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: lamictal / keflex / navane / inderal / depakote attending: chief complaint: transfer from osh, seizure major surgical or invasive procedure: lumbar puncture history of present illness: ms. is a 53yo woman with pmh significant for seizure disorder, brain injury, and ?atypical multiple sclerosis who presents with right face twitch and right arm shaking. history is obtained from her sister, from , and from her primary neurologist, dr. . she lives in an , and was noted yesterday to have generalized tonic-clonic activity beginning on the right side and lasting 90 minutes. ems gave her valium 5mg pr at the facility and brought her to . she persisted with right sided seizure activity there and was given valium 10mg and ativan 1mg, as well as loaded with dilantin 1000mg. she was transferred to the micu. here she was given an additional valium 5mg x 2 and ativan 1mg x 3 for persistent twitching in her face and right hand. since the ativan, her facial twitching has apparently improved, but she continues to have hand twitches. she also had an eeg, which showed left sided slowing on preliminary read. apparently she has a long history of seizure disorder, possibly from a history of traumatic brain injury (though per dr. , records from that hospitalization indicate she may have only had a very mild injury) and has been managed on dilantin and keppra. since she has seen dr. , she has had at least two episodes of status epilepticus and one generalized seizure, as well as some less significant seizures which are characterized by left gaze preference and left sided tonic-clonic activity. her dilantin levels had been somewhat difficult to control. he tried adding lamictal, but this caused a rash. at the time of her last visit () dr. had discussed the addition of a third , possibly zonegran (less likely topamax), to the dilantin 200mg and keppra 1500mg . her sister had wanted to keep the current course because she felt she was doing well where she was living and did not want to upset that. however, she had several dilantin levels drawn since her last visit, with 15.4 in .5 in , and 3.. her sister reports that the medication dose had been changed to 200mg qam and 100mg qpm in , and a review of her records indicates that this may have occurred in an urgent care appointment secondary to slurred speech and a recent fall and a non-trough level of 15.9. according to her sister, the patient has no short-term memory. she has been living in an facility and frequently calls her even right after she has left without remembering her visit. the patient walks with a walker at baseline and goes out for dinner and shopping with her sister. ms. also carries a diagnosis of "atypical ms", which she brought with her to dr. . according to dr. , she has had stable deficits for many years without any flare-like episodes. she had an mri in that showed multiple plaque-like lesions, but these were entirely stable since . she is not undergoing any treatment. reportedly she has been evaluated at , , and possibly . she has not had an lp as far as dr. knows. past medical history: h/o head trauma atypical ms seizures depression hypercholesterolemia social history: lives in . sister is hcp family history: not elicited physical exam: icu exam: vs: t99.5, bp 126/72, hr 99, rr 15, sao2 99%/ra genl: lying in bed, right hand moving rhythmically, ngt in place ms: not following commands, withdraws to noxious stimuli, making incomprehensible vocalizations cn: perrl, corneal reflex intact, nasal tickle intact, face symmetric. motor: moving right hand rhythmically with occasional right face twitching as well. moves all extremities to stimuli, l > r sensation: intact to noxious stimuli in all four extremities reflexes: 3+ throughout, both toes upgoing recent exam: afebrile, vss following commands, oriented to name, place. able to carry on simple conversation. no dysarthria, speech fluent. cn: peerl, eom full, tongue midline motor: moves all extremities with some strength, improved bilaterally reflexes: as above pertinent results: admission labs: 03:54am blood wbc-11.4*# rbc-3.96* hgb-12.1 hct-35.1* mcv-88 mch-30.6 mchc-34.6 rdw-13.1 plt ct-152 07:50am blood neuts-83.3* lymphs-10.1* monos-5.3 eos-1.1 baso-0.2 03:54am blood pt-12.3 ptt-26.7 inr(pt)-1.1 03:54am blood glucose-97 urean-12 creat-0.4 na-137 k-3.8 cl-101 hco3-26 angap-14 03:54am blood albumin-4.0 calcium-8.0* phos-2.9 mg-2.0 03:54am blood alt-14 ast-18 alkphos-92 totbili-0.3 03:54am blood phenyto-18.4 discharge labs: 07:25am blood phenyto-5.1* u/a: 03:04pm urine color-straw appear-clear sp -1.010 03:04pm urine blood-sm nitrite-neg protein-neg glucose-neg ketone-15 bilirub-neg urobiln-neg ph-5.0 leuks-mod 03:04pm urine rbc-6* wbc-29* bacteri-occ yeast-none epi-<1 03:04pm urine color-yellow appear-clear sp -1.015 03:04pm urine blood-lg nitrite-neg protein-tr glucose-neg ketone-neg bilirub-neg urobiln-0.2 ph-6.5 leuks-neg 03:04pm urine rbc-* wbc- bacteri-few yeast-none epi-0-2 csf: 02:20pm cerebrospinal fluid (csf) wbc-6 rbc-2* polys-0 lymphs-92 monos-8 02:20pm cerebrospinal fluid (csf) wbc-6 rbc-0 polys-0 lymphs-95 monos-5 02:20pm cerebrospinal fluid (csf) totprot-56* glucose-77 02:20pm cerebrospinal fluid (csf) angiotensin 1 converting enzyme-pnd 02:20pm cerebrospinal fluid (csf) vdrl-pnd 02:20pm cerebrospinal fluid (csf) virus (jcv) dna detection by polymerase chain reaction (pcr)-pnd 02:20pm cerebrospinal fluid (csf) varicella dna (pcr)-pnd 02:20pm cerebrospinal fluid (csf) herpes simplex virus pcr-pnd 02:20pm cerebrospinal fluid (csf) ebv-pcr-pnd 02:20pm cerebrospinal fluid (csf) cytomegalovirus - pcr-negative other: cryptococcus: negative csf negative blood cx ngtd urine cx lactobacillus csf cytology: negative for malignant cells. reactive lymphoid cells. immunotyping negative. cxr : no evidence for pneumonia. no change since prior study of . ct head findings: there is moderately severe, confluent periventricular white matter hypodensity surrounding the frontal horns, posterior horns, and more superiorly, involving the centra semiovale. these findings are unchanged from prior studies, and may relate to the "atypical" demyelinating process, suggested in the indication on the prior mri; however, they are non-specific. there is no evidence of acute intra- or extra- axial hemorrhage. there is no shift of normally midline structures. the ventricles are mildly prominent, but are unchanged from the prior study. there is no interval loss of focal -white matter differentiation to suggest acute infarction, though ct is not sensitive in the early stages. no focal masses is seen. impression: 1) no intracranial hemorrhage or mass effect; no significant interval change from ct of . 2) diffuse, confluent periventricular white matter hypodensity, which may relate to an underlying demyelinating process (as suggested in the indication provided for the prior mri). the markedly low-attenation (14-15 ) centered within this process suggests either irreversible demyelination with cavitation ("black hole"), or lacunar infarction on a vascular basis. generalized and marked callosal atrophy (on the mr) also suggest advanced, irreversible disease. 3) no mass is appreciated on this limited non-contrast study; if clinically concerned, an mri with gadolinium is recommended. mri: there is a similar configuration of increased t2 signal in the periventricular white matter of both cerebral hemispheres, suggesting demyelinating disease. as previously noted, there is associated volume loss, thinning of the corpus callosum, and slight widening of the ventricles. on post-contrast images, there is a probably stable appearance of a 5mm linear, focal area of enhancement in the left centrum semiovale, of uncertain etiology. also ehancing is 3mm linear lesion in the left hippocampal cortex anteriorly, not seen on the mr, but that study was very motion- degraded. the hippocampus would be a most unusual site for involvement by multiple sclerosis. there is no apparent mass lesion or mass effect. no changes in the overall morphology of the brain are identified. the surrounding osseous and soft tissue structures are unremarkable. the major vascular flow patterns are normal. impression: 1. stable appearance of confluent areas of increased t2 signal in the periventricular white matter, consistent with severe demyelinating disease. 2. enhancing lesions in the left centrum semiovale and also left hippocampal cortex. this former lesion was evident on mr dating back to , though is more prominent at this time, likely due to less motion degradation of the current scan. etiology of these enhancing lesions is uncertain, but could be atypical manifestations of demyelination. eeg: abnormality #1: throughout the recording there were frequent bursts of generalized theta and delta slowing. facial twitching was described by the technologist and seen on the video. this is primarily right-sided, facial movement clinically and did not appear to involve the forehead or eye. there were no clear eeg correlate. abnormality #2: the background voltages were occasionally lower on the left side, and there were additional bursts of delta slowing seen broadly on the left side alone. abnormality #3: the background rhythms were dominated by much faster beta rhythm. they appeared to reach an 8 hz frequency on the right at times, though the background was disorganized and slow on both sides for much of the recording. it was of much lower voltage on the left. hyperventilation: could not be performed. intermittent photic stimulation: could not be performed. sleep: no normal waking or sleeping morphologies were seen. cardiac monitor: showed a generally regular rhythm. impression: abnormal portable eeg due to the bursts of generalized slowing and additional left-sided slowing and voltage dimunition, along with some slowing of the background. the generalized and background features indicate a wide-spread encephalopathy. the left sided slowing and voltage reduction surpassed an additional dysfunction on the left side, possibly wide-spread cortical dysfunction. there is a possibility of a structural lesion on the left, but the encephalopathy dominated the overall picture. there were no clear epileptiform discharges. no eeg correlate was established for the facial twitching. the lack of eeg correlate to the facial twitching does not exclude a central cause (and, indeed, this appeared most likely based on the clinical and video observations). brief hospital course: 53yo woman with h/o seizure disorder, demyelinating disease, and brain injury, presents with prolonged seizure, now unresponsive with persistent twitching of right arm and face. this is most consistent with complex partial seizures with a focus in the left hemisphere, most likely the motor strip. in the past, her seizures were on the left side, which implies that she now has a new focus. it is possible that this is secondary to her underlying demyelinating disease, but per report this has not been very active. other possibilities include infection, including her uti. it is likely that these seizures began due to subtherapeutic dilantin levels on her new dose of 200mg/100mg. her seizure management is difficult, given the higher doses were causing her to fall and slur her speech. discussed with dr. the addition of an alternate with the possibility of tapering down the dilantin in the future, and he agreed that she may benefit from zonegran. cannot use lamictal or depakote due to reactions. topamax is another possibility, but not ideal in a patient with preexisting cognitive deficits. she was started on zonegran at 50mg daily with plans to increase by 50mg every other week to a goal dose of 200mg/day; she was on 100mg daily at discharge and should have her dose increased on and again on . she was continued on keppra and dilantin with trough checked frequently and adjustment as needed. ativan was used for breakthrough seizures (facial twitching). mri/mra showed new temporal lesions, but it is unclear if these are the cause or effect of her seizures. she will need to have a repeat mri in several months for further evaluation. lp was done and had no changes to suggest a different etiology (ie negative cytology and negative immunophenotyping). oligoclonal bands were not assessed as there was not enough csf per the laboratory. she will need repeated dilantin troughs with one time dose when trough is subtherapeutic. pending tests: angiotensin 1 converting enzyme ebv-pcr herpes simplex virus pcr virus (jcv) dna pcr lyme, total eia with reflex to csf ratio varicella dna (pcr) vdrl 2. atypical ms: discussed with her outpt neurologist (dr. in ); no current role for ms medications. mri was performed and showed new lesions vs sz effects in the left temporal lobe. she also had a new lesion on her last mri in the centrum semiovale. lp was done to evaluate for malignancy, and no malignant cells were seen. immunotyping was negative as well (per verbal report). unfortunately, oligoclonal bands could not be sent from the csf (lab sent csf for other studies and there was not enough left over for ocbs). this was relayed to the family (). given that she does have new lesions on mri, if ocbs were sent this would have weighed in in her dx of ms, and it's possible she could benefit from ms therapy. this was relayed to the family, and they will readdress this with dr. (ms doctor). the family is confident in any decision dr. would make re: therapy for her ms. 3. fevers on admission: pt w/ positive u/a, treated with bactrim x 3 days with defervescence. 4. depression: continue escitalopram; assess need to change medication as an outpatient. 5. fen: ngt was placed given her altered mental status, and she has been unable to pass a swallow evaluation, but has improved. this should be repeated in several days as her mental status continues to clear. commun: sister is hcp. dispo: pt/ot worked with patient during admission medications on admission: dilantin 200/100 keppra 1500 mg lexapro 20 mg q day folate 1 mg q day calcium 1 tab discharge medications: 1. zonisamide 100 mg capsule : one (1) capsule po daily (daily): increase by 50mg every other week (next increase ). 2. phenytoin 50 mg tablet, chewable : four (4) tablet, chewable po qam (once a day (in the morning)). 3. phenytoin 50 mg tablet, chewable : three (3) tablet, chewable po qpm (once a day (in the evening)). 4. phenytoin 50 mg tablet, chewable : one (1) tablet, chewable po every other day (every other day). 5. levetiracetam 500 mg tablet : four (4) tablet po bid (2 times a day). 6. escitalopram 10 mg tablet : two (2) tablet po daily (daily). 7. folic acid 1 mg tablet : one (1) tablet po daily (daily). 8. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 9. docusate sodium 150 mg/15 ml liquid : one hundred (100) mg po bid (2 times a day). 10. senna 8.6 mg tablet : one (1) tablet po bid (2 times a day). 11. bisacodyl 10 mg suppository : one (1) suppository rectal daily (daily) as needed for constipation. 12. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection tid (3 times a day). discharge disposition: extended care facility: & rehab center - discharge diagnosis: seizure history of atypical multiple sclerosis memory loss status post brain injury urinary tract infection discharge condition: stable, much improved from admission, and almost at baseline. discharge instructions: take all medications as prescribed. please increase zonegran dose by 50 every other week until it reaches 200mg daily, with first dose change to 150mg daily and second dose change to 200mg daily. follow up with dr. , dr. , and dr. upon discharge. call the doctor or go to the emergency room with increased seizure frequency, unresponsiveness, new weakness or numbness, or any other concerning symptoms. followup instructions: please follow up with a repeat mri in several months to evaluate new lesions in the brain. follow up with: dr. () on at 915am. dr. () on at 145pm. dr. () on at 10am. procedure: venous catheterization, not elsewhere classified spinal tap incision of lung diagnoses: pure hypercholesterolemia urinary tract infection, site not specified other convulsions dysthymic disorder multiple sclerosis other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms late effects of motor vehicle accident late effect of intracranial injury without mention of skull fracture 

Answer: The patient is high likely exposed to