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: weakness in both legs major surgical or invasive procedure: spinal tap history of present illness: 20 yo male previously healthy with 1 wk h/o back pain (coccyx to midback) and 3 day history of progressive lower extremity weakness, over the last 1 day also hypophonia, shortness of breath, intermittent blurry vs double vision. about 2 weeks ago he took off the doors of his jeep and had one time that a friend jumped on his back. these both may have strained his back but he did not have any pain at the time, no clear injury. a few days later now 10 days ago he had onset of back pain, from his tailbone to midback, primarily on sides and less in midline. the back pain persisted. then 3 days ago while at work he noticed that when he bent down, it was hard to stand up. the following day he had progressive weakness of his lower extremities to the point that today when getting out of the car he collapsed to the ground because he could not support his weight. also over the last 1 day his speech has become soft and raspy, increased work of breathing with speaking. he has also over the last 1 day had shortness of breath with any level of activity. he has not had chest pain or palpitations. yesterday and today he has had some trouble swallowing, feeling like things were sticking. he has had blurry and possibly slight double vision intermittently x1 day. he has had difficulty initiating a urinary stream x a couple of days, worsening constipation over the last 1 week. in the ed he also developed headache (frontal and top of head) with photophobia, numbness sensation l face. he did see his pmd yesterday and had an mr of t and l spine which was reportedly normal. we do not have those results or images here today. ros: denies fevers, stiff neck. denies numbness/tingling. he has had some nausea x2 days no vomiting. no diarrhea. no rashes. no syncope or seizures. no confusion, difficulty coming up with the right words. no tick or bug bites. no preceeding illnesses. past medical history: nasal reconstructive surgery pyloric stenosis as a baby s/p surgery double urethra as a baby s/p repair before age 3 social history: lives at college, and studying entrepreneurship. he is an ra at school. he also works for a restaurant/bar. family history: no family history of autoimmune disease, blood clotting disorders. maternal 1st cousin with muscle weakness since birth no definite diagnosis physical exam: per admitting resident pe: t98.6 hr 95 rr 20 bp 159/97 o2 100% ra gen: awake, alert, not in distress, lying in bed. non-toxic appearance. skin: no rashes. heent: ncat, no conjunctival injection, mucous membranes moist, oropharynx clear. neck: supple, no meningismus. slight pain in back with neck flexion. no cervical tenderness. resp: clear to auscultation bilaterally. able to count to 25 in one breath. cv: regular rate, normal s1/s2, no murmurs, rubs, or gallops abd: bowel sounds present, abdomen soft, non-tender, and non-distended. no hepatosplenomegaly or masses palpable. rectum: rectal tone normal. no saddle anaesthesia. extrem: warm and well-perfused. no arthralgia. rom full. neuro: ms - awake, alert, interactive. oriented to person, place, and date. speech is fluent. intact registration, recall at 10 minutes. intact repetition, naming, comprehension. attentions is considered to be appropriate, says backwards. no left-right confusion. cranial nerves - pupils equal and reactive (5 to 3mm); eom smooth and full; with persistent upgaze develops vertical diplopia (possibly very slight l hyperopia); on persistent lateral gaze no diplopia or fatiguability; no nystagmus; visual field full with confrontation test, intact facial sensation on initial exam but on later exam with l facial numbness had decreased sensation to lt and temperature on l face; face symmetric with full strength of facial muscles, hearing intact to finger rub bilaterally, palate elevation is symmetric, and tongue protrusion is symmetric and full movement. sternocleidomastoid and trapezius are strong and normal volume. tone - normal in upper extremities, low in lower extremities strength - neck flexion/extension. bilat delt tri wrex fex fflx io. lower extremity exam below ip hipabd hipadd quad ham gastr ta tflx r 2 3 2 3+ 3 5 4- 4 4 4 l 2 3 2 3+ 3 5 4- 4 4 4 reflexes - biceps triceps brachioradialis patellar ankle r 2+ 2+ 2+ 0 0 l 2+ 2+ 2+ 0 0 plantar responses flexor bilaterally sensation - except face as above, intact to light touch, vibration, jps throughout. temperature sensation decreased from mid calf down bilaterally in stocking pattern. coordination - no dysmetria and smooth finger to nose. gait - not assessed due to weakness unable pertinent results: 05:05am blood wbc-5.9 rbc-4.52* hgb-13.2* hct-36.3* mcv-80* mch-29.2 mchc-36.4* rdw-12.9 plt ct-203 05:30am blood wbc-5.3 rbc-4.61 hgb-13.6* hct-37.6* mcv-81* mch-29.5 mchc-36.2* rdw-13.0 plt ct-197 06:40am blood wbc-5.3 rbc-4.70 hgb-13.5* hct-38.6* mcv-82 mch-28.7 mchc-35.0 rdw-12.9 plt ct-190 06:40am blood wbc-6.9 rbc-4.97 hgb-14.4 hct-40.7 mcv-82 mch-28.9 mchc-35.3* rdw-12.9 plt ct-220 02:59am blood wbc-6.0 rbc-4.84 hgb-14.3 hct-39.9* mcv-82 mch-29.6 mchc-35.9* rdw-13.2 plt ct-200 03:57am blood wbc-8.7 rbc-5.05 hgb-15.2 hct-41.1 mcv-81* mch-30.0 mchc-36.9* rdw-13.2 plt ct-218 05:50pm blood wbc-8.7 rbc-5.27 hgb-15.6 hct-43.0 mcv-82 mch-29.6 mchc-36.3* rdw-13.1 plt ct-227 05:05am blood neuts-58.0 lymphs-29.6 monos-7.0 eos-3.7 baso-1.6 05:50pm blood neuts-77.4* lymphs-15.2* monos-5.4 eos-1.5 baso-0.5 05:05am blood plt ct-203 05:30am blood plt ct-197 06:40am blood plt ct-190 06:40am blood plt ct-220 02:59am blood pt-14.0* ptt-33.3 inr(pt)-1.2* 05:50pm blood plt ct-227 05:50pm blood pt-13.5* ptt-29.1 inr(pt)-1.2* 05:05am blood glucose-96 urean-19 creat-0.8 na-139 k-4.1 cl-103 hco3-29 angap-11 05:30am blood glucose-89 urean-21* creat-0.9 na-142 k-4.2 cl-105 hco3-28 angap-13 06:40am blood glucose-101* urean-26* creat-1.0 na-140 k-4.2 cl-104 hco3-26 angap-14 02:59am blood glucose-100 urean-21* creat-1.1 na-138 k-3.9 cl-103 hco3-28 angap-11 05:50pm blood glucose-91 urean-23* creat-1.0 na-141 k-3.7 cl-103 hco3-27 angap-15 10:10pm blood alt-17 ast-25 alkphos-63 05:05am blood calcium-9.5 phos-4.4 mg-2.0 05:30am blood calcium-9.6 phos-4.4 mg-2.0 06:40am blood calcium-9.7 phos-4.1 mg-2.0 02:59am blood calcium-9.6 phos-4.1 mg-2.0 03:57am blood calcium-9.8 phos-4.5 mg-1.9 05:50pm blood calcium-9.6 phos-3.9 mg-1.8 06:40am blood tsh-3.0 10:10pm blood hbsag-negative hbsab-negative hbcab-negative hav ab-negative 02:59am blood rheufac-<3 03:28pm blood -negative 03:28pm blood crp-2.1 07:15pm blood iga-151 03:28pm blood b2micro-1.5 10:47pm blood hiv ab-negative 04:45pm blood vanco-7.2* 10:10pm blood hcv ab-negative 08:45pm blood adenovirus pcr-pnd 03:15pm blood virus b antibodies-pnd 05:40pm blood htlv i and ii, with reflex to western blot-neg 03:28pm blood west nile virus serology-pnd 10:10pm blood gq1b igg antibodies-pnd 10:10pm blood mycoplasma pneumoniae antibody, igg-high 10:10pm blood mycoplasma pneumoniae antibody igm-neg 10:10pm blood acetylcholine receptor modulating antibody-pnd 10:10pm blood acetylcholine receptor antibody-neg 07:00pm urine color-yellow appear-clear sp -1.016 07:00pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-6.5 leuks-neg 07:00pm urine 05:13pm cerebrospinal fluid (csf) wbc-165 rbc-9* polys-0 lymphs-95 monos-1 other-4 05:13pm cerebrospinal fluid (csf) wbc-180 rbc-10* polys-0 lymphs-96 monos-1 other-3 08:15pm cerebrospinal fluid (csf) wbc-175 rbc-4* polys-1 lymphs-95 monos-3 other-1 08:15pm cerebrospinal fluid (csf) wbc-140 rbc-6* polys-0 lymphs-95 monos-4 other-1 05:13pm cerebrospinal fluid (csf) totprot-178* glucose-55 ld(ldh)-24 08:15pm cerebrospinal fluid (csf) totprot-396* glucose-44 ld(ldh)-35 01:16pm cerebrospinal fluid (csf) enterovirus pcr-pnd 05:13pm cerebrospinal fluid (csf) herpes 6 pcr-pnd 05:13pm cerebrospinal fluid (csf) west nile virus serology-pnd 10:06pm cerebrospinal fluid (csf) varicella dna (pcr)-neg 10:06pm cerebrospinal fluid (csf) cytomegalovirus - pcr-neg 10:06pm cerebrospinal fluid (csf) mycoplasma pneumoniae dna, pcr-neg 10:06pm cerebrospinal fluid (csf) herpes simplex virus pcr-neg reque 10:06pm cerebrospinal fluid (csf) ebv-pcr-neg 10:06pm cerebrospinal fluid (csf) lyme, total eia with reflex to csf ratio-pnd 02:23pm other body fluid cd45-done kappa-done cd19-done lamba-done cd16/56-done 02:23pm other body fluid cd3-done cd4-done cd8-done 02:23pm other body fluid ipt-done microbiology 8:15 pm csf;spinal fluid 3. **final report ** gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. fluid culture (final ): no growth. 10:10 pm serology/blood **final report ** lyme serology (final ): no antibody to b. burgdorferi detected by eia. reference range: no antibody detected. negative results do not rule out b. burgdorferi infection. patients in early stages of infection or on antibiotic therapy may not produce detectable levels of antibody. patients with clinical history and/or symptoms suggestive of lyme disease should be retested in weeks. 3:28 pm serology/blood source: venipuncture. **final report ** rapid plasma reagin test (final ): nonreactive. reference range: non-reactive. 5:13 pm csf;spinal fluid source: lp tube 3. **final report ** cryptococcal antigen (final ): cryptococcal antigen not detected. (reference range-negative). performed by latex agglutination. results should be evaluated in light of culture results and clinical presentation. gram stain (final ): no polymorphonuclear leukocytes seen. 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. fungal culture (preliminary): no fungus isolated. acid fast culture (preliminary): the sensitivity of an afb smear on csf is very low.. if present, afb may take 3-8 weeks to grow.. viral culture (preliminary): no virus isolated so far. 3:57 am blood (ebv) ebvp added to chem#f-. **final report ** - virus vca-igg ab (final ): positive by eia. - virus ebna igg ab (final ): positive by eia. - virus vca-igm ab (final ): negative <1:10 by ifa. interpretation: results indicative of past ebv infection. in most populations, 90% of adults have been infected at sometime with ebv and will have measurable vca igg and ebna antibodies. antibodies to ebna develop 6-8 weeks after primary infection and remain present for life. presence of vca igm antibodies indicates recent primary infection. 8:45 pm blood (cmv ab) **final report ** cmv igg antibody (final ): negative for cmv igg antibody by eia. < 4 au/ml. reference range: negative < 4 au/ml, positive >= 6 au/ml. cmv igm antibody (final ): negative for cmv igm antibody by eia. interpretation: no antibody detected. greatly elevated serum protein with igg levels > mg/dl may cause . interference with cmv igm results. 8:45 pm immunology hiv-1 viral load/ultrasensitive (pending): 5:00 am blood culture blood culture, routine (pending): radiology mri of the cervical, thoracic, and lumbar spine dated . clinical history: 20-year-old man with 1-1/2 weeks history of back pain and three days history of lower extremity weakness, with weakness and absent reflexes in lower extremity, hypophonic voice, shortness of breath, dysphagia. technique: mri of the cervical, thoracic, and lumbar spine was performed both before and after the administration of intravenous contrast, as per the standard departmental protocol. comparisons: none. findings: mr cervical spine: the vertebral body height and alignment is maintained. there is normal bone marrow signal. there is no evidence of disc herniation, spinal canal narrowing, or neural foraminal narrowing. the visualized posterior fossa and cervical cord demonstrate normal signal intensity on t2 images. there may be subtle leptomeningeal enhancement along the cord, although this is difficult to corroborate on the axial images. mr thoracic spine: the vertebral body height and alignment is maintained. there is normal bone marrow signal. there is no disc herniation, spinal canal narrowing, or neural foraminal narrowing. visualized thoracic cord demonstrates normal signal intensity and morphology. there is enhancement of the leptomeninges surrounding the conus medullaris, with extension into the lumbar spine as detailed below. lumbar spine: vertebral body height and alignment is maintained. there is normal bone marrow signal. there is no disc herniation, spinal canal or neural foraminal narrowing. there is leptomeningeal enhancement surrounding the conus medullaris with extension along several nerve roots of the cauda equina. impression: leptomeningeal enhancement surrounding the cauda equina and involving several nerve roots of the cauda equina. differential considerations include guillain- syndrome, meningitis, lymphoma as well as other infectious and inflammatory etiologies including lyme disease in proper clinical setting. the study and the report were reviewed by the staff radiologist. ct torso indication: 20-year-old male with new lower extremity weakness and back pain. no prior examinations for comparison. technique: helical mdct images were acquired through the torso with intravenous and oral contrast. coronal and sagittal multiplanar reformations were generated. findings: evaluation is suboptimal, due to delayed phase of contrast imaging. chest: the lungs are clear, other than mild bibasilar atelectasis. the heart and great vessels are unremarkable. there is no pulmonary embolus. there is no axillary, hilar, or mediastinal lymphadenopathy. a small hiatal hernia is present. abdomen: the spleen is enlarged, measuring up to 16 cm. the liver, gallbladder, pancreas, adrenals, and kidneys are unremarkable. the stomach and small bowel are normal. pelvis: the appendix, colon, and rectum are normal. a foley catheter is present in the bladder. the prostate and seminal vesicles are unremarkable. there is no free fluid in the pelvis. impression: splenomegaly. no evidence of malignancy. brief hospital course: mr. was admitted to neurology service for evaluation of progressive lower extremity weakness. the possible differentials at the time of admission were polyradiculopathy/neuropathy. because he had complains of breathing difficulties at the time of admission, he was admitted to neuro icu for observation. he was evaluated with mri of brain and spine which showed enhancement of the multiple roots supporting the clinical diagnosis of polyradiculpathy. for further evaluation, diagnostic csf was done which showed 140-180 cells and -346 of protein suggesting inflammatory etiology as the cause. due to high pleocytosis, this was not very consistent with diagnosis of gbs. he was started on antibiotics and antiviral to cover for empiric meningitis. he was clsely monitered in icu for respiratory status. frequent nif and vc were checked , which was continued even after transfer to floor. the respiratory parameters were alwyas within normal limits. infectious disease recs were followed for work up of possible infectious etiologies. he had extensive work up for finding infectious . the work up, so far has been negative including lyme, rpr, ebv, cmv, hiv ab. few of the tests are still pending. he underwnet autoimmune work up with , rf, esr and crp all of which were negative. consideration of possible paraneoplastic etiology was given and he underwent ct scan of torso to rule out visceral cancer which was negative. csf was sent for cytology which is pending at this time. due to rapid improvement and absense of systemic features of bacteremia/viremia, antibiotics/ virals were stopped as suggested by id team. ivig was not considered in therapy due to csf pleocytosis and presentation inconsistent with gbs. he showed steady improvement in muscle power. he was seen by occupational and pt who suggested acute care facility for rehab purposes. medications on admission: naprosyn 500mg po bid scalaxin 800mg po bid discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: 5000 (5000) injection tid (3 times a day). 2. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 3. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain. 4. lorazepam 0.5 mg tablet sig: one (1) tablet po hs (at bedtime) as needed for insomnia. 5. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for c. 6. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 7. magnesium hydroxide 400 mg/5 ml suspension sig: thirty (30) ml po q8h (every 8 hours) as needed for constipation. 8. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain or t>100.4. discharge disposition: extended care facility: - discharge diagnosis: polyradiculopathy, inflammatory, ? infectious (viral) discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitte for evaluation of progressive weakness. you were initially admitted to icu for close observation and later were shifted to neurology floor. you had diagnostic spinal tap and mri and were diagnosed with inflammatory polyradiculopathy, most likely infectious in origin, likely viral. you were evaluated by infectious disease service and underwent extensive blood and csf tests to rule out infectious etiologies. few of those tests are pending at this time. you were evaluated by physical therapy who suggested extended care facility for rehab purposes. please take your medicines as advised. please call 911/ your doctor for any questions. please follow up with the appointments scheduled. followup instructions: provider: . & phone: date/time: 1:00 provider: , id west (sb) phone: date/time: 9:30 procedure: spinal tap incision of lung diagnoses: retention of urine, unspecified other respiratory abnormalities unspecified viral meningitis diplopia 

Answer: The patient is high likely exposed to