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: sulfa (sulfonamides) / penicillins / lipitor attending: chief complaint: headache, left sided weakness major surgical or invasive procedure: none history of present illness: patient is an 82 yo man who was transferred to and admitted to neurosurgery for brainstem hemorrhage. history dates back to about 4-5 weeks ago when he had sudden onset dysphagia and odynophagia. had an extensive work up at an osh as well as here with ent and ent eval here showed no an anatomic process. according to his daughter, he had multiple head imaging studies including mri which were apparently normal, but was diagnosed clinically with having had a stroke. his speech was slurred mildly from this, but he was easily understandable. also, he received a peg for the dysphagia, but after about weeks was starting to take applesauce and oatmeal by mouth. while at rehab, he developed atrial flutter and was transferred to for treatment of this. he was discharged to rehab tuesday, and was doing well. on friday was found to have confusion, headache, left hemiparesis and worsened dysarthria. was taken to hospital where a ct showed a brainstem hemorrhage with intraventircular spread and blood in occipital horns as well as question of likely small subdural versus focal subarachnoid clot in the inter hemispheric fissure anteriorly. was transferred here to , where he was following commands, confused, and had left leg weakness which was . he had to be intubated for mri secondary to confusion and was intubated yesterday for several hours for the study. was noted to be very sedated yesterday am and evening, with minimal movement on the left side, and this has improved significantly as sedation was washed out. his daughter at bedside feels that he appears much less sedated than yesterday and seems to be less confused. also seems to be moving his left side better. after transfer, repeat head ct showed no acute change. past medical history: a-fib and a-flutter s/p peg placement hypercholesterolemia copd spinal stenosis benigin rib tumor intermittent vertigo decreased hearing social history: sulfa (sulfonamides) penicillins lipitor family history: nc physical exam: t- 98.9 bp- 129-172/54-76 hr- 72-84 rr- 24 o2sat 99 ra gen: lying in bed, nad heent: nc/at, extremely dry oral mucosa neck: no tenderness to palpation, normal rom, supple, no carotid or vertebral bruit back: no point tenderness or erythema cv: rrr, nl s1 and s2, no murmurs/gallops/rubs lung: clear to auscultation bilaterally abd: +bs soft, nontender, peg ext: no edema neurologic examination: mental status: opens eyes to loud voice and only maintains for 3-5 seconds before closing again. cannot assess orientation well as he is so profoundly dysarthric, but seems to say no to options of 'hospita;" and "". follows 2 step command with rue and only 1 step with lue. dysarthric to point that only "base-ball" on could be discerned and otherwise cannot understand him. no apparent neglect. severely inattentive. cranial nerves: pupils equally round and reactive to light, 3 to 2 mm bilaterally. can read, but does not blink to threat either side. could not tolerate funoscopy. extraocular movements intact bilaterally, no nystagmus. sensation seems intact v1-v3 but unreliable. facial movement down just slightly left. hearing terrible in left ear at baseline, and hears only loud voice in right ear today. palate elevation asymmetrical with elft slightly higher than right. gag intact but requires significant stimulus. trapezius normal bilaterally. tongue midline, movements intact motor: normal bulk bilaterally. tone paratonic throughout. no observed myoclonus. has significant intention tremor which is improved from yesterday. has asterixis. mild left pronator drift tri fe ff ip h r 5 5 5 5 5 4+ 4+ l 5- 5 5 4 5 5- 5- difficult to assess dorsiflexion and plantarflexion, but at least . sensation: intact to light touch x 4, could not otherwise assess. reflexes: trace /tr bilaterally. absent br, knees and ankles toes up left, equivocal right. coordination: could not do fnf due to inattention. did not assess gait. discharge examination: pt is globally disoriented. his speech is fluent. naming of low frequency objects intact. he has persistently dysarthric speech. pt has a tendency to sundown at night, but easily re-directs. pertinent results: 12:40pm blood wbc-2.7*# rbc-3.57* hgb-10.4* hct-31.2* mcv-88 mch-29.2 mchc-33.4 plt ct-261 02:06am blood wbc-9.7# rbc-3.20* hgb-9.5* hct-28.2* mcv-88 mch-29.5 mchc-33.6 rdw-14.0 plt ct-250 06:44am blood wbc-6.7 rbc-4.00* hgb-12.2* hct-34.6* mcv-87 mch-30.5 mchc-35.3* rdw-13.3 plt ct-358 12:40pm blood pt-17.1* ptt-39.1* inr(pt)-1.5* 07:17pm blood pt-15.5* ptt-32.4 inr(pt)-1.4* 06:40am blood pt-14.8* ptt-34.3 inr(pt)-1.3* 05:59am blood pt-15.0* ptt-35.1* inr(pt)-1.3* 12:40pm blood glucose-131* urean-26* creat-1.7* na-135 k-4.1 cl-98 hco3-28 angap-13 06:40am blood alt-19 ast-22 alkphos-86 totbili-0.7 05:59am blood calcium-9.2 phos-3.1 mg-1.7 iron-37* cholest-143 05:59am blood caltibc-241* vitb12-1087* ferritn-538* trf-185* 05:59am blood %hba1c-5.8 05:59am blood triglyc-71 hdl-31 chol/hd-4.6 ldlcalc-98 06:40am blood ammonia-35 urine culture (final ): ciprofloxacin requested by dr. . enterococcus sp.. >100,000 organisms/ml.. sensitivities: mic expressed in mcg/ml _________________________________________________________ enterococcus sp. | ampicillin------------ 16 r ciprofloxacin--------- 1 s nitrofurantoin-------- 128 r tetracycline---------- =>16 r vancomycin------------ <=1 s ct head w/o contrast 1:10 pm 1. hemorrhage within the prepontine cistern and layering within the occipital horns of the lateral ventricles bilaterally. 2. likely small subdural versus focal subarachnoid clot in the inter hemispheric fissure anteriorly. ct head w/o contrast 4:22 am allowing for positional differences, little change is seen compared to prior study. hemorrhage again seen in the prepontine and premedullary cistern, and layering within the occipital horns of the lateral ventricles bilaterally. high-density material also again seen in the interhemispheric fissure anteriorly, possibly representing small subdural versus focal subarachnoid clot. mass effect from the medulla is not significantly changed from prior study. there is no shift of midline structures. the configuration of the ventricles is little changed from prior. visualized paranasal sinuses are normally aerated ct head w/o contrast 2:24 pm little interval change compared to . persistent hemorrhage within the basal cisterns with intraventricular extension in both lateral ventricles. unchanged mild-to-moderate communicating hydrocephalus. there is a prominent vascular focus likely related to the left anterior cerebral artery/ supraclinoid internal carotid artery (series 2, im 13) and as suggested before pt. would need a cta or mra to assess for aneurysm. chest (portable ap) 11:25 am new et tube tip is 4.3 cm above the carina. cardiomediastinal contours are unchanged with cardiac size normal. there is no pneumothorax. the right lung is grossly clear. minimal increased opacity in the left lower lobe is new, likely atelectasis. residual contrast material is in the visualized colon. new ill-defined opacity in the left lower parahilar region is new mr head w & w/o contrast 11:57 am 1. subarachnoid hemorrhage in the basal cisterns as well as intraventricular hemorrhage in both lateral ventricles with mild-to-moderate communicating hydrocephalus. 2. increased signal within the left side of the pons without slow diffusion, could be secondary to edema from a small brainstem hemorrhage extending into the interpeduncular cistern. 3. ct angiography or mra can help for further assessment of the appearances in the cistern of lamina terminalis and evaluation of vascular structures in the posterior fossa. 4. no enhancing parenchymal lesions are identified. in particular, no enhancing lesion is seen within the medulla. mra brain w/o contrast 3:24 pm there is evidence of vascular flow in both internal carotids, the posterior circulation demonstrates segmental narrowing at the junction of the vertebral and the basilar artery, which may represent vasospasm, however atherosclerotic changes cannot be completely ruled out. both medial cerebral arteries as well as the anterior cerebral arteries are patent. segmental narrowing is identified in the junction of the vertebral arteries, rising the possibility of vasospasm, atherosclerotic changes cannot be completely ruled out. followup is recommended. mr head w/o contrast 3:24 pm small subacute ischemic event is demonstrated in the anterior aspect of the medulla oblongata as described in detail above, which demonstrates hyperintensity signal on the diffusion-weighted sequence and low signal intensity in the corresponding adc map. persistent subarachnoid hemorrhage in the prepontine cistern as well as intraventricular hemorrhage. unchanged microvascular ischemic changes in the subcortical white matter. no other new lesions are identified. conventional cerebral angiogram: mild vasospasm of r m2 and a2 segments. ia verapamil was given. ? mild vasospasm versus chronic stenosis of l vertebral artery. brief hospital course: mr. was admitted to the neurosurgery icu for closer monitoring. his hospital course by problem is as follows: 1) brain stem hemmorhage with associated sah and some vasospasm: he was transfered from an osh after being found to have a brain stem bleed. his anticoagulation was reversed with ffp and his coumadin was stopped. his blood pressure was maintained at a map of < 130 and he was kept normoglyemic and normothermic. he was started on keppra for seizure prophylaxis. he was significantly dysarthric and intermittently quite confused, therefore in order to tolerate an mri he was intubated. these images showed the bleed but no clear structural or vascular lesions. an mra was not obtained at that time. as part of a secondary strok prevention, labs were checked and his a1c was 5.8. his hdl was 31 and his ldl was 98. given that his mechanism was not clearly atherosclerotic, he was only continued on his fenofibrate. after extubation, mr. was severely encephalopathic. neurology was consulted to further evaluate this and felt that it was likely multifactorial, due to his sah, brainstem hemorrhage, sedatives and renal impairment. work-up for the encephalopathy included lft's, ammonia, b12 and tsh as well as ct to r/o hydrocephalus. all of these studies were wnl. sedating medications were avoided and within a few days his mental status had returned to baseline dysarthria and intermittent confusion but generally oriented. the cause of his bleed was still not clear (vascular vs. spontaneous vs. structural). therefore he was sent for mra to look for aneurysm. he was not intubated for this study and did not tolerate more than a few minutes. the only sequence obtained thus was a dwi which showed a question of a small r medullary infarct. therefore, the following day he was given a small dose of haldol and the images were repeated with mra and mri. this study did show the infact. his vessels did not show aneurysm but did show variability in diameter, concerning for possible vasospasm vs. atherosclerotic changes. his prior ct had not shown significant calcium deposits along the vessels, making the findings more concerning for vasospasm. these results were discussed with dr. from neurosurgery in order to decide if there was a need for triple h therapy or calcium channel blocker. dr. did not feel that such intervention was needed. as the possibility of aneurysm had still not been definitively answered, mr. was arranged to have a conventional low dye load angio. he was pre-treated with mucomyst and ivf for nephro-protection. the angio showed a mild degree of vasospasm, but there was also a degree of atherosclerotic stenosis. ia verapamil was given by the interventional neuroradiologist. given the mild degree of vasospasm and a neurologic examination that has largely returned to baseline, there was no need for triple h therapy or nimodipine. coumadin will be held indefinitely given the hemorrhage. 2) medullary infarction: this finding occured later during his hospital course. his exam did not appear to change from the infarct, however subtle findings may not have been appreciated due to the dysarthria and intermittent confusion the patient experience. the mechanism was felt to be vaso-spasm. his blood pressure was allowed to auto-regulate to 140-160s but not higher given the concominant sah. anti-platelet medication was also held until the angio was done. 3) htn: his blood pressure was allowed to autoregulate for 5 days after the infarct was identified with the paramenters above. during his course he remained significantly hypertensive and he was continued on amiodarone. metoprolol was also started at a low dose as acei were avoided given his ckd. 4) afib/flutter: on admission, his anti-coagulation was stopped given his sah. cardiology was consulted for evaluation and manegement of fib/flutter in order to discuss possible ablation. they felt that this was not indicated, and agreed on continuing his amiodarone. his dose was initially 400 mg po tid as he completed his load. he was then tapered to 200 for 14 days starting on . this will be completed on after which he can be started on maintenance dose of 200 qd. cardiology did not feel that he required a tte as he had recently had one at an osh. in regards for long term anti-coagulation, this issue will be addressed at his follow-up appointments with both neurology and cardiology. 5) uti: during his period of encephalopathy, a ua was checked to evaluate for possible infectious causes of confusion. the ua was postive and he was started on a 10 day course of cipro as he has a sulfa allergy. his cultures grew enterococcus which was cipro sensitive. his 10 day course will be completed on . 6) renal insufficency: his baseline creatinine is about 1.2. during his course, the cr started to rise with a concominenet rise in bun. his tube feed free wated was titrated up, however this did not result in improved renal function, therefore he was given ivf which brought the creatinin down. because of his ckd, an ct angio was never performed. as described above, he was pre-treated for nepho-protection prior to his angiogram. bun/cr were re-checked prior to discharge and should be trended at rehab to insure the pt does not develop contrast induced nephropathy. 4) dysphagia: mr. had developed dysphagia on a prior admission due to epiglotitis and required to 8) anemia of chronic disease. medications on admission: 1. fenofibrate micronized 145 mg qpm 2. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 3. nortriptyline 25 mg capsule sig: two (2) capsule po hs 4. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid 5. warfarin 1 mg tablet sig: three tablet po daily at 4 pm. 6. lisinopril 5 mg tablet sig: two (2) tablet po daily (daily). 7. amiodarone 200 mg tablet sig: two (2) tablet po tid (3 times a day): take amioderone 400mg tid x 7 days, then decrease to 200mg x 14 days, then decrease 200 mg daily. 8. bisacodyl 10 mg suppository hs (at bedtime) as needed. 9. enoxaparin 80 mg/0.8 ml syringe sig: one (1) subcutaneous (2 times a day): discontinue once therapeutic on coumadin with goal inr . discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed. 2. fenofibrate micronized 145 mg tablet sig: one (1) tablet po q pm (). 3. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 4. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed. 5. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day) for 7 days. 6. famotidine 20 mg tablet sig: one (1) tablet po bid (2 times a day). 7. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po hs (at bedtime) as needed. 8. lisinopril 5 mg tablet sig: one (1) tablet po once a day. 9. metoprolol tartrate 25 mg tablet sig: 0.5 tablet po bid (2 times a day). 10. amiodarone 200 mg tablet sig: one (1) tablet po once a day: start in seven days once amiodarone dosing is complete. 11. ciprofloxacin 500 mg tablet sig: one (1) tablet po q12h (every 12 hours) for 4 days: for uti. 12. nystatin 100,000 unit/ml suspension sig: five (5) ml po qid (4 times a day) as needed. discharge disposition: extended care facility: discharge diagnosis: 1) brain stem hemmorhage with associated sah and some vasospasm 2) medullary infarction 3) htn 4) dysphagia 5) uti 6) renal insufficency 7) afib/flutter 8) anemia of chronic disease discharge condition: stable dysarthria, waxing mental status with global disorientation, sundowns at night, no focal motor deficits. discharge instructions: 1. please take all medications as prescribed 2. please call your doctor or come to the closest ed if you develop new symptoms followup instructions: 1) please follow-up with dr. , md phone: on 3:00 ***you are scheduled for a ct scan ( to this appointment. it is scheduled for 2pm. please arrive no later than 1:45pm. do not eat for after 11am (npo for 3 hours before you ct scan). 2) please follow-up with dr. , md phone: on 1:15 md procedure: arteriography of cerebral arteries arteriography of cerebral arteries diagnoses: anemia in chronic kidney disease pure hypercholesterolemia urinary tract infection, site not specified chronic airway obstruction, not elsewhere classified atrial fibrillation subarachnoid hemorrhage atrial flutter intracerebral hemorrhage pulmonary collapse encephalopathy, unspecified communicating hydrocephalus occlusion and stenosis of carotid artery with cerebral infarction hemiplegia, unspecified, affecting nondominant side dysphagia, unspecified 

Answer: The patient is high likely exposed to