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: erythromycin base attending: chief complaint: r. arm twitching, sent to for respiratory monitoring major surgical or invasive procedure: none history of present illness: mrs. is an 85 yo f with hx of severe copd (fev1 of 0.63), htn, diastolic chf with preserved ef, recently admitted with a copd exacerbation and rll pna started on levofloxacin and prednisone taper who presents from rehab today because of concern for seizure activity. per nursing and neuro notes, she was doing well in the am and ate breakfast and then began having twitching in her arms and legs around noon with increasing confusion. she at this time was still talking but her speech supposedly was not normal. she was given 100 mg of dilantin and 25 mg of trazodone and transferred her for further evaluation. she also was noted to have a temp of 99.2 this am with diarrhea and emesis. patient's baseline is apparently aaox3, pleasant, and normal language. . in the ed, neurology evaluated her and found her dilantin level to be subtherapeutic at 1.9. she was loaded with 1g iv dilantin in the ed and she had an eeg showing severe encephalopathy but no convulsive status. she had a head ct which showed no evidence of ich/mass but showed ?air fluid levels in the sinus. additionally, during her eeg, she was placed on high levels of oxygen during her transportation and eeg stay and her o2 sats were in the mid 90's. when she returned from her test, she was noted to be more lethargic and her abg showed 7.09/91/71 -> she was placed on bipap and her oxygen was decreased to maintain her oxygenation in the high 80's and her next abg was 7.16/72/66. she awoke up more and she tore off her bipap. additionally, neurology recommended that an lp should be done and mri with stroke protocol, however she was just started on vanco/ceftriaxone/ampicillin and transferred here without an lp/mri. she was given 3 liters of fluid in the er prior to transfer. . on arrival to the the patient was able to relate only part of her story, stating that she had had diarrhea for the last few days in her nursing home but was told to see if it would resolve on its own. she notes feeling thirsty and dry and says all she has had to eat in the last few days was one banana and a little bit of ice water. she denies neck pain or stiffness, denies photophobia, says she had a headache at the nursing home that has resolved. at baseline she uses 3l o2 by nc at all times. she denies any awareness of twitching but says she had been feeling weak and dropped her whole tray of food this morning. past medical history: -copd/emphysema: on l home o2. pfts : fev1 0.63 (38% pred), fev1/fvc 38 (57% pred.). baseline pco2 70. followed by dr . known baseline of 88-92% on 3l o2. -htn -h/o asthma -cri (baseline creatinine 1.0-1.2) -chf: diastolic dysfuntion. ef 60-65% e:a ratio=0.69 -anemia (baseline hct of 30) -h/o legionnaire's disease in social history: tobacco use since age 16, quit in . she denies etoh and use of any other substances. recently hospitalized and transferred to nh on family history: noncontributory physical exam: 97.8, 109/25, 67, 20, 85-95% on 1lnc gen- nad, confused, oriented to self, place, year heent- mm dry neck- no jvd cv- rr, no m chest- ctab abd- soft, nt/nd, +bs ext- no c/c/e neuro- aaox3, knows year/name/location, at times uses nonsensical words, muscle strength 5/5 bilaterally, +2 patellar reflexes bilaterally pertinent results: head ct: no evidence of intracranial hemorrhage. mucosal thickening of right sphenoid sinus. questionable air fluid level. . cxr: resolved right lower lobe pneumonia. persistent left lower lobe linear atelectasis. no evidence of chf or pneumothorax. . eeg showing severe encephalopathy with generalized bursts of slowing with suppressive bursts that follow, theta/delta background. no nonconvulsive status. . brief hospital course: mrs. is an 85 yo f with hx of severe copd with recent copd exacerbation, lll pna who presented with a questionable seizure episode from rehab and had acute respiratory acidosis in the setting of being on 100% fio2. she was noted to have an abnormal eeg in the setting of being on 100% fio2. she was noted to have increasing confusion and this was attributed to co2 retention. . in the icu, the pt was found to be maintaining her o2 sats at 88-92 on 1-3lnc. she refused bipap adamantly for co2 retention, and reconfirmed her desire not to be intubated. the icu team was unable to increase her ventilation artificially. the pt was continued on her usual outpatient inhalers and nebulizers, and given her solumedrol. she was found to have a metabolic acidosis (baseline bicarb 35 and on presentation it was 25) so her diamox was stopped, which she has been on as an outpatient and was recently increased in . it is unclear why she also had a respiratory acidosis beyond her usual retention. it has been postulated by her outpatient pulmonologist that she may additionally have a central process decreasing her respiratory drive and perhaps this may be playing a role. given that she was dni and also refusing bipap, with stable vital signs throughout her stay in the unit she was called out to the floor. on the floor, she remained stable with oxygen saturation at goal of 89-93% on 2l. she was encouraged to use the incentive spirometer and was able to maintain her goal o2 sats. . the patient's mental status was not at baseline on admission- with inattention, some word finding difficulties and increased confusion, although she was oriented x 3. the icu team did not believe that this was secondary to meningitis, as she was afebrile, had no nuchal rigidity, no headache or photophobia. the patient refused lp and the icu team did not give her prophylactic antibiotics for meningitis. eeg by neuro in the er showed diffuse encephalopathy, which may be consistent with other metabolic abnormalities or infection. an mri/mra (limited study) done to rule out acute stroke and head ct were negative. the pt was continued on her outpatient dilantin and her mental status gradually trended toward baseline. she was not having inattention or confusion at the time of discharge. . she came in appearing quite dehydrated in the setting of several days of diarrhea. it was thought that this was likely a viral gastroenteritis that had been noted at her rehab facility. the pt was hydrated. while on the floor she was kept npo to prevent aspiration. her mental status gradually improved and she was able to tolerate a po diet at the time of discharge. . the pt completed her course of levofloxacin (which she was on as an outpatient) for recently diagnosed rll pneumonia. she presented with acute renal failure and was hydrated with ivf with resolution of acute renal failure. . the pt was noted to have difficulty swallowing and there was concern for aspiration so she was made npo and given iv medications. she underwent a picc placement on . as her mental status was significantly improved, she underwent a repeat speech and swallow evaluation and was able to pass the test. she was able to tolerate a po diet at the time of discharge. . she reported a single episode of fleeting chest pain during this hospitalization, during which she had no ekg changes and no elevation of cardiac enzymes. medications on admission: 1. levofloxacin 250 mg po qd (last dose for 7d course) 2. prednisone taper (just finished taper on ) 3. lisinopril 10 mg po qd 4. dilantin er 300 mg po qhs , 5. asa 81 mg po qd . docusate 100 mg po bid 7. senna 1 tab po bid 8. acetazolamide 250 mg po qd 9. fluoxetine 20 mg po qd 10. pantoprazole 40 mg po qd 11. ipratropium 1 neb q6h 12. albuterol 1 neb q6h 13. budesonide 1 neb q6h 14. albuterol 1-2p q4-6 prn 15. tylenol prn 16. heparin 5000 sc tid 17. vitamin d 50,000 units q week 18. fosamax 70 mg po qfriday discharge medications: 1. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 2. fluoxetine 20 mg capsule sig: one (1) capsule po daily (daily). 3. acetaminophen 325 mg tablet sig: one (1) tablet po q4-6h (every 4 to 6 hours) as needed. 4. heparin (porcine) 5,000 unit/ml solution sig: one (1) injection tid (3 times a day). 5. cholecalciferol (vitamin d3) 400 unit tablet sig: one (1) tablet po daily (daily). 6. alendronate 70 mg tablet sig: one (1) tablet po qfri (every friday). 7. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours). 8. budesonide 0.25 mg/2 ml solution for nebulization sig: one (1) ml inhalation q6h (every 6 hours): add to pt's nebs. 9. albuterol sulfate 0.083 % solution sig: one (1) inhalation q6h (every 6 hours): give with other nebs. 10. lisinopril 10 mg tablet sig: one (1) tablet po daily (daily). 11. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po once a day. 12. aspirin ec 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). 13. phenytoin 100 mg/4 ml suspension sig: one (1) po q8h (every 8 hours). 14. outpatient lab work you will need to have your dilantin, free dilantin and albumin levels checked and your dose of dilantin adjusted by your physician at the rehab on 15. senna 8.6 mg capsule sig: one (1) capsule po once a day as needed for constipation. discharge disposition: extended care facility: nursing & rehab center - discharge diagnosis: primary: mental status changes in the setting of dehydration. . secondary: -copd/emphysema: on l home o2. pfts : fev1 0.63 (38% pred), fev1/fvc 38 (57% pred.). baseline pco2 70. followed by dr . known baseline of 88-92% on 3l o2. -htn -h/o asthma -cri (baseline creatinine 1.0-1.2) -chf: diastolic dysfuntion. ef 60-65% e:a ratio=0.69 -anemia (baseline hct of 30) -h/o legionnaire's disease in discharge condition: stable, mentating well at baseline discharge instructions: please report to the emergency room if you have increasing confusion, difficulty breathing, fever or chills. . you should continue to use your incentive spirometer 10 times an hour while awake. . weigh yourself every morning, md if weight > 3 lbs. adhere to 2 gm sodium diet. fluid restriction: none followup instructions: provider: , md. phone: . date/time: provider: breathing tests phone: date/time: 9:10 provider: , m.d. phone: date/time: 9:30 provider: , intepretation billing date/time: 9:30 md, procedure: venous catheterization, not elsewhere classified non-invasive mechanical ventilation diagnoses: acidosis congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified other convulsions chronic kidney disease, unspecified other emphysema chronic obstructive asthma with (acute) exacerbation dehydration hyperosmolality and/or hypernatremia diastolic heart failure, unspecified unspecified psychosis adjustment disorder with depressed mood 

Answer: The patient is high likely exposed to