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: heparin agents attending: chief complaint: altered mental status major surgical or invasive procedure: intubation, mechanical ventilation replacement of tunneled hemodialysis catheter history of present illness: 66 yo french creole speaking female h/o diabetes, end-stage renal disease on hd and hypertension who intially presented to acutely delirious. she reportedly became acutely altered, not making sense, and combative at home starting at 1300. her husband brought her to . in the osh, she was noted to have a bs > 500 and question of intermittent episodes of muscle rigidity. ?seizure activity. became responsive only to pain. ct did not show acute process. lp done: no wbc, two rbcs, however no further testing of csf was provided. she was given haldol and ativan for agitation and labetalol 20 iv and hydralazine 10 iv x 2 for blood pressures noted to be 233/103 -> 126/100. no antibiotics given. transferred to for further management. . upon arrival to the ed, initial vs: 97.2 231/119. initially triggered for ams. labs notable for wbc of 11.2 with left shift. lactate of 2.6. gave vanc/cefepime. ua small blood, 300 protein and 300 glucose. cxr: no consolidation. ekg: sinus tachycardia with st depressions and was given 600 mg pr asa. exam also notable for warm, tender left forearm. she notably had a graft created and subsequently ligated secondary to steal syndrome. transplant was called and will see patient when arrives to micu. . given her alterd state and concern she wasn't protecting airway, she was intubated. of note, family confirmed full code status. two pivs placed. noted to have fevers to 40 degrees c and given pr tylenol and toradol. also, nipride gtt started for severe hypertension (158-267/71-126). renal was called and felt no acute need for hd at this time. vs prior to transfer: t40 hr 115 154/73 23 100% on ac. . upon arrival to the micu, patient was intubated and sedated on propofol and febrile to 104.1. . review of systems: unable to obtain past medical history: esrd on hd m/w/f type 2 diabetes hypertension gerd osteomyelitis glaucoma hepatitis b hepatitis c hemorrhoids c. diff colitis hit antibody positive social history: -home lives with , her husband -cigarettes none -alcohol none -caffeine light family history: noncontributory physical exam: on admission: vitals: t:104 bp:215/89 p: 100 r: o2: 100% ac general: intubated, sedated, no acute distress heent: sclera anicteric, dry mm, oropharynx clear neck: supple, jvp not elevated, no lad chest: right tunneled hd line in place without erythema/warmth or swelling lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: tachycardic, normal s1 + s2, systolic murmur, no rubs abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley in place ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. left old graft is mildly warm, however does not appear erythematous. no fluctuance appreciated. at discharge: vitals: t:97.9 bp:150/60 p:70 r:16 o2:98% ra fs 181 general: nard, comfortable, alert and interactive heent: ncat, perrl, sclerae anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad, no carotid bruits chest: right tunneled hd line in place without erythema/warmth or swelling lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi, resp unlabored and no accessory muscle use cv: rrr, normal s1/s2 abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema. left old graft does not appear erythematous. no fluctuance or exudate appreciated. neuro: awake, a&ox1 (knows name), cns ii-xii grossly intact, moving all extremities spontaneously with 5/5 strength throughout except lue (chronic), sensation grossly intact throughout, dtrs 2+ and symmetric, gait unsteady pertinent results: admission labs: 09:00pm blood wbc-11.2* rbc-4.76 hgb-12.3 hct-38.6 mcv-81* mch-25.8* mchc-31.8 rdw-22.8* plt ct-214 09:00pm blood neuts-89.6* lymphs-6.8* monos-2.3 eos-0.6 baso-0.6 09:00pm blood glucose-83 urean-38* creat-4.8* na-140 k-4.6 cl-102 hco3-23 angap-20 09:00pm blood ck(cpk)-182 12:30pm blood calcium-8.3* phos-4.5 mg-1.9 . discharge labs: 134 | 97 | 15 < 132 agap=11 3.6 | 30 | 3.7 ca: 8.8 mg: 1.8 p: 3.5 mcv: 80 3.6 > 9.0 / 26.6 < 158 n:60.1 l:28.9 m:8.6 e:2.2 bas:0.2 . micro: 9:00 pm blood culture blood culture, routine (final ): no growth. . 11:30 pm urine site: catheter urine culture (final ): no growth. . 12:22 am blood culture blood culture, routine (final ): no growth. . 1:45 am mrsa screen source: nasal swab. mrsa screen (final ): no mrsa isolated. . 2:25 am blood culture source: line-hd line. blood culture, routine (final ): no growth. . - virus vca-igg ab (final ): this is a corrected report . equivocal by eia. previously reported as positive by eia. reported to and read back by pat boynkins @ 2:35 pm. - 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. . cmv viral load (final ): cmv dna not detected. . 11:38 am urine source: catheter. urine culture (final ): no growth. . cxr: semi-upright ap view of the chest: study is limited due to patient rotation and positioning. right-sided dual-lumen central venous catheter tip terminates within the proximal right atrium. heart size is likely mildly enlarged. the lungs are grossly clear without focal consolidation. no pleural effusion or pneumothorax is identified. impression: limited study due to rotation. no acute cardiopulmonary abnormality. . ultrasound a/v fistula: the left brachial artery and the left cephalic vein are patent, presenting with normal doppler waveforms. the left ligated av graft is occluded with no evidence of flow. impression: patent left brachial artery and cephalic veins. . mra brain without contrast: there is flair, t2 and diffusion high signal in the splenium of corpus callosum without convincing adc changes. a further punctate focus of t2 and flair hyperintense lesion is seen in the right occipital white matter, bright on diffusion and adc map, suggesting a late subacute infarct. multiple foci of t2 and flair hyperintensities are seen in the subcortical and deep white matter, with confluent signal changes in the parietal lobe white matter and periventricular regions suggesting small vessel ischemic change. the ventricles and sulcal configuration are slightly prominent for patient's age. susceptibility imaging demonstrates artifacts related with basal ganglia calcifications. punctate foci of gradient artifacts are seen in the left parietal lobe and both cerebellum which may represent previous microhemorrhage. there is no intracranial mass or mass effect. the visualized paranasal sinuses are clear. bilateral lens implants are demonstrated. mra brain: images are degraded by motion artifact. there is no gross evidence of an aneurysm, vascular malformation or flow-limiting stenosis. the vertebral arteries are codominant. the basilar artery is patent. both posterior cerebral arteries are visualized. there is probable irregularity and narrowing of the p2 segments. impression: 1. abnormal diffusion signal changes in the splenium of corpus callosum with t2 and flair hyperintensity and no corresponding adc changes suggesting late subacute infarct. further punctate focus of subacute infarct in the right occipital white matter. 2. small vessel ischemic changes in the subcortical and deep white matter. 3. mra brain image quality is degraded by motion. within this limitation, no evidence of a large aneurysm or vascular malformation is demonstrated. probable irregularity and narrowing of the p2 segments, right more than left. . right lower extremity ultrasound: findings: real-time grayscale and color doppler evaluation of the right internal jugular, axillary, brachial, basilic, and cephalic veins were obtained. there is normal compressibility, wall-to-wall color flow, and augmentation throughout. wall-to-wall color flow was seen in the left subclavian vein. impression: no evidence of left upper extremity deep venous thrombosis. brief hospital course: ms was transferred from with severe hypertension, fever, hyperglycemia, and ams. she was admitted to the icu where she was initially intubated for airway protection. she was extubated safely and became more awake and alert and was called out to the inpatient floor on . her hospital course is outlined below. . *) altered mental status: etiology of altered mental status is unclear. likely is hypertensive emergency or some form of acute toxic-metabolic encephalopathy. she did not appear postictal or infected. after control of her blood pressure and blood sugar, her agitation and unresponsiveness resolved although her confusion did not. she was initially intubated for airway protection but was successfully extubated. treatment for her altered mental status revolved around treating the other problems which are described below. a mri/mra of the head was obtained which showed some chronic/sub-acute changes. antibiotics were continued empirically to cover for possible infections and were stopped when culture data returned negative. at the time of discharge was breathing room air, feeding herself, following commands, and answering questions though according to both the interpreter and family she was still quite confused. she was followed by neurology and an eeg was performed the day of discharge. she will have neurology followup 4-6 weeks after discharge. she was evaluated by physical therapy and found to have occasional loss of balance with significant distractibility and poor insight, requiring supervision. . *) fever: culture data from csf was obtained daily from . all antibiotics were stopped, including acyclovir, given negative cultures and negative pcr. etiology is unclear and fever resolved quickly without significant leukocytosis. cultures at were also all negative. she remained afebrile off all antibiotics and no clear localizing source was ever found by exam, imaging, or laboratory data. hiv was negative. . *) hypertensive emergency: patient notably on nifedipine, amlodipine, lasix, hydralazine, labetalol, and lisinopril at home with normotensive readings per records; however, with difficult to control bps per pcp . it is possible that patient missed her multiple medications and as a consequence, became severely hypertensive, resulting in hypertensive emergency. blood pressures have been better controlled since restarting home meds. her home medications were titrated as follows: lasix was stopped as this is likely doing nothing due to her renal failure, and nifedipine was held over the course of her hospitalization as it could not be crushed. instead, labetalol and lisinopril were increased. it was noted that if her medications were not given on schedule her blood pressure rose rapidly. . *) esrd: she was followed by nephrology and received hemodialysis t/th/sa. her tunneled line was noted to have one arterial lumen clotted off, and although hd was possible the line was changed by interventional radiology given the potential nidus for infection. . *) diabetes: insulin dependent and quite brittle likely due to esrd. her glargine was halved and she was maintained with a lispro insulin sliding scale. her blood sugars remained difficult to control with episodes of hyperglycemia to the 230s and her insulin will need close monitoring as an outpatient. as her oral intake improves she may require 10 units of glargine at bedtime, which was her previous outpatient regimen. . *) microcytic anemia: baseline hct appears to be 25-28% with low mcv likely in low iron state from esrd. on admission her hct was well above baseline, and it trended down to baseline with hydration. she had no evidence of bleeding. . *) leukopenia: her wbc count trended down over the hospitalization. after discussion with pharmacy the most likely culprit medication was thought to be vancomycin; because she is a dialysis patient vancomycin stayed in her system longer. her wbc count was monitored and stabilized between . she was never neutropenic. . *) hyperlipidemia: her simvastatin was continued. aspirin was added given the possibility of stroke and her risk factors for cad. . *) glaucoma: her timolol, latanoprost, and apraclonidine eye drops were all continued. . *) transition of care: patient was discharged to rehab for continued physical therapy and supervision. she will require the following services: - physical therapy as needed for evaluation and treatment - hemodialysis tuesday, thursday, saturday - follow up with her primary care physician 1-2 weeks of discharge for blood pressure and blood sugar checks. - re-check cbc in one week to ensure stabilization of wbc count - follow up with a neurologist in weeks; eeg results pending at the time of discharge. medications on admission: medications: per atrius records timolol maleate 0.5 % ophthalmic gel forming solution instill 1 drop to each eye daily simvastatin 20 mg daily lisinopril 10 mg daily latanoprost (xalatan) 0.005 % ophthalmic drops instill 1 drop to each eye at bedtime labetalol 200 mg oral tablet 1 tablet twice daily insulin lispro (humalog) 100 unit/ml subcutaneous solution use 2-10 units with meals using the sliding scale insulin glargine () 100 unit/ml subcutaneous solution inject 10 units subcutaneously at 9pm hydralazine 50 mg oral tablet take one tablet by mouth every 6 hours furosemide 20 mg oral tablet take 1 tablet daily apraclonidine (iopidine) 0.5 % ophthalmic drops instill 1 drop in each eye three times daily amlodipine 10 mg daily ergocalciferol, vitamin d2, 50,000 unit oral capsule take 1 capsule weekly for 12 weeks nifedipine 60 mg oral tablet sustained release daily ferrous sulfate 325 mg (65 mg iron) tab 1 tablet three times daily discharge medications: 1. simvastatin 10 mg tablet : two (2) tablet po qhs (once a day (at bedtime)). 2. timolol maleate 0.5 % drops : one (1) drop ophthalmic daily (daily). 3. latanoprost 0.005 % drops : one (1) drop ophthalmic hs (at bedtime). 4. hydralazine 50 mg tablet : one (1) tablet po q6h (every 6 hours). 5. amlodipine 5 mg tablet : two (2) tablet po daily (daily). 6. acetaminophen 325 mg tablet : two (2) tablet po q6h (every 6 hours) as needed for fever. 7. apraclonidine 0.5 % drops : one (1) drop ophthalmic tid (3 times a day). 8. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 9. b complex-vitamin c-folic acid 1 mg capsule : one (1) cap po daily (daily). 10. aspirin 325 mg tablet : one (1) tablet po daily (daily). 11. labetalol 100 mg tablet : three (3) tablet po bid (2 times a day). 12. ergocalciferol (vitamin d2) 50,000 unit capsule : one (1) capsule po once a week for 10 weeks. 13. ferrous sulfate 325 mg (65 mg iron) tablet : one (1) tablet po three times a day. 14. colace 100 mg capsule : one (1) capsule po twice a day as needed for constipation. 15. insulin glargine 100 unit/ml cartridge : five (5) units subcutaneous at bedtime. 16. insulin lispro 100 unit/ml cartridge : 1-6 units subcutaneous with meals as needed for elevated blood sugar: 1 unit for blood sugar 150-199, and 1 additional unit for every 50 points that your blood sugar is higher than that. 17. lisinopril 20 mg tablet : one (1) tablet po daily (daily). 18. ondansetron 4 mg tablet, rapid dissolve : one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea or vomiting. discharge disposition: extended care facility: nursing discharge diagnosis: primary: - hypertensive emergency - hyperglycemia - acutely altered mental status, likely toxic-metabolic encephalopathy - insulin-dependent diabetes secondary: - end-stage renal failure requiring hemodialysis - chronic microcytic anemia discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: ambulatory - requires supervision and light assistance. discharge instructions: dear ms , it was a pleasure caring for you at . you were hospitalized with mental status changes, extremely high blood pressure, and extremely high blood sugar. you were initially in the icu and you became more alert and were able to go to an inpatient medicine floor. you have been seen by the hemodialysis team for your renal failure and by the neurology team for your mental status changes. your blood pressure and diabetes have been under better control. you are still confused some of the time and you will be going to rehab to continue to recover. we have made the following changes to your medications: - stop furosemide (lasix) - stop nifedipine - change labetalol to 300mg twice daily - change glargine (insulin , -acting) to 5mg at night - change lisinopril to 20mg daily - start nephrocaps - start lansoprazole - start aspirin you should follow up with your primary care doctor within one week after your discharge from . you should follow up with a neurologist as below. you had an eeg on and this result is still pending. followup instructions: follow up with your primary care , b. within one week to follow up your hospitalization. neurologist follow-up department: neurology when: wednesday at 4:30 pm with: drs. & mclluduff building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube hemodialysis venous catheterization for renal dialysis central venous catheter placement with guidance diagnoses: hypertensive chronic kidney disease, malignant, with chronic kidney disease stage v or end stage renal disease anemia in chronic kidney disease end stage renal disease renal dialysis status esophageal reflux toxic encephalopathy chronic hepatitis c without mention of hepatic coma diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled unspecified glaucoma other and unspecified hyperlipidemia long-term (current) use of insulin fever, unspecified kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure other specified antibiotics causing adverse effects in therapeutic use ileostomy status other complications due to renal dialysis device, implant, and graft colostomy status leukocytopenia, unspecified 

Answer: The patient is high likely exposed to