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: naproxen / trazodone / compazine / motrin / toradol attending: chief complaint: change in mental status major surgical or invasive procedure: intubated on and extubated on with micu stay from -> history of present illness: patient is a 46 yo woman with h/o hep c and ivda who is transfered from osh, presented to the ed with altered mental status, neck stiffness, and petechial rash. she recieved vanco, ceftriaxone and acyclovir. lp deferred in ed secondary to thrombocytopenia. in ed, she was also given 2l ivf. patient was recently admitted in for headache thought to be either viral meningitis, post lp headache vs. more likely, pain seeking behavior. past medical history: 1. fibroids 2. chronic pain 3. opiate dependence 4. etoh 5. agoraphobia 6. depression 7. hepatitis c secondary to ivdu per notes, but patient reports due to blood transfusion 8. ?renal stones 9. splenomegaly and thrombocytopenia; per prior omr notes, has been extensively evaluated in the past with viral serologies and bm biopsy 10. ? bipolar affective disorder. history of psych hospitalization at age 20 following assault, at age 30 during parents separation and in after od attempt social history: widowed in - husband w/basal cell carcinoma, heroin abuse- 1bag/day for 2y, but currently denies. occassional etoh, no tobacco. lives w/son, worked in customer relations for . family history: father w/alcoholism physical exam: vs: 99.8 bp 184/107-->146/89 p 94 o2 ac 100% 500 14 5 gen: intubated/sedated heent: no jvd, no lad, op clear with no thrush. upper back, arms, legs with excoriations. face with mild erythema. lungs: cta b heart: rrr, no m/r/g abd: soft, hypoactive bowel sounds, nt, vertical midline scar, ruq scar extr: no c/c/e neuro: opens eyes to commands pertinent results: admission labs: 08:25pm wbc-4.3# rbc-3.93* hgb-11.0* hct-32.2* mcv-82 mch-28.1 mchc-34.3 rdw-17.9* 08:25pm plt count-55* 08:25pm neuts-64.3 lymphs-26.8 monos-5.9 eos-2.3 basos-0.7 08:25pm pt-16.5* ptt-37.9* inr(pt)-1.5* 08:25pm glucose-109* urea n-4* creat-0.6 sodium-140 potassium-3.7 chloride-107 total co2-27 anion gap-10 08:25pm alt(sgpt)-16 ast(sgot)-40 ck(cpk)-174* alk phos-151* amylase-47 tot bili-1.0 08:33pm lactate-1.3 08:25pm lipase-26 08:25pm ck-mb-4 ctropnt-<0.01 08:25pm albumin-3.9 calcium-8.8 phosphate-3.9 magnesium-1.9 . ct neck : 1. no fluid collections or abscesses are identified within the neck. there are no pathologically enlarged lymph nodes. 2. endotracheal tube cuff appears slightly overdistended, with no adjacent pneumomediastinum. 3. bilateral hypodense thyroid nodules, with scattered coarse calcifications are likely benign. thyroid ultrasound could be performed on a nonemergent basis if clinically indicated. . ct chest/abd/pelvis : 1. no evidence of pulmonary embolism, as clinically questioned. enlarged pulmonary artery, compatible with pulmonary arterial hypertension. 2. bilateral pleural effusions with adjacent airspace disease, likely representing atelectasis. 3. findings consistent with cirrhosis with associated splenomegaly likely reflecting portal hypertension. . ct head : no intracranial hemorrhage or mass effect. . cxr : 1. recommend pulling the endotracheal tube at least 2 cm back. 2. increased density of the retrocardiac space could represent atelectasis versus underlying hiatal hernia. clinical correlation recommended. . cxr : probable worsening of bilateral pleural effusions with new left lower lobe opacity. given rapidity of onset atelectasis or aspiration pneumonitis is favored over rapid developing pneumonia. . renal us : unremarkable evaluation of bilateral kidneys without evidence for hydronephrosis, obstructing stone or renal mass. . kub : ascites with retained oral contrast in the distal colon and rectum. no contrast seen corresponding to renal fossae or course of ureters. . x-ray of right shoulder ( findings: there is no fracture or dislocation. the glenohumeral and acromioclavicular joints are within normal limits. the coracoclavicular interval is appropriate. the regional soft tissues radiographically are unremarkable. the visualized adjacent lung is clear. . impression: no radiographic evidence of traumatic bony injury to the shoulder. please note, not mentioned above, there are very tiny curvilinear opacities in the region of the greater tuberosity which are likely due to calcific tendinitis and are not felt to be due to acute trauma. . ecg : sinus at 80, nl intervals and axis, no st/t wave changes. . microbiology: blood cx - ngtd urine cx - negative rpr - pending . discharge labs: 05:15am blood wbc-2.1* rbc-3.11* hgb-8.6* hct-25.5* mcv-82 mch-27.7 mchc-33.7 rdw-18.6* plt ct-75* 05:15am blood glucose-94 urean-14 creat-1.6* na-140 k-3.9 cl-107 hco3-26 angap-11 05:15am blood calcium-8.3* phos-4.6* mg-1.6 brief hospital course: impression/plan: pt is a 46 yo woman hep c, splenomegaly & pancytopenia of unclear etiology, depression/anxiety, hx prescription narcotic abuse who p/w acute mental status changes intubated. she was successfully extubated on hd 2 and then developed acute renal failure (likely contrast induced nephropathy). 1. altered mental status/delirium/possible benzodiazepine overdose - unclear etiology for this. toxicology screen at osh was not done and here only positive for opiates (she was given then in ed)she was initially intubated for airway protection, and successfully extubated on hd#2. pt was initially thought to have meningitis, though an lp could not be performed. she was initially treated with meningeal dosing abx (vancomycin and ceftriaxone). however, exam did not support meningitis and upon review on omr records, patient has a history of neck pain (tension headache). her altered mental status was thought to possibly be toxic metabolic in etiology or hepatic encephalopathy secondary to her underlying cirrhosis (elevated ammonia level on admission). another concern was ttp in the setting of mental status changes, renal failure, anemia, and thrombocytopenia (see below). however, heme-onc saw pt and felt that this was unlikely secondary to smear. eeg showed nonspecific mild encephalopathy. lactulose was started po. panculture was negative for infection. additionally, question of withdrawing from substances (clonazepam, antispasmotics, other drugs) are more likely as on the day of the call out, pt was found to have bottles of clonipin under her pillows; although she denies taking the pills, she appeared very sedated and the bottles were filled on (same day she was admitted to the ), prescribed at hospital. called the pharmacy who filled the presciption , unable to read the signature of the prescription as it was a hand written prescription. called hospital and on call psychiatrist dr. ), pt was admitted briefly (1-2 days) for gi symptoms thought to be pancreatitis at , and was discharged on clonipin (2mg po bid) as this was her outpatient medications by one of the interns on the floor. because of her sedation, benzos and dilaudid were discontinued (she was briefly kept on ciwa scale). psychiatry evaluated pt, and recommended seroquel 25mg po tid for agitation and anxiety, and continue haldol prn for agitation. she became more alert and less sedated after above regimen. physical therapy and occupational therapy worked with the patient, and she did well, and cleared her to go home. social worker were involved throughout her stay to provide support and resources for her substance abuses. 2. fever: initially had fever on admission to icu. likely source thought to be a new lll pna (aspiration vs. hospital acquired). ceftriaxone, vancomycin, and flagyl were started but d/c'd on hd #5 as cxr improved and pneumonitis was posibble. pancultures were negative. although she has ascites, she never had abdominal pain or asterixis suggesting spontanous bacterial peritonitis. right shoulder xray done for pain was negative for acute fractures. 3. non-oliguric acute renal failure- creatinine rose to peak of 4.1 from 0.7. seen by nephrology who thought it to be consistent with a contrast induced nephropathy (atn) given dates. creatinine steadily decreased to 1.6 at the time of discharge. cryoglobulin negative. atn from dye is most likely. 4. s/p intubation: intubated for ams and for ease of obtaining imaging studies. extubated on hd #2. 5. pancytopenia: etiology was unclear and patient reports having a bone marrow biopsy with "inconclusive results". hiv negative in . baseline platelets are around 55k. she had a brief platelet drop from her baseline, hem/onc was consulted for concerns of ttp (given that this episode occured around same time of her arf). peripheral smear on heme review with no evidence of hemolysis. fibrinogen, fdp, and dat negative per heme recommendations. pt received vitamin k x 3 doses po. her cbc remained stable around her baseline after that. 6. neck pain - thought to be chronic as above; muscle relaxants were d/c'd secondary to patients mental status and over sedation. dilaudid was initially continued in the micu, but was discontinued on the floor as pt was seen to hiding bottles of clonipin under pillow and appear extremently sedated on the day of the transfer to the floor. her mental status improved after stopping sedating medications (narcotics, benzo, muscle relaxants, etc). 7. pt reports pain all over and non-localizing except for neck pain as above. all workup were negative. more likely pain seeking behavior. secondary to severe sedation, her muscle relaxant and dilaudid was d/c'ed. she was kept on tylenol for pain which she tolerated well, although she complained of pain, but after reassurance and for her safety (not wanting her to be oversedated), she didn't get further narcotics. 8. chronic hepatitis c- not previously worked-up. no evidence of decompensation. abdominal us in findings had evidence of cirrhosis, no portal vein thrombosis or clot. afp is 4.9. we started lactulose as above. 9. substance abuse (etoh, opiates) - was on a ciwa which was d/cd. continued thiamine and folate. problem #1 above as pt was found to hide her clonipin bottles under her pillows, and all sedative meds were d/c'ed given severe sedation. psych recommended seroquel 25mg po tid for agitation and anxiety w/ haldo prn. she tolerated that regimen well. medications on admission: on recent d/c in : 1. thiamine hcl 100 mg tablet sig: one (1) tablet po daily 2. clonazepam 1 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 3. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 4. oxycodone 5 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain. 5. tizanidine 2 mg capsule sig: one (1) capsule po at bedtime. discharge medications: 1. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q8h (every 8 hours) as needed for titrate for bms per day. disp:*1 bottle* refills:*0* 4. quetiapine 25 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for agitation and anxiety for 2 weeks. disp:*42 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: altered mental status (improved, extensive work up negative, and most likely from sedative medications) pancytopenia (stable) acute renal failure from iv contrast (improving) radiolographic evidence of cirrhosis discharge condition: afebrile, vital sign stable, tolerating po, and ambulating discharge instructions: you were admitted for altered mental status, and extensive workup for infectious causes were negative. eeg is negative for seizures. you mental status has improved after you were taken off a lot of the sedation medications, including clonopin or other benzodiazepam, dilaudid, muscle relaxant. psychiatry team evaluated you inpatient, and recommended that instead of taking benzodiazepam (clonopin) for agitation and anxiety, try seroquel (less sedating) as needed for your anxiety, which you were given a presciption. please follow up with your pcp, . (see appointment time below) regarding any adjustment of your medications from now on, as it is very important to coordinate all of your medical care in one place. . please take your medications as prescribed. do not exceed 2grams of tylenol every day for control of your pain. do not take any nsaids (including ibuprofen, motrin, etc.) until your kidney function is close to your baseline. . call 911 or go to the nearest emergency room if you have fever>101, chills, chest pain, shortness of breath, severe nausea, vomiting, abdominal pain, or diarrhea, or any other symptoms that are concerning to you. followup instructions: please follow up with your pcp, . , on at 2:50pm (address: ). procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: pneumonia, organism unspecified thrombocytopenia, unspecified cirrhosis of liver without mention of alcohol chronic hepatitis c without mention of hepatic coma acute kidney failure, unspecified depressive disorder, not elsewhere classified pulmonary collapse opioid type dependence, continuous drug-induced delirium unspecified sedatives and hypnotics causing adverse effects in therapeutic use other drugs and medicinal substances causing adverse effects in therapeutic use 

Answer: The patient is high likely exposed to