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: no known allergies / adverse drug reactions attending: chief complaint: altered mental status major surgical or invasive procedure: none history of present illness: 77 yo m with dm type i, ckd (baseline cr 1.4), history of cva, subacute r. foot ulcer, recent pneumonia, presented to ed with worsening mental status, transferred to for further management. . per daughter, patient was in his normal state of health until , when he fainted in the bathroom. he was found by wife in the bathtub, but had no signs of trauma or brusing. ems evaluated the patient and all vital signs were normal thus he was not admitted to the hospital. on , patient was noted to be unsteady on his feet, lethargic, and had severe diarrhea. presented to ed on where he was diagnosed with lll pneumonia and treated with iv antbiotics. ct head at the time showed old infarct but no acute lesions. he clinically improved and was discharged on and as doing well. at 3 am on the day of admission, patient got up to go to bathroom. wife called out to him and patient reported that he was doing well. however, by 8 am the same morning, there were major changes in his mental status. patient was confused, lethargic, weak and unable to stand. he represented to on . . there, vs were t:99.2 bp:160/80, hr 92, o2 sat 97% 2l and patient was noted to be rigoring. abg 7.53/ 24/134/20 with blood sugar of 208. blood pressure remained stable. repeat cxr was unremarkable. ct head showed old left watershed infarct of indeterminate age consistent with history of 2 prior strokes. mild cerebral atrophy with chronic white matter ischemic changes. no mri was performed. neurologic exam was notable for occasional aphasia but no other deficits. kub showed stools but no obstruction. he was transferred to for further management. . in the ed, initial vs were: t(oral): 99.4, t(rectal): 102, hr:100 bp:155/87 rr:16 o2sat:100% 3l nc. he proceed to desatted to the 69% on ra, which improved to 80% on 2l nc, then 100% on fm. his mental status was noted to be very altered. neural exam notable for intact gaze, reactive pupils (blind on right eye), questionable hyperreflexia, and was moving extremities but not following commands. lumbar punction was performed which showed clear csf, wbc of 13 and 19 in tubes 1 and 4, respectively, and rbc of 77 and 31 respectively. protein elevated at 86, and decreased glucose 77 (90% of serum). csf cultures were sent. patient treated with 2 grams of vancomycin. . of note, patient's baseline functional status is high. he is always alert and oriented x3, and despite being hard of hearing with residual aphasia from his stroke, he is able to hold conversations and be independent for his adls. his presenting state is thus a market departure from norm . on the floor, patient was arousable to voice and intermittently follows commands. occasionally answers yes/no questions with slurring. he was initally tachycardic and hypertensive to the 190 systolic. abg was 7.45/31/242/22 on facemask. two hours after arrival, patient was noted to have right down-looking gaze. he then proceeded to have a violent tonic-clonic seizure. his respiratory status decompensated acutely and he was intubated. an a-line was placed. . review of sytems: (+) per hpi (-) denies fever, chills, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denied cough, shortness of breath. denied chest pain or tightness, palpitations. denied nausea, vomiting, constipation or abdominal pain. no recent change in bowel or bladder habits. no dysuria. denied arthralgias or myalgias. past medical history: - type i dm - hypertension - two strokes in (second one more severe, with aphasia) - benign prostatic hypertrophy - chronic kidney disease (baseline cr=1.4) - gerd (mild) - recent right diabetic foot infection since . amputation in the past right third toe in . - tore right rotator cuff, no surgical intervention - blind in right eye since birth (from forceps trauma) social history: lives with wife in own house. six kids all involved. smoke: never. alcohol: never. illicits: never. family history: father kidney failure. mother of old age. physical exam: exam on admission: vitals: t: 99.7 bp:198/100 p:128 r:11 o2:99% fm general: arousable, minimally responsive, nad heent: sclera anicteric, l pupil 3 mm, r pupil 4 mm. left pupil reactive to light. afferent pupillary defect on the right side. mild esotropia. responds to confrontation. oropharynx clear neck: supple, difficult to observe jvp, no lad lungs: anterior exam, no wheezes, rales, rhonchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, soft bowel sounds present, no rebound tenderness or guarding, no organomegaly skin: multiple corns on both arms, chest, no obvious rash, no vescicles gu: foley in place, draining clear urine ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro exam: arousable, answers "yes and no" at times, squeezes both hands and wiggles right toes. grimace to repositioning. neg babinski. unable to elicit reflexes. upper extremities rigidity with cogwheeling. pertinent results: 1. labs on admission: 04:45pm blood wbc-9.4 rbc-4.49* hgb-13.6* hct-37.6* mcv-84 mch-30.2 mchc-36.1* rdw-14.1 plt ct-229 01:05am blood pt-13.8* ptt-26.1 inr(pt)-1.2* 04:45pm blood glucose-85 urean-20 creat-1.5* na-137 k-3.6 cl-106 hco3-19* angap-16 04:45pm blood alt-21 ast-24 ld(ldh)-187 ck(cpk)-147 alkphos-63 totbili-1.0 04:45pm blood ctropnt-0.02* 01:05am blood ck-mb-5 ctropnt-0.02* 09:17am blood ck-mb-6 ctropnt-0.03* 01:05am blood albumin-3.0* calcium-7.3* phos-2.1* mg-1.9 09:17am blood triglyc-77 04:45pm blood tsh-0.53 04:45pm blood asa-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 02:23am blood freeca-1.11* 04:45pm urine color-yellow appear-clear sp -1.025 04:45pm urine blood-sm nitrite-neg protein-100 glucose-100 ketone-15 bilirub-neg urobiln-0.2 ph-5.0 leuks-neg 04:45pm urine rbc-1 wbc-<1 bacteri-none yeast-none epi-0 04:45pm urine hours-random urean-965 creat-149 na-112 k-52 cl-129 04:45pm urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg . 2. labs on discharge: . 3. imaging/diagnostics: - cxr (): no acute cardiopulmonary process. . - mri head (): 1. extensive confluent t2/flair hyperintensity involving the left frontal, parietal, and occipital lobes with associated cortical thinning and destruction, particularly in the left frontal lobe, are most consistent with encephalomalacia secondary to prior infarction. mra may provide further insight into the etiology of these signal abnormalities. 2. increased t2/flair signal in the left cerebellar hemisphere with associated volume loss is consistent with prior infarction. 3. no hydrocephalus to indicate increased intracranial pressure. 4. no evidence of acute infarction or intracranial hemorrhage. . - mri head (): no new abnormality of the brain is seen. other findings discussed above. . - eeg (): this is an abnormal video eeg due to the presence of a low voltage, slow, and disorganized background which represents a severe encephalopathy. there were no areas of persistent focal slowing although occasionally, severe encephalopathy can obscure focal findings. there were no clear epileptiform discharges or electrographic seizures. . - renal ultrasound (): 1. no evidence of obstruction, hydronephrosis, or stones. 2. simple cyst in the upper pole of the right kidney. 3. decompressed bladder with foley catheter. . 4. microbiology: - blood cultures (): negative . - urine cultures: (, ): negative . - sputum cultures: gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive cocci. in clusters. 1+ (<1 per 1000x field): gram negative rod(s). respiratory culture (final ): sparse growth commensal respiratory flora. yeast. sparse growth. . - csf cultures: gram stain (final ): no polymorphonuclear leukocytes seen. 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. viral culture (preliminary): no virus isolated. . - csf serologies: 11:06pm cerebrospinal fluid (csf) herpes simplex virus pcr-test - negative 06:09pm cerebrospinal fluid (csf) ebv-pcr-test name negative 06:09pm cerebrospinal fluid (csf) enterovirus pcr-test name negative 06:09pm cerebrospinal fluid (csf) state/cdc lab test-pnd pending 08:18am cerebrospinal fluid (csf) cytomegalovirus - pcr-test negative 08:18am cerebrospinal fluid (csf) varicella dna (pcr)-test negative brief hospital course: 77 yo m with dm type i, ckd (baseline cr 1.4), history of cva, subacute r. foot ulcer, recent pneumonia, transferred to for altered mental status. . # altered mental status: etiologies considered include toxic metabolic, vasular insult, or infectious. serum/urine toxocology screens negative and electrolytes within normal limits. infectious causes considered include uti (ua negative), pneumonia (cxr no acute process), infected foot ulcer (well healed on exam), and skin (no obvious lesions), and finally intracranial. lumbar puncture result showed lymphocytic predominance suggestive of viral encephalitis. hsv pcr, lyme, rpr, enterovirus, ebv, vzv were all negative. eee and west and cdc panel were sent and pending. patient emperically treated with acyclovir and vancomycin/ceftriaxone/ampicillin for bacterial meningitis. shortly after arrival in the icu patient witnessed to have tonic-clonic seizure and was urgently intubated for airway protection. infectious disease and neurology consulted. two mris were performed which showed chronic changes from prior strokes but no acute findings. two eegs were which showed signs of severe encephalopathy but no seizure focus. at the request of the family, patient was extubated and made cmo. he finally expired on at 945 am. . # volatile blood pressure: blood pressure was fairly volatile initially, with sbp in the 80s shortly after intubation and then up in the 180s while agitated. aggressively fluid resuscitated. ventilatory settings were adjusted accordingly and labetalol up titrated to 1200 mg po/ng q8h. all antihypertensives were stopped after patient made cmo. . # acute on chronic kidney disease: per report, baseline cr 1.4. initially worsened and cr peaked 3.2. renal was consulted and thought etiology most likely atn. all medications were renally dosed and ace-i held. renal ultrasound showed simple cysts but no hydronephrosis. renal function improved and cr was 1.8 prior to being made cmo. patient was able to maintain urine output throughout. . # gi bleed: patient had occult positive ngt aspiration as well as stool on hod #7 most likely from gastritis. patient placed on ppi. . # right foot ulcer: continued routine wound care. . # type i diabetes mellitus: controlled with insulin sliding scale. medications on admission: - lantus 100 units qam - simvastatin 20 mg po qam - plavix 75 mg qam - verapamil ( of 120 mg ? e.r. pill) 60 mg qam - lisinopril 10 mg qam - prilosec 20 mg apm - lexapro (escitalopram) 10 mg po qnoon - onglyza (saxagliptin) 5 mg qpm discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung insertion of endotracheal tube arterial catheterization diagnoses: acute kidney failure with lesion of tubular necrosis unspecified septicemia severe sepsis hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other convulsions hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (luts) ulcer of other part of foot chronic kidney disease, stage iii (moderate) acute respiratory failure long-term (current) use of insulin unspecified gastritis and gastroduodenitis, with hemorrhage encounter for palliative care do not resuscitate status encephalopathy, unspecified late effects of cerebrovascular disease, aphasia mixed acid-base balance disorder unspecified viral meningitis diabetes with other specified manifestations, type i [juvenile type], not stated as uncontrolled unspecified non-arthropod-borne viral diseases of central nervous system 

Answer: The patient is high likely exposed to