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 attending: chief complaint: obtundation major surgical or invasive procedure: hemodialysis nasogastric intubation history of present illness: 70yo woman with h/o of esrd on hd, htn, dementia, and bipolar disorder with paranoia presents with obtundation and uncontrolled hypertension in the setting of missing several sessions of dialysis. . patient was referred to the ed from dialysis, where she had presented with lethargy and htn after 10-12 days without dialysis. of note, she has a history of paranoia with refusal of medications and dialysis, per her nephrologist's report (dr. ). her pcp had begun discussions with pt's health care proxy and her son about moving toward comfort care but son felt that patient always agreed to care when he is with her, but refuses when he leaves. in the ed, initial vs: 98 0 100% nrb. bs 147. patient was unresponsive to voice/touch but withdrew from pain. labs significant for abg 7.54/30/159 and ptt 150 with a lactate of 1.7. blood cultures were sent and she was given 1 dose of levaquin 750mg iv. she also received labetalol 20mg iv x 1 and then was put on labetalol gtt with decrease in bp from peak of 240/120 to 198/112 over 2 hours. she was admitted to the for emergent hemodialysis and bp mgmt. past medical history: esrd on hd lithium (nephrologist, dr. ) htn diabetes insipidus lithium bipolar disorder vascular dementia (s/p neurobehavioral testing ) paranoia mgus: +monoclonal igg kappa detected seizure disorder: witnessed during admission to multiple admissions with refusal to undergo dialysis x weeks with subsequent mental status change following dialysis recent admission with fevers and hypertension, fevers resolved without antibiotics social history: lives at rehab. graduated college, used to work as tech at . widowed with two children. son lives in . is hcp and personal care assistant for last 4 years. family history: n/c physical exam: on admission - ed vitals as noted. upon transfer to medical floor: pt lethargic, not responding to command, eventually said ", that hurts" to repeated sternal rub. pupils small but reactive to light. ngt in place. lungs with coarse breath sounds anteriorly. rrr s1s2, ii/vi sem abd soft, nd, nt, nabs le no edema, feet warm, 1+ dp pulses babinski equivocal b/l, dtr 1+ patellar & brachial. access: r ij tunnelled hd catheter, lue piv pertinent results: 10:44pm potassium-6.9* 09:13pm glucose-112* urea n-54* creat-7.9* sodium-136 potassium-6.6* chloride-97 total co2-25 anion gap-21* 09:13pm calcium-10.1 phosphate-4.6*# magnesium-2.5 09:13pm wbc-8.2 rbc-4.10* hgb-13.6 hct-42.8 mcv-104* mch-33.2* mchc-31.8 rdw-16.4* 10:44pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 03:50pm phenytoin-<0.6* imaging: cxr : there is a dual-lumen dialysis catheter via right internal jugular approach whose tip terminates in the right atrium. the patient is angled and slightly rotated, which limits assessment. there is increased linear and patchy opacity in the retrocardiac left lower , represent atelectasis or developing pneumonia. there is no definite pulmonary vascular congestion. lung volumes are low. no definite pleural effusions are noted. . ct head : the extracalvarial soft tissues are unremarkable. the calvarium and skull base are intact without fracture or suspicious osseous lesion. a calcified plaque is noted in the cavernous and supraclinoid portions of the internal carotid arteries. the included paranasal sinuses and mastoid air cells are clear. the globes are intact with lenses in place. intracranially, the ventricles are prominent but midline. likewise, the cortical sulci and subarachnoid cisterns are prominent. these findings reflect an overall generalized brain parenchymal volume loss which is within normal limits accounting for the patient's stated age. there has been no significant progression since the prior examination. a small lacunar infarct is less conspicuous in the head of the right caudate nucleus, slightly more conspicuous around low attenuation lesion within the right basal ganglia, also likely due to lacunar infarction versus a prominent perivascular space. the - white matter interface is well defined. there is no intracranial hemorrhage or ct evidence of acute cortical stroke. brief hospital course: a/p: 70yo woman who lives at rehab with bipolar d/o, dementia, ckd stage v on hd, htn, seizure d/o, admitted to with obtundation after missing several sessions of hd. . # altered mental status in setting of baseline dementia: improved dramatically after several hemodialysis sessions. two cts of head where done to eval for evolving stroke and these were without stroke. she was found to have sub therapuetic levels of dilantin and so this was re-loaded and maintenance with keppra and dilantin re-started. please note speech and swallow eval of . she was treated initially with vancomycin for possible line infection in setting of mild leukocytosis but blood cx's remained negative and so this was discontinued. . # ckd stage v: renal following closely, getting daily hd. pth within normal and so cinacalcet discontinued. last hd was . . # low-grade fever on admission: no localizing signs/sx, hd tunnelled line without evidence of infection. received empiric levofloxacin in ed, also vancomycin dosed at hd by level. follow blood cultures and redose vanco by trough. if blood cultures grow, then hd catheter may have to be removed. if blood cx remain negative, then can discontinue vanco. . # hypertensive urgency: stabilized in on labetalol gtt and after several dialysis sessions, pt required only po lopressor and intermittent hydralazine. on discharge she should restart norvasc, lisinopril, and toprol. . # bipolar d/o: off all neuroleptics & sedatives while mentation cleared, and did have some early morning agitation. risperidone should be restarted. of note, ativan 0.25mg iv given with marked sedation. . #f/e/n: see speech and swallow eval. . # code: dnr/dni medications on admission: medications (per discharge summary): risperidone 1 mg po bid aspirin 325 mg daily acetaminophen 325-650 q6h prn amlodipine 10mg daily cinacalcet 30 mg daily folic acid 1 mg daily sevelamer 800 mg tid w/ meals simvastatin 40 mg daily levetiracetam 500 mg po bid phenytoin sodium extended 300mg daily senna 8.6 mg daily docusate sodium 100 mg cholecalciferol (vitamin d3) 1000 units daily metoprolol succinate 25 mg daily calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). lisinopril 10 mg daily lorazepam 0.5 mg po q4h prn anxiety discharge medications: 1. risperidone 1 mg tablet sig: one (1) tablet po twice a day. 2. aspirin 325 mg tablet sig: one (1) tablet po once a day. 3. tylenol 325 mg tablet sig: one (1) tablet po once a day. 4. norvasc 10 mg tablet sig: one (1) tablet po once a day. 5. folic acid 1 mg tablet sig: one (1) tablet po once a day. 6. simvastatin 40 mg tablet sig: one (1) tablet po once a day. 7. levetiracetam 500 mg tablet sig: one (1) tablet po bid (2 times a day). 8. phenytoin 100 mg/4 ml suspension sig: three hundred (300) mg po q24h (every 24 hours). 9. senna 8.6 mg tablet sig: two (2) tablet po at bedtime. 10. colace 100 mg capsule sig: two (2) capsule po twice a day as needed for constipation. 11. cholecalciferol (vitamin d3) miscellaneous 12. calcium acetate 667 mg capsule sig: two (2) capsule po three times a day. 13. lisinopril 20 mg tablet sig: one (1) tablet po once a day. 14. toprol xl 25 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: delerium discharge condition: stable discharge instructions: please contact dr. if patient refuses any medication or if patient in increasingly confused, febrile, or has other concerning symptoms. followup instructions: please follow up with dr. md procedure: hemodialysis insertion of other (naso-)gastric tube diagnoses: hypertensive chronic kidney disease, malignant, with chronic kidney disease stage v or end stage renal disease hyperpotassemia end stage renal disease epilepsy, unspecified, without mention of intractable epilepsy hypertensive encephalopathy personal history of noncompliance with medical treatment, presenting hazards to health other bipolar disorders vascular dementia, uncomplicated cerebral atherosclerosis delusional disorder 

Answer: The patient is high likely exposed to