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: no known allergies / adverse drug reactions attending: chief complaint: jaundice major surgical or invasive procedure: esophagoduodenoscopy () dobhoff placement (, ) history of present illness: this is a 58-year-old woman with a history of hyperlipidemia, known fatty liver, and history of anxiety presenting with jaundice. history is obtained from her and her son, . son states that for the past three months she has been unwell. she has had significant social stressors including divorce from a 30-year marriage and failure of her business. her husband left her within the past several months. her son has been visiting and states he has found her in bed covered in her own feces and she has been deeply depressed. he had tried to persuade her to seek care but she had been reluctant. she had also been weak and falling at home and he once found her with what he described as a black eye. she denied concern for abuse stating that she lived alone. she has a history of heavy alcohol use, up to a bottle of vodka or a large bottle of wine daily. she admits to her most recent alcohol use being . her son confirms this history and adds that she may have been drinking until (her birthday), but it was on that day that he noticed the jaundice and physically removed all alcohol from the house. she has been taking ativan and ambien regularly despute being lost to regular medical care since . she admits to taking the ambien but it is nto clear how regulary she has been taking the ativan. her son states that he placed ativan by her bed to see if she took it while he was gone and she did not. her urine tox is negative for benzos. . she denies fevers, chills, hematemesis, hematochezia, abdominal pain, chest pain and shortness of breath. she states about a week ago her stool did look darker to her. . in the ed, initial vitals were 99.2 62 100/63 18 100%. a diagnostic paracentesis was negative for sbp. a cxr was negative. dre in ed revealed stool that was ob negative. . on transfer: temperature 97.9. pulse 68. respiratory rate 16. blood pressure 113/53. rhythm normal sinus rhythm. o2 saturation 100. o2 flow ra. pain level 0. past medical history: 1. htn 2. anxiety 3. fatty liver with abnormal lfts 4. hyperlipidemia, last check and was 338 total 5. bipolar disorder diagnosed 6. alcohol dependence social history: recent divorce. used to be antiques dealer until recently -tobacco history: none -etoh: prior heavy use. last use or -illicit drugs: none family history: mother died of chf, also had breast cancer. father died of mi. htn in sister, brother and father. dm in pgm (late in life). mgm and mother had breast cancer. no ovarian cancer. mgf had etoh liver disease of some kind. physical exam: admission physical exam: vs: 98.5 102/49 71 20 (by my count 32) 99% ra weight 152 lbs general: nad, anxious appearing, diffusely jaundiced heent: sclera icteric. perrl, eomi. mildly dry mm, op clear. palate jaundiced. neck: supple, no lad cardiac: rrr, nl s1 s2, no mrg lungs: ctab, no rales wheezes or rhonchi abdomen: soft, non-tender, mildly distended. cannot palpate liver edge. extremities: warm and well perfused, no clubbing or cyanosis. 1+ le edema skin: macular erythematous rash diffusely, most prominent on upper extremeties with elbow sparing. frank jaundice. neuro: alert, oriented x 3, slight asterixis, cn ii-xii tested and intact, strength 5/5 throughout, gait normal . discharge pe: vs: 98.9 132/62 72 100%ra general: nad heent: sclera icteric. ng tube in place. cardiac: rrr, nl s1 s2, no mrg lungs: ctab, no rales wheezes or rhonchi abdomen: soft, non-tender, mildly distended. cannot palpate liver edge. extremities: warm and well perfused, no clubbing or cyanosis. 1+ le edema neuro: alert, oriented x 3, no asterixis pertinent results: admission labs: 06:44pm blood wbc-19.1*# rbc-2.20*# hgb-8.1*# hct-24.1*# mcv-109*# mch-36.8* mchc-33.7 rdw-16.8* plt ct-486* 06:44pm blood neuts-79* bands-1 lymphs-6* monos-5 eos-9* baso-0 atyps-0 metas-0 myelos-0 06:44pm blood pt-17.6* ptt-34.0 inr(pt)-1.7* 06:44pm blood glucose-163* urean-45* creat-2.3*# na-131* k-3.8 cl-98 hco3-17* angap-20 06:44pm blood alt-42* ast-84* alkphos-193* totbili-17.4* dirbili-12.0* indbili-5.4 06:44pm blood lipase-283* ggt-150* 06:44pm blood albumin-2.8* calcium-8.8 phos-2.9 mg-1.8 iron-147 08:44pm blood lactate-4.2* hematology labs: 06:44pm blood caltibc-173* ferritn-300* trf-133* 05:50am blood vitb12-1422* folate-10.7 03:30pm blood hapto-54 03:30pm blood ret man-6.0* hepatitis labs: 05:50am blood triglyc-170* hdl-18 chol/hd-10.6 ldlcalc-139* 05:50am blood hbsag-negative hbsab-negative hbcab-negative hav ab-negative igm hbc-negative 05:50am blood hcv ab-negative 05:50am blood ama-negative 05:50am blood -positive * titer-1:80 05:50am blood afp-3.0 05:50am blood igg-1349 iga-1144* igm-236* 05:50am blood ceruloplasmin-25 06:44pm blood lipase-283* ggt-150* cardiac: 09:11am blood ck-mb-3 ctropnt-0.02* probnp-9322* 03:23am blood ck-mb-2 ctropnt-<0.01 lactate trend: 08:44pm blood lactate-4.2* 09:20pm blood lactate-2.6* 06:24am blood lactate-1.7 09:18am blood lactate-1.3 discharge labs: microbiology: blood culture - no growth blood culture - no growth swab r/o vancomycin resistant enterococcus - negative urine culture (final ): escherichia coli. 10,000-100,000 organisms/ml.. presumptive identification. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | ampicillin------------ 4 s ampicillin/sulbactam-- 4 s cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ <=1 s meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ <=1 s trimethoprim/sulfa---- <=1 s urine culture - no growth blood culture - no growth blood culture - no growth serology/blood helicobacter pylori antibody test - negative stool clostridium difficile toxin a & b test - negative blood culture - no growth urine culture - no growth blood culture - no growth mrsa screen - negative stool clostridium difficile toxin a & b test - negative imaging: ruq ultrasound (): liver and gallbladder ultrasound: the liver appears heterogenous in echotexture with a nodular contour. no definite focal hepatic lesion is seen. the gallbladder wall appears mildly thickened, likely due to underlying liver disease. no gallstones are noted. the common bile duct is normal in caliber, measuring 0.5 cm, and there is no evidence of intrahepatic biliary dilatation. the main portal vein is patent but shows reversed hepatofugal flow. the spleen measures 13 cm which is mildly enlarged. the visualized portions of the pancreas are unremarkable. there is moderate to large amount of ascites, particularly in the right lower quadrant. impression: 1. cirrhosis with hepatofugal flow within the main portal vein. moderate to large amount of ascites and mild splenomegaly. 2. mild gallbladder wall thickening that is likely due to underlying liver disease. 3. no biliary dilatation. . cxr (): findings: lung volumes are low. no focal consolidation, pleural effusion, or pneumothorax is seen. heart size is top normal. linear opacity projecting over the right middle lobe likely represents atelectasis. impression: low lung volumes without radiographic evidence for acute cardiopulmonary process. . renal ultrasound (): findings: note is made that this is a limited study due to the patient's body habitus. the right kidney measures 10.4 cm, and the left kidney measures 11.3 cm. there is no hydronephrosis, and no renal stones are identified. no cyst or solid mass is seen in either kidney. there is a moderate amount of ascites within the abdomen. impression: 1. no hydronephrosis, and no renal stones identified. 2. moderate ascites. . egd (): impression: - varices at the lower third of the esophagus - mild portal gastropathy, old residual in the stomach - abnormal mucosa in the duodenum - otherwise normal egd to third part of the duodenum recommendations: - follow up with liver center and pcp. she should be on a ppi and beta blockers for prevention of variceal bleeding. . cxr (): mild cardiomegaly is stable. new multifocal lung opacities right grater than left are consistent with asymmetric pulmonary edema, multifocal pneumonia cannot be totally excluded. follow up after diuresis is recommended. there is no evident pneumothorax or pleural effusion. . cxr (): cardiomegaly is stable. there are low lung volumes. small bilateral pleural effusions, larger on the right are new. difuse lung consolidations, larger on the right lung have progressed. these are more consistent with worsening pulmonary edema. infectious process remains possible. follow up is recommended. . echo (): normal left ventricular cavity size with mild symmetric left ventricular hypertrophy and preserved global left ventricular systolic function. dilated right ventricle consistent with possible volume overload. mild aortic regurgitation. mild to moderate mitral regurgitation. mild to moderate tricuspid regurgitation. mild pulmonary artery systolic hypertension. . ekg (): nsr, no acute st/tw changes. . le ultrasound (): findings: grayscale and doppler son of right common femoral, superficial femoral, deep femoral, popliteal and proximal calf veins were performed. there is normal compressibility, flow and augmentation throughout. impression: no dvt in the right lower extremity. . ng tube placement by ir: procedure and findings: the patient was placed supine on the imaging table. after administration of lido-gel, an 8 french - tube, stiffened with the wire, was passed through right nostril into the third part of the duodenum. injection of contrast demonstrated the post-pyloric location. the wire was removed and the catheter was flushed with water. the tube was then secured with a bridle. the patient experienced epistaxis from the left nostril briefly at the beginning of the procedure, which she stated is not unusual for her. after placement of the bridle, however, she began to again have epistaxis again, which continued for approximately 10 minutes. impression: fluoroscopic placement of an 8 french nasointestinal tube. the tiplocation is post-pyloric and the tube is ready to use. given history of frequent epistaxis, the continued use of a bridle should be reviewed by the primary team. . discharge labs; 05:35am blood wbc-7.8 rbc-2.35* hgb-8.4* hct-25.0* mcv-107* mch-35.9* mchc-33.7 rdw-18.6* plt ct-271 05:35am blood pt-15.2* ptt-32.0 inr(pt)-1.4* 05:35am blood glucose-133* urean-29* creat-1.1 na-131* k-4.6 cl-100 hco3-21* angap-15 05:35am blood alt-30 ast-67* alkphos-120* totbili-3.8* 05:35am blood calcium-9.9 phos-3.7 mg-1.6 brief hospital course: summary: 58 yo f presenting with hyperbilirubinemia, renal failure, leukocytosis and anemia, diagnosed with new liver failure in setting of alocholic hepatitis. . # hyperbilirubinemia, ascites, edema, liver failure: the patient had known risk factors for etoh hepatitis, and her previous elevation in lfts was in the context of admitted etoh use. however, given the lack of previous history, other causes were investigated. infectious hepatitis and aih labs were negative. she was treated with albumin. egd revealed 4 cords of grade 2 varices. started nadolol , but d/c for bronchoconstriction. propranolol was then started on . her meld score reduced to 16. diruesis was started to reduce ascites and peripheral edema. dobhoff feeding tube placed for tube feeding given poor nutritional status. this came out on and was replaced after the patient could not maintain caloric intake. tube feeds continued at goal at the time of discharge. . # kidney injury: cr elevated at 2.2 on admission, last value 0.8 in . renal ultrasound no evidence of obstruction or hydronephrosis. repeat urine lytes showed that she was pre-renal with una < 10, fena 0.08%. hrs was considered and treatment with albumin, octreotide and midodrine was initiated. a course of 5 days treatment did not improve renal function and these treatments were therefore discontinued. creatinine improved at the time of discharge to a stable value of ~1 . # leukocytosis: the patient had leukocytosis that persisted throughout admission. she was treated for a uti/pneumonia, but other infectious work-up was negative . # uti: urine culture positive for e coli, treated with cipro for 3 days. later urine cultures negative. . # anemia and duodenal ulcer: patient presented with anemia (hct 24.1), required 3 units prbcs to maintain hct. she was guaiac negative. egd found duodenal ulcer that was cauterized. her ulcer was treated with ppi. . # respiratory distress and micu course: on the night of , the patient spiked a temperature to 101 and developed a new oxygen requirement. she was started on vanc/zosyn for hospital acquired pneumonia but continued to be tachypnic. in the early morning of , patient became acutely hypoxic with crackles throughout her lung fields. a cxr was consistent with flash pulmonary edema. she was treated with iv diuresis and was transferred to the icu for respiratory distress. echocardiography was consistent with volume overload, but there was no clear precipitant for flash pulmonary edema. the patient recovered rapidly with diuresis and was transferred back to the floor on . the cardiology team was consulted and recommended outpatient follow-up to ensure resolution of right ventricular distension with appropriate diuresis. # depression / etoh abuse: per family, the patient has been struggling with depression for the last 2 years, which has been the main driver for her etoh abuse. the patient denied hi/si. social work was involved for help with placement and outpatient services. continued vitamin supplementation. . # mania: patient had visual hallucination overnight. she became more manic, was not sleeping, and exhibited pressured speech and disorganized thoughts. psychiatry consultation was obtained. she was diagnosed with a mania nos and was treated with haldol. other medications were not started in the context of liver failure. she was initially subject to section 12 for 3 days, however this was discontinued as her mental status normalized with treatment. this will need outpatient follow-up. she needs intensive outpatient psychotherapy (potentially dual diagnosis facility) upon leaving ltac. . # hyponatremia: 131 on presentation, normalized on hydration. dropped again with initiation of tube feeding, rose with fluid restriction at 1.5 l. . # right shoulder dislocation: appeared to be grade iii superior dislocation of right clavicle. the patient reported that this is secondary to a fall in and that she did not seek treatment. she had good mobility and strength in the arm. per up-to-date, treatment for grade iii dislocations is conservative, and at as her function was good there was no indication for orthopedic intervention. # htn: discontinued home atenolol, pressures well controlled. # hyperlipidemia: found to have dyslipidemia with low hdl and elevated ldl. treatment deferred to outpatient follow-up # hyperglycemia: brief period of hyperglycemia on admission, rapidly resolved. iss used for the first two days of admission. # insomnia: discontinued home ambien and ativan, used trazodone prn . # code: full # contact: , son ===================================================== transitional issues: - treatment of dyslipidemia - psychiatric follow-up for substance abuse, mania - consider transplant listing once patient has achieved 3 months sobriety - cardiology follow-up to ensure resolution of right heart volume overload - per psychiatry: in outpatient setting, could consider the following non-urgent recommendations. 1) neuropsychological testing to determine whether or not there may be longterm cognitive deficits associated with etoh abuse 2) consider cross-tapering haldol to another medication with more mood-stabilizing properties (e.g. quetiapine) - trend wbc for persistent leukocytosis. - trend hct, transfusions for symptomatic anemia - check ekg once a week to eval qtc while on haldol - encourage po intake, regular nutritional assessments while on tube feeds - assess when able to change psychiatric meds based on lfts - trend lfts, chemistry, cbc daily until sees liver in outpatient followup medications on admission: lorazepam 0.5mg tablets take one-half to one tablet by mouth three times daily as needed atenolol 100 mg tab one tablet(s) by mouth once a day zolpidem 10mg tablets take to 1 tablet by mouth every night at bedtime as needed discharge medications: 1. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 4. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. 5. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 6. propranolol 10 mg tablet sig: one (1) tablet po bid (2 times a day). 7. haloperidol 5 mg tablet sig: one (1) tablet po hs (at bedtime). 8. spironolactone 25 mg tablet sig: one (1) tablet po daily (daily). 9. haloperidol 2 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for agitation. 10. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain: no more than 2 grams/ day. 11. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: two (2) puff inhalation q4h (every 4 hours) as needed for wheeze. 12. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for itching. 13. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 15. trazodone 50 mg tablet sig: 0.5 tablet po at bedtime as needed for insomnia. discharge disposition: extended care facility: - discharge diagnosis: primary: alcoholic hepatitis urinary tract infection hyponatremia acute kidney injury malnutrition anemia diastolic heart failure esophageal varices ascites pneumonia cirrhosis duodenal ulcer right shoulder dislocation manic disorder nos substance abuse fatty liver disease discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: it was a pleasure taking care of you at . you came to the hospital after being found to have jaundice. you were found to have liver disease, causing jaundice, and kidney disease, causing fluid buildup throughout your body. this was treated with hydration and medications that reduce toxin buildup. tests were performed to understand the extent of your disease. you were determined to have cirrhosis (long term damage of your liver), likely due to alcohol intake. you were treated with diuretics to reduce the fluid overload in your body. an endoscopy revealed a duodenal ulcer that was thought to be the cause of some slow gi bleeding. the ulcer was cauterized (burned) and you were treated with omeprazole. you had an episode of respiratory distress that led to a brief stay in our intensive care unit. you were there overnight and responded well to medical treatment. you then returned to the floor. you were found to have some aspects of mania during your stay. our psychiatry team worked with you and suggested treatment with haldol. they also suggested a stay in a psychiatric facility to help you gain control of this disease. we made the following changes to your medications: - stop ambien - stop atenolol - stop ativan - start haldol for mania - start thiamine, folic acid, multivitamin - start omeprazole for ulcer treatment - start furosemide and spironolactone to treat fluid overload and swelling - start propranolol for blood pressure and to prevent gi bleeding please follow-up with your outpatient providers as listed below. followup instructions: name: , / , md. location: cardiac services address: , 7, , phone: *it is recommended that you see a cardiologist within 4-6 weeks. please call the number above to set up an appointment. name: , md specialty: internal medicine location: medical care ctr address: , , phone: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. they can call the number listed above. department: liver center when: friday at 1:20 pm with: , md building: lm campus: west best parking: garage procedure: other endoscopy of small intestine enteral infusion of concentrated nutritional substances percutaneous abdominal drainage diagnoses: pneumonia, organism unspecified urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified hepatorenal syndrome other pulmonary insufficiency, not elsewhere classified iron deficiency anemia secondary to blood loss (chronic) unspecified protein-calorie malnutrition hyposmolality and/or hyponatremia portal hypertension other and unspecified hyperlipidemia anxiety state, unspecified other sequelae of chronic liver disease rash and other nonspecific skin eruption other ascites chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction esophageal varices in diseases classified elsewhere, without mention of bleeding other specified disorders of stomach and duodenum diastolic heart failure, unspecified epistaxis insomnia, unspecified other abnormal glucose acute alcoholic hepatitis other diseases of trachea and bronchus acute edema of lung, unspecified jaundice, unspecified, not of newborn family history of diabetes mellitus family history of malignant neoplasm of breast other and unspecified escherichia coli [e. coli] family history of other cardiovascular diseases nonspecific abnormal results of function study of liver alcoholic fatty liver duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation, without mention of obstruction bipolar i disorder, most recent episode (or current) manic, unspecified sedative, hypnotic or anxiolytic dependence, unspecified closed dislocation of acromioclavicular (joint) other and unspecified alcohol dependence, episodic 

Answer: The patient is high likely exposed to