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: syncope major surgical or invasive procedure: right inferior epigastric artery embolization by interventional radiology, history of present illness: 64 yo right-handed female with hx mvr, hx hemorrhagic stroke and subsequent seizures, and htn, with recent hospitalization at after a fall with acute left subdural hematoma, s/p emergent evacuation and craniotomy, discharged on heparin (for mechanical heart valve) to and noted to be awake, alert, and oriented at that time. at appromately 10 pm on , she was noted to be unresponsive with no clear description of preceeding events available. however, it was thought she may have had a seizure and was transferred to ed where she was given 8 mg valium, 1500 mg fosphenytoin iv. she was transferred to on for further management and work-up. past medical history: subdural hemorrhage, s/p evacuation and craniotomy mvr s/p rheumatic heart disease on coumadin for mechanical valve h/o hemorrhagic stroke history of seizure disorder (prior to sdh) hypertension hyperlipidemia ef 60% on tte social history: lives with husband (but currently transferred from rehab); has a lovely large family that frequently visits and is actively involved in her care. she is an ex-smoker, ppd x 10 years, no etoh or drugs family history: history of rheumatic heart disease in sisters physical exam: admission physical exam: vs: 99.9 (t max 100.3), p 75, bp 140/51, rr 16, 100% on ventilator gen: intubated, sedated cardio: rr, ii/vi sem with ? click pulm: cta anteriorly abd; soft, nt, nd neuro; intubated, sedated, does not awake to painful stimuli. pupils 2 mm and minimally responsive. does not withdraw to painful stimuli. flaccid tone throughout. 2+ reflexes biceps, triceps, brachioradialis, patellar, b/l, upgoing toe on right. discharge physical exam: vs: afebrile, on ra general: appears comfortable, conversant with somewhat slowed speech heent: cnii - xii in tact, left side of head shaved from prior ns, incision on left side of head cdi, stables removed on prior ot discharge lungs: cta b/l, scant crackles at bases cardio: rr, ii/vi sem with ? click abd: binder on, quarter-sized ecchymosis on rlq, minimally ttp diffusely, + bs skin: no rashes, wwp extremities: slight rle edema (r>l), right lateral malleolus minimally ttp with full rom of ankle though pt reporting some pain with movement pertinent results: admission labs: 05:05am blood wbc-7.0 rbc-1.96*# hgb-6.5*# hct-19.9*# mcv-101* mch-33.4* mchc-33.0 rdw-14.3 plt ct-264 05:05am blood neuts-73.3* lymphs-16.1* monos-7.9 eos-2.0 baso-0.6 05:05am blood pt-12.5 ptt-25.6 inr(pt)-1.1 05:05am blood glucose-91 urean-5* creat-0.2* na-141 k-2.9* cl-114* hco3-20* angap-10 03:46pm blood calcium-8.3* phos-2.5* mg-1.4* cardiac enzymes: 05:36am blood ck(cpk)-284* 11:49am blood ck(cpk)-257* 05:57am blood ck(cpk)-172* 05:36am blood ck-mb-3 ctropnt-0.18* 11:49am blood ck-mb-2 ctropnt-0.13* 05:57am blood ck-mb-2 ctropnt-0.11* hematocrit on discharge: hct-28.7 hct-27.3 hct-28.7 other labs on discharge: 05:33am blood wbc-12.8* rbc-3.01* hgb-9.2* hct-28.7* mcv-96 mch-30.5 mchc-32.0 rdw-15.7* plt ct-563* 05:33am blood glucose-216* urean-7 creat-0.4 na-137 k-3.5 cl-99 hco3-27 angap-15 urine studies: 07:00pm urine blood-mod nitrite-neg protein-30 glucose-neg ketone-neg bilirub-neg urobiln-neg ph-7.0 leuks-neg 07:00pm urine rbc-79* wbc-8* bacteri-none yeast-none epi-0 microbiology: c diff: negative , 24, 25/09 bcx: negative , 25/09 ucx: negative imaging: head ct w/o contrast: 1. unchanged and evolved appearance to left temporoparietal intraparenchymal hemorrhage and small left subdural hematoma. 2. no new focus of hemorrhage or shift of midline structures. 3. punctate hypodense focus anterior to the left lateral ventricle has persisted over 7 days. eeg: this is an abnormal video-eeg study due to slow theta frequency background with left posterior sharp transients. breech artifact was noted in the left temporal and centroparietal regions. the slow background suggests a encephalopathy affecting both cortical and subcortical structures. medications, metabolic disturbances, and infection are among the most common causes. there were no electrographic seizures or electrographic correlate to push-button activations. ct abdomen/pelvis w/ contrast: 1. large right rectus sheath hematoma extending into the extraperitoneal pelvis as well as the retroperitoneum. 2. mild right renal collecting system dilatation related to mass effect on the right ureter from the hemorrhage. 3. cholelithiasis. 4. cardiomegaly. cta abd/pelvis: 1. extensive right rectus sheath hematoma extending into the extraperitoneal pelvis and also the retroperitoneum, not significantly changed since examination one day prior performed . no increase in size, and no evidence of active extravasation in arterial, venous or delayed phases. 2. persistent mild renal collecting system dilation secondary to mass effect of the hemorrhage on the right distal ureter. 3. cholelithiasis without secondary signs of cholecystitis. 4. small amount of intra-abdominal ascites. 5. bibasilar atelectasis and cardiomegaly. 6. small hiatal hernia. cxr: 1. probably standard position of endotracheal tube. could consider pa and lateral for better definition. 2. perihilar predominant, ill-defined airspace opacification suggests pulmonary edema. underlying infection cannot be excluded. could consider another film after diuresis. cxr: there is a new left lower lobe infiltrate which given history likely represents pneumonia. there continues to be bibasilar subsegmental atelectasis. there is also pulmonary vascular redistribution consistent with fluid overload. impression: new left lower lobe infiltrate. right le us: no evidence of dvt right ankle/foot x-ray: no previous images. three views of the foot and three of the ankle show some generalized soft-tissue prominence without evidence of acute bone or joint space abnormality. video swallow: ms. presents with mild oropharyngeal dysphagia characterized by mildy reduced bolus formation, swallow delay and incomplete epiglottic deflection. patient was noted with one episode of flash penetration before the swallow with consecutive straw sips of thin liquids which cleared spontaneously. no deep penetration or aspiration was observed. recommend a po diet of thin liquids and small bites of soft solid consistencies. please continue 1:1 supervision to assist with feeding and monitor swallow safety. pills may be given whole or crushed with puree. please continue to monitor at rehab. this swallowing pattern correlates to a dysphagia outcome severity scale (doss) rating of level 5, mild dysphagia. recommendations: 1. po diet of thin liquids and small bites of soft solids. 2. pills whole or crushed with puree. 3. continue 1:1 supervision to assist with feeding and monitor swallow safety. 4. q8 oral care. 5. patient seated upright for all meals. 6. monitor for adequate caloric intake as indicated. 7. please continue to monitor at rehab and recommend repeat speech and swallow evaluation prior to upgrading diet. patient would also benefit from speech and language services at rehab. brief hospital course: seizure disorder: ms. was admitted to the neurosurgery service after transfer from for possible new head bleed. she was on a heparin drip while at rehab with plans to start warfarin on . she was monitored initially in the sicu and required intubation for airway protection with gcs (extubated successfully on ). repeat head ct upon admission showed no evidence of acute bleed. she was monitored with contiuous eeg initially. she was transferred to the neurology service, and her seizure medications were adjusted. she is being discharged on levetiracetam mg po bid and zonisamide 100 mg po qd. rectus sheath hematoma: ms. had a hct of 19 and was transfused 2 units rbc on admission. on the fifth hospital day, ms. complained of abdominal pain prompting abdominal ct on that showed a large rectus sheath hematoma on the right side. hct dropped from ~30 to 26 and she was subsequently transfused 2 units rbc's, though she remained hemodynamically stable. interventional radiology performed more imaging on looking for a source of the bleed. there was no active bleeding at the time of the study, making it difficult to identify the source. a prophylactic embolization of the right inferior epigastric artery was performed as it was felt this could have been the source. there apeared to be partial compression of the right ureter on imaging, though no further intervention was performed on the ureter since her renal function remained relatively stable. overnight from to , she required another transfusion for decreasing blood counts, though, again, she remained hemodynamically stable. an abdominal binder had been placed on to help control the bleed. her hematocrit stabilized at ~29 by and was 28.7 upon discharge on . it is unclear what caused the hemorrhage and at what point it developed. she was noted to be on sq insulin sliding scale upon admission, though she has no prior diagnosis of dm (confirmed with patient and pcp). anticoagulation, mechanical mitral valve: heparin was restarted on since the bleed appeared to be stable by that time and she was considered to be high risk due to a mechanical mitral valve. a lower ptt goal of 60-70 was recommended by cardiology due to the recent bleed. coumadin was not restarted in the hospital, though it is recommended to be started at 4 mg qhs beginning on upon discharge. goal inr is 2.5 - 3.5 for mechanical valve. it is noted that she was on aspirin 325 mg on admission. this was discontinued and should be held until pcp . volume overload: patient was noted to be short of breath at rest and volume overloaded on exam in the setting of multiple blood transfusions and ivf for ct contrast exposure. cxr was consistent with volume overload. she had a slight troponin leak in this setting, though she had no chest pain and no ekg changes concerning for ami (i.e., no t wave or st segment changes). recent tte from showed ef 60%; echo was not repeated this admission. she was treated with several doses of lasix 10 mg iv with great improvement in her volume status. she was weaned from 2lnc to room air and appeared euvolemic on exam prior to discharge. pneumonia, leukocytosis: throughout most of her stay, ms. had a persistent leukocytosis of 15-20 and a 2l nc oxygen requirement that was thought to be due to a pneumonia, though no clear infiltrate was identified on cxr. she was started empirically on vancomycin + ceftriaxone on for hap and then switched empirically to vancomycin + zosyn on since her leukocytosis persisted. upon transfer to the medicine service on , her wbs was still elevated at 17 and her o2 requirement remained at 2l, though she had been afebrile. blood and urine cultures as well as cxr were repeated for an infection work-up. all cultures were negative, including a stool c diff from (when she finally had a bm). cxr from showed a lll infiltrate c/f pneumonia. she was continued on vancomycin + zosyn, and her leukocystosis slowly improved to 12.8 on discharge. antibiotics are to continue through for treatment of hap. right ankle pain: ms. was noted to have some right lower leg and ankle pain beginning . she had slight asymmetric swellin of the right leg. rle ultrasound was performed since she was considered to be at risk for dvt with her immoblization and being off anticoagulation for several days; the ultrasound was negative for dvt. she also had difficulty bearing weight on the right foot and focal tenderness at her right lateral malleolus. x-ray of the foot and ankle were nagtive for fracture and showed generalized soft tissue swelling. she reported that she has worn a brace for stability on that foot ever since her stroke though she did not have it at the hospital. it was recommended that her husband bring this to the rehab facility, and it is suspected that she may have some foot/ankle pain secondary to not wearing this brace in recent days. dysphagia: the patient was followed by speech and swallow for mild dysphagia. please see results of video swallow study and recommendations in the pertinent results section of this summary. picc: ms. has a picc in her left arm from during her prior hospitalization. the need for this should be readdressed once heparin is discontinued and iv antibiotics are completed. medications on admission: per discharge summary: 1. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 2. insulin regular human 100 unit/ml solution sig: one (1) injection asdir (as directed). 3. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 4. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 5. levetiracetam 500 mg tablet sig: three (3) tablet po bid (2 times a day). 6. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. 7. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for wheezing . 8. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily). 9. lorazepam 0.5 mg iv prn seizure > 3 minutes please call house office prior to using. repeat x 1 if needed. 10. heparin flush (10 units/ml) 2 ml iv prn line flush picc, heparin dependent: flush with 10ml normal saline followed by heparin as above daily and prn per lumen. 11. 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. 12. heparin drip sliding scale heparin solution: 25,000 in 250cc of d5w discharge medications: 1. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever, pain. 2. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 3. senna 8.8 mg/5 ml syrup sig: one (1) tablet po bid (2 times a day) as needed for constipation. 4. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day). 5. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation every six (6) hours as needed for sob, wheeze. 6. ipratropium bromide 0.02 % solution sig: one (1) inhalation q6h (every 6 hours) as needed for sob, wheeze. 7. vancomycin in dextrose 1 gram/200 ml piggyback sig: one (1) gram intravenous q 12h (every 12 hours) for 3 days: please continue through . 8. piperacillin-tazobactam-dextrs 4.5 gram/100 ml piggyback sig: 4.5 grams intravenous q6h (every 6 hours): please continue through . 9. calcium carbonate 500 mg tablet, chewable sig: one (1) tablet, chewable po bid (2 times a day). 10. keppra 1,000 mg tablet sig: two (2) tablet po every twelve (12) hours: take mg twice a day. 11. zonisamide 100 mg capsule sig: one (1) capsule po daily (daily). 12. heparin (porcine) in d5w 25,000 unit/250 ml parenteral solution sig: see dosing sheet intravenous asdir (as directed) for 2 days: please see attached dosing sheet. 13. med administration meds can be given whole in puree due to mild dysphagia. 14. q8 oral care 15. coumadin 4 mg tablet sig: one (1) tablet po at bedtime: goal inr 2.5 - 3.5. 16. labs please monitor cbc and inr daily beginning on until stable. discharge disposition: extended care facility: - discharge diagnosis: primary diagnoses: (1) rectus sheath hematoma (2) pneumonia (3) seizure disorder secondary diagnoses: (1) subdural hematoma (2) mechanical mitral valve requiring anticoagulation discharge condition: stable. sbp in the 120's, breathing comfortably on room air. with minimal swelling of right lower leg compared to the left. discharge instructions: you were admitted ot the hospital for seizures, and your medication has been adjusted to control these. you had a bleed in your abdomen called a rectus sheath hematoma, which was treated by a procedure called "embolization" that helps block bleeding in the artery. your blood counts were a little low, so you were given a blood transfusion. your anticoagulation was initially held while you were bleeding, though it was restarted once your bleeding stabilized. you were also treated for a pneumonia and for extra fluid on your lungs. you are being discharged to a rehab facility for further physical therapy and treatment. please call the doctor or return to the emergency department if you feel short of breath, develop fevers, or feel lightheaded or dizzy. followup instructions: (1) please call your primary care doctor to be seen for follow-up 1-2 weeks after you are discharged from the rehab facility. doctors at the rehab facility will follow you while you are there. (2) you need an appointment for a four week follow-up with dr. in neurosurgery. his office is working on scheduling something for the week of . they will call your home phone number to give you an appointment time (they will leave a message for your husband). you will need a non-contrast head ct that day prior to talking to the doctor, and they are also scheduling this for you. (3) you also need an appointment to be seen by dr. in neurology for follow-up related to your seizures. the phone number is . the office is scheduling you something for the week of or the next available appointment. they will also be calling your home phone to leave an appointment time. if you do not hear from these doctor's offices by friday , please call these offices to ask about the status of those appointments. procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours insertion of endotracheal tube transcatheter embolization for gastric or duodenal bleeding arteriography of other specified sites diagnoses: congestive heart failure, unspecified unspecified essential hypertension acute posthemorrhagic anemia other and unspecified hyperlipidemia heart valve replaced by other means pneumonitis due to inhalation of food or vomitus other late effects of cerebrovascular disease long-term (current) use of anticoagulants nontraumatic hematoma of soft tissue anticoagulants causing adverse effects in therapeutic use acute diastolic heart failure encephalopathy, unspecified pain in joint, ankle and foot generalized convulsive epilepsy, without mention of intractable epilepsy dysphagia, unspecified 

Answer: The patient is high likely exposed to