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: haldol / darvon / keppra attending: chief complaint: altered mental status major surgical or invasive procedure: intubation history of present illness: 52 year old woman with cirrhosis secondary to hepc and alcohol, gi bleed secondary to portal gastropathy s/p tips, recurrent hepatic encephalopathy who is referred after being found lethargic and responsive only to sternal rub. . of note she was just discharged on following an admission for hepatic encephalopathy. during that admission her tips was found to be patent on doppler. . earlier today she was noted at her to be lethargic and responsive to noxious stimuli. at baseline she is confused and with delusional thought content. her vitals prior to transfer wer unremarkable. . upon arrival to the ed she was awake, but with her eyes closed responding to painful stimuli with yelling. her initial vital signs were 99.4 62 104/61 14 100%ra. iv lines were placed. a foley was placed. she was intubated for airway protection with a #7.0 ett with etomidate and rocuronium. an ogt was placed and both ett and ogt were confirmed in good position by cxr. she was sedated with propofol. post intubated she was hypertensive to 213/130 but normalized without directed antihypertensives. she also received 1l of ns, kayexalete/glucose/insulin (k 6.6), and one dose of lactulose. past medical history: 1) iron deficiency anemia 2) gi bleed - presumed secondary to hemorrhoids, s/p tips; also w/ known portal gastropathy 3) sigmoid diverticulosis 4) schatzki's ring 5) duodenal polyps and duodenitis 6) mgus 7) ?etoh/ hcv cirrhosis followed in liver center 8) psychotic disorder 9) polysubstance abuse - etoh, cocaine, marijuana 10) copd 11) ?? h/o complex partial seizures 12) subcutaneous variceal rupture s/p hematoma exploration in llq 13) chronic kidney disease (baseline cr ~1.4) social history: history of tobacco and etoh abuse. she is originally from , and changed her name when she became a practicing muslim. she worked as an administrative assistant when she was younger, but is now on ssdi (for schizophrenia and seizure disorder, per pt, both now quiescent). family history: mother: asthma, grandmother with diabetes, htn. no family history of liver disease or bleeding disorders. great aunt with epilepsy. physical exam: afebrile, p77, bp 134/70, r 13, 100% ra gen: intubated and sedated heent: ett in place. atraumatic. mmm. perrla. jvp flat chest: clear anterior and laterally cv: non-displaced pmi. rrr no m/r/g abd: soft flat no fluid wave. active bowel sounds. llq 4x3cm open superficial wound ext: marked muscle wasting. 2+ radial bilat and 2+ dp bilat. no edema neuro: intubated and sedated pertinent results: admission labs: 06:28pm wbc-4.5 rbc-3.36* hgb-11.0* hct-32.7* mcv-98 mch-32.9* mchc-33.7 rdw-15.5 06:28pm plt count-195 06:28pm glucose-92 urea n-48* creat-1.8* sodium-136 potassium-8.1* chloride-105 total co2-20* anion gap-19 06:28pm pt-15.7* ptt-49.2* inr(pt)-1.4* . discharge labs: 09:15am blood wbc-3.8* rbc-3.66* hgb-11.5* hct-36.8 mcv-100* mch-31.5 mchc-31.4 rdw-14.6 plt ct-133* 09:15am blood pt-16.0* inr(pt)-1.4* 09:15am blood glucose-100 urean-21* creat-1.3* na-138 k-4.7 cl-111* hco3-15* angap-17 09:15am blood calcium-10.3* phos-4.2 mg-1.8 09:15am blood alt-32 ast-35 alkphos-104 totbili-1.7* . studies: ct head w/o contrast impression: no evidence of acute intracranial hemorrhage, no change from prior studies. . chest (portable ap) findings: portable ap upright chest radiograph is obtained. low lung volumes limits evaluation. the lungs appear clear bilaterally, demonstrate no evidence of pneumonia or chf. no pleural effusions or evidence of pneumothorax is seen. cardiomediastinal silhouette is normal. no pneumothorax is seen. visualized osseous structures are intact. a stent is noted in the right upper quadrant compatible with tips. . ecg study date of rate pr qrs qt/qtc p qrs t 69 182 86 424/439 70 -9 62 sinus rhythm. consider left atrial abnormality. normal ecg. since previous tracing of , increased voltage. . liver or gallbladder us (single organ) impression: 1. patent tips with appropriate velocities throughout. 2. no evidence for ascites. 3. small amount of sludge in the gallbladder. brief hospital course: 62 year old woman with cirrhosis c/b portal gastropathy s/p tips with recurrent hepatic encephalopathy presenting with altered mental status requiring intubation overnight for airway protection. . 1. hepatic encephalopathy: pt's altered mental status is likely hepatic encephalopathy as pt improved with increased lactulose. she required intubation overnight for airway protection. there is no clear precipitant. there is no clear evidence of infection though patient did have a fever in the icu; this fever may have been due to aspiration peri-intubation. she had a ruq that was negative for acute pathology, and she had no ascites to tap. urine culture was negative. bcxs have no growth to date. sputum culture did grow moderate mrsa, sparse gnrs; however, pt is known to be colonized with mrsa and has no other s/sxs to suggest infection. cxrs have been unremarkable. she tested negative for influenza and c. diff as well. her zyprexa and keppra were held on admission and added back as the pt's mental status returned to baseline, and she tolerated them well. she was continued on lactulose & rifaximin. . 2. hepatitis c virus cirrhosis: her lfts and coags remained at baseline. pt was continued on lactulose/rifaximin for hepatic encephalopathy. her lasix was held on admission due to acute on chronic renal failure. . 3. acute on chronic kidney disease: pt's baseline creatinine is 1.1-1.4. pt was likely volume depleted poor po intake on diuretics. her lasix was held on admission and her creatinine returned to baseline. she will follow up with dr. to determine whether she should continue on diuretics. . 4. hypertension: pt's metoprolol was titrated up to toprol xl 200 mg daily. sbp at discharge ranged from 110-140. . 5. anemia: this is multifactorial due to kidney disease, liver disease, and chronic blood loss. she was continued on iron supplements. she will resume aranesp as an outpatient. . 6. psychosis: patient was continued on her home regimen of zyprexa. . 7. seizure disorder: pt was restarted on her keppra at lower dose given her liver/kidney disease. she had no seizures while in house. . 8. code status: full medications on admission: keppra 750 mg zyprexa 5mg zyprexa 5 mg q6prn metoprolol 50 q8hours acetaminophen 325-650 mg q4:prn milk of magnesium prn bisacodyl 10 mg pr daily:prn maalox 30 ml q4:prn pantoprazole 40 mg daily aranesp 25 mcg qmonday last dose klor-con 20 meq daily lasix 40 mg daily ferrous sulfate 325 mg daily lactulose ursodiol 300 mg q12 multivitamin daily lactulose 30 ml qid rifaximin 600 mg discharge medications: 1. lactulose 10 gram/15 ml syrup : sixty (60) ml po tid (3 times a day): please titrate to bowel movements a day. 2. rifaximin 200 mg tablet : three (3) tablet po bid (2 times a day). 3. ursodiol 300 mg capsule : one (1) capsule po bid (2 times a day). 4. metoprolol succinate 100 mg tablet sustained release 24 hr : two (2) tablet sustained release 24 hr po daily (daily). 5. levetiracetam 500 mg tablet : one (1) tablet po bid (2 times a day). 6. olanzapine 5 mg tablet : one (1) tablet po twice a day. 7. olanzapine 5 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po q6h (every 6 hours) as needed for agitation. 8. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 9. ferrous sulfate 325 mg (65 mg iron) tablet : one (1) tablet po daily (daily). 10. hexavitamin tablet : one (1) cap po daily (daily). 11. acetaminophen 160 mg/5 ml solution : 325-650 po q8h (every 8 hours) as needed for fever or pain: please limit to 2 gm per day. 12. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) as needed. 13. aranesp (polysorbate) 25 mcg/0.42 ml syringe : one (1) injection once a week. discharge disposition: extended care facility: health care - discharge diagnosis: primary: hepatic encephalopathy . secondary: hepatitis c virus cirrhosis acute on chronic kidney disease seizure disorder hypertension multifactorial anemia discharge condition: stable, alert, not oriented discharge instructions: you were admitted for decreased responsiveness. you required a breathing tube for one night. your mental status has improved with increases in your lactulose. please make sure you take enough lactulose to make bowel movements a day. . please take your medications as directed. . if you develop lightheadedness, chest discomfort, shortness of breath, abdominal pain, blood in your stools, or decreased responsiveness, please call your primary care physician . at or dr. at ( or go to the emergency department. followup instructions: please keep the following appointments: provider: , md phone: date/time: 11:20 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: anemia in chronic kidney disease chronic hepatitis c with hepatic coma alcoholic cirrhosis of liver acute kidney failure, unspecified portal hypertension chronic airway obstruction, not elsewhere classified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified infection with microorganisms resistant to penicillins chronic kidney disease, unspecified unspecified schizophrenia, unspecified methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site iron deficiency anemia, unspecified epilepsy, unspecified, without mention of intractable epilepsy other specified disorders of stomach and duodenum 

Answer: The patient is high likely exposed to