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: past medical history: 1. the patient has a left lower quadrant incision for evacuation of a psoas abscess in the past which may have included an incidental appendectomy. 2. history of depression, on effexor and klonopin with good effect. 3. no prior history or present history of suicidal ideation or acts. 4. recent history of irregular menses which is normal for her age. allergies: the patient is allergic to sulfa medication which gives her a rash. admission medications: 1. effexor 75 mg q.d. 2. klonopin 1 mg q.h.s. on admission. physical examination on admission: the patient had a temperature of 99.0, heart rate 100, blood pressure 140/50, 99% room air saturation. neurologically, there were no focal signs. she was intact from both a sensory and motor standpoint. there was no evidence of ataxia or tremor. she was alert and oriented times three and quite pleasant to converse with. respiratory: clear to auscultation bilaterally. cardiovascular: regular rhythm, normal s1, s2, no murmur, no carotid bruit. abdomen: soft, nondistended, no ascites. mild hepatomegaly with moderate right upper quadrant tenderness to palpation. no peritoneal signs, no hernia. the patient was having loose stool which included charcoal material given at an outside hospital. extremities: no edema, 2+ dp and pt pulses bilaterally. the patient had normal 2+ reflexes throughout. laboratory values on admission: white blood cell count 10, hematocrit 45, platelets 311,000. pt 22, inr 3.3, ptt 47. sodium 141, potassium 2.6, chloride 112, c02 13, bun 35, creatinine 1.1, blood sugar 123, ast 2,900, alt 2,500, alkaline phosphatase 90, total bilirubin 2.2, amylase 162, lipase 71, albumin 3.0. beta hcg negative. blood gas 7.31/32/135, 17, minus 9. past surgical history: 1. orthotopic cadaver liver transplant and silastic wound closure on . 2. evacuation of intra-abdominal hematoma, tru-cut needle biopsy, intraoperative ultrasound on . hospital course: the patient was admitted to the medical intensive care unit on . she had no evidence of neurologic changes or encephalopathy in the first 48 hours. transplant evaluation was undertaken in case transplantation would eventually be needed. a ct angiogram revealed an 1,800 cubic centimeter liver which was enlarged and fatty, enhancing at 23 hounsfield units. she was noted to have a replaced left hepatic artery which was replaced from the left gastric. she had normal hepatic vein anatomy but two right portal veins in the anterior and posterior branch with a single left portal vein. echocardiogram revealed normal wall motion and ejection fraction of 55% and trivial mitral regurgitation. she was cmv negative, hiv negative, hepatitis negative. by , the patient was profoundly coagulopathic with a prothrombin time of 44, fibrinogen 92, and a low platelet count. the plan was instituted to infuse ffp to keep her inr less than 3, give cryoprecipitate as necessary to keep the fibrinogen greater than 150 and to continue serial coagulations, hematocrit, fibrinogen, and platelet checks and replacement. the patient remained hemodynamically stable for the next 24 hours. psychiatry evaluated the patient for ability to consent and the patient was indeed able to consent to liver transplantation if necessary. she has a very supportive family who are involved in her care closely. at 3:00 a.m. on , the transplant service was called urgently to evaluate the patient for an acute drop in hematocrit, hypotension, and worsening coagulopathy. on evaluation, her hematocrit was 24, prothrombin time 31, and the patient had bright red blood in her stomach after placement of a nasogastric tube. she continued to have bright red blood from the stomach throughout the remainder of the morning. she was resuscitated with 4 units of blood, 6 units of ffp, and 1 unit of cryoprecipitate in addition to platelets. her chest x-ray was noted to be negative. the patient had only mild evidence of encephalopathy at this time. she was taken to ct scan for an abdominal ct which was negative. there was no hematoma, no free air. the portal vein, sma, and celiac access were patent. there was no rectus hematoma. there was a small amount of ascitic fluid around the gallbladder and the pelvis. egd was not pursued in order to avoid sedation and out of concern that it may exacerbate the bleeding. with the correction of the coagulopathy and aggressive resuscitation the bleed resolved. the patient was never hypotensive nor did she experience any mental status changes. during this event, a radial a line was also placed by the transplant service so blood gases could be followed serially and close blood pressure monitoring observed. on , the patient was noted to be slightly hypoxic and had an episode of sinus tachycardia to the 150s with mild st depressions. her care had been assumed the day prior by the transplant surgery service given her instability and complex care. her sinus tachycardia resolved with 10 mg of lasix. the patient was given lasix and her blood gases improved staving off intubation. troponins taken around the time of this event peaked at 1.9 and there was no evidence of myocardial ischemia. the service placed a left subclavian cordis son at this time for even closer hemodynamic management in anticipation of liver transplantation. the patient was listed on for a cadaveric liver transplantation. a suitable offer was not received until . at this time, the patient developed acute renal failure necessitating dialysis on the day of transplantation. she developed progressive encephalopathy requiring intubation. the patient continue to be encephalopathic and required a ffp drip. there was no evidence of infection prior to transplantation. on the day prior to transplantation, , the patient had a creatinine of 1.7. on this day she required the institution of a d20 infusion at 40 cc an hour to maintain normal glycemia. her hypoglycemia was taken as evidence of further liver failure. her total bilirubin went up to 9.0. her transaminases were 6,000 and 6,400. her inr was maintained near 2 on an ffp drip. she remained hemodynamically stable with a cardiac index of 4.6. her platelet count was maintained at greater than 100,000, hematocrit greater than 25, and fresh frozen plasma drip instituted to keep an inr of less than 3. an additional feature of concern was worsening hepatorenal failure and acute renal failure requiring dialysis the morning of transplantation. it was felt that the amanita poisoning had also effected her kidneys in that the renal failure would not be necessarily reversible by liver transplantation. she was also started on low-dose nitroglycerin for pulmonary hypertension. her pulmonary artery pressure in the afternoon of was 60/30. prior to transplantation the patient would require inhaled nitric oxide to maintain pulmonary artery pressures in a suitable range. the multiorgan failure resulting from her liver failure was complicated by features consistent with amanita poisoning of other organ systems including the kidneys. on , the patient had further neurologic decompensation and was completely incomprehensible and could only open eyes occasionally to command. at one point, she was combative and pulled her arterial line. a left brachial arterial line had to be placed by the transplant service. she continued on tpn and received hemodialysis after placement of a temporary quinton. isoagglutinin a and b titers were done in case a blood type specific match could not be found in time. by the morning of , the patient was quite moribund and her prognosis looked extremely poor. on , a size match but suboptimal liver became available. the liver had significant macro and microsteatosis but given the patient's moribund condition we elected to proceed with cadaveric liver transplantation. after preservation, the liver seemed to swell a bit and was over sized for the patient. it is also possible that the patient's recipient liver size was overestimated by ct scan. at the time of initial transplantation due to size mismatching it was not possible to perform a choledochodocostomy. the abdomen had to be left open, having been closed with silastic sheeting in a running continuous fashion. at the conclusion of the case the patient was mildly coagulopathic, hypothermic, and was taken to the icu for further resuscitation. a pediatric feeding tube was brought out through the skin in addition to jp drains. the feeding tube served as a bile drain and was in the donor common bile duct. the patient would remain coagulopathic postoperatively requiring continuous ffp infusion throughout the remainder of her hospital course. the patient also would remain in renal failure requiring cvvhd throughout her hospital course. her gi system was not functional and she remained tpn dependent with silastic closure of her abdomen. the patient would not experience neurologic improvement. she was continued on empiric unasyn postoperatively until day number seven. she also received fluconazole, valcyte, and pentamidine prophylaxis. the patient was on a solu-medrol taper, cellcept 1,000 b.i.d. for immunosuppression postoperatively. on postoperative day number one, she required further 8 units of packed red blood cells, 16 units of ffp, 4 units of platelets, and 4 units of fresh frozen plasma. the patient was reexplored on postoperative day number three, . at this time, a choledochodocostomy was performed over a t tube. a tru-cut needle biopsy at that time revealed extensive zone ii and iii necrosis with 20% macro and microsteatosis. a hematoma was evacuated and some oozing from the left adnexa treated with argon beam coagulation. on postoperative day number six, the patient experienced tonic clonic seizures of short duration. her head ct at this time was negative. she was treated with dilantin. an eeg was nonspecific. on postoperative day number seven, her antibiotic coverage was broadened with vancomycin and cefepime. she had no evidence of infection. her cultures including multiple line cultures and blood cultures remained negative throughout her hospital course until the final day in which she was found to have mrsa colonization without infiltrate. the neurology service was following closely. on postoperative day number nine, she was found to have absent cold caloric reflexes and decerebrate posturing. her pupils at this time were reactive and her corneal reflexes were intact. despite the mixed examination, the neurologic service felt that it was possible that the patient had suffered an irreversible brain stem injury. the patient's white blood cell count continued to fall from day eight to day nine and she was started on neupogen on postoperative day number nine for a white blood cell count of 1.7. her antibiotic coverage was broadened to include vancomycin, cipro, zosyn, and amphotericin. on postoperative day number 12, there were no signs of neurologic improvement and the diagnosis of irreversible brain stem injury seemed certain. she entered a hyperdynamic state consistent with sepsis. she had a white blood cell count of 0.4 despite daily maximal neupogen dosing and had her first postoperative fever. she was started on neo-synephrine drip that evening. her physiology was consistent with sepsis despite the broad antibiotic coverage and absence of positive cultures. there was no evidence of infiltrate on chest x-ray and all of her lines have been changed numerous times. we had undergone an extensive consultation with the patient's family and they were aware of the neurologic prognosis. we gradually reached the decision that the patient even if she did survive would have no hope of meaningful neurologic recovery. there was evidence of recovering liver function; however, towards the end of her course. a tru-cut needle biopsy done on postoperative nine revealed only mild steatosis with significant periportal hepatocyte regeneration and only mild centrolobular hepatocellular necrosis. there was evidence of polymorphonucleocyte infiltration which was suggestive of possible infection. she started to make small amounts of thin bile on postoperative day number ten. by postoperative day number 13, given the continued multiorgan dysfunction and permanent brain stem injury, the patient's family wished to withdrawal care. the patient was made comfort measures only and expired a short time later. a postmortem examination was performed. this postmortem examination was to include the central nervous system. disposition: the patient died on the day of discharge. , m.d.,ph.d. 02-366 dictated by: medquist36 d: 14:47 t: 19:16 job#: procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances enteral infusion of concentrated nutritional substances hemodialysis closed (percutaneous) [needle] biopsy of liver closed (percutaneous) [needle] biopsy of liver venous catheterization for renal dialysis control of hemorrhage, not otherwise specified other transplant of liver pulmonary artery wedge monitoring other laparotomy diagnoses: acute and subacute necrosis of liver acute kidney failure, unspecified defibrination syndrome alkalosis hepatic encephalopathy hemorrhage of gastrointestinal tract, unspecified toxic effect of mushrooms eaten as food accidental poisoning from mushrooms and other fungi 

Answer: The patient is high likely exposed to