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: ibuprofen attending: chief complaint: headache, blurry vision and hd line displacement major surgical or invasive procedure: hd tunneled line placement history of present illness: this is a 31 yo male with h/o biliary atresia s/p liver age 4, now again with cirrhosis, esrd on hd, awaiting liver/kidney , recently discharged with klebsiella bacteremia and mssa cellulitis, completed abx therapy on tuesday, who presented to the ed after his hd catheter fell out. he reported nausea, vomiting, and dark stools. he also reported "white vision" as well while in the ed. . in the ed, initial vs: 98.2 f, bp 131/83, hr 108, r 21, o2-sat 98% ra. given the visual changes, patient had an initial head ct which was negative. neurology evaluated the patient and recommended an mri/mra. that was also obtained in the ed with multiple cortical/subcortical infarcts which could be consistent with septic emboli. the patient was being evaluated by ophthalmology for the visual loss, and while he was being examined, the patient had a seizure. ativan 1 mg x 1 was given, and the patient was then noted to be post-ictal and not following commands. he was placed on a nrb for his o2 sats. at 4 pm, when he was re-evaluated by neurology, he was following come commands, and also was moving all extremities. lp was not performed in the ed because consent could not be obtained while patient was post-ictal. he was given vancomycin and 2 gm ctx in the ed for meningitis coverage. he is also being given ampicillin as well. the patient also had a new hd catheter placed and a new post pyloric tube placed by ir while he was in the ed as well. blood cultures were drawn and pending. neurology recommended a repeat head ct while he was in the ed, which was performed prior to transfer. he was also loaded with keppra, 500 mg x 1, followed by repeat 500 mg in 4 hours, followed by 500 mg daily with add'l 500 mg after hd. leni's were also ordered in the ed given his h/o of r to l shunt on prior echo with bubble study and were negative for dvt. an echo was also ordered, but not done prior to transfer. id was notified of the patient's admission and agreed with the above antibiotic regimen. . currently, patient appears comfortable. ha still present but unchanged from earlier in the day. otherwise denies pain, denies blurred vision. states he is hungry, eager for dinner. generally speaks in simple sentences but is cooperative with exam. past medical history: -biliary atresia s/p liver at age 4 (25 years ago) -asthma, well-controlled -right hip avascular necrosis, per ortho may need thr -postinfectious glomerulonephritis s/p renal biopsy showed igg dominent exudative proliferative gn, c/w postinfectious gn -nephrotic syndrome (4.1g proteinuria), hypoalbuminemia -small bowel resection social history: denies any tobacco, etoh or illict drug use. lives at home with parents. has one child with a prior girlfriend. does not work. family history: nc physical exam: vitals - t: 98.4 bp: 132/92 hr: 102 rr: 22 02 sat: 95% on ra general: awake, oriented to , date, in nad laying in bed in micu at time of exam heent: no cervical lad, no thyroidmegaly, neck supple, no jvd, hd catheter in place r neck cardiac: tachycardic to ~100, regular, no clear murmur lung: cta bilaterally abdomen: soft, nt/nd, +nabs, no organomegaly ext: pitting edema of le bilaterally, 2+ radial and dp pulses b/l neuro: strength 5/5 in ue and le; sensation grossly intact b/l, cn ii-xii intact, although eye movements (vertical and horizontal) are not smooth (unclear whether patient has difficulty following commands; looks away frequently during exam). no babinski. patellar reflexes difficult to assess (given absence of reflex hammer) but are present and equal (+). derm: multiple (dozens) discrete skin lesions on arms, abdomen, lower legs that appear to be the result of scratching/excoriations, scabbed over, some with surrounding erythema suggestive of possible superinfection. no lesions on back where patient is unable to reach. marks on lower spine where lp was attempted. well-healed scars on abdomen from at age 4. pertinent results: 04:10pm glucose-95 urea n-20 creat-2.3* sodium-137 potassium-3.5 chloride-103 total co2-25 anion gap-13 04:10pm calcium-8.0* phosphate-5.7*# magnesium-2.0 11:00am ck(cpk)-49 11:00am ctropnt-0.01 04:00am ascites wbc-45* rbc-1605* polys-0 lymphs-70* monos-0 mesotheli-0 macrophag-30* 12:19am glucose-115* lactate-1.9 na+-139 k+-3.3* cl--101 tco2-30 12:05am glucose-119* urea n-15 creat-2.1* sodium-138 potassium-3.4 chloride-103 total co2-28 anion gap-10 12:05am alt(sgpt)-13 ast(sgot)-40 ck(cpk)-57 alk phos-418* tot bili-0.7 12:05am lipase-28 12:05am albumin-1.2* calcium-7.6* phosphate-3.5 magnesium-1.8 12:05am asa-neg ethanol-negimpression: mr : 1. multiple foci of acute infarction in both cerebral hemispheres. the wide, inter-territorial distribution and uniform temporal appearance of the lesions, in this clinical context, are strongly suggestive of "watershed" infarction; an embolic etiology is less likely. 2. normal mra and mrv of the brain and mra neck. acetmnphn-8.0* bnzodzpn-neg barbitrt-neg tricyclic-neg . repeat mr : impression: evolution of previously seen foci of decreased diffusion. the distribution may represent a combination of a "watershed" type infarct related to hypoperfusion and embolic (either bland or septic) phenomenon. however, there is no new infarct identified. eeg: this is an abnormal noncontinuous extended routine eeg due to slowing and disorganization of the background rhythm and bursts of semirhythmic, moderate voltage, bifrontally predominant generalized theta/delta activity. the first finding suggests a mild to moderate encephalopathy. medications, toxic/metabolic disturbances, and infections are common causes. the generalized slowing suggests possible deep or midline dysfunction. no epileptiform discharges or electrographic seizures were seen during this recording and this telemetry captured no pushbutton activations. tee: no thrombus is seen in the left atrial appendage. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the ascending, transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque to 30 cm from the incisors. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mass or vegetation is seen on the mitral valve. moderate (2+) mitral regurgitation is seen. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. . mri l spine: impression: no valvular vegetations seen. moderate mitral regurgitation. normal biventricular function.impression: 1. diffuse central clumping of the cauda equina in this patient with a congenitally narrow canal. the findings suggest arachnoiditis and are similar to the prior study. 2. severe canal narrowing just inferior to the l4-5 disc space secondary to osseous proliferative changes and epidural lipomatosis. 3. moderate bilateral subarticular zone narrowing at l4-5 with what appeared to be mildly swollen bilateral l5 roots. 4. bilateral l5 spondylolysis with fluid clefts and surrounding edema is most likely all degenerative. no drainable fluid collection is identified and the lack of interval change from the study one month prior makes infection unlikely though should be correlated with clinical findings. . brief hospital course: mr was admitted for (1) replaced of his tunneled line and (2) a constellation of neurological findings including headache, changes in vision, and while in ed, a seizure. he was admitted to the icu for airway protection and loaded with keppra. eeg was negative for epileptiform activity. two micu teams attempted an lp however they were unsuccessful in obtaining fluid. he was empirically started on antibiotics for meningitis, however all of his symptoms acutely resolved. he was transferred to the floor where repeat eeg again was non-epileptiform although showing nonspecific activity in the occipital area. an mri showed evidence for embolization; septic emboli was a possibility, however other embolic phenomena were also a possibility, given that embolization could have occured at the moment of displacement of his hd line. the presence of av shunts secondary to hepatopulmonary syndrome would have allowed for migration of venous emboli. infectious work up repeatedly revealed negative blood and urine cultures. chest x-ray was unremarkable. mri of l spine given prior fluid collection was not suspicious for infection. peritoneal fluid was negative for sbp. tee was negative for vegetations. repeat mri showed continued presence of previously seen mri but again was not necessarily consistent with septic phenomena. given resolution of symptoms, antibiotics were discontinued and he continued to remain at his baseline. keppra was continued given his prior seizure with instruction to discontinue keppra after 2 weeks if no seizure event occured. follow up with renal, neurology, and opthamology was obtained and time of discharge. medications on admission: albuterol sulfate inhaler every 6 hours prn furosemide 20 mg by mouth once daily ipratropium bromide 1 daily prn lactulose 30 ml up to 1 times daily (written for up to 4times daily but doesnt need it) metoprolol 25mg twice daily oxycodone 5 mg q8 hours prn pain reglan 1 tablet 4 times a day sucralfate 10 ml 4 times a day tacrolimus 0.5 mg twice daily. caltrate 600 plus vit d omeprazole 40mg twice daily lidoderm patch 5% on low back discharge medications: 1. lactulose 10 gram/15 ml syrup sig: thirty (30) ml po q6h (every 6 hours) as needed for titrate to 3 bms daily. 2. tacrolimus 0.5 mg capsule sig: one (1) capsule po daily (daily). disp:*30 capsule(s)* refills:*2* 3. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). disp:*30 cap(s)* refills:*2* 4. levetiracetam 500 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. levetiracetam 500 mg tablet sig: one (1) tablet po hd protocol (hd protochol): please take 1 tablet during hemodialysis . disp:*30 tablet(s)* refills:*2* 6. metoclopramide 10 mg tablet sig: 0.5 tablet po qidachs (4 times a day (before meals and at bedtime)). 7. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 8. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). disp:*30 tablet(s)* refills:*2* 9. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 10. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 11. camphor-menthol 0.5-0.5 % lotion sig: one (1) appl topical qid (4 times a day) as needed for itchiness. 12. cholecalciferol (vitamin d3) 400 unit tablet sig: two (2) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 13. calcium acetate 667 mg capsule sig: one (1) capsule po tid w/meals (3 times a day with meals). 14. oxycodone 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 15. sucralfate 1 gram tablet sig: one (1) tablet po qid (4 times a day). discharge disposition: home with service facility: vna southeastern ma discharge diagnosis: 1. emboli to brain causing seizure, nausea/vomiting, blurry vision - now clinically resolved, unlikely septic, more likely ischemic 2. cirrhosis secondary to congenital biliary atresia 3. end stage renal disease secondary to post-strep gn on hemodialysis discharge condition: stable for home, saturating normally at room air. discharge instructions: dear mr , it was a pleasure caring for you while you were at . you were admitted because your line fell out; you also experienced multiple symptoms including nausea, vomiting, and blurry vision. you also had a seizure while you were here. we performed an imaging study of your brain which showed several areas that were concerning for a stroke or infection. because we were worried about infection, we performed several studies to search for an infectious source, however we could not find any sign of infection in your body. we did briefly start you on antibiotics but your symptoms cleared spontaneously, which suggests that this is less likely to be an infection. for this reason, you do not need to take antibiotics when you go home. . because you had a seizure, we started you on a medicine called keppra, which helps prevent seizures. you should continue to take this medicine for another two week period. this helps to prevent further seizures. if by the end of two weeks, you have had no further seizures, neurology can help you to stop this medicine. you will need to see neurology as an outpatient. your follow up appointments are scheduled below. . the medication changes we made during this hospitalization are: (1) we started you on keppra 500 mg daily. you should continue to take this daily and you will also receive it just prior to hemodialysis. (2) instead of taking tacrolimus 0.5 mg twice a day, you should take tacrolimus 0.5 mg daily in the morning. (3) you should take nephrocaps 1 capsule daily every morning. this medicine is good for your kidneys. (4) we have decreased your metoprolol dose to 12.5 mg twice a day. (5) we have decreased your omeprazole to 40 mg daily. (6) we started you on vitamin d 800 units daily. followup instructions: 1. please follow up with dr from neurology on at 230 pm at the clinic at . 2. please follow up with your liver doctor at 1 pm. if you have any questions regarding this appointment, please call . 3. please follow up with opthomology at given your vision difficulties. please call to set up this appointment at your earliest convenience. procedure: spinal tap incision of lung enteral infusion of concentrated nutritional substances hemodialysis venous catheterization for renal dialysis percutaneous abdominal drainage diagnoses: end stage renal disease renal dialysis status cirrhosis of liver without mention of alcohol unspecified protein-calorie malnutrition other convulsions nausea with vomiting other specified cardiac dysrhythmias other ascites cerebral embolism with cerebral infarction encephalopathy, unspecified complications of transplanted liver surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation precipitous drop in hematocrit profound impairment, both eyes, impairment level not further specified 

Answer: The patient is high likely exposed to