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: morphine attending: chief complaint: right sided weakness major surgical or invasive procedure: tpa administered history of present illness: hpi: patient is a 83 year old rhm with hx of afib on coumadin, dm, cad, hypercholesterolemia, and mild dementia who was found aphasic with vomitus at 9:40pm. his last known well time was 9:30 and when the ems arrived around 9:50, he was found to be not talking and completely hemiplegic on right side. he was taken to where he was evaluated per telemed with neurologist at who recommended iv tpa given that his inr was 1.3 and his significant deficits. iv tpa started at 12:10 am (2hrs 40 mins after last known well time) and finished at 1:20 at which point, he was transferred here for further evaluation and care. patient arrived at 1:45 and upon evaluation, he was showing some improvement with moving his right leg which was completely plegic per report. nihss after iv tpa here in ed: 2 for loc questions 1 for minor facial paralysis 4 for no movement of rue 1 for drift of rle 1 mild/mod sensory loss 3 for mute, global aphasia 2 for severe dysarthria total 14 patient was taken for cta/ctp which showed no hemorrhagic transformation plus patent proximal vessels but did have increased mtt and decreased cbv on reformatted images. however, patient continued to make significant improvements including almost full strength in rue plus improvement of facial palsy as well. per wife, patient was in his usoh until this evening. no infectious symptoms and no report of chest pain. he was taking all his meds including coumadin. however, he did have a bout of pneumonia 2 weeks ago hence was on levaquin for 10 days which finished 5 days prior to admission. patient walks with a cane at baseline and has mild dementia but still highly independent - he still drives, pays own bills and takes own meds. past medical history: 1. atrial fibrillation on coumadin 2. hepatocellular carcinoma per biopsy () 3. dm 4. htn 5. hypercholesterolemia 6. cad s/p mi and cabg - lvef 29% 7. oa 8. depression 9. pvd and claudication social history: sh: lives with wife - highly independently functioning as noted in hpi. quit smoking 20 yrs ago and no etoh. retired grocery store manager. family history: no strokes physical exam: exam on admission . neurologic examination: mental status: awake and alert, cooperative with exam - follows simple commands: opens and closes eyes, points to ceiling and etc. able to utter "good" and says his name but severe dysarthria. repetition not intact. cranial nerves: small pupils bilaterally but reactive. eomi without nystagmus. blinks to visual threats in all directions. slight r facial droop. tongue midline and palate elevated symmetrically. motor: normal bulk and tone bilaterally. no observed myoclonus or tremor. r pronator drift. tri grip ip h q df pf r 5 5 5 5 5 5 5 5 5 l 5 5 5 5 5 5 5 5 5 sensation: seems intact to lt and pin prick although unclear if asymmetry present given aphasia. reflexes: +2 and symmetric for ues but trace for l patellar and none for r and no achilles. toes upgoing bilaterally coordination: no dysmetria with ftn but had difficulty comprehending the task. gait: deferred. exam on discharge: gen: awake and alert, oriented to person, place, occasionally date heent: ncat, anicteric, no injections, perrla, mmm cor: rrr s1s2 no mgr pulm: diminished at left base, transmitted upper airway sounds abd: +bs, soft, nt, nd extrem: no cce pertinent results: 04:56am blood wbc-7.4 rbc-3.39* hgb-10.3* hct-31.2* mcv-92 mch-30.4 mchc-33.0 rdw-16.2* plt ct-255 05:10am blood wbc-8.1 rbc-3.66* hgb-11.3* hct-34.0* mcv-93 mch-30.9 mchc-33.2 rdw-16.4* plt ct-284 05:10am blood pt-32.7* ptt-27.6 inr(pt)-3.4* 04:56am blood pt-16.8* ptt-26.5 inr(pt)-1.5* 05:10am blood glucose-127* urean-39* creat-1.3* na-152* k-3.7 cl-113* hco3-25 angap-18 05:30am blood glucose-131* urean-38* creat-1.4* na-149* k-4.1 cl-111* hco3-26 angap-16 08:05am blood glucose-126* urean-33* creat-1.3* na-146* k-3.6 cl-109* hco3-24 angap-17 03:25am blood glucose-92 urean-26* creat-1.2 na-145 k-4.2 cl-108 hco3-29 angap-12 04:56am blood glucose-109* urean-24* creat-1.2 na-143 k-4.3 cl-107 hco3-29 angap-11 03:24pm blood ck-mb-notdone ctropnt-0.09* 03:25am blood ck-mb-3 ctropnt-0.09* 04:56am blood ck-mb-notdone ctropnt-0.11* 05:10am blood calcium-8.7 phos-4.3 mg-2.1 05:30am blood calcium-9.1 phos-4.2 mg-1.7 08:05am blood calcium-8.3* phos-3.7 mg-1.6 03:25am blood calcium-8.7 phos-3.4 mg-1.7 04:56am blood calcium-8.6 phos-3.9 mg-1.7 cholest-101 04:56am blood %hba1c-6.6* 04:56am blood triglyc-58 hdl-41 chol/hd-2.5 ldlcalc-48. 04:56am blood tsh-1.5 ct/cta: 1. no acute intracranial hemorrhage. 2. the ct perfusion study demonstrates ischemia in the distribution of the inferior division of the left middle cerebral artery. it is not clear whether the blood volume in the posterior temporal portion of this territory is slightly reduced, i.e. whether an area of infarction is also present. questionable focal loss of /white matter differentiation in the posterior left temporal lobe on the non-contrast ct scan is also inconclusive with respect to the presence of an acute infarction. 3. extensive cervical and intracranial atherosclerosis. moderate, 50% stenosis in the proximal left internal carotid artery. mild stenoses at the origins of both vertebral arteries. 4. abrupt cut-off in a small distal branch of the inferior division of the left middle cerebral artery, likely related to embolic occlusion. 5. emphysema. atelectasis. not clear if pleural effusions are present. 6. cervical spondylosis. mri: 1. several small diffusion abnormalities in the left temporal and left basal ganglia consistent with acute infarct in the posterior division of the left mca. 2. no evidence of acute large hemorrhage, mass, or small microvascular hemorrhages. 3. small vessel ischemic disease. ct head negative for acute process done 1 week after stroke cxr : large left pleural effusion and small right pleural effusion are unchanged. left lower lobe atelectasis is stable. the upper lobes are clear. cardiomegaly is partially obscured by the pleuroparenchymal abnormalities. patient is status post cabg. there is no pneumothorax. no new lung abnormalities are present. brief hospital course: a/p: patient is an 83 yo man with pmhx of dm, htn, cad, chf with ef 20%, afib, hcc here with acute mca stroke managed with transferred to for further management. # mca stroke: patient is s/p tpa. head ct without acute changes . resolving defecits on exam and dysarrthria improved as well on discharge. the stroke occured in the setting of a subtherapeutic inr. coumadin was restarted shortly after tpa administration. patient's inr climbed despite holding coumadin to 8.6. 2.5 mg vitamin k which resulted in a trending down of the inr to 2.3. the elevated inr was thought to be due to lack of nutrition, antibiotics and liver disease (he has hcc). given the difficulty with his inr, lovenox was started when his inr was 2.3. he should continue lovenox for his atrial fibrillation and asa 81 mg daily. he has neurology follow-up. he needs to work with pt. speech and swallow initially thought he was an aspiration risk because of his poor mental status, but as his mental status improved, he was able to eat purreed food with thickened liquids and per nurse was not aspirating at all. this may be able to be advanced as he continues to improve and regain strength so he will need repeat assessment at some point. . # mental status changes: patient was intermittently agitated and somnolent. repeat ct head was negative. he was noted to have a uti and was hypernatremic so these were the likely causes. we treated the uti with ceftriaxone and the hypernatremia with d5 w and his mental status improved. he still has some short-term memory problems but patient has early dementia at baseline. oriented to name and hospital and intermittently date. will need periodic labs to assess electrolytes especially if his po intake declines. . # uti: treated with ceftriaxone for 5 days, ua negative on discharge so antibiotics were discontinued . # hypernatremia: likely due to poor po intake when somnolent. resolved with d5w. cont to monitor chem-7 every few days . # arf: his creatinine climbed to 1.5 and his exam was volume overloaded. we diuresed him with 40 mg iv lasix for 3 days and diuresed several liters of fluid. on discharge his creatinine was down to 1.1. ua without casts, rare urine eos. . # chf with ef 15-20%: patient received fluids after his stroke and lasix was held. he became very overloaded with 2+ pitting edema to his knees on exam and crackles on lung exam. patient received several 40 mg iv boluses of lasix and diuresed liters per day for 3 days. on discharge, his respiratory status was improved and his le edema was resolved. we also continued asa, carvedilol and added 5 mg lisinopril once his creatinine normalized. we continued him on 40 mg po lasix but his volume status should be watched closely and this should be adjusted based on his clinical exam. . # htn: well-controlled, cont carvedilol and lisinopril . # dm: held rosiglitazone in setting of chf. covered with riss. check fs qid. . # cad: continued asa, statin, betablocker. started acei. . # afib: rate controlled with carvedilol without any rvr, started lovenox for anticoagulation once his inr was between as his inr was difficult to manage for the above reasons on coumadin. . # hyperlipidemia: increased atorvastatin on this admission. . # hcc: inoperable per dr. , patient declined other treatment per wife. prognosis per family is < 1 year. lfts elevated on this admission, no baseline to compare. trending down on discharge. . # dementia: continued donepezil . # fen: restarted pureed diet with thick liquids per s/s eval and per nurse, no aspiration events. . # access: piv . # code: dnr/i- confirmed with his wife- hcp medications on admission: 1. lipitor 20mg daily 2. bupropion 100mg 3. coreg 12.5 4. cilostazol 100 5. aricept 5 daily 6. avandia 4 daily 7. coumadin 5 daily 8. asa 325 daily discharge medications: 1. atorvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 2. bupropion 100 mg tablet sig: one (1) tablet po twice a day. 3. carvedilol 12.5 mg tablet sig: two (2) tablet po bid (2 times a day). 4. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 5. donepezil 5 mg tablet sig: one (1) tablet po hs (at bedtime). 6. insulin regular human 100 unit/ml solution sig: as directed injection asdir (as directed). 7. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours) as needed for wheezing. 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q6h (every 6 hours) as needed for wheezing. 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 11. lisinopril 5 mg tablet sig: one (1) tablet po daily (daily). 12. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed. 13. enoxaparin 80 mg/0.8 ml syringe sig: one (1) injection subcutaneous (2 times a day). 14. lasix 40 mg tablet sig: one (1) tablet po once a day: this may need to be adjusted based on his volume status. discharge disposition: extended care facility: - discharge diagnosis: primary left mca ischemia s/p iv tpa chf uti hypernatremia secondary htn afib hyperlipidemia dementia discharge condition: stable discharge instructions: you were initially admitted because of a stroke. you received medication in time to dissolve the clot which was causing the symptoms. we also started you on lovenox for atrial fibrillation to help reduce your risk of recurrent stroke. while you were here, you became volume overloaded and received lasix and are now improved. in addition, you became confused and were diagnosed with a uti and were hypernatremic. you were treated for both of these issues and your confusion improved. please take all medications as directed. please follow-up with all outpatient appointments. please return to the ed if you experience any fever, chest pain, difficulty breathing, abdominal pain or any other concerning symptoms. followup instructions: provider: , md phone: date/time: 1:30 please follow-up with your pcp after leaving rehab. procedure: injection or infusion of thrombolytic agent diagnoses: abnormal coagulation profile urinary tract infection, site not specified congestive heart failure, unspecified unspecified essential hypertension acute kidney failure, unspecified atherosclerosis of native arteries of the extremities with intermittent claudication atrial fibrillation aortocoronary bypass status depressive disorder, not elsewhere classified other persistent mental disorders due to conditions classified elsewhere old myocardial infarction long-term (current) use of anticoagulants osteoarthrosis, unspecified whether generalized or localized, site unspecified malignant neoplasm of liver, primary hyperosmolality and/or hypernatremia acute on chronic systolic heart failure cerebral artery occlusion, unspecified with cerebral infarction delirium due to conditions classified elsewhere status post administration of tpa (rtpa) in a different facility within the last 24 hours prior to admission to current facility 

Answer: The patient is high likely exposed to