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: seizures major surgical or invasive procedure: intubation extubation history of present illness: this is a 69yo m with a history of seizure disorder recently controlled on lamictal and tegretol, multiple cvas and history of sdh x 2, prostate ca, mdd, poor swallowing function and history of aspiration pna, questionable history of htn who presents as an ed to ed transfer following at least three witnessed seizures at home and in the outside ed without intervening returning to baseline. the wife provides the history. he was in his usoh until early this morning, she reports that "yesterday was and he looked like a million bucks". he may have missed his am dose of aeds, but did take his regularly scheduled pm dose. this morning, at 3am, he was found in bed following one of his usual generalized seizure spells with his head turning to the left, both arms and legs shaking as well as loss of consciousness. this lasted for about 30 seconds. he did regain consciousness enough in the intervening period to take his pills (which he usually takes with pudding). he then had another event at 8:30am, which was similar. this time, he did not regain consciousness. the wife called her neurologist and he suggested switching over to keppra in the morning. he continued to be poorly responsive, and so he was brought to the ed, where he had another event in the ed, the details of which are not clear. the neurologist in the ed left a consultant note in his chart, the pertinents of which are as follows: - he was not "responsive" to 1g of iv keppra - he was noted on exam to have a right sided spastic posturing of the upper extremity, constant opsoclonus, no spontaneous movements or myoclonus, occasional roving eye movements, as well as an upgoing toe on the left. he was transferred to the for continuous eeg monitoring to rule out ncse. review of systems: unable to obtain from patient. the wife reports that his health has been well lately. he has not been suffering from fevers, chills, change in consciousness, new changes in strength, etc. his wife reports that his urine has been dark lately. past medical history: the patient's past history includes a first stroke occurring 7 years ago, presenting predominantly as leg weakness, but he apparently got back to baseline without difficulties. four to five years ago, he had a second stroke with prominent right hemiparesis, which also resolved. he went on to have two subdural hematoma evacuations with the most recent one presenting with left upper extremity weakness. three years ago, he went on to have what sounds like a more prominent stroke consisting of right hemiparesis and aphasia. unfortunately, he never recovered from that stroke. aside from the strokes and subdural hematomas as outlined above, he has periods of depression, gastroparesis, prostate cancer, being hard of hearing, as well as having some unclear abdominal surgery for a difficult to access colon polyp. regarding his seizures, he is followed by dr. at associates. his last seizure was in / of this year, and medication changes were made at that time (see d/c summary from records). his aeds currently are listed below. he has about 3 seizures per year, his family reports, and they usually occur in the setting of the holidays. they do not give me a history of seizures in the setting of pneumonia, although he has weak swallow function and has had problems with aspiration pna in the past. social history: the patient currently lives in with his wife. is a former police officer at who stopped working 10 years ago, due to some unknown medical problem. at baseline, he is completely dependent on his wife for all adls. he has an expressive aphasia and is not particularly verbal, but does understand simple commands and questions, and can show a thumbs up sign, respond to simple questions, etc. he takes his pills with pudding. family history: family history: unknown, possibly raised in an orphanage per chart review. physical exam: admission examination: vitals: 100f, hr 90s, bp: 80s-100s systolic general: sedated, intubated on cmv 16/500/80%/5, breathing 17 breaths/min heent: nc/at, no conjunctival icterus noted, mmm, no lesions noted in oropharynx neck: supple, no stiffness no masses or lymphadenopathy pulmonary: lungs cta bilaterally without r/r/w cardiac: occasional pauses, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, no masses or organomegaly noted. extremities:warm and well perfused skin: no rashes or lesions noted. neurologic: - patient is intubated and sedated at the time of the exam on fentanyl/versed - there are no spontaneous movements or tremors noted - he does not follow commands - his eyes do not open to vigorous sternal rub or orbital pressure - when his eyes are forcibly opened, his pupils are in midposition without roving eye movements or evidence of opsoclonus - pupils are 0.5-1mm bilaterally, symmetric and react sluggishly to light - positive corneal reflexes - vors are difficult to attain - strong gag/cough - there is no withdrawal/flexion/extension to painful stimulation of any of his extremities - there is grossly increased tone on the right>left, particularly his right upper extremity - all reflexes are symmetric and + - toes are up bilaterally . . discharge examination: minimal shoulder abduction on left and otherwise no power in lue. good power 4+/5 in rue. in le 2 in hip flexion and knee flexion and 3 in knee ext and ankle dorsi. 4s in rle save 5 in knee ext. plantars ext bilat. brisk reflexs throughout r>l. severe aphasia more expressive than receptive and can mumble perhaps a few words. pertinent results: admission labs: 07:45pm pt-13.6* ptt-24.3 inr(pt)-1.2* 07:45pm plt count-257 07:45pm hypochrom-1+ anisocyt-normal poikilocy-1+ macrocyt-normal microcyt-normal polychrom-1+ ovalocyt-1+ 07:45pm neuts-87* bands-1 lymphs-10* monos-2 eos-0 basos-0 atyps-0 metas-0 myelos-0 07:45pm wbc-11.5* rbc-3.76* hgb-12.2* hct-35.1* mcv-93 mch-32.4* mchc-34.7 rdw-12.2 07:45pm calcium-9.5 phosphate-3.2 magnesium-1.9 07:45pm estgfr-using this 07:45pm glucose-222* urea n-17 creat-1.1 sodium-129* potassium-4.5 chloride-93* total co2-22 anion gap-19 . other pertinent labs: 02:53pm blood ck(cpk)-214 01:15am blood ck-mb-4 ctropnt-<0.01 02:53pm blood ck-mb-6 ctropnt-<0.01 12:48am blood lipase-13 08:55am blood %hba1c-5.2 eag-103 01:15am blood albumin-3.4* calcium-8.2* phos-2.8 mg-1.8 cholest-128 01:15am blood triglyc-33 hdl-66 chol/hd-1.9 ldlcalc-55 ldlmeas-62 01:15am blood tsh-1.2 09:22pm blood glucose-110* lactate-2.1* na-128* k-3.8 cl-98 09:22pm blood freeca-1.14 . aed levels: 01:15am blood carbamz-5.5 02:03am blood carbamz-15.2* 12:48am blood carbamz-14.2* 04:12am blood carbamz-11.2 01:15 lamotrigine 3.4 l (4.0-18.0 mcg/ml) . . abgs: 09:22pm blood type-art rates-16/18 tidal v-500 fio2-100 po2-406* pco2-38 ph-7.42 caltco2-25 base xs-0 aado2-275 req o2-52 -assist/con intubat-intubated 05:27am blood type-art po2-217* pco2-39 ph-7.42 caltco2-26 base xs-1 09:00pm blood type-art po2-129* pco2-39 ph-7.38 caltco2-24 base xs--1 . discharge labs: 08:55am blood wbc-4.3 rbc-3.11* hgb-10.1* hct-30.0* mcv-97 mch-32.4* mchc-33.5 rdw-13.0 plt ct-230 08:45am blood pt-12.0 ptt-27.5 inr(pt)-1.1 08:55am blood glucose-122* urean-8 creat-0.6 na-140 k-4.1 cl-103 hco3-31 angap-10 12:48am blood alt-17 ast-26 ld(ldh)-152 alkphos-68 amylase-53 totbili-0.3 08:55am blood calcium-8.9 phos-3.1 mg-1.8 . . urine: 08:40pm urine color-yellow appear-hazy sp -1.022 08:40pm urine blood-tr nitrite-neg protein-30 glucose-tr ketone-10 bilirub-neg urobiln-2* ph-5.5 leuks-tr 08:40pm urine rbc-3* wbc-5 bacteri-mod yeast-none epi-0 08:40pm urine amorphx-rare 08:40pm urine mucous-rare 12:10pm urine color-yellow appear-hazy sp -1.012 12:10pm urine blood-sm nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-mod 12:10pm urine rbc-4* wbc-70* bacteri-mod yeast-none epi-0 transe-1 12:10pm urine mucous-occ . . microbiology: 12:10 pm urine source: catheter. **final report ** urine culture (final ): gram positive bacteria. 10,000-100,000 organisms/ml.. alpha hemolytic colonies consistent with alpha streptococcus or lactobacillus sp. . time taken not noted log-in date/time: 11:58 am urine site: clean catch hem # 1290m-. **final report ** urine culture (final ): gram positive bacteria. >100,000 organisms/ml.. alpha hemolytic colonies consistent with alpha streptococcus or lactobacillus sp. enterococcus sp.. >100,000 organisms/ml.. tetracycline <=2 mcg/ml. sensitivity testing performed by sensititre. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------<=0.12 s tetracycline---------- s vancomycin------------ <=1 s . blood culture blood culture, routine-no growth blood culture blood culture, routine-no growth . . radiology: chest (portable ap) study date of 7:53 pm findings: single supine ap portable view of the chest was obtained. endotracheal tube is seen, terminating approximately 6.7 cm above the level of the carina. nasogastric tube is seen coursing below the level of the diaphragm, coiling in the expected location of the gastric fundus. mild bibasilar opacities are seen, right greater than left, which could relate to aspiration though an early infectious process cannot be excluded in the appropriate clinical setting. no pleural effusion or pneumothorax is seen. the cardiac silhouette is top normal. the aorta is calcified. impression: 1. endotracheal and nasogastric tubes in appropriate position. 2. mild bibasilar, right greater than left, subtle opacities may relate to aspiration or possible pulmonary vascular engorgement although underlying infectious process is not excluded in the appropriate clinical setting. . ct head w/o contrast study date of 7:58 pm findings: there is no acute intracranial hemorrhage, midline shift, acute mass effect, or hydrocephalus. there are large areas of hypodensity/encephalomalacia in the bilateral mca distribution, suggesting remote infarction/insult. patient is status post bilateral craniotomies. the visualized paranasal sinuses and mastoid air cells are clear. prominence of the sulci and ventricles likely related to age-related parenchymal loss as well as secondary effect from remote infarcts. there is hypodensity in the region of the left cerebellum which may be due to a prior infarct. impression: 1. no acute intracranial hemorrhage. 2. extensive hypodensities in the bilateral mca distributions suggesting remote infarcts/insults. hypodensity in the left cerebellum also likely from prior infract. . mr head w & w/o contrast study date of 12:28 pm findings: there is no evidence of acute infarct identified. there are chronic bilateral middle cerebral artery infarcts identified with extensive cystic encephalomalacia and t2 hyperintensities. following gadolinium, no abnormal parenchymal, vascular or meningeal enhancement seen. chronic left cerebellar infarcts are also seen. there is moderate ventriculomegaly likely ex vacuo due to chronic infarcts. there is no evidence of chronic or acute blood products. postoperative changes are seen in the right parietal region. impression: no evidence of acute infarct. bilateral middle cerebral artery chronic infarcts. no enhancing brain lesions. no mass effect or hydrocephalus. brain atrophy. . chest (portable ap) study date of 4:38 am findings: in comparison with the study of , there are bibasilar opacifications, more prominent on the right, that appear to be mildly increased. in view of the clinical history, the possibility of aspiration must be seriously considered. asymmetric pulmonary vascular congestion would also be a possible cause for this appearance. monitoring and support devices remain in place. . chest (portable ap) study date of 3:59 am mpression: ap chest compared to and 28: a largely dependent pulmonary edema is mild to moderate, but increased since . bilateral infrahilar consolidation is generally due to atelectasis, but pneumonia is not excluded. small bilateral pleural effusions are present. heart size is normal. no pneumothorax. feeding tube ends in the distal stomach. . . cardiology: ecg study date of 7:43:04 pm normal sinus rhythm with ventricular bigeminy. early r wave transition. non-specific st-t wave abnormalities. no previous tracing available for comparison. read by: , intervals axes rate pr qrs qt/qtc p qrs t 90 184 116 376/428 42 16 100 . ecg study date of 12:10:28 pm baseline artifact. the underlying rhythm is probably sinus rhythm with normal intervals. slight st segment elevation seen in lead v6 is likely a normal variant at this patient's age. compared to the previous tracing of ventricular bigeminy is not present on the current tracing. non-ventricular beats appear similar on both tracings. tracing #1 read by: , d. intervals axes rate pr qrs qt/qtc p qrs t 64 0 114 438/445 0 13 103 . . neurophysiology: eeg study date of impression: this is an abnormal portable eeg due to diffuse slowing of background consistent with a moderate encephalopathy. potential causes include but are not limited to sedative medication effect and metabolic, hypoxic or infectious disturbances. there were occasional sharp transients in the parietal regions but no definite epileptiform discharges. no electrographic seizures were present in the record. . eeg study date of impression: this is an abnormal continuous icu monitoring study because of diffuse background slowing more apparent in the first few hours of recording indicative of a moderate diffuse encephalopathy. potential causes include but are not limited to sedative medication effect, and metabolic, toxic or hypoxic disturbances. however, multifocal subcortical structural lesions cannot be ruled out as they may mimic the pattern of encephalopathy. in addition, background was asymmetric with more slowing and lower voltage on the right consistent with an underlying subcortical dysfunction. after 17:00, frequent semi-periodic sharp waves appeared in the left central parietal region with no further evolution to electrographic seizures consistent with an underlying epileptogenic focus. . eeg study date of impression: this is an abnormal continuous icu monitoring study because of diffuse background slowing indicative of a moderate diffuse encephalopathy. potential causes include but are not limited to sedative medication effect, and metabolic, toxic or hypoxic disturbances. however, multifocal subcortical structural lesions cannot be ruled out as they may mimic the pattern of encephalopathy. also, multifocal subcortical structural lesions cannot be ruled out as they may mimic the pattern of encephalopathy. in addition, background was asymmetric with more slowing and lower voltage on the right consistent with an underlying subcortical dysfunction. throughout the recording, frequent semi-rhythmic sharp waves appeared in the left central parietal region with no evolution into electrographic seizures. this finding is indicative of a highly active underlying epileptogenic focus. . eeg study date of impression: this is an abnormal continuous icu monitoring study because of diffuse background slowing indicative of a moderate diffuse encephalopathy. potential causes include but are not limited to sedative medication effect, and metabolic, toxic or hypoxic disturbances. however, multifocal subcortical structural lesions cannot be ruled out as they may mimic the pattern of encephalopathy. in addition, background was asymmetric with more slowing and lower voltage on the right consistent with an underlying subcortical dysfunction. throughout the recording, frequent semi-rhythmic sharp waves appeared in the left central parietal region with no evolution into electrographic seizures. this finding is indicative of a highly active underlying epileptogenic focus. brief hospital course: 69yo m with pmh of seizure disorder, multiple strokes with residual severe neurological deficit with bilateral hemiparesis right worse than left and severe aphasia and history of sdh x 2, prostate ca, mdd, poor swallowing and h/o aspiration pna, htn who was transferred from osh after having at least three witnessed seizures at home and three seizures in osh ed without intervening return regaining consciousness. this was in the setting of missing his aed doses on the morning of although he had taken his evening doses. he continued to be poorly responsive in osh ed. he was then transferred to for evaluation of possible status epilepticus. intubated in ed for airway protection on . he was transferred to the neurological icu for further observation. he was started on iv keppra 1g (it had also been the intention of his outpatient neurologist to start him on keppra prior to admission) and given his missed doses of aeds was given an extra dose of tegretol 800mg. he was found to have a uti on u/a which later grew enterococcus and was started on iv ceftriaxone. he was also found to have right greater than left bibasal opacities on cxr in keeping with possible aspiration pneumonia. ct head revealed extensive hypodensities in the bilateral mca distributions in keeping with his old infarcts in addition to a hypodensity in the left cerebellum also likely from prior infract. he went on to have an mri which revealed no acute infarct. his carbamazepine levels were high and this improved after reducing his dose from 800mg to 600mg . his lamotrigine was also increased to the dose intended by his neurologist of 400mg . he was extubated on , observed overnight and transfered to floor on . he was monitored on eeg telemetry from and although this showed slowing in keeping with previous sizeable bilateral mca infarcts in addition to semi-rhythmic sharp waves in the left central parietal region in keeping with a seizure focus but there were no seizures present either clinically or electrographically. he initially had an ng tube due to poor swallow and latterly passed s&s assessment and was started on pureed solids and thin liquids which he tolerated well although is at chronic risk for aspiration. he was changed to oral augmentin for his uti/aspiration pneumonia on and will continue this to complete a 10 day course finishing on . he was assessed by pt who found his pivoting ability was poor and per the preference of his wife was discharged home on with a lift and services of , pt and home health aide. he has neurology follow-up with his outpatient neurologist. he will have carbamzepine levels checked on prior to his neurology appointment. medications on admission: atenolol 25mg daily citalopram 30mg daily tegretol xr 800mg lamictal 200mg - per neurologist 400mg simvastatin 20mg qhs asa 81mg daily discharge medications: 1. lift please provide one lift 2. simvastatin 10 mg tablet sig: two (2) tablet po hs (at bedtime). 3. citalopram 20 mg tablet sig: 1.5 tablets po daily (daily). 4. senna 8.6 mg tablet sig: one (1) tablet po at bedtime. disp:*30 tablet(s)* refills:*2* 5. docusate sodium 100 mg tablet sig: one (1) tablet po twice a day as needed for constipation. disp:*40 tablet(s)* refills:*0* 6. amoxicillin-pot clavulanate 500-125 mg tablet sig: one (1) tablet po q8h (every 8 hours) for 3 days: to stop on . disp:*7 tablet(s)* refills:*0* 7. keppra 1,000 mg tablet sig: one (1) tablet po twice a day. disp:*60 tablet(s)* refills:*2* 8. atenolol 25 mg tablet sig: one (1) tablet po daily (daily). 9. outpatient lab work please check carbamazepine level on and fax to dr at tel . 10. lamictal 200 mg tablet sig: two (2) tablet po twice a day: brand name only - no substitution. disp:*120 tablet(s)* refills:*2* 11. tegretol xr 200 mg tablet extended release 12 hr sig: three (3) tablet extended release 12 hr po twice a day: brand name only - no substitution. disp:*180 tablet extended release 12 hr(s)* refills:*2* 12. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po once a day. discharge disposition: home with service facility: homecare discharge diagnosis: seziures in the setting of missed medication doses intercurrent urinary tract infection and aspiration pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. neurological: minimal shoulder abduction on left and otherwise no power in lue. good power 4+/5 in rue. in le 2 in hip flexion and knee flexion and 3 in knee ext and ankle dorsi. 4s in rle save 5 in knee ext. plantars ext bilat. brisk reflexs throughout r>l. severe aphasia can mumble perhaps a few words. discharge instructions: it was a pleasure taking care of you during your stay at the . you presented folowing 3 seizures where you did not regain consciousness in between. out of concern for your airway, you had a breathing tube placed and were admitted to the icu. you had no further seizures either clinically or on eeg monitoring. the likely cause of your seizures was missed doses on day and infection. you were felt to have an aspiration pneumonia in addition to a urinary tract infection. you were started initially on iv antibiotics for this and this was changed to oral medications. we added an additional anti-seizure medication called keppra which you should continue to take (it was also your neurologist, dr plan to start you on this). the blood level of your tegretol was high and we reduced your dose to 600mg twice daily. you improved and were transferred to the neurology floor. you were assessed by speech and swallow who felt that you could manage pureed solids and thin liquids. you were also assessed by physical therapy who felt that your standing and pivoting was not as good as it had been and needed a lift. you were discharged home with services on . . . medication changes: we started keppra 1000mg twice daily we decreased carbamazepine (tegretol) to 600mg twice daily we started augmentin 500mg three time sdaily which you should take until the end of we started laxatives please continue your other medications as prescribed followup instructions: please see your pcp within the next 1-2 weeks following discharge you should check labs on for anti-seizure drug levels prior to your neurology appointment. . we have organised the following follow-up apointment with your neurologist dr . . dr. neurology , :05 a.m. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: urinary tract infection, site not specified unspecified essential hypertension hyposmolality and/or hyponatremia personal history of malignant neoplasm of prostate pneumonitis due to inhalation of food or vomitus major depressive affective disorder, single episode, unspecified grand mal status streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group d [enterococcus] aphasia quadriplegia, unspecified gastroparesis late effects of cerebrovascular disease, other paralytic syndrome, bilateral physical restraints status 

Answer: The patient is high likely exposed to