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: upper gi bleed major surgical or invasive procedure: egd with esophageal banding. history of present illness: hpi: 51 yo f, hx etoh abuse, who was doing well until about one year ago when she was diagnosed with cirrhosis. apparently, the patient went to her pcp and was sent for an ultrasound. she was given the dx of cirrhosis at that time. over the following year, the patient did not follow up with her physician and she continued to drink alcohol. in mid- (), she began vomiting blood at home. she did not go to the hospital at that time. the pt continued vomiting and decided to go to osh ed 3 days later (). she was admitted at that time with hct=14 and sbp=80's. during her hospital admission, she had an egd/esophageal banding of varicies. she had a few episodes of melena, but no further hematemesis. she was discharged after 5 days. after returning home, she did not have any further bleeding and had abstained from etoh, without any dk stools, melena, brbpr, hematemesis, f/c, nausea, abd pain, no dysuria, + ble edema. about 2 weeks later, she was in the car with her sister, and began vomiting blood/clots again. her sister brought her to osh ( on ). pt admitted to osh w/episode of hematemesis of clots, then 500cc brb en route to osh. at osh ed p 114, bp 88/49pt had massive hemoptysis, intubated for airway protection (abg 7.43/26/81). they thought that earlier banding 2-3 weeks ago may have dislodged. pt tx w/endoscopy, hypertonic saline inj. tx w/ 4u prbcs, hct 24-23! given more units prbcs, hct 31 prior to transfer, inr 1.9, alb 2.0, tbili 23.6, dbili 15.4. tx w/vanco x1, zosyn x1. patient was then transferred to for further management of varicies and liver disease. she was admitted to the micu and given an aditional prbcs and had another egd. patient was intubated for airway control. gi performed another esophageal banding. pt did not bleed further. she was extubated and did well. only concern was patient's decreased mental status s/p extubation thought to be related to receiving ativan. prior to admission, she was fully functional, occupied as a teacher. she was teaching until 3 weeks prior to this admission. a/p: 51 yo f, hx etoh abuse, hx recent variceal bleed at osh tx w/banding, now represents after wks w/recurrent ugib, hematemesis, hct 24->29.8 despite 6u prbcs and hypertonic saline injection at osh, hypotensive to 90s, +ngt lavage. patient now transferred from icu with hct 39 and no active bleeding. pt with leukocytosis (25) with cxr lul infiltrate and mild decrease in ms. 1) ugib -esophageal varices (given acute blood loss, recent hx w/banding, egd at osh); pt s/p transfusion and banding in icu, now stable -npo, ivf, iv ppi , octreotide gtt (50mcg) -cont octreotide gtt -cont. propranolol for variceal bleeding prophylaxis -maintain 2 large bore ivs -consider possible tips, will follow with gi 2) cirrhosis: pt w/ h/o cirrhosis (class c), although no biopsy proven dx; ruq u/s w/dopplers w/patent pv, ascites, retrograde r sided flow, anterograde l sided flow; pt with high inr (1.9 s/p vit k) and high bili (25). not transplant candidate. -follow lfts, coags, plts, alb, bili: alb still low, tbili -liver following with dr. 3) ascites: diagnostic tap in am . removed 4.5 liters of fluid which showed 30 wbc, 95 rbcs with 11poly,32lymphs,25monos,29macs, and total protein less than 0.3 and albumin less than 1. -prophylactic sbp tx w/ ctx x 5 days () -follow wbc count and temp curve -lasix, aldactone and prn paracentesis. 4) encephalopathy: pt received ativan in icu, possibly cause of decresaed ms. /c ativan, haldol for agitation -start lactulose 5) leukocytosis: pt has wbc=25 but afebrile, s/p tap --> no sbp. cxr shows ?lul infiltrate. wbc count rising despite ceftriaxone. concerned for hospital acquired/vent associated vs. aspiration pneumonia. -will cont ceftriaxone for pneumonia coverage -will add clindamycin for better staph/anaerobic coverage 6) anemia: pt currently not actively bleeding, s/p transfusion, hct stable at 39. -follow hct 7) arf: pt initially in prerenal arf, likely volume depletion, now resolved. cr=0.9 -follow creatine 8) fen: pt lytes wnl, except low bicarb. will follow -nutrition via ng tube 9) prophylaxis -pneumoboots, ppi iv 10) full code: discussed with sister, would like full code for now until quality of life/life expectancy can be discussed with liver team. be changed in the near future. 11) dispo -will be evaluated later in hosp course; unclear endpoint now. past medical history: etoh abuse x 10 yrs, ascites x months; recent hospitalization for ugib w/hct 15 requiring 5u prbcs - egd w/portal gastropathy and gr esoph varices s/p banding; gallstones, rosacea social history: patient has h/o alcohol abuse, has not had any alcohol for at least 2 weeks prior to admission. she is a substitue teacher and often guides tours to europe. family history: non-contributory physical exam: pe: vs: t=96.9 bp=112/70 hr=75 rr=24 02=94% (5l 50% mask) gen: middle aged woman, lying in bed, jaundiced, nad heent: perrl ou, eomi bilaterally, icteric sclera, op clear, dry mm lymph: minimal submandibular lad, no other lad skin: + jaundice, + spider angiomas over chest cv: non-displaced pmi, rrr, normal s1s2, no m/r/g resp: no accessory muscle use, minimal rales left middle lung field, poor air exchange, no wheezes/ronchi abd: normo active bs, non-tender, markedly distended, no masses, dull to percussion laterally, could not assess shifting dullness, no organomegaly appreciated ext: 2+ edema to knees bilaterally, no cyanosis or clubbing pulses: 2+ dp/pt pulses bilaterally neuro: cn ii-xii intact bilat; sensation and motor exams intact bilaterally pertinent results: 10:44pm alt(sgpt)-22 ast(sgot)-127* ld(ldh)-249 alk phos-82 amylase-65 tot bili-17.3* 10:44pm lipase-19 10:44pm albumin-1.4* calcium-6.4* phosphate-3.8 magnesium-1.8 10:44pm wbc-19.9* rbc-3.29* hgb-10.2* hct-29.8* mcv-91 mch-30.9 mchc-34.1 rdw-16.5* 10:44pm glucose-146* urea n-29* creat-1.8* sodium-134 potassium-4.4 chloride-108 total co2-17* anion gap-13 10:44pm pt-20.3* ptt-45.9* inr(pt)-2.7 brief hospital course: micu course: at osh ed p 114, bp 88/49pt had massive hemoptysis, intubated for airway protection (abg 7.43/26/81). they thought that earlier banding 2-3 weeks ago may have dislodged. pt tx w/endoscopy, hypertonic saline inj. tx w/ 4u prbcs, hct 24-23! given more units prbcs, hct 31 prior to transfer, inr 1.9, alb 2.0, tbili 23.6, dbili 15.4. tx w/vanco x1, zosyn x1. ems: ? given vit k 10mg im in ems, dopa gtt transiently then d/c'ed, fent iv, ativan iv, ns 1000cc. # ugib -ddx: esophageal varices (given acute blood loss, recent hx w/banding, egd at osh), pud, - tear -npo, ivf, iv ppi , octreotide gtt (50mcg) -ogt grossly + for blood clots and some brb, not clearing w/almost 1l ns; maintain low intermittent suction -t&s sent off, xfusing 4u prbcs o/n (hct drop 29 to 26 while here), check hcts q 4 hrs; stable x 24 hrs, check q 8 hrs; goal hct <28 -ffp 4u/vit k to reverse inr of 2.7 -gi fellow did endoscopy o/n, s/p banding of 3 varices; follow closely for evidence of further gib -octreotide gtt continue -: start propranolol for variceal bleeding prophylaxis # liver disease -most likely cirrhosis (class c), although no biopsy proven dx; ruq u/s w/dopplers w/patent pv, ascites, retrograde r sided flow, anterograde l sided flow -follow lfts, coags, plts, alb, bili: alb still low, tbili rising to 23 -prophylactic sbp tx w/ ctx x 5 days () -diagnostic tap in am . removed 4.5 liters of fluid which showed 30 wbc, 95 rbcs with 11poly,32lymphs,25monos,29macs, and total protein less than 0.3 and albumin less than 1. -encephalopathy: ativan w/caution (liver metabolized, but type i/ii metabolism) -adding lasix 40/aldactone 100, ? lactulose # hemodynamics -bp 90/50s, dropping to mid-80s requiring ns boluses to maintain maps; xfuse as necessary, ivf ns -uop better after bladder pressure to 18 post paracentesis; hold on ivf maintenance, bolus as needed only #leukocytosis -wbc 19, no fever but ? thick secretions per ett; check u/a+cx, sputum gs/cx; blood cx if spikes; already s/p zosyn/vanco at osh so decreased yield of micro data -diagnostic paracentesis in am as above in #1; on sbp tx w/ctx (although tap neg, but abx given prior to at osh) #arf -unclear baseline, cr 1.8, improving to 1.2. likely increased bladder pressure from tense ascities. -most likely prerenal in setting of hypovolemia, may be related to liver disease -follow closely, check urine lytes, cr, fena, urine eos w/recent abx use. #resp failure -intubated for airway protection, has mild met acid/resp alka; extubated -sedation: ativan iv prn #acid-base -likely type i rta by +urine ag, lowish k and non ag met acid #le edema - bilat lenis negative #access 3 pivs (18g) in place, consider cordis for better access #fen -now extubated, taking po via dop off tube. # prophylaxis -pneumoboots, ppi medical course: once the patient was transferred to the floor, she remained stable without further bleeding. her hematocrit stabilized at 36-39. she continued to be followed by the liver team (dr. while on the floor. she remained on tube feeds through her dobhoff tube. the patient was still full code when she was transferred from the icu, but after discussions with the patient, her health care proxy (sister , and the liver team, the patient and her health care proxy made the decision to be dnr/dni. ms. mental status was slightly altered after being transferred; however, this improved with time. it was thought that her altered ms could have been related to the ativan she received in the icu vs. hepatic encephalopathy. the ativan was held and she was given lactulose for ?encephalopathy. her wbc count remained elevated after being transferred as well. however, she remained afebrile, and paracentesis in icu was negative for sbp, and she remained ceftriaxone for empiric treatment. her cxr showed possibilty of lul pneumonia. in the setting of recently being on ventilator, her coverage was broadened to include clindamycin. her wbc count remained stable and decreased slightly to 23. after being transferred to the floor, the patient did not have adequate access. a femoral line was placed for the evening, until a picc line could be placed the following day. the femoral line was pulled out after about 24 hours. the patient's creatinine increased (0.9-->1.4-->1.6) while on the floor. this was likely secondary to prerenal arf because of patient's third spacing. she was given ivf hydration. on , the patient pulled out her dobhoff tube, foley, and rectal tube. on that day (), the patient (with her health care proxy, and family) decided that she did not want to follow with any more treatment. she decided that she just wanted to go home and be in peace, with hospice care. her sister made arrangements for her to leave the following day. the patient was to go home and live with her sister on , and hospice care would visit her there. on , the patient and her health care proxy (sister reiterated that she did not want to stay in the hospital, and did not want any further treatment aside from hospice care at home. the patient's mental status was clear, and she stated that she understood the consequences of her decision, even the possiblility of more bleeding, coma, and even death. dr. (liver team) also saw ms. before discharge. he expressed his concern that she may be making the decision quickly and suggested that she stay until the following day (monday) so that she could have a family meeting along with the social worker and a psychiatrist. he suggested that this may allow her and her family to ensure that they were making a sound decision. the patient refused this suggestion and said that all she wanted to do was go home. she stated that she has seen many of her friends die in the past, and she did not want to struggle like they had. she reiterated the fact that she understood the possible consequences of her decision: that with treatment she may have a chance of surviving, and without treatment, she has a high likelihood of not surviving. the patient was discharged home with hospice care and given medications for palliative treatment. medications on admission: minocycline prn discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. disp:*30 tablet(s)* refills:*0* 2. lorazepam 1 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for agitation. disp:*60 tablet(s)* refills:*0* 3. scopolamine base 1.5 mg patch 72hr sig: one (1) transdermal q72h prn () as needed for secretions. disp:*10 * refills:*0* 4. prochlorperazine 25 mg suppository sig: suppositorys rectal q12h (every 12 hours) as needed for nausea/vomiting. disp:*30 suppository(s)* refills:*0* 5. heparin flush (porcine) in ns 100 unit/ml kit sig: one (1) intravenous once a day: please flush picc line after use. disp:*20 * refills:*2* 6. roxanol 20 mg/ml solution sig: po q2-4h prn as needed for pain. disp:*30 cc* refills:*0* discharge disposition: home with service facility: vna of discharge diagnosis: primary: end stage liver disease secondary: cirrhosis, esophageal varices discharge condition: fair discharge instructions: please use prescribed medications for palliative/comfort care: morphine to control pain; ativan for anxiety; scopolamine for control of secretions; compazine for control of nausea and vomiting. followup instructions: patient will receive care from hospice. 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 percutaneous abdominal drainage arterial catheterization endoscopic excision or destruction of lesion or tissue of esophagus transfusion of packed cells transfusion of other serum diagnoses: pneumonia, organism unspecified acidosis alcoholic cirrhosis of liver acute kidney failure, unspecified acute respiratory failure esophageal varices in diseases classified elsewhere, with bleeding hepatic encephalopathy 

Answer: The patient is high likely exposed to