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: frequent seizures major surgical or invasive procedure: none history of present illness: 86f with a pmh of seizure disorder (gtc in none since) on keppra likely secondary to hemorrhagic left parieto-occipital iph (although imaging suggests left frontal) in , symptomatic bradycardia and syncope s/p ppm, dementia, chronic c. difficile, htn, hld is emergently transferred to the neuro icu after uncontrolled focal and secondarily generalised seizures. the patient presented to the ed on after multiple episodes of generalized shaking at home without loss of consciousness, reportedly while lying in bed. episodes noted to be 30 second to 1 minute and per previous neurology documentation, she stated that she remembers these events happening, but is generally a poor historian. these events were reported to md (patient's pcp, by caregiver who recommended that patient be evaluated in the ed. per report, one of the episodes may have resulted in a fall. patient has had a recent history of falls and was seen by np on regarding two prior falls on . she underwent evaluation including cbc and bmp which were unremarkable, and ua demonstrating 63 wbcs and few bacteria. note from that visit, reports caretaker describing "gross tremors and shaking of the right arm. this evidently had happened several times." as well, the patient reported right lower extremity as well as soreness of the upper arms since her falls. on presentation to the ed, she was not experiencing any episodes of shaking, but was unable to give a clear history of the events. in the ed, her ua was repeated and was floridly positive with 90 wbcs, positive nitrites, many bacteria and was treated for uti with ceftriaxone iv. it was felt to be unclear at that time whether she was having seizures versus rigors. she also underwent a r knee film given fall, reports of pain, and notable ecchymoses distal to her tkr which was negative for any acute finding. as well, ecg demonstrated new twi in v1,v2-v3 and she had initial tnt of 0.03. given unclear history and presence of uti, patient was admitted to the geriatrics service. neurology were consulted on given concern for continued seizures. in her initial medicine documentation, this described an "episode of shaking movements, during which she was fully alert and conversant for roughly 30 seconds and showed no signs of increased confusion afterward". this likely represents a focal motor seizure. apparently, per pcp, . has experienced episodes of arm shaking in the past in the setting of uti, which resolve after antibiotic treatment. she continued to have episodes of "jerking" of her bilateral extremities with preservation of consciousness. these episodes again lasted for less than a minute each. on the description by neurology, the patient had distinct episodes of rhythmic jerks of her legs bilaterally (r>l) lasting ~1 minute. she describes a "funny feeling, like the air is moving" which occurs seconds before the jerks begin. each event began with extension of the r leg and on one occasion progressed to involve the r arm. she retained consciousness during each episode and was able to state her name and converse. however, after each episode, she was noted to have weakness of her entire right side (not the face) with dysarthric speech. neurology recommendations were to obtain a non-contrast head ct to r/o recurrent intraparenchymal hemorrhage which showed stable encephalomalacia in the left frontal lobe without new changes and to give a loading dose of levetiracetam 500mg iv x1 in addition to increasing levetiracetam maintenance to 1000mg po bid and starting the patient on eeg ltm. she unfortunately did not get her keppra doses until after midnight as she lost iv access as is described below. the patient was started on ltm and at that time, and i was called by dr , epilepsy icu attending at 21:15 that the technician had noted seizure activity every 15 minutes with focal jerking of her right leg>arm and had recorded a sample (as eeg not networked) which showed clear seizure activity. i reviewed the patient and during my assessment, she was still having frequent partial seizures. eeg showed left frontal (f4) and fz-cz phase reversing sharp waves and before seizure fz-cz fast activity leading to rhythmic cz epileptiform discharges and left frontal sharp waves then followed by right frontal delta slowing - in between background 7-8hz. clinically she had trembling of the right leg followed by focal right leg >> arm jerking and right gaze deviation but with retained consciousness partially at that point. patient was not greatly responsive but could move symmetrically and say a few words significantly confused at that time. i alerted the medicine resident and advised to give another 500mg iv keppra in addition to increased dose at 1000mg . unfortunately the medical team had great difficulties placing an iv (had been lost prior to giving her the increased keppra dose). patient was given keppra eventually after midnight (after eventually getting iv access) but at that time was having frequent focal seizures (one of the neurology nurses was working as a float) having 5 focal seizures since midnight when she came on shift. she was given 3 total doses of iv lorazepam 0.5mg throughout the day. she then started having secondarily generalised events after 0200 (she had 3 witnessed by the nurse) and was triggered on the medical floor. the semiology per report was head turning to the right and forced right gaze deviation. when i assessed the patient i witnessed one of these episodes where she had minimal left leg jerking but primarily on the right with head turn to the right, right gaze deviation and patient was unresponsive lasting just less than 30 seconds. eeg showed generalised spike and wave discharges (although given that a few of the leads had come off this was somewhat more difficult) and then latterly showed generalised delta slowing and primarily pleds 1-2hz in the cz/pz leads and occasional sharp waves scattered bilaterally. given her continued uncontrolled seizures, the patient was transferred to the neuro icu under dr and orders were put in to give iv lorazepam only for significant generalised seizures *to avoid intubation) and loading with 20mg/kg fosphenytoin and starting standing 100mg q8h. patient had a further focal motor seizure lasting 30s in the icu with retained consciousness. patient was drowsy but arousable and verbalising but very confused. she had likely right-sided paresis mostly affecting the right arm which was moving much less spontaneously and the right leg was much less affected. patient denied pain but given mental status was not able to obtain full ros. past medical history: - seizure disorder after loc in and had witnessed gtc seizure during inpatient hospitalisation / on keppra well controlled felt likely hemorrhagic stroke no breakthrough seizures documented since - syncope s/p ddd pacemaker placement ( pacemaker, sensia sedr01) for symptomatic bradycardia and syncopal episodes last checked (underlying intrinsic rhythm is sinus rhythm) - htn - hld - left parietal-occipital iph (although imaging suggests left frontal) - per previous documentation, was on plavix since for ?vague sx's of tia. in had parietooccipital hemorrhagic stroke in the setting of hypertension and medication noncompliance. plavix d/c'd. has cognitive deficit and peripheral field cuts as a result. - chronic c difficile colitis x3 episodes currently on po vancomycin - alzheimer's dementia mmse 15/30 on on donepezil - depression - gerd - hard of hearing - urinary incontinence - vitamin d deficiency - oa knees social history: the patient lives on the second story of a two-family home with her husband, . she has six children. she is a high school graduate and was a homemaker. denies alcohol or smoking. reports to home assistants, one in the morning and one in the afternoon every day who help make meals. she has help 8:00 a.m. to 4:00 p.m. eats regular diet with stable weight. per previous documentation, independent with her adls, assistance with iadls. is a daughter who is very involved. family history: per previous documentation significant for heart disease, hypertension, and depression. physical exam: physical exam on admission to icu: vitals: t:97.3 p:782 r:20 bp:120/70 sao2:97% ra general: drowsy but rousable, confused but moving all 4 limbs symmetrically. latterly she had evidence of right . heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple, no carotid bruits appreciated. no nuchal rigidity. pulmonary: clear but decreased breath sounds right base. cardiac: rrr, nl. s1s2, soft esm. abdomen: soft, nt/nd, normoactive bowel sounds. extremities: no c/c/e bilaterally, 2+ radial, dp pulses bilaterally. calves snt bilaterally. skin: no rashes or lesions noted. neurological examination: - mental status: patient was drowsy and confused and on occasion was able to say her name but other times said a different name. she was verbalising except when she had the secondarily generalised seizures as decsribed above. she was not oriented to place or time. she was drowsy and was not able to cooperate with further mental staus testing. obeys simple commands. - cranial nerves: i: olfaction not tested. ii: mild anisocoria right 2.5mm left 2mm and both reactive. blinks to threat bilaterally. funduscopic exam reveals no papilledema or hemorrhages but technically challenging exam due to patient cooperation. iii, iv, vi: eomi without nystagmus. v: facial sensation intact to light touch. good power in muscles of mastication. vii: no facial weakness, facial musculature symmetric. viii: hearing intact to voice bilaterally. ix, x: palate elevates symmetrically - obeys commands. : 5/5 strength in trapezii and scm bilaterally. xii: tongue protrudes in midline with normal velocity movements. - motor: normal bulk, tone throughout. no pronator drift bilaterally. no adventitious movements, such as tremor, noted. no asterixis noted. patient initially earlier in the evening had good symmetrical purposeful movements however latterly had right arm>>leg following her frequent focal seizures. patient had brisk withdrawal on the left arm and leg but on the right had slight withdrawal in the right arm and reduced withdrawal (but much better than the arm) in the right leg but unable to get antigravity. - sensory: grimaces to noxious throughout. notes that she can feel light touch all 4 limbs. - dtrs: throughout. there was no evidence of clonus. negative. plantar response was extensor bilaterally. - coordination: no intention tremor or ataxia on spontaneous movements but unable to formaly test. - gait: unable to assess. last day ph/ex: awake, drowsy, oriented to person and place but not to time(m/d/y), cranial nerve intact, no tremor,bilateral spastisity pertinent results: 10:41am glucose-98 urea n-14 creat-1.0 sodium-142 potassium-4.3 chloride-107 total co2-24 anion gap-15 10:41am ck(cpk)-197 10:41am ck-mb-4 ctropnt-<0.01 10:41am calcium-9.4 phosphate-3.1 magnesium-2.1 01:49am lactate-2.6* 01:39am urine color-straw appear-hazy sp -1.008 01:39am urine blood-neg nitrite-pos protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-lg 01:39am urine rbc-2 wbc-90* bacteria-many yeast-none epi-<1 trans epi-<1 01:39am urine mucous-rare 01:30am glucose-99 urea n-20 creat-1.1 sodium-138 potassium-4.2 chloride-102 total co2-23 anion gap-17 01:30am ck(cpk)-209* 01:30am ck-mb-5 ctropnt-0.03* 01:30am wbc-8.2 rbc-4.12* hgb-12.8 hct-38.3 mcv-93 mch-31.0 mchc-33.4 rdw-12.0 01:30am neuts-69.9 lymphs-20.7 monos-4.3 eos-4.6* basos-0.5 01:30am plt count-342 11:35am urea n-18 creat-1.1 sodium-143 potassium-4.0 chloride-104 total co2-24 anion gap-19 11:35am estgfr-using this 11:35am calcium-10.1 11:35am wbc-8.4 rbc-4.20 hgb-13.0 hct-39.5 mcv-94 mch-31.0 mchc-33.0 rdw-13.0 11:35am plt count-351 11:35am urine color-yellow appear-hazy sp -1.012 11:35am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.5 leuk-lg 11:35am urine rbc-1 wbc-63* bacteria-few yeast-none epi-2 ecg : sinus rhythm. poor r wave progression with t wave inversion in leads v1-v2. cannot exclude a septal infarction of indeterminate age. non-specific t wave inversion in lead avl. very slight non-specific inferior st elevation. cxr : frontal and lateral views of the chest demonstrate low lung volumes without pleural effusion, focal consolidation or pneumothorax. mild perihilar vascular congestion is noted. heart size is normal. there is no pulmonary edema. small opacities in the left lower lobe best seen on the lateral view may reflect aspiration. pacemaker leads project over right atrium and right ventricle. compression deformities of mid thoracic vertebral bodies are unchanged. knee xr : three non-standing views of the right knee show a normal three-part tkr with cemented components. no fracture, bone destruction and appearances unchanged from similar exam . ct head : impression: 1. no acute intracranial abnormality. 2. stable encephalomalacia in the left frontal lobe, likely the sequela of prior infarction. 3. stable sequelae of chronic small vessel ischemic disease and age-related atrophy. cxr : semi-upright portable chest radiograph is obtained. newly placed dobbhoff tube is seen with tip curled within the fundus of the stomach. the lungs are low in volume with minimal left basal atelectasis. cardiomediastinal contours are unchanged. no pneumothorax is seen. dual-lead pacemaker is seen with leads in expected location of right atrium and right ventricle. 07:15am blood wbc-9.3 rbc-3.58* hgb-11.2* hct-34.3* mcv-96 mch-31.2 mchc-32.5 rdw-12.8 plt ct-401 07:15am blood wbc-9.3 rbc-3.58* hgb-11.2* hct-34.3* mcv-96 mch-31.2 mchc-32.5 rdw-12.8 plt ct-401 07:15am blood plt ct-401 06:20am blood glucose-85 urean-24* creat-1.0 na-137 k-5.0 cl-101 hco3-22 angap-19 07:15am blood alt-90* ast-32 ld(ldh)-242 alkphos-135* totbili-0.1 10:41am blood ck-mb-4 ctropnt-<0.01 06:20am blood calcium-9.7 phos-4.7* mg-2.3 brief hospital course: 86f with a pmh of seizure disorder (gtc in , none since) on keppra, likely secondary to hemorrhagic left frontal iph in , symptomatic bradycardia and syncope s/p ppm, dementia, chronic c. difficile, htn, hld, who was initially admitted to the medicine service for shaking episodes in the context of a uti. on the floor patient had several focal motor seizures involving right leg>arm jerking and neurology was consulted. ct head showed no new changes and keppra was increased. eeg showed frequent focal motor seizures with cz-fz and left frontal epileptiform discharges. she then began to have secondarily generalized events, and due to her uncontrolled seizures despite increased keppra and 3 doses of iv lorazepam 0.5mg patient was transferred to the neuro icu service overnight from . # neuro: she was connected to eeg monitoring, which initially showed frequent focal seizures originating in the l frontoparietal region q15 minutes. she was loaded with fosphenytoin 1300mg and started on 100mg iv q8hrs. her seizure activity initially resolved but subsequently recurred in the afternoon of , and she was loaded with an additional 500mg iv keppra and started on 1500mg iv bid. seizures were thought to be related to her prior iph in the setting of a reduced seizure threshold due to her uti. however the seizure focus on eeg appeared to be separated from the location of her iph. as she could not undergo mri, a ct with contrast was performed to investigate for an new underlying lesion. the patient was started on lacozamide but it was discotinued as she developed severe drug reaction. we increased keppra to mg and added gabapentin 300 mg to her meds . #drug reaction: she developed generalized erythematous rash all over her body and elevated liver enzyme , started on topical and systemic steroid:75 mg solumedrol, after lft improved and rash vanished we d/c topical steroid and taper solumedrole dose with change to po prednisone, we will taper it down in 6 weeks with checking lft every week till they become normal. # cv: she was maintained on telemetry monitoring with no significant events. # resp: her respiratory status remained stable. cxr was clear with no evidence of pneumonia. # id: she remained afebrile during her icu stay. she was continued on ceftriaxone for treatment of her uti until her sensitivities returned. she was switched to nitrofurantoin based on the sensitivity data. the result came back positive for pseudomona as colonization, we stoped antibiotic. he was continued on oral vancomycin for chronic c.diff colitis # fen: she was initially maintained npo given her depressed mental status. as she became more alert she was seen by speech and swallow and was cleared for a regular diet with ground solids and thin liquids. *************** she was transferred to the neurology floor on . . seizures - she was started on lacosamide to help further control her seizures. an ecg was checked for pr interval monitoring. her right sided weakness continued to improve. . uti - she was treated with nitrofurantoin for a total of 7 days for her uti. . pending studies: final eeg reports . transitional care issues: please f/u her seizure frequency and side effects on her new anticonvulsant regimen. medications on admission: donepezil - 10 mg tablet - 1 tablet(s) by mouth daily levetiracetam - 750 mg tablet - 1 tablet(s) by mouth twice a day metoprolol succinate - 25 mg tablet extended release 24 hr - 0.5 (one half) tablet(s) by mouth daily omeprazole - 20 mg capsule, delayed release(e.c.) - 1 capsule(s) by mouth 30 minute before meals simvastatin - 20 mg tablet - 1 tablet(s) by mouth daily vancomycin - 125 mg capsule - 1 capsule(s) by mouth two times a day medications - otc calcium carbonate-vitamin d3 - 600 mg-200 unit tablet - 1 tablet(s) by mouth twice a day with food ergocalciferol (vitamin d2) - 400 unit tablet - 1 tablet(s) by mouth daily discharge medications: 1. donepezil 10 mg po hs 2. gabapentin 300 mg po hs seizure 3. levetiracetam mg po bid 4. metoprolol tartrate 12.5 mg po bid hold for sbp<100, hr<55 5. omeprazole 20 mg po bid gastritis prophylaxis 6. prednisone 40 mg po daily drug reaction duration: 6 weeks 40 mg po for 1 week, then 30 mg po for 1 week, then 20 mg po for 1 week, then 15 mg for 1 week, then 10 mg for 1 week, then 5 mg po for 1 week and then stop tapered dose - down 7. simvastatin 20 mg po daily 8. vancomycin oral liquid 125 mg po/ng discharge disposition: extended care facility: senior healthcare of discharge diagnosis: primary diagnosis: seizures, urinary tract infection, drug reaction to lacosamide. secondary diagnosis: hypertension, hyperlipidemia, clostridium difficile-related diarrhea discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: dear ms. , you were hospitalized due to symptoms of limb shaking resulting from a seizure. the brain is the part of your body that controls and directs all the other parts of your body. it normally communicates with electrical signals. when an abnormal electrical signal develops and forms a short circuit, this produces a seizure. seizures produce many different symptoms and can occur again. in particular, seizures that cause loss of consciousness (even if only temporary) can endanger you and place you at risk of harm. accordingly, we would like to help you prevent the recurrence of seizures. we are changing your medications as follows: 1.increased keppra to mg for seizure control. 2.started gabapentin 300 mg daily at night, will add 100 mg every week to the goal of 300 mg q8h as tolerated 3.continue taoering dose of prednisone oral, as instructed: 40 mg for 1 week, then decrease it to 30 mg for another week, then decrease it to 20 mg for 1 week, then decrease it to 15 mg for 1 week, then decrease it to 10 mg daily for 1 week, then change it to 5 mg for 1 more week and then stop taking prednisone please take your other medications as prescribed. please followup with neurology and your primary care physician as listed below. if you experience any of the symptoms below, please seek medical attention. because of the risk of future seizures, you must take the following seizure precautions: - you cannot drive a motor vehicle for at least 6 months after your last seizure during which you had impairment of consciousness (a staring spell or full loss of consciousness). - avoid swimming in a pool or body of water unattended. - when using the bathroom at home, please do not lock the door (so that if you have a seizure someone can reach you). - do not climb to high heights (e.g. trees, ladders, etc.). - do not engage in activities where temporary impairment of consciousness might cause you to fall or be placed in a dangerous position. it was a pleasure providing you with care during this hospitalization. followup instructions: provider: , md phone: date/time: 12:00 provider: clinic phone: date/time: 11:30 follow up visit in epilepsy clinic: ,at 8:30 am dr, procedure: video and radio-telemetered electroencephalographic monitoring diagnoses: esophageal reflux pure hypercholesterolemia urinary tract infection, site not specified unspecified essential hypertension depressive disorder, not elsewhere classified other late effects of cerebrovascular disease intestinal infection due to clostridium difficile unspecified hearing loss grand mal status cardiac pacemaker in situ dermatitis due to drugs and medicines taken internally alzheimer's disease dementia in conditions classified elsewhere without behavioral disturbance knee joint replacement late effects of cerebrovascular disease, cognitive deficits other abnormal blood chemistry urinary incontinence, unspecified generalized nonconvulsive epilepsy, with intractable epilepsy unspecified vitamin d deficiency nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [ldh] history of fall hydantoin derivatives causing adverse effects in therapeutic use other and unspecified escherichia coli [e. coli] other and unspecified anticonvulsants causing adverse effects in therapeutic use eosinophilia osteoarthrosis, localized, not specified whether primary or secondary, lower leg swelling of limb localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy other forms of epilepsy and recurrent seizures, with intractable epilepsy 

Answer: The patient is high likely exposed to