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: patient recorded as having no known allergies to drugs attending: chief complaint: seizure, altered mental status. major surgical or invasive procedure: lumbar puncture (). history of present illness: history obtained from hcp and neuro notes 52 y/o m with pmhx of type i dm, htn, ckd and dka c/b hypoxic brain injury who had a witnessed generalized tonic clonic seizure today this morning which lasted approximately 1 minute. per report, he was then noted to be postictal and yawning but "he was moving all 4 extremities at the time" and bs was >200. the rehab team cannot tell if there was a gaze deviation or bowel incontinence. he did not receive any meds. brother reports that at baseline the patient is able to converse and comprehend, but has difficulty with naming. at baseline patient is able to walk with assist using a belt and a person following with a wheelchair. has recently been able to walk up 16 stairs. per patient's brother/hcp, pt's blood glucose levels have been fluctuating recently and he reportedly had an episode of hypoglycemia yesterday with a glucose poc of 24 because the patient missed a meal. brother saw patient last night at which time he was able to discuss his children and his retirement. pt had a uti last week which was treated with ceftriaxone, last dose ~48 hours ago. of note, he has had a foley in since admission to the nh. hcp reported that he has had recurrent infections while at rehab and recently treated for cdiff (stopped abx for cdiff on ). initial vs on arrival to the ed: t 97.6 bp 173/94 rr 18 sats 95%2l nc. given new onset seizure and mental status changes, pt was given ativan 2mg iv and there were multiple unsuccessful attempts at lumbar puncture. head ct did not show any acute changes from baseline. neuro was consulted and pt was empirically treated with ceftriaxone 2grams, vancomycin 1gram, ampicillin 2grams, acyclovir 1gram. pt was given ivf but this was stopped after cxr showed increased pulm edema. on arrival to the micu, pt was somnolent but arousable to stimuli. pt would shout out in clear language to stop and says "" but otherwise, he does not follow commands. of note, he falls to sleep and exhibits cheynes breathing. family provided additional ros: pt has been c/o chills at night but denies fevers. good appetite, some diarrhea, recent uti, no significant cough or shortness of breath. improving with swallow function, advanced to regular diet approx wks ago. no nausea or vomiting. past medical history: dm1 since age 38, insulin pump requiring. hba1c 9.6 on hypertension diastolic heart failure hyerplipidemia ckd ( cr of 3.0) h/o acute pancreatitis h/o dka with associated hypoxic brain injury and prolonged icu stay requiring trach & peg (now weaned from trach but peg in place) social history: used to work as an mechanic, but had to stop working when he lost driver's license after repeated episodes of hypoglycemia. not married. pt has been living at rehab since admission in /. family history: non-contributory. physical exam: pe: 99.5 bp 169/74 hr 74 rr 3-12 sats 95% on ra gen: lying in bed, somnolent but arousable, not following commands and reports pain when touched anywhere heent: nc/at, dry mucosa neck: supple cv: rrr, nl s1 and s2, no murmurs/gallops/rubs lung: not compliant with exam but subtle inspiratory crackles at bases bilaterally abd: soft, mildly ttp diffusely, no rebound/guarding, nabs. lower ext: no edema, warm, good dpulses rue: warm, erythematous, edematous pertinent results: labs at admission: 08:15am blood wbc-8.5 rbc-4.68# hgb-13.6*# hct-41.9# mcv-90 mch-29.1 mchc-32.5 rdw-17.1* plt ct-230 08:15am blood neuts-82.0* lymphs-11.7* monos-4.3 eos-1.5 baso-0.5 08:15am blood pt-11.1 ptt-26.9 inr(pt)-0.9 08:15am blood glucose-202* urean-61* creat-5.6*# na-137 k-4.2 cl-94* hco3-32 angap-15 08:13pm blood alt-22 ast-21 ld(ldh)-269* alkphos-126 totbili-0.3 08:15am blood calcium-10.0 phos-5.4* mg-2.3 04:15am blood osmolal-308 08:15am blood tsh-5.5* 08:15am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 08:22am blood lactate-1.4 csf fluid analysis: -wbc-2 rbc-2* polys-1 lymphs-56 monos-43 -totprot-75* glucose-136 ld(ldh)-38 -herpes simplex virus pcr- pending micro data: - bcx: pending - ucx: negative - csf hsv pcr: negative - csf: cryptococcal antigen negative gram stain (final ): no pmns. no microorganisms. fluid culture (preliminary): no growth. fungal culture (preliminary): no fungus isolated. viral culture (preliminary): - c. diff: negative - ucx: negative imaging studies: - ecg: sinus rhythm. borderline prolonged/upper limits of normal qtc interval is non-specific. otherwise, tracing is within normal limits. clinical correlation is suggested. since the previous tracing of the rate is slower and low amplitude t wave changes have decreased. intervals axes rate pr qrs qt/qtc p qrs t 63 126 94 444/449 59 18 70 . - ct head: 1. no acute intracranial process. 2. unchanged old infarctions. - cxr: 1. mild chf. 2. left retrocardiac opacity, most likely representing atelectasis, pneumonia cannot be excluded. - abd x-ray: no evidence of bowel obstruction. no free intraperitoneal air. - eeg: abnormal portable eeg due to the slow and disorganized background and frequent bursts of generalized slowing. these findings indicate a widespread encephalopathy affecting both cortical and subcortical structures. there were some sharp features before the generalized slowing, but they were not simple spike or sharp and slow wave complexes, and they appeared repetitively for only a few seconds at a time. the tracing cannot rule out the occurrence of seizures at other times, but the bursts of slowing and even sharp waves appeared more likely related to the encephalopathy. if clinical suspicion for seizures persists, a repeat tracing or longer monitoring could be helpful. there were no areas of persistent focal slowing, but encephalopathies may obscure focal findings. - renal u/s: echogenic kidneys suggesting underlying medical renal disease. there is no nephrolithiasis, hydronephrosis, or renal mass lesion - right ue u/s: no right upper extremity dvt. brief hospital course: # seizure/altered mental status: neuro exam was generally non-focal aside from right sided and lower extremity weakness, which had reportedly been stable since his hypoxic brain injury several months ago. he was empirically treated with vanc, ceftriaxone, ampicillin and acyclovir for possible meningitis. lp was eventually obtained after an initially unsuccesful attempt. csf was not concerning for infection, and antibiotics/antivirals were discontinued. neuro was consulted and recommended starting keppra. in the micu, his toxic metabolic work up revealed a mildly elevated tsh and normal free t4. infectious workup was unrevealing. pt was initially continued on empiric metronidazole for possible c diff given his history of recurrent cdiff, recent abx course and elevated wbc count, but this was discontinued when his toxin assay came back negative. eeg was performed and showed findings likely related to encephalopathy. mental status was improved by day 2 of admission and pt was called out to the floor. he did not have any further seizures, and his mental status improved to his baseline mental status from prior to the seizure, according to his brothers. will follow up with neurology as an outpatient. # acute on chronic renal failure: pt has ckd with baseline creatinine of 3.5-3.9 and presented with a creatinine of 5.8 and a hemoconcentrated cbc. his creatinine had a variable result to volume repletion, but eventually improved to 5.0. nephrology was consulted. a family meeting was held between the patient, brothers, and the renal service, during which the brothers were told that hemodialysis may not have a significant benefit in the patient's quality of life. the family may consider seeing a local nephrologist to further discuss the risks/benefits of hemodialysis. # diastolic chf: the patient was generally euvolemic during the hospitalization. he was intermittently given iv fluids to treat his , and did not have significant edema, oxygen desaturation, or other signs of significant volume overload, despite holding diuretics. his respiratory status was stable. he was continued on hydralazine, amlodipine and labetalol for bp control. # typei dm: pt with h/o labile bs and severe episode of dka complicated by hypoxic brain injury. of note, his bs after the seizure was >170 though his family had been feeding him his meals and the day prior to admission, his bs was 24 due to missing a meal. given the lability of his blood sugars, the patient was given tube feeds at a low rate, and his initial insulin regimen was conservative to avoid repeat episodes of hypoglycemia. upon transfer to the floor, though, his blood sugars were somewhat labile, especially after the re-introduction of a diet. he was seen by who recommended adding bedtime glargine, and his fingersticks were subsequently better controlled. his insulin doses will likely have to be adjusted further as his oral diet and tube feeds are adjusted. . # obstructive sleep apnea: the patient underwent a sleep study as recommended by the neurology service. the neurology attending planned to evaluate the sleep study. the patient was recommended to sleep on his side. . # fen: the patient was given tube feeds. on , he was seen by speech and swallow therapy. he was written for a regular diet, which he tolerated, but did not have sufficient po intake to warrant discontinuation of his tube feeds. . # code: the patient was full code for the duration of the hospitalization, as confirmed with the health care proxy ( c; h) medications on admission: miconazole tp ranitidine 150mg amlodipine 10mg daily heparin 5000u sc tid insulin humolog ss labetalol 600mg tid calcium acetate 667mg nitroglycerin patch lasix 100mg lantus 16units daily metolazone 2.5mg daily hydralazine 50mg q6hr tylenol/percocet prn discharge medications: 1. miconazole nitrate 2 % powder sig: one (1) appl topical tid (3 times a day) as needed for axilla . 2. ranitidine hcl 150 mg tablet sig: one (1) tablet po twice a day. 3. heparin (porcine) 5,000 unit/ml solution sig: 5,000 units injection tid (3 times a day). 4. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). 5. labetalol 200 mg tablet sig: three (3) tablet po tid (3 times a day). 6. insulin glargine 100 unit/ml solution sig: eighteen (18) units subcutaneous qam. 7. insulin glargine 100 unit/ml solution sig: eight (8) units subcutaneous at bedtime. 8. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). 9. hydralazine 25 mg tablet sig: two (2) tablet po q6h (every 6 hours). 10. insulin lispro subcutaneous discharge disposition: extended care facility: - discharge diagnosis: primary: seizure acute on chronic kidney injury diabetes mellitus . secondary: history of hypoxic brain injury hypertension diastolic heart failure hyerplipidemia discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: mr. , you were admitted with a seizure. you were found to be hypogylcemic (low blood sugar) and this was treated. you had a lumbar puncture to evaluate for an infection in your spinal fluid. the lumbar puncture results did not show infection. you had worsening kidney function, which is now stable. your diabetes was difficult to control, but your blood sugars are now more stable. you have had some swelling of your right arm, but your ultrasound was negative for a blood clot. we made the following changes to your medications: -started levetiracetam 500 mg tabs, one tab by mouth twice daily -changed your insulin regimen: please see the attached sheet for your new regimen followup instructions: please follow up with your primary care doctor after you are discharged from rehab. department: neurology when: wednesday at 1 pm with: drs. & building: sc clinical ctr campus: east best parking: garage procedure: spinal tap incision of lung enteral infusion of concentrated nutritional substances diagnoses: obstructive sleep apnea (adult)(pediatric) congestive heart failure, unspecified acute kidney failure, unspecified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified other convulsions chronic kidney disease, unspecified alkalosis encephalopathy, unspecified chronic diastolic heart failure nutritional marasmus diabetes with other specified manifestations, type i [juvenile type], uncontrolled 

Answer: The patient is high likely exposed to