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: sulfa (sulfonamide antibiotics) / tetracycline analogues attending: chief complaint: psychosis (auditory and visual hallucinations)/tachycardia major surgical or invasive procedure: lumbar puncture history of present illness: 59 yo woman with h/o depression, anxiety, asthma who presents sectioned from therapist. she was noted to be very disorganized, psychotic, and hallucinating at therapy and sent in for evaluation. she reportedly had a fall yesterday and no loc. . in the ed, initial vs were: 97.6 108 183/85 20 97. she was tachycardic 108 which improved after fluids to 80 (1 liter). labs notable for wbc 13.4, nl chemistry, d-dimer 488, ast 42, ldh 293, valproate 85 negative cardiac enzymes. u/a negative. ekg showed sinus tachycardia, na/ni and no st/t changes. cxr negative, ct head with no bleed, sinus retention cyst. pt subsequently pulled out iv. she was agitated and got 1mg ativan pox2. . she remained intermittently tachycardic and felt to need evaluation of this prior to admission to psych. . of note, psychiatry spoke to pts friend who felt that she has not been doing well and has been depressed: not going out of the house, not getting up, crying, not answering the phone but had never known her to hallucinate. . per patient's primary care doctor's office, patient has baseline leukocytosis and was previously seen by a hematologist in the system who did not find underlying pathology. she has also been documented with tachycardia on medical visits, hr110 in ; she also frequently misses appointments due to severe anxiety and depression (predominantly of hoarding, isolating nature - no previous history of hallucinations/psychosis). . currently unable to obtain good history from patient, as she is intermittnetly falling asleep. when aroused, patient is disorganized in her speech, asking about the difference between apple cinnamon and apple cider, tangential but alert and oriented x3. past medical history: anxiety depression ptsd allergic rhinitis esophageal reflux tension headaches asthma hypertension atopic dermatitis cholelithiasis fatty liver obesity social history: works for dry cleaner, rare etoh, denies smoking family history: noncontributory physical exam: vitals: t:98.8 bp:126/60-140/78 p:120-125 r:16 o2: 94-95%ra general: alert, oriented x3 but mumbling and difficult to focus. would awaken to verbal stimuli and attempt to answer question in somewhat pressured/garbled speech and falls asleep quickly thereafter. also with apneic episodes and loud snoring. some tangential thoughts this morning (ex: what is the difference between apple cinnamon and apple cider?) heent: ncat, eomi without nystagmus, dry mucus membranes, mucus crusting around eyes (l>r), nasal congestion (audible) neck: soft, supple, no jvd, no nuchal rigidity lungs: ctab, no wheezing/rhonchi/rales cv: regular rhythm, tachycardia, no murmurs/gallops/rubs, normal s1/s2 abdomen: soft, non-tender, obese, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, +dp/pt pulses, no clubbing/cyanosis/edema neuro: strength and sensation grossly intact, moving all extremities, gait unable to assess pertinent results: d-dimer: 488 . trop-t: <0.01 . chem 7 141 102 17 90 agap=11 4.0 32 0.7 . alt: 30 ap: 95 tbili: 0.5 ast: 42 ldh: 293 lip: 24 . valproate: 85 . urine benzos, barbs, opiates, cocaine, amphet, mthdne negative . cbc 13.4 12.3 433 38.4 n:64.4 l:25.0 m:6.1 e:3.9 bas:0.7 . urinalysis neg . b12 486 tsh 1.0 ammonia 29 . csf gram stain, bacterial and viral cultures neg hsv pcr negative wbc 2 rbc 6 polys 3 totprot glucose ld(ldh) 37 61 19 . abgs: po2 pco2 ph tco2 ag 79* 50* 7.40 32* 4 70* 59* 7.35 34* 4 not intuba2 84* 54* 7.37 32* 3 62* 48* 7.43 33* 6 not intuba2 . cta chest: 1. no evidence of pulmonary embolism or other acute pulmonary pathology. 2. cholelithiasis. 3. hepatic hypodensity, incompletely characterized. . ekg: sinus tachycardia. possible left ventricular hypertrophy. no previous tracing available for comparison. intervals axes rate pr qrs qt/qtc p qrs t 110 142 70 344/431 61 -12 28 . cxr: no acute cardiopulmonary processes . ct head: no intracranial processes brief hospital course: micu course: admitted tachycardic and apneic, determined to be osa c/b enlarged tongue. started on nasal cpap, resolved. still tachycardic, cta negative for pe. mental status cleared significantly. . 59 year old female with h/o depression, anxiety, htn, asthma presents for section 12 from therapist for psychotic symptoms and tachycardia . # altered mental status: initially unclear and thought likely due to progressing psychiatric illness and ativan received in ed. psychiatry initially felt her presentation was consistent with psychotic depression or previously subclinical bipolar or psychotic disorder. patient has been on depakote, suggesting the need for some mood stabilization as target of pharmacotherapy. in further discussions with family, however, her recent hallucinations were felt to be inconsistent with what would be expected with psychotic depression, and inconsistent with her past mental health manifestations. head trauma was also felt less likely given negative ct head. infectious etiology less likely, despite leukocytosis which is apparently close to baseline. cxr, urinalysis, lfts all negative and patient does not have localizing symptoms/fevers; no nuchal rigidity or significant concern for csf infection and ultimate lumbar puncture analysis was negative for bacterial, fungal, viral etiologies. other toxic metabolic etiologies include b12/thiamine deficiency, hypo/hyperthyroidism psychosis, syphillis, illicit drug use work up for which were all negative. given neurological exam grossly intact, lower suspicion for these etiologies as well. patient became progressively somnolent, altered on the floor, responding only to noxious stimuli and unsafe to take po medications. she was started on thiamine and underwent lumbar puncture as aforementioned. patient was noted to be audible obstructing while sleeping. on continuous pulse oximetry, patient was noted to desaturate frequently while sleeping to <88% o2.serial abgs were performed which showed progressive hypoxia, hypercarbia. sleep was ultimately consulted and recommended bipap settings. patient then had a 20 second apneic episode and was transferred to the micu. there, she was transitioned to cpap with face mask. as she could not tolerate the face mask, she was switched to nasal cpap with good effect. her mental status improved dramatically thereafter and upon return to the general medical floor, patient was conversant, interactive and asking intelligent, informed questions about her medical conditions. throughout this, patient was continued on her home psych and other medications. psychiatry followed patient throughout this hospitalization and eventually felt her presenting symptoms not due to psychiatric illness, but likely severe sleep depression secondary to obstructive sleep apnea. patient was discharged straight to her follow-up pulmonary appointment and will also have close followup with her psychiatrist (psychiatry np) and primary care doctor. social work also saw patient in-house. . # tachycardia - most likely dehydration in the setting of recent poor po intake (given mental status/psychiatric issues) and per physical exam (dry mucus membranes). pulmonary emboli was lower on the differential in the setting of no hypoxia and d dimer 488. eventual cta for pulmonary emboli was also negative. cardiac etiology also felt to be unlikely given normal ekg and negative cardiac enzymes x2. tsh was within normal limits and no events were noted on telemetry. patient was on intravenous fluids when altered and transitioned to po intake with some improvement in her tachycardia to 90-100s. . # htn- continued home lisinopril/hctz & nifedipine per home regimen. although blood pressures were high (sbp140s), patient's home regimen was not altered during this admission in setting of her other issues. she was encouraged to discuss this further with her primary care doctor, especially since initiation of cpap may help with hypertension management. . # asthma- continued home inhalers . # gerd- continued pantoprazole . # code: presumed full . # emergency contact: daughter psychiatrist - pcp . and medications on admission: (per records, unable to confirm from pt) tobramycin/dexamethaone 0.3%-0.1% drops. i drop to ea eye daily through . paxil 40 mg daily divalproex sr 1250 mg po qhs klonopin 0.5 mg po bid pantoprazole delayed release 40 mg po daily proair hfa 90 mcg/actuation inh 1-2 puffs q 4-6 hrs prn fluticasone 50 mcg/actuation - 2 sprays ea nostril daily loratadine 10 mg po daily prn lisinopril/hctz 5/12.5mg daily ketoconazole topical cream apply to affected areas nifedipine 90 mg po daily trazodone 25 - 100 mg po qhs prn . allergies: sulfa, tetracycline, tomatoes discharge medications: 1. non-invasive positive pressure ventilation home phone: / work phone: next of : (daughter) insurance: nhp commcare id#: nhp0163117 type: autoset bipap machine with nasal mask; psv 0, pressure range 5-15 2. paroxetine hcl 20 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). disp:*30 tablet, delayed release (e.c.)(s)* refills:*2* 4. fluticasone 50 mcg/actuation spray, suspension sig: two (2) spray nasal daily (daily). disp:*1 bottle* refills:*2* 5. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every 4-6 hours as needed for shortness of breath or wheezing. disp:*1 inhaler (mdi)* refills:*0* 6. loratadine 10 mg tablet sig: one (1) tablet po once a day as needed for allergy symptoms. disp:*30 tablet(s)* refills:*0* 7. nifedipine 90 mg tablet sustained release sig: one (1) tablet sustained release po daily (daily). disp:*30 tablet sustained release(s)* refills:*2* 8. ketoconazole 2 % cream sig: one (1) application topical twice a day: to affected skin areas. disp:*1 tube* refills:*2* 9. lisinopril-hydrochlorothiazide 10-12.5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 10. flovent hfa 110 mcg/actuation aerosol sig: one (1) puffs inhalation twice a day. disp:*1 inhaler (mdi)* refills:*2* 11. depakote er 250 mg tablet sustained release 24 hr sig: five (5) tablet sustained release 24 hr po once a day. disp:*150 tablet sustained release 24 hr(s)* refills:*2* 12. nystatin 100,000 unit/ml suspension sig: fifteen (15) ml po four times a day as needed for oral pain. disp:*240 ml* refills:*0* discharge disposition: home with service facility: vna discharge diagnosis: primary: sleep deprivation, severe obstructive sleep apnea, depression/anxiety, hypertension secondary: asthma, allergic rhinitis, gerd, post-traumatic stress disorder discharge condition: mental status: clear and coherent level of consciousness: alert and interactive activity status: ambulatory - independent discharge instructions: -you were admitted with hallucinations and found to be delirious (very sleepy, difficult to wake, confused). it was felt that you were suffering from severe sleep deprivation due to obstructive sleep apnea (when your airways get blocked while sleeping, causing you to wake briefly, repeatedly gasping for air). you were started on a cpap breathing machine, which uses high pressure air to keep your airways open. you responded very well. . -it is important that you continue to take your medications as directed. we made the following changes to your medications during this admission: --> stop klonopin 0.5mg twice daily --> stop trazodone 25-100mg before bed as needed --> start flovent inhaler twice daily . -contact your doctor or come to the emergency room should your symptoms return. also seek medical attention if you develop any new fever, chills, trouble breathing, chest pain, nausea, vomiting or unusual stools. followup instructions: appointment #1 department: neurology (sleep clinic) when: tuesday at 11:20 am with: dr / building: sc clinical ctr campus: east best parking: garage . appointment #2 dr. therapist wednesday, at 8 am * review your depression/anxiety medications and discuss whether there are other regimens that could work better for you (less weight gain, more management of symptoms) . appointment #3 dr. primary care friday, at 2:40pm * discuss whether your blood pressure medications should be increased procedure: spinal tap incision of lung non-invasive mechanical ventilation diagnoses: obstructive sleep apnea (adult)(pediatric) esophageal reflux unspecified essential hypertension asthma, unspecified type, unspecified dysthymic disorder other specified cardiac dysrhythmias dehydration posttraumatic stress disorder allergic rhinitis, cause unspecified hallucinations lack of adequate sleep 

Answer: The patient is high likely exposed to