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: transferred to micu for altered mental status major surgical or invasive procedure: intracranial pressure monitor placement central venous line placement history of present illness: 20 y/o f w/no past med hx who originally presented to hospital on complaining of one week of nausea, headache, ear pain, neck pain, and suprapubic pain. reportedly the day before she had slept all day and c/o a generalized headache. she went to the ed, where she it was felt she had a uti (wbcs/bacturia) and otitis media ("bloody ear"). she was treated with amoxicillin. her symptoms became progressively worse, and she had fevers and chills. she returned to the emergency room the next day c/o suprapubic discomfort, fever, n/v, headache, and back pain. she had cva tenderness and was febrile to 101.1. at that time she had no meningismus and a normal mental status, nonfocal neuro exam. her wbc at that time was 20, which was elevated from 9 the day prior. she was admitted with a diagnosis of pyelo and treated with ceftriaxone and/or ciprofloxacin (unclr from notes which she received). she was given lorazepam 1 mg for anxiety. approximately 8 am on , she was found by her nurse to be unresponsive. she was incontinent of stool and urine. her eyes were open and deviated to the left. she was responsive to pain. hemodynamically, she was tachycardic in the 140s (sinus) and febrile to 103. bp 110/70. exam was otherwise unremarkable. they felt she was postictal and she was given ativan and loaded with dilantin (1000 mg). a noncontrast ct scan was negative. she was given vancomycin, continued on ceftriaxone (2 g iv q12h) and acyclovir. an lp revealed an opening pressure of 380 (?mm). wbc 988, rbc 45. differential on wbc was 58 pmns, 25 lymphs, 17 monos. gram stain negative for bacteria. glucose 80, protein 167. she also received dexamethasone 10 mg iv given the meningitis. she continued to have deviation of her eyes as well as lip smacking, and was transferred to on the neurology/sicu service on for further management. she was evaluated by neurology on arrival who felt she had encephalomeningitis and recommended an mri. she was intubated for her mental status. at that time, she was on dilantin, propofol, and ativan gtt. she continued to seize (w/occasional decerebrate posturing, downward eye deviation) and was loaded with depakote. the mri demonstrated enhancement of medial temporal lobes, caudate, and thalamus bilaterally and symmetrically. mrv was negative for thrombosis. she had a ct scan of her sinuses (given hx of otitis) which revealed mucosal thickening but no evidence of sinusitis, as well as a 5 mm dense soft tissue mass which appeared to be adherent to her left tympanic membrane, of unclear significance. she was continued on the aforementioned antibiotics and ampicillin was added. ent evaluated her and felt that it was either a foreign body vs. osteoma, and that it was not related to her meningoencephalitis. she was then transferred to the medical icu. past medical history: none social history: lives with her parents in , . occasionally uses her boyfriend's klonepin, also + ecstasy. tobacco unknown, etoh unknown. works as a cashier at an auto dealer. family history: noncontributory physical exam: t: 100.8 bp: 119/58 p: 105 vent: ac 500x16 peep 5 fio2 40%, sao2 99% gen: intubated, sedated heent: eeg leads in place, tongue protruding, pupils deviated inferiorly, sclerae anicteric, mmm neck: no lymphadenopathy, or thyromegaly chest: lungs clear to auscultation bilaterally cv: tachycardic, regular, no m/r/g abd: soft, nontender, nondistended. hypoactive bowel sounds. no hepatosplenomegaly. ext: warm, no edema. skin: diaphoretic, no rash pertinent results: 06:37pm blood wbc-25.8* rbc-4.13* hgb-13.1 hct-38.1 mcv-92 mch-31.8 mchc-34.5 rdw-11.9 plt ct-139* 03:38am blood wbc-22.8* rbc-3.70* hgb-11.6* hct-33.5* mcv-91 mch-31.4 mchc-34.7 rdw-12.0 plt ct-147* 06:37pm blood neuts-88* bands-4 lymphs-1* monos-7 eos-0 baso-0 atyps-0 metas-0 myelos-0 06:37pm blood hypochr-normal anisocy-normal poiklo-normal macrocy-normal microcy-2+ polychr-occasional 03:38am blood plt ct-147* 06:37pm blood pt-12.8 ptt-26.3 inr(pt)-1.1 06:37pm blood fibrino-527* d-dimer-695* 04:24pm blood glucose-92 urean-5* creat-0.5 na-145 k-3.4 cl-112* hco3-25 angap-11 06:37pm blood alt-28 ast-30 ld(ldh)-194 alkphos-69 totbili-0.2 04:24pm blood calcium-7.9* phos-1.4* mg-1.8 04:24pm blood phenyto-8.7* valproa-71 04:38pm blood type-art po2-196* pco2-33* ph-7.48* calhco3-25 base xs-2 intubat-intubated 04:38pm blood lactate-2.0 mri: mr : there is abnormal, elevated t2/flair signal involving the medial temporal lobes, and continuing into the tails and thr bodies of the caudate nuclei, and portions of the thalamus bilaterally and symmetrically. there is corresponding abnormal signal on the diffusion- weighted sequences in these regions. an accompanying adc map is not available to distinguish true slowed diffusion from t2 shine- through effect. there is no susceptibility artifact or abnormal bright t1 signal to suggest hemorrhage. the brain parenchyma demonstrates otherwise unremarkable signal intensity. the ventricles, cisterns, and sulci are unremarkable. no definite enhancement is noted in the areas of signal abnormality on the post gadolinium-enhanced sequences. mr : the venous sinuses demonstrate no evidence of thrombosis. there is mild asymmetry of the transverse and the sigmoid sinuses which is likely developmental. expected areas of artifact on the 3d images without corresponding evidence of flow abnormality/thrombus on the axial source data. impression: 1) constellation of concerning for limbic encephalitis involving the medial temporal lobes, basal ganglia, caudate, and portions of the thalamus. possible etiologies include viral, herpes, and listeria encephalitis; less likely a paraneoplastic syndrome. correlate with clinical symptoms and lumbar puncture results. 2) no evidence of venous sinus thrombosis. ct: : there is mild mucosal thickening of the maxillary, ethmoid, and sphenoid sinuses. there are no air-fluid levels or area of osseous destruction. there is more polypoid focal thickening in the right maxillary sinus likely representing a retention cyst. the mastoid processes and air cells are clear. there is a small amount of cerumen in the right external auditory canal but no evidence of an infectious process. centered on the left tympanic membrane is a focal, circular, hyperdense soft tissue mass. it is difficult to definitively localize this soft tissue mass; however, it appears adherent to the tympanic membrane within the middle ear rather than within the external auditory canal. there is a trace amount of fluid/soft tissue adjacent to it. there is no associated osseous destruction. the dentition and remaining osseous structures are unremarkable. the orbits appear normal. the visualized brain parenchyma is unremarkable. impression: 1) no evidence of mastoiditis. 2) sinus polypoid and mucosal thickening without evidence to suggest acute sinusitis. 3) 5mm focal, dense soft tissue mass, which is difficult to definitively localize but appears adherent to the tympanic membrane within the middle ear. this finding is of unclear etiology and significance, and does not appear likely to represent the source of the patient's clinically suspected encephalomeningitis. there is no associated osseous destruction. after treated for the acute process, an ent consult may be helpful. cxr: no acute cardiopulmonary process. ett at thoracic inlet. brief hospital course: the pt was admitted to micu on from the sicu service. the following summarizes her micu course (for sicu course, see hpi). she was admitted on an ativan gtt, as well as depakote and dilantin. she continued to seize through this regimen, despite reloading with both the dilantin and depakote. she was then placed on phenobarbitol (loading dose and daily dosing). she was continued on the same antibiotic regimen (ceftriaxone, vancomycin, ampicillin, acyclovir). id felt that the most likely diagnosis was eee given the clinical scenario and mri . unfortunately, the only treatment for this is supportive care. she continued to spike temperatures. on , she began to have worsening hypernatremia. she became progressively hypotensive requiring pressors, including norepinephrine and phenylephrine. her head ct revealed cerebral edema. she was given mannitol and an intracranial pressure monitor was placed. her sodium continued to rise, to >180. a family meeting was held and the goals of care were changed to comfort measures only, given the poor prognosis of her encephalitis. she was extubated, placed on a morphine drip, and died peacefully with her family by her side. medications on admission: medications on transfer: ativan gtt at 4 mg/hr phenytoin 100 q8h depakote 250 q8h ceftriaxone 2 g iv q12h ampicillin 2 g iv q6h vancomycin 1 g iv bid acyclovir 500 iv q8h protonix sq heparin insulin ss cipro ear gtt discharge medications: none discharge disposition: expired discharge diagnosis: encephalitis (likely eastern equine) discharge condition: expired discharge instructions: none followup instructions: none procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube enteral infusion of concentrated nutritional substances intravascular imaging of intrathoracic vessels arterial catheterization other diagnostic procedures on brain and cerebral meninges diagnoses: other convulsions acute respiratory failure alkalosis hyperosmolality and/or hypernatremia eastern equine encephalitis 

Answer: The patient is high likely exposed to