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: patient recorded as having no known allergies to drugs attending: chief complaint: headache major surgical or invasive procedure: egd history of present illness: mr. is a 56 yo m with no past medical history who presented to caritas at 2:30 pm on after taking "a handful" (according to osh records 25-100 pills) of tylenol ~ 30 hour prior presentation (3 days ago). he took tylenol for severe ha in the setting of family problems. denies any suicidal attempts or ideas. the next day after tylenol consumption, he vomited coffee ground emesis x 3 and had black stools x 2 and abdominal pain. . at the osh ed, he was given mom, activated charcoal and n-acetylcysteine and reglan. pt was admitted and monitored in a step down unit closely and continued on high dose n-acetylcysteine. gi was consulted for elevating lfts/coags and recommended a transfer to for liver transplant evaluation. for chest pain and mildly elevated troponin and ck in the setting of no ecg changes, cardiology was consulted. cards recommended an echo, asa, low dose bb for htn. . currently, pt only c/o mild headache and thirst. denies any f/c, stiff neck, chest pain ,sob, n/v, jaundice, abdominal pain, easy bruising or bleeding or n/v. he had 4 episodes of black stools yesterday with lactulose. at baseline, he denies any exertional cp or sob and works as a nurse assistance at a nursing home. past medical history: none social history: pack smoking x 20 years, quit 1 month ago. no etoh, no iv drug abuse. originally from and moved to the states in '. pt was born and raised in , emigrated to us 21 years ago. lives in , wife now lives in with a friend. sister is in and is supportive. pt was married once before, divorced many years ago but remains friendly with ex-wife. married for the second time 4 years ago, wife was in until 16 months ago. pt fears that she was using him for a green card, as her behavior changed dramatically when she came to the us. pt works 2 full-time jobs as a cna in 2 nursing homes. no children. family history: non-contributory physical exam: vitals: p 76, bp 138/79, rr 18, o2 98 on ra gen: nad, tired appearing male heent: icteric, perrl, eomi, dry mucus membrane neck: supple neck, jvp not elevated. cv: rrr with no m/r/g pulm: bibasilar crackles otherwise cta bilat abd: obese, soft, nt, nabs. pt had a bm and + guaiac positive ext: no edema, clubbing, cyanosis. 2+ dp bilaterally neuro: ao x 3. no asterixis. cn ii-xii intact, moves all ext without hindrance pertinent results: labs at osh: on wbc 12.5, hct 52.7, plt 293 na 137, k 4.1, cl 110, co2 16.4, bun 18, creat 1.4, glucose 102, ast 247, alt 476, tp 7.9, ablumin 4.8, pt 15.5. inr 1.8. ptt 34.4. . tylenol level: 87 (, 6 pm), 58.1 ( 10 pm), <10 () . inr trended up to 1.8-->2.1--> 2.9--> 4.6--> 4.9 on 16:00-> 3.3-> 2.6 ( 6am) ptt 35.1, 36.9, 38.4, 50.6, 44.2 plt 293--> 278--> 234--> 181-->131 --> 115 (5/29am) hct 52.7--> 50.5--> 47.5--> 46.9--> 43.2 -> 38.3 (5/29am) wbc 12.5--> 15.6--> 15.6--> 15--> 11.3 alt 475, , 6622, 4142, 2588 ( am) ast 247, , 5500, 7690, 7300 ( am) ammonia 93 on -> 67 am amylase 740 tuberculosis 2.8--> 1.8-->1.4 --> 1.0 (5/29am) creat 1.4-->1.2--> 1.3 -->1.1 ( am) ck 332--> 295--> 292--> 319-->330--> 308 (5/29am) ckmb 11.9-->11.4--> 10.4--> 9.3. -> 6 ( am) trop i 0.37, 0.37, 0.32, 0.26, 0.31 --> trop t 0.03 (5/29am) . 12:35am blood alt-7690* ast-4142* ld(ldh)-2418* ck(cpk)-308* totbili-0.8 06:10am blood alt-7300* ast-2588* ld(ldh)-1305* alkphos-76 totbili-1.0 04:23pm blood alt-5344* ast-1304* ld(ldh)-582* alkphos-74 totbili-1.9* 07:19pm blood alt-5225* ast-1048* alkphos-75 totbili-2.6* 05:25am blood alt-3698* ast-462* alkphos-68 totbili-2.6* 06:25am blood alt-2145* ast-113* alkphos-62 totbili-1.5 06:10am blood alt-1419* ast-51* alkphos-64 totbili-1.2 06:20am blood alt-996* ast-33 alkphos-63 totbili-0.8 06:20am blood alt-672* ast-26 alkphos-59 totbili-0.5 05:33am blood alt-476* ast-25 alkphos-59 totbili-0.5 . 06:25am blood hbsag-negative hbsab-positive hav ab-positive igm hbc-negative 06:10am blood igm hav-negative 07:19pm blood hiv ab-negative 06:25am blood hcv ab-negative 06:20am blood gastrin-pnd 05:17pm blood herpes simplex virus 1 and 2 antibody igm-pnd . tte : the left atrium is normal in size. the estimated right atrial pressure is 11-15mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). regional left ventricular wall motion is normal. tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). 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. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. impression: mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function.mild pulmonary artery systolic hypertension. . cxr : no prior for comparison. cardiac, mediastinal, and hilar contours are within normal limits. no pleural effusion or pneumothorax on this single view. lung fields appear clear. osseous structures also appear within normal limits. impression: no acute cardiopulmonary abnormality identified. brief hospital course: mr. is a 56 yo male with no significant transferred from osh for tylenol overdose and elevated lfts/coags and evaluation for liver transplant. . 1) hepatic failure: patient took a toxic/potentially lethal amount of tylenol (estimated at 15-30 grams) in the absence of complicating etoh use. tylenol level was 87 at time of presentation to outside hospital, approximately 30 hours following ingestion which is considered far above the level of concern for liver failutre according to the nomogram. he was treated with activated charcoal prior to arrival at our institution. he was transferred to the micu to be evaluated for possible liver transplant. he was evaluated by the hepatology service who felt that he did not meet yet criteria for transplant (ph <7.3 or inr >6.5 + arf + encephalopathy). toxicology consult was obtained who recommened to continue high dose n-acetylcysteine until normalization of his inr. inr trended down from 3.3 to 1.1 at the time of discharge. during the course of micu stay and following transfer to the medical service, liver function tests continued to improve/normalize. . 2) gi bleed: patient initially presented with coffee ground emesis and black tarry guiac-positive stools in the setting of elevated inr. he was started on ppi but no immediate intervention was performed given his elevated inr. evidence of gi bleed resolved with normalization of his inr, and an egd performed 2 days later did not reveal lesions of severe concern (see below). given his age and absence of prior colon cancer screening, he was recommened to undergo an outpatient screening colonoscopy. . 3) esophagitis: patient had daily low-grade fevers for duration of hospital course and also complained of pain with swallowing. he was observed to only consume a liquid diet secondary to pain. given history of coffee ground emesis as well as herpetic lesion noted on his upper lip, an egd was performed. this study revealed diffuse ulcerative esophagitis, ulcers in the antrum. and erythema and granularity of the duodenum. based on this finding, the following laboratory tests were performed: cmv antibody, ebv antibody, hsv 1,2 antibody, and gastrin level. in consideration of possible immunocompromised state, hiv antibody and viral load were sent. hiv antibody was negative. all other results were pending at the time of discharge. at time of discharge, he was tolerating a regular solid diet. . 4) chest pain: patient complained of chest pain at outside hospital and was found to have mildly elevated cardiac enzymes. ecg suggestive of la enlargement with possible lvh. ce leak likely due to demand in the setting of tylenol overdose and mild renal insufficiency and trended down with resolution of hepatic failure. no anginal or sob prior to tylenol overdose. tte revealed left ventricular hypertrophy with preserved systolic function. he was restarted on low-dose beta-blocker, but asa was held in the setting of melena and elevated inr. he has been recommended for an outpatient exercise tolerance test. . 4) depressive disorder, nos: patient reports tyelenol ingestion in the setting of a headache which was the result of family stressors. he denies that this was a suicide attempt, but demonstrated little insight into the severity of his actions and resulting illness. he was monitored closely with 1:1 sitter. he was followed by psychiatry for the duration of his hospital course given concern that this event was precipitated by intent to self-harm. following resolution of his medical issues, he was transferred to inpatient psychiatry unit for further evaluation and treatment. . 5) acute renal failure: creatinine was mildly elevated to 1.3 at time of admission, with electrolytes from outside hospital consistent with pre-renal etiology. creatinine improved to 1.0 with hydration. . 6) hypertension: low-dose beta-blocker was restarted with good control. medications on admission: medications on transfer from hospital: asa 325mg daily- on hold lopressor 12.5 mg q8 zofran 4mg iv q8/prn mucomyst 600 mg po q4 lactulose 30 ml tid normal saline 100cc/hr vitamin k 5 mg x 1 on discharge medications: 1. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 2. sucralfate 1 g tablet sig: one (1) tablet po qid (4 times a day). tablet(s) 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 6. lidocaine hcl 2 % solution sig: twenty (20) ml mucous membrane tid (3 times a day) as needed for swallowing pain. 7. acyclovir 400 mg tablet sig: one (1) tablet po 5x/day for 7 days. tablet(s) discharge disposition: extended care discharge diagnosis: hepatic failure acetaminophen overdose ulcerative esophagitis depressive disorder, nos acute renal failure hypertension discharge condition: continues to have low-grade fevers. vital signs otherwise stable. denies active suicidal ideations. discharge instructions: you were hospitalized for liver failure following a toxic ingestion of tylenol. you should avoid consuming any tylenol products. . you are being transferred to the inpatient psychiatric service for further evaluation. followup instructions: you are being discharged to an inpatient psychiatric facility for further evaluation. . once you return home, you should contact your primary care physician . at to schedule a follow-up appointment. you should discuss scheduling an outpatient screening colonoscopy and exercise tolerance test with him. . you should also follow-up with dr. in the division of gastroenterology to discuss your test results. please call ( to schedule an appointment. procedure: esophagogastroduodenoscopy [egd] with closed biopsy diagnoses: unspecified essential hypertension acute and subacute necrosis of liver acute kidney failure, unspecified acquired coagulation factor deficiency depressive disorder, not elsewhere classified blood in stool gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction helicobacter pylori [h. pylori] other esophagitis late effect of poisoning due to drug, medicinal or biological substance late effects of accidental poisoning 

Answer: The patient is high likely exposed to