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: penicillins attending: chief complaint: fluent perseverative speech, confusion major surgical or invasive procedure: intubation () history of present illness: is an 81-year-old man with history of htn, hld, prostate transferred from osh for seizure. history is obtained via chart review as patient is intubated. he was at physical therapy this am for his left shoulder when he became confused, repetitive, and could not follow commands. this started at 09:40. when asked his name, he would respond, ", my name," and would move all extremities on his own and speech was clear although he remained "confused." he was taken via ems to ed and en route he had a seizure lasting 45-60 seconds and then was thought to be post-ictal afterwards. his fs was 90 and was thought to be in afib with a possible run of vtac per ems while en route. upon arrival to ed, t 96.7 p 80 rr 16 bp 140/67 100% on nrb. he was noted to be non-verbal, un-arousable, and unresponsive, with gaze to the right. after arrival he had another witnessed seizure in the ed, possibly lasting 30 seconds. he received a total of 4 mg ativan, 1 g dilantin, and then was intubated receiving etomidate, succinylcholine and propofol. a ct head prior to transfer was unrevealing. bp was transiently up to 216/99 p 119 prior to transfer. per his pcp (dr. ) he has no history of seizure, stroke, or cns infections and is a bright and independent person at baseline. per ems note he may have had a similar episode last month and was seen at for that. past medical history: cardiovascular - htn, hld oncologic - prostate ca (treated > 10 years ago) social history: lives with wife. family history: not known physical exam: at admission: gen; lying in bed, intubated heent; nc/at, ett in place cv: rrr, ii/vi sem pulm; cta anteriorly abd; soft, nt, nd extr; no edema skin; multiple ecchymoses on arms neuro; ms; (off propofol x5 minutes) eyes closed but grimaces and briefly opens eyes to noxious. does not follow any commands or attempt to speak. cn; eyes conjugate in midposition, pupils 3mm and minimally reactive. does not blink to threat. brisk corneals b/l. face obscured by ett. + gag. motor; normal bulk, increased tone in legs b/l. spontaneously moves arms and briskly withdraws all extremities to noxious stimuli. reflexes; 1+ and symmetric at biceps, brachioradialis, and patellars. toes upgoing b/l. __________________________________________________________ at discharge: pertinent results: eeg - impression: this extended routine video eeg telemetry captured no pushbutton activations. automated and routine sampling captured several brief runs of sharp and slow wave discharges but no clinical correlate. the interictal period showed one every 1-1.5 second periodic epileptiform discharges over the left hemisphere. the background otherwise showed a well-organized posterior predominant rhythm on the right and generalized delta and theta frequency slowing over the left hemispheric leads. cxr - impression: endotracheal tube ends approximately 5 cm above the carina. given low lung volumes, bibasilar opacities likely represent atelectasis, although pneumonia cannot be excluded. eeg - impression: this is an abnormal continuous icu video eeg telemetry due to a few brief electrographic seizures with no clinical correlation all occurring between 9:00 and 10:00 a.m. the interictal period showed one every 1-1.5 second periodic lateralized epileptiform discharges (pleds) over the left hemisphere. the background otherwise showed a well- organized posterior predominant rhythm on the right and generalized delta and theta frequency slowing over the left hemispheric leads. these findings are consistent with an epileptogenic focus in the left hemisphere related to an underlying structural lesion. the eeg was improved compared to previous day's recording as the electrographic seizures were shorter and less frequent. mri brain c/s contrast - impression: 1. t2 hypointense focus in the posterior aspect of the left thalamus with slowed diffusion and mild contrast enhancement, most likely representing a subacute infarct. with regard to enhancement, a followup study should be scheduled in four to six weeks to definitely rule out underlying mass such as lymphoma. 2. evidence of global cerebral volume loss as well as sequela of chronic small vessel ischemic disease. mri/mra/mr - brain mri: there are now new acute infarcts identified in the left posterior temporal and occipital regions since the previous study. the previously seen left thalamic infarct has evolved. there are no definite new infarcts identified in the right cerebral hemisphere. previously noted changes of small vessel disease and brain atrophy are seen. there is no midline shift. there is no evidence of abnormal parenchymal, vascular, or meningeal enhancement seen. the mr increase in time to peak in the left occipital lobe, corresponding to the region of infarct. no definite decreased blood volume is appreciated. subtle increase in the time to peak is identified in the right occipital lobe. impression: 1. acute infarcts are now seen in the left posterior temporal and occipital lobes. no definite new infarcts are seen in the right cerebral hemisphere. 2. no enhancing brain lesions or mass effect is seen. otherwise, the mri of the brain is not changed since the previous study. 3. increased time to peak is identified in the left posterior temporal and occipital lobes corresponding to the infarcts seen and could indicate ischemia. subtle increased time to peak is identified in the right occipital lobe which could indicate ischemia in the right occipital region. however, no definite new infarct is seen in this region. mra head: the head mra normal flow signal in the arteries of anterior and posterior circulation without stenosis or occlusion. impression: normal mra of the head. eeg impression: this is an abnormal continuous icu video eeg telemetry due to two electrographic seizures in the right hemisphere maximum at t4 and p4 correlating with no clinical correlation on video. also there were periodic lateralized epileptiform discharges (pleds) over the left hemisphere. the background otherwise was markedly suppressed and slow over both hemispheres occasionally reaching low amplitude theta frequency intermixed with delta. these findings are consistent with independent epileptogenic foci in both hemispheres likely related to underlying structural lesions. after 21:00, a burst suppression of background was seen related to midazolam administration. compared to prior day's eeg, there were fewer and shorter electrographic seizures. tte w/bubble study the left atrium is moderately dilated. no atrial septal defect is seen by 2d or color doppler; single bubble contrast injection negative for right to left shunt at atrial level. no late contrast is seen in the left heart (suggesting absence of intrapulmonary shunting). there is mild symmetric left ventricular hypertrophy. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef 70%). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. there are three aortic valve leaflets. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis (valve area 1.2 cm2). the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is moderate pulmonary artery systolic hypertension. there is no pericardial effusion. if clinically indicated, a transesophageal echocardiographic examination is recommended. impression: suboptimal image quality. no obvious intracardiac mass or shunt. however, due to the technically suboptimal nature of this study, a cardiac source of embolus cannot be excluded. if clinically indicated, a transesophageal echocardiogram (with or without bubble study) is recommended to exclude cardiac source of embolus. carotid duplex series impression: right ica with stenosis 40-59%. left ica with stenosis 60-69%. antegrade bilateral vertebral artery flow. eeg , m 81 neurophysiology report eeg study date of object: roe, ekg, video, to . referring doctor: dr. findings: abnormality #1: the background is markedly abnormal. it shows, for the vast majority of the record, that the two hemispheres appear to be working relatively independently of each other. over the left hemisphere, there is a fairly persistent pseudoperiodic spike and wave and sharp slow wave discharge broadly present across the left posterior quadrant maximum in the region of the occipital pole. these discharges occur every two to four seconds and interposed between them is a period of marked electrical suppression. the bursts, themselves, in addition to having an epileptiform transient have frontal central irregular theta and suppression of electrical activity except for the spike wave discharge posteriorly. the right hemisphere has similar pseudoperiodic bursting but no clearly identified epileptiform transients. the periods vary from two to six seconds in duration and appear to be occurring relatively independently of the activity on the left. there is also marked suppression of electrical activity in the posterior quadrant on the right when the bursts themselves occur. at about 2:30 in the morning, the amplitude of the background bursts seem to increase slightly and there appeared to be more frequent synchronization between the two hemispheres. sleep: no cycling of sleep activity was identified. pushbuttons: there were no pushbuttons. seizure detections: did not detect any sustained events. automated interictal files: almost all of the occipital sharp discharges from the left were detected. cardiac monitor: shows a regular rhythm. impression: this eeg gives evidence for an extremely severe diffuse encephalopathy that, curiously, appears independently in the two hemispheres. the right hemisphere appears to be a burst and burst suppressive pattern with no clear epileptic features. the left is a similar pattern seen with a different periodicity to the right and with an occipitally predominant broadly based epileptiform discharge seen with most of the bursts. there were no sustained seizures and most of the effect in the burst and burst suppressive pattern may very well reflect the effects of systemic medication. ue us - impression: left distal cephalic venous thrombosis. eeg impression: this eeg continues to show a severe diffuse encephalopathy. in comparison to the previous 24 hours, most of this record was synchronous over the two hemispheres and there was little epileptiform activity from the left after 22:00 and, overall, it appears to be a slight improvement to the record. the pattern is still most in keeping with drug effect. eeg impression: this tracing still shows a fairly significant diffuse encephalopathy although the suppressive bursts appear to be somewhat shorter, particularly near the end of the record, on the morning of the 15th. on the morning of the 14th, there was one brief electrographic seizure from the right central temporal region that was not associated with a clinical accompaniment. eeg impression: this eeg did not capture any electrical evidence for sustained seizure discharges. a few isolated left occipital discharges were still seen but they occur very infrequently. the tracing is still compatible with a moderate to moderately severe diffuse encephalopathy with a bursting pattern of electrical activity and suppressive bursts. no clear laterality, except for the occipital discharges, was noted. eeg impression: this eeg gives evidence still for a moderately severe diffuse encephalopathy with suppressive bursts and intervening activity that appears more normal than on previous studies but still shows leftsided slowing, particularly over the more posterior aspects of the left hemisphere admixed with interictal sharp and epileptic spike discharges relatively infrequently in the left occipital pole. it should be noted that there was one brief electrographic seizure discharge from the right temporal central region lasting about 30+ seconds that appeared to be without any electrographic correlate. eeg impression: this eeg gives evidence for both encephalopathic as well as multifocal abnormalities. the encephalopathic features are loss of normal background and suppressive bursts. the epileptiform activity was seen in the left occipital pole and right mid-temporal and there appears to be fairly discrete right lateral temporal slow wave abnormality suggestive of additional structural pathology in that region. nchct - impression: 1. no evidence of hemorrhage, mass effect or shift in normally midline structures. 2. evolution of known left parieto-occipital infarction, compared to previous studies. 3. poorly-defined hypodensities in the superficial aspect of the right posterior occipital lobe; additional infarction (presumably, embolic) at this site is not excluded. eeg impression: this 24-hour recording shows a fairly persistent posterior left temporal slow wave focus suggestive of a subcortical structural lesion. the left occipital relatively rare epileptiform transients seem to increase significantly throughout the course of the record, both in their frequency of occurrence as well as their distribution. no sustained seizures, however, were identified and the background continues to be a diffusely abnormal encephalopathic pattern. brief hospital course: 81 yo m h/o htn, hl, prostate ca p/w perseverative and fluent speech disturbance and two convulsive seizures with post-ictal lethargy and confusion and left hemisphere seizure activity, likely secondary to a subacute posterior thalamic ischemic stroke. status epilepticus - at the osh, he was given 4 mg of lorazepam, 1000 mg of phenytoin, was intubated at the outside hospital, and was sedated with propofol. phenytoin was switched to fosphenytoin at transfer, and he was given an additional 500 mg iv since his phenytoin was subtherapeutic. he had evidence of 20 second runs suggesting left hemisphere seizure activity and pleds despite the second loading dose. valproate sodium was added for further seizure suppression. he was initially treated empirically for hsv encephalitis, but his lp cell counts were not suggestive of infection and his hsv pcr was negative. his mri revealed a subacute left posterior thalamic ischemic stroke which may correlate with an antecedent event three weeks prior to admission when he was noted to be confused with right arm symptoms (described as pain at that time). he was started on aspirin and continued on his home medications for hypertension. a second , valproate sodium, was added for further suppression as he was continuing to have frequent pleds. his propofol was then weaned for possible extubation but he remained quite lethargic. overnight on , he had electroencephalographic seizures affecting the right hemisphere as well as report of nonrhythmic arm and leg movements. we opted to switch from propofol to midazolam (as the patient was requiring ivf boluses to maintain blood pressure) and uptitrate for burst suppression. concerned for new lesions, we obtained a repeat mri with mra and mr to identify a seizure focus (mr spectroscopy was not readily available due to requirements to transfer the patient to another campus for which the patient was not stable enough). while the patient's midazolam was being uptitrated, he had one 60 second right hemisphere electroencephalographic seizure at 20 mg/hr overnight on , but seizures where suppressed at 25 mg/hr. he had additional electroencephalographic evidence of seizures on , so levetiracetam 500 q12h was started as a third antiseizure . he did not have any more eeg evidence of seizures over and but did on ; epilepsy recommended to wean off the midalazom infusion and valproate sodium. he was successfully weaned from the midazolam infusion with gradually returning background activity, and we started simplifying his antiseizure regimen under close observation in the icu. he was maintained on fosphenytoin and levetiracetam. his eeg gradually showed more return of background activity but continued to show sharp discharges from the left occipital lobe. his clinical exam very slowly recovered, first with brainstem reflexes and subsequently increased motor response to noxious stimuli and then eye opening. however, he never recovered the ability to attend to the examiner or follow commands. acute subacute ischemic stroke - his initial mri revealed a subacute stroke, likely affecting the left posterior choroidal artery. we suspected this event was likely the result of small vessel disease (hypertension), but artery-to-artery and cardioaortoembolic etiologies are also possible. as this event was subacute, he was started on an antiplatelet and kept normotensive. however, in light of the additional seizure activity, we pursued further imaging with a repeat mri which revealed an acute ischemic infarction of the left occipital and temporal lobes, possibly the event that triggered the initial series of seizures. this was more strongly suggestive of artery-to-artery or , we pursued a carotid/vertebral artery ultrasound and tte. we increased his aspirin from 81mg to 325mg and kept him normotensive. given the distribution of strokes suggesting an embolic source and normal vessel imaging with a report of afib en route to the osh, he will likely need anticoagulation for stroke prevention; he has a chads of 4. he started him on a heparin gtt. klebsiella pneumonia - on , the patient had two episodes of o2 desaturations in the setting of fever. he was found to have 4+ gnr which were identified as pan-sensitive klebsiella. he was treated with cefepime 2gm q12h initially, but his antibiotics were broadened to cefepime, vancomycin and tobramycin due to worsening of his infection with increased leukocytosis. acute kidney injury/acute tubular necrosis - the patient's renal function worsening from (peak of 2) in the setting of relative hypotension in the setting of his pulmonary infection requiring pressors and fluid boluses. his renal us was negative for obstruction or hydronephrosis and his fe urea was most consistent with atn, likely from hypoperfusion. his fluid status was monitored closely and his blood pressure stabilized. his antihypertensives were held. his renal function improved back to cr 1.3 and he required further diuresis but continued to show signs of (to cr 3.1) whenever diuresis was pursued. he had anasarca and significant volume overload including pulmonary congestion which did not permit downtitration of his ventilator settings, yet his kidneys would not tolerate pharmacologic diuresis. liver dysfunction - the patient has a noted mild coagulopathy and synthetic dysfunction (low albumin), likely contributing to his third-spacing and peripheral edema. his wife agreed that as a young man it is likely that he had consumed excess amounts of alcohol, and he most recently was still drinking glasses of hard liquor at a time. this baseline liver dysfunction has likely contributed to both his volume overload as well as his prolonged sedation from midazolam. goals of care - several discussions with the wife , , and other family members were held which revealed hope regarding the patient's prognosis but also understanding of the severity of his illnesses. in discussions with the family on , it was found that he actually had a living will which indicated that he would want to be dnr/dni. the family came to the hospital on and decided to make the patient dnr/dni with goals of care directed toward comfort measures only. he was extubated and placed on a morphine infusion for pain and air hunger. he passed away on at 3:30 pm of hypoxic respiratory failure. his family was notified and declined autopsy. medications on admission: -tricor 145 mg daily -zocor 80 -lisinopril 20 daily -folate 1 mg -norvasc 5 mg daily discharge medications: n/a discharge disposition: expired discharge diagnosis: seizures, status epilepticus subacute ischemic stroke discharge condition: deceased discharge instructions: n/a followup instructions: n/a procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus diagnoses: acute kidney failure with lesion of tubular necrosis unspecified pleural effusion friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site acquired coagulation factor deficiency hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation personal history of malignant neoplasm of prostate chronic kidney disease, unspecified other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure acute respiratory failure grand mal status cerebral embolism with cerebral infarction hyperosmolality and/or hypernatremia ventilator associated pneumonia alcoholic liver damage, unspecified 

Answer: The patient is high likely exposed to