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: history of present illness: the patient is a 70-year-old female with a past medical history significant for nonalcoholic steatohepatitis with end-stage liver disease complicated by multiple admissions for hepatic encephalopathy, esophageal varices, insulin-dependent diabetes mellitus, hypothyroidism, asthma, and fibromyalgia who was transferred from hospital for further management of acute renal failure and hypotension. the patient presented to hospital on after twisting her ankle with increasing shortness of breath and frequency episodes of nausea and vomiting with decreased oral intake. she twisted her ankle on , and the shortness of breath began on . she was being treated for a left lower extremity cellulitis with levofloxacin for 10 days with improvement of her cellulitis. of note, the dose of levofloxacin had been increased from 250 mg to 500 mg p.o. twice per day. the patient had also noticed a decrease in her urine output starting on . at hospital, the patient was noted to be in acute renal failure with her creatinine increased to 5.7 (from a baseline of 1.2 to 1.5), a potassium of 6.3, and a blood urea nitrogen of 121. the initial impression at hospital was that the acute renal failure was secondary to acute interstitial nephritis secondary to levofloxacin. she received two dialysis treatments at hospital. the patient was noted to be hypertensive status post dialysis at hospital, requiring pressors. she was started on dopamine at hospital prior to transfer to for further management. upon transfer to medical intensive care unit, the patient was noted to be tachycardic and in atrial fibrillation. therefore, the dopamine was changed to levophed; which was quickly weaned off. the patient was also dialyzed twice in the medical intensive care unit with minimal fluid removal secondary to hypotension. urine eosinophils were negative, and the fractional excretion of sodium was noted to be less than 0.4%, with a urine sedimentation showing muddy brown casts; consistent with a prerenal/acute tubular necrosis picture secondary to volume depletion. the patient was started on clindamycin and flagyl for her cellulitis. however, after blood cultures obtained in the medical intensive care unit revealed 2/4 bottles positive for coagulase-negative staphylococcus, antibiotic coverage was changed to vancomycin and flagyl. the patient also ruled in for a non-st-elevation myocardial infarction with electrocardiogram showing global st depressions and a peak troponin to 14.7. an echocardiogram was done which showed no wall motion abnormalities. the patient was transferred to the general medicine floor for further care. past medical history: 1. nonalcoholic steatohepatitis with end-stage liver disease; complicated by varices, hepatic encephalopathy, and ascites. 2. hypothyroidism. 3. insulin-dependent diabetes mellitus; complicated by neuropathy. 4. asthma. 5. migraine headaches. 6. cholelithiasis. 7. fibromyalgia. 8. macrocytic anemia. 9. recurrent cellulitis. 10. obesity. 11. glaucoma. 12. cataracts. 13. cervical spondylosis. 14. hyperlipidemia. medications on transfer: 1. vancomycin 1 g intravenously times one. 2. aztreonam 1 g intravenously times one. 3. aspirin 81 mg p.o. once per day. 4. nph insulin 29 units subcutaneously q.a.m. and 12 units subcutaneously q.p.m. 5. humalog insulin sliding-scale. 6. levothyroxine 75 mcg p.o. once per day. 7. metronidazole 500 mg intravenously twice per day. 8. lactulose 30 cc p.o. q.8h. as needed (titrated to three bowel movements per day). 9. vitamin e. 10. sevelamer ocular eyedrops. 11. prednisolone acetate eyedrops. 12. flurbiprofen eyedrops. 13. brimonidine eyedrops. 14. tramadol 15 mg p.o. q.12h. as needed. 15. albuterol 1 to 2 puffs inhaled q.4-6h. as needed. 16. protonix 40 mg p.o. once per day. allergies: penicillin, vioxx, and aspirin. social history: the patient lives with her husband at home. she denies any tobacco, alcohol, or intravenous drug use. physical examination on presentation: physical examination on admission revealed temperature was 98.4, blood pressure was 98 to 116/25 to 53, heart rate was 79 to 88, respiratory rate was 19, and oxygen saturation was 95% on room air. in general, the patient was an obese female in no acute distress. head and neck examination revealed pupils were equal, round, and reactive to light. extraocular movements were intact. mild scleral icterus. mucous membranes were moist. no oropharyngeal lesions. the neck with a right internal jugular line clean, dry, and intact. the neck was supple. cardiovascular examination revealed normal first heart sounds and second heart sounds. a regular rate and rhythm. there was a 2/6 systolic ejection murmur heard over the left upper sternal border. the lungs revealed rales in the lower one half of the lung fields bilaterally. no wheezes or rhonchi. the abdomen was obese, soft, and nontender. there were normal active bowel sounds. the spleen tip was palpable. extremity examination revealed 2+ pitting edema in the arms and legs. there was a 5-cm x 2-cm ulcer on the left pretibial region. neurologic examination revealed alert, mentated well, and moved all four extremities spontaneously. pertinent laboratory values on presentation: laboratory data revealed sodium was 136, potassium was 3.3, chloride was 104, bicarbonate was 22, blood urea nitrogen was 34, creatinine was 2.2 (decreased from 3.6 on ), and blood glucose was 195. white blood cell count was 6.9, hematocrit was 27.3, and platelets were 50. inr was 1.6 and partial thromboplastin time was 33.5. alt was 111, ast was 124, alkaline phosphatase was 354, total bilirubin was 4.2, amylase was 48, and lipase was 40. a.m. cortisol was 12.5; increased to 23.4 with cosyntropin stimulation test. calcium was 8.7, phosphate was 3.2, and magnesium was 1.7. creatine kinase levels were 141, 112, and 125 with corresponding troponin levels of 14.7, 12.9, 12.2, and 10.1. urinalysis with 69 red blood cells, 305 white blood cells, 30 mg/dl of protein, trace ketones, and small bilirubin. no bacteria. no yeast. no eosinophils. antinuclear antibody negative. rheumatoid factor negative. spep with immunoglobulin g of 1592, immunoglobulin a of 468, immunoglobulin m of 174, c3 of 51, and c4 of 14. pertinent radiology/imaging: a chest x-ray on with bilateral interstitial edema with bilateral pleural effusions. an echocardiogram done on revealed a left ventricular ejection fraction of greater than 70% with no regional wall motion abnormalities. trivial mitral regurgitation. brief summary of hospital course by issue/system: our impression was that this patient is a 70-year-old female with a past medical history significant for nonalcoholic steatohepatitis, with end-stage liver disease, and insulin-dependent diabetes mellitus whose clinical picture was thought to be consistent with hypotension and prerenal azotemia leading to acute tubular necrosis in the setting of intravascular volume depletion secondary to decreased oral intake and nausea and vomiting with concomitant diuretic use and possibly sepsis secondary to cellulitis. 1. renal issues: the patient likely initially had prerenal azotemia secondary to volume depletion, leading to acute tubular necrosis. in the medical intensive care unit, the patient was virtually anuric and was requiring dialysis. however, upon transfer to the floor, the patient no longer required dialysis and had spontaneous recovery of her renal function, with her creatinine decreasing to 1.4 and an increase in her urine output. as the patient was still significantly volume overloaded with anasarca, lasix was re-initiated at 40 mg intravenously twice per day with good diuresis and continued improvement in her renal function. aldactone was restarted at 25 mg p.o. twice per day and titrated upward to 50 mg p.o. twice per day. 2. cardiovascular system: the patient ruled in for a non-st-elevation myocardial infarction with a peak troponin to 14.7 while in the medical intensive care unit. cardiac enzymes were cycled and continued to trend downward. a cardiac echocardiogram was done which showed an ejection fraction of 70% with no wall motion abnormalities. the patient had some degree of pulmonary edema secondary to extravascular volume overload due to a combination of acute tubular necrosis and cirrhosis. the patient was given lasix 40 mg intravenously twice per day with excellent diuresis. the patient always maintained good oxygenation with oxygen saturations in the mid 90s on room air. 3. infectious disease issues: the patient had a left lower extremity cellulitis, and 2/4 bottles grew coagulase-negative staphylococcus. the source for the bacteremia was thought to be related to her central line. the patient was to be continued on a 14-day course of vancomycin and flagyl to cover her cellulitis and a possible line infection. the patient also had a urinalysis checked on the floor secondary to hematuria which revealed many bacteria. she was started on levaquin as well; pending urine culture identification and sensitivity results. the patient remained afebrile throughout her stay on the floor. 4. gastrointestinal issues: the patient has end-stage liver disease and cirrhosis secondary to nonalcoholic steatohepatitis. while in the medical intensive care unit, there was a transient elevation in her transaminases which was attributed either to hepatic congestion versus hepatic ischemia from hypotension. however, the patient's transaminases returned toward her baseline toward the end of her hospital stay. 5. hematologic issues: the patient had one blood transfusion while in the medical intensive care unit for a hematocrit of 27. no bleeding source was identified. the patient likely has anemia secondary to liver disease. the patient is also thrombocytopenic; likely from sequestration with her liver disease and splenomegaly. 6. endocrine issues: the patient was continued on nph and a regular insulin sliding-scale; as recommendations. insulin doses were constantly adjusted as the patient had increasing insulin requirements throughout her hospital stay as her oral intake increased. 7. mobility issues: the patient was fairly reluctant to mobilize herself and to cooperate with physical therapy, as she continuously complained of feeling tired and felt uncomfortable with the edema in her hands and legs. however, physical therapy recommended that the patient would benefit from a rehabilitation stay prior to discharge home. condition at discharge: condition on discharge was stable. discharge status: the patient was to be discharged to rehabilitation. medications on discharge: 1. levofloxacin 250 mg p.o. q.24h. 2. spironolactone 50 mg p.o. twice per day. 3. potassium chloride 40 meq p.o. twice per day. 4. vancomycin 1 g intravenously q.12h. (to complete a 14-day course). 5. lactulose 30 cc p.o. q.8h. as needed (titrated to three loose bowel movements per day). 6. miconazole powder. 7. heparin 5000 units subcutaneously q.12h. 8. furosemide 40 mg intravenously twice per day. 9. flagyl 500 mg p.o. three times per day. 10. albuterol nebulizers as needed. 11. acular. 12. prednisolone. 13. flurbiprofen eyedrops. 14. aspirin 81 mg p.o. once per day. 15. tocopheryl 400 units p.o. once per day. 16. tramadol 15 mg p.o. q.12h. as needed. 17. tylenol p.o. as needed. 18. phenaseptic throat spray as needed. 19. colace 100 mg p.o. twice per day. 20. brimonidine eyedrops. 21. albuterol meter-dosed inhaler 1 to 2 puffs inhaled q.4-6h. as needed. 22. protonix 40 mg p.o. once per day. 23. levothyroxine 75 mcg p.o. once per day. 24. nph 40 units subcutaneously q.a.m. and 20 units subcutaneously q.p.m. 25. regular insulin sliding-scale. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified hemodialysis diagnoses: subendocardial infarction, initial episode of care acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified cirrhosis of liver without mention of alcohol cellulitis and abscess of leg, except foot hepatic encephalopathy ulcer of lower limb, unspecified 

Answer: The patient is high likely exposed to