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: history of present illness: 46 year old with ten day history of fevers and emesis times one. his headache initially started on , when he was evaluated at a clinic without any significant interventions occurring. the headache did not improve over the next few days and he presented to an outside hospital on . he was found to be febrile with temperature to 100.1. his course at the outside hospital included a ct of the head and a magnetic resonance scan of the brain and spinal cord, which were both negative, except for nonspecific microangiopathic findings on the magnetic resonance scan. he had two lumbar punctures at the outside hospital which showed between 2 and 16 white blood cells with 90% lymphocytes and a total protein of 196 and glucose of 40. there were 57 red blood cells seen in tube #4 on the initial lumbar puncture. gram stain and cerebrospinal fluid culture were negative, as well as a negative acid fast bacilli pcr of the cerebrospinal fluid. he was started on acyclovir due to concern for hsv encephalitis which was stopped after two days when his hsv cerebrospinal fluid titers came back negative. acyclovir was then restarted on and was continued until date of admission to . an eeg was also performed during his hospitalization at the outside hospital, which showed nonspecific abnormalities but no epileptiform activity. his mental status initially improved during the first few days of admission at the outside hospital, however, this deteriorated over the last four days prior to transfer per family's report. of note, on the previous admission, he was noted to have an ileus which was thought secondary to abrupt cessation of his ssri. on , he had an episode of desaturation to 84%. an arterial blood gases was performed which showed hypercapnia with a pc02 of 70 and he was, therefore, electively intubated for airway protection. upon presentation to , he was intubated and unresponsive, despite being off sedation. his family states that he has no other recent complaints prior to hospitalization at the outside hospital. they have not noticed any focal neurologic deficits, diarrhea, night sweats, rash or weight loss. he had no recent vaccinations or ill contacts. there were no rashes noted. past medical history: 1.) pulmonary tuberculosis, diagnosed , treated with nine months of inh, rifampin and pyrazinamide. sensitive testing revealed no resistance for drug therapy. 2.) depression. 3.) history of hepatitis b. social history: the patient is originally from . he moved to the u.s. nine years ago. he has been living with his two brothers since. speaks minimal english but understands english when spoken to. he is unemployed but previously worked at . he is a former smoker and quit nine years ago. family states that the patient does not use alcohol or intravenous drugs. allergies: no known drug allergies. medications: zoloft 100 mg q. day. zyprexa 10 mg q. day. tylenol. medications on transfer: acyclovir 600 mg q. eight hours. peri-colace one tablet p.o. twice a day. calcium carbonate 1,250 mg p.o. three times a day. pepcid 20 mg q. day. physical examination: vital signs on admission to the intensive care unit revealed temperature of 98.8; blood pressure 138/78; heart rate 98; respiratory rate 12. oxygen saturation 94%. ventilatory settings simv tidal volume 500. respiratory rate of 12. peep of five. fi02 of 40%. in general, the patient is intubated and sedated. he would follow occasional commands. his neck is extremely stiff with decreased range of motion in all directions. his left pupil was constricted but reactive. his left pupil was sluggish and minimally reactive. he had no thyromegaly. his sclera were anicteric. on lung auscultation, breath sounds were decreased throughout but he was otherwise clear to auscultation. cardiovascular: regular rate, normal s1 and s2, no mitral regurgitation. abdominal examination: soft, mildly distended, decreased bowel sounds but no appreciable hepatosplenomegaly. extremities: no cyanosis, clubbing or edema. 2+ dorsalis pedis and posterior tibial pulses bilaterally. no apparent rash. neurologic: he responds to tactile stimuli. he is off sedation but very lethargic. he moved all four extremities. laboratory data: white blood cells of 8.2; hemoglobin of 15.6; hematocrit of 42.2. differential revealed 77 neutrophils, 18% bands, 2% lymphocytes. platelets 279; pt of 12.6; ptt 33.3; inr of 1.1. sodium of 134; potassium of 4.0; chloride 92; bicarbonate 31; bun 32; creatinine 0.9; glucose 133. alt 44; ast 92; ldh 340. cpk was 2265; alkaline phosphatase 61; total bilirubin 1.2; ck mb 23. index 1.0; calcium 8.2; phosphorus 2.4; magnesium 2.4; albumin 3.4; ammonia level was 36. laboratory data: rpr nonreactive. cryptococcal antigen was non detectable. rubeola igg was positive. toxoplasma igm and igg was negative. acid fast bacilli sputum smear was negative times three. cryptococcal antigen cerebrospinal fluid was negative. cerebrospinal fluid gram stain was negative. cerebrospinal fluid fluid culture was negative. cerebrospinal fluid viral culture negative. cmv igm antibody negative. cmv igg positive. hsv serum igg positive. tuberculosis, pcr csf negative. coccsoidy antibody negative. urine histoplasma negative. hiv antibody and hiv viral load both negative. blood cultures negative times nine sets. cerebrospinal fluid analysis on revealed white blood cell count of 34; red blood cells of 12; 77% polys, protein of 115 and glucose of 41. cerebrospinal fluid revealed white blood cells of 8; red blood cells of 7; 88% lymphs, protein 110; glucose 48; ldh 60. radiology data: ct of chest on revealed multifocal pattern of consolidation, involving upper lobes and superior segments of lower lobes. reactivation tuberculosis and differential diagnosis as well as aspiration and atypical pneumonia. small right sided effusion. no cavitary abscesses within the lung. ct head on : no hemorrhage, mass or abscess. magnetic resonance scan of head on revealed no abnormal meningeal enhancement, chronic inflammatory pan sinus disease; small tiny foci of g2 hyperintensity within the right basal ganglia which are nonspecific in appearance, possibly related to small vessel changes. other considerations include demyelinating process and most likely vasculitis or hiv encephalopathy. chronic deformity of right eye globe, related to either old trauma or prior inflammatory disease. magnetic resonance scan of the spine on revealed no evidence of epidural abscess or spinal cord compression. 2.2 times 8.4 cm enhancing soft tissue fluid collection in the lower neck. ct of the abdomen and pelvis on revealed focal fatty infiltration of the liver. no other abdominal or pelvic pathology. impression: 46 year old with history of tuberculosis, presenting with headache, fever and altered mental status at outside hospital. transferred to for further evaluation. hospital course: 1.) infectious disease. his constellation of headache, fever, meningismus and altered mental status made leading diagnosis meningeal encephalitis. the differential diagnoses included bacterial meningitis, tuberculosis meningitis, hsv encephalitis, cryptococcus; hiv encephalitis and acute disseminating encephalomyelitis. all of the diagnoses listed above, except for adm were ruled out with multiple serologic and cerebrospinal fluid testing. his cerebrospinal fluid, acid fast bacilli, pcr, although not completely sensitive test, came back negative on at least two occasions. his sputum was acid fast bacilli negative times three, after concern was raised on chest ct that there were signs of possible reactivation tuberculosis. he was on anti-tuberculosis medications for approximately four days while reactivation tuberculosis was ruled out. serial lumbar punctures showed improvement in pleocytosis, however, continued elevated protein and decreased glucose. gram stains were continued to be negative. he completed a 21 day course of acyclovir for possible hsv encephalitis. in addition to meningoencephalitis, he was also treated for fourteen days of ceptaz for hospital acquired ventilator associated pneumonia. he was also treated with nystatin and fluconazole for oral thrush. throughout the hospitalization, he had occasional episodes of hypothermia with p.o. temperatures measuring in the low 90's. blood cultures taken during these episodes continued to be negative and it was unclear the etiology of the hypothermia. 2.) pulmonary. the patient was intubated at the outside hospital for airway protection. he has a history of insensitive pulmonary tuberculosis. he completed a nine month course and was ruled out for reactivation during the hospitalization. he was extubated on and reintubated the same evening for low tidal volumes and respiratory distress. he continued having difficulty being weaned from the ventilator and was unable to generate large tidal volumes with minimal pressure support, likely secondary to respiratory muscle weakness. therefore, a tracheostomy was placed on and he was weaned to tracheostomy mask ventilation the following day. he has done very well on the tracheostomy and is currently being weaned with poor cough and thick secretions being limiting factors. 3.) neurology. as stated above, patient with presumptive diagnosis of meningoencephalitis of unclear etiology. a ct scan of the head was performed on which was within normal limits. he had no significant elevated opening pressure on lumbar puncture and cerebrospinal fluid studies showed no organism pleocytosis with elevated protein and decreased glucose. eeg was performed on and showed no evidence of seizure activity but generalized encephalopathy. his mental status improved significantly in the final two weeks of his hospitalization although he did have occasional episodes of agitation. a magnetic resonance scan of the brain was performed on which showed no meningeal enhancement and possible ischemic disease and dullness basal ganglia. on , he had an episode of hypotension and hypothermia which raised concern for spinal shock, prompting an magnetic resonance scan of the spine which revealed no evidence of abscess or spinal cord compression. emg was performed on , secondary to weakness of the lower extremities. the emg showed polyneuropathy with axonal distribution and mild asymmetry which raised the concern for mononeuritis multi-plex. although this was felt likely related to his meningoencephalitis, no unifying diagnosis could be established. his lower extremity weakness improved and it was not felt that further imaging studies were needed. at the time of dictation, he still had some residual lower extremity weakness, with the left mildly weaker than the right. his mental status, however, was markedly improved from admission and per family report was approaching baseline condition. 4.) cardiovascular. during hospitalization, the patient had occasional episodes of hypotension with systolic blood pressures falling into the low 70's. on most occasions, these responded to intravenous fluid boluses. dopamine was transiently used for occasions which his blood pressures did not respond to fluid boluses. given the hypotension and hypothermia, there was concern for adrenal insufficiency and a cortisol stimulation test showed a starting cortisol level which was significantly decreased at 1.3. he was, therefore, started on hydrocortisone and transitioned to prednisone for a taper, starting on . an echocardiogram was performed on which showed an ejection fraction of greater than 55% and no valvular abnormalities. his dopamine was discontinued completely on and he did well with systolic blood pressures in the 100 to 110 range for the remainder of his hospitalization. it was thought that given his size, this was probably his baseline blood pressure. 5.) renal. the patient had significant urine output in the second half of his hospitalization with, at times, greater than 400 cc an hour of urine output sustained for a number of hours. there was some concern for a neurogenic process such as diabetes insipidus given his overall clinical picture. this, however, was not the case as urinalysis were performed and found to be 400. the renal team was consulted and felt that his urine output was secondary to mobilization of fluid and recommended limiting his intravenous fluids. by the time of dictation, his urine output was appropriate at about 30 to 50 cc an hour and his foley was discontinued. 6.) endocrinology. as discussed above, the patient was treated with hydrocortisone 100 mg q. six hours times seven days for sepsis related adrenal insufficiency. thyroid function tests were also performed and showed a decreased t3, progressively falling tsh but a normal free t3-4. these findings were likely consistent with sick thyroid and he was not treated. at the time of dictation, the patient had been discontinued from hydrocortisone and began a prednisone taper which will last over the next two weeks. he was continued on reglan sliding scale, secondary to hyperglycemia from steroid use. 7.) fen/gastrointestinal. prior to transfer to the outside hospital, patient with diagnosed ileus. his abdomen was firm with decreased bowel sounds and with comorbid conditions. a ct of the abdomen was performed to rule out abdominal pathology. the ct of the abdomen showed no significant abnormalities aside from fatty infiltrative liver. rectal examination showed no signs of impaction. although he did not move his bowels for the first few days of hospitalization, once the tube feedings were initiated, he had adequate stool output. his liver function tests were slightly elevated on admission but his hepatitis panel was negative except for hepatitis b surface antibody and hepatitis a igg. it was felt that these were both chronic in nature. his nitrogen balance, once at goal tube feeds, was calculated to be -2 grams, which was within normal limits, considering his critical condition. at the time of dictation, he was still continued on criticare tube feeds, at a goal of 65 cc per hour. a speech and swallow study was pending for possible p.o. intake. of note, clostridium difficile and stool viral cultures were all negative on multiple occasions, performed secondary to diarrhea. 8.) psychiatry. per family, patient with severe depression on zoloft and zyprexa at home. once he was stabilized, his zoloft was restarted. after extubation, he was agitated, mostly at night and his zyprexa was restarted at 5 mg q. hs as well as haldol 2 mg prn during the day. discharge diagnoses: meningioencephalitis, likely viral in etiology. sepsis. hospital acquired pneumonia. status post tracheostomy for respiratory muscle weakness. polyneuropathy, status post emg. sepsis induced adrenal insufficiency. history of hepatitis b. history of tuberculosis. depression. a subsequent discharge summary will be dictated at the time of discharge with a complete list of medications and discharge instructions. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung spinal tap incision of lung insertion of endotracheal tube temporary tracheostomy diagnoses: pneumonia, organism unspecified unspecified septicemia depressive disorder, not elsewhere classified candidiasis of mouth acute respiratory failure hypotension, unspecified paralytic ileus other enterovirus diseases of central nervous system 

Answer: The patient is high likely exposed to