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: tegretol / haldol / risperidone attending: chief complaint: acute renal failure secondary to antibiotics major surgical or invasive procedure: none history of present illness: 41yo female with bipolar d/o, heroin use in past, h/o mrsa, recent hep c, recent history of septic joint s/p debridment p/w acute renal failure. pt first presented to on with question of septic arthritis of r ankle. pt underwent r. calcaneus irrigation and debridement, removal of hardware, bone biopsy of r. calcaneus, and arthrotomy right ankle, irrigation and debridement. cultures from this procedure with + mrsa and enterobacter cloacae. on , pt was started on iv vancomycin. on , pt had picc line placed and when advised that she would need to go to a rehab for 4-6 weeks of iv antibiotics, refused to be discharged to a rehab. after lengthy discussion, pt was discharged on oral cipro 750 mg po bid and oral linezolid 600 mg po bid. she was seen for f/u on with dr. . mitty and had safety labs drawn at that time. her discharge bun/cr on was 16/0.7 and repeat labs from yesterday with bun/cr: 33/4.5, platelets also slightly low at 116. pt was contact but did not want to come to hospital initially. she was seen in clinic today, foot okay from ortho perspective, sent to ed for arf. patient knew that her renal function was worsening, although didn't know progression rate. cr 3.6 today. patient reports tired. pt also reports diarrhea with soft stool since discharge, stool moved from to brown color, the episode occurs in the morning, reports no odor/blood. report positive cough since last admission, productive with rare brownish sputum, endorses 25 ppy history of smoking. patient also report rashes on the elbows b/l, believes that the rash is from crawling on the floor to the bathroom (goes to bathroom to urinate 3-4x per night). no change in urine amount, color, frequency from baseline. . in the ed, initial vs were: t98.1 p72 bp108/82 r18 o2 sat97% ra. patient was given ivf. . on the floor, pts vital signs were stable. tired and sleepy from the day. . review of sytems: . (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. . past medical history: mva in with resultant r. calcaneal fracture, r. femur fracture, r. femoral neck fracture with rod implantation and l. radius fracture bipolar substance abuse (heroine - 5-6yrs use, quit 2 years ago on suboxone) + mrsa screen in hep c social history: social history: + ivdu (heroin), + thc, + smoking, denies etoh, no travel lives in urban area, no insect bites, 1 cat, 10 lifetime sexual partners, denies hiv but notes "hep b exposure". family history: mo- emphysema fa - etoh and drug abuse physical exam: physical exam: vitals: t:97.8 bp:98/56 p:60 r: 18 o2:100% ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear, perrl, eomi, skin scratchs on chin and forhead neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema, + suture, well healed posteriorly to the lateral ankle and anterior-medially on the right ankle, without any signs of infection/bleed, r foot is mildly edematous 1+ to the ankle. neuro: a/ox3, cns intact, strength and sensation intact throughout, 2+ dtrs, . pertinent results: 12:50pm blood wbc-5.9 rbc-3.34* hgb-11.4* hct-34.2* mcv-102* mch-34.1* mchc-33.4 rdw-14.2 plt ct-104* 12:50pm blood neuts-62.6 lymphs-29.2 monos-4.6 eos-3.0 baso-0.6 07:10am blood wbc-4.7 rbc-2.54* hgb-8.5* hct-25.5* mcv-100* mch-33.5* mchc-33.4 rdw-15.9* plt ct-161 07:10am blood plt ct-161 05:43pm blood hypochr-normal anisocy-1+ poiklo-occasional macrocy-2+ microcy-normal polychr-normal tear dr 12:50pm blood plt ct-104* 01:10pm blood esr-85* 01:10pm blood ret aut-0.6* 07:40am blood vitb12-312 folate-6.5 hapto-112 06:05am blood tsh-0.42 01:10pm blood crp-4.6 12:40pm blood c3-137 c4-32 06:18am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-pos barbitr-neg tricycl-neg 12:50pm blood lipase-28 12:50pm blood alt-24 ast-30 alkphos-61 totbili-0.3 12:40pm blood ck(cpk)-22* 07:40am blood ld(ldh)-182 12:50pm blood glucose-81 urean-31* creat-3.6* na-137 k-5.5* cl-103 hco3-26 angap-14 07:10am blood glucose-114* urean-10 creat-1.2* na-138 k-3.7 cl-103 hco3-28 angap-11 08:21pm urine bnzodzp-pos barbitr-neg opiates-pos cocaine-neg amphetm-neg mthdone-neg 09:11pm urine hours-random urean-252 creat-46 na-65 totprot-less than 09:11pm urine eos-negative 02:25pm urine rbc-* wbc-0-2 bacteri-few yeast-occ epi-0-2 hcv genotype (final ): hepatitis c genotype, 1. performed by invader assay. this assay detects the six major hcv genotypes 1, 2, 3, 4, 5, & 6.. this test was developed and its performance characteristics were determined by the clinical microbiology laboratory. it has not been cleared or approved by the u.s. food and drug administration. the fda has determined that such clearance or approval is not necessary. this test is used for clinical purposes. it should not be regarded as investigational or for research. hcv viral load (final ): 17,900,000 iu/ml. performed using the cobas ampliprep / cobas taqman hcv test. detection range 43 - 69,000,000 iu/ml. as of , hcv viral load is performed by the fda-approved, cobas ampliprep-taqman assay, replacing the hcv asr assay previously developed and validated by the microbiology laboratory. urine culture (final ): yeast. <10,000 organisms/ml. chest (pa & lat) impression: mild interstitial edema. no radiographic evidence of pneumonia. renal u.s. impression: normal renal ultrasound. liver or gallbladder us (single organ) impression: 1) no focal parenchymal abnormality is identified in the liver. no imaging findings to suggest hepatic cirrhosis. 2) borderline enlargement of the spleen. brief hospital course: assessment and plan: this is a 41yo female with bipolar d/o, heroin use in past, h/o mrsa, recent hep c, recent history of septic joint s/p debridment p/w acute renal failure. . # arf: this is due to her po antibiotic for her septic joint, likely due to the prolong course of ciprofloxacin and linezolid. renal us showed within normal limits. after iv hydration, her creatinine plateaued around 1.2 - 1.3. infectious disease recommended iv vancomycin and ceftriaxone renally dosed for the patient (roughly 4 wks). paitent had a picc placed on in anticipation for discharge to rehab. she will have to follow up with her infectious disease doctor on the , at which time the duration of her iv antibiotic treatment will be reassessed. if she leaves ama from her rehab, picc should be discontinued. she will not be able to get any po antibiotics but she should follow up with infectious disease doctors. . # r. ankle s/p drainage: her wound was well healed. orthopedics followed and evaluated her ankle. they removed the sutures and will follow her as on outpatient on . her pain was well controlled on oxycodone 5mg q4h prn. . # respiratory depression due to heroin use: patient had an episode of respiratory depression secondary to heroin use. this event was due to patient's inability to cope with her diagnosis of hep c and her other medical issues. after this episode she had a short stay in the micu(see micu course). patient was stable after transferring back to the floor. her neurotin and valium were titrated up to alleviate anxiety with a good response. she saturated well on room air. she was maintained on no visitors for the stay of her hospitalization. . #micu course: on , patient had an associate inject heroin into her, and became cyanotic and apnic for one minute. she was bagged and resumed spontaneous breathing, but remained lethargic throughout the night. she was transferred to the micu overnight for observation. she remained stable from a respiratory standpoint. oxycodone was held and she was given tylenol for pain. addiction services and social work were consulted. - continue seroquel, valium, and oxycodone . # bipolar: her symptoms are currently stable. she should continue home medications renally dosed - on gabapentin, aripiprazole, quetiapine. . # anxiety/muscle spasm: she is stable on diazepam 10mg. . # hep c infection: she is very distressed by her recent diagnosis of hep c infection (viral load 18 million, type 1). rus showed normal liver anatomy and no lft changes. pt did not follow up with liver clinic since last admission. she will need an outpatient follow up with the liver clinic. . # macrocytic anemia: she had macrocytic anemia with elevated mcv is elevated, appears to be baseline to . b12 and folate are within normal range. her blood smear showed occasional tear drop cells, with expected macrocytes of unequal shape and size. retic count was inappropriately low. tsh level was wnl. she was given empirical vit b12 repletion. she should follow up as outpatient with hematology (b12 is 312, likely will benefit from mma testing). . # fen: no ivf, replete electrolytes, renal diet . # prophylaxis: subcutaneous heparin, ambulate . # access: picc, peripherals . # code: full . # communication: patient medications on admission: medications (d/c summary from ): 1. aripiprazole 15 mg tablet sig: one (1) tablet po daily (daily). 2. gabapentin 300 mg capsule sig: two (2) capsule po tid (3 times a day). 3. hydromorphone 4 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. disp:*175 tablet(s)* refills:*0* 4. diazepam 10 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for spasm and anxiety. disp:*56 tablet(s)* refills:*0* 5. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours). 6. oxycodone 10 mg tablet sustained release 12 hr sig: one (1) tablet sustained release 12 hr po q12h (every 12 hours). disp:*28 tablet sustained release 12 hr(s)* refills:*0* 7. linezolid 600 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 1 weeks. disp:*14 tablet(s)* refills:*0* 8. quetiapine 25 mg tablet sig: two (2) tablet po bid (2 times a day). 9. ciprofloxacin 250 mg tablet sig: three (3) tablet po q12h (every 12 hours) for 2 weeks. disp:*84 tablet(s)* refills:*0* discharge medications: 1. senna 8.6 mg tablet sig: one (1) tablet po twice a day as needed for constipation. 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. aripiprazole 15 mg tablet sig: one (1) tablet po daily (daily). 4. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 5. nicotine 21 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 6. quetiapine 25 mg tablet sig: one (1) tablet po qpm (once a day (in the evening)). 7. quetiapine 25 mg tablet sig: 0.5 tablet po qam (once a day (in the morning)). 8. cyanocobalamin 500 mcg tablet sig: two (2) tablet po daily (daily). 9. gabapentin 300 mg capsule sig: one (1) capsule po tid (3 times a day). 10. diazepam 5 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for anxiety. 11. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours). 12. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain fever. 13. vancomycin 1,000 mg recon soln sig: one (1) intravenous every twelve (12) hours for 2 weeks. 14. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: one (1) intravenous once a day for 2 weeks. 15. 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. 16. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. 17. outpatient lab work weekly cbc with diff, bun, creatinine, and vancomycin troughs all laboratory results should be faxed to infectious disease r.ns. at (. discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: 1. acute renal failure, now resolved 2. septic joint secondary: 1. bipolar disorder 2. anxiety 3. macrocytic anemia 4. thrombocytopenia, now resolved discharge condition: hemodynamically stable; ambulatory with crutches discharge instructions: you were admitted to the hospital for acute renal failure in the setting of being on long term antibiotics. it was likely the ciprofloxacin that caused this renal failure. we stopped this medicine and changed your treatment to vancomycin and ceftriaxone. your kidney function returned to . we found that you also had anemia with borderline normal vitamin b12. we provided you with vitamin b12. you had an episode of apnea during the hospitalization secondary to using heroin; for this you required a short stay in the intensive care unit. you remained without a fever and with stable blood pressure throughout your hospitalization. in addition, the infection in your ankle continues to improve. while you were in the hospital, your kidney function continued to improve. we were able to control your pain and cramps with oxycodone and valium. aside from the antibiotics, there were no other changes to your medications. please return to the hospital for any worsening leg pain, fevers, chills, chest pain, shortness of breath, nausea, vomitting, worsening diarrhea, decreased amount of urination, pain with urination or any other concerns. followup instructions: 1. please call your primary care doctor, dr. , to make a follow up appointment. call on monday to make this appointment. 2. please call the liver clinic at ( to make an appointment for further care of hepatitis c. 3. infectious disease. provider: , md phone: date/time: 9:00 4. clinic. provider: , md phone: date/time: 2:45 procedure: venous catheterization, not elsewhere classified diagnoses: thrombocytopenia, unspecified anemia, unspecified chronic hepatitis c without mention of hepatic coma acute kidney failure, unspecified other pulmonary insufficiency, not elsewhere classified other, mixed, or unspecified drug abuse, unspecified opioid type dependence, unspecified pyogenic arthritis, ankle and foot diarrhea methicillin resistant staphylococcus aureus in conditions classified elsewhere and of unspecified site bipolar disorder, unspecified other specified antibiotics causing adverse effects in therapeutic use other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms other and unspecified anti-infectives causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to