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: tegretol attending: chief complaint: increasing seizure frequency major surgical or invasive procedure: none history of present illness: mr. is a 24 year-old man with a past medical history including developmental delay and epilepsy who presents with an increase in seizure frequency despite a recent up-titration in anti-epileptic drugs. . mr. was reportedly diagnosed with seizure disorder by the age of three and is thought to have symptomatic generalized epilepsy. notes describe approximately five seizure subtypes characterized by: 1) staring episodes lasting seconds; 2) the tonic extension of arms following deep inspiration; 3) head/upper extremity loss of tone following deep inspiration; 4) (secondarily) generalized tonic clonic seizures; 5) jerking of upper extremities. previously tried, and discontinued, anti-epileptic drugs include dilantin (frequent urination and dazed eyes), valproate (worsening seizures, malodorous bowel movements, excessive urination, glazed eyes), tegretol (rash), and ativan (excessive muscle weakness). . he moved to a group home in , at which time he was able to walk (despite ataxia) and feed himself. he is non-verbal at baseline and, at best, able to follow simple requests. however, records document a general decline in function in the six months prior to admisison. he can no longer feed himself and requires full assistance with activities of daily living. in this setting, he has developed an increase in seizure frequency (now as many as five seizures daily) and status requiring admission on two occasions. during the last admisison () at , telemetry was thought to be consistent with -gastaut syndrome (frequent multi-focal and generalized epileptic discharges, often as semi-rhythmic 2 hz runs). to address the syndrome, topamax was increased (to 250 mg po bid) and vimpat (peak of 150 mg po tid) was added. there is no known history of recent head trauma. he is on augmentin for a presumed sinus infection. past medical history: - seizure disorder - since age of 3 - mental retardation - ataxic diplegia - acne - myopia - atopic dermatitis - hypothyroidism - chronic congestion - frequent aspiration pna - gerd - static encephalopathy - quadriparesis social history: the patient has lived at group home since . the patient's parents are his legal guardians and they live in . family history: the patient's mother is 48 and healthy and the father is 54 and also healthy. the patient has two brothers in their 20s, both healthy. there is family history of dm on both sides of family, thyroid disorder. physical exam: at admisson: physical examination: vitals: t: 97 p: 66 r: 12 bp: 98/62 sao2: 100% ra general: awake, nad. non-verbal. heent: long face (right aspect seems smaller than left), pointed ears, atruamatic, no scleral icterus noted. neck: supple. cardiac: regular rate, normal s1 and s2. pulmonary: lungs clear to auscultation bilaterally. abdomen: round. normoactive bowel sounds. soft. non-tender, non-distended. extremities: warm, well-perfused. flexion at wrists. skin: no rashes or concerning lesions noted. neurologic examination: mental status: * degree of alertness: alert. cranial nerves: * i: olfaction not evaluated. * ii: perrl 5 to 4mm and brisk. gaze conjugate. * iii, iv, vi: tracks nearly fully in horizontal and vertical directions. * v: facial sensation intact to light touch in the v1, v2, v3 distributions. * vii: no facial droop, right ptosis (previously documented). * viii: hearing difficult to assess motor: * tone: increased in upper extremities bilaterally. * adventitious movements: no tremor or asterixis noted. strength: * left upper extremity: moves spontaneously at least versus gravity * right upper extremity: moves spontaneously at least versus gravity * left lower extremity: moves spontaneously at least versus gravity * right lower extremity: moves spontaneously at least versus gravity reflexes: * left: 2+ throughout biceps, bracheoradialis, 3+ patella * right: 2+ thoughout biceps, bracheoradialis, 3+ patella * babinski: flexor bilaterally sensation: * light touch: intact bilaterally in lower extremities, upper extremities, trunk, face coordination * seems to reach with relative accuracy. pertinent results: admission labs: . wbc-5.5 rbc-5.33 hgb-14.5 hct-43.3 mcv-81* plt-235 glucose-102* urea n-14 creat-0.8 sodium-144 potassium-3.7 chloride-112* total co2-23 anion gap-13 alt(sgpt)-20 ast(sgot)-16 ld(ldh)-137 alk phos-77 tot bili-0.3 albumin-4.1 calcium-8.6 phosphate-2.3* magnesium-2.1 . discharge labs: . to be filled in . eeg (): per daily note with frequent generalized slow spike and slow wave discharges and at times, focal left temporal epileptiform discharges. . eeg (): impression: this telemetry captured three pushbutton activations. they did not show clear electrographic seizure activity, and there was no definite seizure activity on video, either. nevertheless, there were many runs of irregular generalized slow sharp and wave activity at about 1 hz, if without clinical changes. there were also some other paroxysmal rhythmic changes in the eeg that suggested seizures though they did not seem to have a clinical effect. . eeg (): impression: this is an abnormal video eeg study due to multiple electrographic seizures as described above in pushbutton and seizure detection files. this telemetry captured one pushbutton activation. note is also made of interictal frequent generalized spike and slow wave discharges as well as a mixed theta/delta background activity. . eeg (): per daily note overnight, he had decreased frequency of seizures. he had about 6 clinical tonic seizures, but briefer than prior seizures, without clusters and without progression to face and arm clonus. . eeg (): per daily note overnight, he had decreased frequency of seizures. he had about 4 tonic seizures. however, this morning, the sitter reports 4 very brief seizures in a span of 20 minutes. otherwise, he is more awake and alert today. . eeg (): per daily note over the last 24 hours, he did not have any prolonged tonic seizures on his eeg. group home observer saw no seizures this morning. the telemetry from overnight showed very brief events lasting less than 5 seconds and on video, the patient had no overt symptoms. background activity showed diffuse slowing with generalized and multifocal spikes (mostly left temporal) and slow spike and wave discharges. . eeg ( -): per daily note over the last 24 hours, he had 2 slightly tonic seizures on his eeg. group home observer noted a cluster of 4 typical staring seizures this morning for which he was given ativan. the telemetry from overnight showed very brief events lasting less than 5 seconds and on video, the patient had no overt symptoms. background activity showed diffuse slowing with generalized and multifocal spikes (mostly left temporal) and slow spike and wave discharges. overall, he has had a decrease in the frequency of seizures. . eeg (); impression: this is an abnormal video eeg study due to multiple tonic seizures lasting approximately 40 seconds in duration characterized by slight back arching, a deep inspiration followed by decreased respiration, and eye lid and bifacial myoclonus. this telemetry captured 20 pushbutton activations. compared to the prior 24 hours, this eeg is worse due to increased seizure frequency. . imaging . chest x-ray (): impression: ap chest reviewed in the absence of prior chest radiographs: . lateral aspect of the right chest is excluded from the examination. the other pleural surfaces are normal. . triangular opacity at the base of the left lung should be considered pneumonia until proved otherwise, alternatively atelectasis or pulmonary infarct. the remainder of the imaged lungs is clear and there is no appreciable pleural effusion. heart size is normal and there is no evidence of central adenopathy. . chest x-ray (): findings: as compared to the previous radiograph, there is no relevant change. the pre-described triangular retrocardiac opacity is unchanged in size and severity. as noted in the previous report, this opacity has to be considered as pneumonia unless proven otherwise. . no other focal parenchymal opacities. borderline size of the cardiac silhouette. no pulmonary edema. no pleural effusions. . chest x-ray (): findings: there is s-shaped scoliosis of the thoracolumbar spine. there is mild atelectasis at the left lung base. heart is top normal in size. remainder of the lungs appear clear. brief hospital course: mr. is a 24 year-old man with a past medical history including developmental delay and epilepsy who presented for a scheduled long-term monitoring admission with an increase in seizure frequency despite a recent up-titration in anti-epileptic drugs. he was admitted to the general neurology service from to for characterization of events by electroencephalogram (eeg) and optimization of the anti-epileptic drug regimen. . neuro: at the time of the admission, eeg leads were placed. the initial phase of eeg telemetry revealed slow spike and wave activity and focal temporal lobe epileptiform discharges. several medication changes were made in the first few days of monitoring. the keppra dose was decreased, and a topamax wean was initiated. in addition, vimpat was tapered and ultimately discontinued. banzel was initiated and up-titrated. patient continued to have frequent seizure activity both clinically and electrographically. on the several days prior to transfer, would have clusters of brief episodes of staring and tonic stiffening lasting seconds at a time, usually clustering over a 30 minute period. he was given ativan 1 mg for clusters of 4 or more seizures in a one hour period. prior to discharge the possibility of dietary changes to help decrease seizure frequency was discussed. while a ketogenic diet may be considered in the future, for now we had recommended an attempt at diet as a first step to evaluate for tolerability and efficacy. . pulm: video eeg demonstrated periods of apenea associated with seizures and independently. accordingly, continuous oxygen saturation monitoring was initiated and supplemental oxygen was provided. despite supplemental oxygen, periods of desaturation as low as the 40s - and more frequently to the 60-70 range - was noted. a sleep study was performed as an inpatient. had 5 obstructive apneas, 20 central apneas, 18 hypopneas with desaturation of 4% and an apnea hypopnea index of 7.8 (mild sleep apnea by ahi criteria). on sleep study he had rare desaturations below 80. it was suspected that his major pathology was obstructive but central sleep apneas may have also been playing a role. he was tolerating 2 l/min nasal cannula while sleeping at night and this is to be continued upon discharge. . id in the course of the admission, a chest x-ray raised the possibility of a pneumonia. however, because the patient was afebrile with no evidence of a leukocytosis, the choice was made to monitor him clinically rather than prescribe antibiotics. follow-up chest x-rays revealed the resolution of the abnormality. medications on admission: - phenobarbitol 150mg daily - topamax 250mg - keppra 2000mg - clonipin 0.25mg at 8am and noon, 0.5mg at 8pm - vimpat 150mg tid - levothyroxine 100 mcg daily - doxycycline 100mg - albuterol neb 3ml - calcium 600mg - vitamin d 800units daily - loratidine 10mg daily - diazepam 20mg pr prn - diastat acudial 15mg po prn - delsym prn cough - loratadine 10mg qam - vimpat 150mg tid - vitamin d qam - acidophilus with meals - augmentin 875mg d4/10 . all: - tegretol (rash) - bee stings, mosquitos discharge medications: 1. rufinamide 400 mg tablet sig: three (3) tablet po twice a day. disp:*180 tablet(s)* refills:*2* 2. home oxygen home oxygen. please administer 2 liters per minute via nasal cannula each night during sleep. 3. levothyroxine 100 mcg tablet sig: one (1) tablet po daily (daily). 4. clonazepam 0.5 mg tablet sig: 0.5 () tablet po three times a day. 5. doxycycline hyclate 100 mg capsule sig: one (1) capsule po bid (2 times a day). 6. calcium 600 600 mg (1,500 mg) tablet sig: one (1) tablet po twice a day. 7. phenobarbital 100 mg tablet sig: 1.5 tablets po hs (at bedtime). 8. topiramate 100 mg tablet sig: one (1) tablet po bid (2 times a day). 9. levetiracetam 500 mg tablet sig: three (3) tablet po bid (2 times a day). 10. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation (2 times a day). 11. vitamin d 400 unit tablet sig: two (2) tablet po once a day. 12. loratadine 10 mg tablet sig: one (1) tablet po once a day. 13. diastat acudial 12.5-15-17.5-20 mg kit sig: one (1) rectal once a day as needed for seizure. discharge disposition: extended care facility: discharge diagnosis: developmental delay intractable epilepsy gastaut syndrome sleep apnea discharge condition: drowsy but arousable to voice. nonverbal. moves all extremities spontaneously and antigravity. discharge instructions: you were admitted with increasing seizure frequency and for changes in your anti-epileptic medications while undergoing continuous eeg monitoring. changes to your medications are as follows; topamax was decreased from 250 mg to 100 mg keppra was decreased from mg to 1500 mg vimpat was stopped. (you had been taking 150 mg tid) clonopin will be decreased to 0.25 mg tid rufinamide was started and dose is 1200 mg at time of discharge. continuous oxygen at 2l/min via nasal cannula during sleep was started. followup instructions: please follow up with your pcp as well as your neurologist, dr. in weeks. you can schedule an appointment at . procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more insertion of endotracheal tube enteral infusion of concentrated nutritional substances other bronchoscopy other bronchoscopy diagnoses: esophageal reflux unspecified acquired hypothyroidism pneumonitis due to inhalation of food or vomitus unspecified sleep apnea grand mal status dermatitis due to drugs and medicines taken internally fever, unspecified quadriplegia, unspecified other acne hydantoin derivatives causing adverse effects in therapeutic use penicillins causing adverse effects in therapeutic use dysphagia, unspecified diplegia of upper limbs generalized convulsive epilepsy, with intractable epilepsy other atopic dermatitis and related conditions unspecified delay in development myopia 

Answer: The patient is high likely exposed to