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: benadryl / iodine; iodine containing / sulfa (sulfonamides) / penicillins / morphine / ambien attending: chief complaint: confusion major surgical or invasive procedure: lumbar puncture history of present illness: the pt is a 74 year-old right-handed woman with multiple medical problems who presented with alteration in consciousness. the pt was unable to offer a history at the time of my encounter. therefore, the following history is per the medical record, and the pt's daughter who was present at bedside. the pt had been complaining to her daughter of generalized malaise over the past two days. she had no known fever or focal signs of infection such as cough, abdominal pain, vomiting, diarrhea, dysuria. she had been otherwise her usual interactive, relatively independent self. at approximately 2pm today, she awoke from a nap and complained to her daughter of right temporal headache. she described the headache as sharp. at about this time, the pt decided to check her fsbs and her daughter noted that the pt was having difficulty managing putting the test strips into the glucometer and appeared confused. her daughter helped her and her fsbs was 357. she complained of not feeling well, so her daughter helped her to her bedroom. there, she became more confused and per the daughter was answering some questions inappropriately. the daughter noted that she seemed to be perseverating on certain answers to questions. after another half an hour, the pt's speech became unintelligible and she became less and less responsive to her name. her daughter called ems. ems reports that on their arrival, the pt was "awake, non verbal, not following commands". they also document gaze to left. she was taken to an osh where she was noted to have "lip smacking and bilateral limb jerking." work-up included reportedly "negative ct", normal cbc, electrolytes notable for glucose of 317 and creatinine of 1.2. no temperature was documented on osh records. at the osh, she received 2g iv ceftriaxone, 800mg iv acyclovir, 2mg iv ativan. she was transferred to for further management. the pt was unable to offer a review of systems. past medical history: -hypertension -hyperlipidemia -type ii diabetes mellitus, insulin dependent, with neuropathy -pvd s/p fem- bypass -cad with h/o mi -h/o cataracts s/p removal -h/o barrett's esophagus -hypothyroidism -h/o multiple "tias"--symptoms were disorientation per omr social history: pt lives with her daughter, but is fully independent in all adls. daughter describes her as "sharp". no history of tobacco, alcohol, illicit drug abuse. family history: no history of seizures or neurological disease. physical exam: vitals: t: 101.4f pr p: 107 r: 16 bp: 168/p sao2: 97% 3l nc general: lying in bed with eyes closed. heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: no nuchal rigidity pulmonary: lungs cta bilaterally without r/r/w cardiac: tachycardic, rr, nl. s1s2, no m/r/g noted abdomen: some ttp in epigastrium noted. extremities: no c/c/e bilaterally skin: no rashes or lesions noted. neurologic: -mental status: does not respond to verbal command but opens eyes briskly noxious stimuli. she mutters incomprehensible sounds. she does not follow commands. -cranial nerves: perrl 3 to 2mm and brisk. funduscopic exam technically impossible as pt firmly holds eyelids closed on attempted examination of fundi. eomi to oculocephalic maneuver. corneal reflex and nasal tickle present bilaterally. no overt facial asymmetry. gag reflex intact. -motor: normal bulk throughout. paratonic throughout. withdraws briskly to noxious stimuli in all four extremities. irregular orobuccal movements noted (old per daughter, and attributed to use of reglan in the past). pt did have episodes of bilateral limb myoclonus, occurring in each limb independently. -sensory: grimaces to noxious stimuli in all four extremities. -dtrs: tri pat ach l 3 3 3 3 4 r 3 3 3 3 4 plantar response was extensor bilaterally. pertinent results: 07:35pm blood wbc-10.8 rbc-4.35# hgb-13.6# hct-38.9# mcv-89 mch-31.3 mchc-35.0 rdw-13.2 plt ct-561*# 05:05am blood wbc-10.6 rbc-3.28* hgb-10.1* hct-30.1* mcv-92 mch-30.7 mchc-33.4 rdw-14.1 plt ct-485* 03:31am blood pt-13.4* inr(pt)-1.2* 07:35pm blood glucose-316* urean-27* creat-1.1 na-134 k-4.5 cl-94* hco3-25 angap-20 08:53am blood glucose-141* urean-16 creat-1.4* na-140 k-3.6 cl-110* hco3-17* angap-17 07:35pm blood alt-20 ast-22 ck(cpk)-47 alkphos-100 amylase-30 totbili-0.3 03:31am blood albumin-3.7 calcium-8.0* phos-3.3 mg-1.6 01:50am blood tsh-2.9 03:31am blood osmolal-331* 11:14am blood osmolal-299 11:14am blood crp-22.1* 01:50am blood phenyto-7.7* 05:05am blood phenyto-14.1 07:35pm blood asa-5 ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 11:00pm urine color-yellow appear-clear sp -1.019 11:00pm urine blood-mod nitrite-neg protein-neg glucose-1000 ketone-15 bilirub-neg urobiln-neg ph-7.0 leuks-neg 11:00pm urine rbc-* wbc-0-2 bacteri-none yeast-none epi-0 11:00pm urine bnzodzp-neg barbitr-neg opiates-pos cocaine-neg amphetm-neg mthdone-neg ----- 09:10pm cerebrospinal fluid (csf) wbc-2 rbc-950* polys-71 lymphs-17 monos-12 09:10pm cerebrospinal fluid (csf) wbc-4 rbc-665* polys-72 bands-1 lymphs-23 monos-4 09:10pm cerebrospinal fluid (csf) totprot-51* glucose-152 hsv pcr neg. ---- bcx neg ucx neg : ct head w/o contrast findings: no intra- or extra-axial hemorrhage is identified. there is no mass effect or shift of normally midline structures. there is no hydrocephalus. again seen is a 5 mm hypodensity in the white matter of the left frontal lobe posteriorly consistent with a remote lacunar infarct. the visualized paranasal sinuses and mastoid air cells are clear. surrounding soft tissue structures appear unremarkable. impression: no evidence of intracranial hemorrhage or mass effect. eeg (): abnormality #1: throughout this recording the presence of diffusely slowed mixed frequency background rhythms in the delta and theta range were observed. abnormality #2: generalized bursts of mixed frequency delta slowing followed by periods of suppression were observed. abnormality #3: there were infrequent brief bursts of sharp theta slowing seen over the left temporal region. no sustained epileptiform activity was observed. background: described as above. hyperventilation: could not be performed. intermittent photic stimulation: could not be performed. sleep: no definitive sleep wake cycles were observed. cardiac monitor: showed a sinus tachycardia with a rate of approximately 100 bpm. impression: this is an abnormal eeg due to the presence of diffusely slowed background rhythms along with bursts of generalized mixed frequency delta and theta slowing. no suppressions following these. in addition there appears to a focal area of irritability over the left temporal region with frequent bursts over theta activity seen here. no electrographic seizures were recorded. no sustained epileptiform activity was seen. this is most consistent with a moderate causes of an encephalopathy included: medications, metabolic changes, and infectious processes. origin and correlation should done to rule out a focus in the left temporal region as sharp features were observed here during this recording. eeg (): findings: abnormality #1: throughout the recording there were frequent bursts of generalized mixed frequency slowing, often in the delta range. abnormality #2: the background rhythm was slow and disorganized typically reaching a hz maximum in most areas. abnormality #3: there was occasional additional slowing in the temporal regions bilaterally followed more on the left. hyperventilation: could not be performed. intermittent photic stimulation: could not be performed. sleep: no normal waking or sleeping morphologies were seen. cardiac monitor: showed a generally regular rhythm. impression: abnormal portable eeg due to the bursts of generalized slowing and slow background along with occasional temporal slowing. the first two abnormalities signify a widespread encephalopathic condition affecting both cortical and subcortical structures. medications, metabolic disturbances, and infection are among the most common causes. the temporal slowing raises the possibility of additional subcortical dysfunction in each hemisphere, but the etiology cannot be specified by the tracing. there were occasional sharp features but no overtly epileptiform abnormalities. mr head w & w/o contrast; mra brain w/o contrast (): mri brain: this examination is severely limited by patient motion. no evidence of severe hydrocephalus, large hematoma, or herniation is seen. evaluation of the brain parenchyma, signal intensity, and patterns of contrast enhancement are limited given the presence of severe motion. scattered areas of abnormal signal seen in the periventricular white matter and pons are unchanged compared to . mra brain: both internal carotid arteries, anterior cerebral arteries, posterior cerebral arteries, middle cerebral arteries, and the basilar artery are patent; however, evaluation of the intracerebral arterial vasculature is severely limited by patient motion. impression: severely limited examination secondary to patient motion shows no hydrocephalus, large hematoma, or herniation. if warranted, repeat imaging could be performed (if patient motion artifact could be improved). mr head w & w/o contrast; mr contrast gadolin (): findings: the diffusion images demonstrate no evidence of slow diffusion to indicate acute infarct. the ventricles and extraaxial spaces are mildly prominent due to mild brain atrophy. a few small foci of t2 hyperintensity are noted in the white matter including a chronic lacune in the left corona radiata. these findings are unchanged from the previous study of . there is no evidence of acute or chronic blood products seen. no mass effect or hydrocephalus. impression: somewhat limited study due to motion. gadolinium-enhanced images could not be obtained as patient was unable to continue. unchanged appearances compared with with small vessel disease and chronic left basal ganglia lacune. no acute infarct. brief hospital course: 1. neuro: the pt is a 74 year-old woman with multiple medical problems who presented with fever and altered mental status. on neurologic examination, she was profoundly encephalopathic with episodic myoclonus and has brisk but symmetric reflexes with ankle clonus and upgoing toes. otherwise, there were no lateralizing signs. the presence of fever and altered mental status was concerning for central nervous system infection. there was also concern for infectious and toxic-metabolic processes. a cxr was normal. a head ct showed a 5 mm hypodensity in the white matter of the left frontal lobe posteriorly consistent with a remote lacunar infarct only. she had a mildly elevated wbc ct in the serum. an lp showed 4 wbcs and 600-950 rbcs. protein was slightly elevated and glucose was normal. gram stain was negative. she was started on vancomycin, ampicillin, acyclovir (with ivf bolus to prevent arf), and ceftriaxone. she was initially admitted to the icu for close monitoring. she was initially very confused and agitated without verbal output. she then slowly improved over the next several days, gradually speaking more and following more commands. she became more oriented to her surroundings and less agitated. the antibiotics were stopped after cultures were negative for 3 days. the acyclovir was stopped after her hsv returned negative. tox screens showed only + opiates which she is on at home. opiate overdose was considered, but not consistent with her presentation. she had an eeg which showed generalized slowing and a focal area of irritability over the left temporal region with frequent bursts over theta activity and sharp features. it was ultimately postulated that her presentation was likely due to seizure. she had no observed seizure activity. she was on dilantin for most of the hospital stay, but she easily developed toxic levels. she was therefore switched to keppra prior to discharge. two mris were performed in attempt to identify seizure focus, but the pt was unable to tolerate these studies very well due to underlying anxiety and superimposed tardive dyskinesia. therefore, no clear seizure focus was elucidated. she will follow-up in clinic after discharge. 2. cad/htn:we continued her home plavix and asa. her antihypertensives were initially held, but were then restarted when her bp began to be elevated. these were norvasc and metoprolol. she was also started on a clonidine patch. this controlled her bp well. 3. endocrine: she was continued on her home levoxyl. she was also continued on glargine and riss without problems. she was initially hyperglycemic, and serum osms were checked and returned at 331. hyperosmolar coma was considered, but her glucose was not high enough for this diagnosis. a repeat osm ~6 hours later, after glucose was corrected was normal at 290. 4. funguria: the pt was found to have yeast in the urine. she was treated with a 7 day course of oral fluconazole. 5. clostridium difficile gastroenteritis: the pt complained of nausea and abdominal pain once her mental status cleared. she developed diarrhea which was positive for c.diff. she was treated with a fourteen day course of metronidazole, to be completed as an outpatient. 6. anemia: the pt did have a slight drop in her hematocrit and was found to have guaiac positive stool. she did require a transfusion of one unit of prbcs. gastroenterology was called and they felt that further work-up could be done on an outpatient basis after her hematocrit stabilized following transfusion. 7. anxiety: the pt was seen by the psychiatry service as she had complaints of worsening anxiety. they recommended discontinuing effexor, buspar and amitriptyline and starting seroquel. she responded well to this change. 8. arf: the pt had a slight bump in her creatinine to 1.4 after treatment with acyclovir which normalized after aggressive ivf and discontinuation of this drug. medications on admission: -lipitor 10mg po daily -gabapentin 600mg po tid -asa 81mg po daily -protonix 40mg po daily -effexor 75mg po daily -buspirone 5mg po bid -insulin glargine and humalog sliding scale -levothyroxine 25mg po daily -plavix 75mg po daily -amitriptyline 50mg po qhs -vicodin prn discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. clonidine 0.1 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qmon (every monday). 3. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 6. metronidazole 500 mg tablet sig: one (1) tablet po tid (3 times a day) for 10 days. disp:*30 tablet(s)* refills:*0* 7. fluconazole 200 mg tablet sig: one (1) tablet po q24h (every 24 hours) for 2 days. disp:*2 tablet(s)* refills:*0* 8. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q12h (every 12 hours). disp:*60 tablet, delayed release (e.c.)(s)* refills:*2* 9. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 10. levetiracetam 500 mg tablet sig: one (1) tablet po daily (daily) for 3 days: take one tablet per day for three days, then take one tablet for three days, then take one tablet in the morning and two tablets in the evening for three days, then take two tablets thereafter. disp:*120 tablet(s)* refills:*2* 11. insulin please continue your insulin regimen as prior to admission 12. quetiapine 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* discharge disposition: home with service facility: centrus home care discharge diagnosis: -probable seizure -hypertension -diabetes mellitus -funguria -clostridium difficile enterocolitis discharge condition: stable. neurologic examination notable for orobuccal dyskinesias but otherwise normal. discharge instructions: please call your primary care physician or return to the emergency room if you experience loss of consciousness, limb shaking, new onset numbness or weakness, difficulty speaking, difficulty walking, or other concerning symptoms. please continue all medications as prescribed and attend all follow-up appointments. followup instructions: provider: phone: date/time: 2:00 provider: study phone: date/time: 10:30 provider: study phone: date/time: 11:00 please follow-up with your primary care doctor within 7-10 days after discharge. neurology: drs. and at clinical center, . at 4pm. md, procedure: venous catheterization, not elsewhere classified spinal tap incision of lung enteral infusion of concentrated nutritional substances transfusion of packed cells diagnoses: anemia, unspecified unspecified essential hypertension acute kidney failure, unspecified unspecified acquired hypothyroidism other convulsions diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes peripheral vascular disease, unspecified other and unspecified hyperlipidemia anxiety state, unspecified intestinal infection due to clostridium difficile other and unspecified mycoses 

Answer: The patient is high likely exposed to