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: minocycline / heparin agents attending: chief complaint: ha, dizziness, le numbness and weakness major surgical or invasive procedure: lumbar puncture x2 history of present illness: pt. is a 24 y/o with a history of spinal stenosis s/p l5-s1 laminectomy who we are consulted for le weakness and numbness. pt. was in his usoh until monday, 6 days pta, when he developed a bifrontal and retroorbital headache. it was a stabbing pain that was relieved with ibuprofen but recurred over the next several days. pt. reports no diplopia, trouble swallowing, trouble speaking or slurred speech, no ear pain, ear fullness, or trouble hearing with the headache. then on thursday morning when he woke up pt. noticed nausea and dizziness. he describes this as a sensation that the room was spinning. it continued constantly for the next several hours, with no change with change in position. because of these symptoms he presented to an osh ed on thursday evening. there a head ct was performed and was negative, and he was diagnosed with an ear infection and discharged home with amoxicillin. the next morning the dizziness continued, and pt. reports that he threw up ~3 times that day. in the afternoon his mother gave him dramamine for the nausea. after taking the dramamine pt. developed lower abdominal pain. he also started noticing numbness in his legs and weakness in his legs that afternoon. he describes his legs "felt asleep" and like they had less sensation, did not notice any pins and needles. he felt like he had trouble walking, and fell once, and is not sure if this was weakness, or the numbness in his legs or his dizziness. he did not notice any bowel or bladder incontinence or any saddle anesthesia. he presented again to the ed on saturday because of these new symptoms. there a foley was placed with 1100 cc out. the abdominal pain resolved after the foley was placed but the le numbness continued. he was transferred to for lumbar imaging. past medical history: spinal stenosis s/p l5-s1 laminectomy in social history: accountant, no tobacco, occasional etoh, no illicits. lives with mother and father. sexually active with girlfriend. family history: mothe with disease, maternal gm with seizures starting at age 73, no family history of stroke, diabetes, or other autoimmune disease physical exam: t- 98.9 bp- 132/74 hr- 80 rr- 21 o2sat 98% on ra gen: lying in bed, nad heent: nc/at, moist oral mucosa neck: no tenderness to palpation, normal rom, supple, no carotid or vertebral bruit back: no point tenderness or erythema cv: rrr, nl s1 and s2, no murmurs/gallops/rubs lung: clear to auscultation bilaterally abd: +bs soft, nontender ext: no edema neurologic examination: mental status: awake and alert, cooperative with exam, normal affect. oriented to person, place, and date. attentive, says backwards. speech is fluent with normal comprehension and repetition; naming intact. no dysarthria. and writing intact. registers , recalls in 5 minutes. no right left confusion. no evidence of apraxia or neglect. cranial nerves: pupils equally round and reactive to light, 4 to 2 mm bilaterally. visual fields are full to confrontation. extraocular movements intact bilaterally, no nystagmus. sensation intact v1-v3. facial movement symmetric. hearing intact to finger rub bilaterally. palate elevation symmetrical. sternocleidomastoid and trapezius normal bilaterally. tongue midline, movements intact motor: normal bulk bilaterally. tone normal. no observed myoclonus or tremor. no pronator drift. normal rectal tone. tri wf we fe ff ip h q df pf te tf r 5 5 5 5 5 5 5 5- 5 5 5 5 5 5 l 5 5 5 5 5 5 5 5- 5 5 5 5 5 5 sensation: decreased to pinprick, cold, light touch in bilateral le and lower abdomen and back with t7 level. proprioception intact in toes bilaterally. sensation intact to all modalities in bilateral ue. reflexes: +2 and symmetric throughout. toes mute bilaterally coordination: finger-nose-finger normal, heel to shin normal, rams normal. gait: pt. able to stand in front of bed with a wide base, but feels too unsteady to walk feeling like he does not know where his feet are pertinent results: 140 103 17 ------------< 98 4.1 26 1.2 ca: 9.4 mg: 2.2 p: 3.6 alt: 40 ap: 59 ast: 18 wbc 11.1 hgb 16.2 plt 239 hct 44.5 n:72.1 l:20.1 m:6.6 e:0.7 bas:0.4 ua negative heparin dependent antibodies positive (pf4 antibody by ) imaging mri l-spine without contrast: the alignment of the lumbar spine is unremarkable. there is evidence of disc degenerative changes with disc desiccation involving the l2/3 through l5/s1 disc interspaces. post-surgical changes from previous laminectomy at l5/s1 are identified. the conus is situated at t11/12. the central canal appears congenitally small throughout. however, no significant central canal stenosis is identified. at l2/3, there is a mild central disc bulge without evidence of central canal stenosis or foraminal narrowing. at l3/4, there is a small central disc herniation associated with a central bulge without evidence of significant central canal stenosis or neural foraminal narrowing. at l4/5, there is a small left paramedian disc bulge without evidence of central canal stenosis or significant neural foraminal narrowing. at l5/s1, there is a small central disc bulge with an associated annular tear. post- laminectomy changes are identified. there is no central canal stenosis or neural foraminal narrowing. impression: congenitally small central canal with multilevel disc degenerative changes and a small disc herniation at l3/4. no evidence of significant central canal stenosis or neural foraminal narrowing. brief hospital course: patient is a 24 y/o with a history of lumbar spinal stenosis who presents with ha, nausea and dizziness, le weakness and numbness, and urinary retention. his exam is significant for loss of sensation with a t7 sensory level and bilateral ip weakness. he has brisk le reflexes which makes unlikely as a cause of le weakness. it is difficult to localize all of his symptoms with one lesion. it is possible that dizziness and vertigo are labrynthitis as suggested and are unrelated to his le symptoms. if vertigo is related to le weakness there would have to be a multifocal process affecting the cerebellar vermis and thoracic spine. given his t7 level there is concern for a thoracic lesion, either from spinal stenosis, disc herniation, adem or infectious myelitis. transfered from unit to floor 1. neuro: workup included a lumbar puncture with rbc 21 and wbc 166 with lymphocytic predominance (prot 72, gluc 60). mri head, c, and t spine with contrast that showed increased t2 signal at multiple c and t levels and cerebellar peduncle, medulla. emg was consistent with spinal process and did not show demyelination peripherally. differential diagnosis included infectious, postinfectious and inflammatory. infectious: patient was covered with vancomycin, ceftriaxone and acyclovir. per id recommendation, ampicillin was added to cover for listeria given brainstem involvement. lyme titer was preliminarily positive on however negative on confirmatory western blot. inflammatory: esr and crp were normal. there were no oligo-clonal bands in csf. ace level normal. other: b12 was normal. treatment: patient was started on solumedrol 1g iv q24 on for total of 14 day course. he was switched to prednisone then resumed solumedrol when repeat mri brain showed increased inflammation (restricted diffusion in enlarging lesion in l internal capsule measuring ~1 cm. new lesion in l middle cerebellar peduncle. unchaged t2 hyperintensity in pontomedullary junction and nonenhancing t2 hyperintensity noted in cervical and thoracic cord). repeat mri of head, c and t spine were improved on ; although t2 hyperintense lesions remain within the left internal capsule, left middle cerebellar peduncle, and at the pontomedullary junction, all of the lesions are considerably improved and show no mass effect or enhancement. marked interval improvement in the appearance of t2-signal abnormalities in the cervical and thoracic cords, including reduced expansile mass effect among the cervical lesions. repeat lp performed by fluro on showed rbc wbc 671 prot 136* gluc 84 which shows improvement. oligoclonal bands were again negative in the csf. final diagnosis was myelitis/rhombencephalitis of unclear etiology. based on this admission, we were unable to differntiate between adem versus first presentation of multiple sclerosis. he will follow longitudinally with an outpatient neurologist who specializes in demyelinating diseases dr. . 2. cv: continued telemetry. cycled enzymes which were negative x3. 3. id: infectious disease was consulted. patient was started on ceftriaxone on and will complete a 28 day course to cover for lyme cns infection given the initial positive test. he will need to have his lyme titer repeated which will be done in clinic as an outpatient after completion of this antibiotic course. vancomycin that was initially started on was eventually discontinued on when csf cultures returned as negative. ampicillin/gentamicin was added for listeria coverage. ampicillin course will be for 5 wks (started -) and he completed a gentamicin x10 day course (). azithromycin was also added to cover mycoplasma and subsequently discontinued when serum igm titers were negative. acyclovir was also started for hsv covered and discontinued when hsv pcr returned as negative. final csf results included: culture neg, fungal culture neg; histoplasma antigen neg; crypto antigen neg. additionally, serum results included: cryptococcal antigen negative, cmv negative, toxo negative, hbv immune, hcv negative, mycoplasma pneumoniae antibody, igg pos, igm neg; histoplasma ab neg, blastomyces ab neg, hiv neg, rpr neg. stool: viral culture - routine neg, ebv igm negative, positive igg (immune). ppd negative neg and monospot negative. test still pending at discharge: eee, west patient will follow-up in clinic as an outpatient. 4. gi: patient developed severe constipation requiring daily disempaction x3 days. patient had nausea and vomitting requiring him to be npo and ngt was placed to intermittent suction. protonix qd was started. kub was negative for obstruction and suggested gas filled loops of colon. patient received golytely and milk of molasses enema with moderate results. gi was consulted and recommended gastrogaffin enema which did not show an obstruction and suggested paresis of the colon. patient had small amount of vomit that was gastrocult postive however his hct remained stable and hd stable. per gi, felt likely d/t irritation of stomach lining from ngt and suggested increasing to protonix . if patient did not improve, would have given iv neostigmine x1 however on , patient started having spontaneously bowel movements. at that time, he was on lactulose tid, dulculax pr among additional bowel medications. patient was advanced slowly and was tolerating a regular diet at discharge. his stools continue to be loose and bowel regimen was gradually decreased. 5. heme: patient's platelet count began gradually downtrending during this hospital course with unclear etiology. platelet count will need close following and hit antibody was positive. all heparin products were held. this should be confirmed by serotonin release assay. consider alternative method for prophylaxis for deep venous thrombosis. careful medication review for medication induced thrombocytopenia needs to be performed and patient should be switched to alternative medications as indicated. 6. pulm: on hd #2, patient had increasing tachypnea and work of breathing on the afternoon so was in admitted to the neuro intensive care unit for monitoring between to . chest x-ray was negative for pneumonia. chest ct noncontrast to r/o parenchymal disease was negative and just showed left-sided atelectasis. patient sat'ing in high 90's on room air at time of discharge. 7. psych: patient developed steroid psychosis. he was continued seroquel 25mg po bid. 8. fen: patient passed a speech and swallow evaluation but was recommended to have 1:1 supervision with meals. patient was tolerating small portions of a regular diet upon discharge. 9. ppx: bm meds, ppi , hsc medications on admission: amoxicillin ibuprofen discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 3. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 4. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for fever or pain. 5. quetiapine 25 mg tablet sig: one (1) tablet po bid (2 times a day). 6. insulin regular human 100 unit/ml solution sig: per sliding units injection asdir (as directed). 7. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). 8. lorazepam 0.5 mg tablet sig: 0.5-1 tablet po q4h (every 4 hours) as needed for anxiety, hiccups. 9. prednisone 20 mg tablet sig: three (3) tablet po daily (daily) for 5 doses: start . 10. prednisone 50 mg tablet sig: one (1) tablet po daily (daily) for 5 doses: start . 11. prednisone 20 mg tablet sig: two (2) tablet po daily (daily) for 5 doses: start . 12. prednisone 10 mg tablet sig: three (3) tablet po daily (daily) for 5 doses: start . 13. prednisone 20 mg tablet sig: one (1) tablet po daily (daily) for 5 doses: start . 14. prednisone 10 mg tablet sig: one (1) tablet po daily (daily) for 5 doses: start . 15. prednisone 5 mg tablet sig: one (1) tablet po daily (daily) for 5 doses: start . 16. prednisone 5 mg tablet sig: one (1) tablet po daily (daily) for 5 doses: start . 17. ceftriaxone-dextrose (iso-osm) 2 g/50 ml piggyback sig: two (2) grams intravenous q24h (every 24 hours) for 9 days: until . 18. dolasetron 12.5 mg/0.625 ml solution sig: 12.5 mg intravenous q8h (every 8 hours) as needed for nausea. 19. pantoprazole 40 mg recon soln sig: forty (40) mg intravenous q12h (every 12 hours). 20. lactulose 10 g/15 ml solution sig: fifteen (15) ml po three times a day as needed for constipation: please give if constipated until stools. 21. med alert no heparin or heparin flushes secondary to heparin induced thrombocytopenia antibody positive. discharge disposition: extended care facility: - discharge diagnosis: rhomboencephalomyelitis constipation high dose steroid induced delirium hit antibody positive discharge condition: neurologically stable. paraparesis. upper extremities motor except for slight finger extensor weakness. torso sensory level at t5-t6 to pin bilaterally. discharge instructions: please follow up with your physicians as scheduled below. you will need a referral from your primary care physician to with the neurologist, dr. on . we have placed a referral request on your behalf with your primary care physician's office via: . please take all medications as prescribed. followup instructions: infectious disease provider: , md phone: date/time: 10:00 primary care physician: . phone wed. at 10:00 am neurology provider: , md phone: date/time: 9:00 procedure: venous catheterization, not elsewhere classified spinal tap incision of lung spinal tap incision of lung insertion of other (naso-)gastric tube removal of impacted feces diagnoses: adrenal cortical steroids causing adverse effects in therapeutic use pulmonary collapse constipation, unspecified retention of urine, unspecified anticoagulants causing adverse effects in therapeutic use drug-induced delirium paraplegia unspecified infectious and parasitic diseases unspecified causes of encephalitis, myelitis, and encephalomyelitis other encephalitis and encephalomyelitis due to other infections classified elsewhere labyrinthitis, unspecified degeneration of lumbar or lumbosacral intervertebral disc acute (transverse) myelitis nos 

Answer: The patient is high likely exposed to