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: patient recorded as having no known allergies to drugs attending: chief complaint: hypertensie urgency major surgical or invasive procedure: intubation due to acute respiratory distress . hemodialysis history of present illness: 58 y/o female with h/o esrd on hd, s/p renal tx in with acute on chronic rejection in , initially presenting with a 4-5 days episode of severe frontal headaches, n/v/d and decreased appetite. pt reports symptoms started on after she had received dialysis that day. she missed her hd 2 days prior to admission due to severe ha and malaise. pt denies having had changes in vision, numbness or weaknesses, syncopes, sob, cp, anuria or edema during that time. during her next hd session on it was noted that pt had sbp >200-250 patient was also c/o headache and sent to ed for htn management. pt was admitted to the ed for severe hypertensive crisis, given captopril, labetolol 20mg, 40mgx2, 80mg then started on nitro and labetolol gtt. she also received dilaudid for her ha and she was transferred to the micu for hypertensive urgency and fevers (102). . micu she had two seizures on in the early morning hours, most likely due to hypertensive leucoencephalopathy. the first tonic-clonic convulsion (at 4am, lasting for about 3min) was witnessed, a respiratory code was called but the intubation failed (esophagus). at 6am the pt awoke, was disoriented, agitated and started screaming. shortly after she suffered from a second seizure which stopped after lorazepam 2mg iv, pt was then successfully intubated and entered brief post-ictal coma (with intact brain stem reflexes). pt was transferred to the floor 48 hours later for optimalization of her bp. past medical history: #s/p renal transplant in , acute on chronic rejection in , now esrd on hd. . #iga nephropathy in , 7-8months hd prior to transplant . #htn . #depression . #s/p rheumatic fever in childhood social history: lives alone with cats. no family in the area. denies tob/etoh/ivdu/substances. works part-time as asst. coffee shop manager. unable to obtain health insurance for past year, which has limited her access to f/u medical care for her transplant. family history: father died age 80. mother with lung ca, died @64. many aunts/uncles with ca. sister with breast ca, survived. no family hx renal problems. physical exam: t 99.6 bp 174/75 (146/66-190/96) hf 91 bpm (83-105 rr 18 (18-24) o2-sat 100%(97%)on 2l i/os: 1012/275, after midnight 1132/0 general alert, orientated, cooperative; pleasant; skin warm, good color, normal turgor; no signs of ulcers, petechiae, erythema or jaundice; pt has bruises on her back (left lower chest) and arms; mild bilat. le edemas; heent no visual impairment, no conjunctival injections, anicteric sclerae; moist gums and tongue; lymph no signs of lymphadenopathy; neck good carotid pulses, no bruits; respir no use of accessory muscles, no retractions, symmetrical thorax expansion, both lungs are equally ventilated, no wheezes, crackles over both lower lobes l>r, decreased bs over lll; cardio rhythmic, hr 91bpm, s1+ s2, systolic crescendo-decrescendo murmur, no gallops or rubs; abdomen no skin liver signs, normal bowel sounds over all four quadrants, no pain on light or deep palpation, no guarding, no masses; no hepatospleno-megaly, no flank pain; pulses good palpable carotic, radialis, ulnaris, dorsalis pedis and tibialis pos. pulses; muscskel no swelling of joints, no redness, no warmth; normal range of motion; neuro coherent, alert and orientated; normal cn ii to xii, normal strength ,normal sensory on both arms and legs; pertinent results: 07:00pm glucose-86 urea n-18 creat-5.4*# sodium-142 potassium-4.5 chloride-100 total co2-30 anion gap-17 07:00pm alt(sgpt)-11 ast(sgot)-14 ck(cpk)-67 alk phos-58 amylase-61 tot bili-1.0 07:00pm lipase-27 07:00pm ctropnt-0.04* 07:00pm ck-mb-notdone 07:00pm albumin-4.3 calcium-9.4 phosphate-4.3# magnesium-1.6 07:00pm wbc-3.4* rbc-3.17* hgb-9.9* hct-29.8* mcv-94 mch-31.4 mchc-33.3 rdw-19.1* 07:00pm neuts-69.5 lymphs-23.5 monos-5.3 eos-1.4 basos-0.3 07:00pm neuts-69.5 lymphs-23.5 monos-5.3 eos-1.4 basos-0.3 07:00pm anisocyt-2+ macrocyt-1+ microcyt-1+ 07:00pm plt smr-very low plt count-44*# 07:00pm pt-12.4 ptt-23.4 inr(pt)-1.1 . upon d/c: hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 04:50am 5.6 3.76* 11.4* 33.9* 90 30.3 33.5 18.4* 148* differential neuts bands lymphs monos eos baso atyps metas 05:17am 55.4 33.1 6.5 4.1* 1.0 red cell morphology hypochr anisocy poiklo macrocy microcy polychr ovalocy bite fragmen 05:17am 1+ 1+ 1+ basic coagulation (pt, ptt, plt, inr) pt ptt plt smr plt ct inr(pt) 04:50am 148* miscellaneous hematology esr 07:00pm 7 chemistry renal & glucose glucose urean creat na k cl hco3 angap 04:50am 80 22* 4.0*# 140 3.5 101 27 16 enzymes & bilirubin alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili indbili 05:00am 281* other enzymes & bilirubins lipase 05:17am 33 cpk isoenzymes ck-mb ctropnt 07:00pm 0.04* 07:00pm notdone chemistry totprot albumin globuln calcium phos mg uricacd iron 04:50am 8.6 4.3 1.7 hematologic folate hapto 05:00am <20* other chemistry ammonia 05:17am 19 pituitary tsh 06:20am 2.0 other endocrine cortsol 06:00am 18.7 antibiotics vanco 05:17am 14.3* neuropsychiatric phenyto valproa phenyfr %phenyf 04:50am 68 lab use only greenhd prblm redhold 07:15am amarie & j . adamts 13: negative metanephrines serum - wnl hit - negative . ct head : impression: unchanged appearance of ct compared with the prior examination obtained earlier on the same day. no hemorrhage is seen. hypodensities are again noted in the white matter bilaterally. if hypertensive encephalopathy is clinically suspected, mri would be helpful for further assessment. . eeg : impression: this is an abnormal portable eeg due to the presence of intermittent right central parietal and left temporal and central sharp transients. this finding appears to be independent and more frequent over the right side. additionally, there are prolonged bursts of generalized slowing, bifrontally predominant and slow and disorganized background rhythm. this abnormality suggests cortical dysfunction over the right central parietal region and possible left central and temporal region. the bursts of the generalized slowing and the background slowing suggests a deep, midline subcortical dysfunction and are consistent with an encephalopathy. there was no seizure activity recorded. . echo : conclusions: there is moderate symmetric left ventricular hypertrophy. the left ventricular cavity size is normal. overall left ventricular systolic function is normal (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets are mildly thickened. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is a small pericardial effusion. . mri abdomen: findings: both native kidneys are markedly atrophic. single renal arteries are identified bilaterally, without evidence for stenosis. the transplant renal artery rises from the right external iliac artery. there is no evidence for stenosis within the renal transplant artery. this artery trifurcates approximately 1.4 cm from its origin. the aorta is normal in caliber without evidence for atherosclerosis. the common iliac, external iliac and visualized portions of the common femoral arteries are widely patent. the transplanted kidney is identified in the right hemipelvis, measuring 10.7 cm in length. there is severe cortical thinning. the urothelium of the renal pelvis is abnormally thickened and edematous and demonstrates enhancement on post-gadolinium imaging. this finding is nonspecific, however, can be seen in both rejection and infection. there is no significant hydronephrosis of the transplanted kidney and no focal renal lesions are identified. the partially visualized liver is unremarkable. there is no intra- or extrahepatic biliary dilatation. the pancreas and adrenal glands are unremarkable. the spleen is abnormally low in signal on t1-weighted imaging, consistent with iron deposition. the visualized bowel is normal and there is no significant lymphadenopathy. impression: 1. no evidence for renal artery stenosis in either the native kidneys or transplant kidney. 2. severe cortical thinning of the transplant kidney. abnormally thickened and edematous renal transplant urothelium. this is a nonspecific finding that can be seen in rejection and infection. findings were discussed with dr. at the time of the examination. . mri of the head: impression: 1. no interval change in multiple nonspecific foci of increased flair signal intensity throughout both cerebral hemispheres, non-specific. 2. apparent flair-hyperintensity in the sulcal subarachnoid spaces. this finding may represent a technical artifact, or less likely blood products, cells or protein within the subarachnoid space. 3. normal mra of the circle of . . carotid us: findings: duplex evaluation was performed of both carotid arteries. minimal plaques identified. on the right, peak systolic velocities are 106, 60, 87 in the ica, cca, and eca respectively. the ica to cca ratio is 1.6. this is consistent with less than 40% stenosis. on the left, peak systolic velocities are 75, 72, 78 in the ica, cca, and eca respectively. the ica to cca ratio is 1. this is consistent with less than 40% stenosis. there is antegrade flow in both vertebral arteries. impression: minimal plaque with bilateral less than 40% carotid stenosis. brief hospital course: 58 y.o. f admitted for malignant hypertension after missing hd session and nonadherent with her medications. patient with subsequent seizures due to severe hypertension and slowly resolving confusion due to reversible hypertensive leukoencephalopathy. patient was also found to be in microangiopathic thrombotic anemia with platelet consumption. her symptoms, confusion and cbc returned to her normal baseline upon control of her blood pressure. . # confusion the pt presented with waxing and episodes of confusion when she was transferred from the micu to the floor. she was disoriented to location, time and suffered from post-ictal amnesia. the possible ddx included post-ictal vs. ic bleeding (ct scan was negative) vs. secondary to leukoencephalopathy vs. sepsis vs. delirium vs. medication. since the pt mental status improved steadily parallel to bp control, it was thought to be reversible changes secondary to hypertensive leukoencephalopathy. the pt has been stable over the past days and is discharged with a fully recovered mental status. . # fevers pt spiked temperature when still on the micu and started on 7 day course of ceftriaxone. since the pt had signs of lll atelectasis on cxr a possible pna could not be fully excluded. the pt also just had been intubated and had central lines in place. the obtained sputum showed strep. pneumoniae and she was treated empirically for that with ceftriaxone. drug fever was also in the differential since the pt showed no other signs of infections (chills, elevated wbc, sob) but remained with intermittent fevers. she was newly started on phenytoin. after she was changed to valproic acid, pt remained afebrile over the prior to discharge and without any signs of active infection. . #. seizures: pt presented at micu with new onset seizures, 2 generalized clonic episodes (each about 3min), which required intubation. pt was monitored throughout post-ictal state and transferred to the floor after she was stable. she has been seizure-free since then. initial seizures likely htn emergency - hypertensive leukoencephalopathy. patient did not have evidence of trauma, systemic infection, no electrolyte abnormalities especially with esrd, no evidence of acute bleed with underlying thrombocytopenia. - head ct negative x 2 on negative for hemorrhage or mass, mri was not thought to be necessary at this point, neuro recs. - eeg impression: suggests cortical dysfunction over the right central parietal region and possible left central and temporal region. the bursts of the generalized slowing and the background slowing suggests a deep, midline subcortical dysfunction and are consistent with an encephalopathy. there was no seizure activity recorded. pt was initially started on phenytoin for seizure prophylaxis to which she responded well. however, pt developed a fever which was thought to be drug induced (eosinophilia accompanied febrile episode). therefore phenytoin was d/c and pt was started on valproic acid instead. her valproic acid have been monitored closely to titrate dosage, currently she is on valproic acid 500mg po bid standing, last valproic level on was 75. pt will f/u with neurology as an outpatient to adjust further treatment. . #. hypertension: pt was admitted for hypertensive urgency with end organ damage - hypertensive leukoencephalopathy and microangiopathic hemolytic anemia. obtained secondary hypertension work-up was negative (incl. mri abdomen, tsh, cortisol - serum epinephrine and metanephrine were within normal limits). she has a history of not taking her medications, missing hd may also have complicated situation along with worsening renal failure/hypoperfusion/high raas. history from previous admission of bp elevated >200s but responded to lasix and labetalol. pt in ed initially was started on nitro gtt and nipride gtt in ed. drips were stopped after seizures and improved bp control. there were no ecg changes or evidence of cardiac ischemia. bp was hard to control at first but stabilized over the past 72h under enforced treatment with labetalol, lisinopril, clonidine, nifedipine and intermittent hydralazine (which was d/c on , due to orthostatic symptoms). repeated adjustments in bp-regimen were made to optimize current treatment and prevent hypotensive episodes. pt is discharged on lisinopril 40mg po to qhs, clonidine tts 3 patch qthurs, labetalol 800mg po bid and nifedipine 120mg po qhs. the set goal for her sbp is 120-170, since the pt probably has a history of long-standing maltreated htn and is used to high pressures. she complains about light-headedness and dizziness once pressures get too low. however, given her recent hypertensive episode it is essential for her to be well controlled. also considering a component of non-compliance it is important that the pt will f/u with pcp and for monitoring of compliance. . #. esrd pt is s/p renal transplant in and tx rejection in , now back on hd, 3 times a week. pt received hd throughout her hospital course and will be followed by renal as an outpatient, receiving hd at the . she will be continued on her prednisone taper for immuno suppression with her graft. there was no evidence of compromising renal artery stenosis on the mri. hd per their schedule, next hd sessioned for . . #. cn iii palsy pt had two episodes of right sides ptosis/lat. deviation/diplopia and mydriasis (reactive to light), accompanied by right hemicranial ha during hd on - resolving within 10 minutes. initial ddx included arteritis temporalis (esr 7) vs. tia vs. right posterior artery aneurysm. the obtained work-up included mri/mra (questionable subarachnoidal bleeding), carotid duplex (minimal bilat. stenosis <40%) and lp (no xanthocromia,clear and colorless). since the clinical findings (ptosis, lat. deviation, mydriasis or diplopia)totally resolved and the work/up was negative, the intermittent cniii palsy is thought to be secondary to transient ischemia due to hypotension. pt will f/u with dr. , neurologist as an outpatient. . #. severe headache pt presented with severe fronto-facial ha, accompanied by n/v on (day after lp). she reported that the ha was similar to the one on her initial presentation. the ha was thought to be triggered by pt not following instruction after lp, such as bed-rest and high pressure overnight (up to 220s sbp. ha resolved throughout the day, initially treated with oxycodone-acetaminophen and fioricet for ha, as well as dolasetron for nausea. neuro saw pt and did not find signs for focal lesion or papilledema, which could be indicative for post-lp complications. pt is asymptomatic on day of discharge, denying ha, n/v, dizziness or blurry vision this am. . #. anemia - normocytic. pt initially presented with hct of 29.8, normocytotic. the anemia is thought to be secondary to esrd (not treated with epo previously) vs. occult bleeding vs. hemolysis. retic count in was 1.4%, indicating an impaired production. the hemolysis studies obtained revealed an elevated ldh and a decreased haptoglobin, which are found in hemolysis. the anemia is thought to be secondary to esrd and initial microangiopathic hemolytic anemia induced by hypertensive urgency. hct slightly decreased over the days prior to discharge, 32.3 on to 25.6 on . hemolysis labs obtained revealed elevated ldh (not compared to previous days), haptoglobin <20 (measured twice), normal direct and total bili. no signs of active bleeding, pt is asymptomatic (denies sob, not tachycardic, no dizziness) nor signs of severe hemolysis (jaundice, splenomegaly). anemia and decrease in hct is thought to be due to esrd, acd and hospital course (hd, frequent blood draws). however, labs indicate an additional hemolytic component. pt was given 2 units of blood on at hd, in addition to usual epoetin administration during hd sessions. she responded adequately to transfusion, hct rose from 25.6 to 28.1 to 33.9 in am of . . #. thrombocytopenia pt initially presented with ptl of 44. the thrombocytopenia were thought to be either microangiopathic hemolytic anemia secondary to her hypertensive urgency vs. ttp. indicative for an underlying ttp are the following findings are thrombocytopenia, hemolysis, schistocytes, elevated ldh, decreased haptoglobin, elevated creatinine, mental status changes and fever. however the obtained adamts13 to test for ttp was negative. given that the pt hct stabilized once her bp was controlled better made a mha secondary to hypertensive crisis most likely. interestingly, the pt had a similar thrombocytopenic episode in when she was hospitalized for her renal tx rejection. the ptl count has been steadily increasing since , being 148 on day of discharge. . # full code medications on admission: meds at home: labetalol 600 mg daily asa lipitor prednisone 5mg folic acid . upon transfer: labetalol hcl 300mg po tid lisinopril 10mg po daily aspirin 81mg po daily prednisone 5mg po daily trazodone hcl 25mg po hs:prn phenytoin 100mg iv q8h oxymetazoline hcl 1 spry nu :prn amoxicillin 500mg po q24h acetaminophen 325/650mg po q4-6h:prn senna 1 tab po bid:prn magnesium sulfate 2gm/100ml ns iv once iss discharge medications: 1. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). disp:*30 tablet, chewable(s)* refills:*2* 2. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for headache. disp:*30 tablet(s)* refills:*0* 3. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 4. sertraline 50 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 5. labetalol 200 mg tablet sig: four (4) tablet po bid (2 times a day). disp:*240 tablet(s)* refills:*2* 6. lisinopril 20 mg tablet sig: two (2) tablet po hs (at bedtime). disp:*60 tablet(s)* refills:*2* 7. clonidine 0.3 mg/24 hr patch weekly sig: one (1) patch weekly transdermal qthur (every thursday). disp:*4 patch weekly(s)* refills:*2* 8. valproic acid 250 mg capsule sig: two (2) capsule po q12h (every 12 hours). disp:*120 capsule(s)* refills:*2* 9. lanthanum 500 mg tablet, chewable sig: one (1) tablet, chewable po three times a day. disp:*90 tablet, chewable(s)* refills:*2* 10. trazodone 50 mg tablet sig: 0.5 tablet po once mr1 (once and may repeat 1 time) as needed for insomnia for 1 doses. disp:*15 tablet(s)* refills:*0* 11. nifedipine 60 mg tablet sustained release sig: two (2) tablet sustained release po daily (daily). disp:*60 tablet sustained release(s)* refills:*2* discharge disposition: home discharge diagnosis: hypertensive urgency with secondary leukencephalopathy and microangiopathic hemolytic anemia . esrd, s/p renal transplantation in , tx rejection in now back on dialysis discharge condition: stable discharge instructions: please go to clinic tomorrow to have your blood pressure checked by a nurse. . please see your primary care physician or present to the ed for any of the following symptoms: headaches, blurry vision, changes in vision, nausea, vomiting, chest pain, shortness of breath, swelling of your legs, weaknesses of limbs or any other symptoms that worry you. followup instructions: please have your blood pressure checked at the women's clinic at carny tomorrow; . your next scheduled appointment for dialysis at the is on thursday, the . . please see dr. , , neurology on thursday, at 1pm on neurology unit cc8 (sb) for seizure follow-up. . . you have an appointment with your primary care physician . , scheduled for monday, at 2.30pm, women's clinic at hospital. . . you also have a set appointment with your therapist for monday at 6pm, women's clinic at hospital. . procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung insertion of endotracheal tube hemodialysis insertion of other (naso-)gastric tube transfusion of packed cells diagnoses: hypertensive chronic kidney disease, malignant, with chronic kidney disease stage v or end stage renal disease pneumonia, organism unspecified end stage renal disease urinary tract infection, site not specified long-term (current) use of steroids other pulmonary insufficiency, not elsewhere classified other convulsions depressive disorder, not elsewhere classified personal history of other diseases of circulatory system epistaxis hypotension of hemodialysis third or oculomotor nerve palsy, partial unspecified causes of encephalitis, myelitis, and encephalomyelitis other non-autoimmune hemolytic anemias 

Answer: The patient is high likely exposed to