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: hypotension, overdose, lft abnormalities, encephalopathy major surgical or invasive procedure: intubation history of present illness: ms. is a 32 year old woman with a history of crohn's disease and chronic anemia who was admitted to hospital today with acute mental status changes in the setting of a suspected overdose. she lives on a cell block where she is allowed to take and maintain her own medications. today was suspected of taking 23 tabs of benadryl, but patient does not recall complete events. patient also admits to taking 6 325mg tabs of acetaminophen. she was found to be confused with "rambling" speech at 7pm. she also notes difficulty with urination. she presented to with the above complaints. . at , ms. was found to be hypotensive to sbps in the 70's, io access was obtained, 5l ns was administered and 2 units prbc given for a hct of 23. later a picc was placed in the micu for further access. she was also found to have a tylenol level of 21 (upper limit is 20) and was started on mucomyst and has recieved 9000mg bolus nac, 3000mg over 4hrs. ct abd/pelvis demonstrated extensive colitis, small volume ascites, and a consolidation in the rml and rll concerning for pneumonitis. a ct head w/o contrast was obtained which was within normal limits. . in addition to the confusion, ms. notes worsening shortness of breath for the past 1 week with associated cough, myalgias, and worsening lower extremity edema. she has lost 60 lb over the past 6 months in conjunction with her crohn's disease. . on arrival to the micu, ms. was aox3 with appropriate concentration but had intermittent word finding difficulty and difficulty maintaining goal directed communication. past medical history: crohn's disease-diagnosed approximately 1 month ago self mutilation per report from ems iron deficiency anemia social history: currently incarcerated for a 6 month sentence. otherwise lives in an apartment alone. - tobacco: 5 pack year smoking history, quit 6 months ago - alcohol: occassional red wine with dinner - illicits: none family history: non-contributory physical exam: admission exam tmax: 35.9 ??????c (96.6 ??????f) tcurrent: 35.9 ??????c (96.6 ??????f) hr: 130 (130 - 140) bpm bp: 98/74(78) {98/51(60) - 125/108(112)} mmhg rr: 24 (21 - 34) insp/min spo2: 97% heart rhythm: st (sinus tachycardia) general: alert, oriented, difficutly with goal directed communication. tremulous heent: sclera icteric, dry mm, + mydriasis, oropharynx clear, eomi, perrl 5mm pupils staring into room lighting neck: supple, jvp not elevated, no lad cv: tachycardic rate and regular rhythm, normal s1 + s2, ii/vi flow murmur at rusb, rubs, gallops lungs: diffuse rhonchi on r abdomen: soft, non-tender, non-distended, bowel sounds present, no organomegaly gu: foley in place ext: cool 1+ pulses diffusely, no clubbing, cyanosis or edema neuro: cnii-xii intact, 5/5 strength upper/lower extremities, grossly normal sensation, + asterixis, 2+ reflexes bilaterally, gait deferred discharge exam -expired pertinent results: admission labs 04:44am blood wbc-7.2 rbc-3.63* hgb-11.5* hct-35.4* mcv-98 mch-31.8 mchc-32.6 rdw-20.3* plt ct-110* 04:44am blood neuts-89* bands-4 lymphs-4* monos-3 eos-0 baso-0 atyps-0 metas-0 myelos-0 nrbc-1* 04:44am blood hypochr-normal anisocy-2+ poiklo-normal macrocy-3+ microcy-normal polychr-occasional target-2+ burr-2+ 04:44am blood pt-23.4* ptt-66.1* inr(pt)-2.2* 12:39pm blood fibrino-154* 03:02pm blood esr-7 04:44am blood glucose-92 urean-19 creat-0.6 na-138 k-2.9* cl-98 hco3-25 angap-18 04:44am blood alt-103* ast-45* ld(ldh)-461* alkphos-151* totbili-3.9* dirbili-3.2* indbili-0.7 03:23am blood lipase-4 04:44am blood albumin-1.4* calcium-6.7* phos-2.9 mg-1.9 iron-41 03:23am blood tsh-1.1 04:44am blood hbsag-negative hbsab-negative hbcab-negative hav ab-positive 04:44am blood asa-neg acetmnp-9* bnzodzp-neg barbitr-neg tricycl-neg 05:04am blood lactate-6.1* discharge labs -expired other important labs 09:50pm blood aca igg-2.4 aca igm-3.8 03:23am blood vitb12-greater th folate-12.5 hapto-46 03:30pm blood anca-negative b 09:50pm blood crp-184.6* 03:30pm blood rheufac-<3 10:18am blood c3-36* c4-19 hiv negative micro data 4:22 pm sputum source: expectorated. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive cocci. in pairs and clusters. respiratory culture (preliminary): cancelled in error . further incubation required to determine the presence or absence of commensal respiratory flora. staph aureus coag +. moderate growth. 6:59 am urine source: catheter. addon request for leg per fax b y , j. on @ 0924. **final report ** urine culture (final ): escherichia coli. >100,000 organisms/ml.. presumptive identification. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. piperacillin/tazobactam sensitivity testing available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | amikacin-------------- <=2 s ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ =>16 r meropenem-------------<=0.25 s nitrofurantoin-------- <=16 s tobramycin------------ 8 i trimethoprim/sulfa---- =>16 r legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. 6:42 pm bronchoalveolar lavage bronchial lavage. gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 1+ (<1 per 1000x field): gram negative rod(s). respiratory culture (final ): ~3000/ml commensal respiratory flora. escherichia coli. ~3000/ml. cefazolin interpretative criteria are based on a dosage regimen of 2g every 8h. piperacillin/tazobactam sensitivity testing available on request. yeast. ~4000/ml. of two colonial morphologies. staph aureus coag +. ~1000/ml. isolates are considered potential pathogens in amounts >=10,000 cfu/ml. sensitivities performed on culture # (). sensitivities: mic expressed in mcg/ml _________________________________________________________ escherichia coli | amikacin-------------- <=2 s ampicillin------------ =>32 r ampicillin/sulbactam-- 16 i cefazolin------------- <=4 s cefepime-------------- <=1 s ceftazidime----------- <=1 s ceftriaxone----------- <=1 s ciprofloxacin---------<=0.25 s gentamicin------------ =>16 r meropenem-------------<=0.25 s tobramycin------------ 8 i trimethoprim/sulfa---- =>16 r potassium hydroxide preparation (final ): test cancelled, patient credited. this is a low yield procedure based on our in-house studies if pulmonary histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis or mucormycosis is strongly suspected, contact the microbiology laboratory (7-2306). immunoflourescent test for pneumocystis jirovecii (carinii) (final ): negative for pneumocystis jirovecii (carinii).. fungal culture (preliminary): yeast. acid fast smear (final ): no acid fast bacilli seen on direct smear. no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): 10:18 am sputum source: endotracheal. gram stain (final ): >25 pmns and <10 epithelial cells/100x field. no microorganisms seen. respiratory culture (final ): rare growth commensal respiratory flora. staph aureus coag +. sparse growth. of three colonial morphologies. this isolate is presumed to be resistant to clindamycin based on the detection of inducible resistance . yeast. sparse growth. not resmebling cryptococcus. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin----------- r erythromycin---------- r gentamicin------------ <=0.5 s levofloxacin---------- =>8 r oxacillin------------- 0.5 s trimethoprim/sulfa---- <=0.5 s fungal culture (preliminary): yeast. aspergillus fumigatus. acid fast smear (final ): no acid fast bacilli seen on concentrated smear. acid fast culture (preliminary): no mycobacteria isolated. studies ecg : sinus tachycardia with baseline artifacta. borderline low qrs voltage in the limb leads. diffuse non-diagnostic t wave flattening. no previous tracing available for comparison. ecg : supraventricular tachycardia with a p wave prior to every qrs complex. this could represent circus movement tachycardia. however, extreme sinus tachycardia cannot be excluded. low voltage. non-specific st segment and t wave abnormalities. clinical correlation is suggested. compared to the previous tracing the rate is faster. otherwise, no significant change. ruq u/s : note is made that this is a limited study due to the patient's limited ability to cooperate. the hepatic architecture is heterogeneous throughout and increased in echogenicity consistent with fatty infiltration. no biliary dilatation is seen and the common duct measures 0.4 cm. the portal vein is patent with hepatopetal flow. the gallbladder is normal with no gallstones identified. the pancreas and midline structures including the aorta and ivc are predominantly obscured from view by overlying bowel gas. the spleen is not enlarged measuring 6.8 cm. no hydronephrosis is seen on limited views of the kidneys. no ascites is seen in the abdomen. a small right pleural effusion is noted. impression: 1. echogenic heterogeneous liver consistent with fatty infiltration. other forms of liver disease and more advanced liver disease including significant hepatic fibrosis/cirrhosis cannot be excluded on this study. 2. small right pleural effusion. cxr : pa and lateral images of the chest show a moderate-sized right pleural effusion. there is no pleural effusion on the left. an underlying consolidation on the right cannot be excluded. the heart size is normal. there is no evidence of pulmonary edema. the osseous structures are unremarkable. impression: unilateral right-sided moderate pleural effusion. an underlying consolidation cannot be excluded. further evaluation to determine etiology is recommended. cxr : et tube is in standard placement. nasogastric tube ends in the lower esophagus and would need to be advanced at least 15 cm to move all the side ports into the stomach. moderate right pleural effusion which increased substantially from to is stable. a cluster of nodular opacities projecting over the right lung apex has been present since at least and should be evaluated as possible malignancy. new small region of peribronchial opacification in the left lower lobe is concerning for possible pneumonia. pleural effusion on the left is small, if any. no pneumothorax. the heart is not enlarged, but is substantially obscured by consolidation in the right middle and lower lobe which has worsened since . head ct : there is no evidence of hemorrhage, edema, mass, mass effect, or infarction. however, subtle abnormalities would be difficult to detect due to limitation of the imaging, secondary to beam-hardening artifact emanating from external monitoring device. the ventricles and sulci are normal in size and configuration. the basal cisterns appear patent. no fracture is identified. a mucus retention cyst is seen in the left maxillary sinus, and mucosal thickenming is noted in the ethmoidal air cells. the mastoid air cells, and middle ear cavities are clear. conclusion: no evidence of acute intracranial process, though study is limited secondary to artifact. ct chest/abdomen/pelvis : ct of the chest: there are numerous bilateral airspace nodular opacities, many of which display central cavitation. for example, a 1.5 x 1.3 cm nodular opacity involving left upper lobe is seen with central cavity (2:24). a cluster of such nodular opacities predominate in right lung apex (2:14). left perihilar consolidation is noted. right lung base consolidation is also present with associated peripheral ground-glass opacities. moderate right and small left nonhemorrhagic pleural effusions appear progressed from prior study. there is notable obliteration of the bronchus intermedius by surrounding consolidation (2:25). otherwise, tracheobronchial tree appears patent. the heart is normal in size with small pericardial effusion. the aorta appears normal in caliber without aneurysmal changes. the great vessels appear unremarkable. there is no pneumothorax-a few bubbles of air around the epipericardial fat region are seen, decreased from prior outside study and of uncertain significance. thyroid gland displays homogeneous attenuation. no pathologically enlarged axillary lymph nodes are seen. there is no mediastinal lymphadenopathy. the esophagus is patulous with significant amount of contrast material layering within its lumen, which predisposes the patient to aspiration. an et tube appears appropriately positioned. ng tube is seen coursing through the esophagus terminating in the stomach. small hiatal hernia is present. ct of the abdomen: evaluation of visceral organs is limited due to lack of intravenous contrast. liver demonstrates decreased attenuation, suggestive of fatty deposition. no discrete hepatic lesion is identified. there is no evidence of intrahepatic or extrahepatic biliary ductal dilatation. gallbladder demonstrates increased attenuation, suggestive of vicarious excretion of contrast. spleen, pancreas, adrenal glands, and kidneys appear unremarkable. no pathologically enlarged mesenteric or retroperitoneal lymph nodes are seen. moderate amount of ascites appears progressed from prior study. small and large bowel loops are normal in caliber without evidence of obstruction or pneumatosis. there is minimal wall thickening involving the ascending colon, which may be at least partially attributable to under-distention. there is no free air within the abdomen. ct of the pelvis: a foley is within the bladder with small amount of air within its lumen. rectum and sigmoid colon is unremarkable. small amount of contrast material is seen throughout the colon related to recent ct exam. moderate amount of free fluid is seen within the pelvis. the uterus appears unremarkable. no pathologically enlarged pelvic or inguinal lymph nodes are noted. generalized soft tissue anasarca is present. osseous structures: no suspicious lytic or sclerotic lesion is seen. impression: 1. numerous bilateral nodular opacities, many of which demonstrate central cavitations. left perihilar consolidation is present. right lung base consolidation is also noted with adjacent areas of ground-glass opacities. the constellation of the above findings is concerning for infectious etiology. given patient's immunosuppressed status, opportunistic infections are also considered, namely tuberculosis. other less likely differential considerations include vasculitis and septic emboli. 2. moderate right and small left non-hemorrhagic pleural effusions appear progressed from prior study. 3. patulous esophagus is filled with moderate amount of contrast material, which predisposes the patient to aspiration. 4. small pericardial effusion. 5. moderate amount of ascites and generalized anasarca appears progressed from prior exam. 6. small hiatal hernia. 7. decreased attenuation of the liver, suggestive of fatty deposition. tte : overall left ventricular systolic function is normal lvef>55%). right ventricular chamber size and free wall motion are normal. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is moderate pulmonary artery systolic hypertension. there is a small pericardial effusion, located over the right ventricular free wall and apex. there are no echocardiographic signs of tamponade. lenis : occlusive thrombus within the left popliteal vein, left posterior tibial and peroneal veins. the remainder of the visualized lower extremity vessels bilaterally are patent and compressible. tte : poor image quality. there is a small to moderate sized pericardial effusion. no right ventricular diastolic collapse is seen. there is brief right atrial diastolic invagination. there is significant, accentuated respiratory variation in mitral/tricuspid valve inflows, consistent with impaired ventricular filling. these findings are suggestive of elevated intrapericardial pressure without overt tamponade (rv collapse) - clinical correlation is suggested. in addition, rv systolic function appears preserved (no overt pulmonary embolism however this cannot be excluded on the basis of this study). compared with the prior study (images reviewed) of , the heart rate has further increased. the effusion may be slightly larger. head ct : 1. loss of white differentiation with sulcal effacement concerning for diffuse cereberal edema- correlate clinically for etiology. high attenuation material in the basal cisterns appears to more likely a sequela of diffuse cerebral edema (pseudo-sah) rather than true sah. minimal narrowing of ventricles. 2. cerebellar tonsillar herniation. brief hospital course: ms. is a 32 year old woman with a pmhx s/f newly diagnosed crohn's disease (on remicade and steroids) who presented with hypotension and altered mental status in the context of a possible overdose of bendadryl. she had a very complicated hospital course, detailed below, and unfortunately expired on . . # overdose: pt is incarcerated at time of admission, and lives on a cell block where she has access to otc meds. per report, she took 23 benadryl, unknown why. her tox screen was otherwise negative though she could have ingested something else. she presented with symptoms typical for an anti-cholinergic toxidrome: dry, altered mental status, tachycardic, mydriasis, urinary retention. toxicology was consulted and recommended ativan, though she continued to worsen, per below, and ativan did not relieve her symptoms. she likely did have a anti-cholinergic toxidrome on admission, but this was then overshadowed by her other issues and overwhelming infection (below). . # respiratory failure: she was intubated on for worsening mental status and airway protection. her initial cxr on was significant for a pleural effusion. however, on her thorax ct scan showed multiple, cavitating lesions. alternatively, these could have been pneumatoceles staph infection. the differential was infection vs rheumatologic process. her sputum culture did grow staph aureus, and id did think that this could be consistent with overwhelming staph aureus infection in an immunocompromised host. tuberculosis was also on the differential, though she was ruled out with afb negative smear x3. rheumatology thought this was less likely to be a vasculitis, and rheumatologic labs were negative. she was put on very broad spectrum antibiotics, though this did little to stop her decline. she went into dic and ards to her likely staph pna. on day of her death she had no spontaneous respirations on the vent. a head ct was done and showed brainstem herniation, consistent with b/l dilated, fixed pupils, indicating likely brain death. family meeting was held and it was decided to extubate patient. she expired shortly thereafter. . # dic: pt was found to be in dic on . she was transfused cryoglobulin intermittently. . # ardsl she was on the ardsnet protocol for several days prior to expiration. . # hypotension: initially thought to be toxidrome (per above). however by hospital day 3, she was intubated and had increasing pressor requirements. etiology thought overwhelming sepsis per above. . # crohn's disease: unsure if she actually has crohn's, as no pathologic data that we are aware of. outpatient crohn's meds were stopped medications on admission: prednisone 10mg per taper ferrous sulfate 325mg folic acid 1mg daily lactase 3000 units tid multivitamin colazal 2.24gm tid azathioprine 50mg daily remicade infusions tylenol 650mg tid protonix 40mg daily albuterol 2puffs q4h prn sob discharge medications: expired discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: n/a followup instructions: n/a md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours parenteral infusion of concentrated nutritional substances insertion of endotracheal tube arterial catheterization closed [endoscopic] biopsy of bronchus central venous catheter placement with guidance diagnoses: thrombocytopenia, unspecified toxic encephalopathy acute posthemorrhagic anemia sepsis hypopotassemia regional enteritis of unspecified site acute respiratory failure defibrination syndrome pneumonitis due to inhalation of food or vomitus carrier or suspected carrier of methicillin resistant staphylococcus aureus encephalopathy, unspecified accidents occurring in residential institution poisoning by aromatic analgesics, not elsewhere classified aspergillosis methicillin resistant staphylococcus aureus septicemia acute venous embolism and thrombosis of unspecified deep vessels of lower extremity venous embolism and thrombosis of superficial vessels of lower extremity accidental poisoning by aromatic analgesics, not elsewhere classified 

Answer: The patient is high likely exposed to