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: patient recorded as having no known allergies to drugs attending: chief complaint: etoh and medication overdose major surgical or invasive procedure: respiratory intubation history of present illness: the patient is a 55-year-old male with pmh of alcoholism who presents after a dangerous combination of alcohol intoxication and accidental medication overdose. per report, patient's partner says he "fell off the wagon" 2-3 days ago after being sober for years. he drank large quantities of port wine and took extra medications reportedly "by mistake." the partner is pretty sure that the patient was intoxicated when he multiple tablets of wellbutrin, seroquel, propranolol and klonipin but he is uncertain of specific amount. he later stated that he was not absolutely certain whether the patient actually ingested any wellbutrin and propanolol. ultimately, the amount and combination of pills taken was unclear. the patient's longtime partner of nearly thirty years came home and found him semi-alert and called ems immediately. . according to his partner, mr. had been coughing/wheezing for several months now but had no complaints of fevers or chills. he had been complaining about pain in his neck since a fall down a few stairs a few days prior to this current incident. . in our ed, initial vital signs were t97.3 bp 90/54 hr 68 rr 12 oxygen saturation of 95% via nrb. he was placed on nrb for low oxygen saturations <90. he was somnolent on arrival to hospital but still responsive to tactile stimuli. fingerstick glucose was 140 on arrival. he quickly became hypotensive to sbp 73/47. he was given ivf x3l total. ekg was normal, without any alarming st changes. peripheral dopamine was started for rapid bp correction and he was intubated for hypoxia and airway protection. toxicology consult was called and they recommended that the pressor choice be switched to levofed. he was also given narcan x2 with no effect. once the medication history was flushed out, he was given calcium which did increase his rate from 58 to 88 and his sbp increased by 10. he was given glucagon 1mg with no further effect. toxicology consult recommended trying high dose glucagon 5mg and if that works, starting a glucagon gtt at 1-5mg/hr. they also recommend serial ekgs for monitoring. he was also given vancomycin and ceftriaxone due to initial concern for possible sepsis. . he had chest xray which showed question widened mediastinum and patient reported some chest discomfort on arrival. cta was done which showed normal aorta. fast scan was done which showed no pericardial effusion, and no intra-abdominal bleeds. cxr/ct did show bilateral infiltrates consistent with an aspiration. hemodynamic instability was worrisome and he was transferred to the intensive care unit for close monitoring. . on arrival to the icu he was hypoxic with o2 saturation of 85% on fio2 of 50%, hr in 50's. he was suctioned, et tube pulled back 2cm and peep increased to 14, fio2 to 100% with slow recovery of o2 saturation. he was continued on levophed and an arterial line was placed for better hemodynamic monitoring. . past medical history: alcoholism hypertension depression social history: the patient lives in with his partner of over 30 years. he has local family but has limited contact with them. he reports that he and his partner do not work because they have enough money to allow them not to need to work. mr. reports drinking only one glass of wine a day, yet also endorses drinking enough prior to admission that he got confused when taking his medications. thus, history somewhat questionable. denies illicit drug use. he reports having been sober for a stretch of 14-15 years in the past (w/ help of rehab, aa), but started drinking again about 13 years ago in the context of a few deaths in the family. per his partner, his drinking has been much more heavy in recent months. family history: noncontributory. physical exam: initial admission exam: vitals: bp 110/48, hr 58 regular w/occasional pvc's, rr 15 100% fio2 100% vc 100%/500/16/14 , weight of 97kg, 70" . general: sedated, intubated, not responding to verbal commands heent: nc/at, pupils pinpoint but equal and reactive bilaterally cv: bradycardic, regular, no appreciable murmur lungs: decreased breath sounds at right base, otherwise good air movement bilaterally abdomen: slightly distended, bs+, no hsm, no apparent tenderness ext: dp's palpable bilaterally, trace edema bilaterally neuro: unable to assess sedation pertinent results: initial admission labs : . pt: 12.2 ptt: 28.5 inr: 1.0 . na 136, cl 102, bun 30, cr 2.2, glucose 129, k 4.3, hco3 22 agap=16 . ck: 304 mb: 4 trop-t: <0.1 . alt: 38 ap: 86 tbili: 0.2 alb: 3.9 ast: 47 ldh: 217 : 51 lip: 143 . serum etoh 339* serum asa, acetmnphn, , , tricyc negative . urine benzos pos * urine barbs, opiates, cocaine, amphet, mthdne negative . wbc 6.4 hgb 11.3 hct 34.6* plt 329 mcv 97 n:38.9 l:54.5 m:2.6 e:3.6 bas:0.4 . abg: 1) 7.14/59/64/21 lactate 2.2 2) 7.22/50/123/22 lactate 1 (rate increased from 16->20) . . glucose-69* urea n-30* creat-1.5* sodium-137 potassium-5.2* chloride-111* total co2-18* anion gap-13, calcium-7.3* phosphate-3.6 mg-2.0 wbc-6.7 rbc-3.31* hgb-11.0* hct-32.7* mcv-99* mch-33.2* mchc-33.5 rdw-13.9, plt count-234 02:58pm lactate-0.9 12:38pm other body fluid wbc-0 rbc-0 polys-40* lymphs-11* monos-12* eos-5* other-32* abg on assist-control vent: peep-5 o2-100 po2-123* pco2-50* ph-7.22* total co2-22 base xs--7 aado2-561 req o2-90-intubated 10:22am lactate-1.0 08:55am lactate-2.2* 08:55am o2 sat-86 03:50am alt(sgpt)-38 ast(sgot)-47* ld(ldh)-217 ck(cpk)-304* alk phos-86 amylase-51 tot bili-0.2 03:50am lipase-143* 03:50am ck-mb-4 ctropnt-<0.01 03:50am albumin-3.9 03:50am tsh-3.1 . urine studies: . 03:50am urine benzos-pos, barbits-neg, opiates-neg, cocaine-neg amphetmines-neg, methadone-neg. 03:50am urine color-straw appear-clear sp -1.009 03:50am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg . microbiology studies: urine culture (final ): no growth. . rapid plasma reagin test (final ): nonreactive. . blood culture, routine (final ): no growth blood culture, routine (final ): no growth. blood culture, routine (final ): no growth. blood culture, routine (final ): no growth. . bal legionella culture (final ): no legionella isolated. . rapid respiratory viral antigen test (final ): respiratory viral antigens not detected. specimen screened for: adeno,parainfluenza 1,2,3 influenza a,b and rsv. . legionella urinary antigen (final ): negative for legionella serogroup 1 antigen. . bronchoalveolar lavage results (final report ) gram stain 1+ (<1 per 1000x field): polymorphonuclear leukocytes. 2+ (1-5 per 1000x field): gram positive cocci. in pairs, chains, and clusters. 2+ (1-5 per 1000x field): gram positive rod(s). 2+ (1-5 per 1000x field): budding yeast. respiratory culture (final ): 10,000-100,000 organisms/ml. oropharyngeal flora. staph aureus coag +. 10,000-100,000 organisms/ml.. staphylococcus species may develop resistance during prolonged therapy with quinolones. therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. testing of repeat isolates may be warranted. penicillin sensitivity available on request. sensitivities: mic expressed in mcg/ml _________________________________________________________ staph aureus coag + | clindamycin-----------<=0.25 s erythromycin----------<=0.25 s gentamicin------------ <=0.5 s levofloxacin---------- 0.25 s oxacillin-------------<=0.25 s trimethoprim/sulfa---- <=0.5 s . . additional studies and imaging: ekg: rate 60, sinus rhythm, nml axis, no ischemic st changes, no previous tracing for comparison . portable cxr: the heart size is within normal limits. there is mild prominence to the superior mediastinum. there are low lung volumes. no effusion or pneumothorax is detected. mild prominence to the superior mediastinum. low lung volumes without radiographic evidence of pneumonia. . ct chest without contrast: endotracheal tube tip terminates 2 cm from the carina. ng tube courses through the mediastinum with tip and side port within the stomach. no mediastinal hematoma is present. aortic contour follows a normal course throughout the chest without irregularity or evidence to suggest rupture. moderate to large bibasilar consolidations are noted bilaterally. no suspicious lytic or sclerotic lesions are identified. impression: 1. moderate to large posterior consolidations bilaterally. given history findings are strongly suggestive of aspiration. 2. normal aortic contour without evidence of aortic injury on this non- contrast enhanced ct. . head ct w/o contrast: there is no evidence of hemorrhage, edema, masses, mass effect, or infarction. the ventricles and sulci are normal in caliber and configuration. no fractures are identified. the patient is status post endotracheal tube intubation. there are associated nasopharyngeal secretions.impression:1. no evidence of edema or hemorrhage. . ekg: rate 86, normal sinus rhythm, modest inferior st-t wave changes are non-specific and may be wnl. since the previous tracing of sinus tachycardia is now absent. . cxr: diffuse bilateral pulmonary edema has decreased. the persistent bilateral airspace opacities may represent multifocal pneumonia. the aortic arch is mildly tortuous but unchanged. the left lower chest is excluded from the field of view; other pleural surfaces are normal. no pneumothorax is present. impression: interval improvement in pulmonary edema. possible persisent multifocal pneumonia. . tte echo: the left atrium is mildly dilated. (lvef >55%) the estimated cardiac index is normal (>=2.5l/min/m2).normal biventricular cavity sizes with preserved global and regional biventricular systolic function.mild pulmonary artery systolic hypertension. mild tricuspid regurgitation with normal valve morphology. . pre-discharge labs: 07:15am blood wbc-10.0 rbc-3.15* hgb-10.2* hct-30.7* mcv-98 mch-32.4* mchc-33.2 rdw-14.3 plt ct-637* 07:25am blood plt ct-464* 07:15am blood glucose-97 urean-17 creat-1.1 na-143 k-4.4 cl-105 hco3-29 angap-13 02:36am blood lipase-91* 07:15am blood calcium-9.4 phos-3.9 07:20am blood vitb12-1034* folate-16.3 07:15am blood alt-26 ast-25 ld(ldh)-272* ck(cpk)-136 alkphos-69 totbili-0.3 brief hospital course: in summary, mr. is a 55-year old male with pmh of alcoholism and depression who presented with somnolence, bradycardia and hypotension after etoh intoxication and "accidental" ingestion of multiple medications. he endured some initial hypoxia secondary to severe sedation and in the setting of an aspiration event as noted via imaging studies. additional issues outlined in detail below. . #hypoxia/sob: - the patient presented to the ed emergently on with oversedation, hypoxia and systolic blood pressures that dropped to the 70s requiring emergency pressor therapy. he was placed on a high flow non-rebreather mask initially and then needed to be intubated with immediate admit to micu for his hemodynamic instability and hypoxia. bilateral pulmonary infiltrates were noted on cxr/ct which were felt to be secondary to aspiration pneumonitis vs aspiration pna. mucous plug was also in the possible differential but there were very minimal secretions on suctioning attempts. he was given levofloxacin initially and cultures were sent off. abg just prior to micu admission was ph 7.14, po2 64, pco2 59, bicarb 21. upon transfer to the regular medical floor the patient was doing well with oxygen saturations 94-95% on 2l nc and rr ranging in the low 20s. blood cultures were negative to date but broncheoalveolar lavage showed coagulase positive staphylococcus/mssa. ammonia level was within normal limits , lfts were improving and there was no real concern for hepatic encephalopathy anymore. on the medical floor he was initially continued on iv unasyn and then gradually switched over to po augmentin as discharge approached. he was continued on 2l nc with oxygen saturation goal >95% which he achieved without difficulty and he was gradually weaned to room air. his initial dry cough on transfer improved as well. repeat cxrs showed improvement in pulmonary edema but very persisent multifocal pneumonia was questioned so he was continued on antibiotics. an echo showed no evidence of any serious valve abnormalities or vegetations and overall ef was 55%. by time of discharge he was breathing 97% room air and his cough had nearly abated. . # hypertension/tachycardia/agitation: after a few days in the micu the patient had bouts of hypertension with sbps >170s, sweats, fevers, and tachycardia to 120-130s range. these changes were likely due to etoh withdrawal in conjunction with benzodiazepine withdrawal and possibly related to other toxic ingestions. these dynamic changes made weaning the patient from the vent especially challenging in the micu. he became extremely agitated when sedating medications were tapered and was unable to be extubated successfully for several days. moreover, he appeared to have delirium from multiple medications which were still wearing off. he received a very large amount of benzodiazepines during the first three days of admission and these were ultimately discontinued for concern of toxicity. psychiatry and the toxicology staff were consulted and he was switched to standing and prn haldol which had a very good outcome and helped to ease his agitation and stabilize his tachycardia. the possibility of neuroleptic malignant syndrome was considered as well. of note, the patient got some zyprexa for agitation and he had already ingested a large amount of seroquel during his overdose; both of these medications can cause nms. ck levels returned elevated but not quite in the usual range seen in nms so this diagnosis was unlikely. it was felt that mr. ' delirium was multifactorial in the setting of recent hypoxia, ongoing sedation and polysubstance withdrawal from his etoh/benzodiazepines. a few doses of morphine worked well for his agitation as well. psychiatry continued to follow the patient with the medical service once he transferred to the medical floor from the micu. ammonia panel and rpr were unremarkable and soon after transfer the to medical floor he was managed on lower and lower doses of ativan and haldol and he gradually improved with hrs returning to 60-80 range and blood pressure normalized. lfts and ck levels also trended downwards. . #fevers: the patient had high persistent fevers in the 101-102 range in the micu after admission. he also had hypotension in the ed but this felt to be directly related to his overdose and etoh intoxication versus a sepsis picture. as noted, scattered bilateral pulmonary infiltrates were noted on cxr/ct and were felt to be the source of his fevers. iv unasyn was given. urine and blood cultures all returned negative. urine legionella was negative. bal showed coagulase positive staphylococcus on cultures so antibiotics were continued. neuroleptic maliganant syndrome was suspected as well but ck levels trended downward making this unlikely. there was some moderate hematuria on ua repeat but this was attributed to witnessed foley manipulation during his multiple episodes of agitation as opposed to infection. an lp was considered upon transfer to the medical floor but fortunately his fevers began to lessen and after days he stopped having high spikes. ultimately, the fevers may have been a combination of his polysubstance withdrawal in combination with fevers secondary to aspiration related pneumonia. he was afebrile and had no left shifts or leukocytosis at time of discharge. . #altered mental status: as aforementioned the patient presented with hypotension and bradycardia which was attributed to the combination of propranolol, seroquel and possibly prozac/wellbutrin per the patient's partner. on repeated questioning the patient admitted that the overdose was an accident and an unintentional act that occured in the setting of extreme etoh intoxication. the patient still appeared very agitated, diaphoretic and confused on transfer out of micu. initial confusion likely secondary to receiving 500mg diazepam over 30hrs for presumed etoh withdrawal while in micu. he had some intermittent autonomic hyperactivity and htn with sbps to 160-170s and serious inattention on exam. he also had a slight tremor in his hands bilaterally which is likely from his sedative withdrawal. the patient's partner noted that he sometimes noticed he had a mild tremor at his baseline too. psychiatry continued to follow the patient and advised the team to continue haldol and ativan for his agitation. he was started on haldol 5mg iv prn dosing every few hours and haldol standing 2.5mg iv q6hrs which was slowly tapered down and he was gradually weaned down from ativan 1mg qid to 1mg t.i.d, b.i.d., and then qdaily dosing. he became very belligerent and tried to pull out his iv lines initially so soft restraints were needed along with a 1:1 sitter on his first night out of the micu which was only a day after being extubated. he recovered quickly and became less confused and more attentive over the subsequent hospital stay and by the time of his discharge he was still plagued by some mild irritability and some amnesia surrounding his overdose and micu stay but he was alert and oriented to person, place and time at time of his discharge. social work and psychiatry services offered additional counseling and despite offers to set him up with specific resources he reported he was planning to make a conscious effort to try to stop drinking after discharge with support of aa and professional supports as needed. . #acute renal failure -per records, the patient's baseline creatinine 1-1.3 and he presented in the ed with an initial cr level of 2.2 which was likely in the setting of direct nephrotoxic influence of the multiple medications he ingested as well as the renal hypoperfusion that occurred in the setting of his sbps dropping to the 70s prompting the need for pressor support. he also had a pre-renal component which cna be explained by recent etoh abuse and tendency for dehydration. mr. was given ivf resuscitation and throughout his hospital stay his renal function recovered. by the time of discharge creatinine was down to 1.1 range and bun 17. . #hypertension: as outlined above, the patient's blood pressure was poorly controlled in the micu with intermittent autonomic surges of tachycardia and sbp increases to the 160s-170s. he was restarted on his daily propranolol and his blood pressures returned to 130-140s prior to discharge. . #pancreatitis: while in the micu, the patient had an acute rise in his lipase levels which eventually peaked at and then continued to trend downward. the increase was possibly due to etoh or propofol with increased triglycerides. abdomen somewhat firm but not tense. he tolerating tube feeds very well and then continued on a regular diet on the regular medical floor once he transferred out of the micu. on exam he denied any abdominal pain, no guarding and no rebound noted. . #etoh abuse ?????? the patient's partner endorses that patient has been sober for years, and only recently ??????fell off the wagon?????? over the last few months. the extent of his withdrawal, however, suggests that his use of alcohol is potentially much more extensive. he was continued on daily thiamine, folate and he was seen by psychiatry as well as the addictions consult social worker. teams counseled him on etoh's harmful effects and several means of support were explored with the patient ranitidine was continued for gi protection. . #loose stools -these loose bowel movements were initially noted on . follow-up stool and c.difficile labs were all unremarkable. by time of discharge his diarrhea had stopped and he denied any abdominal pain, cramps, or changes in the color of his stool. no bloody stools. . #anemia - the patient's baseline hct is ~40 according to recent records, and he was also noted to be borderline macrocytic therefore anemia likely secondary to nutritional deficiency in the setting of etoh abuse. no evidence of any gi bleeding. an order to gaiac stools was placed and daily hcts were trended. b12 and folate levels were normal. the patient will plan to follow up with his primary care physician ~ 1 week timeframe to address his anemia in more detail. . #fluids, electrolytes and nutrition: tolerating po medications well, repleting electrolytes as needed, thiamine given daily. . # access ??????the patient had a right picc that was placed for access for tpn and multiple medications as well. this was eventually pulled and a regular iv was placed. . #prophylaxis: the patient was placed on a bowel regimen, subcutaneous heparin shots were given daily for dvt prophylaxis and ranitidine was continued for gi protection. the patient was treated as a full code for the entirety of his hospital course and communication occurred with the patient daily and with his mother and partner of nearly 30 years. the psychiatry service felt that mr. was safe to leave the hospital but he was advised to follow-up with his primary care physician, . and his previous counselor upon leaving the hospital. . medications on admission: wellbutrin 150mg daily (decreased from twice daily) seroquel 150mg daily klonopin 1mg (recently decreased) propranolol 40mg 55/60 (started ) prozac 20mg qid (recent increase in dose from tid -qid over last week) lotral 5/20mg one daily diclofenac sodium 100mg daily fenofibrate 134mg daily allopurinol 300mg daily tramadol 50mg neurontin 300mg 1-2 tabs prn melatonin 5mg qhs advil prn for migraine discharge disposition: home discharge diagnosis: primary: alcoholism overdose depression . secondary: hypertension discharge condition: at time of discharge the patient had more stable vital signs and he appeared less anxious and confused. discharge instructions: it was a pleasure taking care of you here at during your hospitalization. you were admitted to the hospital after consuming a large amount of alcohol mixed with multiple medications. this impaired your breathing and your mental status. you had to stay in the medical intensive care unit for a week and then you were transferred to the general medical floor. during your hospital stay you became very confused and needed additional medications and a breathing machine called a ventilator to help you breath for about a week. . you were also treated with antibiotics for a suspected lung infection. . while you were in the hospital you were seen by a psychiatrist and a social worker in order to help with the management of your depression and your additional alcohol consumption. . the psychiatry service felt that you were safe to leave the hospital but you are advised to please follow-up with your primary care physician, . and your previous counselor upon leaving the hospital. . if you have any thoughts of wanting to harm yourself or others please go to the emergency room, call 911 immediately, or contact your primary care physician. return to the emergency room if you have worsening fevers, chills, cough, productive sputum, bloody vomit, shortness of breath, chest pains or any other concerns. please avoid using a class of medications called benzodiazepines and please avoid alcohol consumption as it may be dangerous to your health. as discussed, please consider helpful groups such as alcoholics anonymous which can be a very supportive social network as you try to avoid alcohol use. followup instructions: please follow-up with your primary care physician, . on friday, at 8:50am at at phone # , and location: , , . please call to make an appointment as soon as possible with your psychiatrist, dr. , at . (phone # ). , , . you also have an appointment with rheumatology: provider: , md phone: date/time: 4:00 procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube closed [endoscopic] biopsy of bronchus diagnoses: anemia, unspecified unspecified essential hypertension acute kidney failure, unspecified poisoning by benzodiazepine-based tranquilizers accidental poisoning by benzodiazepine-based tranquilizers acute respiratory failure other specified cardiac dysrhythmias pneumonitis due to inhalation of food or vomitus poisoning by other antipsychotics, neuroleptics, and major tranquilizers fever, unspecified acute pancreatitis accidental poisoning by other specified tranquilizers acute alcoholic intoxication in alcoholism, continuous accidental poisoning by agents primarily affecting cardiovascular system poisoning by cardiac rhythm regulators accidental poisoning by antidepressants 

Answer: The patient is high likely exposed to