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: codeine attending: chief complaint: respiratory failure major surgical or invasive procedure: right subclavian central line placement intubation picc placement history of present illness: the patient presented to osh ed yesterday w/neck pain since the 17th. per the osh, she was somnolent and found to be acidotic on abg; she was then intubated and r triple lumen femoral placed. discussion with family per osh records indicates that she was found down for an undetermined amount of time. cxr initially showed extensive right-sided pna and the next day (day of transfer) was notable for left upper lobe infiltrate. exam was notable for fresh track marks. pt was treated with vancomycin, gatifloxicin and unasyn per osh id consult. utox + for cocaine and opiates, bz. by report, responded to narcan (awoke). head ct was negative for acute intracranial abnormality. 2 sets of blood cultures were + for gram + cocci; echo (tte) negative for vegetations and ef was 70%. * the patient was transferred to per her son's request. she was on levophed and dopamine prior to transfer, and transferred on dopamine and bicarb gtts. she received 6 liters of ivfs by report to resident over the phone. she has been ordered 1 u prbc, but needs to come from red cross, so they're trying to get the blood sent directly here. her last abg was 7.37/40/287 on ac 500, peep 8, rr 22, fio2 100%. she had stim test but no results are available yet. past medical history: hepatitis c (liver biopsy in as showing stage iii fibrosis) waldenstrom's macroglobulinemia/lymphoma history of ivdu depression sialolithiasis fine tremor peripheral neuropathy s/p prolonged icu stay for heroin and benzodiazepine overdose multi-lobar pneumonia (m. cattharalis) social history: hx for polysubstance abuse, lives with her son family history: noncontributory physical exam: pe: af 37.2c/ 105/65// 88// 100% vented and on dopamine acutely-ill female, looks younger than stated age. flushed, awake, uncomfortable in appearance. heent: eomi, perrl, conjunctiva injected, tan exudate right eye, mm dry. neck: supple, no lad heart: rr, no m/g/r nl s1s2 lungs: diffusely rhonchorous, r>l, reduced bs at left base, no rales abd: distended, diffusely tender, no bs audible, no organomegaly ext: warm, well-perfused, no lower extremity edema, track marks in left antecub, no splinter hemorrhages. 2+ dps b/l pertinent results: osh labs: select labs below : wbc 0.9, 39%pmns, 31%bands, 16l, 12m, 1 atyp, 1 meta : wbc 2.2, 11%pmns, 62%band, 9l, 4 atyps, 2 m, 1 b, 9 metas inr 1.5 ck 2628, bun 40, creat 1.7, ti .02 - echo - the left atrium is normal in size. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). regional left ventricular wall motion is normal. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the pulmonary artery systolic pressure could not be determined. there is a small (~1cm) anterior pericardial effusion but without evidence of hemodynamic compromise. cxr - 1. peripheral and basilar predominant interstitial pattern affecting the right lung to a much greater degree than the left, in corresponding to more extensive areas of consolidation on earlier radiograph of . these findings may be due to slowly resolving pneumonia, but areas of interstitial disease from drug toxicity, previously masked by an overlying pneumonia, is within the differential diagnosis, particularly if the patient has received bleomycin therapy. continued radiographic followup is recommended to assess for resolution. if persistent, a high-resolution ct may be considered. 2. splenomegaly. . cxr pa/lat : impression: 1. no radiographic evidence of acute, displaced rib fracture. if symptoms are localized to a specific area, coned-down rib films with metallic marker may be helpful. 2. interstitial lung opacities as described above. please see recent report regarding differential diagnosis and recommendations. 11:54pm urine color-yellow appear-clear sp -1.020 11:54pm urine blood-lg nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-0.2 ph-5.0 leuk-tr 09:05pm type- ph-7.30* 09:05pm lactate-5.1* 09:05pm freeca-0.96* 08:38pm glucose-220* urea n-30* creat-1.1 sodium-137 potassium-4.3 chloride-103 total co2-21* anion gap-17 08:38pm alt(sgpt)-81* ast(sgot)-196* ld(ldh)-528* ck(cpk)-* alk phos-62 amylase-22 tot bili-1.1 08:38pm alt(sgpt)-81* ast(sgot)-196* ld(ldh)-528* ck(cpk)-* alk phos-62 amylase-22 tot bili-1.1 08:38pm albumin-2.6* calcium-6.6* phosphate-2.2* 08:38pm albumin-2.6* calcium-6.6* phosphate-2.2* 08:38pm vanco-13.8* 08:38pm wbc-5.5# rbc-4.09* hgb-11.5* hct-34.2* mcv-84 mch-28.2 mchc-33.7 rdw-16.0* 08:38pm neuts-82* bands-14* lymphs-1* monos-2 eos-0 basos-0 atyps-0 metas-1* myelos-0 08:38pm hypochrom-2+ anisocyt-1+ poikilocy-occasional macrocyt-normal microcyt-1+ polychrom-normal ovalocyt-occasional brief hospital course: 49 year-old female with history significant for hepatitis c, iv drug use, and waldenstrom's macroglobulinemia now transferred from outside hospital with high grade bacteremia, septic shock, and respiratory failure. * 1) respiratory failure: her respiratory secondary to a right upper lobe pneumonia. on transfer, her pao2 to fio2 ratio was less than 200, which is consistent with ards. therefore, she was switched to pressure control ventillation to keep her peak pressures less than 30. at those pressures, she was pulling tidal volumes of about 400 cc. she was intially covered with broad spectrum antibiotics vancomycin, levofloxacin, and cefepime. when her blood cultures grew out strep. pneumonia, noted from the osh, she was switched to penicillin. she became febrile on and self-extubated on , and later had to be reintubated on due to tachypnea and alkalemia. she was extubated successfully on and weaned without difficulty to nasal cannula. switched to vanco on for positive blood culture (gpc) on . the plan is 14 days should finish on . the pt remained satting well on room air until discharge. . 2) strep pneumo sepsis: initially, the etiology of her gram positive cocci bacteremia was unclear. her history of iv drug use and her fresh track marks on exam, there was initial supicion for endocarditis. however, at the outside hospital, she had a negative transthoracic echocardiogram for endocarditis. she had an abdominal ultrasound that was negative for ascites, therefore, sbp was unlikely the source. once her blood cultures grew out strep. pneumonia, it seemed most likely that her pneumonia was the source of her bacteremia. on transfer, she was on dopamine through a femoral line to maintain her blood pressure. on arrival, she had a subclavian line placed. initially, she required 3l of iv boluses to maintain her cvp above 15 (accounting for peep). she was continued on the dopamine and vasopressin was added. on hospital day 2, she was weaned off of the dopamine and maintained on the vasopressin; however, due to low urine output, she was switched back to the dopamine and off of the vasopressin. her cortisol stimulation test at the outside hospital showed an appropriate response. however, when she was taken off of the stress dose steroids, she desaturated. therefore, she was continued on the steroids. 7 days of high-dose steroids, then transitioned to prednisone. lp on . the sepsis was likely from pnumococcal pneumonia. see respitroy failure section for discussion of pneumonia treatment. the plan was to continue vanc at discharge for a 14 day course to be be completed . . 3) rhabdomyolysis: she was found down by report. he cks were elevated on initial presentation to the outside hospital, which is consistent with rhabdomyolysis. her ck trended down with iv hydration within her first few days here. . 4) acute renal failure: her elevated creatinine was likely secondary to hypoperfusion in the setting of hypotension. her creatinine improved with iv fluids. on discharge the patient's cr was 0.5. . 5) hepatitis c: her interferon was held during this admission. her liver enzymes were elevated. she had a negative abdominal ultrasound for ascites. dr. aware pt was admitted. cryocrit was negative. . 6) pancytopenia: the etiology is not clear and may be related to hcv and interferon treatment, possibly to waldenstrom's macroglobulinemia. she was transfused when hct dropped less than than 22. . 7) rash: groin rash c/ . treated with miconazole topical . 8) s/p fall on overnight. d/ced her own a-line during the fall. no head trauma. patient c/o lumbar back pain, mild headache. - oxycodone prn - fall precautions, one to one sitter . 9) ekg changes: noted . cards consulted for flipped t waves in precordial leads. tte with nothing remarkable. ekg changes reversed once extubated. . 8) fen: she was started on tube feeds. her electrolytes were repleted. she was given iv fluid boluses as above. transitioned to po diet once extubated. . 9) uti - found to have positive urinalysis on . given 3 day course of cipro. . 10. hiv test sent on , she was informed that the test was negative. . 11) cxr - patient with interstitial findings on cxr. likely resolving pna but could be drug toxicity. will need follow up cxr once pna completely resolved. . 12. prophylaxis: she was maintained on pneumoboots, heparin sc, ppi and a bowel regimen. miconazole to groin rash. fall precautions, one-to-one sitter. * access: a right subclavian and a right a-line were place. the femoral line was removed. right a-line d/ced and left a-line placed on . l a line d/ced by patient on . r subclavian d/ced . picc placed at bedside on . * code: full . dispo: pt going to medications on admission: meds at home: amoxicillin 500mg--one tablet three times a day x 10 days effexor xr 37.5mg--3 by mouth every day flonase 50mcg--one spray each nostril every day gabapentin 300mg--take one tablet at bedtime ibuprofen 600 mg--one tablet by mouth q 6 hours as needed naprosyn 500mg--take two pills by mouth every morning and one pill by mouth every evening as needed for for pain with food pegylated interferon --as directed by gi seroquel 25mg--3 by mouth at bedtime . meds on transfer: tequin, pepcid, vancomycin, unasyn, hydrocort, fluorinef, mso4 discharge medications: 1. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. quetiapine 25 mg tablet sig: one (1) tablet po bid (2 times a day). 4. vancomycin 1,000 mg recon soln sig: one (1) g intravenous q 12h (every 12 hours) for 4 days. discharge disposition: extended care facility: - discharge diagnosis: streptococcal pneumoniae and bacteremia discharge condition: stable. discharge instructions: please call your doctor or return to the er if you experience any shortness of breath, persistent cough or fevers /chills. followup instructions: you have an appointment to see the nurse practitioner at dr. office, brain 10:40am. phone: . provider: , md phone: date/time: 1:0 patient will need follow up with dr. within 1-2 weeks. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung enteral infusion of concentrated nutritional substances arterial catheterization infusion of vasopressor agent diagnoses: acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified chronic hepatitis c without mention of hepatic coma severe sepsis acute respiratory failure pneumococcal septicemia [streptococcus pneumoniae septicemia] pneumococcal pneumonia [streptococcus pneumoniae pneumonia] rhabdomyolysis candidiasis of vulva and vagina polyclonal hypergammaglobulinemia combinations of opioid type drug with any other drug dependence, unspecified 

Answer: The patient is high likely exposed to