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: latex / lorazepam attending: chief complaint: medication overdose major surgical or invasive procedure: # a-line # subclavian line # mechanical intubation history of present illness: ms. is a 22yo f with extensive psychiatric history (3 previous suicide attempts, schizophrenia, depression, anxiety, bipolar, borderline, alcohol abuse), transferred from micu with ards after multidrug od at friend's house. she normally has meds delivered by vna, however apparently accessed her med box while at a friend's house. she then called 911 on reporting she had attempted suicide with 24x clonazepam 0.5mg, 10x benadryl 25mg, 20-30x topamax 25mg, 6x ibuprofen 800mg, 10x effexor 150mg, 10x loratadine 10mg (although she may also have taken abilify and other home meds as listed below). upon presentation to , ngt was placed and she received charcoal. serum tox screen was negative for salicylate, acetaminophen, ethanol, and barbiturates, benzos (however urine benzo tox was positive), and tcas. shortly thereafter, she was intubated for airway protection after becoming increasingly sedated. she was noted to have prolonged qtc (to 490 on admission h+p) thought effexor which, by report, had resolved prior to transfer. from the ed, she was admitted to the icu. on , per transfer note "attempted to wean from respirator--failed sbt." on the day of transfer to () she had a leukocytosis of 21.5 and she spiked temp to 103.3. in this setting, she desatted to 76-84% at which time fio2 was increased to 1.0 (settings unclear prior to this). cxr at that time reportedly demonstrated b/l infiltrates and clinical picture was concerning for ards. she received vancomycin, cefepime, solumedrol, and therapeutic dose of enoxaparin presumably for empiric rx of possible pe. she also received furosemide 100mg iv and excreted 2-3l. she was initially placed on ac vt 500, peep 7.5, fio2 75%, with abg 7.25/56/63. this was then adjusted as follows in the setting of her desaturation: (1) vt 360x32, peep 10 or 14 (unclear), fio2 90%: abg 7.25/51/65. on this settings, pt desatted to 86%. (2) vt 450x28, peep 14, fio2 100%: abg 7.32/52/165/26. just prior to transfer, o2 sat was documented as 99%. she has been transferred to out of concern for ards and further ventilation management. past medical history: # psychiatric --schizophrenia --depression --anxiety --bipolar disorder --borderline --alcohol abuse --h/o suicide attempts # cv --hypertension --hyperlipidemia # pulmonary --obstructive sleep apnea --asthma # gi --gastritis # other --morbid obesity social history: # personal: lives at home. 2 suicide attempts at age 16. had been pregnant, miscarried, attempted suicide 8/. transferred to group home, and then received visiting nurse services (nizhoni health system, , ma) to supervise medication administration given h/o suicide attempts. # professional: unemployed. # tobacco: 2+ ppd, started at age 14. # alcohol: 4 packs wine coolers twice weekly. # recreational drugs: rare. family history: non-contributory physical exam: vs: temp: 101.2 bp: 113/53 hr: 99 nsr rr: 28 o2sat 100% ac 400/28 peep 16 fio2 0.80 gen: intubated, sedated, morbidly obese, nad heent: perrl, anicteric, mmm, op without lesions neck: no supraclavicular or cervical lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or thyroid nodules resp: cta b/l anteriorly, lateral and posterior exam limited by body habitus cv: rrr, s1 and s2 wnl, no m/r/g appreciated on exam abd: obese, +b/s, soft, nt, no masses or hepatosplenomegaly appreciated ext: no c/c/e, warm, 2+dp/pt pulses skin: no rashes/no jaundice neuro: sedated, not arousable. not following commands. mute toes b/l. 1+ biceps, patellar dtrs. pertinent results: labs from osh prior to transfer: chem 7: na 142, k 4.2, cl 113, hco3 25, bun 6, creatinine 0.8 cbc: wbc 21.5, hct 34.2 labs on admission: wbc-20.8*# hct-32.7* mcv-81* plt ct-323 diff: neuts-90.8* bands-0 lymphs-7.3* monos-1.7* eos-0.1 baso-0.1 pt-15.0* ptt-30.4 inr(pt)-1.3* glucose-127* urean-10 creat-0.8 na-145 k-3.7 cl-109* hco3-30 angap-10 alt-14 ast-33 ld(ldh)-519* alkphos-77 amylase-70 totbili-0.2 albumin-3.0* calcium-8.0* phos-2.7 mg-2.2 iron-11* caltibc-229* ferritn-85 trf-176* other pertinent labs: triglyc-268* hdl-22 chol/hd-10.3 ldlcalc-151* tsh-2.4 free t4-0.95 labs on discharge: wbc-13.1* hct-34.9* mcv-80* plt ct-573* glucose-199* urean-12 creat-0.8 na-138 k-4.2 cl-102 hco3-27 angap-13 micro: blood cx x2 negative urine cx negative sputum cx negative blood cx x2 negative catheter tip culture negative stool culture cdiff positive imaging: ekg: sinus rhythm. normal ecg. since previous tracing of , probably no significant change intervals axes rate pr qrs qt/qtc p qrs t 95 166 84 354/415 22 18 21 cxr: as compared to the previous examination of , , there is no major change. the endotracheal tube has been removed, the lung volumes, however, have not decreased. the nasogastric tube and the central venous access line are in unchanged position. in almost unchanged manner, multifocal bilateral lung consolidations are seen, they predominate at the left lung base. no pneumothorax, no evidence of larger pleural effusions. impression: in comparison to , status post extubation. no other relevant radiographic changes in the interval. lle u/s: no evidence of deep vein thrombosis of the right or left lower extremity. cta: overall, findings are most compatible with extensive aspiration pneumonia. suboptimal evaluation of the distal pulmonary artery branches. no evidence of central pulmonary embolism. brief hospital course: 22yo f with h/o multiple psychiatric pathologies, admitted with respiratory failure and fever. intubated with ards secondary to overdose. . # respiratory failure/ards: ms. was intubated on for airway protection as she became increasingly sedated in the setting of multidrug ingestion during a suicide attempt. while intubated, she developed fevers and bilateral infiltrates on cxrs at osh. she was also increasingly hypoxic on the day of transfer () with p/f ratios consistently less than 200 w/ clinical picture concerning for ards. she received cefepime/vanco, solumedrol, and furosemide in this setting. in this context, her labs more likely reflected acute respiratory acidosis with metabolic compensation over the past several days. given hypoxia and morbid obesity (although probable infiltrates on cxr), patient ruled out for a pe by cta and ble lenis also negative. patient was extubated successfully on and transfered to the medical floor on , to continue her course of antibiotics. . # pneumonia (vap): as mentioned above, ms. developed a temperature to 103.3 with bilateral opacities seen on cxr at the osh, 2 days post intubation. she also had an elevated wbc in this setting. given the time course, it seemed unlikely that is was aspiration prior to intubation causing pneumonitis. cxr upon admission here showed bilateral haziness, although it was difficult to interpret given very low lung volumes and body habitus. she was treated for presumed vap with a 14 day course of vancomycin and zosyn (although sputum cultures here were negative). final culture from showed rare growth of mssa. . # psychiatric: ms. has a h/o schizophrenia, depression, anxiety, bipolar disorder, borderline personality disorder, substace abuse and multiple suicide attempts. initially her psychiatric meds were held in the setting of an acute ingestion. during the hospitalization, the medications were slowly restarted per the psychiatry team (abilify, zyprexa and seroquel). she will need inpatient psychiatric hospitalization after discharge for psychopharmacology evaluation and therapeutic intervention. she was maintained on a 1:1 sitter during the course of her hospitalization due to the concern that she was a danger to herself. . # c. diff colitis: after completing her course of intravenous antibiotics, the patient's wbc count remained elevated and she was having diarrhea. she tested positive for cdiff on . she was started on flagyl on and should complete a 14 day course of oral flagyl (last dose on ). . # tachycardia: ms. was noted to have a sinus tachycardia on her ekgs. she was ruled out for pe. thryoid function was normal. this tachycardia did not respond to a fluid challenge so she was not felt to be hypovolemic. her hr ranged in the 90s to 110s. it was felt that there was likely a component of infection and anxiety contributing. on telemetry, her heart rate intermittently would become elevated and would decrease overnight with rest. we sent metanephrines to rule out pheochromocytoma which were slightly elevated but not enough to be consistent with this diagnosis. she was on propranolol as an outpatient for control of her tachycardia. this was titrated up to 20mg po tid. her heart rate will need to be monitored by her primary care physician to prevent long term effects of chronic tachycardia. on discharge, her hr was in the 80s - low 100s. . # hypertension: after transfer to the floor, she was restarted on propranolol for tachycardia. she will be discharged on a dose of 20mg tid. her blood pressure has been well controlled on this dose. . # anemia: she has a microcytic anemia which has remained stable throughout her hospitalization. in setting of h/o gastritis and menstruation, it is most likely iron deficiency anemia. she is guaiac negative. iron studies were somewhat mixed, although pointed toward iron deficiency anema. she may benefit from oral iron supplementation although it would be best for patient to minimize her pills and the potential for overdose must be weighed. . # hyperlipidemia: she has hyperlipidemia, but we will defer restarting a statin to her pcp. . # obstructive sleep apnea: ms. had recent sleep study as outpatient, although for unclear reasons she was never started on cpap. she was started on bipap while hospitalized on the settings documented in her outpatient sleep study (cpap level: 8 cm/h2o, supp o2: 2 l/min, to maintain spo2 to >92) and tolerated it well. she reported feeling more rested. she will need to continue on this as an outpatient. . # gastritis: she was maintained on a ppi. . # vaginal yeast infection: she was treated with diflucan on . she is also using miconazole powder prn. . # fen: she was maintained on a regular diet. she did not require any intravenous fluids once she was transferred to the floor. . # ppx: she was ordered for heparin sc for dvt prophylaxis, but often refused. she was ambulating aroud her room. she used a ppi for gi prophylaxis and had a bowel regimen prn. medications on admission: medications prior to admission: pharmacy, ma # albuterol 2puffs q4-6h prn # flovent 1puff daily # eucerin cream # ibuprofen 800mg prn pain # lovastatin 40mg daily # lavatadine 10mg daily # ranitidine 150mg tid # selsen blue # propranolol 10mg tid # ziprasidone (geodon) 40mg # clonazepam 0.25mg prn pain # clonazepam 0.25mg qhs # fiber tabs 2tabs rid # colace 100mg # bisacodyl 5mg twice weekly # topamax 75mg # cogentin 0.5mg daily # venlafaxine (effexor) 300mg qhs # abilify 15mg qhs . medications on transfer: # furosemide 80mg # enoxaparin 120mg sc # vancomycin 1g iv # cefepime 1g iv # solumedrol 60mg iv # morphine 4mg iv # acetaminophen 650mg ng # ibuprofen 600mg ng # propofol gtt # pepcid 20mg iv # duonebs q6h . allergies: # latex --> unknown # lorazepam --> unknown (however patient tolerates clonazepam as she is on this as outpatient) # bees --> anaphylaxis discharge medications: 1. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day). 2. aripiprazole 10 mg tablet sig: one (1) tablet po hs (at bedtime). 3. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 6 days: last dose on . 4. olanzapine 5 mg tablet, rapid dissolve sig: 1.5 tablet, rapid dissolves po bid (2 times a day). 5. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po daily (daily) as needed for agitation. 6. quetiapine 25 mg tablet sig: three (3) tablet po hs (at bedtime). 7. propranolol 10 mg tablet sig: two (2) tablet po tid (3 times a day): hold for sbp <90, hr <55. 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed. 10. aluminum-magnesium hydroxide 225-200 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed. 11. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). discharge disposition: extended care facility: discharge diagnosis: primary diagnosi: medication overdose ards vap cdiff secondary diagnosis: htn hyperlipidemia sinus tachycardia schizophrenia depression anxiety bipolar disorder borderline personality disorder alcohol abuse obstructive sleep apnea asthma gastritis morbid obesity discharge condition: stable. afebrile. no further diarrhea. discharge instructions: you were admitted because you developed respiratory failure in the setting of medication overdose in a suicide attempt. you were intubated and treated with antibiotics for a presumed pneumonia. you then developed an infection in your gi tract called cdiff. you are being treated for this infection with a medication called flagyl. please continue taking this until , which would be a 14 day course total. your stool will test positive for cdiff for up to 2-3 months even after successful treatment, so the only way to know if you relapse with this infection is if you develop diarrhea, fevers, or worsening leukocytosis. you are being discharged to a psychiatric facility for further psychiatric care. it is very important that you continue this care. many of your medications have been changed and it will be important that you work with your new providers to help get you on the most effective medication regimen. please continue taking all medications as prescribed. please adhere to the psychiatric plans as outlined by your team. please follow-up with your pcp upon discharge from your psychiatric facility. many of your medications have been changed and you have had an extensive hospitalization, so it will be important for you to follow-up with her for further medical care. please call your pcp or return to the er if you develop any of the following symptoms: fevers, chills, shortness of breath, difficulty breathing, chest pain, nausea, vomiting, diarrhea, abdominal cramping, or any other worrisome symptoms. followup instructions: please follow-up with your pcp, , 1-2 weeks after discharge from your psychiatric hospitalization. her phone number is . procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube arterial catheterization arterial catheterization diagnoses: obstructive sleep apnea (adult)(pediatric) unspecified essential hypertension asthma, unspecified type, unspecified unspecified schizophrenia, unspecified suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents poisoning by benzodiazepine-based tranquilizers other and unspecified hyperlipidemia acute respiratory failure other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus intestinal infection due to clostridium difficile poisoning by other antipsychotics, neuroleptics, and major tranquilizers morbid obesity iron deficiency anemia, unspecified other and unspecified complications of medical care, not elsewhere classified suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics bipolar disorder, unspecified unspecified gastritis and gastroduodenitis, without mention of hemorrhage poisoning by other and unspecified anticonvulsants suicide and self-inflicted poisoning by other specified drugs and medicinal substances candidiasis of vulva and vagina poisoning by antiallergic and antiemetic drugs borderline personality disorder poisoning by propionic acid derivatives 

Answer: The patient is high likely exposed to