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: liver failure, kidney failure, and altered mental status major surgical or invasive procedure: -tunneled line for hemodialysis -picc line -transfusion with 2u prbcs history of present illness: this is a 47-year-old woman with a pmhx. significant for alcohol abuse and bipolar disorder who is transferred to for acute liver failure, acute kidney injury, and altered mental status. according to records obtained from various outside facilities, patient was brought into on by a friend who was concerned that patient was "drinking a pint of vodka" for the past 5 days. at that time, patient declined detox, and checked out of the hospital, stating that she would follow-up with her outpatient therapist. on , patient had a normal chemistry panel (bun of of 20, creatinine of 0.8), ast of 28, alt of 27, acetaminophen level of <2.0 and serum alcohol level of 360. patient denied si and was discharged home. . the following day (), patient was admitted to norcap lodge (detox facility) in , where she was monitored for etoh and ?opiate withdrawal. she was given clonidine (in tapered doses), acetaminophen (total of 3 doses of 325mg over 2 days), mylanta, benadryl, motrin, imodium, ativan, melatonin, reglan, triaminic cold relief, and desyrel per withdrawal protocol. patient also reports taking "8 vicodin) on for shoulder pain, stating that she is prescribed 24 pills of vicodin/month by her physician. to healthcare providers at norcap, patient complained of extreme nausea and abdominal pain on , and she was transferred to for further work-up. . at , patient was found to have a serum acetaminophen level of <10 but positive urine level, an etoh level of 10, lipase of 798, bili of 1.9, ast of , alt of 8010, and ultrasound with trace ascites and normal portal and hepatic flow. patient was given zofran, magnesium, and 9545mg of nac and transferred to . . in ed, initial vitals were: 98.7 74 172/108 16 100%. she was given 2 l of ivf, 3.25grams of nac, 4mg iv morphine, cipro 400mg for presumed uti, and seen by transplant, hepatology, and toxicology services. lfts were trending down with ast of , alt of 6585, ldh: 8245, and lipase of 840. bun/ creatinine was 47/4.7, and patient was making minimal concentrated urine. ruq ultrasound showed good portal and hepatic flow, and ct abdomen (without contrast) was remarkable only for pancreatic stranding. patient was deemed not to be a transplant candidate due to her current etoh abuse, and was admitted to the micu for further work-up and treatment. past medical history: --etoh abuse --bipolar disorder --history of acetaminophen overdose as a teenager (was taking it for menstrual cramps) and needed to get her "stomach pumped" social history: patient is reportedly a binge drinker. as per notes from , patient was sober for 8 years until when she went through a divorce, death of a loved one, and lost her job. other social history unable to be obtained due to patient's mental status on admission. family history: according to outside notes, strong family history of alcoholism and mother with depression. physical exam: admission physical exam: vs: afebrile, hr: 73, bp 182/103 (though not accurate as per nursing), sp02 92% on ra general: somnolent, responsive to voice, no acute distress heent: pearla, throat clear and non-erythematous chest: clear to auscultation bilaterally cardiac: rrr, no murmurs, rubs, or gallops abdomen: +bs, diffusely tender, more so in ruq extremities: warm and dry, no edema bilaterally neuro: knows she's in , thinks she's at , responsive to voice discharge physical exam: vs: t-99.2 bp-140/82 hr-93 rr-18 o2sat-98%ra gen: nad, well-appearing heent: perrla, eomi, sclerae anicteric, op clear, no cervical lymphadenopathy, trachea midline cv: rrr. normal s1,s2. no m/r/g. resp: ctab. abdomen: soft, nt, nd. bowel sounds active. no abnormal masses. no hepatosplenomegaly. extr: 2+dp pulses bilaterally. no le edema. neuro: a&ox3. cn2-12 grossly intact. pertinent results: labs upon admission: 09:49pm type-art temp-37.2 po2-69* pco2-40 ph-7.33* total co2-22 base xs--4 intubated-not intuba 09:49pm lactate-1.5 08:50pm urine hours-random creat-181 sodium-73 potassium-36 chloride-51 tot prot-478 calcium-3.9 prot/crea-2.6* albumin-167 alb/crea-922.7* 08:50pm urine osmolal-287 08:50pm urine bnzodzpn-pos barbitrt-neg opiates-pos cocaine-neg amphetmn-neg mthdone-neg 08:50pm urine color-amber appear-hazy sp -1.016 08:50pm urine blood-tr nitrite-neg protein-100 glucose-100 ketone-tr bilirubin-neg urobilngn-neg ph-5.5 leuk-neg 08:50pm urine rbc-13* wbc-64* bacteria-many yeast-none epi-4 08:50pm urine wbcclump-few 07:51pm glucose-98 lactate-1.9 na+-137 k+-3.9 cl--96* tco2-24 07:51pm hgb-13.2 calchct-40 07:40pm glucose-106* urea n-47* creat-4.7* sodium-135 potassium-3.9 chloride-97 total co2-26 anion gap-16 07:40pm estgfr-using this 07:40pm alt(sgpt)-6585* ast(sgot)-* ld(ldh)-8245* ck(cpk)-280* alk phos-110* tot bili-1.1 07:40pm lipase-840* 07:40pm ck-mb-2 07:40pm calcium-8.3* phosphate-2.6* magnesium-2.2 07:40pm hbsag-negative hbs ab-negative hbc ab-negative hav ab-positive 07:40pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 07:40pm hcv ab-negative 07:40pm hcv ab-negative 07:40pm wbc-5.6 rbc-4.06* hgb-13.0 hct-37.9 mcv-93 mch-32.0 mchc-34.3 rdw-14.4 07:40pm neuts-81.3* lymphs-15.7* monos-0.5* eos-2.2 basos-0.4 07:40pm plt smr-low plt count-84* 07:40pm pt-15.7* ptt-26.9 inr(pt)-1.4* . labs upon discharge: ct abdomen : impression: 1. diffuse hepatic hypoattenuation, may be related to edema from hepatitis, or possibly due to more longstanding fatty infiltration. 2. suggestion of edema at the pancreatic head and moderate amount of peripancreatic stranding concerning for pancreatitis in the appropriate clinical setting. 3. free fluid tracking along the right paracolic gutter into the pelvis. 4. perinephric fluid, possibly resulting from acute renal failure. 5. diverticulosis without diverticulitis. . abdominal ultrasound 1. mildly coarsened liver echotexture, without focal lesion. 2. normal gallbladder. 3. patent hepatic arteries, portal veins, and hepatic veins. patent ivc and splenic vein. 4. small amount of perinephric fluid about the left kidney. . renal ultrasound : 1. no hydronephrosis identified. scant trace of free fluid seen bilaterally surrounding the kidney. 2. no evidence of renal artery stenosis. mildly elevated resistive indices consistent with chronic renal disease. mrcp : wet read 1. mild heterogeneous texture of the head and body of the pancreas accompanied by peripancreatic fluid and interstitial edema consistent with pancreatitis. 2. small-to-moderate amount of ascites in perihepatic, perisplenic and paracolic gutters. 3. loss of corticomedullary differentiation in both kidneys consistent with renal failure. 4. small-to-moderate amount of pleural effusion. . : renal ultrasound: impression: 1. no hydronephrosis identified. scant trace of free fluid seen bilaterally surrounding the kidney. 2. no evidence of renal artery stenosis. mildly elevated resistive indices consistent with chronic renal disease. . : echocardiogram: the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef >55%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic stenosis or aortic regurgitation. no masses or vegetations are seen on the aortic valve. the mitral valve leaflets are structurally normal. there is no mitral valve prolapse. no mass or vegetation is seen on the mitral valve. mild (1+) mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is a trivial/physiologic pericardial effusion. . : chest x-ray impression: compared to and 27: mild pulmonary edema, bibasilar atelectasis, and small pleural effusions have increased since , cardiomegaly is borderline, and mediastinal veins are not dilated. dialysis catheter ends in the mid svc. no pneumothorax. . : tunnel line placement u/s uncomplicated placement of a angiodynamics 23 cm double-lumen, tunneled hemodialysis catheter via the left internal jugular vein with the tip in the right atrium. . : picc line placement cxr impression: 1. new left picc, tip at upper svc. 2. mild cardiomegaly. microbiology: - virus vca-igg ab (final ): positive by eia. - virus ebna igg ab (final ): positive by eia. - virus vca-igm ab (final ): negative <1:10 by ifa. interpretation: results indicative of past ebv infection. cmv igg antibody (final ): positive for cmv igg antibody by eia. 89 au/ml. reference range: negative < 4 au/ml, positive >= 6 au/ml. cmv igm antibody (final ): negative for cmv igm antibody by eia. interpretation: infection at undetermined time. varicella-zoster igg serology (final ): positive by eia. . : blood cultures: _________________________________________________________ staph aureus coag + | clindamycin----------- =>8 r erythromycin---------- =>8 r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- =>4 r rifampin-------------- <=0.5 s tetracycline---------- 2 s trimethoprim/sulfa---- <=0.5 s vancomycin------------ <=0.5 s - : blood cultures no growth : urine culture: gram positive bacteria. >100,000 organisms/ml. alpha hemolytic colonies consistent with alpha streptococcus or lactobacillus sp. brief hospital course: 47-year-old woman with a history of etoh abuse who is transferred from osh for acute etoh and tylenol hepatitis, pancreatitis, arf, and altered mental status. # acute renal failure: due to tylenol toxicity, which can occur in up to 50% of pts with acetaminophen induced fulminant hepatic failure. pt with primary ag metabolic acidosis from uremia. pt was started on hd for acidosis and continued on this for volume overload. she was transiently given sodium bicarb supplements. she was also given replacement dosing vit d (vit d=13) supplements. remainder of electrolytes stayed within normal limits. pt had complete pre-hd workup with negative hepatitis panel and ppd negative. starting , her urine output increased remarkably (~4-5l urine output daily) as she entered the diuresis stage of atn and hd was discontinued. she required fluid boluses to maintain euvolemia, and was encouraged to drink 2-3l of oral fluids until her urine output decreases. #septic thrombophlebitis: pt had left dorsum of hand septic thrombophlebitis from iv line infection. 4 blood cultures positve for gpc and she had fevers of 100.8. pt was given vancomycin iv with hemodialysis with goal trough 15-20. given development of thrombocytopenia, patient switched from vancomycin to daptomycin. 1st dose of daptomycin 400 mg iv q48h on and 2nd dose on . she received transthoracic echocardiogram which did not show valvular vegetation. thrombophlebitis healed well and she will f/u with id and continue on daptomycin until . # fulminant hepatitis: secondary to etoh coupled with acetaminphen toxicity. completed course of nac iv for 20 hrs and had impressive improvement of hepatic function. over course of admission lfts downtrended ast 20,000->35 and alt 8000->50s. inr and tbili normalized. workup for other etiologies of hepatitis was negative. she will follow with hepatology as outpatient for further monitoring of liver failure. # pancreatitis: likely secondary to etoh. over course of admission, lipase downtrended 840->100->78. she was kept npo until abd pain improved and was given dilaudid for pain control. mrcp showed no signs of necrosis or pseudocysts or complications of pancreatits. her diet was advanced to regular which she tolerated well. # altered mental status: initially presented with somonlence likely multifactorial: etoh withdrawel, benzos, renal failure, hepative failure. last drink or . she was initialy started on ciwa and then weaned off. pts mental status cleared and she became lucid and was discharged with normal mental status. # substance abuse: psych evaluated pt and did not see any signs of suicidaility. they did not recommend antidepressents in the setting of acute illness. pt encouraged to continue psych follow up after discharge. she was quite anxious throughout her stay requiring intermittent benzodiazepines. these should be discontinued one week after discharge (only 5 tabs provided upon discharge) in order to avoid the possibility of continued substance abuse. # uti: e. coli uti sensitive to cipro. she completed 7 day course for complicated cystitis. # hypertension: pt with htn (160s) and was started on amlodipine 5mg daily, which was later uptitrated to 7.5 mg daily. she has a pcp follow up appointment in 1 week at which time bp can be evaluated and medication regimen changed if needed. she was full code for this admission. she will be discharged to home (independently ambulating and was evaluated by physical therapy) where her mother will be living with her for several weeks to aid in her care. transition of care: -renal follow up: plan for complete recovering of renal function. continue to assess renal function regularly and urine output. -needs continued psych support for her drug addiction and depressive issues -needs continued follow up with hepatology service to continue to assess liver -needs pcp f/u for blood pressure management -needs id f/u for complete resolution of mrsa bacteremia, outpatient lab results planned and will be faxed to id medications on admission: vicodin (dose unknown) discharge medications: 1. outpatient lab work please draw the following once per week starting and continuing through : cbc/diff, bun, cr, esr, crp, and fax results to the clinic at (, pcp . at and her new nephrologist (name and fax # to be determined). 2. multivitamin tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 3. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily) for 6 weeks: use 14mg patch x6 weeks then decrease to 7mg patch x2 weeks then stop. you cannot smoke while on the patch. talk to your primary care for refills of the patch in 2 weeks. disp:*14 patch 24 hr(s)* refills:*0* 4. amlodipine 5 mg tablet sig: 1.5 tablets po daily (daily). disp:*30 tablet(s)* refills:*2* 5. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po 1x/week (tu) for 7 weeks: last dose to be taken , . after this, start taking 1000 units of vit d daily (you can find this over the counter). disp:*7 capsule(s)* refills:*0* 6. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q4h prn () as needed for nausea. disp:*24 tablet, rapid dissolve(s)* refills:*0* 7. daptomycin 500 mg recon soln sig: four hundred (400) mg intravenous q48h for 16 days: stop . disp:*3600 mg* refills:*0* 8. lorazepam 0.5 mg tablet sig: one (1) tablet po at bedtime as needed for anxiety. disp:*5 tablet(s)* refills:*0* 9. calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po three times a day: please take with meals. disp:*30 tablet, chewable(s)* refills:*2* 10. daily picc maintenance discharge disposition: home with service facility: community vna discharge diagnosis: fulmanent hepatitic failure - secondary to alcohol and tylenol acute renal failure- acute tubular necrosis secondary to tylenol pancreatitis mrsa bactermia normocytic anemia - due to renal failure alcohol withdrawl urinary tract infection alcohol abuse 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 for alcohol and tylenol toxicity. your liver, pancreas and kidneys were all severely inflamed and affected by these drugs. we urge you to continue to get help regarding your drinking and drug abuse problems. this is very serious. drugs can damage your organs and be fatal. your liver function gradually improved with time. you were given nac, a medicine to help oppose the dangerous effects that tylenol has on the liver. you have an follow up appointment with the liver center (dr. as detailed below. your liver function tests will be completed at that time. you had a pancreatitis which caused your abdominal pain. it gradually improved and you tolerated a regular diet. your kidneys were not functioning normally and you were started on hemodialysis temporarily to clear your body toxins. however, during your admission your kidney function has improved and you are urinating which is a good prognostic sign. you will not need dialysis upon leaving the hospital, but you should follow closely with your new kidney doctor. because you are urinating a lot, please continue to drink 2-3 liters of fluid by mouth daily until your urine output decreases. you also developed an infection in your skin around an iv site that resulted in a blood infection with methicillin resistant staph aureus. you received a picc line and will be receiving antibiotics until for this infection. home nursing services will administer this antibiotic for you. you received an echocardiogram which did not show infection on the valves in your heart. you will follow up with the infectious disease doctors . you have anemia likely due to your kidney failure and received blood transfusions. as your kidney's recover, your anemia is expected to improve. medication changes: start multivitamin 1 tab daily start nicotine patch 14mg daily x6 weeks then 7mg daily x2 weeks then stop. you cannot smoke while on the patch start amlodipine 7.5mg daily start vitamin d 50,000 units daily x7 weeks then vitamin d 1000units daily thereafter(this can be found over the counter) start zofran 4mg by mouth every 4-6 hours as needed for nausea start daptomycin 400mg iv every other day until start lorazepam 0.5mg 1 tab at night for anxiety start calcium carbonate 500mg three times daily (take with meals) - this is important to lower your phosphorus it was a pleasure caring for you. we wish you a speedy recovery. followup instructions: the following appointments have been scheduled for you: name: , location: medical center address: , , phone: appointment: tuesday 3:15pm with: dr. - nephrologist location: - dept is out of the wound care clinic address: , phone: appointment: friday 11:00am department: infectious disease when: tuesday at 11:00 am with: , m.d. building: lm campus: west best parking: garage department: infectious disease when: friday at 11:00 am with: , md building: lm bldg () campus: west best parking: garage department: liver center when: wednesday at 1 pm with: , md building: lm bldg () campus: west best parking: garage md procedure: hemodialysis venous catheterization for renal dialysis venous catheterization for renal dialysis removal of other device from thorax central venous catheter placement with guidance central venous catheter placement with guidance diagnoses: acidosis thrombocytopenia, unspecified other chronic pain tobacco use disorder acute kidney failure with lesion of tubular necrosis urinary tract infection, site not specified acute and subacute necrosis of liver hyposmolality and/or hyponatremia accidental poisoning by other opiates and related narcotics constipation, unspecified other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure family history of psychiatric condition other ascites infection and inflammatory reaction due to other vascular device, implant, and graft poisoning by other opiates and related narcotics metabolic encephalopathy hypovolemia accidents occurring in residential institution poisoning by aromatic analgesics, not elsewhere classified bipolar disorder, unspecified other and unspecified alcohol dependence, unspecified other specified anemias phlebitis and thrombophlebitis of upper extremities, unspecified acute pancreatitis methicillin resistant staphylococcus aureus septicemia toxic effect of ethyl alcohol accidental poisoning by alcoholic beverages disorders of bursae and tendons in shoulder region, unspecified accidental poisoning by aromatic analgesics, not elsewhere classified long-term (current) use of non-steroidal anti-inflammatories (nsaid) substance abuse in family 

Answer: The patient is high likely exposed to