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: sulfa (sulfonamide antibiotics) attending: chief complaint: transfer for management of pancreatitis major surgical or invasive procedure: central line arterial line history of present illness: hpi: this is a 61 year-old female with a history of etoh abuse, cholelithiasis s/p cholecystectomy, who presents from an osh with likely acute pancreatitis. . pt was initially admitted to the osh for two episodes of epigastric pain and abnormal lfts (ast 466 alt 268). us and mrcp were reportedly normal. she was discharged with diagnosis of alcoholic hepatitis. that evening, pt called her gi doctor complaining of severe abdominal pain, n/v, tremulousness. she presented to the ed and was re-admitted. she was noted to be jaundiced, groggy, with a protuberant abdomen. wbc was 13.8, k 2.8, bili 7.7, ast 324, alt 370, alk phos 251, lipast 4877. tox screen and etoh levels were negative. her abdomen became distended, tense, very tender, with no bowel sounds. she was transferred to the icu for closer monitoring. she was treated with ivf and aggressive pain control with dilaudid 1mg iv q3. additionally she was sedated on precedex and an ativan drip at 4mg/h. pt was intubated for airway protection on the morning of . ct of the abdomen revealed enlarged indistinct pancreas, extensive peripancreatic fluid consistent with severe pancreatitis and pancreatic necrosis, no loculated or drainable fluid collections or evidence of perforation. also noted were small bilateral pleural effusions and moderate amount of free fluid in the deep pelvis. . past medical history: etoh abuse htn h/o cholelithiasis s/p cholecystectomy oa of hips s/p bilateral thr depression h/o heart murmur social history: divorced, no children, lives alone. works as a ballet teacher. former smoker, quit 20 years ago. drinks 1 bottle of wine per day. family history: family medical history: mother died of lung ca at age 76. father died of mi at 43. brother with hypertension. multiple family members with alcoholism. physical exam: vitals: t: 97.9, bp: 103/52 hr: 77 rr: 19 o2sat: 100% vent settings: ps 10/5, rr 19, fio2 40%, vt 400s gen: intubated, sedated heent: icteric sclera, pupils pinpoint and sluggishly responsive, ngt (with bilious drainage) and dobhoff neck: no jvd, no bruits, no cervical lymphadenopathy, trachea midline, l infraclavicular line cor: rrr, 2-3/6 sem at llsb pulm: lungs ctab anteriorly abd: tense, distended, very decreased bowel sounds ext: cool hands and feet, no c/c/e neuro: sedated, non-responsive to painful stimuli skin: jaundiced pertinent results: ========== radiology/neurology ========== mrcp 1. necrotozing, hemorrhagic pancreatitis involving majority of the body and tail and portions of the head and neck. small portion of enhancing pancreatic tissue remains in the distal tail and portions of the head. there is no pancreatic ductal dilatation, however, a portion in the region of the genu is attenuated but not disrupted at this time. 2. large bilateral pleural effusions and small-to-moderate ascites. 3. the portal vein, smv, and sma are patent. note is made ct head there is no evidence of acute intracranial hemorrhages, edema, masses, mass effect, or large area of infarction. the lateral ventricles are slightly prominent for age and represent mild volume loss. the sulci are normal in caliber and configuration. there is no evidence of bony fracture. eeg markedly abnormal portable eeg due to the moderately severe suppression of the background throughout. the background was slow, and it was intermittent, alternating with much lower voltage patterns. there was a brief episode of some "lightening," but the background remained encephalopathic throughout. medication effect is probably the most common cause of such recordings. there were no areas of prominent focal slowing, but encephalopathies may obscure focal findings. there were no epileptiform features. mr no intracranial abnormalities detected. specifically, no evidence of hemorrhage or infarction. incidentally noted adipose accumulation over the right malar eminence and right maxillary sinus air-fluid level. ct a/p impression: 1. severe pancreatitis with extensive pancreatic necrosis sparing portions of the head and tail. 2. bilateral pleural effusions, slightly increased. 3. marked narrowing of the splenic vein and possible non- occlusive thrombus within its mid portion. 4. peripancreatic phlegmon and free fluid in pelvis. tte the left atrium is normal in size. the right atrial pressure is indeterminate. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. left ventricular systolic function is hyperdynamic (ef>75%). the estimated cardiac index is high (>4.0l/min/m2). there is a mild resting left ventricular outflow tract obstruction. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to increased stroke volume due to high cardiac output. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. no masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. no masses or vegetations are seen on the tricuspid valve, but cannot be fully excluded due to suboptimal image quality. there is moderate pulmonary artery systolic hypertension. there is an anterior space which most likely represents a fat pad. impression: suboptimal image quality. no valvular vegetations identified, but cannot definitively exclude given poor acoustic windows. hyperdynamic left ventricular function with resting tachycardia. normal left ventricular systolic function. technically suboptimal to exclude focal wall motion abnormality. moderate pulmonary hypertension ct chest 1. multifocal patchy areas of consolidation may reflect an infectious process. 2. moderate pulmonary edema including moderate pleural effusions, slightly smaller compared to the recent abdominal ct. 3. 2.3-cm spiculated right right lobe nodule is worrisome for malignancy. for which short interval followup, after patient's acute symptoms resolved, is recommended. 4. anasarca. 5. hemorrhagic pancreatitis, incompletely assessed. ct chest impression: 1. no pulmonary embolism. 2. interval worsening of multifocal areas of consolidation, probably reflecting an ongoing infectious process. 3. moderate pulmonary edema with slightly increased moderate pleural effusions bilaterally. 4. 8-mm right lower lobe opacity, smaller compared to the previously seen 2.3 cm spiculated right lower lobe nodule and probably represents atelectasis versus consolidation. a chest ct following resolution of patient's acute symptoms is again advised. 5. anasarca. ========== labs ========== 05:29pm lactate-1.3 05:24pm alt(sgpt)-174* ast(sgot)-80* ld(ldh)-764* alk phos-107 amylase-614* tot bili-2.8* 05:24pm lipase-676* 05:24pm albumin-2.3* calcium-7.8* phosphate-2.4* magnesium-2.2 05:24pm neuts-59 bands-20* lymphs-11* monos-7 eos-0 basos-0 atyps-0 metas-2* myelos-1* nuc rbcs-1* 05:24pm pt-13.3 ptt-29.7 inr(pt)-1.1 brief hospital course: # acute severe hemorrhagic pancreatitis: lipase was elevated to 4788 at the osh. osh ct showed pancreatitis and concern for pancreatic necrosis. etoh pancreatitis is the most likely etiology. she underwent mrcp at our hospital which demonstrated hemorrhagic, necrotic pancreatitis. patient was managed conservatively with aggressive fluid replacement. a surgery consult was obtained and did not advise any operative or ir procedures for the peripancreatic inflammation. she subsequently developed acute lung injury, bilat pleural effusions, anasarca,and ascites as a result of the severe pancreatitis. her course was complicated by vent associated pneumonia as well. she also showed altered mental status during her icu stay related to toxic and metabolic encephalopathy. patient required insulin replacement therapy while she was in the unit and on the floor. she was then transferred from the icu to the floor. there, she had pt/ot, blood transfusion for anemia from hemorrhagic pancreatitis, and diuresis. before transfer to rehab she was noted to have significant and had cxr. this showed possible loculated left upper lobe effusion. she underwent repeat ct of the chest on which showed moderate bilateral pleural effusions and anterior loculated left pleural effusion. case was discussed with interventional pulmonary service and given the patient's improving clinical status and lack of active evidence of infection, they recommended not performing a paracentesis to evaluate the loculated effusion. the patient was educated to return if she develops fevers, rigors, sweats, worsening difficulty breathing. . # altered mental status: her mental status was altered and related to toxic and metabolic encephalopathy. head imaging was negative (ct and mri)including eeg. she is back to normal mental functioning after her prolonged and complicated course. . # vap: sputum grew mssa (imipenem sensitive). she was initially on vancomycin and imipenem. vancomycin d/ced (). she was transition ed from imipenem ( ?????? ) to nafcillin on , but imipenem was restarted again given decompensating respiratory status. ct chest on was concerning for worsening multifocal pneumonia, so her antibiotics were changed from imipenem to vanco/zosyn. microbiology data has been negative since . 14 day course of antibiotics were completed on . cough improved with expectorant and mucous clearing device. before transfer to rehab she was noted to have significant and had cxr. this showed possible loculated left upper lobe effusion. she underwent repeat ct of the chest on which showed left anterior loculated effusion. . # pulmonary edema/acute lung injury: extubated but emergently re-intubated during event with svt and hypotension. patient was extubated again . ct chest showed interstitial changes and pleural effusions. bronchoscopy on was wnl, and samples significant only for 2+ polys and staph aureus. she continued to receive to lasix with effective diuresis. . # svt: patient has prior h/o of afib. reportedly never anticoagulated. episodes of svt appear to be precipitated by diuresis. she was emergently re intubated on during episode of svt with hypotension that did not respond to electrical cardioversion. patient was loaded on amiodarone and remained in nsr thereafter. cta was negative for pe. she was then placed on maintenance dose of 200 mg /day. patient was also continued on home dose of metoprolol. . # horase voice: patient had traumatic intubation and continues to have a hoarse voice. ent reports vocal cords functional and will continue to take time to recover. plan for pt to f/u with ent in 2 wks after discharge. . # rll nodule ?????? rll nodule appreciated on chest ct. this will require outpatient follow up in 10 - 30 days after discharge. pcp was notified on . . # nasal skin necrosis possibly related to her icu stay. she was seen by plastic surgery on . the necrosis is not infected. they recommended local care and out patient follow up at their resident clinic. . . . medications on admission: toprol xl 50 qd celexa 80 qd lisinopril 40mg po qd hctz 25 oxycodone 5 q6 discharge medications: 1. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 3. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for fever. 4. loperamide 2 mg capsule sig: one (1) capsule po tid (3 times a day) as needed. 5. trazodone 50 mg tablet sig: 0.5 tablet po hs (at bedtime) as needed. 6. guaifenesin 100 mg/5 ml syrup sig: 5-10 mls po q6h (every 6 hours) as needed. 7. white petrolatum-mineral oil 42.5-56.8 % ointment sig: one (1) appl ophthalmic prn (as needed). 8. lorazepam 0.5 mg tablet sig: one (1) tablet po q8h (every 8 hours) as needed for anxiety. 9. lorazepam 1 mg tablet sig: one (1) tablet po hs (at bedtime) as needed. 10. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 11. metoprolol succinate 50 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po daily (daily). 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 13. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours). 14. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 15. amiodarone 200 mg tablet sig: one (1) tablet po daily (daily). 16. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 17. lasix 20 mg tablet sig: one (1) tablet po once a day for 5 days. discharge disposition: extended care facility: of discharge diagnosis: severe necrotizing haemorrhagic pancreatitis acute respiratoy failure acute lung injury vap discharge condition: stable. discharge instructions: you had severe necrotizing haemorrhagic pancreatitis resulted in respiratoy failure, intubation, acute lung injury, lung infection and anemia. we found a small lung lesion that needs to be followed up with repeat ct of the chest once you recover. followup instructions: pcp: , . . please call the office at to schedule appointment in a 1 or 2. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube fiber-optic bronchoscopy fiber-optic bronchoscopy arterial catheterization transfusion of packed cells diagnoses: toxic encephalopathy unspecified essential hypertension adrenal cortical steroids causing adverse effects in therapeutic use acute posthemorrhagic anemia unspecified protein-calorie malnutrition depressive disorder, not elsewhere classified anxiety state, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure alkalosis methicillin susceptible staphylococcus aureus in conditions classified elsewhere and of unspecified site other diseases of lung, not elsewhere classified other ascites diarrhea other specified complications of procedures not elsewhere classified ventilator associated pneumonia alcohol abuse, continuous acute pancreatitis paroxysmal supraventricular tachycardia acute edema of lung, unspecified other diseases of spleen other specified disorders of skin edema other voice and resonance disorders secondary diabetes mellitus without mention of complication, not stated as uncontrolled, or unspecified 

Answer: The patient is high likely exposed to