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 / aspirin / sulfa (sulfonamides) / duragesic attending: chief complaint: sudden right sided weakness major surgical or invasive procedure: none history of present illness: 81 yo woman with a history of htn and recent bout of bronchitis and fractures who was in her usoh earlier today, about to eat lunch with her husband, when suddenly she slumped to the right at 12:20pm. she was weak on the right and nonverbal. ems took patient to where she was noted to have right hemiplegia and aphasia. vitals at : 171/114, 92 nsr, rr 18, 100% on 2lnc (at 14:10). she had a head ct negative for bleed, and was transferred to the for iv t-pa. patient arrived at at 1448. stroke team was notified at 1430 and responded at 1430. labs were drawn at osh. ct done at osh and films available for our review. ekg ordered at 1450 and results available at 1505. iv t-pa was administered at 1510 based on her weight of 122 pounds. initially, her exam by the ed neurologist was as follows: she was awake, alert, following one step commands only, very dsyarthric but able to say, "ahh...", unable to comprehend her speech output. she had a left gaze preference and eyes did not move past midline, right face droop. right body flacid plegia without response to noxious stimuli. she did extend the right toe to noxious stimuli. right foot with upgoing toe. after iv t-pa administration she was taken to mri. mri showed a large left mca stroke. her exam transiently improved in that she was able to lift her right arm to gravity. this improvement was short lived. started on labetolol gtt in ed for sbp 190's. no vision loss (tia), no weakness in the past. past medical history: -hypertension - renal cancer, s/p nephrectomy by dr. at 1.5 years ago, s/p chemotherapy (last dose 6 months ago) follwed by dr. at . has a portacath over the right chest. - bladder cancer vs spread of renal cancer, unclear - recent bronchitis and fractures - endometriosis with small bowel obstructions requiring surgery (last obstruction 3 yrs ago) - djd social history: lives at home, married, one son estranged, never smoked, one glass of wine with dinner, no drugs, no alternative medicine. no aids to walk. using visiting nurse fracture/bronchitis. retired head teller and book keeper at a bank. director of volunteers at a library, not currently working. lives in , ma. family history: husband unable to answer, has a twin brother who is obese and another brother and sister. physical exam: vitals: fs 106, t 97, p 80, bp 170/80, 100% gen: frail elderly appearing woman in nad skin: no rash heent: nc/at, anicteric sclera, mmm neck: supple, no carotid bruits chest: normal respiratory pattern, course bs bilaterally cv: regular rate and rhythm with ? sys murmur abd: softly distended, rare bs extrem: no edema neuro: mental status: patient is alert, awake, pleasant. oriented to person, place "hospital" when given a list of places to chose from, "" and "winter". mildly inattentive. language: speaks primarily with single words but will repeat and string 4 words together, good comprehension following multistep commands, marked dysarthria. is aware that she had a stroke. pays less attention to the right but is able to look to the right. did not count one person standing far to the right. no left/right mismatch, recognizes her right arm as her own. cranial nerves: visual fields: full to left/right/upper/lower fields. pupils:3->2 mm, consenual constriction to light. eoms full, gaze conjugate. no nystagmus or ptosis. facial sensation intact over v1/2/3 to light touch. both upper and lower face weakness on the right. hearing decreased on the right. marked dysarthria. symmetric elevation of palate. trapezius bilaterally. tongue midline without atrophy or fasciulations. sensory: no sensation to touch right leg, decreased in the right arm, normal right face. no withdrawl to pain right arm but does withdrawl right leg to pain. motor: right flacid. no adventitious movements. strength- - left side is essentially full strength throughout. - right side: lifts right arm to gravity but unable to provide any resistence. right biceps weak . right triceps 4-/5 (provide minimal resistence). right hand is completely weak unable to wiggle fingers/grasp/straighten fingers. right leg is stronger - ip/ham/df. quads/plantar flexion full. reflexes: br tri pat ach toes rt: 1 0 0 0 0 down left: 2 2 2 1 1 down coordination: intact on left gait: patient on bedrest pertinent results: labs: cbc normal except hct 33.7, chem7, coags and ua normal cardiac enzymes negative. risk factor screening: hba1c 5.6 triglyc 184 tchol 172 ldl 102 hdl 33 radiology: brain mri: acute left mca infarct, sparing basal ganglia. mra with occlusion of the posterior division of the left middle cerebral artery in its proximal portion. ct head w/o contrast (s/p tpa): no acute intracranial hemorrhage. carotid series: scattered bilateral ica plaque, no appreciable associated stenosis, however (graded as less than 40% bilaterally). elbow (ap, lat & oblique) right: large elbow joint effusion. no distinct fracture line is identified. tte: ef>55%. trivial mr. otherwise normal. brief hospital course: 81 yo female with history of hypertension, renal and bladder cancer s/p chemotherapy p/w acute onset of lack of speech and right-sided weakness. taken by ems to . presentation was concerning for new stroke. noncontrast head ct was negative for a bleed and she was transferred to for iv t-pa. received t-pa on at 15:10 (2hrs 50 min after onset of symptoms). transiently improved - able to lift right arm, attended to the right, followed commands, no verbal output. transferred to sicu for 24 hour monitoring and post t-pa protocol. mri confirmed large acute infarct in left mca distribution with occlusion on mra. patient had no known history of stroke/seizure, no known cardiac arrhythmias, was a nonsmoker and nondiabetic. on she went into rapid afib with hr in 150's ~2am. 5mg iv lopressor was administered with conversion to sinus rhythm. she experienced a second episode of afib (hr 130's, sbp 160's) ~5:30am on , which resolved before metoprolol administration. sbp's remained above 140, and dosing of 25 mg metoprolol was initiated and maintained until discharge with good rate control achieved. she was changed to toprol xl for easier dosing on day of discharge. dose may need to be titrated as needed for rate control. additionally, ace inhibitor should be added as tolerated, with goal sbp<120. coumadin 2mg was started on for secondary stroke prevention given the atrial fibrillation, with plan of allowing inr to rise slowly over 1 week due to size of infarct. baseline inr on was 1.0. echocardiogram with normal la size, normal lv systolic function and no thrombus. carotid us without significant stenosis (< 40% stenosis bilaterally). blood sugars remained between 85 and 130, with fingersticks discontinued on hospital day 5. hgba1c was 5.6. lipid screening revealed total cholesterol of 172, ldl 102, hdl 33 and triglycerides 184. atorvastatin 20 mg qd started on once she was cleared to take po. given severe dysarthria, speech and swallow evaluation was done to evaluate for aspiration. video swallow study cleared her for pureed solids and nectar prethickened liquids with chin tuck, pills administered whole in puree. patient complained of r elbow pain on . films revealed large joint effusion without fracture line. additional history that patient's husband grabbed arm to prevent her from falling during onset of symptoms was elicited. pain and effusion most likely secondary to traumatic hyperextension of elbow. recommend ice and analgesics. in weeks if pain not improved, her elbow should be re-evaluated. can contact dr. in rheumatology, , for further assistance if needed. patient was given standing percocets for fractures with option of refusal, due to broca's aphasia and inability to ask for meds when in pain. neuro exam on discharge was somewhat improved. she was aware that she had a stroke, was oriented to person, place and date. she was able to repeat and name high frequency objects but was not fluent, had severe dysarthria, right face droop, with a very weak right hand but able to lift arm to gravity. on discharge she was able to move fingers and wrist slightly with gravity and was felt to be improving somewhat. she had decreased tone in r upper extremity. lower extremities had full strength bilaterally. medications on admission: - lorazepam 0.5mg twice a day prn for anxiety, darvocet 100-650mg one to two tabs every 4 hours prn, albuterol and cough medicine with codeine for bronchitis, z-pack (completed days), mvi - not taking antihypertensives, formerly took norvasc discharge medications: 1. pantoprazole sodium 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 2. heparin sodium (porcine) 5,000 unit/ml solution sig: one (1) ml injection tid (3 times a day) as needed for dvt prophylaxis. 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q4-6h (every 4 to 6 hours) as needed. 4. atorvastatin calcium 20 mg tablet sig: one (1) tablet po daily (daily). 5. warfarin sodium 2 mg tablet sig: one (1) tablet po hs (at bedtime). 6. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q6h (every 6 hours): pt may refuse, but please offer as broca's aphasia makes it difficult for her to ask. 7. zolpidem tartrate 5 mg tablet sig: 1-2 tablets po hs (at bedtime) as needed. 8. metoprolol succinate 50 mg tablet sustained release 24hr sig: one (1) tablet sustained release 24hr po daily (daily). 9. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 10. senna 8.6 mg capsule sig: one (1) tablet po bid (2 times a day) as needed. 11. bisacodyl 5 mg tablet sig: two (2) tablet po bid (2 times a day) as needed: alternatively, may give pr. discharge disposition: extended care facility: tcu discharge diagnosis: left middle cerebral artery infarction complicated by dysphagia atrial fibrillation hypertension hypercholesterolemia fractures (prior to admission) elbow pain, likely due to traumatic hyperextension discharge condition: improved, though still with right hemiparesis with significant right arm and face weakness. also still with broca's aphasia and severe dysarthria. discharge instructions: take all medicines as prescribed. we have started you on two new medications, lipitor for your cholesterol and coumadin to thin your blood. keep all follow-up appointments. call your doctor or return to the ed if you develop new weakness on your left side, difficulty seeing or understanding. followup instructions: follow-up with your pcp 1-2 weeks after discharge from rehab. dr. will continue to manage your blood pressure and coumadin dosing. follow-up in clinic with dr. in about 3 months on at 1pm. call for more information or to reschedule. md, procedure: injection or infusion of thrombolytic agent diagnoses: pure hypercholesterolemia unspecified essential hypertension atrial fibrillation personal history of malignant neoplasm of kidney cerebral artery occlusion, unspecified with cerebral infarction effusion of joint, upper arm 

Answer: The patient is high likely exposed to