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: unresponsiveness major surgical or invasive procedure: admission to medical icu history of present illness: pcp: , . . initial history obtained from records and telephone conversation with ex-husband . hpi: the patient is a 60 year old woman with history of hepc cirrhosis, hcc on liver list who was found unresponsive at home earlier today by her home health aide and eventually referred to . her ex-husband last saw the patient on day when she joined them for dinner. per his report, she seemed shaky but otherwise near her baseline. saturday he called the patient and she was slurring her words notably and sleepy sounding. she stated to him sshe had been taking her medication including "something for sleep." he stated that he had concerns for oxycontin use although he was unsure she had any available because he had thought that she had a recent prescription. he called monday and had no answer via telephone. she was initially brought to an osh where vitals were normal. she was described as aox2. she had basic chemistries which were notable for na of 131, cr1.3, tbili 4.2, ammonia 79, serum tox negative. empiric narcan was given without significant effect. a head ct was unremarkable. she received haldol 5mg iv x2, ativan 1mg iv x1 for agitation. she received 1 liter of ns. she was transfered for further evaluation. . of note, she was admitted for abdominal distention and pain at which time paracentesis was performed with was negative for sbp. mri during that admission showed 2 enhancing lesions in the right lobe of the liver that are concerning for hepatocellular carcinoma, especially in view of an increased afp to >140 from her baseline of 50-70. she was considered for biopsy early in the new year. . upon arrival in the ed, her vital signs were 98.9 80 130/72 18 99%ra. a cxr was done. ngt was placed. u/s abd showed only small amount of ascites to no paracentesis was attempted. she received levofloxacin for a ua that was concerning for infection. . ros: unobtainable past medical history: . past medical history: # hcv cirrhosis: s/p multiple treatment regimens, estimated has had hep c for ~30 years, acquired during iv drug use. last vl >580k (, genotype 1) - grade 2 esophageal varicies + portal hypertensive gastropathy () - ascites - hepatic encephalopathy - afp 140, hepatic lesions concerning for hepatoma # psoriasis # s/p tah for uterine ca # diverticulosis social history: quit smoking 8 years ago (40 pack year history). former ivdu at age 27. no etoh. used occasional amphetamines from - while she was in a graduate program for literature at the mfa. lives alone. she lives in assisted housing currently in , ma. divorced in 3 yrs ago, separated 4 years. 10 years married. had one son from a prior relationship. family history: mother and sister died of uterine ca. father with tuberculosis and lung disease died in 60s of etohism and lung disease. physical exam: vs: temp: 97.9 bp: 135/78 hr: 118 rr: 13 o2sat 100%ra gen: cachetic caucasian moaning in bed. heent: perrl (4->2mm bilat), eomi, anicteric, dry mm, neck: supple. no supraclavicular or cervical lymphadenopathy, no jvd, resp: cta b/l with good air movement throughout cv: regular tachy, s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e, warm, good pulses skin: no rashes neuro: arouses to noxious stimuli and voice. not following commands. moving 4 extremities spontenously and purposelessly. cn: pupils equal and reactive. eomi. face symmetric. jaw strength normal. head turn strong. motor: normal tone. decrease bulk throughout 5/5 strength throughout. no sensory deficits to light touch appreciated. pertinent results: laboratory studies: urine tox screen neg (amph/barb/benzo/canna/cocaine/opiates) ua 1.019 neg gluc/ket/blood. trace leuk . ekg: noisy baseline secondary to motion artifact. sinus @ ~120. normal intervals. . imaging: osh ct head ()- motion artifact. no gross pathology . cxr: the cardiomediastinal silhouette and hilar contours are normal. the lungs are clear with no pleural effusion, pneumothorax or focal consolidation. the osseous structures of the thorax appear normal. cytology: negative for malignant cels renal u/s: no hydro, masses, stones echocardiogram the left atrium is elongated. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 70%) there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. mild to moderate (+) mitral regurgitation is seen. moderate tricuspid regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. compared with the findings of the prior study (images reviewed) of , mitral and tricuspid regurgitation are now present; mild pulmonary hypertension also present. abd u/s - 1. cirrhotic liver with unchanged massive ascites and gallbladder wall thickening. 2. unchanged 2-cm lesion within the right lobe. 3. patent portal vein, hepatic veins, and hepatic artery. u/s son imaging of the abdomen reveals a large amount of peritoneal ascites. a suitable skin site was selected and marked on the skin in the right lower quadrant for paracentesis to be performed by the medicine service. hematology 07:07pm blood wbc-7.2 rbc-3.19* hgb-11.5* hct-32.1* mcv-101* mch-36.1* mchc-35.9* rdw-14.4 plt ct-120* 06:00am blood wbc-4.9 rbc-2.01* hgb-7.3* hct-20.7* mcv-103* mch-36.3* mchc-35.2* rdw-16.9* plt ct-69* 04:36am blood wbc-6.4 rbc-2.83*# hgb-10.0*# hct-29.2*# mcv-103* mch-35.4* mchc-34.3 rdw-19.0* plt ct-87* 02:48am blood wbc-5.5 rbc-2.59* hgb-8.9* hct-25.4* mcv-98 mch-34.4* mchc-35.2* rdw-18.1* plt ct-67* 05:50am blood wbc-4.2 rbc-2.54* hgb-8.7* hct-25.1* mcv-99* mch-34.2* mchc-34.6 rdw-19.2* plt ct-101* 05:30am blood wbc-4.3 rbc-2.53* hgb-8.3* hct-24.7* mcv-98 mch-32.8* mchc-33.7 rdw-19.0* plt ct-104* 05:35am blood wbc-4.5 rbc-2.47* hgb-8.2* hct-24.3* mcv-98 mch-33.1* mchc-33.7 rdw-19.2* plt ct-106* coagulation 05:35am blood pt-24.8* ptt-52.4* inr(pt)-2.4* chemistry 07:07pm blood glucose-102 urean-34* creat-1.1 na-134 k-3.9 cl-98 hco3-31 angap-9 05:30am blood glucose-110* urean-42* creat-1.5* na-137 k-4.4 cl-104 hco3-26 angap-11 05:35am blood glucose-88 urean-40* creat-1.6* na-134 k-4.4 cl-102 hco3-25 angap-11 07:07pm blood alt-35 ast-107* ld(ldh)-320* alkphos-115 amylase-95 totbili-3.8* 03:03am blood alt-40 ast-120* alkphos-127* totbili-4.1* 05:30am blood alt-29 ast-105* ld(ldh)-287* alkphos-116 totbili-5.7* 05:35am blood alt-32 ast-115* alkphos-117 totbili-6.1* cardiac biomarkers 02:48am blood ck-mb-4 ctropnt-<0.01 04:50am blood ck-mb-4 ctropnt-0.01 04:45am blood ck-mb-6 ctropnt-<0.01 calcium 05:35am blood calcium-9.1 phos-3.5 mg-1.9 05:30am blood albumin-3.5 calcium-9.2 phos-3.2 mg-2.1 thyroid 04:50am blood tsh-2.2 04:50am blood free t4-0.64* tumor markers 06:13am blood afp-58.0* complement 05:25am blood c3-20* c4-9* toxin 07:07pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg whole blood/lactate 09:43pm blood lactate-2.0 07:07pm wbc-7.2 rbc-3.19* hgb-11.5* hct-32.1* mcv-101* mch-36.1* mchc-35.9* rdw-14.4 07:07pm neuts-75.2* lymphs-12.3* monos-10.9 eos-1.5 basos-0.2 07:07pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg discharge laboratories: cbc wbc 4.9 25.3 plt 107 chem na 133 k 4.5 cl 96 hc03 30 bun 38 cr 1.8 gluc 117 ca 9.2 phos 3.9 mg 2.0 lfts: alt 37 ast 130 ap 115 tbili 6.4 pt 23.8 ptt 49.3 inr 2.3 brief hospital course: # encephalopathy - patient was initially admitted to the hospital for altered mental status. that was thought to be due to an underlying urinary tract infection. her mental status improved with lactulose and treatment of the uti. while on the floor her lactulose was continued. during the hospitalization, there was a three day period of time that the patient was refusing her lactulose. in this setting, and in the setting of worsening pulmonary edema and a question of pneumonia she again became encephalopathic. her lactulose was restarted and her mind cleared. during this time she was also tapped, and was negative for sbp. she was continued on lactulose and rifaximin while in house. we felt that she needed 24 hour supervision, and she agreed to skilled nursing facility.. . # hepatorenal syndrome: on call out from the micu, the patient was noted to have worsening renal function and hyponatremia. urine lytes were consistent with hepatorenal syndrome. renal was consulted and agreed with management. renal ultrasound did not show any evidence of obstruction of hydronephrosis. she was started on midodrine, octreotide and albumin. he cr intially continued to increase despite maximal treatment. in the setting of pulmonary edema, iv diuresis was started. with diuresis, her cr improved towards her baseline but then worsened this past week. *diuretics were held the two days prior to discharge. she should have every other day labs this week with results faxed to center at fas # . if creatinine is stabilizing, lasix can be restarted at 40mg max 80mg po daily and spironolactone 50mg po daily max 100mg po daily. #pulmonary edema - during the hospitalization, the patient clinically had evidence of volume overload thaw was seen on ct scan. initially she was requiring nasal canula oxygen. she was diuresed with iv lasix and after removal of fluid was comfortable on room air. renal was following the patient in house because of initial concern about the need for dialysis or cvvh, but she had no ultrafiltration during this admission. . #hospital aquired pneumonia - during the hospitalization, the patient became febile with decreased oxygen saturation on room air. it was not clear if the destuartion was due to the pulmonary edema discussed above or could be due to pneumonia. she was empirically covered broadly with vanc and cefepime which was continued for 7 days. sputum cultures were negative. . #tachycardia - during the hospitalization she had an episode of chest pain and acute tachycardia. she was seen by cardiology who thought she had an atrial tachycardia. cardiac enzymes were negative x 3. a repeat echo was without significant change. she was maintained on a beta blocker. . # esld and hcc: pt has known esophageal varices. she also has known heptic lesions that are concerning for hcc. one of the lesions was seen on liver ultrasound and was initially evaluated for rfa. treatment with rfa was held while in house because the patient was at the top of the list. this will need to be readdressed. she was continued on lactulose and rifaximin. also maintained on sbp prophylaxis with various antibiotics while in house. continued on beta blocker, although more cardio selective in the setting of her atrial tachycardia. . # anemia and thrombocytopenia: hct drifted down during this hospitalization. previous iron studies consistent with chronic disease, likely from cirrhosis. noted small ammount of blood in stool during hospitalization. be component of portal gastropathy. recent studies: colonoscopy without source, egd with gastropathy and 1 cord of varices, s/p 2units of blood on . also with evidence of hemolysis on labs likely from a recent transfusion, combs test was negative. # fall: pt had a fall overnight on , felt to be mechanical. no head trauma and no loc. medications on admission: . medications: per d/c summary 1. spironolactone 200 mg daily 2. furosemide 80 mg daily 3. lactulose 30mls prn; titrate to bms daily 4. ciprofloxacin 250 mg po q24h 5. cholecalciferol (vitamin d3) 400 unit daily 6. calcium carbonate 500 mg qid prn 7. nadolol 20 mg po daily 8. clotrimazole 10 mg troche qid 9. tretinoin 0.025 % cream appl topical qhs 10. hydroxyzine hcl 25 mg q4h prn 11. reglan 5 mg tablet tidac and hs 12. simethicone 60 mg po qid prn . allergies: nkda discharge medications: 1. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 2. rifaximin 200 mg tablet : three (3) tablet po bid (2 times a day). 3. camphor-menthol 0.5-0.5 % lotion : one (1) appl topical tid (3 times a day) as needed. 4. calcium carbonate 500 mg tablet, chewable : one (1) tablet, chewable po qid (4 times a day) as needed. 5. metoprolol tartrate 25 mg tablet : 0.5 tablet po bid (2 times a day). 6. lactulose 10 gram/15 ml syrup : thirty (30) ml po tid (3 times a day). 7. acetaminophen 325 mg tablet : two (2) tablet po q8h (every 8 hours) as needed. 8. ursodiol 300 mg capsule : one (1) capsule po bid (2 times a day). 9. albuterol sulfate 2.5 mg/3 ml solution for nebulization : one (1) inh inhalation q4h (every 4 hours) as needed. 10. ipratropium bromide 0.02 % solution : one (1) inh inhalation q6h (every 6 hours) as needed. 11. ciprofloxacin 250 mg tablet : one (1) tablet po q24h (every 24 hours): for sbp prophy. tablet(s) discharge disposition: extended care facility: center discharge diagnosis: primary: hepatic encephalopathy secondary: hepatorenal syndrome end state liver disease/cirrhosis hepatitis c diverticulosis discharge condition: improved. pt is alert, oriented. discharge instructions: you were admitted with severe hepatic encephalopathy, a condition where the brain does not function properly because of your advanced liver disease. you were admitted to the medical intensive care unit. your condition improved with lactulose and rifaximin. your kidney function showed moderate impairment, thought to be related to liver disease. ** changes to your medications ** please see your new medication sheet for your most up to date medication list. your nadolol was changed to metoprolol. your hydroxyzine, simethicone, tretinoin, clotrimazole, and metoclopromide were discontinued. your spironolactone and furosemide (lasix) are being held because of your kidney function. if you develop worsening abdominal pain, fever, chills, bleeding from the gi tract, or other concerning symptoms, please return to the hospital. followup instructions: you have the following appointment made for you: clinic phone: date/time: 1:00 she should have labs checked tomorrow , on , and , and weekly thereafter. labs include cbc, chemistry including sodium and creatinine, coags including pt/inr, and lfts including bilirubin. these should be faxed to the center attention : fax: . procedure: percutaneous abdominal drainage diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified anemia, unspecified urinary tract infection, site not specified cirrhosis of liver without mention of alcohol chronic hepatitis c without mention of hepatic coma acute kidney failure, unspecified hepatorenal syndrome other specified cardiac dysrhythmias malignant neoplasm of liver, primary hepatic encephalopathy esophageal varices in diseases classified elsewhere, without mention of bleeding diverticulosis of colon (without mention of hemorrhage) 

Answer: The patient is high likely exposed to