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: no known allergies / adverse drug reactions attending: chief complaint: confusion major surgical or invasive procedure: intubation right sided tunneled line removal of right sided tunneled line history of present illness: 24 y/o female with long-standing history of etoh abuse and pancreatitis (drinks approximately 1 gallon of vodka per day), who has been attempting to self detox, transferred from hospital, after found down at home. it appears that her mother may have called 911. when ems arrived, her house was noted to be disordered with feces on floor. she was felt to be intoxicated, but arousable. she reported her last drink as 12 pm today. she denied other toxin ingestions. vitals were hr 160s, sbp 80s for ems. an io was placed in the right tibia. there was also ? of black stools and coffee ground emesis. she was transferred to osh hospital, where she was tachycardic to hr 130s. she also had dark emesis and dark stool. quantitative hcg < 2. head/cspine negative. io attempted to be removed, but unable to be done. reportedly, the plastic part was broken off, but the metal needle remained in the tibia. she was given zofran and benzodiazepines. she received a dose of zosyn 3.375 mg. labs were notable for low potassium, high cr. as no icu beds were available, she was transferred to . here, she was tachycardic, but not hypotensive. she was easily arousable, answering questions appropriately, stating she "felt unwell." urine sample here with ? infection. stox and utox negative. hct here 28.6, down from hct 44.8. this hct drop was felt to be inappropriately low for the degree of ivf she received (4l ivf). this in combination with her reported dark stool and emesis, led to guiac exam here, which showed guaiac positive stool. she was started on protonix gtt. ngt deferred given low suspicion for active bleeding. labs here notable for mildly elevated lactate, bandemia, and given concern for sepsis, she received vancomycin and clindamycin. toxic shock syndrome was considered as a diagnosis. pelvic exam showed no cmt or adnexal tenderness. rectal probe was placed. she received reglan, ativan 2 mg x 2 doses, 1 gram tylenol, and 4l ivf in our ed. ekg notable for sinus tachycardia without ischemic changes. cxr without evidence for infiltrate. vitals on transfer: 101.9, hr 130, rr 24, bp 140/86, 100% 2l nc. mental status: arousable, sleepy/somnolent access: 18 g, 20 g, 22 g on arrival to the micu, patient's vs: 101.6, hr 133, bp 161/91, rr 24, 100% 2l nc past medical history: - etoh abuse - pancreatitis - -calve-perthes disease social history: extensive history of etoh use and abuse. denies illicit drugs. not sexually active. mother is currently hospitalized for etoh related issues. family history: etoh abuse in mother. otherwise non-contributory physical exam: admission exam vitals: 101.6, 133, 161/91, 16, 100% 2l nc general: sleepy/somnolent, arousable, no acute distress heent: anicteric sclera, mmm, op clear, perrl neck: supple, jvp difficult to estimate given body habitus but not felt to be elevated, no lad cv: tachycardic, regular rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, mildly distended, reports some discomfort upon palpation of epigastric and ruq region, bowel sounds present but hypoactive, liver edge felt 1-2 cm below costal margin, no rebound or guarding gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: cnii-xii grossly intact, perrl, grossly normal sensation, not cooperative with strength exam due to sleepy/somnolence, no neck stiffness, 2+ reflexes bilaterally, gait deferred. skin: erythematous blanching rash on waist discharge exam vitals: temp: 99.3 bp: 166/114 (112/84-180/110) 120 (74-120) 93% ra i/o: 1688/1900+ general: alert and oriented in no acute distress, slightly tremulous heent: anicteric sclera, mmm, op clear, perrl neck: supple, jvp no elevated, no lad chest wall: right sided tunneled line with blood around the insertion site cv: regular rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: nabs, mildly distended, no tenderness to palpation, ext: warm, well perfused, 2+ pulses, no clubbing or cyanosis, 1+ edema neuro: cnii-xii grossly intact, no nystagmus noted, perrl, intact eom, grossly normal sensation, strength 5/5 bil, pertinent results: on admission: 01:30am wbc-5.5 rbc-2.78* hgb-9.4* hct-28.6* mcv-103* mch-33.8* mchc-32.9 rdw-13.9 01:30am neuts-83* bands-9* lymphs-3* monos-2 eos-0 basos-0 atyps-0 metas-3* myelos-0 01:30am hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-2+ microcyt-normal polychrom-normal 01:30am glucose-188* urea n-23* creat-2.6* sodium-132* potassium-3.1* chloride-94* total co2-13* anion gap-28* 01:30am alt(sgpt)-209* ast(sgot)-930* ld(ldh)-663* ck(cpk)-2465* alk phos-84 tot bili-5.0* dir bili-4.1* indir bil-0.9 01:30am lipase-4680* 01:30am albumin-3.5 calcium-6.0* phosphate-1.5* magnesium-1.4* iron-78 01:30am triglycer-627* 01:30am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 01:05am urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 01:05am urine color-yellow appear-cloudy sp -1.017 01:05am urine blood-lg nitrite-neg protein-300 glucose-70 ketone-10 bilirubin-sm urobilngn-2* ph-6.0 leuk-tr 01:05am urine rbc-1 wbc-47* bacteria-many yeast-none epi-4 trans epi-1 trends: 03:44am blood wbc-6.9 rbc-2.45* hgb-8.3* hct-26.6* mcv-109* mch-33.7* mchc-31.0 rdw-15.0 plt ct-34* 03:33am blood wbc-7.1 rbc-2.74* hgb-8.8* hct-28.3* mcv-103* mch-32.1* mchc-31.1 rdw-17.8* plt ct-85* 03:00am blood wbc-9.8 rbc-2.56* hgb-8.2* hct-26.4* mcv-103* mch-32.0 mchc-31.0 rdw-18.2* plt ct-153 01:25pm blood wbc-11.5* rbc-2.69* hgb-8.7* hct-27.3* mcv-102* mch-32.6* mchc-32.1 rdw-18.1* plt ct-175 02:07am blood wbc-12.9* rbc-3.05* hgb-9.6* hct-30.0* mcv-99* mch-31.7 mchc-32.1 rdw-18.5* plt ct-174 08:12pm blood neuts-85* bands-5 lymphs-6* monos-2 eos-0 baso-0 atyps-0 metas-1* myelos-1* 06:09pm blood neuts-80.7* lymphs-9.3* monos-5.9 eos-3.5 baso-0.5 02:07am blood neuts-77* bands-1 lymphs-8* monos-13* eos-0 baso-0 atyps-0 metas-1* myelos-0 04:01am blood neuts-pnd lymphs-pnd monos-pnd eos-pnd baso-pnd 01:15pm blood hypochr-occasional anisocy-occasional poiklo-normal macrocy-2+ microcy-normal polychr-normal 04:19am blood hypochr-3+ anisocy-2+ poiklo-1+ macrocy-1+ microcy-normal polychr-1+ ovalocy-1+ target-1+ stipple-occasional tear dr 04:35am blood pt-13.4* ptt-28.7 inr(pt)-1.2* 03:30pm blood plt ct-164 03:33am blood glucose-86 urean-44* creat-5.8* na-142 k-3.2* cl-105 hco3-16* angap-24* 03:00am blood glucose-77 urean-62* creat-8.1* na-141 k-3.4 cl-106 hco3-13* angap-25* 04:35am blood glucose-106* urean-37* creat-5.3* na-140 k-3.1* cl-98 hco3-21* angap-24* 04:19am blood glucose-130* urean-47* creat-6.4* na-143 k-3.2* cl-102 hco3-27 angap-17 02:07am blood glucose-98 urean-26* creat-4.6* na-138 k-3.6 cl-97 hco3-24 angap-21* 06:09pm blood glucose-69* urean-44* creat-5.7* na-138 k-3.6 cl-113* hco3-13* angap-16 09:56pm blood glucose-151* urean-43* creat-5.7* na-139 k-3.3 cl-103 hco3-17* angap-22* 02:07am blood glucose-98 urean-26* creat-4.6* na-138 k-3.6 cl-97 hco3-24 angap-21* 03:05pm blood glucose-96 urean-31* creat-5.1* na-137 k-3.7 cl-97 hco3-24 angap-20 03:44am blood alt-317* ast-942* ck(cpk)-1158* alkphos-93 totbili-3.5* 03:33am blood alt-191* ast-310* ld(ldh)-453* alkphos-115* totbili-3.6* 04:00am blood alt-131* ast-118* ld(ldh)-421* alkphos-126* totbili-2.1* 03:00am blood alt-91* ast-67* ld(ldh)-426* alkphos-123* totbili-1.7* 04:35am blood alt-70* ast-50* alkphos-141* totbili-1.7* 04:19am blood alt-58* ast-41* ld(ldh)-459* alkphos-129* totbili-1.2 02:07am blood alt-52* ast-50* alkphos-122* totbili-1.5 01:30am blood lipase-4680* 01:15pm blood lipase-1734* 08:12pm blood lipase-1270* 03:04am blood lipase-1052* 03:44am blood lipase-390* 01:25pm blood calcium-8.7 phos-1.1* mg-1.9 04:19am blood calcium-8.6 phos-2.3* mg-1.8 03:30pm blood calcium-8.9 phos-1.8* mg-1.8 02:07am blood calcium-8.8 phos-2.2* mg-1.7 03:05pm blood calcium-9.0 phos-4.2# mg-2.4 01:30am blood caltibc-200* ferritn-1175* trf-154* 01:15pm blood ferritn-1531* 01:30am blood triglyc-627* 08:12pm blood triglyc-771* 03:04am blood triglyc-704* 03:44am blood triglyc-269* 06:30am blood hbsag-negative hbsab-positive hbcab-negative 08:12pm blood ama-negative smooth-negative 08:12pm blood -negative 08:12pm blood igg-626* 08:12pm blood hiv ab-negative 06:47am blood vanco-26.9* 01:30am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 06:18pm blood type-central ve temp-38.3 rates-26/ tidal v-400 peep-5 fio2-40 po2-47* pco2-32* ph-7.46* caltco2-23 base xs-0 intubat-intubated 06:06pm blood type- temp-37.7 rates-/20 tidal v-350 peep-0 fio2-40 po2-52* pco2-46* ph-7.42 caltco2-31* base xs-4 intubat-intubated vent-spontaneou 02:22am blood type-central ve temp-37.2 po2-39* pco2-35 ph-7.49* caltco2-27 base xs-3 03:10pm blood type-central ve temp-38.1 rates-/26 fio2-40 o2 flow-12 po2-52* pco2-43 ph-7.42 caltco2-29 base xs-2 intubat-not intuba 03:18pm blood lactate-1.0 07:20am blood lactate-1.0 06:03am blood lactate-0.5 04:40pm blood lactate-0.6 03:18pm blood freeca-1.12 01:35pm blood freeca-1.22 08:44am blood freeca-1.08* 05:07pm urine rbc-18* wbc->182* bacteri-few yeast-none epi-31 transe-1 05:45am urine rbc->182* wbc->182* bacteri-few yeast-many epi-7 transe-1 10:10am urine rbc-32* wbc-61* bacteri-few yeast-none epi-2 transe-2 renalep-<1 microbiology urine urine culture-pending inpatient stool c. difficile dna amplification assay-final inpatient urine urine culture-final {yeast} inpatient sputum gram stain-final; respiratory culture-final {yeast} inpatient urine urine culture-final {yeast} inpatient blood culture blood culture, routine-pending inpatient blood culture blood culture, routine-pending inpatient urine urine culture-final {yeast} inpatient sputum gram stain-final; respiratory culture-final inpatient urine urine culture-final {yeast} inpatient immunology hcv viral load-final inpatient mrsa screen mrsa screen-final inpatient urine urine culture-final {escherichia coli} inpatient blood culture blood culture, routine-final emergency blood culture blood culture, routine-final emergency ruq us impression: 1. echogenic liver consistent with fatty deposition. other forms of liver disease including significant hepatic cirrhosis/fibrosis cannot be excluded on this examination. 2. splenomegaly. 3. normal appearance of the gallbladder. no free fluid. 4. normal ultrasound appearance of the kidneys. . cxr findings: single portable ap chest radiograph was obtained. low lung volumes accentuate interstitial markings and the pulmonary vasculature. despite these limitations, the lungs are clear. no nodule, consolidation, effusion, or pneumothorax is present. the heart and mediastinal contours are normal. impression: low lung volumes. imaging tib/fib (ap & lat) right port study date of 1:20 am impression: no evidence of osteomyelitis surrounding retained intraosseous needle. abdomen u.s. (complete study) port study date of 11:14 am impression: 1. echogenic liver consistent with fatty deposition. other forms of liver disease including significant hepatic cirrhosis/fibrosis cannot be excluded on this examination. 2. splenomegaly. 3. normal appearance of the gallbladder. no free fluid. 4. normal ultrasound appearance of the kidneys. chest (portable ap) study date of 2:06 am findings: as compared to the previous radiograph, the endotracheal tube, the two feeding tubes, and the left internal jugular vein catheter are unchanged. the extent of bilateral pleural effusions has substantially increased, leading to widespread and relatively severe homogeneous opacification of the right and left hemithorax. extensive subsequent atelectasis must be suspected. borderline size of the cardiac silhouette, unchanged. portable abdomen study date of 6:30 am ression: dobbhoff tube terminates in the second portion of the duodenum. renal u.s. port study date of 11:22 am pression: no evidence of perinephric abscess or fluid collection. portable abdomen study date of 12:29 pm pression: dobbhoff tube terminates near the ligament of treitz in the proximal jejunum. chest (portable ap) study date of 2:41 am compared with at 7:18 a.m., the et tube and nasogastric-type tubes have been removed. right ij and left subclavian central lines both overlie the distal svc. there are low inspiratory volumes. cardiomediastinal silhouette is prominent, but unchanged. there is upper zone re-distribution, vascular plethora and diffuse vascular blurring, consistent with chf. there is increased opacity at the left base, likely representing a combination of a moderate-sized pleural effusion and underlying collapse and/or consolidation. there is atelectasis at the right base and possible minimal blunting at the right costophrenic angle. compared with the earlier film, the chf findings are similar, possibly slightly worse. the changes at the left base are stable. chest x-ray : impression: marked improvement since , with improved pulmonary vascular congestion, marked decrease in pleural effusions, and improving aeration of both lung bases. discharge labs: 06:10am blood wbc-7.1 rbc-2.70* hgb-8.6* hct-27.6* mcv-102* mch-31.9 mchc-31.2 rdw-15.8* plt ct-286 02:21am blood pt-11.3 ptt-26.2 inr(pt)-1.0 06:10am blood glucose-107* urean-24* creat-1.8* na-140 k-4.3 cl-110* hco3-21* angap-13 06:50am blood alt-42* ast-47* alkphos-89 totbili-1.0 06:10am blood calcium-8.7 phos-5.5* mg-1.2* brief hospital course: 24 y/o female with history of etoh abuse and pancreatitis transferred after being found down at home, and noted to be disoriented with fever, hypotension, tachycardia, oliguric acute renal failure, with ? of black stools, and found to have severe pancreatitis. # alcoholic pancreatitis and shock/respiratory failure: pt presented w/ severe pancreatitis, w/ bisap score 4 (did not meet age criteria). also w/ hypoperfusion, elevated lactate, and oliguric renal failure (for which hd was eventually started). given fever, altered mental status, and elevated bilirubin with ? ruq discomfort, cholangitis and cholecystitis were initially considered but a ruq showed no abnl gallbladder. also had a uti so urosepsis may have played some role, and she was treated with cefepime x4d then ceftriaxone x3 days. blood cultures negative. given her very elevated lipase (4300) and shock picture, pancreatic necrosis and/or infection was on the differential; was initially given vancomycin/clinda in the ed. she was then placed on vancomycin/cefepime/flagyl and eventually received 2 days of vancomycin, 3 days of flagyl and 4 days of cefepime plus 3 more days of ceftriaxone. her hemodynamics were confounded by alcohol withdrawal (likely contributed to her tachycardia and hypertension). on she became tachycardic to 160's, desatted to low 70's laying flat, in respiratory distress with withdrawal symptoms so she was intubated for airway management. post-pyloric tube feeds started while intubated. significantly fluid overloaded in the setting of receiving ivf for her hypotension and shock, complicated by atn (see below) and poor urine output. patient was eventually started on dialysis and fluid was ultrafiltrated off and she was able to be extubated on with this intervetion. patient initially continued to be hypertensive to sbps 150s, tachycardic to 120s and tachypneic in 40s after extubation. patient had been on midazolam and fentanyl while intubated for sedation, thus concern patient may both be having etoh and narcotic withdrawl. patient's ciwa scale was adjusted and was placed on clonidine with improvement of her vital signs. by the time she was called out of the micu, she was 80-90's bpm's and frequency of ciwa > 10 was down, still mildly hypertensive. she was discharge on clonidine 0.1mg twice a day with planned follow up with her pcp on . # altered mental status: initially a broad differential. ct head without contrast at outside hospital prior to transfer was without acute process. patient's mental status improved throughout her course with improvement of her electrolytes and lfts. likely it was related to pancreatitis and toxic/metabolic encephalopathy. she was mentating normally when called out of the micu and at discharge. # acute renal failure: likely atn in setting of severe pancreatitis/hypoperfusion. her cr peaked around 8. she was started on hemo-dialysis while in the unit with a temporary hd line. on the floor, she received a tunneled line with plans for continued dialysis as an outpatient however the patient improved and started making adequate amounts of urine. the tunneled line was removed the day of her discharge. her creatinine at the time of discharge was 1.8 with no electrolyte abnormalities. # anion gap metabolic acidosis: likely multifactorial from uremia, lactate, and etoh. respiratory compensation was adequate initially. however, as her renal function worsened her acidosis was managed by ventilation. after dialysis this improved. she had no ag when called out of micu and upon discharge. # elevated lfts: likely alcohol induced, but differential diagnosis also includes acute viral hepatitis as well as shock liver. stox and utox are negative, and tylenol level negative. at peak these were ast 1238 alt 239. hepatitis serologies were sent are were negative. abdominal us showed fatty liver vs cirrhosis. these were trended and were well trended down when she left the micu (52/50). her lfts were last check on and her ast was 47 and alt 47. # ?gib/anemia: noted to have anemia and a reported history of black stools at home. suspect ugib from chemical gastritis (i.e. etoh). low suspicion for variceal bleed. started on protonix gtt in ed. patient was maintain on iv protonix and hcts were trended she did required a total of 3 u prbcs. her hct stabilized over her micu stay and was 29.1 on transfer to the floor. her hct upon discharge was 27.6. she was discharged on pantoprazole 40mg twice a day and was advised to follow up with a gastroenterologist for possible endoscopy/colonoscopy. # uti. as above patient had positive ucx for e coli treated with cefepime then ceftriaxone for a week long course. patient then had several fevers in micu, where her urine taken at that time was + with >182 wbcs but urine cultures grew yeast x3. for this she was given a 3 day course of fluconazole and her foley was changed. # social issues: pt has unstable home situation and severe etoh abuse (drinks 1 gallon vodka daily). social work and psychiatry were consulted. social work felt that the patient was benefit from an inpatient setting the patient preferred being treated as an outpatient. # code: full this admission =============================================== transitional issues # patient has a follow up appointment with her pcp on and should have her electrolytes including creatinine checked at that time. # she will need to follow up with gastroenterology for suspected gi bleed during her micu course # she will need to follow up with a nephrologist to ensure that she will no longer need dialysis # she plans on scheduling an outpatient psychiatry appointment medications on admission: - denies taking any medications with exception of intermittent ativan discharge medications: 1. pantoprazole 40 mg po q12h rx *pantoprazole 40 mg twice a day disp #*60 tablet refills:*0 (zero) 2. clonidine 0.1 mg po bid please hold for sbp <100 or hr <60 rx *clonidine 0.1 mg twice a day disp #*10 tablet refills:*0 (zero) discharge disposition: home discharge diagnosis: primary diagnosis - alcohol withdrawal - acute renal failure requiring dialysis - gi bleed - complicated uti - pancreatitis secondary diagnosis - depression discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were were admitted to the hospital on after you were found unresponsive. you were transferred to the icu and you required a breathing tube. you were in the icu for approximately 2 weeks. this occurred because of the amount of alcohol you were consuming. you were going through severe withdrawal during your time in the icu. you have opted to go to an outpatient alcohol treatment program. please make an appointment as soon as possible. you will be continued on clonidine 0.1mg twice a day for withdrawal and should continue until you meet with your pcp on . you were noted to have kidney failure. you required dialysis and your kidney function improved. prior to your dishcharge you did not require any more dialysis. you should have your kidney function/ creatinine checked during your visit with your primary care doctor. you were noted to have some gastrointestinal bleeding during your hospitalization. you did not have any more bleeding after you left the icu. you should follow up with a gastroenterologist as an outpatient. medications changed: start clonidine 0.1 mg (please discuss continuing this with your pcp on ) start pantoprazole 40mg followup instructions: you have an appointment with you pcp . md at the beacon family practice. please call at on when your insurance has started. it is strongly recommended that you enroll in an out patient alcohol treatment program. please contact the following agency to enroll: health and education services , please make an appontnment with psychiatry as soon as possible. you have information regarding scheduling this appointment. please make an appointment with a nephrologist as soon as possible as well. please make this appointment within 1 week of discharge. (. please make an appointment with gastroenterology as soon as your insurance is processed. phone: ( description: gastroenterology department of medicine location: lmob 8e/west organization: phone: ( procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis incision with removal of foreign body or device from skin and subcutaneous tissue diagnoses: acidosis thrombocytopenia, unspecified anemia, unspecified acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified toxic encephalopathy acute respiratory failure other shock without mention of trauma hemorrhage of gastrointestinal tract, unspecified systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction rhabdomyolysis acute pancreatitis other and unspecified alcohol dependence, continuous acute alcoholic hepatitis alcohol withdrawal other and unspecified escherichia coli [e. coli] other fluid overload juvenile osteochondrosis of hip and pelvis other alcohol-induced mental disorders postprocedural aspiration pneumonia 

Answer: The patient is high likely exposed to