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: history of present illness: this is a -year-old male with hypertension, coronary artery disease (status post coronary artery bypass graft), history of vasovagal syncope since childhood, and atrial fibrillation (on coumadin) who presented initially to hospital on ; status post fall times two. he initially fell two days prior to presentation and hit his forehead. on the day of presentation, he fell for a second time and banged his head on the occipital area. at hospital, he was found to have a subdural hematoma and a subarachnoid hemorrhage in the right frontal lobe with a shear injury in this same distribution. he was reversed with vitamin k and fresh frozen plasma secondary to coagulopathy induced by coumadin use. while in the intensive care unit at hospital he was noted to have an alteration in mental status; however, this was thought secondary to the patient receiving 1 mg of ativan the night before. he also had desaturations with an arterial blood gas showing 7.43/48/67 on a 35% face mask. no clear pulmonary pathology was noted on a chest x-ray. he underwent a magnetic resonance imaging and magnetic resonance angiography of the head which showed some "brain stem edema" and a "questionable vascular abnormality on the right, possibly representing an aneurysm in the cerebral vasculature." a neurosurgery consultation was obtained at the outside hospital and recommended that because the images were not completely clear that he be transferred to for evaluation of computed tomography angiogram. upon arrival to he was admitted to the surgical intensive care unit where he was monitored overnight. after consultation with the neurosurgery team, it was felt that the probability of a vascular lesion was small; and, therefore, a computed tomography angiogram was deferred. he was stabilized in the intensive care unit and transferred out to the neurosurgery floor on hospital day two. due to his continued oxygen requirement, a repeat chest x-ray was performed which showed mild congestive heart failure as well as right lower lobe and left lower lobe collapse versus consolidation. given the alteration of his mental status it was felt that he was probably aspiration; and, therefore, a provisional diagnosis of aspiration pneumonia versus pneumonitis was made. a video swallowing study was performed which found pharyngeal dysphagia and aspiration with thin liquids. therefore, on , he was transferred to the medicine service for management of congestive heart failure and an evaluation for aspiration pneumonia. past medical history: 1. hypertension. 2. non-insulin-dependent diabetes mellitus. 3. rheumatic heart disease; status post mitral valve replacement in . 4. history of vasovagal syncope since childhood. 5. hyperlipidemia. 6. mild memory impairment diagnosed in . 7. history of esophageal ring. 8. coronary artery disease; status post 3-vessel coronary artery bypass graft in at (saphenous vein graft to first obtuse marginal, posterior descending artery, and left anterior descending artery). 9. atrial fibrillation (on coumadin therapy); chronic. 10. benign prostatic hypertrophy. 11. status post cholecystectomy. 12. status post appendectomy. 13. status post right inguinal hernia repair in . 14. status post bilateral cataract surgery in . medications on admission: (home medications included) 1. lasix 40 mg p.o. q.d. 2. zestril 20 mg p.o. q.d. 3. coumadin (as directed). 4. zocor 10 mg p.o. q.d. 5. potassium chloride. 6. glucophage 500 mg p.o. b.i.d. 7. norvasc 5 mg p.o. q.d. 8. amoxicillin (spontaneous bacterial peritonitis prophylaxis). 9. ambien p.o. q.h.s. as needed. medications on transfer: (from the neurosurgery service) 1. flagyl 500 mg intravenously t.i.d. (started on ). 2. levaquin 250 mg q.d. (started on ). 3. vitamin k 10 mg subcutaneously (times three days). 4. senna. 5. regular insulin sliding-scale. 6. protonix 40 mg p.o. q.d. 7. enalapril 5 mg p.o. q.d. 8. albuterol and atrovent nebulizers as needed. 9. tylenol p.o. as needed. allergies: lopid (causes stomach upset and worsening of dysphagia) and flecainide (causes nausea and anorexia). social history: he is a retired attorney. he lives independently with his wife. history of tobacco or alcohol use. physical examination on presentation: vital signs on transfer revealed temperature was 95.6, blood pressure was 146/70, heart rate was 72, respiratory rate was 20, oxygen saturation was 97% on 3 liters and 84% on room air. in general, the patient was alert and in no apparent distress. he was mildly tachypneic and was arousable but did not follow commands. on head, eyes, ears, nose, and throat examination his bilateral pupils were pinpoint. his mucous membranes were dry. jugular venous pulsation was at 10 cm to 12 cm. chest examination revealed bilateral basilar crackles were noted (right greater than left) with diffuse rhonchi (also right side greater than left side). cardiovascular examination demonstrated an irregularly irregular with a 2/6 systolic murmur. no rubs were noted. the abdominal examination revealed soft, nontender, and nondistended. normal active bowel sounds. extremity examination demonstrated no cyanosis, clubbing, or edema. on neurologic examination, he not cooperative with a majority of the examination. on occasion he opened his eyes to command. he was responsive to sternal rub. he mumbled incoherently for the majority of the time; however, he answered questions in simple 1-word to 2-word answers on occasion. pertinent laboratory values on presentation: laboratory values on transfer revealed sodium was 141, potassium was 4.5, chloride was 110, bicarbonate was 21, blood urea nitrogen was 38, creatinine was 1.4, and blood glucose was 140. white blood cell count was 6.8, hematocrit was 32.8, and platelets were 174. inr was 1.6 (down from a high of 1.8 on admission). pertinent radiology/imaging studies: 1. a posterior/anterior and lateral chest x-ray on revealed mild congestive heart failure, right lower lobe and left lower lobe areas of consolidation versus collapse. 2. a computed tomography of the head without contrast on revealed an acute hemorrhage of 2.2 cm in the left ambient cistern. no shift of midline structures. no blood in the ventricles. a minimal degree of blood and cortical sulci in the bilateral cerebral hemispheres. no vascular infarctions. stable compared to examination on the previous day. 3. a video pharyngeal swallowing study revealed normal chewing and bolus formation with delayed epiglottic .................. and laryngeal elevation. aspiration noted with thin liquids. no cough induced by aspiration. no evidence zenker diverticulum. 4. an upper extremity venous doppler to evaluate for right arm swelling showed no evidence of right upper extremity deep venous thrombosis. 5. a transthoracic echocardiogram on revealed an ejection fraction of 40%, mild nonobstructive focal hypertrophy at the base of the septum, hypokinesis of the intraventricular septum and apex, 1+ aortic regurgitation, 1 to 2+ mitral regurgitation (however, likely underestimated secondary to annuloplasty ring), 3+ tricuspid regurgitation, moderate pulmonary systolic hypertension. impression: this is a -year-old male status post fall times two leading to a subarachnoid hemorrhage and subdural hematoma secondary to coumadin use with a history of coronary artery disease, diabetes, and hypertension now with evidence of mild congestive heart failure and aspiration pneumonia. the patient was transferred to the medicine service for percutaneous endoscopic gastrostomy tube placement and congestive heart failure management. hospital course by issue/system: 1. neurologic issues: the patient was initially transferred from an outside hospital secondary to a subarachnoid hemorrhage and subdural hematoma which were found to be stable by serial computed tomography examinations. after a discussion with the neurosurgery team it was felt that no further imaging was necessary and that the areas of question were stable. he demonstrated no focal neurologic deficits; however, his alteration in mental status may have partially been secondary to the lesions. the staples were removed in the occipital area secondary to lac repair approximately five days prior to transfer. although the alteration in mental status was in party secondary to the subarachnoid and subdural hemorrhages, it was complicated by the patient receiving benzodiazepines for sleep, and concurrent infectious process, as well as poor nutritional status. his mental status improved with the discontinuation of benzodiazepines, and by the time of discharge he was able to follow occasional commands and was responsive to voice. although it is not completely clear how much mental acuity he will recover in the long-term, it was felt that once his infection is cleared and his nutritional status improves his mental status should begin to improve. 2. cardiovascular system: the patient has a history of atrial fibrillation, hypertension, and coronary artery disease (status post coronary artery bypass graft and mitral valve repair in ). he was aggressively fluid rehydrated while he was nothing by mouth. therefore, this resulted in mild-to-moderate congestive heart failure. an echocardiogram was performed during this hospitalization which showed an ejection fraction of 40%. therefore, it was felt that a large component was diastolic function. he was diuresed initially with lasix intravenously and transitioned to p.o. lasix once a percutaneous endoscopic gastrostomy tube was placed. his blood pressure was controlled with intravenous enalapril initially and switched to his outpatient dose of lisinopril. cardiology was consulted and felt that the risks of a recurrent or worsening of current blood outweighed the embolic risk from his atrial fibrillation; and, therefore, coumadin would be held indefinitely. of note, his coumadin was for his atrial fibrillation and not for his mitral valve. he did remain in atrial fibrillation throughout this hospitalization; however, he had good rate controlled. 3. infectious disease issues: given his clinical picture, as well as findings on chest x-ray, he was treated for an aspiration pneumonia with levaquin and flagyl. he had mild low-grade temperatures; however, he remained with a normal white blood cell count throughout this hospitalization. he was to continue antibiotics (to complete a 14-day course) for aspiration pneumonia. 4. pulmonary system: as above, he a supplemental oxygen requirement secondary to aspiration pneumonia/pneumonitis and congestive heart failure. his oxygen was weaned to 3 liters nasal cannula at the time of discharge when he was saturating in the high 90s. albuterol and atrovent nebulizers were given on one or two occasions secondary to wheezing and showed minimal effect, as he has no prior history of chronic obstructive pulmonary disease. 5. hematologic issues: on admission, the patient was anticoagulated secondary to atrial fibrillation. both at the outside hospital and prior to transfer to the medicine service he was reversed with fresh frozen plasma and vitamin k. his inr remained in the 1.5 to 1.7 range throughout his hospitalization. as a risk of recurrent falls outweigh the risk of anticoagulation, he should be off coumadin indefinitely. 6. endocrine system: the patient with a history of non-insulin-dependent diabetes mellitus. while he was nothing by mouth his metformin was held, and he was maintained on a regular insulin sliding-scale. once the percutaneous endoscopic gastrostomy tube was placed and tube feeds were initiated, he was restarted on his metformin. 7. fluids/electrolytes/nutrition issues: a percutaneous endoscopic gastrojejunostomy tube was placed by interventional radiology on , and tube feeds were initiated 24 hours later. the composition of tube feeding and rate still be decided at the time of this dictation, but will be added in a discharge summary addendum. 8. renal system: the patient with chronic renal insufficiency; at his baseline creatinine of approximately 1.5. no acute electrolyte abnormalities were noted. 9. family contact issues: the patient's daughter is his health care proxy (telephone number ). condition at discharge: condition on discharge was stable. discharge diagnoses: 1. subarachnoid hemorrhage and subdural hematoma; status post fall times two. 2. congestive heart failure; likely diastolic function. 3. aspiration pneumonia. 4. atrial fibrillation. 5. coronary artery disease; status post coronary artery bypass graft. 6. status post percutaneous endoscopic gastrojejunostomy tube placement. 7. altered mental status; likely secondary to infection, nutritional status, and intracranial hemorrhage. 8. diabetes mellitus. 9. chronic atrial fibrillation. medications on discharge: 1. lopressor 12.5 mg p.o. b.i.d. 2. zantac 150 mg p.o. q.d. 3. lasix 40 mg p.o. q.d. 4. flagyl 500 mg p.o. t.i.d. (to complete a 14-day course on ). 5. levaquin 250 mg p.o. q.d. (to complete a 14-day course on ). 6. lisinopril 20 mg p.o. q.d. 7. metformin 500 mg p.o. b.i.d. 8. regular insulin sliding-scale. discharge disposition: the patient was to be discharged to a rehabilitation facility which is to be decided. , m.d. dictated by: medquist36 procedure: venous catheterization, not elsewhere classified enteral infusion of concentrated nutritional substances percutaneous [endoscopic] gastrostomy [peg] percutaneous [endoscopic] gastrostomy [peg] diagnoses: congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled atrial fibrillation unspecified fall pneumonitis due to inhalation of food or vomitus diastolic heart failure, unspecified subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness 

Answer: The patient is high likely exposed to