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: altered mental status, drug overdose (?flexeril) major surgical or invasive procedure: fasciotomy of lle anterior compartment debridement lle placement of tunneled hd catheter by ir intubation history of present illness: 47yo female h/o depression with past suicide presenting s/p overdose of flexeril. per report patient was found "asleep" on couch by boyfriend. unclear how long had been unattended (~24hr). boyfriends empty flexeril bottle found next to patient. unclear how many pills were ingested. ems administered narcanx3. initially presented to an osh. intubated for airway protection. started on levophed for persistent hypotension. labs creatinine 3.9, k: 5.8, wbc 17 with 21% bandemia. ck 51k. utox + methadone. r ij as well as 3 peripherals placed for access. received 9l of ns, vanc, zosyn for presumed aspiration. started on nac bolus + ggt for planned 24hr though tylenol negative. patient transferred to ed, initial vs: afebrile, 112hr, 112/61 (map 73) on 0.5 levophed, 70% 400/14/30. sedated on fentanyl and versed. labs with k: 6.7. kayxelate administered. no qt prolongation, no peak twaves. nabicarb not started. cxr c/w ards and patient started on ards net protocal. review of systems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain, or changes in bowel habits. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. denies rashes or skin changes. past medical history: depression with past suicide attempts social history: history of heavy alcohol abuse smokes 1 ppd lives with her boyfriend family history: unknown physical exam: admission exam: t 97.4 hr 110 bp 118/68 rr 24 o2 sat 98% on cmv with peep of 15 vt 400 gen: intubated, non-responsive heent: sclera anicteric, mmm, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema discharge exam: afebrile, hr 90s; bp 130-150s; rr 18; 95%ra general - well-appearing f in nad, comfortable heent - nc/at, perrla, eomi, sclerae anicteric, mmm, op clear neck - supple, no jvd, no carotid bruits lungs - ctab, no crackles, rhonchi, wheezes heart - rrr, no mrg, nl s1-s2 abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - lle s/p fasciotomy, wound d/c/i, surrounding erythema and swelling decreased, wound healing, in cast with windows. sutures taken out. both lower extremities warm, well-perfused neuro - no gross deficiency, aaox3, appropriate skin - erythema surrounding suture overlaying hd line resolved, now only around suture, non-tender, no drainage pertinent results: admission labs 02:00am blood wbc-6.9 rbc-4.18* hgb-11.6* hct-37.6 mcv-90 mch-27.8 mchc-30.9* rdw-14.8 plt ct-191 02:00am blood neuts-84* bands-6* lymphs-4* monos-2 eos-0 baso-0 atyps-0 metas-4* myelos-0 05:28am blood pt-11.5 ptt-22.3* inr(pt)-1.1 05:28am blood glucose-143* urean-39* creat-3.5* na-143 k-7.2* cl-115* hco3-16* angap-19 02:00am blood alt-138* ast-397* ck(cpk)-* alkphos-64 totbili-0.2 05:28am blood lipase-18 05:28am blood probnp-1254* 03:18pm blood ck-mb-greater th ctropnt-0.03* 04:49am blood ctropnt-0.02* 05:28am blood calcium-6.0* phos-6.3* mg-1.9 02:00am blood albumin-3.1* 08:29am blood osmolal-310 08:29am blood hbsag-negative hbsab-negative hbcab-negative 02:00am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-pos 08:29am blood hcv ab-negative 02:08am blood type-art rates-24/0 tidal v-500 peep-10 fio2-70 po2-66* pco2-46* ph-7.12* caltco2-16* base xs--14 -assist/con intubat-intubated 02:20am blood glucose-115* na-143 k-6.7* cl-118* calhco3-14* pertinent results 02:00am blood alt-138* ast-397* ck(cpk)-* alkphos-64 totbili-0.2 05:28am blood alt-151* ast-435* ck(cpk)-* alkphos-65 totbili-0.2 03:18pm blood alt-146* ast-481* ck(cpk)-* alkphos-63 totbili-0.4 04:49am blood alt-154* ast-492* ld(ldh)-871* ck(cpk)-* alkphos-78 totbili-0.3 12:01am blood fibrino-826* 04:49am blood ctropnt-0.02* 03:18pm blood ck-mb-greater th ctropnt-0.03* 03:09am blood lipase-29 05:28am blood lipase-18 08:46am blood caltibc-260 ferritn-201* trf-200 05:48am blood caltibc-217* ferritn-137 trf-167* 03:40pm blood hapto-359* 03:03pm blood vanco-18.4 07:00am blood vanco-16.3 discharge labs: 06:36am blood wbc-8.8 rbc-2.89* hgb-8.3* hct-24.9* mcv-86 mch-28.7 mchc-33.4 rdw-16.2* plt ct-340 06:36am blood glucose-92 urean-33* creat-8.0*# na-137 k-4.2 cl-96 hco3-27 angap-18 06:36am blood calcium-9.1 phos-6.5* mg-2.1 micro: blood culture x2 pending urine culture negative sputum culture negative clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). imaging: ct head 1. no evidence of hemorrhage, large vessel territorial infarction, or shift of normally midline structures. 2. the sulci are not clearly delineated. while this may be a normal finding in a brain without atrophy, given the patient's clinical status, diffuse cerebral edema cannot be excluded. the cerebellar tonsils are slightly low-lying. correlate clinically. an mri may be obtained for further characterization if necessary if there is no ci . cxr as compared to the previous radiograph, there is improvement with reduction of the bilateral parenchymal opacities. however, there is still evidence of moderate fluid overload, cardiomegaly, and likely a small left pleural effusion. the presence of an additional, aspiration related change at the right lung base cannot be excluded. no pneumothorax. the monitoring and support devices are in constant position. cxr an et tube is present, 4.1 cm above the carina. an ng tube is present, extending beneath the diaphragm, off the film. there is cardiomegaly. there is increased retrocardiac density with air bronchograms and obscuration of the left hemidiaphragm, consistent with left lower lobe collapse and/or consolidation. there is some patchy right perihilar and infrahilar opacity and upper zone re-distribution. this may all represent chf, though a superimposed pneumonic infiltrate on the right is difficult to exclude. possible small left effusion. right costophrenic sulcus clear. compared with , the right base consolidation is slightly improved. left lower lobe consolidation slightly worse. pulmonary edema is unchanged. possible small left effusion, unchanged. cxr the et tube is present, 5.0 cm above the carina. an ng tube is present, tip extending beneath the diaphragm, overlying the stomach. a dual-lumen right ij catheter is present, with lead tips over distal svc and upper right atrium. a left-sided picc line is present, tip over proximal svc. there are low inspiratory volumes, with pulmonary vascular plethora, consistent with chf. there is increased retrocardiac density, consistent with left lower lobe collapse and/or consolidation. the possibility of small effusions cannot be excluded. cxr : indings: in comparison with the study of , the nasogastric tube extends to the mid body of the stomach. side hole is distal to the esophagogastric junction. there is continued enlargement of the cardiac silhouette with some decrease in pulmonary vascular congestion. the monitoring and support devices remain in place. cxr : previous heterogeneous opacification in the right lung which improved from through has not improved subsequently, consistent with persistent multifocal pneumonia. additionally, mild pulmonary edema most readily detected in the left lung, continues to improve. heart is top normal size, decreased. small right pleural effusion remains. no pneumothorax. left picc line ends alongside a dual-channel right supraclavicular central venous catheter in the mid-to-low svc. no pneumothorax. brain mri : impression: no significant abnormalities on mri of the brain. no evidence of acute or subacute infarct seen. no evidence of mass effect or brain herniation identified. ct left leg w/o contrast : impression: 1. generalized ill defined low attenuation appearance of the muscles of the deep compartment of the left calf, likely the sequela of known previous compartment syndrome. diffuse intramuscular hemorrhage interleaving between the soleus muscle fibers could also give this appearence although this is felt to be less likely. 2. no evidence of a localized hematoma or other discrete left lower extremity fluid collection. : hd line site ultrasound: impression: edematous soft tissues at the patient's hd tunnel line, consistent with cellulitis. no free fluid identified. blood cultures from , , negative urine culture from negative 9:00 am sputum source: endotracheal. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram negative rod(s). respiratory culture (final ): sparse growth commensal respiratory flora. c. diff toxin negative on blood culture from no growth at thte time of discharge. brief hospital course: 47 y/o female with h/o depression found unresponsive, ? flexeril overdose (found empty bottle next to the bed), with renal failure requiring hd secondary to rhabdomyolysis or atn, respiratory failure secondary to ams and pneumonia s/p extubation, compartment syndrome s/p fasciotomy, waxing/ delirium now resolved. # delirium: patient with waxing/ mental status. likely multifactorial, related to pain, icu delirium and benzo-intoxication. ct head at time of admission showed potential cerebral edema, concerning for hypoxic injury while patient was unconsious. mri brain w/o significant abnormalities. also may have etoh abuse so treated with iv thiamine x 7 days, followed by po thiamine. in the micu, patient required precedex for ongoing delirum, started . she had scheduled ativan in case of withdrawal from benzos or alcohol, then transitioned to valium which was tappered from 10mg q6h by 25% daily. also received prn 5mg iv haldol for agitation. seroquel initially started at 25mg tid and uptitrated to 100mg tid, but eventually dced once patients mental status improved to baseline after coming out of the icu. patient kept npo while delirious. mental status cleared a few days after leaving the micu and was able to stop all benzodiazepines, haldol and seroquel. # hypertension: sbp 140-160s on hd days, but as high as 170s on other days. patient with no history of htn. new htn likely ckd and some volume overload and anxiety. started on amlodipine 5mg daily. # hd line infection vs cellulitis: erythema overlying hd line tunnel. initially started near suture site, now tracking along the tunnel. no drainage. ? cellulitis vs skin irritation. patient has been on vanc or cefazolin since admission when erythema developed. planned to cover with keflex for cellulitis x1 week (starting ) and then stop and monitor site at hd center. ultrasound hd tunnel area w/o abscess, c/w cellulitis. keflex 500mg (last day ), to be taken after hd on hd days. # alcohol abuse/withdrawal: patient has a long hx of alcohol abuse. given non-responsiveness, give ativan throughout initial days in house based on vital signs, for tachycardia and hypertension. after extubation, she was very agitated and tachycardic, thought to be a component of alcohol withdrawal, and was thus treated with ativan, then converted to diazepam, then tappered (see above). # hypoxic respiratory failure/pneumonia. possible etiology includes /ards secondary to opioids or naloxone vs aspiration (?rll opacity) vs pulmonary edema vs infection. can occur with opioids, possibly with use of naloxone, which can cause a rapid surge of catecholamines occurs in the setting of withdrawal which leads to increased afterload and increased interstitial edema. given the patient??????s leukocytosis and bandemia, (osh labs notable for wbc 17 with 21% bands) also because of cxr findings concerning for ?aspiration or infection, the patient has been initiated on empiric vancomycin (renally dosed) and zosyn, which she received 5 days of. her ventilator settings were set via ardsnet protocol. cultures were consistently negative and her abx were discontinued. she was subsequently extubated on . on , she had episode of tachypnea, diaphoresis and fever, cxr revealed worsening bilateral opacifications and, although she had completed the initial empiric course of vanc/zosyn, she was continued on vanc and cefepime for coverage for vap (extubated on ). also likely component of fluid overload, which is being managed by hd. completed vanc/cefepime x 8 days for vap. # flexeril overdose/suicide attempt- events unwitnessed, but patient found down by her boyfriend with bottle of empty flexeril. does endorse depression and says she is not surprised taht she overdosed. flexeril has similar toxicity to tcas. the patient had ekgs and was monitored on telemetry for qrs widening and sodium bicarbonate was given. patient evaluated by psychiatry and initially placed on section 12 with 1:1 sitter once patient extubated and awake. towards discharge, patient denied si, and psychiatry thought she was safe to be off section 12. best team set up partial day program in , to start on . # . unknown baseline creatinine, but no h/o ckd. etiology likely multifactorial secondary to rhabdo/ atn (initially presented with hypotension). dialysis initiated on . s/p tunneled line placement. currently hd-dependant. course unclear, patient may or may not recover kidney function. started on sevelamer, nephrocaps, calcium acetate. plan to start iv iron at hd center, followed by po iron. also getting epo with hd. # compartment syndrome: pt had pain out of proportion (although she was sedated and not responsive, she became agitated) with palpation of her lle in the am of . ortho consult was called and the patient was diagnosed with compartment syndrome. fasciotomy on , complete resection of anterior compartment (secondary to extensive necrosis) on . patient likely will have permanent foot drop. orthopedic tech saw patient and fitted -valve cast with foot in the neutral position to prevent foot drop, then re-made cast with windows for wound care. there was initially concern of bleeding (unexplained anemia), but ct lle on without evidence of bleed. sutured dc'd on prior to discharge. follow up with orthopedic surgery on . follow up with outpatient pt on . # anemia: hct low, with 3 unit prbc transfused this admission. likely 2/2 blood loss from or, also from renal failure. iron studies suggest iron deficiency. hemolysis and dic labs negative. ct lle without evidence of hematoma. started epo with dialysis and iv iron to be started at outpatient hd, followed by po iron. # transitional issues: follow up (see attached) - psych partial program in (to start ) - hemodialysis (to start ) - outpatient pt () - orthopedics () - pcp follow up final blood culture results medications on admission: none (previously on ssris, but no current meds) discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 tab* refills:*0* 2. sevelamer carbonate 800 mg tablet sig: three (3) tablet po tid w/meals (3 times a day with meals). disp:*270 tablet(s)* refills:*0* 3. cephalexin 500 mg capsule sig: one (1) capsule po q12h (every 12 hours) for 2 days: last day ; on days of hemodialysis, take medication after dialysis session. disp:*4 capsule(s)* refills:*0* 4. outpatient physical therapy please provide physical therapy for patient given recent left lower leg fasciotomy secondary from compartment syndrome. 5. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). disp:*180 capsule(s)* refills:*0* 6. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: flexeril overdose rhabdomyolysis acute kidney injury delirium compartment syndrome pneumonia anemia cellulitis depression suicide attempt discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: dear ms. , it was a pleasure participating in your care at . you were admitted because you were found unconscious with a question of flexeril overdose. due to being unconscious for an unknown amount of time, you had muscle breakdown in your left leg, which was treated with surgerical debridement. you will continue with outpatient physical therapy. you also had kidney failure, and were started on hemodialysis, which will continue as an outpatient. we also treated you with several blood transfusions for anemia. you will continue treatment for depression at an outpatient psychiatric facility (see below) we made the following changes to your medications: started nephrocaps started sevelamer started calcium acetate started keflex (last day ) started amlodipine you will received intravenous iron at dialysis, and after that, your nephrologist may start oral iron pills followup instructions: tuesday - dialysis center 237- tel: nephrologist: dr. (office 1-) after , you will have dialysis tuesday, thursday, saturday at 3:00pm wednesday 9:00 am -partial program , ( * in case of emergency, you can call emergency services or name: np department: womens health internal medicine location: greater chc address: , , phone: appointment: tuesday 2:00pm department: orthopedics when: tuesday at 11:40 am with: ortho xray (scc 2) building: sc clinical ctr campus: east best parking: garage department: orthopedics when: tuesday at 12:00 pm with: , np building: campus: east best parking: garage name: , department: obgyn address: , , phone: appointment: wednesday 2:30pm *please arrive for this appointment at 2:00pm and remember to bring your insurance card as well as a photo id with you. department: rehabilitation services when: friday at 11:00 am with: , mspt building: campus: east best parking: garage procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis fasciotomy other myectomy other myectomy diagnoses: acidosis hyperpotassemia acute kidney failure with lesion of tubular necrosis cellulitis and abscess of trunk acute posthemorrhagic anemia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified depressive disorder, not elsewhere classified chronic kidney disease, unspecified acute respiratory failure pneumonitis due to inhalation of food or vomitus kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure ventilator associated pneumonia other and unspecified alcohol dependence, unspecified delirium due to conditions classified elsewhere rhabdomyolysis suicide and self-inflicted poisoning by other specified drugs and medicinal substances alcohol withdrawal other acquired deformities of ankle and foot nontraumatic compartment syndrome of lower extremity other fluid overload poisoning by skeletal muscle relaxants local infection due to central venous catheter 

Answer: The patient is high likely exposed to