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: penicillins / naproxen / dilantin attending: chief complaint: feces on walls major surgical or invasive procedure: hemodialysis hd line placement re-suturing of permacath site history of present illness: 47 yo female with hiv, hep c, hepatic encephalopathy, presented to er for smearing feces on the wall. notes from nursing home state rash started , blood shot eyes and low grade temps. pt states rash is itchy but not painful. per family members, rash started at least for 1 wk. rocephin started recently ?date, d/c . pt denied any new meds, but is not a reliable historian. pt recent admit at hosp for grand mal seizure, also admit at hosp on for abd pain. in , pt passed a large amount of foul smelling green diarrhea, guaiac + stool and ms has improved. stool was sent for c-diff and various stool cx. bcx sent. ct head ordered. past medical history: 1. hepatitis c cirrhosis-genotype 1, vl 6,500,000 . incomplete treatment trial with ifn/ -, stopped due to neutropenia 2. esophageal varices- egd-varices at the gastroesophageal junction, grade i 3. h/o hepatic encephalopathy with multiple admissions for this 4. hiv-(- vl>100,000 copies, cd4 233)- was off of avr therapy since late but restarted a few months ago 5. renal failure secondary to diabetes 6. diabettes mellitus 7. gerd 8. chronic pancreatitis 9. htn 10. cholecystectomy social history: no current smoking, alcohol, no drug use. the patient has a prior history of heavy alcohol use and has not drank in over a year. 25-pack-year smoking history. prior history of cocaine use/ivdu but quit many years ago. pt was homeless but now lives at a nursing home. family history: mother with type 2 diabetes. physical exam: 98.4 78 107/70 18 99%ra gen: aa female lying in bed in dark, refused to have lights on due to 'lights bothers me', my eyes hurts. heent: conjunctiva injected bilat, lips with erosions and crust, palate with erythematous lesions. neck: slightly stiff, no lad, no jvd cv: reg rate, s1 s2, +harsh systolic murmur loudest at rusb abd:+distension, +occasional spider angioma, +dullness to percussion laterally over abd, +tenderness ruq&over epigastrum,nr/no mass, no pulsation ext: +2 le pitting edema with diminished dp pulses. neuro: lethargic, eye exam difficult due to covered with lots of pus. oriented to person and place. not cooperative. skin: diffused erythematous lesions including palms and soles with red macules and papules, some lesions excoriated; some lesions on leg non-blanching. pertinent results: cxr: no radiographic evidence of acute cardiopulmonary process. 03:54pm glucose-83 urea n-61* creat-3.7* sodium-134 potassium-3.4 chloride-106 total co2-17* anion gap-14 03:54pm alt(sgpt)-19 ast(sgot)-47* alk phos-135* amylase-395* tot bili-0.6 03:54pm lipase-123* 03:54pm albumin-1.9* calcium-6.9* phosphate-3.9 magnesium-1.3* 03:54pm acetone-neg 03:54pm phenytoin-9.8* 03:54pm wbc-8.5 rbc-2.77* hgb-8.9* hct-26.5* mcv-96 mch-32.1* mchc-33.5 rdw-18.4* 03:54pm neuts-41* bands-2 lymphs-20 monos-32* eos-1 basos-1 atyps-3* metas-0 myelos-0 03:54pm hypochrom-normal anisocyt-1+ poikilocy-1+ macrocyt-occasional microcyt-occasional polychrom-normal target-occasional burr-occasional teardrop-occasional 03:54pm plt smr-low plt count-113* 03:54pm pt-14.2* ptt-36.8* inr(pt)-1.4 05:21pm ammonia-50* 04:00pm lactate-1.8 . micro studies: urine pend blood cx , pend eye swab: gram stain 2+pmns, no microorg, virus neg. bacterial cx appears to be cancelled. respiratory culture viral cx negative hsv viral swab oropharynx negative for hsv csf: negative cryptococcus, neg fluid cx, viral cx, fungal cx, with gram stain showing no pmns and no microorganisms. . punch biopsy, skin left anterior thigh: vacuolar interface dermatitis with pigment laden scale, scattered epidermal civatte bodies, edema, and superficial dermal pigment incontinence. no epidermal necrosis is seen in this sample, however there is a focal early subepidermal split. the findings are consistent with an interface-type reaction including an interface-type drug reaction and/or a lesion along the spectrum of erythema multiforme/ syndrome. . mri head : 1. right parietal lobe lesion with susceptibility and questionable adjacent tiny area of enhancement, corresponding to the lesion seen on the patient's prior ct study of . this likely represents a small focus of hemorrhage versus a vascular malformation. . cxr impression: 1. right ij line is in good position. there is no pneumothorax. 2. focal opacity at the left costophrenic angle consistent with atelectasis or infiltrate. 3. eighteen millimeter nodule seen in the left mid lung field, which was in a different position on a prior study from . if clinically indicated, further evaluation with a chest ct is recommended. . ct torso : heart size mildly enlarged, tunnel dialysis cath in proximal ra; no hilar lad, bibasilar lad, no pulm nodules; small left pleural effusion; liver/gb/spleen/bowel unremarkable; suggstion of renal disease; no osseous lesions; large amount of ascites . ct head : tiny high attenuation focus representing hemorrhage unchanged from with small amt of edema; also area of high attenuation below r parietal bone but image limited by motion and is likely motion artifact but new subdural bleed cannot be excluded . xray l/t/s spine: no fracture . ct head repeat : intraventricular hemorrhage in the r occipital . . ct head : interval increase in degree of hemorrhage present within the septum pellucidum and layering within the lateral ventricles bilaterally with stable appearance of right centrum semiovale foci of hemorrhage. . ct head : findings: hemorrhage within the septum pellucidum is unchanged when compared to prior study. the blood within the occipital horns of the lateral ventricles is also unchanged. the ventricles are stable in size since the prior study. there is no evidence of hydrocephalus. again noted is a small focus of hemorrhage in the right centrum semiovale which is unchanged when compared to the prior study. impression: stable appearance of the head. stable hemorrhage within the septum pellucidum and within the lateral ventricles. no new hemorrhage identified. . ct head findings: there is a new area of high density in the anterior interhemispheric fissure extending on both sides of the anterior falx cerebri. some of this may be subdural in nature, but it appears to largely represent subarachnoid blood. it is layering along the right a1 portion of the anterior cerebral artery. ventricular dimension is unchanged. impression: new anterior interhemispheric hemorrhage with features as discussed above. this hemorrhage may be in continuity with the septal hematoma superiorly, but this is indefinite. . brief hospital course: a/p 47 yo female with hiv, hep c, hepatic encephalopathy, presented to er for change mental status and rash, found to be syndrome based on clinical impression with supporting skin 4mm punch biopsy. pt then seemed to develop a fibrinogen defect causing ivh and resulting in 2 micu transfers for iv amicar. . #ivh: pt fell off ir table on , resulting in r eye hematoma and laceration. pt was taken immediately for ct head and neck. c spine was negative for fracture. she had no c spine ttp, so c collar was removed. pt did have lumbar and thoracic spinous process tenderness so xray of spine was ordered. on read of head ct, there was the old subcortical small bleed and ?new r parietal bleed vs motion artifact. xray of spine was negative for fracture. repeat head ct showed the ?subdural bleed was an artifact, but there was a new area of intraventricular hemorrhage in the r occipital . heme onc was contact and recommended iv amicar (given it was felt the pt had a fibrin related defect), neuro agreed. the pt was transferred to the micu for iv amicar for 24 hrs at 0.2 gm/hr after an initial 1 gm loading dose. she was also given cryoprecipitate. repeat ct head on revealed interval increase in degree of hemorrhage present within the septum pellucidum and layering within the lateral ventricles bilaterally with stable appearance of right centrum semiovale foci of hemorrhage. neurosurgery at this time felt the pt had no evidence of hydrocephalus and no obstruction of her 3rd and 4th ventricles (thus there was no further intervention). the pt was started on metoprolol 25 mg and hydralazine 25 mg po qid to maintain sbp less than 140 (pts sbp was up to 160 on ). repeat ct head on revealed stable appearance of the hemorrhage in the lateral ventricle. the pt was again transferred to the floor on with repeat head ct on . the pt found to have a new area of high density in the anterior interhemispheric fissure extending on both sides of the anterior falx cerebri. the pt was given plt to maintain above 100, vit k for inr of 68, and cryoprecipitate to maintain fibrinogen levels greater than 200. she was again transferred to the micu for iv amicar infusion while patient was intubated as she was somnolent and unable to protect her airways. patient's neurological status continued to deteriorate and she remained unresponsive. patient's family decided to make the patient dnr/dni and she was extubated. patient remained apnic after extubated and comfortable on morphine drip. she expired on . . #. ams: her mental status intially appeared to have returned to her baseline after a large bowel movement in the ed. lp was clear essentially ruling out meningitis, especially hsv meningitis. she was initially mostly clear mentally, but at times seems to have short-term memory difficulty. however, neuro was concerned that pt was becoming more encephalopathic so her lactulose was titrated up to 45 q 8 hr prn for 2 bm per day. following her ivh on , the pts mental status declined, at times only responsive to painful stimuli and not following commands. patient remained in sub-optimal mental status with acute worsening after re-bleeding discovered on . . # bleeding diathesis: neuro felt that the small rounded density seen in subcortical white matter on head ct from was not a hemorrhage, but needed to be evaluated by mri head w/ contrast and susceptibility series given her hiv history. mri was c/w small hemorrhage vs vascular malformation. this finding was not alarming until the pt developed a subsequent bleed in the pineal region on , further evolution of bleed on , and new vs extension of bleed into the anterior interhemispheric region. in addition the pt underwent permacath placement for hd , complicated by persistent oozing at site. initially it was felt her catheter was oozing secondary to a mechanical complication. however, the pt subsequently developed oozing from her l thigh bx site and bleeding from her nose (). the ddx of the continued bleeding included mechanical,low plt count, plt dysfunction, and coagulopathy esld and crf. vwf screen was neg, but in setting of multiple blood products. factor viii was wnl. dic labs (fibrinogen nl) and coags wnl. pt received 30 mcg ddavp x3 on , cryo x1 on , ffp on bag plt , 2 bag plt/10 ug ddavp/30 ug ddavp , 30 ug ddavp on , and plt plus cryo on . she was taken to ir x 1 with suture placement and dressing, taken back at 3am for persistent ooze, given silver nitrate cautery, with hemostasis. general surgerywas called, and sutured permacath site on , resutured it for persistent bleed. pt was taken to ir on with thrombin injected around permacath site and new sutures placed. on pt was taken to ir to examine the permacath for leak, but the pt fell off ir table and further workup was haulted. heme/onc was consulted for the pts bleeding, and it was felt pts bleeding may be secondary to functional fibrinogenemia in the setting of esld (fibrinogen prior ot receiving ffp/cryo this admission was in the 100s). per heme/onc recs, topical amicar was applied to the pts permacath and thigh bx site, achieving temporary hemostasis. the pts depakote was also discontinued on given that depakote has been noted to cause bleeding in the setting of surgery. once the pt was noted to have a new intraventricular hemorrhage in her r occipital on , the pt was started on iv amicar per heme/onc recs for emergent bleeding, and the pt was transferred to the unit. please see above for further course of her ivh. . #. conjunctivitis: the pt was noted to have bilateral conjuncitivitis with mucopurulent discharge bilaterally. ophthalmology was consulted for further management in this hiv positive patient. her conjunctivitis was originally concerning for neisseria gonorrhea per ophthalmology, cx swab sent, gram stain sent (not done, cancelled test) and viral cx found to be negative. given possible severe allergy to pcn and ceftriaxone and possibly levoflox, we curbsided id, and the pt received 6 days of po azithromycin, with erythromycin eye drops. however, on physicial exam pt still with mucopurulent discharge, and bilateral conjuncitivits. since she was not improving, ophtho recommeded starting polysporin ointment. her mucopurulent discharge resolved on polysporin. on , the decision was made to stop po azithromycin. artifical tears was ordered for the pt as well. the pt received polysporin ointment qid in house and after d/c she was ordered artificial tears q 6 hr prn. the pt is to follow up in clinic after discharge. . #. rash: dermatology was consulted in the ed and felt that this rash was consistent with a syndrome due to levofloxacin, ceftriaxone, or dilantin. less likely to be caused by oral hsv, and pt was initially tx with iv acyclovir, which was subsequently discontinued. her skin punch biopsy in the anterior left thigh revealed vacuolar interface dermatitis with pigment laden scale, scattered epidermal civatte bodies, edema, and superficial dermal pigment incontinence, with no epidermal necrosis, a focal early subepidermal split. the findings are consistent with an interface-type reaction including an interface-type drug reaction and/or a lesion along the spectrum of erythema multiforme/ syndrome. hsv culture of the erosions present in the patient's mouth were negative for hsv. iv acyclovir was initially started empirically, then discontinued, as it was felt that the risk of nephrotoxicity outweighed the ?benefit. rocephin, levaquin, and dilantin were held. per derm, all aromatic anti-convulsants (dilantin, carbamezapine, phenobarbital) should not be given as they cross-react. the pt experienced improvement over a several day course using the following treatments: triamcinolone ointment 0.1% over affected area, bacitracin topically to vulvar erosions., for mucosal lesions and mouth pain- ordered lidocaine mouthwash prn. . # crf: on admission the pt had a left av fistula in place, not yet mature. crcl is <10 so renally dose meds. pt started hd on . received 2 units prbcs and . received another unit prbc on and on . calcitriol, nahco3 (will be corrected in hd) were discontinued. . #. ?history of seizure disorder neuro was consulted for . given history of childhood seizures, pt is at risk for further seizures, although we did have her records from . neuro recommended discontinuing dilantin, and the pt was started depakote 250mg po bid. this was titrated up to 250 mg tid and was subsequently discontinued once it was overlapped with keppra for 2 days (depakote was discontinued in the setting of bleeding as per above, and due to her liver disease). the pt was then continued on keppra. . #fever: pt spiked temp 101 on night of and , low grade temp on subsequent nights. unclear . u cx, c diff neg. cxr had ? lml nodule and possible lll loculated effusion, however ct torso from shows no nodule (nipple shadow on cxr apparently) and small bl pleural effusions, no acute intrab process. pt also c/o diarrhea at this time, but likely due to sjs. pt has large ascites and mild mid-ab pain, but sbp unlikely and pt at risk for bleeding with paracentesis. ua, urine cx, stool cx, and blood cx were all repeated on for continued low grade fevers. a component of the pts ivh could have also been contributing to her fever at that time. . #. elevated pancreatic enzymes: the pt has known chronic pancreatitis, with her enzymes at baseline levels. the pt is currently off haart which has been attributed in the past to causing her pancreatitis. ct torso on was negative for signs of pancreatitis. . 8. anemia: recent anemia w/u consistent with anemia of chronic dz, likely from renal failure. given also has guaiac positive stool, gib is another source though no overt bleeding. patient received 2 units prbcs in hd , 2 units prbcs after hd. baseline 22-25. . #h/o hepatic encephalopathy: no clear signs of encephalopathy during hospitalization. pt showed no asterixis. increased ascites on us of abdomen . patient was continued on lactulose. . #hiv/hepc: off haart therapy since last admission in contributing to elevated pancreatic enzymes. last cd4 was 233 in . also coinfected with hepc, hep b negative. will hold on haart at this time in setting of bleed. last cd4 135 with cd4/cd8 ratio of 0.2. the pt was started on atovaquone for pcp on . . 9. fen: renal heart dm diet. replete all lytes. . 10. ppx: ppi, lactulose, pneumoboots (holding heparin given guiac + stool, low plt) . 11. code: full code -> dnr/dni-> cmo medications on admission: ceftriaxone (d/c ) insulin dilantin (according to notes was not on this ) levaquin colace protonix lactulose calcitrol phoslo bicitra discharge medications: none discharge disposition: extended care discharge diagnosis: 1. altered mental status 2. syndrome 3. end-stage renal failure on hemodialysis 4. conjunctivitis bilateral eyes 5. human immunodeficiency virus 6. hepatitis c 7. cirrhosis 8. type ii diabetes mellitus discharge condition: deceased discharge instructions: none followup instructions: none procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube hemodialysis venous catheterization for renal dialysis transfusion of packed cells other incision of skin and subcutaneous tissue closed biopsy of skin and subcutaneous tissue transfusion of other serum transfusion of platelets transfusion of coagulation factors diagnoses: end stage renal disease obstructive hydrocephalus cirrhosis of liver without mention of alcohol diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic hepatitis c with hepatic coma acquired coagulation factor deficiency other convulsions unspecified fall human immunodeficiency virus [hiv] disease hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease hemorrhage complicating a procedure defibrination syndrome long-term (current) use of insulin chronic pancreatitis other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness hydantoin derivatives causing adverse effects in therapeutic use acute conjunctivitis, unspecified 

Answer: The patient is high likely exposed to