodynamically stable condition, with appropriate gyn and gi follow up. medications on admission: medications - prescription ergocalciferol (vitamin d2) - 50,000 unit capsule - 1 capsule(s) by mouth every other week lactulose - 10 gram/15 ml solution - 30ml solution(s) by mouth once a day lansoprazole - (prescribed by other provider: ) - 30 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth once a day lidocaine - 5 % (700 mg/patch) adhesive patch, medicated - apply as directed once a day oxycodone - 5 mg capsule - 1 capsule(s) by mouth every 8 hours as needed for pain propranolol - (prescribed by other provider: ) - 20 mg tablet - 1 tablet(s) by mouth twice a day rifaximin - 200 mg tablet - 2 tablet(s) by mouth three times a day spironolactone - (prescribed by other provider: ) - 50 mg tablet - 1 tablet(s) by mouth twice a day trazodone - 50 mg tablet - 1 tablet(s) by mouth at bedtime medications - otc acetaminophen - (otc) - dosage uncertain --------------- --------------- --------------- --------------- . medications on transfer: xifaxan 1200 mg qd nexium 40 mg iv q 12 octreotide 50 mcg/hour trazodone 25 mg qhs prn lactulose 20 grams qd fentanyl 50 mcgq 4 hr prn . allergies: demerol results in confusion and nausea. discharge medications: 1. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po tid (3 times a day). disp:*5 bottles* refills:*2* 2. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). disp:*30 adhesive patch, medicated(s)* refills:*1* 3. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*30 tablet(s)* refills:*2* 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po every twelve (12) hours. disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 5. propranolol 40 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 6. oxycodone 5 mg tablet sig: one (1) tablet po every 6-8 hours as needed for pain for 10 days: hold for sedation. disp:*30 tablet(s)* refills:*0* 7. zofran 4 mg tablet sig: one (1) tablet po every eight (8) hours as needed for nausea. disp:*30 tablet(s)* refills:*2* 8. trazodone 50 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. disp:*30 tablet(s)* refills:*0* 9. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po every other week. disp:*8 capsule(s)* refills:*2* 10. outpatient physical therapy please complete outpatient pt given severe osteoarthritis of the leg. 11. outpatient lab work cbc, chem 10, lfts, ptt/pt/inr and please fax results to dr. office at . discharge disposition: home discharge diagnosis: prmary: esophageal and gastric variceal bleed secondary: alcoholic cirrhosis, pancreatitis, gerd. discharge condition: stable hematocrit, hemodynamically stable without bleeding. discharge instructions: you were transferred from an outside hospital with a variceal bleed. you had a tips revision and embolization of bleeding varices. you tolerated this well. you were intubated for bleeding. you had several blood transfusions. you were transferred out of the icu and had no repeated bleeding episodes and are otherwise stable. you had vaginal bleeding and were seen by gynecology that feels this is your menses. you will need to follow up with your liver doctor, gynecology and to discuss your osteoarthritis. -please take all medications as prescribed to you -please do not take your diuretics until you follow up with your liver doctor as you appear dry on exam and based on liver tests -please return to the hospital if you experience bleeding from your mouth, bleeding from your rectum or black stools. this is an emergency should you experience confusion, increasing shakiness, shortness of breath, chest pain, leg swelling, fevers, chills or any other symptom concerning to you, please call your or call dr. at the cosco bay clinic () or go to the nearest emergency room. followup instructions: ultrasound phone: date/time: 9:30 follow up in the ob/ clinic for endometrial biopsy. # is . provider: , md phone: date/time: 11:00 provider: , md phone: date/time: 3:00 . please call dr. m.d to follow up regarding your hip surgery. please arrange for physical therapy evaluation as an outpatient with your home provider. please follow up for the echocardiogram scheduling. please call to set up the appointment. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified other endoscopy of small intestine insertion of endotracheal tube angioplasty of other non-coronary vessel(s) other endovascular procedures on other vessels other endovascular procedures on other vessels transfusion of packed cells transfusion of platelets insertion of sengstaken tube phlebography of the portal venous system using contrast material procedure on two vessels diagnoses: thrombocytopenia, unspecified esophageal reflux tobacco use disorder unspecified pleural effusion alcoholic cirrhosis of liver acquired coagulation factor deficiency portal hypertension other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure alkalosis other complications due to other vascular device, implant, and graft other sequelae of chronic liver disease fever, unspecified esophageal varices in diseases classified elsewhere, with bleeding hematemesis varices of other sites other specified noninflammatory disorders of vagina alcohol abuse, in remission osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh body mass index between 19-24, adult antidepressant type abuse, in remission 

Answer: The patient is high likely exposed to