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: erbitux attending: chief complaint: transfer from hospital with seizures, fever, ams, intubated. major surgical or invasive procedure: endotracheal intubation at outside hospital rij placement at osh and replacement at lumbar puncture ngt placement gj tube placement history of present illness: a 68 year-old female with history of cerebrovascular accident x 3, left tonsillar carcinoma, no known history of seizures presenting to hospital with new onset convulsive seizures. she was unable to protect her airway and was intubated in the ed, complicated due to her radiation for tonsillar cancer. potassium on admission was 2.2, with magnesium 1.7 and other electrolytes within normal limits. wbc count 8.8 on admission. she had no history of head trauma and ct head x 2 showed multiple old ischemic changes but no new process. mri was not performed. eeg x 3 showed persistent epileptiform activity in the left cerebral hemishere, however, unclear when the eegs were performed relative to the convulsive seizures. infectious evaluation was negative as below. she has been treated with phenobarbital, fosphenytoin, intermittent ativan, and a midazolam drip for her seizures. it is unclear when her last convulsive seizure occurred. per her discharge summary, her dilantin has ranged 14-19 and her last phenobarbital level was 11.4. she was febrile to 101.4 , 100.8 , 100.6 and 102 . wbc count peaked at 20.4 . chest x-ray after intubation showed a developing infiltrate at the right lung base, which improved on subsequent imaging. infectious evaluation including bal at the time of intubation, urine, and blood cultures were negative at the time of discharge - she never underwent lumbar puncture. she was initially treated with ceftriaxone and clindamycin for aspiration pneumonia. she was on diflucan as an outpatient for a fungal urinary tract infection and this was continued during her admission. a rij was placed , and due to her fevers, a lij was attempted but unsuccessful; the rij remains in place. her antibiotics have been changed to zosyn and linezolid at some point prior to transfer. on arrival to the icu, she is intubated and sedated. there is no observed seizure activity when sedation is off. she responds to touch but does not follow commands. she has a gag with suction. she moves all extremities well. review of sytems: unable to obtain. past medical history: - cerebrovascular accident x 3, last - left-sided squamous cell tonsillar cancer status post radiation and "a few cycles" of erbitux - history of encephalopathy suspected secondary to erbitux use, status post acyctlovir for potential herpetic encephalitis - negative eeg at that time - history of erbitux related lung toxicity versus aspiration pneumonitis - hyperthyroidism on propylthiouracil - chronic atrial fibrillation/flutter, rate-controlled with digoxin and diltiazem, on coumadin in the past but not currently - history of albicans urinary tract infection social history: patient was originally from and moved ~3 years ago to , when se re-married. she was happily living at home with husband in . she has history of severe alcohol abuse and intoxication with withdrawal and seizures. she used to be as heavy smoker as well. family history: sister with ovarian cancer. physical exam: on admission: temp: 36.7 ??????c hr: 96 bp: 120/68 rr: 15 ventilator mode: cmv/assist/autoflow vt (set): 400 ml ps : 12 cmh2o rr (set): 14 peep: 5 cmh2o fio2: 40% spo2: 100% abg: 7.49/45/119 general appearance: no acute distress eyes / conjunctiva: perrl, large tongue head, ears, nose, throat: normocephalic cardiovascular: (pmi normal), (s1: normal), (s2: normal), (murmur: no(t) systolic, no(t) diastolic) peripheral vascular: (right radial pulse: present), (left radial pulse: present), (right dp pulse: present), (left dp pulse: present) respiratory / chest: (expansion: symmetric), (breath sounds: clear : ) abdominal: soft, non-tender, bowel sounds present, no(t) distended extremities: right: absent, left: absent, no(t) cyanosis, no(t) clubbing skin: warm, no(t) rash: neurologic: responds to: noxious stimuli, movement: non -purposeful, tone: increased upon transfer: vitals: t: 98.2 bp: 157/97 p: 100 r: 20 spo2 100% 21% facemask general: alert, no acute distress, follows commands, responds y/n questions, cachectic. heent: sclera anicteric, mmm, oropharynx clear, thick secretions in mouth with dry mucous membranes. neck: supple, jvp not elevated, no lad lungs: absence of wheezes, rales, but ronchi present bilateraly cv: regular rate and rhythm, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, tenderness in left flank, where peg was recently placed, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: adequate muscle tone in upper and lower extremities, decreased reflexes 1+/3+ in upper and lower extremities including deltoid, biceps, triceps, patelar, aquilean bilateraly. sensitivity and propiosception not evaluable. cn , vestibular, 11, 12 intact. 9 & 10 normal, but with decreased gag reflex. normal sphincter tone. minimental not evaluable, but patient follows commands and opens eyes spontaneusly. pertinent results: on admission: 10:07pm wbc-10.2 rbc-3.11* hgb-9.5* hct-27.2* mcv-88 mch-30.5 mchc-34.9 rdw-17.4* 10:07pm neuts-82.9* lymphs-10.9* monos-3.1 eos-2.6 basos-0.5 10:07pm plt count-404 10:07pm pt-14.3* ptt-27.0 inr(pt)-1.2* 10:07pm urine color-yellow appear-clear sp -1.015 10:07pm urine blood-sm nitrite-neg protein-30 glucose-neg ketone-neg bilirubin-neg urobilngn-neg ph-6.5 leuk-sm 10:07pm urine rbc-0-2 wbc- bacteria-few yeast-none epi-0 renal epi-0-2 10:07pm phenobarb-14.7 phenytoin-15.0 10:07pm digoxin-0.7* 10:07pm free t4-0.56* 10:07pm tsh-1.9 10:07pm albumin-2.4* calcium-8.3* phosphate-3.9 magnesium-1.9 10:07pm alt(sgpt)-34 ast(sgot)-28 alk phos-119* tot bili-0.3 10:07pm glucose-99 urea n-14 creat-0.7 sodium-133 potassium-3.2* chloride-95* total co2-32 anion gap-9 10:26pm lactate-1.0 k+-3.0* 10:28pm type-art po2-105 pco2-48* ph-7.45 total co2-34* base xs-7 11:34pm cerebrospinal fluid (csf) wbc-6 rbc-612* polys-53 lymphs-44 monos-3 11:34pm cerebrospinal fluid (csf) wbc-2 rbc-64* polys-50 lymphs-40 monos-10 11:34pm cerebrospinal fluid (csf) protein-24 glucose-60 upon discharge: 07:50am blood wbc-8.8 rbc-3.53* hgb-11.0* hct-31.4* mcv-89 mch-31.1 mchc-34.9 rdw-17.2* plt ct-716* 07:50am blood pt-13.3 ptt-67.5* inr(pt)-1.1 07:50am blood glucose-103 urean-14 creat-0.7 na-136 k-3.5 cl-93* hco3-30 angap-17 07:15am blood ld(ldh)-213 totbili-0.3 reports: spinal fluid: negative for malignant cells . echocardiogram: : the left atrium is elongated. there is mild symmetric left ventricular hypertrophy with normal cavity size and regional/global systolic function (lvef>55%). right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) are mildly thickened but aortic stenosis is not present. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. mild (1+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. there is a trivial/physiologic pericardial effusion. cxr: the nasogastric tube is appropriately positioned 2.7 cm above the carina. the right internal jugular central venous line tip overlies the svc. there is no pneumothorax. the nasogastric tube has been appropriately advanced. the cardiomediastinal silhouette is stable. there are small bilateral pleural effusions and increased retrocardiac opacity likely representing atelectasis. cxr: a single portable radiograph of the chest demonstrates a nasogastric tube coiled in the stomach. the left internal jugular central venous catheter seen on has been removed. the left basilar atelectasis seen on the previous study has resolved. the lungs are clear. no effusion is appreciated. trachea is midline. the aorta is calcified and tortuous. mri : technique: t1 sagittal and axial and flair t2 susceptibility and diffusion axial images were obtained before gadolinium. t2 and flair coronal images of the temporal lobes acquired. following gadolinium, mp-rage coronal images were obtained with sagittal and axial reformats. the mp-rage post-gadolinium images are limited by motion. there are no prior examinations for comparison. findings: images through the brain demonstrate mild-to-moderate brain atrophy and moderate changes of small vessel disease with a chronic cortical infarct in the left parietal lobe and chronic infarct in the right basal ganglia putaminal region. there is no mass effect, midline shift or hydrocephalus. no acute infarct. diffusion images demonstrate a tiny area of increased signal in the left frontal cortical region which is too small to characterize on adc map. coronal images through the temporal lobes demonstrate hippocampal atrophy but no intrinsic signal abnormalities are seen. the post-gadolinium images are limited by motion as described above. however, no large areas of enhancement are seen. impression: chronic left parietal and right basal ganglia infarcts. small vessel disease and brain atrophy. tiny area of increased signal on diffusion in the left frontal cortical region is too small to characterize on the adc map and could be due to either a tiny acute infarct or t2 shine through. limited gadolinium images demonstrate no large area of enhancement. chronic micro hemorrhages are seen in the right basal ganglia, left temporal region which could be due to previous ischemia. video swallow: moderate oral and pharyngeal dysphagia resulting in penetration during the swallow and subsequent aspiration after the swallow on all consistencies. please refer to the speech and swallow specialist's report for recommendation and for more details. carotid usg: 1. less than 40% stenosis in the right and left internal carotid arteries. brief hospital course: 68 year-old female with history of cerebrovascular accident x 3, tonsillar carcinoma, no known history of seizures transferred from hospital with seizures and fevers. # seizures: pt was admitted to osh with seizures, fever, ams. osh eeg x 3 have shown persistent epileptiform activity from a focus in the left cerebral hemisphere, without ability for continuous eeg monitoring ?????? unclear timing of eeg with regard to convulsive episodes. unclear etiology. her prior cvas may be epileptogenic foci. there were electrolyte abnormalities on admission, however, the patient persisted with seizures after correction. she had no history of head trauma and ct head x 2 showed multiple old ischemic changes but no new process. patient has history of cancer and may have metastasis ?????? mri was not performed at osh. infectious evaluation as below ?????? lp not performed at osh, lp negative on admission here, although has been on antibiotics. home medications not known to contribute to seizure activity. no report of toxicology screen on admission to osh. no clot by echo. eeg without seizure and phenobarbital was discontinued . mri no evidence of encephalitis, so acyclovir discontinued. mri does show what could be new embolic stroke in left frontal cortical region where osh saw seizure activity. patient placed on heparin gtt and transitioned to coumadin on , but it was stopped for peg placement and re-started on at 2.5 mg daily. since we were having variable levels of phenytoin, pt was switched to keppra. please stop phenytoin in 4 days and contine keppra at current dose. there were not any seizures at this hospital and the etiology was unknown, but thought to be multifactorial in the setting of possible infection and new embolic stroke. . # fevers, leukocytosis: unclear etiology - seizures versus infection vs drug related. osh bal from admission grew only yeast, urine and blood cultures negative. rij in place since without erythema or discharge. patient initially on diflucan, ceftriaxone, and clindamycin for aspiration, but changed to zosyn and linezolid at some point prior to transfer to . patient had an lp that was negative for infection, with normal protein and glucose, cultures without any growth. however, since ams and fever made high the suspicion for infection patient was treated empirically with vancomycin, ceftriazone, ampicillin. there was question of hospital acquired pna and patient only grew mrsa from sputum. antibiotics were stopped on and has been afebrile since then. # respiratory failure: intubated for airway protection in the setting of aspiration. was treated for aspiration pneumonia with ceftriaxone and clindamycin for an unknown course. chest x-ray on admission here with question retrocardiac opacity but excellent gas exchange and negative sputum. patient was extubated on without complications. she has been stable breathing comfortably on room air. she uses facemask only to humidify air since there is concern for thick mucus and plugging, with difficulty clearing secretions. please keep facemask with as much humidity as possible. # atrial flutter: rate-controlled with digoxin and diltiazem. titrated up diltiazem. continued digoxin and for rate control. on heparin gtt and was started and therapeutic on 2.5 mg of coumadin, which was stopped for peg placement. re-started on . since patient has documented chronic afib, we do not think she will benefit from ablation at this point, and she will still require anticoagulation for secondary stroke prevention. # anemia: normocytic with stable hct in the low 30s during this hospitalizaion. patient was guaiac negative and with ferritin of 1159 suggesting anemia of chronic disease. # hyperthyroidism: unclear etiology - grave's disease versus functioning nodule(s). tsh 1.9, free t4 0.56 during this acute illness. continued propylthiouracil. # squamous cell tonsillar cancer: status post chemoradiation. no acute issues. patient was seen by ent who did not see any mass or lession in throat. they aspirated thick secretions close to the epiglottis, and additional secretions on the right side of the glottis could not be aspirated. they could not rule out cystic lesion. she will need follow up with her oncologist within 6 months and keep air humidified. # fen: no ivf, replete electrolytes, tube feeds throug peg as continuous. can change to bolus if patient tolerates. please continue free water flushes. . # prophylaxis: heparin gtt and coumadin; bowel regimen, ppi. . # access: peripherals. . # code: dnr, but ok to intubate if respiratory failure. . # communication: husband phone number: . # disposition: to rehab. medications on admission: medications on transfer: linezolid 600 mg iv q12h zosyn 4.5 gm iv q6h fosphenytoin 100 mg iv q8h phenobarbital 120 mg iv q12h fentanyl drip midazolam drop digoxin 0.125 mg po daily diltiazem 60 mg po q6h combivent inh q6h protonix 40 mg po daily aspirin 325 mg po daily fluconazole 200 mg po daily propylthiouracil 50 mg po daily zofran 4 mg iv q8h:prn nausea . medications at home: aspirin 81 mg po daily diltiazem cr 180 mg po daily atenolol 50 mg po daily digoxin 0.25 mg po daily combivent inh q4h diflucan 100 mg po daily propylthiouracil 50 mg po daily senna 8.6 mg po daily bactroban one application to nares for mrsa documented coumadin (on hold for unclear duration) discharge medications: 1. propylthiouracil 50 mg tablet sig: one (1) tablet po daily (daily). 2. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). 3. acetaminophen 325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for fever, pain. 4. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed. 5. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 6. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day) as needed. 7. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 8. diltiazem hcl 90 mg tablet sig: one (1) tablet po q6h (every 6 hours). 9. atenolol 25 mg tablet sig: three (3) tablet po daily (daily). 10. phenytoin 50 mg tablet, chewable sig: two (2) tablet, chewable po tid (3 times a day) for 6 days. 11. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 12. levetiracetam 500 mg tablet sig: two (2) tablet po bid (2 times a day). 13. warfarin 2.5 mg tablet sig: one (1) tablet po daily (daily). 14. heparin please continue heparin drip per protocol with target ptt 60-100. discharge disposition: extended care facility: hospital of and islands discharge diagnosis: primary diagnosis: new onset seizures possible new stroke . secondary diagnosis: history of cerebrovascular accident x 3 history of squamous cell carcinoma of the tonsil s/p radiation and chemotherapy with erbitux (3 cycles) history of encephalopathy of etiology: erbitux vs hsv paroxismal atrial fibrillation / atrial flutter discharge condition: stable, alert, obeys commands and answers y/n questions, tolerating tube feeds. patient needs mitts occasionaly to protect ivs and peg since she gets very agitated occasionally. discharge instructions: you were transfered at icu from hospital after being admitted with alter mental status, confuson and fever. doctors that you were not able to protect your airway, so you were intubated. you were transfered to this hospital for further care. in here you were slowly weaned off the ventilator. you had a lumbar puncture to rule out infection in the brain. you had bloot test and blood cultures done. after extensive infectious work up we did not find a source of infection. however, you were being treated with broad expectrum antibiotics and your blood test improved and you stopped having fevers. . you had an mri of your brain that suggested a new small stroke. you had a few episodes of abnormal heart rhythm that were controlled with medications and coumadin. . you were on 3 different medications to control your seizures and you will require long therapy with keppra as indicated below. you will need follow up with your neurology back home in months. . your thyroid funciton was checked and it was normal. . you were also seen by ent to assess for your tonsilar cancer. only thick secretions were seen. it is very important that you week yourself well hydrated through the peg and your mouth humidified with the facemask. . we expect that you will be improving within the next weeks to months little by little as you did after your prior stroke. . you are being discharge to a rehab where they can follow you up. followup instructions: please follow up with your pcp , within the next month. he is aware that you were here and of what it has been happening. . please follow with your neurologist within the next 1-2 months. md procedure: continuous invasive mechanical ventilation for 96 consecutive hours or more spinal tap incision of lung enteral infusion of concentrated nutritional substances closed [endoscopic] biopsy of bronchus percutaneous (endoscopic) jejunostomy [pej] diagnoses: anemia, unspecified atrial fibrillation other convulsions atrial flutter thyrotoxicosis without mention of goiter or other cause, and without mention of thyrotoxic crisis or storm acute respiratory failure pneumonitis due to inhalation of food or vomitus cerebral artery occlusion, unspecified with cerebral infarction malignant neoplasm of tonsil 

Answer: The patient is high likely exposed to