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: respiratory failure, hepatitis major surgical or invasive procedure: central venous line placement arterial line placement intubation mechanical ventilation history of present illness: patient intubated & unable to answer questions. history obtained from medical chart and patient's mother, . ms. is a 41 y/o f with pmh of hepatitis c and ivdu who presented to osh with several days of abdominal pain, n/v, and jaundice. she described the pain as constant and diffuse. she reported subjective fevers with cough. denied urinary symptoms or change in stool color. per the patient's mother, ms. was seen by her stepfather four days ago and he noticed that she "looked ill and yellow." reportedly took 4 tylenol tables (unknown strength yesterday morning). at the osh, she received 3 mg iv dilaudid, 12.5 mg phenergan, and 1 l ns. blood pressure reported at 106/59 at osh with tachycardia to 101. reported cxr no infiltrates (?). blood cultures were sent and she was found to have transaminases ast > , alt > 8000 and transferred to for treatment of liver failure. of note, in osh ed, patient reported prolonged sobriety but recent use of opiates and alcohol but stopping 4 days prior to presentation; reported not being able to keep down pos since that time. initial vitals in ed: t 96.8, hr 122, bp 84/32 --> 58/18, o2 98%. she was noted to be lethargic and was given narcan. she was intubated with succinylcholine, etomidate, vecuronium; she received a repeat dose of etomidate at 0345. she received a total of 5 l ns and code sepsis was initiated. right ij was placed. she received vancomycin 1 g iv x 1, levofloxacin 750 mg iv x 1, flagyl 500 mg iv x 1, zofran 4 mg, and zosyn 4.5 mg iv x 1. she was on levophed gtt but this was weaned to off at 0430 due to hypertension (160s systolic). ros (obtained at osh): + subjective fever, no chills. no chest pain, diaphoresis, doe, orthopnea, edema. + cough but nonproductive. + nausea/diarrhea, jaundice, vomiting, anorexia. denies hematemesis, hematochezia, melena. + dizziness. + cold intolerance. + easy bruising/bleeding. denied suicidal ideation. past medical history: hepatitis c h/o hepatitis b (per records from osh) h/o pancreatitis h/o ivdu depression/anxiety h/o kidney stones per mother social history: recently in prison for dui/reckless driving and drug convictions. then let out of prison to rehab in and returned to home about one week ago. no permanent housing at present. living at a shelter or with a male friend per mother. + alcohol use this week, though until last week was at a rehab/shelter in and presumably was not drinking. + heroin use (within last 24-96 hours by report). + tobacco, 1 ppd. family history: noncontributory. physical exam: t: 95.9 bp: 128/51 hr: 127 rr: o2 100% on a/c fio2 80, tv 500, rr 20, peep 5 gen: intubated, sedated heent: + scleral icterus & conjunctival edema. tongue dry, op clear, poor dentition neck: supple, no palpable lymphadenopathy, r ij catheter in place cv: tachycardic, regular, no appreciable murmur lungs: no wheeze, crackles r > l abd: slightly distended, hyperactive bowel sounds ext: feet & hands cool, good cap refill, no peripheral edema skin: no rash neuro: sedated. able to move all four extremities. pupils small but reactive bilaterally. eyes remain toward ceiling when head moved side to side (+ doll's eyes), withdraws to pain pertinent results: osh labs: ========= wbc 8.9 (87%n, 6% lymphs, 5% bands), hct 38, plt 129 lipase 145 amylase 48 glucose 77 na 138, k 3.6, cl 100, co2 26, bun 9, cr 0.8 protein 7.3, albumin 3.7 bili 3.2 ca 9.1 ast alt 8040 alk phos 141 serum pregnancy negative inr reportedly 3 admission labs: =============== 01:00am blood wbc-16.3* rbc-4.24 hgb-13.5 hct-38.1 mcv-90 mch-31.9 mchc-35.4* rdw-12.4 plt ct-131* 06:00am blood wbc-23.6* rbc-3.54* hgb-10.7* hct-33.6* mcv-95 mch-30.2 mchc-31.9 rdw-12.4 plt ct-120* 01:00am blood glucose-23* urean-16 creat-1.2* na-143 k-3.2* cl-103 hco3-20* angap-23 06:00am blood glucose-94 urean-13 creat-0.8 na-144 k-3.3 cl-115* hco3-14* angap-18 01:00am blood alt-6760* ast-* alkphos-142* totbili-3.5* 12:12pm blood alt-4216* ast-7188* ld(ldh)-3595* alkphos-84 totbili-3.9* 01:00am blood albumin-3.6 calcium-9.0 phos-2.9 mg-1.6 microbiology: ============= blood culture blood culture, routine-final { , }; aerobic bottle gram stain-final inpatient blood culture blood culture, routine-final {streptococcus pneumoniae}; anaerobic bottle gram stain-final; aerobic bottle gram stain-final emergency blood culture blood culture, routine-final {streptococcus pneumoniae}; anaerobic bottle gram stain-final blood culture blood culture, routine-preliminary {staphylococcus, coagulase negative, staphylococcus, coagulase negative}; anaerobic bottle gram stain-final; aerobic bottle gram stain-final studies: ======== ct abd / pelvis 1. dense bilateral large consolidations with small associated pleural effusion, worrisome for pneumonia. 2. abdominal fluid, periportal edema and pericholecystic fluid, consistent with volume overload. 3. left renal cortical defect probably indicative of remote pyelonephritis. 4. heterogenous liver consistent with hepatitis. 5. retroperitoneal edema. . ruq us ruq focused ultrasound: there is a small amount of perihepatic ascites. the right, left, and middle hepatic veins demonstrate appropriate flow, although waveforms are not triphasic. the portal vein demonstrates normal hepatopetal flow. impression: the hepatic veins demonstrates normal flow but non-triphasic waveforms that may be due to decrease complicance secondary to diffuse hepatic disease. . cta abd / pelvis impression: 1. interval improvement in bibasilar pulmonary consolidations suggests an interval improvement in the underlying pneumonia. 2. interval development of the anasarca, bilateral pleural effusion, and progression of the ascitic fluid suggests volume overload status. 3. mild thickening of sigmoid and descending colon. this most likely reflects colitis-probably c diff. . no evidence of bowel ischemia is noted. 4. stable left renal cortical defect probably indicative of remote pyelonephritis. . tte the left atrium is normal in size. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef 60-70%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. the estimated pulmonary artery systolic pressure is normal. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. impression: no obvious vegetations seen on this technically suboptimal study . ct abd /pelvis 3.21 1. interval improvement in both bilateral consolidations and pleural effusions. 2. anasarca with no significant change in ascites and pelvic free fluid. 3. cortical thinning at the site of likely old infection in the left kidney. . tte 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. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal. right ventricular chamber size and free wall motion are normal.the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve leaflets are structurally normal with trivial mitral regurgitation. no mass or vegetation is seen on the mitral valve. there is a trivial/physiologic pericardial effusion. impression: no echocardiographic evidence of endocarditis. mild tricuspid regurgitation. . cta chest findings: direct comparison is made to prior examination dated . current examination reveals a stable appearing right-sided pneumatocele. small area of dependent soft tissue attenuation is again identified, as on prior ct. given the patient's clinical history, fungal ball should be a differential consideration for this finding. overall, there is significant improvement in the appearance of the lung parenchyma, which do demonstrate a persistent areas of bilateral, diffuse air trapping. areas of increased interstitial markings seen at the left lung base. this likely represents areas of pulmonary fibrosis. focal, confluent area of opacity is also seen at the right lung base, which may represent a persistent area of infection or atelectasis. there is no evidence of main, central, or segmental pulmonary embolism. the main pulmonary artery measures 3.1 cm. this enlargement suggests underlying pulmonary arterial hypertension. there is a small-to-moderate sized pericardial effusion. no significant hilar or mediastinal lymphadenopathy is identified. visualized portions of the upper abdomen are grossly unremarkable. no suspicious lytic or blastic bony lesions are identified. impression: 1. no evidence of pulmonary embolism. 2. continued improvement in the patient's pulmonary disease with pneumatocele identified. dependent soft tissue attenuation suggests the possibility of a fungal ball. recommend clinical correlation. also, area of possible fibrosis seen at the left lung base. brief hospital course: 41 yo female with history of alcohol and iv drug abuse presents with sepsis and hypoxia. . the patient was in the micu from through . during this time, she was treated for: -sepsis: required intubation, siginficant ventilatory support and 3 pressors. dic. resp failure/ards from presumed aspiration event/s.pneumo pneumonia. she had s. pneumoniae bacteremia, enterococcal uti, and candidal fungemia during her micu course. -s. pneumo pneumonia and bacteremia with ceftriaxone, then meropenem because of elevated bilirubin. there was a concern about prolonged altered mental status off all sedation in the periextubation period, raising a concern about meningitis. no lp performed, and her mental status improved without other intervention. the plan was to treat the patient empirically for meningitis. -she also was persistently febrile despite broad spectrum antibiotics. blood cultures grew and the patient was treated with iv caspofungin given her lft abnormalities. once her lfts normalized/returned to baseline, the plan was to change to fluconazole (although she only completed 16 d course of caspofungin). ophthalmology was consulted, and no evidence of fungal infection was discovered via fundoscopic exam. -fulminant hepatic failure with inr to 5.9, ast>15,000, alt>8,000. thought to be shock liver, also a possible tylenol component and the patient was treated with nac initially. -anemia: thought to be a slow drift, guaiac negative, no evidence of hemolysis on most recent labs -altered mental status: prolonged somnolence off sedation, likely related to liver failure and use of benzos during sedation. treated with lactulose and ms improved slowly. methadone held. -volume overload: patient ~19 l positive at transfer, had been autodiuresing. cr stable . medical floor course: . she was transferred to the floor, autodiuresed and continued to show significant improvement in her lfts, when she developed another fever and hypoxia and was transferred back to the micu for a likely aspiration event. she was re-intubated and continued on treatment for her many infections. she was followed closely by infectious disease, and she again improved considerably and was extubated on . she had completed all courses of antibiotics while in the micu, and was off of antibiotics on re-transfer to the floor. her liver enzymes also continued to improve slowly, but remained elevated on transfer to the floor. . on the floor (round 2), she primarily complained of generalized weakness, which was likely due to her critical illness and prolonged icu course. she worked closely with physical therapy and occupational therapy, and made significant improvement while inpatient. neurology was consulted for right arm numbness and weakness, which was contributed to possible injury experienced with arterial line placement while in the icu; it was recommended that she follow up with physical therapy for continued strength training. she was also significantly anxious during this hospital stay. she was seen by social work and addictions consult, and being treated with xanax initially for her significant anxiety. psychiatry was consulted for assistance in management of anxiety; she was put on clonazepam instead. . after 1 week on the floor she developed progressive leukocytosis. surveillance cultures were obtained and revealed coag negative staph, the source of which was considered to be her picc line. the line was pulled and she was started on vancomycin for 7 day course. after blood cultures were negative for 48 hrs another picc line was placed to complete treatment. this second picc line was pulled on discharge. furthermore, a cta was performed to evaluate pleuritic chest pain, which did show improvement of airspace disease with a pneumatoceole. given her hx of fungemia, this raised concerns for a fungal ball in the right lung. id and pulmonary were contact regarding this issue, and it was determined that the airspace was unchanged, unlikely represented an active infection, and may represent sequelae from previous infection (likely bacterial). she was encouraged to follow up with pulmonary regarding this issue in 8 weeks time. she also had a progressive eosinophilia upon discharge; this was considered secondary to vancomycin. she will require a follow up cbc with differential in 5 days post discharge to ensure the leukocytosis / eosinophilia has resolved. . medications on admission: none per report. discharge medications: 1. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po bid (2 times a day): patient should have loose bowel movements a day. 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 4. multivitamin,tx-minerals tablet sig: one (1) tablet po daily (daily). 5. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). 6. clonazepam 0.5 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 7. clonazepam 0.5 mg tablet sig: one (1) tablet po daily (daily) as needed. discharge disposition: extended care facility: discharge diagnosis: 1) s. pneumonia pneumonia 2) ards 3) candidemia 4) hepatic failure 5) substance abuse 6) staph bacteremia 7) pneumatoceole discharge condition: weak physically, with numbness of right hand. mildly jaundiced. highly anxious. left sided picc line in place. hemodynamically stable and afebrile. discharge instructions: you were admitted to the hospital with a severe lung and blood infection. you were treated in the intensive care unit, and maintained on life support. you also experienced a fungal infection of the blood and a repeat bacterial infection of the blood. you completed treatment for the first bacterial infection and the fungal infection. you are currently being treated with an antibiotic for the most recent bacterial infection (which was likely caused by the first picc line). you should follow up with infectious disease as below. . you were noted to have liver dysfunction from underlying hepatitis. you should continue to follow up with a liver specialist regarding your care. . you were noted to have anxiety and a history of substance abuse. you will benefit from therapy and a treatment program. please continue your new medication clonazepam for anxiety as prescribed. please follow up with psyciatry. . you were also found to have an air pocket in your lung. you should follow up with a lung doctor 2 months to ensure that this is unchanged. . please start below attached medications. . if you experience shortness of breath, chest pain, cough, fevers, chills, diarrhea, abdominal pain, please contact your doctor or return to the for help. followup instructions: please see your primary care physician, pulmonologist, infectious disease doctor, substance abuse counseling/behavioral therapist. . you have an appointment with your infectious disease doctor on at 9:30am with dr. , phone # . . you have an appointment with your pulmonologist on at 1:30pm, phone# . clinic located at , building. please show up at 1:00pm for testing at pulmonary function lab phone:. . you have an appointment with your primary care physician on , at 8:00am at community health center, phone# . . you should follow up with psychiatry. call for referral to see a psychiatrist for treatment of your anxiety. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances arterial catheterization closed [endoscopic] biopsy of bronchus diagnoses: urinary tract infection, site not specified chronic hepatitis c without mention of hepatic coma acute posthemorrhagic anemia acute and subacute necrosis of liver unspecified protein-calorie malnutrition severe sepsis 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 pneumonitis due to inhalation of food or vomitus septic shock streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] pneumococcal septicemia [streptococcus pneumoniae septicemia] pneumococcal pneumonia [streptococcus pneumoniae pneumonia] other and unspecified infection due to central venous catheter other candidiasis of other specified sites eosinophilia 

Answer: The patient is high likely exposed to