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: rle pain, chills major surgical or invasive procedure: upper endoscopy colonoscopy capsule endoscopy history of present illness: ms is a 46yof with h/o hx of traumatic brain injury and developmental delay, hep c, dm and pseudoseizures, on coumadin since for persistant lle dvt, who presents with pain in rle and subjective fever/chills. care taker found her in a cold sweat, and less responsive, so called ems. history limited by pt being a poor historian. the symptoms began earlier on day of admission, and associated with general body weakness. she also complains of feeling sob and with mild mid-chest pain, pt unable to further characterize. she denies dysuria or other urinary changes. she denies any other pain. she denies nausea, vomiting, diarrhea, cough, or headaches. she had a fall 2 days ago and broke her left radial head, and per pt did hurt her leg as well. . of note, her prior history is significant for an unprovoked dvt on involving the left superficial femoral vein, nonocclusive. the record notes no recent travel, trauma, surgeries, ocps. she has no known malignancy. she has been on warfarin since that time with inr goal to 2.5-3 range. she had ongoing symptoms in and had leni done at that time which showed non-occlusive thrombus of the left common femoral vein is similar in appearance to prior imaging studies. prior ct has demonstrated thrombus in the left pelvic vein. she is now on coumadin indefinitely. she was seen in the ed at that time and found to have an inr of 1.0. unclear if she was taking coumadin but was restarted and given lovenox to bridge. . in the ed, initial vs were: t: 99.6, bp: 102/59, p: 127, rr: 20, o2 sat: 100% on ra. her inr was found to be 24, with severely elevated pt and ptt as well. there was concern for spontaneous bleed vs compartment syndrome, so ortho was consulted who felt that this was not compartment syndrome, but instead cellulitis. she was given vancomycin and unasyn, as well as morphine for pain and vitamin k 10mg iv x1. an ej line was placed. ortho did feel that she should get q2h serial compartment checks, with measurement of compartment pressure if exam changes. on arrival to the micu, she is in nad though complaining of pain in rle, mostly in the calf. she also has mild sob and is mildly tachypneic, though was 100% on room air. past medical history: - tbi in childhood after fall from window; had r parietal craniotomy and subsequent l hemiparesis and cognitivie deficits - adult pseuodseizures (with multiple negative eegs), says last seizure was over 5 years ago - childhood epilepsy - hep c - dm - anemia - anxiety disorder - s/p tubal ligation social history: lives in home, case manager , history of cocaine use and alcohol, with relapse several years ago, +35 pack year smoking hx and is still smoking 1ppd; not on ocps or any estrogens. highest level of education 9th grade, does not work, previous employment hx as guard. single, not sexually active. family history: denies family history of blood clots. otherwise non-contributory. physical exam: admission exam tcurrent: 37.4 ??????c (99.3 ??????f) hr: 127 (127 - 129) bpm bp: 96/68(76) {96/60(69) - 105/68(76)} mmhg rr: 17 (17 - 21) insp/min spo2: 94% general: alert, oriented though poor historian, nad heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, unable to assess jvp 2/2 strong/fast carotid pulsations, no lad cv: tachycardic, no mrg, normal s1 + s2 lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley rle: skin clean and intact, +warmth rle>lle; thigh is soft. leg compartments firm but compressible, firmer than contralateral side. no pain w/ passive stretch. 2+ dp pulse. no obvious erythema. + pitting edema up to knee. lle: skin clean and intact, compartments soft. no pain w/ passive stretch. 2+ dp pulse neuro: cnii-xii intact, lue: bicep, wrist extension/flexion, intraosseious, rue: 5/5 strength throughout, lle: 4/5 strength throughout; rle: 5/5 strength; sensation to lt intact throughout 5/5 strength upper/lower extremities, grossly normal sensation, 2+ reflexes bilaterally, gait deferred, finger-to-nose intact .. discharge pe: 24hr tmax 99.7 tc 96.7 hr 80 bp 100/50 rr 18 sao2 95 on ra general: alert, nad heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, no jvp, no lad cv: tachycardic, no mrg, normal s1 + s2 lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: no foley rle: skin clean and intact, no pain w/ passive stretch. 2+ dp pulse. no obvious erythema. trace edema. neuro: cnii-xii intact, rue: bicep, wrist extension/flexion, intraosseious, lue: 5/5 strength throughout, rle: 4/5 strength throughout; lle: 5/5 strength; sensation to lt intact throughout pertinent results: admission labs: 05:18pm blood wbc-8.9 rbc-2.81*# hgb-9.2*# hct-27.0*# mcv-96 mch-32.6* mchc-34.0 rdw-14.2 plt ct-229 11:27pm blood wbc-7.8 rbc-2.13* hgb-7.2* hct-21.2* mcv-99* mch-33.8* mchc-34.0 rdw-14.2 plt ct-206 04:45am blood wbc-8.9 rbc-2.27* hgb-7.3* hct-21.4* mcv-95 mch-32.3* mchc-34.2 rdw-15.0 plt ct-186 07:48am blood wbc-9.0 rbc-2.67* hgb-8.5* hct-24.4* mcv-92 mch-31.7 mchc-34.7 rdw-16.2* plt ct-171 05:18pm blood pt->150 ptt-146.1* inr(pt)-24.0* 11:27pm blood pt-25.4* ptt-37.6* inr(pt)-2.4* 11:27pm blood ret aut-1.4 06:01am blood ret aut-2.9 05:18pm blood glucose-216* urean-20 creat-1.3* na-139 k-4.2 cl-101 hco3-25 angap-17 11:27pm blood glucose-190* urean-17 creat-1.0 na-139 k-4.2 cl-106 hco3-20* angap-17 04:45am blood glucose-137* urean-15 creat-0.8 na-141 k-4.2 cl-110* hco3-24 angap-11 05:18pm blood alt-25 ast-35 alkphos-36 totbili-0.5 11:27pm blood alt-28 ast-54* ld(ldh)-239 alkphos-31* totbili-0.9 05:18pm blood albumin-3.6 04:45am blood albumin-2.8* calcium-7.4* phos-3.3 mg-1.9 iron-128 iron studies/b12, folate 04:45am blood caltibc-286 vitb12-404 folate-11.4 ferritn-87 trf-220 06:43am blood tsh-4.0 06:43am blood t4-6.6 06:43am blood vanco-3.2* lactate trend: 05:21pm blood lactate-6.6* 06:38pm blood lactate-4.4* 09:04pm blood lactate-3.8* 04:59am blood lactate-1.4 inr trend: 05:18pm blood pt->150 ptt-146.1* inr(pt)-24.0* 11:27pm blood pt-25.4* ptt-37.6* inr(pt)-2.4* 04:45am blood pt-16.6* ptt-34.7 inr(pt)-1.6* 03:19am blood pt-13.1* ptt-38.3* inr(pt)-1.2* 06:45am blood pt-19.8* ptt-40.0* inr(pt)-1.9* 06:43am blood pt-20.3* inr(pt)-1.9* 06:01am blood pt-20.8* inr(pt)-2.0* 05:48am blood pt-23.0* inr(pt)-2.2* 05:50am blood pt-28.9* inr(pt)-2.8* 06:55am blood pt-27.6* inr(pt)-2.7* 08:32am blood pt-24.7* inr(pt)-2.4* 07:20am blood pt-22.4* inr(pt)-2.1* 06:00am blood pt-19.0* inr(pt)-1.8* 07:00am blood pt-20.2* ptt-39.4* inr(pt)-1.9* discharge labs: 07:00am blood wbc-7.5 rbc-2.88* hgb-8.7* hct-27.6* mcv-96 mch-30.1 mchc-31.4 rdw-15.3 plt ct-711* 07:00am blood pt-20.2* ptt-39.4* inr(pt)-1.9* 06:00am blood glucose-119* urean-10 creat-0.8 na-142 k-4.6 cl-105 hco3-28 angap-14 ruq ultrasound: 1. no focal liver lesions identified. 2. mild gallbladder wall edema is likely related to third spacing in the setting of hypoalbuminemia. 3. small volume perihepatic ascites. 4. tiny bilateral pleural effusions, as on recent ct from . echo : the left atrium is normal in size. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve. the pulmonary artery systolic pressure could not be determined. there is a very small pericardial effusion. the effusion appears circumferential. there are no echocardiographic signs of tamponade. impression: no valvular vegetations or abscesses appreciated. indeterminate pulmonary artery systolic pressure. very small, circumferential pericardial effusion without echocardiographic evidence of tamponade. intestinal biopsies a. ileocecal valve: 1. colonic mucosa with no diagnostic abnormalities recognized; multiple levels examined. 2. scant adipose tissue is present. b. 50 cm: colonic mucosa with no diagnostic abnormalities recognized; multiple levels examined. cta chest 1. there is no evidence of central pulmonary embolism. the visualization of more peripheral branches is limited due to patient motion, suboptimal contrast bolus, and contrast flow artifact; the segmental and subsegmental pulmonary arteries cannot be reliably assessed for pulmonary embolism. 2. mild bibasilar atelectasis. 3. new small pleural effusions. ct abd/ pelvis: 1. no retroperitoneal hematoma. no acute intra-abdominal abnormality on this non-contrast ct. 2. bibasilar dependent consolidation, probably atelectasis. ct lower extremities: 1. no acute fracture. 2. no hematoma identified. 3. slight enlargement of the right lower extremity when compared to the left. there is subcutaneous swelling and edema most prominent along the right lateral thigh. 4. degenerative changes as described above. brief hospital course: ms is a 46yof with h/o hx of traumatic brain injury and developmental delay, hep c, dmii and pseudoseizures, on coumadin since for persistant lle dvt, who presents with pain in rle and subjective fever/chills, 2 days after a fall. . # tachypnea: on initial presentation to the micu, the patient was tachypneic with a score is 6, putting her at high risk for pe. she was not hypoxic, but given her history of lle dvt, as well as her sinus tachycardia, the patient underwent cta while on the general medicine floor, which was negative for any central pulmonary embolus. . # rle pain/erythema: while in the micu, the patient was started on vanc/unasyn for possible cellulitis. ortho was also following her and doing serial compartment checks. she also had a r leni, which was negative for any dvts. the patient also had a ct pelvis and extremities to evaluate for any rp bleed or bleeding into thigh that could account for this pain, given her elevated inr on presentation; both were negative. . on transfer to the general medicine floor, it was decided to stop the vanc/unasyn as there was low clinical suspicion for cellulitis based on exam. the patient continued to elevated her rle. she was initially pain controlled with oxycodone and tylenold; but because of her increased lethargy on arrival to the floor, the patient's narcotics were d/ced and her pain was controlled on tylenol. upon discharge, her pain was resolved. she also was seen by pt while in patient. . # supratherapeutic inr: the patient is anticoagulated for her chronic lle dvts. she was found to have an inr of 24 in the ed, and after getting 10 mg vitamin k iv in the ed, her repeat inr was down to 2.4. possible that this was a spurious result. the patient was evaluated for evidence of rp bleed, or bleeding into extremities with ct, which were negative. she was also initially followed by ortho out of concern for compartment syndrome. on transfer to the floor, the patient's inr was subtherapeutic and the patient's coumadin was increased to 4mg daily. the patient's inr was 1.9 at the time of discharge and was continued on her coumadin 4mg daily. she will need to follow up in coumadin clinic for inr monitoring and dose adjustments after rehab. . # acute kidney injury: the patient has a baseline creat of 0.8, and on admission, creat found to be 1.3. likely prerenal and after fluids, her creat had returned to her baseline. . # fever of unclear etiology: after being called out from the micu, the patient had fever of unclear etiology, with temperatures ranging from 100.5 to ~101. she had a negative infectious work up, including, blood cultures, urine cultures, echo, cdiff; her picc line was also pulled. cmv, ebv, and parvo virus labs were also were sent, as it was thought that a viral syndrome could have accounted for her fevers and her anemia (see below). ebv demonstrated past infection and cmv and parvo were pending at the time of discharge. . although no source was ever found, the patient remained afebrile for 96 hours prior to discharge from hospital. . # lactic acidosis: the patient was found to have lactate of 6.6 on admission with unclear etiology. possible that this could have been do to some underlying infection, but no source of infection was indentified. more likely, however, is that lactic acidosis occurred secondary to metformin use in the setting of acute kidney injury due to dehydration. the patient's metformin was held while in patient and she was given fluids in the micu. upon transfer to the medicine floor, the patient's lactic acidosis had resolved. her metformin was held during the hospitalization. upon discharge, the patient's creat had normalized, and she was discharge on a insulin sliding scale. here outpatient primary care provider should determine if she should be restarted on metformin. . # anemia: the patient has baseline crit in the high 30s, with most recent crit in our system from at 38.0. on presentation crit was found to be 27 and downtrended in the micu as low as 21, with no active source found. in the setting of her elevated inr, ct abdomen and extremities were done to rule out any hematomas, or rp bleed that could account for crit drop. iron studies, b12, folate, and hemolysis labs were all normal although these were obtained after 1 unit of blood was given. the patient was found to have guaic positive brown stool in the ed. she was also found to have inappropriately low retic count. . on transfer to the floor, the patient had anemia work up that included egd, capsule endoscopy, and colonoscopy by gi. the patient did not have any possible sources of bleeding, as per gi. the patient had an inappropriately low retic count, and her peripheral smear was viewed which did not show significant evidence of schistocytes or teardrop cells. spep/upep was also within normal limits. . # left radial head fracture: pt was seen for fall on and found to have have left radial head fracture. as per her clinic appt, no acute intervention was indicated, and her pain was controlled as above. . # epilepsy: the patient follows with neurology at ; while in patient she was continued on her home gabapentin, divalproax, and lorazepam. . # anxiety/psychotic disorder: the patient's mood has been stable while in patient; she was continued on risperdal, amitryptiline, and lorazepam at home doses. . #dm last a1c 6.0% in . on metformin at home, was stop due to lactic acidosis (see above) and acute illness and put on hiss. . #hep c - no evidence of decompensation. it is unclear if she would be a candidate for therapy given possible difficulties with compliance and psychiatric history. hcv viral load in was 31,000 iu/ml. .. transitional issues: - liver follow-up: the patient was instructed by her pcp to follow up in the liver clinic in regards to her hep c; another appointment was set up for her to follow with liver as an outpatient. - metformin induced lactic acidosis: it is possible that the patient's initial lactic acidosis was secondary to metformin use in the setting of acute kidney injury. her metformin was not restarted upon discharge. - rehab for a less than 30 day stay for evaluation and treatment. medications on admission: acetaminophen-codeine - 300 mg-30 mg tablet - 1 tablet(s) by mouth q4-6 br6700377 albuterol sulfate - 90 mcg hfa aerosol inhaler - 1 puff ih q4-6 as needed for wheeze, cough albuterol sulfate - (prescribed by other provider) - dosage uncertain amitriptyline - (prescribed by other provider) - 10 mg tablet - 2 tablet(s) by mouth at bedtime ciclopirox - 0.77 % cream - apply to soles of feet twice a day as directed. compression stocking - - apply one large compression stocking to right calf daily with activity divalproex - (prescribed by other provider) - 500 mg tablet extended release 24 hr - 1 tablet(s) by mouth twice a day ergocalciferol (vitamin d2) - 50,000 unit capsule - 1 capsule(s) by mouth qweekly once a week for 6 weeks fluticasone - 50 mcg spray, suspension - 1 spray in twice a day gabapentin - (prescribed by other provider) - 400 mg capsule - 1 capsule(s) by mouth twice a day lorazepam - 1 mg tablet - 1 tablet(s) by mouth at bedtime at night metformin - (prescribed by other provider) - 500 mg tablet - 1 tablet(s) by mouth twice a day risperidone - (prescribed by other provider) - 4 mg tablet - 1 tablet(s) by mouth twice a day tolterodine - 2 mg capsule, ext release 24 hr - 1 capsule(s) by mouth daily warfarin - 2 mg tablet - take up to 3 tablet(s) by mouth daily or as directed by coumadin clinic acetaminophen - 500 mg tablet - 1 tablet(s) by mouth every six (6) hours as needed for pain; do not exceed mg/day blood sugar diagnostic - strip - use to monitor your blood sugar up to 4 times a day or as directed blood-glucose meter - kit - use as directed to monitor blood glucose twice daily and as needed docusate sodium - 100 mg capsule - 1 capsule(s) by mouth twice a day lancets - misc - use as directed to monitor your blood sugar up to 4 x per day as directed sennosides - 8.6 mg tablet - 1 tablet(s) by mouth twice a day as needed for constipation discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation q6h (every 6 hours) as needed for sob or wheeze. 2. amitriptyline 10 mg tablet sig: two (2) tablet po hs (at bedtime). 3. ciclopirox 0.77 % cream sig: one (1) topical twice a day: apply to soles of feet twice daily. 4. divalproex 500 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po bid (2 times a day). 5. acetaminophen 500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain: do not exceed 4 gm in 24 hours. 6. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 7. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 8. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). 9. fluticasone 50 mcg/actuation spray, suspension sig: one (1) nasal twice a day. 10. gabapentin 400 mg capsule sig: one (1) capsule po bid (2 times a day). 11. lorazepam 1 mg tablet sig: one (1) tablet po hs (at bedtime). 12. risperidone 2 mg tablet sig: two (2) tablet po bid (2 times a day). 13. warfarin 4 mg tablet sig: one (1) tablet po tue, wed, , sat, sun: adjust for goal inr . 14. warfarin 3 mg tablet sig: one (1) tablet po monday, friday: adjust for goal inr . 15. insulin lispro 100 unit/ml solution sig: one (1) injection w meals subcutaneous asdir (as directed): per sliding scale . 16. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 17. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). discharge disposition: extended care facility: rehabilitation & care center - discharge diagnosis: primary diagnosis: metformin induced lactic acidosis anemia secondary diagnosis: traumatic brain injury diabetes type ii discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms. , it was a pleasure taking care of you while you were hospitalized at . you were admitted to the hospital because you were not feeling well at home; in the emergency room, there was concern you had a leg infection and some of your other blood markers were elevated. because of this, you were initially admitted to the intensive care unit. while you were in the intensive care unit, you were started on antibiotics. your antibiotics were stopped when there was no sign of any infection in your leg. you had fevers and we did not determine the cause. your fevers resolved on their own and no source of infection was found. you also had low blood counts. you had no sign of any bleeding and all your studies were normal. we made the following changes to your medications: -stopped metformin -stopped tolterodine -started insulin sliding scale -started pantoprazole 40 mg by mouth daily it is very important that you follow up with your outpatient doctors (see below for appointments). followup instructions: department: liver center when: thursday at 3:00 pm with: , md building: lm bldg () campus: west best parking: garage department: div. of gastroenterology when: wednesday at 2:00 pm with: , md building: ra (/ complex) campus: east best parking: main garage name: , md location: /east address: , e/cc-6, , phone: please discuss with the staff at the facility a follow up appointment with your pcp when you are ready for discharge. procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine closed [endoscopic] biopsy of large intestine diagnoses: acidosis acute posthemorrhagic anemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified viral hepatitis c without hepatic coma unspecified fall dysthymic disorder long-term (current) use of anticoagulants fever, unspecified personal history of venous thrombosis and embolism closed fracture of head of radius other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy lack of normal physiological development, unspecified 

Answer: The patient is high likely exposed to