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: meropenem attending: chief complaint: seizure major surgical or invasive procedure: downsizing of trach peg placement picc history of present illness: the patient is a 28 year old male with a history of alcohol abuse who was recently discharged after an extended icu admission for pancreatits/hematemesis who during his hospital stay had a cardiac arrest and subsequent anoxic brain injury (see discharge summary). mri showed diffuse anoxic injury, and ct showed loss of /white matter differentiation. he began having seizure activity on and was treated with keppra. he also had an eeg that was nondiagnostic, and subsequent eeg that showed seizures in the occipital lobe. keppra was increased and seizures were controlled prior to d/c. . mr. was discharged to a rehab hospital where he was found to have what was believed to be two siezures yesterday and one today with persistent eye deviation to the right. he was given ativan, after which tremors reportedly stopped, and then transfer was arranged directly to the icu. past medical history: depression alcoholism pancreatitis s/p cardiac arrest tracheostomy anoxic brain injury social history: patient originally from western mass. works for a it computing company. not married and without children, lives with a roomate in . significant alcohol use for 5-6 years, drinking 6 mixed drinks daily with withdrawl symptoms. 1.5 ppd of cigarrettes, denies drug use. family history: mother with dm2. physical exam: vitals: t:100.5 p:120 r: 30 bp: 136/68 sao2: 100 % on 35% tm general: lying in bed, nad heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: lungs poor inspiratory effor bilaterally cardiac: tachy but regular abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. extremities: no c/c/e bilaterally, 2+ radial, dp pulses bilaterally. skin: no rashes or lesions noted. neurologic: -mental status: arousable to stimuli. does not follow commands, appears to neglect right side. -cranial nerves: pupils 2-> 5mm bilaterally, blinks to threat. l eye gaze preference. face symmetric. -motor: hypertonic with diffuse myoclonus in upper extremities with any movements. able to grip bilaterally. -sensory: unable to test. -dtrs: tri pat ach l 3 3 3 2 1 r 3 3 3 2 1 plantar response was flexor bilaterally. -coordination: unable to test. -gait: unable to test. pertinent results: wbc 40.4, hb 9.2, hct 30.5, plt 732, mcv 95 n 52, b 2, l 37, m 5, e 3, ba 0, meta 1 hypochr 2+, anisocy 1+, poiklo 1+, macrocy 1+, microcy 1+, tear-dr 1+ na 145, k 3.1, cl 113, hco3 23, bun 19, cr 0.9, gluc 23 ca .8, mg 1.6, p 3.9 alt 26, ast 47, ap 125, ldh 243, tbili 1.1, alb 2.6 ck 29 pt 16.1, ptt 40.8, inr 1.5 fibrinogen 372 . micro: , , c. diff negative c. diff pending fecal cx: pending , bcx: pending ucx: sternotrophomonas maltophilia, bactrim sensitive . images: . cxr: persistent lower lung volumes. small to moderate left pleural effusion is unchanged. tracheostomy tube is in standard position. right picc remains in place with tip in the upper svc. no evidence of pneumothorax. bibasilar atelectasis are unchanged. cardiomediastinal contours are also stable ng tube tip is in the stomach. . leni: 1. no deep vein thrombosis in the right leg. 2. cyst in the right popliteal fossa which may have ruptured or contains hemorrhage. . ct abdomen w/ and w/o contrast: 1. interval enlargement of the pancreatic pseudocysts in the mid body, tail and head of the pancreas. 2. new - nonocclusive thrombus in the superior mesenteric vein extending to the junction of the splenic vein. 3. interval enlargement of fluid collection lateral to the antrum of the stomach. 4. unchanged colonic wall thickening. . mri head: no seizure focus identified. diffuse volume loss. resolution of previously noted hypoxic changes in the cortex. new changes in the pons and midbrain which could represent a central pontine myelinolysis/osmotic demyelination. . ekg: sinus tachycardia with nonspecific <1mm st depressions . ruq u/s-impression: 1. no deep vein thrombosis in the right leg. 2. cyst in the right popliteal fossa which may have ruptured or contains hemorrhage. the study and the report were reviewed by the staff radiologist. . -impression: no hemorrhage, mass, or fracture. atrophy likely secondary to global anoxic brain injury. would recommend mri. findings were discussed with at 9:55 a.m. on . . cta abd-impression: 1. no significant change in the appearance of numerous pancreatic pseudocysts, replacing the tail and distal pancreatic body, and also adjacent to the head of the pancreas and the gastric antrum. there are no new intra-abdominal fluid collections identified. the residual normal pancreatic tissue again demonstrates normal enhancement. there is no evidence for new inflammation involving this region. peripancreatic stranding persists. 2. redemonstration of diffuse hepatic steatosis. 3. minimal, if any, residual clot in the smv. the smv and splenic vein as well as the main portal vein, are patent, though a focal narrowing of the splenic vein is noted. 4. unchanged colonic wall thickening, nonspecific. the study and the report were reviewed by the staff radiologist. . eegimpression: this telemetry captured no pushbutton activations. routine sampling continues to show poorly organized and low attenuation background rhythm with frequent left occipital and posterior temporal discharges. seizure detection files showed one electrographic seizure. there was no clinical correlate. overall, this recording is unchanged compared to the previous 24 hours. . eeg-impression: this telemetry captured no pushbutton activations. routine sampling continues to show a poorly organized and low attenuation background. however, the left occipital discharges are less frequent and no runs were seen on routine sampling. seizure detection files showed one possible electrographic seizure with right sided body jerking. overall, there are less seizures on this recording compared to the previous 24 hours. . cxrthe tracheostomy tip is 6.7 cm above the carina. the right picc line tip is in the medial portion of right subclavian vein. there is no change in the high position of both hemidiaphragms and bibasilar atelectasis. the gastrostomy is projecting over its expected position in the left upper abdomen. no interval development of pneumothorax, pleural effusion, or pulmonary edema has been demonstrated. brief hospital course: 28 y/o male with an anoxic brain injury s/p cardiac arrest in the setting of necrotizing pancreatitis etoh who was recently d/c'd from to rehab/ltc. was seen by a neurologist at rehab after 2 seizures who in consultation with epileptology at decided patient to be transfered back to for further evaluation to include neurology consult and 24hr eeg. . # seizure: mr. has an anoxic brain injury and has had seizures treated with keppra. mri and eeg results as above. transfered to for neurology eval and presumptive 24hr eeg. it is possible that these seizures are from benzo withdrawal after the decrease in dose of the valium is possible but not probable and more likely a result of his anoxic brain injury. he remained on neurology service who performed a 24 hr eeg and keppra was continued. after development of wbc and fever he was transfered to medicine but recieved several other eegs including 24 hr eeg on which showed evidence of seizure activity. he was followed by the neurology service and placed on keppra and standing ativan. in addition, after witnessed tc seizures on he was loaded with dilantin and started on both po and iv regimens. his target dilantin levels were changed based on his albumin levels. currently, pt's target levels are between . pt is currently on 200mg tid po dilantin. intermittently, pt had been given iv fosphenytoin for loading doses. levels of dilantin should be continually monitored and pt should be given 500mg po dilantin as needed for when levels are below goal. he should be having levels two to three times a week for the first two weeks or so to make sure he remains therapeutic. his mental status seems related to seizure activity.. . # fevers/tachypnea/tachycardia: pt has had persistent fevers/tachypnea/tachycardia which were evaluated during the prior hospitalization. multiple blood/urine cx were initially negative and the sputum cx were thought to be colonization. eventually, pt grew multiple different colonies of pseudmonas and alcaligenes, including cephalosporin resistant pseudomonas. he was followed by the id service and treated with tobramycin and ceftazidime. this regimen will be completed on . in addition, there is some question of whether pt had an allergic rxn to meropenem, causing a blistering skin rash. he is to complete the above course. if he clinically worsens, meropenem could be considered, but likely should have another id consult due to the hx of a reaction. . # pea arrest: occurred at 02:30 on . patient was noted by housestaff to become increasingly bradycardic on tele. on evaluation, pt found nonresponsive with no bp or pulse. chest compressions initiated for pea arrest. pt with agonal breathing and suctioned by rt for copius secretions; respirations given through ambu bag. he developed a rhythm concerning for vfib; one 200j shock was delivered with subsequent rhythm of sinus bradycardia. femoral line placed. pt given 1 amp epinephrine and 1 amp bicarb with increase in hr to 150 and bp 180/132. fsbs 21, and pt received 1 amp d50. duration of pea arrest was 7 minutes. pt transferred to micu for further management. vs on transfer:bp 94/64, hr 112, o2sat 99%. - unclear etiology. mucous plugging likely given copious secretions, especially since he has had pea arrest in this setting before (during hospitalization 6/). possible presepsis in setting of pneumonia given leukocytosis and low grade temps. have been complicated by ams in setting of hypoglycemia. seizure with unwitnessed tonic clonic movements also a possibility, perhaps triggered by hypoglycemia. pe less likely with rapid recovery and as pt on heparin gtt, although subtherapeutic. . # neuro eval post-code: concern for herniation v. progression of anoxic brain injury v. bleed given posturing, roving eye movements, and weak corneal reflex in setting of hypertension to sbp 230s. does have seizure activity noted on eeg at admission typified by rue clonus and right gaze deviation which he did not exhibit after the code. his mental status slightly improved to where he would occasionally nod his head yes/no to questions. he appears to recognize his family. . # hypertension: baseline sbp 110s-140s. after he received epinephrine during the code was sbp sustained >200. also be related to clonic movements. received hydral 10mg iv and started on nitro gtt without effect. subsequently received 2 doses of ativan and hydralazine 20mg iv with improvement in sbp to 130. after this point, his blood pressure remained normotensive. . # hypoglycemia: fsg 90s-120s on stable dose of glargine. he had iatrogenic hypoglycemia to 20, likely continuation of glargine while tube feeds discontinued, and this occured around the time of the pea arrest as described above. could be also decreased in setting of infection. fs now stable on the attached regular insulin sliding scale. . # hypercalcemia: unclear etiology, ? bone turnover given low pth. patient recieved aggressive iv fluids and endocrine consult recommended calcitonin. he was also given iv bisphosphonate. his calcium levels improved. in addition, he was started on vitamin d. he should continue vitamin d twice weekly for 4 weeks and then have his level rechecked. . #hyponatremia - pt with persisent hyponatremia thought to likely be related to siadh from his neurologic issues and seizure activity. his medications and tube feeds were concentrated, he was placed on a fluid restriction. urine electrolytes were consistent with an siadh pattern. he did worsen with diuresis and should be closely monitored if lasix started. . # volume overload: pt was volume up during prior hospitalization and was on dialysis renal failure. he has had return of renal function and now is being diuresed with lasix 40mg po daily. he is currently autodiuresing. . # etoh/benzo withdrawal: continued valium taper. currently on ativan q6h but for seizure ppx. also has been getting folic acid/mvi/thiamine which we will continue. . # hypothyroidism - newly started on levothyroxine; should be continued at current dose and have a tsh checked in about 1.5 weeks. . # weakness - should continue pt daily. . # pancreatitis - patient has history of severe pancreatitis complicated by known necrosis and pseudocytst. were worried that he was having increasing pain and that it may have been the source of his fevers before his vap became apparent. ct scan was done showing no change, but surgery was reconsulted to see if it was surgical. he is not a candidate. by the time of discharge, his lipase was trending down and he had no apparent pain and was tolerating tube feeds. . # nutrition - had peg tube placed on , tolerating tube feeds at the time of discharge. continue with concentrated tfs secondary to hyponatremia. . # smv thrombus - patient had known smv thrombus found incidentally on ct scan during prior hospitalization. had been anticoagulated on heparin gtt until we tried to bridge him with coumadin. had difficulty maintaining therapeutic level and had an interaction with dilantin. thought he would benefit best from lovenox injections for the long run until more stabalized on antiseizure medication. medications on admission: -albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 8-15 puffs inhalation q2h (every 2 hours) as needed for sob, cough, bronchospasm. -heparin (porcine) 5,000 unit/ml solution sig: one (1) 5000 injection tid (3 times a day). -famotidine 20 mg tablet sig: one (1) tablet po q12h (every 12 hours). -acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for fever. -furosemide 40 mg tablet sig: one (1) tablet po daily (daily). -levetiracetam 1000 mg po bid -diazepam 5 mg tablet sig: one (1) tablet po hs (at bedtime). -insulin (glargine 40units qhs) -metoprolol 25mg po/ng tid -mvi daily -folic acid 1mg daily -thiamine 100mg daily -ranitidine 150mg daily -omeprazole 20mg discharge medications: 1. multivitamins tablet, chewable sig: one (1) ml po daily (daily). 2. ipratropium-albuterol 18-103 mcg/actuation aerosol sig: puffs inhalation q6h (every 6 hours). 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q2h (every 2 hours) as needed for sob/wheezing. 4. acetaminophen 160 mg/5 ml solution sig: one (1) po q6h (every 6 hours) as needed for fever, pain. 5. insulin regular human 100 unit/ml solution sig: as directed injection asdir (as directed). 6. enoxaparin 100 mg/ml syringe sig: one (1) subcutaneous q12h (every 12 hours). 7. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 8. ergocalciferol (vitamin d2) 50,000 unit capsule sig: one (1) capsule po 2x/week (mo,th). 9. dextromethorphan poly complex 30 mg/5 ml suspension, sust.release 12 hr sig: ten (10) ml po q12h (every 12 hours) as needed for cough. 10. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 11. phenytoin 125 mg/5 ml suspension sig: 200mg po tid (3 times a day). 12. famotidine 20 mg tablet sig: one (1) tablet po twice a day. 13. keppra 1,000 mg tablet sig: two (2) tablet po twice a day. 14. lorazepam 1 mg tablet sig: one (1) tablet po every six (6) hours. 15. ceftazidime 2 gram recon soln sig: one (1) recon soln injection q8h (every 8 hours) for 5 days: to end on . 16. tobramycin sulfate 40 mg/ml solution sig: one (1) injection q48h (every 48 hours) for 3 doses: to end on . 17. dilantin kapseal 100 mg capsule sig: five (5) capsule po as directed: to be given daily if dilantin level not in range. 18. percocet 5-325 mg tablet sig: one (1) tablet po every four (4) hours as needed for pain. discharge disposition: extended care facility: & rehab center - discharge diagnosis: anoxic brain injury depression alcoholism pancreatitis s/p pulseless electrical activity cardiac arrest tracheostomy discharge condition: stable. discharge instructions: you were admitted for change in mental status, seizures, as well as complications of your severe pancreatitis. while you were here, you were treated for a pseudomonal ventilator associated pneumonia and were followed by the infectious disease service. in addition, you were noted to have seizures for which you were followed by the neurology service and were started on antiepileptic medications. you were seen by the surgical service as well to evaluate for your severe pancreatitis and pseudocysts. you had the placement of a trach tube which was down-sized. in addition, you underwent placement of a peg tube in the or. . you will need to have these issues further treated at rehab. . please take all your medications as prescribed and follow up with the appointments below. . please return to the hospital for seizures, vomiting, fevers, or any other changes or concerns. followup instructions: you will need to follow up with the following specialties . 1.neurology 2.general surgery 3.endocrine 4.primary care physician procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more parenteral infusion of concentrated nutritional substances insertion of endotracheal tube enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] closed [endoscopic] biopsy of bronchus closed [endoscopic] biopsy of bronchus replacement of tracheostomy tube injection or infusion of oxazolidinone class of antibiotics diagnoses: urinary tract infection, site not specified unspecified septicemia hyposmolality and/or hyponatremia unspecified acquired hypothyroidism other convulsions depressive disorder, not elsewhere classified sepsis acute respiratory failure pneumonia due to pseudomonas cardiac arrest anoxic brain damage cerebral edema encephalopathy, unspecified ventilator associated pneumonia acute vascular insufficiency of intestine acute pancreatitis cyst and pseudocyst of pancreas other and unspecified alcohol dependence, continuous hypercalcemia hypoglycemia, unspecified 

Answer: The patient is high likely exposed to