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: tylenol overdose major surgical or invasive procedure: right ij hd catheter insertion, left ij triple lumen catheter insertion hemodialysis history of present illness: ms. is a 24yf who is transferred from osh with tylenol, motrin, aleve and advil od. on the patient reports that her boyfriend broke up with her and at 8:30pm she took ~80 extrastrength tylenol, ~20 aleve, ~20 advil, ~20 motrin. she vomited shortly after taking the pills and vomitted ~10 tylenol pills. she was driving at the time of the od. she had severe nausea and had multiple bouts of emesis. she denies hematemesis but does report severe abdominal pain in the ruq. the following day at 3:30pm, she told her co-worker what she had done and was taken to osh by ambulance. at 6:30pm mucomyst and protonix gtt. she remained hemodynamically stable with an intact mental status. lab values at osh were significant for a tylenol level of 153 and salicylate 21 at 22 hours after the od. alt 1209, ast 1149, ao 69, tuberculosis 4.7. the patient was transferred to for further managment. of note the patient did have a similar overdose when she was 11 years old--she either overdosed on her mother's "heart pills" or tylenol. when asked if this was a suicide attempt, she insists that she has never attempted suicide and that these two attempts were to get attention. past medical history: pmh: od at 11yrs--treated with ng lavage psh: none hpv s/p leep iud placement social history: employed in cleaning houses. 12pack smoking year history, social etoh use. marijuana in past but has not smoked in many years. denies hx ivdu. family history: mild mr in mother and sister. 3 sisters with asthma. "heart disease" in mother physical exam: on admission: vs t 97.7 hr 74 bp 122/68 rr 96% sat ra gen: a and o x 3. flat affect. minimal insight card: rrr midsystolic click. no m/r/g pulm: end expiratory wheeze abd: exquisitely ttp in ruq. no rebound. voluntary gaurding ext: no edema physical examination: on admission to liver service vs (in sicu) 98.3 (tm 99.4 at 0400) bp 122/75 hr 70 rr 18 o298/ra general - young well nourished anxious appearing young caucasian female, sitting in bed at bedside, flat affect, aox3 heent - perrl, b/l scleral hemorrhage w clear conjunctival discharge, eomi, unable to assess if sclerae icteric, mmm, op clear neck - supple, no jvd lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - pmi non-displaced, rrr, no mrg, nl s1-s2 abdomen - soft/nt, mild tenderness, no rebound/guarding extremities - diffuse nonpitting edema in ue/le, no c/c, 2+ peripheral pulses (radials, dps) skin - no rashes or lesions neuro - awake, a&ox3, cns ii-xii grossly intact, muscle strength throughout, sensation grossly intact throughout pertinent results: 03:23am pt-58.5* ptt-40.1* inr(pt)-6.6* 03:23am wbc-31.1* rbc-4.52 hgb-14.3 hct-41.9 mcv-93 mch-31.6 mchc-34.1 rdw-13.6 03:23am asa-13.8 ethanol-neg acetmnphn-72* bnzodzpn-neg barbitrt-neg tricyclic-neg 03:23am hcg-<5 03:23am albumin-3.8 calcium-8.1* phosphate-3.9 magnesium-1.8 03:23am lipase-45 03:23am alt(sgpt)-7485* ast(sgot)-8310* ld(ldh)-6180* ck(cpk)-107 alk phos-50 amylase-39 tot bili-3.1* 03:23am fibrinoge-144* 03:23am glucose-117* urea n-11 creat-1.1 sodium-138 potassium-3.4 chloride-109* total co2-13* anion gap-19 05:13am urine blood-sm nitrite-neg protein-75 glucose-tr ketone-50 bilirubin-neg urobilngn-neg ph-6.5 leuk-sm 05:52am hcv ab-negative 05:52am hbsag-negative hbs ab-positive hbc ab-negative hav ab-negative cxr: findings: in comparison with study of , there has been placement of a right ij catheter that extends to the upper portion of the svc and a left ij catheter that extends slightly more distally. no evidence of pneumothorax. there is some increased prominence of the transverse diameter of the heart with ill-defined pulmonary vessels suggesting elevated pulmonary venous pressure. hazy opacification in the right hemithorax could represent layering effusion. mild atelectatic changes are seen at the bases. cxr: impression: 1. new retrocardiac consolidation without evidence of volume loss, likely pneumonia, but may represent atelectasis. 2. small left pleural effusion with interval decrease in the small right-sided effusion. 3. stable position of right ij line with slight advancement of the left ij line into the mid-to-lower svc. ruq u/s impression: no hydronephrosis. no cyst or stone or solid mass seen bilaterally. increased echogenicity of the kidneys bilaterally is consistent with diffuse parenchymal disease. liver u/s mpression: 1. echogenic liver consistent with fatty infiltration; other forms of more severe hepatic fibrosis/cirrhosis cannot be ruled out. 2. small bilateral pleural effusions. 3. thickened gallbladder wall likely reactive given underlying liver disease/toxicity. ct abd impression: 1. left pleural effusion with associated passive atelectasis. 2. diffuse subcutaneous anasarca as well as edema throughout the mesentery, likely representing aggressive hydration. 3. no evidence of retroperitoneal bleed. 06:00am blood hcv ab-negative 05:52am blood hcv ab-negative 4:35 am immunology chm s# h. **final report ** hcv viral load (final ): hcv rna detected, less than 43 iu/ml. performed using the cobas ampliprep / cobas taqman hcv test. linear range of quantification: 43 iu/ml - 69 million iu/ml. limit of detection: 18 iu/ml. 4:20 am immunology chm s# h quantitation beyond 850,000 iu/ml added . **final report ** hcv viral load (final ): hcv rna detected, less than 43 iu/ml. performed using the cobas ampliprep / cobas taqman hcv test. linear range of quantification: 43 iu/ml - 69 million iu/ml. limit of detection: 18 iu/ml. 2:08 am stool consistency: not applicable source: stool. **final report ** clostridium difficile toxin a & b test (final ): feces negative for c.difficile toxin a & b by eia. (reference range-negative). 5:52 am serology/blood source: venipuncture. **final report ** rapid plasma reagin test (final ): nonreactive. reference range: non-reactive. copper test result reference range/units copper, 24 hour urine 66 h 15-60 mcg/24 h 24 hr urine volume 1350 ml/24 h report comment: ph:5 this test was performed at: /chantilly chantilly, , md comment: source: cvs egd findings: esophagus: normal esophagus. stomach: other unable to visualize stomach due to large food bolus duodenum: normal duodenum. impression: unable to visualize stomach due to large food bolus otherwise normal egd to third part of the duodenum brief hospital course: ms. is a 24 year old female who was initially admitted to the sicu two days after intentional overdose of tylenol, motrin, aleve, and advil resulting in fulminant hepatic failure and acute renal failure requiring dialysis. in regards to her liver failure, her tylenol level upon transfer was noted to be 153. she was maintained on a mucomyst drip which was initially started immediately upon admission to the osh approximately 22 hours after consumption of medications. this was continued throughout her icu course. upon transfer to , her bilirubin was elevated to 3.1, inr was 6.6, and transaminases were in the 7000s. her inr continued to rise as high as 10 on hd#2 when this was reversed with ffp and vitamin k for cvl and dialysis line placement. at the time of transfer her bilirubin was her transaminases continued to rise and peaked on at and and are now trending down. they were 1166 and 57 at the time of transfer out of the sicu. her total bilirubin was 12.3 at the time of transfer. during her icu course she was noted to have worsening hepatic encephalopathy, however was always arousable and oriented, and never required intubation or placement of cerebral bolt. after several days however, her lethargy began improving and at the time of transfer she was alert, awake, oriented x 3, and following commands without difficulty. upon admission to the sicu she was evaluated by social work and psychiatry because of the overdose and was diagnosed with adjustment disorder vs. mdd, and was felt to require psychiatric admission once medically cleared. she was maintained on 1:1 during her entire sicu course. #tylenol overdose: taken 80tabs at home prior to admission to osh after breakup with her boyfriend. she was transferred to for further care and consideration for liver transplant. pt has been on sicu followed by transplant surgery, hepatology, toxicology, psychiatry and nephrology. pt was listed as status 1 however did not require a transplant. likely will not transplant now unless she decompensates. labs on admisison: () inr 6.6, peaked later that day to 9.5. creat (pk) 6.8, peak transaminases alt , ast . admission bilirubin 3.1, and increased to peak 20.2 in setting of concomitant infections: hap, uti, and cdiff. bilirubin and wbc trended down after initiation of flagyl for ciff and continuation of vanco and zosyn for hap. she was started on nac @ 6.25mg/kg/hr on admission per toxicology recommendations and was discontinued on . synthetic function and glucose levels improving and pt did not require insulin coverage after transfer to general wards on . postprandial nausea eventually resolved. she was transfused 1u prbc on and for slowly downtrending hct. egd negative for varices, gastropathy or other findings. she was continued on ppi until dx'd w cdiff then swtiched to h2 blocker. most likely explanation for anemia is gastritis icu stay and noncompliance w ppi during initial days in transfer to general liver wards. she was also started on pantoprazole until dx'd w cdiff and then changed to ranitidine. pt was followed by psychiatry during her stay. she was continued w 1:1 sitter while in-house with plan to transfer to inpt psych unit when medically cleared. sec. 12 signed, in chart. she was taken for liver biopsy on (transjugular) for unresolving lfts, low ceruloplasmin, and workup of possible wilson's d. liver biopsy showed resolving inflammation tylenol overdose. expect lfts to resolve over time. urine copper slightly elevated. possible kf rings on bedside ophthalmology exam. she will follow up at ophthalmology clinic for slit lamp exam - appt in dc plan. liver copper level pending - will be followed up by dr. at liver clinic follow up in . rest of liver workup to be completed as an outpatient. medically cleared from hepatic standpoint. plan for weekly labs drawn: cbc, chem10, coags, and lfts. to be followed by the liver clinic. # arf: course has been complicated by anuria on hospital day 2 and metabolic acidosis. she was seen and followed by nephrology. her ua was significant for muddy brown casts consistent with atn from tylenol and nsaid induced toxicity. her cr on admission was initially 1.1, however this began to quickly rise and she began having worsening oliguria. she was also noted to have a gap and nongap metabolic acidosis. this was initially treated with sodium bicarbonate. however, she ultimately required dialysis. she is currently dialyzed on a monday, wednesday, and friday schedule. had first hd last friday via r-ij, and was last dialyzed on wednesday . renal u/s obtained for prognostic value. tunneled line was deferred for improving renal function. hd was discontinued on after pt exhibited multiple days of increasing urine output >1l daily and spontaneously decreasing serum creatinine . hd line was removed on . pt cont to put out >2l urine daily, and serum creatinine resolving towards normal. renal team signed off given resolving kidney injury. would continue to avoid nsaids. # hap: hd# 7 her wbc count was noted to rise from 8.8 to 18.6. urine and blood cultures were sent and remain negative. a portable chest xray was concerning for a retrocardiac opacity that may represent a pneumonia. she was started on empiric vancomycin and zosyn for hap and questionable chest xray findings on portable study. she continued to exhibit low grade temps however was never hypoxic, and did not have cough, sputum production, pleurisy, sob or chest pain. she completed an 8 day course of abx. on she complained of sob and noted to have fever to 102. chest xray suggestive of pneumonia likely aspiration event from vomiting episode one day before. she was started on vancomycin, iv flagyl, and cefepime for broad coverage given underlying liver disease and prior icu stay. she completed 8 day course on w/o difficulty and has been afebrile since initiation. negative blood cultures. picc removed on . # cdiff: pt continued to have abd pain and low grade temps on the floor. normal stool output. cdiff positive on repeat toxin assay and pt was started flagyl 500mg q8 on with plan to continue coverage until . wbc downtrended and low grade temps abated after initiation of flagyl. plan to continue po flagyl therapy for 2 weeks to prevent relapse given recent broad spectrum antibiotic therapy. # uti: urine cx growing coag neg staph that was obtained in icu. foley cath dc'd and culture susceptibility to vancomycin - pt completed 8 day course w concomitant coverage for hap. # psych: pt denies si/hi/ah/vh however it is clear that she intentionally overdosed. pt is unable to signout ama. social work and psychiatry following. pt has no hcp, estranged from mother/sisters, ex-boyfriend does not want to be involved, 5yo daughter in full custody of grandparents. has been texting w ex boyfriend over last few days prior to transfer to psych. unwilling to discuss w team. describes abd discomfort likely capsular irritation from tylenol injury. will cont to feel this sensation pending liver healing up to 3-6months possible. alleviated anxiety and sensation w 0.25mg po lorazepam qhs. insomnia managed with trazodone 25mg qhs w good effect. medications on admission: none discharge medications: 1. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for discomfort. 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po daily (daily). 3. metronidazole 500 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 13 days: continue for 13 day course to prevent relapse given recent broadspectrum abx. discharge disposition: extended care facility: deaconness 4 discharge diagnosis: tylenol overdose hospital acquired pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital after an overdose on a number of over the counter medications including tylenol. while you were here, these medications caused your liver and kidneys to fail. you required dialysis to filter your blood since your kidneys could not do so. at the time of discharge, you are no longer requiring dialysis as your kidneys have recovered. also, you were treated here for a pneumonia and a uti. you were found to have an infection in your colon which requires antibiotic treatment. your follow up test for this infection was negative however you need to continue this antibiotic to prevent recurrence for another 2 weeks. . the following changes were made to your medications: started flagyl for 14 days started ranitidine to prevent gi pain and formation of ulcers . please follow up with your doctors as stated below. followup instructions: department: center when: monday at 1:45 pm with: , md building: sc clinical ctr campus: east best parking: garage * will contact you with appt information regarding time. department: liver center when: thursday with: , md building: lm campus: west best parking: garage procedure: venous catheterization, not elsewhere classified other endoscopy of small intestine hemodialysis venous catheterization for renal dialysis percutaneous abdominal drainage arterial catheterization transjugular liver biopsy diagnoses: acidosis hypocalcemia anemia, unspecified acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified acute and subacute necrosis of liver hypopotassemia pneumonitis due to inhalation of food or vomitus intestinal infection due to clostridium difficile major depressive affective disorder, single episode, unspecified other ascites hepatic encephalopathy staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus poisoning by aromatic analgesics, not elsewhere classified suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics other and unspecified coagulation defects unspecified gastritis and gastroduodenitis, without mention of hemorrhage insomnia, unspecified conjunctival hemorrhage other fluid overload unspecified adjustment reaction poisoning by propionic acid derivatives 

Answer: The patient is high likely exposed to