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: mental status changes major surgical or invasive procedure: none history of present illness: 72 yo m h/o hyponatremia on tabs (not getting for the past month), schizophrenia, htn, dm2, and recent l stroke with resultant weakness and recent treatment for om with ciprofloxacin presents to ed after behaving strangly at subacute rehab. his wife states that he was behaving in an odd manner on the morning of admission. at 10am he stopped answering questions and became averbal. he had difficulty verbalizing and became profoundly weak. he had an episode of incontinence (per wife this was because he was too weak to get up.). he was staring off into space. she felt his behavior was c/w past episode of stroke and rushed him to the ed. in the ed, he was found to have only his baseline facial and strength asymmetry and to be hard of hearing. ct revealed no hemorrhage nor mass effect. routine labs showed a sodium of 111 and repeat revealed 112. on exam the pt was found to be confused, unable to follow commands, and disoriented. he was also noted to have bilateral fluid behind his tm's. lp was refused by the patient's wife in the . in addition, she declined a central line. therefore, 3% ns was given via piv. . he received vanco 1gram, ctx 2grams, and 3% ns at 40cc/hr for a total of appx 80cc prior to admission to the . . ros: unable to elicit a review of systems from the patient. per wife, since his stroke he has been hard of hearing in the r ear, had difficulty with vision in his right eye, had a facial droop and had some weakness. today he had a subjective fevers, incontinence as described above, and heavy breathing. he has had no cough. past medical history: hyponatremia - reportedly longstanding and treated with tabs (thought to be due to siadh). however, tabs are not listed on the patient's home medications sheet. htn dm2 and gastroparesis stroke with resultant weakness () - affected r face (droop, loss of hearing, loss of eyesight) and episode in - ? sz, ? tia. hypercholesterolemia "chronic ear problems" - recent rx for om with ciproflox hard of hearing (hears better from l) ugib 20 yrs ago with 9 unit tx requirement schizophrenia social history: married, lives with wife, married x 26 yrs, 1 child. no smoking history. no illicits. etoh - previously drank up to two bottles per day. last drink 4 yrs ago. family history: non-contributory physical exam: 100.3, 136/82, 21, 99% ra gen: nad, lying in bed, appearing mildly disoriented, but calm and nad heent: mild anisocoria, eomi, op erythematous, but otherwise clear. sclera anicteric. outer ear canals with cerumen present. tm's perforated bilaterally. neck: supple, jvd not elevated. ln: no cervical nor axial lad cv: rrr, iii/vi sem heard best at apex. no jvd nor hjr. lung: clear laterally and posteriorly abd: soft, nt, nd, +bs. no masses. no hsm. ext: no clubbing, cyanosis, nor edema. neuro: ms: alert but not oriented to city and date nor person. unable to register objects for recall exam. speech dysarthric and halting with word finding difficulty. pt unable to repeat "today is a sunny day," completely. apraxia to tooth brushing/hair combing. calculation not tested. distant recall: the pt states that he is from , but unable to say the name of his home town. cn: i not tested. ii with r pupil constricted and minimally reactive and l pupil 3mm -> 2mm. ? paradoxical dilation on swing test. iii, iv, vi with intact extraoccular muscles. v with intact sensation. vii with r droop. viii with impaired hearing r> with some uvula deviation to r. x, shrug . xii tongue midline. motor: biceps, grip, wrist extensors with l slightly weaker. hip flexors, dorsiflexion, and plantarflexion bilaterally. coordination: fnf intact on l but with some terminal tremor on r. slight r pronator drift. reflexes: ue 1+ brachioradialis/biceps bilat. patellar r 2+, l 1+. ankles unable to elicit bilaterally. sensation: pt unable to cooperate with exam. gait: deferred. pertinent results: cxr on admit: the cardiac and mediastinal contours are within normal limits. a small amount of calcification is seen at the aortic knob. pulmonary vasculature appears unremarkable. no pleural effusions are identified. there is an ill-defined opacity at the right base. no pneumothoraces are identified. the osseous structures appear unremarkable. impression: ill-defined opacity in the right lower lobe could represent pneumonia. . ct head on admit: hypodensity is seen in the paraventricular white matter surrounding both lateral ventricles. more focal hypodensities are seen adjacent to the anterior of the left lateral ventricle and in the right basal ganglia consistent with lacunar infarcts. there is no acute intracranial hemorrhage, shift of normally midline structures, or hydrocephalus. osseous structures and soft tissues are unremarkable. the visualized paranasal sinuses and mastoid air cells are clear other than a minimal amount of mucosal thickening in the ethmoid air cells. . ekg: rate 84, sinus, ?l atrial abnormality, axis nml, pr depression iii and avf. tw flattening in avl. 1/2mm st elevation in iii. ? early r wave transition in precordial leads. . mri of the brain with and without contrast. clinical history: recent stroke. left upper quadrant visual field cut and cerebellopontine angle cistern abnormality on outside mri. technique: multiplanar pre- and post-contrast t1-weighted images, axial t2-weighted, susceptibility flair and diffusion-weighted images were obtained. the prior outside mri is not available. comparison is made to the ct of . findings: there is patchy t2-hyperintensity in the deep cerebral white matter, corresponding to the abnormality seen on ct. multiple areas of flair hypointensity surrounded by flair hyperintensity is seen consistent with old white matter infarcts. there is involvement of the corona radiata and centrum semiovale bilaterally. there is a punctate old lacune in the right lentiform nucleus, visible on the ct. there is probably a minute old right thalamic infarct as well. old infarcts are seen in the ventral right paramedian pons. no area of restricted diffusion is seen to suggest a recent infarct. post-contrast images show enhancement in the white matter of a left frontal gyrus. on the sagittal and coronal images, this is somewhat linear in appearance may represent a poorly visualized developmental venous anomaly. no corresponding abnormality is seen on the flair images to suggest a several-week-old infarct. the lesion is linear rather than rounded, arguing strongly against a lesion such as metastasis. the internal auditory canals are normal in size and symmetric. no mass or abnormal enhancement is seen to suggest a vestibular schwannoma. comparison with the ct shows that the mastoid air cells are very poorly formed. the left mastoid antrum is enlarged compared to the right. on the mri, there is peripheral enhancing soft tissue in it. there is also enhancing soft tissue in the right mastoid antrum/epitympanum. the ventricles and sulci are somewhat prominent as seen on the ct. the craniovertebral junction is normal. impression: 1. there is no evidence of a recent infarct. 2. there is an enhancing lesion in a mid left frontal gyrus, likely a poorly visualized developmental venous anomaly. a followup study in months is suggested. 3. there are extensive microvascular changes in the cerebral white matter with old small vessel territory infarcts in the cerebral white matter, the right lentiform nuclei, thalamus and pons. 4. there is white matter volume loss with thinning of the corpus callosum and enlargement of the ventricles. 5. there are inflammatory changes in the mastoid antrum. radiology final report video oropharyngeal swallow 11:12 am video oropharyngeal swallow reason: please perform video speech and swallowing evaluation before medical condition: 72 year old man with hyponatremia and related ams. now s/p equivocal bedside s/s evaluation reason for this examination: please perform video speech and swallowing evaluation before placing pt on po diet. indication: 72-year-old male with change in mental status and equivocal bedside swallow evaluation. video oropharyngeal swallow: a swallowing video fluoroscopy study was performed today in collaboration with the speech and language pathology division. various consistencies of barium including thin liquid, nectar thickened, pudding, a cookie coated with barium and a 13 mm barium tablet were self administered. both the oral and pharyngeal phases were within functional limits. no premature spillover or vallecular/pharyngeal residue was identified. a 13 mm barium tablet passed freely through the pharynx. no aspiration or penetration was identified during the examination. impression: within functional limits. no aspiration or penetration. . radiology final report chest (portable ap) 6:01 am chest (portable ap) reason: evaluate for infiltrate medical condition: 72 year old man with ?rll infiltrate, please evaluate for interval change reason for this examination: evaluate for infiltrate ap chest, 5:25 a.m. history: possible right lower lobe pneumonia. impression: ap chest compared to : lung volumes have improved and peribronchial opacification and bronchial wall thickening in the right lower lung has cleared. this may have represented aspiration but there is no radiographic evidence of progression to pneumonia. heart is normal size. there is no pleural abnormality or good evidence for central adenopathy. 10:50pm glucose-128* urea n-9 creat-0.8 sodium-121* potassium-3.8 chloride-87* total co2-24 anion gap-14 10:50pm albumin-4.4 calcium-9.2 phosphate-3.1 magnesium-1.8 10:50pm wbc-8.4 rbc-3.77* hgb-11.2* hct-30.5* mcv-81* mch-29.7 mchc-36.7* rdw-13.8 10:50pm plt count-340 10:50pm pt-12.1 ptt-29.8 inr(pt)-1.0 06:40pm sodium-112* 06:40pm alt(sgpt)-14 ast(sgot)-18 alk phos-79 amylase-64 tot bili-0.4 06:40pm lipase-28 06:40pm osmolal-244* 06:36pm urine hours-random creat-26 sodium-60 chloride-49 06:36pm urine osmolal-250 05:15pm urine color-yellow appear-clear sp -1.007 05:15pm urine blood-neg nitrite-neg protein-neg glucose-tr ketone-tr bilirubin-neg urobilngn-neg ph-7.0 leuk-neg 05:00pm k+-4.3 04:55pm glucose-199* urea n-9 creat-0.8 sodium-111* potassium-4.6 chloride-82* total co2-18* anion gap-16 04:55pm alt(sgpt)-14 ast(sgot)-28 ld(ldh)-236 ck(cpk)-112 alk phos-77 tot bili-0.4 04:55pm ck-mb-3 04:55pm ctropnt-<0.01 04:55pm calcium-8.5 phosphate-2.8 magnesium-1.5* 04:55pm osmolal-239* 04:55pm wbc-8.3 rbc-3.56* hgb-10.3* hct-28.7* mcv-81* mch-28.8 mchc-35.8* rdw-13.4 04:55pm neuts-81.2* lymphs-8.5* monos-9.8 eos-0.3 basos-0.2 04:55pm pt-12.3 ptt-29.4 inr(pt)-1.1 04:55pm plt count-333 brief hospital course: 72 yo m h/o hyponatremia siadh, hypertension, diabetes, recent otitis media treated with cipro presents with mental status changes, fever and hyponatermia. . # mental status changes: the patient has some baseline deficit from his recent stroke including facial droop, apraxia, expressive aphasia, hearing loss and fnf exam. in addition to these neurologic findings, the patient has new mental status changes on admission including loss of long term memory, decreased concentration and ability to follow only simple tasks. the most likely cause for these acute changes remains hyponatremia. there is a small possibility of meningitis with extension of otitis media to mastoid and into the cns. however, patient has a supple neck, lgf only, and appears in no acute distress, making bacterial meningitis/encephalitis less likely. wife refuses lp on behalf of the patient although multiple physician on the team has communicated the risk and benefits to her. differential also includes less likely processes including non-convulsive status (pt is interactive, making this much less likely), hsv encephalitis, med effect, recurrent ischemic stroke or diaschesis (unlikely given no new neuro deficits) . patient's hyponatremia was corrected throughout hospital stay( see below). he was treated empirically for meningiits given the combination of fever and altered mental status. as above, no csf sample was obtained because his wife refused. is committed to finish 2 weeks course of vancomycin, levofloxacin and ampicillin. mri of the head was obtain which showed old microvascular changed in thalamus and pons. eeg was obtained and the read was pending at the time of discharge. there was no seizure activity observed while patient was in house. pateint's mental status improved tremendously throughout hospital stay . # hyponatremia: patient is euvolemic hyponatremia. most likely etiologies include siadh, adrenal insufficiency, hypothyroidism. with siadh, would expect that urine osms would be higher than they are but urine na is 60 which would be more consistent with siadh. random cortisol and tsh level is normal. patient was given 80cc hypertonic saline for sodium correction in ed. his soium corrected and remain in high 120s range throughout hospital stay with just fluid restriction to 1500cc. tablet was not started and should be considered as outpatient. . # stroke neurology team was consulted while patient was in house. they though that his physical examination was compatible with pontine stroke. mri was obtained which confirmed the old pontine stroke. he did not have a new stroke during this hospitalization. patient was continued on plavix. he will need repeat mri in months. . # recent om and current fluid in ear canal: recently treated with cipro. appears to have chronic perforation of tm bilaterally with ? some drainage. no evidence of mastoiditis. . # dm2- restarted on metformin and reglan. . # htn - continue on lisinopril and norvasc. . # schizophrenia - risperdal was held while patient was in the hospital. this should be restarted as outpatient when his sodium is stable. . of note, there was also an incidental finding of possible enlarged thyroid nodule on cxr. thyroid ultrasound could be planned as outpatient for further evaluation. . patient remained full code. all communication was with his wife and his pcp . . medications on admission: metformin 850mg omeprazole 20mg daily reglan 5mg norvasc 5 daily lisinopril 20 daily plavix 75 daily kcl 10meq daily mvi daily zocor 20mg qhs risperdol 2mg qhs senokot 2tab otc tabs (pt has not been getting them at the subacute rehab where he was living) discharge medications: 1. insulin regular human 100 unit/ml solution sig: asdir unit injection asdir (as directed). 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 3. heparin (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day). 4. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 5. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 6. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 7. simvastatin 10 mg tablet sig: two (2) tablet po daily (daily). 8. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 9. ciprofloxacin 0.3 % drops sig: three (3) drop ophthalmic (2 times a day) as needed for otitis media for 5 days. 10. metformin 850 mg tablet sig: one (1) tablet po bid (2 times a day). 11. metoclopramide 10 mg tablet sig: 0.5 tablet po bid (2 times a day). 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 13. vancomycin 1,000 mg recon soln sig: 1000 (1000) mg intravenous every twelve (12) hours for 12 days. 14. ceftriaxone-dextrose (iso-osm) 2 g/50 ml piggyback sig: two (2) gm intravenous q12h (every 12 hours) for 12 days. 15. ampicillin 500 mg capsule sig: one (1) capsule po every six (6) hours for 12 days. discharge disposition: extended care facility: & retirement home - discharge diagnosis: 1. hyponetremia 2. fever, unclear source, treated for meningitis secondary diagnosis pontine stroke otitis media diabetes hypertension schizophrenia discharge condition: stable discharge instructions: please return to the hospital or call your doctor if you have chest pain, shortness of breath, confusion, fever, chills, nausea, abdominal pain, diarrhea, new weakness, new vision loss or if there are any concerns at all. please take all prescribed medication. you need to continue your antibiotic for 12 more days. followup instructions: stroke f/u: , md, caritas , st josephs , at 2:45pm. . will need outpatient mri head follow up in 3 months please call dr. at as soon as you are discharged. you need to have your sodium folowed up within 2 weeks. your pcp office has been contact with your discharge. your risperdal has been stopped while you are in the hospital. please discuss with your primary care physician before you restart it. you need to have ultrasound of your thyroid done as outpatient. your primary care physician office can facilitate that. procedure: venous catheterization, not elsewhere classified diagnoses: pure hypercholesterolemia unspecified essential hypertension diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled unspecified schizophrenia, unspecified other late effects of cerebrovascular disease other disorders of neurohypophysis gastroparesis other late effects of cerebrovascular disease, facial weakness late effects of cerebrovascular disease, disturbances of vision unspecified otitis media 

Answer: The patient is high likely exposed to