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: found down major surgical or invasive procedure: lumbar puncture endotracheal intubation history of present illness: 72m with gout, initially admitted to micu after found down between two cars on , following the patient's likely first ever seizure. there was report of "seizure-like" activity at the scene, and patient could not speak, was mumbling to ems. he appeared somewhat postictal and had eye deviation to the right. he later became combative with ems. . in the ed the patient was tremulous and not speaking. he again became combative and was intubated. intial vitals in the ed showed a heart rate of 140 and blood pressure 210/120 with adequate oxygen saturation. labs were notable for a lactate of 9.6 and white count of 17.6. ct torso revealed potential aspiration pneumonia. the patient continued to shake after intubation and was given ativan 2mg x2. past medical history: - prostate cancer, no known mets, s/p multiple ?turp procedures - skin cancer (unknown type), s/p surgical removal near right nasolabial fold - gout - htn, not on meds - patient denies seizure history, though son initially questioned past seizure but was unsure. no history of cva, head trauma, other cns insults. social history: married, lives with wife. and daughter in . works as an architecture designer full time. plays soccer from time to time. smokes 1 ppd x 50 years. rare (1/year) etoh. denies other drug use. family history: mother died of brain cancer at age 87. father died at age when his "doctor forgot to change his pacemaker battery". physical exam: vitals: t:96.6 bp:124/81 p:89 r:14 o2: 98% fio2 50% general: sedated, unresponsive, intubated. heent: pupils 2mm, reactive, sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema pertinent results: 11:51am wbc-17.9* hgb-16.0 hct-49.5 mcv-85 rdw-14.9 plt ct-359 neuts-62.3 lymphs-26.2 monos-8.8 eos-2.0 baso-0.8 pt-12.3 ptt-22.4 inr(pt)-1.0 glucose-156* urean-40* creat-1.6* na-141 k-4.5 cl-105 hco3-12* angap-29* albumin-4.3 calcium-10.0 phos-4.2 mg-2.2 alt-20 ast-14 ld(ldh)-197 ck(cpk)-64 alkphos-60 totbili-0.3 ctropnt-<0.01 -> 0.14 -> 0.27 -> 0.15 . 06:24pm blood ck-mb-15* mb indx-3.9 ctropnt-0.14* 03:06am blood ck-mb-18* mb indx-4.0 ctropnt-0.27* 03:00pm blood ck-mb-12* mb indx-3.1 ctropnt-0.15* . urine and serum tox negative . cxr : endotracheal tube high. consider advancing 4 cm for more optimal placement. nasogastric tube in satisfactory position. central vascular congestion without overt edema or pneumonia. . : xray pelvis: the sacrum is obscured by contrast within the patient's bladder. extensive surgical clips are identified in the pelvis. the pelvis is intact without fracture or dislocation. the sacrum and sacroiliac joints are unremarkable. degenerative changes are noted at the lumbosacral junction. bilateral femoral heads are appropriately located with no fracture of the proximal femurs identified. . ct torso: 1. no evidence of acute thoracic or abdominal traumatic injury. 2. bilateral basal opacities in the lung could represent dependent atelectatic changes. considering the presence of fluid in the right main bronchus in this intubated patient, aspiration cannot be ruled out. diffuse emphysematous changes of both lungs. 3. high position of the endotracheal tube, 7 cm from the carina. recommended advancement of the tube. 4. hypoattenuating 7-mm liver lesion, too small to characterize, most probably represent hepatic cyst. . ct c-spine: 1. no acute cervical spine fracture. 2. multilevel degenerative disease with posterior osteophytes at c4, c5, c6, c7, and t1 levels, causing mild spinal canal narrowing at that level. the presence of these osteophytes may predispose the patient to have cord injury, depending on the type of trauma. recommended mri of c-spine, if the patient has signs of cord injury. . : head ct: no acute intracranial hemorrhage, edema, masses, mass effect, or major vascular territorial infarction. the -white matter differentiation is well preserved. white matter hypodensities are noted in bifrontal white matter, consistent with chronic microangiopathic ischemic disease. the ventricles and sulcal spaces appear normal in caliber and configuration. the basal cisterns are widely patent. bilateral mastoid air cells, external auditory canals appear clear. . ekg admission: sinus tachycardia at rate 125, normal axis, prolonged qrs, rbbb, twi in iii, avf. brief hospital course: 72m with history of gout, prostate cancer, and remote history of skin cancer (?type), admitted to the micu with altered mental status and intubation after likely seizure. . # altered mental status: patient was intubated for airway protection and need for further testing given initial aggression/agitation, after being quite somnolent. likely representing post-ictal changes. he was extubated on and did well. he was initially delerious after extubation, getting out of bed in the icu and pulling at lines and his foley. over the subsequent 12 hours he cleared and was back at his baseline, fully alert and oriented. did not recall much of the prior days' events. imaging and seizure workup as noted below. . # seizure. as above, this was patient's first reported seizure. he was loaded with dilantin and neurology was consulted. head imaging included initial ct, with subsequent mri on the morning of discharge. the prelimary read showed post-seizure changes, with the final read as follows: "extensive areas of flair hyperintensity in the cortex, in the frontal lobes on both sides as well as left temporal lobe, with another focus in the left frontal subcortical white matter; a 0.8 x 0.6 mm round enhancing lesion noted in the right frontal lobe anterior to the frontal . the differential diagnosis for the flair hyperintense areas includes seizure- associated phenomena, drug induced, other etiologies like encephalitis, viral in etiology. however, given the small enhancing lesion in the right frontal lobe, superimposed inflammatory or infective etiologies, less likely neoplastic etiology like metastasis are also in the differential diagnosis. followup evaluation in a few days can be considered to assess the stability of the flair signal abnormalities based on the clinical condition. correlate with labs to confirm the nature of the enhancing lesion." these findings will be communicated to his pcp and should be subsequently communicated to his new neurologist in the area once this is established. lp was also performed and was normal. iv fosphenytoin changed to po dilantin. he is due for dilantin level check on thursday or friday of this week. mri findings also need followup with establishment of a neurologist in his area, as after discussion with the patient and the neurology team, he preferred to be seen in the area. reemphasized that he cannot legally drive given the recent seizure. . # elevated troponins/nstemi. troponin t peaked at 0.27 (ref range < 0.10); ck peak 451 with mbi of 4%. likely was demand in the setting of seizure. there were no ischemic changes on ekg and patinet reported no chest pain or shortness of breath. he was initially started on asa, beta blocker, and statin therapy, which were discontinued at discharge given lack of evidence for use in troponin elevation related to demand. he should followup with his pcp for consideration of stress testing/cardiac workup. . # renal insufficiency. baseline was unknown. denies past history of renal insufficiency. improved on daily basis with hydration and was 1.3 at the time of discharge. will followup with pcp. . # urinary frequency/dribbling: he had foley trauma in micu when, while delerious, he attempted self dc of foley catheter. urology was consulted. he had bladder neck contracture on cystoscopy. he initially did not have foley re-placed, as contracture providing patient with some degree of continence. however, with persistent dribbling, urology placed foley on day of discharge. he will return home with the foley, and was given instructions on how to set up followup with dr. for further management and foley removal. should see him within 1-2 weeks. oxybutinin was tried for symptomatic benefit. . # code: full . # dispo: patient was discharged home on monday, . given the holiday weekend, was unable to make appointments for patient prior to leaving the hospital. he was given instructions for followup with urology, and the importance of pcp followup was stressed. i called his pcp's office on tuesday to make appointment for thursday, . will fax dc summary and reports. will need dilantin level check, neurology referral, possible eventual cardiac workup as above. left message for patient regarding details of his appointment. medications on admission: - allopurinol ?dose - end of : was on indomethacin, percocets, prednisone for gout flare. discharge medications: 1. oxybutynin chloride 5 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*0* 2. phenytoin sodium extended 100 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*90 capsule(s)* refills:*0* 3. allopurinol oral discharge disposition: home discharge diagnosis: seizure . prostate cancer gout hypertension elevated troponins discharge condition: medically stable for discharge home discharge instructions: mr , . you were admitted to the hospital after being found down by some cars on the sidewalk. you were initially agitated and tremulous, and you were intubated for protection of your airway. you underwent a lumbar puncture (spinal tap) which was unrevealing for potential causes of altered mental status. tests for herpes simplex virus in your spinal fluid were pending at the time of discharge. . your episode was ultimately believed to be a seizure. you were started on new anti-seizure medicine, which you should continue to take, upon discharge. you were taken off of the ventilator, and were stable enough for transfer to the regular medical floor. once there, you felt comfortable and your thinking was much clearer. you had a foley catheter placed by a urologist, to stay in for 1-2 weeks. you should call ( to make an appointment with dr , for catheter removal. . the following changes were made to your home regimen: -added oxybutynin 5 mg by mouth, three times daily -added phenytoin 100 mg by mouth, three times daily . please also continue to take allopurinol at the dose recommended by whichever provider prescribes it for you. . you should call your doctor or return to the emergency room if you experience any of the following: -uncontrollable shaking, tremulousness or repetitive movements -loss of consciousness -severe chest pain or chest pressure -blood in your urine, or painful urination . as discussed, you will not be allowed to drive for at least the next six months. do not drive until you are cleared to do so by a physician. followup instructions: please follow up with your pcp within one week. please ask him to address your elevated troponin levels. you will also need a dilantin level drawn and followed up by your pcp on thursday or friday of this week. your pcp should also refer you to a neurologist within your area who could see you within 1-2 weeks. pcp: , , md . please follow up with dr (urology) in weeks for foley catheter removal urology 440 ( procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung spinal tap incision of lung insertion of endotracheal tube other cystoscopy diagnoses: acidosis subendocardial infarction, initial episode of care tobacco use disorder unspecified essential hypertension acute kidney failure, unspecified gout, unspecified pneumonitis due to inhalation of food or vomitus bladder neck obstruction epilepsy, unspecified, without mention of intractable epilepsy injury to bladder and urethra, without mention of open wound into cavity urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure urinary incontinence, unspecified 

Answer: The patient is high likely exposed to