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 / keflex attending: chief complaint: altered mental status major surgical or invasive procedure: none history of present illness: 38 y/o woman with sle, htn, presenting with tremors and confusion since . on admission, the patient was extremely confused and a poor historian. per discussion with the pt's sister by the primary admitting team, the patientt had been feeling tired, confused, lethargic, reporting occ fevers and chills, also with signifcant word finding difficulty. seen by neuro in er. concern is mainily toxic metabolic--?meningitis (possibly fungal given long-term prednisone use). tox screen (urine/serum) neg, blood cx, urine cx pending. past medical history: pulm htn, sle: rash, arthritis, nephritis (on cytoxan/steroids), (recent flare ), ttp (s/p splenectomy ', tx w/plasmapheresis in past), apla on coumadin (h/o dvt), s/p splenectomy, alpha thalasemmia, hgb c social history: lives alone, no tob, occ etoh, no ivdu; worked previously as a systems analyst, but now on disability for her brother family history: 4 sisters, 1 brother: 1 sister w/ colitis 1 sister w/ arthritis (unknown type) 1 sister w/ thyroiditis physical exam: exam on admission (per medicine team): 190's sbp, alert and oriented to person/place. over course of day she had worsening mental status, not able to follow commands, echolalia. pe t 102 p120 bp150/110 rr 24 pox 97%/ra gen - thin african american f lying in bed, nad but appears anxious heent - perrla, not able to follow commands for eom; no scleral icterus, mmm neck - supple, no lad cv - nl s1 s2 tachy rrr no m/r/g pulm - cta bilat, no wheezes/rales abd - + bs, soft nt/nd, no hsm ext - no edema, warm, thin, no palpable cords neuro - echolalia, only able to follow some commands, no hyperreflexia pertinent results: on admission: cbc- wbc 2.0, hgb 10.4, hct 33.2, plat's 482 chem 7- na 133, potassium 5.0, chloride 101, bicarb 20, bun 54 cr 1.8 , glucose 144 ptt 39.2, inr 3.9 urine: nitrates neg, luek's neg, protein 500, glucose neg. blood tox screen: neg tsh 2.0 ammonia 32 on transfer from micu: cbc: wbc-3.3, hgb 10.5, hct 35.7, plat's 401 chem 7: na 135, k 4.2, cl 105, bicarb 19, bun 35, cr 1.1 glucose 83 ca- 8.6, phos 4.4 , mag 2.7 inr 1.4, ptt 67.7 hsv from csf negative complement levels: c3-74, c4-25 on transfer back to the floor: 09:05am blood glucose-102 urean-53* creat-1.7* na-131* k-4.2 cl-100 hco3-20* angap-15 05:50am blood glucose-106* urean-43* creat-1.1 na-136 k-4.3 cl-106 hco3-19* angap-15 04:00pm blood c3-74* c4-25 02:00am blood tsh-2.0 10:00am blood ammonia-32 02:00am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg brief hospital course: admitted to general medicine service: consults- 1) neuro: found to be confused, lack of anterograde memory, disorientation, inattention; ddx included vascular abn (but not explained by mri finding of acute l corpus callosum stroke), uremia, vit b deficiency, "infection" -lp, labs, infection screen tox screen, eeg for , goal sbp 140/90s 2) renal: pre-renal azotemia in acute illness, sle flare, ? ttp; -u lytes, fena, u osm, u pr/cr ratio; volume challenge w/ns 1l 3)rheum eval: ddx of delta ms cerebritis, apa syndrome causing stroke, infection, uremia, steroid toxicity (less likely) course- transfused with 4 u ffp to correct inr for lp; multiple lp attempts unsuccessful by floor team/attg; plan for neuro to try this pm. pt empirically started on ctx 2gm iv, vanco 1gm iv, acyclovir 5mg/kg iv. pt w/worsening mental status, difficult to control htn and lack of adequate iv access -> xfer to icu for closer monitoring and w/u. ms.s's ams and renal function improved over the next 2 days and she was transferred back to the floor. 1)ams--ms.s presented with worsening confusion, difficulty with word finding, and echolalia. the differential diagnosis was initially meningitis of infectious etiology, cerebritis, stroke secondary to apla, or toxic metaboloic encephalopathy. lp came back negative and her abx were stopped. mri showed evidence of acute infarction in the corpus callosum, but nothing that would explain her symptomatology. eeg report: possibly normal eeg but the excessive amount of drowsiness and sleep in this record raises the suspicion of an early diffuse encephalopathy. cerebritis was considered less likely, as she had been on 60 mg of prenisone when the ams occurred, she had never had neuro presentation of a flare, and her behavior did not fit in the classic description of cerebritis and her c3 and c4 levels were only slightly decreased. toxic-metabollic encephalopathy to bactrim is the most likely explanation, as the only real intervention that was done between time of presentation and time of resolution was to withhold bactrim pcp prophylaxis and bactrim encephalitis has been described in the literature. one other possibility is that the ams was secondary to ms.s's htn; however, her bp was never at a level to charaterize it as a hypertensive emergency. it was noted, though, that on several occasions, ms.s's behavior seemed a bit altered and at these times, her bp was in the 110/160 range. at the time of this dictation, the etiology of her ams remains unclear. neurology was re-consulted to determine whether a repeat eeg was indicated and psych was consulted to evaluate whether mrs. was competent to make medical decisions. 2) nephritis--ms.s has grade iv nephropathy by biospy on a prior admission. at presentation, she was in acute renal insufficiency, with cr of 1.8. she was found to be pre-renal, as it corrected to 1.1 with fluid administration. she was kept on 60mg prednisone throughout her stay and received her monthly pulse cytoxan prior to d/c. nephrology was consulted and followd the course of her hospitalization. it was thought that her kidneys were very sensitive and hydration, renal dosing, and continuing prednisone and cytoxan were the most appropriate measures to undertake. 3) apla--because ms.s has anti-phospholipid antibody syndrome, she was anticoagulated on heparin then lovenox and bridged to coumadin. ms.s was discharged on 7.5mg coumadin and is to follow-up with her pcp on , to adjust her regimine. her mri showed evidence of micro-infarction, likely related to her apla, she has had a dvt in the past, and there is a mention of pulmonary htn that may be related to small pe's that did not require medical intervention, all of which suggest fairly aggressive anti-coagulation to a goal inr of .5. 4) hypertension--ms.s's bp was difficult to control. initially, she was on her home meds of lopressor 50qd and hctz 12.5 qd. in the micu she was sitched to hydralazine. when she returned to the floor, her bp was labile with a range ot 130's/80's to 160's/110's. the metoprolol was increased to 75bid and norvasc 5 mg qd was added, with the possibility fo increasing to 10qd. she tolerated this regimen and remained in the...range throughout the duration of her stay. 5) leukopenia--ms.s's wbc ranged from the high 2.0's to the low 4.0's. it was thought that this was related to either the cytoxan or sle. as her wbc were stable for several days prior to scheduled cytoxan treatment, she received her dose as scheduled. medications on admission: prednisone 60, cytoxan, metoprolol, bactrim, coumadin, folate protonix 40, ca, vit d, alendronate, nacitrate, norvasc 5, hctz discharge medications: 1. thiamine hcl 100 mg tablet sig: one (1) tablet po qd (once a day). :*30 tablet(s)* refills:*2* 2. folic acid 1 mg tablet sig: one (1) tablet po qd (once a day). :*30 tablet(s)* refills:*2* 3. multivitamin capsule sig: one (1) cap po qd (once a day). :*30 cap(s)* refills:*2* 4. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). :*30 tablet, delayed release (e.c.)(s)* refills:*2* 5. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po tid (3 times a day). :*90 tablet, chewable(s)* refills:*2* 6. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po qd (once a day). :*30 tablet(s)* refills:*2* 7. alendronate sodium 5 mg tablet sig: one (1) tablet po qd (once a day). :*30 tablet(s)* refills:*2* 8. sodium citrate-citric acid 500-334 mg/5 ml solution sig: thirty (30) ml po bid (2 times a day). :*1800 ml(s)* refills:*2* 9. prednisone 20 mg tablet sig: three (3) tablet po qd (once a day). 10. amlodipine besylate 5 mg tablet sig: one (1) tablet po qd (once a day). :*30 tablet(s)* refills:*2* 11. metoprolol tartrate 25 mg tablet sig: three (3) tablet po bid (2 times a day). :*180 tablet(s)* refills:*2* 12. lovenox 60 mg/0.6ml syringe sig: one (1) injection subcutaneous twice a day for 6 doses: as directed by a physician. :*6 injections* refills:*0* 13. warfarin sodium 7.5 mg tablet sig: one (1) tablet po hs (at bedtime). discharge disposition: home with service facility: discharge diagnosis: primary: 1. acute change in mental status. 2. new hyperintensity on mri in corpus callosum c/w cva. secondary: 1. systemic erythematosis. 2. class iii diffuse proliferative glomeronephritis. 3. nephrotic syndrome. 4. antiphospholipid antibody syndrome. 5. itp s/p splenectomy. 6. ttp/microangiopathic hemolytic anemia. 7. hemoglobin c variant. 8. anemia of chronic disease. 9. immunosuppresion: high dose prednisone and cytoxan. 10. hypertension. discharge condition: good. discharge instructions: please return to hospital for worsening pain, confusion, muscle/joint aches, chest pain, fever, or any other serious complaints. please follow-up with dr. on wed to get your inr checked if not theraputic today. we will call today regarding inr instructing whether to take lovenox. follow up on at the clinic for your cytoxan treatment. followup instructions: please follow-up with dr. on at 10:15am. provider: , rn where: hematology/oncology phone: date/time: 9:00 provider: 2 date/time: 9:00 provider: , md where: lm phone: date/time: 4:00 provider: . , clinic date/time: 1:30 md, procedure: venous catheterization, not elsewhere classified spinal tap incision of lung transfusion of packed cells diagnoses: systemic lupus erythematosus anemia in chronic kidney disease nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere unspecified essential hypertension acute kidney failure, unspecified cerebral artery occlusion, unspecified with cerebral infarction other thalassemia other non-autoimmune hemolytic anemias 

Answer: The patient is high likely exposed to