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: penicillins attending: chief complaint: found down major surgical or invasive procedure: intubation repeat intubation egd bronchoscopy attempted right subclavian line placement placement of left ij central line repeat placement of left ij central line history of present illness: 38 y/o f with hx. etoh cirrhosis, mult osh admissions for withdrawals and dts (continues to drink 2 pints of vodka daily) and mult osh dicharges 'ama' was found by police 'down' and intoxicated with multiple bruises. brought to , where she was noted to have an etoh level of 389 (at 1300h ), a bp of 75/44 (up to 124 sbp s/p 3 litres ns), lul infiltrate and ? mediastinal pathology; head ct: showing no acute pathology, brain atrophy, bilateral maxillary air fluid levels. stated that she had not been eating or drinking for weeks (except vodka). the hospitalist there saw her, felt that she needed ercp (due to a hypoechoic mass of the pancreas seen under his care there one month previously for a similar admission). they gave her ctx/azithro, lactulose, 10 of kcl iv, and transferred her here "for ercp". on arrival at our ed, she was noted to be diffusely rhonchorous, satting in the 80's, adamantly refusing foley, rectal exam. had "coffee ground emesis" on her shirt, but denied vomiting. she had mult bruises apparent. she was put on a nrb and was persistently tachy to the 130's (133 94/65 18 94% nrb). she then had a melanotic stool per the ed (approx 200 cc, guaiac pos), and protonix was started. she was intubated. an ogt was placed. gi was called per the ed resident, and suggestion was made to call the liver team. liver recommended octreotide gtt, and this was started. she was given 4 mg ativan and ptopofol was up titrated for agitation/tremulousness to 40 mcg/kg/min and she was sent to ct for head and torso scans en route to the tsicu under the micu green service. notable initial labs in our ed: k:3.0 lactate:4.4 ammonia: 60 serum etoh 239 serum asa, acetmnphn, , , tricyc negative past medical history: etoh abuse (ongoing) with hx. mult admissions, w/d sz./dt hypoechoic area on pancreas noted on abd. u/s at osh - refused w/u depression asthma tobacco use thrombocytopenia attributed to alcoholism and liver disease in records from osh, but plts normal here etoh hepatitis social history: has 3 kids, all minors no hx. ivdu per boyfriend chronic etoh, drinks 2 pints vodka daily family history: unknown physical exam: 100 114 112/67 21 100% on fio2 of 1.0 vent: ac 20x500 peep 5 fio2 1.0 peak 37 plat 26 sedated, but grimacing, writhing in bed, tremulous sclerae jaundiced, pupils equally round, sluggishly reactive no jvd or lad skin dry tachy, reg, no mrg diffusely rhonchorous with wheezing abdomen distended, hepatomegaly, bowel sounds present no edema or rash moves all four estremities foley in place 3 piv's in ue's discharge physical examination t 98 p90-110 bp150s/70s r12-20 psv 14/5 fio2 0.4 98-100% gen- up in chair, awake, alert heent- mild scleral icterus, perrla, eomi, moist mucus membrane, trach site intact cv- regular, no r/m/g resp- clear bilaterally abdomen- soft, distended, nontender, normal bowel sounds, g tube site intact ext- no edema pertinent results: admission labs: 06:40pm pt-14.5* ptt-34.3 inr(pt)-1.3* 06:40pm plt smr-normal plt count-201 lplt-1+ 06:40pm hypochrom-normal anisocyt-1+ poikilocy-normal macrocyt-3+ microcyt-normal polychrom-normal 06:40pm neuts-92.7* bands-0 lymphs-4.8* monos-1.6* eos-0.4 basos-0.6 06:40pm wbc-15.3* rbc-2.91* hgb-11.3* hct-31.6* mcv-109* mch-38.9* mchc-35.9* rdw-18.8* 06:40pm asa-neg ethanol-239* acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 06:40pm ammonia-60* 06:40pm albumin-2.6* calcium-6.7* 06:40pm lipase-78* 06:40pm alt(sgpt)-131* ast(sgot)-478* alk phos-313* amylase-56 tot bili-14.1* 06:40pm glucose-86 urea n-6 creat-0.4 sodium-127* potassium-3.2* chloride-82* total co2-28 anion gap-20 07:00pm lactate-4.4* k+-3.0* pertinent labs/studies: . imaging: : ct head 1. no intracranial hemorrhage or mass effect is identified. 2. there is prominence of the ventricles and sulci, which is slightly unusual in a patient of this age, and is consistent with cerebral atrophy. 3. fluid within the sphenoid sinus is likely related to patient's intubation. . : ct c/a/p 1. endotracheal tube tip within the right bronchus intermedius with associated bilateral upper lobe atelectasis. this was discussed with dr. at the time of the examination. 2. enlarged, fatty liver consistent with the patient's given history of liver disease. . : abdominal us - impression: no evidence of ascites. . : echocardiogram (tte) the left atrium is normal in size. left ventricular wall thickness, cavity size, and systolic function are normal (lvef>55%). regional left ventricular wall motion is normal. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion and no aortic regurgitation. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. . : ct c/a/p 1. patent mesenteric vasculature. no significant bleeding source identified. 2. patchy opacities, most prominently involving the upper lobes. given the recent bilateral upper lobe collapse, this most likely represents reexpansion edema. 3. markedly enlarged fatty attenuation liver. 4. severe anasarca. . : ct sinus - impression: fluid within the sphenoid and ethmoid sinuses, which may be secondary to intubation. mild sinus mucosal thickening. . : ct a/p - 1. possible thickening in the upper cecum and ascending colon. this appearance is difficult to evaluate due to underdistension, but there is apparent stratification of the wall which is also suspicious for colitis. 2. increased ascites since the prior study. this may be due to an edematous state, but can also be seen in infectious colitis. 3. improved upper lobe opacities in the lungs. 4. left lower lobe collapse. this was discussed with dr. at 11 pm on the same day. 5. fatty infiltration of the liver. . : portable cxr findings: upright radiograph of the chest. endotracheal tube is identified with its tip approximately 4.5 cm from the carina. left-sided internal jugular line is seen with its tip unchanged in position and overlying the upper to mid svc. cardiomediastinal silhouette is unchanged. left retrocardiac density representing atelectasis vs. airspace disease appears stable. some improvement in the right basilar atelectasis is noted. no pleural effusion or pneumothorax is identified. nasogastric tube is identified with its proximal side port below the diaphragm. impression: stable left retrocardiac density representing atelectasis vs. airspace disease. . . procedures: egd- no bleeding etiology . . microbiology blood cultures: : 1/4 bottles vre : 1/4 bottles vre ; ; : ngtd to : ngtd . urine cultures: : > 100k yeast : > 100k yeast . sputum cultures: to : multiple cultures growing yeast, no bacterial growth . bal: : cultures negative including fungal, afb, pcp, : viral screen - cultures growing hsv-i . stool: - : c. diff negative x 5 . cmv ab - negative brief hospital course: the patient is a 38 year old female with history of chronic significant alcohol abuse who was found down, intubated in the e.d. respiratory distress with course complicated by sepsis. . #. respiratory failure the patient was initially seen in the e.d. able to answer questions, but decompensated shortly thereafter requiring intubation for airway protection and hypoxia. the patient was admitted to the micu on a vent. after initial treatment for potential sepsis with levo, flagyl, and aztreonam the patient was extubated. however, the patient developed significant tachypnea and respiratory distress requiring repeat intubation. imaging at the time of repeat intubation demonstrated likely volume overload vs. less likely an early ards like pattern. despite completion of antibiotics for potential vap there has been considerable difficulty weaning the patient from the ventilator. imaging has revealed intermittent lobar collapse and re-expansion and bronchoscopy did not reveal any bronchial lesions or obstruction. multiple sputum cultures performed have revealed only growth of yeast. bal performed on revealed no bacterial growth but did demonstrate hsv-i growth on viral culture, for which acyclovir therapy was started on . the patient was initially thought to be volume overloaded given her need for aggressive volume resuscitation on admission. however, weaning from the vent has been limited despite adequate diuresis. difficulty to wean was also attributed to muscle deconditioning and her persistent agitated state. patient eventually had tracheostomy/peg tube on . this was complicated by bleeding as discussed below. she completed treatement of vap with levo/flagyl. she started autodiuresing with intermittent help from lasix and her cxr became clear. scheduled nebs and fluticasone were started with good effect. she also completed 3 days course of solumedrol for acute wheezing episode. on discharge, she tolerated intermittent courses of psv on . . #. id - given the patient's respiratory distress on admission, the patient was initially treated with levo/flagyl for potential aspiration pna. given rising wbc and lactate as well as hypotension, vancomycin and aztreonam was additionally added empirically for extended spectrum in the setting of likely sepsis. stress dose steroids were initiated but discontinued when labs were not consistent with adrenal insufficiency. given persistent fevers and interstitial pattern on plain films, azithromycin was additionally added for atpyical coverage. the patient completed a day course of anti-biotics but again developed fevers and rising wbc for which a course of flagyl was started for possible c. diff colitis. blood cultures from subsequently grew vre for which the patient has been started on a course of linezolid. as above, cultures from bal performed on demonstrated no bacterial growth but viral cultures have subsequently revealed hsv-i for which treatment with acyclovir has been started for potential hsv-i pna. in summary, besides +vre(which she received full course of linezolid) and +hsv on bal(which she received treatment dose of acyclovir), all other cultures(blood, urine, sputum, stool) had not demonstrated any growth since admission. she does occasionally have low grade temperature of 100 which resolves spontaneously. her hemodynamics had remained stable. . #.bleeding - on admission from the e.d. the patient was reported to be experiencing recent hematemesis with what appeared to be coffee ground material on her shirt. after intubation the patient underwent egd which revealed a fragment of a tooth near the vocal cords but demonstrated no significant esophageal varices and revealed no evidence for recent ugi bleeding. the patient was guaiac negative and initially had no clinical episodes of gi bleeding during her hospitalization. later in her course the patient experienced significant oral mucosal bleeding from oral lesions requiring multiple prbc transfusion and ffp. ent packed it multiple times. oral mucosal bleeding eventually stopped after ett changed to tracheostomy. post tracheostomy, this was complicated by bleeding from trach site and new subclavian site that required multiple unit of prbc transfusion, 4u ffp, 4u cryoprecipitate and also 24hours of amicar. bleeding eventually stopped and her hematocrit had been stable since then. all the coagulation and dic studies have remained normal. hematology was consulted but could not figure out the etiology of her bleeding. . # sedation/agitation agitation thought to be due to anxiety, delirium and encephalopathy. she required high dose fentanyl/versed drip initially. this was weaned off to standing and tapering doses of fentanyl patch and valium after her acute issues were settles. on discharge, she was doing well and sitting up in chair. . #. alcoholic hepatitis/cirrhosis - on admission the patient had abdominal imaging revealing the liver to be enlarged and with fat infiltration but not definitively cirrhotic. no ascites was present on multiple abdominal imaging studies. on admission the patient had a meld score of 19 with subsequent worsening synthetic function, rising inr and bilis during this admission. the patient was maintained on lactulose and rifaximin and was ultimately started on pentoxyfilline for acute alcoholic hepatitis given desire to avoid steroid treatment in the setting af acute infection. her liver function test improved throughout hospital stay. # prophylaxis patient was maintainted on gi prophylaxis and pneumoboots. no heparin was given because of her bleeding tendency. # access: her central line and a line was pulled on discharge. she had not required iv medication for days leading up to discharge # nutrition patient remained on tube feeds and tolerated that well. # communication daily plans have been communicated to patient's sister and mother. will remain full code and go to rehab for ventilatory wean. medications on admission: (patient reported to be non-compliant) advair albuterol dilantin prozac discharge medications: 1. lactulose 10 g/15 ml syrup : thirty (30) ml po tid (3 times a day). 2. rifaximin 200 mg tablet : two (2) tablet po tid (3 times a day). 3. folic acid 1 mg tablet : one (1) tablet po daily (daily). 4. potassium & sodium phosphates mg packet : two (2) packet po bid (2 times a day). 5. thiamine hcl 100 mg tablet : one (1) tablet po daily (daily). 6. ursodiol 300 mg capsule : one (1) capsule po tid (3 times a day). 7. albuterol 90 mcg/actuation aerosol : six (6) puff inhalation q4h (every 4 hours). 8. ipratropium bromide 17 mcg/actuation aerosol : six (6) puff inhalation q6h (every 6 hours). 9. fluticasone 110 mcg/actuation aerosol : two (2) puff inhalation (2 times a day). 10. citalopram 20 mg tablet : one (1) tablet po daily (daily). 11. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical daily (daily) as needed for pain: to skin 12 hrs on then 12 hrs off . 12. olanzapine 5 mg tablet, rapid dissolve : two (2) tablet, rapid dissolve po bid (2 times a day). 13. fentanyl 50 mcg/hr patch 72hr : one (1) patch 72hr transdermal q72h (every 72 hours): please wean as tolerated. 14. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 15. diazepam 5 mg tablet : one (1) tablet po q6h (every 6 hours): wean as tolerated. 16. lorazepam 2 mg/ml syringe : 1-2 mg injection every hours as needed for agitation. discharge disposition: extended care facility: & rehab center - discharge diagnosis: 1. respiratory failure, failure to wean from ventilator post tracheostomy 2. bleeding tendency, believed to be from her liver disease, no definitive etiology 3. hypertension 4. anxiety 5. aloholic hepatitis 6. depression discharge condition: stable, trach discharge instructions: please return to the hospital or call your doctor if you have bleeding, shortness of breath, fever, chills, chest pain or if there are any concerns at all followup instructions: 1. please follow up with your pcp , . within 2 weeks of your discharge from rehab. 2. please call( to set up appointment at the liver center. procedure: venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more other endoscopy of small intestine insertion of endotracheal tube fiber-optic bronchoscopy fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] other intubation of respiratory tract temporary tracheostomy closed [endoscopic] biopsy of bronchus transfusion of packed cells other irrigation of (naso-)gastric tube transfusion of other serum removal of intraluminal foreign body from esophagus without incision transfusion of coagulation factors injection or infusion of oxazolidinone class of antibiotics diagnoses: congestive heart failure, unspecified acute and subacute necrosis of liver acquired coagulation factor deficiency severe sepsis pulmonary collapse hemorrhage complicating a procedure other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute and chronic respiratory failure pneumonitis due to inhalation of food or vomitus paralytic ileus infection and inflammatory reaction due to other vascular device, implant, and graft hematemesis encephalopathy, unspecified hyperosmolality and/or hypernatremia streptococcal septicemia oliguria and anuria acute alcoholic hepatitis critical illness myopathy acute esophagitis alcohol withdrawal acute alcoholic intoxication in alcoholism, continuous herpes simplex with other specified complications pneumonia due to other virus not elsewhere classified open wound of tooth (broken) (fractured) (due to trauma), complicated 

Answer: The patient is high likely exposed to