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: hypothermia major surgical or invasive procedure: lumbar puncture endotracheal intubation central venous line history of present illness: 66 y/o male brought in by ems for hypothermia. by ems report, patient found standing in the st. in after indeterminate amount of time outside. fs 91. bp 96/57 with pulse of 50, rr 16, sat 99% ra. patient reports going out for the paper today, then forgeting where he was. he claims he was only outside for several minutes. his only symptome was dizziness, but he did not fall or loose consciousness. he has not been eating well, and has been having diarrhea described as loose stools without melena or blood for the last 3 months. also reports leg weakness over the last several months. records indicate he was complaining of left foot pain to the parametics. he denies fever, chills, headache, chest pain, dyspnea, dysuria. . in ed, oral temp 90.6 hr 60 bp 95/53. he received 5 l ns and 750 mg levofloxacin. past medical history: depression/anxiety bph s/p turp crohn's disease recurrant leg infections social history: lives at senior housing in . graduated high school. hcp is his cousin, at (. family history: mental illness on fathers side. physical exam: general: male in no distress. vitals: t 96.3 rectal hr 66 bp 90/57 rr 18 sat 97%ra skin: no lesions heent: anicteric, perrl, mild right lateral eye deviation, mouth dry neck: no stiffness, no masses, no lad, palpable carotid pulses, no bruits, no tracheal deviation, no jvp elevation chest: no supraclavicular or axillary lad, lungs clear to asculation, no wheezes/rhonchi/crackles heart: normal pmi, rrr, no murmurs/gallops/rubs abdomen: flat, no scars, nabs, soft, no organomegaly, no masses, no guarding, no rebound. ext: no clubbing/cyanosis/edema. good pulses. neuro: ms oriented to person, year/month/day. cn ii-xii intact muscle strength 5/5 with some effort difficulty pertinent results: admission labs: ----------------- 12:35pm wbc-6.4 rbc-4.12* hgb-12.1* hct-35.6* mcv-86 mch-29.4# mchc-34.1 rdw-14.3 12:35pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-pos barbitrt-neg tricyclic-neg 12:35pm neuts-68 bands-0 lymphs-26 monos-3 eos-2 basos-0 atyps-1* metas-0 myelos-0 12:35pm plt smr-low plt count-126* 12:35pm free t4-1.2 12:35pm tsh-1.1 12:35pm ck-mb-notdone 12:35pm alt(sgpt)-59* ast(sgot)-34 ld(ldh)-169 ck(cpk)-77 alk phos-50 amylase-51 tot bili-0.3 12:35pm glucose-102 urea n-26* creat-0.8 sodium-149* potassium-4.0 chloride-111* total co2-32 anion gap-10 01:10pm urine bnzodzpn-pos barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg . other labs: ------------- 04:34am blood wbc-8.4 rbc-3.26* hgb-9.5* hct-28.8* mcv-89 mch-29.1 mchc-32.9 rdw-15.1 plt ct-160 04:34am blood glucose-87 urean-19 creat-2.0* na-140 k-4.3 cl-107 hco3-22 angap-15 02:00pm blood glucose-114* urean-17 creat-1.8* na-138 k-4.1 cl-107 hco3-25 angap-10 03:43am blood glucose-101 urean-15 creat-1.7* na-144 k-4.1 cl-107 hco3-29 angap-12 07:20am blood glucose-94 urean-14 creat-1.4* na-141 k-4.1 cl-105 hco3-30 angap-10 07:15am blood alt-125* ast-83* ld(ldh)-252* alkphos-66 totbili-0.5 07:51pm blood alt-112* ast-71* ld(ldh)-198 ck(cpk)-169 alkphos-62 totbili-0.4 04:34am blood alt-58* ast-36 ld(ldh)-253* alkphos-55 totbili-0.3 03:43am blood alt-61* ast-37 ld(ldh)-226 alkphos-57 totbili-0.3 07:20am blood alt-53* ast-34 ld(ldh)-249 alkphos-61 totbili-0.3 04:00am blood cortsol-25.6* 04:40am blood cortsol-42.3* 05:10am blood cortsol-44.8* 12:35pm blood tsh-1.1 12:35pm blood free t4-1.2 02:30am blood ammonia-22 02:30am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-pos barbitr-neg tricycl-neg 12:35pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-pos barbitr-neg tricycl-neg 06:37pm blood type-art temp-36.7 fio2-21 po2-118* pco2-49* ph-7.43 caltco2-34* base xs-7 intubat-not intuba vent-spontaneou 08:14pm blood type-art po2-247* pco2-54* ph-7.39 caltco2-34* base xs-6 11:45pm blood type-art temp-36.2 rates-12/ tidal v-500 peep-5 fio2-60 po2-313* pco2-46* ph-7.43 caltco2-32* base xs-5 intubat-intubated 05:32pm blood type-art temp-35.9 rates-/14 tidal v-280 peep-5 fio2-40 po2-94 pco2-46* ph-7.41 caltco2-30 base xs-3 intubat-intubated 09:57am urine color-yellow appear-clear sp -1.007 09:57am urine blood-lg nitrite-neg protein-tr glucose-neg ketone-10 bilirub-neg urobiln-neg ph-5.0 leuks-tr 09:57am urine hours-random urean-172 creat-41 na-106 k-11 cl-104 11:46pm urine bnzodzp-pos barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg 01:10pm urine bnzodzp-pos barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg 11:21pm cerebrospinal fluid (csf) wbc-20 rbc-2870* polys-56 lymphs-32 monos-4 eos-8 11:21pm cerebrospinal fluid (csf) wbc-15 rbc-3505* polys-68 lymphs-32 monos-0 11:21pm cerebrospinal fluid (csf) totprot-53* glucose-65 ld(ldh)-14 11:21 pm csf;spinal fluid source: lp. quantity not sufficient for acid fast smear (maw). gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (final ): no growth. fungal culture (preliminary): no fungus isolated. acid fast culture (preliminary): the sensitivity of an afb smear on csf is very low.. if present, afb may take 3-8 weeks to grow.. viral culture (preliminary): no virus isolated so far. . 11:21 pm csf;spinal fluid source: lp. **final report ** cryptococcal antigen (final ): cryptococcal antigen not detected. performed by latex agglutination. (reference range-negative). results should be evaluated in light of culture results and clinical presentation. . hsv pcr () - negative . discharge labs: ---------------- wbc-10.7, hct-38, plt-294 na-139, k-4.3, cl-101, hco3-28, bun-13, cr-1.1, gluc-84, ca-9.7, mg-2.2, phos-3.4 . studies: --------- ecg (): sinus rhythm. left anterior fascicular block. since the previous tracing of sinus bradycardia is absent. otherwise, baseline artifact on previous tracing makes comparison difficult. . renal u.s. 9:30 am renal ultrasound: the right kidney measures 10 cm and left kidney measures 11 cm, with no hydronephrosis, masses or stones. the cortices of both kidneys are mildly thinned. no echogenic calculi are identified. a 1.4 x 1 x 1.2 cm simple cyst with increased through transmission is seen within the lower pole of the left kidney. foley catheter is seen within a decompressed bladder. impression: 1. no evidence of echogenic renal calculi or hydronephrosis. 2. mild thinning of the renal cortices which likely represents medical renal disease . chest (portable ap) 4:54 am the tip of the et tube is in satisfactory position approximately 4.7 cm above the carina. an ng tube is present, tip beneath diaphragm overlying stomach. there are low inspiratory volumes. doubt chf. there is continued opacity at the right base medially, consistent with collapse and/or consolidation. the extreme right costophrenic angle is excluded from the film. no gross effusion is identified. no pneumothorax detected. compared with and allowing for differences in technique, there has probably been some re-expansion of atelectasis in the right lung. otherwise, i doubt significant interval change. . mr head w & w/o contrast 2:15 pm findings: there is no evidence of hemorrhage, edema, masses, mass effect or infarction. the ventricles and sulci are normal in caliber and configuration. no diffusion abnormalities are identified. bilateral t2 and flair hyperintensities are grossly stable since and likely represent chronic small vessel ischemia. there are no areas of abnormal enhancement. mra: the intracranial vertebral and internal carotid arteries and their major branches are unremarkable without evidence of stenosis, occlusion, or aneurysm formation. incidentally noted is a small right a1, likely a congenital variant. impression: grossly unchanged since without evidence of acute intracranial process. . eeg (): findings: abnormality #1: in the most awake-appearing portions of this tracing, a moderately well-organized 7-7.5 hz theta frequency background was seen. background: as above. hyperventilation: was contraindicated. intermittent photic stimulation: could not be performed as the test was requested as a portable study. sleep: no transitions from sleep to wakefulness were seen. cardiac monitor: revealed a generally regular rhythm with average rate of 66 bpm. impression: this eeg demonstrates a slow background rhythm consistent with a mild encephalopathy or similar findings may be seen in patients with extensive subcortical white matter disease located bilaterally or in deep, midline locations. no evidence of ongoing seizures is seen. . head ct (): ct head w/o contrast 9:56 pm non-contrast head ct: there is no acute intracranial hemorrhage. again seen are scattered subcortical white matter hypodensities suggesting chronic small vessel ischemic disease. the more focal area of hypoattenuation within the right frontal lobe anteriorly is unchanged compared to one day prior. visualized paranasal sinuses and mastoid air cells are clear. the osseous structures are unremarkable. impression: no acute intracranial hemorrhage. chronic microvascular ischemic disease. again, mri with dwi is more sensitive for acute ischemia. . ct head w/o contrast 6:36 pm findings: the study is motion degraded. there is no evidence of hemorrhage, edema, mass, or mass effect. there are scattered periventricular and subcortical white matter hypodensities, suggestive of chronic small vessel ischemic disease. more focal hypodensity in the right frontal white matter may reflect a small lacunar infarct. the ventricles and sulci are normal in caliber and configuration. there is no fracture. impression: mild small vessel ischemic changes. no intracranial hemorrhage. please note that mri with diffusion-weighted imaging is more sensitive for the detection of acute infarction. brief hospital course: 66 y/o male with hypothermia. . 1. hypothermia: improved with warming. was initially treated for sepsis and empirically on levaquin for posssible sepsis, however no evidence of sepsis. patient had a normal temp during the remainder of the hospitalization. . 2. delirium: acute delerius episode on early am. psychiatry was consulted, as he was on so many baseline psychotropic medications. seratonin syndrome was suspected in the setting of an elevated fluoxetine dose interacting with other medications, and all serotonergic medications were discontinued, including fluoxetine, buspirone, asacol and hysocamine. this required icu transfer and patient was intubated for airway protection. he was successfully extubated 3 days later. ct head showed no acute changes. he also received an initial dose of cyproheptadine, which did not impressively change his mental status. he had an mri with no acute change (results as above). an lp was done with results as above. significant number of red cells seen (likely traumatic), but patient empirically placed on acyclovir for possible hsv meningoencephalitis. once hsv pcr returned on the day prior to discharge, this was discontinued. prior to discharge, patient was oriented x 3 and appeared to back to baseline mental status. he was ultimately restarted on diazepam and risperdal. . 3. acute renal falure - this was in setting of acyclovir. cr elevated to as high as 2. this improved with hydration and was back to baseline level on discharge. . 4. gi bleed - patient had an episode of coffee ground emesis while in the icu. hct was as low as 28, however patient received significant iv fluid for decreased bp. his hct was 38 on discharge. hematocrit recheck is recommended in 10 days to ensure stability. . 5. depression/anxiety/mild mental retardation: see above regarding medication changes. he should follow up with his primary psychiatrist. . 6. crohn's: home medications were held. no episodes of abdominal discomfort. these medications can be restarted as an outpatient. . 7. hyperlipidemia - lfts were elevated so lipitor was held. lfts should be monitored as an outpatient and lipitor can be restarted if lft remain normal. . 8. htn - bp decreased while patient in the icu. metoprolol was held. bp should be monitored as an outpatient, and consideration should be given to restarting this as an outpatient. . of note, during the course during the course of this hospitalization, the patient's cousin, who is his hcp, allegedly threatened to kill one of the physicians due to the patient's acute delirium which likely resulted from unusually high doses of ssris. mr. was subsequently barred from entering the hospital. the patient was discharged to health on . he was originally set to be discharged on but due to bed unavailability this was postponed. on the day of discharge, health care proxy was called and was informed that the patient will be leaving to go to rehab. this was done at the patient's request. it was noted in the chart that in the icu, patient's proxy had brought up that patient be dnr/dni. this was brought up on phone with the proxy on discharge day. mr stated that in event of a cardiac and respiratory arrest - he did want manual chest compressions but no shocks, mechanical ventilation, intubation or other artificial means of resuscitation. it was discussed with him at length that manual compressions alone would rarely be effective without the other aspects of cpr eg shocks, mechanical ventilation etc. he understood this and still wanted patient to only have manual compressions on chest. dr was contact as well. per her, the patient has mental retardation and will need further detailed neuropsych assessment to determine if the patient has capacity to make his medical decisions. upon my discussion with patient today, he had minimal recollection of the events during the hospitalization and could not tell me details about his hospital stay except that he had "hypothermia". this was discussed at length with legal ( ). the patient will need formal capacity testing to determine if he can understand and make his own decisions about medical care and code status. since there were concerns during this hospital stay about the health care proxy's descisions and that the patient stated at times that the cousin wanted to shoot him, it would be best if patient had a formal capacity evaluation and further determination of the decision maker be deferred to that time. it is recommended that social work and legal services should be involved at the rehab to pursue this further. extensive discussion was held with legal services - prior to discharge. medications on admission: asacol 800 mg tid buspirone 20 mg diazepam 2 mg fluoxetine 60 mg hyoscyamine 0.125 tid lamictal 12.5 mg daily lipitor 10 mg qhs metoprolol xl 100 mg qhs mva risperdal 2 mg qhs vit b12 100 mcg daily discharge medications: 1. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 3. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed for constipation. 4. risperidone 2 mg tablet sig: one (1) tablet po at bedtime as needed for agitation. 5. diazepam 2 mg tablet sig: one (1) tablet po q12h (every 12 hours) as needed for anxiety. 6. vitamin b-12 100 mcg tablet sig: one (1) tablet po once a day. 7. multiple vitamins tablet sig: one (1) tablet po once a day. 8. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). discharge disposition: extended care facility: health care center discharge diagnosis: primary: altered mental status - likely secondary to serotonin syndrome hypothermia - resolved secondary: acute renal failure - in setting of acyclovir, resolved gi bleed depression/anxiety dyslipidemia crohn's disease bph s/p turp mental retardation discharge condition: afebrile, vital signs stable discharge instructions: you were admitted due to hypothermia. you subsequently had a change in your mental status, likely from an interaction of your medications (serotonin syndrome). this resulted in intubation. you subsequently were placed on a medication, acyclovir that resulted in worsening of your kidney function. this has improved. since your spinal fluid test for hsv was negative, this medication was stopped. due to the reaction you had that caused the change in your mental status, many of your psychiatric medications (fluoxetine, buspar, and lamictal) were held and your crohn's disease medications (hycosamine and mesalamine) were stopped as well. your lipitor was held because there was an elevation in your liver enzymes. your metoprolol was held due to low blood pressures. these can be restarted if your primary doctor rechecks your liver tests and finds them to be back to your baseline and your blood pressure is elevated. you should follow up with your primary doctor and your psychiatrist about restarting the appropriate medications. . please call your doctor or return to the emergency room if you were to develop worsening headache, change in your vision, high fever, or increased confusion. followup instructions: 1) primary care - dr. . (. please call to arrange a follow up appointment within the next 1-2 weeks. 2) psychiatry - dr. . . message left to set up appointment. you should call as well to schedule an appointment in the next 1-2 weeks regarding your psych meds. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung insertion of endotracheal tube diagnoses: unspecified essential hypertension acute kidney failure, unspecified hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) dysthymic disorder other and unspecified hyperlipidemia regional enteritis of unspecified site acute respiratory failure hemorrhage of gastrointestinal tract, unspecified other extrapyramidal diseases and abnormal movement disorders delirium due to conditions classified elsewhere hypothermia other drugs and medicinal substances causing adverse effects in therapeutic use mild intellectual disabilities 

Answer: The patient is high likely exposed to