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: outside hospital transfer for seizures major surgical or invasive procedure: intubation and extubation history of present illness: 86 yo female with med hx of dmii, htn, cri who presented to osh with tonic clonic seizures in the setting of glucose of 500 and markedly positive ua then transferred to . pt lives alone in and was found down by her neighbor. ems found pt propped up in chair incotinent of urine and stool and brought her to osh. at osh pt had witnessed tonic clonic seizure which resolve with 2mg ativan and was intubated for severe metabolic and respiratory acidoses. abg at osh was 6.8/68/436 and wet read on head head ct was neg. ecg revealed lateral twi with first set of ce neg. in ed here her abg was 7.42/26/486 with vss and she was continued on iv levofloxacin and sent to the . . on arrival to the icu, the patient was intubated and sedated. she has since been extubated, and is satting well on o2 via nc. during her icu course, the patient had a ct of the head showing a mass vs. infarction and the neurology service has been following. an mri of the brain was done today, and is pending. an eeg has also been ordered to look for a seizure focus. in addition, the patient has begun to rule in for an mi with +troponin, although ekg is unchanged. . on admission, the patient was a&o x 3. she denied cp/sob, n/v, diarrhea, abdominal pain, ha, dizziness, or f/c. past medical history: 1. diabetes diagnosed in . currently on glyburide 5 mg. fingersticks ranging 54-90 in the morning. 2. bilateral pneumonia in . 3. hypertension diagnosed in . 4. high cholesterol. 5. history of migraines 6. lactose intolerance. 7. hyperparathyroidism 8. cri-suspectedly due to htn and dmii with baseline creat 2.2-2.8 in the last year . past surgical history: thyroidectomy in . social history: currently lives alone. husband died in , was a disabled veteran. has 1 son who lives in . denies smoking, quit 27 years ago. no alcohol. no domestic violence. no sexual abuse. does wear a seatbelt. family history: nc physical exam: vs - 99.5 - 133/35 - 87 - 26 - 96% gen - elderly female, lying in bed, nad heent - perrl ou, anicteric, mmm, op clear neck - no elevation of jvp, supple cv - rrr, normal s1s2, +3/6 systolic murmur @lusb; no r/g resp - + crackles at bases bilaterally (l>r). no w/r abd - nabs, soft, nd, nt, no masses ext - no c/c/e neuro - oriented to person only; cn ii-xii grossly bilaterally; strength ~ in upper and lower ext bilaterally; 2+ reflexes bilaterally; sensation grossly intact in the upper and lower ext bilaterally. pertinent results: micro data - sputum (): gpc, gpr blood cx: pndg csf cx: negative urine cx: negative . radiology - ct chest () 1. 8 mm calcified nodule in the posterior segment of right upper lobe, which probably representing calcified granuloma as noted in the prior chest x-ray. 2. 3 mm noncalcified granuloma in the right upper lobe. please follow up in 1 year if this patient has no history of malignancy. 3. small bilateral pleural effusion with atelectasis and linear scarring. 4. coronary artery calcifications. 5. cystic lesions in the liver, measuring 8 hounsfield units, probably representing liver cysts. 6. 10 mm pretracheal lymphadenopathy. . ct head () ill-defined abnormal attenuation involving the right insula and frontal lobe with mild associated mass effect and loss of -white differentiation. this appearance could be consistent with infarction with mild hemorrhage, or a neoplasm, particularly lymphoma, which may appear hyperdense. the differential includes other neoplastic or infectious processes. further evaluation with mri is recommended. . mri brain (): pending . tte (): pending . 12:00pm blood wbc-17.7*# rbc-3.04* hgb-9.6* hct-27.1* mcv-89 mch-31.6 mchc-35.3* rdw-12.7 plt ct-157 06:25am blood wbc-14.7* rbc-3.31* hgb-10.4* hct-29.2* mcv-88 mch-31.4 mchc-35.6* rdw-13.8 plt ct-131* 06:00am blood wbc-10.2 rbc-2.94* hgb-9.3* hct-26.7* mcv-91 mch-31.5 mchc-34.7 rdw-13.8 plt ct-171 06:30am blood wbc-8.5 rbc-3.14* hgb-9.5* hct-26.0* mcv-83 mch-30.2 mchc-36.5* rdw-14.0 plt ct-200 12:00pm blood glucose-168* urean-37* creat-2.5* na-140 k-5.4* cl-111* hco3-18* angap-16 05:00am blood glucose-120* urean-34* creat-2.0* na-141 k-4.5 cl-112* hco3-18* angap-16 06:30am blood glucose-57* urean-34* creat-2.0* na-136 k-4.0 cl-105 hco3-22 angap-13 12:00pm blood ck(cpk)-522* 12:00pm blood ck-mb-8 12:00pm blood alt-10 ast-22 alkphos-63 amylase-71 totbili-0.6 12:00pm blood ctropnt-0.16* 06:25am blood ck(cpk)-1060* 06:25am blood ck-mb-90* mb indx-8.5* ctropnt-1.38* 06:00am blood ck(cpk)-481* 06:00am blood ck-mb-22* mb indx-4.6 ctropnt-2.67* 06:15am blood ck(cpk)-158* 06:15am blood ck-mb-4 ctropnt-3.61* 06:30am blood ck(cpk)-121 06:30am blood ck-mb-3 ctropnt-3.49* 07:40am blood calcium-10.0 phos-2.4* mg-1.9 04:34am blood caltibc-218* vitb12-167* folate-8.2 hapto-99 ferritn-121 trf-168* 07:40am blood pth-236* brief hospital course: 86 yo female with a past medical history of dmii, htn, cri who presented to an osh with tonic clonic seizures in the setting of glucose of 500 and markedly positive ua, then transferred to icu for further managment. she has since stabilized and is being transferred to the floor. . 1) seizure - the patient had tonic clonic seizures on presentation to the osh. it was felt unikely for this 86 y/o pt to have new onset epilepsy at this age, so imaging and an lp were performed; the lp did not show an infectious process, yet an mri showed a questionable acute or sub-acute infarct. an eeg demonstrated an epileptogenic focus in the same area as this questionable infarct. neurology was consulted and felt that she did not require anti-epileptics and that anticoagulation (for her atrial fibrillation, as described below) should be held in the acute setting and would be re-evaluated after a repeat head ct. the patient had no subsequent seizures throughout the remainder of the admission, but after initial concern for hypoglycemia and hyponatremia lowering her threshold, decision was made to start keppra, which she is tolerating well. 2) nstemi - cardiac enzymes were checked at admission and were elevated (ck 522, mb 8, tn .16); her ecg showed anterolateral st depressions. mrs. for mi, and her ck peaked at 1060 on the third day of admission and subsequently declined. her troponin reached 1.86 at the time and also declined, though bumped again in the setting of rapid afib (see below) to 3.64 and then declined; this exaggerated bump and slow decline was felt to be secondary to her renal insufficiency. mrs. and her family decided she did not want to undergo cardiac catheterization, so her medical management was maximized; there was a debate as to how this should be managed in light of the question of cva on mri, but it was felt that acute anticoagulation for the nstemi was of greater importance. initially, she was on a heparin drip, but this was stopped as her enzyme levels declined. in addition to the heparin, she was kept on an aspirin, clopidogrel, atorvastatin, metoprolol (with a goal heart rate of 55-60), and lisinopril. she denied chest pain throughout the admission. ecg's were followed and showed some resolution of the st depression by then end of the admission. an echo was checked that demonstrated an ef of 35-40%; anterior, apical, and septal severe hypokinesis -her med regimen now includes asa/plavix/statin/acei/beta blocker 3)atrial fibrillation - mrs. does not carry a history if atrial fibrillation, but was found to be paroxysmally in it during this hospitalization. given the possible stroke, the team and consultants decided to hold off on anticoagulation. she was rate controlled with metoprolol with good effect, and the patient alternated between sinus rhythm and atrial fibrillation. -decision regarding anticoagulation will be made as outpatient by neurology team depending on her repeat hd ct 4) leukocytosis - mrs. count was high on admission (17.7), then trended down to 12 and eventually to 8. the source of this was felt to be multifactorial, including a uti, seizure, and her nstemi. her clinical exam revealed no other possible source of infection. her lp failed to demonstrate any evidence of infection. as her wbc trended down and she remained afebrile, her antibiotics were stopped, and she remained afebrile with a decreasing wbc for the rest of the admission. she developed a cough and delirium and a pna was diagnosed for which she will complete a 10d course of levofloxacin. her cultures all were without growth and she had been afebrile for greater than 48' at the time of discharge. 5) anemia - her baseline hct appears to be near 31 where she stayed for most of the admission. she required a total of four transfusions over the entire seven days with a goal hematocrit > 30 in light of her nstemi. her anemia work-up showed that she was guaiaic negative, yet her iron studies pointed to a mild iron deficiency anemia and a b12 deficiency, folate wnl. negative hemolysis labs. b12 injections were started and she will be transitioned over to oral b12 and fe as an outpatient. an iron and b12 deficiency work-up was recommended as an outpatient. additionally, she can be considered for erythropoetin therapy given her poor baseline renal function. she was transfused 2u prbcs during this admit for low hematocrit in setting of nstemi to keep her hct >30. 6) chronic renal insufficiency and acute renal failure - her renal failure was felt to be due to a pre-renal state, likely due to dehydration. her baseline poor renal function is likely due to her longstanding htn and dmii. her renal function improved slightly but remained poor for the entire admission. medications were renally dosed. as an outpatient, she should be seen by a nephrologist for evaluation; other outpatient measures could include initiation of erytropoetin, as above, and evaluation for hyperparathyroidism, as below. 7) dmii / hyperglycemia - she was hyperglycemic on admission, but this resolved on regular insulin sliding scale. her home dose of glyburide was restarted, but she became mild hypoglycemic on this dose (5mg daily) so she was changed to 2.5mg daily, however ultimately she was kept off of the glyburide for recurrent hypoglycemia. she did require a d5 drip one night for low blood sugars, but at the time of discharge she had normal blood sugars for 2d. 8) hypophosphotemia - she was hypophosphotemic at admission. a pth level was checked and came back very elevated at 236. although this is likely due to hypovitaminosis d from her chonic renal insufficiency, this potentially could represent a primary process. it was felt best to wait until mrs. was through the acute setting of her mi and seizure to work this up thoroughly. she may need a parathyroid scan as an outpatient. 9) dehydration - the patient appeared dehydrated when she was first admitted. this correlated with a prerenal etiology of her acute renal failure. she was given iv fluids, but by the end of the admission was taking adequate orals and did not require iv supplementation. 10) functional status - by the end of the admission, mrs. functional status seemed markedly limited compared to her pre-admission abilities. this is primarily due to deconditioning and extensive time spent in bed. the patient, her family, and pt/ot all agreed she would greatly benefit from a rehabilitation facility with physical and occupational therapy. 11) hyponatremia - pt became hyponatremic briefly, likely due to the free water she received for the aforementioned hypoglycemia. with fluid restriction, this improved with a discharge sodium of 131 - she should have this rechecked in 1-2d of reaching rehab. 12) ? uti: you have bacteria in your urine culture (vre) but not a current urine infection as your urinalysis is negative, you don't have any signs of fever/white blood cell count elevation. you are likely colonized with this bacteria, but to be safe we will treat you with nitrofurantoin for a 10d course 50mg four times daily (sensitivity to this was intermediate, was resistant to vanco/levo). you need a repeat urinalysis and urine culture/sensitivity upon arrival at rehab to ensure that this is resolving - please perform this on and follow results. medications on admission: aspirin 81mg--one by mouth every day atenolol 50mg--one by mouth every day glyburide 5mg--one by mouth every day hydrochlorothiazide 25mg--one by mouth every day lipitor 10mg--one by mouth every day . allergies: none. discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 3. atorvastatin calcium 80 mg tablet sig: one (1) tablet po daily (daily). 4. clopidogrel bisulfate 75 mg tablet sig: one (1) tablet po daily (daily). 5. heparin sodium (porcine) 5,000 unit/ml solution sig: 5000 (5000) units injection tid (3 times a day). 6. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 7. ferrous sulfate 325 (65) mg tablet sig: one (1) tablet po daily (daily). 8. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 9. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 10. multivitamin capsule sig: one (1) cap po daily (daily). 11. cyanocobalamin 1,000 mcg tablet sig: one (1) tablet po once a day. 12. metoprolol tartrate 50 mg tablet sig: two (2) tablet po q8h (every 8 hours). 13. glyburide 2.5 mg tablet sig: one (1) tablet po daily (daily). 14. levetiracetam 250 mg tablet sig: one (1) tablet po bid (2 times a day). 15. furosemide 20 mg tablet sig: one (1) tablet po daily (daily). 16. levofloxacin 250 mg tablet sig: one (1) tablet po q48h (every 48 hours) for 10 doses. 17. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q6h (every 6 hours). 18. cetylpyridinium chloride lozenge sig: one (1) mucous membrane every 6-8 hours as needed for cough. 19. insulin regular human 100 unit/ml solution sig: as directed by sliding scale injection asdir (as directed): per sliding scale as needed for elevated fsbs. 20. potassium & sodium phosphates mg packet sig: one (1) packet po bid (2 times a day) for 2 days. 21. magnesium oxide 400 mg tablet sig: one (1) tablet po bid (2 times a day) for 2 days: please do not give at same time as levofloxacin. 22. nitrofurantoin macrocrystal 50 mg capsule sig: one (1) capsule po qid (4 times a day) for 10 days: day#1 is . discharge disposition: extended care facility: - discharge diagnosis: 1. syncope of unknown etiology 2. nstemi 3. atrial fibrillation 4. anemia 5. chf 6. cri 7. subacute cva 8. elevated pth 9. hyponatremia 10. vre in urine, colonizer discharge condition: fair, without seizure, resolving mi, hemodynamically stable and afebrile for greater than 48' discharge instructions: weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1500cc please call your primary care doctor if you experience chest pain, shortness of breath, palpitations, decrease in the amount that you are urinating, or witnessed seizure activity. you will need to have your parathyroid hormone (it is elevated) followed by your primary care doctor - she is aware of this. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1000-1500cc please call your primary care doctor if you experience chest pain, shortness of breath, palpitations, decrease in the amount that you are urinating, or witnessed seizure activity. you will need to have your parathyroid hormone (it is elevated) followed by your primary care doctor - she is aware of this. do not take glyburide anymore - your blood sugars remained low on this medication; only use your sliding scale insulin. consideration for changing statin to lower dose at later point may be considered (high dose is for nstemi on this admission). weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet fluid restriction: 1000-1500cc please call your primary care doctor if you experience chest pain, shortness of breath, palpitations, decrease in the amount that you are urinating, or witnessed seizure activity. you will need to have your parathyroid hormone (it is elevated) followed by your primary care doctor - she is aware of this. do not take glyburide anymore - your blood sugars remained low on this medication; only use your sliding scale insulin. consideration for changing statin to lower dose at later point may be considered (high dose is for nstemi on this admission). you have bacteria in your urine culture (vre) but not a current urine infection as your urinalysis is negative, you don't have any signs of fever/white blood cell count elevation. you are likely colonized with this bacteria, but to be safe we will treat you with nitrofurantoin for a 10d course 50mg four times daily. you need a repeat urinalysis and urine culture/sensitivity upon arrival at rehab to ensure that this is resolving - please perform this on and follow results. please check chemistry panel including renal function, magnesium, potassium and phosphate on . followup instructions: provider: , medicine (private) where: adult medicine unit healthcare - 1000 - , phone: date/time: 2:00 you have an appointment with a neurologist for your seizure; before seeing him, you will also need to get a ct-scan of your head. the ct-scan will be on :00am in the building, fourth floor (their number is if you have questions). your appointment with the neurologist, dr. , is at 3:00 pm, also on , in the building on the eight floor. provider: , md where: neurology phone: date/time: 3:00 provider: , medicine (private) where: adult medicine unit healthcare - 1000 - , phone: date/time: 2:00 you have an appointment with a neurologist for your seizure; before seeing him, you will also need to get a ct-scan of your head. the ct-scan will be on :00am in the building, fourth floor (their number is if you have questions). your appointment with the neurologist, dr. , is at 3:00 pm, also on , in the building on the eight floor. provider: , md where: neurology phone: date/time: 3:00 md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung transfusion of packed cells diagnoses: pneumonia, organism unspecified subendocardial infarction, initial episode of care urinary tract infection, site not specified congestive heart failure, unspecified acute kidney failure, unspecified hyposmolality and/or hyponatremia hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other convulsions acute respiratory failure disorders of phosphorus metabolism iron deficiency anemia, unspecified other vitamin b12 deficiency anemia syncope and collapse diabetes with renal manifestations, type ii or unspecified type, not stated as uncontrolled carrier or suspected carrier of other specified bacterial diseases 

Answer: The patient is high likely exposed to