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: altered mental status, hyperkalemia major surgical or invasive procedure: none history of present illness: hpi: 81 yo f with h/o seizure disorder, htn, esrd on hd, meningioma s/p resection and dm who initially presented on from were she was found to be nonverbal and unresponsive. in the ed she was hypertensive to the 200's requiring a labatolol gtt and had a k of 7.1 (improved with bicarb and insulin). one day pta she developed nausea and vomiting. per report her initial neurologic exam was remarkable for profound encephalopathy with increased rue tone. . she was loaded with iv phenytoin for a subtherapeutic level; she transiently developed complete heart block during the infusion. ct head revealed a lobulated mass in the left ventricular atrium. she was given empiric ceftriaxone 2g, ampicillin, vanco, and acyclovir for possible meningitis. she was transferred to the for further managment. in the her bp was controlled. she was dialyzed and an lp was performed. . of note she was recently admitted to (discharged 2 wks ago) after a tonic clonic sz at dialysis. her phenytoin level was subtherapeutic at that time. she was reloaded. she had been on phenobarb, which was stopped. . currently she is alert and following verbal commands. she is able to answer some questions with one word response. . social hx: denies etoh or tobacco use. pt was ambulatory and conversant living at home prior to recent admission. currently living at . nurse reports that she was ambulatory with a walker and was alert and oriented prior to decompensation. . family hx: denies h/o sz disorder. reports fh of dm and htn. . past medical history: pmh: - seizure disorder. per report she was sz free on phenobarb and dilantin until 2 weeks ago. - h/o right frontal meningioma in 's s/p resection in - encephalomalacia per her epileptologist (dr. at 2988) - esrd on hd 3x/wk - suboptimal given reversed intake and outflow ports - ?clot in l ue av fistula - dm2 - htn - hyperlipidemia - ?hyperthyroidism social history: social hx: denies etoh or tobacco use. pt was ambulatory and conversant living at home prior to recent admission. currently living at . nurse reports that she was ambulatory with a walker and was alert and oriented prior to decompensation. family history: family hx: denies h/o sz disorder. reports fh of dm and htn. physical exam: physical exam: tc 98.1, 148/62, 70, 18, 98% 2l nc, fs 128 general: appears comfortable lying in bed, nad heent: no scleral icterus, mmm, op clear, r pupil 4mm, l pupil 3mm, minimally reactive, able to squeeze eyes shut and open mouth on command neck: supple, no jvd, right ej in place pulmonary: ctab cardiac: rrr, nl s1s2, no m/r/g noted abdomen: soft, nt/nd, nl bs, no hsm. extremities: weak dp/pt pulses, no edema neuro: following verbal commands, moving all extremities. cogwheel rigidity of upper extremities. patellar and biceps reflexes brisk and symmetric, toes upgoing. garbled speech, occasionally able to answer question with one word response. occasionaly myoclonic jerking movements of upper and lower extremities. right leg externally rotated. . pertinent results: 05:00am blood wbc-12.3* rbc-3.74* hgb-12.9 hct-39.2 mcv-105* mch-34.4* mchc-32.8 rdw-16.0* plt ct-253 05:00am blood neuts-80.7* lymphs-12.0* monos-6.3 eos-0.5 baso-0.4 07:00am blood pt-11.8 ptt-22.7 inr(pt)-1.0 04:50am blood glucose-148* urean-82* creat-9.2* na-131* k-7.5* cl-94* hco3-15* angap-30* 07:00am blood alt-81* ast-77* alkphos-108 amylase-117* totbili-0.1 04:50am blood ck(cpk)-57 04:39pm blood ck(cpk)-44 07:00am blood lipase-29 04:40am blood lipase-17 04:50am blood ck-mb-4 ctropnt-0.07* 04:39pm blood ck-mb-4 ctropnt-0.07* 04:40am blood vitb12-1387* folate-greater th 10:35am blood ammonia-30 04:39pm blood tsh-1.6 04:50am blood phenyto-1.4* 04:40am blood phenyto-17.9 phenyfr-3.7* %phenyf-21* 02:28pm blood phenyto-12.8 04:50am blood asa-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 08:40am blood lactate-1.3 . imaging: ct head : lobulated mass in the left ventricular atrium. no clear evidence of acute hemorrhage or territorial infarction. . cxr : lungs clear. small left pleural effusion. mild cardiomegaly. atherosclerotic calcification above the aortic knob suggests aberrant right subclavian artery. tips of dual r supraclavicular catheter project over the svc and superior cavoatrial junction respectively. . ekg: nsr, rate 54, lad, twi in v1 and v2 with j-point elevation and 2mm st elevation, poor r wave progression, no other st/tw changes. . mri : lobulated mass in the left ventricular atrium, which could represent an intraventricular meningioma. there are no signs of recurrent meningioma in the right frontal postoperative region. an additional tiny focus of enhancement and signal abnormality is noted along the right side of the cerebellum. . eeg : prelim - diffuse encephalopathy . brief hospital course: 81 yo resident with esrd on hd, meningioma s/p resection/regrowth, htn, dm, and sz d/o initially admitted to the intesive care unit with altered ms, hypertension, and hyperkalemia. . 1) altered mental status likely to hypertensive leukoencephalopathy: the patient presented unresponsive from . at presentation she was found to be hypertensive in the 200s and started on a labetolol drip. her k was found to be 7.1 and resolved with insulin and bicarb. a ct head did not show evidence of stroke or hemmorrhage, but a lobulated mass was seen in the left ventricular atrium. a urine tox screen was found to be negative and tsh, ammonia and lfts were wnl. she was given empiric ceftriaxone 2g, ampicillin, vanco, and acyclovir for possible meningitis and transferred to the unit. the differential included toxic metabolic derangements, leukoencephalopathy secondary to htn, hsv encephalitis, or post-ictal state as pt had h/o recent seizures. an eeg revealed diffuse encephalopathy without evidence of non-convulsive status epilepticus. an mri revealed slight increase in size of her known meningioma since without mass effect, bleed or cva. an lp was performed by ir (noted to be difficult to perform) and revealed many rbc's, no wbc's, high protein, and normal glucose. all culture data was negative and cytology was negative as well. empiric vanco/amp/ctx for bacterial meningitis was d/c'ed on given the lp results. her acyclovir was continued until (started ) when her hsv pcr came back as negative. the patient's mental status started improving during her stay as her blood pressures improved. she was noted to have a significant expressive aphasia. neurology was consulted and thought the patient's symptoms were related to her hypertension and toxic/metabolic derangements. they though her symptoms would improve over time. her blood pressures were controlled to a goal of sbps 140-170 on iv medications and she was then switched to po medications as her ms improved. lisinopril, hydralazine, norvasc and metoprolol were used for bp control. she will need neurosurg to follow up her enlarging meningioma. she was also instructed to follow-up with her outpatient neurologist, dr. . . 2) seizure disorder: the patient was noted to have a recent recurrence of seizures. the differential included recent d/c of phenobarbitol, known meningioma acting as foci, and electrolyte disturbances in the setting of esrd. patient did have a seizure on in the setting of low calcium after hd. she was initially loaded with fosphenytoin. neurology followed the patient and recommended that she start dilantin 200 . her free and total dilantin levels were followed as well as her lfts. eeg was done and showed diffuse encephalopathy but no evidence of non-convulsive status. she had no further seizures during her stay. she was discharged on 200 po bid of dilantin. her level was to be checked in one week and she was to follow-up with her outpatient neurologist, dr. . . 3) complete heart block: she had complete heart block during her phenytoin infusion. this was thought to be secondary to phenytoin infusion and after that time the infusion was done slowly. she had no further episodes of heart block. . 4) htn: she was initially on labetolol gtt for sbp >200. her goal sbp was 140-170. it was noted that her bps were higher in the right arm than the left, so bps were taken from the left arm. when she was transferred to the floor she had been receiving prn metoprolol, but this was not enough to control her blood pressures. she was initially started on iv antihypertensives and then changed to po meds including lisinopril, norvasc, metoprolol and hydralazine. aggressive blood pressure control was attempted as it was thought her ms changes were due to hypertensive leukoencephalopathy. her blood pressures were in the 160s on the day of discharge. . 5) esrd on hd t/th/sa: pt receives dialysis on t/th/sa. she was followed by the renal team during her stay. initially it was thought her dialysis port was not working well, but she had excellent flows through the port during the second half of her admission. her electrolytes were followed and she was given phos binders once she could tolerate po meds. . 6) ?hyperthyroidism: her tsh was drawn and noted to be normal off medications. . 7) dm2: she was continued on a riss and qid fs were checked. . 8) hypercholesterolemia: she was continued on lipitor 10 mg qd . 9) fen: she was initially unable to perform a speech and swallow due to her mental status. as her ms improved she had an evaluation and she was changed to a diet of ground, thin liquids with 1:1 supervision during meals. she was given liquids by straw with cuing, crushed meds and given with purees. she was continued on a diabetic/renal/low salt diet. . 10) ppx: she was continued on sc heparin, ppi and was kept on aspiration/seizure precautions. . 11) code: full as per chart (discussed with daugther in ) . 12) communication: daughter - () . 13) access: r groin line removed. r sc hd line in place. pt has had fistulas in arms bilat, therefore, unable to place picc line. r ej placed 5/10/1/06 and removed on . medications on admission: . medications at home: - metoprolol 100mg po tid - lisinopril 20mg po daily - asa 81mg po daily - dilantin 200mg po bid - lipitor 10mg po daily - nephrocaps 1 tab po qam - phoslo 667mg po tid - compazine prn - ?riss . transer meds: - metoprolol 5 mg iv q6h:prn - acyclovir 300 mg iv q24h - pantoprazole 40 mg iv q24h - acetaminophen 325-650 mg po/pr q4-6h:prn - phenytoin 200 mg iv q12h - aspirin 300 mg pr daily - prochlorperazine 10 mg iv q6h:prn - heparin 5000 unit sc tid - insulin ss discharge medications: 1. heparin (porcine) 5,000 unit/ml solution sig: 5000 units injection tid (3 times a day). 2. hydralazine 50 mg tablet sig: one (1) tablet po q6h (every 6 hours). 3. phenytoin sodium extended 100 mg capsule sig: two (2) capsule po bid (2 times a day). 4. lisinopril 20 mg tablet sig: one (1) tablet po daily (daily). 5. amlodipine 5 mg tablet sig: two (2) tablet po hs (at bedtime). 6. metoprolol tartrate 50 mg tablet sig: two (2) tablet po tid (3 times a day). 7. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 8. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 9. atorvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 10. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 11. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day) as needed for constipation. 12. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 13. calcium acetate 667 mg capsule sig: two (2) capsule po tid w/meals (3 times a day with meals). 14. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 15. prochlorperazine 10 mg iv q6h:prn 16. insulin please place patient on a regular insulin sliding scale per the protocol of your institution 17. outpatient lab work please have dilantin level checked in one week and send the results to dr. , in weeks. his phone number is . discharge disposition: extended care facility: - discharge diagnosis: primary diagnosis: toxic metabolic and hypertensive encephalopathy seizure disorder . secondary diagnosis: diabetes type 2 discharge condition: stable wtih baseline expressive aphasia discharge instructions: you are being discharged to a rehabilitiation facility. . please take your medications as prescribed. . please call your doctor or return to the er if you become more confused, have very elevated blood pressures, have chest pain, shortness of breath, headaches, dizziness or other concerning symptoms. followup instructions: please follow-up with neurosurgery regarding the meningioma in your brain. please call ( to make an appointment in the next weks. . please follow-up with your neurologist, dr. , in weeks. his phone number is . you should have a dilantin level checked in one week and have the results sent to his office. . please follow-up with your primary care doctor, dr. , in weeks. his phone number is . procedure: spinal tap incision of lung diagnoses: hyperpotassemia end stage renal disease toxic encephalopathy diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other convulsions thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease atrioventricular block, complete metabolic encephalopathy aphasia unspecified causes of encephalitis, myelitis, and encephalomyelitis personal history of benign neoplasm of the brain 

Answer: The patient is high likely exposed to