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: patient recorded as having no known allergies to drugs attending: chief complaint: fever major surgical or invasive procedure: intubation central venous catheter dialysis plasmapharesis history of present illness: this is a previously healthy 51 y/o female with h/o ibs who recently underwent a complicated surgical course for a ruptured appy, s/p bowel abscesses, who now p/w abdominal pain, n/v/, bloody diarrhea, arf, and thrombocytopenia. please see osh course for details as patient is unable to provide a full history. . osh course - presented to osh 3 weeks ago with c/o abdominal pain x 2 days duration. taken to or and found to have an acute gangrenous perforated appendicitis, underwent lap appy with placement of a jp drain. however, continued to have jp drainage of clear fluid, fevers, tender abd and decreased bs. covered with broad-spectrum abx, subsequent ct scan revealed an acute phlegmon at original surgical site. therefore, 12-days post-op, patient was taken back to the or for an ex-lap with loa and drainage of intra-abdominal abscess. she was maintained on broad-spectrum abx, improved clinically, and was d/c'd home on post-op day 18 on cholestryamine, lomotil, fosamax, calcium, colace, percocet, and lactobacillus. however, 3 days pta to on , pt developed abdominal pain, n/v, bloody diarrhea. she was admitted on to osh and found to be tachy and dehydrated. afebrile and normotensive initially. abdominal kub on admission showed air fluid level in the right colon with multiple fluid-filled small bowel loops w/o dilitation. labs significant on admission for wbc 16k, bun 14/cr 1.3, plts 425k. during her course, bun increased to 45 with cr up to 4.3 with oliguria developing. plts dropped to to 96l, wbc up to 23k. concern for hus-ttp was raised, as peripheral smear also showed several schistocytes (1 per 50x field). pt has been vanc and zosyn for coverage, begun today , and was continued on po flagyl and vancomycin since admission for concern of c diff. past medical history: 1. s/p ruptured appendix , s/p appy 2. s/p 2 bowel abscesses 2. s/p cholecystectomy 3. ibs 4. osteopenia social history: lives at home with her husband and daughters. full-time. no tobacco, occasional etoh, no illicits. family history: father w/history of leukemia, cad. physical exam: vs: tc 97.5, bp 105/65, hr 116, rr 10, sao2 98%/ra general: pleasant female in nad, ao x 3, difficult historian heent: nc/at, perrl, eomi. mm dry, op clear neck: supple, no lad or tmg chest: cta-b, no w/r/r cv: rr tachy, s1 s2 normal, sm best heard at apex abd: distended, slightly firm but not tense, no ttp; surgical site healing well, c/d/i; decreased bs ext: no c/c/e, wwp neuro: ao x 3, slow to give history and poor recall. ms throughout, sensation intact. cn ii-xii intact skin: no rashes pertinent results: 11:04pm blood wbc-21.6* rbc-4.04* hgb-12.2 hct-37.3 mcv-92 mch-30.2 mchc-32.8 rdw-14.8 plt ct-99* 04:28am blood wbc-15.4* rbc-2.49* hgb-7.7* hct-22.1* mcv-89 mch-31.1 mchc-35.0 rdw-16.1* plt ct-87* 04:25am blood wbc-20.3* rbc-1.82* hgb-5.7* hct-16.5* mcv-91 mch-31.2 mchc-34.5 rdw-20.4* plt ct-40* 03:28am blood hypochr-normal anisocy-1+ poiklo-normal macrocy-normal microcy-1+ polychr-1+ 04:21am blood hypochr-1+ anisocy-1+ poiklo-2+ macrocy-1+ microcy-1+ polychr-occasional ovalocy-occasional schisto-2+ stipple-1+ 11:04pm blood glucose-142* urean-51* creat-5.4* na-142 k-4.1 cl-111* hco3-19* angap-16 04:28am blood glucose-90 urean-48* creat-6.3* na-139 k-3.9 cl-107 hco3-22 angap-14 03:08am blood glucose-129* urean-105* creat-7.2* na-143 k-4.6 cl-107 hco3-26 angap-15 11:04pm blood ld(ldh)-1218* totbili-0.4 dirbili-0.2 indbili-0.2 04:28am blood alt-75* ast-104* ld(ldh)-2635* alkphos-60 totbili-0.5 11:04pm blood hapto-30 04:28am blood vitb12-351 folate-7.6 hapto-28* 03:08am blood hapto-<20* 05:43pm blood c3-47* c4-9* 05:43pm blood -negative 05:43pm blood anca-negative b 04:03am blood heparin dependent antibodies- negative 05:43pm blood adamts13 activity and inhibitor-pnd lyme serology (final ): negative rpr - nonreactive blood culture aerobic bottle-final; anaerobic bottle-final inpatient no growth blood culture aerobic bottle-final; anaerobic bottle-final inpatient no growth echo the left atrium is normal in size. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). there is no ventricular septal defect. 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. no masses or vegetations are seen on the aortic valve. the mitral valve leaflets are structurally normal. the mitral valve leaflets are elongated. there is mild mitral valve prolapse. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. the timing of the mitral regurgitation is late systolic. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. ct abd/pelvis . ct of the abdomen: there is moderate bilateral dependent atelectasis with small bilateral pleural effusions. no lung nodules or definite consolidations are identified. no pericardial effusion. there is very mild biliary ductal dilatation. the gallbladder has been removed. the spleen, adrenal glands, and pancreas are normal. the kidneys have a very unusual appearance with lack of enhancement of the cortices, presumably due to patient's acute renal failure. there has been increased amount of ascites compared to one day prior. again demonstrated is an abnormal loop of proximal-to-mid ileum with wall thickening. this loop is abutting a pocket of ascites in the left lower quadrant. the terminal ileum and the jejunum are both normal. there is no evidence of pneumatosis. oral contrast has now passed through to the rectum with no evidence of obstruction. there is also mild wall thickening of the ascending colon, also unchanged compared to one day prior. on the arterial phase of imaging, the aorta and all of its major vessels are patent. the sma is opacified into its distal branches. ct of the pelvis: oral contrast has passed through to the distal colon. there appears to be high density rounded structure in the sigmoid colon which is likely contrast in a diverticulum. the uterus is unremarkable. air is seen within the bladder which has a foley catheter. no suspicious lytic or sclerotic lesions. renal u.s. port comparison made to ct from . the right kidney measures 10.0 cm, the left kidney measures 9.3 cm. greyscale images demonstrate mildly increased echogenicity to both kidneys, suggestive of chronic medical renal disease, but no focal mass, stone or hydronephrosis. there is no perinephric fluid collection. color doppler examination demonstrates reduced flow bilaterally, but markedly worse on the right. identification of arterial waveforms on the right was difficult, with measurement only possible centrally. minimal venous flow is identified on the right. single resistive index measured on the right was 0.7. flow was slightly better on the left, but still abnormal. resistive indices measured in interlobar branches on the left ranged from 0.7 - 0.9. neurophysiology report eeg study date of abnormality #1: at the beginning of the record, 4 minutes after propofol infusion was stopped, a slow background was noted, interspersed with bursts of generalized suppressed background. as the recording progressed, the generalized bursts consisted of moderate amplitude delta slowing. abnormality #2: occasional triphasic waves were noted with an anterior to posterior lag. abnormality #3: infrequent left parasagittal sharp waves were noted. abnormality #4: a hz slow and disorganized background rhythm was noted. background: as above. hyperventilation: contraindicated due to patient's mental status. intermittent photic stimulation: portable study precluded photic stimulation. sleep: no normal sleep/wake transitions were seen. cardiac monitor: a generally regular rhythm was noted with an average rate of 96 beats per minute. impression: this is an abnormal eeg due to the bursts of suppressed background and then bursts of generalized slowing, triphasic waves, infrequent left parasagittal sharp waves and the slow and disorganized background rhythm. the bursts of slowing, the triphasic waves, and the disorganized background suggest a moderate encephalopathy, which may be seen with infections, toxic metabolic abnormalities or medication effect. the left parasagittal waves suggest a left parasagittal focus of potential epileptogenesis. mr head w/o contrast findings: diffusion images demonstrate no evidence of acute infarct. the ventricles and extra-axial spaces are normal in size without midline shift, mass effect, or hydrocephalus. there are no territorial infarcts seen. the suprasellar and craniocervical regions are normal on the sagittal images. mild mucosal thickening is seen in the ethmoid and maxillary sinuses. brief hospital course: 51 y/o female with complicated surgical history s/p ruptured appy, now with bloody diarrhea, arf, thrombocytopenia, ?ms changes concerning for ttp/hus. . # ttp/hus: although hemolytic anemia was not significant initially, arf, thrombocytopenia, and altered mental status in the setting of bloody diarrhea was concerning for hus. hem/onc consultant did not feel that given lack of hemolytic anemia, ttp was unlikely, thus plasmapheresis was not initiated. her renal failure was thought to be due to atn and did not improve and became almost anuric. renal u/s showed no flow to kidneys and no hydronephrosis. renal consultant started hd on , but despite dialysis, her mental status did not improve. pt then later developed siginificant hemolytic anemia during her micu stay, and daily plasmapheresis was started on . her mental status improved dramatically after her first plasmapheresis and ldh improved gradually. her platelets rose to 70-80,000 although her anemia didn't improve significantly. adamts13 level returned low at 26 but there were no inhibitors present. on , transfusion team felt that given no significant changes in hematocrit and plalets despite daily plasmapheresis and adamts13 findings, weighing the risk:benefit it appears reasonable to plan to hold off on tpe at this time. transfusion followed and further sessions of tpe were held because platelets continued to trend up. on , a new tunneled catheter line was placed by ir. the old catheter was pulled by the medical team on after the new catheter proved to function well during hd. . # arf - hus/ttp. unable to send urine lytes as pt initially anuric. renal consultant started hd on . tunnelled hd line was placed on as renal failure didn't improve despite plasmapheresis. pt continued to have hd on qod basis, receiving epoietin at hd. ct abdomen showed no hydronephrosis. her urine output trended up throughout her admission with 1.5l on day prior to discharge. 24 urine collection was completed. patient had decreased sbp to 90 after last hd session, and was kept one extra day for observation. . # thrombocytopenia - hus/ttp adamts13 inhibitor(-); adamts13 activity 26(normal >=67); hit ab was negative. initially, smear here was w/o schistos per heme c/s. developed worsening mental status through out hospital stay. on started having schistocytes on peripheral smear. plasmapharesis started on - had 6 sessions with improvement in platelets. platelets trended up until . they began to trend down. hydralazine which was started around the time of trend down was stopped as well as all heparin products. her hit antibody was repeated and again negative. because of the long half life of hydralazine, it was thought that this medication was causing the thrombocytopenia that continued through . transfusion team and heme/onc were reconsulted for the possibility of plasma exchange. they did not feel that pt would benefit from plasma exchange because the cause of thrombocytopenia was much more likely a med effect than exacerbation of ttp. the heme team also did not feel that a bone marrow biopsy would be helpful because the other cell lines were not down. pt's platelets began to trend back up . the heme team and transfusion team felt comfortable with pt being discharged to be followed up with outpatient labs to be drawn on hd. # anemia- hemolysis. pt required prbc intermittently to keep hct >21, she was started on epoietin with hd. fibrinogen and ldh levels were followed and continued to show that pt had hemolytic process ongoing. ldh did continue to trend down and fibrinogen trended down. upon discharge from the micu, she required transfusion of 1 unit prbc's on on hd. her hct appropriately increased and remained stable throughout the rest of her admission. # n/v/diarrhea - many etiologies possible given recent history of complicated appendectomy/abscess. ct abd showed bowel thickening concerning for infection. treated with zosyn and flagyl. serial abdominal exams by micu and surgical teams revealed diffuse tenderness that did not change with time. repeat ct abd/pelvis on showed persistent bowel thickening concerning for inflammation. all her stool cx remained negative, however. surgery followed, and pt was kept npo until . pt was then started on clears on . on the medical floor, pt's nausea initially persisted and appeared to be due to uremia. repeat ct of her abdomen on showed intestinal edema likely due to pt's persistent fluid overload. pt tolerated clear diet with some episodes of nausea that resolved with continued hd. she was tolerated full liquids and by tolerated regular diet. nausea resolved with increased urine output and stable hd. she was restarted on outpatient dose of cholestyramine. # pt was initially placed on vanc/zosyn/flagyl which were all later discontinued as cultures remained negative. leukocytosis improved with plasmapheresis. pt remained afebrile. all cultures were negative. pt remained afebrile and her leukocytosis improved without intervention other than hd. # altered mental status - initially was unclear of etiology. neurology was consulted. exam, eeg, and mri all consitent with metabolic encephalopathy. after one session of plasmapheresis, pt's mental status significantly improved and returned to baseline. it remained at baseline for the remainder of her hospitalization. # fluid overload after pt received tpe. repeat tte was done which showed normal ef and no wall motion abnormalities. it did show that pt had moderate pulmonary hypertension. (this should be reevaluated outpatient when pt is not acutely ill.) on pt had episode of flash pulmonary edema, renal did emergent hd and removed several liters of fluid. she had daily hd until when she was started on an every other day schedule. she had sessions of ultrafiltration for fluid removal daily from until . she had hypertension secondary to her renal failure and fluid overload. she was started on metoprolol titrated up to 100mg tid and was started on nifedipine 10mg tid. her bp was well controlled on this regimen. repeat cxr showed pt w/o pleural effusions or consolidation, but with persistent fluid in vasculature. # fen-pt was on tpn for nutrition while bowel rest, picc placed . clear liquid diet was started on . on , pt was taking regular po diet. tpn was d/ced and picc line was pulled on the day of discharge. # ppx- pneumoboots, pt and ot were consulted and worked with the patient they felt that the pt was stable for discharge home. medications on admission: 1. vancomycin 2. zofran 3. zosyn discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 2. epoetin alfa 10,000 unit/ml solution sig: one (1) injection asdir (as directed): with hd. 3. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 4. cholestyramine-sucrose 4 g packet sig: one (1) packet po daily (daily). disp:*30 packet(s)* refills:*2* 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 capsules* refills:*2* 7. nifedipine 90 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). disp:*30 tablet sustained release(s)* refills:*2* discharge disposition: home with service facility: home health care discharge diagnosis: acquired ttp/hus from unclear precipitant renal failure requiring hemodialysis volume overload pulmonary hypertension of unclear etiology discharge condition: medically stable to be discharged to rehab facility. discharge instructions: you were admitted with ttp/hus and developed renal failure requiring hemodialysis. please take medications as indicated below. if you develop fevers/chills, chest pain, shortness of breath, abdominal pain, nausea/vomiting, or any other concerning symptoms, please tell your rehab doctor or report to the nearest er. followup instructions: please follow up with provider: , md phone: date/time: 3:30. pt was found to have moderate pulmonary hypertension while inpatient, please follow up with repeat tte when not acutely ill. nephrology: please follow up with dr. on friday at 9am. clinical center . please call with questions. hematology/oncology: please follow up with dr. and dr. on provider: , md phone: date/time: 1:00 provider: , md phone: date/time: 1:00. please call ( with questions. md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified parenteral infusion of concentrated nutritional substances insertion of endotracheal tube hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis therapeutic plasmapheresis transfusion of packed cells diagnoses: other and unspecified noninfectious gastroenteritis and colitis acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified congestive heart failure, unspecified other chronic pulmonary heart diseases hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease thrombotic microangiopathy metabolic encephalopathy disorder of bone and cartilage, unspecified hypotension of hemodialysis irritable bowel syndrome nutritional marasmus hemolytic-uremic syndrome 

Answer: The patient is high likely exposed to