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: gentamicin / seroquel / latex attending: chief complaint: seizures major surgical or invasive procedure: endotracheal intubation history of present illness: mr. is a 54 year old gentleman with a pmh significant for polysubstance abuse, cad s/p pci, and seizure disorder admitted for possible seizures. per report, the patient was noted today to have chest pain clutching his chest. at that time, ems was called with report of seizure activity. he received 2 mg im ativan in ems without resolution of seizure activity. . in the ed, initial vs 99.8 70 156/113 100% ac 500x14, 10, 1.0 with abg 7.34/48/165. the patient had a urine tox screen positive for amphetamines and had a negative cta chest and nchct. evaluation in the ed was non-localizing, and the patient was admitted to the micu for further management. . the patient was initially admitted to on for si and depression. at that time, the admission note states that he had recently been discharged from hospital 2 weeks prior for depression, and that he has a history of abuse of pain medications. in addition, the patient has a history of suicide attempts via od and car crash. his daughter states that he has a history of addiction to morphine, hydromorphone, and valium due to his chronic pain, and that he has been admitted to an inpatient substance abuse facility since . . currently, the patient is intubated, and sedated. past medical history: htn hld cad s/p pci depression polysubstance abuse on suboxone left parietal tumor seizure disorder - has not had a seizure in 5 years. neck and back pain s/p c5-7 fusion social history: lives with daughter. - 1 ppd x5 years. etoh - none per daughter. illicit or herbal drugse except for pain medication addiction. family history: non-contributory physical exam: admission: vs: 98.1 54 147/88 100%ac 500x16, 10, 1.0 gen: intubated, sedated heent: ett in place cv: nl s1+s2, no m/r/g pulm: ctab abd: s/nd +bs ext: no c/c/e. neuro: pupils 2->1 mm bilaterally. 1+ biceps, brachioradialis, patellear reflexes bilaterally. no evidence of rigidity or clonus. downgoing toes bilaterally. . discharge: vs: 98.8 98.6 122/88 109-162/75-100 70 62-76 18 95%ra 8h 60/750 24h 480/675+ not saved, +bmx1 gen: awake, alert, appears fatigued, nad heent: ncat, eomi, right eye deviated to right, dry mm, no scleral icterus, op clear cvs: rrr, nl s1 s2, no m/r/g pulm: no use access mm of breathing, ctab without wheezes or crackles abd: +bs, soft, ntnd ext: warm, dry, no , slight erythema and edema of rue around picc site, slight tenderness to palpation neuro: a&ox3, awake, alert, 4/5 strength rue, though difficult to assess if related to effort, gait not assessed pertinent results: admission labs: 03:28pm blood wbc-5.6 rbc-4.42* hgb-14.2 hct-39.3* mcv-89 mch-32.2* mchc-36.2* rdw-13.4 plt ct-305 03:28pm blood neuts-66.8 lymphs-26.7 monos-4.9 eos-1.2 baso-0.4 03:28pm blood pt-14.4* ptt-29.5 inr(pt)-1.2* 03:28pm blood glucose-118* urean-23* creat-0.9 na-142 k-4.2 cl-104 hco3-28 angap-14 04:39am blood glucose-82 urean-18 creat-0.6 na-143 k-3.3 cl-110* hco3-23 angap-13 03:28pm blood alt-14 ast-13 alkphos-49 totbili-0.4 03:28pm blood lipase-25 03:28pm blood ctropnt-<0.01 11:34pm blood ck-mb-3 ctropnt-<0.01 04:39am blood ck-mb-3 ctropnt-<0.01 03:28pm blood albumin-4.4 calcium-10.0 phos-3.7 mg-2.0 03:28pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-pos barbitr-neg tricycl-neg 03:28pm blood valproa-106* . pertinent labs: 01:35am blood ck-mb-2 ctropnt-<0.01 04:49am blood caltibc-254* vitb12-1163* folate-6.6 ferritn-116 trf-195* 04:39am blood valproa-89 04:40pm blood phenyto-7.5* 02:19am blood phenyto-6.0* 03:28am blood phenyto-5.7* 11:47pm blood phenyto-10.9 valproa-92 . discharge labs: 05:25am blood wbc-4.4 rbc-3.75* hgb-11.8* hct-32.9* mcv-88 mch-31.4 mchc-35.7* rdw-13.5 plt ct-258 05:25am blood glucose-93 urean-15 creat-0.6 na-142 k-3.5 cl-108 hco3-26 angap-12 . micro: bcx : 9:12 pm blood culture source: line-picc. blood culture, routine (preliminary): staphylococcus, coagulase negative. isolated from only one set in the previous five days. sensitivities performed on request.. anaerobic bottle gram stain (final ): gram positive cocci in clusters. reported to and read back by beaver at 8pm on . aerobic bottle gram stain (final ): gram positive cocci. in clusters. . blood cx : no growth blood cx , , : pending . studies: ecg: sinus with 1:1 conduction, bradycardic. na-ni. no acute st-t wave changes. . cta: no pe/dissection. no fx identified. cervical anterior fusion hardware not visualized. . cth: no ich. no acute process. cxr: 1. endotracheal tube in appropriate position. nasogastric tube coursing below the level of the diaphragm, inferior aspect not included. 2. clear lungs . c-spine : findings: c1 through the mid-body of c6 are visualized. there is preservation of the cervical lordosis. there has been prior anterior fusion at c5 through c7 with metallic plate and two sets of screws. there is loss of disc height at c4-c5, but the remainder of the disc spaces are preserved. there is no fracture or spondylolisthesis between flexion and extension. there is no prevertebral soft tissue edema. visualized lung apices are clear. a right-sided central venous catheter is incompletely evaluated. . mri : impression: 1. status post spinal fusion from c5 to c7. 2. moderate severe spinal stenosis at c4-5 level above the level of fusion due to disc osteophyte and thickening of the ligaments with indentation on the spinal cord without abnormal signal seen within the spinal cord. severe left-sided and moderate-to-severe right-sided foraminal narrowing is seen at this level. 3. degenerative changes at other levels as described above. 4. no evidence of epidural abscess, discitis or osteomyelitis. . rue u/s : impression: occlusive thrombus seen within the right cephalic vein, which is a superficial vein. no thrombus is seen within any of the deep veins of the right arm. note is made of a picc line in one of the two brachial veins. brief hospital course: hospital course: mr. is a 54 year old gentleman with a pmh significant for polysubstance abuse, cad s/p pci, and seizure disorder admitted for possible seizures. pt was intubated in the ed for airway protection. pt was monitored in the icu and was followed closely by who did not see eeg activity consistent with seizures. he was extubated and transferred to the medical floors for further management. he had some right arm and neck pain, and mri showed spinal stenosis. he had fevers, but no source of infection. one blood culture grew cons and was initially started on vancomycin which was discontinued. pt was evaluated by psychiatry and he did not meet inpatient criteria for follo-up. pt was discharged with psychiatric follow-up, and continued on home medications. pt was discharged with the ride to assist with getting to appointments. . active issues: # seizure-like activity: he was followed by and monitored on 24-hour eeg monitoring. he did have several episodes of myclonic jerking that were not associated with any eeg evidence of seizures. the eeg was negative over several days but did show epileptiform activity consistent with history of epilepsy. in the setting of medication non-compliance he may have had a seizure prior to admission. he did have urine toxicology positive for amphetamines and toxicology was consulted but they did not feel that his presentation was concerning for amphetamine overdose. mri brain was negative. initially, was loaded on dilantin and was also started on depakote. when his depakote level was therapeutic, the dilantin was stopped and he was continued on his home depakote dose. he was transferred to the medicine floors and had no further seizure-like activity. he was continued on his home dose of depakote and instructed to follow-up with as an outpatient. . # chest pain: patient has a history of cad s/p pci. per report, was complaining of chest pain this afternoon at rehab. acs was ruled out with serial cardiac biomarkers and repeat ecg. carvedilol, asa, plavix, and statin were restarted when began to take pos. on the medicine floors, he had an episode of chest pain, though ecg was unchanged and cardiac markers were again negative. pt was hypertensive at the time, and his chest pain improved as his bp was better controlled. . # respiratory: patient underwent rsi in the ed for airway protection in the setting of possible seizures. he was extubated without complications. . # fever: fevers in icu, though no clear source. pt had 1 bottle growing gpc's, and was speciated to coag negative staph, likekly contaminate. started on vancomycin initially, and then discontinued once speciated as cons. pt defervesced and had no fevers for 48hrs prior to discharge. . # substance abuse: positive for amphetamines on admission. pt has long-history of substance abuse, and was taking narcotics prior to admission at . at he was in treatment for detox. pt was given fentanyl for concern for withdrawal in icu. on the floors, narcotics were held. psych was consulted, and pt decided he wanted to go home and was enthusiastic about attending aa. he was set up with the ride to help with getting rides to meetings and oupatient psychiatry. pt was counseled on avoidance of narcotics and valium. . # depression: continued on fluoxetine in micu. remeron was restarted on the floors. pt was evaluated by psychiatry, and recommended continuing fluoxetine and remeron. pt to follow-up closely with psychiatry. as above, sw consulted for issues as outlined above, pt reports unable to make it to previous appts given difficulty with rides. . # right upper extremity weakness, neck pain: exam inconsistent as reportedly able to perform tasks without weakness. mri demonstrated severe spinal stenosis, which may have been contributing to his pain and some right upper arm weakness. per this is a chronic condition and recommended outpatient follow-up with spine. . # anemia: normocytic. stable since admission. vitamin b12, folate normal. fe on low end of normal, ferritin not elevated, with low transferrin saturation suggestive of iron deficiency. hct was stable and he had no symptoms or signs of bleeding. started on iron supplementation. he was instructed to follow-up with his pcp for further management to have appropriate colon cancer screening with colonoscopy. . # superficial thrombophlebitis: pt had some right arm swelling at site of picc, found to have thrombosis of superficial vein. picc removed, pt treated symptomatically. . # htn: antihypertensives were initially held in the micu. on the floors he was hypertensive, and home medications were restarted: hctz 25 mg daily, hydralazine 100 mg po tid, amlodipine 5mg daily, and lisinopril 40mg daily. pt's bp better controlled after starting home meds. . # hld: pt was discharged on home dose of crestor. . transitional care: 1. code: full 2. follow-up - pcp psychiatry - spine 3. contact: ( (daughter) 4. medical management: - start aspirin 81mg, colace, ferrous sulfate, potassium for hypokalemia here with labs to be checked as outpatient on discharge - counseled on avoiding all illicits 5. barrier to rehospitalization: history of substance abuse, concern for non-compliance with follow-up 6. needs outpatient screening colonoscopy for concern of iron-deficiency anemia. medications on admission: pharmacy: , last filled there - coreg 25mg po bid - valproate er 500mg 2 tabs - fluoxetine 40mg daily - hctz 25mg daily - hydral 100 tid - imdur 30 daily - crestor 40mg daily - lisinopril 40 daily - amlodipine 5 daily - plavix 75 mg daily - remeron 45mg qhs - valium 5mg tab, tid:prn - fiorect-codeine 50-325 apap-40mg caffeine-30mg codeine - dilaudid 4mg tid:prn pain - morphine sulfate er 30mg - fentanyl patch filled 50mcg discharge medications: 1. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 2. crestor 40 mg tablet sig: one (1) tablet po once a day. 3. fluoxetine 40 mg capsule sig: one (1) capsule po once a day. 4. carvedilol 25 mg tablet sig: one (1) tablet po twice a day. 5. isosorbide mononitrate 30 mg tablet extended release 24 hr sig: one (1) tablet extended release 24 hr po daily (daily). 6. hydrochlorothiazide 25 mg tablet sig: one (1) tablet po once a day. 7. hydralazine 100 mg tablet sig: one (1) tablet po three times a day. 8. divalproex 500 mg tablet extended release 24 hr sig: two (2) tablet extended release 24 hr po bid (2 times a day). 9. amlodipine 5 mg tablet sig: one (1) tablet po daily (daily). 10. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 11. mirtazapine 45 mg tablet sig: one (1) tablet po at bedtime. 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day. disp:*30 tablet, chewable(s)* refills:*2* 13. docusate sodium 100 mg tablet sig: one (1) tablet po twice a day as needed for constipation. disp:*60 tablet(s)* refills:*0* 14. ferrous sulfate 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 15. outpatient physical therapy please evaluate and treat. 16. outpatient lab work please have chem 7 for electrolytes, bun/cr checked on and bring or fax results to primary care doctor, dr. , at . 17. potassium chloride 20 meq tablet, er particles/crystals sig: one (1) tablet, er particles/crystals po once a day. disp:*30 tablet, er particles/crystals(s)* refills:*2* discharge disposition: home discharge diagnosis: primary diagnoses: 1. seizure like activity 2. fevers 3. substance abuse 4. anemia 5. chest pain secondary diagnoses: 1. depression 2. anemia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , you were admitted to the hospital for seizure like activity. you were observed closely in the icu and required intubation. you were evaluated by and eeg was done, but showed no seizures. you also had fevers and were initially started on antibiotics, however, this was discontinued as there was no infection in the blood. you had chest pain, but the cardiac enzymes were normal and ecg was normal. you had some neck pain and right upper arm weakness, and mri showed some cervical spine narrowing. you should follow-up with spine specialists for this. you also had a small blood clot in one of your veins. you should use warm packs for this to help with the discomfort. you were evaluated by the physical therapists, who recommended outpatient physical therapy. the following medications were changed during this admission: - stop dilaudid, morphine, valium, vistaril, fiorcet-codeine, and fentanyl *** you had prescriptions for these medications prior to admission at . do not take these medications. - start aspirin 81mg by mouth daily - start ferrous sulfate 325mg by mouth daily - start docusate sodium 100mg by mouth twice daily **the ferrous sulfate (iron) can cause some constipation. the docusate is a stool softener that will help you have bowel movements. - start potassium chloride tablets 20meq by mouth daily **your potassium levels were low here. this medication is to help replace your potassium. please discuss this with your primary care doctor. you should have your labs checked at your appointment with her on tuesday of next week (, see below) to make sure that your potassium levels are normal. please continue all other medications you were on prior to this admission. it is important that you avoid all illicit drugs. these can be very harmful and even life-threatening to your health. it is very important that you make it to all your appointments. we tried to arrange for the ride for you. however, you will need to re-apply when you are discharged. in the mean time, please do make it to your appointments. this is very important for your long-term health. you were found to have anemia here. your iron was on the low normal range. we saw no evidence of bleeding here. however, you should discuss with your pcp further workup such as age-appropriate colon cancer screening with colonoscopy. followup instructions: please follow-up with the following appts: name: , location: route 44 medical address: 106 route 44, , phone: appt: at 11:45am ***note-at this appt please discuss with dr obtaining a psychiatrist for medication managemenet and counseling needs department: when: wednesday at 2:00 pm with: , md building: ks building (/ complex) campus: east best parking: garage department: spine center when: thursday at 10:00 am with: , md building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours enteral infusion of concentrated nutritional substances diagnoses: acidosis other chronic pain tobacco use disorder unspecified essential hypertension percutaneous transluminal coronary angioplasty status other and unspecified hyperlipidemia other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure iron deficiency anemia, unspecified fever, unspecified phlebitis and thrombophlebitis of superficial veins of upper extremities other and unspecified infection due to central venous catheter bipolar disorder, unspecified chest pain, unspecified spinal stenosis in cervical region epilepsy, unspecified, with intractable epilepsy arthrodesis status combinations of opioid type drug with any other drug dependence, unspecified cheyne-stokes respiration 

Answer: The patient is high likely exposed to