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: no known allergies / adverse drug reactions attending: chief complaint: seizures major surgical or invasive procedure: intubation history of present illness: the patient is a 45 year old man with a history of epilepsy (since childhood), substance abuse, and chronic pain (on methadone) presenting as a transfer from an outside facility for status epilepticus in the setting of rapid anticonvulsant and benzodiazepine withdrawal. a more detailed history could not be obtained at this time due to the patient's intubated status and inattentiveness, so this information is primarily obtained from the transferred records from . he reportedly has been underreporting his seizure frequency to his outpatient physicians (his neurologist is dr. in order to avoid losing the legal ability to drive. he was admitted for long-term monitoring to evaluate his seizures. his carbamazepine level at admission was low. he had several typical seizures which were described as left head version followed by opisthotonus, lasting minutes and followed by post-ictal confusion and aggressive behavior. he was restarted back on tegretol and depakote but continued to have clusters of seizures, including events where he fell out of bed. due to the increased frequency and difficulty with managing his post-ictal aggression, he was sedated and intubated. he reportedly also might have intranasally inhaled crushed pills brought to him by a friend (reportedly alprazolam, a plastic tube was found in his bed), resulting in somnolence and some missed doses of anticonvulsants; this was a behavior previously suspected prior to admission when it was thought that he was abusing alprazolam to self-medicate for anxiety and possibly his seizures. attempts to wean propofol reportedly resulted in return of seizure activity, so he was kept sedated and transferred to for further management. he was also being treated for str. pneumonia growing from a sputum culture. his abdomen was also moderately distended which was thought to be secondary to constipation. he had a total of 3.5 days of emu monitoring and 5 days of icu care. since arrival, we have been decreasing his propofol infusion with hopes of improving his level of awareness in anticipation of extubation. his mental status has remained suppressed. his seizure disorder is thought to have started at age 16 after a head injury from a motor vehicle collision that resulted in loss of consciousness and coma. his initial seizure semiology reportedly involved right eye gaze deviation with subsequent giggling or other vocalized sounds and then secondary generalized tonic-clonic activity. he would have post-ictal confusion and lethargy subsequently. he did not often have urinary incontinence. he did not usually bite his tongue. past medical history: neurologic - epilepsy (described as frontal lobe, since his teenage years, reportedly after having suffered a head injury in a motor vehicle collision) msk - prior l1-l2 transverse process fracture, chronic pain (on methadone), per omr r ankle repair psychiatric - substance abuse gastrointestinal - per omr s/p appendectomy hematologic - per omr s/p splenectomy social history: current tobacco use, unquantified. some etoh, unquantified. not known if he uses illicit drugs, but he is thought to overuse/abuse alprazolam. construction worker. family history: twin. no known history of epilepsy. physical exam: admission physical examination (performed while on propofol): vs afebrile, 122/66, 64, 17, 98% on cmv 12/550/8/60% general: nad, lying in bed comfortably. intubated and sedated head: nc/at, no conjunctival icterus, intubated neck: right subclavian line, supple, no nuchal rigidity, + ng tube cardiovascular: rrr, no m/r/g pulmonary: equal air entry bilaterally abdomen: soft, nt, nd, +bs, no guarding, vertical scar from prior laparotomy, + foley catheter extremities: warm, no edema, palpable radial/dorsalis pedis pulses skin: no rashes or lesions, multiple large tattoos on upper extremities neurologic examination: - mental status - on propofol for sedation. no significant arousal to voice, non-noxious, or noxious stimuli. - cranial nerves - perrl 3->2 brisk. no blink to threat. eomi, no nystagmus. +corneals bilaterally. no facial asymmetry. could not elicit doll's eye reflexes - motor - normal bulk and tone. withdraws all four extremities to noxious stimuli. - sensory: withdraws - reflexes: areflexic at biceps, patella and achilles. toes are down. - coordination - unable to assess at the time of examination. - gait - unable to assess at the time of examination. pertinent results: admission labs: 07:54pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-pos 08:00pm urine rbc-<1 wbc-16* bacteria-none yeast-none epi-0 08:00pm urine blood-neg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-4* ph-6.0 leuk-sm 08:00pm pt-11.8 ptt-29.1 inr(pt)-1.1 08:00pm plt count-198 08:00pm wbc-7.0 rbc-3.78* hgb-11.0* hct-35.4* mcv-94# mch-29.1 mchc-31.1 rdw-15.2 08:00pm neuts-65.5 lymphs-23.2 monos-6.7 eos-3.8 basos-0.8 08:00pm asa-neg ethanol-neg carbamzpn-5.9 acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 08:00pm phenytoin-12.4 valproate-47* 08:00pm albumin-2.8* calcium-8.1* phosphate-4.0 magnesium-1.9 08:00pm alt(sgpt)-18 ast(sgot)-37 ld(ldh)-208 alk phos-53 tot bili-0.2 discharge labs: 06:22am blood wbc-8.0 rbc-4.46* hgb-13.3* hct-40.9 mcv-92 mch-29.8 mchc-32.5 rdw-15.3 plt ct-391 06:22am blood pt-12.7* ptt-30.1 inr(pt)-1.2* 05:25am blood glucose-95 urean-17 creat-0.5 na-141 k-3.7 cl-103 hco3-31 angap-11 06:22am blood calcium-8.9 phos-4.0 mg-2.0 06:22am blood phenyto-12.0 valproa-80 06:22am blood carbamz-3.5* reports: cxr : findings: as compared to the previous radiograph, the patient has been intubated. the tip of the endotracheal tube projects 6.4 cm above the carina. patient also has a left than a right central venous access line as well as a normally positioned nasogastric tube. there is left retrocardiac atelectasis but no evidence of aspiration or pneumonia. minimal fluid overload. no pleural effusions. normal size of the cardiac silhouette. cxr : findings: nasogastric tube has been repositioned, with tip located more proximally within the stomach. side port is not well visualized. heart size is normal, and lungs are grossly clear. brief hospital course: 45yom with pmhx of epilepsy, substance abuse, prior l1-l2 transverse process fracture and chronic pain who p/w difficult to control seizures in the setting of a rapid bzd and anticonvulsant withdrawal during a planned long-term monitoring admission. # neuro: pt was transferred to on four anticonvulsants and a propofol infusion. continuous video eeg was initiated which revealed an encephalopathic pattern without seizures. his propofol infusion was weaned off. he was successfully extubated and his medications were adjusted. on discharge he was on valproate 750mg q6h, carbamezepine 400/600/600 and phenytoin 100mg tid. his medication side effects improved on this dosing and he was able to walk and had no double vision. he did complain of some blurred vision that he felt was related to his glasses being the wrong prescription. we recommended that he visit his opthalmologist for this issue. # id: pt was put on abx on for hcap, which were broadened, and continued until for an 8 day total course.. # pulm: we continued pt's albuterol and advair. # psych: we continued pt's fluoxetine and methadone. we decreased the pt's seroquel dose given his other medication side effects. we started him on a nicotine patch , which was continued at discharge. # code: full pending studies: none transitional care issues: patient may need his aeds further decreased if his side effects do not further resolve. medications on admission: medications at the time of discharge from osh - phenytoin 200mg iv q6hrs - tegretol 400/600/600 - keppra 750mg iv q6hrs - depacon 750mg iv q6 - methadone 85mg daily - seroquel 50mg tid - oxycodone 5/325mg q6hr prn pain - albuterol inh - lovenox 40mg q24hr - protonix 40mg iv daily - ceftriaxone 1g daily - propofol 60ug/kg/min - daily nicotine patch 21mg/day - prozac 40mg daily medications at home prior to emu admission: - tegretol 400mg - depakote 750/500 - methadone 85mg daily - seroquel 50mg tid - combivent/flovent - prozac 40mg daily discharge medications: 1. carbamazepine 200 mg tablet sig: 2-3 tablets po three times a day: take 400mg (2 tabs) at 8am, then 600mg (3 tabs) at noon and 8pm. disp:*240 tablet(s)* refills:*2* 2. methadone 10 mg/ml concentrate sig: eighty five (85) mg po daily (daily). 3. fluoxetine 20 mg capsule sig: two (2) capsule po daily (daily). 4. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) disk with device inhalation (2 times a day). 5. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation q6h (every 6 hours) as needed for wheezing. 6. valproic acid 250 mg capsule sig: three (3) capsule po q6h (every 6 hours). disp:*360 capsule(s)* refills:*2* 7. quetiapine 50 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 8. phenytoin sodium extended 100 mg capsule sig: one (1) capsule po tid (3 times a day). disp:*90 capsule(s)* refills:*2* 9. nicotine 21-14-7 mg/24 hr patch, td daily, sequential sig: one (1) patch transdermal once a day for 3 weeks: use 21mg patch per day x 7days, then 14mg patch per day x 7days, then 7mg patch per day x7 days, then stop. disp:*21 patches* refills:*0* discharge disposition: home discharge diagnosis: seizures medication side effects discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were seen in the hospital for seizures and medication side effects. your medications were adjusted until your seizures were under better control and your side effects were acceptable. we made the following changes to your medications: 1) we changed your carbamezepime to 400mg at 8am, 600mg at noon and 600mg at 8pm 2) we changed your depakote to 750mg every 6 hours 3) we changed your seroquel to 50mg at night 4) we started you on phenytoin at 100mg three times a day 5) we started you on a nicotine patch at 21mg once a day for 1 week, then you will use 14mg once a day for 1 week, then you will use 7mg for one week and then stop. please continue to take your other medications as previously prescribed. if you experience any of the below listed danger signs, please contact your doctor or go to the nearest emergency room. it was a pleasure taking care of you. please follow the following general seizure safety guidelines: seizure safety ________________________________________________________________ the following tips will help you to make your home and surroundings as safe as possible during or following a seizure. some people with epilepsy will not need to make any of these changes. use this list to balance your safety with the way you want to live your life. make sure that everyone in your family and in your home knows: - what to expect when you have a seizure - correct seizure first aid - first aid for choking - when it is (and isn't) necessary to call for emergency help avoid things that are known to increase the risk of a seizure: - forgetting to take medications - not getting enough sleep - drinking a lot of alcohol - using illegal drugs in the kitchen: - as much as possible, cook and use electrical appliances only when someone else is in the house. - use a microwave if possible. - use the back burners of the stove. turn handles of pans toward the back of the stove. - avoid carrying hot pans; serve hot food and liquids directly from the stove onto plates. - use pre-cut foods or use a blender or food processor to limit the need for sharp knives. - wear rubber gloves when handling knives or washing dishes or glasses in the sink. - use plastic cups, dishes, and containers rather than breakable glass. in the living room: - avoid open fires. - avoid trailing wires and clutter on the floor. - lay a soft, easy-to-clean carpet. - put safety glass in windows and doors. - pad sharp corners of tables and other furniture, and buy furniture with rounded corners. - avoid smoking or lighting fires when you're by yourself. - try to avoid climbing up on chairs or ladders, especially when alone. - if you wander during seizures, make sure that outside doors are securely locked and put safety gates at the top of steep stairs. in the bedroom: - choose a wide, low bed. - avoid top bunks. - place a soft carpet on the floor. in the bathroom: - unless you live on your own, tell a family member or before you take a bath or shower. - hang the bathroom door so it opens outward, so it can be opened if you have a seizure and fall against it. - don't lock the bathroom door. hang an "occupied" sign on the outside handle instead. - set the water temperature low so you won't be hurt if you have a seizure while the water is running. - showers are generally safer than baths. consider using a hand- held shower nozzle. - if taking a bath, keep the water shallow and make sure you turn off the tap before getting in. - put non-skid strips in the tub. - avoid using electrical appliances in the bathroom or near water. - use shatterproof glass for mirrors. at work: - consider telling your co-workers that you have epilepsy and the correct first aid for seizures. - climb only as high as you can fall without injuring yourself. - when working around machinery, make sure that safety features are in place, and consider wearing protective clothing. - try to keep consistent work hours so you don't have to go a long time without sleep. - try to limit your exposure to flashing lights if this can trigger your seizures. out and about: - carry only as many medications with you as you will need, and 2 spare doses. - wear a medical alert bracelet to let emergency workers and others know that you have epilepsy. - stand well back from the road when waiting for the bus and away from the platform edge when taking the subway. - if you wander during a seizure, take a friend along. - don't let fear of a seizure keep you at home. sports: - use common sense to decide which sports are reasonable. - exercise on soft surfaces. - wear a life vest when you are close to water. - avoid swimming alone. make sure someone with you can swim well enough to help you if you need it. - wear head protection when playing contact sports or when there is a risk of falling. - when riding a bicycle or rollerblading, wear a helmet, knee pads, and elbow pads. avoid high traffic areas; ride or skate on side roads or bike paths. driving: - you may not drive in unless you have been seizure- free for at least 6 months. - always wear a seatbelt. parenting: - childproof your home as much as possible. - if you are nursing a baby, sit on the floor or bed with your back supported so the baby will not fall far if you should lose consciousness. - feed the baby while he or she is seated in an infant seat. - dress, change, and sponge bathe the baby on the floor. - move the baby around in a stroller or small crib. - keep a young baby in a playpen when you are alone, and a toddler in an indoor play yard, or childproof one room and use safety gates at the doors. - when out of the house, use a bungee-type cord or restraint harness so your child cannot wander away if you have a seizure that affects your awareness. - explain your seizures to your child when he or she is old enough to understand. followup instructions: follow up with your pcp . on the at 4:20pm- location: greater health center address: , , phone: follow up with dr. at () on tuesday, at 9:45 am please also make a follow-up appointment in the next 1-2 weeks with your ophthalmologist for an eye exam. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube video and radio-telemetered electroencephalographic monitoring diagnoses: other chronic pain tobacco use disorder constipation, unspecified long-term (current) use of other medications other acquired absence of organ grand mal status personal history of noncompliance with medical treatment, presenting hazards to health other encephalopathy pneumococcal pneumonia [streptococcus pneumoniae pneumonia] sedative, hypnotic or anxiolytic abuse, unspecified late effects of motor vehicle accident generalized convulsive epilepsy, without mention of intractable epilepsy personal history of traumatic fracture late effect of intracranial injury without mention of skull fracture 

Answer: The patient is high likely exposed to