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: history of present illness: the patient is a 64 year-old female with a complex medical history significant for seizure disorder and cerebrovascular accident in the past, also with a history of deep venous thrombosis and atrial fibrillation on coumadin who presented to an outside hospital two days prior to admission with left sided weakness, question of slurred speech. workup at the outside hospital was notable for a negative head ct on and with some improvement in her left sided weakness on , but appeared to have a waxing and course over 36 hours. at baseline she is normally oriented, conversational and able to be attentive and following commands. since the day of admission she was noted to have myoclonic type twitching with right nasal labial fold and right upper extremity. the left side is not consistently weak per report. upon presentation to the patient was able to follow commands, but was not conversant. the course at the outside hospital was notable for heparinization for atrial fibrillation and history of deep venous thrombosis as well as a temperature spike to 102. at her baseline the patient is quite debilitated, bed bound and has not walked in one year, but is typically conversant and oriented. past medical history: significant for end stage renal disease on hemodialysis three times per week, hypertension, insulin dependent diabetes mellitus, coronary artery disease with an ef of greater then 50%, chronic atrial fibrillation on coumadin, history of right hip fracture, status post pontine cerebrovascular accident, msr bacteremia, c-diff colitis, bipolar disorder with paranoia status post total abdominal hysterectomy, bilateral salpingo-oophorectomy, history of deep venous thrombosis and history of seizures, currently on lamictal. allergies: dilantin. medications as an outpatient: regular insulin sliding scale, atenolol 50 mg per day, lamictal 12 mg per day, lipitor 10 mg per day, aspirin 325 mg per day, folate, diovan 160 mg per day, zantac 150 mg per day. social history: she lives at home with her daughter who has a home health care aid and hospital bed. family history: noncontributory. physical examination: blood pressure 168/86. heart rate 68. she was afebrile. in general she was intermittently arousable. her oropharynx was with dry mucous membranes. no lesions. cardiac examination exhibited a regular rate and rhythm. normal s1 and s2 with a 2 out of 6 systolic murmur. her lungs demonstrated decreased breath sounds with poor effort and some bibasilar crackles. her abdomen was soft, nontender, normoactive bowel sounds. she had 2+ pulses distally with no edema. on neurological examination she showed no response to voice. cyclic episodes of rhythmic twitching at right nasal labial fold and bilaterally arms. twitching worsens and with manipulation with arms. responds to pain without localizing. general movements of bilateral arms. no movements of legs. yells to pain. cranial nerves, no blink to threat. pupils poorly reactive. closes her eyes to bright light. corneal reflexes positive. gag was positive. tongue and palette midline. face symmetric. tonic left deviation of eyes, which do not cross midline with dolls. motor examination she was hypertonic upper extremity and lower extremity. twitching worsens with manipulation of upper extremity. arms stay elevated as lifted. legs demonstrated poor movement. she had general atrophy. ankle with limited tone. deep tendon reflexes were decreased generally. reacts to pain in all extremities. hospital course: this 64 year-old left handed female with a history of seizures presented with waxing and , change in mental status acutely, tonic eye deviation and twitch essentially appeared as an akinetic mute. it was doubtful that such lesion exists to cause a kinetic mutism, but left weakness may have been post ictal paralysis. it was thought that the patient was most likely in status epilepticus, although an ischemic lesion could not be ruled out. her issues were as follows: 1. neurological: status post epilepticus was terminated with ativan 1 mg q ten minutes and then she was transferred to the intensive care unit for phenobarbital load 20 mg per kilogram. the phenobarbital load with the ativan resulted in an immediate change in her mental status with more responsiveness and better control of motor activity. an electroencephalogram was performed that demonstrated electrical activity in the frontal lobes that could have been consistent with epileptiform activity, but showed no acute seizure activity while on the phenobarbital. seizures were treated by titrating up her lamictal. on her dose was increased to 25 mg b.i.d. and the patient will be discharged with instructions to continue titrating lamictal in 25 mg increments every week to a goal of 300 mg b.i.d. as tolerated. an mri/mra of her brain to look for intracranial circulation defects and evidence of new ischemia was negative suggesting that the patient had not had a new acute infarct. 2. cardiovascular: the patient has a history of hypertension, coronary artery disease and was admitted to the intensive care unit and found to have an elevated troponin i of 9.3 with a negative ckmb. it was unclear whether this was secondary to cardiac ischemia, renal failure or congestive heart failure or a combination of above. echocardiography was performed on demonstrating no new wall motion abnormalities and an ef of greater then 55% and an increase in mitral regurgitation compared to prior echocardiogram. after dialysis her troponin decreased down to 4.7. because of the normal ck and no electrocardiogram changes with a normal echocardiogram, it was decided that she is not having an acute ischemic event and that her mitral regurgitation be treating increasing after load reduction. for this reason diovan was increased from 160 mg per day to 240 mg per day. she was continued on beta blockers and will be discharged on her home dose of atenolol 50 mg per day. she is continued on zestril 2.5 mg per day for after load reduction as well as lipitor and aspirin for coronary artery disease. the patient was placed on heparin for atrial fibrillation on admission and on discharge she will be recoumadinized with a goal inr of 2.3 and covered with lovenox until the goal inr is reached. 3. renal: the patient remained on hemodialysis during the hospital stay and there were no acute issues. 4. infectious disease: the patient presented to an outside hospital with a fever of 102. she was given one dose of gentamycin and vancomycin during hemodialysis. cultures remained negative. during her hospital stay on she again had a fever to 101.1. she was given a single dose of vancomycin and levofloxacin after cultures of urine and blood were taken. chest x-ray showed no evidence of pneumonia or atelectasis. she was given no further antibiotics until blood culture results came back. 5. endocrine: the patient has a history of insulin dependent diabetes mellitus with somewhat labile blood sugar by finger stick ranging from a low of 47 to a high of 500. for now she will continue on her nph regimen until her diet is stabilized. 6. fluids, electrolytes and nutrition: the patient had swallowing evaluation to ensure that the seizure activity had not left her with a diminished ability to swallow or increased risk for aspiration pneumonia. it was decided that she would need to be maintained on honey thick liquids and a soft pureed diet as she demonstrated some risk for aspiration with thin liquids. she will continue on her regimen of renagel and nephrocaps. the patient is being discharged to home with plans of services. her daughter has a home health care aid already in place and is able to care for the patient at home. discharge status: full code. discharge diagnoses: seizure disorder with a history of cerebrovascular accident, end stage renal disease on hemodialysis. insulin dependent diabetes mellitus. , m.d. dictated by: medquist36 procedure: enteral infusion of concentrated nutritional substances hemodialysis hemodialysis hemodialysis diagnoses: abnormal coagulation profile atrial fibrillation hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease diabetes with ketoacidosis, type i [juvenile type], not stated as uncontrolled infection and inflammatory reaction due to other vascular device, implant, and graft other specified paralytic syndrome ulcer of heel and midfoot other acute and subacute forms of ischemic heart disease, other generalized convulsive epilepsy, without mention of intractable epilepsy 

Answer: The patient is high likely exposed to