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: delirium major surgical or invasive procedure: elective intubation for lp and mri s/p extubation lumbar puncture history of present illness: patient is an 81 year-old gentleman with past medical history including htn who was referred to the emergency department by his pcp after contacting her with complaint of sudden loss of memory. per report, patient was at his baseline state of health until noon, when his partner noted him to be sitting in a chair, confused. he was speaking in portuguese, which was unusual as he generally communicates in english; speech was not slurred. he did not know his partner's name but was aware of his own name. no obvious facial droop, unilateral weakness, complaints of headache, gait unsteadiness during this time according to his partner. episode lasted approximately 45 minutes, patient then returned to baseline without intervention. ems was called, patient refused transport, and patient's partner brought him to . vs in ed at 3:37 pm were t 98.8; bp 234/114; hr 51; 95% ra. . in the ed, patient received hyralazine for his bp. patient developed ha and was given morphine for pain control. he complaiend of itchign and was given benadryl 25mg iv and later solumedrol 125mg iv for his rash?. patient then became paranoid and combative, and was given total of 10mg haldol. at 7 pm, patient spiked temp to 101.6. neurology was consulted in ed, and they suspected mental state was secondary to medications, but given fever, there was some concern for underlying infectious process and recommended lp and mri, with broad spectrum antibiotics coverage. prior to transfer to icu, he was given 2mg versed. . diagnostic studies included chem 10, ua, cbc, lfts, cardiac enzymes, all of which were within normal limits. serum tox screen was negative, and urine tox was positive for opiates (patient known to take oramorph) but otherwise negative. head ct showed no evidence of intracranial hemorrhage; white matter disease and prior lacunar infarcts were unchanged. past medical history: 1. htn 2. gerd 3. hyperlipidemia 4. arthritis (possibly ra) 5. h/o prostate ca s/p xrt and chronic pain 6. h/o colon ca s/p partial colectomy in social history: patient emigrated from approximately 50 years ago. homosexual male who lives with his partner, . tobacco use. occasional alcohol consumption. no illicit drugs. family history: nc physical exam: vitals: t 98.6; hr 88; bp 184/83; rr 20; 98% ra gen: mildly agitated, follows commands, in restraints, responds to name and orients to voice heent: mmm. sclerae anicteric. op clear. neck: no jvd. supple chest: cta b/l. heart: tachycardic, rrr. no mrg abd: soft, nt/nd. +bs. no organomegaly ext: erythematous rash on r shoulder with area of central hyperpigmentation but no vesicles or crusted lesions. neuro: agitated, but re-orientable. responds to name. does not follow commands, likley agitation. no myoclonus. unable to test all reflexes, but biceps 2+. unable to assess gait, strength, sensation, proprioception cooperation issues. pertinent results: 09:28pm comments-green top 09:28pm lactate-2.7* 07:42pm urine hours-random 07:42pm urine bnzodzpn-neg barbitrt-neg opiates-pos cocaine-neg amphetmn-neg mthdone-neg 05:20pm urine color-yellow appear-clear sp -1.020 05:20pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirubin-neg urobilngn-1 ph-7.5 leuk-neg 04:15pm glucose-91 urea n-24* creat-1.0 sodium-139 potassium-3.8 chloride-101 total co2-30 anion gap-12 04:15pm alt(sgpt)-15 ast(sgot)-31 ck(cpk)-111 alk phos-88 amylase-88 tot bili-0.6 04:15pm ck-mb-5 ctropnt-<0.01 04:15pm albumin-4.4 calcium-9.3 phosphate-3.3 magnesium-2.2 04:15pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 04:15pm wbc-5.7 rbc-4.51* hgb-14.3 hct-40.4 mcv-90 mch-31.6 mchc-35.3* rdw-13.4 04:15pm neuts-62.2 lymphs-28.8 monos-3.1 eos-5.4* basos-0.6 04:15pm plt count-205 04:15pm pt-12.4 ptt-27.2 inr(pt)-1.1 . csf 2 wbc, 0 rbc 34 totprot 91 glucose gram stain negative cryptococcal ag negative . mri impression: 1. there is no change from . 2. no recent infarct is seen on the diffusion-weighted images. 3. there are fairly extensive microvascular changes in the cerebral white matter and there is an old right pontine infarct. . ct head impression: stable appearance of the brain, without evidence of intracranial hemorrhage or acute territorial infarction by ct. stable evidence of white matter hypodensity, suggestive of chronic small vessel ischemic disease, as well as prior small lacunar infarcts. . portable cxr: impression: new medial biapical opacities which are nonspecific. infection cannot be excluded. as this appearance could be seen in radiation pneumonitis, correlation with a history of radiation therapy is suggested. . carotid dopplers: brief hospital course: 81m with hx htn p/w word-finding difficulty, hypertensive urgency, later developing agitation, ? headache, and fever. . # confusion/agitation initial presenting complaint was confusion (patient speaking in portuguese) which resolved on arrival to ed. patient later became combative in the ed and received several cns-active medications including benadryl, morphone, haldol, versed, and ativan. head ct negative for acute bleed, but with possible area of encephalomalacia in the left sylvian fissure. patient was covered broadly with vancomycin, ceftriaxone, ampicillin, and acyclovir for empiric meningitis treatment given ? headache and rash on arm. - lp negative for meningitis or encephalitis picture - stroke on differential, mri/mra done which was negative for ischemic changes or encephalitic changes. - neurology was consulted, initially thought findings were consistent with tia but mri/mra not suggestive. seizure moved higher on differential, symptoms at presentation could have been post-ictal state, eeg showed no epileptiform activity. - patient's mental status improved significantly over 36 hours, and was communicating appropriately, aox3 at time of discharge - carotid dopplers showed <40% stenosis bilaterally - he will follow up with neurology in clinic. . # fever - source unclear; no localizing exam findings except rash on r arm/shoulder (which is several days old), but no weeping lesions or crusting to suggest infection. ua negative. blood and urine cultures pending. cxr with -apical opacities which could be infection, but no pulmonary symptoms. no leukocytosis or bandemia. empiric vancomycin, ceftriaxone, ampicillin were discontinued once lp was negative. acyclovir was continued empirically for vzv encephalitis. fever could be acounted for by seizure, although eeg showed no epileptiform activity. . # hypertension - patient is intermittently compliant with medications at home, and appears to live in 180s-190s at home based on omr notes. initially maintained bp < 180-200 and allowed autoregulation given concerns for stroke. once mri/mra was negative, goal sbp of 160 was pursued. when it was determined that he did not have a stroke, we aggressively attempted to manage his bp, and it was eventually well-controlled on lisinopril 40 and atenolol 75 qd. please titrate meds as necessary. . # rash not in dermatomal distribution suggestive of shingles. patient with bilateral itching history, could be dermatitis secondary to pruritus. given no other localizing source of infection, dermatology was consulted for assistance with rash and ? vzv/hsv. suspicion for the latter was low. derm felt it was changes from scratching the area. the rash resolved during the admission. . # depression - on celexa as outpatient. this was held until his ms d. . # gerd - on prilosec at home, protonix here . # prostate cancer - on casodex, lupron injections, proscar as outpatient medications on admission: asa 81 casodex 50 daily celexa 20 calcium +d 600-125 lupron q3 months mirapex .125 hs prn mvi nasonex oramorph sr 15 daily prilosec 20 proscar 5 forte 500 b12 1000 qweek zestril 20 daily discharge medications: 1. aspirin 81 mg tablet, chewable : one (1) tablet, chewable po daily (daily). 2. mupirocin calcium 2 % cream : one (1) appl topical (2 times a day). 3. triamcinolone acetonide 0.1 % cream : one (1) appl topical (2 times a day) for 2 weeks. 4. camphor-menthol 0.5-0.5 % lotion : one (1) appl topical (2 times a day) as needed for pruritus. 5. hexavitamin tablet : one (1) cap po daily (daily). 6. finasteride 5 mg tablet : one (1) tablet po daily (daily). 7. citalopram 20 mg tablet : one (1) tablet po daily (daily). 8. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day) as needed. 9. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 10. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 11. atenolol 25 mg tablet : three (3) tablet po daily (daily). 12. simethicone 80 mg tablet, chewable : one (1) tablet, chewable po qid (4 times a day) as needed for cramping. 13. lisinopril 20 mg tablet : two (2) tablet po daily (daily). 14. ursodiol 300 mg capsule : two (2) capsule po bid (2 times a day). 15. oxycodone 5 mg tablet : one (1) tablet po q8h (every 8 hours) as needed for abd pain. discharge disposition: extended care facility: - discharge diagnosis: delirium, unknown etiology discharge condition: stable. at cognitive baseline. discharge instructions: please take all your medicines as prescribed. . please return to the hospital if you experience fevers, chills, night sweats, vomiting, chest pain or shortness of breath. . please keep all of your follow-up appointments. followup instructions: please call to make an appointment with dr. in neurology as soon as possible. . please make a follow-up appointment with your primary care doctor as soon as possible. procedure: spinal tap incision of lung diagnoses: esophageal reflux hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified personal history of malignant neoplasm of prostate chronic kidney disease, unspecified other and unspecified hyperlipidemia personal history of malignant neoplasm of large intestine hypertensive encephalopathy unspecified transient cerebral ischemia contact dermatitis and other eczema, unspecified cause 

Answer: The patient is high likely exposed to