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: shellfish derived attending: chief complaint: seizure/overdose major surgical or invasive procedure: mechanical intubation history of present illness: pt is a 30 yo f w/ history of depression and opiod dependence p/w a seizure in setting of intentional overdose on tramadol. patient initially presented to the ed with an unclear complaint but was tearful. she stated that she had had a seizure while in the taxi cab on the way over to the ed but it was unclear why she was coming to the hospital in the first place; pt would not provide a complete history. it was eventually determined that she had taken 60 pills of ultram earlier in the evening shortly after finding out that her boyfriend had cheated on her; pt endorsed this was an intentional suicide attempt. no other details of the history were available at that time as the patient was intubated in ed and no collateral sources were available. . on arrival at the ed she was alert and oriented but noted to be agitated and labile. she was tachycardic to 160s and hypertensive to 158/105. on exam she was noted to have small but reactive pupils (3 -> 2 mm) and persistent clonus in her right lower extremity, as well as 8-10 beats of clonus in her left lower extremity. she also exhibited hyperreflexia bilaterally in her lower extremities. she was able to respond to questions. an ekg showed sinus tach with normal qtc ~430. ativan was about to be initiated when the pt had another 30 second tonic clonic seizure in ed witnessed by ed physicians.pt had no apnea but remained post-ictal for 10-15 minutes and was slow to arouse. . toxicology was consulted who felt that her findings overall were potentially concerning for serotonin syndrome, although it was more likely that her symptoms were limited to medication-induced seizures. treatment with supportive measures initiated, however given her repeated seizures it was felt that an elective intubation was warranted. this was discussed with the patient who agreed, and she was intubated with etomodate and succinate and started on a propafol gtt for sedation. her vital signs at the time of transfer to the unit were 105 118/69 100%/fio2. she remained afebrile. . in the micu, pt was stablized and was able to be quickly extubated w/out difficulty (). pt did not have additional seizures. however, code purple was called for agitation/hostility towards staff/wanting to leave hospital; pt pulled out all iv lines, refusing labs. psych was consulted and pt was sectioned (section 12; can't leave ama). per toxicology, needed to monitor for seizures for at least 24 hours; use benzos not haldol for agitation, and held of restarting cymbalta. on , lorazepam 2 mg po/ng q4h:prn agitation ordered, b/c pt almost code purpled again for smoking and lighting match after a bowel movement. on pt called out to the floor . tox said to monitor lower extremity clonus. eventually pt will be transferred to inpt psych when bed available; currently sectioned 12 so not ok to leave ama. psych will continue to follow her while inpatient. . per most recent psych note; "pt. is frustrated by continued stay in the hospital. she is irritable and vaguely threatening, suggesting that she could hang herself in the icu if she wished but denying active si or intent. "i think about it all the time". she is disappointed about missing a job interview postponed to tommorrow morning. denies recent stress. says taking 12 ultram was "nothing for a heroin addict like me" reports sober for 2 years. seen crying in her rooom before evaluation. she denies this during evaluation "everything is fine". denies opiate withdrawal symptoms. received lorazepam 2 mg twice overnight for anxiety. nonerequired during the day per nursing staff." . on transfer vs were stable 97.8 afebrile, 132/78 (117-132/68-78) 84 (84-92) 97%ra. when asked about pain pt stated she always has pain. wanted to know when she would be leaving. . review of systems: by report of the patient's family from the toxicology team she has not endorsed any recent si or hi. the patient has never been hospitalized for psychiatric reasons before(according to family). review of systems otherwise unable to obtain. . past medical history: multiple wrist surgeries (after being pushed down the stairs by ex-boyfriend) rsd s/p spinal stimulator hepatitis c reports head trauma from mva with brief loc years ago denies h/o seizures depression h/o ivdu h/o alcoholism ? kidney disease (per boyfriend, unclear details) chronic pain social history: lives with boyfriend in . recently laid off job in advertising agency. spent 4 months in jail for drug possession about 2 years ago. h/o physical abuse by boyfriends. finished high school, no college. parents divorced, mother remarried. did not meet her real dad or discover her step father was not her real father until the age of 10. now all 3 parents are actively involved and supportive. -reports opiate addiction starting after wrist injury and being prescribed moriphine. addicted to heroin (iv), morphine and oxycodone. states she has been sober for 2 years, denies methadone or suboxone maintenance. -denies alcohol use -smokes ppd -denies marijuana or cocaine use -denies benzo use family history: mother's twin has bipolar disorder, brother has depression and is addicted to heroin. no family h/o suicide attempts. physical exam: vitals: hr 101 bp 117/68 rr 16 o2 sat 100% vent settings: cmv fio2 100% vt 500 peep 5 f 16 general: nonresponsive heent: mmm neck: supple, jvp not elevated, no lad lungs: coarse breath sounds bilaterally cv: rrr no r/g/m appreciated abdomen: soft, mildly obese, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: +foley, +rash on genitalia ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: admission labs 09:25pm urine hours-random 09:25pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-pos 08:15am urine hours-random 08:15am urine ucg-negative 08:15am urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-pos 08:15am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 06:19am k+-3.7 05:35am glucose-71 urea n-7 creat-0.7 sodium-138 potassium-3.8 chloride-105 total co2-24 anion gap-13 05:35am estgfr-using this 05:35am hcg-<5 05:35am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 05:35am wbc-15.4* rbc-4.29 hgb-13.6 hct-38.0 mcv-89 mch-31.8 mchc-35.8* rdw-13.2 05:35am neuts-78.5* lymphs-16.2* monos-3.9 eos-0.8 basos-0.6 05:35am plt count-221 . discharge labs . . ecg study date of 5:37:04 am artifact is present. regular supraventricular tachycardia which is most likely sinus. there are small r waves in the anterior leads which are most likely due to lead placement. non-specific st-t wave changes. no previous tracing available for comparison. intervals axes rate pr qrs qt/qtc p qrs t 152 0 90 270/431 0 87 -83 . chest (portable ap) study date of 6:41 am findings: an endotracheal tube is with tip in standard position 4.4 cm above the level of the carina. a nasogastric tube terminates within the mid stomach. there is diffuse perihilar interstitial abnormality. there are no pleural effusions or pneumothorax. cardiomediastinal and hilar contours are normal, with normal heart size. hardware overlying the mid trachea, can be confirmed to be external to the patient upon discussion with the clinical team. . impression: 1. endotracheal tube in standard position 4.4 cm above the carina. 2. diffuse interstitial abnormality for which differential includes pulmonary edema and atypical infections such as viral pneumonia or pcp. . brief hospital course: pt is 30f w/pmh of depression (no prior suicide attempts) and opiod abuse (2yr sobriety per pt) here with seizure in setting of intentional ultram overdose after found out boyfriend's infidelity. . # seizures/ultram overdose: seizures were most likely medication (ultram)-induced seizures but some concern for complete serotonin syndrome. no known prior history of seizures. toxicology was consulted and followed pt at the time of transfer to micu and recommended to monitor lower extremity clonus and to hold home cymbalta. serial ekgs were performed to monitor intervals have been stable. benzo prn (versed gtt)was used for seizures and agitation; however no additional seizures occured after arrival to micu. pt was stablized and was able to be called out to the floor on . # airway protection: electively intubated for airway protection in the setting of seizures in the e.d, was extubated soon after in the icu and tolerated room air well. . #depression: unclear history and no previous known si/hi or hospitalizations but now with apparent attempt in setting of social stressor. psych has seen the patient and sectioned 12 her after code purple was called for agitation and threatening behavoir. currently denies any suicidal thoughts but remains agitated at times. needs inpatient psych treatment once stable. pt was able to be transferred to the floor for continued monitoring and management while awaiting psych bed placement. pt was also restarted on cymbalta (low dose of 20mg daily) and gabapentin 300 tid initially when brought to the floor; medications were titrated per psych recs as needed in inpt psych. gabapentin was eventually increased back to the pt's home dose of 800mg, 800mg and 1600mg (at night). . initially plan was to transfer to inpt psych facility; however, upon reevaluation by psychiatry after transfer to the floor it was felt that pt no longer was actively suicidal and that she agreed to a concrete plan of outpt follow. she no longer met section 12 criteria. it was felt that the overdose was an act of impulsivity and not consistent with a suicide attempt. therefore, psychiatric hospitalization deemed unnecessary. as the pt was medically stable and requesting to be discharge home, she was discharged under own care with planned outpt follow-up with her pcp, /therapist at health center, as well as the pain specialist at . pt also agreed to continue with aa/na and home group for substance abuse treatment. she also agreed to call 911 or go to the nearest ed if she was feeling worse or developing thoughts of harming herself and was in agreement w/plan to d/c tramadol. medications on admission: (not able to confirm at time of admission) celexa neurontin ultram discharge medications: 1. duloxetine 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 2. gabapentin 400 mg capsule sig: two (2) capsule po bid (2 times a day). 3. gabapentin 400 mg capsule sig: four (4) capsule po hs (at bedtime). discharge disposition: home discharge diagnosis: primary: medication overdose induced seizure possible suicide attempt 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 you had a seizure as a result of overdosing on tramadol and their was concern that this was a suicide attempt or gesture of self harm. you required intubation and admission to the icu for stabilization of your condition. you were able to be extubated after your condition improved. you were seen by psychiatry who felt that you were initially unsafe to discharge as your overdose was viewed initially as a suicide attempt or gesture of self harm. for this reason, after psychiatry's initial evaluation, you were received a section 12 meaning that you were not allowed to leave the hospital setting over concerns that you may harm yourself or others. however, your condition improved and after additional evaluation and assessment it was determined that you could be discharged home with close follow-up and in the care of your family. . the following changes were made to your medications: - please start taking cymbalta 20mg. please discuss this medication with your and other doctors; adjustments may may need to be made. - please stop taking tramadol. - please continue to take all of your other home medications as prescribed. do not take more than the prescribe dose. please be sure to take all medication as prescribed. . please be sure to keep all follow-up appointments with your pcp, /psychologist, pain doctor and other health care providers. followup instructions: please be sure to keep all follow-up appointments with your pcp, /psychologist, pain doctor and other health care providers. please be sure to contact your main doctor to make follow-up appointments within the next week. please be sure to call their offices tomorrow morning to arrange follow-up appointments. . we have also scheduled a follow-up appointment with your primary care doctor who can also help to ensure your symptoms resolve and that you have the appropriate follow-up. name: , n. address: 409 , , phone: appointment: at 1:30pm . as agreed to prior to discharge, please call 911 immediately if you have any suicidal thoughts or feelings or other concerns about your safety. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: other chronic pain tobacco use disorder unspecified viral hepatitis c without hepatic coma other convulsions depressive disorder, not elsewhere classified opioid type dependence, unspecified other postprocedural status suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics personal history of alcoholism poisoning by other specified analgesics and antipyretics reflex sympathetic dystrophy, unspecified history of physical abuse 

Answer: The patient is high likely exposed to