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: no known allergies / adverse drug reactions attending: chief complaint: lithium toxicity major surgical or invasive procedure: left femoral temporary hemodialysis catheter placed on hemodialysis on history of present illness: 47 yo female w/ h/o bipolar d/o, schizophrenia and dm2, who presents to the ed from -hri with progressively worsening mental status and tremulousness, found to have a lithium level of 3.5. history was obtained by patient's nurse -hri. at some point in , pt's clozapine was discontinued due to agranulocytosis. this resulted in an acute psychotic episode, requiring hospitalization at -hri on . she has been hospitalized at this facility for the past 5 weeks. her nurse notes that over the first 2-3 weeks of her hospitalization, she steadily became more psychotic and paranoid, believing that she was being poisoned. for the past 3 weeks, pt. has had very poor po intake. per her nurse, she did not have any nausea, vomiting, diarrhea, abdominal pain, sob, cough, chest pain, fevers, or dysuria. of note, a full set of basic labs were obtained on . these were all wnl, including a bun/cr of 24/0.8. she was started on lithium 300mg tid on . over the past week, staff have noted that she has been increasingly tremulous and unsteady on her feet, requiring a walker to ambulate. over the past two days, pt. became increaisngly confused and incoherent. she was refusing to get out of bed and being more agitated. a lithium level was checked and was 3.5. this prompted transfer to ed. in the ed, initial vs were: 100.2 120 115/92 18 97% labs were notable for lithium level of 3.0. na 133 k 5.5 cl 101 hco3- 23 bun 47 cr 3.3 glucose 84. ast 32 alt 24 ap 103 t bili 0.4. wbc 11.9 (74.2% pmn) hct 43.8 plt 288. ptt 30.5 inr 1.0 pt. was noted to be very tremulous and agitated. a temporary hd line was placed in the ed. for her agitation, she was given a total of 4mg of ativan, and was transfered to the micu for hd and further management. on arrival to the micu, vs:t 97.8 hr 95 bp 111/68 rr 19 97% on ra review of systems: as per hpi. unable to obtain further ros due to mental status past medical history: 1. schizophrenia 2. bipolar d/o 3. dm2 4. hypothyroidism social history: unable to obtain family history: unable to obtain physical exam: physical exam on admission vs:t 97.8 hr 95 bp 111/68 rr 19 97% on ra general: oriented to self. stated the date was . mumbling incoherently heent: sclera anicteric, dry mucous membranes, oropharynx clear, eomi, perrl neck: supple, jvp not elevated, no lad cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi abdomen: soft, diffusely tender to palpation, no rebound tenderness or guarding, non-distended, bowel sounds present, no organomegaly gu: foley ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: minimal tremor at rest, but all four extremities exhibit significant tremor with active and passive motion. no rigidity noted. unable to assess strength as pt. uncooperative with exam. patellar dtrs were 3+ bilaterally. 4 beats of clonus elicited with ankle dorsiflexion bilaterally. physical exam on discharge: vs - 97.6, 129/68, 73, 20, 96% ra general - ms. is an overweight female found lying in bed resting in nad. patient blinking frequently and is tremulous. heent - nc/at, perrl, eomi, sclerae anicteric, mmm, op clear neck - supple, no thyromegaly, no jvd, no lymphadenopathy lungs - cta bilat, no r/rh/wh, good air movement, resp unlabored, no accessory muscle use heart - normal rrr, no mrg, nl s1-s2 abdomen - nabs, soft/nt/nd, no masses or hsm, no rebound/guarding extremities - wwp, no c/c/e, 2+ peripheral pulses (radials, dps) lue with edema (mostly in hand and forearm), very minimal erythema of dorasal aspect of hand, no warmth. rue with midline access in place and without surround erythema. pertinent results: 01:47pm blood wbc-11.9* rbc-4.57 hgb-14.5 hct-43.8 mcv-96 mch-31.8 mchc-33.2 rdw-13.7 plt ct-288 03:54am blood wbc-6.3 rbc-3.43* hgb-10.5* hct-32.9* mcv-96 mch-30.6 mchc-31.9 rdw-13.5 plt ct-160 01:47pm blood glucose-84 urean-47* creat-3.3* na-133 k-5.5* cl-101 hco3-23 angap-15 03:54am blood glucose-66* urean-9 creat-0.8 na-138 k-3.6 cl-108 hco3-27 angap-7* 03:54am blood calcium-7.8* phos-3.2 mg-1.6 06:12pm blood tsh-0.99 01:47pm blood lithium-3.0* 04:34am blood lithium-1.0 01:05pm blood lithium-1.2 06:20pm blood lithium-1.1 03:54am blood lithium-1.0 12:03pm blood lithium-0.9 ua : clean 2:50 pm blood culture blood culture, routine (preliminary): streptococcus species. probable multiple morphologies. anaerobic bottle gram stain (final ): reported to and read back by ,9/05/12,12:05pm. gram positive cocci in pairs and chains. ekg : nsr, no abnormalities cxr : impression: no acute cardiopulmonary process. tte : the left atrium is normal in size. left ventricular wall thicknesses and cavity size are normal. due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. overall left ventricular systolic function is normal (lvef>55%). the number of aortic valve leaflets cannot be determined. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. no mitral regurgitation is seen. the estimated pulmonary artery systolic pressure is normal. there is no pericardial effusion. impression: suboptimal image quality. no evidence of vegetations. left ventricular function is probably normal, a focal wall motion abnormality cannot be fully excluded. lue us : findings: grayscale and color doppler son evaluation was performed of the left upper extremity. normal compressibility and flow was seen in the left subclavian, internal jugular, brachial, basilic and cephalic veins without evidence of left upper extremity dvt. labs on discharge: 07:00am blood wbc-7.0 rbc-3.49* hgb-10.9* hct-32.4* mcv-93 mch-31.1 mchc-33.6 rdw-14.2 plt ct-281 07:00am blood glucose-122* urean-9 creat-0.9 na-138 k-3.9 cl-104 hco3-25 angap-13 07:00am blood lithium-<0.2 brief hospital course: ms. is a 47 y/o female with a h/o schizophrenia, bipolar, dm, and hypothyroidism who presented to with altered mental status and tremulous and was found to have lithium toxicity, , and streptococcus viridans in bacteremia. acute issues: # lithium toxicity: the patient was found to ahve a lithium level of 3.0 on arrival. it is unlikely that this represents an overdose as patient has been an inpatient at a psychiatric hospital. she has only been on lithium for approximately 1 week. it is likely that patient sustained an acute kidney injury over the course of the past few weeks, causing decreased renal lithium clearance, resulting in toxicicty. toxicology and renal were consulted. temporary femoral hd line was placed, and she was dialyzed x 1 session. lithium level was checked 6 hours after dialysis and was 1.0, re-check was 1.2, then came down to 0.9 as uop picked up. her lithium level decreased again to 0.7 and then to < 0.2. # acute renal failure: the patient was found to have a cr of 3.3 on presentation (baseline was 0.8 on ). this was likely pre-renal poor po intake over past few weeks. she received 2l boluses of ns and had maintenance fluids of ns at 200-250cc. her uop increased significantly with aggressive hydration and her creatinine returned to her baseline of 0.8. # streptococcus viridans bacteremia: the patient was found to have strep viridans present in bottles. the patient was initially started on vancomycin and it was thought that the gram positive cocci represented a contamination. upon speciation of strep viridans, infectious disease was consulted. they considered this a low risk bacteremia and recommended 14 days of ceftriaxone 2 g iv daily from negative cultures. repeat cultures on were with no growth. the temporary hemodialysis catheter tip was sent for culture on and was with no growth. a midline was placed on for antibiotic administration and antibiotics will be completed on . # ams/psychosis: improved somewhat after dialysis and normalization of lithium level. agitation was generally well controlled with prn ativan. continued to be agitated and responding to internal stimuli. her antipsychotics were initially held in setting of acute lithium toxicity due to increased risk of nms. psych was consulted and followed patient. they recommended re-starting her aripiprazole and it was slowly titrated back to home dose of 30 mg daily. she was discharged to inpatient psych bed on 4. chronic: # schizophrenia/bioplar: psych was consulted and followed patient. initially all psych meds were held in the setting of acute lithium toxicity. her aripriprazole was started back and slowly titrated back to home dose. the remainder of psych meds were held. she was discharged to inpatient psych bed on 4. #dm2: the patient's home metformin was held during hospitalization and she was maintained on insulin sliding scale. #hypothyroidism: the patient's tsh was within normal limits. her home synthroid was continued during hospitalization and cytomel will be restarted upon discharge. transitional issues: -will need to complete 14 day course of ceftriaxone with 9/6 conuted as day 1 (to be completed on ). -psychiatry to continue titrating and adjust psychiatric medicaitons. -patient will need to restart metformin when not refusing to eat. - patient will need panorex and/or dental eval for multiple caries when acute psychosis improves as possible source for her bacteremia medications on admission: preadmission medications listed are correct and complete. information was obtained from -hri. 1. aripiprazole 30 mg po daily 2. bupropion (sustained release) 200 mg po bid 3. benztropine mesylate 1 mg po bid 4. bisacodyl 5 mg po daily 5. cytomel 10 mcg po daily 6. chloral hydrate 500 mg po qhs 7. clonazepam 1 mg po q4h:prn anxiety 8. clonazepam 0.5 mg po bid 9. haloperidol 10 mg po bid 10. lithium carbonate 300 mg po qhs 11. metformin (glucophage) 500 mg po daily 12. ibuprofen 400 mg po q6h:prn pain 13. omeprazole 20 mg po q 12h 14. prazosin 1 mg po hs 15. levothyroxine sodium 50 mcg po daily 16. vitamin d 1000 unit po daily discharge medications: 1. aripiprazole 30 mg po daily 2. ibuprofen 400 mg po q6h:prn pain 3. levothyroxine sodium 50 mcg po daily 4. ceftriaxone 2 gm iv q24h 5. bisacodyl 5 mg po daily 6. cytomel 10 mcg po daily 7. omeprazole 20 mg po q 12h 8. vitamin d 1000 unit po daily discharge disposition: extended care facility: 4 discharge diagnosis: primary diagnosis: lithium toxicity streptococcs viridans bacteremia secondary diagnosis: schizophrenia bipolar discharge condition: mental status: confused - always. level of consciousness: alert and interactive. activity status: currently refusing to get out of bed, previously ambulatory. discharge instructions: ms. , you were admitted to the hospital for lithium toxicity and you were also found to show that your kidneys were not functioning well. you were treated with one session of hemodialysis and you lithium level came down in to the normal range. we gave you iv (through your vein) fluids and you kidney function returned to . while you were here we also found that you had a bacteria in your blood. to treat this we are giving you iv (through your vein) antibiotics. while you were here psychiatry followed you and adjusted your medications. it was a pleasure caring for you, your doctors followup instructions: pcp and psychiatry follow up to be scheduled by inpatient psychiatry. procedure: hemodialysis venous catheterization for renal dialysis diagnoses: hyperpotassemia diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute kidney failure, unspecified unspecified acquired hypothyroidism unspecified schizophrenia, unspecified bacteremia other and unspecified special symptoms or syndromes, not elsewhere classified dehydration streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus accidents occurring in residential institution drug-induced delirium bipolar disorder, unspecified other psychotropic agents causing adverse effects in therapeutic use abnormal involuntary movements essential and other specified forms of tremor abnormal reflex 

Answer: The patient is high likely exposed to