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: hydromorphone attending: chief complaint: confusion. major surgical or invasive procedure: lumbar puncture . history of present illness: pt presents from rehab today with headache and increased confusion at rehab. pt recently discharged on for an admission for headache and altered mental status. by the time of his arrival to the floor during that admission his mental status changes had essentially resolved and his headache was thought consistent with chronic headache he has had for at least a month. he had a ct scan during that admission, which was stable. . today, mr neuro-oncologist dr. got a call from rehab center reporting confusion. apparently the patient was forgetting the details of his recent hospitalization and confused as to where he was and where he had been. per his wife, he has not participated in rehab since his recent admission on and has been consistently confused at rehab. he also reported headache, which per the patient was unchanged from what he has been dealing with for months. this is bifrontal and throbbing in character. it has not improved with treatment for sinusitis with fluticasone. the patient also reports he is unsure of the details of his confusion and feels like he has been progressively improving. further details are not available at this time. the physician at rehab did not feel comfortable managing the patient so he was transferred in to . in the ed initial vs were t 97.3, p 96, bp 126/85, rr 18, o2 92% ra. he complained of chronic headache but had no other complaints he had a ct head, which was stable as well as cxr and ua. his ua showed very mild pyuria and thus he received po ciprofloxacin *1. he was evaluated by dr. in the ed who thought he appeared stable from his previous baseline and was ready to discharge him back to rehab but when the patient's wife reported more chronically altered mental status a decision was made to admit him for further work-up. . on the floor the patient cannot remember why he was transferred to but confabulates a story about needing to be brought here to have a bowel movement (likely due to apparently asking to defecate in the ambulance and being told he had to wait to get to ). he reports persistent headache. he reports his abdominal pain, which was an issue during his last hospitalization has improved. . ros: + per hpi as well as for weakness (chronic) that he thinks is improving denies fevers, chills, night sweats. denies change from chronic intermittent diploplia. denies neck pain or stiffness. denies chest pain, shortness of breath, wheezing, or cough. denies acute abdominal pain, nausea, vomiting, or diarrhea. denies any change in baseline weakness. denies dysuria or foul smelling urine. denies melena or hematochezia. denies vertigo. past medical history: glioblastoma multiforme, with following history -- headaches and leg weakness, ct at showed right temporal lobe mass-->started on dexamethasone. --: subtotal resection of the r temporal lobe mass by papavassilious path positive for gbm --: received involved field irradiation as well as temozolamide followed by four cycles adjuvant temozolomide -- ventriculoperitoneal shunt placement -- diagnosed with pe, started on lmwh -- procarbazine, ccnu, and vincristine (pcv) (received 2 cycles) --: prolonged hospitalization during which time he had pcp pna, /p pea arrest and flail chest from compression, placement of ivc filter for pe; discharged to course c/b c. difficile, esbl pna -: started bevacizumab . other past medical history - previous left knee cartilage operation - osteoporosis - epilepsy - steroid induced myopathy social history: previously an accountant. in rehab recently after prolonged hospitalization and deconditioning due to steroid myopathy. no history of tobacco or illicits. no history of problem alcohol. family history: father with cad in 40's and cabg*3 at 40 (but lived to 85). mother still living and has htn. one sibling with ptca for cad, other three siblings healthy. physical exam: admission exam: vs: t 96.8, bp 118/85, p 93, rr 20, o2 94% on ra heent: visible shunt under left side of scalp w/o surrounding redness or erythema, sclerae anicteric, mmm, op w/o lesions and no signs thrush cv: rrr, no m/r/g; no jvd appreciated pulm: poor respiratory effort bilaterally though limited by pt positioning as pulling to sitting on own, no adventitious sounds appreciated, respiratory movement equal bilaterally abdomen: mildly ttp diffusely (but less so then on admission 5 days ago), no guarding or rebound, no hsm or mass appreciated, bowel sounds normoactive extrem: w and wp, trace edema bilaterally neuro: alert and oriented *3, 5/5 strength in rue, 5-/5 in lue, 4-/5 hip flexors in rle, in lle, eom full and intact, mild asterixis? skin: diffuse ecchymoses and skin atrophy pertinent results: admission labs: wbc-5.6 rbc-4.16* hgb-13.8* hct-41.4 mcv-99* rdw-17.7* plt ct-279 ---neuts-63.1 lymphs-21.0 monos-13.7* eos-1.2 baso-1.1 glucose-89 urean-24* creat-0.7 na-138 k-4.2 cl-98 hco3-28 alt-50* ast-42* ld(ldh)-257* alkphos-95 totbili-0.3 albumin-4.1 calcium-9.7 phos-5.4* mg-2.2 valproa-91 ua: color-yellow appear-clear sp -1.025 blood-neg nitrite-neg protein-tr glucose-neg ketone-40 bilirub-neg urobiln-neg ph-5.5 leuks-sm rbc-2 wbc-4 bacteri-few yeast-none epi-0 . ct abdomen/pelvis: 1. no evidence of acute abdominal or pelvic processes. 2. bilateral common femoral and external iliac thrombus small amount of thrombus within the infrarenal ivc filter. new left common iliac vein thrombus is also noted. 3. stable bibasilar atelectasis and bilateral 4-mm lower lobe nodules. 4. hepatic steatosis. . ct head: 1. no acute intracranial hemorrhage, new mass effect, or shift of normally midline structures. 2. post-treatment changes in the right temporal lobe. 3. unchanged left ventriculostomy and slight ventricular enlargement. 4. unchanged right sphenoid and mastoid/middle ear sinus disease as described above. . cxr: port-a-cath is unchanged with catheter tip located in region of the right atrium. lung volumes are low with stable elevation of the right hemidiaphragm. vp shunt courses along the left chest wall into the upper abdomen. no definite signs of pneumonia or chf. no large pleural effusion or pneumothorax is seen. heart size cannot be assessed fully though appears grossly stable. mediastinal contour is unchanged. bony structures appear intact. . cxr: no pneumonia, edema or effusion. . 24 hour eeg: impression: this is an abnormal continuous icu monitoring study because of severe diffuse background slowing, indicative of severe diffuse cerebral dysfunction. background activity over the right hemisphere showed more severe focal slowing and occasional sharp waves over the right temporal region. these findings indicate a potentially epileptogenic focal structural lesion in the right temporal region. compared to the prior day's recording, there were no significant change. . cxr: impression: lung volumes remain very low with marked elevation of the right hemidiaphragm, chronic since at least . small accompanying right pleural effusion or pleural thickening is also stable. moderate cardiomegaly exaggerated by low lung volumes, unchanged. lungs grossly clear. right-sided central venous infusion port ends in the right atrium close to the tricuspid valve. . mri brain: impression: 1. increased enhancement demonstrated within the resection cavity, involving the parenchyma of the residual right temporal lobe and also extending in a nodular fashion in its lateral aspect suggestive of subpial involvement and, perhaps, progressive involvement of the overlying dura. the appearance suggests progression of disease since . 2. no separate foci of enhancement to suggest new sites of disease. no evidence of interval infarction. 3. expected continued evolution of blood products within the resection cavity, with no evidence of new hemorrhage. . discharge labs: : wbc 8.3, hb 10.8, hct 32.4, mcv 98, plt 185. : pt 13.5, inr 1.2, ptt 32.7. : retic 1.5. : na 144, k 3.8, cl 107, co2 25, bun 7, creat 1.1, glucose 94. : ca 8.4, phos 4.3, mg 1.8, fe 69, tibc 285, b12 1864, folate >20, ferritin 549, tsh 4.1. : am cortisol 3.7. : acth stim test at 0min 4.0, at 30min 17.8, at 60min 19.2. : h. pylori ab negative. : csf protein 178, glucose 42, ldh 56. brief hospital course: 56yo man with right temporal gbm s/p resection currently on bevacizumab, steroid-induced myopathy (bed bound), and chronic issues with delirium admitted for altered mental status and headache. transferred to icu after found unresponsive on the floor hypoxic, febrile to 104.0f, and having seizure-like activity. lumbar puncture was negative for infection. hypoxia and fever resolved, so he was transfered out of icu on iv valproate and antibiotics possible for aspiration pneumonia, though cxrs x2 and cultures were negative. eegs showed seizure activity at the site of tumor. brain mri showed progression of cns disease. family meeting with dr. confirmed transition to home hospice and comfort measures. . # seizure d/o and altered mental status: due to progression of disease. minimal improvement with valproate and lorazepam. tsh normal. csf negative, vdrl pending. mri showed progression of disease. continued valproate, changed to po because of iv med shortage and normal swallow eval. however, he did not take po very well because of acute delirium (waxing and ), but tolerated the liquid formulation. eeg prelim report showed improvement of the severe diffuse background slowing seen on the previous eegs and , but the focal slowing and occasional sharp waves over the right temporal region associated with his tumor remain unchanged. modafenil started without any response and therefore discontinued.pt was restarted on dexamethasone and mental status did improve, therefore pt d/c with dexamethasone and titration will done at the discretion of neuro-oncology. . # adrenal insufficiency: low am cortisol and borderline acth (cosyntropin) stim test is concerning for adrenal insufficiency. although he was at risk due to the long history of steroids, he did not require steroids in the recent acute illness in the icu. dexamethasone was stopped after very slow taper. with little down side to a trial of steroids especially considering progression of cns disease, dexamethasone 4mg iv q8hr was restarted . changed to liquid. . # hypoxia/fever: due to aspiration pneumonia vs. seizure. episode preceded by vomiting. however, cxrs x2 negative. lp negative. u/a negative. cultures negative. normal repeat bed-side swallow eval. po resumed, but with recurrence of vomiting. changed vancomycin and pip/tazo to clindamycin for aspiration pneumonia , avoiding penicillins that may lower seizure threshold. # vomiting: unclear etiology. likely due to cns progression of disease. started metoclopramide for possible gastroparesis. h. pylori ab negative.on d/c pt able to tolerate po and not complaining of nausea. . # gbm: s/p resection, currently maintained on bevacizumab. restaging mri showed progression of disease. neuro-oncology had a discussion with family and given evidence of both clinical progression and radiologic progression with poor performance status plan was to discharge patient to hospice care. . # thrombocytopenia: possibly drug-related. concerning meds included valproate, pip/tazo, vancomycin, heparin (flushes and sc). stable. coags normal, renal function normal. . # anemia: anemia labs unremarkable. stable. . # acute renal failure: resolved with iv fluids. . # abdominal pain: chronic since vp shunt was placed. ct unremarkable. continued analgesia prn. . . # fen: restarted regular diet with normal swallow eval. repleted hypokalemia. . # gi prophylaxis: continued outpatient ppi and bowel regimen. . # access: peripherals. . # precautions: seizure. . # code: dnr/dni. medications on admission: atovaquone 1500 mg po daily colchicine 0.6 mg po daily gabapentin 900 mg qam, 400 mg qafternoon, and 1200 mg qpm ibuprofen 600 mg tid prn lidocaine patch nystatin suspension qid ondansetron 4 mg q 8 hrs prn valproic acid 1250 mg po q8hrs apap 325-650 po q4hrs prn headache ascorbic acid 500 mg po bid ca carbonate 500 mg po tid mvi daily senna 1 tab po bid prn tramadol 50 mg po q4hrs prn fluticasone nasal spray esomeprazole 40 mg po daily alendronate 70 mg qweek potassium 20 meq daily loperamide 2 mg po daily prn vit d 400 mg po tid fluconazole 100 mg po daily florastor 250 mg po tid hctz 25 mg po daily methylphenidate 15 mg po daily heparin 5000 units sc tid albuterol nebs tid discharge medications: 1. lidocaine 5 %(700 mg/patch) adhesive patch, medicated : one (1) adhesive patch, medicated topical daily (daily). disp:*15 adhesive patch, medicated(s)* refills:*0* 2. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) neb inhalation q4h (every 4 hours) as needed for shortness of breath or wheezing. disp:*60 ml* refills:*0* 3. docusate sodium 50 mg/5 ml liquid : one hundred (100) mg po bid (2 times a day) as needed for constipation. disp:*600 ml* refills:*2* 4. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed for constipation. 5. acetaminophen 650 mg/20.3 ml solution : mg po q6h (every 6 hours) as needed for pain. disp:*1200 ml* refills:*2* 6. valproic acid (as sodium salt) 250 mg/5 ml syrup : 1500 (1500) mg po q8h (every 8 hours). disp:*1800 mg* refills:*0* 7. ondansetron 4 mg tablet, rapid dissolve : tablet, rapid dissolves po q8h (every 8 hours) as needed for nausea. disp:*30 tablet, rapid dissolve(s)* refills:*0* 8. dexamethasone 1 mg/ml drops : four (4) mg po three times a day. disp:*120 ml* refills:*0* 9. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (). disp:*30 tablet,rapid dissolve, dr(s)* refills:*0* 10. vancomycin 125 mg capsule : one (1) capsule po q6h (every 6 hours). disp:*56 capsule(s)* refills:*0* discharge disposition: home with service facility: seasons hospice discharge diagnosis: 1. altered mental status. 2. headache. 3. glioblastoma multiforme (brain cancer). 4. nausea/vomiting. 5. hypoxia (low oxygen). 6. seizures. 7. pneumonia. 8. fever. 9. steroid-induced myopathy (muscle weakness). discharge condition: mental status: confused - sometimes. level of consciousness: lethargic but arousable. activity status: bedbound. discharge instructions: mr was admitted to the hospital for altered mental status and headache. in the hospital, he was found on the floor with low oxygen and seizure activity. he was transfered to the intensive care unit (icu) and started on antibiotics for a possible aspiration pneumonia. he also had a lumbar puncture (spinal tap), which did not show an infection. chest x-rays and cultures have not revealed any infection.the low oxygen levels improved, and mr was transfered out of the icu. however, he continued to have confusion. eegs measuring brain waves showed chronic seizure activity in the region of the brain tumor. a brain mri showed progression of the tumor, the likely cause of confusion and seizures. because of continued progression of disease avastin treatment was discontinued and care now focusing on keeping patient comfortable.mr did develop an increase in bowel movements and because of prior history of clostridium difficile colitis stool cultures were obtained and patient was started on oral vancomycin empirically. at the time of discharge stool for c.diff is still pending.pt being discharged with home hospice services. changes in medications: decadron was restarted -please contact dr for titration of decadron dose. valproic acid dose increased oral vancomycin started gabapentin, heparin sq , colchicine, atovaquone,aspirin, fluconazole -discontinued. pending results on d/c: stools for c.dif vdrl to evaluate for neuro-syphilis ( although not highly likely) followup instructions: please contact dr for any question or concerns. procedure: spinal tap incision of lung diagnoses: pneumonia, organism unspecified adrenal cortical steroids causing adverse effects in therapeutic use acute kidney failure, unspecified candidiasis of mouth hypopotassemia osteoporosis, unspecified epilepsy, unspecified, without mention of intractable epilepsy personal history of venous thrombosis and embolism abdominal pain, other specified site altered mental status headache encounter for palliative care do not resuscitate status personal history of antineoplastic chemotherapy personal history of irradiation, presenting hazards to health presence of cerebrospinal fluid drainage device nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] malignant neoplasm of temporal lobe other nonspecific findings on examination of urine other myopathies 

Answer: The patient is high likely exposed to