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: telaprevir attending: chief complaint: rash major surgical or invasive procedure: right internal jugular central venous line placement. transesophageal echocardiogram history of present illness: 55 y/o hcv on telaprevir, hypothyroidism, depression, presents with diffuse rash. rash began 5 weeks ago and telaprevir was given for a 12 week course (finished on ). however, rash has persisted despite stopping telaprevir. she denies fevers, nausea, vomiting, diarrhea. she has denies oral lesions. rash burns and is pruritic. in the ed initial vitals were: 109 122/81 14 100%. rectal temp 101.6. exam was notable for mild lethargy and confusion and some dyspnea. labs showed lactate 6.1, hco3 21, ast/alt 65/28, ldh 660, tbili 2.8, dbili 1.4, hct 29 (baseline 35 prior to telaprivir), wbc 7.8 with 18.4% eosinophils. ua notable for wbc 51, leuk/nitrite negative. cvl placed. cxr showed appropriate cvl placement, otherwise no acute intrathoracic process. ruq us showed thickened gall bladder edema. ct torso showed no pe/dissection, but cirrhosis with extensive varices and mesenteric/colonic/gallbladder edema. hepatology and surgery were consulted. surgey did not feel gallbladder edema was related to an acute infectious process, but rather secondary to cirrhosis. she received vancomycin 1g, metronidazole 500mg and ciprofloxacin 400mg. she was also seen by dermatology who send dfa for vzv/hsv, recommended topical agents and covering for bacterial superinfection and will preform punch biopsy in the morning. she was also seen by hepatology (dr. who recommended micu admission). she was given 4l ns with improvement in lactate 6.1 to 4.2. also received 30ml lactulose. vitals prior to transfer hr 80-90 sbp 123. . on arrival to the micu, her vitals were 96.6 (oral), 94, 129/63, rr- 98% on ra. past medical history: hypothyroidism depression hepatitis c obesity migraine headaches peripheral edema *s/p adj gastric band (vg) & hiatal hernia repair s/p hystorectomy due to excessive vaginal bleeding and ?precanerous condition anemia social history: social history: - tobacco: never - alcohol: only as a teenager - illicits: never family history: family history: husband also has hep c, but patient had hep c prior to meeting husband. physical exam: vitals: 96.6 (oral), 94, 129/63, rr- 98% on ra. general: alert, oriented x3, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad, r ij in place cv: regular rate and rhythm, normal s1 + s2, 2/6 systolic murmur lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: obese soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema skin: extensive erythrodermic rash with confluent erythematous eruption with scaling over 80-90% of body, sparing distal extremities physical exam on discharge: vss, afebrile o: general aaox3 in nad, heent: no erythema on the face, no lesion in the oropharynx, mmm cardiac: rrr, no mrg appreciated lungs: ctab abdomen: soft, nontender nondistended, no rebound or guarding extremities: 1+pitting edema l>r , warm well perfused skin: mostly normal skin with a few patchy areas on lower extremities of healing rash. pertinent results: admission labs: 01:45pm blood wbc-7.8# rbc-2.68* hgb-9.2* hct-29.1* mcv-109* mch-34.1* mchc-31.4 rdw-20.4* plt ct-93* 01:45pm blood neuts-52.6 bands-0 lymphs-23.9 monos-4.5 eos-18.4* baso-0.6 01:45pm blood hypochr-normal anisocy-2+ poiklo-2+ macrocy-2+ microcy-normal polychr-1+ ovalocy-1+ tear dr2+ 02:28pm blood pt-19.5* ptt-43.4* inr(pt)-1.8* 01:45pm blood glucose-137* urean-13 creat-0.7 na-139 k-4.5 cl-105 hco3-21* angap-18 01:45pm blood alt-28 ast-65* ld(ldh)-660* ck(cpk)-104 alkphos-94 totbili-2.8* dirbili-1.4* indbili-1.4 01:45pm blood lipase-75* 01:45pm blood ck-mb-3 probnp-156 01:45pm blood ctropnt-<0.01 02:50pm blood ctropnt-<0.01 01:45pm blood calcium-8.0* phos-3.0 mg-1.8 02:55pm blood lactate-6.1* 09:59pm urine color- appear-clear sp -1.041* 09:59pm urine blood-sm nitrite-neg protein-tr glucose-neg ketone-neg bilirub-sm urobiln-8* ph-6.0 leuks-neg 09:59pm urine rbc-6* wbc-51* bacteri-none yeast-none epi-0 renalep-<1 09:59pm urine casthy-4* 09:59pm urine mucous-many 09:59pm urine eos-negative 09:59pm urine hours-random urean-615 creat-153 na-<10 k-50 cl-17 09:59pm urine osmolal-541 discharge labs: 06:35am blood wbc-2.6* rbc-2.10* hgb-7.3* hct-23.3* mcv-111* mch-34.7* mchc-31.3 rdw-21.5* plt ct-40* 06:35am blood pt-15.7* ptt-40.1* inr(pt)-1.4* 06:35am blood glucose-137* urean-10 creat-0.5 na-137 k-3.6 cl-104 hco3-28 angap-9 06:35am blood alt-28 ast-70* alkphos-87 totbili-2.0* 06:35am blood albumin-2.1* calcium-8.0* phos-2.6* mg-1.8 pertinent labs: 03:36am blood i-hos-done 05:30pm blood fibrino-61* 10:30am blood thrombn-26.2* 10:30am blood ret man-4.1* 10:30am blood aca igg-2.6 aca igm-2.6 05:28am blood caltibc-165* vitb12-1787* folate-10.3 ferritn-649* trf-127* 10:30am blood cryoglb-no cryoglo 01:45pm blood hapto-<5* 05:40am blood tsh-0.60 01:45pm blood tsh-2.4 01:45pm blood free t4-0.97 03:06am blood freeca-1.19 micro: 2:45 pm blood culture **final report ** blood culture, routine (final ): staph aureus coag +. consultations with id are recommended for all blood cultures positive for staphylococcus aureus and species. final sensitivities. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. staphylococcus, coagulase negative. final sensitivities. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | staphylococcus, coagulase negative | | clindamycin-----------<=0.25 s <=0.25 s erythromycin----------<=0.25 s <=0.25 s gentamicin------------ <=0.5 s <=0.5 s levofloxacin---------- 0.25 s 0.25 s oxacillin------------- 0.5 s <=0.25 s tetracycline---------- <=1 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ <=0.5 s anaerobic bottle gram stain (final ): gram positive cocci in pairs and clusters. reported to and read back by dr at 10:42. aerobic bottle gram stain (final ): gram positive cocci in pairs and clusters. : direct antigen test for herpes simplex virus types 1 & 2 (final ): uninterpretable due to inadequate specimen. : direct antigen test for varicella-zoster virus (final ): uninterpretable due to inadequate specimen. : urine culture (final ): staph aureus coag +. 10,000-100,000 organisms/ml.. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s nitrofurantoin-------- <=16 s oxacillin-------------<=0.25 s trimethoprim/sulfa---- <=0.5 s : blood cultures- ngtd : rapid plasma reagin test (final ): nonreactive. imaging: ruq u/s: impression: 1. new circumferential gallbladder mural thickening and edema. in a patient with a history of cirrhosis, considerations include cholecystitis or alternatively third spacing of fluids in a patient with hypoalbuminemia, hepatitis or right heart dysfunction. 2. coarse hepatic echotexture consistent with cirrhosis. 3. patent portal venous system. cxr: ap and lateral views of the chest: there is mild cardiomegaly which is unchanged. mediastinal and hilar contours are normal. the lungs show no focal consolidation, pleural effusion or pneumothorax. ct chest + abdomen + pelvis: 1. no evidence of pulmonary embolism, aortic dissection or aortic aneurysm. 2. nodular liver consistent with the provided history of cirrhosis, with splenomegaly and extensive varices. 3. anasarca and diffuse mesenteric edema. in that context, circumferential gallbladder mural edema is likely related to third spacing of fluids or hepatitis, with a similar process possibly also explaining moderate colonic mural thickening/edema. 4. 3mm left lower lobe pulmonary nodule. in the absence of risk factors for pulmonary malignancy, no specific followup is necessary. in the presence of those factors, would recommend dedicated chest ct in 12months. echo: the left atrium is elongated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 0-5 mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). there is a mild resting left ventricular outflow tract obstruction. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. the aortic arch is mildly dilated. the abdominal aorta is mildly dilated. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. trace aortic regurgitation is seen. the mitral valve leaflets are structurally normal. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: normal left ventricular cavity size with mild symmetric left ventricular hypertrophy and preserved global and regional biventricular systolic function. mild resting left ventricular outflow tract obstruction. mildly dilated ascending aorta, aortic arch, and abdominal aorta. mild mitral regurgitation. mild pulmonary artery systolic hypertension. compared with the prior study (images reviewed) of , a mild resting lvot obstruction is now present. mild dilitation of the aortic arch and abdominal aorta is now seen. the severity of pulmonary artery systolic hypertension has increased and is now mild. : transesophageal echo: no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal (lvef>55%). the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to 30 cm from the incisors. the aortic valve leaflets (3) are mildly thickened. there are filamentous strands on the aortic leaflets consistent with lambl's excresences (normal variant). no masses or vegetations are seen on the aortic valve. the mitral valve leaflets are mildly thickened/myxomatous. mild posterior leaflet mitral prolapse may be present. no mass or vegetation is seen on the mitral valve. mild (1+) (late systolic) mitral regurgitation is seen. there is mild tricuspid regurgitation, which may be underestimated due to an eccentric jet. no mass or vegetation is seen on the tricuspid valve. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. impression: no mass or vegetation seen. normal left ventricular function cxr : impression: 1. new right picc terminating 1 cm beyond superior cavoatrial junction. 2. unchanged mild pulmonary vascular congestion. pathology: diagnosis: skin, right upper arm; punch (a): epidermal spongiosis with neutrophil-containing parakeratotic scale, surface bacterial organisms and focal interface changes (see microscopic description and comment). microscopic description: sections show epidermis with semi confluent parakeratotic scale which contains neutrophils and scattered surface bacterial organisms (highlighted on a gram stain). there is epidermal acanthosis with spongiosis and lymphocyte exocytosis. there are focal interface changes, and rare dyskeratotic cells are seen. in the dermis there is a predominantly perivascular mononuclear infiltrate with spill into the interstitium. occasional superficial dermal neutrophils and rare eosinophils are also seen. focal red blood cell extravasation is present. no fungal organisms are seen on a gms stain. a specific immunostain for cmv is negative. a specific treponemal immunostain is in process and the result will be reported in an addendum. multiple tissue levels have been examined. comment. the histologic features in this sample are consistent with a reaction to telaprevir, although a reaction (in whole or in part) to other drugs cannot be excluded. if there is continuing clinical concern re-biopsy may yield additional information. clinical correlation is suggested. brief hospital course: 55f with hep c cirrhosis, anemia, hypothyroidism, depression who developed erythroderma on telepavir and ribavarin complicated by mssa bacteremia. . #. rash- extensive erythrodermic rash with confluent erythematous eruption with scaling over 80-90% of body, sparing distal extremities at the time of admission. this rash worsened after having stopped telepavir and still taking the , patient will no longer be able to be on either of these medications. she was originally managed in the micu, as she had evidence of dress syndrome. she was evaluated by dermatology who held off on treating her with po steroids as she was recently on telepavir. she had a punch biopsy which showed the type of rash that would be expected with telepavir reaction. she was treated with topical steroids and the rash had improved significantly at the time of discharge. on dishcarge she had no crusting or blistering areas of the skin. her face had no rash on it, her legs had some scattered areas of peeling skin, but no papules. the lesions on her palms had resolved. she was discharged on triamcinalone 0.1% topical steroid twice a day for up to 2 weeks. #mssa bacteremia- patient developed bacteremia. this was most likely due to her diffuse skin infection which became secondarily infected. she was originally treated with vancomycin and then once speciated was switched to nafcillin. she underwent a tte and a tee which showed no evidence of endocarditis. she became afebrile and her repeat cx on was ngtd at the time of discharge. she was seen by id who felt that she would require at least 3 weeks of iv nafcillin and will follow-up with id who will determine if further treatment is necessary. she had a picc line placed for this treatment course. she will need to go to a to have this iv medication administered. . #. hep c cirrhosis- chronic hepatitis c (genotype 1a) with no clear risk factors, diagnosed in . currently on ribavirin and peginterferon alfa-2a having completed a 12-week course of incivek 650mg 10 day prior to admission (). ruq ultrasound demonstrates circumferential gallbladder mural thickening and edema, and cirrotic liver, but no evidence of ascites. most recent hcv viral load was undetectable at week 8 of telepavir. she was restarted on her peginterferon prior to discharge.she should not be continued on ribavarin. because the pts platelet count dropped to 35, we decreased the dose of peginterferon to 130mcg per week. platetlet count will need to be closely monitored. . #anemia- patient was pancytopenic which can be a side effect of the interferon. she has been on procrit in the past and was restarted on this prior to discharge. she will need to continue on this. her hct was around 23-25 during her admission and is opposed to blood product administration due to religious reasons so never received any blood transfusions during her stay. #. hepatic encephalopathy- patient had altered mental status with elevated ammonia levels at the osh prior to transfer likely due to hepatic encephalopathy in the setting of acute infection and reaction. she was treated with lactulose and this resolved completely and she was not continued on this at the time of discharge as she was stable without it. . #. hypothyroidism-patient was originally on her home dose of levothyroxine (150mcg/day) hwoever she was complaining of feeling tremulous so this dose of decreased to 100mcg prior to discharge and she noted an improvement in symptoms. #. depression- no current si/hi. continue home dose of venlafaxine transitional issues: pending labs: skin biopsy results, blood cultures from medications started: 1. nafcillin (antibiotic), 2. procrit (injection for anemia) 3. spironolactone 50mg by mouth once a day (diuretic to get fluid out of your legs) 4. furosemide 20mg by mouth once a day (diuretic to get fluid out of your legs) 5. ointment for your legs 6. benadryl as needed for the itching 7. oxycodone as needed for pain 8. triamcinolone ointment for affected rash areas medications changed: 1. levothyroxine decreased to 100mcg per day 2. pegasys interferon decreased from 180mcg per week to 130mcg per week because of low platelets medications stopped: 2. ribavarin- b/c of worsening rash while on it. follow-up you will need to have your platelet count and your hematocrit counts checked while you are at rehab as these numbers are low and you are starting on treatment for your anemia you have follow-up appointments schedule with dr. to discuss your further treatment for your hcv (for now you are continuing on the interferon shots every week) you also have a follow-up appointment scheduled with dermatology to ensure that your rash is resolving. **you will need weekly blood draws while at rehab with the results to be faxed to the id office here at *** -cbc, basic metabolic panel, lfts faxed to attne: medications on admission: levothyroxine 150mcg dialy peginterferon alfa-2a - (recording only) - 180 mcg/0.5 ml kit - inject 180mcg/0.5ml sq once weekly ribavirin - 600 mg spironolactone 100mg daily telaprevir 375 mg tablet - 2tablet(s) by mouth every 8 hours venlafaxine 150 mg capsule,ext release dialy medications - otc calcium citrate-vitamin d3 - (prescribed by other provider; otc) - 500 mg (calcium)-400 unit tablet, chewable - one tablet(s) by mouth twice daily cholecalciferol (vitamin d3) - (prescribed by other provider) - 1,000 unit capsule - 1000 units capsule(s) by mouth once daily multivitamin - (otc) - capsule - 1 capsule(s) by mouth once a day discharge medications: 1. spironolactone 50 mg tablet sig: one (1) tablet po once a day. 2. calcium carbonate 200 mg calcium (500 mg) tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 3. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 4. multivitamin tablet sig: one (1) tablet po daily (daily). 5. petrolatum ointment sig: one (1) appl topical (2 times a day). 6. venlafaxine 150 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po once a day. 7. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 8. diphenhydramine hcl 25 mg capsule sig: one (1) capsule po hs (at bedtime) as needed for puritis/insomnia. 9. peginterferon alfa-2a 180 mcg/ml solution sig: one (1) injection subcutaneous 1x/week (mo): please give 130mcg once a week on mondays. 10. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 11. triamcinolone acetonide 0.1 % ointment sig: one (1) appl topical (2 times a day) for 2 weeks: apply to affected areas . 12. nafcillin 2 g iv q4h 13. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 14. docusate sodium 100 mg capsule sig: two (2) capsule po bid (2 times a day) as needed for constipation. 15. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain for 2 weeks. disp:*20 tablet(s)* refills:*0* 16. epoetin alfa 4,000 unit/ml solution sig: one (1) injection qmowefr (monday -wednesday-friday). discharge disposition: extended care facility: senior healthcare - discharge diagnosis: primary: erythroderma, hepatitis c cirrhosis, bacteremia secondary: hypothyroidism, anemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear ms. , it was a pleasure caring for you while you were here at . you were admitted to the hospital because you had a full body rash that was felt to be a reaction to the telapavir medication that you were taking for your hcv. you had already completed this treatment and were still on the ribavarin so we also stopped your ribavarin. you were origianlly in the icu because your rash so so diffuse. dermatology saw you and took a biopsy of the rash, and started you on some creams to help with it. at the time of your discharge your rash was much improved with just a little left on your legs. one of the complications from having such a large rash is that your skin was not protecting you from normal bacteria and you got a bacterial infection in your blood called bacteremia. you were seen by the infectious disease specialists who felt that you would require a total of at least 3 weeks of iv antibotics for this (nafcillin). they will be following up with you to determine if more is needed. you had a picc line (long iv line) placed for this to be done at rehab. you had no signs that the infection had affected your heart valves. transitional issues: pending labs: skin biopsy results, blood cultures from medications started: 1. nafcillin (antibiotic), 2. procrit (injection for anemia) 3. spironolactone 50mg by mouth once a day (diuretic to get fluid out of your legs) 4. furosemide 20mg by mouth once a day (diuretic to get fluid out of your legs) 5. ointment for your legs 6. benadryl as needed for the itching 7. oxycodone as needed for pain 8. triamcinolone ointment for affected rash areas medications changed: 1. levothyroxine decreased to 100mcg per day medications stopped: 2. ribavarin- b/c of worsening rash while on it. follow-up you will need to have your platelet count and your hematocrit counts checked while you are at rehab as these numbers are low and you are starting on treatment for your anemia you have follow-up appointments schedule with dr. to discuss your further treatment for your hcv (for now you are continuing on the interferon shots every week) you also have a follow-up appointment scheduled with dermatology to ensure that your rash is resolving. **you will need weekly blood draws while at rehab with the results to be faxed to the id office here at *** -cbc, basic metabolic panel, lfts faxed to attne: followup instructions: name: , : family medicine address: 65 rt 134, , phone: **please discuss with the staff at the facility the need for a follow up appointment with your pcp when you are ready for discharge** . department: orthopedics when: tuesday at 11:15 am with: , m.d. building: campus: east best parking: garage . department: liver center when: tuesday at 12:00 pm with: building: lm campus: west best parking: garage . department: infectious disease when: tuesday at 1:30 pm with: , md building: lm bldg () campus: west best parking: garage . department: dermatology when: wednesday at 1:45 pm with: , md building: sc clinical ctr campus: east best parking: garage md procedure: diagnostic ultrasound of heart closed biopsy of skin and subcutaneous tissue central venous catheter placement with guidance diagnoses: cirrhosis of liver without mention of alcohol chronic hepatitis c with hepatic coma hyposmolality and/or hyponatremia unspecified acquired hypothyroidism depressive disorder, not elsewhere classified bacteremia methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site antiviral drugs causing adverse effects in therapeutic use obesity, unspecified bariatric surgery status other specified erythematous conditions other pancytopenia unspecified erythematous condition 

Answer: The patient is high likely exposed to