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: nsaids / penicillins / codeine / tricyclic antidepressant / demerol / talwin attending: chief complaint: alteration in mental status. major surgical or invasive procedure: right hemicraniectomy history of present illness: the patient is a 50 year old man with a right frontal glioma s/p resection and recent xrt treatment now presenting with increased lethargy on . the patient is unable to give a history so the details are taken from the chart. the patient was recently discharged from the neurology service on for a biopsy and resection of his right frontal mass. in the interval time, he has been in rehab at and while there, he has been noted to be inattentive, disinhibited and with poor insight, in addition to mild left sided weakness. however, he typically is interactive and responsive, today the patient appeared "obtunded" to staff--not responding to questions or following commands. he did fall to the ground about 2 days prior after an "aggressive episode of shaking" but appeared to be at his baseline following that event. no more seizure activity has been noted. he has not had any infectious stigmata. his most recent dilantin level was 13.7. he was transferred to ed for further management. past medical history: -h/o right frontal gliomatosis cerebri -h/o narcotic abuse -osteoarthritis - hepatitis + a/b/c social history: -lives at -at baseline had been walking with a cane -long h/o tobacco use -h/o narcotic abuse family history: -not available physical exam: exam upon admission: vitals: 101.1 97 105/59 97% general: scar on right frontal area neck: supple lungs: clear to auscultation cv: regular rate and rhythm abdomen: non-tender, non-distended, bowel sounds present ext: warm, no edema neurologic examination upon admission: eyes closed, will open eyes to loud voice but quickly shuts them, not following commands, frequently attempts to sit-up, arms in restraints; pupils appear equally reactive, eye looking toward right and midline; mild left facial; increased tone on left; spontaneous mvt x4 but more brisk on right; withdraws to pain more vigorously on right arm and leg; dtrs, 2+ throughout, toe up on left, down on right pertinent results: 01:02pm blood wbc-11.0 rbc-4.17* hgb-13.7* hct-39.7* mcv-95 mch-32.8* mchc-34.5 rdw-14.4 plt ct-188 01:02pm blood neuts-83.4* lymphs-11.4* monos-4.2 eos-0.3 baso-0.8 01:02pm blood pt-11.9 ptt-27.1 inr(pt)-1.0 01:02pm blood glucose-120* urean-17 creat-0.8 na-136 k-3.8 cl-98 hco3-24 angap-18 01:02pm blood alt-123* ast-105* ck(cpk)-134 alkphos-124* amylase-37 totbili-0.7 01:02pm blood albumin-4.2 calcium-9.1 phos-4.4 mg-2.1 01:02pm blood phenyto-9.9* ct head w/o contrast () findings: there is no acute intracranial hemorrhage. subfalcine herniation is again identified, but has increased now with approximately 11 mm of leftward shift, previously 9 mm. right-sided uncal herniation also is present. there is also increasing effacement of the quadrigeminal plate cistern consistent with transtentorial herniation. the previously seen area of possible hemorrhage in the right frontal lobe, likely the biopsy site, has since resolved. a small amount of low attenuation fluid is seen in that area related to post-interventional changes. the large right frontal lobe lesion is difficult to see on this study, compared with prior mr study, but is likely unchanged. patient has undergone prior right-sided parietal craniotomy and there is also a prior burr hole present in the right frontal bone. osseous structures are otherwise unremarkable. minimal circumferential mucosal thickening is seen in the right maxillary sinus, and a minimal amount of mucosal thickening in the antrum of the left maxillary sinus. remaining visualized paranasal sinuses and mastoid air cells are clear. soft tissues are unremarkable. impression: 1. worsening right-to-left subfalcine herniation, and new right-sided uncal herniation and transtentorial herniation. 2. no acute intracranial hemorrhage. ct head w/o contrast () findings: the study is compared with most recent non-contrast ct examination dated , as well as a series of studies dating to . since yesterday's examination, the patient has undergone right hemicraniectomy with decompression, with expected postoperative pneumocephalus and extra-axial hemorrhage at the site of the surgical defect. there is persistent 8 mm leftward shift of the septum pellucidum (this measured 11 mm, previously), with subfalcine herniation, effacement of the right and "trapping" of the left lateral ventricles. however, there has been significant improvement in the degree of right uncal herniation with improvement in the appearance of the basilar cisterns, indicative of improvement in the degree of downward transtentorial herniation. the cerebral aqueduct and fourth ventricle remain uneffaced, and there is no evidence of tonsillar herniation. the poorly defined, infiltrative large mass centered in the deep matter of the right frontal lobe remains relatively occult on ct examination. impression: right hemicraniectomy and decompression with significant improvement in right uncal and downward transtentorial herniation, persistent subfalcine herniation with trapping of the left lateral ventricle. ct head w/o contrast (): findings: comparison with the prior study shows continued extensive right to left subfalcine herniation and accompanying compression of the right lateral ventricle. there appears to be very little change in the extent of contralateral left lateral ventricular dilatation. there is no evidence for the presence of intracranial hemorrhage that has developed since the prior study. conclusion: stable, grossly abnormal study. : ap portable upright view. the left lateral hemithorax is not fully included on the image. this study is further limited by motion. a patchy opacity in the left lower lobe likely represents pneumonia. there is no evidence of a left pleural effusion, and no right pleural effusion. the right lung appears clear. there is no pulmonary edema. cardiac and mediastinal contours are stable. the imaged bones appear unremarkable. surgical clips are present in the right upper quadrant of the abdomen. impression: left lower lobe pneumonia. given the limitations of the study, further evaluation by pa and lateral views is suggested eeg (): findings: abnormality #1: throughout the recording the background rhythm remained slow and disorganized, typically reaching a hz maximum in most areas. abnormality #2: there were additional bursts of generalized slowing. there were also occasional bursts of additional delta slowing in the right frontal region or left temporal region, but these were minimal. hyperventilation: could not be performed. intermittent photic stimulation: produced no activation of the record. sleep: the patient appeared to remain awake or drowsy throughout most of the record. no stage ii sleep was obtained. cardiac monitor: showed a generally regular rhythm. impression: abnormal portable eeg due to the slow and disorganized background and bursts of generalized slowing. these findings indicate a widespread encephalopathic condition affecting both cortical and subcortical structures. medications, metabolic disturbances, and infection are among the most common causes. there were a few bursts of focal slowing but no areas of persistent focal slowing. there were no epileptiform features. nchct : 1. extensive right to left subfalcine herniation and compression of the right lateral ventricle, which was seen on the prior examination. there is no new intracranial hemorrhage. brief hospital course: mr. is a 50yo man with h/o glioblamotosis cerebri who presented with altered mental status and for radiation treatment for his tumor. 1. altered mental status: pt was admitted to the neuroicu and started on dexamethasone and mannitol for herniation. he also received a 500mg bolus of intravenous dilantin. by the next morning, he was much more awake, oriented, and following commands. he appeared to be back to his baseline. his repeat head ct showed some mild improvement, but he continued to have significant edema with midline shift from right sided gliomatosis cerebri. his medications were continued without problems. then went for a hemicraniectomy on the right in order to provide decompression on by dr. . this was done because he will continue to receive xrt and chemo which will likely result in more swelling in the future. he tolerated the procedure well and was quickly extubated after returning to the icu from the or. after surgery, he had significant facial edema, but his mental status and level of consciousness were back to his baseline. mannitol was slowly weaned. he was transferred to the floor on post-op day three where he remained stable until discharge. after he passed his speech and swallow evaluation, keppra was added as a prophylactic anticonvulsant. he is now at a theraputic dose of keppra 1000mg . the phenytoin is being tapered, now at 100mg , and plan to decrease to 100mg qday tomorrow and then off,as it will decrease the bioavailability of his chemo. he received his first planning session and first dose of wbxrt today on the omed service. he will be transferred back to where he will continue wbxrt with temodar given one hour before xrt. decadron will be continued during xrt because of risk of increased swelling. he will see dr. one month after discharge and should schedule an mri for that time as well. exam on discharge: awake, alert, fluent, some disinhibition, mild inattention (digit span forwards ), no neglect, mild left hemiparesis (delt at least antigravity, provides resistence in other umn muscle groups). he was started on zyprexa to help with agitation which is likely secondary to decadron and frontal lobe location of the tumor. of note, the csf fluid collection on the right side of his head may increase in size in response to radiation. should this happen, he should be kept in a seated position as long as possible throughout the day to decrease swelling and increase the likelihood of his helmet fitting. additionally, his mental status is stable (waxes and wanes between oriented x 1 and x 3) and he is afebrile. crp 4.6, esr 29. he does require a sitter at all times for his mental status and should wear his helmet at all times (especially when oob. if sitter can reliably keep him in bed may remove helmet). 2.lll pneumonia: the patient was found to have a lll pneumonia on cxr on admission. given that he was at a hospital when this developed, he was started on vancomycin and ceftazidime to cover for mrsa, typical cap bacterium, and pseudomonas. he was treated witha total of a ten day course of antibiotics. he had essentially normal wbc counts here. his initial fever also resolved on antibiotics. no other source of infection was found and blood cultures were negative. as he has been on high dose decadron for approximately one month, we started bactrim for pcp . 3. s/p right hemicraniectomy: as above, the pt underwent a decompressive hemicraniectomy on the right. his bone flap is stored at and will likely be re-attached in months to allow for swelling with radiation. he should wear the helmet provided for him when out of bed (really at all times if pt may get out of bed without warning given his mental status). 4. oral thrush: pt has been maintained on clotrimazole toches qid to treat oral thrush. the patient is discharged to rehab. he requires a sitter at all times. his mental status waxes and wanes but he is at risk for falls, and for this reason should wear his helmet certainly when oob, and if possible at all times. he will continue with his chemotherapy/radiation treatment, for which he should be brought to . he should receive temodar as prescribed one hour before all radiation treatments. he will follow up with dr. . medications on admission: -methadone -dilantion 100 tid -protonix -nicotine -dexamethasone 3 mg tid -temodar discharge medications: 1. methadone 10 mg tablet sig: four (4) tablet po tid (3 times a day). 2. clotrimazole 10 mg troche sig: one (1) troche mucous membrane qid (4 times a day). 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed for t>101.5. 4. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily) as needed. 5. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 6. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 7. dexamethasone 4 mg tablet sig: one (1) tablet po q8h (every 8 hours). 8. phenytoin sodium extended 100 mg capsule sig: one (1) capsule po bid (2 times a day) for 2 days: please give today (), then only qday tomorrow , then stop. tapering off. 9. lactulose 10 g/15 ml syrup sig: thirty (30) ml po q6h (every 6 hours) as needed. disp:*1 ml(s)* refills:*3* 10. cyanocobalamin 1,000 mcg/ml solution sig: one (1) injection weekly () for 4 weeks. disp:*4 * refills:*0* 11. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 12. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 13. zyprexa zydis 10 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po at bedtime. 14. morphine 15 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 15. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 16. miconazole nitrate 2 % powder sig: one (1) appl topical qid (4 times a day) as needed. 17. miconazole nitrate 2 % cream sig: one (1) appl topical (2 times a day) as needed. 18. insulin lispro (human) 100 unit/ml solution sig: one (1) subcutaneous asdir (as directed). 19. hydrocortisone 1 % cream sig: one (1) appl topical tid (3 times a day) as needed. 20. haloperidol 1 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for agitation. 21. trimethoprim-sulfamethoxazole 160-800 mg tablet sig: one (1) tablet po daily (daily) as needed for pcp . 22. dolasetron 100 mg tablet sig: one (1) tablet po daily (daily) while receiving chemotherapy. discharge disposition: extended care facility: & rehab center - discharge diagnosis: -gliomatosis cerebri -s/p right hemicraniectomy -left lower lobe pneumonia - hep a/b/c discharge condition: stable. neurologic examination notable for left facial droop, mild left hemiparesis. patient requires use of helmet at all times when out of bed, as he is s/p hemicraniectomy discharge instructions: please continue all medications as prescribed. note that we are tapering dilantin - please give today and qday tomorrow , then discontinue dilantin. please attend all follow-up appointments. please be sure to give pt his temodar chemotherapy by mouth one hour prior to all radiation appointments. if you experience worsening weakness, numbness, speech or visual difficulties, or other concerning symptoms, please return to the emergency department for evaluation. use helmet at all times when out of bed followup instructions: please return to for scheduled radiation therapy. please give temodar by mouth one hour prior ot all radiation treatments. neuro-oncology: provider: , md phone:, one month from discharge. at the time you make the appointment, please schedule an mri. procedure: venous catheterization, not elsewhere classified other repair of cerebral meninges other craniectomy other radiotherapeutic procedure other immobilization, pressure, and attention to wound diagnoses: anemia, unspecified unspecified viral hepatitis c without hepatic coma other convulsions candidiasis of mouth opioid type dependence, continuous compression of brain pneumonitis due to inhalation of food or vomitus osteoarthrosis, unspecified whether generalized or localized, site unspecified hemiplegia, unspecified, affecting unspecified side malignant neoplasm of cerebrum, except lobes and ventricles 

Answer: The patient is high likely exposed to