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: penicillins / codeine attending: chief complaint: aphasic major surgical or invasive procedure: tpa (osh) history of present illness: the pt is a 60 year-old r-handed female with a pmh of ibs, asthma, fibromyalgia, and anxiety who presents with right sided weakness and a transfer from hospital. patient was last seen normal at 7 pm by her family. she reportedly fell at somepoint around 9 pm ems was called an her fingerstick was 99. she was taken to hospital where neurocall was paged at 10:28 pm. a dr. was contact at 11:00 pm. a nchct was reportedly normal. tpa (54 mg) was then given (23:10) over 1 hour and patient was transferred to for further management. (meds and pmh not confirmed as patient is aphasic son does not know what her meds / med history that well). much of this background is taken from osh records. ros: could not be performed as patient is aphasic. she recently sprained her right ankle past medical history: -anxiety -lyme disease -ibs -asthma -fibromyalgia -cholecystectomy social history: drinks liquor daily - equivalent of about 5 shots (in mixed drinks) per day. hx of seiure/dts when tried to quit in the . family history: nc physical exam: vitals: t: 97.1 p:75-87 r: 14-26 bp:119-135/52-72 sao2:95%-98% on ra general: awake, lying in bed heent: nc/at, no scleral icterus noted, mmm, no lesions noted in oropharynx neck: supple, no carotid bruits appreciated, large hematoma on right neck appears to be resolving pulmonary: lungs cta bilaterally without r/r/w cardiac: rrr, nl. s1s2, no m/r/g noted abdomen: soft, nt/nd, no masses or organomegaly noted. extremities:warm and well perfused skin: no rashes or lesions noted. neurologic: -mental status: alert, comprehension to simple commmands intact. verbal production is limited to one-two words with hesistancy and much difficulty, appropriate. able to sing verse of "happy birthday" -cranial nerves: i: olfaction not tested. ii: perrla, reacts to threat bilateraly. iii, iv, vi: left gaze preference. able to cross midline. vii: right facial droop with flattening ix, x: palate elevates symmetrically. : 5/5 strength in trapezii and scm bilaterally. xii: tongue midline -motor: lue: full movement lle: full movement rue: flacid, subtle lateral movement of fingers, thumb, and wrist rle: antigravity with increased effort -sensory: grimaced to noxious in all 4 extremities. no withdrawl on right. -dtrs: tri pat ach l 2 2 2 2 1 r 3 3 3 3 2 plantar response was flexor on left and extensor on right . -coordination: not formally tested, however no obvious ataxic movements -gait: not tested pertinent results: 02:16am blood wbc-9.0 rbc-3.53* hgb-11.8* hct-34.7* mcv-99* mch-33.5* mchc-34.0 rdw-14.7 plt ct-282 08:35am blood pt-11.9 ptt-22.1 inr(pt)-1.0 02:16am blood glucose-112* urean-4* creat-0.5 na-137 k-3.1* cl-109* hco3-21* angap-10 02:16am blood calcium-7.6* phos-1.7* mg-2.1 08:35am blood %hba1c-5.4 eag-108 08:35am blood triglyc-81 hdl-77 chol/hd-2.1 ldlcalc-66 02:16am blood tsh-1.6 06:00am blood factor v leiden-pnd 06:00am blood prothrombin mutation analysis-pnd 06:00am blood fibrino-614* day of discharge: 06:00am blood pt-17.3* ptt-75.5* inr(pt)-1.5* brief hospital course: # stroke: the patient was admitted to the neuro icu for observation after tpa at osh. the patient has remained hemodynamically stable throughout her stay and her neurological exam continues to improve. re-imaging at 24 hours post-tpa demonstrated no sign of bleed. the cause of the patient's stroke was unclear. there was suspected clot in the left ica, however dissection could not be ruled out. mra with t1 fat suppression was not suggestive of disection and it was felt that the occulsion of the left ica was a clot only. tte was limited but tee did not identify any intracardic source of emboli. thus a hypercoaguability work up was initiated. factor v leiden and prothrombin gene mutation studies were sent but were pending at the time of discharge. ct torso was without evidence of malignancy. of note, the patient was on estrogen/progesterone replacement therapy and this may have been a cause of hypercoagubility. this has been discontinued. the patient was started on a heparin gtt and transistioned to coumadin. she should remain on coumadin for at least 3 months until the clot in her carotid artery has organized with the vessel wall and to prevent any stump emboli. in addition, coumadin might be indicated even beyond that period, since she she has an embolic appearing stroke, but the source for her embolism is unknown at this time. because her inr was only 1.5 at the time of discharge, she should be continued on lovenox until therapeutic inr is obtained. on arrival, the patient was initially unable to speak, follow commands and had a dense right hemiparesis. over the course of her hospitalization, this improved significantly and she developed much better strength on her left side. though she remains non-fluent, the patient's comprehension has improved and she can follow simple commands. she is able to state her name. her is better than her directed speech and spontaneous speech is at times very clear and up to 6 words. speech/swallow eval the day of discharge showed continued aspiration with thin liquids, also noted with impaired mastication due to limited dentition. she should remain on current diet of nectar-thick liquids and pureed solids. she will will benefit from intensive speech, language, and swallowing services at rehab facility to address dysphagia and aphasia. she will continue to need agressive pt/ot as well. # etoh abuse: the patient's family reported a history of alcohol use of up to 5 brandys per night. she was maintained on a ciwa alcohol assessment scale with no signs of withdrawal through her hospitalization. # falls: the patient fell out of her bed twice in the initial days out of the icu. the patient appeared to have difficulty understanding the requirements for staying in bed. repeat ct scans after these falls did not demonstrate any signs of hemorrhage. # cardiovascular: the patient was kept on telemetry and did not have any evidence of arrhythmia. cardiac ischemia was ruled out by cardiac enzymes x 3. tee was normal as above. # endo: fasting lipid panel was notable fro ldl 66. a1c was 5.4. # pulmonary: the patient has a history of asthma, and was kept on albuterol prn. # code: full contact: mother: sons: : medications on admission: -albuterol / atrovent -prozac 40 mg po daily -nortriptyline 30 mg -librium 10 mg po prn -esradiol 1 mg po qhs -medroxypr 2.5 mg po qhs -fiorcet prn discharge medications: 1. fluoxetine 20 mg capsule sig: two (2) capsule po daily (daily). 2. nortriptyline 10 mg capsule sig: three (3) capsule po hs (at bedtime). 3. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. 4. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing. 5. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 6. thiamine hcl 100 mg tablet sig: one (1) tablet po daily (daily). 7. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 8. enoxaparin 80 mg/0.8 ml syringe sig: one (1) subcutaneous every twelve (12) hours. discharge disposition: extended care facility: hospital discharge diagnosis: primary: left middle cerebral artery ischemic stroke secondary: anxiety lyme disease asthma fibromyalgia tobacco abuse alcohol abuse discharge condition: mental status: aphasic level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. neurologic: nonfluent aphasia, follows simple commands, near full strength on the right discharge instructions: you were admitted for treatment following tpa for a stroke. we have investigated for causes of your stroke and it was felt that this was dur to a clot in your carotid artery. you will need to be on a blood thinning medication (coumadin) for the treatment of this clot and prevention of further clots/strokes. we could not find the cause of this clot. there are several tests still pending. you will to follow up in the neurology clinic for additional testing. you are being discharged for further rehabilitation. you need to stop smoking. followup instructions: neurology provider: , .d. phone: date/time: 3:00 md, procedure: diagnostic ultrasound of heart diagnoses: tobacco use disorder asthma, unspecified type, unspecified anxiety state, unspecified alcohol abuse, continuous aphasia myalgia and myositis, unspecified urinary incontinence, unspecified occlusion and stenosis of carotid artery with cerebral infarction hemiplegia, unspecified, affecting dominant side 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