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: penicillins / effexor attending: chief complaint: diarrhea for 3 weeks major surgical or invasive procedure: picc line insertion, lumbar puncture attempt history of present illness: 49 y/o female with a history of seizure disorder, niddm, hypertension, alcohol abuse, presenting with persistent non-bloody diarrhea and dehydration for the past 10 days. patient reports that she was visiting , ate steak a ta cracker , and then began to have severe nausea, vomiting, and diarrhea. she reports associated chills, and overall weakness. she presented to duke with these symptoms and and was admitted for ivf hydration with negative blood and stool cultures per the husband's report. since returning, her symptoms have persisted and worsened to now 10 watery bowel movements per day. yesterday, she presented to her pcp's office with continued diarrhea, vomiting any po intake, tachycardia, and weak bp, and it was recommended she go to the ed. she deferred until this morning as she felt worse today. . in the ed, initial vs were: t 97 p 110 bp 86/47 r 18 o2 sat 100% ra. patient bolused 2 l ns with improvement in sbp to 115. k was found to be 2.6, mg was 1.6, both repleted. cxr was normal. ecg showed subtle flattenning of t waves in v2-v6, and patient was given asp 325. . on the floor, patient's initial vitals t 96.2 hr 100 bp 110/62 rr 16 96% ra. she was somewhat drowsy on interaction; however, stated she feels better after the ivfs. . review of sytems: (+) per hpi (-) denies fever, headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. no dysuria. denied arthralgias or myalgias or skin changes. past medical history: seizures diabetes mellitus hypertension schizophrenia alcohol abuse hepatitis c social history: she lives at home with her husband. she quit working 15 years ago, but was previously in sales and an administrator at a construction company. she quit smoking cigarettes 3 months ago, but previously smoked 1 ppd x >30 years. she has not had any etoh in 6 months, but has a history of etoh abuse. she denies a history of drug abuse, but per prior socialhistories there is a history of cocaine abuse in the past. family history: her maternal uncle had seizures. physical exam: admission physcial exam vitals: t 96.2 hr 100 bp 110/62 rr 16 96% ra general: patient drowsy and somewhat somnolent, oriented x 3, no acute distress heent: sclera anicteric, dry mm, 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: distended, somewhat firm, tender to deep palpation diffusely, hyperactive bowel sounds ext: 2+ pulses, no clubbing, cyanosis or edema skin: no rashes, bruises noted neuro: alert + oriented x 3, appropriate affect discharge physical exam vitals: t 98.1 hr 85 bp 100/53 rr 20 100 ra general: patient was comfortable in nad, aaox3 abd: soft, nontender, slightly distended ext: trace edema, no clubbing or cyanosis pertinent results: admission labs: . 10:30am blood wbc-10.9 rbc-4.74 hgb-12.0 hct-37.3 mcv-79* mch-25.4* mchc-32.2 rdw-19.6* plt ct-341# 10:30am blood glucose-242* urean-29* creat-1.4* na-130* k-2.6* cl-97 hco3-17* angap-19 01:20pm blood alt-11 ast-24 ld(ldh)-461* alkphos-106* totbili-0.1 10:30am blood ctropnt-<0.01 10:30am blood calcium-8.2* phos-4.8* mg-1.6 01:20pm blood valproa-81 01:20pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 10:37am blood lactate-2.0 . ecg : sinus tachycardia. there are small r waves in the anterior leads consistent with possible prior anterior myocardial infarction. non-specific st-t wave changes. compared to the previous tracing st-t wave changes are new. . eeg : continuous eeg: the background was slightly slow reaching a maximum of 7 hz. there were no clear epileptiform discharges or electrographic seizures noted. spike detection programs: there were 91 entries in these files. these represented electrical and muscle artifact. seizure detection programs: there were three entries in these files. these represented electrical and movement artifact. pushbutton activations: there were no entries in these files. sleep: there was no clear sleep architecture noted in the record. cardiac monitor: showed a generally regular rhythm with an average rate of 90 bpm. impression: this is an abnormal video eeg telemetry due to the presence of a slow background which reached a maximum of 7 hz. this represents a mild encephalopathy such as can be seen in toxic/metabolic, diffuse ischemic, or infectious etiologies. there were no clear epileptiform discharges or electrographic seizures noted. . eeg : continuous eeg: the background was slow reaching a maximum of 5.5 hz. of note, from 15:23 onward, the patient is not being recorded, as the leads appear to be off. spike detection programs: there were no entries in these files. seizure detection programs: there were no entries in these files. pushbutton activations: there were no entries in these files. sleep: there was no clear sleep architecture noted in the record. cardiac monitor: showed a generally regular rhythm with an average rate of 100 bpm. impression: this is an abnormal video eeg telemetry due to the presence of a slow background which reached a maximum of 5.5 hz. this represents a moderate to severe encephalopathy such as can be seen in diffuse ischemia, toxic/metabolic, infectious, or other diffuse etiologies. note is made of lack of readable recordings after 15:23. there were no clear epileptiform discharges or electrographic seizures noted. . ct head w/o contrast: impression: no evidence of definite acute abnormalities. the apparent thin left parietal extraaxial hyperdensity is likely an artifact, but could be reassessed by a follow-up ct or by mri. . mr head : findings: there is considerable motion artifact degrading image quality. the gradient echo images are nondiagnostic. there is no intracranial mass, mass effect or abnormal enhancement. no acute infarct is demonstrated. the ventricular dimensions and sulcal prominence are advanced for age. impression: no evidence of intracranial mass, acute infarct or abnormal enhancement. gradient echo images are degraded by motion artifact. mild degree of generalised cerebral atrophy advanced for age. . cxr : findings: in comparison with the study of and , there is some continued opacification in the retrocardiac region medially, concerning for pneumonia. the right picc line now extends to the region of the mid portion of the svc. . cxr : cardiac size is top normal. right picc tip is in the mid svc in unchanged position. retrocardiac opacity has improved consistent with improving atelectases. the right lower lobe opacity consistent with atelectases is unchanged. there is no pneumothorax or pleural effusion. . egd/colonoscopy biopsies: intestinal mucosal biopsies, three: a. duodenum: chronic active duodenitis with prominent increase in subepithelial collagen, surface epithelial damage, and subtotal villous shortening, see note. b. terminal ileum: small intestinal mucosa with largely denuded epithelium and increased subepithelial collagen, see note. c. random colon: 1. colonic mucosa with increased lamina propria chronic inflammation, surface epithelial damage, and increased intraepithelial lymphocytes, see note. 2. no appreciable increase in subepithelial collagen noted on h&e stained sections. note: in evaluable epithelium in the duodenal and terminal ileal biopsies, there is additionally a prominent increase in intraepithelial lymphocytes. the findings are consistent with a collagenous enteritis with concurrent microscopic (lymphocytic) colitis. these entities are known to co-exist in a rare subgroup of patients and show marked clinical response to steroid therapy. no microorganisms or viral cytopathic effect are seen. special stains to rule out possible co-existing infection and to confirm the presence of increased subepithelial collagen will be reported in an addendum. preliminary findings discussed with dr. on by dr. . addendum # 1: trichrome stain highlights a diffuse, markedly increased subepithelial collagen layer thickness in both the duodenal and ileal mucosal biopsies, while showing a patchy increase in the colonic mucosal biopsies. this supports a diagnosis of collagenous enterocolitis. red stain is negative for amyloid deposition in the duodenal biopsy with satisfactory control. giemsa stain reveals no microorganisms in the small intestinal biopsies with satisfactory control. brief hospital course: 49 y/o female with a history of seizure disorder, iddm, hypertension, alcohol abuse, initially presented with persistent, profuse, non-bloody diarrhea, biopsies consistent with collagenous colitis, course complicated by icu transfer for unresponsiveness and altered mental status, likely a post-ictal state from subclinical seizure. . #. collagenous enterocolitis: initially, etiology of patient's diarrhea was thought to be infectious and stool studies indicated a secretory process. she was started on cipro/flagyl and supported with ivfs for dehydration and electrolyte repletion as needed. initial stool studies were negative for infection and c. diff, and stool study results were obtained from duke, which were also negative. her diarrhea continued to be profuse, about 4-5 l/day. ciprofloxacin was discontinued during her icu course due to increase risk of seziures (see below). c. diff pcr and toxin were negative, although patient was continued on flagyl. gi was consulted, and recommended exploring other etiologies of secretory diarrhea, including sending tests for neuroendocrine tumors. (these tests were pending at the time of discharge). egd and colonoscopy was performed and showed no evidence of pseudomembranous colitis, thus flagyl was discontinued. biopsies showed findings consistent with microscopic colitis, and stains conformed the diagnosis of collagenous colitis. patient was started on budesonide 9 mg per day on andwill continue until her appointment with gastroenterology. patient's diarrhea began to decrease with the help of lomotil qid. . #. altered mental status/seizure: patient has a history of seziures controlled on depakote 1000 mg ; she had not been taking this med several days prior to admission due to poor po intake. patient's mental status began to change on hospital day #4. she became increasingly somnolent, was unresponsive. labs showed a worsening nag acidosis and an abg showed 7.33/23/100 with lactate of 1.1. she had no meningeal signs, was afebrile, serum tox negative. due to her history of seziures, and the fact that she had been off her po depakote, neurology recommended giving 1 mg ativan to treat possible seizure. she subsequently became more somnolent and was transferred to the micu. in the icu, 24 hour eeg only showed slow-wave activity, consistent with toxic/metabolic encephalopathy or post-ictal state. head ct and mri were both negative. vanc/ceftriaxone and acyclovir were started for emperic coverage of cns infection. lp was attempted but unsuccessful x 3. patient was transferred abck to the floor stable, but still somnolent. acyclovir was discontinued as viral encephalitis was unlikely. vanc/ceftriaxone was continued for treatment of hospital-acquired pneumonia (see below). her mental status began to clear and patient became more responsive over the next several days. she was maintained on iv depakote and dose was adjusted based on trough levels. once she able to tolerate pos, she was transitioned to po depakote at home dose without complications. she will have her valproate levels checked on with results faxed to dr. . her altered mental status was likely due to a prolonged post-ictal state after a subclinical seizure secondary to patient being off depakote for several days. by discharge, her mental status had cleared and she was interative and back to her baseline. . #. nutritional status: patient's albumin prior to discharge was 1.7, likely secondary to poor intake. the low albumin also caused diffuse edema and thrid spacing from massive ivf hydration over the past several weeks, which made the patient uncomfortable. nutrition was consulted and recommended that patient drink supplemetal formulas along with full po diet to increase protein intake to ultimately raise the albumin. as per gi she should be on a gluten free diet. . #. schizophrenia: on admission, patient had not been taking clozapine for several days. her dose was held through most of her admission as she was not able to tolerate pos. psych recommended starting at 12.5 mg once a day and slowly titrating up to patient's home dose. one 12.5 mg dose was administered; however, the patient became orthostatic, and subsequent doses were held. her clozaril was held prior to discharge and will discuss restarting during her follow up appointment with . . #. hypertension: lisinopril was held during patient's admission due to dehydration and labile blood pressures. she should discuss restarting lisinopril during her primary care appointment. . #. iddm: patinet's lantus was halved to 5 units qhs as she was not tolerating pos and sugars were maintained on an iss during admission. medications on admission: omeprazole 20 mg cap, delayed release 1 capsule(s) by mouth daily divalproex 500 mg tab, delayed release 2 tablet(s) by mouth twice daily clozapine 100 mg tab 3 tablet(s) by mouth daily at bedtime multivitamin tab 1 tablet(s) by mouth daily folic acid 1 mg tab 1 tablet(s) by mouth daily lantus 100 unit/ml subq cartridge subcutaneous 16-18 units cartridge(s) q pm glipizide 5 mg tab oral 1 tablet(s) once daily, in am lomotil 2.5 mg-0.025 mg tab oral 1 tablet(s) , as needed lisinopril 5 mg tab oral 1 tablet(s) once daily vitamin b-1 100 mg tab oral 1 tablet(s) once daily discharge medications: 1. divalproex 500 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po bid (2 times a day). 2. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po daily (daily). 3. multivitamin tablet sig: one (1) tablet po once a day. 4. lantus 100 unit/ml cartridge sig: 16-18 units subcutaneous at bedtime. 5. glipizide 5 mg tablet sig: one (1) tablet po once a day. 6. outpatient lab work please check valproate level and fax results to dr. (phone: , fax: ). 7. budesonide 3 mg capsule, sust. release 24 hr sig: three (3) capsule, sust. release 24 hr po daily (daily). disp:*30 capsule, sust. release 24 hr(s)* refills:*0* 8. diphenoxylate-atropine 2.5-0.025 mg tablet sig: one (1) tablet po q6h (every 6 hours). disp:*120 tablet(s)* refills:*0* 9. outpatient lab work please check cbc have results faxed to , l . discharge disposition: home with service facility: vna discharge diagnosis: primary: microscopic colitis hypotension seizure disorder seconadary: schizophrenia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were seen in the hospital because of persistent diarrhea. this diarrhea was found to be due to an autoimmune process called microscopic colitis. this condition is treated with the steroid budesonide which you will continue until your appoinment on . you will be followed by the gastrointestinal doctors for this condition. you were also noted to have low blood pressures. this was most likley due to all the fluid you were losing with the diarrhea. your lisinopril was held and should continue to be held. you should discuss restarting this medication with your primary care doctor. you should have your blood count checked on when you have your valproate level checked. your clozapine was also held because of the concern that it was lowering your blood opressure further. you should discuss restarting when you meet with on . the neurologists visited you during your admission. you will have a follow up appointment with dr. . you will have your valproate levels checked and the results will be sent to dr. . you should start a gluten free diet after you are discharged. this was recommended by your gastroenterologists to prevents worsening diarrhea. medications changes during this admission hold lisinopril hold clozapine continue budesonide continue lomotil (stop when your diarrhea stops) followup instructions: gastrointestinal: thursday @ 8:20 am with dr. name: , l. location: community health center address: , , phone: appointment: monday, at 4:15pm name: , specialty: psychiatry location: , phone: appointment: wednesday, at 11:30am department: neurology when: tuesday at 7:30 pm with: , md building: sc clinical ctr campus: east best parking: garage nutrition services phone: ( appt: please contact nutrition services directly to set up nutrition counseling. discuss your doctors of a gluten free diet. procedure: venous catheterization, not elsewhere classified esophagogastroduodenoscopy [egd] with closed biopsy closed [endoscopic] biopsy of large intestine central venous catheter placement with guidance diagnoses: pneumonia, organism unspecified other and unspecified noninfectious gastroenteritis and colitis anemia, unspecified toxic encephalopathy diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified hyposmolality and/or hyponatremia unspecified viral hepatitis c without hepatic coma personal history of tobacco use alcohol abuse, unspecified hypopotassemia unspecified schizophrenia, unspecified diaphragmatic hernia without mention of obstruction or gangrene hypotension, unspecified epilepsy, unspecified, without mention of intractable epilepsy duodenitis, without mention of hemorrhage leukocytosis, unspecified mixed acid-base balance disorder malnutrition of mild degree 

Answer: The patient is high likely exposed to