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: reason for admission: seizures major surgical or invasive procedure: none. history of present illness: mr. is a 63yo male with pmh significant for seizures, atrial fibrillation, and s/p cabg who is being transferred from osh for management of seizures. per patient's wife, on tuesday the patient complained of seeing spots in his eyes. on wednesday night/early morning the patient complained of seeing spots again. at approximately 4am mr. attempted to go the bathroom but fell on the floor at which time his wife woke up and found her husband seizing. she called 911 and the patient was brought to hospital. initial vitals in ed were t 100.4 bp 182/66 ar 128 rr 14 o2 sat 96% ra. in the ed he had another generalized tonic clonic seizure. he was given keppra via the ngt. he was intubated for airway protection. per osh records, the intubation was difficult and required help of anesthesiologist. ct scan of head and c spine were unrevealing. . he was then transferred to the icu for closer management. in the icu the patient spiked a temperature to 102 and he was given rocephin and clindamycin for suspected aspiration pneumonia. on at 3am patient went into 15-30 minutes of status epilepticus. he was loaded with dilantin 500mg iv x1. and placed on benzos. ventilation settings at this time were: simv tv 600 rr 10 fio2 60% ps 15 peep 5. he was then transferred to for further management. . per patient's wife, he was diagnosed with seizures 1 year ago when he had a seizure at home and presented to . found to have cva which was thought to be cause of seizure. he was started on keppra. he has not had a seizure since then but has complained of seeing spots occasionally. she is followed closely by her neurologist and saw him 1 month ago. . no recent fevers, chills, chest pain, sob, dizziness, or dysuria. per wife, the patient has good and bad days but had been feeling well prior to this admission. past medical history: 1)cad s/p cabg 9 years ago 2)seizure disorder-last seizure 1 year ago 3)atrial fibrillation on anticoagulation 4)ulcerative colitis social history: patient lives with wife in . currently retired. no history of tobacco, alcohol, or ivda. family history: nothing relevant, per wife physical exam: vitals t 102.4 bp 159/114 ar 103 rr 14 vent settings: ac fi02 1.0 tv 600 rr 14 peep 5 gen: patient sedated, responsive to sternal rub heent: ett in place heart: irregularly, irregular. +systolic murmur lungs: course breath sounds anteriorly abdomen: obese, soft, nt/nd, decreased bss extremities: no edema, 2+ dp/pt pulses bilaterally pertinent results: 05:30pm pt-24.6* ptt-43.6* inr(pt)-2.5* 05:30pm plt count-259 05:30pm wbc-5.7 rbc-3.38* hgb-12.9* hct-37.5* mcv-111* mch-38.3* mchc-34.6 rdw-16.1* 05:30pm tsh-0.39 05:30pm albumin-3.1* calcium-8.1* phosphate-3.1 magnesium-2.4 05:30pm ck-mb-6 ctropnt-0.10* 05:30pm lipase-12 05:30pm alt(sgpt)-25 ast(sgot)-27 ld(ldh)-312* ck(cpk)-187* alk phos-47 amylase-174* tot bili-1.5 05:30pm glucose-124* urea n-14 creat-1.2 sodium-143 potassium-3.9 chloride-111* total co2-21* anion gap-15 06:11pm urine uric acid-few 06:11pm urine rbc-* wbc- bacteria-few yeast-none epi-0-2 06:11pm urine blood-lg nitrite-neg protein-tr glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-5.0 leuk-neg 06:11pm urine color-amber appear-clear sp -1.028 09:51pm phenytoin-4.5* 09:51pm digoxin-0.9 10:51pm type-art temp-38.2 rates-14/0 tidal vol-600 peep-5 o2-60 po2-133* pco2-43 ph-7.36 total co2-25 base xs--1 -assist/con intubated-intubated 03:22am blood wbc-5.0 rbc-3.24* hgb-12.3* hct-34.8* mcv-107* mch-38.0* mchc-35.4* rdw-17.3* plt ct-223 03:14am blood wbc-4.5 rbc-2.98* hgb-11.3* hct-32.0* mcv-107* mch-38.1* mchc-35.4* rdw-16.8* plt ct-209 03:22am blood glucose-115* urean-12 creat-1.2 na-143 k-4.0 cl-113* hco3-21* angap-13 03:44pm blood glucose-119* urean-10 creat-1.0 na-143 k-3.7 cl-111* hco3-21* angap-15 03:14am blood glucose-119* urean-8 creat-0.9 na-143 k-3.6 cl-110* hco3-21* angap-16 03:01am blood glucose-92 urean-5* creat-0.8 na-146* k-3.2* cl-111* hco3-25 angap-13 03:01am blood lipase-75* 03:22am blood asa-neg ethanol-neg acetmnp-neg bnzodzp-pos barbitr-neg tricycl-neg medical condition: 63 year old man with sob, hypoxia reason for this examination: r/o dvt shortness of breath and hypoxia. question dvt. grayscale and doppler son were performed of the ij, subclavian and axillary veins on the left and of the ij on the right. there was diminished compressibility in the left cephalic vein compatible with acute thrombosis. there was normal compressibility, flow, and augmentation in the other vessels. impression: superficial venous thrombus noted in the cephalic vein. no dvt. medical condition: 63 year old man with sob, hypoxia reason for this examination: r/o dvts indication: rule out dvt. scale and doppler son of bilateral common femoral, superficial femoral, popliteal, posterior tibial and peroneal veins was performed. there is normal compressibility, color flow, and augmentation. impression: no evidence of right or left leg dvt. the study and the report were reviewed by the staff radiologist. dr. dr. approved: fri 8:37 am brief hospital course: hd#1 (): patient arrived in the micu-6 the afternoon of intubated, sedated and in stable condition with ngt in place. on arrival active patient medications included keppra 1000 mg and sedation with fentanyl 50 mcg/hr and midazolam 4 mg/hr. all other home medications were intially held. given suspicion for meningitis in the setting of seizure + fevers patient was given one dose of ceftriaxone 2 gm iv with infectious disease consent required for further treatment. also, a history suspicious for patient was sent for urgent mra of head & neck and mr of head which showed: 1)no enhancing lesions. chronic infarct in left parieto-occipital lesion, and 2)50% narrowing of right proximal ica. left ica origin atheroma." patient was initially seen on unit by neurology who recommended continuation of keppra, eeg to evaluate for seizure activity, echo for new murmur + fever, lp when inr < 1.5, and an increase in versed drip with consideration of dilantin load if patient seized again. suctioning from ett showed brownish-grey aspirate and ua that day showed no organisms. patient remained febrile throughout first day in micu. . hd#2 (): patient received tylenol for fever overnight and had echo and eeg in the morning. echo showed no signs of valvular vegetations and eeg showed no signs of an epileptiform focus. in the setting of seizure + fevers meningitis remained at the top of our differential diagnosis and an lp was arranged. prior to admission patient had taken coumadin for his atrial fibrillation and on transfer to micu initial inr was 2.5, patient was initially given 3 units of ffp with following inr=1.7. transfusion of two more units of ffp resulted in no change in inr so plan for lp was aborted. during the day patient became very anxious, became tachycardic to the 140s, began demonstrating tremor in his lower extremities bilaterally and started pulling against his restraints. his fentanyl was incresaed to 75 mg/hr and versed was increased to 5.0 mcg/hr. he was also bolused with dilantin 1000 mg iv once since patient was also displaying tremor in le bilaterally while sedated. patient remained tachycardic to the 120s-130s depsite the increase in sedation and diltiazem 60 mg po qid was started with diltiazem 5 mg iv for immediate control. to empirically cover aspiration pneumonia vancomycin & flagyl were started and id approval for ceftriaxone therapy (to cover pneumococcus) was obtained. ampicillin was also started to cover listeria monocytogenes and acyclovir was started due to concern for hsv encephalitis after blood drawn for hsv pcr. temperature spiked to 101 at 18:00 with repeat panculture including mini-bal which showed 1+ pmns and oropharyngeal flora. ett was advanced 1 cm after cxr showed approx 5 cm above the carina. patient remained npo. . hd#3 (): patient remained febrile and began having episodes of loose stools. patient with long history of ulcerative colitis, but stool sample sent for c.diff toxin which was negative. restarted on 6-mercaptopurine for uc. lp was re-attempted prior to which patient received an additional 5 units of ffp with following inr=1.3. following lp tube feedings were intiated and changed later in the day to include fiber with a goal of 90 cc/hr. urine output was noted to be poor, patient putting out approximately 15 cc/hr. two fluid boluses of 500 cc were given with no effect. . hd#4 (): patient remained febrile, with attempts to wean sedation aborted due to increased patient anxiety/agitation. in light of negative blood/csf/urine cultures acyclovir, ampicillin and ceftriaxone were discontinued. mr. continued to take vancomycin for sputum culture that grew 2+ g(+) cocci in pairs and clusters and flagyl for empiric tx of c.diff diarrhea despite negative stool toxin screens. ct of chest with contrast showed: 1)bilateral pleural effusions with associated atelectasis & consolidation, left>right, 2)2 small pulmonary nodules in rul ~4 cm in diameter, 3)airspace disease in the lul, and 4)coronary artery and mitral annulus calcifications. . hd#5 (): patient continued to be febrile, reaching temperature of 102 degrees overnight. also continued to have loose stools with output of 2l, flagyl discontinued due to multiple negative c.diff toxin screens. however, stool was re-sent for c.diff a&b toxins and banana flakes were added to tube feeds to bulk-up stools. plan for gi consult the following day. urine output continued to be poor, patient was given one-time dose of lasix iv 40 mg with transient increase in uop. patient was placed on trial of pressure support starting @ 13:00 and continuing on throughout the night without adverse events. sedation was gradually weaned with fentanyl decreased from 75 mcg/hr to 60 mcg/hr and versed at 4.0 mg/hr. patient continued to have episodes of anxiety throughout the day for which he was given lorazepam 1 mg iv for breakthrough relief. picc line was place in right arm in the a.m. zosyn 4.5 mg iv q8h was started to empirically cover g(-) organisms causing pneumonia . hd#6 (): no high fever spikes, but patient ran low-grade fever of 100.5. per cxr, pna not progressing/worsening. azithromycin 500 mg po bid added to cover atypical causes of pna (mycoplasma/chlamydia/etc). gi consulted for increased, watery stool output (patient has h/o uc treated with 6-mp, requested consult to determine any additional management options/symptomatic relief). no recommendations per gi, cannot determine at this time if current stooling is any change from baseline. per neurology, keppra dose was increased to 1250 mg po bid (from 1000 mg). patient on coumadin as outpatient for a.fib, held on admission to perform lp. heparin ggt restarted for dvt prophylaxis. given another single dose of lasix 40 mg iv to removed third-spaced fluid, net -850 cc at end of day with los fluid net +8.6l. diltiazem ggt titrated up to 10 u/hr to maintain hr<100 bpm. overnight, patient became agitated on cpap+ps, ac restarted briefly for a few hours and placed back on pressure support. . hd#7 (): patient placed back on pressure support with ps 15/peep 8 (increased from ). arterial line placed in right arm without complications. abg showed 7.44/33/102/23. dosed again with lasix 40 mg iv to removed fluid that had third spaced into tissues/pleural space. continued vanc/zosyn/azithro. again spiked temperature to 101.5 degrees at mid-day and was pancultured. patient also became tachycardic with hr increase to 130s-140s, diltiazem drip increased to 10 mg/hr. began having apneic episodes on pressure support and was placed back on ac at 20:00. sedation weaned to versed 3.0 mg/hr and fentanyl 25 mcg/hr. lost last piv access, patient only with arterial line and right picc line. k 3.2, corrected. tube feeds held due to continued high gastric residuals. during late afternoon/evening patient was dosed once again with lasix 20 mg iv with repeat cr 1.8. . hd#8 (): cr this a.m. 2.0. urine sent for urine lytes (na, bun, creatinine), urine eosinophils, microscopic analysis. likely due to hypovolemia secondary to diuresis. lasix held today, monitoring cr for improvement of . throacic ultrasound performed to look for possible empyema/loculated plueral effusions and did not reveal any significant fluid collection that would benefit from throacentesis. patient remained on ac vent overnight, risbi in the a.m. 103, mid-day abg on ac 7/46/36/106. decided to give patient spontaneous breathing trial. patient maintained own ventilation for 30 min at which time respirations were ~40/min, sao2 92% and patient having difficulty breathing. trial was stopped and patient put back on pressure support with ps 5/peep 0. id consulted for further work-up of fuo. recommended checking borellia and ehrlichia serologies and inspecting peripheral smear of blood for parasites (babesiosis) if spiked temp again. also recommended changing azithromycin to doxycycline if spiked temp again. later in evening patient spiked temp to 102.5 and id recs were instituted. . hd#9 (): renal consulted for decline in renal fxn and proposed atn vs. prerenal azotemia vs. ain, though most likely non-oliguric atn. recommended increase in free water intake as patient was also hypernatremic and renally dosing medications. renal us showed no evidency of hydronephrosis. had ct of head/sinuses which showed no acute sinusitis with mild mucosal thickening and non-contrast ct of chest & abdomen which showed: 1. bilateral pleural effusions with associated atelectasis and consolidation, greater on the left than the right. this is stable from prior exam. 2. stable pulmonary nodules in the upper lobe. 3. stable extensive coronary artery and aortic calcifications. 4. no discrete focus of infection is identified although this study is limited by lack of contrast. 5. anasarca of the body wall in abdomen and pelvis. . hd#10 (): stopped diltiazem gtt & started esmolol gtt to control hr & bp. sedation weaned and discontinued and patient extubated, after which patient was tachypneic but abgs looked good. id recommended further checking cmv serologies, patient spiked temp to 101 and blood was cultured again for anaerobic bacteria and fungus. . hd#11 (): patient continued tx with iv vancomycin (dosed by levels) and renally-dosed zosyn. received 1 gm vanc when afternoon levels 13.5. attempted to wean esmolol gtt, could not maintain adequate control of hr & bp. stopped drip and gave metoprolol 25 mg po tid, soon increased to 75 mg po tid with additional dosing of diltiazem 10 mg iv once to control rate. patient then started on diltiazem 30 mg po qid in addition to metoprolol 75 mg po tid to control rate, though patient continued to be tachycardic and htnive throughout day. metroprolol increased to 100 mg po tid and diltiazem increased to 60 mg po qid. overnight patient remained confused, likely residual effect of multiple heavy sedatives, and attempted to climb out of bed and required one-time doses of ativan & zyprexa. patient will require one-on-one sitter upon tx to floor. patient had tee which showed no vegetations and severely deformed aortic valve. d/c'd doxycycline per id recs and had repeat cxr due to increased airway secretions and concern over ?aspiration while taking a.m. medications. order placed for speech & swallow eval, post-poned until tomorrow due to patient having brief episode of tachypnea and sats down to 92% requiring non-rebreating mask. per renal, adjusted dose of keppra according to gfr, approved by neuro and will be seen by their service tomorrow. na noted to be 149 and given 1l d5w over 24 hours. . hd#12 (): patient not seen by neuro. patient continued to be hypernatremic and was given 1l d5w @ 200 cc/hr and another at 125 cc/hr. metoprolol was increased to 100 mg po tid and diltiazem was increased to 60 mg po qid to control heart rate. per nursing that morning, patient had questionable episode of aspiration while taking morning medications. repeat cxr showed marginal worsening infiltrates in the rml. later that night patient dropped sats to 85% and given cpap for 30 minutes with improvement. he had several hours of respiratory stability but eventually re-developed tachypnea (50) and hypoxemia (7.48/36/61 on nrb) followed by an episode of hypotension and was re-intubated. the rest of hospital summary will be in problem-based format: . 1)hypoxic respiratory failure: patient intubated @ osh in setting of status epilepticus in order to protect airway. initially struggling against ventilator requiring increases in sedation, suctioning of ett showing brownish- sputum. now weaning sedation with vent on cpap+ps as patient tolerates, decreased sputum production. arterial line placed , d/ced by pt on . pt extubated , required supplemental o2 via nc and hiflow nrb over following days & developed tachypnea and hypoxia early morning of requiring re-intubation. leni and l ueni show no dvt, ct chest same day showing new bilat ll consolidation concerning for aspiration, bridging small-to-moderate pleural effusions and new hydrostatic pulmonary edema. bnp 30,173 on . serial cardiac enzymes r/o mi. -rested overnight on psv, good sbt this a.m. and extubated without complications. ngt placed prior to extubation for tube feedings due to recent h/o aspiration. -continue suppl. 02, wean as tolerated to maintain sa02 >90%. chest pt. patient oob with assist to chair. -thoracic us showed ~1.6 ml of pleural fluid, ip unable to tap effusions. -aspriation pna most likely culprit, cont iv vanc/zosyn renal dosing. concern for developing lung abscess. currently on day 13/14 of zosyn regimen, will extend until chest can be re-imaged and abscess confirmed/ruled-out. -continue lasix gtt with goal of net negative 1l fluid balance today. if patient auto-diureses may stop gtt and begin scheduled regimen. -daily cxr -pt to evaluate for rehab. . 2)fevers: patient presents with fevers since he was admitted to osh. likely cause of new onset seizures. possible sources of infection include lll infiltrate. no report of productive cough, dysuria, other symptoms at home. still unclear source. tee done, blood and urine negative to date, cdiff negative, csf negative. lack of leukocytosis may be due to uc tx with 6-mp. , , c.diff screens negative. blood culture showing not growth. non-contrast ct of head/chest/abdomen for eval of possible sinusitis and surveillance of occult focus of infection =>no infectious source. pt continues to spike temps nightly. tee shows not evidence of endocarditis and a severely deformed aortic valve. -lyme, -hsv, c.diff toxin b negative. relatively afebrile through but spiked temp to 102 degrees am of , resolved to low-grade temp ~100.5 by . negative ehrlichia/coxiella/legionella bal culture. - tylenol prn for fever - continue broad coverage of pna. zosyn renally dosed to 2.25 gm iv q6 hours, back on scheduled vanc 750 mg iv daily, follow vanc levels - check routine vanc levels. - f/u and blood cultures as well as fungal/afb cultures. c.diff rechecked and negative . - f/u additional id recs, appreciate input, . 3)acute kidney injury: cr stable now. likely due to hypovolemia/prerenal azotemia secondary to lasix diuresis. urine lytes show no eosinophiluria, fena and feuria indicate intrinsic renal etiology of . - cr stable, monitor daily - renal consult, appreciate recs - dose medications for patient's creatinine - continue lasix gtt, stop if cr >2.5. start schuled iv lasix this pm. . 4)hypernatremia: increased to 149 & decreased to 139 with d5w supplementation. morning of found to be 155 but patient sedated after reintubation and difficult to assess for mental status changes. patient with good uop. -na now wnl -ngt placed prior to extubation and tube feedings stopped. gently re-start tube feedings this pm. d/c free water boluses. -continue lasix gtt and monitor uop. -daily chem7. . 5)atrial fibrillation: patient remains in atrial fibrillation; confirmed by ekg on admission to osh and . previously on coumadin for a.fib. - on heparin drip at 1400 u/hr. holding coumadin 5 mg po daily. - shows severe as with valve diameter of 0.8 cm2. patient will need aggressive rate control to decrease stress to heart. - continue metoprolol 100 mg tid, po diltiazem increased at 90 mg po qid. . 6)seizure disorder (requiring intubation): patient was diagnosed with seizure disorder 1 year ago in setting of cva. now presents with recurrent seizures despite being on keppra. differential for seizures include infection, stroke, metabolic encephalopathy, drugs, head trauma, tumors, etc. most likely infection since patient has been febrile. concerned about meningitis as a possible etiology though ruled out by negative lp. mra head/neck and mr of head show no new enhancing lesions. same day echo for new murmur showed no vegetations and eeg showed no epileptiform focus. - infectious etiology continues to be at top of differential, but pneumonia only foci identified thus far. - keppra renally-dosed to 750 mg po bid, approved by neuro. - iv ativan if patient becomes symptomatic for seizures . 7)ulcerative colitis: patient on mercaptopurine as outpatient. per wife, patient has history of cramping and loose stools on a regular basis. - continue mercaptopurine 75 mg po daily. 400 cc stool op yesterday. - per gi consult, no evidence current stool op is change from baseline. - banana flakes added to tube feeds if having loose stools. . 8)cad s/p cabg: no complaint of recent sob or chest pain during this admission. - continuing home statin, on oral beta blocker and ccb for rate & pressure control. . 9)fen: - speech & swallow evaluation shows okay to take pre-thickened nectar feeds, however will initially feed via ngt s/p extubation. - repeat speech & swallow study in the am - restart nutren full-strength tube feedings tonight at 10 cc/hr with goal of 45 cc/hr, advance as tolerated and checking residuals q6 hours . 10)access: right picc line placed . arterial line placed in rue and pivx1 (20g). . 11)prophylaxis: iv heparin, ppi. . 12)code: full (verified with wife . 13)dispo: c/o to floor bed. . final instructions to accepting team: 1) monitor na 2) follow mental status for return to baseline. will likely need 1:1 sitter due to increased pm agitation, pulling ngt, well-controlled with iv ativan. 3) continue iv zosyn (day 14) due to concern for ? lung abscess. per id okay to d/c vanc (18 day course total) 4) follow-up 9/12 & blood cultures, fungal/afb culture 5) wean 02, continue chest pt and 6) speech & swallow to perform video swallow eval once mental status improves 7) screen for rehab 8) f/u pt/ot consult on day of transfer, oob with assistance. medications on admission: digoxin diltiazem 240mg po daily lasisx 40mg po daily isordil coumadin omeprazole purinethol 75mg po daily keppra 750mg po daily discharge medications: keppra 750 mg po bid diltiazem 90 mg po qid metoprolol 100 mg po tid asa 81 mg po daily lasix 40 mg iv bid zosyn 2.25 gm iv q6 hours (day 14/16) protonix 40 mg iv daily mercaptopurine 75 mg po daily ativan 1 mg iv prn agitation discharge disposition: extended care facility: northeast - discharge diagnosis: recurrent seizures/status epilepticus of unknown etiology requiring intubation complicated by aspiration pneumonia and recurrent fevers. discharge condition: stable, mental status not returned to baseline. discharge instructions: please keep all scheduled medical appointments. call a physician or go to the emergency room if experiencing the following symptoms: chest pain, shortness of breath, change in mental status/increased confusion, fever greater than 102 degrees, recurrent seizures or loss of consciousness, onset of weakness or loss of sensation or any other concerning symptoms. followup instructions: please call your neurologist and primary care provider within two weeks of leaving rehabilitation to set up an appointment. please also have your primary care provider refer you to a cardiologist or see your pre-existing cardiologist to evaluate a valvular abnormality that was noted during your hospital stay. procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung diagnostic ultrasound of heart fiber-optic bronchoscopy enteral infusion of concentrated nutritional substances thoracentesis other lavage of bronchus and trachea transfusion of other serum diagnoses: pneumonia, organism unspecified coronary atherosclerosis of native coronary artery acute kidney failure with lesion of tubular necrosis unspecified essential hypertension hyposmolality and/or hyponatremia atrial fibrillation aortocoronary bypass status rheumatic heart failure (congestive) acute respiratory failure pneumonitis due to inhalation of food or vomitus personal history of other diseases of circulatory system mitral valve insufficiency and aortic valve stenosis ulcerative colitis, unspecified epilepsy, unspecified, with intractable epilepsy 

Answer: The patient is high likely exposed to