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: percocet / cefazolin / vicodin / oxycodone attending: chief complaint: confusion major surgical or invasive procedure: 1) intubation 2) lumbar puncture 3) tee 4) picc line history of present illness: the patient is a 47 year old female with a history of type ii diabetes on insulin, peripheral vascular disease, hepatitis c and recent admission for septic right knee on fluconazole for parapsilosis who presents from home with one day of confusion. per her husband she was in her ususal state of health on the morning prior to presentation. she took her blood pressure and took all of her medications. she ate a normal breakfast and then went to bed in the early afternoon saying that she had she had a headache and was feeling nauseated. she vomitted once (bilious material) in the early afternoon but then was able to eat dinner. per her husband she does not usually have headaches so this was an unusual complaint. she did not note any fevers, chills, neck pain, back pain, worsening leg pain, abdominal pain, difficulty urinating or anything other symptoms. she was last noted to be at her usual mental status at approximatley 7 pm on the evening prior to admission. she did not sleep well that night. at 9 am her husband woke up and noticed that she was lying in bed and had soiled herself and was not making sense. he called 911 and she was taken to . he does not think that she took any medications for her pain other than tylenol, although does note that she has been using a fentanyl patch and dilaudid post-operatively. she was initially taken to . blood glucose in the field was 239. her initial vitals were t: 99.0, hr 86, bp: 224/86, rr: 16, o2: 95% on ra. she received narcan 0.8 mg iv, ativan 1 mg iv, zofran 4 mg iv. she had a ct of the head which compared to prior dated showed many white matter lesions involving both cerebral hemispheres and with the greatest involvement in the subcortical white matter. differential includes septic emboli, cholesterol emboli and less likely encephalitis. she was transferred to our hospital for neurologic evaluation. in the ed, initial vs were: t: 98.9 hr: 95 bp: 185/75 rr: 16 o2: 99% on ra. she had an lp which was notable for an opening pressure of 20 cm. she received vancomycin 1 gram iv x 1, gentamycin 200 mg iv x 1 (3 mg/kg), and acyclovir 700 mg iv x 1 (10 mg/kg). she has not yet received fungal coverage. she was seen by the neurology consult service who recommended a broad workup for systemic causes of delerium including infectious workup, toxicology screening, thiamine, folate and multivitamins. she was transferred to the micu for further management. on arrival to the micu she is oriented to person but otherwise does not respond to questions. she responds that her head hurts. she is agitated and moving in the bed. unable to obtain review of systems. past medical history: type 2 diabetes since age 25. insulin-dependent peripheral artery disease s/p bypass-left lower extremity hypertension hypercholesterolemia hepatitis c c. parapsilosis right knee arthritis s/p open biopsy and synovectomy on currently on fluconazole alcohol abuse social history: 30 pack year smoking history, quit five years ago. per my interview no current alcohol or drug use but per neurology interview she generally drinks - 1 pint of "100 proof" daily. last drink was at least one day prior to admission. no history of dts or withdrawal seizures. also smokes marijuana daily. lives with her husband and 8 year old child. works as a cash administrator. family history: no known history of early neurologic deficits physical exam: admission physical exam: vitals: t: 99.8 bp: 147/78 p: 124 r: 18 o2: 97% on ra general: alert to person only, agitated, does not respond to questions appropriately, moving all extremities heent: peerla, sclera anicteric, mm dry, dentition poor, oropharynx clear neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: foley draining clear yellow urine ext: warm, well perfused, 1+ pulses, no clubbing, cyanosis or edema, multiple excorations. right knee with staples, incision clean, dry, intact without erythema. right lateral knee with area of fluctuance, erythema, without warmth. rectal/vaginal: present neurologic: perrl, eomi, no facial droop, moving all extremities, withdraws to pain symmetrically, reflexes 2+ and symmetric pertinent results: admission: chemistries: glucose-277* urea n-16 creat-1.2* sodium-142 potassium-4.0 chloride-106 total co2-14* anion gap-26* alt(sgpt)-16 ast(sgot)-26 ck(cpk)-59 alk phos-81 tot bili-0.2 lipase-157* ck-mb-notdone ctropnt-0.01 calcium-9.5 phosphate-3.3 magnesium-1.8 ammonia-36 acetone-small osmolal-315* tsh-0.35 lactate-1.4 type- po2-52* pco2-32* ph-7.38 caltco2-20* base xs--4 hematology: wbc-11.9* hct-36.8 353 neuts-86.4* lymphs-9.8* monos-1.9* eos-1.6 basos-0.2 urine studies: color-yellow appear-clear sp -1.013 blood-mod nitrite-neg protein-100 glucose-neg ketone-150 bilirubin-neg urobilngn-neg ph-6.5 leuk-neg rbc-* wbc- bacteria-occ yeast-none epi-0-2 toxicology: asa-neg ethanol-neg acetmnphn-neg bnzodzpn-pos barbitrt-neg tricyclic-neg urine bnzodzpn-pos barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg cerebrospinal fluid: protein-53* glucose-170 wbc-2 rbc-248* polys-42 lymphs-43 monos-15 wbc-2 rbc-608* polys-54 lymphs-28 monos-18 ============================= discharge labs: cr 1.2 wbc rbc hgb hct mcv mch mchc rdw plt ct 7.2 2.46* 7.7* 23.4* 95 31.2 32.8 13.7 363 imaging: portable cxr : study is limited due to underpenetration and respiratory motion. the patient is also rotated. cardiac silhouette is likely mildly enlarged. mediastinal and hilar contours are grossly unremarkable. the lungs are grossly clear. no sizable pleural effusion or pneumothorax is seen; however, the extreme right costophrenic angle is excluded from field of view. transthoracic echocardiogram : the left atrium and right atrium are normal in cavity size. there is mild symmetric left ventricular hypertrophy with normal cavity size and global systolic function (lvef>65%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. tissue doppler imaging suggests a normal left ventricular filling pressure (pcwp<12mmhg). right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. the aortic valve leaflets (?#) appear structurally normal with good leaflet excursion. no masses or vegetations are seen on the aortic valve, but cannot be fully excluded due to suboptimal image quality.. no aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. no masses or vegetations are seen on the mitral valve, but cannot be fully excluded due to suboptimal image quality. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. eeg : the patient was recorded entirely in stages i and ii of sleep. it appeared that medication effect was evident both in stages i and ii of sleep. whether the presence of the seemingly excessive amount of sleep and the absence of full wakefulness was a pathological condition or simply a manifestation of medication cannot be determined from this record. no discharging features were, however, seen in the record. there was no evidence for non-convulsive status, as well. transesophageal echocardiogram : no atrial septal defect is seen by 2d or color doppler. overall left ventricular systolic function is normal (lvef>55%). there are simple atheroma in the aortic arch and descending thoracic aorta. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no masses or vegetations are seen on the aortic valve. no aortic valve abscess is seen. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mass or vegetation is seen on the mitral valve. trivial mitral regurgitation is seen. no vegetation/mass is seen on the pulmonic valve. there is no pericardial effusion. mri brain : extensive white matter abnormalities involving the posterior distribution as well as extending to involve the frontal and parietal lobes in a watershed distribution. given the conciliation of these findings, these are again most concerning for posterior reversible encephalopathy syndrome. again differential considerations include a toxic or metabolic process. microbiology: csf : no growth to date blood cultures , (mycolytic), , - no growth to date urine cultures , - no growth to date \ brief hospital course: 47 yo woman with ho dm ii on insulin (last a1c 5), pvd, hep c, and recent admission for septic r knee on fluconazole for parapsilosis who presented to ed on for confusion x 1 day. # delerium: patient found to have multiple new white matter lesions on ct that were initially thought to be infectious in etiology. patient was admitted to micu for alcohol withdrawl with very high bps as well as dka with ag. infectious w/u of cns was negative with negative csf and blood cx. an mri head was done for further evaluation of these lesions. because of very high bps in micu (probably due to severe dts) and classic mri findings, the diagnosis of posterior reversible leukoencephalopathy (pres) was made. patient's pressures were aggressively treated with goal systolics in 150s (close to her baseline at home). upon aggressive bp reduction, patient's mental status significantly improved. on the floor the patient continued to have a waxing and delerium. tight blood pressure control continued with goal sbps in the 150s. neurology followed the patient and recommended to continue close blood pressure management with goal pressures 130s-150s systolic, as well as to continue fluconazole for fungal septic arthritis, and continue close blood glucose management. these instructions were followed. as blood pressure was stabilized to target levels with multiple antihypertensive medications, tight glucose control was obtained with insulin fixed and sliding scale, and antifungal treatment continued, the patient's mental status showed significant gradual improvement. upon discharge on , the pt was alert and oriented x3, alert, interactive, and appropriate. patient has outpatient follow with dr. in the dept of neurology. # type ii diabetes/diabetic ketoacidois: on preentation the patients anion gap was 23 with ua positive for ketones and positive serum acetone. osmolar gap was 10 which was not suggestive of a toxic ingestion and her lactate was not elevated. toxicology screen was negative with exception of benzodiazepines. renal function within normal limits. although she is a type ii diabetic it was felt that her acidosis was most likely secondary to her diabetes versus alcoholic ketosis versus starvation ketosis. she was started on in insulin drip and received aggressive iv hydration. she was subsequently transitioned back to a regimen of lantus with a regular insulin sliding scale. her blood sugars remained elevated and her insulin regimen required titration while in the icu. while on the floor the patient was started on in a humalog insulin sliding scale, with fixed dose of glargine in the morning. this fixed dose and sliding scale was adjusted to obtain tight control of her blood sugars. upon discharge, tight control was obtained with most fingersticks between 100-200. outpatient dose of glargine increased from 18 units qam to 45 units qam. suggest continued uptitration as needed. patient discharged on humalog sliding scale. would suggest restarting glyburide and stopping humalog when discharged from rehab. # hypertension: her blood presusres were grossly elevated on presentation in the setting of missing her antihypertensive medications and alcohol withdrawal. she was initially treated with iv medications and subsequently transitioned to an oral regimen which was uptitrated. at the time of micu discharge she was on a regimen of lisinopril 40 mg daily, hctz 25 mg daily, labetolol 400 mg tid and hydralazine 30 mg po qid. at home her blood pressures typically run in the 150s to 180s systolic per her husband. on the floor her blood medications were titrated and altered to meet target goals of 130s-150s systolic. upon discharge her blood pressure medications were amlodipine 5mg daily; metoprolol 50 mg q6hours; hctz 25 mg daily; hydralazine 25 mg q6hours; lisinopril 40mg daily. instructions have been provided in the discharge worksheet for how to continue to titrate down these blood pressure medications as tolerated, in order to maintain target bp levels and to simplify the outpatient medication regimen. # fungal knee infection: cultures from grew for which she has been on fluconazole. she is followed here by our infectious disease service. given the concerning lesions on her head ct she underwent an evaluation for endocarditis including tte and tee which were negative for vegitation. on presentation there was an area of fluctance on the right lateral knee with erythema and warmth concerning for infection. this area was later aspirated by orthopedics and found to grow parapsilosis. fluconazole is being continued and the patient will likely require a course of fluconazole that requires several months. she will continue to be seen by orthopedics and infectious diseases as an outpatient following discharge, and she has outpatient follow-up appointments scheduled. # nutrition: patient was on tube feeds via ngt in the micu. upon discharge she was tolerating a po diet without difficulty and had successfully passed a speech and swallow evaluation. patient was a full code on this admission. medications on admission: home medications (per husband, unclear what she is actually taking): glyburide 5 mg hydrochlorothiazide 25 mg daily atenolol 25 mg daily lisinopril 40 mg daily fentanyl patch (might be wearing) fluconazole 400 mg daily diazepam (empty) senna prn enoxaparin 30 mg lantus 18 u daily dilaudid 2-4 mg po q4h:prn tylenol 1000 mg po q6h:prn omeprazole 20 mg daily discharge medications: 1. multivitamin tablet sig: one (1) tablet po daily (daily). 2. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 3. hydrochlorothiazide 12.5 mg capsule sig: two (2) capsule po daily (daily). 4. lidocaine 5 %(700 mg/patch) adhesive patch, medicated sig: one (1) adhesive patch, medicated topical daily (daily). 5. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 6. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 7. hydralazine 25 mg tablet sig: one (1) tablet po q6h (every 6 hours). 8. fluconazole 200 mg tablet sig: two (2) tablet po q24h (every 24 hours). 9. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 10. metoprolol tartrate 50 mg tablet sig: one (1) tablet po q6h (every 6 hours). 11. insulin glargine subcutaneous 12. humalog subcutaneous 13. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). discharge disposition: extended care facility: discharge diagnosis: 1) posterior reversible leukoencephalopathy 2) alcoholic ketoacidosis 3) hypertensive crisis 4) septic arthritis 5) delerium discharge condition: stable, afebrile. discharge instructions: you were admitted to the medical intensive care unit (micu) because of confusion and severe alcohol withdrawl. because of your alcohol withdrawl, your blood pressures were dangerously high. these high blood pressures caused brain damage and were likely the cause of your persistent confusion. you are being discharged rehabilitation facility in good condition, with stable vital signs. while you were hospitalized your blood pressure was managed with medications which lowered it to a safe level. as your blood pressure improved your mental status improved. during your hospitalization you were also treated with fluconazole for an infection in your knee. also during your hospitalization, we managed your blood sugars with insulin. your blood sugars were persistently elevated and required close management to bring them to a safe level. . please proceed to the emergency department with any new or otherwise concerning symptoms such as, delerium, shortness of breath, fever, chest pain, or other concerning symptoms. . stop taking: --atenolol --dilaudid --fentanyl patch --lovenox --glyburide: you can discuss restarting this medication with your primary care physician after discharge from rehab. changes to meds: --lantus increased to 45 units every morning new meds: --metoprolol --hydralazine --amlodipine --folic acid --multivitamin --lidocaine patch . you have multiple outpatient follow-up appointments scheduled below. please follow-up with all outpatient appointments as scheduled. followup instructions: you have appointments with the following providers: , md phone: date/time: 11:00 provider: . & phone: date/time: 4:30 provider: , md phone: date/time: 2:15 provider: , md phone: on procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified spinal tap incision of lung diagnostic ultrasound of heart insertion of endotracheal tube enteral infusion of concentrated nutritional substances arthrocentesis diagnoses: unspecified viral hepatitis c without hepatic coma other and unspecified hyperlipidemia long-term (current) use of insulin cerebral edema malignant essential hypertension atherosclerosis of native arteries of the extremities, unspecified other candidiasis of other specified sites alcohol withdrawal delirium diabetes with ketoacidosis, type ii or unspecified type, uncontrolled chronic total occlusion of artery of the extremities pyogenic arthritis, lower leg 

Answer: The patient is high likely exposed to