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 attending: chief complaint: right hand weakness and dysarthria - "code stroke" major surgical or invasive procedure: tpa administration history of present illness: mr. is a 86-year-old right-handed man presenting with dysarthria and right hand weakness on a background of collagenous colitis and irregular heart rhythm, coronary artery disease and numerous other problems. mr. was at home at this morning. he awoke normally and ate breakfast according to his typical routine. he then sat down to watch television. he was holding the remote control in his right hand. on trying to change channel, the remote control fell out of his hand, which he then noticed that he could not move. he thinks that his voice became slower and less clear at about the same time. there was no headache, his leg was not weak, he could understand and speak, but said that others found him difficult to understand. the staff called his pcp's coverage who noted normal vitals and recommended coming to the ed. his functional status: uses a walker, needs help with washing, dressing, has meals prepared for him. cognitive: quite intact. review of systems is positive for shortness of breath that has been present for two years, worse over the last few days and worse still this morning. he knows that his heart is irregular. there is no chest pain or recent episode of chest pain. no recent infections, fever, chills. all other review of systems negative except as above. time code stroke called: 12:34 time neurology at baseline for evaluation: 12:39 time (and date) the patient was last known well: , 10:00 nih stroke scale score: 4 contraindications to t-pa: none t-: y time given: 13:09 i was present during the ct scanning and reviewed the images as they were captured. nihss: nih ss: 1a. level of consciousness: 0 1b. loc questions: 0 1c. loc commands: 0 2. best gaze: 0 3. visual: 0 4. facial palsy: 0 5a. motor arm, left: 0 5b. motor arm, right: 2 6a. motor leg, left: 0 6b. motor leg, right: 0 7. limb ataxia: 1 8. sensory: 0 9. best language: 0 10. dysarthria: 1 11. extinction and inattention: 0 past medical history: past medical history: 1. abdominal abscess - the patient had an abdominal abscess that grew pseudomonas aeruginosa which was drained and treated with antibiotics in 10/. 2. prostate cancer - this was diagnosed in . the patient was treated with radiation therapy. prostate cancer has now reoccurred with a pelvic mass and possible bone met. being treated with lupron therapy by dr. . 3. basal and squamous cell skin cancers 4. cad status post stent x6 (last was eight years ago), cardiologist is dr. . 5. hypertension 6. hypothyroidism 7. bilateral hearing loss - the patient wears hearing aids bilaterally. he reports that his hearing loss is greater in the left ear than the right. 8. headaches 9. diverticulitis - 10. orthostatic hypotension and micturition syncope 11. dysphagia, negative barium swallow in , both liquids and solids egd shows pulsatile extrinsic compression from aberrant subclavian artery and possible left-sided aortic arch 12. glaucoma, at least from , blind in left eye. 13. osteopenia 14. collagenous colitis, dx in 15. hearing loss is marked, using bilateral hearing aids at home 16. possible prior tia. patient presented to hospital in ? several years ago with neurologic symptoms. he was told that he did not have a stroke. per son. past surgical history: 1. status post drainage of abdominal abscess - 2. status post removal of basal cell and squamous cell skin cancers 3. status post appendectomy - appendix was ruptured at the time of this surgery in . 4. status post bilateral carpal tunnel repair social history: lives at , . wife is 84. son, , is hcp and power of attorney. smoked ~ 60 pack year. smoked ppd for ~50 years, quit . rare etoh. family history: father with coronary disease in 60s. mother and brother with hypertension. his sister has hypertension and cancer of unknown origin. physical exam: exam on admission: vitals: 97.9 f 70 bpm 155/64 mmhg 18 breaths 98% 3l nc general appearance: comfortable, no apparent distress. heent: nc, op clear, mmm. neck: supple. no bruits. lungs: cta bilaterally. mild wheeze cardiac: irregular. normal s1/s2. no m/r/g. abdominal: soft, nt, bs+ extremities: trophic changes throughout, most marked at ankles. onychomycosis. gu: foley in place. neurologic: mental status: awake and alert, cooperative with exam, normal affect. orientation: oriented to person, place, date and context. language: normal fluency, comprehension, repetition, naming. no paraphasic errors. cranial nerves: i: not tested. ii: right pupil, round and reactive. left pupil irregular and fixed at about 5 mm, distended scleral vessel at limbus of . visual fields are full to confrontation on the right and, the left eye is blind. iii, iv, vi: extraocular movements intact bilaterally without nystagmus. v, vii: facial strength and sensation intact and symmetric. mouth appeared asymmetric due to denture. viii: hearing diminished bilaterally. ix, x: palatal elevation symmetric. : sternocleidomastoid and trapezius normal bilaterally. xii: tongue midline without fasciculations. posture normal and no truncal ataxia. tone normal in arms, mildly increased in both legs. power d b t we wf fe fab | ip q h at g/ tf r 4 4+ 4- 0 0 0 0 | 5 5 5 5 5 5 5 l 5 5 5 5 5 5 5 | 5 5 5 5 5 5 5 reflexes: b t br pa ac right 1 1 0 0 0 left 1 1 0 0 0 (reenforcement not attempted) toes up on left and down on right. sensation intact to light touch, pinprick bilaterally, but mildly diminished over right hand. vibration, joint position mildly impaired at feet. normal finger nose on left, normal on left (feet not tested). gait: deferred. pertinent results: 03:43pm blood wbc-10.2 rbc-3.89* hgb-11.2* hct-34.7* mcv-89 mch-28.8 mchc-32.2 rdw-16.1* plt ct-211 12:40pm blood pt-13.3 ptt-24.1 inr(pt)-1.1 02:40pm blood fibrino-483* 12:40pm blood glucose-124* urean-29* creat-1.3* na-145 k-4.2 cl-109* hco3-25 angap-15 04:18pm blood %hba1c-6.2* eag-131* 03:43pm blood triglyc-62 hdl-25 chol/hd-2.4 ldlcalc-24 ekg: sinus rhythm with atrial premature beat and ventricular premature beat. left bundle-branch block. since the previous tracing of intra-atrial conduction delay is less prominent and further intraventricular conduction delay is present. ct head: no acute intracranial process. specifically, there is no ct evidence of a large vascular territorial infarction, although mri is a more sensitive test to rule out acute ischemia or infarction, particularly in the setting of extensive chronic small vessel ischemic disease. there are scattered, tiny, punctiform calcifications, superficially located in the sulci of the right cerebral hemispheres (e.g. 2:12), likely representing old healed neurocysticercosis. mri of head: 1. numerous bilateral, left greater than right, cortical infarcts, acute. 2. no evidence of hemorrhage. 3. moderate atherosclerotic involvement of the vessels of the head and neck, particularly of the proximal left internal carotid artery. echocardiogram: the left atrium is mildly dilated. there is mild symmetric left ventricular hypertrophy with normal cavity size. there is moderate regional left ventricular systolic dysfunction with basal inferior akinesis and hypokinesis of the inferolateral and lateral walls. there is milder hypokinesis of the remaining segments (lvef = 35%). no masses or thrombi are seen in the left ventricle. right ventricular chamber size and free wall motion are normal. the ascending aorta is mildly dilated. mild (1+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. there is mild pulmonary artery systolic hypertension. significant pulmonic regurgitation is seen. the end-diastolic pulmonic regurgitation velocity is increased suggesting pulmonary artery diastolic hypertension. the main pulmonary artery is dilated. there is no pericardial effusion. impression: moderate regional left ventricular systolic dysfunction, c/w cad (lcx distribution). mild aortic regurgitation. moderate mitral regurgitation. mild pulmonary hypertension. compared with the report of the prior study (images unavailable for review) of , lv function has significantly deteriorated (although on the left ventriculogram from the lv function appears to be similar to today's echocardiogram). brief hospital course: mr. is an 86 year-old right-handed man with a history of hypertension, cad s/p stents x 6, cardiac arrhythmia, prostate cancer with pelvic recurrence and possible metastasis, collagenous colitis, and dysphagia who developed right upper extremity weakness (most prominent in the distal extremity) and dysarthria on the day of admission. he received tpa approximately 3 hours after the onset of his symptoms. head ct did not demonstrate an acute intracranial hemorrhage, but head mr revealed numerous acute, bilateral, cortical infarcts, particularly in the area of the left precentral gyrus. the patient's history and examination were consistent with a cortical stroke, resulting in a "cortical hand" and mild dysarthria. echocardiogram did not demonstrate thrombi, vegetations, or other masses, though there was moderate regional lv systolic dysfunction. ekg was notable for atrial and ventricular premature beats with lbbb, and telemetry revealed pvcs and runs of ventricular tachycardia. given the frequent pvc's and non-sustained vtach's, cardiology was consulted who recommended titrating up metoprolol as tolerated and restarting low dose lisinopril once safe from stroke perspective. he was also recommended to maintain k+ > 4.0 and mg2+ > 2.0. due to the bilateral nature of the infarcts and the presence of cardiac arrhythmias, the stroke was likely caused by thromboemboli of cardiac origin. there may have been contributions from hypercoagulability of inflammation (collagenous colitis) and dehydration. while hospitalized, the patient underwent swallowing evaluations, which revealed small amounts of aspiration while swallowing. as a result, he was kept npo and received home medications and enteral nutrition through a dobhoff tube. after a follow-up swallowing evaluation suggested advancement to po nectar-thick liquids and soft solids, his po diet was advanced appropriately, and his dobhoff tube was removed. due to worsened shortness of breath, he also received albuterol nebulizers q6h prn with improvement in his breathing as well as furosemide boluses. per family, his dyspnea has been long-standing and does not appear to have any clinical correlates including cxr and o2 saturation. during his stay, mr. dysarthria mostly resolved, though he continued to have distal right upper extremity weakness at the level of the wrist and fingers. given the bilateral infarcts consistent with embolic strokes, coumadin was discussed with family and he was started on coumadin with aspirin bridging. patient's aspirin should be discontinued once coumadin therapeutic with inr > 2.0. also, given the , he was started on low dose simvastatin 10mg once daily. patient was also found to have urinary tract infection on and was started on ciprofloxacin. given that this is a complicated uti, he will be treated with 10 days of abx. he will be following up with dr. (neurologist) as an outpatient. medications on admission: - lupron injections, every four months, last on - levothyroxine 25 mcg - asa 81 mg - lisinopril 2.5 mg - bisacodyl 10 mg pr prn constipation - loperamide 2 mg qd prn diarrhea - apap 1000 mg q8h prn pain - milk of mag., prn - fleets enema prn - toprol xl 100 mg qd - vitamin d3 800 u qd - cholestyramine 4 g qd - simvastatin 20 mg qd - travatan 0.004 % od qd - ca carbonate 500 mg chew tid - colace 100 mg qd discharge medications: 1. senna 8.8 mg/5 ml syrup sig: one (1) tablet po bid (2 times a day). 2. docusate sodium 50 mg/5 ml liquid sig: one (1) po bid (2 times a day). 3. bisacodyl 5 mg tablet, delayed release (e.c.) sig: two (2) tablet, delayed release (e.c.) po daily (daily) as needed for constipation. 4. acetaminophen 650 mg/20.3 ml solution sig: one (1) po q6h (every 6 hours) as needed for pain or fever. 5. levothyroxine 25 mcg tablet sig: one (1) tablet po daily (daily). 6. therapeutic multivitamin liquid sig: one (1) tablet po daily (daily). 7. budesonide 3 mg capsule, ext release 24 hr sig: one (1) capsule, ext release 24 hr po tid (3 times a day). 8. latanoprost 0.005 % drops sig: one (1) drop ophthalmic hs (at bedtime). 9. aspirin 325 mg tablet sig: one (1) tablet po daily (daily) for 7 days: please stop once patient's inr > 2.0 and coumadin therapeutic. 10. cholestyramine-sucrose 4 gram packet sig: one (1) packet po daily (daily). 11. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) inhalation q6h (every 6 hours) as needed for shortness of breath. 12. lisinopril 5 mg tablet sig: 0.5 tablet po daily (daily). 13. simvastatin 10 mg tablet sig: one (1) tablet po daily (daily). 14. warfarin 5 mg tablet sig: one (1) tablet po hs (at bedtime): goal inr 2~3 and please stop asa once inr > 2.0. 15. metoprolol tartrate 25 mg tablet sig: 2.5 tablets po bid (2 times a day). 16. ciprofloxacin 250 mg tablet sig: two (2) tablet po q24h (every 24 hours) for 9 days: started on for uti. discharge disposition: extended care facility: - discharge diagnosis: stroke - embolic strokes likely from cardiac arrhythmia urinary tract infection discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). neuro deficit: patient has unreactive left eye. mild dysarthria and complains of dyspnea but this is chronic. r hand weakness - wrist extenstion and some flexion of fingers but "cortical hand." discharge instructions: you were admitted to the hospital as "code stroke" for acutely weakened right hand and slurring of speech. given the acute presentation and nihss score of 4, he received ivtpa and was initially admitted to the icu. his mri showed multiple, bihemispheric strokes likely embolic etiology. he was monitored on telemetry which showed multi-focal atrial tachycardia and pvc's hence cardiology was also consulted who recommended titrating up metoprolol as tolerated. given the embolic strokes, coumadin was discussed with the patient and family and he was started on coumadin with asa bridging this admission. asa should be discontinued once coumadin therapeutic (inr 2~3). he was also found to have urinary tract infection during this admission and was started on ciprofloxacin 500mg once daily on . patient is returning to where he resided before admission and will receive physical and occupation therapy. followup instructions: please follow-up with dr. , neurologist who oversaw your care during this admission on 2:30 pm , clinic provider: , md,phd: date/time: 10:00 provider: , lpn phone: date/time: 10:30 md, procedure: enteral infusion of concentrated nutritional substances injection or infusion of thrombolytic agent diagnoses: other and unspecified noninfectious gastroenteritis and colitis unspecified essential hypertension unspecified acquired hypothyroidism secondary malignant neoplasm of other specified sites percutaneous transluminal coronary angioplasty status paroxysmal ventricular tachycardia malignant neoplasm of prostate unspecified hearing loss old myocardial infarction cerebral embolism with cerebral infarction dysarthria urinary catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure infection and inflammatory reaction due to indwelling urinary catheter acute edema of lung, unspecified other musculoskeletal symptoms referable to limbs other premature beats 

Answer: The patient is high likely exposed to