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: aspiration, seizure major surgical or invasive procedure: none history of present illness: patient is an 87 yo spanish speaking woman with dementia (requiring nursing care), diabetes ii, chf, atrial fibrillation who presented to the ed yesterday with seizure like activity in the setting of recent failure to thrive. her family noted a gradual decline over the last few weeks with lethargy/increased confusion, decreased po intake, diarrhea last week, no vomiting or fevers. she was also more confused than normal (baseline does not know where she is, doesn't hold a coherent conversation), no headaches, no vomiting, no dyspnea, chest pains. she last spoke around 1430 and then was being fed dinner and doing poorly when she dropped the fork from her left hand and began shaking the left arm. ems was called, upon arrival ems noted the patient to have l-sided posturing (and enroute l arm shaking for a few seconds/posturing to left side, eyes rolled back) and she was vomiting. past medical history: ftt, iddm, chf, dementia, htn, djd, gerd, anemia, afib, uti. os s/p btka, h/o s/p right thyroidetomy social history: lives at rehab x 7 months, family decided to move her there as she was unable to walk and she was becoming more combative/aggressive, no h/o smoking but did use chewing tobacco 'her whole life' until 2 years ago, no etoh or illicit drugs, from , moved to area in family history: 1 daughter, 2 sons w/dm physical exam: admission: t afebrile bp 120/64 hr 67 rr 16 sao2 100% cvp 2-5 general: elderly woman, intubated/sedated, moves all extremities to stimulation heent: ncat, perrl, eomi cv: irregular rate, no m/r/g appreciable pulm: roncerous. no crackles. abd: soft, non-distended, non-tender, no organomegaly ext: no c/e/c. fingers cold b, b feet warm and well-perfused with 2+ dp pulses neuro: perrl. eomi. sensation intact v1-v3. facial movement symmetric. motor: normal bulk bilaterally. tone normal. no observed myoclonus or tremor no pronator drift reflexes: +2 and symmetric throughout. toes downgoing bilaterally . discharge: t 96.3 bp 121/58 hr 76 rr 20 sao2 89-93% ra, sao2 99% 2l general: elderly woman, alert, speaking spanish but not truley communicating heent: ncat, perrl, eomi, mildly elevated jvp cv: irregular rate, no m/r/g appreciable pulm: ctab, no labored breathing, occ fine crackles in bases bilaterally abd: soft, non-distended, non-tender, no organomegaly ext: no c/e/c. neuro: alert, speaking but not communicative, pneumoboots in place skin; no rashes, pertinent results: admission labs 04:55pm blood wbc-10.7 rbc-4.90 hgb-14.3 hct-46.1 mcv-94 mch-29.2 mchc-31.0 rdw-13.6 plt ct-341 04:55pm blood neuts-67.1 lymphs-24.9 monos-6.2 eos-1.4 baso-0.4 04:55pm blood glucose-198* urean-19 creat-0.7 na-141 k-5.3* cl-99 hco3-18* angap-29* 04:55pm blood alt-16 ast-36 ck(cpk)-52 alkphos-77 totbili-0.7 04:55pm blood ctropnt-<0.01 01:45am blood ck-mb-notdone ctropnt-<0.01 04:55pm blood albumin-4.3 calcium-9.5 phos-4.5 mg-1.7 04:55pm blood tsh-5.9* 01:45am blood free t4-1.2 02:44am blood phenyto-13.2 05:09pm blood glucose-175* lactate-10.0* na-143 k-3.9 cl-100 calhco3-19* 05:09pm blood hgb-14.9 calchct-45 05:09pm blood freeca-1.12 imaging ct pelvis/abdomen-5/5-1. no definite evidence of intra-abdominal acute process. 2. moderate right basilar atelectasis. please note, aspiration or early pneumonia is difficult to exclude given this appearance. 3. cardiomegaly and coronary artery calcification. 4. small hiatal hernia. . ct head -no intracranial hemorrhage or evidence of major vascular territorial infarct. chronic microvascular disease. . mri head - 1. no evidence of acute infarction. multiple flair hyperintense foci in the cerebral white matter, pons, on both sides, most likely representing sequela of chronic small vessel occlusive disease, givent he aptient's age and risk factors. 2. prominent ventricles and extra-axial csf spaces most likely due to age- appropriate parenchymal volume loss. however, superimposed alzheimer's dementia cannot be excluded, given the mild dilation of the temporal horns and small hippocampi. 3. small linear focus of enhancement in the left occipital lobe, seen only on the mprage sequences, could represent a small developmental venous anomaly. however, dedicated mr angiogram was not performed on the present study. this can be considered based on clinical discretion. . eeg -abnormal portable eeg due to the slow and disorganized background and bursts of generalized slowing. these findings indicate a widespread encephalopathic condition affecting both cortical and subcortical structures. medications, metabolic disturbances, and infection are among the most common causes. there were no areas of prominent focal slowing, and there were no epileptiform features . echo--possible small mitral valve vegetation. normal global and regional biventricular systolic function. moderate aortic regurgitation. moderate mitral regurgitation. moderate tricuspid regurgitation. moderate pulmonary hypertension. compared with the prior study (images reviewed) of , severity of valvular regurgitation has increased slightly. pulmonary pressures are higher. the other findings are similar. a transesophageal study may better be able to assess the mitral valve morphology. . cxr's :the endotracheal tube terminates approximately 3 cm from the carina. patient rotation somewhat limits interpretation. lung volumes are low, but pulmonary vasculature does not appear engorged. there is no evidence of pleural effusion. no focal parenchymal opacities are seen in the lungs. the cardiac size, mediastinum and hila cannot be fully evaluated due to patient rotation. :ap single view with patient in semi-erect sitting position demonstrates patient in semi-oblique position towards the right. the dobbhoff line is seen and apparently has not passed the hiatus. otherwise, there is no evidence of any new abnormality, but as before, pulmonary vascular congestion is present and the lateral pleural sinuses are blunted. impression: unsuccessful advancement of dobbhoff line finding resistance in hiatal area. : as compared to the previous radiograph, there is considerable patient rotation. the endotracheal tube, nasogastric tube and central venous access line right have been removed. the lung volumes are slightly smaller than before, there is unchanged mild-to-moderate bilateral pleural effusions and signs suggesting mild volume overload. retrocardiac atelectasis is unchanged. there is no evidence of newly appeared parenchymal opacities. . microbiology data -bcx-staph coag negative 2/3 bottles bcx- negative bxc pending -urine culture negative -csf-cryptococcal ag negative, hsv neg, prot 113, glucose 85, wbc 4 -sputum cx-1+gnr brief hospital course: 89 yo woman with dementia, dm, atrial fibrillation, chf who presented with lethargy/altered mental status, witnessed to have a possible seizure, and admitted to the icu after intubation. . # altered mental status/seizure: eeg showed widespread encephalopathy, ct was negative for acute pathology. per pt's family, pt has a history of seizure in setting of urosepsis. a full infections work up was performed. she was initially on ceftriaxone/ampicillin and acyclovir for concern for meningitis. ceftriaxone/ ampicillin/acyclovir were discontinued. an lp was not suggestive of bacterial or viral infection, hsv negative. blood cultures were negative, only coag nesg staph (positive from the same set) that was likely contaminant. prior to speciation, she was on vancomycin for possible gram positive bacteremia. she also received a tte which did not show any over vegetations - see below. ua and ucx were negative. given her vomiting, it was thought that she may have an aspiration pna. although she had no leukocytosis, no fever and no infiltrate on cxr, she did grow 2+ gnr in her sputum. for this she was on unasyn and vancomycin for possible aspiration pna. an ekg showed no new arrythmia and cardiac enzymes were negative making a primary cardiac event with hypoxia unlikely. a metabolic cause was also thought to be unlikely as electrolytes were normal. head ct was negative for bleeding. mri showed no new pathology. she was followed by neurology. per their discussion, her seizure may have been a manifestation of underly neurodegenerative disease. she was intially given dilantin and then switched to keppra. she was on keppra 500 at discharge. she should be titrated up to keppra 1,000mg on . she had no further seizures but was maintanted on seizure precautions. . # intubation: pt was intubated for airway protection and is required minimal ventilator support. she was easily extubated. . # possible bacteremia: pt was reported to have bcxs with gpcs, prompting concern for endocarditis with septic emboli to brain (neg on mri). an echo showed no overt vegetations but a questionable hyper-echo area on the aortic valve where vegetation could not be ruled out. however, upon clarification with the lab, pt has only bcxs positive with coag neg staph which was likely contaminant. given that further blood cultures were negative and that the coag neg staph was likely a contaminant, no further endocardidtis work up was pursued. she did receive 7 days of vancomycin. her tte was discussed with cardiology who noted that the patient has aortic and mitral valve abnormalities and that if the clinical suspicion for endocarditis is low that these possible vegetations may just be fibrin strands. please draw routine blood cultures on monday and with any fever. if blood cultures are positive, please readmit patient to . . # possible aspiration pna: given the witnessed aspiration event, there was a concern of aspriation pna. she did not have a fever, leukocytosis or infiltrated but did have 2+ gnr on sputum. she was treated with unasyn and vancomycin for 7 days, day 1 was . she received a speech and swallow evaluation which she passed w/o evidence of impaired swallowing. it was ultimately decided that she did not have an aspiration pna w/o fever, leukocytosis or infiltrated and her abx was stopped at 7 days rather than the planned 14 day course. . # acute on chronic systolic congestive heart failure: the patient has a known ef of 40% but was not admitted on any heart failure regimen. she received 6+l in the ed and on day 1 in the micu. she had subsequent volume overload and was diuresed. several days later, she was found to have hypoxia 86% ra, crackles and elevated jvp. a cxr showed pulmonary edema. she was once again diuresed with lasix 10 iv for two days - put out 1.5-2l daily. she was started on low dose lisinopril and every other day lasix without adverse effect, stable creatinine. she did have slightly low k with diuresis which required repletion. she will need chem 7 every other day to monitor sodium, potassium and creatinine. . # hypotension/bradycardia: pt had a brief episode in ed with the rest of vs being stable. this may have been drug effect after intubation or a vagal episode. this has not recurred. . # atrial fibrillation: currently rate-controlled but has had some episodes of rvr. she was maintained on metoprolol and asa 325mg. . # diabetes: her home metformin was held and she was on a humalog sliding scale. metformin was restarted at discharge. medications on admission: metformin 500 vicodin prn flovent 110 albuterol prn tylenol prn robitussin prn prozac 20 daily asa 325 daily seroquel 50mg qam lopressor 25 discharge medications: 1. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 3. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day) for 4 days. 4. keppra 1,000 mg tablet sig: one (1) tablet po twice a day: start after 4 days of keppra 500mg . 5. metformin 500 mg tablet sig: one (1) tablet po twice a day. 6. flovent hfa 110 mcg/actuation aerosol sig: one (1) puff inhalation twice a day. 7. albuterol sulfate 2.5 mg/3 ml solution for nebulization sig: nebs inhalation q6h (every 6 hours) as needed for wheezing. 8. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 9. lopressor 50 mg tablet sig: tablet po twice a day. 10. seroquel 50 mg tablet sig: one (1) tablet po once a day. 11. vicodin 5-500 mg tablet sig: one (1) tablet po every six (6) hours as needed for pain. 12. lasix 20 mg tablet sig: tablet po qod. 13. lisinopril 10 mg tablet sig: one (1) tablet po once a day. discharge disposition: extended care facility: healthcare- discharge diagnosis: seizure acute on chronic systolic congestive heart failure discharge condition: improved discharge instructions: you were admitted for a seizure. you did not have a brain infection or head bleeding. you seizure was most likely due to underlying dementia. you were started on anti-seizure medications. you were started on a low dose and your medications will need to be titrated up. . you were found to have an aspiration pneumonia due to vomiting and received antibiotics. . if you have another seizure, fevers, chill or respiratory distress, you should return to the emergency room. followup instructions: please call your primary care provider to arrange for an appointment in the next two weeks. . this patient has been started on lisinopril and lasix for heart failure. she will need every day chem 7 to monitor her sodium, potassium and creatinine. . please draw routine surveillance blood cultures on monday . md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung insertion of endotracheal tube diagnoses: acidosis esophageal reflux congestive heart failure, unspecified atrial fibrillation other convulsions diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled encephalopathy, unspecified acute on chronic systolic heart failure below knee amputation status senile dementia with delirium 

Answer: The patient is high likely exposed to