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: penicillins / codeine / rifaximin attending: chief complaint: melena and coffee ground emesis. major surgical or invasive procedure: revision of tips embolization of duodenal varix egd intubated bronchoscopy history of present illness: 46 year old female with a history of alcohol and hcv cirrhosis, esophageal and duodenal varices, multiple gi bleeds, status post tips. recently admitted on with hematemesis and melena. per report, on day of admission , the patient had originally experienced episodes of vomiting "coffee ground" material, which was preceded by abdominal pain. when found by ems, she was in bed dry heaving, having dark color diarrhea, and only oriented to name. in ed, she was intubated for airway protection and transferred to the icu. she underwent egd, which revealed a large duodenal varix as culprit, that was unable to be banded or injected. she then underwent embolization, followed by tips revision. her hct was stable afterwards. she was also noted to be difficult to wean off the ventilator, and was noted on bronchoscopy to have a pneumonia that was likely secondary to aspiration. she was treated for 7 days with vancomycin and aztreonam. when she was transfered to cc-7 from the micu on she was being actively diuresed. past medical history: *cirrhosis -heavy etoh abuse, +hcv (viral load undetectable), c/b coagulopathy/thrombocytopenia, elevated portal pressures with varices and portal gastropathy s/p tips * early celiac sprue dx on bx egd however not on diet since has no symptoms according to patient *chronic le neuropathy *diastolic chf a. last echo in , pasp 28, ef >55% b. ett/mibi: , no ischemic regions *anemia: baseline hct ~30, chronic blood loss, ?sprue *asthma *depression *osteopenia *hypothyroidism *s/p ccy for cholelithiasis *tah for endometrial hyperplasia *mild copd *gerd social history: lives with husband and 29 year old son. heavy etoh abuse in the past, but last drink occurred on , per patient. history of positive screens in past. stopped tobacco on "day of admission ()", per patient. 1 ppd x 30 years. no ivdu. family history: father died of mi in 80's. many alcoholics in family. one cousin with celiac sprue. physical exam: physical exam (on admission to medical floor ). . vitals: t:98.6, bp:102/60, hr:73, rr:20, rr:93% room air general: no acute distress. patient examined and laying comfortably in bed. denies fever, chest pain, abdominal pain, nausea, and vomiting. heent: mild scleral icterus. no phrenular icterus. poor dentition. moist mucous membranes. neck: supple. no cervical adenopathy. lungs: clear to auscultation, bilaterally. slightly decreased breath sounds in lower lung fields. cardiac: regular rate and rhythm. normal s1 and s2. no murmurs, rubs, or gallops. abd: surgical scar. soft. active bowel sounds throughout. nontender and nondistended. ext: minimal dorsal feet edema. nonpitting. 2+ bilateral dp and radial pulses, bilaterally. skin: multiple telangiectasias on chest. no palmar erythema. ecchymosis on left wrist. neuro: alert and oriented to person, place, and date. mildly confused during questioning, but could relate current president. asterixis. pertinent results: 04:48pm blood wbc-7.6 rbc-2.89* hgb-9.2* hct-26.6* mcv-92 mch-31.9 mchc-34.7 rdw-17.7* plt ct-95* 03:52am blood wbc-4.7 rbc-3.10* hgb-9.8* hct-28.7* mcv-93 mch-31.7 mchc-34.2 rdw-17.3* plt ct-54* 04:27am blood wbc-8.7 rbc-3.29* hgb-10.3* hct-29.2* mcv-89 mch-31.2 mchc-35.2* rdw-16.2* plt ct-56* 02:54am blood wbc-10.5 rbc-2.72* hgb-8.7* hct-24.5* mcv-90 mch-32.1* mchc-35.6* rdw-15.7* plt ct-89*# 09:22pm blood wbc-17.5*# rbc-2.70* hgb-8.5* hct-24.1* mcv-89 mch-31.3 mchc-35.1* rdw-16.5* plt ct-216# 09:00pm blood wbc-15.8*# rbc-2.45*# hgb-7.7* hct-21.8*# mcv-89 mch-31.2 mchc-35.1* rdw-16.4* plt ct-196# 04:48pm blood plt ct-95* 04:48pm blood pt-17.6* ptt-32.9 inr(pt)-1.6* 09:00pm blood pt-22.9* ptt-44.5* inr(pt)-2.3* 11:48am blood fibrino-277 02:54am blood fibrino-188 04:48pm blood glucose-88 urean-11 creat-0.7 na-142 k-4.2 cl-109* hco3-24 angap-13 09:00pm blood glucose-261* urean-77* creat-1.2* na-138 k-4.1 cl-92* hco3-24 angap-26* 04:52am blood alt-23 ast-37 ld(ldh)-179 alkphos-56 amylase-9 totbili-3.4* 09:00pm blood alt-24 ast-69* ck(cpk)-52 alkphos-78 amylase-20 totbili-3.9* 04:52am blood lipase-15 04:48pm blood calcium-8.4 phos-2.2* mg-1.9 09:00pm blood albumin-3.6 calcium-8.9 phos-5.5*# mg-1.5* 05:49am blood cortsol-5.3 11:39am blood cortsol-0.9* 01:09pm blood type-art po2-93 pco2-40 ph-7.50* caltco2-32* base xs-6 09:43am blood type-art temp-37.3 rates-/16 tidal v-890 fio2-50 po2-81* pco2-45 ph-7.43 caltco2-31* base xs-4 intubat-intubated vent-spontaneou 09:44pm blood glucose-267* lactate-8.3* 03:18am blood lactate-2.5* . urine culture: no growth. negative for legionella. blood cultures: no growth. sputum: pending. . 08:40pm urine color-yellow appear-clear sp -1.022 08:40pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.0 leuks-tr . studies: endoscopy : varices at the lower third of the esophagus. congestion and erythema in the antrum; stomach body and fundus compatible with gastroapathy. erythema and friability in the first part of the duodenum compatible with duodenitis. varices at the second part of the duodenum. . head ct : no evidence of acute intracranial process. widespread sinus opacification. however, this could be seen in intubation. subcutaneous left parietal nodule, unchanged. it measures 13 mm in diameter and may represent a sebaceous cyst. . bronchoscopy : indication: respiratory failure with left-sided atelectasis,hypoxemia, lack of chest rise on the left. noted: the airways were examined to the subsegmental level bilaterally and there were no endobronchial lesions seen. the right side was within normal limits, however, the left side was completely obstructed by tenacious and copious thick secretions which were therapeutically aspirated. subsequent to the bronchoscopy, the airways on the left side were patent and the patient had good chest rise on the left. brief hospital course: a/p: 46 year old female with alcohol and questionable hcv cirrhosis and portal hypertension, admitted for variceal bleed and status post tips revision and varix embolization. stable hematocrit over the past several days. . 1) gi bleed: -emergent egd on revealed grade 1 varices in distal of esophagus that were not bleeding; portal gastropathy was noted. the protruding second part of the duodenum showed stigmata of recent bleed. the varix was smaller than on prior egd, consistent with recent embolization. no bleeding was visualized so no intervention was performed. despite no evidence of bleed, hematocrit fell from 31 on to 21 on . patient was continued on octreotide gtt and protonix gtt; she also received 6 units packed rbcs and 6 units ffp. - on the patient's pre-tips gradient was 13mmhg and post-tips gradient was 9mmhg. on patient underwent tips revision and repeat embolization. if patient rebleeds, then injection of glue (experimental) will be considered. once transferred from the micu, she continued proton pump inhibitor, . her hematocrit stayed stable in high 20's (nadir was 20-21 during acute gi bleed). . 2) end stage liver disease: -etiology likely from alcoholic or hcv cirrhosis. patient was followed by gi and liver teams throughout her hospital stay. she received lactulose, rifamixin and spironolactone during hospital stay; she was discharged on these medications. the patient has no history of sbp, so prophylaxis was not restarted. she was maintained on low dose nadolol 10mg. she will follow up with dr. on . . 3) hypokalemia: transferred from icu and noted to have hypokalemia, probably secondary to diuresis. lasix and sliding scale insulin were discontinued, but she remained on spironolactone. by the time of discharge, her potassium was in the range of 3.5-4.0. she was not discharged with any potassium supplementation due to concern for hyperkalemia on spironolactone. patient was instructed to return to for follow up electrolyte blood work on at dr. office. . 4) hypoxemia: -bronchoscopy revealed and therapeutically aspirated left mainstem mucous plugs, presumed to be the result of pneumonia secondary to aspiration. patient was treated with 7 day course of vancomycin and aztreonam. patient was slowly weaned off the ventilator on . a series of cxrs showed mild interstitial edema, moderate right and small left pleural effusion which worsened minimally and a left lower lobe atelectasis that improved. patient had persistent pleural effusions but was aggressively diuresed. on discharge, she did not require supplemental oxygenation to maintain an oxygen saturation in the mid 90's. . 5) hypotension: -while in the icu the patient's sbp fell to 80-90's on , so she received 3l ivf. there was initial concern for sepsis, so patient was started on a seven day-course vancomycin, aztreonam and flagyl for presumed aspiration pneumonia (stopped on ). there was also concern about adrenal insufficiency (see below). patient initially required levophed for pressure support, but was weaned off pressors, as she was stable following blood product and ivf bolus infusions. on she was started on nadolol 10mg for her portal hypertension, had some spb's in high 80's/low 90's. orthostatics were normal. was discharged with week's worth of nadolol with instructions to follow up with dr. on . . 6) adrenal insufficiency: -patient had a cortisol 0.9 on admission to the icu, but increased to 6 with acth. this prompted a questioned underlying adrenal insufficiency given her low level on admission and patient received a week's course of hydrocortisone 50mg (finished ). repeat cortisol level on was 10.3. patient should have a repeat cortisol stimulation test at pcp visit on to assess adrenal function in non-stress situation and after a period since finishing steroid course. . 7) neuropathy: -gabapentin was initially held due to concern for renal clearance but was restarted once the patient left the icu. . 8) hypothyroidism: -patient continued with her levothyroxine treatment throughout her hospital course. . 9) fen: -due to concern for her volume overload and early celiac disease, patient was discharged with instructions to follow low-salt and gluten free diet. medications on admission: medications at last discharge (): 1. gabapentin 300 mg capsule sig: three (3) capsule po tid (3 times a day). 2. levothyroxine 25 mcg tablet sig: two (2) tablet po daily (daily). 3. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime). 4. nadolol 20 mg tablet sig: one (1) tablet po daily (daily). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). 6. levofloxacin 500 mg tablet sig: one (1) tablet po q24h (every 24 hours). discharge medications: 1. albuterol 90 mcg/actuation aerosol sig: six (6) puff inhalation q4h (every 4 hours) as needed. 2. spironolactone 100 mg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*2* 3. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). :*180 tablet(s)* refills:*2* 4. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). :*30 tablet(s)* refills:*2* 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). :*60 tablet, delayed release (e.c.)(s)* refills:*2* 6. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. :*30 tablet(s)* refills:*0* 7. nicotine 21 mg/24 hr patch 24hr sig: one (1) patch 24hr transdermal daily (daily). :*30 patch 24hr(s)* refills:*2* 8. gabapentin 300 mg tablet sig: three (3) capsule po tid (3 times a day). :*270 capsule(s)* refills:*2* 9. lactulose 10 g/15 ml syrup sig: thirty (30) ml po tid (3 times a day): hold if having three regular bowel movements each day. :*2700 ml(s)* refills:*2* 10. nadolol 20 mg tablet sig: 0.5 tablet po daily (daily). :*14 tablet(s)* refills:*0* 11. outpatient lab work please have blood work drawn on monday, . have basic metabolic panel drawn. please fax results to dr. office. thank you. discharge disposition: home discharge diagnosis: primary: duodenal varix bleed alcohol induced cirrhosis delirium aspiration pneumonia . secondary: adrenal insufficiency? hypothyroidism neuropathy diastolic chf asthma depression osteopenia early celiac disease discharge condition: stable discharge instructions: **you have been admitted for a gi bleed. you were treated and the bleed was stabilized. while in the icu, you developed an aspiration pneumonia, so you received antibiotics. your cirrhosis also was treated. **when you go home, you need to take all medications that are prescribed. you should remain on a gluten-free and sodium free diet, as recommended by gi. **you have an outpatient appointment with dr. and dr. resident, , on friday, at 1pm and 2:30pm. **if you develop any light headedness, dizziness, difficulty concentrating, vomiting, bleeding from your rectum, or any other concerning symptoms, please call your doctor immediately or go to the nearest ed. ** you have been provided a "prescription" to have your blood drawn on monday at the building. the results will be sent to dr. office. ** in addition, you will need to contact the patient assistance program () in the next to weeks to try and have the rifaximin prescription subsidized. followup instructions: you are scheduled for an appointment with dr. at 1:00 pm on friday, . , . you have an appointment with dr. office at 2:30pm on friday . ** you will have blood work drawn on monday, . procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine insertion of endotracheal tube enteral infusion of concentrated nutritional substances angioplasty of other non-coronary vessel(s) closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus insertion of non-drug-eluting peripheral (non-coronary) vessel stent(s) transcatheter embolization for gastric or duodenal bleeding transfusion of packed cells other irrigation of (naso-)gastric tube transfusion of other serum phlebography of the portal venous system using contrast material infusion of vasopressor agent cranial or peripheral nerve graft insertion of one vascular stent procedure on single vessel diagnoses: acute posthemorrhagic anemia acute and subacute necrosis of liver alcoholic cirrhosis of liver acquired coagulation factor deficiency unspecified septicemia severe sepsis other and unspecified alcohol dependence, in remission portal hypertension unspecified acquired hypothyroidism chronic airway obstruction, not elsewhere classified hypopotassemia acute respiratory failure pneumonitis due to inhalation of food or vomitus other shock without mention of trauma blood in stool celiac disease hematemesis varices of other sites unspecified hereditary and idiopathic peripheral neuropathy diastolic heart failure, unspecified foreign body in main bronchus inhalation and ingestion of other object causing obstruction of respiratory tract or suffocation unspecified viral hepatitis c with hepatic coma 

Answer: The patient is high likely exposed to