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: s/p seizure major surgical or invasive procedure: s/p intubation history of present illness: 59 yo m w/ hx etoh withdrawal seizures and dmii who is transferred from osh s/p seizures and intubation for airway protection. pt has had 2 etoh withdrawal seizures, 2 and 4 yrs ago. his last drink was the day pta (reportedly around 9pm) and at 2:30pm on the day of admission his wife (who does not live with him) noted that the patient had dysarthria. at that time, he got up from his chair and slumped forward but his wife caught him and called 911. when ems arrived, pt started shaking w/ his eyes closed w/out bowel or bladder dysfunction or tongue biting. he arrived @ where he was hypertensive to 260/160 p 70-130. he received ativan 2mg iv for and was intubated ~ 230-310pm. at ~ 630pm he also received 4mg iv versed, 100mcg fentanyl, 120mg succinyl and 10mg vecuronium before being sent to . on the way to , he became agitated in the ambulance and was moving all extremities -- he received another 4mg ativan and 30mcg fentanyl. on arrival to he received 50mcg fentanyl, 8mg ativan, and was started on a propofol gtt, currently @ 80mcg/kg/hr. ros per his wife is no hx of trauma or fever. past medical history: 1. alcoholism with 7 hard liquor drinks a day: multiple dts 2. alcohol withdrawal seizure 2 and 4 years ago 3. dmii 4. s/p cva in : arm weakness that resolved social history: he lives alone and is a machinist. he smokes ppd and drinks 7 hard liquor drink and up to a pint of a day, no ivdu; he is separated from his wife. family history: non-contributory physical exam: t 100.2 pr hr 81 (70-90's) bp 159/80 (140-200/80-110) ac 650 x 10 (not overbreathing) 5 40% sat 100% gen: cauc m intubated, sedated lying in stretcher in nad heent: perrl b/l heart: rrr, s1, s2, no m/r/g lungs: ctbla, no rales, no wheezing abd: s/nt/nd/no masses ext: no edema derm: erythroderma on b/l hands, not involving palms, no other rash on chest, face or extremities neuro (done by neurology once off propofol): no facial assymetry, tongue midline, gag intact. normal muscle tone. moves arms and legs spontaneously with right>left. sensation intact to pain in 4 extremities. dtr are 2+/4 in arms and 0/4 in legs. toes upgoing bilaterally. neuro (post-extubation): right handed, delirious, waxing and ms. disoriented x 3 multiple times despite attempt to re-orient. +dysarthria, making paraphasic errors with repetition. +apraxia as pt attempted to move his head to brush his teeth instead of using his hands. cn: ? visual field deficit as pt confused. unable to do extraocular movement as he does not follow finger. +slight right ptosis. tongue midline, able to shrug shoulders equally. normal tone, no rigidiy or resting tremor. strengths of all 4 extremities. reflex patellar, ankle bilaterally, toes equivocal bilaterally, ?decreased pinprick and vibration of ble but unsure if pt is just confused. cerebellar exam deferred as pt confused. pertinent results: admit labs: cardiac enzymes: 07:55pm ck(cpk)-295* 07:55pm ck-mb-6 ctropnt-0.02* 05:10am ck-mb-6 ctropnt-0.02* 05:10am alt(sgpt)-11 ast(sgot)-18 ck(cpk)-343* alk phos-62 tot bili-0.6 02:48pm ck(cpk)-489* 02:48pm ck-mb-7 ctropnt-0.01 head ct: comparison: comparison is made to mri performed on the same day. technique: 8-mdct axial images of the head were obtained without iv contrast: findings: there is no evidence of acute intracranial hemorrhage, mass effect, shift of normally midline structures, major vascular territorial infarcts. the -white matter differentiation is preserved. the ventricles are of normal size. there is no evidence of hydrocephalus. the cisterns are preserved and symmetric. there is fluid/mucus in the right maxillary sinus. there is mucosal thickening and fluid in the posterior ethmoid cells. the mastoid air cells are normally aerated. the patient is intubated. there is a hypodense area in the right occipital region consistent with an old infarct. there is a round hypodensity in the right occipital region in the corticomedullary junction that cannot be seen in the mri. it is probably due to volume averaging. impression: 1) there is no evidence of acute intracranial hemorrhage. 2) chronic infarct in the right occipital region. 3) sinus disease as described above. mri: findings: there are no areas of elevated signal to suggest acute brain ischemia on the diffusion-weighted scans. the conventional images show a large area of mixed t1 and t2 signal within the right occipital and temporal lobes, consistent with a chronic infarction. there are numerous smaller areas of elevated t2 signal, consistent with chronic microvascular infarction within the white matter of both cerebral hemispheres, as well as the posterior aspect of the thalamus on the right side. there is a 5 mm area of susceptibility within the right posterior frontal, superior parasagittal region (that is not visible on the followup ct scan). the combination of findings suggests that the abnormality could represent chronic blood products, as opposed to a meningioma. further evaluation of this finding could be achievable with gadolinium enhanced mr. there is no hydrocephalus or shift of normally midline structures. the surrounding osseous and soft tissue structures are notable for a small air fluid level and mucosal thickening within the right maxillary sinus, as well as minor mucosal thickening within the sphenoid, both ethmoid, frontal, and mastoid sinuses. these sinus abnormalities could represent an allergic or some other type of inflammatory process, as well as relate to intubation. conclusion: no sign of an acute infarct. large chronic right-sided posterior cerebral artery distribution infarct. other findings as noted above. chest x-ray: portable chest, one view: there are no prior studies available for comparison at this time. there is an et tube 4 cm above the carina. there is an ng tube coiled in the stomach. the heart is mildly enlarged. the aorta is ectatic and unfolded. there is linear atelectasis in the right mid/lower lung zones. the remainder of the lungs are clear. there is no chf, focal pneumonia, or pleural effusion. chest ct: findings: the finding of mediastinal widening corresponds to prominent mediastinal fat. there is no hematoma or adenopathy. the patient is intubated and an ng tube is present. there is bilateral lower lobe atelectasis and small bilateral pleural effusions. superimposed pneumonia is not excluded. the appearance makes aspiration unlikely. no pneumothorax. there is coronary artery calcification. the heart is somewhat enlarged. the upper abdomen shows no gross abnormalities. there are no osseous lesions detected. some colonic diverticula are noted. impression: 1) mediastinal widening on chest x-ray corresponds to prominent mediastinal fat. 2. bilateral lower lobe collapse with small effusions. superimposed pneumonia is not excluded though aspiration seems unlikely based on the appearance. chest x-ray: ap bedside chest: the cardiac silhouette is prominent even allowing for semi-erect position. slight prominence of the central pulmonary vessels but no overt interstitial or alveolar edema. the left lower lobe behind the heart is opacified and both hemidiaphragms are poorly visualized. no ptx identified. since similar suboptimal bedside exam 2 days ago, the left lower lobe process has developed or increased. et and ng tubes satisfactorily positioned. enlarged aorta. impression: left lower lobe atelectasis. equivocal vascular congestion/fluid overload and/or small effusions. these assessments limited by bedside semi-erect positioning bilateral carotid dopplers: findings: there is minimal scattered calcific plaque involving both carotid systems. the peak systolic velocities are normal as are the ica to cca ratios. there is normal antegrade flow in both vertebral arteries. impression: no appreciable ica or cca stenosis bilaterally. 07:55pm wbc-15.4* rbc-4.55* hgb-14.2 hct-41.4 mcv-91 mch-31.2 mchc-34.3 rdw-12.2 07:55pm neuts-94.7* bands-0 lymphs-3.3* monos-1.9* eos-0.1 basos-0.1 07:55pm plt smr-normal plt count-261 07:55pm pt-12.5 ptt-22.3 inr(pt)-1.0 07:55pm alt(sgpt)-11 ast(sgot)-19 ck(cpk)-295* alk phos-72 amylase-83 tot bili-0.7 07:55pm lipase-24 07:55pm glucose-317* urea n-14 creat-1.0 sodium-140 potassium-3.1* chloride-102 total co2-21* anion gap-20 07:55pm albumin-4.0 calcium-8.5 phosphate-2.2* magnesium-1.6 brief hospital course: icu course: he was admitted to the as pt was intubated for airway protection. his head ct and mri ruled out acute bleed or new stroke. he was seen by neurology whose impression was seizure secondary to alcohol withdrawl. he was placed on standing valium and tight ciwa scale. he also had anion gap with possible dka, so he was placed on insulin gtt. he was initially sedated with propofol and to versed and back to propofol. initially, he was persistently agitated requiring multiple 40 mg of valium per ciwa. his bp continued to be elevated up to 220's. his high bp was thought to be from withdrawl, but persisted even after his withdrawl was adequately treated with valium and when pt is at rest without agitation. he has a hx of htn but not on any medications at home. he may likely have very elevated bp as baseline. he was started on captopril and metoprolol. on admission, he was noted to have dterioration in oxygenation and increased secretion from the ett, cxr with lll opscification consistent with aspiration pneumonia. clindamycin was started on , and levofloxacin was added on after sputum cx grew gnr. he was successfully extubated on . he remained delirious post-extubation, but was able to tolerate po when he was more awake. he was seen by swallow evaluation after receiving po valium, so showed some risk for aspiration when he is more lethargic. after transfer to floor: . 1. seizure: given history of chronic alcoholism with alcoholic withdrawal seizures and recent history of abstaining from alcohol for several hours, seizure activity felt likely etoh withdrawal. pt's reported last drink was approximately 17 hours before seizure activity and blood etoh level was zero on admission, suggesting alcohol withdrawl seizure (as seizures typically occur between 6 and 48 hours after last drink in chronic alcoholics). patient maintained on valium ciwa and required large amounts of valium to control withdrawal symptoms. also maintained on standing valium given that he had seizure on admission. discontinued standing valium on , day of discharge. patient had an eeg which demonstrated no seizure activity on . no further seizures while here. patient had mri which showed no sign of an acute infarct. noted to have large chronic right-sided posterior cerebral artery distribution infarct. head ct showed no evidence of acute intracranial hemorrhage but demonstrated chronic infarct in the right occipital region. therefore no acute mass or infarct to explain seizure activity. bilateral carotid doppler ultrasounds demonstrated no abnormalities with normal flow. patient was followed by neurology who felt he did not need seizure prophylaxis given that seizure likely from withdrawal from alcohol. patient cannot drive or operate machinery for 6 months. 2.other neuro: as above, paitent had head ct/mri/carotid dopplers as part of seizure/syncope work-up. noted to have old stroke in posterior cerebral artery distribution. patient with weakness on standing, dysmetria and trouble with fine motor movements. also with left homonymous hemianopsia. felt likely secondary to old stroke, possible neuropathy, benzodiazepine side affects and possible long-term alcohol abuse affects. followed by neurology here who he needs to follow-up with in 4 weeks. (dr. . maintained on thiamine/folate, multi-vitamin. will need rehab to help him regain strength as he also is now debilitated. aspirin/statin maintained for secondary stroke prophylaxis. 3. alcohol abuse: social work very involved in case. patient will need alcohol cessation programs when he is discharged from acute rehab. treatment center contact in . patient to follow-up there once out of acute rehab. 4. alcoholic ketosis: pt has history of dmii and was admitted with hyperglycemia, anion gap of 17 and glucose and ketones in urine, concerning for early dka vs. alcoholic ketosis. felt to be alcoholic/starvation ketosis. patient treated with aggressive hydration, insulin and lyte correction. stable for days before discharge. . 5. pulm: patient was intubated for airway protection with seizure. extubated out of icu. diagnosed with pneumonia, likely secondary to aspiration. patient was weaned from supplemental oxygen by . he will complete 7 day course of clindamycin/levoquin. finished clindamycin course, will need 2 more days of levoquin. . 6. cardiovascular: a)patient ruled out for mi; ekg without concerning changes, cardiac enzymes cycled, troponin with slight elevation but felt likely secondary to demand, remained flat. statin, beta-blocker, aspirin as noted for other indications. b)hypertension: despite getting through withdrawal period, persistently hypertensive. appears to have baseline hypertension. ace inhibition, beta-blockade and calcium channel blockers titrated up to maintain sbp<140 with good affect on current regimen. . full code throughout admission, dvt and gi prophlaxis maintained with subcutaneous heparin and protonix. medications on admission: none discharge medications: 1. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) 5000 units injection tid (3 times a day). 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 3. therapeutic multivitamin liquid sig: one (1) cap po daily (daily). 4. acetaminophen 160 mg/5 ml elixir sig: three y five (325) mg po q4-6h (every 4 to 6 hours) as needed. 5. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 6. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 7. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 8. atorvastatin calcium 20 mg tablet sig: one (1) tablet po daily (daily). 9. lisinopril 20 mg tablet sig: two (2) tablet po daily (daily). 10. amlodipine besylate 5 mg tablet sig: one (1) tablet po daily (daily). 11. metoprolol succinate 100 mg tablet sustained release 24hr sig: three (3) tablet sustained release 24hr po daily (daily). 12. aspirin 325 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 13. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 14. docusate sodium 150 mg/15 ml liquid sig: one (1) po bid (2 times a day). 15. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 16. levaquin 500 mg tablet sig: one (1) tablet po once a day for 2 days. discharge disposition: extended care facility: hospital - discharge diagnosis: primary: 1) alcohol withdrawal seizure secondary: 2) alcohol abuse - continuous 3) aspiration pneumonia 4) history of cva in past, abnormal mri 5) hypertension 6) type 2 diabetes mellitus discharge condition: good discharge instructions: take all medications as prescribed. follow-up as below. contact md if you develope any new weakness or have sensory changes or if you develop any new concerning symptoms. followup instructions: 1) establish a primary care provider in as per our discussion with you, your wife and . you should be see within 1-2 weeks of discharge from the rehab. we have spoken to dr. . you should call her at to schedule an appointment. 2) follow-up in clinic at the - you should probably have a repeat mri. the mri you had here on admission was abnormal and showed evidence of an old stroke. there was a question of an underlying tumor, though the suspicion was low. your repeat mri should be performed with gadolinium. you must call to set up an appointment with dr. 4 weeks from today. 3) have a repeat chest x-ray in 6 weeks to ensure your pneumonia has cleared. given your smoking history and age, we need to make sure there is no underlying mass. 4) refrain from alcohol or tobacco consumption. 5) make an appointment with an opthamologist to have your eyes checked. given your diabetes, you are at increased risk for going blind and need to have your eyes checked at least once per year. 6) as we discussed, you a car or operate heavy machinery for 6 months after your seizure. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube diagnoses: acidosis diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled other convulsions acute respiratory failure pneumonitis due to inhalation of food or vomitus other and unspecified alcohol dependence, continuous alcohol withdrawal 

Answer: The patient is high likely exposed to