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: fever, respiratory failure major surgical or invasive procedure: endotracheal intubation, lumbar puncture, insertion of cvl history of present illness: 52 yo female, h/o hyperlipidemia, dm, htn, presenting after returning from with fever of unknown origin. pt originally presented to on day after returning from . as per their notes, she had been feeling unwell since the 2nd leg of her flight, with symptoms of fever, chills, diffuse muscular pain, ha, weakness, and rigors. her husband, who was still in , had similar symptoms that were resolving. she was in a rural area in inday, bitten by many mosquitos, and had stitches place in her left ear for a stretched piercing. she had denied diarrha, photophobia, nuchal rigidity, nausea; she had been complaining of pain in the left ear x 1 day. . at , she was found to be febrile to 103.5, hemodynamically stable with a hr=130. ua was negative, bld/urine cultures were drawn (and remain negatibe), and hct was 40.3, plts 210, wbc=3.9. she had a mild transaminitis. ekg showed lbbb (thought to be old), and thick/thin smear was negative for parasites. lp was not performed/felt to not be clinically indicated. she was started on ceftriaxone 2 mg, and monitored. further workup included hepatitis serologies (pending), tte which showed severely depressed ef=25%. she had mild drop in hematocrit/plts. she did not improve and was intubated on hypoxic respiratory failure (?flash pulmonary edema vs. ards). doxycycline was added to medication regimen, 1 dose of po quinidine was administered. sbp dropped, and she was started on dopamine with stabilization of her bp and resumption of urine output. ct of the head was performed and was negative for any acute process. upon the wishes of family, she was transferred for for further care. . upon transfer, she had a brief episode of hypotension upon transfer that responded to fluid bolus. she remains on dopamine gtt, propofol gtt, insulin gtt and is saturating adequately on ac ventilation. she was febrile to 101 on transfer. past medical history: pmh: 1. htn 2. dm2 3. hypercholesterolemia 4. pyelo in past, pan-sensitive klebsiella, with respiratory failure requiring fm o2 (no intubation)/sepsis, at (?ards)-- 5. s/p ccy 6. normal c-scope in 7. chf: ef reportedly 35% in past (?was this in setting of urosepsis), followed by dr. at social history: no t/e/d, recently returned from as above; was there for 12 days, rural area family history: father with cancer physical exam: pe: bs: 101.0 86 (sr) 94/56 23 100% ac, fio2=100%, tv=500, r=14, breathing at 23, peep=5 gen: intubated, sedated, unresponsive heent: perrl, op clear, mmm neck: no jvd lungs: rhonchorous diffusely to anterior exam, no w/r cv: 2/6 sem at lusb abd: soft, nt/nd, nabs extr: no c/c/e, dp 2+ bilat left ear: with stitches, mild erythema lines: right femoral, 2 x piv; no erythematous neuro: toes downgoing bilaterally, sedated pertinent results: relevant labs/studies: brief hospital course: 1. fever: she initially presented to the osh with fevers (as high as 105.0). etiology for this was explored at length. blood, urine cultures (including fungal and mycolytic cultures) were drawn and were persistently negative. stool cultures were also sent and remained negative. thick/thin preps were prepared and were negative for parasistes x 6. although she did receive 1 dose of quinidine and 1 dose of malarone, therapy for malaria was discontinued given low likelihood of this. lp was performed upon arrival to and was negative for signs of infection. hepatitis serologies were sent, bal was sent for viral/bacterial organisms, and legionella urinary antigen was negative. dengue fever and leptospirosis were also sent. she was started on ceftriaxone, vanco, ampicillin, azithromycin initially upon presentation to . ampicillin was discontinued with negative lp results. she eventually defervesced. cause of febrile illness was likely a viral source. all antibiotics were stopped after 4-5 days given lack of a source. all serologies (leptospira, hepatitis, mycoplasma) were negative, dengue still pending. she respiked with evidence of an infiltrate s/p failed extubation and was started on vanco/zosyn for vap. she remained afebrile after this one temp spike and completed a 10-day course of vanc/zosyn. patient was taken to the or in order to get a permanent tunnelled line. procedure was complicated by 3 degree av block and was transfer to micu. in the micu, after having two femoral lines and a temporal wire pacer patient spiked . because suspition of line associated infection, she was given 1 dose of vancomycin. 2 days after, patient was transfer to the floor. she remained having low grade fever and spiked to 101 while on the floor again. femoral lines were removed. pacer wire was being kept until definitive tunneled catheter was placed given previous complication. multiple blood culrues and urine cultures were drawn and all came back negative. patient received a second dose of vancomycin on the floor and had a red man reaction. she developed a rash. given persistent negative results for fever source, and rash drug fever was contemplated. temporary pacer wire was also removed on . patient fevers decreased and remained afebrile since . on ,fevers returnedand felt were to drug fever. all antibiotics were discontinued with resolution of rash and serum eosinophilia.patients temp. pm heardware removedas well as her temp if hd line on . patient remained to have low grade temps(100.0 max) but all blood, urine, sputum, andtips cultures remained without growth. dengue fever serologies (from and ) were still pending at the time of discharge. will foloow up in clinic on . . 2. hepatitis: although ast/alt were within normal limits at osh, they were extremely elevated upon presentation to (to 10,000's, ast peaked at 16,000). alkaline phosphatase/bilirubin were within normal limits while ldh was also elevated to 8000. liver was consulted and believed that the rise in alt/ast was less consistent with dengue fever and more consistent with shock liver episode of hypotension peri-intubation at osh (induced by sedating medications, lasix). hepatitis, ebv, cmv serologies were sent to exclude infectious causes; all serologies were negative. supportive care was given, and liver function improved to within normal limits. . 3. renal failure: creatinine started to rise and urine output decreased upon transfer. urine was examined and had many muddy brown casts. urine sodium was high at 110. this was most likely consistent with atn, given episode of hypotension described above. due to anuria, metabolic acidosis and rising creatinine up to 10, renal made the decision to dialyze. a temporary dialysis catheter was placed, and hd was started during anuric period to manage acid/base status and volume issues. pt's urine output started to increase however she stilled required hd. patient was taken for a permanent tunneled hd catheter on and procedure was complicated by av block. patient was transfered to the unit. patient urine output continue improving however given pericardial rub on auscultation she still required hemodialysis. temporary catheter was placed on by ir and removed on . she maintained excellent urine output,only requiring hd to manage a question of uremic rub. last dialysis was on ,with creatine remaining stable at 3.0. patient will follow up in clinic and her pcp to review her creatine. at this time, patient was instructed to not continue any nephrotoxic agents (ace,nsaids) until a baseline creatine is established. . 4. respiratory failure: this was likely hypercarbic, secondary to capillary leak/respiratory distress. she was initially maintained on assist control and weaned as tolerated. after eight days of intubation, she was extubated but failed requiring re-intubation likely secondary to volume overload, tachypnea underlying metabolic acidosis. there may have been vocal cord edema (no cuff leak), so she was given 48 hours of decadron. nif was appropriate, and extubation was accomplished (after 13 days of intubation). she continued to improve and was satting well on room air on discharge. . 5. hypotension: she was hypotensive peri-intubation period, likely from sedating medications and lasix she received. she was dopamine upon transfer here, transitioned to levophed. this was weaned after one day, and she remained hemodynamically stable. . 6. chf/cardiomyopathy: ef on tte at was <20%, no vegetations, global lv hk. records from osh cardiologist showed that in mid-, pt had a normal ejection fraction. however, when she was admitted to in for urosepsis, she was found to have an ef of <20%. this was thought to be an ischemic cardiomyopathy, with anterior/apical wma, and also sepsis. ... ef was likely depressed in the setting of inflammation/sepsis and will likely recover. cvps in icu were adequate in the range of . lopressor was restarted, and hydralazine/nitrate were added for afterload reduction. asa was started when coagulopathy when stable. acei was held in-house and should be restarted when renal function normalizes. she will need follow up tte 3-4 weeks after discharge to reassess for recovery of function. last echo 35% ef after her second micu stay. patient should get a repeat echo as an outpatient in 1 month time. given her renal insufficency, ace was not initiated. -- rhythm: she was taken to the or for placement of a r ij permacath. after the procedure, she was noted to have second degree heart block, with possible runs of v tach, then brady into 40s. r ij permacath was removed. sbp was in the 70s, hr 50s. her heart rate climbed to the 150s, thought to be atrial tachycardia with 3:1 heart block. levophed was begun and uptitrated to 0.1mcg/min, without adequate recovery of bp. epi gtt begun. dccv attempted, with 200j, 300j x2. this was unsuccessful. bp was 140s/30s, rate in 50s. pt was then noted to have a junctional rhythm with rbbb rather than lbbb, and appeared to have complete av dissociation. hr in 40s-50s. temp wire placed via right femoral vein for complete av dissoc on . posterirly vvi pacer placed . patient back to sinus with lbbb. temp pm was removed without complications, and remained in nsr. her betablocker should be restarted as an outpatient. . 7. coagulopathy: inr was initially mildly elevated, and platelets dropped. hematocrit dropped in this setting. hematology was consulted and felt that this was all in the setting of sepsis. hemolysis labs were normal, and fibrinogen remained >100. she was supported with platelets and prbc as needed. as she improved clinically, hematologic parameters remained stable, . 8. dm: she was put on insulin drip while in the icu for aggressive blood sugar control. this was transitioned to ssi when extubated, taking pos. at time of discharge, patient was started on glipizide 2.5mg po bid with excellent sugar control. . 9. hypercholesterolemia. lipitor was held initially given elevated transaminases. triglycerides were elevated. she will need resumption of lipid management as an outpatient. at time of discharge, all lft abnormalities resolved. . 10. psych: 1 day after being transfer from the micu (inital stay), she became extremyly withdrawn and was not talking to anybody. psychiatry was consulted, and later that day patient started to interact again. patient had a depresed mood and was extremely frustrated because she could not go home. after being admitted for the second time to the micu, patient again became extremely withdrawn. unclear dx uremia vs. catatonic depression vs. icu psychosis. psych recommend seroquel with good improvement. on , seroquel was discontined and,as her health returned, so did hermood. at time of discharge, she was with ample social support and without need of mood stablizers. medications on admission: meds at home: asa 81 mg, atenolol 25 mg, moexipril 7.5 mg, metformin 500 mg, lipitor 40 mg meds on transfer: tylenol prn fioricet prn restoril prn ins gtt propofol gtt dopamine gtt ceftriaxone 2 gm q24 (d3) asa 81 mg lipitor 40 mg protonix 40 mg doxycycline 100 mg iv bid quinidine po x 1 nkda discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 2. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 3. glipizide 5 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* discharge disposition: home with service discharge diagnosis: ards sepsis chf arf dm2 complete heart block discharge condition: home in stable condition, afebrile, no oxygen requirments, ambulating without difficulty, with stable creatine. discharge instructions: please take all medications as directed. please avoid motrin (nsaids) until you see your pcp. have changed a lot of your prior medications due to your kidney disease; please see this medication list and discuss with your pcp reinitiation of your prior medications (you were on asa 81 mg, atenolol 25 mg, moexipril 7.5 mg, metformin 500 mg, lipitor 40 mg) followup instructions: please call your pcp, . today (his office is expecting your call. we wish you to see him this friday to have your blood chemistries to be check and blood sugars. dr. will arrange to have your lipid profile checked, liver function as well as a repeat echo of your heart in 1 months time. your dengue result is pending at time of discharge. please follow up in clinic: provider: , md phone: date/time: 11:30 md procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung enteral infusion of concentrated nutritional substances hemodialysis other electric countershock of heart venous catheterization for renal dialysis venous catheterization for renal dialysis insertion of temporary transvenous pacemaker system closed [endoscopic] biopsy of bronchus incision with removal of foreign body or device from skin and subcutaneous tissue infusion of vasopressor agent diagnoses: pneumonia, organism unspecified other primary cardiomyopathies acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute and subacute necrosis of liver unspecified septicemia cardiac complications, not elsewhere classified acute respiratory failure unspecified viral infection atrioventricular block, complete dermatitis due to drugs and medicines taken internally other specified antibiotics causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to