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 / ace inhibitors attending: chief complaint: found unresponsive major surgical or invasive procedure: intubation history of present illness: patient is a 68 yo woman with pmh of mi, htn, breast ca s/p treatment without recurrence, bipolar, right lung nodule. she is primarily russian speaking but understands some english. she lives alone in an appartement and was last hear from yesterday at 1800 when she spoke with her sister. she was well at that time and had no complaints. this morning, the patient did not show up for her adult daycare program. the daughter was notified of this and called 911 around 1000 to have them go check on her mother. ems arrived at 1030 and found her on the floor, unresponsive with gcs 3. their notes are minimal, but report stable vital signs including sats of 96% on o2 and bs 198. they reported no facia droop. they witnessed a generalized seizure lasting unknown period of time which was treated with ativan 2mg. arrived to ed unresponsive except for sternal rub. per ed, she was noted to move both sides but r>l with sternal rub. she was not following any commands and was not moving sponatneously. she had a second witnessed gtc seizure lasting 1 minute in the ed which was treated with 2mg ativan iv. the patient's daughter says that the patient has been going to adult day care for "depression and living alone", but says the patient has no diagnosis of dementia. reports that the patient does live alone (was erroneously reported earlier that pt may live in nursing home). was last heard from yesterday at 1800. was not depressed at that time, but has been noted to be extremely manic the last 2 weeks. the patient has h/o bipolar but has not had a manic episode for weeks now. reports that her mother some times enjoys being manic, but is also sometimes exhausted and tormented by this state. has had suicide attempt by overdose in the past, about 5 yrs ago and more recently has had mild unintentional overdoses when trying to self medicate for insomnia. the daughter reports that in addition to the mania, her memory has been poor these last 2 weeks. she recently started seeing a new psychiatrist who started her on lithium. past medical history: pmh: per daughter, has no h/o stroke or seizures. per notes: 1. her past medical history is significant for coronary artery disease, status post myocardial infarction and she has been followed by you for this. 2. hypertension. 3. dyslipidemia. 4. bilateral breast cancer, status post treatment without recurrence. 5. osteoarthritis, particularly affecting both knees but she states that the osteoarthritic knee pain is different than her claudication symptoms. 6. depression, status post ect and being followed actively by a psychiatrist. 7. history of tubulovillous adenoma. 8. right lung nodule followed by serial cat scans without progression. social history: smokes. there is no history of drug or alcohol abuse. she is a retired engineer. she lives in in an appartment. there was report from ems and ed that patient was coming from some type of elderly living situation, however daughter says that this is just an appartment complex with security and that there is no nursing care or other there. the patient goes to adult day care during the day time. family history: there is no family history for premature coronary artery disease or sudden cardiac death. physical exam: t- 99.2 r bp- 123/53 hr- 110 rr- vented o2sat 100 vent gen: lying in bed, getting bagged pre-intubation. sedated with ativan. not yet paralyzed but soon. heent: nc/at, moist oral mucosa neck: hard collar back: no erythema cv: rrr, nl s1 and s2, no murmurs/gallops/rubs lung: clear to auscultation bilaterally abd: +bs soft ext: no edema neurologic examination: mental status: getting bagged pre-intubation and now s/p 4mg ativan. eyes closed and does not respond to sternal rub or other noxious stim x 4. does not follow commands. no spontaneous movement. cranial nerves: pupils 2mm and only minimally reactive bilaterally. no doll's reflex. no deviation. no blink to threat. no corneals. no gag. tongue midline. face difficult to assess. motor: normal bulk bilaterally. tone flaccid throughout. no observed myoclonus or tremor does not withdraw to noxious stim x 4 and no spontaneous. noted by ed to move with sternal rub right greater than left. sensation: no withdrawl or grimace x 4. reflexes: trace at biceps, otherwise absent. toes mute bilaterally coordination: na. gait: na. romberg: na pertinent results: 10:58pm ck(cpk)-979* 10:58pm ck-mb-17* mb indx-1.7 ctropnt-0.02* 05:59pm type-art po2-124* pco2-46* ph-7.41 total co2-30 base xs-4 05:59pm lactate-1.3 05:45pm glucose-129* urea n-16 creat-1.1 sodium-135 potassium-2.8* chloride-99 total co2-26 anion gap-13 05:45pm ck(cpk)-784* 05:45pm ck-mb-18* mb indx-2.3 ctropnt-0.01 05:45pm calcium-9.0 phosphate-3.0# magnesium-1.7 05:45pm phenytoin-11.2 lithium-2.0* 01:15pm cerebrospinal fluid (csf) protein-41 glucose-103 01:15pm cerebrospinal fluid (csf) wbc-1 rbc-0 polys-0 lymphs-40 monos-60 12:35pm wbc-14.7*# rbc-4.40# hgb-13.4# hct-39.0# mcv-89# mch-30.3 mchc-34.3# rdw-14.9 12:35pm neuts-94.6* bands-0 lymphs-3.0* monos-2.2 eos-0.2 basos-0 12:35pm neuts-94.6* bands-0 lymphs-3.0* monos-2.2 eos-0.2 basos-0 12:35pm hypochrom-normal anisocyt-normal poikilocy-normal macrocyt-normal microcyt-normal polychrom-normal 12:35pm plt smr-normal plt count-236# 11:55am urine hours-random 11:55am urine hours-random 11:55am urine gr hold-hold 11:55am urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 11:55am urine color-straw appear-clear sp -1.006 11:55am urine blood-tr nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-neg 11:55am urine rbc-0 wbc-0 bacteria-none yeast-none epi-0 11:25am glucose-126* na+-139 k+-3.4* cl--99* tco2-14* 11:10am alt(sgpt)-31 ast(sgot)-40 ck(cpk)-349* alk phos-106 amylase-88 tot bili-0.3 11:10am lipase-100* 11:10am ck-mb-12* mb indx-3.4 11:10am ctropnt-0.02* 11:10am albumin-4.4 calcium-9.8 phosphate-6.7* magnesium-2.2 11:10am lithium-2.4*# 11:10am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 11:10am pt-13.4* ptt-25.4 inr(pt)-1.2* 11:08am comments-green top 11:08am glucose-66* lactate-7.8* na+-142 k+-1.9* cl--127* tco2-6* 11:00am urea n-8 creat-0.5 11:00am estgfr-using this 11:00am amylase-26 11:00am asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 11:00am wbc-5.5 rbc-2.36* hgb-7.0* hct-23.4* mcv-99* mch-29.8 mchc-30.0* rdw-14.8 11:00am plt count-146* eeg : this is a likely normal portable eeg. no focal, lateralized, or epileptiform discharges were noted. no seizure activity was noted. if clinically warranted, the study could be repeated during the more waking state so that transitions in state could be evaluated. cxr : an endotracheal tube terminates with its tip 3 cm above the carina in satisfactory position. the cardiomediastinal contour is normal. allowing for technique, the heart is not definitely enlarged. there is a linear retrocardiac density and blunting of the left costophrenic angle likely due to left lower lobe atelectasis. the right lung is clear. the bony thorax is normal. nchct : 1. no evidence of intracranial hemorrhage or other acute process. an mri is recommended if there is concern for acute stroke. 2. cerebellar lacunes, mild small vessel ischemia changes. c-spine ct : 1) no evidence of fracture or dislocation. 2) mild degenerative changes. 3) heterogeneous thyroid with suggestion of a left lobe nodule. correlation with clinical evaluation is recommendend. 4) emphysema. mri/a head : small right frontal subcortical acute infarction, otherwise unremarkable study. sequela of small vessel ischemia and old bilateral cerebellar infarcts. eeg : abnormal eeg due to the mildly slow and very disorganized background with bursts of generalized slowing. these findings indicate a widespread encephalopathy affecting both cortical and subcortical structures. medications, metabolic disturbances, and infection are among the most common causes. there were no areas of prominent focal slowing, and there were no epileptiform features. carotid u/s : duplex and color doppler demonstrate normal carotid systems bilaterally. there is also normal antegrade flow involving both vertebral arteries. echo : the left atrium is mildly elongated. the estimated right atrial pressure is 0-5mmhg. there is mild symmetric left ventricular hypertrophy with normal cavity size and systolic function (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets appear structurally normal with good leaflet excursion. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are structurally normal. no mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is an anterior space which most likely represents a fat pad. mild symmetric left ventricular hypertrophy with preserved global and regional biventricular systolic function. moderate mitral annular calcification. no definite structural cardiac source of embolism identified. brief hospital course: the patient was initially admitted to the neurology icu with diagnosis of seizures. initial psychiatric medications were held, and she was intubated for decreased mental status. she was loaded with dilantin. her lithium level was found to be elevated to 2.4; she was seen by toxicology, who felt that dialysis was not indicated at this point. her lithium level trended down in the blood, though psychiatry pointed out that cns levels remain quite high for a lengthier period of time, and that she may prove to be slow to return to baseline. the seizures were felt to be related to the lithium toxicity, thus dilantin was discontinued. her eeg showed no epileptiform activity. she was extubated within 24 hours. incidentally, she was found to have a punctate infarct on mri in the right frontal lobe (mri performed as part of workup for seizure). she was transferred to the floor, where lfts were found to be elevated, and gradually trended down once she was taken off statin therapy. her second eeg showed mild encephalopathy with a background of 7.5 hz and periodic generalized slowing. her renal function also worsened slightly during the hospital stay, after reinitiation of hctz, lasix and an ace-i for blood pressure control. this improved with iv fluid and elimination of her renally cleared medications. intermittently, she had some urinary retention, thought due to dehydration from not eating or drinking enough; both her bun/creatinine and urinary output improved with some iv fluid boluses, and at the time of discharge, she was urinating without a foley catheter and eating and drinking. hctz and lisinopril were reinitiated with no change in her bun/creatinine. peak transaminases were: ast 150, alt 106, ldh 450; at discharge, ast 59, alt 85, alk phos 85, tbili 0.4, ldh 323. her mental status after extubation was consistent with inattention, suggestive of encephalopathy. she also had auditory hallucinations, and became mute (without neurological cause) on one day. she required a sitter for her active hallucinations and agitation at times. this was felt to be related to toxic-metabolic disturbances above (transaminitis, elevated bun/creatinine (creat to 1.4 peak), and residual effects from the lithium). psychiatry followed her throughout the admission and she was noted to have some improvement of the encephalopathy; as this cleared she was noted to be more manic on exam, with pressured speech and inappropriate laughter. she had been placed on zyprexa with doses titrated up to 5mg plus 10mg qhs at the time of discharge, to treat both the delirium and the mania. she had a rash at discharge that was felt to be consistent with zoster; she was started on valtrex at the time of discharge. she had guaiac positive stools at one point (no frank blood), and as her hematocrit was stable (minus dilutional effects from iv fluid boluses), she was instructed to follow up with gi as an outpatient. regarding workup of the incidental stroke, her echo and carotids were normal, revealing no source of embolus. her a1c was 5.7, suggesting no diabetes, and as her cholesterol panel was checked (hdl 54, ldl 81, tchol 169, trig 172) and was near goal for this patient with cad history and stroke, and due to her transaminitis, statin therapy was not continued. she was continued on aspirin and plavix for stroke prevention, and ultimately the stroke was felt to be related to an accumulation of vascular risk factors with no obvious embolic source. medications on admission: cymbalta 40 clonipin 1 lasix 20 daily pepcid 20 topamax 25 - not taking, per family loperamide 2 colace seroquel 200 qhs prednisone (has bottle, but old rx and doubt taking) lisinopril/hctz 20/25 daily benadryl 50 daily trazadone 150 daily vytorin 10/40 plavix 75 daily lopressor 50 lacmital 50 - not taking, per family discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 3. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 4. famotidine 20 mg tablet sig: one (1) tablet po q24h (every 24 hours). 5. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 6. albuterol sulfate 0.083 % (0.83 mg/ml) solution sig: puff inhalation q4h (every 4 hours) as needed for wheezing. 7. ipratropium bromide 0.02 % solution sig: 1-2 puffs inhalation q8h (every 8 hours) as needed for wheezing. 8. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po daily (daily). 9. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 10. olanzapine 5 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po bid (2 times a day). 11. olanzapine 10 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po qhs (once a day (at bedtime)). discharge disposition: extended care facility: elizabeths discharge diagnosis: seizures due to lithium toxicity right frontal stroke discharge condition: stable. the patient was awake, alert, laughing frequently. she was able to do the days of the week forward only and could identify objects on her meal . she had diffuse motor impersistence on exam. discharge instructions: please take your medications as prescribed and follow up with appointments as scheduled. followup instructions: please call your primary care physician, at ( to schedule follow up in weeks. please call neurology clinic to set up follow up with either dr. ] or dr. in weeks. there was evidence of microscopic blood in your stool. please call ( to set up an outpatient follow up. md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube diagnoses: coronary atherosclerosis of native coronary artery tobacco use disorder toxic encephalopathy unspecified essential hypertension chronic airway obstruction, not elsewhere classified personal history of malignant neoplasm of breast other convulsions peripheral vascular disease, unspecified other and unspecified hyperlipidemia pneumonitis due to inhalation of food or vomitus old myocardial infarction other diseases of lung, not elsewhere classified hypoxemia cerebral artery occlusion, unspecified with cerebral infarction home accidents other psychotropic agents causing adverse effects in therapeutic use other alteration of consciousness osteoarthrosis, localized, not specified whether primary or secondary, lower leg bipolar i disorder, most recent episode (or current) manic, unspecified herpes zoster without mention of complication 

Answer: The patient is high likely exposed to