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: "confusion", transferred from osh with a diagnosis of intracranial hemorrhage major surgical or invasive procedure: picc line placement peg tube palcement history of present illness: this is a rh 84 year old woman with a past medical history significant for hypertension who presents with "confusion" and was found to have left occipital hemorrhage with intraventricular extension at hospital, placed on nitro drip and transferred to for further managment. apparently she had c/o headache x 2-3 days prior to presentation per nephew. she was at home today and elder care services came as scheduled and found her confused and house in shambles. she was sent to osh ed where ct scan showed bleed. patient cannot recall or tell none of the event - she is awake/alert however and answering questions. she can follow simple commands if given slowly - but easily distracted, somewhat inattentive and perseverative. uti found at osh as well; given 400mg of ciprofloxacin. says she feels there is nothing wrong with her, though if specifically pressed on it, she admits she is "not seeing well" - though cannot describe why. past medical history: htn left knee replacement social history: lives alone, has elder care services, never married, no kids. has an elderly sister, , and nephew, . family history: cad, dm, htn in multiple family members. sister alive and in her 90's. physical exam: physical exam: afebrile; bp 208/107; hr 60s; rr 18; o2 sat 100% o2 nc gen - no acute distress. appears comfortable. heent - mmm. o/p clear. no scleral icterus or injection. neck - supple. no lad or carotid bruits appreciated. lungs - cta bilaterally heart - rrr, nl s1/s2 abd - soft, nt/nd, nabs ext - warm, 2+ peripheral pulses throughout. no edema. neurologic: ms: alert and oriented x1 - knows she is in the hospital, but does not know which one. cannot tell me the date. cannot tell me anything of what happened today or yesterday. knows her age and birthdate. believes she is in hospital for "stroke" - but does not think she is having any current problems. refuses to attempt attention/memory testing. repitition intact. naming intact to high frequency objects. speech fluent with normal content and prosody, and without paraphasic errors or hesitancy. follows simple axial and appendicular commands - though is somewhat perseverative, difficult to change topics, and inattentive. cn: perrl. eoms intact without nystagmus. visual fields - right homonymous hemianopsia. facial sensation and movement intact bilaterally. tongue protrudes midline without fasiculations. sternocleidomastoids intact bilaterally. shoulder shrug intact bilaterally. motor: moves all extremities spontaneously and symmetrically. seems to be full strength in ues, but not attentive enough to follow formal strength commands in les - though is moving against gravity and some resistance bilaterally (at least ). reflexes: symmetric throughout. toes appear upgoing bilaterally. sensation: intact throughout to light touch, pinprick and cold. no extinction to dss. coordination: ftn intact bilaterally, does not follow instructions to perform tasks of ffm and gait: deferred pertinent results: admission labs: 05:48pm blood wbc-13.3* rbc-4.24 hgb-12.6 hct-35.3* mcv-83 mch-29.7 mchc-35.8* rdw-13.4 plt ct-333 05:48pm blood neuts-77.9* lymphs-16.8* monos-3.9 eos-1.1 baso-0.4 05:48pm blood pt-12.6 ptt-24.3 inr(pt)-1.0 05:48pm blood glucose-108* urean-20 creat-1.0 na-130* k-3.0* cl-94* hco3-27 angap-12 05:48pm blood alt-10 ast-18 ld(ldh)-213 alkphos-65 totbili-0.5 03:35pm blood lipase-27 05:48pm blood ctropnt-0.01 05:48pm blood calcium-8.5 phos-2.4* mg-1.5* 11:47pm blood phenyto-12.6 other labs: 03:35pm blood albumin-3.0* 03:35pm blood iron-183* caltibc-202* ferritn-124 trf-155* 03:53am blood vitb12-296 folate->20.0 03:35pm blood cholest-160 triglyc-78 hdl-37 chol/hd-4.3 ldlcalc-107 03:53am blood tsh-1.5 rpr -non-reactive microbiology: blood cultures pending urine culture no growth urine culture lactobacillus irome ci;tire pending nc head ct : area of intraparenchymal hemorrhage in the left occipital lobe, with likely extension into the left occipital , with some associated surrounding edema. as no prior studies are provided for comparison, determination of progression of this abnormality cannot be made. brain mri/mra : limited mri and mra of the brain due to motion. left occipital hemorrhage and right occipital and right cerebellar infarction. nc head ct : 1. new hypodensity within the right occipital lobe, which has progressed compared to the prior study of , likely representing evolving infarction in the territory of the right pca. 2. stable appearance of intraparenchymal hemorrhage within the left occipital lobe, extending into the occipital of the lateral ventricle. no interval increase in edema or mass effect, and no new areas of hemorrhage identified. cxr: there has been interval placement of a right picc line, with the tip overlying the distal svc. a nasogastric tube is seen within the esophagus, with the distal tube oriented cephalad above the left hemidiaphragm, apparently within a hiatal hernia. the heart and mediastinum are unchanged. once again, there is diffuse increased opacity of the right hemithorax, related to a layering right effusion. while the interstitial markings are prominent, there is no overt failure. echocardiogram : 1. the left atrium is moderately dilated. 2. the left ventricular cavity size is normal. regional left ventricular wall motion is normal. left ventricular systolic function is hyperdynamic (ef>75%). 3. the aortic valve leaflets are moderately thickened. there is mild aortic valve stenosis. trace aortic regurgitation is seen. 4. the mitral valve leaflets are mildly thickened. mild (1+) mitral regurgitation is seen. 5. there is mild pulmonary artery systolic hypertension. ct chest : 1) moderate-sized bilateral pleural effusion, associated with atelectasis. 2) no mass in the right upper lobe. 3) two noncalcified pulmonary nodules measuring 3 mm in diameter in the right upper lobe. please follow in one year if this patient has no history of malignancy, and please follow in three months if this patient has history of malignancy. 4) large hiatal hernia associated with 2-cm paraesophageal lymph node. 5) marked degenerative changes with compression fracture of the thoracic spine. brief hospital course: 1. left occipital bleed with intraventricular extension and right occipital infarction. 84 yo woman with history of hypertension who was transferred from the osh with left occipital bleed. she had right hemianopsia on initial exam and was also confused but followed simple commands. head ct day after admission showed a roughly 20cc bleed in the left occipital lobe, cortical, round appearing, with some interventricular extension, no hydrocephalus. the patient was loaded with dilantin in the ed. she was initially admitted to the intensive care unit. the patient was very hypertensive on admission. her bp was initially controlled in the icu with nipride, then switched to nicardipine. she was in the icu for several days as her blood pressure was difficult to control. eventually she was transitioned to po hctz, , labetalol and hydralazine. hctz was later stopped because of hyponatremia. glycemic control was maintained with riss. she was transferred out of the icu to neurology service on . the patient had been intermittently very agitated and aggressive which delayed mri/mra planned for work up of her occipital bleed. on she developed mental status changes, became more somnolent, lethargic. non-contrast head ct was obtained which now showed new infarction in the right occipital lobe. mri/mra were done and were unrevealing for potential cause of the patient's bilateral occipital events. the etiology of her bleed felt most likely to be a hemorrhagic transformation of an occipital infarct, although extension of hemorrhage into the ventricle is difficult to explain in this setting. other possibilities for occipital hemorrhage in this patient are amyloid angiopathy and less likely htn. mri/mra were negative for mass or aneurysm. the patient has atrial fibrillation (was not on anticoagulation) which is a potential source of thromboembolism to the brain. transthoracic echo was also checked and did not show thrombi or vegetations. at the time of discharge the patient could see some movements and larger objects. she was oriented to self and place. she followed simple commands but her mental status was not improved enough for safe self feeding. she had g-j tube placed on by interventional radiology. prior to discharge, she was tolerating tube feeds without difficulty. she will need to have her gastric tube changed in 3 months. 2. confusion, likely secondary to the occipital lobe bleed vs. uti. the patient was given a banana bag on admission. tsh was checked and was normal. rpr was non-reactive. folate >20. b12 was borderline low, and the patient was started on supplements. lfts were normal. 3. seizure-like activity. on evening of admission (), the patient had seizure like activity with tonic arm posturing and eye gaze. dilantin level was checked and was therapeutic. seizure activity may have been due to the cortical bleed, or may have been secondary to hypokalemia (k 2.9). dilantin was continued and ms. required reloading to keep dilantin level closer to therapeutic range. she was continued on dilantin until peg tube placement. dilantin was stopped prior to discharge. 4. leukocytosis. the patient's wbc peaked at 20k on . she remained afebrile throughout her hospitalization. she was started on levaquin on for uti diagnosed at the outside hospital. chest x-ray on showed new retrocardiac opacity suggestive of atelectasis or new infiltrate or effusion. flagyl was added on given rising wbc to cover for possible aspiration pneumonia. the patient was maintained on aspiration precautions. the patient did not have sputum to send for culture. bilateral effusions were noted on cxr and chest ct. the patient had no diarrhea and her abdominal exam was benign. c. diff toxin was negative. the patient's wbc started to trend down on . the patient completed a course of levaquin and flagyl. crp and esr were checked because of concern for persistent leukocytosis and came back at 110 and 18.7, respectively. however, given recent cerebral infarct, hemorrhage, g/j tube placement and recent infection. breast exam was done and was negative. she had no lad. leukocytosis was attributed to recent infection. the patient will need outpatient follow up to ensure that she is up to date on all age appropriate cancer screening. the patient or family did not know the contact information or spelling of the pcp's last name ? dr. . 5. anemia, normocytic. hct dropped from 35 to 29, but remained stable at around 30. then it dropped again from 29 to 25 and the patient was transfused one unit of prbcs. there was no localizing source of bleeding and decrease in hct was attributed to dilutional effect. hemolysis labs were negative. reticulocyte count 2.4%. iron studies (pre-transfusion) were checked and reveled low normal serum iron, elevated ferritin and slightly low tibc. the above picture is most c/w anemia of chronic disease but would recommend rechecking when the patient is over acute illness. the patient needs to have complete work up for amenia as an outpatient. serum and urine protein electrophoresis was sent and the results were still pending at the time of discharge. b12 level was borderline low thus the patient was given b12 in the hospital. 6. hypertension. patient's blood pressure was difficult to control. her medications were adjusted. on the patient had a hypertensive episode with sbp in 250's while she was in interventional radiology for peg tube placement due to missed doses of po meds. her mental exam after this episode was unchanged. stat head ct was obtained and showed on changes. ekg was also unchanged. her systolic blood pressures have been in 130's on the day of discharge on irbesartan, labetalol, and hydralazine. 7. renal insufficiency. baseline cr is unknown. fe na calculated to be 0.1% which is consistent with prerenal failure. she was rehydrated gently with ns at 80cc/hr. her cr stayed between 0.9 and 1.5. 8. atrial fibrillation. original ekg showed afib. the patient was monitored on telemetry and would go in/out of afib. she was not anticoagulated initially given acute intracranial hemorrhage. she was rate controlled on labetalol with hr in 60's. head ct on showed no new hemorrhage or progression of existing hemorrhage. the patient was started on coumadin on . goal inr . her coumadin level needs to be monitored and coumadin dose adjusted. 9. hyponatremia. the patient's na went down to 128. this felt to be likely secondary to hctz as work up was c/w renal wasting. hctz was stopped. serum osm 285. urine osm 485. urine na (on hctz) was 47. fena 1%. the patient was started on standing lasix prior to discharge and her electrolytes need to be carefully monitored. 10. urethral nodule. this was noted by nursing staff during foley catheter change. the 1 cm smooth pink/purple pedunculated nodule inside urethra did not appear infected but was tender. urology were consulted for management recommendations. they did not feel that immediate intervention was necessary and recommended outpatient follow up which was arranged. 11. pulmonary nodules. chest ct was done for evaluation of the nodule that was seen on chest x-ray. this was not confirmed on chest ct and felt to be an artery or artifact. final chest ct results showed two 3 mm rul nodules, paraesophageal lymph node, pulmonary effusions, and vertebral compression fracture. pulmonary nodules seen on chest ct will need to be followed up with repeat chest ct to evaluate for interval changes. 12. volume overload. the patient developed anasarca and total body volume overload likely secondary to retention due to poor nutritional status, diastolic dysfunction, and possible as an adverse reaction to medications causing water retention. she was started on lasix prior to discharge with the goal of negative 1 liter volume balance a day. she will need daily weights and frequent reassessment of her volume status. 13. fen: the swallowing evaluation was attempted, however, the patient was confused and not cooperative. ngt was placed and tf started. peg tube was placed on for nutrition because the patient's mental status and cooperation remained poor to allow for independent feeding. she was tolerating tube feedings well. 14. prophylaxis: ppi, pneumoboots, sc heparin, bowel regimen. 15. full code medications on admission: 1. hctz/lisinopril 20/25 2. hctz/irbesartan 12.5/300 3. doxepin 50mg daily 4. paxil 20 mg daily discharge disposition: extended care facility: rehab discharge diagnosis: 1. left occipital hemorrhage 2. right occipital infarction 3. cortical blindness 4. anemia 5. atrial fibrillation 6. renal insufficiency 7. hypertension 8. urinary tract infection 9. bilateral pleural effusions 10.urethral nodule discharge condition: patient is cortically blind. she is able to see movements and some larger objects. she follows simple commands, oriented to self and place. she did not pass swallowing evaluation dut to poor cooperation/mental status. discharge instructions: take all medicines as prescribed. keep all follow-up appointments. call your doctor or return to the ed if you develop sudden weakness of an arm or leg, difficulty speaking or understanding, slurring of your speech or difficulty swallowing. followup instructions: please call to schedule a follow up appointment with the primary care physician, . (?spelling, unable to obtain contact information for the primary care provider from the patient or family). the patient will need a follow up appointment in weeks after discharge from a nursing facility. the patient will need to follow up regarding lab results that were still pending at the time of discharge. please follow up with , md, phd. where: neurology phone: date/time: 1:30 please follow up with dr. in urology for urethral nodule. appointment schedules for at 2 pm. office located at on the 6 th floor. phone (. please call to schedule a g/j tube change in 3 months (due ). md, procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrojejunostomy transfusion of packed cells diagnoses: anemia, unspecified unspecified pleural effusion urinary tract infection, site not specified unspecified essential hypertension atrial fibrillation other convulsions pneumonitis due to inhalation of food or vomitus cerebral artery occlusion, unspecified with cerebral infarction unspecified intracranial hemorrhage 

Answer: The patient is high likely exposed to