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: lisinopril / atazanavir / fresh fruit / cephalosporins / raltegravir / maraviroc / hydralazine attending: chief complaint: fluid overload, shortness of breath major surgical or invasive procedure: none history of present illness: 54 yo f with h/o hiv on haart (cd4=437 ), dm2 (diet controlled), ckd, r-sided chf w/severe pulm htn, with two recent admissions to for hypersensitivity reaction c/b polymicrobial bacteremia (including vre/mrsa), iatrogenic , c. diffcolitis (currently finishing a course of oral vanco). haart and chf regimen (hydral, metoprolol, isosorbide, torsemide) held on d/c; chf regimen switched to ethacrynic acid and clonidine, now with increased weight from 118 baseline to 155 lbs. pt was admitted to from /12 after p/w severe rash with desquamation of skin on palms, soles and oral/vaginal mucosal involvement. suspicious for sjs but w/u in burn unit at ultimately felt more c/w desquamating lichenoid hypersensitivity reaction thought to be from art, specifically recently started raltegravir and maraviroc (new as of ) +/- ceftriaxone use. admit there c/bcons bsi (?line-related), arf, mental status changes, brief bout of iatrogenic presumed d/t mucosal use of topical steroids. ultimately d/c to rehab and returned with polymicrobial bacteremia (vre, mrsa, proteus, klebsiella and esbl ecoli--?skin breakdown, ?line) and cdiff colitis along with worsening of her rash again. she was again briefly in the burn icu and intubated, but quickly transferred to the floor where skin improved with topical therapies (bactroban, steroid cream, vaseline) and she was treated with imipenem/vanco/metronidazole for her bacteremia and po vanco for c diff. she was also restarted on a new haart regimen after discussion with her id team of fosamprenavir 1400mg ,abacavir 300mg and lamivudine 150mg daily. during this time her prior chf regimen of furosemide/metoprolol/isosorbide/hydralazine was stopped, reportedly d/t concerns that some may have contributed to her rash though association not clear. she was ultimately d/c'd home off many of her long-standing meds and newly on ethacrynic acid 50mg and clonidine 0.1mg daily for her htn and chf. since d/c home patient reports she has felt increasingly sob for the last 3 days and is having increased le edema. she gets sob walking down her and has gained >10lbs since d/c (138 on d/c up to 155 in clinic). today she describes that she could not walk to the door of her hospital room without becoming markedly fatigued. she denies cp/palps/f/c/abd pain/n/v. she has been taking her meds as prescribed. she reports not using the recommended ointments and creams today and is c/o cracking of the skin on her hands and feet as well as diffuse dryness and itching. lips still sore, but no vaginal soreness currently. patient arrived to floor this am eating 2 slices of pizza. on the floor, vs were: t98.7 p90 bp143/73 r o2 sat 100ra review of sytems: (+) per hpi (-) denies fever, chills, night sweats, denies headache, sinus tenderness, rhinorrhea or congestion. denies chest pain or tightness, palpitations. denies nausea, vomiting, diarrhea, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denies arthralgias or myalgias. ten point review of systems is otherwise negative. past medical history: - hiv, diagnosed in , on haart (cd4=437 ), -patient recently presented to ed on with severe desquamating rash and transferred to burn unit. rash was determined to desquamating lichenoid hypersensitivity reaction which was treated by stopping art, avoidance of cephalosporins and drugs of abuse such as cocaine. dermatology was consulted on admission and recommended wrapping patient in saran wrap and using vaseline for skin care. no mucosal involvement was noted on admission. she was given copious ivf, and hugger was utilized given insensible losses and impaired thermoregulation. dermatology re-evaluation on revealed worsening mucosal involvement and new erythroderma. this raised concern for progression of her severe drug hypersensitivity eruption. this was felt to be secondary to art, specifically abacavir and lamuvidine, and potentially ceftriaxone to her recent admission to . she is not currently on any related medications. of note, her last attempted art was on resulting in maculo-papular rash. s/p transfer to burn unit - hepatitis c - no response to peg-ifn/ribavirin - shingles - migraines - htn - dm ii - history of mrsa - recurrent uti - recurrent nephrolithiasis - hsv - pancytopenia haart medications - ckd baseline creatinine 2.85-3.0, followed by dr. (nephrolithiasis, pyelonephritis & perinephric abscess c/b perinephric hematoma during stenting ) social history: lives at home in . has 3 children: one son is her hcp, one daughter with hydrocephalus/seizure disorder is in a nursing home ( pediatric care), 3rd child (female) died in childhood from complications of hiv. - worked as a counselor (no longer working) - former heavy smoker, currently 1 pack q2 weeks. - former etoh abuse, none since - former ivdu, none since - recent cocaine use () family history: - father died of mi - mother with diabetes - sister with lung cancer at age 38 and was a heavy smoker. - brother with diabetes physical exam: on admission vitals: t98.7 p90 bp143/73 r o2 sat 100ra weight 155.8kg gen: chronically ill appearing female, nad heent: sclera anicteric, op with persistant desquamation/dryness around lips, no segmented/well demarcated areas of hyperpigmentation of oral mucosa neck: supple; +jvd up to angle of mandible cor: s1s2, rrr, holosystolic murmur across precordium, hyperdynamic, ?rv heave lungs: ctab, no wheezes/rales abd; distended, normal bs, soft, nt, +hepatomegaly, no splenomegaly, +fluid wave ext: 3+pitting edema up to thighs b/l skin: diffusely dry and flakey; areas of persistent cracking/oozing on palms, soles by heels and b/t toes, no other obvious desquamation or blistering at this point on discharge vs: 98.5 127/66 64 18 100%ra i/o: 1010/450+; wt: 58.9kg-->58.7 general - sleeping in bed this morning, nad heent: sclera anicteric, op with persistant hypopigmented desquamation around lips, no segmented/well demarcated areas of hyperpigmentation of oral mucosa neck: supple, no appreciable jvd heart: s1s2, rrr, holosystolic murmur across precordium, faint diastolic murmur auscultatation lungs: b/l crackles, new today, no wheezing, rhonchi abd; distended, normal bs, soft, nt, +hepatomegaly, no splenomegaly ext: 1+ le edema unchanged w/tenderness, no joint erythema. skin: desquamation slowly healing, minimal cracking on palms, soles by heels and b/l toes, no other obvious desquamation or blistering pertinent results: on admission 08:00pm glucose-130* urea n-37* creat-2.0*# sodium-138 potassium-4.9 chloride-111* total co2-16* anion gap-16 08:00pm calcium-7.9* phosphate-3.9 magnesium-1.7 08:00pm wbc-8.4 rbc-2.68* hgb-7.9* hct-26.3* mcv-98 mch-29.4 mchc-30.0* rdw-18.2* 08:00pm plt count-155# 08:00pm pt-12.1 ptt-33.7 inr(pt)-1.1 notable labs/reports cxr cardiomegaly is unchanged, moderate to severe as well as prominence of the main pulmonary artery, findings that might be consistent with pulmonary hypertension. lungs are essentially clear. no focal consolidations, pleural effusion, or pneumothorax is seen. no definitive pulmonary edema is noted as well. ecg sinus rhythm. left atrial abnormality. non-specific st segment changes in the anterolateral leads. borderline low voltage in the limb leads. compared to the previous tracing of the ventricular rate is slower. tee : the left atrium is normal in size. no spontaneous echo contrast or thrombus is seen in the body of the left atrium/left atrial appendage or the body of the right atrium/right atrial appendage. the right atrium is dilated. no atrial septal defect is seen by 2d or color doppler.there are simple atheroma in the aortic arch and descending thoracic aorta. overall left ventricular systolic function is normal. the aortic valve leaflets (3) are mildly thickened. no masses or vegetations are seen on the aortic valve. mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. mild to moderate (+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. no discrete vegetation is seen. moderate to severe tricuspid regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. impression: moderate to severe tricuspid regurgitation. mild moderate aortic regurgitation. mild to moderate mitral regurgitation. no discrete vegetation or abscess seen. moderate pulmonary artery systolic hypertension. simple atheroma in the arch and descending thoracic aorta. , md type and screen ab positive: in the future, ms. should be transfused with e antigen negative red cells. approximately 70% of abo compatible blood will be e antigen negative. 11:20 pm blood culture **final report ** blood culture, routine (final ): staph aureus coag +. consultations with id are recommended for all blood cultures positive for staphylococcus aureus, yeast or other fungi. sensitivities performed on culture # 355-5657b . anaerobic bottle gram stain (final ): reported to and read back by dr. @ 650pm . gram positive cocci in pairs and clusters. aerobic bottle gram stain (final ): gram positive cocci in clusters. 1:00 pm urine **final report ** urine culture (final ): no growth. 3:19 am blood culture site: central line **final report ** blood culture, routine (final ): no growth. discharge labs: 05:37am blood wbc-6.4 rbc-2.42* hgb-7.1* hct-22.5* mcv-93 mch-29.3 mchc-31.4 rdw-18.1* plt ct-171 05:46am blood pt-12.1 ptt-45.1* inr(pt)-1.1 05:37am blood glucose-83 urean-45* creat-2.6* na-128* k-4.8 cl-99 hco3-19* angap-15 05:37am blood calcium-7.6* phos-4.5 mg-2.0 brief hospital course: 54f with pmhx hiv on haart, r sided heart failure, and recent erythrodermic skin eruptions s/p 2 complicated burn unit admissions since possibly med induced now presents in fluid overload on new chf regimen of ethacrinic acid. active issues: #fluid overload/weight gain- likely an acute on chronic chf exacerbation. patient presented approximately 30 pounds above her dry weight (155.8 lb on admisson). some of her fluid overload may be attributed to steroid use. she was treated with lasix gtt and metolazone until euvolemic and her weight was 54.7kg. the heart failure service suggested that she undergo a rhc and echo during this hospital admission to assess her intravascular volume and severity of pulmonary htn. she was diuresed until euvolemic. however, rhc was not pursued during this admission to hypotension and sepsis (see below). her diuretics were d/c prior to discharge worsening kidney function thought to be to intravascular volume depletion (see below). her volume status will be monitored closely and diuretics reinitiated when appropriate. #mrsa septiciemia: patient was febrile and hypotensive on the general medicine floor. was transferred to the micu for suspected sepsis and need for central venous access. patient was transferred on am. a left femoral cvl was placed since patient would not cooperate for a ij line placement. she was found to have four positive blood cxs with mrsa. she was initially started on daptomycin iv and meropenem iv and eventually narrowed to vancomycin iv (id was following). she had a fever on am, was subsequently cultured, and did not have any fevers since that time. she was bolused a total of 2l over the first 24 hours of her micu admission. has not had any hypotensive events since the first 24 hours. a tte and tee were performed which did not show evidence of ie. #erythroderma/skin breakdown rash appears stable with fresh wound on palms of hands, heels, and waist. skin break down is causing the patient a lot of pain. derm recommended bactroban cream tid on affected areas and to keep gloves on hands at all times. she was given oxycodone for pain control. during her hospitalization, her skine desquamation decreased and skin fissures began to heal nicely. derm recommendations were ordered while she was in the micu. she was also started on benadryl 12.5mg iv q6h for puritus since the patient scratches at her skin (risk for further bacteremia). once the puritus improved iv benadryl was discontinued and she was continued on the skin regimen as recommended by dermatology as listed above. #c diff infection she was continued on vancomycin po until and then stopped. on she spiked a fever to 101.4, and had increased watery bm's. vancomycin po was restarted at 125mg po q6h. continued this dose while the patient until her vancomycin iv was completed on . during this time her diarrhea decreased in frequency to maximum of 2 per day and stools began to become more formed. # hyponatremia: sodium has been down trending over the last few days, 128 today. serum osmolality is isotonic at 285 on . serum lipid levels are pending. however, given her complicated medical history she could have potentially hypertonic and hypotonic etiologies for her hyponatremia making her serum osmolality difficult to interpret. her volume status is difficult to assess given known dcfh and low albumin with possible third spacing. hyponatremia is likely multifactorial given patient on diuretics for chf. am cortisol was 11, 13.3 on repeat slightly lower than expected, patient was on prednisone 5mg daily which was stopped prior to this admission, so unlikely that adrenal insufficiency is contributing, but is possible. would not pursue crh stimulation test at this point given multiple contributing factors to her hyponatremia, which appears to be improving with accurate free water restriction. she also had a tsh of 50, ft4 0.79, but this is after she became septic and found to have mrsa bacteremia as well as chronic c. diff which can elevate the tsh. lipid panel showed slightly elevated triglycerides otherwise unremarkable. combination of hyponatremia and hyperkalemia may be to intravascular volume depletion leading to increased proximal tubule reabsorption of both sodium and potassium. therefore, due to intravascular volume depletion we stopped her diuretics. her electrolytes and fluid status will be monitored very closely by her pcp and diuretics reintroduced when appropriate. #chronic kidney disease baseline creatinine around 2, and increased to 2.9 with diuresis. at this point, patient was euvolemic and aggressive diuresis was discontinued. she was switched to torsemide as outlined above for discharge. trending down while in the micu and stabilized around 2 upon transfer to the floor where it remained until discharge, but increased to 2.6 prior to discharge which is when diuretics were held as outlined above. #positive urine culture- growing klebsiella- as per id, can hold off treating unless she is symptomatic. avoiding foley catheter. was treated briefly with meropenem while in icu and then coverage was stopped. repeat urine culture was negative. #metabolic acidosis: bicarb was 16, likely from rta. currently 19 with diuresis. her chem panel was followed daily and bicarb flutuated between 19-20 up until discharge. given her overall decline in kidney function, this will continue to be monitored upon discharge while off diuretics for better assessment of her kidney function. # elevated uric acid: noted on to be 18.5 -- but now trending downward. unclear cause. patient has a family history of gout. can be elevated uric acid with heart failure. no clear signs of active gout on exam, but given aggressive diuresis, she is at risk for precipitation of crystals. repeat on was 13. there were no signs of acute gout attack up until discharge. chronic issues: #hiv currently 10d into new haart with unboosted fosamprenavir 1400mg , abacavir 300mg and lamivudine 150mg daily. these medications were ontinued while she was inpatient. lamuvidine was decreased to 100mg due to renal insufficiency while in the micu and was continued at this dose until discharge. transitional issues: - patient was discharged off diuretics, please weigh her daily. if weight increases by more than 3 lbs, please evaluate for volume overload and consider restarting diuretics with torsemide - patient should be evaluated by ot and social work prior to d/c home medications on admission: preadmissions medications listed are incomplete and require futher investigation. information was obtained from webomr. 1. clonidine 0.1 mg po bid hold for sbp<90 2. ethacrynic acid 50 mg po bid 3. fosamprenavir 1400 mg po q12h 4. lamivudine 150 mg po daily 5. omeprazole 40 mg po daily 6. prednisone 5 mg po daily 7. vancomycin *nf* 250 mg oral every 6 hours duration: 7 days 8. abacavir sulfate 300 mg po bid discharge medications: 1. abacavir sulfate 300 mg po bid 2. fosamprenavir 1400 mg po q12h 3. lamivudine 150 mg po daily 4. aquaphor ointment 1 appl tp daily 5. aveeno bath 1 pkg tp 6. bupropion (sustained release) 150 mg po qam 7. isosorbide mononitrate (extended release) 30 mg po daily 8. metoprolol succinate xl 50 mg po daily 9. omeprazole 40 mg po daily 10. oxycodone (immediate release) 5 mg po bid severe pain rx *oxycodone 5 mg 1 tablet(s) by mouth twice daily disp #*20 tablet refills:*0 discharge disposition: extended care facility: - discharge diagnosis: chf exacerbation (worsening heart failure) mrsa bacteremia (blood stream infection) clostridium difficile colitis (diarrhea caused by an infection) discharge condition: mental status: confused - sometimes, but otherwise alert and oriented. level of consciousness: alert and interactive, but lethargic at times. activity status: ambulatory - independent. discharge instructions: ms. , you were admitted to after presenting with extra fluid in your legs and lungs and worsening heart failure. you were treated with water pills to get the extra fluid off of your body. you also have a blood stream infection and infection in your bowels causing diarrhea that both were treated with antibiotics. overall, your medical condition is much improved, but because you are very weak you will be discharged to a rehabilitation center. you will not be discharged on water pills, but dr. and the physicians at the rehabilitation center will be monitoring your fluid status very closely and will restart the water pills if your weight starts to increase meaning that you are holding on to too much fluid. you were not eating very much while in the hospital and we encourage you to increase your food intake so that you do not become too malnourished. please limit your salt intake to 2 grams per day. weigh yourself every morning, md if weight goes up more than 3 lbs. please see below for your follow-up appointments. it was a pleasure caring for you and we wish you a speedy recovery! followup instructions: department: when: wednesday at 9:00 am with: , md building: sc clinical ctr campus: east best parking: garage department: west clinic when: thursday at 11:00 am with: , md building: de building ( complex) campus: west best parking: garage procedure: diagnostic ultrasound of heart central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: acidosis hyperpotassemia abnormal coagulation profile anemia, unspecified urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified hyposmolality and/or hyponatremia acute on chronic diastolic heart failure depressive disorder, not elsewhere classified sepsis candidiasis of mouth human immunodeficiency virus [hiv] disease chronic kidney disease, stage iii (moderate) intestinal infection due to clostridium difficile hypertensive chronic kidney disease, benign, with chronic kidney disease stage i through stage iv, or unspecified methicillin resistant staphylococcus aureus septicemia chronic kidney disease, stage ii (mild) other specified erythematous conditions unspecified pruritic disorder other specified diseases of sebaceous glands 

Answer: The patient is high likely exposed to