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: expidited pre-transplant workup for decompensated cirrhosis; maroon blood in colostomy bag major surgical or invasive procedure: right heart catheterization upper endoscopy ileoscopy history of present illness: ms. is a pleasant 44 year old woman with a history of uc s/p total colectomy, psc diagnosed in , cirrhosis diagnosed in , and cml on gleevac (since ) who presents for expidited pre-transplant workup from clinic. the patient states that she first experienced clinical manifestations of her liver disease in following her total colectomy. a biopsy performed at that time revealed cirrhosis with extensive canalicular cholestasis. liver disease was well controlled until after her colectomy in , when her bilirubin began to rise. in the last two months, she has become more symptomatic with jaundice and volume overload. on , the patient was admitted to hospital with worsening ascites, anasarca, and acute kidney injury. following her discharge, she has experienced episodes of severe fatigue and mild dyspnea on exertion. . today, she presented to liver clinic for transplantation evaluation and complained of non-productive cough x 5 days, sob, ongoing fatigue. she has not had any history of prior gi bleed and denies any hematochezia, melena, hematemesis, diarrhea, nausea or vomiting. she was admitted directly from liver clinic for hypotension to the 70s and need for expedited transplant work up. labs on arrival were notable for wbc of 21.6. a small amount of ascites was seen on us, therefore she was sent for ir guided paracentesis, which was unusucessful. vanc/ceftriaxone was started for coverage of sbp and pna given recent respiratory symptoms. she was also given albumin for sbp treatment. while on the floor, maroon stool was noted in her colostomy bag and hematocrit was found to be 17.9, therefore transfusion was started and she was transferred to the icu for urgent egd. pressures on transfer were in the 90s, hr in the 80s. past medical history: -uc s/p total colectomy in -psc diagnosed in -cirrhosis diagnosed in (c/b jaundice and ascites) -cml on gleevac (since ) -foot fracture s/p surgery -deaf in r social history: ms. is independent with her adls. she is a stay at home mom that is fully functioning and active with her two teenage children, a 13 year old son and a 15 year old daughter. she and her husband recently relocated to ri from pa for her husband's job. pt denies any substance use or abuse history, including: smoking, alcohol, marijuana, or any other illicit drugs. ms. has a degree in business from cal state and worked as an account manager for an hmo prior to having children. family history: father (and likely son) - ulcerative colitis; grandmother died of chf; dm ii in all 4 grandparents, mother with htn, mom, brother, daughter with asthma physical exam: on admission: vitals: bp:123/50 p:97 r:22 o2:100% general: alert, oriented, no acute distress, jaundice heent: sclera icteric, mmm, oropharynx clear neck: supple, jvp at angle of jaw, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, mild ttp throughout, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly. stoma without evidence of active bleeding gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: a&ox3, cnii-xii intact, sensation and strength grossly intact in all extremities skin: spider angiomas on chest . on discharge: vs: t:99.1 bp:98/44 p:80 rr:18 o2:100%ra gen: sitting comfortably in bed in nad heent: scleral icterus; mmm, no jvp or lymphadenopathy card: normal s1, s2, no murmurs, rubs or gallops lungs: clear to auscultation bilaterally; no wheezes, rales, or rhonchi abdomen: soft, non-tender, rlq ostomy draining brown stool; no evidence of bleed ext: trace edema to mid-calf; warm, well-perfused; 2+ dp pulses neuro: a&ox3, cnii-xii intact, sensation and strength grossly intact in all extremities skin: jaundiced, with spider angiomas on chest pertinent results: labs on admission: 05:49am blood wbc-4.3 rbc-3.05* hgb-9.9* hct-26.8* mcv-88 mch-32.5* mchc-36.9* rdw-18.2* plt ct-82* 05:49am blood pt-17.9* ptt-34.2 inr(pt)-1.6* 05:49am blood glucose-84 urean-31* creat-1.4* na-133 k-3.7 cl-105 hco3-16* angap-16 05:49am blood alt-94* ast-132* ld(ldh)-287* alkphos-115* totbili-33.1* 05:49am blood albumin-2.7* calcium-8.0* phos-3.3 mg-1.8 . other pertinent labs: 03:15pm blood ama-negative 03:15pm blood -negative 03:15pm blood igg-592* iga-69* igm-less than 10:12pm blood lactate-1.2 09:38am blood fibrino-305 03:29pm blood pep-no specifi . discharge labs: 05:20am blood wbc-1.4* rbc-2.59* hgb-8.1* hct-23.9* mcv-92 mch-31.4 mchc-34.0 rdw-18.2* plt ct-41* 05:20am blood glucose-97 urean-31* creat-1.4* na-139 k-3.5 cl-110* hco3-18* angap-15 05:20am blood alt-60* ast-87* alkphos-73 totbili-32.5* 05:20am blood albumin-3.8 calcium-8.9 phos-3.2 mg-2.0 . micro: : stool culture: no salmonella, shigella, campylobacter found. : urine cultures negative : blood cultures: strep viridans positive in bottles : feces negative for c.difficile toxin a & b by eia. : blood culture x 2 negative . imaging: . liver or gallbladder us (singl; duplex dopp abd/pel 1. patent hepatic vasculature. 2. small scarred and distorted liver, which makes it difficult to assess for small focal lesions. consider alternative forms of imaging such as ct or mri to further characterize the hepatic architecture. 3. scant trace of ascites, however, the amount is insufficient to safely tap. 4. splenomegaly. 5. small gallbladder polyp. . cxr : impression: mild-to-moderate pulmonary edema, likely of noncardiogenic origin given the lack of cardiomegaly. no evidence of pneumonia. . echo : the left atrium and right atrium are normal in cavity size. left ventricular wall thicknesses and cavity size are normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: hyperdynamic biventricular systolic function. no significant valvular abnormality seen. mildly elevated pulmonary artery pressures that likely reflect increased flow rather than intrinsic lung disease. . mrcp : 1. markedly cirrhotic / fibrotic liver with segmental atrophy of the entire left lobe and segment viii of the liver. no suspicious focal liver lesion identifed. there is peripheral segmental intra-hepatic biliary dilatation in keeping with primary sclerosing cholangitis. 2. while the middle and left hepatic vein are diminutive owing to the extensive fibrosis centrally and within the left lobe of the liver, all the visualised hepatic and portal veins are patent. note is made of the left hepatic artery arising from the left gastric artery, with conventional origin of the right hepatic artery. 3. sequela of portal hypertension including splenomegaly, para-esophageal and left upper quadrant varices, recanalisation of the para-umbilical vein, and trace of perihepatic ascites. . ruq ultrasound : 1. loculated ascites in the right lower quadrant. 2. multiple vessels in this region noted some of which may represent varices. . pulmonary function tests : spirometry 7:47 am pre drug post drug actual pred %pred actual %pred %chg fvc 2.60 3.23 81 fev1 1.95 2.48 78 mmf 1.48 2.95 50 fev1/fvc 75 77 97 . lung volumes 7:47 am pre drug post drug actual pred %pred actual %pred tlc 4.48 4.76 94 frc 2.59 2.54 102 rv 1.62 1.54 106 vc 2.90 3.23 90 ic 1.89 2.23 85 erv 0.96 1.00 96 rv/tlc 36 32 113 he mix time 0.00 . dlco 7:47 am actual pred %pred dsb 15.18 20.18 75 va(sb) 4.09 4.76 86 hb 8.20 dsb(hb) 19.15 20.18 95 dl/va 4.68 4.24 110 . right heart cardiac catheterization : 1. resting hemodynamics revealed elevated right side and left sided filling pressures with an rvedp 17 mm hg and mean pcw 23 mm hg. cardiac output was elevated with an index of 5.30 l/min/m2. mild pulmonary hypertension with a pasp 42mm hg and mean pa pressure of 30 mm hg. final diagnosis: 1. mild pulmonary hypertension. 2. elevated pulmonary wedge pressure. . bilateral screening mammogram : no evidence for malignancy. annual mammogram is recommended. results discussed with the patient . teeth panorex : lower right 2nd molar s/p root canal with continued surrounding radiolucency. likely normal post-root canal changes; however, must correlate clinically. brief hospital course: ms. is a pleasant 44 yo f with hx uc s/p colectomy, and cirrhosis psc, admitted from liver clinic due to recent decompensation and need for expedited transplant workup; admission complicated by bleed and leukocytosis. . #. gib: on admission, the patient was found to be hypotensive to sbp in the 70's with a hematocrit of 17.9. she was found to have maroon stool in colostomy bag. she was transferred to the icu out of concern for variceal bleed given history of liver disease. egd/ileostomy in the icu were remarkable for absence of varices and a non-bleeding ulcer at the ge junction with old blood in the stomach. she did have significant peristomal bleeding in the icu, which was thought to be the primary source of the bleed. she underwent ultrasound that showed peristomal varices. she was transfused a total of 6 units of prbcs, 2 units of ffp. she was started on a ppi and octreotide for ge junction ulcer and peristomal varices. peristomal bleeding was stopped by transplant surgery with surgicel. with stabilization of her hematocrit, the patient was transferred back to the medical floor. she continued to have minor oozing from around her stoma without hemodynamic significance. per transplant surgery recommendations, the patient was discharged with silver nitrate for peristomal bleeding. she was also discharged on a ppi for ulcer prophylaxis. . #. leukocytosis: on admission, the patient was found to have a leukocytosis to 21 in the setting of hypotension to the 70's. leukocytosis was initially concerning for sbp given ascitic fluid, however she was unable to undergo paracentesis under ir due to scant amount of fluid present. chest x-ray was normal and urine cultures showed no growth. stool cultures were negative. the patient was started on ceftriaxone, vancomycin, and albumin for presumed sbp. on day 2 of hospitalization, blood cultures grew strep viridans so ceftriaxone was continued. her wbc count returned to . the patient then became leukopenic, likely secondary to gleevac. she was discharged on ciprofloxacin daily prophylaxis for sbp. . #. hypotension: the patient was admitted with hypotension to the 70's, most likely due to gib. hypotension improved following a total of 6 units prbcs and stabilization of bleed. the patient did not spike fevers or have a localizing source of infection on admission to support sepsis as a cause of hypotension. pressures improved to the 90s-100s, and remained stable for the remainder of admission. . # cirrhosis psc: complicated by jaundice, ascites, and possible hepatic encephalopathy. recent decompensation without clear etiology. patient admitted for expedited transplant workup which included mrcp, pfts, echo, cxr, screening mammogram, pap smear, right heart catheterization, and panorex (given history of strep viridans). the patient also underwent all routine pre-transplant laboratory testing. hematology was consulted for recommendations on management of cml in a transplant patient. they continued the patient on gleevac, and commented that cml with gleevac use should have no effect on peri-transplant management or post-transplant prognosis. the patient will follow up with her transplant hepatologist as an outpatient. she will need a bone mineral density test as an outpatient. . # : the patient was admitted with a creatinine of 1.4 (baseline 0.6-0.8 last month). urine electrolytes consistent with prerenal azotemia. the patient was repleted with both crystalloid and colloid for volume resuscitation. creatinine did not improve at discharge. . # metabolic acidosis: the patient was admitted with both an anion gap and non-gap metabolic acidosis. anion gap metabolic acidosis likely due to renal failure. etiology of non-gap acidosis unclear, as patient was without diarrhea, evidence of fistula or medication which could be contributing. concern for renal tubular acidosis. acidosis improved during the admission with iv fluids. . # hyponatremia: the patient was admitted with hyponatremia to 117. hyponatremia likely hypovolemic, as it normalized with fluid resuscitation. . # ulcerative colitis s/p total colectomy with end ileostomy: chronic. patient without further gi symptoms following total colectomy. routine ostomy care was maintained throughout admission. . # cml: diagnosed in . patient stable on gleevac which was continued in house at the recommendation of the hematology service. during admission, gleevac was decreased to 200 mg daily, as the patient became increasingly pancytopenic (wbc count nadir 1.4, baseline 3.0). as part of the patient's pretransplant workup, the hematology/oncology team noted that cml with gleevac use should have no effect on peri-transplant management or post-transplant prognosis. . # code: full code medications on admission: lactulose 1tbsp potassium 1tbsp daily urosiol 250 mg gleevac 400 mg discharge medications: 1. lactulose 10 gram/15 ml syrup sig: fifteen (15) ml po tid (3 times a day). 2. ursodiol 250 mg tablet sig: one (1) tablet po tid (3 times a day). 3. silver nitrate applicators misc sig: miscs topical prn (as needed) as needed for stomal bleeding. disp:*30 sticks* refills:*0* 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 5. ciprofloxacin 250 mg tablet sig: one (1) tablet po q24h (every 24 hours). disp:*30 tablet(s)* refills:*2* 6. imatinib 400 mg tablet sig: 0.5 tablet po daily (daily). disp:*15 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary diagnoses: psc cirrhosis (decompensated with jaundice, ascites); peri-stomal variceal bleed secondary diagnoses: spontaneous bacterial peritonitis, chronic myeloid leukemia, ulcerative colitis s/p total colectomy discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to for an expedited pre-transplant workup. on admission, you were found to have an elevated white blood cell count and a very low red blood cell count (anemia). . for your anemia, you were transferred to the icu, where you underwent upper endoscopy and ileoscopy. you were found to have old blood in your stomach, but no evidence of active bleed. you were found to have significant bleeding from around your stoma. the bleeding was stopped by our surgical colleagues with surgicel and you were transfused 6 units of packed red blood cells. you underwent ultrasound that showed varices around your stoma. you were treated with a medication called octreotide to decrease the pressure in your varices. . because of your elevated white blood cell count, we were concerned that you had infection of your ascites. you went to interventional radiology, but did not have enough ascites in your abdomen to adequately sample. you were treated with antibiotics for presumed "spontaneous bacterial peritonitis", or infection of ascites. you underwent blood cultures that were positive for a bacterium - streptococcus viridans. you did not have any fevers throughout admission. with antibiotics, your white blood cell count improved. upon discharge, you will start ciprofloxacin 250 mg daily to prevent against future episodes of spontaneous bacterial peritonitis. . you were followed by oncology for your cml throughout your admission. they feel that your cml and use of gleevac will not be affected by a liver transplant in the future. all of your blood cell counts decreased during admission, likely due to use of gleevac. on discharge, you should decrease your gleevac dose to 200 mg daily. . while in the hospital, you underwent a near-complete pretransplant workup. you underwent ekg, chest x-ray, mrcp, pulmonary function tests, pap smear, mammogram, right heart catheterization, and dental panorex. you had many screening labs for infectious and immunologic processes. at this point, none of your tests preclude you from transplant. . medications changed this admission: decrease gleevac to 200 mg daily start ciprofloxacin 250 mg daily for spontaneous bacterial peritonitis prophylaxis start protonix 40 mg daily for gi bleeding prophylaxis apply silver nitrate around ostomy as needed for bleed hold potassium until you have undergone follow up lab testing with your pcp followup instructions: name: , specialty: family medicine location: primary care of address: , unit#a1 , phone: **we are working on a follow up appointment with dr. within 1 week. you will be called at home with the appointment. if you have not heard from the office within 2 days or have any questions, please call the number above. ** . department: transplant when: wednesday at 9:20 am with: transplant clinic building: lm campus: west best parking: garage procedure: other endoscopy of small intestine right heart cardiac catheterization endoscopy of small intestine through artificial stoma diagnoses: acidosis other iatrogenic hypotension acute posthemorrhagic anemia hyposmolality and/or hyponatremia portal hypertension other chronic pulmonary heart diseases diaphragmatic hernia without mention of obstruction or gangrene surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation unspecified hearing loss other specified disorders of biliary tract other ascites awaiting organ transplant status hemorrhage of gastrointestinal tract, unspecified varices of other sites precipitous drop in hematocrit mechanical complication of colostomy and enterostomy personal history of antineoplastic chemotherapy leukocytosis, unspecified biliary cirrhosis spontaneous bacterial peritonitis esophageal varices without mention of bleeding attention to colostomy other fluid overload fever presenting with conditions classified elsewhere acute kidney failure with other specified pathological lesion in kidney gastrojejunal ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction universal ulcerative (chronic) colitis other pancytopenia chronic myeloid leukemia, in remission 

Answer: The patient is high likely exposed to