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: hematochezia, abdominal distension major surgical or invasive procedure: esophagogastroduodenoscopy colonoscopy with biopsies ultrasound guided paracentesis history of present illness: 47f with pmh of chronic depression, hemorrhoids x 20+ years presents with brbpr for past 2 weeks. patient states that 2 weeks ago, she drank tap water, which she normally does not do, and began to have diarrhea. since then, she has been going to the bathroom every hour, with small amounts of loose stool, until two days ago, when she became more constipated. she has noticed her hemorrhoids more recently, in the sense that when she uses the bathroom, she can feel them popping out from her sphincter, and finds blood on the toilet paper when she wipes. there is no pain associated with her hemorrhoids. at the same time, she has noticed worsened abdominal distension and her clothes no longer fit. she denies abdominal pain, nausea, or vomiting. yesterday, she had a fever of 100f with some sweats, but has not noticed any fevers since. she was also complaining of reflux symptoms over the past three days for which she had been taking an over the counter anti-acid. in the ed, initial vs were: 98.8, 106, 116/80, 18, 100% ra. labs were notable for an hct of 24.5 with an mcv of 122, plt of 109, ap of 204, t-bili of 3, ast of 62, alt of 18, amylase of 219, lipase of 123, inr of 1.7 and negative serum/urine tox screens. a ct of her abdomen/pelvis with contrast was notable for a thickened colonic wall consistent with colitis and a moderate amount of free fluid in the pelvis/paracolic gutters. she was given levofloxacin, with plans to start flagyl but did not receive this in the er. she was given 4g of mg and 40meq of potassium. gi was consulted with possible plans for a colonoscopy on monday, she had two 18 gauge iv's placed but was not transfused any prbc's in the er. she was admitted to the icu for frequent hct monitoring. vs on transfer were: t 98.4, bp 118/86, rr 17, o2 sat 100% ra. on arrival to the icu her initial vs were: t98, hr99, bp129/88, rr20, sat 100% (ra). she looks comfortable with no abdominal pain, nausea/vomiting. she does feel somewhat lightheaded, but no chest pain or sob. review of systems: positive per hpi. other review checked and unremarkable. past medical history: hemorrhoids depression (hx of si, insomnia) etoh abuse, in remission (last drink > 1 year ago, last heavy use approximately 4 years ago) anemia secondary to folate deficiency asthma hyperthyroidism s/p ablation, now hypothyroid htn low back pain secondary to djd s/p tubal ligation s/p fibroidectomy social history: unemployed, social support from mother but serious financial limitations - tobacco: 1 pack/day for 20 years - alcohol: former alcohol abuse (up to pink whisky/night), quit using alcohol last year, reports much less alcohol over the past four years - illicits: none family history: diabetes mellitus and cancer in members. no inflammatory bowel disease she knows about. physical exam: admission physical exam: vitals: t:98 bp:129/88 p:99 r:20 o2:100%(ra) general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: tachycardic, normal s1 + s2, no murmurs, rubs, gallops abdomen: +bs, very distended, liver edge 4cm below costophrenic margin, tympanic to percussion, no tenderness to palpation gu: no foley ext: warm, well perfused, no edema discharge physical exam: all vital signs stable and within normal limits. pt appeared comfortable. mild jaundice. heart and lung exam within normal limits. abdominal exam notable for significantly diminished distension after u/s guided paracentesis. abdomen nontender and liver edge no appreciated. bowel sounds positive. no masses. otherwise exam notable for no asterixis. pertinent results: =================== laboratory results =================== admission labs: wbc-6.0 rbc-2.02*# hgb-8.4*# hct-24.5*# mcv-122*# rdw-15.2 plt count-109* --neuts-75.5* lymphs-15.1* monos-8.3 eos-0.7 basos-0.4 pt-18.6* ptt-32.7 inr(pt)-1.7* glucose-92 urea n-5* creat-0.7 sodium-139 potassium3.0* chloride-98 total co2-29 alt(sgpt)-18 ast(sgot)-62* ld(ldh)-204 ck(cpk)-103 alk phos-204* amylase-219* tot bili-3.0* albumin-3.8 calcium-8.7 phosphate-2.7 magnesium-1.3* lipase-123* ctropnt-<0.01 ck-mb-2 serum tox: asa-neg acetmnphn-neg ethanol-neg ucg neg, ua: blood-neg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-sm urobilngn-8* ph-6.5 leuk-sm rbc-1 wbc-3 bacteria-few yeast-none epi-33 urine tox: bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg discharge labs: wbc-7.9 rbc-2.52* hgb-9.8* hct-29.0* mcv-115* rdw-18.3* plt ct-85* pt-18.8* ptt-36.2* inr(pt)-1.7* glucose-83 urean-2* creat-0.6 na-133 k-3.6 cl-101 hco3-23 other important labs caltibc-221* ferritn-176* trf-170* vitb12-1123* folate-7.4 tsh-33* hbsag-negative hbsab-negative hbcab-negative hav ab-negative hcv ab-negative anti smooth muscle antibody- positive * -negative paracentesis: wbc-270* rbc-25* polys-3* lymphs-16* monos-73* mesothe-8* totpro-3.1 albumin-1.8 ============== microbiology ============== urine culture : no growth stool culture and c diff toxin assay: negative peritoneal fluid culture : gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (preliminary): no growth. anaerobic culture (preliminary): ============== other studies ============== ecg : sinus rhythm. poor r wave progression with low qrs voltage in the precordial leads and the limb leads. compared to the previous tracing of the qrs voltage has decreased and there is poor r wave progression. ct abdomen and pelvis w/ contrast : impression: 1. heterogeneously enhancing liver with a gastroesophageal varix and ascites; consider an acute inflammatory process of the liver. correlate for clinical presence of hepatitis. 2. thickened right colonic wall, with lesser thickening of the left colon wall and transverse colon sparing; this finding may be nonspecific in the setting of ascites; another consideration is colitis (infectious versus inflammatory etiologies). liver/ gb u/s : impression: 1. heterogeneous liver with patchy areas of increased echogenicity, finding suggestive of steatosis or possibly acute inflammation. no definite hepatic lesion is identified. 2. diffuse gallbladder wall edema, likely secondary to edema and/or underlying liver disease. no signs of acute cholecystitis. 3. no intra- or extra-hepatic biliary ductal dilatation. 4. moderate ascites, largest pocket in the right lower quadrant. brief hospital course: 47f with pmh of chronic depression, hypothyroidism, and alcohol abuse presenting with hematochezia and abdominal distension and signs of acute liver injury with secondary portal hypertension/ascites. 1) portal hypertension complicated by ascites due to acute or chronic hepatitis: pt presented with thromobocytopenia, increased transaminases with ast>alt, elevated bilirubin, and elevated inr that did not normalize with vitamin k. she also had ascites that was eventually revealed to have a saag of 1.3 suggestive of being due to portal hypertension. imaging revealed heterogeneous liver. overall picture is somewhat confusing. possible patient has chronic portal hypertension due to cirrhosis (most likely due to previous alcohol abuse) but imaging not strictly typical and though saag met criteria for being due to portal hypertension ascites albumin was relatively high. other possibility would be an acute hepatitis causing acute portal hypertension. most likely etiology of this would be alcoholic hepatitis but patient vehemently denies continued alcohol use to multiple individuals. extensive work up for causes of liver disease was unremarkable except for positive low titre anti-smooth antibody but with negative . she remained with an elevated bili, inr, and low platelets suggesting chronic cirrhosis but given she was otherwise stable she was discharged to follow up in liver clinic for further management and work up. she was cautioned about other manifestations of decompensated cirrhosis (i.e. encephalopathy) and warned to have a low threshold to seek medical care. she was started on 20 mg po lasix daily at time of discharge to help control ascites. 2) hematochezia: on presentation patient had bright red blood per rectum with major concern being for a hemorrhoidal bleed vs diverticular bleed vs bleeding from colitis (as ct seemed to suggest inflammation). never had large volume of blood and never with dark blood suggesting more likely from a lower gi source. the patient's hct on presentation was 24.5 and increased to around 30 after transfusion of one unit with stability thereafter. upper and lower endoscopy failed to reveal a clear source of bleeding though there were hemorrhoids, which could certainly explain blood that was seen. to complete work up should get a capsule endoscopy to evaluate for small bowel avms. gi elected to arrange this as an outpatient. at time of discharge hct stable >48 hrs w/o any transfusion. 3) ? fevers: pt reported low grade fevers prior to presentation. ed ct scan concerning for colitis so she was started on cipro/metronidazole though never febrile here. colonoscopy did not show any colitis and c diff negative so metronidazole stopped. sbp was also entertained as a source of fever but by time of paracentesis (deferred due to bedside procedure being technically infeasible and the deferred for endoscopies) she had received four days of antibiotics. therefore she completed five days of ciprofloxacin for possible sbp. no prophylaxis was started as diagnosis never confirmed and seemed unlikely. 4) anemia. patient has hx of anemia from folate deficiency. hct on presentation at 24.5 likely reflects baseline anemia with component of gi bleeding. labs suggested no current deficiencies. possible some degree of sequestration due to portal hypertension. she felt considerably better after transfusion and with higher hct. she will follow up for hct rechecks. 5) hypothyroidism: pt acknowledged taking levothyroxine irregularly at best. tsh 33 suggestive of very poor adherence. levothyroxine restarted in hospital. she will follow up with pcp for tsh rechecks. 6) depression. pt with significant history of depression and had not been taking meds regularly. she was restarted on fluoxetine and aripiprazole in house. 7) poor adherence: discussed with social work and largely due to very limited income and large debts for housing. patient discussed and reassured her that the infrastructure at clinic where she plans to be seen should be very helpful in working with financial issues and helping to make sure she does not miss care. patient was reassured. need for close follow up, particularly for hepatic issues was repeatedly emphasized. transitional issues: -pt will follow up with pcp to assess for signs of dehydration, tolerance of daily furosemide regime -pt will follow up with pcp and liver to assess resolution of ascites -pt will follow up with liver to discuss further work up of liver disease, trend labs, and discuss need for biopsy -pt will follow up with pcp to recheck anemia and trend as well as platelet count -final ascites culture results and serum ceruloplasmin pending at time of discharge. medications on admission: levothyroxine 200mcg daily - not taking everyday metoprolol 100mg daily - not taking hctz 50mg daily amlodipine 5mg daily fluoxetine 60mg daily - not taking regularly abilify 20mg daily - not taking everyday but thinks she should be calcium 1000mg vitamin d iron melatonin 3mg discharge medications: 1. fluoxetine 20 mg capsule sig: three (3) capsule po daily (daily). disp:*30 capsule(s)* refills:*1* 2. aripiprazole 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*0* 3. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 5. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 6. furosemide 20 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 7. senna 8.6 mg tablet sig: 1-2 tablets po twice a day as needed for constipation. discharge disposition: home discharge diagnosis: primary diagnoses: acute decompensated cirrhosis complicated by ascites acute gi bleed (source unclear) secondary diagnoses: depression hypothyroidism discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted with gi bleeding and swelling of your abdomen. we think the swelling in the abdomen was due to liver disease, likely due to your previous heavy alcohol use (we have excluded viruses and some other common causes though the liver doctor you follow up might perform other investigations). despite using a camera to look at significant portions of your upper and lower gi tract we did not pinpoint a source of bleeding. nevertheless, the bleeding resolved on its own and it is likely a slow source so gi feels it can be worked up as an outpatient. your medications have been changed. you have been started on an acid blocking medication to help prevent further episodes of bleeding. your blood pressure medicines have been held as your blood pressure is normal without them. finally, you have been started on a diuretic called furosemide (lasix) to help you get rid of excess fluid on the body. followup instructions: department: post clinic when: thursday at 9:00 am with: dr building: sc clinical ctr south campus: east best parking: garage note: this appointment is with a hospital-based doctor as part of your transition from the hospital back to your primary care provider. this visit, you will see your regular primary care doctor in follow up department: liver center when: thursday at 10:15 am with: , md building: lm campus: west best parking: garage procedure: other endoscopy of small intestine percutaneous abdominal drainage endoscopic polypectomy of large intestine closed [endoscopic] biopsy of large intestine diagnoses: thrombocytopenia, unspecified unspecified essential hypertension acute posthemorrhagic anemia alcoholic cirrhosis of liver other and unspecified alcohol dependence, in remission unspecified acquired hypothyroidism hypopotassemia constipation, unspecified blood in stool other ascites personal history of noncompliance with medical treatment, presenting hazards to health benign neoplasm of colon other and unspecified coagulation defects internal hemorrhoids without mention of complication external hemorrhoids without mention of complication chronic pulmonary heart disease, unspecified folate-deficiency anemia 

Answer: The patient is high likely exposed to