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: levaquin attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization intraarterial tpa with merci procedure and penumbra device left frontal tooth extration () peg tube placement () history of present illness: 66 y/o m with hx of cad s/p cabg in , dm, chf, htn, and pvd presents with approximately a week long history of intermittent chest pain. the pain would come on consistently after dinner and be substernal and feel like burning. he would then get a "funny" feeling down the lateral aspects of his arms and also start to have some tingling in his gums. the pain would last for approx 40 minutes and then go away. he tried both tums and nitro and got no relief. . on he presented to with these complaints and was ruled out by ekgs and enzymes. he was worked up for atypical chest pain. a ct of chest without contrast was negative. he was started on prednisone for inflammation and doxycycline for possible lymes disease (sounds like he had a positive culture). he was discharged to home when two days ago he had the pain again. substernal, radiating to arms, no diaphoresis or shortness of breath. it was while he was driving and was now relieved by nitro (which was different than his other episodes). he went to bed that night and then woke up again with the pain. it again was relieved by nitro, so he decided to return to the hopsital. he had positive troponin rise, negative ck, and possible new ekg changes with st depressions. he was transferred to here at that time. . on ros he does endorse six months of increasing dyspnea on exertion, fatigue and inability to get very far without needing to sit down. is dizzy when standing still. has not fallen. no fevers or chills or changes in weight. past medical history: -cad s/p cabg in with svg->diagonal, rca, lad, and distal om-1; lima->distal branch of lad, s/p pci ami/vf arrest s/p ptca of the lad and ramus, imi s/p pci of the lcx and lad, s/p multivessel pci, s/p des to svg->lad -diastolic chf -diabetes mellitus -hyperlipidemia -hypertension -pvd s/p bilateral iliac stents with bilateral isrs s/p pta, moderated isr of left iliac stent -s/p cholecystectomy -cataract in right eye s/p lens implant -diverticulosis and diverticulitis, last colonoscopy -chronic renal failure (baseline cr 1.4) -arthritis -pleurisy -polycythemia -gerd -copd, pfts showed mild obstructive airway disease but not consistent with emphysema, vital capacity 3.15 liters which was 73% of predicted, fev1 was 2.60 liters which was 76% of predicted. -severe back pain/degenerative disc disease- followed by dr. hernia s/p repair -l5-s1 spondylyitis -pancytopenia -fatty liver social history: lives at home with wife, is independent, continues to smoke 1 ppd for 45 years, occasional etoh at social occasions, no illicit drugs. family history: father with leukemia, chf near the end of his life; mother still alive; one brother with hx of colon cancer, now in remission. physical exam: on admission: vs - t 98.2, 134/81, p66-79, r 16-20, 97% on ra gen - in bed, sitting up, nad heent - atnc, perrla, eomi, supple neck, no jvd, no bruits cv - rrr, no m,r,g lungs - cta b abd - soft, nt, nd, no hsm or masses, normoactive bowel sounds ext - cool, no hair growth from mid shin down, nonpalpable pulses, are dopplerable, sensation and motor grossly intact neuro - cn intact, moves all 4 extremities, no focal deficits physical exam at neurology unit admission: nih stroke scale score: 1a. loc: arousable to minor stimulation = 1 1b. loc questions: does not say month/age = 2 1c. commands: opens eyes on command, does not squeeze hands = 1 2. best gaze: left gaze deviation = 2 3. visual field: complete hemianopia = 2 4. facial palsy: flattening of left nlf = 2 5. motor arm: left-no movement = 4 right-no drift = 0 6. motor leg left-no movement = 4 right-no drift = 0 7. no ataxia = 0 8. sensory: unilateral sensory loss on the left = 1 9. best language: mild to moderate aphasia = 1 10. dysarthria: severe aphasia = 2 11. extinction/neglect: appears to neglect left side = 1 _______________________ total score: 23 physical exam upon discharge: patient remains with eyes closed most of the time, even when awake. at times he is able to say isolated words and 3 to 4 words sentences to express his feelings, and at times he just mumbles. he is able to follow simple commands such as show fingers, but he also shows perseverating. his eyes movements are impaired to vertical gaze deviation, and barely cross midline to left and slow to the right horizontal movements. he does not showed any voluntary movements from left upper and lower extremities. right extremities are normal in tone, strenght and reflexes. there was a time that he presented less movement at the right lower limb, but this was resolved. pertinent results: labs admission: 09:45pm ck(cpk)-154 09:45pm ck-mb-10 mb indx-6.5* ctropnt-0.12* 09:45pm pt-13.2 ptt-71.2* inr(pt)-1.1 01:05pm glucose-138* urea n-28* creat-1.4* sodium-138 potassium-4.6 chloride-103 total co2-23 anion gap-17 01:05pm ck(cpk)-168 01:05pm ctropnt-0.13* 01:05pm ck-mb-11* mb indx-6.5* 01:05pm calcium-9.4 phosphate-3.6 magnesium-2.0 01:05pm wbc-10.7 rbc-5.08 hgb-15.8 hct-44.8 mcv-88 mch-31.0 mchc-35.2* rdw-14.3 01:05pm neuts-64.1 lymphs-29.2 monos-4.4 eos-2.0 basos-0.3 01:05pm plt count-255 01:05pm pt-14.4* ptt-145.9* inr(pt)-1.3* labs from discharge: hematology complete blood count wbc rbc hgb hct mcv mch mchc rdw plt ct 06:45am 14.3* 3.81* 11.6* 33.6* 88 30.5 34.6 14.5 544* differential neuts bands lymphs monos eos baso atyps metas 02:25am 68.8 21.8 4.0 5.1* 0.3 source: line-aline basic coagulation (pt, ptt, plt, inr) pt ptt plt ct inr(pt) 10:30am 30.0 03:19am 57.0* chemistry renal & glucose glucose urean creat na k cl hco3 angap 06:45am 185* 20 0.9 136 4.4 102 23 15 enzymes & bilirubin alt ast ld(ldh) ck(cpk) alkphos amylase totbili dirbili 10:55am 20 31 58 69 0.3 other enzymes & bilirubins lipase 10:55am 75* cpk isoenzymes ck-mb mb indx ctropnt 02:25am 3 0.10*1 chemistry totprot albumin globuln calcium phos mg uricacd iron cholest 06:45am 9.0 3.5 1.9 lipid/cholesterol cholest triglyc hdl chol/hd ldlcalc 05:50am 99 228*1 23 4.3 30 other studies: usg from lower extremities ():no evidence of deep vein thrombosis in either leg chest ct findings: equivocal subsegmental filling defects in pulmonary artery branches of left lower lobe that could represent flow artifact in this study with respiratory motion. if high clinical suspicious of pulmonary embolism, a repeat study is recommended. limited evaluation of lung parenchyma due to respiratory motion does not reveal lung nodules or consolidation. presence of dependent atelectasis. no pleural effusion. nasogastric tube can be seen in the esophagus. heart size is within normal limits. coronary stents and bypass graft is noted. atherosclerotic calcification in the aorta. no pericardial effusion. bilateral hilar lymph nodes are noted. limited evaluation of the abdominal organs is unremarkable. bone windows: status post sternotomy. degenerative changes seen of the thoracic spine. impression: equivocal findings of pulmonary embolism and left lower lobe, that could represent flow artifact. if high clinical suspicious of pulmonary embolism, a repeat study is recommended. repeat chest ct findings: equivocal subsegmental filling defects in pulmonary artery branches of left lower lobe that could represent flow artifact in this study with respiratory motion. if high clinical suspicious of pulmonary embolism, a repeat study is recommended. limited evaluation of lung parenchyma due to respiratory motion does not reveal lung nodules or consolidation. presence of dependent atelectasis. no pleural effusion. nasogastric tube can be seen in the esophagus. heart size is within normal limits. coronary stents and bypass graft is noted. atherosclerotic calcification in the aorta. no pericardial effusion. bilateral hilar lymph nodes are noted. limited evaluation of the abdominal organs is unremarkable. bone windows: status post sternotomy. degenerative changes seen of the thoracic spine. impression: equivocal findings of pulmonary embolism and left lower lobe, that could represent flow artifact. if high clinical suspicious of pulmonary embolism, a repeat study is recommended. neuroimaging: ct hyperdensity of the right caudate head and putamen, presumably reflecting hemorrhagic infarction, enhancement of infarcted tissue, or both. there is also gyriform hyperdensity with the same differential and a possiblity of a small amount of subarachnoid hemorrhage. with associated moderately extensive subarachnoid hemorrhage. brain mri/mra () 1. large acute infarction with extensive hemorrhagic transformation in the right middle cerebral artery territory. small acute infarction in the right anterior cerebral artery territory. 2. successful revascularization of the right internal carotid and middle cerebral arteries brief hospital course: he initially presented to with chest pain and diaphoresis which did not respond to sl nitro x3. he was seen by cardiology, and ces showed ck 123->116->94, ck-mb 1.5->1.8->1.2, tropt 0.02->0.04->0.03. he was instructed to quit smoking and follow up with his cardiologist. per the cardiology admission note, he was also "started on prednisone for inflammation and doxycycline for possible lyme disease." however, he continued to have substernal burning chest pain radiating into his bilateral arms over the past week. he returned to where ces showed ck 164, ck-mb 5.1, and tropt 0.1, and ekg per report showed old q in inferior leads, some 1mm elevations, lateral st depressions. he was continued on asa, loaded with plavix 300 mg, and started on heparin gtt. he was transferred to for further evaluation. he was admitted to cardiology on , continued on heparin gtt, asa 325 daily, plavix 75 mg daily, and crestor was changed to atorvastatin 80 mg daily. trop t peaked at 0.17, ck-mb at 11. he had a cardiac cathterization which showed known occlusions of svg-om1, svg-om3, svg-pda, lima-d1; and successful ptca and stenting of the proximal svg-lad graft with a cypher des. during the cath, he received bivalirudin bolus and gtt, fentanyl 200 mcg iv x1, nicardipine 200 mcg ic bolus, versed 1 mg iv x1, and sodium bicarbonate iv. he was to be discharged home on . at 10:20 am the nurse found him to be normal in his room. at approximately 11:10 am, the nurses noted that the nurse call button had been pulled out of the wall. he was found to have a dense left hemiplegia and decreased responsiveness. a code stroke was called. the patient was found to be awake but with decreased alertness, left facial droop, left hemiparesis, left eye deviation, and dysarthria. nihss 23. head cta and ctp showed complete occlusion of the cervical and intracranial right ica and of the right mca, the right aca is patent, likely supplied by the anterior communicating artery, subtle loss of -white matter differentiation and a large area of matched decreased cerebral blood volume and flow in the right middle cerebral artery territory, consistent with a large acute infarction, no evidence of hemorrhage. he was taken immediately to cerebral angiography, where he had ia tpa and merci to the right ica, and penumbra to the right mca, with ia ntg to right mca for spasm. he was intubated and transferred to the neuroicu. in the neurology icu, he was maintained on aspirin and plavix. mri/mra head showed a large acute infarction with extensive hemorrhagic transformation in the right mca territory, small acute infarction in the right aca territory, and successful revascularization of the right ica and mca. repeat head cts showed increased mass effect and right uncal herniation, and he was started on mannitol. he remained stable and mannitol was discontinued. tte showed lvef 40%, no thrombus/mass in the body of the lv, no asd or pfo. usg of the legs no evidence of venous thrombosis. eeg showed asymmetry with low voltage activity over the right side, and overall diffuse encephalopathy. he had some fluctuations in his mental status due to infection (see below) and remained significantly abulic. at times during his stay, he complained of chest pain, but cardiac enzymes were always unremarkable and ekg was unchanged. he was maintained on asa, plavix, and eventually heparin/coumadin (see below). he was treated with antihypertensives and cholesterol lowering medications. after extubation he was found to have persistent high respiratory rate (20-32). as this was concerning for pulmonary embolism, he underwent two consecutive chest cta; both revealed a small lesion in the lower segment of the left inferior lobe. heparin was started on , and warfarin 5mg daily was started (held prior to this for procedures). goal inr is . he was discharged on lovenox as a bridge to coumadin and will need to have inrs checked until the inr is therapeutic. he was noted to have a recent lyme titer positive at his pcp's office and was treated with doxycycline 100 mg po bid to complete a 14 day course; discontinued on . he had a fever and was diagnosed with a pseudomonas uti. he was initially started on cefazolin but this was changed to cefepime after persistent fever. he completed a 7 day course on . his diabetes was managed by , with lantus, humalog, and oral hypoglycemics. a1c was 13.7. he had a loose left front tooth, which was extracted on without complications. he passed his swallow study but he was waxing and wanning in his mental status and not holding well the po intake. he had peg placed on . medications on admission: asa 325 mg daily plavix 75 mg daily imdur 30 mg daily valsartan 80 mg daily atenolol 25 mg daily crestor 10 mg daily ezetimibe 10 mg qhs niaspan 1000 mg daily tricor 145 mg qhs metformin 1000 mg glyburide 5 mg januvia 100 mg daily nexium 40 mg daily percocet 1 tab q6 hr prn (usually takes ) discharge medications: 1. fenofibrate micronized 145 mg tablet sig: one (1) tablet po daily (). 2. atorvastatin 80 mg tablet sig: one (1) tablet po daily (daily). 3. ezetimibe 10 mg tablet sig: one (1) tablet po daily (daily). 4. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily). 5. acetaminophen 325 mg tablet sig: two (2) tablet po q6h (every 6 hours) as needed for pain, fever. 6. nitroglycerin 0.3 mg tablet, sublingual sig: one (1) tablet, sublingual sublingual prn (as needed) as needed for chest pain. 7. niacin 100 mg tablet sig: five (5) tablet po bid (2 times a day). 8. docusate sodium 50 mg/5 ml liquid sig: two (2) po bid (2 times a day). 9. oxycodone-acetaminophen 5-325 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for pain. 10. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 11. simethicone 80 mg tablet, chewable sig: one (1) tablet, chewable po qid (4 times a day) as needed. 12. isosorbide dinitrate 10 mg tablet sig: one (1) tablet po tid (3 times a day). 13. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po daily (daily). 14. citalopram 20 mg tablet sig: one (1) tablet po daily (daily). 15. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). 16. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day). 17. bisacodyl 10 mg suppository sig: one (1) suppository rectal daily (daily). 18. enoxaparin 100 mg/ml syringe sig: ninety (90) units subcutaneous q12h (every 12 hours). 19. warfarin 5 mg tablet sig: one (1) tablet po once daily at 4 pm. 20. insulin glargine subcutaneous 21. glyburide 5 mg tablet sig: one (1) tablet po bid (2 times a day). 22. metformin 500 mg tablet sig: two (2) tablet po bid (2 times a day). discharge disposition: extended care facility: hospital - discharge diagnosis: primary diagnosis: 1. nstemi 2. coronary artery disease 3. hyperlipidemia 4. right mca stroke 5. left inferior pulmonary embolism 6. urinary tract infection 7. loose tooth status post extraction . secondary diagnosis: 1. diabetes 2. hypertension 3. positive lyme titer discharge condition: he was abulic, preferring to keep his eyes closed (even when awake), with decreased but appropriate speech output, ability to follow commands with his right side, left neglect, and a dense left hemiparesis. discharge instructions: you were admitted to the hospital for chest pain. it was determined to be related to your heart because we saw a rise in your cardiac enzymes. your pain was also relieved by nitro, again making us think it was related to your heart. we monitored you over the weekend while you were on a heparin drip through your iv. you did well and only had the recurrence of chest pain once. your cardiac enzymes also started to decrease. unfortunately before your discharge you presented subtle onset of left sided weakness, and code stroke was called. you underwent procedures to remove a clot from your left cerebral artery. during this acute phase you were intubated with mechanical ventilation. after your doctors noted that presented fast breathing, and you were found to have pulmonary embolism. to treat and prevent further episodes you need to take coumadin to make your blood thinner. you also had a broken tooth, which was removed during this admission. although you passed the swallow evaluation you had significant fluctuation of your mental status, which required a tube in your stomach, so you can receive your medications and feeds consistently. your diabetes was out of control and some adjustment of your medications was required. please call your doctor or return to the hospital for any new weakness, numbness, tingling, visual changes, loss of consciousness, chest pain, shortness of breath, lightheadedness, fainting, nausea, vomiting or any other conerns. call 911 if it is an emergency. please stop smoking. information was given to you on admission regarding smoking cessation. followup instructions: cardiology: please follow up with dr. . his phone number is if you need to change your appointment. neurology: , md phone: date/time: 2:00 endocrinology: please contact clinic to schedule a follow up appointment procedure: venous catheterization, not elsewhere classified continuous invasive mechanical ventilation for 96 consecutive hours or more combined right and left heart cardiac catheterization coronary arteriography using two catheters injection or infusion of thrombolytic agent percutaneous [endoscopic] gastrostomy [peg] arteriography of cerebral arteries insertion of (naso-)intestinal tube other surgical extraction of tooth insertion of drug-eluting coronary artery stent(s) cranial or peripheral nerve graft insertion of one vascular stent excision of lingual thyroid percutaneous transluminal coronary angioplasty [ptca] procedure on single vessel procedure on two vessels procedure on vessel bifurcation endovascular removal of obstruction from head and neck vessel(s) diagnoses: end stage renal disease subendocardial infarction, initial episode of care coronary atherosclerosis of native coronary artery tobacco use disorder urinary tract infection, site not specified congestive heart failure, unspecified chronic airway obstruction, not elsewhere classified coronary atherosclerosis of autologous vein bypass graft other chronic pulmonary heart diseases hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease compression of brain cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure iatrogenic pulmonary embolism and infarction accidents occurring in residential institution atherosclerosis of native arteries of the extremities, unspecified diastolic heart failure, unspecified diverticulosis of colon (without mention of hemorrhage) diabetes with peripheral circulatory disorders, type i [juvenile type], not stated as uncontrolled pseudomonas infection in conditions classified elsewhere and of unspecified site iatrogenic cerebrovascular infarction or hemorrhage lyme disease spondylosis of unspecified site, without mention of myelopathy cerebral thrombosis with cerebral infarction polycythemia vera occlusion and stenosis of carotid artery with cerebral infarction ankylosing spondylitis cracked tooth 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