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: 1. acute mental status changes 2. emergency htn major surgical or invasive procedure: 1. resection of brachial artery aneurysm with vein graft repair of artery 2. placement of a double lumen 14.5 french tunneled hemodialysis catheter history of present illness: pt sedated and intubated. information taken from chart. 52 yo m with alport's syndrome, esrd on hd, renal transplant x 2, diastolic chf, htn who presents with agitation and altered mental status. he was at hemodialysis today when he became agitated. hd was stopped midway and he was brought to the ed. per the renal attg note, he has been combative through the last several hd sessions, but this time he was even more so. per the note, he was acting intoxicated but did not smell of etoh. in the ed, his vitals showed hr in the low 100s and bp 220's/130's. he was given hydral. he was noted to have a very large aneurysmal av fistula. vascular surgery was called. he was started on an esmolol gtt before coming up to the floor. of note, the renal attg note states that he has a hx of cocaine abuse in the past. micu course: htn emergency with ams in setting of initial bp 220/130 while at hd appeared confused, combative. admitted to micu, started labetolol gtt, intubated for airway protection, tox screen negative, head mri-neg, underwent surgical repair of rue fistula aneurysm which was actively expanding w/htn emergency, hd catheter placed, extubated friday. infection w/u negative, walking, mentating as baseline, titrating bp meds, standing hydral added, toprol, lisinopril baseline sbp 160s. while on floor, pt mentating well, denies any complaints, no ha/visual changes, no confusion. no cp/palp, no sob. comfortable. states he's now getting some sensation in his rue p surgical repair of expanding fistula aneurysm. he has no further complaints. past medical history: 1. alport's syndrome: c/b esrd on hd and deafness 2. esrd: s/p failed renal transplant x 2 ( and ), now on hd m/w/f 3. malignant hypertension 4. h/o chf w/ dilated cardiomyopathy: now w/ recovered fxn, echo w/ ef>55%, 1+ mr 5. svt s/p ablation 6. h/o seizures: likely metabolic etiology per notes 7. restless legs syndrome 8. anemia of chronic disease 9. h/o respiratory failure secondary to pulmonary edema 10. pruritis: treated w/ prednisone, mirapex social history: divorced w/2 children, and he lives with his son and daughter. 3 pack yr hx. occ etoh. hx marijuana and cocaine, none x 2 yrs. no ivdu. family history: mother with alport's syndrome, father with cad and cabg at age 60, brother died at 16 yrs old from esrd physical exam: vs: 99 bp 148/90 hr 82 18 99%ra gen: nad, pleasant, cooperative heent: mmm resp: ctabl, no crackles, no wheezing cv: reg nml, s1, s2, ii/vi sem abd: soft nd/nt +bs ext: rue-dressing in place with jp drain-~10cc serosang fluid, hd cath in r chest-non-tender, no drainage, no peripheral edema, warm 2+dp pulses b/l neuro: a&ox3, no focal deficits, appropriate, following commands, strength 5/5 throughout pertinent results: 02:30pm blood wbc-7.5 rbc-3.20* hgb-9.4* hct-29.1* mcv-91 mch-29.3 mchc-32.2 rdw-19.2* plt ct-192 07:31am blood wbc-6.4 rbc-3.26* hgb-9.4* hct-29.3* mcv-90 mch-28.8 mchc-32.1 rdw-19.4* plt ct-171 02:35am blood wbc-9.0 rbc-3.32* hgb-9.9* hct-31.3* mcv-94 mch-29.7 mchc-31.5 rdw-19.3* plt ct-155 04:20am blood wbc-9.9 rbc-3.12* hgb-9.0* hct-28.5* mcv-91 mch-29.0 mchc-31.7 rdw-19.1* plt ct-167 07:15am blood wbc-6.0 rbc-2.94* hgb-8.7* hct-27.5* mcv-94 mch-29.6 mchc-31.7 rdw-19.5* plt ct-205 05:40am blood wbc-8.1 rbc-2.80* hgb-8.3* hct-25.4* mcv-91 mch-29.7 mchc-32.7 rdw-18.9* plt ct-237 08:00am blood wbc-8.3 rbc-2.97* hgb-8.7* hct-27.8* mcv-93 mch-29.2 mchc-31.3 rdw-19.4* plt ct-249 11:49pm blood pt-12.1 ptt-30.3 inr(pt)-1.0 02:30pm blood glucose-85 urean-88* creat-19.1*# na-136 k-7.1* cl-98 hco3-18* angap-27* 07:15am blood glucose-147* urean-27* creat-10.3*# na-138 k-4.6 cl-98 hco3-28 angap-17 08:00am blood glucose-102 urean-42* creat-14.3* na-137 k-4.8 cl-96 hco3-24 angap-22* 11:49pm blood ck(cpk)-4391* 07:05pm blood alt-16 ast-24 alkphos-110 amylase-499* totbili-0.3 07:05pm blood lipase-105* 11:49pm blood ctropnt-0.10* 11:49pm blood ck-mb-12* mb indx-0.3 02:30pm blood calcium-8.6 phos-8.4*# mg-2.9* 08:00am blood calcium-9.5 phos-5.4* mg-2.1 11:49pm blood vitb12-647 folate-13.0 11:49pm blood osmolal-304 11:49pm blood tsh-3.8 07:05pm blood asa-neg ethanol-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg non-contrast ct of the head. findings: there is no evidence of intracranial hemorrhage, mass effect, or shift of normally midline structures. -white matter differentiation is preserved. the ventricles are normal in size and symmetric. there is moderate cavernous carotid athersclerotic calcifications. the visualized paranasal sinuses and mastoid air cells are clear. there is congenital nonfusion of the c1 vertebral body. impression: no evidence of intracranial hemorrhage. technique: multiplanar t1- and t2-weighted images of the brain were performed. an mr angiogram of the circle of was also obtained with 3d time-of-flight images, including reconstruction of multiplanar maximum intensity projection reconstructions. mri of the brain: faint foci of hyperintensity in the vertex parietal sulci on the flair images show a bilateral symmetric distribution. these may be artifactual or could be explained by propofol administration or hyperoxygenation. no signal abnormalities are demonstrated within the basal cisterns. there is no mass effect, hydrocephalus, or shift of the normally midline structures. a mild extent of scattered punctate foci of t2 hyperintensity in the deep, subcortical, and periventricular white matter of the cerebral hemispheres is most suggestive of chronic small vessel infarcts. however, there is no area of restricted diffusion to suggest a recent infarct. no susceptibility artifacts are present. a small amount of fluid and/or mucosal thickening is present in the sphenoid sinus, as well as mucosal thickening in the ethmoid sinuses, an appearance that can be seen in intubation. the frontal and maxillary sinuses, as well as mastoid air cells are clear, aside from a tiny area of mucosal thickening along the medial wall of the left maxillary sinus, likely inflammatory in origin. mr angiogram: a 4-mm aneurysm is present along the anterior communicating artery without a well-defined neck. the a1 segment of the left anterior cerebral artery is small. blood supply to each anterior cerebral artery predominantly stems from the right a1 segment. the right posterior communicating artery is either very small or absent. there is no evidence of stenosis or arteriovascular malformation. impression: 1. evidence of chronic small vessel infarction in the cerebral white matter, but no evidence of recent infarction, encephalitis, or other acute intracranial process. 2. small anterior communicating artery aneurysm of 4 mm in diameter. neurosurgical evaluation is recommended. the findings were discussed with dr. on . specimen submitted: brachial artery aneurysm. procedure date tissue received report date diagnosed by dr. /tk?????? previous biopsies: skin rt zygoma exc. renal bx diagnosis: artery, right brachial aneurysm, resection: a. atherosclerosis with thrombus. b. blood vessel with changes consistent with aneurysm. eeg: findings: abnormality #1: the background is low voltage, slow, and disorganized, typically in the hz range with a superimposed faster beta frequency rhythm. the background is punctuated by frequent and prolonged bursts of high amplitude polymorphic delta slowing in a generalized distribution and persisting for 5-10 seconds at a time. background: as above. hyperventilation: could not be performed as this was a portable study. intermittent photic stimulation: could not be performed as this was a portable study. sleep: no normal waking or sleeping morphologies were noted. cardiac monitor: showed a generally regular rhythm with an average rate of 66 beats per minute. impression: this is an abnormal portable eeg due to the low voltage, slow, and disorganized background which was frequently admixed with prolonged bursts of high amplitude generalized delta frequency slowing. findings are consistent with a moderate global encephalopathy, suggestive of bilateral subcortical or deep midline dysfunction. medications, metabolic disturbances, and infection are among the common causes of encephalopathy. no clearly focal or epileptiform findings were noted, although encephalopathic patterns may obscure focal eeg abnormalities. no electrographic seizures were seen brief hospital course: this is a 52 yo m with alport's syndrome, esrd on hd, renal transplant x 2, diastolic chf, htn who presented on with agitation and altered mental status while he was at hemodialysis. hd was stopped midway and he was brought to the ed. per the renal attg note, he has been combative through the last several hd sessions, but this time he was even more so. he was acting intoxicated but did not smell of etoh. in the ed, his vitals showed hr in the low 100s and bp 220's/130's. he was given hydralazine. he was started on an esmolol gtt. he was noted to have a very large aneurysmal av fistula which was actively expanding. transplant surgery was called who resected the right brachial artery aneurysm. he had then a placement of a double lumen 14.5 french tunneled hemodialysis catheter. micu course: patient was admitted to the micu with htn emergency with ams in setting of initial bp 220/130 while at hd appeared confused and combative. he was started on labetolol gtt and intubated for airway protection. his tox screen was negative, head mri was negative. he was extubated on . his infection work-up was negative. he started to walk and mental status was at baseline. the change in mental status may be attributed to eleveated blood pressures as well as his kidney failure and missed . on he was then admitted to the medicine service. while on floor, pt was mentating well, denied any complaints, no ha/visual changes, no confusion. no cp/palp, no sob. he was on lisinopril, toprol, and hydralazine and his systolic blood pressures were in the range of 140-150. because of potential compliance difficulties, hydralazine was discontinued and amolodipine 5mg daily was started in addition to troprol 100mg daily and lisinopril 40mg daily. he will followup with a new pcp one day after discharge. pt refused to stay one more day for bp monitoring. on the mra scan which was done for the work-up of his mental status changes, a 4mm anterior communiting aneurysm was incidentally found. neurosurgery was consulted who recommended an outpatient follow-up with dr. () in 1 week. he will follow-up in transplant clinic on for removal of his staples and evaluation of his aneurysmal fistula. he will receive hd via a portacath and will continue on mon-wed-friday hd at his regular clinic. he also has chronic anemia likely to his renal disease. per renal recommendation, iron studies were sent and he will follow-up with his pmd to investigate other causes for his anemia. his hct was stable throughout this admission but was lowest on discharge at 25. pt refused to stay for further evaluation. he will receive epo at outpt hd as indicated, though this may continue to exacerbate his htn. medications on admission: 1. lisinopril 40mg daily 2. prednisone 5mg daily 3. phoslo 1334mg tid with meals 4. metoprolol xl 100mg daily - stopped 3months pta discharge medications: 1. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). disp:*60 tablet(s)* refills:*2* 2. prednisone 5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 3. sevelamer 800 mg tablet sig: two (2) tablet po three times a day: to help decrease phosphorous. disp:*180 tablet(s)* refills:*2* 4. amlodipine 5 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 5. metoprolol succinate 100 mg tablet sustained release 24 hr sig: one (1) tablet sustained release 24 hr po once a day. disp:*30 tablet sustained release 24 hr(s)* refills:*2* discharge disposition: home discharge diagnosis: 1. emergency htn 2. acute mental status changes 3. right brachial artery aneurysm 4. esrd 5. alport's syndrome 6. 4mm anterior communicating artery aneurysm 7. anemia discharge condition: improved vs: t99 bp148/90 hr82 rr18 o2sat99%ra discharge instructions: you were admitted to the hospital for acute mental status changes and high blood pressure. you received antihypertensive medications and your blood pressure improved. you aneurysm in your right arm was expanding during your hospital stay and you had vascular surgery to remove the aneurysm. a new hemodialysis catheter was placed in your right chest. you need to follow-up with vascular surgery for removal of your staples. an anterior communicating artery aneurysm was incidentally found on a mra scan while you were in the hospital. you need to follow-up with neurosurgery for further care. please contact your pcp or come directly to the ed if you experience fever, unresolved headaches, blurry vision, changes in your mental status, or shortness of breath. followup instructions: 1. you have a follow-up appoitment with your pcp, . , on tuesday, , at 3pm. location is of building. if you have any questions, please call . 2. you have a follow-up appointment with dr. , transplant surgery, on thursday, , at 10:45am. if you have any questions, please call . 3. neurosurgery follow-up with dr. in 1 week. . md, procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube hemodialysis resection of vessel with replacement, upper limb vessels diagnoses: anemia in chronic kidney disease end stage renal disease congestive heart failure, unspecified acute respiratory failure arteriovenous fistula, acquired cerebral aneurysm, nonruptured peripheral vascular complications, not elsewhere classified surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation hypertensive encephalopathy surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation accidents occurring in unspecified place diastolic heart failure, unspecified complications of transplanted kidney other complications due to renal dialysis device, implant, and graft other specified congenital anomalies cardiomyopathy in other diseases classified elsewhere hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage v or end stage renal disease 

Answer: The patient is high likely exposed to