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: morphine / ativan attending: chief complaint: altered mental status. major surgical or invasive procedure: right subclavian vein central line. history of present illness: mrs. is a 73-year-old woman with an extensive medical history most notable for the diagnosis of cns lymphoma in was brought in to an osh ed by the staff at her nursing home () yesterday when she was found to have altered mental status at 1800; she is typically a&o x3 but was "pleasantly confused." she was unable to carry on a conversaton, eat, or bear weight. her initial vital signs at the osh were unremarkable (temperature 98.5 f, pulse 68, blood pressure 103/62, respiratory rate 18, and oxygen saturation 98% in room air). a head ct was done and reportedly showed mild midline shift. she was given dexamethasone 10 mg iv and transferred to the ed. she was also given ceftriaxone 1 gram iv for a presumed uti given a dirty u/a (large le, slightly cloudy, 25 protein, 5 ketones). labs there were similar to labs here, although there wbc was normal (9.8) with 86% pmn. in our ed, radiology reviewed the patient's head ct and felt it was unchanged compared with a head mri performed here on . she was then sent to 7 for admission. she currently cannot provide any history. she denies pain. past medical history: 1. cns lymphoma diagnosed when an osh head ct showed a left frontal mass with significant associated edema; a subsequent brain biopsy here confirmed the diagnosis of cns lymphoma. pet scanning showed no evidence of fdg avidity elsewhere. bone marrow biopsy did not show lymphoma. she has been treated with four cycles of rituximab and demozolomide, most recently on . 2. cervical cancer s/p tah-bso and pelvic xrt that was complicated by radiation proctitis and right kidney failure () for which she was treated with a cystectomy and nephrectomy with an ileostomy and ileal conduit. 3. chronic renal failure 4. renal tubular acidosis 5. c. difficile colitis 6. deep venous thrombosis 7. gastroesophageal reflux disease 8. recurrent mrsa uti 9. chronic anemia 10. osteoporosis with multiple compression fractures social history: ms. is a widow and formerly lived in . her son, , is her health care proxy. she lives alone. she quit smoking cigarettes in ; she has more than a 20-pack-year smoking history. she denies alcohol or illicit drug use or abuse. family history: non-contributory. physical exam: vital signs: temperature 96.2 f, pulse 53, blood pressure 94/62, respiratory rate 18, oxygen saturation 100% in room air. general: frail, cachectic, elderly woman with temporal wasting skin: no rashes or lesions. heent: no sinus tenderness. anicteric sclerae. pupils reactive (3 mm to 2 mm on right, 2 mm to 1 mm on left) to light. op clear without lesions or thrush. poor dentition with upper dentures. neck: soft, supple. lymph nodes: no cervical or supraclavicular adenopathy. cardiovascular: rrr, normal s1 and s2, no m/r/g. pulmonary: poor effort, dense crackles more prominent on the left (over the lower to of the lung field) than on the right (over the lower of the lung field). no wheezes or rhonchi. abdomen: soft, non-tender, non-distended, active bowel sounds. ileostomy site clean. ostomy bag with slightly cloudy urine. back: no spinal tenderness. genitourinary: no cva tenderness. extremities: no edema, warm. lue picc site non-tender, dressing clean. neurological examination: oriented only to person; she thinks the year is and cannot name this place. able to follow one-step commands. cn ii-xii intact. assessment of muscle strength limited by lack of cooperation, but strength is in deltoids, in triceps, left biceps, unable to assess right biceps, grip, 4+/5 iliopsoas, unable to assess quads, hamstrings, dorsi-flexion. pertinent results: laboratory results: 02:00am blood wbc-11.6* rbc-3.95* hgb-12.6 hct-37.5 mcv-95 mch-31.9 mchc-33.6 rdw-17.1* plt ct-188 12:00am blood wbc-0.2*# rbc-2.97* hgb-9.5* hct-28.9* mcv-97 mch-31.8 mchc-32.8 rdw-16.4* plt ct-58* 09:30am blood pt-12.2 ptt-24.3 inr(pt)-1.0 12:00am blood gran ct-720* 12:00am blood wbc-6.7 lymph-4* abs -268 cd3%-91 abs cd3-244* cd4%-43 abs cd4-114* cd8%-51 abs cd8-136* cd4/cd8-0.8* 02:00am blood glucose-93 urean-34* creat-1.2* na-136 k-5.8* cl-107 hco3-18* angap-17 09:30am blood alt-20 ast-12 alkphos-110 amylase-82 totbili-0.1 02:00am blood calcium-8.8 phos-4.3 mg-1.7 09:30am blood vitb12-526 folate-greater th 02:00am blood tsh-8.9* 09:30am blood free t4-1.3 relevant imaging: 1)chest x-ray (): no change in normal heart size, tortuous aorta, significant thoracic kyphoscoliosis is noted. the right lung and the upper portion of the left lung are unremarkable. new left retrocardiac opacity is noted with indistinction of the left hemidiaphragm and possible small amount of left pleural effusion . 2)ct scan head (): 1. increase in vasogenic edema in left but increasingly also involving the right frontal lobe. 2. increased subfalcine herniation with midline shift to the right. 3)eeg (): this is an abnormal eeg in the waking and drowsy states due to the bursts of rhythmic slowing seen in the left frontotemporal region, without any obvious clinical correlate. this suggests subcortical dysfunction in that region. very rare sharp waves were seen in the left parietal region towards the end of the recording, suggestive of an area of cortical hypersynchrony but no electrographic seizures were seen. the bursts of generalized slowing suggest subcortical or deep midline dysfunction. if clinical suspicion is high for subclinical seizures, continuous bedside telemetry may be helpful for further diagnosis. 4)mri (): increase in the number and extent of enhancing lesions involving multiple areas of the brain as described above as well as an increase in the surrounding white matter edema. 5)eeg (): markedly abnormal portable eeg due to the persistent and occasionally rhythmic sharp wave discharges in the left frontal region and due to the disorganized and slow background. the first abnormality indicates an area of cortical hypersynchrony in the left frontal region. this could provide a focus for seizures. discharges were persistent and occasionally rhythmic although they did not constitute a definite clinical seizure at the time of the recording. they suggest the possibility of seizures emanating from this site at other times. the slow and disorganized background indicates a widespread encephalopathy. medications, metabolic disturbances, and infection are among the most common causes. 6)mri (): 1. decreased total number enhancing lesions within the brain parenchyma suggestive of chemotherapy steroid response. unchanged vasgogenic edema. 2. new hyperintense t1 lesions displaying restricted diffusion predominantly within the prefrontal subcortical white matter. differential diagnosis includes new small hemorrhagic metastatic lesions or hemorrhagic small vessel infarcts from an etiology such as vasculitis. brief hospital course: mrs. is a 73-year-old woman who recently received 4 cycles of rituximab and temozolomide for treatment of cns lymphoma who p/w altered mental status possibly from seizure though toxic metabolic also could be contributing. (1)altered mental status: patient initially presented with mental status changes. ct head on admission showed increased mid-line shift. given the acute change and underlying brain mass, seizure was high on the differential although she had been on keppra. she was loaded with phenytoin and continued on a maintenance dose. she was also continued on keppra. she remained on dexamethasone but she was given a 10 mg iv load. eeg on admission did not suggest seizure activity and was consistent with an encephalopathy. toxic/metabolic causes were also considered. u/a on admission was suggestive of a uti. she had received a dose of ceftriaxone at the osh but given her history of pseudomonal uti she was started on vancomycin and ceftazidime. on patient acutely decompensated with decreased responsiveness. pupils were sluggish with questionable right pupillary defect. her sbp dropped to 70's; she was started on pressors and then transferred to the icu. repeat ct scan was unchanged. repeat eeg consistent with seizure activity in l frontal area, in area of underlying lymphoma. she was also loaded with depakote. neurology and neurosurgery followed patient closely. linezolid was added for possible urosepsis. she was eventually weaned off pressors and completed a course of antibiotics for uti. her mental status slowly returned to baseline and was then transferred back to the oncology service. she became more alert and was at baseline mental status, per family. on she acutely decompensated in the setting of receiving ativan but was also thought to be septic in the setting of hypotension. dr. spoke with family who would like to make her cmo with focus on comfort care. at time of discharge she was placed on ativan 0.5 mg to prevent seizure activity. all other medications were stopped. (2)cns lymphoma: ct scan at osh reportedly not changed from mri but repeat imaging here showed an increased midline shift. repeat mri was done. she was maintained on decadron and anti-epileptics as above. in the icu she also received etoposide and rituxan. repeat mri showed response to chemotherapy. dr. spoke with family and they are in agreement with no more chemotherapy. (3)diarrhea: patient found to have profuse amounts of diarrhea. c. diff negative. per son, she has a history of malabsorption. poor response to loperamide and lomotil. she was also given opioid tincture. her oral feeds were stopped and her diarrhea improved. rectal tube in place. (4)history of dvt: patient had been on dalteparin at nursing home. no evidence of dvt at this time. dalteparin was d/c'ed and she was maintained on heparin sq. (5)fen: once patient had been transferred out of she had been able to take adequate po. given her acute decline in mental status, all oral feeds were stopped. (6)code status: comfort measures only, verified with patient's son on with patient's son. medications on admission: dexamethasone 2 mg daily dalteparin 2500 international units sq daily levetiracetam "two tabs" twice daily ranitidine 150 mg twice daily sodium bicarbonate 325 mg three times daily omeprazole 20 mg daily imodium 2 mg four times daily vitamin b12 250 mcg daily oscal 500 mg twice daily discharge medications: 1. ativan 0.5 mg tablet sig: one (1) tablet po twice a day: please give as sublingual. 2. opium tincture 10 mg/ml tincture sig: 5-10 drops po every hours as needed for diarrhea. 3. loperamide 2 mg capsule sig: one (1) capsule po qid (4 times a day) as needed for diarrhea. 4. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. discharge disposition: extended care facility: greycliff - discharge diagnosis: 1)seizure 2)urinary tract infection 3)lymphoma 4)altered mental status discharge condition: stable discharge instructions: 1)please take all medications as listed in the discharge instructions. 2)she will be discharged only on sublingual ativan 0.5mg twice daily for seizure control. all other medications were stopped since focus of care will be on comfort. followup instructions: no appointments scheduled at this time procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances injection or infusion of cancer chemotherapeutic substance diagnoses: urinary tract infection, site not specified other convulsions other malignant lymphomas, lymph nodes of head, face, and neck 

Answer: The patient is high likely exposed to