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: seizure major surgical or invasive procedure: thoracentesis () with interventional pulmonology. eeg history of present illness: 63 y/o m with pmhx of htn, hep c cirrhosis c/b encephalopathy and dm who was found by ems after having a generalized tonic/clonic seizure on a bus, lasting 1-2 minutes with urine incontinence and fbs >500 (critically high). pt was given 2mg narcan for pinpoint pupils with no significant effect. pt was transported to ed and stopped seizing spontaneously. he was notably restless, confused but responsive on arrival to . he may have had a similar episode in . . in the ed, initial vs were: t 99 p 70 bp 200/palp r 18 o2 99% ra. pt underwent ct head which was negative and ct c-spine showed no evidence of fracture and some question of gas in fascial layers. cxr showed a question of retrocardiac opacity. pt received ceftriaxone 2grams, vancomycin and ativan 0.5mg iv for question of meningitis in setting of ms changes and seizure. however, ms cleared and lp was not performed due to low suspician for meningitis. serum osmolarity returned at 340 and pt was given 4l ns ivf and 20units iv insulin. . on arrival to the icu, pt was tired but responsive. he was not wanting to speak but denied cp, sob, nausea, abd pain, diarrhea, cough, fevers, congestion or prior seizures. he did not remember the events from the afternoon but was able to give me the phone number for his family who provided additional past medical information. in the unit the patients glucose was controlled, he was kept on ciwa protocal but showed no signs of withdrawl. pts urine osms were also corrected. in the unite the patient did not have another seizure. . on arrival to the floor pt seems somewhat tired and withdrawn but is easily able to interact and withdrawl. pt notes no pain, shortness of breath, nausea, vomiting, fevers. pt is resting comfortably past medical history: type ii dm hypertension hepatitis c cirrhosis c/b encephalopathy s/p tips on lactulose and rifamixin h/o hospitalization for hyperglycemic hyperosmolar state versus hepatic encephalopathy hyperglycemia (most recently at in early ), social history: pt lives with his daughter and wife. pt denies any etoh, smoking or illicit drug use history. family history: non-contributory physical exam: vitals: t: 98.5 bp: 170/85 p:71 r: 18 o2 sat: 97% on ra general: responsive, oriented x3, pleasant, thin gentleman. heent: dry mmm neck: supple lungs: ctab, no wheezes, rales, ronchi cv: rrr normal s1 + s2 abdomen: soft, positve bowel sounds, no rebound tenderness or guarding ext: dry, 2+ pulses, no clubbing, cyanosis or edema, lower extremity is very thin. neuro: cn ii - xii intact, normal sensation in the upper/lower extremity. 5/5 strength in the biceps, deltoids, illiopsoas. pertinent results: labs: : wbc-7.3 rbc-4.16* hgb-11.9* hct-38.0* mcv-91 mch-28.6 mchc-31.3 : wbc-6.8 rbc-3.66* hgb-10.6* hct-32.6* mcv-89 mch-28.8 mchc-32.4 rdw-15.3 plt ct-116* : wbc-6.8 rbc-3.97* hgb-11.3* hct-35.3* mcv-89 mch-28.4 mchc-32.0 rdw-15.9* plt ct-142* : pt-13.6* ptt-29.5 inr(pt)-1.2* : pt-14.2* ptt-34.8 inr(pt)-1.2* : glucose-153* urean-28* creat-1.4* na-138 k-4.0 cl-109* hco3-20* angap-13 : glucose-202* urean-27* creat-1.6* na-140 k-3.9 cl-113* hco3-19* angap-12 : glucose-153* urean-34* creat-1.7* na-136 k-4.1 cl-109* hco3-21* angap-10 : alt-54* ast-68* ld(ldh)-366* ck(cpk)-251* alkphos-260* amylase-156* totbili-0.4 : alt-40 ast-58* alkphos-245* totbili-0.6 : alt-37 ast-63* ld(ldh)-276* ck(cpk)-102 alkphos-205* totbili-0.4 : lipase-655* : lipase-371* : ck-mb-3 ctropnt-<0.01 : ck-mb-2 ctropnt-<0.01 : ck-mb-2 ctropnt-<0.01 : ck-mb-2 ctropnt-<0.01 : asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg : glucose-greater th lactate-7.0* na-133* k-5.0 cl-93* calhco3-22 04:17am blood lactate-1.9 . microbiology: pleural fluid gram stain (final ): 3+ (5-10 per 1000x field): polymorphonuclear leukocytes. 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): no growth. blood culture, routine (final ): no growth. urine culture (final ): no growth. studies: cxr: ()retrocardiac opacity suspicious for pneumonia. conversely this may represent incomplete collapse of the left lower lobe. if clinically feasible, consider pa and lateral views for further evaluation. there are other signs of volume loss which support the contention of atelectasis over pneumonia; however, pneumonia cannot be excluded. cxr: ()compared to the film from two days ago, there has been marked worsening appearance of the left lower lobe infiltrate. there is a moderate-sized left pleural effusion and a small right effusion, both of whichhave increased compared to prior. there is pulmonary vascular redistributionand perihilar haze suggesting an element of fluid overload. cxr: () again seen are bilateral pleural effusions, moderate on the left,small on the right and are of similar size and appearance compared to the prior study. there continues to be pulmonary vascular redistribution and cardiomegaly suggesting chf. an underlying infectious infiltrate in either lower lobe cannot be excluded cxr: () decreased left effusion, consistent with history of thoracentesis, without pneumothorax. a focal consolidation in the re-expanded left lung is suggested and attention is warranted on followup imaging. ct head: () no acute intracranial process. mr is most sensitive in the detection of acute stroke. incidental notes as above. ct cspine (): 1. no acute fracture of the cervical spine. 2. incidental note is made of air within small to tiny venous vessels throughout the neck, presumbaly via injection. correlate clinically. doppler abd us: 1. shrunken cirrhotic nodular liver consistent with known cirrhosis. no focal hepatic mass lesions are identified. 2. tips stent is patent with normal directional flow. however, velocities are slightly lower than expected ranging from 69 to 72 cm/s throughout. short interval ultrasound followup is recommended. 3. small bilateral pleural effusions and trace infrahepatic ascites. eeg (): this is an abnormal routine eeg in the waking and drowsy states due to a slow theta frequency background as well as occasional one to two second bursts of moderate voltage, sudden onset polymorphic theta/delta activity with sharp components. this is a non-specific finding but likely suggestive of an encephalopathy. brief hospital course: *****follow up: (the following should be followed up by dr. , pcp)*********** 1. cytology from the pleural fluid is being analyzed by pathology at . these results should be followed up. 2. cxr after pleural fluid was removed from left lung showed a round focal consolidation in the re-expanded left lower lobe is suggested. follow up imaging as an outpatient is warranted. 3. diabetes management. . assessment and plan: 63 y/o m with pmhx of dm, hep c cirrhosis and htn who was brought in by ems after being found seizing with hyperglycemic non-ketosis and abnormal lfts. . # seizures: pt presented after seizure in the setting of hyperglycemia. no prior history of seizures. pt denies fevers, substance abuse and tox screen negative. seizure could have been due to hyperosmolarity and electrolyte shifts in setting of honk. low suspician for infection given normal wbc count and resolution of lactate after seizure. unlikely dts and hepatic encephalopathy does not usually precipitate seizures. pt was monitored in the icu. he recieved iv fluids and his blood sugar was controlled. blood and urine cultures were negative. chest xray showed a pleural effusion see below. pt was followed by the neurology service and eeg was performed. eeg was consistent with encephalopathy, without concern for focus of seizure. . # dm2 uncontrolled with complications/hyperosmotic non-ketosis: pt presented with elevated serum osms, bs >500 and confusion s/p seizure. he received 4l ivf and insulin 20units iv prior to arrival. on arrival to icu, serum osmolarity was within normal range, electrolytes corrected and bs at 150. pt was continued on basal insulin with sliding scale. electrolytes were monitored and continued to be repleted. . # pleural effusion: pt has pleural effusion on cxr, which developed since admission. initially there was concern that this may represent a pneumonia. pt was treated for 5 days on levofloxacin for community recquired pneumonia. interventional pulmonology drained the effusion and it was discovered to be transudative. pleural effusion culture and gram stain was negative for infection. cytology is still pending on discharge. on reexpansion of the lung there is suggestion of a round focal consolidation. both the cytology and this focal consolidation should be followed up as an outpatient. . # chronic hep c cirrhosis: pt with known dx of cirrhosis managed at on lactulose & rifaximin with recurrent encephalopathy. mental status very close to baseline per family, though tired. denies h/o gi bleed though managed on nadolol as outpatient. ruq us findings were consistent with cirrhosis. . # chronic kidney disease: after discussion with pts pcp it is clear that pt is at his baseline. medications were renally dosed and nephrotoxins avoided. . *****follow up: (the following should be followed up by dr. , pcp)*********** 1. cytology from the pleural fluid is being analyzed by pathology at . these results should be followed up. 2. cxr after pleural fluid was removed from left lung showed a round focal consolidation in the re-expanded left lower lobe is suggested. follow up imaging as an outpatient is warranted. 3. diabetes management. medications on admission: nadolol 80mg daily lactulose qid rifaximin 400mg tid lisinopril 40 daily lasix 40mg daily amlodipine 5mg daily discharge medications: 1. famotidine 20 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. rifaximin 200 mg tablet sig: two (2) tablet po tid (3 times a day). 3. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po qid (4 times a day). 4. nadolol 80 mg tablet sig: one (1) tablet po daily (daily). 5. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 6. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 7. lasix 40 mg tablet sig: one (1) tablet po once a day. 8. lantus insulin 20 units in the morning. 9. insulin sliding scale as prescribed by your pcp discharge disposition: home discharge diagnosis: primary: seizure secondary to hyperglycemia non ketosis. . secondary: transudative pleural effusion community acquired pneumonia discharge condition: stable. afebrile. sating 98% on room air. discharge instructions: you were admitted to the hospital after having a seizure. on admission you were found to have a very high blood sugar level. this extremely elevated blood sugar is thought to be what caused your seizure. you blood sugar and electrolyte balances were managed with intravenous fluids and insulin. during your stay you were also elvaluated for other causes of seizures. you underwent eeg (a study to look for causes of seizures) and the neurology team thought that the seizure was caused by hyperglycemia (high blood sugar). during your stay you also developed fluid surronding the left lung. this fluid was drained during your stay. you were also treated for a probable community acquired pneumonia with levofloxacin for 5 days. during your stay you did not have any more seizures and were afebrile. the following changes were made to you medicine regimen. - start famotidine 20mg by mouth daily - increase your lantus dose to 20 u in the morning please return to the hospital or contact your primary care physician if you develop chest pain, shortness of breath, fever, nausea, vomiting, diarrhea, blood sugars > 250, seizure, or other changes from your baseline level of function that concern you. followup instructions: you have a follow up appointment with dr. on at 5:00pm. please follow up in regards to the following issues: - left pleural effusion: (cytology pending at ) - diabetes control, blood pressure control procedure: thoracentesis diagnoses: pneumonia, organism unspecified unspecified pleural effusion cirrhosis of liver without mention of alcohol chronic hepatitis c with hepatic coma hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified chronic kidney disease, unspecified generalized convulsive epilepsy, without mention of intractable epilepsy diabetes with hyperosmolarity, type ii or unspecified type, uncontrolled 

Answer: The patient is high likely exposed to