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: hyperglycemia noted at major surgical or invasive procedure: picc line placement history of present illness: 73m, h/o seizures, cva with l sided deficits, htn, peg for dysphagia, ems reported that mental status is near baseline according to (localizes to pain), dnr/dni, sent to ed because at , noted to be lethargic and had fsbg of 800. not a known diabetic and no treatment for this was given at . chem7 showed elevated cr, na, glc, and wbc, so he was sent to . ems witnessed a tonic clonic seizure, 2-3 minutes, seizure activity broke by the time iv access was obtained, and then brought him to ed. on arrival to ed, did not open eyes, now moves arms somewhat and opens eyes. blood sugar 774, given insulin 10 iv x2, then on drip at 10 for first hour, now on 15, b/c sugar is still critically high. 3rd l of ns hanging now. also febrile to 102.6 on arrival. cxr clean, urine clear. abd soft, nontender. blood and urine cultures sent. given vanc and ctx empirically. at time of transfer, t102, hr 120s (sinus), bp 110s, o2 sats 95-97% on 2l rr 18. ros: pt unable to provide past medical history: strokes from ruptured intracerebral aneurysms in and or with residual left sided deficits (has not been able to walk since the stroke in ') and aphasia, peg for dysphagia h/o seizure do dementia htn h/o hepc hepatitis, apparently not active h/o neurosyphilis, treated in hypothyroidism social history: nursing home resident () since . sent here with no personal belongings. family history: noncontributory physical exam: vitals: t: 98.1 bp:113/66 hr:114 rr:23 o2sat:99%2l gen: chronically ill appearing elderly african american man heent: eomi, surgical pupils with gaze fixed to patient's right, sclera anicteric, no epistaxis or rhinorrhea, mm dry, op clear neck: supple, able to passively touch chin to chest. no jvd, carotid pulses brisk, no bruits, no cervical lymphadenopathy, trachea midline cor: ii/vi early systolic murmur at rusb, normal s1 s2, radial pulses +2 pulm: lungs ctab, no w/r/r abd: soft, nt, nd, +bs, no hsm, no masses ext: no c/c/e, no palpable cords neuro: neg kernig's and brudzinski. nonverbal. cn ii ?????? xii grossly intact. moves r arm, l hand contractured. muscle wasting throughout. skin: spotchy hypopigmentation on chest. no jaundice, cyanosis, or gross dermatitis. no ecchymoses. pertinent results: chest (portable ap) study date of : upright ap view of the chest: the heart size is normal. the aorta is mildly unfolded. pulmonary vascularity is normal. hilar contours are within normal limits. the lungs demonstrate low inspiratory volumes, but otherwise are clear. no pleural effusions or pneumothorax. thoracic scoliosis convex to the right is again demonstrated. impression: no acute cardiopulmonary abnormality. ct head w/o contrast study date of : findings: there is no hemorrhage, hydrocephalus, shift of normally midline structures, or evidence of acute major vascular territorial infarct. the -white matter differentiation is preserved. hypodensities in the periventricular and subcortical white matter reflect chronic microvascular ischemic change. right frontal and left parieto-occipital lobe encephalomalacia is compatible with old infarcts. tiny hypodensities in the right subinsular region is consistent with lacunes. the ventricles and sulci are prominent, compatible with age- related involutional change. there has been a right frontal craniotomy. the visualized paranasal sinuses and mastoid air cells are normally aerated. the surrounding soft tissues are unremarkable. impression: no intracranial hemorrhage. chest (portable ap) study date of : low lung volumes. the tip of the picc line remains unchanged. no failure or infiltrates are seen. impression: no pneumonia. admission laboratory work: 07:20pm blood wbc-16.3* rbc-5.04 hgb-15.0 hct-46.5 mcv-92 mch-29.8 mchc-32.3 rdw-12.6 plt ct-175 07:20pm blood neuts-80.2* lymphs-11.2* monos-7.8 eos-0.1 baso-0.5 07:20pm blood glucose-774* urean-48* creat-2.1* na-158* k-3.6 cl-120* hco3-20* angap-22* 07:20pm blood pt-15.5* ptt-33.8 inr(pt)-1.4* 07:20pm blood calcium-10.1 phos-5.3* mg-2.4 07:20pm blood phenyto-3.8* 07:14pm blood glucose-greater th lactate-9.5* cardiac enzymes: 01:00am blood ck-mb-7 ctropnt-0.04* 05:00am blood ck-mb-8 ctropnt-0.04* 11:23am blood ck-mb-10 mb indx-0.2 ctropnt-0.02* 06:07pm blood ck-mb-10 mb indx-0.1 ctropnt-0.02* cpks: 01:00am blood ck(cpk)-1754* 05:00am blood ck(cpk)-2635* 11:23am blood ck(cpk)-5212* 06:07pm blood ck(cpk)-6733* 04:00am blood ck(cpk)-5812* microbiology: stool clostridium difficile toxin a & b test-pending mrsa screen mrsa screen-pending urine urine culture-final (no growth) blood culture blood culture, routine-pending blood culture blood culture, routine-pending brief hospital course: micu course: # fevers/elevated wbc: cxr clear at presentation. urine clear except for high glucose. abdomen was soft and non-tender with no rebound at presentation. no signs of ruq pathology/cholecystitis on lfts. history of seizures raised suspicion for cns infection, although no signs of meningismus on exam; family refused lp to conclusively rule out meningitis. regardless, patient was treated empirically in first 24 hours with acyclovir, vancomycin, ampicillin, and ceftriaxone at meningitis dosing. on morning of , culture data and clinical signs remained unrevealing, and with no specific source of infection identified, on , ceftriaxone was stopped as well. # hyperosmolar hyperglycemic state: hyperglycemic to 774 at presentation with hypernatremia to 158 (corrected for elevated glc, corrna was 169). likely hhs (no ketones in urine, so unlikely dka). catalyst is likely infectious process. hyperglycemia resolved within 12 hours of presentation. initially treated with insulin gtt, and given his high insulin requirement, d5 1/2ns as well, and then transitioned to subcutaneous insulin on . nutren pulmonary full strength tube feedings were started on , at nutrition's recommendation, and although pt had been on nocturnal cycled tube feeds at his nursing home, and nutrition consults recommended round the clock tube feedings to simplify blood sugar management. he will therefore receive lantus + riss for euglycemic control. # hypernatremia: goal was to decrease sodium 12 meq in 24 hrs. from evening presentation on to evening of , sodium went from 158 to 162. on morning of , patient's fluids. he continued to receive tube feeds with q6h 250 ml free water flushes, and na was down to 148 on . # acute renal failure: cr was 1.8 on arrival. likely was prerenal. creatinine resolved quickly to 0.7 by morning of . # hypertension: antihypertensives held at presentation due to concern for dehydration and impending sepsis, but since he has been stable, on , lisinopril 5mg (home dose was 40mg) and metoprolol 50mg (was on 100mg at home). # seizure disorder: has history of seizures and upon admission had seizure in setting of fever and dilantin level of 3.8; not clear when last seizure was. still unsure if meningitis was present but without lp cannot know this. reloaded with 500mg dilantin iv x 2 and am dilantin level on was supratherapeutic at 28; however, this was not a trough level. a true trough was taken on morning of and was 13.8. # constipation: patient was without bm from admission to morning of and had evidence of stool-filled colon on cxr. lactulose was given on until patient stooled in the afternoon. medicine floor course: the patient was evaluated by the service and his insulin regimen was titrated. new service recs recommended reverting his tube feeds back to his nocturnal tube feeds and titrating his insulin regimen to that schedule. the patient's lantus was titrated to 10 units qam with a lispro sliding scale. the patient will need close further insulin titration on an outpatient basis. no clear etiology for the patient's fevers and leukocystosis was discovered (family had refused lp). perhaps there was a viral infection. the patient's bp meds were uptitrated to his home regimen with strict holding parameters on discharge. would continue prior tf regimen. medications on admission: lisinopril 40mg daily metoprolol 100mg hydralazine 50mg qid milk of magnesia dilantin 25mg colace liquid 100mg discharge medications: 1. lisinopril 40 mg tablet sig: one (1) tablet po once a day. 2. milk of magnesia 400 mg/5 ml suspension sig: thirty (30) cc po qmwf: resume prior dosage and frequency of this med. 3. phenytoin 50 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day): increased from 25 mg po bid. 4. metoprolol tartrate 100 mg tablet sig: one (1) tablet po twice a day: hold for sbp< 100, hr<55. 5. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day): hold for diarrhea. 6. hydralazine 50 mg tablet sig: one (1) tablet po four times a day: hold for sbp<100. 7. acetaminophen 160 mg/5 ml solution sig: ten (10) ml po q6h (every 6 hours) as needed for pain. 8. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection injection tid (3 times a day). 9. lantus 100 unit/ml solution sig: ten (10) units subcutaneous qam. 10. humalog 100 unit/ml solution sig: one (1) unit subcutaneous at meals: administer per sliding scale. discharge disposition: extended care facility: - discharge diagnosis: hyperosmolar hyerglycemic state seizure acute renal failure fevers, leukocytosis hypernatremia discharge condition: vital signs stable discharge instructions: patient to retrun to ed if he is having consistently elevated blood sugars>500 that do not improve with sliding scale insulin, fevers, rigors, hypotension, seizures. followup instructions: patient to f/u with urban med pcp 1 week. will be followed at . procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances diagnoses: thrombocytopenia, unspecified acute kidney failure with lesion of tubular necrosis unspecified essential hypertension chronic hepatitis c without mention of hepatic coma unspecified acquired hypothyroidism other persistent mental disorders due to conditions classified elsewhere constipation, unspecified late effects of cerebrovascular disease, hemiplegia affecting unspecified side epilepsy, unspecified, without mention of intractable epilepsy fever, unspecified diabetes mellitus without mention of complication, type ii or unspecified type, uncontrolled hyperosmolality and/or hypernatremia late effects of cerebrovascular disease, aphasia rhabdomyolysis leukocytosis, unspecified gastrostomy status nonspecific abnormal electrocardiogram [ecg] [ekg] other late effects of cerebrovascular disease, dysphagia dysphagia, unspecified unspecified erythematous condition 

Answer: The patient is high likely exposed to