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: seizure major surgical or invasive procedure: none history of present illness: 80 y/o m with questionable seizure disorder, parkinson's on sinemet, recently diagnosed uti on ciprofloxacin transferred from osh following witnessed tonic clonic seizures x 2. . per medical records, patient c/o progressive right lower extremity weakness with painful leg spasms x 2- 3mths. due to impaired mobility, he was unable to take care of himself at home and had several subsequent falls. also according to notes, he was displaying increasingly aggitated behavior/ unstable mood. he initially presented to an osh on and was evaluated with negative ct head and mri spine. his symptoms were attributed to parkinson's dx and his dose of sinemet was increased. he was discharged to a nursing home. . at his nursing home, 2 days prior, he was noted to have cloudy/ foul smeeling urine and was dx with pansensitive citrobacter uti, and started on ciprofloxacin. this afternoon, he had witnessed tonic clonic seizures x 2 lasting less than 2 min each at nh. he was initially brought to an osh and sent to for neurologic evaluation. . vs at : were t 97.4 hr 107 bp 118/73 rr 18 spo2 100% 2l. his exam was notable for poor attention and confusion with initial labs revealing leukocytosis to 24.9 with grossly positive u/a. due to recent seizure activity, he was placed in a c- collar and cleared with a ct c-spine with clinical exam. neurology evaluated patient in ed and felt that most of his symptoms were due to his underlying infection. past medical history: parkinsonism anxiety htn seizure disorder social history: recently moved to nursing home. his y/o mother is his healthcare proxy and former primary caregiver. , smoking or ivda. family history: non-contributory. physical exam: admission exam: vs: temp: 97.4 hr: 107 bp: 118/73 rr: 18 sao2: 100% 2l gen: elderly, chronically ill appearing male heent: masked facies, b/l erythematous conjunctiva with purulent discharge around r eye, perrl, eomi, anicteric. dry oral mucosa with dentures in place and moderate amt dried mucus secretions plastered to upper palate neck: trachea midline, jvp at base of neck resp: cta b/l with good air movement throughout cv: tachycardic s1 and s2 wnl, no m/r/g abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e +2 dp pulse skin: no rashes/no jaundice/no splinters neuro: aaox2 (not to place- thought ). r sided facial droop. strength 4/5 right upper and lower extremity. grosly intact to light touch. +3 dtr throughout right with upgoing toes. dysmetria on fnf . discharge exam: vs: tm 97.8, tc 97.0, bp 140-160/70-74, hr 81-82, rr 20, so2 96% gen: elderly male in nad heent: conjunctivae clear with no erythema neck: trachea midline, jvp at base of neck resp: unlabored breathing, ctab cv: rrr, normal s1, s2 abd: s/nt/nd, bs+ ext: warm, 2+ peripheral pulses neuro: masked facies, aaox3, cn ii-xii intact, strength 5/5 on the left and on the right, cogwheel rigidity present, sensation intact, with dysmetria on fnf pertinent results: initial results: . 06:20pm wbc-24.9* rbc-3.95* hgb-12.7* hct-36.9* mcv-93 mch-32.2* mchc-34.5 rdw-12.8 06:20pm neuts-95.0* lymphs-2.6* monos-2.1 eos-0.1 basos-0.2 06:20pm plt count-187 06:20pm pt-13.7* ptt-26.3 inr(pt)-1.2* 06:20pm glucose-110* urea n-30* creat-1.1 sodium-137 potassium-4.1 chloride-99 total co2-28 anion gap-14 07:20pm urine mucous-mod 07:20pm urine rbc-21-50* wbc-21-50* bacteria-few yeast-none epi-0-2 07:20pm urine blood-lg nitrite-neg protein-150 glucose-neg ketone-tr bilirubin-neg urobilngn-neg ph-6.5 leuk-mod 07:20pm urine color- appear-cloudy sp -1.012 08:52pm lactate-1.7 . microbiology: . urine culture (, osh): citrobacter uti (pansensitive) . ekg (): sinus tachycardia. left axis deviation. t wave abnormalities. no previous tracing available for comparison. . imaging: . ct c-spine (): 1. no acute fracture. 2. minimal retrolisthesis of c3 on c4 may be degenerative but is age-indeterminate and clinical correlation is advised. 3. tracheal secretions may predispose to aspiration. . ct head without contrast () (report from outside hospital): chronic-appearing bilateral lacunar infarcts with no intraparrenchymal hemorrhage or extra-axial fluid collections. no mass effect or midline shift. . interval results: . 05:40am blood caltibc-142* ferritn-894* trf-109* 05:40am blood %hba1c-5.1 eag-100 05:40am blood triglyc-89 hdl-37 chol/hd-2.4 ldlcalc-35 06:22am blood crp-39.0* . lower extremity u/s (): acute dvt involving right posterior tibial veins. . eeg (): this is an abnormal routine eeg in the waking and drowsy states due to the slow 8 hz posterior predominant rhythm which may be seen in generalized encephalopathy such as due to medications, ischemia, or toxic/metabolic etiologies, as well as medication effect. there were no focal, lateralized, or epileptiform features noted. . mra brain without contrast/mr with and without contrast(): 1. two heterogeneously enhancing lesions in the left parietal lobe subcortical white matter, the larger one measuring 3.2 x 2.8 x 3.9 cm with mild-to-moderate surrounding edema without significant mass effect. differential diagnosis includes primary glial neoplasm vs metastasis/ lymphoma. other etiologies such as inflammatory or subacute infarction are less likely given the thick rind of tissue in the periphery. to correlate clinically and consider neurosurgical consult. 2. patent major intracranial arteries without focal flow-limiting stenosis, occlusion, or aneurysm more than 2 mm within the resolution of mr angiogram. mild atherosclerotic disease involving the basilar, internal carotid, and the mca branches without flow-limiting stenosis. . cxr (): patchy opacity left base. this finding is similar, but slighlty more prominent, than on an outside film dated that has been scanned into pacs. . lower extremity u/s (): thrombus now visualized in the right popliteal vein as well as the posterior tibial and peroneal veins on the right. . discharge labs: . 06:19am blood wbc-8.8 rbc-3.27* hgb-10.3* hct-30.9* mcv-94 mch-31.5 mchc-33.4 rdw-13.2 plt ct-373 06:19am blood glucose-94 urean-18 creat-0.7 na-139 k-4.2 cl-104 hco3-30 angap-9 06:19am blood calcium-8.3* phos-3.4 mg-2.1 brief hospital course: 80 year-old male with parkinson's disease, a questionable history of a seizure disorder and a recently diagnosed uti being treated with ciprofloxacin who was transferred from an osh following two witnessed tonic clonic seizures. . 1. tonic-clonic seizures: on admission there was report of a history of seizure disorder with recent witnessed epileptic activity in setting of likely infection and medication known to lower seizure threshold. the patient was confused on arrival to the ed which was attributed to a post-ictal state with ct scan at osh showing no evidence of stroke and no significant metabolic derangement on laboratory testing. the patient was admitted to the icu and started on keppra for seizure prophylaxis by neurology recommendations and his antibiotic was changed to ceftriaxone. his mental status was significantly improved the morning after admission. the patient was subsequently transferred from the icu to the medicine service. as part of the patient's seizure workup, an mri was ordered which revealed two heterogeneously enhancing lesions in the left parietal lobe, with suspicion for a malignant glioma. an eeg revealed diffuse slowing consistent with encephalopathy but no epileptiform activity was noted. the information was presented to the patient and given the progressive nature of his parkinson's disease and debilitated state he chose not to undergo any further evaluation of the brain lesions. the patient clearly expressed the risks of not pursuing any further evaluation or treatment and was willing to accept the consequences. the patient was discharged on keppra 500 mg twice a day for seizure prophylaxis which was the dose started on admissionto . . 2. right lower extremity dvt: several days into his admission, the patient developed right lower extremity erythema and swelling. a lower extremity ultrasound was performed and revealed a right posterior tibial vein thrombosis. vascular surgery was consulted and recommended repeat ultrasound in 48 hours. repeat ultrasound revealed presence of the thrombosis in the right peroneal and right popliteal veins in addition to the original location. vascular surgery was again contact and an ivc filter was placed without complication. post-procedure evaluation did not reveal any hematoma or venous hum at the site. vascular surgery reported that this patient would not be a candidate for ivc filter removal and that no follow-up was necessary. . 3. urinary tract infection: the patient was admitted two days into a course of ciprofloxacin for a urinary tract infection that was culture positive for citrobacter, which was pan-sensitive. given the neurological complications associated with ciprofloxacin in the elderly, the patient was switched to ceftriaxone. the patient completed a total of 10 days of antibiotics (from the start of the ciprofloxacin) as an inpatient. of note, the patient was transferred to the medicine service with a foley in place but was discontinued. the patient subsequently failed to void, was started on tamsulosin for presumed bph and the foley was replaced. two days later the patient failed to void once again and was found to have 700 cc of urine on bladder scan. the foley was again replaced and was present at discharge. given the patient's urinary retention observed as an inpatient, it is likely that this contributed to the development of his urinary tract infection. ** the foley may be possible to discontinue as an outpatient and another trial is likely warranted. ** . 4. aspiration risk: the patient was evaluated by speech and swallow in the icu and was started on a dysphagia diet and nectar-thickened liquids due to high aspiration risk. the patient repeatedly expressed interest in eating a regular diet. the patient again failed a bedside evaluation. it was decided that while inpatient that he should remain on the recommended diet. the patient clearly understood the risks of eating a regular diet and drinking normal liquids, particuarly that aspiration was high likely. he stated that given his underlying illness he would assume the risk. ** the patient again expressed interest in eating a regular diet at discharge, understood the risks and demonstrated clear capacity to make his own decisions. this should be re-addressed as an outpatient but the patient should likely be allowed to eat the diet he wishes. ** . 5. right-sided weakness: the patient reported chronic right-sided weakness on presentation that most likely represented an old neurologic deficit from his prior cva that was exacerbated by worsening malnutrition and acute illness. the patient's listed pcp was called to discuss the patient's baseline, however the pcp had only known the patient for the several days that he was at the nursing home, and could not provide much background information. the patient was continued on sinemet although it seemed unlikely that parkinson's disease was a major contributor to this particular problem. . 6. parkinson's disease: the patient was admitted on sinemet for his parkinson's disease of unknown duration. the patient had masked-facies and bradykinesia with some cogwheel rigidity of the upper extremities on examination. the patient was continued on his sinement during this hospitalization without problem. . 7. leukocytosis: the patient had a normal white count on transfer to the. several days into his stay on the medicine floor, the patient's white count was elevated to 13. the patient reported a new cough that was concerning for a possible aspiration event. a chest x-ray revealed a patchy left lower lobe opacity that was possibly increased over an outside film scanned into the system and likely represented atelectasis vs possible early infectious infiltrate. the patient had a known uti as per above. given the location of the infiltrate on chest x-ray, there was low suspicion for an aspiration event but one could not be ruled out definitely. given that the patient was already on a third generation cephalosporin and clinical suspicion was low for another infectious process, no additional antibiotic coverage was added. the following day the patient's white count was down to 11.3 and was 8.8 the following day, the morning of discharge. . 8. anemia: the patient's hematocrit was 37 on admission. the patient received vigorous hydration in the icu prior to transfer to the medicine floor and his hematocrit declined to 32.8 at time of transfer to the medicine service. given his poor oral intake, the patient was continued on intermittent fluids on the floor. his hematocrit stabilized at approximately 30 and remained so for the next eight days until the time of discharge. the patient was guaiac negative. iron studies were ordered and were consistent with anemia of chronic disease (caltibc 142, ferritin 894, trf 109) which was consistent with the patient's underlying disease process. medications on admission: 1. carbidopa-levodopa - 25-100 1 tablet(s) four times daily 2. cyanocobalamin (vitamin b-12) - 100 mcg 1 syringe(s) monthly 3. tylenol 4. mylanta prn 5. biscodyl 6. ciprofloxacin: started yesterday 250 mg for a uti discharge medications: 1. carbidopa-levodopa 25-100 mg tablet sig: one (1) tablet po qid (4 times a day). 2. cyanocobalamin (vitamin b-12) injection 3. tylenol oral 4. bisacodyl 5 mg tablet oral 5. mylanta oral 6. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 7. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po bid (2 times a day). 8. calcium carbonate 200 mg (500 mg) tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 9. levetiracetam 500 mg tablet, sig: one (1) tablet by mouth twice a day. discharge disposition: extended care facility: manor extended care facility - discharge diagnosis: primary diagnosis: seizures brain tumor (likely malignant glioma but there is no tissue diagnosis) . secondary diagnoses: parkinsonism hypertension anxiety discharge condition: mental status: clear and coherent. level of consciousness: lethargic but arousable. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: mr. : . you were admitted to after experiencing several seizures. an imaging study of your brain was performed that revealed several tumors. after lengthy discussions with you, it was decided that you did not want to pursue further treatment. although you do not want to have treatment of your tumors, you have been given medication to help prevent the seizures that the tumors are likely causing. also, on admission to the hospital you were being treated for a urinary tract infection with an antibiotic called ciprofloxacin. as this medication can be associated with neurological side-effects in elderly individuals, you were changed to another antibiotic called ceftriaxone. you completed your course of this antibiotic in the hospital and will not need any further antibiotics. . the following changes have been made to your medications: . 1. start keppra 500 mg by mouth twice a day, in the morning and in the evening. this medication will help prevent seizures. 2. start vitamin d 400 unit tablet. take one tablet twice a day. 3. start calcium carbonate 500 mg tablet. take one tablet by mouth three times a day. 4. start tamsulosin 0.4 mg tablet by mouth. take one tablet by mouth at night. this medication will help prevent urinary retention. 5. stop ciprofloxacin. you completed your course of antibiotics in the hospital for your urinary tract infection. . no other changes were made to your medications. you should continue taking all other medications as previously prescribed. followup instructions: please follow-up with your outpatient physicians as you feel appropriate. procedure: interruption of the vena cava diagnoses: urinary tract infection, site not specified unspecified essential hypertension unspecified protein-calorie malnutrition hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (luts) paralysis agitans malignant neoplasm of parietal lobe retention of urine, unspecified late effects of cerebrovascular disease, hemiplegia affecting unspecified side do not resuscitate status dehydration hypovolemia other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms acute venous embolism and thrombosis of deep vessels of distal lower extremity history of fall generalized convulsive epilepsy, without mention of intractable epilepsy 

Answer: The patient is high likely exposed to