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: no known allergies / adverse drug reactions attending: chief complaint: mental status changes major surgical or invasive procedure: : right craniotomy and evacuation of subdural hematoma history of present illness: this is an 88 year old man with dementia who fell approximately 8 days prior to presentation in while visiting his daughter. was trying to use the bathroom and hit his head, started to experience some confusion and gait instability, was taken to the hospital where a ct was negative, but was found to have a uti and was admitted. on his second hospital day he fell out of bed, but it is unclear weather imaging was obtained. he returned to his facility, but was having considerable difficulty ambulating. he presents after a head ct at revealed an acute on subacute subdural hematoma. at baseline, the patient ambulates with a walker and is able to feed himself, but needs assistance with all other adls. past medical history: dementia, htn, pacer, esophageal strictures s/p release c/b gi bleed, right ca tract, prostate ca s/p radiation, renal adenocarcinoma s/p l nephrectomy. social history: lives at the arbors in the dementia unit, frequently goes to to stay with daughter. family history: nc physical exam: on admission: t:98.3 bp: 129/87 hr:70 r o2sats 95 4l gen: wd/wn heent: ncnt neck: supple. lungs: cta bilaterally. cardiac: rrr. paced abd: soft, nt, extrem: warm and well-perfused. neuro: mental status: lethargic but arousable. orientation: self, three daughters (number no), knows security number at baseline,but not at this time. language: some slurring cranial nerves: i: not tested ii: pupils right surgical, left 1 to .5mm iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation intact and symmetric. viii: hard of hearing ix, x: palatal elevation symmetrical. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. motor: antigravity with all four extremities, difficult to asses drift and isolated muscle groups. physical exam upon discharge: eo spontaneous,non-verbal, right pupil surgical, left pupil brisk; purposeful left ue, right ue and bilat le withdraws antigravity pertinent results: ct head- impression: unchanged subacute right subdural and left parafalcine hematomas, with moderate mass effect on the right lateral ventricle and minimal leftward midline shift. no new hemorrhage or acute large vascular territorial infarction is detected. the examination is little changed since . ct head-postop status post evacuation of subdural hematoma with slight decrease in mass effect. no new hemorrhage seen. unchanged appearance of the falx subdural hematoma. cxr nasogastric tube ends in the upper stomach. transvenous right atrial and right ventricular pacer leads are unchanged in standard placements respectively. heart is top normal size, though increased compared to and there is also greater pulmonary vascular engorgement, so i see no edema or definite pleural effusion. cxr nasogastric tube and dual lead pacemaker are unchanged in appearance. the lungs appear well aerated. the heart is normal in size with normal cardiomediastinal silhouette. no effusion or pneumothorax is seen. lens there is normal compressibility, flow and augmentation of bilateral common femoral, superficial femoral, popliteal and calf veins. impression: no dvt. ct head slight decrease in pneumocephalus and sdh overlying the right cerebral hemisphere. decreased sdh in the left parafalcine region. unchanged minimal hemorrhage overlying both leaflets of the tentorium cerebelli. no change in minimal leftward midline shift. no new hemorrhage or acute large vascular territorial infarction cxr an ng tube is present, tip overlying fundus. a left-sided dual-lead pacemaker is present, with lead tips over right atrium and right ventricle. a patchy opacity at the right base seen on a film from at 8:19 a.m. is considerably improved; minimal residual opacity is present. this suggests resolving atelectasis. a focal pneumonic infiltrate or area of aspiration is considered much less likely. heart size is at the upper limits of normal or slightly enlarged, with left ventricular configuration and the aorta is unfolded. there is borderline upper zone redistribution, but no overt chf. there is minimal atelectasis at the left lung base. no gross effusion. : cxr: as compared to the previous radiograph, there is no relevant change. unchanged appearance of the lung parenchyma. no evidence of pneumonia. : lower extremity doppler ultrasound: negative for dvt ** bedside swallow evaluation:** history returned again today to reassess this 88 y/o man admitted to on after multiple week hx including fall in fl, confusion, gait instability, uti, fall out of bed at osh, difficulty ambulating at , etc. head cts revealed acute on subacute sdh and pt was txferred to for urgent r craniotomy and drain placement on . we have been following the pt during this admission, however pt consistently too lethargic to participate and with excess secretions making po intake unsafe. he's had ngt placement throughout this admission for nutrition, hydration, and medications. per chart and discussion with neurosurg, family is considering peg but is undecided. geriatrics is involved and per notes are concerned regarding prognosis given his pmh including moderate alzheimer's. pmhx: dementia, htn, pacer, esophageal strictures s/p release c/b gi bleed, right ca tract, prostate ca s/p radiation, renal adenocarcinoma s/p l nephrectomy. evaluation: the examination was performed while the patient was seated upright in the bed on 11. cognition, language, speech, voice: eyes open on arrival to room. once interacted with, begins moaning but no eye contact. response to questions. does withdraw to pain/discomfort with repositioning and placement of o2 monitor. once, mid-evaluation, pt turns head toward me, makes direct eye contact, and . only vocalizations heard are ah, humming, and moaning. teeth: intact in fair to good condition from what i can see secretions: congested cough intermittently at baseline. deep yankauer suctioning prior to pos (-) for return. dry/cracked tongue, but otherwise evidence of good oral care. oral motor exam: face grossly symmetrical. does not follow commands for eval. good jaw strength, as clamps down against spoon intermittently. gag present on deep suctioning. swallowing assessment: pt was offered ice chips (x2), thin liquid (tspn x3), nectar thick liquids (tspn x8-12), pureed solids (tspn x4-6). despite wakefulness and intermittent attentiveness, pt with limited interaction with pos. he often closes mouth against spoon, requires 10-30 seconds of encouragement before opening mouth. mouth opening is limited. oral phase appeared delayed/prolonged without overt oral cavity residue. laryngeal elevation delayed and reduced to palpation. pt had overt cough/sputter after tspns of thin liquid which was not observed with other consistencies, however intermittent congested cough increased during eval, concerning for intermittent aspiration of other consistencies. at end of eval, pt deep oropharyngeal suctioned via yankauer, (+) for return of moderate amounts of puree from posterior oropharynx. o2 sats stable at 94-97% throughout except when coughing on thin, at which time they dipped to 91% briefly and then returned. summary / impression: presents today with overt s/sx of aspiration of thin liquids and concern for intermittent (possibly silent) aspiration of nectar thick liquids and purees. pt also with documented upper airway congestion concerning for aspiration of oral secretions. safest recommendation based on today's evaluation remains npo with alternative means of nutrition, hydration, and medication. videoswallow study could provide more detailed/objective data, though due to pt's current mental status, not likely to participate and is, as such, not recommended currently. given pt's premorbid functioning and poor progress in the last week and a half since his neurosurgical intervention, would agree with md teams that further discussion of goals of care is warranted prior to pursuing peg placement. we are happy to participate in family meeting when one is scheduled. this swallowing pattern correlates to a functional oral intake scale (fois) rating of 1 out of 7. recommendations: 1. continue npo 2. continue q4 oral care 3. continue short term nutrition, hydration, and medication 4. family meeting encouraged regarding overall prognosis and goals of care as well as specifics of nutritional maintenance. 5. we will f/u. these recommendations were shared with the patient, nurse and medical team. ____________________________________ , m.s., ccc-slp pager # face time: 10:10-10:30 total time: 60 minutes addendum by , ms slp on at 1:44 pm: family meeting has been scheduled for this evening at 5:30pm, a time at which our department is unfortunately unavailable. today's results, as outlined above, have been discussed by phone with neurosurg pa and fellow. agree with fellow that further improvements in swallow function are likely to be seen on a period of weeks rather than days. d/c to ltach or other setting that can manage ngt while awaiting further recovery seems ideal if possible and if within family's/pt's goals of care. in the interim, pt can be receiving pt, cognitive-linguistic therapy, and swallow therapy to maximize recovery. to manage secretions optimally, would encourage continued q4 oral care with consideration of antibacterial such as chlorhexadine, as is available in the sage qcare kits here at . if the family has further specific questions regarding swallow function after the meeting this evening, please page and we'll be happy to speak with them tomorrow in person or by phone. updated recommendations 1. npo including no ice, no oral meds 2. continue q4 oral care with sage qcare kits, consider addition of chlorhexadine 3. continue short term nutrition, hydration, and medication via ngt pending further improvements in overall medical/neurological status. 4. continued pt, cognitive-linguistic tx, and swallow tx here as able and in rehab/ltach setting after d/c to maximize functioning. , ms, ccc-slp pager # brief hospital course: on the patient was admitted to the neurosurgery service. he was given one unit of platelets for his daily asa use. on he was taken to the or and underwent a craniotomy and evacuation of the sdh. this was without complication. he was extubated and transferred to the sicu. post op head ct revealed good evacuation. on he was lethargic but eo to voice and he moved all extremities. he was cleared for transfer to the stepdown unit. he remained stable overnight in the step down unit into . on his exam remained stable and he worked with pt/ot as well. his dressing was removed and his incision was clean dry and inntact with dissolvable sutures. he was started on tube feeds via ngt per nutritions recommendations. in the evening his incision was noted to be swollen,warm and red but he remained afebrile and there was no drainage, therefore it was recommended to apply ice packs and continue to monitor. a foley was replaced for urinary retention. on he was cleared for transfer to the floor. on he was febrile and a work up was initiated. chest x-ray showed small patchy left opacity. he was seen by nutrition and tf were djusted. his multi vitamin was stpopped when goal was reached per the nutrition team. he was again febrile on , ua was positive and cipro was started. lenis ruled out dvt. ct head was done for lethergy and this showed slight improvement in sdh. on , repeat cxr showed that the patchy opacity at the right base improved. his rr was 28, so chest pt/albuterol/atrovent were ordered prn. ivf were increased to 50cc/hr for hypernatremia and rf changes. on : tmax 100.8 ax. ivf to nss. on the overnight of into the patient was febrile to 101.5 axillary and a full fever workup was initiated. lower extremity doppler ultrasound was negative for dvt. cxr negative for clear pneumonia. blood and urine cultures were negative. his mental status began to improve and on and he was following simple commands. speech and swallow evaluation was performed however he was unable to consistently follow commands. the therapist noted delayed or prolonged oral phase and delayed laryngeal elevation. strict npo still recommended at this time. on the evening of a family meeting was held with neurosurgery, geriatrics and the hcp. it was decided at this time that it would be best to transfer the patient to rehab with an ngtube for an additional week or so. at that time the decision as to whether to place a peg tube or not could be re-visited. on he remained stable and afebrile. he was cleared for discharge to rehab facility pending bed availability. he was offered a bed at rehab and discharged to there on the afternoon of . medications on admission: namenda 10mg , allopurinol 100mg qd, citalopram 30mg qd, metoprolol tartrate 25mg qd, foltx 2.5/25/2 1 tab daily, asa 81mg qd, mvi, augmentin 500 for uti discharge medications: 1. docusate sodium 50 mg/5 ml liquid : one (1) po bid (2 times a day). 2. allopurinol 100 mg tablet : one (1) tablet po daily (daily). 3. citalopram 20 mg tablet : 1.5 tablets po daily (daily). 4. metoprolol tartrate 25 mg tablet : one (1) tablet po daily (daily). 5. folic acid 1 mg tablet : one (1) tablet po daily (daily). 6. pyridoxine 50 mg tablet : one (1) tablet po daily (daily). 7. cyanocobalamin (vitamin b-12) 100 mcg tablet : 0.5 tablet po daily (daily). 8. acetaminophen 650 mg/20.3 ml solution : po q6h (every 6 hours) as needed for fever or pain. 9. bisacodyl 5 mg tablet, delayed release (e.c.) : two (2) tablet, delayed release (e.c.) po daily (daily). 10. senna 8.8 mg/5 ml syrup : one (1) tablet po bid (2 times a day). 11. oxycodone 5 mg tablet : one (1) tablet po q4h (every 4 hours) as needed for pain. 12. heparin (porcine) 5,000 unit/ml solution : 5000 (5000) units injection tid (3 times a day). 13. hydralazine 25 mg tablet : one (1) tablet po q6h (every 6 hours) as needed for sbp>160. 14. ciprofloxacin 250 mg tablet : one (1) tablet po q12h (every 12 hours) for 4 days: discontinue following final dose on . 15. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization : one (1) neb inhalation q4h (every 4 hours) as needed for wheeze/sob. 16. ipratropium bromide 0.02 % solution : one (1) neb inhalation q4h (every 4 hours) as needed for wheeze/sob. 17. nystatin 100,000 unit/ml suspension : five (5) ml po qid (4 times a day) for 5 days: d/c followign final dose on . 18. lansoprazole 30 mg tablet,rapid dissolve, dr : one (1) tablet,rapid dissolve, dr daily (daily). 19. sodium chloride 0.9% flush 3 ml iv q8h:prn line flush peripheral line: flush with 3 ml normal saline every 8 hours and prn. discharge disposition: extended care facility: for the aged - macu discharge diagnosis: subdural hematoma pleural effusion dysphagia uti hypernatremia discharge condition: mental status: confused - always. activity status: bedbound. level of consciousness: lethargic but arousable. discharge instructions: general instructions ?????? have a friend/family member check your incision daily for signs of infection. ?????? take your pain medicine as prescribed. ?????? exercise should be limited to walking; no lifting, straining, or excessive bending. ?????? you have dissolvable sutures you may wash your hair and get your incision wet. ?????? increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. we generally recommend taking an over the counter stool softener, such as docusate (colace) while taking narcotic pain medication. ?????? unless directed by your doctor, do not take any anti-inflammatory medicines such as motrin, aspirin, advil, and ibuprofen etc. ?????? clearance to drive and return to work will be addressed at your post-operative office visit. ?????? make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. followup instructions: follow-up appointment instructions ????????????please call ( to schedule an appointment with dr. , to be seen in 6 weeks. ??????you will need a ct scan of the brain without contrast. procedure: incision of cerebral meninges enteral infusion of concentrated nutritional substances replacement of indwelling urinary catheter diagnoses: unspecified pleural effusion urinary tract infection, site not specified hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage i through stage iv, or unspecified personal history of malignant neoplasm of prostate chronic kidney disease, unspecified cardiac pacemaker in situ hyperosmolality and/or hypernatremia personal history of malignant neoplasm of kidney subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness fall from other slipping, tripping, or stumbling unspecified deficiency anemia other specified retention of urine history of fall other dysphagia dementia, unspecified, without behavioral disturbance 

Answer: The patient is high likely exposed to