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: confusion, speech arrest major surgical or invasive procedure: right knee aspiration history of present illness: 69 yo m with hx htn, hld, afib not on anticoagulation, and transferred from osh as a code stroke after episode of confusion this afternoon followed by global aphasia. per his wife he was in his usual state of health this am and after lunch time (? 12:00) appeared confused after returning home from the grocery store without groceries and was wandering around the house. he kept saying "i don't know" in response to questions. he went to an osh and there underwent a noncontrast ct head and then became globally aphasic and not responding to any commands and he was transferred here. past medical history: cardiovascular - atrial fibrillation (not on anticoagulatin), htn, hl endocrine - dm2, s/p thyroid surgery renal - chronic nephrolithiasis with ckd gout social history: no tobacco or illicits. occasional beers on weekends (not daily). family history: no strokes or seizures. physical exam: at admission: gen; lying in bed, awake heent; jaw clenched cv; irreg, no murmurs pulm; cta anteriorly abd; soft, nt, nd extr; no edema neuro; ms; awake, but does not follow any commands or attempt to speak. cn; perrl 4mm-->3mm, does not reliably blink to threat on left. eyes conjugate in midposition. does not track. face appears symmetric. motor; normal tone. able to maintain all limbs symmetrically and antigravity. sensory; withdraws to pain, but more grimace on right than left with noxous arm stimulation reflexes; toes mute b/l ______________________________________________ at discharge: awake, alert, intermittently confused, language fluent with intact comprehension, moving all 4 with full power, dtrs 2 and symmetric throughout pertinent results: 05:38pm wbc-9.7 rbc-4.13* hgb-12.9* hct-36.3* mcv-88 mch-31.1 mchc-35.4* rdw-14.0 05:38pm plt count-157 05:38pm pt-12.6 ptt-25.9 inr(pt)-1.1 05:38pm tsh-1.8 05:38pm albumin-4.4 calcium-8.7 phosphate-4.6* magnesium-2.2 05:38pm ctropnt-<0.01 05:38pm lipase-44 05:38pm alt(sgpt)-32 ast(sgot)-31 ld(ldh)-209 alk phos-91 tot bili-0.3 05:38pm glucose-191* urea n-39* creat-2.5* sodium-143 potassium-4.0 chloride-104 total co2-27 anion gap-16 06:07pm urine rbc-1 wbc-5 bacteria-few yeast-none epi-0 06:07pm urine blood-sm nitrite-neg protein-300 glucose-150 ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-tr 06:07pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 09:04pm phenytoin-13.8 . :joint fluid joint fluid analysis wbc rbc polys lymphs monos nrbc macro 14:44 * 3000* 88* 0 6 1* 5 source: knee joint fluid crystal shape locatio birefri comment 14:44 few needle i/e1 neg c/w monoso2 . 2:44 pm joint fluid source: knee. **final report ** gram stain (final ): 1+ (<1 per 1000x field): polymorphonuclear leukocytes. no microorganisms seen. fluid culture (final ): no growth. . imaging : ct head without contrast: findings: encephalomalacic changes are present in the right parietal and occipital lobes in the right mca and pca territories. there is no acute intracranial hemorrhage. -white matter differentiation remains preserved. the ventricles are normal in size and configuration. overall, there is little change from the outside hospital ct performed three hours prior. visualized paranasal sinuses and mastoid air cells are clear. soft tissues of the orbits are within normal limits. scout images demonstrate the endotracheal tube ending 3.5 cm above the carina and an oj tube coursing towards the stomach although the tip is excluded from view. impression: encephalomalacic changes involving the right parietal and occipital lobes. no acute intracranial process identified. little change since the outside hospital ct performed three hours prior. . : mr without contrast: impression: acute infarcts in the distribution of the left posterior cerebral artery. chronic right posterior cerebral artery infarct. brain atrophy. . : chest radiograph: findings: ap supine portable chest radiograph is obtained. an endotracheal tube is seen with its tip located approximately 3.6 cm above the carina. the ng tube courses into the left upper quadrant with its tip just beyond the ge junction. lung volumes are low with crowding of bronchovasculature, and no definite sign of pneumonia or chf. no large pleural effusion or pneumothorax. bony structures appear grossly intact. impression: appropriately positioned et tube. og tube may be advanced slightly for more optimal positioning. . : eeg: impression: this 24 hour video eeg telemetry captured no pushbutton activations and 2 electrographic seizures with no clinical correlation on video. occasional interictal sharp wave discharges were seen over the left frontal temporal admixed with theta and delta frequency slowing, consistent with a focus of epileptogenicity. the background rhythm demonstrated an 8 hz maximal posterior predominant alpha rhythm intermixed with theta and delta likely related to a mild to moderate encephalopathy. . : ecg: probable sinus tachycardia with first degree a-v block and atrial premature beats. non-specific inferolateral st segment depression and t wave changes. no previous tracing available for comparison. . : tte: the left atrium is mildly dilated. the left atrium is elongated. the right atrium is moderately dilated. no atrial septal defect or patent foramen ovale is seen by 2d, color doppler or saline contrast with maneuvers. there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef 70%). there is considerable beat-to-beat variability of the left ventricular ejection fraction due to an irregular rhythm/premature beats. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the aortic arch is mildly dilated. there are focal calcifications in the aortic arch. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . : carotid studies: impression: right ica with stenosis <40%. left ica with stenosis 0%. . : ct head without contrast: impression: 1. evidence of prior chronic infarction in the right parietooccipital region. 2. focal ill-defined hypodensities in the left occipital region corresponding with areas of acute left pca infarcts seen on recent mr study. 3. no new large acute territorial infarction. no hemorrhage or mass effect. . : bilateral knee plain films: findings: due to swollen joints the patient is unable to internally rotate the knee. mild soft tissue swelling. the presence of small effusions is likely. bilateral mild degenerative changes in the femorotibial joint and severe degenerative changes in the femoropatellar joint. no evidence of fracture. no evidence of chronic inflammatory changes . : eeg: impression: this eeg gives evidence mainly for an encephalopathic- appearing abnormality with background slowing and bursts of slowing with suppressive bursts. this would suggest widespread diffuse cortical, as well as subcortical, neuronal dysfunction. there are some asymmetric features suggesting attenuation of background posteriorly on the right and increased epileptiform interictal activity from the left temporal posterior frontal region suggesting there may be more isolated structural damage. . : ecg: atrial fibrillation with a controlled ventricular response. compared to the previous tracing of the ventricular response has slowed. the lateral st-t wave changes are less prominent. otherwise, no diagnostic interim change. . : eeg: impression: this eeg gives evidence for mild to moderate diffuse encephalopathy with superimposed focal slowing over the right posterior quadrant and more significantly fairly continuously across the left temporal and, to a lesser degree, posterior lateral frontal region. the left temporal frontal area also exhibits intermittent interictal epileptic activity spontaneously and two short runs of unsustained but increased frequency discharges. cardiac monitor continues to be abnormal. brief hospital course: brief hospital course: 69 yo m h/o af (not on anticoagulation), htn, hl, dm2, ckd from chronic nephrolithiasis p/w confusion, speech arrest, and convulsive seizure of unclear etiology. seizure - the patient had an episode of confusion (answering "i don't know" to all questions) followed by speech arrest. he was subsequently able to follow commands but would not verbalize. while in the ed of an osh and en route to a ct scanner, his jaw clenched and he reportedly had a convulsive seizure. he was sedated and intubated and transferred to for further care. he was loaded with phenytoin. he had no lateralizing signs on his neurologic exam, and an eeg on showed no seizure activity but did show intermittent left frontal and temporal sharp waves and intermittent diffuse slowing of the background rhythm. on mri he was found to have a subacute left occipital-temporal ischemic stroke, likely the etiology of his seizures. he has had no further witnessed seizure activity but was monitored on ltm. he was extubated without difficulty and his mental status has cleared. ltm showed no seizures and it was stopped. on the patient was found on the floor and was unable to tell how he got there. out of concern for seizure as the etiology, he was loaded with keppra and placed on eeg for another 24 hours. again the eeg failed to show any seizure activity. the phenytoin is slowly being tapered off and the patient is being continued on keppra 1 g po bid. the patient's alertness level decreased initally when started on the 2 aeds but has now improved since the phenytoin taper. he has follow up in clinic. ischemic stroke - the patient has evidence on his initial nchct of an old ischemic stroke affecting the right parietal and occipital lobes, but there were no signs of new areas of infarction. he subsequently had a nc mri brain on which showed a left occipital-temporal ischemic stroke. he was started on warfarin and bridged with a heparin infusion. he is to be maintained at a goal inr of . currently his inr is 4.4 and please hold his warfarin until his inr is 2. atrial fibrillation - the patient was briefly bradycardic to the 40s overnight on but this resolved. he was on aspirin but not on anticoagulation prior to this event. throughout the rest of his stay the patient was restarted on his home medications but continued to have episodes of rvr. his diltiazem was increased to 90mg po qid and metoprolol was increased to 25mg po bid. digoxin 0.125mg po daily was continued as well. ep was consulted and recommended that the digoxin be stopped as they did not feel it was helping. the metoprolol can be increased to tid if needed. the patient's heart rate remained primarily in the 80s on this regimen. please continue him on telemetry at rehab to ensure he is stable on this regimen. he has an outpatient appointment with cardiology. gout - after transfer to the floor the patient complained of right knee pain as well as minor left ankle tenderness. his home medication allopurinol had been held while he was in the icu but restarted at transfer. these joints as well as his left knee were warm and swollen. rheumatology was consulted who tapped the right knee and confirmed crystal proven gout in the joint. given the large amount of pain the patient was in, we gave him iv steroids x 1 followed by a po prednisone taper. his pain is much improved. after he finishes the prednisone taper, please start colchicine 0.6mg po every other day (renal dosing) to help prevent future flares. he has follow up in clinic. hyperglycemia - while on the steroids for his gout flare, his blood sugars have been high. please continue him on an insulin sliding scale until the prednisone taper is over. chronic renal failure - we contact his pcp and confirmed that his recent cr values range around 2.3-2.5. after this we restarted his previous dose of lisinopril per his pcp, 10mg po daily. medications on admission: levothyroxine 50 mcq daily indomethacin 50 mg tid prn sildenafil 50 mg prn doxazosin 2 mg daily metoprolol succinate 25 daily lisinopril 20 daily allopurinol 100 daily pravastatin 40 daily? (not clear which statin the patient was taking) aspirin 81 daily digoxin 0.125 mg daily sodium bicarbonate 650 tid diltiazem 90 mg atorvastatin 40 daily discharge medications: 1. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 2. acetaminophen 650 mg/20.3 ml solution sig: one (1) tab po q6h (every 6 hours) as needed for pain/fever. 3. insulin regular human 100 unit/ml solution sig: one (1) unit injection asdir (as directed): insulin sliding scale. 4. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed) as needed for dryness. 5. atorvastatin 40 mg tablet sig: one (1) tablet po hs (at bedtime). 6. doxazosin 1 mg tablet sig: two (2) tablet po hs (at bedtime). 7. allopurinol 100 mg tablet sig: one (1) tablet po daily (daily). 8. levothyroxine 50 mcg tablet sig: one (1) tablet po daily (daily). 9. sodium bicarbonate 650 mg tablet sig: one (1) tablet po tid (3 times a day). 10. famotidine 20 mg tablet sig: one (1) tablet po daily (daily). 11. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 12. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 13. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 14. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 15. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 16. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 17. diltiazem hcl 90 mg tablet sig: one (1) tablet po qid (4 times a day). 18. prednisone 20 mg tablet sig: 2.5 tablets po daily (daily) for 2 days: please taper dose. give 50mg po daily x 2 days, then 40mg x 2 days, then 20mg x 2 days, then 10mg x 2 days and stop. 19. phenytoin sodium extended 100 mg capsule sig: one (1) capsule po qhs (once a day (at bedtime)) for 4 days. 20. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm: please hold until inr is less than 2. goal inr . 21. dextrose 50% 12.5 gm iv prn hypoglycemia protocol 22. metoprolol tartrate 5 mg iv q8h:prn tachycardia > 120 hold if sbp<120. please notify ho by text-page if givein iv mtp. 23. colchicine 0.6 mg tablet sig: one (1) tablet po every other day: please start after prednisone is complete. discharge disposition: extended care facility: - discharge diagnosis: left pca stroke seizures crystal-proven gout atrial fibrillation with rvr discharge condition: mental status: confused - sometimes. level of consciousness: alert and interactive. activity status: ambulatory - independent. neurological exam: awake, alert, intermittently confused, language fluent with intact comprehension, moving all 4 extremities with full power. discharge instructions: it was a pleasure caring for you during your stay. you were admitted to the hospital for evaluation of your shaking and confusion episodes. these episodes turned out to be seizures. these seizures were coming from the left side of your brain and imaging shows that you had a stroke days to weeks prior on the left side of your brain as well. this damage caused by the stroke is likely the cause of your seizure events. additionally the imaging showed that you suffered a right sided stroke months previously. -your seizures were controlled with the help of an anti-seizure medicine. please continue to take one of these medicines, keppra 1 g by mouth twice a day. we are currently tapering off your phenytoin. please take 100mg by mouth at bedtime until (last dose) , then stop. - we have you on a blood thinner, warfarin (coumadin) to decrease the chances of stroke since you have atrial fibrillation. your inr will have to be measured frequently by blood draws. your goal inr is . currently your inr is high so we are holding the warfarin. please restart taking 2mg by mouth at night once the inr is 2. your dose of this medicine will likely change as you are being tapered off phenytoin, which is a medicine that affects your warfarin levels. -during your stay, your hospital course was complicated by atrial fibrillation with a difficult to control heart rate. we consulted the cardiology team, who recommended stop digoxin and continuing on diltiazem and metoprolol at this time. they do not currently feel that you would benefit from any other intervention at this time. -you had knee pain while in the hospital as well. the rheumatology team removed some fluid from your right knee and confirmed crystals present, consistent with a gout flare. given the amount of pain you were in, we treated you with steroids to decrease the inflammation. please continue to prednisone taper we have placed you on as written (50mg x2days, 40mg x2days, 20mg x2days, 10mg x2 days, and then stop). you should start taking colchicine 0.6 mg by mouth every other day after finishing this taper to prevent recurrent attacks. please continue taking allopurinol 100mg by mouth daily. for the long term, you need to be consistently on allopurinol and your dose should be titrated as an outpatient to reach a uric acid level <6. this can be done by rheumatology. please see them in clinic as scheduled. -while you are on the steroids, your blood sugar has been high. we have asked that you be monitored with a insulin sliding scale while you are on steroids. this can be discontinued afterwards. followup instructions: clinic: provider: , md phone: date/time: 3:00pm cardiology clinic: provider: , m.d. phone: date/time: 1:40pm, bldg, . clinic: provider: , md phone: date/time: 10:30, bldg, procedure: insertion of endotracheal tube arthrocentesis diagnoses: diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified atrial fibrillation other convulsions chronic kidney disease, unspecified other and unspecified hyperlipidemia cerebral embolism with cerebral infarction aphasia acute gouty arthropathy 

Answer: The patient is high likely exposed to