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: lorazepam attending: chief complaint: witnessed seizure major surgical or invasive procedure: intubation, femoral line history of present illness: hpi: 78 y/o m with pmh notable for cad s/p cabg, esrd on hd, history of right focal seizure with hyperperfusion syndrome and recent d/c () after l cea by pomposell who presents with seizures. the patient was found at 730 am at nursing home with seizure like acitivity, "jerking all over" for 2-3 minutes. vitals at that time t 97.7, bp 132/70, hr 74, rr 20, o2 97%. he was treated with valium 5 mg im x 1. staff at his nursing facility called for routine bls transport at 930 am. en route via ems, the patient was noted to have seizure activity (r eye deviation, tongue fasiculations, and beat nystagmus) again and was given another 5 mg valium x 1. . on arrival in ed, the patient's vitals were t 98.8, hr 79, bp 171/74, rr 16, 99%, fsbs 268. he was noted to have a weak gag reflex and only responsive to pain on the left side. he was quickly intubated for airway protection with rocuronium, lidocaine, and etomidate. he was loaded with dilantin 1000 mg x 1 and bps were noted to decrease in setting of propofol/dilantin iv. about one hour after paralytics given pt had a 3rd seizure described as beat nystagmus of eyes & twitching of deltoid. a head ct was without signs of an acute bleed. carotid u/s done stat given recent cea and was normal. he was given an additional 5 mg iv valium in addition to dilantin load. no further seizure activity after dilantin loading. due to hypotension, a femoral line was placed and the patient was changed to fentanyl& midaz prior to arrival in the icu. given concern for meningitis, he received ceftriaxone 2 g iv x 1, acyclovir 600 mg iv x 1, and vanc 1 mg iv x 1. he also received 500 cc ns. . on arrival to icu, the pt is intubated and sedated and unresponsive to voice. no active seizure activity obvious on exam. further ros obtained from family. the patient complained of intermittent palpatations on (thursday) and again on saturday, a "thump" in his chest (not chest pain). yesterday the family notes that he was mildly lethargic after taking ? tylenol. he was able to participate in pt earlier in day without difficulty. . past medical history: pmh: (from omr) - cad - 3v disease; s/p cabg x 4v (). ett-mibi : small territory ischemia - chf (post-cabg echo ef 40%. echo : ef 40-45%.) - carotid stenosis, s/p r cea - stroke - diabetes type ii - hypertension - renal insufficiency (cr 6 range) - hd- dependent (mwf) - albuminuria - h/o phimosis s/p circumcision - vitiligo - r stapes surgery - retinopathy (laser coag ) - squamous cell carcinoma - (left hand, invasive) - renal artery stenosis (left 70-90% by mri ) - aortic stenosis (echo : mild) . social history: non-smoker (never smoked); occ. etoh; no ivdu. recently at nursing facility but previously lived at home with wife. retired. family history: father- died of pulmonary edema, chf at age 77. mother-died age 81, had dm. physical exam: t:95.6 bp:164/65 hr:68 rr:12 o2 100% on cmv fio2 80%/ vt 700/ rr10/ peep 5 gen: elderly male, intubated & sedated, opens eyes to voice heent: no scleral icterus, tongue moist and midline, r pupil larger than left but both reactive, + oculocephalic reflex, no eye deviation or nystagmus noted, eeg leads in place neck: supple, no lymphadenopathy, no meningismus cv: rrr, normal s1, s2, lungs: clear anteriorly, no wheezing or rhonchi abd: soft, no grimace with palpation, normoactive bowel sounds ext: feet cool with + dp pulses bilaterally, not rigid in ue or le skin: no rashes/lesions, ecchymoses. neuro: sedated, opens eyes to voice, weak bilateral hand grip on command, face symmetric, r pupil > l pupil but both reactive, + gag (coughs with tube repositioning), toes mute bilaterally, dtrs 2+ at bilateral biceps, 1+ at bilateral patellae; withdraws to pain mainly in rue pertinent results: 10:16am pt-12.8 ptt-29.9 inr(pt)-1.1 10:16am plt count-118* 10:16am neuts-92.6* lymphs-4.7* monos-2.3 eos-0.3 basos-0.1 10:16am wbc-8.3# rbc-3.46* hgb-11.9* hct-33.0* mcv-95 mch-34.6* mchc-36.2* rdw-14.8 10:16am albumin-4.1 calcium-9.6 phosphate-5.1* magnesium-2.0 10:16am ck-mb-3 10:16am ctropnt-0.08* 10:16am lipase-26 10:16am alt(sgpt)-65* ast(sgot)-54* ck(cpk)-62 alk phos-147* tot bili-0.4 10:16am glucose-234* urea n-46* creat-6.8* sodium-139 potassium-4.5 chloride-94* total co2-19* anion gap-31* 10:22am lactate-10.9* k+-4.4 04:44pm cerebrospinal fluid (csf) wbc-0 rbc-0 polys-20 lymphs-20 monos-60 04:44pm cerebrospinal fluid (csf) protein-57* glucose-128 05:03pm urine rbc->50 wbc- bacteria-few yeast-none epi-0 05:03pm urine blood-lg nitrite-neg protein-30 glucose-1000 ketone-neg bilirubin-neg urobilngn-neg ph-8.0 leuk-tr 05:03pm urine color-yellow appear-hazy sp -1.013 05:03pm pt-13.1 ptt-34.4 inr(pt)-1.1 05:03pm plt count-111* 05:03pm neuts-85.5* lymphs-9.7* monos-3.9 eos-0.7 basos-0.1 05:03pm wbc-7.1 rbc-3.28* hgb-11.2* hct-30.6* mcv-93 mch-34.3* mchc-36.7* rdw-14.6 05:03pm phenytoin-7.0* 05:03pm calcium-9.2 phosphate-4.2 magnesium-1.8 05:03pm ck-mb-notdone ctropnt-0.07* 05:03pm ck(cpk)-61 05:03pm glucose-244* urea n-47* creat-6.7* sodium-139 potassium-4.3 chloride-99 total co2-29 anion gap-15 05:56pm lactate-1.3 05:56pm type-art temp-35.3 po2-233* pco2-29* ph-7.57* total co2-27 base xs-5 intubated-intubated . cxr: findings: the patient is status post endotracheal intubation with the tip residing 2.4 cm above the carina. the lungs are clear. there is no evidence of pleural effusions or pneumothorax. the mediastinal and cardiac contours are stable. there is a nasogastric tube in place that courses below the diaphragm. the visualized osseous structures are normal. impression: endotracheal tube with tip 2.4 cm above the carina. . ct head: there is no evidence of hemorrhage, edema, mass effect, or acute infarction. there is hypodensity in the bilateral basal ganglia consistent with old chronic lacunar infarctions. there is periventricular hypodensity consistent with chronic small vessel ischemic changes. there is hypodensity in the right cerebral watershed territory. the ventricles and sulci are prominent consistent with age- related involutional changes. there is no shift of the normally midline structures. there are vascular calcifications noted in the bilateral vertebral and internal carotid arteries consistent with atherosclerotic disease. there is no evidence of fractures. there is mild bilateral mucosal thickening of the ethmoid sinuses. the sphenoid, maxillary sinuses and the mastoid air cells are well aerated. impression: no evidence of hemorrhage. . us carotid: 1. patent left internal carotid artery status post carotid endarterectomy. findings are consistent with 0% stenosis in the left internal carotid artery. the right carotid artery was not evaluated due to the emergent nature of the exam. . 4:44 pm csf;spinal fluid #3. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (preliminary): : mri brain, mra head and neck. clinical information: patient with diabetes and seizures, for further evaluation. technique: t1 sagittal and flair, t2, susceptibility and diffusion axial images were obtained. t2 coronal images acquired. 2d time-of-flight mra of the neck vessels and 3d time-of-flight mra of the circle of were obtained. comparison was made with the previous brain mri examination of and ct angiography of . findings: the examination is limited secondary to motion. there is now new increased signal identified diffusely in the left cerebral hemisphere involving the left-sided subcortical white matter including extension to the left corona radiata and posterior limb of the internal capsule. there is increased signal seen both in the genu of corpus callosum as well as on the left side of the splenium of corpus callosum. there is no acute infarct identified or signs of slow diffusion seen. although, the diffusion images are limited by motion. an area of chronic blood products is seen in the right parietal lobe subcortical region. multiple prominent perivascular spaces are identified. chronic lacunes are seen in bilateral basal ganglia region and also involving the periventricular white matter and the right caudate head. there is mild-to-moderate brain atrophy seen without hydrocephalus or midline shift. impression: the asymmetric finding seen in the left cerebral hemisphere could be secondary to chronic ischemia and white matter disease given the patient has a high-grade stenosis of the left petrous and pre-cavernous carotid artery. however, appearances are somewhat atypical. in presence of multiple prominent perivascular spaces in both cerebral hemispheres and absence of mass effect, this does not appear to be secondary to infiltrating neoplasm. perfusion imaging can be obtained for further evaluation. in presence of end- stage renal disease, an mr -labeled perfusion or ct perfusion can be acquired for further assessment. mra of the head: the head mra demonstrates loss of flow signal in the petrous and pre-cavernous left internal carotid artery indicative of atherosclerotic disease and greater than 50% stenosis. irregularity of the flow signal is seen in the right petrous and pre-cavernous carotid indicative of atherosclerotic disease. both middle cerebral arteries demonstrate normal flow signal. the right distal vertebral artery is not visualized. impression: atherosclerotic disease with high-grade narrowing of the left petrous and pre-cavernous internal carotid artery. mild atherosclerotic disease involving the right petrous and pre-cavernous internal carotid. non- visualization of the right distal vertebral artery probably secondary to occlusion in the neck. mra of the neck: the neck mra demonstrates non-visualization of the right vertebral artery from its origin indicative of occlusion. the left vertebral artery and both carotid arteries in the neck demonstrate normal flow signal. impression: non-visualization indicative of occlusion of right vertebral artery in the neck. , m 78 neurophysiology report eeg study date of object: ee, in pt w/video,/08. referring doctor: dr. findings: pushbuttons: none were identified. automated interictal epileptiform activity: low voltage, beta frequency background was seen on the time-sampled intervals. automated spike detection: this algorithm identified 98 events; two were for right frontocentral spike and slow wave discharges. the remainder were artifactual in nature. automated seizure detection: this algorithm identified 28 events, all of which were related to artifacts. sleep: there were no sleep periods seen on the sampled intervals. cardiac monitor: revealed a generally regular rhythm with average rate of 90 bpm. impression: this 24 hour eeg telemetry failed to capture any epileptiform activity. note is made of a low voltage, fast background. brief hospital course: this is a 78 y/o man with pmh notable for hx of r focal seizures with hyperperfusion syndrome, cad s/p cabg, recent carotid endarterectomy, and type 2 dm admitted with seizures x 3 on . in the ed, he was intubated for airway protection. he was hypotensive while he was on propofol. hospital course is reviewed below by problem: # seizures: the patient did have a history of right focal motor seizures following his first carotid endarterectomy in and was on dilantin for a period of time (unclear for how long). he apparently never had a generalized tonic-clonic seizure at that time. for this episode, differential includes infectious, stroke, toxic metabolic, and primary seizure disorder. he had a head ct which showed no acute hemorrhage. mri showed diffuse white matter disease limited to the left hemisphere (see mri results above). this was suggestive of reperfusion injury status post carotid endarterectomy. the vascular team suggested transcranial doppler to r/o reperfusion syndrome non-emergently. a lactate of 10 on admission was likely secondary to seizure, as it was 1 on repeat on arrival to the icu. - of note, he was initially covered with vancomycin, ceftriaxone, ampicillin, and acyclovir. csf only showed mild elevation of protein, therefore his antibiotics were stopped. his acyclovir was stopped on , after his hsv pcr was negative. - he had eeg monitoring (see results section). when he was admitted he was loaded with dilantin. he was changed to keppra while inpatient given renal failure on dialysis; keppra was dosed renally. # esrd on hd: renal was consulted and he had his dialysis as an inpatient. # type 2 dm: maintained on an insulin sliding scale with good glycemic control. # anemia: hct remained near a recent baseline. # thrombocytopenia: stayed near baseline. # cad: continue asa and statin. cardiac enzymes were stable. # code: full code, confirmed with patient's wife, , who is his hcp, (home), (cell). son is . medications on admission: meds: mom 30mg qhs prn dulcolax supp 10mg daily prn fleet enema prn senna 8.6mg po bid colace 100mg po bid tylenol 650mg po tid (apparently standing) bisacodyl 10mg ec po daily prn calcitriol 25mcg cap po daily diovan 160mcg po daily isosorbide mononitrate 90mg daily lipitor 80mg daily metoprolol succ er 125mg daily nifedipine er 120mg sa daily sertraline 100mg daily enalapril 30mg po bid bualbital-apap-caffeine tab q4h prn ha one cap po daily phoslo 667mg po tid ac asa 81mg daily ferrous sulfate 325mg po daily colace 100 po bid prn . allergies: ativan (hallucinations) discharge medications: 1. acetaminophen 325 mg tablet : one (1) tablet po q6h (every 6 hours) as needed. 2. magnesium hydroxide 400 mg/5 ml suspension : thirty (30) ml po q12h (every 12 hours) as needed for constipation. 3. docusate sodium 100 mg capsule : one (1) capsule po bid (2 times a day) as needed for constipation. 4. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 5. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 6. atorvastatin 40 mg tablet : two (2) tablet po daily (daily). 7. sertraline 100 mg tablet : one (1) tablet po daily (daily). 8. b complex-vitamin c-folic acid 1 mg capsule : one (1) cap po daily (daily). 9. calcium acetate 667 mg capsule : one (1) capsule po tid w/meals (3 times a day with meals). 10. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 11. heparin (porcine) 5,000 unit/ml solution : one (1) injection tid (3 times a day). 12. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 13. nifedipine 60 mg tablet sustained release : two (2) tablet sustained release po daily (daily). 14. metoprolol succinate 25 mg tablet sustained release 24 hr : five (5) tablet sustained release 24 hr po daily (daily). 15. ferrous sulfate 325 mg (65 mg iron) tablet : one (1) tablet po daily (daily). 16. calcitriol 0.25 mcg capsule : one (1) capsule po daily (daily). 17. isosorbide mononitrate 30 mg tablet sustained release 24 hr : three (3) tablet sustained release 24 hr po daily (daily). 18. enalapril maleate 10 mg tablet : two (2) tablet po bid (2 times a day). 19. levetiracetam 250 mg tablet : one (1) tablet po bid (2 times a day). 20. levetiracetam 250 mg tablet : one (1) tablet po qmowefr (monday -wednesday-friday). give after dialysis. 21. insulin insulin sc sliding scale q6h glucose insulin dose 0-70 mg/dl 1 amp d50 humalog insulin 71-150 mg/dl 0 units 151-200 mg/dl 2 units 201-250 mg/dl 4 units 251-300 mg/dl 6 units 301-350 mg/dl 8 units 351-400 mg/dl 10 units > 400 mg/dl notify m.d. discharge disposition: extended care facility: nursing and rehab discharge diagnosis: 1. probable reperfusion injury 2. seizures discharge condition: he is globally weak, but no focal neurological deficit. he is also emotionally labile about his current weakness, and is frustrated that he is not improving quicker. discharge instructions: you have had seizures, you must take medication for your seizures to prevent them. if you seizures increase in frequency, please go to your nearest ed. you have weakness, and need rehabilitation to improve your strength. followup instructions: vascular lmob (nhb) phone: date/time: 10:45 vascular: , md phone: date/time: 11:20 neurology: please call ( to organize an appointment with dr. in weeks time. pcp: , s. - please organize an appointment with your pcp weeks time. procedure: venous catheterization, not elsewhere classified spinal tap incision of lung insertion of endotracheal tube hemodialysis video and radio-telemetered electroencephalographic monitoring diagnoses: other iatrogenic hypotension thrombocytopenia, unspecified end stage renal disease coronary atherosclerosis of unspecified type of vessel, native or graft aortocoronary bypass status aortic valve disorders other convulsions diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes occlusion and stenosis of carotid artery without mention of cerebral infarction hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease acute respiratory failure personal history of other malignant neoplasm of skin other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation accidents occurring in other specified places occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction atherosclerosis of native arteries of the extremities, unspecified diabetes with ophthalmic manifestations, type ii or unspecified type, not stated as uncontrolled background diabetic retinopathy central nervous system complication 

Answer: The patient is high likely exposed to