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 / sulfa (sulfonamide antibiotics) / benadryl / aspirin attending: chief complaint: s/p fall, seizure major surgical or invasive procedure: intubation () extubation () history of present illness: 80 year old female presents s/p fall last night at her nursing home. patient fell out of bed at 11pm last night, was placed back in bed by the nursing home staff. some reports that she could have perhaps had a headache or slightly confused at that time, but this is unclear. this morning was noted to have garbled speech, non-fluid speech, and so was sent to for evaluation. per nh, patient has baseline dementia but is usually alert and oriented. here she was initially a&ox2 (person, hospital) and moving all extermities. per discussion with the husband, patient is alert and oriented x2 only and per previous records, the patient is confused at baseline possibly in the setting of persistent uremia. did not receive any antibiotics at the rehab such as cipro. . in the ed, initial vs were: 98.8, 71, 171/96, 18, 97% 2l nc. patient triggered for generalized tonic clonic seizure which lasted for 1-2 minutes. was given 2mg iv ativan and intubated for airway protection. noted to be a very difficult intubation. given concern for head bleed, she received ct head which showed no acute intracranial bleed preliminarily. she was also loaded with phenytoin 1000 mg. cxr showed a widened mediastinum, because there was no prior cxr to compare to, the ed performed cta neck/chest which showed no arterial dissection or major occlusions. it was noted to have some diffuse subcutaneous emphysema, which may have been a result of the difficult intubation. an lp was performed given acute mental status change to rule out meningitis which did not show any evidence of meningitis. patient was given emperic vancomycin 1g, ceftriaxone 1g, levofloxacin 750mg, and metronidazole 500mg. was noted to have creatinine of 5.6, unfortunately got iv contrast with cta, was given 1 l of iv fluids. vital signs on transfer were: hr 70 (a-paced), 170/105, 16, 100% (ventilated peep 5, fio2 60) . in the micu, patient is intubated and sedated and not responding to commands. sedation is being weaned. . review of systems: unable to obtain due to intubation/sedation past medical history: mild dementia with agitation atrial fibrillation not on coumadin, likely secondary to history of gi bleed and frequent falls subdural hematoma, history of acute tubular necrosis with increased calcium in the past, chronic renal insufficiency (stage v ckd) with baseline creatinine of 4.5-5.3 hypertension seizure disorder osteoporosis pacemaker for tachybrady syndrome (pacer is guidant insignia mode ddd, programed rate 70 bpm, underlying rhythm sb, not pacer dependent). history of gi bleed bilateral total knee replacement remote history of cva, b12 and folate deficiency, s/p appendectomy, cholecystectomy, stress test in with myoview negative, echocardiogram and , ef of 55%, mild lvh, mild mr, mild tr. social history: lives at a nursing home ( village). - tobacco: denies (per report) - alcohol: denies (per report) - illicits: denies (per report) family history: unknown physical exam: admission exam general: intubated, sedated, not following commands heent: sclera anicteric, mm dry, oropharynx clear neck: supple, jvp not elevated, no lad; pacemaker in place. lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, 2+ pitting edema . discharge exam general: alert and oriented to person but not time and place heent: sclera anicteric, mm dry, oropharynx clear neck: supple, jvp not elevated, no lad; pacemaker in place. lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, 2+ pitting edema pertinent results: admission labs 07:00am blood wbc-6.7 rbc-3.71* hgb-11.5* hct-39.5 mcv-107* mch-31.0 mchc-29.1* rdw-17.9* plt ct-216 07:00am blood pt-12.7 ptt-22.4 inr(pt)-1.1 07:00am blood glucose-117* urean-75* creat-5.6* na-146* k-4.2 cl-103 hco3-26 angap-21* 07:00am blood albumin-4.1 calcium-8.1* phos-4.2 mg-2.6 07:14am blood lactate-6.4* 09:35am urine rbc-0 wbc-0 bacteri-occ yeast-none epi-0 09:35am urine blood-lg nitrite-neg protein-500 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg 11:53am urine bnzodzp-neg barbitr-neg opiates-pos cocaine-neg amphetm-neg mthdone-neg . pertinent labs 07:00am blood ck-mb-4 07:00am blood ctropnt-0.04* 03:34am blood ck-mb-4 ctropnt-0.04* 03:25pm blood phenyto-9.4* 03:41am blood phenyto-9.1* 03:35pm blood lactate-1.1 . discharge labs 03:41am blood wbc-5.7 rbc-3.76* hgb-11.8* hct-39.6 mcv-105* mch-31.3 mchc-29.7* rdw-18.0* plt ct-200 03:41am blood glucose-84 urean-64* creat-4.9* na-143 k-4.8 cl-106 hco3-25 angap-17 . pertinent reports ekg (): atrial paced rhythm at 70 beats per minute. q waves in leads v1-v3 suggesting possible prior anterior wall myocardial infarction. no previous tracing available for comparison. . cta head/neck/chest (): there is no evidence of acute intracranial hemorrhage. evidence of small vessel ischemic disease as described above. subcutaneous emphysema in the cervical soft tissues, extending into the mediastinum and tracking along the facial planes and carotid space. bilateral atelectasis and pleural effusions. multiple thyroid nodules are visualized, correlation with thyroid ultrasound is recommended . . cxr (): 1. wide mediastinum. no prior examinations available for comparison. given history, ct examination should be considered. 2. linear lucencies in the soft tissues over the neck could indicate subcutaneous emphysema. ct examination may be considered to evaluate this and for the presence of pneumomediastinum. 3. satisfactory position of endotracheal and nasogastric tubes. brief hospital course: 80 year old female with multiple medical problems including atrial fibrillation not on coumadin, frequent falls, seizure disorder, chronic kidney disease who presents from rehab s/p fall and with altered mental status. . 1. altered mental status post fall: likely due to seizures that led to her fall and perhaps was post-ictal morning of the fall. patient also had frequent falls noted and has been transitioned to a nursing home since her last admission to in . no fever or leukocytosis to indicate an infection. no evidence of ventricular arrythmias on her pacer per ep, only a few episodes of atrial fibrillation. no evidence of meningitis on lp. head and neck ct negative for acute intracranial bleed or aortic dissection. toxicology screen is negative so less likely ingestion leading to ams. . she was intubated in the setting of her altered mental status. no mri done as she had a pacemaker. she was loaded with phenytoin iv 1000 mg and received phenytoin 100 mg iv tid. she was extubated on and she has done well clinically since then. she was transitioned to 100 mg po tid. neurology wants to have her follow-up with them in one month as outpatient. . # respiratory failure: patient intubated in the ed for airway protection during the seizure. oxygenating well with no evidence of pneumonia or aspiration in the ed. patient was a very difficult intubation and has signs of subcutaneous emphysema on cxr. home lasix was held on admission. she was extubated on and was weaned down to room air. she has been oxygenating well on room air. home lasix was restarted on . . # seizure: patient with witnessed tonic clonic seizure in the ed. has a history of seizure disorder. she was loaded with phenytoin 1000 mg iv x 1 and started on phenytoin 100 mg iv tid which was transitioned to 100 mg po tid when she was tolerating oral diet. . # acute on chronic renal failure: admitted with creatinine of 5.4 which is higher than her baseline creatinine of 4.8. she received iv bicarbonate and mucomyst as she was given dye load for her ct angiogram. home lasix was held on admission. creatinine improved with intravenous fluid repletion to 4.9 prior to discharge. home lasix was restarted. she was continued on home sodium bicarbonate, nephrocaps and vitamin d. . # hypernatremia: sodium slightly elevated at 146 which resolved with fluid repletion. . # htn: restarted on home metoprolol and increased amlodipine to 10 mg po qdaily. . # af: a-paced. ep interrogated pacer and noted some episodes of af but no vt or vf noted. no anticoagulation given hx of falls. . # communication: patient/ husband (hcp) . # code: full (discussed with hcp) medications on admission: sodium bicarbonate tablets 1300 mg po tid vitamin d 400 mg po bid metoprolol 25 mg po bid risperdone 0.25 mg po bid bisacodyl milk of magnesia tylenol 325 mg po q6h:prn pain, fever procrit 60,0000 u/ml 1 ml sq on fridays vicodin 1 table po q6h:prn pain ativan 0.5 mg po q6h:prn anxiety folic acid 1 tablet po daily nephrocaps po tid with meals protonix 40 mg po daily lasix 40 mg po daily celexa 10 mg po daily was also discharged on amlodipine 5 mg po daily for hypertension but not on rehab meds. discharge medications: 1. sodium bicarbonate 650 mg tablet sig: two (2) tablet po tid (3 times a day). 2. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po bid (2 times a day). 3. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 4. risperidone 0.25 mg tablet sig: one (1) tablet po bid (2 times a day). 5. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 6. milk of magnesia 400 mg/5 ml suspension sig: one (1) po once a day as needed for constipation. 7. tylenol 325 mg tablet sig: one (1) tablet po every six (6) hours as needed for fever or pain. 8. procrit 20,000 unit/2 ml solution sig: 60,000 units injection once a week: on sundays. 9. vicodin 5-500 mg tablet sig: one (1) tablet po every eight (8) hours as needed for pain. 10. folic acid 1 mg tablet sig: one (1) tablet po once a day. 11. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 12. protonix 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 13. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 14. citalopram 20 mg tablet sig: 0.5 tablet po daily (daily). 15. phenytoin sodium extended 100 mg capsule sig: one (1) capsule po q8h (every 8 hours). 16. amlodipine 5 mg tablet sig: two (2) tablet po daily (daily). discharge disposition: extended care facility: village discharge diagnosis: primary diagnosis 1. seizure disoder 2. atrial fibrillation 3. history of falls discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: you were admitted because you were noted to have a fall in setting of likely seizure. you had seizure in the emergency department which led to intubation. you were given a medication called phenytoin to treat your seizures. you were extubated next day and have had not difficulty breathing since then. . following medication changes were made to your medication regimen: start phenytoin 100 mg by mouth three times a day increase amlodipine to 10 mg by mouth once a day followup instructions: please follow up with neurology in one month procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung insertion of endotracheal tube diagnoses: chronic kidney disease, stage v acute kidney failure with lesion of tubular necrosis atrial fibrillation other persistent mental disorders due to conditions classified elsewhere other b-complex deficiencies acute respiratory failure osteoporosis, unspecified cardiac pacemaker in situ personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits emphysema (subcutaneous) (surgical) resulting from procedure accidental fall from bed knee joint replacement hypertensive chronic kidney disease, benign, with chronic kidney disease stage v or end stage renal disease other alteration of consciousness mixed acid-base balance disorder history of fall epilepsia partialis continua, without mention of intractable epilepsy other fluid overload nontoxic uninodular goiter 

Answer: The patient is high likely exposed to