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: left sided plegia major surgical or invasive procedure: brain biopsy history of present illness: mr. is a 51 y/o male in previously good health until approximately 2 weeks prior to admission. while down in in visiting his children when he developed some left sided-weakness and numbness. he underwent a brain biopsy at a hospital on which revealed a preliminary dx of grade ii astrocytoma. the pt was then transferred to an rehab facility via medivac (due to the hurricane) on . he subsequently was discharged on . from there he while traveling to , ma he developed acute shortness of breath on , upon landinghe was taken to an outside ed and later transferred to where he was intubated for airway protection and dyspnea. he was found to have a small pe. while in ed his neurologic status and exam deteriorated. he became more lethargic, not following commands, and without spontaneous speech. physical exam revealed a dense left hemiplegia. past medical history: 1. hypertension 2. demyelinating brain/cns disease 3. right frontal craniotomy on () 4. e-coli uti ->levoquin social history: lives at home with family; per ex wife no tobacco/etoh/ivdu. family history: non-contributory physical exam: amission exam: t:98.7 bp: 122/83 hr: 56 r 16 o2sats 100% 2lnc gen: wd/wn, comfortable, nad. heent: pupils: eoms could not be adequately assessed neck: supple. lungs: cta bilaterally. cardiac: rrr. s1/s2. abd: soft, nt, bs+ extrem: warm and well-perfused. neuro: mental status: lethargic, not following commands. orientation: not oriented. recall: none. language: no spontaneous speech cranial nerves: i: not tested ii: pupils equally round and reactive to light, to mm bilaterally. visual fields are full to confrontation. iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation could not be effectively tested. viii: could not be tested. ix, x: not tested. : not tested motor: normal bulk and tone bilaterally. no abnormal movements, tremors. strength could not be tested. pronator drift could not be tested patient withdraws to noxious stimuli with all 4 extremities right > left sensation: not tested toes downgoing bilaterally right frontal incision c/d/i on discharge: see hosp course for d/c exam pertinent results: labs on admission: 12:15am blood wbc-11.7* rbc-3.78* hgb-11.3* hct-32.8* mcv-87 mch-30.0 mchc-34.6 rdw-13.0 plt ct-580* 12:15am blood neuts-67.4 lymphs-26.6 monos-4.3 eos-1.1 baso-0.6 12:15am blood pt-11.8 ptt-27.9 inr(pt)-1.0 12:15am blood glucose-113* urean-25* creat-0.5 na-138 k-4.1 cl-101 hco3-27 angap-14 12:15am blood ck(cpk)-73 12:15am blood ctropnt-<0.01 12:15am blood calcium-9.4 phos-4.1 mg-2.2 06:04am blood phenyto-2.3* labs on discharge: 06:15am blood wbc-3.6* rbc-3.30* hgb-10.4* hct-29.9* mcv-91 mch-31.5 mchc-34.7 rdw-17.2* plt ct-822* 06:15am blood neuts-52.2 lymphs-30.0 monos-7.0 eos-9.0* baso-1.8 05:40pm blood pt-13.2 ptt-65.6* inr(pt)-1.1 06:15am blood glucose-92 urean-3* creat-0.4* na-140 k-3.9 cl-103 hco3-26 angap-15 06:15am blood alt-21 ast-19 ld(ldh)-177 alkphos-91 totbili-0.3 06:15am blood albumin-3.6 calcium-9.2 phos-4.5 mg-1.9 05:40pm blood triglyc-146 hdl-45 chol/hd-5.2 ldlcalc-160* 06:30am blood tsh-0.18* 06:30am blood t4-5.5 t3-85 calctbg-0.95 tuptake-1.05 t4index-5.8 free t4-1.1 10:50am blood hbsab-positive hbcab-positive 08:00pm blood hbsag-negative 08:00pm blood ama-positive smooth-negative 08:00pm blood -negative 10:50am blood antitpo-103* 05:40pm blood pep-polyclonal igg-2285* iga-370 igm-310* ife-no monoclo 02:05pm blood hiv ab-negative 05:13am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-neg 12:40pm cerebrospinal fluid (csf) wbc-6 rbc-141* polys-7 lymphs-84 monos-9 test name result reference range --------- ------ --------------- multiple sclerosis profile cerebrospinal fluid (csf) igg index 0.44 index <=0.85 igg, csf 4.40 mg/dl <=8.1 albumin, csf 20.60 mg/dl <=27.0 igg/albumin, csf 0.21 ratio <-0.21 synthesis rate, csf 0.00 mg/24 h <=12 igg, s 1570 mg/dl (high) albumin, s 3250 mg/dl 3200-4800 igg/albumin, s 0.5 ratio (high) <=0.4 serum bands 0 bands csf bands 0 bands csf olig bands 0 bands <4 interpretation -------------- the oligoclonal band assay detected 3 or less igg bands in the csf, which are not present in the serum. this is a negative result. ekg(): sinus bradycardia. early repolarization. no previous tracing available for comparison. xxxxxxxxxxxxxxxxxxxxxxxxx biopsy: brain, frontal lobe, right, biopsy: subcortical white matter with sharply demarcated zones of demyelination. see note. note: luxol fast blue and bodian stains show sharply demarcated areas of demyelination with preserved axons. immunohistochemical stains for cd68 and cd3 show dense infiltration of macrophages and scattered t cells in areas of demyelination. immunostain for sv40 ( virus) is negative. these findings are consistent with multiple sclerosis in the appropriate clinical context. imaging: cta chest(): impression: small peripheral pulmonary embolus within the right lower lobe. head ct(): impression: extensive edema of the hemispheres, with involvement of the corpus callosum, compatible with the reported history of glioblastoma multiforme. le ultrasound (): impression: no evidence of lower extremity dvt. mri head (): impression: 1. extensive bifrontal vasogenic edema with two small foci of enhancement. findings are nonspecific and may correspond to the reportedly biopsy-proven glioblastoma multiforme. given the overall paucity of enhancement, hemorrhage or necrosis, however, lymphoma remains a distinct possibility. 2. small amount of blood products along the right frontal lobe biopsy tract. 3. unusual pattern of non-enhancing uniform t1- and t2-hyperintensity confined to the right basal ganglia, of unclear etiology, but likely secondary to the adjacent extensive tumor and peritumoral edema, perhaps on the basis of altered perfusion (though there is no evidence of frank infarction); a less likely consideration is direct tumor infiltration. comment: focused mri with spectrscopy, arterial-spin label perfusion, and dynamic susceptibility perfusion analysis has been recommended, to better characterize both the primary process and the findings in the ipsilateral basal ganglia. mr (): redemonstration of extensive bifrontal edema infiltrating the corpus callosum, with small areas of posterior enhancement. overall, the appearance favors glioblastoma over lymphoma, although encephalitis can have the same imaging appearance. correlation with prior mr examinations is critical to evaluate the evolution of these findings in the setting of the patient's biopsy and possible ischemic event. 2. abnormal pectroscopic evaluation demonstrating high choline in all three regions selected, which can be seen in malignant brain tumors but also can be seen with lymphoma and demyelination, as well as infectious processes. 3. normal mr perfusion study with no definite areas of hyperperfusion to definitely suggest malignancy. 4. failed arterial spin labeling. mr brain : impression: 1. no specific evidence of intracranial infection; though subtle findings of infection may be obscured by the global abnormalities, above. 2. new opacification of the sphenoid sinuses, and thickening of the right frontal sinus; though these findings may be "passiv," related to prolonged supine positioning and/or intubation, infection cannot be excluded. 3. extensive bifrontal edema infiltrating the corpus callosum with small foci of marginal enhancement, dorsally, overall stable, with no new enhancing focus seen. 4. further pathologic t1-hyperintensity within the right basal ganglia, and in cortex overlying the zones of white matter edema, of uncertain clinical significance. though this may relate to a primary infiltrative neoplastic (or demyelinative) process, secondary ischemic or neurodegenerative processes remain differential considerations. ct torsoe: 1. no obvious neoplastic process identified in the chest, abdomen or pelvis. 2. small left upper lobe pulmonary nodule is unchanged compared to . in the absence of malignancy or significant risk factors (ie smoking), no further follow-up is needed. if this history does exist, follow- up in one year is recommended. mr brain : 1. no significant change in extent of white matter flair hyperintensity and right basal ganglia t1 hyperintensity from recent mri from . improvement compared to . 2. sphenoid sinusitis. brief hospital course: patient was admitted to after immediate transfer from airport for respiratory distress. his presentation is quite complicated. per osh records, and discussions with ex-wife, . mr. was apparently visiting with his family in , la, when he developed left sided weakness and sensory deficits. he was hospitalized at medical center in merron, la. during this hospitalization, he was discovered to have significant bilateral frontal brain mass. he subsequently underwent right sided biopsy to identify pathology. per osh pathology identified grade ii astrocytoma. he was apparently hospitalized for 4 weeks, but then needed to be med-evac from la because of the hurricane warnings. he was then transferred to a rehab facility in , (st. medical center). apparently because the patient's ex-wife resided in ma, she requested he be transferred to ma, as he had no friends/family in . during his medical flight to ma, he experienced sob and desaturations and upon landing was taken to an osh ed where he was intubated and later transferred to after a subsegmental pe was identified. he was initially managed in the icu for two days secondary to his respiratory status issues, but after several subsequent stable blood gasses and no further issues with respiration; he was weaned to extubation. after he was extubated, he was transferred to floor status on . neuro-oncology and radiation oncology consults were obtained, and secondary to the inadequacy of documentation provided, it was recommended to pursue an additional biopsy. however, due to lack of legal documentation to identify the ex-wife as the health care proxy, guardianship and guidance was initiated with the legal department. in the interim however, various specialized mri and pet scans were ordered to further interrogate the pathology of his intracranial mass. results are listed previously in this document. his initial pathology was reviewed by another outside pathologist and the slides were sent here for review and the final descision, as above, is a demyelinating process and not oncologic. with this new information he was transfered to the neurology service for further evaluation and treatment. he had an lp which was unremarkable and negative for oligoclonal bands. he had an extensive evaluation for causes. sginificant but unrelated findings incluided evidenve of prior hep b infection and low tsh and eleveated tpo antibody. these findings were discusse with gi and endocrien respectively and recommmended following labs periodically. for his demyelinating lesion he completed 5 days of 1gm/day iv solumedrol and 5 days of ivig without any response. he had another mri without significant change and then underwent cytoxan induction. heme/onc was consulted to help manage this. during induction he was aggresively hydrated, treated with mesna and had daily ua's. he had minimal amount of rbc's in urine which cleared with hydration and resolved after finishing the course of cytoxan. he will follow-up with neurology clinic where they will discuss continuing cytoxan at that time. he should have a follow-up cbc w/dif in 1 week. his discarge neuro exam is significant for abulia, but oriented x3. he has significant left facial weakness, with intact extra-ocular movemnts. perrl and tongue midline. strength exam is difficult due to motor impersistance but on the right side he can move agaist resistance. left ue is flaccid paresis and le is antigravity. he has brisk reflexes on the left side. sensation is intact throughout but he does extinguish with bilateral stimulation. medications on admission: lopressor 50mg folic acid 1mg daily protonix 40mg daily thiamine 100mg daily dilantin 100mg daily decadron 4mg q6h percocet 7.5/325 prn phenergan injection prn discharge medications: 1. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 3. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 4. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 6. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 7. methylphenidate 5 mg tablet sig: two (2) tablet po bid (2 times a day). 8. acetaminophen 160 mg/5 ml solution sig: four (4) tsp po q6h (every 6 hours) as needed. tsp 9. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 10. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). discharge disposition: extended care facility: tower center discharge diagnosis: demyelinating cns disorder discharge condition: neurologically stable discharge instructions: you were admitted because of severe weakness of your left arm and leg. this is from a condition that destroys the lining of your nerves of your brain. you will need regular follow-up with the neurology doctors. followup instructions: cbc w/dif in 2wks provider: . & phone: date/time: 10:00 provider: mri phone: date/time: 12:20 procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung insertion of endotracheal tube diagnoses: malignant neoplasm of brain, unspecified bacteremia multiple sclerosis hematuria, unspecified other pulmonary embolism and infarction streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group b demyelinating disease of central nervous system, unspecified 

Answer: The patient is high likely exposed to