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: benzodiazepines attending: chief complaint: seizures major surgical or invasive procedure: lumbar puncture intubation history of present illness: 41 m w/ pmh epilepsy, bacterial meningitis a few months ago, presented to the ed after seizures yesterday, first at 8:30 am and last night 7:00 pm. 3 mg ativan given at home by his brother. in the ed, initial vitals: 103.4, 98, 209/153, 16. in 4-pt restraints aggitation (paradoxical reaction to benzos). given valium, haldol to get a ct scan/lp. t 103.4. intubated for ct/ lp. ct neg. lp done. cxr x 2. foley placed. ua neg. also given 5l ns although never hypotensive. 2 g ceftriaxone, 1 g vanc, 800 acyclovir iv, 10 decadron given. also tylenol 1 g pr, lido/succ/etomodate/fentanyl/versed for intubation. ros not obtainable as patient intubated and sedated. past medical history: -generalized tonic clonic seizures, with onset in - was monitored during admission, where pushbutton captured two seizures that were characterized clinically by staring, and had a l temporal onset, so some question of focal onset seizures with secondary generalization. mri head normal and , bursts of generalized slowing on eeg. initially started on dilantin, which was transitioned to because of side effects on dilantin (unsteadiness, nystagmus) in he complained of sedation on higher doses of , lamictal was added and has been slowly tapered up. -meningitis: presented on with 7 seizures. lp was performed and showed wbc, 66 protein, 89 glucose. he was treated empirically for bacterial meningitis, but csf cultures eventually came back with no growth. -bipolar nos -cognitive d/o nos -hyperlipidemia social history: born in . college grad. moved to us after college and has been working in it. married x 3 months (but together for 5 years). daily marijuana use. family history: non-contributory physical exam: (admission exam) vs: temp: 98 bp: 135/74 hr: 88 rr: o2sat 100% on ac 50% fio2, 5 peep, 550/12. gen: intubated and sedated heent: perrl, anicteric, ett in place neck: no supraclavicular or cervical lymphadenopathy resp: cta b/l with good air movement throughout cv: rr, s1 and s2 wnl, ii/vi systolic murmur at lusb abd: nd, +b/s, soft, nt, no masses or hepatosplenomegaly ext: no c/c/e, warm, good pulses skin: erythematous plaque on plantar aspect of r foot (exam upon transfer to the floors) vitals: t: 97.8 tm 99.7 p: 73-133 r: 16 bp: 133-176/88-95 sao2: 96% ra general: awake, cooperative, nad. heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple, no carotid bruits appreciated. no nuchal rigidity pulmonary: lungs cta bilaterally without r/r/w cardiac: rrr abdomen: soft, nt/nd, normoactive bowel sounds, no masses or organomegaly noted. skin: r red patch on plantar surface of r foot neurologic: -mental status: alert, oriented x 3. attentive, able to name backward with some difficulty. language is fluent with intact repetition and comprehension. normal prosody. there were no paraphasic errors. speech was not dysarthric. able to follow both midline and appendicular commands. pt. was able to register 3 objects and recall at 5 minutes. there was no evidence of apraxia or neglect. -cranial nerves: olfaction not tested. perrl 4 to 2mm and brisk. vff to confrontation. there is no ptosis bilaterally. funduscopic exam revealed no papilledema, exudates, or hemorrhages. eomi without nystagmus. normal saccades. facial sensation intact to light touch no facial droop, facial musculature symmetric. hearing intact to finger-rub bilaterally. palate elevates symmetrically. 5/5 strength in trapezii and scm bilaterally. tongue protrudes in midline. -motor: normal bulk, tone throughout. no pronator drift bilaterally. no adventitious movements noted. no asterixis noted. delt bic tri wre ffl fe io ip quad ham ta edb l 5 5 5 5 5 5 5 5 5 5 5 5 5 5 r 5 5 5 5 5 5 5 5 5 5 5 5 5 5 -sensory: no deficits to light touch -coordination: no intention tremor, dysdiadochokinesia noted. no dysmetria on fnf or hks bilaterally. -dtrs: tri pat ach l 2 2 2 2 1 r 2 2 2 2 1 plantar response was flexor bilaterally. -gait: attempted to test, but patient felt unsteady standing up, will therefore defer until patient feels more stable pertinent results: 05:55am blood wbc-8.3 rbc-5.16 hgb-15.2 hct-43.3 mcv-84 mch-29.4 mchc-35.1* rdw-14.0 plt ct-313 10:50pm blood neuts-91.5* lymphs-4.6* monos-3.6 eos-0.2 baso-0.1 05:55am blood plt ct-313 05:55am blood pt-12.7 ptt-26.3 inr(pt)-1.1 05:55am blood glucose-98 urean-18 creat-0.9 na-142 k-3.6 cl-108 hco3-24 angap-14 08:36am blood alt-27 ast-22 alkphos-68 amylase-91 totbili-0.3 08:36am blood lipase-21 05:55am blood calcium-9.8 phos-3.1 mg-2.3 12:40pm blood anca-negative b 12:40pm blood -negative 12:40pm blood crp-5.7* 03:00am blood igg-959 iga-118 igm-73 10:50pm blood asa-neg acetmnp-neg bnzodzp-neg barbitr-neg tricycl-neg 03:37am blood comment-green top 03:37am blood lactate-1.6 10:50pm blood lactate-3.0* htlv-i/ii antibody reflex panel htlv-i/ii ab, negative negative zonisamide 13.7 10.0-40.0 mcg/ml lamotrigine 1.1 l 4.0 - 18.0 mcg/ml 10:50pm urine blood-sm nitrite-neg protein-neg glucose-neg ketone-50 bilirub-neg urobiln-neg ph-5.0 leuks-neg 10:50pm urine color-yellow appear-clear sp -1.012 10:50pm urine rbc-0-2 wbc-0-2 bacteri-none yeast-none epi-0 10:50pm urine uric ax-few 10:50pm urine bnzodzp-neg barbitr-neg opiates-neg cocaine-neg amphetm-neg mthdone-neg 11:27am cerebrospinal fluid (csf) wbc-8 rbc-193* polys-33 lymphs-40 monos-28 11:27am cerebrospinal fluid (csf) wbc-5 rbc-1095* polys-10 lymphs-77 monos-13 05:00am cerebrospinal fluid (csf) wbc-90 rbc-11* polys-92 lymphs-4 monos-4 05:00am cerebrospinal fluid (csf) wbc-40 rbc-1750* polys-91 lymphs-2 monos-7 11:27am cerebrospinal fluid (csf) totprot-35 glucose-73 05:00am cerebrospinal fluid (csf) totprot-54* glucose-108 lyme disease ab screen 0.2 index herpes simplex virus, type 1 & 2 dna, real-time pcr hsv 1 dna not detected not detected hsv 2 dna not detected not detected brief hospital course: mr. is 41 year-old man who is well known to the neurology service after several recent admissions for meningitis and increased seizure frequency. he has a pmh significant presumed primary generalized seizures for which he is followed by the epilepsy service as well as a mood disorder. he presented on the 7th with after having had seizures the prior evening. his brother gave him 3 mg ativan prior to coming to the ed. in the ed he was febrile to 103.4, agitated and in 4-pt restraints. the agitation was presumed to be secondary to a paradoxical reaction to benzo's, however a tox screen was not done. a ct was done which showed no bleed or mass but did have partially opacified right mastoid air cells. he was pan cultured with a cxr which did not show pna but did have moderate interstitial edema. he also had a negative ua and blood cultures which have had no growth to date. he required intubation to have an lp which showed wbc 40 with 1750 rbc's in tube 1, and wbc 90 (poly predominant) with 11 rbc's in tube 4. his protein was elevated and his glucose was 108. he was started on empiric coverage for meningitis with acyclovir, ctx, vancomycin and a dose of decadron. his hospital course has been significant for an elevated cr of 1.3 on admission which as has now trended down. he was extubated yesterday without difficulty. his infectious work-up has been negative including mri's of his brain and spine as well as csf and blood cultures. he has been empirically treated with antibiotics as above and continued on his aed regimen with the addition of ativan. he was also started on flagyl for a possible septic lateral thrombophlebitis. his pulmonary edema improved on repeat cxr's. his work-up for recurrent meningitis has been quite extensive. he has had an hiv which was negative, a work-up for immunoglobulins and/or complement deficiency with igg, iga, igm levels all normal. he has also had a malignancy work-up with serum cytology and a ct torso which were negative. upon transfer to the floors: mr. was continued on his aed regimen: ativan 1mg po q8h (to be tapered gradually once stable), 300 mg po daily and lamictal 250mg po bid. he also continued on his antibiotic regimen day # 3: vancomycin 1000 mg iv q 12h, flagyl 500 mg iv q8h, ceftriaxone 2 gm iv q12h and acyclovir 800 mg iv q8h; a repeat lp was performed for further, more detailed workup (which was also found to be negative). consideration was also given to performing a cisternogram in order to rule out a csf leak, but this was not performed as an inpatient. mr. was discharged to home in pursuit of this as an outpatient. he remained fever free and without headache on the day of discharge. further studies: csf cytology: negative for malignant cells. imaging: ct head (): partially opacified right mastoid air cells. otherwise normal study. cxr (): no acute cardiopulmonary process. cxr () - post intubation: the cardiomediastinal silhouette is stable, and the lungs are clear. an endotracheal tube has been placed with tip terminating 4.5 cm from the carina and nasogastric tube terminating within the stomach with side port well below the gastroesophageal junction mr head +/- contrast (): 1. no intracranial mass lesions, or foci of abnormal enhancement. 2. fluid within the right mastoid air cells, and left maxillary sinus is minimally decreased since . dedicated temporal bone ct scan is recommended to exclude dehiscence as a possible route of intracranial infection. mr spine +/- contrast (): no evidence for spinal infection. mild degenerative changes as detailed above. ct orbits (): persistent mastoid air cell opacification, with no bony destruction. eeg (): abnormal portable eeg due to the slow background frequencies (usually obscured by faster frequencies of likely medication effect) and due to the generalized slowing and occasional slowing prominently over the left hemisphere. the background and generalized slowing suggests a widespread encephalopathy. medications, metabolic disturbances, and infection are among the most common causes. the faster beta background suggests use of a benzodiazepine medication. the focal slowing over the left side raises concern for focal subcortical abnormality in the left hemisphere, but this is difficult to discern clearly given the superimposed features of encephalopathy and medication effect. there were no clearly epileptiform features. tte (): normal biventricular cavity sizes with preserved global and regional biventricular systolic function. no valvular pathology or pathologic flow identified. medications on admission: acetaminophen mg po q6h:prn lamotrigine 200 mg po daily qpm lamotrigine 250 mg po daily qam acyclovir 800 mg iv q8h propofol 5-20 mcg/kg/min iv drip titrate to sedation ceftriaxone 2 gm iv q12h vancomycin 1000 mg iv q 12h famotidine 20 mg iv q12h zonisamide 300 mg po daily heparin 5000 unit sc tid discharge medications: 1. lamotrigine 100 mg tablet sig: two (2) tablet po twice a day: take 2 100 mg tabs twice daily with 2 25 mg tabs twice daily, for total of 250 mg ; do not substitute; name brand medically necessary. :*120 tablet(s)* refills:*2* 2. zonisamide 100 mg capsule sig: three (3) capsule po daily (daily). :*90 capsule(s)* refills:*1* 3. zolpidem 5 mg tablet sig: one (1) tablet po hs (at bedtime). :*30 tablet(s)* refills:*0* 4. omeprazole 20 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. :*60 capsule, delayed release(e.c.)(s)* refills:*1* 5. lorazepam 0.5 mg tablet sig: one (1) tablet po tid (3 times a day) as needed for seizure: take tablet sublingually following a seizure to prevent recurrence; may repeat x 1 if needed. :*10 tablet(s)* refills:*3* 6. lorazepam 0.5 mg tablet sig: one (1) tablet po see below for 4 days: take 1 tab x 2 days after d/c and then take 1 tab qday x 2 days, then off. :*6 tablet(s)* refills:*0* 7. lamictal 25 mg tablet sig: two (2) tablet po twice a day: take 2 100 mg tabs twice daily with 2 25 mg tabs twice daily, for total of 250 mg ; do not substitute; name brand medically necessary. :*120 tablet(s)* refills:*2* discharge disposition: home discharge diagnosis: meningitis seizures discharge condition: good - back to baseline discharge instructions: you have been diagnosed with recurrent meningitis, but the cause is still unclear. have also had seizures; please return if you are having more seizures or new symptoms of meningitis (fever, neck or severe head pain). followup instructions: follow up with dr. wed. at 3:30pm; building (/ complex), neurology unit cc8 (sb) - call follow up with infectious disease service: 11:00a id, lm , basement for cisternogram: provider: ,two date/time: , arrive at 7:30am (ground floor of building). procedure will be at 9am - xsp west neuro phone: date/time: 9:00. instructions for procedure: -no aspirin or blood thinners for 5 days prior to the procedure -eat nothing after midnight the night before (arrive with empty stomach) -you will need a ride home after the procedure - not allowed to drive -you must call to confirm the procedure with at . try to do this as soon after discharge as you are able. infectious diseases follow up: provider: , md phone: date/time: 11:00 primary care: please arrange a follow-up appointment with dr. () in weeks. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours spinal tap incision of lung insertion of endotracheal tube diagnoses: other bipolar disorders meningitis due to unspecified bacterium acute mastoiditis without complications generalized convulsive epilepsy, without mention of intractable epilepsy 

Answer: The patient is high likely exposed to