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: patient recorded as having no known allergies to drugs attending: chief complaint: unresponsive at hd major surgical or invasive procedure: none history of present illness: hpi: 77 yo man with h/o longstanding htn c/b esrd, several lacunar strokes, multivascular dementia with poor baseline cognitive function, limited verbal ability and comprehension, as well as poor memory, who presented with ams today from his outpatient dialysis center. . per pt's wife and neurology resident, pt had some agitation last night, talking with his wife and pacing with walker. he finally fell asleep around 3am, awoke at 4am for dialysis at 6:30, slightly groggy but responding appropriately to his wife before hd. her received his usual dose of 50mg benadryl before dialysis, and then slept through the entire dialysis, which is unusual for him (last known "awake" time was 6:30am). following dialysis, staff tried to wake him up with verbal and tactile stim and he was unresponsive. staff tried applying cold packs to head, no response. bp was "high" and rr was 12 (other vs unavailable). wife tried to move his head which felt heavy and stiff, and entire body looked stiff with no spontaneous mvmt. at one point, wife tried to move him and he slapped her hand away, thus wife thought he was "alright." however, was again unresponsive, eyes closed just after this. . when ems arrived, he had his eyes open and was looking around initially, though unresponsive. in er, still unresponsive, bg found to be 49 - given 1amp d50, with no return to bl, thus code stroke called. neuro arrival within 5 minutes, and initial nihss score high in every category as pt unresponsive; tpa not given as last well-time was 6:30am (5.5 hrs ago) and not clear to be stroke. per neuro recommendation, pt underwent head ct followed by head mri, both of which were unrevealing for etiology of his ams. he initially had 1mg ativan given for possible sz, and when no response, he was loaded on iv dilaudid. had bedside eeg in the er that did not show definite sz activity, but neuro recommends continuing dilantin. also notable, pt had sbp in the 250s while in ed. . per wife, the patient's baseline is: limited speech and comprehension, walks with walker, brushes teeth and feeds self but wife helps him with most other adls, including transfers. he has some urinary and bowel incontinence at baseline. he has complained of no (and wife has noticed no) f/c/cp/sob/uri sx/gi/gu sx; he has chronic lbp and as usual took vicodin this am. no visual, hearing, sp/sw problems, no new weakness/numbness; has fallen (falls occ. at bl) but no head trauma. past medical history: -esrd related to htn nephropathy -s/p avf in both arms, r arm is functional -htn x >20 yrs -multivascular dementia -bph -chronic lbp with djd, spinal stenosis -macrocytic anemia, unclear if from esrd social history: retired plumber; no tob, etoh or drugs; lives with wife; has 2 children. family history: no strokes or cad physical exam: vitals: t 97.0, hr 51, bp 151/84, rr 18, sat 100% on 2lnc, uo 78cc/3h gen: initially sleeping and intermittently apneic, aroused to touch, poorly responsive and not following commands, withdraws to pain heent: perrl (5 to 3 mm), eomi with approp tracking, mouth closed and not opening for exam neck: turning head with no apparent discomfort; tunnelled line into l scv cv: bradycardic, regular, +s4, no s3, no m/r lungs: cta abd: thin, soft, nt (no grimace or withdrawal), nd, no hsm ext: ue -- l pulsatile avf without bruit or thrill, 2+ radial pulse; r avf with overlying bandage, with thrill and bruit, 2+ radial pulse le -- thin, no edema, cool bilaterally but with 2+ dp pulses bilaterally neuro: a) ms: unresponsive to verbal, opens eyes to tactile stim, withdraws to pain, not following commands, nonverbal b) cn: perrla 5->3; +blink to threat bilat; could not look in mouth or test gag as teeth clenched shut c) sensorimotor: moving all 4 ext and neck, resisting extension of arm for abg d) dtrs: 1+ biceps bilaterally, 1+ at knees bilaterally, toes upgoing with babinski bilaterally pertinent results: 10:43pm potassium-6.1* 08:53pm glucose-81 urea n-33* creat-8.8* sodium-138 potassium-6.5* chloride-99 total co2-28 anion gap-18 08:53pm alt(sgpt)-19 ast(sgot)-54* ck(cpk)-198* alk phos-68 tot bili-0.4 08:53pm ck-mb-7 ctropnt-0.22* 08:53pm calcium-8.7 phosphate-4.0 magnesium-1.8 08:53pm tsh-3.2 08:53pm wbc-4.8 rbc-3.79* hgb-13.4* hct-41.6 mcv-110* mch-35.3* mchc-32.1 rdw-17.0* 08:53pm plt count-148* 08:53pm pt-11.7 ptt-29.3 inr(pt)-1.0 . pcxr : 1. new retrocardiac opacity, which likely indicates pneumonia. atelectasis is a less likely diagnostic consideration. 2. hypertensive configuration of the heart and aorta. 3. indwelling dialysis catheter as above. . brain mri: no evidence of acute infarct. mra: head mra is somewhat limited by motion. there is no evidence of vascular occlusion seen. there is diminished flow signal intensity visualized in the intracranial arteries which appears artifactual. the basilar artery flow void as well as the basilar artery flow signal on source images is maintained. impression: somewhat limited normal mra of the head . head ct: no acute intracranial hemorrhage or mass effect. no significant change from . . eeg: this is an abnormal eeg in the waking and sleeping states due to the low voltage slow posterior rhythm as well as bursts of bilateral frontal 4 hz slowing. this suggests an encephalopathic pattern which may be seen with medications or toxic metabolic abnormalities. . pcxr: mild chf with left greater than right small pleural effusions. brief hospital course: micu course: - ct, mri/mra, eeg all negative for acute pathology. etiology of altered mental status thought to be multifactorial - 1)by history patient took double of the usual dose of benadryl. 2)patient found to be hypoglycemic. 3) renal failure. 4)all superimposed on baseline that per family is altered. - patient was intially started on dilantin but the etiology was ultimately deemed not to be seizure. the patient should see his behavioral neurologist, dr. , for whether he should restart this medication. - plan to go to dialysis with possible removal of tunneled catheter if dialysis through fistula is successful. - elevated potassium was treated with good effect with kayexalate, insulin and d-50. - patient was incidentally found to have a retrocardiac opacity but was not treated because of lack of fever and normal white blood cell count. - home were held on admission, but were subsequently restarted and the blood pressure remained stable. # ams: unclear etiology although possible precipitants include hypoglycemia, seizure, altered bp; neurology was consulted, eeg was performed and showed no seizure. head ct and mri/a were unremarkable. benadryl/trazodone were held. mental status improved to baseline per his family. trazodone was held. he should try to avoid >25 mg at a time of benadryl. blood sugars returned to . . # cv: had slight tnt bump though with no change in ecg and known esrd; ruled out for mi, no cp/sob. # htn: became very hypertensive to >200/100, not controlled on home meds, so patient was changed to labetalol 400 mg tid in addition to his norvasc for better bp control, his bp improved to 140/90. . # esrd: had elevated cr, k on admit. dialyzed with improved k. will continue increased frequency of hd for a few days. due for another hd session the day after d/c. his fistula has matured as was used for effective hd. he will need to follow up with dr. as an outpatient to have his tunnelled hd cath removed. pt. did not want to stay in the hospital to have this removed. he was restarted on his sensipar, renal caps, and fosrenal. he will follow up with dr. and dr. . . # thrombocytopenia: plt count mildly low at 141k (recent bl 167k-190k) follow up as an outpatient. . medications on admission: 1. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 2. lopressor 12.5 mg 3. lanthanum 1,000 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day). disp:*120 tablet, chewable(s)* refills:*2* 4. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. benadryl 25 mg capsule sig: one (1) capsule po every hours as needed for agitation. 6. renal caps 1 mg capsule sig: one (1) capsule po once a day. 7. trazodone 50 mg hs. discharge medications: 1. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 2. labetalol 200 mg tablet sig: two (2) tablet po tid (3 times a day). disp:*180 tablet(s)* refills:*2* 3. lanthanum 1,000 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day). disp:*120 tablet, chewable(s)* refills:*2* 4. cinacalcet 30 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. benadryl 25 mg capsule sig: one (1) capsule po every hours as needed for agitation. 6. renal caps 1 mg capsule sig: one (1) capsule po once a day. discharge disposition: home discharge diagnosis: altered mental status hypoglycemia end stage renal failure hypertensive urgency vascular dementia discharge condition: stable discharge instructions: please continue medications as listed below. please follow up for dialysis tomorrow. please also follow up with dr. to have your tunnelled catheter removed. followup instructions: 1. please call dr. office tomorrow to schedule a follow up appointment to have your tunnelled catheter removed. 2. please follow up with your nephrologist in the next week. 3. please go for dialysis tomorrow. 4. follow up with your pcp weeks. procedure: hemodialysis diagnoses: hyperpotassemia end stage renal disease congestive heart failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease diabetes with other specified manifestations, type ii or unspecified type, not stated as uncontrolled altered mental status backache, unspecified unspecified late effects of cerebrovascular disease diastolic heart failure, unspecified vascular dementia, uncomplicated cerebral atherosclerosis unspecified deficiency anemia 

Answer: The patient is high likely exposed to