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: meningitis major surgical or invasive procedure: lumbar puncture history of present illness: 84y/o f with history of dm, htn, tias () initially transferred from osh after presenting to osh on with sudden onset of l hand numbness x1 minute, which resolved spontaneously. pt was also noted to have elevated bp to 200s. recent head ct was negative; pt was given sc insulin and iv labetalol in ed. pt denied fevers/chills, n/v, diarrhea, cough, bleeding, dysuria, or appetite or weight change. . at osh, pt was initially thought to have hypertensive encephalopathy; mri/mra of brain were unremarkable. pt's bp came under better control the following day, but she also became obtunded. neurology performed lp. csf had 425 wbc with 97% pmns, 3% lymphs. pt developed leukocytosis subsequently, was culture negative. pt was placed on acyclovir, ceftriaxone 1g iv q12, and vancomycin. also developed acute renal failure with decreased urine output; cr climbed from 1.4 on admission to 4.0 on discharge. at osh, pt was seen by renal consultant, who felt that pt likely had atn. pt was also hyperglycemic into 400s with + ketonuria and was placed on insulin gtt with d5. one day prior to transfer to , pt became tachypneic. pt was intubated, and abg was 7.29/29/180. on day of transfer, pt became hypotensive with bp 70/palp. she was started on dopamine with bp increasing to 104/64. pt was then transferred intubated and on pressors to icu for further care. past medical history: 1. dm ii 2. htn 3. tia - r hand and face 4. glaucoma 5. hyperlipidemia 6. vitamin d deficiency social history: married. denies tobacco, etoh, ivdu per osh notes. lives in facility with husband. family history: noncontributory physical exam: vs: t 98.6 144/39 on dopamine 5 mcg/kg/min and levophed 0.175 mcg/kg/min hr 105 23 95% ac 600x14/0.4/5 gen: intubated, sedated neuro: not responsive to noxious stimuli, minimal r corneal reflex, pupils minimally reactive and pinpoint, doll's eyes heent: as above; mm dry cv: rrr, nl s1/s2, 3/6 systolic murmur loudest at base with radiation into carotids; ? radiation into axillae pulm: clear anteriorly, no wheezes or crackles abd: soft, distended, not tympanitic, voluntary guarding, hypoactive bowel sounds, no hsm or masses ext: warm, bounding pulses, 1+ edema bilaterally skin: no rashes pertinent results: osh (): wbc 9.4, hct 35.2, plts 273 na 153, k 3.9, cl 100, hco3 24, bun 15, cr 1.4, glucose 461 trop 0.03 . ekg: 112 bpm, sinus tachycardia; nl intervals and axis; early r wave progression; flattening of t waves in v5-v6, no st elevation/depression . admission labs: . cbc/diff: wbc-30.2*# rbc-3.58* hgb-10.0* hct-31.4* mcv-88 mch-27.9 mchc-31.8 rdw-15.0 neuts-93.0* lymphs-4.4* monos-2.4 eos-0 basos-0.1 plt count-335 . lytes: glucose-199* urea n-35* creat-3.9*# sodium-149* potassium-3.5 chloride-116* total co2-9* anion gap-28* albumin-2.4* calcium-6.7* phosphate-6.8* magnesium-1.2* . ua: color-straw appear-clear sp -1.009 blood-tr nitrite-neg protein-neg glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-5.0 leuk-neg rbc-* wbc- bacteria-mod yeast-none epi-0-2 granular-0-2 fine granular casts . studies: 1) cxr : neg for infiltrate 2) echo : ef 70%, mild 1+mr, no vegetations 3) ct head : abnl bilat foci of hypodensity/edema at -white interface of frontal, parietal, occipital lobes, largest 1.8 cm, ?early abcess; no hemorrhage, no midline shift 4) eeg: no epileptiform activity; slow and disorganized background with continuous burst of delta frequency slowing and bifrontal temp sharp features c/w widespread encephalopathy 5) mri head: multiple acute infarcts in both cerebral and cerebellar hemispheres brief hospital course: 1. meningoencephalitis: on arrival to , the patient was obtunded with a high wbc count and neutrophilic pleocytosis in the csf at the outside hospital, suggesting likely bacterial meningitis/encephalitis, with possible etiologies including s. pneumonia, listeria, or n. meningitidis. given the negative head ct and mri/mra, her acute mental status change was unlikely related to a stroke. at the outside hospital, there was also a concern for hsv meningitis, though an hsv pcr returned negative. she was transferred to on ceftriaxone, acyclovir, and vancomycin. she was continued on ceftriaxone and vancomycin and ampicillin was added for listeria. infectious disease was consulted and they recommended discontinuation of vancomycin. they felt the clinical history was most consistent with listeria, though the patient's csf cultures at the outside hospital remained negative. her initial exam was concerning for decreased brainstem function given the lack of occulocephalic reflex and lack of corneal reflexes. therefore, she was sedated with propofol while she was intubated so that her neurological function could be monitored easily. given her persistent decreased neurological function on hospital day 2, neurology was consulted. dilantin was restarted given the possibility of seizures secondary to irritation from meningoencephalitis. an eeg showed diffuse slowing with frontal temporal sharp features consistent with encephalopathy without evidence of epileptiform activity. a repeat head ct showed multiple hypodense lesions consistent with early abscess. serum cryptoccal and lyme serologies were negative. repeat mri revealed multiple foci of slow diffusion involving both cerebellar hemispheres and cerebral hemispheres predominantly involving the parietooccipital lobes. findings were indicative of multiple acute infarcts and thought likely to be related to inflammation from meningitis causing vasospasms. although the infarcts were considered likely related to inflammation, there was a theoretical concern for endocarditis and septic emboli. the patient had a tte which revealed no valvular vegetations. a tee was attempted, but the patient's posterior oropharynx was small and she had a desaturation event during the procedure. both infectious disease and neurology felt the concern for endocarditis was so low that it did not warrant intubating and sedating the patient for a repeat tee. an lp was repeated and revealed resolution of the pleocytosis, normal protein and normal glucose with negative cultures. neurology suggested mri of the patient's cervical and thoracic spine given the concern for the infarcts and seeding of her spine. this was also attempted, but given claustrophobia, the patient did not tolerate the mri. these have been schedule at an open mri facility after discharge. the patient's mental status improved dramatically throughout her hospitalization. 2. hypotension/sepsis: the patient was hypotensive on transfer to the icu. her hypotension was attributed to sepsis given her elevated lactate and white count. she was transfered on dopamine 5mcg/kg/min and levophed 0.175mcg/kg/min with a cvp low at 8. she responded well to fluid boluses and her pressors were weaned off within the first 24 hours of her admission. a cortisol stimulation test showed adequate adrenal function. she did not require fluid boluses after 48 hours. 3. acute renal failure: the patient was admitted with a creatinine of 3.9. her renal failure was attributed to atn in the setting of hypoperfusion and sepsis. her urine sediment was positive for muddy brown casts. her medications were renally dosed. her creatinine improved to 1.1 by discharge and her urine output picked up considerably as she mobilized her total body fluid and her kidneys recovered. 4. dm2: on transfer, the patient was initially hyperglycemic and required an insulin drip to control her sugars in the setting of the acute infection. during the first 24-48 hours, she was transitioned to an insulin sliding scale with nph. the nph dose was titrated down and eventually discontinued and her glipizide was restarted and titrated up as needed. 5. new murmur: the patient was noted to have a systolic murmur on arrival that was not reported at the outside hospital. this new murmur was concerning for endocarditis versus a high flow murmur from a hyperdynamic state. a transthoracic echo was negative for vegetations, although it did show 1+ mitral regurgitation. on subsequent exams, heart sounds were distant under her coarse breath sounds, so it was difficult to assess the presence or abscence of the murmur. given that all of the blood cultures were negative, endocarditis seemed less likely. as noted above, the patient did not tolerate a tee and it was decided to forgo further testing as the suspcion for endocarditis was quite low. 6. anemia: at the outside hospital, she had a drop in hematocrit from 35 to 26 and was 31 on arrival. she had normal hemolysis labs. she was quaiac positive, suggesting a slow gi bleed. her hematocrit drifted down during this admission, which was partially due to dilution with agressive fluid resuscitation and partially due to the gi source. she was transfused for a hematocrit less than 25. after transfer to the medicine service, her hematocrit remained stable throughout the remainder of her admission. 7. hypertension: once she was adequately fluid resuscitated and her sepsis treated and sedation stopped, the patient became hypertensive to the 200s. she required numerous doses of iv metoprolol to lower her pressure. she was also loaded with po metoprolol, which was titrated up. she was subsequently restarted on her hydrochlorothiazide and valsartan with good control of her blood pressure. 8. abdominal distention: the patient had initial abdominal distension and hypoactive bowel sounds without evidence of an acute abdomen. an abdominal plain film was negative for free air or obstruction. as she had bowel movements, her abdominal distention improved. 9. metabolic acidosis: the patient presented with an anion gap of 24 and a barcarbonate of 9. this indicated that she had both an anion gap and a non-gap acidoses. factors contributing to her acidosis are lactic acidosis, possible ketoacidosis, and uremia. since her bicarbonate was low, she was given bicarbonate in her fluids. her acidosis improved within 24 hours of admission. 10. fen: the patient was initially continued on tube feeds. once extubated, the patient passed a speech and swallow evaluation and was given a cardiac diet with thin liquids and regular solids. she episodically complained of pills "getting stuck" though was able to tolerate her food. a barium swallow may be considered as an outpatient. medications on admission: on transfer: insulin drip ns with nahco3 at 150cc/hr versed drip glucotrol xl 10mg po daily (held) hctz 25mg po daily (held) plavix 75mg po daily lipitor 10mg po daily protonix 40mg po daily lumigan ou 1 gtt daily dilantin 100mg iv q8 acyclovir 10mg/kg iv q24 ceftriaxone 1g iv q12 vancomycin 1g iv q24 flagyl 250mg iv q12 sc heparin bumex 2mg iv q12 zaroxolyn 5mg iv q12 discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. atorvastatin calcium 10 mg tablet sig: one (1) tablet po daily (daily). 3. metoprolol tartrate 50 mg tablet sig: 1.5 tablets po tid (3 times a day). 4. valsartan 160 mg tablet sig: one (1) tablet po daily (daily). 5. glipizide 5 mg tab, sust release osmotic push sig: three (3) tab, sust release osmotic push po daily (daily). 6. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day): until ambulating. 7. albuterol sulfate 0.083 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 8. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for shortness of breath or wheezing. 9. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po daily (daily). 10. furosemide 40 mg tablet sig: one (1) tablet po once a day. 11. ampicillin sodium 2 g recon soln sig: two (2) grams injection q6h (every 6 hours) for 3 days. 12. ceftriaxone sodium 1 g recon soln sig: one (1) gram intravenous twice a day for 3 days. 13. phenytoin sodium extended 100 mg capsule sig: one (1) capsule po tid (3 times a day). 14. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 15. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 16. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 17. heparin lock flush (porcine) 100 unit/ml syringe sig: one (1) ml intravenous daily (daily) as needed for 3 days: into central venous line. 18. outpatient mri please perform open mri of brain, cervical spine and thoracic spine. this is an 84yo female patient with history of dm and htn who was admitted to with meningoencephalitis with evidence of small cortical infarcts on previous mri (done while intubated). please evaluate status of infarcts and look for abscess on c- and t-spine mri. fax the results of the mris to: the patient's pcp, , md: fax number , office number ( fax the results to neurologists , md , md: fax number , office number . you should also send a copy of the films to drs. and at . , . attention: dr. in neurology discharge disposition: extended care facility: for the aged - acute rehab discharge diagnosis: primary diagnoses: 1. meningoencephalitis 2. acute tubular necrosis secondary diagnoses: 1. hypertension 2. diabetes mellitus 3. tia discharge condition: good discharge instructions: you are discharged to a rehabilitation facility where you should continue all medications as prescribed. please alert the staff there or contact your primary care physician if you experience headache, visual changes, fevers, chills, night sweats or other concerns. please keep all follow-up appointments. followup instructions: please schedule a follow-up appointment with your primary care physician . within two weeks after discharge. (. his office does not open again until tuesday, . you have a follow-up appointment with neurologist dr. on at 4:00pm. you have an open mri of the brain scheduled for friday, at 1:15pm at shields mri. there will also be a cervical mri on at 9:00am and a thoracic mri on at 2:00pm. this is located at in . . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung enteral infusion of concentrated nutritional substances transfusion of packed cells infusion of vasopressor agent diagnoses: acidosis anemia, unspecified acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension unspecified septicemia severe sepsis acute respiratory failure septic shock paralytic ileus other encephalopathy hyperosmolality and/or hypernatremia cerebral artery occlusion, unspecified with cerebral infarction other malaise and fatigue diabetes with ketoacidosis, type ii or unspecified type, not stated as uncontrolled lack of coordination unspecified causes of encephalitis, myelitis, and encephalomyelitis 

Answer: The patient is high likely exposed to