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: altered mental status major surgical or invasive procedure: intubation in the medical intensive care unit history of present illness: 52 y/o woman with iddm, diabetic polyneuropathy, htn, , hepatitis c who has been extremely depressed at home, stating that "she wants to die" and refusing to take her medications per her daughter who brought her to the for nausea, vomiting, ams. on arrival in the ed, she was found to be febrile to 101.6, tachy to 131, hemodynamically stable, yet somnolent and oriented only to person. her initial labs were remarkable for a glucose of 1300, a gap of 31, ketonuria, and a k of 6.3. her ecg did not show any ischemic changes, but did have diffuse peaked tw changes. she was given iv insulin 5 u push, put on 5 u per hour infusion, given 6 litres of ns bolus, calcium gluconate, levaquin and flagyl emperically. her ua was negative, cxr clear. blood cultres were sent times two. past medical history: 1. iddm diagnosed in , followed at by dr. . no recent hba1c on file. 2. diabetic polyneuropathy 3. hypertension 4. grave's disease, on tapazole 5. reactive airway disease 6. seronegative arthritis, followed in rheumatology 7. hepatitis c, genotype 1a, biopsy with grade 1 inflammation, no on antiviral therapy 8. gerd 9. migraines 10.bilateral knee arthroscopy in 11.s/p tah and pelvic floor surgery with bladder lift social history: she lives at home with her 2 daughters, aged 24 and 21. no sick contacts. she is a life-long non-smoker. no etoh. family history: positive for dm, mother died of colon cancer. physical exam: per dr. t 101.6 115 141/92 29 100% on ra gen - somnolent but arousable to voice heent - non-icteric, eomi, perrla, mm dry cv - tachy, reg, no m/r/g lungs - cta anteriorly, poor compliance with exam abd - diminished bs, soft, nt, nd ext - no edema or rash, dry skin neuro - somnolent but arousable to voice, moves all four, oriented to person only pertinent results: ed labs: glucose 1356 bun 31 cr 1.5 na 126 k 6.3 hco3 13 anion gap of 31 ketonuria ekg: no ischemic changes but positive peaked t waves ua negative cxr clear . admission labs: 149 i 120 i 11 --------------< 139 3.4 i 23 i 0.7 . ph 7.32 pco2 33 po2 47 hco3 18 basexs -8 . trop-*t*: <0.01 ck: 28 mb: notdone ca: 8.9 mg: 2.1 p: 2.3 d alt: 16 ap: 133 tbili: 0.4 alb: 3.3 ast: 18 : 15 lip: 12 tsh:<0.02 free-t4:2.5 . 12.1 18.8 >----< 343 36.2 pt: 12.5 ptt: 22.0 inr: 1.1 lactate:5.5 serum asa, acetmnphn, , , tricyc negative . cultures: blood cultures negative except : coag neg staph csf cultures negative urine cultures negative sputum: 2+ gm pos cocci, 1+ gm pos rods . csf: analysis wbc rbc polys lymphs monos macroph 4th 10 609* 67 12 0 21 1st 17 7650* 67 23 0 10 hsv negative . thyroid: ft4 2.5 to 0.9 hiv negative . imaging: cxr portable ap : portable semi-upright chest radiograph reviewed. the lungs are grossly clear. the pleura are normal without pneumothorax. the heart and mediastinal contours are within normal limits. pulmonary vasculature is normal. the right subclavian central venous catheter overlies the lower svc. . ct spine: negative for fracture head ct: negative . mri head: diffusion images demonstrate no evidence of acute infarct. the ventricles and extraaxial spaces are normal in size. there are no focal signal abnormalities or evidence of age inappropriate brain or medial temporal atrophy. following gadolinium, no abnormal parenchymal, vascular, or meningeal enhancement seen. mild mucosal thickening is seen in both mastoid air cells. again noted is occipitalization of c1 with mild tonsillar ectopia. impression: no significant change or evidence of acute infarct. no enhancing lesions. no mass effect, hydrocephalus, or focal signal abnormalities. . eeg: this is an abnormal eeg in the waking and sleeping stages due to the bursts of generalized slowing seen in drowsiness. this is a nonspecific finding which may be observed with deep midline subcortical dysfunction, or could represent a state of altered sleepiness. . right upper ex ultrasound: no dvt brief hospital course: 52 year old woman with iddm, htn, , hep. c, depression admitted with altered mental status thought likely due to dka. hospital course by problem . 1) dm1- dka on admission. in the icu, pt was started on insulin gtt and seen by the consult team. weaned off insulin gtt within a few hours as her ag closed and started on nph 70/30. dka thought secondary to medication non compliance. however, an evaluation for occult infection was also performed as well (see below). she was transferred to the floor and was stable. subsequently she had a hypoglycemic seizure. she was seen by neuro and transferred back to the micu. she was intubated briefly for airway protection. her blood glucose stabilized and she was transferred back to the floor. we adjusted her insulin regimen so that she now is getting glargine 33mg qhs and insulin humalog sliding scale four times a day. she has very close followup with . . 2) infectious diseases - the pt was febrile to 101.6 in ed with occasional fevers while in the icu and on the floor. the pt was pan-cultured several times (see above). c.diff was also sent given the pt's diarrhea, however was negative. had leukocytosis on admission which trended down. she had fevers after her seizure so an lp was performed. it showed 10 wbcs which, in the setting of a seizure and altered mental status - she was treated for presumed meningitis with vanco and meropenem for 10d. her fevers stopped and she successfully completed her antibiotics. . 3) psych: the patient had a flat affect and even was catatonic briefly during her stay. she was evaluated closely by the neurologists and psychiatrists. we performed multiple imaging modalities and lab studies. her only metabolic abnormality was thyroid disease (see below). we started remeron 30mg qhs and then zoloft 25mg qd during her stay. she had significant improvement in her mood. she had also experienced some dementia/neurocognitive deficits associated with this depression. the etiology was unclear. however, given the lack of imaging abnormalities and her improvement, it was thought not to be neurologic in origin. we scheduled her for neurocognitive testing as an outpatient. we also scheduled her for a vna and also "best" program to help with her mood and deficits. her family was counseled substantially on the importance of assisting the patient with her illnesses. . 3) htn - as the pt was hypotensive on admission, bp meds were held while in the icu, but were restarted once transferred to the floor with good result. . 4) disease - on admission, had an undetectable tsh and elevated free t4, likely medication non-compliance. pt's hyperthyroid state may have contributed to compliants of diarrhea. methimazole was restarted and recs, the pt will likely need rai ablation of thyroid for more definitive treatment in the future. will recheck tfts in four days to check for response on methimazole treatment. . 5) reactive airways disease - the pt was continued on outpatient meds. . 6) hepatitis c - lfts stable. the pt has never been on antiviral therapy. medications on admission: 1. gabapentin 300 mg capsule sig: one (1) capsule po bid (2 times a day). 2. methimazole 5 mg tablet sig: two (2) tablet po tid (3 times a day). 3. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 4. polyvinyl alcohol-povidone 1.4-0.6 % dropperette sig: drops ophthalmic prn (as needed). 5. zomig 2.5 mg tablet sig: one (1) tablet po qday prn. 6. cyclobenzaprine 10 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 7. docusate sodium 100 mg capsule sig: one (1) capsule po daily (daily). 8. metoclopramide 10 mg tablet sig: one (1) tablet po hs (at bedtime). 9. diazepam 5 mg tablet sig: one (1) tablet po q12h (every 12 hours) as needed. 10. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). 11. serevent diskus inhalation 12. sulfasalazine 500 mg tablet sig: three (3) tablet po twice a day. 13. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. 14. flovent 220 mcg/actuation aerosol sig: two (2) inhalation twice a day. 15. hyzaar 100-25 mg tablet sig: one (1) tablet po once a day. 16. hyoscyamine sulfate 0.375 mg tablet sustained release 12hr sig: one (1) tablet sustained release 12hr po twice a day. 17. insulin take 80 units qam and 90 units qpm, as directed by your pcp discharge medications: 1. albuterol-ipratropium 103-18 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours) as needed. disp:*1 unit* refills:*2* 2. gabapentin 300 mg capsule sig: one (1) capsule po bid (2 times a day). disp:*60 capsule(s)* refills:*2* 3. sulfasalazine 500 mg tablet sig: three (3) tablet po bid (2 times a day). disp:*180 tablet(s)* refills:*2* 4. hyoscyamine sulfate 0.375 mg capsule, sust. release 12hr sig: one (1) capsule, sust. release 12hr po bid (2 times a day). disp:*60 capsule, sust. release 12hr(s)* refills:*2* 5. losartan 50 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 6. montelukast 10 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 7. flovent 220 mcg/actuation aerosol sig: two (2) inh inhalation twice a day. disp:*1 unit* refills:*2* 8. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation every six (6) hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*2* 9. remeron 30 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*2* 10. methimazole 10 mg tablet sig: three (3) tablet po once a day. disp:*90 tablet(s)* refills:*2* 11. aluminum-magnesium hydroxide 225-200 mg/5 ml suspension sig: 15-30 mls po qid (4 times a day) as needed. 12. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 13. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 14. sertraline 50 mg tablet sig: 0.5 tablet po qam (once a day (in the morning)). disp:*15 tablet(s)* refills:*2* 15. insulin glargine 100 unit/ml solution sig: thirty three (33) units subcutaneous at bedtime. disp:*1 bottle* refills:*2* 16. humalog 100 unit/ml solution sig: variable units subcutaneous at breakfast, lunch, and dinner: take blood sugar at each meals. adjust insulin dose as follows: if blood glucose=61-80 take 0 units, if 81-120 take 4u, if 121-160 take 6u, if 161-200 take 8u, if 201-240 take 10u, if 241-280 take 12u, if 281-320 take 14u, if 321-360 take 16u, if 361-400 take 18u. disp:*1 bottle* refills:*2* 17. humalog 100 unit/ml solution sig: variable units subcutaneous at bedtime: check blood sugar at nighttime. if 61-200, give 0 units. if 201-240 give 2u, if 241-280 give 3u, if 281-320 give 4u, if 321-360 give 5u, if 361-400 give 6u. disp:*1 bottle* refills:*2* 18. insulin syringes (disposable) syringe sig: one (1) syringe miscell. four times a day: please provide patient with a syringe that goes up to 50 units. . disp:*120 syringes* refills:*2* discharge disposition: home with service facility: discharge diagnosis: 1. insulin dependent diabetes mellitus (type 1) 2. diabetic polyneuropathy 3. hypertension 4. grave's disease, on tapazole 5. reactive airway disease 6. seronegative arthritis, followed in rheumatology 7. hepatitis c, genotype 1a, biopsy with grade 1 inflammation, no on antiviral therapy 8. gerd 9. migraines 10.bilateral knee arthroscopy in 11.s/p tah and pelvic floor surgery with bladder lift 12.major depression 13.hypoglycemic seizure 14.possible cns infection 15. anemia discharge condition: stable. discharge instructions: you were admitted to the hospital with extremely high blood sugar levels. you were treated in the icu with insulin and transferred to the floor. you then experienced a seizure and were transferred back to the icu. you were followed very closely by the neurologists and the psychiatrists, and we think your seizure was related to hypoglycemia. we also treated you with iv antibiotics. you were showing symptoms of depression which we treated medically. you improved during your stay. . it is extremely important for you to keep all of your followup appointments. we have made some adjustments to your insulin medications so you very much need to keep your appointments at . your family has agreed to help you with your medications and we also are sending a visiting nurse in your care. . please check your blood sugars four times a day and use the appropriate amount of insulin to balance your blood sugar levels. if you have an extremely high level (>400) please contact your doctor immediately. if you have a low level (<60) please eat some crackers and drink 4 oz of juice. recheck your blood sugar in 15 minutes and if it continues to be low, please call your doctor or visit an emergency department. . if you experience chest pain, shortness of breath, severe abdominal pain, nausea, vomiting, or fever please call your doctor or visit an emergency department. . please follow up with your primary care provider and your doctor within 1 week of discharge. . it is very important for you to have a colonoscopy in the next three months. followup instructions: you need to call your physician, . , to schedule an appointment within the next week. he can be reached at . please keep your appointment with dr. practitioner, , on at 1:00pm. please keep your appointment with dr. at on at 8:30am colonoscopy: provider: west,room four gi rooms date/time: 8:00 provider: , md phone: date/time: 9:00 please undergo neurocognitive testing with provider: , : date/time: 8:30 md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified spinal tap incision of lung insertion of endotracheal tube diagnoses: unspecified essential hypertension unspecified viral hepatitis c without hepatic coma asthma, unspecified type, unspecified other convulsions polyneuropathy in diabetes acute respiratory failure bacteremia long-term (current) use of insulin insulins and antidiabetic agents causing adverse effects in therapeutic use major depressive affective disorder, single episode, unspecified personal history of noncompliance with medical treatment, presenting hazards to health diarrhea toxic diffuse goiter without mention of thyrotoxic crisis or storm encephalopathy, unspecified diabetes with neurological manifestations, type i [juvenile type], uncontrolled diabetes with ketoacidosis, type i [juvenile type], uncontrolled meningitis, unspecified diabetes with other specified manifestations, type i [juvenile type], uncontrolled 

Answer: The patient is high likely exposed to