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 / vancomycin / gentamicin attending: chief complaint: seizure major surgical or invasive procedure: none history of present illness: the patient is a 40 yo man (unknown if l or r handed), with paraplegia following mva, asthma, gerd, substance abuse, ? seizure disorder, decubitus ulcers, s/p osteomyelitis who was brought to ed by ems. per ems records, the family called ems for confusion at home. he apparently had been taken off benzo's and narcotics recently (not known when and what he had been taking). he was found to have shaking in his upper body, but was able to respond to voice. on the way in he was given ativan 5mg im. upon arrival in the ed (23.06), he still had rhythmical movements in his upper body and respiratory muscles. he was able to mumble to voice but could not follow any commands. shorlty after arrival, the seizure activity appeared to stop, but then it resumed. he was given 6mg ativan iv and 5mg valium iv and was loaded on dilantin 1.5g iv. around 23.45, after the dilantin was loaded, the seizure broke. ros: not able to obtain past medical history: 1. paraplegia s/p mva at age 15 2. hx of decubitus ulcer on right buttock s/p failed attempt at closure 3. asthma 4. gerd 5. hx of pos ppd - treated 17 yrs ago 6. hx of utis 7. hx of substance abuse social history: ppd tobacco occasional etoh - none in last month; lives in village, recently living with sister. reported cocaine use 2 weeks before event, claims none more recently than that. family history: noncontributory. physical exam: vitals: t100.6 bp210/170 -->156/90 in ed --->70's/40's after med load rr21 so2 100 hr 86 gen: lethargic, responding to voice with mumbling, not following commands heent: mmm neck: no lad; no carotid bruits; neck supple lungs: clear to auscultation bilaterally heart: regular rate and rhythm, normal s1 and s2 abdomen: normal bowel sounds, soft, nontender, nondistended; old scars extremities: decubitus ulcers buttocks and several lesions r-foot; amputated toes bilat. mental status: letahrgic; not following commands; mumbles when asked to give his name cranial nerves: ii: blink to threat, pupils equally round and reactive to light both directly and consensually, 4-->2 mm bilaterally. iii, iv, vi: during seizure, eyes midline to slight r-deviation; does not track following seizure. respond to tickle nose. face looks symmetrical. able to vocalize. motor system: during seizure, moves both upper extremities as well as abdominal muscles; no facial twitching. after seizure, tries to take off mask with r-hand, good strength. some spontaneous movement in l-arm, but much less than r and no response on l to noxious. le: no spontaneous movements or movements elicited by noxious stimuli. wasting of distal muscles l-hand >r-hand. sensory system: withdraws to noxious stimuli in r hand, not left. no response in le (s/p paraplegia) reflexes: not able to elicit reflexes. toes: mute bilaterally. coordination: not able to test gait: not able to test pertinent results: 08:57pm phenytoin-18.0 05:40am glucose-134* urea n-6 creat-0.6 sodium-144 potassium-3.6 chloride-108 total co2-25 anion gap-15 05:40am alt(sgpt)-14 ast(sgot)-27 ld(ldh)-253* alk phos-88 amylase-113* tot bili-0.5 05:40am lipase-25 05:40am ck-mb-8 ctropnt-<0.01 05:40am albumin-3.9 calcium-8.8 phosphate-3.3 magnesium-1.5* 05:40am tsh-0.87 05:40am phenytoin-27.3* 05:40am wbc-12.1* rbc-5.33 hgb-15.6 hct-45.2 mcv-85 mch-29.3 mchc-34.6 rdw-14.7 05:40am neuts-81.8* lymphs-13.3* monos-3.1 eos-1.4 basos-0.3 05:40am plt count-229 05:40am pt-12.6 ptt-31.6 inr(pt)-1.1 11:53pm glucose-93 lactate-1.6 na+-145 k+-3.8 cl--108 tco2-28 11:45pm urea n-8 creat-0.6 11:45pm alt(sgpt)-16 ast(sgot)-25 ld(ldh)-215 ck(cpk)-309* alk phos-80 amylase-95 tot bili-0.4 11:45pm lipase-34 11:45pm ck-mb-6 11:45pm albumin-3.7 calcium-9.2 phosphate-3.4 magnesium-1.9 11:45pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-pos barbitrt-neg tricyclic-neg 11:45pm urine hours-random 11:45pm urine bnzodzpn-pos barbitrt-neg opiates-pos cocaine-pos amphetmn-neg mthdone-neg 11:45pm wbc-9.6 rbc-4.71 hgb-13.9* hct-39.9* mcv-85 mch-29.6 mchc-34.9 rdw-14.5 11:45pm plt count-183 11:45pm pt-13.0 ptt-30.8 inr(pt)-1.1 11:45pm fibrinoge-330 11:45pm urine color-yellow appear-clear sp -1.012 11:45pm urine rbc-* wbc-0-2 bacteria-rare yeast-none epi-0 cxr: impression: bibasilar opacities likely due to lower lobe collapse or possibly pneumonia secondary to aspiration. ct head : non-contrast head ct. findings: high-attenuation material is identified layering within several right parietal sulci concerning for subarachnoid hemorrhage. there is no evidence of mass effect, shift of normally midline structures or hydrocephalus. a 2.1 x 2.0cm low-attenuation focus in the right posterior parietal lobe with a slightly higher attenuation center, concerning for possible mass with surrounding edema. additional ill- defined areas of low attenuation are seen in the white matter tracts of the bilateral occipital lobes and may represent vasogenic edema. no other definite parenchymal abnormality is identified. the surrounding soft tissue and osseous structures are unremarkable. visualized paranasal sinuses and mastoid air cells are well aerated. impression: 1. high-density material layering within several right parietal lobe sulci consistent with subarachnoid hemorrhage. 2. a 2-cm focal area of hypoattenuation within the right superior parietal lobe with central area of low attenuation concerning for possible underlying mass lesion with surrounding edema; alternatively, this may simply represent edema surrounging matter. 3. hypoattenuation within the white matter tracts of the bilateral occipital lobes, which may reflect vasogenic edema. these findings are concerning for underlying lesion and followup with mr or contrast-enhanced ct is recommended when the patient is more stable. these findings were discussed with dr. at 1:00 a.m. on . eeg following am: background: showed an alpha frequency at times but was most often a lower voltage fast record. hyperventilation: could not be performed. intermittent photic stimulation: could not be performed. sleep: the patient appeared to remain awake or mildly drowsy throughout the recording. no stage ii sleep was obtained. cardiac monitor: showed an irregular rhythm at times. there were long periods of a normal sinus rhythm, but there were other periods with far less regular rhythm. impression: normal eeg in the waking and drowsy states. the faster background rhythms raise the possibility of medication effect. there were no areas of focal slowing, and there were no epileptiform features. an abnormal cardiac rhythm was noted, but this would be assessed better through routine ecg tracings. cervical spine. history: pre mri, neck hardware. a single ap view of cervical spine shows cerclage wires likely about the spinous processes of lower cervical vertebrae. there is no lateral view for assessment of the location of these wires. mri brain and mrv and mra of the head clinical information: patient with subarachnoid hemorrhage and possible mass on ct, for further evaluation. technique: t1 sagittal and flair t2 susceptibility and diffusion axial images of the brain were obtained. 3d time-of-flight mra of the circle of was acquired. 2d time-of-flight mrv of the head was obtained. the examination was limited by motion and several sequences were repeated. findings: brain mri: the flair and t2 images demonstrate increased signal along the post-parietal and occipital regions bilaterally. there is no corresponding slow diffusion identified. the ventricles and extraaxial spaces are normal in size without midline shift, mass effect, or hydrocephalus identified. subtle increased signal along the sulci in the right parietal region is consistent with subarachnoid hemorrhage seen on ct. there is no evidence of increased signal identified within the region of superior sagittal sinus. impression: bilateral parietal and superior occipitals t2 and flair hyperintensities without corresponding diffusion abnormalities. these findings could be secondary to contusions or less likely secondary to reversible encephalopathy . clinical correlation recommended. no acute infarcts. mra of the head: the head mra is limited by motion. somewhat tortuous intracranial arteries are visualized. flow signal is seen in both middle cerebral arteries, internal carotid, right vertebral and basilar artery. the left vertebral appears to be ending in posterior-inferior cerebellar artery. impression: motion-limited mra demonstrates flow signal in the major intracranial arteries. mrv of the head: the head mrv is also severely limited by motion. flow signal is identified in the superior sagittal sinus and also in the deep venous system. impression: motion-limited mrv of the head demonstrates flow signal in the major venous sinuses. head ct dated . findings: again, note is made of hyperdense hemorrhage within the sulci of right parietal lobe, overall unchanged compared to the prior study. again, note is made of hypodense areas in subcortical white matter in bilateral frontal and parietal lobes, which may represent edema or contusion, unchanged compared to the prior study. no shift of normally limited structures. no new mass effect. bilateral ventricles are symmetric in size. note is made of mucosal thickening in bilateral ethmoid sinuses. the osseous and soft tissue structures are unremarkable. impression: 1. overall unchanged appearance of subarachnoid hemorrhage in the right parietal lobe sulci compared to the prior study. 2. unchanged appearance of hypodensity in the subcortical white matter in bilateral frontal and parietal lobes, which may represent contusion; however, further characterization is not possible on this ct scan. further clinical assessment as well as further evaluation by mri if necessary, should be considered. left shoulder, three views: no fracture, dislocation, or focal osseous abnormality seen. the glenohumeral and acromioclavicular joint spaces are preserved. visualized left lung apex is clear. surrounding soft tissues are within normal limits. impression: no fracture or dislocation. brief hospital course: 40 yo man with paraplegia following mva, asthma, gerd, substance abuse, ?seizure disorder, decubitus ulcers, s/p osteomyelitis who presented in apparent partial status. the seizures broke following ativan, valium and dilantin load (1.5g). tox screen positive for cocaine, opioids and benzo. per records, he had been taken off benzo's and narcotics recently by pcp. exam (postictal) he was noted to have spontaneous movements in r-arm, trace movements in l arm (may be baseline as he is paraplegic), lethargic, not able to follow commands. etiology was thought to be likely related to withdrawal from benzos and opiates, as well as recent cocaine use, causing a seizure and hypertensive encephalopathy. he was admitted to the neurology icu for further workup. as the presentation was suspicious for partial status epilepticus, eeg was performed showing no ongoing seizure activity; head imaging initially showed high-density material layering within several right parietal lobe sulci consistent with subarachnoid hemorrhage, as well as a 2-cm focal area of hypoattenuation within the right superior parietal lobe with central area of low attenuation concerning for possible underlying mass lesion with surrounding edema; alternatively, this was felt simply represent edema surrounging matter. mri was performed to rule out an underlying neoplastic or vascular lesion - high signal in the parietal lobes bilaterally were suggestive of a reversible leukencephalopathy. lp ruled out meningitis as a cause of seizure and current presentation. as blood pressure normalized and the patient woke up more from post-ictal state, he was transferred to the floor for further management. his exam improved to baseline, with c7 and below weakness, as well as plegia of the lower limbs. mental status was intact. dilantin, which had been started for seizure, was d/c'ed once eegs showed there to be no evidence of an underlying sz d/o. the seizure was felt likely to be a withdrawal seizure from benzos. as his blood pressure was under control in hospital, hypertensive encephalopathy was thought likely some autonomic dysfunction with his known upper cord lesion history. the patient declined substance abuse counseling, to prevent future episodes like this. he did well on neurontin; as withdrawal had caused the clinical picture, the neurology team recommends not continuing these meds. however, pcp will be following the patient after discharge, and the patient will call to make further plans to adopt a good pain control regimen. with exam at baseline, and no need for acute rehab per pt, he was discharged home with services, including wound care for his chronic pressure ulcers. medications on admission: neurontin 400 mg tid, valium and dilaudid recently discontinued vs patient ran out. discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for fever. 2. gabapentin 400 mg capsule sig: one (1) capsule po tid (3 times a day). 3. tizanidine 2 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 4. nicotine 14 mg/24 hr patch 24hr sig: one (1) patch 24hr transdermal daily (daily). discharge disposition: home with service facility: vna discharge diagnosis: hypertensive encephalopathy seizure benzodiazepine and opioid withdrawal discharge condition: stable, at baseline discharge instructions: please return to ed if you have new symptoms of seizure or stroke. followup instructions: f/u with dr. - call for appointment. also, please call him for prescriptions should you wish to continue dilaudid and valium, which we are currently not recommending in light of recent withdrawal. procedure: arterial catheterization diagnoses: esophageal reflux asthma, unspecified type, unspecified other convulsions cocaine abuse, unspecified opioid type dependence, continuous personal history of other malignant neoplasm of skin pressure ulcer, other site pressure ulcer, buttock hypertensive encephalopathy drug withdrawal other toe(s) amputation status paraplegia late effects of motor vehicle accident sedative, hypnotic or anxiolytic dependence, continuous 

Answer: The patient is high likely exposed to