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: methadone attending: chief complaint: agitation/encephalopathy major surgical or invasive procedure: intubation history of present illness: 49m with a history of bipolar disorder, substance abuse, untreated hepatitis c, seizure disorder and iddm found allegedly breaking into an apartment building, brought to the ed by police, reporting no trauma, but in agitated delerium, vss, normal fs, threatening to bite people. was sedated and restrained. still uninterviewable. fs repeatedly normal. omr review shows long psych history including self inflicted wounds, past dx of bipolar with substance abuse and character disorder and si with plan. in the ed inital vitals were: 11:40 t: 98.2 102 124/64 18 100% - nsr 98 rsr' v1, qtc 417 s/p 15 haldol, qiii, c/w prior - on arrival, threatening to bite people and yelling he has hiv, agitated -> , 4-pointed. - fs 356 @ 1400hr - 1430hr for facilitated work work up - 1530 + 50 benadryl, line established, placed on continuous monitoring. - 1634 ecg acquired, 5 and then 5 im droperidol - labs - intubated with 100 roc, 20 etomidate, 8-0 tube, 22@incisors - cxr: tube and og in place - propofol - foley -> 1450 ml out. - 16g l ej - nchct and torso - lp: op 22, clear - vanc + unasyn in initial emergency department assessment, patient is grossly altered, afebrile, no rash, no signs of trauma or meningismus, no nystagmus or clonus. to facilitate medical work up patient was sedated to perform tests (got 15 haldol, 6 ativan, 50 benadryl, 10 droperidol) but remained very agitated. pupils minimally reactive, mid range, no nystagmus. patient did present to the ed the night prior brought in by the authorities after being found in a stairwell at . he was hyperglycemic in the context of getting two tabs of glucose and was discharged. on arrival to the icu, patient is intubated and sedated with no purposeful movements. pinpoint pupils are non-reactive. past medical history: per omr hx includes: - iddm dx with diabetic neuropathy - hep b dx - hep c - never treated - s/p mva with closed head injury - seizures from (s/p head injury) to , spontaneously resolved (took tegretol and dilantin in the past) - severe low back pain since mva in and also since being beaten in - goes to pain clinic at , narcotic dependent surgical: self inflicted shallow stab wound to left lower abdomen from box cutter: local exploration social history: patient is sudanease, divorced, has one daughter. his brother lives locally and reports that the patient lives in an apartment family history: father and mother had diabetes. physical exam: admission: vitals: t:95.9 axillary bp: 168/100 p: 89 r: 16 o2: 100 general: intubated, sedated, no purposeful movements heent: pupils pinpoint and non-reactive. sclera anicteric, mmm, neck: supple, jvp not elevated, no lad lungs: clear to auscultation bilaterally, no wheezes, rales, rhonchi 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 ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema discharge: vs: tm afebrile tc hr 60s bp 140-160s/80s-90s rr 20 sao2 97% ra i/o general: nad uncomfortable. calm eating breakfast without restraints. eyes: anicteric perrl ent: mmm oropharynx clear hard of hearing. dry mm. neck: no lad jvp: cvs: rrr nl s1 s2 no mrg no edema lungs: no rales no wheeze comfortable. abdomen: soft nontender bowel sounds present no hepatosplenomegaly skin: no rashes warm dry decubitus ulcers: lymph: no cervical lad no axillary lad no inguinal lad neuro: oriented x3 fluent speech. no tremor or asterixis. psych: alert calm mood/affect: pertinent results: admission labs: 05:00pm blood wbc-5.0 rbc-4.94 hgb-14.9 hct-40.3 mcv-82 mch-30.1 mchc-36.9* rdw-13.5 plt ct-165 05:00pm blood neuts-65.9 lymphs-25.6 monos-5.9 eos-1.0 baso-1.7 05:00pm blood pt-12.3 ptt-27.8 inr(pt)-1.1 05:00pm blood glucose-194* urean-8 creat-0.9 na-144 k-3.8 cl-107 hco3-23 angap-18 05:00pm blood alt-293* ast-227* ck(cpk)-1666* alkphos-89 totbili-1.5 05:00pm blood ck-mb-10 mb indx-0.6 ctropnt-<0.01 05:00pm blood albumin-4.3 05:00pm blood tsh-2.2 05:00pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 06:15pm blood type-art rates-/16 tidal v-500 peep-5 fio2-40 po2-142* pco2-47* ph-7.36 caltco2-28 base xs-0 intubat-intubated vent-controlled 05:08pm blood glucose-187* lactate-2.4* na-145 k-3.7 cl-109* 06:06pm cerebrospinal fluid (csf) wbc-0 rbc-0 polys-0 lymphs-63 monos-31 macroph-6 06:06pm cerebrospinal fluid (csf) totprot-33 glucose-142 ld(ldh)-26 06:06pm cerebrospinal fluid (csf) herpes simplex virus pcr-pnd notable studies: micro: blood cultures no growth 6:06 pm csf;spinal fluid source: lp tube 3. gram stain (final ): no polymorphonuclear leukocytes seen. no microorganisms seen. this is a concentrated smear made by cytospin method, please refer to hematology for a quantitative white blood cell count.. fluid culture (preliminary): fungal culture (preliminary): acid fast culture (preliminary): the sensitivity of an afb smear on csf is very low.. if present, afb may take 3-8 weeks to grow.. viral culture (preliminary): 6:06 pm csf;spinal fluid source: lp tube 3. **final report ** cryptococcal antigen (final ): cryptococcal antigen not detected. (reference range-negative). performed by latex agglutination. results should be evaluated in light of culture results and clinical presentation. . images: ct head w/o contrast study date of 2:55 pm wet read: mlhh wed 9:42 pm no intracranial hemorrhage or fractures. multiple subcutaneous hyperdensities in the frontal scalp and bitemporal regions, likely dermal calcifications, but please correlate for superficial retained foreign bodies. chest (portable ap) study date of 5:12 pm findings: portable ap supine chest radiograph obtained. endotracheal tube is seen with its tip residing approximately 3.0 cm above the carina. ng tube courses into the left upper quadrant with its distal side port at the level of the ge junction. the lungs appear clear bilaterally without focal consolidation, effusion, or pneumothorax. cardiomediastinal silhouette is normal. bony structures appear intact. impression: tube positioned appropriately. orogastric tube may be advanced for more optimal positioning. lungs are clear. ct chest w/contrast study date of 8:39 pm ct abd & pelvis with contrast study date of 8:39 pm wet read: mlhh wed 10:08 pm no acute intrathoracic or abdominal process. mild 14-cm splenomegaly. scattered prominent retroperitoneal lymph nodes, not pathologically enlarged. accessory r renal artery. normal retrocecal appendix discharge/notable labs: 06:18am blood wbc-4.6 rbc-4.83 hgb-14.0 hct-39.5* mcv-82 mch-29.0 mchc-35.5* rdw-13.5 plt ct-171 06:18am blood glucose-184* urean-6 creat-0.7 na-143 k-3.4 cl-105 hco3-24 angap-17 06:18am blood ck(cpk)-1046* 06:11am blood alt-250* ast-192* ld(ldh)-333* ck(cpk)-1303* alkphos-80 totbili-2.1* 06:18am blood calcium-8.6 phos-3.1 mg-1.8 04:30am blood vitb12-1352* 05:00pm blood tsh-2.2 studies pending at discharge: none brief hospital course: 49m with a history of bipolar disorder, substance abuse (narcotics, cocaine, amphetamines), untreated chronic hepatitis c, and type ii diabetes on insulin admitted with encephalopathy and severe agitation felt to be due to drug intoxication. #agitation/encephalopathy/amphetamine and cocaine dependence with intoxication/bipolar disorder: patient was brought in by police extremely agitated. he required large amounts of sedatives and antipsychotics and was intubated for protection against self injury and injury to staff. he was admitted to the intensive care unit and workup for cause of encephalopathy and agitation was notable only for a urine toxicology positive for cocaine and amphetamines but head ct, lumbar puncture, and infectious and metabolic workup was all otherwise unremarkable. he required 4 point restraints and large amounts of iv haldol and ativan but his mental status and agitation slowly improved. he was seen by the psychiatric service and was initially kept in the hospital on a section xii as he was felt to be at risk for harming himself/others. however as his mental status returned to baseline he was no longer felt to be at risk for injury to himself or others. he asked for percocet and adderall continuously during his admission stating that his outpatient providers prescribed this. his case was discussed with his outpatient psychiatrist dr. in (pager is ; office ) who said that she had prescribed him adderall but that she felt he was abusing it and recommended that we avoid amphetamines, benzodiazepines, and narcotics as patient has history of doctor shopping and abusing all these medications. he also does not receive regular pcp care although it was confirmed that dr. (medical resident at ) recently prescribed the patient 210 tablets of percocet. patient was maintained on regimen of fluphenazine for his bipolar disorder, but the patient refused this once his mental status reurned to baseline. on the day of discharge the patient was felt to no longer be a danger to himself or others and that ultimately the cause of his agitation/encephalopathy on admission was due to amphetamine and cocaine abuse. the patient was discharged to follow up with his outpatient psychiatrist and pcp for clarification of medication regimen. of note, he never did admit to abusing prescriptions or cocaine. #hypertension: this was felt to be both essential and related to recent amphetamine/cocaine use with component of withdrawal as well. he was maintained on clonidine which was discontinued on discharge when his outpatient medications of lisinopril and atenolol were confirmed with his pharmacy. patient was adviced not to take atenolol if he was using cocaine. #type 2 diabetes on insulin: patient was noted to be on insulin at home. he was treated with sliding scale in house and then discharged to restart his usual home regimen of lantus 50 units daily with novolog 10 units sc with meals. #transaminitis/hepatitis c: liver chemistries were elevated but stable during admission without evidence of decompensation. #code: full #disposition: patient was discharged with pcp and outpatient psychiatry follow up. medications on admission: it is unclear what the patient is actually taking. however most recent notes from pcp at and confirmation with his pharmacy health first pharmacy in (closed sundays) say that the following medications were refilled on : lidoderm patch to left shoulder daily percocet 5/325 1-2 tabs q4h prn pain-- 210 tablets dispensed by dr. at aspirin 81mg po daily tramadol 50mg po qid prn pain gabapentin 300mg po qid prn pain lantus 50 units sc daily novolog 10units sc with meals lisinopril 40mg po daily atenolol 25mg po daily omeprazole 20 mg po daily lithium 600mg po bid--last filled adderall 20mg po tid--last filled discharge medications: 1. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. 2. lithium carbonate 300 mg tablet extended release sig: two (2) tablet extended release po twice a day: please start with 1 tablet twice a day for one week before increasing to your usual 2 tablets twice a day. 3. gabapentin 300 mg capsule sig: one (1) capsule po four times a day as needed for pain. 4. lisinopril 40 mg tablet sig: one (1) tablet po once a day: take first dose . 5. lantus 100 unit/ml solution sig: fifty (50) units subcutaneous once a day. 6. novolog 100 unit/ml solution sig: ten (10) units subcutaneous at mealtime. 7. aspirin low dose 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. discharge disposition: home discharge diagnosis: cocaine and amphetamine toxicity hypertension type 2 diabetes mellitus transaminitis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: you were admitted to the hospital after being found wandering by the police. you were confused and agitated and required intubation before your mental status ultimately returned to baseline. it is felt that you were altered to due to drugs in your system including both amphetamines and cocaine. you were seen by the psychiatry service and started on medications. your mental status returned to and you are discharged to follow up with your outpatient psychiatrist dr. and your pcp . (medical resident medical) this week as you will likely have your psychiatric medications changed. also you should have your blood pressure checked to make sure no more changes are required. please restart your usual blood pressure medications tomorrow . please do not use atenolol if you are exposed to cocaine. please avoid cocaine, amphetamines, and overuse of narcotics in the future. please also avoid alcohol as this can be injurious to your liver. please take all your medications as prescribed. followup instructions: please follow up with your pcp and psychiatrist this week. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung diagnoses: toxic encephalopathy unspecified essential hypertension chronic hepatitis c without mention of hepatic coma diabetes with neurological manifestations, type ii or unspecified type, not stated as uncontrolled polyneuropathy in diabetes long-term (current) use of insulin epilepsy, unspecified, without mention of intractable epilepsy accidental poisoning by central nervous system stimulants bipolar disorder, unspecified poisoning by cocaine accidental poisoning by psychostimulants cocaine dependence, unspecified physical restraints status amphetamine and other psychostimulant dependence, unspecified poisoning by amphetamines 

Answer: The patient is high likely exposed to