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: percocet / lasix / keflex / wellbutrin / sulfa (sulfonamide antibiotics) / dilantin attending: chief complaint: altered mental status major surgical or invasive procedure: history of present illness: mr. is a 65 yo male w/ metastatic melanoma on ctla-4 antibody protocol who presented to on with complaint of weakness and diminishing po intake x 3 days, per wife. according to his wife, he was ambulatory the day pta and then was noted to be lethargic and confused on the morning of admission. she reports that he had not been eating or drinking for 3 days, and she had found food she had prepared for him in the trash. of note, patient was seen in the brain clinic on and reported upper respiratory tract symptoms, including a frontal headache, nasal congestion, and erythema around his eyes. he was treated with azithromycin for sinusitis. . on arrival to the ed on , he was felt to be dehydrated and was admitted for rehydration. a temperature of 101.1 was documented at time of admission. he received ivf following admission to the medicine service. he subsequently developed urinary retention and was started on levofloxacin for uti and ?sinusitis. a neurology consultation was obtained and ct and lp were performed which showed protein 75, glucose 58, wbc 13 (12n,78l,10m). gram stain: occ polys, no organisms. culture(-). afb(-). it was concluded that his altered mental status was related to "metabolic encephalopathy" in the setting of uti vs. sinusitis. he was treated with levofloxacin. po intake remained poor and mental status continued to deteriorate. his wife states that he was ambulating until monday, and has been lying in the fetal position for the past two days. given his persistent and declining mental status, he was transferred to the omed service for further evaluation and management. . upon arrival to omed, labs were notable for cortisol of <0.3 and sodium of 122. team was concerned for leptomeningeal spread vs. cns infection. he was started on acyclovir empirically for possible viral meningitis and plan was for repeat mri and lp (to obtain opening pressure and cytology). past medical history: past medical history: 1. metastatic melanoma with known mets to brain and lungs - he was diagnosed with melanoma in when a right anterior neck lesion was discovered. he then underwent excision and biopsy at this time and underwent 8 months of alpha-interferon treatment. he then developed right chest wall pain and a ct of the torso revealed metastatic disease to the lungs and the patient subsequently underwent 26 rounds of il-2 therapy ending on . a head mri in did not reveal any intracranial masses. however, on he developed a headache with continuous occipital and neck pain that progressed to an intermittent bilateral frontal head pain with cough only and associated sensitivity to light. on , he was taken to an osh for evaluation and found to have an intracranial lesion on head ct. he was then transferred to for a craniotomy on by , m.d., ph.d., which was performed on . this was followed by whole brain cranial irradiation to 3600 cgy in 12 fractions. 2. bph 3. hypercholesterolemia 4. h/o viral meningitis in 5. h/o shingles in 6. h/o mrsa bacteremia . past surgical history: 1. s/p appendectomy 2. s/p craniotomy for single met to right temporal lobe performed by dr. in social history: lives at home with his wife. 3 sons and 1 daughter. part-time as a dispatcher for trucking company. smokes 1ppd x 20yrs. occasional etoh use. family history: non-contributory physical exam: gen: nad, opens eyes to voice, non-cooperative for exam heent: perrl. cv: rrr, no mrg appreciated. pulm: ctab though poor inspiratory effort anteriorly; does not sit forward abd: +bs, soft, ntnd ext: no , 2+ dp pulses neuro: pupils equal and reactive to light. patient responds to voice but cannot follow commands. replies yes to most questions. cannot repeat words and can only move feet to voice. he is stiff and resistant to any attempts to change his position. can withdraw to pain and startles easily. reflexes symmetric. withdraws to babinski. pertinent results: wbc 7.9 / hct 32.3 / plt 465 na 122 / k 3.8 / cl 90 / co2 24 / bun 3 / cr .8 / bg 88 alb 3.2 / ca 8.7 / mg 1.4 / serum osm 247 cortisol < .3 tsh 2.3 / t4 9.2 alt 15 / ast 23 / ldh 236 / alk phos 60 / tuberculosis .6 inr 1.2 urine na 182 / urine cr 111 urine osm 543 mr no significant change since the previous mri of . no leptomeningeal enhancement is identified. post-surgical changes are seen as described previously. 12:00am blood wbc-10.0 rbc-3.46* hgb-11.9* hct-32.6* mcv-94 mch-34.4* mchc-36.6* rdw-14.1 plt ct-465* 12:00am blood glucose-115* urean-17 creat-0.9 na-133 k-4.0 cl-102 hco3-22 angap-13 03:33am blood ck(cpk)-193* 08:21pm blood ck(cpk)-244* 03:33am blood ck-mb-2 ctropnt-<0.01 08:21pm blood ck-mb-2 ctropnt-<0.01 12:00am blood calcium-8.6 phos-3.6 mg-2.1 04:03pm blood caltibc-200* vitb12-1633* folate-14.7 ferritn-467* trf-154* 11:58am blood osmolal-271* 04:03pm blood tsh-2.3 04:03pm blood t4-9.2 09:38pm blood cortsol-3.6 08:21pm blood cortsol-<0.3* 8:21 pm csf;spinal fluid **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (final ): no growth. 08:21pm cerebrospinal fluid (csf) wbc-6 rbc-31* polys-0 lymphs-72 monos-24 atyps-3 macroph-1 08:21pm cerebrospinal fluid (csf) wbc-10 rbc-69* polys-1 lymphs-72 monos-24 atyps-2 macroph-1 08:21pm cerebrospinal fluid (csf) totprot-65* glucose-59 04:55pm cerebrospinal fluid (csf) herpes simplex virus pcr-test name brief hospital course: mr. is a 65 year old gentleman with metastatic melanoma on ctla-4 protocol transferred from osh for altered mental status. 1. altered mental status: csf analysis at osh demonstrated protein of 75 with lp with csf of 65 concerning for hsv encephalitis. patient was started on iv acylcovir empirically. leptomeningeal spread of malignancy was also considered, with csf cytology non-diagnostic and mri without significant findings. hsv pcr on the csf as well as all other culture data was negative (though other viral pcr/cultures were not done). he received 7 days of iv acyclovir. we decided not to re-lp to perform further studies as the risks outweighed the benefits, his mental status had cleared, and it would unlikely change the treatment plan. the patient was also found to be hyponatremic to 121 during his admission, which was may have contributed to his altered mental status and he had adrenal insufficiency which could have contributed as well. eeg was done which did not show evidence of seizure, but did show possible subcortical dysfunction within the right temporal lobe. 2. hyponatremia: patient came in with sodium of 121 and the differential diagnosis included siadh and adrenal insufficiency. random cortisol was low (0.3) and urine sodium was high. we treated him with fluid restriction of 1l day and his sodium cam up to 130, then we changed this to 2l day so he would not become dehydrated at home and his sodium returned to a normal range. he was also continued on dexamethasone. the etiology of his hyponatremia was likely multifactorial. 3. adrenal insufficiency: he completed in mid- a dexamethasone taper. on admission, his serum cortisol was below assay. he was hyponatremic as well so we treated him with dexamethasone. we did not start a taper of his dexamethosone and suggested he start this as an outpatient. his previous taper was very slow, over one month, so his next one should be even slower. 4. fever: patient was febrile to 101 at osh, but was afebrile during his hospital course. he had negative cultures at and had 1/2 bottles of coag neg staph at osh with follow-up cultures negative. antimicrobial therapy was held during his admission. 5. sinusitis: patient was treated with a 7 day course of levofloxacin. 6. conjunctivitis: treated with 7 day course of erythromycin drops. 7. metastatic melanoma: per primary oncologist, dr. . 8. bph: patient continued on tamsulosin. 9. dyslipidemia: statin held during admission. he was instructed to resume on discharge. medications on admission: outpatient medications: dexamethasone taper since , stopped atorvastatin finasteride levetiracetam 1g lorazepam 1mg q6-8h prn prochlorperazine 10mg 1 hour prior to radiotherapy ranitidine 150mg tamsulosin 0.8mg daily azithromycin to have been completed pet omr . transfer medications: 1. keppra 1000 mg twice a day. 2. ofloxacin one drop ou b.i.d. 3. simvastatin 40 mg a day. 4. tamsulosin 0.4 mg a day. 5. promethazine p.r.n. 6. tylenol p.r.n. 7. calcium carbonate 1-2 tablets q.i.d. p.r.n. 8. vicodin one to two tabs q.4h. p.r.n. 9. ibuprofen p.r.n. 10. heparin flush. discharge medications: 1. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po hs (at bedtime). 2. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 3. prochlorperazine maleate 10 mg tablet sig: one (1) tablet po once as needed: please take 1 hour prior to radiotherapy. 4. ranitidine hcl 150 mg capsule sig: one (1) capsule po twice a day. 5. dexamethasone 4 mg tablet sig: 2.5 tablets po daily (daily): please continue until your appointment with dr. . disp:*75 tablet(s)* refills:*2* 6. acyclovir sodium 500 mg recon soln sig: eight hundred (800) mg intravenous q8h (every 8 hours) for 6 days: last day . disp:*144 g* refills:*0* 7. simvastatin 40 mg tablet sig: one (1) tablet po once a day. discharge disposition: home with service facility: discharge diagnosis: primary: 1. altered mental status likely viral encephalitis 2. metastatic melanoma. discharge condition: stable, afebrile, alert and oriented x3 discharge instructions: 1. you were admitted for altered mental status. we determined that you were likely not having a seizure. you were continued on keppra, which you will need to continue taking as an outpatient. we believe you may have had a viral infection in your brain or your mental status may have been from adrenal insufficiency. we also found your sodium was low. we treated you with iv antiviral medications, decadron and your mental status improved back to baseline. . 2. unless otherwise indicated, you should resume all of your home medications as taken prior to admission. it is very important that you take all of your medications as prescribed. we added the following medications: stopped lorazepam added dexamethasone 10mg po daily. you should talk to dr. about slowly tapering this medication at your follow up appointment. . 3. it is very important that you keep all of your doctor's appointments as below. 4. if you develop chest pain, shortness of breath, or other concerning symptoms, please call your doctor or go to your local emergency department immediately. followup instructions: provider: , md phone: date/time: 1:00 provider: scan phone: date/time: 9:00 provider: , rn phone: date/time: 2:00 . please call your primary care doctor, cueni, to schedule a follow up appointment in the next 1-2 weeks. md, procedure: venous catheterization, not elsewhere classified spinal tap incision of lung transfusion of packed cells diagnoses: pneumonia, organism unspecified urinary tract infection, site not specified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) secondary malignant neoplasm of lung metabolic encephalopathy glucocorticoid deficiency other disorders of neurohypophysis personal history of malignant melanoma of skin anemia in neoplastic disease acute sinusitis, unspecified unspecified non-arthropod-borne viral diseases of central nervous system conjunctivitis, unspecified 

Answer: The patient is high likely exposed to