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: penicillins attending: chief complaint: altered mental status major surgical or invasive procedure: picc placed history of present illness: 77 year old male with history of atrial fibrillation on coumadin, diabetes mellitus, htn who initially presented with altered mental status, delerium and fever. he was intuabed at an outside hospital for airway protection and transferred to for management. . on initial presentation, patient presented from home with altered mental status for one day. per patient's wife he had been alert and oriented and fully functional at baseline. he was at his baseline the night prior to admission and had no complaints. when he woke up the next morning he was confused and talking to people who weren't there and unable to follow commands. he was naked and combative. he has no history of recent travel. no recent sick contacts. was generally otherwise healthy. . he was initially taken to hospital where he was intubated for airway protection for his delerium. he had a negative toxicology screen. ua showed significant glucose, protein and blood but negative wbcs, negative nitrite and esterase. chemistries were notable for a normal sodium, creatinine of 1.3 and calcium. wbc count was elevated at 16.7 with 91.5 % neutrophils. inr was elevated at 2.4. he received lidocaine, etomoddate, vecuronium and succinylcholine for intubation. he received propofol for sedation. he had a ct head without contrast which was negative for acute hemorrhage. he had a cxr which showed a concern for a left lower lobe pneumonia and he received vancomycin 1 gram x 1 and moxifloxacin 400 mg iv x1. he was transferred to the emergency room for further management. past medical history: atrial fibrillation hypertension skin cancer diabetes mellitus social history: no smoking, alcohol or illicit drug use. lives with his wife. performs all his adls independently. no recent travel or sick contacts. family history: non contributory. physical exam: 97.7 112/63 77 18 100%/ra nad cv: irregular rhythm, no m/r/g ctab abd: soft, nt, nd, no rebound, no guarding ext: no c/c/e neuro exam: a&o x3, no focal motor or sensory deficits, able to say the days of the week backward but not the months of the year pertinent results: 06:09am blood wbc-8.6 rbc-3.44* hgb-10.3* hct-30.8* mcv-90 mch-30.0 mchc-33.5 rdw-13.7 plt ct-252 06:23am blood wbc-8.1 rbc-3.46* hgb-10.4* hct-31.5* mcv-91 mch-30.2 mchc-33.1 rdw-13.4 plt ct-238 04:37am blood wbc-8.7 rbc-3.64* hgb-11.2* hct-32.3* mcv-89 mch-30.8 mchc-34.7 rdw-13.6 plt ct-192 03:38am blood wbc-8.3 rbc-3.56* hgb-10.5* hct-32.6* mcv-92 mch-29.6 mchc-32.3 rdw-13.6 plt ct-207 05:02am blood wbc-6.5 rbc-3.41* hgb-10.2* hct-30.8* mcv-90 mch-29.9 mchc-33.1 rdw-13.4 plt ct-173 09:54am blood wbc-8.1 rbc-3.31* hgb-10.1* hct-29.2* mcv-88 mch-30.5 mchc-34.5 rdw-13.5 plt ct-154 04:22am blood wbc-7.8 rbc-2.77*# hgb-8.4*# hct-24.6*# mcv-89 mch-30.2 mchc-34.0 rdw-13.4 plt ct-157 02:00am blood neuts-78.3* lymphs-13.8* monos-4.4 eos-3.4 baso-0.2 04:22am blood neuts-79.1* lymphs-14.1* monos-4.9 eos-1.5 baso-0.3 06:09am blood pt-17.4* ptt-35.5* inr(pt)-1.6* 07:09am blood pt-15.4* ptt-32.6 inr(pt)-1.4* 04:40am blood pt-14.2* ptt-33.4 inr(pt)-1.2* 09:43am blood pt-15.7* ptt-28.8 inr(pt)-1.4* 02:00am blood pt-17.8* ptt-33.1 inr(pt)-1.6* 01:49pm blood pt-19.4* ptt-29.6 inr(pt)-1.8* 02:10pm blood pt-34.9* ptt-37.7* inr(pt)-3.7* 12:23am blood esr-59* 06:09am blood ret aut-0.6* 06:09am blood glucose-64* urean-25* creat-1.2 na-144 k-3.3 cl-107 hco3-28 angap-12 06:23am blood glucose-67* urean-26* creat-1.2 na-142 k-3.4 cl-104 hco3-30 angap-11 07:27am blood glucose-141* urean-27* creat-1.2 na-141 k-3.9 cl-103 hco3-28 angap-14 04:40am blood glucose-154* urean-26* creat-1.2 na-141 k-6.1* cl-103 hco3-28 angap-16 04:37am blood glucose-138* urean-25* creat-1.3* na-144 k-3.5 cl-105 hco3-28 angap-15 04:22pm blood glucose-173* urean-20 creat-1.4* na-145 k-4.1 cl-105 hco3-26 angap-18 03:38am blood glucose-109* urean-18 creat-1.4* na-145 k-3.9 cl-108 hco3-28 angap-13 03:19pm blood glucose-141* urean-17 creat-1.3* na-144 k-4.4 cl-110* hco3-28 angap-10 05:02am blood glucose-95 urean-16 creat-1.2 na-145 k-3.6 cl-109* hco3-28 angap-12 02:00am blood glucose-170* urean-20 creat-1.2 na-142 k-3.9 cl-109* hco3-25 angap-12 04:22am blood glucose-232* urean-25* creat-1.4* na-147* k-3.4 cl-102 hco3-24 angap-24* 08:48pm blood k-4.7 01:55pm blood glucose-457* urean-27* creat-1.4* na-136 k-5.1 cl-100 hco3-25 angap-16 05:02am blood alt-19 ast-34 ld(ldh)-209 ck(cpk)-272* alkphos-76 totbili-0.2 02:00am blood alt-19 ast-40 ld(ldh)-210 ck(cpk)-766* alkphos-63 totbili-0.2 09:54am blood alt-14 ast-41* ld(ldh)-322* ck(cpk)-1244* alkphos-65 totbili-0.4 08:48pm blood ck(cpk)-598* 01:55pm blood alt-13 ast-19 ck(cpk)-155 alkphos-90 amylase-35 totbili-0.5 05:02am blood ck-mb-4 ctropnt-0.05* 02:00am blood ck-mb-7 09:54am blood ck-mb-9 ctropnt-0.08* 08:48pm blood ck-mb-6 ctropnt-0.18* 06:09am blood calcium-8.4 phos-3.4 mg-2.3 iron-51 06:23am blood calcium-8.6 phos-3.7 mg-2.2 07:27am blood albumin-3.3* calcium-8.7 phos-3.3 mg-2.1 cholest-215* 04:40am blood calcium-4.7* phos-3.3 mg-1.1* 05:00pm blood mg-2.0 04:37am blood calcium-8.6 phos-3.5 mg-2.0 04:09pm blood mg-2.3 09:54am blood albumin-3.0* calcium-7.6* phos-2.4*# mg-2.4 04:22am blood albumin-3.1* calcium-7.6* phos-4.1 mg-2.4 01:55pm blood albumin-3.7 calcium-9.0 phos-3.2 mg-1.9 06:09am blood caltibc-260 vitb12-559 folate-12.2 ferritn-282 trf-200 01:55pm blood %hba1c-12.7* 07:27am blood triglyc-191* hdl-26 chol/hd-8.3 ldlcalc-151* 09:54am blood osmolal-297 06:09am blood vanco-15.3 06:23am blood vanco-28.4* 08:03am blood vanco-11.7 08:48pm blood digoxin-1.5 01:55pm blood greenhd-hold 05:18am blood type-art temp-36.6 rates-/26 tidal v-513 peep-5 fio2-40 po2-144* pco2-46* ph-7.44 caltco2-32* base xs-6 intubat-intubated vent-spontaneou 02:03am blood lactate-1.0 04:32am blood lactate-1.7 07:08pm blood lactate-1.6 02:18pm blood lactate-3.4* brief hospital course: the patient was transferred from outside hospital to emergency department. in the emergency room his initial vitals were t: 102 bp: 149/58 hr: 87 rr: 16 o2: 100% on ventilator. he received ceftriaxone 2 grams, ampicillin 2 grams, acyclovir 900 mg, one liter normal saline and tylenol. he had a ct torso which did not show pneumonia and he had a non-contrast ct head which was negative. lp was not performed because of elevated inr. he was admitted to the micu for further management. . in the icu, patient received 6 units of ffp for reversal of inr before lp could be safely obtained by ir on hospital day 3. lp notable for protein of 178, wbc 3, rbc 12, glucose 116. patient was continued on vancomycin, cetriaxone, ampicillin, and acyclovir pending the results of csf cultures. mri of the head showed no evidence of any infection. patient was mildly hypotensive but never required pressors. anti-hypertensives were restarted on hospital day 4 after sbp > 200, and patient was successfully extubated on hospital day 5. he was now called out of the icu for further management. . vital signs at the time of transfer to the floor were: t97.8, hr 89 (in fib/flutter), bp 139/60 by nibp (168/61 by a-line), rr 22 o2 93% 2l nc. los fluid balance of +3.2l, net out 550cc for the day, with 2.9l of uop over the day. on the floor, patient was continued on broad spectrum antibiotics and acyclovir as culture data was difficult to inerpret as patient was on empiric antibiotics for about 48 hours prior to lp. mental status steadily improved. with regard to his hypertension, patient's blood pressure continued to remain elevated despite treatment with amlodipine 5mg, lisinopril 40mg, and metoprolol 75mg tid. it is likely that the patient's blood pressure was not optimally controlled as an outpatient. his amlodopine was increased to 10mg qd. his blood pressures were reasonable on this regimen. on , his hsv pcr came back as negative and his acyclovir was discontinued. pt was continued on vancomycin, ceftriaxone, and ampicillin to cover for possible bacterial meningitis for full two week course (last day of treatment will be ). it is unclear it patient had a known diagnosis of diabetes prior to his hospital admission but he was found to have a hgba1c of 13 at presentation consistent with longstanding diabetes. pt was strated on glargine and insulin sliding scale. blood sugars were reasonable on this regimen. on presentation, pt's ekg demosntrated deep st wave depressions and t wave inversions in the inferior and lateral leads. he denies any history of chest pain. he had been on digoxin on presentation but his digoxin level was found to be 1.5 and he initially had bradycardia so his digoxin was held. cardiac enzymes were elevated on presentation but trended downward with clinical picture more consistant with demand ischemia rather than true acs. pt was treated with aspirin 325mg qd, metorpolol. a lipid panel was checked to determine need for statin therapy. patient ldl was found to be 151 and triglycerides were 191. he was started on lipitor. patient did not have any episodes of chest pain throughout his hospital course. pt has a history of atrial fibrillation which was rate controlled on metoprolol. as his inr was reversed with ffp in the unit, pt was tritrated back to therapeutic inr with lovenox bridge. patient's digoxin was held during this admission due to mild bradycardia. his heartrate remained in a good range without the digoxin, therefore the medication was not continued in patient's discharge medication. of note, patient had mild episode of acute kidney injury with elevated creatinine in the icu. this returned to baseline with improvement of mental status and iv hydration. pt was also found to have a small right heal ulcer on presentation which he had not been aware of prior to admission. pt consistently had good pedal pulses. the ulcer was treated with daily wet to dry dressing changes performed by the wound care team. medications on admission: asa 81 qd coumadin 5mg qd metoprolol sr 100 qd lisinopril 40mg qd digoxin 250 mcg qd discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 2. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 3. metoprolol tartrate 25 mg tablet sig: three (3) tablet po tid (3 times a day). disp:*270 tablet(s)* refills:*1* 4. enoxaparin 100 mg/ml syringe sig: one (1) 90 subcutaneous q12 hours (). disp:*10 1* refills:*2* 5. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*2* 6. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 7. ceftriaxone in dextrose,iso-os 2 gram/50 ml piggyback sig: one (1) intravenous twice a day for 6 days. disp:*24 g* refills:*0* 8. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) intravenous q 24h (every 24 hours) for 6 days. disp:*6 grams* refills:*0* 9. ampicillin sodium 2 gram piggyback sig: one (1) intravenous every six (6) hours for 6 days. disp:*48 g* refills:*0* 10. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* discharge disposition: extended care facility: care center discharge diagnosis: meningitis discharge condition: stable discharge instructions: you were admitted with altered mental status and fevers secondary to meningitis/encephalitis. initially you had difficulty breathing and stayed in the intensive care unit while you were intubated. you were treated with broad spectrum antibiotics and acyclovir. you lab work demonstrated no hsv infection therefore you are leaving only with antibiotics and no longer on the acyclovir. . we had to reverse your coumadin in order preform a lumbar puncture and obtain a csf sample. you are currently being bridged back to your therapeutic coumadin level with lovenox. you were also noticed to have some ekg changes on arrival consistent with nstemi with mild elevation of your cardiac enzymes. you should call you primary care doctor as an outpatient to schedule a cardiac stress test. . you were also noted to have elevated blood sugars and started on an insulin sliding scale and glargine. you should work with your primary care doctor as an outpatient to determine the best regimen to control you blood glucose levels . you blood pressures were also elevated during your hospital admission so we started you on a new blood pressure medication - amlodipine 10mg by mouth once per day. . we also found a small ulcer on your right heel and left fore arm that we are treating with daily wet-to-dry dressing changes medication changes include: * we started amlodipine, glargine, antibiotics (ampicillin, vancomycin, ceftriaxone), lovenox until you are therapeutic on your coumadin, and lipitor * we increased your aspirin to 325mg per day * we changed your metoprolol to 75 po three times per day * your heart rate was slightly low when you were admitted therefore we did not give you your digoxin. you can talk with your primary care provider about when to restart this. followup instructions: please follow up with your primary care provider 2 weeks please follow up with dr. of neurology in weeks, call ( to make this appointment procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung enteral infusion of concentrated nutritional substances arterial catheterization diagnoses: subendocardial infarction, initial episode of care unspecified essential hypertension acute kidney failure, unspecified atrial fibrillation acute respiratory failure long-term (current) use of anticoagulants abdominal aneurysm without mention of rupture pressure ulcer, heel hyperosmolality and/or hypernatremia pressure ulcer, stage ii diabetes with ketoacidosis, type ii or unspecified type, uncontrolled meningitis due to unspecified bacterium 

Answer: The patient is high likely exposed to