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: this is a 56 year old white male with a past medical history of seizure disorder on tegretol and mental retardation among others. the patient was found down at home today by ems. per the patient's brother, the patient lives alone and the family periodically "checks in with him". no one has heard from the patient for three days so the ems broke the door down. the patient was found down unconscious, covered in emesis as well as blood (question nosebleed). the patient was noted to have multiple abrasions over his body. little is known about the patient's other history. he was admitted to last week with a change in mental status. his mental status there was described as awake, alert, but minimally attentive. his course was complicated by an upper gastrointestinal bleed. esophagogastroduodenoscopy showed severe erosive esophagitis, question of , and small gastric polyps. the patient was discharged on fluconazole, tegretol, prilosec, and loperamide. apparently, the patient's father died on one year ago and the patient was depressed related to this. many empty pill bottles were found next to him. the patient was brought to emergency department where his gcs was 6 with oxygen saturation in the 80s. the patient was intubated. he was hemodynamically stable with blood pressure in the 120s and heart rate in the 90s. left groin line was placed. chest x-ray showed a right lower lobe pneumonia and bilateral apical opacities. ct of the head was negative. ct of the spine was negative for any cervical spine fractures. the patient was transferred to the medical intensive care unit for further evaluation and treatment. past medical history: 1. mental retardation. 2. hypertension. 3. seizure disorder secondary to meningitis as a child. 4. hypercholesterolemia. 5. fecal incontinence. 6. recent upper gastrointestinal bleed secondary to erosive esophagitis. 7. status post coronary artery bypass graft in . 8. atrial fibrillation. medications on admission: 1. tegretol. 2. pravachol. 3. atenolol. 4. zantac. 5. fluconazole allergies: no known drug allergies. family history: non contributory. social history: the patient denies alcohol or tobacco use. he lives alone in an apartment in , and is able to care for himself. once awake, he described how he takes the subway to see his primary care physician, . , at , and described how he gets there. he also reports that he walks to the grocery store and buys his own groceries. he keeps in close contact with a social worker, , that works in his building. his brother, , lives in and checks in with the patient periodically. review of systems: unknown. physical examination: vital signs revealed blood pressure of 90/45, temperature maximum 102.4, heart rate 96 to 110, respiratory rate 16 to 21, oxygen saturation 95 to 98% on "many" liters of oxygen. general - the patient is not responsive but moving in athetotic pattern. skin - multiple abrasions on bilateral lower extremities (dip of all toes, lateral malleoli and dorsum of feet). no petechiae. no jaundice. head, eyes, ears, nose and throat examination - the pupils are 2.0 millimeters and reactive bilaterally. unable to assess extraocular movements. bilateral periorbital erythema and edema. right eye with subconjunctival hemorrhage superior to pupil. no battle sign. respiratory is clear to auscultation anteriorly. examination limited due to the patient's unresponsiveness. cardiovascular - regular rate and rhythm, no murmurs, rubs or gallops. abdomen is soft, normoactive bowel sounds, nontender, nondistended, no organomegaly. extremities - no cyanosis, clubbing or edema, pulses 2+ bilaterally. abrasions on lateral malleoli bilaterally and dorsum of feet. rectal is guaiac negative. neurologically, the patient is moving all four extremities, withdraws to pain, no posturing, no corneal or gag reflex (but on propofol). toes downgoing. laboratory data: white blood cell count 17.6, hematocrit 34.3, platelets 364,000, neutrophils 71%, bands 18%, lymphocytes 6%. urinalysis is nitrite positive, protein trace, bilirubin small, ph 5.0, blood negative, red blood cells 0 per high power field, white blood cells 0-2 per high power field, bacteria rare. chem7 revealed sodium 141, potassium 4.4, chloride 105, bicarbonate 13, blood urea nitrogen 56, creatinine 4.2, glucose 100, anion gap 23. cpk , mb 91, index 0.8. toxicology screen - aspirin negative, etoh negative, tylenol negative, benzodiazepines negative, barbiturates negative, tcas negative. carbamazepine 33 (). electrocardiogram revealed normal sinus rhythm, pr interval 204 consistent with first degree av block, left atrial enlargement, qrs 140, q-tc 450, peaked t waves, 1.0 to 2. elevation in v1, v2, but pattern is left bundle branch block, no t wave inversions, q wave only in lead iii. imaging studies: ct of the head revealed cerebellar atrophy, mucosal thickening of maxillary and ethmoid sinus. ct spine revealed normal alignment of vertebra, no fractures, no subluxation, positive degenerative changes in c4-c5, c5-c6, c6-c7. chest x-ray revealed hazy opacities in the bilateral apices and right lower lobe - ? aspiration. hospital course: 1. toxicology - the patient was noted to have elevated carbamazepine levels. dr. from toxicology recommended charcoal for absorption of the toxin. carbamazepine levels were monitored q3hours. activated charcoal 30 grams were given at the time of arrival to the medical intensive care unit and three hours afterwards and need for further doses was evaluated in the a.m. after admission. the patient most likely had a carbamazepine overdose (question intentional or confused or due to interaction with fluconazole, recently begun for candidiasis). the levels were reduced to therapeutic range with charcoal treatment and intravenous hydration. they were monitored for a couple days after that, however, remained in normal limits for the duration of the hospital course. 2. cardiology - the patient had a new widening of the qrs on initial electrocardiogram and this was likely related to sodium channel blocking activity of tegretol. one amp of bicarbonate was pushed and the electrocardiogram was rechecked. qrs prolongation resolved rapidly after the bicarbonate and resolution of the patient's acidemia. 3. pulmonary - due to the patient's findings on chest x-ray of right lower lobe and bilateral apical opacities, he was assumed to have suffered an aspiration event causing aspiration pneumonia. he was started on levofloxacin 500 mg intravenously q.d. and clindamycin 300 mg t.i.d. intravenously which was continued for fourteen days. while in the medical intensive care unit, he was kept on the ventilator with full support, however, once he improved, on , he was extubated. no complications after extubation. the levofloxacin and clindamycin were continued for a fourteen day course and discontinued starting on . the patient's lung findings improved rapidly over the course of the stay and for the last six days he was clear to auscultation bilaterally with normal oxygen saturation and no signs or symptoms, i.e., cough. 4. renal - initially the patient's creatinine was increased to 4.2. he also had elevated creatinine kinase enzyme levels around 10,000. this was most likely rhabdomyolysis and resolved with hydration and bicarbonate and eventually the cks trended downward. the elevated creatinine normalized within the first couple of days around , and was postulated to be due to acute renal failure secondary to severe hydration. his decreased potassium was also suspected to be secondary to diarrhea, gastrointestinal losses. 5. gastrointestinal - his recent gastrointestinal bleed at secondary to erosive esophagitis prompted nasogastric tube lavage on admission in the emergency department which was clear. he was treated with intravenous protonix for the duration of his hospital course up until discharge. multiple clostridium difficile toxin assays were sent which were negative. his abdominal examination continued to appear benign. 6. neurology - the patient's altered mental status was likely secondary to the tegretol overdose. his ct of the head was negative for any acute process. cerebrospinal fluid cultures for hsv and urine toxicology screens were negative, not consistent with these as possible etiologies of altered mental status. the patient was also while intubated on propofol and thus not allowing assessment of his current mental status. a few days later, a ct was done of the head again which showed minimal intraventricular and subarachnoid blood. neurology recommendations included electroencephalogram and magnetic resonance scan to further workup altered mental status. two lumbar punctures were also done, one at admission and one later on. both were bloody with increased protein, however, ct of the head initially did not reveal an acute bleed. the repeat ct on , is stated above. neurology did not feel that these were large enough to be treated and thus would resolve on their own. follow-up ct will need to be obtained one week after discharge. 7. hematology - the patient's hematocrit was 34.3 on admission and dropped to 26.7 on hospital day number one. he was transfused with two units after which his hematocrit remained stable for the duration of the admission. 8. trauma - he was seen by trauma surgery to be evaluated for cervical spine instability; they recommended that he be kept in a cervical collar even though he had no fracture, since ligamentous injury was not ruled out at the time. later on in the course of the hospitalization when he was moved to the floor, flexion and extension spine films were done and approved by neurosurgery as clear and thus the collar was removed. he will follow-up with neurosurgery a week or two after discharge when he will be reevaluated with flexion and extension films as well as a head ct to follow his subarachnoid blood and intraventricular blood seen on ct of the head on . 9. dermatology - the patient was also seen by dermatology while in the medical intensive care unit for his multiple abrasions on bilateral malleoli and forehead. initially, it was felt that these may be trauma induced erosions versus herpetic erosions. dfa for hsv type i and type ii as well as zbz were negative except for an hsv type i dfa which was positive. all other cultures of the wound were negative and acyclovir, which was started empirically when dermatology first saw him for hsv, was discontinued when these cultures and dfa came back negative. these abrasions were treated with bacitracin ointment and wound dressing changes b.i.d. 10. psychiatry - while in the medical intensive care unit, the patient was also seen by psychiatry who was unable to fully evaluate him while he was sedated. they recommended an electroencephalogram and magnetic resonance scan to evaluate mental status if this did not improve once he was extubated. they also were questioning the fact that his carbamazepine level of 33 implied overingestion, suggesting possible assault or possible suicide attempt. the hypothesis that was generated was that perhaps the patient had a seizure and overdosed with tegretol during postictal confusion. later on in the hospitalization, they revisited the patient when he was alert, awake and oriented. the patient disclosed that he had had a seizure on the day of admission. he did not know anything about the overingestion of the tegretol, however, he did deny assault or suicidal attempts. at the time of discharge, the patient was not considered to have any psychiatric issues as he was cheerful and responsive to questions. the psychiatry team felt that it was reasonable that he was going to be discharged to a temporary rehabilitation facility prior to returning home to care for himself. 11. hospital floor course - the patient was extubated on , and moved to the floor on . his respiratory status was stable and oxygen was in the process of being weaned. his issues of tegretol overdose as well as rhabdomyolysis were resolved and levels of tegretol as well as cks were trending downward towards normal limits. as aspiration pneumonia continued to be treated with levofloxacin and clindamycin for a fourteen day course. the patient continued to improve respiratory wise with good oxygen saturation, good respiratory rate and clear lung examination. neurology: he had a repeat head ct done on the day of transfer from the medical intensive care unit to the floor which was not different from the study and was notable for perhaps a slightly larger bleed ("subdural fluid collection"). it was decided that a repeat ct would be done one to two weeks after discharge when following up with neurosurgery unless there was significant clinical deterioration. during his continued hospital course, he had no neurological deficits, no signs of central nervous system infection. magnetic resonance scan and electroencephalogram were postponed as the patient's mental status continued to improve progressively and once he was awake, was alert and oriented times three. eventually as stated previously, his cervical collar was removed once he was clinically cleared with extension and flexion cervical spine films. he was continued on lopresor 100 mg b.i.d. for his hypertension and was switched to atenolol 100 mg q.d. on discharge. nutrition - the patient had a nasogastric tube in since the medical intensive care unit stay and due to aspiration pneumonia history as well as neck instability, tube feeds were started on this patient two days after he reached the floor in efforts to give him nutrition. swallow specialist was consulted. for the first couple of days, he failed the swallow studies with signs and symptoms of aspiration upon taking thin liquids. eventually, he did better with liquids and was started on soft solids and thick liquids. this continued to be his diet upon discharge. he remains on aspiration precautions. his hematocrit remained stable during his hospital floor course and his abrasions on his extremities continued to be treated with bacitracin ointment application to the wounds with dressing changes twice a day. of note, the patient's brother visited him once during his medical intensive care unit stay at which time he was unable to talk to the patient. his brother visited one more time while he was on the floor. he described the patient was slowly returning to his baseline and at baseline the patient talks and is fully functional, transports himself around the city, and is very meticulous about his medication regimen by taking the right amount at the right time, never over or under. disposition: to subacute/acute rehabilitation facility until function returns to baseline. rehab - . pcp: . . () condition on discharge: stable. medications on discharge: 1. tegretol 200 mg p.o. t.i.d. 2. atenolol 100 mg p.o. q.d. 3. bacitracin ointment apply b.i.d. to wounds. , m.d. dictated by: medquist36 procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: pure hypercholesterolemia unspecified essential hypertension aortocoronary bypass status other convulsions pneumonitis due to inhalation of food or vomitus poisoning by other and unspecified anticonvulsants unspecified intellectual disabilities poisoning by other specified drugs and medicinal substances, undetermined whether accidentally or purposely inflicted other disorders of muscle, ligament, and fascia 

Answer: The patient is high likely exposed to