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: altered mental status. major surgical or invasive procedure: mechanical ventilation. history of present illness: this is a 45-year-old gentleman with a pmhx. of tonic-clonic seizures (in context of history of head injury and skull fracture 25 years ago) on lamotrigine, htn, hypercholesterolemia, and anxiety who is transferred from the micu to the general medicine floor after an acute change in mental status at work and gait instability. . patient states he has experienced progressive fatigue for the past 6 months. he developed a headache and "sinus congestion" 2 days ago, and began taking otc medication (sudafed) for nasal stuffiness. patient has also been taking herbal supplement (one of which contains lithium) for the past 2 months, which he buys on the internet; patient states that his doctor will no longer refill his prescriptions, as he hasn't been in to see her for a long time. . patient drove to work on day of admission without any trouble. however, when he got to his office he was found to be increasingly confused and with slurred speech. he was told to "go home" by his boss, but his behavior became increasingly more bizzare (couldn't lift bottle of water to his lips, weak, confused, unbalanced, etc). and ems was called. . on arrival to the ed, vs were: t97.3, hr 110->95, bp 140/110, rr 16, o2 sat 100% on 100% nrb. patient was found to be somnolent in the ed and neurology was consulted. thought that episode was likely due to intoxication from multiple medications, including lithium (in one of the herbal supplements he was taking). his tox screen was positive for: tricyclics, amphetamine (sudafed), and methadone (possibly from ultram). patient was given ceftriaxone and vanc for presumed meningitis. an lp was done, which was not consistent with bacterial infection however, patient was continued on acyclovir. mr. was intubated for a gcs of (withdrawal to pain). and transferred to the micu. he did well overnight and was extubated the following morning. his lithium level is coming down, and he is being followed by neurology and toxicology. vitals on transfer: bp: 124/78, hr: 100, rr: 16, sp02: 99% on ra. . ros: as per hpi. patient denies chest pain, shortness of breath, headache, nausea, vomiting, diarrhea, pain with urination, current fevers or chills. past medical history: - generalized seizure disorder on lamictal, no recent dose changes. patient states that last seizure was a few days prior to arrival and wittnesed by wife. normally post-ictal. - migraines that are temporally related to seizures and started recently after seizure disorder diagnosis made - anxiety (?) - takes clonazepam prn - htn - hl - gout - history of mva with skull fracture while in his 20s. social history: patient works as a development programmer for medtech. he is married and has no children. lives with his wife and 3 cats. no tobacco, alcohol, or other illicits. patient used to chew tobacco but quit 10 years ago. family history: uncle with bladder cancer. another uncle with myeloma. two uncles with lung cancer. high cholesterol in mother's side of the family. physical exam: vitals: bp: 124/78 p: 100 r: 16 18 spo2: 99% on ra general: alert, oriented, no acute distress heent: sclera anicteric, mmm, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema, with pneumoboots on. neuro: grossly intact bilaterally without focal deficits pertinent results: labs on admission: 08:45am pt-10.9 ptt-22.1 inr(pt)-0.9 08:45am plt count-214 08:45am neuts-54.5 lymphs-39.0 monos-3.7 eos-1.6 basos-1.1 08:45am wbc-8.8 rbc-4.56* hgb-13.6* hct-39.3* mcv-86 mch-29.8 mchc-34.5 rdw-13.0 08:45am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-pos 08:45am lithium-0.3* 08:45am calcium-9.2 phosphate-3.8 magnesium-1.9 08:45am lipase-25 08:45am alt(sgpt)-34 ast(sgot)-18 ld(ldh)-150 alk phos-102 tot bili-0.2 08:45am estgfr-using this 08:45am urea n-10 creat-1.0 08:50am hgb-14.4 calchct-43 08:50am hgb-14.4 calchct-43 09:41am cerebrospinal fluid (csf) protein-42 glucose-61 09:42am cerebrospinal fluid (csf) wbc-1 rbc-0 polys-0 lymphs-37 monos-63 09:45am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 09:45am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 09:45am urine color-straw appear-clear sp -1.010 09:45am urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-pos mthdone-pos 09:45am urine hours-random 12:52pm lithium-0.9 01:00pm type- po2-38* pco2-51* ph-7.36 total co2-30 base xs-1 images / studies: ct of c-spine : ct cervical spine: there is no acute fracture or malalignment within the cervical spine. patient is intubated with secretions in the posterior nasopharynx. prevertebral soft tissue appears within normal limits. extensive opacification of the right greater than left maxillary sinuses is noted. slight atelectatic appearance of the right maxillary sinus is better depicted on accompanying head ct, suggestive of chronic sinusitis. there is no focal thyroid lesion. deep cervical soft tissues are unremarkable. there is no lymphadenopathy. lung apices are clear. impression: no cervical spine fracture or malalignment. ct head : non-contrast head ct: there is no intracranial hemorrhage, mass effect, edema, midline shift, or acute hydrocephalus. there is no major vascular territorial infarction. the -white matter differentiation is preserved. prominent right frontal extra-axial space with mild mass effect on the right frontal lobe as well as right frontal osseous cortical thinning likely represents an arachnoid cyst. tiny hypodensity in the left basal ganglia is likely a dilated perivascular space. suprasellar and basilar cisterns are patent. there is extensive mucosal thickening within the right maxillary sinus with a slight atelectatic appearance to the bony sinus, suggestive of chronic sinusitis. mild mucosal thickening is also noted in the left maxillary sinus and ethmoidal air cells. remainder of paranasal sinuses and mastoid air cells are well aerated. soft tissues and globes are intact. impression: 1. no acute intracranial pathology. 2. right frontal arachnoid cyst. 3. likely chronic paranasal sinus disease. chest x-ray : chest, ap: endotracheal tube terminates 4.5 cm from the carina. nasogastric tube has side port in the distal esophagus and tip just beyond the gastroesophageal junction. there is no pneumothorax or pleural effusion. the cardiomediastinal and hilar contours are normal. the lungs are clear. impression: ett in standard position. ngt at gej, please advance. mri/mrv/mra head : mri of the brain: there is no evidence of intracranial hemorrhage, edema, intra-axial masses, mass effect or infarction. again seen is an arachnoid cyst anterior to the right frontal lobe (8:19), unchanged from the prior ct. the ventricles and sulci are normal in size and configuration. there is circumferential mucosal thickening at right maxillary sinus with a central hypointense signal, likely representing inspissated secretions or fungus ball. there is a mucus retention cyst at the anterior wall of the left maxillary sinus. the remainder of the paranasal sinuses and mastoid air cells are clear. mrv of the head: there is no evidence of deep or superficial cortical or dural sinus venous thrombosis. the right transverse sinus is dominant, the left appears hypoplastic without evidence of thrombosis. there is a small pacchioni granulation in the left transverse sinus (1103:86). mra of the head: there is no evidence of hemodynamically significant stenosis, occlusion, dissection, aneurysm or vascular malformation of the intracranial vertebral arteries, basilar arteries, carotid arteries, circle of or their major branches. impression: 1. no evidence of intracranial hemorrhage, edema or infarction. 2. there is no evidence of intracranial venous thrombosis. 3. mucosal thickening of the right maxillary sinus with central hypointense signal, likely representing inspissated secretions from chronic sinusitis or less likely a fungus ball. chest x-ray : chest, ap: new orogastric tube has side port in the distal esophagus and tip just beyond the gastroesophageal junction. endotracheal tube remains 5 cm from the carina. there is no pneumothorax or pleural effusion. the cardiomediastinal and hilar contours are normal. impression: ogt at gej; this may be advanced a few centimeters for optimal positioning. brief hospital course: this is a 45-year-old gentleman with a past medical history of epilepsy (attributed to mva in his 20s), anxiety, hypertension, gout, and hypercholesterolemia who is admitted with altered mental status and fall. . change in mental status: resolved gradually over course of hospitalization, but likely from gradual "build-up" of multiple prescribed and herbal medications. mr. states that his pcp has stopped giving him prescriptions for many of his anti-anxiety medications (because he hasn't gone to see her in a while), and he has needed to buy anxiolytics over the internet. patient is taking clonapin, amitryptiline, and tramadol in addition to sudafed and a supplement that contains lithium. these medications are undoubtedly contributing to confusion, slurred speech, and change in mental status. however, other etiologies of mental status change must also be considered such as infection or seizure. patient did complain of sinus congestion for a few days prior to admission (even missed work on the day prior to admission) but cxr and u/a unremarkable, and lp not consistent with bacterial infection. patient was satrted on acyclovir during hospitalization, but this was stopped prior to discharge. his hsv pcr is pending, and must be followed up by his outpatient provider. . another potential etiology of mental status change is seizure (given history) however, patient had a slowly declining mental status (over an hour or two) and no seziure activity was wittnesed and he was not post-ictal. he was seen by neurology and an eeg was done, which showed general encephalopathic changes. . patient's unnecessary medications were discontinued: provigil, ultram, citalopram, clonazepam. his lamictal was continued. his lithium level was checked until it was 0.3. an mri brain did not show evidence of hemorrhage, edema, or infarction. patient improved on his own and was extubated on . he was transferred to the general medical floor in stable condition, and was completely alert and oriented. he was eager to go home on day of discharge. neurology also suggested neuro-cognitive testing (patient was complaining of gradual memory loss) as an outpatient. . # seizure disorder: event unlikely seizure related, with no witnessed event, no post-ictal state, and negative eeg. patient was continued on lamictal 200 mg , and follow-up with his outpatient neurologist, dr . . # htn: will clarify home bp medications and touch base with patient's pcp. for now, but will treat high pressures as needed. . # hyperlipidemia: home regimen unknown. patient will follow up with pcp for lipid management. . # anxiety/depression: no evidence of overdose except +tox for methadone (which could be related to ultram patient was taking at home). home medication list contains clonazepam and celexa. according to patient, he bought anxiolytics over the internet (the herbal supplements) because he hadn't seen his pcp in some time, and she refused to give him any more prescriptions until he made an appointment. during admssion, patient was not given any anxiolytics, and exhibited no over signs of anxiety. he will likely need further treatment for anxiety and depression as an outpatient. patient will follow-up with pcp for this issue. he is in agreement with this plan. . # sinusitis: as seen on mri. patient has chronic frontal headaches and post-nasal drip. he had low-grade fevers on first day of admisison. patient will take augmentin for 14 days as an outpatient. he will follow-up with his pcp. medications on admission: precsiption medications per rite-aid pnarmacy: 1) provigil 200 mg po daily (last refill ) 2) midrin (generic version) 2 capsules po at onset of headache, repeat once prn (last refill ) 3) astelin nasal spray 2 sprays to each nostril (last refill ) 4) lamotrigine 200 mg po bid (last refill ) 5) clonazepam 0.5 mg once daily prn (last refill ) 6) lisinopril/hctz 20/12.5 mg po once daily (last refill ) 7) citalopram 20 8) tramadol 50-100mg q4-6 9) amitriptyline 100mg 10) allopurinol ?dose unclear 11) cholesterol meds unknown herbals -lithium orotate 120mg po q24 -pregnesolone -centropheoxine discharge medications: 1. lamotrigine 100 mg tablet sig: two (2) tablet po bid (2 times a day). disp:*120 tablet(s)* refills:*2* 2. augmentin xr 1,000-62.5 mg tablet sustained release 12 hr sig: two (2) tablet sustained release 12 hr po every twelve (12) hours for 14 days. disp:*56 tablet sustained release 12 hr(s)* refills:*0* 3. allopurinol 300 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: primary: 1. herbal medication overdose/interaction . secondary: 1. epilepsy 2. anxiety 3. hypercholesterolemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you on this admission. you came to the hospital because you had a change in mental status and some confusion. we believe that this was because of some herbal supplements you were taking at home. it is very important that you stop taking these supplements, and see your primary care doctor on a regular basis. . your primary care doctor will need to follow-up on blood cultures that are pending from this hospitalization. . you were also found to have a sinus infection on mri. please take augmentin (antibiotic) for a 14 day course. . the following changes were made to your medications: 1. start taking augmentin two 1000 mg tablets every 12 hours for 14 days. 2. continue taking lamictal (anti-seizure medication) 200mg twice a day 3. continue taking allopurinol 300mg qd . please take all of your medication as prescribed. please keep all of your follow-up appointments. . return to the hospital if you develop fever, chest pain, shortness of breath, change in mental status/confusion, loss of consciousness, dizziness, palpitations, seizures, abdominal pain, nausea, vomiting, diarrhea, or any other concerning signs or symptoms. followup instructions: please call your pcp at: early next week to make an appointment in 1 week. . please call your neurologist early next week to make an appointment for the next 1-2 weeks. do 12-bdu procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung insertion of endotracheal tube diagnoses: gout, unspecified abnormality of gait dysthymic disorder other and unspecified hyperlipidemia epilepsy, unspecified, without mention of intractable epilepsy altered mental status dysarthria encephalopathy, unspecified migraine, unspecified, without mention of intractable migraine without mention of status migrainosus chronic maxillary sinusitis poisoning by other specified psychotropic agents unspecified psychosis accidental poisoning by other psychotropic agents 

Answer: The patient is high likely exposed to