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 / iodine; iodine containing / carbamazepine attending: chief complaint: change in mental status major surgical or invasive procedure: hemodyalysis history of present illness: 58 yo m with esrd on hd, seizure disorder, hcv, presents with confusion and sbp in 250/140's. patient was found eating soap and trying to break into neighbour's house. per his son, he missed hd on but went on saturday. he says his father gets confused with episodes of seizure although his current behavior is not typical for these. he does not know of any recent illness. he reports his father has been tappering off ativan from 1 mg tid to 0.5 mg which has been making less drowsy. he also told his son he may not have taken all of his bp meds the last few days. . in the ed, vs 97.6 90 235/149 22 92% ra. started on on labetalol gtt, toprol xl 200 mg po, ativan 1 mg iv,asa. evaluated by nephrology with plans to dialyse this am. ekg showing lvh with strain, unchanged, tnt 0.22. patient transfered to icu for close monitoring and treatment of hypertensive emergency. . upon arrival to the floor, patient confused and non cooperative. denies cp, sob, no f/c/s, no n/v/d, no ha, dizziness, denies any complaints. past medical history: - seizure disorder: since childhood, began as generalized tonic-clonic. he was treated with phenobarbitol and mysoline. later, was changed to depakote and dilantin. depakote was discontinued roughly 4 years ago due to elevated ammonia levels. since, then his seizures have increased in frequency and severity. as a result, muliple medications inculding lamictal, trileptal, tegretol and keppra have been tried and he has most recently been on combination of keppra and lamictal. his seizures have been occuring about once every 1-2 months. usual episodes are characterized by confusion and disorientation with rare, generalized tonic clonic episodes. h/o of non-convulsive status -esrd on hd (m,w,f) due to idiopathic glomerulonephritis, s/p 2 failed renal transplants -labile hypertension -hypothyroidism -peripheral disease -hypoparathyroidism -hepatitis c -chf-systolic w/ ef 45% and diastolic dysfunction (echo ) -svt/avnrt s/p ablation -multiple fistulas -h/o mrsa line infection -recent admission for infected l upper arm av fistula. -h/o mechanical falls admitted -h/o vre, mrsa social history: lives at home, on disability, has two sons. smokes 1ppd x 40 yrs, no etoh, drugs. family history: mother with breast ca; father alive with cad & chf; sons healthy. physical exam: vs: 98.0 185/108 72 14 100% 2l nc gen: cachectic, ashen color, nad, talkative but confused heent: op dry, perrl, sclera dull neck: supple, prominent carotid pulsations, right tunneled ij lungs: bibasilar crackles, good air entry cvs: nl s1 s2, rrr abd: soft, nt, slightly distended, bs+, liver crosses midline, edge palpable 2 cm below left costal margin, spleen not enlarged ext: wasted, warm, dry, 2+ dp pulses b/l neuro: a&o x 3 but confused, says "why do they only play silent night at ", cn ii-xii intact, perrl, full strength thoughout, sensation intact; no asterixis pertinent results: 02:00am blood wbc-10.8# rbc-4.20* hgb-12.0* hct-35.5* mcv-85 mch-28.7 mchc-33.9 rdw-18.4* plt ct-221 04:06am blood wbc-5.0# rbc-3.97* hgb-11.4* hct-33.6* mcv-85 mch-28.6 mchc-33.8 rdw-18.6* plt ct-216 02:00am blood neuts-81.5* lymphs-12.1* monos-5.6 eos-0.3 baso-0.5 02:00am blood anisocy-2+ poiklo-1+ microcy-1+ 02:00am blood plt ct-221 12:09pm blood pt-12.8 ptt-32.4 inr(pt)-1.1 04:06am blood plt ct-216 02:00am blood glucose-88 urean-56* creat-7.3*# na-142 k-5.5* cl-94* hco3-24 angap-30* 12:09pm blood k-3.7 04:58pm blood glucose-102 urean-36* creat-4.8*# na-140 k-4.2 cl-99 hco3-28 angap-17 04:06am blood glucose-97 urean-46* creat-5.5* na-141 k-4.5 cl-101 hco3-25 angap-20 02:00am blood alt-20 ast-40 ck(cpk)-137 alkphos-114 amylase-56 totbili-0.8 12:09pm blood ck(cpk)-95 04:58pm blood ck(cpk)-77 02:00am blood ctropnt-0.22* 12:09pm blood ck-mb-notdone ctropnt-0.21* 04:58pm blood ck-mb-notdone ctropnt-0.20* 02:00am blood albumin-4.6 calcium-9.7 phos-8.2*# mg-2.3 04:58pm blood calcium-9.1 phos-6.1*# mg-2.1 04:06am blood calcium-8.5 phos-8.5*# mg-2.3 02:00am blood ferritn-279 02:00am blood osmolal-317* 12:09pm blood ammonia-41 12:09pm blood tsh-1.9 01:25pm blood type- temp-36.1 ph-7.35 02:16am blood lactate-2.7* k-5.8* 01:25pm blood freeca-1.13 . chest (portable ap) 2:15 am . ap upright portable chest x-ray: a right internal jugular central venous catheter is again seen. the distal tips are not clearly identified, but are likely positioned in the svc. the cardiac silhouette is enlarged but stable. the aorta is extremely tortuous. the left atrium is extremely enlarged. the hila appears slightly more prominent than on prior exam, and there is minimal pulmonary redistribution. no pneumothorax is seen. plate-like atelectasis is again seen at the right lung base, less prominent than on prior exam. there has been interval resolution of a right lung base opacity. no definite consolidation or effusion is noted. the surrounding soft tissue and osseous structures are stable. impression: 1. no definite consolidation. interval resolution of previously seen right lung base opacity. 2. mild/moderate chf. 3. plate-like atelectasis at left lung base. . ct head w/o contrast 1:59 am . findings: there is no significant interval change since the prior exam. there is no intra- or extra-axial hemorrhage, mass effect, or shift of normally midline structures. low attenuation in the right parietal, and left frontal white matter are again noted. a left basal ganglia lacunar infarction is less clearly identified on today's study, possibly related to slice selection. the density values of the remaining brain parenchyma are within normal limits. the -white matter differentiation is preserved. prominence of the extra- axial spaces mainly in the posterior fossa are unchanged since . the visualized paranasal sinuses are clear. tiny amount of fluid is seen in scattered left mastoid air cells. prominent subcutaneous calcifications are likely venous in origin. impression: no intracranial hemorrhage or mass effect. no significant interval change since . . eeg impression: this is an abnormal eeg due to the independent left and right parietal sharp waves, as well as the disorganized and slow background rhythm and bursts of generalized delta slowing. the first abnormality suggests independent left and right parietal cortical irritability, while the the last two abnormalities suggest a mild to moderate encephalopathy, which may be seen with infections, toxic metabolic abnormalities, ischemia or medications. . ecg sinus rhythm. possible left atrial abnormality. left anterior fascicular block. non-specific intraventricular conduction delay of the left bundle-branch block type. left ventricular hypertrophy. non-specific st-t wave abnormalities which may be due in part, to left ventricular hypertrophy. compared to the previous tracing of no significant change. brief hospital course: mr. is a 58 yo m with esrd on hd, labile hypertension, seizure disorder who presents in a confusional state with sbp 230/140s. his hospital course is summarized below by problem. . # hypertensive emergency. patient presented with likely hypertensive encephalopathy. patient reportedly did not take all of his bp meds prior to admission. the differential included seizure or post ictal state given a history of non convulsive seizures that present with odd behavior/confusion. he was treated with a labetalol gtt which was rapidly tapered off. he was urgently dialysed. his blood pressure remained elevated at 180s/110s. 3l of fluid were removed with hd. he was restarted on all of his outpatient bp medications including acei, ccb, bb and clonidine. on the day of discharge his bp was improved to 140-180/60-80's. his regimen was not changed. he will follow up with dr. as scheduled. in addition, an ammonia level was checked which was normal and his lfts were within normal range. he did not have asterixis on exam. he was treated with empiric lactulose however hepatic encephalopathy is less likely. . # esrd on hd. patient carried a diagnosis of idiopathic glomerulonephritis s/p failed renal transplantation x 2. his cr was 7.3, k of 5.5, phos 8.2, lactate 2.7 ag of 28 on admission likely secondary to uremia. he was urgently dialysed with removal of 3l of fluid. he refused any recommended changes in his renal medication regimen including increasing phosphate binders. . # seizure dsrd. long standing, has failed multiple regimens in the past, recurrent seizures per omr. the only recent changes were that the patient was tapered his ativan dose due to sedation during the day. per his son he was more alert on this new regimen however his behavior was not entirely consistent with his prior seizure activity. neurology changed his regimen slightly by given him 1 mg of ativan qhs. an eeg showed evidence of encephalopathy likely secondary to his underlying hypertension as well a pattern possibly consistent with a post ictal state. he as not in status during the eeg. his mental status improved on the day of discharge to his reported baseline per his pcp. is to continue lamictal, keppra and ativan for seizure management. . # chf. mildly fluid overloaded on exam likely secondary to diastolic chf in setting of malignant hypertension. h/o both systolic/diastolic chf, ef 45% (echo ). his blood pressure was treated as above. he remained able to lie flat, sating well on room air. fluid was removed with hd. . # hcv. not on treatment. lfts wnl, ammonia level wnl. transiently treated with lactulose. outpatient follow up required. . # hypothyroid. tsh was 1.9. not on treatment. . patient was discharged home directly from the icu with improved bp control, mentation improved. patient is scheduled for outpatient follow up. he was provided a list of his medication and any changes. medications on admission: - nephrocaps 1 daily - lamictal 250 mg b.i.d. - keppra 375 mg b.i.d. and 250 mg after each hd session (3x per wk) - lorazepam 0.5 mg b.i.d. - toprol-xl 200 mg once daily - nifedipine 120 mg once daily - lisinopril 20 mg once hs - plavix 75 mg once daily - asa 81 mg once daily - clonidine 0.1 mg b.i.d. - prevacid 30 mg once daily - nortriptyline 10 mg q.h.s. - tums discharge medications: 1. b complex-vitamin c-folic acid 1 mg capsule : one (1) cap po daily (daily). 2. levetiracetam 250 mg tablet : 1.3 tablets po bid (2 times a day). 3. levetiracetam 250 mg tablet : one (1) tablet po after hd on hd days (). 4. lamotrigine 100 mg tablet : 2.5 tablets po bid (2 times a day). 5. lorazepam 1 mg tablet : one (1) tablet po hs (at bedtime). disp:*30 tablet(s)* refills:*0* 6. lorazepam 0.5 mg tablet : one (1) tablet po bid (2 times a day). 7. nortriptyline 10 mg capsule : one (1) capsule po hs (at bedtime). 8. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 9. metoprolol succinate 100 mg tablet sustained release 24hr : two (2) tablet sustained release 24hr po daily (daily). 10. lisinopril 20 mg tablet : one (1) tablet po hs (at bedtime). 11. clopidogrel 75 mg tablet : one (1) tablet po daily (daily). 12. clonidine 0.1 mg tablet : one (1) tablet po bid (2 times a day). 13. nifedipine 60 mg tablet sustained release : two (2) tablet sustained release po daily (daily). 14. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 15. calcitriol 0.25 mcg capsule : one (1) capsule po daily (daily). disp:*30 capsule(s)* refills:*0* 16. sevelamer 800 mg tablet : one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: hypertensive encephalopathy secondary: esrd on hd labile hypertension seizure disorder hepatitis c discharge condition: good - improved bp control and improved mental status discharge instructions: please take all of your medications as directed. please follow up with your doctors as listed below. please return to the hospital immediately with any confusion, headaches, dizziness, shortness of breath, chest pain or any other problems. weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet followup instructions: neurology: provider: , md phone: date/time: 8:30 please call dr. in the next week to make a follow up appointment. tel: please continue your hemodyalysis as you were prior to being admitted to the hospital. procedure: hemodialysis diagnoses: hypertensive chronic kidney disease, malignant, with chronic kidney disease stage v or end stage renal disease end stage renal disease tobacco use disorder unspecified acquired hypothyroidism unspecified viral hepatitis c without hepatic coma peripheral vascular disease, unspecified epilepsy, unspecified, without mention of intractable epilepsy hypertensive encephalopathy combined systolic and diastolic heart failure, unspecified history of fall 

Answer: The patient is high likely exposed to