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: heparin agents / motrin / phenobarbital / vancomycin attending: chief complaint: altered mental status major surgical or invasive procedure: none history of present illness: this is a 68 yo woman with a history of large b cell lymphoma, s/p sct , complicated by intra-parenchymal and sdh and subsequent seizures with baseline aphasia who presents with confusion and worsening gait. of note she has had multiple admissions for the same symptoms and recent admission for altered mental status (worsening gait, aphasia) of unclear etiology though seemed to improve with antibiotics (though no clear infection). of note her ms waxed and waned during that admission with no evidence of seizure activity corresponding, negative lp and mri. she does have a chronically trapped left ventricle so neurosurgery was consulted regarding semi-elective stereotactic drainage of her chronically trapped left ventricle when all infectious issues resolved. regarding infection she had c.diff neg x2, wbc on ua but culture negative (was treated with ceftazidime transitioned to cefixime for discharge- for 10 day course). she was also treated briefly with levofloxacin starting on admit for cough, but returned + for influenza b. she returned to the ed today with complaint of functional decline at home, characterized by increased episodes of agitation and yelling. per her husband this she was doing better on discharge but not back to baseline. in the several days prior to admission, she had a slowly decline, with episodes of aggitation (sometimes aggressive), worsening aphasia, and worsening ambulation (she was unable to get to bathroom, seemingly unable to move her feet). of note she had a couple of falls at home recently. her husband reports this is very similar to her presentation in and when she was admitted . he notes no focal symptoms at home (no cough, ha, sob, nausea, vomitting, diarrhea, constipation, abdominal pain, dysuria, rash). in the ed, initial vs were: t 99.2 rectal p 66 bp 192/66 r 18 o2 100% ra. bp down to 116/59 after ativan. patient was given ativan 1mg iv x2 for agitation with good effect, though on previous admit had paradoxical rxn to ativan and responded well to haldol. she was seen in the ed by the neurology service and thought to have no new neurologic symptoms on exam. head ct neg. on arrival to the floor, she was found to less responsive and difficult to arouse. neurology consulted and recommended ativan with the possibility that she may have been seizing. over the course of the subsequent hour, she became arousable and followed commands but remained somnolent and confused. ros: she is unable to provide. per her husband no fevers, chills, c/o ha, neck pain, cough, sob, cp, palpitations, nausea, vomitting, diarrhea, constipation, dysuria, back pain, rash, joint swelling or pain, abdominal pain. she ate some breakfast this morning with his assistance and slept poorly last night, waking frequently. he does note her bp has been elevated to 160 systolic this past week. past medical history: 1. high-grade large b cell non-hodgkin's lymphoma diagnosed . she was treated with 6 cycles of r-chop through . treatment course complicated by fever and neutropenia. supportive care with neulasta and aranesp given. pet at the end of treatment showed no fdg-avid disease. stem cell mobilization performed . anutologous stem cell transplant with beam chemotherapy was done in . 2. intra-parenchymal hemorrhage and sub-dural hematoma s/p evacuation x 4 following fall. 3. seizure disorder- as above 4. heparin-induced thrombocytopenia in 5. suprarenal ivc filter placed on (large infrarenal ivc clot and thrombosis of left common iliac and left femoral veins seen at that time) 6. c. difficile colitis and 7. staphylococcus hand infection treated with incision and drainage and subsequent antibiotics 8. right toe staphylococcus infection 9. hypertension 10. osteoarthritis 11. peripheral neuropathy (attributed to her chemotherapy) 12. tonsillectomy 13. cholecystectomy . excision of a benign abdominal tumor 15. bilateral pulmonary emboli and lle dvt in social history: ms. worked at as a customer support service. she is currently disabled. she has been married for over 40 years. she has two children, one son and one daughter and four grandchildren. she is a nonsmoker and does not drink alcohol. family history: notable for cancer and prostate cancer. physical exam: gen: elderly woman in nad, lying in bed with eyes closed heent: nc/at, mm slightly dry, sclera anicteric, op clear without ulcerations, exudates, or erythema neck: supple, no lad or elevated jvp cv: rrr, no murmurs, rubs, gallops, nl s1, s2 resp: scant rales in left base, no wheezes or rhonchi, unlabored breathing abd: soft nt/nd, no hsm, bowel sound present back: no cvat extrem: no cyanosis, clubbing, edema, + hammer toes skin: large right shoulder/back ecchymosis, abrasions and ecchymosis over both knees, no other rashes neuro: drowsy, mumbling with some coherant words and sentences, does follow motor commands (but does not open her eyes); cn ii-xii intact, perrla, motor: nl bulk and tone, strength 5/5 ue (shoulder abduction, adduction, elbow felx/ext, wrist ext, grip), le (hip flex, knee flex/ext, dorsiplantar flex/ext) bilaterally, sensation intact to light touch bilaterally, dtr's 2+ biceps, triceps, bracioradialis, 1+ patellar, toes downgoing bilaterally. no myoclonus, gait defered pertinent results: ct head: 1. no hemorrhage or evidence of acute edema. 2. atrophy, microangiopathic change, and large area of left temporoparietal occipital encephalomalacia, unchanged. 3. interval increase in right maxillary sinus opacification and air-fluid level. cxr: low lung volumes. no evidence of pneumonia. brief hospital course: icu course: 1. altered mental status: admitted to icu for monitoring after episode of somnolence which improved with ativan administration. neurology followed closely. patient had eeg which demonstrated diffuse slowing without seizure activity. keppra continued, keppra level pending. toxic metabolic work up started. no evidence of infection. plan for 24 hour eeg, mri/mra and lp under fluoroscopic guidance tomorrow. during icu course, had brief periods of calling out initially, but at transfer, no further episodes of agitation or somnolence for hours. 2. hip pain: x-ray negative for fracture 3. seizure disorder: eegs as above. checking keppra level. continued on keppra, lamotrigine and gabapentin 4. disposition: transferred to neurology service for further work up. seen by bmt team, they will follow. floor hospital course: patient was transferred to neurology service and prolonged video eeg monitoring was initiated. she had several episodes of screaming and agitation, no eeg correlation for seizure activity was noted. patient responded well to low doses of haldol. on patient had a prolonged episode in the morning where she was unresponsive, eeg showed fast activity but lots superimposed artifacts were noted. she was in a presumed non convulsive status, ativan 2mg + 2mg was given and we noticed eeg changes and clinically the patient improved and became responsive. on keppra was decreased and the discontinued on due to the possibility of contributing for her behavioral deterioration. lamotrigine was increased on 300mg twice a day. patient had a schedule ventriculostomy with shunt of the encephalomalacia cavity per neurosurgery. during this admission this procedure was cancelled and will be re-addressed after evaluation of her lymphoma stage status. on patient presented episode of unresponsiveness, not responded to ativan iv, no obvious change in the eeg. abg revealed hypoxia. chest cta was done concerning for pe which she had in the past, and showed 1. limited exam demonstrates no definite pe. 2. new ground-glass and tree-in- opacities within both lungs concerning for an infectious process. in addition urine culture was positive for enterococcus. patient started on ciprofloxacin, linezolid and piperacillin-tazobactam. she was gradually improving her overall condition. the agitation periods were sparse and less prn haldol was required. her cognitive function was markedly improved. the prolonged eeg monitoring showed frequent activity in the left temporal region. short runs of fast activity was seen with no clear clinical correlation. patient underwent brain pet to evaluate areas of abnormal metabolism and significant changes were observed. on neurontin was discontinued and lyrica was started with the goal of better seizure/epileptiform activity control. patient had an 8 days course of antibiotics. after d/c atb she continued to present episodes of agitiation and confusion. cultures from urine, blood were negative. keppra was discontinued on . eeg leads were placed on and iv depakote was given. depakote 500mg standing dose was initiated on , and lamotrigine was decrease to dose 150mg (from 300mg ) micu course: on the medical intensive care unit team was called to the bedside for an episode of unresponsiveness. per the neurology team this episode was acute. it occurred while she was on continuous eeg monitoring and there was no seizure activity present. there was report per the neurology team that she was bradycardic at the initiation of this episode but this was unable to be confirmed. on arrival she was unresponsive to sternal rub and hypotensive to the 70s. her blood sugar was normal. her abg was without hypercarbia. her electrolytes were within normal limits with the exception of a midly elevated serum sodium. her ekg was without ischemic changes. she had only a picc line in place so additional peripheral access was obtained and she received two liters of normal saline boluses. she transiently required peripheral dopamine while iv access was being obtained prior to micu transfer. while in the medical icu no interventions were taken. she was hemodynamically stable. her mental status improved to baseline within approximately 30 minutes of arrival. it was felt her episode was primarily neurologic in nature so her care was returned to the neurology service. floor course: patient was transferred back to the floor and remained stable. red blood cell was persistently dropping, patient received 2 units transfusion on and hct remained stable thereafter. on metoprolol 25mg was restarted due to persistent elevated blood pressure and sustained heart rate of 120beats/min. this was titrated up to 50mg . on she developed fever, somnolence and diarrhea. stools were positive for c. dif. she also had a positive ua at that time. she was covered with iv flagyl, zosyn, and vancomycin. medicine was consulted. urine culture only grew yeast and cleared after foley removal. she received iv flagyl for 7 days with improvement in her mental status before transition to po vancomycin w/ planned 14 day course (). she had a relative decrease in her bp and metoprolol was stopped and during recovery again titrated for elevated sbp. in the setting of c. dif she was found to have some subclinical seizure activity on eeg while off lyrica and lamotrigine due to inability to take po. she also has an episode on of decreased responsiveness. both responded to iv ativan 1mg. on she developed a gradually increasing transaminitis which resolved by . this recurred on and peaked on . right upper quadrant u/s and ammonia were normal. it was attributed to depakote and seemed to occur and worsen as she recovered from c. dif and began eating again. she was put back on keppra with vitamin b6 to help with any adverse effects on mood with plan to wean off depakote but she developed severe agitation and would either scream or cry when staff entered the room and had some violent behavior. keppra and b6 were stopped and carnitor added on and by the following morning she was much less agitated. patient refused her po medications and lab draws occasionally. she has intermittent screaming when agitated which generally self resolve. in the past these have been treated with low dose haldol if she is truely combative. this has not been necessary in over 2 weeks. on she developed right arm swelling and was found to have thrombus around her picc which was removed. no anticoagulation was pursued given her history of intracranial hemorrage. calorie count found that she's only consuming 30% of the calories she needs. she is not taking the supplement well per her husband who is aware of her poor intake. he expresses consistent wishes not to have a peg placed. recommend encouraging high calorie foods as possible. palliative care consult was obtained to assist in discussing goals of care. was taking only 30% of her goal calories, yet the husband does not want a g-tube, yet he hopes she'll improve. family meeting with her long term and current care providers was recommended. plan of care and long term goals were discussed at the meeting. the family was considering going home with nursing and seeing how she does, home hospice, or rehab and leaning toward the 1st option. the following day pt was more somnolent and developed tachypnea and hypoxia followed by bilious emesis. she was evaluated by medicine and transferred back to the micu. she was presumed to have aspiration. the family made the decision to move to comfort care and she was transferred back to the floor. the following day she was breathing easily and alert appering comfortable. the morning of discharge she was flushed but breathing comfortably. home hospice was arranged at home. midline catheter remains in place for comfort medications. medications on admission: atovaquone 750 mg/5 ml po daily gabapentin 300 mg po q12h lamotrigine 275 mg tablet po bid ->husband giving her 225 due to confusing nature of d/c medications leucovorin calcium 10 mg po daily metoprolol tartrate 25 mg po bid pantoprazole 40 mg po q24h multivitamin po daily thiamine hcl 100 mg po daily senna with docusate sodium 8.6-50 mg as needed for constipation albuterol sulfate 2.5 mg /3 ml (0.083 %) q6h ipratropium bromide 0.02 q6h polyvinyl alcohol 1.4 % 1-2 drops ophthalmic every 4 hours as needed for eye irritation calcium carbonate 500 mg one po 3 times a day acetaminophen 325 mg 1-2 tablets po every 6 hours as needed levetiracetam 1000 mg po 3 times a day lorazepam 0.5mg prn discharge medications: 1. acetaminophen 650 mg suppository : two (2) suppository rectal q4h (every 4 hours) as needed for fever or pain. disp:*30 suppository(s)* refills:*0* 2. morphine concentrate 20 mg/ml solution : 1-20 mg po q1h (every hour) as needed for pain, shortness of breath. disp:*30 ml* refills:*0* 3. valproic acid (as sodium salt) 250 mg/5 ml syrup : ten (10) ml po q12h (every 12 hours): concentrated elixer to be provided for po/pr administration when able, then will be given iv. disp:*200 * refills:*2* 4. lorazepam 2 mg/ml concentrate : 0.5-2 mg po every four (4) hours: to be given sublingual. disp:*qs 1 month * refills:*2* 5. lorazepam in normal saline 100 mg/100 ml (1 mg/ml) solution : one (1) mg intravenous q1h as needed for status epilepticus: to be given in midline. disp:*30 ml* refills:*0* 6. haldol : 0.5-4 sublingual every 4-6 hours as needed for agitation or delerium. discharge disposition: home with service facility: hospice of the good discharge diagnosis: primary seizure disorder hospital acquired pneumonia urinary tract infection clostridium difficile right arm deep venous thrombosis aspiration secondary: large b cell lymphoma intracranial bleeding/ encephalomalacia/ aphasia discharge condition: fair discharge instructions: you were admitted to this hospital to evaluate episodes of agitation alternating with unresponsiveness. you underwent prolonged video eeg monitoring and in one ocasion seizure was noted. you presented other unresponsiveness events with hypoxia associated to hospital acquire pneumonia and other suggestive of vasal vagal reflex. your seizure medications were adjusted: depakote was started during this admission. because of drug interaction lamictal was decreased in half dose. lyrica was also initiated and neurontin discontinued. because of increases in your liver enzymes while on depakote, keppra was started in preparation to stop depakote. you had increased agitation on keppra so this was stopped. vitamin b6 was given to help with the potential side effects of keppra without success. no infectious source was identified at the begining, but in your day 8 of admission you were found to have pneumonia and positive urine culture. you had 8 days course with antibiotics. then you were found to have a c. dif infection treated with flagyl iv and then vancomycin by mouth. a family meeting occured to discuss goals of care on . on you developed respiratory distress and vomiting. the decision was made to redirect your care toward comfort measures and home hospice was arranged. followup instructions: none as needed procedure: venous catheterization, not elsewhere classified removal of other device from thorax video and radio-telemetered electroencephalographic monitoring diagnoses: pneumonia, organism unspecified urinary tract infection, site not specified toxic encephalopathy unspecified essential hypertension hypopotassemia other malignant lymphomas, unspecified site, extranodal and solid organ sites other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure intestinal infection due to clostridium difficile other complications due to other vascular device, implant, and graft complications of transplanted bone marrow surgical or other procedure not carried out because of patient's decision streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] accidents occurring in residential institution surgical or other procedure not carried out because of contraindication other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy 

Answer: The patient is high likely exposed to